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BACKGROUND: Coronavirus 19 (COVID-19) has created complex pressures and challenges for healthcare systems worldwide; however, little is known about the impacts COVID-19 has had on regional/rural healthcare workers. The Loddon Mallee Healthcare Worker COVID-19 Study (LMHCWCS) cohort was established to explore and describe the immediate and long-term impacts of the COVID-19 pandemic on regional and rural healthcare workers. METHODS: Eligible healthcare workers employed within 23 different healthcare organisations located in the Loddon Mallee region of Victoria, Australia, were included. In this cohort study, a total of 1313 participants were recruited from November 2020-May 2021. Symptoms of depression, anxiety, post-traumatic stress, and burnout were measured using the Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7), Impact of Events Scale-6 (IES-6), and Copenhagen Burnout Inventory (CBI), respectively. Resilience and optimism were measured using the Brief Resilience Scale and Life Orientation Test-Revised (LOT-R), respectively. Subjective fear of COVID-19 was measured using the Fear of COVID-19 Scale. RESULTS: These cross-sectional baseline findings demonstrate that regional/rural healthcare workers were experiencing moderate/severe depressive symptoms (n = 211, 16.1%), moderate to severe anxiety symptoms (n = 193, 14.7%), and high personal or patient/client burnout with median total scores of 46.4 (IQR = 28.6) and 25.0 (IQR = 29.2), respectively. There was a moderate degree of COVID-19-related fear. However, most participants demonstrated a normal/high degree of resilience (n = 854, 65.0%). Based on self-reporting, 15.4% had a BMI from 18.5 to 24.9 kgm2 and 37.0% have a BMI of 25 kgm2 or over. Overall, 7.3% of participants reported they were current smokers and 20.6% reported alcohol consumption that is considered moderate/high-risk drinking. Only 21.2% of the sample reported consuming four or more serves of vegetables daily and 37.8% reported consuming two or more serves of fruit daily. There were 48.0% the sample who reported having poor sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI). CONCLUSION: Regional/rural healthcare workers in Victoria, Australia, were experiencing a moderate to high degree of psychological distress during the early stages of the pandemic. However, most participants demonstrated a normal/high degree of resilience. Findings will be used to inform policy options to support healthcare workers in responding to future pandemics.

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BACKGROUND: Workplace aggression is becoming increasingly prevalent in health care, with serious consequences for both individuals and organisations. Research and development of organisational interventions to prevent and minimise workplace aggression has also increased. However, it is not known if interventions prevent or reduce occupational violence directed towards healthcare workers. OBJECTIVES: To assess the effectiveness of organisational interventions that aim to prevent and minimise workplace aggression directed towards healthcare workers by patients and patient advocates. SEARCH METHODS: We searched the following electronic databases from inception to 25 May 2019: Cochrane Central Register of Controlled Trials (CENTRAL) (Wiley Online Library); MEDLINE (PubMed); CINAHL (EBSCO); Embase (embase.com); PsycINFO (ProQuest); NIOSHTIC (OSH-UPDATE); NIOSHTIC-2 (OSH-UPDATE); HSELINE (OSH-UPDATE); and CISDOC (OSH-UPDATE). We also searched the ClinicalTrials.gov (www.ClinicalTrials.gov) and the World Health Organization (WHO) trials portals (www.who.int/ictrp/en). SELECTION CRITERIA: We included randomised controlled trials (RCTs) or controlled before-and-after studies (CBAs) of any organisational intervention to prevent and minimise verbal or physical aggression directed towards healthcare workers and their peers in their workplace by patients or their advocates. The primary outcome measure was episodes of aggression resulting in no harm, psychological, or physical harm. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods for data collection and analysis. This included independent data extraction and 'Risk of bias' assessment by at least two review authors per included study. We used the Haddon Matrix to categorise interventions aimed at the victim, the vector or the environment of the aggression and whether the intervention was applied before, during or after the event of aggression. We used the random-effects model for the meta-analysis and GRADE to assess the quality of the evidence. MAIN RESULTS: We included seven studies. Four studies were conducted in nursing home settings, two studies were conducted in psychiatric wards and one study was conducted in an emergency department. Interventions in two studies focused on prevention of aggression by the vector in the pre-event phase, being 398 nursing home residents and 597 psychiatric patients. The humour therapy in one study in a nursing home setting did not have clear evidence of a reduction of overall aggression (mean difference (MD) 0.17, 95% confidence interval (CI) 0.00 to 0.34; very low-quality evidence). A short-term risk assessment in the other study showed a decreased incidence of aggression (risk ratio (RR) 0.36, 95% CI 0.16 to 0.78; very low-quality evidence) compared to practice as usual. Two studies compared interventions to minimise aggression by the vector in the event phase to practice as usual. In both studies the event was aggression during bathing of nursing home patients. In one study, involving 18 residents, music was played during the bathing period and in the other study, involving 69 residents, either a personalised shower or a towel bath was used. The studies provided low-quality evidence that the interventions may result in a medium-sized reduction of overall aggression (standardised mean difference (SMD -0.49, 95% CI -0.93 to -0.05; 2 studies), and physical aggression (SMD -0.85, 95% CI -1.46 to -0.24; 1 study; very low-quality evidence), but not in verbal aggression (SMD -0.31, 95% CI; -0.89 to 0.27; 1 study; very low-quality evidence). One intervention focused on the vector, the pre-event phase and the event phase. The study compared a two-year culture change programme in a nursing home to practice as usual and involved 101 residents. This study provided very low-quality evidence that the intervention may result in a medium-sized reduction of physical aggression (MD 0.51, 95% CI 0.11 to 0.91), but there was no clear evidence that it reduced verbal aggression (MD 0.76, 95% CI -0.02 to 1.54). Two studies evaluated a multicomponent intervention that focused on the vector (psychiatry patients and emergency department patients), the victim (nursing staff), and the environment during the pre-event and the event phase. The studies included 564 psychiatric staff and 209 emergency department staff. Both studies involved a comprehensive package of actions aimed at preventing violence, managing violence and environmental changes. There was no clear evidence that the psychiatry intervention may result in a reduction of overall aggression (odds ratio (OR) 0.85, 95% CI 0.63 to 1.15; low-quality evidence), compared to the control condition. The emergency department study did not result in a reduction of aggression (MD = 0) but provided insufficient data to test this. AUTHORS' CONCLUSIONS: We found very low to low-quality evidence that interventions focused on the vector during the pre-event phase, the event phase or both, may result in a reduction of overall aggression, compared to practice as usual, and we found inconsistent low-quality evidence for multi-component interventions. None of the interventions included the post-event stage. To improve the evidence base, we need more RCT studies, that include the workers as participants and that collect information on the impact of violence on the worker in a range of healthcare settings, but especially in emergency care settings. Consensus on standardised outcomes is urgently needed.

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OBJECTIVE: To explore the likely impact of future trajectories of morbidity and mortality in Australia. METHODS: Estimates of mortality and morbidity were obtained from a previous assessment of Australia's health from 1993 to 2003, including projections to 2023. Outcomes of interest were the difference between life expectancy (LE0) and health-adjusted life expectancy (i.e. absolute lost health expectancy (ALHE0)), ALHE0 as a proportion of LE0 and the partitioning of changes in ALHE0 into additive contributions from changes in age- and cause-specific mortality and morbidity. RESULTS: Actual and projected trajectories of mortality and morbidity resulted in an expansion of ALHE0 of 1.22 years between 1993 and 2023, which was equivalent to a relative expansion of 0.7% in morbidity over the life course. Most (93.8%) of this expansion was accounted for by cardiovascular disease, diabetes and cancer; of these, the only unfavourable trend of any note was increasing morbidity from diabetes. CONCLUSIONS: Time spent with morbidity will most likely increase in terms of numbers of years lived and as a proportion of the average life span. This conclusion is based on the expectation that gains in LE0 will continue to exceed gains in ALHE0, and has important implications for public policy. WHAT IS KNOWN ABOUT THE TOPIC? Although the aging of Australia's population as a result of declining birth and death rates is well understood, its relationship with levels of morbidity is not always fully appreciated. This is most noticeable in the policy discourse on primary prevention, in which such activities are sometimes portrayed as having unrealised potential with respect to alleviating growth in health service demand. WHAT DOES THIS PAPER ADD? This paper sheds new light on these relationships by exploring the likely impact of future trajectories of both morbidity and mortality within an additive partitioning framework. The results suggest a modest expansion of morbidity over the life course, most of which is accounted for by only three causes. In two of these (cardiovascular disease and cancer), the underlying trends in both mortality and morbidity have been favourable for some time due, at least in part, to success in primary prevention. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Although there may be good arguments in favour of a greater focus on primary prevention as currently practiced, reducing overall demand for health services is unlikely to be one of them. To make such an argument valid, policy makers should consider shifting their attention to the effectiveness of primary prevention as it relates to causes other than cardiovascular disease and cancer, particularly those with a predominantly non-fatal impact, such as diabetes and degenerative diseases of old age.

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OBJECTIVE: To analyse the implications of using different methods to predict diabetes prevalence for the future. APPROACH: Different methods used to predict diabetes were compared and recommendations are made. CONCLUSION: We recommend that all projections take a conservative approach to diabetes prevalence prediction and present a 'base case' using the most robust, contemporary data available. We also recommend that uncertainty analyses be included in all analyses. IMPLICATIONS: Despite variation in assumptions and methodology used, all the published predictions demonstrate that diabetes is an escalating problem for Australia. We can safely assume that unless trends in diabetes incidence are reversed there will be at least 2 million Australian adults with diabetes by 2025. If obesity and diabetes incidence trends, continue upwards, and mortality continues to decline, up to 3 million people will have diabetes by 2025, with the figure closer to 3.5 million by 2033. The impact of this for Australia has not been measured.

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OBJECTIVE: To describe the magnitude and distribution of health problems in Australia, in order to identify key opportunities for health gain. DESIGN: Descriptive epidemiological models for a comprehensive set of diseases and injuries of public health importance in Australia were developed using a range of data sources, methods and assumptions. Health loss associated with each condition was derived using normative techniques and quantified for various subpopulations, risks to health, and points in time. The baseline year for comparisons was 2003. MAIN OUTCOME MEASURES: Health loss expressed as disability-adjusted life years (DALYs) and presented as proportions of total DALYs and DALY rates (crude and age-standardised) per 1000 population. RESULTS: A third of total health loss in 2003 was explained by 14 selected health risks. DALY rates were 31.7% higher in the lowest socioeconomic quintile than in the highest, and 26.5% higher in remote areas than in major cities. Total DALY rates were estimated to decline for most conditions over the 20 years from 2003 to 2023, but for some causes, most notably diabetes, they were projected to increase. CONCLUSION: Despite steady improvements in Australia's health over the past decade, there are still opportunities for further progress. Significant gains can be made through achievable changes in exposure to a limited number of well established health risks.

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