Volume 217 Issue 3

Religious LGBTQA+ conversion practices cause significant mental health harms. The health sector needs to recognise, support and respect survivors in ways that are affirming of sexual and gender diversity.

Jennifer Power · Timothy W Jones · Tiffany Jones · Nathan Despott · Maria Pallotta‐Chiarolli · Joel Anderson

With a history of border politics and deterrence strategies underpinning the Australian Government’s refugee and immigration policies, when it comes to refugee and asylum seeker health, politics can no longer be removed from advocacy

Nilanthy Vigneswaran

SGLT2 inhibitors show promise in improving metabolic and cardiovascular health in type 1 diabetes, yet ideal candidates for therapy require careful selection

Jennifer R Snaith · Jerry R Greenfield

A 69-year-old man had three hospital admissions from April to July 2021 with persistent fever of unknown origin

Anna Grosse · Tania Salehi · Mandy Callary · Jane R Hecker · Pravin Hissaria

A 65-year-old man presented to the emergency department with right facial weakness and transient dysphagia

Julia Lim · Cameron Shaw

A 21-year-old man noticed a blackish discoloration of the tongue at day 6 of oral penicillin intake following the extraction of retained molars

Dennis A Nowak · Benjamin E Nowak

Although the methods and rhetoric have changed over time, conversion practices remain prevalent in Australia

S Whyte

Born on 4 October 1937, Don Grimes grew up in Albury, New South Wales, his father a fitter and turner with NSW Railways and his mother a nurse

Michael Kirby · Patti Warn

Diversity and equity are both imperative when it comes to publishing high quality literature that promotes better health outcomes

Alisha Dorrigan · Elizabeth Zuccala · Nicholas J Talley

The first step to improving outcomes for women with stroke is to identify them

Else Charlotte Sandset · Maren Ranhoff Hov

To maximise its health benefits, self-testing for infectious diseases must be reliable, accessible, and affordable

Deborah A Williamson · Sharon R Lewin

Refining the assessment of symptoms in women in pre-hospital emergency services care could improve patient outcomes

Xia Wang · Cheryl Carcel · Benjumin Hsu · Sultana Shajahan · Matthew Miller · Sanne Peters · Deborah A Randall · Alys Havard · Julie Redfern · Craig S Anderson · Louisa Jorm · Mark Woodward

It is important to provide options for obtaining both oral fluid- and blood-based HIV self-tests

Dana YL Lee · Jason J Ong · Kirsty Smith · Muhammad S Jamil · Ruthy McIver · Rebecca Wigan · Kate Maddaford · Anna McNulty · John M Kaldor · Christopher K Fairley · Benjamin Bavinton · Marcus Chen · Eric PF Chow · Andrew E Grulich · Martin Holt · Damian P Conway · Mark Stoove · Handan Wand · Rebecca J Guy

It may be safe to de-label many patients because their reactions do not meet anaphylaxis criteria

Beau Z Carr · Kymble Spriggs · Samar Ojaimi · Elizabeth Leahy · Sara L Barnes

Very high influenza vaccination rates among health and aged care staff will be crucial if influenza activity increases this winter

Lyn‐li Lim · Noleen J Bennett · Sheena G Sullivan · Ann L Bull · Leon J Worth

For too long gender-based violence has been seen as the domain of social services or justice, with policy failing to resource an integrated response by the health system

Kelsey L Hegarty · Shawana Andrews · Laura Tarzia

To the Editor: We read with interest the article by Kelly and colleagues,1 In our opinion, the authors’ statement “Access to timely gender‐affirming care is associated with improved mental health outcomes and overall wellbeing” is not well supported by the two citations provided. The first citation is a systematic review by Rew and colleagues.2 A critique of this review was recently published.3 Rew et al, in response, clarified that they did not make any causal statements about puberty blockers and reported improved mental health outcomes, but believe their findings warrant more rigorous longitudinal studies.4 Kelly and colleagues’ second citation is a systematic review by Mahfouda et al.5 This review concluded there is only scarce and preliminary evidence that hormonal and surgical gender‐affirming treatments in adolescents are associated with mental health benefit and improved quality of life. The available evidence was described as having multiple methodological limitations and being at medium to high risk of bias. The authors called for further urgent research to clarify long term outcomes on psychological functioning and safety. Importantly, two recent systematic reviews by the United Kingdom’s National Institute for Health and Care Excellence found that the results of the studies investigating the benefits or adverse effects of puberty blockers and gender‐affirming hormones are of very low certainty and, as the studies themselves may not be reliable, any identified changes could be due to confounding, bias or chance.6,7 The recently published interim report of the UK’s Cass Review also noted that there are different views on the benefits versus harms of early social transition and more information about outcomes is required.8 In conclusion, the literature does not support there being a robust evidence base for the gender‐affirming social, medical and surgical interventions for children and adolescents. Rather, the literature highlights the scarce and low quality evidence and the urgent need for more high quality evidence. In any consideration of the processes of informed consent and/or court consent it would seem imperative that there is acknowledgement of the uncertain evidence base underpinning these interventions. Thus, it is of concern that Kelly and colleagues fail to do this.

Alison Clayton · Roberto D’Angelo · Patrick Clarke

In reply

Ken C Pang · Fiona Kelly · Simona Giordano