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    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

    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.
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    • 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.
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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

      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: 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.

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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

        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.
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        • 9. Chen X, Zhou Q, Liu J, et al. Autoimmune manifestations of visceral leishmaniasis in Chinese patients. Ann Palliat Med 2021; 10: 12699‐12705.
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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

          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



          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.
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          • 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).
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          • 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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            Developing the green operating room: exploring barriers and opportunities to reducing operating room waste

            Ludmilla Pillay, Kenneth D Winkel and Timothy Kariotis
            Med J Aust || doi: 10.5694/mja2.52394
            Published online: 19 August 2024

            Summary

            • The Australian health care system contributes 7% of the national greenhouse gas emission footprint and generates massive waste streams annually. Operating rooms are a particular hotspot, generating at least 20% of the total hospital waste.
            • A systematic search of several global academic databases was conducted in mid‐2022 (articles from 1992 to 2022) for peer‐reviewed research relevant to waste management in the operating rooms. We then used thematic analysis to enumerate and characterise the strategies and barriers to sustainable waste management in the operating room.
            • The waste reduction strategies focused on avoidance of high carbon products; correct waste segregation and reduced overage; reusing, reprocessing, and repurposing devices; and improved recycling. The first barrier identified was a constrained interpretation of the concept of “first do not harm”, ingrained in surgeons’ practices, in prioritising single‐use surgical products. The second barrier was ineffective or insufficient waste education. The third barrier was the immediate cost of implementing waste management compared with the long term realisation of environmental and economic benefits. The last barrier to implementing institutional practice change was the lack of policies and regulations at the local hospital, federal and international levels.
            • We also evaluated the knowledge gaps in current surgical waste research, including lack of benchmarking data and standardised regulations concerning reusable or reprocessed devices, as well as the methods used to promote pro‐sustainability behavioural change.

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            • 1 University of Melbourne, Melbourne, VIC
            • 2 Centre for Health Policy, University of Melbourne, Melbourne, VIC



            Open access:

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

            Acknowledgements: 

            We would like to acknowledge Forbes McGain (Western Health, Melbourne) for his invaluable knowledge and support on this research.

            Competing interests:

            No relevant disclosures.

            • 1. Foran P. Education report. ACORN: The Journal of Perioperative Nursing in Australia. 2015; 28: 28‐30.
            • 2. Australian Institute of Health and Welfare. Hospital resources 2015–16: Australian hospital statistics. 2017. https://www.aihw.gov.au/reports/hospitals/ahs‐2015‐16‐hospital‐resources/summary (viewed Aug 2022).
            • 3. World Health Organization. Climate change. 2023. https://www.who.int/news‐room/fact‐sheets/detail/climate‐change‐and‐health (viewed Aug 2023).
            • 4. Lee BK, Ellenbecker MJ, Moure‐Eraso R. Analyses of the recycling potential of medical plastic wastes. Waste Manag 2002; 22: 461‐470.
            • 5. Lee RJ, Mears SC. Greening of orthopedic surgery. Orthopedics 2012; 35: e940‐944.
            • 6. Cuncannon A, Dosani A, Fast O. Sterile processing in low‐ and middle‐income countries: an integrative review. J Infect Prev 2021; 22: 28‐38.
            • 7. Wyssusek KH, Keys MT, van Zundert AAJ. Operating room greening initiatives ‐ the old, the new, and the way forward: a narrative review. Waste Manag Res 2019; 37: 3‐19.
            • 8. Rizan C, Bhutta MF, Reed M, Lillywhite R. The carbon footprint of waste streams in a UK hospital. J Clean Prod 2021; 286: 125446.
            • 9. World Health Organization. Health‐care waste. 2018. https://www.who.int/news‐room/fact‐sheets/detail/health‐care‐waste (viewed Sept 2022).
            • 10. Waste and climate change. Secretariat of the Pacific Regional Environment Programme. 2009. https://www.sprep.org/climate_change/PYCC/documents/ccwaste.pdf (viewed May 2024).
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              Priorities for planetary health equity in Australia

              Sharon Friel, Katherine Trebeck, Nicholas Frank, Sandro Demaio, Megan Arthur, Chelsea Hunnisett and Francis Nona
              Med J Aust || doi: 10.5694/mja2.52397
              Published online: 19 August 2024

              Much evidence exists showing the very real threats to human survival, premature deaths and poor health outcomes from the nexus between the impacts of climate change and economic and social inequities.1,2 Given this crisis of planetary health equity — defined here as the equitable enjoyment of good health in a stable Earth system — preventive action is needed to address the common underlying drivers of climate change and health inequities. These drivers are located within the consumptogenic system, which is the web of institutions, actors, policies, commercial activities and norms that encourages and rewards the exploitation of natural resources, production of fossil fuels, and hyperconsumerism of fossil fuel‐reliant goods and services, which results in environmental degradation, climate change, and social and health inequities.2 In this perspective article, we relay the urgency — identified by researchers, senior bureaucrats, politicians, former business leaders and civil society groups in a Planetary Health Equity Hothouse Policy Symposium3 — for transforming the consumptogenic system, with a focus on economic models, policy coherence, and advocacy. We highlight the opportunities for the health sector to provide leadership in these issues.

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              • 1 Planetary Health Equity Hothouse, Australian National University, Canberra, ACT
              • 2 Edinburgh Futures Institute, University of Edinburgh, Edinburgh, UK
              • 3 Victorian Health Promotion Foundation (VicHealth), Melbourne, VIC
              • 4 University of Melbourne, Melbourne, VIC
              • 5 Climate and Health Alliance, Melbourne, VIC
              • 6 Carumba Institute, Queensland University of Technology, Brisbane, QLD


              Correspondence: sharon.friel@anu.edu.au


              Open access:

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

              Acknowledgements: 

              Sharon Friel receives funding through an Australian Research Council Laureate Fellowship.

              Competing interests:

              No relevant disclosures.

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                Overcoming disparities in hepatocellular carcinoma outcomes in First Nations Australians: a strategic plan for action

                Jessica Howell, Troy Combo, Paula Binks, Kylie Bragg, Sarah Bukulatjpi, Kirsty Campbell, Paul J Clark, Melissa Carroll, Jane Davies, Teresa de Santis, Kate R Muller, Bella Nguyen, John K Olynyk, Nicholas Shackel, Patricia C Valery, Alan J Wigg, Jacob George and Stuart K Roberts
                Med J Aust || doi: 10.5694/mja2.52395
                Published online: 12 August 2024

                Every year, about 1800 Australians die of hepatocellular carcinoma (HCC), the most common type of primary liver cancer.1

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                • 1 St Vincent's Hospital, Melbourne, VIC
                • 2 Burnet Institute, Melbourne, VIC
                • 3 University of Melbourne, Melbourne, VIC
                • 4 Monash University, Melbourne, VIC
                • 5 Charles Darwin University, Darwin, NT
                • 6 Southern Adelaide Local Health Network, Adelaide, SA
                • 7 Miwatj Health Aboriginal Corporation, Nhulunbuy, NT
                • 8 Royal Darwin and Palmerston Hospitals, Darwin, NT
                • 9 University of Queensland, Brisbane, QLD
                • 10 Princess Alexandra Hospital, Brisbane, QLD
                • 11 John Hunter Hospital, Newcastle, NSW
                • 12 Flinders University, Adelaide, SA
                • 13 Fiona Stanley Fremantle Hospital Group, Perth, WA
                • 14 Curtin University, Perth, WA
                • 15 Edith Cowan University, Perth, WA
                • 16 Launceston General Hospital, Launceston, TAS
                • 17 QIMR Berghofer Medical Research Institute, Brisbane, QLD
                • 18 Storr Liver Centre, Westmead Millenium Institute, Sydney, NSW
                • 19 Westmead Hospital, Sydney, NSW
                • 20 University of Sydney, Sydney, NSW
                • 21 Alfred Hospital, Melbourne, VIC


                Correspondence: jess.howell@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: 

                Jessica Howell's salary is supported by an NHMRC Investigator Fellowship, NHMRC Program grant, Burnet Institute Program grant and University of Melbourne strategic grant. We gratefully acknowledge First Nations Australians as the original custodians of this land, who have generously shared their wisdom and stories that led to and informed this work.

                Competing interests:

                Jessica Howell has received speaker fees and participated in advisory boards for Eisai, Astra Zeneca, Roche and Gilead; and received competitive grant funds from Gilead Sciences and Eisai. Troy Combo has participated in an advisory board for Astra‐Zeneca. Paula Binks has participated in advisory boards for Eisai and Astra‐Zeneca. Kylie Bragg has participated in an advisory board for Astra‐Zeneca. Kate Muller has participated in an advisory board for Astra‐Zeneca. Alan Wigg has participated in advisory boards for Eisai. Jacob George has participated in advisory boards and received honoraria for talks from Novo Nordisk, Astra‐Zeneca, Roche, BMS, Pfizer, Cincera, Pharmaxis, Boehringer Mannheim. Stuart Roberts has participated in advisory boards for Eisai, Astra‐Zeneca and Roche.

                • 1. Australian Institute of Health and Welfare. Liver cancer statistics. 2018. https://www.canceraustralia.gov.au/cancer‐types/liver‐cancer/statistics (viewed Mar 2024).
                • 2. Wigg AJ, Narayana SK, Hartel G, et al. Hepatocellular carcinoma amongst Aboriginal and Torres Strait Islander peoples of Australia. EClinicalMedicine 2021; 36: 100919.
                • 3. Australian Institute of Health and Welfare. Determinants of health for Indigenous Australians. Jul 2022. https://www.aihw.gov.au/reports/australias‐health/social‐determinants‐and‐indigenous‐health (viewed Mar 2024).
                • 4. Lubel JS, Roberts SK, Strasser SI, et al. Australian recommendations for the management of hepatocellular carcinoma: a consensus statement. Med J Aust 2020; 214: 475‐483. https://www.mja.com.au/journal/2021/214/10/australian‐recommendations‐management‐hepatocellular‐carcinoma‐consensus
                • 5. Howell J, Ward JS, Davies J, et al. Hepatocellular carcinoma in Indigenous Australians: a call to action. Med J Aust 2021; 214: 201‐202. https://www.mja.com.au/journal/2021/214/5/hepatocellular‐carcinoma‐indigenous‐australians‐call‐action
                • 6. Howell J, Pedrana A, Cowie BC, et al. Aiming for the elimination of viral hepatitis in Australia, New Zealand, and the Pacific Islands and Territories: where are we now and barriers to meeting World Health Organization targets by 2030. J Gastroenterol Hepatol 2019; 34: 40‐48.
                • 7. Hong TP, Gow P, Fink M, et al. Novel population‐based study finding higher than reported hepatocellular carcinoma incidence suggests an updated approach is needed. Hepatology 2016; 63: 1205‐1212.
                • 8. Flores JE, Hong T, Thompson AJ, et al. Metabolic‐associated fatty liver disease and alcohol‐related liver disease are leading causes of hepatocellular carcinoma: interim analysis of the HOMER‐2 study. J Gastroenterol Hepatol 2022; 37: 56.
                • 9. Littlejohn M, Davies J, Yuen L, et al. Molecular virology of hepatitis B virus, sub‐genotype C4 in northern Australian Indigenous populations. J Med Virol 2014; 86: 695‐706.
                • 10. Davies J, Li SQ, Tong SY, et al. Establishing contemporary trends in hepatitis B sero‐epidemiology in an Indigenous population. PLoS One 2017; 12: e0184082.
                • 11. Davies J, Bukulatjpi S, Sharma S, et al. Development of a culturally appropriate bilingual electronic app about hepatitis B for Indigenous Australians: towards shared understandings. JMIR Res Protoc 2015; 4: e70.
                • 12. Hosking K, De Santis T, Vintour‐Cesar E, et al. “The most culturally safe training I've ever had”: the co‐design of a culturally safe Managing hepatitis B training course with and for the Aboriginal health workforce of the Northern Territory of Australia. BMC Health Serv Res 2023; 23: 935.
                • 13. Clark PJ, Stuart KA, Leggett BA, et al. Remoteness, race and social disadvantage: disparities in hepatocellular carcinoma incidence and survival in Queensland, Australia. Liver Int. 2015; 35: 2584‐2594.
                • 14. Australian Government. National agreement on closing the gap. Closing the gap in partnership, July 2020. https://www.closingthegap.gov.au/sites/default/files/files/national‐agreement‐ctg.pdf (viewed July 2024).
                • 15. National Aboriginal Community Controlled Health Organisation and The Royal Australian College of General Practitioners. National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. 3rd ed. East Melbourne: RACGP, 2018.
                • 16. Hla TK, Bukulatjpi SM, Binks P, et al. A “one stop liver shop” approach improves the cascade‐of‐care for Aboriginal and Torres Strait Islander Australians living with chronic hepatitis B in the Northern Territory of Australia: results of a novel care delivery model. Int J Equity Health 2020; 19: 64.
                • 17. Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander health survey. Dec 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 Mar 2024).
                • 18. Howell J, Pedrana A, Schroeder SE, et al. A global investment framework for the elimination of hepatitis B. J Hepatol 2021; 74: 535‐549.
                • 19. Lubel JS, Strasser SI, Thompson AJ, et al. Australian consensus recommendations for the management of hepatitis B. Med J Aust 2022; 216: 478‐486. https://www.mja.com.au/journal/2022/216/9/australian‐consensus‐recommendations‐management‐hepatitis‐b
                • 20. Pedrana A, Howell J, Scott N, et al. Global hepatitis C elimination: an investment framework. Lancet Gastroenterol Hepatol 2020; 5: 927‐939.
                • 21. Cooke GS, Andrieux‐Meyer I, Applegate TL, et al. Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol Hepatol 2019; 4: 135‐184.
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                • 24. Cancer Council Australia. Clinical practice guidelines for hepatocellular carcinoma surveillance for people at high risk in Australia. 2023 [website]. https://www.cancer.org.au/clinical‐guidelines/liver‐cancer/hepatocellular‐carcinoma (viewed Mar 2024).
                • 25. Best J, Bechmann LP, Sowa JP, et al. GALAD score detects early hepatocellular carcinoma in an international cohort of patients with nonalcoholic steatohepatitis. Clin Gastroenterol Hepatol 2020; 18: 728‐735.
                • 26. Bernardes CM, Martin J, Cole P, et al. Lessons learned from a pilot study of an Indigenous patient navigator intervention in Queensland, Australia. Eur J Cancer Care (Engl) 2018; 27. https://doi.org/10.1111/ecc.12714.
                • 27. Australia and New Zealand liver and intestinal transplant registry. 34th Annual report ANZLITR, report on liver and intestinal transplantation activity to 31/12/2022. https://www.anzlitr.org/wp‐content/uploads/2024/04/ANZLITR_34th_Annual.pdf (viewed July 2024).
                • 28. Sabesan S, Poxton M. Health equity in clinical trials for regional, rural and First nations communities: need for networked clinical trial system, through a values and purpose‐aligned system culture. Aust J Rural Health 2024; 32: 588‐591.
                • 29. Panozzo S, Bryan T, Mason T, et al. Bridging cultures in palliative care: a qualitative study of the care of Indigenous Australians with advanced illness. Palliat Med 2023; 37: 498‐507.
                • 30. Morris BA, Anderson K, Cunningham J, Garvey G. Identifying research priorities to improve cancer control for Indigenous Australians. Public Health Res Pract 2017; 27: 2741735.
                • 31. D'Aprano A, Lloyd‐Johnson C, Cameron D, et al. Trusting relationships and learning together: a rapid review of Indigenous reference groups in Australian Indigenous health research. Aust N Z J Public Health 2023; 47: 100051.

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                  Notification rates for syphilis in women of reproductive age and congenital syphilis in Australia, 2011–2021: a retrospective cohort analysis of national notifications data

                  Belinda Hengel, Hamish McManus, Robert Monaghan, Donna B Mak, Amy Bright, Ximena Tolosa, Kellie Mitchell, Lorraine Anderson, Jackie R Thomas, Nathan Ryder, Louise Causer, Rebecca J Guy and Skye McGregor
                  Med J Aust || doi: 10.5694/mja2.52388
                  Published online: 29 July 2024

                  Abstract

                  Objectives: To estimate notification rates for infectious syphilis in women of reproductive age and congenital syphilis in Australia.

                  Study design: Retrospective cohort study; analysis of national infectious syphilis and enhanced congenital syphilis surveillance data.

                  Setting, participants: Women aged 15–44 years diagnosed with infectious syphilis, and babies with congenital syphilis, Australia, 2011–2021.

                  Main outcome measures: Numbers and rates of infectious syphilis notifications, by Indigenous status and age group; numbers and rates of congenital syphilis, by Indigenous status of the infant; antenatal care history for mothers of infants born with congenital syphilis.

                  Results: During 2011–2021, 5011 cases of infectious syphilis in women aged 15–44 years were notified. The notification rate for Aboriginal and Torres Strait Islander women rose from 56 (95% confidence interval [CI], 45–65) cases per 100 000 in 2011 to 227 (95% CI, 206–248) cases per 100 000 population in 2021; for non‐Indigenous women, it rose from 1.1 (95% CI, 0.8–1.4) to 9.2 (95% CI, 8.4–10.1) cases per 100 000 population. The notification rate was higher for Aboriginal and Torres Strait Islander women than for non‐Indigenous women (incidence rate ratio [IRR], 23.1; 95% CI, 19.7–27.1), lower for 15–24‐ (IRR, 0.7; 95% CI, 0.6–0.9) and 35–44‐year‐old women (IRR, 0.6; 95% CI, 0.5–0.7) than for 25–34‐year‐old women, and higher in remote regions than in major cities (IRR, 2.7; 95% CI, 2.2–3.8). During 2011–2021, 74 cases of congenital syphilis were notified, the annual number increasing from six in 2011 to a peak of 17 in 2020; the rate was consistently higher among Aboriginal and Torres Strait Islander infants than among non‐Indigenous infants (2021: 38.3 v 2.1 per 100 000 live births). The mothers of 32 infants with congenital syphilis (43%) had not received antenatal care.

                  Conclusions: The number of infectious syphilis notifications for women of reproductive age increased in Australia during 2011–2021, as did the number of cases of congenital syphilis. To avert congenital syphilis, antenatal screening of pregnant women, followed by prompt treatment for infectious syphilis when diagnosed, needs to be improved.

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                  • 1 The Kirby Institute, Sydney, NSW
                  • 2 University of Notre Dame Australia, Fremantle, WA
                  • 3 Communicable Disease Control Directorate, Western Australia Department of Health, Perth, WA
                  • 4 Office of Health Protection, Australian Department of Health, Canberra, ACT
                  • 5 Public Health Intelligence Branch, Queensland Department of Health, Brisbane, QLD
                  • 6 Kimberley Aboriginal Medical Services Council Inc, Broome, WA
                  • 7 Sexual Health Pacific Clinic, Hunter New England, Newcastle, NSW


                  Correspondence: bhengel@kirby.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:

                  Applications for access to the data we analysed for this study should be directed to the Australian Department of Health and Aged Care.

                  Acknowledgements: 

                  We acknowledge the contribution and valuable insights of the Kirby Institute Aboriginal and Torres Strait Islander Reference Group, and State and Territory Health Department surveillance officers.

                  Competing interests:

                  No relevant disclosures.

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                    Group A streptococcal colitis: an under‐recognised entity?

                    Samuel W L‐W Baumgart, Suzanne English, Tony Sebastian, Sarika Suresh and Timothy J Gray
                    Med J Aust || doi: 10.5694/mja2.52382
                    Published online: 29 July 2024

                    In August 2023, an otherwise healthy 54‐year‐old woman presented to hospital with acute onset fevers and sweats, followed by four days of nausea, vomiting, generalised severe abdominal pain and diarrhoea. The diarrhoea was non‐bloody, with more than ten bowel motions per day. The patient worked as a support worker for older people, and denied previous diarrhoeal illness, sick contacts, consumption of undercooked food, and recent travel.

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                    • Concord Repatriation General Hospital, Sydney, NSW



                    Patient consent:

                    The patient provided written consent for publication.

                    Acknowledgements: 

                    We thank the Microbial Genomics Laboratory, NSW Health Pathology – Institute of Clinical Pathology and Medical Research, for genomic analysis of the isolate.

                    Competing interests:

                    No relevant disclosures.

                    • 1. Breiman RF, Davis JP, Facklam RR, et al. Defining the group a streptococcal toxic shock syndrome, rationale and consensus definition. JAMA 1993; 269: 390‐391.
                    • 2. Brouwer S, Rivera‐Hernandez T, Curren BF, et al. Pathogenesis, epidemiology and control of group A Streptococcus infection. Nat Rev Microbiol 2023; 21: 431‐447.
                    • 3. Birrel JM, Boyd R, Currie BJ, et al. Socio‐environmental and clinical features of invasive group A streptococcal disease in the Northern Territory of Australia. Commun Dis Intell (2018) 2023; 47; https://doi.org/10.33321/cdi.2023.47.39.
                    • 4. Department of Health and Aged Care. Group A streptococcal disease – invasive (iGAS). https://www.health.gov.au/diseases/group‐a‐streptococcal‐disease‐invasive‐igas (viewed Aug 2023).
                    • 5. Maraj B, Huang A, Patel S. Acute colitis in a patient with Streptococcus pyogenes bacteraemia. Am J Med 2018; 131: e13‐e14.
                    • 6. Isozaki A, Matsubara K, Yui T, et al. Group A B‐haemolytic streptococcal hemorrhagic colitis complicated with pharyngitis and impetigo. J Infect Chemother 2007; 13: 411‐413.
                    • 7. Arthur C, Linam LE, Linam WM. Group A beta‐haemolytic streptococcal colitis with secondary bacteraemia. Pediatr Infect Dis J 2012; 31: 1093‐1095.
                    • 8. Ronnachit A, Ellenberger KA, Gray TJ, et al. Streptococcus pneumoniae causing intra‐abdominal and pelvic infection: a case series. Cureus 2017; 9: e1967.
                    • 9. Davis MR, Keller N, Brouwer S, et al. Detection of Streptococcus pyogenes M1UK in Australia and characterization of the mutation driving enhanced expression of superantigen SpeA. Nat Commun 2023; 14: 1051.
                    • 10. Tewodros W & Kronvall G. M Protein gene (emm type) analysis of group A beta‐hemolytic streptococci from Ethiopia reveals unique patterns. J Clin Microbiol 2005; 43: 4369‐4376.
                    • 11. Sakota V, Fry A, Lietman T, et al. Genetically diverse group A streptococci from children in far‐western Nepal share high genetic relatedness with isolates from other countries. J Clin Microbiol 2006; 44: 2160‐2166.

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                      National pharmacovigilance of seasonal influenza vaccines in Australia

                      Megan O'Moore, Belinda Jones, Megan Hickie, Catherine Glover, Lucy Deng, Yuanfei Huang, Michael Dymock, Evelyn Tay, Julie A Marsh and Nicholas Wood
                      Med J Aust || doi: 10.5694/mja2.52381
                      Published online: 29 July 2024

                      The early detection of adverse events following immunisation (AEFI) is essential to protect public health and to maintain confidence in vaccination. Vaccine pharmacovigilance — the monitoring, detection, investigation and actioning of vaccine safety signals — occurs across a collaborative landscape that includes the Therapeutic Goods Administration (TGA), the nationally funded surveillance initiative AusVaxSafety, and state and territory health departments.

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                      • 1 Therapeutic Goods Administration, Canberra, ACT
                      • 2 National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW
                      • 3 Telethon Kids Institute, Perth Children's Hospital, Perth, WA
                      • 4 Wesfarmers Centre of Vaccine and Infectious Diseases, Telethon Kids Institute, Perth, WA
                      • 5 University of Sydney, Sydney, NSW
                      • 6 Children's Hospital at Westmead, Sydney, NSW


                      Correspondence: megan.omoore@health.gov.au
                      Acknowledgements: 

                      AusVaxSafety surveillance is funded under a contract with the Australian Department of Health and Aged Care. The authors acknowledge the participants and staff at the surveillance sites, state and territory health departments, and Telethon Kids Institute, and the contribution of the surveillance tools SmartVax, Vaxtracker, and Microsoft COVID Vaccine Management System. The authors also wish to thank the Therapeutic Goods Administration staff of the Vaccines Surveillance Section, Adverse Event and Medicine Defects Section, and Technical and Safety Improvement Section, who support the safety surveillance of influenza vaccines.

                      Competing interests:

                      No relevant disclosures.

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