Yaqoot Fatima

This joint position statement of Australian sleep and primary care organisations provides information to healthcare providers on the management of adults with insomnia symptoms in Australia. Perspectives of sleep researchers, psychologists, sleep physicians, general practitioners, pharmacists, nurses, advocacy and implementation experts, and people with lived experience of insomnia are represented. Insomnia may present as an acute disorder (lasting up to 3 months) or a chronic disorder (lasting for 3 months or longer). Untreated insomnia is associated with lowered mood, daytime function, productivity, and quality of life. Insomnia assessment and diagnosis is based on self-reported symptoms. Insomnia occurring in the context of other conditions should be considered a ‘comorbid condition’ that requires concurrent and targeted assessment and management. Recommendations about healthy sleep practices (sleep hygiene) are not an adequate stand-alone treatment for chronic insomnia. Multi-component Cognitive Behavioral Therapy for insomnia (CBTi) is the recommended ‘first line’ treatment for insomnia. There is evidence that CBTi is effective in a range of settings, in the presence of comorbid conditions, and when delivered in different modalities (e.g., individual sessions, group settings, tele-health, self-guided digital programs). Other evidence-based psychological and behavioral therapies may be appropriate for specific presentations, and in people that do not respond to CBTi. Medicines used for insomnia management are not recommended as the ‘first line’ treatment for insomnia but may be appropriate in conjunction with CBTi or as second-line treatment if CBTi is not effective or appropriate. Sleep medications may be considered in people with acute insomnia that is caused by a clear precipitant (e.g., bereavement, medical crisis, psychosocial stressors) and resulting in significant distress and/or functional impairment. If used, specific benzodiazepines and ‘z-drugs’ may be indicated for up to 2-4 weeks of use at the lowest effective dose, melatonin may be used for up to 13 weeks, and dual orexin receptor antagonists are generally only recommended for chronic insomnia. Sedating antihistamines, antidepressants, antipsychotics, cannabinoids, and complementary medications are not recommended. Collaboration between people with insomnia and a range of clinicians is important for the management of insomnia and associated sleep, mental and physical health conditions. Collaboration between sleep and primary care organisations has led to the development and implementation of healthcare provider education programs on insomnia assessment and management.

Study Objectives
Emerging evidence indicates that Indigenous peoples experience disproportionately high rates of obstructive sleep apnea (OSA). This systematic review aimed to examine OSA prevalence, contributing factors, and intervention or treatment outcomes among Indigenous peoples worldwide.

Methods
We systematically searched PubMed, Embase, CINAHL, Cochrane CENTRAL, ATSI Health, Web of Science and PsycINFO (last searched 30 June, 2025), and grey literature for original research involving Indigenous peoples (≥18 years) diagnosed with OSA via self-report or laboratory-based measures (e.g., polysomnography). Data extraction focused on study characteristics and key findings. Methodological quality was assessed using NIH tools, and cultural appropriateness was evaluated using the CREATE Aboriginal and Torres Strait Islander Quality Appraisal Tool. A narrative synthesis was conducted.

Results
From 599 records, 41 studies from six countries were included. OSA prevalence among Indigenous populations varied widely (community-based samples, 6.5%-69%; referred samples, 85-95%; self-reported diagnosis, 1.2%-8.4%; hospital audit diagnoses, 0.8-11.4%), with only one study reporting a robust population-based estimate (~6.5% among Māori). Severe cases predominated in referred samples. Factors associated with OSA included male sex, age, BMI, neck circumference, craniofacial and geographic factors, and symptoms such as snoring. Treatment evidence was limited to CPAP, with low adherence.

Conclusions
Findings suggests that OSA is common among Indigenous peoples across diverse settings. However, prevalence estimates are heterogeneous and limited by differences in study design, sampling frame, and diagnostic approaches, with most evidence based on referred clinical samples. Improving awareness and culturally responsive screening and management may improve outcomes. Sleep health among Indigenous peoples warrants a higher priority in research, policy and practice.

Registration
The protocol for this systematic review was registered with Prospero (CRD42024466932).

Sleep is often framed as a universal biological necessity, yet there is no universally accepted definition of sleep health. For Aboriginal and Torres Strait Islander peoples (hereafter respectfully referred to as First Nations peoples), the concept of sleep health is shaped by cultural knowledges, spiritual connections, and, regrettably, by histories of displacement, ongoing inequities, and intergenerational trauma. For many First Nations peoples, healthy sleep extends beyond rest and restoration. Sleep, particularly dreaming, is an opportunity to connect with ancestors, gain inspiration for art, songs, and dances, and strengthen connections with culture and traditions. Sleep health is deeply intertwined with connection to Country, kinship systems, and collective wellbeing. Despite this, mainstream sleep science continues to privilege Western biomedical norms while overlooking the cultural, social, and environmental contexts that shape how First Nations communities understand and experience sleep health. This gap has real consequences: limiting the relevance of sleep research; constraining clinical practice; and perpetuating inequities in sleep health and associated outcomes for First Nations peoples.

Background
More than one-third of births in Australia are by caesarean section (C-section), projected to reach 45% by 2030. Understanding sociodemographic, clinical, and obstetric practice factors shaping C-section trends is critical for informing policy and maternity care.
Methods
We conducted a population-based study of 642,857 pregnancies in Queensland (July 2007–December 2017) using the Perinatal Data Collection. Births were classified with the Robson Classification System. Trends in group size, C-section rates, and indications were described. Modified Poisson regression with generalised estimating equations estimated crude and adjusted incidence rate ratios (IRRs) for major Robson groups (RGs).
Findings
Of 214,569C-sections, key contributors were repeat C-sections (RG5, 38.2%), nulliparous elective (RG2, 20.9%), nulliparous spontaneous labour (RG1, 10.7%), and preterm (RG10, 7.0%) births. Although overall C-section rates remained relatively stable (33.3% in 2007 vs 34.4% in 2017), increasing clinical, demographic, and service-related risk profiles and substantial within-group variation were observed. Between 2007 and 2010 and 2015–2017, C-section declined in RG1 (IRR 0.84) but increased with maternal age ≥ 40 years (IRR 2.27) and pharmacological induction (IRR 1.93). Smaller reductions occurred in RG2 (IRR 0.93), with higher risk for BMI ≥ 30 (IRR 1.24) and private care (IRR 1.18). Minimal change was seen in RG5 and RG10 (IRR 1.00), though hypertension (IRR 1.54) and fetal risk (IRR 1.44) strongly influenced RG10. Midwifery-led care consistently reduced C-section across RGs (IRR 0.83–0.95). Elective C-sections were largely due to non-absolute indications and maternal preference.
Conclusion
Stable overall C-section rates mask clinically important heterogeneity driven by maternal and fetal risk profiles and obstetric practices. Expanded analytic use of Robson classification can support group-specific benchmarking, identify modifiable drivers, and inform targeted strategies to optimise C-section use nationally.

Prolonged exposure to high concentrations of trihalomethanes (THMs), which are water disinfection by-products, poses a significant human health risk. This study investigated the spatial-temporal distribution of THM concentrations, the exceedance of the Australian drinking water guideline value (250 μg/L), and the environmental factors associated with THM concentrations in public drinking water supplies across Queensland, Australia, to help guide strategies for mitigating THM exposure. We employed a data linkage approach, integrating spatial water quality monitoring data covering 27 local government areas (LGAs) from 2009 to 2020 with environmental data from the Bureau of Meteorology. Key outcomes were THM concentrations and exceedances. Analyses included time-trends, multiple generalised linear models and logistic regression models. The median monthly THM concentration was 78 μg/L [IQR 49, 119 μg/L]. Between 2009 and 2020, the median THM concentration increased from 38 μg/L to 73 μg/L, while the incidence of exceedance increased from 2.3% to 3.0%. THM exceedances were significantly lower in water from treatment plants (AOR = 0.15, 95% CI [0.07, 0.30]), in LGAs within South-East Queensland (AOR = 0.07, 95% CI [0.01, 0.33]), during spring (AOR = 0.39, 95% CI [0.21,0.70]), in advantaged socio-economic areas and major cities. Increase in temperature was associated with greater THM exceedance (AOR = 1.21, 95% CI [1.07,1.37]), but lower during periods of bushfire (exp(β) = 0.85, 95% CI [0.76,0.95]). Rainfall and NDVI were not significantly associated with THM concentration and exceedances. The elevated concentrations and repeated exceedances highlight a persistent challenge coupled with systemic inequities. We recommend consistent THM data collection, monitoring, optimizing treatment and infrastructure upgrades in disadvantaged regions to improve water quality and protect public health.

Introduction: Indigenous populations experience a disproportionately higher burden of early onset of type 2 diabetes mellitus (T2DM). To contribute towards addressing this health disparity, evidence-based culturally appropriate interventions are urgently needed. This systematic review examines interventions designed to improve the prevention and management of T2DM among Indigenous children and youth.

Methods: A comprehensive search of five electronic databases was carried out in February 2023 to identify relevant studies published in English. We included studies of all designs involving Indigenous children and youth under 25 years of age. An adapted version of the National Institute of Health (NIH) quality assessment tool for pre-post intervention studies was used for quality assessment. Due to the heterogeneity of methods used by reviewed publications, the convergent integrated approach developed by Joanna Briggs Institute (JBI) for mixed-method systematic reviews was employed in the analysis. Prospero registration ID: CRD42023423671.

Results: The search identified 1127 publications, and 25 studies with a total of 4594 participants from four countries were eligible after screening. Notably, most (80%) originated from North America. Most interventions involved < 100 participants and lasted 6 months or less (58%). While knowledge and behaviours improved for most interventions, longer and culturally responsive interventions, often combining both community and school-based elements, demonstrated a greater effect on key anthropometrics and biomarkers associated with the risk of T2DM.

Conclusion: This review highlights the urgent need for more research to address T2DM among Indigenous youth. Future research should prioritise culturally appropriate, long-term interventions that engage communities and empower Indigenous youth to make healthy choices.

We aimed to explore the role of Indium (In), Terbium (Tb), Yttrium (Y), and Lanthanum (La) in the serum of women with recurrent pregnancy loss (RPL) and compare them to controls. Additionally, the study aimed to examine the relationship between REE levels and oxidative DNA damage, to identify potential risk factors contributing to RPL. This case-control study included 30 RPL cases and 30 controls with uncomplicated pregnancy. Inductively Coupled Plasma Mass Spectrometer was used to evaluate levels of In, Tb, Y, and La in the serum samples in both groups. The relationship between REE levels, Total Antioxidant Capacity (TAC), and DNA damage was studied by correlation analysis. There was a significant increase in levels of In, Tb, Y, and La in the serum of the RPL group in contrast to the control group (P < 0.001). Furthermore, a negative correlation was observed between increased Y, Tb, La, and TAC in RPL cases (significant at P < 0.05), indicative of weakened antioxidant defenses. Moreover, increased levels of Y, Tb, and La exhibited a positive correlation with the DNA damage marker, statistically significant at P < 0.05. These findings highlight the potential role of oxidative stress-induced DNA damage and metal intoxication in the development of RPL, underscoring the importance of further research to clarify underlying mechanisms and develop preventive strategies.

In recent years, health research in the Western Pacific region has seen a rise in the use of co-design as a research approach.1 While the growing acceptance and use of co-design research is encouraging, inconsistencies in how co-design is defined, implemented, evaluated, and reported often make it difficult to determine the extent to which co-design principles are genuinely applied.2 Addressing this variability is essential for ensuring transparency, comparability, and robust evaluation of co-designed health interventions.

Trihalomethanes (THMs), water disinfection byproducts resulting from the reaction of chlorine with organic matter during drinking water disinfection, pose potential long-term health risks. This study investigated the challenges, opportunities, and management strategies employed by Drinking Water Service Providers (DWSPs) to minimise THM formation and concentrations in their water supplies. Semi-structured, in-depth interviews were conducted with personnel from water treatment and supply agencies representing 23 Local Government Areas in Queensland, Australia. Data analysis utilised the situational analysis conceptual framework alongside the reflexive thematic analytical procedure to identify key themes and contextual factors. Occasional THM exceedances were attributed to challenges associated with extreme weather conditions, geographical location issues, staffing limitations, inadequate resources, and aging infrastructure. Current preventive and management strategies use by DWSPs included enhanced coagulation, proactive flushing, setting intervention trigger points, powdered activated carbon dosing, aeration, chlorine gas application, increased sampling, and water source blending. Opportunities for improved THM management encompassed the strategic utilisation of diverse water sources, leveraging internal expertise through knowledge sharing, modifying procedures to reduce chlorine re-dosing and water age, fostering collaboration through THM management groups, and exploring emerging technologies like nanofiltration, ion exchange, and advanced catalytic oxidation. This study provides insights into the challenges, opportunities, and existing strategies used for THM management in Queensland. The identified measures provide actionable guidance for water utilities aiming to enhance drinking water safety and reduce public health risks associated with THM exposure. By adopting these approaches, DWSPs can proactively minimise THM formation and ensure safe public water.

Obstructive Sleep Apnea (OSA) is a highly prevalent, yet significantly under-recognized disorder in First Nations Australians. Responding to strong community demand for local capacity building for sleep health equity, this paper outlines the Let’s Yarn About Sleep – OSA (LYAS-OSA) program protocol. The LYAS-OSA program will involve the co-design, implementation, and evaluation of a place-based, culturally responsive, nurse-led, and Aboriginal Health Worker-supported model for OSA diagnosis and management for First Nations peoples. This program will partner with health services and organizations across 12 communities in Queensland, Australia. The program will be conducted from 2023-2027. During the setup and development stage, an advanced data analytics study of secondary data will examine OSA phenotypes and symptomatology in First Nations Queensland communities. In addition, consumers and healthcare professionals will be engaged in co-design workshops to inform the development of a service-delivery model framework. In stage two, local capacity-building activities for Aboriginal Health Workers and nurses will be undertaken, with training on OSA diagnosis and management. This work will culminate in delivering and evaluating the co-designed service model. This community-led approach to co-designing, implementing, and evaluating the LYAS-OSA service delivery model will advance knowledge to deliver culturally responsive, context-responsive, OSA diagnosis and management care for First Nations communities. The LYAS-OSA program outputs will significantly contribute to the evidence base and service delivery provision for OSA care, thereby improving sleep health equity for First Nations Australians.