University of Canberra

Aims Achieving equitable healthcare access is a global challenge. Improving whole-population mental health and reducing the global burden of mental disorders is a key recommendation of the 2018 Lancet Global Mental Health Commission, which proposed monitoring national indicators, including the proportion of people with severe mental disorders who are service-users. This study aims to derive an equity indicator from national datasets integrating need, service utilisation and socioeconomic status, and demonstrate its utility in identifying gaps in mental health service use amongst those with the greatest need, thereby guiding equitable healthcare delivery. Methods We present a case study of a universal health insurance scheme (Medicare) in Australia. We developed the equity indicator using three national datasets. Geographic areas were linked to an area-based socioeconomic deprivation quintile (Census 2016). Per geographic area, we estimated the number with a mental healthcare need using scores ≥30 on the Kessler-10 (Australian National Health Surveys 2015 and 2018), and obtained the number of services used, defined as mental health-related contacts with general practitioners and mental health professionals (Medicare administrative data 2015–2019). We divided the number of services by the population with an estimated mental healthcare need and averaged these use-rates across each socioeconomic deprivation quintile. The equity indicator is the ratio of the use-rates in the least versus most deprived quintiles. Results Those estimated to have the greatest need for mental healthcare in 2019 ranged between 8.2% in the most disadvantaged area quintile (Q1) and 2.4% in the least (Q5), corresponding to a proportional increase of 27.7% in Q1 and 19.5% in Q5 since 2015. Equity-indicator-adjusted service rates of 4.2 (3.8–4.6) and 23.9 (22.4–25.4) showed that individuals with the highest need for care residing in Q1 areas received a stark 6 times fewer services compared to their Q5 counterparts, producing an equity indicator of 6. Conclusions As the global prevalence of common mental disorders may be increasing, it is crucial to calculate robust indicators evaluating the equity of mental health service use. In this Australian case study, we developed an equity indicator enabling the direct comparison of geographic areas with different need profiles. The results revealed striking inequities that persisted despite publicly-funded universal healthcare, recent service reforms and being a high-income country. This study demonstrates the importance and feasibility of generating such an indicator to inform and empower communities, healthcare providers and policymakers to pursue equitable service provision.

Purpose We examined how heat exposure affects muscle and cerebral oxygenation kinetics using statistical parametric mapping (SPM) during repeated treadmill sprints. Methods Eleven recreationally active males performed three sets of five 5-s sprints with 25 s of recovery and 3 min between sets in hot (38 °C) and temperate (25 °C) conditions. Continuous measurements of muscle (vastus lateralis) and cerebral (prefrontal cortex) tissue oxygenation were obtained using near-infrared spectroscopy. One-way ANOVA SPM{F} statistics were applied to pooled sprint data, with each condition including 15 time-series (three sets of five sprints) combined. Each time-series included the sprint and subsequent recovery phases. Results Muscle tissue saturation index further decreased in hot compared to temperate condition, from the middle of the 5-s sprint phase (~ 2.9 s) until the end of the recovery period (p < 0.001), while total hemoglobin concentration was significantly higher in the early phase of recovery (from 5.1 to 11.8 s, p = 0.003). Cerebral tissue saturation index decreased from 0.7 s to 13.0 s (p < 0.001) in the heat. Total hemoglobin concentration was lower in hot condition during both the sprint phase and the initial third of the recovery (from 0 to 11.7 s, p < 0.001), as well as during the recovery (from 20.5 to 24.8 s, p = 0.007). Conclusion Adding heat stress to repeating treadmill sprints further lowered muscle oxygenation levels during both the sprint and recovery phases, and limited cerebral tissue perfusion during the sprint and the initial recovery phases. The use of SPM for continuous analysis of near-infrared spectroscopy data provides new insights beyond summary statistics.

The separation between people and nature is a key driver of environmental decline. Despite increased interest in nature connectedness, we know little about nature disconnection or the degree of connectedness required for pro-environmental choices. Using a large probability sample of Australians (N = 1101), we explore differences in the characteristics, attitudes, and priorities among those with low, moderate, and high nature connectedness levels. Compared to those more connected, individuals with low connectedness were younger, more urban, and less educated. They spent less time in nature, enjoyed nature less, were less impacted by environmental problems, and rated climate change as less severe, suggesting insulation or detachment from the natural environment. Even a moderate level of connectedness was linked to a significant uplift in pro-environmental attitudes, behaviours, and priorities (e.g. environmental vs. economic issues). Our work contributes towards a comprehensive understanding of nature (dis)connection, with practical implications for interventions targeting a more sustainable future. SharedIt link to full text: https://rdcu.be/d1T3X

Background Opisthorchis viverrini (OV) and soil-transmitted helminths (STH) are two of the most common helminths contributing to the Neglected Tropical Disease (NTDs) burden in the Lower Mekong Basin. Although mass drug administration is the cornerstone of control programs to reduce morbidity caused by these infections, this approach has limitations in preventing re-infections. Elimination requires additional measures such as reservoir host treatment, improved hygiene and health education to reinforce MDA's impact. This study aims to examine the impact of a scalable multi-component One Health Helminth Elimination program in the Lower Mekong Basin (HELM) that combines human praziquantel (PZQ) and albendazole (ALB) treatment with a program that includes the “Magic Glasses” and the “Lawa Model” interventions with health promotion at their core. Methods This study will employ a cluster randomized controlled trial (cRCT) in 18 rural communities (with sub-district or villages as cluster units) across Cambodia, Laos and Thailand. The control arm will receive one round of PZQ/ALB treatment, while in the intervention arm, multi-component HELM program will be implemented, which includes PZQ/ALB treatment together with the Magic Glasses and Lawa Model interventions. OV and STH infections levels will be evaluated in individuals aged 5–75 years at baseline and will be repeated at follow-up (12 months after the HELM intervention), using modified formalin ethyl-acetate concentration technique and quantitative PCR. The primary outcome of the study will be cumulative incidence of human OV and STH infections. Outcomes between the study arms will be compared using generalized linear mixed models, accounting for clustering. Discussion Evidence from this trial will quantify the impact of a multi-component One Health control strategy in interrupting Ov and STH infections in the Lower Mekong Basin. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12622000353796. Prospectively registered 28 February 2022.

Active movement extent discrimination assessment (AMEDA) is a psychophysical task that evaluates proprioception and tactile acuity of the lower limbs, and it is a method of determining sensorimotor ability. Sensorimotor ability is the ability to judge small differences in movement tasks through the process of receiving sensory messages (sensory input) and producing a response (motor output). Participant attention lapses in prior psychophysical studies have been implicated as a cause for increased measurement variance thresholds in these types of assessments. Since minimizing the time needed for the AMEDA may help to reduce attention lapses, we compared the reliability of the 50-repetition AMEDA protocol (Group 1) with that of a 25-repetition protocol (Group 2). We assessed the split half reliability of these two approaches, using the Spearman-Brown Adjusted Pearson correlation (r). For each method, we calculated Bland-Altman Plots and Intra Class Correlation Coefficients to compare the reliability of the two data sets and determine the 95% confidence intervals. Split-half test re-test Spearman-Brown Adjusted Pearson r (r full ) was Group 1 r full = 0.83 and Group 2 r full = 0.85. The Bland-Altman Plots indicated only a small degree of bias from the zero-difference line, with 95% of the difference points lying within the limits of agreement. For Group 1, the intraclass correlation coefficient (ICC) two-way, agreement was 0.83 (95% CI 0.54–0.93) and for Group 2, the ICC, two-way, agreement, was 0.85 (95% CI 0.66–0.93). The MDC90 for Group 1 was 0.082 AUC units and for Group 2, it was 0.086 AUC units. The combined data for Group 1 plus Group 2 Bland-Altman Plot indicated only a small degree of bias from the zero-difference line, with 95% of the difference points lying within the limits of agreement. The MDC90 for the combined groups was 0.08 AUC units. The multiple methods from previous research assessing test re-test reliability that we applied to our two data sets indicate that the 25-response AMEDA was a reliable system for evaluating sensorimotor function in the lower limbs and may be an alternative for the more traditional 50-response protocol in which lapses in participant attention from fatigue or other biases may be a concern. There are also practical advantages in time restricted athletic screenings to a shorter administration of this assessment.

There is increasing interest in health professions education (HPE) in applying argument-based validity approaches, such as Kane’s, to assessment design. The critical first step in employing Kane’s approach is to specify the interpretation-use argument (IUA). However, in the HPE literature, this step is often poorly articulated. This article provides guidance on developing the IUA using a worked example involving a workplace performance assessment tool. In developing the IUA, we have drawn inspiration from approaches used in the discipline of language assessment to situate the inferences, warrants and assumptions in the context of the assessment tool. The worked example makes use of Toulmin’s model of informal logic/argumentation as a framework to structure the IUA and presents Toulmin diagrams for each inference such that the reader can connect the argument chain together. We also present several lessons learned so the reader can understand the issues we grappled with in developing the IUA. A well laid out IUA allows the argument to be critiqued by others and provides a framework to guide collection of validity evidence, and therefore is an essential ingredient in the work of assessment design and validation.

This research study examines the cyber security factors that affect the consumer attitude toward online shopping, focusing on Bangladesh, a developing country facing increasing cyber threats in recent years. Understanding significant factors influencing consumers to buy from online platforms is crucial for building trust and ensuring a secure shopping environment. Using a quantitative research approach, this study analyses the impact of demographic factors such as gender, age employment status, knowledge about cyber security, website quality, secure payment systems, and the global pandemic on consumer attitude towards online shopping. Research indicates that while demographics do not significantly affect attitude, employment status, and cyber security knowledge and awareness are key influencers. Additionally, global pandemics such as COVID-19 have enhanced consumer awareness of cyber security, a trend likely to continue post-pandemic.

Waterbird population and species diversity maintenance are important outcomes of wetland conservation management, but knowledge gaps regarding waterbird movements affect our ability to understand and predict waterbird responses to management at appropriate scales. Movement tracking using satellite telemetry is now allowing us to fill these knowledge gaps for highly mobile waterbirds at continental scales, including in remote areas for which data have been historically difficult to acquire. We used GPS satellite telemetry to track the movements of 122 individuals of three species of ibis and spoonbills (Threskiornithidae) in Australia from 2016 to 2023. We analysed movement distances, residency periods and areas, and foraging-site fidelity. From this we derived implications for water and wetland management for waterbird conservation. This is the first multi-year movement tracking data for ibis and spoonbills in Australia, with some individuals tracked continuously for more than five years including from natal site to first breeding attempt. Tracking revealed both inter- and intra-specific variability in movement strategies, including residency, nomadism, and migration, with individuals switching between these behaviours. During periods of residency, areas used and distances travelled to forage were highly variable and differed significantly between species. Sixty-five percent of identified residency areas were not associated with wetlands formally listed nationally or internationally as important. Tracking the movements of waterbirds provides context for coordinated allocation of management resources, such as provision of environmental water at appropriate places and times for maximum conservation benefit. This study highlights the geographic scales over which these birds function and shows how variable waterbird movements are. This illustrates the need to consider the full life cycle of these birds when making management decisions and evaluating management impacts. Increased knowledge of the spatio-temporal interactions of waterbirds with their resource needs over complete life cycles will continue to be essential for informing management aimed at increasing waterbird numbers and maintaining long-term diversity.

This study investigated the effect of sodium hyperhydration on thermal and cardiovascular strain and exercise performance in unacclimatized endurance-trained females exercising in the heat and whether effects differ between menstrual cycle (MC) Phase 1 (low estrogen and progesterone) and MC Phase 4 (moderate estrogen and high progesterone). Twelve female cyclists/triathletes completed four trials in a randomized, double-blinded, crossover design. Participants consumed 30 ml·kg ⁻¹ fat-free mass fluid with either sodium chloride (7.5 g·kg ⁻ ¹ ) or placebo (sucrose) 2 hr prior to 75 min of steady-state cycling (60% ) followed by a 200-kJ time trial (TT) in 34 °C and 60% relative humidity, with both interventions completed during MC Phase 1 and Phase 4. Rectal temperature and heart rate were measured at baseline, every 5 min during steady state, every 50 kJ of TT, and TT completion. Body mass was measured every 30 min preexercise and pre and post steady state and TT to assess hydration status. Linear mixed models were fitted to estimate intervention and MC phase effect. There were no significant sodium hyperhydration or MC phase effects on rectal temperature or heart rate ( p > .05). Body mass increased with sodium versus placebo (0.38 [0.02, 0.74] kg; p = .04), with a greater increase in MC Phase 4 (0.69 [0.17, 1.2] kg; p < .001). TT performance improved with sodium versus placebo (−1.55 [−2.46, −0.64] min; p = .001), with a greater improvement in MC Phase 4 (−1.85 [−3.16, −0.55] min; p = .005). Sodium hyperhydration is a promising heat mitigation strategy for females undertaking prolonged exercise in the heat, especially during MC Phase 4 and when fluid access is limited.

The value of creative writing as an adjunct to clinical treatment is well-known. Creative writing has been used successfully in a wide range of healthcare and rehabilitation settings, with people suffering from aphasia, dementia, cancer, heart attacks, depression, mental illness, post-traumatic stress disorder and anxiety disorders, and dealing with pain. Poetry, in particular, has been identified as a powerful reflective tool. This project aimed to: facilitate the creation of a safe space in which participants can enjoy open discussion of written works, share readings and offer feedback; give participants the opportunity and basic skills to write expressively and creatively; evaluate whether the writing of poetry can help reframe personal narratives in a controlled setting in ways that facilitate meaningful self-reflection and improve well-being. The programme was delivered through eight face-to-face creative writing workshops, each lasting 1 hour, from February to May 2023. Fourteen participants engaged with the pilot programme. This paper discusses the practical lessons learnt regarding the staging of a programme outside an educational facility, as well as the specific dynamics of the hospital context, including creative pedagogical discoveries made in this participant-driven environment. The programme was evaluated through a survey, responses to which were overwhelmingly positive, especially in the qualitative comments. Participants welcomed the opportunity to express themselves creatively, both through oral storytelling and written work, in the safe space created during the programme. Interactions were dynamic and raised issues that were important to participants, who gave voice to the uniqueness of their experiences, helping re-establish agency.

Background Clinical care contributes to at least 50% of the greenhouse gas (GHG) emissions of healthcare. This includes the 40% of healthcare that is harmful or low value, adding avoidable emissions without improving health or quality of care. Clinicians are well-placed to mitigate emissions associated with the provision of clinical care. This study aimed to explore clinicians’ views on a new construct we have termed ‘carbon health literacy’ to understand how knowledge, skills and capacities related to the emissions of clinical care has application in clinical practice. Methods Qualitative interviews were conducted between August 2022 and February 2023 with clinicians from Australia (n = 15) and Canada (n = 13). Clinicians with an interest in climate change and healthcare sustainability were sampled from a variety of clinical specialty areas, such as primary care, nursing, anaesthetics, and emergency. Clinicians were recruited through advertising on social media and via professional networks. A pre-piloted interview schedule was used to guide the interviews. Interviews were audio recorded, transcribed verbatim and analysed using framework analysis. Results Participants viewed carbon health literacy as an increasingly important skill for clinicians to have or acquire, though they reported that the level of carbon health literacy and knowledge needed varies by job roles, clinical specialty areas, and individual capacity to generate healthcare system change. Many clinicians reported implementing strategies to mitigate their work-related GHG emissions, such as reducing waste or choosing lower carbon commuting options. There was limited awareness of reducing low-value care as a strategy to decrease emissions. All participants had encountered barriers to providing low-carbon care, including managing patient expectations, inadequate training and information, and limited capacity to generate system change in their organisational roles. Conclusions To support the delivery of high value low carbon healthcare, work is needed to build the carbon health literacy of clinicians and remove other barriers currently impeding their capacity to practice and promote sustainable clinical care.

This study examines the relationship between respondents’ vaccine hesitancy, reported media consumption patterns, ideological leanings, and trust in science. A large-scale survey conducted in the US in 2022 (N = 1,646) assessed self-reported COVID-19 vaccination, trust in science, and reported media consumption. Findings show that, regardless of personal ideology, individuals who consumed less conservative media and had a more ideologically diverse media diet were more likely to be fully vaccinated and boosted. Additionally, consuming more conservative media was negatively associated with trust in science, but this relationship was weaker among those with a more ideologically diverse media diet. By incorporating data from an earlier wave of the survey in the summer of 2020, before COVID-19 vaccines were available, we found that a less conservative and more ideologically diverse media diet in 2022 predicted vaccination behavior in 2022, controlling for prior vaccine intentions and media consumption in 2020. A similar survey conducted in the UK in the summer of 2020 paralleled patterns in the US regarding vaccine intentions and media consumption. These results suggest that an ideologically diverse media diet is associated with reduced vaccine hesitancy. Public health initiatives might benefit from encouraging ideologically diverse media consumption. Supplementary Information The online version contains supplementary material available at 10.1038/s41598-024-77408-4.

Trade and sustainable development (TSD) chapters in international trade agreements include labour provisions with a view to prevent a “race to the bottom” and reaffirm the existing international labour commitments. When properly formulated and implemented, these provisions could have positive normative impacts on the international and domestic rule of law. This article provides a critical analysis of the evolution of labour standards in international trade agreements, particularly focusing on the European Union’s (EU) approach, in comparison with the approach in the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP). More specifically, it considers ways in which trade agreements contribute to the improvement of labour standards in domestic legal systems. While EU trade agreements embrace minimum standards under international labour law rather than higher standards that apply in the EU legal order, the article argues that there is at least a normative shift towards a more efficient implementation of labour rights through EU agreements, which could make a limited contribution to the rule of law.

Background In response to the well-documented fragmentation within its mental health system, Australia has witnessed recently rapid expansion in the availability of digital mental health care navigation tools. These tools focus on assisting consumers to identify and access appropriate mental health care services, the proliferation of such varied web-based resources risks perpetuating further fragmentation and confusion for consumers. There is a pressing need to systematically assess the characteristics, comprehensiveness, and validity of these navigation tools, especially as demand for digital resources continues to escalate. Objective This study aims to identify and describe the current landscape of Australian digital mental health care navigation tools, with a focus on assessing their comprehensiveness, identifying potential gaps, and the extent to which they meet the needs of various stakeholders. Methods A comprehensive infoveillance approach was used to identify Australian digital mental health care navigation tools. This process involved a systematic web-based search complemented by consultations with subject matter experts. Identified navigation tools were independently screened by 2 authors, while data extraction was conducted by 3 authors. Extracted data were mapped to key domains and subdomains relevant to navigation tools. Results From just a handful in 2020, by February 2024 this study identified 102 mental health care navigation tools across Australia. Primary Health Networks (n=37) and state or territory governments (n=21) were the predominant developers of these tools. While the majority of navigation tools were primarily designed for consumer use, many also included resources for health professionals and caregivers. Notably, no navigation tools were specifically designed for mental health care planners. Nearly all tools (except one) featured directories of mental health care services, although their functionalities varied: 27% (n=27) provided referral information, 20% (n=21) offered geolocated service maps, 12% (n=12) included diagnostic screening capabilities, and 7% (n=7) delineated care pathways. Conclusions The variability of navigation tools designed to facilitate consumer access to mental health services could paradoxically contribute to further confusion. Despite the significant expansion of digital navigation tools in recent years, substantial gaps and challenges remain. These include inconsistencies in tool formats, resulting in variable information quality and validity; a lack of regularly updated service information, including wait times and availability for new clients; insufficient details on program exclusion criteria; and limited accessibility and user-friendliness. Moreover, the inclusion of self-assessment screening tools is infrequent, further limiting the utility of these resources. To address these limitations, we propose the development of a national directory of mental health navigation tools as a centralized resource, alongside a system to guide users toward the most appropriate tool for their individual needs. Addressing these issues will enhance consumer confidence and contribute to the overall accessibility, reliability, and utility of digital navigation tools in Australia’s mental health system.