Topics

Evidence to inform conversations on Aboriginal health issues — in response to COVID‐19 and beyond

Nearly everyone has been affected in some way by the coronavirus disease 2019 (COVID‐19) pandemic, and it is a public health risk for Aboriginal peoples and communities.1 The impacts of the pandemic are pervasive, wide‐ranging and continue to affect people and communities differently. Concerns about the indirect impacts of COVID‐19, caused by missed, delayed and avoided health care — not as a direct consequence of COVID‐19 infections — are shared internationally.2,3,4

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1 Agency for Clinical Innovation, Sydney, NSW
2 Far West Mental Health Drug and Alcohol Service, Broken Hill, NSW
3 Junction Neighbourhood Centre, Sydney, NSW
4 First Peoples Disability Network, Sydney, NSW
5 National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners, Canberra, ACT

Correspondence: tara.dimopoulosbick@health.nsw.gov.au

Acknowledgements:

We acknowledge the contributions of everyone who participated in these important conversations. We acknowledge that as the host of these conversations, NSW Health was privy to the ancient and traditional process of yarning and the respect and sharing of knowledge that this involves. We acknowledge the lands on which these conversations took place, the lands of an ancient and continuing culture, and we acknowledge and pay respect to the elders past, present and emerging of these Aboriginal lands. These lands always were and always will be Aboriginal land. We thank Kim Sutherland and Jean‐Frederic Levesque from the Agency for Clinical Innovation and the Critical Intelligence Unit for their ongoing support.

Competing interests:

No relevant disclosures.

1. Crooks K, Casey D, Ward JS. First Nations peoples leading the way in COVID‐19 pandemic planning, response and management. Med J Aust 2020; 213: 151–152. https://www.mja.com.au/journal/2020/213/4/first-nations-peoples-leading-way-covid-19-pandemic-planning-response-and
2. Sud A, Jones ME, Broggio J, et al. Collateral damage: the impact on outcomes from cancer surgery of the COVID‐19 pandemic. Ann Oncol 2020; 31: 1065–1074.
3. Newby JM, O’Moore K, Tang S, et al. Acute mental health responses during the COVID‐19 pandemic in Australia. PLoS One 2020; 15: e0236562.
4. Power T, Wilson D, Best O, Brockie T, et al. COVID‐19 and Indigenous peoples: an imperative for action. J Clin Nurs 2020; 29: 2737–2741.
5. McAnulty JM, Ward K. Suppressing the epidemic in New South Wales. N Engl J Med 2020; 382: e74.
6. Sutherland K, Chessman J, Zhao J, et al. Impact of COVID‐19 on healthcare activity in NSW. Australia. Public Health Res Pract 2020; 30: 3042030.
7. Moynihan R, Sanders S, Michaleff ZA, et al. Pandemic impacts on healthcare utilisation: a systematic review [preprint]. medRxiv 2020; 2020.10.26.20219352.
8. Yashadhana A, Pollard‐Wharton N, Zwi AB, Biles B. Indigenous Australians at increased risk of COVID‐19 due to existing health and socioeconomic inequities. Lancet Regional Health Western Pacific 2020; 1: 100007.
9. Eades S, Eades F, McCaullay D, et al. Australia’s First Nations’ response to the COVID‐19 pandemic. Lancet 2020; 396: 237–238.
10. Carson B, Dunbar T, Chenhall R, Bailie R editors. Social determinants of Indigenous health. London: Routledge, 2007.
11. World Health Organization. Social determinants of health. https://www.who.int/social_determinants/en/ (viewed Oct 2020).
12. Kingsley J, Munro‐Harrison E, Jenkins A, Thorpe A. “Here we are part of a living culture”: understanding the cultural determinants of health in Aboriginal gathering places in Victoria, Australia. Health Place 2018; 54: 210–220.
13. Abrams EM, Szefler SJ. COVID‐19 and the impact of social determinants of health. Lancet Resp Med 2020; 8: 659–661.
14. Shah GH, Shankar P, Schwind JS, Sittaramane V. The detrimental impact of the COVID‐19 crisis on health equity and social determinants of health. J Public Health Manag Pract 2020; 26: 317–319.
15. Australian Health Practitioner Regulation Agency. Aboriginal and Torres Strait Islander Health Strategy – statement of intent. https://www.ahpra.gov.au/About-Ahpra/Aboriginal-and-Torres-Strait-Islander-Health-Strategy/Statement-of-intent.aspx (viewed Jan 2021).
16. Child Family Community Australia. LGBTIQA+ communities: glossary of common terms. CFCA resource sheet – Nov 2019. https://aifs.gov.au/cfca/publications/lgbtiq-communities (viewed Jan 2021).
17. Hindman L. COVID‐19: ethical decision‐making for First Peoples living with disability. First Peoples Disability Network Australia, 2020. https://fpdn.org.au/covid-19-ethical-decision-making-for-first-peoples-living-with-disability/ (viewed Jan 2021).
18. Katz I, Jones A, Newton B, Reimer E. Life journeys of victim/survivors of child sexual abuse in institutions: an analysis of Royal Commission private sessions. Royal Commission into Institutional Responses to Child Sexual Abuse. Canberra: Commonwealth of Australia. 2017. https://www.arts.unsw.edu.au/sites/default/files/documents/Life_journeys_of_victims_survivors_of_child_sexual_abuse_in_institutions.pdf (viewed Jan 2021).
19. Dudgeon P, Derry K, Wright M. A national COVID‐19 pandemic issues paper on mental health and wellbeing for Aboriginal and Torres Strait Islander Peoples. Perth: University of Western Australia, 2020. https://apo.org.au/sites/default/files/resource-files/2020-06/apo-nid306661.pdf (viewed Jan 2021).

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Research

Seroprevalence of SARS‐CoV‐2‐specific antibodies in Sydney after the first epidemic wave of 2020

Heather F Gidding, Dorothy A Machalek, Alexandra J Hendry, Helen E Quinn, Kaitlyn Vette, Frank H Beard, Hannah S Shilling, Rena Hirani, Iain B Gosbell, David O Irving, Linda Hueston, Marnie Downes, John B Carlin, Matthew VN O'Sullivan, Dominic E Dwyer, John M Kaldor and Kristine Macartney

Med J Aust 2021; 214 (4): . || doi: 10.5694/mja2.50940
Published online: 1 March 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Statistics, epidemiology and research design

Abstract

Objectives: To estimate SARS‐CoV‐2‐specific antibody seroprevalence after the first epidemic wave of coronavirus disease 2019 (COVID‐19) in Sydney.

Setting, participants: People of any age who had provided blood for testing at selected diagnostic pathology services (general pathology); pregnant women aged 20–39 years who had received routine antenatal screening; and Australian Red Cross Lifeblood plasmapheresis donors aged 20–69 years.

Design: Cross‐sectional study; testing of de‐identified residual blood specimens collected during 20 April – 2 June 2020.

Main outcome measure: Estimated proportions of people seropositive for anti‐SARS‐CoV‐2‐specific IgG, adjusted for test sensitivity and specificity.

Results: Thirty‐eight of 5339 specimens were IgG‐positive (general pathology, 19 of 3231; antenatal screening, 7 of 560; plasmapheresis donors, 12 of 1548); there were no clear patterns by age group, sex, or location of residence. Adjusted estimated seroprevalence among people who had had general pathology blood tests (all ages) was 0.15% (95% credible interval [CrI], 0.04–0.41%), and 0.29% (95% CrI, 0.04–0.75%) for plasmapheresis donors (20–69 years). Among 20–39‐year‐old people, the age group common to all three collection groups, adjusted estimated seroprevalence was 0.24% (95% CrI, 0.04–0.80%) for the general pathology group, 0.79% (95% CrI, 0.04–1.88%) for the antenatal screening group, and 0.69% (95% CrI, 0.04–1.59%) for plasmapheresis donors.

Conclusions: Estimated SARS‐CoV‐2 seroprevalence was below 1%, indicating that community transmission was low during the first COVID‐19 epidemic wave in Sydney. These findings suggest that early control of the spread of COVID‐19 was successful, but efforts to reduce further transmission remain important.

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1 National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Sydney, NSW
2 Northern Clinical School, University of Sydney, Sydney, NSW
3 Women and Babies Research, Kolling Institute, Sydney, NSW
4 The Kirby Institute, University of New South Wales, Sydney, NSW
5 The University of Sydney, Sydney, NSW
6 Centre for Women’s Infectious Diseases, Royal Women’s Hospital, Melbourne, VIC
7 Australian Red Cross Lifeblood, Sydney, NSW
8 Western Sydney University, Sydney, NSW
9 University of Technology Sydney, Sydney, NSW
10 NSW Health Pathology–Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, NSW
11 Murdoch Children’s Research Institute, Melbourne, VIC
12 The University of Melbourne, Melbourne, VIC
13 Centre for Infectious Disease and Microbiology, Westmead Hospital, Sydney, NSW
14 Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW

Correspondence: heather.gidding@sydney.edu.au

Acknowledgements:

This study was funded by the NSW Ministry of Health. The National Centre for Immunisation Research and Surveillance is supported by the Australian Department of Health, the NSW Ministry of Health, and the Children’s Hospital at Westmead. Heather Gidding and John Kaldor are supported by National Health and Medical Research Council fellowships. Australian governments fund Australian Red Cross Lifeblood to provide blood, blood products and services to the Australian community.

We thank everyone who contributed to this investigation, especially the laboratory staff who collected the specimens and the scientific staff who performed the IFA and neutralisation assays, including Katherine Tudo, Melanie Lograsso and Bassam Al Zahroon (NSW Health Pathology–Institute of Clinical Pathology and Medical Research); Andrew Cullen, Ian Chambers, Annabelle Farnsworth, Karen Wagner and Daniel Clifford (Douglass Hanly Moir Pathology); Agustin Franco, Pratibha James and Michael Mark (4Cyte Pathology); Juliette Holland and Kartik Naidu (Laverty Pathology); Rebecca Burrell, Philip Britton and Alex Micati (Children’s Hospital at Westmead); Elizabeth Knight (Australian Red Cross Lifeblood); and Darren Croese (NSW Health Pathology incident management team). We are grateful to Lucy Armstrong (National Centre for Immunisation Research and Surveillance) for her help with coordinating the study; Heather Whitaker and Nick Andrews (Public Health England) for their statistical advice and sharing their analysis code; James McCaw and Jodie McVernon (Peter Doherty Institute) for their advice on the initial study design; and Michelle Cretikos, Roy Byun, Sheena Adamson and Laura Collie (NSW Ministry of Health) for their helpful advice.

Competing interests:

No relevant disclosures.

1. World Health Organization. WHO timeline: COVID‐19. Updated 29 June 2020. https://www.who.int/news-room/detail/08-04-2020-who-timeline---covid-19 (viewed Oct 2020).
2. Shaban R, Li C, O’Sullivan M, et al. COVID‐19 in Australia: our national response to the first cases of SARS‐CoV‐2 infection during the early biocontainment phase. Intern Med J 2020; https://doi.org/10.1111/imj.15105 [online ahead of print].
3. Australian Department of Health. COVID‐19, Australia: epidemiology report 13. Reporting week ending 26 April 2020. May 2020. https://www1.health.gov.au/internet/main/publishing.nsf/Content/novel_coronavirus_2019_ncov_weekly_epidemiology_reports_australia_2020.htm (viewed Oct 2020).
4. NSW Ministry of Health. COVID‐19 Weekly surveillance in NSW: epidemiological week 19, ending 9. May, 2020. https://www.health.nsw.gov.au/Infectious/covid-19/Documents/covid-19-surveillance-report-20200512.pdf (viewed Oct 2020).
5. Peeling RW, Wedderburn CJ, Garcia PJ, et al. Serology testing in the COVID‐19 pandemic response. Lancet Infect Dis 2020; 20: e245–e249.
6. COVID‐19 Immunity Task Force (Public Health Agency of Canada). SeroTracker. https://serotracker.com/Dashboard (viewed Oct 2020).
7. Australian Department of Health. Australian National Disease Surveillance Plan for COVID‐19. Updated 30 May 2020. https://www.health.gov.au/resources/publications/australian-national-disease-surveillance-plan-for-covid-19 (viewed Oct 2020).
8. NSW Ministry of Health. Enhanced surveillance plan for COVID‐19 in NSW. Updated 22 Nov 2020. https://www.health.nsw.gov.au/Infectious/covid-19/Pages/surveillance-plan.aspx (viewed Nov 2020).
9. Australian Bureau of Statistics. Estimated resident population (ERP) and components by SA2 and above (ASGS 2016), 2017 onwards. http://stat.data.abs.gov.au/Index.aspx?DataSetCode=ABS_ERP_COMP_SA (viewed Oct 2020).
10. Hueston L, Kok J, Guibone A, et al. The antibody response to SARS‐CoV‐2 infection. Open Forum Infectious Diseases 2020; 7: ofaa387.
11. Australian Bureau of Statistics. 3301.0. Births, Australia, 2018. Dec 2019. https://www.abs.gov.au/statistics/people/population/births-australia/2019#data-download (viewed Oct 2020).
12. Post N, Eddy D, Huntley C, et al. Antibody response to SARS‐CoV‐2 infection in humans: a systematic review [pre‐print]. 30 Aug 2020. medRxiv 2020; https://doi.org/10.1101/2020.08.25.20178806.
13. Brochot E, Demey B, Touzé A, et al. Anti‐spike, anti‐nucleocapsid and neutralizing antibodies in SARS‐CoV‐2 inpatients and asymptomatic carriers. Front Microbiol 2020; 11: 584251.
14. Health Information and Quality Authority (Ireland). Evidence summary of the immune response following infection with SARS‐CoV‐2 or other human coronaviruses; version 3. 6 Aug 2020. https://www.hiqa.ie/reports-and-publications/health-technology-assessment/evidence-summary-immunity-response-following (viewed Oct 2020).
15. Robbiani DF, Gaebler C, Muecksch F, et al. Convergent antibody responses to SARS‐CoV‐2 in convalescent individuals. Nature 2020; 584: 437–442.
16. Hicks SM, Pohl K, Neeman T, et al; SARS‐CoV‐2 Testing in Elective Surgery Collaborators. A dual antigen ELISA allows the assessment of SARS‐CoV‐2 antibody seroprevalence in a low transmission setting. J Infect Dis 2021; 223: 10–14.
17. McAnulty JM, Ward K. Suppressing the epidemic in New South Wales. N Engl J Med 2020; 382: e74.

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Editorials

Preventing suicide by young people requires integrative strategies

Michael J Dudley and Ping-I Lin

Med J Aust 2021; 214 (3): . || doi: 10.5694/mja2.50939
Published online: 15 February 2021

Correction(s) for this article:

Erratum | Published online: 14 December 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Mental disorders

We need more robust strategies with targeted, customised approaches, and funding for evidence‐based interventions

Suicide is the leading cause of death of young people in Australia,1 despite extensive research into risk factors for self‐harm. In this issue of the MJA, Hill and colleagues2 report their analysis of National Coronial Information System (NCIS) data for the 3365 young people (10–24 years old) who died by suicide in Australia during 2006–2015. Most were boys or young men (74%); many had diagnosed or possible mental health problems (57%), but fewer than one in three had been in contact with mental health services. A large proportion (38%) were not employed or in education or training at the time of their deaths; 14% were Indigenous Australians, 8% resided in remote locations, and 38% lived in the socio‐economically most disadvantaged regions of Australia.2 Although Hill and her co‐authors could not assess causal relationships between these factors and suicide, their statistics suggest potential targets for focused prevention.

1 Adolescent Service, Prince of Wales and Sydney Children's Hospitals, Sydney, NSW
2 University of New South Wales, Sydney, NSW
3 South Western Sydney Local Health District, Sydney, NSW

Correspondence: m.dudley@unsw.edu.au

Competing interests:

No relevant disclosures.

1. Australian Bureau of Statistics. Causes of death, Australia: reference period, 2019 (table 1.3). 23 Oct 2020. https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/latest-release (viewed Dec 2020).
2. Hill NTM, Witt K, Rajaram G, et al. Suicide by young Australians, 2006–2015: a cross‐sectional analysis of national coronial data. Med J Aust 2021; 214: 133–139.
3. Tatz C; Australian Institute of Aboriginal and Torres Strait Islander Studies. Aboriginal suicide is different: a portrait of life and self‐destruction. 2nd ed. Canberra: Aboriginal Studies Press, 2005.
4. Steering Committee for the Review of Government Service Provision. Overcoming Indigenous disadvantage: key indicators 2020. Canberra: Productivity Commission, 2020. https://www.pc.gov.au/research/ongoing/overcoming-indigenous-disadvantage/2020 (viewed Dec 2020).
5. Tighe J, Shand F, McKay K, et al. Usage and acceptability of the iBobbly App: pilot trial for suicide prevention in Aboriginal and Torres Strait Islander youth. JMIR Ment Health 2020; 7: e14296.
6. Referendum Council. Uluru Statement from the Heart. 26 May 2017. https://ulurustatement.org (viewed Dec 2020).
7. Too LS, Leach L, Butterworth P. Mental health problems and internet access: results from an Australian national household survey. JMIR Ment Health 2020; 7: e14825.
8. Richardson‐Cooke J. Suicide in rural and remote Australia: mental health strategies cannot effectively operate in isolation (Future Directions International strategic analysis paper). 28 Jan 2020. https://www.futuredirections.org.au/wp-content/uploads/2020/01/Mental-and-Rural-Health-in-Rural-and-Regional-Australia.pdf (viewed Dec 2020).
9. Tiller E, Fildes J, Hall S, et al. Mission Australia youth survey report 2020. https://www.missionaustralia.com.au/what-we-do/research-impact-policy-advocacy/youth-survey (viewed Dec 2020).
10. McPherson E. Mothers who lost sons to suicide after Centrelink debts write heartbreaking letters to Senate. 9 News (Sydney), 17 Aug 2020. https://www.9news.com.au/national/centrelink-robodebt-mothers-who-lost-sons-to-suicide-write-heartbreaking-letters-to-senate/d69bd6fc-2257-4a83-ae77-5c5c6b1384f4 (viewed Dec 2020).
11. Stuckler D, Basu S. The body economic: why austerity kills. London: Allen Lane, 2013.
12. Too LS, Spittal MJ, Bugeja L, et al. The association between mental disorders and suicide: a systematic review and meta-analysis of record linkage studies. J Affect Disord 2019; 259: 302–313.
13. Hjelmeland H, Knizek BL. Suicide and mental disorders: a discourse of politics, power, and vested interests. Death Stud 2017; 41: 481–492.
14. Lawrence D, Johnson S, Hafekost J, et al. The mental health of children and adolescents: report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing (here: pp. 67, 86). Aug 2015. https://www.health.gov.au/internet/main/publishing.nsf/Content/9DA8CA21306FE6EDCA257E2700016945/%24File/child2.pdf (viewed Dec 2020).
15. Atkinson JA, Lawson K, Skinner A, Hickie I; Brain and Mind Centre (University of Sydney). Road to recovery, part 2: investing in Australia’s mental wealth. July 2020. https://www.sydney.edu.au/content/dam/corporate/documents/brain-and-mind-centre/road-to-recovery-part-2-economic-short-report.pdf (viewed Dec 2020).
16. Hiscock H, Neely RJ, Lei S, Freed G. Paediatric mental and physical health presentations to emergency departments, Victoria, 2008–15. Med J Aust 2018; 208: 343–348. https://www.mja.com.au/journal/2018/208/8/paediatric-mental-and-physical-health-presentations-emergency-departments
17. Perera J, Wand T, Bein KJ, et al. Presentations to NSW emergency departments with self-harm, suicidal ideation, or intentional poisoning, 2010–2014. Med J Aust 2018; 208: 348–353. https://www.mja.com.au/journal/2018/208/8/presentations-nsw-emergency-departments-self-harm-suicidal-ideation-or
18. Productivity Commission (Australian Government). Mental health: Productivity Commission inquiry report. Volume 1 (Report no. 95). 30 June 2020. https://www.pc.gov.au/inquiries/completed/mental-health/report/mental-health-volume1.pdf (viewed Dec 2020).
19. Productivity Commission (Australian Government). Mental health: Productivity Commission inquiry report. Volume 2 (Report no. 95). 30 June 2020. https://www.pc.gov.au/inquiries/completed/mental-health/report/mental-health-volume2.pdf (viewed Dec 2020).
20. Schley C, Yuen K, Fletcher K, Radovini A. Does engagement with an intensive outreach service predict better treatment outcomes in “high-risk” youth? Early Interv Psychiatry 2012; 6: 176–184.
21. Bilsen J. Suicide and youth: risk factors. Front Psychiatry 2018; 9: 540.
22. NSW Health. NSW School-Link initiative (Mental Health Reform 2017–18). Dec 2017. https://www.health.nsw.gov.au/mentalhealth/resources/Factsheets/school-link.pdf (viewed Jan 2021).
23. Robinson J, Bailey E, Witt K, et al. What works in youth suicide prevention? A systematic review and meta-analysis. EClinicalMedicine 2018; 4: 52–91.
24. Kothgassner OD, Robinson K, Goreis A, et al. Does treatment method matter? A meta-analysis of the past 20 years of research on therapeutic interventions for self-harm and suicidal ideation in adolescents. Borderline Personal Disord Emot Dysregul 2020; 7: 9.
25. Productivity Commission (Australian Government). Mental health: Productivity Commission inquiry report. Actions and findings (Report no. 95). 30 June 2020. https://www.pc.gov.au/inquiries/completed/mental-health/report/mental-health-actions-findings.pdf (viewed Dec 2020).
26. Barber CW, Miller MJ. Reducing a suicidal person’s access to lethal means of suicide: a research agenda. Am J Prev Med 2014; 47 (3 Suppl 2): S264–S272.
27. Large M, Nielssen O. The need to prevent suicide by hanging in Australia [letter]. Aust N Z J Psychiatry 2020; https://doi.org/10.1177/0004867420951249 [online ahead of print].

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Editorials

Biosimilars: is interchangeability the proof of the pudding?

Gregory T Moore and Charlotte Keung

Med J Aust 2021; 214 (3): . || doi: 10.5694/mja2.50912
Published online: 15 February 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Digestive system diseases

Pharmaceutical preparations

While apparently non‐inferior to originator biologics, other factors need to be considered before switching

Biologic drugs are large monoclonal antibodies or genetically engineered proteins produced by live organisms. With highly specific targets, they have revolutionised the treatment of inflammatory, endocrine, and malignant conditions. However, these drugs are expensive, partly because of the complex and costly manufacturing processes required, partly because long periods of therapy are often needed.

1 Monash Health, Melbourne, VIC
2 Monash University, Melbourne, VIC

Correspondence: gregory.moore@monash.edu

Competing interests:

Gregory Moore has received payment for advisory boards from AbbVie, BMS, Chiesi, Emerge, Gilead, Hospira, Janssen, Orphan, MSD, Pfizer, Shire, Takeda; speaker’s fees from AbbVie, Ferring, Janssen, Orphan, Pfizer, Roche, Shire, and Takeda; and research and educational support from AbbVie, Janssen, Pfizer, Shire, and Takeda.

1. Australian Department of Health. Which biosimilar medicines are available in Australia? Updated 10 Sept 2020. https://www1.health.gov.au/internet/main/publishing.nsf/Content/biosimilar-which-medicines-are-available-in-australia (viewed Nov 2020).]
2. Therapeutic Goods Administration (Australian Department of Health). Biosimilar medicines regulation, version 2.2. Apr 2018. https://www.tga.gov.au/publication/biosimilar-medicines-regulation (viewed Nov 2020).
3. Park W, Hrycaj P, Jeka S, et al. A randomised, double‐blind, multicentre, parallel‐group, prospective study comparing the pharmacokinetics, safety, and efficacy of CT‐P13 and innovator infliximab in patients with ankylosing spondylitis: the PLANETAS study. Ann Rheum Dis 2013; 72: 1605–1612.
4. Yoo DH, Hrycaj P, Miranda P, et al. A randomised, double‐blind, parallel‐group study to demonstrate equivalence in efficacy and safety of CT‐P13 compared with innovator infliximab when coadministered with methotrexate in patients with active rheumatoid arthritis: the PLANETRA study. Ann Rheum Dis 2013; 72: 1613–1620.
5. Haifer C, Srinivasan A, An YK, et al. Switching Australian patients with moderate to severe inflammatory bowel disease from originator to biosimilar infliximab: a multicentre, parallel cohort study. Med J Aust 2021; 214: 128–133.
6. Jørgensen KK, Olsen IC, Goll GL, et al. NOR‐SWITCH study group. Switching from originator infliximab to biosimilar CT‐P13 compared with maintained treatment with originator infliximab (NOR‐SWITCH): a 52‐week, randomised, double‐blind, non‐inferiority trial. Lancet 2017; 389: 2304–2316.
7. Jørgensen KK, Goll GL, Sexton J, et al. Efficacy and safety of CT‐P13 in inflammatory bowel disease after switching from originator infliximab: exploratory analyses from the NOR‐SWITCH main and extension trials. BioDrugs 2020; 34: 681–694.
8. Ye BD, Pesegova M, Alexeeva O, et al. Efficacy and safety of biosimilar CT‐P13 compared with originator infliximab in patients with active Crohn’s disease: an international, randomised, double‐blind, phase 3 non‐inferiority study. Lancet 2019; 393: 1699–1707.
9. Ben‐Horin S, Yavzori M, Benhar I, et al. Cross‐immunogenicity: antibodies to infliximab in Remicade‐treated patients with IBD similarly recognise the biosimilar Remsima. Gut 2016; 65: 1132–1138.
10. Goncalves J, Myung G, Park M, et al. SB5 shows cross‐immunogenicity to adalimumab but not infliximab: results in patients with inflammatory bowel disease or rheumatoid arthritis. Therap Adv Gastroenterol 2019; 12: 1756284819891081.
11. Strik AS, van de Vrie W, Bloemsaat‐Minekus JPJ, et al. SECURE study group. Serum concentrations after switching from originator infliximab to the biosimilar CT‐P13 in patients with quiescent inflammatory bowel disease (SECURE): an open‐label, multicentre, phase 4 non‐inferiority trial. Lancet Gastroenterol Hepatol 2018; 3: 404–412.
12. Australian Department of Health. Biosimilar uptake drivers. 2018. https://www.pbs.gov.au/general/biosimilars/biosimilar-uptake-drivers-q-and-a.pdf (viewed Nov 2020).
13. Glintborg B, Loft AG, Omerovic E, et al. To switch or not to switch: results of a nationwide guideline of mandatory switching from originator to biosimilar etanercept. One‐year treatment outcomes in 2061 patients with inflammatory arthritis from the DANBIO registry. Ann Rheum Dis 2019; 78: 192–200.
14. Lauret A, Moltó A, Abitbol V, et al. Effects of successive switches to different biosimilars infliximab on immunogenicity in chronic inflammatory diseases in daily clinical practice Semin Arthritis Rheum 2020; 50: 1449–1456.
15. Zarrin AA, Bao K, Lupardus P, Vucic D. Kinase inhibition in autoimmunity and inflammation. Nat Rev Drug Discov 2021; 20: 39–63.

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Perspectives

What are people saying on social networking sites about the Australian alcohol consumption guidelines?

Benjamin C Riordan, Daniel T Winter, Paul S Haber, Carolyn A Day and Kirsten C Morley

Med J Aust 2021; 214 (3): . || doi: 10.5694/mja2.50902
Published online: 15 February 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Substance-related disorders

Information science

General medicine

Posts provide valuable feedback during public consultation for health guidelines

Guidelines provide important information on key health behaviours that can influence the population, with public consultation forming an important part of guideline development.1 Public consultation provides transparency, while improving the quality, legitimacy and acceptability of guidelines to the public.1 Although the public are encouraged to provide formal feedback, they may also discuss and provide valuable feedback on popular social networking sites such as Twitter and Reddit. Social networking sites are universal, with 5.8 million Australians using Twitter and 110 000 using Reddit each month.2 Given that a number of these posts are publicly available, they can be used to answer research questions and track health behaviours,3,4,5 and may be an informative source of feedback on health guidelines during public consultation.6

1 University of Sydney, Sydney, NSW
2 Royal Prince Alfred Hospital, Sydney, NSW

Correspondence: benjamin.riordan@sydney.edu.au

Competing interests:

No relevant disclosures.

1. National Health and Medical Research Council. 2016 NHMRC standards for guidelines. Canberra: NHMRC, 2016 https://www.nhmrc.gov.au/guidelinesforguidelines/standards (viewed Mar 2020).
2. Social Media Statistics Australia — October 2020. Social Media News Australia, 2020; 1 Oct. https://www.socialmedianews.com.au/social-media-statistics-australia-october-2020/ (viewed Dec 2020).
3. Riordan B, Merrill J, Ward R. “Can’t wait to blackout tonight”: an analysis of the motives to drink to blackout expressed on Twitter. Alcohol Clin Exp Res 2019; 43: 1769–1776.
4. Cavazos‐Rehg PA, Krauss MJ, Sowles S, et al. A content analysis of depression‐related Tweets. Comput Human Behav 2016; 54: 351–357.
5. Curtis B, Giorgi S, Buffone AEK, et al. Can Twitter be used to predict county excessive alcohol consumption rates? PLoS One 2018; 13: e0194290.
6. Stautz K, Bignardi G, Hollands GJ, Marteau TM. Reactions on Twitter to updated alcohol guidelines in the UK: a content analysis. BMJ Open 2017; 7: e015493.
7. Australian Institute of Health and Welfare. International health data comparisons, 2018 (AIHW Cat. No: PHE 237). Canberra: AIHW, 2018. https://www.aihw.gov.au/reports/phe/237/international-health-data-comparisons-2018/contents/health-risk-factors (viewed Feb 2020).
8. National Health and Medical Research Council. Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Canberra: NHMRC, 2020: https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol (viewed Dec 2020).
9. Kearney M, Heiss A, Briatte F. Package ‘rtweet’. https://cran.r-project.org/web/packages/rtweet/rtweet.pdf (viewed Dec 2019).
10. Rivera I. Package ‘RedditExtractoR’. https://cran.r-project.org/web/packages/RedditExtractoR/RedditExtractoR.pdf (viewed Dec 2019).
11. Wojcik S, Hughes A. Sizing up Twitter users. 24 Apr 2019. Washington, DC: Pew Research Center, 2019. https://www.pewresearch.org/internet/2019/04/24/sizing-up-twitter-users/ (viewed Mar 2020).
12. Barthel M, Stocking G, Holcomb J, Mitchell A. Reddit news users more likely to be male, young and digital in their news preferences. 25 Feb 2016. Washington, DC: Pew Research Center, 2016. https://www.journalism.org/2016/02/25/reddit-news-users-more-likely-to-be-male-young-and-digital-in-their-news-preferences/ (viewed Mar 2020).
13. Mervis J. Privacy concerns could derail Facebook data‐sharing plan. Science 2019; 365: 1360–1361.
14. Bastos M, Walker ST. Facebook’s data lockdown is a disaster for academic researchers. The Conversation 2018; 11 Apr. https://theconversation.com/facebooks-data-lockdown-is-a-disaster-for-academic-researchers-94533 (viewed Apr 2020).

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Research

Modelling the impact of relaxing COVID‐19 control measures during a period of low viral transmission

Nick Scott, Anna Palmer, Dominic Delport, Romesh Abeysuriya, Robyn M Stuart, Cliff C Kerr, Dina Mistry, Daniel J Klein, Rachel Sacks‐Davis, Katie Heath, Samuel W Hainsworth, Alisa Pedrana, Mark Stoove, David Wilson and Margaret E Hellard

Med J Aust 2021; 214 (2): . || doi: 10.5694/mja2.50845
Published online: 1 February 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Statistics, epidemiology and research design

Infectious diseases

Environment and public health

Abstract

Objectives: To assess the risks associated with relaxing coronavirus disease 2019 (COVID‐19)‐related physical distancing restrictions and lockdown policies during a period of low viral transmission.

Design: Network‐based viral transmission risks in households, schools, workplaces, and a variety of community spaces and activities were simulated in an agent‐based model, Covasim.

Setting: The model was calibrated for a baseline scenario reflecting the epidemiological and policy environment in Victoria during March–May 2020, a period of low community viral transmission.

Intervention: Policy changes for easing COVID‐19‐related restrictions from May 2020 were simulated in the context of interventions that included testing, contact tracing (including with a smartphone app), and quarantine.

Main outcome measure: Increase in detected COVID‐19 cases following relaxation of restrictions.

Results: Policy changes that facilitate contact of individuals with large numbers of unknown people (eg, opening bars, increased public transport use) were associated with the greatest risk of COVID‐19 case numbers increasing; changes leading to smaller, structured gatherings with known contacts (eg, small social gatherings, opening schools) were associated with lower risks. In our model, the rise in case numbers following some policy changes was notable only two months after their implementation.

Conclusions: Removing several COVID‐19‐related restrictions within a short period of time should be undertaken with care, as the consequences may not be apparent for more than two months. Our findings support continuation of work from home policies (to reduce public transport use) and strategies that mitigate the risk associated with re‐opening of social venues.

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1 Burnet Institute, Melbourne, VIC
2 University of Copenhagen, Copenhagen, Denmark
3 Institute for Disease Modeling, Bellevue, WA, United States of America

Correspondence: nick.scott@burnet.edu.au

Acknowledgements:

We thank Allan J Saul, Angela Davis, Joseph Doyle, Sherrie Kelly and Suman Majumdar (Burnet Institute) for their contributions to parameter estimates, and additional members of the Institute for Disease Modelling team who contributed to the base Covasim model.

Competing interests:

No relevant disclosures.

1. Victorian Department of Health and Human Services. Victoria's COVID‐19 restrictions. https://www.dhhs.vic.gov.au/victorias-restriction-levels-covid-19 (viewed May 2020).
2. Australian Department of Health. Coronavirus (COVID‐19) current situation and case numbers. https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers#total-cases-recoveries-and-deaths (viewed Aug 2020).
3. Price DJ, Shearer FM, Meehan MT, et al. Early analysis of the Australian COVID‐19 epidemic. Elife 2020; 9: e58785.
4. Australian Department of Health. 3‐Step framework for a COVIDSafe Australia. May 2020. https://www.health.gov.au/resources/publications/3-step-framework-for-a-covidsafe-australia (viewed May 2020).
5. Australian Bureau of Statistics. National, state and territory population, Mar 2020. Sept 2020. https://www.abs.gov.au/statistics/people/population/national-state-and-territory-population/latest-release (viewed Sept 2020).
6. Gilbert N. Agent‐based models. London: Sage, 2008.
7. Costantino V, Heslop DJ, MacIntyre CR. The effectiveness of full and partial travel bans against COVID‐19 spread in Australia for travellers from China. J Travel Med 2020; 27: taaa081.
8. Adekunle AI, Meehan M, Alvarez DR, et al. Delaying the COVID‐19 epidemic in Australia: evaluating the effectiveness of international travel bans. Aust N Z J Public Health 2020; 44: 257–259.
9. Moss R, Wood J, Brown D, et al. Modelling the impact of COVID‐19 in Australia to inform transmission reducing measures and health system preparedness [pre‐print]; version 1, 11 Apr 2020. medRxiv 2020; https://doi.org/10.1101/2020.04.07.20056184
10. Fox GJ, Trauer JM, McBryde E. Modelling the impact of COVID‐19 upon intensive care services in New South Wales. Med J Aust 2020; 212: 468–469. https://www.mja.com.au/journal/2020/212/10/modelling-impact-covid-19-intensive-care-services-new-south-wales
11. Koo JR, Cook AR, Park M, et al. Interventions to mitigate early spread of SARS‐CoV-2 in Singapore: a modelling study. Lancet Infect Dis 2020; 20: 678–688.
12. Chang SL, Harding N, Zachreson C, et al. Modelling transmission and control of the COVID‐19 pandemic in Australia [e‐print]; version 3, 3 May 2020. arXiv 2020; 10218v3.
13. Chao DL, Oron AP, Srikrishna D, Famulare M. Modeling layered non‐pharmaceutical interventions against SARS‐CoV-2 in the United States with Corvid [pre‐print]; version 1, 11 May 2020. medRxiv 2020; https://doi.org/10.1101/2020.04.08.20058487
14. Ferguson N, Laydon D, Nedjati Gilani G, et al. Report 9: Impact of non‐pharmaceutical interventions (NPIs) to reduce COVID‐19 mortality and healthcare demand. Imperial College London, 16 Mar 2020. http://hdl.handle.net/10044/1/77482 (viewed May 2020).
15. Aleta A, Martin‐Corral D, Pastore y Piontti A, et al. Modeling the impact of social distancing, testing, contact tracing and household quarantine on second‐wave scenarios of the COVID‐19 epidemic [pre‐print]; version 1, 18 May 2020. medRxiv 2020; https://doi.org/10.1101/2020.05.06.20092841
16. Kretzschmar M, Rozhnova G, van Boven M. Isolation and contact tracing can tip the scale to containment of COVID‐19 in populations with social distancing [preprint]; version 3, 16 April 2020. medRxiv 2020: https://doi.org/10.1101/2020.03.10.20033738
17. Kucharski AJ, Klepac P, Conlan A, et al. Effectiveness of isolation, testing, contact tracing and physical distancing on reducing transmission of SARS‐CoV-2 in different settings. Lancet Infect Dis 2020; 20: 1151–1160.
18. Milne GJ, Xie S. The effectiveness of social distancing in mitigating COVID‐19 spread: a modelling analysis [pre‐print]; version 1, 23 March 2020. medRxiv 2020; https://doi.org/10.1101/2020.03.20.20040055
19. Kerr C, Stuart RM, Mistry D, et al. Covasim: an agent‐based model of COVID‐19 dynamics and interventions [preprint]; version 1, 15 May 2020. medRxiv 2020; https://doi.org/10.1101/2020.05.10.20097469
20. Institute for Disease Modelling. Info hub, research and reports page. https://covid.idmod.org/#/ResearchandReports (viewed May 2020).
21. Statista. Daily cumulative total of COVIDSafe app downloads in Australia in 2020. https://www.statista.com/statistics/1153879/australia-covidsafe-app-downloads/#:~:text=At%20June%206%2C%202020%20the,at%20around%20five%20million%20downloads (viewed Oct 2020).

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Perspectives

Putting the “good” into Good Clinical Practice

Tanya Symons, Steve Webb and John R Zalcberg

Med J Aust 2021; 214 (2): . || doi: 10.5694/mja2.50908
Published online: 1 February 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Statistics, epidemiology and research design

Ethics and law

Pharmaceutical preparations

Current Good Clinical Practice guidelines are bureaucratic and should align with less burdensome examples of international trial policy

Clinical trials must be conducted in ways that protect participants and produce reliable results. Both are central tenets of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) Good Clinical Practice (GCP) guideline.1 The ICH GCP guideline was developed to harmonise the conduct of trials across world regions and, since the mid‐1990s, its core principles have provided the bedrock for trial conduct. However, the devil is in the detail and, in the case of the ICH GCP guideline, that detail (and the interpretation of each word) has far‐reaching consequences.

1 University of Sydney, Sydney, NSW
2 Royal Perth Hospital, Perth, WA
3 Monash University, Melbourne, VIC

Correspondence: tanya.symons@sydney.edu.au

Competing interests:

No relevant disclosures.

1. International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use. ICH Harmonised Guideline: Integrated addendum to ICH E6 (R1): guideline for good clinical practice E6 (R2). ICH, 2016. https://database.ich.org/sites/default/files/E6_R2_Addendum.pdf (viewed Dec 2020).
2. Yusef S, Bosch J, Devereaux PJ, et al. Sensible guidelines for the conduct of large randomized trials. Clin Trials 2008; 5: 38–39.
3. Rule S, Legouill S. Bureaucracy is strangling clinical research. BMJ 2019; 364: 1097.
4. Mentz R, Hernandez A, Berdan L, et al. Good clinical practice guidance and pragmatic clinical trials: balancing the best of both worlds. Circulation 2016; 133: 872–880.
5. Co‐ordinated response to the consultation by the International Council for Harmonisation (ICH) on its proposed E6 (R2) “Integrated Addendum” to the ICH E6 Guideline for “Good Clinical Practice”. Updated open letter to EMA & ICH from 5 research organisations and an international consortium of 119 health researchers in 22 countries. 26 Feb 2016. https://moretrials.net/?download_id=029bb92127a231e9c1d925b8cf5c6d6a (viewed June 2020).
6. International Council for Harmonisation. ICH reflection on “GCP renovation”: modernization of ICH E8 and subsequent renovation of ICH E6. January 2017. https://admin.ich.org/sites/default/files/2019-04/ICH_Reflection_paper_GCP_Renovation_Jan_2017_Final.pdf (viewed May 2020).
7. International Council for Harmonisation. Final concept paper ICH E6(R3): guideline for good clinical practice. 17 Nov 2019. https://database.ich.org/sites/default/files/E6-R3_FinalConceptPaper_2019_1117.pdf (viewed May 2020).
8. Grimes DA, Hubacher D, Nanda K, et al. The Good Clinical Practice guideline: a bronze standard for clinical research. Lancet 2005; 366: 172–174.
9. National Statement on Ethical Conduct in Human Research 2007 (Updated 2018). The National Health and Medical Research Council, the Australian Research Council and Universities Australia. Commonwealth of Australia, Canberra. https://www.nhmrc.gov.au/about-us/publications/national-statement-ethical-conduct-human-research-2007-updated-2018 (viewed Dec 2020).
10. Sharp MS. Consent documents for oncology trials: does anybody read these things? Am J Clin Oncol 2004; 27: 570–575.
11. Hallinan ZP, Forrest A, Uhlenbrauck G, et al. Barriers to change in the informed consent process: a systematic literature review. IRB 2016; 38: 1–10.
12. Krishnamurti T, Argo N. A patient‐centered approach to informed consent: results from a survey and randomized trial. Med Decis Making 2016; 36: 726–740.
13. Reith C, Landray M, Devereaux PJ, et al. Randomized clinical trials: removing unnecessary obstacles. N Engl J Med 2013; 369: 1061–1065.
14. Regulation (EU) No 536/2014 of the European Parliament and of the Council of 16 April 2014 on clinical trials on medicinal products for human use, and repealing Directive 2001/20/EC. https://ec.europa.eu/health/sites/health/files/files/eudralex/vol-1/reg_2014_536/reg_2014_536_en.pdf (viewed Dec 2020).
15. National Health and Medical Research Council. Safety monitoring and reporting in clinical trials involving therapeutic goods. Canberra: National Health and Medical Research Council. Canberra: NHMRC, 2016. https://www.nhmrc.gov.au/about-us/publications/safety-monitoring-and-reporting-clinical-trials-involving-therapeutic-goods (viewed Dec 2020).
16. Collins R. Sensible guidelines for clinical trials: are current European regulations ‘a gift to America’? Interview by Barry Shurlock. Eur Heart J 2013; 35: 1767–1768.
17. Sheetz N, Wilson B, Benedict J, et al. Evaluating source data verification as a quality control measure in clinical trials. Ther Innov Regul Sci 2014; 48: 671–680.
18. Meeker‐O’Connell A, Glessner C, Behm M, et al. Enhancing clinical evidence by proactively building quality into clinical trials. Clin Trials 2016; 13: 439–444.
19. Food and Drug Administration. Information sheet guidance for sponsors, clinical investigators, and IRBs. Frequently asked questions – statement of investigator (Form FDA 1572). https://www.fda.gov/media/78830/download (viewed Dec 2020).
20. Health Research Authority; Medicines and Healthcare Products Regulatory Agency. Joint Statement on the Application of Good Clinical Practice to Training for Researchers (HRA, MHRA, Devolved Administrations for Northern Ireland, Scotland and Wales). Updated Feb 2020. https://www.hra.nhs.uk/planning-and-improving-research/policies-standards-legislation/good-clinical-practice/joint-statement-application-good-clinical-practice-training-researchers-hra-mhra-devolved-administrations-northern-ireland-scotland-and-wales/ (viewed Dec 2020).

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Editorials

Unprofessional behaviour in Australian hospitals

Anthony Scott and Danny Hills

Med J Aust 2021; 214 (1): . || doi: 10.5694/mja2.50891
Published online: 18 January 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

General medicine

Health services administration

Inappropriate behaviour harms health workers and patients, and evidence‐based solutions are needed

Health care is the largest employment sector in Australia, more than 1.7 million workers (14% of all employees).1 Incivility, bullying, aggression, and negative workplace cultures seem endemic and have repeatedly been associated with poor workforce and clinical outcomes, but high quality evaluation of interventions for eliminating these behaviours are rare.2,3,4

1 Melbourne Institute: Applied Economic and Social Research, Melbourne, VIC
2 Federation University Australia, Ballarat, VIC

Correspondence: a.scott@unimelb.edu.au

Competing interests:

No relevant disclosures.

1. Australian Bureau of Statistics. 6291.0.55.003. Labour force, Australia, detailed (May 2020). June 2020. https://www.abs.gov.au/statistics/labour/employment-and-unemployment/labour-force-australia-detailed/may-2020 (viewed Sept 2020).
2. Westbrook J, Sunderland N, Atkinson V, et al. Endemic unprofessional behaviour in health care: the mandate for a change in approach. Med J Aust 2018; 209: 380–381. https://www.mja.com.au/journal/2018/209/9/endemic-unprofessional-behaviour-health-care-mandate-change-approach
3. Mannion R, Davies H. Understanding organisational culture for healthcare quality improvement. BMJ 2018; 363: k4907.
4. Choo EK, Byington CL, Johnson NL, et al. From #MeToo to #TimesUp in health care: can a culture of accountability end inequity and harassment? Lancet 2019; 393: 499–502.
5. Westbrook J, Sunderland N, Li L, et al. The prevalence and impact of unprofessional behaviour among hospital workers: a survey in seven Australian hospitals. Med J Aust 2021; 214: 31–37.
6. Hills DJ, Joyce CM, Humphreys JS. A national study of workplace aggression in Australian clinical medical practice. Med J Aust 2012; 197: 336–340. https://www.mja.com.au/journal/2012/197/6/national-study-workplace-aggression-australian-clinical-medical-practice
7. Hills D, Lam L, Hills S. Workplace aggression experiences and responses of Victorian nurses, midwives and care personnel. Collegian 2018; 25: 575–582.
8. Fear NT, Seddon R, Jones N, et al. Does anonymity increase the reporting of mental health symptoms? BMC Public Health 2012; 12: 797.
9. Edwards P, Roberts I, Clarke M, et al. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev 2009; MR000008.
10. Joyce CM, Scott A, Jeon SH, et al. The “Medicine in Australia: Balancing Employment and Life (MABEL)” longitudinal survey: protocol and baseline data for a prospective cohort study of Australian doctors’ workforce participation. BMC Health Serv Res 2010; 10: 50.
11. Saini V, Garcia‐Armesto S, Klemperer D, et al. Drivers of poor medical care. Lancet 2017; 390: 178–190.

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The indirect impacts of COVID‐19 on Aboriginal communities across New South Wales

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Author

Seroprevalence of SARS‐CoV‐2‐specific antibodies in Sydney after the first epidemic wave of 2020

Topics

Abstract

Author

Preventing suicide by young people requires integrative strategies

Topics

Author

Biosimilars: is interchangeability the proof of the pudding?

Topics

Author

What are people saying on social networking sites about the Australian alcohol consumption guidelines?

Topics

Author

Modelling the impact of relaxing COVID‐19 control measures during a period of low viral transmission

Topics

Abstract

Author

Putting the “good” into Good Clinical Practice

Topics

Author

Unprofessional behaviour in Australian hospitals

Topics

Author

Outcomes for patients with COVID‐19: known knowns, known unknowns, and unknown unknowns

Topics

Author

A New Year, the top research articles, and a call to deliver a “net zero” Australian health care system by 2040

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The indirect impacts of COVID‐19 on Aboriginal communities across New South Wales

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Comment

Do you have any competing interests to declare? *

Seroprevalence of SARS‐CoV‐2‐specific antibodies in Sydney after the first epidemic wave of 2020

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Abstract

Author

Comment

Do you have any competing interests to declare? *

Preventing suicide by young people requires integrative strategies

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Comment

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Biosimilars: is interchangeability the proof of the pudding?

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Comment

Do you have any competing interests to declare? *

What are people saying on social networking sites about the Australian alcohol consumption guidelines?

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Author

Comment

Do you have any competing interests to declare? *

Modelling the impact of relaxing COVID‐19 control measures during a period of low viral transmission

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Abstract

Author

Comment

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Putting the “good” into Good Clinical Practice

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Author

Comment

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Unprofessional behaviour in Australian hospitals

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Comment

Do you have any competing interests to declare? *

Outcomes for patients with COVID‐19: known knowns, known unknowns, and unknown unknowns

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A New Year, the top research articles, and a call to deliver a “net zero” Australian health care system by 2040

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Pagination