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The article discusses the Direct Action Emissions Reduction Fund (ERF) White Paper regarding the greenhouse gas emission in Australia based on Climate Change Authority's assessment of the science and economics.

The article reveals a study which identified the most frequently cited journals in the health reform documents prepared by three major health reform initiatives of Australia, the National Health and Hospitals Reform Commission, the National Primary Health Care Strategy working group, and the Preventative Health Taskforce. It shows that journal articles were cited frequently in discussion papers, commissioned papers and reports from Australian organizations and governments. It also notes that the most cited journal was the "Medical Journal of Australia."

Similarly, we can expect gender balance on guideline committees to lead to fairer highlighting of questions of particular concern to women and men, leading to more focused recommendations and ultimately better health outcomes for all. Keywords: Gender identity; Guidelines as topic EN Gender identity Guidelines as topic 73 74 2 02/07/23 20230201 NES 230201 Gender balance can lead to more focused recommendations and better health outcomes for everyone Clinical practice guidelines are recommendations for standards of care that are supported by strong scientific evidence. One and a half million medical papers reveal a link between author gender and attention to gender and sex analysis. [Extracted from the article]

The article discusses the paper "Building healthy bones throughout life" paper, presented by the non-profit organization Osteoporosis Australia, which focuses on the adequate intake of calcium, serum levels of vitamin D, and the adequate physical activity for people.

The article presents information on a report released by the Australia National Health and Medical Research Council (NHMRC) on public perceptions on research, evidence, cause and effect. According to the report, the NHMRC believes that describing its methods for examining an area of public interest would be useful.

The authors express their opinion on the impact of having two medical degree in Australia on the medical profession in the country. They explain how having a Bachelor of Medicine (BMed) or a Bachelor of Medicine, Bachelor of Surgery (MB BS) might pose the risk of forming a two-tiered system which will lead to a divided medical profession. The proposal of the Australian Qualifications Framework (AQF) Council stipulated in a consultation paper regarding a universal system for higher education coursework degrees is discussed.

The article describes the implementation of an electronic medication management system (eMMS) in an Australian teaching hospital. The success of eMMS is said to hinge on a positive workplace culture, acceptance of the major effect on work practices by all staff, and timely system response to user feedback. Other factors critical to a successful implementation are training and support for clinicians, a usable system, and adequate decision support.

However, the disconnect between the schedule fee and the fees charged by providers still leaves patients vulnerable to open-ended out-of-pocket fees (Box). Keywords: Economics, medical; Health financing; Health policy; Health systems; Healthcare disparities; Socioeconomic status EN Economics, medical Health financing Health policy Health systems Healthcare disparities Socioeconomic status 294 297 4 04/18/23 20230415 NES 230415 Out-of-pocket fees create access barriers to health care, exacerbating health inequalities In Australia, 15% of all expenditure on health care comes directly from individuals in the form of out-of-pocket fees - this is almost double the amount contributed by private health insurers.[1] There is concern that vulnerable groups - socio-economically disadvantaged people and older Australians in particular, who also have higher health care needs - are spending larger proportions of their incomes on out-of-pocket fees for health care.[2] A 2019 study identified that one in three low income households are spending more than 10% of their income on health care.[3] This might create economic hardship, and individuals do forgo care,[4] with one in four Australians without a health care condition and up to one in two with certain health conditions avoiding care because of the cost.[4] Health care services in Australia are delivered through a mixture of public and private providers, with governments subsidising the costs of care but out-of-pocket fees remaining a significant component.[5] Australia is not unique in this, with similar systems in New Zealand, Ireland, France, Germany, the Netherlands, and the United Kingdom. 3 Callander EJ, Fox H, Lindsay D. Out-of-pocket healthcare expenditure in Australia: trends, inequalities and the impact on household living standards in a high-income country with a universal health care system. [Extracted from the article]

Objectives: To identify the financing and policy challenges for Medicare and universal health care in Australia, as well as opportunities for whole‐of‐system strengthening. Study design: Review of publications on Medicare, the Pharmaceutical Benefits Scheme, and the universal health care system in Australia published 1 January 2000 – 14 August 2021 that reported quantitative or qualitative research or data analyses, and of opinion articles, debates, commentaries, editorials, perspectives, and news reports on the Australian health care system published 1 January 2015 – 14 August 2021. Program‐, intervention‐ or provider‐specific articles, and publications regarding groups not fully covered by Medicare (eg, asylum seekers, prisoners) were excluded. Data sources MEDLINE Complete, the Health Policy Reference Centre, and Global Health databases (all via EBSCO); the Analysis & Policy Observatory, the Australian Indigenous HealthInfoNet, the Australian Public Affairs Information Service, Google, Google Scholar, and the Organisation for Economic Co‐operation and Development (OECD) websites. Results: The problems covered by the 76 articles included in our review could be grouped under seven major themes: fragmentation of health care and lack of integrated health financing, access of Aboriginal and Torres Strait Islander people to health services and essential medications, reform proposals for the Pharmaceutical Benefits Scheme, the burden of out‐of‐pocket costs, inequity, public subsidies for private health insurance, and other challenges for the Australian universal health care system. Conclusions: A number of challenges threaten the sustainability and equity of the universal health care system in Australia. As the piecemeal reforms of the past twenty years have been inadequate for meeting these challenges, more effective, coordinated approaches are needed to improve and secure the universality of public health care in Australia. [ABSTRACT FROM AUTHOR]

As Australia increasingly faces devastating weather events and natural disasters associated with climate change, strong political engagement by governments is necessary to implement effective policies that address the health impacts of climate change. Keywords: Climate change; Politics; Public health; Public policy EN Climate change Politics Public health Public policy 196 202 7 03/21/23 20230315 NES 230315 Urgent and sustained political engagement is needed to address the health impacts of climate change Recent extreme weather events and natural disasters in Australia, such as the 2019-2020 Black Summer bushfires and catastrophic floods throughout 2021-2022, have resulted in considerable negative impacts for community and individual health and wellbeing. However, whereas countries around the world are taking action to mitigate climate change, Australia lags, ranking 59/64 in the Climate Change Performance Index.[1] Australia's political engagement on health and climate change is particularly poor. The previous conservative Liberal-National Coalition governments (2013-2022) downplayed the health impacts of climate change, and avoided the use of climate change terminology when discussing the health, social and economic impacts of extreme weather events. [Extracted from the article]

Objectives: To assess the composition by gender of Australian clinical practice guideline development panels; to explore guideline development‐related factors that influence the composition of panels. Design, setting, participants: Survey of clinical guidelines published in Australia during 2010–2020 that observed the 2016 NHMRC Standards for Guidelines, identified (June 2021) in the NHMRC Clinical Practice Guideline Portal or by searching the Guideline International Network guidelines library, the Trip medical database, and PubMed. The gender of contributors to guideline development was inferred from gendered titles (guideline documents) or pronouns (online biographies). Main outcome measures: The overall proportion of guideline panel members — the guideline contributors who formally considered evidence and formulated recommendations (ie, guideline panel chairs and members) — who were women. Results: Of 406 eligible guidelines, 335 listed the names of people who contributed to their development (82%). Of 7472 named contributors (including 511 guideline panel chairs [6.8%] and 5039 guideline panel members [67.4%]), 3514 were men (47.0%), 3345 were women (44.8%), and gender could not be determined for 612 (8.2%). A total of 215 guideline panel chairs were women (42.1%), 280 were men (54.8%); 2566 guideline panel members were men (50.9%), 2071 were women (41.1%). The proportion of female guideline panel members was smaller than 40% for 179 guidelines (53%) and larger than 60% for 71 guidelines (21%). The median guideline proportion of female panel members was smaller than 50% for all but two years (2017, 2018). Conclusions: The representation of women in health leadership roles in Australia does not reflect their level of participation in the health care workforce. In particular, clinical guideline development bodies should develop transparent policies for increasing the participation of women in guideline development panels. [ABSTRACT FROM AUTHOR]

Objectives: To assess the use of NHMRC Indigenous research guidelines by Australian researchers and the degree of Aboriginal and Torres Strait Islander governance and participation in Indigenous health research. Design, setting, participants: Cross‐sectional survey of people engaged in Indigenous health research in Australia, comprising respondents to an open invitation (social media posts in general and Indigenous health research networks) and authors of primary Indigenous health research publications (2015–2019) directly invited by email. Main outcome measures: Reported use of NHMRC guidelines for Indigenous research; reported Indigenous governance and participation in Indigenous health research. Results: Of 329 people who commenced the survey, 247 people (75%) provided responses to all questions, including 61 Indigenous researchers (25%) and 195 women (79%). The NHMRC guidelines were used "all the time" by 206 respondents (83%). Most respondents (205 of 247, 83%) reported that their research teams included Indigenous people, 139 reported dedicated Indigenous advisory boards (56%), 91 reported designated seats for Indigenous representatives on ethics committees (37%), and 43 reported Indigenous health research ethics committees (17%); each proportion was larger for respondents working in Indigenous community‐controlled organisations than for those working elsewhere. More than half the respondents reported meaningful Indigenous participation during five of six research phases; the exception was data analysis (reported as apparent "none" or "some of the time" by 143 participants, 58%). Conclusions: Indigenous health research in Australia is largely informed by non‐Indigenous world views, led by non‐Indigenous people, and undertaken in non‐Indigenous organisations. Re‐orientation and investment are needed to give control of the framing, design, and conduct of Indigenous health research to Indigenous people. [ABSTRACT FROM AUTHOR]

Objective: To compare longer term (12‐month) mortality outcomes for Indigenous and non‐Indigenous people admitted to intensive care units (ICUs) in Australia. Design, setting, participants: Retrospective registry‐based data linkage cohort study; analysis of all admissions of adults (16 years or older) to Australian ICUs, 1 January 2017 – 31 December 2019, as recorded in the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD), linked using the SLK‐581 key to National Death Index data. Main outcome measures: Unadjusted and adjusted mortality risk, censored at twelve months from the start of index ICU admission. Secondary outcomes were unadjusted and adjusted mortality twelve months from admission to the ICU. Results: The APD recorded 330 712 eligible ICU admissions during 2017–2019 (65% of all ICU admissions registered), of which 11 322 were of Indigenous people (3.4%). Median age at admission was lower for Indigenous patients (51.2 [IQR, 36.7–63.6] years) than for non‐Indigenous patients (66.5 [IQR, 52.7–76.1] years). Unadjusted mortality risk was similar for Indigenous and non‐Indigenous patients (hazard ratio, 1.01; 95% CI, 0.97–1.06), but was higher for Indigenous patients after adjusting for age, admission diagnosis, illness severity, hospital type, jurisdiction, remoteness and socio‐economic status (adjusted hazard ratio, 1.20; 95% CI, 1.14–1.27). Twelve‐month mortality was higher for Indigenous than non‐Indigenous patients (adjusted odds ratio, 1.24; 95% CI, 1.16–1.33). Conclusions: Twelve‐month mortality outcomes are poorer for people admitted to ICUs in Australia than for the general population. Further, after adjusting for age and other factors, survival outcomes are poorer for Indigenous than non‐Indigenous people admitted to ICUs. Critical illness may therefore contribute to shorter life expectancy among Indigenous Australians. [ABSTRACT FROM AUTHOR]

In April 2008, the Australian Government established the National Preventative Health Taskforce to develop a National Preventative Health Strategy by June 2009. The Strategy will provide a blueprint for tackling the burden of chronic disease currently caused by obesity, tobacco and excessive consumption of alcohol. The Taskforce has produced a discussion paper, Australia: the healthiest country by 2020. It presents a wide range of options, some of them contentious, to achieve this ambitious target. [ABSTRACT FROM AUTHOR]

The article focuses on the challenges at the Princess Alexandra Hospital (PAH) in Australia for transforming into an integrated digital tertiary hospital, with topics including the use of electronic medical records (EMR) in the hospital, medical technology management, and the medical care quality.

Summary: The MJA–Lancet Countdown on health and climate change in Australia was established in 2017 and produced its first national assessment in 2018 and annual updates in 2019, 2020 and 2021. It examines five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co‐benefits; economics and finance; and public and political engagement. In this, the fifth year of the MJA–Lancet Countdown, we track progress on an extensive suite of indicators across these five domains, accessing and presenting the latest data and further refining and developing our analyses.Within just two years, Australia has experienced two unprecedented national catastrophes — the 2019–2020 summer heatwaves and bushfires and the 2021–2022 torrential rains and flooding. Such events are costing lives and displacing tens of thousands of people. Further, our analysis shows that there are clear signs that Australia's health emergency management capacity substantially decreased in 2021.We find some signs of progress with respect to health and climate change. The states continue to lead the way in health and climate change adaptation planning, with the Victorian plan being published in early 2022. At the national level, we note progress in health and climate change research funding by the National Health and Medical Research Council. We now also see an acceleration in the uptake of electric vehicles and continued uptake of and employment in renewable energy.However, we also find Australia's transition to renewables and zero carbon remains unacceptably slow, and the Australian Government's continuing failure to produce a national climate change and health adaptation plan places the health and lives of Australians at unnecessary risk today, which does not bode well for the future. [ABSTRACT FROM AUTHOR]

Every Doctor, Every Setting: a national framework to guide coordinated action on the mental health of doctors and medical students, 2019 [website]. https://lifeinmind.org.au/every-doctor-every-setting (viewed Feb 2022). For many years, the Australasian Doctors' Health Network (http://www.adhn.org.au/) of doctors' health services has provided confidential helplines for medical practitioners. Keywords: Doctors' health; Health policy; Education, professional EN Doctors' health Health policy Education, professional 338 341 4 09/27/22 20221001 NES 221001 Coordinated systemic change and enhanced access to care are needed to improve doctors' wellbeing Over the past decade, there has been growing recognition of the prevalence of psychological distress across the medical profession and that practitioner wellbeing has significant implications for patient safety. [Extracted from the article]

Such principles could support infrastructure developers, data regulators, data custodians, data users, and the public to identify how data systems could be designed and governed to support social equity. Centring equity in data-driven public health: a call for guiding principles to support the equitable design and outcomes of Australia's data integration systems Keywords: Social justice; Data collection EN Social justice Data collection 341 343 3 05/03/23 20230501 NES 230501 We need to design data systems that hold social and health equity as a core value and desired outcome of data integration The secondary use of health data - and data pertaining to the social determinants of health - is widely acknowledged as an underutilised yet powerful contributor to research and evidence-based policy. [Extracted from the article]

Keywords: General practice; Primary care; Health services research EN General practice Primary care Health services research 288 290 3 04/18/23 20230415 NES 230415 We must complement simplistic responses to urgent problems with strategic, considered, long term redesign across the whole health system Universal health coverage (UHC) provides all people with access to the full range of quality health services they need (inclusive of health promotion, prevention, treatment, rehabilitation and palliative care), when and where they need them, without financial hardship.[1] The World Health Organization is explicit that achieving UHC "requires strong, people-centred primary health care".[1] In Australia, Medicare is the financing instrument underpinning our nation's claim to ensuring UHC. General practice, Primary care, Health services research Irrespective of whether these improve primary care provision, more than the currently reported 15% of Australian medical graduates[21] must choose general practice training if we are to meet the demands of the more than 85% of the Australian population who see their GP at least once a year. [Extracted from the article]

Gene therapy for haemophilia, chimeric antigen receptor T (CAR-T) cell therapy for cancer, and gene editing illustrate many of the issues. Gene therapy for haemophilia is entering the late clinical trial stage, with at least ten ongoing trials for haemophilia A and six for haemophilia B.9 This form of I in vivo i gene therapy involves a single intravenous injection of an adeno-associated virus (AAV) vector that has been engineered to home to the liver and produce the required clotting factor there for the remainder of an adult's life. Keywords: Molecular medicine; Biomedical engineering; Molecular biology; Cell biology; Stem cells; Immunotherapies EN Molecular medicine Biomedical engineering Molecular biology Cell biology Stem cells Immunotherapies 65 70 6 07/19/22 20220715 NES 220715 Many technical and regulatory hurdles have been overcome, but the field has a long way to go Who would have thought a small piece of messenger RNA (mRNA) wrapped in a delectable lipid could do so much? In particular, CAR-T cell immunogene therapies that target CD19 on B cells have achieved complete response and remission rates of 77% and 80% in acute lymphoblastic leukaemia.19,20 Traditional CAR-T cell therapies are manufactured by collecting peripheral blood T cells from patients with B-cell malignancies and genetically engineering them in a specialised laboratory to express a receptor (such as the CD19 receptor). [Extracted from the article]

Summary: ▪In this narrative review, we summarise the vast and burgeoning research on the potential and established indirect impacts on children of the COVID‐19 pandemic. We used a community child health lens to organise our findings and to consider how Australia might best respond to the needs of children (aged 0–12 years).▪We synthesised the literature on previous pandemics, epidemics and natural disasters, and the current COVID‐19 pandemic. We found clear evidence of adverse impacts of the COVID‐19 pandemic on children that either repeated or extended the findings from previous pandemics.▪We identified 11 impact areas, under three broad categories: child‐level factors (poorer mental health, poorer child health and development, poorer academic achievement); family‐level factors that affect children (poorer parent mental health, reduced family income and job losses, increased household stress, increased abuse and neglect, poorer maternal and newborn health); and service‐level factors that affect children (school closures, reduced access to health care, increased use of technology for learning, connection and health care).▪There is increasing global concern about the likely disproportionate impact of the current pandemic on children experiencing adversity, widening existing disparities in child health and developmental outcomes.▪We suggest five potential strategy areas that could begin to address these inequities: addressing financial instability through parent financial supplements; expanding the role of schools to address learning gaps and wellbeing; rethinking health care delivery to address reduced access; focusing on prevention and early intervention for mental health; and using digital solutions to address inequitable service delivery. [ABSTRACT FROM AUTHOR]

The article presents quotes from contributors to the "Medical Journal of Australia" in 2008 including a reviewer stressing that the conjunction of quantitative and qualitative approaches does not constitute a mixed-methods approach, another reviewer noting that general practitioners (GPs) tend to educate themselves silly and a reviewer talking about the lack of legs of a submission.

Introduction: The absence of high quality evidence for basic clinical dilemmas in immune thrombocytopenic purpura (ITP) underlines the need for contemporary guidelines relevant to the local treatment context. ITP is diagnosed by exclusions, with a hallmark laboratory finding of isolated thrombocytopenia. Main recommendations: Bleeding, family and medication histories and a review of historical investigations are required to gauge the bleeding risk and possible hereditary syndromes. Beyond the platelet count, the decision to treat is affected by individual bleeding risk, disease stage, side effects of treatment, concomitant medications, and patient preference. Treatment is aimed at achieving a platelet count > 20 × 109/L, and avoidance of severe bleeding. Steroids are the standard first line treatment, with either 6‐week courses of tapering prednisone or repeated courses of high dose dexamethasone providing equivalent efficacy. Intravenous immunoglobulin can be used periprocedurally or as first line therapy in combination with steroids. Changes in management as a result of this statement: There is no consensus on choice of second line treatments. Options with the most robust evidence include splenectomy, rituximab and thrombopoietin receptor agonists. Other therapies include azathioprine, mycophenolate mofetil, dapsone and vinca alkaloids. Given that up to one‐third of patients achieve a satisfactory haemostatic response, splenectomy should be delayed for at least 12 months if possible. In life‐threatening bleeding, we recommend platelet transfusions to achieve haemostasis, along with intravenous immunoglobulin and high dose steroids. [ABSTRACT FROM AUTHOR]

The author reflects on the importance for licensing authorities to strengthen their services for the medical practitioners in Australia. He cites the paper released by former head of the Western Australian Health Services Kim Snowball, who criticizes the Medical Board of Australia for being out of touch and too slow to act on complaints in the medical profession. The author also agrees with Snowball and calls the need for the agency to address the issue.

Of Recommendations and Levels Of Evidence: Chapter 2: Screening and assessment for unhealthy alcohol use Screening Screening for unhealthy alcohol use and appropriate interventions should be implemented in general practice (Level A), hospitals (Level B), emergency departments and community health and welfare settings (Level C). Quantity-frequency measures can detect consumption that exceeds levels in the current Australian guidelines (Level B). The Alcohol Use Disorders Identification Test (AUDIT) is the most effective screening tool and is recommended for use in primary care and hospital settings. For screening in the general community, the AUDIT-C is a suitable alternative (Level A). Indirect biological markers should be used as an adjunct to screening (Level A), and direct measures of alcohol in breath and/or blood can be useful markers of recent use (Level B). Assessment Assessment should include evaluation of alcohol use and its effects, physical examination, clinical investigations and collateral history taking (Level C). Assessment for alcohol-related physical problems, mental health problems and social support should be undertaken routinely (GPP). Where there are concerns regarding the safety of the patient or others, specialist consultation is recommended (Level C). Assessment should lead to a clear, mutually acceptable treatment plan which specifies interventions to meet the patient's needs (Level D). Sustained abstinence is the optimal outcome for most patients with alcohol dependence (Level C). Chapter 3: Caring for and managing patients with alcohol problems: interventions, treatments, relapse prevention, aftercare, and long term follow-up Brief interventions Brief motivational interviewing interventions are more effective than no treatment for people who consume alcohol at risky levels (Level A). Their effectiveness compared with standard care or alternative psychosocial interventions varies by treatment setting. They are most effective in primary care settings (Level A). Psychosocial interventions Cognitive behaviour therapy should be a first-line psychosocial intervention for alcohol dependence. Its clinical benefit is enhanced when it is combined with pharmacotherapy for alcohol dependence or an additional psychosocial intervention (eg, motivational interviewing) (Level A). Motivational interviewing is effective in the short term and in patients with less severe alcohol dependence (Level A). Residential rehabilitation may be of benefit to patients who have moderate-to-severe alcohol dependence and require a structured residential treatment setting (Level D). Alcohol withdrawal management Most cases of withdrawal can be managed in an ambulatory setting with appropriate support (Level B). Tapering diazepam regimens (Level A) with daily staged supply from a pharmacy or clinic are recommended (GPP). Pharmacotherapies for alcohol dependence Acamprosate is recommended to help maintain abstinence from alcohol (Level A). Naltrexone is recommended for prevention of relapse to heavy drinking (Level A). Disulfiram is only recommended in close supervision settings where patients are motivated for abstinence (Level A). Some evidence for off-label therapies baclofen and topiramate exists, but their side effect profiles are complex and neither should be a first-line medication (Level B). Peer support programs Peer-led support programs such as Alcoholics Anonymous and SMART Recovery are effective at maintaining abstinence or reductions in drinking (Level A). Relapse prevention, aftercare and long-term follow-up Return to problematic drinking is common and aftercare should focus on addressing factors that contribute to relapse (GPP). A harm-minimisation approach should be considered for patients who are unable to reduce their drinking (GPP). Chapter 4: Providing appropriate treatment and care to people with alcohol problems: a summary for key specific populations Gender-specific issues Screen women and men for domestic abuse (Level C). Consider child protection assessments for caregivers with alcohol use disorder (GPP). Explore contraceptive options with women of reproductive age who regularly consume alcohol (Level B). Pregnant and breastfeeding women Advise pregnant and breastfeeding women that there is no safe level of alcohol consumption (Level B). Pregnant women who are alcohol dependent should be admitted to hospital for treatment in an appropriate maternity unit that has an addiction specialist (GPP). Young people Perform a comprehensive HEEADSSS assessment for young people with alcohol problems (Level B). Treatment should focus on tangible benefits of reducing drinking through psychotherapy and engagement of family and peer networks (Level B). Aboriginal and Torres Strait Islander peoples Collaborate with Aboriginal or Torres Strait Islander health workers, organisations and communities, and seek guidance on patient engagement approaches (GPP). Use validated screening tools and consider integrated mainstream and Aboriginal or Torres Strait Islander-specific approaches to care (Level B). Culturally and linguistically diverse groups Use an appropriate method, such as the "teach-back" technique, to assess the need for language and health literacy support (Level C). Engage with culture-specific agencies as this can improve treatment access and success (Level C). Sexually diverse and gender diverse populations Be mindful that sexually diverse and gender diverse populations experience lower levels of satisfaction, connection and treatment completion (Level C). Seek to incorporate LGBTQ-specific treatment and agencies (Level C). Older people All new patients aged over 50 years should be screened for harmful alcohol use (Level D). Consider alcohol as a possible cause for older patients presenting with unexplained physical or psychological symptoms (Level D). Consider shorter acting benzodiazepines for withdrawal management (Level D). Cognitive impairment Cognitive impairment may impair engagement with treatment (Level A). Perform cognitive screening for patients who have alcohol problems and refer them for neuropsychological assessment if significant impairment is suspected (Level A).Summary Of Key Recommendations and Levels Of Evidence: Chapter 5: Understanding and managing comorbidities for people with alcohol problems: polydrug use and dependence, co-occurring mental disorders, and physical comorbidities Polydrug use and dependence Active alcohol use disorder, including dependence, significantly increases the risk of overdose associated with the administration of opioid drugs. Specialist advice is recommended before treatment of people dependent on both alcohol and opioid drugs (GPP). Older patients requiring management of alcohol withdrawal should have their use of pharmaceutical medications reviewed, given the prevalence of polypharmacy in this age group (GPP). Smoking cessation can be undertaken in patients with alcohol dependence and/or polydrug use problems; some evidence suggests varenicline may help support reduction of both tobacco and alcohol consumption (Level C). Co-occurring mental disorders More intensive interventions are needed for people with comorbid conditions, as this population tends to have more severe problems and carries a worse prognosis than those with single pathology (GPP). The Kessler Psychological Distress Scale (K10 or K6) is recommended for screening for comorbid mental disorders in people presenting for alcohol use disorders (Level A). People with alcohol use disorder and comorbid mental disorders should be offered treatment for both disorders; care should be taken to coordinate intervention (Level C). Physical comorbidities Patients should be advised that alcohol use has no beneficial health effects. There is no clear risk-free threshold for alcohol intake. The safe dose for alcohol intake is dependent on many factors such as underlying liver disease, comorbidities, age and sex (Level A). In patients with alcohol use disorder, early recognition of the risk for liver cirrhosis is critical. Patients with cirrhosis should abstain from alcohol and should be offered referral to a hepatologist for liver disease management and to an addiction physician for management of alcohol use disorder (Level A). Alcohol abstinence reduces the risk of cancer and improves outcomes after a diagnosis of cancer (Level A). [ABSTRACT FROM AUTHOR]

The authors reflect on the need to improve the health services for Aboriginal children in Australia. They say that the result of regular monitoring for health status and health policy for Aboriginal children conducted by the Australian Institute of Health and Welfare are critical. They states that existing policies on alcohol restrictions, housing policy, and education policy has potential impact for the Aboriginal children in Northern Territory.

Its full potential is beyond the Australian borders; collaborative projects between Australian stroke specialists and Pacific physicians focused on acute stroke care and reperfusion therapies are being planned. Moreover, the initial review and expedited diagnosis performed by the stroke physician reduces unnecessary transfers for specialist assessment and investigations at the comprehensive stroke centre. Keywords: Telemedicine; Technology; Stroke EN Telemedicine Technology Stroke 498 500 3 06/07/22 20220601 NES 220601 Telestroke is an example of technology facilitating the delivery of time-dependent therapies in regional Australia Stroke telemedicine, or "telestroke", refers to the diagnosis and treatment of patients using telecommunications technology. [Extracted from the article]

Keywords: Meningitis; Anti-infective agents; Ethics, research EN Meningitis Anti-infective agents Ethics, research 508 508 1 12/15/20 20201201 NES 201201 Medicine in the pre-antibiotic era offers lessons still relevant today, particularly regarding the prudent use of valuable medications The handwritten line on an archived envelope stored in a safe in The Children's Hospital at Westmead undercroft - " I The first child in Australia to have "Penicillin" therapy i " (Box 1) - understates the remarkable story of how an experimental drug was requested, approved and delivered in secrecy during the Second World War for one child. Keefer personally vetted each penicillin request, restricting its use to cases in which all other treatments had failed.5 To better understand its potential and limitations, he collected detailed information on all patients given penicillin. Only patients with severe infections caused by sulfonamide-resistant, penicillin-susceptible streptococci, gonococci and staphylococci, should receive penicillin, and only then if a cure could be expected. Multimodal programs incorporate pharmacokinetic and pharmacodynamic principles to avoid treatment failure through undertreatment, as experienced by Peter in 1943.20 In the future, strengthening these antimicrobial stewardship programs by integrating molecular technologies and high throughput screening methods will be critical. [Extracted from the article]

CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development. [ABSTRACT FROM AUTHOR]

Objective: To assess the demographic, social, and clinical characteristics of young Australians who die by suicide. Design: Retrospective analysis of National Coronial Information System (NCIS) data. Setting, participants: People aged 10–24 years who died by suicide in Australia during 2006–2015. Main outcome measures: Demographic, social, and clinical characteristics of young people who died by suicide; circumstances of death recorded in the NCIS. Results: 3365 young people died of suicide during 2006–2015 (including 2473 boys and men, 73.5%); 1292 people (38.4%) lived in areas of greater socio‐economic disadvantage. Free text reports were included in the NCIS for 3027 people (90%), of whom 1237 (40.9%) had diagnosed mental health disorders and 475 (15.7%) had possible mental health disorders. Alcohol consumption near the time of death was detected in 1015 of 3027 cases (33.5%); histories of self‐harm were recorded in 940 cases (31.1%) and of illicit substance misuse in 852 (28.1%). Adverse life events included history of abuse or neglect (223, 7.4%), suicide of relatives, friends, or acquaintances (202, 6.7%), and financial difficulties (174, 5.8%). Conclusions: Three‐quarters of the young people who died by suicide were boys or young men, and 57% had diagnosed or possible mental health disorders, suggesting that the mental health and wellbeing of young Australians should be a key target for youth suicide prevention. To reduce the number of youth suicides, it is imperative that prevention strategies target the mental health and psychosocial stressors that lead to suicidal crises in young people. [ABSTRACT FROM AUTHOR]

Objectives: To describe the characteristics and outcomes of patients with COVID‐19 admitted to intensive care units (ICUs) during the initial months of the pandemic in Australia. Design, setting: Prospective, observational cohort study in 77 ICUs across Australia. Participants: Patients admitted to participating ICUs with laboratory‐confirmed COVID‐19 during 27 February – 30 June 2020. Main outcome measures: ICU mortality and resource use (ICU length of stay, peak bed occupancy). Results: The median age of the 204 patients with COVID‐19 admitted to intensive care was 63.5 years (IQR, 53–72 years); 140 were men (69%). The most frequent comorbid conditions were obesity (40% of patients), diabetes (28%), hypertension treated with angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers (24%), and chronic cardiac disease (20%); 73 patients (36%) reported no comorbidity. The most frequent source of infection was overseas travel (114 patients, 56%). Median peak ICU bed occupancy was 14% (IQR, 9–16%). Invasive ventilation was provided for 119 patients (58%). Median length of ICU stay was greater for invasively ventilated patients than for non‐ventilated patients (16 days; IQR, 9–28 days v 3 days; IQR, 2–5 days), as was ICU mortality (26 deaths, 22%; 95% CI, 15–31% v four deaths, 5%; 95% CI, 1–12%). Higher Acute Physiology and Chronic Health Evaluation II (APACHE‐II) scores on ICU day 1 (adjusted hazard ratio [aHR], 1.15; 95% CI, 1.09–1.21) and chronic cardiac disease (aHR, 3.38; 95% CI, 1.46–7.83) were each associated with higher ICU mortality. Conclusion: Until the end of June 2020, mortality among patients with COVID‐19 who required invasive ventilation in Australian ICUs was lower and their ICU stay longer than reported overseas. Our findings highlight the importance of ensuring adequate local ICU capacity, particularly as the pandemic has not yet ended. [ABSTRACT FROM AUTHOR]

Objective: To characterise the working arrangements of medical research scientists and support staff in Australia during the COVID-19 pandemic, and to evaluate factors (in particular: wearing pyjamas) that influence the self-assessed productivity and mental health of medical institute staff working from home.Design: Prospective cohort survey study, 30 April - 18 May 2020.Setting, Participants: Staff (scientists and non-scientists) and students at five medical research institutes in Sydney, New South Wales.Main Outcome Measures: Self-assessed overall and task-specific productivity, and mental health.Results: The proportions of non-scientists and scientists who wore pyjamas during the day were similar (3% v 11%; P = 0.31). Wearing pyjamas was not associated with differences in self-evaluated productivity, but was significantly associated with more frequent reporting of poorer mental health than non-pyjama wearers while working from home (59% v 26%; P < 0.001). Having children in the home were significantly associated with changes in productivity. Larger proportions of people with toddlers reported reduced overall productivity (63% v 32%; P = 0.008), and reduced productivity in writing manuscripts (50% v 17%; P = 0.023) and data analysis (63% v 23%; P = 0.002). People with primary school children more frequently reported reduced productivity in writing manuscripts (42% v 16%; P = 0.026) and generating new ideas (43% v 19%; P = 0.030). On a positive note, the presence of children in the home was not associated with changes in mental health during the pandemic. In contrast to established researchers, early career researchers frequently reported reduced productivity while working at home.Conclusions: Our findings are probably applicable to scientists in other countries. They may help improve work-from-home policies by removing the stigma associated with pyjama wearing during work and by providing support for working parents and early career researchers. [ABSTRACT FROM AUTHOR]

The article profiles Australian doctor and researcher Ben McNeil. It states that he works as an oceanographer and senior lecturer at the University of New South Wales in Sydney and has been a researcher in the ocean science for 17 years. It mentions that he founded the website Thinkable.org, wherein it allows people to connect with scientists, and connect the latest ideas in video format.

■The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031 (the Endgame Strategy) is the blueprint to eliminate rheumatic heart disease (RHD) in Australia by 2031. Aboriginal and Torres Strait Islander people live with one of the highest per capita burdens of RHD in the world. ■The Endgame Strategy synthesises information compiled across the 5-year lifespan of the End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRE). Data and results from priority research projects across several disciplines of research complemented literature reviews, systematic reviews and narrative reviews. Further, the experiences of those working in acute rheumatic fever (ARF) and RHD control and those living with RHD to provide the technical evidence for eliminating RHD in Australia were included. ■The lived experience of RHD is a critical factor in health outcomes. All future strategies to address ARF and RHD must prioritise Aboriginal and Torres Strait Islander people's knowledge, perspectives and experiences and develop co-designed approaches to RHD elimination. The environmental, economic, social and political context of RHD in Australia is inexorably linked to ending the disease. ■Statistical modelling undertaken in 2019 looked at the economic and health impacts of implementing an indicative strategy to eliminate RHD by 2031. Beginning in 2019, the strategy would include: reducing household crowding, improving hygiene infrastructure, strengthening primary health care and improving secondary prophylaxis. It was estimated that the strategy would prevent 663 deaths and save the health care system $188 million. ■The Endgame Strategy provides the evidence for a new approach to RHD elimination. It proposes an implementation framework of five priority action areas. These focus on strategies to prevent new cases of ARF and RHD early in the causal pathway from Streptococcus pyogenes exposure to ARF, and strategies that address the critical systems and structural changes needed to support a comprehensive RHD elimination strategy. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of type 2 diabetes mellitus has increased in children and adolescents due largely to the obesity epidemic, particularly in high risk ethnic groups. β-Cell function declines faster and diabetes complications develop earlier in paediatric type 2 diabetes compared with adult-onset type 2 diabetes. There are no consensus guidelines in Australasia for assessment and management of type 2 diabetes in paediatric populations and health professionals have had to refer to adult guidelines. Recent international paediatric guidelines did not address adaptations to care for patients from Indigenous backgrounds.Main Recommendations: This guideline provides advice on paediatric type 2 diabetes in relation to screening, diagnosis, diabetes education, monitoring including targets, multicomponent healthy lifestyle, pharmacotherapy, assessment and management of complications and comorbidities, and transition. There is also a dedicated section on considerations of care for children and adolescents from Indigenous background in Australia and New Zealand.Changes in Management AsA Result Of the Guidelines: Published international guidelines currently exist, but the challenges and specifics to care for children and adolescents with type 2 diabetes which should apply to Australasia have not been addressed to date. These include: recommendations regarding care of children and adolescents from Indigenous backgrounds in Australia and New Zealand including screening and management; tighter diabetes targets (glycated haemoglobin, ≤ 48 mmol/mol [≤ 6.5%]) for all children and adolescents; considering the use of newer medications approved for adults with type 2 diabetes under the guidance of a paediatric endocrinologist; and the need to transition adolescents with type 2 diabetes to a diabetes multidisciplinary care team including an adult endocrinologist for their ongoing care. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate whether an alternative model of care in aged care facilities, including in-house general practitioners, influenced health outcomes for residents.Design: Stepped wedge, cluster randomised controlled trial over 90 weeks (31 December 2012 - 21 September 2014), with a 54-week pre-trial retrospective data period (start: 19 December 2011) and a 54-week post-trial prospective data collection period (to 4 October 2015).Participants, Setting: Fifteen residential aged care facilities operated by Bupa Aged Care in metropolitan and regional cities in four Australian states.Intervention: Residential aged care facilities sought to recruit general practitioners as staff members; care staff roles were redefined to allow registered nurses greater involvement in care plan development.Main (primary) Outcome Measures: Numbers of falls; numbers of unplanned transfers to hospital; polypharmacy.Results: The new model of care could be implemented in all facilities, but four could not recruit in-house GPs at any time during the trial period. Intention-to-treat analyses found no statistically significant effect of the intervention on the primary outcome measures. Contamination-adjusted intention-to-treat analyses identified that the presence of an in-house GP was associated with reductions in the numbers of unplanned hospital transfers (incidence rate ratio [IRR], 0.53; 95% CI, 0.43-0.66) and admissions (IRR, 0.52; 95% CI, 0.41-0.64) and of out-of-hours GP call-outs (IRR, 0.54; 95% CI, 0.36-0.80), but also with an increase in the number of reported falls (IRR, 1.37; 95% CI, 1.20-1.58).Conclusions: Recruiting GPs to work directly in residential aged care facilities is difficult, but may reduce the burden of unplanned presentations to hospitals and increase the reporting of adverse events.Trial Registration: Australia New Zealand Clinical Trial Registry, ACTRN12613000218796 (25 February 2013). [ABSTRACT FROM AUTHOR]

Objectives: To estimate the carbon footprint of five common hospital pathology tests: full blood examination; urea and electrolyte levels; coagulation profile; C-reactive protein concentration; and arterial blood gases.Design, Setting: Prospective life cycle assessment of five pathology tests in two university-affiliated health services in Melbourne. We included all consumables and associated waste for venepuncture and laboratory analyses, and electricity and water use for laboratory analyses.Main Outcome Measure: Greenhouse gas footprint, measured in carbon dioxide equivalent (CO2 e) emissions.Results: CO2 e emissions for haematology tests were 82 g/test (95% CI, 73-91 g/test) for coagulation profile and 116 g/test (95% CI, 101-135 g/test) for full blood examination. CO2 e emissions for biochemical tests were 0.5 g/test CO2 e (95% CI, 0.4-0.6 g/test) for C-reactive protein (low because typically ordered with urea and electrolyte assessment), 49 g/test (95% CI, 45-53 g/test) for arterial blood gas assessment, and 99 g/test (95% CI, 84-113 g/test) for urea and electrolyte assessment. Most CO2 e emissions were associated with sample collection (range, 60% for full blood examination to 95% for coagulation profile); emissions attributable to laboratory reagents and power use were much smaller.Conclusion: The carbon footprint of common pathology tests was dominated by those of sample collection and phlebotomy. Although the carbon footprints were small, millions of tests are performed each year in Australia, and reducing unnecessary testing will be the most effective approach to reducing the carbon footprint of pathology. Together with the detrimental health and economic effects of unnecessary testing, our environmental findings should further motivate clinicians to test wisely. [ABSTRACT FROM AUTHOR]

Objective: To examine the prevalence of psychotropic medicine dispensing before and after older people enter residential care.Design: Retrospective national cohort study; analysis of Registry of Senior Australians (ROSA) data.Setting, Participants: All concession card-holding residents of government-subsidised residential aged care facilities in Australia who entered residential care for at least three months between 1 April 2008 and 30 June 2015.Main Outcome Measures: Proportions of residents dispensed antipsychotic, benzodiazepine, or antidepressant medicines during the year preceding and the year after commencing residential care, by quarter.Results: Of 322 120 included aged care residents, 68 483 received at least one antipsychotic (21.3%; 95% CI, 21.1-21.4%), 98 315 at least one benzodiazepine (30.5%; 95% CI, 30.4-30.7%), and 122 224 residents at least one antidepressant (37.9%; 95% CI, 37.8-38.1%) during their first three months of residential care; 31 326 of those dispensed antipsychotics (45.7%), 38 529 of those dispensed benzodiazepines (39.2%), and 25 259 residents dispensed antidepressants (19.8%) had not received them in the year preceding their entry into care. During the first three months of residential care, the prevalence of antipsychotic (prevalence ratio [PR], 3.37; 95% CI, 3.31-3.43) and antidepressant dispensing (PR, 1.05; 95% CI, 1.04-1.07) were each higher for residents with than for those without dementia; benzodiazepine dispensing was similar for both groups (PR, 1.01; 95% CI, 0.99-1.02).Conclusions: Dispensing of psychotropic medicines to older Australians is high before they enter residential care but increases markedly soon after entry into care. Non-pharmacological behavioural management strategies are important for limiting the prescribing of psychotropic medicines for older people in the community or in residential care. [ABSTRACT FROM AUTHOR]

Objectives: To describe research into non-clinical support eye health care for Aboriginal and Torres Strait Islander (Indigenous) Australians, the people who provide such care, and its impact on eye health outcomes.Study Design: Systematic review and qualitative analysis of peer-reviewed research publications.Data Sources: Peer-reviewed research articles published between January 2000 and July 2018 and included in MEDLINE/EMBASE, Web of Science, Informit, EBSCO (CINAHL and Anthropology Plus), or ProQuest Central.Study Selection: We included English language, peer-reviewed articles reporting empirical data on non-clinical support for eye health for Indigenous Australians. Two authors independently assessed the titles and abstracts of 1678 unique articles for inclusion in a full text review; the full texts of 104 publications were reviewed, of which 77 were excluded and 27 included in our qualitative analysis.Data Synthesis: Qualitative analysis identified five key areas of non-clinical support for Indigenous eye health: coordination of eye care, integrating and linking services, cultural support, health promotion, and social and emotional support. People who provide non-clinical support include eye health coordinators, Aboriginal Health Workers, primary care clinicians, family members, carers, and community-based liaison workers. The availability of non-clinical support is associated with increased patient attendance at eye care services, higher visual acuity examination and cataract surgery rates, broader eye health knowledge, and greater cultural responsivity.Conclusion: Non-clinical support is critical for facilitating attendance at appointments by patients and ensuring that preventive, primary, and tertiary eye care services are accessible to Indigenous Australians. Greater financial investment is needed to support key providers of non-clinical support, especially eye health coordinators, community-based liaison officers, and family members and carers. [ABSTRACT FROM AUTHOR]

Objectives: To investigate blood lead levels in an Australian birth cohort of children; to identify factors associated with higher lead levels.Design, Setting: Cross-sectional study within the Barwon Infant Study, a population birth cohort study in the Barwon region of Victoria (1074 infants, recruited June 2010 - June 2013). Data were adjusted for non-participation and attrition by propensity weighting.Participants: Blood lead was measured in 523 of 708 children appraised in the Barwon Infant Study pre-school review (mean age, 4.2 years; SD, 0.3 years).Main Outcome Measure: Blood lead concentration in whole blood (μg/dL).Results: The median blood lead level was 0.8 μg/dL (range, 0.2-3.7 μg/dL); the geometric mean blood lead level after propensity weighting was 0.97 μg/dL (95% CI, 0.92-1.02 μg/dL). Children in houses 50 or more years old had higher blood lead levels (adjusted mean difference [AMD], 0.13 natural log units; 95% CI, 0.02-0.24 natural log units; P = 0.020), as did children of families with lower household income (per $10 000, AMD, -0.035 natural log units; 95% CI, -0.056 to -0.013 natural log units; P = 0.002) and those living closer to Point Henry (inverse square distance relationship; P = 0.002). Associations between hygiene factors and lead levels were evident only for children living in older homes.Conclusion: Blood lead levels in our pre-school children were lower than in previous Australian surveys and recent surveys in areas at risk of higher exposure, and no children had levels above 5 μg/dL. Our findings support advice to manage risks related to exposure to historical lead, especially in older houses. [ABSTRACT FROM AUTHOR]

Objectives: To describe changes in childhood cancer incidence in Australia, 1983-2015, and to estimate projected incidence to 2035.Design, Setting: Population-based study; analysis of Australian Childhood Cancer Registry data for the 20 547 children under 15 years of age diagnosed with cancer in Australia between 1983 and 2015.Main Outcome Measures: Incidence rate changes during 1983-2015 were assessed by joinpoint regression, with rates age-standardised to the 2001 Australian standard population. Incidence projections to 2035 were estimated by age-period-cohort modelling.Results: The overall age-standardised incidence rate of childhood cancer increased by 34% between 1983 and 2015, increasing by 1.2% (95% CI, +0.5% to +1.9%) per annum between 2005 and 2015. During 2011-2015, the mean annual number of children diagnosed with cancer in Australia was 770, an incidence rate of 174 cases (95% CI, 169-180 cases) per million children per year. The incidence of hepatoblastoma (annual percentage change [APC], +2.3%; 95% CI, +0.8% to +3.8%), Burkitt lymphoma (APC, +1.6%; 95% CI, +0.4% to +2.8%), osteosarcoma (APC, +1.1%; 95%, +0.0% to +2.3%), intracranial and intraspinal embryonal tumours (APC, +0.9%; 95% CI, +0.4% to +1.5%), and lymphoid leukaemia (APC, +0.5%; 95% CI, +0.2% to +0.8%) increased significantly across the period 1983-2015. The incidence rate of childhood melanoma fell sharply between 1996 and 2015 (APC, -7.7%; 95% CI, -10% to -4.8%). The overall annual cancer incidence rate is conservatively projected to rise to about 186 cases (95% CI, 175-197 cases) per million children by 2035 (1060 cases per year).Conclusions: The incidence rates of several childhood cancer types steadily increased during 1983-2015. Although the reasons for these rises are largely unknown, our findings provide a foundation for health service planning for meeting the needs of children who will be diagnosed with cancer until 2035. [ABSTRACT FROM AUTHOR]

Objectives: To assess the numbers of paracetamol overdose-related hospital admissions and deaths in Australia since 2007-08, and the overdose size of intentional paracetamol overdoses since 2004.Design, Setting: Retrospective analysis of data on paracetamol-related exposures, hospital admissions, and deaths from the Australian Institute of Health and Welfare National Hospital Morbidity Database (NHMD; 2007-08 to 2016-17), the New South Wales Poisons Information Centre (NSWPIC; 2004-2017), and the National Coronial Information System (NCIS; 2007-08 to 2016-17).Participants: People who took overdoses of paracetamol in single ingredient preparations.Main Outcome Measures: Annual numbers of reported paracetamol-related poisonings, hospital admissions, and deaths; number of tablets taken in overdoses.Results: The NHMD included 95 668 admissions with paracetamol poisoning diagnoses (2007-08 to 2016-17); the annual number of cases increased by 44.3% during the study period (3.8% per year; 95% CI, 3.2-4.6%). Toxic liver disease was documented for 1816 of these patients; the annual number increased by 108% during the study period (7.7% per year; 95% CI, 6.0-9.5%). The NSWPIC database included 22 997 reports of intentional overdose with paracetamol (2004-2017); the annual number increased by 77.0% during the study period (3.3% per year; 95% CI, 2.5-4.2%). The median number of tablets taken increased from 15 (IQR, 10-24) in 2004 to 20 (IQR, 10-35) in 2017. Modified release paracetamol ingestion report numbers increased 38% between 2004 and 2017 (95% CI, 30-47%). 126 in-hospital deaths were recorded in the NHMD, and 205 deaths (in-hospital and out of hospital) in the NCIS, with no temporal trends.Conclusions: The frequency of paracetamol overdose-related hospital admissions has increased in Australia since 2004, and the rise is associated with greater numbers of liver injury diagnoses. Overdose size and the proportion of overdoses involving modified release paracetamol have each also increased. [ABSTRACT FROM AUTHOR]

The article focuses on the issue of restructuring primary health care in Australia.

The article discusses the status of Aboriginal health in Australia which highlights the lack of improvement on the community control of public health services, inter-sectoral collaboration and health monitoring. The author argues that the reinvention of organizations and the transformation of structures, systems and technologies are necessary to achieve a transformative change in the public policy, financing and relationship across the societal silos.

The article discusses the recommendations for the Review of Medical Intern Training, the framework for internship commissioned by the Council of Australian Governments. Topics include the opportunity to reevaluate the educational governance structure especially in pre-vocational training, the increase in the clinical risks due to lack of knowledge of doctors, and the implementation of standard by the Australian Medical Council for training organization.

In Australia, there is limited use of primary health care data for research and for data linkage between health care settings. This puts Australia behind many developed countries. In addition, without use of primary health care data for research, knowledge about patients' journeys through the health care system is limited. There is growing momentum to establish "big data" repositories of primary care clinical data to enable data linkage, primary care and population health research, and quality assurance activities. However, little research has been conducted on the general public's and practitioners' concerns about secondary use of electronic health records in Australia. International studies have identified barriers to use of general practice patient records for research. These include legal, technical, ethical, social and resource-related issues. Examples include concerns about privacy protection, data security, data custodians and the motives for collecting data, as well as a lack of incentives for general practitioners to share data. Addressing barriers may help define good practices for appropriate use of health data for research. Any model for general practice data sharing for research should be underpinned by transparency and a strong legal, ethical, governance and data security framework. Mechanisms to collect electronic medical records in ethical, secure and privacy-controlled ways are available. Before the potential benefits of health-related data research can be realised, Australians should be well informed of the risks and benefits so that the necessary social licence can be generated to support such endeavours. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a systemic disease of unknown aetiology, characterised by non-caseating granulomatous inflammation. It most commonly manifests in the lungs and intrathoracic lymph nodes but can affect any organ. This summary of an educational resource provided by the Thoracic Society of Australia and New Zealand outlines the current understanding of sarcoidosis and highlights the need for further research. Our knowledge of the aetiology and immunopathogenesis of sarcoidosis remains incomplete. The enigma of sarcoidosis lies in its immunological paradox of type 1 T helper cell-dominated local inflammation co-existing with T regulatory-induced peripheral anergy. Although specific aetiological agents have not been identified, mounting evidence suggests that environmental and microbial antigens may trigger sarcoidosis. Genome-wide association studies have identified candidate genes conferring susceptibility and gene expression analyses have provided insights into cytokine dysregulation leading to inflammation. Sarcoidosis remains a diagnosis of exclusion based on histological evidence of non-caseating granulomas with compatible clinical and radiological findings. In recent years, endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal lymph nodes has facilitated the diagnosis, and whole body positron emission tomography scanning has improved localisation of disease. No single biomarker is adequately sensitive and specific for detecting and monitoring disease activity. Most patients do not require treatment; when indicated, corticosteroids remain the initial standard of care, despite their adverse side effect profile. Other drugs with fewer side effects may be a better long term choice (eg, methotrexate, hydroxychloroquine, azathioprine, mycophenolate), while tumour necrosis factor-α inhibitors are a treatment option for patients with refractory disease. [ABSTRACT FROM AUTHOR]