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    Female genital mutilation or cutting: an updated medico‐legal analysis

    Ben Mathews and Elizabeth Dallaston
    Med J Aust 2020; 213 (7): . || doi: 10.5694/mja2.50768
    Published online: 5 October 2020

    A recent landmark High Court decision both directs and reassures medical and other practitioners in clinical and community settings that no parent or individual can compel this unlawful procedure

    Many people from countries where female genital mutilation or cutting (FGM/C) is customary have migrated to Australia and other nations. Legislation in many of these nations prohibits any person, including medical practitioners, from conducting FGM/C.1 Important questions exist about the nature of the prohibition, and lawful and ethical practice in dealing with requested FGM/C. Medical practitioners, community practitioners and religious leaders deserve sound guidance about legal responsibilities and optimal clinical practice.

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      Impact of antivaccination campaigns on health worldwide: lessons for Australia and the global community

      Helen Petousis‐Harris and Lisbeth Alley
      Med J Aust 2020; 213 (7): . || doi: 10.5694/mja2.50779
      Published online: 5 October 2020

      The arrival of social media coincides with the point at which the antivaccination movement became globally coordinated

      The antivaccination movement has roots in the first vaccine, smallpox, although opposition to the practice of artificially inducing immunity reaches back to the practice of variolation. Despite over two centuries of vaccination practice and all the advances in medical science and societal changes that have occurred over this time, the objections still follow the same themes. These have been eloquently described as: vaccines cause idiopathic illness, unholy alliance for profit, vaccines as poisonous chemical cocktails, cover‐up, towards totalitarianism, vaccine immunity is temporary, vaccines are ineffective, and health lifestyle alternative.1 For over two centuries, antivaccination activities, distribution of literature, membership and scientific establishment responses remained unchanged.2


      • 1 University of Auckland, Auckland, New Zealand
      • 2 Immunisation Advisory Centre, University of Auckland, Auckland, New Zealand


      Competing interests:

      No relevant disclosures.

      • 1. Leask JA, Chapman S. An attempt to swindle nature: press anti‐immunisation reportage 1993–1997. Aust N Z J Public Health 1998; 22: 17–26.
      • 2. Wolfe RM, Sharp LK. Anti‐vaccinationists past and present. BMJ 2002; 325: 430–432.
      • 3. Ryan J. A history of the internet and the digital future. Reaktion Books 2013.
      • 4. Brügger N. A brief history of Facebook as a media text: the development of an empty structure. First Monday 2015; 20: https://doi.org/10.5210/fm.v20i5.5423.
      • 5. Markowitz LE, Tsu V, Deeks SL, et al. Human papillomavirus vaccine introduction — the first five years. Vaccine 2012; 30 (Suppl): F139–F148.
      • 6. Smith N, Graham T. Mapping the anti‐vaccination movement on Facebook. Inf Commun Soc 2019; 22: 1310–1327.
      • 7. Jamison AM, Broniatowski DA, Dredze M, et al. Vaccine‐related advertising in the Facebook Ad Archive. Vaccine 2020; 38: 512–520.
      • 8. Global Advisory Committee on Vaccine Safety. Global Advisory Committee on Vaccine Safety, 4–5 December 2019. Review of case studies of vaccine safety communications and lessons learnt. Wkly Epidemiol Rec 2020; 4: 25–36.
      • 9. Simms KT, Hanley SJB, Smith MA, et al. Impact of HPV vaccine hesitancy on cervical cancer in Japan: a modelling study. Lancet Public Health 2020; 5: e223–e234.
      • 10. Hansen PR, Schmidtblaicher M, Brewer NT. Resilience of HPV vaccine uptake in Denmark: decline and recovery. Vaccine 2020; 38: 1842–1848.
      • 11. World Health Organization. Ten threats to global health in 2019. Geneva: WHO, 2019. https://www.who.int/vietnam/news/feature-stories/detail/ten-threats-to-global-health-in-2019 (viewed Aug 2020).
      • 12. World Health Organization. Urgent health challenges for the next decade. Geneva: WHO, 2020. https://www.who.int/news-room/photo-story/photo-story-detail/urgent-health-challenges-for-the-next-decade (viewed Aug 2020).
      • 13. Lane S, MacDonald NE, Marti M, Dumolard L. Vaccine hesitancy around the globe: analysis of three years of WHO/UNICEF Joint Reporting Form data — 2015–2017. Vaccine 2018; 36: 3861–3867.
      • 14. Lo NC, Hotez PJ. Public health and economic consequences of vaccine hesitancy for measles in the United States. JAMA Pediatr 2017; 171: 887–892.
      • 15. Hanley SJ, Yoshioka E, Ito Y, Kishi R. HPV vaccination crisis in Japan. Lancet 2015; 385: 2571.
      • 16. World Health Organization; UNICEF. Samoa: WHO and UNICEF estimates of national immunization coverage: 2019 revision. https://www.who.int/immunization/monitoring_surveillance/data/wsm.pdf (viewed Aug 2020).
      • 17. Guarino Ben, Satija N, Sun LH. Deadly measles outbreak hits children in Samoa after anti‐vaccine fears. Washington Post 2019; 28: . Nov. https://www.washingtonpost.com/health/2019/11/26/deadly-measles-outbreak-hits-children-samoa-after-anti-vaccine-fears/ (viewed Aug 2020).
      • 18. Samoa arrests vaccination critic amid deadly measles crisis. BBC News 2019; 6 Dec. https://www.bbc.com/news/world-asia-50682881 (viewed Aug 2020).
      • 19. Duckor‐Jones A. Tragedy in paradise: how Samoa is faring after the measles epidemic. New Zealand Listener 2020; 5 Feb. https://www.noted.co.nz/currently/currently-world/samoa-measles-how-its-faring-after-the-epidemic (viewed Aug 2020).
      • 20. Greenberg J, Dubé E, Driedger M. Vaccine hesitancy: in search of the risk communication comfort zone. PLoS Curr 2017; 9: ecurrents.outbreaks.0561a011117a1d1f9596e24949e8690b.
      • 21. Corcoran B, Clarke A, Barrett T. Rapid response to HPV vaccination crisis in Ireland. Lancet 20186; 391: 2103.
      • 22. Berry NJ, Danchin M, Trevena L, et al. Sharing knowledge about immunisation (SKAI): an exploration of parents’ communication needs to inform development of a clinical communication support intervention. Vaccine 2018; 36: 6480–6490.
      • 23. Chung Y, Schamel J, Fisher A, Frew PM. Influences on immunization decision‐making among US parents of young children. Matern Child Health J 2017; 21: 2178–2187.
      • 24. Dubé E, Gagnon D, Vivion M. Best practices for addressing vaccine hesitancy. Can Commun Dis Rep 2020; 46: 48–51.
      • 25. Gesualdo F, Zamperini N, Tozzi AE. To talk better about vaccines, we should talk less about vaccines. Vaccine 2018; 36: 5107.
      • 26. Fagerlin A, Wang C, Ubel PA. Reducing the influence of anecdotal reasoning on people's health care decisions: is a picture worth a thousand statistics? Med Decis Making 2005; 25: 398–405.
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        Ethical issues in reproductive genetic carrier screening

        Lisa Dive and Ainsley J Newson
        Med J Aust 2021; 214 (4): . || doi: 10.5694/mja2.50789
        Published online: 28 September 2020

        Publicly funded reproductive carrier screening programs must weigh up a number of ethical considerations

        Reproductive genetic carrier screening (RCS) is undertaken by individuals or couples to determine their likelihood of having a child with particular autosomal recessive or X‐linked genetic conditions. It can be undertaken by anyone of reproductive age who wishes to have it, regardless of their family history or ancestry, and either before or during pregnancy.1 Some forms of RCS are currently available in Australia on a user‐pays basis, costing around $400–$500 per person. It is usually accessed via general practitioners but can also be accessed directly from testing companies.2 People who receive an increased chance result are offered genetic counselling to explore their reproductive options, which might include steps to avoid having a child with a genetic condition. Taking the test before pregnancy gives those with an increased chance result a wider range of reproductive options compared with prenatal testing.3

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        • University of Sydney, Sydney, NSW


        Acknowledgements: 

        The Australian Reproductive Genetic Carrier Screening Project (Mackenzie's Mission) is funded by the Australian Government Medical Research Future Fund as part of the Australian Genomics Health Futures Mission (GHFM73390 [MRFF‐G‐MM]). The funding source had no direct role in the planning, writing or publication of this article. The authors thank Alison Archibald, Edwin Kirk, Nigel Laing and Martin Delatycki, as well as members of the Mackenzie's Mission Research and Gene Selection Committees, for helpful discussions that informed the drafting of this article.

        Competing interests:

        Lisa Dive's position at the University of Sydney is funded by Mackenzie's Mission. Ainsley Newson is a Chief investigator with Mackenzie's Mission.

        • 1. Henneman L, Borry P, Chokoshvili D, et al. Responsible implementation of expanded carrier screening. Eur J Hum Genet 2016; 24: e1–e12.
        • 2. Delatycki MB, Alkuraya F, Archibald A, et al. International perspectives on the implementation of reproductive carrier screening. Prenat Diagn 2020; 40: 301–310.
        • 3. van der Hout S, Dondorp W, de Wert G. The aims of expanded universal carrier screening: autonomy, prevention, and responsible parenthood. Bioethics 2019; 33: 568–576.
        • 4. Mackenzie's Mission. https://www.mackenziesmission.org.au (viewed June 2020).
        • 5. Delatycki MB, Laing N, Kirk E. Expanded reproductive carrier screening — how can we do the most good and cause the least harm? Eur J Hum Genet 2019; 27: 669–670.
        • 6. De Wert GM, Dondorp WJ, Knoppers BM. Preconception care and genetic risk: ethical issues. J Community Genet 2012; 3: 221–228.
        • 7. Kater‐Kuipers A, De Beaufort ID, Galjaard R‐JH, et al. Ethics of routine: a critical analysis of the concept of ‘routinisation’ in prenatal screening. J Med Ethics 2018; 44: 626–631.
        • 8. Asch A. Prenatal diagnosis and selective abortion: a challenge to practice and policy. Am J Public Health 1999; 89: 1649–1657.
        • 9. Savell K, Karpin I. The meaning of “serious disability” in the legal regulation of prenatal and neonatal decision‐making. J Law Med 2008; 16: 233–245.
        • 10. Kirk EP, Ong R, Boggs K, et al. Gene selection for the Australian Reproductive Genetic Carrier Screening Project (“Mackenzie's Mission”). Eur J Hum Genet 2020; https://doi.org/10.1038/s41431-020-0685-x.
        • 11. Rowe CA, Wright CF. Expanded universal carrier screening and its implementation within a publicly funded healthcare service. J Commun Genet 2020; 11: 21–38.
        • 12. Newson AJ. Ethical aspects arising from non‐invasive fetal diagnosis. Semin Fetal Neonatal Med 2008; 13: 103–108.
        • 13. Schuurmans J, Birnie E, van den Heuvel LM, et al. Feasibility of couple‐based expanded carrier screening offered by general practitioners. Eur J Hum Genet 2019; 27: 691–700.
        • 14. Holtkamp KC, Mathijssen IB, Lakeman P, et al. Factors for successful implementation of population‐based expanded carrier screening: learning from existing initiatives. Eur J Public Health 2017; 27: 372–377.
        • 15. Newson AJ, Leonard SJ, Hall A, Gaff CL. Known unknowns: building an ethics of uncertainty into genomic medicine. BMC Med Genomics 2016; 9: 57.
        • 16. Plantinga M, Birnie E, Schuurmans J, et al. Expanded carrier screening for autosomal recessive conditions in health care: arguments for a couple‐based approach and examination of couples’ views. Prenat Diagn 2019; 39: 369–378.
        • 17. Haque IS, Lazarin GA, Kang HP, et al. Modeled fetal risk of genetic diseases identified by expanded carrier screening. JAMA 2016; 316: 734–742.
        • 18. Bennett R. Antenatal genetic testing and the right to remain in ignorance. Theor Med Bioeth 2001; 22: 461–471.
        • 19. Hildt E. Autonomy and freedom of choice in prenatal genetic diagnosis. Med Health Care Philos 2002; 5: 65–72.
        • 20. Ong R, Howting D, Rea A, et al. Measuring the impact of genetic knowledge on intentions and attitudes of the community towards expanded preconception carrier screening. J Med Genet 2018; 55: 744–752.
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          Addressing the oral health needs of Indigenous Australians through water fluoridation

          Andrew McAuliffe, Chris Bourke and Lisa M Jamieson
          Med J Aust 2020; 213 (6): . || doi: 10.5694/mja2.50744
          Published online: 21 September 2020

          To the Editor: Poor oral health profoundly affects a person's ability to eat, speak, socialise, work and learn.1 It has an impact on social and emotional wellbeing, productivity in the workplace, and quality of life. Pain from dental caries is a common experience. In children, dental caries may require treatment under a hospital‐based general anaesthetic — at considerable cost and itself not without risk.2 Poor oral health in childhood is the leading cause of poor adult oral health.1

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          • 1 Australian Healthcare and Hospitals Association, Canberra, ACT
          • 2 University of Adelaide, Adelaide, SA


          Competing interests:

          No relevant disclosures.

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            Three‐dimensional printing in a pandemic: panacea or panic?

            Michael Wagels and Dietmar W Hutmacher
            Med J Aust 2020; 213 (6): . || doi: 10.5694/mja2.50753
            Published online: 21 September 2020

            Patience and well designed studies are important for balancing opportunity and risk in uncertain times

            Even before they had to deal with the COVID‐19 pandemic, clinicians were negotiating the infiltration of three‐dimensional printing (3DP) into several aspects of medicine. This development probably began with the invention of stereolithography by Charles Hull in 1983.1 The technology has found broad application in engineering and manufacturing, particularly for computer‐aided design of machine parts. Its principles were also relevant to related aspects of clinical medicine, beginning with the production of reference biomodels from imaging data, and later in virtual surgical planning. It did not take long for the workflow that provided these services in the clinical environment to expand into other areas.

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            • 1 The Australian Centre for Complex Integrated Surgical Solutions, Princess Alexandra Hospital, Brisbane, QLD
            • 2 The University of Queensland, Brisbane, QLD
            • 3 ARC Centre in Additive Biomanufacturing, Queensland University of Technology, Brisbane, QLD


            Competing interests:

            No relevant disclosures.

            • 1. Jain A, Bansal KK, Tiwari A, et al. Role of polymers in 3D printing technology for drug delivery: an overview. Curr Pharm Des 2018; 24: 4979–4990.
            • 2. Ballard DH, Trace AP, Ali S, et al. Clinical applications of 3D printing: primer for radiologists. Acad Radiol 2018; 25: 52–65.
            • 3. Williams E, Bond K, Isles N, et al. Pandemic printing: a novel 3D‐printed swab for detecting SARS‐CoV-2. Med J Aust 2020; 213: 276–279.
            • 4. Vitali J, Cheng M, Wagels M. Utility and cost‐effectiveness of 3D‐printed materials for clinical use. Journal of 3D Printing in Medicine 2019; 3: 209–218.
            • 5. Langridge B, Momin S, Coumbe B, et al. Systematic review of the use of 3‐dimensional printing in surgical teaching and assessment. J Surg Educ 2018; 75: 209–221.
            • 6. Australian Department of Health, Therapeutic Goods Administration. Manufacturing medical devices and IVDs. Sept 2017. https://www.tga.gov.au/node/4425 (viewed July 2020).
            • 7. Bowling M. Catholic colleges printing thousands of face shields for frontline healthcare workers. The Catholic Leader (Brisbane), 8 Apr 2020. https://catholicleader.com.au/news/iona-college-plans-to-print-13000-face-shields-for-frontline-healthcare-workers (viewed July 2020).
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              Beyond the womb: respiratory symptoms in children following acute in utero exposure to fire smoke

              Julie M Marchant and Anne B Chang
              Med J Aust 2020; 213 (6): . || doi: 10.5694/mja2.50757
              Published online: 21 September 2020

              Air pollution poses global health, equity, and environmental problems with short and long term consequences

              The impact of environmental pollutants from diverse sources on health and well‐being is widely recognised.1 However, much remains unknown, including the relative contributions of specific air pollutants, their size effects, the periods of maximum vulnerability, and the longer term effects of acute and prolonged exposure, particularly in children.2,3 The expected increases in the number and intensity of bushfires, as seen in Australia during the summer of 2019–20, require that the effects of such extreme events on public health be explored.


              • 1 Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
              • 2 Queensland Children's Hospital, Brisbane, QLD
              • 3 Menzies School of Health Research, Darwin, NT


              Correspondence: anne.chang@menzies.edu.au
              Acknowledgements: 

              Anne Chang is supported by a National Health and Medical Research Council Practitioner Fellowship (APP1058213) and a top‐up fellowship from the Queensland Children's Hospital Foundation (grant 50286). Julie Marchant is supported by an Early Career Fellowship Grant from the Queensland Children's Hospital Foundation (RPC0772019).

              Competing interests:

              No relevant disclosures.

              • 1. The Lancet Respiratory Medicine. Time to blow away the cobwebs. Lancet Respir Med 2018; 6: 231.
              • 2. The Lancet Respiratory Medicine. Fuelling advances in paediatric lung health. Lancet Respir Med 2020; 8: 125.
              • 3. Black C, Tesfaigzi Y, Bassein JA, Miller SA. Wildfire smoke exposure and human health: significant gaps in research for a growing public health issue. Environ Toxicol Pharmacol 2017; 55: 186–195.
              • 4. Willis GA, Chappell K, Williams S, et al. Respiratory and atopic conditions in children two to four years after the 2014 Hazelwood coalmine fire. Med J Aust 2020; 213: 269–275.
              • 5. Shao J, Zosky GR, Hall GL, et al. Early life exposure to coal mine fire smoke emissions and altered lung function in young children. Respirology 2020; 25: 198–205.
              • 6. Melody SM, Ford J, Wills K, et al. Maternal exposure to fine particulate matter from a coal mine fire and birth outcomes in Victoria, Australia. Environ Int 2019; 127: 233–242.
              • 7. Abdo M, Ward I, O'Dell K, et al. Impact of wildfire smoke on adverse pregnancy outcomes in Colorado, 2007–2015. Int J Environ Res Public Health 2019; 16: 3720.
              • 8. Jayachandran S. Air quality and early‐life mortality: evidence from Indonesia's wildfires. J Human Resources 2009; 44: 916–954.
              • 9. Reid CE, Brauer M, Johnston FH, et al. Critical review of health impacts of wildfire smoke exposure. Environ Health Perspect 2016; 124: 1334–1343.
              • 10. Sun X, Luo X, Zhao C, et al. The associations between birth weight and exposure to fine particulate matter (PM2.5) and its chemical constituents during pregnancy: a meta‐analysis. Environ Pollut 2016; 211: 38–47.
              • 11. Sapkota A, Chelikowsky AP, Nachman KE, et al. Exposure to particulate matter and adverse birth outcomes: a comprehensive review and meta‐analysis. Air Qual Atmos Health 2012; 5: 369–381.
              • 12. Black C, Gerriets JE, Fontaine JH, et al. Early life wildfire smoke exposure is associated with immune dysregulation and lung function decrements in adolescence. Am J Respir Cell Mol Biol 2017; 56: 657–666.
              • 13. Bui DS, Lodge CJ, Burgess JA, et al. Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life. Lancet Respir Med 2018; 6: 535–544.
              • 14. Duong M, Islam S, Rangarajan S, et al. PURE investigators. Mortality and cardiovascular and respiratory morbidity in individuals with impaired FEV1 (PURE): an international, community‐based cohort study. Lancet Glob Health 2019; 7: e613–e623.
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                Current COVID‐19 guidelines for respiratory protection of health care workers are inadequate

                C Raina MacIntyre, Michelle Ananda‐Rajah, Mark Nicholls and Ashley L Quigley
                Med J Aust 2020; 213 (6): . || doi: 10.5694/mja2.50752
                Published online: 21 September 2020

                Guidelines need to reflect the mounting evidence for airborne transmission of SARS‐CoV‐2

                The guidelines for protection of health care workers in Australia state that a medical mask is indicated for routine care of patients with coronavirus disease 2019 (COVID‐19), and a respirator only for aerosol‐generating procedures.1 These guidelines are not aligned with the growing body of scientific evidence regarding transmission and prevention of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection.

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                • 1 The Kirby Institute, Sydney, NSW
                • 2 Central Clinical School, Monash University, Melbourne, VIC
                • 3 ANZICS, Melbourne, VIC
                • 4 UNSW, Sydney, NSW


                Correspondence: ashley.quigley@unsw.edu.au
                Competing interests:

                No relevant disclosures.

                • 1. Australian Government Department of Health. Guidance on the use of personal protective equipment (PPE) in hospitals during the COVID‐19 outbreak. Version 6 (19/06/2020). https://www.health.gov.au/resources/publications/guidance-on-the-use-of-personal-protective-equipment-ppe-in-hospitals-during-the-covid-19-outbreak (viewed Aug 2020).
                • 2. Bahl P, Doolan C, de Silva C, et al. Airborne or droplet precautions for health workers treating COVID‐19? J Infect Dis 2020;. https://doi.org/10.1093/infdis/jiaa189 [Epub ahead of print].
                • 3. Wang W, Xu Y, Gao R, et al. Detection of SARS‐CoV‐2 in different types of clinical specimens. JAMA 2020; 323: 1843–1844.
                • 4. Guo Z‐D, Wang Z‐Y, Zhang S‐F, et al. Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards, Wuhan, China, 2020. Emerg Infect Dis 2020; 26: 1583–1591.
                • 5. Santarpia JL, Rivera DN, Herrera V, et al. Aerosol and surface contamination of SARS‐CoV‐2 observed in quarantine and isolation care. Sci Rep 2020; 10: 12732.
                • 6. Leung NHL, Chu DKW, Shiu EYC, et al. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat Med 2020; 26: 676–680.
                • 7. Fears AC, Klimstra WB, Duprex P, et al. Persistence of severe acute respiratory syndrome coronavirus 2 in aerosol suspensions. Emerg Infect Dis 2020; 26: 2168‐2171.
                • 8. Chu DK, Akl EA, Duda S, et al. Physical distancing, face masks, and eye protection to prevent person‐to-person transmission of SARS‐CoV‐2 and COVID‐19: a systematic review and meta‐analysis. Lancet 2020; 395: P1973–P1987.
                • 9. MacIntyre CR, Chughtai AA. A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. International. Int J Nurs Stud 2020; 108: 103629.
                • 10. Cook T, Kursumovic E, Lennane S. Exclusive: deaths of NHS staff from covid‐19 analysed. Health Serv J 2020; 22 Apr; https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-covid-19-analysed/7027471.article (viewed Aug 2020).
                • 11. Hunter E, Price DA, Murphy E, et al. First experience of COVID‐19 screening of health‐care workers in England. Lancet 2020; 395: e77–e78.
                • 12. Sikkema RS, Pas SD, Nieuwenhuijse DF, et al. COVID‐19 in health‐care workers in three hospitals in the south of the Netherlands: a cross‐sectional study. Lancet Infect Dis 2020;. https://doi.org/10.1016/s1473-3099(20)30527-2 [Epub ahead of print].
                • 13. Keeley AJ, Evans C, Colton H, et al. Roll‐out of SARS‐CoV‐2 testing for healthcare workers at a large NHS Foundation Trust in the United Kingdom, March 2020. Eurosurveillance 2020; 25: 2000433.
                • 14. Campell A. The SARS Commission: spring of fear. Toronto: Government of Ontario 2006. http://www.archives.gov.on.ca/en/e_records/sars/report/index.html (viewed Aug 2020).
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                  Burning to reduce fuels: the benefits and risks of a public health protection strategy

                  Fay H Johnston
                  Med J Aust 2020; 213 (6): . || doi: 10.5694/mja2.50751
                  Published online: 21 September 2020

                  We need to burn, but it is not a cure‐all and the side effects can be serious

                  Fire disasters are one of many serious and escalating environmental health problems that the world, and Australia in particular, is now facing.1 During the black summer of 2019–2020, population exposure to bushfire smoke was almost an order of magnitude greater than that documented for any of the fire seasons for at least the previous two decades, and it was estimated to be responsible for more than 400 premature deaths.2 The fires themselves, including firefighting‐related accidents and injuries, claimed a further 33 lives.3 Furthermore, the trauma experienced by communities affected by the fires, including serious risks to life, homes and livelihoods, will have ongoing psychological, physical health, social and economic impacts.4


                  • Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS


                  Correspondence: fay.johnston@utas.edu.au
                  Competing interests:

                  No relevant disclosures.

                  • 1. Whitmee S, Haines A, Beyrer C, et al. The Rockefeller Foundation–Lancet Commission on planetary health. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health. Lancet 2015; 386(10007): 1973–2028.
                  • 2. Johnston FH, Borchers Arriagada N, Morgan GG, et al. Unprecedented health costs of smoke‐related PM2.5 from the 2019–20 Australian megafires. Nat Sustain 2020. In press.
                  • 3. Jalaludin B, Johnston F, Vardoulakis S, Morgan G. Reflections on the catastrophic 2019–2020 Australian bushfires. The Innovation 2020; 1: 100010.
                  • 4. Newnham EA, Titov N, McEvoy P. Preparing mental health systems for climate crisis. Lancet Planet Health 2020; 4: e89–e90.
                  • 5. Rutter H, Savona N, Glonti K, et al. The need for a complex systems model of evidence for public health. Lancet 2017; 390: 2602–2604.
                  • 6. Bowman DM, O'Brien JA, Goldammer JG. Pyrogeography and the global quest for sustainable fire management. Annu Rev Env Resour 2013; 38: 57–80.
                  • 7. Bowman DMJS, Balch J, Artaxo P, et al. The human dimension of fire regimes on Earth. J Biogeogr 2011; 38: 2223–2236.
                  • 8. Penman TD, Collins L, Duff TD, et al. Scientific evidence regarding the effectiveness of prescribed burning. In: Leavesley A, Wouters M, Thornton R; editors. Prescribed burning in Australasia: the science, practice and politics of burning the bush. Melbourne: Australasian Fire and Emergency Services Council, 2020; pp 99–110.
                  • 9. Scott RE, Neyland MG, McElwee DJ, Baker SC. Burning outcomes following aggregated retention harvesting in old‐growth wet eucalypt forests. Forest Ecol Manag 2012; 276: 165–173.
                  • 10. Meier EA, Thorburn PJ. Long term sugarcane crop residue retention offers limited potential to reduce nitrogen fertilizer rates in Australian wet tropical environments. Front Plant Sci 2016; 7: 1017.
                  • 11. Costello O. Fire has spirit. In: Leavesley A, Wouters M, Thornton R; editors. Prescribed burning in Australasia: the science, practice and politics of burning the bush. Melbourne: Australasian Fire and Emergency Services Council, 2020; pp 66–67.
                  • 12. Morgan G, Tolhurst K, Poynter M, et al. Prescribed burning in south‐eastern Australia: history and future directions. Aust For 2020; 83: 4–28.
                  • 13. Trauernicht C, Brook BW, Murphy BP, et al. Local and global pyrogeographic evidence that indigenous fire management creates pyrodiversity. Ecol Evol 2015; 5: 1908–1918.
                  • 14. McCaw WL. Managing forest fuels using prescribed fire–a perspective from southern Australia. For Ecol Manag 2013; 294: 217–224.
                  • 15. Schwilk DW, Keeley JE, Knapp EE, et al. The national Fire and Fire Surrogate study: effects of fuel reduction methods on forest vegetation structure and fuels. Ecol Appl 2009; 19: 285–304.
                  • 16. Johnson CN, Prior LD, Archibald S, et al. Can trophic rewilding reduce the impact of fire in a more flammable world? Philos T R Soc B 2018; 373: 20170443.
                  • 17. Curran TJ, Perry GL, Wyse SV, et al. Managing fire and biodiversity in the wildland‐urban interface: A role for green firebreaks. Fire 2018; 1: 3.
                  • 18. Bowman DM, Daniels LD, Johnston FH, et al. Can air quality management drive sustainable fuels management at the temperate wildland–urban interface? Fire 2018; 1: 27.
                  • 19. Australasian Fire and Emergency Services Authorities Council. National position on prescribed burning. Melbourne: AFAC, 2016. https://knowledge.aidr.org.au/media/4869/national-position-on-prescribed-burning.pdf (viewed Aug 2020).
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                    Motherhood and medicine: systematic review of the experiences of mothers who are doctors

                    Rebekah Hoffman, Judy Mullan, Marisa Nguyen and Andrew D Bonney
                    Med J Aust 2020; 213 (7): . || doi: 10.5694/mja2.50747
                    Published online: 14 September 2020

                    Abstract

                    Objective: To synthesise what is known about women combining motherhood and a career in medicine by examining the published research into their experiences and perspectives.

                    Study design: We reviewed peer‐reviewed articles published or available in English reporting original research into motherhood and medicine and published during 2008–2019. Two researchers screened each abstract and independently reviewed full text articles. Study quality was assessed.

                    Data sources: CINAHL, MEDLINE, PsycINFO, Web of Science, and Scopus abstract databases.

                    Data synthesis: The database search identified 4200 articles; after screening and full text assessment, we undertook an integrative review synthesis of the 35 articles that met our inclusion criteria.

                    Conclusions: Three core themes were identified: Motherhood: the impact of being a doctor on raising children; Medicine: the impact of being a mother on a medical career; and Combining motherhood and medicine: strategies and policies. Several structural and attitudinal barriers to women pursuing both medical careers and motherhood were identified. It was often reported that women prioritise career advancement by delaying starting a family, and that female doctors believed that career progression would be slowed by motherhood. Few evaluations of policies for supporting pregnant doctors, providing maternity leave, and assisting their return to work after giving birth have been published. We did not find any relevant studies undertaken in Australia or New Zealand, nor any studies with a focus on community‐based medicine or intervention studies. Prospective investigations and rigorous evaluations of policies and support mechanisms in different medical specialties would be appropriate.

                    Protocol registration: PROSPERO CRD42019116228.

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                    • Graduate School of Medicine, University of Wollongong, Wollongong, NSW


                    Correspondence: rhoffman@uow.edu.au
                    Acknowledgements: 

                    We thank University of Wollongong librarian Brian Kenady for his guidance and the time taken to developing our search strategy.

                    Competing interests:

                    No relevant disclosures.

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                      Sexual misconduct by doctors: a problem that has not gone away

                      Cherrie Ann Galletly
                      Med J Aust 2020; 213 (5): . || doi: 10.5694/mja2.50734
                      Published online: 7 September 2020

                      The medical profession has the opportunity to prevent further harm to patients and damage to public trust

                      Bismark and colleagues1 report the disappointing finding that health practitioners, particularly doctors, continue to be found guilty of sexual misconduct with patients. During 2011–2016, Australian regulators received more than 100 notifications of sexual misconduct by Australian doctors each year. As with other sexual crimes, it is likely that many victims do not make formal complaints; in this study, only 34% of notifications were made by affected patients.


                      • 1 Adelaide Medical School, University of Adelaide, Adelaide, SA
                      • 2 Ramsay Health Care (SA), The Adelaide Clinic, Adelaide, SA
                      • 3 Northern Adelaide Local Health Network, Adelaide, SA


                      Competing interests:

                      No relevant disclosures.

                      Online responses are no longer available. Please refer to our instructions for authors page for more information.
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