Topics

Abstract

Objective: To explore the values of Aboriginal people in the Northern Territory during their perioperative journey.

Design: A community‐based participatory action research approach was used, integrating yarning, deep listening and reflection methods to gather qualitative data in culturally appropriate ways. Data collection involved two yarning circles followed by interpretation and triangulation sessions with co‐researchers.

Setting: Conducted in non‐health care settings in Garramilla (Darwin) between May 2023 and September 2024, the study included participants from urban, regional and remote NT Aboriginal communities.

Participants: Purposive and snowball sampling were used to engage 18 participants with lived experience of surgery, who share expertise in renal health journeys and have kinship ties spanning from Saltwater Country to Desert Country, with diverse age, language and gender representation.

Main outcome measures: Thematic insights into what First Nations peoples in the NT value during the perioperative journey, to inform culturally safe models of care.

Results: Respect emerged as the core principle in the perioperative journey, with family involvement, cultural practices and effective communication identified as key elements. Respect was evident in honouring cultural protocols, integrating traditional healing practices and recognising patient autonomy. Family involvement was highlighted as essential, with kinship ties influencing shared decision‐making processes and support throughout the perioperative experience. Culturally competent communication, including the use of interpreters and clear explanations, played a critical role in bridging cultural differences and ensuring shared understanding. Together, these elements fostered a sense of safety, belonging and empowerment. Ultimately, trust was identified as an overarching outcome that unified these interconnected values, enhancing patient comfort, engagement and overall satisfaction in the perioperative journey.

Conclusion: Respect is integral to Aboriginal people in the perioperative journey, and they value family, culture and communication when navigating surgery. When these values coalesce, trust is generated. These findings highlight the need to integrate culturally informed, patient‐centred care models that prioritise respect and trust building to improve accessibility, experience and surgical outcomes.

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1 Menzies School of Health Research, Charles Darwin University, Darwin, NT
2 Royal Darwin Hospital, Tiwi, NT
3 University of Melbourne, Melbourne, VIC
4 Flinders University, Darwin, NT
5 Austin Health, Melbourne, VIC
6 Purple House, Alice Springs, NT

Correspondence: edith.waugh@menzies.edu.au

Open access:

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

Data Sharing:

Data collected and analysed during the study are not publicly available due to privacy issues and ethical considerations. Data may be available from the corresponding author on reasonable request.

Acknowledgements:

Warning: Aboriginal and Torres Strait Islander readers are advised that this article captures the knowledge and lived experiences of Indigenous people who have passed. With permission from family, we refer to our senior co‐author as “Jampijinpa” Ross. This article is a testament to his contributions to First Nations health. Out of cultural sensitivity, we do not use the names nor images of Indigenous people who participated in this research who have subsequently passed away.

Edith Waugh received an ANZCA Foundation (Australian and New Zealand College of Anaesthetists) Health Equity Grant 2022. The funding allowed planning, coordination and completion of focus (yarning) groups; participation and sharing of First Nations knowledge was appropriately reimbursed. Edith Waugh is supported by an Australian Government Research Training Scholarship. Matthew Hare is supported by the National Health and Medical Research Council (grant number 1194698), the Sylvia and Charles Viertel Foundation and an Australian Diabetes Society Skip Martin Fellowship.

The Top End Indigenous Reference Group and research assistant Stephanie Long from the INFERR (INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on hemodialysis) study at Menzies School of Health Research were the catalysts leading to this study. This study emerged in response to their feedback about exploring postoperative outcomes for First Nations people in the Northern Territory and the need for this research to incorporate patient values.

Competing interests:

No relevant disclosures.

Author contributions:

Waugh EB: Conceptualization; methodology; investigation (data collection); formal analysis; writing – original draft; writing – review and editing; project administration; funding acquisition. Hefler M: Methodology; formal analysis; writing – review and editing; supervision. Pascoe S: Methodology; investigation (data collection); formal analysis; writing – review and editing; project administration. Mayo M: Conceptualization; writing – review and editing; supervision. Hare MJL: Writing – review and editing; supervision. Story DA: Writing – review and editing; funding acquisition, supervision. Wilkshire N: Writing – methodology; investigation (data collection); formal analysis; review and editing; supervision. Henwood P: Writing – methodology; investigation (data collection); formal analysis; review and editing; supervision. Croker D: Writing – methodology; investigation (data collection); formal analysis; review and editing; supervision. Ross J: Writing – methodology; investigation (data collection); formal analysis; review and editing; supervision.

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Perspective

Climate and environmental crisis: effects on ear and hearing health in Australia and for Aboriginal and Torres Strait Islander peoples

Georgia M Tongs (Wiradjuri), Isabella Ludbrook, Jennifer H Martin, Robert Eisenberg and Kelvin M Kong (Worimi)

Med J Aust 2025; 223 (1): . || doi: 10.5694/mja2.52689
Published online: 7 July 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Otorhinolaryngologic diseases

Environment and public health

Indigenous health

As a collaborative research team, we acknowledge the diverse perspectives, lived experiences, and cultural knowledges that shape our work. We are united in our commitment to examining health and climate through the lens of Aboriginal and Torres Strait Islander peoples, recognising the profound and disproportionate impacts these intersecting issues have on Indigenous communities globally.

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1 John Hunter Hospital, Newcastle, NSW
2 University of Newcastle, Newcastle, NSW
3 Hunter Medical Research Institute, Newcastle, NSW
4 University of New South Wales, Sydney, NSW
5 Macquarie University, Sydney, NSW

Correspondence: i.ludbrook@student.unsw.edu.au

Open access:

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

Competing interests:

Kelvin Kong is a Guest Editor for the 2025 NAIDOC Week MJA Special Issue and was not involved in any editorial decision making about this article.

Author contributions:

Tongs G: Formal analysis, investigation, methodology, resources, visualization, writing – original draft, writing – review and editing. Ludbrook I: Conceptualization, formal analysis, methodology, project administration, resources, supervision, visualization, writing – original draft, writing – review and editing. Martin J: Conceptualization, formal analysis, methodology, project administration, supervision, writing – original draft, writing – review and editing. Eisenberg R: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, visualization, writing – original draft, writing – review and editing. Kong K: Conceptualization, formal analysis, investigation, methodology, resources, supervision, writing – original draft, writing – review and editing.

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Systematic review

Online first

Factors that affect the provision of medical abortion services in Australian primary care: a mixed methods systematic review

Greta Skahill and Mridula Shankar

Med J Aust || doi: 10.5694/mja2.52707
Published online: 30 June 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

General medicine

Health services administration

Statistics, epidemiology and research design

Abstract

Objectives: To synthesise primary research findings about factors that affect medical abortion provision by general practitioners, nurses, midwives, and pharmacists in Australia.

Study design: Mixed methods systematic review of peer‐reviewed primary publications of qualitative, quantitative, and mixed methods studies of the provision of medical abortion in Australian primary care, 1 January 2013 – 18 January 2025.

Data sources: MEDLINE, Scopus, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature).

Data synthesis: Twenty‐three publications satisfied our inclusion criteria. We undertook a thematic synthesis of the qualitative study findings to identify barriers and facilitators of medical abortion provision, and assessed the confidence of each review finding using the GRADE‐CERQual approach; we also compared the qualitative synthesis with quantitative study findings. We developed ten review findings grouped under three themes: moral, legal, and regulatory influences on abortion care (three review findings; very low to moderate confidence); the absence of a systems‐based approach to abortion provision (six review findings; moderate to high confidence); and early medical abortion belongs in primary care (one review finding; high confidence). Barriers to providing medical abortion include the absence of a supportive service delivery strategy, insufficient Medicare remuneration, geographic isolation, limited access to training, and colleagues who conscientiously object to abortion. Facilitators of its provision include clinician support networks and personal motivation to improve access to reproductive health care.

Conclusions: A range of individual, service level, and system factors exacerbate the effects of geographic location and financial considerations on the provision of medical abortion in Australian primary care. Our findings indicate that financial and structural support is needed for the geographic decentralisation of medical abortion training and services, the establishment of nurse‐led models of care, and the integration of abortion care into primary care.

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1 The University of Melbourne, Melbourne, VIC
2 Nossal Institute for Global Health, the University of Melbourne, Melbourne, VIC

Correspondence: gskahill@student.unimelb.edu.au

Open access:

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

Acknowledgements:

We are grateful to Rana Islamiah Zahroh (Nossal Institute for Global Health, the University of Melbourne) for training the authors in applying GRADE‐CERQual to qualitative evidence synthesis findings. We thank Alya Hazfiarini (Nossal Institute for Global Health, the University of Melbourne) for providing input on the quality appraisals. We are grateful to Shelly Makleff (Centre for Health Equity, the University of Melbourne) for her input to our discussion of values clarification workshops for health care providers.

Competing interests:

No relevant disclosures.

Received 30 October 2024, accepted 24 February 2025

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19. Marie Stopes Health. MS health: June 2023 update. Melbourne: MSI Reproductive Choices, July 2023. https://resources.mshealth.com.au/20230704‐MS‐Health‐June‐2023.pdf (viewed Oct 2024).
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22. Marie Stopes Australia. Nurse‐led medical termination of pregnancy in Australia: legislative scan. Second edition. Melbourne: Marie Stopes Australia, 2022. https://resources.msiaustralia.org.au/Nurse‐led‐MToP‐in‐Australia‐legislative‐scan.pdf (viewed Oct 2024).
23. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71.
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29. Lewin S, Bohren M, Rashidian A, et al. Applying GRADE‐CERQual to qualitative evidence synthesis findings: paper 2. How to make an overall CERQual assessment of confidence and create a summary of qualitative findings table. Implement Sci 2018; 13 (Suppl 1): 11‐23.
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31. Colvin CJ, Garside R, Wainwright M, et al. Applying GRADE‐CERQual to qualitative evidence synthesis findings: paper 4. How to assess coherence. Implement Sci 2018; 13 (Suppl 1): 33‐41.
32. Noyes J, Booth A, Lewin S, et al. Applying GRADE‐CERQual to qualitative evidence synthesis findings: paper 6. How to assess relevance of the data. Implement Sci 2018; 13 (Suppl 1): 51‐61.
33. Glenton C, Carlsen B, Lewin S, et al. Applying GRADE‐CERQual to qualitative evidence synthesis findings: paper 5. How to assess adequacy of data. Implement Sci 2018; 13 (Suppl 1): 43‐50.
34. Lee RY, Moles R, Chaar B. Mifepristone (RU486) in Australian pharmacies: the ethical and practical challenges. Contraception 2015; 91: 25‐30.
35. Newton D, Bayly C, McNamee K, et al. “… a one stop shop in their own community”: medical abortion and the role of general practice. Aust N Z J Obstet Gynaecol 2016; 56: 648‐654.
36. Keogh LA, Newton D, Bayly C, et al. Intended and unintended consequences of abortion law reform: perspectives of abortion experts in Victoria, Australia. J Fam Plann Reprod Health Care 2017; 43: 18‐24.
37. Dawson AJ, Nicolls R, Bateson D, et al. Medical termination of pregnancy in general practice in Australia: a descriptive–interpretive qualitative study. Reprod Health 2017; 14: 39.
38. Hulme‐Chambers A, Clune S, Tomnay J. Medical termination of pregnancy service delivery in the context of decentralization: social and structural influences. Int J Equity Health 2018; 17: 172.
39. de Moel‐Mandel C, Graham M, Taket A. Snapshot of medication abortion provision in the primary health care setting of regional and rural Victoria. Aust J Rural Health 2019; 27: 237‐244.
40. de Moel‐Mandel C, Graham M, Taket A. Expert consensus on a nurse‐led model of medication abortion provision in regional and rural Victoria, Australia: a Delphi study. Contraception 2019; 100: 380‐385.
41. Keogh L, Croy S, Newton D, et al. General practitioner knowledge and practice in relation to unintended pregnancy in the Grampians region of Victoria, Australia. Rural Remote Health 2019; 19: 5156.
42. Keogh LA, Gillam L, Bismark M, et al. Conscientious objection to abortion, the law and its implementation in Victoria, Australia: perspectives of abortion service providers. BMC Med Ethics 2019; 20: 11.
43. Deb S, Subasinghe AK, Mazza D. Providing medical abortion in general practice: general practitioner insights and tips for future providers. Aust J Gen Pract 2020; 49: 331‐337.
44. De Moel‐Mandel C, Taket A, Graham M. Identifying barriers and facilitators of full service nurse‐led early medication abortion provision: qualitative findings from a Delphi study. Aust J Adv Nurs 2020; 38: 18‐26.
45. Ogden K, Ingram E, Levis J, et al. Termination of pregnancy in Tasmania: access and service provision from the perspective of GPs. Aust J Prim Health 2021; 27: 297‐303.
46. Mazza D, Seymour JW, Sandhu MV, et al. General practitioner knowledge of and engagement with telehealth‐at‐home medical abortion provision. Aust J Prim Health 2021; 27: 456‐461.
47. Desai A, Maier B, James‐McAlpine J, et al. Views and practice of abortion among Queensland midwives and sexual health nurses. Aust N Z J Obstet Gynaecol 2022; 62: 219‐225.
48. Malatzky C, Hulme A. “I love my job … it's more the systems that we work in”: the challenges encountered by rural sexual and reproductive health practitioners and implications for access to care. Cult Health Sex 2022; 24: 735‐749.
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50. Mainey L, O’Mullan C, Reid‐Searl K. Working with or against the system: nurses’ and midwives’ process of providing abortion care in the context of gender‐based violence in Australia. J Adv Nurs 2023; 79: 1329‐1341.
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52. Saldanha S, Caddy C, Williams H, et al. Early medical abortion provision via telehealth in Victoria: a qualitative descriptive study. Aust J Gen Pract 2024; 53: 794‐798.
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54. Noonan A, Millar E, Tomnay JE, et al. “Imagine if we had an actual service …”: a qualitative exploration of abortion access challenges in Australian rural primary care. Rural Remote Health 2024; 24: 9229.
55. Moulton JE, Arefadib N, Botfield JR, et al. A nurse‐led model of care to improve access to contraception and abortion in rural general practice: co‐design with consumers and providers. J Adv Nurs 2025; 81: 1019‐1037.
56. Srinivasan S, James SM, Kwek J, et al. What do Australian primary care clinicians need to provide long‐acting reversible contraception and early medical abortion? A content analysis of a virtual community of practice. BMJ Sex Reprod Health 2025; 51: 94‐101.
57. Liwanag HJ, James O, Frahsa A. A review and analysis of accountability in global health funding, research collaborations and training: towards conceptual clarity and better practice. BMJ Global Health 2023; 8: e012906.
58. Merner B, Haining CM, Willmott L, et al. Health providers’ reasons for participating in abortion care: a scoping review. Womens Health (Lond) 2024; 20: 17455057241233124.
59. Harris LH. Recognizing conscience in abortion provision. N Engl J Med 2012; 367: 981‐983.
60. Williams J, Mayes C. Abortion in Australia: what does the overturning of Roe v Wade have to do with it? [podcast]. Undisciplinary, 5 Aug 2022. https://undisciplinary.buzzsprout.com/1104002/episodes/11073451‐abortion‐in‐australia‐what‐does‐the‐overturning‐of‐roe‐v‐wade‐have‐to‐do‐with‐it (viewed Oct 2024).
61. Turner KL, Page KC. Abortion attitude transformation: a values clarification toolkit for global audiences. Chapel Hill: Ipas, 2008. https://www.ipas.org/wp‐content/uploads/2020/06/VALCLARE14‐VCATAbortionAttitudeTransformation.pdf (viewed Feb 2025).
62. Turner KL, Pearson E, George A, Andersen KL. Values clarification workshops to improve abortion knowledge, attitudes and intentions: a pre–post assessment in 12 countries. Reprod Health 2018; 15: 40.
63. Guiahi M, Wilson C, Claymore E, et al. Influence of a values clarification workshop on residents training at Catholic Hospital programs. Contracept X 2021; 3: 100054.
64. Emmerich N. The provision of abortion in Australia: service delivery as a bioethical concern. Monash Bioeth Rev 2024; 42: 200‐219.
65. Long C. Health specialists say biased Medicare rebates are costing women more [online]. ABC News (Australia), 4 Apr 2024. https://www.abc.net.au/news/2024‐04‐04/medicare‐bias‐costing‐women‐more‐mbs‐schedule/103664726?utm_campaign=abc_news_web&utm_content=link&utm_medium=content_shared&utm_source=abc_news_web (viewed Oct 2024).
66. Cheng HC, de Costa C. Abortion education in Australian medical schools. Aust N Z J Obstet Gynaecol 2021; 61: 793‐797.
67. Millar E. Abortion stigma, abortion exceptionalism, and medical curricula. Health Sociol Rev 2023; 32: 261‐276.
68. Srinivasan S, James SM, Kwek J, et al. What do Australian primary care clinicians need to provide long‐acting reversible contraception and early medical abortion? A content analysis of a virtual community of practice. BMJ Sex Reprod Health 2025; 51: 94‐101.
69. Queensland Health. Termination of pregnancy: action plan 2032. Mar 2024. https://www.health.qld.gov.au/__data/assets/pdf_file/0028/1316467/Termination‐of‐Pregnancy‐Plan_Digital.pdf (viewed Oct 2024).
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71. Parliament of Western Australia. Abortion Legislation Reform Act 2023. https://www.legislation.wa.gov.au/legislation/statutes.nsf/law_a147399.html (viewed June 2025).
72. Mazza D, Shankar M, Botfield JR, et al. Improving rural and regional access to long‐acting reversible contraception and medical abortion through nurse‐led models of care, task‐sharing and telehealth (ORIENT): a protocol for a stepped‐wedge pragmatic cluster‐randomised controlled trial in Australian general practice. BMJ Open 2023; 13: e065137.
73. Australia Department of Health. National women's health strategy 2020–2030. Updated 31 Oct 2023. https://www.health.gov.au/sites/default/files/documents/2021/05/national‐women‐s‐health‐strategy‐2020‐2030_0.pdf (viewed Oct 2024).

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Editorial

Ending nuclear weapons, before they end us

Kamran Abbasi, Parveen Ali, Virginia Barbour, Marion Birch, Inga Blum, Peter Doherty, Andy Haines, Ira Helfand, Richard C Horton, Kati Juva, José Florencio F Lapeña, Robert Mash, Olga Mironova, Arun Mitra, Carlos A Monteiro, Elena N Naumova, David Onazi, Tilman A Ruff, Peush Sahni, James Tumwine, Carlos Umaña, Paul Yonga and Chris Zielinski

Med J Aust 2025; 222 (11): . || doi: 10.5694/mja2.52676
Published online: 16 June 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Global health

In May 2025, the World Health Assembly (WHA) will vote on re‐establishing a mandate for the World Health Organization (WHO) to address the health consequences of nuclear weapons and war.1 Health professionals and their associations should urge their governments to support such a mandate and support the new United Nations (UN) comprehensive study on the effects of nuclear war

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1 The British Medical Journal, London, United Kingdom
2 International Nursing Review, Sheffield, United Kingdom
3 University of Sheffield, Sheffield, United Kingdom
4 Medical Journal of Australia, Sydney, NSW, Australia
5 Medicine, Conflict and Survival, London, United Kingdom
6 International Physicians for the Prevention of Nuclear War, Hamburg, Germany
7 University of Melbourne, Melbourne, VIC, Australia
8 London School of Hygiene and Tropical Medicine, London, United Kingdom
9 International Physicians for the Prevention of Nuclear War, Springfield (OR), United States
10 The Lancet, London, United Kingdom
11 International Physicians for the Prevention of Nuclear War, Helsinki University Central Hospital, Helsinki, Finland
12 University of the Philippines System, Ermita (NCR), Philippines
13 African Journal of Primary Health Care and Family Medicine, Cape Town, South Africa
14 Stellenbosch University, Stellenbosch, South Africa
15 International Physicians for the Prevention of Nuclear War, Russian Cardiology Research and Production Complex, Sechenov University, Moscow, Russian Federation
16 International Physicians for the Prevention of Nuclear War, Ludhiana, India
17 Indian Doctors for Peace and Development, Ludhiana, India
18 Revista de Saúde Pública, São Paulo, Brazil
19 University of São Paulo, São Paulo, Brazil
20 Journal of Public Health Policy, Boston (MA), United States
21 Tufts University, Boston (MA), United States
22 International Physicians for the Prevention of Nuclear War, Society of Nigerian Doctors for the Welfare of Mankind, Abuja, Nigeria
23 Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
24 International Physicians for the Prevention of Nuclear War, University of Melbourne, Melbourne, VIC, Australia
25 National Medical Journal of India, New Delhi, India
26 All India Institute of Medical Sciences, New Delhi, India
27 Makerere University, Kampala, Uganda
28 Kabale University, Kabale, Uganda
29 International Physicians for the Prevention of Nuclear War, Costa Rican Ministry of Health, San José, Costa Rica
30 East African Medical Journal, Nairobi, Kenya
31 CA Medlynks, Nairobi, Kenya
32 Centre for Global Health, University of Winchester, Winchester, United Kingdom
33 World Association of Medical Editors, Winchester, United Kingdom

Correspondence: czielinski@ippnw.org

Author contribution statement:

Tillman Ruff and Andy Haines developed the idea of the editorial and led drafting along with Chris Zielinski. All other authors contributed significantly to the editorial content.

Competing interests:

All relevant disclosures are listed in the Supporting Information.

1. World Health Organization. Effects of nuclear weapons and nuclear war on health and health services; Executive Board 156th session [EB156/CONF./10]; 5 Feb 2025. https://apps.who.int/gb/ebwha/pdf_files/EB156/B156_CONF10‐en.pdf (viewed Mar 2025).
2. Tomonaga M. The atomic bombings of Hiroshima and Nagasaki: a summary of the human consequences, 1945–2018, and lessons for Homo sapiens to end the nuclear weapon age. Journal for Peace and Nuclear Disarmament 2019; 2: 491–517.
3. Nobel Prize Organization. Nobel Peace Prize 2024. https://www.nobelprize.org/prizes/peace/2024/summary/ (viewed Feb 2025).
4. Nobel Prize Organization. Award ceremony speech: presentation speech by Jørgen Watne Frydnes, Chair of the Norwegian Nobel Committee, 10 December 2024. https://www.nobelprize.org/prizes/peace/2024/ceremony‐speech/ (viewed Feb 2025).
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6. Robock A, Xia L, Harrison CS, et al. Opinion: how fear of nuclear winter has helped save the world, so far. Atmos Chem Phys 2023; 23: 6691–6701.
7. Helfand I, Haines A, Ruff T, et al. The growing threat of nuclear war and the role of the health community. World Med J 2016; 62: 86–94.
8. Kristensen H, Korda M, Johns E, et al. Status of world nuclear forces. Washington (DC):Federation of American Scientists, 2025. https://fas.org/initiative/status‐world‐nuclear‐forces/ (viewed Mar 2025).
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10. Mecklin J, editor; Science and Security Board. Closer than ever: it is now 89 seconds to midnight. 2025 Doomsday Clock Statement. Chicago (IL): Bulletin of the Atomic Scientists, 2025. https://thebulletin.org/doomsday‐clock/2025‐statement/ (viewed Mar 2025).
11. Xia L, Robock A, Scherrer K, et al. Global food insecurity and famine from reduced crop, marine fishery and livestock production due to climate disruption from nuclear war soot injection. Nat Food 2022; 3: 586–596.
12. United Nations General Assembly. Nuclear war and scientific research [A/C.1/79/L.39]; 15 Oct 2024. https://reachingcriticalwill.org/images/documents/Disarmament‐fora/1com/1com24/resolutions/L39‐.pdf (viewed Mar 2025).
13. General Assembly Hall. General Assembly: 55th plenary meeting. Item 98 – A/79/408 DR XVII as a whole. Nuclear war effects and scientific research; 12 Apr 2024. https://reachingcriticalwill.org/images/documents/Disarmament‐fora/1com/1com24/votes‐ga/408DRXVII.pdf (viewed Mar 2025).
14. World Health Organization. Effects of nuclear war on health and health services, 2nd ed. Geneva: WHO, 1987. https://iris.who.int/handle/10665/39199 (viewed Mar 2025).
15. World Health Organization. Health and environmental effects of nuclear weapons (WHA46/30). Geneva: WHO, 1993. https://iris.who.int/bitstream/handle/10665/175987/WHA46_30_eng.pdf?isAllowed=y&sequence=1 (viewed Mar 2025).
16. Abbasi K, Ali P, Barbour V, et al. Reducing the risks of nuclear war. BMJ 2023; 382: 1682.
17. International Campaign to Abolish Nuclear Weapons. Treaty on the Prohibition of Nuclear Weapons. Geneve: ICAN, 2017. https://www.icanw.org/tpnw_full_text (viewed Mar 2025).

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Perspective

Online first

Fan‐first heat‐health protection

Angie Bone, Federico Tartarini and Ollie Jay

Med J Aust || doi: 10.5694/mja2.52662
Published online: 2 June 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Social determinants of health

Heat‐related illnesses occur when environmental heat stress exceeds the body's physiological limits of heat tolerance. This most often arises when these limits are already constrained by cofactors such as older age, chronic diseases and certain medications.1 Global heat‐related mortality, estimated to be about 489 000 deaths per year,2 is predicted to increase substantially as climate change progresses.3

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1 Monash Sustainable Development Institute, Monash University, Melbourne, VIC
2 Heat and Health Research Centre, University of Sydney, Sydney, NSW
3 University of Sydney, Sydney, NSW

Correspondence: angie.bone@monash.edu

Open access:

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

Acknowledgements:

Ollie Jay acknowledges funding from the National Health and Medical Research Council (NHMRC) Investigator Grant (2021/GNT2009507).

Competing interests:

Angie Bone is a Board Member of Doctors for the Environment Australia.

1. Ebi KL, Capon A, Berry P, et al. Hot weather and heat extremes: health risks. Lancet 2021; 398: 698‐708.
2. Zhao Q, Guo Y, Ye T, et al. 2021 Global, regional, and national burden of mortality associated with non‐optimal ambient temperatures from 2000 to 2019: a three‐stage modelling study Lancet Planet Health 2021; 5: e415‐e425.
3. Chen K, de Schrijver E, Sivaraj S, et al. Impact of population aging on future temperature‐related mortality at different global warming levels. Nat Commun 2024 15: 1796.
4. International Energy Agency. The Future of Cooling. Paris: IEA, 2018. https://www.iea.org/reports/the‐future‐of‐cooling (viewed Sept 2024).
5. Albanese V, Shah S, Hammet T, et al. 2024 Summer Survey Report v1.3. Sweltering Cities, 2024. https://swelteringcities.org/2024/04/04/summer‐survey‐2024/ (viewed Sept 2024).
6. Australian Council of Social Service. ACOSS Summer Heat Survey 2024. ACOSS, 2024. https://www.acoss.org.au/wp‐content/uploads/2024/03/ACOSSHeatSurveyReport2024.pdf (viewed Sept 2024).
7. United Nations Environment Programme. About Montreal Protocol [website]. https://www.unep.org/ozonaction/who‐we‐are/about‐montreal‐protocol (viewed Sept 2024).
8. Lundgren‐Kownacki K, Hornyanszky ED, Chu TA, et al. Challenges of using air conditioning in an increasingly hot climate. Int J Biometeorol 2018; 62: 401‐412.
9. Tartarini F, Schiavon S, Jay O, et al. Application of Gagge's energy balance model to determine humidity‐dependent temperature thresholds for healthy adults using electric fans during heatwaves. Build Environ 2022; 207: 108437.
10. Zhai Y, Zhang Y, Zhang H, et al. Human comfort and perceived air quality in warm and humid environments with ceiling fans. Build Environ 2015; 90: 178‐185.
11. Tartarini F, Schiavon S, Cheung T, Hoyt T. CBE Thermal Comfort Tool: Online tool for thermal comfort calculations and visualizations. SoftwareX, 2020; 12: 100563.
12. Jay O, Hoelzl R, Weets J, et al. Fanning as an alternative to air conditioning – a sustainable solution for reducing indoor occupational heat stress. Energy Build 2019; 193: 92‐98.
13. Kent MG, Huynh NK, Mishra AK, et al. Energy savings and thermal comfort in a zero energy office building with fans in Singapore. Build Environ 2023; 243: 110674.
14. Malik A, Bongers C, McBain B, et al. The potential for indoor fans to change air conditioning use while maintaining human thermal comfort during hot weather: an analysis of energy demand and associated greenhouse gas emissions. Lancet Planetary Health 2022; 6: e301‐e309.
15. McKinsey & Company. Pathways to a low‐carbon economy: Version 2 of the global greenhouse gas abatement cost curve [website]. McKinsey & Company, 2009. https://www.mckinsey.com/capabilities/sustainability/our‐insights/pathways‐to‐a‐low‐carbon‐economy#/ (viewed Sept 2024).
16. Jay O, Capon A, Berry P, et al. Reducing the health effects of hot weather and heat extremes: from personal cooling strategies to green cities. Lancet 2021; 398: 709‐724.
17. Suresh Bhuvad S, You R, Chen Q. Evaluation of physiological and thermal comfort effectiveness of ceiling fan and table fan during a heat wave. Energy Build 2024; 322: 114706.
18. Ravanelli NM, Hodder SG, Havenith G, Jay O. Heart rate and body temperature responses to extreme heat and humidity with and without electric fans. JAMA 2015; 313: 724‐725.
19. Morris NB, English T, Hospers L, et al. The effects of electric fan use under differing resting heat index conditions: a clinical trial. Ann Inter Med 2019; 171: 675‐677.
20. Morris NB, Chaseling G, English T, et al. Electric fan use for cooling during hot weather: a biophysical modelling study. Lancet Planet Health 2021; 5: e368‐e377.
21. Chaseling GK, Vargas NT, Hospers L, et al. Simple strategies to reduce cardiac strain in older adults in extreme heat. N Engl J Med 2024; 391: 1754‐1757.
22. O'Connor FK, Meade RD, Wagar KE, et al. Effect of electric fans on body core temperature in older adults exposed to extreme indoor heat. JAMA 2024; 330: 1752‐1754.
23. International Organization for Standardization. ISO 7730: 2005. Ergonomics of the thermal environment. Analytical determination and interpretation of thermal comfort using calculation of the PMV and PPD indices and local thermal comfort criteria. Edition 3. ISO, 2005. https://www.iso.org/standard/39155.html (viewed Sept 2024).
24. Sera F, Hashizume M, Honda Y, et al. Air conditioning and heat‐related mortality: a multi‐country longitudinal study. Epidemiology 2020; 31: 779‐787.
25. Gupta S, Carmichael C, Simpson C, et al. Electric fans for reducing adverse health impacts in heatwaves. Cochrane Database Syst Rev 2012; 7: CD009888.
26. Tartarini F, Jay O. Heatwatch [website]. Sydney: University of Sydney, 2024. https://heatwatch.sydney.edu.au/ (viewed Sept 2024).

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Narrative review

Current gaps in knowledge and future research directions for Aboriginal and Torres Strait Islander children with cancer

Alexandra Truong, Kayla Williams‐Tucker (Ngarluma, Wongutha, Wudjari Noongar), Ahmi Narkle (Whadjuk Goreng Noongar), Eden Slicer (Gundungurra), Jessica‐Elise Chapman (Kamilaroi, Bundjalung), Jessica Lawler, Rishi S Kotecha, Hetal Dholaria, Justine R Clark (Adnyamathanha), Alex Brown (Yuin), Raelene Endersby, Nicholas G Gottardo and Jessica Buck (Kamilaroi)

Med J Aust 2025; 222 (10): . || doi: 10.5694/mja2.52650
Published online: 2 June 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Indigenous health

Neoplasms

Pediatric medicine

Summary

Paediatric cancer is the leading cause of disease‐related death in Australian children. Limited research focuses on cancer in Aboriginal and Torres Strait Islander children.
Although there appears to be a lower incidence of cancer overall in Aboriginal and Torres Strait Islander children compared with non‐Indigenous children, a high proportion of Aboriginal and Torres Strait Islander children are diagnosed with acute myeloid leukaemia.
Five‐year overall survival is lower for many cancer types in Aboriginal and Torres Strait Islander children.
There is a need for Indigenous‐specific research focused on molecular and genetic profiles, pharmacogenomics and survivorship, both within Australia and globally.
Future research in this space should be co‐designed and led by Aboriginal and Torres Strait Islander communities; alongside clinicians, researchers and services to ensure that the priorities of Aboriginal and Torres Strait Islander people are met.

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1 WA Kids Cancer Centre, The Kids Research Institute Australia, Perth, WA
2 Centre for Child Health Research, The University of Western Australia, Perth, WA
3 The University of Notre Dame Australia, Fremantle, WA
4 University of New South Wales, Sydney, NSW
5 Perth Children's Hospital, Perth, WA
6 The Kids Research Institute Australia, Adelaide, SA

Correspondence: jessica.buck@thekids.org.au

Open access:

Open access publishing facilitated by The University of Western Australia, as part of the Wiley ‐ The University of Western Australia agreement via the Council of Australian University Librarians.

Acknowledgements:

We acknowledge the First Nations Childhood Cancer Advisory Group for their advice in preparing this manuscript. We acknowledge our Elders and the communities in which we live and write. We also acknowledge First Nations people living with and passed from cancer, and their families.

Competing interests:

No relevant disclosures.

1. Australian Institute of Health and Welfare. Australia's Children. Canberra: AIHW, 2020. https://www.aihw.gov.au/reports/children‐youth/australias‐children/contents/health/health‐australias‐children (viewed Nov 2024).
2. Youlden DR, Baade PD, Green AC, et al. The incidence of childhood cancer in Australia, 1983–2015, and projections to 2035. Med J Aust 2020; 212: 113‐120. https://www.mja.com.au/journal/2020/212/3/incidence‐childhood‐cancer‐australia‐1983‐2015‐and‐projections‐2035
3. Youlden DR, Baade PD, Moore AS, et al. Childhood cancer survival and avoided deaths in Australia, 1983–2016. Paediatr Perinat Epidemiol 2023; 37: 81‐91.
4. Signorelli C, Wakefield CE, McLoone JK, et al. Childhood cancer survivors’ reported late effects, motivations for seeking survivorship care, and patterns of attendance. Oncologist 2023; 28: e276‐e286.
5. Huria T, Palmer SC, Pitama S, et al. Consolidated criteria for strengthening reporting of health research involving indigenous peoples: the CONSIDER statement. BMC Med Res Methodol 2019; 19: 173.
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Scoping review

Urgent care centres for reducing the demand on emergency departments: a scoping review of published quantitative and qualitative studies

Feby Savira, Madison Frith, Clarissa J Aditya, Sean Randall, Naomi White, Andrew Giddy, Lauren Spark, Jamie Swann and Suzanne Robinson

Med J Aust 2025; 222 (9): . || doi: 10.5694/mja2.52663
Published online: 19 May 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Health services administration

Emergency medicine

Abstract

Objectives: To identify published studies that examined the impact of urgent care centres on the numbers of presentations to emergency departments (EDs), or explored the experiences and views of patients and practitioners regarding urgent care centres as alternative sources of health care and advice.

Study design: Scoping review of qualitative and quantitative studies published to 28 August 2024.

Data sources: MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, and CINAHL databases; grey literature searches.

Data synthesis: Of 2698 potentially relevant publications, 51 met our inclusion criteria (30 quantitative studies; 21 qualitative studies). Urgent care centres of various types were led by general practitioners in 41 of 51 studies, primarily managed people with non‐urgent conditions or minor illnesses in 34 studies and non‐emergency but urgent conditions in eight, and nine of the 22 studies that discussed funding indicated that access to the centres was free of charge. The effect of urgent care centres on ED presentation numbers was mixed; all seven studies of after‐hours clinics, one of two studies of 24‐hour clinics, and four of five studies of walk‐in centres reported reduced ED visit numbers; in eleven studies that reported effects on hospital admissions from the ED, they were lower in seven (studies of an urgent cancer care centre, four community health centres, and a general practitioner cooperative). Patient satisfaction with urgent care centres is generally as high as with other primary care services; they preferred them to EDs, and preferred personal triage to telephone triage. Reasons for people choosing urgent care centres included easier access and the unavailability of doctors or appointments elsewhere. Clinicians reported increased workload, mixed experiences with the coordination of care, concerns about unregistered or undocumented people using the services, and protocol confusion, particularly with respect to triage. Continuity of care was a concern for both clinicians and patients.

Conclusions: Urgent care centres, especially walk‐in and after‐hours clinics, can help reduce the number of ED presentations and reduce health care costs. Patient satisfaction with such clinics is high, but public health education could guide people to appropriate care for non‐urgent health problems. Training in the management of conditions frequently seen in urgent care centres is needed to ensure consistent, effective care.

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1 Institute for Health Transformation, Deakin University, Melbourne, VIC
2 Western Victoria Primary Health Network, Ballarat, VIC
3 Melbourne, VIC

Correspondence: feby.savira@deakin.edu.au

Open access:

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

Acknowledgements:

The study was funded by Western Victoria Primary Health Network as part of the Priority Primary Care Centre evaluation program. The funders had no role in the planning, writing, or publication of this review. We acknowledge the support received from the Western Victoria Primary Health Network to conduct this study and to ensure evidence‐based research in Victoria and Australia.

Competing interests:

Naomi White, Andrew Giddy, and Jamie Swann are employees of the Western Victoria Primary Health Network.

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Shifting focus to adolescent wellbeing and inclusive participation in the digital age

Stephanie R Partridge, Allyson R Todd, Si Si Jia and Rebecca Raeside, with the Health Advisory Panel for Youth at the University of Sydney (HAPYUS)

Med J Aust || doi: 10.5694/mja2.52653
Published online: 19 May 2025

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AUTHORS
REFERENCES

Topics

Health occupations

Social determinants of health

General medicine

Environment and public health

Information science

Older generations often say the “youth of today aren't resilient” yet Gen Z faces a rapidly changing world, such as COVID‐19, climate change and technological advancements.

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1 University of Sydney, Sydney, NSW
2 Charles Perkins Centre, University of Sydney, Sydney, NSW

Correspondence: stephanie.partridge@sydney.edu.au

Open access:

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

Acknowledgements:

Stephanie Partridge is supported by a University of Sydney Horizon Fellowship and a National Heart Foundation Future Leader Fellowship (Grant No. 106646). Allyson Todd is a young person and PhD student supported by a Postgraduate Research Scholarship in Adolescent Health and Nutrition from the University of Sydney. Rebecca Raeside is supported by a National Health and Medical Research Council SOLVE CHD Primary and Supplementary Research Scholarship. Si Si Jia is supported on a Research Training Program Stipend Scholarship and a Postgraduate Research Scholarship from the King and Amy O'Malley Trust. The Health Advisory Panel for Youth at the University of Sydney (HAPYUS) is funded by the Australian Government Department of Health and Aged Care Medical Research Future Fund Primary Care Grant (2006315). These funding sources had no role in the design of this study and did not have any role during its execution, analyses, interpretation of the data, or decision to submit results.

The Health Advisory Panel for Youth at the University of Sydney (HAPYUS): Sara Wardak, Shuwei Guo, Yi Ying Lim, Moudasir Jalili, Lucy Goodyer, Lucy Gee, Lucy Agland, Natalie Ryan, Nitika Sharma, Caitlyn Lee, Chloe Caldwell, Elena Wang; University of Sydney, Sydney, NSW.

Competing interests:

No relevant disclosures.

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