Topics

In Australia, highly effective direct‐acting antiviral (DAA) therapy has been available for people with chronic hepatitis C through the Pharmaceutical Benefits Scheme (PBS) since March 2016. All clinicians, including general practitioners, have prescribing authority.1 In many countries, DAA prescribing is restricted to specific medical specialties,2 creating barriers to treatment by disrupting the cascade of care and limiting access for those unable or unwilling to attend specialist services.3 In this study, we characterised DAA prescribing by GPs in the Australian model of DAA access.

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1 The Kirby Institute, UNSW Sydney, Sydney, NSW
2 Centre for Population Health, NSW Health, Sydney, NSW
3 76 Prince Medical, Orange, NSW

Correspondence: bhajarizadeh@kirby.unsw.edu.au

Acknowledgements:

The Kirby Institute is funded by the Australian Department of Health and Ageing. Gregory Dore, Gail Matthews and Marianne Martinello were supported by National Health and Medical Research Council (NHMRC) fellowships. Jason Grebely was supported by an NHMRC Investigator grant.

Competing interests:

Gregory Dore is a consultant/advisor and has received research grants from Gilead, AbbVie, Merck, Bristol‐Myers Squibb, and Cepheid. Jason Grebely is a consultant/advisor and has received research grants from Gilead, AbbVie, Hologic, Indivior, Merck, and Cepheid. Gail Matthews has received research funding, advisory board payments, and speaker payments from Gilead, and research funding and speaker payments from Janssen.

1. Hajarizadeh B, Grebely J, Matthews GV, et al. Uptake of direct‐acting antiviral treatment for chronic hepatitis C in Australia. J Viral Hepat 2018; 25: 640–648.
2. Marshall AD, Cunningham EB, Nielsen S, et al; International Network on Hepatitis in Substance Users (INHSU). Restrictions for reimbursement of interferon‐free direct‐acting antiviral drugs for HCV infection in Europe. Lancet Gastroenterol Hepatol 2018; 3: 125–133.
3. Radley A, Robinson E, Aspinall EJ, et al. A systematic review and meta‐analysis of community and primary‐care‐based hepatitis C testing and treatment services that employ direct acting antiviral drug treatments. BMC Health Serv Res 2019; 19: 765.
4. Iranpour N, Dore GJ, Martinello M, et al. Estimated uptake of hepatitis C direct‐acting antiviral treatment among individuals with HIV co‐infection in Australia: a retrospective cohort study. Sex Health 2020; 17: 223–230.
5. Australian Department of Health. General practice workforce providing primary care services in Australia. Updated 17 June 2020. https://hwd.health.gov.au/resources/data/gp‐primarycare.html (viewed June 2021).

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Research

Screening outcomes by risk factor and age: evidence from BreastScreen WA for discussions of risk‐stratified population screening

Naomi Noguchi, Michael L Marinovich, Elizabeth J Wylie, Helen G Lund and Nehmat Houssami

Med J Aust 2021; 215 (8): . || doi: 10.5694/mja2.51216
Published online: 23 August 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Diagnostic techniques and procedures

Environment and public health

Neoplasms

Women's health

Abstract

Objectives: To estimate rates of screen‐detected and interval breast cancers, stratified by risk factor, to inform discussions of risk‐stratified population screening.

Design: Retrospective population‐based cohort study; analysis of routinely collected BreastScreen WA program clinical and administrative data.

Setting, participants: All BreastScreen WA mammography screening episodes for women aged 40 years or more during 1 July 2007 ‒ 30 June 2017.

Main outcome measures: Cancer detection rate (CDR) and interval cancer rate (ICR), by risk factor.

Results: A total of 323 082 women were screened in 1 026 137 screening episodes (mean age, 58.5 years; SD, 8.6 years). The overall CDR was 68 (95% CI, 67‒70) cancers per 10 000 screens, and the overall ICR was 9.7 (95% CI, 9.2‒10.1) cancers per 10 000 women‐years. Interactions between the effects on CDR of age group and five risk factors were statistically significant: personal history of breast cancer (P = 0.039), family history of breast cancer (P = 0.005), risk‐relevant benign conditions (P = 0.012), hormone‐replacement therapy (P = 0.002), and self‐reported symptoms (P < 0.001). The influence of these risk factors (except personal history) increased with age. For ICR, only the interaction between age and hormone‐replacement therapy was significant (P < 0.001), although weak interactions between age and family history of breast cancer or having dense breasts were noted (each P = 0.07). The influence of family history on ICR was significant only for women aged 40‒49 years.

Conclusions: Screening CDR and (for some risk factors) ICR were higher for women in some age groups with personal histories of breast cancer or risk‐relevant benign breast conditions or first degree family history of breast cancer, women with dense breasts or self‐reported breast‐related symptoms, and women using hormone‐replacement therapy. Our findings could inform the evaluation of risk‐based screening.

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1 The University of Sydney, Sydney, NSW
2 Curtin University, Perth, WA
3 BreastScreen WA, Perth, WA
4 Royal Perth Hospital, Perth, WA
5 Sydney School of Public Health, University of Sydney, Sydney, NSW

Correspondence: naomi.noguchi@sydney.edu.au

Acknowledgements:

Nehmat Houssami is supported by the National Breast Cancer Foundation (NBCF) Chair in Breast Cancer Prevention program (EC‐21‐001) and by a National Health and Medical Research Council Investigator (Leader) grant (1194410). Michael Marinovich is supported by a National Breast Cancer Foundation Investigator Initiated Research Scheme grant (IIRS‐20‐011). We thank Sonia El‐Zaemey and Kim Kee Ooi (BreastScreen WA) for extracting and cleaning the data for our analysis.

Competing interests:

No relevant disclosures.

1. Myers ER, Moorman P, Gierisch JM, et al. Benefits and harms of breast cancer screening: a systematic review. JAMA 2015; 314: 1615–1634.
2. Australian Institute of Health and Welfare. BreastScreen Australia monitoring report 2018 (Cat. no. CAN 116; Cancer Series no. 112). Updated 2 Oct 2018. https://www.aihw.gov.au/reports/cancer/breastscreen‐australia‐monitoring‐report‐2018/contents/table‐of‐contents (viewed Apr 2021).
3. Pashayan N, Morris S, Gilbert FJ, Pharaoh PDP. Cost‐effectiveness and benefit‐to‐harm ratio of risk‐stratified screening for breast cancer: a life‐table model. JAMA Oncol 2018; 4: 1504–1510.
4. Cancer Council. Roadmap for optimising screening in Australia: breast. Undated. https://www.cancer.org.au/about‐us/policy‐and‐advocacy/early‐detection‐policy/breast‐cancer‐screening/optimising‐early‐detection (viewed Apr 2021).
5. Houssami N, Hunter K. The epidemiology, radiology and biological characteristics of interval breast cancers in population mammography screening. NPJ Breast Cancer 2017; 3: 12.
6. Australian Institute of Health and Welfare. BreastScreen Australia data dictionary, version 1.2 (Cat. no. CAN 127; Cancer Series no. 123). Updated 29 Apr 2019. https://www.aihw.gov.au/reports/cancer‐screening/breastscreen‐australia‐data‐dictionary‐version‐1‐2/contents/table‐of‐contents (viewed Apr 2021).
7. D’Orsi C, Sickles E, Mendelson E, et al. ACR BI‐RADS® Atlas, breast imaging reporting and data system. Fifth edition. Reston (VA): American College of Radiology, 2013.
8. Australian Bureau of Statistics. 2033.0.55.001. Technical paper. Socio‐economic Indexes for Areas (SEIFA). 2016. https://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/756EE3DBEFA869EFCA258259000BA746/$File/SEIFA%202016%20Technical%20Paper.pdf (viewed Apr 2021).
9. BreastScreen Australia. National accreditation standards. Updated 16 Jan 2019. https://www.health.gov.au/sites/default/files/documents/2019/09/breastscreen‐australia‐national‐accreditation‐standards‐nas‐breastscreen‐australia‐national‐accreditation‐standards.pdf (viewed Apr 2021).
10. Spiegelman D, Hertzmark E. Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol 2005; 162: 199–200.
11. Houssami N, Lockie D, Clemson M, et al. Pilot trial of digital breast tomosynthesis (3D mammography) for population‐based screening in BreastScreen Victoria. Med J Aust 2019; 211: 357–362. https://www.mja.com.au/journal/2019/211/8/pilot‐trial‐digital‐breast‐tomosynthesis‐3d‐mammography‐population‐based
12. Yang XR, Chang‐Claude EL, Couch FJ, et al. Associations of breast cancer risk factors with tumor subtypes: a pooled analysis from the Breast Cancer Association Consortium Studies. J Natl Cancer Inst 2011; 103: 250–263.
13. Collaborative Group on Hormonal Factors in Breast Cancer. Familial breast cancer: collaborative reanalysis of individual data from 52 epidemiological studies including 58 209 women with breast cancer and 101 986 women without the disease. Lancet 2001; 358: 1389–1399.
14. Jones ME, Schoemaker MJ, Wright L, et al. Menopausal hormone therapy and breast cancer: what is the true size of the increased risk? Br J Cancer 2016; 115: 607–615.
15. Lee S, Kolonel L, Wilkens L, et al. Postmenopausal hormone therapy and breast cancer risk: the Multiethnic Cohort. Int J Cancer 2006; 118: 1285–1291.
16. Bakken K, Fournier A, Lund E, et al. Menopausal hormone therapy and breast cancer risk: Impact of different treatments. The European Prospective Investigation into Cancer and Nutrition. Int J Cancer 2011; 128: 144–156.
17. Moshina N, Sebuødegård S, Lee CI, et al. Automated volumetric analysis of mammographic density in a screening setting: worse outcomes for women with dense breasts. Radiology 2018; 288: 343–352.
18. Vachon CM, van Gils CH, Sellers TA, et al. Mammographic density, breast cancer risk and risk prediction. Breast Cancer Res 2007; 9: 217.
19. Gierach GL, Ichikawa L, Kerlikowske K, et al. Relationship between mammographic density and breast cancer death in the Breast Cancer Surveillance Consortium. J Natl Cancer Inst 2012; 104: 1218–1227.

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Perspectives

Medico‐legal risks associated with fragmented care in general practice

Jack Marjot, Georgie Haysom and Penny Browne

Med J Aust 2021; 215 (5): . || doi: 10.5694/mja2.51205
Published online: 23 August 2021

ARTICLE
AUTHORS
REFERENCES

Topics

General medicine

Ethics and law

Medical education

Fragmented patient care can lead to missed diagnoses, inappropriate prescribing and failure of preventive medicine

“Continuity of care” refers to the holistic management of a patient by a single practitioner, or a well integrated network of practitioners in close communication. The definition of fragmented care is not established, but here we consider it to be three or more different general practitioners managing the same underlying condition or presenting complaint.

Avant Mutual, Sydney, NSW

Correspondence: jack.marjot@health.nsw.gov.au

Competing interests:

No relevant disclosures.

1. Van Walraven C, Oake N, Jennings A, Forster AJ. The association between continuity of care and outcomes: a systematic and critical review. J Eval Clin Pract 2010; 16: 947–956.
2. Pereira Gray DJ, Sidaway‐Lee K, White E, et al. Continuity of care with doctors‐a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open 2018; 8: e021161.
3. Barker I, Steventon A, Deeny SR. Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data. BMJ 2017; 356: j84.
4. National Health Performance Authority. Healthy communities: frequent GP attenders and their use of health services in 2012–13. Sydney: NHPA, 2015. https://www.aihw.gov.au/getmedia/570c83c4‐bfb4‐48b5‐807d‐935a1db34a1e/aihw‐mhc‐nhpa‐11‐frequent‐gp‐attenders‐and‐use‐of‐health‐services‐2012‐13‐report‐March‐2015.pdf.aspx?inline=true (viewed Dec 2020).
5. Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med 2005; 165: 1493–1499.
6. Singh H, Giardina TD, Meyer AN, et al. Types and origins of diagnostic errors in primary care settings. JAMA Intern Med 2013; 173: 418–425.
7. Avant Research. Opioid prescribing‐related claims. Sydney: Avant Research, 2019. https://www.avant.org.au/Resources/Public/Opioid‐prescribing‐related‐claims (viewed Dec 2020).

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Research

The characteristics of SARS‐CoV‐2‐positive children who presented to Australian hospitals during 2020: a PREDICT network study

Laila F Ibrahim, Doris Tham, Vimuthi Chong, Mark Corden, Simon Craig, Paul Buntine, Shefali Jani, Michael Zhang, Shane George, Amit Kochar, Sharon O’Brien, Karen Robins‐Browne, Shidan Tosif, Andrew Daley, Sarah McNab, Nigel W Crawford, Catherine Wilson and Franz E Babl

Med J Aust 2021; 215 (5): . || doi: 10.5694/mja2.51207
Published online: 16 August 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Pediatric medicine

Infectious diseases

Diagnostic techniques and procedures

Abstract

Objectives: To examine the epidemiological and clinical characteristics of SARS‐CoV‐2‐positive children in Australia during 2020.

Design, setting: Multicentre retrospective study in 16 hospitals of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network; eleven in Victoria, five in four other Australian states.

Participants: Children aged 0‒17 years who presented to hospital‐based COVID‐19 testing clinics, hospital wards, or emergency departments during 1 February ‒ 30 September 2020 and who were positive for SARS‐CoV‐2.

Main outcome measures: Epidemiological and clinical characteristics of children positive for SARS‐CoV‐2.

Results: A total of 393 SARS‐CoV‐2‐positive children (181 girls, 46%) presented to the participating hospitals (426 presentations, including 131 to emergency departments [31%]), the first on 3 February 2020. Thirty‐three children presented more than once (8%), including two who were transferred to participating tertiary centres (0.5%). The median age of the children was 5.3 years (IQR, 1.9‒12.0 years; range, 10 days to 17.9 years). Hospital admissions followed 51 of 426 presentations (12%; 44 children), including 17 patients who were managed remotely by hospital in the home. Only 16 of the 426 presentations led to hospital medical interventions (4%). Two children (0.5%) were diagnosed with the paediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2 (PIMS‐TS).

Conclusion: The clinical course for most SARS‐CoV‐2‐positive children who presented to Australian hospitals was mild, and did not require medical intervention.

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1 Murdoch Children’s Research Institute, Melbourne, VIC
2 University of Melbourne, Melbourne, VIC
3 Western Health, Melbourne, VIC
4 Austin Hospital, Melbourne, VIC
5 Northern Hospital Epping, Melbourne, VIC
6 Monash Health, Melbourne, VIC
7 Monash University, Melbourne, VIC
8 Eastern Health, Melbourne, VIC
9 Box Hill Hospital, Melbourne, VIC
10 The Children’s Hospital at Westmead, Sydney, NSW
11 The University of Sydney, Sydney, NSW
12 John Hunter Hospital, Newcastle, NSW
13 Gold Coast University Hospital, Gold Coast, QLD
14 The University of Queensland Child Health Research Centre, Brisbane, QLD
15 Women’s and Children’s Hospital, Adelaide, SA
16 Perth Children’s Hospital, Perth, WA
17 Curtin University, Perth, WA
18 University Hospital Geelong, Geelong, VIC

Correspondence: Laila.Ibrahim@mcri.edu.au

Acknowledgements:

This study was unfunded, but was supported by a National Health and Medical Research Council (NHMRC) Centre of Research Excellence grant for paediatric emergency medicine (GNT1171228) and the Victorian Government Infrastructure Support Program. The participation of Franz Babl was partly funded by an NHMRC Practitioner Fellowship (GNT1124466) and by the Royal Children’s Hospital Foundation. Laila Ibrahim was supported by a Clinician‐Scientist Fellowship from the Murdoch Children’s Research Institute.

We acknowledge the staff who assisted with data retrieval: Visakan Krishnananthan and Caoimhe Basquille (emergency medicine, Eastern Health); Rebecca Gormley (Sunshine Hospital, Western Health); Gaby Nieva (Women’s and Children’s Hospital, Adelaide); and Rebecca Hughes (Royal Children’s Hospital Melbourne).

Competing interests:

No relevant disclosures.

1. Lavezzo E, Franchin E, Ciavarella C, et al; Imperial College COVID‐19 Response Team. Suppression of a SARS‐CoV‐2 outbreak in the Italian municipality of Vo’. Nature 2020; 584: 425–429.
2. Neeland MR, Bannister S, Clifford V, et al. Innate cell profiles during the acute and convalescent phase of SARS‐CoV‐2 infection in children. Nat Commun 2021; 12: 1084.
3. Zimmermann P, Curtis N. Why is COVID‐19 less severe in children? A review of the proposed mechanisms underlying the age‐related difference in severity of SARS‐CoV‐2 infections. Arch Dis Child 2021; 106: 429–439.
4. Graff K, Smith C, Silveira L, et al. Risk factors for severe COVID‐19 in children. Pediatr Infect Dis J 2021; 40: e137–e145.
5. Shekerdemian LS, Mahmood NR, Wolfe KK, et al; International COVID‐19 PICU Collaborative. Characteristics and outcomes of children with coronavirus disease 2019 (COVID‐19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr 2020; 40: e137–e145.
6. Alfraij A, Bin Alamir AA, Al‐Otaibi AM, et al. Characteristics and outcomes of coronavirus disease 2019 (COVID‐19) in critically ill pediatric patients admitted to the intensive care unit: a multicenter retrospective cohort study. J Infect Public Health 2020; 14: 193–200.
7. Jiang L, Tang K, Levin M, et al. COVID‐19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis 2020; 20: e276–e288.
8. Davies P, Evans C, Kanthimathinathan HK, et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2 (PIMS‐TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health 2020; 4: 669–677.
9. Cheung EW, Zachariah P, Gorelik M, et al. Multisystem inflammatory syndrome related to COVID‐19 in previously healthy children and adolescents in New York City. JAMA 2020; 324: 294–296.
10. 2019‐nCoV National Incident Room Surveillance Team. 2019‐nCoV acute respiratory disease, Australia. Epidemiology Report 1. Reporting week 26 January – 1 February 2020. Commun Dis Intell (2018) 2020; 44: https://doi.org/10.33321/cdi.2020.44.13.
11. COVID‐19 National Incident Room Surveillance Team. COVID‐19 Australia: Epidemiology Report 26. Fortnightly reporting period ending 27 September 2020. Commun Dis Intell (2018) 2020; 44: https://doi.org/10.33321/cdi.2020.44.78.
12. COVID‐19 National Incident Room Surveillance Team. COVID‐19, Australia: Epidemiology Report 2 (Reporting week ending 19:00 AEDT 8 February 2020). Commun Dis Intell (2018). 2020; 44: https://doi.org/10.33321/cdi.2020.44.14.
13. Ibrahim LF, Tosif S, McNab S, et al. SARS-CoV‐2 testing and outcomes in the first 30 days after the first case of COVID‐19 at an Australian children’s hospital. Emerg Med Australas 2020; 32: 801–808.
14. Babl FE, Krieser D, Oakley E, Dalziel S. A platform for paediatric acute care research. Emerg Med Australas 2014; 26: 419–422.
15. Paediatric Active Enhanced Disease Surveillance. Surveillance and research: PIMS‐TS. https://www.paeds.org.au/web/our-work/surveillance-and-research (viewed June 2021).
16. Australian Department of Health. Coronavirus disease 2019 (COVID‐19). CDNA national guidelines for public health units. Updated 24 June 2021. https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm (viewed June 2021).
17. Gilbert EH, Lowenstein SR, Koziol‐McLain J, et al. Chart reviews in emergency medicine research: where are the methods? Ann Emerg Med 1996; 27: 305–308.
18. Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID‐19 among children in China. Pediatrics 2020; 145: e20200702.
19. Bassareo PP. Pediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2 (PIMS‐TS) in the United Kingdom and Ireland: what is new? Lancet Reg Health Eur 2021; 3: 100090.
20. Parri N, Lenge M, Cantoni B, et al; CONFIDENCE Research Group. COVID‐19 in 17 Italian pediatric emergency departments. Pediatrics 2020; 146: e20201235.
21. Kidd M, Richter A, Best A, et al. S‐variant SARS‐CoV‐2 lineage B1.1.7 is associated with significantly higher viral loads in samples tested by ThermoFisher TaqPath RT‐qPCR. J Infect Dis 2021; 223: 1666–1670.
22. Planas D, Bruel T, Grzelak L, et al. Sensitivity of infectious SARS‐CoV‐2 B.1.1.7 and B.1.351 variants to neutralizing antibodies. Nat Med 2021; 27: 917–924.
23. Madhi SA, Baillie V, Cutland CL, et al; NGS‐SA Group; Wits‐VIDA COVID Group. Efficacy of the ChAdOx1 nCoV‐19 Covid‐19 vaccine against the B.1.351 variant. N Engl J Med 2021; 384: 1885–1898.
24. The Royal Children’s Hospital Melbourne. Wallaby: Hospital‐in-the‐Home. COVID‐19 resources. https://www.rch.org.au/wallaby/COVID-19_resources (viewed June 2021).
25. Kaji AH, Schriger D, Green S. Looking through the retrospectoscope: reducing bias in emergency medicine chart review studies. Ann Emerg Med 2014; 64: 292–298.

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Editorials

COVID‐19 in children: time for a new strategy

Mary‐Louise McLaws

Med J Aust 2021; 215 (5): . || doi: 10.5694/mja2.51206
Published online: 16 August 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Pediatric medicine

Environment and public health

Health services administration

We need to consider offering vaccination to adolescents and young adults

The generally mild course of coronavirus disease 2019 (COVID‐19) in children, as observed during the early phase of the pandemic, may not continue to be typical as the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) mutates. In this issue of the MJA, Ibrahim and colleagues1 describe the characteristics of children positive for SARS‐CoV‐2 who presented to 16 Australian hospitals during February – September 2020, when the Wuhan strain of the virus was circulating in Australia. Reassuringly, most of the 393 children did not need hospital care, and there were no deaths.1 However, 44 children were admitted to hospital (11%), including two who developed paediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2 (PIMS‐TS), and 17 were managed with hospital in the home care.1

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1 University of New South Wales, Sydney, NSW
2 WHO Health Emergencies Programme, Ad‐hoc COVID‐19 Infection Prevention and Control Guidance Development Group

Correspondence: m.mclaws@unsw.edu.au

Competing interests:

No relevant disclosures.

1. Ibrahim LF, Tham D, Chong V, et al. The characteristics of SARS‐CoV-2‐positive children who presented to Australian hospitals during 2020: a PREDICT network study. Med J Aust 2021; 215: 217–221.
2. Mehta NS, Mytton TO, Mullins EWS, et al. SARS‐CoV-2 (COVID‐19): what do we know about children? A systematic review. Clin Infect Dis 2020; 71: 2469–2479.
3. Li F, Li YY, Liu MJ, et al. Household transmission of SARS‐CoV-2 and risk factors for susceptibility and infectivity in Wuhan: a retrospective observational study. Lancet Infect Dis 2020; 21: 617–628.
4. Ritchie H, Ortiz‐Ospina E, Beltekian D, et al. Coronavirus (COVID‐19) hospitalizations. Our World in Data (UK). Updated 10 July 2021. https://ourworldindata.org/covid-hospitalizations (viewed July 2021).
5. Public Health England. SARS‐CoV-2 variants of concern and variants under investigation in England. Technical briefing 17. 25 June 2021. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/997418/Variants_of_Concern_VOC_Technical_Briefing_17.pdf (viewed July 2021).
6. Public Health England. SARS-CoV‐2 variants of concern and variants under investigation in England. Technical briefing 18. 9 July 2021. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1001009/Variants_of_Concern_VOC_Technical_Briefing_18.pdf (viewed July 2021).
7. Riley S, Wang H, Eales O, et al; COVID‐19 Genomics UK (COG‐UK) Consortium. REACT‐1 round 12 report: resurgence of SARS‐CoV-2 infections in England associated with increased frequency of the Delta variant [preprint]. medRxiv, 21 June 2021. https://doi.org/10.1101/2021.06.17.21259103 (viewed July 2021).
8. Riley S, Eales O, Haw D, et al. REACT‐1 round 13 interim report: acceleration of SARS‐CoV-2 Delta epidemic in the community in England during late June and early July 2021 [preprint]. medRxiv, 8 July 2021. https://doi.org/10.1101/2021.07.08.21260185 (viewed July 2021).
9. Ong SWX, Chiew CJ, Ang LW, et al. Clinical and virological features of SARS‐CoV-2 variants of concern: a retrospective cohort study comparing B.1.1.7 (Alpha), B.1.315 (Beta), and B.1.617.2 (Delta) [preprint]. Preprints with The Lancet (SSRN), 7 June 2021. https://doi.org/10.2139/ssrn.3861566 (viewed July 2021).
10. Public Health England. SARS-CoV‐2 variants of concern and variants under investigation in England. Technical briefing 15. 11 June 2021. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/993879/Variants_of_Concern_VOC_Technical_Briefing_15.pdf (viewed July 2021).
11. Allen H, Vusirikala A, Flannagan J, et al; COG‐UK Consortium. Increased household transmission of COVID‐19 cases associated with SARS‐CoV-2 Variant of Concern B.1.617.2: a national case‐control study. National Infection Service, Public Health England, June 2021. https://khub.net/documents/135939561/405676950/Increased+Household+Transmission+of+COVID-19+Cases+-+national+case+study.pdf/7f7764fb-ecb0-da31-77b3-b1a8ef7be9aa (viewed July 2021).
12. Public Health England. COVID‐19 vaccination: a guide to phase 2 of the programme. Updated 14 June 2021. https://www.gov.uk/government/publications/covid-19-vaccination-guide-for-older-adults/covid-19-vaccination-a-guide-to-phase-2-of-the-programme (viewed July 2021).
13. NHS England. COVID‐19 vaccinations. https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-vaccinations (viewed July 2021).
14. US Food and Drug Administration. Coronavirus (COVID‐19) update: FDA authorizes Pfizer–BioNTech COVID‐19 vaccine for emergency use in adolescents in another important action in fight against pandemic [media release]. 10 May 2021. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use (viewed July 2021).
15. Creech CB. It’s true even in a pandemic: children are not merely little adults. Clin Infect Dis 2020; 71: 2480–2481.

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Narrative review

Co‐occurring depression and insomnia in Australian primary care: recent scientific evidence

Alexander Sweetman, Leon Lack, Emer Van Ryswyk, Andrew Vakulin, Richard L Reed, Malcolm W Battersby, Nicole Lovato and Robert J Adams

Med J Aust 2021; 215 (5): . || doi: 10.5694/mja2.51200
Published online: 16 August 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Nervous system diseases

Pharmaceutical preparations

Mental disorders

General medicine

Summary

Depression and insomnia commonly co‐occur, resulting in greater morbidity for patients, and difficult diagnostic and treatment decisions for clinicians.
When patients report symptoms of both depression and insomnia, it is common for medical practitioners to conceptualise the insomnia as a secondary symptom of depression. This implies that there is little purpose in treating insomnia directly, and that management of depression will improve both the depression and insomnia symptoms.
In this review, we present an overview of research investigating the comorbidity and treatment approaches for patients presenting with depression and insomnia in primary care.
Evidence shows that clinicians should avoid routinely conceptualising insomnia as a secondary symptom of depression. This is because insomnia symptoms: (i) often occur before mood decline and are independently associated with increased risk of future depression; (ii) commonly remain unchanged following depression treatment; and (iii) predict relapse of depression after treatment for depression only. Furthermore, compared with control, cognitive behaviour therapy for insomnia improves symptoms of both depression and insomnia.
It is critical that primary care clinicians dedicate specific diagnostic and treatment attention to the management of both depression (eg, psychotherapy, antidepressants) and insomnia (eg, cognitive behaviour therapy for insomnia administered by trained therapists or psychologists through a mental health treatment plan referral, by online programs, or by a general practitioner or nurse) when they co‐occur. These treatments may be offered concurrently or sequentially (eg, insomnia treatment followed by depression treatment, or vice versa), depending on presenting symptoms, history, lifestyle factors and other comorbidities.

1 Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA
2 National Centre for Sleep Health Services Research, Flinders University, Adelaide, SA
3 College of Medicine and Public Health, Flinders University, Adelaide, SA

Correspondence: alexander.sweetman@flinders.edu.au

Acknowledgements:

This work was supported by a National Health and Medical Research Council Centres of Research Excellence program of research, aiming to position primary care at the centre of sleep health management in Australia (GNT1134954).

Competing interests:

Leon Lack and Nicole Lovato have received research funding from Re‐Timer Pty Ltd.

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Editorials

The expanding geographic range of dengue in Australia

Annelies Wilder‐Smith

Med J Aust 2021; 215 (4): . || doi: 10.5694/mja2.51185
Published online: 16 August 2021

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Statistics, epidemiology and research design

If suitable mosquito vectors are present in a region, returning infected travellers can initiate local transmission

Dengue outbreaks outside their usual geographic distribution — the subtropics and tropics of Asia, Africa, and Latin America — always attract media attention. The first major autochthonous dengue outbreaks in Europe were in Madeira (Portugal) in 2012;1 smaller clusters have been reported in France, Croatia,2 and Italy.3 Despite suitable mosquito vectors, the seasonal window for the establishment of dengue in Europe is short and the risk of its propagation, even in southern Europe, is low.4 It could, however, increase with global warming;5 for example, importation of dengue into more temperate climate zones in China has resulted in local outbreaks in cities such as Shanghai.6

1 Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
2 Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany

Correspondence: annelies.wilder-smith@uni-heidelberg.de

Competing interests:

No relevant disclosures.

1. Wilder‐Smith A, Quam M, Sessions O, et al. The 2012 dengue outbreak in Madeira: exploring the origins. Euro Surveill 2014; 19: 20718.
2. Tomasello D, Schlagenhauf P. Chikungunya and dengue autochthonous cases in Europe, 2007–2012. Travel Med Infect Dis 2013; 11: 274–284.
3. Lazzarini L, Barzon L, Foglia F, et al. First autochthonous dengue outbreak in Italy, August 2020. Euro Surveill 2020; 25: 2001606.
4. Massad E, Amaku M, Coutinho FAB, et al. Estimating the probability of dengue virus introduction and secondary autochthonous cases in Europe. Sci Rep 2018; 8: 4629.
5. Lillepold K, Rocklöv J, Liu‐Helmersson J, et al. More arboviral disease outbreaks in continental Europe due to the warming climate? J Travel Med 2019; 26: taz017.
6. Ma Y, Li S, Wan Z, et al. Phylogenetic analyses of dengue virus serotypes imported to Shanghai, China. J Travel Med 2020; 27: taaa195.
7. Ritchie SA, Pyke AT, Hall‐Mendelin S, et al. An explosive epidemic of DENV‐3 in Cairns, Australia. PLoS One 2013; 8: e68137.
8. Masyeni S, Yohan B, Somia IKA, et al. Dengue infection in international travellers visiting Bali, Indonesia. J Travel Med 2018; 25: tay061.
9. Walker J, Pyke A, Florian P, et al. Re‐defining the dengue‐receptive area of Queensland after the 2019 dengue outbreak in Rockhampton. Med J Aust 2021; 215: 182.
10. Russell RC, Currie BJ, Lindsay MD, et al. Dengue and climate change in Australia: predictions for the future should incorporate knowledge from the past. Med J Aust 2009; 190: 265–268. https://www.mja.com.au/journal/2009/190/5/dengue-and-climate-change-australia-predictions-future-should-incorporate
11. Queensland Health. Queensland dengue management plan 2015‒2020. Sept 2015. https://www.health.qld.gov.au/__data/assets/pdf_file/0022/444433/dengue-mgt-plan.pdf (viewed July 2021).
12. Trewin BJ, Kay BH, Darbro JM, Hurst TP. Increased container‐breeding mosquito risk owing to drought‐induced changes in water harvesting and storage in Brisbane, Australia. Int Health 2013; 5: 251–258.
13. van den Hurk AF, Nicholson J, Beebe NW, et al. Ten years of the Tiger: Aedes albopictus presence in Australia since its discovery in the Torres Strait in 2005. One Health 2016; 2: 19–24.
14. Montgomery BL, Shivas MA, Hall‐Mendelin S, et al. Rapid Surveillance for Vector Presence (RSVP): development of a novel system for detecting Aedes aegypti and Aedes albopictus. PLoS Negl Trop Dis 2017; 11: e0005505.
15. Utarini A, Indriani C, Ahmad RA, et al; AWED Study Group. Efficacy of Wolbachia‐infected mosquito deployments for the control of dengue. N Engl J Med 2021; 384: 2177–2186.
16. Ritchie SA. Wolbachia and the near cessation of dengue outbreaks in Northern Australia despite continued dengue importations via travellers. J Travel Med 2018; 25: tay084.

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Editorials

The future of rehabilitation for older Australians

Ian D Cameron, Maria Crotty and Susan E Kurrle

Med J Aust 2021; 215 (4): . || doi: 10.5694/mja2.51184
Published online: 16 August 2021

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Rehabilitation

Gerontology

We urgently need a national strategy to reduce overreliance on hospital services for functional recovery treatments

In this issue of the Journal, Soh and colleagues report their study of the outcomes of inpatient rehabilitation for older people.1 Their findings can be interpreted in a variety of ways. Most participants (396 of 618, 60%) recovered pre‐admission levels of functional performance (as measured with the Activities of Daily Living [ADL] scale), but cognitive impairment (64% of participants) and frailty (the median Clinical Frailty Score at admission was 6 = “moderately frail”) were confirmed as negative prognostic factors. Within three months of discharge from inpatient rehabilitation, 160 of the 618 had been newly institutionalised (26%) and 75 of the 693 initially included patients had died (11%). Recovery of ADL function was, as expected, more frequent than recovery of the more complex functioning assessed by the Instrumental Activities of Daily Living scale (35%). But 110 of the 192 people living at home prior to admission who made no functional gains on the ADL during rehabilitation (57%) were still at home at the three‐month follow‐up and had probably received some benefit from the coordinated rehabilitation program. While the investigation by Soh and colleagues was a single centre study, their findings are broadly similar to those of an older Australian multicentre study.2

1 John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, NSW
2 Flinders University, Adelaide, SA
3 Hornsby Ku‐ring-gai Hospital, Sydney, NSW

Correspondence: ian.cameron@sydney.edu.au

Competing interests:

Susan Kurrle is the Clinical Director, Rehabilitation and Aged Care Network, in the Northern Sydney Local Health District (NSLHD). Ian Cameron is employed by the NSLHD. Maria Crotty is the Unit Head of Rehabilitation in the Southern Adelaide Local Health Network (SAHLN). The opinions expressed in this editorial do not reflect the policy of NSLHD or SAHLN.

1. Soh CH, Reijnierse EM, Tuttle C, et al. Trajectories of functional performance recovery after inpatient geriatric rehabilitation: an observational study. Med J Aust 2021; 215: 173–179.
2. Cameron ID, Schaafsma FG, Wilson S, et al. Outcomes of rehabilitation in older people–functioning and cognition are the most important predictors: an inception cohort study. J Rehabil Med 2012; 44: 24–30.
3. Mitchell R, Harvey L, Brodaty H, et al. Hip fracture and the influence of dementia on health outcomes and access to hospital‐based rehabilitation for older individuals. Disabil Rehabil 2016; 38: 2286–2295.
4. Killington M, Davies O, Crotty M, et al. People living in nursing care facilities who are ambulant and fracture their hips: description of usual care and an alternative rehabilitation pathway. BMC Geriatr 2020; 20: 128.
5. Cameron ID, Kurrle SE. Frailty and rehabilitation. Interdiscip Top Gerontol Geriatr 2015; 41: 137–150.
6. World Health Organization. Rehabilitation 2030: a call for action. https://www.who.int/initiatives/rehabilitation-2030 (viewed June 2021).
7. Cameron ID, Fairhall N, Langron C, et al. A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial. BMC Med 2013; 11: 65.
8. Dyer SM, Standfield LB, Fairhall N, et al. Supporting community‐dwelling older people with cognitive impairment to stay at home: a modelled cost analysis. Australas J Ageing 2020; 39: e506–e514.
9. Australian Institute of Health and Welfare. Trends in hospitalised injury due to falls in older people 2007–08 to 2016–17 (AIHW cat. no. INJCAT 206). Canberra: AIHW, 2019. https://www.aihw.gov.au/reports/injury/trends-in-hospitalised-injury-due-to-falls (viewed June 2021).
10. Hopewell S, Adedire O, Copsey BJ, et al. Multifactorial and multiple component interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2018; 7: CD012221.
11. NSW Health. NSW rehabilitation model of care. Jan 2015. https://aci.health.nsw.gov.au/resources/rehabilitation/rehabilitation-model-of-care/rehabilitation-moc (viewed June 2021).
12. Australian Department of Health. Transition care programme. Updated July 2021. https://www.health.gov.au/initiatives-and-programs/transition-care-programme (viewed July 2021).
13. Australian Department of Health. Short Term Restorative Care (STRC) Programme. Updated July 2021. https://www.health.gov.au/initiatives-and-programs/short-term-restorative-care-strc-programme (viewed July 2021).

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Prescribing of direct‐acting antiviral therapy by general practitioners for people with hepatitis C in an unrestricted treatment program

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Screening outcomes by risk factor and age: evidence from BreastScreen WA for discussions of risk‐stratified population screening

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The characteristics of SARS‐CoV‐2‐positive children who presented to Australian hospitals during 2020: a PREDICT network study

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COVID‐19 in children: time for a new strategy

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Co‐occurring depression and insomnia in Australian primary care: recent scientific evidence

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The expanding geographic range of dengue in Australia

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The future of rehabilitation for older Australians

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Effectiveness of COVID‐19 vaccines: findings from real world studies

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Prescribing of direct‐acting antiviral therapy by general practitioners for people with hepatitis C in an unrestricted treatment program

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Screening outcomes by risk factor and age: evidence from BreastScreen WA for discussions of risk‐stratified population screening

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Medico‐legal risks associated with fragmented care in general practice

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The characteristics of SARS‐CoV‐2‐positive children who presented to Australian hospitals during 2020: a PREDICT network study

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COVID‐19 in children: time for a new strategy

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Co‐occurring depression and insomnia in Australian primary care: recent scientific evidence

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The expanding geographic range of dengue in Australia

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Effectiveness of COVID‐19 vaccines: findings from real world studies

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