暂无摘要。

BACKGROUND: Including Aboriginal and Torres Strait Islander people and communities through consultation has been a key feature of policy implementation throughout the Australian Government\'s \"Closing the Gap\" (CTG) strategy. However, consultation often reinforces power imbalances between government and local community and can undervalue or marginalise Indigenous knowledge and leadership. Occupational therapy has a short history of examining colonial power structures within the profession, but there has been limited progress to decolonise consultation and practice.
METHODS: Drawing on decolonising research methodology and positioned at the interface of knowledge, comparative case studies were used to understand policy implementation in two regions. In Shepparton, Victoria, CTG policy was implemented predominately through an Aboriginal Community Controlled Health Organisation, and in Southern Adelaide, South Australia, CTG policy was implemented through mainstream state government and non-government providers in the absence of a local Aboriginal-controlled organisation. Findings were examined critically to identify implications for occupational therapy.
RESULTS: Our case studies showed that policy stakeholders perceived consultation to be tokenistic and partnerships were viewed differently by Aboriginal and non-Indigenous participants. Participants identified the need to move beyond a rhetoric of \"working with\" Aboriginal and Torres Strait Islander people, to promote Aboriginal leadership and really listen to community so that policy can respond to local need. The findings of this research show that Aboriginal-controlled services are best positioned to conduct and respond to community consultation.
CONCLUSIONS: A decolonising approach to consultation would shift the status quo in policy implementation in ways that realign power away from colonial structures towards collaboration with Indigenous leadership and the promotion of Aboriginal-controlled services. There are lessons for occupational therapy from this research on policy implementation on authentic, decolonised consultation as a key feature of policy implementation. Shifting power imbalances through prioritising Indigenous leadership and honouring what is shared can drive change in CTG policy implementation processes and outcomes.

This case study of the merger of four hospitals in western Victoria reports on the views of participants affected by the merger - as staff or from the communities - about 2 years after the merger. Respondents reported that many of the sought-after benefits of the merger were being delivered. However, the merger process itself attracted criticism, and it is here that this merger can provide lessons for others. Although there was a long lead time of consultation prior to the formal decision to merge, there was very little time to plan the next steps of implementation - there were only days between the decision and the merger taking effect. Future mergers should manage that differently. There is also a lot of literature on mergers which might provide a check list to enhance the likelihood of success in future mergers.

UNASSIGNED: We describe a severe case of swimmer\'s itch in Victoria with widespread bullous eruption, which is a rare manifestation of this condition and presented a diagnostic challenge. This is the first case reported in Victoria, having been previously reported in more northern parts of Australia; with climate change trends, swimmer\'s itch is likely to become increasingly common in southern parts of the region.

Capability maturity models have been developed and are widely used within healthcare aiming to assess the degree of digitization of the organization, but empirical assessments of the models themselves has been undertaken infrequently. We present a mixed-method approach to assessing a novel health capability maturity model developed by a state government responsible for the management of 86 health services. The approach was designed to be suitable for system level assessment of services and pooled the wisdom and experience of subject matter experts and key stakeholders using a combination of survey and interviews to test and tune the proposed assessment approach and parameters. We applied the approach to assess the target capability model across a number of public health services in Victoria, Australia. The result showed sufficient validity to be able to generate recommendations for further improvement of the capability model and the assessment approach to enable broader application within Australia.

Ecological and statistical models were developed using freshwater algal assemblages to assess water quality and ecological health of a regulated river. These models were used to inform configuration of flows to maintain or improve environmental conditions of the waterway whilst meeting consumptive water supply commitments. The flow regime of the MacKenzie River, western Victoria, Australia, has been substantially modified since the construction of a water supply reservoir on its upper reach in 1887. Water is withdrawn at several locations downstream of the reservoir, creating a substantially modified flow regime, impacting key environmental values of the river. To assess the impact of the different flow regimes on river health and ecosystem function, ten sites were repeatedly sampled along the river between February 2012 and April 2014. Physical and chemical characteristics of water, including pH, temperature, turbidity, electrical conductivity, dissolved oxygen, total nitrogen, total phosphorous, cations, and anions, were measured. Biological properties of the algal periphyton communities, including dry mass, ash-free dry mass, chlorophyll-a concentration, and species composition, were also measured. Exploration of the algal assemblage and water chemistry data using the computationally unconstrained ordination technique such as principal component analysis principal component analysis (PCA), correspondence analysis (CA), detrended correspondence analysis (DCA), and canonical correspondence analysis (CCA) indicated two strong gradients in the data sets. Furthermore, the quantitative ecosystem response models have been developed as the prototype tool to assist in the future configuration of flows in this river. The empirical data and models showed the lower reaches of the river to be in poor condition under low flows, but this condition improved under flows of 35 ML/day, as indicated by the reduction in green algae and cyanobacteria and improvement. Finally, the results are presented to tailor discharge and duration of water volume by amalgamation of consumptive and environmental flows to improve the condition of the stream thereby supplementing the flows dedicated to environmental outcomes.

OBJECTIVE: From 2010 to 2022, the Victorian Department of Health operated a heat health alert system. We explored whether changes to morbidity occurred during or directly after these alerts, and how this differed for certain population groups.
METHODS: We used a space-time-stratified case-crossover design and conditional logistic regression to examine the associations between heat health alerts and heat-related and all-cause emergency department (ED) presentations and hospital admissions at the state-wide level, with models created for the whole population and subgroups. Data were included for the warm season (November-March) from 2014 to 2021.
RESULTS: Increases occurred in heat-related ED presentations (OR 1.73, 95% CI: 1.53-1.96) and heat-related hospital admissions (OR 1.23, 95% CI: 1.16-1.30) on days on or after heat health alerts. Effect sizes were largest for those 65 years and older, Aboriginal and Torres Strait Islander people, and those living in the most disadvantaged areas.
CONCLUSIONS: We confirm that increases in morbidity occurred in Victoria during heat health alerts and describe which population groups are more likely to require healthcare in a hospital.
CONCLUSIONS: These findings can inform responses before and during periods of extreme heat, data-driven adaptation strategies, and the development of heat health surveillance systems.

To examine protective and risk factors for Buruli ulcer (BU), we conducted a case-control study of 245 adult BU cases and 481 postcode-matched controls across BU-endemic areas of Victoria, Australia. We calculated age- and sex-adjusted odds ratios for socio-environmental, host, and behavioral factors associated with BU by using conditional logistic regression. Odds of BU were >2-fold for persons with diabetes mellitus and persons working outdoors who had soil contact in BU-endemic areas (compared with indoor work) but were lower among persons who had bacillus Calmette-Guérin vaccinations. BU was associated with increasing numbers of possums and with ponds and bore water use at residences. Using insect repellent, covering arms and legs outdoors, and immediately washing wounds were protective; undertaking multiple protective behaviors was associated with the lowest odds of BU. Skin hygiene/protection behaviors and previous bacillus Calmette-Guérin vaccination might provide protection against BU in BU-endemic areas.

Inferring the spatiotemporal spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via Bayesian phylogeography has been complicated by the overwhelming sampling bias present in the global genomic dataset. Previous work has demonstrated the utility of metadata in addressing this bias. Specifically, the inclusion of recent travel history of SARS-CoV-2-positive individuals into extended phylogeographical models has demonstrated increased accuracy of estimates, along with proposing alternative hypotheses that were not apparent using only genomic and geographical data. However, as the availability of comprehensive epidemiological metadata is limited, many of the current estimates rely on sequence data and basic metadata (i.e. sample date and location). As the bias within the SARS-CoV-2 sequence dataset is extensive, the degree to which we can rely on results drawn from standard phylogeographical models (i.e. discrete trait analysis) that lack integrated metadata is of great concern. This is particularly important when estimates influence and inform public health policy. We compared results generated from the same dataset, using two discrete phylogeographical models: one including travel history metadata and one without. We utilized sequences from Victoria, Australia, in this case study for two unique properties. Firstly, the high proportion of cases sequenced throughout 2020 within Victoria and the rest of Australia. Secondly, individual travel history was collected from returning travellers in Victoria during the first wave (January to May) of the coronavirus disease 2019 (COVID-19) pandemic. We found that the implementation of individual travel history was essential for the estimation of SARS-CoV-2 movement via discrete phylogeography models. Without the additional information provided by the travel history metadata, the discrete trait analysis could not be fit to the data due to numerical instability. We also suggest that during the first wave of the COVID-19 pandemic in Australia, the primary driving force behind the spread of SARS-CoV-2 was viral importation from international locations. This case study demonstrates the necessity of robust genomic datasets supplemented with epidemiological metadata for generating accurate estimates from phylogeographical models in datasets that have significant sampling bias. For future work, we recommend the collection of metadata in conjunction with genomic data. Furthermore, we highlight the risk of applying phylogeographical models to biased datasets without incorporating appropriate metadata, especially when estimates influence public health policy decision making.

Research into the co-creation of healthy food retail is in its early stages. One way to advance co-creation research is to explore and understand how co-creation was applied in developing, implementing, and evaluating a heath-enabling initiative in a supermarket in regional Victoria, Australia. A case study design was used to explore and understand how co-creation was applied in the Eat Well, Feel Good Ballarat project. Six documents and reports related to the Eat Well, Feel Good Ballarat project were analyzed with findings from the focus groups and interviews. Motivations to develop or implement health-enabling supermarket initiatives differed among the participants. Participants considered that initial negotiations were insufficient to keep the momentum going and to propose the value to the retailers to scale up the project. Presenting community-identified needs to the supermarket helped gain the retailer\'s attention, whilst the co-design process helped the implementation. Showcasing the project to the community through media exposure kept the supermarket interested. Retailers\' time constraints and staff turnover were considered significant barriers to partnership building. This case study contributes insights into applying co-creation to health-enabling strategies in food retail outlets using two co-creation frameworks.