The objectives of study 1 were to use expert opinion to identify the limitations of the Health Anxiety Inventory – Short Version (SHAI) for administration in medical populations and to develop an adapted version for medical populations. The objective of the second study was to evaluate the psychometric properties of the adapted measure. A three-round Delphi study method was used in study 1. Eight experts with experience of living with a physical health condition and four experts by profession working within physical health were invited to review the SHAI. Study 2 employed a cross-sectional mixed methods questionnaire design. Individuals with multiple sclerosis (n=115), myalgic encephalomyelitis/chronic fatigue syndrome (n=84) and chronic pain (n=116) were invited to complete a battery of questionnaires via an online survey. The adapted version of the SHAI for Medical Populations (HAI-M) consisted of 12 items scoring from 0 to 3, reaching high consensus (75% agreement) for administration in medical populations. All groups rated the HAI-M as more acceptable than the SHAI and no significant differences were found on HAI-M scores between clinical groups. The HAI-M demonstrated high internal consistency (.875), good test–retest reliability (.812) and convergent validity (.801). Divergent validity was also acceptable (.515). This study provides preliminary evidence for a psychometrically sound health anxiety screening tool for use in medical populations.

1. (1) To gain insights into the presentation of health anxiety in medical conditions.

2. (2) To consider the validity and reliability of using questionnaire measures developed using analogue sample norms, and how this may affect measurement when used in different context and settings.

3. (3) The process of systematically adapting, developing and testing standardised measures for use in special subgroups.

This review provides an overview of patient-reported outcome measure (PROMs) utilized to assess the impact of advance care planning (ACP) among older adults and evaluates their psychometric properties.

The inclusion criteria were as follows: (1) studies that targeted older adults; (2) studies using of any type of measurement tools that measure patient-reported ACP program outcomes; and (3) studies published in English or Korean. Following PRISMA guidelines, a systematic review was conducted, encompassing electronic searches across 5 databases including PubMed, EMBASE, Cochrane Library, CINHAL, and PsycINFO and manual searches of umbrella reviews on ACP interventions. General characteristics of the selected measures were extracted, and their methodological quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.

Out of 19,503 studies initially identified, 74 met the inclusion criteria, reporting on a total of 202 measures. These measures were categorized into 4 domains reflecting the targets of ACP interventions: process (n = 56), action (n = 18), process and action (n = 16), quality of care (n = 63), and health status (n = 49). Despite the breadth of measures identified, none fully met all recommended psychometric properties outlined in the checklist.

While this review aids in the selection of measures for both practical and research purposes, it underscores the necessity for further validation of PROMs in assessing ACP outcomes in older adults, advocating for rigorous psychometric evaluations and adherence to standards like the COSMIN checklist to ensure reliable and valid data. It suggests the need for shortened versions and researcher assistance to address the challenges older adults face with self-reported PROMs and improve participation rates.

To characterise children’s lunchbox contents for food, waste, and packaging.

A cross-sectional study was conducted. Lunchboxes were photographed at two time points on the same day: before first morning break to capture food and packaging and post-lunch break to capture food waste. Contents were coded using an audit tool developed using REDCap.

23 sites across metropolitan Adelaide, South Australia including 14 preschools and 9 primary schools in low (n=8), medium (n=7), and high (n=8) socioeconomic areas.

Preschool (3-5 years) to Grade 7 (6-13 years) school students.

673 lunchboxes were analysed. Grain foods dominated (with at least half of them being discretionary varieties), with 92% of lunchboxes having at least one item from that category, followed by fruits (78%), snacks (62%), dairy (32%), and vegetables (26%). Lunchboxes of preschool children contained more fruits (92% vs 65%; χ2(1)=73.3, P<0.01), vegetables (36% vs 16%; χ2(1)=34.0, P<0.01), and dairy items (45% vs 19%; χ2(1)=53.6, P<0.01), compared to lunchboxes of primary school children. Snack foods were more prevalent in primary school (68%) than preschool (55%; χ2(1)=11.2, P<0.01). Discretionary foods appeared more frequently, and single-use packaging accounted for half (53%) of all packaging in lunchboxes, primarily from snacks and grain foods. Preschool children had less single-use packaging but more food waste. Vegetables were the most wasted food group.

Sandwiches, fruits, and various snacks are typical lunchbox foods, often accompanied by single-use packaging. Considering both health and environmental factors in lunchbox choices could benefit children and sustainability efforts in schools.

This systematic review aims to synthesize evidence from current literature to describe how Electronic Medical Record (EMR) primary care data have been used for antimicrobial stewardship activities internationally.

Systematic literature review.

We searched Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, Scopus, and Web of Science from January 1, 2013 to September 23, 2023 to retrieve studies that included concepts of “antimicrobial stewardship,” “primary care,” and “electronic medical records.” We used narrative synthesis to classify and interpret results. Data were grouped and tabulated by similar themes and concepts, including strengths, facilitators, barriers, and limitations for antimicrobial stewardship.

A total of 265 articles were identified from the initial search, of which 34 full-text articles from 10 countries met all criteria and were included in the review. Six categories of EMR data use were identified from the studies, these were for: assessing antimicrobial prescribing quality, measuring the effectiveness of an intervention, analyzing antimicrobial prescribing trends, assessing patient and provider characteristics in prescribing, evaluating novel tools or measures, and measuring specific conditions and outcomes. Facilitators of use of EMR data were generally well-described across the studies reviewed; however, barriers were not. Barriers described were centered around EMR system design and technical challenges in data extraction. Completeness of EMR data was the most consistently described limitation.

Our study highlights the range of uses of EMR data in supporting AMS in primary care internationally, and its strengths, facilitators, and barriers to use.

Various committees provide health technology assessment (HTA) recommendations to the Australian government on health technology subsidization. All committees include consumer members, but operations vary across committees. To support the committee’s consumer members and facilitate consumer input, the Consumer Evidence and Engagement Unit (CEEU) was launched in 2019. The CEEU aims to enhance inclusion of consumer input in Commonwealth HTA processes.

The CEEU operates within the Australian Government Department of Health and Aged Care in a hybrid format. The core functions of the CEEU include secretariat support for the HTA Consumer Consultative Committee (CCC), which comprises consumer members from all HTA committees. The CEEU also summarizes consumer input for the HTA committees. In 2022, the CEEU launched the Conversations for Change series, which was developed through a range of different consultation activities. As a result, an ongoing “Changing Conversations” mandate is in place, to build and sustain relational, non-transactional partnerships in a true collaborative style.

The HTA committees and subcommittees operate across cycles with overlapping timelines, requiring consumer input to be gathered at different timepoints for different purposes. The CEEU has launched materials, including the Consultation Hub and HTA Engage, and is developing a Consultation Toolkit to raise awareness and facilitate these processes. The role of the HTA CCC is evolving as a forum to enable consumer committee members to share experiences and receive CEEU support. Improvements in consultation processes have enabled the CEEU to provide consumer comments to consumer committee members to facilitate genuine representation of consumer and other external stakeholder views.

Managing consumer input can be resource intensive, however there is increasing recognition of the importance of consumer engagement in Australian HTA. The CEEU expects continued growth and a wider remit from 2024, as new processes and changes occur. Additional materials are planned to support consumer committee members and to build capacity among consumers and consumer organizations.

Celiac disease (CD), an autoimmune disorder triggered by gluten, impacts about one percent of the population. Only one-third receive a diagnosis, leaving the majority unaware of their condition. Untreated CD can lead to gut lining damage, resulting in malnutrition, anemia, and osteoporosis. Our primary goal was to identify at-risk groups and assess the cost-effectiveness of active case finding in primary care.

Our methodology involved systematic reviews and meta-analyses focusing on the accuracy of CD risk factors (chronic conditions and symptoms) and diagnostic tests (serological and genetic). Prediction models, based on identified risk factors, were developed for identifying individuals who would benefit from CD testing in routine primary care. Additionally, an online survey gauged individuals’ preferences regarding diagnostic certainty before initiating a gluten-free diet. This information informed the development of economic models evaluating the cost-effectiveness of various active case finding strategies.

Individuals with dermatitis herpetiformis, a family history of CD, migraine, anemia, type 1 diabetes, osteoporosis, or chronic liver disease showed one and a half to two times higher risk of having CD. IgA tTG, and EMA demonstrated good diagnostic accuracy. Genetic tests showed high sensitivity but low specificity. Survey results indicated substantial variation in preference for certainty from a blood test before initiating a gluten-free diet. Cost-effectiveness analyses showed that, in adults, IgA tTG at a one percent pre-test probability (equivalent to population screening) was the most cost effective. For non-population screening strategies, IgA EMA plus HLA was most cost effective. There was substantial uncertainty in economic model results.

While population-based screening with IgA tTG appears the most cost effective in adults, decisions for implementation should not solely rely on economic analyses. Future research should explore whether population-based CD screening aligns with UK National Screening Committee criteria and requires a long-term randomized controlled trial of screening strategies.

In 2021, the Australian Government Department of Health and Aged Care’s Consumer Evidence and Engagement Unit (CEEU) launched an online consultation hub to provide a centralized pathway for consumer engagement in health technology assessment (HTA) processes. The hub enables consumers (patients, carers, health professionals, and citizens) to provide commentary on items being considered by HTA committees for subsidization.

A survey was developed by the CEEU, committee members, and consumer representatives to facilitate consultation on applications assessed by the Pharmaceutical Benefits Advisory Committee (PBAC)—a principal Australian HTA committee. Questions were designed as simple and engaging, including guidance on the type of information required. Responses are summarized thematically by efficacy, safety, accessibility, and quality-of-life impacts of the proposed health technology. New surveys are launched to coincide with each PBAC meeting agenda publication and allow a ten-week consultation period. Awareness of consultations is supported by the CEEU’s HTA Engage e-newsletter, which alerts the public and targeted stakeholders.

The hub surveys have enabled streamlined consumer commentary to be provided for PBAC considerations. It has also allowed increased time for quality consultation with stakeholders. The success of the hub is further demonstrated in the current development of a similar survey for another principal committee, the Medical Services Advisory Committee (MSAC), to transition its consultation processes to the hub. Of note, while consumers’ feedback on the hub is positive, there remains a desire for educational resources and face-to-face interactions to support consumer engagement in HTA processes. The CEEU are developing materials to address and further support this need.

In a time when technological communication can be optimized to complement face-to-face conversations, it is vital consumer engagement in HTA processes follows suit. To facilitate continued engagement that is sustainable for both present and future Australians, the CEEU continues to evolve a strategy regarding virtual consultations to increase consumer awareness and education and promote effective participation in Australian HTA.