Medical Journal of Australia最新文献

{"title":"Australasian Diabetes in Pregnancy Society (ADIPS) 2025 consensus recommendations for the screening, diagnosis and classification of gestational diabetes.","authors":"Arianne Sweeting, Matthew Jl Hare, Susan J de Jersey, Alexis L Shub, Julia Zinga, Cecily Foged, Rosemary M Hall, Tang Wong, David Simmons","doi":"10.5694/mja2.52696","DOIUrl":"https://doi.org/10.5694/mja2.52696","url":null,"abstract":"<p><strong>Introduction: </strong>In the context of a global obesity and diabetes epidemic, gestational diabetes mellitus and other forms of hyperglycaemia in pregnancy are increasingly common. Hyperglycaemia in pregnancy is associated with short and long term complications for both the woman and her baby. These 2025 consensus recommendations from the Australasian Diabetes in Pregnancy Society (ADIPS) update the guidance for the screening, diagnosis and classification of hyperglycaemia in pregnancy based on available evidence and stakeholder consultation.</p><p><strong>Main recommendations: </strong>Overt diabetes in pregnancy (overt DIP) should be diagnosed at any time in pregnancy if one or more of the following criteria are met: (i) fasting plasma glucose (FPG) ≥ 7.0 mmol/L; (ii) two-hour plasma glucose (2hPG) ≥ 11.1 mmol/L following a 75 g two-hour pregnancy oral glucose tolerance test (POGTT); and/or (iii) glycated haemoglobin (HbA_1c) ≥ 6.5% (≥ 48 mmol/mol). Irrespective of gestation, gestational diabetes mellitus should be diagnosed using one or more of the following criteria during a 75 g two-hour POGTT: (i) FPG ≥ 5.3-6.9 mmol/L; (ii) one-hour plasma glucose (1hPG) ≥ 10.6 mmol/L; (iii) 2hPG ≥ 9.0-11.0 mmol/L. Women with risk factors for hyperglycaemia in pregnancy should be advised to have the HbA_1c measured in the first trimester. Women with HbA_1c ≥ 6.5% (≥ 48 mmol/mol) should be diagnosed and managed as having overt DIP. Before 20 weeks' gestation, and ideally between ten and 14 weeks' gestation, if tolerated, women with a previous history of gestational diabetes mellitus or early pregnancy HbA_1c ≥ 6.0-6.4% (≥ 42-47 mmol/mol), but without diagnosed diabetes, should be advised to undergo a 75 g two-hour POGTT. All women (without diabetes already detected in the current pregnancy) should be advised to undergo a 75 g two-hour POGTT at 24-28 weeks' gestation.</p><p><strong>Changes in management as a result from this consensus statement: </strong>These updated recommendations raise the diagnostic glucose thresholds for gestational diabetes mellitus and clarify approaches to early pregnancy screening for women with risk factors for hyperglycaemia in pregnancy.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369053","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":"Platform trials: key features, when to use them and methodological challenges.","authors":"Robert Mahar, Steve Webb, Ian Marschner, Andrew B Forbes, Katherine J Lee","doi":"10.5694/mja2.52711","DOIUrl":"https://doi.org/10.5694/mja2.52711","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369054","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":"New evidence supports a greater focus on streptococcal skin infections to prevent rheumatic fever.","authors":"Michael G Baker, Julie Bennett, Teuila Percival, Alison Leversha, Jason Gurney, Nicole J Moreland","doi":"10.5694/mja2.52708","DOIUrl":"https://doi.org/10.5694/mja2.52708","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326120","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":"Factors that affect the provision of medical abortion services in Australian primary care: a mixed methods systematic review.","authors":"Greta Skahill, Mridula Shankar","doi":"10.5694/mja2.52707","DOIUrl":"https://doi.org/10.5694/mja2.52707","url":null,"abstract":"<p><strong>Objectives: </strong>To synthesise primary research findings about factors that affect medical abortion provision by general practitioners, nurses, midwives, and pharmacists in Australia.</p><p><strong>Study design: </strong>Mixed methods systematic review of peer-reviewed primary publications of qualitative, quantitative, and mixed methods studies of the provision of medical abortion in Australian primary care, 1 January 2013 - 18 January 2025.</p><p><strong>Data sources: </strong>MEDLINE, Scopus, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature).</p><p><strong>Data synthesis: </strong>Twenty-three publications satisfied our inclusion criteria. We undertook a thematic synthesis of the qualitative study findings to identify barriers and facilitators of medical abortion provision, and assessed the confidence of each review finding using the GRADE-CERQual approach; we also compared the qualitative synthesis with quantitative study findings. We developed ten review findings grouped under three themes: moral, legal, and regulatory influences on abortion care (three review findings; very low to moderate confidence); the absence of a systems-based approach to abortion provision (six review findings; moderate to high confidence); and early medical abortion belongs in primary care (one review finding; high confidence). Barriers to providing medical abortion include the absence of a supportive service delivery strategy, insufficient Medicare remuneration, geographic isolation, limited access to training, and colleagues who conscientiously object to abortion. Facilitators of its provision include clinician support networks and personal motivation to improve access to reproductive health care.</p><p><strong>Conclusions: </strong>A range of individual, service level, and system factors exacerbate the effects of geographic location and financial considerations on the provision of medical abortion in Australian primary care. Our findings indicate that financial and structural support is needed for the geographic decentralisation of medical abortion training and services, the establishment of nurse-led models of care, and the integration of abortion care into primary care.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317358","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":"Symptom burden, quality of life, and diagnostic journey of people with postural orthostatic tachycardia syndrome, Australia, 2021-24: a descriptive patient registry data study.","authors":"Marie-Claire Seeley, Gemma Wilson, Eric Ong, Amy Langdon, Jonathan Chieng, Danielle Bailey, Kristina Comacchio, Amanda Page, Dennis H Lau, Celine Gallagher","doi":"10.5694/mja2.52710","DOIUrl":"https://doi.org/10.5694/mja2.52710","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326121","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":"A salute to ten years of Australian Clinical Care Standards: celebrations and challenges.","authors":"Alice L Bhasale, Carolyn Hullick, Maria B Sukkar, Anne Duggan","doi":"10.5694/mja2.52697","DOIUrl":"https://doi.org/10.5694/mja2.52697","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317357","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":"Bone health perspectives among Indigenous people: a qualitative study.","authors":"Troy Walker Yorta Yorta, Karan P Singh, Vanessa Gan, Brooke Conley Ngiyampaa, Jessica Bravo, Nigel Smith Weilwan, April Clarke Eastern Maar Kirrae Whurrung Djap Wurrung, Jackson Baker, Louise J Maple-Brown, Robin M Daly, Jennifer Browne, Jesse Zanker, Cat Shore-Lorenti, David Scott, Peter R Ebeling, Ayse Zengin","doi":"10.5694/mja2.52704","DOIUrl":"https://doi.org/10.5694/mja2.52704","url":null,"abstract":"<p><strong>Objectives: </strong>To explore perspectives and beliefs on bone health among Indigenous adults in Victoria.</p><p><strong>Design: </strong>Qualitative focus groups with semi-structured questions. Focus group discussions were analysed for themes and subthemes using an Indigenous research framework based on three concepts: Ways of Knowing, Ways of Being and Ways of Doing.</p><p><strong>Setting, participants: </strong>Focus groups were conducted at Aboriginal Community-controlled organisations and Community centres. Men and women aged ≥ 35 years who identified as Indigenous and were able to give informed consent were invited to participate.</p><p><strong>Results: </strong>Eighty-two Indigenous people participated in twelve focus groups across ten sites in Victoria. Most participants (64) were women, and the majority lived in metropolitan centres, regional centres and large rural towns (Modified Monash categories 1-3). Five themes were developed around the Indigenous framework proposed by Karen Martin-Booran Mirraboopa - Ways of Knowing, Ways of Doing and Ways of Being - which guided participants in identifying knowledge of exercise for bone and muscle health; connection to Country; importance of regular preventive health activities; food and nutrients as good medicine for bone health; and healthy futures for Community through education. An overarching theme of holistic health, including the aspect of spirituality and related lifestyle factors pertaining to musculoskeletal health, was highlighted.</p><p><strong>Conclusion: </strong>Increasing bone health awareness by a co-created Community education program was valued as it would be beneficial for Indigenous people across the life course. To be effective, incorporating traditional Indigenous ways and knowledge along with present-day health evidence is required.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310143","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":"Health: a complex and intertwined problem","authors":"Virginia Barbour","doi":"10.5694/mja2.52694","DOIUrl":"https://doi.org/10.5694/mja2.52694","url":null,"abstract":"&lt;p&gt;This issue of the &lt;i&gt;MJA&lt;/i&gt; covers a wide spectrum of topics, ranging from nuclear war — possibly the biggest potential threat to human health — through to articles on a variety of topics of practical clinical relevance.&lt;/p&gt;&lt;p&gt;Beginning with an editorial on nuclear war,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; this multijournal, international editorial is targeted to support work being undertaken at the World Health Assembly to lobby for the re-establishment of a mandate at the World Health Organization (WHO) to address the health consequences of nuclear weapons and war.&lt;/p&gt;&lt;p&gt;This editorial follows on from one published in 2023 from the same group of international authors, including from this journal.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; That editorial called for a range of actions, including a verifiable, timebound agreement to eliminate nuclear arsenals. The lack of progress on these aims makes this current editorial even more important.&lt;/p&gt;&lt;p&gt;Medical professionals have a unique authority to advocate on the dangers of nuclear war and the editorial reinforces that: “Health professionals and their associations should urge their governments to support such a mandate and support the new United Nations comprehensive study on the effects of nuclear war”. The urgency and rationale for these calls are clear. As this new editorial states, there is “compelling evidence of the catastrophic humanitarian consequences of nuclear war, its severe global climatic and famine consequences, and the impossibility of any effective humanitarian response”. We will continue to advocate with colleagues internationally on this threat.&lt;/p&gt;&lt;p&gt;Turning to articles of immediate clinical importance, especially as we head into the southern hemisphere winter, this issue includes a highly topical pair of articles on respiratory syncytial virus (RSV) infection — a disease that predominantly affects infants, the most vulnerable in our community.&lt;/p&gt;&lt;p&gt;The first, a research letter by Bloomfield and colleagues,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; reports exciting new information on the effect of nirsevimab immunisation of infants on RSV-associated hospitalisations from Western Australia in 2024. This research letter describes outcomes after the approval of nirsevimab in November 2023 in Australia and then a commitment by the WA government to an age-inclusive universal nirsevimab program. The research letter reports that “immunising 71% of infants prior to and during the RSV season was associated with 57% fewer admissions [from RSV]”. These are important initial results. Implementation and monitoring are ongoing on a national level; these results will be important for future programmatic planning. The second article, a narrative review by Barnett and colleagues,&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; describes the current state of RSV preventives for children and outlines the logistical and other considerations for future immunisation programs.&lt;/p&gt;&lt;p&gt;Finally, the &lt;i&gt;MJA&lt;/i&gt; has an ongoing interest in publishing on climate and healt","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 11","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52694","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144292215","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":"Is it time to retire the label \"CALD\" in public health research and practice?","authors":"Sabine Allida, Della Maneze","doi":"10.5694/mja2.52705","DOIUrl":"https://doi.org/10.5694/mja2.52705","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285144","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":"Health and economic benefits of improving pre-hospital identification of stroke in Australian women: a modelling study.","authors":"Thomas Gadsden, Lei Si, Emily R Atkins, Cheryl Carcel, Xia Wang, Stephen Jan, Mark Woodward, Laura E Downey","doi":"10.5694/mja2.52701","DOIUrl":"https://doi.org/10.5694/mja2.52701","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the long term gains in life years and quality-adjusted life years (QALYs) and the cost savings that could be achieved if ischaemic stroke was identified in women with the same level of accuracy received by men, versus the status quo.</p><p><strong>Design: </strong>Decision tree and Markov model decision analysis.</p><p><strong>Settings, participants: </strong>Two arms including 5513 women aged under 70 years: a hypothetical scenario, in which women receive the same level of accuracy of stroke identification as men (yet experienced symptoms relevant to women); and the status quo. Transitions between post-stroke health states, recurrent stroke and death were made in 1-year cycles over 50 years from a societal perspective.</p><p><strong>Main outcome measures: </strong>Years of life lived, QALYs and costs per patient in the hypothetical scenario relative to the status quo. Results were extrapolated to the national level based on the annual number of ischaemic stroke hospitalisations among women across Australia in the financial year 2020-21.</p><p><strong>Results: </strong>Compared with the status quo, the hypothetical arm gained 0.14 years of life, gained 0.08 QALYs and saved $2984 per patient. At the national level, for the financial year 2020-21, this equates to 252 life years and 144 QALYs gained, and cost savings of $5.4 million. Outcomes were most sensitive to the probability of an accurate assessment of stroke, short term treatment costs, patient age, and transition probabilities to 90-day post-stroke health states.</p><p><strong>Conclusions: </strong>Enhancing the timely and accurate identification of ischaemic stroke among Australian women in the pre-hospital setting would yield significant health benefits and cost savings to Australian society as a whole.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285143","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}