Potentially modifiable dementia risk factors in all Australians and within population groups: an analysis using cross-sectional survey data

Background: Dementia is the second leading cause of disease burden in Australia. We aimed to calculate the population attributable fractions (PAFs) of dementia attributable to 11 of 12 previously identified potentially modifiable health and social risk factors (less education, hearing loss, hypertension, obesity, smoking, depression, social isolation, physical inactivity, diabetes, alcohol excess, air pollution, and traumatic brain injury), for Australians overall and three population groups (First Nations, and those of European and Asian ancestry). // Methods: We calculated the prevalence of dementia risk factors (excluding traumatic brain injury) and PAFs, adjusted for communality, from the cross-sectional National Aboriginal and Torres Strait Islander Health Survey (2018–19), National Aboriginal and Torres Strait Islander Social Survey (2014–15), National Health Survey (2017–18), and General Social Survey (2014) conducted by the Australian Bureau of Statistics. We conducted sensitivity analyses using proxy estimates for traumatic brain injury (12th known risk factor) for which national data were not available. // Findings: A large proportion (38·2%, 95% CI 37·2–39·2) of dementia in Australia was theoretically attributable to the 11 risk factors; 44·9% (43·1–46·7) for First Nations Australians, 36·4% (34·8–38·1) for European ancestry, and 33·6% (30·1–37·2) for Asian ancestry. Including traumatic brain injury increased the PAF to 40·6% (39·6–41·6) for all Australians. Physical inactivity (8·3%, 7·5–9·2), hearing loss (7·0%, 6·4–7·6), and obesity (6·6%, 6·0–7·3) accounted for approximately half of the total PAF estimates across Australia, and for all three population groups. // Interpretation: Our PAF estimates indicate a substantial proportion of dementia in Australia is potentially preventable, which is broadly consistent with global trends and results from other countries. The highest potential for dementia prevention was among First Nations Australians, reflecting the enduring effect of upstream social, political, environmental, and economic disadvantage, leading to greater life-course exposure to dementia risk factors. Although there were common dementia risk factors across different population groups, prevention strategies should be informed by community consultation and be culturally and linguistically appropriate. // Funding: Australian National Health and Medical Research Council and University College London Hospitals’ National Institute for Health Research (NIHR) Biomedical Research Centre, and North Thames NIHR Applied Research Collaboration

Mass infection is not an option: we must do more to protect our young.

Funder: Medical Research CouncilFunder: Wellcome Trus

Vaccinating adolescents against SARS-CoV-2 in England: a risk-benefit analysis.

OBJECTIVE: To offer a quantitative risk-benefit analysis of two doses of SARS-CoV-2 vaccination among adolescents in England. SETTING: England. DESIGN: Following the risk-benefit analysis methodology carried out by the US Centers for Disease Control, we calculated historical rates of hospital admission, Intensive Care Unit admission and death for ascertained SARS-CoV-2 cases in children aged 12-17 in England. We then used these rates alongside a range of estimates for incidence of long COVID, vaccine efficacy and vaccine-induced myocarditis, to estimate hospital and Intensive Care Unit admissions, deaths and cases of long COVID over a period of 16 weeks under assumptions of high and low case incidence. PARTICIPANTS: All 12-17 year olds with a record of confirmed SARS-CoV-2 infection in England between 1 July 2020 and 31 March 2021 using national linked electronic health records, accessed through the British Heart Foundation Data Science Centre. MAIN OUTCOME MEASURES: Hospitalisations, Intensive Care Unit admissions, deaths and cases of long COVID averted by vaccinating all 12-17 year olds in England over a 16-week period under different estimates of future case incidence. RESULTS: At high future case incidence of 1000/100,000 population/week over 16 weeks, vaccination could avert 4430 hospital admissions and 36 deaths over 16 weeks. At the low incidence of 50/100,000/week, vaccination could avert 70 hospital admissions and two deaths over 16 weeks. The benefit of vaccination in terms of hospitalisations in adolescents outweighs risks unless case rates are sustainably very low (below 30/100,000 teenagers/week). Benefit of vaccination exists at any case rate for the outcomes of death and long COVID, since neither have been associated with vaccination to date. CONCLUSIONS: Given the current (as at 15 September 2021) high case rates (680/100,000 population/week in 10-19 year olds) in England, our findings support vaccination of adolescents against SARS-CoV2

Alcohol, tobacco and illicit drug use amongst same-sex attracted women: results from the Western Australian Lesbian and Bisexual Women's Health and Well-Being Survey

Background: The prevalence of alcohol, tobacco and illicit drug use has been reported to be higheramongst lesbian and bisexual women (LBW) than their heterosexual counterparts. However, few studieshave been conducted with this population in Australia and rates that have been reported vary considerably.Methods: A self-completed questionnaire exploring a range of health issues was administered to 917women aged 15-65 years (median 34 years) living in Western Australia, who identified as lesbian orbisexual, or reported having sex with another woman. Participants were recruited from a range of settings,including Perth Pride Festival events (67.0%, n = 615), online (13.2%, n = 121), at gay bars and nightclubs(12.9%, n = 118), and through community groups (6.9%, n = 63). Results were compared against availablestate and national surveillance data.Results: LBW reported consuming alcohol more frequently and in greater quantities than women in thegeneral population. A quarter of LBW (25.7%, n = 236) exceeded national alcohol guidelines by consumingmore than four standard drinks on a single occasion, once a week or more. However, only 6.8% (n = 62)described themselves as a heavy drinker, suggesting that exceeding national alcohol guidelines may be anormalised behaviour amongst LBW. Of the 876 women who provided data on tobacco use, 28.1% (n =246) were smokers, nearly double the rate in the female population as a whole. One third of the sample(33.6%, n = 308) reported use of an illicit drug in the previous six months. The illicit drugs most commonlyreported were cannabis (26.4%, n = 242), meth/amphetamine (18.6%, n = 171), and ecstasy (17.9%, n =164). Injecting drug use was reported by 3.5% (n = 32) of participants.Conclusion: LBW appear to use alcohol, tobacco and illicit drugs at higher rates than women generally,indicating that mainstream health promotion messages are not reaching this group or are not perceivedas relevant. There is an urgent need for public health practitioners working in the area of substance useto recognise that drug consumption and use patterns of LBW are likely to be different to the widerpopulation and that special considerations and strategies are required to address the unique and complexneeds of this population

Best practice cognitive assessment with older Aboriginal and Torres Strait Islander Peoples: a scoping review protocol

The proposed scoping review forms part of a broader project designed to enhance the utility of the KICA (LoGiudice et al., 2006), the only culturally specific and psychometrically validated dementia screen for Aboriginal and Torres Strait Islander peoples. The review will focus on two questions: 1) What is current best practice in cognitive assessment methods, items and tools for older (i.e., ≥45 years) First Nations peoples internationally? 2) What are the gaps, barriers and strengths of the KICA and its use with Aboriginal and Torres Strait Islander peoples? The review will use a descriptive analytical method (Levac et al., 2010) and follow PRISMA-ScR (Tricco et al., 2018) reporting guidelines to i) determine common themes and recommendations among best practice guidelines for First Nations cognitive assessment and ii) generate a pool of possible revisions, items, and adaptations for the KICA tool

SARS-CoV-2 Delta variant: a systematic review of transmissibility and severity in children

Objectives: To review the evidence of the transmissibility and severity of infection with the Delta variant of SARS-CoV-2 in children. Design: Systematic review. Data sources: PubMed, Embase, medRxiv, Web of Science, and WHO COVID database. Study selection: English language original articles, case reports, commentaries, and letters with relevant primary data, which examined evidence for the transmissibility and severity of infection with the Delta variant of SARS-CoV-2 in children. Methods: Five databases were searched for articles from the period October 2020 to March 2022. Reference lists of eligible studies and grey literature were hand searched for additional studies for inclusion. Articles that provided adequate epidemiological data including infection, transmission, or severity (including hospitalisation and death) with probable or confirmed cases of the Delta variant of SARS-CoV-2 in children (aged ≤9 years) and adolescents (aged 10 to 19 years) were included. Data were extracted for country of origin; participant characteristics (age and sex); sample size; vaccination status; and outcomes, including incidence, secondary attack rate, hospitalisation, ICU, and mortality. All included studies were assessed for bias using the Joanna Briggs Institute Critical Appraisal checklists. Results: 298 studies were found through database searching. After screening, 21 studies were included in the systematic review. Of the included studies, all were deemed to be of moderate to high quality, therefore all were included in the final analysis. Increased incidence was reported in two population studies in the USA and Australia during the period of Delta predominance. Age-related data were available for 14 studies and showed higher rates of infection in older children compared to younger children. Attack rates in educational settings were higher when an adult was the primary case. Data on severity were available from 12 studies and showed that severe disease remained rare, with increasing hospitalisation numbers in proportion to increasing paediatric cases. Vaccination was protective for severe disease, with studies in the United States, Israel and Europe showing less healthcare encounters, emergency department presentations and hospitalisations amongst vaccinated adolescents. Several studies pointed to educational and household settings as key sites for paediatric infection with the Delta variant. Conclusion: A growing proportion of COVID-19 cases were diagnosed in children during the study period due to increased transmissibility of the SARS-CoV-2 Delta variant, with an increasing number of outbreaks observed in household and educational settings likely attributed to low vaccine coverage among children. While severe disease remains uncommon, the impact of vaccination in both adults and adolescents has been shown to reduce paediatric hospitalisation rates