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Global, regional, and national burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
No full textBackground: Combating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets. Methods: The primary data sources were population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. We estimated chronic HBV infection and the burden of HBV-related diseases, defined as an aggregate of cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B. We used DisMod-MR 2.1, a Bayesian mixed-effects meta-regression tool, to estimate the prevalence of chronic HBV infection, cirrhosis, and aetiological proportions of cirrhosis. We used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer. We used the Cause of Death Ensemble modelling (CODEm) model, a tool that selects models and covariates on the basis of out-of-sample performance, to estimate mortality due to cirrhosis, liver cancer, and acute hepatitis B. Findings: In 2019, the estimated global, all-age prevalence of chronic HBV infection was 4·1% (95% uncertainty interval [UI] 3·7 to 4·5), corresponding to 316 million (284 to 351) infected people. There was a 31·3% (29·0 to 33·9) decline in all-age prevalence between 1990 and 2019, with a more marked decline of 76·8% (76·2 to 77·5) in prevalence in children younger than 5 years. HBV-related diseases resulted in 555 000 global deaths (487 000 to 630 000) in 2019. The number of HBV-related deaths increased between 1990 and 2019 (by 5·9% [–5·6 to 19·2]) and between 2015 and 2019 (by 2·9% [–5·9 to 11·3]). By contrast, all-age and age-standardised death rates due to HBV-related diseases decreased during these periods. We compared estimates for 2019 in 194 WHO locations to WHO-GHSS 2020 targets, and found that four countries achieved a 10% reduction in deaths, 15 countries achieved a 30% reduction in new cases, and 147 countries achieved a 1% prevalence in children younger than 5 years. As of 2019, 68 of 194 countries had already achieved the 2030 target proposed in WHO Interim Guidance of an all-age HBV-related death rate of four per 100 000. Interpretation: The prevalence of chronic HBV infection declined over time, particularly in children younger than 5 years, since the introduction of hepatitis B vaccination. HBV-related death rates also decreased, but HBV-related death counts increased as a result of population growth, ageing, and cohort effects. By 2019, many countries had met the interim seroprevalence target for children younger than 5 years, but few countries had met the WHO-GHSS interim targets for deaths and new cases. Progress according to all indicators must be accelerated to meet 2030 targets, and there are marked disparities in burden and progress across the world. HBV interventions, such as vaccination, testing, and treatment, must be strategically supported and scaled up to achieve elimination. Funding: Bill & Melinda Gates Foundation
Characterising the tsunami hazard in estuaries: an examination of the influences of elevation, tide, morphology, and tsunami wave parameters
No full textTsunamis can cause devastation to coastal communities around the world with populations living at low elevation around estuaries especially exposed. This thesis characterises the tsunami hazard in estuaries by examining the influence of elevation, tide, morphology, and tsunami wave parameters and expands the evidence base used in the estimation and management of this potential threat. Overall, this thesis shows that there is some tolerance for bathymetric data uncertainty used in tsunami modelling in the order of 3-5 m with model results showing maximum runup uncertainty of 10-30% depending on estuary morphology. Results further show that within riverine estuaries, both estuary entrance dimensions and the presence of estuary channel constrictions show a disproportionately large influence on the tsunami hazard along the length of the estuary with significant channel constrictions causing an elevated tsunami hazard downstream and a reduced hazard upstream. Tsunami modelling of these channel constrictions is shown to be sensitive to changes in depth and therefore tide. This thesis demonstrates that the application of a static tide in tsunami modelling is only appropriate for use with channel constrictions at high tide but at other tide levels can be reliable for the open coast, estuary mouths, and 1-2 hours from tsunami arrival. Tsunamis occurring at high tide are more likely to cause inundation, however, findings within this thesis show that tsunamis coinciding with a low tide are more likely to cause higher maximum current speeds with the fastest current speeds occurring at the shallowest water depths with rare exceptions. Tsunami wave parameters are also considered and tsunami wave period is found to be of most concern when modelling tsunamis in small bays (7 km in length) show greater wave amplification for longer wave periods. Such wave amplification within coastal bays can be significant especially in V-shaped bays where maximum water level amplification can result in maximum water levels 80% higher than adjacent locations. Due to the demonstrated amplification of the tsunami hazard, this thesis concludes that V-shaped bays should be considered a priority for tsunami estimation. New, simplified methods for tsunami estimation in riverine estuaries are presented which require only minimal input data and do not require access to complex tsunami modelling. These methods include attenuation rates and a tsunami estimation workflow which takes into account estuary dimensions and influential estuary channel features. This thesis shows that tsunami estimation using only estuary entrance and channel feature elevation data can provide maximum water level estimates within 110% of complex modelling results
Sperm-specific proteins: new implications for diagnostic development and cancer immunotherapy
No full textSpermatozoa are comprised of many unique proteins not expressed elsewhere. Sperm-specific proteins are first expressed at puberty, after the development of immune tolerance to self-antigens, and have been assumed to remain confined inside the seminiferous tubules, protected from immune cell recognition by various mechanisms of testicular immune privilege. However, new data has shown that sperm-specific proteins are released by the tubules into the surrounding interstitial fluid; from here they can contact immune cells, potentially promote immune tolerance, and enter the circulation. These new findings have clinical implications for diagnostics and therapeutics targeted at a specific class of proteins known as cancer-testis antigens (CTA), the opportunity to identify new communication pathways in the testis, and to discover new ways to monitor testis function
Delivery of telehealth nutrition and physical activity interventions to adults living in rural areas: a scoping review
No full textBackground: Lifestyle behaviours related to smoking, alcohol, nutrition, and physical activity are leading risk factors for the development of chronic disease. For people in rural areas, access to individualised lifestyle services targeting behaviour change may be improved by using telehealth. However, the scope of literature investigating telehealth lifestyle behaviour change interventions for rural populations is unknown, making it difficult to ascertain whether telehealth interventions require adaptation for rural context via a systematic review. This scoping review aimed to address this gap, by mapping existing literature describing telehealth lifestyle interventions delivered to rural populations to determine if there is scope for systematic review of intervention effectiveness in this research topic. Methods: The PRISMA extension for scoping review checklist guided the processes of this scoping review. A search of eight electronic databases reported in English language until June 2023 was conducted. Eligible studies included adults (18 years and over), who lived in rural areas of high-income countries and undertook at least one synchronous (video or phone consultation) telehealth intervention that addressed either addictive (smoking or alcohol), or non-addictive lifestyle behaviours (nutrition or physical activity). Studies targeting addictive and non-addictive behaviours were separated after full text screening to account for the involvement of addictive substances in smoking and alcohol studies that may impact behaviour change interventions described. Studies targeting nutrition and/or physical activity interventions are presented here. Results: The search strategy identified 17179 citations across eight databases, with 7440 unique citations once duplicates were removed. Full texts for 492 citations were retrieved and screened for inclusion with 85 publications reporting on 73 studies eligible for data extraction and analysis. Of this, addictive behaviours were comprised of 15 publications from 13 studies. Non-addictive behaviours included 70 publications from 58 studies and are reported here. Most interventions were delivered within the United States of America (n = 43, 74.1%). The most common study design reported was Randomised Control Trial (n = 27, 46.6%). Included studies involved synchronous telehealth interventions targeting nutrition (11, 18.9%), physical activity (5, 8.6%) or nutrition and physical activity (41, 70.7%) and were delivered predominately via videoconference (n = 17, 29.3%). Conclusions: Despite differences in intervention characteristics, the number of randomised control trials published suggests sufficient scope for future systematic reviews to determine intervention effectiveness related to nutrition and physical activity telehealth interventions for rural populations. Trial Registration: The scoping review protocol was not pre-registered
Culturally Informed Australian Aboriginal and Torres Strait Islander Evaluations: A Scoping Review
No full textRigorous and effective evaluations inform policy and service delivery and create evidence of program impacts and outcomes for the communities they are designed to support. Genuine engagement of communities is a key feature of effective evaluation, building trust and enhancing relevancy for communities and providing meaningful outcomes and culturally relevant findings. This applies to Indigenous peoples' leadership and perspectives when undertaking evaluations on programs that involve Indigenous communities. This systematic scoping review sought to explore the characteristics of culturally informed evaluations and the extent of their application in Australia, including the use of specific evaluation tools and types of community engagement. Academic and grey literature were searched between 2003 and 2023, with 57 studies meeting the inclusion criteria. Over time, there was an increase in the number of culturally informed evaluations undertaken, predominantly in the health and wellbeing sector. Around a quarter used a tool specifically developed for Indigenous evaluations. Half of the publications included Indigenous authorship; however, most studies lacked detail on how evaluations engaged with communities. This review highlights the need for further development of evaluation tools and standardised reporting to allow for shared learnings and improvement in culturally safe evaluation practices for Aboriginal and Torres Strait Islander communities
‘What's she doing here?’ Overcoming barriers to the implementation of Expert by Experience positions in academia
No full textIntroduction: Experts by Experience involvement in the education of health professionals has gained momentum as an important strategy in ensuring quality, person-centred education. Despite being a requirement for occupational therapy programs in Australia and internationally, involvement is variable and limited. Barriers to the implementation of academic roles have been identified, including negative attitudes of colleagues, systemic barriers, and insufficient evidence of their value. Mental health academics who do not identify as having lived experience (referred to as allies) have provided crucial support for Experts by Experience. Understanding their perspectives on implementation barriers and how they can be addressed is crucial to facilitating a broader level of meaningful involvement. Methods: A qualitative exploratory research project was conducted, involving in-depth interviews with mental health academic allies (n = 16) from Australia, Ireland, and New Zealand. Participants were from the disciplines of nursing, occupational therapy, social work, and psychiatry. Data were analysed thematically. Findings: Two main themes were identified from the data analysis process: convincing colleagues and dealing with university barriers. Participants described varying attitudes from colleagues towards Experts by Experience, with many not understanding or appreciating their contribution to education and student outcomes. At the university level, reluctance to embrace innovation and funding and other resource shortages presented impediments to the implementation of Expert by Experience roles. Participants described using creative measures to overcome institutional barriers and encourage greater acceptance of such roles by colleagues. Conclusion: This research describes how allies experienced and overcame barriers they faced when supporting the implementation of academic positions for Experts by Experience. Allies have an important role to play in overcoming systemic barriers, and the approaches they have taken to achieve this may be an important source of learning for others with similar aspirations
Have gloves and gowns had their day? An Australian and New Zealand practice and attitudes survey about contact precautions for MRSA and VRE colonisation
No full textBackground: ‘Contact precautions,’ are recommended for hospitalised patients with known methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) colonisation. Despite increasing observational evidence suggesting that gowns and gloves are of no added benefit over hand hygiene and environmental cleaning, guidelines continue to recommend them. Methods: A cross-sectional online survey of infection prevention professionals, infectious diseases physicians and microbiologists in Australian and New Zealand hospitals was conducted. The purpose was to explore variations in current approaches to known MRSA and VRE colonisation, and determine clinical equipoise for a proposed randomised control trial (RCT) to withdraw the use of gowns and gloves in this setting. Results: 226 responses from 122 hospitals across all Australian jurisdiction and multiple regions of New Zealand were received. While most hospitals implement contact precautions for MRSA (86%) and VRE (92%), variations based on MRSA and VRE subtypes are common. There was strong interest in removing glove and gown use for MRSA (72% and 73%, respectively) and VRE (70% and 68%, respectively). 62% of surveyed hospitals expressed interest in participating in a proposed cluster RCT comparing discontinuation of gown and glove use as part of contact precautions for MRSA and VRE, with their ongoing use. Conclusion: The mandated use of PPE in the context of MRSA and VRE colonisation warrants further examination. An RCT is needed to definitively address this issue and to promote a widespread change in practice, if warranted
Build Back Safely: Evaluating the Occupational Health and Safety in Post-Disaster Reconstruction
No full textCurrent trends in disaster response and management include various stakeholders, including non-government organisations (NGOs), volunteer groups and other humanitarian organisations, working alongside governmental agencies. Together, they are directly involved in reconstruction efforts, with support often extending from the early response to long-term reconstruction. The common goal of reconstruction efforts spanning the last few decades is the ambition to “Build Back Better”. More recently, there have been efforts to expand the scope of the reconstruction efforts to “Build Back Safer” and to raise awareness about the quality and safety of the final products, such as housing and infrastructure. Disaster management studies rarely address the construction process after disasters, or the working conditions of the builders, and often pay little attention to the health and safety of the extended workforce. This study identifies critical factors affecting workers, volunteers, local communities and other staff working on disaster reconstruction projects through a systematic literature review of academic publications. A total of 35 publications were thematically analysed, reduced from an initial selection of 394 publications selected between 2004 to 2022. The findings from this study highlight the vulnerabilities experienced by workers and the broader community involved in post-disaster reconstruction and acknowledge challenges integrating health and safety concerns into the practice and governance of global humanitarian systems
The Increasing Role of Short-Term Sperm Storage and Cryopreservation in Conserving Threatened Amphibian Species
No full textMultidisciplinary approaches to conserve threatened species are required to curb biodiversity loss. Globally, amphibians are facing the most severe declines of any vertebrate class. In response, conservation breeding programs have been established in a growing number of amphibian species as a safeguard against further extinction. One of the main challenges to the long-term success of conservation breeding programs is the maintenance of genetic diversity, which, if lost, poses threats to the viability and adaptive potential of at-risk populations. Integrating reproductive technologies into conservation breeding programs can greatly assist genetic management and facilitate genetic exchange between captive and wild populations, as well as reinvigorate genetic diversity from expired genotypes. The generation of offspring produced via assisted fertilisation using frozen–thawed sperm has been achieved in a small but growing number of amphibian species and is poised to be a valuable tool for the genetic management of many more threatened species globally. This review discusses the role of sperm storage in amphibian conservation, presents the state of current technologies for the short-term cold storage and cryopreservation of amphibian sperm, and discusses the generation of cryo-derived offspring
Family inclusion in child protection: Knowledge, power and resistance
No full textThe inclusion of families throughout the child protection process can improve lifelong outcomes for children who have been removed from their parents’ care. However, child protection authorities have struggled to prioritize principles of family inclusion within systems that position families as risky. While parents’ experiences of powerlessness within child protection systems have been well documented, little is known about parents’ perspectives on family inclusion specifically. We engaged six parents who had experienced removal of children from their care in interviews and focus groups as part of a larger study that examined practitioners’, carers’, lawyers’ and parents’ views on family inclusion in Australia. In this article we report on parents’ experiences and recommendations for improving family inclusion. Through the analytical framework of Foucauldian concepts of power, knowledge and acts of resistance we highlight the complexities of parents’ lives and intersections in their experiences of systemic and social exclusion. In identifying the importance of collaboration, decision making and parental identity these findings suggest that the advocacy of parents for inclusion in the lives of their children is an underutilized asset in child protection systems