Background: The pandemic of Coronavirus Disease 2019 (COVID-19) is a timely reminder of the nature and impact of Public Health Emergencies of International Concern. As of 12 January 2022, there were over 314 million cases and over 5.5 million deaths notified since the start of the pandemic. The COVID-19 pandemic takes variable shapes and forms, in terms of cases and deaths, in different regions and countries of the world. The objective of this study is to analyse the variable expression of COVID-19 pandemic so that lessons can be learned towards an effective public health emergency response. Methods: We conducted a mixed-methods study to understand the heterogeneity of cases and deaths due to the COVID-19 pandemic. Correlation analysis and scatter plot were employed for the quantitative data. We used Spearman’s correlation analysis to determine relationship strength between cases and deaths and socio-economic and health systems. We organized qualitative information from the literature and conducted a thematic analysis to recognize patterns of cases and deaths and explain the findings from the quantitative data. Results: We have found that regions and countries with high human development index have higher cases and deaths per million population due to COVID-19. This is due to international connectedness and mobility of their population related to trade and tourism, and their vulnerability related to older populations and higher rates of non-communicable diseases. We have also identified that the burden of the pandemic is also variable among high- and middle-income countries due to differences in the governance of the pandemic, fragmentation of health systems, and socio-economic inequities. Conclusion: The COVID-19 pandemic demonstrates that every country remains vulnerable to public health emergencies. The aspiration towards a healthier and safer society requires that countries develop and implement a coherent and context-specific national strategy, improve governance of public health emergencies, build the capacity of their (public) health systems, minimize fragmentation, and tackle upstream structural issues, including socio-economic inequities. This is possible through a primary health care approach, which ensures provision of universal and equitable promotive, preventive and curative services, through whole-of-government and whole-of-society approaches.

Current evidence indicates that maternal diets before and during pregnancy could influence rates of preterm birth, low birth weight (LBW) and small for gestational age (SGA) births. However, findings have been inconsistent. This review summarised evidence concerning the effects of maternal diets before and during pregnancy on preterm birth, LBW and SGA. Systematic electronic database searches were carried out using PubMed, Embase, Scopus and Cochrane library using the preferred reporting items for systematic reviews and meta-analyses guidelines. The review included forty eligible articles, comprising mostly of prospective cohort studies, with five randomised controlled trials. The dietary patterns during pregnancy associated with a lower risk of preterm birth were commonly characterised by high consumption of vegetables, fruits, whole grains, fish and dairy products. Those associated with a lower risk of SGA also had similar characteristics, including high consumption of vegetables, fruits, legumes, seafood/fish and milk products. Results from a limited number of studies suggested there was a beneficial effect on the risk of preterm birth of pre-pregnancy diet quality characterised by a high intake of fruits and proteins and less intake of added sugars, saturated fats and fast foods. The evidence was mixed for the relationship between maternal dietary patterns during pregnancy and LBW. These findings indicate that better maternal diet quality during pregnancy, characterised by a high intake of vegetables, fruits, whole grains, dairy products and protein diets, may have a synergistic effect on reducing the risk of preterm birth and SGA.

To examine the association between endometriosis and women's health-related quality of life (HRQoL). This study included 3728 women born in 1973-78 using data from the Australian Longitudinal Study on Women's Health. Women with endometriosis were identified using self-reported longitudinal surveys linked to administrative health records. A mixed effect model with only random intercept and generalised estimating equations with binary logistic regressions were used to examine the association between endometriosis and health-related quality of life over eight time points. Each HRQoL scale was analysed in terms of binary outcomes by comparing women who had a lower HRQoL (scoring below the 25th percentile) with those who had a higher HRQoL (scoring above the 25th percentile). Women's HRQoL was assessed using the 36-item Short Form Survey every 3 years from 1996 to 2018. Endometriosis was associated with significantly worse reports of HRQoL over time. In the comparison against women without endometriosis, the following adjusted odds ratios (95 % confidence intervals) were calculated for women with endometriosis having worse scores on the eight domains of the Short Form Survey: physical functioning 1.33 (1.19, 1.50), role physical 1.57 (1.41, 1.74), bodily pain 1.65 (1.48, 1.82), general health 1.61 (1.42, 1.81), vitality 1.38 (1.23, 1.55), social functioning 1.38 (1.25, 1.53), role emotion 1.19 (1.06, 1.33), mental health 1.32 (1.18, 1.48). Women with endometriosis also had significantly lower physical health 1.68 (1.51, 1.88) and mental health components scores 1.28 (1.14, 1.44). Endometriosis is associated with worse physical, mental, and social functioning and well-being. Bodily pain was the most affected HRQoL domain.

Endometriosis has been linked with higher rates of a variety of symptoms; however, the findings from longitudinal studies are scarce and inconsistent. To examine the association between endometriosis and common symptoms in a prospective cohort study. This study included 7606 women born in 1973-78 using data from the Australian Longitudinal Study on Women's Health surveyed each 3 years from 2009 to 2018. We identified women with endometriosis using self-report from each survey and linked administrative health data. At each survey, women also completed a checklist on the presence of 24 symptoms. Generalised estimating equations for multinomial responses were used for analyses. Women with endometriosis had significantly more menstrual symptoms than those without endometriosis with adjusted odds ratios (95% CIs) for severe period pain 3.61 (3.11-4.19), heavy menstrual bleeding 2.40 (2.10-2.74), irregular bleeding 1.76 (1.52-2.03), and pre-menstrual tension 1.52 (1.32-1.76); and had higher odds of mental health problems: depression 1.67 (1.39-2.01), anxiety 1.59 (1.24-2.03); allergies and non-specific symptoms: allergies/ hay-fever/ sinusitis 1.62 (1.40-1.89), severe tiredness 1.79 (1.56-2.05), sleep difficulty 1.56 (1.35-1.81), and palpitations 1.77 (1.37-2.18). There was also a strong association with other forms of pain: backpain 1.76 (1.53-2.04), headaches/migraines 1.50 (1.29-1.74), and stiff/ painful joints 1.65 (1.41-1.93). Women with endometriosis also had increased odds of developing bowel and urinary symptoms; constipation 1.67 (1.35-2.08), haemorrhoids/piles 1.46 (1.12-1.90), indigestion/heartburn 1.25 (1.03-1.52), urine burn/stings 2.80 (1.71-4.58), and vaginal discharge/irritation 1.37 (1.03-1.82). The association between each symptom and endometriosis was similar whether endometriosis was surgically confirmed or clinically suspected. No association was found between endometriosis and the risk of skin problems, leaking urine, or breathing difficulty. This study suggests that women with endometriosis are more likely to report not only menstrual symptoms, but also that there is an increased risk of mental health disorders, other pain symptoms, bowel and urinary symptoms, and non-specific symptoms such as severe tiredness and difficulty sleeping.

STUDY QUESTION: What are the patterns of health service use (HSU) before and after endometriosis diagnosis? SUMMARY ANSWER: Women with endometriosis had higher rates of visits to general practitioners (GPs), specialists, and diagnostic imaging before and after diagnosis compared to those without the condition; however, after diagnosis, their visits to GPs and specialists other than obstetricians/gynaecologists decreased compared to before, while visits to obstetricians/gynaecologists and use of diagnostic imaging increased. WHAT IS KNOWN ALREADY: Women with endometriosis have higher rates of healthcare use compared to those without the condition; however, no longitudinal study has examined patterns of HSU over a prolonged period before and after diagnosis. STUDY DESIGN, SIZE, DURATION: The Australian Longitudinal Study on Women’s Health linked to a national administrative health record. A total of 30 473 women, born in 1973–1978 and 1989–1995, from two cohorts with data collected from 1996 to 2021, as online or postal questionnaires. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women with endometriosis were identified using the self-report surveys and their administrative health records. A control group of women without endometriosis was randomly selected and age-matched with women with endometriosis. The final sample included 9545 women from the 1973–1978 cohort (1909 cases, 7636 controls) and 7510 from the 1989–1995 cohort (1502 cases, 6008 controls). Women’s HSU was assessed using the Medicare Benefits Schedule database. A random intercept zero-inflated negative binomial model was used to compare outcomes between cases and controls, addressing skewed data, over-dispersion, and excess zeros. MAIN RESULTS AND THE ROLE OF CHANCE: In both cohorts, women with endometriosis had a higher level of HSU, both before and after diagnosis, compared with those without the condition. For the 1973–1978 cohort, women with endometriosis had a higher rate of visits to GPs before and after diagnosis (adjusted incidence rate ratio: 1.19, 95% CI 1.14, 1.23 and 1.24, 95% CI 1.19, 1.30, respectively), specialists other than obstetricians/gynaecologists (1.50, 95% CI 1.40, 1.61, and 1.36, 95% CI 1.27, 1.46), and for diagnostic imaging (1.15, 95% CI 1.10, 1.21, and 1.20, 95% CI 1.15, 1.26). The average number of these visits remained consistent in the early years, peaked around 3 years before diagnosis, and then partly declined post-diagnosis, to later stabilize at a higher level than those without the condition. Following the diagnosis, women with endometriosis had a higher number of visits to obstetricians/gynaecologists (1.11, 95% CI 1.05, 1.17) than their matched controls, with a marked increase in the first 6 years post-diagnosis, but gradually returned to same levels as the control group. After diagnosis, women with endometriosis had a lower rate of visits to GPs (0.95, 95% CI 0.93, 0.98) and specialists other than obstetricians/gynaecologists (0.88, 95% CI 0.82, 0.93) compared to before their diagnosis, while they had a higher rate of visits to obstetricians/gynaecologists (1.09, 95% CI 1.01, 1.18) and diagnostic imaging (1.07, 95% CI 1.01, 1.14). Similar patterns of HSU were observed in the 1989–1995 cohort, regardless of whether surgically confirmed or clinically suspected cases of endometriosis were used, though the evidence for changes in specific HSU before and after diagnosis was weaker. LIMITATIONS, REASONS FOR CAUTION: Approximately half of the women with endometriosis were clinically suspected cases without laparoscopic confirmation, which may result in an overestimation of prevalence and introduce the risk of misdiagnosis, potentially influencing clinical management and research findings. WIDER IMPLICATIONS OF THE FINDINGS: The continued high level of HSU among women with endometriosis, even over a decade after diagnosis, suggests that they have substantially greater healthcare needs than other women. The distinct patterns of the use of healthcare in the years before and after endometriosis diagnosis can support efforts to improve diagnosis, management, and treatment outcomes for patients and to reduce healthcare costs. STUDY FUNDING/COMPETING INTEREST(S): The Australian Longitudinal Study on Women’s Health is funded by the Australian Government Department of Health and Aged Care. G.D.M. and G.M. are Australian National Health and Medical Research Council Leadership Fellows (GNT2009577 and GNT1177194). D.G.G. was funded by MRFF EndoAIMM (RFEHP100126). Funding sources had no role in the study design, data analysis, interpretation, or manuscript writing. The authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER: N/A.