Background: In a rapidly warming climate, heatwaves pose an increasing threat to human health. However, limited knowledge exists regarding the impact on health outcomes in the Northern Territory (NT) or the role humidity may play. Our study aimed to evaluate the association between heatwaves, humidity and emergency department (ED) presentations in the NT.

Methods: Using a space-time-stratified case-crossover design and conditional Poisson regression models, we analysed the association between heatwaves, humidity and ED presentations in the NT from 2001 to 2023. Heatwaves were identified using the Excess Heat Factor (EHF) method, with both temperature-only and temperature-plus-humidity metrics. Relative risks (95% confidence intervals) were estimated for all-cause ED presentations and stratified by demographic and principal diagnostic categories.

Results: All-cause ED presentations increased by 4.0% on severe/extreme heatwave days for both temperature-only and temperature-plus-humidity metrics (RR=1.04, 95% CI 1.02-1.06), and by 1.1% (RR=1.01, 95% CI 1.00-1.02) for low-intensity heatwaves. Specific to temperature-only severe/extreme heatwaves, ED presentations significantly increased for visitors to the NT (RR=1.08, 95% CI 1.02-1.16), those living with diabetes (RR=1.14, 95% CI 1.07-1.21) and people presenting with skin conditions (RR=1.05, 95% CI 1.00-1.09). Temperature-plus-humidity heatwaves significantly increased ED presentations for those aged 50-64 years (RR 1.07, 95% CI 1.03-1.11), those with cardiovascular conditions (RR=1.09, 95% CI 1.02-1.15) and those with urinary conditions (RR=1.10, 95% CI 1.03-1.18). Aboriginal peoples had no increase in presentations during low-intensity heatwaves, while non-Aboriginal presentations increased by 1.0% under both EHF metrics (RR=1.01, 95% CI 1.00-1.02).

Conclusion: Health impacts increased with heatwave severity, varying by sub-category and humidity inclusion. These differences call for a dual heatwave warning system in tropical regions, noting Australia’s heatwave warning system is based solely on temperature, and does not directly account for humidity. Preventative interventions targeting high-risk populations are needed, while Aboriginal socio-cultural adaptations to low-intensity heatwaves may offer valuable lessons.

Background: Breast cancer, the most common cancer among women worldwide, shows significant disparities across populations. However, understanding the burden of breast cancer among Indigenous women is challenging, because specific data on Indigenous peoples is unavailable in global cancer statistics. This study was aimed at systematically reviewing existing global evidence of breast cancer incidence, mortality, and survival among Indigenous women.
Methods: PubMed, Web of Science, CINAHL, and Embase were searched for studies published in the past 10 years (2013–2023). The Newcastle-Ottawa quality assessment scale was used to assess the quality of the included studies. A random-effects meta-analysis was performed to determine pooled 5-year survival rate estimates and adjusted hazard ratios. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used to report results.
Results: Overall, 54 studies were included in the systematic review, and 32 studies were included in the meta-analysis. The number of breast cancer cases ranged from 3 to 20,325 among Indigenous women, and 67 to 3,341,855 among non-Indigenous women. Age-adjusted breast cancer incidence rates ranged from 19 to 165.2 per 100,000 among Indigenous women, and from 21.5 to 190.4 per 100,000 among non-Indigenous women. Indigenous women had a 34% higher mortality risk (95% CI: 1.22–1.48) than non-Indigenous women. The 5-year survival rate was 77% among Indigenous women (95% CI: 70.81%–83.43%; p < 0.001) and 81% among non-Indigenous women (95% CI: 71.64%–90.21%; p < 0.001).
Conclusion: Despite having a lower incidence of breast cancer, Indigenous women experience higher mortality risk and lower survival rates than non-Indigenous women. Although survival has improved over time, disparities in breast cancer outcomes persist. Continued efforts to enhance screening participation and healthcare access are essential to address the disparities in breast cancer outcomes.
Keywords: Breast cancer; Indigenous women; Incidence; Mortality; Survival; Epidemiology

Background: Māori experience mass imprisonment in New Zealand, impacting on the health and wellbeing of those who are imprisoned, their whānau and communities. Community re-entry is an opportunity to address the adverse impacts of imprisonment, but in the current environment presents multiple challenges to accessing healthcare and other critical services.
Methods: TIAKI – meaning ‘to care’ – is a Kaupapa Māori mixed-methods research project. We are resourcing whānau with lived experience of imprisonment as researchers (kairangahau) to develop self-determined pathways supporting community re-entry wellbeing. Alongside this we are using routinely collected Government data linked in the IDI to understand community entry pathways for Māori. We have developed a Tikanga and Māori Data Sovereignty framework, informing the way we prioritise lived experience and use data collected in circumstances of coercion.
Results: 7,398 Māori were released from prisons between June 2021 and May 2022. This presentation focuses on examination of health care access data for this cohort in the twelve months after release. It will describe the process of working with coerced data informed by lived experience kairangahau, and present results of linked data analyses. Our findings indicate inadequate primary care for Māori across a range of access and quality measures, and high need for mental health support and gaps in access.
Conclusion: Data collected by Government provides a resource for holding Government to account. Our framework and research process provides a method for using these data in way that prioritises the voices of those whose data has been collected and aims to use these data for positive transformational change. Research findings highlight gaps in service provision and the urgent requirement for equitable access to high-quality health care, developed and designed in ways that privilege the views of Māori with lived experience of imprisonment.

Background
Can linked administrative data be used to transform New Zealand's only sample survey on indigenous wellbeing into a longitudinal study?
NZ's Integrated Data Infrastructure (IDI) is a research database of administrative and survey datasets containing a range of variables linkable at the individual level. Te Kupenga is a large nationally representative post-censal survey of NZ's indigenous population (Māori) and is accessible in the IDI. Te Kupenga is the only official survey with Māori culturally-informed variables, but it is often under-utilised in research.

Methods
The Te Kupenga survey was used as a foundational cohort and linked at an individual level to outcomes and determinants from various administrative datasets from different time periods. Outcomes included Ambulatory Sensitive Hospitalisations (ASH) and COVID-19 vaccinations, while determinants included individual, household, and geographic variables.

Results
Results outlined the impact of culturally relevant wellbeing indicators and their effect on health outcomes for Māori. However, linking a representative survey to admin data created issues of loss to follow-up and missing data, as the original sample was not maintained after linkages. Loss to follow-up and missingness differed depending on variables and time periods. Consequently, creating new universally applicable weights was not possible. However, we constructed a robust, generally applicable process for re-weighting survey data to account for missingness and loss to follow-up in admin data.

Conclusion
This project demonstrated an approach for turning a sample survey into a longitudinal cohort using admin data, creating a method that can be used for other official statistics surveys. Furthermore, this research signified the importance of cultural wellbeing and its effects on health disparities for the Māori population.

Background: In Aotearoa New Zealand there are large and enduring health inequities between Māori (Indigenous) and non-Māori tamariki (children). These inequities result from systems failures, differential access to the determinants of health and unresponsive, poor quality, and siloed health service delivery. The Harti Hauora Tamariki (Harti) programme was a whānau (family) Māori centric multilevel programme to support wellbeing via culturally safe engagement, electronic needs assessment and navigation to wellbeing services.

Methods: A randomised controlled trial (RCT) measured the impact of Harti at a hospital paediatric ward. Primary measures were hospital readmission risk at 30-days, 6 and 12 months post-hospital discharge. Analysis is also underway to examine 5-year outcomes.

Results: In total, 965 children were recruited; 485 (50.3%) in the intervention group; 480 (49.7%) in the control group, with over half of participants Māori. No significant differences in readmission risk were found for any timepoints in the first 12 months post discharge. Significant differences were found in the documentation of unmet need, referrals to and receipt of wellbeing services, and satisfaction with care. Further, qualitative research highlighted the critical role of Māori navigation staff. Following the RCT, and through the COVID-19 environment, Harti has been implemented in emergency and community services and has evolved into the WHIRI model of care with research and clinical arms.

Conclusions: Harti had positive individual, whānau and systems level impacts and we will present 5-year outcomes. Harti also enables health equity gain for Māori, maximising the value delivered from scarce resources for improving wellbeing. We will discuss the Harti model of care, WHIRI evolution into multiple settings including cancer and maternity care, and describe how lessons learnt from these processes can upscale and be adapted to support further capacity building to advance health improvement and health equity in the future.

Background: Indigenous people experience a disproportionately higher burden of early onset of type 2 diabetes mellitus (T2DM). To address this health disparity, effective evidence-based interventions are urgently needed. This systematic review examines interventions specifically designed to prevent and manage T2DM in Indigenous children and young adults.
Methods: Five electronic database searches were carried out in February 2023 to identify publications on T2DM prevention and management among Indigenous children and youth under 25yrs old. The search adhered to the PRISMA guidelines. We included studies of all designs, written in English. An adapted version of the NIH quality assessment tool for pre-post intervention studies was used for quality assessment. The convergent integrated approach developed by Joanna Briggs Institute for mixed-method systematic reviews was employed in the analysis. Prospero registration ID: CRD42023423671.
Results: The search identified 1,127 publications, of which 26 studies (total n= 4,914 participants) met the inclusion criteria after screening. The majority of included studies (76%) originated from North America. Most interventions involved less than 100 participants and had a duration of 6 months or less (58%). Interventions combining community- and school-based approaches showed more promise in reducing T2DM risk factors. While most interventions demonstrated improvements in knowledge and behaviours, longer, culturally responsive interventions appeared to have a greater impact on anthropometric measures and biomarkers associated with T2DM.
Conclusion: This review highlights the limited body of research focused on early T2DM prevention and management in Indigenous children and youth. Most studies prioritize short-term outcomes and are implemented over brief periods, with a limited focus on long-term impacts on anthropometric measures and biomarkers—critical indicators for diabetes prevention. Further research is urgently needed to develop and evaluate culturally appropriate, sustainable interventions that address the specific needs of Indigenous communities and demonstrate long-term effectiveness in preventing and managing T2DM.

Objective: Early life exposure to air pollution can trigger physiological reactions that potentially influence bone development. We aimed to identify periods of susceptibility to air pollution in early life in relation to bone health at age six years.
Methods: We used data from the COPSAC2010 study, an ongoing population-based mother-child cohort in Denmark (n=700). We modelled daily ambient air pollution concentrations of nitrogen dioxide and particulate matter with a diameter of ≤2.5 and ≤10 μm at the home addresses during pregnancy and childhood, using the Danish Eulerian Hemispheric Model (DEHM)–urban background model (UBM)–Danish Air Pollution and Human Exposure Modelling System (AirGIS) model system. Bone mineral density (BMD) and area-adjusted bone mineral content (aBMC) were measured by dual-energy x-ray absorptiometry at age six. We performed distributed lag non-linear modelling (DNLM) adjusted for several socioeconomic characteristics to assess the associations between air pollution and bone health and identify windows of susceptibility.
Results: 518 children were included. We identified a window of susceptibility for PM10 exposure between 2.8 to 3.2 years of age with aBMC (-9.0; CI -17.9 to -0.1 per 10 µg/m3 increase in PM10). In sex-stratified analyses, associations for both PM2.5 and PM10 with aBMC followed similar trends, but were only statistically significant in boys, and not in girls. Also, we identified a positive association between PM10 and PM2.5 from conception to ~ 7 months of gestation with aBMC (e.g., 14.4; CI 0.7 to 28.2 per 5 µg/m3 increase in PM2.5) (Figure). Nevertheless, all associations disappeared after correction for multiple testing.
Conclusion: We observed conflicting evidence regarding the impact of air pollution during pregnancy and early childhood on bone health outcomes at age six. We showed a protective effect during pregnancy, while, around 3 years of age may represent a critical period for negative effects on bone health, particular in boys.

Objective: Climate change intensifies wildfire frequency and severity, amplifying landscape fire-sourced smoke (LFS) and its health impacts. However, the impacts of climate change on global LFS and associated mortality remain unclear. In this study, we aim to integrate advanced deep neural networks and high-resolution datasets to project global LFS-derived fine particulate matter (PM2.5) and ozone (O3) from 2020 to 2100 and quantify the attributable mortality.

Material and Methods: We proposed a deep neural network model ‘APForecaster’ with validated LFS data, bias-corrected climate projections, and high-resolution spatiotemporal inputs to project global daily LFS-derived PM2.5 and O3 at a high spatial resolution (0.25° × 0.25°) from 2020 to 2100 under different Shared Socioeconomic Pathways (SSPs). By integrating these LFS projections with population mortality data and wildfire-specific exposure-response relationships, we assessed future patterns and trends in wildfire pollution and related mortality under diverse climate and socioeconomic scenarios. We also evaluated how LFS exposure and future sociodemographic factors, such as population growth and baseline mortality rates, will shape LFS-attributable mortality across various SSP scenarios

Results: We found that climate change is projected to significantly increase LFS and associated mortality, with annual deaths reaching 4.63 million by 2100 under a high-emission climate scenario. Conversely, a low-emission pathway could reduce this burden by 68%, preventing 1.90 million deaths annually. While LFS may decline in hotspots in Europe, Sub-Saharan Africa, and the Amazon Basin, low-income countries will continue to face high risks of LFS and mortality by 2100.

Conclusion: Our results uncovered potential patterns and trends in future wildfire smoke and related mortality under future varying climate and sociodemographic scenarios. They offer valuable insights for policymakers on wildfire management, resource allocation, and targeted strategies for climate adaptation and mitigation.