Centralising Local Aboriginal Language and Culture in Healthy Skin Books on the See Treat Prevent (SToP) Trial in the Kimberley Region of Western Australia: A Process and Impact Inquiry

Language is significant for communicating knowledge across cultures and generations and has the power to attribute meanings and alter our worldviews. More than 250 Aboriginal and Torres Strait Islanders languages were spoken in 1788. This number has diminished to approximately 110 languages spoken in 2016, of which 90% were considered endangered in 2019. Language custodians and speakers across Australia are working to preserve and ensure languages are strongly spoken into the future. Language revitalisation initiatives can facilitate (re)connection to Country, cultures and communities and be recognised as acts of reconciliation for Aboriginal and Torres Strait Islander peoples. In a health context, recent evidence indicates that connection to language and culture is important in promoting overall health and wellbeing for Indigenous people. Embedding culture and language into health resources is now a key strategy for public health to reduce the existing health inequities experienced by Aboriginal and Torres Strait Islander people. With the increased demand for Indigenous language health promotion resources, practical policies and guidelines on development and distribution are required. Furthermore, investigation is warranted into the effectiveness and impact of local community context and how end users perceive and may apply these resources. MethodsThis study reports a qualitative research process and impact inquiry of Aboriginal community-led healthy skin resources to address the gaps in understanding the development and impact of Indigenous language health promotion resources. The development of these resources is described in detail, followed by an impact inquiry, including perspectives from six end users employed in health care, health ethics and governance. Data for this impact inquiry were collected via audio recorded semi-structured interviews, which were transcribed verbatim before an inductive thematic analysis was conducted. It is anticipated that these perspectives will help guide best practice in the development and use of future resources in language. FindingsOur study validates how strong Aboriginal leadership from Elders and community members guided the development of the books. Using local language custodians and speakers to translate healthy skin messages facilitated two-way learning opportunities and enabled self-determination in the communities. Healthcare practitioners articulated the benefit of using language and visuals to help explain skin infections and their sequelae. An Aboriginal health research ethics committee and research governance staff believed these books were best practice for guiding future health promotion resources in an Aboriginal context

Genome-wide meta-analysis of ascertainment and symptom structures of major depression in case-enriched and community cohorts

Background. Diagnostic criteria for major depressive disorder allow for heterogeneous symp-tom profiles but genetic analysis of major depressive symptoms has the potential to identify clinical and etiological subtypes. There are several challenges to integrating symptom data from genetically informative cohorts, such as sample size differences between clinical and community cohorts and various patterns of missing data. Methods. We conducted genome-wide association studies of major depressive symptoms in three cohorts that were enriched for participants with a diagnosis of depression (Psychiatric Genomics Consortium, Australian Genetics of Depression Study, Generation Scotland) and three community cohorts who were not recruited on the basis of diagnosis (Avon Longitudinal Study of Parents and Children, Estonian Biobank, and UK Biobank). We fit a series of confirmatory factor models with factors that accounted for how symptom data was sampled and then compared alternative models with different symptom factors. Results. The best fitting model had a distinct factor for Appetite/Weight symptoms and an additional measurement factor that accounted for the skip-structure in community cohorts (use of Depression and Anhedonia as gating symptoms). Conclusion. The results show the importance of assessing the directionality of symptoms (such as hypersomnia versus insomnia) and of accounting for study and measurement design when meta-analyzing genetic association data

Treatment of Primary Liver Tumors with Yttrium-90 Microspheres (TheraSphere®) in High Risk Patients: Analysis of Survival and Toxicities

This retrospective study was undertaken to obtain information regarding the survival and toxicities after Yttrium-90 microspheres treatment in patients with primary liver malignancies. Baseline, treatment, and follow-up data were collected and analyzed for 21 patients treated with Yttrium-90 microspheres. Survival analysis was then performed. The results of this study showed that median survival for all the patients was 120 days. Twenty of 21 patients were categorized as high-risk with a median survival of 114 days. It was also found that one high-risk patient has survived 858 days with no recurrence of disease. Acute grade 3-5 toxicities were recorded for nine patients and consisted of elevations in AST and bilirubin, thrombocytopenia, abdominal pain, ascites, nausea, fatigue, and death. This study concluded that Yttrium-90 is a low-toxicity, outpatient alternative for individuals with liver cancer and without many options. The maximal value, however, may lie in the treatment of low-risk patients

Treatment of primary liver tumors with Yttrium-90 microspheres (TheraSphere) in high risk patients: analysis of survival and toxicities.

This retrospective study was undertaken to obtain information regarding the survival and toxicities after Yttrium-90 microspheres treatment in patients with primary liver malignancies. Baseline, treatment, and follow-up data were collected and analyzed for 21 patients treated with Yttrium-90 microspheres. Survival analysis was then performed. The results of this study showed that median survival for all the patients was 120 days. Twenty of 21 patients were categorized as high-risk with a median survival of 114 days. It was also found that one high-risk patient has survived 858 days with no recurrence of disease. Acute grade 3-5 toxicities were recorded for nine patients and consisted of elevations in AST and bilirubin, thrombocytopenia, abdominal pain, ascites, nausea, fatigue, and death. This study concluded that Yttrium-90 is a low-toxicity, outpatient alternative for individuals with liver cancer and without many options. The maximal value, however, may lie in the treatment of low-risk patients

Acute COVID-19 severity and 16-month mental morbidity trajectories in patient populations of six nations

AbstractBACKGROUNDThe aim of this multinational study was to assess the development of adverse mental health symptoms among individuals diagnosed with COVID-19 in the general population by acute infection severity up to 16 months after diagnosis.METHODSParticipants consisted of 247 249 individuals from seven cohorts across six countries (Denmark, Estonia, Iceland, Norway, Scotland, and Sweden) recruited from April 2020 through August 2021. We used multivariable Poisson regression to contrast symptom-prevalence of depression, anxiety, COVID-19 related distress, and poor sleep quality among individuals with and without a diagnosis of COVID-19 at entry to respective cohorts by time (0-16 months) from diagnosis. We also applied generalised estimating equations (GEE) analysis to test differences in repeated measures of mental health symptoms before and after COVID-19 diagnosis among individuals ever diagnosed with COVID-19 over time.FINDINGSA total of 9979 individuals (4%) were diagnosed with COVID-19 during the study period and presented overall with a higher symptom burden of depression (prevalence ratio [PR] 1·18, 95% confidence interval [95% CI] 1·03-1·36) and poorer sleep quality (1·13, 1·03-1·24) but not with higher levels of symptoms of anxiety or COVID-19 related distress compared with individuals without a COVID-19 diagnosis. While the prevalence of depression and COVID-19 related distress attenuated with time, the trajectories varied significantly by COVID-19 acute infection severity. Individuals diagnosed with COVID-19 but never bedridden due to their illness were consistently at lower risks of depression and anxiety (PR 0·83, 95% CI 0·75-0·91 and 0·77, 0·63-0·94, respectively), while patients bedridden for more than 7 days were persistently at higher risks of symptoms of depression and anxiety (PR 1·61, 95% CI 1·27-2·05 and 1·43, 1·26-1·63, respectively) throughout the 16-month study period.CONCLUSIONAcute infection severity is a key determinant of long-term mental morbidity among COVID-19 patients.</jats:sec