Medical Journal of Australia最新文献

{"title":"Smartphone-activated volunteer responders and survival to discharge after out-of-hospital cardiac arrests in Victoria, 2018–23: an observational cohort study","authors":"Belinda Delardes, Mads Christian Tofte Gregers, Emily Nehme, Michael Ray, Dylan Hall, Tony Walker, David Anderson, Daniel Okyere, Ashanti Dantanarayana, Ziad Nehme","doi":"10.5694/mja2.52673","DOIUrl":"10.5694/mja2.52673","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To compare the likelihood of patient survival to discharge and of bystander cardiopulmonary resuscitation (CPR) and defibrillation for cases of out-of-hospital cardiac arrest in which at least one smartphone-activated volunteer responder (SAVR) arrived before emergency medical services (EMS) with cases in which EMS arrived first.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Population-based observational cohort study; analysis of Victorian Ambulance Cardiac Arrest Registry (VACAR) data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Victoria, 12 February 2018 – 31 August 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>All cases of out-of-hospital cardiac arrest not witnessed by EMS personnel, except events in residential aged care facilities, in which EMS personnel did not attempt resuscitation, or for which the EMS dispatch code was ineligible for SAVR activation; events during coronavirus disease 2019 pandemic lockdowns were also excluded (SAVR program pause: rural areas: 23 March 2020 – 16 October 2020; metropolitan areas: 23 March 2020 – 9 November 2020).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Primary outcome: survival to hospital discharge. Secondary outcomes: bystander CPR, bystander defibrillation, any return of spontaneous circulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 9196 cases of out-of-hospital cardiac arrest included in our analysis, 1158 (12.6%) had been attended by SAVRs: before EMS arrival in 564 cases (48.7%) and after EMS arrival in 594 cases (51.3%). The risk-adjusted odds of patient survival to hospital discharge were higher for events in which SAVRs arrived before EMS than for those not attended by SAVRs (adjusted odds ratio [aOR], 1.37; 95% confidence interval [CI], 1.02–1.85), as were those of bystander CPR (aOR, 7.59; 95% CI, 4.97–11.6) and bystander defibrillation (aOR, 16.0; 95% CI, 9.23–27.7); the likelihood of return of spontaneous circulation was similar for the two event groups. SAVRs arriving after EMS did not influence any of the assessed outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The arrival of SAVRs before EMS personnel was associated with greater likelihood of patient survival to hospital discharge and of byst","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 10","pages":"504-509"},"PeriodicalIF":6.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52673","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094313","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":"Optimising the impact of smartphone-activated volunteer responder programs on out-of-hospital cardiac arrest outcomes by increasing responder density","authors":"Alan Morrison, Paul Simpson","doi":"10.5694/mja2.52674","DOIUrl":"10.5694/mja2.52674","url":null,"abstract":"<p>The chain of survival outlines the critical steps in resuscitation that increase the likelihood of survival for people who experience out-of-hospital sudden cardiac arrest, including bystander cardiopulmonary resuscitation (CPR) and early defibrillation as important components.<span><sup>1</sup></span> Some authors suggest that focusing on the links at which most patients enter the chain would achieve the greatest improvements in outcomes.<span><sup>2</sup></span></p><p>Survivors of out-of-hospital cardiac arrest often remark, “I was lucky,” especially when someone nearby noticed their collapse and performed CPR or defibrillation before emergency medical services personnel had arrived. In Australia, where most out-of-hospital cardiac arrests happen in private residences, this “luck” may simply be that the event was in a public location. But what if we could reduce the role of luck in survival? What if receiving bystander CPR was highly probable, regardless of where the out-of-hospital cardiac arrest occurs?</p><p>Smartphone-activated volunteer responder (SAVR) programs may reduce the element of luck in surviving cardiac arrest. While the technology often garners attention in these initiatives, it is the responders themselves who are its foundation and ultimately determine the impact of the program.</p><p>In this issue of the <i>MJA</i>, Delardes and colleagues report a population-based observational cohort study of the impact of an SAVR program on survival to hospital discharge after sudden cardiac arrest in the community.<span><sup>3</sup></span> The authors analysed data, extracted from the Victorian Ambulance Cardiac Arrest Registry (VACAR), for 9196 out-of-hospital cardiac arrests not witnessed by emergency medical services personnel during 12 February 2018 – 31 August 2023. In 1158 incidents (12.6%), an SAVR arrived on the scene; 897 of these events (77%) were in private residences, and the SAVR arrived before emergency medical services in 564 cases (48.7%). The arrival of SAVRs before emergency medical services was associated with greater likelihood of bystander CPR (adjusted odds ratio [aOR], 7.59; 95% confidence interval [CI], 4.97–11.6), bystander defibrillation (aOR, 16.0; 95% CI, 9.23–27.7), and survival to hospital discharge (aOR, 1.37; 95% CI, 1.02–1.85) than for cases not attended by SAVRs.<span><sup>3</sup></span> The observational nature of the study precludes claims of causality, but the findings are nevertheless significant and contribute to growing international evidence for the positive community impact of SAVR programs.</p><p>A key factor in the success of SAVR programs is responder density, per 100 000 population or square kilometre.<span><sup>4</sup></span> Higher density implies closer proximity of responders to out-of-hospital cardiac arrests, facilitating their more rapid arrival, sometimes before emergency medical services. Delardes and colleagues did not report the number of SAVRs in Victoria or by remoteness, but S","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 10","pages":"502-503"},"PeriodicalIF":6.7,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52674","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094310","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":"Hyperkalaemic cardiac arrest due to cream of tartar ingestion.","authors":"Daniel Yee Lee Ng, Laksmi Govindasamy, Andrew Hughes, Hwee Min Lee","doi":"10.5694/mja2.52670","DOIUrl":"https://doi.org/10.5694/mja2.52670","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020716","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":"Cultivating trust: ethical imperatives to dismantle institutional racism in health care.","authors":"Supriya Subramani","doi":"10.5694/mja2.52675","DOIUrl":"https://doi.org/10.5694/mja2.52675","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975340","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":"Dialysis care in Australia: a call for reform and innovation.","authors":"Dharshana Sabanayagam, Angela Makris, Frederika Sciberras, Nicole J Scholes-Robertson, Germaine Wong","doi":"10.5694/mja2.52672","DOIUrl":"https://doi.org/10.5694/mja2.52672","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034055","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":"Neisseria meningitidis: an uncommon cause of conjunctivitis","authors":"Chloe Story, Tina Marinelli, Simeon Crawford, Amrita Ronnachit","doi":"10.5694/mja2.52665","DOIUrl":"10.5694/mja2.52665","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 10","pages":"498-499"},"PeriodicalIF":6.7,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969916","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 prevalence of intimate partner violence in Australia: a national survey","authors":"Ben Mathews, Kelsey L Hegarty, Harriet L MacMillan, Monica Madzoska, Holly E Erskine, Rosana Pacella, James G Scott, Hannah Thomas, Franziska Meinck, Daryl Higgins, David M Lawrence, Divna Haslam, Sara Roetman, Eva Malacova, Timothy Cubitt","doi":"10.5694/mja2.52660","DOIUrl":"10.5694/mja2.52660","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To estimate the prevalence in Australia of intimate partner violence, each intimate partner violence type, and multitype intimate partner violence, overall and by gender, age group, and sexual orientation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>National survey; Composite Abuse Scale (Revised)—Short Form administered in mobile telephone interviews, as a component of the Australian Child Maltreatment Study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Australia, 9 April – 11 October 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>8503 people aged 16 years or older: 3500 aged 16–24 years and about 1000 each aged 25–34, 35–44, 45–54, 55–64, or 65 years or older.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Proportions of participants who had ever been in an intimate partner relationship since the age of 16 years (overall, and by gender, age group, and sexual orientation) who reported ever experiencing intimate partner physical, sexual, or psychological violence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Survey data were available for 8503 eligible participants (14% of eligible persons contacted), of whom 7022 had been in intimate relationships. The prevalence of experiencing any intimate partner violence was 44.8% (95% confidence interval [CI], 43.3–46.2%); physical violence was reported by 29.1% (95% CI, 27.7–30.4%) of participants, sexual violence by 11.7% (95% CI, 10.8–12.7%), and psychological violence by 41.2% (95% CI, 39.8–42.6%). The prevalence of experiencing intimate partner violence was significantly higher among women (48.4%; 95% CI, 46.3–50.4%) than men (40.4%; 95% CI, 38.3–42.5%); the prevalence of physical, sexual, and psychological violence were also higher for women. The proportion of participants of diverse genders who reported experiencing intimate partner violence was high (62 of 88 participants; 69%; 95% CI, 55–83%). The proportion of non-heterosexual participants who reported experiencing intimate partner violence (70.2%; 95% CI, 65.7–74.7%) was larger than for those of heterosexual orientation (43.1%; 95% CI, 41.6–44.6%). More women (33.7%; 95% CI, 31.7–35.6%) than men (22.7%; 95% CI, 20.9–24.5%) reported multitype intimate partner violence. Larger proportions of participants aged 25–44 years (51.4%; 95% CI, 48.9–53.9%) or 16–24 years (48.4%, 95% CI, ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 9","pages":"440-448"},"PeriodicalIF":6.7,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52660","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034094","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":"Preventing intimate partner violence in Australia: unlocking the primary prevention potential of general practice","authors":"Georgina Sutherland, Karen Block","doi":"10.5694/mja2.52661","DOIUrl":"10.5694/mja2.52661","url":null,"abstract":"<p>Violence against women is a pernicious global public health and human rights problem. It is also preventable. One of the key requisites for evidence-based violence prevention policy and practice is robust and reliable data that identify who experiences violence, the types and patterns of violence perpetrated, and insights into the context and settings in which violence occurs. While no single data source can provide all the answers, in this issue of the <i>MJA</i>, Mathews and colleagues<span><sup>1</sup></span> contribute a crucial piece to the data puzzle.</p><p>Prevalence estimates from their large, nationally representative survey confirm what we know about intimate partner violence in Australia: it is pervasive and frequent; the determinants of risk are complex and multifaceted; it disproportionately affects women and people of diverse genders. Importantly, these findings add nuance to what can be gleaned from previous population-based data on intimate partner violence, such as the Australian Bureau of Statistics Personal Safety Survey.<span><sup>2</sup></span> This includes deeper insights into the nature and extent of specific forms of violence included in the broad categories of physical, sexual, and psychological violence, their polymorphic structure, and how it is perpetrated across all types of intimate relationships.</p><p>In particular, Mathews and colleagues draw attention to the growing, and concerning, body of evidence about the prominence of violence in the intimate relationships of adolescents and young people, especially young women.<span><sup>3, 4</sup></span> The authors report that 48.4% of participants aged 16–24 years have experienced violence in an intimate relationship. For young women, experiences of all types of violence, including multiple, distinct forms of violence was more frequent than for young men of the same age.<span><sup>1</sup></span></p><p>Their findings prompt Mathews and colleagues to join other researchers, policymakers, and advocates in sounding the alarm that intimate partner violence against women, especially young women, remains widespread, despite decades of research, policy, and practice attention.<span><sup>5</sup></span> It is possible that increasing prevalence reflects a greater willingness among young people to disclose violence, and greater awareness of what constitutes violent and abusive behaviour in early intimate and dating relationships. But overall, the findings give pause for thought about how national policy and prevention strategies can be better tailored to reach and influence young people during this critical developmental stage.</p><p>As highlighted by Mathews and colleagues, health systems and clinical care are key settings for effective primary prevention of intimate partner violence and early intervention. First, however, we need a shared understanding of what is meant by prevention. Primary prevention must address gendered social norms, power imbalances and practices that d","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 9","pages":"438-439"},"PeriodicalIF":6.7,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52661","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020718","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":"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}