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Background & Aims There is increasing disparity in liver-related mortality worldwide. Although there are many biologic and lifestyle risk factors for liver-related mortality, the effects of inequalities in social and economic determinants of health have received little attention. We investigated changes in liver-related mortality from 1985 through 2015 in 36 countries, using 4 international health and economic databases, and searched for socioeconomic factors that might influence these trends. Methods We collected information on sex- and country-specific liver-related mortality from countries with designated high usability data from the World Health Organization mortality database. We obtained data on alcohol consumption per capita, percentage of adults with body mass index greater than 30kg/m2, health expenditure per capita, gross domestic product per capita, Gini index, national unemployment estimates and diabetes prevalence from the World Health Organization global health observatory data repository, the World Bank database, and the International Diabetes Federation. We examined changes in mortality using Joinpoint regression analysis. Univariate analysis and a mixed-effects linear model were used to identify factors associated with liver-related mortality. Results From 1985 to 2015, mean liver-related deaths per 100,000 persons increased in men, from 23.8 to 26.1, and women, from 9.7 to 11.9. Increased liver-related mortality was associated with male sex, high level of alcohol consumption, obesity, and indicators of national wealth and government health expenditure gross domestic product or government expenditure on health. Conclusions In addition to established risk factors for liver mortality, this study identified addressable economic factors associated with liver-related mortality trends. Healthcare professionals and policy makers may wish to consider these factors to reduce liver-related mortality.

© 2017 Academy of Nutrition and Dietetics Background The Australian Government has introduced a voluntary front-of-package labeling system that includes total sugar in the calculation. Objective Our aim was to determine the effect of substituting added sugars for total sugars when calculating Health Star Ratings (HSR) and identify whether use of added sugars improves the capacity to distinguish between core and discretionary food products. Design This study included packaged food and beverage products available in Australian supermarkets (n=3,610). The product categories included in the analyses were breakfast cereals (n=513), fruit (n=571), milk (n=309), non-alcoholic beverages (n=1,040), vegetables (n=787), and yogurt (n=390). Added sugar values were estimated for each product using a validated method. HSRs were then estimated for every product according to the established method using total sugar, and then by substituting added sugar for total sugar. The scoring system was not modified when added sugar was used in place of total sugar in the HSR calculation. Products were classified as core or discretionary based on the Australian Dietary Guidelines. To investigate whether use of added sugar in the HSR algorithm improved the distinction between core and discretionary products as defined by the Australian Dietary Guidelines, the proportion of core products that received an HSR of ≥3.5 stars and the proportion of discretionary products that received an HSR of <3.5 stars, for algorithms based upon total vs added sugars were determined. Results There were 2,263 core and 1,347 discretionary foods; 1,684 of 3,610 (47%) products contained added sugar (median 8.4 g/100 g, interquartile range=5.0 to 12.2 g). When the HSR was calculated with added sugar instead of total sugar, an additional 166 (7.3%) core products received an HSR of ≥3.5 stars and 103 (7.6%) discretionary products received a rating of ≥3.5 stars. The odds of correctly identifying a product as core vs discretionary were increased by 61% (odds ratio 1.61, 95% CI 1.26 to 2.06; P<0.001) when the algorithm was based on added compared to total sugars. Conclusions In the six product categories examined, substitution of added sugars for total sugars better aligned the HSR with the Australian Dietary Guidelines. Future work is required to investigate the impact in other product categories.

Australia remains the only developed country to have endemic levels of trachoma (a prevalence of 5% or greater among children) in some regions. Endemic trachoma in Australia is found predominantly in remote and very remote Aboriginal communities. The Australian Government funds the National Trachoma Surveillance and Reporting Unit to collate, analyse and report trachoma prevalence data and document trachoma control strategies in Australia through an annual surveillance report. This report presents data collected in 2013. Data are collected from Aboriginal and Torres Strait Island communities designated at-risk for endemic trachoma within New South Wales, the Northern Territory, South Australia and Western Australia. The World Health Organization grading criteria were used to diagnose cases of trachoma in Aboriginal children, with jurisdictions focusing screening activities on the 5-9 years age group; but some children in the 1-4 and 10-14 years age groups were also screened. The prevalence of trachoma within a community was used to guide treatment strategies as a public health response. Aboriginal adults aged 40 years or over were screened for trichiasis. Screening coverage for the estimated population of children aged 5-9 years and adults aged 40 years or over in at-risk communities required to be screened in 2013 was 84% and 30%, respectively. There was a 4% prevalence of trachoma among children aged 5-9 years who were screened. Of communities screened, 50% were found to have no cases of active trachoma and 33% were found to have endemic levels of trachoma. Treatment was required in 75 at-risk communities screened. Treatment coverage for active cases and their contacts varied between jurisdictions from 79% to 100%. Trichiasis prevalence was 1% within the screened communities.

Background: Niger's low-burden, sex-work-driven HIV epidemic is situated in a context of high economic and demographic growth. Resource availability of HIV/AIDS has been decreasing recently. In 2007-2012, only 1% of HIV expenditure was for sex work interventions, but an estimated 37% of HIV incidence was directly linked to sex work in 2012. The Government of Niger requested assistance to determine an efficient allocation of its HIV resources and to strengthen HIV programming for sex workers. Methods: Optima, an integrated epidemiologic and optimization tool, was applied using local HIV epidemic, demographic, programmatic, expenditure, and cost data. A mathematical optimization algorithm was used to determine the best resource allocation for minimizing HIV incidence and disability-adjusted life years (DALYs) over 10 years. Results: Efficient allocation of the available HIV resources, to minimize incidence and DALYs, would increase expenditure for sex work interventions from 1% to 4%-5%, almost double expenditure for antiretroviral treatment and for the prevention of mother-to-child transmission, and reduce expenditure for HIV programs focusing on the general population. Such an investment could prevent an additional 12% of new infections despite a budget of less than half of the 2012 reference year. Most averted infections would arise from increased funding for sex work interventions. Conclusions: This allocative efficiency analysis makes the case for increased investment in sex work interventions to minimize future HIV incidence and DALYs. Optimal HIV resource allocation combined with improved program implementation could have even greater HIV impact. Technical assistance is being provided to make the money invested in sex work programs work better and help Niger to achieve a cost-effective and sustainable HIV response.

The disruptive and at times traumatic nature of military service can create mental health issues among veterans Wounded, injured or ill personnel, even if their physical and psychological rehabilitation goes well, can experience an acute loss of purpose and structure that is provided during their military service, especially post-discharge It is also increasingly recognised that contemporary veterans have unique requirements, and in this context, military personnel often find their traditional medical and psychological treatments are insufficient to address their needs Fortunately, there is growing evidence that a range of exercises, such as physical activity as well as animal- and art-based activities can serve as worthwhile adjuncts to more familiar programs of rehabilitation and reintegration There is growing evidence that these activities reduce anxiety, depression and PTSD symptoms — all of which are relevant to military personnel The theoretical basis concerning symptom reduction includes behavioural, cognitive and neurophysiological theories Tests of these theories may result in enhanced treatment This paper will describe these adjunct activities and how they are being implemented with Australian Defence Force (ADF) personnel, with particular focus on the evidence and theories surrounding art-based endeavours as an adjunct to established therapies

Air travel during the COVID-19 pandemic is challenging for travellers, airlines, airports, health authorities, and governments. We reviewed multiple aspects of COVID peri-pandemic air travel, including data on traveller numbers, peri-flight prevention, and testing recommendations and in-flight SARS-CoV-2 transmission, photo-epidemiology of mask use, the pausing of air travel to mass gathering events, and quarantine measures and their effectiveness. Flights are reduced by 43% compared to 2019. Hygiene measures, mask use, and distancing are effective, while temperature screening has been shown to be unreliable. Although the risk of in-flight transmission is considered to be very low, estimated at one case per 27 million travellers, confirmed in-flight cases have been published. Some models exist and predict minimal risk but fail to consider human behavior and airline procedures variations. Despite aircraft high-efficiency filtering, there is some evidence that passengers within two rows of an index case are at higher risk. Air travel to mass gatherings should be avoided. Antigen testing is useful but impaired by time lag to results. Widespread application of solutions such as saliva-based, rapid testing or even detection with the help of "sniffer dogs" might be the way forward. The "traffic light system" for traveling, recently introduced by the Council of the European Union is a first step towards normalization of air travel. Quarantine of travellers may delay introduction or re-introduction of the virus, or may delay the peak of transmission, but the effect is small and there is limited evidence. New protocols detailing on-arrival, rapid testing and tracing are indicated to ensure that restricted movement is pragmatically implemented. Guidelines from airlines are non-transparent. Most airlines disinfect their flights and enforce wearing masks and social distancing to a certain degree. A layered approach of non-pharmaceutical interventions, screening and testing procedures, implementation and adherence to distancing, hygiene measures and mask use at airports, in-flight and throughout the entire journey together with pragmatic post-flight testing and tracing are all effective measures that can be implemented. Ongoing research and systematic review are indicated to provide evidence on the utility of preventive measures and to help answer the question "is it safe to fly?".

Background: An increased prevalence of common mental disorders and suicide has been reported among physicians worldwide. We aimed to assess which, if any, interventions are effective at reducing or preventing symptoms of common mental health disorders or suicidality in physicians. Methods: For this systematic review and meta-analysis MEDLINE, EMBASE, PsycINFO, and Cochrane CENTRAL (database inception to March 26, 2018), reference lists of included studies, and additional sources were systematically searched and screened by two independent reviewers. We included randomised controlled studies or controlled before–after studies of interventions to reduce depression, anxiety, or suicidality in physicians, as assessed by a validated outcome measure. Both organisation-level and physician-directed interventions were considered. Our primary outcome was differences in symptoms of common mental health disorders following intervention. We used random-effects modelling for the main meta-analyses and planned subgroup and sensitivity analyses. The study protocol is registered with PROSPERO, number CRD42018091646. Findings: We identified 2992 articles for screening, of which eight were included in the systematic review (n=1023 physicians) and seven in the meta-analysis. Results indicated a moderate effect in favour of the physician-directed interventions for reduction in symptoms of common mental health disorders (standardised mean difference 0·62; 95% CI 0·40–0·83; p<0·0001). Separate analyses showed physician-directed interventions resulted in reductions of symptoms of depression, anxiety, and suicidality. No evidence of significant heterogeneity was found (Q=3·78; p=0·44). Interpretation: Physician-directed interventions are associated with small reductions in symptoms of common mental health disorders among physicians. Research regarding organisational interventions aimed at improving physicians' mental health via modification of the work environment is urgently needed. Funding: Health Workforce Programme, Commonwealth Department of Health, Australian Government, iCare Foundation, and NSW Health.

Background: Little is known about research priorities in adult palliative care. Identifying research priorities for adult palliative care will help in increasing research quality and translation. Objective: The aim was to identify the views of health professionals' research priorities in adult palliative care that lead to development of a palliative care research agenda in Australia. Design: A modified three-round Delphi survey. Setting/Subjects: Palliative care researchers and clinicians in Australia were invited to participate. Results: A total of 25 panelists completed round 1, 14 completed round 2, and 13 completed round 3. Round 1 resulted in 90 research priorities in 13 categories. Round 2 showed consensus agreement on 19/90 research priorities. Round 3 resulted in the top 10 research priorities of the 19 achieving consensus in round 2. Panelists agreed that research is needed on the transition to palliative care; improving communication about prognosis; increasing access to palliative care for indigenous communities, people who wish to remain at home, and people in aged care; addressing family caregivers' needs; promoting patients' and families' decision making; improving cross-cultural aspects of palliative care; determining the effects of assisted dying legislation; and improving bereavement care in rural, remote, and Aboriginal populations. Conclusions: The expert panelists identified the top 10 research priorities for adult palliative care. These identified research priorities are the most urgent topics requiring attention to increase the quality of life of patients requiring palliative care and their family members.

Objectives: Deciding to disclose a mental illness in the workplace requires thoughtful informed decision making. Decision aids are increasingly used to help people make complex decisions, but need to incorporate relevant factors for the context. This study aimed to identify factors and processes that influence decision making about such disclosure to inform the development of a disclosure decision aid tool for employees in male dominated industries. Methods: We invited 15 partner organisations in male dominated industries to facilitate the recruitment of employees who either had disclosed a mental health condition in their workplace; or occupied a position to whom employees disclosed to focus groups addressing the aims. Results: The majority of the organisations had explicit policies that employees must disclose and so were unable to be seen countenancing non-disclosure as an option. Two focus groups were conducted (n = 13) with mainly male (62%), full-time employees (85%), and both disclosed (46%) and authority (54%) groups. Six themes, all barriers, were identified as influencing decision making processes: knowledge about symptoms, and self-discrimination (internal), stigma and discrimination by others, limited managerial support, dissatisfaction with services, and/or a risk of job or financial loss (external). Conclusion: Decisions to disclose mental health conditions, even by those who had done so, appear driven entirely by consideration of negative aspects. This suggests that anti-discrimination policy, legislation, awareness campaigns, and manager training have yet to change negative perceptions, and that any decision aid tool needs to incorporate counterfactual positive aspects that appear not to be an important consideration in such male dominated workplaces. There is a disconnect between organisational policies favouring disclosure and employees favouring non-disclosure that has caused tension within the organisational culture. Decision aid tools may assist employees with an active disclosure without waiting for an event to occur, giving the control of the decision back to the employee.

Background: Rates of suicide appear to be increasing, indicating a critical need for more effective prevention initiatives. To increase the efficacy of future prevention initiatives, we examined the spatial distribution of suicide deaths and suicide attempts in New South Wales (NSW), Australia, to identify where high incidence 'suicide clusters' were occurring. Such clusters represent candidate regions where intervention is critically needed, and likely to have the greatest impact, thus providing an evidence-base for the targeted prioritisation of resources. Methods: Analysis is based on official suicide mortality statistics for NSW, provided by the Australian Bureau of Statistics, and hospital separations for non-fatal intentional self-harm, provided through the NSW Health Admitted Patient Data Collection at a Statistical Area 2 (SA2) geography. Geographical Information System (GIS) techniques were applied to detect suicide clusters occurring between 2005 and 2013 (aggregated), for persons aged over 5 years. The final dataset contained 5466 mortality and 86,017 non-fatal intentional self-harm cases. Results: In total, 25 Local Government Areas were identified as primary or secondary likely candidate regions for intervention. Together, these regions contained approximately 200 SA2 level suicide clusters, which represented 46% (n = 39,869) of hospital separations and 43% (n = 2330) of suicide deaths between 2005 and 2013. These clusters primarily converged on the Eastern coastal fringe of NSW. Conclusions: Crude rates of suicide deaths and intentional self-harm differed at the Local Government Areas (LGA) level in NSW. There was a tendency for primary suicide clusters to occur within metropolitan and coastal regions, rather than rural areas. The findings demonstrate the importance of taking geographical variation of suicidal behaviour into account, prior to development and implementation of prevention initiatives, so that such initiatives can target key problem areas where they are likely to have maximal impact.

Mouse models of thromboembolism are frequently used to investigate platelet function in vivo and, according to European Union (EU) legislation, must be conducted in the context of replacement, refinement and reduction. We have previously developed a refined real-time mouse model of thromboembolism as an alternative to models of thromboembolic mortality which inflict considerable pain and suffering. Real-time monitoring involves infusion of radiolabelled platelets into the circulation of anaesthetized mice, and platelet aggregation is measured as increases in platelet-associated counts in the pulmonary vasculature following injection of platelet agonists. This gives a definitive data set on the tissue localization and extent of platelet activation. We developed an additional, more simplistic alternative to mortality models based on blood microsampling which entails the measurement of circulating platelet counts following agonist stimulation. Blood microsamples were collected from the tail vein of anaesthetized mice at three different time points leading to a reduction in animal numbers. Platelet counts significantly dropped 1 minute after stimulation with collagen or thrombin and were restored over 10 minutes. These results correlate with those obtained via real-time monitoring and were confirmed by immunohistochemistry. Pre-treatment of mice with aspirin significantly inhibited the decrease in platelet counts following collagen. These data suggest that blood microsampling may be implemented as a simplistic refined alternative to mortality models of thromboembolism when specialized monitoring equipment, or use of radioactive isotopes for real-time monitoring, which remains the 'gold standard', is not feasible. Microsampling refines and reduces animal procedures in compliance with current EU legislation

Women in post-conflict, low-income, post-conflict (LI-PC) countries are at risk of exposure to the traumatic events (TEs) of war and intimate partner violence (IPV), forms of stress that are known to lead to depression and other adverse mental health outcomes. We aimed to assess an index of exposure to these two forms of trauma to identify pregnant women attending antenatal clinics in conflict-affected Timor-Leste at high risk of depression and other forms of stress. A large, cross-sectional study of women in the second trimester of pregnancy was conducted in the four main government antenatal clinics in Dili district of Timor-Leste, between May 2014, and January 2015. The sample consisted of 1672 consecutive women, 3 to 6 months pregnant, with a response rate of 96%. We applied the Edinburgh Postnatal Depression Scale, the Kessler-10 psychological distress scale and the Harvard Trauma Questionnaire. IPV was assessed by the World Health Organisation measure. Composite categories of conflict-related TEs and severity of IPV showed a dose-response relationship with depressive symptoms: for exposure to four or more conflict-related TEs and severe psychological IPV, the adjusted odds ratio (AOR) was 3.95 (95% confidence interval (CI) 2.10-7.40); for four or more TEs and physical abuse, AOR 8.16 (95% CI 3.53-18.85); and for four or more TEs and severe psychological and physical abuse, AOR 9.78 (95% CI 5.31-18.02). For any mental distress, the AOR for four or more TEs and severe psychological abuse was 3.60 (95% CI 2.08-6.23); for four or more TEs and physical abuse 7.03 (95% CI 3.23-15.29); and for four or more TEs and severe psychological and physical abuse the AOR was 10.45 (95% CI 6.06-18.01). Of 184 women (11% of the sample) who reported ≥4 TEs and either physical abuse alone or in combination with severe psychological abuse, 78 (42%) reached threshold for depressive symptoms and 93 (51%) for any mental distress, a 10-fold increase in depressive and other mental health symptoms. Priority should be directed to providing urgent mental health and social interventions for this group of women. Our findings offer a framework for a tiered approach to detection, guiding prevention and intervention strategies for IPV and associated mental health problems in low-income post-conflict countries.

Clinical Practice become Clinical Science in the Years 1720-1820. There were many Reasons for This Transformation. The Discoveries By Santorio Santorio, William Harvey, Marcello Malpighi, Giovanni Alfonso Borelli, Lorenzo Bellini, Thomas Sydenham, Giovanni Maria Lancisi were perceived by the students who Asked for Change in the Medical Curriculum. In 1761 Morgagni Centered the Study of Diseases on Morbid Anatomy, a Way To Control at Autopsy the Validity of Diagnosis. J.P. Frank Who Worked on Public Health and John Locke who Supported a Method of Scientific Reasoning Based on Asking questions were also Instrumental for Changes. Hospitals, Formerly Hospices for The Poor,Became Places for Curing and Healing. Military Hospitals Represented Models to be Followed. In Vienna Marie Therese Inaugurated the Allegemein Krankenhaus in 1785. In Revolutionary France Fourcroy with the Law Frimaire an III,1794 gave a new Rationale. Medicine and Surgery Were Unified in the Curriculum. Basic sciences Were Introduced. Dissection Become Compulsory,Practical Teaching Become The Rule. But it Was With John Hunter, Domenico Cotugno and P. Joseph Desault That the Great Advancement Was Achieved. They Were Anatomist and Therefore The Made The Knowledge of Human Body The Core of Medical Curriculum. However Experimentations on Animals , as Well as Practical Beside Teaching at The Hospital Also Became Important. Through Their Work Hospitals and Universities Were Associated in a Common Goal. Key words: Clinical science - Domenico Cotugno - P.J. Desault - John Hunter - Anatomy - Clinical teaching - Percussion - Auscultation - Morbid anatomy

Intro -- Editorial Committee -- Editor-in-Chief -- Editors -- Preface -- Contents -- Contributors -- Abbreviations -- Part I Autophagy and Neuropsychological Disorders -- 1 Autophagy and Alzheimer's Disease -- 1.1 The Role of Autophagy in the Pathogenesis of AD -- 1.1.1 Aβ and Autophagy -- 1.1.2 Tau Metabolism and Autophagy -- 1.1.3 Other Factors Associated with AD and Autophagy -- 1.2 Autophagy-Targeted Therapy for the Treatment of AD -- 1.3 Autophagy in Other Types of Dementia -- 1.3.1 DLB and Autophagy -- 1.3.2 FTD and Autophagy -- 1.3.3 VD and Autophagy -- 1.3.4 Prion Disease and Autophagy -- 1.4 Conclusion -- References -- 2 Autophagy and Parkinson's Disease -- 2.1 The Pathogenesis of Parkinson's Disease -- 2.1.1 Pathogenesis of Parkinson's Disease -- 2.1.2 Molecular Pathogenesis -- 2.2 The Roles of Autophagy in the Pathogenesis of PD -- 2.2.1 PD-Related Genes and Autophagy -- 2.2.2 Oxidative Damage, Mitochondrial Dysfunction and Autophagy -- 2.2.3 Selective Autophagy -- 2.2.4 Lysosome Function and Autophagy -- 2.2.5 Synaptic Vesicle Trafficking and Autophagy -- 2.2.6 Neurotoxic Parkinson's Disease Model and Autophagy -- 2.3 Autophagy Regulation in PD Treatment -- 2.3.1 Small Molecular Autophagy Regulators in PD Models -- 2.3.2 Autophagy-Related Genes Regulation in PD Models -- 2.4 Conclusion -- References -- 3 Autophagy and Motor Neuron Diseases -- 3.1 Introduction -- 3.2 SOD1 and Autophagy -- 3.2.1 Degradation of mSOD1 Protein -- 3.2.2 SOD1 and Autophagic Flux -- 3.3 TDP-43 and Autophagy -- 3.3.1 Degradation of TDP-43 Protein -- 3.3.2 Loss-of-Function -- 3.4 C9orf72 and Autophagy -- 3.4.1 Loss-of-Function of the C9orf72 Protein -- 3.4.2 RNA-Mediated Toxicity -- 3.4.3 Dipeptide Repeat Proteins Gain-of-Function Mechanism -- 3.4.4 C9orf72 and Autophagy -- 3.5 Other ALS-Related Genes and Autophagy -- 3.5.1 Ubiquilin-2 -- 3.5.2 VCP.

In 2017, a dengue epidemic of unexpected magnitude occurred in Sri Lanka. A total of 186,101 suspected cases and 440 dengue-related deaths occurred. We conducted a comprehensive analysis of this epidemic by comparing national surveillance data for 2017 with data from the preceding 5 years. In all Sri Lanka districts, dengue incidence in 2017 increased significantly over incidence during the previous 5 years. Older schoolchildren and young adults were more clinically symptomatic than those at extremes of age. Limited virologic surveillance showed the dominant circulating variant was dengue virus type 2 cosmopolitan genotype in the most affected district. One quarter of total annual cases were reported 5 weeks after the southwest monsoon started. Changes in vector abundance were not predictive of the increased incidence. Direct government expenditures on dengue control activities in 2017 were US $12.7 million. The lessons learned from this outbreak are useful for other tropical nations facing increasing dengue incidence.