Medical Journal of Australia最新文献

{"title":"Advancing equity: the urgent need to include trans and gender diverse people in cervical cancer prevention in Australia.","authors":"Kade Booth, Jamie Bryant, Shiva Chandra, Cristyn Davies, Lucille Kerr, Katie Wynne, Melissa A Carlson, Barrie Shannon, Sav Zwickl, Tamara Butler, Lisa J Whop","doi":"10.5694/mja2.70041","DOIUrl":"https://doi.org/10.5694/mja2.70041","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959359","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 role of GLP-1 receptor agonists in the management of obesity: risks and opportunities for the Australian health care system.","authors":"Patrick Gm Bolton","doi":"10.5694/mja2.70044","DOIUrl":"https://doi.org/10.5694/mja2.70044","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959507","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 role of GLP-1 receptor agonists in the management of obesity: risks and opportunities for the Australian health care system.","authors":"Deshan Sebaratnam, Jessie T Lu, Helen Y Sun","doi":"10.5694/mja2.70042","DOIUrl":"https://doi.org/10.5694/mja2.70042","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959421","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":"Medication delivery and dispensing interval preferences of people who use antihypertensive medications in Australia: a survey study.","authors":"Carissa Bonner, Michael A Fajardo, Rachael M Keast, Emily Atkins, Niamh Chapman, Kristie R Weir, Anthony Rodgers, Aletta E Schutte","doi":"10.5694/mja2.70034","DOIUrl":"https://doi.org/10.5694/mja2.70034","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959405","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":"An Aboriginal women-led approach to design a maternal and child health model when cardiometabolic complications are experienced in pregnancy in South Australia.","authors":"Karrina DeMasi Barkandji, Dana Shen Ngarrindjeri, Phoebe McColl, Amanda Richards-Satour Adnyamathanha And Barngarla, Carolyn Renehan Central Arrernte, Kim Morey Anmatyerr And Eastern Arrernte, Karen Glover Mein Tnk And Wotjobaluk, Cathy Leane Dharug, Kristine Woods-Hampton Anmatijerre, Lorraine Garay Anangu, Eloise Baker Adnyamathanha And Barngarla, Rebecca Nielsen Kalkadoon, Katharine Brown","doi":"10.5694/mja2.70033","DOIUrl":"https://doi.org/10.5694/mja2.70033","url":null,"abstract":"<p><strong>Objective: </strong>To develop a culturally responsive maternal and child health model, centred on Aboriginal and Torres Strait Islander women's knowledge of health, wellbeing and expressed health priorities, to address gaps in care for those who experience cardiometabolic complications in pregnancy.</p><p><strong>Design: </strong>Health services and systems co-design.</p><p><strong>Setting: </strong>Health services in South Australia providing maternal and child primary, acute and chronic disease management care.</p><p><strong>Participants: </strong>Nineteen Aboriginal women from urban, regional and remote areas of South Australia participated in 2024, with most having personal experience of cardiometabolic complications in pregnancy and some contributing professional experience.</p><p><strong>Main outcome measure: </strong>Development of a culturally responsive, evidence-based model of care to support Aboriginal women with cardiometabolic complications in pregnancy.</p><p><strong>Results: </strong>Through a collaborative approach and an iterative co-design process, participants shared lived experiences, identified systemic issues and developed solutions to address gaps in maternal and child health care. Culturally safe spaces enabled deep reflection, open dialogue and collective decision making. With this, we developed a model of care that included a vision statement, guiding principles, a conceptual framework and 18 priority areas. In addition, eight health system enablers were identified to support implementation.</p><p><strong>Conclusion: </strong>This project demonstrates the value of Aboriginal women's leadership in shaping health systems. This process highlights the value of culturally grounded, community-led co-design approaches to health service and system reform. For health systems and service providers and managers, this is an opportunity to foster meaningful change by listening to and acting on the voices of Aboriginal women. In doing so, they will meet their responsibility to address inequities. Researchers and health organisations must do more than amplify these voices; rather, they must listen, act and ensure that systems respond to what women say they need. This is a pivotal moment to drive systemic change for equitable and culturally safe maternal and child health care.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959443","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":"Values in health and health care for Indigenous people globally: an umbrella review.","authors":"Lynda J Coe, Yvonne Dimitropoulos, Kiri Mealings, Dylan Barnes, Catherine M McMahon","doi":"10.5694/mja2.70027","DOIUrl":"10.5694/mja2.70027","url":null,"abstract":"<p><strong>Objectives: </strong>To review and synthesise the global evidence regarding what Indigenous people value in health and health care.</p><p><strong>Study design: </strong>The Joanna Briggs Institute (JBI) protocol for umbrella reviews was used. Thematic meta-synthesis was conducted using collaborative yarning with an Indigenous researcher and a non-Indigenous researcher to generate concepts of value in health and health care.</p><p><strong>Data sources: </strong>Systematic, scoping and narrative reviews, written in English and published between 1 January 2000 and 1 January 2024, which directly included the perspectives of Indigenous people describing the value of health and/or a field of health care, were included. Databases searched included MEDLINE, Embase, CINAHL, Scopus and the Cochrane Database of Systematic Reviews.</p><p><strong>Data synthesis: </strong>Twenty-five reviews that analysed what is valued in health and health care by Indigenous people globally were identified. The literature demonstrated a clear distinction between Indigenous and Western paradigms of health and health care, with Indigenous paradigms grounded in culture. Indigenous cultural determinants of health included: identity; land, Country and community; and spirituality and traditional healing. For health care, five core values for Indigenous people globally were identified: decolonised and holistic systems of care; culturally safe health services and care; Indigenous and culturally aware non-Indigenous workforce; accessibility; and communication, trust and rapport building.</p><p><strong>Conclusions: </strong>This umbrella review highlights the importance of culture, Indigenous sovereignty and self-determination in health and accessing health care. It also reveals the importance of cultural safety and responsiveness in the delivery of health care services. The findings will be used to inform a conceptual framework of values in health and health care to develop a community-reported outcome measure. This framework will guide genuine and meaningful engagement with Indigenous communities to co-design and deliver health care that is effective, responsive and culturally safe.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883145","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":"Socio-economic position and the prevalence of ten chronic diseases in Australia, 2021: a whole of population census data analysis.","authors":"Joanna Y Gong, Emily D Williams, Agus Salim, Spiros Fourlanos, Jonathan E Shaw, Dianna J Magliano","doi":"10.5694/mja2.70032","DOIUrl":"10.5694/mja2.70032","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate differences in the prevalence of specific chronic diseases in Australia by selected measures of socio-economic position, and by age group and sex, using representative national census population data.</p><p><strong>Study design: </strong>Cross-sectional, whole of population study; analysis of 2021 Australian census data.</p><p><strong>Participants, setting: </strong>People aged 40 years or older for whom 2021 Australian census health status and socio-economic position-related data were available.</p><p><strong>Main outcome measures: </strong>Age-standardised prevalence of ten chronic diseases (arthritis, asthma, cancer, dementia, diabetes, heart disease, kidney disease, lung disease, mental health conditions, and stroke), by socio-economic position (Index of Relative Socio-economic Disadvantage [IRSD], income category, educational level, occupational grade), age group, and sex; mean change in prevalence across socio-economic position categories.</p><p><strong>Results: </strong>Health status responses and data that allowed IRSD categorisation were available for 11.3 million people aged 40 years or older (92% of all adults aged 40 years or older). The proportions of people who reported nine chronic diseases (exception: cancer) increased with increasing socio-economic disadvantage as measured by IRSD decile and income. The increases were less marked for people aged 80 years or older than for those aged 40-79 years, and more marked for women than men. For people aged 40-59 or 60-79 years, the increase in age-standardised chronic disease prevalence per one decile decrease in IRSD was greatest for lung disease in both women (40-59 years, 18.4% per decile; 60-79 years, 10.6% per decile) and men (40-59 years, 16.9% per decile; 60-79 years, 11.0% per decile). In people aged 80 years or older, the increase in prevalence per one decile decrease in IRSD was greatest for kidney disease in women (6.0% per decile) and for mental health conditions in men (7.1% per decile). The age-standardised prevalence of cancer decreased by 0.4-1.1% per one decile decrease in IRSD for all age groups and both sexes, except for men aged 40-59 years (increased by 0.1% per IRSD decile). Consistent relationships with educational level or occupational grade were not found.</p><p><strong>Conclusions: </strong>The prevalence of chronic disease differs by socio-economic position, but the direction, magnitude, and consistency of the effect differs by disease, socio-economic position measure, age, and sex. Understanding the relationship between different socio-economic position measures and chronic diseases facilitates the formulation of directed interventions.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873907","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":"Opioids and the challenges of managing chronic non-cancer pain in rural Australia: a qualitative study.","authors":"Jessica A Thomas, Jill Benson, Philip Davidson, Paul R Ward","doi":"10.5694/mja2.70022","DOIUrl":"10.5694/mja2.70022","url":null,"abstract":"<p><strong>Objective: </strong>To investigate why rural general practitioners prescribe opioids for people with chronic non-cancer pain, with the aims of explaining geographic differences in opioid prescribing and improving pain management in rural areas.</p><p><strong>Study design: </strong>Qualitative study; interviews with convenience sample of rural general practitioners.</p><p><strong>Setting, participants: </strong>Seventeen rural general practitioners who had prescribed opioids for people with chronic non-cancer pain during the preceding twelve months; the interviews were undertaken during 11 September 2023 - 31 May 2024.</p><p><strong>Major outcome measures: </strong>Contextual and individual factors that influence decision making by rural general practitioners about prescribing opioids for people with chronic non-cancer pain.</p><p><strong>Results: </strong>We found that rural opioid prescribing is influenced more by health care system deficiencies than lack of knowledge among practitioners. Two major themes were identified: systematic constraints (insufficient time for alternative management strategies and the influence of Medicare remuneration); and limited access to multidisciplinary pain management (limited availability of non-pharmaceutical treatments, colleagues for consultation, and referral pathways). Participants described feeling trapped between brief consultations and complex deprescribing requirements; Medicare remuneration schedules encourage shorter appointments (and therefore continuing current management) rather than comprehensive pain management. Implementing evidence-based guidelines was difficult in rural areas with limited resources. The limited availability of allied health services further restricted alternative pain management approaches. Participants reported greater psychological pressure to justify opioid deprescribing than prescribing. Doctors acknowledged that the evidence for the value of opioids for managing chronic pain was limited but felt caught between inadequate system resources and patient demands.</p><p><strong>Conclusion: </strong>We found a marked disparity between evidence-based guidelines for chronic pain management and the reality of rural medical practice. Rural doctors operating in a difficult context resort to prescribing opioids because of systemic inadequacies rather than lack of awareness of their limited value. Chronic pain management in rural areas could be improved by better Medicare support for longer pain management consultations, improved access to allied health, rural area-specific guidelines that take resource constraints into account, and improved support for general practitioners in pain management and deprescribing.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873906","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":"Federal health workforce policy in Australia and its implications: a descriptive policy document review.","authors":"Stephanie M Topp, Thu Nguyen, Lana M Elliott","doi":"10.5694/mja2.70021","DOIUrl":"https://doi.org/10.5694/mja2.70021","url":null,"abstract":"<p><strong>Objective: </strong>To identify which federal health workforce policies are current in Australia, and describe their mode, scope, and focus.</p><p><strong>Study design: </strong>Descriptive policy document review; categorisation according to the Howlett-Ramesh policy instrument framework.</p><p><strong>Setting: </strong>Health workforce policy documents available on the Australian Department of Health and Aged Care website, 1 June - 31 October 2024.</p><p><strong>Main outcome measures: </strong>Primary policy focus (specific health profession, population group or location); scope of policy (alignment with one or more strategic domains: supply, distribution, or performance), service sectors affected by policy, substantive mention of specific health professions; policy instrument types.</p><p><strong>Results: </strong>We included 121 policy documents in our analysis. By policy group, the number of documents was greatest for the rural health workforce (35), aged care (22), and Aboriginal and Torres Strait Islander health workforce (19); the numbers were lowest for pharmacy (three) and allied health (one), and none had public health or emergency care as their focus. Mixed policy instruments (multiple interest group programs, sub-programs, incentives, grants) were more numerous (98 documents) than government-led instruments (23 documents). Health workforce supply was a focus of 72 documents, performance of 57 documents, and distribution of 42 documents. Document nomenclature was inconsistent; 44 documents had policy labels that did not correspond to their content or purpose.</p><p><strong>Conclusion: </strong>We identified substantial fragmentation in Australian federal health workforce policy. The absence of a unified federal health workforce strategy exacerbates policy fragmentation, undermining coordinated workforce planning and equity. Adopting a consistent policy nomenclature and reducing imbalances in strategic focus are critical for effective health workforce reform. Our findings provide a baseline for analyses of policy processes and governance in Australian health workforce policymaking.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862330","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":"Explaining risk in chronic conditions: the Yolŋu science of signs.","authors":"Emma Haynes, Alison Mitchell, Minitja Marawili Yolŋu, Dawn C Bessarab Bardi","doi":"10.5694/mja2.70031","DOIUrl":"https://doi.org/10.5694/mja2.70031","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873905","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}