Medical Journal of Australia最新文献

{"title":"Beyond Fibrosis Stratification: Integrating Behavioural, Metabolic and Policy-Level Interventions in Metabolic Dysfunction-Associated Steatotic Liver Disease","authors":"Yousef Hakimi, Prarthana Thiagarajan, Michael Braude","doi":"10.5694/mja2.70309","DOIUrl":"10.5694/mja2.70309","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 10","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081293","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":"Epidemiology and Quality of Care for Aboriginal and Torres Strait Islander Peoples Treated by Emergency Medical Services for Stroke in Victoria, Australia: Retrospective Analysis of Linked Data","authors":"Candice Menezes, Ziad Nehme, Luke J. Burchill, Tegwyn McManamny, Angela Dos Santos, Michelle Crilly, Luke P. Dawson, Benjamin Clissold, David Anderson, Emily Nehme","doi":"10.5694/mja2.70303","DOIUrl":"https://doi.org/10.5694/mja2.70303","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To examine the epidemiology of stroke and transient ischaemic attack (TIA), and quality of care provided to Aboriginal and Torres Strait Islander (‘Indigenous’) patients presenting to emergency medical services (EMSs) with stroke or TIA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective population-based data linkage study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, Participants</h3>\u0000 \u0000 <p>Victoria, Australia. Patients aged ≥ 18 years with hospital-confirmed stroke or TIA who presented to EMSs between 1 January 2015 and 30 June 2019 and were successfully linked with hospital or mortality datasets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Thirty- and 90-day mortality, crude and age-standardised incidence rates, EMS quality of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 32,163 patients, 287 (0.9%) were Indigenous. Indigenous patients were younger than non-Indigenous patients (median age, 62 vs. 77 years, <i>p</i> < 0.001). Age-standardised incidence of EMS attendance was higher within the Indigenous population (343 vs. 144 per 100,000 person-years; incidence rate ratio, 2.383 [95% confidence interval (CI), 2.084–2.711]). Rates of call-taker identification of stroke or TIA and hospital diagnoses were comparable; however, Indigenous patients were less likely to receive a stroke assessment from paramedics (166/285 [58.2%] vs. 21,271/31,605 [67.3%]; <i>p</i> = 0.001) and more frequently taken to stroke-capable hospitals (257/275 [93.5%] vs. 27,371/30,647 [89.3%]; <i>p</i> = 0.027), but less frequently taken to endovascular thrombectomy-capable hospitals (67/275 [24.4%] vs. 10,015/30,647 [32.7%]; <i>p</i> = 0.003). Adjusted mortality was similar between groups (30 days: hazard ratio, 0.814 [95% CI, 0.518–1.279]; 90 days: hazard ratio, 0.805 [95% CI, 0.534–1.214]). However, age-standardised incidence of 90-day mortality was higher within the Indigenous population (39 vs. 24 per 100,000 person-years; incidence rate ratio, 1.621 [95% CI, 1.031–2.398]). Indigenous patients also more often recontacted EMSs for any reason within 90 days (subdistribution hazard ratio, 1.548 [95% CI, 1.194–2.007]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The age-standardised incidence of EMS attendance for stroke in the Indigenous population was more than double that for the non-Indigenous popu","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 10","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068159","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":"Intranasal Adrenaline Use for the Management of Insect Venom-Induced Anaphylaxis","authors":"Thomas J. Young,&nbsp;Wilhelmina R. F. Johnson,&nbsp;Braydon L. Pennington,&nbsp;Troy Wanandy,&nbsp;Wun Y. Lau,&nbsp;Thanh-Thao A. Le","doi":"10.5694/mja2.70306","DOIUrl":"10.5694/mja2.70306","url":null,"abstract":"<div>\u0000 \u0000 <p>Intranasal adrenaline has recently become available in Australia as a needle-free alternative to adrenaline autoinjectors for anaphylaxis management. Intranasal adrenaline may be particularly suitable for patients with barriers to adrenaline autoinjector usage, such as needle aversion or poor compliance with autoinjector carriage. However, although the data supporting real-world efficacy of intranasal adrenaline for anaphylaxis are growing, there is no published evidence confirming its efficacy in insect venom anaphylaxis. We report three cases of intranasal adrenaline (neffy, CSL Seqirus, Victoria, Australia) used to treat insect venom-induced anaphylaxis. Clinicians should be aware of the availability and current level of evidence for intranasal adrenaline for anaphylaxis management.</p>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030840","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":"Living Evidence for Australian Pregnancy and Postnatal Care (LEAPP): Transforming the Australian Pregnancy and Postnatal Care Guidelines","authors":"Miranda S. Cumpston,&nbsp;Anneliese Arno,&nbsp;Shaira N. Baptista,&nbsp;Shannon Barnes,&nbsp;Zoe Bradfield,&nbsp;Samantha P. Chakraborty,&nbsp;Caroline S. E. Homer,&nbsp;Stefan C. Kane,&nbsp;Nisha Khot,&nbsp;Steve McDonald,&nbsp;Steven McGloughlin,&nbsp;Tanya Millard,&nbsp;Jeremy J. N. Oats,&nbsp;Loyal Pattuwage,&nbsp;Matthew Quigley,&nbsp;Abdulbasit Seid,&nbsp;Rachel Silk,&nbsp;Alecia Staines,&nbsp;Anneliese Synnot,&nbsp;Alison Teate,&nbsp;Heath White,&nbsp;Tari Turner,&nbsp;the LEAPP Guideline Development Group","doi":"10.5694/mja2.70301","DOIUrl":"10.5694/mja2.70301","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The Living Evidence for Australian Pregnancy and Postnatal Care (LEAPP) program was established in 2023 to update and transition the <i>Australian Pregnancy Care Guidelines</i> into living guidelines and to establish new, living <i>Australian Postnatal Care Guidelines</i>. The program is a collaboration of the Australian Living Evidence Collaboration (ALEC), the Australian College of Midwives, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and 23 other Australian health organisations. The guidelines are developed using methods designed to meet the National Health and Medical Research Council standards. Clinical questions are prioritised by clinician and lived experience input. For each prioritised question, evidence is reviewed using systematic methods (existing published reviews or conducted de novo), contextual factors such as feasibility and equity are considered and new or updated recommendations are drafted. A lived experience panel and multidisciplinary clinical panels review draft recommendations. Unanimous endorsement by all 25 partner organisations is required before publication. Surveillance searches are conducted for most topic areas every 6 months. New and updated content is progressively added to the published guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Recommendations</h3>\u0000 \u0000 <p>As of August 2026 (version 11), the <i>Australian Pregnancy Care Guidelines</i> include 277 recommendations on more than 80 topics; 229 are new or updated since 2023. The new <i>Australian Postnatal Care Guidelines</i> include 149 recommendations on more than 20 topics. The guidelines are published online at https://livingevidence.org.au/living-guidelines/leapp/.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Changes in Management as a Result of the Guideline</h3>\u0000 \u0000 <p>New or updated recommendations include continuity of care, assessment and support on vaping, increased testing for syphilis, reduced testing for proteinuria, guidance on progesterone and cervical cerclage to prevent preterm birth, bereavement support, assessment and support for psychological birth trauma, screening for family violence, side sleeping in later pregnancy and a recommendation against vitamin D.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030775","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":"Q Fever Visceral Abscesses After Contact With Native Australian Marsupials","authors":"Samantha J. Laws,&nbsp;Enzo Binotto,&nbsp;James Stewart,&nbsp;Jennifer Ho,&nbsp;Trent Yarwood,&nbsp;Josh Hanson,&nbsp;Simon Smith","doi":"10.5694/mja2.70305","DOIUrl":"10.5694/mja2.70305","url":null,"abstract":"<p>We describe two patients in Far North Queensland with acute Q fever. One patient had their infection complicated by a splenic abscess, the other developed a hepatic abscess. Both patients had contact with small Australian marsupials in the weeks before presentation and both required prolonged doxycycline to treat their infection.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024107","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":"Hepatitis C Among First Nations Australians: A Rethink Is Required to Meet the 2030 Elimination Target","authors":"James Ward,&nbsp;Emily Pegler,&nbsp;Kellie Stacy,&nbsp;Stephen Harfield","doi":"10.5694/mja2.70299","DOIUrl":"10.5694/mja2.70299","url":null,"abstract":"<p>Australia aims to eliminate hepatitis C as a public health threat by 2030 among all populations. It is timely to review national elimination efforts for First Nations Australians and discuss what is required to reach elimination targets. In 2020, First Nations Australians accounted for 18% of people living with chronic hepatitis C, despite representing 4% of the population. Over the past 5 years, about 15% of hepatitis C cases notified nationally occurred among First Nations peoples, with slower uptake of curative direct-acting antiviral treatment than non-Indigenous people. Achieving elimination will require implementation of strategies with an equity framework applied to address gaps in data and care cascades for hepatitis C.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024104","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":"Sovereignty and Survival: Understanding Lung Cancer Outcomes for Aboriginal and Torres Strait Islander People in Australia, a Case–Control Study","authors":"Alice R. T. Bergin,&nbsp;Luc te Marvelde,&nbsp;Roger L. Milne,&nbsp;Benjamin J. Solomon,&nbsp;Kris Ivanova,&nbsp;Peter Savas,&nbsp;Stephen J. Luen,&nbsp;Jay Hamann,&nbsp;Andrea Casey,&nbsp;Nicole Watt,&nbsp;Sue M. Evans,&nbsp;Gail Garvey,&nbsp;Sherene Loi","doi":"10.5694/mja2.70278","DOIUrl":"10.5694/mja2.70278","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To identify factors contributing to the known increased age-standardised incidence and mortality rates for lung cancer for Aboriginal and Torres Strait Islander people in Victoria, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Type</h3>\u0000 \u0000 <p>Retrospective, population-based, case–control study using Victorian Cancer Registry (VCR) data and linked health administrative datasets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting and Participants</h3>\u0000 \u0000 <p>Self-identified Aboriginal and Torres Strait Islander people (respectfully referred to hereon as Aboriginal) and non-Aboriginal people (aged &gt; 18 years) diagnosed with lung cancer from 1 January 2008 to 31 December 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Clinical, pathological, demographic, socio-economic factors and biomarkers (programmed cell death-ligand 1 [PD-L1], anaplastic lymphoma kinase [<i>ALK</i>] and <i>c-ros</i> oncogene [<i>ROS1</i>]) were assessed. Endpoints were all-cause and lung cancer-specific mortality. Survival analyses were conducted using Cox regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Aboriginal people (<i>N</i> = 512) were younger (<i>p</i> &lt; 0.001), more likely to live outside a major city (<i>p</i> &lt; 0.001) and in areas of greatest disadvantage (<i>p</i> &lt; 0.001) than non-Aboriginal people (<i>N</i> = 43,468). More Aboriginal females had small cell lung cancer compared with non-Aboriginal females (17% vs. 10%), more Aboriginal males had adenocarcinomas (41% vs. 36%) and squamous cell carcinomas (26% vs. 20%), compared with non-Aboriginal males. There were no differences in the proportions of PD-L1-positive disease nor <i>ALK</i> or <i>ROS1</i> gene rearrangements. A higher risk of all-cause mortality (hazard ratio, 1.12; 95% CI, 1.01–1.24; <i>p</i> = 0.03) for Aboriginal people after stratification for age, sex and lung cancer subtype was identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study identified that Aboriginal people were younger, more likely to be living outside of major cities and in areas of greatest inequity than non-Aboriginal people, which is an ongoing manifestation of colonisation. Aboriginal people diagnosed with lung cancer had an increased all-cause mortality compared with non-Aboriginal people.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70278","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The GenV Biobank: Enabling Biological Research in a Large Longitudinal Population-Representative Cohort of Australian Newborns and Their Parents","authors":"Katherine Lange,&nbsp;Kim L. Powell,&nbsp;Yeukai Mangwiro,&nbsp;Tony Frugier,&nbsp;Donna T. Geddes,&nbsp;Melissa Wake,&nbsp;Richard Saffery","doi":"10.5694/mja2.70304","DOIUrl":"10.5694/mja2.70304","url":null,"abstract":"<div>\u0000 \u0000 <p>Generation Victoria (GenV), Australia's largest population-representative cohort study, has established a scalable and pragmatic approach to biobanking. This article describes the guiding principles used to overcome previous obstacles and build this unique population-representative mega-cohort birth biobank. By prospectively banking residual clinical biosamples and strategically collecting additional biosamples for targeted multi-omics analyses, GenV reduces participant burden while enabling comprehensive biological research. Designed for long-term follow-up from birth through childhood and beyond, the GenV biobank represents an openly accessible resource, available to the Australian biomedical researcher community through established data and biospecimen access pathways.</p>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001959","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":"Unlocking the Potential of Virtual Care in Australian Outpatient Services","authors":"Ramya Walsan,&nbsp;Rebecca Mitchell,&nbsp;Karol Petrovska,&nbsp;Tracey Webster,&nbsp;Reema Harrison","doi":"10.5694/mja2.70302","DOIUrl":"10.5694/mja2.70302","url":null,"abstract":"<p>Virtual care has become a critical component of contemporary health system reform, offering opportunities to improve access, continuity and efficiency of care. Virtual care is particularly relevant for chronic disease management, as it can support more continuous, coordinated and person-centred models of care. This commentary draws on evidence from a national project titled Smarter Hospitals and examines trends in virtual care use across four service areas (cancer, renal disease, mental health or conditions requiring rehabilitation) over 2019–2024, as well as key factors shaping virtual care use and opportunities to realise its full potential.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990591","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":"ADHD Across the Lifespan: Reconsidering Assumptions of Diagnostic Permanence","authors":"Calina Ouliaris","doi":"10.5694/mja2.70298","DOIUrl":"10.5694/mja2.70298","url":null,"abstract":"<div>\u0000 \u0000 <p>Attention-deficit/hyperactivity disorder (ADHD) is increasingly diagnosed across the lifespan, yet there is a growing tendency to treat diagnoses as permanently fixed once assigned. Diagnosis requires not only the presence of characteristic symptoms but also clinically significant functional impairment that is most appropriately explained by ADHD, rather than another condition. Longitudinal evidence demonstrates that ADHD trajectories are heterogeneous and non-linear, with fluctuating symptom expression and variable relationships to functional impairment. Rather than conceptualising an ADHD diagnosis as permanently fixed, greater recognition of this complexity supports longitudinal clinical formulation and more adaptive biopsychosocial care across the lifespan.</p>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982945","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}