Crystal Man Ying Lee’s research while affiliated with Curtin University and other places

This study explored whether digital health content was included in current higher education curriculum, barriers and enablers to inclusion, key skills required and university educators' confidence in delivering content in undergraduate and postgraduate health courses in Western Australia. A three-stage design included: 1) desktop audit of course (n = 117) and unit (n = 1559) descriptors for digital health-related keywords; 2) semi-structured interviews with university educators (n = 15); and 3) online survey of final year students (n = 14). Health, allied health, medicine, nursing and midwifery disciplines at five universities were included. The audit identified limited digital health-related keywords. Interviews identified unsystematic application of digital health content across disciplines. Five themes for digital health curriculum were identified; only one required discipline-specific content. Despite low responses, students supported a need for additional training opportunities to support digital health skill implementation in practice. Comprehensive and ongoing digital health curricula and practice opportunities are needed for undergraduate and postgraduate health workers. Consideration should be given to the skills of university educators and clinical supervisors regarding their own confidence in delivering digital health teaching and practice opportunities for students. A universal approach, supplemented by discipline-specific content, may create efficiencies in curriculum development and support a common language and understanding across professions.

Aims To determine the adherence rate in users of each class of glucose‐lowering medication and identify the key socio‐demographic factors influencing adherence. Methods The 45 and Up Study is an ongoing cohort study of residents aged ≥45 years in New South Wales, Australia. We analysed Pharmaceutical Benefits Scheme records from 2013 to 2019 of the 21 341 study participants who self‐reported having diabetes. Medication adherence was estimated as the proportion of days covered for each 12‐month period for up to the fifth 12‐month period. Results A consistent pattern was observed across all drug classes, where the percentage of adherent (proportion of days covered ≥0.8) users was highest in the first 12 months, followed by a drop in the second 12 months. For prevalent users on the same drug class for the full 5‐year period, higher percentages of adherent users compared to the first 12 months were observed for glucagon‐like peptide 1 receptor agonists (77.7% vs 74.2%). For incident users on the same drug class for the full 5‐year period, a higher percentage of adherent users compared to the first 12 months was observed for sodium‐glucose cotransporter 2 inhibitors (84.2% vs 78.4%). Moreover, no socio‐demographic subgroup was consistently more or less adherent to medications. Conclusions Initial adherence was good and remained relatively high over time in this cohort. Nevertheless, adherence was still a challenge in some individuals. Practitioners should recognize the possibility of non‐adherence and consider this at each consultation.

Aims To establish the increased all-cause mortality risk after an inpatient episode of care with a diagnosis of a severe psychiatric disorder in young people. Methods The data included all psychiatric inpatient episodes for psychiatric diagnoses in Western Australia between 2005 and 2022 linked with the state death registry. Participants were only included if they turned 18 years of age between 2005 and 2016, so survival from first adult admission until the study end date could be compared with age-gender matched life tables. Results A total of 18,893 individuals had an admission with a primary or secondary diagnosis for a selected psychiatric diagnosis in the study period, across which time 485 died. Admission for substance use disorders presented the greatest risk of mortality, increasing the risk of death in early adulthood by more than three times (observed/expected = 3.07; 95% confidence interval = [2.76, 3.42]; p < 0.001), followed closely by bipolar disorders (observed/expected = 2.95; 95% confidence interval = [2.09, 4.03]; p < 0.001), while having any two or more comorbid disorders was associated with an increased death rate (observed/expected = 3.30; 95% confidence interval = [2.72, 3.97]; p < 0.001). The Kaplan–Meier curves also suggested that the proportionate increased risk of mortality remained relatively constant across the study period for all diagnoses. Conclusion Inpatient admission for psychiatric disorders increased the risk of all-cause mortality in early adulthood by between two and three times and the increased death rate did not substantively reduce over time. Effective long-term support services are needed to reduce the premature mortality observed among these young adults.

Background Achieving survival free from physical disability or neurocognitive impairment, known as disability-free survival (DFS), is a key public health goal. This study aimed to (1) determine the long-term interactive effects of depression and cardiometabolic diseases (CMDs) on DFS, and (2) explore any associated antidepressant treatment effect on improvements in DFS among older adults. Methods We used data from the ASPREE trial and its observational follow-ups (2010–2019), involving community-dwelling adults aged ≥ 70 years (≥65 for U.S. minorities). Time-updated Cox models were used to estimate the combined effect of depression and CMDs (type 2 diabetes, dyslipidemia, hypertension, chronic kidney disease, metabolic-associated steatotic liver disease, and major adverse cardiovascular events) as well as cardiometabolic multimorbidity (≥2 CMDs) on DFS. To evaluate the improvement in DFS associated with antidepressant treatment in individuals with depression, we estimated the number needed to treat (NNT) to achieve a one-year increase in DFS through antidepressant therapy. Findings 18,739 participants (mean [SD] age, 75.1 [4.6] years; 56.0% female) were included, with a median follow-up of seven years; individuals with both depression and CMDs demonstrated a significantly lower DFS compared to those without either condition. In individuals with depressive symptoms, antidepressant use was associated with a median increase in DFS of 2.95 years (95% CI, 2.12–3.04), with an estimated NNT of 8.05 (95% CI, 5.63–14.86) associated with a one-year increase in DFS. Interpretation Integrating depression treatment into chronic disease management, when appropriate, is associated with an improvement in DFS among older adults. Funding 10.13039/501100001778Deakin University Postgraduate Research Scholarship.

Background Congenital Muscular Torticollis (CMT) is the third most common musculoskeletal condition in infancy, and if untreated can lead to significant disability. While a range of conservative treatments are commonly used in the management of CMT, an understanding of their efficacy and safety is limited. This systematic review and meta-analysis, without language or discipline restriction, was conducted to address this knowledge gap. Methods Electronic searches of CENTRAL, PubMed, 22 other electronic databases, three trials registers and Google Scholar, were conducted for randomised controlled trials, which examined any non-surgical, non-pharmacological interventions, including but not limited to manual treatments, movement therapy, acupuncture, adjunctive therapies and physical support, in children aged 0 to 5 years with CMT. Two reviewers independently assessed the risk of bias of the included studies using the Cochrane Risk of bias 1 tool, rated their certainty of evidence using grading of recommendations assessment, development and evaluation (GRADE) framework, and performed random-effects meta-analyses. Results One hundred studies (80 from China) involving 8125 participants published between 1990 and 2023 were included. Adding manual therapy to an active control resulted in short-term improvements in passive cervical rotation (odds ratio (OR) 9.79, 95%CI 4.26,22.50), passive cervical lateroflexion (OR 2.66, 95%CI 1.17,6.04), active cervical rotation (OR 3.94, 95%CI 1.08,14.35), symmetric head posture (OR 4.55, 95%CI 2.57,8.05), sternocleidomastoid tumour thickness (mean difference (MD) -2.12 mm, 95%CI -2.98,-1.26) and development of symmetrical movement (standardised MD -0.70, 95%CI -0.95,-0.45). The addition of an electrophysical agent to an active control reduced sternocleidomastoid tumour thickness (MD -2.03 mm, 95%CI -2.67,-1.39) and optimised Tuina reduced tumour thickness more than traditional Tuina (MD -1.20 mm, 95%CI -1.80,-0.59). Adverse events were uncommon but poorly reported, with 71 (71%) of studies providing no data. Study heterogeneity limited pooling of data for meta-analysis, and there was very low to low certainty evidence for all results, due to high risk of bias, small sample sizes and study heterogeneity. Conclusions This review found that non-surgical, non-pharmacological treatments may be effective for CMT, but the certainty of evidence is very low to low. These findings are important in informing clinical guidelines and management for CMT and highlight an urgent need for large definitive trials that address the limitations of current studies. Protocol registration Cochrane Database of Systematic Reviews (No.: CD012987).

Objective This study aimed to investigate the physical health conditions among health service users in the first year since recorded mental disorder diagnosis in Western Australia. Methods Community mental health, emergency department (ED) and inpatient records of individuals aged ⩾ 18 years with a recorded mental disorder diagnosis in state-funded health services were analysed. We identified long-term physical health conditions recorded within the first year of the first recorded mental disorder diagnosis. Prevalence of physical comorbidity across time was estimated using multinomial logistic regression. Mean number of health service contacts in the first year of the recorded mental disorder diagnosis was obtained using generalised linear model. Results Altogether, 253,362 individuals were included. Within the first year of the first recorded mental disorder, the prevalence of at least one physical comorbidity ranged from 20.0% in 2006 to 14.5% in 2020. Cardiovascular disease was the most common comorbidity, but the most common combinations of comorbidities became more varied over time. The number of ED and inpatient contacts were higher in subgroups with a higher number of physical comorbidities (ED contacts: 2.4 [95% confidence intervals: 2.4, 2.4] for no comorbidities to 3.6 [3.4, 3.8] for ⩾ 3 comorbidities; inpatient contacts: 2.6 [2.6, 2.7] for no comorbidities to 4.5 [4.1, 4.9] for ⩾ 3 comorbidities). Conclusion With a substantial proportion of individuals with mental disorders already having physical comorbidities on their first year of contact with state-funded health services, and the comorbidity combinations becoming more diverse, there is a need to implement more comprehensive joint mental and physical health services.

Objective To assess the prevalence and trends of chronic kidney disease (CKD) in Western Australia (WA) from 2010 to 2020 using linked pathology data. Design A retrospective observational cohort study using linked de-identified data from WA pathology providers, hospital morbidity records and mortality records. Setting A Western Australian population-based study. Participants All individuals aged 18 years and older with at least one serum creatinine test. Primary outcome measure CKD status as determined by estimated glomerular filtration rate and urine albumin-creatinine ratio. Results Analysing data from 2 501 188 individuals, there was a significant increase in age-sex standardised CKD prevalence from 4.7% in 2010 to 6.0% in 2020, with annual average percentage change of 3.0% (95% CI: 2.3% to 3.7%). Prevalence of CKD stages 3 and above was 4.8% in 2020. Higher CKD prevalence was observed in regional and remote areas compared with major cities, and among individuals in the most socioeconomically disadvantaged quintiles. Sensitivity analysis indicated minor impacts from data exclusions and methodological choices. Conclusions CKD prevalence in WA has been steadily increasing, reflecting broader Australian trends. The study highlights significant disparities in CKD prevalence based on age, socioeconomic status and geographic remoteness.

Objectives Coronary heart disease (CHD) is the leading cause of global morbidity and mortality, yet no comprehensive evaluation of its global economic costs exists. We conducted a systematic review with meta-analysis to examine the costs of CHD treatment by region and CHD subtypes, examine whether there are cost difference by sex, and examine costing methodologies. Design We conducted a systematic review and meta-analysis of non-randomised studies. Data sources We searched Medline, Embase, CINAHL, EconLit and Google Scholar from 1 January 2000 to February 2023. Eligibility criteria for selecting studies We included observational studies reporting economic costs of CHD treatment and outcomes for adults that were published in English. Data extraction and synthesis Data extraction and quality assessment were independently undertaken by two reviewers. Costs were converted to percentage of gross domestic product (GDP) per capita of corresponding country. A random-effects model was used for meta-analysis using StataSE V.18 to calculate the pooled percentage. Heterogeneity was assessed using the I² statistic. Meta-regression and bias assessment were performed. Results Out of 20 100 records identified, 37 studies (including 2 564 189 individuals) from 22 countries were included in the qualitative synthesis and the quantitative meta-analysis. In most countries, the annual cost of CHD exceeds many times the total health expenditure per capita. The pooled direct annual cost of CHD per patient varied from 4.9% to 137.8% of GDP per capita (Int$ purchasing power parity), with pooled percentage of 21.7% (95% CI 15.3, 28.1) for those with CHD. Slight difference in the annual pooled cost of CHD was observed, with a 2% of GDP per capita higher cost in men (95% CI 0.8, 3.2). Most studies applied a top-down costing approach (n=21). Conclusions The review illustrates the expense associated with CHD, which is varied by region and CHD subtypes. The observed cost difference by sex warrants further exploration of sex-specific factors influencing cost disparities. Exploring advanced costing methods such as time-driven activity-based costing can optimise resource allocation and identify opportunities to reduce unnecessary costs and cost disparities. PROSPERO registration number CRD42023412044.

Introduction Chronic kidney disease (CKD) is a significant burden on health systems globally, with limited up-to-date information on health system costs, particularly for non-dialysis patients. This study estimates the direct healthcare costs of CKD within Australia. Methods The study utilised the CKD.WA dataset, a linked repository for the state of Western Australia, containing public and private pathology, hospital, emergency and mortality data for over 2 million people, along with a secondary dataset of general practice records. Costs were calculated for individuals with CKD in 2019 and compared to controls without CKD to identify costs attributable to CKD. Cost items included hospital, emergency, medication, general practice, pathology, dialysis and outpatient services. Costs were expressed in 2023 AUD. Results There were 114,899 individuals with CKD in 2019. Average yearly costs attributable to CKD were $3,367 for Stage 1,$4,114 for Stage 2, $3,607 for Stage 3a,$6,572 for Stage 3b, $11,456 for Stage 4 and$62,558 for Stage 5. Non-dialysis hospital costs were the biggest contributor, followed by dialysis costs. The estimated total cost of CKD to Australia was $8.3 billion for 2019. Conclusion These findings highlight the significant cost burden of CKD. While CKD costs per individual are highest in later stages, the greater number of early-stage CKD cases means the majority of the cost burden is located among early-stage cases. Primary and secondary prevention strategies are likely key to reducing costs.