Modelling jurisdictional disparities in the cascade of care for chronic hepatitis B in Australia: impact of treatment uptake on mortality.

OBJECTIVE: Investigate the cascade of care for chronic hepatitis B (CHB) and estimate impacts of increasing treatment uptake on attributable burden, according to jurisdiction. METHODS: A mathematical model of CHB in Australia was utilised, combined with notifiable disease and Medicare data. We estimated the proportion with CHB who were diagnosed, engaged in care and receiving treatment in each state/territory, and projected future mortality. RESULTS: The highest uptake of all measures was in New South Wales, however, the largest increase over time occurred in Northern Territory. No jurisdiction is due to meet 2022 targets of treatment uptake or mortality reduction. Previously declining mortality is predicted to plateau or increase in all jurisdictions except Northern Territory. The largest gap in the cascade of care was most commonly diagnosed individuals not engaged in care; however, in Victoria and Tasmania it was lack of diagnosis. CONCLUSIONS: Measures of the cascade of care varied substantially between jurisdictions; while all require improvements to reduce mortality, the specific gaps vary, as do potential impacts. IMPLICATIONS FOR PUBLIC HEALTH: Improving the cascade of care for CHB will require jurisdictionally tailored approaches. If improvements are not made, more deaths will occur due to CHB in most states and territories.

Stressors, manifestations and course of COVID-19 related distress among public sector nurses and midwives during the COVID-19 pandemic first year in Tasmania, Australia.

Impacts of the COVID-19 pandemic on the mental health of healthcare workers has been established, linking workplace factors with high levels of stress, anxiety, depression, insomnia and burnout. Less established is how COVID-19 affects both work, home and social life of nurses and midwives concurrently. This study describes the prevalence and severity of anxiety, depression, post-traumatic stress disorder (PTSD) and insomnia and examines their associations with stressors within the work, home and social environment, among nurses and midwives. A longitudinal, mixed-methods, online survey explored the psychological health of public sector nurses and midwives during the COVID-19 pandemic first year. Surveys were conducted in April (initial) and June 2020 (3-month), and April 2021 (12-month) and consisted of psychological tests including the Patient Health Questionnaire, General Anxiety Disorder, Insomnia Severity Index, and the Impact of Events Scale-Revised; workplace and lifestyle questions, together with free-text comments. The relative strengths of the associations between predictor and outcome variables were estimated using repeated measures ordered logistic regression, and free text responses were themed. Data show diagnostic levels of anxiety (23%, 18%, 21%) at surveys one, two and three respectively, depression (26%, 23% and 28%), PTSD (16%, 12% and 10%) and insomnia (19%, 19% and 21%). The strongest predictors of psychological distress were current home and family stress and poor clinical team support. Factors which will help preserve the mental health of nurses and midwives include strong workplace culture, reducing occupational risk, clear communication processes, and supporting stable and functional relationships at home. The COVID-19 pandemic has increased the visibility of mental distress on nurses and midwives and established they are pivotal to healthcare. The health service has a duty-of-care for the welfare of nurses and midwives who have entered this psychologically taxing profession to future proof service delivery and safeguard its service-response capacity.

Natural products isolation studies of the paleoendemic plant species Nothofagus gunnii and Nothofagus cunninghamii.

The first natural product isolation studies of Nothofagus gunnii (Hook.f.) Oerst and Nothofagus cunninghamii (Hook.f.) Oerst have been undertaken. A previously unreported stilbene derivative, pinosylvin monoacetate, was isolated from the leaves of N. gunnii, in addition to 14 known compounds; including the flavonoids galangin, pinobanksin, catechin and quercetin; sesquiterpenoids such as, ilicol and (+)-ß-costol acetate; 2,4-dihydroxy-6-methoxychalcone and pinosylvin. Four known flavonoid natural products, catechin, quercetin, ayanin, and avicularin were isolated from the leaves of N. cunninghamii. This study reveals that N. gunnii is a rich source of flavonoid, chalcone and stilbene compounds, while primarily hydroxyflavonoid compounds are found in N. cunninghamii. The isolated phytochemicals are consistent with the evolutionary relationships suggested to exist among Nothofagus species.

Competing risks of death and kidney failure in a cohort of Australian adults with severe chronic kidney disease.

OBJECTIVES: To examine the competing risks of death (any cause) and of kidney failure in a cohort of Australian adults with severe chronic kidney disease. DESIGN: Population-based cohort study; analysis of linked data from the Tasmanian Chronic Kidney Disease study (CKD.TASlink), 1 January 2004 - 31 December 2017. PARTICIPANTS: All adults in Tasmania with incident stage 4 chronic kidney disease (estimated glomerular filtration rate [eGFR], 15-29 mL/min/1.73 m2 ). MAIN OUTCOME MEASURES: Death or kidney failure (defined as eGFR below 10 mL/min/1.73 m2 or initiation of dialysis or kidney transplantation) within five years of diagnosis of stage 4 chronic kidney disease. RESULTS: We included data for 6825 adults with incident stage 4 chronic kidney disease (mean age, 79.3 years; SD, 11.1 years), including 3816 women (55.9%). The risk of death increased with age - under 65 years: 0.18 (95% CI, 0.15-0.22); 65-74 years: 0.39 (95% CI, 0.36-0.42); 75-84 years, 0.56 (95% CI, 0.54-0.58); 85 years or older: 0.78 (95% CI, 0.77-0.80) - while that of kidney failure declined - under 65 years: 0.39 (95% CI, 0.35-0.43); 65-74 years: 0.12 (95% CI, 0.10-0.14); 75-84 years: 0.05 (95% CI, 0.04-0.06); 85 years or older: 0.01 (95% CI, 0.01-0.02). The risk of kidney failure was greater for people with macroalbuminuria and those whose albumin status had not recently been assessed. The risks of kidney failure and death were greater for men than women in all age groups (except similar risks of death for men and women under 65 years of age). CONCLUSIONS: For older Australians with incident stage 4 chronic kidney disease, the risk of death is higher than that of kidney failure, and the latter risk declines with age. Clinical guidelines should recognise these competing risks and include recommendations about holistic supportive care, not just on preparation for dialysis or transplantation.

Characterising non-linear associations between airborne pollen counts and respiratory symptoms from the AirRater smartphone app in Tasmania, Australia: A case time series approach.

Pollen is a well-established trigger of asthma and allergic rhinitis, yet concentration-response relationships, lagged effects, and interactions with other environmental factors remain poorly understood. Smartphone technology offers an opportunity to address these challenges using large, multi-year datasets that capture individual symptoms and exposures in real time. We aimed to characterise associations between six pollen types and respiratory symptoms logged by users of the AirRater smartphone app in Tasmania, Australia. We analyzed 44,820 symptom reports logged by 2272 AirRater app users in Tasmania over four years (2015-2019). With these data we evaluated associations between daily respiratory symptoms and atmospheric pollen concentrations. We implemented Poisson regression models, using the case time series approach designed for app-sourced data. We assessed potentially non-linear and lagged associations with (a) total pollen and (b) six individual pollen taxa. We adjusted for seasonality and meteorology and tested for interactions with particulate air pollution (PM2.5). We found evidence of non-linear associations between total pollen and respiratory symptoms for up to three days following exposure. For total pollen, the same-day relative risk (RR) increased to 1.31 (95% CI: 1.26-1.37) at a concentration of 50 grains/m3 before plateauing. Associations with individual pollen taxa were also non-linear with some diversity in shapes. For all pollen taxa the same-day RR was highest. The interaction between total pollen and PM2.5 was positive, with risks associated with pollen significantly higher in the presence of high concentrations of PM2.5. Our results support a non-linear response between airborne pollen and respiratory symptoms. The association was strongest on the day of exposure and synergistic with particulate air pollution. The associations found with Dodonaea and Myrtaceae highlight the need to further investigate the role of Australian native pollen types in allergic respiratory disease.

Short term magnesium supplementation to reduce dark cutting in pasture finished beef cattle.

This study assessed the capacity of magnesium supplementation to reduce muscle glycogen loss, ultimate pH and increase plasma magnesium in pasture fed slaughter cattle. Beef cattle (n = 1075) from 14 farms were supplemented with or without magnesium pellets for 7-14 days prior to slaughter. Magnesium was allocated at 9.83 g of elemental magnesium per head per day, while the control diet was balanced to be isoenergetic and isonitrogenous, but contained no added magnesium. Groups of cattle (n = 44) were slaughtered at the same processing plant over two consecutive seasons, from August - September 2016 to May - July 2017. Magnesium supplementation increased muscle glycogen (P < 0.01) in cattle supplied from 2 of 14 farms, and increased plasma magnesium in 4 of 14 farms (P < 0.01). Magnesium supplementation had no effect on overall incidence of ultimate pH between the magnesium and control supplementation groups. The benefits of short term magnesium supplementation prior to slaughter was inconsistent for protecting muscle glycogen.

Population Vitamin D Stores Are Increasing in Tasmania, and This Is Associated With Less BMD Loss Over 10 Years.

CONTEXT: Vitamin D deficiency is a common, modifiable determinant of musculoskeletal health. OBJECTIVE: There are limited data that examine the longitudinal change in population 25-hydroxyvitamin D (25[OH]D) and none that evaluate the long-term skeletal outcomes of longitudinal vitamin D status. METHODS: A prospective cohort analysis was conducted of community-dwelling adults aged 50 to 80 years who had 25(OH)D assessed by radioimmunoassay and bone mineral density (BMD) by dual-energy x-ray absorptiometry at baseline (n = 1096), 2.5 (n = 870), and 10 (n = 565) years. Sun exposure was quantified by questionnaire and supplement use at clinic review. 25(OH)D less than 50 nmol/L was considered deficient. Participants were provided with their 25(OH)D results. RESULTS: Over 10 years 25(OH)D increased (52.2 ±â€…17.0 to 63.5 ±â€…23.6 nmol/L, P < .001). Participants with baseline deficiency had larger 25(OH)D increases than baseline sufficient participants (19.2 ±â€…25.3 vs 1.6 ±â€…23.3 nmol/L, P < .001). Longitudinal change in 25(OH)D was associated with baseline summer (ß = 1.46, P < .001) and winter (ß = 1.29, P = .003) sun exposure, change in summer (ß = 1.27, P = .002) and winter (ß = 1.47, P < .001) sun exposure, and vitamin D supplement use (ß = 25.0-33.0, P < .001). Persistent vitamin D sufficiency was associated with less BMD loss at the femoral neck (ß = 0.020, P = .027), lumbar spine (ß = 0.033, P = .003), and total hip (ß = 0.023, P = .021) compared to persistent vitamin D deficiency. Achieving vitamin D sufficiency was associated with less BMD loss at the lumbar spine (ß = 0.045, P < .001) compared to persistent vitamin D deficiency. CONCLUSIONS: Population 25(OH)D concentration increased because of a combination of increased sun exposure and supplement use. Maintaining or achieving vitamin D sufficiency was associated with less BMD loss over 10 years.

Disease modifying therapies for relapsing-remitting multiple sclerosis: Use and costs in Australia (1996-2019).

BACKGROUND: New disease modifying therapies (DMT) to control relapsing-remitting multiple sclerosis (RRMS) have been introduced to the market in the past few years and are now widely used in Australia. OBJECTIVE: To analyse the dispensed use of government subsidised RRMS DMTs in Australia from 1996 to 2019. METHODS: We obtained data of dispensed use of DMTs from the Australian Government's Pharmaceutical Benefits Scheme (PBS) administered by Medicare Australia. We measured use as defined daily dose (DDD) per 100,000 population per day. We obtained jurisdictional population data from the Australian Bureau of Statistics. RESULTS: Total DMT use increased by an average of 18% annually, from 2.4 (in 1996) to 69.9 DDD/100,000/day in 2019. Interferon ß1B was the most commonly used medicine between 1996 and 2000, Interferon ß1A between 2001 and 2014, and fingolimod subsequently. Among Australian states, Tasmania (the southernmost state) had the highest dispensed DMT use of 94.6 DDD/100,000/day in 2019. Concession beneficiaries under the Government's PBS had both lower use and cost per patient than general beneficiaries did. Fingolimod and ocrelizumab accounted for 55% of total expenditure on MS drug therapy in 2019. CONCLUSION: The use of oral DMTs might increasingly replace parenteral treatments in the near future. Given the current substantial government expenditure on oral DMTs, it will be imperative to examine the real world effectiveness of DMTs.

Papuan mitochondrial genomes and the settlement of Sahul.

New Guineans represent one of the oldest locally continuous populations outside Africa, harboring among the greatest linguistic and genetic diversity on the planet. Archeological and genetic evidence suggest that their ancestors reached Sahul (present day New Guinea and Australia) by at least 55,000 years ago (kya). However, little is known about this early settlement phase or subsequent dispersal and population structuring over the subsequent period of time. Here we report 379 complete Papuan mitochondrial genomes from across Papua New Guinea, which allow us to reconstruct the phylogenetic and phylogeographic history of northern Sahul. Our results support the arrival of two groups of settlers in Sahul within the same broad time window (50-65 kya), each carrying a different set of maternal lineages and settling Northern and Southern Sahul separately. Strong geographic structure in northern Sahul remains visible today, indicating limited dispersal over time despite major climatic, cultural, and historical changes. However, following a period of isolation lasting nearly 20 ky after initial settlement, environmental changes postdating the Last Glacial Maximum stimulated diversification of mtDNA lineages and greater interactions within and beyond Northern Sahul, to Southern Sahul, Wallacea and beyond. Later, in the Holocene, populations from New Guinea, in contrast to those of Australia, participated in early interactions with incoming Asian populations from Island Southeast Asia and continuing into Oceania.

Distinct Drimane Chemotypes in Tasmanian Mountain Pepper (Tasmannia lanceolata): Differences in the Profiles of Pungent Leaf Phytochemicals Associated with Altitudinal Cline.

This study assesses whether the distinct altitudinal cline in leaf morphology (decreased leaf width and length with increased altitude) in Tasmanian mountain pepper (Tasmannia lanceolata) is associated with changes in the leaf chemistry of wild populations from different ecological landscapes and altitudes. The presence of distinct pungent drimane sesquiterpenoid chemotypes was identified: subalpine woodland and wet sclerophyll forest chemotypes. Isolation studies and analysis of extracts revealed that wet sclerophyll forest T. lanceolata populations featured polygodial as the principal terpenoid, with profiles similar to the commercial cultivars sampled. In contrast, the subalpine woodland populations contained the drimane sesquiterpenoids 1ß-acetoxy-9-deoxyisomuzigadial and 3ß-acetoxydrimenin and the conspicuous absence of the pungent principle polygodial.

Effects of soil- and climate data aggregation on simulated potato yield and irrigation water requirement.

Input data aggregation affects crop model estimates at the regional level. Previous studies have focused on the impact of aggregating climate data used to compute crop yields. However, little is known about the combined data aggregation effect of climate (DAEc) and soil (DAEs) on irrigation water requirement (IWR) in cool-temperate and spatially heterogeneous environments. The aims of this study were to quantify DAEc and DAEs of model input data and their combined impacts for simulated irrigated and rainfed yield and IWR. The Agricultural Production Systems sIMulator Next Generation model was applied for the period 1998-2017 across areas suitable for potato (Solanum tuberosum L.) in Tasmania, Australia, using data at 5, 15, 25 and 40 km resolution. Spatial variances of inputs and outputs were evaluated by the relative absolute difference (rAD¯) between the aggregated grids and the 5 km grids. Climate data aggregation resulted in a rAD¯ of 0.7-12.1%, with high values especially for areas with pronounced differences in elevation. The rAD¯ of soil data was higher (5.6-26.3%) than rAD¯ of climate data and was mainly affected by aggregation of organic carbon and maximum plant available water capacity (i.e. the difference between field capacity and wilting point in the effective root zone). For yield estimates, the difference among resolutions (5 km vs. 40 km) was more pronounced for rainfed (rAD¯ = 14.5%) than irrigated conditions (rAD¯ = 3.0%). The rAD¯ of IWR was 15.7% when using input data at 40 km resolution. Therefore, reliable simulations of rainfed yield require a higher spatial resolution than simulation of irrigated yields. This needs to be considered when conducting regional modelling studies across Tasmania. This study also highlights the need to separately quantify the impact of input data aggregation on model outputs to inform about data aggregation errors and identify those variables that explain these errors.

Women Remain at Risk of Iodine Deficiency during Pregnancy: The Importance of Iodine Supplementation before Conception and Throughout Gestation.

In Australia, pregnant women are advised to take an iodine supplement (I-supp) (150 µg/day) to reduce risks to the foetus associated with iodine deficiency (ID). To examine the impact of this recommendation on iodine status, and to identify factors that contribute to adequacy during gestation, supplement use and Urinary Iodine Concentration (UIC) was measured in 255 pregnant women (gestation range 6 to 41 weeks) in Tasmania. The median UIC (MUIC) of 133 µg/L (Inter-quartile range 82⁻233) was indicative of ID, being below the 150⁻249 µg/L range for adequacy during pregnancy. Women taking an iodine-containing-supplement (I-supp) had a significantly higher MUIC (155 µg/L) (n = 171) compared to the combined MUIC (112.5 µg/L) (n = 84) of those who had never (120 µg/L) (n = 61) or were no longer taking an I-supp (90 µg/L) (n = 23) (p = 0.017). Among women reporting I-supp use, the MUIC of those commencing the recommended 150 µg/day prior to conception was significantly higher than those starting supplementation following pregnancy confirmation: 196 (98⁻315) µg/L (n = 45) versus 137.5 (82.5⁻233.5) µg/L (n = 124), p = 0.032. Despite recommendations for iodine supplementation pregnant Tasmanian women remain at risk of ID. Commencing an I-supp of 150 µg/day prior to conception and continuing throughout pregnancy is required to ensure adequacy. Timely advice regarding the importance of adequate iodine nutrition, including supplementation is needed to reduce the risk of irreversible in utero neurocognitive damage to the foetus.

Metal and Isotope Analysis of Bird Feathers in a Contaminated Estuary Reveals Bioaccumulation, Biomagnification, and Potential Toxic Effects.

The Derwent estuary, in south east Tasmania, is highly contaminated with heavy metals, mainly due to past industrial pollution. This study sought to determine the extent of contamination, bioaccumulation, and biomagnification in the resident bird community and therefore to infer the potential for adverse effects in birds. Thirteen metals were measured from breast feathers (n = 51 individuals) of eight sympatric species of aquatic bird. Stable carbon (δ13C) and nitrogen (δ15N) isotopes were used to identify dietary sources of contaminants, trophic level, and potential biomagnification through food chains. Generalised linear models revealed that metal burdens were often poorly correlated with δ 13C, indicating their uptake from a range of freshwater, brackish, and marine carbon sources-not surprising due to widespread contamination across the tidal estuary. Feather mercury increased significantly with trophic level (inferred from δ15N). White-bellied Sea-eagle Haliaeetus leucogaster samples contained 240 times more mercury than feral Goose Anser cygnoides. Feather arsenic and copper concentrations were significantly higher in birds feeding lower in the food chain. For several piscivorous species, both chick and adults were sampled revealing significantly higher feather mercury, zinc, and selenium in adults. Feathers from birds found dead along the banks of the estuary had significantly higher lead loads than from live birds, and numerous individuals had levels of mercury, zinc, and lead above toxic thresholds reported in other studies. These results highlight the need to include biota from higher trophic levels in contaminant monitoring programs to understand fully the fate and broader implications of contaminants in the environment.

Extraction of carboxylic acid-containing diterpenoids from Dodonaea viscosa via pressurised hot water extraction.

Pressurised hot water extraction (PHWE) was employed to effect the extraction of two carboxylic acid-containing ent-labdane diterpenoids from Dodonaea viscosa. The different extraction profile provided by PHWE in this case suggests that this recently developed method also has applications as a complementary tool for natural products extraction.

Identifying and acting on potentially inappropriate care? Inadequacy of current hospital coding for this task.

INTRODUCTION: Recent Australian attempts to facilitate disinvestment in healthcare, by identifying instances of 'inappropriate' care from large Government datasets, are subject to significant methodological flaws. Amongst other criticisms has been the fact that the Government datasets utilized for this purpose correlate poorly with datasets collected by relevant professional bodies. Government data derive from official hospital coding, collected retrospectively by clerical personnel, whilst professional body data derive from unit-specific databases, collected contemporaneously with care by clinical personnel. AIM: Assessment of accuracy of official hospital coding data for hyperbaric services in a tertiary referral hospital. METHODS: All official hyperbaric-relevant coding data submitted to the relevant Australian Government agencies by the Royal Hobart Hospital, Tasmania, Australia for financial year 2010-2011 were reviewed and compared against actual hyperbaric unit activity as determined by reference to original source documents. RESULTS: Hospital coding data contained one or more errors in diagnoses and/or procedures in 70% of patients treated with hyperbaric oxygen that year. Multiple discrete error types were identified, including (but not limited to): missing patients; missing treatments; 'additional' treatments; 'additional' patients; incorrect procedure codes and incorrect diagnostic codes. Incidental observations of errors in surgical, anaesthetic and intensive care coding within this cohort suggest that the problems are not restricted to the specialty of hyperbaric medicine alone. Publications from other centres indicate that these problems are not unique to this institution or State. CONCLUSIONS: Current Government datasets are irretrievably compromised and not fit for purpose. Attempting to inform the healthcare policy debate by reference to these datasets is inappropriate. Urgent clinical engagement with hospital coding departments is warranted.

Temporal trends in thyroid-stimulating hormone (TSH) and thyroid peroxidase antibody (ATPO) testing across two phases of iodine fortification in Tasmania (1995-2013).

CONTEXT: Tasmania is an island state of the Australian Commonwealth with a well-documented history of mild iodine deficiency. Between 2001 and 2009, Tasmania experienced two incremental phases of iodine fortification. OBJECTIVE: To examine trends in thyroid-stimulating hormone (TSH) and thyroid peroxidase antibody (ATPO) testing and their relationship to different phases of iodine nutrition in the Tasmanian population between 1995 and 2013. DESIGN: Retrospective longitudinal study. SETTING AND PARTICIPANTS: The major primary care and largest public hospital pathology providers in Tasmania submitted data for all TSH and ATPO tests performed between 1995 and 2013. Data linkage methodology was used to determine trends in TSH and ATPO testing. RESULTS: A total of 1.66 million TSH assessments, involving 389,910 individual patients, were performed in Tasmania between 1995 and 2013. There was approximately a fourfold increase in the overall rate of TSH testing during this period with the rate of incident TSH assessment remaining relatively stable over the study period. The incidence of overt suppression and elevation of TSH (TSH≤0.1 mIU/L and ≥10 mIU/L) declined 62.3% and 59.7%, respectively, with a trend for increased incidence of borderline TSH elevation ≥4.0 mIU/L. The incidence of thyroid autoimmunity as determined by the proportion of abnormal ATPO results remained stable, with the absolute number of positive test results increasing during the study period. CONCLUSION: Iodine supplementation of this mildly iodine-deficient population was not associated with an obvious increase in incidence of overt thyroid dysfunction or autoimmunity. Whilst the volume of TSH testing increased over the study period, the increase was driven by patients undergoing follow-up TSH assessments.