Louise Wilson, Tessa Copp, Martha Hickey, Bec Jenkinson, Susan J Jordan, Rachel Thompson, Gita D Mishra, Jenny A Doust
<div> <section> <h3> Objectives</h3> <p>To estimate the prevalence of heavy menstrual bleeding among Australian women from young adulthood to midlife (22–48 years) and investigate the characteristics of women who experience this condition; to investigate the relationship of heavy menstrual bleeding and health-related quality of life.</p> </section> <section> <h3> Study design</h3> <p>Longitudinal cohort survey study (Australian Longitudinal Study on Women's Health, ALSWH).</p> </section> <section> <h3> Setting, participants</h3> <p>Australia; baseline cohort of 14 247 women born during 1973–1978, recruited in 1996; eight post-baseline surveys undertaken at 3-year intervals, 2000–2021.</p> </section> <section> <h3> Main outcome measures</h3> <p>Self-reported frequency of heavy menstrual bleeding during the preceding twelve months (never/rarely, sometimes, often); frequency of heavy menstrual bleeding by socio-demographic, behavioural, health, and reproduction-related characteristics; mean physical and mental health-related quality of life scores (36-item Short Form health survey, SF-36) by frequency of heavy menstrual bleeding. Results are weighted to adjust for oversampling of participants from rural and remote areas.</p> </section> <section> <h3> Results</h3> <p>Data for 11 311 respondents to at least one ALSWH post-baseline survey were included in our prevalence analysis. The prevalence of sometimes or often experiencing heavy menstrual bleeding increased from 17.6% at age 22 years (124 of 691 respondents) to 32.1% at 48 years (359 of 1132 respondents); the proportion who reported often experiencing the condition increased from 6.1% (45 participants) to 12.1% (136 participants). The likelihood of often experiencing heavy menstrual bleeding increased with body mass index (40 kg/m<sup>2</sup> or greater <i>v</i> 18.5–24.9 kg/m<sup>2</sup>: risk ratio [RR], 2.27; 95% confidence interval [CI], 1.93–2.67), and was greater for respondents who reported low iron levels (RR, 2.26; 95% CI, 2.03–2.51) or endometriosis (RR, 2.29; 95% CI, 2.06–2.54). Similar associations were seen for sometimes experiencing heavy bleeding. Mean health-related quality of life scores for women who reported heavy menstrual bleeding were lower in all domains and for the summary mental health and physical health scores than for women who reported never or rarely experiencing the condition; the differences were greater for women who often experienced heavy menstrual bleeding.</p>
{"title":"Women who experience heavy menstrual bleeding: prevalence and characteristics from young adulthood to midlife, Australia, 2000–2021: a longitudinal cohort survey study","authors":"Louise Wilson, Tessa Copp, Martha Hickey, Bec Jenkinson, Susan J Jordan, Rachel Thompson, Gita D Mishra, Jenny A Doust","doi":"10.5694/mja2.52596","DOIUrl":"10.5694/mja2.52596","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To estimate the prevalence of heavy menstrual bleeding among Australian women from young adulthood to midlife (22–48 years) and investigate the characteristics of women who experience this condition; to investigate the relationship of heavy menstrual bleeding and health-related quality of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Longitudinal cohort survey study (Australian Longitudinal Study on Women's Health, ALSWH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Australia; baseline cohort of 14 247 women born during 1973–1978, recruited in 1996; eight post-baseline surveys undertaken at 3-year intervals, 2000–2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Self-reported frequency of heavy menstrual bleeding during the preceding twelve months (never/rarely, sometimes, often); frequency of heavy menstrual bleeding by socio-demographic, behavioural, health, and reproduction-related characteristics; mean physical and mental health-related quality of life scores (36-item Short Form health survey, SF-36) by frequency of heavy menstrual bleeding. Results are weighted to adjust for oversampling of participants from rural and remote areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data for 11 311 respondents to at least one ALSWH post-baseline survey were included in our prevalence analysis. The prevalence of sometimes or often experiencing heavy menstrual bleeding increased from 17.6% at age 22 years (124 of 691 respondents) to 32.1% at 48 years (359 of 1132 respondents); the proportion who reported often experiencing the condition increased from 6.1% (45 participants) to 12.1% (136 participants). The likelihood of often experiencing heavy menstrual bleeding increased with body mass index (40 kg/m<sup>2</sup> or greater <i>v</i> 18.5–24.9 kg/m<sup>2</sup>: risk ratio [RR], 2.27; 95% confidence interval [CI], 1.93–2.67), and was greater for respondents who reported low iron levels (RR, 2.26; 95% CI, 2.03–2.51) or endometriosis (RR, 2.29; 95% CI, 2.06–2.54). Similar associations were seen for sometimes experiencing heavy bleeding. Mean health-related quality of life scores for women who reported heavy menstrual bleeding were lower in all domains and for the summary mental health and physical health scores than for women who reported never or rarely experiencing the condition; the differences were greater for women who often experienced heavy menstrual bleeding.</p>\u0000 ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 4","pages":"191-197"},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52596","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066788","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}
Melanie Wong, Bradley Gardiner, Rob Stirling, Golsa Adabi, Brooke Riley, Jyotika D Prasad, GregoryI Snell
{"title":"Putting international practice into action: the first case of lung transplantation for COVID-19 in Victoria, Australia","authors":"Melanie Wong, Bradley Gardiner, Rob Stirling, Golsa Adabi, Brooke Riley, Jyotika D Prasad, GregoryI Snell","doi":"10.5694/mja2.52597","DOIUrl":"10.5694/mja2.52597","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 4","pages":"179-180"},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066785","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>Programs for Aboriginal and Torres Strait Islander people for improving the modifiable risk factors of tobacco smoking, nutrition, alcohol consumption, physical activity, and social and emotional wellbeing can reduce the prevalence of chronic disease.<span><sup>1</sup></span> However, health promotion programs have typically focused on the individual level rather than broader actions, such as establishing supportive environments or reorienting health care services.<span><sup>1</sup></span> To facilitate health equity for Aboriginal and Torres Strait Islander people, these actions must take into account both the social and the cultural determinants of health and wellbeing.<span><sup>2</sup></span></p><p>In this issue of the <i>MJA</i>, Dissanayake and colleagues assessed the effects on chronic disease risk factors of a novel dietary and lifestyle program that incorporates traditional knowledge and practices, the Hope for Health program, in a single-arm trial in a remote northeast Arnhem Land Yolŋu community.<span><sup>3</sup></span> The program was co-designed with a group of senior Yolŋu women, and had been successfully piloted. Strong Aboriginal ownership, governance, and cultural approaches were apparent. At the start of the trial, the 55 adult participants were overweight or obese (based on their body mass index [BMI] or waist circumference); by the end of the four-month program, desirable changes in chronic disease risk factors had been achieved, including in anthropometric (weight, BMI, waist circumference) and some cardiometabolic health measures (reduced low-density lipoprotein cholesterol and glycated haemoglobin [HbA<sub>1c</sub>] levels). Median walking and moderate and vigorous physical activity also increased by more than 100 minutes per day for the 19 participants for whom analysable data were available. Some dietary improvements were also reported.<span><sup>3</sup></span></p><p>The single-arm design of the study by Dissanayake and colleagues was appropriate for the co-designed program. A recent review found that the number of experimental studies of diabetes interventions including Aboriginal and Torres Strait Islander participants was low.<span><sup>4</sup></span> However, the authors could report changes in diet, exercise, and metabolic biomarkers can only as being associated with the program; a direct causal effect cannot be assumed. Randomised controlled trials may not be the optimal study design for interventional research involving Aboriginal and Torres Strait Islander people because of problems related to bias, sample size, and ethics.<span><sup>5</sup></span> This view is consistent with decisions described by Dissanayake and colleagues that revised the study from a randomised controlled trial to a single arm format because of community concerns that participants allocated to the control arm could be at risk of health deterioration, and the desire for inclusive family participation.<span><sup>3</sup></span></p><p>A recen
{"title":"Embedding culture in co-designed chronic disease programs for Aboriginal and Torres Strait Islander people","authors":"Rona Macniven, Karla J Canuto","doi":"10.5694/mja2.52599","DOIUrl":"10.5694/mja2.52599","url":null,"abstract":"<p>Programs for Aboriginal and Torres Strait Islander people for improving the modifiable risk factors of tobacco smoking, nutrition, alcohol consumption, physical activity, and social and emotional wellbeing can reduce the prevalence of chronic disease.<span><sup>1</sup></span> However, health promotion programs have typically focused on the individual level rather than broader actions, such as establishing supportive environments or reorienting health care services.<span><sup>1</sup></span> To facilitate health equity for Aboriginal and Torres Strait Islander people, these actions must take into account both the social and the cultural determinants of health and wellbeing.<span><sup>2</sup></span></p><p>In this issue of the <i>MJA</i>, Dissanayake and colleagues assessed the effects on chronic disease risk factors of a novel dietary and lifestyle program that incorporates traditional knowledge and practices, the Hope for Health program, in a single-arm trial in a remote northeast Arnhem Land Yolŋu community.<span><sup>3</sup></span> The program was co-designed with a group of senior Yolŋu women, and had been successfully piloted. Strong Aboriginal ownership, governance, and cultural approaches were apparent. At the start of the trial, the 55 adult participants were overweight or obese (based on their body mass index [BMI] or waist circumference); by the end of the four-month program, desirable changes in chronic disease risk factors had been achieved, including in anthropometric (weight, BMI, waist circumference) and some cardiometabolic health measures (reduced low-density lipoprotein cholesterol and glycated haemoglobin [HbA<sub>1c</sub>] levels). Median walking and moderate and vigorous physical activity also increased by more than 100 minutes per day for the 19 participants for whom analysable data were available. Some dietary improvements were also reported.<span><sup>3</sup></span></p><p>The single-arm design of the study by Dissanayake and colleagues was appropriate for the co-designed program. A recent review found that the number of experimental studies of diabetes interventions including Aboriginal and Torres Strait Islander participants was low.<span><sup>4</sup></span> However, the authors could report changes in diet, exercise, and metabolic biomarkers can only as being associated with the program; a direct causal effect cannot be assumed. Randomised controlled trials may not be the optimal study design for interventional research involving Aboriginal and Torres Strait Islander people because of problems related to bias, sample size, and ethics.<span><sup>5</sup></span> This view is consistent with decisions described by Dissanayake and colleagues that revised the study from a randomised controlled trial to a single arm format because of community concerns that participants allocated to the control arm could be at risk of health deterioration, and the desire for inclusive family participation.<span><sup>3</sup></span></p><p>A recen","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 4","pages":"181-182"},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52599","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066779","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}
Hasthi UW Dissanayake, George Gurruwiwi, J Dhurrkay, Josh C Tynan, Sabine Braat, Benjamin Harrap, Tim Trudgen, Sarah Hanieh, Bronwyn Clark, Michaela Spencer, Michael Christie, Emma Tonkin, Emily Armstrong, Leonard C Harrison, John M Wentworth, Julie K Brimblecombe, Beverley-Ann Biggs
<div> <section> <h3> Objective</h3> <p>To evaluate the impact of a 4-month dietary and lifestyle program co-designed and led by Aboriginal and Torres Strait Islander people on weight and metabolic markers, diet, and physical activity in overweight and obese adults in a remote Indigenous community.</p> </section> <section> <h3> Study design</h3> <p>Single arm, pre–post intervention study.</p> </section> <section> <h3> Setting, participants</h3> <p>Adult residents (18–65 years) of a remote Northern Territory community with body mass index (BMI) values of at least 25 kg/m<sup>2</sup> or waist circumferences exceeding 94 cm (men) or 80 cm (women).</p> </section> <section> <h3> Intervention</h3> <p>Hope for Health, a culturally sensitive 4-month program supporting self-managed health improvement based on dietary and lifestyle change, 1 August to 30 November 2022.</p> </section> <section> <h3> Main outcome measures</h3> <p>Weight loss of at least 5%; changes in BMI, waist circumference, other metabolic markers (blood pressure, biomarkers of metabolic health and inflammation), diet, and physical activity; participant perceptions of the program.</p> </section> <section> <h3> Results</h3> <p>We assessed outcomes for 55 participants who completed weight assessments at both baseline and program end (mean age, 42.5 years [standard deviation, 10.1 years]; 36 women [65%]). Forty participants lost and 15 gained weight; overall mean weight loss was 1.5 kg (95% confidence interval [CI], 0.5–2.4 kg), and ten participants (18%; 95% CI, 9–31%) achieved at least 5% weight reduction. The mean change in BMI (53 participants) was –0.60 kg/m<sup>2</sup> (95% CI, –0.93 to –0.27 kg/m<sup>2</sup>), in waist circumference (53 participants) –3.2 cm (95% CI, –4.7 to –1.7 cm), and in low-density lipoprotein cholesterol level (37 participants) –0.28 mmol/L (95% CI, –0.47 to –0.08 mmol/L); the relative decline in the HbA<sub>1c</sub> level geometric mean (50 participants) was 11% (95% CI, 6–15%). The intake of breads and cereals (median change, –1.5 [95% CI, –2.0 to –1.0] serves/day) and sugar-sweetened beverages (–0.6 [95% CI, –1.4 to –0.1] serves/day) declined; the amount of moderate and vigorous physical activity increased by a median of 103 min/day (95% CI, 74–136 min/day; 19 participants). The program focus on integrating healthy bodies and networks of kin, healthy governance,
{"title":"Improving cardiometabolic risk factors in Aboriginal and Torres Strait Islander people in northeast Arnhem Land: single arm trial of a co-designed dietary and lifestyle program","authors":"Hasthi UW Dissanayake, George Gurruwiwi, J Dhurrkay, Josh C Tynan, Sabine Braat, Benjamin Harrap, Tim Trudgen, Sarah Hanieh, Bronwyn Clark, Michaela Spencer, Michael Christie, Emma Tonkin, Emily Armstrong, Leonard C Harrison, John M Wentworth, Julie K Brimblecombe, Beverley-Ann Biggs","doi":"10.5694/mja2.52593","DOIUrl":"10.5694/mja2.52593","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the impact of a 4-month dietary and lifestyle program co-designed and led by Aboriginal and Torres Strait Islander people on weight and metabolic markers, diet, and physical activity in overweight and obese adults in a remote Indigenous community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Single arm, pre–post intervention study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Adult residents (18–65 years) of a remote Northern Territory community with body mass index (BMI) values of at least 25 kg/m<sup>2</sup> or waist circumferences exceeding 94 cm (men) or 80 cm (women).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Intervention</h3>\u0000 \u0000 <p>Hope for Health, a culturally sensitive 4-month program supporting self-managed health improvement based on dietary and lifestyle change, 1 August to 30 November 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Weight loss of at least 5%; changes in BMI, waist circumference, other metabolic markers (blood pressure, biomarkers of metabolic health and inflammation), diet, and physical activity; participant perceptions of the program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We assessed outcomes for 55 participants who completed weight assessments at both baseline and program end (mean age, 42.5 years [standard deviation, 10.1 years]; 36 women [65%]). Forty participants lost and 15 gained weight; overall mean weight loss was 1.5 kg (95% confidence interval [CI], 0.5–2.4 kg), and ten participants (18%; 95% CI, 9–31%) achieved at least 5% weight reduction. The mean change in BMI (53 participants) was –0.60 kg/m<sup>2</sup> (95% CI, –0.93 to –0.27 kg/m<sup>2</sup>), in waist circumference (53 participants) –3.2 cm (95% CI, –4.7 to –1.7 cm), and in low-density lipoprotein cholesterol level (37 participants) –0.28 mmol/L (95% CI, –0.47 to –0.08 mmol/L); the relative decline in the HbA<sub>1c</sub> level geometric mean (50 participants) was 11% (95% CI, 6–15%). The intake of breads and cereals (median change, –1.5 [95% CI, –2.0 to –1.0] serves/day) and sugar-sweetened beverages (–0.6 [95% CI, –1.4 to –0.1] serves/day) declined; the amount of moderate and vigorous physical activity increased by a median of 103 min/day (95% CI, 74–136 min/day; 19 participants). The program focus on integrating healthy bodies and networks of kin, healthy governance,","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 4","pages":"183-190"},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52593","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066781","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}
Belinda Hengel, Rebecca J Guy, Dawn Casey, Lorraine Anderson, Kirsty Smith, Kelly Andrewartha, Tanya D Applegate, Amit Saha, Philip Cunningham, Lucas DeToca, William D Rawlinson, Marianne Martinello, Annie Tangey, Prital Patel, Mark DS Shephard, Susan Matthews, Louise Causer
<p>First Nations people experience high levels of chronic disease, resulting from a history of colonisation, institutional racism and policies that have disempowered participation in practices that would otherwise support health and wellbeing.<span><sup>1, 2</sup></span> In addition, First Nations people living in remote areas have limited access to primary and specialist care, hospital and pathology services and reduced infrastructure.<span><sup>3, 4</sup></span> These factors contribute to infectious diseases having a disproportionately greater impact on First Nations people living in remote areas compared with urban settings.<span><sup>4, 5</sup></span> Funded by the Australian Government and with First Nations-led governance, the Aboriginal and Torres Strait Islander COVID-19 Point-of-Care Testing Program (hereafter referred to as the program) was implemented in early 2020. Testing was conducted by primary care clinicians using the GeneXpert assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; Xpert Xpress SARS-CoV-2, Cepheid) enabling increased access to molecular-based testing, and therefore quicker results. The program rapidly became the world's largest decentralised SARS-CoV-2 molecular point-of-care (POC) testing network.<span><sup>6</sup></span> The program was delivered across three distinct epidemiological phases of the coronavirus disease 2019 (COVID-19) epidemic in Australia, each with associated public health responses (Box 1).</p><p>To inform future infectious disease pandemic preparedness and responses, we used an adapted POC testing framework,<span><sup>6</sup></span> based on the World Health Organization health system building blocks<span><sup>7</sup></span> to systematically review program documents, including standard operating procedures, internal team communications, and formal program updates to partners. The review process identified, collated and documented key recommendations. Box 2 shows the updated framework, which now includes workforce and training, results support, and reflects an enhanced focus on the community as central to program effectiveness.</p><p>The success of the COVID-19 response in First Nations communities in Australia is attributed to engagement and leadership by First Nations people.<span><sup>8, 9</sup></span> The program was overseen by the National Aboriginal and Torres Strait Islander Health Protection subcommittee (formerly the Aboriginal and Torres Strait Islander Advisory Group on COVID-19) of the Australian Health Protection Committee.<span><sup>10</sup></span> This group was made up of representatives from Aboriginal community-controlled health services, other First Nations experts and government; and was responsible for the co-design and oversight of the program, and final approval of protocols, expansions and allocation of testing resources. Consistent with National Pathology Accreditation Advisory Council (NPAAC) guidelines on POC testing,<span><sup>11</sup></span> the
{"title":"Decentralised COVID-19 molecular point-of-care testing: lessons from implementing a primary care-based network in remote Australian communities","authors":"Belinda Hengel, Rebecca J Guy, Dawn Casey, Lorraine Anderson, Kirsty Smith, Kelly Andrewartha, Tanya D Applegate, Amit Saha, Philip Cunningham, Lucas DeToca, William D Rawlinson, Marianne Martinello, Annie Tangey, Prital Patel, Mark DS Shephard, Susan Matthews, Louise Causer","doi":"10.5694/mja2.52589","DOIUrl":"10.5694/mja2.52589","url":null,"abstract":"<p>First Nations people experience high levels of chronic disease, resulting from a history of colonisation, institutional racism and policies that have disempowered participation in practices that would otherwise support health and wellbeing.<span><sup>1, 2</sup></span> In addition, First Nations people living in remote areas have limited access to primary and specialist care, hospital and pathology services and reduced infrastructure.<span><sup>3, 4</sup></span> These factors contribute to infectious diseases having a disproportionately greater impact on First Nations people living in remote areas compared with urban settings.<span><sup>4, 5</sup></span> Funded by the Australian Government and with First Nations-led governance, the Aboriginal and Torres Strait Islander COVID-19 Point-of-Care Testing Program (hereafter referred to as the program) was implemented in early 2020. Testing was conducted by primary care clinicians using the GeneXpert assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; Xpert Xpress SARS-CoV-2, Cepheid) enabling increased access to molecular-based testing, and therefore quicker results. The program rapidly became the world's largest decentralised SARS-CoV-2 molecular point-of-care (POC) testing network.<span><sup>6</sup></span> The program was delivered across three distinct epidemiological phases of the coronavirus disease 2019 (COVID-19) epidemic in Australia, each with associated public health responses (Box 1).</p><p>To inform future infectious disease pandemic preparedness and responses, we used an adapted POC testing framework,<span><sup>6</sup></span> based on the World Health Organization health system building blocks<span><sup>7</sup></span> to systematically review program documents, including standard operating procedures, internal team communications, and formal program updates to partners. The review process identified, collated and documented key recommendations. Box 2 shows the updated framework, which now includes workforce and training, results support, and reflects an enhanced focus on the community as central to program effectiveness.</p><p>The success of the COVID-19 response in First Nations communities in Australia is attributed to engagement and leadership by First Nations people.<span><sup>8, 9</sup></span> The program was overseen by the National Aboriginal and Torres Strait Islander Health Protection subcommittee (formerly the Aboriginal and Torres Strait Islander Advisory Group on COVID-19) of the Australian Health Protection Committee.<span><sup>10</sup></span> This group was made up of representatives from Aboriginal community-controlled health services, other First Nations experts and government; and was responsible for the co-design and oversight of the program, and final approval of protocols, expansions and allocation of testing resources. Consistent with National Pathology Accreditation Advisory Council (NPAAC) guidelines on POC testing,<span><sup>11</sup></span> the ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 4","pages":"172-178"},"PeriodicalIF":6.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52589","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066777","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}
<p>Several countries have legalised medicinal cannabis during the past two decades; more recently, some jurisdictions, including parts of the United States, Canada, and Uruguay, have legalised recreational cannabis.<span><sup>1</sup></span> Legislative models differ between countries, particularly with regard to access to medicinal cannabis, commercialisation, the availability of cannabis dispensaries, and cannabis-containing confectionery (“edibles”).<span><sup>2</sup></span></p><p>One potential harm of increased access to cannabis is poisoning. It is widely believed that cannabis is safe in overdose,<span><sup>3</sup></span> but it can cause central nervous system (CNS) excitation, CNS depression, hallucinations, psychosis, and cardiac dysrhythmias.<span><sup>4</sup></span> The risk of severe toxicity is greater for children, in whom it can lead to apnoea and coma; in one United States study, 32 of 60 children (0–10 years) hospitalised with cannabis intoxication required intensive care.<span><sup>5</sup></span> Several studies have reported increases in the number of poisonings following medicinal and recreational cannabis legalisation, particularly in children.<span><sup>6</sup></span> Edibles are particularly high risk products because of their palatability and the possibility of large ingestions.<span><sup>2</sup></span> Most reports on this problem are from North America.<span><sup>6</sup></span></p><p>In Australia, the medicinal use of cannabidiol (CBD) was legalised in June 2015, and that of cannabis and tetrahydrocannabinol (THC) in November 2016.<span><sup>7</sup></span> We therefore evaluated recent cannabis poisoning exposures in Australia, stratified by ingestion intent, age group, and product type. We analysed data from the New South Wales Poisons Information Centre (NSWPIC), which receives about 50% of all calls to Australian poisons information centres; 65% of calls are from within NSW, 35% from other states.<span><sup>8</sup></span> We extracted data on demographic and exposure characteristics, patient disposition, and cannabinoid product types for calls during 1 July 2014 – 30 June 2024. We calculated crude and age-adjusted population exposure call rates (Supporting Information, supplementary methods), and used Joinpoint regression (version 4.9.0.1) to estimate annual percentage changes (APCs) in age-adjusted rates and to detect trend change points. The study was approved by the Sydney Children's Hospitals Network Human Research Ethics Committee (2021/ETH00165).</p><p>There were 3796 calls about cannabis poisoning exposures (2039 regarding exposures of boys or men, 54%) during 2014–24. The exposed person exhibited symptoms of poisoning at the time of the call in 3184 cases (84% of calls); 2783 people (74%) were in hospital at the time of the call or were referred to hospital (Supporting Information, table 1). The number of calls increased during 2014–24 by 12.8% per year (95% confidence interval [CI], 10.3–15.4% per year), and n
{"title":"Cannabis poisonings in Australia following the legalisation of medicinal cannabis, 2014–24: analysis of NSW Poisons Information Centre data","authors":"Rose Cairns, Sara Allaf, Nicholas A Buckley","doi":"10.5694/mja2.52586","DOIUrl":"10.5694/mja2.52586","url":null,"abstract":"<p>Several countries have legalised medicinal cannabis during the past two decades; more recently, some jurisdictions, including parts of the United States, Canada, and Uruguay, have legalised recreational cannabis.<span><sup>1</sup></span> Legislative models differ between countries, particularly with regard to access to medicinal cannabis, commercialisation, the availability of cannabis dispensaries, and cannabis-containing confectionery (“edibles”).<span><sup>2</sup></span></p><p>One potential harm of increased access to cannabis is poisoning. It is widely believed that cannabis is safe in overdose,<span><sup>3</sup></span> but it can cause central nervous system (CNS) excitation, CNS depression, hallucinations, psychosis, and cardiac dysrhythmias.<span><sup>4</sup></span> The risk of severe toxicity is greater for children, in whom it can lead to apnoea and coma; in one United States study, 32 of 60 children (0–10 years) hospitalised with cannabis intoxication required intensive care.<span><sup>5</sup></span> Several studies have reported increases in the number of poisonings following medicinal and recreational cannabis legalisation, particularly in children.<span><sup>6</sup></span> Edibles are particularly high risk products because of their palatability and the possibility of large ingestions.<span><sup>2</sup></span> Most reports on this problem are from North America.<span><sup>6</sup></span></p><p>In Australia, the medicinal use of cannabidiol (CBD) was legalised in June 2015, and that of cannabis and tetrahydrocannabinol (THC) in November 2016.<span><sup>7</sup></span> We therefore evaluated recent cannabis poisoning exposures in Australia, stratified by ingestion intent, age group, and product type. We analysed data from the New South Wales Poisons Information Centre (NSWPIC), which receives about 50% of all calls to Australian poisons information centres; 65% of calls are from within NSW, 35% from other states.<span><sup>8</sup></span> We extracted data on demographic and exposure characteristics, patient disposition, and cannabinoid product types for calls during 1 July 2014 – 30 June 2024. We calculated crude and age-adjusted population exposure call rates (Supporting Information, supplementary methods), and used Joinpoint regression (version 4.9.0.1) to estimate annual percentage changes (APCs) in age-adjusted rates and to detect trend change points. The study was approved by the Sydney Children's Hospitals Network Human Research Ethics Committee (2021/ETH00165).</p><p>There were 3796 calls about cannabis poisoning exposures (2039 regarding exposures of boys or men, 54%) during 2014–24. The exposed person exhibited symptoms of poisoning at the time of the call in 3184 cases (84% of calls); 2783 people (74%) were in hospital at the time of the call or were referred to hospital (Supporting Information, table 1). The number of calls increased during 2014–24 by 12.8% per year (95% confidence interval [CI], 10.3–15.4% per year), and n","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 3","pages":"155-157"},"PeriodicalIF":6.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52586","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033489","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}
<p>Australia's health care system is grappling with a mismatch of demand and capacity, with bottlenecks in access to, and transitions of, care and rising costs.<span><sup>1</sup></span> Hospital-in-the-home (HITH) models of care are suggested as sustainable patient-centred, value-based solutions.<span><sup>2</sup></span></p><p>HITH is defined as a 24-hour, 7-days-a-week service of “acute inpatient equivalent care, utilising highly skilled staff, hospital technologies, equipment, medication, and safety and quality standards, to deliver hospital-level care within a person's place of residence or preferred (non-hospital) treatment location”.<span><sup>3</sup></span> HITH models vary in clinical governance, combination and frequency of in-person or telehealth visits, patient selection and clinician staffing.<span><sup>4-6</sup></span> When HITH substitutes for hospital location of care (admission avoidance, AA) are compared to early supported discharge (ESD) or other hospital outreach services, clinical outcomes and patient satisfaction are comparable or improved, and care is cost-effective.<span><sup>7, 8</sup></span> However, evidence describing those patients for whom HITH is optimal and processes to recognise and respond to deteriorating HITH patients remains limited.<span><sup>9, 10</sup></span></p><p>The Australian Commission on Safety and Quality in Health Care (ACSQHC) defines health service standards of care, including “recognising and responding to acute deterioration” in a patient's physical, cognitive or mental state.<span><sup>11</sup></span> Currently, systems for managing deteriorating patients focus on hospital-located patients with escalation when mismatches in “clinical needs and the local resources to manage them” are identified.<span><sup>12</sup></span> In hospitals with rapid response teams, rates of activation of these teams vary considerably (1.35–71.3 per 1000 admissions).<span><sup>13</sup></span> Mixed efficacy in improving patient outcomes is observed, with concern regarding cost-effectiveness, sustainability, disruption to usual hospital routines, mortality as an outcome measure, deskilling of ward staff, and the impact on patient-centred care and doctor–patient relationships, especially in end-of-life care.<span><sup>14</sup></span> Relevant to the current context, evidence shows an increased reliance on systems for managing deteriorating patients with increasing patient complexity, economic and hospital capacity stress, and a focus on patient flow.<span><sup>14</sup></span></p><p>HITH models of care attached to Australian health services are subject to ACSQHC safety and quality accreditation standards.<span><sup>11, 15</sup></span> Despite HITH being available in Australia for many years, gaps remain in translation of hospital systems to manage deteriorating patients to HITH locations of care, standardised definitions, and data collection, making audit, research, benchmarking and policy difficult.<span><sup>8, 16</sup><
{"title":"A future for the hospital-in-the-home (HITH) deteriorating patient: shifting the paradigm","authors":"Mya Cubitt, Seok Lim","doi":"10.5694/mja2.52588","DOIUrl":"10.5694/mja2.52588","url":null,"abstract":"<p>Australia's health care system is grappling with a mismatch of demand and capacity, with bottlenecks in access to, and transitions of, care and rising costs.<span><sup>1</sup></span> Hospital-in-the-home (HITH) models of care are suggested as sustainable patient-centred, value-based solutions.<span><sup>2</sup></span></p><p>HITH is defined as a 24-hour, 7-days-a-week service of “acute inpatient equivalent care, utilising highly skilled staff, hospital technologies, equipment, medication, and safety and quality standards, to deliver hospital-level care within a person's place of residence or preferred (non-hospital) treatment location”.<span><sup>3</sup></span> HITH models vary in clinical governance, combination and frequency of in-person or telehealth visits, patient selection and clinician staffing.<span><sup>4-6</sup></span> When HITH substitutes for hospital location of care (admission avoidance, AA) are compared to early supported discharge (ESD) or other hospital outreach services, clinical outcomes and patient satisfaction are comparable or improved, and care is cost-effective.<span><sup>7, 8</sup></span> However, evidence describing those patients for whom HITH is optimal and processes to recognise and respond to deteriorating HITH patients remains limited.<span><sup>9, 10</sup></span></p><p>The Australian Commission on Safety and Quality in Health Care (ACSQHC) defines health service standards of care, including “recognising and responding to acute deterioration” in a patient's physical, cognitive or mental state.<span><sup>11</sup></span> Currently, systems for managing deteriorating patients focus on hospital-located patients with escalation when mismatches in “clinical needs and the local resources to manage them” are identified.<span><sup>12</sup></span> In hospitals with rapid response teams, rates of activation of these teams vary considerably (1.35–71.3 per 1000 admissions).<span><sup>13</sup></span> Mixed efficacy in improving patient outcomes is observed, with concern regarding cost-effectiveness, sustainability, disruption to usual hospital routines, mortality as an outcome measure, deskilling of ward staff, and the impact on patient-centred care and doctor–patient relationships, especially in end-of-life care.<span><sup>14</sup></span> Relevant to the current context, evidence shows an increased reliance on systems for managing deteriorating patients with increasing patient complexity, economic and hospital capacity stress, and a focus on patient flow.<span><sup>14</sup></span></p><p>HITH models of care attached to Australian health services are subject to ACSQHC safety and quality accreditation standards.<span><sup>11, 15</sup></span> Despite HITH being available in Australia for many years, gaps remain in translation of hospital systems to manage deteriorating patients to HITH locations of care, standardised definitions, and data collection, making audit, research, benchmarking and policy difficult.<span><sup>8, 16</sup><","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 4","pages":"168-171"},"PeriodicalIF":6.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52588","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023798","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":"Shortages of benzathine benzylpenicillin G in Australia highlight the need for new sovereign manufacturing capability.","authors":"Rosemary Wyber, Glenn Pearson, Laurens Manning","doi":"10.5694/mja2.52590","DOIUrl":"https://doi.org/10.5694/mja2.52590","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007994","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}
Grace FitzGerald, Jon Cook, Peter Higgs, Charles Henderson, Sione Crawford, Thileepan Naren
<p>There is a need to improve access to and experiences of palliative care for people who use alcohol and other drugs when faced with terminal medical conditions. Effective harm reduction interventions mean that people who use alcohol and other drugs are living longer, and continue to use substances as older individuals.<span><sup>1-3</sup></span> People who use drugs demonstrate high levels of resilience in the face of a lifetime of structural disadvantage and exclusion, but are still more likely to die at an earlier age than the general population.<span><sup>4, 5</sup></span> They also experience accelerated age-related declines in functioning compared with non-drug using persons of similar age, and often have complex care needs due to accumulated health effects from their substance use and a high prevalence of past trauma.<span><sup>6</sup></span> The provision of palliative care to people who use drugs can be challenging for clinicians, specifically how to manage pain, anxiety and distress among these individuals.<span><sup>7</sup></span> Person-centred care is often obstructed by policies that make generalisations about the risks associated with the use of alcohol and other drugs while receiving medical care. Clinicians and health services looking to improve access to palliative care should integrate the perspectives of people with lived and living experience of drug use into their person-centred care and explore opportunities for the harms of stigma to be minimised. Box 1 provides a list of elements of person-centred care.</p><p>There is good evidence that early access to palliative care can improve the wellbeing of people with serious illness; however, structurally marginalised people face significant barriers to accessing palliative care.<span><sup>8, 9</sup></span> Some people who use drugs experience severe debility in their day-to-day lives and present to health services acutely symptomatic of advanced or terminal medical conditions that might have been contained with active management earlier in the disease process.<span><sup>10</sup></span> People who use alcohol and other drugs often receive palliative care following an emergency department presentation with symptoms of advanced disease, rather than being referred to palliative care services by primary care providers in the early phases of illness.<span><sup>11</sup></span> Delays in health care access and appropriate treatment are influenced by both anticipatory and experienced stigma.<span><sup>12, 13</sup></span> There is evidence that people who use drugs avoid presenting to health care services for fear of being judged, dismissed or disheartened by having their health concerns incorrectly assumed to be a consequence of their substance use.<span><sup>10, 12</sup></span> People who use drugs are further excluded from health care services by complex referral pathways and limited appreciation from clinicians of the multiple competing priorities of marginalised communities.<span><su
{"title":"Improving palliative care for people who use alcohol and other drugs","authors":"Grace FitzGerald, Jon Cook, Peter Higgs, Charles Henderson, Sione Crawford, Thileepan Naren","doi":"10.5694/mja2.52585","DOIUrl":"10.5694/mja2.52585","url":null,"abstract":"<p>There is a need to improve access to and experiences of palliative care for people who use alcohol and other drugs when faced with terminal medical conditions. Effective harm reduction interventions mean that people who use alcohol and other drugs are living longer, and continue to use substances as older individuals.<span><sup>1-3</sup></span> People who use drugs demonstrate high levels of resilience in the face of a lifetime of structural disadvantage and exclusion, but are still more likely to die at an earlier age than the general population.<span><sup>4, 5</sup></span> They also experience accelerated age-related declines in functioning compared with non-drug using persons of similar age, and often have complex care needs due to accumulated health effects from their substance use and a high prevalence of past trauma.<span><sup>6</sup></span> The provision of palliative care to people who use drugs can be challenging for clinicians, specifically how to manage pain, anxiety and distress among these individuals.<span><sup>7</sup></span> Person-centred care is often obstructed by policies that make generalisations about the risks associated with the use of alcohol and other drugs while receiving medical care. Clinicians and health services looking to improve access to palliative care should integrate the perspectives of people with lived and living experience of drug use into their person-centred care and explore opportunities for the harms of stigma to be minimised. Box 1 provides a list of elements of person-centred care.</p><p>There is good evidence that early access to palliative care can improve the wellbeing of people with serious illness; however, structurally marginalised people face significant barriers to accessing palliative care.<span><sup>8, 9</sup></span> Some people who use drugs experience severe debility in their day-to-day lives and present to health services acutely symptomatic of advanced or terminal medical conditions that might have been contained with active management earlier in the disease process.<span><sup>10</sup></span> People who use alcohol and other drugs often receive palliative care following an emergency department presentation with symptoms of advanced disease, rather than being referred to palliative care services by primary care providers in the early phases of illness.<span><sup>11</sup></span> Delays in health care access and appropriate treatment are influenced by both anticipatory and experienced stigma.<span><sup>12, 13</sup></span> There is evidence that people who use drugs avoid presenting to health care services for fear of being judged, dismissed or disheartened by having their health concerns incorrectly assumed to be a consequence of their substance use.<span><sup>10, 12</sup></span> People who use drugs are further excluded from health care services by complex referral pathways and limited appreciation from clinicians of the multiple competing priorities of marginalised communities.<span><su","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 4","pages":"164-167"},"PeriodicalIF":6.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52585","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007990","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}
<p>History and humanities; Diagnostic techniques and procedures</p><p>The work of prisoner-of-war (POW) doctors imprisoned by the Japanese is well known, with men such as Edward “Weary” Dunlop, Bruce Hunt and Rowley Richards celebrated as heroes of the many prison camps scattered across South-East Asia during the Second World War.<span><sup>1</sup></span> While accounts of captive medical officers have focused on the general medical and surgical treatment of POWs, the remarkable diaries of Major Kennedy Byron Burnside (Box 1), head of an Australian bacteriology and pathology laboratory in the sprawling Changi prison camp complex, offer a detailed view of the specific pathology services available in the camp. The diaries reveal the integral role that pathology played in the provision of medical care and advancement of medical research in Changi and suggest that the medical and scientific cultures that developed among Allied personnel in Japanese captivity were part of a broader health infrastructure that drew on many forms of prisoner labour and expertise.</p><p>Kennedy Burnside was born in Victoria in 1913, educated at Melbourne Grammar, and graduated from the University of Melbourne in 1937. He was resident and then registrar at the Alfred Hospital from 1938 to 1939. In July 1940, he joined the Australian Army Medical Corps with the rank of captain and served in various Australian general hospitals. Burnside was sent to Singapore in April 1941 as head of the 2nd Mobile Bacteriological Laboratory, a small unit tasked with studying tropical diseases and providing support services such as blood typing to casualty clearing stations and hospitals treating soldiers wounded in the fight against the Japanese. He was promoted to major a few months later.</p><p>When Singapore fell in February 1942, Burnside and his unit were sent to Changi, the main POW camp in South-East Asia, which, at its peak, held over 50 000 Allied POWs. Although the situation in Changi never descended to the appalling conditions of the work camps along the Burma–Thailand Railway (hereafter, the railway), the camp was overcrowded and inadequately provisioned, and the prisoners were vulnerable to sudden displays of harsh discipline from their captors. Crucially, however, the Allied forces retained significant autonomy over the internal organisation of the camp, including the provision of medical services. This resulted in an improvised but extensive health infrastructure that replicated many aspects of conventional military medicine. Burnside remained in charge of his laboratory for most of his captivity and assumed several other roles including acting commander of the re-organised 9/10 Field Ambulance. In mid-1943, he became the Australian Imperial Force's anti-malaria officer, and from December 1943 to May 1944, assisted in the British–Australian combined hospital's malaria centre. Along with most POWs, Burnside moved from the general Changi camp to the adjacent Changi Gaol in mid-
{"title":"Prisoner of war pathology in Changi, 1942–1945","authors":"Kate Ariotti, Elizabeth Roberts-Pedersen","doi":"10.5694/mja2.52581","DOIUrl":"10.5694/mja2.52581","url":null,"abstract":"<p>History and humanities; Diagnostic techniques and procedures</p><p>The work of prisoner-of-war (POW) doctors imprisoned by the Japanese is well known, with men such as Edward “Weary” Dunlop, Bruce Hunt and Rowley Richards celebrated as heroes of the many prison camps scattered across South-East Asia during the Second World War.<span><sup>1</sup></span> While accounts of captive medical officers have focused on the general medical and surgical treatment of POWs, the remarkable diaries of Major Kennedy Byron Burnside (Box 1), head of an Australian bacteriology and pathology laboratory in the sprawling Changi prison camp complex, offer a detailed view of the specific pathology services available in the camp. The diaries reveal the integral role that pathology played in the provision of medical care and advancement of medical research in Changi and suggest that the medical and scientific cultures that developed among Allied personnel in Japanese captivity were part of a broader health infrastructure that drew on many forms of prisoner labour and expertise.</p><p>Kennedy Burnside was born in Victoria in 1913, educated at Melbourne Grammar, and graduated from the University of Melbourne in 1937. He was resident and then registrar at the Alfred Hospital from 1938 to 1939. In July 1940, he joined the Australian Army Medical Corps with the rank of captain and served in various Australian general hospitals. Burnside was sent to Singapore in April 1941 as head of the 2nd Mobile Bacteriological Laboratory, a small unit tasked with studying tropical diseases and providing support services such as blood typing to casualty clearing stations and hospitals treating soldiers wounded in the fight against the Japanese. He was promoted to major a few months later.</p><p>When Singapore fell in February 1942, Burnside and his unit were sent to Changi, the main POW camp in South-East Asia, which, at its peak, held over 50 000 Allied POWs. Although the situation in Changi never descended to the appalling conditions of the work camps along the Burma–Thailand Railway (hereafter, the railway), the camp was overcrowded and inadequately provisioned, and the prisoners were vulnerable to sudden displays of harsh discipline from their captors. Crucially, however, the Allied forces retained significant autonomy over the internal organisation of the camp, including the provision of medical services. This resulted in an improvised but extensive health infrastructure that replicated many aspects of conventional military medicine. Burnside remained in charge of his laboratory for most of his captivity and assumed several other roles including acting commander of the re-organised 9/10 Field Ambulance. In mid-1943, he became the Australian Imperial Force's anti-malaria officer, and from December 1943 to May 1944, assisted in the British–Australian combined hospital's malaria centre. Along with most POWs, Burnside moved from the general Changi camp to the adjacent Changi Gaol in mid-","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 3","pages":"125-129"},"PeriodicalIF":6.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52581","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007992","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}
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