Frykberg G, Ojinnaka-Psillakis A, Saw P
… +20 more, Kapeke K, Kim C, Furlong A, Maury S, Price AMH, Sly PD, Dee Hawkins T, Muse K, Sahlberg P, Warrilow P, Stanley FJ, Cory J, Wallace C, Valvasori A, Brown N, Olsson CA, Wang Y, Goldfeld SR, Calder R, Lycett K
OBJECTIVES: To investigate how young people's experiences of recognition in learning influence their wellbeing and to identify practical strategies for a more holistic and equitable educational approach that values diver...OBJECTIVES: To investigate how young people's experiences of recognition in learning influence their wellbeing and to identify practical strategies for a more holistic and equitable educational approach that values diverse competencies beyond traditional academic measures. DESIGN: The project used a youth co-research and participatory design. Young people with recent experience of secondary education led the study alongside university and industry-based researchers. SETTING: Data were collected between 13 May and 27 June 2024, through five participatory workshops and 10 in-depth interviews, conducted online and in person. Workshops were conducted across four contexts: two school settings (one mainstream school, one flexible learning school), one university setting (with students admitted through non-Australian Tertiary Admission Rank pathways), and one online context. PARTICIPANTS: 60 young people aged 15-29 years from Tasmania, Victoria, South Australia and New South Wales. MAIN OUTCOME MEASURES: Subjective and qualitative expression of knowledge and skills, wellbeing, and social connection. RESULTS: Young people reported that the current education system values conformity over creativity and forces them to follow prescribed pathways through learning, rather than pursue interests, curiosities and passions. This contributes considerably to poor sense of self, heightened anxiety and stress. Comparatively, when young people experience broader forms of recognition, they have greater understanding of themselves, feel safe, are engaged, can identify knowledge and skills they have acquired, have developed social connections and have a sense of subjective wellbeing. Forms of broader recognition that acknowledge non-formal learning, adopt alternative assessment and credentialing, foster supportive relationships and assert a commitment to overcoming disadvantage are essential to educational experiences that promote wellbeing. CONCLUSIONS: Broader recognition of learning, through non-formal learning, trusted relationships, supportive environments and learner agency, strengthens wellbeing across three dimensions: knowledge and skills, subjective wellbeing, and social connection. Redefining success in education to include recognition of broader learning - shaped by learners and their contexts - can enhance engagement, improve outcomes, disrupt disadvantage, and support more equitable systems that promote wellbeing and lifelong learning.
OBJECTIVE: To explore how redesigning learner recognition systems can value First Nations students' diverse knowledges and skills, facilitating systemic educational reform aligned with Indigenous definitions of success,...OBJECTIVE: To explore how redesigning learner recognition systems can value First Nations students' diverse knowledges and skills, facilitating systemic educational reform aligned with Indigenous definitions of success, wellbeing, and sense of belonging. DESIGN: Social lab methods employing iterative co-design, guided by First Nations-led frameworks aligned with the United Nations Declaration on the Rights of Indigenous Peoples, ensuring community accountability and Indigenous self-determination. SETTING: This study was part of the Learner's Journey Social Lab facilitated by Learning Creates Australia, which was conducted from 1 October 2020 to 31 October 2021. The First Nations team was co-convened in partnership with the National Indigenous Youth Education Coalition. PARTICIPANTS: Seventy-two participants from First Nations communities, including students and young people (aged 14-25 years), educators, community representatives, allied health professionals, policy makers, and academics. PROCESS: Development of an Indigenous Nation-led learning charter model, informed by thematic analysis of interviews and a focus group exploring First Nations students' learning journeys, ambitions, and social and cultural determinants of wellbeing. VALUES: Recognition and validation of Indigenous learning journeys; alignment of educational practices with cultural determinants of social and emotional wellbeing through the development of an Indigenous Nation-led learning charter; and enhanced agency, belonging and First Nations-defined success in educational environments. RESULTS: The Indigenous Nation-led learning charter was developed to support student sense of belonging; facilitate wellbeing-centred relationships and partnerships between schools, communities, and custodians; and increase student engagement and agency through recognition of cultural, community, and identity-related learning. The charter model is supported and implemented through a place-based community of practice and learner wellbeing recognition tool. CONCLUSION: Centring Indigenous sovereignty, self-determination and wellbeing necessitates significant shifts in educational practice and relationships, ultimately supporting holistic learner success and community wellbeing.
OBJECTIVE: To examine the presentation, investigation, and clinical management of women diagnosed with endometriosis in Australian general practices during 2011-2021. STUDY DESIGN: Open cohort study; analysis of Medicine...OBJECTIVE: To examine the presentation, investigation, and clinical management of women diagnosed with endometriosis in Australian general practices during 2011-2021. STUDY DESIGN: Open cohort study; analysis of MedicineInsight data. SETTING, PARTICIPANTS: Women aged 14-49 years who were active patients at Australian general practices participating in MedicineInsight and were diagnosed with endometriosis at these practices, 1 January 2011 - 31 December 2021. MAIN OUTCOME MEASURES: The number of women with first documented diagnoses of endometriosis in general practices and the annual age-standardised prevalence; documented symptoms prior to documented endometriosis diagnosis; time from initial symptoms to diagnosis; general practitioner requests for diagnostic investigations and prescribing of medications. RESULTS: First diagnoses of endometriosis at their regular general practices were recorded for 19 786 women during 2011-2021; the annual age-standardised prevalence increased from 1.78 per 100 women in 2011 to 2.86 per 100 women in 2021. At least one symptom was documented prior to diagnosis for 13 202 women (66.7%), including 8073 (40.8%) with pelvic pain and 4371 (22.1%) with dysmenorrhea. The median time from first symptom documentation to first documented endometriosis diagnosis was 2.5 years (interquartile range, 0.9-5.6 years). The proportion of women for whom general practitioners requested pelvic ultrasound prior to diagnosis increased from 202 of 1068 of those diagnosed in 2011 (18.9%) to 1099 of 2259 women diagnosed in 2021 (48.6%). The proportions of women who received general practitioner prescriptions were larger during the five years after than the five years preceding endometriosis diagnoses for levonorgestrel intrauterine devices (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.36-1.65) and non-contraceptive progestogens (OR, 1.65; 95% CI, 1.51-1.81), and smaller for oral contraceptive pills (OR, 0.47; 95% CI, 0.45-0.50). The proportions of women prescribed opioids (OR, 1.35; 95% CI, 1.29-1.42), tricyclic antidepressants (OR, 1.93; 95% CI, 1.77-2.11), and gabapentinoids (OR, 2.60; 95% CI, 2.30-2.91) were also larger after endometriosis diagnoses; the proportion for each medication type was highest one year after diagnosis, but then declined. CONCLUSION: Our findings provide unique insights into the presentation and management of endometriosis in Australian general practice and could inform interventions for improving the clinical management of this often debilitating condition.
OBJECTIVES: To estimate the risk of death after hospitalisation with non-fatal intentional self-poisoning in New South Wales, and to estimate the associated number of years of life lost. STUDY DESIGN: Retrospective obser...OBJECTIVES: To estimate the risk of death after hospitalisation with non-fatal intentional self-poisoning in New South Wales, and to estimate the associated number of years of life lost. STUDY DESIGN: Retrospective observational study; analysis of Poisoning And enVenomation Linkage to evaluate Outcomes and clinical Variation in Australia (PAVLOVA) study data. SETTING, PARTICIPANTS: All index admissions to New South Wales public and private hospitals of people after non-fatal intentional self-poisoning (ie, were discharged from the index admission alive), 1 January 2011 - 30 September 2020. MAIN OUTCOME MEASURES: Standardised mortality ratio (compared with general population mortality rate; SMR), overall, and by cause of death (data available only for 2011-2018); years of life lost (YLL) overall, and by cause of death (2011-2018), age group, and sex. RESULTS: Index admissions of people with non-fatal intentional self-poisoning were identified for 48 951 people; their median age was 32.8 years (interquartile range [IQR], 20.8-47.5 years), 30 274 were girls or women (61.8%), and 3449 died during follow-up (median, 4.9 years; IQR, 2.7-7.3 years). The all-cause SMR was 3.1 (95% confidence interval [CI], 3.0-3.2); by cause of death, the SMR was highest for external cause deaths (16.8; 95% CI, 15.9-17.8), including accidental poisoning (30.3; 95% CI, 27.4-33.2) and suicide deaths (25.1; 95% CI, 23.2-27.1). Among natural causes of death, the SMR was highest for infectious and parasitic diseases (5.4; 95% CI, 3.9-6.8), digestive diseases (4.2; 95% CI, 3.4-5.0), and respiratory diseases (3.0; 95% CI, 2.5-3.4). The estimated overall premature mortality burden was 110 301.4 YLL; the median value per death was similar for women (31.1 YLL; IQR, 15.0-43.0 YLL) and men (33.2 YLL; IQR, 19.7-44.9 YLL). During 2011-2018, the total mortality burden was 79 821.6 YLL; by cause of death, the major contributors were deaths from suicide (26 945.2 YLL; 33.8%), accidental poisoning (17 436.1 YLL; 21.8%), other injuries (6026.8 YLL; 7.5%), and natural causes (29 413.5 years; 36.8%). CONCLUSIONS: The risk of death is markedly higher after hospitalisation with intentional self-poisoning than for the general population, but suicide deaths only cause about one-third of the mortality burden in terms of lost years of life; deaths from accidental poisoning and natural causes are also major contributors. Referrals to specialist psychiatric and physical health care and brief interventions for treating psychiatric and substance use conditions are appropriate after hospitalisation with intentional self-poisoning.
OBJECTIVE: To review reporting on a case series of "inpatient therapy" administered to pre-pubertal children presenting with gender expansive behaviours previously published in the MJA and to compare this reporting to th...OBJECTIVE: To review reporting on a case series of "inpatient therapy" administered to pre-pubertal children presenting with gender expansive behaviours previously published in the MJA and to compare this reporting to the adulthood recollections and past contemporaneous medical records of a person who had received such treatment. DESIGN: Retrospective analysis of autoethnography, archived mental health records, and patient details published in a 1987 MJA case series of eight children. SETTING: Stubbs Terrace Hospital, a Western Australian state-funded child and adolescent psychiatric hospital, no longer in operation. PARTICIPANT: Jayne McFadyen (J), a transgender woman whose recollections align with the clinical details supplied for Case 5 in the case series, and an author of this article. MAIN OUTCOME MEASURES: Concordance and discordance among details documented in the published case series, J's autoethnography of her hospital treatment, and archived childhood psychiatric records obtained through freedom of information. RESULTS: J's recollections align closely with details in the archived records. Both align with many, but not all, published details, most notably the following published statement: "No conscious attempt was made by the staff members to encourage masculine or feminine role behaviours." Some of the verified recollections are of psychologically coercive and aversive practices typical of sexual orientation and gender identity and expression change or suppression efforts (SOGICE). Despite inpatient treatment aimed at suppressing or changing her transgender identity and expression, J's sense of whom she understood herself to be remained steadfast. CONCLUSION: A retrospective review of "inpatient treatment" intended to re-direct gender expansive identity formation revealed pseudo-psychological strategies reliant on denial and repression. These were directed towards extinguishing childhood behaviours deemed to be socially undesirable. These practices are indistinguishable from the defining characteristics of suppression or change practices, or so-called "conversion therapy", seeking to achieve cisgender and heterosexual outcomes, efforts which are now known to be futile and harmful.