Medical Journal of Australia最新文献

{"title":"The Telephysiotherapy for Older People (TOP-UP) program for improving mobility in people receiving aged care: a hybrid type 1 effectiveness–implementation randomised controlled trial","authors":"Rik Dawson,&nbsp;Marina Pinheiro,&nbsp;Juliana Oliveira,&nbsp;Abby Haynes,&nbsp;Vasikaran Naganathan,&nbsp;Morag E Taylor,&nbsp;Nina Bowes,&nbsp;Karn Nelson,&nbsp;Jenny Rayner,&nbsp;Catherine Sherrington","doi":"10.5694/mja2.70004","DOIUrl":"10.5694/mja2.70004","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the effectiveness and implementation of a telephysiotherapy program for improving mobility, mobility goal attainment, and quality of life of people receiving at-home or residential aged care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Hybrid type 1 effectiveness–implementation randomised controlled trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>People aged 65 years or older who were receiving community or residential aged care services in Australia, 1 September 2021 – 30 November 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Intervention</h3>\u0000 \u0000 <p>Telephysiotherapy for Older People (TOP-UP): six-month program of ten telephysiotherapy (Zoom) sessions for assessment and tailored exercise prescription, supported by trained aged care workers and exercise videos.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Primary outcome: mobility (Short Physical Performance Battery [SPPB] score at baseline and six months). Secondary outcomes: fall rate (per person), proportion of people with falls, SPPB components (sit-to-stand performance, balance, gait speed), pain (visual analogue scale), mobility goal attainment, physical activity (Incidental and Planned Exercise Questionnaire), quality of life (EQ-5D-5L visual analogue scale).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1348 people were screened at 27 sites, and 242 eligible people were recruited for the trial (mean age, 83 years [standard deviation, 8 years]; 158 women [65%]); 92 of 120 intervention group participants and 100 of 122 control group participants completed the six-month. After adjusting for baseline mobility scores, the mean difference in mobility score at six months (intervention <i>v</i> control group) was 2.1 (95% confidence interval [CI], 1.4–2.7) points. Sit-to-stand performance was more likely to improve in intervention than control participants (adjusted odds ratio, 2.7; 95% CI, 1.3–4.3); intervention participants reported greater quality of life (EQ-5D-5L visual analogue scale: adjusted mean difference, 6.2 [95% CI, 1.8–10.7] points) and less pain (visual analogue scale: adjusted mean difference, –1.1 [95% CI, –1.8 to –0.3] points), and a smaller proportion experienced falls (29, 32% <i>v</i> 44, 44%; risk ratio, 0.62; 95% CI, 0.42–0.92). Of 1348 screened people, 242 enrolled in the trial (18.0%), ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 4","pages":"205-213"},"PeriodicalIF":8.5,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675223","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 2024 report of the MJA–Lancet Countdown on health and climate change: Australia emerging as a hotspot for litigation","authors":"Rishu Thakur,&nbsp;Supriya Mathew","doi":"10.5694/mja2.70007","DOIUrl":"10.5694/mja2.70007","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 5","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659594","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":"The 2024 report of the MJA–Lancet Countdown on health and climate change: Australia emerging as a hotspot for litigation","authors":"Paul J Beggs,&nbsp;Alistair J Woodward,&nbsp;Kathryn Bowen","doi":"10.5694/mja2.70006","DOIUrl":"10.5694/mja2.70006","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 5","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649863","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":"The public health impacts of mining in Australia.","authors":"Javier Cortes-Ramirez, Ruby N Michael, Leisa-Maree Toms, Melissa Haswell","doi":"10.5694/mja2.70005","DOIUrl":"https://doi.org/10.5694/mja2.70005","url":null,"abstract":"<p><p>Australia is rich in minerals of commercial interest along with oil and gas, and mining activities are carried out in almost all states and territories. The public health impacts of mining on the Australian general population need to be addressed to enable a comprehensive cost-benefit assessment of these activities balanced against their broader impacts. This systematic search and thematic review of the literature evidenced that exposure to agents released during mining operations, such as cadmium, iron, manganese, zinc, arsenic and lead, is associated with neoplastic and non-neoplastic diseases in adults and children. Mining of lead is specifically associated with negative fertility effects in men and with intellectual disability and impaired immune function in children. Asbestos mining is associated with higher morbidity and mortality due to respiratory and non-respiratory cancers, and recent analyses have identified a higher risk of severe respiratory and circulatory diseases in communities in proximity to coal mining. Although unconventional gas extraction is more newly introduced in Australia, research has found a higher risk of hospitalisation by all-causes and for circulatory, respiratory and blood and immune diseases, especially in children. These findings are consistent with extensive research globally, but human studies in this field are scarce in Australia. Multisectoral approaches are required to address these impacts, including committed involvement of the mining industry, the academic sector and, especially, the different levels of government.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642916","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":"A precautionary approach to social media: protecting young minds in an evolving digital world","authors":"Ivana Stankov,&nbsp;Yonatal Tefera,&nbsp;Melissa Bradley,&nbsp;Alison Pickering,&nbsp;Emma Willoughby,&nbsp;Carmel Williams","doi":"10.5694/mja2.52722","DOIUrl":"10.5694/mja2.52722","url":null,"abstract":"&lt;p&gt;The negative impact of social media on children's mental health has raised concerns at the highest levels&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; despite limited causal evidence. To mitigate concerns, Meta (a social technology company that owns several social media platforms) created “teen accounts”,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; several European nations are considering age-based restrictions, and Australia legislated a world-first social media ban for children under 16 years.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Debates concerning social media's impact on young people's mental health are polarised. One view is that social media harms mental health through social comparisons, cybervictimisation and fears of missing out.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; An alternative view attributes the rising rates of youth mental illness since the coronavirus disease 2019 pandemic to broader societal factors&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; and increased mental health awareness.&lt;/p&gt;&lt;p&gt;The relationship between social media and mental health is complex and dynamic. As mental health exists along a continuum, framing it solely as a discrete set of outcomes (eg, anxiety, depression) overlooks social media's potential effects across the continuum. Social media has been linked to sleep, self-esteem and eating behaviours.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Exposure to harmful content, cyberbullying, misinformation and identity theft also represent significant concerns.&lt;/p&gt;&lt;p&gt;Delineating social media's mental health impacts is challenging and evolving. Yet the absence of unequivocal evidence of harm is not evidence of its absence. The precautionary principle, which emphasises proactive harm mitigation in the face of scientific uncertainty, is important here.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; This perspective is guided by an interpretivist epistemology and shaped by our experiences as public health researchers and policy makers working on youth mental health. We argue that the debate over whether social media's impact on mental health is correlational or causal should not delay actions to protect young people's wellbeing. Moreover, we believe that system-oriented approaches can harness social media's potential for good while minimising its risks.&lt;/p&gt;&lt;p&gt;Australia's recent legislation to ban social media for children and adolescents aged under 16 years is a bold and precautionary move. However, the effectiveness of the ban hinges on its enforceability and the capacity to prevent access to social media through alternative means. As such, this age-based ban should not be viewed as a panacea but rather a component of a multifaceted approach. We believe that the implementation of comprehensive social media use guidelines for young people is integral to this multifaceted approach. Even in countries such as Australia with legislated age bans, guidelines are essential in establishing a framework for responsible behaviour. This is because: (i) bans may be circumvented; (ii) bans may be lifted or modified in the future; and (iii) regar","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 5","pages":"230-232"},"PeriodicalIF":8.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52722","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637396","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":"Spinal cord stimulation patterns of care, re-interventions, and costs for private health insurers, Australia, 2011–22: a retrospective observational study","authors":"Caitlin MP Jones,&nbsp;Christopher G Maher,&nbsp;Rachelle Buchbinder,&nbsp;Ian A Harris,&nbsp;Chung-Wei Christine Lin,&nbsp;Christopher Hayes,&nbsp;Alexandra Gorelik","doi":"10.5694/mja2.70001","DOIUrl":"10.5694/mja2.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate spinal cord stimulation patterns of care, the proportions of people who require unplanned surgical interventions after receiving definitive spinal cord stimulator implants, and the costs to private health insurers in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Retrospective observational study; analysis of deidentified private health care insurers benefits payments data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>People admitted to hospital for spinal cord stimulation-related surgical procedures, 11 January 2011 – 13 April 2022, with full or partial costs coverage by five general private health care insurers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Patterns of care; proportions of people with stimulator implants who subsequently require surgical re-intervention, overall and within 36 months of receiving definitive implants; costs to insurer for trial, definitive implantation, and re-interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analysed data for 11 451 admissions of 5839 people; mean age at first admission was 60.2 years (standard deviation, 15.4 years), 3717 people were women (63.7%). Median follow-up time was 48 months (interquartile range [IQR], 33–72 months). Definitive stimulators were implanted in 4361 people (74.7%), of whom 3244 had previously had at least one stimulation trial (74.3%; one trial only: 2970 people); 1478 people (25.3%) had trials but never proceeded to definitive implants. Surgical re-interventions were required by 1011 people with definitive implants (23.2%); the median time to the first re-intervention was 16.8 months (IQR, 6.2–39.8 months). The cumulative probability of requiring surgical re-intervention at 36 months was 0.35. The median cost to the insurer of a trial implant was $13 689, for a definitive implant (device, medical, and hospital costs for initial procedure and re-interventions) $55 635.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>About one in four people will require surgical re-intervention within 36 months of receiving a definitive spinal cord stimulator, and the costs for the procedure are high. Both findings are concerning given the paucity of evidence for their efficacy in treating chronic pain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 5","pages":"243-247"},"PeriodicalIF":8.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637399","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":"Dignity of risk in residential aged care: a call to reframe understandings of risk","authors":"Maria Foundas","doi":"10.5694/mja2.70002","DOIUrl":"10.5694/mja2.70002","url":null,"abstract":"&lt;p&gt;The Royal Commission into Aged Care Quality and Safety sent a powerful message to the community that older Australians deserve to be treated with dignity and respect, and affirmed a government commitment to completely transform the aged care system. As a consequence of this reform agenda, the focus in residential aged care has acquired a rights-based lens.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; This includes the right for individuals to make their own decisions, including choices that involve risk. Dignity of risk is the “principle of allowing an individual the dignity afforded by risk taking”,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; encouraging providers to balance the harms and benefits of paternalism and examine the justifiability of protective measures. The &lt;i&gt;Aged Care Act 2024&lt;/i&gt; sets out a Statement of Rights and Principles, and compliance obligations to strengthened Quality Standards and the Code of Conduct for Aged Care, which facilitate autonomy, choice, and independent decision making.&lt;span&gt;&lt;sup&gt;2, 4, 5&lt;/sup&gt;&lt;/span&gt; Dignity of risk is respected when risk-based choices are supported — decisions such as the refusal of mobility assistance in the context of heightened falls risk, choice of food texture despite choking hazard or aspiration risk, or engagement in activities that risk injury or unexplained absence. Duty of care is often referenced to justify actions or behaviours that inhibit risk taking, but this mostly sits within the narrow view of preserving physical safety. This can lead to a paternalism grounded in care that ultimately deprives residents of opportunities to take and accept risks to live a dignified life. Repositioning risk as having both positive and negative outcomes, and necessary to quality of life and dignity in aged care, is an essential step towards realising person-centred care (Box 1 and Box 2).&lt;/p&gt;&lt;p&gt;Robert Perske was the first to connect the concept of dignity with taking of risks. Perske claimed the denial of persons with intellectual disabilities “exposure to normal risks commensurate with their functioning tends to have a deleterious effect on both their sense of human dignity and their personal development”.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Perske argued that the real world is not always safe and predictable, every day yielding the possibility of risk, and that individuals are enabled to thrive through risk taking.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Perske claimed human dignity in risk, and dehumanising indignity in overprotection. This early notion of dignity through risk taking, and recognition of a need to shift away from paternalism, has subsequently played a similar role in the context of aged care, mental illness, hospice care, and rehabilitation.&lt;span&gt;&lt;sup&gt;7-9&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;It is a human reality that risks are present in everyday life, and risk can be seen as either a threat to be managed, or a positive opportunity for growth.&lt;span&gt;&lt;sup&gt;6-8, 10, 11&lt;/sup&gt;&lt;/span&gt; Older adults who take risks experience a range of dignity-enhancing benef","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 4","pages":"186-188"},"PeriodicalIF":8.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637397","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":"Models of care across settings supporting ageing in place: a narrative review","authors":"Maria C Inacio,&nbsp;Stephanie Harrison,&nbsp;Johannes Schwabe,&nbsp;Maria Crotty,&nbsp;Gillian E Caughey","doi":"10.5694/mja2.70003","DOIUrl":"10.5694/mja2.70003","url":null,"abstract":"<p>\u0000 \u0000 </p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 4","pages":"218-225"},"PeriodicalIF":8.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637398","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 incidence of and risk factors for hospitalisations and amputations for people with diabetes-related foot ulcers in Queensland, 2011–19: an observational cohort study","authors":"Yuqi Zhang,&nbsp;Susanna M Cramb,&nbsp;Steven M McPhail,&nbsp;Rosana Pacella,&nbsp;Jaap J van Netten,&nbsp;Ewan M Kinnear,&nbsp;Peter A Lazzarini","doi":"10.5694/mja2.52703","DOIUrl":"10.5694/mja2.52703","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 incidence, risk factors, and length of stay for hospitalisations, with and without amputations, of people with diabetes-related foot ulcers (DFU).&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;Prospective observational cohort study; secondary analysis of linked Diabetic Foot Services and Queensland Hospital Admitted Patient Data Collection data.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Settings, participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;All people with DFU who visited any of 65 outpatient Diabetic Foot Service clinics in Queensland for the first time during 1 July 2011 – 31 December 2017, followed until first DFU-related hospitalisation, ulcer healing, or death, censored at 24 months.&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;First overnight hospitalisations for which the principal diagnosis was DFU-related (International Statistical Classification of Diseases, tenth revision, Australian modification; Australian Classification of Health Interventions codes), by amputation procedure type (none, minor [distal to ankle], major [proximal to ankle]).&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 4709 people with DFU (median age, 63 years (interquartile range [IQR], 54–72 years); 3275 men [69.5%]; type 2 diabetes, 4284 [91.0%]), DFU-related hospitalisations were recorded for 977 people (20.7%): 669 without amputations (68.5%), 258 with minor amputations (26.4%), and 50 with major amputations (5.1%). The incidence of first DFU-related hospitalisations was 50.8 (95% confidence interval [CI], 47.7–54.1) per 100 person-years lived with DFU before healing, death, or loss to follow-up. The incidence of first DFU-related hospitalisation with no amputation was 39.0 (95% CI, 36.2–42.1), with minor amputation 18.0 (95% CI, 17.0–20.0), and with major amputation 5.3 (95% CI, 4.4–6.3) per 100 person-years with DFU. The median length of stay for DFU-related hospitalisations was six (IQR, 3–12) days with no amputations, ten (IQR, 5–19) days with minor amputations, and 19 (IQR, 11–38) days with major amputations. The risks of all DFU-related hospitalisation outcomes were higher for people with deep ulcers or severe peripheral artery disease. The risks of DFU-related hospitalisation with no amputations were also greater for people aged 37–59 years than for those aged 60 years, and for people with cardiovascular disease, infections, or previous amputations; with minor amputations for people who smoked, had end-stage renal","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 3","pages":"149-158"},"PeriodicalIF":8.5,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52703","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618739","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":"Clinicians’ discretion to contact patients’ at-risk relatives about their genetic risk: new guidance from Australia's privacy regulator provides timely clarification","authors":"Jane Tiller,&nbsp;Margaret FA Otlowski","doi":"10.5694/mja2.52712","DOIUrl":"10.5694/mja2.52712","url":null,"abstract":"<p>Genetic risk information is relevant not just for individuals who are tested, but also for their blood relatives. Cascade genetic testing of at-risk relatives can save lives. For younger relatives who can access preventive measures, ensuring they know about the availability of testing is particularly important. Challenges with family communication pose a major barrier to family risk notification.<span>¹</span> Internationally, assisting index cases to notify their at-risk relatives is considered a public health imperative.<span>^1-3</span></p><p>One strategy to increase access to cascade screening is for clinicians to contact at-risk relatives directly, with patient consent. Although international studies indicate this strategy increases cascade testing uptake, its legality has been queried in numerous jurisdictions.<span>^4-6</span></p><p>Following author JT's engagement with the Office of the Australian Information Commissioner (OAIC) — Australia's privacy regulator — regarding the uncertainty about this practice in Australia, the OAIC recently updated its guidance to clinicians about the application of federal privacy law to this question. This guidance clarifies clinicians’ discretion to assist patients with notifying their relatives about genetic risk without breaching federal privacy laws.</p><p>The importance of ensuring at-risk relatives can be adequately informed of serious genetic risk was considered by the Essentially Yours inquiry into the protection of human genetic information more than 20 years ago.<span>⁷</span> At the time, the inquiry Committee was concerned that “privacy legislation inappropriately constrains health professionals’ decisions about [disclosures of genetic information to genetic relatives]” (at 21.83), even where patients do not consent to disclosure, which the Committee concluded should be permissible in certain circumstances.</p><p>In 2003, the Committee recommended amendments to the <i>Privacy Act 1988</i> (Cth) (Privacy Act) to permit clinicians to disclose patients’ genetic information to their relatives, where it is necessary to lessen or prevent a serious threat to the relative's life, health or safety (recommendation 21-1), and the development of guidelines for clinicians (recommendation 21-2). In response, the Privacy Act was amended and the National Health and Medical Research Council developed comprehensive guidelines (section 95AA guidelines)<span>⁸</span> for clinicians to follow when patients do not consent to disclosure.<span>^{9, 10}</span></p><p>Under these guidelines, Dr Netix in our hypothetical case study (Box 1) could legally notify Cassie's sister Molly of her possible genetic risk, even without Cassie's consent. However, Australian clinicians have a poor understanding of this discretion,<span>¹¹</span> leading to significant confusion about their ability to assist patients by directly notifying at-risk relatives with ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 3","pages":"123-126"},"PeriodicalIF":8.5,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52712","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618738","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}