Context and aim
The impact of pre-existing mental disorders on mortality following traumatic
spinal injury (TSI) is unknown. We evaluated mortality rates by pre-existing mental
disorder, compared to the general population, and stratified by age at injury. Mental disorder included mental illness (MI), substance use disorder (SUD) or dual diagnosis (MI+SUD).
Methods and research findings
Using a data linkage cohort study design, individuals with acute TSI were identified from hospital records in NSW, Australia, linked with ambulance and emergency department records from June 2013- June 2016 inclusive. Death records were linked to 31st December 2018.We calculated all-cause and cause-specific crude mortality rates, age- and sex-adjusted standardised mortality ratios (SMR), modelling the association between pre-existing mental disorder and mortality by fitting flexible parametric survival models, age stratified (16-64/≥65 years old). 23·1% of the cohort had MI only, 5·5% had SUD only, 4·6% had dual diagnosis. The crude mortality rate was 84·1 (95%CI: 81·8-86·5) deaths/ 1000 person-years. Compared to the general population, those 16-64 years old with dual diagnosis (SMR=17·6; 95%CI: 14·1-21·9), SUD only (SMR=9·2; 95%CI: 7·3-11·7), and MI only (SMR=4·4; 95%CI: 3·3-5·8) had markedly elevated mortality. Compared to study individuals without mental disorder, all mental disorder groups showed increased risk of mortality after TSI, except the MI only group in the younger age stratum.
Translational outcomes
Ascertaining pre-existing mental disorders in patients with TSI is crucial to reduce the risk of mortality, particularly for individuals aged 16-64 years.
Future actions
Integration of TSI treatment and rehabilitation services with mental healthcare and addiction medicine is likely critical for reducing health disparities after TSI for people with pre-existing mental disorders.

Context:
Providing reliable population health outcome measures for small geographical areas such as local government areas (LGAs) is important when assessing health needs and planning health services as different areas may have significantly different health needs. The Public Health Act 2016 requires all LGAs to develop a local public health plan. In LGAs with small population sizes and small event counts however, it may not be possible to derive reliable epidemiological measures and so efforts to assess health needs and plan health services are hampered.

Methods:
Advanced analysis methods like Bayesian modelling were explored to estimate epidemiological measures for LGAs across WA. Bayesian approaches combine prior information and raw data to borrow information between neighbouring areas and time points to provide complete spatial/temporal coverage of estimates across a region of interest. We applied spatio-temporal Bayesian methods to 10 years (2011-2020) of administrative (e.g., hospitalisation, mortality data) and survey data. Different spatio-temporal Bayesian models were developed for different data types and fit using Markov chain Monte Carlo methods and nimble/CARBayesST packages in R.

Outcomes:
Through Bayesian modelling, annual count estimates and uncertainty measures were produced to derive epidemiological measures (e.g., prevalence, age standardised rate, age-specific rate, years of life lost, and years lost to disability) with increased stability and certainty for a variety of health metrics/conditions for all WA LGAs and HDs. As a result, the modelled estimates have allowed for a more complete picture of population health outcomes and trends to be observed across WA.

Future actions:
The Bayesian approach explored has filled gaps in data commonly observed among small/population-sparse areas when using conventional epidemiological methods. This approach can be applied to other data, allowing public health professionals access to data that forms a more complete picture of population health outcomes to improve the quality of public health planning.

What is the problem/issue that requires public health action?

Prevention has many health, social, environmental and economic co-benefits. State and national frameworks and strategies call for cross-sector partnerships to address the social determinants of health. In an environment where growth in investment in prevention has stagnated, public sector organisations must avoid ‘working in silos’ and prioritise identifying shared goals, and pooling skills and resources to advance the preventive health agenda.

What do we know or have we learned to address this problem/issue, and how has this finding been derived?

The WA Department of Health has met informally with WA public sector agencies since 2011, to identify intersecting policy agendas, and map complementary strategies, policies and initiatives for prevention of chronic disease and injury.

Other agency’s initial concerns that health already accounts for over one-third of the state budget and dominates government priorities contributed to hesitancy to meet. We overcame this by reassuring agencies we came with ‘no asks or demands’, and offered to lend a supportive voice for their initiatives where they intersected with those of health, and act as a system navigator for agencies needing to collaborate with health. This led to ongoing discussions about opportunities for mutually beneficial engagement.

In 2023, the findings from this project were shared publicly for the first time. The report documents substantial areas of shared interest across government in WA. 380 common strategies, policies and initiatives from 23 agencies were mapped across healthy and safe settings, healthy people and communities, healthy food and drinks, and healthy recreation.

How has this been used in practice?

The report provides a strong foundation for cross-government collaboration on actions for prevention and opportunities for further engagement. We have forged valuable connections, leading to trusting and productive partnerships and co-benefits for other agencies. Prevention has been further embedded in WA Government policy.

What actions should we take in the future to address the problem/issue?

A non-prescriptive, co-benefits approach to building cross-sector collaboration for healthy policies in government settings works in WA. A co-benefits approach to collaboration could have broader application in building public health coalitions beyond government.

Underpinned by a rapidly ageing demographic, falls are a growing population health issue in Queensland. In 2020/2021, fall related incidents were the most common call for service by the Queensland Ambulance Service (QAS), representing 8.7% of all incidents. The large majority (81%) were transported to a hospital Emergency Department (ED). 68% of these patients required hospital admission suggesting some patients could be managed in the community. In response the Falls Co-Response Program was implemented as a partnership between the QAS and Queensland Health (QH). A paramedic and allied health practitioner (AHP) (physiotherapist or occupational therapist) respond to a Triple Zero (000) call for a person who has fallen providing multidisciplinary assessment and intervention.

Evidence recommends use of a falls risk screening tool to identify future falls risks and inform the intervention approach. Education is recommended for all patients who have fallen or identified at risk of falling. Interventions to optimise the environment, exercise programs improving balance and mobility and targeted intervention for individually identified risk factors has also shown to reduce future risk of falling.

48% of patients seen by the program have remained at home after a fall reducing the burden on ED’s with an estimated saving of 2000 patient hours in the first six months. This has been possible through comprehensive multidisciplinary assessment and intervention. The Falls Risk Assessment Tool is used to inform falls risk. Education and immediate interventions are provided to address falls risks for the individual, in their home environment. QH provided Follow-Up Pathways are available for continuation of care.

The partnership between QAS and QH has achieved reach across the Brisbane region providing timely access to individualised, holistic assessment, early intervention and connected care pathways in or close to home. Consumers reported their wishes were respected and valued interventions to reduce future falls risk.

Context and aim
Comprehensive toxicology testing of emergency department (ED) presentations has become a prominent data source on emerging drug-related threats in Australia. We review three state and national toxicosurveillance systems and their contribution to drug intelligence and harm reduction responses in Australia and internationally.

Methods and analysis
The Emerging Drugs Network of Australia (EDNA), the New South Wales Prescription, Recreational and Illicit Substance Evaluation program (PRISE) and the EDNA-Victoria study (EDNAV) conduct comprehensive toxicology screening of blood samples from eligible ED presentations. Collectively, these initiatives detected a total of 1,120 NPS across 716 ED presentations in Australia between 2022-2023.

Translational outcomes
Public health translation and impact from EDNA, EDNAV and PRISE include:
1. Evidence-informed responses: clinical and toxicological evidence have directly informed rapid, locally appropriate drug alerts released by state government health authorities; e.g. laboratory-confirmed evidence of severe harms caused by novel opioid exposure prompted public drug alerts in multiple jurisdictions.
2. Within and across jurisdictional collaboration: data confirming a national cluster of acute thebaine poisonings from non-food grade poppy seeds entering the food supply chain resulted in a national recall of contaminated products by Food Standards Australia New Zealand.
3. Partnerships & information sharing: collaboration with national information sharing networks such as the Prompt Response Network has enabled rapid dissemination of drug intelligence data with government departments, consumers, harm reduction services and other key stakeholders. Formal partnership with the United Nations Office on Drugs and Crime has also enabled Australia’s contribution of NPS detections from ED presentations to their global surveillance network for the first time.

Future actions
Embedding multi-agency toxicosurveillance systems within and across jurisdictions into Australia’s strategic approach to reduce drug-related harms is critical. There are few other reliable signal sources able to accurately identify new and emerging NPS in such a timely manner.

Context

Each year in Australia, more than 3,000 families experience stillbirth or newborn death and 100,000 experience miscarriage. The psychosocial consequences for families are profound with implications for the health system, economy, and society.

Access to the right support at the right time is vital to the wellbeing of bereaved families. A holistic public health approach to bereavement care is needed, involving shared responsibility between communities and health services, and providing universal, selective, and indicated support.

Despite the application of public health principles in bereavement research, implementation remains fragmented. Improving perinatal bereavement care requires a multilevel approach with cross-sector collaboration essential to building integrated support networks for bereaved families.

Aim

Our study uses a public health approach to examine the types of supports accessed and needed by bereaved families.

Methods

471 bereaved parents and family members completed an online survey, and 24 participated in a follow-up interview.

Research Findings

Fewer than half (41%) of survey respondents received the support they needed after their loss. Common barriers were not knowing where to find support (37%) and finding it hard to ask for support (37%). While family and friends were frequently accessed sources of support (73%), fewer found this support helpful (58%). Community-based bereavement support organisations were highly accessed (67%) and rated as helpful (85%), with peer support rated most highly by those who accessed it (91%).

Translational outcomes

By identifying gaps and opportunities, the findings shed light on approaches to strengthen the capacity of communities and health systems to meet parents’ needs. This approach aligns to the Compassionate Communities model in palliative care, recognising the need to move beyond health care systems to more holistic approaches to effect meaningful change.

Future actions

Our findings underscore the importance of proactive care pathways, strengthening cross-sector partnerships, improving grief literacy across communities and ensuring universal sources of support for bereaved families.