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    Social media: the root cause of rising youth self‐harm or a convenient scapegoat?

    Helen Christensen, Aimy Slade and Alexis E Whitton
    Med J Aust || doi: 10.5694/mja2.52503
    Published online: 4 November 2024

    Recent events have reignited debate over whether social media is the root cause of increasing youth self‐harm and suicide. Social media is a fertile ground for disseminating harmful content, including graphic imagery and messages depicting gendered violence and religious intolerance. This proliferation of harmful content makes social media an unwelcoming space, especially for women, minority groups, and young people, who are more likely to be targeted by such content, strengthening the narrative that social media is at the crux of a youth mental health crisis.

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    • Black Dog Institute, Sydney, NSW


    Correspondence: a.whitton@unsw.edu.au
    Acknowledgements: 

    This work is supported by a Medical Research Future Fund Million Minds Suicide Prevention Grant (APP1200195). Alexis Whitton is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant (grant # 2017521). Helen Christensen is a recipient of a NHMRC Investigator Grant (#1155614). The funding body did not play a role in the decision to write or publish this manuscript.

    Competing interests:

    No relevant disclosures.

    • 1. Susi K, Glover‐Ford F, Stewart A, et al. Research review: viewing self‐harm images on the internet and social media platforms: Systematic review of the impact and associated psychological mechanisms. J Child Psychol Psychiatry 2023; 64: 1115‐1139.
    • 2. Bould H, Mars B, Moran P, et al. Rising suicide rates among adolescents in England and Wales. Lancet 2019; 394: 116‐117.
    • 3. Haidt J. The anxious generation: how the great rewiring of childhood is causing an epidemic of mental illness. Penguin Random House, 2024.
    • 4. Arendt F, Scherr S, Romer D. Effects of exposure to self‐harm on social media: Evidence from a two‐wave panel study among young adults. New Media and Society 2019; 21: 2422‐2442.
    • 5. Karp P. Guardian Essential poll: voters back age verification for pornography, gambling and social media. The Guardian 2024; 7 May. https://www.theguardian.com/australia‐news/article/2024/may/07/australia‐esafety‐law‐changes‐age‐verification‐social‐media (viewed May 2024).
    • 6. Levitz E. What the evidence really says about social media's impact on teens’ mental health: did smartphones actually “destroy” a generation? Vox 2024; 12 Apr. https://www.vox.com/24127431/smartphones‐young‐kids‐children‐parenting‐social‐media‐teen‐mental‐health (viewed May 2024).
    • 7. Li SH, Batterham PJ, Whitton A, et al. Cross‐sectional and longitudinal associations of screen time with depression and anxiety and the influence of maladaptive social media use and gender [preprint]. Lancet 2024; 26 June; https://doi.org/10.2139/ssrn.4872339.
    • 8. Orben A, Przybylski AK. The association between adolescent well‐being and digital technology use. Nat Hum Behav 2019; 3: 173‐182.
    • 9. Orben A, Przybylski AK. Reply to: underestimating digital media harm. Nat Hum Behav 2020; 4: 349‐351.
    • 10. Twenge JM, Haidt J, Joiner TE, et al. Underestimating digital media harm. Nat Hum Behav 2020; 4: 346‐348.
    • 11. Tang S, Werner‐Seidler A, Torok M, et al. The relationship between screen time and mental health in young people: a systematic review of longitudinal studies. Clin Psychol Rev 2021; 86: 102021.
    • 12. Valkenburg PM, Meier A, Beyens I. Social media use and its impact on adolescent mental health: an umbrella review of the evidence. Curr Opin Psychol 2022; 44: 58‐68.
    • 13. Sanders T, Noetel M, Parker P, et al. An umbrella review of the benefits and risks associated with youths’ interactions with electronic screens. Nat Hum Behav 2024; 8: 82‐99.
    • 14. Kreski N, Platt J, Rutherford C, et al. Social media use and depressive symptoms among United States adolescents. J Adolesc Health 2021; 68: 572‐579.
    • 15. Cunningham S, Hudson CC, Harkness K. Social media and depression symptoms: a meta‐analysis. Res Child Adolesc Psychopathol 2021; 49: 241‐253.
    • 16. Pretorius C, Chambers D, Cowan B, et al. Young people seeking help online for mental health: cross‐sectional survey study. JMIR Ment Health 2019; 6: e13524.
    • 17. Wong K, Chan CS, Chan M, et al. Who seeks help online? Comparing online and offline help‐seeking preferences amongst youths with suicidal ideation. J Affect Disord 2021; 292: 21‐29.
    • 18. Lavis A, Winter R. #Online harms or benefits? An ethnographic analysis of the positives and negatives of peer‐support around self‐harm on social media. J Child Psychol Psychiatry 2020; 61: 842‐854.
    • 19. Thorn P, La Sala L, Hetrick S, et al. Motivations and perceived harms and benefits of online communication about self‐harm: An interview study with young people. Digital Health 2023; 9: 20552076231176689.
    • 20. Cronin TJ, Pepping CA, Lyons A. Mental health service use and barriers to accessing services in a cohort of transgender, gender diverse, and non‐binary adults in Australia. Sex Res Social Policy 2023; https://doi.org/10.1007/s13178‐023‐00866‐4.
    • 21. Selkie E, Adkins V, Masters E, et al. Transgender adolescents’ uses of social media for social support. J Adolesc Health 2020; 66: 275‐280.
    • 22. Whitton A, Hudson J, Werner‐Seidler A, et al. Turning the tide on depression: a vision that starts with Australia's youth. Sydney: Black Dog Institute, 2022. https://www.blackdoginstitute.org.au/wp‐content/uploads/2022/10/Youth‐Depression‐Report_Full.pdf (viewed May 2024).
    • 23. Gao CX, Teo SM, Brennan N, et al. Climate concerns and young people's mental health: findings from the 2022 Mission Australia Youth Survey. Melbourne: Orygen and Sydney: Mission Australia, 2023. www.orygen.org.au/getmedia/4d21728e‐f589‐40a1‐a271‐ba9a070e86ff/Mission‐Australia‐Orygen‐climatechange‐report‐17APRIL.aspx?ext=.pdf (viewed May 2024).
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    • 25. Etchells P. Unlocked: the real science of screen time (and how to spend it better). London: Piatkus, 2024.
    • 26. Robinson J, Thorn P, McKay S, et al. #Chatsafe 2.0. updated guidelines to support young people to communicate safely online about self‐harm and suicide: a Delphi expert consensus study. PLoS One 2023; 18: e0289494.
    • 27. US Surgeon General's Advisory. Social media and youth mental health (2023). https://www.hhs.gov/sites/default/files/sg‐youth‐mental‐health‐social‐media‐advisory.pdf (viewed May 2024).

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      An Aboriginal and Torres Strait Islander adolescent model of primary health care

      Stephen Harfield, Peter Azzopardi, Gita D Mishra and James S Ward
      Med J Aust || doi: 10.5694/mja2.52484
      Published online: 28 October 2024

      Aboriginal and Torres Strait Islander adolescents aged 10–24 years represent 30% of the Aboriginal and Torres Strait Islander population.1 As a population group, these adolescents are a strong and resilient cohort. However, the health and wellbeing of Aboriginal and Torres Strait Islander adolescents needs improvement and is generally poorer compared with non‐Indigenous adolescents.2,3 It is during this life stage that the gap in morbidity and mortality widens between Aboriginal and Torres Strait Islander adolescents and non‐Indigenous adolescents, and when a difference in mortality between genders also occurs.2,3 Injury and mental health‐related conditions are the leading cause of the increased burden of disease among Aboriginal and Torres Strait Islander adolescents.2,4 Both injury and mental health‐related conditions contribute to higher rates of health system engagement, hospitalisations, mortality and the increased health gap between Aboriginal and Torres Strait Islander adolescents and non‐Indigenous adolescents.2,4 Similarly, pregnancy‐related needs among Aboriginal and Torres Strait Islander adolescent females increase health system engagement, which requires different health system functions. Sexually transmitted infections contribute to health system engagement and excess disease burden experienced by Aboriginal and Torres Strait Islander adolescents. Additionally, as does their engagement in health risk behaviours, such as smoking, alcohol and other drug consumption, and poor diet.2,3

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      • 1 Poche Centre for Indigenous Health, University of Queensland, Brisbane, QLD
      • 2 School of Public Health, University of Queensland, Brisbane, QLD
      • 3 Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA
      • 4 The Kids Research Institute, Adelaide, SA
      • 5 Murdoch Children's Research Institute, Melbourne, VIC


      Correspondence: s.harfield@uq.edu.au
      Acknowledgements: 

      SH was supported by an Australian Government research training program scholarship, an Aboriginal and Torres Strait Islander research training program, UQ Poche Centre for Indigenous Health Research top‐up scholarships, and a Lowitja Institute higher degree research top‐up scholarship. Funders were not involved in the concept, design and writing of the article or in the decision to submit the article for publication.

      Competing interests:

      No relevant disclosures.

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        Adherence to clinical care standards and mortality after hip fracture surgery in New South Wales, 2015–2018: a retrospective population‐based study

        Lara Harvey, Morag E Taylor, Ian A Harris, Rebecca J Mitchell, Ian D Cameron, Pooria Sarrami and Jacqueline Close
        Med J Aust || doi: 10.5694/mja2.52470
        Published online: 21 October 2024

        Abstract

        Objectives: To determine whether adherence to hip fracture clinical care quality indicators influences mortality among people who undergo surgery after hip fracture in New South Wales, both overall and by individual indicator.

        Study design: Retrospective population‐based study; analysis of linked Australian and New Zealand Hip Fracture Registry (ANZHFR), hospital admissions, residential aged care, and deaths data.

        Setting, participants: People aged 50 years or older with hip fractures who underwent surgery in 21 New South Wales hospitals participating in the ANZHFR, 1 January 2015 – 31 December 2018.

        Main outcome measures: Thirty‐day (primary outcome), 120‐day, and 365‐day mortality (secondary outcomes) by clinical care indicator adherence level (low: none to three of six indicators achieved; moderate: four indicators achieved; high: five or six indicators achieved) and by individual indicator.

        Results: Registry data were available for 9236 hip fractures in 9058 people aged 50 years or older during 2015–2018; the mean age of patients was 82.8 years (standard deviation, 9.3 years), 5510 patients were women (69.4%). Complete data regarding adherence to clinical care indicators were available for 7951 fractures (86.1%); adherence to these indicators was high for 5135 (64.6%), moderate for 2249 (28.3%), and low for 567 fractures (7.1%). After adjustment for age, sex, comorbidity, admission year, pre‐admission walking ability, and residential status, 30‐day mortality risk was lower for high (adjusted relative risk [aRR], 0.40; 95% confidence interval [CI], 0.30–0.52) and moderate indicator adherence hip fractures (aRR, 0.61; 95% CI, 0.46–0.82) than for low indicator adherence hip fractures, as was 365‐day mortality (high adherence: aRR, 0.59 [95% CI, 0.51–0.68]; moderate adherence: aRR, 0.74 [95% CI, 0.63–0.86]). Orthogeriatric care (365 days: aRR, 0.78; 95% CI, 0.61–0.98) and offering mobilisation by the day after surgery (365 days: aRR, 0.74; 95% CI, 0.67–0.83) were associated with lower mortality risk at each time point.

        Conclusions: Clinical care for two‐thirds of hip fractures attained a high level of adherence to the six quality care indicators, and short and longer term mortality was lower among people who received such care than among those who received low adherence care.

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        • 1 Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW
        • 2 UNSW Sydney, Sydney, NSW
        • 3 Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
        • 4 John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and University of Sydney, Sydney, NSW
        • 5 New South Wales Institute of Trauma and Injury Management, Sydney, NSW


        Correspondence: l.harvey@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 for this population‐based linked data study will not be shared as we do not have ethics approval to do so.

        Acknowledgements: 

        This study was supported by the National Health and Medical Research Council (NHMRC; project grant GNT1164680). Lara Harvey received salary support from the same NHMRC project grant. The NHMRC had no role in the study design, data collection, analysis, interpretation, reporting, or publication. Morag Taylor receives remuneration as a data analyst for the Australian and New Zealand Hip Fracture Registry (ANZHFR; 0.2 fulltime equivalent position).

        We thank the NSW Ministry of Health, the NSW Register of Births, Deaths, and Marriages, and the Australian Institute of Health and Welfare for providing access to the administrative data, and the Centre for Health Record Linkage (CHeReL) and the Australian Institute of Health and Welfare Data Linkage Unit for the probabilistic linkage of records.

        Competing interests:

        Lara Harvey is a member of the ANZHFR Research Sub‐committee. Morag Taylor is a parttime data analyst at the ANZHFR and a member of the ANZHFR Research Sub‐committee. Ian Harris is a past and inaugural co‐chair of the ANZHFR. Rebecca Mitchell is a member of the ANZHFR Steering Group, chairs the ANZHFR Data Sub‐committee, and is a member of the ANZHFR Research Sub‐committee. Ian Cameron is a member of the ANZHFR Steering Group. Jacqueline Close is an inaugural and current co‐chair of the ANZHFR.

        • 1. Australian and New Zealand Hip Fracture Registry. Annual report 2022. Sept 2022. https://anzhfr.org/wp‐content/uploads/sites/1164/2022/08/ANZHFR‐2022‐Annual‐Report‐Full‐e‐Report‐v2.pdf (viewed July 2024).
        • 2. Dyer SM, Crotty M, Fairhall N, et al; Fragility Fracture Network (FFN) Rehabilitation Research Special Interest Group. A critical review of the long‐term disability outcomes following hip fracture. BMC Geriatr 2016; 16: 158.
        • 3. Watts JJ, Abimanyi‐Ochom J, Sanders KM. Osteoporosis costing all Australians: a new burden of disease analysis 2012 to 2022 (here: table 41). Sydney: Osteoporosis Australia, 2012. https://healthybonesaustralia.org.au/wp‐content/uploads/2022/09/burden‐of‐disease‐analysis‐2012‐2022.pdf (viewed July 2024).
        • 4. Australian Institute of Health and Welfare. The problem of osteoporotic hip fracture in Australia (Bulletin 76) (here: table A2.2). Mar 2010. https://www.aihw.gov.au/getmedia/ea96bc4d‐0b97‐4c5a‐b792‐08b343752adc/10695.pdf.aspx?inline=true (viewed July 2024).
        • 5. Stephens AS, Toson B, Close JCT. Current and future burden of incident hip fractures in New South Wales, Australia. Arch Osteoporos 2014; 9: 200.
        • 6. Harvey L, Mitchell R, Brodaty H, et al. Differing trends in fall‐related fracture and non‐fracture injuries in older people with and without dementia. Arch Gerontol Geriatr 2016; 67: 61‐67.
        • 7. Kenyon‐Smith T, Nguyen E, Oberai T, Jarsma R. Early mobilization post‐hip fracture surgery. Geriatr Orthop Surg Rehabil 2019; 10: 2151459319826431.
        • 8. Klestil T, Röder C, Stotter C, et al. Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta‐analysis. Sci Rep 2018; 8: 13933.
        • 9. Zeltzer J, Mitchell RJ, Toson B, et al. Orthogeriatric services associated with lower 30‐day mortality for older patients who undergo surgery for hip fracture. Med J Aust 2014; 201: 409‐411. https://www.mja.com.au/journal/2014/201/7/orthogeriatric‐services‐associated‐lower‐30‐day‐mortality‐older‐patients‐who
        • 10. Australian and New Zealand Hip Fracture Registry Steering Group. Australian and New Zealand guideline for hip fracture care: improving outcomes in hip fracture management of adults. Sept 2014. https://anzhfr.org/wp‐content/uploads/sites/1164/2021/12/ANZ‐Guideline‐for‐Hip‐Fracture‐Care.pdf (viewed July 2024).
        • 11. Australian Commission on Safety and Quality in Health Care. Hip fracture: clinical care standard. Sept 2016. https://www.safetyandquality.gov.au/publications‐and‐resources/resource‐library/hip‐fracture‐clinical‐care‐standard‐2016 (viewed July 2024).
        • 12. Farrow L, Hall A, Wood AD, et al. Quality of care in hip fracture patients: the relationship between adherence to national standards and improved outcomes. J Bone Joint Surg Am 2018; 100: 751‐757.
        • 13. Griffin XL, Achten J, Parsons N, Costa ML. Does performance‐based remuneration improve outcomes in the treatment of hip fracture? Bone Joint J 2021; 103‐B: 881‐887.
        • 14. Patel R, Judge A, Johansen A, et al. Multiple hospital organisational factors are associated with adverse patient outcomes post‐hip fracture in England and Wales: the REDUCE record‐linkage cohort study. Age Ageing 2022; 51: afac183.
        • 15. Kjærvik C, Stensland E, Byhring HS, et al. Hip fracture treatment in Norway: deviation from evidence‐based treatment guidelines: data from the Norwegian Hip Fracture Register, 2014 to 2018. Bone Jt Open 2020; 1: 644‐653.
        • 16. Harvey LA, Harris IA, Mitchell R, et al. Improved survival rates after hip fracture surgery in New South Wales, 2011–2018. Med J Aust 2022; 216: 420‐421. https://www.mja.com.au/journal/2022/216/8/improved‐survival‐rates‐after‐hip‐fracture‐surgery‐new‐south‐wales‐2011‐2018
        • 17. von Elm E, Altman DG, Egger M, et al; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61: 344‐349.
        • 18. Toson B, Harvey LA, Close JC. The ICD‐10 Charlson Comorbidity Index predicted mortality but not resource utilization following hip fracture. J Clin Epidemiol 2015; 68: 44‐51.
        • 19. Australian Commission on Safety and Quality in Health Care. Hip fracture: clinical care standard. Sept 2023. https://www.safetyandquality.gov.au/publications‐and‐resources/resource‐library/hip‐fracture‐clinical‐care‐standard‐2023 (viewed July 2024).
        • 20. Aqil A, Hossain F, Sheikh H, et al. Achieving hip fracture surgery within 36 hours: an investigation of risk factors to surgical delay and recommendations for practice. J Orthop Traumatol 2016; 17: 207‐213.
        • 21. Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta‐analysis. J Orthop Trauma 2014; 28: e49‐e55.
        • 22. Aprisunadi, Nursalam N, Mustikasari M, et al. Effect of early mobilization on hip and lower extremity postoperative: a literature review. SAGE Open Nurs 2023; 9: 23779608231167825.
        • 23. Sheehan KJ, Goubar A, Almilaji O, et al. Discharge after hip fracture surgery by mobilisation timing: secondary analysis of the UK National Hip Fracture Database. Age Ageing 2021; 50: 415‐422.
        • 24. Lyles KW, Colón‐Emeric CS, Magaziner JS, et al; HORIZON Recurrent Fracture Trial. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 2007; 357: 1799‐1809.
        • 25. Yu SF, Cheng JS, Chen YC, et al. Adherence to anti‐osteoporosis medication associated with lower mortality following hip fracture in older adults: a nationwide propensity score‐matched cohort study. BMC Geriatr 2019; 19: 290.
        • 26. Griffiths F, Mason V, Boardman F, et al. Evaluating recovery following hip fracture: a qualitative interview study of what is important to patients. BMJ Open 2015; 5: e005406.
        • 27. Amarilla‐Donoso FJ, López‐Espuela F, Roncero‐Martín R, et al. Quality of life in elderly people after a hip fracture: a prospective study. Health Qual Life Outcomes 2020; 18: 71.
        • 28. Griffin XL, Parsons N, Achten J,et al. Recovery of health‐related quality of life in a United Kingdom hip fracture population. The Warwick Hip Trauma Evaluation: a prospective cohort study. Bone Joint J 2015; 97‐B: 372‐382.

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          Changes in the incidence of type 2 diabetes in Australia, 2005–2019, overall and by socio‐demographic characteristics: a population‐based study

          Dianna J Magliano, Lei Chen, Jedidiah I Morton, Oyunchimeg Buyadaa, Agus Salim and Jonathan E Shaw
          Med J Aust || doi: 10.5694/mja2.52461
          Published online: 21 October 2024

          Abstract

          Objectives: To estimate changes in the incidence of clinically diagnosed type 2 diabetes in Australia, overall and by age, sex, socio‐economic disadvantage, geographic remoteness, and country of birth.

          Study design: Population‐based study; analysis of National Diabetes Services Scheme (NDSS) data (age–period–cohort models).

          Setting, participants: Data were extracted for incident cases of type 2 diabetes, 1 January 2005 to 31 December 2019, in residents of the Australian Capital Territory, New South Wales, Queensland, and Victoria aged 20 years or older registered with the NDSS. The numbers of people at risk were obtained from the Australian Bureau of Statistics.

          Main outcome measures: Changes in the incidence of type 2 diabetes, 2005–2019, by age, postcode‐level socio‐economic disadvantage (Index of Relative Socioeconomic Disadvantage) and remoteness (major city, inner regional, outer regional/remote/very remote), and country of birth, stratified by sex.

          Results: During 2005–2019, 741 535 people aged 20 years or older with incident type 2 diabetes were registered with the NDSS; 421 190 were men (56.8%). Overall, the incidence of type 2 diabetes increased with age (until about age 70 years) and socio‐economic disadvantage for both sexes; it was higher in inner regional areas than in major cities or outer regional/remote/very remote areas during 2005–2015, but highest among people in major cities after 2015. The age‐standardised incidence of type 2 diabetes increased during 2005–2010, both among men (annual percentage change [APC], 4.4%; 95% confidence interval [CI], 3.6–5.2%) and women (APC, 2.9%; 95% CI, 2.2–3.7%); it declined during 2010–2019 among both men (APC, –5.2%; 95% CI, –5.4% to –4.9%) and women (APC, –6.5%; 95% CI, –6.8% to –6.2%). In general, similar patterns (but of differing magnitude) applied to all age, sex, socio‐economic disadvantage, and remoteness groups. However, the incidence of type 2 diabetes increased during 2011–2019 among people born in Asia, North Africa and the Middle East, and the Pacific Islands.

          Conclusions: The incidence of type 2 diabetes in Australian adults declined during 2010–2019 across all age, sex, socio‐economic disadvantage, and remoteness groups, but increased among people from Asia, North Africa and the Middle East, and the Pacific Islands.

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          • 1 Baker Heart and Diabetes Institute, Melbourne, VIC
          • 2 Monash University, Melbourne, VIC
          • 3 Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
          • 4 Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, VIC



          Open access:

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


          Data Sharing:

          Aggregated NDSS data may be made available upon reasonable request to the corresponding author. Limitations on use of the data may apply, subject to approval from the data custodians.

          Acknowledgements: 

          We analysed data from the National Diabetes Services Scheme (NDSS), an initiative of the Australian government administered by Diabetes Australia. Dianna J Magliano (APP2016668) and Jonathan E Shaw (APP1173952) are supported by National Health and Medical Research Council Investigator Grants. The study was partially supported by a Diabetes Australia Research Program grant and the Operational Infrastructure Support Program of the Victorian government, which had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

          Competing interests:

          Jonathan E Shaw has received consultancy fees from AstraZeneca, Sanofi, Novo Nordisk, Eli Lilly, Mylan, Pfizer, Roche, and Abbott. He has also received payments and honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, and educational events from AstraZeneca, Mylan, Boehringer Ingelheim, Roche, Zuellig, and Eli Lilly.

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            A community within social and ecological communities: a new philosophical foundation for a just residential aged care sector

            Lachlan Green, Bridget Pratt and David Kirchhoffer
            Med J Aust || doi: 10.5694/mja2.52472
            Published online: 14 October 2024

            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.

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            • 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.
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            • 9. Behrens K. Exploring African holism with respect to the environment. Environ Values 2010; 19: 465‐484.
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            • 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: 13 December 2025

              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.

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              • 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).
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              • 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.
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              • 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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                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

                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



                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.

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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

                  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



                  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.

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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

                    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.

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                      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

                      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.

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