Load forecasting method based on CEEMDAN and TCN-LSTM.

Aiming at the problems of high stochasticity and volatility of power loads as well as the difficulty of accurate load forecasting, this paper proposes a power load forecasting method based on CEEMDAN (Completely Integrated Empirical Modal Decomposition) and TCN-LSTM (Temporal Convolutional Networks and Long-Short-Term Memory Networks). The method combines the decomposition of raw load data by CEEMDAN and the spatio-temporal modeling capability of TCN-LSTM model, aiming to improve the accuracy and stability of forecasting. First, the raw load data are decomposed into multiple linearly stable subsequences by CEEMDAN, and then the sample entropy is introduced to reorganize each subsequence. Then the reorganized sequences are used as inputs to the TCN-LSTM model to extract sequence features and perform training and prediction. The modeling prediction is carried out by selecting the electricity compliance data of New South Wales, Australia, and compared with the traditional prediction methods. The experimental results show that the algorithm proposed in this paper has higher accuracy and better prediction effect on load forecasting, which can provide a partial reference for electricity load forecasting methods.

Understanding health literacy in men: a cross-sectional survey.

BACKGROUND: Males have a shorter life expectancy than females. Men are less likely to seek the advice of a health professional or utilise preventive health services and programs. This study seeks to explore health literacy and the characteristics affecting this among Australian men. METHODS: Four hundred and thirty-one adult males engaged with the New South Wales Rural Fire Service, completed an online cross-sectional survey, undertaken from September - November 2022. The survey tool captured demographic data, health status and lifestyle risk characteristics. Health literacy was measured using the 44-item Health Literacy Questionnaire (HLQ). Descriptive statistics, frequencies, percentages, means and standard deviations, were used to describe the sample. Interferential statistics, including the Mann-Whitney U Test and the Kruskal-Wallis Test, were used to explore differences between demographics and HLQ scales. RESULTS: For the first 5 scales (4-point Likert scale), the lowest score was seen for 'Appraisal of health information' (Mean 2.81; SD 0.52) and the highest score was seen for 'Feeling understood and supported by healthcare providers ' (Mean 3.08; SD 0.64). For the other 4 scales (5-point Likert scale), the lowest score was seen for 'Navigating the healthcare system' (Mean 3.74; SD 0.69). The highest score was seen for 'Understand health information well enough to know what to do' (Mean 4.10; SD 0.53). Age, income level and living in an urban/rural location were significantly related to health literacy scales. CONCLUSIONS: This study provides new insight into men's health literacy and the factors impacting it. This knowledge can inform future strategies to promote men's engagement with health services and preventive care.

Innovative use of Australian cancer registry data for early detection of the effects of epidemics and other mass disruptions on cancer incidence.

BACKGROUND: Predictive modelling using pre-epidemic data have long been used to guide public health responses to communicable disease outbreaks and other health disruptions. In this study, cancer registry and related health data available 2-3 months from diagnosis were used to predict changes in cancer detection that otherwise would not have been identified until full registry processing was completed about 18-24 months later. A key question was whether these earlier data could be used to predict cancer incidence ahead of full processing by the cancer registry as a guide to more timely health responses. The setting was the Australian State of New South Wales, covering 31 % of the Australian population. The study year was 2020, the year of emergence of the COVID-19 pandemic. METHODS: Cancer detection in 2020 was modelled using data available 2-3 months after diagnosis. This was compared with data from full registry processing available from 2022. Data from pre-pandemic 2018 were used for exploratory model building. Models were tested using pre-pandemic 2019 data. Candidate predictor variables included pathology, surgery and radiation therapy reports, numbers of breast screens, colonoscopies, PSA tests, and melanoma excisions recorded by the universal Medical Benefits Schedule (MBS). Data were analysed for all cancers collectively and 5 leading types. RESULTS: Compared with full registry processing, modelled data for 2020 had a >95 % accuracy overall, indicating key points of inflexion of cancer detection over the COVID-disrupted 2020 period. These findings highlight the potential of predictive modelling of cancer-related data soon after diagnosis to reveal changes in cancer detection during epidemics and other health disruptions. CONCLUSIONS: Data available 2-3 months from diagnosis in the pandemic year indicated changes in cancer detection that were ultimately confirmed by fully-processed cancer registry data about 24 months later. This indicates the potential utility of using these early data in an early-warning system.

Using a patient-reported outcome measure to assess quality of life at Western Sydney Sexual Health Centre.

Background Attaining a good quality of life (QOL) is a priority for people living with HIV (PLHIV). We explored the interaction between QOL and the associated demographic, behavioural and clinical factors for PLHIV attending an outer-metropolitan clinical setting in Western Sydney, Australia. The clinic's cohort of PLHIV is characterised by relatively high proportions of women, heterosexual men, and patients from culturally and linguistically diverse (CALD) communities. Methods We assessed QOL using the PozQol tool that is specifically designed for PLHIV. QOL scores and de-identified socio-demographic and clinical data were extracted from the electronic and paper medical records of PLHIV who completed a PozQol tool (September 2020-March 2022). We performed descriptive analyses and logistic regression to identify associations. Results Among 188 patients, there were 77.7% men, 21.3% women, 1.1% transwomen; 67.0% were born overseas, 85.1% spoke English, 84.4% were Medicare-eligible, 85.9% were employed, 58.5% were diagnosed with HIV 6-20years ago, and 33.0% within the past 5years. Overall, 58.0% had a high or very high QOL. A low score in any domain was associated with Medicare-ineligibility. Low QOL scores in specific domains were associated with the following factors: health (being born overseas, having partners of both sexes), psychological (unemployment, having a mental health condition, having a viral load >20 copies/mL), social (unemployment), and functional (Medicare-eligibility, unemployment, having a viral load >20 copies/mL). Conclusions The PozQol tool has enhanced understanding of factors impacting on QOL for PLHIV attending our service in Western Sydney. Identifying patients with low QOL scores allows targeted clinical interventions to improve QOL, and re-alignment of clinical services to better support PLHIV.

Long-term cohort study of patients presenting with hypercapnic respiratory failure.

OBJECTIVE: We sought to describe the long-term prognosis for a population-based cohort of people with hypercapnic respiratory failure (HRF) and the associations between underlying diagnoses and the risks of death and rehospitalisation. METHODS: We performed a historical cohort study of all persons with HRF in the Liverpool local government area in New South Wales, Australia, in the 3-year period from 2013 to 2015. Cohort members were identified using arterial blood gas results from Liverpool Hospital demonstrating pH ≤7.45 and PaCO2 >45 mm Hg within 24 hours of presentation. Linked health data were obtained from statewide registries with a minimum follow-up period of 6 years. The primary outcomes were time to death from any cause and the standardised mortality ratio (SMR) which compares the observed to the expected number of deaths in the same population. Secondary outcomes were time to rehospitalisation and the associations between death and/or hospitalisation and underlying diagnoses. RESULTS: The cohort comprised 590 adults aged between 15 and 101 years. Overall, 415 (70.3%) participants died in the follow-up period. Among those who survived the index admission, the probability of survival at 1, 3 and 5 years was 81%, 59% and 45%, respectively. The overall SMR was 9.2 (95% CI 7.6 to 11.0), indicating a near 10-fold risk of death than otherwise expected for age. Most (91%) survivors experienced rehospitalisation, with median (IQR) time to readmission of 3.9 (1.2-10.6) months. Congestive cardiac failure and neuromuscular disease were associated with an increased risk of death, whereas chronic obstructive pulmonary disease and sleep disordered breathing increased the risk of rehospitalisation. CONCLUSIONS: HRF is associated with poor survival and high risk of rehospitalisation in the 5 years following an index event. The underlying disease appears to have some influence on overall survival and subsequent hospitalisations.

Low HIV drug resistance prevalence among recently diagnosed HIV-positive men who have sex with men in a setting of high PrEP use.

INTRODUCTION: New South Wales (NSW) has one of the world's highest uptake rates of HIV pre-exposure prophylaxis (PrEP). This uptake has been credited with sharp declines in HIV transmission, particularly among Australian-born gay and bisexual men. Concerns have been raised around the potential for the emergence of tenofovir (TFV) and XTC (lamivudine/emtricitabine) resistance in settings of high PrEP use. Such an emergence could also increase treatment failure and associated clinical outcomes among people living with HIV (PLHIV). Despite low levels of nucleoside reverse-transcriptase inhibitor (NRTI) resistance relating to PrEP use in clinical settings, there are few published studies describing the prevalence of NRTI resistance among people newly diagnosed with HIV in a setting of high PrEP use. METHODS: Using HIV antiretroviral drug resistance data linked to NSW HIV notifications records of people diagnosed from 1 January 2015 to 31 December 2021 and with HIV attributed to male-to-male sex, we described trends in TFV and XTC resistance. Resistance was identified using the Stanford HIV Drug Resistance genotypic resistance interpretation system. To focus on transmitted drug resistance, resistance prevalence estimates were generated using sequences taken less than 3 months post-HIV diagnosis. These estimates were stratified by timing of sequencing relative to the date of diagnosis, year of sequencing, birthplace, likely place of HIV acquisition, and stage of HIV at diagnosis. RESULTS: Among 1119 diagnoses linked to HIV genomes sequenced less than 3 months following diagnosis, overall XTC resistance prevalence was 1.3%. Between 2015 and 2021, XTC resistance fluctuated between 0.5% to 2.9% and was 1.0% in 2021. No TFV resistance was found over the study period in any of the sequences analysed. Higher XTC resistance prevalence was observed among people with newly acquired HIV (evidence of HIV acquisition in the 12 months prior to diagnosis; 2.9%, p = 0.008). CONCLUSIONS: In this Australian setting, TFV and XTC resistance prevalence in new HIV diagnoses remained low. Our findings offer further evidence for the safe scale-up of PrEP in high-income settings, without jeopardizing the treatment of those living with HIV.

Investigation of landscape risk factors for the recent spread of varroa mite (Varroa destructor) in European honeybee (Apis mellifera) colonies in New South Wales, Australia.

In June 2022, an exotic pest of the European honeybee (Apis mellifera), the varroa mite (Varroa destructor), was detected in surveillance hives at the Port of Newcastle, New South Wales (NSW). Previously, Australia remained the only continent free of the varroa mite. In September 2023, the National Management Group decided to shift the focus of the response from eradication to management. It is estimated that the establishment of varroa mite in Australia could lead to more than $70 million in losses each year due to greatly reduced pollination services. Currently, there are no reported studies on the epidemiology of varroa mite in NSW because it is such a recent outbreak, and there is little knowledge of the factors associated with the presence of V. destructor in the Australian context. We sourced publicly available varroa mite outbreak reports from June 22 to December 19, 2022, to determine if urbanization, land use, and distance from the incursion site are associated with the detection of varroa mite infestation in European honeybee colonies in NSW. The outcome investigated was epidemic day, relative to the first detected premises (June 22, 2022). The study population was comprised of 107 premises, which were declared varroa-infested. The median epidemic day was day 37 (July 29, 2022), and a bimodal distribution was observed from the epidemic curve, which was reflective of an intermittent source pattern of spread. We found that premises were detected to be infected with varroa mite earlier in urban areas [median epidemic day 25 (July 17, 2022)] compared to rural areas [median epidemic day 37.5 (July 29, 2022)]. Infected premises located in areas without cropping, forests, and irrigation were detected earlier in the outbreak [median epidemic days 23.5 (July 15, 2022), 30 (July 22, 2022), and 15 (July 7, 2022), respectively] compared to areas with cropping, forests, and irrigation [median epidemic days 50 (August 11, 2022), 43 (August 4, 2022), and 47 (August 8, 2022), respectively]. We also found that distance from the incursion site was not significantly correlated with epidemic day. Urbanization and land use are potential factors for the recent spread of varroa mite in European honeybee colonies in NSW. This knowledge is essential to managing the current varroa mite outbreak and preventing future mass varroa mite spread events.

Moving from idea to reality: The barriers and enablers to implementing Child and Family Hubs policy into practice in NSW, Australia.

BACKGROUND: Adverse childhood experiences can impact physical and mental health throughout the lifespan. To support families experiencing adversity and improve child health and developmental equity, an integrated, multi-sector response is required. Child and Family Hubs (Hubs) are a feasible and acceptable approach to providing such a response. In the Australian context, a number of federal and New South Wales (NSW) state policies support an integrated, multi-sector response using Hubs to support families experiencing adversity. This study examined NSW policy stakeholder and health service manager perspectives on the barriers and enablers to translating policy into practice in the implementation of Child and Family Hubs. METHODS: Semi-structured interviews were conducted with 11 NSW government policy stakeholders and 13 community health service managers working in child and family policy and planning or child and family community-based services. Interviews were of 30-60 min duration and explored stakeholder knowledge, perspectives and experiences around childhood adversity, and barriers and enablers to operationalizing policies supporting Hubs. Analysis of barriers and facilitators to implementation of Hub models of care was undertaken using the Consolidated Framework for Implementation Research (CFIR). RESULTS: Key barriers that emerged included short-term and inconsistent funding, lack of resourcing for a Hub co-ordinator, limited support for evaluation and insufficient time to plan for Hub implementation. Key enablers included flexibility and adaptability of Hub models to meet local needs, formal change management processes, strong governance structures and engagement among Hub practitioners. Key insights included the importance of targeted strategies to support sustained individual practice change and the need for organization-wide commitment to enable the successful adoption and maintenance of the Hub model of care. CONCLUSIONS: This study provides valuable insights and contributes evidence around what is needed to strengthen and support the operationalization and scalability of the Hub model of care. Key recommendations for Hub practitioners include the importance of formal change management processes and establishment of strong governance structures, while key recommendations for policymakers include the need for sustainable Hub funding and a standardized, evidence-based framework to support Hub implementation and evaluation.

EPIC-CP pilot trial study protocol: a multicentre, randomised controlled trial investigating the feasibility and acceptability of social prescribing for Australian children with cerebral palsy.

INTRODUCTION: The social determinants of health contribute to poorer health outcomes for children with cerebral palsy (CP) and are barriers to families accessing health services. At an individual level, social determinants of health are experienced as unmet social needs, for example, unsafe housing conditions. There is emerging evidence that clinical pathways for the systematic identification and referral to services for unmet social needs can support families to address these needs. These clinical pathways have not been implemented for children with CP. The objectives are to investigate the feasibility and acceptability of two co-designed social needs clinical pathways for parents/caregivers of children with CP-social prescribing (ie, Community Linker plus resource pack) compared with resource pack only. METHODS AND ANALYSIS: This pilot randomised controlled trial will run at the three tertiary paediatric rehabilitation services in New South Wales, Australia. A total of 120 participants will be recruited, with randomisation stratified by study site. A survey tool will be used to identify families experiencing unmet social needs. Parents/caregivers who report one or more unmet social need/s and consent will be eligible. The active control group will receive a resource pack containing information on community services to support unmet social needs. The social prescribing intervention group will receive one-on-one Community Linker support, in addition to the resource pack. The survey tool, intervention, logic model, and resource pack were co-designed with patient families and their healthcare workers. Feasibility of the research design and the clinical pathways will be evaluated using the number/proportion of parents/caregivers who complete the survey tool, consent, engage with the intervention, and complete research measures. Acceptability will be evaluated using questionnaires and qualitative interviews. ETHICS AND DISSEMINATION: Human research ethics approval was granted by the Sydney Children's Hospitals Network Human Research Ethics Committee (2022/ETH01688). Participants and stakeholders will receive updates and findings via regular communication channels including meetings, presentations, and publications. TRIAL REGISTRATION NUMBER: Australia New Zealand Clinical Trials Registry: 12622001459718.

Retrospective audit compares screening and treatment of pregnancy-related anaemia in regional New South Wales with Australian guidelines.

BACKGROUND: Anaemia during pregnancy is common worldwide. In Australia, approximately 17% of non-pregnant women of reproductive age have anaemia, increasing to a rate of 25% in pregnant women. This study sought to determine the rate of screening for anaemia in pregnancy in regional New South Wales, and to determine whether screening and treatment protocols followed the recommended guidelines. METHODS: This retrospective study reviewed antenatal and postnatal (48 h) data of women (n = 150) who had a live birth at Bathurst Hospital between 01/01/2020 and 30/04/2020. Demographic data, risk factors for anaemia in pregnancy, antenatal bloods, treatments provided in trimesters one (T1), two (T2) and three (T3), and postpartum complications were recorded. These were compared to the Australian Red Cross Guidelines (ARCG) using descriptive statistics. RESULTS: Of the women with screening data available (n = 103), they were mostly aged 20-35yrs (79.6%), 23.3% were obese, 97.1% were iron deficient, 17% were anaemic and only a few (5.3%) completed the full pregnancy screening as recommended by the ARCG while a majority completed only partial screenings specifically Hb levels in T1 (56.7%), T2 (44.7%) and T3 (36.6%). Compliance to oral iron was largely undocumented, but constipation was a common side effect among the women. IV iron was administered in 14.0% of women, approximately 1.75x higher than the recommended rate. CONCLUSIONS: This study provided useful information about compliance to screening and treatment guidelines for anaemia in pregnancy. We identified the need for improved documentation and communication between various health providers to ensure adequate antenatal care to prevent maternal complications during pregnancy. This will improve patient care and encourage further developments in maternal care, bridging the rural health gap.

Accounting for minimum data required to train a machine learning model to accurately monitor Australian dairy pastures using remote sensing.

Precision in grazing management is highly dependent on accurate pasture monitoring. Typically, this is often overlooked because existing approaches are labour-intensive, need calibration, and are commonly perceived as inaccurate. Machine-learning processes harnessing big data, including remote sensing, can offer a new era of decision-support tools (DST) for pasture monitoring. Its application on-farm remains poor because of a lack of evidence about its accuracy. This study aimed at evaluating and quantifying the minimum data required to train a machine-learning satellite-based DST focusing on accurate pasture biomass prediction using this approach. Management data from 14 farms in New South Wales, Australia and measured pasture biomass throughout 12 consecutive months using a calibrated rising plate meter (RPM) as well as pasture biomass estimated using a DST based on high temporal/spatial resolution satellite images were available. Data were balanced according to farm and week of each month and randomly allocated for model evaluation (20%) and for progressive training (80%) as follows: 25% training subset (1W: week 1 in each month); 50% (2W: week 1 and 3); 75% (3W: week 1, 3, and 4); and 100% (4W: week 1 to 4). Pasture biomass estimates using the DST across all training datasets were evaluated against a calibrated rising plate meter (RPM) using mean-absolute error (MAE, kg DM/ha) among other statistics. Tukey's HSD test was used to determine the differences between MAE across all training datasets. Relative to the control (no training, MAE: 498 kg DM ha-1) 1W did not improve the prediction accuracy of the DST (P > 0.05). With the 2W training dataset, the MAE decreased to 342 kg DM ha-1 (P < 0.001), while for the other training datasets, MAE decreased marginally (P > 0.05). This study accounts for minimal training data for a machine-learning DST to monitor pastures from satellites with comparable accuracy to a calibrated RPM which is considered the 'gold standard' for pasture biomass monitoring.

Data-driven collaborative QUality improvement in Cardiac Rehabilitation (QUICR) to increase program completion: protocol for a cluster randomized controlled trial.

BACKGROUND: Coronary heart disease (CHD) is the leading cause of deaths and disability worldwide. Cardiac rehabilitation (CR) effectively reduces the risk of future cardiac events and is strongly recommended in international clinical guidelines. However, CR program quality is highly variable with divergent data systems, which, when combined, potentially contribute to persistently low completion rates. The QUality Improvement in Cardiac Rehabilitation (QUICR) trial aims to determine whether a data-driven collaborative quality improvement intervention delivered at the program level over 12 months: (1) increases CR program completion in eligible patients with CHD (primary outcome), (2) reduces hospital admissions, emergency department presentations and deaths, and costs, (3) improves the proportion of patients receiving guideline-indicated CR according to national and international benchmarks, and (4) is feasible and sustainable for CR staff to implement routinely. METHODS: QUICR is a multi-centre, type-2, hybrid effectiveness-implementation cluster-randomized controlled trial (cRCT) with 12-month follow-up. Eligible CR programs (n = 40) and the individual patient data within them (n ~ 2,000) recruited from two Australian states (New South Wales and Victoria) are randomized 1:1 to the intervention (collaborative quality improvement intervention that uses data to identify and manage gaps in care) or control (usual care with data collection only). This sample size is required to achieve 80% power to detect a difference in completion rate of 22%. Outcomes will be assessed using intention-to-treat principles. Mixed-effects linear and logistic regression models accounting for clusters within allocated groupings will be applied to analyse primary and secondary outcomes. DISCUSSION: Addressing poor participation in CR by patients with CHD has been a longstanding challenge that needs innovative strategies to change the status-quo. This trial will harness the collaborative power of CR programs working simultaneously on common problem areas and using local data to drive performance. The use of data linkage for collection of outcomes offers an efficient way to evaluate this intervention and support the improvement of health service delivery. ETHICS: Primary ethical approval was obtained from the Northern Sydney Local Health District Human Research Ethics Committee (2023/ETH01093), along with site-specific governance approvals. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001239651 (30/11/2023) ( https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386540&isReview=true ).

Characterization of Echinostoma spp. (Trematoda: Echinostomatidae Looss, 1899) infecting ducks in south-eastern Australia.

Waterbirds, are one of the popular game animals and are of significant relevance to parasite spread due to their ability to fly and migrate great distances in relatively short periods of time. In Australia, however, the knowledge of parasites infecting native waterbirds is lacking with some of the last reports occurring over 50 years ago. The study aimed to characterise Echinostoma spp. infecting wild native Australian ducks found in the southern regions of the Murray Darling Basin (MDB). Ducks (n = 98) were collected from southern New South Wales within the MDB catchment. Three different species of native ducks were found including Anas superciliosa (n = 37), Anas gracilis (n = 47) and Chenonetta jubata (n = 14), of which 4.3 %, 2.7 % and 7.1 %, respectively, were found to be infected with adult stages Echinostoma spp. Examination of the parasites revealed the presence of two morphotypes. The 18S, 28S and ITS rRNA as well as the mitochondrial nad1 genes were sequenced for representative isolates of the two morphotypes. These sequences were then compared with existing sequences of Echinostoma spp. available in the GenBank. Phylogenetic analysis based on the ITS region indicated that the two morphotypes were genetically distinct. Although there are comparable sequences of Echinostoma spp. in Australia these morphotypes appear to be genetically distinct. Based on their distinct morphology and genetics we suggest that these two morphotypes are previously undescribed in Australia. This study sheds light on the presence of Echinostoma parasites in native Australian waterbirds and highlights the need for further research to better understand the diversity and prevalence of these parasites in the region.

Improving Outcomes for Regional Families in the Early Years: Increasing Access to Child and Family Health Services for Regional Australia.

Providing child and family health (CFH) services that meet the needs of young children and their families is important for a child's early experiences, development and lifelong health and well-being. In Australia, families living in regional and rural areas have historically had limited access to specialist CFH services. In 2019, five new specialist CFH services were established in regional areas of New South Wales, Australia. The purpose of this study is to understand the regional families' perceptions and experiences of these new CFH services. A convergent mixed-methods design involving a survey and semi-structured interviews with parents who had used the service was used for this study. Data collected include demographics, reasons for engaging with the service, perception, and experience of the service, including if the service provided was family centred. Triangulation of the quantitative and qualitative analysis uncovered three main findings: (i) The regional location of the service reduced the burden on families to access support for their needs; (ii) providing a service that is family-centred is important to achieve positive outcomes; and (iii) providing a service that is family-centred advances the local reputation of the service, enabling a greater reach into the community. Providing local specialist CFH services reduces the burden on families and has positive outcomes; however, providing services that are family-centred is key.

Smoking Cessation Pharmacotherapy Use in Pregnancy.

Importance: Significant evidence gaps exist regarding the safety of smoking cessation pharmacotherapies during pregnancy, especially for the risk of congenital malformations. Consequently, professional bodies advise against the use of varenicline and bupropion and recommend caution with nicotine replacement therapy (NRT). Contemporary estimates of the use of smoking cessation pharmacotherapies during pregnancy are lacking. Objective: To quantify the proportion of individuals using prescribed smoking cessation pharmacotherapies during pregnancy and during the first trimester specifically, in 4 countries. Design, Setting, and Participants: This retrospective, population-based cohort study used linked birth records, hospital admission records, and dispensing records of prescribed medications from all pregnancies resulting in birth between 2015 and 2020 in New South Wales, Australia; New Zealand; Norway; and Sweden. Data analyses were conducted in October and November 2023. Exposure: Prescribed smoking cessation pharmacotherapy use (varenicline, NRT, and bupropion) during pregnancy was defined as days' supply overlapping the period from date of conception to childbirth. Main Outcomes and Measures: Prevalence of use among all pregnancies and pregnancies with maternal smoking were calculated. Among women who used a pharmacotherapy, the proportion of women with use during the first trimester of pregnancy was also calculated. Results: Among 1 700 638 pregnancies in 4 countries, 138 033 (8.1%) had maternal smoking and 729 498 (42.9%) were younger than 30 years. The prevalences ranged from 0.02% to 0.14% for varenicline, less than 0.01% to 1.86% for prescribed NRT, and less than 0.01% to 0.07% for bupropion. Among pregnant individuals who smoked, use of pharmacotherapies was up to 10 times higher, with maximum prevalences of 1.25% for varenicline in New South Wales, 11.39% for NRT in New Zealand, and 0.39% for bupropion in New Zealand. Use in the first trimester occurred among more than 90% of individuals using varenicline, approximately 60% among those using NRT, and 80% to 90% among those using bupropion. Conclusions and Relevance: In this cohort study of pregnant individuals in 4 high-income countries, the low prevalence of varenicline and bupropion use during pregnancy and higher prevalence of NRT use aligned with current clinical guidelines. As most use occurred in the first trimester, there is a need for evidence on the risk of congenital malformations for these medications.

Clinical characteristics, associated comorbidities and hospital outcomes of neonates with sleep disordered breathing: a retrospective cohort study.

OBJECTIVE: Awareness of the need for early identification and treatment of sleep disordered breathing (SDB) in neonates is increasing but is challenging. Unrecognised SDB can have negative neurodevelopmental consequences. Our study aims to describe the clinical profile, risk factors, diagnostic modalities and interventions that can be used to manage neonates with SDB to facilitate early recognition and improved management. METHODS: A single-centre retrospective study of neonates referred for assessment of suspected SDB to a tertiary newborn intensive care unit in New South Wales Australia over a 2-year period. Electronic records were reviewed. Outcome measures included demographic data, clinical characteristics, comorbidities, reason for referral, polysomnography (PSG) data, interventions targeted to treat SDB and hospital outcome. Descriptive analysis was performed and reported. RESULTS: Eighty neonates were included. Increased work of breathing, or apnoea with oxygen desaturation being the most common reasons (46% and 31%, respectively) for referral. Most neonates had significant comorbidities requiring involvement of multiple specialists (mean 3.3) in management. The majority had moderate to severe SDB based on PSG parameters of very high mean apnoea-hypopnoea index (62.5/hour) with a mean obstructive apnoea index (38.7/hour). Ten per cent of patients required airway surgery. The majority of neonates (70%) were discharged home on non-invasive ventilation. CONCLUSION: SDB is a serious problem in high-risk neonates and it is associated with significant multisystem comorbidities necessitating a multidisciplinary team approach to optimise management. This study shows that PSG is useful in neonates to diagnose and guide management of SDB.

School performance in children with prenatal drug exposure and out-of-home care in NSW, Australia: a retrospective population-based cohort study.

BACKGROUND: Prenatal drug exposure (PDE) is a global public health problem that is strongly associated with the need for child protection services, including placement into out-of-home care (OOHC). We aimed to assess school outcomes for children with PDE (both with and without neonatal abstinence syndrome [NAS]) and the association of school performance with OOHC. METHODS: Using linked population health, OOHC, and school test data, we compared results on the Australian standardised curriculum-based test, the National Assessment Program-Literacy and Numeracy (NAPLAN), for children with PDE who were born in New South Wales (NSW) between 2001 and 2020 and had completed at least one NAPLAN test between Jan 1, 2008, and June 30, 2021, administered in Year 3 (age 8-9 years), Year 5 (age 10-11 years), Year 7 (age 12-13 years), or Year 9 (age 14-15 years). Linked datasets included NSW Perinatal Data Collection (birth data), NSW Admitted Patient Data Collection (hospital diagnoses), NSW Education Standards Authority (NAPLAN scores), NSW Family and Community Services Dataset-KiDS Data Collection (OOHC information), NSW Mental Health Ambulatory Data Collection, and NSW Registry for Births, Deaths, and Marriages. The primary outcome was scoring above or below the National Minimum Standard (NMS) in any test domain (mathematics, language, writing, and spelling) at each year level, comparing the relative risk of scoring below NMS between children with and without PDE (and with or without NAS within the PDE group), and with and without OOHC contact. The association between OOHC on the likelihood of scoring above NMS was also investigated for PDE and non-PDE cohorts. FINDINGS: The PDE cohort included 3836 children, and the non-PDE cohort included 897 487 children. Within the PDE cohort, 3192 children had a NAS diagnosis and 644 children had no NAS diagnosis. 1755 (45·8%) children with PDE required OOHC compared with 12 880 (1·4%) of 897 487 children without PDE. Children with PDE were more likely than children without PDE to score below NMS in any domain from Year 3 (risk ratio 2·72 [95% CI 2·58-2·76]) to Year 9 (2·36 [2·22-2·50]). Performance was similar regardless of a NAS diagnosis (Year 3: 0·96 [0·84-1·10]; Year 9: 0·98 [0·84-1·15]). The likelihood of scoring above NMS in Year 9 was reduced for children with PDE and without NAS (0·57 [0·45-0·73]) and NAS (0·58 [0·52-0·64]) compared with those without PDE, and also for children who received OOHC (0·60 [0·57-0·64]) compared with those without OOHC, when adjusted for confounders. Among children with PDE, those receiving OOHC had a similar likelihood of scoring above NMS compared with children who did not receive OOHC, from Year 3 (1·01 [0·92-1·11]) to Year 9 (0·90 [0·73-1·10]), when adjusted for confounding factors. By contrast, among children without PDE, those receiving OOHC were less likely to score above NMS than those who did not receive OOHC, from Year 3 (0·78 [0·76-0·80]) to Year 9 (0·58 [0·54-0·61]). INTERPRETATION: Compared with children without PDE, school performance in children with PDE-regardless of whether they were diagnosed with NAS-is poor, and the gap widens with age. The risk of poor performance persists regardless of OOHC status. This finding underscores the need for all children with PDE to receive long-term, culturally sensitive, and proactive support to improve life success. FUNDING: SPHERE Mindgardens Neuroscience Network, Australian Red Cross, Alpha Maxx Healthcare, Centre for Research Excellence for Integrated Health and Social Care, National Health and Medical Research Council, and University of Sydney.

Out-of-pocket health care expenses for people with and without cancer, New South Wales, 2020: a cross-sectional study.

OBJECTIVES: To investigate self-reported out-of-pocket health care expenses, both overall and by cost type, for a large population-based sample of Australians, by cancer status and socio-demographic and medical characteristics. STUDY DESIGN: Cross-sectional study. SETTING, PARTICIPANTS: New South Wales residents participating in the 45 and Up Study (recruited aged 45 years or older during 2005-2009) who completed the 2020 follow-up questionnaire; survey responses linked with New South Wales Cancer Registry data. MAIN OUTCOME MEASURES: Proportions of respondents who reported that out-of-pocket health care expenses during the preceding twelve months exceeded $1000 or $10 000; adjusted odds ratios (aORs) for associations with socio-demographic and medical characteristics. RESULTS: Of the 267 357 recruited 45 and Up Study participants, 45 061 completed the 2020 survey (response rate, 53%); 42.7% (95% confidence interval [CI], 42.2-43.1%) reported that overall out-of-pocket health care expenses during the previous year exceeded $1000, including 55.4% (52.1-58.7%) of participants diagnosed in the preceding two years and 44.9% (43.7-46.1%) of participants diagnosed with cancer more than two years ago. After adjustment for socio-demographic factors, out-of-pocket expenses greater than $1000 were more likely to be reported by participants with cancer than by those without cancer (diagnosis in past two years: aOR, 2.06 [95% CI, 1.77-2.40]; diagnosis more than two years ago: aOR, 1.22 [95% CI, 1.15-1.29]). The odds of out-of-pocket expenses exceeding $1000 increased with area-based socio-economic advantage and household income, and were higher for people with private health insurance (v people with Medicare coverage only: aOR, 1.64; 95% CI, 1.53-1.75). Out-of-pocket expenses exceeding $10 000 were also more likely for participants diagnosed with cancer during the past two years (v no cancer: aOR, 3.30; 95% CI, 2.56-4.26). CONCLUSIONS: People diagnosed with cancer during the past two years were much more likely than people without cancer to report twelve-month out-of-pocket health care expenses that exceeded $1000. Out-of-pocket expenses for people with cancer can exacerbate financial strain at a time of vulnerability, and affect health care equity because some people cannot pay for all available treatments.

Real-world utilisation of SARS-CoV-2 rapid antigen testing to enable face-to-face learning in Australian schools, an ecological study.

OBJECTIVE: The objective of this study was to describe the use of SARS-CoV-2 rapid antigen testing of COVID-19 contacts in New South Wales schools to determine return to in-person school attendance instead of home quarantine, between 6 November and 21 December 2021. METHODS: COVID-19 school contacts were required to quarantine for two weeks postexposure to the case. Students who opted into daily rapid antigen testing logged their results in a database, prior to school attendance, and obtained SARS-CoV-2 nucleic amplification acid testing on day 12-16. Secondary attack rates (SARs) in schools utilising rapid antigen testing (Test-to-Stay schools) and those not utilising rapid antigen testing (non-Test-to-Stay school) were calculated. RESULTS: We identified 9,887 people in 293 schools who reported performing at least one rapid antigen test (RAT). The SAR in RAT schools was 3.4% (95% confidence interval: 2.7-4.1) and non-RAT schools was 2.8% (95% confidence interval: 2.4-3.3). A total of 30,535 school days were preserved through this program. CONCLUSIONS: The use of RATs preserved in-person learning without a significant increase to SAR. IMPLICATION FOR PUBLIC HEALTH: Disruptions in face-to-face learning have long-term detrimental impacts on children and adolescents. Rapid antigen testing has been shown to be beneficial to maintain face-to-face learning in Australian schools and may be a useful method to safeguard from school disruptions in future pandemics.