Medical Journal of Australia最新文献

{"title":"International Women’s Day and the right to health: a view from the clinical frontline","authors":"Aajuli Shukla","doi":"10.5694/mja2.52609","DOIUrl":"https://doi.org/10.5694/mja2.52609","url":null,"abstract":"<p>As this issue of the <i>MJA</i> is published, the world will be celebrating International Women's Day on 8 March 2025 and the rights of women continue to be critical to health. As a general practitioner working in the sphere of women's health for several years now, I have seen the gradual shift towards a more conservative view of women's health and a lack of equity around the management of chronic health issues. Hormone replacement therapy to treat menopause, for instance, continues to be out of reach for many due to high costs and poor access. More broadly, women continue to have experiences with a health system that is often invalidating and traumatic. The impacts of these are especially worse for women from socially disadvantaged backgrounds, Indigenous women, immigrants and refugees, and women with disabilities.</p><p>Menstrual issues are a common presentation in primary care and, despite their high prevalence and impact on daily functioning, they continue to be under-reported and undermanaged. In this issue of the <i>MJA</i>, Wilson and colleagues (https://doi.org/10.5694/mja2.52596) report on heavy menstrual bleeding in a cohort of women participating in the Australian Longitudinal Study on Women's Health from young adulthood to midlife. The prevalence of heavy menstrual bleeding increased from 17.6% at age 22 years to 32.1% at 48 years. Almost a third of the cohort reported heavy menstrual bleeding by middle age that has a significant impact on mood and social and physical functioning. Mean health-related quality of life scores for women who reported heavy menstrual bleeding were lower in all domains and for the summary mental health and physical health scores than for women who reported never or rarely experiencing the condition; the differences were greater for women who often experienced heavy menstrual bleeding. Although the study was unable to examine conditions such as a history of fibroids or adenomyosis as a cause for heavy menstrual bleeding, most middle-aged women in Australia struggle to access progesterone-producing implants due to the cost and lack of access to the service (https://www.bayer.com.au/en/womens-health-collaboration). Worse, if the condition fails to respond to hormonal measures, as noted by my colleagues and I, women struggle to access gynaecological care for further treatment in the current cost-of-living crisis.</p><p>Kirkman and colleagues (https://doi.org/10.5694/mja2.52602), in their research article in this issue of the <i>MJA</i>, found that of the 80 clinical guidelines in Australia they examined, there were varied levels of inclusiveness in dealing with sex and gender matters in health care and most guidelines were at the lower end of the inclusiveness scale. The majority of the 80 guidelines (46 of them) made no mention of clinical practice concerning gender. Only 12 developed ideas of gender in any detail, including discussion of topics such as gender inequality, transgender health and intersectiona","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 4","pages":"163"},"PeriodicalIF":6.7,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52609","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527709","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":"Updating the diagnosis and management of elevated serum ferritin levels in the era of routine ferritin testing of blood donors by Australian Red Cross Lifeblood.","authors":"Gary D Zhang, James Chen, Daniel M Johnstone, Martin B Delatycki, Katie Allen, John K Olynyk","doi":"10.5694/mja2.52618","DOIUrl":"https://doi.org/10.5694/mja2.52618","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516058","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":"Tick tock: the travelling time bomb","authors":"Matthew AK Martin, Maxwell E Olenski","doi":"10.5694/mja2.52615","DOIUrl":"10.5694/mja2.52615","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 6","pages":"300-302"},"PeriodicalIF":6.7,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501941","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":"Mandatory research projects by medical specialist trainees: suboptimal today, world-leading tomorrow?","authors":"Nicholas J Talley AC","doi":"10.5694/mja2.52612","DOIUrl":"10.5694/mja2.52612","url":null,"abstract":"<p>In Australia, the medical colleges have a monopoly on the training of specialists. If you want to be a registered gastroenterologist, a cardiothoracic surgeon, or a general practitioner, you must complete the relevant college training (or an equivalent training program) and meet the minimum expected standards, which are high in this country. Australian specialists are internationally recognised as clinically first rate, as indicated by overall health outcomes,<span><sup>2</sup></span> a testament to our college clinical training programs.</p><p>At most colleges in Australia and in specialty training programs in similar countries, completing a research project during training is mandatory. In this issue of the <i>MJA</i>, Stehlik and colleagues report the results of their cross-sectional survey of research project activity during training in Australia and New Zealand. The survey was sent to college trainees in eleven specialties,<span><sup>3</sup></span> including the Royal Australasian College of Physicians (RACP), which alone has more than 4400 advanced trainees in 2025 (personal communication). A total of 371 responses were obtained, a rather low number. The survey results are consequently not necessarily generalisable, but the results are still sobering. Almost 80% of survey respondents developed their research questions in isolation or on the basis of clinical discussions, more than 50% received little input from others regarding the study design, 85% of projects were not part of ongoing high quality research, most trainees undertook the research in their own time, and 85% of the evaluable studies submitted to the authors of the study had a moderate to high risk of bias, suggesting research waste. On the positive side, half of the projects were published, usually with the trainee as first author, almost 50% of respondents felt that the effort involved was worthwhile, and since completing their fellowships more than 70% had considered initiating new research.<span><sup>3</sup></span></p><p>If producing excellent clinicians is the goal of specialty training, why should we care about the quality of research during training? One could argue that the minority with serious academic interests can pursue these after specialisation by, for example, completing a PhD or equivalent training, although most never do. Indeed, for 40 years it has been recognised that interest in careers as clinician–scientists has been steadily falling in the United States<span><sup>4</sup></span> and Australia.<span><sup>5</sup></span></p><p>Why then should colleges retain mandatory trainee research projects? One compelling reason is that medical knowledge is growing so rapidly that keeping up is challenging.<span><sup>6</sup></span> Evidence-based practice is more important than ever, but this requires critical thinking and analytic skills, including how to read the literature expertly and translate new information into best practice. Arguably, unless you have had appro","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 5","pages":"229-230"},"PeriodicalIF":6.7,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52612","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143502009","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 impact of pay-for-performance incentives for stroke unit access on public hospital costs and use, Queensland, 2012–17: interrupted time series analysis","authors":"Rohan Grimley, Joosup Kim, Helen M Dewey, Nadine E Andrew, Taya A Collyer, Eleanor S Horton, Greg Cadigan, Dominique A Cadilhac","doi":"10.5694/mja2.52607","DOIUrl":"10.5694/mja2.52607","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the impact of pay-for-performance financial incentives for improving stroke unit access in Queensland public hospitals on hospital costs and use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Population-based longitudinal study; interrupted time series analysis of linked hospital admissions, emergency department, and hospital costs data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>First admissions with stroke or myocardial infarction of adult Queensland residents (18 years or older) to public hospitals for more than one day during 1 July 2009 – 31 December 2011 (pre-incentive period), 1 January 2012 – 31 December 2012 (intervention implementation period), and 1 January 2013 – 30 June 2017 (intervention period). Admissions to neurosurgical wards of people with intracerebral haemorrhage were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Intervention</h3>\u0000 \u0000 <p>Queensland Health pay-for-performance program: Quality Improvement Payments (QIP). Initial three years: payments to hospitals contingent on progressively increasing targets for the proportion of people with stroke admitted to acute stroke units. Subsequent years: 10% loading on Diagnosis Related Group-based payments for the care of patients with primary diagnoses of stroke admitted to stroke units.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Changes in level and rates of change of outcomes (hospital length of stay, patient-attributed hospital costs, non-elective hospital re-admissions) for admissions of people with stroke or myocardial infarction (as control condition) before and after the introduction of the QIP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analysed data for 23 572 people admitted with stroke and 39 511 admitted with myocardial infarction. The median acute length of stay did not change significantly during the implementation year for either patient group; and pre-intervention downward trends declined to near zero for both groups. The difference between the pre-incentive and implementation periods in median total hospital costs per patient with stroke was not statistically significant (–$1692; interquartile range [IQR], –$4440 to $1056), in contrast to the difference for patients with myocardial infarction (–$4278; IQR, –$5280 to –$3275). The proportion of non-elective hospital re-admissions was c","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 5","pages":"249-258"},"PeriodicalIF":6.7,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52607","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492194","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":"Mandatory research projects during medical specialist training in Australia and New Zealand: a survey of trainees’ experiences and reports","authors":"Paulina Stehlik, Caitlyn Withers, Rachel C Bourke, Adrian G Barnett, Caitlin Brandenburg, Christy Noble, Alexandra Bannach-Brown, Gerben B Keijzers, Ian A Scott, Paul P Glasziou, Emma C Veysey, Sharon Mickan, Mark Morgan, Hitesh Joshi, Kirsty Forrest, Thomas G Campbell, David A Henry","doi":"10.5694/mja2.52611","DOIUrl":"10.5694/mja2.52611","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine how many specialist trainees are required to conduct research projects, how they conduct these studies, and their views on the value of these activities; to assess the design and reporting quality of their research reports.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Online, anonymous survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Current and recent trainees (past five years) at Australian and New Zealand specialist colleges, recruited through eleven colleges and snowballing; survey was available 31 March – 31 December 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Whether trainees were required to conduct research as part of specialty training; how they conducted their projects; the skills mix of the project team and access to relevant expertise and supervision; trainee views on mandatory research during specialty training; research engagement after training. Respondents were invited to submit project reports for reporting and methodological quality evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 371 people commenced the survey; 361 respondents provided answers about mandatory research projects during specialist training, including 311 (86%) who had been required to complete projects. Seventy-six of 177 people who had completed projects (43%) provided information about 92 projects and submitted 34 project reports for evaluation. Thirty-eight projects (41%) investigated questions developed by the trainees alone; in 48 cases (52%) trainees had planned their projects with little outside input; of the 69 study protocols developed (75% of projects), 60 were developed by the trainees. The median proportion of time devoted to the research project exceeded 50% for trainees in ten of twelve colleges. Respondents typically worked in non-collaborative teams, restricted to members of their own specialty, and additional expertise was limited to statisticians, allied health professionals, and nurses. Eighty-seven of 174 participants who had completed projects (50%) felt that doing so was very or moderately important for their clinical careers; 36 of 67 respondents (54%) supported the requirement for scholarly projects during specialty training; 33 of 61 respondents (54%) had participated in research after completing training, and 44 (72%) had considered doing so. Twenty-five of 34 available reports had been published; in 27 assessable reports,","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 5","pages":"231-239"},"PeriodicalIF":6.7,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52611","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501938","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":"Management of Mycobacterium ulcerans infection (Buruli ulcer) in Australia: consensus statement.","authors":"Stephen Muhi, Victoria Rv Cox, Matthew O'Brien, Jonathan T Priestley, Jodie Hill, Adrian Murrie, Anthony McDonald, Peter Callan, Grant A Jenkin, N Deborah Friedman, Kasha P Singh, Callum Maggs, Peter Kelley, Eugene Athan, Paul Dr Johnson, Daniel P O'Brien","doi":"10.5694/mja2.52591","DOIUrl":"https://doi.org/10.5694/mja2.52591","url":null,"abstract":"<p><strong>Introduction: </strong>Buruli ulcer, caused by Mycobacterium ulcerans, is increasing in incidence and spreading to new areas in southeast Australia. With increasing experience and emerging evidence, this consensus statement considers contemporary data to provide up-to-date recommendations to clinicians who may encounter this disease. The emergence of Buruli ulcer in previously non-endemic areas highlights the importance of increasing clinician and community awareness of this disease. Main recommendations and changes in management as a result of this consensus statement: Buruli ulcer is a notifiable disease in Victoria, the Northern Territory and Queensland. Cases identified in other states or territories should be discussed with relevant health authorities. We call for Buruli ulcer to be made nationally notifiable to monitor for its potential emergence in non-endemic regions. Diagnosis using polymerase chain reaction is sensitive and specific if performed correctly; a dry swab under the undermined edge of ulcers or a tissue sample via punch biopsy if the lesion is not ulcerated is recommended. If swabs are incorrectly performed or performed on non-ulcerated skin, they can give a false negative result. There is high quality evidence to support treatment of eight weeks' duration using rifampicin-based dual oral antibiotic therapy, in combination with clarithromycin or a fluoroquinolone; relapse is very rare but can occur in people with risk factors. There is emerging evidence for shorter durations of treatment (six weeks) in individuals with small lesions who are at low risk of relapse and in those who have undergone surgical excision of the lesion (four weeks). Patients should be warned that ulcers typically enlarge with antibiotic treatment, will not have healed by completion of antibiotics, and take a median of four to five months to heal. Surgical management is usually not required, but may be beneficial to reduce healing times, avoid or reduce the duration of antibiotics, and manage paradoxical reactions. Early identification and treatment of paradoxical reactions is important, as they are associated with increased tissue necrosis and delayed wound healing. Good wound care is critical in successful treatment of Buruli ulcer, as it enhances healing and prevents secondary bacterial infection. Compared with adults, children have a higher proportion of non-ulcerative and severe lesions, are less likely to experience adverse antibiotic effects, but have higher rates of paradoxical reactions; specialist referral is recommended.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483671","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":"Methylphenidate and (lis)dexamfetamine toxicity-related deaths of adults, Australia, 2000–24: analysis of NCIS data","authors":"Shane Darke,&nbsp;Amy Peacock,&nbsp;Johan A Duflou,&nbsp;Michael Farrell,&nbsp;Julia Lappin","doi":"10.5694/mja2.52604","DOIUrl":"10.5694/mja2.52604","url":null,"abstract":"&lt;p&gt;The stimulants methylphenidate, dextroamfetamine, and lisdexamfetamine are prescribed for the treatment of attention deficit hyperactivity disorder (ADHD) in adults.&lt;span&gt;&lt;sup&gt;1-4&lt;/sup&gt;&lt;/span&gt; The prescribing of ADHD medications has increased notably since 2000,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; and, while they are considered to have good safety profiles, the number of poisonings in Australia has also increased.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; Few reports on fatal poisonings with these drugs in adults have been published.&lt;span&gt;&lt;sup&gt;5-8&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;We therefore conducted a retrospective observational study of deaths in Australia of people aged 15 years or older in which methylphenidate or (lis)dexamfetamine toxicity was implicated. We searched records in the National Coronial Information System (NCIS), a database of medico-legal death investigation records provided by the coroners’ courts of each Australian jurisdiction; all suspected drug overdose deaths in Australia must be reported to coroners for investigation. We included all closed cases (deaths in which the coronial process had been completed) of deaths during 1 January 2000 – 30 July 2024 in which methylphenidate was listed in the NCIS drug coding fields set as contributing to death. These fields code for external factors that contributed to death according to the coronial investigation. We also searched records for “ADHD”, “dexamphetamine”, “lisdexamphetamine”, and “dextroamphetamine”, as well as for their registered brand names. The Justice Human Research Ethics Committee (M0063) and the University of New South Wales Human Research Ethics Committee (HC220754) approved the study. Our report conforms with STROBE (Supporting Information) guidelines for observational study reports.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;We identified 64 deaths in which ADHD medications were implicated: 41 methylphenidate-related, 23 (lis)dexamfetamine-related. The mean age at death was 38.2 years (standard deviation, 10.7 years); 45 were men. Substance use problems were documented in 45 cases. Evidence from witnesses or the death scene indicated probable injection of the drug as the terminal event in 18 cases. ADHD diagnoses were documented for 37 people, other mental health problems for 44 people. Fifty-one deaths were deemed unintentional. In 49 cases, death was attributed to polysubstance toxicity; the most frequent clinical presentation form was sudden collapse (20 cases) (Box 1).&lt;/p&gt;&lt;p&gt;Blood toxicology results that covered all major drug classes were available for 63 of 64 deaths. In no case was there evidence for use of both methylphenidate and (lis)dexamfetamine by an individual. In the cases in which they were detected, the median methylphenidate concentration was 0.06 mg/L (interquartile range [IQR], 0.03–0.20 mg/L; range, 0.01–2.50 mg/L); the median amfetamine concentration was 0.11 mg/L (IQR, 0.03–0.40 mg/L; range 0.01–1.20 mg/L). Other drugs were detected in 57 cases, most frequently sedative–hypnotics (35 ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 5","pages":"259-261"},"PeriodicalIF":6.7,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52604","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449220","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":"Social inequalities in eligibility rates and use of the Australian National Disability Insurance Scheme, 2016–22: an administrative data analysis","authors":"George Disney,&nbsp;Yi Yang,&nbsp;Peter Summers,&nbsp;Alexandra Devine,&nbsp;Helen Dickinson,&nbsp;Anne M Kavanagh","doi":"10.5694/mja2.52594","DOIUrl":"https://doi.org/10.5694/mja2.52594","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To assess differences in eligibility rates and use of the National Disability Insurance Scheme (NDIS).&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;Analysis of NDIS unit-record administrative 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;Applicants for NDIS support aged 7 years or older, 1 July 2016 – 31 August 2022 (eligibility analysis); active NDIS participants aged 7 years or older on 31 August 2022 (plan size and spending analyses).&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;Differences in NDIS eligibility rates by broad age group (under 55 years &lt;i&gt;v&lt;/i&gt; 55 years or older), gender (girls and women &lt;i&gt;v&lt;/i&gt; other applicants), and residential socio-economic status (three lowest deciles of the Index of Relative Socioeconomic Disadvantage &lt;i&gt;v&lt;/i&gt; other areas); differences in NDIS personal plan size (allocation) and spending (use) by gender and residential socio-economic status.&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;During 2016–22, 705 594 people aged 7 years or older had applied for NDIS support; 485 676 applicants with recorded decisions were included in our analysis (393 152 eligible, 92 524 ineligible). Eligibility rates were highest for applicants with brain injury or stroke, intellectual disability, or autism (900 or more per 1000 applicants), and only minor inequalities by socio-demographic group were evident. Eligibility rates were lower for applicants with physical disability, psychosocial disability, or unclassified (other) disability (60–75%). Eligibility inequalities were most marked for people with physical disability, with fewer approvals for women and girls than men and boys (145 [95% confidence interval {CI}, 138 − 152] fewer approvals per 1000 applicants), for people aged 55 years or older than for younger applicants (235 [95% CI, 227–242] fewer approvals per 1000 applicants), and for people from lower socio-economic status areas than for those from other areas (86 [95% CI, 78–93] fewer approvals per 1000 applicants). The eligibility rate for applicants with psychosocial disability was lower for women and girls than men and boys (83 [95% CI, 77–89] fewer approvals per 1000 applicants). Inequalities in plan sizes and spending by socio-economic group and gender for the 312 268 active participants at 31 August 2022 were smaller.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 3","pages":"135-143"},"PeriodicalIF":6.7,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52594","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143423806","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":"Addressing inequality of health care","authors":"Michael Skilton","doi":"10.5694/mja2.52601","DOIUrl":"https://doi.org/10.5694/mja2.52601","url":null,"abstract":"&lt;p&gt;Inequality in access to health services and the rising cost of the health system are both challenges to the Australian health system (https://www.health.gov.au/about-us/the-australian-health-system). A number of articles in this issue of the &lt;i&gt;MJA&lt;/i&gt; are relevant to describing the nature of these challenges and how they may be addressed.&lt;/p&gt;&lt;p&gt;The National Disability Insurance Scheme (NDIS) replaced a disability care system that was inequitable and provided limited choice and access to appropriate support. The self-directed nature of the NDIS is designed to, at least in part, overcome these limitations and address deeply rooted barriers that hinder people with disability from fully engaging in society. In this issue, Disney and colleagues used NDIS data to quantify the inequalities in the allocation and use of NDIS support (https://doi.org/10.5694/mja2.52594). They found that older applicants, those who are women or girls, and those living in socio-economically disadvantaged areas are less likely to be deemed eligible for the NDIS. As Smith-Merry and Chang note in their associated editorial (https://doi.org/10.5694/mja2.52587), inequality of access is linked to social inequities, in addition to providing guidance for future research to inform a more tailored and inclusive approach to support provision.&lt;/p&gt;&lt;p&gt;Obesity is a major contributor to the burden of disease in Australia and is strongly linked with social inequalities and disadvantage. After the failure of so many previous anti-obesity medications (https://journals.biologists.com/dmm/article/5/5/621/3257/Anti-obesity-drugs-past-present-and-future), the glucagon-like peptide-1 (GLP-1) receptor agonists provide perhaps a glimpse of light at the end of the tunnel. Supported by strong evidence of both weight loss and broader health benefits, and amidst a wave of viral celebrity engagement, their worldwide usage has skyrocketed. Within this context, Kanellis and colleagues discuss the role of GLP-1 receptor agonists in obesity (https://doi.org/10.5694/mja2.52582), with a specific focus on identifying funding models and models of care relevant for Australia. By addressing these challenges, the potential of GLP-1 receptor agonists to revolutionise obesity care in a sustainable and equitable manner can be fully realised.&lt;/p&gt;&lt;p&gt;There are also challenges on the individual level for patients. The decline in bulk-billing by general practitioners and the current cost of living crisis have affected affordability of health care for many people. Through analysis of Medicare bulk-billing rates and out-of-pocket costs for non-bulk-billed general practitioner services, Saxby and Zhang highlight the differences in access to affordable health care on the basis of geographic region, with those in remote and socio-economically disadvantaged areas of Australia having the highest out-of-pocket costs (https://doi.org/10.5694/mja2.52562). In their associated editorial, Rosenberg and Hickie describe three issues t","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 3","pages":"109"},"PeriodicalIF":6.7,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52601","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143423601","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}