A critical review of clinician-directed nudges.

As nudges-subtle changes to the way options are presented to guide choice-have gained popularity across policy domains in the past 15 years, healthcare systems and researchers have eagerly deployed these light-touch interventions to improve clinical decision-making. However, recent research has identified the limitations of nudges. Although nudges may modestly improve clinical decisions in some contexts, these interventions (particularly nudges implemented as electronic health record alerts) can also backfire and have unintended consequences. Further, emerging research on crowd-out effects suggests that healthcare nudges may direct attention and resources toward the clinical encounter and away from the main structural drivers of poor health outcomes. It is time to move beyond nudges and toward the development of multi-level, structurally focused interventions.

Disparities in Depression and Anxiety That Impact Self-Identified Sexual Minority People Affect a Broader Group of Same-Gender Attracted Young Adults.

PURPOSE: Prior work suggests sexual minority (e.g., gay, bisexual) young adults are at greater risk for depression and anxiety. However, the majority of said work focuses exclusively on self-reported sexual minority identity and neglects same-gender attraction. The current study aimed to characterize links between identity- and attraction-based indicators of sexual minority status and depression and anxiety in young adults, and to examine the ongoing significance of caregiver support in mental health during this key developmental period. METHODS: 386 youth (mean age = 19.92 years; SD = 1.39) reported their sexual orientation identity and experiences of attraction toward men and/or women. Participants also reported on anxiety, depression, and caregiver social support. RESULTS: While less than 16% of participants identified as sexual minority individuals, nearly half reported same-gender attraction. Self-identified sexual minority participants reported significantly higher depression and anxiety than self-identified heterosexual participants. Similarly, same-gender attracted individuals exhibited heightened depression and anxiety compared to exclusively different-gender attracted individuals. Greater caregiver social support predicted lower depression and anxiety. DISCUSSION: The present findings suggest that not only are self-identified sexual minority individuals at heightened risk for depression and anxiety symptoms, but also that this risk extends to a larger group of young people who experience same-gender attraction. These results demonstrate that better mental health supports may be needed for youth who identify as sexual minority individuals or report same-gender attraction. That higher caregiver social support was associated with lower mental illness risk suggests caregivers may be key to mental health promotion during young adulthood.

Epidemiological and clinical characteristics of legionellosis in Northern Australia, 2010-2021.

Objective: This study describes characteristics of the legionellosis cases occurring between 2010 and 2021 in the Northern Territory (NT), Australia. Methods: We retrospectively reviewed 53 cases of legionellosis during the defined period and documented patient and clinical characteristics, diagnostics, and seasonality of infection. Results: All cases were sporadic. The incidence rate in the NT was higher than the Australian median rate (2.1 and 1.5 per 100,000 population per year respectively). Aboriginal and Torres Strait Islander patients presented at a younger age than did non-Indigenous patients (median 41 and 60 years of age respectively), and overall there was a male preponderance. There was a higher proportion of legionellosis in the months with increased humidity, with a greater number of L. longbeachae infections detected overall (59%) than of L. pneumophila (41%). The majority of cases were diagnosed serologically (57% of L. pneumophilia and 93% of L. longbeachae ). Conclusions: Legionellosis in the NT is more common, seasonal, and may be underreported due to current reliance on serological testing for diagnosis. The higher incidence of legionellosis, and the younger age of Aboriginal and Torres Strait Islander patients of the NT, have public health implications, given that the clinical presentation of legionellosis is indistinguishable from other forms of pneumonia.

An outbreak of leptospirosis associated with cattle workers during the wet season, in the Northern Territory of Australia, 2021.

Abstract: An outbreak of leptospirosis occurred in the Top End of the Northern Territory, Australia, during the wet season in early 2021. There were 14 outbreak cases; most were male (12/14; 86%) and non-Indigenous (13/14; 93%) with a median age of 22 years (range 19-52 years). We conducted a descriptive case series to investigate the outbreak. We determined that the outbreak was most likely due to higher than usual rainfall in a workplace with exposure to cattle, heightened by wearing clothing and footwear which offered little protection, with limited use of personal protective equipment (PPE). Increased and ongoing education for cattle industry workers, and promotion of the use of appropriate clothing and PPE, may minimise the risk of future outbreaks. Australia's national surveillance case definition for leptospirosis should be reviewed to incorporate the use of nucleic acid testing in the detection of leptospirosis.