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The Future Healthy Countdown 2030 consensus statement: core policy actions and measures to achieve improvements in the health and wellbeing of children, young people and future generations. 2030 年未来健康倒计时共识声明:改善儿童、青年和后代健康与福祉的核心政策行动和措施。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-18 DOI: 10.5694/mja2.52494
Kate Lycett, Hannah Lane, Georgie Frykberg, Susan Maury, Carolyn Wallace, Luisa Taafua, Bernie Morris, Anne Hollonds, Pasi Sahlberg, Kevin Kapeke, Ngiare Brown, Jordan Cory, Peter D Sly, Craig A Olsson, Fiona J Stanley, Anna M H Price, Planning Saw, Khalid Muse, Peter S Azzopardi, Susan M Sawyer, Rebecca Glauert, Marketa Reeves, Roslyn Dundas, Sandro Demaio, Rosemary Calder, Sharon R Goldfeld

Introduction: This consensus statement recommends eight high-level trackable policy actions most likely to significantly improve health and wellbeing for children and young people by 2030. These policy actions include an overarching policy action and span seven interconnected domains that need to be adequately resourced for every young person to thrive: Material basics; Valued, loved and safe; Positive sense of identity and culture; Learning and employment pathways; Healthy; Participating; and Environments and sustainable futures.

Main recommendations: Provide financial support to invest in families with young children and address poverty and material deprivation in the first 2000 days of life. Establish a national investment fund to provide sustained, culturally relevant, maternal and child health and development home visiting services for the first 2000 days of life for all children facing structural disadvantage and/or adversity. Implement a dedicated funding model for Aboriginal and Torres Strait Islander community-controlled early years services across the country to ensure these services are fully resourced to provide quality early learning and integrated services grounded in culture and community. Properly fund public schools, starting by providing full and accountable Schooling Resource Standard funding for all schools, with immediate effect for schools in communities facing structural disadvantage. Establish legislation and regulation to protect children and young people aged under 18 years from the marketing of unhealthy and harmful products. Amend the electoral act to extend the compulsory voting age to 16 years. Legislate an immediate end to all new fossil fuel projects in Australia. Establish a federal Future Generations Commission with legislated powers to protect the interests of future generations.

Changes in approach as a result of this statement: Together, these achievable evidence-based policies would significantly improve children and young people's health and wellbeing by 2030, build a strong foundation for future generations, and provide co-benefits for all generations and society.

导言:本共识声明建议采取八项高级别可跟踪政策行动,这些行动最有可能在 2030 年之前显著改善儿童和青少年的健康和福祉。这些政策行动包括一项总体政策行动,涉及七个相互关联的领域,需要为每个青少年的茁壮成长提供充足的资源:物质基础;价值、爱和安全;积极的认同感和文化;学习和就业途径;健康;参与;以及环境和可持续的未来:提供财政支持,投资于有幼儿的家庭,解决生命最初 2000 天的贫困和物质匮乏问题。设立国家投资基金,为所有面临结构性不利因素和/或逆境的儿童提供持续的、与文化相关的母婴健康和发展家访服务。在全国范围内为土著居民和托雷斯海峡岛民社区控制的幼儿服务实施专门的资助模式,确保这些服务获得充足的资源,以提供基于文化和社区的优质早期学习和综合服务。为公立学校提供适当资金,首先为所有学校提供全额和负责任的 "学校教育资源标准"(Schooling Resource Standard)资金,对面临结构性不利条件的社区内的学校立即生效。制定法律法规,保护 18 岁以下儿童和青少年免受不健康和有害产品营销的影响。修订选举法,将义务投票年龄延长至 16 岁。立法规定立即停止澳大利亚所有新的化石燃料项目。成立联邦后代委员会,赋予其保护后代利益的法定权力:这些可实现的循证政策加在一起,将在 2030 年之前显著改善儿童和青少年的健康和福祉,为子孙后代打下坚实的基础,并为所有世代和社会带来共同利益。
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引用次数: 0
Out-of-hospital cardiac arrests in Victoria, 2003-2022: retrospective analysis of Victorian Ambulance Cardiac Arrest Registry data. 2003-2022 年维多利亚州院外心脏骤停事件:对维多利亚州救护车心脏骤停登记数据的回顾性分析。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-18 DOI: 10.5694/mja2.52532
Emily Nehme, David Anderson, Ross Salathiel, Anthony Carlyon, Dion Stub, Peter A Cameron, Andrew Wilson, Sile Smith, John J McNeil, Ziad Nehme

Objectives: To examine changes in out-of-hospital cardiac arrest (OHCA) characteristics and outcomes during 2003-2022, and 12-month outcomes for people who experienced OHCA during 1 January 2010 - 30 June 2022.

Study design: Retrospective observational study; analysis of Victorian Ambulance Cardiac Arrest Registry (VACAR) data.

Setting, participants: OHCA events in Victoria not witnessed by emergency medical services personnel, 1 January 2003 - 31 December 2022.

Main outcome measures: Crude and age-standardised annual OHCA incidence rates; survival to hospital discharge.

Results: Of 102 592 OHCA events included in our analysis, 67 756 were in men (66.3%). The age-standardised incidence did not change significantly across the study period (2003: 89.1 cases, 2022: 91.2 cases per 100 000 population; for trend: P = 0.50). The proportion of OHCA cases with attempted resuscitation by emergency medical services in which bystanders attempted cardio-pulmonary resuscitation increased from 40.3% in 2003/2004 to 72.2% in 2021/2022, and that of public access defibrillation from 0.9% to 16.1%. In the Utstein comparator group (witnessed OHCA events in which the initial cardiac rhythm was ventricular fibrillation or ventricular tachycardia, with attempted resuscitation by emergency medical services), the odds of survival to hospital discharge increased during 2003-2022 (adjusted odds ratio (aOR), 3.08; 95% confidence interval [CI], 2.22-4.27); however, the odds of survival was greater than in 2012 only in 2018 (aOR, 1.37; 95% CI, 1.04-1.80) and 2019 (aOR, 1.68; 95% CI, 1.28-2.21). The COVID-19 pandemic was associated with reduced odds of survival (aOR, 0.63; 95% CI, 0.54-0.74). Of 3161 people who survived OHCA and participated in 12-month follow-up, 1218 (38.5%) reported full health according to the EQ-5D.

Conclusion: Utstein survival to hospital discharge increased threefold during 2003-2022, and the proportions of cases in which bystanders provided cardio-pulmonary resuscitation or public access defibrillation increased. The COVID-19 pandemic was associated with a substantial reduction in survival, and new strategies are needed to improve outcomes.

研究目的研究设计:回顾性观察研究;分析维多利亚州救护车心脏骤停登记处(VACAR)数据:回顾性观察研究;分析维多利亚州救护车心脏骤停登记处(VACAR)数据:主要结果测量指标:主要结果测量指标:粗略和年龄标准化的 OHCA 年度发病率;出院后的存活率:在我们分析的 102 592 例 OHCA 事件中,67 756 例为男性(66.3%)。在整个研究期间,年龄标准化发病率变化不大(2003 年:每 10 万人 89.1 例,2022 年:每 10 万人 91.2 例;趋势:P = 0.50):P = 0.50).旁观者尝试心肺复苏的 OHCA 病例比例从 2003/2004 年的 40.3% 增加到 2021/2022 年的 72.2%,公共场所除颤的比例从 0.9% 增加到 16.1%。在乌特施泰因参照组(初始心律为心室颤动或室性心动过速,并尝试过急救服务复苏的目击型 OHCA 事件)中,2003-2022 年期间出院后存活的几率有所上升(调整后的几率比(aOR),3.08;95% 置信区间[CI],2.22-4.27);然而,只有在 2018 年(aOR,1.37;95% CI,1.04-1.80)和 2019 年(aOR,1.68;95% CI,1.28-2.21)的存活几率大于 2012 年。COVID-19 大流行与存活几率降低有关(aOR,0.63;95% CI,0.54-0.74)。在3161名OHCA幸存者中,有1218人(38.5%)接受了为期12个月的随访,根据EQ-5D报告,他们完全健康:结论:2003-2022 年间,乌特斯坦患者出院后的存活率增加了三倍,旁观者提供心肺复苏或公共除颤的病例比例也有所增加。COVID-19大流行导致存活率大幅下降,因此需要新的策略来改善结果。
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引用次数: 0
Scabies: a clinical update. 疥疮:临床更新。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-18 Epub Date: 2024-10-25 DOI: 10.5694/mja2.52505
Laxmi Iyengar, Alvin H Chong, Andrew C Steer

Scabies is the most common neglected tropical disease with cutaneous manifestations, disproportionately affecting socially disadvantaged populations living in overcrowded settings. Scabies infestation is characterised by a generalised intractable pruritus, and is often complicated by secondary bacterial infection, which can lead to a range of complications. Scabies is a clinical diagnosis and requires an adequate degree of suspicion. The use of dermoscopy may improve diagnostic accuracy. In Australia, the first-line treatment recommended for scabies is topical permethrin 5% cream, applied to the whole body and repeated in one week. Oral ivermectin is subsidised by the Pharmaceutical Benefits Scheme with streamlined authority for patients who have completed and failed treatment with topical therapy, have a contraindication to topical treatment or have crusted scabies. Early identification and prompt initiation of treatment is key to minimise the disease burden of scabies.

疥疮是最常见的被忽视的热带疾病,以皮肤表现为主,严重影响生活在拥挤环境中的社会弱势群体。疥虫感染的特点是全身性难治性瘙痒,通常会继发细菌感染,从而导致一系列并发症。疥疮是一种临床诊断,需要充分的怀疑。使用皮肤镜可以提高诊断的准确性。在澳大利亚,推荐的疥疮一线治疗方法是外用 5%氯菊酯乳膏,涂抹全身,一周后重复使用。口服伊维菌素由 "药品福利计划"(Pharmaceutical Benefits Scheme)提供补贴,对于已完成局部治疗但治疗失败、有局部治疗禁忌症或疥疮结痂的患者,可简化审批。早期识别和及时开始治疗是将疥疮疾病负担降至最低的关键。
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引用次数: 0
Erratum. 勘误。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-18 DOI: 10.5694/mja2.52534
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引用次数: 0
The equitable challenges to quality use of modulators for cystic fibrosis in Australia. 澳大利亚在高质量使用囊性纤维化调节剂方面面临的公平挑战。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-18 DOI: 10.5694/mja2.52527
Laura K Fawcett, Shafagh A Waters, Adam Jaffe
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引用次数: 0
Participation of Indigenous children and young people to improve health and wellbeing 土著儿童和青年参与改善健康和福祉。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-17 DOI: 10.5694/mja2.52490
Jordan Cory (Kamilaroi), Hope Kuchel (Barkindji), Bonnie Dukakis (Gunditjmara), Rhian Dicker (Palawa), Sandra Eades (Noongar)
<p>Participation is widely recognised as a determinant of children and young people's health.<span><sup>1</sup></span> Both the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) (Article 18) and the Convention on the Rights of the Child (Article 12) enshrine participation as an inalienable right.<span><sup>2, 3</sup></span> Despite this, the exclusion and non-participation of Indigenous children, adolescents and young people persists.<span><sup>4</sup></span></p><p>Indigenous children and young people experience worse health outcomes than their non-Indigenous peers and are starkly over-represented in the contact with youth justice and in out-of-home care.<span><sup>5-7</sup></span> We propose this is in part due to their exclusion and non-participation — both as children and as Indigenous people.<span><sup>4, 5, 7</sup></span> These children and young people's stories are often told for them, if at all.<span><sup>4</sup></span> “It didn't matter what I screamed at (Child Protection Services), they wanted to tell my story for me, decide for me, know what was best for me. That's easier than listening, isn't it?”, said one Indigenous young person in contact with the youth justice system.<span><sup>6</sup></span></p><p>Indigenous young people are less likely to access primary health services despite having more health needs than non-Indigenous counterparts.<span><sup>8</sup></span> Most children and young people in the youth justice system have severe neurodevelopmental disorders — nearly all previously undiagnosed and untreated.<span><sup>9</sup></span> Current mainstream health and youth services are failing to provide culturally safe rudimentary services and meet Indigenous children and young people's unique needs.<span><sup>5, 7, 8, 10</sup></span> They have not been designed with meaningful participation of Indigenous people, let alone children and young people.<span><sup>5, 8</sup></span> There is an urgency for meaningful participation of Indigenous children and young people in reform.<span><sup>4, 7, 8</sup></span> There is an urgency for decision makers to listen and act.<span><sup>4, 5, 7, 8</sup></span></p><p>Best-practice mechanisms like the case study provided in this article, the Victorian based youth-led, Indigenous-led Koorie Youth Council, which centres self-determination, can ensure that Indigenous children and young people are empowered.<span><sup>4</sup></span> This article is part of the 2024 <i>MJA</i> supplement for the Future Healthy Countdown 2030, which examines how participating affects the health and wellbeing of children, young people and future generations. Society must not only uphold Indigenous children and young people's rights, but also value their strengths and the expertise they hold about their own lives.<span><sup>4, 5, 7, 8, 11</sup></span></p><p>Participation is not a binary, it exists on a spectrum indicating the degree of agency afforded to individuals or groups to relationally determine
1 《联合国土著人民权利宣言》(UNDRIP)(第 18 条)和《儿童权利公约》(第 12 条)都将参与视为一项不可剥夺的权利。2, 3 尽管如此,土著儿童、青少年和年轻人被排斥和不参与的现象依然存在。4 与非土著同龄人相比,土著儿童和青少年的健康状况更差,与青少年司法机构接触和接受家庭外照料的人数明显过多。5-7 我们认为,部分原因在于他们作为儿童和土著人被排斥和不参与、4 "我对(儿童保护服务机构)大喊大叫并不重要,他们想替我讲述我的故事,替我做决定,知道什么对我最好。6 尽管土著青少年比非土著青少年有更多的健康需求,但他们获得初级医疗服务的可能性较低。8 青少年司法系统中的大多数儿童和青少年都有严重的神经发育障碍--几乎所有的人以前都未被诊断和治疗。目前的主流保健和青年服务未能提供文化上安全的基本服务,也未能满足土著儿童和青 年的独特需求、8当务之急是让土著儿童和青年切实参与改革。4、5、7、8当务之急是让决策者倾听并采取行动。4、5、7、8最佳实践机制,如本文提供的案例研究--以维多利亚州青年为基础、以土著为主导、以自决为中心的 Koorie 青年理事会--可以确保土著儿童和青年获得权力。本文是 2024 年 MJA 为《2030 年未来健康倒计时》(Future Healthy Countdown 2030)所做补充的一部分。社会不仅要维护土著儿童和青少年的权利,还要重视他们的力量以及他们对自己生活所掌握的专业知识。参与不是二元对立的,它存在于一个范围内,表明赋予个人或群体以关系决定结果的代理程度。12 1992 年,哈特对阿恩斯坦的参与阶梯进行了改编,承认成人是儿童和青少年的关系 权力持有者。15 从发展的角度看,参与也使儿童和青少年有机会实践代理权、评估关系 权力动态并邀请他人参与共同事业、16 土著人的健康概念本质上是关系性的,不仅包括以人类为中心的与家庭、亲属和社 区的关系,还包括与历史、国家、土地、精神和文化的关系。儿童和青少年并不是孤立存在的,正如布朗芬布伦纳的生态模型所描述的,他们受到周围环境的影响(方框 2)。20 参与,或儿童和青少年在生态系统中的关系代理,是土著健康的一个关键决定因素。这是许多主流青年社会和健康框架的共同点,令人遗憾。16, 21, 22 这些框架通常没有经过跨文化发展或测试,不适合土著环境,而且无论意图如何,都可能造成伤害、22 有鉴于此,毛利学者图希瓦伊-史密斯(Tuhiwai Smith)向学者和临床医 生提出挑战,要求他们对方法论进行去殖民化。
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引用次数: 0
Management of people after stroke in 383 Victorian general practices, 2014–2018: analysis of linked stroke registry and general practice data 2014-2018 年维多利亚州 383 家全科诊所对中风患者的管理:中风登记和全科诊所关联数据分析。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-17 DOI: 10.5694/mja2.52511
Muideen T Olaiya, Joosup Kim, Christopher Pearce, Kiran Bam, Dominique A Cadilhac, Nadine E Andrew, Lauren M Sanders, Amanda G Thrift, Mark R Nelson, Seana Gall, Monique F Kilkenny
<div> <section> <h3> Objective</h3> <p>To evaluate the management in Victorian general practice of people who have been hospitalised with stroke or transient ischaemic attacks (TIA).</p> </section> <section> <h3> Study design</h3> <p>Retrospective observational study; analysis of linked Australian Stroke Clinical Registry (AuSCR) and general practice data.</p> </section> <section> <h3> Setting</h3> <p>383 general practices in the Eastern Melbourne, South Eastern Melbourne, and Gippsland primary health networks (Victoria), 1 January 2014 – 31 December 2018.</p> </section> <section> <h3> Participants</h3> <p>Adults who had been hospitalised with acute stroke or TIA and had at least two encounters with the same general practice during the observation period (7–18 months after the acute event).</p> </section> <section> <h3> Main outcome measures</h3> <p>Assessment of cardiometabolic risk factors (blood pressure, serum lipids, blood glucose, urinary protein); prescribing of guideline-recommended prevention medications (blood pressure-, lipid-, or glucose-lowering, antithrombotic agents); attainment of guideline targets for cardiometabolic risk factors at final assessment during observation period.</p> </section> <section> <h3> Results</h3> <p>During 2014–2018, 3376 eligible AuSCR registrants (1465 women, 43.4%) had at least two encounters with one of the 383 general practices during the observation period; median age at stroke onset was 73.9 (interquartile range, 64.4–81.9) years, 737 events were TIAs (21.8%). Blood pressure was assessed in 2718 patients (80.5%), serum lipids in 1830 (54.2%), blood glucose in 1708 (50.6%). Prevention medications were prescribed for 2949 patients (87.4%), including lipid-lowering (2427, 71.9%) and blood pressure-lowering agents (2363, 70.0%). Blood glucose targets had been achieved by 1346 of 1708 patients assessed for this risk factor (78.8%), blood pressure targets by 1935 of 2717 (71.2%), and serum lipid targets by 765 of 1830 (41.8%). The incidence of having risk factors assessed was lower among patients aged 60 years or younger (incidence rate ratio [IRR], 0.97; 95% confidence interval [CI], 0.92–1.03) and those over 80 years of age (IRR, 0.92; 95% CI 0.88–0.97) than for those aged 61–80 years, and for women (IRR, 0.91; 95% CI, 0.87–0.95) and people with dementia (IRR, 0.89; 95% CI, 0.81–0.98). The likelihood of hav
目的:评估维多利亚州全科医生对中风或短暂性脑缺血发作(TIA)住院患者的管理:评估维多利亚州全科医生对中风或短暂性脑缺血发作(TIA)住院患者的管理情况:研究设计:回顾性观察研究;分析关联的澳大利亚中风临床登记处(AuSCR)和全科医生数据:2014年1月1日至2018年12月31日,墨尔本东部、墨尔本东南部和吉普斯兰初级医疗网络(维多利亚州)的383家全科诊所:曾因急性中风或 TIA 住院治疗,且在观察期间(急性事件发生后 7-18 个月)至少在同一全科诊所就诊两次的成年人:评估心脏代谢风险因素(血压、血脂、血糖、尿蛋白);开具指南推荐的预防药物(降压药、降脂药或降糖药、抗血栓药);在观察期内的最终评估中达到心脏代谢风险因素的指南目标:2014-2018年期间,3376名符合条件的AuSCR注册者(1465名女性,43.4%)在观察期内与383家全科诊所中的一家至少有过两次会面;中风发病时的中位年龄为73.9(四分位间范围为64.4-81.9)岁,737起事件为TIA(21.8%)。2718 名患者(80.5%)接受了血压评估,1830 名患者(54.2%)接受了血脂评估,1708 名患者(50.6%)接受了血糖评估。为 2949 名患者(87.4%)开具了预防药物处方,包括降脂药(2427 人,71.9%)和降压药(2363 人,70.0%)。在因这一风险因素而接受评估的 1708 名患者中,有 1346 人(78.8%)达到了血糖目标;在 2717 名患者中,有 1935 人(71.2%)达到了血压目标;在 1830 名患者中,有 765 人(41.8%)达到了血脂目标。60 岁或以下患者(发病率比 [IRR],0.97;95% 置信区间 [CI],0.92-1.03)和 80 岁以上患者(发病率比 [IRR],0.92;95% 置信区间 [CI],0.88-0.97)接受风险因素评估的几率低于 61-80 岁患者,也低于女性(发病率比 [IRR],0.91;95% 置信区间 [CI],0.87-0.95)和痴呆患者(发病率比 [IRR],0.89;95% 置信区间 [CI],0.81-0.98)。与 61-80 岁的患者相比,60 岁及以下(IRR,0.92;95% CI,0.88-0.97)和 80 岁以上(IRR,0.96;95% CI,0.92-0.997)的患者以及女性(IRR,0.95;95% CI,0.91-0.98)和痴呆症患者(IRR,0.88;95% CI,0.78-0.98)接受预防药物治疗的可能性较低:全科医生对中风或 TIA 住院患者的管理有待改进。结论:全科医生对中风或 TIA 住院患者的管理有待改进。有效监测心脏代谢风险因素将使全科医生能够优化对需要仔细关注的患者的护理,以防止不良继发事件的发生。
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引用次数: 0
Intergenerational equity and the health of Australia's young people 代际公平与澳大利亚年轻人的健康。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-17 DOI: 10.5694/mja2.52515
Elizabeth Zuccala, Michael Skilton
<p>Decades of public health research have taught us that childhood and adolescence are a critical window for investing in the health of populations. Simply put, ensuring young people have a safe and healthy start to life pays dividends across the life course for individuals, their families, and communities. Despite this knowledge, Australia's children and adolescents continue to face enormous threats to their lifelong health and wellbeing. From growing inequality and declining standards of living to the climate crisis and environmental degradation, to conflict, violence and growing mistrust in our institutions and political processes, it is young people who will bear the greatest burden of the most pressing social and economic challenges of our time. Given the central role that the health sector has in responding to and meeting these challenges, this issue of the <i>MJA</i> is dedicated to child and adolescent health.</p><p>The Future Healthy Countdown 2030 aims to drive systemic changes to Australia's policy environments to improve the health and wellbeing of young people and future generations. The second annual series of Countdown articles appears in a supplement to this issue of the <i>MJA</i> (https://www.mja.com.au/journal/2024/221/10/supplement). Building on the breadth of existing work by advocates and experts, the capstone article in the supplement, by Lycett and colleagues (https://doi.org/10.5694/mja2.52494), reports on development of eight policy actions that are most likely to substantially improve health and wellbeing for children and young people by 2030. The authors recommend that Australia: establish a federal Future Generations Commission; address poverty and material deprivation in the first 2000 days of life; expand access to maternal and child health and development home visiting services; implement a dedicated funding model for Aboriginal and Torres Strait Islander community-controlled early years services; properly fund public schools; protect children from the marketing of unhealthy and harmful products; lower the voting age to 16 years; and immediately end all new fossil fuel projects. In recognition of the fact that young people are experts on their own lives and needs, five subsequent articles in the supplement take a deep dive into the importance of young peoples’ meaningful participation in decision-making initiatives, both within and beyond the health sector, to support their health and wellbeing.</p><p>The tendency of adults to make decisions about young people without genuine consideration of their views and preferences is highlighted by the current debate about social media and the merits of age-based restrictions. The relative harms and benefits of social media for the mental health and wellbeing of children and adolescents, including appropriate policy responses, is a valid and important issue. Yet too often, public and political discourse reduces nuanced and at times conflicting evidence to black-and-white judg
数十年的公共卫生研究告诉我们,儿童和青少年时期是投资于人口健康的关键窗口期。简而言之,确保青少年有一个安全健康的人生开端,对个人、家庭和社区的一生都大有裨益。尽管如此,澳大利亚儿童和青少年的终生健康和福祉仍然面临着巨大的威胁。从日益加剧的不平等和生活水平的下降,到气候危机和环境恶化,再到冲突、暴力以及对我们的机构和政治进程日益增长的不信任,我们这个时代最紧迫的社会和经济挑战将由年轻人来承担。鉴于卫生部门在应对和迎接这些挑战方面所发挥的核心作用,本期《未来健康倒计时2030》(The Future Healthy Countdown 2030)将专门讨论儿童和青少年的健康问题,旨在推动澳大利亚政策环境的系统性变革,以改善青少年和子孙后代的健康和福祉。第二期年度倒计时系列文章刊登在本期MJA的增刊上(https://www.mja.com.au/journal/2024/221/10/supplement)。在倡导者和专家现有工作的广泛基础上,Lycett 及其同事 (https://doi.org/10.5694/mja2.52494) 在增刊中撰写了顶点文章,报告了到 2030 年最有可能大幅改善儿童和青少年健康与福祉的八项政策行动的发展情况。作者建议澳大利亚:成立联邦后代委员会;解决生命最初2000天的贫困和物质匮乏问题;扩大母婴健康和发展家访服务的覆盖面;为土著居民和托雷斯海峡岛民社区控制的幼儿服务实施专门的资助模式;为公立学校提供适当的资金;保护儿童免受不健康和有害产品营销的影响;将投票年龄降至16岁;立即停止所有新的化石燃料项目。认识到年轻人是自己生活和需求的专家这一事实,本增刊随后的五篇文章深入探讨了年轻人有意义地参与卫生部门内外的决策行动以支持其健康和福祉的重要性。社交媒体对儿童和青少年心理健康和幸福的相对危害和益处,包括适当的政策应对措施,是一个有效而重要的问题。然而,公共和政治讨论往往将细微的、有时是相互矛盾的证据简化为非黑即白的判断。克里斯滕森及其同事 (https://doi.org/10.5694/mja2.52503) 在一篇观点文章中,深思熟虑地研究了青少年使用社交媒体与自残和自杀之间的潜在关系。他们得出结论认为,因果关系的证据不足,"限制社交媒体可能会产生有害影响",并提出了更好地理解和解决这一问题的建议。Watkeys及其同事(https://doi.org/10.5694/mja2.52498)报告了新南威尔士州的调查结果,即26.9%的儿童在15岁生日之前使用过医疗保险补贴的心理健康服务,有证据表明在获得医疗服务方面存在与社会经济地位和地理位置相关的不平等现象。贾德及其同事(https://doi.org/10.5694/mja2.52489)指出,在南澳大利亚州,3.2%的青少年在 12 至 17 岁期间因精神健康相关诊断而住院治疗。这与他们早年(0-11 岁)与儿童保护系统的接触程度有明显的不同,在 12-17 岁因精神疾病住院的青少年中,约有 45% 曾与儿童保护服务机构有过接触。这就强调了对因精神健康状况而住院的青少年采取创伤知情方法的重要性。除精神健康外,本期还收录了有关各种主题的有见地的文章,包括土著居民和托雷斯海峡岛民青少年初级卫生保健模式(https://doi.org/10.5694/mja2.52484)、澳大利亚脑瘫患病率的变化(https://doi.org/10.5694/mja2.52487)、变性青少年的福利保障(https://doi.org/10.5694/mja2.52504)以及儿科脑癌的临床试验(https://doi.org/10.5694/mja2.52506)。我们希望您在阅读本期主题刊物时能和我们一样享受策划的乐趣。
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引用次数: 0
Guidelines for the design and implementation of youth participation initiatives to safeguard mental health and wellbeing 设计和实施青年参与活动以保障心理健康和幸福的指导原则。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-17 DOI: 10.5694/mja2.52485
Kailin Guo, Danica Meas, Dominik Mautner, Fulin Yan, Imeelya Al-Hadaya, Amarina Donohoe-Bales, Lily Teesson, Stephanie R Partridge, Magenta B Simmons, Mariam Mandoh, Emma L Barrett, Maree R Teesson, Scarlett Smout, Marlee Bower

Introduction

Worldwide, young people are increasingly engaged in participation and decision-making initiatives regarding issues that affect their lives through advisory groups, representative councils, advocacy and activism. Emerging evidence suggests that these initiatives may have an impact on the mental health and wellbeing of the youth involved. These guidelines, which are based on a scoping review of global evidence and led by a youth advisory group with lived experience of participation initiatives, summarise evidence-based recommendations for designing and implementing youth participation initiatives that protect the mental health and wellbeing of the young people involved. Development of these guidelines followed methods outlined by the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument and the strength of the evidence behind each recommendation was aligned with the National Health and Medical Research Council Levels of Evidence and recommendation grading system.

Main recommendations

The guidelines include 20 recommendations and three good practice recommendations, addressing the following areas:
  • prioritising clear and respectful communication;
  • creating safe and flexible practices for young people;
  • facilitating social and emotional support;
  • empowering young people to participate in meaningful and impactful ways; and
  • supporting young people to develop skills.

Changes in approach as a result of the guidelines

These guidelines are expected to provide cross-sectoral, global groups with the confidence to design and implement youth participation initiatives, using the best-available evidence, in ways that safeguard the mental health of the participating young people.

导言:在世界范围内,越来越多的年轻人通过咨询小组、代表理事会、宣传和行动主义,参与到影响其生活的问题的参与和决策行动中来。新的证据表明,这些活动可能会对参与其中的青少年的心理健康和幸福产生影响。这些指南是在对全球证据进行范围审查的基础上制定的,并由一个具有参与活动经验的青年咨询小组牵头,总结了在设计和实施青年参与活动时以证据为基础的建议,以保护参与活动的青少年的心理健康和幸福。这些指南的制定遵循了研究与评估指南评估(AGREE)工具所规定的方法,每项建议背后的证据强度都与国家健康与医学研究委员会的证据等级和建议分级系统相一致:指导方针包括 20 项建议和 3 项良好实践建议,涉及以下领域:优先考虑清晰和相互尊重的沟通;为年轻人创造安全和灵活的实践;促进社会和情感支持;增强年轻人以有意义和有影响的方式参与的能力;以及支持年轻人发展技能:这些指导原则有望为跨部门的全球性团体提供信心,使其能够利用现有的最佳证据,以保 障参与青年心理健康的方式设计和实施青年参与活动。
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引用次数: 0
Co-designing integrated child and family hubs for families experiencing adversity 为遭遇逆境的家庭共同设计儿童与家庭综合中心。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-17 DOI: 10.5694/mja2.52486
Alicia Montgomery, Suzy Honniset, Teresa Hall, Santuri Rungan, Ally Drinkwater, Rebecca Bosward, Tammy Meyers Morris, Huei Ming Liu, Valsamma Eapen, John Eastwood, Raghu Lingam, Harriet Hiscock, Susan Woolfenden, Sharon R Goldfeld
<p>There is increasing interest internationally in the potential for integrated care hubs to improve mental health outcomes for children experiencing adversity.<span><sup>1</sup></span> Termed “child and family hubs” throughout this article, these hubs refer to collaborative initiatives integrating health, education and/or social care, typically in one site. In Australia, the 2020 Productivity Commission Mental Health Inquiry identified the need for significant reform, including focus on early intervention and person-centred care in childhood and adolescence, to address the shortcomings of siloed national mental health care systems and to increase accessibility of care for families at greatest risk of experiencing adversity.<span><sup>2</sup></span> Childhood adversity is a broad term used to describe negative early life experiences and circumstances, such as socio-economic disadvantage, abuse, neglect, family violence, parental mental illness, bullying and discrimination.<span><sup>3, 4</sup></span> The cumulative and negative impacts of childhood adversity on intergenerational health and wellbeing are significant, and necessitate a multisectoral response.<span><sup>5</sup></span> This article is part of the 2024 <i>MJA</i> supplement for the Future Healthy Countdown 2030,<span><sup>6</sup></span> which examines how participating affects the health and wellbeing of children, young people and future generations. We look at this from the perspective of a public community paediatric service in metropolitan Sydney, involved in co-designing child and family hubs to deliver health services to families experiencing adversity.</p><p>There are currently over 460 Australian child and family hubs that focus on building connections between existing services to create a “one-stop shop” for families seeking support in relation to health, development and wellbeing.<span><sup>7, 8</sup></span> Although organisational adaptation varies by context (Box 1), several core components of child and family hubs can be identified. These include co-design of hub components with families, non-stigmatising entry, family-centred care, parental capacity building, co-location of services, workforce development, and local leadership.<span><sup>9</sup></span></p><p>To best respond to the needs of local communities, a robust co-design of child and family hubs should involve people with lived and professional experience of health and social care service utilisation and provision. Co-design is a method on the continuum of participatory approaches to service development and evaluation, which are essential for preventing services that fail to engage vulnerable families by not meeting their needs, or by failing to optimise cultural safety.<span><sup>10</sup></span> We define co-design as the “active involvement of a diverse range of participants in exploring, developing, and testing responses to shared challenges”.<span><sup>11</sup></span> Given the increase in utilisation of co-desi
通过相称的普遍性方法18 ,电子枢纽将寻求以最终用户所需的规模和强度提供普遍服务(方框 4)。参与该倡议的许多合作者都参与了温德姆谷(Wyndham Vale)和马里克维尔(Marrickville)儿童与家庭中心的实施和评估。这些地点以及新南威尔士州费尔菲尔德(Fairfield)的第三个地点已被选为电子枢纽的测试地点。以学校为基础的枢纽在全球拥有不断扩大的证据基础,是儿童和家庭获得医疗服务的熟悉而方便的地点。由于社区成员希望通过设在学校的综合 "一站式服务点 "获得医疗服务,因此在南澳大利亚州立卫生署(SLHD)建立了一个校本综合护理试点项目。Yudi Gunyi 学校是一所专门的中学,招收有挑战行为的学生,这些学生无法进入主流学校学习。在这所学校里,Ngaramadhi Space 护理模式是与原住民社区共同设计的,历时十年,旨在提供以儿童和家庭为中心的多学科整体护理(方框 5)。本文介绍了在三种情况下(医疗、教育和数字环境)共同设计儿童与家庭中心的集体经验,其中强调了几项关键经验。在所述的所有中心中,有逆境儿童的家庭都表示需要服务导航和家庭整体支持方面的帮助。尽管这些原则在各中心的实施情况不尽相同,但有逆境生活经历的利益相关者都表示,他们参与服务设计和实施过程非常重要。本文中描述的案例表明,有逆境家庭参与的共同设计是可能的,但具有挑战性。温德姆谷(Wyndham Vale)和马里克维尔(Marrickville)的儿童与家庭中心的共同设计遵循了一个明确的理论框架内的分阶段方法。对儿童和家庭中心的正式评估正在进行中,但对温德姆谷采用的共同设计过程的稳健方法的价值进行了专门评估,使用的是公众和患者参与评估工具(PPEET)32 。人们发现,不同背景的共同设计参与者从合作以产生相互学习的过程中获得了满足感,并认为该过程增加了当地对中心的信任和所有权。在共同设计 "Ngaramadhi 空间 "校本中心的过程中,信任和社区自主权的重要性得到了重 申。该计划的社区驱动性质意味着,在研究框架内,行动(即对高需求学生的紧急评估)优先于正式的共同设计。通过倾听社区的声音,采取循序渐进的实施方法,我们努力赢得社区、学生和家庭的信任。随着信任度的提高,我们制定了让家庭参与模式改进的措施;例如,消费者满意度调查和获得伦理批准的正式定性研究评估。9 与社区建立信任和根深蒂固的联系的过程历时数年,随着时间的推移,社区利益相关者和服务提供者都发生了变化,这一过程仍在继续。这里介绍的以健康为基础的中心和 eHub 表明这是可以实现的,而 Ngaramadhi 空间的经验则表明了社区代表的重要性,在这种情况下,非常重要的护理需求阻碍了照顾者直接参与共同设计。正如温德姆谷儿童与家庭中心(Wyndham Vale Child and Family Hub)的发展所表明的那样,儿童和年轻人可以直接参与为经历逆境的家庭提供服务的共同设计。然而,在这种情况下,儿童与成人之间的权力差异会被放大,因此必须采取反思性的方法。必须考虑到与儿童发展年龄相适应的沟通方式和适合儿童的环境。正如温德姆谷中心(Wyndham Vale hub)所展示的那样,涉及参与性艺术活动的创造性方法可能会很有用。
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Medical Journal of Australia
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