Volume 219 Issue 10

Individualised glucocorticoid weaning can reduce the risk of cushingoid side effects and facilitate prompt restoration of adrenal function

David J Torpy · Wu Tzen Lim

Remission of type 2 diabetes is achievable with a variety of management modalities, but a combination of these may be required for maintenance of remission

Stephen N Stranks · Gary A Wittert

The Australian Cancer Plan is a landmark national policy reform to achieve equity of cancer outcomes and experiences for all Australians

Daniel Chaji · Anna Boltong · Carolyn Der Vartanian · Adam Lambert · Cindy Toms · Vivienne Milch · Claire Howlett · Dorothy Keefe

A 56-year-old woman of European ancestry from a suburban area of Far North Queensland was referred to the local cardiothoracic unit for a right lower lobe lung lesion

Sigrid G Theodore · Hannah J Sawkins · Manish Mathew · Sumit Yadav · Robert Norton

The nationwide use of insulin began 100 years ago with experiments in an Adelaide laboratory

Sophie Templer

Fasting blood glucose assessment may be appropriate as an initial screening test for gestational diabetes

Dev AS Kevat

A formal investigation of the vitamin C status of Australians should be undertaken

Jenny E Gunton · Nada Bechara

The Future Healthy Countdown 2030 will provide a targeted accountability framework to examine policy with a health and wellbeing lens for Australia’s children, young people and future generations

Sandro Demaio · Sharon R Goldfeld · Susan Maury

Fasting blood glucose assessment could be adequate for ruling out GDM in women at low absolute risk of glycaemia-related pregnancy complications

Nina JL Meloncelli · Adrian G Barnett · Cate M Cameron · David McIntyre · Leonie K Callaway · Michael C d'Emden · Susan J de Jersey

Socio-economic disadvantage increases the risk of vitamin C deficiency and is a significant public health problem

Puja Bhattacharyya · Kathrin Schemann · San San Min · David R Sullivan · Stephen J Fuller

There were fewer long consultations, Indigenous health assessments, and practice nurse/Aboriginal health worker consultations during the first year of the pandemic

Geoffrey K Spurling · Deborah A Askew · Noel E Hayman

Despite the large national DFD burden, Australian regions implementing guideline-based care have demonstrated large reductions in their regional DFD burdens and costs

Peter A Lazzarini · Anita Raspovic · Jenny Prentice · Robert J Commons · Robert A Fitridge · James Charles · Jane Cheney · Nytasha Purcell · Stephen M Twigg

Velandai Srikanth

Natasha Reid · Leonard C Gray

A framework to spotlight the health and wellbeing of children and young people in Australia has been established to track progress annually and drive coordinated action and accountability. The framework, called the Future Healthy Countdown 2030, is published as a supplement in the Medical Journal of Australia (MJA). “Despite many gains, such as increased immunisation rates and education attainment, inequities have increased steadily in Australia over the past two decades,” write Dr Kate Lycett and her colleagues. “One in six children [in Australia] live in poverty, one in four experience overweight or obesity, [and] three in five adults report experiencing some form of child maltreatment,” they wrote. Dr Lycett is a senior research fellow in the School of Psychology at Deakin University. “Measuring what matters to children and young people needs to be placed at the heart of policy decision making, with government commitment to regular reporting and with clear accountability mechanisms,” Dr Lycett and her colleagues stress. “This inaugural MJA supplement proposes a path forward for Australia to create policy environments that centre on the health and wellbeing of our children and young people and future generations.” Improving the current trajectory for children and young people requires better consideration of the upstream root causes of issues such as the social determinants of health, prevention, and the pre-distribution of spending, they wrote. The voices of children and young people should also be considered in decision making, according to Dr Lycett and her colleagues. The Future Healthy Countdown 2030 aims to spotlight the health and wellbeing of children and young people, the authors wrote, by: “measuring and monitoring progress on critical indicators in the lead-up to 2030;galvanising policy and public action, while providing accountability for essential improvements on critical indicators;showcasing the best available evidence that can be actioned to affect core measures; andspotlighting current policy priorities that need urgent attention”. Current policies for children and young people often focus on their closest environments, such as family, school and community, Dr Lycett and her colleagues wrote. “[While] these are key to ensuring children can thrive … the effects of policies within a wider circle of environmental influences — workplaces, societal, economic, political and cultural — also have an impact on their lives,” Dr Lycett and her colleagues wrote. The societal factors that promote a civil society for children and young people include equality/diversity, trust and care, valuing parents, prevention more than cure, and safe places for all (here). Although Australia has already made “tremendous” progress in what matters to children and young people, a literature review revealed that existing frameworks for reporting varied greatly, with very few indicators being measured annually, biennially or triennially, they wrote. The Future Healthy Countdown 2030 uses six domains from the ARACY’s the Nest, with one added domain, which are: healthy;material basics;learning and employment pathways;participating;positive sense of identity and culture;valued, loved, safe; andenvironments and sustainable futures.“In this first inaugural Future Healthy Countdown 2030 supplement, we asked Australia’s experts across child and youth health and wellbeing to canvass each of the seven domains used in the Countdown framework,” Dr Lycett and her colleagues wrote. “They were asked to propose key indicators for progress in these domains [where change could make a difference] for all children and young people [by 2030] and, most importantly, for children in Australia who are the most vulnerable to poor outcomes. “We plan to publish a refined set of Countdown indicators … in 2024.” The supplement is supported by the Victorian Health Promotion Foundation (VicHealth), the Murdoch Children’s Research Institute (MCRI), and the Australian Research Alliance for Children and Youth (ARACY). Read the Supplement in the Medical Journal of Australia.

Sam Hunt

The lung condition bronchiectasis remains under-recognised and undertreated in Australia, despite being the third most common chronic respiratory disorder, according to a perspective published in the Medical Journal of Australia. An updated position statement on chronic suppurative lung disease and bronchiectasis in children, adolescents and adults has been published to help medical professionals in diagnosing and treating bronchiectasis. Bronchiectasis is an obstructive lung disease featuring abnormal dilatation of the bronchi and is characterised by chronic cough, sputum production and recurrent respiratory infections that can have significant impact on quality of life. In Australia, it is most commonly found in Indigenous populations in remote northern communities, with 1470 per 100000 children aged less than 14 years and 23% of Indigenous adults undergoing computed tomography scans having evidence of bronchiectasis. The condition has a devastating impact on life expectancy, with Indigenous Australians with bronchiectasis dying 20 years earlier than non-Indigenous adults with bronchiectasis. In an Australian cohort study, 60% of adults referred for bronchiectasis had symptoms dating back to childhood. Since bronchiectasis is potentially reversible if diagnosed and treated early in children, the authors hope to raise awareness of the disease with the updated statement. The updated position statement expands on the 2015 guidelines, with modifications to 28 of the existing statements offering greater detail and explanatory comments. The statements provide guidance for health practitioners for when to refer children to paediatric respiratory specialist services, suggested investigations for determining underlying aetiology, suggestions for antibiotic selection, and recommendations for optimising management of patients. The update highlights the need to investigate underlying causes and comorbid conditions of bronchiectasis and emphasises the importance of providing patients with continuity of care when transitioning from paediatric to adult services. The 2023 publication also covers emerging issues such as advising against the use of electronic cigarettes, and the potential of telehealth in maintaining equitable access to specialist services in remote areas. Further updates in the future are expected as understanding of the disease evolves. Read the perspective in the Medical Journal of Australia

Annika Howells

Conducting a thorough investigation of a patient’s history of chronic cough and ordering chest x-rays are among the new recommendations in an updated position statement for the diagnosis and management of chronic cough. A chronic cough is defined as a daily cough of greater than four weeks in children and greater than eight weeks in adults (here). Cough is the most common symptom leading to medical consultation, write Associate Professor Julie Marchant and her colleagues in the Medical Journal of Australia. “Chronic cough results in significant health care costs, impairs quality of life and may indicate the presence of a serious underlying condition,” Associate Professor Marchant and colleagues wrote. Associate Professor Marchant is a paediatric respiratory physician at the Queensland Children’s Hospital and a senior research fellow in the QUT Cough Asthma and Airways Research Group at the Australian Centre for Health Services Innovation (AusHSI). Prevalence of chronic cough The prevalence of chronic cough in adults has been estimated to be 9.6% globally and 8.8% in Australia (here and here), with the prevalence of chronic cough gradually increasing to a peak when people are aged in their 60s (here). The condition is estimated to occur in 3% of people who have never smoked, 4% of people who used to smoke, and 8% of people who currently smoke (here). Overall, chronic cough presents more commonly in middle-aged women (here). In a recent study of Australian children presenting to emergency departments, 7.5% had chronic cough, and 20–23% had persistent cough at day 28 (here). The disproportionate burden on Aboriginal and Torres Strait Islander peoples The prevalence of chronic wet cough in children living in Indigenous communities is around 13% (here). “First Nations Australians are disproportionately affected by conditions that present with chronic wet cough, such as protracted bacterial bronchitis and bronchiectasis,” wrote Associate Professor Marchant and her colleagues. “The mortality difference between First Nations and non-First Nations Australians with bronchiectasis is about 22 years (here).” “In 180 First Nations children aged < 5 years presenting to primary care in urban Queensland for any reason, 24% had a history of chronic cough in the previous 12 months (here).” Recommendations Several recommendations for the prevention and management of chronic cough are listed. “Assessment of children and adults requires a focused history of the chronic cough to elicit any red flag cough pointers that may indicate an underlying disease,” Associate Professor Marchant and her colleagues wrote. “Further assessment with examination should include a chest x-ray and spirometry (age, > 6 years). “Separate paediatric and adult diagnostic management algorithms should be followed.” “[The] management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns,” they wrote. “Aboriginal and Torres Strait Islander adults and children should be considered high risk groups.” The authors thanked the Lung Foundation Australia and the Thoracic Society of Australia and New Zealand for their support in the preparation of the guidelines. Read the position statement in the Medical Journal of Australia or the full statement update

Sam Hunt

Med J Aust 2023; 219 (10 Suppl).