Volume 224 Issue 3

Giant cell arteritis (GCA) is the most prevalent systemic vasculitis of the elderly and can lead to irreversible vision loss and stroke. We report the case of an 84-year-old woman who presented with a persistent headache, prompting investigation for GCA, initially with a temporal artery ultrasound (TAUS) scan. The results were suggestive of GCA and the diagnosis was confirmed on a subsequent temporal artery biopsy (TAB). TAUS is now part of the classification criteria of GCA, and a diagnosis can be made without biopsy. TAB should be reserved for high-risk patients with a negative TAUS result.

Thomas Glynn, Michelle T. Leech, Stacy K. Goergen, Emily Lin, Nadeem Toodayan, Ralph Junckerstorff

Introduction The Australian Guidelines for the Assessment and Diagnosis of Fetal Alcohol Spectrum Disorder were released in May 2025. These guidelines, updated from the 2016 Australian Guide, were developed through extensive stakeholder consultation, a comprehensive review of empirical evidence and the application of a novel Grading of Recommendations, Development and Evaluation (GRADE)-based approach for developing evidence-based diagnostic criteria. Recommendations The guidelines include 11 GRADE-based recommendations, forming the core of the diagnostic criteria, and 11 lived experience statements, supporting client-centred assessment approaches. The guidelines also feature 40 good practice statements and 18 implementation considerations, tools and tips as practical resources and supports for practitioners. Changes in Management as a Result of the Guidelines Key changes in the new guidelines include: A minimum prenatal alcohol exposure threshold for diagnosis to support more precise identification of fetal alcohol spectrum disorder (FASD); The assessment of neurodevelopmental impairments and functioning has been refined, including detailed advice for practitioners seeking to identify clinically significant impairments; Inclusion/exclusion of neurodevelopmental domains as part of the assessment; and Revisions to some of the content of the included neurodevelopmental domains. Changes have also been made with attention to the needs of First Nations Australians and people from other culturally and linguistically diverse backgrounds. The guidelines advocate for the use of shared decision-making approaches, promoting collaboration between practitioners, individuals attending for assessment and their support network. Importantly, the guidelines will enable an accessible, holistic and flexible assessment process, supporting timely and accurate assessment and diagnosis of FASD in Australia. The rigorous development process also provides practitioners with confidence in the guidelines, promoting increased uptake of assessment and diagnostic practices, and informing international diagnostic criteria and guidelines.

Natasha Reid · Nicole Hewlett, Nicole Hayes, Zachary Munn, Haydn Till, Delyse Hutchinson · James Stewart, Max Naglazas, Andrea Crawford, Raewyn C. Mutch, Carmela F. Pestell, Rowena Friend, Lisa K. Akison · Chelsea Vanderpeet, Prue Walker, Matthew Gullo, Doug Shelton, Elizabeth J. Elliott, Fiona Kay, Katrina Harris, Jayden Logan, Storm Anderson · Natalie R. Kippin, Seema Padencheri, Sophie Harrington, Diana Barnett, Kelly Skorka, Robyn Doney · Philippa Middleton

Objectives To quantify the association between care alignment to the treatment step of the Cancer Council Victoria and Department of Health Victoria Optimal care pathways for people with breast cancer (OCP) (second edition) and survival. Design Retrospective population-based cohort study using the Victorian Cancer Registry and linked administrative health datasets. Setting, Participants Adult women diagnosed with invasive, unilateral breast cancer from 1 July 2012 to 31 December 2019 in Victoria, Australia. Main Outcome Measures Breast cancer-specific and overall survival for women whose care did or did not align to the treatment step of the OCP expressed as adjusted hazard ratios. Interaction between OCP alignment and cancer stage at diagnosis was also assessed. Results Of 29,591 eligible women, 17,152 (58.0%) were fully aligned, 7086 (23.9%) were partially aligned and 5353 (18.1%) were not aligned to the treatment step of the breast cancer OCP. Median follow-up was 1481days (interquartile range, 850–2210days). Adjusting for measured sociodemographic and clinical factors, OCP treatment alignment was associated with 23% (95% confidence interval [CI], 14%–31%) and 34% (95% CI, 29%–40%) lower risk of death from breast cancer and all causes, respectively, compared with non-alignment. By cancer stage, OCP alignment was significantly associated with 40% (95% CI, 27%–50%) and 30% (95% CI, 14%–42%) lower risk of breast cancer death for Stage II and III cancers, respectively, and 39% (95% CI, 26%–49%), 49% (95% CI, 42%–55%) and 33% (21%–44%) lower risk of all-cause death for Stage I, II and III cancers, respectively. Conclusions Risk of death was lower for women with breast cancer whose treatment aligned to the OCP compared with women whose treatment did not align. Our findings support the promotion and implementation of the breast cancer OCP.

Brandon S. Hao, Juan C. Quiroz, Ian N. Olver, Claire M. Vajdic

Objectives To analyse longitudinal change in motor neuron disease (MND) mortality in Australia from 1986 to 2023. Design Australian population-based study of MND mortality. Setting All MND mortality and Australian population data from 1 January 1986 to 31 December 2023 were obtained from the Australian Bureau of Statistics. Main Outcome Measures MND mortality records were analysed, and certified deaths were summarised by year of registration. MND mortality rates, 95% confidence intervals (CIs) and Joinpoint regression trends were calculated. Data were further subset by demographic and geographical categories to report Australian MND mortality by age group, sex, state/territory location and remoteness areas classification. Results In Australia, the total number of MND deaths more than tripled over the past 37years, from 238 in 1986 to 781 in 2023. The unadjusted mortality rate in 1986 was 1.49 (95% CI, 1.30–1.69) per 100,000 population and increased to 2.93 (95% CI, 2.73–3.14) per 100,000 population by 2023. After age standardisation, the annual percentage change across 1986–2023 was determined to be 0.47% (95% confidence limit, 0.16–0.86). Joinpoint modelling suggests a more recent reduction in adjusted mortality rates. In 2023, MND accounted for 0.43% of all-cause deaths in Australia, increasing from 0.21% in 1986. The number of MND deaths in Australia peaked at age 70–79years. MND mortality was higher among men than women (rate ratio, 1.41; 95% CI, 1.33–1.51). MND mortality rates were similar among New South Wales, Victoria and Queensland (2.93, 3.08 and 2.85 per 100,000 population, respectively), with higher rates in South Australia and Tasmania (3.44 and 4.12 per 100,000 population, respectively). MND mortality rates were higher in inner and outer regional areas (3.90 and 3.24 per 100,000 population, respectively) compared with major cities (2.79 per 100,000 population). Conclusions Adjusted MND mortality rates in Australia increased over 37years.

Carol M. Y. Lee, Rupendra N. Shrestha, Julian Gold, Mark Stevenson, Kelly L. Williams, Lyndal Henden, Sandrine K. K. Chan Moi Fat, Zoe Zussa, Amanda Wright, Martin Jude, Mark A. S. Laidlaw, Willem J. R. Fokkink, Dominic B. Rowe

Objective To explore primary care providers' perspectives on (i) healthcare needs and barriers to care for Aboriginal and Torres Strait Islander children and adolescents; and (ii) enablers and opportunities to strengthen care. Study Design A qualitative study; interviews and open-ended survey responses. Setting Primary care providers who work with Aboriginal and Torres Strait Islander children and young people in health and education settings in New South Wales and the Australian Capital Territory. Data were collected between 23 March 2022 and 13 October 2023. Main Outcome Measures Sixteen interviews and 33 open-ended survey responses were analysed using reflexive thematic analysis with a hybrid inductive/deductive approach. Results Participants reported that some of the most important health needs for children and young people related to mental health. They recognised that the presenting complaint was not always the underlying or only concern, demonstrated an understanding of trauma-informed care and acknowledged the importance of collaborative services that engaged support networks. Barriers to care included a lack of cultural safety in mainstream services, challenging social circumstances, financial concerns, being unaware of available services and privacy and confidentiality concerns. To improve care, staff identified several areas needing change including having a package of services tailored for young people; additional training for providers in child and adolescent health, particularly for mental healthcare, trauma-informed care and communication with young people; providing a safe and engaging environment; support for staff self-care; and additional resources. Conclusions Supporting mental health needs is a key aspect of caring for children and adolescents. To provide optimal primary healthcare, service providers require specialist skills. To support adolescents and children, participants identified a need for ongoing training, professional development and organisational support to ensure best practice care is sustained. This work has informed the development of training and other resources for partner health services.

Christianna Digenis, Rachel Reilly, Peter Azzopardi, Hilina Winkenweder, Odette Pearson, Kane Ellis, Jane Fisher, Debra J. Rickwood, Choong-Siew Yong, Ngiare Brown

We performed a 15-year retrospective audit of all cases of malignant otitis externa (MOE) referred to Alice Springs Hospital in Central Australia from 2009 to 2024, the largest Australian series of MOE. Data on demographics, risk factors, microbiological culture results, management and outcomes were collected, identifying 64 cases of MOE, with the incidence increasing over time. The incidence of MOE was associated with Indigenous status and the presence of diabetes mellitus and chronic kidney disease. Pseudomonas, Staphylococcus aureus and fungal pathogens predominate as causal agents. Complications and mortality were common.

George P. Drewett, Mini Jacob, Belle Culhane, Amy Booth, Connor Wright, Sajan Thomas, Anjali Abraham

Elder abuse can lead to serious physical injuries and long-term psychological consequences, but its recognition and documentation in healthcare settings remain limited. This study used linked data from four Australian states to examine elder abuse coded during emergency department presentations and hospitalisations among 965,986 older people assessed for aged care services between 2010 and 2019. Only 580 people (0.06%) had elder abuse coded during an emergency department presentation or hospitalisation, highlighting substantial under-recognition and under-reporting in hospital settings.

Stephanie L. Harrison, Sahar Barmomanesh, Bryan Morden, Maria C. Inacio, Gillian E. Caughey, on behalf of the ROSA Consumer and Community Advisory Committee

Objectives To review and thematically map published research on health-related climate change mitigation or adaptation interventions in Australia. Study Design Systematic mapping of published peer-reviewed research studies and reviews examining outcomes associated with climate change and health interventions in Australia. Data Sources MEDLINE, Scopus, Google Scholar, published from 1 January 2008 to 1 March 2024, and manual searches of peer-reviewed literature. Data Synthesis Eighty-three publications (49 original research, 34 reviews) were included, categorised under four themes: (i) health system decarbonisation (18); (ii) health system adaptation, vulnerability and resilience (24); (iii) health co-benefits of climate change mitigation (9); and (iv) adaptation outside the health system to protect health from climate impacts (26). Six additional studies spanned several of these themes. Ten decarbonisation studies focused on hospital-based clinical care interventions. In comparison, adaptation studies focused on interventions in a wider variety of health services and community settings. Twenty publications focused on heat, with fewer publications on other climate-related hazards (bushfires, floods and droughts). Adaptation interventions largely focused on addressing physical health impacts of climate change, with less attention on psychosocial or mental health impacts. Studies on health co-benefits of mitigation focused on urban greening, shading, cool materials, healthier diets, carbon pricing of food and Indigenous land management. Across all themes, four studies focused on First Nations peoples. Original studies mainly used survey methods, with three studies employing randomised controlled trials and seven using life cycle assessments. Overall, there was limited evidence of stakeholder engagement. Conclusions A sustained increase in research on climate change and health interventions will help realise the vision of ‘healthy, climate-resilient communities, and a sustainable, resilient, high quality, net zero health system’ of the National Health and Climate Strategy. Evidence from local contexts and priority populations, using interdisciplinary methods and stakeholder engagement, will support action on climate change and health in Australia.

Sotiris Vardoulakis, Luise Kazda, Rebecca Haddock, Alexandra L. Barratt, Forbes McGain, Kinley Wangdi, Enembe Okokon, Daniela Espinoza Oyarce, Gopika Indu, Nigel Goodman, Veronica Matthews, Phoebe Spurrier, Alice McGushin, Georgia Behrens, Madeleine Skell

Matthew Samarin

Gin S. Malhi, Erica Bell, Kinga Szymaniak, Philip M. Boyce, Jeffrey C. L. Looi

Katharine A. Wallis, Joanna Moncrieff

Hayden Burch, Forbes McGain, Scott McAlister

Jason Chuen

Jesse Ey, Guy J. Maddern

Emma McGonigal, Andrew V. White, Valerie Sung, Karen Liddle, Lilian Downie, Emily Shepard

R. Dawson, M. Pinheiro, J. Oliveira, et al. The Telephysiotherapy for Older People (TOP-UP) program for improving mobility in people receiving aged care: a hybrid type 1 effectiveness–implementation randomised controlled trial. Med J Aust 2025; 223: 205-213. https://onlinelibrary.wiley.com/doi/10.5694/mja2.70004 In Box 6, the first data row erroneously stated that the intervention had 192 participants instead of 92. The table should read as follows: BOX 6 | Six-month outcomes of the telephysiotherapy for older people (TOP-UP) trial, 1 September 2021 to 30 November 2023: falls.

K. Thapaliya, A. Sweeting, K. I. Black, A. Poprzeczny, D. Mazza, L. E. Grzeskowiak, “Incidence of GLP-1 Receptor Agonist Use by Women of Reproductive Age Attending General Practices in Australia, 2011–2022: A Retrospective Open Cohort Study,” Medical Journal of Australia 223, no. 7 (2025): 365–371, https://onlinelibrary.wiley.com/doi/10.5694/mja2.70026 In Box 4, the y-axis should read ‘Proportion (%)’, as shown below: Box 4. Proportion of women aged 18–49 years who conceived within 6months of the first prescribing of glucagon-like peptide-1 (GLP-1) receptor agonists, 2011–2022, by type 2 diabetes status.