Medical Journal of Australia最新文献

{"title":"A future for the hospital-in-the-home (HITH) deteriorating patient: shifting the paradigm","authors":"Aaron BO Wong, Brian H Le","doi":"10.5694/mja2.70056","DOIUrl":"10.5694/mja2.70056","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 8","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069987","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":"Scoping review of variation in clinical guidelines for delivery of injectable long-acting penicillin across Australia and Aotearoa New Zealand.","authors":"Shriyutha Vaka, Lisa J Whop, Sophie J Kirk, Laurens Manning, Rosemary Wyber","doi":"10.5694/mja2.70050","DOIUrl":"https://doi.org/10.5694/mja2.70050","url":null,"abstract":"<p><strong>Objective: </strong>This scoping review explores existing clinical guidelines on administration of benzathine benzylpenicillin (Bicillin L-A, Pfizer Australia) in Australia and Aotearoa New Zealand. The objective is to understand existing delivery guidance to address variation in care and cultural safety considerations, to support messaging during periods of stockout and to inform planning for new administration techniques.</p><p><strong>Data sources: </strong>Semi-structured Google search to identify publicly available clinical resources for each jurisdiction of Australia and for New Zealand. The search was conducted from October to December 2023.</p><p><strong>Design: </strong>Government reports and publicly available clinical guidelines were included. This scoping review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR).</p><p><strong>Results: </strong>This guideline review demonstrates that guidance on administration of Bicillin L-A in Australia and New Zealand has strong, consistent, biomedical recommendations but underdeveloped cultural considerations. Across the features of culturally safe practice, existing clinical guidelines provide consistent information on biomedical knowledge and skills, less information about practising culturally safe behaviours and relatively little guidance on addressing power differentials.</p><p><strong>Conclusions: </strong>Cultural safety inclusions should be considered for future administration guidance development.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033748","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":"Sex- and gender-responsive management of anxiety disorders: future pathways for research, education, policy and practice","authors":"Bronwyn M Graham","doi":"10.5694/mja2.70038","DOIUrl":"10.5694/mja2.70038","url":null,"abstract":"<p>\u0000 \u0000 </p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 7","pages":"372-378"},"PeriodicalIF":8.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033778","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":"Birth prevalence, clinical sequelae, and management of congenital cytomegalovirus infections in Australia, 1999-2023: a national prospective study.","authors":"Ece Egilmezer, Suzy M Teutsch, Carlos Nunez, Stuart T Hamilton, Adam W Bartlett, Pamela Palasanthiran, Elizabeth J Elliott, William D Rawlinson","doi":"10.5694/mja2.70047","DOIUrl":"https://doi.org/10.5694/mja2.70047","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the birth prevalence, clinical manifestations, and management of congenital cytomegalovirus (CMV) infections in Australia, 1999-2023.</p><p><strong>Study design: </strong>Longitudinal observational study; analysis of prospectively collected Australian Paediatric Surveillance Unit (APSU) data.</p><p><strong>Setting, participants: </strong>Australia, 1 January 1999 - 1 January 2024.</p><p><strong>Major outcome measures: </strong>Number of definite congenital CMV infections during study period and after the establishment of universal neonatal hearing screening (1 January 2004); clinical sequelae of definite infections; proportion of infants with symptomatic definite infections treated with antiviral medications.</p><p><strong>Results: </strong>During 1 January 1999 - 1 January 2024, 586 cases of congenital CMV infection were reported to the APSU (8.15 [95% confidence interval, 7.50-8.83] infections per 100 000 births), including 479 definite infections (82%). The most frequent sequelae of definite infections were small for gestational age or intrauterine growth restriction (135 infants, 28.2%); neurological conditions (most frequently: deafness [183, 38.2%], microcephaly [89, 18.6%]); liver disease with jaundice (130, 27.1%), hepatomegaly (75, 15.7%), or hepatitis (85, 14.7%); and bone marrow conditions (most frequently: thrombocytopaenia [139, 29.0%], petechiae/purpura [89, 18.6%]). Of 168 Guthrie card tests (newborn blood spot screening), 154 (91.7%) were CMV-positive (polymerase chain reaction DNA detection), including 143 that provided the sole reason for classifying the cases as definite congenital CMV infections. During 1 January 2004 - 1 January 2024, 447 of 506 cases (88.3%) were definite congenital CMV infections, of which 366 (81.9%) were symptomatic; 116 of these infants (32%) were treated with antiviral medications.</p><p><strong>Conclusions: </strong>The number of reported definite congenital CMV infections during 1 January 1999 - 1 January 2024 was only 1.0% of the number expected in Australia on the basis of their estimated prevalence in developed countries. The number of reported cases has continuously increased since 1999, as has the use of antiviral therapy. Surveillance of congenital CMV infections, the major infectious cause of congenital malformations, needs to be expanded to fully assess their prevalence and the associated disease burden, and to inform prevention strategies.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040076","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":"Cause-specific mortality among Queensland people with cirrhosis, by cirrhosis aetiology and decompensation status, 2007-22: a retrospective cohort study.","authors":"Vikas Bhasker, Jessica R Fong, Paul J Clark, Gunter F Hartel, Richard Skoien, James O'Beirne, Elizabeth E Powell, Patricia C Valery","doi":"10.5694/mja2.70036","DOIUrl":"https://doi.org/10.5694/mja2.70036","url":null,"abstract":"<p><strong>Objective: </strong>To determine the cumulative incidence of overall and cause-specific mortality among Queensland residents admitted to hospital with cirrhosis during 2007-22, by cirrhosis aetiology.</p><p><strong>Study design: </strong>Retrospective cohort study; analysis of linked Queensland Hospital Admitted Patient Data Collection and Queensland Registry of Births, Deaths and Marriages data.</p><p><strong>Setting, participants: </strong>Adult Queensland residents (18 years or older) admitted to Queensland hospitals with cirrhosis during 1 July 2007 - 31 December 2022.</p><p><strong>Main outcome measures: </strong>Ten-year mortality, all-cause and cause-specific (liver-related, extrahepatic cancer, cardiovascular disease), by cirrhosis aetiology.</p><p><strong>Results: </strong>A total of 22 525 people were followed for a median of 6.9 years (interquartile range, 3.5-11.1 years). Their mean age at the index admission with cirrhosis was 61.2 years (standard deviation, 13.0 years), 14 895 were men (66.1%), and the most frequent causes of cirrhosis were alcohol use (9550 people, 42.4%), metabolic dysfunction-associated steatotic liver disease (MASLD; 5108 people, 22.7%), and chronic hepatitis C virus (HCV) infection (4780 people, 21.2%). A total of 12 387 people (55.0%) had died by 31 December 2022; overall mortality among people with alcohol-related cirrhosis was 57.9%, with MASLD cirrhosis 52.1%, and with HCV-related cirrhosis 51.6%. The proportions of deaths attributed to liver disease were larger for people who experienced decompensation during follow-up than those who did not (alcohol-related cirrhosis: 2538 of 3890 deaths [65.2%] v 523 of 1637 [31.9%]; HCV-related cirrhosis: 1158 of 1714 deaths [67.6%] v 331 of 753 [44.0%]). Ten-year liver-related mortality was highest among people with alcohol-related cirrhosis (48.8%; 95% confidence interval [CI], 47.2-50.4%) or HCV-related cirrhosis (44.3%; 95% CI, 42.3-46.3%); ten-year extrahepatic cancer mortality (18.8%; 95% CI, 16.8-20.9%) and cardiovascular disease mortality (15.6%; 95% CI, 13.8-17.7%) were highest among people with MASLD cirrhosis. In multivariable competing risks regression analyses, people with MASLD cirrhosis were less likely than people with alcohol-related cirrhosis to die of liver disease (adjusted subdistribution hazard ratio [sHR], 0.55; 95% CI, 0.51-0.60) and more likely to die of extrahepatic cancer (adjusted sHR, 1.21; 95% CI, 1.04-1.41).</p><p><strong>Conclusions: </strong>Mortality among people who have been hospitalised with cirrhosis is high, and there is substantial variation in cause-specific mortality by cirrhosis aetiology. Care for these patients could be improved by identifying chronic liver disease earlier, and by treating cardiovascular disease and extrahepatic malignancies in people with MASLD.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033745","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":"Adult attention deficit hyperactivity disorder in Australia: how its current commercial model for diagnosis and treatment is encouraging misdiagnosis","authors":"Richard CJ Bradlow,&nbsp;Ferghal Armstrong,&nbsp;Edward Ogden","doi":"10.5694/mja2.70049","DOIUrl":"10.5694/mja2.70049","url":null,"abstract":"&lt;p&gt;Attention deficit hyperactivity disorder (ADHD) in adults is a significant public health issue. It can be associated with adverse outcomes such as educational underachievement, reduced productivity, substance use disorders, involvement in crime, and increased morbidity and mortality.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;From 2013 to 2020, the number of Australians diagnosed with ADHD more than doubled,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; and by 2022–2023, about 470 000 individuals were prescribed ADHD medications — an increase of approximately 300% in ten years.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; This rise, particularly pronounced among adults, is attributed to growing public awareness,&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; amplified by social media platforms such as TikTok where ADHD-related content is reported to have had over 36 billion views.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Most adults with ADHD are diagnosed by private psychiatrists. The dearth of public services for ADHD raises serious concerns regarding equity of access and the potential that normal behavioural variability is “medicalised”.&lt;/p&gt;&lt;p&gt;The growing prevalence of ADHD diagnoses and stimulant prescriptions is controversial, with concerns that many prescribers may not be adhering to relevant prescribing codes.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; There is a risk that complex psychosocial issues may be misattributed to ADHD.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; This latter concern is grounded in psychiatry’s history of over-simplified biological explanations to complex psychosocial causes.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The greater availability of stimulants in the community has contributed to misuse and diversion, particularly in adolescents and young adults for study or recreational activities. In the 2022–2023 national drug strategy household survey, 2.1% of adults report using prescribed stimulants for non-medical purposes in the past year. The highest usage was in the 20–29 year age group where 4.8% reported non-prescribed use in the past year.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; Although the rise in stimulant prescriptions has not led to an increase in stimulant-related deaths,&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; there has been a rise in hospital presentations for stimulant-related poisonings.&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The private model of ADHD diagnosis and treatment in Australia means that patients are often obliged to pay thousands of dollars and spend time on waiting lists before they can be assessed.&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt; This system selects out the people who have the financial capacity to afford the high medical costs and who possess the patience and organisational skills to navigate the complicated system, possibly excluding people who do not have the means to access private psychiatry. ADHD Foundation Australia notes that obtaining an appointment with a psychiatrist is “extremely difficult” and the situation for obtaining diagnosis and treatment is described as having reached a “crisis point”.&lt;span&gt;&lt;sup&gt;12&lt;/sup&gt;&lt;/span&gt; Complex psychosocial i","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 8","pages":"384-386"},"PeriodicalIF":8.5,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033762","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":"Reducing unprofessional practices in referrals to abortion care: proposing a minimum professional standard","authors":"Shelly Makleff,&nbsp;Bronwen Merner,&nbsp;Kirsten I Black,&nbsp;Louise Keogh","doi":"10.5694/mja2.70043","DOIUrl":"10.5694/mja2.70043","url":null,"abstract":"&lt;p&gt;Unprofessional abortion referral practices are a threat to person-centred abortion care. Evidence globally shows that unprofessional abortion referral practices can generate misinformation, communicate judgement, and hinder timely access to care — causing distress and harm to abortion seekers.&lt;span&gt;&lt;sup&gt;1-6&lt;/sup&gt;&lt;/span&gt; These harmful referral practices occur across the health care workforce and are not limited to individuals claiming a conscientious objection.&lt;span&gt;&lt;sup&gt;1-6&lt;/sup&gt;&lt;/span&gt; This suggests a need to define best practice for abortion referral and encourage professionalism in referral practices. Addressing this gap, this perspective article: (i) applies the principles of medical professionalism to abortion referral, (ii) proposes a minimum standard for professional abortion referral, and (iii) identifies strategies across the health system to promote person-centred referrals.&lt;/p&gt;&lt;p&gt;Policy discussions around refusal to participate in abortion care (eg, conscientious objection) often focus on whether the health practitioner is willing to refer an abortion seeker to a willing provider.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Refusing practitioners who do refer are assumed to be acting in line with professional standards, while those who do not refer are generally seen as unprofessional and obstructing care. Although this focus on willingness to refer is warranted, particularly as referral is legally obligated in many jurisdictions,&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; we argue that the act of providing an abortion referral is necessary but not sufficient to meet professional standards. How a referral is carried out is also a critical component of the professional obligations towards abortion seekers.&lt;/p&gt;&lt;p&gt;Abortion-specific guidelines are clear that practitioners who refuse to participate in abortion should refer their patients onwards. For example, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists &lt;i&gt;Clinical guideline for abortion care&lt;/i&gt; states that practitioners who have a conscientious objection to abortion should “inform the woman how to access the closest provider of abortion services within a clinically reasonable time” and “must not impose delay, distress or health consequences on a woman seeking an abortion”, but does not provide further details.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Medical codes of conduct provide additional guidance for ethical and professional behaviour, but these are often broadly worded and cover the entire scope of practice. The Medical Board of Australia &lt;i&gt;Good medical practice: a code of conduct for doctors in Australia&lt;/i&gt; states that all providers should act in their “patients’ best interests when making referrals” and that their personal views should not “adversely affect the care of your patient or the referrals you make”.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;There is also specific guidance for conscientious objection. The Australian Medical Association's position statement on conscientious objection tell","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 7","pages":"346-349"},"PeriodicalIF":8.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015737","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":"Linguistic manoeuvres: obstetric violence camouflages harm and loss of consent from birth","authors":"Harsha Ananthram,&nbsp;Liz Sutton,&nbsp;Rebecca Matthews,&nbsp;Nadine Montgomery,&nbsp;James Titcombe,&nbsp;Ajay Rane","doi":"10.5694/mja2.70045","DOIUrl":"10.5694/mja2.70045","url":null,"abstract":"&lt;p&gt;The recent inquiries into birth trauma in New South Wales (NSW) and the United Kingdom (UK)&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; have led to increased scrutiny of maternity care standards. These inquiries found that a failure to listen, poor communication, and care that lacked balanced information, adequate pain relief and kindness were hurting birthing women. Women also experience harm from unsolicited interventions. The antenatal provision of good quality information is critical to consent at birth. Informing women about available choices during pregnancy, or the decoding of the birth experience after birth, risks being hindered by hyperbolic discussions focused on “obstetric violence”. In this article, we problematise the term “obstetric violence” and suggest that it may confuse harm done to women by the promotion of “normal birth”. In this article, “woman” represents all women and birthing people.&lt;/p&gt;&lt;p&gt;Birth trauma — both physical and psychological — carries lifelong impacts.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Causes include complications in pregnancy, psychosocial circumstances, safety concerns, fear, loss of control, poor clinical communication, lack of respect, unmanaged pain in labour and birth injury.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;There is no consensus regarding the definition of obstetric violence.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Latin American and Caribbean definitions focus on the medicalisation of what is argued to be the natural (by default, good) process of childbirth.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; However, this privileging of the natural obscures trauma that women report from the intentional denial of access to information or interventions during birth.&lt;/p&gt;&lt;p&gt;Birthing women must own the narrative regarding their experiences and name them as they wish. Obstetric violence includes instances of verbal, physical and emotional abuse by clinicians&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; and is not restricted to care provided by obstetricians. Confusingly, obstetric violence appears to malign obstetric practice while obscuring the contribution of others. When women report bullying by midwives as found in this notably small study,&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; it would appear that some female carers risk internalising the very misogyny that they argue they have rejected.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The Royal Australian and New Zealand College of Obstetricians and Gynaecologists states that the term “obstetric violence” is “incorrect and in fact may limit opportunities to reduce patient experience of birth trauma”.&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; Linguistically, obstetric violence — when conflated with “intervention” — furthers an anti-medicalisation/anti-intervention agenda that may compromise patient safety and leave poor behaviour unaddressed. It also raises an important question: what of the violence that results from the promotion of “normal birth”?&lt;/p&gt;&lt;p&gt;For context, the NSW inquiry occurred in the shadow of the “Towards Normal Birth” policy implemented there.&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/s","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 7","pages":"343-345"},"PeriodicalIF":8.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015765","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":"Greenhouse gas emissions associated with anaesthetic gases in Australia, 2002-2022: a retrospective descriptive analysis.","authors":"Krista Verlis, Jessica F Davies, Forbes McGain, Hayden Burch, Alexandra L Barratt, Luise Kazda","doi":"10.5694/mja2.70046","DOIUrl":"https://doi.org/10.5694/mja2.70046","url":null,"abstract":"<p><strong>Objectives: </strong>To assess changes in greenhouse gas emission rates associated with the use of anaesthetic gases (desflurane, sevoflurane, and isoflurane) in Australian health care during 2002-2022, overall and by state or territory and hospital type.</p><p><strong>Study design: </strong>Retrospective descriptive analysis of IQVIA anaesthetic gases purchasing data.</p><p><strong>Setting: </strong>All Australian public and private hospitals, 1 January 2002 - 31 December 2022.</p><p><strong>Main outcome measures: </strong>Absolute carbon dioxide equivalent (CO₂e) emissions and CO₂e emissions rate per 100 000 population by gas and year, overall and by state/territory and hospital type (public or private).</p><p><strong>Results: </strong>The overall emissions rate increased from 74 t CO₂e per 100 000 population in 2002 to 328 t CO₂e per 100 000 population in 2012, most rapidly during 2002-2004 (annual percentage change [APC], 51%; 95% confidence interval [CI], 38-62%). The rate then declined to 83 t CO₂e per 100 000 population in 2022, most rapidly during 2017-2022 (APC, -21%; 95% CI, -23% to -20%). Patterns of emissions rate change were similar for all states and territories. More units of sevoflurane than of desflurane or isoflurane were purchased each year throughout 2002-2022, but desflurane provided the largest proportion of total emissions from anaesthetic gases during 2002-2022: 33% in 2002, 88% in 2013, and 68% in 2022. Mean emission rates per 100 000 population during 2002-2022 were highest for South Australia/Northern Territory (276 t CO₂e per year) and lowest for Victoria/Tasmania (196 t CO₂e per year). The desflurane emissions rate was consistently higher for private than public hospitals; it declined for public hospitals during 2009-2018 (APC, -8%; 95% CI, -10% to -5%) and 2018-2022 (APC, -43%; 95% CI, -48% to -37%), but for private hospitals only during 2017-2022 (APC, -20%; 95% CI, -24% to -17%).</p><p><strong>Conclusions: </strong>In Australia, the CO₂e emissions rate for anaesthetic gases increased during 2002-2008 but declined during 2017-2022, at first primarily in public hospitals. Continuing to reduce the use of anaesthetic gases, particularly desflurane, will advance the decarbonisation of clinical practice in Australian health care.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015719","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":"Incidence of GLP-1 receptor agonist use by women of reproductive age attending general practices in Australia, 2011–2022: a retrospective open cohort study","authors":"Kailash Thapaliya,&nbsp;Arianne Sweeting,&nbsp;Kirsten I Black,&nbsp;Amanda Poprzeczny,&nbsp;Danielle Mazza,&nbsp;Luke E Grzeskowiak","doi":"10.5694/mja2.70026","DOIUrl":"10.5694/mja2.70026","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To examine longitudinal changes in the initial prescribing of glucagon-like peptide 1 (GLP-1) receptor agonists for women of reproductive age in Australia; to determine whether contraception recommendations are being followed; and to estimate the frequency of pregnancy among women using GLP-1 receptor agonists.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Study design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Retrospective open cohort study; analysis of MedicineInsight general practice data.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting, participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Women aged 18–49 years who visited participating general practices three or more times during the study period (1 January 2011 – 31 July 2022).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Main outcome measures&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Age-standardised incidence of initial GLP-1 receptor agonist prescribing, by year and type 2 diabetes status; proportion of women using highly effective contraception at the time of GLP-1 receptor agonist initiation (contraception overlap); age-standardised incidence of pregnancy within six months of the first prescribing of GLP-1 receptor agonists.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Of 1 635 684 women aged 18–49 years, 18 010 (1.1%) were first prescribed GLP-1 receptor agonists during 2011–2022, of whom 3739 (20.8%) had type 2 diabetes. The age-standardised incidence of GLP-1 receptor agonist prescribing for women with type 2 diabetes increased from 13.0 per 1000 women in 2011 to 88.5 per 1000 women in 2022; for women without type 2 diabetes, it increased from 0 to 14.9 per 1000 women. Of the 6293 women first prescribed GLP-1 receptor agonists during 2022, 6954 (90.5%) did not have type 2 diabetes. Contraception overlap with first prescribing of GLP-1 receptor agonists was determined for 3825 women (21.2%). Pregnancies within six months of GLP-1 receptor agonist prescribing were documented for 232 of 10 781 women for whom at least six months of follow-up data were available.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The prescribing of GLP-1 receptor agonists for women of reproductive age is increasing in Australia, and most prescriptions are for women not diagnosed with type 2 diabetes. Fewer than one in four women are using contraception at the time of treatment initiation, and a considerable number are pregnant within six months of the initial prescribing of GLP-1 receptor agonists. Further","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 7","pages":"365-371"},"PeriodicalIF":8.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959458","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}