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The Royal Commission into Defence and Veteran Suicide recently published research analysis of the risk of suicide based on data from the Australian Defence Force (ADF). We aim to provide a brief summary of the salient findings, as well as a commentary from a clinical perspective for the psychiatric profession providing care for ADF serving members and veterans who bear a burden of psychiatric morbidity related to the nature of their work. The suicide risk from current and past service, and in certain roles, highlight the challenges facing those in military service, with implications for the time spent on active deployment and transition post-deployment. [ABSTRACT FROM AUTHOR]

Objective: Specialised mental healthcare delivery is highly labour intensive, and the COVID-19 pandemic has exacerbated workforce shortfalls. We explore the information on the mental healthcare labour supply in Australia from a health policy viewpoint. Our purpose is to stimulate discussion, further research and development of interventions. Conclusions: The mental healthcare labour market has a number of features that make it prone to shortages and other distortions. These include: the labour-intensive nature of healthcare work;, long-training periods; that traditional policy levers like pay are only partially effective; as well as other challenges in retaining and recruiting mental health nurses and psychiatrists, especially in public mental health services. Further research is needed to develop and evaluate effective interventions. [ABSTRACT FROM AUTHOR]

There are many identified challenges for mental healthcare services in Australia and New Zealand including design, infrastructure and workforce shortfalls. In the 2024 RANZCP Workforce Report over 75% of trainees and psychiatrists endorsed symptoms of burnout, and over 80% reported that workforce shortages contributed. There is a need for effective leadership to reform and renew healthcare services. Clinical expertise is necessary, but not sufficient for leadership of mental healthcare services through substantial cultural and organisational renewal. Expertise and prosocial skills are needed for effective cultural leadership, based upon expressed generosity and kindness that leads to a corresponding reputation that empowers cooperation. Leaders will need such skills to effect change and improve mental healthcare delivery and patient experiences. [ABSTRACT FROM AUTHOR]

Women with severe mental illness and pregnancy suffer substantial travails in accessing care for mental and perinatal health. Women with psychotic illnesses such as schizophrenia face higher risks of pregnancy and postnatal complications. Similarly, lack of access to holistic psychiatric care presents particular perils for these women and their children. Tailored care for these mothers-to-be and their babies is needed to prevent and ameliorate health complications, mental and physical. This will require targeted funding of services that connect women with and provide continuity of care. [ABSTRACT FROM AUTHOR]

Directly or indirectly, medical practitioners influence health‐care policy and spending through their clinical decision‐making. As medical expertise and technology has grown, and patient choice has been empowered by the consumer movement, there are now many more medical interventions than can be accommodated in a finite national health‐care budget. We reviewed the Australian Medical Council, Medical School and Medical Specialist curricula. In Australia, medical students, doctors and medical specialists do not appear to have specific health economics education that would improve skills to select beneficial and cost‐effective care. We propose a framework for medical practitioner health economics education. [ABSTRACT FROM AUTHOR]

What is known about this topic? We discuss a recently published paper that alleges clinicians are causal agents of non-compliant billing of Medicare. What does this paper add? The paper's arguments are partially supported by unreferenced assertions, potential logical fallacies, inaccurate reporting of referenced material and unsubstantiated rhetoric. What are the implications for practitioners? Due to the lack of substantive evidence, it cannot be concluded that clinicians are the causal agents of non-compliant billing of Medicare. [ABSTRACT FROM AUTHOR]

Objective: Improvements in success rates of assisted reproduction led to predictions that infertility surgery in both women and men would become extinct in developed countries. We sought to identify the changes in reproductive surgery that occurred between 2001 and 2015 to determine whether these predictions have been accurate. Design: The Australian Institute of Health and Welfare (AIHW) national procedural dataset and the Australian Medicare Benefits Scheme (MBS) claims database were searched for procedure data for male and female reproductive surgery and assisted reproduction from January 2001 to December 2015. The denominators were based on annual point estimates of the total population aged 25–44 years (female) and 25–55 years (male) from the Australian Bureau of Statistics (ABS). This dataset provides procedures undertaken but not their indications. Results: Over the study period the incidence of tubal surgery fell by 66%, vasectomy reversal by 33%, and surgical varicocoelectomy by 50%. In contrast, the rate of hysteroscopic myomectomy increased by 48%, hysteroscopic septoplasty by 125%, and laparoscopy for severe endometriosis increased by 84%. In vitro fertilisation oocyte retrievals increased by 90%. The rate of abdominal myomectomy was unchanged. Conclusion: Fertility surgery is not dead but has evolved. [ABSTRACT FROM AUTHOR]

Background: There are several accepted approaches to management of ectopic pregnancy, both surgical and non‐surgical. When a surgical approach is used, there appears to be an equipoise between tubal preservation and removal. We sought to determine the patterns of surgical management of ectopic pregnancy in Australia since the year 2000. Materials and Methods: Data regarding hospital admissions for ectopic pregnancy were extracted from the Australian Institute of Health and Welfare national procedural dataset for the years 2000–2013. Surgical procedures were classified as open or laparoscopic, and involving salpingotomy or salpingectomy (tubal removal). The results were stratified into age bands. Results: Over the study period hospital admission rates for ectopic pregnancy rose in women under the age of 30, without an increase in surgical procedures, while the rate of surgical procedures fell in women in older age groups. Rates of management of ectopic pregnancy via laparotomy fell in all age groups, as did rates of tubal preservation. Conclusion: Since the year 2000 there have been changes in the management of ectopic pregnancy, with significant reductions in open surgery and tubal preservation. [ABSTRACT FROM AUTHOR]

Background: Preterm birth is a common cause of adverse neonatal and childhood outcomes, in both the short and long term. Preterm labor is commonly associated with inflammation at the maternal-fetal interface. There is some indirect evidence that mast cells (MCs) might represent a link between hormonal influences and local reactions leading to the onset of labor. Patients and methods: The placentas and membranes of 51 uncomplicated spontaneous term births were compared to those from 50 spontaneous preterm births. Immunohistochemical staining for MC tryptase was undertaken allowing MC concentration, location, and degranulation status to be determined. Regression modeling was used to compare results. Results: There were no significant differences in the demographic characteristics of the two cohorts. There were significantly more MCs in the decidua for term births than preterm births (P=0.03). The presence of histological chorioamnionitis did not affect MC concentrations. Conclusion: Despite evidence suggesting a possible role for MCs in spontaneous preterm birth, this study found that the concentration of decidual MCs was in fact significantly lower in preterm compared to term birth. [ABSTRACT FROM AUTHOR]