Medical Journal of Australia最新文献

{"title":"Inequity of access to voluntary assisted dying for New Zealand citizens residing permanently in Australia.","authors":"Christopher J Barlow","doi":"10.5694/mja2.52519","DOIUrl":"https://doi.org/10.5694/mja2.52519","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583185","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}

{"title":"Beyond acute infection: mechanisms underlying post-acute sequelae of COVID-19 (PASC)","authors":"Anurag Adhikari,&nbsp;Janesha Maddumage,&nbsp;Emily M Eriksson,&nbsp;Sarah J Annesley,&nbsp;Victoria A Lawson,&nbsp;Vanessa L Bryant,&nbsp;Stephanie Gras","doi":"10.5694/mja2.52456","DOIUrl":"10.5694/mja2.52456","url":null,"abstract":"<p>\u0000 \u0000 </p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S9","pages":"S40-S48"},"PeriodicalIF":6.7,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52456","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568902","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}

{"title":"The crux of modern health care challenges","authors":"Michael Skilton","doi":"10.5694/mja2.52488","DOIUrl":"10.5694/mja2.52488","url":null,"abstract":"&lt;p&gt;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 &lt;i&gt;MJA&lt;/i&gt; covers a broad range of subjects that could be considered some of the most critical challenges in modern health and health care.&lt;/p&gt;&lt;p&gt;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 &lt;i&gt;MJA&lt;/i&gt;, 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.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 9","pages":"451"},"PeriodicalIF":6.7,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52488","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564685","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}

{"title":"An allied health model of care for long COVID rehabilitation","authors":"Joanne M Wrench,&nbsp;Leigh R Seidel Marks","doi":"10.5694/mja2.52457","DOIUrl":"10.5694/mja2.52457","url":null,"abstract":"&lt;p&gt;Although the acute disease burden of coronavirus disease 2019 (COVID-19) in Australia has reduced, the longer term impacts are becoming increasingly apparent.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; The health impact at a population level is significant, with between 10% and 20% of people having persistent symptoms after a COVID-19 infection.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Patient testimonies describe the devastating impact of symptoms left untreated by health services.&lt;span&gt;&lt;sup&gt;6, 7&lt;/sup&gt;&lt;/span&gt; The functional sequalae of long COVID include reduced quality of life&lt;span&gt;&lt;sup&gt;8, 9&lt;/sup&gt;&lt;/span&gt; and difficulty engaging in normal life roles, including family, work and caring responsibilities.&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;As the world has returned to normal, many people living with long COVID continue to report feeling left behind and isolated by persistent symptoms.&lt;span&gt;&lt;sup&gt;12&lt;/sup&gt;&lt;/span&gt; Alongside this, many people report feeling ignored or not believed by health care providers, who often struggle to pinpoint physiological impairment and associated treatments.&lt;span&gt;&lt;sup&gt;13&lt;/sup&gt;&lt;/span&gt; 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.&lt;/p&gt;&lt;p&gt;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.&lt;span&gt;&lt;sup&gt;14&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;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.&lt;span&gt;&lt;sup&gt;15, 16&lt;/sup&gt;&lt;/span&gt; In this regard, Australian and international guidelines recommend multidisciplinary and coordinated allied health care as a practice standard for people with long COVID,&lt;span&gt;&lt;sup&gt;17, 18&lt;/sup&gt;&lt;/span&gt; and there is emerging evidence of corresponding functional improvement.&lt;span&gt;&lt;sup&gt;19, 20&lt;/sup&gt;&lt;/span&gt; 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","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S9","pages":"S5-S9"},"PeriodicalIF":6.7,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52457","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568873","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}

{"title":"Living with long COVID and its impact on family and society: a couple's view","authors":"Karlie M Flannigan,&nbsp;Gerard M Flannigan","doi":"10.5694/mja2.52466","DOIUrl":"10.5694/mja2.52466","url":null,"abstract":"&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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).&lt;/p&gt;&lt;p&gt;During my whole time in hospital, my husband and youngest son also had COVID-19. They were in home iso","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S9","pages":"S10-S11"},"PeriodicalIF":6.7,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52466","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569024","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}

{"title":"The economic burden of long COVID in Australia: more noise than signal?","authors":"Mary Rose Angeles,&nbsp;Thi Thu Ngan Dinh,&nbsp;Ting Zhao,&nbsp;Barbara de Graaff,&nbsp;Martin Hensher","doi":"10.5694/mja2.52468","DOIUrl":"10.5694/mja2.52468","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To estimate the potential economic burden of long COVID in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The working age Australian population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S9","pages":"S31-S39"},"PeriodicalIF":6.7,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52468","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569050","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}

{"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":"221 S9","pages":"S18-S22"},"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}

{"title":"Long COVID in Victoria","authors":"David A Watters,&nbsp;Lance Emerson","doi":"10.5694/mja2.52467","DOIUrl":"10.5694/mja2.52467","url":null,"abstract":"&lt;p&gt;An editorial in the &lt;i&gt;Medical Journal of Australia&lt;/i&gt; 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”.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; In this issue of the &lt;i&gt;MJA&lt;/i&gt;, we publish the supplement &lt;i&gt;The impact of long COVID in Victoria 2020–2023&lt;/i&gt;. 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.&lt;/p&gt;&lt;p&gt;The 2022–23 parliamentary inquiry into long COVID, &lt;i&gt;Sick and tired, casting a long shadow&lt;/i&gt;, 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.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; 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&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;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”.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;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”.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; In this editorial, and throughout the supplement","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S9","pages":"S3-S4"},"PeriodicalIF":6.7,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52467","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568984","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}

{"title":"Five decades of debate on burnout.","authors":"Renzo Bianchi, James F Sowden","doi":"10.5694/mja2.52512","DOIUrl":"https://doi.org/10.5694/mja2.52512","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568794","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}

{"title":"Persistent symptoms after COVID-19: an Australian stratified random health survey on long COVID","authors":"Alex Holmes,&nbsp;Lance Emerson,&nbsp;Louis B Irving,&nbsp;Emma Tippett,&nbsp;Jeffrey M Pullin,&nbsp;Julie Young,&nbsp;David A Watters,&nbsp;Adina Hamilton","doi":"10.5694/mja2.52473","DOIUrl":"10.5694/mja2.52473","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To determine the impact of persistent symptoms after coronavirus disease 2019 (COVID-19) in an Australian population.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design, setting, participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Main outcome measures&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Persistent new symptoms, recovery, and daily function using validated questionnaires for fatigue, neurocognitive symptoms, anxiety, depression and quality of life.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S9","pages":"S12-S17"},"PeriodicalIF":6.7,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52473","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569006","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}