Melbourne School of Population and Global Health - Research Publications
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ItemThe New Protectionism: Risk Aversion and Access to Indigenous Heritage Records(Australian Society of Archivists, 2024)This article discusses the problems encountered in accessing archival Indigenous language records, both by Indigenous people looking for information on their own languages and by non-Indigenous researchers supporting language work. It is motivated by Indigenous people not being able to access materials in archives, libraries, and museums that they need for heritage reasons, for personal reasons, or for revitalisation of language or cultural performance. For some of the authors, the experience of using Nyingarn, which aims to make manuscript language material available for re-use today, has been dispiriting, with what we term the ‘new protectionism’ preventing use of these materials.
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ItemA Population-Based Family Case-Control Study of Sun Exposure and Follicular Lymphoma Risk(AMER ASSOC CANCER RESEARCH, 2024-01-09)BACKGROUND: Epidemiologic evidence suggests an inverse association between sun exposure and follicular lymphoma risk. METHODS: We conducted an Australian population-based family case-control study based on 666 cases and 459 controls (288 related, 171 unrelated). Participants completed a lifetime residence and work calendar and recalled outdoor hours on weekdays, weekends, and holidays in the warmer and cooler months at ages 10, 20, 30, and 40 years, and clothing types worn in the warmer months. We used a group-based trajectory modeling approach to identify outdoor hour trajectories over time and examined associations with follicular lymphoma risk using logistic regression. RESULTS: We observed an inverse association between follicular lymphoma risk and several measures of high lifetime sun exposure, particularly intermittent exposure (weekends, holidays). Associations included reduced risk with increasing time outdoors on holidays in the warmer months [highest category OR = 0.56; 95% confidence interval (CI), 0.42-0.76; Ptrend < 0.01], high outdoor hours on weekends in the warmer months (highest category OR = 0.71; 95% CI, 0.52-0.96), and increasing time outdoors in the warmer and cooler months combined (highest category OR = 0.66; 95% CI, 0.50-0.91; Ptrend 0.01). Risk was reduced for high outdoor hour maintainers in the warmer months across the decade years (OR = 0.71; 95% CI, 0.53-0.96). CONCLUSIONS: High total and intermittent sun exposure, particularly in the warmer months, may be protective against the development of follicular lymphoma. IMPACT: Although sun exposure is not recommended as a cancer control policy, confirming this association may provide insights regarding the future control of this intractable malignancy.
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ItemTeacher-Mediated Interventions to Support Child Mental Health Following a Disaster: A Systematic Review.(Public Library of Science (PLoS), 2015-12-08)OBJECTIVES: This review sought to identify, describe and assess the effectiveness of teacher-mediated interventions that aim to support child and adolescent recovery after a natural or man-made disaster. We also aimed to assess intervention applicability to rural and remote Australian school settings. METHOD: A systematic search of the academic literature was undertaken utilising six electronic databases (EBSCO, Medline, PsycINFO, Embase, ERIC and CINAHL) using terms that relate to: teacher-mediated and school-based interventions; children and adolescents; mental health and wellbeing; natural disasters and man-made disasters. This was supplemented by a grey literature search. RESULTS: A total of 20 articles reporting on 18 separate interventions were identified. Nine separate interventions had been evaluated using methodologically adequate research designs, with findings suggesting at least short-term improvement in student wellbeing outcomes and academic performance. CONCLUSIONS: Although none of the identified studies reported on Australian-based interventions, international interventions could be adapted to the Australian rural and remote context using existing psychosocial programs and resources available online to Australian schools. Future research should investigate the acceptability, feasibility and effectiveness of implementing interventions modelled on the identified studies in Australian schools settings.
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ItemGlobal burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021.(Elsevier, 2024-04-03)BACKGROUND: Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS: The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION: Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING: Bill & Melinda Gates Foundation.
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ItemManaging risks associated with environmental water delivery: a case study of the Goulburn River, Australia(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2024-01-01)
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ItemTrauma-Informed Primary Healthcare for Parents: Multidisciplinary Experiences in Rural Service Implementation(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2023-01-01)
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ItemAccuracy of Local Authority Population Forecasts Produced by a New Minimal Data Model: A Case Study of England(SPRINGER, 2023-12)Abstract The preparation of forecasts for small and local area populations involves many challenges. Standard cohort-component models are problematic because of small numbers, which make estimation of rates unreliable. Because of this, the Synthetic Migration Population Projection (SYMPOPP) model was designed to forecast local populations without need for detailed area-specific information. This model had been used successfully for small area forecasts in Australia. The objective of the paper is to assess its performance when applied to local areas in England. The model uses a bi-regional structure based on a movement population account. Sub-models of total population change are employed to control future change. Fertility, mortality and migration rates are borrowed from national statistics, constrained to small area indicators. The model uses an Excel workbook with VBA routines and is relatively easy and quick to use. Model inputs were calibrated for 2006–2011 and used to forecast for 2011–2021. Results were tested against the census-based 2021 mid-year populations. A new error statistic, Age Structure Error, was used to evaluate Basic and Refined model versions against official projections. The two versions of SYMPOPP posted lower errors. The simple models had fewer areas with errors of 10% or more (12.3–12.6%) compared with the official projections (14.5% of areas). Investigation revealed that these errors occurred in local authorities with high military, student, prison, or ethnic minority populations, influenced by factors not captured in a projection model for the general population.
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ItemDisability and loneliness in the United Kingdom: cross-sectional and longitudinal analyses of trends and transitions(BMC, 2023-12-19)BACKGROUND: Loneliness can have a detrimental impact on health, yet little is known about the association between disability and loneliness. METHODS: Secondary analysis of three waves of data collected between 2017 and 2020 by the UK's annual household panel study, Understanding Society. Direct age-standardisation was used to compare the prevalence of loneliness at each wave and the persistence of loneliness across all three waves for participants with/without disabilities aged 16-65 years. Transitional probabilities for the stability of loneliness, the stability of non-loneliness, the onset of loneliness and the offset of loneliness between consecutive waves were also estimated. RESULTS: At each wave, the prevalence of loneliness was significantly higher among respondents with disabilities than respondents without disabilities; these inequalities persisted with no evidence of change over time. The prevalence of persistent loneliness was 46% for respondents with disabilities compared with 22% for respondents without disabilities. Risk factors for the likelihood of persistent loneliness included disability, financial stress, not living as a couple, living in rented accommodation, being female and not being employed. The probability of the onset and stability of loneliness between successive waves were markedly higher for people with disabilities compared with people without disabilities. CONCLUSION: Adults with disabilities were more likely to experience loneliness, become lonely and remain lonely over time than their peers. Policies and interventions aimed at reducing loneliness should ensure that they are accessible and effective for people with disabilities. Further research is needed to explore the health outcomes of persistent loneliness among people with/without disabilities.
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ItemComing of Age on the Margins: A Life Course Perspective on the Time Use of Australian Adolescents with Disabilities(OXFORD UNIV PRESS INC, )Abstract People with disabilities experience persistent, multifaceted disadvantage across the life course. The origins of life course disadvantage among people with disabilities may stem, in part, from exclusion during developmentally sensitive periods in childhood. Time use among adolescents represents a potentially important mechanism implicated in the emergence of disability-related disadvantage, but previous research has largely neglected the time use of school age adolescents with disabilities. Utilizing nationally representative time diary data, this study investigated disability-related differences in adolescents’ time use, and how these gaps vary by sex and age. Results indicated that disability-related differences in time use are widespread and substantial in magnitude. Adolescents with disabilities spend more time in screen-based leisure, alone, and with mothers, and less time in educational activities than non-disabled adolescents. Boys with disabilities additionally spend less time in structured leisure and with peers than non-disabled boys. Differences in time alone, with peers, and in screen-based leisure increase in magnitude at older ages. We conclude that differential time use in adolescence may contribute to multiple persistent disadvantages experienced by people with disabilities over the life course.
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ItemSmall-scale mutations are infrequent as mechanisms of resistance in post-PARP inhibitor tumour samples in high grade serous ovarian cancer(NATURE PORTFOLIO, 2023-12-10)While the introduction of poly-(ADP)-ribose polymerase (PARP) inhibitors in homologous recombination DNA repair (HR) deficient high grade serous ovarian, fallopian tube and primary peritoneal cancers (HGSC) has improved patient survival, resistance to PARP inhibitors frequently occurs. Preclinical and translational studies have identified multiple mechanisms of resistance; here we examined tumour samples collected from 26 women following treatment with PARP inhibitors as part of standard of care or their enrolment in clinical trials. Twenty-one had a germline or somatic BRCA1/2 mutation. We performed targeted sequencing of 63 genes involved in DNA repair processes or implicated in ovarian cancer resistance. We found that just three individuals had a small-scale mutation as a definitive resistance mechanism detected, having reversion mutations, while six had potential mechanisms of resistance detected, with alterations related to BRCA1 function and mutations in SHLD2. This study indicates that mutations in genes related to DNA repair are detected in a minority of HGSC patients as genetic mechanisms of resistance. Future research into resistance in HGSC should focus on copy number, transcriptional and epigenetic aberrations, and the contribution of the tumour microenvironment.