Medical Journal of Australia最新文献

{"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","doi":"10.5694/mja2.52643","DOIUrl":"https://doi.org/10.5694/mja2.52643","url":null,"abstract":"<p><strong>Objectives: </strong>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><p><strong>Study design: </strong>Retrospective cohort study; analysis of Australian and New Zealand Paediatric Intensive Care Registry data.</p><p><strong>Setting, participants: </strong>Children (18 years or younger) admitted to Australian ICUs during 1 January 2013 - 31 December 2020.</p><p><strong>Main outcome measures: </strong>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 v quintiles 2-5) and Indigenous status, adjusted for pre-illness, admission, and ICU and hospital factors.</p><p><strong>Results: </strong>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% v 2.1%) and also for children living in the lowest IRSD quintile than in quintiles 2-5 (2.5% v 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><p><strong>Conclusions: </strong>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 greatest socio-economic disadvantage. Advancing health equity will require further investigation of the reasons for these differences.</p>","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":"143803487","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":"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":"&lt;p&gt;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 &lt;i&gt;MJA&lt;/i&gt; is therefore very much at the front of my mind.&lt;/p&gt;&lt;p&gt;This issue contains the seventh report of the &lt;i&gt;MJA–Lancet&lt;/i&gt; 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”.&lt;/p&gt;&lt;p&gt;Another perspective in this issue of the &lt;i&gt;MJA&lt;/i&gt; 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”.&lt;/p&gt;&lt;p&gt;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}

{"title":"The potential benefits of a needle and syringe program in Australian prisons.","authors":"Alexander J Thompson, Michael H Levy","doi":"10.5694/mja2.52644","DOIUrl":"https://doi.org/10.5694/mja2.52644","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764269","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":"What is needed to improve young people's access to sexual health care through primary care?","authors":"Helen Bittleston, Meredith Temple-Smith","doi":"10.5694/mja2.52642","DOIUrl":"https://doi.org/10.5694/mja2.52642","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753493","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":"2024 Royal Australian College of General Practitioners and Healthy Bones Australia guideline for osteoporosis management and fracture prevention in postmenopausal women and men over 50 years of age.","authors":"Peter Wong, Weiwen Chen, Dan Ewald, Christian Girgis, Morton Rawlin, John Tsingos, Justine Waters","doi":"10.5694/mja2.52637","DOIUrl":"https://doi.org/10.5694/mja2.52637","url":null,"abstract":"<p><strong>Introduction: </strong>This updated guideline replaces the previous Royal Australian College of General Practitioners and Osteoporosis Australia (now, Healthy Bones Australia) guideline from 2017. The accumulation of high quality evidence supporting improvements in clinical practice over the past five years, need for expert consensus and opinion, and new developments in pharmacological management of osteoporosis, especially the role of osteoanabolic therapies, prompted this update. The aim was to provide clear, evidence-based recommendations to assist Australian general practitioners in managing patients over 50 years of age with poor bone health. However, it is useful for any health care professional caring for people with poor bone health and for health administrators and bureaucrats responsible for resource provision and allocation.</p><p><strong>Main recommendations: </strong>Earlier recognition of poor bone health using clinical risk factors, and use of an absolute fracture risk assessment tool, particularly FRAX (https://fraxplus.org/), is encouraged. Widespread population-based osteoporosis screening is not recommended in Australia due to lack of supporting evidence. It is important to recognise patients with \"imminent\" or \"very high\" fracture risk, as this is a group in whom to consider early osteoanabolic therapy. Calcium and vitamin D supplementation are more effective in reducing fracture risk when given to individuals who have calcium and vitamin D deficiency (not to healthy non-institutionalised individuals). CHANGES IN ASSESSMENT AND MANAGEMENT AS A RESULT OF THE GUIDELINE: This guideline provides recommendations for the use of fracture risk assessment tools, particularly FRAX, for risk stratification, addresses the risk of rebound vertebral fracture following denosumab cessation, discusses removal of strontium as a therapy, clarifies \"imminent\" or \"very high\" fracture risk in patients and highlights the importance of calcium and vitamin D status, and the early use of osteoanabolic therapies. The full guideline is freely available at https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/osteoporosis/executive-summary.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710561","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":"Strong medication overdose data, but we need to consider both toxicity and therapeutic need when prescribing.","authors":"Angela L Chiew, Geoffrey K Isbister","doi":"10.5694/mja2.52631","DOIUrl":"https://doi.org/10.5694/mja2.52631","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700905","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":"The relative toxicity of medicines detected after poisoning suicide deaths in Australia, 2013-19: a data linkage case series study.","authors":"Jessy Lim, Nicholas A Buckley, Kate Chitty, Andrea L Schaffer, Jennifer Schumann, Zein Ali, Rose Cairns","doi":"10.5694/mja2.52638","DOIUrl":"https://doi.org/10.5694/mja2.52638","url":null,"abstract":"<p><strong>Objective: </strong>To compare the toxicity (relative to population use) and lethality (relative to poisoning events) of medicines involved in poisoning suicides in Australia; to determine the proportions of cases in which the medicines had recently been dispensed to the deceased person.</p><p><strong>Study design: </strong>Case series study; analysis of linked National Coronial Information System (NCIS) and Pharmaceutical Benefits Scheme (PBS) data.</p><p><strong>Setting, participants: </strong>Closed coronial cases for deaths of people aged ten years or older deemed to have been medicine poisoning suicides (including multiple cause deaths), Australia, 1 July 2013 - 10 October 2019, with recorded post mortem toxicology findings.</p><p><strong>Main outcome measures: </strong>Fatal toxicity index (FTI): deaths per million years of use at the defined daily dose in Australia (2013-2015); proportion of FTI attributable to medicines dispensed to the deceased person during the twelve months preceding their death; estimated case fatality: deaths per number of calls to poisons information centres regarding the medicine (based on the number of calls to the NSW Poisons Information Centre, 2013-2017).</p><p><strong>Results: </strong>During 2013-19, 2132 deaths were classified as medicine poisoning suicide deaths (median age, 51 years [interquartile range, 39-64 years]; 1036 girls or women [49%]). The 5703 detected substances deemed to have contributed to death included 140 medicines. The overall FTI was 32.0 (95% confidence interval [CI], 30.6-33.3) deaths per million years of use; overall estimated case fatality was 1.28% (95% CI, 1.23-1.34%) of poisoning events. FTI and estimated case fatality (each log₁₀ transformed) were moderately correlated (R² = 0.66). Both values were relatively high for most opioids, sedative psychotropics, and tricyclic antidepressants. Specific medicines with high values were phenobarbitone, oxycodone, morphine, clonazepam, nortriptyline, and propranolol; they were relatively low for risperidone and lithium. The proportions of opioids and hypnosedatives that had been recently dispensed to the deceased persons were smaller than for antidepressant, antipsychotic, and antiepileptic medicines.</p><p><strong>Conclusions: </strong>To reduce the risk of suicide, access to medicines of greater toxicity and lethality should be restricted, including by staged supply (regular supply of medicines in limited quantities), and limiting pack sizes; real-time prescription monitoring could detect and minimise stockpiling.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700920","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}