Thileepan Naren, Damien Linnane, Dallas Widdicombe, Jocelyn Chan, Stuart Kinner
Healthcare in Australian custodial settings is hampered by fragmented care, a lack of consistent standards and a lack of accountability. Creating national minimum standards for healthcare in custodial settings, with the aim of equivalence to community standards, will be an important step in reducing health inequalities for some of Australia's most marginalised people.
{"title":"The Need for National Minimum Healthcare Standards in Australian Custodial Settings","authors":"Thileepan Naren, Damien Linnane, Dallas Widdicombe, Jocelyn Chan, Stuart Kinner","doi":"10.5694/mja2.70116","DOIUrl":"10.5694/mja2.70116","url":null,"abstract":"<div>\u0000 \u0000 <p>Healthcare in Australian custodial settings is hampered by fragmented care, a lack of consistent standards and a lack of accountability. Creating national minimum standards for healthcare in custodial settings, with the aim of equivalence to community standards, will be an important step in reducing health inequalities for some of Australia's most marginalised people.</p>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 1","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781601","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}
There is consistent evidence of who is more likely to practise in a rural location; however, current selection criteria used by most specialty colleges do not reflect this. In fact, our evidence-based perspective article shows how specialty selection is likely driving many rural interested graduates away from rural pathways, perhaps never to return post-fellowship. The Australian Government has strongly invested in rural training, with greatly increased opportunities for end-to-end pathways and raised awareness of social accountability of training programs. However, specialty training pathways have been slow to change the selection criteria, which should align with supporting workforce diversity and distribution into rural areas. We highlight potentially untapped opportunities to directly address workforce distribution that require negligible financial costs to change criteria and processes.
{"title":"Specialty College Selection: Why Change is Critical to Support a Future Rural Workforce","authors":"Matthew R. McGrail, Jenny May AM, Katherine Logan","doi":"10.5694/mja2.70121","DOIUrl":"10.5694/mja2.70121","url":null,"abstract":"<div>\u0000 \u0000 <p>There is consistent evidence of who is more likely to practise in a rural location; however, current selection criteria used by most specialty colleges do not reflect this. In fact, our evidence-based perspective article shows how specialty selection is likely driving many rural interested graduates away from rural pathways, perhaps never to return post-fellowship. The Australian Government has strongly invested in rural training, with greatly increased opportunities for end-to-end pathways and raised awareness of social accountability of training programs. However, specialty training pathways have been slow to change the selection criteria, which should align with supporting workforce diversity and distribution into rural areas. We highlight potentially untapped opportunities to directly address workforce distribution that require negligible financial costs to change criteria and processes.</p>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 1","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781596","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}
Saman Khalatbari-Soltani, Edward Jegasothy, Seye Abimbola, Anita van Zwieten
The burden of disease estimates from the Australian Institute of Health and Welfare are influential in driving priorities for actions across research, policy and practice. Following the latest estimates in 2024, much attention focused on top risk factors including obesity, tobacco and diet. Meanwhile, upstream social, economic and political drivers were overlooked. In this perspective, we argue that to effectively move the dial on disease burden, we must shift our focus from downstream action on individual-level risk factors to upstream action on structural causes. Failure to do so represents a missed opportunity to improve population health and tackle health inequity.
{"title":"Inequity Is Our Biggest Killer: Looking Upstream to Tackle the Burden of Disease in Australia","authors":"Saman Khalatbari-Soltani, Edward Jegasothy, Seye Abimbola, Anita van Zwieten","doi":"10.5694/mja2.70119","DOIUrl":"10.5694/mja2.70119","url":null,"abstract":"<div>\u0000 \u0000 <p>The burden of disease estimates from the Australian Institute of Health and Welfare are influential in driving priorities for actions across research, policy and practice. Following the latest estimates in 2024, much attention focused on top risk factors including obesity, tobacco and diet. Meanwhile, upstream social, economic and political drivers were overlooked. In this perspective, we argue that to effectively move the dial on disease burden, we must shift our focus from downstream action on individual-level risk factors to upstream action on structural causes. Failure to do so represents a missed opportunity to improve population health and tackle health inequity.</p>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 1","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781606","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":"Implementing Voluntary-Assisted Dying in New South Wales Correctional Settings","authors":"Daniel Mogg, Michael H. Levy","doi":"10.5694/mja2.70118","DOIUrl":"10.5694/mja2.70118","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 1","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145763122","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}
Harriet Hiscock, Cecilia Moore, Sonia Khano, Lena A. Sanci, Kim M. Dalziel, Gary Freed, Douglas I. R. Boyle, Tammy Meyers Morris, Siaw-Teng Liaw, Jane Le, Yvonne A. Zurynski, Susan Woolfenden, Raghu Lingam
<div> <section> <h3> Objectives</h3> <p>To assess the effectiveness of Strengthening Care for Children (SC4C) for reducing the number of referrals by general practitioners of patients under 18 years of age to hospital services.</p> </section> <section> <h3> Study Design</h3> <p>Stepped-wedge cluster randomised trial; data collected for up to 16 months after the intervention.</p> </section> <section> <h3> Setting</h3> <p>General practices in North Western Melbourne and Central and Eastern Sydney primary health networks, 1 May 2021–30 September 2023.</p> </section> <section> <h3> Participants</h3> <p>General practitioners who worked at least two clinical sessions each week, saw patients under 18 years of age, and for whom at least 1 month of referrals data during the control period were available; families of people under 18 years attending these practices.</p> </section> <section> <h3> Intervention</h3> <p>Weekly (6 months) then fortnightly (6 months) general practitioner–paediatrician co-consultations; monthly paediatrician-led case discussions; weekday phone and email support by paediatricians.</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Proportion of general practitioner visits in which patients were referred to publicly funded hospital outpatient clinics or emergency departments (patient level), overall and by baseline referral rate. Secondary outcomes: Referrals after completion of the intervention; general practitioner confidence regarding child health care; low value care for frequent childhood conditions; family preference for general practitioner or paediatrician care.</p> </section> <section> <h3> Results</h3> <p>One hundred and thirty participating general practitioners from 22 general practices conducted 50,101 consultations during the control period; 125 general practitioners from 21 general practices received the intervention and undertook 96,804 consultations. Patients were referred to hospitals in 2.3% of control period consultations and 1.9% of intervention period consultations (risk difference, −0.34 [95% confidence interval {CI}, −0.69 to 0.004] percentage points). Among general practitioners with high referral rates at baseline (5% or higher), patients were referred to hospital outpatient or emergency department i
{"title":"Strengthening Care for Children (SC4C), an Integrated Paediatrician–General Practitioner Model for Reducing Hospital Referral Rates: A Stepped-Wedge Cluster Randomised Controlled Trial","authors":"Harriet Hiscock, Cecilia Moore, Sonia Khano, Lena A. Sanci, Kim M. Dalziel, Gary Freed, Douglas I. R. Boyle, Tammy Meyers Morris, Siaw-Teng Liaw, Jane Le, Yvonne A. Zurynski, Susan Woolfenden, Raghu Lingam","doi":"10.5694/mja2.70115","DOIUrl":"10.5694/mja2.70115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the effectiveness of Strengthening Care for Children (SC4C) for reducing the number of referrals by general practitioners of patients under 18 years of age to hospital services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Stepped-wedge cluster randomised trial; data collected for up to 16 months after the intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>General practices in North Western Melbourne and Central and Eastern Sydney primary health networks, 1 May 2021–30 September 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>General practitioners who worked at least two clinical sessions each week, saw patients under 18 years of age, and for whom at least 1 month of referrals data during the control period were available; families of people under 18 years attending these practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Intervention</h3>\u0000 \u0000 <p>Weekly (6 months) then fortnightly (6 months) general practitioner–paediatrician co-consultations; monthly paediatrician-led case discussions; weekday phone and email support by paediatricians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Proportion of general practitioner visits in which patients were referred to publicly funded hospital outpatient clinics or emergency departments (patient level), overall and by baseline referral rate. Secondary outcomes: Referrals after completion of the intervention; general practitioner confidence regarding child health care; low value care for frequent childhood conditions; family preference for general practitioner or paediatrician care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred and thirty participating general practitioners from 22 general practices conducted 50,101 consultations during the control period; 125 general practitioners from 21 general practices received the intervention and undertook 96,804 consultations. Patients were referred to hospitals in 2.3% of control period consultations and 1.9% of intervention period consultations (risk difference, −0.34 [95% confidence interval {CI}, −0.69 to 0.004] percentage points). Among general practitioners with high referral rates at baseline (5% or higher), patients were referred to hospital outpatient or emergency department i","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 1","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12799393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145757049","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":"Mandatory research projects during medical specialist training in Australia and New Zealand","authors":"Samuel J White","doi":"10.5694/mja2.70110","DOIUrl":"https://doi.org/10.5694/mja2.70110","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 11","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695303","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":"Mandatory research projects during medical specialist training in Australia and New Zealand","authors":"Laura Ross, Jessica Day","doi":"10.5694/mja2.70112","DOIUrl":"https://doi.org/10.5694/mja2.70112","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 11","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695304","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}
Paulina Stehlik, Caitlin Brandenburg, David A Henry
{"title":"Mandatory research projects during medical specialist training in Australia and New Zealand","authors":"Paulina Stehlik, Caitlin Brandenburg, David A Henry","doi":"10.5694/mja2.70111","DOIUrl":"https://doi.org/10.5694/mja2.70111","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 11","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695305","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}
<p>This issue of the <i>MJA</i> is especially large and diverse. One reason for the size of the issue is because of some process changes that we are making to how we publish, which will kick in at the beginning of 2026. We will be describing more about these changes on the Journal website over the next few weeks, including what you should expect for the Journal’s look and feel in 2026. However, the content mix and our priorities will not change and I’d like to use some of wide range of content in this issue to reflect on some of the areas that we see as our priorities to publish on.</p><p>The research article by Verlis and colleagues on greenhouse gas emissions associated with anaesthetic gases<span><sup>1</sup></span> highlights one of our longstanding interests — the now very well established association between climate change and health outcomes. This article reports that between 2002 and 2022, the main anaesthetic gas that contributed to greenhouse gas emissions in Australia was desflurane, and that reduction in its use since 2017 was associated with a reduction in the overall emissions rate associated with anaesthetic gases. This article is a good example of the type of research that needs to be actively encouraged for us to build a comprehensive knowledge base of how the causes of climate change can be understood and how actions to mitigate them can be developed, particularly within the health sector.</p><p>A research article by Francia and colleagues on the epidemiology of acute rheumatic fever (ARF) and rheumatic heart disease (RHD)<span><sup>2</sup></span> is especially important because this disease, which has an unacceptably large burden in Aboriginal and Torres Strait Islander populations, is almost entirely preventable. As the authors say, “the significant ARF and RHD burden among Indigenous Queenslanders, and vast disparity with non-Indigenous populations, calls for an urgent whole-of-government response”. We agree. One of the Journal highlights of the year was the second NAIDOC week issue led by a team of Indigenous Guest Editors, a process that has helped the Journal commit to prioritising work on Indigenous health led by Indigenous researchers and communities. This year we were also very honoured to be presented with the artwork from Uncle Paul Scott that was displayed on the Journal’s cover, and to meet his community. The editorial from that issue “Indigenous Health Special Issue 2025: carving our path with spirit, strength and solidarity” powerfully explained that issue’s purpose — and an ongoing priority for the <i>MJA</i> “to prioritise, platform, and celebrate Aboriginal and Torres Strait Islander leadership and excellence through health, clinical and academic dialogue”.<span><sup>3</sup></span></p><p>A research article by Ey and colleagues on non-technical errors associated with deaths in surgical care<span><sup>4</sup></span> also reflects a key interest for the Journal, which is the importance of culture in medical practi
{"title":"Celebrating the diversity of publishing in the MJA and the MJA community in 2025","authors":"Virginia Barbour","doi":"10.5694/mja2.70113","DOIUrl":"https://doi.org/10.5694/mja2.70113","url":null,"abstract":"<p>This issue of the <i>MJA</i> is especially large and diverse. One reason for the size of the issue is because of some process changes that we are making to how we publish, which will kick in at the beginning of 2026. We will be describing more about these changes on the Journal website over the next few weeks, including what you should expect for the Journal’s look and feel in 2026. However, the content mix and our priorities will not change and I’d like to use some of wide range of content in this issue to reflect on some of the areas that we see as our priorities to publish on.</p><p>The research article by Verlis and colleagues on greenhouse gas emissions associated with anaesthetic gases<span><sup>1</sup></span> highlights one of our longstanding interests — the now very well established association between climate change and health outcomes. This article reports that between 2002 and 2022, the main anaesthetic gas that contributed to greenhouse gas emissions in Australia was desflurane, and that reduction in its use since 2017 was associated with a reduction in the overall emissions rate associated with anaesthetic gases. This article is a good example of the type of research that needs to be actively encouraged for us to build a comprehensive knowledge base of how the causes of climate change can be understood and how actions to mitigate them can be developed, particularly within the health sector.</p><p>A research article by Francia and colleagues on the epidemiology of acute rheumatic fever (ARF) and rheumatic heart disease (RHD)<span><sup>2</sup></span> is especially important because this disease, which has an unacceptably large burden in Aboriginal and Torres Strait Islander populations, is almost entirely preventable. As the authors say, “the significant ARF and RHD burden among Indigenous Queenslanders, and vast disparity with non-Indigenous populations, calls for an urgent whole-of-government response”. We agree. One of the Journal highlights of the year was the second NAIDOC week issue led by a team of Indigenous Guest Editors, a process that has helped the Journal commit to prioritising work on Indigenous health led by Indigenous researchers and communities. This year we were also very honoured to be presented with the artwork from Uncle Paul Scott that was displayed on the Journal’s cover, and to meet his community. The editorial from that issue “Indigenous Health Special Issue 2025: carving our path with spirit, strength and solidarity” powerfully explained that issue’s purpose — and an ongoing priority for the <i>MJA</i> “to prioritise, platform, and celebrate Aboriginal and Torres Strait Islander leadership and excellence through health, clinical and academic dialogue”.<span><sup>3</sup></span></p><p>A research article by Ey and colleagues on non-technical errors associated with deaths in surgical care<span><sup>4</sup></span> also reflects a key interest for the Journal, which is the importance of culture in medical practi","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 11","pages":"553-555"},"PeriodicalIF":8.5,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695302","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}
Natalie Nanayakkara, Sharon Atkinson-Briggs, Alicia J Jenkins, Neale D Cohen
{"title":"Rethinking diabetes care for Indigenous Australians: the need for Indigenous-codesigned and led diabetes models of care","authors":"Natalie Nanayakkara, Sharon Atkinson-Briggs, Alicia J Jenkins, Neale D Cohen","doi":"10.5694/mja2.70108","DOIUrl":"10.5694/mja2.70108","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 11","pages":"560-564"},"PeriodicalIF":8.5,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534492","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}
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