Medical Journal of Australia最新文献

{"title":"Primary peritonitis in a previously healthy prepubertal female patient","authors":"Danjel Miladinovic, Warren Hargreaves","doi":"10.5694/mja2.52502","DOIUrl":"10.5694/mja2.52502","url":null,"abstract":"<p>A nine-year-old female patient presented with a two-week history of vomiting, diarrhoea, abdominal pain, and a one-week history of dysuria with macroscopic haematuria. There was no recent history of pharyngitis or a skin infection. Her past medical history included medication for attention deficit hyperactivity disorder, but no other significant conditions. On examination in the emergency department, the patient was tachycardic with heart rate 155 beats/minute (reference interval [RI], 70–130 beats/minute), febrile with temperature 38.8°C (RI, 36.4–37.4°C) and her abdomen was soft with generalised tenderness. There was no hypertension or evidence of oedema. Blood results showed leucocytosis with a white cell count of 15.7 × 10<sup>9</sup>/L (RI, 4.5–13.5 × 10<sup>9</sup>/L) and C-reactive protein level of 110 mg/L (RI, < 3 mg/L). There was no associated evidence of toxic shock syndrome. Bedside urine analysis before antibiotic therapy showed leucocytes, blood and protein. The urine sample, as well as a blood and faecal samples were sent for microscopy and culture. Ultrasound scan of the kidneys, ureters and urinary bladder was unremarkable. The patient was admitted for presumed cystitis given little clinical evidence of glomerular nephritis and started on 750 mg intravenous cefazolin.</p><p>Overnight, the patient developed worsening abdominal pain, further vomiting and had ongoing fever. Abdominal examination revealed generalised peritonitis.</p><p>An abdominal ultrasound scan was reported as “suggestive for acute appendicitis”. The patient underwent diagnostic laparoscopy and appendicectomy. Intra-operatively, the appendix appeared normal; however, throughout the abdomen there was turbid fluid and multiple fibrin deposits. The fallopian tubes and ovaries were erythematous (Box) but an intra-operative gynaecological review yielded no concern for pelvic inflammatory disease. In/out catheterisation pre-operatively drained urine with sediment, pus and blood and was again sent for microscopy and culture.</p><p>Both pre- and post-antibiotic therapy urine microscopy and culture showed no significant bacterial growth. The patient had received two doses of 750 mg cefazolin intravenously before operative management. Post-operatively, antimicrobial therapy was escalated to intravenous 4 g piperacillin/0.5 g tazobactam every 8 hours. The post-operative course was uneventful; the patient received five days of intravenous antibiotics and was discharged on Day 5 with no further antimicrobial treatment.</p><p>The patient was well when reviewed two weeks after discharge. On review, the surgical histopathology reported “peri-appendicitis with normal mucosa, moderate acute serositis and underlying neutrophil infiltrate involving the adventitia and muscularis propria only mildly”. Polymerase chain reaction and 16-S molecular testing was not completed but would have been useful for the diagnosis. However, serum anti-DNase B and antistreptolysin O titres were e","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 10","pages":"527-528"},"PeriodicalIF":6.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52502","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522281","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":"Safeguarding the health and wellbeing of transgender young people","authors":"Carmen Pace, Alessandra Chinsen, Ada S Cheung, S. Rachel Skinner, Ken W Knight, Michelle A Tollit, Michelle M Telfer, Ken C Pang","doi":"10.5694/mja2.52504","DOIUrl":"10.5694/mja2.52504","url":null,"abstract":"<p>Transgender (hereafter referred to as trans) people have a gender that is different from the sex assigned to them at birth (Box 1). It is estimated that globally, 1.2–2.7% of people under 19 years identify as trans.<span><sup>1</sup></span> In recent years, there has been a rise in anti-trans campaigns in Australia and overseas. As a result, young trans people are subject to increasing vitriol and discrimination, which represents a clear and present danger to an already marginalised population. The current pattern of public discourse represents a public health risk and poses similar concerns to the debate surrounding marriage equality in Australia several years ago, which had a negative impact on the mental health of LGBTQIA+ people of all ages.<span><sup>2</sup></span></p><p>In this perspective article, we take a health equity, social justice and minority stress lens to the evidence, examine the barriers to health care arising from the politicisation and marginalisation of trans youth, and call for urgent action to safeguard the health and wellbeing of young trans people.</p><p>Despite the documentation of gender diversity in Indigenous cultures over thousands of years,<span><sup>3</sup></span> its existence in Western societies has remained hidden until recently. As trans people have become more visible, societal awareness of gender diversity has improved and more individuals have felt empowered to live authentically as trans. However, this increase has been accompanied by claims of social contagion and fears that trans people represent a threat to fairness in sport, public safety and equality for women.</p><p>This shift in public discourse has been fuelled primarily by disinformation and by accompanying negative and inflammatory media coverage and political debate about young trans people. Media outlets frequently scrutinise trans youth, question their right to socially or medically affirm their gender,<span><sup>4</sup></span> and sensationalise trans identities for “clickbait” (an enticing internet hyperlink, often misleading) and financial gain.<span><sup>4</sup></span> Politicians have similarly engaged in debates questioning the legitimacy of gender-affirming medical treatment for trans youth, inciting division, particularly during election campaigns.<span><sup>5</sup></span> This trend in anti-trans discourse recently culminated in a series of prominent anti-trans rallies across Australia.<span><sup>6</sup></span></p><p>These campaigns have largely been powered by anti-trans groups seeking to restrict the rights of trans people internationally. Broadly united by their view that binary sex and gender are immutable and that trans people are a threat to societal values and safety, this diverse range of groups identifies with trans-exclusionary, radical feminist, religious or simply anti-“gender ideology” causes.<span><sup>7</sup></span> Importantly, they are often funded and supported by religious and right-wing organisations, who have s","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 10","pages":"516-519"},"PeriodicalIF":6.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52504","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503245","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":"Medicare-subsidised mental health service use during the first 15 years of life in New South Wales: a population cohort study","authors":"Oliver J Watkeys, Kimberlie Dean, Kristin R Laurens, Vaughan J Carr, Melissa J Green","doi":"10.5694/mja2.52498","DOIUrl":"10.5694/mja2.52498","url":null,"abstract":"<p>Each year, one in seven Australian children and adolescents experience a mental disorder, but only half receive treatment.<span><sup>1</sup></span> The Australian Institute of Health and Welfare (AIHW) reported that 6% of children aged 5–11 years and 13% of those aged 12–17 years used Medicare-subsidised mental health services during 2021–22.<span><sup>2</sup></span></p><p>We investigated the annual and cumulative incidence of Medicare-subsidised mental health services for children during their first 15 years of life, and the demographic characteristics associated with the types of services used. We analysed Medicare Benefits Schedule (MBS) data for 86 759 children born during 1 January 2002 – 31 December 2005 and included in the New South Wales Child Development Study,<span><sup>3</sup></span> or 94.7% of the record linkage cohort; 4848 children were excluded because information for socio-demographic indices were not recorded in the 2009 NSW Australian Early Development Census.<span><sup>4</sup></span> Record linkage was performed by the NSW Centre for Health Record Linkage (CHeReL) and the AIHW Data Integration Services Centre.</p><p>MBS records for mental health services (1 January 2002 – 31 December 2018) were categorised as being delivered by general practitioners (Better Access treatment plans), psychologists, psychiatrists, occupational therapists or social workers, or other (group therapy, psychological services provided by general practitioners or paediatricians) (Supporting Information, table 1). We assessed associations between demographic factors — sex, Indigenous status, socio-economic position (Index of Relative Socioeconomic Disadvantage),<span><sup>5</sup></span> geographic remoteness (Accessibility/Remoteness Index of Australia)<span><sup>6</sup></span> — and each MBS-subsidised mental health service type in univariable and multivariable logistic regression analyses; we report odds ratios with 99.924% confidence intervals (Bonferroni-adjusted for multiple testing). The NSW Population and Health Services Research Ethics Committee and ACT Health Human Research Ethics Committee (HREC/18/ciphs/49) and the Australian Institute of Health and Welfare Ethics Committee (EO2020/4/1026) approved the study. We report the study in accordance with the STROBE reporting guidelines for observational studies.<span><sup>7</sup></span></p><p>A total of 23 330 of 86 759 children (26.9%) had used MBS-subsidised mental health services prior to their 15th birthdays: 21 535 had received Better Access plans (24.8%), 15 693 had received care from psychologists (18.1%), 2306 had consulted psychiatrists (2.7%), 1844 had received psychological therapy from occupational therapists or social workers (2.1%), and 2391 had received other mental health service types (2.8%) (Box 1). The annual and cumulative incidence of mental health service use each increased exponentially with age for Better Access plans and psychologist care, and more gradually for care from ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 10","pages":"554-557"},"PeriodicalIF":6.7,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52498","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503244","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":"Setting targets, measuring costs, tracking health outcomes and learning lessons","authors":"Virginia Barbour","doi":"10.5694/mja2.52474","DOIUrl":"10.5694/mja2.52474","url":null,"abstract":"<p>This issue of the <i>MJA</i> has a range of articles that examine various aspects of the Australian health system, and which then reflect on the lessons that can be drawn. The articles cover a wide diversity of topics, from stroke targets to hospital-acquired complications, cost barriers to medication access and lessons learnt from the coronavirus disease 2019 (COVID-19) pandemic in remote Aboriginal and Torres Strait Islander communities.</p><p>A perspective by Kleinig and colleagues (https://doi.org/10.5694/mja2.52459) describes the 30/60/90 national stroke targets, which are that, by 2030 in Australia, median times for key interventions for stroke will be under 30, 60 or 90 minutes as appropriate (eg, national median endovascular clot retrieval door-to-puncture time < 30 minutes), and that certified stroke unit care will be provided to more than 90% of patients with primary stroke diagnosis. The authors note the need for a national commitment to meet these targets, and highlight that they are essential, given Australia's lagging position in both speed of treatment and admission to stroke units. Critically, the authors note that there is no need to reinvent the time saving strategies used elsewhere; rather, they need to be adapted to the Australian context.</p><p>In a research article, Ní Chróinín and colleagues (https://doi.org/10.5694/mja2.52462) assess the risk of hospital-acquired complications in people with dementia who were admitted to five public hospitals in the South Western Sydney Local Health District over an eleven-year period. They found that dementia was associated with higher risks of falls, pressure injury, delirium, and pneumonia. This article is an important quantification of risks that might be expected but where the size of the problem has not previously been clear; for example, it shows that patients with dementia were more than four times more likely to fall as matched individuals. It provides more evidence for the need for careful, person-centred care for these vulnerable individuals. In an editorial commenting on the research, Gordon and Hubbard (https://doi.org/10.5694/mja2.52463) noted that this article adds to the evidence of the risks for individuals with dementia, which is closely linked to frailty — itself a risk for hospital-acquired complications. What can be done to reduce these complications? Gordon and Hubbard emphasise the importance of hospital leadership in encouraging attitudes and behaviours that support patient safety, in addition to targeted person-centred interventions.</p><p>Costs of health care are increasingly important and can contribute substantially to cost of living pressures, now widespread across society. In a perspective, Ghinea (https://doi.org/10.5694/mja2.52427) discusses data on access to medication from the Australian Bureau of Statistics (ABS) 2022–23 Patient Experience Survey. They find that there are increasing cost barriers to access compared with previous years, with a dispro","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 8","pages":"401"},"PeriodicalIF":6.7,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52474","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469156","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":"Towards national paediatric clinical practice guidelines","authors":"Mike Starr","doi":"10.5694/mja2.52501","DOIUrl":"10.5694/mja2.52501","url":null,"abstract":"<p><b><i><span>In reply</span></i></b>: I thank Hill and colleagues<span>¹</span> for their interest in my article.<span>²</span> The approach of the Australian Living Evidence Collaboration (ALEC) is impressive and one that guideline developers should aspire to. It is my understanding that the ALEC receives considerable funding from federal and state governments and several charitable foundations. In contrast, the Paediatric Improvement Collaborative (PIC) receives a fraction of ALEC's budget to produce clinical practice guidelines (CPGs). The “iron triangle” refers to the three key constraints that can affect a project.<span>³</span> These are cost, time and quality. It is almost impossible to change one without affecting the others or damaging the quality of the overall project. The approach of PIC CPG development is based on evidence-based medicine (EBM), as described by Sackett and colleagues as the integration of clinical expertise with the best available clinical evidence from systematic research.<span>⁴</span> There are almost 150 PIC CPGs available as point-of-care guidelines for clinicians caring for children, and between 30 and 40 new and updated CPGs are published each year. Within the constraints of the current resources, it is not feasible to use GRADE methods and maintain this output. The current PIC approach to the development of national paediatric CPGs prioritises EBM, collaboration and quality. Significant investment in infrastructure and capacity is required to sustain, and ideally, enhance the process.</p><p>No relevant disclosures.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 10","pages":"564"},"PeriodicalIF":6.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52501","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469154","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":"Mental health-related hospitalisations of adolescents and their contact with child protection services to age 11 years, South Australia: a whole-of-population descriptive study","authors":"Jessica Judd,&nbsp;Rhiannon M Pilkington,&nbsp;Catia Malvaso,&nbsp;Alexandra M Procter,&nbsp;Alicia Montgomerie,&nbsp;Jemma JA Anderson,&nbsp;Jon N Jureidini,&nbsp;Julie Petersen,&nbsp;John Lynch,&nbsp;Catherine R Chittleborough","doi":"10.5694/mja2.52489","DOIUrl":"10.5694/mja2.52489","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 investigate the number of mental health-related hospitalisations of adolescents (12–17 years) in South Australia by level of contact with the child protection system (0–11 years).&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;Whole-of-population descriptive study; analysis of de-identified linked administrative data from the Better Evidence Better Outcomes Linked Data (BEBOLD) platform.&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;Adolescents born in South Australia, 1991–1999; linked SA Department for Child Protection, Admitted Patient Care (SA Health), and South Australian Perinatal Statistics collection (SA Department for Health and Wellbeing) data.&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;Proportion of adolescents (12–17 years) hospitalised with mental health-related diagnoses; proportion of mental health-related hospitalisations of adolescents, by level of child protection contact (0–11 years) (no contact, notification but not screened in, screened-in notification but not investigated, investigation but not substantiated, substantiation, and out-of-home care).&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 175 115 adolescents born during 1991–1999, 5646 (3.2%) had been hospitalised with mental health conditions, and 27 203 (15.5%) had histories of contact with child protection services. The proportion of adolescents admitted to hospital with mental health-related diagnoses increased with the level of prior child protection contact, from 3366 of 147 912 adolescents with no contact (2.3%), to 398 of 6645 with notifications (6.0%), to 209 of 1191 who had been placed in out-of-home care (17.5%). Contact with child protection services was recorded for 2280 of 5646 adolescents admitted to hospital with mental health-related diagnoses (40.4%); 4477 of 10 633 mental health-related hospitalisations (44.9%) were of adolescents with histories of child protection services contact, including 1285 hospitalisations (12.1%) of adolescents for whom substantiated maltreatment (but not out-of-home care) was recorded, and 568 hospitalisations (5.3%) of adolescents who had been placed in out-of-home care.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;About 45% of mental health-related hospitalisations of 12–17-year-old adolescents were of people who had had contact with child pr","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 10","pages":"540-545"},"PeriodicalIF":6.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52489","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469149","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 association of child protection contact with mental health-related hospitalisations of adolescents, and their costs","authors":"Paul Hotton","doi":"10.5694/mja2.52499","DOIUrl":"10.5694/mja2.52499","url":null,"abstract":"&lt;p&gt;Mental health challenges during adolescence are a critical public health concern, especially among young people at particular risk. The study reported by Judd and colleagues&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; in this issue of the &lt;i&gt;MJA&lt;/i&gt; highlights the substantial mental health-related hospitalisation burden among adolescents aged 12–17 years who have had contact with child protection services. In their whole-of-population descriptive study, including 175 115 South Australian adolescents born during 1991–1999, they found that 44.9% of mental health-related hospitalisations were of young people with histories of child protection contact before the age of 11 years, despite only 15.5% of all adolescents having had such contact. Adolescents placed in out-of-home care as children were at particular risk. Strengths of the study include the use of comprehensive linked data; limitations include the non-inclusion of private hospitals data and the underestimation of the overall mental health-related burden by focusing solely on hospitalisations.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The study by Judd and colleagues helps highlight the implications and cost to the health care system of mental health problems among people who had contact with child protection and the importance of developing strength and long term resilience.&lt;/p&gt;&lt;p&gt;The link between child maltreatment and mental health problems is well established,&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; and the impact of multiple forms of child maltreatment has recently been described.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Children who experience abuse and are removed from their families often struggle with mental health or behavioural challenges that make it harder to establish safe, secure, and trusting relationships, and they are at greater risk of mental health problems during adolescence, a key stage in emotional and social development. The trauma of abuse, combined with the instability of the child protection system, leads to complex mental health care needs.&lt;/p&gt;&lt;p&gt;The findings reported by Judd and her colleagues&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; support the view that adolescents who have had child protection contact, especially those placed in out-of-home care, are more frequently hospitalised because of their mental health problems than other adolescents.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; In Australia, mental health care is divided between public and private systems, which leads to challenges and barriers with respect to access, waiting times, resources, and costs, further disadvantaging adolescents with histories of child protection contact.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Differences between services make navigating the health system complex, and available services may not adequately meet the needs of young people, especially if the services are not trauma-informed and culturally safe. The fragmentation of care between providers and sectors often leads to interruption of care and the loss of routine follow-up that could help manage emerging health problems.&lt;span&gt;&lt;","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 10","pages":"531-532"},"PeriodicalIF":6.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52499","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469151","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":"Towards national paediatric clinical practice guidelines","authors":"Kelvin Hill,&nbsp;Steven McGloughlin,&nbsp;Sharon McGowan,&nbsp;Tari Turner","doi":"10.5694/mja2.52500","DOIUrl":"10.5694/mja2.52500","url":null,"abstract":"<p><span>To the Editor:</span> It is encouraging to hear the collaborative effort in paediatric clinical practice guidelines (CPGs).<span>¹</span> CPGs provide a critical tool for clinicians, health administrators and policy makers. We strongly agree that nationally coordinated efforts for evidence synthesis are clearly needed, which can be adapted if required. Starr<span>¹</span> also makes important points around suboptimal adherence to CPGs, including lack of currency and concerns on evidence quality. Evidence is rapidly evolving and previous analysis found that one in five clinical practice recommendations were out of date within three years.<span>²</span> Fortunately, Australia has pioneered living guideline methods, which use frequent (1–3 monthly) surveillance systems and rapid response pathways using robust Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods to ensure recommendations are up to date.<span>³</span> This new model is clearly feasible and has demonstrated an increase in trust, frequency of access and intention to apply advice by stakeholders, in areas as diverse as coronavirus disease 2019 and stroke.<span>^{4, 5}</span> Our experience, contrasting to Starr's, is that this approach is feasible and helpful to develop living guidelines that use reliable GRADE methods and meet National Health and Medical Research Council standards. Living methods (using GRADE) are now considered the gold standard by leading guideline developers such as the National Institute for Health and Care Excellence in England and the World Health Organization. Unfortunately, in Australia there is no national agency to prioritise what guidelines should be developed, let alone sustainable funding to ensure they are kept up to date. We agree with Starr that this must urgently change and call on all governments to invest in CPG infrastructure and capacity. In an age of widespread misinformation and disinformation, it is crucial that Australian clinicians, patients and policy makers have access to reliable, up-to-date, evidence-based information to enable the best possible health care decisions.</p><p>All authors are members of the Australian Living Evidence Collaboration Strategic Advisory Committee.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 10","pages":"564"},"PeriodicalIF":6.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52500","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469153","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":"Physical activity interventions to prevent and manage type 2 diabetes in Aboriginal and Torres Strait Islander people: a systematic review","authors":"Raymond J Kelly,&nbsp;Rona Macniven,&nbsp;Leonid Churilov,&nbsp;Margaret J Morris,&nbsp;David O'Neal,&nbsp;Elif I Ekinci","doi":"10.5694/mja2.52483","DOIUrl":"10.5694/mja2.52483","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 review evidence regarding the impact of physical activity interventions for preventing and managing type 2 diabetes in Aboriginal and Torres Strait Islander Australians.&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;We searched for published reports of physical activity interventions for preventing and managing type 2 diabetes in Indigenous adults (18 years or older). There were no exclusion criteria regarding study type or duration, frequency, length, or intensity of physical activity, except that short term interventions were excluded. We assessed the quality of each study using the Joanna Briggs Institute (JBI) critical appraisal tools and the ethical and methodological quality of studies from an Indigenous Australian perspective with the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE) Critical Appraisal Tool.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Data sources&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;MEDLINE; Scopus, Embase (Elsevier); Cumulative Index to Nursing and Allied Health Literature (CINAHL), Sports Discus, PsycINFO (EBSCO); Informit Complete; ProQuest Dissertations and Theses, and ProQuest Health and Medicine; each from their inception to 30 October 2022.&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;The database searches identified 703 potentially relevant records; after removing duplicates and initial screening, the full text of 27 articles was assessed for eligibility. Nine studies met our inclusion criteria: two randomised controlled trials, five cohort studies, one quasi-experimental study, and one repeated cross-sectional study. Eight studies were rated as being of low or medium quality (median JBI score, 54%; interquartile range [IQR], 36–64%); seven studies were rated as being of low to medium ethical and methodological quality from the Indigenous perspective (median CREATE score, 50%; IQR, 36–64%). Six studies reported changes in glycated haemoglobin (HbA&lt;sub&gt;1c&lt;/sub&gt;) levels, of which two (both cohort studies) reported significantly lower mean HbA&lt;sub&gt;1c&lt;/sub&gt; levels after the intervention, but only one publication provided detailed results. No randomised controlled trials that investigated the effect of a combination of physical activity and dietary change for Indigenous Australians diagnosed with type 2 diabetes were identified. Differences in study design, outcome variables, and the small number of studies precluded meta-analysis.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 9","pages":"486-490"},"PeriodicalIF":6.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52483","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469150","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":"An Aboriginal and Torres Strait Islander adolescent model of primary health care","authors":"Stephen Harfield,&nbsp;Peter Azzopardi,&nbsp;Gita D Mishra,&nbsp;James S Ward","doi":"10.5694/mja2.52484","DOIUrl":"10.5694/mja2.52484","url":null,"abstract":"&lt;p&gt;Aboriginal and Torres Strait Islander adolescents aged 10–24 years represent 30% of the Aboriginal and Torres Strait Islander population.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; As a population group, these adolescents are a strong and resilient cohort. However, the health and wellbeing of Aboriginal and Torres Strait Islander adolescents needs improvement and is generally poorer compared with non-Indigenous adolescents.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; It is during this life stage that the gap in morbidity and mortality widens between Aboriginal and Torres Strait Islander adolescents and non-Indigenous adolescents, and when a difference in mortality between genders also occurs.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; Injury and mental health-related conditions are the leading cause of the increased burden of disease among Aboriginal and Torres Strait Islander adolescents.&lt;span&gt;&lt;sup&gt;2, 4&lt;/sup&gt;&lt;/span&gt; Both injury and mental health-related conditions contribute to higher rates of health system engagement, hospitalisations, mortality and the increased health gap between Aboriginal and Torres Strait Islander adolescents and non-Indigenous adolescents.&lt;span&gt;&lt;sup&gt;2, 4&lt;/sup&gt;&lt;/span&gt; Similarly, pregnancy-related needs among Aboriginal and Torres Strait Islander adolescent females increase health system engagement, which requires different health system functions. Sexually transmitted infections contribute to health system engagement and excess disease burden experienced by Aboriginal and Torres Strait Islander adolescents. Additionally, as does their engagement in health risk behaviours, such as smoking, alcohol and other drug consumption, and poor diet.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Eighty per cent of excess mortality among Aboriginal and Torres Strait Islander adolescents is preventable within the current health system.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; These deaths are “preventable or treatable within the current health system given timely and effective health care”.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; This suggests that within the current health care system, there are many opportunities to intervene and for health gain, and to optimise future health and intergenerational health.&lt;/p&gt;&lt;p&gt;Aboriginal and Torres Strait Islander adolescents access health care services across a range of settings, including community and primary health care, both mainstream and the community-controlled sector, and hospitals and emergency departments. Yet, evidence suggests the health and wellbeing needs of Aboriginal and Torres Strait Islander adolescents are unmet by current health care services.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; Aboriginal and Torres Strait Islander adolescents are less likely to access health care than other groups within the Aboriginal and Torres Strait Islander population.&lt;span&gt;&lt;sup&gt;5, 6&lt;/sup&gt;&lt;/span&gt; Additionally, Aboriginal and Torres Strait Islander adolescents encounter several barriers when accessing health care services, including a lack of culturally appropriate services, financial barriers, geograp","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 10","pages":"512-515"},"PeriodicalIF":6.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52484","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469145","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}