Topics

Abstract

Objectives: To quantify the cost of hospital separations attributable to environmental risk factors in the Northern Territory, including for Indigenous and remote subgroups.

Study design: A retrospective cross‐sectional secondary data analysis of hospital separations data. Data collection, analysis and presentation were guided by our Indigenous Steering Committee.

Setting and participants: All episodes of care from 1 July 2021 to 30 June 2022 with an inpatient separation (discharge, transfer, death) from NT public hospitals were included. Non‐inpatient episodes of care (outpatient, emergency department and primary care presentations) were excluded.

Major outcome measures: Individual hospital separations were classified as environmentally attributable if the International statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD‐10‐AM) code for their primary diagnosis matched an included disease. Included diseases were based on environmental attributable fractions previously generated for the Kimberley region, contextualised to the NT. Costs were assigned to individual hospital separations based on activity‐based funding allocations.

Results: Environmental risk factors contributed more than $72 million to inpatient hospital costs in the NT over 1 year. Environmental risks disproportionately affected children aged 0–4 years ($10.9 million), Indigenous people ($47.2 million) and those in remote areas ($41.7 million). Skin disease made up the largest contribution by a single disease ($26.4 million). The two largest categories of environmental risk were “water quality, sanitation and hygiene” and “home condition”, together contributing $37.3 million in costs.

Conclusions: Quantifying the economic impact of preventable environmental risk in the NT bolsters the argument for strengthening environmental health initiatives. Health disparities between groups reflect the interconnectedness of environmental, social and cultural determinants of health. Targeted interventions to reduce inequities in housing, sanitation and water quality are needed. Delivering on existing environmental health commitments through meaningful partnerships and coordinated action across sectors such as housing and education is essential, particularly within the Northern Territory Implementation Plan on Closing the Gap.

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1 Northern Territory Department of Health, Darwin, NT
2 Belmont University, Nashville (TN), United States

Correspondence: tanji.lamba@gmail.com

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:

Deidentified data underlying this study may be available on reasonable request and will be considered on a case‐by‐case basis. Interested parties may contact the corresponding author to discuss.

Acknowledgements:

We extend our gratitude to the Financial Modelling and Analysis team at NT Health for providing costing data for each inpatient episode. We are also very thankful to Iris Raye and Lisa Fereday, members of the Indigenous Steering Committee who were involved with this project, for their contributions and cultural guidance, which enriched the depth and relevance of our study. We also acknowledge Yashdeep Srivastava and Nicola Slavin for their contributions as members of the expert advisory panel.

Competing interests:

All authors either are currently or have been previously employed by NT Health. They currently receive or have previously received a salary from NT Health.

Author contributions:

Lamba G: Conceptualization, data curation, formal analysis, investigation, methodology, writing – original draft, writing – review and editing. Esler D: Conceptualization, supervision, writing – review and editing. Zhao Y: Conceptualization, data curation, methodology, writing – review and editing. Ward T: Conceptualization, investigation, methodology, writing – review and editing. Connors C: Conceptualization, resources, supervision. Spry M: Conceptualization, data curation, investigation, project administration, writing – review and editing.

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Research

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Changes in patient management after preoperative MRI for newly diagnosed breast cancer: a multicentre prospective observational study

Michael L Marinovich, Nehmat Houssami, Andrew Spillane, Gregory B Mann, Donna Taylor, Michelle Reintals, Nadine Phillips, Max K Bulsara, Patsy Siok Hwa Soon, Tracey Dickens and Christobel M Saunders

Med J Aust || doi: 10.5694/mja2.70051
Published online: 10 November 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Neoplasms

Diagnostic techniques and procedures

Surgical procedures, operative

Abstract

Objectives: To understand whether and how breast magnetic resonance imaging (MRI) at cancer diagnosis influences treatment planning, and whether subpopulations of patients with newly diagnosed breast cancer benefit in terms of most appropriate management.

Design: Multicentre prospective observational study.

Setting: Seven centres across New South Wales, Victoria and Western Australia during the period 15 September 2020 to 14 July 2022.

Participants: Patients with newly diagnosed early breast cancer meeting predefined criteria for whom multidisciplinary team normal practice deemed MRI would aid treatment planning.

Intervention: Preoperative contrast‐enhanced MRI.

Main outcome measures: Reasons for requesting MRI; pre‐MRI versus post‐MRI changes in treatment plans; changes justified by pathology findings.

Results: 387 eligible participants were enrolled. MRI was most frequently requested for dense breasts (252 [65%]), clinical and/or radiological size discrepancy (161 [42%]), multifocality (108 [28%]) and young age (105 [27%]). Change in treatment plan after MRI occurred for 198 participants (51% [95% CI, 46–56%]), including a change in breast surgery plan for 119 participants (31% [95% CI, 26–36%]). More mastectomies were planned after MRI (15% v 28%; absolute risk difference [RD], 13 percentage points [95% CI, 9–17]; P < 0.001), including unilateral mastectomy (14% v 24%; RD, 10 percentage points [95% CI, 6–14]; P < 0.001) and bilateral mastectomy (1% v 4%; RD, 3 percentage points [95% CI, 1–5]; P < 0.001). No increases in planned mastectomies occurred for women aged ≥ 70 years (RD, –3 percentage points [95% CI, –15 to 9]; or in those for whom neoadjuvant therapy was planned (RD, 2 percentage points [95% CI, –11 to 14]). Change in surgery was deemed justified by pathology findings in 75 of 88 women who experienced a change (85% [95% CI, 75–91%]).

Conclusions: Preoperative MRI findings led to changes in surgical management for a third of selected women with early breast cancer, increasing the mastectomy rate. In most cases, the changes were deemed appropriate. MRI findings did not change planned mastectomy in those aged ≥ 70 years, indicating that these women may not experience changes in surgical plans after such testing.

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1 Daffodil Centre, University of Sydney and Cancer Council NSW, Sydney, NSW
2 University of Sydney, Sydney, NSW
3 Melanoma Institute Australia, Sydney, NSW
4 University of Melbourne, Melbourne, VIC
5 Royal Melbourne Hospital, Melbourne, VIC
6 Royal Women’s Hospital, Melbourne, VIC
7 Royal Perth Hospital, Perth, WA
8 University of Western Australia, Perth, WA
9 BreastScreen SA, Adelaide, SA
10 University of Adelaide, Adelaide, SA
11 Institute for Health Research, University of Notre Dame Australia, Fremantle, WA
12 Bankstown‐Lidcombe Hospital, Sydney, NSW
13 UNSW Sydney, Sydney, NSW

Correspondence: cmsaunders@unimelb.edu.au

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.

Data Sharing:

The data that underlie this report are available for sharing. Enquiries should be directed to the corresponding author.

Author contributions:

Marinovich ML: Formal analysis, writing – original draft, writing – review and editing. Houssami N: Methodology, writing – review and editing. Spillane A: Investigation, writing – review and editing. Mann GB: Investigation, writing – review and editing. Taylor D: Investigation, writing – review and editing. Reintals M: Investigation, writing – review and editing. Phillips N: Formal analysis, writing – review and editing. Bulsara MK: Methodology, writing – review and editing. Soon P: Investigation, writing – review and editing. Dickens T: Project administration, writing – review and editing. Saunders CM: Conceptualization, funding acquisition, supervision, methodology, writing – review and editing.

Acknowledgements:

This study was supported by a grant from the Medical Research Future Fund's (Australian Government Department of Health, Disability and Ageing) Targeted Health System and Community Organisation Research initiative (MRF1177121). The funder had no role in study design, data collection, analysis or interpretation, reporting, or publication. We thank Jocelyn Lippey, Saud Hamza and Helen Ballal for coordinating recruitment at their respective study sites, and Breast Cancer Trials for providing data management services.

Competing interests:

Michael Marinovich and Nehmat Houssami received funding from the National Breast Cancer Foundation (2023/IIRS0028 and EC‐21‐001) paid to their institutions. Nehmat Houssami received funding from the National Health and Medical Research Council (1194410) paid to her institution, and is a member of the BreastScreen Australia National Policy Review Expert Advisory Group 2023–2025. Andrew Spillane, Patsy Soon, Tracey Dickens and Christobel Saunders received funding from the Medical Research Future Fund (MRF1177121) for this study, paid to their institutions. Andrew Spillane has been paid speaker fees from Eli Lilly Australia and The Limbic, and is Deputy Chair of the Board of Breast Cancer Trials. Donna Taylor is a member of the Breast Imaging Advisory Committee of the Royal Australian and New Zealand College of Radiologists.

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Guideline summary

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The first Australian evidence‐based guidelines on male infertility

Darren J Katz, Liza O’Donnell, Robert I McLachlan, Tim J Moss, Clare V Boothroyd, Veena Jayadev and Sarah R Catford

Med J Aust || doi: 10.5694/mja2.70080
Published online: 3 November 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Anatomy and physiology

Endocrine system diseases

Environment and public health

Health occupations

Men's health

Urologic diseases

Surgical procedures, operative

Abstract

Introduction: Infertility affects about one in six couples and a male factor may contribute to 50% of cases. Until recently, no Australian‐based clinical guidelines for the management of male infertility had been published. A panel of experts was assembled to formulate the first Australian evidence‐based guidelines on male infertility.

Main recommendations:

The initial evaluation of male fertility should include a reproductive and medical history, physical (including scrotal) examination and semen analysis, and simultaneous evaluation of the female partner.
Further evaluation of men with suspected infertility should be guided by an expert in male reproduction and include hormonal evaluation and an estimate of testicular volume. Extra tests according to clinical indication are sperm DNA testing, somatic genetic testing and imaging.
Varicocele treatment should be considered in men with infertility who have a clinical varicocele(s) and associated clinical indications.
Men with azoospermia should be evaluated to differentiate between obstructive and non‐obstructive azoospermia.
Micro testicular sperm extraction is the preferred method of sperm retrieval in men with non‐obstructive azoospermia and prior diagnostic biopsy or fine needle aspiration is not required.
The management of male infertility should include counselling men regarding potentially modifiable risk factors, associated health conditions, and implications for their future health and offspring.
Surgical management of infertility includes retrieval of sperm for use in assisted reproductive technology and treatment of varicocele, and non‐surgical management includes management of hormonal disorders.
Specific guidelines are included for men with cryptorchidism, varicoceles and Klinefelter syndrome and cancer and male infertility.

Changes in management as a result of the guidelines: These first Australian evidence‐based guidelines will serve as a long overdue clinical aid to the large number of practitioners who provide services to men with infertility. The broad and comprehensive nature of the guidelines will facilitate evidence‐based care for the most common areas of male infertility. The formulation of these guidelines by experts representing key stakeholder organisations should enhance the promotion of the guideline statements and help raise awareness of this common condition.

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1 Men’s Health Melbourne, Melbourne, VIC
2 Western Health, Melbourne, VIC
3 The University of Melbourne, Melbourne, VIC
4 Centre for Endocrinology and Reproductive Health, Hudson Institute of Medical Research, Melbourne, VIC
5 Griffith University, Brisbane, QLD
6 Healthy Male, Melbourne, VIC
7 Monash University, Melbourne, VIC
8 Monash IVF Group, Melbourne, VIC
9 Care Fertility, Brisbane, QLD
10 Concord Repatriation General Hospital, Sydney, NSW
11 The Royal Women’s Hospital, Melbourne, VIC
12 Alfred Health, Melbourne, VIC

Correspondence: dkatz@menshealthmelbourne.com.au

Data Sharing:

This article contains no original data.

Acknowledgements:

Funding for administrative support in formulating these guidelines was provided by Healthy Male under contract from a grant to UNSW Sydney from the Medical Research Future Fund’s Emerging Priorities and Consumer‐Driven Research initiative (EPCD000007). We acknowledge Simon von Saldern and Carmen Broadhurst from Healthy Male for assisting with planning and publication of the full guidelines.

Competing interests:

Tim Moss is an employee of Healthy Male, which receives funding from the Australian Government. Liza O’Donnell was previously employed by Healthy Male. Clare Boothroyd owns a private fertility unit providing medically assisted reproductive services. Rob McLachlan has equity holding in Monash IVF Group.

Author contributions:

Darren Katz: Conceptualization, methodology, investigation, formal analysis, writing – original draft preparation. Liza O’Donnell: Conceptualization, methodology, investigation, project administration, writing – original draft preparation. Robert McLachlan: Conceptualization, methodology, investigation, formal analysis, funding acquisition, project administration, writing – review and editing. Tim Moss: Conceptualization, methodology, investigation, project administration, funding acquisition, writing – review and editing. Clare Boothroyd: Conceptualization, methodology, investigation, formal analysis, writing – original draft preparation. Veena Jayadev: Conceptualization, methodology, investigation, formal analysis, writing – review and editing. Sarah Catford: Conceptualization, methodology, investigation, formal analysis, writing – original draft preparation.

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Research

Online first

Greenhouse gas emissions associated with anaesthetic gases in Australia, 2002–2022: a retrospective descriptive analysis

Krista Verlis, Jessica F Davies, Forbes McGain, Hayden Burch, Alexandra L Barratt and Luise Kazda

Med J Aust || doi: 10.5694/mja2.70046
Published online: 27 October 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Anesthesia, analgesia and pain

Environment and public health

Statistics, epidemiology and research design

Abstract

Objectives: To assess changes in greenhouse gas emission rates associated with the use of anaesthetic gases (desflurane, sevoflurane, and isoflurane) in Australian health care during 2002–2022, overall and by state or territory and hospital type.

Study design: Retrospective descriptive analysis of IQVIA anaesthetic gases purchasing data.

Setting: All Australian public and private hospitals, 1 January 2002 – 31 December 2022.

Main outcome measures: Absolute carbon dioxide equivalent (CO₂e) emissions and CO₂e emissions rate per 100 000 population by gas and year, overall and by state/territory and hospital type (public or private).

Results: The overall emissions rate increased from 74 t CO₂e per 100 000 population in 2002 to 328 t CO₂e per 100 000 population in 2012, most rapidly during 2002–2004 (annual percentage change [APC], 51%; 95% confidence interval [CI], 38–62%). The rate then declined to 83 t CO₂e per 100 000 population in 2022, most rapidly during 2017–2022 (APC, –21%; 95% CI, –23% to –20%). Patterns of emissions rate change were similar for all states and territories. More units of sevoflurane than of desflurane or isoflurane were purchased each year throughout 2002–2022, but desflurane provided the largest proportion of total emissions from anaesthetic gases during 2002–2022: 33% in 2002, 88% in 2013, and 68% in 2022. Mean emission rates per 100 000 population during 2002–2022 were highest for South Australia/Northern Territory (276 t CO₂e per year) and lowest for Victoria/Tasmania (196 t CO₂e per year). The desflurane emissions rate was consistently higher for private than public hospitals; it declined for public hospitals during 2009–2018 (APC, –8%; 95% CI, –10% to –5%) and 2018–2022 (APC, –43%; 95% CI, –48% to –37%), but for private hospitals only during 2017–2022 (APC, –20%; 95% CI, –24% to –17%).

Conclusions: In Australia, the CO₂e emissions rate for anaesthetic gases increased during 2002–2008 but declined during 2017–2022, at first primarily in public hospitals. Continuing to reduce the use of anaesthetic gases, particularly desflurane, will advance the decarbonisation of clinical practice in Australian health care.

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1 Sydney School of Public Health, the University of Sydney, Sydney, NSW
2 Austin Health, Melbourne, VIC
3 The University of Melbourne, Melbourne, VIC
4 Western Health, Melbourne, VIC
5 Health Research Institute, University of Canberra, Canberra, ACT

Correspondence: krista.verlis@sydney.edu.au

Open access:

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

Data Sharing:

The purchasing data we analysed are not publicly available and cannot be shared by the authors, as we do not have permission from the data custodian to do so.

Acknowledgements:

Krista Verlis and Luise Kazda are supported by the Healthy Environments And Lives (HEAL) National Research Network, which receives funding from the National Health and Medical Research Council (NHMRC) Special Initiative in Human Health and Environmental Change (grant no. 2008937). Jess Davies received a research scholarship from the Australian and New Zealand College of Anaesthetists (ANZCA). These funds were used to help pay for the IQVIA data. The funding sources were not involved in planning, writing or publishing this work, nor did they have any role in the research.

Competing interests:

Forbes McGain receives royalties from Medihood for the co‐invented, patented McMonty hood.

Authors’ contributions:

Funding acquisition: Krista Verlis, Luise Kazda, Jess Davies, Alexandra Barratt. Conceptualisation: Krista Verlis, Luise Kazda, Jess Davies, Alexandra Barratt. Data curation: Krista Verlis, Luise Kazda. Formal analysis: Krista Verlis, Luise Kazda, Forbes McGain. Methodology: Krista Verlis, Luise Kazda, Jess Davies, Forbes McGain, Hayden Burch, Alexandra Barratt. Project administration: Krista Verlis, Luise Kazda, Alexandra Barratt. Supervision: Luise Kazda, Alexandra Barratt. Visualisation: Krista Verlis, Luise Kazda. Writing (original draft): Krista Verlis. Writing (review and editing): Krista Verlis, Luise Kazda, Jess Davies, Forbes McGain, Hayden Burch, Alexandra Barratt.

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Guideline summary

Clinical practice guidelines for hepatocellular carcinoma surveillance for people at high risk in Australia: summary of recommendations

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 and Eleonora Feletto

Med J Aust 2025; 223 (8): . || doi: 10.5694/mja2.70061
Published online: 20 October 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Neoplasms

Digestive system diseases

Environment and public health

Abstract

Introduction: Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer, the sixth most common cause of cancer death in Australia. With shifting aetiologies and a growing at‐risk population, consistent routine surveillance recommendations are key to early detection of HCC and improved survival. We developed new evidence‐based HCC surveillance guidelines for people at high risk in Australia due to liver disease and/or other risk factors. These guidelines 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.

Main recommendations:

This article summarises the recommendations and practice points for key population subgroups who were identified as potentially benefitting from routine HCC surveillance in the form of six‐monthly ultrasound scans, with or without α‐fetoprotein testing.
People with liver cirrhosis and a non‐HCC‐related life expectancy of greater than six months are recommended to receive routine HCC surveillance.
People with chronic hepatitis B virus infection who do not have liver cirrhosis are recommended to receive routine HCC surveillance if they have a family history of HCC, are Aboriginal or Torres Strait Islander peoples, or have an Asian, Pacific, or sub‐Saharan African background, with varying start ages recommended for each group.
People with stage 3 non‐cirrhotic liver fibrosis (F3) may be recommended to receive routine HCC surveillance based on individual risk assessment, or otherwise monitored for progression to cirrhosis.

The final guidelines were approved by the National Health and Medical Research Council (NHMRC) in April 2023.

Changes in management as a result of the guideline: 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. These guidelines were accompanied by the Roadmap to liver cancer control, a coordinated ten‐year plan for advancing liver cancer prevention and early detection in Australia. The full guidelines can be accessed at https://cancer.org.au/clinical‐guidelines/liver‐cancer/hepatocellular‐carcinoma.

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1 Storr Liver Centre, Westmead Institute for Medical Research, Sydney, NSW
2 University of Sydney, Sydney, NSW
3 University of Melbourne, Melbourne, VIC
4 WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
5 Monash University, Melbourne, VIC
6 Alfred Hospital, Melbourne, VIC
7 University of Western Australia, Perth, WA
8 Sir Charles Gairdner Hospital, Perth
9 Menzies School of Health Research, Darwin, NT
10 Royal Darwin Hospital, Darwin, NT
11 Kirby Institute, University of New South Wales, Sydney, NSW
12 Flinders Medical Centre, Adelaide, SA
13 Consumer co‐researcher
14 Northern Territory Centre for Disease Control, Alice Springs, NT
15 NSW Multicultural HIV and Hepatitis Service (MHAHS), NSW Health, Sydney Local Health District, Sydney, NSW
16 QIMR Berghofer, Brisbane, QLD
17 Hepatitis B Voices Australia, Melbourne, VIC
18 Cancer Council Victoria, Melbourne, VIC
19 The Daffodil Centre, a joint venture with Cancer Council New South Wales, University of Sydney, Sydney, NSW
20 Centre for Outcomes Research and Effectiveness, University College London, London, United Kingdom Of Great Britain And Northern Ireland
21 Centre for Community‐Driven Research – Australia, Canberra, ACT
22 Cancer Council Australia, Sydney, NSW

Correspondence: eleonora.feletto@sydney.edu.au

Open access:

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

Acknowledgements:

Cancer Council Australia was funded by the Department of Health and Aged Care to develop these guidelines as part of the Roadmap to Liver Cancer Control project. Cancer Council Australia sub‐contracted the Daffodil Centre, a joint venture between Cancer Council NSW and the University of Sydney, to perform the systematic reviews and predictive modelling, and provide project coordination to support guideline development. Jane Davies receives research funding from an Investigator Grant through Medical Research Futures Fund (MRFF1194615). The funding body did not influence the content of this guideline summary. We thank the guidelines working groups, including Dr Emily He, A/Prof Simone Strasser, Prof Gail Matthews, Dr Koya Ayonrinde, Dr Michael Wallace, Dr Kirsty Campbell, Paula Binks, Prof Alan Wigg, Prof Andrew Wilson, Teresa De Santis, A/Prof Anouk Dev, Dr Ken Liu, Dr Ammar Majeed, Dr William Mude, A/Prof Jessica Howell, Dr Cameron Gofton, Dr Sid Sood, Dr Katelin Haynes, Dr Thomas Tu, John Didlick, Dr Lynne Pezzullo, and Russell Shewan. The modelling team would like to thank Barbara de Graaf and Anh Nguyen for their assistance. We would like to acknowledge and thank Ms Jenni Harman for her editorial assistance.

Competing interests:

See the Supporting Information for competing interests.

Author contributions:

George J: Visualization, writing – original draft, writing – review and editing. Allard NL: Visualization, writing – original draft, writing – review and editing. Roberts S: Visualization, writing – review and editing. Adams LA: Visualization, writing – review and editing. Davies J: Visualization, writing – review and editing. Hajarizadeh B: Visualization, writing – review and editing. MacLachlan JH: Visualization, writing – review and editing. Mahady SE: Visualization, writing – review and editing. Altus R: Writing – review and editing. Brown C: Writing – review and editing. Fry DC: Writing – review and editing. Greenwood‐Smith B: Writing – review and editing. Smud N: Writing – review and editing. Valery PC: Writing – review and editing. Yussf N: Writing – review and editing. Broun K: Writing – review and editing. Campbell D: Investigation, methodology, writing – review and editing. Canfell K: Conceptualization, writing – review and editing. Carle C: Investigation, methodology, writing – review and editing. Freeman V: Investigation, methodology, writing – review and editing. Grogan P: Conceptualization, funding acquisition, writing – review and editing. Holliday C: Visualization, writing – review and editing. Hughes S: Investigation, methodology, writing – review and editing. Kelly A: Writing – review and editing. van Kemenade C: Investigation, methodology, project administration, writing – review and editing. Latumahina C: Investigation, methodology, project administration, writing – review and editing. McAtamney A: Conceptualization, project administration, writing – review and editing. Varlow M: Conceptualization, funding acquisition, writing – review and editing. Worthington J: Investigation, methodology, writing – original draft, writing – review and editing. Yuill S: Investigation, methodology, writing – review and editing.Feletto E: Visualization, investigation, methodology, project administration, funding acquisition, writing – original draft, writing – review and editing.

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Socio‐economic position and the prevalence of ten chronic diseases in Australia, 2021: a whole of population census data analysis

Joanna Y Gong, Emily D Williams, Agus Salim, Spiros Fourlanos, Jonathan E Shaw and Dianna J Magliano

Med J Aust || doi: 10.5694/mja2.70032
Published online: 20 October 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Social determinants of health

General medicine

Environment and public health

Statistics, epidemiology and research design

Abstract

Objectives: To investigate differences in the prevalence of specific chronic diseases in Australia by selected measures of socio‐economic position, and by age group and sex, using representative national census population data.

Study design: Cross‐sectional, whole of population study; analysis of 2021 Australian census data.

Participants, setting: People aged 40 years or older for whom 2021 Australian census health status and socio‐economic position‐related data were available.

Main outcome measures: Age‐standardised prevalence of ten chronic diseases (arthritis, asthma, cancer, dementia, diabetes, heart disease, kidney disease, lung disease, mental health conditions, and stroke), by socio‐economic position (Index of Relative Socio‐economic Disadvantage [IRSD], income category, educational level, occupational grade), age group, and sex; mean change in prevalence across socio‐economic position categories.

Results: Health status responses and data that allowed IRSD categorisation were available for 11.3 million people aged 40 years or older (92% of all adults aged 40 years or older). The proportions of people who reported nine chronic diseases (exception: cancer) increased with increasing socio‐economic disadvantage as measured by IRSD decile and income. The increases were less marked for people aged 80 years or older than for those aged 40–79 years, and more marked for women than men. For people aged 40–59 or 60–79 years, the increase in age‐standardised chronic disease prevalence per one decile decrease in IRSD was greatest for lung disease in both women (40–59 years, 18.4% per decile; 60–79 years, 10.6% per decile) and men (40–59 years, 16.9% per decile; 60–79 years, 11.0% per decile). In people aged 80 years or older, the increase in prevalence per one decile decrease in IRSD was greatest for kidney disease in women (6.0% per decile) and for mental health conditions in men (7.1% per decile). The age‐standardised prevalence of cancer decreased by 0.4–1.1% per one decile decrease in IRSD for all age groups and both sexes, except for men aged 40−59 years (increased by 0.1% per IRSD decile). Consistent relationships with educational level or occupational grade were not found.

Conclusions: The prevalence of chronic disease differs by socio‐economic position, but the direction, magnitude, and consistency of the effect differs by disease, socio‐economic position measure, age, and sex. Understanding the relationship between different socio‐economic position measures and chronic diseases facilitates the formulation of directed interventions.

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1 Baker Heart and Diabetes Institute, Melbourne, VIC
2 The Royal Melbourne Hospital, Melbourne, VIC
3 Western Health, Melbourne, VIC
4 The University of Melbourne, Melbourne, VIC
5 Monash University, Melbourne, VIC
6 King’s College London, London, United Kingdom
7 La Trobe University, Melbourne, VIC

Correspondence: joanna.gong@baker.edu.au

Correspondence: joannagong@unimelb.edu.au

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.

Data Sharing:

No original data were generated by this study.

Acknowledgements:

Dianna J Magliano and Jonathan E Shaw are supported by National Health and Medical Research Council Investigator grants. Joanna Y Gong holds National Health and Medical Research Council, National Heart Foundation of Australia, Rowden White, and Sheppard M Lowe scholarships. The funding sources had no role in study design, data collection, analysis or interpretation, reporting, or publication.

Competing interests:

Jonathan E Shaw has received consulting fees from GlaxoSmithKline, and payment for lectures and work on a program committee for Astra Zeneca and lectures for Boehringer Ingelheim, Novo Nordisk, Roche, Zuellig Pharmaceutical, and Eli Lilly. Spiros Fourlanos has received consulting fees from Mylan and Pfizer, and presentation honoraria from Astra Zeneca, Boehringer Ingelheim, Eli Lilly, and Novo Nordisk.

Author contributions:

Dianna J Magliano: conceptualisation, methodology, writing (review and editing), visualisation, supervision. Jonathan E Shaw: conceptualisation, methodology, writing (review and editing), visualisation, supervision. Joanna Y Gong: conceptualisation, methodology, formal analysis, writing (review and editing), visualisation. Emily D Williams: conceptualisation, methodology, writing (review and editing), supervision. Agus Salim: methodology, formal analysis, writing (review and editing), visualisation, supervision. Spiros Fourlanos: writing (review and editing), supervision.

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Opioids and the challenges of managing chronic non‐cancer pain in rural Australia: a qualitative study

Jessica A Thomas, Jill Benson, Philip Davidson and Paul R Ward

Med J Aust || doi: 10.5694/mja2.70022
Published online: 13 October 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Anesthesia, analgesia and pain

General medicine

Substance-related disorders

Abstract

Objective: To investigate why rural general practitioners prescribe opioids for people with chronic non‐cancer pain, with the aims of explaining geographic differences in opioid prescribing and improving pain management in rural areas.

Study design: Qualitative study; interviews with convenience sample of rural general practitioners.

Setting, participants: Seventeen rural general practitioners who had prescribed opioids for people with chronic non‐cancer pain during the preceding twelve months; the interviews were undertaken during 11 September 2023 – 31 May 2024.

Major outcome measures: Contextual and individual factors that influence decision making by rural general practitioners about prescribing opioids for people with chronic non‐cancer pain.

Results: We found that rural opioid prescribing is influenced more by health care system deficiencies than lack of knowledge among practitioners. Two major themes were identified: systematic constraints (insufficient time for alternative management strategies and the influence of Medicare remuneration); and limited access to multidisciplinary pain management (limited availability of non‐pharmaceutical treatments, colleagues for consultation, and referral pathways). Participants described feeling trapped between brief consultations and complex deprescribing requirements; Medicare remuneration schedules encourage shorter appointments (and therefore continuing current management) rather than comprehensive pain management. Implementing evidence‐based guidelines was difficult in rural areas with limited resources. The limited availability of allied health services further restricted alternative pain management approaches. Participants reported greater psychological pressure to justify opioid deprescribing than prescribing. Doctors acknowledged that the evidence for the value of opioids for managing chronic pain was limited but felt caught between inadequate system resources and patient demands.

Conclusion: We found a marked disparity between evidence‐based guidelines for chronic pain management and the reality of rural medical practice. Rural doctors operating in a difficult context resort to prescribing opioids because of systemic inadequacies rather than lack of awareness of their limited value. Chronic pain management in rural areas could be improved by better Medicare support for longer pain management consultations, improved access to allied health, rural area‐specific guidelines that take resource constraints into account, and improved support for general practitioners in pain management and deprescribing.

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1 Flinders University, Adelaide, SA
2 Goolwa Medical Centre, Goolwa, SA
3 Torrens University Australia, Adelaide, SA

Correspondence: jessica.thomas@flinders.edu.au

Open access:

Open access publishing facilitated by Flinders University, as part of the Wiley – Flinders 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:

The study was supported by Flinders University funding for advanced studies research. The funder played no role in the study design, conduct, data analysis, and interpretation of the research.

Competing interests:

No relevant disclosures.

Author contributions:

Jessica A Thomas, Paul R Ward were responsible for the initial research design. Jessica A Thomas performed the literature review for the research project. JAT wrote the ethics application. Jessica A Thomas performed the data collection. Jessica A Thomas, Paul R Ward contributed to the data analysis. Jessica A Thomas wrote the first draft of the manuscript. Jessica A Thomas, Paul R Ward, Philip Davidson, Jill Benson agreed on the final version of the manuscript before submission.

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Federal health workforce policy in Australia and its implications: a descriptive policy document review

Stephanie M Topp, Thu Nguyen and Lana M Elliott

Med J Aust || doi: 10.5694/mja2.70021
Published online: 6 October 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Health services administration

Abstract

Objective: To identify which federal health workforce policies are current in Australia, and describe their mode, scope, and focus.

Study design: Descriptive policy document review; categorisation according to the Howlett–Ramesh policy instrument framework.

Setting: Health workforce policy documents available on the Australian Department of Health and Aged Care website, 1 June – 31 October 2024.

Main outcome measures: Primary policy focus (specific health profession, population group or location); scope of policy (alignment with one or more strategic domains: supply, distribution, or performance), service sectors affected by policy, substantive mention of specific health professions; policy instrument types.

Results: We included 121 policy documents in our analysis. By policy group, the number of documents was greatest for the rural health workforce (35), aged care (22), and Aboriginal and Torres Strait Islander health workforce (19); the numbers were lowest for pharmacy (three) and allied health (one), and none had public health or emergency care as their focus. Mixed policy instruments (multiple interest group programs, sub‐programs, incentives, grants) were more numerous (98 documents) than government‐led instruments (23 documents). Health workforce supply was a focus of 72 documents, performance of 57 documents, and distribution of 42 documents. Document nomenclature was inconsistent; 44 documents had policy labels that did not correspond to their content or purpose.

Conclusion: We identified substantial fragmentation in Australian federal health workforce policy. The absence of a unified federal health workforce strategy exacerbates policy fragmentation, undermining coordinated workforce planning and equity. Adopting a consistent policy nomenclature and reducing imbalances in strategic focus are critical for effective health workforce reform. Our findings provide a baseline for analyses of policy processes and governance in Australian health workforce policymaking.

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1 James Cook University, Townsville, QLD
2 Queensland University of Technology, Brisbane, QLD

Correspondence: stephanie.topp@jcu.edu.au

Open access:

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

Data Sharing:

The study data can be accessed by contacting the corresponding author.

Acknowledgements:

Stephanie M Topp holds a National Health and Medical Research Council Investigator grant (GNT2034261). The funding source had no role in the planning, design, data collection, analysis, interpretation, writing, or publication of the work.

Competing interests:

No relevant disclosures.

Author contributions:

Conceptualisation: Stephanie M Topp; methodology: Stephanie M Topp, Thu Nguyen; data curation: Thu Nguyen; formal analysis: Stephanie M Topp, Thu Nguyen, Lana M Elliott; writing (original draft): Stephanie M Topp, Thu Nguyen; writing (review and editing): Stephanie M Topp, Thu Nguyen, Lana M Elliott; funding acquisition: Stephanie M Topp; supervision: Stephanie M Topp.

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A retrospective cross‐sectional analysis of the economic impact of environmental risk factors on inpatient hospital separations in the Northern Territory

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The first Australian evidence‐based guidelines on male infertility

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Greenhouse gas emissions associated with anaesthetic gases in Australia, 2002–2022: a retrospective descriptive analysis

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Clinical practice guidelines for hepatocellular carcinoma surveillance for people at high risk in Australia: summary of recommendations

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Socio‐economic position and the prevalence of ten chronic diseases in Australia, 2021: a whole of population census data analysis

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Abstract

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Comment

Do you have any competing interests to declare? *

Opioids and the challenges of managing chronic non‐cancer pain in rural Australia: a qualitative study

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Abstract

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Do you have any competing interests to declare? *

Federal health workforce policy in Australia and its implications: a descriptive policy document review

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Abstract

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Comment

Do you have any competing interests to declare? *

Sex‐ and gender‐responsive management of anxiety disorders: future pathways for research, education, policy and practice

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Summary

Author

Comment

Do you have any competing interests to declare? *

The forgotten pandemic: Hong Kong influenza in Australia (1968–1970)

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Author

Comment

Do you have any competing interests to declare? *

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