Medical Journal of Australia最新文献

{"title":"Future Healthy Countdown 2030: from passive trickle-down to active participation for improved health and wellbeing of children, young people and future generations","authors":"Kevin Kapeke, Anne Hollonds, Susan Maury","doi":"10.5694/mja2.52491","DOIUrl":"10.5694/mja2.52491","url":null,"abstract":"<p>What is it like to be growing up in Australia? Although Australia is one of the wealthiest countries in the world, health and wellbeing measures are not only stalling for many children and young people, but they are actually moving backwards in some domains.<span><sup>1</sup></span></p><p>This is because the safety, health and wellbeing of children are not a national priority and there is a lack of government accountability for evidence-based reform. This was demonstrated in an analysis of 12 years of Royal Commissions and inquiries, which found thousands of recommendations repeated over this time.<span><sup>2</sup></span></p><p>Regarded as the responsibility of states and territories, unlike other important issues, children appear nowhere on the list of priorities for the National Cabinet. It is a choice to not address the social determinants of health and wellbeing. We wait until a crisis or a crime compels a reaction. Politics is getting in the way of prevention, leaving our most vulnerable children behind as victims of “federation failure”.<span><sup>2</sup></span></p><p>At its core, this tragedy is due to a lack of respect for the human rights of children and young people. Despite ratifying the United Nations Convention on the Rights of the Child in 1990 (https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-child), we have failed to incorporate their rights into Australia's laws.</p><p>Rather than centring and respecting the human rights of children and young people, Australia relies on the deeply flawed trickle-down approach, allowing policy to be dominated by the limited concerns of adults. This compromises the future wellbeing of children and of our communities, as well as limiting the health, development, learning and wellbeing of too many children right now. To turn this around, we need to look closely at the evidence and work together across the federation, making child safety, health and wellbeing a priority for the National Cabinet.</p><p>Health is inextricably linked to environment. Since the framing of social determinants of health was first introduced,<span><sup>3</sup></span> the concept has expanded to include political,<span><sup>4</sup></span> commercial,<span><sup>5</sup></span> digital<span><sup>6</sup></span> and environmental determinants of health,<span><sup>7</sup></span> among other framings. The human world is complex, incorporating multiple spheres, all of which influence health and wellbeing. The greatest burden from unhealthy environments rests on the young.</p><p>The Future Healthy Countdown 2030 documents what is going wrong for children, young people and future generations and, also, what needs urgent action to turn things around. The Countdown was introduced in a 2023 supplement published in the <i>Medical Journal of Australia</i>.<span><sup>1</sup></span> Seven domains capture the complex forces that influence physical health, mental health and wellbeing for children, young people an","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S10","pages":"S3-S5"},"PeriodicalIF":6.7,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52491","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644453","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":"Wellbeing, participation and connection in the middle years of childhood","authors":"Sharon Bessell, Tim Moore, Gerry Redmond","doi":"10.5694/mja2.52495","DOIUrl":"10.5694/mja2.52495","url":null,"abstract":"<p>Ensuring the health and wellbeing of children is a fundamental societal goal, which is best achieved when children are connected to their communities, have opportunities for meaningful participation, and enjoy strong and supportive relationships across generations, within and beyond their families. This means investing in individual children and families and in their communities. It also means creating communities that are inclusive of children and actively providing pathways for children to participate in a range of social and civic activities. The purpose of this article is to highlight the relationship between participation, health and wellbeing, for children aged in the middle years.</p><p>Middle childhood, defined here as between six and 12 years of age, corresponds with primary school. But children's lives are characterised by more than school. During middle childhood, children begin to gain independence while remaining strongly connected to their families, yet children's place is often understood to be either the family or school. Limiting children's domains to family and school has resulted in the privatisation of childhood and in their exclusion from public spaces, with deleterious impacts on social relationships.<span><sup>1</sup></span> Loneliness among children in middle childhood may result from a lack of social connection and has serious implications for health and wellbeing.<span><sup>2</sup></span> These concerns are exacerbated in a context of polycrisis encompassing challenges to children's wellbeing and mental health, from climate change to conflict, failing systems across welfare, education and health care and declining standards of living.<span><sup>3</sup></span> Given the significance of middle childhood and complexity within which children live, there has been insufficient policy consideration of children's lives beyond school and family. Yet engagement with community, beyond school and family, is essential for children's sense of belonging, and their overall health and wellbeing.<span><sup>4</sup></span> Without policy support, children's engagement with community is especially challenging for those whose families are under stress or experiencing financial hardship.</p><p>Our argument here is twofold. First there is a need for policies and services to be more responsive to middle childhood. In Australia, there is a strong and justifiable focus on the early years. Yet, as we create the conditions in which children and their families can thrive during the early years of life, we need to take care not to create a policy and service cliff as children move into middle childhood. Our second argument is that efforts to foster children's health and wellbeing must consider how to build child-inclusive communities that are welcoming to children and in which children can actively participate in ways that are meaningful to them. The Future Healthy Countdown 2030<span><sup>5</sup></span> presents an opportunity to advocate for chil","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S10","pages":"S23-S25"},"PeriodicalIF":6.7,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52495","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644461","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":"Aboriginal and Torres Strait Islander infants admitted to the Hunter New England neonatal intensive care unit, 2016-2021: a retrospective medical record audit.","authors":"Jessica Bennett, Michelle Kennedy, Jamie Bryant, Amanual Mersha, Larissa Korostenski, Michelle Stubbs, Justine Parsons, Luke Wakely","doi":"10.5694/mja2.52533","DOIUrl":"https://doi.org/10.5694/mja2.52533","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648639","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":"Beware of the rinse: magic mouthwash as a rare cause of iatrogenic Cushing syndrome and secondary adrenal insufficiency.","authors":"Mike Lin, Lisa Horgan, Albert Hsieh","doi":"10.5694/mja2.52523","DOIUrl":"https://doi.org/10.5694/mja2.52523","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623328","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 New South Wales Pharmacy Trial for herpes zoster: on the nose?","authors":"Christian P Pappas, Timothy R Holmes, Minas T Coroneo","doi":"10.5694/mja2.52531","DOIUrl":"https://doi.org/10.5694/mja2.52531","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623332","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":"Participation in the National Bowel Cancer Screening Program by people with severe mental illness, Australia, 2006-2019: a national data linkage study.","authors":"Steve Kisely, Rebecca Seth, Susan J Jordan, Bradley Kendall, Dan J Siskind, Grant Sara, Justin Chapman, Lisa Brophy, David M Lawrence","doi":"10.5694/mja2.52521","DOIUrl":"https://doi.org/10.5694/mja2.52521","url":null,"abstract":"<p><strong>Objective: </strong>To compare rates of participation in the National Bowel Cancer Screening Program (NBCSP) and follow-up for people with severe mental illness with those for people without severe mental illness or not prescribed antidepressants.</p><p><strong>Study design: </strong>Retrospective cohort study; analysis of de-identified linked NBCSP, Pharmaceutical Benefits Scheme (PBS), and Medicare Benefits Schedule (MBS) data.</p><p><strong>Setting: </strong>Australia, 2006-2019.</p><p><strong>Participants: </strong>People aged 50-74 years (NBCSP-eligible) with severe mental illness, defined as those dispensed two or more prescriptions for second generation antipsychotics or for lithium (PBS data), and a random sample of people aged 50-74 years eligible for Medicare-subsidised services but never prescribed psychotropic medications (antipsychotics, lithium, antidepressants).</p><p><strong>Main outcome measures: </strong>NBCSP participation (returned faecal occult blood test sample), valid test result, positive test result, and follow-up colonoscopy rates.</p><p><strong>Results: </strong>A total of 119 475 people with severe mental illness and 1 090 574 control group people were included in our analyses. The proportion of women was larger in the severe mental illness group (51.3%) than the control group (48.7%), as were the proportions who lived in inner regional areas (23.5% v 19.1%) or in areas in the lowest socio-economic quintile (21.8% v 14.7%). The NBCSP participation rate was lower among people with severe mental illness (adjusted incidence rate ratio [IRR], 0.70; 95% confidence interval [CI], 0.69-0.84). The proportion of valid test results was smaller for people with severe mental illness (95.9% v 98.7%; adjusted IRR, 0.97; 95% CI, 0.96-0.99), and the positive test result proportion larger (12.3% v 6.6%; adjusted IRR, 2.01; 95% CI, 1.94-2.09). The proportion of positive test results followed by colonoscopy was smaller for people with severe mental illness (71.7% v 82.6%; adjusted IRR, 0.88; 95% CI, 0.85-0.92).</p><p><strong>Conclusions: </strong>People with severe mental illness were less likely to participate in the NBCSP or to undergo colonoscopy after a positive test result than other Australians. These differences may contribute to higher colorectal cancer mortality among people with severe mental illness. The contributions of differences in cancer stage at diagnosis and subsequent treatment to higher colorectal cancer mortality require further study.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623331","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":"Decolonisation, Indigenous health research and Indigenous authorship: sharing our teams' principles and practices.","authors":"Pat Dudgeon Bardi, Helen Milroy Palyku, Belle Selkirk Noongar, Ashleigh Wright Nunga, Kahli Regan Wongi And Noongar, Shraddha Kashyap, Rama Agung-Igusti, Joanna Alexi, Abigail Bray, Joan Chan, Ee Pin Chang, Sze Wing Georgiana Cheuk, Jemma Collova, Kate Derry, Chontel Gibson Gamilaraay","doi":"10.5694/mja2.52509","DOIUrl":"https://doi.org/10.5694/mja2.52509","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623329","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":"Interventions for Aboriginal and Torres Strait Islander people with type 2 diabetes that modify its management and cardiometabolic risk factors: a systematic review.","authors":"Ciying Tan, Zoe Williams, Mohammad Ashraful Islam, Ray Kelly, Tuguy Esgin, Elif I Ekinci","doi":"10.5694/mja2.52508","DOIUrl":"https://doi.org/10.5694/mja2.52508","url":null,"abstract":"<p><strong>Objectives: </strong>To review studies of interventions for reducing the impact of type 2 diabetes in Aboriginal and Torres Strait Islander people. The primary aim was to review and summarise the characteristics and findings of the interventions. The secondary aims were to assess their effects on diabetes and cardiometabolic risk factors, and the proportions of people with type 2 diabetes who achieved therapeutic targets with each intervention.</p><p><strong>Study design: </strong>We searched eight electronic databases for publications of studies including Aboriginal or Torres Strait Islander people aged 15 years or older with diagnoses of type 2 diabetes, describing one or more diabetes interventions, and published in English during 1 January 2000 - 31 December 2020. Reference lists in the assessed articles were checked for further relevant publications.</p><p><strong>Data sources: </strong>MEDLINE (Ovid), Web of Science (Clarivate), the Cochrane Library, Global Health (EBSCO), Indigenous Collection and Indigenous Australia (Informit), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP).</p><p><strong>Results: </strong>The database searches yielded 1424 unique records; after screening by title and abstract, the full text of 55 potentially relevant articles were screened, of which seventeen met our eligibility criteria: eleven cohort studies (seven retrospective audits and four prospective studies), three randomised controlled trials, and three observational, non-randomised follow-up studies. Twelve publications reported site-based (Aboriginal or Torres Strait Islander health service or diabetes clinic) rather than individual-based diabetes interventions. Interventions with statistically significant effects on mean glycated haemoglobin (HbA_1c) levels were laparoscopic adjustable gastric banding, a 5-day diabetes self-management camp, treatment of Strongyloides stercoralis infections, community-based health worker-led management, point-of-care testing, and self-management approaches.</p><p><strong>Conclusions: </strong>Few interventions for Aboriginal and Torres Strait Islander people with type 2 diabetes have been reported in peer-reviewed publications. Improving diabetes care services resulted in larger proportions of people achieving therapeutic HbA_1c targets. Outcomes were better when Aboriginal and Torres Strait Islander communities were involved at all levels of an intervention. High quality studies of holistic, culturally safe and accessible interventions should be the focus of research.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623330","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":"“If you build it, they will come”: the convergence of funding, research and collaboration in paediatric brain cancer clinical trials","authors":"Jordan Hansford,&nbsp;Santosh Valvi,&nbsp;Jasper de Boer,&nbsp;Geoff McCowage,&nbsp;Dinisha Govender,&nbsp;Maria Kirby,&nbsp;David Ziegler,&nbsp;Neevika Manoharan,&nbsp;Timothy Hassall,&nbsp;Brandon Wainwright,&nbsp;Frank Alvaro,&nbsp;Paul J Wood,&nbsp;David Eisenstat,&nbsp;Dong Anh Khuong Quang,&nbsp;Misty Jenkins,&nbsp;Matthew Dun,&nbsp;Stephen J Laughton,&nbsp;Raelene Endersby,&nbsp;Andrew Dodgshun,&nbsp;Nicholas Gottardo","doi":"10.5694/mja2.52506","DOIUrl":"10.5694/mja2.52506","url":null,"abstract":"&lt;p&gt;Each year, approximately 1000 children in Australia and New Zealand, aged 0–14 years, are diagnosed with cancer. Despite paediatric cancer accounting for less than 1% of all cancer cases, the impact on their families and communities is profound and disproportionate.&lt;span&gt;&lt;sup&gt;1-3&lt;/sup&gt;&lt;/span&gt; Paediatric brain cancers are the most significant cause of cancer-related deaths within this age group, responsible for 40% of fatalities despite representing only 14% of diagnoses.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Although significant advances in paediatric cancer treatments have pushed overall cure rates above 80%, the outlook for many brain tumour types remains bleak.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Moreover, survivors often face lifelong clinical sequelae that severely diminish their quality of life,&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; with 60% of survivors unable to reach independence in adulthood.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; This stark reality underscores the need for the expansion of clinical trials and integrated preclinical research aimed at improving outcomes for these individuals.&lt;/p&gt;&lt;p&gt;Conducting clinical trials in paediatric oncology faces many challenges, notably in regions with small populations spread across large geographic areas. Additional challenges include the rarity of each diagnosis, requiring international collaboration for patient accrual within feasible timelines.&lt;span&gt;&lt;sup&gt;7-9&lt;/sup&gt;&lt;/span&gt; The limited duration and availability of grant funding complicates this, as the time for patient accrual and the generation of meaningful outcome data often surpasses funding periods. The specificity of diagnoses and the need for complex, multi-agent therapies reduce the appeal of these trials to pharmaceutical companies, which favour single-drug therapies. This necessitates consistent funding to maintain a skilled workforce in clinical trial conduct and monitoring. In this context, the Australian and New Zealand Children's Haematology/Oncology Group (ANZCHOG) and the Australian Brain Cancer Mission (ABCM)&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; have been addressing these challenges. By strategically deploying funds and fostering collaborations, ABCM and ANZCHOG have tackled the barriers that hinder clinical trial execution. ABCM provides the financial support needed for partnerships and trial capacity enhancement. ANZCHOG leads in navigating the challenges of paediatric oncology trials, building a network that overcomes logistical and financial constraints to facilitate progress and discovery.&lt;/p&gt;&lt;p&gt;Initiated in 2017 with the targeted mission of enhancing brain cancer outcomes, the ABCM strategically mobilises resources, collaborations and research with the goal to double brain cancer survival rates.&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; This mission is supported by a detailed strategic framework, blending substantial financial backing with extensive stakeholder engagement and a co-funded model that unites government, philanthropic and private sectors. This strategy not only amplifies research fu","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 10","pages":"520-523"},"PeriodicalIF":6.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52506","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605004","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":"Defining the gap, emphasising the deficit.","authors":"Bridie Mulholland","doi":"10.5694/mja2.52518","DOIUrl":"https://doi.org/10.5694/mja2.52518","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605061","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}