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    The Australasian Society of Clinical Immunology and Allergy infant feeding for allergy prevention guidelines

    Preeti A Joshi, Jill Smith, Sandra Vale and Dianne E Campbell
    Med J Aust 2019; 210 (2): . || doi: 10.5694/mja2.12102
    Published online: 14 January 2019

    Abstract

    Introduction: The Australasian Society of Clinical Immunology and Allergy, the peak professional body for clinical immunology and allergy in Australia and New Zealand, develops and provides information on a wide range of immune‐mediated disorders, including advice about infant feeding and allergy prevention for health professionals and families. Guidelines for infant feeding and early onset allergy prevention were published in 2016, with additional guidance published in 2017 and 2018, based on emerging evidence.

    Main recommendations:

    • When the infant is ready, at around 6 months, but not before 4 months, start to introduce a variety of solid foods. (This is not a strict window of introduction but rather a recommendation not to delay the introduction of solid foods beyond 12 months.)
    • Introduce peanut and egg in the first year of life in all infants, regardless of their allergy risk factors.
    • Hydrolysed (partially and extensively) formula is no longer recommended for the prevention of allergic disease.

     

    Changes in management a result of the guidelines: The guidelines specifically recommend introducing solid foods at around 6 months of age and introducing peanut and egg in the first year of life in all infants to prevent allergy development. Hydrolysed formula is no longer recommended for prevention of allergic disease. A new document outlining the reasons for and the method of peanut introduction to high risk infants is available for health professionals.


    • 1 Australasian Society of Clinical Immunology and Allergy, Sydney, NSW
    • 2 The Children's Hospital at Westmead, Sydney, NSW
    • 3 University of Sydney, Sydney, NSW


    Competing interests:

    Preeti Joshi is currently the chair of the ASCIA paediatric committee and the deputy chair of the National Allergy Strategy allergy prevention project. Sandra Vale is coordinator of the National Allergy Strategy. Jill Smith is the ASCIA CEO and company secretary. Dianne Campbell was chair of the ASCIA paediatric committee from 2011 to 2017, has received funding for unrelated research from the NHMRC, the Allergy and Immunology Foundation of Australasia and the Australian Food Allergy Foundation, and has received travel expenses to attend investigator meetings from DBV Technologies.

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      Baby boomers and booze: we should be worried about how older Australians are drinking

      Ann M Roche and Victoria Kostadinov
      Med J Aust 2019; 210 (1): . || doi: 10.5694/mja2.12025
      Published online: 14 January 2019

      Alcohol research has traditionally focused on younger age groups; consumption patterns and predictors for older people have received only limited attention. However, the number of older Australians has increased substantially in recent years, accompanied by unprecedented changes in their alcohol consumption patterns. Older people are vulnerable to a range of alcohol‐related adverse effects, including falls and other injuries, diabetes, cardiovascular disease, cancer, mental health problems, obesity, liver disease, and early onset dementia and other brain injury.1,2,3 These vulnerabilities are a cause for clinical concern.

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      • National Centre for Education and Training on Addiction, Flinders University, Adelaide, SA


      Correspondence: ann.roche@flinders.edu.au
      Competing interests:

      No relevant disclosures.

      • 1. Crome I, Dar K, Janikiewicz S, et al. Our invisible addicts: first report of the Older Persons’ Substance Misuse Working Group of the Royal College of Psychiatrists. Second edition (College Report CR211). London: Royal College of Psychiatrists, 2018. https://www.rcpsych.ac.uk/files/pdfversion/CR211.pdf (viewed Aug 2018).
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      • 6. Wadd S, Lapworth K, Sullivan M, et al. Working with older drinkers. Bedford: Tilda Goldberg Centre, University of Bedfordshire, 2011. http://alcoholresearchuk.org/downloads/finalReports/FinalReport_0085 (viewed Aug 2018).
      • 7. Barry KL, Blow FC. Drinking over the lifespan: focus on older adults. Alcohol Res 2016; 38: 115–120.

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        Screening for perinatal depression and predictors of underscreening: findings of the Born in Queensland study

        Macarena A San Martin Porter, Kim Betts, Steve Kisely, Gino Pecoraro and Rosa Alati
        Med J Aust 2019; 210 (1): . || doi: 10.5694/mja2.12030
        Published online: 14 January 2019

        Abstract

        Objectives: To investigate screening with the Edinburgh Postnatal Depression Scale (EPDS) as part of Queensland prenatal care services, as well as maternal and socio‐demographic factors associated with not being screened.

        Design, setting: Cross‐sectional retrospective analysis of data from the Queensland population‐based Perinatal Data Collection for July 2015 – December 2015.

        Participants: All women giving birth in Queensland during the second half of 2015.

        Main outcome measures: Screening with the EPDS, with the values “yes” (health professional recorded an EPDS score), “no” (health professional reported it was not performed), and “not stated”.

        Results: Of 30 468 women who gave birth in Queensland, 21 735 (71.3%) completed the EPDS during pregnancy; 18 942 pregnant women were enrolled as public patients (91.0%) and 2762 as private patients (28.8%). After adjusting for other socio‐demographic factors, screening was less likely for women who were aged 36 years or more (v 25 years or younger: adjusted odds ratio [OR], 0.69; 95% CI, 0.60–0.79), enrolled as private patients (aOR, 0.05; 95% CI, 0.05–0.06), born overseas (aOR, 0.75; 95% CI, 0.68–0.82), Indigenous Australians (aOR, 0.47; 95% CI, 0.39–0.56), single or separated (aOR, 0.83; 95% CI, 0.73–0.94), or of higher socio‐economic status.

        Conclusions: Four years after clinical guidelines recommending universal screening with the EPDS were published, screening rates for private and public health care patients differed markedly. Our results may inform future comparisons and analyses of the impact on screening of recent changes to Medicare definitions intended to increase that of women in private health care.

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        • 1 Institute for Social Science Research, University of Queensland, Brisbane, QLD
        • 2 University of Queensland, Brisbane, QLD
        • 3 Curtin University, Perth, WA


        Correspondence: m.sanmartinporter@uq.edu.au
        Competing interests:

        No relevant disclosures.

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          Access to rehabilitation for patients with stroke in Australia

          Elizabeth A Lynch, Shylie Mackintosh, Julie A Luker and Susan L Hillier
          Med J Aust 2019; 210 (1): . || doi: 10.5694/mja2.12034
          Published online: 14 January 2019

          Abstract

          Objective: To identify factors associated with receiving acute goal‐directed treatment, being assessed for ongoing rehabilitation, and receiving post‐acute rehabilitation after having a stroke.

          Design: Retrospective analysis of National Stroke Audit data for patients with acute stroke treated at Australian hospitals during 1 September 2014 – 28 February 2015.

          Setting, participants: 112 Australian hospitals that admit adults with acute stroke.

          Main outcomes: Associations between patient‐related and organisational factors and the provision of rehabilitation interventions.

          Results: Data for 3462 patients were eligible for analysis; their median age was 74 years, 1962 (57%) were men, and 2470 (71%) had received care in a stroke unit. 2505 patients (72%) received goal‐directed treatment during their acute admission; it was not provided to 364 patients (10.5%) who were responsive, had not fully recovered, and did not refuse treatment. Factors associated with higher odds of receiving goal‐directed treatment included goal‐setting with the patient and their family (odds ratio [OR], 6.75; 95% CI, 5.07–8.90) and receiving care in a stroke unit (OR, 2.08; 95% CI, 1.61–2.70). 1358 patients (39%) underwent further rehabilitation after discharge from acute care; factors associated with receiving post‐acute rehabilitation included care in a stroke unit (OR, 1.73; 95% CI, 1.34–2.22) and having an arm or speech deficit. Dementia was associated with lower odds of receiving acute goal‐directed treatment (OR, 0.49; 95%, 0.33–0.73) and post‐acute rehabilitation (OR, 0.43; 95%, 0.30–0.61).

          Conclusions: Access to stroke units and to early and ongoing rehabilitation for patients after stroke can be improved in Australia, both to optimise outcomes and to reduce the burden of care on underresourced community and primary care providers.

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          • 1 Adelaide Nursing School, University of Adelaide, Adelaide, SA
          • 2 NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, VIC
          • 3 Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC
          • 4 University of South Australia, Adelaide, SA


          Acknowledgements: 

          Elizabeth Lynch is supported by a National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery grant (1077898) and an NHMRC Early Career Fellowship (1138515). The audit data, initially collected with the Australian Stroke Data Tool (AuSDaT), were provided by the Stroke Foundation of Australia. We thank Kelvin Hill for valuable feedback when reviewing drafts of the manuscript.

          Competing interests:

          No relevant disclosures.

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          • 23. Paker N, Buğdaycı D, Tekdöş D, et al. Impact of cognitive impairment on functional outcome in stroke. Stroke Res Treat 2010; 2010: 1–5.
          • 24. Moyle W, Borbasi S, Wallis M, et al. Acute care management of older people with dementia: a qualitative perspective. J Clin Nurs 2011; 20: 420–428.
          • 25. Brodaty H, Draper B, Low LF. Behavioural and psychological symptoms of dementia: a seven‐tiered model of service delivery. Med J Aust 2003; 178: 231–234. https://www.mja.com.au/journal/2003/178/5/behavioural-and-psychological-symptoms-dementia-seven-tiered-model-service

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            Regulatory and other responses to the pharmaceutical opioid problem

            Gabrielle Campbell, Nicholas Lintzeris, Natasa Gisev, Briony Larance, Sallie Pearson and Louisa Degenhardt
            Med J Aust 2019; 210 (1): . || doi: 10.5694/mja2.12047
            Published online: 12 December 2018

            How is Australia responding to the trends in pharmaceutical opioid utilisation and opioid harms?

            In the past 20 years, there have been substantial increases in the use of pharmaceutical opioids in many countries including Australia, which has one of the highest levels of opioid utilisation globally.1 Almost 15 million opioid prescriptions were dispensed in 2015 and our use of high potency opioids has also increased.2 One of the main drivers is the higher use of prescription opioids for chronic non‐cancer pain (CNCP).3 In parallel to escalating use, opioid‐related harms have also increased. Since 2000, there has been a shift in hospitalisations due to opioid poisonings and opioid‐related deaths from predominantly heroin to pharmaceutical opioids.4 Extramedical use — defined as any use of a medication outside the formal medical system or inconsistent with a doctor's prescription5 — is also relatively common; the most recent household survey indicates that “non‐medical use” was reported by 4.8% of the Australian population.4


            • 1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
            • 2 University of Sydney, Sydney, NSW
            • 3 Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
            • 4 University of Wollongong, Wollongong, NSW
            • 5 Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
            • 6 Menzies Centre for Health Policy, University of Sydney, Sydney, NSW


            Correspondence: G.Campbell@unsw.edu.au
            Acknowledgements: 

            Gabrielle Campbell, Natasa Gisev, Briony Larance and Louisa Degenhardt are supported by National Health and Medical Research Council fellowships (No. 1119992, 1091878, 1073858, and 1135991). The National Drug and Alcohol Research Centre at the University of New South Wales is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvements Grant Fund.

            Competing interests:

            Some of the authors have received investigator‐initiated untied educational grants from Reckitt Benckiser and Indivior for studies of buprenorphine–naloxone (Briony Larance, Louisa Degenhardt and Nicholas Lintzeris), buprenorphine depot (Briony Larance, Louisa Degenhardt and Nicholas Lintzeris), naloxone (Louisa Degenhardt), the development of an opioid‐related behaviour scale (Briony Larance, Louisa Degenhardt and Nicholas Lintzeris), projects regarding opioid dependence treatment (Nicholas Lintzeris), and a study of opioid substitution therapy uptake among patients with CNCP (Briony Larance, Louisa Degenhardt, Gabrielle Campbell and Nicholas Lintzeris). Louisa Degenhardt and Briony Larance have also received an untied educational grant from Seqirus for studies of tapentadol. None of these are directly relevant to the current manuscript.

            • 1. Berterame S, Erthal J, Thomas J, et al. Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study. Lancet 2016; 387: 1644–1656.
            • 2. Karanges EA, Blanch B, Buckley NA, Pearson SA. Twenty‐five years of prescription opioid use in Australia: a whole‐of‐population analysis using pharmaceutical claims. Br J Clin Pharmacol 2016; 82: 255–267.
            • 3. Kolodny A, Courtwright DT, Hwang CS, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health 2015; 36: 559–574.
            • 4. Australian Institute of Health and Welfare. Non‐medical use of pharmaceuticals: trends, harms and treatment, 2006–07 to 2015–16. (Drug treatment series no. 30. Cat. No. HSE 195) Canberra: AIHW; 2017. https://www.aihw.gov.au/reports/illicit-use-of-drugs/non-medical-use-pharmaceuticals/contents/table-of-contents (viewed Nov 2018).
            • 5. Larance B, Degenhardt L, Lintzeris N, et al. Definitions related to the use of pharmaceutical opioids: extramedical use, diversion, non‐adherence and aberrant medication‐related behaviours. Drug Alcohol Rev 2011; 30: 236–245.
            • 6. National Drug Strategy. National Pharmaceutical Drug Misuse Framework for Action (2012–2015). Commonwealth of Australia; 2012. http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/drug-mu-frm-action (viewed Nov 2018).
            • 7. Cairns R, Brown JA, Buckley NA. The impact of codeine re‐scheduling on misuse: a retrospective review of calls to Australia's largest poisons centre. Addiction 2016; 111: 1848–1853.
            • 8. Schug SA, Dobbin MD, Pilgrim JL. Caution with the forthcoming rescheduling of over‐the‐counter codeine‐containing analgesics. Med J Aust 2018; 208: 51–52. https://www.mja.com.au/journal/2018/208/1/caution-forthcoming-rescheduling-over-counter-codeine-containing-analgesics
            • 9. Therapeutic Goods Administration. Prescription strong (Schedule 8) opioid use and misuse in Australia — options for a regulatory response. Consultation paper. Canberra: Commonwealth of Australia; 2018. https://www.tga.gov.au/sites/default/files/consultation-prescription-strong-schedule-8-opiod-use-misuse-in-australia-options-for-regulatory-response.pdf (viewed Nov 2018).
            • 10. Fink DS, Schleimer JP, Sarvet A, et al. Association between prescription drug monitoring programs and nonfatal and fatal drug overdoses. Ann Intern Med 2018; 168: 783–790.
            • 11. Pauly NJ, Slavova S, Delcher C, et al. Features of prescription drug monitoring programs associated with reduced rates of prescription opioid‐related poisonings. Drug Alcohol Depend 2018; 184: 26–32.
            • 12. Islam MM, McRae IS. An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions. BMC Pharmacol Toxicol 2014; 15: 46.
            • 13. Peacock A, Degenhardt L, Hordern A, et al. Methods and predictors of tampering with a tamper‐resistant controlled‐release oxycodone formulation. Int J Drug Policy 2015; 26: 1265–1272.
            • 14. Larance B, Lintzeris N, Ali R, et al. The diversion and injection of a buprenorphine‐naloxone soluble film formulation. Drug Alcohol Depend 2014; 136: 21–27.
            • 15. Larance B, Dobbins T, Peacock A, et al. The effect of a potentially tamper‐resistant oxycodone formulation on opioid use and harm: main findings of the National Opioid Medications Abuse Deterrence (NOMAD) study. Lancet Psychiatry 2018; 5: 155–166.
            • 16. Therapeutic Guidelines. Analgesic: therapeutic guidelines. Melbourne: eTG Complete; 2018. https://tgldcdp.tg.org.au/etgcomplete (viewed Nov 2018).
            • 17. Hogg MN, Gibson S, Helou A, et al. Waiting in pain: a systematic investigation into the provision of persistent pain services in Australia. Med J Aust 2012; 196: 386–390. https://www.mja.com.au/journal/2012/196/6/waiting-pain-systematic-investigation-provision-persistent-pain-services
            • 18. Larance B, Campbell G, Moore T, et al. Concerns and help‐seeking among patients using opioids for management of chronic noncancer pain. Pain Med 2018; https://doi.org/10.1093/pm/pny078 [Epub ahead of print].
            • 19. Nielsen S, Larance B, Degenhardt L, et al. Opioid agonist treatment for pharmaceutical opioid dependent people. Cochrane Database Syst Rev 2016; (5): CD011117.
            • 20. Nielsen S, Larance B, Lintzeris N. Opioid agonist treatment for patients with dependence on prescription opioids. JAMA 2017; 317: 967–968.
            • 21. Worley MJ, Heinzerling KG, Shoptaw S, Ling W. Pain volatility and prescription opioid addiction treatment outcomes in patients with chronic pain. Exp Clin Psychopharmacol 2015; 23: 428–435.
            • 22. Holliday S, Magin P, Oldmeadow C, et al. An examination of the influences on New South Wales general practitioners regarding the provision of opioid substitution therapy. Drug Alcohol Rev 2013; 32: 495–503.
            • 23. Scarborough J, Eliott J, Braunack‐Mayer A. Opioid substitution therapy — a study of GP participation in prescribing. Aust Fam Physician 2011; 40: 241–245.
            • 24. Hotham E, Roche A, Skinner N, Dollman B. The general practitioner pharmacotherapy prescribing workforce: examining sustainability from a systems perspective. Drug Alcohol Rev 2005; 24: 393–400.
            • 25. Longman C, Lintzeris N, Temple‐Smith M, Gilchrist G. Methadone and buprenorphine prescribing patterns of Victorian general practitioners: Their first 5 years after authorisation. Drug Alcohol Rev 2011; 30: 355–359.
            • 26. Dwyer R, Olsen A, Fowlie C, et al. An overview of take‐home naloxone programs in Australia. Drug Alcohol Rev 2018; 37: 440–449.

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              Licence to swill: James Bond’s drinking over six decades

              Nick Wilson, Anne Tucker, Deborah Heath and Peter Scarborough
              Med J Aust 2018; 209 (11): . || doi: 10.5694/mja18.00947
              Published online: 10 December 2018

              Abstract

              Objectives: To describe the patterns of alcohol use in James Bond movies over six decades.

              Design: Film content analysis.

              Setting: Wide range of international locations in 24 James Bond movies (Eon Productions series, 1962–2015).

              Main outcome measures: Drinking episodes for Bond and major female characters; alcohol product placement in films; peak estimated blood alcohol concentrations; features relevant to DSM-5 criteria for alcohol use disorder.

              Results: Bond has drunk heavily and consistently across six decades (109 drinking events; mean, 4.5 events per movie). His peak blood alcohol level was estimated to have been 0.36 g/dL, sufficient to kill some people. We classified him as having severe alcohol use disorder, as he satisfied six of 11 DSM-5 criteria for this condition. Chronic risks for Bond include frequently drinking prior to fights, driving vehicles (including in chases), high stakes gambling, operating complex machinery or devices, contact with dangerous animals, extreme athletic performance, and sex with enemies, sometimes with guns or knives in the bed. Notable trends during the study period included a decline in using alcohol as a weapon (P = 0.023) and an increase in the number of alcohol products in his environment (for alcohol-related product placement: P < 0.001), but his martini consumption has been steady. Drinking by lead female characters and a random selection of 30 of his sexual partners was fairly stable over time, but also occasionally involved binges.

              Conclusions: James Bond has a severe chronic alcohol problem. He should consider seeking professional help and find other strategies for managing on-the-job stress.

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              • 1 University of Otago, Wellington, New Zealand
              • 2 Wellington, New Zealand
              • 3 Te Aka Kura, Hamilton, New Zealand
              • 4 Oxford University, Oxford, United Kingdom


              Correspondence: nick.wilson@otago.ac.nz
              Competing interests:

              No relevant disclosures.

              • 1. Wilson N, Tucker A. Die Another Day, James Bond’s smoking over six decades. Tob Control 2016; 26: 489-490.
              • 2. McAnally HM, Robertson LA, Strasburger VC, Hancox RJ. Bond, James Bond: a review of 46 years of violence in films. JAMA Pediatr 2013; 167: 195-196.
              • 3. Alrutz AS, Kool B, Robinson T, et al. The psychopathology of James Bond and its implications for the revision of the DSM-(00)7. Med J Aust 2015; 203: 452-456. <MJA full text>
              • 4. Jonason PK, Webster GD, Schmitt DP, et al. The antihero in popular culture: life history theory and the dark triad personality traits. Rev Gen Psychol 2012; 16: 192-199.
              • 5. Neuendorf K, Gore K, Dalessandro A, et al. Shaken and stirred: a content analysis of women’s portrayals in James Bond films. Sex Roles 2010; 62: 747-761.
              • 6. Croley JA, Reese V, Wagner RF. Dermatologic features of classic movie villains: the face of evil. JAMA Dermatol 2017; 153: 559-564.
              • 7. Johnson G, Guha IN, Davies P. Were James Bond’s drinks shaken because of alcohol induced tremor? BMJ 2013; 347: f7255.
              • 8. Wikipedia. James Bond in film. Updated Sept 2018. https://en.wikipedia.org/wiki/James_Bond_in_film (viewed Sept 2018).
              • 9. Leigh D. James Bond drinks: the complete guide to the drinks of James Bond, 2nd edition. Amazon Digital Services, 2012.
              • 10. Andersson A, Wirehn AB, Olvander C, et al. Alcohol use among university students in Sweden measured by an electronic screening instrument. BMC Public Health 2009; 9: 229.
              • 11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, Fifth edition (DSM-5). Arlington (VA): American Psychiatric Association, 2013.
              • 12. Jones S. James Bond product placement: the definitive timeline of brands in Bond [online]. Hollywood Branded [website]. 14 May 2018. http://blog.hollywoodbranded.com/blog/james-bond-product-placement-the-definitive-timeline-of-brands-in-bond (viewed Sept 2018).
              • 13. AlcoholAlert! Blood Alcohol Level and You [webpage]. 2017. http://www.alcoholalert.com/blood-alcohol-level.html (viewed Sept 2018).
              • 14. Afshar M, Netzer G, Salisbury-Afshar E, et al. Injured patients with very high blood alcohol concentrations. Injury 2016; 47: 83-88.
              • 15. Schlueter N, Tveit AB. Prevalence of erosive tooth wear in risk groups. Monogr Oral Sci 2014; 25: 74-98.
              • 16. Ponsford J, Tweedly L, Taffe J. The relationship between alcohol and cognitive functioning following traumatic brain injury. J Clin Exp Neuropsychol 2013; 35: 103-112.

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                The emergence and characteristics of the Australian Mamil

                Adrian E Bauman, Katrina Blazek, Lindsey Reece and William Bellew
                Med J Aust 2018; 209 (11): . || doi: 10.5694/mja18.00841
                Published online: 10 December 2018

                Abstract

                Background: The Mamil (middle-aged man in Lycra) appears to be an emergent cycling-focused species.

                Objectives: To explore the nature and distribution of the Mamilian species; to determine whether rates of cycling by middle-aged men in Australia have changed since the pre-Mamilian era.

                Setting: Secondary analysis of representative population-based datasets. National sport participation data from the Exercise, Recreation and Sport (2002–2004, 2008–2010) and Ausplay surveys (2016) were analysed to assess trends in recreational and exercise-related cycling, including by middle-aged men (45–64 years of age). Data from New South Wales Population Health Surveys (2006, 2010, 2014) and Australian censuses (2006, 2011, 2014) were analysed to assess trends in cycling to work.

                Main outcome measures: Cycling participation rates (at least once or at least once a week in the past 12 months); rates of cycling to work.

                Results: The proportion of middle-aged men who cycled for exercise or recreational purposes at least once a week during the previous year increased from 6.2% (95% CI, 5.5–7.0%) during 2002–2004 to 13.2% (95% CI, 11.9–14.6%) in 2016. The prevalence of Mamils in the most affluent residential areas has more than doubled since 2002–2004, and is twice as high as in the least advantaged locations. Media reports of “Mamils” corroborate these temporal trends.

                Discussion: Mamils in Australia are socially graded, and also grade themselves according to bicycle-related expenditure and hill gradients overcome. They often form cohesive and supportive groups, but may not reflect a population-wide social movement to increase physical activity among adult Australians.

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                • 1 University of Sydney, Sydney, NSW
                • 2 New South Wales Ministry of Health, Sydney, NSW


                Correspondence: adrian.bauman@sydney.edu.au
                Acknowledgements: 

                This work was completed while Katrina Blazek was employed as a trainee in the NSW Biostatistics Training Program funded by the NSW Ministry of Health. She undertook this work while based at the Prevention Research Collaboration, Charles Perkins Centre at the School of Public Health, the University of Sydney. We thank several (medically) “specialised” Mamils who provided anonymous source material.

                Competing interests:

                Between us, we own up to having four functional bicycles, with a total value of no more than $1200, substantially less than that of a single set of the Mavic Aksium wheels often seen on Mamilian bicycles.

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                  Adding kindness at handover to improve our collegiality: the K-ISBAR tool

                  David J Brewster and Bruce P Waxman
                  Med J Aust 2018; 209 (11): . || doi: 10.5694/mja18.00755
                  Published online: 10 December 2018

                  Much has been written recently about the mental health of the Australian medical workforce, with doctors being burned out, bullied, harassed and mentally unwell.1,2 Why are doctors so unkind to each other? What has happened to collegiality? While we are from different medical backgrounds, we are united in the belief that it is time for change; time for a united response from the Australian medical profession focusing on collegiality, using kindness and understanding as the catalyst and clinical handover as the opportunity.


                  • 1 Cabrini Clinical School, Monash University, Melbourne, VIC
                  • 2 Cabrini Health, Melbourne, VIC
                  • 3 School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC


                  Correspondence: dbrewster@cabrini.com.au
                  Acknowledgements: 

                  We thank Dr Malcolm Clark for his contribution to an earlier draft of this article.

                  Competing interests:

                  No relevant disclosures.

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                    From the curious case of Patient K to TOP GEAR and Bond

                    Nicholas J Talley AC
                    Med J Aust 2018; 209 (11): . || doi: 10.5694/mja18.01086
                    Published online: 10 December 2018

                    Celebrating a great year for the MJA with our 2018 holiday issue

                    Welcome to the traditional summer edition of the MJA! In place of all the ground-breaking research, expert reviews, meta-analyses, and penetrating perspectives we publish throughout the year, we present a fascinating potpourri of the amusing and interesting articles and commentaries we have received as entries for our annual Christmas competition, before reviewing the best research we published during 2018.

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                    • Editor-in-Chief, the Medical Journal of Australia, on behalf of the MJA Editorial team


                    Correspondence: ntalley@mja.com.au
                    Competing interests:

                    No relevant disclosures for this article. A complete list of my conflict of interest disclosures is found at

                    • 1. Wilson N, Tucker D, Heath D, Scarborough P. License to swill: James Bond’s drinking over six decades. Med J Aust 2018; 209: 495-500.
                    • 2. Ellis M, Sun M, Wood M, Chan WO. The Observational Physician and surGEon Automobile Response (TOP GEAR) survey. Med J Aust 2018; 209: 503-505.
                    • 3. Teo SS, Manivel V. C-ABC: cash before care in a private emergency department? Med J Aust 2018; 209: 509-510.
                    • 4. Bauman AE, Blazek K, Reece L, Bellew W. The emergence and characteristics of the Australian Mamil. Med J Aust 2018; 209; 490-494.
                    • 5. Elisha R. The curious case of patient K. Med J Aust 2018; 209: 501-502.
                    • 6. Cairns R, Brown JA, Dawson AH, et al. Carols by glow sticks: a retrospective analysis of Poisons Information Centre data. Med J Aust 2018; 209: 505-508.
                    • 7. Prince SA. The Christmas e-list (an ode to big data). Med J Aust 2018; 209: 510.
                    • 8. Tong EY, Roman CP, Mitra B, et al. Reducing medication errors in hospital discharge summaries: a randomised controlled trial. Med J Aust 2017; 206: 36-39. <MJA full text>
                    • 9. Chanchlani S, Chang D, Ong JSL, Anwar A. The value of peer mentoring for the psychosocial wellbeing of junior doctors: a randomised controlled study. Med J Aust 2018; 209: 401-405. <MJA full text>
                    • 10. Khan E, Brieger D, Amerena J, et al. Differences in management and outcomes for men and women with ST-elevation myocardial infarction. Med J Aust 2018; 209: 118-123. <MJA full text>
                    • 11. Huynh Q, Negishi K, De Pasquale C, et al. Effects of post-discharge management on rates of early re-admission and death after hospitalisation for heart failure. Med J Aust 2018; 208: 485-491. <MJA full text>
                    • 12. Davis K, Remenyi B, Draper ADK, et al. Rheumatic heart disease in Timor-Leste school students: an echocardiography-based prevalence study. Med J Aust 2018; 208: 303-307. <MJA full text>
                    • 13. Zbrojkiewicz D, Vertullo C, Grayson JE. Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000–2015. Med J Aust 2018; 208: 354-358. <MJA full text>
                    • 14. Cheney K, Farber R, Barratt AL, et al. Population attributable fractions of perinatal outcomes for nulliparous women associated with overweight and obesity, 1990–2014. Med J Aust 2018; 208: 119-125. <MJA full text>
                    • 15. Davies SJ, Lum JAG, Skouteris H, et al. Cognitive impairment during pregnancy: a meta-analysis. Med J Aust 2018; 208: 35-40. <MJA full text>
                    • 16. Hong TP, Gow PJ, Fink M, et al. Surveillance improves survival of patients with hepatocellular carcinoma: a prospective population-based study. Med J Aust 2018; 209: 348-354. <MJA full text>
                    • 17. Evans MA, Millar JL, Earnest A, et al. Active surveillance of men with low risk prostate cancer: evidence from the Prostate Cancer Outcomes Registry–Victoria. Med J Aust 2018; 208: 439-443. <MJA full text>
                    • 18. Curchin DJ, Harris VR, McCormack CJ, Smith SD. Changing trends in the incidence of invasive melanoma in Victoria, 1985–2015. Med J Aust 2018; 208: 265-269. <MJA full text>

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                      Methods of melanoma detection and of skin monitoring for individuals at high risk of melanoma: new Australian clinical practice guidelines

                      Nikki R Adler, John W Kelly, Pascale Guitera, Scott W Menzies, Alex J Chamberlain, Paul Fishburn, Alison E Button‐Sloan, Clinton Heal, H Peter Soyer and John F Thompson
                      Med J Aust 2019; 210 (1): . || doi: 10.5694/mja2.12033
                      Published online: 2 December 2018

                      Abstract

                      Introduction: The evidence‐based national clinical practice guidelines for the management of cutaneous melanoma published in 2008 are currently being updated. This article summarises the findings from multiple chapters of the guidelines on different methods of melanoma detection and of monitoring the skin for patients at high risk of melanoma. Early detection of melanoma is critical, as thinner tumours are associated with enhanced survival; therefore, strategies to improve early detection are important to reduce melanoma‐related mortality.

                      Main recommendations:

                      • Clinicians who perform skin examinations for the purpose of detecting skin cancer should be trained in and use dermoscopy.
                      • The use of short term sequential digital dermoscopy imaging to detect melanomas that lack dermoscopic features of melanoma is recommended to assess individual melanocytic lesions of concern.
                      • The use of long term sequential digital dermoscopy imaging to detect melanomas that lack dermoscopic features of melanoma is recommended to assess individual or multiple melanocytic lesions for routine surveillance of high risk patients.
                      • The use of total body photography should be considered in managing patients at increased risk for melanoma, particularly those with high naevus counts and dysplastic naevi.
                      • There is insufficient evidence to recommend the routine use of automated instruments for the clinical diagnosis of primary melanoma.

                       

                      Management overview: Determining the relative indications for each diagnostic method and how each method should be introduced into the surveillance of a patient requires careful consideration and an individualised approach.


                      • 1 Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC
                      • 2 Armadale Dermatology, Melbourne, VIC
                      • 3 Melanoma Institute Australia, Sydney, NSW
                      • 4 University of Sydney, Sydney, NSW
                      • 5 Royal Prince Alfred Hospital, Sydney, NSW
                      • 6 Sydney Melanoma Diagnostic Centre, University of Sydney, Sydney, NSW
                      • 7 Victorian Melanoma Service, Alfred Health, Melbourne, VIC
                      • 8 Glenferrie Dermatology, Melbourne, VIC
                      • 9 Norwest Skin Cancer Centre, Sydney, NSW
                      • 10 Melanoma Patients Australia, Brisbane, QLD
                      • 11 MelanomaWA, Perth, WA
                      • 12 Dermatology Research Centre, Diamantina Institute, University of Queensland, Brisbane, QLD
                      • 13 Princess Alexandra Hospital, Brisbane, QLD


                      Correspondence: nikki.adler@monash.edu
                      Acknowledgements: 

                      The development of the new Australian clinical practice guidelines for the diagnosis and management of melanoma was funded by Cancer Council Australia and the Melanoma Institute Australia, with additional support from the Skin Cancer College Australasia and the Australasian College of Dermatologists. Nikki Adler is supported by a Research Training Program stipend scholarship, Monash University. H Peter Soyer has an NHMRC Practitioner Fellowship. John Thompson is supported by the Melanoma Foundation at the University of Sydney.

                      Competing interests:

                      No relevant disclosures.

                      • 1. Australian Institute of Health and Welfare. Cancer in Australia 2017. (Cat. no. CAN 100) Canberra: AIHW; 2017. https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2017/contents/table-of-contents (viewed Oct 2018).
                      • 2. Doran CM, Ling R, Byrnes J, et al. Estimating the economic costs of skin cancer in New South Wales, Australia. BMC Public Health 2015; 15: 952.
                      • 3. Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 2009; 27: 6199–6206.
                      • 4. Mar VJ, Chamberlain AJ, Kelly JW, et al. Clinical practice guidelines for the diagnosis and management of melanoma: melanomas that lack classical clinical features. Med J Aust 2017; 207: 348–350. https://www.mja.com.au/journal/2017/207/8/clinical-practice-guidelines-diagnosis-and-management-melanoma-melanomas-lack
                      • 5. Sladden MJ, Nieweg OE, Howle J, et al. Updated evidence‐based clinical practice guidelines for the diagnosis and management of melanoma: definitive excision margins for primary cutaneous melanoma. Med J Aust 2018; 208: 137–142. https://www.mja.com.au/journal/2018/208/3/updated-evidence-based-clinical-practice-guidelines-diagnosis-and-management
                      • 6. National Health and Medical Research Council. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. Stage 2 Consultation. NHMRC; 2009. https://www.mja.com.au/sites/default/files/NHMRC.levels.of.evidence.2008-09.pdf (viewed Oct 2018).
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