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According to the Royal Commission into Aged Care Quality and Safety (hereafter, the Royal Commission), Australian residential aged care (RAC) inadequately caters to the physical, social and psychological needs of older people. The Royal Commission states that aged care requires “a philosophical shift” that centres on people receiving care and establishes “new foundational principles and core values.”1

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1 Australian Catholic University, Brisbane, QLD
2 Queensland Bioethics Centre, Australian Catholic University, Brisbane, QLD

Correspondence: lachlan.green@acu.edu.au

Open access:

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

Competing interests:

Bridget Pratt and David Kirchhoffer are affiliated with the Queensland Bioethics Centre, which receives funding from the Roman Catholic Archdiocese of Brisbane, the Catholic Bishops of Queensland, Mater Misericordiae Limited, Saint Vincent's Health Australia and Southern Cross Care Queensland. Authors’ views are their own.

1. Royal Commission into Aged Care Quality and Safety. Final report: care, dignity and respect (Volume 1: Summary and recommendations). Canberra: Commonwealth of Australia, 2021. https://www.royalcommission.gov.au/aged‐care/final‐report (viewed May 2024).
2. Aged Care Quality and Safety Commission. Guidance and resources for providers to support the aged care quality standards. Canberra: ACQSC, 2023. https://www.agedcarequality.gov.au/resource‐library/guidance‐and‐resources‐providers‐support‐aged‐care‐quality‐standards (viewed Feb 2024).
3. Aged Care Quality and Safety Commission. Charter of aged care rights. Canberra: ACQSC, 2019. https://www.agedcarequality.gov.au/resource‐library/charter‐aged‐care‐rights‐poster (viewed Feb 2024).
4. Australian Law Reform Commission. Elder Abuse ‐ a national legal response (ALRC Report 131). Canberra: ALRC, 2017. https://www.alrc.gov.au/publication/elder‐abuse‐a‐national‐legal‐response‐alrc‐report‐131/ (viewed Dec 2023).
5. Royal Commission into Aged Care Quality and Safety. Final report: Care, dignity and respect (Volume 2: The current system). Canberra: Commonwealth of Australia, 2021. https://www.royalcommission.gov.au/aged‐care/final‐report (viewed May 2024).
6. Miller E, Burton LO. Redesigning aged care with a biophilic lens: a call to action. Cities Health 2023; 7: 260‐272.
7. Powers M, Faden R. Social justice: the moral foundations of public health and health policy. Oxford: Oxford University Press, 2006.
8. Nussbaum M. Women and human development. Cambridge: Cambridge University Press, 2000.
9. Behrens K. Exploring African holism with respect to the environment. Environ Values 2010; 19: 465‐484.
10. Hewitt J. Just healthcare and human flourishing: why resource allocation is not just enough. Nurs Ethics 2019; 26: 405‐417.
11. Young IM. Justice and the politics of difference. Princeton: Princeton University Press, 1990.
12. Leopold A. A Sand County almanac. Oxford: Oxford University Press, 1949.
13. Graham M. Some thoughts about the philosophical underpinnings of Aboriginal worldviews. Worldviews: Environment, Culture, Religion 1999; 3: 105‐118.
14. Tieu M, Matthews S. The relational care framework: promoting continuity or maintenance of selfhood in person‐centred care. J Med Philos 2024; 49: 85‐101.
15. Rawls J. A theory of justice. Cambridge, Massachusetts: Belknap Press, 1971.
16. Wenner DM. The social value requirement in research: from the transactional to the basic structure model of stakeholder obligations. Hastings Cent Rep 2018; 48: 25‐32.
17. Etzioni A. The spirit of community: rights, responsibilities and the communitarian agenda. London: Fontana Press, 1993.

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Pregnancy, childbirth and the postpartum period: opportunities to improve lifetime outcomes for women with non‐communicable diseases

Jenny A Ramson, Myfanwy J Williams, Bosede B Afolabi, Stephen Colagiuri, Kenneth W Finlayson, Bianca Hemmingsen, Kartik K Venkatesh and Doris Chou

Med J Aust 2024; 221 (7): . || doi: 10.5694/mja2.52452
Published online: 7 October 2024

Correction(s) for this article:

Erratum | Published online: 30 July 2025

Topics

Women's health

Non‐communicable diseases (NCDs), such as cardiovascular disease, malignant neoplasms, chronic respiratory diseases and diabetes, are the primary cause of death and disability among women,1,2 with women remaining susceptible throughout their life spans.3 Estimates indicate that women in most countries (88%) have a higher probability of dying before the age of 70 from an NCD than from communicable, perinatal and nutritional conditions combined.4 Most premature deaths due to NCDs (86%) occur in low and middle‐income countries (LMICs),5 but health inequalities persist in high income countries (HICs) and NCDs affect some population groups more than others.4 In addition, the effects of the pandemic of NCDs on global health are intertwined with effects of climate change.6

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1 Ampersand Health Science Writing, Kalaru, NSW
2 UNDP‐UNFPA‐UNICEF‐WHO‐World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
3 University of Lagos, Lagos, Nigeria
4 Centre for Clinical Trials, Research and Implementation Science, University of Lagos, Lagos, Nigeria
5 World Health Organization Collaborating Centre on Physical Activity, Nutrition and Obesity, University of Sydney, Sydney, NSW
6 University of Central Lancashire, Lancashire, United Kingdom
7 Ohio State University, Columbus, Ohio, United States

Correspondence: choud@who.int

Open access:

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

Acknowledgements:

This work was funded by the UNDP‐UNFPA‐UNICEF‐WHO‐World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co‐sponsored program executed by the World Health Organization (WHO) and the Global NCD Platform. Ongoing work on pregnancy and diabetes is additionally supported by the Leona M. and Harry B. Helmsley Charitable Trust. The funding sources did not have any role in the writing of this article. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

Competing interests:

Doris Chou has worked with HRP, Helmsley Foundation and the United States Agency for International Development. She has received a grant from Global NCD Platform, travel reimbursements to attend the Society for Maternal‐Fetal Medicine meeting. Jenny Ramson and Myfanwy Williams are contractors for the World Health Organization (WHO) and have received travel reimbursements from WHO. Bosede Afolabi received funding from the Tertiary Education Trust Fund, Nigeria for a clinical trial (the PIPSICKLE trial examining the effectiveness of low dose aspirin versus placebo in preventing intrauterine growth restriction in pregnant women with sickle cell disease). Bosede received honoraria from the American Society of Hematology for a presentation, and travel reimbursements from the American Society of Hematology and National Heart, Lung, and Blood Institute/National Institutes of Health (USA). Stephen Colagiuri is an honorary board member for the Juvenile Arthritis Foundation Australia Board and the Glycaemic Index Foundation Board. Kenneth Finlayson received consultancy fees from WHO as part of a program of work to support guideline development. Kartik Venkatesh received honoraria from the American Diabetes Association and grants from the US National Institutes of Health, Patient‐Centered Outcomes Research Institute and Agency for Healthcare Research. He is on the Obstetrics and Gynecology (Green Journal) editorial board and is an associate editor of the Society of Maternal Fetal Medicine – American Journal of OG/GYN Special Edition.

1. World Health Organization. Global health estimates 2021: Global health estimates: leading causes of DALYs. Disease burden, 2000‐2021 [website]. https://www.who.int/data/gho/data/themes/mortality‐and‐global‐health‐estimates/global‐health‐estimates‐leading‐causes‐of‐dalys (viewed Aug 2024).
2. World Health Organization. Global health estimates: cause‐specific mortality, 2000‐2021 [website]. https://www.who.int/data/gho/data/themes/mortality‐and‐global‐health‐estimates/ghe‐leading‐causes‐of‐death (viewed Aug 2024).
3. Carcel C, Haupt S, Arnott C, et al. A life‐course approach to tackling noncommunicable diseases in women. Nat Med 2024; 30: 51‐60.
4. Bennett JE, Stevens GA, Mathers CD, et al. NCD Countdown 2030: worldwide trends in non‐communicable disease mortality and progress towards Sustainable Development Goal target 3.4. Lancet 2018; 392: 1072‐1088.
5. World Health Organization. Noncommunicable diseases fact sheet [website]. Geneva: WHO, Sept 2023. https://www.who.int/news‐room/fact‐sheets/detail/noncommunicable‐diseases (viewed June 2024).
6. World Health Organization. Climate change and noncommunicable diseases: connections [website]. Geneva: WHO, 2023. https://www.who.int/news/item/02‐11‐2023‐climate‐change‐and‐noncommunicable‐diseases‐connections#:~:text=There%20is%20increasing%20strong%20evidence,serious%20risks%20to%20mental%20health (viewed June 2024).
7. Institute for Health Metrics Evaluation. Global burden of disease study [website]. IHME. https://vizhub.healthdata.org/gbd‐results/ (viewed Aug 2024).
8. World Health Organization. Strategies toward ending preventable maternal mortality (EPMM). Geneva: WHO, 2015.
9. United Nations Department of Economic and Social Affairs. UN Sustainable Development Goal 3 targets and indicators [website]. United Nations, 2015. https://sdgs.un.org/goals/goal3#targets_and_indicators (viewed June 2024).
10. World Health Organization. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division [website]. Geneva: WHO, 2023. https://iris.who.int/bitstream/handle/10665/366225/9789240068759‐eng.pdf?sequence=1 (viewed May 2024).
11. Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2: e323‐333.
12. Australian Institute of Health and Welfare. Maternal deaths in Australia 2018‐2020. Australian Government, AIHW, 2023. Catalogue number PER 121.
13. Heise L, Greene ME, Opper N, et al. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet 2019; 393: 2440‐2454.
14. Australian Institute of Health and Welfare. Deaths in Australia [website]. Australian Government, June 2024. https://www.aihw.gov.au/reports/life‐expectancy‐deaths/deaths‐in‐australia/contents/about (viewed June 2024).
15. Australian Institute of Health and Welfare. Deaths in Australia. Data tables [website]. Australian Government, Sept 2023. https://www.aihw.gov.au/reports/life‐expectancy‐deaths/deaths‐in‐australia/data (viewed June 2024).
16. Australian Institute of Health and Welfare. Burden of disease [website]. Australian Government, August 2024. https://www.aihw.gov.au/reports‐data/health‐conditions‐disability‐deaths/burden‐of‐disease/overview (viewed June 2024).
17. Frenk J, Gómez‐Dantés O. The triple burden: disease in developing nations. Harvard Int Rev. 2011; 33: 36‐40.
18. Asogwa OA, Boateng D, Marzà‐Florensa A, et al. Multimorbidity of non‐communicable diseases in low‐income and middle‐income countries: a systematic review and meta‐analysis. BMJ Open 2022; 12: e049133.
19. Australian Institute of Health and Welfare. Multimorbidity [website]. Australian Government, June 2024. https://www.aihw.gov.au/reports/australias‐health/multimorbidity (viewed June 2024).
20. Brauer M, Roth GA, Aravkin AY, et al. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403: 2162‐2203.
21. World Health Organization. Protecting maternal, newborn and child health from the impacts of climate change: a call for action [website]. WHO, Nov 2023. https://www.who.int/publications/i/item/9789240085350 (viewed June 2024).
22. Akselrod S, Banerjee A, Collins TE, et al. Integrating maternal, newborn, child health and non‐communicable disease care in the sustainable development goal era. Front Public Health 2023; 11: 1183712.
23. Simkovich SM, Foeller ME, Tunçalp Ö, et al. Integrating non‐communicable disease prevention and control into maternal and child health programmes. BMJ 2023; 381: e071072.
24. Firoz T, Pineles B, Navrange N, et al. Non‐communicable diseases and maternal health: a scoping review. BMC Pregnancy Childbirth 2022; 22: 1‐14.
25. Jung J, Sultana S, Aziz S, et al. Mapping the research landscape: effectiveness of non‐communicable interventions withinantenatal, intrapartum and postpartum care: an overview of systematic reviews [abstract]. J Paediatr Child Health 2024; 60 Supp1: 116.
26. Jung J, Karwal EK, McDonald S, et al. Prevention and control of non‐communicable diseases in antenatal, intrapartum, and postnatal care: a systematic scoping review of clinical practice guidelines since 2011. BMC Med 2022; 20: 1‐17.
27. Sundari Ravindran TK, Teerawattananon Y, Tannenbaum C, Vijayasingham L. Making pharmaceutical research and regulation work for women. BMJ 2020; 371: m3808.
28. Kikuchi K, Ayer R, Okawa S, et al. Interventions integrating non‐communicable disease prevention and reproductive, maternal, newborn, and child health: a systematic review. Biosci Trends 2018; 12: 116‐125.
29. Lal A, Abdalla SM, Chattu VK, et al. Pandemic preparedness and response: exploring the role of universal health coverage within the global health security architecture. Lancet Glob Health 2022; 10: e1675‐1683.
30. Atun R, Jaffar S, Nishtar S, et al. Improving responsiveness of health systems to non‐communicable diseases. Lancet 2013; 381: 690‐697.
31. Souza J, Tunçalp Ö, Vogel J, et al. Obstetric transition: the pathway towards ending preventable maternal deaths. BJOG 2014; 121: 1‐4.
32. Manolova G, Waqas A, Chowdhary N, et al. Integrating perinatal mental healthcare into maternal and perinatal services in low and middle income countries. BMJ 2023; 381: e073343.
33. UNICEF. The global strategy for woman's children's and adolescents’ health (2016‐2030) [website]. New York; UNICEF, May 2016. https://data.unicef.org/resources/global‐strategy‐womens‐childrens‐adolescents‐health/ (viewed June 2024).
34. George AS, Amin A, de Abreu Lopes CM, Ravindran TKS. Structural determinants of gender inequality: why they matter for adolescent girls’ sexual and reproductive health. BMJ 2020; 368: l6985.
35. Hickey S, Roe Y, Ireland S, et al. A call for action that cannot go to voicemail: research activism to urgently improve Indigenous perinatal health and wellbeing. Women Birth 2021; 34: 303‐305.

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Perspective

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30/60/90 National stroke targets and stroke unit access for all Australians: it's about time

Timothy J Kleinig and Lisa Murphy, For the 30/60/90 National Stroke Targets Taskforce

Med J Aust || doi: 10.5694/mja2.52459
Published online: 25 September 2024

Topics

Health services administration

Information science

Nervous system diseases

Vascular diseases

Stroke is the world's second‐leading cause of death and the third‐leading cause of death and disability.1 In Australia, stroke is the third most common cause of death and a leading cause of disability.2 As a result, stroke is costly to the health system, society and the individual.3

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1 Royal Adelaide Hospital, Adelaide, SA
2 University of Adelaide, Adelaide, SA
3 Stroke Foundation, Melbourne, VIC

Correspondence: timothy.kleinig@adelaide.edu.au

Open access:

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

Acknowledgements:

Geoff Donnan and Stephen Davis for their helpful manuscript comments. Lachlan Dalli for assistance with the updated AuSCR data trends, and the hospital coordinators who have contributed data via the AuSCR.

Competing interests:

No relevant disclosures for named authors. The Angels Initiative (a non‐promotional healthcare project of Boehringer Ingelheim International to improve stroke care around the world) provided support for the 2023 National Stroke Targets 30/60/90 workshop and logistical support surrounding this. The Angels Initiative is a member of the Australian Stroke Coalition taskforce. The Angels Initiative did not propose any target or amendment to any target, and had no input into this manuscript.

1. GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990‐2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20: 795‐820.
2. Australian Institute of Health and Welfare. Deaths in Australia [website]. Australian Government AIHW, 2023. https://www.aihw.gov.au/reports/life‐expectancy‐deaths/deaths‐in‐australia/contents/leading‐causes‐of‐death (viewed Mar 2024).
3. Deloitte Access Economics. The economic impact of stroke in Australia, 2020. https://www.deloitte.com/content/dam/assets‐zone1/au/en/docs/services/economics/dae‐economic‐impact‐stroke‐report‐061120.pdf (viewed Mar 2024).
4. Langhorne P, Ramachandra S, Stroke Unit Trialists Collaboration. Organised inpatient (stroke unit) care for stroke: network meta‐analysis. Cochrane Database Syst Rev 2020; 4: CD000197.
5. Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta‐analysis of individual patient data from randomised trials. Lancet 2014; 384: 1929‐1935.
6. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large‐vessel ischaemic stroke: a meta‐analysis of individual patient data from five randomised trials. Lancet 2016; 387: 1723‐1731.
7. Meretoja A, Keshtkaran M, Saver JL, et al. Stroke thrombolysis: save a minute, save a day. Stroke 2014; 45: 1053‐1058.
8. Meretoja A, Keshtkaran M, Tatlisumak T, et al. Endovascular therapy for ischemic stroke: Save a minute‐save a week. Neurology 2017; 88: 2123‐2127.
9. Australian Commission on Safety and Quality in Health Care. Acute stroke clinical care standard. Australian Commission on Safety and Quality in Health Care, 2019. https://www.safetyandquality.gov.au/sites/default/files/2022‐05/Acute‐Stroke‐Clinical‐Care‐Standard‐2019.pdf (viewed Mar 2024).
10. Park PSW, Frost T, Tan S, et al. The quest to reduce stroke treatment delays at a Melbourne metropolitan primary stroke centre over the past two decades. Intern Med J 2022; 52: 1978‐1985.
11. Cadilhac DA DL, Morrison J, et al. The Australian Stroke Clinical Registry annual report 2022. The Florey Institute of Neuroscience and Mental Health, December 2023. https://auscr.com.au/wp‐content/uploads/2024/03/australian‐stroke‐clinical‐registry‐annual‐report‐2022.pdf (viewed Mar 2024).
12. The Swedish Stroke Register. Riksstroke: quality of the Swedish stroke care 2022. Riksstroke – The Swedish Stroke Register, 2023. https://www.riksstroke.org/wp‐content/uploads/2023/12/Arsrapport‐2022‐engelsk‐sammanfattning_final.pdf (viewed Mar 2024).
13. Xian Y, Xu H, Smith EE, et al. Achieving more rapid door‐to‐needle times and improved outcomes in acute ischemic stroke in a nationwide quality improvement intervention. Stroke 2022; 53: 1328‐1338.
14. Sentinel Stroke National Audit Programme. SSNAP Summary for July ‐ September 2023 admissions and discharges. King's College London, 2023. https://www.strokeaudit.org/Documents/National/Clinical/JulSep2023/JulSep2023‐SummaryReport.aspx (viewed Mar 2024).
15. Nogueira RG, Haussen DC, Smith EE, et al. Higher procedural volumes are associated with faster treatment times, better functional outcomes, and lower mortality in patients undergoing endovascular treatment for acute ischemic stroke. Ann Neurol 2023; https://doi.org/10.1002/ana.26803 [online ahead of print].
16. Cadilhac DA DL, Morrison J, et al. The Australian Stroke Clinical Registry annual report 2021. The Florey Institute of Neuroscience and Mental Health, December 2022. https://auscr.com.au/wp‐content/uploads/2022/12/auscr‐2021‐annual‐report.pdf (viewed Mar 2024).
17. Garcia‐Esperon C, Bladin CF, Kleinig TJ, et al. The acute telestroke model of care in Australia: a potential roadmap for other emergency medical services? Med J Aust 2022; 216: 498‐500. https://www.mja.com.au/journal/2022/216/10/acute‐telestroke‐model‐care‐australia‐potential‐roadmap‐other‐emergency‐medical
18. Australian Stroke Coalition. ASC Stroke Unit Certification Project [website]. Australian Stroke Coalition, 2024. https://australianstrokecoalition.org.au/portfolio/certification/ (viewed Mar 2024).
19. Stroke Foundation. National acute stroke services framework 2023. Stroke Foundation, 2023. https://informme.org.au/media/xkkfjqm1/national‐acute‐stroke‐services‐framework‐2023.pdf (viewed Mar 2024).
20. Australian Stroke Alliance. The plan [website]. Australian Stroke Alliance, 2024. https://austrokealliance.org.au/our‐story/the‐plan/ (viewed Mar 2024).
21. Xian Y, Xu H, Lytle B, et al. Use of strategies to improve door‐to‐needle times with tissue‐type plasminogen activator in acute ischemic stroke in clinical practice: findings from target: stroke. Circ Cardiovasc Qual Outcomes 2017; 10: e003227.
22. Choi PMC, Tsoi AH, Pope AL, et al. Door‐in‐door‐out time of 60 minutes for stroke with emergent large vessel occlusion at a primary stroke center. Stroke 2019; 50: 2829‐2834.
23. Campbell BCV. Optimal Imaging at the primary stroke center. Stroke 2020; 51: 1932‐1940.
24. Sarraj A, Goyal N, Chen M, et al. Direct to angiography vs repeated imaging approaches in transferred patients undergoing endovascular thrombectomy. JAMA Neurol 2021; 78: 916‐926.
25. Reeves MJ, Fonarow GC, Smith EE, et al. Twenty years of get with the guidelines‐stroke: celebrating past successes, lessons learned, and future challenges. Stroke 2024; 55: 1689‐1698.
26. Li Q, Yakhkind A, Alexandrov AW, et al. Code ICH: a call to action. Stroke 2024; 55: 494‐505.
27. Kleinig TJ, Abou‐Hamden A, Laidlaw J, et al. Early minimally invasive intracerebral hemorrhage evacuation: a phase 2a feasibility, safety, and promise of surgical efficacy study. J Neurointerv Surg 2024; 16: 555‐558.
28. Committee on the Learning Health Care System in America. Best care at lower cost: the path to continuously learning health care in America. Institute of Medicine of the National Academies, The National Academies Press, 2013. https://nap.nationalacademies.org/catalog/13444/best‐care‐at‐lower‐cost‐the‐path‐to‐continuously‐learning (viewed Mar 2024).

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Research

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Lessons learnt from the first two SARS‐CoV‐2 Omicron waves of the COVID‐19 pandemic in six remote Aboriginal and Torres Strait Islander communities in Queensland, Australia: a retrospective epidemiological review

Allison Hempenstall, Barbara Telfer, Sean Cowley, Shalomie Shadrach, Caroline Taunton, Jay Short, Nicolas Smoll, Roy Rasalam, Oscar Whitehead, Peter Roach, Karen Koko, Josh Stafford, Rittia Matysek, Renarta Whitcombe, Gulam Khandaker, Jason King, Nishila Moodley, Maree Finney, Rica Lacey, Steven Donohue, Richard Gair and Katie Panaretto

Med J Aust || doi: 10.5694/mja2.52426
Published online: 30 September 2024

Topics

Infectious diseases

Indigenous health

Environment and public health

Abstract

Objective: To describe the preparedness for, epidemiological characteristics of and public health responses to the first and second waves of coronavirus disease 2019 (COVID‐19) in six remote Aboriginal and Torres Strait Islander communities in Queensland from late 2021.

Design: This was a descriptive epidemiological study. Data were collated by each participating public health unit. Case and outbreak characteristics were obtained from the statewide Notifiable Conditions System.

Setting, participants: Six discrete remote First Nations communities across Queensland were selected to represent a broad geographic spread across the state: Badu Island, Cherbourg, Lockhart River, Palm Island, Woorabinda and Yarrabah. People with a positive severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) test result recorded between 13 December 2021 and 12 June 2022 who acquired the infection and isolated in one of the six communities.

Main outcome measures: COVID‐19 vaccination coverage among First Nations people; number of COVID‐19 cases reported; and attack rates for each community.

Results: All six First Nations communities led the COVID‐19 preparedness and planning. COVID‐19 vaccination coverage rates before the first outbreak ranged from 59% to 84% for the first dose and from 39% to 76% for the second dose across the six communities. During the study period, 2624 cases of COVID‐19 in these communities were notified to Queensland Health. Attack rates for each community were: Badu Island, 23%; Cherbourg, 34%; Lockhart River, 18%; and Palm Island, Woorabinda and Yarrabah, 35% each. The 2624 cases included 52 cases (2%) involving hospital admission and two cases (< 1%) in which the person died from COVID‐19.

Conclusions: It is likely that the co‐designed, collaborative partnerships between local councils, community‐controlled health services, state health services and public health units positively impacted the management and outcomes of COVID‐19 in each of the six communities.

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1 James Cook University, Townsville, QLD
2 Torres and Cape Hospital and Health Service, Cairns, QLD
3 Queensland Health, Brisbane, QLD
4 Darling Downs Hospital and Health Service, Toowoomba, QLD
5 Townsville Hospital and Health Service, Townsville, QLD
6 Central Queensland Hospital and Health Service, Rockhampton, QLD
7 Cairns and Hinterland Health Service, Cairns, QLD
8 Gurriny Yealamucka Health Service, Yarrabah, QLD
9 Lockhart River Primary Health Care Centre, Lockhart River, QLD

Correspondence: allison.hempenstall@jcu.edu.au

Data sharing:

No data sharing is available from this study in line with Indigenous data sovereignty.

Acknowledgements:

We acknowledge the people living in the six communities included in our study, and are grateful for the support from and partnerships with the local councils: Torres Strait Island Regional Council, Cherbourg Aboriginal Shire Council, Lockhart River Aboriginal Shire Council, Palm Island Aboriginal Shire Council, Woorabinda Aboriginal Shire Council and Yarrabah Aboriginal Shire Council. We also thank the local public health unit staff, Queensland Health primary health care centres and other stakeholders from these six communities for their support. In addition, we thank Marko Simunovic, Principal Business Analyst, Queensland Health, for his data quality work and Kathy Piotrowski, Data Manager, Queensland Health, for creating the figure in Box 1.

Competing interests:

No relevant disclosures.

1. 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 Reg Health West Pac 2020; 1: 100007.
2. Thurber KA, Barrett EM, Agostino J, et al. Risk of severe illness from COVID‐19 among Aboriginal and Torres Strait Islander adults: the construct of ‘vulnerable populations’ obscures the root causes of health inequities. Aust N Z J Public Health 2021; 45: 658‐663.
3. Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander Health Survey. Canberra: Australian Bureau of Statistics, 2019. https://www.abs.gov.au/statistics/people/aboriginal‐and‐torres‐strait‐islander‐peoples/national‐aboriginal‐and‐torres‐strait‐islander‐health‐survey/latest‐release (viewed Dec 2022).
4. Rudge S, Massey PD. Responding to pandemic (H1N1) 2009 influenza in Aboriginal communities in NSW through collaboration between NSW Health and the Aboriginal community‐controlled health sector. N S W Public Health Bull 2010; 21: 26‐29.
5. Millalen P, Nahuelpan H, Hofflinger A, Martinez E. COVID‐19 and Indigenous peoples in Chile: vulnerability to contagion and mortality. AlterNative 2020; 16(4): 399‐402.
6. Australian Institute of Health and Welfare. First Nations people and the health system. Canberra: AIHW, 2024. https://www.aihw.gov.au/reports/australias‐health/indigenous‐australians‐use‐of‐health‐services (viewed July 2024).
7. Maclean H, Elphick K. COVID‐19 legislative response—human biosecurity emergency declaration explainer. Flagpost (Parliament of Australia); 19 Mar 2020. https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/FlagPost/2020/March/COVID‐19_Biosecurity_Emergency_Declaration (viewed Dec 2022).
8. 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.e1. https://www.mja.com.au/journal/2020/213/4/first‐nations‐peoples‐leading‐way‐covid‐19‐pandemic‐planning‐response‐and
9. Australian Government Department of Health and Aged Care. CDNA national guidance for remote Aboriginal and Torres Strait Islander communities for COVID‐19. Canberra: Australian Government, 2022. https://www.health.gov.au/sites/default/files/documents/2022/02/cdna‐national‐guidance‐for‐remote‐aboriginal‐and‐torres‐strait‐islander‐communities‐for‐covid‐19.pdf (viewed Dec 2022).
10. Queensland Aboriginal and Islander Health Council. COVID‐19 (coronavirus) resources. Brisbane: QAIHC, 2022. https://www.qaihc.com.au/resources/covid‐19‐coronavirus‐resources (viewed Dec 2022).
11. Australian Bureau of Statistics. Queensland: Aboriginal and Torres Strait Islander population summary. Canberra: ABS, 2022. https://www.abs.gov.au/articles/queensland‐aboriginal‐and‐torres‐strait‐islander‐population‐summary (viewed Dec 2022).
12. Australian Government Department of Health and Aged Care. Coronavirus (COVID‐19) at a glance – 12 December 2021 [infographic]. Canberra: Australian Government, 2021. https://www.health.gov.au/resources/publications/coronavirus‐covid‐19‐at‐a‐glance‐12‐december‐2021?language=en (viewed Dec 2022).
13. Queensland Government. Queensland borders re‐open [media release]. 6 Dec 2021. Brisbane: Queensland Government, 2021. https://statements.qld.gov.au/statements/93994 (viewed Dec 2022).
14. Queensland Health. Public health units. Brisbane: Queensland Health, 2023. https://www.health.qld.gov.au/system‐governance/contact‐us/contact/public‐health‐units (viewed Mar 2023).
15. Queensland Government. Disaster management [website]. Brisbane: Queensland Government, 2021. https://www.disaster.qld.gov.au (viewed Dec 2022).
16. Torres Strait Island Regional Council. Badu. Cairns: TSIRC, 2022. https://www.tsirc.qld.gov.au/communities/badu (viewed Dec 2022).
17. National Indigenous Australians Agency. Communities. Canberra: Australian Government, 2022. https://www.indigenous.gov.au/communities (viewed Dec 2022).
18. Australian Bureau of Statistics. 2021 census all persons quickstats. Canberra: ABS, 2021. https://abs.gov.au/census/find‐census‐data/quickstats/2021/AUS (viewed Dec 2022).
19. Australian Institute of Health and Welfare. Canadian National Occupancy Standard. Canberra: AIHW, 2017. https://meteor.aihw.gov.au/content/386254 (viewed Mar 2023).
20. Australian Institute of Health and Welfare; National Indigenous Australians Agency. Measures. 2.01 Housing. In: Aboriginal and Torres Strait Islander Health Performance Framework. Canberra: AIHW. https://www.indigenoushpf.gov.au/measures/2‐01‐housing (viewed Dec 2022).
21. Queensland Health. List of notifiable conditions. Brisbane: Queensland Government, 2023. https://www.health.qld.gov.au/clinical‐practice/guidelines‐procedures/diseases‐infection/notifiable‐conditions/list (viewed Mar 2023).
22. Australian Government Department of Health and Aged Care. Coronavirus (COVID‐19) – CDNA national guidelines for public health units. Canberra: Australian Government, 2020. https://www.health.gov.au/resources/publications/coronavirus‐covid‐19‐cdna‐national‐guidelines‐for‐public‐health‐units?language=en (viewed Dec 2022).
23. von Elm E, Altman DG, Egger M, et al; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007; 335: 806‐808.
24. Huria T, Palmer SC, Pitama S, et al. Consolidated criteria for strengthening reporting of health research involving indigenous peoples: the CONSIDER statement. BMC Med Res Methodol 2019; 19: 173.
25. Australian Government Department of Health and Aged Care. Stay up to date with your COVID‐19 vaccines. Canberra: Australian Government, 2023. https://www.health.gov.au/our‐work/covid‐19‐vaccines/getting‐your‐vaccination/stay‐up‐to‐date (viewed Mar 2023).
26. Queensland Health. Sotrovimab prescribing guideline [guideline retired]. Brisbane: Queensland Health, 2021. https://www.health.qld.gov.au/clinical‐practice/guidelines‐procedures/novel‐coronavirus‐qld‐clinicians (viewed Mar 2023).
27. Power T, Wilson D, Best O, et al. COVID‐19 and Indigenous peoples: an imperative for action. J Clin Nurs 2020; 29: 2737‐2741.
28. Smith CR, Enns C, Cutfeet D, et al. COVID‐19 in a remote First Nations community in British Columbia, Canada: an outbreak report. CMAJ Open 2021; 9: E1073‐E1079.
29. Markham F, Smith D, Morphy F. Indigenous Australians and the COVID‐19 crisis: perspectives on public policy. Canberra: Australian National University, 2020. https://caepr.cass.anu.edu.au/research/publications/indigenous‐australians‐and‐covid‐19‐crisis‐perspectives‐public‐policy (viewed Dec 2022).
30. National Agreement on Closing the Gap. August 2022. https://www.closingthegap.gov.au/sites/default/files/2022‐09/ctg‐national‐agreement_apr‐21‐comm‐infra‐targets‐updated‐24‐august‐2022_0.pdf (viewed Dec 2022).
31. Hengel B, Causer L, Matthews S, et al. A decentralised point‐of‐care testing model to address inequities in the COVID‐19 response. Lancet Infect Dis 2021; 21: e183‐e190. Erratum in: Lancet Infect Dis 2021; 21: e182.
32. Begay M, Kakol M, Sood A, Upson D. Strengthening digital health technology capacity in Navajo communities to help counter the COVID‐19 pandemic. Ann Am Thorac Soc 2021; 18: 1109‐1114.
33. Thomas EE, Haydon HM, Mehrotra A, et al. Building on the momentum: sustaining telehealth beyond COVID‐19. J Telemed Telecare 2022; 28: 301‐308.

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Guideline summary

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Recommendations from the 2024 Australian evidence‐based guideline for unexplained infertility: ADAPTE process from the ESHRE evidence‐based guideline on unexplained infertility

Michael F Costello, Robert J Norman, Luk Rombauts, Cynthia M Farquhar, Lisa Bedson, Marlene Kong, Clare V Boothroyd, Rebecca Kerner, Rhonda M Garad, Trudy Loos, Madeline Flanagan, Ben W Mol, Aya Mousa, Daniela Romualdi, Baris Ata, Ernesto Bosch, Samuel Santos‐Ribeiro, Ksenija Gersak, Roy Homburg, Nathalie Le Clef, Mina Mincheva, Terhi Piltonen, Sara Somers, Sesh K Sunkara, Harold Verhoeve and Helena J Teede, For the Australian NHMRC Centre for Research Excellence in Reproductive Life UI Guideline Network and the ESHRE guideline group for unexplained infertility

Med J Aust || doi: 10.5694/mja2.52437
Published online: 16 September 2024

Topics

Women's health

General medicine

Statistics, epidemiology and research design

Abstract

Introduction: The 2024 Australian evidence‐based guideline for unexplained infertility provides clinicians with evidence‐based recommendations for the optimal diagnostic workup for infertile couples to establish the diagnosis of unexplained infertility and optimal therapeutic approach to treat couples diagnosed with unexplained infertility in the Australian health care setting. The guideline recommendations were adapted for the Australian context from the rigorous, comprehensive European Society of Human Reproduction and Embryology (ESHRE) 2023 Evidence‐based guideline: unexplained infertility, using the ADAPTE process and have been approved by the Australian National Health and Medical Research Council.

Main recommendations: The guideline includes 40 evidence‐based recommendations, 21 practice points and three research recommendations addressing:

definition — defining infertility and frequency of intercourse, infertility and age, female and male factor infertility;
diagnosis — ovulation, ovarian reserve, tubal factor, uterine factor, laparoscopy, cervical/vaginal factor, male factor, additional testing for systemic conditions; and
treatment — expectant management, active treatment, mechanical‐surgical procedures, alternative therapeutic approaches, quality of life.

Changes in assessment and management resulting from the guideline: This guideline refines the definition of unexplained infertility and addresses basic diagnostic procedures for infertility assessment not considered in previous guidelines on unexplained infertility. For therapeutic approaches, consideration of evidence quality, efficacy, safety and, in the Australian setting, feasibility, acceptability, cost, implementation and ultimately recommendation strength were integrated across multidisciplinary expertise and consumer perspectives in adapting recommendations to the Australian context by using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework, which had not been used in past guidelines on unexplained infertility to formulate recommendations. The Australian process also included an established data integrity check to ensure evidence could be trusted to guide practice. Practice points were added and expanded to consider the Australian setting. No evidence‐based recommendations were underpinned by high quality evidence, with most having low or very low quality evidence. In this context, research recommendations were made including those for the Australian context. The full guideline and technical report are publicly available online and can be accessed at https://www.monash.edu/medicine/mchri/infertility and are supported by extensive translation resources, including the free patient ASKFertility mobile application (https://www.askfertility.org/).

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1 NHMRC Centre for Research Excellence in Women's Health in Reproductive Life, Sydney, NSW
2 University of New South Wales, Sydney, NSW
3 Robinson Research Institute, University of Adelaide, Adelaide, SA
4 Monash University, Melbourne, VIC
5 University of Auckland, Auckland, New Zealand
6 Repromed, Adelaide, SA
7 Whitsundays Doctors Service, Airlie Beach, QLD
8 Care Fertility, Brisbane, QLD
9 Adelaide, SA
10 Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
11 Monash Health, Melbourne, VIC
12 Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
13 Koç University Hospital, Istanbul, Turkey
14 IVI RMA, Valencia, Spain
15 IVI RMA, Lisbon, Portugal
16 University of Ljubljana and University Medical Centre, Ljubljana, Slovenia
17 Liverpool Women's Hospital, Hewitt Fertility Centre, Liverpool, United Kingdom
18 European Society of Human Reproduction and Embryology, Grimbergen, Belgium
19 London, United Kingdom
20 Oulu University Hospital, Medical Research Centre, University of Oulu, Oulu, Finland
21 Ghent University Hospital, Ghent, Belgium
22 King's College London, London, United Kingdom
23 Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

Correspondence: helena.teede@monash.edu

Open access:

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

Acknowledgements:

The Australian National Health and Medical Research Council (NHMRC) funded the guideline development through the Centre for Research Excellence in Women's Health in Reproductive Life (CRE WHiRL) (APP1171592) administered by Monash University, Australia. The NHMRC was the approver of the Guideline but had no influence on the outcome. This work builds on the work of ESHRE and sections where relevant are reproduced here with permission. Copyright of the original UI Guideline belongs to European Society of Human Reproduction and Embryology (all rights reserved). The content of the original ESHRE guidelines has been published for personal and educational use only and is adapted here with permission. No part of the ESHRE guidelines may be translated or reproduced in any form without prior written permission of the ESHRE communications manager. Monash University is subject to copyright. Monash holds the copyright for the Australian adapted UI Guideline and recommendations. No commercial use is authorised. Apart from any use permitted under the Copyright Act 1968, no part may be reproduced by any process without written permission from ESHRE and Monash University.

Competing interests:

Lisa Bedson is employed by Repromed Fertility Specialists. Claire Boothroyd is on the Merck‐funded male factor infertility guideline, and received speaker fees from Organon, Merck, Da Vinci, Ferring, Besins, Gideon Richter as well as private practice or professional income from Owner Care Fertility (IVF unit offering treatments). Michael Costello has received speaker honoraria from Merck/CREI. Cynthia Farquhar has been funded by Cochrane for evidence synthesis and advisory board roles; she has also been the Chair NZICA and a WHO, task force and infertility guideline member, President elect ASPIRE, and RANZCOG research and guideline lead. Robert Norman declared NHMRC funding via research grants, MRFF funding, advisory board member as Chair of the Clinical Advisory Committee at Westmead Fertility, Chair Board of HOPE Research Institute Vietnam, consulting honoraria past trainer Flinders Fertility, consultant Vinmec Hospital Vietnam and speakers fee or honoraria from several pharmaceutical companies in India. Luk Rombauts declared research grants/contracts with Monash IVF Group and was on an advisory board for Merck with private practice income from LIF Rombauts Pty Ltd. Daniela Romualdi received consulting fees from SICS Editore, UCB Pharmax, honoraria from IBSA and Novo Nordisk. Baris Ata received speakers fees from Merck, Ferring, IBSA, Organon and Abbott. Ernesto Bosch received research grants from Roche diagnostics and IBSA with consulting fees from Merck, Ferring, Gedeon Richter, Mint diagnostics and speaker's fees from Merck, Ferring, Gedeon Richter, IBSA, salary from IVI RMA Valencia, ownership by stock or partnership from IVI RMA Valencia and Mint diagnostics. Samuel Santos‐Ribeiro received research grants from MSD, Ferring, Merck, Abbott, Roche, Obseva and consulting fees from Ferring, MSD and speaker's fees from Ferring, MSD and Besins. Mina Mincheva received consulting fees from Mojo Fertility Ltd. Terhi Piltonen Research received a grant from Roche and speaker's fees from Gedeon Richter, Roche, Exeltis. Helena Teede receives competitive grant funding from government sources and holds unpaid international leadership roles with WHO and professional societies. Natalie Vujovich, Rhonda Garad, Trudy Loos, Marlene Kong, Sara Somers, Roy Homburg, Donia Scicluna, Ksenija Gersak and Nathalie Le Clef have nothing to declare.

1. Practice Committee of the American Society for Reproductive Medicine. Evidence‐based treatments for couples with unexplained infertility: a guideline. Fertil Steril 2020; 113: 305‐322.
2. Zegers‐Hochschild F, Adamson GD, Dyer S, et al. The international glossary on infertility and fertility care, 2017. Fertil Steril 2017; 108: 393‐406.
3. Buckett W, Sierra S. The management of unexplained infertility: an evidence‐based guideline from the Canadian Fertility and Andrology Society. Reprod Biomed Online 2019; 39: 633‐640.
4. National Health and Medical Research Council. NHMRC levels of evidence and grades for recommendations for developers of guidelines. Canberra: NHMRC, 2009. https://www.mja.com.au/sites/default/files/NHMRC.levels.of.evidence.2008‐09.pdf (viewed June 2024).
5. Costello MF, Teede H, Farquhar C, et al. Australian evidence‐based guideline for unexplained infertility: ADAPTE process from the ESHRE evidence‐based guideline on unexplained infertility 2024 [website]. Melbourne: Monash University, 2024. https://bridges.monash.edu/articles/online_resource/Australian_evidence‐based_guideline_for_unexplained_infertility_ADAPTE_process_from_the_ESHRE_evidence‐based_guideline_on_unexplained_infertility_2024_/26061295 (viewed June 2024).
6. Guideline Group on Unexplained Infertility; Romualdi D, Ata B, Bhattacharya S, et al. Evidence‐based guideline: unexplained infertility. European Society of Human Reproduction and Embryology, 2023. https://www.eshre.eu/guideline/UI (viewed Aug 2024).
7. Guideline Group on Unexplained Infertility; Romualdi D, Ata B, Bhattacharya S, et al. Evidence‐based guideline: unexplained infertility^†. Hum Reprod 2023; 38: 1881‐1890.
8. ADAPTE Collaboration (2009). The ADAPTE Process: resource toolkit for guideline adaptation; version 2.0. Guideline International Network, 2010. https://g‐i‐n.net/wp‐content/uploads/2021/05/ADAPTE‐Resource‐toolkit‐V2.1‐March‐2010‐updated‐disclaimer.pdf](viewed Aug 2024).
9. Mousa A, Le Clef N, Costello M, et al. Technical report for the Australian Adaptation of the ESHRE Evidence‐based guideline for unexplained infertility 2024. Melbourne: Monash University, 2024. https://bridges.monash.edu/articles/report/Technical_Report_for_the_Australian_Adaptation_of_the_ESHRE_Evidence‐based_guideline_for_unexplained_infertility_2024_/26299363 (viewed June 2024).
10. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ 2010; 182: E839‐E842.
11. Higgins J, Thomas J, Chandler J, et al; editors. Cochrane handbook for systematic reviews of interventions version 6.4 [updated Aug 2023]. Cochrane, 2023. https://training.cochrane.org/handbook/current (viewed Aug 2024).
12. Mousa A, Flanagan M, Tay CT, et al. Research Integrity in Guidelines and evIDence synthesis (RIGID): a framework for assessing research integrity in guideline development and evidence synthesis. Lancet eClinicalMedicine 2024; https://doi.org/10.1016/j.eclinm.2024.102717.
13. Mol BW, Lai S, Rahim A, et al. Checklist to assess Trustworthiness in RAndomised Controlled Trials (TRACT checklist): concept proposal and pilot. Res Integr Peer Rev 2023; 8: 6.
14. Lazzari E, Baffour B, Chambers GM. Residential proximity to a fertility clinic is independently associated with likelihood of women having ART and IUI treatment. Hum Reprod 2022; 37: 2662‐2671.
15. Gilbert E, Walker R, Simon D, et al. “We are only looking at the tip of the iceberg in infertility”: perspectives of health providers about fertility issues and management among Aboriginal and Torres Strait Islander people. BMC Health Serv Res 2021; 21: 704.
16. Clarke M, Whitson N, Williams C, Robson SJ. A silent burden‐prolapse, incontinence, and infertility in Australian Aboriginal and Torres Strait Islander women: a systematic search and narrative review. Int J Gynaecol Obstet 2021; 155: 268‐274.
17. Keller E, Botha W, Chambers GM. What features of fertility treatment do patients value? Price elasticity and willingness‐to‐pay values from a discrete choice experiment. Appl Health Econ Health Policy 2023; 21: 91‐107.
18. World Health Organization. WHO laboratory manual for the examination and processing of human semen. Geneva: WHO, 2021. https://www.who.int/publications/i/item/9789240030787 (viewed Aug 2024).
19. Goth C, Godehardt D, Godehardt E, et al. Time to pregnancy: results of the German prospective study and impact on the management of infertility. Hum Reprod 2003; 18: 1959‐1966.
20. Björndahl L, Kirkman Brown J; Editorial Board Members of the WHO Laboratory Manual for the Examination and Processing of Human Semen. The sixth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen: ensuring quality and standardization in basic examination of human ejaculates. Fert Steril 2022; 117: 246‐251.
21. Wessel JA, Mochtar MH, Besselink DE, et al. Expectant management versus IUI in unexplained subfertility and a poor pregnancy prognosis (EXIUI study): a randomized controlled trial. Hum Reprod 2022; 37: 2808‐2816.
22. Lai S, Wang R, van Wely M, et al. IVF versus IUI with ovarian stimulation for unexplained infertility: a collaborative individual participant data meta‐analysis. Hum Reprod Update 2024; 30: 174‐185.
23. Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci 2022; 17: 75.
24. Au LS, Feng Q, Shingshetty L, et al. Evaluating prognosis in unexplained infertility. Fertil Steril 2024; 121(5): 717‐729.
25. Norman RJ. Prophecy, prediction, and prognosis — can we improve the advice we give on the chance of pregnancy and treatment options for infertility? Fertil Steril 2024; 121: 715‐716.
26. Bensdorp AJ, van der Steeg JW, Steures P, et al. A revised prediction model for natural conception. Reprod Biomed Online 2017; 34: 619‐626.

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Medical education

Online first

Updating the diagnosis and management of iron deficiency in the era of routine ferritin testing of blood donors by Australian Red Cross Lifeblood

Gary D Zhang, Daniel Johnstone, Michael F Leahy and John K Olynyk

Med J Aust || doi: 10.5694/mja2.52429
Published online: 16 September 2024

Topics

Hematologic diseases

Iron deficiency is the most common micronutrient deficiency worldwide1 and the predominant cause of anaemia, which affects one‐quarter of the global population.2

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1 Fiona Stanley Hospital, Perth, WA
2 University of Western Australia, Perth, WA
3 University of Newcastle, Newcastle, NSW
4 Royal Perth Hospital, Perth, WA
5 Curtin University, Perth, WA

Correspondence: gary.zhang@health.wa.gov.au

Open access:

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

Competing interests:

No relevant disclosures.

1. McLean E, Cogswell M, Egli I, et al. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993‐2005. Public Health Nutr 2009; 12: 444‐454.
2. GBD 2021 Anaemia Collaborators. Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990‐2021: findings from the Global Burden of Disease Study 2021. Lancet Haematol 2023; 10: e713‐e734.
3. Australian Bureau of Statistics. Australian health survey: biomedical results for nutrients. Canberra: ABS, 2013. https://www.abs.gov.au/statistics/health/health‐conditions‐and‐risks/australian‐health‐survey‐biomedical‐results‐nutrients/latest‐release (viewed Sept 2023).
4. Australian Red Cross Lifeblood. Lifeblood stats and snacks 2023 [website]. Australia, 2023. https://www.lifeblood.com.au/news‐and‐stories/vital‐reads/2023‐stats‐and‐snacks (viewed Apr 2024).
5. Australian Red Cross Lifeblood. Ferritin (iron) testing [website]. Australia, 2023. https://www.lifeblood.com.au/blood/learn‐about‐blood/iron‐health/ferritin‐testing (viewed Oct 2023).
6. Snook J, Bhala N, Beales ILP, et al. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut 2021; 70: 2030‐2051.
7. Pasricha SR, Tye‐Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. Lancet 2021; 397: 233‐248.
8. Gastroenterological Society of Australia (GESA). Clinical update for general practitioners and physicians: iron deficiency. Melbourne: GESA, 2022. https://www.gesa.org.au/public/13/files/Education%20&%20Resources/Clinical%20Practice%20Resources/Iron%20Deficiency/Iron%20Deficiency%20Clinical%20Update%202022%20APPROVED.pdf (viewed Feb 2024).
9. Rockey DC, Altayar O, Falck‐Ytter Y, Kalmaz D. AGA technical review on gastrointestinal evaluation of iron deficiency anemia. Gastroenterology 2020; 159: 1097‐1119.
10. World Health Organization. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: WHO, 2020. https://www.who.int/publications/i/item/9789240000124 (viewed Oct 2023).
11. Low MS, Grigoriadis G. Iron deficiency and new insights into therapy. Med J Aust 2017; 207: 81‐87. https://www.mja.com.au/journal/2017/207/2/iron‐deficiency‐and‐new‐insights‐therapy
12. The Royal College of Pathologists of Australasia. Iron studies standardised reporting protocol. Second edition: November 2021. Sydney: RCPA, 2021. https://www.rcpa.edu.au/getattachment/554ba672‐4d34‐4e7c‐b812‐5741359bca78/Iron‐Studies‐Standardised‐Reporting‐Protocol.aspx (viewed Apr 2024).
13. Saunders AV, Craig WJ, Baines SK, Posen JS. Iron and vegetarian diets. Med J Aust 2013; 199 Suppl 4: S11‐16. https://www.mja.com.au/journal/2013/199/4/iron‐and‐vegetarian‐diets
14. Lam JR, Schneider JL, Quesenberry CP, Corley DA. Proton pump inhibitor and histamine‐2 receptor antagonist use and iron deficiency. Gastroenterology 2017; 152: 821‐829.
15. Gowanlock Z, Lezhanska A, Conroy M, et al. Iron deficiency following bariatric surgery: a retrospective cohort study. Blood Adv 2020; 4: 3639‐3647.
16. Mahadev S, Laszkowska M, Sundström J, et al. Prevalence of celiac disease in patients with iron deficiency anemia ‐ a systematic review with meta‐analysis. Gastroenterology 2018; 155: 374‐382.
17. Hershko C, Hoffbrand AV, Keret D, et al. Role of autoimmune gastritis, Helicobacter pylori and celiac disease in refractory or unexplained iron deficiency anemia. Haematologica 2005; 90: 585‐595.
18. Alexandre L, Manning C, Chan SSM. Prevalence of gastrointestinal malignancy in iron deficiency without anaemia: a systematic review and meta‐analysis. Eur J Intern Med 2020; 72: 27‐33.
19. Pennazio M, Spada C, Eliakim R, et al. Small‐bowel capsule endoscopy and device‐assisted enteroscopy for diagnosis and treatment of small‐bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352‐376.
20. Atkin W, Dadswell E, Wooldrage K, et al. Computed tomographic colonography versus colonoscopy for investigation of patients with symptoms suggestive of colorectal cancer (SIGGAR): a multicentre randomised trial. Lancet 2013; 381: 1194‐1202.
21. Moretti D, Goede JS, Zeder C, et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice‐daily doses in iron‐depleted young women. Blood 2015; 126: 1981‐1989.
22. Stoffel NU, Zeder C, Brittenham GM, et al. Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron‐deficient anemic women. Haematologica 2020; 105: 1232‐1239.
23. Stoffel NU, Cercamondi CI, Brittenham G, et al. Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice‐daily split dosing in iron‐depleted women: two open‐label, randomised controlled trials. Lancet Haematol 2017; 4: e524‐e533.
24. Kaundal R, Bhatia P, Jain A, et al. Randomized controlled trial of twice‐daily versus alternate‐day oral iron therapy in the treatment of iron‐deficiency anemia. Ann Hematol 2020; 99: 57‐63.
25. Avni T, Bieber A, Grossman A, et al. The safety of intravenous iron preparations: systematic review and meta‐analysis. Mayo Clin Proc 2015; 90: 12‐23.

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Research

Non‐index hospital re‐admissions after hospitalisation with acute myocardial infarction and geographic remoteness, New South Wales, 2005–2020: a retrospective cohort study

Md Shajedur Rahman Shawon, Jennifer Yu, Art Sedrakyan, Sze‐Yuan Ooi and Louisa Jorm

Med J Aust 2024; 221 (6): . || doi: 10.5694/mja2.52420
Published online: 16 September 2024

Topics

Cardiovascular diseases

General medicine

Health services administration

Abstract

Objectives: To examine the frequency of re‐admissions to non‐index hospitals (hospitals other than the initial discharging hospital) within 30 days of admission with acute myocardial infarction in New South Wales; to examine the relationship between non‐index hospital re‐admissions and 30‐day mortality.

Study design: Retrospective cohort study; analysis of hospital admissions (Admitted Patient Data Collection) and mortality data (Registry of Births, Deaths and Marriages).

Setting, participants: Adults admitted to NSW hospitals with acute myocardial infarction re‐admitted to any hospital within 30 days of discharge from the initial hospitalisation, 1 January 2005 – 31 December 2020.

Main outcome measures: Proportion of re‐admissions within 30 days of discharge to non‐index hospitals, and associations of non‐index hospital re‐admissions with demographic and initial hospitalisation characteristics and with 30‐day and 12‐month mortality, each by residential remoteness category.

Results: Of 168 097 people with acute myocardial infarction discharged alive, 28 309 (16.8%) were re‐admitted to hospital within 30 days of discharge, including 11 986 to non‐index hospitals (42.3%); the proportion was larger for people from regional or remote areas (50.1%) than for people from major cities (38.3%). The odds of non‐index hospital re‐admission were higher for people with ST‐elevation myocardial infarction, for people whose index admissions were to private hospitals, who were transferred between hospitals or had undergone revascularisation during the initial admission, were under 65 years of age, or had private health insurance; the influence of these factors was generally larger for people from regional or remote areas than for those from large cities. After adjustment for potential confounders, non‐index hospital re‐admission did not influence mortality among people from major cities (30‐day: adjusted odds ratio [aOR], 1.09; 95% confidence interval [CI], 0.99–1.20; 12‐month: aOR, 0.98, 95% CI, 0.93–1.03), but was associated with reduced mortality for people from regional or remote areas (30‐day: aOR, 0.81; 95% CI, 0.70–0.95; 12‐month: aOR, 0.88; 95% CI, 0.81–0.96).

Conclusions: The geographically dispersed Australian population and the mixed public and private provision of specialist services means that re‐admission to a non‐index hospital can be unavoidable for people with acute myocardial infarction who are initially transferred to specialised facilities. Non‐index hospital re‐admission is associated with better mortality outcomes for people from regional or remote areas.

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1 Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
2 Prince of Wales Hospital and Community Health Services, Sydney, NSW
3 Eastern Heart Clinic Pty Ltd, Sydney, NSW
4 Weill Cornell Medical College, New York, United States of America
5 Prince of Wales Hospital, Sydney, NSW

Correspondence: s.shawon@unsw.edu.au

Open access:

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

Data sharing:

The data underlying this article will be shared upon reasonable request to the corresponding author.

Competing interests:

No relevant disclosures.

1. Wang H, Zhao T, Wei X, et al. The prevalence of 30‐day readmission after acute myocardial infarction: a systematic review and meta‐analysis. Clin Cardiol 2019; 42: 889‐898.
2. Brooke BS, Goodney PP, Kraiss LW, et al. Readmission destination and risk of mortality after major surgery: an observational cohort study. Lancet 2015; 386: 884‐895.
3. Havens JM, Olufajo OA, Tsai TC, et al. Hospital factors associated with care discontinuity following emergency general surgery. JAMA Surg 2017; 152: 242‐249.
4. Tsai TC, Orav EJ, Jha AK. Care fragmentation in the postdischarge period: surgical readmissions, distance of travel, and postoperative mortality. JAMA Surg 2015; 150: 59‐64.
5. Snow K, Galaviz K, Turbow S. Patient outcomes following interhospital care fragmentation: a systematic review. J Gen Intern Med 2020; 35: 1550‐1558.
6. Sakowitz S, Madrigal J, Williamson C, et al. Care fragmentation after hospitalization for acute myocardial infarction. Am J Cardiol 2023; 187: 131‐137.
7. Rymer JA, Chen AY, Thomas L, et al. Readmissions after acute myocardial infarction: how often do patients return to the discharging hospital? J Am Heart Assoc 2019; 8: e012059.
8. Australian Institute of Health and Welfare. Australia's hospitals at a glance. Updated 18 July 2024. https://www.aihw.gov.au/reports/hospitals/australias‐hospitals‐at‐a‐glance/contents/summary (viewed July 2024).
9. Australian Bureau of Statistics. Regional population. Statistics about the population and components of change (births, deaths, migration) for Australia's capital cities and regions, 2022–23. 26 Mar 2024. https://www.abs.gov.au/statistics/people/population/regional‐population/latest‐release. (viewed July 2023).
10. Centre for Health Record Linkage (NSW Health). Datasets. 2024. https://www.cherel.org.au/datasets (viewed July 2024).
11. Innes K, Hooper J, Bramley M, DahDah P. Creation of a clinical classification. International statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD‐10‐AM). Health Inf Manag 1997; 27: 31‐38.
12. Boyd JH, Randall SM, Ferrante AM, et al. Accuracy and completeness of patient pathways: the benefits of national data linkage in Australia. BMC Health Serv Res 2015; 15: 312.
13. Australian Bureau of Statistics. IRSD. In: Census of Population and Housing: Socio‐Economic Indexes for Areas (SEIFA), Australia, 2016 (2033.0.55.001). 27 Mar 2018. https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2033.0.55.001~2016~Main%20Features~IRSD~19 (viewed July 2024).
14. Australian Institute of Health and Welfare. Australian hospital peer groups (cat. no. HSE 170). 16 Nov 2015. https://www.aihw.gov.au/reports/hospitals/australian‐hospital‐peer‐groups/summary (viewed Nov 2023).
15. Australian Bureau of Statistics. Remoteness structure. Australian Statistical Geography Standard (ASGS), edition 3, July 2021 – June 2026. 20 July 2021. https://www.abs.gov.au/statistics/statistical‐geography/remoteness‐structure (viewed Nov 2023).
16. Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 2011; 46: 399‐424.
17. Bureau of Health Information. Exploring clinical variation in readmission. Return to acute care following discharge from hospital, eight clinical conditions, NSW, July 2012 – June 2015. 12 Apr 2017. https://www.bhi.nsw.gov.au/BHI_reports/readmission/clinical‐variation‐in‐readmission (viewed Nov 2023).
18. Dunlay SM, Weston SA, Killian JM, et al. Thirty‐day rehospitalizations after acute myocardial infarction: a cohort study. Ann Intern Med 2012; 157: 11‐18.
19. Lujic S, Watson DE, Randall DA, et al. Variation in the recording of common health conditions in routine hospital data: study using linked survey and administrative data in New South Wales, Australia. BMJ Open 2014; 4: e005768.

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Research

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Policies on the collection, analysis, and reporting of sex and gender in Australian health and medical research: a mixed methods study

Cheryl Carcel, Amy Vassallo, Laura Hallam, Janani Shanthosh, Kelly Thompson, Lily Halliday, Jacek Anderst, Anthony KJ Smith, Briar L McKenzie, Christy E Newman, Keziah Bennett‐Brook, Zoe Wainer, Mark Woodward, Robyn Norton and Louise Chappell

Med J Aust || doi: 10.5694/mja2.52435
Published online: 9 September 2024

Topics

Statistics, epidemiology and research design

Abstract

Objective: To explore the policies of key organisations in Australian health and medical research on defining, collecting, analysing, and reporting data on sex and gender, and to identify barriers to and facilitators of developing and implementing such policies.

Study design: Mixed methods study: online planning forum; survey of organisations in Australian health and medical research, and internet search for policies defining, collecting, analysing, and reporting data by sex and gender in health and medical research.

Setting, participants: Australia, 19 May 2021 (planning forum) to 12 December 2022 (final internet search).

Main outcome measures: Relevant webpages and documents classified as dedicated organisation‐specific sex and gender policies; policies, guidelines, or statements with broader aims, but including content that met the definition of a sex and gender policy; and references to external policies.

Results: The online planning forum identified 65 relevant organisations in Australian health and medical research; twenty participated in the policy survey. Seven organisations reported at least one relevant policy, and six had plans to develop or implement such policies during the following two years. Barriers to and facilitators of policy development and implementation were identified in the areas of leadership, language and definitions, and knowledge skills and training. The internet search found that 57 of the 65 organisations had some form of sex and gender policy, including all ten peer‐reviewed journals and five of ten research funders; twelve organisations, including eight peak body organisations, had published dedicated sex and gender policies on their websites.

Conclusion: Most of the organisations included in our study had policies regarding the integration of sex and gender in health and medical research. The implementation and evaluation of these policies is necessary to ensure that consideration of sex and gender is adequate during all stages of the research process.

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1 The George Institute for Global Health, University of New South Wales, Sydney, NSW
2 Australian Human Rights Institute, University of New South Wales, Sydney, NSW
3 Nepean Blue Mountains Local Health District (NSW Health), Penrith, NSW
4 Centre for Social Research in Health, University of New South Wales, Sydney, NSW
5 The University of Melbourne, Melbourne, VIC
6 Victorian Department of Health, Melbourne, VIC
7 The George Institute for Global Health, Imperial College London, London, United Kingdom

Correspondence: ccarcel@georgeinstitute.org.au

Correspondence: c.carcel@unsw.edu.au

Open access:

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

Data sharing:

To request access to de‐identified data, please contact the corresponding author.

Acknowledgements:

We acknowledge the contributions of Jacqui Webster, Colman Taylor, and Elizabeth Duck‐Chong to this study as part of our Advisory Group (https://www.sexandgenderhealthpolicy.org.au/our‐team). Cheryl Carcel is supported by a Heart Foundation Postdoctoral Fellowship (102741) and a National Health and Medical Research Council (NHMRC) Investigator grant (Emerging Leadership 1; APP2009726), Kelly Thompson by an NHMRC Investigator grant (Emerging Leadership 1, APP1194058), and Mark Woodward by an NHMRC Investigator grant (APP1174120), and program grant (APP1149987). An anonymous philanthropic donor provided monetary support for the study but had no role in the design, analysis, interpretation, or write‐up of the study.

Competing interests:

No relevant disclosures.

1. Rexrode KM, Madsen TE, Yu AYX, et al. The impact of sex and gender on stroke. Circ Res 2022; 130: 512‐528.
2. Woodward M. Rationale and tutorial for analysing and reporting sex differences in cardiovascular associations. Heart 2019; 105: 1701‐1708.
3. White J, Tannenbaum C, Klinge I, et al. The integration of sex and gender considerations into biomedical research: lessons from international funding agencies. J Clin Endocrinol Metab 2021; 106: 3034‐3048.
4. Tannenbaum C, Ellis RP, Eyssel F, et al. Sex and gender analysis improves science and engineering. Nature 2019; 575: 137‐146.
5. European Commission. Gender equality in Horizon 2020 [fact sheet]. 9 Dec 2013. https://genderedinnovations.stanford.edu/FactSheet_Gender_091213_final_2.pdf (viewed Mar 2024).
6. National Institutes of Health. NIH policy guidelines on the inclusion of women and minorities as subjects in clinical research. Updated 6 Dec 2017. https://grants.nih.gov/policy/inclusion/women‐and‐minorities/guidelines.htm (viewed Aug 2024).
7. Peters SAE, Babor TF, Norton RN, et al. Fifth anniversary of the Sex And Gender Equity in Research (SAGER) guidelines: taking stock and looking ahead. BMJ Glob Health 2021; 6: e007853.
8. Nature journals raise the bar on sex and gender reporting in research [editorial]. Nature 2022; 605: 396.
9. Wainer Z, Carcel C. Sex and gender in health research: updating policy to reflect evidence. Med J Aust 2020; 212: 57‐62. https://www.mja.com.au/journal/2020/212/2/sex‐and‐gender‐health‐research‐updating‐policy‐reflect‐evidence
10. Sex and Gender in Health and Medical Research Australia Group. Project glossary (terms and definitions for “sex and gender policies in health and medical research”). 2021. https://www.sexandgenderhealthpolicy.org.au/glossary (viewed July 2024).
11. Johnson JL, Greaves L, Repta R. Better science with sex and gender: facilitating the use of a sex and gender‐based analysis in health research. Int J Equity Health 2009; 8: 14.
12. Monro S, Carpenter M, Crocetti D, et al. Intersex: cultural and social perspectives. Cult Health Sex 2021; 23: 431‐440.
13. Fausto‐Sterling A. Gender/sex, sexual orientation, and identity are in the body: how did they get there? J Sex Res 2019; 56: 529‐555.
14. Brady B, Rosenberg S, Newman CE, et al. Gender is dynamic for all people. Discov Psychol 2022; 2: 41.
15. Sawer, M. Governing for the mainstream: implications for community representation. Australian Journal of Public Administration 2022: 61: 39‐49.
16. George Institute for Global Health. Ensuring the collection, analysis and reporting of sex‐ and gender‐specific health data in Australia. 29 May 2018. https://www.georgeinstitute.org/events/ensuring‐the‐collection‐analysis‐and‐reporting‐of‐sex‐and‐gender‐specific‐health‐data‐in (viewed Feb 2024).
17. Australian Bureau of Statistics. Standard for sex, gender, variations of sex characteristics and sexual orientation variables, 2020. 14 Jan 2021. https://www.abs.gov.au/statistics/standards/standard‐sex‐gender‐variations‐sex‐characteristics‐and‐sexual‐orientation‐variables/2020 (viewed June 2021).
18. Heidari S, Babor TF, De Castro P, et al. Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use. Res Integr Peer Rev 2016; 1: 2.
19. Office of Research on Women's Health (National Institutes of Health). NIH policy on sex as a biological variable. Undated. https://orwh.od.nih.gov/sex‐gender/orwh‐mission‐area‐sex‐gender‐in‐research/nih‐policy‐on‐sex‐as‐biological‐variable (viewed Mar 2024).
20. National Institutes of Health. Consideration of sex as a biological variable in NIH‐funded research. 9 June 2015. https://grants.nih.gov/grants/guide/notice‐files/not‐od‐15‐102.html (viewed May 2022).
21. Health Canada. Considerations for inclusion of women in clinical trials and analysis of sex differences. 29 May 2013. https://www.canada.ca/en/health‐canada/services/drugs‐health‐products/drug‐products/applications‐submissions/guidance‐documents/clinical‐trials/considerations‐inclusion‐women‐clinical‐trials‐analysis‐data‐sex‐differences.html (viewed Apr 2022).
22. Haverfield J, Tannenbaum C. A 10‐year longitudinal evaluation of science policy interventions to promote sex and gender in health research. Health Res Policy Syst 2021; 19: 94.
23. Dorrigan A, Zuccala E, Talley NJ. Striving for gender equity at the Medical Journal of Australia. Med J Aust 2022; 217: 138‐139. https://www.mja.com.au/journal/2022/217/3/striving‐gender‐equity‐medical‐journal‐australia
24. National Health and Medical Research Council. NHMRC gender equity strategy 2022–2025. https://www.nhmrc.gov.au/research‐policy/gender‐equity/nhmrc‐gender‐equity‐strategy‐2022‐2025. (viewed Jan 2022).
25. Australian Department of Health and Aged Care; National Health and Medical Research Council. Statement on sex, gender, variations of sex characteristics and sexual orientation in health and medical research. Aug 2024. https://www.nhmrc.gov.au/research‐policy/gender‐equity/statement‐sex‐and‐gender‐health‐and‐medical‐research (viewed Aug 2024).
26. Association of Australian Medical Research Institutes. What should AAMRI do to support improved use of sex and gender in research practices and decision making: a deliberative panel approach. Response to the recommendations. 14 Sept 2023. https://aamri.org.au/wp‐content/uploads/2023/09/AAMRIs‐Sex‐and‐Gender‐Policy‐Recommendations‐for‐Health‐and‐Medical‐Research.pdf (viewed Mar 2024).
27. Hallam L, Vassallo A, Hallam C, et al. Sex and gender reporting in Australian health and medical research publications. Aust N Z J Public Health 2023; 47: 100005.
28. Canadian Institute for Health Research. Integrating sex & gender checklist: partnership development grants for the healthy & productive work initiative. Updated 18 Nov 2015. https://www.cihr‐irsc.gc.ca/e/49336.html (viewed Aug 2024).
29. Moullin JC, Dickson KS, Stadnick NA, et al. Ten recommendations for using implementation frameworks in research and practice. Implement Sci Commun 2020; 1: 42.

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Medical education
Lessons from practice

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A case of visceral leishmaniasis masquerading as autoimmune hepatitis

Vinny Ea, Brigitte Papa and Rimma Goldberg

Med J Aust || doi: 10.5694/mja2.52412
Published online: 26 August 2024

Topics

Immune system diseases

Digestive system diseases

Infectious diseases

A 72‐year‐old man with a history of well controlled type 2 diabetes was admitted to a tertiary metropolitan hospital for investigation of fevers, night sweats and unintentional weight loss of 18 kg over six months. He had pancytopenia with no symptoms or signs to suggest a focal infection, malignancy or rheumatological disease. Prior outpatient investigation findings revealed mild splenomegaly, with a normal bone marrow aspirate and positron emission tomography scan. At its nadir, the haemoglobin level was 106 g/L (reference interval [RI], 125–175 g/L), white cell count 1.9 × 10⁹/L (RI, 4.0–11.0 × 10⁹/L), neutrophil count 1.2 × 10⁹/L (RI, 2.00–8.00 × 10⁹/L) and platelets 120 × 10⁹/L (RI, 150–450 × 10⁹/L). Notably, liver function test results were mildly elevated in a mixed pattern with alkaline phosphatase 138 U/L (RI, 30–110 U/L), γ‐glutamyl transferase 605 U/L (RI, 5–50 U/L) and alanine aminotransferase 78 U/L (RI, 5–40 U/L), with associated antinuclear antibody titre of more than 1280 (RI, < 160), and an elevated immunoglobulin G level of 38.6 g/L (RI, 7.5–15.6 g/L). Pertinent negative results included negative human immunodeficiency virus (HIV) and viral hepatitis serology, and negative anti‐smooth muscle and anti‐liver–kidney microsomal antibodies. Given these findings and the ongoing diagnostic dilemma, a liver biopsy was performed, showing mild interface hepatitis and lymphoplasmacytic infiltrate in the portal tracts (Box 1), and leading to a probable diagnosis of autoimmune hepatitis. Administration of azathioprine 25 mg and prednisolone 40 mg daily was initiated and the patient was discharged following improvement of his liver function test results.

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

Correspondence: rimma.goldberg@monash.edu

Open access:

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

Acknowledgements:

We thank infectious disease physicians Dr Ouli Xie and Dr Sabine De Silva for their diagnosis and management of visceral leishmaniasis, pathologist Dr Sukhpal Dayan for reporting the patient’s histopathology slides and reviewing the written case report, and microbiology scientist Pei Vern Fong for acquiring the microbiology slides.

Competing interests:

No relevant disclosures.

1. Mann S, Frasca K, Scherrer S, et al. A review of leishmaniasis: current knowledge and future directions. Curr Trop Med Rep 2021; 8: 121‐132.
2. Ruiz‐Postigo JA, Jain S, Mikhailov A, et al. Global leishmaniasis surveillance: 2019–2020, a baseline for the 2030 roadmap. Wkly Epidemiol Rec 2021; 35: 401‐419.
3. Roberts T, Barratt J, Sandaradura I, et al. Molecular epidemiology of imported cases of leishmaniasis in Australia from 2008 to 2014. PLoS One 2015; 10: e0119212.
4. Burza S, Croft SL, Boelaert M. Leishmaniasis. Lancet 2018; 392: 951‐970.
5. Seaman J, Mercer AJ, Sondorp E. The epidemic of visceral leishmaniasis in western Upper Nile, southern Sudan: course and impact from 1984 to 1994. Int J Epidemiol 1996; 25: 862‐871.
6. da Silva MR, Stewart JM, Costa CH. Sensitivity of bone marrow aspirates in the diagnosis of visceral leishmaniasis. Am J Trop Med Hyg 2005; 72: 811‐814.
7. Antinori S, Calattini S, Longhi E, et al. Clinical use of polymerase chain reaction performed on peripheral blood and bone marrow samples for the diagnosis and monitoring of visceral leishmaniasis in HIV‐infected and HIV‐uninfected patients: a single‐center, 8‐year experience in Italy and review of the literature. Clin Infect Dis 2007; 44: 1602‐1610.
8. le Fichoux Y, Quaranta JF, Aufeuvre JP, et al. Occurrence of Leishmania infantum parasitemia in asymptomatic blood donors living in an area of endemicity in southern France. J Clin Microbiol 1999; 37: 1953‐1957.
9. Chen X, Zhou Q, Liu J, et al. Autoimmune manifestations of visceral leishmaniasis in Chinese patients. Ann Palliat Med 2021; 10: 12699‐12705.
10. Tunccan OG, Tufan A, Telli G, et al. Visceral leishmaniasis mimicking autoimmune hepatitis, primary biliary cirrhosis, and systemic lupus erythematosus overlap. Korean J Parasitol 2012; 50: 133‐136.
11. Argov S, Jaffe CL, Krupp M, et al. Autoantibody production by patients infected with Leishmania. Clin Exp Immunol 1989; 76: 190‐197.
12. Aronson N, Herwaldt BL, Libman M, et al. Diagnosis and treatment of leishmaniasis: clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2016; 63: 1539‐1557.

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Perspective

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The loneliness epidemic: a holistic view of its health and economic implications in older age

Lidia Engel and Cathrine Mihalopoulos

Med J Aust || doi: 10.5694/mja2.52414
Published online: 26 August 2024

Topics

Gerontology

Social determinants of health

Loneliness has been described as an epidemic and is one of the most pressing public health concerns in Australia and internationally.1,2 In contrast to social isolation, which is an objective measure of social interactions and relationships, loneliness is defined as a subjective experience where one perceives a discrepancy between desired and actual social relationships in terms of quality or quantity.3 Although it is common and natural to feel lonely at times, prolonged and intense periods of loneliness have been linked to adverse health outcomes.4 Older adults are more prone to loneliness and social isolation compared with other age groups.5 Reasons for this include significant life transitions and events, such as retiring from work, increased financial difficulties, loss of friends and widowhood, changes in living arrangements (eg, transitioning to residential aged care), increase in solitary living, and a decline in both health and independence.5,6 Older people at particular risk of loneliness include those living on low incomes, living with a disability, living in rural areas or with housing stress, who are single, childless or living alone, who are vulnerable or at risk of elder abuse, and those with low levels of literacy or communication technology skills (Box).7 A growing body of evidence has highlighted the significant health burden associated with loneliness, with more recent studies also suggesting that loneliness has become an economic problem due to an increase in service use and demand for institutional care. This development requires both effective and cost‐effective strategies to tackle loneliness.11,12

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Monash University Health Economics Group (MUHEG), Monash University, Melbourne, VIC

Correspondence: cathy.mihalopoulos@monash.edu

Open access:

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

Competing interests:

No relevant disclosures.

1. Relationships Australia. Is Australia experiencing an epidemic of loneliness? Findings from 16 waves of the Household Income and Labour Dynamics of Australia Survey; working paper, September 2018. https://www.relationships.org.au/wp‐content/uploads/An‐epidemic‐of‐loneliness‐2001‐2017.pdf (viewed Jan 2024).
2. Office of the Surgeon General. Our epidemic of loneliness and isolation: the US Surgeon General's Advisory on the healing effects of social connection and community; 2023. https://www.hhs.gov/sites/default/files/surgeon‐general‐social‐connection‐advisory.pdf (viewed Jan 2024).
3. Lim MH, Badcok J, Smith B, et al. Ending loneliness together in Australia. Sydney: Ending Loneliness Together, 2020. https://endingloneliness.com.au/wp‐content/uploads/2020/11/Ending‐Loneliness‐Together‐in‐Australia_Nov20.pdf (viewed Jan 2024).
4. Hawkley LC, Cacioppo JT. Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Ann Behav Med 2010; 40: 218‐227.
5. Lim MH, Eres R, Vasan S. Understanding loneliness in the twenty‐first century: an update on correlates, risk factors, and potential solutions. Soc Psychiatry Psychiatr Epidemiol 2020; 55: 793‐810.
6. Engel L, Brijnath B, Chong TWH, et al. Quality of life and loneliness post‐bereavement: Results from a nationwide survey of bereaved older adults. Death Stud 2023; 47: 994‐1005.
7. Mansour G. Ageing is everyone's business: a report on isolation and loneliness among senior Victorians. Melbourne: State of Victoria, Department of Health and Human Services; 2016. https://www.seniorsonline.vic.gov.au/services‐information/ageing‐everyones‐business‐report‐social‐isolation‐and‐loneliness‐among‐senior (viewed Jan 2024).
8. Gardiner C, Geldenhuys G, Gott M. Interventions to reduce social isolation and loneliness among older people: an integrative review. Health Soc Care Community 2018; 26: 147‐157.
9. Quan NG, Lohman MC, Resciniti NV, Friedman DB. A systematic review of interventions for loneliness among older adults living in long‐term care facilities. Aging Ment Health 2020; 24: 1945‐1955.
10. Butler SS. Evaluating the Senior Companion Program: a mixed‐method approach. J Gerontol Soc Work 2006; 47: 45‐70.
11. Kung CSJ, Kunz JS, Shields MA. Economic aspects of loneliness in Australia. Aust Econ Rev 2021; 54: 147‐163.
12. Mihalopoulos C, Le LK, Chatterton ML, ET AL. The economic costs of loneliness: a review of cost‐of‐illness and economic evaluation studies. Soc Psychiatry Psychiatr Epidemiol 2019; 55: 823‐836.
13. Chawla K, Kunonga TP, Stow D, et al. Prevalence of loneliness amongst older people in high‐income countries: a systematic review and meta‐analysis. PLoS One 2021; 16: e0255088.
14. von Soest T, Luhmann M, Hansen T, Gerstorf D. Development of loneliness in midlife and old age: its nature and correlates. J Pers Soc Psychol 2020; 118: 388‐406.
15. Gardiner C, Laud P, Heaton T, Gott M. What is the prevalence of loneliness amongst older people living in residential and nursing care homes? A systematic review and meta‐analysis. Age Ageing 2020; 49: 748‐757.
16. Badcock JC, Lim MH, Brophy L, et al. A guide to measuring loneliness for community organisations. Ending Loneliness Together, 2021. https://endingloneliness.com.au/wp‐content/uploads/2021/08/A‐Guide‐to‐Measuring‐Loneliness‐for‐Community‐Organisations_Ending‐Loneliness‐Together.pdf (viewed Jan 2024).
17. Courtin E, Knapp M. Social isolation, loneliness and health in old age: a scoping review. Health Soc Care Community 2017; 25: 799‐812.
18. Holt‐Lunstad J, Smith TB, Baker M, et al. Loneliness and social isolation as risk factors for mortality: a meta‐analytic review. Perspect Psychol Sci 2015; 10: 227‐237.
19. Cacioppo JT, Hawkley LC. Social isolation and health, with an emphasis on underlying mechanisms. Perspect Biol Med 2003; 46 (Suppl): S39‐S52.
20. Hajek A, Kretzler B, König HH. Multimorbidity, loneliness, and social isolation. A systematic review. Int J Environ Res Public Health 2020; 17: 8688.
21. Duncan A, Kiely D, Mavisakalyan A, et al. Stronger Together: loneliness and social connectedness in Australia. Focus on the States Series, No. 8/21; November 2021. Bankwest Curtin Economics Centre, 2021. https://bcec.edu.au/assets/2021/11/139532_BCEC‐Stronger‐Together‐report_WEB.pdf (viewed Oct 2023).
22. Gerst‐Emerson K, Jayawardhana J. Loneliness as a public health issue: the impact of loneliness on health care utilization among older adults. Am J Public Health 2015; 105: 1013‐1019.
23. Hanratty B, Stow D, Collingridge Moore D, et al. Loneliness as a risk factor for care home admission in the English Longitudinal Study of Ageing. Age Ageing 2018; 47: 896‐900.
24. Valtorta NK, Moore DC, Barron L, et al. Older adults’ social relationships and health care utilization: a systematic review. Am J Public Health 2018; 108: e1‐e10.
25. Engel L, Lee YY, Le LK‐D, et al. Reducing loneliness to prevent depression in older adults in Australia: A modelled cost‐effectiveness analysis. Mental Health and Prevention 2021; 24; https://doi.org/10.1016/j.mhp.2021.200212.
26. Barjaková M, Garnero A, d'Hombres B. Risk factors for loneliness: a literature review. Soc Sci Med 2023; 334: 116163.

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