Bullying, discrimination, and sexual harassment among intensive care unit nurses in Australia and New Zealand: An online survey.

BACKGROUND: Bullying, discrimination, and sexual harassment are significant problems within healthcare organisations but are often under-reported. Consequences of these behaviours within a healthcare setting are wide ranging, affecting workplace environments, personal well-being, and patient care and leading to increased staff turnover and quality of patient care and outcomes. Whilst there has been some work undertaken in the general nursing workforce, there is a dearth of evidence regarding the extent and impact of these behaviours on the nursing workforce in intensive care units (ICUs) in Australia and New Zealand. OBJECTIVE: We aimed to determine self-reported occurrences of bullying, discrimination, and sexual harassment amongst ICU nurses in Australia and New Zealand. METHODS: A prospective, cross-sectional, online survey of ICU nurses in Australia and New Zealand was undertaken in May-June 2021, distributed through formal colleges, societies, and social media. Questions included demographics and three separate sections addressing bullying, sexual harassment, and discrimination. RESULTS: In 679 survey responses, the overall reported occurrences of bullying, discrimination, and sexual harassment in the last 12 months were 57.1%, 32.6%, and 1.9%, respectively. Perpetrators of bullying were predominantly nurses (59.6%, with 57.9% being ICU nurses); perpetrators of discrimination were nurses (51.7%, with 49.3% being ICU nurses); and perpetrators of sexual harassment were patients (34.6%). Respondents most commonly (66%) did not report these behaviours as they did not feel confident that the issue would be resolved or addressed. CONCLUSIONS: Determining the true extent of bullying, discrimination, and sexual harassment behaviours within the ICU nursing community in Australia and New Zealand is difficult; however, it is clear a problem exists. These behaviours require recognition, reporting, and an effective resolution, rather than normalisation within healthcare professions and workplace settings in order to support and retain ICU nursing staff.

Community-Led Health Initiatives for Torres Straits Island Communities in a Changing Climate: Implementing Core Values for Mitigation and Adaptation.

First Nations Peoples have a long history of living in Australia's changing climate and a deep knowledge of their traditional estate ('Country'). However, human-induced climate change raises unforeseen risks to the health of First Nations Peoples-especially in remotely located communities. This includes the Torres Strait Islands, where a local leader asked our Torres Strait Islander co-author, 'We know that you will return to your Country-unlike previous researchers. So how can you help with climate change?' In response, this research describes four core values focused on supporting First Nations Peoples' health and wellbeing: co-design, appropriate governance, support for self-determination, and respectfully incorporating Indigenous Knowledges into health-protective climate initiatives. Supporting the health and wellbeing of Torres Strait Islanders to continue living in the remote Torres Strait Islands in a changing climate can enable long-term care for Country, maintenance of culture, and a sense of identity for First Nations Peoples. Ensuring these core values are implemented can support the health of present and future generations and will likely be applicable to other First Nations communities.

Cost and affordability of healthy, equitable and more sustainable diets in the Torres Strait Islands.

OBJECTIVES: To assess the cost, cost differential and affordability of current and recommended (healthy, equitable, culturally acceptable and more sustainable) diets in the Torres Strait Islands and compare with other Queensland locations. METHODS: The Aboriginal and Torres Strait Islander Healthy Diets ASAP (Australian Standardised Affordability and Pricing) methods protocol was applied in five randomly selected communities in the Torres Strait Islands. RESULTS: The current diet was 32% more expensive than that recommended; 'discretionary' foods comprised 64% of the current diet cost. Families could save at least A$281.38 a fortnight by switching to recommended diets. However, these cost 35-40% more than elsewhere in Queensland. Recommended diets would cost 35% of median and 48% of welfare household income in the Torres Straits. CONCLUSIONS: While less expensive than the current diet, recommended diets are unaffordable for most households. Consequently, many Torres Strait Islander families are at high risk of food insecurity and diet-related disease. IMPLICATIONS FOR PUBLIC HEALTH: Urgent policy action is required to further lower the relative price of recommended diets, and also increase household incomes and welfare supplements to equitably improve food security and diet-related health, and contribute to environmental sustainability in the Torres Strait Islands.

Climate change and infectious diseases in Australia's Torres Strait Islands.

OBJECTIVE: This research seeks to identify climate-sensitive infectious diseases of concern with a present and future likelihood of increased occurrence in the geographically vulnerable Torres Strait Islands, Australia. The objective is to contribute evidence to the need for adequate climate change responses. METHODS: Case data of infectious diseases with proven, potential and speculative climate sensitivity were compiled. RESULTS: Five climate-sensitive diseases in the Torres Strait and Cape York region were identified as of concern: tuberculosis, dengue, Ross River virus, melioidosis and nontuberculous mycobacterial infection. The region constitutes 0.52% of Queensland's population but has a disproportionately high proportion of the state's cases: 20.4% of melioidosis, 2.4% of tuberculosis and 2.1% of dengue. CONCLUSIONS: The Indigenous Torres Strait Islander peoples intend to remain living on their traditional country long-term, yet climate change brings risks of both direct and indirect human health impacts. Implications for public health: Climate-sensitive infections pose a disproportionate burden and ongoing risk to Torres Strait Islander peoples. Addressing the causes of climate change is the responsibility of various agencies in parallel with direct action to minimise or prevent infections. All efforts should privilege Torres Strait Islander peoples' voices to self-determine response actions.

Deaths with Dementia in Indigenous and Non-Indigenous Australians: A Nationwide Study.

BACKGROUND: The prevalence of dementia is generally reported to be higher among Indigenous peoples. OBJECTIVE: The rates and coding of dementia mortality were compared between Indigenous and non-Indigenous Australians. METHODS: De-identified individual records on causes of death for all people aged 40 years or more who died in Australia between 2006 and 2014 (n = 1,233,084) were used. There were 185,237 records with International Classification of Diseases, Tenth Revision, codes for dementia (Alzheimer's Disease, vascular dementia, or unspecified dementia) as the underlying cause of death or mentioned elsewhere on the death certificate. Death rates were compared using Poisson regression. Logistic regression was used to assess whether dementia was more likely to be classified as 'unspecified' type in Indigenous Australians. RESULTS: The rates of death with dementia were 57% higher in Indigenous Australians, compared to non-Indigenous, relative rate (RR) 1.57, 95% confidence interval (CI) (1.48, 1.66), p < 0.0001. This excess of deaths was highest at ages below 75 (RRs > 2, test for interaction p < 0.0001), and among men (test for interaction p < 0.0001). When the underreporting of Indigenous status on the death certificate was taken into account the relative rate increased to 2.17, 95% CI (2.07, 2.29). Indigenous Australians were also more likely to have their dementia coded as 'unspecified' on their death certificate (Odds Ratio 1.92, 95% CI (1.66, 2.21), p < 0.0001), compared to the non-Indigenous group. CONCLUSION: This epidemiological analysis based on population level mortality data demonstrates the higher dementia-related mortality rate for Indigenous Australians especially at younger ages.