Issues
Volume 223 Issue 8
Cover image credit: Yok_onepiece/shutterstock.com.
Editor’s choice
Access to mental health services continues to be under duress
Access to mental health services continues to be a significant problem for most Australians.1 This problem has been exacerbated in regional and rural areas.1 Most recently though, psychiatrists in the public hospital system in New South Wales threatened to walk off the job en masse due to a myriad reasons, the most prominent being the substantial pay gap for clinicians in NSW compared with other states.1 In this issue of the MJA, Huber and colleagues2 tried to identify modifiable causes of stress in clinicians and administrators working in NSW psychiatric emergency care centres. The study design was qualitative and 35 participants across 12 sites were interviewed. Systemic challenges at three levels were identified in staff interactions with patients and carers, the broader health system and the hospital. The study found that relational work (the core of clinician–service user interactions) is both meaningful and difficult. Psychiatric Emergency Care Centres (PECC) are the nexus of suicide risk management, with conflicting system expectations of staff to ensure safe care while making risky discharge decisions, which causes anxiety and high turnover. Moreover, there is tension between the model of care and the frequent reality of PECCs being used to manage patient flow, which leads to clinicians feeling professionally undervalued by the hospital. Two protective themes enabling staff to meet these challenges were developed. First, well defined treatment protocols enhanced clinical satisfaction, continuity of care for patients, and supported wellbeing. Second, working in a collaborative team environment with a flattened hierarchy fostered autonomy and robust teamwork. On the other end of the spectrum is access to community‐based paediatricians and psychiatrists, especially for attention deficit hyperactivity disorder (ADHD) and developmental assessments. Rates of ADHD diagnosis have increased substantially in the past ten years and the reasons for this are complex and multifactorial.3 In this issue of the MJA, Bradlow and colleagues4 examine adult ADHD in Australia and how its current commercial model for diagnosis and treatment may be encouraging misdiagnosis. The rise in ADHD diagnoses and the most appropriate management approaches are debated. This rise is particularly pronounced among adults, the authors write, and could be in part attributed to growing public awareness, amplified by social media platforms such as TikTok, where ADHD‐related content is reported to have had over 36 billion views. The authors note that “most adults with ADHD are diagnosed by private psychiatrists”. The dearth of public services for ADHD raises serious concerns regarding equity of access and the potential that normal behavioural variability is “medicalised”. Their view is that there is a risk that complex psychosocial issues may be misattributed to ADHD. This latter concern is grounded in psychiatry’s history of oversimplified biological explanations to complex psychosocial causes. Pharmacotherapy for the condition is not without harm, they write, although the rise in stimulant prescriptions has not led to an increase in stimulant‐related deaths, there has been a rise in hospital presentations for stimulant‐related poisonings. It is important to consider how the current ongoing issues around the cost of living will affect access to essential health care services without causing a significant burnout within health professionals and researchers. This issue of the MJA also includes clinical practice guidelines for hepatocellular carcinoma surveillance for people at high risk in Australia.5 With metabolic syndrome and prevalence of fatty liver on the rise, these guidelines provide up‐to‐date information regarding the surveillance of high risk populations. The recommendations were developed by a working group of experts in liver cancer control and included evidence reviews, synthesis and adaptation of existing guidelines for the Australian context, and predictive modelling. The updated guidelines formalise recommendations for people with cirrhosis, identify other patient groups who are recommended for surveillance, and highlight gaps in evidence where the benefit of surveillance is unclear.
Aajuli Shukla
Perspective
Adult attention deficit hyperactivity disorder in Australia: how its current commercial model for diagnosis and treatment is encouraging misdiagnosis
High costs and inconsistent diagnostic standards for attention deficit hyperactivity disorder in adults contribute to overdiagnosis in high-functioning individuals and exclusion of more impaired patients
Richard CJ Bradlow · Ferghal Armstrong · Edward Ogden
The importance of universal child and family health services for equitable early development
By optimising existing investments and leveraging Australia’s strong universal foundation, we can enhance child and family health services and improve outcomes for all children and their families
Anna MH Price · Elodie O’Connor · Sharon R Goldfeld
From words to action: time for Australia to take shared decision making implementation seriously
Shared decision making is widely recognised in Australian health care policy but remains inconsistently implemented in practice. We highlight the Australian context, with international examples and suggested strategies to progress its implementation
For the Australian Shared Decision Making Research Network
Medical education
A case of Lyme carditis in a returned traveller: a rare cause of reversible heart block in Australia
A well 37-year-old male patient presented to a tertiary hospital in New South Wales in July 2024 with presyncope and his smart watch alerts indicating resting bradycardia at 40 beats per minute
Eunice Chuah · Hari Sritharan · Zachariah Seidman · Avedis A Ekmejian · Karin Chia
Medical history
The forgotten pandemic: Hong Kong influenza in Australia (1968–1970)
Without advance knowledge of the virulence and behaviour of a novel pathogen, pandemic response planning is difficult. Australia’s ability to manage future pandemics will depend not only on robust scientific and health care systems but also on fostering public trust and resilience
Matthew Brown · Alan W Hampson · John Gerrard
Research
The first live term birth following uterus transplantation in Australia
Uterus transplantation could be adopted as an assisted reproductive technology for women with uterine factor infertility
Rebecca Deans · Brigitte Gerstl · Antonia W Shand · Sarah Lyons · Aaron Budden · Helen L Barrett · Grant Luxton · Mangalee Fernando · Kenneth Yong · Karen Keung · Kaushalya Arulpragasam · Henry Pleass · King Man Wan · Eva Kehag · Jana‐Emily Pittman · Mianna Lotz · Maria Fenn · Erin Nesbitt‐Hawes · Lily Byun · Katrina Tang · Mats Brannstrom · Jason Abbott
Identifying modifiable causes of stress in clinicians and administrators working in New South Wales psychiatric emergency care centres, 2023–24: a qualitative study
Conflicting demands in crisis care units can be alleviated by a flat team hierarchy and clear treatment protocols
Jacqueline P Huber · Alyssa Milton · Matthew Brewer · Kat Fry · Sean Evans · Jason Coulthard · Nicholas Glozier
Effectiveness of COVID‐19 vaccine boosters for reducing COVID‐19 mortality among people aged 65 years or older, Australia, August 2023 – February 2024: a retrospective observational cohort study
Regular vaccine boosting saves lives, particularly of older Australians, who are at greatest risk of death from COVID-19
Bette Liu · Anish Scaria · Sandrine Stepien · Kristine Macartney
Research letter
Medication delivery and dispensing interval preferences of people who use antihypertensive medications in Australia: a survey study
Most people prefer in-person pickup at pharmacies to postal delivery, and longer dispensing intervals, if it saves costs
Carissa Bonner · Michael A Fajardo · Rachael M Keast · Emily Atkins · Niamh Chapman · Kristie R Weir · Anthony Rodgers · Aletta E Schutte
Guideline summary
Clinical practice guidelines for hepatocellular carcinoma surveillance for people at high risk in Australia: summary of recommendations
A summary of recommendations and practice points for key population subgroups who were identified as potentially benefitting from routine hepatocarcinoma surveillance in the form of ultrasound scans, with or without ?-fetoprotein testing
Jacob George · Nicole L Allard · Stuart K Roberts · Leon A Adams · Jane Davies · Behzad Hajarizadeh · Jennifer H MacLachlan · Suzanne E Mahady · Rosalie Altus · Catherine Brown · David C Fry · Belinda Greenwood‐Smith · Natali Smud · Patricia C Valery · Nafisa Yussf · Kate Broun · Denise Campbell · Karen Canfell · Chelsea Carle Harrison · Victoria Freeman · Paul Grogan · Catherine Holliday · Suzanne Hughes · Anna Kelly · Cathelijne Kemenade · Claire Latumahina · Amanda McAtamney · Megan Varlow · Joachim Worthington · Susan Yuill · Eleonora Feletto
Letter to the editor
A future for the hospital‐in‐the‐home (HITH) deteriorating patient: shifting the paradigm
Davide R Tomassoni · Iftah Amith
A future for the hospital‐in‐the‐home (HITH) deteriorating patient: shifting the paradigm
Aaron BO Wong · Brian H Le
Concurrent use of hormonal long‐acting reversible contraception by women of reproductive age dispensed teratogenic medications, Australia, 2013–2021
Aaron E Boyce · Tony Caccetta · Jo‐Ann See · Rosemary L Nixon AM
Concurrent use of hormonal long‐acting reversible contraception by women of reproductive age dispensed teratogenic medications, Australia, 2013–2021
Michelle KY Chen · Adrian Lim · Deshan F Sebaratnam
Notification
NOTIFICATION: Chronic Fatigue Syndrome
10.5694/(ISSN)1326-5377 0025-729X 1326-5377 © 2025 AMPCo Pty Ltd. 10.5694/mja2.70066 © 2025 AMPCo Pty Ltd. n/a n/a NOTIFICATION: V. Toulkidis, "Chronic Fatigue Syndrome," The Medical Journal of Australia 176, no. S9 (2002): S17‐S55, https://doi.org/10.5694/j.1326‐5377.2002.tb04499.x. This notification is for the above guidelines, published online on 6 May 2002 in the Medical Journal of Australia (MJA; AMPCo Pty Ltd) and in Wiley Online Library (wileyonlinelibrary.com), and has been issued by agreement between the MJA and John Wiley & Sons Australia. The notification has been issued to inform readers of concerns that the information contained therein is outdated.
Mild traumatic brain injury and concussion and persisting post‐concussion symptoms: new guidelines to support evidence‐based assessment and management in Australia and Aotearoa New Zealand
Karen M Barlow · Jennie L Ponsford · Alice Theodom · Gill Cowen · Gavin A Davis · Vicki Anderson · Franz E Babl · David Cole · Jennifer Cullen · Stuart R Dalziel · Melinda Fitzgerald · Howard Flavell · Caroline Yates · Rebecca Kimble · John H Olver · Rhonda Orr · Mark Ralfe · Michael Rose · Nick Rushworth · Julia Treleaven · Gary Browne · Nathan Delang · Sarah Harris · Gary Mitchell · Sean Tweedy
Splenic injury in severe cases of the zoonoses Q fever and rickettsial infection: diagnostic challenges
Ashleigh Drury · Philippa Harrison · Aiveen Bannan
Medicolegal consequences of doctors accepting bequests and gifts under a patient’s will
Nicole E Kroesche · Tina L Cockburn · Kelly Purser · Karen A Sullivan
Special issue on gender and health: listening to the voices of patients
Elizabeth Zuccala
Cass Review does not guide care for trans young people
Julia K Moore · Cate Rayner · S Rachel Skinner · Katie Wynne · Blake S Cavve · Brodie Fraser · Uma Ganti · Claire McAllister · Gideon Meyerowitz‐Katz · Tram Nguyen · Anja Ravine · Brian Ross · Darren B Russell · Liz A Saunders · Aris Siafarikas · Ken C Pang
Advancing equity: the urgent need to include trans and gender diverse people in cervical cancer prevention in Australia
Kade Booth · Jamie Bryant · Shiva Chandra · Cristyn Davies · Lucille Kerr · Katie Wynne · Melissa A Carlson · Barrie Shannon · Sav Zwickl · Tamara Butler · Lisa J Whop
Linguistic manoeuvres: obstetric violence camouflages harm and loss of consent from birth
Harsha Ananthram · Liz Sutton · Rebecca Matthews · Nadine Montgomery · James Titcombe · Ajay Rane