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Climate change — driven primarily by the extraction and burning of fossil fuels — is profoundly affecting our health. Some impacts are direct and immediate, such as from worsening heatwaves and extreme weather events.1 Others are indirect and more complex, including changes to the social determinants of health and the distribution of infectious diseases, and increased water and food insecurity. The risks associated with climate change are not being felt equally, and it is the most disadvantaged people and countries (who have generally contributed the least to climate change) that are disproportionately exposed and vulnerable.2
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We would like to acknowledge the Climate and Health Foundation for providing financial support for the development of this manuscript. The Climate and Health Foundation had no role in the planning, writing or publication of the work.
Philomena Colagiuri received funding from the Climate and Health Foundation for her role as Lancet Countdown Oceania Fellow. The Climate and Health Foundation also provided funding for her to attend COP29 in Baku, Azerbaijan in 2024 (airfare, accommodation, daily stipend). Jake Williams received funding from the Climate and Health Foundation for his role as Lancet Countdown Oceania Fellow. The Climate and Health Foundation also provided funding for him to attend COP29 in Baku, Azerbaijan in 2024. Jake Williams received funding from the Wiser Healthcare Research Collaboration for the 2024 EMCR Seed Grant, and funding from HEAL (Healthy Environments And Lives) National Research Network (National Health and Medical Research Council Grant No. 2008937) for the 2024 Travel Award and 2023 Travel Award. Paul Beggs received funding from the Lancet Countdown for in‐kind support (payment of airfare, accommodation etc.) to attend the Lancet Countdown Annual Meeting, London, 2024. He also received funding from the Climate and Health Foundation for in‐kind support (payment of airfare, accommodation etc.) to attend UNFCCC COP28, Dubai, 2023. Paul Beggs is the Director of Oceania Regional Centre for the Lancet Countdown. Ying Zhang has received funding from the Climate and Health Foundation for in‐kind support (payment of airfare, accommodation etc.) to attend UNFCCC COP28, Dubai, 2023. Ying Zhang is a Co‐Director of Oceania Regional Centre for the Lancet Countdown and is on the Editorial Board for the Journal of Climate Change and Health.
To enable proactive decisions that promote a healthy start to life, our understanding of children's health and development at a population level is only as good as the data we collect and analyse.1 A decade ago, Olver called for improved access and capacity to link data in the Australian context, voiced in the Medical Journal of Australia.2 In the intervening years, there have been varying rates of progress across Australian states and territories. Victoria's routinely collected statewide data documenting children's health and development from pregnancy to school entry, the maternal and child health (MCH) service dataset, is the most comprehensive nationally with the highest population uptake, yet remains unlinked to key health and determinants data and longitudinal cohorts.3 The time to address this is now given increasing policy interest in the first 2000 days (conception to five years of age) demonstrated by the national Early Years Strategy 2024–2034 and the $14 billion rollout of Victoria's Best Start, Best Life reforms.4,5,6
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This perspective article was written as part of Ashleigh Shipton's PhD project “The effect of COVID‐19 pandemic and policies on maternal and child health outcomes in the Western Health region of Victoria: a mixed methods study” funded by the University of Melbourne, Royal Australasian College of Physicians and Murdoch Children's Research Institute. The Royal Children's Hospital Melbourne Human Research Ethics Committee approved Ashleigh Shipton's PhD project as above (reference number: 87751). Melissa Wake was funded by the Australian National Health and Medical Research Council (NHMRC) Principal Research Fellowship 1160906. Sharon Goldfeld was funded by NHMRC Practitioner Fellowship 2026263. Ashleigh Shipton, Meredith O'Connor, Melissa Wake, Sharon Goldfeld, Jatender Mohal and Fiona Mensah's research at the Murdoch Children's Research Institute is supported by the Victorian Government's Operational Infrastructure Support Program. Rhiannon Pilkington was supported by NHMRC CTCS (1187489). Leesa Hooker, Kristina Edvardsson, Helen Lees and Catina Adam's in‐kind support is funded by their teaching and research at La Trobe University. Helen Lees receives in‐kind support from the Municipal Association of Victoria as the maternal and child health policy and program lead. Authors acknowledge that project and salary support for projects unrelated to the present manuscript were received from funding bodies including the NHMRC, Medical Research Future Fund, Paul Ramsay Foundation, State Government of Tasmania, Victorian Government, right@home implementation licence, Australian National Research Organisation for Women's Safety, Victorian Department of Social Services, Family Safety Victoria, Channel 7 Children's Research Foundation, South Australian Department of Human Services, Uniting Communities, Junction Australia, and Commissioner for Aboriginal Children and Young People. Authors acknowledge that payment of honoraria unrelated to the present manuscript were received for lectures, presentations and manuscript peer review. The University of Melbourne had no role in planning or writing this article. The other funders had no role in the planning, writing or publication of this article.
In Australia, little prevalence data around vision impairment exist. However, self‐reported data from the Australian Bureau of Statistics 2017–18 National Health Survey1 suggest that around 800 000 people have a vision impairment or are blind (excluding uncorrected refractive errors).2 The leading cause of vision impairment in working‐age adults are inherited retinal diseases (IRDs)3 — a group of genetic conditions that primarily affect the retina. Other than one particular gene therapy for biallelic RPE65‐associated retinal dystrophy, there are no other clinically available treatments to safely prevent vision loss or restore vision for someone with an IRD.4
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Eden Robertson and Anai Gonzalez‐Cordero are supported by a 2021 Medical Research Future Fund Stem Cell Therapies Mission (APP2016039). Consumers (Meredith Prain, Leighton Boyd, Emily Shepard, Hollie Feller, Sally Karandrews, and Kanae Yamamoto) are also supported by a 2021 Medical Research Future Fund Stem Cell Therapies Mission (APP2016039). Kate Hetherington is supported by the Cancer Institute Translational Program Grant (2021/TPG2112) as well as Luminesce Alliance and the Zero Childhood Cancer National Personalised Medicine Program for children with high risk cancer, a joint initiative of Children's Cancer Institute and Kids Cancer Centre, Sydney Children's Hospital, Randwick.
No relevant disclosures.
Attacks on health care in conflict zones are increasing, depriving civilians of urgently needed care, putting the lives of patients and health care workers at risk, and contributing to the deterioration in the health of affected populations.1 Health care is protected under international humanitarian law but there are challenges faced with its enforcement. Consequently, we opine that physicians and medical societies have a moral imperative to advocate for the enduring protection of health care workers, patients, and health care infrastructure in conflict zones.
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Correspondence: lussier.sandra1@gmail.com
The statements and opinions in this manuscript reflect the authors’ views alone and do not represent the official policies or views of our institutions.
No relevant disclosures.
Culturally safe health care for all people is a requirement for medical practice in Australia and Aotearoa New Zealand.1,2 In both countries, legislation protects the rights of the lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) community. Despite progress toward equality, higher rates of discrimination towards LGBTQI+ communities contribute to double the risk of mental health disorders and increased inequities in health outcomes, such as cardiovascular disease and cancer survivorship, compared with their non‐LGBTQI+ counterparts.3,4,5
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Open access publishing facilitated by University of Otago, as part of the Wiley ‐ University of Otago agreement via the Council of Australian University Librarians.
No relevant disclosures.
Objective: To examine the accuracy of the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), the population‐based clinical quality registry for people with kidney failure, in identifying Aboriginal and/or Torres Strait Islander people.
Design: Population‐based cohort study of reporting accuracy.
Setting: New South Wales, 2006–2020.
Participants: Incident kidney failure patients.
Main outcome measures: Sensitivity and specificity of identification of Aboriginal and/or Torres Strait Islander people in ANZDATA compared with identification with Enhanced Reporting of Aboriginality (ERA) methods using linked health datasets.
Results: Of 11 708 patients, 693 (5.9%) were identified as Aboriginal and/or Torres Strait Islander people using ERA methods, with 484 recognised in ANZDATA. Overall ANZDATA sensitivity was 67.0% (95% CI, 63.3–70.5%), with high specificity (99.8%; 95% CI, 99.7–99.9%). Sensitivity was lowest for males (63.8%; 95% CI, 58.7–68.6), people aged under 18 years (45.0%; 95% CI, 23.1–68.5%) or over 65 years (61.7%; 95% CI, 53.8–69.2%), and those with greater socio‐economic advantage (56.6%; 95% CI, 46.6–66.2%), living in major cities (53.8%; 95% CI, 48.0–59.5%) and with no comorbidities (47.7%; 95% CI, 37.0–58.6%). Aboriginal and/or Torres Strait Islander people identified in ANZDATA had lower rates of waitlisting for kidney transplantation (17.8%
Conclusion: Aboriginal and/or Torres Strait Islander people were under‐reported in ANZDATA. There were multiple biases in characteristics and outcomes for people identified in ANZDATA compared with those identified by ERA using linked data. This highlights the importance of data integration as a quality improvement mechanism and identifying barriers to disclosure.
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Data sharing:
The data for this study will not be shared, as we do not have permission from the data custodians or ethics approval to do so. Data may be available upon request from the data custodians.
Angela Webster is supported by a National Health and Medical Research Council Leadership Fellowship (1177117). This study was supported by a University of Sydney External Research Collaboration Seed Funding Grant (CT34675). We thank ANZDATA and the NSW Ministry of Health for access to registry and population health data, and the Centre for Health Record Linkage for linking the datasets. We are grateful to the MHLL Aboriginal Sovereign Steering Committee, Samantha Bateman and the ANZDATA Aboriginal and Torres Strait Islander Health Working Group for helpful feedback and guidance.
No relevant disclosures.
Introduction: Opioid use and dependence are prevalent among incarcerated people, contributing to elevated rates of overdose and other harms in this population. Opioid agonist treatment (OAT) has been shown to be an effective intervention to mitigate these risks. However, challenges to health care implementation in the custodial sector result in suboptimal and variable access to OAT in prisons nationally.
Main recommendations: Among a national multidisciplinary expert panel, we conducted a modified Delphi study that yielded 19 recommendations to government, relevant health authorities and custodial health services. These recommendations cover five core domains: induction or continuation of OAT, OAT options and administration, transition of care to the community, special populations, and organisational support. Key recommendations include prompt recognition and treatment of opioid withdrawal, active linkage to community‐based OAT providers upon release, and ensuring appropriate organisational support through local protocols, adequate funding, and monitoring of key program indicators.
Changes in management as a result of this statement: This consensus statement addresses a significant gap in national policy on OAT in Australian prisons. The recommendations, finalised in July 2024, set forth best practice standards grounded in evidence and expert consensus. We expect that implementing these recommendations will enhance the quality, consistency and continuity of OAT both within prison and upon release. Optimising OAT provision is crucial for improving health outcomes and addressing the risk of overdose, which is the leading cause of death among people released from prison.
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The Consensus statement was prepared on behalf of the National Prisons Addiction Medicine Network (NPAMN). We acknowledge the time and contributions from everyone on the expert panel: Adrian Dunlop, Andrew Wiley, Bianca Davidde, Christine Watson, David Onu, Ele Morrison, Jeremy Hayllar, Jocelyn Chan, Katerina Lagios, Kevin Fontana, Mark Stoove, Peter Thompson, Rebecca Winter, Shalini Arunogiri, Suzanne Nielsen, Thileepan Naren, and Tom Turnbull. The author(s) received no financial support for the research, authorship, and/or publication of this article.
Rebecca Winter has received investigator‐initiated funding from Gilead Sciences for research unrelated to this work. Thileepan Naren has received speaking honoraria from Camarus. All other authors report no relevant disclosures.
Australia's health care system is grappling with a mismatch of demand and capacity, with bottlenecks in access to, and transitions of, care and rising costs.1 Hospital‐in‐the‐home (HITH) models of care are suggested as sustainable patient‐centred, value‐based solutions.2
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We acknowledge the work of The Austin Hospital‐in‐the‐Home (HITH) team and creators of the flowcharts in the Box, supplied and included with permission. Our thanks to: Angela Sullivan, Nurse Unit Manager, HITH and Virtual Care; Mark Horrigan, Medical Director HITH and Virtual Care; Danielle Panaccio, HITH Consultant; and Daniel Thuys, HITH Case Manager.
No relevant disclosures.
Introduction: Buruli ulcer, caused by Mycobacterium ulcerans, is increasing in incidence and spreading to new areas in southeast Australia. With increasing experience and emerging evidence, this consensus statement considers contemporary data to provide up‐to‐date recommendations to clinicians who may encounter this disease. The emergence of Buruli ulcer in previously non‐endemic areas highlights the importance of increasing clinician and community awareness of this disease.
Main recommendations and changes in management as a result of this consensus statement:
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Abstract
Objectives: To assess the commitment of the ten largest pharmaceutical companies operating in Australia to achieving net zero emissions by evaluating their accountability metrics, ambitions, and quantifiable actions taken.
Study design: Cross‐sectional study; analysis of publicly available company reports published during 12 December 2015 – 31 December 2023.
Setting, participants: Ten largest pharmaceutical companies operating in Australia, defined by total pharmaceutical costs (to patients and Pharmaceutical Benefits Scheme) for PBS‐subsidised medications, as reported in PBS expenditure and prescriptions reports for 2020–21 and 2022–23.
Main outcome measures: Content analysis of publicly available documents for the ten companies using modified criteria from the PricewaterhouseCoopersBuilding blocks for net zero transformation framework , with three domains: accountability, ambition, and action; the Carbon Disclosure Project (CDP) grading; the Science Based Targets initiative (SBTi) approval system. We focused on measurement, target setting, and achievement of emission reductions, and ranked the environmental sustainability of companies using a points and colour coding system.
Results: Three groups could be defined by evidence of their commitment to emissions reductions. The first — companies leading emissions reduction efforts, with SBTi‐approved near term targets, consistent emissions monitoring, well defined commitments, and quantified evidence of action — includes AstraZeneca, Novartis, Johnson & Johnson, Bayer, and Merck & Co. The second group — companies that had made commitments to SBTi‐approved targets but their disclosure records are limited — includes AbbVie and Roche. The third group — without public commitments to achieving net zero emissions, minimal or no SBTi‐approved targets, and minimal disclosure or monitoring of emissions — includes Viatris, Vertex, and Arrotex.
Conclusions: The ten largest pharmaceutical companies in Australia are moving towards net zero greenhouse gas emissions at different rates. Gaps in standardised reporting processes should be closed, and further qualitative research on industry‐wide environmental sustainability policy and practice is needed.