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Bulletin for 4 May 2022


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High-flow oxygen in patients with COVID-19
Despite excluding several medical comorbidities, this trial supports the suggestion to use high-flow nasal cannula HFNC as an option for noninvasive oxygenation in individuals with COVID-19 who have advanced oxygen needs. (See "COVID-19: Respiratory care of the nonintubated hypoxemic adult (supplemental oxygen, noninvasive ventilation, and intubation)", section on 'Noninvasive modalities'.)

Clinical presentation of COVID-19 cases due to Delta and Omicron variant
Symptoms of upper respiratory tract infection (URI) are the most common manifestations of nonsevere COVID-19, although the relative frequency of each symptom may vary by viral variant. In an observational study evaluating the reported clinical symptoms of over 63,000 confirmed COVID-19 cases between two time periods (during Delta variant predominance and Omicron variant predominance), nasal congestion, headache, sneezing, and sore throat were the most common presenting symptoms [5]. Sore throat was more common and alteration or loss of smell was less common during the time period of Omicron predominance. As new variants emerge, the predominant URI symptoms of COVID-19 may continue to change. (See "COVID-19: Clinical features", section on 'Initial presentation'.)

Convalescent plasma in outpatients with COVID-19
Accumulating evidence supports the efficacy of high-titer convalescent plasma for the treatment of outpatients with nonsevere COVID-19.  (See "COVID-19: Convalescent plasma and hyperimmune globulin", section on 'Optimal timing and titer (or antibody level)'.)

Neuronal changes in brains of patients after COVID-19 infection
Changes in brain structure and function after COVID-19 are an area of investigation. Among participants of a prospective biobank study in the United Kingdom that included serial brain magnetic resonance imaging, 401 patients developed COVID-19 between one scan and the next at a mean of five months after infection [26]. Those who had COVID-19 had greater reductions in functional connectivity and structural measurements (gray matter thickness in the orbitofrontal and parahippocampal cortices and global brain size) compared with controls, despite mostly mild infections that did not require hospitalization. Additional data are needed to assess the persistence of these findings over the longer term and whether they have functional implications for patients with post-COVID neurologic symptoms. (See "COVID-19: Neurologic complications and management of neurologic conditions", section on 'Persistent neurologic symptoms after COVID-19 infection'.)

Safety of minimally invasive surgery in patients with COVID-19
A recent meta-analysis organized by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) found no difference in patient and operating staff outcomes between laparoscopic and open abdominal surgery in SARS-CoV-2-positive patients [23]. Based on this finding, SAGES guidelines now suggest that it is safe to perform either minimally invasive or open techniques in patients with COVID-19 as long as safety measures (eg, smoke filtration) and personal protective equipment are in place to protect the staff. (See "Complications of laparoscopic surgery", section on 'COVID-19 precautions'.)

Treatment of chronic hypertension in pregnancy
For pregnant patients with nonsevere chronic hypertension (based on medical history or systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or both on at least two occasions at least four hours apart before 20 weeks of gestation), we recommend antihypertensive treatment (Grade 1B). We prefer labetalol or extended-release nifedipine. (See "Treatment of hypertension in pregnant and postpartum patients", section on 'Background'.)

Bariatric surgery and diabetes remission
Surgical treatment of obesity is an option to treat type 2 diabetes in selected patients who meet weight and/or comorbidity criteria and who are motivated to pursue this type of procedure. (See "Management of persistent hyperglycemia in type 2 diabetes mellitus", section on 'Bariatric surgery'.)


Cochrane Library

Negative pressure wound therapy for surgical wounds healing by primary closure
People with primary closure of their surgical wound and treated prophylactically with NPWT following surgery probably experience fewer SSIs  than people treated with standard dressings but there is probably no difference in wound dehiscence (moderate‐certainty evidence). Cochrane Database of Systematic Reviews – Intervention 26 April 2022

Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women
This update recaps the key findings from our previous review that, for secondary prevention, risedronate 5 mg/day probably prevents non‐vertebral fracture, and may reduce the risk of hip fractures. ). Cochrane Database of Systematic Reviews – Intervention 5 May 2022


Cochrane clinical answers

For people with acute ischemic stroke, what are the effects of recanalization therapies?
For people with acute ischemic stroke, high‐certainty evidence shows that compared with no recanalization therapy, more people had a favorable functional outcome (modified Rankin Scale score of 0 to 2, from asymptomatic to slight disability) with recanalization therapy (438 vs 293 per 1000 people; all results on average), and fewer people died at 3 to 6 months (184 vs 216 per 1000 people), without increasing the risk of symptomatic intracranial hemorrhage. Cochrane clinical answers 19 April 2022

Can combined intermittent pneumatic leg compression and pharmacological prophylaxis prevent venous thromboembolism in people undergoing surgery?
Intermittent pneumatic leg compression (IPC) combined with pharmacological agents may decrease risk of pulmonary embolism and deep vein thrombosis, when compared with IPC alone or with pharmacological prophylaxis alone. Results on bleeding are very uncertain. Cochrane clinical answers 2 May 2022



Practical recommendations to communicate with patients about healthrelated conspiracy theories
Belief in healthrelated conspiracy theories is widespread and has a considerable impact on health attitudes, intentions and behaviours. It is important to recognise the underlying and unsatisfied needs of patients who present to health care workers. This foundation will enable medical professionals to better engage with individuals who are attracted to conspiracy theories by developing shared understanding, trust and empathy as a platform to support patients. MJA 18 April 2022

Adherence by orthopaedic surgeons to AHPRA and Australian Orthopaedic Association advertising guidelines
A large proportion of AOA members who advertise online do not comply with AHPRA and AOA advertising guidelines. MJA 18 April 2022

Management of type 2 diabetes in young adults aged 18–30 years: ADS/ADEA/APEG consensus statement
Changes in management as a result of this statement: Management recommendations for young adults, which differ from those for adults, include:

  • screening for diabetes in young adults with overweight or obesity and additional risk factors, including in utero exposure to type 2 diabetes or gestational diabetes mellitus;
  • more stringent glucose targets (glycated haemoglobin ≤ 6.5% [≤ 48 mmol/mol])
  • in the context of obesity or higher cardiorenal risk, glucagonlike peptide 1 receptor agonists and sodium–glucose cotransporter 2 inhibitors are preferred second line agents
  • βcell decline is more rapid, so frequent review, early treatment intensification and avoidance of therapeutic inertia are indicated
  • a blood pressure target of < 130/80 mmHg, as the adult target of ≤ 140/90 mmHg is too high
  • absolute cardiovascular disease risk calculators are not likely to be accurate in this age group; early statin use should therefore be considered; and
  • a multidisciplinary model of care including an endocrinologist and a certified diabetes educator.

MJA 18 April 2022

Cholecystectomy for people aged 50 years or more with mild gallstone pancreatitis: predictors and outcomes of index and interval procedures
Most NSW people over 50 with mild gallstone pancreatitis did not undergo index cholecystectomy, despite recommendations in international guidelines. Delayed cholecystectomy was associated with more frequent open cholecystectomy procedures and gallstone disease‐related emergency re‐admissions, as well as with low or medium hospital surgical volume, comorbidity, and having private insurance. MJA 2 May 2022



Novel treatments in B cell non-Hodgkin’s lymphomas
This article reviews novel treatments that have been approved recently by the US Food and Drug Administration and are now routinely used in clinical practice. It discusses their mechanisms of action, efficacy and safety, current therapeutic roles, and future directions in the treatment paradigm of different types of B cell non-Hodgkin’s lymphoma. BMJ 20 April 2022  

Development and validation of the symptom burden questionnaire for long covid (SBQ-LC): Rasch analysis
SBQ-LC (version 1.0) is a comprehensive patient reported outcome instrument developed using modern psychometric methods. It measures symptoms of long covid important to people with lived experience of the condition and may be used to evaluate the impact of interventions and inform best practice in clinical management. BMJ 27 April 2022 



Calorie restriction with or without time-restricted eating in weight loss
Among patients with obesity, a regimen of time-restricted eating was not more beneficial with regard to reduction in body weight, body fat, or metabolic risk factors than daily calorie restriction. NEJM 21 April 2022

Nasal high-flow therapy during neonatal endotracheal intubation
Among infants undergoing endotracheal intubation at two Australian tertiary neonatal intensive care units, nasal high-flow therapy during the procedure improved the likelihood of successful intubation on the first attempt without physiological instability in the infant. NEJM 28 April 2022

CT or Invasive coronary angiography in stable chest pain
Among patients referred for ICA because of stable chest pain and intermediate pretest probability of CAD, the risk of major adverse cardiovascular events was similar in the CT group and the ICA group. The frequency of major procedure-related complications was lower with an initial CT strategy. NEJM 28 April 2022



Plating vs closed reduction for fractures in the distal radius in older patients: A secondary analysis of a randomized clinical trial
These findings suggest that in patients 60 years and older, surgical treatment with volar-locking plates does not provide any important functional advantages over nonsurgical treatment at 12 and 24 months. JAMA 27 April 2022 _________________________________________________________________________________

Other journals

Impact of employing primary healthcare professionals in emergency department triage on patient flow outcomes: a systematic review and meta-analysis
Overall, PHCP-led triage interventions improved ED patient flow metrics. There was a significant decrease in ED LOS irrespective of the study design, favouring the PHCP-led interventions. Evidence from well-designed high-quality RCTs is required prior to widespread implementation. Emergency medicine 20 April 2022

The experience of participating in an internet-based cognitive behavioral therapy program among patients with cardiovascular disease and depression: a qualitative interview study
Engaging in an iCBT program tailored for patients with CVD and depression was by the patients perceived as helpful in the treatment of depression. They experienced positive changes in emotions, thoughts, and behaviors which a result of learning to take control of their CVD, being confirmed and getting support. The patients considered working with the iCBT program as demanding and emotionally challenging, but necessary to achieve changes in emotions, thoughts, and behaviors. BMC psychiatry 25 April 2022

Early initiation of tolvaptan is associated with early discharge in patients with heart failure regardless of age
The early initiation of TLV after hospitalization was associated with a shorter length of hospital stay in patients with HF regardless of age. BMC cardiovascular disorders 29 April 2022

Admission vital signs as predictors of COVID-19 mortality: a retrospective cross-sectional study
A multivariate regression model comprising admission oxygen saturation, respiratory rate, glucose and diastolic BP (with/without age) demonstrated promising predictive capacity, and may provide a cost-effective means for early prognostication of patients admitted with COVID-19 in resource-limited settings. BMC emergency medicine 29 April 2022

Reducing thoracic and lumbar radiographs in an urban emergency department through a clinical champion led quality improvement intervention
A multi-component QI intervention led by a clinician champion is an effective way to reduce the overutilization of thoracic and lumbar radiographs in an urban public hospital emergency department. BMC emergency medicine 29 April 2022

What older people and their relatives say is important during acute hospitalisation: a qualitative study
The findings underscore the interrelatedness of older people and their relatives and that patients and relatives are quite consistent in their experiences and opinions. This suggests that listening to the concerns of relatives is important, as they can voice the older patient’s needs and concerns in situations where older people might find it difficult to do so. Furthermore, the results underscore how ‘small things’ matter in relation to how health professionals capture the patient’s individual values, need for care, information and involvement of relatives and that these are essential to ensure predictability and security and a good stay for older people and their relatives. BMC health services research 29 April 2022

Predictors of critical care, mechanical ventilation, and mortality among hospitalized patients with COVID-19 in an electronic health record database
We identified several clinical characteristics associated with receipt of critical care, mechanical ventilation, and death among COVID-19 patients. BMC infectious diseases 29 April 2022

Early prolonged prone position in noninvasively ventilated patients with SARS-CoV-2-related moderate-to-severe hypoxemic respiratory failure: clinical outcomes and mechanisms for treatment response in the PRO-NIV study
Early prolonged PP is safe and is associated with lower non-invasive ventilation (NIV) failure, intubation and death rates in noninvasively ventilated patients with COVID-19-related moderate-to-severe hypoxemic respiratory failure. Early dead space reduction and reaeration of dorso-lateral lung regions predicted clinical outcomes in our study population. Critical care 27 April 2022

Optimal timing of introducing mobilization therapy for ICU patients with sepsis
Achieving mobilization within the first 3 days of ICU stay was significantly associated with better outcomes. Patients with sepsis might benefit most from achieving mobilization within 2–4 days. Journal of intensive care 25 April 2022

Challenging the dogma to “always operate” acute hip fractures: a proof-of-concept pilot study for nonoperative management of undisplaced femoral neck fractures
According with our results, patients sustaining Garden type 1 femoral neck fractures, depending on age and comorbidities, should be treated conservatively with weight bearing and under physiotherapeutic instructions. In case of femoral neck fractures Garden type 2, a surgical treatment should be performed in order to avoid femoral neck fractures to slip after weight bearing by lacking of fracture impaction. Patient safety in surgery 21 April 2022

Timing of pharmacologic venous thromboembolism prophylaxis initiation for trauma patients with nonoperatively managed blunt abdominal solid organ injury: a systematic review and meta-analysis
Initiation of venous thromboembolism prophylaxis (VTEp) earlier than 48 h following hospitalization is associated with an increased risk of failure of NOM but a decreased risk of deep vein thrombosis (DVT). Absolute failure rates of NOM are low. Initiation of VTEp at 48 h may balance the risks of bleeding and VTE. World journal of emergency surgery 25 April 2022


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Mental Health  I Bulletin for May  2022




Webinars (pre-recorded)


Correlation between the quality of nursing handover, job satisfaction, and group cohesion among psychiatric nurses BMC nursing 14 April 2022
The quality of psychiatric nursing handovers has enhanced space. Thus, hospital managers should take various measures to strengthen group cohesion and promote job satisfaction, both of which help improve the quality of psychiatric nursing handovers.

A systematic review of physical activity interventions assessing physical and mental health outcomes on patients with severe mental illness (SMI) within secure forensic settings Journal of psychiatric and mental health nursing 14 April 2022
Only a small number of studies were included and of limited design and quality, with no follow-up assessments, therefore more research is needed to determine the true effects of physical activity for improving SMI symptoms in a forensic setting. This review highlights the need for further studies exploring the barriers and facilitators of physical activity in secure forensic settings. Studies are required that include a more thorough research design. Furthermore, interventions if designed with patients and caring staff in mind may lead to lowered psychiatric symptoms and increased physical health benefits for all in forensic settings.

Exploring individuals’ experiences of hope in mental health recovery: An Interpretative Phenomenological Analysis Journal of psychiatric and mental health nursing 11 April 2022
individuals were more familiar with the concept of hopelessness, had a ready-to-hand vocabulary of “having no hope” and used this by default to inform what hope meant. 
Implications for Practice It is important that all stakeholders appreciate the context specific interpretation of hope and cultivate dialogue and understanding to harness its therapeutic potential.

“They have more than enough to do than patch up people like me.” Experiences of seeking support for self-harm in lockdown during the COVID-19 pandemic Journal of psychiatric and mental health nursing 11 April 2022
Participants identified challenges to coping with life in lockdown, emphasising the role of self-harm. Help-seeking was impeded by feeling like a burden and potential for spreading the virus. People who self-harm exercised self-reliance in response to ‘stay home’ messaging, but some may have struggled without formal support. Online support served an important role in continuity of care during lockdown but could widen inequalities from limited resources and access. Implications for practice: Helping mental health liaison nurses to understand the experiences of people who self-harm during lockdown is critical to providing continuing support to this population. Services should consider how and when they communicate changes to their provisions to the public, and the impact this will have on those in need of support.

Psychiatric nurse's perceptions of their interactions with people who hear voices: A qualitative systematic review and thematic analysis Journal of psychiatric and mental health nursing 8 April 2022 
This is an under investigated area of mental healthcare. None the less this qualitative systematic review highlights that nurses are unclear about how to interact with service users hearing voices with the resultant outcome that service users in great distress may only be receiving minimal benefit from their interactions with the nurses caring for them.

Theoretical approaches to engagement with patients in case‐management programs and assertive outreach teams: a systematic review of the literature Journal of psychiatric and mental health nursing 5 April 2022 
The engagement must be understood as a long-term process. For the creation of the engagement and its maintenance, specialized skills, knowledge and personal attributes are necessary.

Occupational therapy
Effectiveness of sensory modulation for people with schizophrenia: A multisite quantitative prospective cohort study Australian occupational therapy journal 19 April 2022
This study provides evidence to suggest that sensory modulation interventions can be complementary to standard care when utilised appropriately in clinical settings. Findings also suggest that the sensory profile of people with schizophrenia is different to that of the general population and this may have clinical implications. Further longitudinal research is needed with larger and randomised samples, using more targeted measures to better explore effectiveness of sensory modulation interventions.

Reintroducing rest: evaluation of a patient-guided sleep workbook in a community mental health team setting Irish journal of occupational therapy 8 April 2022 
There is a growing need for occupational therapists and clinicians to provide interventions for patients with sleep difficulties and to develop sleep management practice. This patient-guided sleep workbook may be an effective intervention for these patients.

The benefits of nature-based therapy for the individual and the environment: an integrative review Irish journal of occupational therapy 31 March 2022
This integrative review brings together evidence on a diverse range of nature-based therapies, cohorts, associated benefits and 
factors that influence these. The lack of empirical evidence on the benefits of nature-based therapies for the environment is acknowledged as a gap in the literature

Systematic review of Indigenous involvement and content in mental health interventions and their effectiveness for Indigenous populations Australian & New Zealand journal of psychiatry 5 April 2022
A wide range of interventions demonstrated mental health improvements. However, it is difficult to draw generalizable conclusions on intervention effectiveness, given heterogeneity among studies. Studies should employ a thorough assessment of the Indigenous involvement and content of their interventions for reporting and for critical consideration of the implications of their research and whether they address Indigenous determinants of mental health.

Increased global integration in the brain after psilocybin therapy for depression Nature medicine 11 April 2022
Psilocybin therapy shows antidepressant potential, but its therapeutic actions are not well understood. The authors assessed the subacute impact of psilocybin on brain function in two clinical trials of depression.

Patient-reported outcomes of lifestyle interventions in patients with severe mental illness: a systematic review and meta-analysis BMC psychiatry 15 April 2022
This meta-analysis quantifies the effects of lifestyle interventions on PROs. Lifestyle interventions have no significant effect on quality of life, yet they could improve mental health outcomes such as depression and anxiety symptoms. Further use of patient-reported outcome measures in lifestyle research is recommended to fully capture the impact of lifestyle interventions.

Association of psychiatric disorders with incidence of SARS-CoV-2 breakthrough infection among vaccinated adults JAMA psychiatry 14 April 2022
This cohort study suggests that psychiatric disorder diagnoses were associated with an increased incidence of SARS-CoV-2 breakthrough infection among VA patients, with the strongest associations observed for older individuals. Individuals with psychiatric disorders may be at heightened risk for contracting COVID-19 even after vaccination, suggesting the need for targeted prevention efforts.

Mental health symptoms in children and adolescents during COVID-19 in Australia ANZ journal of psychiatry 12 April 2022 
The findings show that Australian children and adolescents experienced considerable levels of mental health symptoms during the initial phase of COVID-19. This highlights the need for targeted and effective support for affected youth, particularly for those with pre-existing vulnerabilities.

Biomarkers of neuroprogression and late staging in bipolar disorder: A systematic review Australian & New Zealand journal of psychiatry 11 April 2022
The studies evaluating the biological basis of the illness progression in bipolar disorder are still scarce and heterogeneous. However, current evidence supports the notion of neuroprogression, the pathophysiological process related to progressive brain changes associated with clinical progression in patients with bipolar disorder. The increase in peripheral inflammatory biomarkers and the neuroanatomical changes in bipolar disorder suggest progressive systemic and structural brain alterations, respectively.

The efficacy and acceptability of exposure therapy for the treatment of post-traumatic stress disorder in children and adolescents: a systematic review and meta-analysis BMC psychiatry 12 April 2022 
Exposure therapy (ET) showed superiority in efficacy at post-treatment/follow-up and depressive symptoms improvement in children and adolescents with PTSD. Patients with single type of trauma may benefit more from ET. And ET is more effective in patients 14 years or older. Moreover, PE could be a better choice.

The prevalence of subthreshold psychiatric symptoms and associations with alcohol and substance use disorders: from a nationally representative survey of 36,309 adults BMC psychiatry 15 April 2022 
The authors found high lifetime subthreshold psychiatric symptoms (SPS) prevalence rates and significant associations with alcohol use disorders (AUD) and substance use disorders (SUD). To the author’s knowledge, this is the first published study evaluating a broad number of SPS. This indicates possible opportunities for early intervention and prevention but requires additional research and development of infrastructure and guidelines to better understand and manage patients who experience SPS.

Effectiveness of a multi-modal hospital-wide doctor mental health and wellness intervention BMC psychiatry 6 April 2022
Following the implementation of individual and organisational-level strategies in two Australian tertiary hospitals, doctors reported a reduction in some key workplace stressors, but no signifcant changes to their mental health or help-seeking for mental health problems. Further research is warranted, particularly to determine if these workplace changes will lead to improved mental health outcomes for doctors once maintained for a longer period.

Subjective cognitive complaints and subjective cognition following electroconvulsive therapy for depression: A systematic review and meta-analysis Australian & New Zealand journal of psychiatry 1 April 2022 
Variability in subjective cognition following electroconvulsive therapy is mostly explained by the degree of post-treatment persisting depression and by the subjective assessment used. Scales measuring exclusively subjective worsening present limited clinical utility and instruments allowing the detection of both improvement and worsening in subjective cognition should be preferred.

Correlates of suicidality in young people with depressive disorders: A systematic review Australian & New Zealand journal of psychiatry 1 April 2022
Findings of this review reinforce the notion that suicidality is a complex phenomenon arising from the interplay of multiple contributing factors. Our findings question the utility of considering a diagnosis of depression as a specific risk factor for suicidality in young people. Suicidality itself is transdiagnostic; adoption of a transdiagnostic approach to investigating its aetiology and treatment is perhaps warranted. Future research investigating specific symptoms, or symptom networks, might help to further our understanding of suicidality among young people experiencing mental illness.

Clozapine and COVID-19 Vaccination: Effects on blood levels and leukocytes. An observational cohort study Acta Psychiatrica Scandinavica 24 March 2022
In general, as regards WBC counts COVID-19 vaccination seems to be safe in patients with SMI. Changes in WBC had no clinical implications. Psychoeducation on the symptoms of clozapine intoxication is recommended, especially in patients with clozapine blood levels approaching the upper limit of the therapeutic range. Increase in the C-reactive protein (CRP) level can signal inflammation rapidly and help to prevent clozapine intoxication following vaccination.

Association between physical activity and risk of depression A systematic review and meta-analysis JAMA psychiatry 13 April 2022
This systematic review and meta-analysis of associations between physical activity and depression suggests significant mental health benefits from being physically active, even at levels below the public health recommendations. Health practitioners should therefore encourage any increase in physical activity to improve mental health.

Neurocognitive development in children at familial high risk of schizophrenia or bipolar disorder JAMA psychiatry 6 April 2022
Results of this study suggest that familial high risk (FHR) of schizophrenia, but not bipolar disorder, is associated with stable neurocognitive impairments in children aged 7 to 11 years, which warrants early attention toward this group.

Control interventions in randomised trials among people with mental health disorders Cochrane Database of Systematic Reviews – Methodology 4 April 2022
This review suggests that different control interventions have a tendency to yield very different estimates for the effects of the experimental intervention and that the choice of control intervention has a large impact on how effective a mental health treatment appears to be. Control interventions in trials with patients with mental health disorders are often poorly reported upon, and guidelines are needed to inform researchers on how to properly design, report, and interpret these trials.

Association between depression and mortality in persons with asthma: a population-based cohort study Allergy, asthma & clinical immunology 1 April 2022 
The present study suggested that depressive disorder was common in asthmatic patients and depression in asthmatic patients was associated with a higher mortality rate. Depression was an independent risk factor for mortality in female patients.

Neuropathology and virus in brain of SARS-CoV-2 infected non-human primates Nature communications 1 April 2022
The authors anticipate their findings will advance the current understanding of the neuropathogenesis of SARS-CoV-2 infection and demonstrate SARS-CoV-2 infected NHPs are a highly relevant animal model for investigating COVID-19 neuropathogenesis among human subjects.

How do lipids influence risk of violence, self-harm and suicidality in people with psychosis? A systematic review ANZ journal of psychiatry 56(5) 2022
There is encouraging evidence of an association between low total cholesterol and aggression towards others as well as suicidality in schizophrenia. Future studies should systematically explore this association in people with schizophrenia who have a significant history of violence, suicidality and self-harm, both inpatients and community, and 
also investigate underlying mechanisms


Mental health in Australia: Psychological distress reported in six consecutive cross-sectional national surveys from 2001 to 2018 Frontiers in psychiatry 1 April 2022
Australia’s population level of psychological distress increased significantly from 2001–2017/18, with levels highest in women and with rates inversely associated with income. This is likely to be indicative of increased community rates of mental disorders. Given that this has occurred whilst mental healthcare expenditure has increased, there is an urgent need to reconsider how best to respond to mental illness, including targeting the most vulnerable based on social determinants such as age, gender, and lower incomes.

The mediating role of complex posttraumatic stress and borderline pattern symptoms on the association between sexual abuse and suicide risk Borderline personality disorder and emotion dysregulation 12 April 2022
Suicide risk assessment and intervention should be an important part of the management of victims of sexual abuse with complex posttraumatic stress disorder (CPTSD) and BP symptoms.

Adversity, attachment and emotion recognition in BPD adolescents: the distinct roles of disengaged and controlling environment BMC psychology 4 April 2022
These results suggest that distinct adverse experiences account for the heterogeneity observed in emotion regulation in BPD patients.

The Pandemic Stressor Scale: factorial validity and reliability of a measure of stressors during a pandemic BMC psychology 8 April 2022 
The Pandemic Stressor Scale showed sufficient factorial validity for the nine measured domains of stressors during the current COVID-19 pandemic.

COVID-19 one year on: identification of at-risk groups for psychological trauma and poor health-protective behaviour using a telephone survey BMC psychology 9 April 2022 
Socio-demographic factors affected both psychological trauma and engagement in health-protective measures at one year after the onset of the pandemic. The theoretical and practical implications of these findings are discussed.

Development and validation of COVID-19 Impact Scale BMC psychology 4 April 2022 
These results support that the COVID-19 Impact Scale (CIS) is a valid assessment of emotional problems and deterioration of the quality of life caused by the COVID-19 pandemic. Finally, the limitations of this study and future research directions are discussed.

Iconic Therapy for the reduction of borderline personality disorder symptoms among suicidal youth: a preliminary study BMC psychiatry 29 March 2022
This preliminary study did not find a statistically significant difference in the effectiveness of the two therapies, probably due to the small sample of participants, but there are some indicators (effect sizes) suggesting that perhaps IT may be superior for reducing BPD symptoms and maladjustment in daily life. Future studies with larger samples and comparisons with established treatments for borderline personality disorder are necessary to confirm that IT effects are significant and persistent in the long term.

Effectiveness of cognitive–behavioural therapies of varying complexity in reducing depression in adults: systematic review and network meta-analysis British journal of psychiatry 29 March 2022 
For people without comorbid conditions healthcare and policy organisations should invest in core CBT. For people <59 years of age with comorbid conditions investments should focus on ultracomplex and complex CBT delivered without the help of mental health professionals.

Effectiveness of a suicide prevention module for adults in substance use disorder treatment A stepped-wedge cluster-randomized clinical trial JAMA 6 April 2022
These findings suggest that Preventing Addiction Related Suicide  (PARS) was effective in improving suicide prevention outcomes and has the potential for wide dissemination and implementation.

Role of mental health in the association between E-Cigarettes and cannabis use American journal of preventative medicine 62(3) 2022
Baseline e-cigarette use and endorsement of severe internalizing mental health/externalizing mental health problems were significantly associated with subsequent cannabis use 
among U.S. adolescents. Efforts to reduce youth vaping and improve youth mental health could help curb cannabis initiation. Tailored interventions may be warranted for e-cigarette‒using adolescents with internalizing mental health problems.

Gamblers’ perceptions of responsibility for gambling harm: a critical qualitative inquiry BMC public health 12 April 2022
This study demonstrates that gamblers’ perceptions of gambling harm are similar to the personal responsibility framings and tropes present in industry and government messaging strategies. Refocusing public communication strategies away from ‘responsible gambling’ messaging, and towards evidence-based approaches, will be an important part of addressing the harms associated with gambling.

Disordered gaming, loneliness, and family harmony in gamers before and during the COVID-19 pandemic Addictive behaviors reports 12 April 2022

  • (Internet) Gaming Disorder scores increased significantly during the pandemic years.
  • Loneliness and family harmony did not change significantly.
  • Correlations between I()GD and loneliness/poorer family harmony increased.
  • The COVID-19 pandemic might have negatively affected the well-being of gamers.

Social Work 

Acceptability of the ‘Crisis Toolbox’: a skills-based intervention delivered in a Crisis Resolution and Home Treatment Team during COVID-19 Community mental health journal 2 April 2022 
This evaluation aimed to examine client satisfaction with the ‘Crisis Toolbox’ (CTB), a brief, skills-based intervention delivered in one CRHTT during COVID-19.

Community violence and internalizing mental health symptoms in adolescents: A systematic review. BMC psychiatry 9 April 2022
This review confirms the positive relationship between community violence and internalizing mental health symptoms in adolescents and provides relevant information that can direct public efforts to build policies in the prevention of both problems.  

Associations between health literacy, cognitive function and general literacy in people with schizophrenia attending community mental health clinics in Australia BMC psychiatry 7 April 2022 
Consistent with previous research in schizophrenia, our participants had reduced educational attainment, aural and reading literacy and cognitive function compared to population norms. However, Health literacy (HL) was better than expected given that previous research has found that people with psychiatric disorders tend to have lower HL, compared to the general population. This may reflect effective case management of our participants whilst attending the community clinics and supports ongoing research and intervention regarding HL in people living with mental illness.

Perspectives on barriers to treatment engagement of people with eating disorder symptoms who have not undergone treatment: a qualitative study BMC psychiatry 7 April 2022
The process by which individuals decide whether or not to engage with ED treatment services is complex and involves intra- and interpersonal negotiations intertwined with health literacy and fear. A factor not prominent in previous research was negative self-perceptions and the belief of being undeserving of treatment. These factors have implications for ongoing community and clinical interventions to further address barriers to ED treatment engagement.

Lifestyle risk factors for obsessive-compulsive symptoms and related phenomena: What should lifestyle interventions target? Australian & New Zealand journal of psychiatry 1 April 2022 
The results speak to the potential importance of lifestyle quality screening, education and lifestyle interventions (e.g. an anti-inflammatory diet) for individuals experiencing compulsivity-related behaviours and/or symptoms. Further research into potential mechanisms of action will allow for more targeted approaches to lifestyle interventions for transdiagnostic compulsive behaviours.

Effect of socioeconomic status on the physical and mental health of the elderly: the mediating effect of social participation   BMC public health 29 March 2022
The socioeconomic status (SES) of the elderly including relatively large income gap, different education levels and occupational categories could indeed have a significant effect on health status of the elderly, and the reason why this effect existed could be partly explained by the mediation effect of social participation. Policymakers should pay more attention to the social participation of the elderly.

The role of pregnancy acceptability in maternal mental health and bonding during pregnancy BMC pregnancy and childbirth 29 March 2022
Consideration of women’s appraisal of their pregnancy acceptability may provide a valuable framework for identifying individuals who may be at risk for mental health and bonding difficulties.


Adolescent psychosocial alcohol-related harms increase risk of later alcohol use disorder (NDARC)
Alcohol-related harms are a broad range of negative consequences that can result from drinking alcohol. These can range from things that only affect your body, such as feeling sick or having a hangover, to things that affect you psychologically and socially, such as having problems with friends or getting into fights.


Suspected deaths by suicide (AIHW)
The data from suicide registers are based on initial police reports and other information available at the time of referral to the coroner. They are not directly comparable with data released by the Australian Bureau of Statistics, which are based on final coronial determinations. However, the differences are generally small.  

The use of mental health services, psychological distress, loneliness, suicide, ambulance attendances and COVID-19 (AIHW)
While there has been a rise in the use of mental health services and an increase in psychological distress during the COVID-19 pandemic, COVID-19 has not been associated with a rise in suspected deaths by suicide in 2020 and 2021./

Webinars (pre-recorded)

Infant and early childhood mental health: Connecting with children and families (Emerging minds)
Synopsis: this webinar explores key concepts and evidence of infant and early childhood mental health, and the importance of using a child-centred and family-focused approach. The practice skills required to effectively engage and connect with young children and their families, and related practice challenges are also discussed.

Supporting the wellbeing of infants and children through a trauma-informed lens (Emerging minds)
Facilitated by Chris Dolman (Senior Practice Development Officer, Emerging Minds), this webinar aimed to recognise complex trauma in infants and children and ways to promote wellbeing.



Bulletin for April 2022


Dementia incidence, APOE Genotype, and risk factors for cognitive decline in Aboriginal Australians: A longitudinal cohort study Neurology 15 March 2022 
These findings provide evidence for higher dementia incidence in Aboriginal Australians from urban areas, where the majority of Aboriginal people reside. This study also sheds light on sociodemographic, health, and genetic factors associated with incident MCI/dementia at older ages in this population, which is critical for targeted prevention strategies.

Uptake of the culturally appropriate ASQ-TRAK developmental screening tool in the Australian Aboriginal and Torres Strait Islander context Child : care, health and development 19 March 2022 
Despite substantive research translation across Australia, with evidence of its acceptability in different contexts, most Aboriginal Community Controlled Organisations have not yet accessed the ASQ-TRAK and most organisations have not participated in training. There is an imperative to progress knowledge translation to improve quality and accessibility of culturally appropriate developmental care. Adequately resourced ASQ-TRAK implementation support is needed to ensure sustainable implementation at scale.

Using a Trauma-Informed Practice Framework to examine how South Australian judges respond to trauma in the lives of Aboriginal defendants QC 11(2) 2022
This article uses a trauma-informed practice framework to examine how South Australian superior court judges acknowledge defendant trauma when sentencing Aboriginal defendants. Trauma-informed sentencing requires that judges realise the presence of trauma, recognise its relevance, respond in a way that is informed by trauma and act to avoid re-traumatisation. By analysing sentencing remarks of 42 defendants identified as Aboriginal, the presence of trauma-informed practice was explored, in terms of judicial decision-making, the sentencing process and the sanction imposed. While not holistic summaries of judges’ reasoning, sentencing remarks are intended to enable the parties and the community to understand sentencing logic. Analysis indicated that judges realised trauma was present in the lives of many Aboriginal defendants but did not always overtly recognise a link between trauma and criminal behaviour and were unlikely to refer to a defendant’s trauma history or use trauma-informed principles of practice in their sentencing response.

Attitudes towards Aboriginal and Torres Strait Islander peoples in Australia: a systematic review Australian journal of psychology 6 March 2022 
The review outlined the relationship between attitudes towards Aboriginal and Torres Strait Islander peoples and demographic, ideological, individual differences, and intergroup factors. This review highlights the need for continued research in this domain to inform appropriate prejudice reduction strategies.

Community co-selection of measures to evaluate the health and wellbeing impact of Aboriginal and Torres Strait Islander community running groups Health promotion journal of Australia 28 March 2022 
Co-selecting measures to evaluate a physical activity programme for Aboriginal and Torres Strait Islander participants can better inform the development of relevant future healthy lifestyle programme evaluation, revealing factors that may be missed as relevant by researchers.

A systematic review on assessment and management of preventive cardiovascular care in primary health for Aboriginal and Torres Strait Islander women and men Australian journal of primary health 8 April 2022 
In promoting positive cardiovascular health for Aboriginal and Torres Strait Islander peoples, there is a need to ensure provision of high-quality risk assessment and management in primary healthcare settings. There is some evidence of gender gaps for Australian women in the provision of cardiovascular risk assessment and management; however, there is little understanding of whether these gaps are also present for Aboriginal and Torres Strait Islander women. A mixed method systematic review was utilised to synthesise existing evidence on the provision of assessment and management against guideline-recommended care for Aboriginal and Torres Strait Islander women, and determine whether gender disparities in provision of care exist for this population. Sixteen studies that report gender-specific data indicate there are significant gaps in the provision of assessment and management for Aboriginal and Torres Strait Islander women and men alike. There is no evidence of incorporation of social and emotional wellbeing into cardiovascular care and limited studies outlining the assessment and management of behaviours and factors that may be protective of cardiovascular health. Furthermore, little is known about the provision of care in mainstream primary health services for Aboriginal and Torres Strait Islander peoples.

Scope and quality of economic evaluations of Aboriginal and Torres Strait Islander health programs: a systematic review ANZ journal of public health 17 March 2022
Despite significant investment in strategies to close the gap in health outcomes for Aboriginal and Torres Strait Islander people, there is limited evidence about what constitutes a cost-effective investment in Aboriginal and Torres Strait Islander healthcare. Implications for public health: More economic evaluation is required to justify the significant investment in health programs for Aboriginal and Torres Strait Islander people.

Using health check data to investigate cognitive function in Aboriginal and Torres Strait Islanders living with diabetes in the Torres Strait, Australia Endocrinology, diabetes and metabolism 5(1) 2022 
Early and subtle decrements in working memory may be a potential complication of diabetes among Aboriginal and Torres Strait Islander residents of the Torres Strait. Several potentially influential variables were not captured in this study (eg medication and diabetes duration). Greater preventative health resources are required for this population, particularly given the emerging elevated dementia rates linked to chronic disease.

Walking together: Relational Yarning as a mechanism to ensure meaningful and ethical Indigenous oral health research in Australia ANZ journal of public health 31 March 2022 
The author’s framework provides an opportunity for all researchers engaging with Indigenous Communities to facilitate meaningful and ethical research and prioritise culturally secure research environments.

Systematic review of Indigenous involvement and content in mental health interventions and their effectiveness for Indigenous populations Australian and New Zealand journal of psychiatry 5 April 2022 
A wide range of interventions demonstrated mental health improvements. However, it is difficult to draw generalizable conclusions on intervention effectiveness, given heterogeneity among studies. Studies should employ a thorough assessment of the Indigenous involvement and content of their interventions for reporting and for critical consideration of the implications of their research and whether they address Indigenous determinants of mental health.

More than three times as many Indigenous Australian clients at risk from drinking could be supported if clinicians used AUDIT-C instead of unstructured assessments Addiction science and clinical practice 5 April 2022 
Evidence-based screening tools like AUDIT-C can help clinicians ensure that Indigenous Australian clients (and their families and communities) who are at risk from alcohol consumption are better detected and supported.

Online resources

Call it out  - First Nations racism register 
The register is a secure way for people to report incidents of racism and discrimination toward First Nations Peoples. The individual reports are collected and analysed to inform an annual report which will help raise awareness and drive systematic change.

Cracks in the ice
This series of Cracks in the Ice: Fact pages are online resources about crystal methamphetamine for Aboriginal and Torres Strait Islander people in the Pitjantjatjara language.

The fact page topics are:

  • Using ice with other drugs
  • Mental health effects of ice
  • How does ice work?
  • What is ice?

Fact pages about crystal methamphetamine are also available in Warlpiri and Torres Strait Islander Creole

Dhalaleena’s story – talking about diabetes (NT Health) 
This video features Dhalaleena, an Aboriginal Health Practitioner with the Top End Regional Health Services, talking about her journey with diabetes.

Topics discussed include:

  • diabetes and glucose
  • the role the pancreas plays in diabetes
  • the importance of maintaining a healthy diet
  • the importance of exercise in managing diabetes.

COVID-19 vaccination: information and mythbusters (WA Health)
These factsheets provide information about the COVID-19 vaccines and aim to ensure WA Aboriginal and Torres Strait Islander communities are informed about the vaccines and are aware of any misinformation.

Rapid Antigen Tests for COVID-19 (Aboriginal Health Council of Western Australia)
This factsheet was developed to help Aboriginal and Torres Strait Islander people understand what a Rapid Antigen Test (RAT) for COVID-19 is and how to use one at home.

It provides information about:

  • what the test detects
  • what to do if a test is positive for COVID-19
  • where to register a positive test
  • where to get free RATs for those who hold concession cards.

Cracks in the ice poster builder 
The Cracks in the Ice poster builder is an interactive online tool for Aboriginal and Torres Strait Islander people that can be used to share information about crystal methamphetamine with the community in the form of a poster. The tool has a selection of key messages, matching pictures, and colours to choose from. When completed, the poster can be downloaded as a print-quality PDF in A5, A4 and A3 formats.

Yarning about COVID-19 vaccination: videos for Aboriginal healthcare workers
The videos feature WA Health Aboriginal and Torres Strait Islander Health Workers yarning about how best to engage Aboriginal and Torres Strait Islander people in yarning about the COVID-19 vaccine.


Overview of Aboriginal and Torres Strait Islander health status, 2021 (Australian Indigenous HealthInfoNet)
This report aims to provide a comprehensive outline of the most recent indicators of the health and current health status of Australia's Aboriginal and Torres Strait Islander people.

Close the Gap campaign report 2022 – Transforming power: voices for generational change (Lowitja Institute) 
This year’s report, produced by the Lowitja Institute for the fourth time, highlights how Aboriginal and Torres Strait Islander peoples are leading the way in transforming health and community services, policies and programs, with foundations of culture and Country at the centre, despite unprecedented health challenges from the ongoing COVID-19 pandemic. It focuses on themes of Aboriginal and Torres Strait Islander-led transformation, gender justice and equity, and allyship – the need for trust and accountability in partnerships to enable transformative change. Among its key recommendations are calls for action on gender and climate justice, a national housing framework, and full implementation of the Uluru Statement from the Heart.

National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework and Implementation Plan 2021–2031 (Australia. Department of Health) 
This national health workforce plan sets a target for Aboriginal and Torres Strait Islander people to be fully represented in the health workforce by 2031.

Connection to community (AIHW) 
Connections to community are an important source of resilience for Indigenous Australians. Previous research has shown that being connected to community builds a sense of cultural identity which can reduce suicide. Although clinically based evidence is vital to targeted interventions with at-risk individuals, an understanding of social determinants of suicide is increasingly important in developing prevention strategies, interventions, and initiatives that connect people to community support.

Protective and risk factors for suicide among Indigenous Australians (AIHW) 
Rates of suicide among Aboriginal and Torres Strait Islander people have increased by 20–24% over the past decade. Understanding how protective and risk factors contribute to suicide is an important step to improve suicide prevention for Indigenous Australians.

Indigenous self-governance for mental health and suicide prevention (AIHW) 
This article recognises that Indigenous organisations are important mechanisms of self-governance. They provide multiple points of engagement across sectors and levels of government. Indigenous Australian organisations and their contribution to Indigenous mental health and suicide prevention is the subject of this article.

Indigenous mental health, housing and homelessness (AIHW) 
The authors examine the evidence of what works and does not work in mental health and suicide prevention programs and policy initiatives associated with housing and homelessness for Indigenous Australians. They report key information about research, evaluation, program, and policy initiatives, identify best-practice approaches and critical success factors for implementation, and outline limitations and gaps in the evidence.

Employment and Indigenous mental health (AIHW) 
This paper provides an overview of policies and programs that address Indigenous employment and mental health and examines the evidence on labour force programs that can improve Indigenous mental health.

National Aboriginal and Torres Strait Islander early childhood strategy (National Indigenous Australians Agency) 
The Strategy aims to refocus investment and policy to ensure all Aboriginal and Torres Strait Islander children are supported to grow up strong and proud in culture, as the future Elders and Custodians of Country across Australia. The Strategy provides a community-informed and evidence-based pathway to achieve the National Agreement on Closing the Gap targets and outcomes for early childhood, and to fulfill joint commitments to the Priority Reforms. The Strategy is informed by an evidence-based framework and builds on existing whole-of-government policy frameworks and strategies.

Acute rheumatic fever and rheumatic heart disease in Australia, 2016–2020 (AIHW) 
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are preventable diseases disproportionately affecting Aboriginal and/or Torres Strait Islander Australians living in regional and remote areas. Prevalence rates were highest in females and young people aged 5–14. These data highlight the important role of jurisdictional control programs and registers in New South Wales, Queensland, Western Australia, South Australia, and the Northern Territory.

Significant dates

National Sorry Day (Reconciliation Australia)
Thursday 26 May 2022 

Synopsis National Sorry Day is a significant day for Aboriginal and Torres Strait Islander people, and particularly for Stolen Generations Survivors and other Aboriginal and Torres Strait Islander peoples. National Sorry Day is a day to acknowledge the strength of Stolen Generation Survivors and reflect and play a part in the healing process as people and a nation. Sorry Day asks us to acknowledge the Stolen Generations, and in doing so, reminds us that historical injustice is still an ongoing source of intergenerational trauma for Aboriginal and Torres Islander families, communities, and peoples.


Improving our understanding of alcohol dependence among Indigenous Peoples (NDARC)
When: Thu, 28 April 2022 - 2:30 PM – 3:30 PM ACST 

Synopsis: This webinar will discuss findings from recent studies on alcohol dependence among Indigenous Peoples from similarly colonised countries.

Webinar (pre-recorded)

Cultural considerations in supporting Aboriginal and Torres Strait Islander children & families (Emerging Minds) 
Synopsis: At the webinar’s completion, participants will be able to:

  • Outline the importance of cultural identity for Aboriginal and Torres Strait Islander children.
  • Describe self-determination when working alongside Aboriginal and Torres Strait Islander families.
  • Identify strategies and resources that support the cultural needs of Aboriginal and Torres Strait Islander children and families at an individual, family, community and organisational level

Bulletin for 5 May 2022

Examining the role of social support in treatment for co-occurring substance use disorder and posttraumatic stress disorder Addictive behaviours reports 11 April 2022 
The findings highlight the critical role of social support during treatment in enhancing outcomes for individuals with co-occurring SUD and PTSD.

Provider perspectives on emergency department initiation of medication assisted treatment for alcohol use disorder BMC health services research 7 April 2022
A large evidence-practice gap exists for the treatment of AUD with Naltrexone, and the ED visit is a missed opportunity for intervention. ED providers are optimistic about implementing AUD treatment in the ED but described many barriers, especially related to knowledge, clarification of roles, and stigma associated with AUD. Applying a formal implementation science approach guided by the Behavior Change Wheel allowed us to transform qualitative interview data into evidence-based interventions for the implementation of an ED-based program for the treatment of AUD.

Can chatbots help to motivate smoking cessation? A study on the effectiveness of motivational interviewing on engagement and therapeutic alliance BMC public health 12 April 2022 
The results of this preregistered study suggest that talking with a chatbot about smoking cessation can help to motivate smokers to quit and that the effect of conversation has the potential to build up over time. We did not find support for an extra motivating effect of the MI-style chatbot, for which we discuss possible reasons. These findings highlight the promise of using chatbots to motivate smoking cessation. Implications for future research are discussed.

“We need to build a better bridge”: findings from a multi-site qualitative analysis of opportunities for improving opioid treatment services for youth Harm reduction journal 17 April 2022
This study identifies fundamental directions for the operationalization and implementation of youth-centered opioid treatment services. These directions are contextualized in youths’ lived experiences accessing services in their local communities, with overarching themes from across sites strengthening their transferability to other settings.

Assessment of community-level vulnerability and access to medications for opioid use disorder JAMA 19 April 2022 
These findings suggest that disaster preparedness planning should include anticipation of access to medications for opioid use disorder and better match the location of services to communities with greater vulnerability to prevent inequities in opioid overdose deaths.

Associations between alexithymia, parental rearing styles, and frequency of drug use in male methamphetamine dependence patients BMC psychiatry 19 April 2022
These results have major implications for understanding the role of alexithymia in craving and addiction, while providing a further and explicit entry point for addiction treatment. Moreover, more attention should be focused on parenting in relation to early experiences.

Hyperbaric oxygen to assist adults with opioid use disorder in reducing methadone dose Journal of addictions nursing 1 March 2022
This study investigated the acceptability, feasibility, and treatment effects of hyperbaric oxygen therapy (HBOT) as an adjunct to reduce withdrawal symptoms for adults initiating a medically supervised methadone dose reduction.

Patients with autism spectrum disorder and co-occurring substance use disorder: A clinical intervention study Substance abuse: research and treatment 17 April 2022
The present study shows promising results of a tailor-made group intervention in a heterogeneous patient population with ASD and co-occurring SUD with positive effects on both symptoms of ASD and SUD.

Mindfulness for smoking cessation Cochrane Database of Systematic Reviews – Intervention 10 April 2022
The authors did not detect a clear benefit of mindfulness
based smoking cessation interventions for increasing smoking quit rates or changing mental health and wellbeing.

Age-based differences in quantity and frequency of consumption when screening for harmful alcohol use Addiction 25 April 2022 
In younger drinkers, frequent drinking is more strongly linked to dependence and harmful drinking subscale scores on the Alcohol Use Disorders Identification Test (AUDIT) than quantity per occasion, yet quantity per occasion has a stronger influence on the overall AUDIT score in this group. In older drinkers, frequency of consumption is not always a significant predictor of the AUDIT dependence subscale and is a weak predictor of the harmful drinking subscale.

Non-invasive brain stimulation for smoking cessation: a systematic review and meta-analysis Addiction 25 April 2022
Non-invasive brain stimulation (NIBS) may improve smoking abstinence rates from 3 to 6 months after quitting smoking, compared with sham NIBS or usual treatment.

Preferences for delivering brief alcohol intervention to risky drinking parents in children’s social care: A discrete choice experiment Alcohol and alcoholism 21 April 2022 
Brief alcohol interventions delivered to parents in social care should focus on the impact upon children and the wider family, they should be a flexible part of on-going casework and should be more intensive and less structured.

The effects of menstrual cycle hormones on responses to Varenicline and Naltrexone among female heavy drinking smokers Alcohol and alcoholism 25 April 2022
These results imply that when women show a greater P4/E2 ratio, typically observed during the luteal phase of the menstrual cycle, they experience an added benefit of naltrexone, versus placebo, for drinking outcomes as shown by greater percent days abstinent. Additional studies in larger samples are warranted as sex hormones offer important information above and beyond comparing women versus men.

Buprenorphine treatment retention and comorbidities among patients with opioid use disorder in a primary care setting American journal on addictions 6 April 2022
This study provides new knowledge of previously unexamined associations between comorbidities (e.g., hypertension) and buprenorphine treatment retention. The robust association between cocaine use and poorer buprenorphine retention serves to resolve prior conflicting data in the literature.

The Overdose Response with Take Home Naloxone (ORTHN)project: Evaluation of health worker training, attitudes and perceptions Drug and alcohol review 20 April 2022 
The ORTHN program is ‘fit for purpose’ for broad implementation in these settings. A number of potential barriers (e.g. time, medication and staffing costs) and enablers (e.g. peer engagement, regulatory framework for naloxone supply) in implementing THN interventions were identified.

Severe bacterial infections in people who inject drugs: the role of injection-related tissue damage Harm reduction journal 2 May 2022
Structural factors and injection drug use networks directly impact drug use, injection drug use practices, and harm reduction knowledge, ultimately resulting in tissue damage and inoculation of bacteria into the host and subsequent development of SBI. Effective healthcare and community prevention efforts targeted toward reducing risk of bacterial infections could prevent long-term hospitalizations, decrease health care expenditures, and reduce morbidity and mortality.

Never give up encouraging patients to give up smoking Guidelines in practice 21 April 2022 
Louise Ross discusses key recommendations in a new NICE guideline on tobacco dependency, which offers some positive new approaches to smoking cessation

Alcohol and other drug treatment services in Australia: early insights
Alcohol and other drug treatment services in Australia: early insights presents key statistics about Australia’s publicly funded alcohol and other drug treatment services and their clients. Early insights is a companion report to the data and analysis presented in Alcohol and other drug treatment services in Australia: annual report.

The Options Study: why some patients discontinue depot buprenorphine (NDARC)
This presentation outlined the Options Study, exploring patients’ experiences with depot buprenorphine, and why some decide to discontinue.

Yesterday, Today and Tomorrow The use of telehealth within behavioural health settings (Turning Point) 
The COVID-19 pandemic necessitated the rapid uptake of telehealth services to deliver treatment for alcohol and other drug (AOD) concerns. However, the Telehealth field itself has been expanding since the 1960’s and is far broader than real time video or phone consultations. This webinar explores the range of telehealth services available within behavioural health settings.

Working effectively with people with a diagnosis of borderline personality disorder (Turning Point)
This presentation provides an overview of the diagnostic criteria for BPD, how to recognise these symptoms as they present in professional settings, the principles of working effectively with people with a diagnosis of BPD, and when and how to make referrals to relevant specialist services

Updated 17 May 2022

Association of congenital and acquired cardiovascular conditions with COVID-19 severity among pediatric patients in the US
The findings suggest that some previous or preexisting cardiovascular conditions are associated with increased severity of COVID-19 among pediatric patients in the US and that morbidity may be increased among individuals children younger than 12 years with previous cardiac arrest. JAMA 17 May 2022

Identifying who has long COVID in the USA: a machine learning approach using N3C data
Patients identified by our models as potentially having long COVID can be interpreted as patients warranting care at a specialty clinic for long COVID, which is an essential proxy for long COVID diagnosis as its definition continues to evolve. We also achieve the urgent goal of identifying potential long COVID in patients for clinical trials. As more data sources are identified, our models can be retrained and tuned based on the needs of individual studies. The Lancet digital health 16 May 2022

Comparison of SARS-CoV-2 antibody response after 2-dose mRNA-1273 vs BNT162b2 vaccines in incrementally immunosuppressed patients
The authors observed similar seroresponses to mRNA-1273 and BNT162b2 vaccines in patients not receiving immunosuppression. However, patients receiving immunosuppression had higher mRNA-1273 vs BNT162b2 vaccination seroresponses. Differential immunogenicity was highest in the most immunosuppressed participants (SOTRs receiving mycophenolic acid or mycophenolate mofetil), with a 2.6-fold higher rate of achieving anti-RBD titers of 250 U/mL or greater. JAMA 16 May 2022

Real world evidence of the neutralizing monoclonal antibody Sotrovimab for preventing hospitalization and mortality in COVID-19 outpatients
Real-world evidence demonstrated sotrovimab effectiveness in reducing hospitalization and all-cause 28-day mortality among COVID-19 outpatients during the Delta variant phase. Journal of infectious diseases 16 May 2022

The impact of COVID19 on chronic disease management in primary care: lessons for Australia from the international experience
The COVID19 pandemic has highlighted inadequacies in health systems around the world and has demonstrated the need to strengthen primary care capacity to ensure safe and comprehensive CDM now and in the future. If primary care is to achieve its goals of chronic disease prevention, early detection and ongoing monitoring during the pandemic and beyond, then attention to enabling equitable access to telehealth and the transition of patients to the confident use of digital tools to support their CDM is needed. As COVID19 becomes a condition that may have long term effects and is predominantly managed in community settings, ongoing research is needed to identify and test effective solutions to these challenges. MJA 16 May 2022

COVID-19: don’t be fooled, the kids are not okay 
The mental health effects of COVID-19 lockdowns and restrictions on children and adolescents may have been hard to pin down, but at the pointy end of the stick – paediatric intensive care units (PICUs) – it’s hard to deny the data. Research published late last week from the Australian and New Zealand Intensive Care Society Paediatric Study Group (ANZICS PSG) and the ANZICS Centre for Outcome and Resource Evaluation (ANZICS CORE), has highlighted an increase in PICU admissions following deliberate self-harm, coinciding with the COVID-19 lockdowns and social restrictions of 2020 and 2021. MJA insight 16 May 2022

Effect of awake prone positioning on endotracheal intubation in patients with COVID-19 and acute respiratory failure : A randomized clinical trial
In patients with acute hypoxemic respiratory failure from COVID-19, prone positioning, compared with usual care without prone positioning, did not significantly reduce endotracheal intubation at 30 days. However, the effect size for the primary study outcome was imprecise and does not exclude a clinically important benefit. JAMA 15 May 2022

Neutralizing antibodies against the SARS-CoV-2 Omicron Variant (BA.1) 1 to 18 weeks after the second and third doses of the BNT162b2 mRNA Vaccine
This cohort study examines neutralizing antibodies against the SARS-CoV-2 Omicron variant (BA.1) after the second and third doses of the BNT162b2 mRNA vaccine among Danish adults. JAMA 13 May 2022

Association of prior BNT162b2 COVID-19 vaccination with symptomatic SARS-CoV-2 infection in children and adolescents during Omicron predominance 
Among children and adolescents, estimated VE for 2 doses of BNT162b2 against symptomatic infection was modest and decreased rapidly. Among adolescents, the estimated effectiveness increased after a booster dose. JAMA 13 May 2022

Risk of infection and hospitalization among vaccinated and unvaccinated children and adolescents in New York after the emergence of the Omicron Variant
The risks of infection and hospitalization were elevated for unvaccinated vs vaccinated children aged 5 to 11 and 12 to 17 years, although the risk declined as Omicron became more prevalent. Protection declined with time since vaccination. These results complement recent findings of reduced vaccine effectiveness for adolescents against the Delta variant and the dual effects of the variant and waning protection against infection, with sustained protection against hospitalizations. JAMA 13 May 2022

Venous or arterial thrombosis and deaths among COVID-19 cases: a European network cohort study
Risks of venous thromboembolism and arterial thromboembolism were up to 1% among COVID-19 cases, and increased with age, among males, and in those who were hospitalised. Their occurrence was associated with excess mortality, underlying the importance of developing effective treatment strategies that reduce their frequency. The Lancet infectious diseases 13 May 2022

Safety and efficacy of BCG re-vaccination in relation to COVID-19 morbidity in healthcare workers: A double-blind, randomised, controlled, phase 3 trial
BCG did not protect healthcare workers from SARS-CoV-2 infection or related severe COVID-19 disease and hospitalisation. eClinicalMedicine 12 May 2022

The impact of post-hospital remote monitoring of COVID-19 patients using pulse oximetry: A national observational study using hospital activity data
The authors found no evidence of early discharges or changes in readmissions associated with the roll out of COVID Virtual Wards across England. Their analysis made pragmatic use of national-scale hospital data, but it is possible that a lack of specific data (for example, on which patients were enrolled and on potentially important confounders) may have meant that true impacts, especially at a local level, were not ultimately discernible. It is important that future research is able to make use of better quality - preferably linked - data, from multiple sites. eClinicalMedicine 12 May 2022

WHO strongly recommends Paxlovid® for people at high risk of severe disease
The World Health Organization (WHO) has updated its living guideline on COVID-19 therapeutics to include a strong recommendation for the oral antiviral nirmatrelvir/ritonavir (available as Paxlovid®). The WHO recommends the drug for patients with non-severe disease who are at highest risk of hospitalisation, calling it the best therapeutic choice for high-risk patients to date. The recommendation is based on new data that shows that nirmatrelvir/ritonavir reduces the risk of hospitalisation by 85% in this group of patients. BMJ 12 May 2022

Audio interview: Forecasting the future of Covid
In this audio interview conducted on May 10, 2022, the editors are joined by infectious disease epidemiologist Marc Lipsitch to discuss Covid forecasting in his role as scientific director of the CDC’s new Center for Forecasting and Outbreak Analytics. NEJM 12 May 2022

Effect of mRNA vaccine boosters against SARS-CoV-2 Omicron infection in Qatar
The messenger RNA (mRNA) boosters were highly effective against symptomatic delta infection, but they were less effective against symptomatic omicron infection. However, with both variants, mRNA boosters led to strong protection against Covid-19–related hospitalization and death. NEJM 12 May 2022

Admissions of children and adolescents with deliberate self-harm to intensive care during the SARS-CoV-2 outbreak in Australia
This study found that the coronavirus pandemic in Australia was associated with a significant increase in admissions of children and adolescents to intensive care with deliberate self-harm. JAMA 11 May 2022

Neuropsychiatric ramifications of severe COVID-19 and other severe acute respiratory infections
The results of this study suggest that disease severity, rather than pathogen, is a relevant factor associated with neuropsychiatric ramifications after severe respiratory infections. JAMA 11 May 2022

Agreement of treatment effects from observational studies and randomized controlled trials evaluating hydroxychloroquine, lopinavir-ritonavir, or dexamethasone for covid-19: meta-epidemiological study
Meta-analyses of observational studies and RCTs evaluating treatments for covid-19 have summary treatment effects that are generally in agreement. Although our evaluation is limited to three covid-19 treatments, these findings suggest that meta-analyzed evidence from observational studies might complement, but should not replace, evidence collected from RCTs. BMJ 10 May 2022

Evaluation of mRNA-1273 Covid-19 vaccine in children 6 to 11 years of age
Two 50-μg doses of the mRNA-1273 vaccine were found to be safe and effective in inducing immune responses and preventing Covid-19 in children 6 to 11 years of age; these responses were noninferior to those in young adults. NEJM 11 May 2022

Older adults mount less durable humoral responses to two doses of COVID-19 mRNA vaccine, but strong initial responses to a third dose
Results underscore the immune benefits of third COVID-19 vaccine doses, particularly in older adults. Journal of infectious diseases 11 May 2022

Factors associated with serological response to SARS-CoV-2 vaccination in patients with Multiple Sclerosis treated with Rituximab
These results suggest that rituximab-treated patients with multiple sclerosis may be vaccinated with tozinameran as soon as possible, with rituximab treatment delayed until B-cell levels reach 40/μL, when an additional vaccine dose should be considered. JAMA 11 May 2022

Agreement of treatment effects from observational studies and randomized controlled trials evaluating hydroxychloroquine, lopinavir-ritonavir, or dexamethasone for covid-19: meta-epidemiological study
Meta-analyses of observational studies and RCTs evaluating treatments for covid-19 have summary treatment effects that are generally in agreement. Although this evaluation is limited to three covid-19 treatments, these findings suggest that meta-analyzed evidence from observational studies might complement, but should not replace, evidence collected from RCTs. BMJ 10 May 2022

Fit-tested N95 masks combined with portable HEPA filtration can protect against high aerosolized viral loads over prolonged periods at close range
Fit-tested N95 masks combined with HEPA filtration protects against high virus aerosol loads at close range and for prolonged periods of time. Journal of infectious diseases 10 May 2022

Clinical features of, and risk factors for, severe or fatal COVID-19 among people living with HIV admitted to hospital: analysis of data from the WHO Global Clinical Platform of COVID-19
In this sample of hospitalised people contributing data to the WHO Global Clinical Platform for COVID-19, HIV was an independent risk factor for both severe COVID-19 at admission and in-hospital mortality. These findings have informed WHO immunisation policy that prioritises vaccination for people living with HIV. As the results mostly reflect the data contribution from Africa, this analysis will be updated as more data from other regions become available. The Lancet HIV 10 May 2022

Assessment of neutralizing antibody response against SARS-CoV-2 variants after 2 to 3 doses of the BNT162b2 mRNA COVID-19 Vaccine
In this cohort study of 82 Japanese participants, 2 doses of the BNT162b2 mRNA vaccine did not induce sufficient neutralizing antibody against the Omicron variant. However, booster vaccination was associated with induction of a high level of neutralizing antibodies against the Omicron variant, irrespective of the recipient’s age. JAMA 9 May 2022

Differences in outcomes and factors associated with mortality among patients with SARS-CoV-2 infection and cancer compared with those without cancer : A systematic review and meta-analysis
Findings of this study suggest that younger patients with cancer are a high-risk population for poor outcomes from COVID-19. JAMA 9 May 2022

Safety, immunogenicity, and reactogenicity of BNT162b2 and mRNA-1273 COVID-19 vaccines given as fourth-dose boosters following two doses of ChAdOx1 nCoV-19 or BNT162b2 and a third dose of BNT162b2 (COV-BOOST): a multicentre, blinded, phase 2, randomised trial
Fourth-dose COVID-19 mRNA booster vaccines are well tolerated and boost cellular and humoral immunity. Peak responses after the fourth dose were similar to, and possibly better than, peak responses after the third dose. The Lancet infectious diseases  9 May 2022

High attack rate of SARS-CoV-2 B.1.1.529 among two-dose vaccinated populations in two indoor entertainment setting outbreaks
The authors estimated attack rates of SARS-CoV-2 B.1.1.529 (Omicron) infection among people attending a nightclub and a graduation ball where >95% had at least 2 vaccine doses. Attack rates were 295/535(55.1%) and 102/189(54.0%) respectively (mean: 5 days post-event). At the ball, attack rates increased with time since vaccination: 12.5% among those vaccinated 1-2 months previously; 68.0% among those vaccinated 3 + months previously; such differences were not found at the nightclub. Recent vaccination prevents Omicron infection, but is time and setting-dependent, emphasising the importance of non-pharmaceutical public health measures in addition to vaccine booster doses to maximise protection in high-risk contexts. Journal of infectious diseases 7 May 2022

Lessons from COVID-19 syndromic surveillance through emergency department activity: a prospective time series study from western Switzerland
ED syndromic surveillance is an effective tool to detect and monitor a COVID-19 outbreak and to predict hospital resource needs. It would have allowed to anticipate ICU occupancy by 13 days, including significant aberration detection at the beginning of the second wave. BMJ open 6 May 2022

Adequacy of serial self-performed SARS-CoV-2 Rapid Antigen detection testing for longitudinal mass screening in the workplace
In this cross-sectional study of self-performed SARS-CoV-2 RADT in an intended-use setting, a modified quick reference guide was associated with significantly improved accuracy in RADT interpretations. JAMA 6 May 2022

Association between the use of psychotropic medications and the risk of COVID-19 infection among long-term inpatients with serious mental illness in a New York state–wide psychiatric hospital system
In this cohort study of adults hospitalized with serious mental illness, the use of second-generation antipsychotic medications was associated with decreased risk of COVID-19 infection, whereas the use of valproic acid was associated with increased risk. Further research is needed to assess the mechanisms that underlie these findings. JAMA 6 May 2022

Analysis of a SARS-CoV-2 convalescent cohort identified a common strategy for escape of vaccine-induced anti-RBD antibodies by Beta and Omicron variants
Through mutations of the K417-E484-N501 triad, SARS-CoV-2 has evolved to evade neutralization by the class I/II anti-RBD antibody fraction of hybrid immunity plasma as the polyclonal antibody response post-vaccination shows limitations in the ability to solve the structural requirements to bind the mutant RBDs. eBioMedicine 6 May 2022

SARS-CoV-2 vaccination diversifies the CD4+ spike-reactive T cell repertoire in patients with prior SARS-CoV-2 infection
These data demonstrate that SARS-CoV-2 vaccination in patients with prior SARS-CoV-2 infection induces a new antigen-specific repertoire and sheds light on the differential immune responses induced by vaccination versus natural infection. eBioMedicine 6 May 2022

Antibody duration after infection from SARS-CoV-2 in the Texas Coronavirus Antibody Response Survey.
Understanding the duration of antibodies to the SARS-CoV-2 virus that causes COVID-19 is important to controlling the current pandemic. Participants from the Texas Coronavirus Antibody REsponse Survey (Texas CARES) with at least one nucleocapsid protein antibody test were selected for a longitudinal analysis of antibody duration. A linear mixed model was fit to data from participants (n= 4,553) with one to three antibody tests over 11 months (10/1/2020-9/16/2021), and models fit showed that expected antibody response after COVID-19 infection robustly increases for 100 days post-infection, and predicts individuals may remain antibody positive from natural infection beyond 500 days, depending on age, body mass index, smoking or vaping use, and disease severity (hospitalized or not; symptomatic or not). Journal of infectious diseases 6 May 2022