Medical Journal of Australia最新文献

{"title":"A community within social and ecological communities: a new philosophical foundation for a just residential aged care sector","authors":"Lachlan Green, Bridget Pratt, David Kirchhoffer","doi":"10.5694/mja2.52472","DOIUrl":"10.5694/mja2.52472","url":null,"abstract":"<p>According to the Royal Commission into Aged Care Quality and Safety (hereafter, the Royal Commission), Australian residential aged care (RAC) inadequately caters to the physical, social and psychological needs of older people. The Royal Commission states that aged care requires “a philosophical shift” that centres on people receiving care and establishes “new foundational principles and core values.”<span><sup>1</sup></span></p><p>We propose reframing RAC as communities within social and ecological communities, to shift away from dominant consumerist approaches to care. Theories of social and environmental justice can then be applied to guide the development of the aged care sector, offering aged care providers and policy makers novel solutions to critical challenges identified by the Royal Commission.</p><p>The Royal Commission asserted that the sector should deliver care and services that assist people to lead active, self-determined, meaningful and dignified lives in safe, caring environments,<span><sup>1</sup></span> but found that systemic flaws and inadequate institutions hindered the sector from achieving this purpose. We maintain that many of these systemic flaws result from an underlying philosophical conception within society of citizens, including RAC residents, as consumers.</p><p>Sector regulation claims a commitment to the dignity of service recipients, embedding the concept as the foundational standard of the current Aged Care Quality Standards and featuring it heavily in the Charter of Aged Care Rights.<span><sup>2, 3</sup></span> Standard 1 states, “Being treated with dignity and respect is essential to quality of life. … Organisations are expected to provide care and services that reflect a consumer's social, cultural, language, religious, spiritual, psychological and medical needs.”<span><sup>2</sup></span> In practice, services delivered across the sector tend to treat RAC residents as consumers rather than with a broader sense of human dignity or personhood. The standards frame dignity as upholding a resident's choices and preferences in all aspects of their care. Currently, an affluent resident in a RAC home that is right for them may be able to attain this vision of dignity and meet all their needs. However, the framing may also compromise holistic human dignity. For example, upholding residents’ consumer rights may mean a RAC provider reduces each resident's services to a list of tasks. This may lead to the perception of residents as no more than a sum of tasks, instead of as people, which, in turn, results in care described as commercialised and transactional, where physical care needs are prioritised over psychological or social needs.<span><sup>1, 4</sup></span></p><p>Although it is true that a person will enter aged care with some degree of need for personal and clinical care services, this consumption of services does not account for the totality of the person. The reduction of RAC residents to consumers has led to","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 9","pages":"469-472"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52472","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365772","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":"Changes in the incidence of type 2 diabetes in Australia, 2005–2019, overall and by socio-demographic characteristics: a population-based study","authors":"Dianna J Magliano, Lei Chen, Jedidiah I Morton, Oyunchimeg Buyadaa, Agus Salim, Jonathan E Shaw","doi":"10.5694/mja2.52461","DOIUrl":"10.5694/mja2.52461","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To estimate changes in the incidence of clinically diagnosed type 2 diabetes in Australia, overall and by age, sex, socio-economic disadvantage, geographic remoteness, and country of birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Population-based study; analysis of National Diabetes Services Scheme (NDSS) data (age–period–cohort models).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Data were extracted for incident cases of type 2 diabetes, 1 January 2005 to 31 December 2019, in residents of the Australian Capital Territory, New South Wales, Queensland, and Victoria aged 20 years or older registered with the NDSS. The numbers of people at risk were obtained from the Australian Bureau of Statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Changes in the incidence of type 2 diabetes, 2005–2019, by age, postcode-level socio-economic disadvantage (Index of Relative Socioeconomic Disadvantage) and remoteness (major city, inner regional, outer regional/remote/very remote), and country of birth, stratified by sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During 2005–2019, 741 535 people aged 20 years or older with incident type 2 diabetes were registered with the NDSS; 421 190 were men (56.8%). Overall, the incidence of type 2 diabetes increased with age (until about age 70 years) and socio-economic disadvantage for both sexes; it was higher in inner regional areas than in major cities or outer regional/remote/very remote areas during 2005–2015, but highest among people in major cities after 2015. The age-standardised incidence of type 2 diabetes increased during 2005–2010, both among men (annual percentage change [APC], 4.4%; 95% confidence interval [CI], 3.6–5.2%) and women (APC, 2.9%; 95% CI, 2.2–3.7%); it declined during 2010–2019 among both men (APC, –5.2%; 95% CI, –5.4% to –4.9%) and women (APC, –6.5%; 95% CI, –6.8% to –6.2%). In general, similar patterns (but of differing magnitude) applied to all age, sex, socio-economic disadvantage, and remoteness groups. However, the incidence of type 2 diabetes increased during 2011–2019 among people born in Asia, North Africa and the Middle East, and the Pacific Islands.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The incidence of type 2 diabetes in Australian adults declined during 2010–2019 across all age, sex, s","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 9","pages":"473-479"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52461","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361747","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":"Harming those we intend to help: hospital-acquired complications in patients with dementia","authors":"Emily H Gordon, Ruth E Hubbard","doi":"10.5694/mja2.52463","DOIUrl":"10.5694/mja2.52463","url":null,"abstract":"<p>Life expectancy has increased around the world, but healthy life expectancy has not kept pace.<span><sup>1</sup></span> Dementia is one of the chronic diseases responsible for this discrepancy. While the age-adjusted incidence of dementia is declining, longer lives mean that the prevalence, and consequently the burden of disability, are increasing.<span><sup>2</sup></span> In Australia, the number of people living with dementia is predicted to more than double, to about 850 000 people, by 2058.<span><sup>3</sup></span> This rise will pose a substantial challenge for hospitals, which are largely designed to meet the needs of robust patients with single, biological disorders rather than frail patients with complex biopsychosocial problems, such as dementia.</p><p>In this issue of the <i>MJA</i>, Ní Chróinín and colleagues<span><sup>4</sup></span> assessed the risk of harm to older patients with dementia admitted to five hospitals in southwestern Sydney during 2010–2020. Among the 217 000 hospitalised patients aged 60 years or older, 11 393 patients with dementia were matched with control patients without dementia, using a propensity score based on key clinical and demographic factors. The characteristics of the well matched cohort were consistent with being a frail patient group: matched patients were older and more likely to be women, to have two or more medical conditions, and to have a history of falls than unmatched patients without dementia.</p><p>The key finding by Author and colleagues was that dementia is an independent risk factor for several hospital-acquired complications, including geriatric syndromes (falls, pressure injuries, delirium) and pneumonia, as well as for in-hospital death. The risks of new incontinence and malnutrition were not significantly greater for patients with dementia, but this could reflect low rates of clinical documentation and coding of these conditions, an inherent limitation for administrative data analyses. The median hospital length of stay was longer for patients with dementia than for matched patients without dementia, but it is not clear whether this is a cause or consequence of hospital-acquired complications.<span><sup>4</sup></span></p><p>Dementia is closely linked with frailty: the risk of dementia is higher in people with frailty, and frailty increases in severity after the onset of dementia.<span><sup>5, 6</sup></span> We have known for some time that older patients with frailty are more likely to experience hospital-acquired complications.<span><sup>7</sup></span> Frailty reflects the progressive failure of a complex system; higher order functions, such as walking, are the first to be compromised by stressors, as they require the precise coordination of multiple physiological components. Prior and incident falls were frequently reported in the study by Ní Chróinín and colleagues.<span><sup>4</sup></span> But why is it that patients with dementia were more than four times as likely to fall in hos","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 8","pages":"420-421"},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52463","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349523","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 likelihood of hospital-acquired complications in older people with dementia: a matched cohort study","authors":"Danielle Ní Chróinín,&nbsp;Vicki Deane,&nbsp;Rinsy Pulikotil Zachariah,&nbsp;Katrina Stott,&nbsp;Bernadette Shepherd,&nbsp;Margaret Perkins,&nbsp;Leesa Giang,&nbsp;Rozina Shekhar,&nbsp;Vaulina Vueti,&nbsp;Mandana Mayahi-Neysi,&nbsp;Amy Montgomery,&nbsp;Kaye Rolls,&nbsp;Steven A Frost","doi":"10.5694/mja2.52462","DOIUrl":"10.5694/mja2.52462","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate whether the likelihood of hospital-acquired complications for older people in Australia differs by whether they have dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Matched cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>People aged 60 years or older with dementia who were admitted to five public hospitals in the South Western Sydney Local Health District, New South Wales, 1 January 2010 to 31 December 2020, and people without dementia admitted during the same period, matched by age, sex, number of medical conditions, and presence of selected specific medical conditions, emergency admission status, history of falls, and admission from a nursing home.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Hospital-acquired complications (falls, pressure injuries, delirium, pneumonia, venous thromboembolism, new incontinence, malnutrition, in-hospital death), by dementia status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 217 459 people aged 60 years or older were admitted to the five hospitals during the study period. The mean age of the 11 393 patients with dementia (83 years; standard deviation [SD], 7.5 years) was higher than that of the 206 065 patients without dementia (73 years; SD, 8.9 years), and the proportion of women slightly larger (55% <i>v</i> 50%). Median hospital length of stay was longer for people with dementia (nine days; interquartile range [IQR], 4–19 days) than for people without dementia (three days; IQR, 1–9 days), and the number of in-hospital deaths higher (768, 7% <i>v</i> 584, 5%). After propensity score-based matching, the risks of falls (odds ratio [OR], 4.7; 95% confidence interval [CI], 3.8–5.7), pressure injury (OR, 1.4; 95% CI, 1.1–1.8), delirium (OR, 2.4; 95% CI, 2.0–3.0), and pneumonia (OR, 1.3; 95% CI, 1.01–1.7) were higher for people with dementia than for those without dementia; differences between the two groups in the risks of venous thromboembolism, malnutrition, and incontinence were not statistically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Given the greater risk of many hospital-acquired complications for people with dementia, targeted models of person-centred care are needed to ensure the best outcomes for these patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 8","pages":"422-425"},"PeriodicalIF":6.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52462","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349524","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":"Adherence to clinical care standards and mortality after hip fracture surgery in New South Wales, 2015–2018: a retrospective population-based study","authors":"Lara Harvey,&nbsp;Morag E Taylor,&nbsp;Ian A Harris,&nbsp;Rebecca J Mitchell,&nbsp;Ian D Cameron,&nbsp;Pooria Sarrami,&nbsp;Jacqueline Close","doi":"10.5694/mja2.52470","DOIUrl":"10.5694/mja2.52470","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 determine whether adherence to hip fracture clinical care quality indicators influences mortality among people who undergo surgery after hip fracture in New South Wales, both overall and by individual indicator.&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 population-based study; analysis of linked Australian and New Zealand Hip Fracture Registry (ANZHFR), hospital admissions, residential aged care, and deaths data.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting, participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;People aged 50 years or older with hip fractures who underwent surgery in 21 New South Wales hospitals participating in the ANZHFR, 1 January 2015 – 31 December 2018.&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;Thirty-day (primary outcome), 120-day, and 365-day mortality (secondary outcomes) by clinical care indicator adherence level (low: none to three of six indicators achieved; moderate: four indicators achieved; high: five or six indicators achieved) and by individual indicator.&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;Registry data were available for 9236 hip fractures in 9058 people aged 50 years or older during 2015–2018; the mean age of patients was 82.8 years (standard deviation, 9.3 years), 5510 patients were women (69.4%). Complete data regarding adherence to clinical care indicators were available for 7951 fractures (86.1%); adherence to these indicators was high for 5135 (64.6%), moderate for 2249 (28.3%), and low for 567 fractures (7.1%). After adjustment for age, sex, comorbidity, admission year, pre-admission walking ability, and residential status, 30-day mortality risk was lower for high (adjusted relative risk [aRR], 0.40; 95% confidence interval [CI], 0.30–0.52) and moderate indicator adherence hip fractures (aRR, 0.61; 95% CI, 0.46–0.82) than for low indicator adherence hip fractures, as was 365-day mortality (high adherence: aRR, 0.59 [95% CI, 0.51–0.68]; moderate adherence: aRR, 0.74 [95% CI, 0.63–0.86]). Orthogeriatric care (365 days: aRR, 0.78; 95% CI, 0.61–0.98) and offering mobilisation by the day after surgery (365 days: aRR, 0.74; 95% CI, 0.67–0.83) were associated with lower mortality risk at each time point.&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;Clinical care for two-thirds of hip fractures attained a high level of adherence to the six quality care indi","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 9","pages":"480-485"},"PeriodicalIF":6.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52470","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349522","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":"30/60/90 National stroke targets and stroke unit access for all Australians: it's about time","authors":"Timothy J Kleinig,&nbsp;Lisa Murphy,&nbsp;For the 30/60/90 National Stroke Targets Taskforce","doi":"10.5694/mja2.52459","DOIUrl":"10.5694/mja2.52459","url":null,"abstract":"&lt;p&gt;Stroke is the world's second-leading cause of death and the third-leading cause of death and disability.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; In Australia, stroke is the third most common cause of death and a leading cause of disability.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; As a result, stroke is costly to the health system, society and the individual.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Three acute stroke interventions have broadly applicable, significant, readily quantifiable health economic benefits: stroke unit care (for both ischaemic stroke and intracerebral haemorrhage)&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; and ischaemic stroke reperfusion therapies, thrombolysis&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; and endovascular thrombectomy (EVT).&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; For every 17 patients treated in a stroke unit, one death or disabled outcome is prevented.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; The number needed to treat to prevent disability for thrombolysis under three hours is ten,&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; and the EVT number needed to treat to prevent functional dependency is five.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Expediting reperfusion therapies substantially magnifies treatment benefits; “saving a minute” gains an extra day of quality-adjusted life following thrombolytic treatment,&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; and an extra week following EVT.&lt;span&gt;&lt;sup&gt;7, 8&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Despite Australia having a national acute stroke clinical care standard,&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; a national stroke registry (www.auscr.com.au), several centres of excellence&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; and population-based reperfusion therapy rates comparable to other high income countries,&lt;span&gt;&lt;sup&gt;11, 12&lt;/sup&gt;&lt;/span&gt; Australia compares poorly internationally in stroke unit admission percentages and speed of reperfusion treatment.&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt; In 2022, Australia's median door-to-needle (thrombolytic) time was 75 minutes.&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt; Only 27% of patients were treated within an hour of hospital arrival, compared with 82% in Sweden,&lt;span&gt;&lt;sup&gt;12&lt;/sup&gt;&lt;/span&gt; 75% in the United States (US),&lt;span&gt;&lt;sup&gt;13&lt;/sup&gt;&lt;/span&gt; and 61% in the United Kingdom (UK).&lt;span&gt;&lt;sup&gt;14&lt;/sup&gt;&lt;/span&gt; In Sweden during 2022, 93% of patients with stroke were admitted to a stroke unit, compared with 75% in Australia. The US, from 2016 to 2019, reported median door-arterial puncture times for non-transferred EVT cases of 78 minutes&lt;span&gt;&lt;sup&gt;15&lt;/sup&gt;&lt;/span&gt; versus 115 minutes in 2022 in Australia.&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Concerningly, door-to-needle times and stroke unit admission percentages have not improved over the past six years (Box 1). Regional and remote Australians are most significantly affected by these treatment gaps.&lt;span&gt;&lt;sup&gt;11, 16&lt;/sup&gt;&lt;/span&gt; Because a higher proportion of Aboriginal and Torres Strait Islander Australians live in non-metropolitan areas, improving national stroke performance is a critical Closing the Gap initiative. Given the poorer stroke outcomes associated with suboptimal stroke care, continued national ine","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 8","pages":"402-406"},"PeriodicalIF":6.7,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52459","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An outbreak of reactive infectious mucocutaneous eruption (RIME) after Mycoplasma pneumoniae infections in Sydney, 2024: retrospective case series","authors":"Joseph Joseph,&nbsp;Kelvin Truong,&nbsp;Artiene Tatian,&nbsp;Orli Wargon","doi":"10.5694/mja2.52434","DOIUrl":"10.5694/mja2.52434","url":null,"abstract":"<p>Reactive infectious mucocutaneous eruption (RIME) is a severe mucocutaneous reaction most frequently seen in children and adolescents after an infectious respiratory illness, particularly <i>Mycoplasma pneumoniae</i> infections.<span>¹</span> It is characterised by prominent oral mucositis, conjunctivitis, and urethral involvement. Cutaneous manifestations are usually limited; the most frequent are vesicobullous eruptions.<span>²</span> RIME is distinguished from Stevens–Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) because it typically has an infectious cause, a milder course, and a favourable prognosis.<span>¹</span></p><p>In this article, we review the cases of thirteen children with RIME diagnosed by a specialist paediatric dermatologist and managed at the Sydney Children's Hospital at Randwick, a New South Wales referral centre, during 1 March – 31 May 2024. We extracted data and photographs from their medical records with the informed consent of their parents or guardians. The study was approved by the Sydney Children's Hospitals Network Human Research Ethics Committee (2024/ETH01030).</p><p>The mean age of the thirteen children (eight boys, five girls) was 11.7 years (range: 7–16 years); twelve were polymerase chain reaction (PCR)-positive for <i>M. pneumoniae</i>. The mean length of respiratory illness preceding the mucocutaneous eruption was 7.4 days (range, 5–10 days). Oral manifestations were evident in all thirteen children, including haemorrhagic crusted lips, mucositis, and lip swelling. Seven children had cutaneous symptoms, limited in six to small targetoid lesions or bullae; eight children had ocular conjunctivitis, and four had urethral lesions (Box; Supporting Information).</p><p>Open access publishing facilitated by the University of Sydney, as part of the Wiley – the University of Sydney agreement via the Council of Australian University Librarians.</p><p>No relevant disclosures.</p><p>The data underlying this study are included in the Supporting Information file; electronic medical records are not available for sharing.</p><p>Received 8 June 2024, accepted 14 August 2024</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 8","pages":"434-435"},"PeriodicalIF":6.7,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52434","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308077","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":"Pregnancy, childbirth and the postpartum period: opportunities to improve lifetime outcomes for women with non-communicable diseases","authors":"Jenny A Ramson,&nbsp;Myfanwy J Williams,&nbsp;Bosede B Afolabi,&nbsp;Stephen Colagiuri,&nbsp;Kenneth W Finlayson,&nbsp;Bianca Hemmingsen,&nbsp;Kartik K Venkatesh,&nbsp;Doris Chou","doi":"10.5694/mja2.52452","DOIUrl":"10.5694/mja2.52452","url":null,"abstract":"&lt;p&gt;Non-communicable diseases (NCDs), such as cardiovascular disease, malignant neoplasms, chronic respiratory diseases and diabetes, are the primary cause of death and disability among women,&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; with women remaining susceptible throughout their life spans.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Estimates indicate that women in most countries (88%) have a higher probability of dying before the age of 70 from an NCD than from communicable, perinatal and nutritional conditions combined.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Most premature deaths due to NCDs (86%) occur in low and middle-income countries (LMICs),&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; but health inequalities persist in high income countries (HICs) and NCDs affect some population groups more than others.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; In addition, the effects of the pandemic of NCDs on global health are intertwined with effects of climate change.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Globally, the proportion of deaths due to NCDs in women of reproductive age increased from 44% in 2010 to 52% in 2019.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Although this trend has declined since the start of the coronavirus disease 2019 (COVID-19) pandemic, the absolute number of NCD deaths has continued to increase.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; In 2021, the most common NCD causes of death among women globally were cardiovascular disease (30% of total deaths in women); malignant neoplasms (14%); respiratory diseases (6%); neurological conditions (5%); and diabetes, digestive diseases and genitourinary diseases (3%).&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The United Nations 2030 Agenda for Sustainable Development recognises both NCDs and maternal mortality rates as major challenges&lt;span&gt;&lt;sup&gt;8, 9&lt;/sup&gt;&lt;/span&gt; (Box 1). Globally, progress towards the United Nations goals is variable. Reduced mortality from NCDs in women by 2030 is attainable in only 35 mostly HICs (19%), and requires a slight acceleration in decline in 50 countries (27%); with these goals not likely to be achieved in 86 countries (46%).&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; In 15 countries (8%), NCD-related mortality rates have stagnated or increased. Although the global maternal mortality rate decreased between 2000 and 2020, it significantly increased between 2016 and 2020 in Europe, North America, Latin America and the Caribbean, and between 2000 and 2020 in eight countries, including the United States.&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; The leading direct cause of maternal mortality is haemorrhage (27.1% globally); however, a similar proportion (27.5%) results from indirect causes, most of which pre-date pregnancy (&gt; 70%).&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt; In Australia in 2018–2020, cardiovascular disease was one of the leading causes of maternal mortality&lt;span&gt;&lt;sup&gt;12&lt;/sup&gt;&lt;/span&gt; (Box 2).&lt;/p&gt;&lt;p&gt;National statistics can mask the greater burden of NCDs for women in some groups, which is often exacerbated by intersecting forms of disadvantage.&lt;span&gt;&lt;sup&gt;13&lt;/sup&gt;&lt;/span&gt; Disparities in the impact of NCDs on subgroups of","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 7","pages":"350-353"},"PeriodicalIF":6.7,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52452","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290490","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":"Lessons learnt from the first two SARS-CoV-2 Omicron waves of the COVID-19 pandemic in six remote Aboriginal and Torres Strait Islander communities in Queensland, Australia: a retrospective epidemiological review","authors":"Allison Hempenstall,&nbsp;Barbara Telfer,&nbsp;Sean Cowley,&nbsp;Shalomie Shadrach,&nbsp;Caroline Taunton,&nbsp;Jay Short,&nbsp;Nicolas Smoll,&nbsp;Roy Rasalam,&nbsp;Oscar Whitehead,&nbsp;Peter Roach,&nbsp;Karen Koko,&nbsp;Josh Stafford,&nbsp;Rittia Matysek,&nbsp;Renarta Whitcombe,&nbsp;Gulam Khandaker,&nbsp;Jason King,&nbsp;Nishila Moodley,&nbsp;Maree Finney,&nbsp;Rica Lacey,&nbsp;Steven Donohue,&nbsp;Richard Gair,&nbsp;Katie Panaretto","doi":"10.5694/mja2.52426","DOIUrl":"10.5694/mja2.52426","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe the preparedness for, epidemiological characteristics of and public health responses to the first and second waves of coronavirus disease 2019 (COVID-19) in six remote Aboriginal and Torres Strait Islander communities in Queensland from late 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This was a descriptive epidemiological study. Data were collated by each participating public health unit. Case and outbreak characteristics were obtained from the statewide Notifiable Conditions System.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Six discrete remote First Nations communities across Queensland were selected to represent a broad geographic spread across the state: Badu Island, Cherbourg, Lockhart River, Palm Island, Woorabinda and Yarrabah. People with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result recorded between 13 December 2021 and 12 June 2022 who acquired the infection and isolated in one of the six communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>COVID-19 vaccination coverage among First Nations people; number of COVID-19 cases reported; and attack rates for each community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All six First Nations communities led the COVID-19 preparedness and planning. COVID-19 vaccination coverage rates before the first outbreak ranged from 59% to 84% for the first dose and from 39% to 76% for the second dose across the six communities. During the study period, 2624 cases of COVID-19 in these communities were notified to Queensland Health. Attack rates for each community were: Badu Island, 23%; Cherbourg, 34%; Lockhart River, 18%; and Palm Island, Woorabinda and Yarrabah, 35% each. The 2624 cases included 52 cases (2%) involving hospital admission and two cases (&lt; 1%) in which the person died from COVID-19.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>It is likely that the co-designed, collaborative partnerships between local councils, community-controlled health services, state health services and public health units positively impacted the management and outcomes of COVID-19 in each of the six communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 8","pages":"426-433"},"PeriodicalIF":6.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290489","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":"Concurrent use of hormonal long-acting reversible contraception by women of reproductive age dispensed teratogenic medications, Australia, 2013–2021: a retrospective cohort study","authors":"Luke E Grzeskowiak,&nbsp;Vivienne Moore,&nbsp;Kelly Hall,&nbsp;Jenni Ilomäki,&nbsp;Danielle Schoenaker,&nbsp;Elizabeth Lovegrove,&nbsp;Danielle Mazza,&nbsp;Kirsten I Black,&nbsp;Debra S Kennedy,&nbsp;Michael J Davies,&nbsp;Alice Rumbold","doi":"10.5694/mja2.52451","DOIUrl":"10.5694/mja2.52451","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 examine patterns in the dispensing of category X medications (Therapeutic Goods Administration categorisation system for prescribing medicines in pregnancy) to women aged 15–49 years in Australia during 2008–2021, and patterns of concurrent use of hormonal long-acting reversible contraception (LARC) and other hormonal contraception.&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 cohort study; analysis of 10% random sample of national Pharmaceutical Benefits Scheme dispensing data.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Participants, setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Women aged 15–49 years dispensed category X medications, Australia, 1 January 2013 – 31 December 2021.&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;Incident and prevalent dispensing of category X medications, by medication class, age group, and year; contraceptive overlap (proportions of women dispensed hormonal LARC or other hormonal contraception that overlapped the first dispensing of category X medications), by medication class.&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;Among 15 627 women aged 15–49 years dispensed category X medications during 2013–2021, the prevalence of dispensing increased from 4.6 in 2013 to 8.7 per 1000 women aged 15–49 years in 2021; the largest increase was for the dispensing of dermatological agents, from 3.9 to 7.9 per 1000 women aged 15–49 years. LARC overlap was inferred for 2059 women at the time of first dispensing of category X medications (13.2%); 3441 had been dispensed any type of hormonal contraception (22.1%). The proportion with LARC overlap was smallest for those dispensed dermatological agents (1806 of 14 331 women, 12.6%); for this drug class, both LARC overlap (adjusted odds ratio [aOR], 0.17; 95% confidence interval [CI], 0.14–0.20) and any hormonal contraception overlap (aOR, 0.28; 95% CI, 0.25–0.32) were less likely for those aged 15–19 years than for women aged 25–29 years.&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;Concurrent use of highly effective hormonal contraception at the time of first dispensing of category X medications is low in Australia, raising concerns about potential fetal harms during unintended pregnancies. Awareness of the importance of hormonal contraception and its uptake by women prescribed category X medications should be increased.&lt;/p&gt;\u0000 &lt;/se","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 7","pages":"367-373"},"PeriodicalIF":6.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52451","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290484","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}