Volume 224 Issue 7

We report a case of a kidney transplant recipient who presented with generalised muscle pain, weakness and brown urine discoloration in the setting of acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Investigations demonstrated rhabdomyolysis with elevated creatine kinase levels and severe acute kidney injury (AKI). A muscle biopsy was consistent with an immune-mediated necrotising myositis. The patient received intravenous fluids, remdesivir and haemodialysis, with subsequent resolution of muscle injury and recovery of kidney function. This case indicates the potential for severe myositis to develop in patients with SARS-CoV-2 infection with the potential for rhabdomyolysis and AKI to occur.

Navya Kataria, Abel Devadass, Lana Sundac, Laura De Souza, Nabeel Sheikh, Samantha Ng, Scott Campbell, Yishen Wang, Ross S. Francis

Indigenous children are seen as an intrinsic, systematic foundation of hope in Aboriginal conceptualisations of hope, yet are grossly overrepresented in Australian suicide statistics. Despite being a target of the Australian Government's almost 20-year-long Closing the Gap campaign, the numbers are only getting worse. ‘It's not depression, it's despair’ are words that echo a sentiment so ghastly for parents of Indigenous children who only hope to bestow them with the gift of exactly that: hope. It is only sensible to counteract this with holistic, culturally empowered, strengths-based well-being programs to both develop Cultural strength while concurrently instilling a sense of Cultural pride and identity.

Rudi Louis Taylor-Bragge

IntroductionDespite evidence of improved outcomes, people with pancreatic cancer have highly variable access to effective pain relief and palliative care. We aimed to develop evidence-based, community-informed standardised pathways to timely pain management and early palliative care for people with pancreatic cancer.Main RecommendationsUsing a multi-method, comprehensive, community engagement and evidence-informed approach, we developed pathways to standardise referral to pain management and early palliative care for people with pancreatic cancer. Community engagement included representation from multidisciplinary clinicians, community groups and people with lived experience from across regions and all Australian states. We developed two pathways: (i) a pathway for pain management for people with resectable pancreatic cancer and (ii) an integrated pathway for pain management and palliative care for people with unresectable pancreatic cancer (https://www.pancare.org.au/pancreatic-cancer-roadmap-projects/pancreatic-cancer-pathways). Clinical guidance providing practical steps and links to evidence accompany the pathways. Key elements of the pathways included:screening for pain at each encounter, comprehensive holistic assessment and management;early consideration of interventional pain management in the event of refractory pain;introduction of palliative care at time of diagnosis of metastatic or unresectable pancreatic cancer with links to suggested language to address potential community hesitancy; andrecommendation to discuss referrals for palliative care and interventional pain management at cancer multidisciplinary meetings.Changes in Management as a Result of the GuidelinesThe pathways developed have set forth best practice standards grounded in evidence and expert consensus. The extensive clinical and community engagement ensures the relevance and ownership of these pathways. Implementation of the pathways will reduce existing variation in access and enhance the quality of care for people with pancreatic cancer. Furthermore, the pathways offer an opportunity to benchmark practice within and between services.

Jennifer Philip, Melanie R. Lovell, Kylee Bellingham, Gail Garvey, Gregory B. Crawford, Nicole M. Rankin, Kara Burns, Isabel Young, Vivienne Milch, Dorothy Keefe, Katrina Anderson, James Lawson, Meinir Krishnasamy

Introduction Eating disorders are more prevalent in people with higher weight than those with low weight. However, contention between the fields of obesity and eating disorders has prevented meaningful progress in research, prevention, identification and coordinated clinical services for people with co-occurring conditions. In Australia, public health approaches and provision of treatment services for people with eating disorders and clinical obesity are siloed, often resulting in contradictory messaging. To address this, a roundtable meeting was held in November 2024 in Sydney, Australia, with 28 experts in one or both of these fields, including researchers, clinicians and service leaders working across paediatric and adult care, and individuals with lived experience. Guided by the National Eating Disorders Collaboration stepped system of care framework, participants identified key challenges and possible solutions, and established five priority actions.Main RecommendationsThe priority actions across sectors are: Health Campaigns focused on raising awareness of eating disorders at higher weight, using appropriate language and reducing weight stigma; improved Screening and Assessment using standardised protocols across healthcare settings; supporting Primary Healthcare and improving the use of Medicare items; Tailored Treatment Pathways including integrated care models; and building Workforce Capacity to upskill professionals to provide safe, person-centred care.Changes in Management as a Result of the StatementThese actions aim to promote improved cross-sector collaboration and effective, safe, coordinated and integrated approaches to prevention, identification and treatment across the fields of obesity and eating disorders. They address the complex medical and psychological needs of those with co-occurring eating disorders and higher weight or clinical obesity through a skilled workforce and improved access to care. Effective integration, collaboration and coordination across services is essential for long-term recovery support.

Hiba Jebeile, Leah Brennan, Tracy Burrows, Xochitl de la Piedad Garcia, Angelique F. Ralph, Supreet Saluja, Evan Atlantis, Sarah P. Garnett, Carmel J. Harrison, Eve T. House, Natalie B. Lister, Lisa Moran, Milan K. Piya, Elizabeth Rieger, Evelyn Smith, Phillipa Hay, Sarah Trobe

Introduction Lung cancer is the leading cause of cancer mortality in Australia. In July 2025, the Australian Government launched the National Lung Cancer Screening Program (the Program). The Program has been designed in accordance with the Medical Services Advisory Committee's recommendations. This article summarises the program guidelines, outlining Program parameters and delivery requirements. The screening and assessment pathway defines the Program structure. The purpose of the guidelines is to ensure safe, effective and high-quality Program delivery, detailing key steps for clinical practice and information for participating healthcare providers.Main RecommendationsThe guidelines provide recommendations for the delivery of targeted low-dose CT screening for lung cancer in the Australian context.Program eligibility is assessed using risk-based eligibility criteria recommended by the Medical Services Advisory Committee, targeting people between 50 and 70 years of age with a history of tobacco cigarette smoking.Smoking cessation supports are to be offered to all potential participants by healthcare providers across the lung cancer screening and assessment pathway.Low-dose CT scan assessment and reporting follow the National Lung Cancer Screening Program's nodule management protocol.Changes in Management as a Result of the GuidelineThis guideline provides recommendations for the delivery of targeted low-dose CT screening for lung cancer in the Australian context. Content includes: guidance on assessing Program eligibility; enrolling eligible participants in the National Cancer Screening Register; completing and fulfilling low-dose CT scan requests; assessing and reporting low-dose CT scan results; managing scan outcomes and actionable additional findings; and communicating scan results. The full guideline is available at https://www.health.gov.au/resources/publications/nlcsp-guidelines.

Nicole M. Rankin, Rebecca Zosel, Lisa J. Whop, Raglan Maddox, Annette McWilliams, Miranda Siemienowicz, Jon Emery, Maria A. R. Lantin, Georgia Bartlett, Mikayla Wolfe, Abbey Diaz, Katrina Anderson, Lillian Liu, Cindy Toms, Sarah McDermott, Peter Bligh, Jeremy Chalke, Stephen Melsom, Claire E. Nightingale, Alison Brown, Sam Pope, Julia Brotherton, Anne Fidler, Michel Itel, Mark Brooke, Diane M. Pascoe, Fraser Brims, Tracy L. Leong, Emily Stone, Dorothy Keefe, Vivienne Milch

Objectives To identify sex-specific multimorbidity patterns in Australia, using the Rx-Risk index (a medication-based measure), to: (i) estimate the prevalence of chronic treated conditions; (ii) map network-based multimorbidity clusters; and (iii) examine how these clusters vary by age, socio-economic status and geographic remoteness.DesignAustralian nationwide cross-sectional study using linked Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) data.SettingAustralian residents aged ≥ 65 years with at least one PBS and/or MBS claim between 1 July 2022 and 30 June 2023.Main Outcome MeasuresSex-specific network-based multimorbidity clusters and cluster profiles by age, socio-economic status and geographic remoteness.ResultsA total of 4,435,784 individuals (mean age, 74.8 years; 53.2% female) were included. Multimorbidity (≥ 2 conditions) was present in 76.1% of the cohort. Three consistent multimorbidity clusters were identified in both sexes: cardiovascular–metabolic, neuropsychiatric–functional decline and inflammatory–musculoskeletal–cancer. The prevalence of these clusters and their component conditions varied across sociodemographic groups, with higher prevalence observed in individuals aged ≥ 85 years and those living in socio-economically disadvantaged areas. Minimal differences were observed between metropolitan and non-metropolitan regions.ConclusionsMultimorbidity was highly prevalent among older Australians with at least one PBS and/or MBS claim during the study year, with multimorbidity clusters showing marked sociodemographic variation in prevalence. These findings highlight the heterogeneity in treated conditions captured in administrative claims and provide insights to inform future research and policy planning for prevention and management of multimorbidity in an ageing population.

Weisi Chen, Christine Y. Lu, Sarah N. Hilmer, Alice A. Gibson, Edwin C. K. Tan

Objectives Our goal was to explore and compare risk factors, patterns of management and survival outcomes in Indigenous compared with non-Indigenous Australian patients using the Victorian Lung Cancer Registry (VLCR).Study TypeA retrospective observational cohort study of the VLCR.SettingData collected from the VLCR between 18 January 2011 and 24 January 2024.ParticipantsPrimary lung cancer patients in the VLCR.Main Outcome MeasuresPatient, disease and management characteristics of Indigenous and non-Indigenous Australian patients. Impacts of patient and clinical variables on treatment and survival, measured by multivariable Cox regression and propensity-matched survival analysis.ResultsWe included 186 Indigenous and 17,439 non-Indigenous Australian patients. Indigenous Australian lung cancer patients were younger in age {median, 62 years (interquartile range [IQR], 55–69 years) vs. median, 71 years (IQR, 63–77 years); p < 0.001}, had lower socio-economic status (lowest quintile, 57 patients [31%] vs. 3274 patients [19%]; p < 0.001), were more likely to be current smokers (118 patients [65%] vs. 5963 patients [35%]; p < 0.001) and had higher levels of respiratory comorbidity (64 patients [34%] vs. 4088 patients [23%]; p < 0.001). There were no statistically significant differences in receipt of guideline-concordant treatment (82 patients [51%] vs. 8036 patients [56%]; p = 0.12) and survival outcomes (median survival, 1.4 vs. 1.5 years; hazard ratio, 1.06 [95% confidence interval, 0.88–1.27]).ConclusionWe found lung cancer patients of Indigenous status were more likely to have demographic disadvantage and clinical risk factors that may contribute to discrepancies in management compared with patients of non-Indigenous status. Identifying barriers to healthcare and treatment in the Indigenous Australian population is an important research priority to improve disparities between the two populations.

Melanie Wong, Mike Lloyd, Jessie Zeng, Sanuki Tissera, Kalinda E. Griffiths, Justine Clark, Jonathan Gillies, Lisa Briggs, Jacqueline Lesage, Tom Wood, Craig Underhill, Sagun Parakh, Louis B. Irving, Wasek Faisal, Rob Blum, Gary E. Richardson, Phillip Parente, Michelle Caldecott, Inger Olesen, Javier Torres, Evangeline Samuel, Christopher Lyne, Katharine See, David Langton, Thomas John, Gavin Wright, Matthew Conron, James Bartlett, Golsa Adabi, Maggie Moore, Susan Harden, Zoe K. McQuilten, John R. Zalcberg, Rob Stirling

Objectives To identify drivers of routine vaccination for Aboriginal and Torres Strait Islander children, from a health service provider perspective, to increase and maintain uptake.DesignThis qualitative study was designed, analysed and guided by Indigenous data sovereignty and governance principles. Data were analysed using inductive content analysis. Subcategories were refined using Miro (Miro Inc), an online collaboration platform. Aboriginal and Torres Strait Islander worldviews were privileged, with Aboriginal researchers leading data analysis in New South Wales (NSW) and contributing to analysis in the Northern Territory (NT).SettingThe study was conducted in NSW and the NT, Australia, with health service providers from urban, rural and remote settings.ParticipantsIndividual and group interviews were undertaken in person or online between 2 May and 28 August 2024, with 18 health service provider participants in the Hunter New England Local Health District in NSW and 17 health service provider participants in the NT.ResultsWe identified six key themes addressing drivers of vaccination for Aboriginal and Torres Strait Islander children for families (knowledge, attitudes and information sources; decision-making), health staff (workforce roles, responsibilities and relationships) and health services (improving access; health service operations; data for decision-making). Providers recommended strategies to improve uptake.ConclusionsHealth service providers in urban, rural and remote locations in Australia can provide valuable insights to inform tailored strategies to improve declining vaccine coverage for Aboriginal and Torres Strait Islander children, aligned with the priorities of the National Immunisation Strategy 2025–2030.

Bianca F. Middleton, Kristy Crooks, Kylie Taylor, Elizabeth Harwood, Katrina K. Clark, Caitlin Kent, Kelly McCrory, Marita Hefler, Jessica Kaufman, David N. Durrheim, Margie H. Danchin

Objectives To investigate maternal child protection histories, and offspring child protection contacts and developmental outcomes, for children at age 5 years.Study DesignObservational cohort study using linked South Australian administrative birth, perinatal, child protection and child development data.Participants, SettingChildren with a South Australian birth registration and a record in the 2009, 2012, 2015 or 2018 Australian Early Development Census (AEDC).Main Outcome MeasuresHighest level of child protection system contact for children before starting school, and developmental vulnerability on one or more AEDC domains.ResultsOf 69,332 children, 7522 (10.8%) had a mother with a history of any child protection contact, and 1019 (1.5%) had a mother with at least one out-of-home care placement. Maternal child protection history was associated with increasing levels of socio-economic and health disadvantage around the time of birth. For example, overall there were 8245/69,332 (11.9%) children born into a home where the parent(s) were unemployed, compared with 549/1019 (53.9%) with a maternal out-of-home care history. For children whose mothers had child protection contact, 3793/7522 (50.4%) had their own child protection contact by age 5 years, compared with 7033/61,810 (11.4%) for children whose mothers had no contact. Of 6771 children whose mothers had child protection contact, 2724 (40.2% [95% confidence interval], 39.1%–41.4%) were developmentally vulnerable on one or more AEDC domains when they started school, compared with 12,002/58,165 (20.6% [95% confidence interval], 20.3%–21.0%) children with no maternal child protection history.ConclusionChild protection contact is common in both mothers and children, and maternal child protection history carries an increased burden of poor development outcomes at school entry. The scale and intersection of child protection system contact, early life disadvantage and poor development outcomes have implications for appropriately resourcing health-led supportive responses as early as possible during the perinatal and early childhood periods.

Meredith Forsyth, Alicia Montgomerie, Kathleen Falster, Deepa Jeyaseelan, Paul Hotton, John Lynch, Rhiannon M. Pilkington

NSW Poisons Information Centre data identified 1030 deliberate prazosin self-poisonings over 11 years, rising from 13 to 170 per year (2014–2024). Young women predominated, likely due to expanded off-label (but accepted) psychiatric use of prazosin. Better evidence on benefits of off-label use is needed to justify increasing risks.

Olivia B. E. Lal, Nicholas A. Buckley, Rose Cairns

Meggan J. Devery, Katie Brooker, Kitty-Rose Foley

Lucio Naccarella, Katrina Plamondon, Alison Brown, Alexandra Kent, Sana Shahram, Donya Eghrari, Nicole M. Rankin, Stephanie Best, Marlena Klaic, Zoe Fehlberg, Michelle Lambert, Sue Crengle

Saman Khalatbari-Soltani, Edward Jegasothy, Seye Abimbola, Anita van Zwieten

Quilty S, Matthews V, Baumann A, et al. Designing Housing to Reduce Overcrowding-Related Harms: Rheumatic Heart Disease as the Canary in the Coal Mine. Med J Aust 2026; https://doi.org/10.5694/mja2.70209    In this perspective article, the state listed for affiliation 4, 5 and 6 was incorrectly listed as “Northwest Territories” when it should be “Northern Territories”.