For the first time, a question relating to certain long-term health conditions was asked in the 2021 Australian population census. The conditions included arthritis, asthma, cancer (including remission), dementia (including Alzheimer's), diabetes (excluding gestational diabetes), heart disease (including heart attack or angina), kidney disease, lung condition (including COPD or emphysema), mental health condition (including depression or anxiety), and stroke. Respondents could indicate either none or any number of these conditions. In this paper, the data on these conditions have been analysed to compare the self-reported prevalence of diseases among the 23.4 million Australians who responded to this question (median age 39 years), of whom 3.2% were Aboriginal and Torres Strait Islander peoples (median age 24 years). Standardised Morbidity Ratios for each disease were calculated for the Aboriginal and Torres Strait Islander peoples by using the relevant age-disease specific morbidity rates for the total population as the 'standard'. Findings of this research revealed that the prevalence of diseases was much higher among the Aboriginal and Torres Strait Islander peoples compared to the total population. The only exception was cancer, where the rates for the two groups were not much different. Gaps in prevalence of diseases in the two groups generally increased with age. The higher rates among the Aboriginal and Torres Strait Islander peoples emphasise the need for continued action on health equity and the development of more nuanced and focused initiatives to reduce the gaps between the Aboriginal and Torres Strait Islander peoples vis-à-vis the total population of Australia. Findings in this paper were consistent with similar studies (albeit largely surveys) on health of the Indigenous peoples in Canada and the Maoris in New Zealand.

BackgroundFemale sterilisation remains a common contraceptive method in many countries. AimsThe aim is to analyse the recent changes in the incidence of female sterilisation in New South Wales (NSW). MethodsData were obtained from the NSW Admitted Patients Data Collection for all female patients who had undergone one of the five sterilisation procedures in a public or private hospitals in NSW during 2010 and 2019. Denominators for calculating sterilisation rates were estimated using census and other population data. ResultsThe number of sterilisation cases dropped from 3407 in 2010 to 2561 in 2019, and the sterilisation rate declined from 22.6 per 10 000 females aged 20-49 in 2010 to 15.4 in 2019. Incidence was at its peak in the 35-39 age group in both years. Indigenous females had higher sterilisation rates than non-Indigenous females born in Australia or overseas. While some foreign-born females had higher sterilisation rates than for those who were in Australia or overseas on average their rates were lower than those who were born in Australia or overseas. There was a clear socio-economic gradient such that females living in the most disadvantaged areas had much higher sterilisation rates than those living in the least disadvantaged areas. The Indigenous, ethnic and socio-economic differences in sterilisation rates persisted in both years of this study. ConclusionAlthough fertility rates in NSW changed little over the 10-year interval a steady decline in sterilisation occurred, consistent with other forms of contraception (particularly long-acting reversible types) increasing concurrently in popularity.

Valerie Beral first crossed my path in the early 1970s in Papua New Guinea (PNG). We were both members of a 10-person epidemiological survey team, headed by the late Ruthven Blackburn, Professor of Medicine at the University of Sydney. Valerie was a medical student with wide interests. We were based at a mission hospital at Baiyer River, where I had worked in 1968. Ruthven was interested in a unique form of liver disease among the Enga people in PNG’s Western Highlands district. He (accompanied by his wife, Ann Woolcock, a respirologist) and his survey team had visited every second January for 2 weeks or so for about a decade. My first impression of Val Beral was of a warm, blithe, highly intelligent, inquisitive and independent young woman. She was intrigued and undaunted by what was a very foreign environment. Each day, weather permitting, the survey team visited the mountain villages, taking their equipment and records with them. They conducted a roll call of local inhabitants, performed physical examinations and took blood samples. Enthusiasm for liver biopsies ran high, promoted by a local myth that the biopsies were removing bad worms!

Background: The complex needs of patients with multiple chronic diseases call for integrated care (IC). This scoping review examines several published Asian IC programmes and their relevant components and elements in managing multimorbidity patients. Method: A scoping review was conducted by searching electronic databases encompassing Medline, Embase, Scopus, and Web of Science. Three key concepts – 1) integrated care, 2) multimorbidity, and 3) Asian countries – were used to define searching strategies. Studies were included if an IC programme in Asia for multimorbidity was described or evaluated. Data extraction for IC components and elements was carried out by adopting the SELFIE framework. Results: This review yielded 1,112 articles, of which 156 remained after the title and abstract screening and 27 studies after the full-text screening – with 23 IC programmes identified from seven Asian countries. The top 5 mentioned IC components were service delivery (n = 23), workforce (n = 23), leadership and governance (n = 23), monitoring (n = 15), and environment (n = 14); whist financing (n = 9) was least mentioned. Compared to EU/US countries, technology and medical products (Asia: 40%, EU/US: 43%-100%) and multidisciplinary teams (Asia: 26%, EU/US: 50%–81%) were reported less in Asia. Most programmes involved more micro-level elements that coordinate services at the individual level (n = 20) than meso- and macro-level elements, and programmes generally incorporated horizontal and vertical integration (n = 14). Conclusion: In the IC programmes for patients with multimorbidity in Asia, service delivery, leadership, and workforce were most frequently mentioned, while the financing component was least mentioned. There appears to be considerable scope for development. Highlights First scoping review to synthesise the key components and elements of integrated care programmes for multimorbidity in Asia. All programmes emphasized ‘distinctive service delivery’, ‘leadership’, and ‘workforce’ components. ‘Financing’ component was least mentioned in identified integrated care programmes.

A survey of the use and impact of International Journal of Epidemiology’s Education Corner Ellie Medcalf, Jonathan Y Huang , Onyebuchi A Arah , Michael O Harhay , Stephen R Leeder, and Katy JL Bell * School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia, Editorial Board, International Journal of Epidemiology, Sydney, Australia, Biostatistics and Human Development, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore, Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore, Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA, Department of Statistics, UCLA College, Los Angeles, CA, USA, Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Clinical Trials Methods and Outcomes Lab, Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA and Editor-in-Chief, International Journal of Epidemiology, Sydney, Australia

ObjectiveTo evaluate the benefits and risks of zinc formulations compared with controls for prevention or treatment of acute viral respiratory tract infections (RTIs) in adults.MethodSeventeen English and Chinese databases were searched in April/May 2020 for randomised controlled trials (RCTs), and from April/May 2020 to August 2020 for SARS-CoV-2 RCTs. Cochrane rapid review methods were applied. Quality appraisals used the Risk of Bias 2.0 and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.ResultsTwenty-eight RCTs with 5446 participants were identified. None were specific to SARS-CoV-2. Compared with placebo, oral or intranasal zinc prevented 5 RTIs per 100 person-months (95% CI 1 to 8, numbers needed to treat (NNT)=20, moderate-certainty/quality). Sublingual zinc did not prevent clinical colds following human rhinovirus inoculations (relative risk, RR 0.96, 95% CI 0.77 to 1.21, moderate-certainty/quality). On average, symptoms resolved 2 days earlier with sublingual or intranasal zinc compared with placebo (95% CI 0.61 to 3.50, very low-certainty/quality) and 19 more adults per 100 were likely to remain symptomatic on day 7 without zinc (95% CI 2 to 38, NNT=5, low-certainty/quality). There were clinically significant reductions in day 3 symptom severity scores (mean difference, MD −1.20 points, 95% CI −0.66 to −1.74, low-certainty/quality), but not average daily symptom severity scores (standardised MD −0.15, 95% CI −0.43 to 0.13, low-certainty/quality). Non-serious adverse events (AEs) (eg, nausea, mouth/nasal irritation) were higher (RR 1.41, 95% CI 1.17 to 1.69, NNHarm=7, moderate-certainty/quality). Compared with active controls, there were no differences in illness duration or AEs (low-certainty/quality). No serious AEs were reported in the 25 RCTs that monitored them (low-certainty/quality).ConclusionsIn adult populations unlikely to be zinc deficient, there was some evidence suggesting zinc might prevent RTIs symptoms and shorten duration. Non-serious AEs may limit tolerability for some. The comparative efficacy/effectiveness of different zinc formulations and doses were unclear. The GRADE-certainty/quality of the evidence was limited by a high risk of bias, small sample sizes and/or heterogeneity. Further research, including SARS-CoV-2 clinical trials is warranted.PROSPERO registration numberCRD42020182044.

Although prophecies of a new viral pandemic were common in infectious disease circles, SARS-CoV-2 was an unpleasant surprise for most epidemiologists. Its worldwide impact has been existential for many—and economic, social and psychological for all. ‘Epidemiology’ has entered the vernacular. The pandemic confronted us with our personal vulnerability. It lifted the lid on poverty, unjust health and socioeconomic inequality, and the often lamentable care of our older citizens. Epidemiological preventive advice to political authorities was adopted—to varying degrees. Predictably, communities’ responses varied. The result was the full spectrum: from apparent success to abject failure in developing and implementing the classical preventive programmes of quarantine, lockdown, case-finding, contact tracing and mask-wearing. Within remarkably short order, the genetics and biology of the virus were unravelled, leading to the development of vaccines. As researchers ‘at a distance’, we pay a sincere tribute to the front-line workers in this global crisis; we honour the memory of those who have succumbed to the deadly enemy. Estimates suggest that more than 3000 health care workers worldwide have died of COVID-19 and related complications. This journal (and many others) has experienced a surge in submissions relating to COVID-19. PubMed records the publication of 104 343 papers on Covid—the first in November 2019—compared with, for interest, 321 685 papers on smoking—the first published in 1811. It was inevitable that many papers sent to us were written in haste and, almost always, with incomplete data. We appreciate the authors’ goodwill in responding to our requests to make their contributions as robust as possible. Our papers cover the spectrum, from fieldwork reports through to sophisticated modelling. Yet, there remain many epidemiological features of the pandemic to be elucidated. Siddhartha Mukherjee, a distinguished New York oncologist, geneticist and author, wrote an article in a recent issue of The New Yorker entitled ‘The Covid Conundrum’. Mukherjee’s conundrum was the huge and puzzling differences in the frequency of COVID-19 among countries. ‘Many regions’, he noted, ‘report a COVID-19 death rate that’s a hundredth of the US rate’. Likewise, in The Economist, reference is made to the 160 000 recorded deaths from COVID-19 in India: ‘as a share of its nearly 1.4 bn people, the tally is miniscule, despite a huge outbreak. A national survey of blood samples suggests that by December (2020) some 22% of Indians had been exposed to [SARS-CoV-2], 30 times the official tally of around 11 m cases to date. If that estimate is right and if India’s fatality rate had been as high as, say, Britain’s, there would have been some 10 m deaths’. Beside our incomplete epidemiological understanding of the virus and its behaviour, which deserves our further attention, there are lessons to learn from controlling COVID-19. Francis Collins, Director of the US National Institutes of Health, writing recently in an editorial in Science, pointed to several, among them being the value that comes from technological readiness to respond to

Background: The global COVID-19 pandemic has prompted an urgent search for interventions to prevent and treat SARS-CoV-2. Higher risk of infection and adverse outcomes coincide with populations with chronic diseases and elderly who are at risk of zinc deficiency. Through several mechanisms zinc may prevent, reduce severity and duration of symptoms. Method: An a priori protocol was registered with PROSPERO on 27th April 2020 (CRD42020182044). Eight databases (one Chinese) and four clinical trial registries (one Chinese) were searched for randomised and quasi-randomised controlled trials (RCTs), evaluating single or adjunct zinc against placebo or active controls, for prevention and/or treatment of SARS-CoV-2, other coronaviruses or related infections. RR constraints included not searching bibliographies or contacting authors, single reviewers with calibration and second reviewer checking, meta-analyses and quality appraisal of critical and study primary outcomes only and reporting results as they became available. Results: 118 publications of 1,627 records met the inclusion criteria (35 Chinese and 83 English publications), 32 for prevention, 78 for treatment and 8 for both. Four RCTs specific to SARS-CoV-2 are ongoing; two are investigating zinc for prevention and two for treatment. As of 7 July 2020, no results were available. A wide range of zinc forms, including nasal spray/gel, lozenges, liquid, tablets and intramuscular were investigated. Conclusion: Currently, indirect evidence suggests zinc may potentially reduce the risk, duration and severity of SARS-CoV-2 infections, particularly for populations at risk of zinc deficiency including people with chronic disease co-morbidities and older adults. Direct evidence to determine if zinc is effective for either prevention or treatment of SARS-CoV-2 is pending. In the interim, assessing zinc status of people with chronic diseases and older adults, as part of a SARS-CoV-2 clinical work-up, is reasonable as both groups have a higher risk of zinc deficiency/insufficiency and poorer outcomes from SARS-CoV-2. (C) 2020 Elsevier Ltd. All rights reserved.

I have an abiding interest in health policy and health reform and how that has shaped our leadership and management of health services. Also, I have a view that healthcare should be viewed as a human service with differing groups of mostly health professionals providing care and services to individuals, groups, and communities. I see this in terms of engagement, wholistic and integrated and patient centred care. Some might say clients and suggest person centred care. Others in the quality and safety sector and the private health care industry, might suggest that people are consumers or even customers. For someone like me predominantly involved in the primary healthcare sector, we talk in addition to patients, in terms of communities, populations and of providers. Our language even goes to commissioning services rather than funding them.

This chapter explores access to healthcare—the timely availability of professional health services to prevent, diagnose, and treat illnesses and to preserve or improve the health of individuals—and its consequences. The ethical context in which access is considered includes the human rights and social justice concepts of ‘a right to healthcare’ and ‘equity of access’. Conscious that these concepts differ from country to country, we offer working definitions. Countries and their governments vary in their political and social attitudes to access. Those with a strong social welfare agenda might focus attention and budgets on social factors such as education and social welfare; these not only determine health, but also access to care. Others, regarding healthcare as the individual’s concern, might give these factors less weight. Despite this complexity and much national variation, access depends, in general, most often on good primary healthcare, public investment, and political will, availability of data to guide resourcing decisions, and the development of a well-trained, integrated workforce with appropriate supporting infrastructure.

ABSTRACT Objective To evaluate the benefits and risks of any type of zinc intervention to prevent or treat SARS-CoV-2. Design A living, systematic review and meta-analysis, incorporating rapid review methods. Data sources 17 English and Chinese databases and clinical trial registries were searched in April/May 2020, with additional covid-19 focused searches in June and August 2020. Eligibilitycriteria and analysis Randomized control trials (RCTs) published in any language comparing zinc to a control to prevent or treat SARS-CoV-2. Other viral respiratory tract infections (RTIs) were included, but the certainty of evidence downgraded twice for indirectness. Screening, data extraction, risk of bias appraisal (RoB-2 tool) and verification was performed by calibrated, single reviewers. RCTs with adult populations were prioritised for analysis. Results 123 RCTs were identified. None were specific to SARS-CoV-2 nor other coronaviruses. 28 RCTs evaluated oral (15-45mg daily), sublingual (45-300mg daily), or topical nasal (0.09-2.6 mg daily) zinc to prevent or treat nonspecific viral RTIs in 3,597 adults without zinc deficiency. Compared to placebo, zinc prevented 5 mild to moderate RTIs per 100 person-months, including in older adults (95% confidence interval 1 to 9) (number needed to treat (NTT)=20). There was no significant difference in the rates of non-serious adverse events (AE). For RTI treatment, a clinically important reduction in peak symptom severity scores was found for zinc compared to placebo (mean difference 1.2 points, 0.7 to 1.7), but not average daily symptom severity (standardised mean difference 0.2, 0.1 to 0.4). 19 fewer per 100 adults were at risk of remaining symptomatic over the first 7 days (2 to 38, NNT=5) and the mean duration of symptoms was 2 days shorter (0.2 to 3.5), however, there was substantial heterogeneity (I2 = 82% and 97%). 14 more per 100 experienced a non-serious AE (4 to 16, NNT=7) such as nausea, or mouth or nasal irritation. No differences in illness duration nor AE were found when zinc was compared to active controls. No serious AE, including copper deficiency, were reported by any RCT. Quality of life outcomes were not assessed. Confidence in these findings for SARS-CoV-2 is very low due to serious indirectness and some concerns about bias for most outcomes. Conclusions Zinc is a potential therapeutic candidate for preventing and treating SARS-CoV-2, including older adults and adults without zinc deficiency (very low certainty). Zinc may also help to prevent other viral RTIs during the pandemic (moderate certainty) and reduce the severity and duration of symptoms (very low certainty). The pending results from seven RCTs evaluating zinc for SARS-CoV-2 will be tracked. Systematic review registration PROSPERO CRD42020182044

[This corrects the article DOI: 10.1016/j.imr.2020.100457.].

Background: The global COVID-19 pandemic has prompted an urgent search for effective interventions. SARS-CoV-2 mortality/morbidity risk increases with age and for those chronic disease co-morbidities, both of which are associated with lower zinc status, as is the risk of infection. Methods: Rapid review methods will be applied to a systematic review of zinc for the prevention or treatment of SARS-CoV-2 and viral respiratory tract infections in humans. Included are published studies reporting randomised and quasi-randomised controlled trials that compare zinc intervention to placebo and/or other comparator interventions. English and Chinese language databases will be searched for primary studies of viral respiratory tract infections and clinical trial registries for SARS-CoV-2 infections. Due to concerns about indirectness, studies evaluating non-SARS-CoV-2 coronavirus infections will be rated down by one level, and non-specific or confirmed non-coronavirus viral infections will be rated down by two levels. Review constraints include (1) using Google translate when screening articles published in languages other than English or Chinese and limited translation (2) following calibration, only one reviewer will screen articles, extract data, appraise quality and conduct the analysis, (3) prioritising data extraction and meta-analyses of SARS-CoV-2 studies and critical outcomes of other viral infections, followed by high risk groups and (4) reporting important preliminary findings prior to peer review if necessary. Discussion: The application of these rapid review methods and broadening the inclusion criteria to include other coronavirus-related viral respiratory tract infections aims to enable a timely evidence appraisal of priority research questions and dissemination of results. Study registration: PROSPERO CRD42020182044.

ObjectiveThe aims of this study were to estimate the average annual out-of-pocket (OOP) expenditure on health care by households in Australia in 2015-16, and to compare this with the estimate for 2009-10.MethodsData from the most recent Household Expenditure Survey (HES) conducted by the Australian Bureau of Statistics were used. Various statistical methods were used to estimate the annual OOP expenditures at the household and national levels.ResultsThe average annual OOP expenditure was A$4290 per household, representing 5.8% of the amount spent on all goods and services. Private health insurance (PHI) premiums, although not a direct expenditure on health care, were 40.6% of the total OOP expenses. Of the remaining 59.4%, nearly half was spent on doctors and other health professionals, and approximately one-third was spent on medicines. Dental treatments and specialist consultations were the most expensive, whereas visits to general practitioners incurred the least OOP expenditure. Households with PHI (58.6%) spent fourfold more on health care than those not insured. Compared with the 2009-10 survey, the biggest increases were in the cost of PHI (50.7%) and copayments to specialists (34.8%) and other health professionals (42.0%).ConclusionsOOP expenditure on health care as a proportion of the total household expenditure on all goods and services has increased by more than 25% between 2009-10 and 2015-16.What is known about the topic?Australian households incur OOP expenses for health care in Australia for a wide range of goods and services, such as copayments to doctors and other health professionals beyond the Medicare rebates, the cost of medicines and other pharmaceutical goods not covered entirely by the Pharmaceutical Benefits Scheme and PHI premiums. Although other estimates of OOP expenditure are available in official reports of the Australian Institute of Health and Welfare, they are based on administrative records rather than consumer reports, and cannot be disaggregated by item or the characteristics of households.What does this paper add?This paper provides detailed information on OOP expenditure on health care as reported by a probability sample of households interviewed for the HES conducted by the ABS during 2015-16. These estimates of OOP expenditure, based on consumer reports, add a further dimension to the information available from administrative records only.What are the implications for practitioners?Practitioners should take account of the effect of increasing copayments for their services, especially on patients belonging to the lower socioeconomic categories. Increasing copayments may lead to people foregoing medical care. Health planners and politicians should note the steady upward drift in OOP expenses and factor these into their policies for future funding of health care.

How can we help to prevent drug-related deaths of young people attending music festivals? One suggestion receiving media attention and polarising the debate is drug testing at the venues.