Melbourne School of Population and Global Health - Research Publications
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ItemThe global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019(ELSEVIER SCIENCE INC, 2022-01)BACKGROUND: In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. METHODS: Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. FINDINGS: There were 1·19 million (95% UI 1·11-1·28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5-65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8-57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9-15·6] per 100 000 person-years) and middle SDI (13·6 [12·6-14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9-25·2) DALYs to the global burden of disease, of which 2·7% (1·9-3·6) came from YLDs and 97·3% (96·4-98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. INTERPRETATION: Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. FUNDING: Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute.
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ItemThe global burden of cancer attributable to risk factors, 2010-19: a systematic analysis for the Global Burden of Disease Study 2019(ELSEVIER SCIENCE INC, 2022-08-20)BACKGROUND: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01-4·94) deaths and 105 million (95·0-116) DALYs for both sexes combined, representing 44·4% (41·3-48·4) of all cancer deaths and 42·0% (39·1-45·6) of all DALYs. There were 2·88 million (2·60-3·18) risk-attributable cancer deaths in males (50·6% [47·8-54·1] of all male cancer deaths) and 1·58 million (1·36-1·84) risk-attributable cancer deaths in females (36·3% [32·5-41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6-28·4) and DALYs by 16·8% (8·8-25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9-42·8] and 33·3% [25·8-42·0]). INTERPRETATION: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. FUNDING: Bill & Melinda Gates Foundation.
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ItemBSL Case Study: Criminology - Drugs and Justice(Tuwhera, Auckland University of Technology, 2022)This Master of Criminology subject has a mix of postgraduate students with a wide range of learning strategies, skillsets, and experiences. Half the students were physically located on campus and the other half were online in a Blended Synchronous Learning (BSL) environment. Although the subject suffered technology failure across the first seven weeks of the 12-week semester, and subsequent changes to the structured learning experiences, the students kept turning up for class. The student cohort worked out ways to engage even when the technology prevented them from engaging in the intended way. In response to the technology fail, the subject coordinator, (me) reverted to a more didactic approach, reducing risk associated with learning, proportional to the risk associated with the technology. Unfortunately, the most important element of the subject design, was also the first technological component to be dropped. The lessons learned included thinking carefully about the vulnerability of the pedagogy in the BSL subject; always have fall back options for interactivity and protect the most essential features of the pedagogy. The deeper lesson however, was that the technology fail allowed for a new set of relationships to emerge in the learning environment. Within the knowledge ecology of the space the cohort responded and adapted through their personal knowledge networks in ways not previously envisioned. The student experience is important – by keeping a focus on the experience (rather than the content), the students will remember it and have a better learning experience.
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ItemSexually transmissible infections, partner notification and intimate relationships: a qualitative study exploring the perspectives of general practitioners and people with a recent chlamydia infection(CSIRO PUBLISHING, 2020)UNLABELLED: Background Individuals diagnosed with a chlamydia infection are advised to notify their sexual partners from the previous 6 months so that they too can get tested and treated as appropriate. Partner notification is an essential component of chlamydia management, helping to prevent ongoing transmission and repeat infection in the index case. However, partner notification can be challenging, particularly in circumstances where a relationship has ended or transmission has occurred beyond the primary relationship. METHODS: In this study we use data from 43 semistructured interviews with general practitioners (GPs) and people with a recent diagnosis of chlamydia. The interviews examined experiences of chlamydia case management in the general practice context. Here, we focus specifically on the effect of a chlamydia infection on intimate relationships in the context of the consultation and beyond.? RESULTS: A chlamydia infection can have significant consequences for intimate relationships. Although GPs reported speaking to their patients about the importance of partner notification and participants with a recent chlamydia infection reported notifying their sexual partners, both would appreciate further support to engage in these conversations. CONCLUSIONS: Conversations with patients should go beyond simply informing them of the need to notify their sexual partners from the previous 6 months, and should provide information about why partner notification is important and discuss strategies for informing partners, particularly for those in ongoing relationships. Ensuring GPs have the training and support to engage in these conversations with confidence is vital.
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ItemSexual identity or religious freedom: could conversion therapy ever be morally permissible in limited urgent situations?(SPRINGER HEIDELBERG, 2021-07)Conversion therapy refers to a range of unscientific, discredited and harmful heterosexist practices that attempt to re-align an individual's sexual orientation, usually from non-heterosexual to heterosexual. In Australia, the state of Victoria recently joined Queensland and the Australian Capital Territory in criminalising conversion therapy. Although many other jurisdictions have also introduced legislation banning conversion therapy, it persists in over 60 countries. Children are particularly vulnerable to the harmful effects of conversion therapy, which can include coercion, rejection, isolation and blame. However, if new biotechnologies create safe and effective conversion therapies, the question posed here is whether it would ever be morally permissible to use them. In addressing this question, we need to closely examine the individual's circumstances and the prevailing social context in which conversion therapy is employed. I argue that, even in a sexually unjust world, conversion therapy may be morally permissible if it were the only safe and effective means of relieving intense anguish and dysphoria for the individual. The person providing the conversion therapy must be qualified, sufficiently independent from any religious organisation and must provide conversion therapy in a way that is positively affirming of the individual and their existing sexuality.
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ItemHearing Parents' Voices: Parental Refusal of Cochlear Implants and the Zone of Parental Discretion(SPRINGER, 2022-03)It has been forty years since the first multi-channel cochlear implant was used in Australia. While heralded in the hearing world as one of the greatest inventions in modern medicine, not everyone reflects on this achievement with enthusiasm. For many people in the Deaf community, they see the cochlear implant as a tool that reinforces a social construct that pathologizes deafness and removes Deaf identity. In this paper, I set out the main arguments for and against cochlear implantation. While I conclude that, on balance, cochlear implants improve the well-being and broaden the open futures of deaf children, this does not justify mandating implants in circumstances where parents refuse them because this may compound unintended harms when society interferes in the parent-child relationship. For this reason, I argue that parental refusal of cochlear implantation falls within Gillam's concept of the zone of parental discretion.
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ItemIdentifying the Patterns of Family Contact for Children in Care(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2022-01-02)Contact between children in care and family members is complex and often emotionally difficult for all concerned. In the context of a wider Australian cross-jurisdictional intervention trial, focusing on contact between children in long-term care and their parents, a snapshot survey of 901 children in Victorian foster care and kinship care placements was undertaken. The aim was to determine which children had seen parents, siblings or extended family members within a 12-month period, and how practitioners explained lack of contact between children and their parents. The study found that most children had had contact with parents or other family members, though children in long-term care were less likely to have seen their parents than those where reunification was still a possibility. Practitioners’ views on why parental contact had not occurred for 18% of the sample illustrate the complexity of the issues involved in contact. IMPLICATIONS To support children’s best interests, professionals should be clear about the purpose of family contact and provide support appropriate to that purpose. With children in long-term care less likely to see their parents, professionals have a role in helping these parents adjust to a new role. Developing strategies to maintain meaningful connections between children in long-term care and their parents may be more effective for children’s best interests than the current emphasis on actual visits.
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ItemDecision-making of municipal urban forest managers through the lens of governance(ELSEVIER SCI LTD, 2020-02)Awareness of the benefits of urban trees has led many cities to develop ambitious targets to increase tree numbers and canopy cover. Policy instruments that guide the planning of cities recognize the need for new governance arrangements to implement this agenda. Urban forests are greatly influenced by the decisions of municipal managers, but there is currently no clear understanding of how municipal managers find support to implement their decisions via new governance arrangements. To fill this knowledge gap, we collected empirical data through interviews with 23 urban forest municipal managers in 12 local governments in Greater Melbourne and regional Victoria, Australia, and analysed these data using qualitative interpretative methods through a governance lens. The goal of this was to understand the issues and challenges, stakeholders, resources, processes, and rules behind the decision-making of municipal managers. Municipal managers said that urban densification and expansion were making it difficult for them to implement their strategies to increase tree numbers and canopy cover. The coordination of stakeholders was more important for managers to find support to implement their decisions than having a bigger budget. The views of the public or wider community and a municipal government culture of risk aversion were also making it difficult for municipal managers to implement their strategies. Decision-making priorities and processes were not the same across urban centres. Lack of space to grow trees in new developments, excessive tree removal, and public consultation, were ideas more frequently raised in inner urban centres, while urban expansion, increased active use of greenspaces, and lack of data/information about tree assets were concerns for outer and regional centres. Nonetheless, inter-departmental coordination was a common theme shared among all cities. Strengthening coordination processes is an important way for local governments to overcome these barriers and effectively implement their urban forest strategies.
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ItemNo Preview AvailableNeospora caninum is not an important contributor to poor reproductive performance of primiparous ewes from southern Australia: evidence from a cross-sectional study(Springer, 2021-10-02)Neospora caninum has been implicated as a sporadic cause of abortion and perinatal deaths in sheep flocks globally. However, its significance as a reproductive pathogen for sheep in Australia remains unknown. The aims of this study were to (i) determine the seroprevalence of N. caninum in Australian breeding ewes and (ii) examine if natural exposure to N. caninum is associated with poor reproductive performance of primiparous ewes in southern Australia. Thirty flocks of primiparous ewes (aged 1–2 years old at lambing) from 28 farms in three states (Western Australia, South Australia and Victoria) were monitored between mating and lamb marking. Blood samples were also collected from multiparous mature ewes (aged 3 years or older) at each farm. Seroprevalence for anti-N. caninum IgG using indirect ELISA was determined for a subset of primiparous ewes that were predominantly determined to be pregnant and subsequently failed to rear a lamb (n = 1279) and randomly selected mature multiparous ewes with unknown reproductive status (n = 558). Neopsora caninum apparent seroprevalence was 0.16% (95% confidence interval 0.03%, 0.5%) in primiparous ewes, with seropositivity identified in two ewes from farms located in South Australia and Victoria. There was no evidence of seropositivity in mature ewes with apparent seroprevalence 0% (0%, 0.45%). These findings suggest that N. caninum infection was not widespread in primiparous ewes or mature multiparous ewes on these farms, and exposure to N. caninum infection was unlikely to explain abortion and perinatal mortalities observed for primiparous ewes.
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ItemNo Preview AvailableThe role of animal welfare in improving the future of farming(CSIRO Publishing, 2022)Context: Animal production plays a critical role in many global challenges around sustainability, including climate change and resilience, One Health and food security. With this role comes pressures on livestock welfare. Aims: This paper demonstrates key contributions animal welfare makes to global sustainability challenges. Methods: This paper highlights ‘win–win’ improvements for both animal welfare and other aspects of sustainability by using the following four case studies: tail docking Australian sheep, agroforestry systems in Ethiopia, the Australian dairy-beef industry, and strategic feeding of goats in Pakistan. Key results: These case studies show how animal welfare can be improved alongside livelihoods. However, even in these win–win situations, the adoption of improved practices is not guaranteed. Conclusions: Long-term, sustained change in animal welfare can simultaneously make in roads to other challenges around sustainability. To do this, we must have a broader understanding of the system in which the animals are raised, so that barriers to change can be identified. Implications: Lessons from these case studies can be applied to other production contexts and challenges, highlighting the universal value of understanding and addressing animal welfare.