Asthma is a chronic respiratory disease that affects more than 250 million people. It is a heterogeneous disease with a variety of symptoms, severity, and underlying mechanisms. Long term remission has been achieved for...Asthma is a chronic respiratory disease that affects more than 250 million people. It is a heterogeneous disease with a variety of symptoms, severity, and underlying mechanisms. Long term remission has been achieved for small subgroups of people with asthma treated with targeted biologic therapy. Accurately defining asthma subgroups is therefore of upmost importance for further reducing the prevalence of asthma. The rapid rise in technologies that enable profiling of a spectrum of analytes provides the opportunity to accurately classify asthma subtypes and to elucidate the underlying causes of disease. Combining these technologies with artificial intelligence will enable more accurate disease prediction, precision diagnoses, and personalised treatments. A major challenge is the prioritisation and effective implementation of these technologies in clinical practice.
Asthma affects more than 300 million people worldwide and is frequently associated with other medical conditions in adults, including chronic obstructive pulmonary disease, ischaemic heart disease, and stroke. Despite th...Asthma affects more than 300 million people worldwide and is frequently associated with other medical conditions in adults, including chronic obstructive pulmonary disease, ischaemic heart disease, and stroke. Despite the huge burden, there has been little progress toward prevention and cure, possibly related to a one-size-fits-all approach. The recent identification of various asthma trajectories over the life course suggests that identifying biomarkers of lifetime transitions could advance progress to prevention and cure. This will require combining data, including for biological samples, from large cohort studies, for analysis using integrated computational biological approaches. We summarise key articles on Australian cohort studies that have characterised asthma trajectories across childhood and adulthood in order to inform research focused on curative approaches. Five Australian cohorts have provided information on childhood and adulthood asthma trajectories and their relationships with early life factors, later life outcomes, and underlying biological mechanisms. Twelve other cohort studies undertaken in Australia could also contribute valuable information. Australian asthma cohort studies have collected a wealth of information across the life course on the drivers, outcomes, and biological mechanisms of asthma. Integrating these resources into harmonised, functionally useful databases will make their data and biospecimens accessible for analysis and research. Australia is well placed for advancing progress in the prevention and cure of asthma.
OBJECTIVE: To assess the feasibility of embedding omega-3 fatty acid testing and targeted supplementation (the Omega-3 Test-and-Treat Program) into routine antenatal care to reduce the risk of preterm birth. STUDY DESIGN...OBJECTIVE: To assess the feasibility of embedding omega-3 fatty acid testing and targeted supplementation (the Omega-3 Test-and-Treat Program) into routine antenatal care to reduce the risk of preterm birth. STUDY DESIGN: Prospective implementation evaluation study, using the Quality Enhancement Research Initiative (QUERI) framework. SETTING, PARTICIPANTS: Women with singleton pregnancies undergoing routine antenatal screening during early pregnancy (before 20 weeks' gestation) and their health care providers, South Australia, 19 April 2021 - 30 June 2022. INTERVENTION: Addition of omega-3 fatty acid testing option to SA Pathology test referral forms for the South Australian Maternal Serum Antenatal Screening (SAMSAS) program, with the aim of identifying women with low omega-3 fatty acid levels during early pregnancy and providing evidence-based supplementation guidance for reducing the risk of preterm birth. MAIN OUTCOME MEASURES: Program feasibility (uptake and fidelity); representativeness of women tested for omega-3 fatty acid status; and omega-3 fatty acid status, by proportion of total serum fatty acids (low, < 3.7%; moderate, 3.7-4.3%; sufficient, > 4.3%). RESULTS: A total of 4801 requests for omega-3 fatty acid tests (26.1% of 18 362 SAMSAS referrals) were submitted to SA Pathology during the initial implementation phase of the Omega-3 Test-and-Treat Program. The monthly number of test requests increased from 15 (2.4% of 627 SAMSAS referrals) in April 2021 to 340 (29.4% of 1156 SAMSAS referrals) in June 2022. The socio-demographic and clinical characteristics of women referred for omega-3 fatty acid testing were similar to those for women who were not. Serum samples were insufficient for omega-3 fatty acid testing in 19 cases; of the 4782 tests performed, omega-3 fatty acid levels were low in 702 (14.7%), moderate in 1638 (34.2%), and sufficient in 2442 tests (51.1%). Of 5057 samples received by the Omega-3 Laboratory, 4935 (97.6%) were analysed within 72 hours. Thirty-three of 4801 omega-3 fatty acid test referrals (0.7%) were for women beyond 20 weeks of pregnancy; 58 referrals (1.2%) were for women with non-singleton pregnancies. CONCLUSION: The Omega-3 Test-and-Treat Program is a feasible approach to reducing the risk of preterm birth with a targeted nutritional intervention that could be integrated into routine antenatal care in Australia.
INTRODUCTION: Infertility affects about one in six couples and a male factor may contribute to 50% of cases. Until recently, no Australian-based clinical guidelines for the management of male infertility had been publish...INTRODUCTION: Infertility affects about one in six couples and a male factor may contribute to 50% of cases. Until recently, no Australian-based clinical guidelines for the management of male infertility had been published. A panel of experts was assembled to formulate the first Australian evidence-based guidelines on male infertility. MAIN RECOMMENDATIONS: The initial evaluation of male fertility should include a reproductive and medical history, physical (including scrotal) examination and semen analysis, and simultaneous evaluation of the female partner. Further evaluation of men with suspected infertility should be guided by an expert in male reproduction and include hormonal evaluation and an estimate of testicular volume. Extra tests according to clinical indication are sperm DNA testing, somatic genetic testing and imaging. Varicocele treatment should be considered in men with infertility who have a clinical varicocele(s) and associated clinical indications. Men with azoospermia should be evaluated to differentiate between obstructive and non-obstructive azoospermia. Micro testicular sperm extraction is the preferred method of sperm retrieval in men with non-obstructive azoospermia and prior diagnostic biopsy or fine needle aspiration is not required. The management of male infertility should include counselling men regarding potentially modifiable risk factors, associated health conditions, and implications for their future health and offspring. Surgical management of infertility includes retrieval of sperm for use in assisted reproductive technology and treatment of varicocele, and non-surgical management includes management of hormonal disorders. Specific guidelines are included for men with cryptorchidism, varicoceles and Klinefelter syndrome and cancer and male infertility. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES: These first Australian evidence-based guidelines will serve as a long overdue clinical aid to the large number of practitioners who provide services to men with infertility. The broad and comprehensive nature of the guidelines will facilitate evidence-based care for the most common areas of male infertility. The formulation of these guidelines by experts representing key stakeholder organisations should enhance the promotion of the guideline statements and help raise awareness of this common condition.
OBJECTIVE: To estimate the number of cancer-related deaths that could be attributed to spatial disparities in survival. DESIGN: Cohort study of cancer registry data. SETTING: Australia, 1 January 2010 to 31 December 2019...OBJECTIVE: To estimate the number of cancer-related deaths that could be attributed to spatial disparities in survival. DESIGN: Cohort study of cancer registry data. SETTING: Australia, 1 January 2010 to 31 December 2019. MAIN OUTCOME MEASURES: The numbers and percentages of cancer-related deaths attributable to spatial disparities in survival were estimated by calculating the numbers of cancer-related deaths that would have occurred if all areas in Australia met or exceeded a benchmark 5-year survival rate. This benchmark corresponded to the survival rate of the area with survival better than 80% of all areas, with "area" referring to residential location at diagnosis. RESULTS: Of all 289 075 cancer-related deaths in Australia in 2010-2019, 33 892 (11.7%) were attributable to spatial disparities in survival. Although numbers were greatest in major cities, as remoteness and area disadvantage increased, the percentages of cancer-related deaths attributable to spatial disparities in survival increased. Of all cancer-related deaths in remote areas and the most socio-economically disadvantaged areas, 1569 of 5208 (30.1%) and 13 469 of 66 775 (20.2%) deaths were attributable to survival disparities, respectively. The highest numbers and percentages of attributable cancer deaths in remote areas were for rare cancers (529/1809 [29.3%]), lung cancer (300/1298 [23.1%]) and head and neck cancers (162/370 [43.8%]). In the most disadvantaged areas, rare cancers (3070/20 512 [15.0%]) and lung cancer (2640/18 057 [14.6%]) had the highest numbers of attributable cancer deaths. CONCLUSIONS: These findings quantify the impact of spatial disparities in survival and highlight the need for equitable access to diagnostic and treatment services across Australia.
Barlow KM, Ponsford JL, Theodom A
… +22 more, Cowen G, Davis GA, Anderson V, Babl FE, Cole D, Cullen J, Dalziel SR, Fitzgerald M, Flavell H, Yates C, Kimble R, Olver JH, Orr R, Ralfe M, Rose M, Rushworth N, Treleaven J, Browne G, Delang N, Harris S, Mitchell G, Tweedy S