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Abstract

Objective: To compare the concordance and acceptability of saliva testing with standard‐of‐care oropharyngeal and bilateral deep nasal swab testing for severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) in children and in general practice.

Design: Prospective multicentre diagnostic validation study.

Setting: Royal Children’s Hospital, and two general practices (cohealth, West Melbourne; Cirqit Health, Altona North) in Melbourne, July–October 2020.

Participants: 1050 people who provided paired saliva and oropharyngeal‐nasal swabs for SARS‐CoV‐2 testing.

Main outcome measures: Numbers of cases in which SARS‐CoV‐2 was detected in either specimen type by real‐time polymerase chain reaction; concordance of results for paired specimens; positive percent agreement (PPA) for virus detection, by specimen type.

Results: SARS‐CoV‐2 was detected in 54 of 1050 people with assessable specimens (5%), including 19 cases (35%) in which both specimens were positive. The overall PPA was 72% (95% CI, 58–84%) for saliva and 63% (95% CI, 49–76%) for oropharyngeal‐nasal swabs. For the 35 positive specimens from people aged 10 years or more, PPA was 86% (95% CI, 70–95%) for saliva and 63% (95% CI, 45–79%) for oropharyngeal‐nasal swabs. Adding saliva testing to standard‐of‐care oropharyngeal‐nasal swab testing increased overall case detection by 59% (95% CI, 29–95%). Providing saliva was preferred to an oropharyngeal‐nasal swab by most participants (75%), including 141 of 153 children under 10 years of age (92%).

Conclusion: In children over 10 years of age and adults, saliva testing alone may be suitable for SARS‐CoV‐2 detection, while for children under 10, saliva testing may be suitable as an adjunct to oropharyngeal‐nasal swab testing for increasing case detection.

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1 The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC
2 The Royal Children’s Hospital, Melbourne, VIC
3 Melbourne Medical School, University of Melbourne, Melbourne, VIC
4 The Royal Women’s Hospital, Melbourne, VIC
5 cohealth, Melbourne, VIC
6 Cirqit Health, Melbourne, VIC
7 The University of Melbourne, Melbourne, VIC
8 Public Health Laboratory, University of Melbourne, Melbourne, VIC
9 Royal Melbourne Hospital, Melbourne, VIC
10 Victorian Infectious Diseases Reference Laboratory, Melbourne Health, Melbourne, VIC
11 Melbourne Health, Melbourne, VIC
12 Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC), Murdoch Children’s Research Institute, Melbourne, VIC

Correspondence: jane.oliver@unimelb.edu.au

Acknowledgements:

Our study was supported by a donation from the Isabel and John Gilbertson Charitable Trust. We acknowledge all participants, and the clinical, administrative and laboratory staff who assisted our study at the Royal Children’s Hospital Melbourne, cohealth, Cirqit Health, the Microbiological Diagnostic Unit Public Health Laboratory, Golden Messenger, the Royal Melbourne Hospital, and the University of Melbourne.

Competing interests:

No relevant disclosures.

1. Public Health Laboratory Network. PHLN guidance on laboratory testing for SARS‐CoV‐2 (the virus that causes COVID‐19), version 1.16. Updated Feb 2021. https://www.health.gov.au/resources/publications/phln-guidance-on-laboratory-testing-for-sars-cov-2-the-virus-that-causes-covid-19 (viewed May 2021).
2. Fernandes LL, Pacheco VB, Borges L, et al. Saliva in the diagnosis of COVID‐19: a review and new research directions. J Dent Res 2020; 99: 1435–1443.
3. Kivelä JM, Jarva H, Lappalainen M, Kurkela S. Saliva‐based testing for diagnosis of SARS‐CoV‐2 infection: a meta‐analysis. J Med Virol 2021; 93: 1256–1258.
4. Khiabani K, Amirzade‐Iranaq MH. Are saliva and deep throat sputum as reliable as common respiratory specimens for SARS‐CoV‐2 detection? A systematic review and meta‐analysis. Am J Infect Control 2021; https://doi.org/10.1016/j.ajic.2021.03.008 [online ahead of print].
5. Buban JM, Villanueva PN, Gregorio GEV. Should RT‐PCR of saliva samples be used for diagnosis of COVID‐19? (Philippine COVID‐19 Living Clinical Practice Guidelines). Updated 15 Mar 2021. https://www.psmid.org/wp-content/uploads/2021/05/SALIVA-RT-PCR-CPG-FINAL_031521_MMA.pdf (viewed May 2021).
6. Tsang NNY, So HC, Ng KY, et al. Diagnostic performance of different sampling approaches for SARS‐CoV‐2 RT‐PCR testing: a systematic review and meta‐analysis. Lancet Infect Dis 2021; https://doi.org/10.1016/S1473-3099(21)00146-8 [online ahead of print].
7. Zhu J, Guo J, Xu Y, Chen X. Viral dynamics of SARS‐CoV‐2 in saliva from infected patients. J Infect 2020; 81: e48–e50.
8. Ruggiero A, Sanguinetti M, Gatto A, et al. Diagnosis of COVID‐19 infection in children: less nasopharyngeal swabs, more saliva. Acta Paediatr 2020; 109: 1913–1914.
9. Chong CY, Kam KQ, Li J, et al. Saliva is not a useful diagnostic specimen in children with coronavirus disease 2019 [letter]. Clin Infect Dis 2020; https://doi.org/10.1093/cid/ciaa1376 [online ahead of print].
10. Han MS, Seong MW, Kim N, et al. Viral RNA load in mildly symptomatic and asymptomatic children with COVID‐19, Seoul, South Korea. Emerg Infect Dis 2020; 26: 2497–2499.
11. Yee R, Truong TT, Pannaraj PS, et al. Saliva is a promising alternative specimen for the detection of SARS‐CoV‐2 in children and adults. J Clin Microbiol 2021; 59: e02686–20.
12. Huber M, Schreiber PW, Scheier T, et al. High efficacy of saliva in detecting SARS‐CoV‐2 by RT‐PCR in adults and children. Microorganisms 2021; 9: 642.
13. Fougère Y, Schwob JM, Miauton A, et al. Performance of RT‐PCR on saliva specimens compared to nasopharyngeal swabs for the detection of SARS‐CoV‐2 in children: a prospective comparative clinical trial [preprint]. medRxiv , 1 Mar 2021. https://doi.org/10.1101/2021.02.27.21252571 (viewed May 2021).
14. Felix AC, De Paula AV, Ribeiro AC, et al. Saliva as a reliable sample for COVID‐19 diagnosis in paediatric patients [preprint]. medRxiv , 31 Mar 2021. https://doi.org/10.1101/2021.03.29.21254566 (viewed May 2021).
15. Al Suwaidi H, Senok A, Varghese R, et al. Saliva for molecular detection of SARS‐CoV‐2 in school‐age children. Clin Microbiol Infect 2021; https://doi.org/10.1016/j.cmi.2021.02.009 [online ahead of print].
16. Department of Health and Human Services (Victoria). Assessment and testing criteria for coronavirus (COVID‐19). Updated 9 Apr 2021. https://www.dhhs.vic.gov.au/assessment-and-testing-criteria-coronavirus-covid-19 (viewed May 2021).
17. Department of Health and Human Services (Victoria). Coronavirus (COVID‐19). https://www.dhhs.vic.gov.au/coronavirus (viewed May 2021).
18. Cohen JF, Korevaar DA, Altman DG, et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open 2016; 6: e012799.
19. Williams E, Bond K, Zhang B, et al. Saliva as a noninvasive specimen for detection of SARS‐CoV‐2. J Clin Microbiol 2020; 58: e00776–20.
20. Ku CW, Shivani D, Kwan JQT, et al. Validation of self‐collected buccal swab and saliva as a diagnostic tool for COVID‐19. Int J Infect Dis 2021; 104: 255–261.
21. Zimba R, Kulkarni S, Berry A, et al; the CHASING COVID Cohort Study Team. Testing, testing: what SARS‐CoV‐2 testing services do adults in the United States actually want? [preprint]. medRxiv, 18 Sept 2020. https://doi.org/10.1101/2020.09.15.20195180 (viewed May 2021).
22. Communicable Diseases Network Australia. Coronavirus disease 2019 (COVID‐19): CDNA national guidelines for public health units; version 3.1. Updated 4 June 2020. https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm (viewed May 2021).
23. Caulley L, Corsten M, Eapen L, et al. Salivary detection of COVID‐19. Ann Intern Med 2021; 174: 131–133.
24. Byrne RL, Kay GA, Kontogianni K, et al. Saliva offers a sensitive, specific and non‐invasive alternative to upper respiratory swabs for SARS‐CoV‐2 diagnosis [pre‐print]. medRxiv, 11 July 2020. https://doi.org/10.1101/2020.07.09.20149534 (viewed May 2021).
25. Landry ML, Criscuolo J, Peaper DR. Challenges in use of saliva for detection of SARS CoV‐2 RNA in symptomatic outpatients. J Clin Virol 2020; 130: 104567.
26. Vogels CBF, Watkins AE, Harden CA, et al. SalivaDirect: a simplified and flexible platform to enhance SARS‐CoV‐2 testing capacity. Med (NY) 2021; 2: 263–280.
27. Ceron JJ, Lamy E, Martinez‐Subiela S,et al. Use of saliva for diagnosis and monitoring the SARS‐CoV‐2: a general perspective. J Clin Med 2020; 9: 1491.

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Editorial

Drug‐induced liver injury caused by herbal and dietary supplements: where to next?

Elliot Freeman and Stuart K Roberts

Med J Aust 2021; 215 (6): . || doi: 10.5694/mja2.51223
Published online: 20 September 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Poisoning

Complementary therapies

Collaboration and education are critical to understanding and managing this mounting public health problem

Drug‐induced liver injury (DILI) is a major cause of acute liver failure, leading to liver transplantation and death,1 and it is one of the most frequent safety‐related causes of drug marketing withdrawals.2 DILI poses a growing challenge for clinicians, researchers, and regulatory bodies, with a vast array of new medications and herbal and dietary supplements constantly becoming available. Despite decades of experience with drug hepatotoxicity and the relatively recent development of clinical guidelines, registries, and other collaborative resources, much is still to be learned in this important field of medicine.

1 The Alfred Hospital, Melbourne, VIC
2 Monash University, Melbourne, VIC

Correspondence: S.Roberts@alfred.org.au

Competing interests:

No relevant disclosures.

1. Russo MW, Galanko JA, Shrestha R, et al. Liver transplantation for acute liver failure from drug induced liver injury in the United States. Liver Transplant 2004; 10: 1018–1023.
2. US Department of Health and Human Services, Food and Drug Administration. Guidance for industry. Drug‐induced liver injury: premarketing clinical evaluation. July 2009. https://www.fda.gov/media/116737/download (viewed June 2021).
3. Larrey D. Epidemiology and individual susceptibility to adverse drug reactions affecting the liver. Semin Liver Dis 2002; 22: 145–155.
4. Nash E, Sabih AH, Chetwood J, et al. Drug‐induced liver injury in Australia, 2009–2020: the increasing proportion of non‐paracetamol cases linked with herbal and dietary supplements. Med J Aust 2021; 215: 261–268.
5. Barnes J, McLachlan AJ, Sherwin CM, Enioutina EY. Herbal medicines: challenges in the modern world. Part 1. Australia and New Zealand. Expert Rev Clin Pharmacol 2016; 9: 905–915.
6. Navarro VJ, Khan I, Björnsson E, et al. Liver injury from herbal and dietary supplements. Hepatology 2017; 65: 363–373.
7. Luber RP, Rentsch C, Lontos S, et al. Turmeric induced liver injury: a report of two cases. Case Reports Hepatol 2019; 2019: 1–4.
8. Therapeutic Goods Administration. An overview of the regulation of complementary medicines in Australia. Mar 2013. https://www.tga.gov.au/overview‐regulation‐complementary‐medicines‐australia (viewed June 2021).
9. Benesic A, Leitl A, Gerbes AL. Monocyte‐derived hepatocyte‐like cells for causality assessment of idiosyncratic drug‐induced liver injury. Gut 2016; 65: 1555.
10. Fontana RJ, Watkins PB, Bonkovsky HL, et al; DILIN Study Group. Drug‐Induced Liver Injury Network (DILIN) prospective study: rationale, design and conduct. Drug Safety 2009; 32: 55–68.
11. National Institute of Diabetes and Digestive and Kidney Diseases. LiverTox: Clinical and research information on drug‐induced liver injury. Bethesda (MD): NIDDKD, 2012 (updated June 2021). https://www.ncbi.nlm.nih.gov/books/NBK547852 (viewed June 2021).
12. Assis DN, Navarro VJ. Human drug hepatotoxicity: a contemporary clinical perspective. Expert Opin Drug Metab Toxicol 2009; 5: 463–473.

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Perspectives

Australian and New Zealand approach to diagnosis and management of vaccine‐induced immune thrombosis and thrombocytopenia

Vivien M Chen, Jennifer L Curnow, Huyen A Tran and Philip Y‐I Choi

Med J Aust 2021; 215 (6): . || doi: 10.5694/mja2.51229
Published online: 20 September 2021

Correction(s) for this article:

Erratum | Published online: 14 December 2025
Erratum | Published online: 14 December 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Hematologic diseases

Environment and public health

Immune system diseases

VITT is a potential complication of ChAdOx1‐nCov‐19 vaccination — early recognition is key to improved outcomes

A syndrome of thrombosis and thrombocytopenia has been described in a small proportion of patients vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). The thrombosis can be severe and, on occasion, fatal. The syndrome has been described in patients receiving adenovirus vector ChAdOx1 nCov‐19 (AstraZeneca) or Ad26.COV2.S (Johnson & Johnson–Janssen) encoding SARS‐CoV‐2 spike protein.1,2,3,4

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1 Concord Hospital, Sydney, NSW
2 ANZAC Research Institute, University of Sydney, Sydney, NSW
3 Westmead Hospital, Sydney, NSW
4 Alfred Hospital, Melbourne, VIC
5 Central Clinical School, Monash University, Melbourne, VIC
6 Canberra Hospital, Canberra, ACT

Correspondence: vivien.chen@sydney.edu.au

Acknowledgements:

This guidance has been produced with ongoing critical review and support from the entire THSANZ VITT advisory group: Vivien Chen (Concord Hospital, Sydney); Huyen Tran (Alfred Hospital, Melbourne); Philip Choi (The Canberra Hospital, ACT); Jennifer Curnow (Westmead Hospital, Sydney); Sanjeev Chunilal (Monash Medical Centre, Melbourne); Christopher Ward (Royal North Shore Hospital, Sydney); Freda Passam (Royal Prince Alfred Hospital, Sydney); Timothy Brighton (Prince of Wales Hospital, Sydney); Beng Chong (St George Hospital, Sydney); Robert Bird (Princess Alexandra Hospital, Brisbane); Anoop Enjeti (John Hunter Hospital, Newcastle); Leonardo Pasalic (ICPMR, Sydney); Emmanuel Favaloro (ICPMR, Sydney); Chee Wee Tan (Royal Adelaide Hospital, Adelaide); Ross Baker (Perth Blood Institute, Murdoch University, WA); Simon McCrae (Launceston Hospital, Tasmania); Ibrahim Tohidi‐Esfahani (ANZAC Research Institute. Sydney); Elizabeth Gardiner (Australian National University, Canberra); Joanne Joseph (St Vincent’s hospital, Sydney); Danny Hsu (Liverpool hospital, Sydney); Laura Young (Auckland City Hospital, NZ); Claire McClintock (Auckland City Hospital, NZ); and Eileen Merriman (Waitemata, NZ). We also thank Haematology Society of Australia and New Zealand contributors Steven Lane and Leanne Berkhan.

Competing interests:

No relevant disclosures.

1. Greinacher A, Thiele T, Warkentin TE, et al. Thrombotic thrombocytopenia after ChAdOx1 nCov‐19 vaccination. N Engl J Med 2021; 384: 2092–2101.
2. Schultz NH, Sorvoll IH, Michelsen AE, et al. Thrombosis and thrombocytopenia after ChAdOx1 nCoV‐19 vaccination. N Engl J Med 2021; 384: 2124–2130.
3. Scully M, Singh D, Lown R, et al. Pathologic antibodies to platelet factor 4 after ChAdOx1 nCoV‐19 vaccination. N Engl J Med 2021; 384: 2202–2211.
4. Muir KL, Kallam A, Koepsell SA, Gundabolu K. Thrombotic thrombocytopenia after Ad26.COV2.S vaccination. N Engl J Med 2021; 384: 1964–1965.
5. Medicines and Healthcare products Regulatory Agency. Coronavirus vaccine ‐ weekly summary of Yellow Card reporting, updated 28 April 2021. https://www.gov.uk/government/publications/coronavirus‐covid‐19‐vaccine‐adverse‐reactions/coronavirus‐vaccine‐summary‐of‐yellow‐card‐reporting (viewed May 2021).
6. Greinacher A, Selleng K, Warkentin TE. Autoimmune heparin‐induced thrombocytopenia. J Thromb Haemost 2017; 15: 2099–2114.
7. Thrombosis and Haemostasis Society of Australia and New Zealand Vaccine Thrombocytopenia Working Group. Suspected vaccine induced immune thrombotic thrombocytopenia (VITT): THANZ advisory statement for haematologists. 29 June 2021. https://www.thanz.org.au/documents/item/591 (viewed Aug 2021).
8. Nazy I, Sachs UJ, Arnold DM, et al. Recommendations for the clinical and laboratory diagnosis of vaccine‐induced immune thrombotic thrombocytopenia (VITT) for SARS‐CoV‐2 infections: communication from the ISTH SSC Subcommittee on Platelet Immunology. J Thromb Haemost 2021; 19: 1585–1588.
9. Lee EJ, Cines DB, Gernsheimer T, et al. Thrombocytopenia following Pfizer and Moderna SARS‐CoV‐2 vaccination. Am J Hematol 2021; 96: 534–537.
10. Hocking J, Chiunilal S, Chen VM, et al. The first known case of vaccine‐induced thrombotic thrombocytopenia in Australia. Med J Aust 2021; 215: 19–20. https://www.mja.com.au/journal/2021/215/1/first‐known‐case‐vaccine‐induced‐thrombotic‐thrombocytopenia‐australia
11. Thaler J, Ay C, Gleixner KV, et al. Successful treatment of vaccine‐induced prothrombotic immune thrombocytopenia (VIPIT). J Thromb Haemost 2021; 19: 1819–1822.
12. Australian Government Department of Health. Joint statement from ATAGI and THANZ on thrombosis with thrombocytopenia syndrome (TTS) and the use of COVID‐19 vaccine AstraZeneca. 23 May 2021. https://www.health.gov.au/news/joint‐statement‐from‐atagi‐and‐thanz‐on‐thrombosis‐with‐thrombocytopenia‐syndrome‐tts‐and‐the‐use‐of‐covid‐19‐vaccine‐astrazeneca (viewed May 2021).

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Editorials

Sex disparities continue to characterise the management of non‐ST‐elevation acute coronary syndrome

Carlo Andrea Pivato, Birgit Vogel and Roxana Mehran

Med J Aust 2022; 216 (3): . || doi: 10.5694/mja2.51253
Published online: 20 September 2021

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REFERENCES

Topics

Cardiovascular diseases

Women's health

Women with non‐ST‐elevation acute coronary syndromes remain understudied and undertreated

Ischaemic heart disease is the leading cause of death for women worldwide, and sex‐related disparities continue to characterise its management.1 Despite initiatives addressing this problem, cardiovascular risk in women is still underestimated and guideline recommendations have failed to develop sex‐specific strategies, primarily because women are underrepresented in clinical trials.1,2,3 In particular, sex‐specific pathophysiological mechanisms of ischaemic heart disease have not been fully elucidated; for example, acute coronary syndromes (ACS) are more frequently associated with non‐obstructive coronary artery disease and spontaneous coronary dissection in women than in men.4,5 Further, the symptoms of myocardial infarction may be different in women, and this contributes to its under‐recognition and, ultimately, to delays in appropriate treatment.6

1 Center for Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
2 The Zena and Michael A Wiener Cardiovascular Institute, New York, NY, United States of America
3 Humanitas University, Milan, Italy

Correspondence: roxana.mehran@mountsinai.org

Competing interests:

Roxana Mehran has received institutional research grants from Abbott, Abiomed, Applied Therapeutics, Arena, AstraZeneca, Bayer, Biosensors, Boston Scientific, Bristol‐Myers Squibb, CardiaWave, CellAegis, CERC, Chiesi, Concept Medical, CSL Behring, DSI, Insel Gruppe, Medtronic, OrbusNeich, Philips, Transverse Medical, and Zoll; personal fees from ACC, Boston Scientific, California Institute for Regenerative Medicine (CIRM), Cine‐Med Research, Janssen, WebMD, and SCAI; consulting fees (paid to her institution) from Abbott, Abiomed, AM‐Pharma, Alleviant Medical, Bayer, Beth Israel Deaconess, CardiaWave, CeloNova, Chiesi, CSL Behring, Concept Medical, DSI, Duke University, Idorsia Pharmaceuticals, Medtronic, Novartis, and Philips; and has equity (less than 1%) in Applied Therapeutics, Elixir Medical, and STEL, and her spouse has similarly minor equity in CONTROLRAD. She sits on the scientific advisory boards for the American Medical Association and the Cardiovascular Research Foundation (no fee); her spouse sits on the Biosensors scientific advisory board.

1. Vogel B, Acevedo M, Appelman Y, et al. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021; 397: 2385–2438.
2. Bairey Merz CN, Andersen H, Sprague E, et al. Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: the Women’s Heart Alliance. J Am Coll Cardiol 2017; 70: 123–132.
3. Cushman M, Shay CM, Howard VJ, et al; American Heart Association. Ten‐year differences in women’s awareness related to coronary heart disease: results of the 2019 American Heart Association National Survey. A special report from the American Heart Association. Circulation 2021; 143: e239–e248.
4. Adlam D, Alfonso F, Maas A, Vrints C; ESC‐ACCA Writing Committee. European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection. Eur Heart J 2018; 39: 3353–3368.
5. Collet JP, Thiele H, Barbato E, et al; ESC Scientific Document Group. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST‐segment elevation. Eur Heart J 2021; 42: 1289–1367.
6. Khan NA, Daskalopoulou SS, Karp I, et al; GENESIS PRAXY Team. Sex differences in acute coronary syndrome symptom presentation in young patients. JAMA Intern Med 2013; 173: 1863–1871.
7. Bachelet BC, Hyun K, D'Souza M, et al. Sex differences in the management and outcomes of non‐ST‐elevation acute coronary syndromes. Med J Aust 2021; 215: 153–155.
8. Kunadian V, Chieffo A, Camici PG, et al. An EAPCI expert consensus document on ischaemia with non‐obstructive coronary arteries in collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. Eur Heart J 2020; 41: 3504–3520.
9. Wilkinson C, Bebb O, Dondo TB, et al. Sex differences in quality indicator attainment for myocardial infarction: a nationwide cohort study. Heart 2019; 105: 516–523.
10. Alabas OA, Gale CP, Hall M, et al. Sex differences in treatments, relative survival, and excess mortality following acute myocardial infarction: national cohort study using the SWEDEHEART Registry. J Am Heart Assoc 2017; 6: e007123.

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Editorials

Excessive PSA testing in general practice

Justin J Coleman

Med J Aust 2021; 215 (5): . || doi: 10.5694/mja2.51208
Published online: 6 September 2021

ARTICLE
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Topics

Diagnostic techniques and procedures

Environment and public health

General medicine

Health services administration

Men's health

Neoplasms

The time for actively recommending the screening of asymptomatic men has passed

There is little doubt that Australian doctors order too many prostate‐specific antigen (PSA) screening tests. The analysis by Franco and colleagues of electronic data for 142 000 Victorian general practice patients, published in this issue of the MJA, found that 46% of men aged 70–74 years had had at least two PSA tests during the preceding two years,1 despite Australian guidelines recommending against PSA screening of asymptomatic men in this age group.2 Indeed, the Royal Australian College of General Practitioners (RACGP) does not recommend PSA screening of most asymptomatic men of any age.3 Some testing might be justified (for example, screening of men at high risk, or prostate disease monitoring), but when Australian general practitioner registrars were asked to record specific reasons for ordering PSA tests, “asymptomatic screening” accounted for three‐quarters of requests.4

1 Top End Health Service, Northern Territory Department of Health, Bathurst Island, NT
2 Flinders University, Darwin, NT

Correspondence: justin.coleman@flinders.edu.au

Competing interests:

No relevant disclosures.

1. Franco GS, Hardie RA, Li L, et al. Prostate‐specific antigen testing of asymptomatic men in Australia: an observational study based on electronic general practice data. Med J Aust 2021; 215: 228–229.
2. Prostate Cancer Foundation of Australia and Cancer Council Australia PSA Testing Guidelines Expert Advisory Panel. PSA testing and early management of test‐detected prostate cancer. Jan 2016. https://wiki.cancer.org.au/australiawiki/images/1/1b/PSA_Testing_and_Early_Management_of_Test‐detected_Prostate_Cancer_‐_Clinical_practice_guidelines_‐_Nov15.pdf (viewed June 2021).
3. Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9th edition. Melbourne: RACGP, 2016. https://www.racgp.org.au/download/Documents/Guidelines/Redbook9/17048‐Red‐Book‐9th‐Edition.pdf (viewed June 2021).
4. Magin P, Tapley A, Davey A, et al. Prevalence and associations of general practitioners’ ordering of “non‐symptomatic” prostate‐specific antigen tests: a cross‐sectional analysis. Int J Clin Pract 2017; 71: e12998.
5. Lowe A, Bennett M, Badenoch S. Research, awareness, support: ten years of progress in prostate cancer. 2012 community attitudes survey. Sydney: Prostate Cancer Foundation of Australia, 2012. https://www.prostate.org.au/media/238805/2012_cas_report_online.pdf (viewed June 2021).
6. Pickles K, Carter SM, Rychetnik L, Entwistle VA. Doctors’ perspectives on PSA testing illuminate established differences in prostate cancer screening rates between Australia and the UK: a qualitative study. BMJ Open 2016; 6: e011932.
7. Movember. We believe that every man has the right to know if he has prostate cancer, and that he deserves the right to treat it rather than suffer from a late‐stage diagnosis. Movember, 13 Oct 2011. https://us.movember.com/story/view/id/2234/movember‐s‐position‐on‐the‐psa‐test (viewed June 2021).
8. Urological Society of Australia and New Zealand. Urological Society of Australia and New Zealand PSA testing policy 2009. http://www.urologysa.com.au/pdf/usanz‐2009‐psa‐testing‐policy‐final1.pdf (viewed June 2021).
9. Ilic D, Djulbegovic M, Jung JH, et al. Prostate cancer screening with prostate‐specific antigen (PSA) test: a systematic review and meta‐analysis. BMJ 2018; 362: k3519.
10. Royal Australian College of General Practitioners. Should I have prostate cancer screening? Aug 2015. https://www.racgp.org.au/download/Documents/Guidelines/prostate‐cancer‐screening‐infosheetpdf.pdf (viewed June 2021).

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Editorials

What is the role of general practice in the Chain of Survival for treating people with cardiac arrest?

Siobhán Masterson and Tomás Barry

Med J Aust 2021; 215 (5): . || doi: 10.5694/mja2.51202
Published online: 6 September 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Emergency medicine

General medicine

Cardiovascular diseases

Patient survival is more likely when general practitioners and their staff are trained in resuscitation and equipped with defibrillators

With increasing appreciation of the importance of post‐resuscitation care and long term patient outcomes, the Chain of Survival for patients with cardiac arrest has evolved.1 However, the first three links have not changed: early recognition and an emergency call for medical help; early cardiopulmonary resuscitation; and early defibrillation. If these steps are not immediately and sequentially activated, further links in the Chain of Survival have little or no impact on survival. The study by Haskins and colleagues2 reported in this issue of the MJA re‐affirms the importance of these three links, and provides direction on how they can be further strengthened in community general practice.

1 HSE National Ambulance Service, Limerick, Ireland
2 National University of Ireland Galway, Galway, Ireland
3 UCD Centre for Emergency Medical Science, University College Dublin, Dublin, Ireland

Correspondence: siobhan.masterson@nuigalway.ie

Competing interests:

No relevant disclosures.

1. Perkins GD, Graesner JT, Semeraro F, et al; European Resuscitation Council Guideline Collaborators. European Resuscitation Council guidelines 2021: executive summary. Resuscitation 2021; 161: 1–60.
2. Haskins B, Nehme Z, Cameron PA, Smith K. Cardiac arrests in general practice clinics or witnessed by emergency medical services: a 20‐year retrospective study. Med J Aust 2021; 215: 222–227.
3. Masterson S, McNally B, Cullinan J, et al. Out‐of-hospital cardiac arrest survival in international airports. Resuscitation 2018; 127: 58–62.
4. Niegsch ML, Krarup NT, Clausen NE. The presence of resuscitation equipment and influencing factors at General Practitioners’ offices in Denmark: a cross‐sectional study. Resuscitation 2014; 85: 65–69.
5. Masterson S, Wright P, Dowling J, et al. Out‐of-hospital cardiac arrest (OHCA) survival in rural Northwest Ireland: 17 years’ experience. Emerg Med J 2011; 28: 437–438.
6. Barry T, Headon M, Glynn R, et al. Ten years of cardiac arrest resuscitation in Irish general practice. Resuscitation 2018; 126: 43–48.
7. Barry T, Headon M, Quinn M, et al. General practice and cardiac arrest community first response in Ireland. Resuscitation Plus 2021; 6: 100127.
8. Bury G, Headon M, Dixon M, Egan M. Cardiac arrest in Irish general practice: an observational study from 426 general practices. Resuscitation 2009; 80: 1244–1247.

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Editorials

Call for emergency action to limit global temperature increases, restore biodiversity, and protect health

Lukoye Atwoli, Abdullah H Baqui, Thomas Benfield, Raffaella Bosurgi, Fiona Godlee, Stephen Hancocks, Richard C Horton, Laurie Laybourn‐Langton, Carlos A Monteiro, Ian Norman, Kirsten Patrick, Nigel Praities, Marcel GM Olde Rikkert, Eric J Rubin, Peush Sahni, Richard SW Smith, Nicholas J Talley, Sue Turale and Damián Vázquez

Med J Aust 2021; 215 (5): . || doi: 10.5694/mja2.51221
Published online: 6 September 2021

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Environment and public health

Wealthy nations must do much more, much faster

The UN General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference (COP26) in Glasgow, UK. Ahead of these pivotal meetings, we — the editors of health journals worldwide — call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature, and protect health.

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1 East African Medical Journal, Makhanda, South Africa
2 Journal of Population, Health and Nutrition, UK
3 Danish Medical Journal, Copenhagen, Denmark
4 PLOS Medicine, San Francisco, CA, USA
5 The BMJ, London, UK
6 British Dental Journal, London, UK
7 The Lancet, London, UK
8 UK Health Alliance on Climate Change, London, UK
9 Revista de Saúde Pública, São Paulo, Brazil
10 International Journal of Nursing Studies, London, UK
11 Canadian Medical Association Journal, Ottawa, Canada
12 Pharmaceutical Journal, London, UK
13 Dutch Journal of Medicine, Amsterdam, The Netherlands
14 New England Journal of Medicine, Waltham, MA, USA
15 National Medical Journal of India, New Delhi, India
16 Medical Journal of Australia, Sydney, NSW, Australia
17 International Nursing Review
18 Pan American Journal of Public Health, Washington, DC, USA

Correspondence: laurie.laybourn@ukhealthalliance.org

Competing interests:

Fiona Godlee serves on the executive committee for the UK Health Alliance on Climate Change and is a Trustee of the Eden Project. Richard Smith is the chair of Patients Know Best, has stock in UnitedHealth Group, has done consultancy work for Oxford Pharmagenesis, and is chair of the Lancet Commission on the Value of Death. A complete list of Nicholas Talley's disclosures is available at https://www.mja.com.au/journal/staff/editor-chief-professor-nick-talley

1. In support of a healthy recovery. https://healthyrecovery.net (viewed July 2021).
2. Intergovernmental Panel on Climate Change. Summary for policymakers. In: Global warming of 1.5°C. An IPCC special report on the impacts of global warming of 1.5°C above pre‐industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty. 2018. https://www.ipcc.ch/sr15/ (viewed July 2021).
3. Intergovernmental Science‐Policy Platform on Biodiversity and Ecosystem Services. Summary for policymakers: the global assessment report on biodiversity and ecosystem services. 2019. https://ipbes.net/sites/default/files/2020‐02/ipbes_global_assessment_report_summary_for_policymakers_en.pdf (viewed July 2021).
4. Watts N, Amann M, Arnell N, et al. The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises. Lancet 2021; 397: 129–170.
5. Rocque RJ, Beaudoin C, Ndjaboue R, et al. Health effects of climate change: an overview of systematic reviews. BMJ Open 2021; 11: e046333.
6. Haines A, Ebi K. The imperative for climate action to protect health. N Engl J Med 2019; 380: 263–273.
7. United Nations Environment Programme and International Livestock Research Institute. Preventing the next pandemic: zoonotic diseases and how to break the chain of transmission. 2020. https://72d37324‐5089‐459c‐8f70‐271d19427cf2.filesusr.com/ugd/056cf4_b5b2fc067f094dd3b2250cda15c47acd.pdf (viewed July 2021).
8. Intergovernmental Panel on Climate Change. Summary for policymakers. In: Climate change and land: an IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems. 2020. https://www.ipcc.ch/site/assets/uploads/sites/4/2020/02/SPM_Updated‐Jan20.pdf (viewed July 2021).
9. Lenton TM, Rockström J, Gaffney O, et al. Climate tipping points—too risky to bet against. Nature 2019; 575: 592–595.
10. Wunderling N, Donges JF, Kurths J, Winkelmann R. Interacting tipping elements increase risk of climate domino effects under global warming. Earth Syst Dynam 2021; 12: 601–619.
11. High Ambition Coalition. https://www.hacfornatureandpeople.org (viewed July 2021).
12. Global Climate and Health Alliance. Are national climate commitments enough to protect our health? https://climateandhealthalliance.org/initiatives/healthy‐ndcs/ndc‐scorecards/ (viewed July 2021).
13. Climate strikers: Open letter to EU leaders on why their new climate law is ‘surrender.’ Carbon Brief 2020; 3 Mar. https://www.carbonbrief.org/climate‐strikers‐open‐letter‐to‐eu‐leaders‐on‐why‐their‐new‐climate‐law‐is‐surrender (viewed July 2021).
14. Fajardy M, Köberle A, MacDowell N, Fantuzzi A. BECCS deployment: a reality check. Grantham Institute Briefing Paper 28. January 2019. https://www.imperial.ac.uk/media/imperial‐college/grantham‐institute/public/publications/briefing‐papers/BECCS‐deployment‐‐‐a‐reality‐check.pdf (viewed July 2021).
15. Anderson K, Peters G. The trouble with negative emissions. Science 2016; 354: 182–183.
16. Climate Action Tracker. https://climateactiontracker.org (viewed July 2021).
17. Secretariat of the Convention on Biological Diversity. Global biodiversity outlook 5. https://www.cbd.int/gbo5 (viewed July 2021).
18. Steffen W, Richardson K, Rockström J, et al. Sustainability. Planetary boundaries: guiding human development on a changing planet. Science 2015; 347: 1259855.
19. UK Health Alliance on Climate Change. Our calls for action. http://www.ukhealthalliance.org/cop26/ (viewed July 2021).
20. Climate Action Tracker. Warming projections global update: May 2021. https://climateactiontracker.org/documents/853/CAT_2021‐05‐04_Briefing_Global‐Update_Climate‐Summit‐Momentum.pdf (viewed July 2021).
21. United Nations Environment Programme. Emissions gap report 2020. UNEP, 2020.
22. Markandya A, Sampedro J, Smith SJ, et al. Health co‐benefits from air pollution and mitigation costs of the Paris Agreement: a modelling study. Lancet Planet Health 2018; 2: e126–e133.
23. Paremoer L, Nandi S, Serag H, Baum F. Covid‐19 pandemic and the social determinants of health. BMJ 2021; 372: n129.

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Research letter

Public support for phasing out the sale of cigarettes in Australia

Emily Brennan, Sarah Durkin, Michelle M Scollo, Maurice Swanson and Melanie Wakefield

Med J Aust 2021; 215 (10): . || doi: 10.5694/mja2.51224
Published online: 30 August 2021

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Environment and public health

As smoking rates continue to decline in some countries, including Australia,1 a goal once unthinkable is now being considered: phasing out the retail sale of combustible tobacco products.2,3 In 2009, 72% of Victorian adults and 57% of smokers felt it would be good if there came a time when cigarettes were no longer available for sale.4 In 2019, we assessed support among Victorian adults for phasing out retail sales, and canvassed their views on timeframes for doing so.

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1 Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC
2 The University of Melbourne, Melbourne, VIC
3 Australian Council on Smoking and Health (ACOSH), Perth, WA

Correspondence: emily.brennan@cancervic.org.au

Acknowledgements:

The Victorian Smoking and Health survey was supported by Quit Victoria, with funding from VicHealth, the Victorian Department of Health and Human Services, and Cancer Council Victoria. We acknowledge the contribution of Linda Hayes, Andrea Nathan and Emily Bain (Cancer Council Victoria) to the collection and analysis of the Victorian Smoking and Health Survey data.

Competing interests:

Emily Brennan, Sarah Durkin, Michelle Scollo and Melanie Wakefield received funding from VicHealth, the Victorian Department of Health and Human Services, and Cancer Council Victoria during the study.

1. Australian Institute of Health and Welfare. National Drug Strategy Household Survey 2019 (Cat. no. PHE 270). Data tables, 2. Tobacco smoking supplementary tables. 16 July 2020, https://www.aihw.gov.au/reports/illicit‐use‐of‐drugs/national‐drug‐strategy‐household‐survey‐2019/data (viewed Aug 2020).
2. Daube M, Moodie R. Exit strategy: we can do it for COVID‐19, why not tobacco? InSight+ [online], 18 May 2020. https://insightplus.mja.com.au/2020/19/exit‐strategy‐we‐can‐do‐it‐for‐covid‐19‐why‐not‐tobacco (viewed May 2021).
3. Gartner C. CREATE a new path to a smoke‐free Australia. InSight+ [online], 12 Oct 2020. https://insightplus.mja.com.au/2020/40/create‐a‐new‐path‐to‐a‐smoke‐free‐australia (viewed May 2021).
4. Hayes L, Wakefield MA, Scollo MM. Public opinion about ending the sale of tobacco in Australia. Tob Control 2014; 23: 183–184.
5. Australian Bureau of Statistics. 3101.0. Population by age and sex, Australian states and territories, Dec 2016. June 2017. https://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/432B4729A87614B1CA2581A70015892B?opendocument (viewed May 2021).
6. Swanson M. Time to talk about phasing out sale of tobacco products. The West Australian (Perth), 31 July 2020. https://edition.thewest.com.au/html5/shared/ShowArticle.aspx?doc=WAN%2F2020%2F07%2F31&entity=Ar03202&sk=E3B375CB&mode=text (viewed May 2021). ■

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Adding saliva testing to oropharyngeal and deep nasal swab testing increases PCR detection of SARS‐CoV‐2 in primary care and children

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Drug‐induced liver injury caused by herbal and dietary supplements: where to next?

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What is the role of general practice in the Chain of Survival for treating people with cardiac arrest?

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Call for emergency action to limit global temperature increases, restore biodiversity, and protect health

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Public support for phasing out the sale of cigarettes in Australia

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The influence of the surveillance time interval on the risk of advanced neoplasia after non‐advanced adenoma removal

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Estimating the abortion rate in Australia from National Hospital Morbidity and Pharmaceutical Benefits Scheme data

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Adding saliva testing to oropharyngeal and deep nasal swab testing increases PCR detection of SARS‐CoV‐2 in primary care and children

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Drug‐induced liver injury caused by herbal and dietary supplements: where to next?

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Australian and New Zealand approach to diagnosis and management of vaccine‐induced immune thrombosis and thrombocytopenia

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Sex disparities continue to characterise the management of non‐ST‐elevation acute coronary syndrome

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Comment

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Excessive PSA testing in general practice

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Do you have any competing interests to declare? *

What is the role of general practice in the Chain of Survival for treating people with cardiac arrest?

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Call for emergency action to limit global temperature increases, restore biodiversity, and protect health

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Public support for phasing out the sale of cigarettes in Australia

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The influence of the surveillance time interval on the risk of advanced neoplasia after non‐advanced adenoma removal

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Estimating the abortion rate in Australia from National Hospital Morbidity and Pharmaceutical Benefits Scheme data

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