Medical Journal of Australia最新文献

{"title":"Incidental findings during lung low-dose computed tomography cancer screening in Australia and Canada, 2016–21: a prospective observational study","authors":"Asha Bonney, Diane M Pascoe, Mark W McCusker, Daniel Steinfort, Henry Marshall, Annette McWilliams, Fraser J Brims, Emily Stone, Paul Fogarty, Jeremy D Silver, Brad Milner, Elizabeth Silverstone, Eugene Hsu, Duy Nguyen, Christopher Rofe, Cameron White, XinXin Hu, John Mayo, Renelle Myers, Kwun M Fong, Renee Manser, Stephen Lam","doi":"10.5694/mja2.52649","DOIUrl":"https://doi.org/10.5694/mja2.52649","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate the type and frequency of incidental findings in people at high risk of lung cancer who undergo baseline low-dose computed tomography (LDCT) lung cancer screening in Australia and Canada.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Prospective observational study; sub-study of the single-arm International Lung Screen Trial (ILST) lung cancer screening study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Australian and Canadian people enrolled in the ILST, 25 August 2016 – 21 November 2020; inclusion criteria: aged 50–80 years, active smoking history, and high risk of lung cancer (estimated six-year lung cancer risk of 1.51% or more, based on the PLCO<sub>m2012</sub> risk prediction model; or a smoking history of 30 pack-years or more). Initial LDCT screening was undertaken at one of five participating hospitals in Australia and one in Canada.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Prevalence of incidental findings during baseline LDCT lung cancer screening (using a research checklist), by country, classified by experienced radiologists as requiring or not requiring clinical follow-up; reporting of incidental findings in clinical reports for treating physicians (two Australian sites only).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 4403 participants completed baseline LDCT screening at the six participating hospitals. The mean age (64–65 years) and the proportions of participants who currently smoked (47–55%) were similar at all six sites; the proportion of female participants was larger in Sydney (52%) and Vancouver (51%) than the other sites (39–44%). At least one incidental finding was made during baseline LDCT screening of 3225 people (72.8%); findings in 454 people (10.3%) required clinical follow-up. The most frequent incidental findings were coronary artery calcification (3022 of 4380 participants with recorded results, 69.0%) and emphysema (2378 of 4401, 54.0%). Marked differences between the Australian and Canadian sites in the prevalence of incidental findings were noted, and also between the two Australian sites in their communication of incidental findings in clinical screening reports.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Incidental findings during lung cancer screening were frequent, and clinical reporting of these","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 8","pages":"403-411"},"PeriodicalIF":6.7,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52649","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143905004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's past is prologue","authors":"Michael Skilton","doi":"10.5694/mja2.52659","DOIUrl":"https://doi.org/10.5694/mja2.52659","url":null,"abstract":"<p>In the year 2000, the XIII International AIDS Conference was held in Durban, South Africa. The Conference Report published in the <i>MJA</i><span><sup>1</sup></span> spoke of the disappointment in the results of a failed prevention trial, optimism for the next generation of vaccines, and findings from a pilot study of five patients who with potent therapy had achieved undetectable viral levels presented by Dr Anthony Fauci. During his closing address, Nelson Mandela<span><sup>2</sup></span> focused the attention of the audience to the situation that was unfolding in Africa, and the need for action:</p><p>He spoke of the need for “… bold initiatives to prevent new infections among young people,” and urged international collaboration.</p><p>Meanwhile in Australia, local efforts to prevent HIV and other bloodborne diseases were facing the threat posed by the heroin epidemic. After the widely publicised suspension of an inner-city needle and syringe outreach service in Sydney in early 1999, the NSW Parliament quickly passed legislation that would lead to the opening of Australia's first legal supervised injecting centre in 2001. Jump forward to 2025 and the Uniting Sydney Medically Supervised Injecting Centre is still operational and has had substantial successes over time,<span><sup>3</sup></span> although this model has not been widely reproduced. In contrast, needle and syringe programs are widely implemented in Australia and form a key component of our National Strategies for preventing and treating bloodborne viral infections, of which hepatitis C virus is now a key focus.<span><sup>4</sup></span> Despite their success, needle and syringe programs are not available to people in prisons in Australia.</p><p>In this issue of the <i>MJA</i>, Houdroge and colleagues<span><sup>5</sup></span> present modelling that supports the health and cost benefits of a proposed nationwide prison needle and syringe program, with about 900 new hepatitis C virus infections being prevented over the first five years of implementation and cost benefits of $2.60 per $1 invested in the program. In the accompanying editorial, Thompson and Levy<span><sup>6</sup></span> write that it is “time to re-think the role of prison needle and syringe programs”, and that “development and implementation of a prison-based needle and syringe program in Australia would be an important advance for harm reduction in correctional facilities”.</p><p>Both Houdroge and colleagues and Thompson and Levy highlight the strong human rights justification for providing prison needle and syringe programs. The United Nations Standard Minimum Rules for the Treatment of Prisoners<span><sup>7</sup></span> — also known as the Nelson Mandela Rules, in honour of Nelson Mandela who spent 27 years in prison and who advocated for fair and humane treatment of all — establish, among other minimum standards, that imprisoned people should have access to the same standards of health care that are available in the ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 8","pages":"375-376"},"PeriodicalIF":6.7,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52659","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143905006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographic remoteness-based differences in in-hospital mortality among people admitted to NSW public hospitals with heart failure, 2002–21: a retrospective observational cohort study","authors":"Imants Rubenis, Gregory Harvey, Karice Hyun, Vincent Chow, Leonard Kritharides, Andrew P Sindone, David B Brieger, Austin CC Ng","doi":"10.5694/mja2.52635","DOIUrl":"https://doi.org/10.5694/mja2.52635","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine associations between remoteness of region of residence and in-hospital mortality for people admitted to hospital with heart failure in New South Wales during 2002–21.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Retrospective observational cohort study; analysis of New South Wales Admitted Patient Data Collection data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Adult (16 years or older) NSW residents admitted with heart failure to NSW public hospitals, 1 January 2002 – 30 September 2021. Only first admissions with heart failure during the study period were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>In-hospital mortality, by remoteness of residence (Australian Statistical Geography Standard), adjusted for age (with respect to median), sex, socio-economic status (Index of Relative Socioeconomic Advantage and Disadvantage [IRSAD], with respect to median), other diagnoses, hospital length of stay, and calendar year of admission (by 4-year group).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 154 853 admissions with heart failure; 99 687 people lived in metropolitan areas (64.4%), 41 953 in inner regional areas (27.1%), and 13 213 in outer regional/remote/very remote areas (8.5%). The median age at admission was 80.3 years (interquartile range [IQR], 71.2–86.8 years), and 78 591 patients were men (50.8%). The median IRSAD score was highest for people from metropolitan areas (metropolitan: 1000; IQR, 940–1064; inner regional: 934; IQR, 924–981; outer regional/remote/very remote areas: 930; IQR, 905–936). During 2002–21, 9621 people (6.2%) died in hospital; the proportion was 8.0% in 2002, 4.9% in 2021. In-hospital all-cause mortality was lower during 2018–21 than during 2002–2005 (adjusted odds ratio [aOR], 0.52; 95% confidence interval [CI], 0.49–0.56); the decline was similar for all three remoteness categories. Compared with people from metropolitan areas, the odds of in-hospital death during 2002–21 were higher for people from inner regional (aOR, 1.12; 95% CI, 1.07–1.17) or outer regional/remote/very remote areas (aOR, 1.35; 95% CI, 1.25–1.45).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In-hospital mortality during heart failure admissions to public hospitals declined across NSW during 2002–21. However, it was higher among people liv","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 7","pages":"348-355"},"PeriodicalIF":6.7,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52635","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143853002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physicians as advocates: an enduring calling","authors":"Elizabeth Zuccala","doi":"10.5694/mja2.52641","DOIUrl":"https://doi.org/10.5694/mja2.52641","url":null,"abstract":"<p>“Medicine is a social science and politics is nothing but medicine on a grand scale”<span><sup>1</sup></span></p><p>Many <i>MJA</i> readers will be familiar with this oft quoted phrase from the 19th century German physician Rudolf Virchow. In his landmark report of a typhus epidemic, Virchow pointed out the links between poverty and the spread of disease. The role of the medical profession, it follows, is not simply to treat individual patients but to also attend to the social conditions that underpin poor health outcomes.</p><p>Consideration of the social determinants of health, as we now call them, is a fundamental part of contemporary public health research and practice and an area the <i>MJA</i> frequently publishes on. In this issue of the Journal, for instance, research by Rubenis and colleagues<span><sup>2</sup></span> investigates place-based disparities in care for cardiovascular diseases. They find that despite recent improvements, patients living in regional and remote areas of New South Wales admitted to hospital with heart failure experience persistently higher in-hospital mortality compared with their metropolitan-dwelling counterparts. Likewise, writing in a perspective article, Robertson and colleagues<span><sup>3</sup></span> explore the many barriers that exist to research participation by people with vision impairment and describe strategies for improving participation by changing information provision and data collection methods.</p><p>Although it is widely accepted that the state of our social world has an enormous influence on health, the role of health experts in moving beyond merely describing and explaining to seeking to transform social conditions to improve health remains contested. This is especially when powerful interests are at play. In such cases, it is common for physicians and researchers to be extorted to stay in their narrowly defined biomedical “lane”, or for those within the profession to worry about tainting their appearance of objective, evidence-driven thinking by engaging in debates of a political nature.</p><p>Bilgrami and colleagues<span><sup>4</sup></span> address this tension in an article on armed conflict and the role of physician advocacy. Globally, attacks on health care — such as the killing, kidnapping and arrest of health care workers, hijacking of medical supplies, obstruction of patients from accessing care, and the bombing, looting and occupation of health facilities — are on the rise. Despite these devastating events, the authors note “most medical associations and societies have been inconsistent when it comes to advocating for the protection of health care workers in conflicts. An argument commonly put forth in recent years is that such organisations must remain apolitical”. Bilgrami and colleagues contrast this approach with notable historical and contemporary examples of successful physician advocacy efforts, as well as with their view of the norms and responsibilities at the heart o","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 7","pages":"323"},"PeriodicalIF":6.7,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52641","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should self-administered voluntary assisted dying be supervised? A Queensland case","authors":"Eliana Close, Katrine Del Villar, Ben P White","doi":"10.5694/mja2.52634","DOIUrl":"https://doi.org/10.5694/mja2.52634","url":null,"abstract":"<p>All Australian states and the Australian Capital Territory have voluntary assisted dying (VAD) laws. Medication management will be topical in these laws’ mandatory reviews following a Queensland coronial inquest into the death of a person who consumed a VAD substance prescribed for their spouse. In a decision issued on 11 September 2024, the coroner found “operational flaws” in Queensland's VAD law, declaring current self-administration procedures “inadequate to provide for medication safety and to prevent deliberate misuse”.<span><sup>1</sup></span> These findings have nationwide relevance as all Australian VAD laws permit eligible persons to self-administer without a health practitioner present.<span><sup>2</sup></span></p><p>On 16 May 2023, ABC (pseudonym), an older person, died after purposely consuming a VAD substance prescribed for their terminally ill spouse.<span><sup>1</sup></span> Due to the sensitive nature of the case, the coroner's report includes a ban on publishing identifying details. Accordingly, ABC, their spouse (the terminally ill patient), and adult child are referred to using neutral terms.</p><p>The circumstances leading to ABC's death are set out in Box 1.</p><p>The coroner recommended that self-administration should be supervised by a health practitioner, an option that was considered by the Queensland Law Reform Commission (prompted by a proposed VAD bill)<span><sup>4</sup></span> but was not adopted.<span><sup>5</sup></span></p><p>The coroner warned of “[f]urther calamity and heartbreak” for patients and families without system reform.<span><sup>1</sup></span> He specifically confined his critical remarks to the system rather than the individuals working within it, noting that QVAD-SPS personnel had not breached the law or any protocol.</p><p>The Australian model of VAD is characterised by narrow eligibility criteria and numerous safeguards.<span><sup>2</sup></span> One of these safeguards is that only medical practitioners (and in some states, nurses or nurse practitioners) who complete mandatory training and meet additional experience and expertise requirements can participate in key aspects of VAD (“VAD practitioners”). Two independent VAD practitioners assess whether a person is eligible for VAD (in the states, only medical practitioners can do VAD assessments; but in the ACT, one practitioner can be a nurse practitioner). If the person is eligible, the lead VAD practitioner (“coordinating practitioner”) writes the prescription for the VAD substance.</p><p>Australian VAD medication protocols are not publicly available but, as in other countries, the VAD substance is a combination of medications used in health care settings (including a Schedule 8 [S8] medicine).<span><sup>3, 6</sup></span> The medication protocol differs depending on the method of administration. Self-administration involves mixing a liquid that a person drinks (or ingests via nasogastric tube), while practitioner administration typically involve","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 8","pages":"390-393"},"PeriodicalIF":6.7,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52634","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143905171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"I am a Civil War.","authors":"Jennifer G Mowbray","doi":"10.5694/mja2.52646","DOIUrl":"https://doi.org/10.5694/mja2.52646","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803482","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":"Social determinants of health and intensive care unit admission rates and outcomes for children, Australia, 2013–2020: analysis of national registry data","authors":"Katie M Moynihan, Vanessa Russ, Darren Clinch, Lahn Straney, Johnny Millar, Marino Festa, Natasha Nassar, Shreerupa Basu, Thavani Thavarajasingam, Debbie Long, Paul J Secombe, Anthony J Slater, the Australian and New Zealand Intensive Care Society Paediatric Study Group and Centre for Outcomes and Resource Evaluation","doi":"10.5694/mja2.52643","DOIUrl":"10.5694/mja2.52643","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate the influence of non-medical social determinants of health on rates of admission and outcomes for children admitted to intensive care units (ICUs) in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Retrospective cohort study; analysis of Australian and New Zealand Paediatric Intensive Care Registry data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Children (18 years or younger) admitted to Australian ICUs during 1 January 2013 – 31 December 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Population-standardised ICU admission rates, overall and by residential socio-economic status (Index of Relative Socio-Economic Disadvantage [IRSD] quintile) and Indigenous status; likelihood of mortality in the ICU by residential socio-economic status (continuous, and quintile 1 <i>v</i> quintiles 2–5) and Indigenous status, adjusted for pre-illness, admission, and ICU and hospital factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data for 77 233 ICU admissions of children were available. The ICU admission rate for Indigenous children was 1.91 (95% confidence interval [CI], 1.87–1.94), for non-Indigenous children 1.60 (95% CI, 1.57–1.64) per 1000 children per year. The rate was higher for children living in areas in the lowest IRSD quintile (1.93; [95% CI, 1.89–1.96]) than for those living in quintile 5 (1.26 [95% CI, 1.23–1.29] per 1000 children per year). Unadjusted in-ICU mortality was higher for Indigenous than non-Indigenous children (2.5% <i>v</i> 2.1%) and also for children living in the lowest IRSD quintile than in quintiles 2–5 (2.5% <i>v</i> 2.0%). After adjustment for all factors, mortality among Indigenous children was similar to that for non-Indigenous children (adjusted odds ratio [aOR], 1.15; 95% CI, 0.92–1.43); it was higher for children living in the lowest IRSD quintile than for those living in quintiles 2–5 (aOR, 1.18; 95% CI, 1.03–1.36). Remoteness and distance between home and ICU did not influence the likelihood of death in the ICU.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The population-standardised ICU admission rate is higher for Indigenous children and children residing in areas of greatest socio-economic disadvantage than for other children in Australia. Adjusted in-ICU mortality was higher for children from areas of great","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 8","pages":"412-421"},"PeriodicalIF":6.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52643","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accountability frameworks for climate change and health: research is leading the way","authors":"Virginia Barbour","doi":"10.5694/mja2.52633","DOIUrl":"https://doi.org/10.5694/mja2.52633","url":null,"abstract":"<p>As I am writing this Editor's Choice, I am in the process of preparing our house in Queensland for a cyclone, predicted to hit Brisbane in about 48 hours. The cover topic of this month's issue of the <i>MJA</i> is therefore very much at the front of my mind.</p><p>This issue contains the seventh report of the <i>MJA–Lancet</i> Countdown on health and climate change, which examines five broad domains: health hazards, exposures and impacts; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement (https://doi.org/10.5694/mja2.52616). The analyses by Beggs and colleagues have some unsurprising but still concerning findings: the exposure to heatwaves in Australia is growing, which in turn increases the risk of heat stress; other health threats such as bushfires and drought — “features of the continent for millennia” — are amplified by climate change. Cyclones, as we are currently facing, are noted as major causes of economic losses. This year, the authors also report against a new indicator: climate litigation over the past decade. The findings are instructive: one case is “a legally significant acceptance, by government, of the science concerning the health impacts of climate change”. However, litigation is just one driver of change. As the authors note: “Nationally, regionally and globally, the next five years are pivotal in reducing greenhouse gas emissions and transitioning energy production to renewables. Australia is now making progress in this direction. This progress must continue and accelerate, and the remaining deficiencies in Australia's response to the health and climate change threat must be addressed”.</p><p>Another perspective in this issue of the <i>MJA</i> discusses the importance of Australia endorsing a fossil fuel non-proliferation treaty (https://doi.org/10.5694/mja2.52610). Colagiuri and colleagues outline the aims of the Fossil Fuel Non-Proliferation Treaty and why it is relevant to health. Starkly put, we are not on track to meet the goals of the Paris Agreement — and as events in the United States unfold, it seems as if political will is shifting even further away from support for the agreement. The authors argue that the Fossil Fuel Non-Proliferation Treaty is a way to directly address the key driver of the climate crisis. It has not been signed by Australia, perhaps unsurprisingly, though eleven Pacific nations, which well understand the risk, have signed on. Endorsing the Fossil Fuel Non-Proliferation Treaty would, the authors argue, be “more than just a climate strategy for Australia; it represents a vital step towards advancing global health justice and fostering regional solidarity”.</p><p>How pharmaceutical companies are progressing in their carbon emission plans is assessed in a research article by Burch and colleagues (https://doi.org/10.5694/mja2.52621). Drawing on publicly available documents on actions during 2015–2023","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 6","pages":"271"},"PeriodicalIF":6.7,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52633","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143786864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 2024 report of the MJA–Lancet Countdown on health and climate change: Australia emerging as a hotspot for litigation","authors":"Paul J Beggs,&nbsp;Alistair J Woodward,&nbsp;Stefan Trueck,&nbsp;Martina K Linnenluecke,&nbsp;Hilary Bambrick,&nbsp;Anthony G Capon,&nbsp;Zerina Lokmic-Tomkins,&nbsp;Jacqueline Peel,&nbsp;Kathryn Bowen,&nbsp;Ivan C Hanigan,&nbsp;Nicolas Borchers Arriagada,&nbsp;Troy J Cross,&nbsp;Sharon Friel,&nbsp;Donna Green,&nbsp;Maddie Heenan,&nbsp;Ollie Jay,&nbsp;Harry Kennard,&nbsp;Arunima Malik,&nbsp;Celia McMichael,&nbsp;Mark Stevenson,&nbsp;Sotiris Vardoulakis,&nbsp;Aditya Vyas,&nbsp;Marina B Romanello,&nbsp;Maria Walawender,&nbsp;Ying Zhang","doi":"10.5694/mja2.52616","DOIUrl":"https://doi.org/10.5694/mja2.52616","url":null,"abstract":"<p>\u0000 \u0000 </p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 6","pages":"272-296"},"PeriodicalIF":6.7,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52616","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143786865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antidepressant prescribing in Australian primary care: time to reevaluate.","authors":"Katharine A Wallis, Anna King, Joanna Moncrieff","doi":"10.5694/mja2.52645","DOIUrl":"https://doi.org/10.5694/mja2.52645","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772332","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}