ARC Centre of Excellence for Environmental Decisions

BackgroundEating disorders can place an individual at significant risk of physical harm. Despite this, there is minimal guidance on how to empower individuals to recognise and minimise potential harms to their physical safety. This paper explores the recommendation to incorporate harm reduction strategies within eating disorders care by an eating disorder consultation service to clinicians working with individuals who have eating disorders. The aim of this paper was to examine how often, and in what contexts, HR approaches were deemed applicable during eating disorder specific public mental health case consultations.MethodsAdult case consultation records from an eating disorder consultation service in Australia were retrospectively analysed to examine the frequency at which harm reduction approaches were considered applicable to the consultation question. Content analysis was performed to examine the context in which the potential utility of harm reduction was discussed.ResultsOut of 45 adult secondary case consultation records accessed, almost three-quarters reported that a harm reduction framework was discussed as part of the secondary consultation. Content analyses revealed that 33.33% of consultations recommended harm reduction in the context of treatment engagement, 21.21% in the context of treatment ambivalence, and 45.45% in the context of concerns for physical safety whilst an individual was engaged in eating disorders care.ConclusionsOur results give preliminary indication that harm reduction approaches may have utility in supporting individuals with eating disorders to reduce their risk of physical harm across the spectrum of motivation and treatment engagement. Given the high incidence of physical harms associated with eating disorders, further studies examining the application and effectiveness of harm reduction approaches for eating disorders would likely be of benefit to the field.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40337-025-01426-4.

The approval process for pharmaceuticals has always included a consideration of the trade-offs between benefits and risks. Until recently, these trade-offs have been made in panel discussions without using a decision model to explicitly consider what these trade-offs might be. Recently, the EMA and the FDA have embraced Multi-Criteria Decision Analysis (MCDA) as a methodology for making approval decisions. MCDA offers an approach for improving the quality of these decisions and, in particular, by using quantitative and qualitative data in a structured decision model to make trade-offs in a logical, transparent and auditable way. This paper will review the recent use of MCDA by the FDA and EMA and recommend its wider adoption by other National Regulatory Authorities (NRAs) and the pharmaceutical industry.

To assess long term survival and patient characteristics associated with survival following acute myocardial infarction (AMI) in Australia and New Zealand. Cohort study. All patients admitted with AMI (ICD-10-AM codes I21.0-I21.4) to all public and most private hospitals in Australia and New Zealand during 2009-2015. All-cause mortality up to seven years after an AMI. 239402 initial admissions with AMI were identified; the mean age of the patients was 69.3 years (SD, 14.3 years), 154287 were men (64.5%), and 64335 had ST-elevation myocardial infarction (STEMI; 26.9%). 7-year survival after AMI was 62.3% (STEMI, 70.8%; non-ST-elevation myocardial infarction [NSTEMI], 59.2%); survival exceeded 85% for people under 65 years of age, but was 17.4% for those aged 85 years or more. 120155 patients (50.2%) underwent revascularisation (STEMI, 72.2%; NSTEMI, 42.1%); 7-year survival exceeded 80% for patients in each group who underwent revascularisation, and was lower than 45% for those who did not. Being older (85 years or older v 18-54 years: adjusted hazard ratio [aHR], 10.6; 95% CI, 10.1-11.1) or a woman (aHR, 1.15; 95% CI, 1.13-1.17) were each associated with greater long term mortality during the study period, as was prior heart failure (aHR, 1.79; 95% CI, 1.76-1.83). Several non-cardiac conditions and geriatric syndromes common in these patients were independently associated with lower long term survival, including major and metastatic cancer, cirrhosis and end-stage liver disease, and dementia. AMI care in Australia and New Zealand is associated with high rates of long term survival; 7-year rates exceed 80% for patients under 65 years of age and for those who undergo revascularisation. Efforts to further improve survival should target patients with NSTEMI, who are often older and have several comorbid conditions, for whom revascularisation rates are low and survival after AMI poor.

Marine spatial planning (MSP) has rapidly become the most widely used integrated, place-based management approach in the marine environment. Monitoring and evaluation of MSP is key to inform best practices, adaptive management and plan iteration. While standardised evaluation frameworks cannot be readily applied, accounting for evaluation essentials such as the definition of evaluation objectives, indicators and stakeholder engagement of stakeholders is a prerequisite for meaningful evaluation outcomes. By way of a literature review and eleven practical MSP case studies, we analysed present day trends in evaluation approaches and unravelled the adoption of evaluation essentials for three categories for monitoring and evaluation for plan making, plan outcomes, and policy implementation. We found that at a global scale the focus of MSP evaluation has shifted over the past decade from evaluating predominantly plan outcomes towards the evaluation of plan making. Independent of the scope of the evaluation, evaluation approaches varied greatly from formal and structured processes, building for instance on MSP goals and objectives, to informal processes based on stakeholder interviews. We noted a trend in the adoption of formalised approaches where MSP evaluations have increasingly become linked to MSP policy goals and objectives. However, the enhanced use of MSP objectives and indicators did not result in a more straightforward reporting of outcomes, e.g. such as the achievement of specific MSP objectives. Overall, we found weak linkages between defined MSP objectives, indicators and available monitoring data. While the apparent shift towards a focus on objectives is promising, we highlight the need of fit-for-purpose monitoring data to enable effective evaluation of those objectives. Hence, effective MSP and adaptive management processes require customised and concurrent monitoring and evaluation strategies and procedures. We argue that evaluation processes would also benefit from a better understanding of the general environmental, socio-economic and socio-cultural effects of MSP. Therefore, to understand better environmental effects of MSP, we praise that forthcoming MSP processes need to deepen the understanding and considerations of cause-effect pathways between human activities and changes of ecosystem state through the adoption of targeted cumulative effects assessments.

We aimed to synthesise data on issues related to stakeholder perceptions of privacy, trust, and transparency in use of secondary data. A systematic literature review of healthcare consumer attitudes towards the secondary use and sharing of health administrative and clinical trial data was conducted. EMBASE/MEDLINE, Cochrane Library, PubMed, CINAHL, Informit Health Collection, PROSPERO Database of Systematic Reviews, PsycINFO, and ProQuest databases were searched. Eligible articles included those reporting qualitative or quantitative original research and published in English. No restrictions were placed on publication dates, study design or disease setting. One author screened articles for eligibility, and two authors were involved in the full text review process. Data was extracted using a pre-piloted data extraction template by one author and checked by another. Conflicts were resolved by consensus. Quality and bias were assessed using the QualSyst criteria for qualitative and quantitative studies. This paper focuses on a subset of 35 articles identified from the wider search which focus on issues of privacy, trust, and transparency. Studies included a total of 56,365 respondents. Results of this systematic literature review indicate that while respondents identified advantages in sharing health data, concerns relating to trust, transparency, and privacy remain. Organisations collecting health data and those who seek to share data or undertake secondary data analysis should continue to develop trust, transparency, and privacy with healthcare consumers through open dialogue and education. Consideration should be given to these issues at all stages of data collection including the conception, design, and implementation phases. While individuals understand the benefits of health data sharing for research purposes, ensuring a balance between public benefit and individual privacy is essential. Researchers and those undertaking secondary data analysis need to be cognisant of these key issues at all stages of their research. Systematic review registration: PROSPERO registration number CRD42018110559 (update June 2020).

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Ecological systems are made up of complex and often unknown interactions and feedbacks. Uncovering these interactions and feedbacks among species, ecosystem functions, and ecosystem services is challenging, costly, and time-consuming. Here, we ask: for which ecosystem features does resolving the uncertainty about the feedbacks from ecosystem function to species improve management outcomes? We develop a dynamic value of information analysis for risk-neutral and risk-prone managers on motif ecosystems and explore the influence of five ecological features. We find that learning the feedbacks from ecosystem function to species does not improve management outcomes for maximising biodiversity, yet learning which species benefit from an ecosystem function improves management outcomes for ecosystem services by up to 25% for risk-neutral managers and 231% for risk-prone managers. Our general approach provides useful guidance for managers and researchers on when learning feedbacks from ecosystem function to species can improve management outcomes for multiple conservation objectives.