Medical Journal of Australia最新文献

{"title":"Improving cardiometabolic risk factors in Aboriginal and Torres Strait Islander people in northeast Arnhem Land: single arm trial of a co-designed dietary and lifestyle program","authors":"Hasthi UW Dissanayake, George Gurruwiwi, J Dhurrkay, Josh C Tynan, Sabine Braat, Benjamin Harrap, Tim Trudgen, Sarah Hanieh, Bronwyn Clark, Michaela Spencer, Michael Christie, Emma Tonkin, Emily Armstrong, Leonard C Harrison, John M Wentworth, Julie K Brimblecombe, Beverley-Ann Biggs","doi":"10.5694/mja2.52593","DOIUrl":"10.5694/mja2.52593","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the impact of a 4-month dietary and lifestyle program co-designed and led by Aboriginal and Torres Strait Islander people on weight and metabolic markers, diet, and physical activity in overweight and obese adults in a remote Indigenous community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Single arm, pre–post intervention study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Adult residents (18–65 years) of a remote Northern Territory community with body mass index (BMI) values of at least 25 kg/m<sup>2</sup> or waist circumferences exceeding 94 cm (men) or 80 cm (women).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Intervention</h3>\u0000 \u0000 <p>Hope for Health, a culturally sensitive 4-month program supporting self-managed health improvement based on dietary and lifestyle change, 1 August to 30 November 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Weight loss of at least 5%; changes in BMI, waist circumference, other metabolic markers (blood pressure, biomarkers of metabolic health and inflammation), diet, and physical activity; participant perceptions of the program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We assessed outcomes for 55 participants who completed weight assessments at both baseline and program end (mean age, 42.5 years [standard deviation, 10.1 years]; 36 women [65%]). Forty participants lost and 15 gained weight; overall mean weight loss was 1.5 kg (95% confidence interval [CI], 0.5–2.4 kg), and ten participants (18%; 95% CI, 9–31%) achieved at least 5% weight reduction. The mean change in BMI (53 participants) was –0.60 kg/m<sup>2</sup> (95% CI, –0.93 to –0.27 kg/m<sup>2</sup>), in waist circumference (53 participants) –3.2 cm (95% CI, –4.7 to –1.7 cm), and in low-density lipoprotein cholesterol level (37 participants) –0.28 mmol/L (95% CI, –0.47 to –0.08 mmol/L); the relative decline in the HbA<sub>1c</sub> level geometric mean (50 participants) was 11% (95% CI, 6–15%). The intake of breads and cereals (median change, –1.5 [95% CI, –2.0 to –1.0] serves/day) and sugar-sweetened beverages (–0.6 [95% CI, –1.4 to –0.1] serves/day) declined; the amount of moderate and vigorous physical activity increased by a median of 103 min/day (95% CI, 74–136 min/day; 19 participants). The program focus on integrating healthy bodies and networks of kin, healthy governance,","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 4","pages":"183-190"},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52593","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066781","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":"Decentralised COVID-19 molecular point-of-care testing: lessons from implementing a primary care-based network in remote Australian communities","authors":"Belinda Hengel, Rebecca J Guy, Dawn Casey, Lorraine Anderson, Kirsty Smith, Kelly Andrewartha, Tanya D Applegate, Amit Saha, Philip Cunningham, Lucas DeToca, William D Rawlinson, Marianne Martinello, Annie Tangey, Prital Patel, Mark DS Shephard, Susan Matthews, Louise Causer","doi":"10.5694/mja2.52589","DOIUrl":"10.5694/mja2.52589","url":null,"abstract":"<p>First Nations people experience high levels of chronic disease, resulting from a history of colonisation, institutional racism and policies that have disempowered participation in practices that would otherwise support health and wellbeing.<span><sup>1, 2</sup></span> In addition, First Nations people living in remote areas have limited access to primary and specialist care, hospital and pathology services and reduced infrastructure.<span><sup>3, 4</sup></span> These factors contribute to infectious diseases having a disproportionately greater impact on First Nations people living in remote areas compared with urban settings.<span><sup>4, 5</sup></span> Funded by the Australian Government and with First Nations-led governance, the Aboriginal and Torres Strait Islander COVID-19 Point-of-Care Testing Program (hereafter referred to as the program) was implemented in early 2020. Testing was conducted by primary care clinicians using the GeneXpert assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; Xpert Xpress SARS-CoV-2, Cepheid) enabling increased access to molecular-based testing, and therefore quicker results. The program rapidly became the world's largest decentralised SARS-CoV-2 molecular point-of-care (POC) testing network.<span><sup>6</sup></span> The program was delivered across three distinct epidemiological phases of the coronavirus disease 2019 (COVID-19) epidemic in Australia, each with associated public health responses (Box 1).</p><p>To inform future infectious disease pandemic preparedness and responses, we used an adapted POC testing framework,<span><sup>6</sup></span> based on the World Health Organization health system building blocks<span><sup>7</sup></span> to systematically review program documents, including standard operating procedures, internal team communications, and formal program updates to partners. The review process identified, collated and documented key recommendations. Box 2 shows the updated framework, which now includes workforce and training, results support, and reflects an enhanced focus on the community as central to program effectiveness.</p><p>The success of the COVID-19 response in First Nations communities in Australia is attributed to engagement and leadership by First Nations people.<span><sup>8, 9</sup></span> The program was overseen by the National Aboriginal and Torres Strait Islander Health Protection subcommittee (formerly the Aboriginal and Torres Strait Islander Advisory Group on COVID-19) of the Australian Health Protection Committee.<span><sup>10</sup></span> This group was made up of representatives from Aboriginal community-controlled health services, other First Nations experts and government; and was responsible for the co-design and oversight of the program, and final approval of protocols, expansions and allocation of testing resources. Consistent with National Pathology Accreditation Advisory Council (NPAAC) guidelines on POC testing,<span><sup>11</sup></span> the ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 4","pages":"172-178"},"PeriodicalIF":6.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52589","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066777","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":"Cannabis poisonings in Australia following the legalisation of medicinal cannabis, 2014–24: analysis of NSW Poisons Information Centre data","authors":"Rose Cairns, Sara Allaf, Nicholas A Buckley","doi":"10.5694/mja2.52586","DOIUrl":"10.5694/mja2.52586","url":null,"abstract":"<p>Several countries have legalised medicinal cannabis during the past two decades; more recently, some jurisdictions, including parts of the United States, Canada, and Uruguay, have legalised recreational cannabis.<span><sup>1</sup></span> Legislative models differ between countries, particularly with regard to access to medicinal cannabis, commercialisation, the availability of cannabis dispensaries, and cannabis-containing confectionery (“edibles”).<span><sup>2</sup></span></p><p>One potential harm of increased access to cannabis is poisoning. It is widely believed that cannabis is safe in overdose,<span><sup>3</sup></span> but it can cause central nervous system (CNS) excitation, CNS depression, hallucinations, psychosis, and cardiac dysrhythmias.<span><sup>4</sup></span> The risk of severe toxicity is greater for children, in whom it can lead to apnoea and coma; in one United States study, 32 of 60 children (0–10 years) hospitalised with cannabis intoxication required intensive care.<span><sup>5</sup></span> Several studies have reported increases in the number of poisonings following medicinal and recreational cannabis legalisation, particularly in children.<span><sup>6</sup></span> Edibles are particularly high risk products because of their palatability and the possibility of large ingestions.<span><sup>2</sup></span> Most reports on this problem are from North America.<span><sup>6</sup></span></p><p>In Australia, the medicinal use of cannabidiol (CBD) was legalised in June 2015, and that of cannabis and tetrahydrocannabinol (THC) in November 2016.<span><sup>7</sup></span> We therefore evaluated recent cannabis poisoning exposures in Australia, stratified by ingestion intent, age group, and product type. We analysed data from the New South Wales Poisons Information Centre (NSWPIC), which receives about 50% of all calls to Australian poisons information centres; 65% of calls are from within NSW, 35% from other states.<span><sup>8</sup></span> We extracted data on demographic and exposure characteristics, patient disposition, and cannabinoid product types for calls during 1 July 2014 – 30 June 2024. We calculated crude and age-adjusted population exposure call rates (Supporting Information, supplementary methods), and used Joinpoint regression (version 4.9.0.1) to estimate annual percentage changes (APCs) in age-adjusted rates and to detect trend change points. The study was approved by the Sydney Children's Hospitals Network Human Research Ethics Committee (2021/ETH00165).</p><p>There were 3796 calls about cannabis poisoning exposures (2039 regarding exposures of boys or men, 54%) during 2014–24. The exposed person exhibited symptoms of poisoning at the time of the call in 3184 cases (84% of calls); 2783 people (74%) were in hospital at the time of the call or were referred to hospital (Supporting Information, table 1). The number of calls increased during 2014–24 by 12.8% per year (95% confidence interval [CI], 10.3–15.4% per year), and n","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 3","pages":"155-157"},"PeriodicalIF":6.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52586","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033489","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 future for the hospital-in-the-home (HITH) deteriorating patient: shifting the paradigm","authors":"Mya Cubitt, Seok Lim","doi":"10.5694/mja2.52588","DOIUrl":"10.5694/mja2.52588","url":null,"abstract":"<p>Australia's health care system is grappling with a mismatch of demand and capacity, with bottlenecks in access to, and transitions of, care and rising costs.<span><sup>1</sup></span> Hospital-in-the-home (HITH) models of care are suggested as sustainable patient-centred, value-based solutions.<span><sup>2</sup></span></p><p>HITH is defined as a 24-hour, 7-days-a-week service of “acute inpatient equivalent care, utilising highly skilled staff, hospital technologies, equipment, medication, and safety and quality standards, to deliver hospital-level care within a person's place of residence or preferred (non-hospital) treatment location”.<span><sup>3</sup></span> HITH models vary in clinical governance, combination and frequency of in-person or telehealth visits, patient selection and clinician staffing.<span><sup>4-6</sup></span> When HITH substitutes for hospital location of care (admission avoidance, AA) are compared to early supported discharge (ESD) or other hospital outreach services, clinical outcomes and patient satisfaction are comparable or improved, and care is cost-effective.<span><sup>7, 8</sup></span> However, evidence describing those patients for whom HITH is optimal and processes to recognise and respond to deteriorating HITH patients remains limited.<span><sup>9, 10</sup></span></p><p>The Australian Commission on Safety and Quality in Health Care (ACSQHC) defines health service standards of care, including “recognising and responding to acute deterioration” in a patient's physical, cognitive or mental state.<span><sup>11</sup></span> Currently, systems for managing deteriorating patients focus on hospital-located patients with escalation when mismatches in “clinical needs and the local resources to manage them” are identified.<span><sup>12</sup></span> In hospitals with rapid response teams, rates of activation of these teams vary considerably (1.35–71.3 per 1000 admissions).<span><sup>13</sup></span> Mixed efficacy in improving patient outcomes is observed, with concern regarding cost-effectiveness, sustainability, disruption to usual hospital routines, mortality as an outcome measure, deskilling of ward staff, and the impact on patient-centred care and doctor–patient relationships, especially in end-of-life care.<span><sup>14</sup></span> Relevant to the current context, evidence shows an increased reliance on systems for managing deteriorating patients with increasing patient complexity, economic and hospital capacity stress, and a focus on patient flow.<span><sup>14</sup></span></p><p>HITH models of care attached to Australian health services are subject to ACSQHC safety and quality accreditation standards.<span><sup>11, 15</sup></span> Despite HITH being available in Australia for many years, gaps remain in translation of hospital systems to manage deteriorating patients to HITH locations of care, standardised definitions, and data collection, making audit, research, benchmarking and policy difficult.<span><sup>8, 16</sup><","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 4","pages":"168-171"},"PeriodicalIF":6.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52588","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023798","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":"Shortages of benzathine benzylpenicillin G in Australia highlight the need for new sovereign manufacturing capability","authors":"Rosemary Wyber, Glenn Pearson, Laurens Manning","doi":"10.5694/mja2.52590","DOIUrl":"10.5694/mja2.52590","url":null,"abstract":"<p>Benzathine benzylpenicillin G (BPG) is the most effective treatment for syphilis and prevention of rheumatic heart disease (RHD), both of which disproportionately affect Aboriginal and Torres Strait Islander people. The ongoing syphilis epidemic in Australia<span><sup>1</sup></span> highlights the importance of a reliable supply of high quality BPG in achieving Australia's commitments to ending RHD and preventing new cases of congenital syphilis.<span><sup>2</sup></span></p><p>BPG is a long-acting penicillin. After intramuscular injection, the BPG crystals slowly release penicillin into the bloodstream, providing sustained concentrations, which prevent the recurrent streptococcal infections that lead to RHD. These sustained concentrations can also treat established syphilis infections. The BPG manufacturing process and mode of delivery has remained largely unchanged since the 1950s. Australia, along with other high income countries, has imported Bicillin-LA (Pfizer), the only BPG preparation with Therapeutic Goods Administration (TGA) approval since the 1990s.<span><sup>3</sup></span> Most low and middle income countries use a lyophilised powder formulation, which, unlike a prefilled syringe, requires mixing with a diluent at administration.</p><p>At a global level, fragmented BPG manufacturing, supply and procurement has led to recurrent global shortages, both of Bicillin-LA and powdered formulations. These shortages have led to an increased incidence of syphilis cases.<span><sup>1</sup></span> There are four manufacturers of the active pharmaceutical ingredient (API); three in China and one in Austria. The Chinese companies produce 95% of the global supply but only the Austrian company produces API under certified Good Manufacturing Practice conditions. Due to low profitability, production of powdered BPG is only triggered by large minimum orders. Large procurement agencies are unable to smooth out supply constraints because of a lack of confidence in manufacturing quality.<span><sup>4</sup></span></p><p>Due to a lack of sovereign manufacturing capacity, Australia is vulnerable to shortages of World Health Organization-listed essential medicines, such as BPG. In the early 2000s, there were short supply disruptions of Bicillin-LA, followed by an extended stockout from 2006 to 2008. During this stockout, a Section 19A exemption to the <i>Therapeutic Goods Act 1989</i> (Cwlth) was secured from the TGA to import a powdered formulation (Pan Benz; Panpharma, France) and there were haphazard efforts to support clinician awareness about how to use the preparation.<span><sup>3</sup></span> Shorter supply disruptions over subsequent decades have also affected Australia. In late 2023, the TGA was notified by Pfizer of an expected stockout lasting into mid-2024.<span><sup>5</sup></span></p><p>Australia's response to the predicted stockout was swift. A Section 19A approval for a powdered product (Brancaster Pharma, UK) was secured in late 2023 and listed","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 5","pages":"223-225"},"PeriodicalIF":6.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52590","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007994","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":"Improving palliative care for people who use alcohol and other drugs","authors":"Grace FitzGerald, Jon Cook, Peter Higgs, Charles Henderson, Sione Crawford, Thileepan Naren","doi":"10.5694/mja2.52585","DOIUrl":"10.5694/mja2.52585","url":null,"abstract":"<p>There is a need to improve access to and experiences of palliative care for people who use alcohol and other drugs when faced with terminal medical conditions. Effective harm reduction interventions mean that people who use alcohol and other drugs are living longer, and continue to use substances as older individuals.<span><sup>1-3</sup></span> People who use drugs demonstrate high levels of resilience in the face of a lifetime of structural disadvantage and exclusion, but are still more likely to die at an earlier age than the general population.<span><sup>4, 5</sup></span> They also experience accelerated age-related declines in functioning compared with non-drug using persons of similar age, and often have complex care needs due to accumulated health effects from their substance use and a high prevalence of past trauma.<span><sup>6</sup></span> The provision of palliative care to people who use drugs can be challenging for clinicians, specifically how to manage pain, anxiety and distress among these individuals.<span><sup>7</sup></span> Person-centred care is often obstructed by policies that make generalisations about the risks associated with the use of alcohol and other drugs while receiving medical care. Clinicians and health services looking to improve access to palliative care should integrate the perspectives of people with lived and living experience of drug use into their person-centred care and explore opportunities for the harms of stigma to be minimised. Box 1 provides a list of elements of person-centred care.</p><p>There is good evidence that early access to palliative care can improve the wellbeing of people with serious illness; however, structurally marginalised people face significant barriers to accessing palliative care.<span><sup>8, 9</sup></span> Some people who use drugs experience severe debility in their day-to-day lives and present to health services acutely symptomatic of advanced or terminal medical conditions that might have been contained with active management earlier in the disease process.<span><sup>10</sup></span> People who use alcohol and other drugs often receive palliative care following an emergency department presentation with symptoms of advanced disease, rather than being referred to palliative care services by primary care providers in the early phases of illness.<span><sup>11</sup></span> Delays in health care access and appropriate treatment are influenced by both anticipatory and experienced stigma.<span><sup>12, 13</sup></span> There is evidence that people who use drugs avoid presenting to health care services for fear of being judged, dismissed or disheartened by having their health concerns incorrectly assumed to be a consequence of their substance use.<span><sup>10, 12</sup></span> People who use drugs are further excluded from health care services by complex referral pathways and limited appreciation from clinicians of the multiple competing priorities of marginalised communities.<span><su","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 4","pages":"164-167"},"PeriodicalIF":6.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52585","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007990","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":"Prisoner of war pathology in Changi, 1942–1945","authors":"Kate Ariotti, Elizabeth Roberts-Pedersen","doi":"10.5694/mja2.52581","DOIUrl":"10.5694/mja2.52581","url":null,"abstract":"<p>History and humanities; Diagnostic techniques and procedures</p><p>The work of prisoner-of-war (POW) doctors imprisoned by the Japanese is well known, with men such as Edward “Weary” Dunlop, Bruce Hunt and Rowley Richards celebrated as heroes of the many prison camps scattered across South-East Asia during the Second World War.<span><sup>1</sup></span> While accounts of captive medical officers have focused on the general medical and surgical treatment of POWs, the remarkable diaries of Major Kennedy Byron Burnside (Box 1), head of an Australian bacteriology and pathology laboratory in the sprawling Changi prison camp complex, offer a detailed view of the specific pathology services available in the camp. The diaries reveal the integral role that pathology played in the provision of medical care and advancement of medical research in Changi and suggest that the medical and scientific cultures that developed among Allied personnel in Japanese captivity were part of a broader health infrastructure that drew on many forms of prisoner labour and expertise.</p><p>Kennedy Burnside was born in Victoria in 1913, educated at Melbourne Grammar, and graduated from the University of Melbourne in 1937. He was resident and then registrar at the Alfred Hospital from 1938 to 1939. In July 1940, he joined the Australian Army Medical Corps with the rank of captain and served in various Australian general hospitals. Burnside was sent to Singapore in April 1941 as head of the 2nd Mobile Bacteriological Laboratory, a small unit tasked with studying tropical diseases and providing support services such as blood typing to casualty clearing stations and hospitals treating soldiers wounded in the fight against the Japanese. He was promoted to major a few months later.</p><p>When Singapore fell in February 1942, Burnside and his unit were sent to Changi, the main POW camp in South-East Asia, which, at its peak, held over 50 000 Allied POWs. Although the situation in Changi never descended to the appalling conditions of the work camps along the Burma–Thailand Railway (hereafter, the railway), the camp was overcrowded and inadequately provisioned, and the prisoners were vulnerable to sudden displays of harsh discipline from their captors. Crucially, however, the Allied forces retained significant autonomy over the internal organisation of the camp, including the provision of medical services. This resulted in an improvised but extensive health infrastructure that replicated many aspects of conventional military medicine. Burnside remained in charge of his laboratory for most of his captivity and assumed several other roles including acting commander of the re-organised 9/10 Field Ambulance. In mid-1943, he became the Australian Imperial Force's anti-malaria officer, and from December 1943 to May 1944, assisted in the British–Australian combined hospital's malaria centre. Along with most POWs, Burnside moved from the general Changi camp to the adjacent Changi Gaol in mid-","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 3","pages":"125-129"},"PeriodicalIF":6.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52581","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007992","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":"Evaluating primary care expenditure in Australia: the Primary Care Spend (PC Spend) model","authors":"Michael Wright,&nbsp;Shona Bates,&nbsp;Andrew W Bazemore,&nbsp;Michael R Kidd AM","doi":"10.5694/mja2.52574","DOIUrl":"10.5694/mja2.52574","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the distribution of health care expenditure (public and private) for primary care and primary health care as proportions of overall health care funding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>The Primary Care Spend model; estimated distribution of expenditure for three tiers of primary care services by provider and function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Primary Care Spend model applied to Australian health expenditure, public and private, 2020–21, from a health sector perspective, as recorded by the Australian Institute of Health and Welfare.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Proportions of all health care spending for essential community and primary health care functions (tier A), comprehensive primary care (services delivered in general practices and family physician clinics; tier B), and enhanced primary care services (long-term holistic patient care; tier C).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2020–21, 33.2% of health spending in Australia was classified as primary health care spending (tier A), 6.0% as comprehensive primary care services (tier B), and 0.8% as long term holistic patient care services (tier C).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The application of the Primary Care Spend model to Australian data provides a more nuanced analysis of expenditure for primary health care than routine health expenditure reports. Its output could be used to inform targets for spending on different tiers, types, and locations of primary care, especially comprehensive and other high value primary care services, and to monitor progress toward these targets.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 3","pages":"149-154"},"PeriodicalIF":6.7,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52574","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the BreastScreen NSW transition from film to digital mammography, 2002–2016: a linked population health data analysis","authors":"Rachel Farber,&nbsp;Nehmat Houssami,&nbsp;Kevin McGeechan,&nbsp;Alexandra L Barratt,&nbsp;Katy JL Bell","doi":"10.5694/mja2.52566","DOIUrl":"10.5694/mja2.52566","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 impact of the transition from film to digital mammography in the Australian national breast cancer screening program.&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 linked population health data analysis (New South Wales Central Cancer Registry, BreastScreen NSW); interrupted time series analysis.&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;New South Wales, 2002–2016.&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;Women aged 40 years or older with breast cancer diagnosed during 2002–2017 who had been screened by BreastScreen NSW and for whom complete follow-up information until the end of the recommended re-screening interval was available.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Intervention&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Transition from film to digital mammography; 2009 defined as transition year (digital mammography becomes dominant screening modality).&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;Population rates of screen-detected cancer, interval cancer, recalls, and false positive findings.&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 study cohort comprised 967 573 women; of the 2 741 555 screens, 1 535 184 used film mammography (2002–2010) and 1 206 371 used digital mammography (2006–2016). The screen-detected cancer rate was 4.86 (95% confidence interval [CI], 4.75–4.97) cases per 1000 screens with film mammography and 6.11 (95% CI, 5.97–6.24) cases per 1000 screens with digital mammography (unadjusted difference, 1.24 [95% CI, 1.06–1.41] cases per 1000 screens). The interval cancer rate was 2.56 (95% CI, 2.48–2.64) cases per 1000 screens with film mammography and 2.84 (95% CI, 2.75–2.94) cases per 1000 screens with digital mammography (unadjusted difference, 0.27 [95% CI, 0.15–0.40] cases per 1000 screens). With the transition to digital mammography, the screen-detected cancer rate increased by 0.07 per 1000 screens, the sum of the decline in the invasive cancer rate (–0.21 cases per 1000 screens) and the rise in the ductal carcinoma in situ detection rate (0.28 cases per 1000 screens); during 2009–2015, it increased by 0.18 cases per 1000 screens per year. With the transition to digital mammography, the interval cancer rate increased by 0.75 cases per 1000 screens (invasive","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 2","pages":"82-90"},"PeriodicalIF":6.7,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52566","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971569","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 social and political framework of health","authors":"Virginia Barbour","doi":"10.5694/mja2.52561","DOIUrl":"10.5694/mja2.52561","url":null,"abstract":"&lt;p&gt;This first 2025 issue of the &lt;i&gt;MJA&lt;/i&gt; marks the beginning of a year in which a new US president takes office and in which Australia will have a federal election. Health is always a social and political issue and should not be confined to health portfolios. As the World Health Organization recognises, “population health is not merely a product of health sector programmes but largely determined by policies that guide actions beyond the health sector” (https://www.who.int/activities/promoting-health-in-all-policies-and-intersectoral-action-capacities). One of the most critical ways in which wider policies can affect health is in the way that they recognise, count and subsequently provide for the diversity of a country's population. With regard to multiculturalism, the Australian Government's Multicultural Access and Equity Policy from 2018 (https://www.homeaffairs.gov.au/about-us/our-portfolios/multicultural-affairs/about-multicultural-affairs/access-and-equity) notes that its aim is to ensure that “Australian Government programs and services meet the needs of all Australians, regardless of their cultural and linguistic backgrounds”. Despite this, the 2024 review &lt;i&gt;Towards fairness: a multicultural Australia for all&lt;/i&gt; (https://www.homeaffairs.gov.au/multicultural-framework-review/Documents/report-summary/multicultural-framework-review-report-english.pdf) noted “systemic barriers faced by individuals from diverse backgrounds within the healthcare and mental health systems”. In regard to LGBTIQA+ individuals, the policy framework is fragmented although, in 2023, the federal government began developing a draft action plan — &lt;i&gt;LGBTIQA+ Health and Wellbeing 10 Year National Action Plan&lt;/i&gt; (https://www.health.gov.au/committees-and-groups/lgbtiqa-plus-health-and-wellbeing-10-year-national-action-plan-expert-advisory-group).&lt;/p&gt;&lt;p&gt;Several articles in this issue of the &lt;i&gt;MJA&lt;/i&gt; reinforce the importance of developing policy coherence and that policies and structures well beyond the health sectors have a direct impact on health outcomes. Possibly one of the most important ways that needs are determined at a population level is the census, next due to be conducted in Australia in 2026. In a letter commenting on the next census, Saxby and Hammoud (https://doi.org/10.5694/mja2.52542) express the concern that many have felt over the discussion of collection of data on LGBTI+ Australians in the 2026 census. After a change of heart by the Australian Government, the 2026 census will include a question on sexual orientation and gender identity. However, as Saxby and Hammoud note, it is not clear if the census will, if it does not align with best practice in collecting these data, provide the evidence base needed for future policy. As they conclude, “Ultimately, health equity is unachievable without data equity. The future of health equity depends on the informed actions we take today to ensure our data accurately reflects the diversity of the entire Austra","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 1","pages":"3"},"PeriodicalIF":6.7,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52561","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971570","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}