Background: Over 3,000 people die by suicide in Australia each year, and suicide is the leading cause of death in Australians aged 15-to-24 years. Hospitalisations related to intentional self-harm are estimated to be 10 times higher than the number of suicide deaths in Australia. Despite the burden placed on the health system, limited pre-hospital population datasets are available to map and track suicide-related harms. This study aimed to characterise demographic and spatiotemporal patterns of suicide and self-harm related (SSH) ambulance presentations in Queensland, Australia.
Design and Methods: Data from the Queensland arm of the National Ambulance Surveillance System (NASS), a unique monitoring system for SSH, mental health and alcohol and other drugs (AOD), were used to investigate demographic and spatiotemporal patterns in SSH ambulance presentations between January 2021 and December 2022. Descriptive statistics were used to present demographic information on ambulance presentations related to suicide deaths, suicide attempts, suicidal ideation, and self-injury. Time and date co-variates and remoteness categories were used to investigate spatiotemporal patterns of SSH presentations. Co-reported AOD, and mental health symptomology were measured alongside other social stressors.
Key Findings: There were 67,478 ambulance attendances involving SSH in 2021 (n=34,516) and 2022 (n=32,962) in Queensland, Australia. SSH attendances occurred in the highest proportion in individuals aged 10-to-24 and 25-to-44 years. Family problems were reported in 32% of SSH attendances. Friday and Sunday mornings (6am and 10am) reported the highest number of suicide death-related attendances, compared with Monday and Sunday evenings (4pm and 8pm) which reported the highest number of self-harm behaviours related attendances. Pharmaceutical drugs were co-reported in 59% of suicide attempt-related attendances.
Discussion and Conclusions: Findings from this study suggest younger Queenslanders are experiencing the highest burden of SSH-related harms resulting in an ambulance attendance. The role pharmaceutical drugs play in suicide attempt-related attendances is notable. State and Federal government approaches to SSH reduction and prevention should consider the raft of social, political, geographic, and economic factors impacting young people’s mental health. Ambulance attendance data is a valuable resource that could be harnessed for ongoing monitoring of SSH outcomes across Australia.

Australian healthcare and public health systems currently give limited attention to managing, caring and supporting people living with dementia and their families. Yet, dementia is the second leading contributor to Australia’s burden of disease, and directly impacts over 400,000 Australians living with dementia and over 1.6 million caregivers. All too often, Australians impacted by dementia are left to learn about the condition themselves, source much-needed services and support, and navigate community life.

This research investigated post-diagnosis experiences of dementia throughout Australia, identifying the priorities of people with dementia and their families. Semi-structured interviews were conducted with 37 people who were diagnosed with dementia or significant others (spouse/partner, child, sibling, friend) in Australia. Interviews explored dementia diagnosis journeys through River of Life storytelling. The Three Perspectives of Human Malady theory guided data analysis, conceptualising dementia as a disease, an illness, and a sickness. This approach reflected multi-dimensional experiences across healthcare, services, personal and family life, and broader community involvement.

The majority of participants reported experiences in navigating healthcare systems, accessing support for dementia and participating in community life as extremely difficult. The time after the dementia diagnosis left many feeling lost and surprised about the limited support for such a major condition. Participants described much of the healthcare system being oriented towards disease and medical perspectives of dementia, including medical appointments, testing, results and getting a diagnosis.

Illness and sickness perspectives of dementia, encompassing how people felt about themselves and living within their community, were pivotal to the experience of dementia. Many reported poor recognition, services and structures addressing the social, emotional and wellbeing perspectives of dementia. A framework reflecting multi-dimensional components for living well with dementia was developed from the findings, and established a post-diagnosis telehealth support program as part of the Centre of Research Excellence in Enhanced Dementia Diagnosis.

Background
Poor sleep is well evidenced to be associated with poor health outcomes. Long workhours can adversely affect sleep quality and in turn poor sleep also affects ability to work longer hours. Further, short workhours may be associated with poor health and poor sleep quality. Workers’ workhours and productivity are therefore affected by sleep. This study aims to estimate the non-linear relationship between workhours and sleep quality in working Australians. We also examine other factors affecting the sleep quality, and the role of domestic unpaid time in this relationship.
Methods
Participants with any positive workhours are included in the analysis in order to allow for marginal effect estimate of workhours on sleep quality, and for non-linear relationship estimation. Sleep quality score is constructed from four sleep quality measures including sleep duration (hours), sleep rating, taking medicine to help sleep, and having problem falling into sleep in 30 minutes. 19,453 observations from Australian nationally representative survey data in 2013, 2017 and 2021 are used. Instrumental variable model is used to correct for reverse relationship between workhours and sleep quality to estimate causal relationship between workhours and sleep.
Results
We found both short and long hours are negatively associated with sleep quality in relation to the standard workhours. The optimal workhours at which sleep quality starts to be compromised if working over this optimal hour was 42-43hours per week even after adjusting for age, sex, presence of preschool children, long-term health condition, alcohol drinking, smoking, household financial situation, neighborhood environment, and job characteristics such as shiftwork, job demand, and work flexibility. We also found that women have a lower optimal workhour (36h/week) than men (47h/week) due to women’s higher domestic unpaid time commitment.
Conclusions
The absence of stable full-time employment or excessive workhours negatively impacts sleep quality, particularly for women who often shoulder additional unpaid domestic responsibilities. Addressing sleep quality through improved working conditions, e.g., reducing part-time or casual employment and minimizing overwork, emerges as a vital strategy for enhancing sleep health. This is particularly crucial in light of the increasing mental health prevalence in Australia which is linked to sleep disturbances.

The limited allocation of resources to geographically diverse populations is an inherent cause of health inequities. Distribution of health service resources between urban and rural areas commonly sees highly populated areas prioritised over more sparsely populated and geographically vast areas. As such, challenges impacting dementia diagnosis, management and care in urban areas are experienced more acutely in rural areas. This research examined equity of access to dementia diagnosis, management and care services for people diagnosed with dementia and/or their significant others (partner/spouse, adult children, siblings, and friends) throughout rural and urban Australia.
A descriptive qualitative study involved conducting online semi-structured interviews with thirty-seven people with experience of the dementia diagnosis process as a patient and/or significant other. Russell’s (2013) Dimensions of Access framework guided data analysis (availability, geography, affordability, accommodation, timeliness, acceptability, and awareness). Disparities in access between urban and rural areas emerged in five key dimensions: 1) availability of healthcare and support services; 2) geography impeding ability to access services; 3) affordability of travel expenses; 4) acceptability of available health professionals and services; and 5) awareness of local services and resources. The dimensions of accommodation and timeliness of care were experienced as challenges irrespective of location, with lengthy appointment wait times and difficulty navigating complex systems.
The study findings have been incorporated into the Centre of Research Excellence in Enhanced Dementia Diagnosis (CREEDDs) accessibility planning and implementation model, as it endeavours to translate innovative dementia diagnostics into clinical practice and achieve timely, accurate and equitable diagnosis throughout Australia.
Significant health inequities persist across the Australian rural-urban divide that must be recognised and addressed in research translation. Employing frameworks that facilitate the identification of inequities and prioritising targeted action to address disparities is vital to ensure equitable dementia diagnosis, management and care nationwide.

Context and aim
Between 2014 and 2023 the number of HIV notifications in WA decreased by 38% to 68 cases. As overall cases declined, the number of cases diagnosed with late-stage HIV infection remained stable and in 2023 a higher proportion of cases were diagnosed with late-stage infection (43%, n=29), compared to 2014 (27%, n=29). Cases diagnosed with late-stage infection are often unaware of their risk of infection and/or experience barriers accessing healthcare and testing services, often facing complex psychosocial circumstances. The Department of Health WA Integrated Case Management Program (ICMP) provides support to people living with HIV (PLHIV) who face these barriers, helping them connect to HIV care and prevent further transmission.

Methods and analysis
The proportion of ICMP clients in 2021 and 2022 who were linked to care and achieved viral suppression (viral load count < 200 copies/ml) following referral to the program was analysed. A statewide estimate on the proportion of PLHIV on treatment who were virally suppressed in 2022 was also calculated as an indicator of access to HIV treatment in WA.

Translational outcomes
In 2021 and 2022, there were 24 referrals to the ICMP to support PLHIV who had disengaged from specialist care. Of those referrals, 63% (n=15) commenced treatment within two months of referral, 54% (n=13) were virally suppressed within three months and 71% (n=17) were virally suppressed within six months. In 2022 an estimated 98% of PLHIV on treatment in WA had achieved viral suppression.

Future actions
The ICMP provides a holistic service to PLHIV with complex needs, including counselling, education, linkage to treatment, advocacy and referrals to relevant agencies. By connecting PLHIV with complex needs to treatment and support services, the ICMP has been a key factor in achieving high levels of HIV viral suppression in WA and will play a pivotal role in the path to the virtual elimination of HIV in WA.

Context and aim: Australian men have poorer health outcomes, which are linked to lower rates of health service use. The National Men’s Health Strategy 2021–2030 highlights the need to better understand the factors influencing men’s use of health services. This study explores the help-seeking preferences, obstacles, and attitudes of Australian men.

Methods: A cross-sectional, nationally representative survey of 1,282 Australian men aged 18 years and older was conducted in March 2021 with a response rate of 91%. Participants responded to a validated questionnaire measuring their preferences for help-seeking related to physical and mental health, and psychological and practical barriers to help-seeking. Multivariate logistic regression analyses determined the adjusted association between age, help-seeking and psychosocial barriers.

Research findings: Men in younger age groups were less likely to seek professional help for both physical (18-29yrs, OR=0.28, 95% CI 0.17-0.49; 30-39yrs, OR=0.35, 95% CI 0.22-0.58) and mental health issues (18-29yrs, OR=0.28, 95% CI 0.16-0.46; 30-39yrs, OR=0.31, 95% CI 0.19-0.49) than men aged 70 and over. Younger men also experience significantly higher levels of psychosocial barriers and practical barriers to seeking help, with 32% of men aged 18-29 reporting three or more obstacles to healthcare engagement, compared to 9.3% of men over 70.

Translational outcomes and future actions: Age is a significant factor in men's health help-seeking preferences in Australia, with a substantial age gradient. These findings highlight the unique help-seeking profile of younger men. Younger Australian men are less likely to seek help proactively, and encounter more practical and psychosocial barriers than older men. The findings underscore the necessity for public health strategies to engage younger men effectively in proactive health management.

Context and aim: The global burden of diabetes is increasing, particularly in low- and middle-income countries (LMICs). Literature shows poor glycaemic control among people with type 2 diabetes (T2DM) in most LMICs. Identifying the factors influencing glycaemic control in this region is crucial for developing effective interventions. This systematic review aimed to evaluate glycaemic control and explore how it relates to people with T2DM living in LMICs.
Methods and analysis: A systematic literature search was conducted in Medline, Embase, CINAHL, PsychINFO and Global health databases to identify articles assessing glycaemic control in LMICs published between 1 January 2001 and 15 April 2024. Information was systematically summarised descriptively following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Study quality was assessed using the modified Newcastle-Ottawa Scale. A random-effect model was used to obtain the pooled proportion of adequate glycaemic control (HbA1c <7%). Heterogeneity (I2) was tested, sensitivity analyses were performed, and publication bias was examined using Egger’s regression test.
Translational outcomes: Among 12,985 records retrieved, 62 studies from 28 countries with 176,304 participants were included. The pooled proportion of adequate glycaemic control was 31% (95% CI: 27%-34%, p<0.001, I2 = 99.11%), with no publication bias (Egger’s regression test, p=0.252). People in upper (31%, 95% CI: 26%-35%) and lower (31%, 95% CI: 26%-37%) middle-income countries had better control than low-income countries (25%, 95% CI: 20%-31%). Overall heterogeneity was high (>86%). Poor glycaemic control was associated with age, female gender, lower education, rural residence, obesity, longer diabetes duration, oral glucose-lowering medications and/insulin use, non-adherence to diet and medication, physical inactivity, and dyslipidaemia.
Future directions: Glycaemic control in LMICs is suboptimal, necessitating targeted interventions. Key strategies include nurse-led clinics, regular healthcare centres audits, and enhanced provider training. Improving patient education, access to affordable medications, and supportive policy changes can improve glycaemic control.