Medical Journal of Australia最新文献

{"title":"Australian and New Zealand joint society consensus statement on genetic testing for monogenic diabetes in adults.","authors":"Sunita Mc De Sousa, Timothy Me Davis, James Harraway, Mark Greenslade, Kathy Hc Wu, Ryan G Paul, Juliet Taylor, Aleena S Ali, Elif I Ekinci, Rinki Murphy, Jerry R Greenfield","doi":"10.5694/mja2.52717","DOIUrl":"https://doi.org/10.5694/mja2.52717","url":null,"abstract":"<p><strong>Introduction: </strong>Monogenic diabetes accounts for 2-5% of diabetes. Although its identification has substantial therapeutic implications, more than 80% of affected individuals are undiagnosed or misdiagnosed as having type 1 or 2 diabetes. This consensus statement reviews genetic testing for monogenic diabetes in adults and provides evidence-based recommendations. With representation from the Australian Diabetes Society (ADS), Endocrine Society of Australia (ESA), Human Genetics Society of Australasia (HGSA), New Zealand Society for the Study of Diabetes (NZSSD) and Royal College of Pathologists of Australasia (RCPA), the writing group: (i) defined questions to be addressed, (ii) conducted critical literature reviews, (iii) graded the evidence, and (iv) generated recommendations that were refined until consensus was achieved. All contemporary literature was considered, with a focus on Australian and New Zealand data, where available.</p><p><strong>Main recommendations: </strong>Indications for genetic testing for monogenic diabetes in adults include: (i) diabetes onset before 12 months of age, (ii) glucokinase (GCK)-hyperglycaemia phenotype, (iii) diabetes onset before 30 years of age without markers of type 1 or 2 diabetes, (iv) syndromic monogenic diabetes phenotype, or (v) high probability of monogenic diabetes using validated screening tools. Individuals undergoing genetic testing should be provided with comprehensive pre- and post-test counselling. Genetic testing typically involves next-generation sequencing, and should include classically syndromic genetic variants (eg, m.3243A>G, HNF1B variants) even in individuals with isolated diabetes. A molecular diagnosis facilitates gene-specific treatment, surveillance, reproductive planning and cascade testing of relatives. In pregnancies of individuals with GCK-hyperglycaemia, maternal treatment can be individualised to known or assumed fetal genotype. Individuals with monogenic diabetes variants of uncertain significance or negative results may be considered for further phenotype or genotype assessment and recruitment into research studies.</p><p><strong>Changes in management: </strong>This consensus statement aims to raise awareness of monogenic diabetes among clinicians involved in the care of patients with diabetes, and to improve genetic testing rates across Australia and New Zealand.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608729","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":"2025 Special Issue on Indigenous Health","authors":"Virginia Barbour,&nbsp;the MJA team","doi":"10.5694/mja2.52700","DOIUrl":"https://doi.org/10.5694/mja2.52700","url":null,"abstract":"<p>We are very proud that this <i>MJA</i> Special Issue on Indigenous health — “Carving our path with spirit, strength and solidarity” — is the second to be edited by a team of Aboriginal and Torres Strait Islander Guest Editors: Professor Pat Dudgeon (Bardi), Professor Jaquelyne Hughes (Wagadagam), Associate Professor Michelle Kennedy (Wiradjuri), Professor Kelvin Kong (Worimi), Professor Odette Pearson (Eastern Kuku-Yalanji and Torres Strait Islander), and Associate Professor Paul Saunders (Biripi). This Special Issue consists of work led by Aboriginal and Torres Strait Islander authors and that underwent careful assessment, discussion, and guidance by the Guest Editors across all stages of the editorial and publication process. The final published articles reflect the care that went into this undertaking. The Editorial<span>¹</span> for this Special Issue is a reflective piece by the Guest Editors, where they examine the vision and impact of this issue. This year, as last,<span>²</span> we received many more articles than could be accommodated in one issue, and we plan to publish additional articles from this Special Issue process later in the year.</p><p>At the <i>MJA</i>, we understand the privilege that it is to publish articles from Aboriginal and Torres Strait Islander researchers. We also understand that a journal like the <i>MJA</i> has a duty to acknowledge and address the imbalance of power that has led in the past to publication in the <i>MJA</i> being a hard and uncomfortable experience for many Aboriginal and Torres Strait Islander authors. As editors of this Journal, we have an ongoing commitment to ensuring that the <i>MJA</i> is a welcoming and respectful place for Aboriginal and Torres Strait Islander authors and their publications, and we look forward to receiving future submissions.</p><p>For the <i>MJA</i> team, it has been an enormous privilege to work with the Guest Editors, and we thank them for their generosity in sharing their time and expertise. We are also very privileged to have on the cover of this Special Issue the powerful carving by Uncle Paul Scott that describes the issue's purpose (Box). His story is a reminder of a shared future: “a story of resilience, of shared journeys, and of walking together, side by side, with respect for each other and the land beneath our feet”.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52700","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573254","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":"Am I on the list? Clinician-reported factors for kidney transplantation non-waitlisting among Aboriginal and Torres Strait Islander people with kidney failure: a cross-sectional study","authors":"Stephen P McDonald AM,&nbsp;Katie Cundale,&nbsp;Christopher E Davies,&nbsp;Kelli Karrikarringka Owen (Kaurna, Nharangga, and Ngarrindjeri),&nbsp;Kerry Dole,&nbsp;Feruza Kholmurodova,&nbsp;Matilda D’Antoine (Paakantyi),&nbsp;Jaquelyne T Hughes (Wagadagam)","doi":"10.5694/mja2.52698","DOIUrl":"https://doi.org/10.5694/mja2.52698","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To describe clinician-reported reasons for non-waitlisting of patients with kidney failure for deceased donor kidney transplantation, and to examine disparities affecting Aboriginal and Torres Strait Islander people.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cross-sectional analysis of data from a national clinical quality registry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants and setting</h3>\u0000 \u0000 <p>Patients receiving dialysis in 26 Australian renal units as of 31 December 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Rates of active waitlisting for kidney transplantation and clinician-reported reasons for non-waitlisting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-six of 1832 Aboriginal and Torres Strait Islander people (2.0%) were actively waitlisted, compared with 512 of 6128 non-Indigenous people (8.4%). For Aboriginal and Torres Strait Islander patients aged &lt; 65 years, 457 of 1204 (38%) were not waitlisted due to a permanent contraindication, 276 (23%) due to a temporary contraindication, and 232 (19%) due to incomplete work-up. Among those with a contraindication, cardiovascular disease was reported as the reason for about a quarter of people in both groups. Obesity was cited for 163 Aboriginal and Torres Strait Islander patients aged &lt; 65 years (22%) and 30 Aboriginal and Torres Strait Islander patients aged ≥ 65 years (10%); in the non-Indigenous group, obesity was cited for 207 (26%) and 163 (9%) patients aged &lt; 65 years and ≥ 65 years, respectively. Cancer was reported for 28 Aboriginal and Torres Strait Islander patients aged &lt; 65 years (4%) and 86 non-Indigenous patients aged &lt; 65 years (11%). Other reasons for non-waitlisting, reported as free text, included patient safety, smoking, age and mental health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Aboriginal and Torres Strait Islander people experience inequities in waitlisting for kidney transplantation across multiple stages of a complex process. Addressing these barriers requires system-level reform and accountability to improve equity in transplantation access.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 1","pages":"46-53"},"PeriodicalIF":6.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52698","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573338","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":"Fulfilling First Nations health, cultural safety and equity accreditation standards in primary medical education: reflections from a First Nations desktop review team","authors":"Paul Saunders,&nbsp;Nicole Mercer,&nbsp;Maria Mackay,&nbsp;Ian Lee,&nbsp;Madelyne Hudson-Buhagiar,&nbsp;Miriam Cavanagh,&nbsp;Emma Milliss,&nbsp;Melody Muscat,&nbsp;Kathleen Martin,&nbsp;Adam Shipp,&nbsp;Melissa Johnson,&nbsp;Belinda Gibb","doi":"10.5694/mja2.52690","DOIUrl":"https://doi.org/10.5694/mja2.52690","url":null,"abstract":"&lt;p&gt;Realising health equality for First Nations Peoples and Communities in Australia and New Zealand (Aotearoa) demands a shift in the way primary medical education providers conceptualise and enact equity, through their functions and programs. Following the release of the &lt;i&gt;Standards for assessment and accreditation of primary medical programs&lt;/i&gt;&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; (2023) by the Australian Medical Council, a desktop review team, comprising First Nations medical education stakeholders from across Australia and Aotearoa, was formed by the Australian Medical Council. The team was tasked with evaluating preliminary self-assessments of primary medical education providers, regarding if and how they are currently positioned to meet the new standards pertaining to First Nations health, cultural safety and equity. In this perspective article, we offer our reflections on the desktop review process. Through sharing our reflections as First Nations Peoples, we aim to inform primary medical education providers and stakeholders of the challenges and benefits in a shared sovereignty approach, to realise meaningful progress in this space, and others.&lt;/p&gt;&lt;p&gt;Most of the authors of this article, but not all, are members of the Australian Medical Council (AMC) Desktop Review Team (DRT) for primary medical programs (9 out of 12 members), as well as members of the AMC Indigenous Policy and Programs (IPP) team (AS, MJ, BG). We are a collective of Aboriginal and Torres Strait Islander Peoples from across Australia (the only Māori DRT member did not opt for authorship on this article), working daily in the medical education context: PS is a Biripi man, NM is a Wadawurrung/Wurundjeri woman, MM (Mackay) is a Wiradjuri woman, IL is a Larrakia/Karajarri man, MH-B is a Wiradjuri woman, MC is a Wonnarua/Kaapay Kuuyun/Yirrganydji/Meriam Mir/Kala woman, EM is a Gundungurra woman, MM (Muscat) is a Bidjara woman, KM is a Central Arrernte/Mara/Bunuba/Kija/Jaru woman, AS is a Wiradjuri man, MJ is a Pitjantjatjara woman and BG is a Dharug woman.&lt;/p&gt;&lt;p&gt;We represent often invisible, yet strong threads, entwined to hold many community relationships, medical schools and societies together. We are united in our efforts to realise a liberatory agenda, one that seeks to progress the medical education space for First Nations Peoples and Communities. Fundamentally, our objective is to amplify First Nations’ conceptualisations, knowledges and voices within medical education, working to attain equality for our peoples through centring equity. We represent great diversity in our cultures, perspectives and experiences; however, are united in our determination to be acknowledged and appreciated within the medical education academy.&lt;/p&gt;&lt;p&gt;We invite you to consider the potentials of social justice and epistemic pluralism within the medical education and health care environments, underpinned by cultural humility. We invite you to conceptualise a space where diverse knowledges, beliefs and rea","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 1","pages":"23-27"},"PeriodicalIF":6.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52690","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573573","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":"Climate and environmental crisis: effects on ear and hearing health in Australia and for Aboriginal and Torres Strait Islander peoples","authors":"Georgia M Tongs (Wiradjuri),&nbsp;Isabella Ludbrook,&nbsp;Jennifer H Martin,&nbsp;Robert Eisenberg,&nbsp;Kelvin M Kong (Worimi)","doi":"10.5694/mja2.52689","DOIUrl":"https://doi.org/10.5694/mja2.52689","url":null,"abstract":"&lt;p&gt;As a collaborative research team, we acknowledge the diverse perspectives, lived experiences, and cultural knowledges that shape our work. We are united in our commitment to examining health and climate through the lens of Aboriginal and Torres Strait Islander peoples, recognising the profound and disproportionate impacts these intersecting issues have on Indigenous communities globally.&lt;/p&gt;&lt;p&gt;Our team includes Aboriginal and Torres Strait Islander researchers, clinicians and allies who bring deep cultural, professional and personal insights to this work. Professor Kelvin Kong AM, a Worimi man and Australia's first Indigenous ear, nose and throat surgeon, has dedicated his career to addressing health inequities, particularly in ear health, guided by cultural values and respect for community leadership. Dr Georgia Tongs, a Wiradjuri woman and emerging researcher, contributes her passion for Indigenous-led health research, strengthened by mentorship and collaboration within the team.&lt;/p&gt;&lt;p&gt;Non-Indigenous team members — Associate Professor Robert Eisenberg, Professor Jennifer Martin, and Dr Isabella Ludbrook — bring their expertise in surgery, public health, climate advocacy, and infectious diseases, while actively engaging in culturally safe, Indigenous-led research practices. Their work is informed by long-standing partnerships with Aboriginal and Torres Strait Islander communities, guided by principles of self-determination, reciprocity and respect.&lt;/p&gt;&lt;p&gt;This research is grounded with Aboriginal and Torres Strait Islander community priorities driving its direction. The project emerged from discussions at the Otitis Media Australia (OMOZ) conference (www.omoz.com.au), where Indigenous health leaders highlighted the urgent need to address otitis media — a condition disproportionately affecting Aboriginal and Torres Strait Islander children — alongside the growing threats of climate change.&lt;/p&gt;&lt;p&gt;We recognise that climate change is not just an environmental issue but a critical health justice issue for First Nations peoples, who face systemic inequities compounded by ecological disruption. Our collective approach centres Indigenous knowledge, resilience, and leadership in developing solutions that promote health equity and climate resilience.&lt;/p&gt;&lt;p&gt;Through this work, we strive to amplify Indigenous voices, uphold cultural authority, and contribute to a future where health and climate policies are shaped by the wisdom and needs of Aboriginal and Torres Strait Islander communities.&lt;/p&gt;&lt;p&gt;We acknowledge the Consolidated criteria for strengthening the reporting of health research involving Indigenous Peoples (CONSIDER) statement&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; and have outlined how each principle was addressed during the research process (Supporting Information).&lt;/p&gt;&lt;p&gt;Otitis media, which is a bacterial infection of the middle ear, is at risk of becoming more prevalent with the progression of climate change. The condition already occurs more frequently in ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 1","pages":"14-18"},"PeriodicalIF":6.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52689","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573600","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":"Taking up the challenge of eliminating racism in health care through talking about race (and culture)","authors":"Chelsea J Watego,&nbsp;David Singh,&nbsp;Kevin Yow Yeh,&nbsp;Helena Kajlich,&nbsp;Saran Singh","doi":"10.5694/mja2.52678","DOIUrl":"https://doi.org/10.5694/mja2.52678","url":null,"abstract":"&lt;p&gt;This perspective article offers a framework for the formulation of an Indigenous antiracist training approach that has been devised through the work of the Queensland University of Technology (QUT)‘s Carumba Institute and Children's Health Queensland Hospital and Health Service (CHQ). Our methodology engages with Indigenist pedagogy, critical race theory, and Indigenous critical race theory to attend to the structural dimension of race; foregrounds Indigenous life worlds, knowledges and experiences; favours institutional transformation over participant satisfaction; and fosters communities of continuing antiracist practice.&lt;/p&gt;&lt;p&gt;All authors of this perspective article are scholars at QUT's Carumba Institute, a world class Indigenous research educational environment that foregrounds Indigenous sovereignty. The Carumba Institute is led by the lead author of this article, Munanjahli and South Sea Islander woman Professor Chelsea Watego, who was born and raised on Yuggera country. She is an Indigenist health humanities scholar, prolific writer and public intellectual, and is one of Australia's leading experts on race and racism. Kevin Yow Yeh is a Wakka Wakka and South Sea Islander man, born and raised on Butchulla/Badjala country, and an educator and researcher interested in race, racism and the pursuit of justice. Dr David Singh, Dr Helena Kajlich and Dr Saran Singh are all non-Indigenous settlers working on the unceded lands of the Turrbal and Yuggera people. Their research is intersectional and focuses particularly on the intersection of race, racism, law and health.&lt;/p&gt;&lt;p&gt;The CONSIDER reporting criteria checklist for health research involving Indigenous peoples&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; was completed for this article and can be found in the Supporting Information.&lt;/p&gt;&lt;p&gt;Despite the Australian Government insisting that it aspires towards a health system “free of racism“,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; there is a contradiction between these grandiose claims and the failure to meaningfully respond to the pervasive crisis of racism within the Australian health system. The aspirational urge to “eliminate” racism disguises the foundational nature of race as a structure of oppression, and the widespread refusal to attend to racism. This persisting refusal to address race and racism in a meaningful way is evidenced in a range of health educational efforts and interventions designed to ameliorate it.&lt;/p&gt;&lt;p&gt;We note the refusal of the &lt;i&gt;Medical Journal of Australia&lt;/i&gt; (&lt;i&gt;MJA&lt;/i&gt;) to publish evidence illuminating how Indigenous peoples experience racial violence within the health system, specifically in regards to how medical rationalisations are deployed to deny the existence of racism.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Inexplicably, an invited editorial on racism in the &lt;i&gt;MJA&lt;/i&gt; special edition on Indigenous health was excluded due to a “defamation risk”, a claim not supported by the independent legal advice the authors obtained. This was not dissimilar to the d","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 1","pages":"4-8"},"PeriodicalIF":6.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52678","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573267","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":"Indigenous Health Special Issue 2025: carving our path with spirit, strength and solidarity","authors":"Paul Saunders (Biripi),&nbsp;Pat Dudgeon (Bardi),&nbsp;Michelle Kennedy (Wiradjuri),&nbsp;Kelvin M Kong (Worimi),&nbsp;Jaquelyne T Hughes (Wagadagam),&nbsp;Odette Pearson (Eastern Kuku-Yalanji and Torres Strait Islander)","doi":"10.5694/mja2.52693","DOIUrl":"https://doi.org/10.5694/mja2.52693","url":null,"abstract":"&lt;p&gt;This Special Issue of the &lt;i&gt;Medical Journal of Australia&lt;/i&gt; builds on the work undertaken with the Lowitja Institute — Australia's only Aboriginal Community Controlled Research Institute — for the inaugural issue in 2024.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; This publication has again been timed to coincide with NAIDOC week, whose 2025 theme “The next generation: strength, vision and legacy” aligns with the &lt;i&gt;MJA&lt;/i&gt;'s purpose, in this issue, to prioritise, platform, and celebrate Aboriginal and Torres Strait Islander leadership and excellence through health, clinical and academic dialogue. This editorial is a reflective piece by the Guest Editors, where we consider the vision and impact of this Special Issue.&lt;/p&gt;&lt;p&gt;As it is in our cultures, we commence by reflecting on a story, a story about a journey, our journey, one that acknowledges our ancestors and our Elders, one that is more than 60 000 years old, and one that guides us on our path forward. Perseverance in the face of adversity is no novel concept for our People. Resilience has been the reality for many Aboriginal and Torres Strait Islander Peoples and Communities for millennia, and this Special Issue seeks to honour that resilience. From extreme climate shifts to megafauna, these vast experiences, borne from Mother Earth, posed many challenges for our ancestors. Yet none were more menacing than the colonial barbarism that followed. The abhorrent physical violence of yesteryear has largely faded, making way for a more subdued, yet equally abhorrent epistemic violence, one that seeks to subjugate and oppress our knowledges. To oppress our knowledges is to invalidate our experiences. To invalidate our experiences is to erase our cultures. To erase our cultures is to dehumanise us. The longevity of our ancient cultures, despite widespread active attempts to erase them, is testament to their strength and beauty, something that should be cherished and celebrated, rather than diminished and oppressed.&lt;/p&gt;&lt;p&gt;A global shift in knowledge production, recognition and dissemination threatens to invalidate and ignore decades of humanitarian-based advancement work undertaken with and by countless Aboriginal and Torres Strait Islander Peoples and Communities. The role of research and scholarship in this climate is central to realising epistemic justice, which cannot be overstated. Following the inaugural Special Issue on Indigenous Health, the &lt;i&gt;MJA&lt;/i&gt; continues to stand beside Aboriginal and Torres Strait Islander Peoples and Communities in the ongoing fight for recognition, reconciliation and self-determination. Given the global and local amplification of epistemic violence experienced by Indigenous Peoples, this fight is important now more than ever. A contemporary silencing of Aboriginal and Torres Strait Islander scholarship is neither crude nor fortuitous, but purposeful, systematic and pervasive. Hard-fought human rights gains by our predecessors and Elders, coupled with greater emphasis on dominant","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 1","pages":"28-29"},"PeriodicalIF":6.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52693","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573594","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":"Core components of a best practice First Nations cancer coordinator role","authors":"Mollie C Wilson,&nbsp;Marissa Mulcahy,&nbsp;Jennifer Philip,&nbsp;Brian H Le,&nbsp;Gail Garvey","doi":"10.5694/mja2.52684","DOIUrl":"https://doi.org/10.5694/mja2.52684","url":null,"abstract":"&lt;p&gt;The health of Aboriginal and Torres Strait Islander peoples (hereafter, respectfully referred to as First Nations Peoples) is holistic and embraces social, emotional, physical, cultural and spiritual wellbeing.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; This goes beyond the mere absence of disease and encompasses connection to land and place, traditional knowledge and healing, equity and social justice. Globally, there is a growing body of Indigenous-led cancer and health initiatives that use Indigenist research approaches and prioritise the needs, perspectives and cultures of Indigenous Peoples and communities.&lt;span&gt;&lt;sup&gt;2-5&lt;/sup&gt;&lt;/span&gt; These approaches acknowledge Indigenous Peoples’ right to self-determination and Indigenous sovereignty.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In Australia, the shift towards First Nations-led health initiatives in cancer care has the potential to positively impact cancer outcomes by promoting a more equitable, culturally safe and effective approach to addressing cancer and policy making with First Nations Peoples. However, there remains much to be done.&lt;/p&gt;&lt;p&gt;Cancer outcomes for First Nations Peoples in Australia continuously fall below the national standards of care.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Although the past decade has seen a reduction in cancer mortality rates for non-Indigenous Australians, the mortality rate for First Nations Peoples has increased by 12% in the same period.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; First Nations Peoples have a higher incidence of fatal, screen-detectable and preventable cancers, are more likely than non-Indigenous Australians to be diagnosed at a later stage of their illness and have a higher likelihood of concurrent complex comorbidities.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;There are several, complex causes for the disparate cancer outcomes experienced by First Nations Peoples, including historical and current policy decisions that have been imposed (and enforced) without consent or consultation.&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; Although these disparities are multifaceted, they are exacerbated by ongoing barriers to access and engagement with high quality cancer care services. Research exploring First Nations Peoples’ experiences and perspectives of cancer care cites multiple barriers, including fear or mistrust of mainstream health services,&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt; experiences of racism,&lt;span&gt;&lt;sup&gt;12&lt;/sup&gt;&lt;/span&gt; health care staff with unconscious biases or limited cultural understanding,&lt;span&gt;&lt;sup&gt;13&lt;/sup&gt;&lt;/span&gt; being away from Country,&lt;span&gt;&lt;sup&gt;14&lt;/sup&gt;&lt;/span&gt; out-of-pocket costs,&lt;span&gt;&lt;sup&gt;15&lt;/sup&gt;&lt;/span&gt; and cultural beliefs or stigma around cancer that elicit feelings of shame and avoidance.&lt;span&gt;&lt;sup&gt;16, 17&lt;/sup&gt;&lt;/span&gt; Engagement is worsened by miscommunication and a lack of care coordination within and between services.&lt;span&gt;&lt;sup&gt;14, 18&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Our team acknowledges the importance of reflexively considering and describing our own backgrounds, perspectives and values that we each contribute to the p","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 1","pages":"19-22"},"PeriodicalIF":6.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52684","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573572","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 voices on the National Lung Cancer Screening Program: a qualitative study from Worimi and Awabakal country","authors":"Tanika L Ridgeway (Worimi),&nbsp;Kayden Roberts-Barker (Wiradjuri),&nbsp;Kade Booth,&nbsp;Michelle Kennedy (Wiradjuri)","doi":"10.5694/mja2.52692","DOIUrl":"https://doi.org/10.5694/mja2.52692","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To gather communities’ perspectives on the upcoming National Lung Cancer Screening Program (NLCSP) to guide appropriate and equitable access and uptake.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Qualitative study using Yarning methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Yarning circles were conducted with Aboriginal and Torres Strait Islander people on Awabakal and Worimi country in December 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-nine Aboriginal and Torres Strait Islander people participated in Yarning circles held at three locations across Awabakal and Worimi country. Community participants felt that the need for equitable and culturally safe NLCSP pathways is critical, with the NLCSP implementation plan and associated guidelines requiring multiple modes of health promotion, flexible eligibility that is equitable, alternative referral pathways to overcome barriers to access, and screening pathways and processes that are culturally responsive and community led.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The NLCSP provides a timely opportunity to improve health outcomes for Aboriginal and Torres Strait Islander peoples. To achieve this, it is essential that the NLCSP is tailored to the needs of each community in accessing preventive health care and upholds rights to self-determination.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 1","pages":"38-45"},"PeriodicalIF":6.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52692","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573601","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":"Decolonising primary health care practice: a definition and its importance","authors":"Tamara J Mackean,&nbsp;Kim O'Donnell,&nbsp;Juanita Sherwood,&nbsp;Shane D'Angelo,&nbsp;Madison Shakespeare,&nbsp;Cleone Wellington,&nbsp;Toby Freeman,&nbsp;Anna M Ziersch,&nbsp;Matt Fisher,&nbsp;Deborah A Askew,&nbsp;Judith M Dwyer,&nbsp;Annette J Browne,&nbsp;Fran Baum AO","doi":"10.5694/mja2.52683","DOIUrl":"https://doi.org/10.5694/mja2.52683","url":null,"abstract":"&lt;p&gt;Decolonising primary health care (PHC) is essential to improving Aboriginal and Torres Strait Islander peoples’ health and wellbeing. Having a definition of decolonising PHC provides a valuable resource for creating and maintaining culturally safe practices within health policy and health services. We developed such a definition through collaboration between Aboriginal researchers, non-Indigenous researchers, PHC services, health professionals and sector stakeholders. Our definition provides a robust basis for (re)building trust with Aboriginal and Torres Strait Islander people through explicit acknowledgement of colonising harms and explicit ways in which these harms can be mitigated. The CONSIDER reporting criteria checklist for health research involving Indigenous peoples&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; was completed for this article and can be found in the Supporting Information.&lt;/p&gt;&lt;p&gt;Australia is, and has been since time immemorial, under the care and custodianship of Aboriginal and Torres Strait Islander Nations.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The British invasion in 1788 and subsequent occupation through its colonial rule and governance, legislation and policy, illegally took control through force with no negotiation or treaty.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Australians continue to occupy contested lands and seas. The violence of colonisation is extreme and ongoing, with the last known massacre of Aboriginal peoples in 1928.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Aboriginal and Torres Strait Islander peoples have been targeted by successive colonist governments resulting in premature deaths, dislocation from lands, suppression of culture and silencing of leaders and advocates.&lt;span&gt;&lt;sup&gt;5, 6&lt;/sup&gt;&lt;/span&gt; Children continue to be stolen from their families through a public service system that remains steeped in its colonial roots.&lt;span&gt;&lt;sup&gt;7, 8&lt;/sup&gt;&lt;/span&gt; The imposition of the colony has disastrous impacts on the health and wellbeing of Aboriginal and Torres Strait Islander peoples.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; Health systems and services are complicit in the imposition of colonial values and are often found to be racist and inaccessible to Aboriginal and Torres Strait Islander peoples.&lt;span&gt;&lt;sup&gt;10, 11&lt;/sup&gt;&lt;/span&gt; Accordingly, a process of decolonisation is vital to ensure that the health system does not continue to perpetuate harm from colonial attitudes and behaviours, including the exclusion of Aboriginal and Torres Strait Islander knowledges and practices regarding health and healing.&lt;span&gt;&lt;sup&gt;10, 12&lt;/sup&gt;&lt;/span&gt; This perspective article seeks to answer the question: how do Aboriginal and Torres Strait Islander PHC services define decolonising practice?&lt;/p&gt;&lt;p&gt;The author group is a mixture of Aboriginal and non-Indigenous researchers across all career stages. TM is a Waljen woman and public health medicine physician; KO is a Malyangapa/Barkindji woman and public health researcher; JS is a Wiradjuri woman and decolonising health researcher; SD is a Kokotha man and I","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 1","pages":"9-12"},"PeriodicalIF":6.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52683","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573252","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}