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Objectives: To examine the clinical characteristics and short term outcomes for children with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections who presented to Australian hospitals during 2020 and 2021.
Design, setting: Retrospective case review study in nineteen hospitals of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network from all Australian states and territories, including seven major paediatric tertiary centres and eight Victorian hospitals.
Participants: SARS‐CoV‐2‐positive people under 18 years of age who attended emergency departments or were admitted to hospital during 1 February 2020 – 31 December 2021.
Main outcome measures: Epidemiological and clinical characteristics, by hospital care type (emergency department [ED] or inpatient care).
Results: A total of 1193 SARS‐CoV‐2‐positive children and adolescents (527 girls, 44%) attended the participating hospitals (107 in 2020, 1086 in 2021). Their median age was 3.8 years (interquartile range [IQR], 0.8–11.4 years); 63 were Aboriginal or Torres Strait Islander people (5%). Other medical conditions were recorded for 293 children (25%), including asthma (86, 7%) and premature birth (68, 6%). Medical interventions were not required during 795 of 1181 ED presentations (67%); children were discharged directly home in 764 cases (65%) and admitted to hospital in 282 (24%; sixteen to intensive care units). The 384 admissions to hospital (including 102 direct admissions) of 341 children (25 infants under one month of age) included 23 to intensive care (6%); the median length of stay was three days (IQR, 1–9 days). Medical interventions were not required during 261 admissions (68%); 44 children received respiratory support (11%) and 21 COVID‐19‐specific treatments, including antiviral and biologic agents (5%). Being under three months of age (
Conclusion: During 2020 and 2021, most SARS‐CoV‐2‐positive children and adolescents who presented to participating hospitals could be managed as outpatients. Outcomes were generally good, including for those admitted to hospital.
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We acknowledge the support of the National Health and Medical Research Council (NHMRC) through a Centre of Research Excellence grant for Paediatric Emergency Medicine (1171228), which also supported Catherine Wilson, who coordinated the study and data collection across the PREDICT network. Franz Babl is supported by an NHMRC Practitioner Fellowship (1124468), which partially supported his role as a senior author and principal investigator for this study.
We also acknowledge the assistance of the hospital staff who assisted with data retrieval: Katrina Pandey and James Gaston (Sunshine Hospital, Western Health); Deepali Thosar (the Children's Hospital at Westmead); Giles Barrington (Royal Hobart Health Service); Amelia Skaczkowski (Royal Darwin Hospital); Jo Miller, Ethan Fernandes, Andrew McGlinchy, Ye Yang Tham, and Olivia Slifirski (Eastern Health: Box Hill, Maroondah, and Angliss hospitals); Gaby Nieva and Lara Caruso (Adelaide Women's and Children's Hospital); Angus Jones and Alyce Callaghan (Queensland Children's Hospital); and Nitaa Eapen, Yilin Liu, Karen Lu, Violet Sattari Bahri, Michael Wojno, Haoyue Zhang, and Zahra Ataie‐Ashtiani (Royal Children's Hospital).
No relevant disclosures.
Our stressed health system needs innovative solutions to care adequately for people with post‐COVID‐19 conditions
The post-coronavirus disease 2019 (COVID-19) condition or syndrome (“long COVID”) is defined as the persistence of existing symptoms or the development of new symptoms, without an alternative explanation, three months after an initial acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The symptoms, of varying and inconstant severity, can impair everyday functioning. Although long COVID can affect many body systems, the most frequent symptoms are fatigue, shortness of breath, and cognitive dysfunction.1 Long COVID lasting more than twelve weeks is estimated to affect 5–10% of people in Australia who have had COVID-19,2 but lower rates following SARS-CoV-2 infections since 2022 have recently been reported in the United Kingdom (4.0% of first infections in adults, 2.4% of re-infections).3
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We acknowledge the work of the fellows of the Australian Academy of Health and Medical Sciences and the Australian Academy of Science and of other experts who contributed to a joint written submission to the Parliamentary Inquiry into Long COVID and Repeated COVID Infections and a subsequent roundtable discussion with the Standing Committee on Health, Aged Care and Sport. The final report of the Standing Committee was released on 24 April 2023.13 The Minister for Health and Aged Care, the Hon. Mark Butler MP, subsequently announced that $50 million would be provided from the Medical Research Future Fund for long COVID research.14
Martin Hensher was a member of the National COVID‐19 Health and Research Advisory Committee Working Group on Long COVID (unremunerated). Lena Sanci co‐leads the long COVID project in APPRISE (Australian Partnership for Preparedness Research on Infectious Disease Emergencies, a Centre for Research Excellence. Tania Sorrell is a chief investigator and an executive member of APPRISE, but has received no remuneration in relation to the Long COVID project.
Growth in Aboriginal and Torres Strait Islander health research requires urgent investment in Aboriginal and Torres Strait Islander ethical governance
Indigenous peoples have been conducting research to understand complex systems of knowledge since time immemorial.1 The embodiment of principles aligned with Indigenous ways of knowing, being and doing is central to the legacy of this expert research practice. In this perspective article, we draw on our lived experiences and a review on the field of practice of ethical research.
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What do the commercial determinants of health look like for goods and services that are human rights?
Follow the money. This is the premise driving commercial determinants of health (CDoH) research. Why do children see gambling advertisements when they watch professional sports? Why do vapes have cartoon logos and candy flavours? Why don't we have better implementation of the Framework Convention on Tobacco Control? Why has progress stagnated on the Paris Climate deal? Money, profits and power cut through all these issues.
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Jennifer Lacy‐Nichols is the recipient of a Fellowship from the Victorian Health Promotion Foundation. Adam Elshaug is Ministerially appointed to the Strengthening Medicare Taskforce and the Medicare Benefits Schedule Review Advisory Committee (MRAC); is health economic and policy advisor to Cancer Australia; is a member of the Research Partnership Advisory Group (translational research priorities 2022–24), Victorian Government Department of Health; is a member of the Victorian Perioperative Learning Health Network Advisory Group (Safer Care Victoria);and holds grants from the National Health and Medical Research Council and the Medical Research Future Fund.
In Australia, paracetamol is the agent most frequently implicated in drug overdoses, and their frequency is increasing, particularly in young people.1 Paracetamol overdose causes significant morbidity despite treatment, and is the leading cause of acute liver failure in Western countries.2 Modified release (MR) paracetamol overdose is associated with a higher rate of liver injury than immediate release paracetamol.3 The sole therapeutic benefit of MR paracetamol is its more convenient dosage regimen (three rather than four times a day).4
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Rose Cairns is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant (1196516); Nicholas Buckley is supported by an NHMRC investigator Grant (2007726). We thank the staff of the New South Wales Poisons Information Centre for collecting the data analysed in our study.
Rose Cairns holds an untied educational grant from Reckitt; this funder had no role in this study.
General practice training is provided in geographically diverse locations across Australia to promote the development of the rural and remote medical workforce. Training in rural and remote locations supports learning locally required types of medical practice and builds both social and professional connections that increase the likelihood of trainees later practising in these communities.1,2 The remote learning model appears to be successful,3 but a 2020 scoping review found only limited evidence for the equivalence of learning outcomes after training in remote or less remote locations.4 We therefore compared formative assessment outcomes for general practice trainees in remote locations with those of trainees in rural or regional locations.
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This project was funded by an Education Research Grant from the Australian College of Rural and Remote Medicine (salaries and research costs).
No relevant disclosures.
Objectives: To determine the proportions of newly diagnosed melanomas treated by different medical specialist types, to describe the types of excisions performed, and to investigate factors associated with treating practitioner specialty and excision type.
Design, setting: Prospective cohort study; analysis of linked data: baseline surveys, hospital, pathology, Queensland Cancer Register, and Medical Benefits Schedule databases.
Participants: Random sample of 43 764 Queensland residents aged 40–69 years recruited during 2011, with initial diagnoses of
Main outcome measures: Treating practitioner type and treatment modality for first incident melanoma; second and subsequent treatment events for the primary melanoma.
Results: During a median follow‐up of 8.4 years (interquartile range, 8.3–8.8 years), 1683 eligible participants (720 women, 963 men) developed at least one primary melanoma (
Conclusions: Most incident melanomas in Queensland are diagnosed in primary care, and nearly half are initially managed by partial excision (shave or punch biopsy). Second or third, wider excisions are undertaken in about 90% of cases.
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This study was supported by the National Health and Medical Research Council (NHMRC; APP1073898; APP1063061; APP1185416). David Whiteman is supported by an NHMRC Research Fellowship (APP11554130). The funders played no role in the design, execution, analysis or interpretation of this study. We thank Cancer Alliance Queensland who maintain the Queensland Cancer Register for their valuable contributions to this study.
No relevant disclosures.
Objective: To determine the feasibility of universal genetic testing of women with newly diagnosed breast cancer, to estimate the incidence of pathogenic gene variants and their impact on patient management, and to evaluate patient and clinician acceptance of universal testing.
Design, setting, participants: Prospective study of women with invasive or high grade
Main outcome measures: Germline testing by DNA sequencing, filtered for nineteen hereditary breast and ovarian cancer genes that could be classified as actionable; only pathogenic variants were reported. Surveys before and after genetic testing assessed pilot phase participants’ perceptions of genetic testing, and psychological distress and cancer‐specific worry. A separate survey assessed clinicians’ views on universal testing.
Results: Pathogenic germline variants were identified in 31 of 474 expanded study phase participants (6.5%), including 28 of 429 women with invasive breast cancer (6.5%). Eighteen of the 31 did not meet current genetic testing eligibility guidelines (probability of a germline pathogenic variant ≥ 10%, based on CanRisk, or Manchester score ≥ 15). Clinical management was changed for 24 of 31 women after identification of a pathogenic variant. Including 68 further women who underwent genetic testing outside the study, 44 of 542 women carried pathogenic variants (8.1%). Acceptance of universal testing was high among both patients (90 of 103, 87%) and clinicians; no decision regret or adverse impact on psychological distress or cancer‐specific worry were reported.
Conclusion: Universal genetic testing following the diagnosis of breast cancer detects clinically significant germline pathogenic variants that might otherwise be missed because of testing guidelines. Routine testing and reporting of pathogenic variants is feasible and acceptable for both patients and clinicians.
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We thank the women who took part in the study, as well as the staff of the Parkville Breast Service and the Parkville Familial Cancer Centre for their assistance and support. The study was supported by grants from the National Breast Cancer Foundation (IIRS‐20‐080) and the National Health and Medical Research Council (NHMRC; 1153049). Geoffrey J Lindeman is supported by an NHMRC Leadership Fellowship (1175960) and the Breast Cancer Research Foundation.
No relevant disclosures.
Objectives: To assess the mental health and wellbeing of health and aged care workers in Australia during the second and third years of the coronavirus disease 2019 (COVID‐19) pandemic, overall and by occupation group.
Design, setting, participants: Longitudinal cohort study of health and aged care workers (ambulance, hospitals, primary care, residential aged care) in Victoria: May–July 2021 (survey 1), October–December 2021 (survey 2), and May–June 2022 (survey 3).
Main outcome measures: Proportions of respondents (adjusted for age, gender, socio‐economic status) reporting moderate to severe symptoms of depression (Patient Health Questionnaire‐9, PHQ‐9), anxiety (Generalized Anxiety Disorder scale, GAD‐7), or post‐traumatic stress (Impact of Event Scale‐6, IES‐6), burnout (abbreviated Maslach Burnout Inventory, aMBI), or high optimism (10‐point visual analogue scale); mean scores (adjusted for age, gender, socio‐economic status) for wellbeing (Personal Wellbeing Index–Adult, PWI‐A) and resilience (Connor Davidson Resilience Scale 2, CD‐RISC‐2).
Results: A total of 1667 people responded to at least one survey (survey 1, 989; survey 2, 1153; survey 3, 993; response rate, 3.3%). Overall, 1211 survey responses were from women (72.6%); most respondents were hospital workers (1289, 77.3%) or ambulance staff (315, 18.9%). The adjusted proportions of respondents who reported moderate to severe symptoms of depression (survey 1, 16.4%; survey 2, 22.6%; survey 3, 19.2%), anxiety (survey 1, 8.8%; survey 2, 16.0%; survey 3, 11.0%), or post‐traumatic stress (survey 1, 14.6%; survey 2, 35.1%; survey 3, 14.9%) were each largest for survey 2. The adjusted proportions of participants who reported moderate to severe symptoms of burnout were higher in surveys 2 and 3 than in survey 1, and the proportions who reported high optimism were smaller in surveys 2 and 3 than in survey 1. Adjusted mean scores for wellbeing and resilience were similar at surveys 2 and 3 and lower than at survey 1. The magnitude but not the patterns of change differed by occupation group.
Conclusion: Burnout was more frequently reported and mean wellbeing and resilience scores were lower in mid‐2022 than in mid‐2021 for Victorian health and aged care workers who participated in our study. Evidence‐based mental health and wellbeing programs for workers in health care organisations are needed.
Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12621000533897 (observational study; retrospective).
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This investigation was supported by the Victorian Government COVID‐19 research fund (Department of Jobs, Precincts and Regions, HHSF/20/12957) and WorkSafe Victoria. The COVIC‐HA investigator team acknowledges the contributions of Allen Cheng, Danny Liew, and Helena Teede (Monash University) to the conceptualisation and delivery of the COVIC‐HA project. The COVIC‐HA investigator team also acknowledges all participating institutions and health care workers for their time and contribution to the COVIC‐HA project and their efforts to keep all Victorians safe throughout the COVID‐19 pandemic. Karin Leder (APP115500), Carol Hodgson (APP1173271), and Philip Russo (APP1156312) are supported by National Health and Medical Research Fellowships. James M Trauer is supported by a Monash Senior Postdoctoral Fellowship.
No relevant disclosures.
If you or anyone you know is experiencing distress, please call Lifeline on 13 11 14 (www.lifeline.org.au) or beyondblue (www.beyondblue.org.au) on 1300 22 46 36.
Abstract
Objective: To investigate in‐hospital mortality among people admitted to Australian intensive care units (ICUs) with conditions other than coronavirus disease 2019 (COVID‐19) during the COVID‐19 pandemic.
Design: National, multicentre, retrospective cohort study; analysis of data in the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS CORE) Adult Patient Database.
Setting, participants: Adults (16 years or older) without COVID‐19 admitted to Australian ICUs, 1 January 2016 – 30 June 2022.
Main outcome measures: All‐cause in‐hospital mortality, unadjusted and relative to the January 2016 value, adjusted for illness severity (Australian and New Zealand Risk of Death [ANZROD] and hospital type), with ICU as a random effect. Points of change in mortality trends (breakpoints) were identified by segmental regression analysis.
Results: Data for 950 489 eligible admissions to 186 ICUs were available. In‐hospital mortality declined steadily from January 2016 to March 2021 by 0.3% per month (P < 0.001; March 2021 v January 2016: adjusted odds ratio [aOR], 0.70; 95% confidence interval [CI], 0.62–0.80), but rose by 1.4% per month during March 2021 – June 2022 (P < 0.001; June 2022 v January 2016: aOR, 1.03; 95% CI, 0.90–1.17). The rise in mortality continued after the number of COVID‐19‐related ICU admissions had declined; mortality increased in jurisdictions with lower as well as in those with higher numbers of COVID‐19‐related ICU admissions.
Conclusion: The rise in in‐hospital mortality among people admitted to Australian ICUs with conditions other than COVID‐19 from March 2021 reversed the improvement of the preceding five years. Changes to health service delivery during the pandemic and their consequences should be investigated further.