Issues
Volume 219 Issue 7
Editor’s choice
Responding to the challenges of emerging health threats
A key role of a medical journal is to highlight and document emerging health threats, as we know only too well from the role that journals played — and continue to play — during the COVID‐19 pandemic. As the pandemic also demonstrated, despite good knowledge of their pathogenesis generally, infectious diseases remain important causes of morbidity and mortality. This issue of the MJA has two examples that span the range of challenges that infectious diseases pose. Flynn and colleagues discuss the threat to Australian public health of carbapenemase‐producing Enterobacterales (CPE) (doi: 10.5694/mja2.52077). These bacteria are not yet endemic in Australia, but they are elsewhere, and where that is the case there are profound medical and financial implications. Although the highest burden is in hospitals, CPE is also a problem outside of health care settings in residential aged care and in the community. As the authors note, “The potential for CPE transmission in the wider community, particularly among vulnerable older people in aged care facilities, is of concern”. They observe that we probably do not know the burden of disease in Australia: “CPE infection is only notifiable in five of the eight states and territories, and consequently, CPE burden is likely underestimated.” In their closing arguments, they urge action now while the burden of disease is still low, and highlight that an “Australian Centre for Disease Control is ideally placed as a national coordinating body to guide a systematic, evidence‐based and harmonised approach to CPE surveillance and public health action. Australia now has a unique opportunity to take coordinated national action to prevent the spread of CPE.” Challenges from another emerging infectious disease are described in an article by Weerasinghe and colleagues (doi: 10.5694/mja2.52076). Mpox emerged as a disease in May 2022 and information about it is still accumulating, with to date just 154 cases reported in Australia. There is a third‐generation smallpox vaccine being rolled out to high risk groups, but as the authors describe in two individuals, there is a possibility of breakthrough infection. They conclude that “Clinicians should be aware of the possibility of breakthrough modified [monkeypox virus] infection in patients with epidemiological risk factors and a characteristic vesiculopustular rash, despite a history of vaccination.” Finally, turning to a non‐infectious emerging public health threat — vaping. Gardner and colleagues describe the prevalence, patterns of use, and socio‐demographic features of e‐cigarette use by Australian adolescents, collected in a survey of students aged 14–17 years from 70 schools in NSW conducted between 1 July and 31 December 2022 (doi: 10.5694/mja2.52075). The findings are startling: “A total of 1094 of 4204 respondents reported ever having used e‐cigarettes (26.0%; 95% CI, 24.8–27.4%); mean age at first use was 14.0 years (SD, 1.3 years).” This should be compared with the findings noted in their introduction: “A national survey in 2019 found that 10% of 14–17‐year‐old Australians had used e‐cigarettes”. The authors note that because of their methodology, “extrapolation of our findings to all Australian adolescents should be cautious”. However, they conclude that “Our findings indicate that strategies for preventing the uptake and reducing the use of e‐cigarettes by Australian adolescents are needed”. As for emerging infectious diseases, the MJA will continue to report on the public health threat posed by vaping, and the strategies needed to counter it.
Virginia Barbour
Perspectives
Carbapenemase‐producing Enterobacterales: a profound threat to Australian public health
Nationally coordinated action is needed to contain the threat of carbapenemase-producing Enterobacterales in Australia
Erin Flynn · Lito E Papanicolas · Nicholas Anagnostou · Morgyn S Warner · Geraint B Rogers · Erin Flynn · Lito E Papanicolas · Nicholas Anagnostou · Morgyn S Warner · Geraint B Rogers
Sodium glucose cotransporter 2 inhibitor‐induced ketoacidosis is unlikely in patients without diabetes
SGLT2 inhibitor use in heart failure patients without diabetes should have minimal risk of ketoacidosis
Lisa M Raven · Christopher A Muir · Jerry R Greenfield
Medical education
Breakthrough mpox despite two‐dose vaccination
Clinicians should be aware of the possibility of breakthrough infection in patients with epidemiological risk factors and a characteristic vesiculopustular rash, irrespective of a history of previous vaccination
Madhara N Weerasinghe · Catriona Ooi · George Kotsiou · Vincent J Cornelisse · Arran Painter · Madhara N Weerasinghe · Catriona Ooi · George Kotsiou · Vincent J Cornelisse · Arran Painter
The not‐so‐natural herb: a case of exogenous Cushing syndrome
A 44-year-old man presented to the emergency department with one month of worsening breathlessness, orthopnoea, paroxysmal nocturnal dyspnoea, and pitting oedema to the thighs
Yi‐An Pan · David Roberts · Yi‐An Pan · David Roberts
Editorials
Is elective spinal surgery overused in private health care in Australia?
We need to get serious about collecting data, using robust definitions of diagnoses, surgical indications, and patient-important outcomes
Susan Liew
Child abuse and premature mortality: disrupting the harm cascade
The health, social, and monetary costs of child abuse and neglect are indefensible on ethical, medical, and financial grounds
Leonie Segal · Harriet Hiscock
Research
Elective spinal surgery in New South Wales adults, 2001–20, by procedure funding type: a cross‐sectional study
Differences in procedure rates suggest that too many private or too few publicly funded spinal procedures are undertaken
Duong Thuy Tran · Adriane M Lewin · Louisa Jorm · Ian A Harris
Sexual abuse during childhood and all‐cause mortality into middle adulthood: an Australian cohort study
Supporting children after sexual abuse is also essential for the adults they become
Nina Papalia · Benjamin L Spivak · Linda Ashford · Ahona Guha · Stefan Luebbers · James RP Ogloff · Nina Papalia · Benjamin L Spivak · Linda Ashford · Ahona Guha · Stefan Luebbers · James RP Ogloff
Hospitalisations and in‐hospital deaths following moderate to severe traumatic brain injury in Australia, 2015–20: a registry data analysis for the Australian Traumatic Brain Injury National Data (ATBIND) project
More effective care strategies are required to reduce the burden of TBI, particularly among younger men
Gerard M O'Reilly · Kate Curtis · Biswadev Mitra · Yesul Kim · Afsana Afroz · Kate Hunter · Courtney Ryder · Delia V Hendrie · Nick Rushworth · Jin Tee · Shane D'Angelo · Emma Solly · Oashe Bhattacharya · Mark C Fitzgerald · Gerard M O'Reilly · Kate Curtis · Biswadev Mitra · Yesul Kim · Afsana Afroz · Kate Hunter · Courtney Ryder · Delia V Hendrie · Nick Rushworth · Jin Tee · Shane D'Angelo · Emma Solly · Oashe Bhattacharya · Mark C Fitzgerald
Study protocol
Activating pharmacists to reduce the frequency of medication‐related problems (ACTMed): a stepped wedge cluster randomised trial
The aim is to reduce risks of medicine-related harm, reduce health care costs and improve efficiency, and enhance person-centred care
Jean Spinks · Richard Violette · Douglas IR Boyle · Dennis Petrie · Laura Fanning · Kerry K Hall · Fiona Kelly · Amanda J Wheeler · Robert S Ware · Joshua Byrnes · Esa Chen · Andrew Donald · Nicolette Ellis · Megan DelDot · Lisa Nissen · Jean Spinks · Richard Violette · Douglas IR Boyle · Dennis Petrie · Laura Fanning · Kerry K Hall · Fiona Kelly · Amanda J Wheeler · Robert S Ware · Joshua Byrnes · Esa Chen · Andrew Donald · Nicolette Ellis · Megan DelDot · Lisa Nissen
Research letter
Prevalence, patterns of use, and socio‐demographic features of e‐cigarette use by Australian adolescents: a survey
Strategies for preventing the uptake and reducing the use of e-cigarettes by Australian adolescents are needed
Lauren A Gardner · Siobhan O'Dean · Katrina E Champion · Emily Stockings · Amy‐Leigh Rowe · Maree Teesson · Nicola C Newton · Lauren A Gardner · Siobhan O'Dean · Katrina E Champion · Emily Stockings · Amy‐Leigh Rowe · Maree Teesson · Nicola C Newton
Letters
Field cancerisation and radiotherapy: a case of treatment complications
Gerald B Fogarty · Elizabeth J Paton · David Christie
Field cancerisation and radiotherapy: a case of treatment complications
James Muir · Sarah K Morton · Selim Ozluer
Diabetes and non‐alcoholic fatty liver disease: a bittersweet symphony
Daniel Clayton‐Chubb · Stuart K Roberts
Dietary management of eosinophilic oesophagitis
Jessica Fitzpatrick · Sarah L Melton · Rebecca E Burgell
Supporting an Aboriginal and Torres Strait Voice to Parliament
Virginia Barbour
Getting to grips with invasive group A streptococcal infection surveillance in Australia: are we experiencing an epidemic?
Thel K Hla · Jeffrey W Cannon · Asha C Bowen · Rosemary Wyber
Mental health of young Australians: dealing with a public health crisis
Patrick D McGorry · David Coghill · Michael Berk
Saltwater injury: a case of chronic cutaneous Mycobacterium marinum infection
Ruby C Lee · Kennedy Wong · Yolanka Lobo · Heba Jibreal