COVID-19 Vaccination Program for Migrant and Refugee Women in Western Australia: Community-Led Approach and Decolonizing Practice Reflections.

The COVID-19 pandemic disproportionately impacted culturally and racially marginalized (CARM) migrants in Australia, with communities having varying levels of accurate knowledge about COVID-19 vaccines. At the height of the pandemic, public health programs that prioritized colonial knowledge and practices resulted in negative social, economic, and health outcomes for CARM communities. To support access to COVID-19 vaccinations and equity in delivery, therefore, it is critical that awareness-raising programs are tailored to meet all communities' intersecting needs. In this paper, we share our reflections on a community-led COVID-19 vaccination awareness program designed specifically for CARM migrant women in Perth, Western Australia. The program was led by CARM migrant women who delivered five public information sessions for women in the Pakistani, Iraqi, Chin, and Indonesian communities. This paper offers an overview of the program and critical reflections on the challenges involved in community-led programs that are underpinned by a commitment to decolonization.

The use of computed tomography in the management of injury in tertiary emergency departments in Western Australia: Evidence of overtesting?

BACKGROUND: This study investigated trends in computed tomography (CT) utilization across different triage categories of injury presentations to tertiary emergency departments (EDs) and associations with diagnostic yield measured by injury severity, hospitalization and length of stay (LOS), and mortality. METHODS: A total of 411,155 injury-related ED presentations extracted from linked records from Western Australia from 2004 to 2015 were included in the retrospective study. The use of CT scanning and diagnostic yield measured by rate of diagnosis with severe injury, hospitalizations and LOS, and mortality were captured annually for injury-related ED presentations. Multivariable regression models were used to calculate the annual adjusted rate of CT scanning for injury presentations and hospitalizations across triage categories, diagnosis with severe injury, LOS, and mortality. The significance of changes observed was compared among patients with CT imaging relative to those without CT. RESULTS: While the number of ED presentations with injury increased by 65% from 2004 to 2015, the use of CT scanning in these presentations increased by 176%. The largest increase in CT use was among ED presentations triaged as semi-/nonurgent (+256%). Injury presentations with CT, compared to those without, had a higher rate of diagnosis with moderate/severe injury and hospitalization but no difference in LOS and mortality. The probability/rate observed in the outcomes of interest had a greater decrease over time in those with CT scanning compared with those without CT scanning across triage categories. CONCLUSIONS: The reduction in diagnostic yield in terms of injury severity and hospitalization found in our study might indicate a shift toward overtesting using CT in ED for injury or a higher use of CT to assist in the management of injuries. This helps health care policymakers consider whether the current increase in CT use meets the desired levels of quality and efficient care.