Medical Journal of Australia最新文献

Restrictions on social media access for users under 16 years raise a critical question about how adolescents in Australia will access sexual and reproductive health (SRH) information, especially where traditional systems often fall short. Social media has become an important source of SRH education, offering timely and relatable content that bridges gaps left by formal education and healthcare. As access to these platforms is restricted, other pathways must be strengthened. This includes investing in comprehensive in- and out-of-school sexuality education, youth-friendly primary care services and safe digital platforms designed with and for adolescents.

Genomic newborn screening (gNBS) can screen for a broad range of genetic conditions, potentially enabling early treatment and improving health outcomes. However, it remains outside publicly funded programmes due to limited evidence and substantial implementation challenges. Offering gNBS in the interim as a fee-for-service option in Australia risks creating inequitable healthcare access, fragmenting care and limiting control over genomic data. Conversely, prohibiting private access may unfairly deny potential benefits to individual infants and families. This article discusses the ethical and practical implications of offering gNBS on a fee-for-service basis prior to a decision being made regarding public funding. Although fee-for-service gNBS undermines equitable access, regulated private offerings by public genomics services could mitigate some of the risks. We emphasise the need for large-scale, well-designed research studies to inform the development and equitable implementation of robust gNBS programmes within public healthcare frameworks.

An older man with Crohn's disease underwent emergency laparotomy for small bowel perforation. A peri-incisional vesiculobullous eruption developed 5 days later. Histopathology demonstrated viral cytopathic changes, immunohistochemistry was positive for herpes simplex virus and HSV-1 DNA confirmed by polymerase chain reaction test, representing the first reported case of localised herpes simplex following abdominal surgery.

A 41-year-old woman presented to the emergency department with a widespread pruritic, erythematous eruption following 6 weeks of kava consumption for anxiety and insomnia. The eruption began on the abdomen and progressively involved the chest, upper back and face. Laboratory investigations revealed mild derangement of liver function test results. Skin biopsy results demonstrated folliculocentric inflammation and necrosis of sebaceous glands, consistent with acute kava dermopathy. Kava, a traditional anxiolytic herbal preparation, has been implicated in both chronic and acute cutaneous reactions, including ichthyosiform and sebotropic eruptions. Its active compounds, kavalactones, are hypothesised to provoke a cytotoxic T-cell–mediated response targeting sebaceous glands. This case is notable as it occurred in an Australian woman with no travel history to the Pacific Islands—a region where kava use is prevalent. Moreover, the distinct histopathological findings, rarely documented in the literature, provide valuable diagnostic insight and serve as a visual reference for clinicians encountering this condition.

Over recent decades, the medical profession has undergone significant changes due to the influence of managerialism, which is characterised by standardisation, efficiency and cost control. Although these principles aim to improve sustainability and transparency within healthcare systems, they often conflict with fundamental aspects of medical professionalism and patient-centred care. This perspective explores how managerialism may negatively affect the medical profession, focussing on its impact on clinician autonomy, the changing nature of medical work, professional identity and collegial relationships within hospital settings. Key challenges faced by doctors include diminishing control over patient care, growing administrative burden, increasing burn-out, erosion of professional values and identity, and fragmentation of collegiality. To address these issues, this perspective advocates for institutional change such as hybrid governance models that integrate professional and managerial expertise to ensure managerial goals remain aligned with clinical realities. Professional bodies and institutions should empower doctors with managerial and leadership competencies to influence organisational change, reconcile clinical and managerial priorities, and uphold professional values and quality patient care within the evolving healthcare landscape. Effective reform requires the considerate integration of managerial systems into healthcare to strengthen, rather than undermine, the professional foundations and ethical values that give medicine its integrity and meaning.