Operation Metro Surge, a joint initiative by the Department of Homeland Security and the United States Immigration and Customs Enforcement (ICE), significantly disrupted daily life in Minnesota. Despite numerous anecdotal reports, the impact and scale of this disruption to local health care systems had not been quantified. An interrupted-time series analysis was used to assess the impact of ICE Metro Surge on missed appointments and reschedule requests in 2 hospital-based general pediatrics practices located on the Minneapolis and St Paul campuses of Minnesota's flagship pediatric hospital. We identified a total of 15 611 eligible appointments in the post-Metro Surge period and 113 934 in the pre-Metro Surge period. The rate of missed appointments among Hispanic/Latiné patients increased by 51.2% during Metro Surge compared to the same time period (the first week of December to second week of February) in the prior 2 years (31.3% vs 20.7%; P < .001). Missed appointment rates increased by 80.4% among Spanish-speaking families (34.1% vs 18.9%, P < .001) and 53.1% among families with a need for interpretation (28.1% vs 18.4%, P < .001). During the Metro Surge period, reschedule requests for well-child visits increased 51% compared to previous years (P < .001). Our findings demonstrate that Metro Surge decreased pediatric outpatient use in Minneapolis and St Paul, Minnesota. The observed decrease in outpatient care exceeded predicted outpatient care based on preexisting and seasonal trends in missed appointments and reschedule requests. The cumulative effect of this period of exacerbated health care disparities and delayed care may have long-term impacts on child health.
Exposure to anthropogenic volatile organic compounds (VOCs) has been associated with preterm birth, yet the spatial distribution of VOC exposures within urban environments remains poorly characterized, particularly for vapor intrusion pathways. Plants have recently been used as a cost-effective, non-invasive tool to "phytoscreen" for belowground contaminants. Here, we evaluated the use of phytoscreening within a birth cohort in metro Detroit, Michigan, USA by (a) assessing participant willingness to allow sampling in residential front yards, (b) quantifying VOC concentrations across plant tissue types (leaves and twigs), and (c) testing whether VOC detections in plants are associated with proximity to brownfield sites. Of 20 pregnant participants, 18 agreed to phytoscreening and sampling was completed at 13 residences, indicating high feasibility. Across 15 plant species, five of six target VOCs (benzene, toluene, ethylbenzene, xylene, trichloroethylene, tetrachloroethylene) were detected. Specifically, toluene was detected at all 13 homes and in 68% of samples. While less common, ethylbenzene was detected in 12 samples across 3 homes and trichloroethylene was detected in one sample that exceeded Michigan's risk-based screening level for soil vapor intrusion. Additionally, VOCs were detected more frequently and at higher concentrations in leaves compared to twigs. However, VOC concentrations in plants were not associated with proximity to known or suspected brownfield sites in this small sample size. Overall, these findings demonstrate the feasibility of phytoscreening in epidemiological studies and highlight its utility for characterizing spatial patterns of VOC exposure. Incorporating plant-based sampling approaches may help identify localized hotspots of human exposure and inform targeted environmental remediation efforts.
Cardiovascular diseases remain a major cause of morbidity and mortality in Ghana. This study aimed to determine the association between anthropometric indices and elevated estimated 10-year cardiovascular disease (CVD) risk among adults in the Kumasi Metropolis. This cross-sectional study involved 480 adults aged 40-79 years. Anthropometric indices and lipid profile were determined using standard methods. Blood pressure was measured using an automated sphygmomanometer. The World Health Organization/International Society of Hypertension laboratory-based risk assessment charts were used to estimate 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk. Estimated CVD risk ≥ 10% was considered elevated. Anthropometric indices were examined for association with elevated risk using chi-square, Fisher's exact and Wilcoxon rank-sum tests. Multivariable modified Poisson regression analysis was used to determine factors associated with elevated estimated CVD risk. An elevated estimated10-year ASCVD risk was observed in 56.9% (103/181) of males and 38.8% (116/299) of females. Lower education level was associated with elevated CVD risk. Waist-to-hip ratio (WHR) (aPR = 1.36, 95% CI: 1.11-1.68), body shape index (ABSI) (aPR = 1.35, 95% CI: 1.08-1.69), hip circumference (HC) (aPR = 0.98, 95% CI: 0.97-0.99), and mid-arm circumference (MAC) (aPR = 0.95, 95% CI: 0.92-0.98) were associated with elevated estimated CVD risk. After stratifying by sex, WHR remained independently associated with elevated estimated CVD risk in females (aPR = 1.36, 95% CI: 1.01-1.84); as did ABSI (aPR = 1.45, 95% CI: 1.05-2.01) and MAC (aPR = 0.93, 95% CI: 0.88-0.99) in males. WHR, ABSI and MAC assessments should be integrated into CVD risk evaluation in Ghana, especially in deprived areas where lipid profile is not routinely assessed.
Superficial vein thrombosis (SVT) of the legs is a common disease linked with venous thromboembolism (VTE), with an uncertain recurrence risk. Data on secondary prevention of recurrent or extending SVT and on its natural history are lacking. Mesoglycan (MGY) shows a mild antithrombotic effect and the capacity to repair the endothelial layer, by restoring the integrity of the glycocalyx. This study aimed to evaluate the efficacy and safety of MGY for secondary prevention of VTE after an episode of lower-limb SVT. This was a multicentre, randomised, double-blind, placebo-controlled, superiority, phase II study conducted at 16 sites in Italy. Patients (aged > 18 years) with lower-limb SVT, who completed a 45-day treatment course of fondaparinux were randomised (1:1) to receive either oral MGY 50 mg or matching placebo twice-daily for 12 months, and were subsequently followed-up for another 12 months. The efficacy outcome was a composite of symptomatic recurrence or extension of SVT; new symptomatic or asymptomatic proximal deep-vein thrombosis, or new symptomatic distal deep-vein thrombosis, or new symptomatic non-fatal pulmonary embolism, or fatal pulmonary embolism at 12 months (primary outcome) and 24 months (secondary outcome) post-enrolment. The primary safety outcome was the incidence of major bleeding and clinically relevant non-major bleeding at 12 months. This trial was registered with EudraCT (2016-005184-13) and ClinicalTrials.gov (NCT03428711). Between March 26, 2018, and Dec 31, 2024, 553 patients were randomly allocated to treatment (272 to MGY and 281 to placebo), below the planned sample size due to slow recruitment because of SARS-CoV2 pandemic. At 12 months, the cumulative rate of efficacy events was 21.8% (54 patients) in the MGY group and 24.5% (63 patients) in the placebo group, respectively, showing no difference between these two groups (HR 0.89, 95% C.I. 0.62-1.29; p = 0.56). At 24 months, the cumulative rate of efficacy events was 30.6% (74 patients) in the MGY group and 42.5% (105 patients) in the placebo group, respectively (p = 0.043). This difference was entirely accounted for by a lower rate of recurrent SVT in the MGY group. The 24-month recurrence rate of SVT was 39% in the placebo group. No bleeding events were observed in either group. No significant differences were observed between MGY and placebo in terms of recurrent or extending SVT, at the end of the 12-month treatment course. However, we recorded a significant difference in favour of MGY at 24 months. These findings should be interpreted cautiously, given that the incidence of recurrent or extending SVT in the placebo group was higher than previously reported and the planned sample size was not reached due to slow recruitment. Our findings need to be confirmed in future, larger studies. Neopharmed Gentili S.p.A.
Local socioeconomic status may influence psychiatrist distribution, yet this remains systematically unexamined in Australia. We aimed to assess how psychiatrist availability varies across regions with differing socioeconomic advantage. Psychiatrist workforce data from the Health Workforce Data Tool (2013-2023) were linked to local government areas-level quintiles of the Index of Relative Socioeconomic Advantage and Disadvantage. We calculated and compared the proportion of local government areas with psychiatrists, psychiatrist counts per local government area, and psychiatrists per 10,000 population by Socio-Economic Indexes for Areas quintile. Panel regression analyses examined per capita variations, adjusting for state/territory and year effects in the same analyses. Outer regional/remote/very remote areas had relatively low access to psychiatrists compared to metropolitan/inner regional areas. Disparities widened over time between the highest socioeconomic status quintile and all others. The average psychiatrist count per 10,000 population for top-quintile local government areas was 2.8 (standard deviation: ±4.8; from 0.6 (standard deviation: ±1.0, Northern Territory) to 5.5 (standard deviation: ±7.0, South Australia)), compared with 0.2-0.5 per 10,000 population for all lower socioeconomic status quintiles. In panel regression with interaction between Socio-Economic Indexes for Areas and remoteness, psychiatrist counts (adjusted for state/territory and year) in non-top-quintile local government areas were 2.6 (95% confidence interval: -4.1 to -1.1) to 3.0 (95% confidence interval: -4.4- to -1.7) per 10,000 population lower than top-quintile metropolitan and inner regional local government areas. Psychiatrists are densely concentrated in high socioeconomic status and metropolitan/inner regional areas. Lower socioeconomic status local government areas shared similar, limited psychiatrist distributions. Targeted strategies are required to improve the equitable distribution of mental health resources across socioeconomic gradients.
Outcomes in status epilepticus (SE) depend on rapid seizure control, yet transport times/resources differ by hospital type. We hypothesized that hospital outcomes vary across hospital types: metro-academic (MA), metro-nonacademic (MNA), and non-metro hospitals (NM). Outcomes of interest included in-hospital mortality, length of stay (LOS), 30-/90-day readmission, discharge disposition, and costs, METHODS: Retrospective cohort of adults with SE from the 2016-2022 NRD. Survey-weighted multivariable logistic regression evaluated in-hospital mortality and 30-/90-day readmission. Linear regression evaluated LOS and cost. Models adjusted for age, Charlson Comorbidity Index, ZIP income quartile, and in-hospital severity markers, reporting adjusted OR/coefficients with 95% confidence intervals/ p-values. SE hospitalizations occurred predominantly at MA hospitals, whereas NM hospitals disproportionately served patients in the lowest income quartile (64%). MA hospitalizations had higher illness severity, characterized by coma (7.4%), use of mechanical ventilators (<24 h: 15.1%, 24-96 h: 20.8%, >96 h: 10.1%), cardiac arrest (1.6%), sepsis (5.5%), vasopressor infusion (2.3%), and tracheostomy placement (2.1%). MA hospitalizations had greater association with in-hospital complications, including respiratory failure (40.1%), pneumonia (8.1%), acute kidney failure (18.5%), venous thromboembolism (2.1%), pressure ulcers (3.4%), and delirium (2.9%). Mortality (3%) and discharge disposition were similar across hospital types. However, MA hospitalizations had higher 30-/90-day readmissions, longer LOS (t = 12.14, p < 0.0001), and higher costs (t = 13.27, p < 0.0001). Despite higher illness severity at MA hospitals, in-hospital mortality and discharge disposition were similar across hospital types. Increased readmissions, LOS, and costs at MA centers likely reflect greater case complexity and may inform resource allocation and interhospital transfer practices.
Consumer and community involvement (CCI) can enhance research and healthcare outcomes. However, orientation processes, including mandatory training, can pose barriers when not designed for consumers, particularly those with diverse communication, language, and literacy needs. To (1) explore consumer and staff experiences of hospital-based orientation, including existing infection control training materials; and (2) co-design an accessible infection control mandatory training resource for consumers who partner with the hospital. Qualitative study using semi-structured interviews (consumers and staff) and a series of three co-design workshops (consumers, staff, researchers). The study was conducted at a metropolitan rehabilitation hospital in Australia in 2025. Participants included consumers, staff and researchers with knowledge in consumer partnering, infection control and orientation. Experiences of consumer orientation, including infection-control training and priorities for the design, content, accessibility and acceptability of a co-designed infection-control training for consumers. Qualitative themes relating to barriers and enablers in consumer orientation and characteristics of the co-designed training resource. Nine participants completed an interview, and 14 contributed to co-design workshops. Consumers described orientation as inflexible, insufficiently tailored and sometimes inaccessible, particularly for people with diverse needs. They valued orientation as an opportunity to build relationships, ask questions and understand their role. Staff highlighted that processes lacked the flexibility needed for person-centred partnering and described challenges in tailoring information for consumer audiences. Interview findings informed co-design workshops in which consumers, staff and researchers developed and refined an infection control training resource for consumers in a hospital setting. Key design features included plain language, visual supports, concise content, opportunities for questions and accessible formatting. Consumer orientation is an important but underexamined stage of healthcare partnering. Accessible, flexible and consumer-centred processes may support inclusive and meaningful involvement. Contributions from staff and consumers were valuable in ensuring that the end product was fit for purpose from organisational and end-user perspectives. Orientation and mandatory training may create barriers when not tailored to consumers' needs. Co-designing accessible training resources offers a practical approach to improving consumer orientation and understanding of infection control principles, supporting more inclusive partnerships with health services. This study was initiated in response to feedback from a consumer network at a metropolitan hospital in Queensland, Australia. Consumers contributed as interview participants and co-designers in developing the training resource.
Fixed-dose combinations (FDCs), particularly sulfonylurea-based triple therapies, play a central role in managing type 2 diabetes in India. With growing focus on safety and personalization, lower-dose alternatives are gaining attention, especially for early-stage and vulnerable patients. To obtain expert consensus from Indian physicians on the clinical relevance, preferred patient profiles, and prescribing intent for a low-dose triple FDC comprising glimepiride 0.5 mg, metformin 500 mg sustained-release (SR), and voglibose 0.2 mg. A structured cross-sectional survey was conducted among 112 physicians from metro and nonmetro regions of India. The survey used close- and open-ended questions to explore the need, clinical positioning, and use scenarios for this low-dose triple combination. Responses were analyzed and synthesized into expert consensus per the Oxford Centre for Evidence-Based Medicine (OCEBM) framework (Level V evidence). Most physicians (86.6%) supported the need for this combination. Common use cases included early-stage diabetes, elderly patients, and those with postprandial hyperglycemia or hypoglycemia risk. It was also preferred for step-up therapy and deintensification with agents, such as SGLT2 inhibitors or insulin (77.7%). Advantages cited included improved safety, simplified dosing, and affordability. Expert consensus affirms this FDC's clinical relevance across multiple diabetes stages. Further real-world evidence and outcome-driven studies are warranted to support broader clinical integration and guideline inclusion.
Peritoneal dialysis is a widely used treatment for kidney failure; however, peritoneal dialysis-related infections (exit-site, tunnel infection, peritonitis) occur frequently. The effect of standardised nurse and patient training on peritoneal dialysis infections is uncertain. The aim of this study was to determine whether implementing an international guideline-based standardised training curriculum for nurse trainers and new peritoneal dialysis patients reduces the risk of peritoneal dialysis-related infections compared with existing local training practices. Targeted Education ApproaCH to improve Peritoneal Dialysis (TEACH-PD) was a pragmatic, investigator-initiated, cluster-randomised controlled trial conducted in Australia and New Zealand. Adult patients 18 years of age or older with kidney failure who required training for incident peritoneal dialysis treatment and who were able to provide written informed consent were eligible. Clusters were randomised 1:1 to either the standardised training curriculum or usual care. Participant data and infection outcomes were routinely collected in national patient registries. The primary outcome was time to first peritoneal dialysis-related infection (exit site infection, tunnel infection, or peritonitis). Secondary outcomes were the first of each individual infection type in the primary composite outcome, catheter removal, haemodialysis transfer, all-cause death and quality of life. This trial was registered with ClinicalTrials.gov, number NCT03816111. Between 22 July 2019 and 29 September 2023, 42 clusters were randomised: 21 to the standardised training group and 21 to the usual care group. Overall, 1462 incident peritoneal dialysis patients were included; 667 were assigned to the standardised training group and 795 to the usual care group. A peritoneal dialysis-related infection occurred in 296 of 667 patients in the standardised training group and 297 of 795 patients in the usual care group (sub-hazard ratio 1.230, 95% confidence interval [CI] 1.004-1.507, p = 0.0457). Secondary outcomes were similar in the two groups. Among patients commencing peritoneal dialysis, the use of a standardised training curriculum for nurses and patients based on the International Society for Peritoneal Dialysis guidelines increased peritoneal dialysis-related infection. Implementation-focused research is needed to identify which elements of training require standardisation and where individualisation is most beneficial to support safe, sustainable and patient-centred peritoneal dialysis care. The TEACH-PD trial is funded by MRFF Clinical Trials Activity: Rare Cancers, Rare Diseases and Unmet Need Grant Opportunity; National Health & Medical Research Council BEAT-CKD Program Grant; Health Research Council of New Zealand grant; Metro South Health Research Support Scheme Research Fund-Health System and Health Economics Project Grant; Queensland Health; South Western Sydney Research Small Grant Scheme; International Society for Peritoneal Dialysis; Translational Research Institute Australia; Amgen and Baxter Healthcare (Vantive).
. More than two million older adults are homebound and five million need help leaving their homes. They often experience social isolation, food insecurity, and lack of connection to community resources. Affordable, adaptable, comprehensive home-based services for those aging in place are lacking. This study examined the benefits of an intergenerational home-based service-learning program on goal attainment in 1) social support, 2) home safety and cleanliness, 3) access to community resources, 4) food access, and 5) improving physical health. . 201 homebound and near-homebound older adults enrolled in Lori's Hands in Newark, DE; Baltimore, MD; and Metro Detroit, MI were surveyed between December 2021 and May 2026. Descriptive and chi-square analyses were conducted to examine changes in domain-specific subjective assessment of goal attainment over time. Findings indicated that 83% of clients reported positive changes in at least one of the five target service areas over six or more months of participation in the program. The majority of participants reported 1) home safety and cleanliness and 2) social support as their most important goals. Results from the chi-square test indicated statistically significant differences in goal attainment for all five service areas. Results from this study suggest that intergenerational in-home support services can improve social support, home safety and cleanliness, physical activity, food access and nutrition, and access to community resources for homebound older adults, thereby supporting aging in place and reducing the load on informal caregivers. . Policies and practice can support a pipeline of health professionals through innovative service-learning models to benefit older adults, caregivers, students, and the broader community.
Due to only 25% of U.S. children meeting the physical activity guidelines, we aimed to determine feasibility of team sports to engage children in at least 60 min of moderate-to-vigorous physical activity daily and increase health knowledge. This 11-week quasi-experimental pre/post intervention study was conducted in two after-school programs around metro Atlanta, GA, USA (C1, n = 18; C2, n = 22). The 11 for Health program is an 11-week active learning model that involves 2 × 45 min per week soccer drills, small-sided games, and health education modules. Assessments included health knowledge and physical fitness metrics such as estimated VO2, standing long jump, balance, agility, and handgrip strength. Non-participants were defined as missing 3 or more sessions and/or not participating in the activities. Descriptive statistics and t-tests were used to compare pre- and post-intervention assessments, stratified by participation level. C1 were on average 9.2 years old, 31% female, and 100% White. C2 were on average 9.8 years, 48% female, and 67% Hispanic and 33% Black. Attendance was 69% (SD 0.26) in average over the 11 weeks for both cohorts, with no difference in attendance between groups. Agility improved significantly [2.7 s(1.5); 95% CI: -3.2,-2.2] overall but no between-group difference was found. C2 participants improved significantly compared to C1 participants (p = 0.006) in left handgrip. C1 performed significantly better on the health knowledge test (p = 0.023; 95% CI: 0.018, 0.225) but neither cohort improved over time. The program is feasible for American children; however, careful consideration of setting and coaching staff is necessary.
Co-design in health services is increasingly recognised as essential for creating services and policies that address patient and community needs. However, genuine co-design can be challenging, with existing toolkits often catering to professionals, reinforcing power imbalances and limiting community leadership. This paper aims to present a novel co-design framework for health services and describe the co-design process taken in its development. The co-design process involved a series of engagement activities (online forums, focus groups, discussions and workshops) with health consumers, health professionals and researchers within a metropolitan health service in Queensland, Australia. This process, co-led by a clinician researcher and health consumer, explored the implicit meaning of co-design and the barriers and enablers to co-design within the local setting, and the strategies required to support operationalisation of co-design. These data were combined with research literature, existing frameworks and lived experience to iteratively co-design the online framework. Eight focus groups, forums and workshops across five hospitals and multiple community health services involved 128 individuals who contributed their professional and lived experience with co-design to inform the development of the co-design framework. The resultant 'Better Healthcare Together' framework includes three main components: (1) before you start co-design, (2) the co-design team and (3) the co-design process. A key feature of the framework is its deliberate focus on power, inclusion, equity, and bringing together diverse lived and professional experience to solve healthcare problems. This co-design framework provides a flexible approach to consumer partnerships, with reflections on the process highlighting the relational nature, the need to avoid expert mindset and the evolving landscape of consumer engagement. While widely used, the framework alone may not build true health system co-design capability due to the need to address systemic and organisational barriers to co-design. Members of the public contributed to this work across all stages of this project, including as project co-leads and co-researchers, members of the steering committee, workshop co-facilitators, and co-design participants. They are also co-authors on this paper.
Effective lymphoedema management depends on early detection and treatment, emphasizing the need for measurement instruments with strong clinimetric properties. This systematic review aimed to identify and evaluate the measurement properties of imaging modalities used to assess soft tissue oedema. A systematic search of Embase, Medline, Web of Science, and CINAHL (inception-December 2, 2025) identified studies evaluating reliability, validity, and/or responsiveness of imaging modalities capable of visualizing internal tissues that evaluated soft tissue oedema in adults. Methodological quality was assessed using the COSMIN Risk of Bias checklist, and measurement properties were rated according to established criteria. Levels of evidence were synthesized using a best-evidence approach. Fifty-nine studies were included, covering six imaging modalities: ultrasound, fluorescence lymphography, magnetic resonance imaging (MRI), lymphoscintigraphy, computed tomography, and dual-energy X-ray absorptiometry. High-quality evidence for sufficient validity was identified exclusively for MRI, particularly in quantifying fluid and soft tissue. High-quality evidence for sufficient reliability was found for MRI in quantifying soft tissue and for fluorescence lymphography when assessing the combination of lymphatic flow and anatomy. Other modalities demonstrated only low- to moderate-level or inconsistent evidence across constructs. MRI currently provides the most robust and consistent evidence for valid and reliable quantification of soft tissue oedema. Standardization of methodology, broader inclusion of patient populations and body regions, and evaluation of underexplored measurement properties are essential to advance the role of imaging in lymphoedema assessment and management. CRD42024611323.
In Australia, research priority setting (RPS) may be misclassified as research requiring ethics approval, despite its purpose as a collaborative, pre-research involvement activity. Treating RPS as research creates delays, diverts resources and undermines partnership principles central to inclusive, community-centred priority setting. Recent revisions to the National Statement on Ethical Conduct in Human Research clarify that pre-research consultation does not require ethics review, creating an opportunity for consistent national practice. We call for institutions to recognise RPS as involvement and provide proportionate, non-ethics oversight to accelerate RPS and deliver more responsive research agendas that reduce waste.
Recurrent/Metastatic (R/M) ACC is aggressive with few effective treatment options. The role of surgery after chemotherapy remains unclear. Moreover, prognostic factors in R/M ACC are not well defined. R/M ACC patients treated at Princess Margaret Cancer Centre (2002-2019) were retrospectively reviewed. Descriptive statistics were used to summarize clinical characteristics. OS was estimated by Kaplan-Meier method. Cox regression analysis was used to compute prognostic variables. Among 83 patients with metastatic ACC [36.2% de novo and 63.8% recurrent], 49 (59.0%) received systemic therapy (ST) with which 15 (30.6%) had a partial response (PR) and 8 (16.3%) had stable disease (SD). 9 (18.4%) had surgery after ST (combined therapy group); 6 (66.6%) were rendered disease free with surgery. The median OS was 26 months (20.4-40.5) for entire cohort (f/up 18 months). OS for patients having combined therapy was 31.2 months (21.4-63.3) vs 24.7 months (17.7-35.2), p = 0.48 for patients receiving systemic therapy alone. Being disease free after surgery was associated with better OS [39.6 (24.8-not reached), vs 23.5 months (21.4-not reached), p = 0.02]. Selected patients with R/M ACC may achieve long term survival with surgery after chemotherapy. These data highlight the potential role for multimodal therapy in managing such patients.
Evidence shows Birthing on Country services are cost-effective and improve outcomes for First Nations women and newborns. This has led to increasing reference to Birthing on Country; however, the term has varying meanings and definitions, resulting in misunderstanding and inaccurate use. In 2022, over 240 delegates from across Australia convened in Mparntwe to build a collective vision and address persistent inequities for First Nations families. Our aim was to explore delegates' understandings and meanings of 'Birthing on Country' as captured in videoed interviews. An exploratory qualitative study design was used, involving participants recruited through purposive and convenience sampling. We applied reflexive thematic analysis remaining closely attentive to participants meanings. Seventy-seven delegates participated in interviews. Analysis generated seven themes: (1) diversity:meaning different things to different people; (2) connections between humans, Ancestors, lands, seas, and the non-human world; (3) all babies in Australia are born on First Nations Country; (4) feeling safe, supported, and healthy; (5) cultural practices and revitalisation; (6) learning and being guided; and (7) First Nations rights and justice. This is the first study to explore what Birthing on Country means across a diverse range of stakeholders. Findings demonstrate Birthing on Country's potential to redress colonisation and advance health equity for First Nations women and communities. The study offers a shared understanding grounded in connection, cultural identity, and reproductive justice, with insights to guide future service design and delivery for Australian First Nations families.
Although rebiopsy at progression on osimertinib is recommended for patients with advanced EGFR-mutant non-small cell lung cancer (NSCLC), its real-world impact on clinical outcomes remains unclear. Rebiopsy on Osi is a multicenter, retrospective study assessing rebiopsy patterns, resistance mechanisms, and their impact on second-line treatment choices and outcomes in routine clinical practice. A total of 457 patients with advanced NSCLC harboring a common EGFR mutation (exon 19 deletion or L858R) who progressed on first-line osimertinib were identified from the Italian ATLAS registry. Patients were stratified according to rebiopsy status (tissue and/or plasma-based next generation sequencing) and receipt of biomarker-driven adaptive second-line therapy. Rebiopsy was performed in 206 patients (45.1%), predominantly via tissue sampling (66.2%). A resistance mechanism was identified in 80 cases (38.8%), with higher detection rates by tissue rebiopsy (46.6%) versus liquid (13.5%). MET amplification/overexpression emerged as the most frequent actionable resistance mechanism. Among 239 patients treated with second-line therapy, 39 (16.3%) received adaptive treatment, including 29 out of 39 patients (74.3%) with MET amplification/overexpression treated with a MET-TKI-based regimen. Median progression-free (PFS) and overall (OS) survival were longer with adaptive therapy (7.3 and 14.1 months) than with rebiopsy without treatment adaptation (6.5 and 12.2 months) or no rebiopsy (5.1 and 8.2 months). In real-world practice, rebiopsy identifies a resistance mechanism in slightly more than one third of patients, with actionable MET amplification/overexpression accounting for approximately one fifth of cases. Biomarker-driven adaptive therapy may improve clinical outcomes, supporting implementation of rebiopsy in routine practice.
Effective treatment and care of substance use disorders requires reliable and valid diagnosis. Their diagnosis in mental health services reportedly remains inconsistent despite their prevalence and associated harms. This study examines routine substance use disorder diagnosis across public adult mental health services to identify patterns. Care recorded in the statewide electronic health record of 58,724 adults over 4 years was analysed. Substance use disorder diagnosis, specified and aggregated by substance class and clinical state, was compared across gender, age, substance class and diagnostic groups. Substance use disorder was present in 34.4% of patients. Common specific substance classes were nicotine, cannabinoids, alcohol and stimulants (excluding cocaine). The most common class at 14.1% was multiple and other drug use. Of those with any substance use disorder, 45.3% had multiple and other drug use or other residual use disorders and 21.3% had substance-induced psychosis. People with schizophrenia had higher proportions of substance use disorders than the entire cohort. Substance use disorder diagnostic practice lacks specificity and consistency with diagnostic classification guidance. Disorders requiring combined consideration of aetiology and comorbidity, including 'multiple and other drug use' disorders and substance-induced psychosis, may be over-diagnosed. Nicotine use disorder is likely under-diagnosed. Improving diagnostic specificity is central to effectively treating substance use disorders. Non-specific substance use disorder diagnoses, including 'multiple and other drug' use, should be avoided unless necessary. Specific substances should be named. Consistent use of diagnostic classifications and ongoing diagnostic review are vital for diagnostic clarification and specific treatment.
Telehealth models have the potential to help overcome challenges associated with the provision of in-person adult occupational therapy (OT) burn care. This study aimed to examine clinician and consumer perceptions of in-person adult burn care within a large adult burns service and explore the key features required to develop and implement an adult OT burns telehealth (OT TeleBurns) model of care. Interviews were conducted with adults after burn injury (n=23), and occupational therapists providing burn care to patients at their local facilities (n=18). Data were analysed first qualitatively to identify challenges with current in-person services, then coded using the Consolidated Framework for Implementation Research (CFIR) 2.0, to identify barriers and facilitators for implementing an adult OT TeleBurns service. Patient travel, local clinical expertise, communication across facilities, and patient attendance were key challenges of in-person services. CFIR constructs identified as strong facilitators for an OT TeleBurns service were the tension to change from in-person services, the relative advantage of telehealth services, and the proposed service's adaptability to the local context and ability to meet participants' needs. Perceived implementation facilitators were ensuring choice of appointment type, building local clinician capability, optimising communication methods, and establishing service governance and clear operational processes. Findings highlight strong support for developing an OT TeleBurns service given significant challenges with in-person care. Existing facilitators indicate high feasibility for implementation with clear clinical pathways and service procedures critical to ensuring an effective and sustainable model. Findings will be used to guide telehealth service development.
Although hearing and vision impairments are considered modifiable dementia risk factors, it remains unclear whether their associations reflect sensory-specific pathways or broader ageing-related vulnerability. Using harmonised data from the Health and Retirement Study (n=22,756) and the English Longitudinal Study of Ageing (n=12,921), we applied multi-state Markov models, time-varying Cox models and disaggregated population attributable fractions (PAFs) to test whether associations depend on their temporal sequence with frailty. Associations weakened after frailty adjustment (adjusted hazard ratios, aHRs, 1.17-1.80 [PAFs 3.4-9.2%] vs 1.08-1.56 [PAFs 1.5-6.6%]). Sensory impairments arising before frailty showed no independent association with incident dementia (aHRs 0.88-1.22 [PAFs -1.3 to 1.5%]), whereas those emerging with or after frailty were consistently associated (aHRs 1.31-2.28 [PAFs 3.4-6.4%]). Conventional estimates may over-attribute dementia burden to sensory impairments by neglecting their ageing context. Frailty-informed approaches may improve targeting and interpretation of sensory interventions for dementia risk reduction.