Medical Journal of Australia最新文献

{"title":"Theme issue on women's health: taking a holistic view","authors":"Francis Geronimo","doi":"10.5694/mja2.52469","DOIUrl":"10.5694/mja2.52469","url":null,"abstract":"<p>Women's health is an essential aspect of global public health that is not only crucial for the individuals affected but also has far-reaching implications for family dynamics, community cohesion, and overall economic stability. While, globally, complications during pregnancy and childbirth remain a leading cause of morbidity and mortality among women of reproductive age, women's health encompasses broad areas of health and wellbeing including non-communicable diseases (NCDs), mental health, and gender-based violence. In these areas important health disparities exist among women and between genders at local, national and global levels. Tackling these health gaps requires an appreciation of their historical, social, environmental and economic roots.</p><p>This issue of the <i>MJA</i> is dedicated to women's health. Ramson and colleagues (https://doi.org/10.5694/mja2.52452) set the scene with a discussion on the opportunities afforded by maternal care contexts for addressing NCDs. Low- and middle-income countries struggle with a mix of NCDs and other health challenges, with evidence indicating that women in these regions experience higher rates of multimorbidity compared with men. The authors explain that a life course approach to women's health, with a focus on addressing NCDs early, can improve maternal and child health outcomes, necessitating enhancements in sexual, reproductive, maternal, newborn and child health services. They propose that policy recommendations should include establishing standardised definitions for NCDs to improve data collection, focusing on primary prevention strategies, integrating care services, addressing inequalities, and providing global guidelines for the management of NCDs in maternity care.</p><p>A noteworthy area of concern in Australian women's health is equitable access to contraception and family planning services, which is a particular challenge in rural and remote areas where health care services may be limited (https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/ReproductiveHealthcare/Report/Chapter_2_-_Enhancing_access_to_contraceptives). Research by Perkins and colleagues (https://doi.org/10.5694/mja2.52438) explored general practitioners’ views on postpartum contraception counselling and provision during postnatal checks. Three themes were generated: preferences for counselling timing, the provision of long-acting reversible contraception (LARC), and opportunities for improving postpartum care. Participants expressed a desire to discuss contraception but had differing opinions on the timing of these discussions, often feeling that postpartum checks were not the ideal moment. While most recommended intrauterine devices (IUDs) and implants as preferred contraceptives, barriers such as long waiting times and insufficient training for IUD insertion limited their provision. Recommendations for improving postpartum contraception care included enhanced training opportunities, fin","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 7","pages":"349"},"PeriodicalIF":6.7,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52469","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378024","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":"Perceived stakeholder benefits of continuously training general practitioners in the same rural or remote practice: interviews exploring the Remote Vocational Training Scheme","authors":"Belinda G O'Sullivan, Patrick Giddings, Matthew R McGrail","doi":"10.5694/mja2.52446","DOIUrl":"10.5694/mja2.52446","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Explore stakeholder perspectives of the benefits of continuously training general practitioners in the same rural or remote practice in distributed locations via the Remote Vocational Training Scheme (RVTS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, setting, participants</h3>\u0000 \u0000 <p>Online one-hour semi-structured interviews were conducted with 27 RVTS staff, participants and supervisors from all states and territories between 16 October and 24 November 2023. Data were deductively and inductively coded by stakeholder type and the range of benefits, and the findings were informed by insights from a project reference group and a stakeholder advisory group. Questions explored the benefits of the RVTS — a program which supports doctors already working in rural, remote and First Nations communities to train towards general practice or rural generalist fellowship while remaining in the same practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcomes measures</h3>\u0000 \u0000 <p>Perspectives on the nature and spread of benefits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Broad benefits were perceived to flow to four system-level stakeholders: communities, health services, participants and policy makers. Perceived participant and community benefits were doctors staying longer in distributed locations with tailored place-based supports and training, doctors building relationships with patients, and doctors learning through longitudinal care. Health service benefits included reduced reliance on locums, improved continuity of accessible and appropriate services in areas otherwise facing major recruitment and retention issues, and the doctors having more time to contribute to improving service quality and upskilling local staff. Policy-maker benefits were sustaining safe and high quality services for distributed populations with high needs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The RVTS model was perceived to offer diverse benefits for different system stakeholders which could improve quality of learning, service delivery and community care. It also aligned with key policy directions for a distributed and sustainable generalist workforce under the goals of the National Medical Workforce Strategy 2021–2031 and the directions set by the independent review of overseas health practitioner regulatory settings led by Robyn Kruk. However, models like the RVTS largely rely on distribution levers to recruit more doctors to the locations it su","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S7","pages":"S29-S34"},"PeriodicalIF":6.7,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52446","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378038","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":"Continuity of service and longer term retention of doctors training as general practitioners in the Remote Vocational Training Scheme","authors":"Matthew R McGrail, Belinda G O'Sullivan, Patrick Giddings","doi":"10.5694/mja2.52448","DOIUrl":"10.5694/mja2.52448","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore continuity of service and longer term retention outcomes of participants of the Remote Vocational Training Scheme (RVTS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, setting, participants</h3>\u0000 \u0000 <p>Retrospective cohort study of all doctors who participated in the RVTS from 2000 to 2023, many of whom are international medical graduates and are expected to work in the same community for three to four years in remote (Modified Monash Model [MMM] categories 4–7) or rural Aboriginal Medical Services (AMS) streams while undertaking training towards general practice fellowship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Continuity of service was measured in the pre-program period (period working in same practice before commencing) and during-program period (period completing the RVTS program in same practice as worked in before commencing the program). Retention was measured firstly within two years, and secondly beyond two years (up to 20 post-completion years) based on: working in the same community (relevant to both streams); working in the same region (Remote Stream only); working in any MMM4–7 community (Remote Stream only); or working anywhere rurally (both streams).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 506 enrolled participants, 373 (73.7%) were international medical graduates. The approximate mean service continuity in the same practice was 1.6 years (standard deviation [SD], 2.2 years) for the pre-program period and 3.6 years (SD, 1.4 years) for the during-program period (mean total, 5.2 years). Two years after completion, 21 out of 43 Remote Stream doctors (49%) and four out of five AMS Stream doctors (80%) remained in the same community. Over the long term, retention in the same community stabilised to 44 out of 242 Remote Stream doctors (18.2%) and seven out of 27 AMS Stream doctors (26%); 72 Remote Stream doctors (29.8%) remained in the same region, 70 Remote Stream doctors (28.9%) were in an MMM4–7 community, and 11 AMS Stream doctors (41%) were in a rural (MMM2–7) community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Strong service continuity outcomes have been achieved by the RVTS, which supports mostly international medical graduates in locations typified by the highest workforce turnover. This suggests that continuity of service could be improved for remote and First Nations communities through place-based retention-focused programs like the RVTS.</p>\u0000 ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S7","pages":"S9-S15"},"PeriodicalIF":6.7,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52448","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378026","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":"Holistic support framework for doctors training as rural and remote general practitioners: a realist evaluation of the RVTS model","authors":"Belinda G O'Sullivan,&nbsp;Patrick Giddings,&nbsp;Ronda Gurney,&nbsp;Matthew R McGrail,&nbsp;Tiana Gurney","doi":"10.5694/mja2.52447","DOIUrl":"10.5694/mja2.52447","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To develop theory about how and why the supervision and support model used by the Remote Vocational Training Scheme (RVTS) addresses the professional and non-professional needs of doctors (including many international medical graduates) who are training towards general practice or rural generalist fellowship while based in the same rural or remote practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, setting, participants</h3>\u0000 \u0000 <p>We conducted a realist evaluation based on the RAMESES II protocol. The initial theory was based on situated learning theory, networked ecological systems theory, cultural theory and geographical narcissism theory. The theory was developed by collecting empirical data through interviews with 27 RVTS stakeholders, including supervisors, participants and RVTS staff. The theory was refined using a project reference and a stakeholder advisory group and confirmed using individual meetings with experts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcomes measures</h3>\u0000 \u0000 <p>Theory about how the contexts of person, place and program interacted to address professional and non-professional needs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The RVTS program offers remote access to knowledgeable and caring supervisors, real-time tailored advice, quality resources and regular professional networking opportunities, including breaks from the community. It worked well because it triggered five mechanisms: comfort, confidence, competence, belonging and bonding. These mechanisms collectively fostered resilience, skills, professional identity and improved status; they effectively counteracted the potential effects of complex and relatively isolated work settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This theory depicts how a remotely delivered supervision and support model addresses the place and practice challenges faced by different doctors, meeting their professional and non-professional needs. The participants felt valued as part of a special professional group delivering essential primary health care services in challenging locations. The theory could be adapted and applied to support other rural and remote doctors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S7","pages":"S16-S22"},"PeriodicalIF":6.7,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52447","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378037","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":"Custodial dermatology for First Nations peoples: a niche service caring for incarcerated communities","authors":"Dana RML Slape (Larrakia),&nbsp;Penelope A Abbott,&nbsp;Kelvin M Kong (Worimi)","doi":"10.5694/mja2.52475","DOIUrl":"10.5694/mja2.52475","url":null,"abstract":"&lt;p&gt;Our group comprises an Aboriginal dermatologist, a general practice clinical researcher and an Aboriginal otolaryngologist. As clinicians and advocates, we have an enduring dedication to the health and wellbeing of First Nations adults and children, particularly as it relates to our work in custodial health due to the overwhelming and racialised hyperincarceration of our communities. It is through this lens that we strive to deliver health care services that meet and exceed our duties under the United Nations obligations. Our position is that our collective human rights focused health care duty extends beyond emergency and primary care needs for incarcerated communities and aspires to ensure equitable and timely accessibility to medical and surgical subspecialty disciplines. Given the complex health needs of those experiencing the intersectional marginalisation of incarceration, chronically ill health, disability and barriers to culturally safe care, health care should be of the same standard or better, to meet the complex needs for incarcerated individuals with the goal of returning healthier people to our communities.&lt;/p&gt;&lt;p&gt;It is within the walls of prisons that Australia's inescapable history as a penal colony and the current relationship with our First Nations peoples collides. There is international acknowledgement of the overincarceration of marginalised communities with an already higher burden of disease, and the inherently unhealthy environment of prisons.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The effectiveness of diversion and decarceration strategies are not evident for First Nations children and adults who continue to be incarcerated at rates substantially above the national average.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Alongside the increasing incarceration rates and decreasing accessibility to care, the accumulation of poor health and disadvantage can be particularly insidious in specialties such as dermatology, where illnesses are often deprioritised despite their high risk of harm.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Infectious, inflammatory and malignant dermatological conditions&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; can lead to serious life-limiting consequences, impose a high symptom burden, and cause significant stigmatising visible differences, ostracism and shame. In providing contemporary custodial health care to an overincarcerated priority population, we must go beyond addressing acute health conditions reactively. It is imperative that prison-based health services are inclusive of subacute, recurrent and chronic diseases, such as skin diseases.&lt;/p&gt;&lt;p&gt;To deliver comprehensive care, it is essential to address not only illnesses but also to ensure the overall wellbeing of the patient. This involves offering wrap-around services that enhance a holistic care model. By integrating these services, we can better identify and treat a broad range of health needs, leading to improved outcomes for both patients and the community.&lt;/p&gt;&lt;p&gt;First Nations clinician-led custo","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 9","pages":"457-459"},"PeriodicalIF":6.7,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52475","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372153","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":"Current approaches to the identification and management of gambling disorder: a narrative review to inform clinical practice in Australia and New Zealand","authors":"Simone N Rodda,&nbsp;Stephanie S Merkouris,&nbsp;Nicki A Dowling","doi":"10.5694/mja2.52471","DOIUrl":"10.5694/mja2.52471","url":null,"abstract":"<p>\u0000 \u0000 </p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 9","pages":"495-500"},"PeriodicalIF":6.7,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52471","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372152","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":"Notification of acute rheumatic fever and rheumatic heart disease in hospitalised people in the Midwest region of Western Australia, 2012–2022: retrospective administrative data analysis","authors":"Ingrid Stacey,&nbsp;Yolande Knight,&nbsp;Claire MX Ong,&nbsp;Amy Lee,&nbsp;Suresh Karuppannan,&nbsp;Allison Christou,&nbsp;Judith M Katzenellenbogen","doi":"10.5694/mja2.52477","DOIUrl":"10.5694/mja2.52477","url":null,"abstract":"&lt;p&gt;Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are caused by untreated group A streptococcus infections. Their prevalence is much higher among First Nations people than other Australians.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Treatment guidelines recommend that people with ARF or RHD be hospitalised (RHD) and notified to jurisdictional RHD registers (ARF, RHD); early diagnosis is associated with better clinical outcomes.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In Western Australia, the notification by clinicians of new ARF and RHD diagnoses has been mandatory since 2009 and 2015 respectively.&lt;span&gt;&lt;sup&gt;2, 4&lt;/sup&gt;&lt;/span&gt; WA RHD Register staff record demographic and clinical details for each case, and commence recall and reminder services for people with ARF or RHD. For people who are hospitalised, clinical coders enter discharge summary information into the WA Hospital Morbidity Data System (HMDS), using International Classification of Diseases, tenth revision, Australian modification (ICD-10-AM) codes (ARF: I00–I02; RHD: I05–I09). The register should also be notified of any person hospitalised with ARF or RHD. In 2020, we estimated that 54% of cases of RHD in First Nations people and 99% of cases in non-Indigenous people in WA were not recorded in the register, but no person-identifiable regional analyses or validation studies have been undertaken.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;For our retrospective administrative data analysis, we validated ARF and RHD hospitalisations in the remote Midwest region of WA, calculated RHD register notification rates, and examined demographic and clinical factors associated with notification. [Correction added on 9 October 2024, after first online publication: this sentence has been corrected.] All hospitalisations with ARF or RHD in the Midwest region during 1 May 2012 – 30 April 2022 were identified in the HMDS. Medical records for the admissions were requested (including discharge summaries, pathology results, specialist reports, emergency presentation and inpatient paper medical records), reviewed, and validated by resident medical officers, with cardiologist support as required. Records that could not be obtained or which indicated that the case did not meet the criteria for possible, probable, or confirmed diagnosis of ARF or RHD&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; were excluded. First Nations people were identified from information in clinical notes in paper medical records and hospital admission records (in which Indigenous status is self-reported or recorded by the clinician).&lt;/p&gt;&lt;p&gt;The study was approved by the Western Australian Aboriginal Health Ethics Committee (project reference 717), the WA Health Department (2016/29), and the WA Country Health Service Human Research Ethics Committee (2022.14). First Nations oversight and governance of the parent project for this study (End RHD in Australia: Study of Epidemiology, ERASE&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;) was provided by First Nations chief investigators. We regularly com","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 9","pages":"493-494"},"PeriodicalIF":6.7,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52477","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372154","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":"Planetary care is good cancer care","authors":"Nikki Burdett,&nbsp;Ben Dunne","doi":"10.5694/mja2.52455","DOIUrl":"10.5694/mja2.52455","url":null,"abstract":"<p><span>To the Editor:</span> Recently, more than 400 Australian doctors (including both authors) signed an open letter published in <i>The Australian</i>,<span>¹</span> calling on our federal government to protect the health of Australians by banning any new fossil fuel projects.</p><p>From the perspective of clinicians treating cancer, there are many reasons that this is an urgent request. Aside from their contribution to greenhouse gas emissions, fossil fuel projects increase air pollution and particulate matter less than or equal to 2.5 μm in diameter (PM_2.5), which are both risk factors for lung cancer.<span>²</span> This includes <i>EGFR</i>-mutated lung cancer, which is classically associated with never smoking or light smoking.<span>³</span> Disturbingly, air pollution is linked to increased mortality in paediatric and young adults with cancer.<span>⁴</span> Air and wastewater pollution generated by fossil fuel projects contains multiple carcinogens. This includes benzene, which is associated with haematological malignancies; additional studies demonstrate a positive association between residential proximity to petrochemical facilities and leukaemia.<span>^5-8</span></p><p>While new projects have been recently approved across the nation, the Beetaloo Basin and Middle Arm project are the most notable, with echoes of the distressing Louisiana petrochemical corridor (United States), which is also referred to as “cancer alley” due to residents’ disproportionate exposure to toxic industrial by-products.<span>^{8, 9}</span> Australia risks creating its own “sacrifice zone”, harming the health of its people and contributing irrevocably to the climate crisis.</p><p>Natural disasters and extreme weather events amplified by climate change also disrupt access to care, which is critical for patients undergoing cancer treatment and translates to poorer outcomes.</p><p>Aside from cancer, there are various other risks, including asthma, cardiovascular disease and pre-term birth. These are avoidable and unacceptable illnesses, which can lead to deaths.</p><p>When the evidence that smoking harmed health was overwhelming, doctors championed this message and took action. In 2024, we — as physicians — need to convey the message that banning new fossil fuel projects is not a political ask, rather is essential to protect the health of our nation.</p><p>Both authors are active members of Doctors for the Environment Australia, and signed the open letter, which is referenced in this manuscript.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 8","pages":"447"},"PeriodicalIF":6.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52455","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361748","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 seroprevalence of antibodies to Japanese encephalitis virus in five New South Wales towns at high risk of infection, 2022","authors":"Keira M Glasgow,&nbsp;Kirsty Hope","doi":"10.5694/mja2.52454","DOIUrl":"10.5694/mja2.52454","url":null,"abstract":"<p><b><i><span>In reply</span></i></b>: On behalf of our co-authors, we thank Islam and Seale for their interest in our article.<span>¹</span> We largely support the general sentiments of Islam and Seale.<span>²</span> The seroprevalence survey that was the focus of our article was undertaken to support and guide the rapid public health response to the emergence of Japanese encephalitis virus (JEV) in New South Wales. The nature of a rapid public health response, which is focused on understanding enough to contain the risk in a short space of time, inherently limits the comprehensiveness of the epidemiological design.</p><p>Although Islam and Seale indicated that outbreaks of JEV have been reported in Australia since 1995,<span>³</span> the few reported cases were sporadic and the single cluster limited to the islands off the north coast of Australia.<span>⁴</span> The outbreak in 2022 represented the first detections of JEV in south-eastern Australia, and was close to 3000 km from the nearest previous case. The emergence of JEV in a largely naïve population in a temperate climate was significant in the course of the disease and presented challenges in understanding JEV transmission dynamics in the Australian context.</p><p>We acknowledge that social science approaches would certainly expand our understanding of risk behaviours contributing to infection, in response to an emerging disease. The One Health approach,<span>⁵</span> referred to by Islam and Seale, has been well practised in NSW, with strong collaboration, communication and coordination across animal, human and environmental sectors.<span>⁶</span> This intersect is particularly important to emphasise and acknowledge when responding to zoonotic and vector-borne disease outbreaks, which tend to impact regional and agricultural communities away from metropolitan centres.</p><p>No relevant disclosures.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 8","pages":"448"},"PeriodicalIF":6.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52454","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361750","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 seroprevalence of antibodies to Japanese encephalitis virus in five New South Wales towns at high risk of infection, 2022","authors":"Md Saiful Islam,&nbsp;Holly Seale","doi":"10.5694/mja2.52453","DOIUrl":"10.5694/mja2.52453","url":null,"abstract":"<p><span>To the Editor:</span> The findings from Baldwin and colleagues,<span>¹</span> regarding the seroprevalence of Japanese encephalitis virus (JEV)-specific antibodies in community members (in settings not traditionally considered as risky), underscore the critical need to characterise transmission pathways and identify probable hosts of infection within New South Wales.</p><p>While critical to understand the scope of infection, what we are currently missing is a deep dive into the factors contributing to the risk of JEV. This is not a criticism of their work but rather a call to action as traditional epidemiological studies do not necessarily capture these points (due to the approaches taken) and there is a need to build stronger partnerships within One Health to ensure that the broader social–ecological risk factors at the individual, family, community, and national levels are captured.<span>²</span></p><p>Given the increasing cases of arboviruses and the shift in epidemiology, it is critical that we start ensuring our epidemiology studies are coupled with opportunities to capture data on exposure history, behaviour and practices that facilitate prevention or transmission. To support public health measures, it is also critical to understand the risk perceptions of community members, what protective measures they are using to avoid mosquito bites and if they are willing to receive vaccines against JEV.</p><p>Regarding risk history, we do not have a good sense of how much time the infected individuals spent outside the home, what kinds of activities they did, and where. Vaccination is the best method to prevent JEV, but did we prepare this community for JEV vaccines? Lessons learnt during the coronavirus disease 2019 pandemic showed that the likelihood of getting the disease and risk perceptions towards the vaccine affected vaccine acceptance.<span>³</span></p><p>Social science intelligence that uses open-ended unstructured interviews, participant observation and group discussion is in the best position to answer these questions.<span>⁴</span> Outbreaks of JEV have been reported in Australia since 1995;<span>⁵</span> however, it is likely that we will see increased JEV incidence. Now is the time to break down siloes and ensure that we are producing outbreak investigations and epidemiological studies that capture these critical social and behavioural factors to inform future approaches.</p><p>No relevant disclosures.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 8","pages":"447-448"},"PeriodicalIF":6.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52453","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361749","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}