Volume 219 Issue 6

New national iGAS surveillance highlights uncertain epidemiology and the need for synthesised health priorities

Thel K Hla · Jeffrey W Cannon · Asha C Bowen · Rosemary Wyber

Governments must invest more in youth mental health to curb rising rates of mental illness

Patrick D McGorry · David Coghill · Michael Berk

A 32-year-old woman presented with a painless but cosmetically bothersome chronic indolent lesion on her left knee

Ruby C Lee · Kennedy Wong · Yolanka Lobo · Heba Jibreal

Accurate diagnosis requires careful interpretation of laboratory results, with repeat serology over time and using a range of different assays

Kate Proudmore · Vicki L Krause · Bart J Currie · Rob Baird

Addressing burnout among physicians might involve identifying the contributing factors and developing a toolbox of evidence-based interventions

Anne E Powell

Walsh SM, Versace VL, Thompson SC, et al. Supporting nursing and allied health student placements in rural and remote Australia: a narrative review of publications by university departments of rural health. Med J Aust 2023; 219 (3 Suppl): S14‐S19. https://doi.org/10.5694/mja2.52032. In this narrative review, the name of the fourth author was incorrect; her name is Leanne J Brown.

New approaches, which place Aboriginal and Torres Strait Islander communities at the heart of discussions and decision making about their futures, are clearly needed; on this basis, the MJA supports an Aboriginal and Torres Strait Islander Voice to Parliament

Virginia Barbour

We need inexpensive methods for distinguishing between people with hypertension who have primary aldosteronism and those who do not

John W Funder

If female doctors receive less pharmaceutical industry funding, gender-based differences in prescribing patterns could result

Barbara Mintzes · David B Menkes

Screening test results for primary aldosteronism were positive for about one-quarter of urban Indigenous and non-Indigenous participants

Elisabeth Ng · Stella M Gwini · Michael Stowasser · Morag J Young · Peter J Fuller · Gurmeet R Singh · Jun Yang

Local guidelines, specific funding of respiratory care for people with neuromuscular disorders, and further training for clinicians are needed

Meredith A Perry · Bernadette Jones · Hemakumar Devan · Alister Neill · Amanda Piper · Tristram Ingham

Transparency of pharmaceutical company support provides an opportunity to assess gender differences

Leah Jones

Incidentally found white matter hyperintensities on neuroimaging are an opportunity to address cardiovascular risk factors to prevent progression to cognitive decline

Thomas P Ottavi · Elizabeth Pepper · Grant Bateman · Mark Fiorentino · Amy Brodtmann

Alain Braillon · Wendy A Rogers

Helen Y Sun · Yaron Gu · Deshan F Sebaratnam

An Australian-first study, published in the Medical Journal of Australia, has found significant prevalence of undiagnosed coeliac disease among first degree relatives of people already diagnosed. The study findings support existing overseas recommendations for screening of first degree relatives for coeliac disease. Coeliac disease is an autoimmune disorder where the ingestion of gluten in genetically susceptible individuals causes gastrointestinal symptoms. Delayed diagnosis of coeliac disease can lead to serious health complications such as osteoporosis, infertility, and small bowel cancer. “We undertook this research to look at the value of finding cases of coeliac disease in people at high risk of coeliac disease in Australia,” lead author Dr James Daveson said. Researchers at the Wesley Research Institute in Brisbane set out to determine the prevalence of undiagnosed coeliac disease among first degree relatives of people who had been diagnosed. A total of 202 first degree relatives (children, siblings or parents) of 134 people with coeliac disease were invited to undergo testing for coeliac disease. Testing included HLA-DQ2/8/7 polymerase chain reaction genotyping for coeliac disease risk alleles and, where possible, small bowel biopsy. The study found seven of 62 child first degree relatives of people with coeliac disease had biopsy-confirmed disease, yielding an estimated prevalence of 11%. For those with coeliac disease susceptibility haplotypes, the prevalence was 14%. Dr Daveson hopes the study will emphasise to health practitioners the importance of family screening for coeliac disease. “Defining such a high rate of undiagnosed … high risk children with coeliac disease is important for Australian health practitioners,” Dr Daveson said. “The most important outcome of this study will be if it highlights the need for first degree relatives of people with coeliac disease to be screened for coeliac disease themselves.”

Annika Howells

The risk of death from breast cancer is 43% higher for women who had at least one treatment interval longer than the recommended treatment timeframes, according to new research. The research, published in the Medical Journal of Australia, examined associations between breast cancer survival and timeliness of treatment. It found that breast cancer-specific survival was poorer for women with breast cancer who received treatment outside the recommended treatment interval timeframes, which are defined by the 2020 Australian guidelines for the treatment for early breast cancer (here). Breast cancer is the second most frequent cause of cancer-related deaths of Australian women, Dr Kou Kou said, who was the lead author of the study and is the Senior Research Officer of Epidemiology at Cancer Council Queensland. “Despite recent efforts to improve therapy, between 33% [and] 52% of women diagnosed with breast cancer do not receive timely treatment,” Dr Kou Kou said. “Our study shows that any delay in commencing or continuing treatment is associated with poorer survival.” The guidelines for the treatment of early breast cancer list six treatment intervals: diagnosis to neoadjuvant therapy (neoadjuvant systemic therapy should start as soon as diagnosis and staging is complete, ideally within two to four weeks);neoadjuvant therapy to surgery (surgery should be performed within four to six weeks of neoadjuvant systemic therapy, allowing for recovery from myelosuppression);diagnosis to surgery (surgery should be performed within one month of decision to treat with surgery for women who do not receive neoadjuvant therapy);surgery to chemotherapy (adjuvant chemotherapy should commence within four to six weeks of surgery);surgery to radiotherapy (women who have completed definitive surgery for breast cancer should commence radiotherapy as soon as possible after wound healing, and within eight weeks of surgery if no adjuvant chemotherapy received); andchemotherapy to radiotherapy (women who have completed definitive surgery for breast cancer should commence radiotherapy within three to four weeks of completing adjuvant chemotherapy). The researchers at Cancer Council Queensland conducted a population-based cohort study of women aged 20–79 years diagnosed with invasive breast cancer between 1 March 2010 and 30 June 2013, as recorded on the Queensland Cancer Register. “We compared treatment intervals for each participating woman with the guidelines,” Professor Peter Baade said, a biostatistician and senior manager of descriptive epidemiology at Cancer Council Queensland. “We found the risk of death from breast cancer was significantly greater for women who underwent surgery more than 29 days after diagnosis, or commenced chemotherapy more than 36 days after surgery, or commenced radiotherapy more than 31 days after completing adjuvant chemotherapy, compared to women who received treatment before the corresponding time points. “The risk of death from breast cancer is 43% higher for women who had at least one treatment interval longer than the recommended timeframe.” There are several reasons why women may have longer than recommended treatment intervals, the researchers said. “A patient’s treatment intervals may be affected by a number of factors, including if they live in regional or remote Australia,” Dr Kou Kou said. “Women using public screening facilities tend to have longer intervals compared to those using private ones. And timing matters too; starting or completing treatment in December to January often leads to longer intervals between treatments. “Women without a family history of ovarian or breast cancer often have longer treatment intervals compared to those with a family history. Smoking, lower household income, and not having private health insurance were linked to longer intervals.” “Therefore, it is vital that the 2020 Australian guidelines for the treatment for early breast cancer are followed as closely as possible. “The clinical evidence is in: these guidelines save lives, so we need to make sure they are being followed by clinicians to give their patients the best chance of survival.” Read the research in the Medical Journal of Australia

Sam Hunt

New research has found general practitioners (GPs) are proactively providing preventive health checks to women in mid-life who need it most, possibly due to sufficient Medicare rebates. The research, published in the Medical Journal of Australia, analysed data from the Australian Longitudinal Study on Women’s Health (ALSWH) to determine whether preventive health checks were being carried out on women in mid-life with the greatest need, as often people who are most in need are the ones who receive the least care. “We wanted to know if the patients getting preventive health checks were those who needed them most and if a patient’s economic position might be a barrier to access,” Professor Jenny Doust said, the study’s senior researcher and clinical professorial research fellow of The University of Queensland. The types of preventive health checks generally available for women aged between 40 and 49 years are checks for those at risk of type 2 diabetes and chronic disease, as well as a heart health check. The research found that women were more likely to have had health checks if they had risk factors for chronic disease, which was in contrast to previous research which found that fewer GP services are provided to people with unhealthy lifestyles. The new findings were mirrored in a recent study looking at the uptake of health checks for Aboriginal and Torres Strait Islander people, which found these went to those who had the greatest health care needs. “Our work shows that, in Australian primary care, people who need preventive care the most are more likely to receive it,” Professor Doust said. “We often hear about the inverse care law, that is the ability to access health care varies inversely with need. “There is some previous evidence of the inverse care law in Australian general practice, with people who have unhealthy behaviours using fewer GP services and those living in disadvantaged areas having shorter GP consultation times. “Our study shows that the inverse care law doesn’t seem to apply here.” The research authors believe one explanation might be that the Medicare rebate paid to GPs for preventive health is at a sufficiently high level for GPs to be incentivised to provide this care. The fact that fewer women in the study underwent heart health checks suggests the rebate for this service may be inadequate compared with the rebate for health checks for diabetes and chronic disease. “It is hard to design health care funding so that people who need care receive it, without also incentivising overservicing to those who can afford to pay more,” Professor Doust said. “Partly, we rely on health care providers being motivated to provide equitable care.” “Our study suggests GPs are doing that.”

Annika Howells