The number of people with dementia is estimated to be 50 million worldwide and projected to grow to 150 million by 2050.¹ As much of the neuropathology of dementia is believed to progressively accumulate 20 to 30 years before diagnosis,² it is important that at-risk individuals are identified so that modifiable risk factors are addressed and available interventions provided.

Research on health inequalities and health disparities has grown exponentially since the 1960s, but this expansion has not been matched by an associated sense of progress. Criticisms include claims that too much research addresses well-trodden questions and that the field has failed to gain public and policy traction. Qualitative studies have found researchers partly attribute these challenges to fragmentation resulting from disciplinary and methodological differences. Yet, empirical investigation (‘research on research’) is limited. This study addresses this gap, employing mixed-methods to examine, at scale, how and why this field is defined by insular research clusters. First, bibliometric analysis identifies and visualizes the 250 most-connected authors. Next, an algorithm was used to identify clustering via citation links between authors. We used researcher profiling to ascertain authors' geographical and institutional locations and disciplinary training, examining how this mapped onto clusters. Finally, causes of siloing were investigated via semi-structured interviews with 45 researchers. The resulting ‘atlas’ of health inequalities and health disparities research identifies eight clusters of authors with varying degrees of connectedness. No single factor neatly describes observed fragmentation, health equity scholars exhibit a diverse disciplinary backgrounds, and geographical, institutional, and historical factors appear to intersect to explain siloed citation patterns. While the configuration of research activity within clusters potentially helps render questions scientifically manageable, it affirms perceptions of the field as fragmented. We draw on Thomas Kuhn and Sheila Jasanoff to position results within theoretical pictures of scientific progress. Newcomers to the field can use our findings to orient themselves within the many streams of health equity scholarship, and existing health equity scholars can use the atlas to move beyond existing geo-disciplinary networks. However, although stronger cross-cluster engagement would be likely to improve insights, the complex nexus of factors underlying the field's structure will likely make this challenging in practice.

Objective To assess the factors that contributed to the successful completion of recruitment for the largest clinical trial ever conducted in Australia, the Aspirin in Reducing Events in the Elderly...

Background Melbourne, Australia, successfully halted exponential transmission of COVID-19 via two strict lockdowns during 2020. The impact of such restrictions on healthcare-seeking behaviour is not comprehensively understood, but is of global importance. We explore the impact of the COVID-19 pandemic on acute, subacute and emergency department (ED) presentations/admissions within a tertiary, metropolitan health service in Melbourne, Australia, over two waves of community transmission (1 March to 20 September 2020). Methods We used 4 years of historical data and novel forecasting methods to predict counterfactual hospital activity for 2020, assuming absence of COVID-19. Observed activity was compared with forecasts overall, by age, triage category and for myocardial infarction and stroke. Data were analysed for all patients residing in the health service catchment area presenting between 4 January 2016 and 20 September 2020. Results ED presentations (n=401 805), acute admissions (n=371 723) and subacute admissions (n=15 676) were analysed. Substantial departures from forecasted presentation levels were observed during both waves in the ED and acute settings, and during the second wave in subacute. Reductions were most marked among those aged >80 and <18 years. Presentations persisted at expected levels for urgent conditions, and ED triage categories 1 and 5, with clear reductions in categories 2–4. Conclusions Our analyses suggest citizens were willing and able to present with life-threatening conditions during Melbourne’s lockdowns, and that switching to telemedicine did not cause widespread spill-over from primary care into ED. During a pandemic, lockdowns may not inhibit appropriate hospital attendance where rates of infectious disease are low.

Introduction: People with dementia of all ages have a human right to equal access to quality health care. Despite evidence regarding its effectiveness, many people living with dementia are unable to access rehabilitation for promoting function and quality of life. Conducted in Australia, this study was designed to (1) explore barriers to access to dementia rehabilitation and (2) identify solutions that improve access to rehabilitation.Methods: People living with dementia (n = 5) and care partners (n = 8) and health professionals (n = 13) were recruited nationally. Experience‐based codesign across three virtual workshops was used to understand barriers and design solutions to improve access to rehabilitation treatments. Socio‐ecological analyses, using the Levesque Access to Health care framework, were applied to findings regarding barriers and to aid selection of solutions.Results: There was high attendance (92.3%) across the three workshops. Barriers were identified at a user level (including lack of knowledge, transport, cost and difficulty navigating the health, aged care and disability sectors) and health service level (including health professional low dementia knowledge and negative attitudes, inequitable funding models and non‐existent or fragmented services). Solutions focused on widespread dementia education and training, including ensuring that people with dementia and their care partners know about rehabilitation therapies and that health professionals, aged care and disability co‐ordinators know how to refer to and deliver rehabilitation interventions. Dementia care navigators, changes to Australia's public funding models and specific dementia rehabilitation programmes were also recommended.Conclusions: Barriers to accessing rehabilitation for people with dementia exist at multiple levels and will require a whole‐community and systems approach to ensure change.Patient or Public Contribution: People with living experience (preferred term by those involved) were involved at two levels within this research. A Chief Investigator living with dementia was involved in the design of the study and writing of the manuscript. People with living experience, care partners and service providers were participants in the codesign process to identify barriers and design potential solutions.

Message framing has been used as a strategy for promoting physical activity (PA) in university students, but the effectiveness of gain-framed (GF), or loss-framed (LF) messages is variable. This study aims to investigate the effects on motivation and PA behaviour of framed messaging on social media in university students. Gain- and loss-framed messages communicated the mental health outcomes of PA. A three-arm feasibility study (n = 148) collected pre-post intervention online questionnaire responses to assess motivation for PA, exercise, active travel, and PA levels, in response to the messaging intervention on Facebook. Both GF and LF messages effectively increased average motivation for PA in comparison to controls (GF by 0.3 (on a 7-point Likert scale), 9% [95% CI: 3–17%], p = 0.007, LF by 0.3, 10% [CI: 3–18%], p = 0.005). Average motivation for exercise increased in comparison to controls (GF by 0.6, 16% [95% CI: 6–26%], p = 0.001, LF by 0.5, 14.6% [95% CI: 5–26%], p < 0.001). Average motivation for active travel increased in comparison to controls (GF by 0.7, 18% [95% CI: 8–29%], p < 0.001, LF by 0.6, 19% [95% CI: 8–30%], p < 0.001). No meaningful differences between GF or LF messages were observed. Framed messages regarding mental health outcomes of PA delivered via social media could be effective for increasing PA motivation in university students. However, based on our results there is no gain- or loss-framed advantage.