Sabine Braat’s research while affiliated with University of Melbourne and other places

Background Flash glucose monitoring (FGM) can improve diabetes management, but no randomised controlled trials (RCTs) of FGM have been undertaken in Indigenous Australian populations. This study aimed to assess the feasibility of performing a RCT of FGM in Indigenous Australians with type 2 diabetes. Methods In this open-labelled pilot RCT, Indigenous adults with type 2 diabetes were randomised to FGM or standard care for 6 months. Eligible participants were being treated with injectable diabetes medications and had a glycosylated haemoglobin (HbA1c) ≥ 7.0%. The feasibility outcome was the proportion of participants completing the trial, and the primary outcome for the future trial was change in HbA1c from baseline to 6 months. Secondary outcomes included change in time spent in target blood glucose (4.0–10.0 mmol/L), safety (hypoglycaemic episodes), and quality of life (EuroQol 5-dimension 3-level (EQ-5D-3L) score). Results Of 126 screened individuals, 74 were eligible, 40 (54%) were randomised, and 39 (97.5%) completed the study. Participants’ baseline characteristics were similar between the FGM and usual care groups, except for sex and body mass index. No between-group differences were observed for the following: change in HbA1c; percentage of time spent in target blood glucose (4.0–10.0 mmol/L), low glucose (< 3.9 mmol/L), and high glucose (> 15.0 mmol/L); or EQ-5D-3L scores. No severe hypoglycaemic episodes occurred. Conclusions This is the first pilot RCT of FGM in Indigenous Australians with type 2 diabetes. The results support a larger RCT. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR12621000021875), retrospectively registered on 14 January 2021.

The binding and neutralising activity of SARS-CoV-2 antibodies are important correlates of protection of current COVID-19 vaccines. SARS-CoV-2 exposure status and COVID-19 vaccine types can influence these responses and the breadth of cross-reactivity to variants. In this longitudinal cohort study, we used SARS-CoV-2-specific multiplex Luminex ® antibody assays and live virus neutralisation of ancestral (VIC01/2020), Delta and Omicron (BA1, BA2 and BA5) SARS-CoV-2 variants to compare antigen-specific binding and neutralising antibody (nAb) responses to primary vaccination (two doses) of adenovirus vectored (AdVV) or mRNA vaccines followed by a booster dose of mRNA vaccine in convalescent (n=51) and infection-naïve individuals (n=47). In a subset of individuals, we performed additional analysis of antibody responses following breakthrough infection. We found that titres of anti-SARS-CoV-2 nAb following primary vaccination (2 doses) with AdVV vaccine were significantly lower than those following mRNA vaccine, irrespective of prior SARS-CoV-2 infection status. However, an mRNA vaccine booster dose resulted in equivalent binding and nAb titres to the ancestral virus in all individuals, irrespective of primary vaccine type. Notably, vaccinated infection-naïve, but not convalescent individuals required the third dose of vaccine (mRNA) to induce nAbs to Omicron subvariants BA1, BA2 and BA5, though titres against the variants were lower than those against the ancestral strain. Importantly, breakthrough infection with Omicron strains induced higher nAb titre rises against the ancestral strain than against Omicron variants consistent with imprinting of the immunologic response and recall of pre-existing immunity to the ancestral strain.

INTRODUCTION Music‐based strategies can reduce distress, agitation, and promote wellbeing in people with dementia. Research in specialized dementia care units is limited. METHODS Mixed‐methods pre‐post study evaluated the feasibility and preliminary effects of Music Attuned Technology Care via eHealth (MATCH) in a dementia‐specialized inpatient ward. Staff completed MATCH training and administered MATCH strategies over 8 weeks with enrolled patients. RESULTS Twenty‐four staff and 14 patients were recruited. Severity of dementia symptoms, measured by the Neuropsychiatric Inventory Questionnaire, was reduced (median change: −3.0, 95% CI: −9.5, 0.5), especially agitation (median change −3.0, 95% confidence interval −5.5, −0.5). Staff reported high acceptability of MATCH (median score: 13 [interquartile range: 12–14]) and implementing strategies enhanced person‐centered care. Patients’ positive responses to music motivated increased use. No changes in staff knowledge or patient depression were found. DISCUSSION MATCH was acceptable to staff and showed potential to reduce agitation symptoms and medication use, warranting further trials to determine effectiveness. Clinical trial registration: The clinical trial is registered with the Australia New Zealand Clinical Trials Registry (ACTRN12623001134617). Highlights MATCH decreased the severity of dementia symptoms, measured by the NPI‐Q. Staff reported high acceptability of MATCH. Personalized music enhanced person‐centered care. Patients’ positive responses to music motivated increased use. No changes in staff knowledge or patient depression were found.

Hospitalised, unwell patients have vital signs such as heart rate (HR), oxygen saturation (SpO2) and temperature measured multiple times a day to detect clinical deterioration and monitor health trajectories. Advancements in contact-free (ambient) sensors (AS) to measure vital signs can help mitigate risks due to skin injury and infection transmission seen in conventional hospital equipment. This prospective, observational clinical study aims to validate vital sign measurements from a multi-channel AS compared to conventional equipment in three cohorts: patients in a hospital ward, patients at home within a Hospital-at-Home service, and healthy volunteers. Data analysis of 571 paired measurements from 29 participants indicates that heart rate measurements via AS were accurate, though they lacked precision, with the clinical agreement range between 6.38 and 6.49 beats per minute. Temperature and oxygen saturation measurements showed less agreement when compared with the reference standard. In conclusion, ambient sensors show promising utility in measuring vital signs, with this study amongst the first of its kind to utilise this in measuring vital signs in hospitalised patient cohorts in both ward and home environments.

Background Menstrual-related absenteeism from work, school, or social activities is an important functional indicator of poor menstrual health that disrupts women's and girls' daily lives and exacerbates gender inequality. We sought to estimate the prevalence of and factors contributing to menstrual-related absenteeism across low-income and middle-income countries.

Objective To evaluate the impact of a 4‐month dietary and lifestyle program co‐designed and led by Aboriginal and Torres Strait Islander people on weight and metabolic markers, diet, and physical activity in overweight and obese adults in a remote Indigenous community. Study design Single arm, pre–post intervention study. Setting, participants Adult residents (18–65 years) of a remote Northern Territory community with body mass index (BMI) values of at least 25 kg/m ² or waist circumferences exceeding 94 cm (men) or 80 cm (women). Intervention Hope for Health, a culturally sensitive 4‐month program supporting self‐managed health improvement based on dietary and lifestyle change, 1 August to 30 November 2022. Main outcome measures Weight loss of at least 5%; changes in BMI, waist circumference, other metabolic markers (blood pressure, biomarkers of metabolic health and inflammation), diet, and physical activity; participant perceptions of the program. Results We assessed outcomes for 55 participants who completed weight assessments at both baseline and program end (mean age, 42.5 years [standard deviation, 10.1 years]; 36 women [65%]). Forty participants lost and 15 gained weight; overall mean weight loss was 1.5 kg (95% confidence interval [CI], 0.5–2.4 kg), and ten participants (18%; 95% CI, 9–31%) achieved at least 5% weight reduction. The mean change in BMI (53 participants) was –0.60 kg/m ² (95% CI, –0.93 to –0.27 kg/m ² ), in waist circumference (53 participants) –3.2 cm (95% CI, –4.7 to –1.7 cm), and in low‐density lipoprotein cholesterol level (37 participants) –0.28 mmol/L (95% CI, –0.47 to –0.08 mmol/L); the relative decline in the HbA 1c level geometric mean (50 participants) was 11% (95% CI, 6–15%). The intake of breads and cereals (median change, –1.5 [95% CI, –2.0 to –1.0] serves/day) and sugar‐sweetened beverages (–0.6 [95% CI, –1.4 to –0.1] serves/day) declined; the amount of moderate and vigorous physical activity increased by a median of 103 min/day (95% CI, 74–136 min/day; 19 participants). The program focus on integrating healthy bodies and networks of kin, healthy governance, vibrant language and ceremony, and a healthy environment were seen as central to its value and benefit. Conclusions Community appreciation of the program and the improvements in cardiometabolic risk factors are encouraging, providing an example of a culturally sensitive, co‐designed initiative led by Indigenous people for reducing the prevalence of chronic disease in remote areas. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12622000174785; prospective: 2 February 2022).

Background Antenatal anaemia is a significant global health problem, affecting 48% of pregnant women in South Asia. The standard of care in Bangladesh is oral iron and folic acid supplementation. However, access and adherence to oral iron supplementation are subpar. An alternative treatment available to address antenatal anaemia is intravenous (IV) iron. Modern IV iron products are routinely used in high-income clinical settings, including primary and secondary care, to deliver a high dose of iron in a single short infusion. A demonstration project will be conducted to test the real-world feasibility and acceptability of implementing an IV iron intervention to treat pregnant women with moderate and severe anaemia in the primary healthcare setting of Bangladesh. In this protocol paper, we describe the implementation research program that will guide the development, implementation, and evaluation of an IV iron intervention in real-world settings. Methods We will use implementation science frameworks to guide the demonstration project. The implementation research program includes three phases: 1) a formative phase in preparation for the implementation of an IV iron intervention involving a review, qualitative research, and readiness assessment; 2) the development and implementation of IV iron intervention care pathways and strategies to support the uptake and delivery of the intervention using a participatory research approach; and 3) a process evaluation of IV iron intervention care pathways and strategies involving qualitative and quantitative assessment of the costs, processes and contextual factors affecting its implementation. Discussion Modern IV iron products present a novel opportunity to reduce the disproportionate burden of antenatal anaemia in low-and-middle income countries (LMICs). The demonstration project will ascertain whether an IV iron intervention can be effectively introduced into routine antenatal care in Bangladesh. The extent to which it is considered an acceptable treatment by pregnant women with moderate or severe anaemia receiving the intervention, healthcare providers delivering the intervention, and policymakers will be determined. If successful, understanding how an IV iron intervention will be implemented across several care pathways and its associated costs will inform the scalability of an IV iron intervention in the primary healthcare system of Bangladesh and provide implementation guidance in other LMICs.