Issues
Volume 218 Issue 8
Editor’s choice
The power of data in addressing planetary health, clinical practice and health worker wellbeing
In discussions around planetary health, biodiversity loss is often highlighted less than climate change and its effects. Yet, as the perspective by Barraclough and colleagues notes, biodiversity and its loss is critically important, including for human health (doi: 10.5694/mja2.51904). Australia has an appalling record on biodiversity and species loss as noted in findings from the 2021 State of the Environment (SOE) report. This is just the latest in a series of reports that draw on ongoing robust data collection from across Australia. The authors argue that biodiversity must be taken seriously: “It is imperative that we acknowledge human dependence on nature and respond to Australia's accelerating environmental decline with the same urgency as any other public health emergency.” They note that “There are several key messages in the SOE report for the medical profession. First, we must recognise that Australia's environmental crisis is a health crisis. We need to use our positions as health experts to advocate for environmental protection for the sake of health.” We agree and echo the final words quoted by the authors from Margaret Chan, former director of the World Health Organization: “A healthy planet and healthy people are two sides of the same coin”. The ongoing relation between planetary health and human health is highlighted by the medical education article by Allen and colleagues on Japanese encephalitis virus (JEV) (doi: 10.5694/mja2.51905). Doctors need to be aware that climate change will present new clinical challenges. Driven by the El Niña weather system, which was made more severe by climate change, leading to flooding in the eastern states of Australia in the past few years, there is now a risk that JEV will become endemic in Australia and will therefore require a change in diagnostic algorithm for encephalitis. As the authors note, JEV now needs to be considered as a differential diagnosis for encephalitis as “there is potential that JEV might become an ongoing seasonal challenge in temperate Australia”. A research article in this issue highlights the critical need to assess the mental health and wellbeing of the health workforce, especially during difficult times such as during the COVID‐19 pandemic. McGuinness and colleagues did three sequential surveys over 12 months of health and aged care workers in Victoria in the second and third years of the COVID‐19 pandemic, 2021 and 2022 (doi: 10.5694/mja2.51918). The findings are challenging and have substantial implications for the health workforce in the face of the pandemic that has not yet ended. The authors found that “measures of burnout, optimism, wellbeing, and resilience were poorer in late 2021 and mid‐2022 than in mid‐2021, but that measures of depression, anxiety, and post‐traumatic stress had improved between late 2021 and mid‐2022”, suggesting the ongoing toll of the pandemic. Indeed, in the third survey in 2022, 54% of survey respondents reported considering leaving their profession. As the authors conclude, “greater support for sector‐wide mental health and wellbeing support programs for health care workers is required”. In a linked editorial, Harvey notes the power of findings such as these in highlighting where action is needed, noting that the report “strengthens the case for immediate action regarding the factors that research has identified as problems, including working hours, work–life balance, fatigue management, administrative burden, and appropriate supervision and resources”. Harvey concludes that “Australia urgently needs better, nationally representative information about its health and aged care workforce, a discussion of its implications, and controlled trials of new workplace interventions”. Finally in this issue, I'd like to highlight the thoughtful reflection on the life and career of Professor Dame Valerie Beral by Canfell and colleagues (doi: 10.5694/mja2.51914). Professor Beral was a leader in so many ways in medical research, a role model for women in science and fierce champion of the power of data in health research, so much so that the authors report that “she once said that if she were stranded on a desert island the one luxury she would choose would be a dataset to analyse”.
Virginia Barbour
Perspectives
Why losing Australia's biodiversity matters for human health: insights from the latest State of the Environment assessment
Biodiversity in Australia is in steep decline, posing major risks to human health
Katherine A Barraclough · Marion Carey · Kenneth D Winkel · Emily Humphries · Brooke Ah Shay · Yi Chao Foong
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
We need to design data systems that hold social and health equity as a core value and desired outcome of data integration
Catherine Smith · Claire M Vajdic · Niamh Stephenson
Medical education
Japanese encephalitis virus: changing the clinical landscape of encephalitis in Australia
A structured diagnostic approach is required when assessing for JEV in patients with encephalitis
Sarah Allen · Celia M Cooper · Ajay Taranath · Allen C Cheng · Philip N Britton
Pentosan polysulfate maculopathy: a brief primer for general practitioners, ophthalmologists, optometrists and urologists
A 55-year-old woman in the United States, with a history of interstitial cystitis diagnosed at age 33 years, was referred for pattern macular dystrophy
Aaron Priluck · Adrian T Fung · Mandeep S Singh
Hemichorea–hemiballismus due to hyperglycaemia
A 77-year-old man with a history of type 2 diabetes was admitted to hospital for acute hyperglycaemia
Manon Levy · Lucien Marchand
Reflection
Reflections on the life and career of Professor Dame Valerie Beral AC DBE FRS FRCOG FMedSci (1943–2022)
Pioneering cancer epidemiologist and champion of women in science
Karen Canfell · Bette Liu · Emily Banks
Editorials
Introducing Australia's clinical care standard for low back pain
A new clinical care standard provides evidence-based guidance to help clinicians deliver best care for people with low back pain
Christopher G Maher · Aline Archambeau · Rachelle Buchbinder · Simon D French · Julie Morphet · Michael K Nicholas · Peter O'Sullivan · Marie Pirotta · Michael J Yelland · Leo Zeller · Nivene Saad · Elizabeth Marles · Alice L Bhasale · Christina Lane
The mental health of health and aged care workers in Australia
As more concerning data are published, is it time to hit the panic button?
Samuel Harvey
Moving breast cancer susceptibility gene testing into the mainstream
Timely delivery of results to guide index cancer treatment and greater equity of access are among the goals of broader testing
Stephanie M Wong · William D Foulkes
Research
Mental health and wellbeing of health and aged care workers in Australia, May 2021 – June 2022: a longitudinal cohort study
Evidence-based mental health and wellbeing programs for workers in health care organisations are needed
Sarah L McGuinness · Owen Eades · Kelsey L Grantham · Shannon Zhong · Josphin Johnson · Peter A Cameron · Andrew B Forbes · Jane RW Fisher · Carol L Hodgson · Jessica Kasza · Helen Kelsall · Maggie Kirkman · Grant M Russell · Philip L Russo · Malcolm R Sim · Kasha Singh · Helen Skouteris · Karen Smith · Rhonda L Stuart · James M Trauer · Andrew Udy · Sophia Zoungas · Karin Leder
Universal genetic testing for women with newly diagnosed breast cancer in the context of multidisciplinary team care
Routine testing removes barriers to testing, identifies additional women with pathogenic variants, leading to revised treatment for many
Dilanka L De Silva · Lesley Stafford · Anita R Skandarajah · Michelle Sinclair · Lisa Devereux · Kirsten Hogg · Maira Kentwell · Allan Park · Luxi Lal · Magnus Zethoven · Madawa W Jayawardana · Fiona Chan · Phyllis N Butow · Paul A James · G Bruce Mann · Ian G Campbell · Geoffrey J Lindeman
Research letters
The Queensland IMplementation of PRecision Oncology in brEast cancer (Q‐IMPROvE) pilot study
Clinically meaningful outcomes can be achieved with matched germline/tumour whole genome sequencing
The Q‐IMPROvE study group
The South Australian Emergency Department Admission Blood Psychoactive Testing (EDABPT) program: first results
Most patients have taken a mixture of agents; the combination of GHB with methamphetamine is particularly frequent
Sam Alfred · Peter Stockham · Emma Partridge · Alastair Ward · Hannah Green · Jake Mallon · Chris Kostakis · Andrew Camilleri · Daniel Haustead
A rise in invasive and non‐invasive group A streptococcal disease case numbers in Melbourne in late 2022
Our findings add to northern hemisphere reports that possibly reflect a worldwide increase in GAS disease
Aleece MacPhail · Wen Jie Isaac Lee · Despina Kotsanas · Tony M Korman · Maryza Graham
Letter
Reducing the burden of group A streptococcal disease in the Northern Territory: the role of chemoprophylaxis for those at greatest risk
To the Editor: We thank Gibney and Steer for their editorial1 in response to our research letter,2 supporting further public health action and research into invasive group A streptococcal (iGAS) disease. However, we are concerned about the statement that the 30‐day risk of iGAS disease for contacts of someone with an index infection is about 2000‐fold higher than background risk. This figure is derived from an English population‐based study3 and cannot be universally applied across circumstances varying in background incidence of GAS‐related disease, which is driven predominantly by socio‐environmental factors. Applying this 30‐day secondary attack rate of iGAS infection in Northern Territory household contacts would translate to about 177 cases per 1000 population (18%) in Indigenous Australian contacts and 2738 per 1000 population (274%) in people receiving haemodialysis.2 In contrast, rates of iGAS infection in household contacts were 3.2 per 1000 population in Canada4 and 0.7 per 1000 population in the United States.5 As described in the NT public health guidelines for iGAS, previous NT and Queensland studies have demonstrated large diversity of iGAS genotypes,6 with less clonality and a greater proportion of sporadic cases rather than transmission directly from another case of iGAS infection. This reflects the stark contrasts in iGAS and other consequences of GAS infection between central and northern Australia and southern states, as seen with so many other health issues linked to socio‐economic disadvantage. Gibney and Steer also note that some authorities recommend antibiotic prophylaxis for close contacts, and others do not.1 We wish to highlight that the NT guidelines for the public health response to iGAS include specific guidance around antibiotic prophylaxis for close contacts (for mother–neonatal pairs, contacts of severe iGAS disease cases, and in other special circumstances), informed by a literature review in the Appendix.6 National guidelines for iGAS are currently being developed and these need to include advice tailored for the vastly different epidemiology seen across Australia, reflecting a contrasting diversity of endemicity of GAS‐related disease. This has also been necessary for the Australian guidelines for diagnosing acute rheumatic fever, with low risk and high risk populations defined.7
Johanna M Birrell · Bart J Currie · Vicki L Krause
Focusing on the challenges facing primary care
Aajuli Shukla
A step in the right direction: the potential role of smartwatches in supporting chronic disease prevention in health care
Graeme Mattison · Oliver J Canfell · Doug Forrester · Chelsea Dobbins · Daniel Smith · David Reid · Clair Sullivan
The impact of climate change on skin health
Austen Anderson · Fiona Bruce · H Peter Soyer · Crystal Williams · Rebecca B Saunderson
Hypertensive retinopathy in the paediatric setting
Nandini Singh · Kanika Chaudhri · Caroline Catt
What is the future of universal health coverage in Australia?
Elizabeth Zuccala
Harnessing fast and slow thinking to ensure sustainability of general practice and functional universal health coverage in Australia
Kirsty A Douglas · Sally Hall Dykgraaf · Danielle C Butler
The NDIS at ten years: designing an equitable scheme for the next decade
Jennifer Smith‐Merry · John Gilroy · Annmaree Watharow
Out‐of‐pocket fees for health care in Australia: implications for equity
Emily J Callander