The Lancet Regional Health: Western Pacific最新文献

{"title":"Targeted lung cancer screening in the age of immunotherapies and targeted therapies – an economic evaluation for Australia","authors":"Jacqueline Roseleur ,&nbsp;Jonathan Karnon ,&nbsp;Harry de Koning ,&nbsp;Vivienne Milch ,&nbsp;Katrina Anderson ,&nbsp;Jacqui Real ,&nbsp;Dorothy Keefe ,&nbsp;Kevin ten Haaf","doi":"10.1016/j.lanwpc.2024.101241","DOIUrl":"10.1016/j.lanwpc.2024.101241","url":null,"abstract":"<div><h3>Background</h3><div>The cost-effectiveness of different lung cancer screening strategies has been evaluated from an Australian public health system perspective using static models. In addition, the impact of novel therapies, including immunotherapies and targeted therapies, on the cost-effectiveness of lung cancer screening has not yet been evaluated comprehensively. We evaluated the benefits, harms and cost-effectiveness of a targeted national lung screening program in Australia, accounting for the increasing uptake of novel therapies, which informed the lung cancer screening recommendations of the Australian Medical Services Advisory Committee (MSAC).</div></div><div><h3>Methods</h3><div>Australia-specific data on lung cancer epidemiology, smoking behaviour and care costs were used to adapt the MIcrosimulation SCreening ANalysis (MISCAN)-Lung model. Benefits, harms and cost-effectiveness of different targeted lung cancer screening scenarios were evaluated for individuals born between 1945 and 1969. The scenarios considered various screening age ranges, intervals and eligibility criteria (minimum accumulated smoking history and PLCOm2012 risk thresholds).</div></div><div><h3>Findings</h3><div>The MSAC-recommended scenario was cost-effective at AUD62,754 per quality-adjusted life-year compared to no screening. This scenario biennially screens current and former smokers (quit ≤10 years ago) who smoked ≥30 pack-years between ages 50 and 70, preventing 62 lung cancer deaths per 100,000 and yielding 8.4 quality-adjusted life-years per prevented lung cancer death. Using novel therapies reduced the incremental costs of screening compared to no-screening by 14.8% but yielded 11.3% fewer incremental quality-adjusted life-years compared to traditional anti-cancer therapies, due to the improved survival yielded by novel therapies. Overall, the cost-effectiveness of screening was better when costs and effects of novel therapies were applied (AUD62,754 vs AUD65,340 per quality-adjusted life-year gained; 4% difference).</div></div><div><h3>Interpretation</h3><div>Targeted lung cancer screening is more cost-effective when costs and effects of novel therapies are applied, although impacts on cost-effectiveness are likely to be marginal.</div></div><div><h3>Funding</h3><div><span>Cancer Australia</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"53 ","pages":"Article 101241"},"PeriodicalIF":7.6,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of blood-borne virus infections and uptake of hepatitis C testing and treatment in Australian prisons: the AusHep study","authors":"Rugiatu Bah ,&nbsp;Yumi Sheehan ,&nbsp;Xiaoying Li ,&nbsp;Gregory J. Dore ,&nbsp;Jason Grebely ,&nbsp;Andrew R. Lloyd ,&nbsp;Behzad Hajarizadeh","doi":"10.1016/j.lanwpc.2024.101240","DOIUrl":"10.1016/j.lanwpc.2024.101240","url":null,"abstract":"<div><h3>Background</h3><div>Incarcerated people are at high risk of blood-borne virus infections, particularly HCV, and a priority population for elimination efforts. This national bio-behavioural survey evaluated blood-borne virus prevalence and HCV testing-and-treatment uptake amongst people in Australian prisons.</div></div><div><h3>Methods</h3><div>Randomly-selected participants from 23 representative prisons nationally were offered point-of-care testing for HIV and HCV (anti-HCV) antibodies, hepatitis B surface antigen (HBsAg), and HCV RNA (if anti-HCV positive). Demographic data and previous HCV testing and treatment were collected by structured interview.</div></div><div><h3>Findings</h3><div>1599 individuals participated (98% participation; 89%male; median age 35 years; 49% ever injected drugs). Prevalence estimates were: 31.7% (95% CI:28.8–34.8) for anti-HCV; 8.0%for HCV RNA (95% CI:6.4–9.9); 0.5% (95% CI:0.2–1.1) for HBsAg, and 0.8% (95% CI: 0.4–1.7) for HIV antibody. Among participants who had ever injected drugs (n = 787), HCV RNA prevalence was highest among those injecting and sharing needles/syringes within the past month [27.9%; adjusted odds ratio (aOR):4.54 (95% CI:2.65–7.77). Among participants (n = 1599), 70.4% (95% CI: 67.4–73.2) had ever been tested for HCV (62.6% in prison). The highest likelihood of having had HCV testing was observed among participants who injected drugs in the past month (aOR = 10.37, 95% CI:5.72–0.18.78). Among those eligible (n = 318), 84.6% (95% CI:79.2–88.7) had ever received HCV treatment (75.0% in prison), and 67.8% (95% CI:61.7–73.4) were cured. The likelihood of HCV treatment was higher among those previously imprisoned, (aOR = 2.67, 95% CI:1.20–5.93).</div></div><div><h3>Interpretation</h3><div>Despite high overall HCV testing and treatment uptake, the lower uptake and substantial ongoing HCV disease burden in some sub-populations highlights the need for continued prison-based elimination efforts with population-specific interventions.</div></div><div><h3>Funding</h3><div>The AusHep study was funded by the <span>Australian Government</span> <span>Department of Health and Aged Care</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"53 ","pages":"Article 101240"},"PeriodicalIF":7.6,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"School mental health prevention and intervention strategies in China: a scoping review","authors":"Diyang Qu ,&nbsp;Xue Wen ,&nbsp;Xuan Cheng ,&nbsp;Anni Zhu ,&nbsp;Zhijun Wu ,&nbsp;Liying Che ,&nbsp;Runsen Chen","doi":"10.1016/j.lanwpc.2024.101243","DOIUrl":"10.1016/j.lanwpc.2024.101243","url":null,"abstract":"<div><div>Student mental health issues remain a significant global concern, imposing considerable health, social, and economic burdens. China has also published numerous national policies prioritizing this area. To further investigate the current prevention and intervention programs, we conducted a scoping review, searching six databases (three in English and three in Chinese) up to May 2024. A total of 77 eligible studies were included. Our findings highlight several gaps in current practices, such as regional disparities in school-based mental health programs, insufficient focus on younger children and developmental issues, limited comprehensive pathways from screening to classification, prevention, and intervention, and a lack of an integrated approach to promoting mental health among children and adolescents. These findings indicate an urgent need for improvements in this field, calling for future studies to help reduce the burden of mental health problems and support the holistic development of children in China.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"53 ","pages":"Article 101243"},"PeriodicalIF":7.6,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful management of a multi-species outbreak of carbapenem-resistant organisms in Fiji: a prospective genomics-enhanced investigation and response","authors":"Tracey Young-Sharma ,&nbsp;Courtney R. Lane ,&nbsp;Rodney James ,&nbsp;Mathilda Wilmot ,&nbsp;Sanjeshni Autar ,&nbsp;Kylie Hui ,&nbsp;Aneley Getahun Strobel ,&nbsp;Jake A. Lacey ,&nbsp;Savneel Kumar ,&nbsp;Ashlyn Datt ,&nbsp;Alvina Lata ,&nbsp;Donna Cameron ,&nbsp;Norelle L. Sherry ,&nbsp;Sisilia Genaro ,&nbsp;Timaima Ditukana ,&nbsp;Ilisapeci Nabose ,&nbsp;Apaitia Goneyali ,&nbsp;Elizabeth Bennett ,&nbsp;Anisi Kavoa ,&nbsp;Shammi Prasad ,&nbsp;Benjamin P. Howden","doi":"10.1016/j.lanwpc.2024.101234","DOIUrl":"10.1016/j.lanwpc.2024.101234","url":null,"abstract":"<div><h3>Background</h3><div>Fiji is a Pacific Island nation grappling with the increasing threat of antimicrobial resistance (AMR). While genomic technologies are increasingly utilised to understand the emergence and spread of AMR globally, its application to inform outbreak responses in low- and middle-income settings has not been reported.</div></div><div><h3>Methods</h3><div>Through an established capacity building program, suspected carbapenem-resistant organisms (CRO) identified at Colonial War Memorial Hospital in Fiji (Jan 2022–Oct 2023) underwent whole genome sequencing and analysis. Following a rapid increase in CROs, a joint outbreak investigation including detailed genomic epidemiology was undertaken. A multi-modal response was co-designed and implemented by hospital staff, and circulating strains monitored to assess impact.</div></div><div><h3>Findings</h3><div>Six large genomic clusters accounted for 73% (n = 223/304) of all sequenced CRO isolates. Four genomic clusters (<em>Acinetobacter baumannii</em> NDM-1, <em>A. baumannii</em> OXA-23/OXA-58<em>, Escherichia coli</em> NDM-7, <em>Pseudomonas aeruginosa</em> NDM-1) were investigated in detail, with affected wards differing between species. Following outbreak interventions, <em>E. coli</em> and <em>P. aeruginosa</em> clusters decreased rapidly, however <em>A. baumannii</em> transmission persisted. Repeated international importation of CROs into Fiji were suspected.</div></div><div><h3>Interpretation</h3><div>Carbapenem-resistant pathogens pose a major threat to the health system in Fiji. Genomics technologies are useful for understanding AMR and guiding successful response, in these settings. Strategies to ensure access to, and judicious use of the technology are justified.</div></div><div><h3>Funding</h3><div>This work was funded by the <span>Australian Government</span> through the <span>Department of Foreign Affairs and Trade Centre for Health Security</span>, <span>Medical Research Future Fund</span> and <span>National Health and Medical Research Council</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"53 ","pages":"Article 101234"},"PeriodicalIF":7.6,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic disadvantage and polygenic risk of overweight in early and mid-life: a longitudinal population cohort study spanning 12 years","authors":"Jessica A. Kerr ,&nbsp;Dorothea Dumuid ,&nbsp;Marnie Downes ,&nbsp;Katherine Lange ,&nbsp;Meredith O'Connor ,&nbsp;Ty Stanford ,&nbsp;Lukar Thornton ,&nbsp;Suzanne Mavoa ,&nbsp;Kate Lycett ,&nbsp;Tim S. Olds ,&nbsp;Ben Edwards ,&nbsp;Justin O'Sullivan ,&nbsp;Markus Juonala ,&nbsp;Ha N.D. Le ,&nbsp;Richard Saffery ,&nbsp;David Burgner ,&nbsp;Melissa Wake","doi":"10.1016/j.lanwpc.2024.101231","DOIUrl":"10.1016/j.lanwpc.2024.101231","url":null,"abstract":"<div><h3>Background</h3><div>We describe BMI by socioeconomic disadvantage and by polygenic risk in parallel cohorts of children and adults (their parents). We examine whether hypothetically intervening to reduce childhood disadvantage could reduce adolescent obesity.</div></div><div><h3>Methods</h3><div>From a population-based cohort (N = 5107) with a mixed design (survey and direct assessment), 24–31% had genotype data: 1607 children (50% male) followed biennially from age 2–3 to 14–15; 2406 adults (36% male) followed from mean age 35–47 years. Exposures were polygenic risk score for BMI, and neighbourhood- and family-level socioeconomic disadvantage categorised as ‘most’ (top two cohort-specific quintiles), ‘average’, or ‘least’ disadvantage (bottom two quintiles). We explored trends in estimated BMI and risk of overweight/obesity by disadvantage, stratified by polygenic risk. We used generalised linear regression to estimate the reduction in overweight/obesity at 14–15 years in children living in ‘least/average disadvantage’ in early childhood relative to those in ‘most disadvantage’, adjusted for confounders. Causal effect estimates were obtained separately for children with higher and lower polygenic risk.</div></div><div><h3>Findings</h3><div>A positive trend between disadvantage and overweight/obesity was most apparent among participants with high polygenic risk. Among children with higher polygenic risk (n = 805), hypothetical target trial results imply that intervening to lessen population-wide neighbourhood disadvantage from most to least disadvantage could reduce adolescent overweight/obesity by 32% (risk ratio (RR) 0.68, 95% CI 0.50–0.92), or by 42% if intervening to lessen family disadvantage (RR 0.58, 95% CI 0.42–0.79). Positive effects were smaller when isolating the population to those with lower polygenic risk (7–17%), and for the whole population, regardless of polygenic risk (25–39%).</div></div><div><h3>Interpretation</h3><div>Children at higher polygenic risk of obesity suffer disproportionate BMI impacts of disadvantage. At the population-level, and especially for those with higher polygenic risk, tackling disadvantage could potentially reduce obesity and associated morbidity, mortality, and costs.</div></div><div><h3>Funding</h3><div><span>Australian National Health and Medical Research Council</span>. Funding information is detailed in the funding statement.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"53 ","pages":"Article 101231"},"PeriodicalIF":7.6,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A contemporary analysis of the Australian clinical and genetic landscape of spinal muscular atrophy: a registry based study","authors":"Lakshmi Balaji ,&nbsp;Robin Forbes ,&nbsp;Anita Cairns ,&nbsp;Hugo Sampaio ,&nbsp;Andrew J. Kornberg ,&nbsp;Lauren Sanders ,&nbsp;Phillipa Lamont ,&nbsp;Christina Liang ,&nbsp;Kristi J. Jones ,&nbsp;Kristen Nowak ,&nbsp;Cullen O'Gorman ,&nbsp;Ian Woodcock ,&nbsp;Nancy Briggs ,&nbsp;Eppie M. Yiu ,&nbsp;Michelle A. Farrar ,&nbsp;Didu Kariyawasam","doi":"10.1016/j.lanwpc.2024.101237","DOIUrl":"10.1016/j.lanwpc.2024.101237","url":null,"abstract":"<div><h3>Background</h3><div>New paradigms of diagnosis and treatment have changed the neurodegenerative trajectory for individuals with spinal muscular atrophy (SMA). Registries are a critical tool to provide real-world data on treatment patterns, their effects and health care provision within this evolving paradigm of care. This study aimed to evaluate the phenotypic and genotypic landscape, treatment patterns and health impact of SMA in Australia through the national registry.</div></div><div><h3>Methods</h3><div>This cross-sectional study investigated demographic, clinical and genetic information, sequelae of weakness, treatment patterns and patient-reported outcomes amongst individuals with SMA enrolled in the Australian Neuromuscular Disease Registry (ANMDR) from 1st January 2020 to 30th April 2023. Descriptive statistics were used for analysis and Chi-Squared or Fisher's exact tests for associations.</div></div><div><h3>Findings</h3><div>195 individuals with SMA enrolled into the ANMDR. 5/195 (2.6%) were deceased by censor date. Of (n = 190) individuals living with SMA, 104/190 (54.7%) were children. Minimum Australian prevalence was 0.73/100,000. <em>SMN2</em> copies were inversely associated with phenotype in those with homozygous <em>SMN1</em> deletions (<em>p &lt; 0.0001</em>)). Treatment was utilised in 154/190 (81%) of the population, with 65/137 (47.6%) of individuals perceiving improvements with therapeutic intervention on Patient/Parent Global Impression of Improvement scale (<em>p &lt; 0.0001</em>). Engagement with multidisciplinary care practitioners was significantly higher among children with SMA than adults (93% versus 12%, <em>p &lt; 0.0001</em>).</div></div><div><h3>Interpretation</h3><div>Despite diagnostic and therapeutic advances, mortality and the multi-systemic health impact of SMA continue to be experienced within the Australian population. Healthcare provision must align with patient-centred outcomes, adapting to meeting their changing but ongoing care requirements. The study identified the considerable unmet need for multidisciplinary care, not only for adults with SMA but also for the emerging cohort of treated children, emphasising the imperative for comprehensive healthcare provision to address their evolving needs.</div></div><div><h3>Funding</h3><div>No funding was received for this study.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"53 ","pages":"Article 101237"},"PeriodicalIF":7.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A complex intervention to reduce antibiotic prescribing in rural China: a cluster randomised controlled trial","authors":"Xingrong Shen ,&nbsp;Beth Stuart ,&nbsp;Enci Cui ,&nbsp;Rong Liu ,&nbsp;Tingting Zhang ,&nbsp;Jing Chai ,&nbsp;Wenjuan Cong ,&nbsp;Xiaowen Hu ,&nbsp;Isabel Oliver ,&nbsp;Guiqing Yao ,&nbsp;Paul Little ,&nbsp;Helen Lambert ,&nbsp;Lucy Yardley ,&nbsp;Christie Cabral ,&nbsp;Debin Wang","doi":"10.1016/j.lanwpc.2024.101236","DOIUrl":"10.1016/j.lanwpc.2024.101236","url":null,"abstract":"<div><h3>Background</h3><div>Excessive use of antibiotics is a widespread problem. We aim to evaluate the efficacy of a multifaceted intervention for reducing antibiotic use in patients with respiratory tract infections (RTIs).</div></div><div><h3>Methods</h3><div>In this two-arm cluster randomized controlled trial, we enrolled patients aged 18+ with symptomatic RTIs at 40 township health centers (THCs) selected from 10 counties in Anhui, China. The THCs were randomized using an online tool (‘Sealed Envelope’) to intervention or usual care (1:1 ratio), stratified by baseline antibiotic prescribing and with random block sizes (4 or 6). The intervention had five components: a half-day clinician training, a WeChat-based peer support group, a decision aid, a poster commitment letter and a patient leaflet. The primary outcome was whether antibiotics were prescribed at the index consultation. Secondary measures included defined daily dose (DDD), illness recovery rate, re-visits to other care-givers or retail pharmacies and incremental cost-effectiveness ratio (ICER). These measures were analyzed using generalized linear mixed modeling controlling for clustering. The study was registered as ISRCTN30652037.</div></div><div><h3>Findings</h3><div>Between December 2021 and September 2022, 1053 patients were recruited (intervention, 21 THCs, n = 552; control, 19 THCs, n = 501), using consecutive sampling. Antibiotic prescribing rate was 55.25% and 66.67% in the intervention and control arms (Odds ratio 0.52, 95% confidence interval [CI]: 0.27, 0.98; p = 0.044). The intervention group also had lower, significant or non-significant, differences for other markers of antibiotic use: DDD (1.57 vs 2.75); prescriptions of two or more types of antibiotics (9.78% vs 11.58%); obtaining antibiotics from retail pharmacies (3.68% vs 5.78) or from other clinics (2.70% vs 4.05%). The intervention resulted in a cost reduction of 9.265 RMB (1.471 USD) per consultation episode and an ICER of −7769.98 RMB or −1233.33 USD/QALYs. The intervention did not encounter any major adverse event.</div></div><div><h3>Interpretation</h3><div>The intervention package was effective and cost-effective in reducing antibiotics prescribing without adverse effects.</div></div><div><h3>Funding</h3><div>The trial was supported by <span>National Natural Science Foundation of China</span> (No. <span><span>81861138049</span></span>) and <span>United Kingdom Research Innovation</span> (No. <span><span>MR/S013717/1</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"53 ","pages":"Article 101236"},"PeriodicalIF":7.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of time to antibiotics on clinical outcome in paediatric febrile neutropenia: a target trial emulation of 1685 episodes","authors":"Gabrielle M. Haeusler ,&nbsp;S Ghazaleh Dashti ,&nbsp;Fiona James ,&nbsp;Franz E. Babl ,&nbsp;Meredith L. Borland ,&nbsp;Julia E. Clark ,&nbsp;Bhavna Padhye ,&nbsp;Heather Tapp ,&nbsp;Frank Alvaro ,&nbsp;Trisha Soosay Raj ,&nbsp;Thomas Walwyn ,&nbsp;David S. Ziegler ,&nbsp;Leanne Super ,&nbsp;Lisa Hall ,&nbsp;Daniel K. Yeoh ,&nbsp;Coen Butters ,&nbsp;Brendan McMullan ,&nbsp;Diane M.T. Hanna ,&nbsp;Richard De Abreu Lourenco ,&nbsp;Monica A. Slavin ,&nbsp;Karin A. Thursky","doi":"10.1016/j.lanwpc.2024.101226","DOIUrl":"10.1016/j.lanwpc.2024.101226","url":null,"abstract":"<div><h3>Background</h3><div>Prompt antibiotic administration for febrile neutropenia (FN) is standard of care, and targets of time to antibiotics (TTA) &lt;60 min are common. We sought to determine the effect of TTA ≥60 versus &lt;60 min on adverse outcomes (intensive care unit (ICU) admission or death) in children with cancer and FN. Effect modification by a decision rule that predicts infection (AUS-rule) and bacteraemia were also investigated.</div></div><div><h3>Methods</h3><div>The prospective, multi-centre (n = 8), Australian PICNICC study dataset was analysed. To control for confounding, we used outcome regression adjusted for propensity score modelled as restricted cubic spline with two degrees of freedom. The propensity score was estimated from a logistic regression model for the exposure on the confounders, identified <em>a priori</em> (age, sex, severely unwell, disease, chemotherapy intensity and site). TTA was defined as time from from emergency triage to first antibiotic dose.</div></div><div><h3>Findings</h3><div>1685 FN episodes in 976 patients were included. Median TTA was 53 min (IQR 37–77 min, 1542 (92%) &lt;120 min). An adverse outcome occurred in 43 (2.6%) episodes (39 ICU; 5 deaths). The confounder-adjusted point estimate suggested a lower risk for adverse outcome associated with TTA ≥60 min (RR 0.62, 95% CI 0.32–1.21), but the wide 95% CI precluded definitive judgement about strength and direction of the effect (unadjusted RR 0.52; 95% CI 0.26, 1.05). Similarly, although the point estimates were suggestive of a null association or reduced risk for adverse outcome associated with TTA ≥60 min for all comparisons across bacteraemia or AUS-rule strata, the 95% CIs were imprecise.</div></div><div><h3>Interpretation</h3><div>For children with FN, there was no definite evidence that TTA ≥60 min from hospital triage (but within 2 h), increased risk of adverse outcome or prolonged hospital admission. This study has important implications for FN TTA mandates, suggesting a more nuanced approach is required.</div></div><div><h3>Funding</h3><div><span>National Health and Medical Research Council</span> and <span>Medical Research Future Fund</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"53 ","pages":"Article 101226"},"PeriodicalIF":7.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is Indigenous cultural health and wellbeing? A narrative review","authors":"Brett J. Biles ,&nbsp;Nina Serova ,&nbsp;Gavin Stanbrook ,&nbsp;Brooke Brady ,&nbsp;Jonathan Kingsley ,&nbsp;Stephanie M. Topp ,&nbsp;Aryati Yashadhana","doi":"10.1016/j.lanwpc.2024.101220","DOIUrl":"10.1016/j.lanwpc.2024.101220","url":null,"abstract":"<div><div>Indigenous cultural health is an emerging field of research and reflects the unique connections Indigenous peoples have with their Country, culture, and knowledge systems. This narrative review explores the concept of cultural health focusing on the interplay between culture, health, and wellbeing within settler colonial contexts. The review is mostly focused on Australian research, despite its international scope. A narrative review methodology was employed, search terms were compiled, and a title and abstract search was executed across two databases (Scopus, PubMed), confined to English language papers, with a focus on Australia. Three key themes were identified: Country; culture, and Indigenous knowledges. Country is vital to health. Culture practices offer frameworks for healing nurturing the relationship between people, Country and culture. Privileging Indigenous knowledges is a means to achieving health and wellbeing. Indigenous cultural health encompasses the interconnectedness of Country, people and culture, demanding a holistic approach that integrates Indigenous knowledges and practices. In Australia, these core components of cultural health must be situated in a contemporary context of ongoing colonisation. This narrative review underscores the importance of culturally centred approaches in addressing health inequities and enhancing the wellbeing of Indigenous peoples.</div></div><div><h3>Funding</h3><div>This study was funded by the <span>Australian Government’s Medical Research Future</span> Fund (MRF2009522 &amp; MRF2025330).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"52 ","pages":"Article 101220"},"PeriodicalIF":7.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Participatory systems modelling to inform improvements in the social and emotional wellbeing of young Aboriginal and Torres Strait Islander people in Australia","authors":"Olivia Iannelli ,&nbsp;Tanja Hirvonen ,&nbsp;Julie Robotham ,&nbsp;Yun Ju Christine Song ,&nbsp;Jo-An Occhipinti ,&nbsp;Grace Yeeun Lee ,&nbsp;Jakelin Fleur Troy ,&nbsp;Catherine Vacher ,&nbsp;Abigail Bray ,&nbsp;Ee Pin Chang ,&nbsp;Ian Bernard Hickie ,&nbsp;Pat Dudgeon","doi":"10.1016/j.lanwpc.2024.101213","DOIUrl":"10.1016/j.lanwpc.2024.101213","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"52 ","pages":"Article 101213"},"PeriodicalIF":7.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}