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Future Healthy Countdown 2030: from passive trickle-down to active participation for improved health and wellbeing of children, young people and future generations 未来健康倒计时 2030：从被动涓滴到积极参与，改善儿童、青年和后代的健康和福祉。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Medical Journal of Australia
Pub Date : 2024-11-17 DOI: 10.5694/mja2.52491
Kevin Kapeke, Anne Hollonds, Susan Maury
<p>What is it like to be growing up in Australia? Although Australia is one of the wealthiest countries in the world, health and wellbeing measures are not only stalling for many children and young people, but they are actually moving backwards in some domains.<span><sup>1</sup></span></p><p>This is because the safety, health and wellbeing of children are not a national priority and there is a lack of government accountability for evidence-based reform. This was demonstrated in an analysis of 12 years of Royal Commissions and inquiries, which found thousands of recommendations repeated over this time.<span><sup>2</sup></span></p><p>Regarded as the responsibility of states and territories, unlike other important issues, children appear nowhere on the list of priorities for the National Cabinet. It is a choice to not address the social determinants of health and wellbeing. We wait until a crisis or a crime compels a reaction. Politics is getting in the way of prevention, leaving our most vulnerable children behind as victims of “federation failure”.<span><sup>2</sup></span></p><p>At its core, this tragedy is due to a lack of respect for the human rights of children and young people. Despite ratifying the United Nations Convention on the Rights of the Child in 1990 (https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-child), we have failed to incorporate their rights into Australia's laws.</p><p>Rather than centring and respecting the human rights of children and young people, Australia relies on the deeply flawed trickle-down approach, allowing policy to be dominated by the limited concerns of adults. This compromises the future wellbeing of children and of our communities, as well as limiting the health, development, learning and wellbeing of too many children right now. To turn this around, we need to look closely at the evidence and work together across the federation, making child safety, health and wellbeing a priority for the National Cabinet.</p><p>Health is inextricably linked to environment. Since the framing of social determinants of health was first introduced,<span><sup>3</sup></span> the concept has expanded to include political,<span><sup>4</sup></span> commercial,<span><sup>5</sup></span> digital<span><sup>6</sup></span> and environmental determinants of health,<span><sup>7</sup></span> among other framings. The human world is complex, incorporating multiple spheres, all of which influence health and wellbeing. The greatest burden from unhealthy environments rests on the young.</p><p>The Future Healthy Countdown 2030 documents what is going wrong for children, young people and future generations and, also, what needs urgent action to turn things around. The Countdown was introduced in a 2023 supplement published in the <i>Medical Journal of Australia</i>.<span><sup>1</sup></span> Seven domains capture the complex forces that influence physical health, mental health and wellbeing for children, young people an
今年的主题是 "参与"，这些文章探讨了在不同年龄、不同发展阶段（0-24 岁）和不同环境下，参与如何改善儿童和青少年的健康和福祉。在一篇以青年为主导的文章中，Kapeke 及其同事10 讨论了将投票年龄降至 16 岁可如何减轻因青年无权制定影响其健康和福祉的政策决定而造成的伤害，这一点在与 2019 年冠状病毒病（COVID-19）大流行相关的封锁期间暴露无遗。贝塞尔及其同事11 有说服力地指出，中童年期（6 至 12 岁）儿童在学校或家庭以外的社区环境中的直接互动受到限制。土著居民和托雷斯海峡岛民儿童及青少年的身体和心理健康状况不佳，这远远超出了他们的承受能力，而这种负担很大程度上可直接归咎于殖民化以及故意剥夺他们对直接影响其生活的事务的积极发言权和参与权。科里及其同事12 讨论了库里青年理事会如何为有意义的、符合文化习俗的对话、参与和表达机构提供代表和支持。Koorie 青年理事会由原住民青年管理，并为原住民青年服务；它提供了与政府和其他相关机构直接接触的渠道，还开发了资源以支持在其他环境中进行文化上安全的接触。这篇文章为设计和实施青年参与计划提出了基于证据的建议，这些建议优先考虑保护青年参与者的心理健康和福祉。蒙哥马利（Montgomery）及其同事14 提供了一份证据综述，说明澳大利亚越来越多的儿童和家庭中心（这些中心在同一地点办公并整合了各种服务）是如何让儿童以一种安全、量身定制且无污名化的方式参与早期干预护理服务的。通过跨角色、跨领域和跨世代的合作，我们的愿景是通过确定以证据和人权为基础的具体、实际和可实现的行动，优先考虑澳大利亚儿童和青少年的健康和福祉。该倡议将继续以儿童和青少年的视角和声音为中心，呼吁政策制定者考虑各领域政策对下一代健康和福祉的长期影响。凯文-卡佩克（Kevin Kapeke）和苏珊-莫里（Susan Maury）受雇于维多利亚州健康促进基金会。凯文-卡佩克（Kevin Kapeke）和苏珊-莫里（Susan Maury）受雇于维多利亚州健康促进基金会，安妮-霍隆兹（Anne Hollonds）是澳大利亚人权委员会国家儿童专员。
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引用次数: 0
Wellbeing, participation and connection in the middle years of childhood 童年中期的幸福、参与和联系。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Medical Journal of Australia
Pub Date : 2024-11-17 DOI: 10.5694/mja2.52495
Sharon Bessell, Tim Moore, Gerry Redmond
<p>Ensuring the health and wellbeing of children is a fundamental societal goal, which is best achieved when children are connected to their communities, have opportunities for meaningful participation, and enjoy strong and supportive relationships across generations, within and beyond their families. This means investing in individual children and families and in their communities. It also means creating communities that are inclusive of children and actively providing pathways for children to participate in a range of social and civic activities. The purpose of this article is to highlight the relationship between participation, health and wellbeing, for children aged in the middle years.</p><p>Middle childhood, defined here as between six and 12 years of age, corresponds with primary school. But children's lives are characterised by more than school. During middle childhood, children begin to gain independence while remaining strongly connected to their families, yet children's place is often understood to be either the family or school. Limiting children's domains to family and school has resulted in the privatisation of childhood and in their exclusion from public spaces, with deleterious impacts on social relationships.<span><sup>1</sup></span> Loneliness among children in middle childhood may result from a lack of social connection and has serious implications for health and wellbeing.<span><sup>2</sup></span> These concerns are exacerbated in a context of polycrisis encompassing challenges to children's wellbeing and mental health, from climate change to conflict, failing systems across welfare, education and health care and declining standards of living.<span><sup>3</sup></span> Given the significance of middle childhood and complexity within which children live, there has been insufficient policy consideration of children's lives beyond school and family. Yet engagement with community, beyond school and family, is essential for children's sense of belonging, and their overall health and wellbeing.<span><sup>4</sup></span> Without policy support, children's engagement with community is especially challenging for those whose families are under stress or experiencing financial hardship.</p><p>Our argument here is twofold. First there is a need for policies and services to be more responsive to middle childhood. In Australia, there is a strong and justifiable focus on the early years. Yet, as we create the conditions in which children and their families can thrive during the early years of life, we need to take care not to create a policy and service cliff as children move into middle childhood. Our second argument is that efforts to foster children's health and wellbeing must consider how to build child-inclusive communities that are welcoming to children and in which children can actively participate in ways that are meaningful to them. The Future Healthy Countdown 2030<span><sup>5</sup></span> presents an opportunity to advocate for chil
确保儿童的健康和福祉是一项基本的社会目标，而要实现这一目标，最好的办法是让儿童与社区建立联系，有机会进行有意义的参与，并在家庭内外享受跨代的强有力的支持关系。这意味着对儿童和家庭个人及其社区进行投资。这也意味着要创建包容儿童的社区，积极为儿童提供参与各种社会和公民活动的途径。本文旨在强调中年期儿童的参与、健康和幸福之间的关系。中年期在这里被定义为 6 至 12 岁，与小学相对应。但儿童生活的特点不仅仅是上学。童年中期，儿童开始获得独立，同时与家庭保持紧密联系，但儿童的位置通常被理解为家庭或学校。将儿童的领域局限于家庭和学校，导致了童年的私有化，使他们被排斥在公共空间之外，对社会关系产生了有害影响1 。3 鉴于中年期儿童的重要性和儿童生活的复杂性，政策对儿童在学校和家庭之外的生活考虑不足。4 如果没有政策支持，对于那些家庭压力大或经济困难的儿童来说，参与社区活动尤其具有挑战性。首先，政策和服务需要更加适应中年儿童的需要。在澳大利亚，对幼儿期的重视是有道理的。然而，当我们创造条件让儿童及其家庭在生命早期茁壮成长时，我们需要注意不要在儿童步入童年中期时造成政策和服务悬崖。我们的第二个论点是，促进儿童健康和幸福的努力必须考虑如何建设包容儿童的社区，这些社区欢迎儿童，儿童可以以对他们有意义的方式积极参与其中。未来健康倒计时 2030》5 为我们提供了一个机会，以倡导儿童在童年中期的发展，并建设包容儿童的社区，为儿童创造参与社会和公民生活的途径。在澳大利亚和全球范围内，对幼年期的政策关注是有大量证据支持的。8 在过去十年中，政策重点已扩展到教育、健康和福利方面。2024 年 5 月推出的《国家幼儿战略》就是一个很好的例证，该战略倡导的愿景是 "澳大利亚所有儿童都能在幼儿时期茁壮成长。9 "澳大利亚早期发展普查"（Australian Early Development Census）在儿童发展的主要方面提供了有力的数据（https://www.aedc.gov.au）；国家 "衡量重要事项框架"（Measuring What Matters Framework）（https://treasury.gov.au/policy-topics/measuring-what-matters）包含了一系列幼儿期指标，而且还设立了幼儿教育部长一职，所有这些都表明，确保儿童在最初的五年中得到良好支持的承诺日益坚定。然而，在澳大利亚和全球的政策中，却忽视了儿童中期在提供从幼年到青年的关键桥梁方面的作用。国家青年办公室 (https://www.youth.gov.au/) 的目标是将青年与政府联系起来，在制定政策和计划时创造真正参与和合作的机会。国家青年战略 Engage！(https://www.youth.gov.au/engage) 将青年定义为 12-24 岁的人。青年办公室指导委员会由 13-24 岁的青年组成，青年咨询小组由 16-25 岁的青年组成，就一系列政策问题提供建议。11 尽管这些发展值得欢迎，但它们也凸显了澳大利亚 6 岁至青春期早期的青少年在政策方面的巨大差距。中间环节缺失。
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引用次数: 0
Aboriginal and Torres Strait Islander infants admitted to the Hunter New England neonatal intensive care unit, 2016-2021: a retrospective medical record audit. 2016-2021年亨特新英格兰新生儿重症监护室收治的土著和托雷斯海峡岛民婴儿：回顾性病历审计。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Medical Journal of Australia
Pub Date : 2024-11-17 DOI: 10.5694/mja2.52533
Jessica Bennett, Michelle Kennedy, Jamie Bryant, Amanual Mersha, Larissa Korostenski, Michelle Stubbs, Justine Parsons, Luke Wakely
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引用次数: 0
Beware of the rinse: magic mouthwash as a rare cause of iatrogenic Cushing syndrome and secondary adrenal insufficiency. 小心漱口水：神奇漱口水是引起先天性库欣综合征和继发性肾上腺功能不全的罕见原因。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Medical Journal of Australia
Pub Date : 2024-11-14 DOI: 10.5694/mja2.52523
Mike Lin, Lisa Horgan, Albert Hsieh
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引用次数: 0
The New South Wales Pharmacy Trial for herpes zoster: on the nose? 治疗带状疱疹的新南威尔士药房试验：在鼻子上？
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Medical Journal of Australia
Pub Date : 2024-11-13 DOI: 10.5694/mja2.52531
Christian P Pappas, Timothy R Holmes, Minas T Coroneo
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引用次数: 0
Participation in the National Bowel Cancer Screening Program by people with severe mental illness, Australia, 2006-2019: a national data linkage study. 2006-2019年澳大利亚重性精神病患者参与全国肠癌筛查计划的情况：一项全国数据链接研究。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Medical Journal of Australia
Pub Date : 2024-11-13 DOI: 10.5694/mja2.52521
Steve Kisely, Rebecca Seth, Susan J Jordan, Bradley Kendall, Dan J Siskind, Grant Sara, Justin Chapman, Lisa Brophy, David M Lawrence

Objective: To compare rates of participation in the National Bowel Cancer Screening Program (NBCSP) and follow-up for people with severe mental illness with those for people without severe mental illness or not prescribed antidepressants.

Study design: Retrospective cohort study; analysis of de-identified linked NBCSP, Pharmaceutical Benefits Scheme (PBS), and Medicare Benefits Schedule (MBS) data.

Setting: Australia, 2006-2019.

Participants: People aged 50-74 years (NBCSP-eligible) with severe mental illness, defined as those dispensed two or more prescriptions for second generation antipsychotics or for lithium (PBS data), and a random sample of people aged 50-74 years eligible for Medicare-subsidised services but never prescribed psychotropic medications (antipsychotics, lithium, antidepressants).

Main outcome measures: NBCSP participation (returned faecal occult blood test sample), valid test result, positive test result, and follow-up colonoscopy rates.

Results: A total of 119 475 people with severe mental illness and 1 090 574 control group people were included in our analyses. The proportion of women was larger in the severe mental illness group (51.3%) than the control group (48.7%), as were the proportions who lived in inner regional areas (23.5% v 19.1%) or in areas in the lowest socio-economic quintile (21.8% v 14.7%). The NBCSP participation rate was lower among people with severe mental illness (adjusted incidence rate ratio [IRR], 0.70; 95% confidence interval [CI], 0.69-0.84). The proportion of valid test results was smaller for people with severe mental illness (95.9% v 98.7%; adjusted IRR, 0.97; 95% CI, 0.96-0.99), and the positive test result proportion larger (12.3% v 6.6%; adjusted IRR, 2.01; 95% CI, 1.94-2.09). The proportion of positive test results followed by colonoscopy was smaller for people with severe mental illness (71.7% v 82.6%; adjusted IRR, 0.88; 95% CI, 0.85-0.92).

Conclusions: People with severe mental illness were less likely to participate in the NBCSP or to undergo colonoscopy after a positive test result than other Australians. These differences may contribute to higher colorectal cancer mortality among people with severe mental illness. The contributions of differences in cancer stage at diagnosis and subsequent treatment to higher colorectal cancer mortality require further study.

研究目的比较重性精神病患者与非重性精神病患者或未服用抗抑郁药的患者参与国家肠癌筛查计划（NBCSP）的比例和随访情况：研究设计：回顾性队列研究；分析去标识化的关联NBCSP、药品福利计划（PBS）和医疗保险福利表（MBS）数据：澳大利亚，2006-2019年：年龄在 50-74 岁之间（符合 NBCSP 条件）的重性精神病患者，定义为开具过两次或两次以上第二代抗精神病药物处方或锂剂处方的患者（PBS 数据），以及随机抽样的年龄在 50-74 岁之间、符合 Medicare 补贴服务条件但从未开具过精神药物（抗精神病药物、锂剂、抗抑郁药）的患者：主要结果测量指标：NBCSP参与率（返回的粪便隐血试验样本）、有效试验结果、阳性试验结果和后续结肠镜检查率：共有 119 475 名重症精神病患者和 1 090 574 名对照组患者参与了我们的分析。重症精神病患者中女性的比例（51.3%）高于对照组（48.7%），居住在内城地区（23.5% 对 19.1%）或社会经济地位最低的五分之一地区（21.8% 对 14.7%）的女性比例也高于对照组。严重精神病患者的 NBCSP 参与率较低（调整后的发病率比 [IRR] 为 0.70；95% 置信区间 [CI]，0.69-0.84）。重度精神病患者的有效检测结果比例较低（95.9% 对 98.7%；调整后的发生率比为 0.97；95% 置信区间为 0.96-0.99），阳性检测结果比例较高（12.3% 对 6.6%；调整后的发生率比为 2.01；95% 置信区间为 1.94-2.09）。重度精神病患者在检测结果呈阳性后再进行结肠镜检查的比例较小（71.7% 对 82.6%；调整后的 IRR，0.88；95% CI，0.85-0.92）：结论：与其他澳大利亚人相比，患有严重精神疾病的人参加NBCSP或在检测结果呈阳性后接受结肠镜检查的可能性较低。这些差异可能是导致严重精神病患者结直肠癌死亡率较高的原因。至于癌症诊断阶段和后续治疗的差异对结肠直肠癌死亡率升高的影响，还需要进一步研究。
{"title":"Participation in the National Bowel Cancer Screening Program by people with severe mental illness, Australia, 2006-2019: a national data linkage study.","authors":"Steve Kisely, Rebecca Seth, Susan J Jordan, Bradley Kendall, Dan J Siskind, Grant Sara, Justin Chapman, Lisa Brophy, David M Lawrence","doi":"10.5694/mja2.52521","DOIUrl":"https://doi.org/10.5694/mja2.52521","url":null,"abstract":"<p><strong>Objective: </strong>To compare rates of participation in the National Bowel Cancer Screening Program (NBCSP) and follow-up for people with severe mental illness with those for people without severe mental illness or not prescribed antidepressants.</p><p><strong>Study design: </strong>Retrospective cohort study; analysis of de-identified linked NBCSP, Pharmaceutical Benefits Scheme (PBS), and Medicare Benefits Schedule (MBS) data.</p><p><strong>Setting: </strong>Australia, 2006-2019.</p><p><strong>Participants: </strong>People aged 50-74 years (NBCSP-eligible) with severe mental illness, defined as those dispensed two or more prescriptions for second generation antipsychotics or for lithium (PBS data), and a random sample of people aged 50-74 years eligible for Medicare-subsidised services but never prescribed psychotropic medications (antipsychotics, lithium, antidepressants).</p><p><strong>Main outcome measures: </strong>NBCSP participation (returned faecal occult blood test sample), valid test result, positive test result, and follow-up colonoscopy rates.</p><p><strong>Results: </strong>A total of 119 475 people with severe mental illness and 1 090 574 control group people were included in our analyses. The proportion of women was larger in the severe mental illness group (51.3%) than the control group (48.7%), as were the proportions who lived in inner regional areas (23.5% v 19.1%) or in areas in the lowest socio-economic quintile (21.8% v 14.7%). The NBCSP participation rate was lower among people with severe mental illness (adjusted incidence rate ratio [IRR], 0.70; 95% confidence interval [CI], 0.69-0.84). The proportion of valid test results was smaller for people with severe mental illness (95.9% v 98.7%; adjusted IRR, 0.97; 95% CI, 0.96-0.99), and the positive test result proportion larger (12.3% v 6.6%; adjusted IRR, 2.01; 95% CI, 1.94-2.09). The proportion of positive test results followed by colonoscopy was smaller for people with severe mental illness (71.7% v 82.6%; adjusted IRR, 0.88; 95% CI, 0.85-0.92).</p><p><strong>Conclusions: </strong>People with severe mental illness were less likely to participate in the NBCSP or to undergo colonoscopy after a positive test result than other Australians. These differences may contribute to higher colorectal cancer mortality among people with severe mental illness. The contributions of differences in cancer stage at diagnosis and subsequent treatment to higher colorectal cancer mortality require further study.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Decolonisation, Indigenous health research and Indigenous authorship: sharing our teams' principles and practices. 非殖民化、土著健康研究和土著作者身份：分享我们团队的原则和实践。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Medical Journal of Australia
Pub Date : 2024-11-11 DOI: 10.5694/mja2.52509
Pat Dudgeon Bardi, Helen Milroy Palyku, Belle Selkirk Noongar, Ashleigh Wright Nunga, Kahli Regan Wongi And Noongar, Shraddha Kashyap, Rama Agung-Igusti, Joanna Alexi, Abigail Bray, Joan Chan, Ee Pin Chang, Sze Wing Georgiana Cheuk, Jemma Collova, Kate Derry, Chontel Gibson Gamilaraay
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引用次数: 0
Interventions for Aboriginal and Torres Strait Islander people with type 2 diabetes that modify its management and cardiometabolic risk factors: a systematic review. 针对原住民和托雷斯海峡岛民 2 型糖尿病患者采取干预措施，以改变其管理和心脏代谢风险因素：系统性综述。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Medical Journal of Australia
Pub Date : 2024-11-10 DOI: 10.5694/mja2.52508
Ciying Tan, Zoe Williams, Mohammad Ashraful Islam, Ray Kelly, Tuguy Esgin, Elif I Ekinci

Objectives: To review studies of interventions for reducing the impact of type 2 diabetes in Aboriginal and Torres Strait Islander people. The primary aim was to review and summarise the characteristics and findings of the interventions. The secondary aims were to assess their effects on diabetes and cardiometabolic risk factors, and the proportions of people with type 2 diabetes who achieved therapeutic targets with each intervention.

Study design: We searched eight electronic databases for publications of studies including Aboriginal or Torres Strait Islander people aged 15 years or older with diagnoses of type 2 diabetes, describing one or more diabetes interventions, and published in English during 1 January 2000 - 31 December 2020. Reference lists in the assessed articles were checked for further relevant publications.

Data sources: MEDLINE (Ovid), Web of Science (Clarivate), the Cochrane Library, Global Health (EBSCO), Indigenous Collection and Indigenous Australia (Informit), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP).

Results: The database searches yielded 1424 unique records; after screening by title and abstract, the full text of 55 potentially relevant articles were screened, of which seventeen met our eligibility criteria: eleven cohort studies (seven retrospective audits and four prospective studies), three randomised controlled trials, and three observational, non-randomised follow-up studies. Twelve publications reported site-based (Aboriginal or Torres Strait Islander health service or diabetes clinic) rather than individual-based diabetes interventions. Interventions with statistically significant effects on mean glycated haemoglobin (HbA1c) levels were laparoscopic adjustable gastric banding, a 5-day diabetes self-management camp, treatment of Strongyloides stercoralis infections, community-based health worker-led management, point-of-care testing, and self-management approaches.

Conclusions: Few interventions for Aboriginal and Torres Strait Islander people with type 2 diabetes have been reported in peer-reviewed publications. Improving diabetes care services resulted in larger proportions of people achieving therapeutic HbA1c targets. Outcomes were better when Aboriginal and Torres Strait Islander communities were involved at all levels of an intervention. High quality studies of holistic, culturally safe and accessible interventions should be the focus of research.

目的回顾有关减少 2 型糖尿病对土著居民和托雷斯海峡岛民影响的干预措施的研究。主要目的是回顾和总结干预措施的特点和结果。次要目的是评估干预措施对糖尿病和心脏代谢风险因素的影响，以及通过每种干预措施达到治疗目标的 2 型糖尿病患者的比例：我们在八个电子数据库中检索了 2000 年 1 月 1 日至 2020 年 12 月 31 日期间用英语发表的研究论文，其中包括年龄在 15 岁或以上、确诊为 2 型糖尿病的原住民或托雷斯海峡岛民，并介绍了一种或多种糖尿病干预措施。数据来源：MEDLINE（Ovid）：数据来源：MEDLINE (Ovid)、Web of Science (Clarivate)、Cochrane Library、Global Health (EBSCO)、Indigenous Collection and Indigenous Australia (Informit)、Cumulative Index to Nursing and Allied Health Literature (CINAHL)、World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP)：通过数据库检索获得了 1424 条唯一记录；经过标题和摘要筛选后，筛选出 55 篇潜在相关文章的全文，其中 17 篇符合我们的资格标准：11 篇队列研究（7 篇回顾性审计和 4 篇前瞻性研究）、3 篇随机对照试验和 3 篇观察性非随机随访研究。有 12 篇文献报道了基于地点（原住民或托雷斯海峡岛民医疗服务机构或糖尿病诊所）而非个人的糖尿病干预措施。对平均糖化血红蛋白（HbA1c）水平有显著统计学影响的干预措施包括腹腔镜可调节胃束带术、为期5天的糖尿病自我管理营、治疗盘尾丝虫病感染、社区卫生工作者主导的管理、护理点检测以及自我管理方法：在同行评审的出版物中，针对土著居民和托雷斯海峡岛民 2 型糖尿病患者的干预措施鲜有报道。改善糖尿病护理服务可使更多患者达到治疗性 HbA1c 目标。当土著居民和托雷斯海峡岛民社区参与到干预措施的各个层面时，效果会更好。对整体性、文化安全性和可及性干预措施的高质量研究应成为研究重点。
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引用次数: 0
“If you build it, they will come”: the convergence of funding, research and collaboration in paediatric brain cancer clinical trials "如果你建造了它，他们就会来"：儿科脑癌临床试验中资金、研究与合作的融合。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Medical Journal of Australia
Pub Date : 2024-11-07 DOI: 10.5694/mja2.52506
Jordan Hansford, Santosh Valvi, Jasper de Boer, Geoff McCowage, Dinisha Govender, Maria Kirby, David Ziegler, Neevika Manoharan, Timothy Hassall, Brandon Wainwright, Frank Alvaro, Paul J Wood, David Eisenstat, Dong Anh Khuong Quang, Misty Jenkins, Matthew Dun, Stephen J Laughton, Raelene Endersby, Andrew Dodgshun, Nicholas Gottardo
<p>Each year, approximately 1000 children in Australia and New Zealand, aged 0–14 years, are diagnosed with cancer. Despite paediatric cancer accounting for less than 1% of all cancer cases, the impact on their families and communities is profound and disproportionate.<span><sup>1-3</sup></span> Paediatric brain cancers are the most significant cause of cancer-related deaths within this age group, responsible for 40% of fatalities despite representing only 14% of diagnoses.<span><sup>2</sup></span> Although significant advances in paediatric cancer treatments have pushed overall cure rates above 80%, the outlook for many brain tumour types remains bleak.<span><sup>4</sup></span> Moreover, survivors often face lifelong clinical sequelae that severely diminish their quality of life,<span><sup>5</sup></span> with 60% of survivors unable to reach independence in adulthood.<span><sup>6</sup></span> This stark reality underscores the need for the expansion of clinical trials and integrated preclinical research aimed at improving outcomes for these individuals.</p><p>Conducting clinical trials in paediatric oncology faces many challenges, notably in regions with small populations spread across large geographic areas. Additional challenges include the rarity of each diagnosis, requiring international collaboration for patient accrual within feasible timelines.<span><sup>7-9</sup></span> The limited duration and availability of grant funding complicates this, as the time for patient accrual and the generation of meaningful outcome data often surpasses funding periods. The specificity of diagnoses and the need for complex, multi-agent therapies reduce the appeal of these trials to pharmaceutical companies, which favour single-drug therapies. This necessitates consistent funding to maintain a skilled workforce in clinical trial conduct and monitoring. In this context, the Australian and New Zealand Children's Haematology/Oncology Group (ANZCHOG) and the Australian Brain Cancer Mission (ABCM)<span><sup>10</sup></span> have been addressing these challenges. By strategically deploying funds and fostering collaborations, ABCM and ANZCHOG have tackled the barriers that hinder clinical trial execution. ABCM provides the financial support needed for partnerships and trial capacity enhancement. ANZCHOG leads in navigating the challenges of paediatric oncology trials, building a network that overcomes logistical and financial constraints to facilitate progress and discovery.</p><p>Initiated in 2017 with the targeted mission of enhancing brain cancer outcomes, the ABCM strategically mobilises resources, collaborations and research with the goal to double brain cancer survival rates.<span><sup>10</sup></span> This mission is supported by a detailed strategic framework, blending substantial financial backing with extensive stakeholder engagement and a co-funded model that unites government, philanthropic and private sectors. This strategy not only amplifies research fu
COZMOS评估了新的联合治疗方案，旨在提高侵袭性脑癌患儿的存活率，而INFORM2 NivEnt则开创了一种精准医疗方法，根据个体肿瘤的遗传特征量身定制治疗方案。ANZCHOG参与国际联盟的范围显著扩大，在与儿童肿瘤组织（COG）8和国际儿科肿瘤学会（SIOP）9等国际合作组织现有合作的基础上，又新增了6个合作伙伴关系（方框3）。这使得澳大利亚和新西兰的儿童能够参与更多的全球临床试验，尤其是创新性的早期试验。这种国际性确保了澳大拉西亚儿童肿瘤学始终处于全球研究工作的前沿，从该领域的世界性进展中获益并为之做出贡献。这些试验组合证明了澳大利亚中枢神经系统肿瘤研究组（ANZCHOG CNS Tumour Group）和澳大利亚中枢神经系统肿瘤协会（ABCM）的战略规划，强调了基础设施资金对执行复杂临床试验的至关重要性，并突出了国际合作在扩大研究范围和影响方面的重要作用。通过这些合作举措，参与临床试验的门槛大大降低，使更多人有机会获得创新治疗。18 尽管在 ABCM 和 ANZCHOG 中枢神经系统肿瘤小组的共同努力下，儿科脑癌临床试验取得了长足进步，但前进的道路上仍充满了操作和后勤方面的挑战。资源限制仍然是一个重大障碍，约 67% 的临床研究人员的资金来自外部非运营资源（ANZCHOG 数据），这凸显了对慈善事业和外部赠款的依赖性。资金的短暂性，以及相当一部分临床研究助理和临床研究护士的短期合同，加剧了招聘和留住人才的挑战，导致他们流向行业，阻碍了临床试验运营的灵活性和连续性。这些挑战突出表明，有必要在 ABCM 之外建立持续的战略性资助机制，以保持当前的发展势头。对多样化治疗方案的需求，特别是在标准治疗无法满足需求时对研究疗法的需求，凸显了持续增加研究和临床试验投资的重要性。这种承诺对于满足社区对临床试验的期望至关重要，尤其是对于预后具有挑战性的疾病，以确保家庭能够找到希望，而不必承受到国外寻求治疗的负担。在战略合作和定向资助的支持下，迄今为止所取得的成就为我们树立了榜样。要在此基础上再接再厉，就必须通过创新的资助模式、灵活的监管和加强国际合作伙伴关系来应对现有的挑战。我们的目标是创建一个持续资助的生态系统，不仅推动儿科脑癌研究，而且激励更广泛的儿科肿瘤学界采取类似举措。这一愿景既是美好的，也是可以实现的，持续的投资将成为临床试验成功新时代的催化剂，最终改变这些儿童和家庭的生活。
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引用次数: 0
Defining the gap, emphasising the deficit. 确定差距，强调不足。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Medical Journal of Australia
Pub Date : 2024-11-07 DOI: 10.5694/mja2.52518
Bridie Mulholland
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引用次数: 0
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