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    Symptom burden, quality of life, and diagnostic journey of people with postural orthostatic tachycardia syndrome, Australia, 2021–24: a descriptive patient registry data study

    Marie‐Claire Seeley, Gemma Wilson, Eric Ong, Amy Langdon, Jonathan Chieng, Danielle Bailey, Kristina Comacchio, Amanda Page, Dennis H Lau and Celine Gallagher
    Med J Aust || doi: 10.5694/mja2.52710
    Published online: 21 July 2025

    Postural orthostatic tachycardia syndrome (POTS) is a multisystem autonomic disorder; its aetiology is poorly understood, and it is associated with significant disability.1 In this article, we report our analysis of Australian POTS Patient Registry data, with the aim of exploring the symptom burden, quality of life, and diagnostic journey of people in Australia with POTS.

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      Implementing voluntary assisted dying in New South Wales correctional settings

      Diya Ahluwalia and Leigh Haysom
      Med J Aust 2025; 223 (2): . || doi: 10.5694/mja2.52688
      Published online: 21 July 2025

      New South Wales was the last Australian state to pass voluntary assisted dying (VAD) legislation, effective on 28 November 2023.1 The Justice Health and Forensic Mental Health Network (JHNSW) is responsible for the health care of people in contact with the criminal justice system in NSW (www.nsw.gov.au/health/justicehealth/) and was tasked with implementing a VAD pathway for prisoners. A steering committee was formed with the Corrective Services NSW (CSNSW; https://correctiveservices.dcj.nsw.gov.au/), the local health district, the CSNSW Inmate Consumer Referent Group, the Mental Health Review Tribunal (https://mhrt.nsw.gov.au/the‐tribunal/), the JHNSW Clinical Ethics Committee, the Victims Support Scheme and the Aboriginal Health and Medical Research Council of NSW (www.ahmrc.org.au) to create dignified and culturally safe pathways for prisoners to access VAD. The ethical and legal challenges of integrating VAD into the NSW correctional settings are highlighted below, with a hypothetical patient journey demonstrating the pathway.

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      • 1 Justice Health and Forensic Mental Health Network, Sydney, NSW
      • 2 University of Newcastle, Newcastle, NSW



      Open access:

      Open access publishing facilitated by The University of Newcastle, as part of the Wiley – The University of Newcastle agreement via the Council of Australian University Librarians.

      Competing interests:

      No relevant disclosures.


      Author contributions:

      Ahluwalia D: Project administration, resources, writing – original draft. Haysom L: Supervision, visualization, writing – review and editing.

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        The incidence of and risk factors for hospitalisations and amputations for people with diabetes‐related foot ulcers in Queensland, 2011–19: an observational cohort study

        Yuqi Zhang, Susanna M Cramb, Steven M McPhail, Rosana Pacella, Jaap J Netten, Ewan M Kinnear and Peter A Lazzarini
        Med J Aust || doi: 10.5694/mja2.52703
        Published online: 14 July 2025

        Abstract

        Objectives: To assess the incidence, risk factors, and length of stay for hospitalisations, with and without amputations, of people with diabetes‐related foot ulcers (DFU).

        Study design: Prospective observational cohort study; secondary analysis of linked Diabetic Foot Services and Queensland Hospital Admitted Patient Data Collection data.

        Settings, participants: All people with DFU who visited any of 65 outpatient Diabetic Foot Service clinics in Queensland for the first time during 1 July 2011 – 31 December 2017, followed until first DFU‐related hospitalisation, ulcer healing, or death, censored at 24 months.

        Main outcome measures: First overnight hospitalisations for which the principal diagnosis was DFU‐related (International Statistical Classification of Diseases, tenth revision, Australian modification; Australian Classification of Health Interventions codes), by amputation procedure type (none, minor [distal to ankle], major [proximal to ankle]).

        Results: Among 4709 people with DFU (median age, 63 years (interquartile range [IQR], 54–72 years); 3275 men [69.5%]; type 2 diabetes, 4284 [91.0%]), DFU‐related hospitalisations were recorded for 977 people (20.7%): 669 without amputations (68.5%), 258 with minor amputations (26.4%), and 50 with major amputations (5.1%). The incidence of first DFU‐related hospitalisations was 50.8 (95% confidence interval [CI], 47.7–54.1) per 100 person‐years lived with DFU before healing, death, or loss to follow‐up. The incidence of first DFU‐related hospitalisation with no amputation was 39.0 (95% CI, 36.2–42.1), with minor amputation 18.0 (95% CI, 17.0–20.0), and with major amputation 5.3 (95% CI, 4.4–6.3) per 100 person‐years with DFU. The median length of stay for DFU‐related hospitalisations was six (IQR, 3–12) days with no amputations, ten (IQR, 5–19) days with minor amputations, and 19 (IQR, 11–38) days with major amputations. The risks of all DFU‐related hospitalisation outcomes were higher for people with deep ulcers or severe peripheral artery disease. The risks of DFU‐related hospitalisation with no amputations were also greater for people aged 37–59 years than for those aged 60 years, and for people with cardiovascular disease, infections, or previous amputations; with minor amputations for people who smoked, had end‐stage renal disease, previous amputations, moderate to severe infections, or peripheral artery disease, or who were not receiving knee‐high offloading or DFU debridement treatments; and with major amputations for people with end‐stage renal disease, peripheral artery disease, or larger ulcers.

        Conclusions: The incidence of DFU‐related hospitalisations among people with DFU was high, and most did not involve amputations. Risk factor profiles differed between hospitalisations with or without amputation procedures. Our findings could assist services determine which people with DFU would benefit most from intensive interventions, potentially averting large numbers of diabetes‐related hospitalisations.

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        • 1 Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD
        • 2 Karolinska Institute, Stockholm, Sweden
        • 3 Jamieson Trauma Institute, Metro North Hospital and Health Service, Brisbane, QLD
        • 4 Metro South Health, Brisbane, QLD
        • 5 Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
        • 6 University of Amsterdam, Amsterdam, The Netherlands
        • 7 The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, QLD


        Correspondence: peter.lazzarini@qut.edu.au


        Open access:

        Open access publishing facilitated by Queensland University of Technology, as part of the Wiley – Queensland University of Technology agreement via the Council of Australian University Librarians.


        Data Sharing:

        The data that support the findings of this study are not publicly available but will be shared after approval by the relevant ethics committees and data custodians: the Queensland Statewide Diabetes Clinical Network and the Queensland Health Statistical Services Branch (https://www.health.qld.gov.au/hsu/research).

        Received 10 May 2024, accepted 6 January 2025

        Acknowledgements: 

        This study was supported by the Chinese Scholarship Council, a Centre for Data Science (Queensland University of Technology) write‐up scholarship, and the National Health and Medical Research Council (NHMRC; 1143435, 1161138, 2008313). The study used the Queensland High Risk Foot Form Database resource. We are most grateful to the Diabetic Foot Working Group, Queensland Statewide Diabetes Clinical Network (Australia), and to the individual centres that provided the data. Susanna M Cramb, Steven M McPhail, and Peter A Lazzarini hold NHMRC Fellowship and Investigator grants; Yuqi Zhang holds a Chinese Scholarship Council PhD grant. The funding sources had no role in study design, collection, analysis, interpretation, writing, or decision to submit the manuscript for publication.

        Competing interests:

        Peter A Lazzarini and Jaap J van Netten are members respectively of the International Working Group on the Diabetic Foot (IWGDF) working groups and editorial board, which are responsible for authoring international evidence‐based guidelines on diabetes foot disease management. Peter A Lazzarini was also co‐chair of Diabetes Feet Australia and the Australian evidence‐based guidelines for the prevention and management of diabetes‐related foot disease. The authors declare that there are no other relationships or activities that might bias, or be perceived to bias, their work.

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          Clinicians’ discretion to contact patients’ at‐risk relatives about their genetic risk: new guidance from Australia's privacy regulator provides timely clarification

          Jane Tiller and Margaret FA Otlowski
          Med J Aust || doi: 10.5694/mja2.52712
          Published online: 14 July 2025

          Genetic risk information is relevant not just for individuals who are tested, but also for their blood relatives. Cascade genetic testing of at‐risk relatives can save lives. For younger relatives who can access preventive measures, ensuring they know about the availability of testing is particularly important. Challenges with family communication pose a major barrier to family risk notification.1 Internationally, assisting index cases to notify their at‐risk relatives is considered a public health imperative.1,2,3

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          • 1 Monash University, Melbourne, VIC
          • 2 University of Tasmania, Hobart, TAS


          Correspondence: jane.tiller@monash.edu


          Open access:

          Open access publishing facilitated by Monash University, as part of the Wiley – Monash University agreement via the Council of Australian University Librarians.

          Acknowledgements: 

          Jane Tiller is supported by a National Health and Medical Research Council Investigator Grant (No. 2023/GNT2025900). This funding supported Jane Tiller's work through salary funding.

          Competing interests:

          No relevant disclosures.


          Author contributions:

          Tiller J: Conceptualization; writing – original draft. Otlowski MFA: Supervision; writing – review and editing.

          • 1. Roberts MC, Dotson WD, DeVore CS, et al. Delivery of cascade screening for hereditary conditions: a scoping review of the literature. Health Aff (Millwood) 2018; 37: 801‐808.
          • 2. Srinivasan S, Won NY, Dotson WD, et al. Barriers and facilitators for cascade testing in genetic conditions: a systematic review. Eur J Hum Genet 2020; 28: 1631‐1644.
          • 3. Rosén A, Krajc M, Ehrencrona H, Bajalica‐Lagercrantz S. Public attitudes challenge clinical practice on genetic risk disclosure in favour of healthcare‐provided direct dissemination to relatives. Eur J Hum Genet 2024; 32: 6‐7.
          • 4. Varesco L, Di Tano F, Monducci J, et al. Cascade genetic testing in hereditary cancer: exploring the boundaries of the Italian legal framework. Fam Cancer 2024; 24: 9.
          • 5. Henrikson NB, Wagner JK, Hampel H, et al. What guidance does HIPAA offer to providers considering familial risk notification and cascade genetic testing? J Law Biosci 2020; 7: lsaa071.
          • 6. Mendes Á, Paneque M, Sequeiros J. Disclosure of genetic risk to family members: a qualitative study on healthcare professionals’ perceived roles and responsibilities. Eur J Hum Genet 2024; 68: 104931.
          • 7. Australian Law Reform Commission. Essentially Yours: the protection of human genetic information in Australia. Sydney: Commonwealth of Australia, 2003. https://www.alrc.gov.au/publication/essentially‐yours‐the‐protection‐of‐human‐genetic‐information‐in‐australia‐alrc‐report‐96/ (viewed Jan 2025).
          • 8. National Health and Medical Research Council. Use and disclosure of genetic information to a patient's genetic relatives under section 95AA of the Privacy Act 1988 (Cth). Guidelines for health practitioners in the private sector. Canberra: NHMRC, 2014. https://www.nhmrc.gov.au/about‐us/publications/guidelines‐approved‐under‐section‐95aa‐privacy‐act‐1988‐cth (viewed Jan 2025).
          • 9. Otlowski MFA. Disclosing genetic information to at‐risk relatives: new Australian privacy principles, but uniformity still elusive. Med J Aust 2015; 202: 335‐337. https://www.mja.com.au/journal/2015/202/6/disclosing‐genetic‐information‐risk‐relatives‐new‐australian‐privacy‐principles#:~:text=Since%202006%2C%20s%2095AA%20of,health%20or%20safety%20of%20the
          • 10. Tiller J, Bilkey G, Macintosh R, et al. Disclosing genetic information to family members without consent: five Australian case studies. Eur J Med Genet 2020; 63: 104035.
          • 11. Meggiolaro N, Barlow‐Stewart K, Dunlop K, et al. Disclosure to genetic relatives without consent — Australian genetic professionals’ awareness of the health privacy law. BMC Med Ethics 2020; 21: 13.
          • 12. Tiller J, Nowak K, Boughtwood T, Otlowski M. Privacy implications of contacting the at‐risk relatives of patients with medically actionable genetic predisposition, with patient consent: a hypothetical Australian case study. BioTech (Basel) 2023; 12: 45.
          • 13. Stott A, Madelli EO, Boughtwood T, et al. Health professionals contacting patients’ relatives directly about genetic risk (with patient consent): current clinical practice and perspectives. Eur J Hum Genet 2025; 33: 476‐484.
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          • 17. Tiller JM, Stott A, Finlay K, et al. Direct notification by health professionals of relatives at‐risk of genetic conditions (with patient consent): views of the Australian public. Eur J Hum Genet 2024; 32: 98‐108.
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            Bone health perspectives among Indigenous people: a qualitative study

            Troy Walker (Yorta Yorta), Karan P Singh, Vanessa Gan, Brooke Conley (Ngiyampaa), Jessica Bravo, Nigel Smith (Weilwan), April Clarke (Eastern Maar, Kirrae Whurrung, Djap Wurrung), Jackson Baker, Louise J Maple‐Brown, Robin M Daly, Jennifer Browne, Jesse Zanker, Cat Shore‐Lorenti, David Scott, Peter R Ebeling and Ayse Zengin
            Med J Aust || doi: 10.5694/mja2.52704
            Published online: 7 July 2025

            Abstract

            Objectives: To explore perspectives and beliefs on bone health among Indigenous adults in Victoria.

            Design: Qualitative focus groups with semi‐structured questions. Focus group discussions were analysed for themes and subthemes using an Indigenous research framework based on three concepts: Ways of Knowing, Ways of Being and Ways of Doing.

            Setting, participants: Focus groups were conducted at Aboriginal Community‐controlled organisations and Community centres. Men and women aged ≥ 35 years who identified as Indigenous and were able to give informed consent were invited to participate.

            Results: Eighty‐two Indigenous people participated in twelve focus groups across ten sites in Victoria. Most participants (64) were women, and the majority lived in metropolitan centres, regional centres and large rural towns (Modified Monash categories 1–3). Five themes were developed around the Indigenous framework proposed by Karen Martin‐Booran Mirraboopa — Ways of Knowing, Ways of Doing and Ways of Being — which guided participants in identifying knowledge of exercise for bone and muscle health; connection to Country; importance of regular preventive health activities; food and nutrients as good medicine for bone health; and healthy futures for Community through education. An overarching theme of holistic health, including the aspect of spirituality and related lifestyle factors pertaining to musculoskeletal health, was highlighted.

            Conclusion: Increasing bone health awareness by a co‐created Community education program was valued as it would be beneficial for Indigenous people across the life course. To be effective, incorporating traditional Indigenous ways and knowledge along with present‐day health evidence is required.

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            • 1 Monash University, Melbourne, VIC
            • 2 National Centre for Healthy Ageing, Melbourne, VIC
            • 3 University of Melbourne, Melbourne, VIC
            • 4 Victorian Aboriginal Community Controlled Health Organisation, Melbourne, VIC
            • 5 Murrumbidgee Local Health District, Moama, NSW
            • 6 Gariwerd Dreaming, Melbourne, VIC
            • 7 Njernda Aboriginal Corporation, Echuca, VIC
            • 8 Menzies School of Health Research, Charles Darwin University, Darwin, NT
            • 9 Royal Darwin and Palmerston Hospitals NT Health, Darwin, NT
            • 10 Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC
            • 11 Deakin University, Melbourne, VIC
            • 12 Royal Melbourne Hospital, Melbourne, VIC


            Correspondence: troy.walker@monash.edu


            Open access:

            Open access publishing facilitated by Monash University, as part of the Wiley ‐ Monash University agreement via the Council of Australian University Librarians.


            Data sharing:

            The data for this study will not be shared, as we do not have permission from the participants or ethics approval to do so.

            Acknowledgements: 

            Thank you to all of the Aboriginal and Torres Strait Islander participants who attended the focus groups and the ACCHOs for hosting the focus groups. This study was funded by was funded by a grant from the National Centre for Healthy Ageing (NCHA) through the Commonwealth Government of Australia, for which Ayse Zengin was the lead investigator. Louise Maple‐Brown was supported by a National Health and Medical Research Council Investigator Grant (11194698).

            Open access publishing facilitated by Monash University, as part of the Wiley ‐ Monash University agreement via the Council of Australian University Librarians.

            Competing interests:

            No relevant disclosures.

            Received 2 July 2024, accepted 18 December 2024

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            • 12. Dudgeon P, Milroy H, Selkirk B, et al. Decolonisation, Indigenous health research and Indigenous authorship: sharing our teams' principles and practices. Med J Aust 2024; 221: 578‐586. https://www.mja.com.au/journal/2024/221/11/decolonisation‐indigenous‐health‐research‐and‐indigenous‐authorship‐sharing‐our
            • 13. Demontiero O, Vidal C, Duque G. Aging and bone loss: new insights for the clinician. Ther Adv Musculoskelet Dis 2012; 4: 61‐76.
            • 14. Martin K. Ways of knowing, being and doing: a theoretical framework and methods for Indigenous and Indigenist research. J Aust Stud 2003; 27: 203‐214.
            • 15. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77‐101.
            • 16. National Health and Medical Research Council, Australian Research Council, Universities Australia. National statement on ethical conduct in human research 2007 (updated 2018). Canberra: Commonwealth of Australia, 2018. https://www.nhmrc.gov.au/about‐us/publications/national‐statement‐ethical‐conduct‐human‐research‐2007‐updated‐2018 (viewed Aug 2024).
            • 17. National Health and Medical Research Council. Keeping research on track II. A companion document to Ethical conduct in research with Aboriginal and Torres Strait Islander peoples and communities: guidelines for researchers and stakeholders. Canberra: Commonwealth of Australia, 2018. https://www.nhmrc.gov.au/sites/default/files/documents/Indigenous%20guidelines/Keeping‐research‐on‐track.pdf (viewed Aug 2024).
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            • 19. National Health and Medical Research Council. Ethical conduct in research with Aboriginal and Torres Strait Islander peoples and communities: guidelines for researchers and stakeholders. Canberra: Commonwealth of Australia, 2018. https://www.nhmrc.gov.au/about‐us/resources/ethical‐conduct‐research‐aboriginal‐and‐torres‐strait‐islander‐peoples‐and‐communities (viewed Aug 2024).
            • 20. Samsudin N, Ooi FK, Chen CK. Bone health status, muscular strength and power, and aerobic and anaerobic capacities of Malaysian male athletes involved in sports with different mechanical loading on bones. Malays J Med Sci 2022; 29: 54‐67.
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              Am I on the list? Clinician‐reported factors for kidney transplantation non‐waitlisting among Aboriginal and Torres Strait Islander people with kidney failure: a cross‐sectional study

              Stephen P McDonald AM, Katie Cundale, Christopher E Davies, Kelli Karrikarringka Owen (Kaurna, Nharangga, and Ngarrindjeri), Kerry Dole, Feruza Kholmurodova, Matilda D’Antoine (Paakantyi) and Jaquelyne T Hughes (Wagadagam)
              Med J Aust 2025; 223 (1): . || doi: 10.5694/mja2.52698
              Published online: 7 July 2025

              Abstract

              Objectives: To describe clinician‐reported reasons for non‐waitlisting of patients with kidney failure for deceased donor kidney transplantation, and to examine disparities affecting Aboriginal and Torres Strait Islander people.

              Design: Retrospective cross‐sectional analysis of data from a national clinical quality registry.

              Participants and setting: Patients receiving dialysis in 26 Australian renal units as of 31 December 2020.

              Main outcome measures: Rates of active waitlisting for kidney transplantation and clinician‐reported reasons for non‐waitlisting.

              Results: Thirty‐six of 1832 Aboriginal and Torres Strait Islander people (2.0%) were actively waitlisted, compared with 512 of 6128 non‐Indigenous people (8.4%). For Aboriginal and Torres Strait Islander patients aged < 65 years, 457 of 1204 (38%) were not waitlisted due to a permanent contraindication, 276 (23%) due to a temporary contraindication, and 232 (19%) due to incomplete work‐up. Among those with a contraindication, cardiovascular disease was reported as the reason for about a quarter of people in both groups. Obesity was cited for 163 Aboriginal and Torres Strait Islander patients aged < 65 years (22%) and 30 Aboriginal and Torres Strait Islander patients aged ≥ 65 years (10%); in the non‐Indigenous group, obesity was cited for 207 (26%) and 163 (9%) patients aged < 65 years and ≥ 65 years, respectively. Cancer was reported for 28 Aboriginal and Torres Strait Islander patients aged < 65 years (4%) and 86 non‐Indigenous patients aged < 65 years (11%). Other reasons for non‐waitlisting, reported as free text, included patient safety, smoking, age and mental health.

              Conclusions: Aboriginal and Torres Strait Islander people experience inequities in waitlisting for kidney transplantation across multiple stages of a complex process. Addressing these barriers requires system‐level reform and accountability to improve equity in transplantation access.

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              • 1 Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA
              • 2 Adelaide EpiCentre, Adelaide, SA
              • 3 National Indigenous Kidney Transplantation Taskforce, Adelaide, SA
              • 4 University of Adelaide, Adelaide, SA
              • 5 AKction Reference Group, Adelaide, SA
              • 6 Northern Territory Department of Health, Alice Springs, NT
              • 7 Flinders University, Darwin, NT
              • 8 Royal Darwin Hospital, Darwin, NT


              Correspondence: stephenm@anzdata.org.au


              Open access:

              Open access publishing facilitated by The University of Adelaide, as part of the Wiley – The University of Adelaide agreement via the Council of Australian University Librarians.


              Data Sharing:

              ANZDATA has established policies for access to various types of data (including those underlying this manuscript). These policies and associated application procedures are available at https://www.anzdata.org.au/anzdata/data‐requests/request‐procedure.

              Acknowledgements: 

              The National Indigenous Kidney Transplantation Taskforce is funded by a grant from the Australian Government Department of Health and Aged Care (4‐BIA3J8Y) that is held by the Transplantation Society of Australia and New Zealand. The Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) receives funding from the Australian Organ and Tissue Authority to support its core operations. Neither body had a role in study design, data collection, data analysis or interpretation of findings. The authors recognise Indigenous peoples research leadership and their knowledges contained within the following cited references: 1,2,8,11,12,18,19,20,31,32 and 34,35,36.

              Competing interests:

              Jaquelyne Hughes is a Guest Editor for the 2025 NAIDOC Week MJA Special Issue and was not involved in any editorial decision making about this article.


              Author contributions:

              McDonald SP: Conceptualization; formal analysis; methodology; supervision; writing – original draft; writing – review and editing. Cundale K: Formal analysis; project administration; writing – original draft; writing – review and editing. Davies C: Data curation; formal analysis; visualization; writing – original draft; writing – review and editing. Owen K: Conceptualization; writing – review and editing. Dole K: Conceptualization; supervision; writing – review and editing. Kholmurodova F: Data curation; formal analysis; visualization. D’Antoine M: Project administration; writing – review and editing. Hughes JT: Conceptualization; methodology; supervision; writing – original draft; writing – review and editing. All authors have reviewed and approved the final manuscript and agree to be accountable for their contributions.

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                What do Aboriginal people in the Northern Territory value during the operation journey? A qualitative study

                Edith B Waugh, Marita Hefler, Sophie Pascoe, Mark Mayo, Matthew JL Hare, David A Story, Neil Wilkshire, Peter Henwood, David Croker and Jampijinpa Ross
                Med J Aust 2025; 223 (1): . || doi: 10.5694/mja2.52695
                Published online: 7 July 2025

                Abstract

                Objective: To explore the values of Aboriginal people in the Northern Territory during their perioperative journey.

                Design: A community‐based participatory action research approach was used, integrating yarning, deep listening and reflection methods to gather qualitative data in culturally appropriate ways. Data collection involved two yarning circles followed by interpretation and triangulation sessions with co‐researchers.

                Setting: Conducted in non‐health care settings in Garramilla (Darwin) between May 2023 and September 2024, the study included participants from urban, regional and remote NT Aboriginal communities.

                Participants: Purposive and snowball sampling were used to engage 18 participants with lived experience of surgery, who share expertise in renal health journeys and have kinship ties spanning from Saltwater Country to Desert Country, with diverse age, language and gender representation.

                Main outcome measures: Thematic insights into what First Nations peoples in the NT value during the perioperative journey, to inform culturally safe models of care.

                Results: Respect emerged as the core principle in the perioperative journey, with family involvement, cultural practices and effective communication identified as key elements. Respect was evident in honouring cultural protocols, integrating traditional healing practices and recognising patient autonomy. Family involvement was highlighted as essential, with kinship ties influencing shared decision‐making processes and support throughout the perioperative experience. Culturally competent communication, including the use of interpreters and clear explanations, played a critical role in bridging cultural differences and ensuring shared understanding. Together, these elements fostered a sense of safety, belonging and empowerment. Ultimately, trust was identified as an overarching outcome that unified these interconnected values, enhancing patient comfort, engagement and overall satisfaction in the perioperative journey.

                Conclusion: Respect is integral to Aboriginal people in the perioperative journey, and they value family, culture and communication when navigating surgery. When these values coalesce, trust is generated. These findings highlight the need to integrate culturally informed, patient‐centred care models that prioritise respect and trust building to improve accessibility, experience and surgical outcomes.

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                • 1 Menzies School of Health Research, Charles Darwin University, Darwin, NT
                • 2 Royal Darwin Hospital, Tiwi, NT
                • 3 University of Melbourne, Melbourne, VIC
                • 4 Flinders University, Darwin, NT
                • 5 Austin Health, Melbourne, VIC
                • 6 Purple House, Alice Springs, NT


                Correspondence: edith.waugh@menzies.edu.au


                Open access:

                Open access publishing facilitated by Charles Darwin University, as part of the Wiley – Charles Darwin University agreement via the Council of Australian University Librarians.


                Data Sharing:

                Data collected and analysed during the study are not publicly available due to privacy issues and ethical considerations. Data may be available from the corresponding author on reasonable request.

                Acknowledgements: 

                Warning: Aboriginal and Torres Strait Islander readers are advised that this article captures the knowledge and lived experiences of Indigenous people who have passed. With permission from family, we refer to our senior co‐author as “Jampijinpa” Ross. This article is a testament to his contributions to First Nations health. Out of cultural sensitivity, we do not use the names nor images of Indigenous people who participated in this research who have subsequently passed away.

                Edith Waugh received an ANZCA Foundation (Australian and New Zealand College of Anaesthetists) Health Equity Grant 2022. The funding allowed planning, coordination and completion of focus (yarning) groups; participation and sharing of First Nations knowledge was appropriately reimbursed. Edith Waugh is supported by an Australian Government Research Training Scholarship. Matthew Hare is supported by the National Health and Medical Research Council (grant number 1194698), the Sylvia and Charles Viertel Foundation and an Australian Diabetes Society Skip Martin Fellowship.

                The Top End Indigenous Reference Group and research assistant Stephanie Long from the INFERR (INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on hemodialysis) study at Menzies School of Health Research were the catalysts leading to this study. This study emerged in response to their feedback about exploring postoperative outcomes for First Nations people in the Northern Territory and the need for this research to incorporate patient values.

                Competing interests:

                No relevant disclosures.


                Author contributions:

                Waugh EB: Conceptualization; methodology; investigation (data collection); formal analysis; writing – original draft; writing – review and editing; project administration; funding acquisition. Hefler M: Methodology; formal analysis; writing – review and editing; supervision. Pascoe S: Methodology; investigation (data collection); formal analysis; writing – review and editing; project administration. Mayo M: Conceptualization; writing – review and editing; supervision. Hare MJL: Writing – review and editing; supervision. Story DA: Writing – review and editing; funding acquisition, supervision. Wilkshire N: Writing – methodology; investigation (data collection); formal analysis; review and editing; supervision. Henwood P: Writing – methodology; investigation (data collection); formal analysis; review and editing; supervision. Croker D: Writing – methodology; investigation (data collection); formal analysis; review and editing; supervision. Ross J: Writing – methodology; investigation (data collection); formal analysis; review and editing; supervision.

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                  Climate and environmental crisis: effects on ear and hearing health in Australia and for Aboriginal and Torres Strait Islander peoples

                  Georgia M Tongs (Wiradjuri), Isabella Ludbrook, Jennifer H Martin, Robert Eisenberg and Kelvin M Kong (Worimi)
                  Med J Aust 2025; 223 (1): . || doi: 10.5694/mja2.52689
                  Published online: 7 July 2025

                  As a collaborative research team, we acknowledge the diverse perspectives, lived experiences, and cultural knowledges that shape our work. We are united in our commitment to examining health and climate through the lens of Aboriginal and Torres Strait Islander peoples, recognising the profound and disproportionate impacts these intersecting issues have on Indigenous communities globally.

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                  • 1 John Hunter Hospital, Newcastle, NSW
                  • 2 University of Newcastle, Newcastle, NSW
                  • 3 Hunter Medical Research Institute, Newcastle, NSW
                  • 4 University of New South Wales, Sydney, NSW
                  • 5 Macquarie University, Sydney, NSW



                  Open access:

                  Open access publishing facilitated by University of New South Wales, as part of the Wiley – University of New South Wales agreement via the Council of Australian University Librarians.

                  Competing interests:

                  Kelvin Kong is a Guest Editor for the 2025 NAIDOC Week MJA Special Issue and was not involved in any editorial decision making about this article.


                  Author contributions:

                  Tongs G: Formal analysis, investigation, methodology, resources, visualization, writing – original draft, writing – review and editing. Ludbrook I: Conceptualization, formal analysis, methodology, project administration, resources, supervision, visualization, writing – original draft, writing – review and editing. Martin J: Conceptualization, formal analysis, methodology, project administration, supervision, writing – original draft, writing – review and editing. Eisenberg R: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, visualization, writing – original draft, writing – review and editing. Kong K: Conceptualization, formal analysis, investigation, methodology, resources, supervision, writing – original draft, writing – review and editing.

                  • 1. Huria T, Palmer SC, Pitama S, et al. Consolidated criteria for strengthening reporting of health research involving indigenous peoples: the CONSIDER statement. BMC Med Res Methodol 2019; 19: 173.
                  • 2. Standen JC, Spencer J, Lee GW, et al. Aboriginal population and climate change in Australia: implications for health and adaptation planning. Int J Environ Res Public Health 2022; 19: 7502.
                  • 3. The Closing the Gap Clearinghouse. Ear disease in Aboriginal and Torres Strait Islander children. Canberra: Australian Institute of Health and Welfare, 2014. https://www.aihw.gov.au/getmedia/c68e6d27‐05ea‐4039‐9d0b‐a11eb609bacc/ctgc‐rs35.pdf?v=20230605181156&inline=true (viewed May 2025).
                  • 4. Bowatte G, Tham R, Perret JL, et al. Air pollution and otitis media in children: a systematic review of literature. Int J Environ Res Public Health 2018; 15: 257.
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                    Factors that affect the provision of medical abortion services in Australian primary care: a mixed methods systematic review

                    Greta Skahill and Mridula Shankar
                    Med J Aust || doi: 10.5694/mja2.52707
                    Published online: 30 June 2025

                    Abstract

                    Objectives: To synthesise primary research findings about factors that affect medical abortion provision by general practitioners, nurses, midwives, and pharmacists in Australia.

                    Study design: Mixed methods systematic review of peer‐reviewed primary publications of qualitative, quantitative, and mixed methods studies of the provision of medical abortion in Australian primary care, 1 January 2013 – 18 January 2025.

                    Data sources: MEDLINE, Scopus, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature).

                    Data synthesis: Twenty‐three publications satisfied our inclusion criteria. We undertook a thematic synthesis of the qualitative study findings to identify barriers and facilitators of medical abortion provision, and assessed the confidence of each review finding using the GRADE‐CERQual approach; we also compared the qualitative synthesis with quantitative study findings. We developed ten review findings grouped under three themes: moral, legal, and regulatory influences on abortion care (three review findings; very low to moderate confidence); the absence of a systems‐based approach to abortion provision (six review findings; moderate to high confidence); and early medical abortion belongs in primary care (one review finding; high confidence). Barriers to providing medical abortion include the absence of a supportive service delivery strategy, insufficient Medicare remuneration, geographic isolation, limited access to training, and colleagues who conscientiously object to abortion. Facilitators of its provision include clinician support networks and personal motivation to improve access to reproductive health care.

                    Conclusions: A range of individual, service level, and system factors exacerbate the effects of geographic location and financial considerations on the provision of medical abortion in Australian primary care. Our findings indicate that financial and structural support is needed for the geographic decentralisation of medical abortion training and services, the establishment of nurse‐led models of care, and the integration of abortion care into primary care.

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                    • 1 The University of Melbourne, Melbourne, VIC
                    • 2 Nossal Institute for Global Health, the University of Melbourne, Melbourne, VIC



                    Open access:

                    Open access publishing facilitated by the University of Melbourne, as part of the Wiley – the University of Melbourne agreement via the Council of Australian University Librarians.

                    Acknowledgements: 

                    We are grateful to Rana Islamiah Zahroh (Nossal Institute for Global Health, the University of Melbourne) for training the authors in applying GRADE‐CERQual to qualitative evidence synthesis findings. We thank Alya Hazfiarini (Nossal Institute for Global Health, the University of Melbourne) for providing input on the quality appraisals. We are grateful to Shelly Makleff (Centre for Health Equity, the University of Melbourne) for her input to our discussion of values clarification workshops for health care providers.

                    Competing interests:

                    No relevant disclosures.

                    Received 30 October 2024, accepted 24 February 2025

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                      Ending nuclear weapons, before they end us

                      Kamran Abbasi, Parveen Ali, Virginia Barbour, Marion Birch, Inga Blum, Peter Doherty, Andy Haines, Ira Helfand, Richard C Horton, Kati Juva, José Florencio F Lapeña, Robert Mash, Olga Mironova, Arun Mitra, Carlos A Monteiro, Elena N Naumova, David Onazi, Tilman A Ruff, Peush Sahni, James Tumwine, Carlos Umaña, Paul Yonga and Chris Zielinski
                      Med J Aust 2025; 222 (11): . || doi: 10.5694/mja2.52676
                      Published online: 16 June 2025

                      In May 2025, the World Health Assembly (WHA) will vote on re‐establishing a mandate for the World Health Organization (WHO) to address the health consequences of nuclear weapons and war.1 Health professionals and their associations should urge their governments to support such a mandate and support the new United Nations (UN) comprehensive study on the effects of nuclear war

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                      • 1 The British Medical Journal, London, United Kingdom
                      • 2 International Nursing Review, Sheffield, United Kingdom
                      • 3 University of Sheffield, Sheffield, United Kingdom
                      • 4 Medical Journal of Australia, Sydney, NSW, Australia
                      • 5 Medicine, Conflict and Survival, London, United Kingdom
                      • 6 International Physicians for the Prevention of Nuclear War, Hamburg, Germany
                      • 7 University of Melbourne, Melbourne, VIC, Australia
                      • 8 London School of Hygiene and Tropical Medicine, London, United Kingdom
                      • 9 International Physicians for the Prevention of Nuclear War, Springfield (OR), United States
                      • 10 The Lancet, London, United Kingdom
                      • 11 International Physicians for the Prevention of Nuclear War, Helsinki University Central Hospital, Helsinki, Finland
                      • 12 University of the Philippines System, Ermita (NCR), Philippines
                      • 13 African Journal of Primary Health Care and Family Medicine, Cape Town, South Africa
                      • 14 Stellenbosch University, Stellenbosch, South Africa
                      • 15 International Physicians for the Prevention of Nuclear War, Russian Cardiology Research and Production Complex, Sechenov University, Moscow, Russian Federation
                      • 16 International Physicians for the Prevention of Nuclear War, Ludhiana, India
                      • 17 Indian Doctors for Peace and Development, Ludhiana, India
                      • 18 Revista de Saúde Pública, São Paulo, Brazil
                      • 19 University of São Paulo, São Paulo, Brazil
                      • 20 Journal of Public Health Policy, Boston (MA), United States
                      • 21 Tufts University, Boston (MA), United States
                      • 22 International Physicians for the Prevention of Nuclear War, Society of Nigerian Doctors for the Welfare of Mankind, Abuja, Nigeria
                      • 23 Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
                      • 24 International Physicians for the Prevention of Nuclear War, University of Melbourne, Melbourne, VIC, Australia
                      • 25 National Medical Journal of India, New Delhi, India
                      • 26 All India Institute of Medical Sciences, New Delhi, India
                      • 27 Makerere University, Kampala, Uganda
                      • 28 Kabale University, Kabale, Uganda
                      • 29 International Physicians for the Prevention of Nuclear War, Costa Rican Ministry of Health, San José, Costa Rica
                      • 30 East African Medical Journal, Nairobi, Kenya
                      • 31 CA Medlynks, Nairobi, Kenya
                      • 32 Centre for Global Health, University of Winchester, Winchester, United Kingdom
                      • 33 World Association of Medical Editors, Winchester, United Kingdom


                      Correspondence: czielinski@ippnw.org


                      Author contribution statement:

                      Tillman Ruff and Andy Haines developed the idea of the editorial and led drafting along with Chris Zielinski. All other authors contributed significantly to the editorial content.

                      Competing interests:

                      All relevant disclosures are listed in the Supporting Information.

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