OBJECTIVES: To investigate the birth prevalence, clinical manifestations, and management of congenital cytomegalovirus (CMV) infections in Australia, 1999-2023. STUDY DESIGN: Longitudinal observational study; analysis of...OBJECTIVES: To investigate the birth prevalence, clinical manifestations, and management of congenital cytomegalovirus (CMV) infections in Australia, 1999-2023. STUDY DESIGN: Longitudinal observational study; analysis of prospectively collected Australian Paediatric Surveillance Unit (APSU) data. SETTING, PARTICIPANTS: Australia, 1 January 1999 - 1 January 2024. MAJOR OUTCOME MEASURES: Number of definite congenital CMV infections during study period and after the establishment of universal neonatal hearing screening (1 January 2004); clinical sequelae of definite infections; proportion of infants with symptomatic definite infections treated with antiviral medications. RESULTS: During 1 January 1999 - 1 January 2024, 586 cases of congenital CMV infection were reported to the APSU (8.15 [95% confidence interval, 7.50-8.83] infections per 100 000 births), including 479 definite infections (82%). The most frequent sequelae of definite infections were small for gestational age or intrauterine growth restriction (135 infants, 28.2%); neurological conditions (most frequently: deafness [183, 38.2%], microcephaly [89, 18.6%]); liver disease with jaundice (130, 27.1%), hepatomegaly (75, 15.7%), or hepatitis (85, 14.7%); and bone marrow conditions (most frequently: thrombocytopaenia [139, 29.0%], petechiae/purpura [89, 18.6%]). Of 168 Guthrie card tests (newborn blood spot screening), 154 (91.7%) were CMV-positive (polymerase chain reaction DNA detection), including 143 that provided the sole reason for classifying the cases as definite congenital CMV infections. During 1 January 2004 - 1 January 2024, 447 of 506 cases (88.3%) were definite congenital CMV infections, of which 366 (81.9%) were symptomatic; 116 of these infants (32%) were treated with antiviral medications. CONCLUSIONS: The number of reported definite congenital CMV infections during 1 January 1999 - 1 January 2024 was only 1.0% of the number expected in Australia on the basis of their estimated prevalence in developed countries. The number of reported cases has continuously increased since 1999, as has the use of antiviral therapy. Surveillance of congenital CMV infections, the major infectious cause of congenital malformations, needs to be expanded to fully assess their prevalence and the associated disease burden, and to inform prevention strategies.
Anxiety disorders are the most prevalent mental illness in Australia and are more common in women relative to men, as well as transgender and gender diverse people relative to cisgender people. Sex and gender differences...Anxiety disorders are the most prevalent mental illness in Australia and are more common in women relative to men, as well as transgender and gender diverse people relative to cisgender people. Sex and gender differences in anxiety prevalence are likely driven by a combination of factors including differential exposure to different types of stressors and trauma, gendered enculturation of different coping responses and perceived stigma of mental illness, differences in medical comorbidities, and differences in symptom presentations. The established impact of gonadal hormone changes on anxiety risk and symptom presentation across the female lifespan underscore the need for sex- and gender-responsive management of anxiety disorders. Better integration of sex and gender considerations in health and medical research, in Australian clinical practice guidelines, and in health and medical education curricula, is needed to improve the quality of care for all people with anxiety disorders.
OBJECTIVE: This scoping review explores existing clinical guidelines on administration of benzathine benzylpenicillin (Bicillin L-A, Pfizer Australia) in Australia and Aotearoa New Zealand. The objective is to understand...OBJECTIVE: This scoping review explores existing clinical guidelines on administration of benzathine benzylpenicillin (Bicillin L-A, Pfizer Australia) in Australia and Aotearoa New Zealand. The objective is to understand existing delivery guidance to address variation in care and cultural safety considerations, to support messaging during periods of stockout and to inform planning for new administration techniques. DATA SOURCES: Semi-structured Google search to identify publicly available clinical resources for each jurisdiction of Australia and for New Zealand. The search was conducted from October to December 2023. DESIGN: Government reports and publicly available clinical guidelines were included. This scoping review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). RESULTS: This guideline review demonstrates that guidance on administration of Bicillin L-A in Australia and New Zealand has strong, consistent, biomedical recommendations but underdeveloped cultural considerations. Across the features of culturally safe practice, existing clinical guidelines provide consistent information on biomedical knowledge and skills, less information about practising culturally safe behaviours and relatively little guidance on addressing power differentials. CONCLUSIONS: Cultural safety inclusions should be considered for future administration guidance development.
OBJECTIVE: To determine the cumulative incidence of overall and cause-specific mortality among Queensland residents admitted to hospital with cirrhosis during 2007-22, by cirrhosis aetiology. STUDY DESIGN: Retrospective...OBJECTIVE: To determine the cumulative incidence of overall and cause-specific mortality among Queensland residents admitted to hospital with cirrhosis during 2007-22, by cirrhosis aetiology. STUDY DESIGN: Retrospective cohort study; analysis of linked Queensland Hospital Admitted Patient Data Collection and Queensland Registry of Births, Deaths and Marriages data. SETTING, PARTICIPANTS: Adult Queensland residents (18 years or older) admitted to Queensland hospitals with cirrhosis during 1 July 2007 - 31 December 2022. MAIN OUTCOME MEASURES: Ten-year mortality, all-cause and cause-specific (liver-related, extrahepatic cancer, cardiovascular disease), by cirrhosis aetiology. RESULTS: A total of 22 525 people were followed for a median of 6.9 years (interquartile range, 3.5-11.1 years). Their mean age at the index admission with cirrhosis was 61.2 years (standard deviation, 13.0 years), 14 895 were men (66.1%), and the most frequent causes of cirrhosis were alcohol use (9550 people, 42.4%), metabolic dysfunction-associated steatotic liver disease (MASLD; 5108 people, 22.7%), and chronic hepatitis C virus (HCV) infection (4780 people, 21.2%). A total of 12 387 people (55.0%) had died by 31 December 2022; overall mortality among people with alcohol-related cirrhosis was 57.9%, with MASLD cirrhosis 52.1%, and with HCV-related cirrhosis 51.6%. The proportions of deaths attributed to liver disease were larger for people who experienced decompensation during follow-up than those who did not (alcohol-related cirrhosis: 2538 of 3890 deaths [65.2%] v 523 of 1637 [31.9%]; HCV-related cirrhosis: 1158 of 1714 deaths [67.6%] v 331 of 753 [44.0%]). Ten-year liver-related mortality was highest among people with alcohol-related cirrhosis (48.8%; 95% confidence interval [CI], 47.2-50.4%) or HCV-related cirrhosis (44.3%; 95% CI, 42.3-46.3%); ten-year extrahepatic cancer mortality (18.8%; 95% CI, 16.8-20.9%) and cardiovascular disease mortality (15.6%; 95% CI, 13.8-17.7%) were highest among people with MASLD cirrhosis. In multivariable competing risks regression analyses, people with MASLD cirrhosis were less likely than people with alcohol-related cirrhosis to die of liver disease (adjusted subdistribution hazard ratio [sHR], 0.55; 95% CI, 0.51-0.60) and more likely to die of extrahepatic cancer (adjusted sHR, 1.21; 95% CI, 1.04-1.41). CONCLUSIONS: Mortality among people who have been hospitalised with cirrhosis is high, and there is substantial variation in cause-specific mortality by cirrhosis aetiology. Care for these patients could be improved by identifying chronic liver disease earlier, and by treating cardiovascular disease and extrahepatic malignancies in people with MASLD.
OBJECTIVES: To assess changes in greenhouse gas emission rates associated with the use of anaesthetic gases (desflurane, sevoflurane, and isoflurane) in Australian health care during 2002-2022, overall and by state or te...OBJECTIVES: To assess changes in greenhouse gas emission rates associated with the use of anaesthetic gases (desflurane, sevoflurane, and isoflurane) in Australian health care during 2002-2022, overall and by state or territory and hospital type. STUDY DESIGN: Retrospective descriptive analysis of IQVIA anaesthetic gases purchasing data. SETTING: All Australian public and private hospitals, 1 January 2002 - 31 December 2022. MAIN OUTCOME MEASURES: Absolute carbon dioxide equivalent (COe) emissions and COe emissions rate per 100 000 population by gas and year, overall and by state/territory and hospital type (public or private). RESULTS: The overall emissions rate increased from 74 t COe per 100 000 population in 2002 to 328 t COe per 100 000 population in 2012, most rapidly during 2002-2004 (annual percentage change [APC], 51%; 95% confidence interval [CI], 38-62%). The rate then declined to 83 t COe per 100 000 population in 2022, most rapidly during 2017-2022 (APC, -21%; 95% CI, -23% to -20%). Patterns of emissions rate change were similar for all states and territories. More units of sevoflurane than of desflurane or isoflurane were purchased each year throughout 2002-2022, but desflurane provided the largest proportion of total emissions from anaesthetic gases during 2002-2022: 33% in 2002, 88% in 2013, and 68% in 2022. Mean emission rates per 100 000 population during 2002-2022 were highest for South Australia/Northern Territory (276 t COe per year) and lowest for Victoria/Tasmania (196 t COe per year). The desflurane emissions rate was consistently higher for private than public hospitals; it declined for public hospitals during 2009-2018 (APC, -8%; 95% CI, -10% to -5%) and 2018-2022 (APC, -43%; 95% CI, -48% to -37%), but for private hospitals only during 2017-2022 (APC, -20%; 95% CI, -24% to -17%). CONCLUSIONS: In Australia, the COe emissions rate for anaesthetic gases increased during 2002-2008 but declined during 2017-2022, at first primarily in public hospitals. Continuing to reduce the use of anaesthetic gases, particularly desflurane, will advance the decarbonisation of clinical practice in Australian health care.
OBJECTIVE: To examine longitudinal changes in the initial prescribing of glucagon-like peptide 1 (GLP-1) receptor agonists for women of reproductive age in Australia; to determine whether contraception recommendations ar...OBJECTIVE: To examine longitudinal changes in the initial prescribing of glucagon-like peptide 1 (GLP-1) receptor agonists for women of reproductive age in Australia; to determine whether contraception recommendations are being followed; and to estimate the frequency of pregnancy among women using GLP-1 receptor agonists. STUDY DESIGN: Retrospective open cohort study; analysis of MedicineInsight general practice data. SETTING, PARTICIPANTS: Women aged 18-49 years who visited participating general practices three or more times during the study period (1 January 2011 - 31 July 2022). MAIN OUTCOME MEASURES: Age-standardised incidence of initial GLP-1 receptor agonist prescribing, by year and type 2 diabetes status; proportion of women using highly effective contraception at the time of GLP-1 receptor agonist initiation (contraception overlap); age-standardised incidence of pregnancy within six months of the first prescribing of GLP-1 receptor agonists. RESULTS: Of 1 635 684 women aged 18-49 years, 18 010 (1.1%) were first prescribed GLP-1 receptor agonists during 2011-2022, of whom 3739 (20.8%) had type 2 diabetes. The age-standardised incidence of GLP-1 receptor agonist prescribing for women with type 2 diabetes increased from 13.0 per 1000 women in 2011 to 88.5 per 1000 women in 2022; for women without type 2 diabetes, it increased from 0 to 14.9 per 1000 women. Of the 6293 women first prescribed GLP-1 receptor agonists during 2022, 6954 (90.5%) did not have type 2 diabetes. Contraception overlap with first prescribing of GLP-1 receptor agonists was determined for 3825 women (21.2%). Pregnancies within six months of GLP-1 receptor agonist prescribing were documented for 232 of 10 781 women for whom at least six months of follow-up data were available. CONCLUSIONS: The prescribing of GLP-1 receptor agonists for women of reproductive age is increasing in Australia, and most prescriptions are for women not diagnosed with type 2 diabetes. Fewer than one in four women are using contraception at the time of treatment initiation, and a considerable number are pregnant within six months of the initial prescribing of GLP-1 receptor agonists. Further evidence and guidelines are needed to support the safe and effective use of GLP-1 receptor agonists by women of reproductive age.
OBJECTIVE: To develop a culturally responsive maternal and child health model, centred on Aboriginal and Torres Strait Islander women's knowledge of health, wellbeing and expressed health priorities, to address gaps in c...OBJECTIVE: To develop a culturally responsive maternal and child health model, centred on Aboriginal and Torres Strait Islander women's knowledge of health, wellbeing and expressed health priorities, to address gaps in care for those who experience cardiometabolic complications in pregnancy. DESIGN: Health services and systems co-design. SETTING: Health services in South Australia providing maternal and child primary, acute and chronic disease management care. PARTICIPANTS: Nineteen Aboriginal women from urban, regional and remote areas of South Australia participated in 2024, with most having personal experience of cardiometabolic complications in pregnancy and some contributing professional experience. MAIN OUTCOME MEASURE: Development of a culturally responsive, evidence-based model of care to support Aboriginal women with cardiometabolic complications in pregnancy. RESULTS: Through a collaborative approach and an iterative co-design process, participants shared lived experiences, identified systemic issues and developed solutions to address gaps in maternal and child health care. Culturally safe spaces enabled deep reflection, open dialogue and collective decision making. With this, we developed a model of care that included a vision statement, guiding principles, a conceptual framework and 18 priority areas. In addition, eight health system enablers were identified to support implementation. CONCLUSION: This project demonstrates the value of Aboriginal women's leadership in shaping health systems. This process highlights the value of culturally grounded, community-led co-design approaches to health service and system reform. For health systems and service providers and managers, this is an opportunity to foster meaningful change by listening to and acting on the voices of Aboriginal women. In doing so, they will meet their responsibility to address inequities. Researchers and health organisations must do more than amplify these voices; rather, they must listen, act and ensure that systems respond to what women say they need. This is a pivotal moment to drive systemic change for equitable and culturally safe maternal and child health care.
OBJECTIVES: To review and synthesise the global evidence regarding what Indigenous people value in health and health care. STUDY DESIGN: The Joanna Briggs Institute (JBI) protocol for umbrella reviews was used. Thematic...OBJECTIVES: To review and synthesise the global evidence regarding what Indigenous people value in health and health care. STUDY DESIGN: The Joanna Briggs Institute (JBI) protocol for umbrella reviews was used. Thematic meta-synthesis was conducted using collaborative yarning with an Indigenous researcher and a non-Indigenous researcher to generate concepts of value in health and health care. DATA SOURCES: Systematic, scoping and narrative reviews, written in English and published between 1 January 2000 and 1 January 2024, which directly included the perspectives of Indigenous people describing the value of health and/or a field of health care, were included. Databases searched included MEDLINE, Embase, CINAHL, Scopus and the Cochrane Database of Systematic Reviews. DATA SYNTHESIS: Twenty-five reviews that analysed what is valued in health and health care by Indigenous people globally were identified. The literature demonstrated a clear distinction between Indigenous and Western paradigms of health and health care, with Indigenous paradigms grounded in culture. Indigenous cultural determinants of health included: identity; land, Country and community; and spirituality and traditional healing. For health care, five core values for Indigenous people globally were identified: decolonised and holistic systems of care; culturally safe health services and care; Indigenous and culturally aware non-Indigenous workforce; accessibility; and communication, trust and rapport building. CONCLUSIONS: This umbrella review highlights the importance of culture, Indigenous sovereignty and self-determination in health and accessing health care. It also reveals the importance of cultural safety and responsiveness in the delivery of health care services. The findings will be used to inform a conceptual framework of values in health and health care to develop a community-reported outcome measure. This framework will guide genuine and meaningful engagement with Indigenous communities to co-design and deliver health care that is effective, responsive and culturally safe.
OBJECTIVE: To investigate why rural general practitioners prescribe opioids for people with chronic non-cancer pain, with the aims of explaining geographic differences in opioid prescribing and improving pain management...OBJECTIVE: To investigate why rural general practitioners prescribe opioids for people with chronic non-cancer pain, with the aims of explaining geographic differences in opioid prescribing and improving pain management in rural areas. STUDY DESIGN: Qualitative study; interviews with convenience sample of rural general practitioners. SETTING, PARTICIPANTS: Seventeen rural general practitioners who had prescribed opioids for people with chronic non-cancer pain during the preceding twelve months; the interviews were undertaken during 11 September 2023 - 31 May 2024. MAJOR OUTCOME MEASURES: Contextual and individual factors that influence decision making by rural general practitioners about prescribing opioids for people with chronic non-cancer pain. RESULTS: We found that rural opioid prescribing is influenced more by health care system deficiencies than lack of knowledge among practitioners. Two major themes were identified: systematic constraints (insufficient time for alternative management strategies and the influence of Medicare remuneration); and limited access to multidisciplinary pain management (limited availability of non-pharmaceutical treatments, colleagues for consultation, and referral pathways). Participants described feeling trapped between brief consultations and complex deprescribing requirements; Medicare remuneration schedules encourage shorter appointments (and therefore continuing current management) rather than comprehensive pain management. Implementing evidence-based guidelines was difficult in rural areas with limited resources. The limited availability of allied health services further restricted alternative pain management approaches. Participants reported greater psychological pressure to justify opioid deprescribing than prescribing. Doctors acknowledged that the evidence for the value of opioids for managing chronic pain was limited but felt caught between inadequate system resources and patient demands. CONCLUSION: We found a marked disparity between evidence-based guidelines for chronic pain management and the reality of rural medical practice. Rural doctors operating in a difficult context resort to prescribing opioids because of systemic inadequacies rather than lack of awareness of their limited value. Chronic pain management in rural areas could be improved by better Medicare support for longer pain management consultations, improved access to allied health, rural area-specific guidelines that take resource constraints into account, and improved support for general practitioners in pain management and deprescribing.
OBJECTIVES: To investigate differences in the prevalence of specific chronic diseases in Australia by selected measures of socio-economic position, and by age group and sex, using representative national census populatio...OBJECTIVES: To investigate differences in the prevalence of specific chronic diseases in Australia by selected measures of socio-economic position, and by age group and sex, using representative national census population data. STUDY DESIGN: Cross-sectional, whole of population study; analysis of 2021 Australian census data. PARTICIPANTS, SETTING: People aged 40 years or older for whom 2021 Australian census health status and socio-economic position-related data were available. MAIN OUTCOME MEASURES: Age-standardised prevalence of ten chronic diseases (arthritis, asthma, cancer, dementia, diabetes, heart disease, kidney disease, lung disease, mental health conditions, and stroke), by socio-economic position (Index of Relative Socio-economic Disadvantage [IRSD], income category, educational level, occupational grade), age group, and sex; mean change in prevalence across socio-economic position categories. RESULTS: Health status responses and data that allowed IRSD categorisation were available for 11.3 million people aged 40 years or older (92% of all adults aged 40 years or older). The proportions of people who reported nine chronic diseases (exception: cancer) increased with increasing socio-economic disadvantage as measured by IRSD decile and income. The increases were less marked for people aged 80 years or older than for those aged 40-79 years, and more marked for women than men. For people aged 40-59 or 60-79 years, the increase in age-standardised chronic disease prevalence per one decile decrease in IRSD was greatest for lung disease in both women (40-59 years, 18.4% per decile; 60-79 years, 10.6% per decile) and men (40-59 years, 16.9% per decile; 60-79 years, 11.0% per decile). In people aged 80 years or older, the increase in prevalence per one decile decrease in IRSD was greatest for kidney disease in women (6.0% per decile) and for mental health conditions in men (7.1% per decile). The age-standardised prevalence of cancer decreased by 0.4-1.1% per one decile decrease in IRSD for all age groups and both sexes, except for men aged 40-59 years (increased by 0.1% per IRSD decile). Consistent relationships with educational level or occupational grade were not found. CONCLUSIONS: The prevalence of chronic disease differs by socio-economic position, but the direction, magnitude, and consistency of the effect differs by disease, socio-economic position measure, age, and sex. Understanding the relationship between different socio-economic position measures and chronic diseases facilitates the formulation of directed interventions.