Medical Journal of Australia最新文献

{"title":"Silicosis research priorities for health care, research, and health and safety professionals, and for people exposed to silica in Australia: a research priority setting exercise","authors":"Hayley Barnes, Sharna Mathieu, Deborah C Glass, Malcolm R Sim, Lin Fritschi, Joanne L Dickinson, Daniel C Chambers, Tim R Driscoll, Graeme Edwards, Nikky LaBranche, Catherine Jones, Jane E Bourke, Ryan F Hoy, Christine R Jenkins, Simon Apte, Anne Holland, Gabriella Tikellis","doi":"10.5694/mja2.70013","DOIUrl":"10.5694/mja2.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To identify the silicosis research priorities of people living with silicosis, workers at risk of silicosis, their partners and caregivers, and of health professionals and researchers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Research priority setting exercise; modified James Lind Alliance framework for research priority setting partnerships, comprising an online survey followed by two forums in which thematic analysis and nominal group analysis were used to establish a list of research priorities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>People with or at risk of silicosis, their partners or caregivers (survey, online forum) and health care professionals, researchers, health and safety professionals (survey, in-person forum), recruited 14 April – 19 December 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Research priorities in four pre-identified areas: prevention, screening and diagnosis, treatment, and living with and managing the impact of silicosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 164 survey respondents (105 medical or research professionals, 34 workers currently or formerly at risk of silicosis, eleven people with confirmed silicosis, and fourteen partners or caregivers) identified 47 key research topics. Fifty-three health care professionals and thirteen people with or at risk of silicosis and their caregivers then ranked the research topics and developed research questions at the two forums. The highest ranked research priorities were research into assessment and optimisation of the hierarchy of controls, compliance and regulation, establishing minimum standards and developing innovative screening methods, early diagnosis, development of effective treatments, identification of biomarkers for risk of progression, developing an optimal care model that includes mental health care, and estimating the economic impact of silicosis. Both participant groups agreed that research into workplace controls is important, as is improving education and awareness, compliance with preventive measures, and screening and diagnosis, including nationally consistent screening and diagnosis practices. The professional participants rated research into silicosis pathogenesis and biomarkers and technological considerations higher than workers and their carers, who focused more on the barriers for and attitudes of workers, specific treatments, and managing ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 5","pages":"257-264"},"PeriodicalIF":8.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742441","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":"A stimulating tale about spinal cord implants for managing chronic pain","authors":"Susan Liew","doi":"10.5694/mja2.70016","DOIUrl":"10.5694/mja2.70016","url":null,"abstract":"<p>When I tell a patient that I do not have a surgical solution for their back pain, the most frequent desperate reply is: “what am I going to do?” I would be happy to say, “Well, one option is to look into a spinal cord stimulator,” if I could believe that they worked. However, the caveat is that any (interventional) treatment should work well, be of low risk, and be affordable and accessible to all who need it.</p><p>Since the first commercially available spinal cord stimulator became available in 1968,<span><sup>1</sup></span> developments in evidence-based device safety and efficacy have been rapidly outpaced by technological advances. Subsequent updates by manufacturers have been all about the hardware and software: a marketer's dream. It was not until 2021 that the Cochrane review of implanted spinal neuromodulation for chronic pain in adults was published; it found “very low-certainty evidence” that spinal cord stimulation “may not provide clinically important benefits on pain intensity compared to placebo stimulation”, and that it “is associated with complications including infection, electrode lead failure/migration and a need for reoperation/re-implantation.”<span><sup>2</sup></span> It was too late to put a brake on the burgeoning industry: the efficacy of spinal cord stimulation might not have been proven, but our device regulators surely also practise <i>primum non nocere</i>? The 2022 analysis of adverse effects of spinal cord stimulators reported to the Therapeutic Goods Administration (TGA) by implant providers and patients found that four devices were being removed for every ten implanted.<span><sup>3</sup></span> Is this why the TGA only subsequently commenced a post-marketing review of spinal cord stimulation devices?</p><p>In 2023, the authors of the Cochrane review of spinal cord stimulation for low back pain concluded that “moderate-certainty evidence suggests there is probably no benefit of [spinal cord stimulation] over placebo on pain, function, or health-related quality of life in the medium term.”<span><sup>4</sup></span> Both PainAustralia and the Medical Technology Association of Australia responded in December 2023 — the former with a consumer experience report,<span><sup>5</sup></span> the latter in a media statement titled “spinal cord stimulator implants vital to chronic pain”<span><sup>6</sup></span> — by arguing that some patients do benefit, but they did not cite any objective outcomes. In January 2024, the TGA imposed conditions on the use of eighteen devices.<span><sup>7</sup></span> In April 2024, the ABC aired the Four Corners episode “Pain factory”,<span><sup>8</sup></span> and by December 2024 the TGA had cancelled its approval of twelve spinal stimulation devices and imposed conditions on the use of 84 of the other 91 devices.<span><sup>9</sup></span></p><p>In this issue of the <i>MJA</i>, Jones and colleagues report the findings of their retrospective study of Australian privately insured patients in wh","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 5","pages":"241-242"},"PeriodicalIF":8.5,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732077","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":"Assessment of metabolic dysfunction-associated fatty liver disease in primary care: a consensus statement summary","authors":"Leon A Adams,&nbsp;William W Kemp,&nbsp;Kate R Muller,&nbsp;Elizabeth E Powell,&nbsp;Stuart K Roberts,&nbsp;Luis Calzadilla Bertot,&nbsp;Stephanie Best,&nbsp;Gary Deed,&nbsp;Jon D Emery,&nbsp;Samantha L Hocking,&nbsp;Graham R Jones,&nbsp;John S Lubel,&nbsp;Sinead Sheils,&nbsp;Stephen M Twigg,&nbsp;Gerald F Watts,&nbsp;Jacob George","doi":"10.5694/mja2.70008","DOIUrl":"10.5694/mja2.70008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Metabolic dysfunction-associated fatty liver disease (MAFLD) is common. This evidence-based consensus statement summary provides recommendations for the assessment and monitoring of adults with MAFLD in primary care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main recommendations</h3>\u0000 \u0000 <p>Adults with type 2 diabetes, obesity or two or more other metabolic risk factors should be tested for MAFLD. Hepatic steatosis should be evaluated using ultrasound, whereas the presence and complications of type 2 diabetes and obesity should be assessed according to current Australian guidelines. Cardiovascular disease, chronic kidney disease and obstructive sleep apnoea are common in people with MAFLD and should be considered as part of a holistic health assessment. Alternative causes of hepatic steatosis, including excess alcohol consumption, must be considered, and patients with elevated serum aminotransferase levels should be tested for hepatitis B and C infection and iron overload. The risk of advanced liver fibrosis requires assessment using the Fibrosis-4 (FIB-4) Index; a low score (&lt; 1.3) is associated with a more than 95% negative predictive value for advanced liver fibrosis. People with an indeterminate FIB-4 score (between 1.3 and 2.7) should undergo second-line assessment with liver elastography or a direct liver fibrosis serum test or, if these tests are unavailable, should be referred to an expert clinician in liver disease. People with MAFLD and a high FIB-4 score (&gt; 2.7), an elevated direct liver fibrosis serum test, high elastography results or with clinical, laboratory or imaging evidence of cirrhosis should be referred for further evaluation. Individuals with a low FIB-4 score (&lt; 1.3), low elastography or direct liver fibrosis serum test results should be monitored with a repeat FIB-4 test at least every three years. Monitoring of weight, body mass index and/or waist circumference and for emergence of type 2 diabetes (in individuals without) should be performed at least annually.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Change in management as a result of this consensus statement summary</h3>\u0000 \u0000 <p>Appropriate identification, assessment and risk stratification of people with MAFLD will aid referral pathways, further investigation and management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 5","pages":"268-276"},"PeriodicalIF":8.5,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732078","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":"Trends in adolescent smoking prevalence before and after the emergence of vaping in Australia: an interrupted time series analysis, 1999-2023.","authors":"Sam J Egger, Michael David, Marianne F Weber, Qingwei Luo, Anita Dessaix, Becky Freeman","doi":"10.5694/mja2.70000","DOIUrl":"https://doi.org/10.5694/mja2.70000","url":null,"abstract":"<p><strong>Objective: </strong>To compare adolescent smoking trends in Australia before and after the emergence of e-cigarettes in about 2010, to evaluate the potential impacts of adolescent vaping on smoking prevalence.</p><p><strong>Design: </strong>Repeated cross-sectional study.</p><p><strong>Setting: </strong>Australian secondary schools.</p><p><strong>Participants: </strong>172 406 students aged 12-17 years who took part in the Australian Secondary Students' Alcohol and Drug Survey between 1999 and 2023.</p><p><strong>Main outcome measures: </strong>Prevalence of ever, past year, past month and past week smoking for 12-17-year-olds, and daily smoking for 14-15-year-olds.</p><p><strong>Results: </strong>From 2014 to 2022-2023, the prevalence of ever vaping among students increased 2.3-fold (from 13.2% to 29.9%), while past month vaping increased 4.8-fold (from 3.3% to 15.7%). From 1999 to 2022-2023, there were substantial declines in the prevalence of ever, past year, past month, past week and daily smoking among students, with reductions ranging between 74% and 89%. However, the rates of decline for these five measures of smoking slowed significantly from 2010 onwards, coinciding with the emergence of vaping. By 2022-2023, there were, respectively, 74 (95% confidence interval [CI], 67-80), 54 (95% CI, 48-60), 25 (95% CI, 21-29) and 16 (95% CI, 12-19) more 12-17-year-olds per 1000, and 7 (95% CI, 4-9) more 14-15-year-olds per 1000 who had engaged in ever, past year, past month, past week and daily smoking than projected by smoking trajectories from the pre-vaping era. These findings were robust to sensitivity analyses, including the use of different time series interruption points (change-years) and controlling for the affordability of cigarettes.</p><p><strong>Conclusion: </strong>Australia's remarkable progress in reducing adolescent smoking has slowed since the emergence of vaping, underscoring the need for integrated tobacco and vaping control strategies.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718094","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":"Identifying modifiable causes of stress in clinicians and administrators working in New South Wales psychiatric emergency care centres, 2023–24: a qualitative study","authors":"Jacqueline P Huber,&nbsp;Alyssa Milton,&nbsp;Matthew Brewer,&nbsp;Kat Fry,&nbsp;Sean Evans,&nbsp;Jason Coulthard,&nbsp;Nicholas Glozier","doi":"10.5694/mja2.70009","DOIUrl":"10.5694/mja2.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To examine the experiences of people in various disciplines working in New South Wales psychiatric emergency care centres (PECCs) to identify factors that influence their wellbeing and how they are managed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Qualitative study; semi-structured interviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Eleven of twelve New South Wales PECCs, NSW Health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Thirty-five nurses, psychiatrists, psychiatry registrars, social workers, occupational therapists, and NSW Health staff working in or with management oversight of PECCs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Experiential relativist framework analysis of the experiences of people working in PECCs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overarching finding was that working in PECCs involved conflicting, concurrent demands. Three major themes were identified: interactions with the patient: relational work is both meaningful and difficult; interactions with the health care system: conflicting expectations regarding the management of suicide risk causes overwhelming anxiety; and interactions with the hospital: the hospital asks for whatever it needs in the moment, causing clinicians to feel that it does not understand the PECC care model. Two protective factors and processes were also identified: a clear treatment framework reduces uncertainty, enhancing clinician satisfaction and continuity of care for patients; and working in a collaborative team with a flat hierarchy enhances satisfaction and autonomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>People working in PECCs experience tension and, at times, considerable anxiety arising not just from the intense emotional demands of crisis care but also from the conflicting demands and expectations of the system in which they work. This tension reduces staff wellbeing and retention, and consequently patient care. These negative effects can be reduced by team cohesion and having a clear treatment framework.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 8","pages":"410-417"},"PeriodicalIF":8.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698962","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 epidemiology of haemodialysis catheter infections in Australia, 2016–20: a prospective cohort study","authors":"Benjamin Lazarus,&nbsp;Kevan R Polkinghorne,&nbsp;Martin P Gallagher,&nbsp;Jayson Catiwa,&nbsp;Nicholas A Gray,&nbsp;Sarah Coggan,&nbsp;Kathryn R Higgins,&nbsp;Girish Talaulikar,&nbsp;Stephen P McDonald AM,&nbsp;Sradha Kotwal","doi":"10.5694/mja2.70014","DOIUrl":"10.5694/mja2.70014","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate the epidemiology in Australia of catheter-related infections in a national cohort of adults with kidney failure with incident haemodialysis central venous catheters (CVCs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Cohort study nested within a cluster-randomised trial (REDUcing the burden of dialysis Catheter Complications, REDUCCTION); analysis of prospectively collected trial data, linked with Australian and New Zealand Dialysis and Transplant (ANZDATA) registry and state hospitalisations data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Thirty-four health services in Australia (excluding Western Australia) that provide chronic haemodialysis and participated in the REDUCCTION trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Adults (18 years or older) with chronic kidney failure who received incident haemodialysis CVCs during 20 December 2016 – 31 March 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Hospitalisation with any haemodialysis CVC infection; haemodialysis CVC-related bloodstream infections reported during the trial and verified by an independent panel.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our analysis included 3943 adults with chronic kidney failure; their mean age was 60.4 years (standard deviation, 15.5 years); 1556 were women (39.5%) and 485 were Aboriginal or Torres Strait Islander people (12.3%). Catheter-related infections were coded for 644 hospitalisations (24.5 per 100 patient-years; 95% confidence interval [CI], 22.6–26.4 per 100 patient-years); the incidence was higher among people under 55 years of age (adjusted incidence rate ratio [IRR], 1.55; 95% CI, 1.21–1.98) and those aged 55–70 years (adjusted IRR, 1.34; 95% CI, 1.05–1.70) than among people over 70 years of age. Community-onset haemodialysis catheter-related bloodstream infections were responsible for 159 hospitalisations (8.2% of 1938 infection-related hospitalisations); 57 of 650 infection-related hospitalisations of people under 55 years of age (8.8%), 62 of 640 of people aged 55–70 years (9.7%), and 40 of 648 of people over 70 years of age (6.2%). The median length of hospital stay with community-onset haemodialysis CVC-related bloodstream infections was ten days (interquartile range, 5–15 days), metastatic spread of infection was detected in twelve cases (7.5%),","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 5","pages":"248-256"},"PeriodicalIF":8.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698963","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":"Effectiveness of COVID-19 vaccine boosters for reducing COVID-19 mortality among people aged 65 years or older, Australia, August 2023 – February 2024: a retrospective observational cohort study","authors":"Bette Liu,&nbsp;Anish Scaria,&nbsp;Sandrine Stepien,&nbsp;Kristine Macartney","doi":"10.5694/mja2.70015","DOIUrl":"10.5694/mja2.70015","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 the effectiveness of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) monovalent XBB.1.5 variant vaccine for reducing coronavirus disease 2019 (COVID-19) mortality among people aged 65 years or older.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Study design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Retrospective observational cohort study; analysis of linked 2021 Australian census, Australian Immunisation Register, and death registrations data.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Australia, 1 August 2023 to 29 February 2024; dominant SARS-CoV-2 Omicron subvariants: XBB-related until early December 2023, then the BA.2.86-related JN.1.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;People aged 65 years or older on 1 August 2023.&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;Relative vaccine effectiveness by time since most recent booster and booster type (XBB.1.5 variant or other), adjusted for age, gender, state/territory, household income, number of medical conditions, number of general practice visits, and influenza vaccination during 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;By 29 February 2024, 1620 COVID-19-specific deaths among 4.12 million people aged 65 years or older had been recorded. COVID-19 mortality was lower among people who had received XBB.1.5 COVID-19 booster doses during the preceding 90 days (21 [95% confidence interval {CI}, 9–52] per 100 000 person-years) than among those whose most recent booster had been more than 365 days ago (72 [95% CI, 61–84] per 100 000 person-years). The relative vaccine effectiveness for XBB.1.5 boosters during the preceding 90 days (&lt;i&gt;v&lt;/i&gt; any booster &gt; 365 days) was 74.7% (95% CI, 59.9–84.1%); for other booster types it was 51.6% (95% CI, 39.3–61.4%). Relative vaccine effectiveness declined with time: for any booster during the preceding 91–180 days (&lt;i&gt;v&lt;/i&gt; any booster &gt; 365 days) it was 31.2% (95% CI, 18.9–41.6%); for any booster during the preceding 181–365 days it was 13.1% (95% CI, 1.8–23.2%). Relative XBB.1.5 vaccine effectiveness was similar in analyses restricted to 1 December 2023 – 29 February 2024, when the dominant Omicron subvariant was JN.1.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Recent booster vaccination with ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 8","pages":"418-422"},"PeriodicalIF":8.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698961","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":"Medical colleges have an obligation to ensure full participation in Clinical Quality Registries","authors":"Robert J Aitken,&nbsp;Julian A Smith,&nbsp;Guy J Maddern","doi":"10.5694/mja2.70010","DOIUrl":"10.5694/mja2.70010","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 5","pages":"233-235"},"PeriodicalIF":8.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675222","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":"Lung cancer biobanking in Australia: challenges and future directions","authors":"Sarah Yeo,&nbsp;Stephen Q Wong,&nbsp;Farzaneh Atashrazm,&nbsp;Andreas Behren,&nbsp;Anthony T Papenfuss,&nbsp;Natalia Vukelic,&nbsp;Lisa Briggs,&nbsp;Ashleigh R Poh,&nbsp;Daniel Steinfort,&nbsp;Natasha Smallwood,&nbsp;Kate Sutherland,&nbsp;Vivek Naranbhai,&nbsp;Sagun Parakh,&nbsp;Tracy Leong","doi":"10.5694/mja2.70012","DOIUrl":"10.5694/mja2.70012","url":null,"abstract":"&lt;p&gt;Lung cancer is the leading cause of cancer-related morbidity and mortality worldwide.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; It is the fifth most common cancer diagnosed in Australia, but accounts for almost 20% of all cancer-related deaths, which is more than breast, prostate and ovarian cancer combined. Global advances in lung cancer management have been driven by early diagnosis, such as lung cancer screening, improved treatment options (targeted therapy and immunotherapy) and improvements in survivorship care. Despite this progress, the five-year survival rate for lung cancer in Australia is 24%.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Reasons for this poor outlook include late presentation with most lung cancer patients presenting with metastatic disease at the time of diagnosis, as well as tumour-specific features including a lack of reliable biomarkers, tumour heterogeneity and drug resistance.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Lung cancer biobanks facilitate translational research aimed at improving lung cancer diagnosis, prognosis and treatment in several ways.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; These repositories collect and store high quality biological samples, such as tissue and blood, as well as detailed clinical information from patients across various stages of disease. This enables researchers to identify and validate predictive and prognostic biomarkers, discover molecular signatures associated with tumour progression and treatment resistance, and develop novel therapies and strategies to overcome resistance.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;This perspective article provides a background on cancer biobanks, outlines the challenges specific to lung cancer biobanks in the Australian context, and discusses future directions.&lt;/p&gt;&lt;p&gt;Biobanks are defined by the Organisation for Economic Co-operation and Development as “a structured resource that can be used for the purpose of genetic research and which include: (a) human biological materials and/or information generated from the analysis of the same; and (b) extensive associated information”.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Cancer-focused biobanks are invaluable collections of biological specimens accompanied by matched health and demographic data. The International Agency for Research on Cancer states that biobanks underpin three rapidly expanding research fields aimed at developing effective strategies to prevent, diagnose and treat cancer: molecular and genetic epidemiology to assess the genetic and environmental bases of cancer; molecular pathology to develop molecular-based classifications and further phenotyping of different cancers; and pharmacogenomics/pharmaco–proteomics to understand the correlation between a patient's genotype/phenotype and their response to drug treatment.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;With the assistance of a medical librarian, a search of Ovid MEDLINE(R) ALL 1946 to 4 April 2025 was conducted using a combination of MeSH headings and keywords containing “lung cancer” and “biobank” (search strategy pro","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 4","pages":"180-184"},"PeriodicalIF":8.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675221","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":"Building health system resilience to climate change: lessons from cardiovascular disease","authors":"Elizabeth Zuccala","doi":"10.5694/mja2.52716","DOIUrl":"https://doi.org/10.5694/mja2.52716","url":null,"abstract":"&lt;p&gt;In December 2023, the Australian Government released its first National Health and Climate Strategy.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Acknowledging that the health effects of a changing climate are already being felt across the country, this strategy set out a whole-of-government plan for addressing the health and wellbeing impacts of climate change. A core component of this strategy is health system resilience — that is, building capacity to anticipate, understand, plan for, and respond to escalating climate impacts on health, wellbeing, and the delivery of care.&lt;/p&gt;&lt;p&gt;What does it mean in practice to build health system resilience to climate change? In this issue of the &lt;i&gt;MJA&lt;/i&gt;, Stewart and colleagues&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; present findings from a randomised controlled trial that provides an instructive example. Their research was premised on the recognition that seasonal and acute weather conditions are drivers of cardiovascular events. Climate change is expected to generate more weather extremes that will, in turn, provoke more cardiovascular events. They hypothesised that a tailored, multifaceted intervention designed to build resilience to external provocations to health would increase days alive and out of hospital among people with multimorbid heart disease, compared with standard care. Their intervention aimed to address the bio-behavioural vulnerability to environmental challenges to cardiovascular health, including participant behaviours, home environmental conditions, clinical factors, and socio-economic resources.&lt;/p&gt;&lt;p&gt;The study did not find statistically significant overall differences between the intervention and standard care groups for the primary outcome (days alive and out-of-hospital) and all-cause hospital readmission and death. However, hospital readmissions were more frequent after dynamic weather events, including storms and acute temperature changes. After adjusting for timing of follow-up, the intervention was associated with significantly fewer days of hospital stay during the summer months. These findings, the authors contend, “challenge the assumption that the management of people with chronic heart disease should be the same all year round” and provide a compelling basis for future research.&lt;/p&gt;&lt;p&gt;Writing in the editorial linked to this research,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Hunter explains that “despite its negative findings, this trial illustrates a critical inflection point in how we conceptualise health and disease in the context of an increasingly volatile climate” and that “the biopsychosocial model must evolve to more explicitly acknowledge the foundational relationship between human health and the environment”.&lt;/p&gt;&lt;p&gt;The National Health and Climate Strategy represents a positive move in this direction, as does the incorporation of climate change, environmentally sustainable health practice, and planetary health into medical school curricula,&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; and the development of climate change and heal","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 2","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52716","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663789","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}