Medical Journal of Australia最新文献

{"title":"Genetic counsellors: facilitating the integration of genomics into health care.","authors":"Tatiane Yanes, Eliza Courtney, Mary-Anne Young, Amy Pearn, Aideen McInerney-Leo, Jodie Ingles","doi":"10.5694/mja2.52568","DOIUrl":"https://doi.org/10.5694/mja2.52568","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-thinking kidney function: a new approach to kidney function estimation and the identification of chronic kidney disease.","authors":"Jessica Dawson, Meg Jardine","doi":"10.5694/mja2.52560","DOIUrl":"https://doi.org/10.5694/mja2.52560","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bulk-billing rates and out-of-pocket costs for general practitioner services in Australia, 2022, by SA3 region: analysis of Medicare claims data.","authors":"Karinna Saxby, Yuting Zhang","doi":"10.5694/mja2.52562","DOIUrl":"https://doi.org/10.5694/mja2.52562","url":null,"abstract":"<p><strong>Objectives: </strong>To examine bulk-billing rates and out-of-pocket costs for non-bulk-billed general practitioner services in Australia at the Statistical Area 3 (SA3) level; to assess differences by area-level socio-economic disadvantage and remoteness.</p><p><strong>Study design: </strong>Retrospective analysis of administrative data (Medicare claims data).</p><p><strong>Setting, participants: </strong>All Medicare claims for non-referred general practitioner services in Australia during the 2022 calendar year, as recorded in the Person Level Integrated Data Asset (PLIDA).</p><p><strong>Main outcome measures: </strong>Mean proportions of general practitioner services that were bulk-billed and mean patient out-of-pocket costs for non-bulk-billed general practitioner visits by SA3 region, adjusted for area-level age and sex, both overall and by area-level socio-economic disadvantage (Index of Relative Socioeconomic Disadvantage quintile) and remoteness (simplified Modified Monash Model category).</p><p><strong>Results: </strong>During 2022, 82% (95% confidence interval [CI], 80-83%) of general practitioner services in Australia were bulk-billed; the mean out-of-pocket cost for non-bulk-billed visits was $43 (95% CI, $42-44). By SA3, mean bulk-billing rates ranged between 46% and 99%, mean out-of-pocket costs for non-bulk-billed general practitioner visit between $16 and $99. Bulk-billing rates were higher in regions in the most socio-economically disadvantaged quintile (86%; 95% CI, 84-88%) than those in the least disadvantaged quintile (73%; 95% CI, 70-76%); the mean rate was not significantly different for remote (86%; 95% CI, 79-92%) and metropolitan areas (81%; 95% CI, 79-83%). Out-of-pocket costs for non-bulk-billed general practitioner services were higher in remote ($56; 95% CI, $46-66) than in metropolitan areas ($43; 95% CI, $42-44), and lower in areas in the most socio-economically disadvantaged quintile ($42; 95% CI, $40-45) than in those in the least disadvantaged quintile ($47; 95% CI, $45-49).</p><p><strong>Conclusion: </strong>Although most general practitioner services are bulk-billed, out-of-pocket costs for non-bulk-billed services are relatively high, particularly for people in remote and socio-economically disadvantaged areas of Australia.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classification of chronic kidney disease in older Australian adults by the CKD-EPI 2009 and 2021 equations: secondary analysis of ASPREE study data.","authors":"Elisa K Bongetti, Rory Wolfe, James B Wetmore, Anne M Murray, Robyn L Woods, Michelle A Fravel, Mark R Nelson, Nigel P Stocks, Suzanne G Orchard, Kevan R Polkinghorne","doi":"10.5694/mja2.52559","DOIUrl":"https://doi.org/10.5694/mja2.52559","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the clinical impact on generally healthy older Australians of changing from the 2009 CKD-EPI (CKD-EPI₂₀₀₉) to the 2021 CKD-EPI (CKD-EPI₂₀₂₁) equation for calculating the estimated glomerular filtration rate (eGFR).</p><p><strong>Study design: </strong>Secondary analysis of data from the prospective ASPirin in Reducing events in the Elderly (ASPREE) cohort study.</p><p><strong>Setting, participants: </strong>Australians aged 70 years or older living in the community and without life-limiting medical conditions, recruited 1 March 2010 - 31 December 2014 for the ASPREE trial.</p><p><strong>Main outcome measures: </strong>Baseline characteristics and long term health outcomes for participants classified to different chronic kidney disease (CKD) stages by CKD-EPI₂₀₂₁ and CKD-EPI₂₀₀₉, and for those classified to the same CKD stage by both equations.</p><p><strong>Results: </strong>Complete data were available for 16 244 Australian ASPREE trial participants. At baseline, their mean age was 75.3 years (standard deviation, 4.4 years), and 8938 were women (55%); the median eGFR (CKD-EPI₂₀₀₉) was 74 mL/min/1.73 m² (interquartile range [IQR], 64-85 mL/min/1.73 m²), the median urine albumin-to-creatinine ratio 0.8 mg/mmol (IQR, 0.5-1.4 mg/mmol). eGFR values were higher for most participants with CKD-EPI₂₀₂₁ than with CKD-EPI₂₀₀₉ (median difference, 3.8 mL/min/1.73 m²; IQR, 3.3-4.4 mL/min/1.73 m²), and 3274 participants (20%) were classified to less advanced CKD stages by CKD-EPI₂₀₂₁. The proportion of participants with eGFR values below 60 mL/min/1.73 m² (clinical CKD) was 17% (2770 participants) with CKD-EPI₂₀₀₉ and 12% (1994 participants) with CKD-EPI₂₀₂₁. Participants were followed up at a median of 6.5 years (IQR, 5.4-7.9 years); the risks of reaching the disability-free survival composite endpoint (adjusted hazard ratio [aHR], 0.94; 95% confidence interval [CI], 0.84-1.05), all-cause mortality (aHR, 0.90; 95% CI, 0.78-1.03), major cardiac events (aHR, 0.94; 95% CI, 0.79-1.13), and hospitalisations with heart failure (aHR, 1.00; 95% CI, 0.67-1.49) were each similar for participants reclassified or not reclassified by CKD-EPI₂₀₂₁.</p><p><strong>Conclusions: </strong>Using CKD-EPI₂₀₂₁ would yield higher eGFR values than the CKD-EPI₂₀₀₉, substantially reducing the proportion of older Australian adults classified as having CKD, without any overall difference in long term health outcomes for people reclassified to less advanced CKD stages. Using the CKD-EPI₂₀₂₁ could markedly reduce the number of referrals of generally healthy older adults to specialist nephrology services.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Making climate change a national health priority: Australia's first National Health and Climate Strategy.","authors":"Georgia Behrens, Madeleine Skellern, Alice McGushin, Paul Kelly, The Hon Ged Kearney","doi":"10.5694/mja2.52552","DOIUrl":"https://doi.org/10.5694/mja2.52552","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood pressure in young Aboriginal and Torres Strait Islander people: analysis of baseline data from a prospective cohort study.","authors":"Berhe W Sahle, Emily Banks, Robyn Williams, Grace Joshy, Garry Jennings, Jonathan C Craig, Nicholas G Larkins, Francine Eades, Rebecca Q Ivers, Sandra Eades","doi":"10.5694/mja2.52558","DOIUrl":"https://doi.org/10.5694/mja2.52558","url":null,"abstract":"<p><strong>Objective: </strong>To assess the distribution of blood pressure levels and the prevalence of hypertension and pre-hypertension in young Indigenous people (10-24 years of age).</p><p><strong>Study design: </strong>Prospective cohort survey study (Next Generation: Youth Wellbeing Study); baseline data analysis.</p><p><strong>Setting, participants: </strong>Aboriginal and Torres Strait Islander people aged 10-24 years living in regional, remote, and urban communities in Central Australia, Western Australia, and New South Wales; recruitment: March 2018 - March 2020.</p><p><strong>Main outcome measures: </strong>Blood pressure categorised as normal, pre-hypertension, or hypertension using the 2017 American Academy of Pediatrics guidelines (10-17 years) or 2017 American College of Cardiology/American Heart Association guidelines (18-24 years); associations of demographic characteristics and health behaviours with hypertension and pre-hypertension, reported as relative risk ratios (RRRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Complete data were available for 771 of 1244 study participants (62%); their mean age was 15.4 years (standard deviation [SD], 3.9 years), 438 were girls or young women (56.8%). Mean systolic blood pressure was 111.2 mmHg (SD, 13.7 mmHg), mean diastolic blood pressure 66.3 mmHg (SD, 11.0 mmHg). Mean systolic blood pressure was higher for male than female participants (mean difference, 6.38 mmHg; 95% CI, 4.60-8.16 mmHg), and it increased by 1.06 mmHg (95% CI, 0.76-1.36 mmHg) per year of age. Mean systolic blood pressure increased by 0.42 mmHg (95% CI, 0.28-0.54 mmHg) and diastolic blood pressure by 0.46 mmHg (95% CI, 0.35-0.57 mmHg) per 1.0 kg/m² increase in body mass index. Ninety-one participants (11.8%) had blood pressure readings indicating pre-hypertension, and 148 (19.2%) had hypertension. The risks of pre-hypertension (RRR, 4.22; 95% CI, 2.52-7.09) and hypertension (RRR, 1.93; 95% CI, 1.27-2.91) were higher for male than female participants; they were greater for people with obesity than for those with BMI values in the normal range (pre-hypertension: RRR, 2.39 [95% CI, 1.26-4.55]; hypertension: RRR, 3.20 [95% CI, 1.91-5.35]) and for participants aged 16-19 years (pre-hypertension: 3.44 [95% CI, 1.88-6.32]; hypertension: RRR, 2.15 [95% CI, 1.29-3.59]) or 20-24 years (pre-hypertension: 4.12 [95% CI, 1.92-8.85]; hypertension: RRR, 4.09 [95% CI, 2.24-7.47]) than for those aged 10-15 years.</p><p><strong>Conclusions: </strong>Blood pressure was within the normal range for most young Indigenous people in our study, but one in three had elevated blood pressure or hypertension. Community-level, culturally safe approaches are needed to avoid the early onset of cardiovascular risks, including elevated blood pressure.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical clinical trial activity in Australia, 2010-20, by specialty: analysis of trial registration data.","authors":"Claire Greenwell, Angela Webster, Ian A Harris, David Beard, Angie Barba, Sarah J Lord","doi":"10.5694/mja2.52555","DOIUrl":"https://doi.org/10.5694/mja2.52555","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical phenotype of COVID-19 vaccine-associated myocarditis in Victoria, 2021-22: a cross-sectional study.","authors":"Julia Smith, Silja Schrader, Hannah Morgan, Priya Shenton, Annette Alafaci, Nicholas Cox, Andrew J Taylor, James Hare, Bryn Jones, Nigel W Crawford, Jim P Buttery, Hazel J Clothier, Daryl R Cheng","doi":"10.5694/mja2.52557","DOIUrl":"https://doi.org/10.5694/mja2.52557","url":null,"abstract":"<p><strong>Objectives: </strong>To describe myocarditis as an adverse event after coronavirus disease 2019 (COVID-19) vaccination, including a detailed description of clinical phenotypes and diagnostic test results and differences by age, sex, and degree of troponin level elevation.</p><p><strong>Study design: </strong>Retrospective cross-sectional study.</p><p><strong>Setting, participants: </strong>Cases of suspected myocarditis following the administration of a COVID-19 vaccine in Victoria during 22 February 2021 - 30 September 2022 reported to Surveillance of Adverse Events Following Vaccination In the Community (SAEFVIC), with symptom onset within 14 days of vaccination, and deemed to be confirmed myocarditis according to the Brighton Collaboration Criteria.</p><p><strong>Main outcome measures: </strong>Demographic (sex, broad age group), vaccine, and clinical presentation characteristics; cardiac investigation results (troponin levels, electrocardiography, echocardiography, cardiac magnetic resonance imaging [cMRI]).</p><p><strong>Results: </strong>Of 454 SAEFVIC reports of suspected COVID-19 vaccine-associated myocarditis, 206 were deemed confirmed cases. The median age of people with confirmed myocarditis was 21 years (interquartile range [IQR], 16-32 years; range, 10-76 years); 129 were aged 24 years or younger (63%), 155 were male (75%). The median time from vaccination to symptom onset was two days (IQR, 1-4 days); 201 cases (98%) followed the administration of mRNA vaccines; five cases followed vaccination with AZD122. Forty-six cases followed first vaccine doses (22%), 138 second doses (67%), and 22 cases third vaccine doses (11.0%). In 201 cases, people initially presented to emergency departments; 129 people were admitted to hospital (63%; median length of stay, two days; IQR, 1-3 days). Five people were admitted to intensive care. Echocardiographic abnormalities were identified in 26 of 200 patients (13%); electrocardiographic abnormalities were identified in 105 of 206 patients (51%; less frequently in female than male patients: adjusted odds ratio, 0.75; 95% confidence interval, 0.64-0.89). Troponin levels were elevated in 205 of 206 patients; the median increase was greater in male (95.3-fold; IQR, 5.8-273-fold) than female patients (9.9-fold; IQR, 4.7-50-fold). No cMRI abnormalities were found in patients for whom the troponin increase was threefold or less.</p><p><strong>Conclusion: </strong>The clinical severity of COVID-19 vaccine-associated myocarditis in Victoria was generally mild. Markers of a more severe phenotype were more frequently recorded for male patients and people aged 24 years or younger. A threefold troponin increase could be used as a threshold for risk stratification of people with COVID-19 vaccine-associated myocarditis, especially in hospitals with limited access to cMRI facilities.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge about COVID-19 vaccines among Aboriginal and Torres Strait Islander people, and attitudes to and behaviours regarding COVID-19 and influenza vaccination: a survey.","authors":"Shea Spierings, Victor M Oguoma, Anthony Shakeshaft, Jim Walker, Maree Toombs, James S Ward","doi":"10.5694/mja2.52551","DOIUrl":"https://doi.org/10.5694/mja2.52551","url":null,"abstract":"<p><strong>Objectives: </strong>To assess Aboriginal and Torres Strait Islander people's knowledge about coronavirus disease 2019 (COVID-19) vaccines, and their attitudes to and behaviours regarding COVID-19 and influenza vaccinations.</p><p><strong>Study design: </strong>Web-based survey.</p><p><strong>Setting: </strong>Australia (excluding the Northern Territory), 1 October 2021 to 31 May 2022.</p><p><strong>Participants: </strong>Convenience sample of Aboriginal and Torres Strait Islander people aged 16 years or older living in Australia.</p><p><strong>Main outcome measures: </strong>Proportions of respondents who reported knowledge about COVID-19 vaccines, and attitudes to and behaviours regarding COVID-19 and influenza vaccinations.</p><p><strong>Results: </strong>A total of 530 people provided valid survey responses; their median age was 27 years (interquartile range, 23-38 years), 255 (48%) were from urban areas, and 309 (58%) were men. Of the 480 participants (91%) who provided complete survey questions (including sex and location information), larger proportion of men than women believed COVID-19 vaccines were very or extremely trustworthy (219, 79% v 124, 61%) and very or extremely effective (212, 76% v 138, 68%). The prevalence of COVID-19 vaccination was lower among respondents aged 60 years or older than among those aged 16-29 years (adjusted prevalence ration [PR], 0.81; 95% confidence interval [CI], 0.66-0.99). After adjusting for socio-demographic factors, the association between intention to receive the influenza vaccine and receiving the COVID-19 vaccine was statistically significant (adjusted PR, 1.18; 95% CI, 1.09-1.27).</p><p><strong>Conclusion: </strong>The high levels of trust in COVID-19 vaccines and their effectiveness indicate that Aboriginal and Torres Strait Islander people are confident about their safety and efficacy and understand the importance of vaccination. The findings also highlight a positive attitude to vaccination and a commitment to preventive health measures among Aboriginal and Torres Strait Islander people.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum.","authors":"","doi":"10.5694/mja2.52549","DOIUrl":"https://doi.org/10.5694/mja2.52549","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}