Zahra Ali Padhani

Background: Guidelines on pre‐pregnancy counselling are primarily clinical, and although recommendations and policy documents on preconception care exist in Australia, they place little or no emphasis on the preconception health of adolescents and young adults. Objective: To identify and prioritise unanswered questions and evidence uncertainties concerning preconception health needs of adolescents and young adults residing in Australia. Design: Research priority exercise. Setting and Participants: Participants included young interest‐holders (18–24 years) and professional interest‐holders from the academic, healthcare, policy, community and government sectors residing in Australia. Methods: James Lind Alliance (JLA) methodology was followed to identify research priorities for preconception health of adolescents and young adults. The process was led by a multidisciplinary steering committee comprising young interest‐holders and professional interest‐holders (including academics and clinicians). A rapid literature review was conducted, from which 80 research questions were developed across 10 domains, which were refined through consultation and prioritised via two rounds of online surveys on Qualtrics using a 9‐point Likert scale. Results: The participants included 14 young interest‐holders in each survey round, with 22 professional interest‐holders in the first round and 30 in the second. Participants from across Australia participated in the survey, but most were from South Australia. In the first survey round, 28 questions across seven domains were prioritised by both professional and young interest‐holders. This was followed by a reprioritisation exercise, resulting in the final top 10 research questions spanning five domains. The highest‐priority research questions identified by the interest‐holders concentrated in the domains of violence and mental health; early intervention and prevention; smoking, tobacco, alcohol, and substance use; access to preconception care and the healthcare system; and priority populations. Conclusion: The study identified the top 10 priority research questions informed by professional and young interest‐holders. It promotes new research and collaboration while offering guidance on future research investments and on designing preconception interventions for adolescents and young adults in Australia. Turning these priorities into research could improve the health outcomes for adolescents and their future generations.

Background: Adolescents in low- and middle-income countries face a disproportionate burden of dietary inadequacy, yet evidence on the determinants of overall diet quality remains scarce. This study assessed the prevalence of macro- and micronutrient inadequate intake and identified factors associated with dietary adequacy among adolescents in rural Pakistan. Methods: A cross-sectional survey was conducted among adolescents using multistage cluster sampling. Dietary intake was assessed through a single 24-h dietary recall; nutrient adequacy was determined using age-and sex-specific Dietary Reference Intake (DRI) standards, including Estimated Average Requirements (EARs), Adequate Intakes (AIs), Estimated Energy Requirements (EERs), and Acceptable Macronutrient Distribution Ranges (AMDRs), as appropriate. Overall dietary adequacy was quantified using the Mean Adequacy Ratio (MAR), calculated as the unweighted mean of nutrient adequacy ratios for fourteen nutrients, including protein, fiber, calcium, iron, zinc, thiamin, riboflavin, niacin, vitamins A, B6, C, D, E, and folate, scaled from 0 to 100. Multivariable linear regression incorporating survey weights and clustering was used to identify independent predictors of MAR using STATA. Results: A total of 1132 adolescents were included. Most of the energy was derived from carbohydrates, and a high proportion of adolescents had energy intakes below age- and sex-specific Estimated Energy Requirement (EER) values, while very high levels of inadequacies were observed for protein, fiber, calcium, vitamin D, and vitamin A. The mean MAR score was 54.04 ± 16.51, indicating overall poor dietary adequacy. In multivariable analysis, male sex (β = 3.26; 95% CI: 1.76, 4.75), belonging to the richest wealth quintile (β = 5.81; 95% CI: 1.76, 9.86), always eating between meals (β = 6.70; 95% CI: 3.93, 9.47), and use of bar soap for handwashing (β = 4.97; 95% CI: 2.00, 7.94) were significantly associated with higher dietary adequacy. Adolescents who were underweight (β = −2.40; 95% CI: −4.81, −0.11) and those with moderate physical activity levels (β = −3.96; 95% CI: −7.62, −0.29) had significantly lower dietary adequacy scores. Conclusions: Dietary inadequacy among rural adolescents in Pakistan was highly prevalent and was associated with socioeconomic, behavioral, and nutritional factors. These findings highlight the need for interventions that address food insecurity, promote equitable food distribution, and strengthen nutrition education to support adolescent health and nutrition. However, these findings should be interpreted in light of the cross-sectional design and the use of a single 24-h dietary recall, which may not reflect habitual dietary intake.

Worldwide, pneumonia, diarrhea, and malaria remain leading causes of death for children under the age of five, even though these diseases are preventable and can be treated. In public health, complex behavioral change interventions are often used. These interventions employ multi-component strategies and work on domains, such as education, policy, and environmental change, to promote prevention, control, and management of childhood diseases. In Tando Muhammad Khan (TMK), the Community Mobilization and Community Incentivization (CoMIC) trial employed a complex, participatory community engagement strategy and included conditional community-based incentives and showed promising results by improving child health related behaviors. A study was conducted to explore the experiences and perceptions of community members regarding the implementation and engagement processes of the CoMIC trial. A total of 13 IDIs and 16 FGDs were conducted to understand the factors behind the community engagement and behavior change that led to the success of the CoMIC trial and its adaptability for wider scale-up. The study identified four key motives for driving community engagement: egoism, altruism, collectivism, and principlism. The community’s close-knit social structure and shared sense of collective growth played a crucial role in encouraging participation and adapting to required behaviors. The trial focused on empowering the community by reinforcing health-seeking behaviors as a community responsibility, promoting cost-sharing to ensure long-term sustainability, and creating collective ownership through active community engagement and Conditional, Collective, Community-based Incentives (C3Is). By strengthening WASH and IYCF practices, increasing immunization uptake, promoting care-seeking behaviors, the intervention aimed to reduce the burden of childhood illnesses such as diarrhea, pneumonia, and malaria, ultimately improving child health outcomes.

Platelet-rich plasma (PRP) therapy is a non-invasive, autologous treatment with regenerative potential in gynaecology beyond fertility applications. This review evaluates PRP in non-fertility-related gynaecological conditions affecting women’s quality of life (QoL). Methods: Following PRISMA-ScR guidelines, we searched Embase, CINAHL, Web of Science, Scopus, CENTRAL, and MEDLINE for studies on PRP in conditions such as vulvar lichen sclerosus (VLS), vulvovaginal atrophy (VVA), sexual dysfunction (SD), stress urinary incontinence (SUI), and interstitial cystitis/bladder pain syndrome (IC/BPS). Of 3660 records screened, 43 studies (randomised controlled trials, quasi-experimental, cohort, and case series) were included. Results: PRP improved symptoms and QoL in several conditions, particularly VLS and SD, and was generally well tolerated with minor adverse effects (e.g., injection-site pain, transient discomfort). Evidence for abnormal uterine bleeding (AUB) and pelvic organ prolapse (POP) was inconclusive. Considerable heterogeneity in preparation protocols and outcome measures limited cross-study comparison. Conclusions: PRP shows promise as a minimally invasive therapy for certain gynaecological conditions. Standardisation of preparation and administration, along with large-scale RCTs, is needed to determine long-term efficacy and safety.

Introduction: Adolescents are considered the healthiest population of all age groups, yet they are vulnerable to illnesses and deaths from preventable causes. We aimed to investigate the burden of morbidity, mortality and risk factors for mortality among adolescents and young adults (10–24 years) in Australia compared with the Organisation for Economic Co-operation and Development (OECD) countries. Methods: We accessed the Global Burden of Disease (GBD) Study 2021 data for OECD countries, including Australia, between 2000 and 2021. Country and age-specific estimates with 95% uncertainty intervals were obtained from the GBD Compare and Results Tool for all-cause mortality and disability-adjusted life years (DALYs). The top 15 level 3 risk factors for mortality for adolescents and young adults were investigated, with rates reported per 100 000 population. Annualised rates of change (ARoC) in mortality and DALY rates were estimated using a log-linear model to quantify temporal trends between distinct time periods. Causes of death by age groups, sex and year for other diseases were measured using the Cause of Death Ensemble model. Results: Between 2000 and 2021, mortality rates in adolescents and young adults decreased in Australia and across OECD regions, with substantial reductions (47.1 in 2000 vs 27.9 in 2021) in Australia. DALYs decreased slightly (11 850.2 in 2000 vs 10 363.9 in 2021), ranking Australia eighth among OECD countries in 2021. The ARoC in Australia showed a decline in the rate of mortality and DALYs by 2.48% and 0.64%, respectively. Overall, OECD countries experienced a slower decline, with an ARoC of 0.92% for mortality and 0.04% for DALYs from 2000-2021. Young adults (20–24 years) had higher mortality and DALYs than other age groups. In 2021, males in Australia and OECD countries had higher mortality rates, while Australian females had more DALYs than males. Alcohol and drug use were the leading risk factors for death. Conclusion: Adolescent and young adult mortality in Australia has declined more than the OECD average, with minimal reduction in disease burden. Disparities in mortality rates and morbidity burden continue to grow across countries, age groups and genders due to the limited focus on males and young adults. This study calls for comprehensive health strategies that address these disparities to reduce the disease burden in young adults, specifically among males.

Migrants and refugees are among the most disadvantaged populations, with limited evidence on the access and uptake of COVID-19 vaccination among them. Therefore this qualitative study explores the behavioral and social drivers of the COVID-19 vaccine among the refugee and migrant population in Pakistan through in-depth interviews and focus group discussions with regular and irregular migrants and refugees residing in Pakistan. Key informant interviews were conducted with stakeholders responsible for overlooking the COVID-19 vaccination process. A total of 18 participants were interviewed to gather insights on COVID-19 vaccine access, uptake, and behaviours among migrants and refugees. Data was collection from June to July 2022, in Karachi, Hyderabad, and Quetta. All the interviews were audio recorded, transcribed, translated, and thematically analysed on Nvivo software. The study found that refugee and migrant communities in Pakistan faced significant challenges to COVID-19 vaccination uptake, with barriers including misconceptions about vaccine safety and efficacy, fears of side effects, and mistrust spread by religious leaders. Participants were refused vaccinations at many centers despite government directives allowing vaccines for those without Computerized National Identity Cards (CNIC). Limited outreach and awareness efforts from the government, fears of identification and deportation, long wait times at vaccination centers, and the absence of female vaccinators in communities with strict gender norms further hindered access. Many participants also reported being charged for vaccination leading to lower vaccine coverage. Despite these challenges, some individuals were motivated to vaccinate due to workplace requirements, peer influence, or personal health concerns. Facilitators included door-to-door vaccination campaigns and school vaccination mandates. Vaccination camps set up by NGOs and government agencies at border areas and migrant-rich districts facilitated access. The study suggests targeted strategies to improve vaccination coverage, including provision of identification documents to migrants, inclusion in policy, and enforcement of multilingual communication to improve healthcare access.