Temporal changes in temperature-related mortality in relation to the establishment of the heat-health alert system in Victoria, Australia

Extreme heat alerts are the most common form of weather forecasting services used in Australia, yet very limited studies have documented their effectiveness in improving health outcomes. This study aimed to examine the temporal changes in temperature-related mortality in relation to the activation of the heat-health alert and response system (HARS) in the State of Victoria, Australia. We examined the relationship between temperatures and mortality using quasi-Poisson regression and the distributed lag non-linear model (dlnm) and compared the temperature-mortality association between the two periods: period 1- prior-HARS (1992-2009) and period 2- post-HARS (2010-2019). Since the HARS heavily weights heatwave effects, we also compared the main effects of heatwave events between the two periods. The heatwaves were defined for three levels, including 3 consecutive days at 97th, 98th, and 99th percentiles. We also controlled the potential confounding effect of seasonality by including a natural cubic B-spline of the day of the year with equally spaced knots and 8 degrees of freedom per year. The exposure-response curve reveals the temperature mortality was reduced in period 2 in comparison with period 1. The relative risk ratios (RRR) of Period 2 over Period 1 were all less than one and gradually decreased from 0.86 (95% CI, 0.72-1.03) to 0.64 (95% CI, 0.33-1.22), and the differences in attributable risk percent increased from 13.2 to 25.3%. The reduction in the risk of heatwave-related deaths decreased by 3.4% (RRp1 1.068, 95% CI, 1.024-1.112 versus RRp2 1.034, 95% CI, 0.986-1.082) and 10% (RRp1 1.16, 95% CI, 1.10-1.22 versus RRp2 1.06, 95% CI, 1.002-1.119) for all groups of people. The study indicated a decrease in heat-related mortality following the operation of HARS in Victoria under extreme heat and high-intensity heatwaves conditions. Further studies could investigate the extent of changes in mortality among populations of differing socio-economic groups during the operation of the heat-health alert system.

Post-lockdown burden of road injury involving hospitalisation in Victoria, Australia: A statewide, population-based time series analysis

OBJECTIVES

Ever since COVID-19, short-term changes in transport injury patterns have been observed. The aim is to examine both the initial and the enduring impact of government lockdown and the pandemic on road injuries requiring hospitalisation and road fatalities.

METHODS

Time series analysis of Transport Accident Commission (TAC) claims involving hospitalisation and fatalities in Victoria, Australia, from July 2016 to May 2023, including lockdown (March 2020 to October 2020) and post-lockdown (November 2020 onwards).

RESULTS

A total of 46 450 TAC claims were included. Average claims during the pre-pandemic period were 652/month. Lockdown restrictions were associated with a statistically significant fall in monthly claims (-255, 95% confidence interval [CI] = -315 to -194, P < 0.01). This was consistent across road users, days of the week, hours of the day, injury severity, sex and central versus rural locations. The post-lockdown period had a statistically significant reduction in monthly claims to 76% (95% CI = 67-84) of pre-pandemic levels (-158, 95% CI = -213 to -102, P <0.01). This was consistent across all subgroups except bicyclist injuries, which remained constant (-8, 95% CI = -16 to 0, P = 0.05). There was a significant upward trend in the fatality-to-claim ratio post-lockdown (0.001, 95% CI = 0-0.001, P <0.01).

CONCLUSION

Road injury requiring hospitalisation decreased significantly during governmental lockdown and has returned to three-quarters of pre-pandemic levels (except bicyclist injuries that have remained constant), but there is an increasingly disproportionate number of fatalities. This represents a new baseline of injury burden for EDs and hospitals that manage trauma patients.

Adult Mental Health Presentations to Emergency Departments in Victoria, Australia between January 2018 and October 2020: Changes Associated with COVID-19 Pandemic Public Health Restrictions

The COVID-19 pandemic and associated public health measures altered patterns of help-seeking for mental health, with increases in emergency department utilisation reported. We examined the association between COVID-19 restrictions and adult emergency department (ED) mental health presentations in Victoria, Australia, through secondary analysis of data from 39 public EDs across the state. Participants were all patients (18+ years) presenting between 1 January 2018 and 31 October 2020 with mental health or intentional self-harm. The main outcome was number of presentations for each mental health condition, by patient age, socioeconomic status (SES), location, and ED triage category. We used a Poisson regression model to compare predicted monthly ED presentations based on trends from 2018, 2019 and 2020 (up to 31 March), with observed presentations during the initial months of the COVID-19 pandemic (1 April to 31 October 2020). There was an average of 4,967 adult mental health presentations per month pre-COVID-19 (1 January-31 March 2020) and 5,054 per month during the COVID-19 period (1 April-31 October 2020). Compared to predicted incidence, eating disorder presentations increased 24.0% in the COVID-19 period, primarily among higher SES females aged 18-24 years. Developmental/behavioural disorder presentations decreased by 19.7% for all age groups. Pandemic restrictions were associated with overall increases in monthly adult ED presentations for mental health, with some disorders increasing and others decreasing. Accessibility of acute mental health services needs to be addressed to meet changing demand and ensure services are responsive to changes in presentations resulting from future public health challenges.

Services for critical and emergency care of children in Victoria

The population of children requiring intensive care in Victoria has increased and changed markedly since the 1990s, the result of many epidemiological, demographic, and social changes, and this is more evident during and after the Covid pandemic. The model of ultra-centralised paediatric intensive care services in the 1990s is not sufficient for the current era, and services are under daily pressure. Solutions will take time and need to be wide-ranging, including increased critical care capacity in selected regional centres, decentralisation of some services for low-risk conditions, improvements and reforms in medical and nursing education, pre-service and post-graduate, including for other acute care disciplines and for general practitioners and a more structured state-wide paediatric system. The effects of changes in disease patterns, social trends and health practice should inform the design of an expanded model of critical and emergency care for children in Victoria that is more fit for purpose in the remainder of this decade and beyond.

Healthy together Victoria and childhood obesity study: effects of a large scale, community-based cluster randomised trial of a systems thinking approach for the prevention of childhood obesity among secondary school students 2014-2016

BACKGROUND

Healthy Together Victoria (HTV) was a Victorian Government initiative that sought to reduce the prevalence of overweight and obesity through targeting chronic disease risk factors including physical activity, poor diet quality, smoking, and harmful alcohol use. The intervention involved a boosted workforce of > 170 local-level staff in 12 communities; employed to deliver system activation around health and wellbeing for individuals, families and communities. A cluster randomised trial (CRT) of a systems thinking approach to obesity prevention was embedded within HTV. We present the two-year changes in overweight and obesity and associated behaviours among secondary school students across Victoria, Australia.

METHODS

Twenty-three geographically bounded areas were randomised to intervention (12 communities) or comparison (11 communities). Randomly selected secondary schools within each community were invited to participate in the trial in 2014 and 2016. Students in Grade 8 (aged approximately 13-15 years) and Grade 10 (aged approximately 15-16 years) at participating schools were recruited using an opt-out approach across July-September 2014 and 2016. Primary outcomes were body mass index (BMI) and waist circumference. Secondary outcomes were physical activity, sedentary behaviour, diet quality, health-related quality of life, and depressive symptoms. Linear mixed models were fit to estimate the intervention effect adjusting for child/school characteristics.

RESULTS

There were 4242 intervention children and 2999 control children in the final analysis. For boys, the two-year change showed improvement in intervention versus control for waist circumference (difference in change: - 2.5 cm; 95% confidence interval [CI]: - 4.6, - 0.5) and consumption of sugar-sweetened beverages per day (< 1 serve: 8.5 percentage points; 95% CI: 0.6, 16.5). For girls, there were no statistically significant differences between conditions.

CONCLUSIONS

HTV seemed to produce favourable changes in waist circumference and sugar-sweetened beverage consumption for boys, however, no effect on BMI was observed. Although the HTV intervention was cut short, and the period between data collection points was relatively short, the changes observed in HTV contribute to the growing evidence of whole-of-community interventions targeting childhood obesity.

TRIAL REGISTRATION

This trial is unregistered. The intervention itself was a policy setting delivered by government and our role was the collection of data to evaluate the effect of this natural experiment. That is, this study was not a trial from the classical point of view and we were not responsible for the intervention.

The effects of diurnal temperature range on mortality and emergency department presentations in Victoria state of Australia: A time-series analysis

State of Victoria, Australia (SVA) has a wide variation of diurnal temperatures (DTR). DTR has been reported to be associated with risk of mortality and morbidity. We examined the association between exposure to DTR and risk of all-cause mortality and emergency department (ED) presentations in the SVA. We obtained data on daily counts of deaths and ED presentations, and weather data from 1 st January 2000─2019. We applied a quasi-Poisson time-series regression analysis to examine the association between daily DTR exposures and risk of mortality and ED presentations. The analyses were queried by age, sex, seasons, ED presentations triages, and departure status. Risk of mortality and ED presentation increased by 0.33% (95% CI: 0.24%-0.43%), and 0.094% (95% CI: 0.077%-0.11%) in relation to one degree increase in the daily DTR. The association between DTR and ED presentations was stronger in children (0-15 years) (0.38% [95% CI: 0.34%-0.42%]) and the elderly (75+ years) (0.34% [95% CI: 0.29%-0.39%]). Resuscitation, which was consistently accounted for the highest vulnerability to DTR variation, increased by 0.79% (95% CI: 0.60%-0.99%). This study suggests that the risk of mortality and ED presentations associates with the increase of DTR. Children, the elderly, and their caregivers need to be made aware of the health risk posed by DTR.

Comparing Voluntary Assisted Dying Laws in Victoria and Western Australia: Western Australian Stakeholders' Perspectives

In 2021, two years after voluntary assisted dying (VAD) laws commenced in Victoria, Western Australia (WA) was the second Australian jurisdiction to permit VAD. While the two regimes are broadly similar, key differences exist. This article reports on findings from a qualitative study of WA participants with VAD experience across four stakeholder groups (patients and families; health practitioners; regulators and VAD system personnel; and health and professional organisation representatives), focusing particularly on participants' reflections on aspects of the WA VAD regime which differs from that in Victoria and the practical implications of those differences. Globally, participants viewed VAD as operating smoothly in Western Australia and, despite identifying some areas for improvement, that WA's model was more functional and accessible than Victoria's. By comparing two different VAD models, this article's findings add to growing empirical evidence about VAD in Australia and can inform future VAD reforms and reviews.

Diet-Related Disease Prevention in a Rural Australian Setting: Understanding Barriers, Enablers, and the Role of Rural Health Services in Supporting Changes in Local Rural Food Environments

Bold and comprehensive action is needed to prevent diet-related diseases in rural areas, which includes improving food environments to enable healthier dietary practices. Rural health services are integral to the health of rural populations, yet their role in community disease prevention is not swell understood. This study sought to understand health service, local government, and food outlet stakeholders' perspectives on (1) the drivers of unhealthy retail environments in a rural setting; (2) the role of rural health services in supporting changes in local food environments; and to (3) identify characteristics of potential interventions. Two Group Model Building workshops were held with health service and local government leaders (n = 9), and interviews were conducted with local food outlet participants (n = 13). Key themes included 'enablers to healthier food environments', 'barriers to healthier food environments', 'Rural health services are a leading broker of knowledge for healthy food environments', and 'characteristics of desirable healthy food environment interventions.'. Rural health services can play a key role in addressing the current barriers to healthy food environments in rural areas. Effective promotion of healthier diets in rural populations will require consideration of key stakeholder perspectives and the development of further evidence on the role that rural health services can play in improving the healthiness of food environments.

Mental health emergency presentations across the Barwon South West region in Victoria, Australia: An epidemiological investigation

OBJECTIVE

To examine mental health emergency presentations across the Barwon South West, Victoria, Australia - an area comprising a range of urban and rural localities.

METHODS

This is a retrospective synthesis of mental health emergency presentations across the Barwon South West (1 February 2017-31 December 2019). De-identified data were obtained from individuals who presented to EDs and urgent care centres (UCCs) within the study region, who had a principal diagnosis of a Mental and Behavioural Disorder (codes F00-F99). Data were sourced from the Victorian Emergency Minimum Dataset and Rural Acute Hospital Database Register (RAHDaR). Age-standardised incident rates for mental health emergency presentations were calculated for the whole sample and for local government areas. Data on usual accommodation, arrival transport mode, referral source, patient disposition and length of ED/UCC stay were also obtained.

RESULTS

We identified 11 613 mental health emergency presentations, with neurotic, stress-related and somatoform disorders (n = 3139, 27.0%) and mental and behavioural disorders due to psychoactive substance use (n = 3487, 30.0%) being the most frequent types of presentations recorded. The highest age-standardised incidence rates (mental health diagnosis per 1000 population/year) were in Glenelg (13.95), whereas Queenscliffe had the lowest incident rates (3.76). Most presentations (n = 3851, 33.2%) tended to occur for individuals aged between 15 and 29 years.

CONCLUSIONS

Neurotic, stress-related and somatoform disorders and mental and behavioural disorders due to psychoactive substance use were the most frequent types of presentations recorded across the sample. RAHDaR represented a small but meaningful contribution to the data.

When policy hits the road: Safe System in Victoria's policy environment

The Safe System approach has globally become the dominant means to address road trauma, with bodies such as the Organisation for Economic Co-operation and Development, European Union, World Bank, World Health Organization, National and State Australian Governments and the United Nations encouraging its uptake. However, whilst there has been significant growth in its application, limited attention has been paid to the extent to which Safe System is integrated into public policy. Anecdotally, as an early adopter of the Safe System approach, Victoria's experience acts an instructive case for other jurisdictions applying the concept to policy. Using an interpretive qualitative case study approach, this study explored whether a) Safe System has influenced Victoria's road safety policy development to date, and b) if the extent to which Safe System has been integrated into public policy. Semi-structured interviews were conducted with Victoria's strategic, government-based, road safety decision-makers. Interviews were structured around the World Health Organization's Policy Development Process framework. The results indicate that Safe System has an implicit role in Victoria's road safety policy. When viewed through the lens of a policy integration framework, the analysis found only partial integration of the Safe System concept within road safety policy in Victoria, with limited flow-on effects of the framework on the policy frame, subsystems, goals and instruments. Governance frameworks, management structures and policy objectives are all influenced by Safe System, with the road safety problem having clearly been established as a cross-cutting issue. However, additional refinement of policy instruments to articulate the role of Safe System as well actively employing the approach in the policy development process is required. These findings confirm that while Victoria's use of Safe System is noteworthy, it may be beneficial for the framework to feature more prominently in policy for it to have the intended effect on road safety.

Twenty years of melanoma in Victoria, Queensland, and South Australia (1997 - 2016)

BACKGROUND

Given the high incidence of melanoma in Australia alongside high mortality with later stage disease, we investigated the populations and locations most at risk, to optimise public health activities in areas where intervention is most needed. This study examines trends and identifies significant prognostic factors and potential disparities in incidence, mortality and survival between population groups in Victoria, Queensland and South Australia.

METHODS

The analysis includes data from the population-based cancer registries of the three states over a twenty-year period (1997-2016). Age-standardized and age-specific incidence rates were calculated, and long-term trends analysed using Joinpoint Regression. Five-year relative survival estimates for the study population were calculated using the cohort method and multivariable flexible parametric survival models were applied for each jurisdiction to calculate adjusted excess mortality hazard ratios for the key characteristics.

RESULTS

There were more males with melanoma than females in all the three states. Over 60% of the cases occurred in the 40-74 years age group. Most melanomas had a Breslow thickness less than or equal to 1.0 mm. For males, Victoria and Queensland had a statistically significant increasing trend whereas in South Australia there was a decreasing trend. For females, the incidence rate trend was stable in Victoria but significantly decreasing in South Australia. In Queensland there was an increasing and statistically significant trend from 2006 to 2016. Across all three states there was a reducing incidence rate in the youngest cohort, stabilizing incidence in the 40-59-year-old age group, and increasing in the oldest cohorts. Five-year relative survival decreased with increasing age and with Breslow thickness across all three jurisdictions. Males had between 43%- 46% excess mortality compared to females in all the three states. There was higher risk with increasing age and Breslow thickness, with the largest risk among the 75 + age group and those with a Breslow thickness of > 4 mm.

CONCLUSION

It is the first time that data from these three registries has been analysed together in a uniform way, covering more than half of the Australian population. This study compares the epidemiology of melanoma across three states and provides a better understanding of trends and factors affecting outcome for Australians with melanoma. While there has been some improvement in aspects of incidence and mortality, this has not been evenly achieved across Australia.

Dataset for the Victorian energy transition including technical, social, economic, and environmental detail

This data relates to existing and planned electricity generation projects in Victoria, Australia. Planning Victoria, part of the Victorian Government, registered most projects. The technical performance data for the projects includes the electricity generated, input fuel, losses in the transmission of electricity, energy storage options, and transparency between grid operators and stakeholders. The social data related to the projects include health data for the effect of Victorian coal plant pollution, including a rich dataset on the health effects of a coal fire in (Jennens, 2021). A dataset for all the health effects of coal plants in Victoria was then compiled. The social data also includes a measure of customer engagement with electricity distribution companies in Victoria and public satisfaction with renewable projects in Victoria. The economic cost data includes capital costs, operation and maintenance costs, and externality costs related to greenhouse gasses emitted. The environmental data used a life cycle assessment and the critical materials needed for the electricity generation projects. The analysis performed was an nBL assessment (Foliente, 2007) which uses a comparative analysis of the four bottom lines (environmental, social, economic and technology). An nBL assessment is similar to a Triple Bottom Line assessment but includes additional parameters. The data used for this nBL analysis was for three scenarios (business as usual, a renewable generation future with electricity imported from other states and a renewable generation future with all electricity generated in Victoria). The first step in managing the raw data was to normalise, standardise and aggregate the data. These steps were done for the four bottom lines and the three scenarios. The reuse potential of this data is high as it is for a pipeline of projects that will continue to evolve. This data would also have the potential for other researchers to compare the Victorian electricity transition with other places internationally.

Mental health consequences of COVID-19 suppression strategies in Victoria, Australia: a narrative review

The COVID-19 pandemic has imposed significant mental health burdens upon the general population worldwide, either directly owing to the disease or indirectly through aggressive public health measures to control spread of the virus that causes COVID-19. In this narrative review, we used a systematic approach to summarize the impact of restrictive lockdown measures on the general mental health of people living in Victoria, Australia during 2020 and to identify the groups with an increased risk of adverse mental health outcomes. A systematic database search (Ovid Medline, PsycINFO, Embase) for articles examining the mental health of Victorians in the context of the COVID-19 pandemic during 2020 yielded 88 articles, of which 15 articles were finally included in this review. We found that the general mental health of Victorians was negatively affected by COVID-19 restrictions during 2020. Although studies reported heterogeneous mental health outcomes, we found that the general population consistently used coping strategies and demonstrated mental health help-seeking behaviors in response to the restrictions. Women, children, young people, carers, people who became unemployed owing to the pandemic, and those with pre-existing psychiatric conditions had a higher risk of adverse mental health consequences during the COVID-19 pandemic in 2020.

International comparison of injury care structures, processes, and outcomes between integrated trauma systems in Québec, Canada, and Victoria, Australia

BACKGROUND

Quality improvement activities in trauma systems are widely based on comparisons between trauma centers within the same system. Comparisons across different trauma systems may reveal further opportunities for quality improvement.

OBJECTIVES

This study aimed to compare the integrated trauma systems in Québec, Canada and in Victoria, Australia, regarding their structures, care processes and patient outcomes.

METHODOLOGY

The elements recommended by the American College of Surgeons were used to compare trauma systems structures. Comparisons of care processes and patient outcomes were based on data from major trauma admissions extracted from trauma registries (2013 and 2017). Care processes included time to reach a definitive care facility, time spent in the emergency department, and time lapsed before the first head computed tomography (CT) scan. These care processes were compared using a z-test of log-transformed times. Hospital mortality and hospital length of stay (LOS) were compared using indirect standardization based on multiple logistic and linear regression.

RESULTS

Major differences in trauma system structure were Advanced Trauma Life Support at the scene of injury (Victoria), the use of validated prehospital triage tools (Québec), and mandatory accreditation of all trauma centers (Québec). Patients in Québec arrived at their definitive care hospital earlier than their counterparts in Victoria (median: 1.93 vs. 2.13 h, p = 0.002), but spent longer in the emergency department (median: 8.23 vs. 5.15 h, p<0.0001) and waited longer before having their first head CT (median: 1.90 vs. 1.52 h, p<0.0001). In-hospital mortality and hospital LOS were higher in Québec than in Victoria (standardized mortality ratio: 1.15, 95% CI: 1.09 - 1.20; standardized LOS ratio: 1.10, 95% CI: 1.09 - 1.11).

CONCLUSION

We observed important differences in the structural components and care processes in Québec and Victoria's trauma systems, which might explain some of the observed differences in patient outcomes. This study shows the potential value of international comparisons in trauma care and identifies possible opportunities for quality improvement.

Revised Species Delimitation in the Giant Water Lily Genus Victoria (Nymphaeaceae) Confirms a New Species and Has Implications for Its Conservation

Reliably documenting plant diversity is necessary to protect and sustainably benefit from it. At the heart of this documentation lie species concepts and the practical methods used to delimit taxa. Here, we apply a total-evidence, iterative methodology to delimit and document species in the South American genus Victoria (Nymphaeaceae). The systematics of Victoria has thus far been poorly characterized due to difficulty in attributing species identities to biological collections. This research gap stems from an absence of type material and biological collections, also the confused diagnosis of V. cruziana. With the goal of improving systematic knowledge of the genus, we compiled information from historical records, horticulture and geography and assembled a morphological dataset using citizen science and specimens from herbaria and living collections. Finally, we generated genomic data from a subset of these specimens. Morphological and geographical observations suggest four putative species, three of which are supported by nuclear population genomic and plastid phylogenomic inferences. We propose these three confirmed entities as robust species, where two correspond to the currently recognized V. amazonica and V. cruziana, the third being new to science, which we describe, diagnose and name here as V. boliviana Magdalena and L. T. Sm. Importantly, we identify new morphological and molecular characters which serve to distinguish the species and underpin their delimitations. Our study demonstrates how combining different types of character data into a heuristic, total-evidence approach can enhance the reliability with which biological diversity of morphologically challenging groups can be identified, documented and further studied.

Food system policy making and innovation at the local level: Exploring the response of Australian local governments to critical food systems issues

ISSUES ADDRESSED

Urgent action is required by all levels of government to create a food system capable of nourishing a rapidly growing population while remaining within planetary boundaries. This study investigated policies and programs implemented by Australian local governments (LGs) that aim to contribute to a healthy, sustainable and equitable food system.

METHODS

An online survey was completed by LGs (n = 64) in New South Wales and Victoria, Australia. Questions focused on LGs' food system-related policies and programs, barriers to and enablers of engaging in food system work and organisational responsibilities for food system work.

RESULTS

Preventing food waste, organising food-related social/cultural events and providing potable water were the most commonly reported activities. Few LGs reported policies/activities on market gardening or sustainable agricultural practices, or strengthening food system resilience. LGs implemented a wide range of initiatives, such as hosting food forums, using research to identify and address food access issues and providing healthy food and drink options within LG-owned/managed facilities. Enablers of food system work included internal LG support, human resources, external funding and partnerships. Barriers included lack of community interest, short-term and/or project-based funding, internal governance issues and restrictive state government planning frameworks.

CONCLUSION

Australian LGs undertake a wide range of actions addressing diverse food system issues; however, internal and external barriers constrain their involvement in creating a healthy, sustainable and equitable food system. SO WHAT?: Legislative reform, combined with increased financial and human resource capacity, would support LGs to expand, strengthen and sustain their food system work.

Using ordered and unordered logistic regressions to investigate risk factors associated with pedestrian crash injury severity in Victoria, Australia

INTRODUCTION

The safety of pedestrians is a major concern in Victoria, Australia. Despite the considerable number of pedestrian fatalities and injuries in traffic crashes, a limited number of studies focused on pedestrian crash severity in Victoria.

METHODS

This study investigates and identifies the influential factors determining the severity of pedestrian injuries in traffic crashes in Victoria by using crash data from 2010 to 2019. An unordered multinomial logit model and an ordered logit model are developed for this purpose.

RESULTS

The results indicate that pedestrian crashes on weekends, in the period of 10 a.m. to 10 p.m., on dark streets, at intersections, in areas with a speed limit above 50 km/h, and on medians or footpaths are associated with a higher probability of severe and fatal injuries. Male pedestrians, children, and older adults (>59) were more likely to sustain a higher level of injury in crashes. Concerning the driver characteristics, no significant relationship was found between pedestrian injury severity and driver gender and license status, but older drivers were more likely to cause severe and fatal injuries. Pedestrian collisions with motorcycles, heavy vehicles, light commercial vehicles, bus/minibus/coach, and trams increase the probability of more severe injuries compared to cars. Moreover, older vehicles are associated with a higher probability of severe pedestrian injuries. Comparison of the model results illustrated that the MNL model was slightly better fitted on the data than the ordered logit model, but the conclusions inferred from these two models were generally similar.

PRACTICAL APPLICATION

To reduce the injuries of pedestrian crashes, we recommend improving lighting conditions and sidewalk design, implementing speed reduction strategies at high pedestrian activity areas, introducing more pedestrian crossings at midblock, installing warning signs to drivers, and discouraging the use of vehicles that are more than 20 years old.

Needle and Syringe Programs in Prisons: Victoria's "Problematic" Policy Position

With high rates of blood-borne virus infection in Australian prisons, a needle and syringe program (NSP) stands ready to deliver similar benefits to its community counterpart. Supplying sterile injecting equipment and safe-use guidance in prisons could improve prisoner health outcomes and the safety of the corrections system. Yet, despite the protestations of public health experts and the recommendations of State, national, and international bodies, Australian States and Territories refuse to implement prison-based NSPs, with serious consequences for prisoner health. This article focuses on the Australian State of Victoria as a case study representative of other jurisdictions. Victoria's inaction is arguably in breach of international standards and the Victorian Charter of Human Rights and Responsibilities, but less likely to constitute a breach of the common law duty of care. Undertaking a legal analysis of these areas, this article examines the potential of each area to support the case for reform of the Victorian Government's policy on a prison-based NSP. Looking ahead, this article suggests reforms to ensure the proper functioning and administration of prison NSPs.

The ingestion of large plastics by recreationally caught southern bluefin tuna Thunnus maccoyii off southern Australia

The occurrence of plastic ingestion by fish is increasing around the world, however there are currently very few studies focusing on the ingestion of macro (>20 mm) and mega (>100 mm) plastics in pelagic predatory fish, particularly in Australian waters. Further to this, information on plastic ingestion in recreationally caught fish is deficient. We report on two cases of macroplastic ingestion and another case of megaplastic ingestion by southern bluefin tuna Thunnus maccoyii (Castelnau, 1872), caught recreationally in Tasmania and Victoria. The plastics ingested ranged from 62 to 283 mm. Despite the large obstructive shapes of the pieces of plastic, all three specimens possessed a healthy body mass, with one actively feeding at the time of capture. These preliminary records contribute to the limited information on the effects of plastic pollution on high value recreationally and commercially important pelagic fish in Australia.

Differences in Uveal Melanoma Age-Standardized Incidence Rates in Two Eastern States of Australia Are Driven by Differences in Rurality and Ultraviolet Radiation

Uveal melanoma (UM) is the second-most-common melanoma in humans and has a high age-standardized incidence rate (ASR) in Australia. Regional patterns of UM ASRs in Australia are unknown. The aim of this study was to determine and compare UM ASRs in two geographically disparate eastern states, Queensland (QLD) and Victoria (VIC), by using cancer registry data that was obtained from 2001 to 2013. World-standardized UM ASRs and incidence-rate ratios (IRRs) were calculated. Higher UM ASR was also observed in anterior UM compared to posterior UM ASR. UM ASR remained unchanged from 2001 to 2013 in QLD but decreased in VIC. A south-to-north latitude trend in UM ASR along the east of Australia is weakly evident, and rural populations have higher UM ASRs than major city populations in both states. Differences in ultraviolent radiation (UVR) susceptibility, indigenous populations, social behaviours, chemical exposure, and socioeconomic status could all be contributing to differences in UM rates between QLD and VIC and between rural compared to major city areas. It is possible that a minority of cases in QLD and VIC might be prevented by sun-protective behaviours. This is important, because these findings suggest that QLD, which is already known to have one of the highest cutaneous melanoma (CM) ASRs in the world, also has one of the highest UM ASRs.

Consumers' experiences of rights-based mental health laws: Lessons from Victoria, Australia

Many countries embarked on reforms of mental health law in the wake of the Convention on the Rights of Persons with Disabilities. These reforms have had varying levels of success. This paper considers the experience of consumers in the Victorian mental health system, drawing on an evaluation that asked consumers and clinicians about their knowledge and experience of rights under the Victorian Mental Health Act, 2014. The data show that consumers were not informed of their rights, were not involved in decisions about treatment, were not able to access safeguards, and could not exercise their rights. The explanations for this include limited staff time, unclear delegations of responsibility, a lack of knowledge, training, and support for rights, and a preference for 'best interests' approaches. The paper identifies tangible reforms that would maintain rights for consumers, including competent refusal of treatment, legislative and regulatory reforms, and training and resourcing. Consumers in this study found that the rights-based framework in the Mental Health Act, 2014 had such an insignificant effect on clinical mental health practice in Victoria that their rights appeared to be illusory.

An Australian collector's authority file, 1973-2020

Background

Biodiversity databases contain omissions and errors, including those resulting from data entry mistakes and from the use of outdated or incorrect data sources. Some of these omissions and errors can be minimised by the use of authority files, such as expert-compiled taxonomic name databases. However, there are few publicly available authority files for collecting events, and the "where", "when" and "by whom" of specimen data are typically entered into biodiversity databases separately and directly, item by item from specimen labels.

New information

Here I describe a publicly available compilation of 3829 of my own collecting events over a 48-year period in Australia. Each record contains a unique combination of date, georeferenced location and location notes.

Collaborative Social-Epidemiology: A Co-analysis of the Cultural and Structural Determinants of Health for Aboriginal Youth in Victorian Schools

Social-epidemiology that excludes Aboriginal voices often fails to capture the full and complex social worlds of Aboriginal people. Using data from an existing co-designed Victorian government Adolescent Health and Wellbeing Survey (2008/9), we worked with Aboriginal organizations to identify data priorities, select measures, interpret data, and contextualize findings. Using this participatory co-analysis approach, we selected "cultural" and "structural" determinants identified by Aboriginal organizations as important and modelled these using principal component analysis. Resulting components were then modelled using logistic regression to investigate associations with "likely being well" (Kessler-10 score < 20) for 88 Aboriginal adolescents aged 11-17 years. Principal component analysis grouped 11 structural variables into four components and 11 cultural variables into three components. Of these, "grew up in Aboriginal family/community and connected" associated with significantly higher odds of "likely being well" (OR = 2.26 (1.01-5.06), p = 0.046). Conversely, "institutionally imposed family displacement" had significantly lower odds (OR = 0.49 (0.24-0.97), p = 0.040) and "negative police contact and poverty" non-significantly lower odds (OR = 0.53 (0.26-1.06), p = 0.073) for "likely being well". Using a co-analysis participatory approach, the voices of Aboriginal researchers and Aboriginal organizations were able to construct a social world that aligned with their ways of knowing, doing, and being. Findings highlighted institutionally imposed family displacement, policing, and poverty as social sites for health intervention and emphasized the importance of strong Aboriginal families for adolescents.

Mental health, substance use, and suicidal ideation during a prolonged COVID-19-related lockdown in a region with low SARS-CoV-2 prevalence

The coronavirus disease 2019 (COVID-19) pandemic has been associated with mental health consequences due to direct (i.e., SARS-CoV-2 infection, potentially due to neuronal or astrocytic infection, microvascular, or inflammatory mechanisms) and indirect (i.e., social and economic impacts of COVID-19 prevention measures) effects. Investigation of mental health in a region with one of the longest lockdowns and lowest COVID-19 prevalence globally (Victoria, Australia) allowed for evaluation of mental health in the absence of substantial direct pandemic mental health consequences. Surveys were administered during 15-24 September 2020 to Victorian residents aged ≥18 years for The COVID-19 Outbreak Public Evaluation (COPE) Initiative. Responses were compared cross-sectionally with April-2020 data, and longitudinally among respondents who completed both surveys. Multivariable Poisson regressions were used to estimate prevalence ratios for adverse mental health symptoms, substance use, and suicidal ideation adjusted for demographics, sleep, and behaviours (e.g., screen-time, outdoor-time). In September-2020, among 1157 Victorians, one-third reported anxiety or depressive disorder symptoms, one-fifth reported suicidal ideation, and one-tenth reported having seriously considered suicide in the prior 30 days. Young adults, unpaid caregivers, people with disabilities, and people with diagnosed psychiatric or sleep conditions showed increased prevalence of adverse mental health symptoms. Prevalence estimates of symptoms of burnout, anxiety, and depressive disorder were unchanged between April-2020 and September-2020. Persistently common experiences of adverse mental health symptoms despite low SARS-CoV-2 prevalence during prolonged lockdown highlight the urgent need for mental health support services.

An Outbreak of Highly Pathogenic Avian Influenza (H7N7) in Australia and the Potential for Novel Influenza A Viruses to Emerge

In 2020, several geographically isolated farms in Victoria, Australia, experienced an outbreak of highly pathogenic avian influenza (HPAI) virus H7N7 and low pathogenic avian influenza (LPAI) viruses H5N2 and H7N6. Effective containment and control measures ensured the eradication of these viruses but the event culminated in substantial loss of livestock and significant economic impact. The avian HPAI H7N7 virus generally does not infect humans; however, evidence shows the ocular pathway presents a favourable tissue tropism for human infection. Through antigenic drift, mutations in the H7N7 viral genome may increase virulence and pathogenicity in humans. The Victorian outbreak also detected LPAI H7N6 in emus at a commercial farm. Novel influenza A viruses can emerge by mixing different viral strains in a host susceptible to avian and human influenza strains. Studies show that emus are susceptible to infections from a wide range of influenza viral subtypes, including H5N1 and the pandemic H1N1. The emu’s internal organs and tissues express abundant cell surface sialic acid receptors that favour the attachment of avian and human influenza viruses, increasing the potential for internal genetic reassortment and the emergence of novel influenza A viruses. This review summarises the historical context of H7N7 in Australia, considers the potential for increased virulence and pathogenesis through mutations and draws attention to the emu as potentially an unrecognised viral mixing vessel.

Clinical manifestations of invasive meningococcal disease in Victoria with the emergence of serogroup W and serogroup Y Neisseria meningitidis

BACKGROUND

Historically, Australian cases of invasive meningococcal disease (IMD) have been most frequently caused by Neisseria meningitidis serogroup B, but recently an increase in cases due to serogroup W (MenW) and serogroup Y (MenY) has occurred.

AIM

To determine whether clinical manifestations of IMD have changed due to increased incidence of MenW and MenY.

METHODS

We performed a retrospective review of IMD cases notified to the Department of Health and Human Services in Victoria, Australia. We compared the period between January 2013 and June 2015 (defined as P1) immediately before the increase in MenW and MenY was noted, with the equal time period of July 2015 to December 2017 (P2), when this increase was observed.

RESULTS

IMD was notified more frequently in P2 than P1 (1.24 vs 0.53 per 100 000 person-years, P < 0.001). IMD cases in P2 were older (46 vs 19 years, P < 0.001), and more likely due to MenW (92/187, 49.2% vs 11/80, 13.8%, P < 0.001) or MenY (31/187, 16.6% vs 4/80, 5.0%, P = 0.01). IMD cases from P2 were more likely bacteraemic (151/187, 80.7% vs 55/80, 68.8%, P = 0.04), while meningitis (68/187, 36.4% vs 41/80, 51.3%, P = 0.03) and rash (65/181, 35.9% vs 45/78, 57.7%, P = 0.002) were less frequent. Intensive care unit admission rates and in-hospital mortality were unchanged.

CONCLUSION

Alongside an increase in IMD in Victoria, the proliferation of cases of MenW and MenY occurred in older patients, and were more often identified through bacteraemia rather than meningitis or purpura fulminans. Clinicians should be aware of these changes to facilitate earlier identification and treatment of IMD.

Environmental impacts of COVID-19 on Victoria, Australia, witnessed two waves of Coronavirus

The COVID-19 pandemic not only has created a global health crisis but also has dramatic effects on the environment. To fight the spread of Coronavirus, governments imposed social distancing policies, which caused negative and positive impacts on the environment. Victoria, the second-most populated state in Australia, was hit by two waves of COVID-19. During the second wave of the pandemic, Victoria, especially Melbourne, experienced one of the most stringent and longest lockdowns globally. In this study, the changes in mobility trends, traffic, air pollution, noise pollution, and waste generation during the first and second waves of COVID-19 in Victoria are evaluated and compared. It was observed that the pandemic had both positive and negative impacts on the environment. During the second wave of the pandemic in Victoria, the mobility trends of public transport hubs, retail and recreation venues, and workplaces experienced a significant drop in movements at respective values of 85%, 83%, and 76% compared to the period of 5 weeks from 3 January to 6 February 2020. PM_2.5 levels were lower by 23% at Alphington and 24% at Footscray from 16 March to 1 May 2020 compared with the average PM_2.5 levels in the past 4 years. It was estimated that the respective daily generations of used face masks during the first wave and second wave of the pandemic in Victoria were approximately 104 and 160 tons.

Facilitators to healthy canteen policy implementation: A qualitative approach

ISSUE ADDRESSED

Governments across the world use guidelines and policy to support improving the quality and nutrition in school canteens, yet little is known about what makes for success in supporting school canteens. This study aimed to investigate the factors influencing the implementation of a healthy school canteen policy.

METHODS

A qualitative descriptive approach using interviews with a purposive sample of Victorian schools that had successfully implemented a healthy school canteen was conducted. Twelve interviews were conducted with principals (n = 4), assistant principal (n = 1), canteen managers (n = 5), food services manager (n = 1) and canteen staff members (n = 3) across six Victorian schools. Data were analysed using a content analysis approach.

RESULTS

Three key themes explained the adoption of policy: Values - emphasising service over profit; Knowledge - understanding of nutrition and the policy; and Support - from within and external to the school.

CONCLUSIONS

Implementation of school canteen policy is more likely to be achieved when a school can focus on the service and educative component of the policy and where there is a shared priority for healthy eating across the entire school community. SO WHAT?: Creating a culture of service and community engagement with a healthy school canteen may increase policy implementation and should be the focus of future health promotion efforts.

An idiopathic upper alimentary tract ulcerative syndrome in weaned dairy calves in Victoria, Australia

An idiopathic clinical syndrome had been described in weaned dairy calves in the state of Victoria, Australia, where affected animals presented with diarrhoea, ill-thrift, enteritis and ulceration of the upper alimentary tract, with occasional oral/nasal ulcers. Between 7 November 2016 and 31 March 2019, 34 Victorian cattle herds were investigated, after each reported five or more weaned calves with diarrhoea and/or ill-thrift, or at least one calf with oral/nasal ulceration. Primary study objectives included the development of a detailed case definition for the clinical syndrome, termed upper alimentary tract ulcerative syndrome (UAUS) and the identification of potential causative virus(es) using metagenomics. A diagnosis of UAUS could not be made based solely on clinical signs and required histopathological assessment of post-mortem samples. Specifically, this included the identification of multifocal to coalescing areas of mucosal epithelial necrosis at all depths of the stratified squamous epithelium of the oesophagus, along with exclusion of bovine viral diarrhoea virus. Based on this case definition, twelve herds were diagnosed with clinical UAUS across the three dairying regions of Victoria, while thirteen were ruled UAUS-negative. The status of the nine remaining herds was unresolved due to a lack of required post-mortem samples. Metatranscriptomic analysis on oral swabs and oesopharyngeal samples from confirmed UAUS cases did not detect a virus common to the cross-sectional sample collection.

Voluntary assisted dying in Victoria: Why knowing the law matters to nurses

In 2017, Victoria became the first state in Australia to pass legislation permitting voluntary assisted dying. Under this law, only those people who are near the end of their lives may access voluntary assisted dying, and because many of these people require nursing care to manage the progression of their illness or their symptoms, it will invariably have an impact on nursing practice. The Victorian law includes a series of procedural steps as safeguards to ensure that the law operates as intended. To support people who choose voluntary assisted dying and to practice safely within boundaries of the law, nurses must be aware of these requirements and how they operate. However, there are often gaps in nurses' legal knowledge. This was demonstrated in an article that aimed to inform nurses about the operation of Voluntary Assisted Dying Act 2017 (Vic) but contained several errors and misstatements of the law. Our article corrects these errors and discusses how the law is intended to be applied by revisiting the fictional case of Chloe - a woman with a terminal illness who is seeking voluntary assisted dying. As the Voluntary Assisted Dying Act 2017 (Vic) also protects nurses from liability if they act in accordance with its provisions, we conclude that sound knowledge and understanding of its operation support nurses to provide the safe, comprehensive and compassionate care their patients deserve at the end of life.

Chlamydia psittaci: a suspected cause of reproductive loss in three Victorian horses

Chlamydia psittaci was detected by PCR in the lung and equine foetal membranes of two aborted equine foetuses and one weak foal from two different studs in Victoria, Australia. The abortions occurred in September 2019 in two mares sharing a paddock northeast of Melbourne. The weak foal was born in October 2019 in a similar geographical region and died soon after birth despite receiving veterinary care. The detection of C. psittaci DNA in the lung and equine foetal membranes of the aborted or weak foals and the absence of any other factors that are commonly associated with abortion or neonatal death suggest that this pathogen may be the cause of the reproductive loss. The detection of C. psittaci in these cases is consistent with the recent detection of C. psittaci in association with equine abortion in New South Wales. These cases in Victoria show that C. psittaci, and the zoonotic risk it poses, should be considered in association with equine reproductive loss in other areas of Australia.

Trends in preterm birth in twin pregnancies in Victoria, Australia, 2007-2017

BACKGROUND

Preterm birth is a major cause of perinatal morbidity and mortality worldwide. In many countries, the preterm birth rate in women with a multiple pregnancy is increasing, mostly due to an increase in iatrogenic preterm birth.

AIMS

To investigate trends in preterm birth in twin pregnancies in Victoria, Australia, in relation to maternal and perinatal complications.

MATERIALS AND METHODS

We conducted a retrospective population-based cohort study in all women with a twin pregnancy who delivered at or after 20 weeks of gestation in the state of Victoria, Australia between 2007 and 2017. Annual spontaneous and iatrogenic preterm birth rates were calculated and trends analysed. Incidence of adverse pregnancy outcomes, maternal complications and risk factors for preterm birth were analysed.

RESULTS

We studied 12 757 women with a twin pregnancy. Between 2007 and 2017 the preterm birth rate increased from 641/1231 (52%) to 803/1158 (69%), mainly due to an increase in iatrogenic preterm birth from 342/1231 (28%) to 567/1158 (49%). This was irrespective of the presence of pregnancy complications. Our study showed neither a decrease in perinatal mortality from 28 weeks of gestation nor in preterm average weekly prospective stillbirth risk.

CONCLUSION

Preterm birth rates in twins in Victoria are increasing, mainly driven by an increase in iatrogenic preterm birth. This occurred both in complicated and non-complicated twin pregnancies, and has not been accompanied by reduction in perinatal mortality from 28 weeks.

Findings in cattle consigned to Victorian knackeries between 2009 and 2018

OBJECTIVE

To describe the causes of death or culling in cattle in Victoria, Australia, through surveillance at knackeries.

METHODS

Data were collected from 2797 adult cattle consigned to four Victorian knackeries over a 10-year period (2009-2018, inclusive). Cattle were sampled either at the point of collection or at a knackery. A single best-fit diagnosis was assigned to each case to describe the cause of loss.

RESULTS

Sampled cattle were predominantly female dairy cattle originating from the three main dairying regions in Victoria. The most commonly diagnosed conditions were calving paralysis (6.8%), followed by mastitis (6.4%), hypocalcaemia (6.4%) and dystocia (5.9%). "Unknown" accounted for 24.2% of the cattle examined.

CONCLUSION

This study provides a unique insight into the causes of death and culling in cattle consigned to Victorian knackeries. The periparturient period was identified as a high risk period for knackery consignment in adult female cattle.

Hip fractures in patients with chronic kidney disease admitted to Victorian hospitals

There is a paucity of epidemiological data in Australia on fracture rates in patients with chronic kidney disease (CKD). Using data from the Victorian Admitted Episodes Dataset, we assessed the incidence of hip fractures requiring hospitalisation between 2006 and 2015, comparing those coded with and without the co-morbidity CKD. ICD-9 and ICD-10 codes were used to determine hip fractures and comorbidities. Overall, 7.4% of 77 076 Victorian hospital admissions for hip fractures had CKD as a co-morbidity, with an increasing proportion over the study period. Mortality was significantly higher in the CKD cohort compared to no CKD, perhaps in part due to increased associated comorbidities of diabetes and ischaemic heart disease.

Circulation of Influenza Type B Lineages in Greece During 2005-2015 and Estimation of Their Impact

The past decades influenza B lineages Victoria and Yamagata cocirculated. Our aim was to estimate the distribution of the two lineages circulating in Greece and any possible mismatching with vaccine influenza B strains. We studied 490 laboratory-confirmed influenza B nonsevere acute respiratory infection (non-SARI) cases diagnosed in the two National Influenza Reference Laboratories by reverse transcriptase polymerase chain reaction from July 1, 2005 to June 30, 2015 and 100 influenza B SARI cases diagnosed from July 1, 2011 to June 30, 2015. Median matching between the circulating influenza B lineages and the vaccine influenza B strains was 19.2% (range: 0-100%) for non-SARI cases during 2005-2015 and 67.6% (range: 41.2-94.1%) for SARI cases during 2011-2015. In two influenza seasons (2005-2006 and 2006-2007), complete lineage mismatch between influenza B non-SARI cases and influenza B vaccine strains was found. We estimated that 5, 12, or 16 laboratory-confirmed SARI cases could have been prevented by quadrivalent influenza inactivated vaccine (QIV) during the 2011-2012 season and 1, 2, or 3 SARI cases during the 2014-2015 season, with a vaccination coverage rate of 70% and a vaccine effectiveness of 20%, 50%, or 70%, respectively. Significant cocirculation of Victoria and Yamagata B strains and mismatching with vaccine influenza B strains were found during 2005-2015 in Greece. The wide use of a QIV instead of a TIV will confer additional immunity and therefore protection against influenza B, and it is expected to prevent several SARI cases annually. Our findings strongly support the recommendations for using QIV.

Influenza B viral load analysis in patients with acute respiratory infection from a tertiary hospital in Brazil

Currently, 2 genotypes of Influenza B viruses (IFB) are cocirculating in humans: Victoria (VIC) and Yamagata (YAM). Infection and viral load (VL) were analyzed in 105 genotyped IFB (59 VIC and 46 YAM) out of 3452 respiratory samples from immunodepressed (ID), immunocompetent (IC) including outpatients (OP) and hospitalized patients (HP) attended during 2001-2013 at São Paulo Hospital. VL (Log₁₀ RNA copies/mL) calculation was possible in 78 samples (47 VIC, 31 YAM). The age group of 12 to 18 years presented the highest detection (14.13%). Rates of infection among groups were of 3.67% (IC), 1.68% (ID), 3.50% (OP), 0.6% (HP), and VLs varied from 2.8 to 10.13 with no difference regarding age, immune status, and disease severity. From 10 OP vaccinated against influenza, 8 (7 children, 1 ID) received a matching strain shot (VIC), and 2 a monovalent influenza A H1N1pdm09. Those patients presented a VL of 6.31 ± 1.62 (mean ± SD). IFB infection rates follow an age pattern, but VL seems not to be related to frequency or clinical outcome. IFB patients with previous immunization could point to some protection for VIC infections since there was no HP. Other immunological aspects, such as lineage infection immune priming, previous infections, and vaccinations, should be further investigated.

High-Throughput MicroRNA Profiles of Permissive Madin-Darby Canine Kidney Cell Line Infected with Influenza B Viruses

Victoria and Yamagata lineages of influenza B viruses are globally circulating in seasonal epidemics. Madin–Darby canine kidney (MDCK) cells are permissive for viral isolation and vaccine manufacture. Nevertheless, the interplay between influenza B viruses and host microRNAs has not been investigated in this cell line. Therefore, the present study aims at high-throughput analysis of canine microRNA profile upon infection of influenza B viruses. Briefly, MDCK cells were infected with Victoria or Yamagata lineage at MOI of 0.01. After being harvested at 6, 12 and 24 h post infection, microRNAs were subjected to high-throughput sequencing based on MiSeq platform (Illumina). The results demonstrated that five microRNAs including cfa-miR-197, cfa-miR-215, cfa-miR361, cfa-miR-1841, and cfa-miR-1842 were overexpressed in both Victoria and Yamagata lineage infections. Interestingly, computational prediction showed that karyopherin alpha 6 (KPNA6) was targeted by cfa-miR-197 and cfa-miR-215. Moreover, the binding sites of both microRNAs were assessed by 3′-UTR reporter assay. The results showed that only cfa-miR-197 could bind to the target sites of KPNA6, leading to suppressing luciferase activity. Additionally, silencing of KPNA6 was confirmed by overexpression of cfa-miR-197. This study provides canine microRNA responses to seasonal influenza B viruses, suggesting that virus-mediated microRNAs might play crucial roles in host gene regulation.

The Epidemiology and Burden of Influenza B/Victoria and B/Yamagata Lineages in Kenya, 2012-2016

Background

The impact of influenza B virus circulation in Sub-Saharan Africa is not well described.

Methods

We analyzed data from acute respiratory illness (ARI) in Kenya. We assessed clinical features and age-specific hospitalization and outpatient visit rates by person-years for influenza B/Victoria and B/Yamagata and the extent to which circulating influenza B lineages in Kenya matched the vaccine strain component of the corresponding season (based on Northern Hemisphere [October–March] and Southern Hemisphere [April–September] vaccine availability).

Results

From 2012 to 2016, influenza B represented 31% of all influenza-associated ARIs detected (annual range, 13–61%). Rates of influenza B hospitalization and outpatient visits were higher for <5 vs ≥5 years. Among <5 years, B/Victoria was associated with pneumonia hospitalization (64% vs 44%; P = .010) and in-hospital mortality (6% vs 0%; P = .042) compared with B/Yamagata, although the mean annual hospitalization rate for B/Victoria was comparable to that estimated for B/Yamagata. The 2 lineages co-circulated, and there were mismatches with available trivalent influenza vaccines in 2/9 seasons assessed.

Conclusions

Influenza B causes substantial burden in Kenya, particularly among children aged <5 years, in whom B/Victoria may be associated with increased severity. Our findings suggest a benefit from including both lineages when considering influenza vaccination in Kenya.

Evaluating the legal assumptions of Victoria's Sex Offender Registration Act 2004 from a psychological perspective

The Sex Offender Registration Act 2004 was introduced in Victoria to decrease recidivism and aid in future investigations and prosecutions. This article reviews literature to evaluate four assumptions inherent to the Act: (a) sexual offenders are more dangerous than non-sexual offenders; (b) sexual offenders who target children are more dangerous than those who target adults; (c) recidivism risk can be accurately assessed for sexual offenders who target adults; and (d) the Act is a useful tool for investigations and prosecutions. The findings suggest that there is little evidence that supports the assumptions. Further, given the relatively narrow scope of the Act, it is unlikely to have a positive impact on the safety of the community.

Classical swine fever in Victorian domestic pigs: evidence of disease freedom

OBJECTIVE

Australia is currently regarded as free of classical swine fever (CSF), a highly contagious disease of pigs caused by a pestivirus. This study aimed to provide additional evidence that the Victorian domestic pig population is free of CSF.

DESIGN

A structured representative sero-prevalence survey of Victorian domestic pigs at slaughter.

METHOD

Three-hundred and ninety-one pigs from 23 holdings were sampled at the time of slaughter between March 2016 and October 2017.

RESULTS

All samples were negative for CSF virus Ab on ELISA. Because of uncertainty in the sensitivity of the CSF Ab ELISA, estimates of the true prevalence of CSF were calculated using Bayesian methods. The median and upper bound of the 95% credible intervals for the true prevalence of CSF was zero when the diagnostic sensitivity of the CSF Ab ELISA was assumed to range from 0.75 to 0.95.

CONCLUSION

These results provide evidence that the population of domestic pigs in Victoria in 2016-2017 was free of CSF.

Impact of age and pre-existing immunity on the induction of human antibody responses against influenza B viruses

Pre-existing immunity to influenza is dependent on a number of factors and can vary greatly within and across influenza subtypes. In this study, volunteers (aged 18–85 years) were vaccinated with split, inactivated Fluzone^TM in four consecutive influenza seasons from 2013 to 2016. The impact of repeat vaccination on breadth and durability of functional antibodies was assessed for total IgG and IgA anti-hemagglutinin (HA) binding antibodies and hemagglutination-inhibition (HAI) activity against both influenza B lineages. Many subjects were able to maintain high seroprotective titers to the vaccine strains in subsequent years, which resulted in low vaccine-induced seroconversion rates. This was especially evident in younger subjects who typically had higher titers and maintained these titers into the following season. In contrast, the HAI titers in elderly subjects were generally lower and more likely to decline prior to the start of the next influenza season. Immunological recall or ‘back-boosting’ to antigenically related viruses was associated with seroconversion. Overall, influenza vaccination in both younger and older people elicited broadly reactive immune responses within a lineage, as well as cross-reactive immune responses between lineages. This study exemplified the impact that age and influenza exposure history have on determining an individual’s ability to respond to future influenza infections.

Epidemiology and outcomes of acute liver failure in Australia

BACKGROUND

Acute liver failure (ALF) is a life-threatening syndrome with varying aetiologies requiring complex care and multidisciplinary management. Its changing incidence, aetiology and outcomes over the last 16 years in the Australian context remain uncertain.

AIM

To describe the changing incidence, aetiology and outcomes of ALF in South Eastern Australia.

METHODS

The database of the Victorian Liver Transplant Unit was interrogated to identify all cases of ALF in adults (> 16 years) in adults hospitalised between January 2002 and December 2017. Overall, 169 patients meeting criteria for ALF were identified. Demographics, aetiology of ALF, rates of transplantation and outcomes were collected for all patients. Transplant free survival and overall survival (OS) were assessed based on survival to discharge from hospital. Results were compared to data from a historical cohort from the same unit from 1988-2001.

RESULTS

Paracetamol was the most common aetiology of acute liver failure, accounting for 50% of cases, with an increased incidence compared with the historical cohort (P = 0.046). Viral hepatitis and non-paracetamol drug or toxin induced liver injury accounted for 15% and 10% of cases respectively. Transplant free survival (TFS) improved significantly compared to the historical cohort (52% vs 38%, P = 0.032). TFS was highest in paracetamol toxicity with spontaneous recovery in 72% of cases compared to 31% of non-paracetamol ALF (P < 0.001). Fifty-nine patients were waitlisted for emergency liver transplantation. Nine of these died while waiting for an organ to become available. Forty-two patients (25%) underwent emergency liver transplantation with a 1, 3 and 5 year survival of 81%, 78% and 72% respectively.

CONCLUSION

Paracetamol toxicity is the most common aetiology of ALF in South-Eastern Australia with a rising incidence over 30 years. TFS has improved, however it remains low in non-paracetamol ALF.

Experiences of racism among Aboriginal and Torres Strait Islander adults living in the Australian state of Victoria: a cross-sectional population-based study

Background

Racism is a key determinant of the health of Indigenous Australians that may explain the unremitting gap in health and socioeconomic outcomes between Indigenous and non-Indigenous Australians. We quantified the population-based prevalence of experiences of racism of Indigenous adults in the Australian state of Victoria and investigated whether this was independent of social determinants and lifestyle risk factors.

Methods

We combined data from the 2011, 2012 and 2014 Victorian Population Health Surveys to obtain a sample size of 33,833 Victorian adults, including 387 Indigenous adults. The survey is a cross-sectional, population-based, computer-assisted telephone interview survey conducted annually. Using logistic regression, experiences of racism was the dependent variable and Indigenous status the primary independent variable of interest. Secondary independent variables included age, sex, rurality, socioeconomic status, social capital, and lifestyle risk factors.

Results

Indigenous Victorian adults were four times more likely than their non-Indigenous counterparts to have experienced racism in the preceding 12 months; odds ratio (OR) = 4.3 (95% confidence interval (CI): 3.2–5.8). Controlling for social determinants and lifestyle risk factors attenuated, but did not eliminate, the association between experiences of racism and Indigenous status; OR = 3.1 (95% CI: 2.2–4.3). The social determinants of age and social trust made the largest contribution to the attenuation of the association. Education also had a large impact on the association, but in the opposite direction, suggesting that a low level of education may be protective against experiences of racism. When the non-Indigenous comparison group consisted of adults of mainly Anglo-Celtic origin, Indigenous adults were seven times more likely (OR = 7.2; 5.3–9.7) to have experienced racism.

Conclusions

Racism directed against Indigenous Victorians is significant and cannot be ascribed to any specific attributes such as socioeconomic status or lifestyle risk factors. We argue that a human rights-based approach to policy-making for the elimination of systemic and interpersonal racism offers an opportunity and viable alternative to current policy-making, that continues to be dominated by a paternalistic approach that reinforces racism and the resulting inequities.

Please note

Throughout this document, the term Indigenous is taken to include people of Aboriginal and Torres Strait Islander descent. While not our preferred term, Indigenous is used in preference to Aboriginal and Koori as not all Indigenous people living in Victoria are Aboriginal or Koori. We recognise that, with the exception of the term ‘Koori’, these terms are Eurocentric having been imposed upon a people of many nations with distinct languages and cultures. The use of such terms is akin to referring to the peoples of the continent of Europe as ‘Europeans’.

The role of super-spreading events in Mycobacterium tuberculosis transmission: evidence from contact tracing

BACKGROUND

In current epidemiology of tuberculosis (TB), heterogeneity in infectiousness among TB patients is a challenge, which is not well studied. We aimed to quantify this heterogeneity and the presence of "super-spreading" events that can assist in designing optimal public health interventions.

METHODS

TB epidemiologic investigation data notified between 1 January 2005 and 31 December 2015 from Victoria, Australia were used to quantify TB patients' heterogeneity in infectiousness and super-spreading events. We fitted a negative binomial offspring distribution (NBD) for the number of secondary infections and secondary active TB disease each TB patient produced. The dispersion parameter, k, of the NBD measures the level of heterogeneity, where low values of k (e.g. k < 1) indicate over-dispersion. Super-spreading was defined as patients causing as many or more secondary infections as the 99th centile of an equivalent homogeneous distribution. Contact infection was determined based on a tuberculin skin test (TST) result of ≥10 mm. A NBD model was fitted to identify index characteristics that were associated with the number of contacts infected and risk ratios (RRs) were used to quantify the strength of this association.

RESULTS

There were 4190 (2312 pulmonary and 1878 extrapulmonary) index TB patients and 18,030 contacts. A total of 15,522 contacts were tested with TST, of whom 3213 had a result of ≥10 mm. The dispersion parameter, k for secondary infections was estimated at 0.16 (95%CI 0.14-0.17) and there were 414 (9.9%) super-spreading events. From the 3213 secondary infections, 2415 (75.2%) were due to super-spreading events. There were 226 contacts who developed active TB disease and a higher level of heterogeneity was found for this outcome than for secondary infection, with k estimated at 0.036 (95%CI 0.025-0.046). In regression analyses, we found that infectiousness was greater among index patients found by clinical presentation and those with bacteriological confirmation.

CONCLUSION

TB transmission is highly over dispersed and super-spreading events are responsible for a substantial majority of secondary infections. Heterogeneity of transmission and super-spreading are critical issues to consider in the design of interventions and models of TB transmission dynamics.

Individual and community predictors of urinary ceftriaxone-resistant Escherichia coli isolates, Victoria, Australia

Background

Ceftriaxone-resistant Enterobacteriaceae are priority pathogens of critical importance. Escherichia coli is the most commonly isolated Enterobacteriaceae. There are few data regarding non-invasive ceftriaxone-resistant E. coli (CR-EC) isolates in the Australian community. We aimed to describe the prevalence, phenotype, geographic variation, and sociodemographic predictors of ceftriaxone-resistance among E. coli isolates recovered from urine specimens.

Methods

In August 2017, we prospectively analysed E. coli isolates recovered from urine specimens submitted to Dorevitch Pathology (Victoria, Australia), a laboratory that services patients in the community and hospitals. In addition to patient-level predictors of ceftriaxone resistance, we mapped patient postcodes to community-level indicators including Index of Relative Socioeconomic Deprivation, remoteness, and proportion of residents born overseas. We used Poisson regression with log link and robust standard errors to quantify the association between ceftriaxone resistance and patient- and community-level factors.

Results

We included 6732 non-duplicate E. coli isolates. Most (89.2%, 6008/6732) were obtained from female patients. Median age was 56 years (IQR, 32–74). Most patients (90.5%, 5789/6732) were neither referred from a hospital nor residing in a residential aged care facility (RACF). Among the 6732 isolates, 5.7% (382) were CR-EC, ranging from 3.5% (44/1268) in inner regional areas to 6.3% (330/5267) in major cities. Extended spectrum ß–lactamase (ESBL) -production was the most common mechanism for ceftriaxone resistance (89%, 341/382). Nitrofurantoin was the most active oral agent against CR-EC. Eight CR-EC isolates (2.4%) were susceptible only to amikacin, meropenem and nitrofurantoin. None were resistant to meropenem. On multivariable analysis, ceftriaxone resistance was associated with age, residence in a RACF (adjusted relative risk [aRR] 2.94, 95% confidence interval [CI] 2.10–4.13), specimen referral from hospital (aRR 2.05, 95% CI 1.45–2.9), and the proportion of residents born in North Africa and the Middle East (aRR 1.30 for each 5% absolute increase, 95% CI 1.09–1.54), South-East Asia (aRR 1.14, 95% CI 1.02–1.27), and Southern and Central Asia (aRR 1.16, 95% CI 1.04–1.28).

Conclusions

These results provide insights into sociodemographic variation in CR-EC in the community. A better understanding of this variation may inform empiric treatment guidelines and strategies to reduce community dissemination of CR-EC.

Variation in Prescription Opioid Dispensing across Neighborhoods of Diverse Socioeconomic Disadvantages in Victoria, Australia

The study examined the relationship between dispensing patterns of prescription opioids, neighborhood-disadvantage-index, and standardized doses dispensed. Three-year’s dispensing data drawn from 80 local government areas (LGAs) within Victoria, Australia’s second most populous state, was analyzed. Quantities dispensed in defined daily dose (DDD)/1000-people/day were computed for LGAs of low, moderate, high, and very high socio-economic disadvantage. LGAs with various levels of dispensing, and neighborhood disadvantage were identified and mapped. A multivariable regression model examined the effect of neighborhood level disadvantage and identified other factors that are associated with standardized doses dispensed. More women were dispensed opioids than men. Dispensing increased with increasing age. Most of the LGAs with relatively high dispensing were socioeconomically disadvantaged and located outside the major cities. Dispensing gradually increased from low disadvantage to very high disadvantage areas. Dispensing of standardized doses were consistently higher in rural areas than in urban areas. Neighborhood level disadvantage, age, sex, and urbanization were significant factors in the standardized doses dispensed. As inappropriate dispensing of opioids is a major public health problem, research should facilitate understanding of utilization in small areas to enable tailored public health programs. Nationwide and consistent introduction of real-time prescription drug-monitoring programs, and structural interventions to reduce the fundamental causes of socioeconomic disadvantage and isolation are recommended.

Exceptional influenza morbidity in summer season of 2017 in Israel may predict the vaccine efficiency in the coming winter

Influenza infections are the leading cause of respiratory viral infections worldwide, and are mostly common in the winter season. The seasonal influenza vaccine is currently the most effective preventive modality against influenza infection. Immediately following each winter season the World Health Organization (WHO) announces the vaccine composition for the following winter. Unexpectedly, during the summer of 2017, in Israel, we observed in hospitalized patients, an exceptionally high numbers of Influenza positive cases. The majority of the influenza B infections were caused by influenza B/Yamagata lineage, which did not circulate in Israel in the previous winter, and most of the influenza A infections were caused by influenza A/H3N2, a strain similar to the strain that circulated in Israel in the previous winter. We therefore predict that these two viruses will circulate in the coming winter of 2017/18 and that the trivalent vaccine, which includes antigenically different viruses will be inefficient.

Assessment of a rtPCR for the detection of virulent and benign Dichelobacter nodosus, the causative agent of ovine footrot, in Australia

BACKGROUND

Ovine footrot is a highly contagious bacterial disease of sheep, costing the Australian sheep industry millions of dollars annually. Dichelobacter nodosus, the causative agent of footrot, is a gram-negative anaerobe classed into virulent and benign strains as determined by thermostability of their respective protesases. Current methods for detection of D. nodosus are difficult and time-consuming, however new molecular techniques capable of rapidly detecting and typing D. nodosus have been reported.

RESULTS

A competitive real-time PCR (rtPCR) method, based on the ability to detect a 2 nucleotide difference in the aprV2 (virulent) and aprB2 (benign) extracellular protease gene has been tested on Australian samples for determining detection rates, along with clinically relevant cut-off values and performance in comparison to the traditional culturing methods. The rtPCR assay was found to have a specificity of 98.3% for virulent and 98.7% for benign detection from samples collected. Sheep with clinical signs of footrot showed a detection rate for virulent strains of 81.1% and for benign strains of 18.9%. A cut-off value of a Ct of 35 was found to be the most appropriate for use in Victoria for detection of sheep carrying virulent D. nodosus.

CONCLUSIONS

In summary, the rtPCR assay is significantly more capable of detecting D. nodosus than culturing, while there is no significant difference seen in virotyping between the two methods.

Variation in Influenza B Virus Epidemiology by Lineage, China

We used national sentinel surveillance data in China for 2005-2016 to examine the lineage-specific epidemiology of influenza B. Influenza B viruses circulated every year with relatively lower activity than influenza A. B/Yamagata was more frequently detected in adults than in children.