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Inequity of access to voluntary assisted dying for New Zealand citizens residing permanently in Australia. 永久居住在澳大利亚的新西兰公民在获得自愿协助死亡方面的不平等。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-06 DOI: 10.5694/mja2.52519
Christopher J Barlow
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引用次数: 0
Beyond acute infection: mechanisms underlying post-acute sequelae of COVID-19 (PASC) 超越急性感染:COVID-19(PASC)急性后遗症的机制。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-03 DOI: 10.5694/mja2.52456
Anurag Adhikari, Janesha Maddumage, Emily M Eriksson, Sarah J Annesley, Victoria A Lawson, Vanessa L Bryant, Stephanie Gras

免疫失调是 2019 年冠状病毒病急性后遗症(PASC)(也称为长 COVID)的一个关键方面,免疫细胞持续激活、T 细胞衰竭、B 细胞特征偏差和免疫通讯紊乱从而导致与自身免疫相关的并发症。肠道正在成为微生物群、新陈代谢和整体功能障碍之间的关键环节,可能与其他慢性疲劳病症和 PASC 有相似之处。免疫血栓和神经信号系统功能障碍强调了在严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)感染的情况下,免疫系统、血液凝固和中枢神经系统之间复杂的相互作用。在设计 PASC 研究方面存在明显的研究空白,尤其是在纵向研究方面,这是一个值得关注的重要领域。
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引用次数: 0
The crux of modern health care challenges 现代医疗挑战的症结所在。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-03 DOI: 10.5694/mja2.52488
Michael Skilton
<p>In rock climbing, the crux is the hardest section, or sections, of a particular climbing route. To solve a crux, the climber must draw on their skill and expertise, problem-solving abilities, perseverance and teamwork, before being able to send it — solve the crux and complete the route. This issue of the <i>MJA</i> covers a broad range of subjects that could be considered some of the most critical challenges in modern health and health care.</p><p>Over the past 55 years, the proportion of people in Australia who die from cardiovascular diseases has halved (https://www.abs.gov.au/statistics/health/causes-death/changing-patterns-mortality-australia/latest-release). Nonetheless, cardiovascular diseases remain a leading cause of death and morbidity. In this issue of the <i>MJA</i>, Figtree and colleagues (https://doi.org/10.5694/mja2.52482) describe the Cardiovascular Health Leadership Research Forum. Established in 2022, this initiative unites governments, health service providers, and the research workforce to tackle major cardiovascular health challenges. By accelerating the implementation of new preventive and therapeutic strategies, it seeks to enhance patient outcomes and produce economic benefits.</p><p>On a broader scale, Jackson (https://doi.org/10.5694/mja2.52476) discusses the National Health Reform Agreement, and the challenges it faces to remain fit-for-purpose for maintaining a high quality equitable health system. Seven policy barriers are identified that have long undermined health system reform, and will need to be addressed for the next agreement to be successful.</p><p>Four further articles discuss key aspects of modern socially responsible health care. Rodda and colleagues (https://doi.org/10.5694/mja2.52471) review current approaches to identifying and managing gambling disorder. Formerly known as pathological gambling, gambling disorder is now classified as a behavioural addiction. Gambling disorder affects only 1% of the population; however, gambling is pervasive in Australian culture with significant costs. Approximately three-quarters of the Australian adult population spent money on gambling in 2022, with total losses of $20–25 billion per year (https://www.aihw.gov.au/reports/australias-welfare/gambling). This does not account for the further social costs of gambling, which are extensive. Of those Australian adults who gamble, almost half are classified as being at risk of harm, with the highest rates in young people and men. The evidence base outlined by Rodda and colleagues provides best practices for identifying gambling disorder and risk thereof, and subsequent treatment.</p><p>Slape and colleagues (https://doi.org/10.5694/mja2.52475) provide a perspective on the establishment of a First Nations custodial dermatology service. This First Nations-led service, established in New South Wales and now extended to the Northern Territory, reflects a commitment to ethical and socially responsible health care services through
在攀岩运动中,"十字路口 "是某条攀岩路线中最难的一段或几段。要解决一个难点,攀岩者必须利用他们的技能和专业知识、解决问题的能力、毅力和团队合作精神,然后才能将其送出--解决难点并完成攀岩路线。本期MJA杂志涉及的主题非常广泛,可以说是现代健康和医疗保健领域最严峻的挑战之一。在过去的55年中,澳大利亚死于心血管疾病的人口比例减少了一半 (https://www.abs.gov.au/statistics/health/causes-death/changing-patterns-mortality-australia/latest-release)。然而,心血管疾病仍然是导致死亡和发病的主要原因。在本期的《医学期刊》上,Figtree及其同事(https://doi.org/10.5694/mja2.52482)介绍了心血管健康领导研究论坛(Cardiovascular Health Leadership Research Forum)。该论坛成立于 2022 年,旨在联合各国政府、医疗服务提供商和研究人员,共同应对心血管健康领域的重大挑战。通过加快实施新的预防和治疗策略,该论坛旨在提高患者的治疗效果并产生经济效益。在更广泛的范围内,杰克逊(https://doi.org/10.5694/mja2.52476)讨论了《国家卫生改革协议》,以及该协议在维持高质量的公平医疗体系方面所面临的挑战。文章指出了长期以来阻碍医疗系统改革的七大政策障碍,要使下一份协议取得成功,就必须解决这些障碍。另有四篇文章讨论了现代社会责任医疗保健的主要方面。Rodda 及其同事 (https://doi.org/10.5694/mja2.52471) 回顾了当前识别和管理赌博障碍的方法。赌博障碍以前被称为病态赌博,现在被归类为行为成瘾。赌博障碍只影响到1%的人口;然而,赌博在澳大利亚文化中无处不在,造成了巨大的损失。2022 年,约四分之三的澳大利亚成年人在赌博上花钱,每年的总损失达 200-250 亿澳元(https://www.aihw.gov.au/reports/australias-welfare/gambling)。这还不包括赌博造成的更大社会成本。在参与赌博的澳大利亚成年人中,几乎有一半被归类为面临伤害风险,其中年轻人和男性的比例最高。罗达及其同事概述的证据基础提供了识别赌博障碍及其风险以及后续治疗的最佳做法。斯莱普及其同事(https://doi.org/10.5694/mja2.52475)提供了建立原住民监护皮肤病服务的视角。这项由原住民主导的服务在新南威尔士州建立,现已扩展到北部地区,体现了通过提供及时、优质、文化上安全的医疗保健服务,满足被监禁者复杂的医疗保健需求,提供符合道德规范、对社会负责的医疗保健服务的承诺。更广泛地说,这项服务的基本原则凸显了在监狱系统内由原住民主导的专科医疗服务的前景。诺兰及其同事(https://doi.org/10.5694/mja2.52471)在研究信中使用了药品福利计划(PBS)中的去身份化配药数据,证明尽管药品福利计划中没有明确的性别确认适应症,但每五个药品福利计划补贴的睾酮处方中就有一个是为变性人开的。在年轻人中,这一数字高达五分之四。他们认为,针对 "性别确认 "的特定 PBS 授权指示将有助于变性人公平地获得医疗服务并提高医疗质量。最后,Fry 及其同事的医学教育文章(https://doi.org/10.5694/mja2.52481),用他们的话说,"旨在作为环境足迹技术的入门介绍,可用于揭示医疗服务对环境的影响",并明确将重点放在温室气体排放上。他们指出了五个关键的行动领域,包括提高医疗环境足迹知识,将环境足迹纳入现有的质量改进、采购和医疗系统绩效框架。这些切实可行的建议不仅对医护人员的个人实践有影响,也许更重要的是,对卫生和医疗领导及管理部门引导的系统变革也有影响。这些都是现代卫生和医疗保健领域最具挑战性的一些方面。就像登山者在峭壁上攀登一样,这些挑战需要医疗和卫生保健界的共同努力,才能为患者和更广泛的社区带来最佳结果。
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引用次数: 0
The economic burden of long COVID in Australia: more noise than signal? 澳大利亚长期慢性病毒性的经济负担:噪音多于信号?
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-03 DOI: 10.5694/mja2.52468
Mary Rose Angeles, Thi Thu Ngan Dinh, Ting Zhao, Barbara de Graaff, Martin Hensher

Objective

To estimate the potential economic burden of long COVID in Australia.

Design

A stock-and-flow model of weekly estimated numbers of people with long COVID (January 2021 to June 2023); application of proxy cost estimates from people living with myalgic encephalomyelitis/chronic fatigue syndrome; time series analysis of labour market and social security datasets.

Setting

The working age Australian population.

Main outcome measures

The likely number of Australians severely impacted by long COVID; the economic cost of long COVID; and the impacts of long COVID, determined by analysis of labour market data.

Results

At its peak in late 2022, between 181 000 and 682 000 Australians may have experienced some long COVID symptoms, of whom 40 000–145 000 may have been severely affected. Severe cases potentially decreased to affecting 10 000–38 000 people by June 2023. The likely economic burden of long COVID in Australia during 2022 was between $1.7 billion and $6.3 billion (some 0.07% to 0.26% of gross domestic product). Labour market data suggest that between 25 000 (February 2023) and 103 000 (June 2023) more working age Australians reported being unable to work due to long term sickness than would have been predicted based on pre-COVID-19 trends. This does not appear to have translated into increased claims for Disability Support Pensions, but numbers of working age Carer Allowance recipients have grown markedly since 2022.

Conclusions

Long COVID likely imposed a small but significant aggregate toll on the Australian economy, while exposing tens of thousands of Australians to substantial personal economic hardship and contributing to labour market supply constraints. Yet while some signal from long COVID is discernible in the labour force data, Australia lacks adequate direct surveillance data to securely guide policy making.

目的估算澳大利亚长程COVID的潜在经济负担:设计:长COVID患者每周估计人数的存量与流量模型(2021年1月至2023年6月);应用肌痛性脑脊髓炎/慢性疲劳综合征患者的替代成本估算;劳动力市场和社会保障数据集的时间序列分析:主要结果测量指标:主要结果测量指标:受到长期慢性疲劳综合征严重影响的澳大利亚人的可能数量;长期慢性疲劳综合征的经济成本;以及通过劳动力市场数据分析确定的长期慢性疲劳综合征的影响:在 2022 年末的高峰期,可能有 181 000 至 682 000 名澳大利亚人出现过一些长期慢性阻塞性肺病症状,其中 40 000 至 145 000 人可能受到严重影响。到 2023 年 6 月,严重病例可能减少到 10 000-38 000 人。2022 年期间,澳大利亚可能因长期慢性阻塞性肺病造成的经济负担在 17 亿澳元至 63 亿澳元之间(约占国内生产总值的 0.07% 至 0.26%)。劳动力市场数据显示,与根据第 19 次 COVID 前的趋势预测相比,有 25000 名(2023 年 2 月)至 103000 名(2023 年 6 月)处于工作年龄的澳大利亚人因长期患病而无法工作。这似乎并没有转化为残疾支持养老金申请的增加,但自 2022 年以来,工作年龄护理津贴领取者的人数明显增加:长期的 COVID 可能会对澳大利亚经济造成微小但巨大的总体损失,同时使数以万计的澳大利亚人面临巨大的个人经济困难,并导致劳动力市场供应紧张。然而,虽然从劳动力数据中可以看出长期失业保险的一些信号,但澳大利亚缺乏足够的直接监控数据来可靠地指导政策制定。
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引用次数: 0
An allied health model of care for long COVID rehabilitation 针对长期 COVID 康复的联合医疗模式。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-03 DOI: 10.5694/mja2.52457
Joanne M Wrench, Leigh R Seidel Marks
<p>Although the acute disease burden of coronavirus disease 2019 (COVID-19) in Australia has reduced, the longer term impacts are becoming increasingly apparent.<span><sup>1</sup></span> The constellation of persistent symptoms is termed “post-acute COVID-19 condition”, also known as “long COVID”, and includes dyspnoea, fatigue, cognitive impairments, headaches, and psychiatric symptoms.<span><sup>2, 3</sup></span> The health impact at a population level is significant, with between 10% and 20% of people having persistent symptoms after a COVID-19 infection.<span><sup>4, 5</sup></span></p><p>Patient testimonies describe the devastating impact of symptoms left untreated by health services.<span><sup>6, 7</sup></span> The functional sequalae of long COVID include reduced quality of life<span><sup>8, 9</sup></span> and difficulty engaging in normal life roles, including family, work and caring responsibilities.<span><sup>10</sup></span> COVID-19 has also disproportionately affected disadvantaged communities who have less access to health care services and less resources to allow for absences from work.<span><sup>11</sup></span></p><p>As the world has returned to normal, many people living with long COVID continue to report feeling left behind and isolated by persistent symptoms.<span><sup>12</sup></span> Alongside this, many people report feeling ignored or not believed by health care providers, who often struggle to pinpoint physiological impairment and associated treatments.<span><sup>13</sup></span> This can lead to a marked discordance between the lived experience of ongoing debilitation and the expectations of the community and health care sector of what recovery from COVID-19 looks like.</p><p>Initially, Australia's response to long COVID followed a specialist clinic model of care, including individual referrals to respiratory and cardiac specialists. With the emergence of milder acute illness, the model of care for long COVID in Australia has now moved to primary care, with general practitioners seen as the coordinators of ongoing services and interventions.<span><sup>14</sup></span></p><p>The heterogeneous nature of long COVID symptoms, coupled with no diagnostic tool or single treatment, means the functional burden of long COVID may best be addressed by symptom management approaches.<span><sup>15, 16</sup></span> In this regard, Australian and international guidelines recommend multidisciplinary and coordinated allied health care as a practice standard for people with long COVID,<span><sup>17, 18</sup></span> and there is emerging evidence of corresponding functional improvement.<span><sup>19, 20</sup></span> In line with these recommendations, the National Health Service in the United Kingdom encourages a three-tiered approach to care, with multidisciplinary interventions offered to people with the most severe symptoms requiring input from two or more professionals, stepping down to community therapy teams, and then self-management pathway
最常见的中重度症状是疲劳、脑雾和心理影响(方框 3)。大多数接受服务的参与者都接受过不止一名多学科团队成员的诊治(63%)。运动生理学是需求量最大的学科,其次是临床心理学和职业疗法(方框 4)。我们的 "失访 "率很低,仅为 7%。个人学科治疗辅以在线自我管理资源22 和定制的虚拟小组项目,共有 72 人参加。长期慢性阻塞性肺气肿干预措施的证据基础正在形成,干预措施以临床指南为基础,如美国国家卫生保健与卓越研究所指南17,这些指南目前主要处于专家共识或低证据水平。根据这些指南,门诊干预措施包括:(i) 一站式协调护理方法;(ii) 对疲劳、脑雾、嗅觉障碍、睡眠和声音变化进行管理;(iii) 临床心理支持和干预,包括对持续症状的适应、持续的 COVID-19 和健康焦虑、一般心理障碍以及病前心理健康问题的加重;(iv) 与高血压专科医疗服务机构合作,对体位性正位性心动过速综合征进行调查、诊断和管理;以及 (v) 职业治疗支持功能改善,使患者能够重新参与重要的活动和生活角色,如工作和照顾他人的责任。澳大利亚为长期慢性心力衰竭患者提供建议的多学科护理的公共卫生服务仍然相对较少。大多数人都无法获得康复服务,而这些服务可以缓解症状、改善生活质量并帮助他们重新扮演有价值的生活角色。ReCOVery 护理模式是根据国际指南开发的,为参与者提供了有影响力的护理。否则,接受我们服务的人很有可能会被我们的医疗系统拒之门外,无法获得传统的伤后或急性康复服务或老年护理服务。ReCOVery 模式为支持患者的阶梯式护理方法提供了可行的蓝图,并通过我们的使用数据为联合医疗学科的需求提供了初步证据。尽管如此,维多利亚州多家公立长期 COVID 诊所的服务资金已基本停止。这加剧了谁能获得医疗服务的不公平,大多数人根本无法负担私人专职医疗服务。获得联合医疗服务的护理计划可由全科医师完成,但只能提供五次治疗,缺口费也很常见。我们几乎只能通过远程医疗来有效运行 ReCOVery 服务。长 COVID 中心远程医疗中心是一种可行的模式,可为最需要的人提供治疗。这种远程医疗模式支持大多数澳大利亚人难以获得的专科治疗,如临床神经心理学。我们认识到,来自不同文化和语言背景以及弱势社区的人可能无法随时使用远程医疗基础设施,因此有些人需要选择以中心为基础的服务。分层(阶梯)治疗是管理长期 COVID 最有效、最具成本效益的方法,已在其他地方成功实施。通过全科医生的评估和转诊来简化流程可能会缓解这一就医障碍。16 尽管全科医生完全有能力成为患者的主要医疗联系人,但他们仍需要通过专职医疗人员进行治疗干预方面的教育和转诊选择。多学科康复治疗是改善有严重持续症状的患者的生活质量、减轻全科医生负担的最有效解决方案。不幸的是,在澳大利亚,除非我们通过公共卫生服务或医疗保险回扣来增加获取机会,否则这种机会将仅限于经济条件较好的人。墨尔本大学通过澳大利亚大学图书馆员理事会达成了 Wiley - 墨尔本大学协议,该协议的一部分就是墨尔本大学提供的开放获取出版服务。
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引用次数: 0
Living with long COVID and its impact on family and society: a couple's view 长期慢性阻塞性肺病患者的生活及其对家庭和社会的影响:一对夫妇的观点。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-03 DOI: 10.5694/mja2.52466
Karlie M Flannigan, Gerard M Flannigan
<p>My name is Karlie, and I am now 56 years old. I contracted coronavirus disease 2019 (COVID-19) in July 2020. I was working in aged and disability care as a human resources (HR) manager, mentor and trainer. I have endured long COVID symptoms for four years since my COVID-19 infection.</p><p>For a perspective of my health before the COVID-19 pandemic, my medical history can be summarised as follows. I have had severe acute asthma since the age of 14 years, treated with multiple medications including ongoing prednisolone. I have had several respiratory arrests and yearly hospital admissions due to severe asthma. I have psoriatic arthritis, which is treated with methotrexate, and was diagnosed with supraventricular tachycardia, requiring two corrective procedures. In 2017, I had a multilobal abdominal tumour from endometriosis and adenomyosis which resulted in a radical hysterectomy. About 20 years ago, I had a workplace accident that caused a Colles fracture, which required multiple reconstructive procedures for my left wrist and arm, and had multiple anterior cruciate ligament and cartilage repair surgeries.</p><p>In the early stages of the pandemic, I must admit I was extremely fearful of having COVID-19. Given my severe acute asthma, I was fully cognisant of the implications of surviving it. At the time, I was an HR manager for an aged care provider. It was the day before masks were mandated, but my office adhered to physical distancing practices. My employer had done everything possible to ensure we were in a safe working environment; however, a team member had come into work without telling anyone they were unwell.</p><p>I was in a room providing instruction to that team member and two other people. We were physically distanced from each other according to the practice at the time. The following evening, I was advised by my manager that I was a close contact to a person who tested positive to COVID-19, who was the team member who was unwell, and that I needed to have a polymerase chain reaction (PCR) test as soon as possible. I did not have a positive result on that first test, but, early the next day, I was symptomatic and began feeling very unwell. I did another PCR test and it was positive for COVID-19.</p><p>Two days after the positive test result, I was admitted to hospital and received oxygen. At that stage, I could only speak two words before being completely breathless; I relied on texting family and friends to communicate. Very quickly, I was placed on high flow oxygen, and, within a week of admission, I was transferred to the intensive care unit.</p><p>By that stage, I was unable to roll myself over in bed. I was asked if I had an advanced care directive and who to contact when I needed to be intubated. I developed secondary pneumonia and spent five weeks in hospital, with a total of 54 days in isolation (including at home).</p><p>During my whole time in hospital, my husband and youngest son also had COVID-19. They were in home iso
我叫 Karlie,现年 56 岁。我于 2020 年 7 月感染了 2019 年冠状病毒病(COVID-19)。我当时在老年和残疾护理机构担任人力资源(HR)经理、导师和培训师。自感染 COVID-19 以来,我已忍受了四年之久的 COVID 症状。要了解我在 COVID-19 大流行之前的健康状况,我的病史可概述如下。我从 14 岁起就患有严重的急性哮喘,曾接受过多种药物治疗,包括泼尼松龙。由于严重哮喘,我曾多次呼吸心跳骤停,每年都要住院治疗。我患有银屑病关节炎,接受甲氨蝶呤治疗,并被诊断患有室上性心动过速,需要进行两次矫正手术。2017 年,我因子宫内膜异位症和子宫腺肌症患上了多叶腹腔肿瘤,导致根治性子宫切除术。大约20年前,我曾因工伤事故导致科莱斯骨折,需要对左手腕和手臂进行多次整形手术,并进行了多次前十字韧带和软骨修复手术。"在大流行病的早期阶段,我必须承认我非常害怕患上COVID-19。鉴于我患有严重的急性哮喘,我充分认识到患上 COVID-19 后的后果。当时,我是一家老年护理机构的人力资源经理。那是在强制要求戴口罩的前一天,但我的办公室坚持采取物理隔离的做法。我的雇主已经尽一切可能确保我们处于一个安全的工作环境中;然而,一名团队成员没有告诉任何人他们身体不适就来上班了。根据当时的惯例,我们彼此保持着物理距离。第二天晚上,我的经理告诉我,我与一名 COVID-19 检测呈阳性的人员(也就是身体不适的团队成员)有密切接触,我需要尽快进行聚合酶链反应 (PCR) 检测。我在第一次检测中没有得到阳性结果,但第二天一早,我就出现了症状,开始感觉非常不舒服。我又做了一次 PCR 检测,结果显示 COVID-19 呈阳性。检测结果呈阳性的两天后,我被送进了医院,并接受了吸氧治疗。在那个阶段,我只能说两句话,然后就完全喘不过气来;我只能靠给家人和朋友发短信来沟通。很快,我就吸上了高流量氧气,入院不到一周,我就被转到了重症监护室。我被问及是否有预先护理指示,以及需要插管时应与谁联系。在我住院期间,我的丈夫和小儿子也患上了 COVID-19。在我整个住院期间,我的丈夫和小儿子也感染了 COVID-19,他们在家中被隔离了 26 天。只有我的两个姐姐被告知了这一情况,因为我的丈夫和儿子不想让我有负担,认为是我传染给了他们。许多症状开始出现,有些几乎是立即出现,有些则在接下来的几个月里慢慢显现出来。我开始出现慢性疲劳、肌肉疲劳、虚弱、头痛以及失眠。当我勉强入睡时,每次只能睡几个小时。我开始脱发,头发会成片脱落,我还出现了光敏感和视力衰退。医生告诉我这些症状与 COVID-19 无关,这让我的病情更加严重。我曾被转诊给一位语言治疗师,但他并不了解我的问题是由 COVID-19 引起的。后来,他们在阅读了我向他们提出的所有相同问题的研究报告后向我道歉。两年多来,我的消化系统一直有问题,包括反流、消化不良、呕吐以及只能吃流质和软食。感染后不久,我还出现了纤维肌痛,这导致我的手和腿疼痛;血压时高时低;以及无明显原因的平衡问题。我没有摔过跤,但走直线时有困难。我经常撞到门口,需要扶着家具才能站稳。我不能服用消炎药,因为我对这些药物过敏。在重症监护室期间,我还患上了广谱β-内酰胺酶。
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引用次数: 0
Factors associated with general practitioner-led diagnosis of long COVID: an observational study using electronic general practice data from Victoria and New South Wales, Australia 与全科医生主导的长期 COVID 诊断相关的因素:一项利用澳大利亚维多利亚州和新南威尔士州全科电子数据进行的观察性研究。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-03 DOI: 10.5694/mja2.52458
Abbish Kamalakkannan, Mirela Prgomet, Judith Thomas, Christopher Pearce, Precious McGuire, Fiona Mackintosh, Andrew Georgiou

Objectives

To investigate associations between sociodemographic factors, pre-existing chronic comorbidities, and general practitioner-led diagnosis of long COVID.

Design, setting, patients

We conducted a retrospective observational case–control study using de-identified electronic general practice data, recorded between January 2020 and March 2023, from 869 general practice clinics across four primary health networks in Victoria and New South Wales.

Main outcome measures

Sociodemographic factors and pre-existing chronic comorbidities associated with general practitioner-led diagnosis of long COVID.

Results

A total of 1588 patients had a recorded general practitioner-led long COVID diagnosis. Females exhibited a higher likelihood of general practitioner-led long COVID diagnosis (adjusted odds ratio [aOR], 1.58; adjusted confidence interval [aCI], 1.35–1.85) compared with males. Patients aged 40–59 years had a higher likelihood of general practitioner-led long COVID diagnosis (aOR, 1.68; aCI, 1.40–2.03) compared with patients aged 20–39 years. The diagnosis was more likely in patients of high socio-economic status (aOR, 1.37; aCI, 1.05–1.79) compared with those of mid socio-economic status. Mental health conditions (aOR, 2.69; aCI, 2.25–3.21), respiratory conditions (aOR, 2.25; aCI, 1.85–2.75), cancer (aOR, 1.64; aCI, 1.15–2.33) and musculoskeletal conditions (aOR, 1.50; aCI, 1.20–1.88) were all significantly associated with general practitioner-led long COVID diagnosis.

Conclusions

Female sex, middle age, high socio-economic status and pre-existing comorbidities, including mental health conditions, respiratory conditions, cancer and musculoskeletal conditions, were associated with general practitioner-led long COVID diagnosis among general practice patients. These factors largely parallel the emerging international evidence on long COVID and highlight the patient characteristics that practitioners should be cognisant of when patients present with symptoms of long COVID.

目的:研究社会人口学因素、原有慢性并发症与全科医生诊断的长期慢性并发症之间的关系:调查社会人口因素、原有慢性并发症与全科医生诊断的长期COVID之间的关联:我们利用维多利亚州和新南威尔士州四个基层医疗网络的 869 家全科诊所在 2020 年 1 月至 2023 年 3 月期间记录的去标识化全科电子数据,开展了一项回顾性观察病例对照研究:主要结果测量:与全科医生诊断的长期COVID相关的社会人口学因素和原有慢性并发症:结果:共有 1588 名患者在全科医生指导下确诊了长 COVID。与男性相比,女性在全科医生指导下确诊长COVID的可能性更高(调整后的几率比[aOR],1.58;调整后的置信区间[aCI],1.35-1.85)。与 20-39 岁的患者相比,40-59 岁的患者在全科医生指导下确诊长 COVID 的可能性更高(aOR,1.68;aCI,1.40-2.03)。与社会经济地位中等的患者相比,社会经济地位高的患者更有可能被诊断出(aOR,1.37;aCI,1.05-1.79)。精神健康状况(aOR,2.69;aCI,2.25-3.21)、呼吸系统状况(aOR,2.25;aCI,1.85-2.75)、癌症(aOR,1.64;aCI,1.15-2.33)和肌肉骨骼状况(aOR,1.50;aCI,1.20-1.88)均与全科医生主导的长期 COVID 诊断显著相关:结论:女性、中年、高社会经济地位和既往合并症(包括精神疾病、呼吸系统疾病、癌症和肌肉骨骼疾病)与全科医生主导的全科病人长期 COVID 诊断有关。这些因素在很大程度上与国际上关于长COVID的新兴证据相一致,并强调了当患者出现长COVID症状时,医生应注意的患者特征。
{"title":"Factors associated with general practitioner-led diagnosis of long COVID: an observational study using electronic general practice data from Victoria and New South Wales, Australia","authors":"Abbish Kamalakkannan,&nbsp;Mirela Prgomet,&nbsp;Judith Thomas,&nbsp;Christopher Pearce,&nbsp;Precious McGuire,&nbsp;Fiona Mackintosh,&nbsp;Andrew Georgiou","doi":"10.5694/mja2.52458","DOIUrl":"10.5694/mja2.52458","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate associations between sociodemographic factors, pre-existing chronic comorbidities, and general practitioner-led diagnosis of long COVID.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, setting, patients</h3>\u0000 \u0000 <p>We conducted a retrospective observational case–control study using de-identified electronic general practice data, recorded between January 2020 and March 2023, from 869 general practice clinics across four primary health networks in Victoria and New South Wales.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Sociodemographic factors and pre-existing chronic comorbidities associated with general practitioner-led diagnosis of long COVID.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1588 patients had a recorded general practitioner-led long COVID diagnosis. Females exhibited a higher likelihood of general practitioner-led long COVID diagnosis (adjusted odds ratio [aOR], 1.58; adjusted confidence interval [aCI], 1.35–1.85) compared with males. Patients aged 40–59 years had a higher likelihood of general practitioner-led long COVID diagnosis (aOR, 1.68; aCI, 1.40–2.03) compared with patients aged 20–39 years. The diagnosis was more likely in patients of high socio-economic status (aOR, 1.37; aCI, 1.05–1.79) compared with those of mid socio-economic status. Mental health conditions (aOR, 2.69; aCI, 2.25–3.21), respiratory conditions (aOR, 2.25; aCI, 1.85–2.75), cancer (aOR, 1.64; aCI, 1.15–2.33) and musculoskeletal conditions (aOR, 1.50; aCI, 1.20–1.88) were all significantly associated with general practitioner-led long COVID diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Female sex, middle age, high socio-economic status and pre-existing comorbidities, including mental health conditions, respiratory conditions, cancer and musculoskeletal conditions, were associated with general practitioner-led long COVID diagnosis among general practice patients. These factors largely parallel the emerging international evidence on long COVID and highlight the patient characteristics that practitioners should be cognisant of when patients present with symptoms of long COVID.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52458","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Long COVID in Victoria 维多利亚州的长 COVID。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-03 DOI: 10.5694/mja2.52467
David A Watters, Lance Emerson
<p>An editorial in the <i>Medical Journal of Australia</i> in early 2023 stated that “Long COVID is precisely the kind of challenge the current Australian health system finds most difficult: a non-fatal chronic condition manifested as complex combinations of symptoms, without a simple diagnostic test or definitive pharmacotherapy”.<span><sup>1</sup></span> Achieving equitable access to supportive health care is challenging because the best models of care are multidisciplinary and coordinated by primary care. These involve medical assessment and coordination, allied health interventions and psychological support, each of which often incur significant out-of-pocket expenses. Thus, long COVID represents a sustained and multiplied disadvantage, with lower socio-economic, cultural, and linguistically diverse groups experiencing the least access to care.<span><sup>2</sup></span> In this issue of the <i>MJA</i>, we publish the supplement <i>The impact of long COVID in Victoria 2020–2023</i>. This collection of seven articles investigates the health and financial burdens of long COVID in Victoria, discusses the biological mechanisms at play, and explores models of care for this complex condition.</p><p>The 2022–23 parliamentary inquiry into long COVID, <i>Sick and tired, casting a long shadow</i>, recognised the need to provide coordinated care for people with long COVID, provided largely in the community but with targeted support from specialists on a case by case basis.<span><sup>3</sup></span> The “long shadow” includes a small but significant impact for the Australian economy, with an estimated health care cost per person affected in Victoria equivalent to the average Victorian wage, as Angeles and colleagues<span><sup>4</sup></span> report in this supplement on long COVID. Another modelling study for the whole Australian population estimated that 1.2–5.4% of the population had symptoms of long COVID during 2022–2023, with 0.7–3.4% to still be affected in December 2024. The total labour loss was estimated at $9.6 billion, or 0.5% of gross domestic product, with the greatest impact in people aged 30–49 years.<span><sup>5</sup></span></p><p>The lived experience of a consumer with long COVID within this supplement reminds us that the above estimates are not just numbers, but represent the lives of many real people: “Together, my husband and I have lost contact with friends, stopped social activities, and resigned from local community groups … We struggled to maintain our previous home, but, most importantly, we struggled to care for ourselves, which has had an impact on our self-worth”.<span><sup>6</sup></span></p><p>The term long COVID was first introduced by people with the condition. It has received support from those with lived experience, and stood the test of time, despite some reluctance to accept its use by some — referring to it as “a term used commonly in the community”.<span><sup>7</sup></span> In this editorial, and throughout the supplement
11 在 COVID-19 大流行的前三年中,随着疫苗接种的引入和毒力较弱的 SARS-CoV-2 变体的出现,维多利亚州长期感染 COVID 的人数比例有所下降。然而,由于社会限制放宽,以及从 2021 年 12 月起维多利亚州人将 "与 COVID 共同生活",因此 Omicron 变体感染人数大大增加,疾病负担也随之加重。世界各地的多项全国性调查证实,PASC 或长程型 COVID 的发病率同样很高。长程型 COVID 症状加重了患者的负担,因为长程型 COVID 患者仍被告知 "这都是你的幻觉",而且正如弗兰尼根和弗兰尼根6 反映他们的长程型 COVID 经验时所说,医生不知道如何治疗他们。维多利亚州和新南威尔士州的一些全科医生也认识到了这一点,本增刊对影响全科医生诊断长COVID的因素进行了研究,12 报告了诊断方面的挑战、专家意见和建议的缺乏,以及获得多学科护理模式的机会有限。初级保健诊所仍然依赖于专科医生的建议,通常是为了排除其他必要的病症,以确诊长 COVID。尽管维多利亚州的一些长期 COVID 医院诊所已经关闭或被重新吸纳,但仍有必要开发资助模式,以提供真正的多学科诊所,并提供强有力的专职医疗投入,正如 Wrench 及其同事在本增刊中所报告的那样,13 以支持持续的康复。COVID-19 大流行已近五年,我们对长程 COVID 的病理生理学、治疗和预后的认识仍有很大差距。不过,我们已经了解到,这种病毒与肺和血管内皮 ACE2(血管紧张素转换酶 2)受体结合,因此能够在身体的各个系统诱发病毒介导的和/或炎症反应。驱动这些炎症反应的基本途径仍在阐明之中,因此目前尚无循证药物疗法。在 2020-2021 年维多利亚州 COVID-19 波期间,感染 COVID-19 的患者因心血管、神经、呼吸、肾脏和血栓性疾病的住院率显著增加。国际上有确凿证据表明,患有肥胖、糖尿病或肾脏疾病等潜在并发症的长期 COVID 患者更有可能入院治疗,而这些并发症在感染 COVID-19 后可能会恶化17 。COVID-19 后神经综合征(PCNS)很常见14 ,包括 "脑雾"、认知和记忆障碍、嗅觉和味觉丧失、平衡失调、言语和语言障碍(包括忘词)、睡眠障碍、锥体外系和运动障碍以及脑血管血栓形成。虽然我们确实知道,感染后病毒可在包括大脑在内的所有组织中发现,而且持续的炎症不利于健康和幸福,但现在要知道感染 SARS-CoV-2 对痴呆症和锥体外系疾病的发病率会产生什么长期影响还为时尚早。本增刊中的维多利亚州 COVID 长期健康调查报告11 指出,COVID-19 后的精神健康后遗症可能也有一些神经和/或炎症因素,但正如该调查所显示的,其原因可能是多因素的,可能来自各种系统紊乱,既可能是单独的,也可能是综合的。维多利亚州长期慢性阻塞性脉管炎健康调查提供了一项持久的数据资产,它将继续为研究人员和临床医生提供帮助,帮助他们了解长期慢性阻塞性脉管炎的影响,并为他们开发更好的多学科护理模式提供机会。特别是,74% 的受访者同意将他们的(去标识化的)数据与其他数据集进行链接以用于进一步研究,62% 的受访者同意在未来的调查中与他们联系。有兴趣的研究人员请联系维多利亚州卫生部维多利亚州数据链接中心。
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引用次数: 0
Five decades of debate on burnout. 五十年来关于职业倦怠的争论
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-03 DOI: 10.5694/mja2.52512
Renzo Bianchi, James F Sowden
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引用次数: 0
Persistent symptoms after COVID-19: an Australian stratified random health survey on long COVID COVID-19 后的持续症状:澳大利亚关于长期 COVID 的分层随机健康调查。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-03 DOI: 10.5694/mja2.52473
Alex Holmes, Lance Emerson, Louis B Irving, Emma Tippett, Jeffrey M Pullin, Julie Young, David A Watters, Adina Hamilton
<div> <section> <h3> Objective</h3> <p>To determine the impact of persistent symptoms after coronavirus disease 2019 (COVID-19) in an Australian population.</p> </section> <section> <h3> Design, setting, participants</h3> <p>We conducted a statewide health survey of a stratified random sample of adults who had had a confirmed acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19-positive group) and their close contacts (control group). The sample was drawn from Victoria's COVID-19 database between January 2020 and October 2022. Data were collected from 12 688 survey respondents between September 2022 and April 2023 (11 174 in the COVID-19-positive group and 1514 in the control group).</p> </section> <section> <h3> Main outcome measures</h3> <p>Persistent new symptoms, recovery, and daily function using validated questionnaires for fatigue, neurocognitive symptoms, anxiety, depression and quality of life.</p> </section> <section> <h3> Results</h3> <p>At a mean of 12.6 months after infection, 4560 respondents in the COVID-19-positive group (39.1%; 95% CI, 37.9–40.3%) reported at least one persistent new symptom, compared with 216 respondents in the control group (20.8%; 95% CI, 18.5–23.1%). A total of 1656 respondents (14.2%; 95% CI, 13.4–15.0%) were classified as having clinical long COVID using the criteria of at least one persistent new symptom and less than 80% recovery three months after the infection. Of the respondents with clinical long COVID, 535 (3.2%; 95% CI, 2.6–3.8%) reported at least moderate problems with usual activities at 12 months after their infection. The proportion of respondents with clinical long COVID was lower for those with more recent infections. The risk factors for clinical long COVID were female sex, age 40–49 years, infection severity, chronic illness, and past anxiety or depression. Factors associated with a decreased risk of having clinical long COVID included infection when the Omicron strain was dominant and infection when the Delta strain was dominant, as compared with when the ancestral strain of the virus was dominant.</p> </section> <section> <h3> Conclusion</h3> <p>Persistent symptoms after COVID-19 are common, though with a lower incidence following infection from less virulent strains. Although long COVID can be largely managed in primary care, a minority of people who have persistent symptoms and impaired function may require specialist care pathways, the effectiveness of which should be
目的确定冠状病毒病2019(COVID-19)后持续症状对澳大利亚人群的影响:我们在全州范围内对确诊感染过急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)的成年人(COVID-19 阳性组)及其密切接触者(对照组)进行了分层随机抽样健康调查。样本来自维多利亚州 COVID-19 数据库,时间跨度为 2020 年 1 月至 2022 年 10 月。2022 年 9 月至 2023 年 4 月期间,从 12 688 名调查对象中收集了数据(COVID-19 阳性组 11 174 人,对照组 1514 人):主要结果指标:持续新症状、恢复情况以及日常功能,使用有效问卷调查疲劳、神经认知症状、焦虑、抑郁和生活质量:感染后平均 12.6 个月,COVID-19 阳性组中有 4560 名受访者(39.1%;95% CI,37.9-40.3%)报告了至少一种持续性新症状,而对照组中有 216 名受访者(20.8%;95% CI,18.5-23.1%)报告了至少一种持续性新症状。共有 1656 名受访者(14.2%;95% CI,13.4-15.0%)被归类为临床长期慢性阻塞性肺病患者,其标准是至少有一种持续的新症状,并且在感染三个月后痊愈率低于 80%。在患有临床长期 COVID 的受访者中,有 535 人(3.2%;95% CI,2.6-3.8%)在感染 12 个月后表示在日常活动方面至少存在中度问题。感染时间较短的受访者出现临床长期 COVID 的比例较低。女性、40-49 岁、感染严重程度、慢性疾病、既往焦虑或抑郁是临床长期 COVID 的风险因素。临床长COVID风险降低的相关因素包括:与祖先病毒株占优势时相比,奥米克龙株占优势时的感染和德尔塔株占优势时的感染:结论:COVID-19 病毒感染后出现持续症状很常见,但感染毒性较低的毒株时发病率较低。虽然长效 COVID 基本上可以在初级保健中得到控制,但少数有持续症状和功能受损的患者可能需要专科护理途径,其有效性应成为未来研究的重点。
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