Background Metabolic syndrome (MetS) is a cluster of risk factors, including cardiovascular disease, diabetes, chronic hypertension, obesity, and hypercholesterolemia, which collectively increase the risk of chronic diseases and adverse health outcomes. Affecting up to 30% of the global population, MetS poses significant challenges for surgical patients, with emerging evidence indicating poorer postoperative outcomes compared to nonaffected populations. Despite its growing prevalence, there is a lack of dedicated interventions to address the specific needs of this group. This study aims to explore the barriers and facilitators influencing the management of MetS in surgical patients, with the goal of informing intervention development.Methods A qualitative, exploratory study was conducted using the Theoretical Domains Framework (TDF) to guide data collection and analysis. Semi-structured interviews were conducted with clinicians involved in the perioperative care of patients with MetS, focusing on their perspectives on barriers and facilitators to effective management. Data were analyzed thematically and mapped to the 14 TDF domains.Results Clinicians identified significant barriers, including resource constraints, fragmented care pathways, and variability in team roles. Facilitators included peer validation, multidisciplinary collaboration, and the integration of decision-support tools. Emotional and motivational factors also emerged as critical determinants of engagement.Conclusion This study underscores the need for targeted interventions to address the unique challenges of managing MetS in surgical contexts. The findings provide a foundation for developing behaviorally informed frameworks, with implications for improving surgical outcomes and reducing healthcare costs.

OBJECTIVES:Chronic pain is a highly debilitating condition that affects older adults and has the potential to increase their odds of experiencing cognitive impairment. The primary objective of this study was to examine the correlation between chronic pain and dementia. Additionally, this research endeavors to ascertain whether the association between chronic pain and dementia differs by age and gender. METHODS:Cross-sectional data were derived from the Survey of Disability, Ageing, and Carers. A total of 20 671 and 20 081 participants aged 65 years and older in 2015 and 2018, respectively, were included in this study. The pooled association between chronic pain and dementia was assessed using a multivariable logistic regression model. Furthermore, the study also examined the multiplicative interaction effects between chronic pain and age, as well as chronic pain and gender, with dementia. RESULTS:The pooled analysis demonstrated that chronic pain was associated with a heightened odds of dementia (adjusted odds ratio 1.95; 95% CI 1.85-2.05) among older Australians compared with their counterparts without chronic pain. The interaction effect indicated that individuals with chronic pain across all age groups exhibited increased odds of living with dementia. Additionally, women with chronic pain had higher odds of dementia compared with their counterparts without chronic pain and being male. CONCLUSIONS:A continuous, coordinated, and tailored healthcare strategy is necessary to determine the pain management goals and explore early treatment options for chronic pain in older adults, particularly in groups with the greatest need.

Background: The purpose of this study was to investigate the association between dementia, chronic pain and self-care limitations. Additionally, the study sought to explore the relationship of co-occurring dementia and chronic pain with self-care limitations. Methods: Cross-sectional data derived from the Survey of Disability, Ageing and Carers (SDAC) was used to conduct this study. The pooled association between dementia, and chronic pain, with self-care limitations was assessed using ordered logistic regression model. Furthermore, the study also examined the group comparison of interaction effects between co-occurring dementia and chronic pain with self-care limitations. Results: The ordered logistic regression analysis indicated that people with dementia had significantly higher odds of experiencing greater self-care limitations (adjusted odds ratio [aOR]: 15.12, 95 % confidence interval [CI]: 12.50-18.29) compared to people without dementia. Similarly, chronic pain was independently associated with increased self-care limitations (aOR: 5.98, 95 % CI: 5.49-6.52) compared to people without chronic pain. Additionally, interaction effect analysis revealed that the co-occurrence of dementia and chronic pain substantially heightened the likelihood of self-care limitations (aOR: 66.54, 95 % CI: 52.27-84.69) relative to people without either condition. Conclusions: Disability was higher among older Australians with dementia and chronic pain, and this risk can be increased if the two conditions co-exist. A continuous, aligned, and personalised healthcare approach is needed to establish self-care priorities, especially in groups of people with the greatest need.

Delirium is a prevalent cognitive disorder among older patients and a common phenomenon following major surgical procedures. This study aimed to identify the significant proteomic biomarkers and examine their association with postoperative delirium (POD). Four electronic databases were used to identify the published articles between 1st January 2000 and 31st December 2023. Among the included 40 studies, the meta-analysis investigated 13 potential cytokines and inflammatory biomarker proteins linked with postoperative delirium. The Hedge's g standardized mean difference (SMD) was applied to calculate the effect size, with 95% confidence intervals (CIs), under the fixed effect or random effect model based on the heterogeneity index of I2. Patients with POD exhibited significantly higher elevated levels of inflammatory biomarkers IL-6 (SMD = 1.45), CRP (SMD = 1.26), GFAP (SMD = 1.15), IL-1B (SMD = 0.95), IL-10 (SMD = 0.57), IL-8 (SMD = 0.56), MCP-1 (SMD = 0.39), and NFL (SMD = 0.44), suggesting that these proteins may play an inevitable role in delirium-associated cytokines and inflammatory response, development and progression of delirium. Conversely, a reduction in IGF-1 protein level (SMD =  - 0.24) was also significantly associated with POD, suggesting a potential vulnerability to delirium. This study paves the way for future research aimed at early diagnosis, personalized treatment, and the development of novel therapeutic strategies to manage delirium effectively.

Background Australia's population is ageing, with forecasts indicating that individuals aged 65 years and over will account for >20 % of the total population by 2066. Ageing is strongly linked with a significant decrease in cognitive capabilities. This study aimed to explore the association between cognitive impairment and four types of health outcomes among older Australians. Methods Data used for this study was collected from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. The final analysis consisted of 11,146 person-year observations from 7035 unique individuals from Wave 2012 and Wave 2016, respectively. A longitudinal random-effects generalised least squares, and ordered logistic regression were used to analyse the association between cognitive impairment and health outcomes. Results The study results suggest that cognitive impairment was negatively associated with general health, mental health, self-assessed health and health satisfaction. Older Australians with cognitive impairment scored lower on general health (beta = -2.82, SE = 0.56), mental health (beta = -2.93, SE = 0.53), self-assessed health (beta = - 0.75, SE = 0.10), and health satisfaction (beta = -0.19, SE = 0.09) compared to the counterparts without cognitive impairment. The heterogeneous results also showed cognitive impairment was associated with poor health outcomes across age groups. Conclusion This study found evidence that cognitive impairment is associated with poor health outcomes. To enhance the physical and mental health and well-being of older adults, the community, government and non-government organizations, and other stakeholders should prioritize routine healthcare prevention, targeted interventions, and treatment practices, particularly for individuals with or at risk of cognitive impairment.

Physical inactivity is a major global health concern and has been identified as a risk factor for cognitive impairment. In Australia, the long-term relationship between physical activity and health-related quality of life (HRQoL) in individuals with cognitive impairment remains under researched. This study aims to address this knowledge gap by using data from a population-based longitudinal study. We used data from two waves (wave 12 [2012] and wave 16 [2016]) of the Household, Income and Labour Dynamics in Australia (HILDA) Survey. Our final analytic sample consisted of 1,168 person-year observations from 985 unique individuals. To investigate the association between physical activity and HRQoL, we employed random-effects Generalized Least Squares (GLS) model. We found that participants engaging in physical activity, < 1 to 3 times per week, showed significant positive associations with the Physical Component Summary (PCS) score [β = 4.41, Standard Error (SE) = 0.68], Mental Component Summary (MCS) score (β = 2.55, SE = 0.74), and SF-6D utility value (β = 0.05, SE = 0.007) compared to those who did not perform any physical activity. Similarly, participants who engaged in physical activity more than three times per week to every day had notably higher scores in PCS (β = 7.28, SE = 0.82), MCS (β = 4.10, SE = 0.84), and SF-6D utility values (β = 0.07, SE = 0.009). There is clear evidence that performing physical activity is positively associated with improved HRQoL in people with cognitive impairment. Our findings underscore the critical role of public health initiatives, such as health education and community-based programs, in promoting physical activity to enhance the HRQoL of older Australians living with cognitive impairment.

BACKGROUND:Monoclonal antibodies (mAbs) are revolutionizing healthcare treatments due to their high efficacy and relative safety, despite their cost. Since they first appeared in the late 1980s, a rapidly growing market has developed. OBJECTIVE:This study aims to analyze concentration levels in the market for mAb innovations through a quantitative patent analysis. Data were analyzed using traditional concentration indicators such as the Herfindahl-Hirschman Index and Concentration Ratio, as well as linear regression and kernel density graphs to evaluate innovation and global technology dissemination strategies. The starting point was patents associated with mAbs registered by the FDA and identified in the IQVIA database up until 2019, and supplemented by data from The Antibody Society, Purple Book, Orange Book, and FDA. RESULTS:Our findings indicate that the market for mAb innovations is moderately concentrated for general patents and unconcentrated for priority patents. However, it is significantly more concentrated than the market for chemical drug innovations. The mAb patent families tend to generate more progeny patents, although they are deposited in fewer countries. Chemical drug patents spread faster. Some companies seem to be central to the development of mAbs worldwide, including Roche, PDL, City of Hope, and Celltech. Other important players in the mAb innovation market are AbbVie, Amgen, Novartis, GSK, Biogen, BMS, Regeneron, J&J, and AstraZeneca. The most relevant patents in the analysis are associated with methods and procedures to obtain mAbs, not with molecules themselves. CONCLUSION:The concentration in the mAb innovation market is higher than the concentration in the market for chemical drugs innovations. Our findings also indicate that expertise in mAbs development and production is concentrated in a few countries. Additionally, our study identified that a few key players from high-income countries are driving innovation in the mAb market.

Background: Delirium, a prevalent cognitive dysfunction in older adults, particularly in hospital and surgical settings, significantly increases patient morbidity, mortality, and healthcare costs. However, economic evaluations of healthcare interventions aimed at its prevention, management, and treatment are scant. This study synthesized the available economic evaluation evidence on both pharmacological and non-pharmacological interventions. Methods: A systematic review was conducted on studies published from January 1, 2000, to December 31, 2023, across multiple databases, including PubMed, MEDLINE, Scopus, and EBSCOhost (CINAHL, PsycINFO, and ECOLIT). We adhered to the PICOS framework for inclusion and exclusion criteria and followed PRISMA guidelines for the analysis. The quality of the studies included was assessed using the CHEERS checklist. The meta-analysis of the cost-effectiveness of multicomponent non-pharmacological intervention was evaluated using incremental net benefits (INB). Results: Sixteen eligible studies met the inclusion criteria including four cost-effectiveness analyses (CEA), two cost-benefit analyses (CBA), three cost-consequence analyses (CCA), and seven cost-saving/minimization analyses. The majority (14/16 studies) evaluated non-pharmacological interventions, while only two studies assessed the cost-effectiveness of drug interventions (i.e. dexmedetomidine). Besides the cost-effective multicomponent interventions, pharmacological intervention was also associated with a cost reduction of a maximum of US$4370 per patient by decreasing the length of ICU stays. The studies predominantly originated from high-income countries. The meta-analysis included four studies and pooled INB of multicomponent non-pharmacological intervention was estimated at US$8014 (95% CI=US$1,060, US$14,969; p-value<0.05) with significant heterogeneity among the studies (I2 = 100%; p-value<0.01). The pooled INB was US$2657 higher for the model-based economic evaluation studies compared to within-trial evaluation. Conclusion: The estimated INB indicated that multicomponent non-pharmacological intervention was a cost-effective strategy to prevent and manage delirium cases which indicates improved patient outcomes and potential cost savings. Future research should focus on low-resource settings and direct comparisons of pharmacological and non-pharmacological approaches to further enhance delirium management practices.

Cancer treatment using systemic therapy and radiotherapy may cause post-therapy complications, resulting in increased unplanned hospitalisation. The evidence on such complications, their impact on unplanned hospitalisations, and associated costs is scant in Australia. We aimed to estimate the prevalence of post-therapy complications, evaluate their impact on unplanned hospitalisation, length of stay (LOS) and investigate the associated medical costs. A retrospective cohort study was conducted among 8,633 cancer patients (1.03 million emergency hospital admissions) in Victoria, Australia from July 2006 to June 2020, from the Australian healthcare system perspective. Multivariate generalised linear regression models were employed to estimate the adjusted association between post-therapy complications and clinical characteristics with hospital LOS and associated hospitalisation medical costs. Approximately 52% of patients were male with an average patient age of 59.9 years. Annually, post-therapy complications leading to unplanned hospitalisations increased by 7.25%, outpacing the growth in overall hospitalisation admissions, which was 5.66% for overall hospitalisation admissions. A significant proportion of patients (71%) experienced multiple complications, with the most common being anemia (26%), sepsis (15%), nausea and vomiting (14%), and neutropenia (11%). Patients undergoing combined systemic and radiotherapy exhibited higher odds of post-therapy complications (OR = 8.24, 95%CI: 7.48 to 9.08) compared with those who only received systemic therapy. Mean hospital stay among patients who experienced post-therapy complications was 2.23 days per admission (360 days per patient), an extra 1.72 days per admission [95%CI: 1.68 to 1.76; 354 days per patient, 95%CI: 336 to 371 days] longer than patients without complications (0.51 days per admission and 6.48 days per patients). Overall, per-admission medical hospitalisation costs among patients with post-therapy complications were $8,791 higher than for patients who did not experience complications ($11,418 vs. $2,627 per admission, 95%CI: $8,685 to $8,897). Per-patient costs for unplanned hospitalisation due to post-therapy complications were significantly $1.82 million higher among patients than those without complications ($1.86 million vs. $33,599 per patient, 95%CI: $1.71 million to $1.94 million). The cost and hospitalisation stay (in days) varied by the type of therapy and cancer type. The study results indicate that post-therapy complications in cancer patients varied by the type of cancer and increased over the study period, leading to longer unplanned hospital stays and higher hospitalisation medical costs. The results highlight the need for better-customized treatment delivery strategies to address this burden and optimise resources in cancer care.

The purpose of this paper is to determine which factors influence the willingness of Italian wine consumers to purchase and pay a premium for sustainably produced wine. Data from 522 Italian consumers were collected using an online convenience sampling method to capture their attitudes and knowledge towards sustainably produced wine. Respondent socio-demographic characteristics were analysed using descriptive statistics. Multivariate logistic regression was used to examine whether the willingness to pay a premium for sustainably produced wines differs significantly based on past environmental related purchasing behaviour and socio-demographic characteristics. The main determinants of Italian consumers’ purchases of sustainably produced wine are wine knowledge, age, previously having bought sustainably produced goods, previously having bought sustainably produced wine, and the price of wine. Income, education, or gender did not positively influence willingness to pay a premium value for sustainably produced wines. This study produced surprising results. Consumers in Italy are buying foods that are sustainably certified and over 60% would be willing to buy a sustainable wine, in theory.

Delirium and Alzheimer's disease (AD) are common causes of cognitive dysfunction among older adults. These neurodegenerative diseases share a common and complex relationship, and can occur individually or concurrently, increasing the chance of permanent mental dysfunction. However, the common molecular pathophysiology, key proteomic biomarkers, and functional pathways are largely unknown, whereby delirium is superimposed on AD and dementia. We employed an integrated bioinformatics and system biology analysis approach to decipher such common key proteomic signatures, pathophysiological links between delirium and AD by analyzing the gene expression data of AD-affected human brain samples and comparing them with delirium-associated proteins. The present study identified the common drug target hub-proteins examining the protein–protein interaction (PPI) and gene regulatory network analysis. The functional enrichment and pathway analysis was conducted to reveal the common pathophysiological relationship. Finally, the molecular docking and dynamic simulation was used to computationally identify and validate the potential drug target and repurposable drugs for delirium and AD. We detected 99 shared differentially expressed genes (sDEGs) associated with AD and delirium. The sDEGs-set enrichment analysis detected the transmission across chemical synapses, neurodegeneration pathways, neuroinflammation and glutamatergic signaling pathway, oxidative stress, and BDNF signaling pathway as the most significant signaling pathways shared by delirium and AD. The disease-sDEGs interaction analysis highlighted the other disease risk factors with delirium and AD development and progression. Among the sDEGs of delirium and AD, the top 10 hub-proteins including ALB, APP, BDNF, CREB1, DLG4, GAD1, GAD2, GFAP, GRIN2B and GRIN2A were found by the PPI network analysis. Based on the maximum molecular docking binding affinities and molecular dynamic simulation (100 ns) results, the ALB and GAD2 were found as prominent drug target proteins when tacrine and donepezil were identified as potential drug candidates for delirium and AD. The study outlined the common key biomolecules and biological pathways shared by delirium and AD. The computationally reported potential drug molecules need a deeper investigation including clinical trials to validate their effectiveness. The outcomes from this study will help to understand the typical pathophysiological relationship between delirium and AD and flag future therapeutic development research for delirium.

This study examines the dynamic relationship between carbon (CO2) emissions and energy usage, economic growth, and the changing industry structure in Bangladesh using annual time series data from 1972 to 2020. To this end, the ARDL Bound co-integration approach as well as the ECM method were employed to analyze the dynamics in the long and short run respectively. The findings reveal a strong positive long-run association between CO2 emissions, economic growth, industry value added and GDP. For agriculture and services value added, no significant long-run relationship could be found. However, both industrial and service sectors show dynamism in the short run indicating that structural industry changes are already reducing CO2 emissions. Thus, the pressing concerns regarding the increase in emissions and the imperative to achieve its growth potential, Bangladesh ought to foster innovative technological, economic, and social solutions that can harmonize energy-intensive development with a heightened emphasis on clean energy adoption, energy conservation initiatives, and efficiency enhancements.

Background The distributional effects of cognitive impairment on inequalities in health-related quality of life (HRQoL) are not well studied. This relationship has not been studied in any Australian health inequality literature. Therefore, this study aims to examine how cognitive impairment affects the distribution of HRQoL across various socio-economic classes amongst older Australians. Methods Data for this study was collected from the Household, Income and Labour Dynamics in Australia (HILDA) survey. The final analysis consisted of 5,247 and 5,614 unique individuals from wave 2012 and wave 2016, respectively. An ordinary least squares (OLS) regression model was used to investigate the relationship between cognitive impairment and HRQoL. Additionally, the Wagstaff-Doorslaer-Watanabe standard concentration index was used to examine socioeconomic inequality in HRQoL. Results The findings revealed pro-rich inequalities in HRQoL, as indicated by the concentration indices of 0.029 and 0.025 for wave 12 and wave 16, respectively. Additionally, the results showed that mild cognitive impairment accounted for 7.60% and 9.03%, respectively, of pro-rich socioeconomic inequality in HRQoL in 2012 and 2016. Conclusion People from lower socioeconomic status (SES) groups tend to have lower HRQoL compared to those from higher SES. This leads to a greater disparity in HRQoL based on SES. Cognitive impairment positively contributed to this inequality in HRQoL. Therefore, it is critical to incorporate cognitive impairment into the design of interventions to reduce socioeconomic inequality in HRQoL.

Delirium is a severe neuropsychiatric illness that occurs frequently in intensive care and postoperative units which results in prolonged hospital stays and increases patient’s mortality and morbidity rates. This review focused on accumulating the common key proteomic signatures significantly associated with delirium. We carried out a systematic literature review of studies on delirium proteomic biomarkers published between 1st January 2000 and 31st December 2023 from the following electronic bibliographic databases including PubMed, Scopus, and EBSCOhost (CINAHL, Medline). A total of 1746 studies were identified and reviewed, and 78 studies were included in our review. The PRISMA guidelines, the PEO framework, and JBI quality assessment method were followed in this review to maintain the inclusion and exclusion criteria and risk of bias assessment. Most of the included studies were of the cohort (68%) and case-control (23%) design. We have accumulated a total of 313 proteins or gene encoded proteins of which 189 were unique. Among the unique proteins, we focused on the top 13 most investigated proteins (IL-6, CRP, IL-8, S100B, IL-10, TNF-a, IL-1b, Cortisol, MCP-1, GFAP, IGF-1, IL-1ra, and NFL) that are significantly associated with delirium. Most of these are cytokines and inflammatory proteins indicating a strong interconnection with delirium. There was remarkable inconsistency among the studies in reporting the specific potential proteomic biomarker. No single proteomic biomarker can be solely used to diagnose and predict delirium. The current review provides a rationale for further molecular investigation of delirium-related proteomic biomarkers. Also, it’s recommended to conduct further in-depth molecular research to decipher drug target biomolecules for potential prognostic, diagnostic, and therapeutic development against delirium.

In recent years mental health disparity has been rising in Australia. The contributing factors to this rising disparity are not well understood. We investigated this by measuring and decomposing socioeconomic mental health inequality in Australia using the Household, Income and Labour Dynamics in Australia (HILDA) panel survey datasets between 2009 and 2017 employing the longitudinal factor decomposition method. In this research, we decompose the Income-Related Health Mobility (IRHM) and the Health-Related Income Mobility (HRIM) index. The IRHM index reflects the effect of the relationship between relative health changes at a constant income level, and the HRIM index represents changes in income ranking or income mobility with a fixed health outcome over time. Our findings suggest that poorer individuals cannot procure private health insurance, experience more long-term health conditions and have larger exposure to life shocks than richer individuals. Thus, long-term health conditions, private health insurance coverage, and number of life disruptions are the primary factors that negatively impact the IRHM index, thereby contributing to an increase in socioeconomic inequality in mental health in Australia. Moreover, the HRIM index exhibits a more pronounced adverse impact from labour force status compared to the relatively weaker positive effects observed in the IRHM index, resulting in a net negative effect from labour force status in this period. To address this, Australian governments should focus on implementing cost-effective intervention policies targeting disadvantaged populations to maximise health system resources and minimise mental health disparity by addressing the socioeconomic determinants of mental health.

Background Evaluating the effects of cancer diagnosis and treatment on a patient’s overall well-being is crucial and health-related quality of life (HRQoL) is a reliable metric for assessing this impact. Little is known about HRQoL among cancer survivors across various stages and treatments. The study examined individual and clinical factors influencing HRQoL among cancer survivors. Methods A cross-sectional study was conducted in two specialised cancer care hospitals in Dhaka, Bangladesh. Cancer-diagnosed adults receiving treatment at selected hospitals from January to May 2022 were enrolled. The 5-level EuroQol-5 Dimensions version (EQ-5D-5L) instrument was used to collect HRQoL data. HRQoL scores were derived using UK value sets. The investigation used a multivariable Tobit regression model to determine the association between independent variables and HRQoL scores. Results A total of 607 adult patients were enrolled, with 55% being females and 66% aged 36 to 64 years. Reported health problems in five EQ-5D domains include mobility (11%), self-care (11%), usual daily activities (19%), pain/discomfort (21%), and anxiety/depression (46%). Patients with throat, brain, lung, blood, and liver cancer had lower utility scores. Advanced-stage cancer survivors had lower utility scores (β = -49 units, 95% codfidence interval [CI]: -0.75 to -0.22) compared to early-stage survivors. Physically inactive survivors had lower utility scores by 0.41 units (95% CI: -0.51 to -0.30) compared to their counterparts. Private hospital patients had higher utility scores, whereas patients belonged to poor socioeconomic groups scored worse than wealthier ones. Conclusions This study highlights the impact of clinical and individual characteristics on HRQoL among cancer survivors. These findings advocate for an enhanced Bangladeshi cancer patient care model through timely interventions or programs, early detection or diagnosis, tailored treatments, and the promotion of physical activity to bolster HRQoL outcomes.

Wine is part of the recent global trend for healthier food sources. However, there is no commonly agreed upon global certification for wine. In fact, wine has unique characteristics that make its designation as ‘sustainable' problematic. There are three distinct obstacles to developing a global sustainability framework for wine. First is related to the consumer and their lack of knowledge and information. Second is based on producers' attitudes. Third stems from the lack of agreement on what exactly certified sustainable wine is. These issues create a negative consumer-producer-certification cycle resulting in confusion and ineffective development and implementation of a widely accepted framework. This limits the global wine industry from developing large scale, measurable, and global sustainability successes. The authors make some recommendations as to how to overcome these issues. This includes education, standardization, a need for continued research, and some form of regulation to avoid deception and confusion for consumers to overcome the information problem.

Background The exact prevalence of dementia in Australia is ambiguous. Australia is a vast continent with a small population, and 80% of the population live in five cities. This study explores recent changes in the prevalence of dementia. It also investigates geographic remoteness as a potential risk factor for developing dementia. Methods Survey of Disability, Ageing and Carers (SDAC), a nationally representative database, was used to conduct this study. A total of 74,862 and 65,487 individuals from 2015 and 2018, respectively, were considered for this study. A multivariable logistic regression model was used to evaluate the association between dementia and geographic remoteness for older adults aged 65 years and over. Results The results reveal that from 2015 to 2018, the prevalence of dementia among adults aged 65 years and older was higher in 2018 (5,229 per 100,000) than in 2015 (5,099 per 100,000). Significant geographical differences in the prevalence of dementia are observed among Australian adults, and this trend appears to be increasing. Furthermore, the unadjusted model revealed that, in 2015, older adults living in major cities had 1.29 (AOR: 1.29, 95% CI: 1.17–1.41) times higher odds of having dementia compared with their counterparts from outer regional and remote areas. In 2018, the adjusted model found that older adults living in major cities had 1.12 (AOR: 1.12, 95% CI: 1.01–1.25) times elevated odds of having dementia than their peers living in outer regional and remote areas. Conclusion There is a rising prevalence of dementia in Australia. Further investigation is required to identify the causes of this increase. Increased public health initiatives should concentrate on behavioural characteristics and contextual environmental factors to ameliorate this trend.

Background: This study aimed to estimate the prevalence of suicidal behaviors, i.e. suicidal ideation (SI), suicidal plan (SP), and suicidal attempt (SA) among adolescents with a focus on parental and peer support in eight SouthEast Asian countries including Bangladesh, Bhutan, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka and Thailand. Method: Data were drawn from Global School-based Student Health Survey (GSHS) covering 42,888 adolescents aged 11-17 years. Weighted prevalence of SI, SP, and SA along with country specific prevalence was computed and binary logistic regression was used to identify associated risk factors. Results: Among 42,888 adolescents 19,113 (44.9%) were males and 23,441 (55.1%) females. Overall prevalence of SI, SP and SA is 9.10%, 10.42% and 8.54%, respectively. Myanmar demonstrated the lowest SI (1.07%) and SP (0.18%) whereas lowest SA was found in Indonesia (3.79%). Maldives had the highest prevalence of SI, SP and SA which were 14.13%, 19.02% and 13.38% respectively. Overall suicidal behaviors were associated with being female [AOR: SI-1.26 (1.06,1.50), SP-1.34 (1.14,1.57)], high levels of sedentary behavior [AOR: SI-2.08 (1.62,2.66), SP-1.86 (1.49,2.32), SA-1.96 (1.45,2.64)], involvement in physical fighting [AOR: SI-1.30 (1.07,1.58), SP-1.37 (1.14,1.65), SA-1.50 (1.17,1.90)], being seriously injured [AOR: SI-1.40 (1.17,1.67), SP1.44 (1.22,1.69), SA-1.74 (1.39,2.17)], being bullied [AOR: SI- 1.68 (1.39,2.02), SP-1.34 (1.12,1.60), SA-1.88 (1.50,2.36)], feeling lonely (most of time or always) [AOR: SI-3.41(2.60,4.46), SP-1.92 (1.48,2.47), SA-2.25 (1.62,3.13)], lack of parental support (never checking homework) [AOR: SI-1.59 (1.25,2.02), SP-1.52 (1.22,1.90)] and not having close friends [AOR: SI-2.19 (1.66,2.89), SP-2.26 (1.74,2.94), SA-4.23 (3.10,5.78)]. Conclusion: Though prevalence of suicidal behaviors varies, a range of cross-cutting risk factors exists that warrant further examination. We recommend focusing on strengthening parental and peer support, targeted programs addressing physical activity, bullying, loneliness and mental-health of adolescents.

BackgroundChronic diseases are considered one of the major causes of illness, disability, and death worldwide. Chronic illness leads to a huge health and economic burden, especially in low- and middle-income countries. This study examined disease-stratified healthcare utilisation (HCU) among Bangladesh patients with chronic diseases from a gender perspective.MethodsData from the nationally representative Household Income and Expenditure Survey 2016-2017 consisting of 12,005 patients with diagnosed chronic diseases was used. Gender differentiated chronic disease stratified-analytical exploration was performed to identify the potential factors to higher or lower utilisation of healthcare services. Logistic regression with step-by-step adjustment for independent confounding factors was the method used.ResultsThe five most prevalent chronic diseases among patients were gastric/ulcer (Male/Female, M/F: 16.77%/16.40%), arthritis/rheumatism (M/F: 13.70%/ 13.86%), respiratory diseases/asthma/bronchitis (M/F: 12.09% / 12.55%), chronic heart disease (M/F: 8.30% / 7.41%), and blood pressure (M/F: 8.20% / 8.87%). Eighty-six percent of patients with chronic diseases utilised health care services during the previous 30 days. Although most patients received outpatient healthcare services, a substantial difference in HCU among employed male (53%) and female (8%) patients were observed. Chronic heart disease patients were more likely to utilise health care than other disease types, which held true for both genders while the magnitude of HCU was significantly higher in males (OR = 2.22; 95% CI:1.51-3.26) than their female counterparts (OR = 1.44; 1.02-2.04). A similar association was observed among patients with diabetes and respiratory diseases.ConclusionA burden of chronic diseases was observed in Bangladesh. Patients with chronic heart disease utilised more healthcare services than patients experiencing other chronic diseases. The distribution of HCU varied by patient's gender as well as their employment status. Risk-pooling mechanisms and access to free or low-cost healthcare services among the most disadvantaged people in society might enhance reaching universal health coverage.