Danielle Hitch, Mary Rose Angeles, Eric Lau, Kelli Nicola-Richmond, Catherine Bennett, Catherine M Said, Sara Holton, Kimberley Haines, Bodil Rasmussen, Genevieve Pepin, Kieva Richards, Martin Hensher
Objectives
To compare hospital admission costs for coronavirus disease 2019 (COVID-19) cases to hospital admission costs for other viral pneumonia cases in Australia, and to describe hospital admission costs for post-COVID-19 condition.
Design, setting, participants
A cost comparison analysis of hospital admissions due to COVID-19 or other viral pneumonias between 1 January 2020 and 30 June 2021 at Victorian public health acute and subacute services.
Main outcome measures
Demographic characteristics, clinical outcomes (including diagnoses, impairment, subacute admission, intensive care unit admissions, ventilation, and length of stay) and cost data (including diagnostic-related groups, and total, direct and indirect costs).
Results
During the study period, 3197 patients were admitted to hospital due to COVID-19 and 15 761 were admitted for other viral pneumonias. Admissions for COVID-19 cost 29% more than admissions for other viral pneumonias. Admissions for COVID-19 requiring intensive care unit admission incurred significantly higher mean costs (A$120 504 or US$90 595) compared with those not requiring intensive care unit admission (A$19 634 or US$14 761). The adjusted cost of admissions related to post-COVID-19 condition was A$11 090 or US$8 337, and these admissions were significantly more likely to be elective. Direct costs accounted for most of the costs for all groups, and admissions for post-COVID-19 condition used less allied health services than other groups.
Conclusions
Given its recent emergence, cases of acute COVID-19 and post-COVID-19 condition have had a significant additional financial impact on Australian hospitals. Further studies are required to understand long term costs and identify trends over time in the context of increased vaccination rates and subsequent variants of severe acute respiratory syndrome coronavirus 2.
{"title":"Hospital costs of COVID-19, post-COVID-19 condition and other viral pneumonias: a cost comparison analysis","authors":"Danielle Hitch, Mary Rose Angeles, Eric Lau, Kelli Nicola-Richmond, Catherine Bennett, Catherine M Said, Sara Holton, Kimberley Haines, Bodil Rasmussen, Genevieve Pepin, Kieva Richards, Martin Hensher","doi":"10.5694/mja2.52465","DOIUrl":"10.5694/mja2.52465","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To compare hospital admission costs for coronavirus disease 2019 (COVID-19) cases to hospital admission costs for other viral pneumonia cases in Australia, and to describe hospital admission costs for post-COVID-19 condition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, setting, participants</h3>\u0000 \u0000 <p>A cost comparison analysis of hospital admissions due to COVID-19 or other viral pneumonias between 1 January 2020 and 30 June 2021 at Victorian public health acute and subacute services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Demographic characteristics, clinical outcomes (including diagnoses, impairment, subacute admission, intensive care unit admissions, ventilation, and length of stay) and cost data (including diagnostic-related groups, and total, direct and indirect costs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the study period, 3197 patients were admitted to hospital due to COVID-19 and 15 761 were admitted for other viral pneumonias. Admissions for COVID-19 cost 29% more than admissions for other viral pneumonias. Admissions for COVID-19 requiring intensive care unit admission incurred significantly higher mean costs (A$120 504 or US$90 595) compared with those not requiring intensive care unit admission (A$19 634 or US$14 761). The adjusted cost of admissions related to post-COVID-19 condition was A$11 090 or US$8 337, and these admissions were significantly more likely to be elective. Direct costs accounted for most of the costs for all groups, and admissions for post-COVID-19 condition used less allied health services than other groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Given its recent emergence, cases of acute COVID-19 and post-COVID-19 condition have had a significant additional financial impact on Australian hospitals. Further studies are required to understand long term costs and identify trends over time in the context of increased vaccination rates and subsequent variants of severe acute respiratory syndrome coronavirus 2.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S9","pages":"S23-S30"},"PeriodicalIF":6.7,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52465","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569020","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":"A Northern Territory-trained health workforce is required to meet its context-specific disease burden and health care needs.","authors":"Dominic Upton, Varunika Ruwanpura","doi":"10.5694/mja2.52513","DOIUrl":"https://doi.org/10.5694/mja2.52513","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558201","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>In this issue of the <i>MJA</i>, Smithers-Sheedy and colleagues<span><sup>1</sup></span> report that rates of cerebral palsy in Australia are declining in a sustained and significant manner, and are among the lowest in the world. During 1995–2016, the overall cerebral palsy incidence rate declined by about 40%.<span><sup>1</sup></span> This change was accompanied by a reduction in the severity of the condition; the incidence of children who required assistive mobility equipment declined from 0.8 per 1000 live births in 1997–1998 to 0.5 per 1000 live births in 2015–2016.<span><sup>2</sup></span> Not only is this incredibly exciting, but the major improvements in the rates and severity of cerebral palsy will have a substantial economic benefit: in 2018, the financial costs of cerebral palsy in Australia were $3.03 billion, not including $2.15 billion in lost wellbeing.<span><sup>3</sup></span></p><p>The strength of the study by Smithers-Sheedy and colleagues stems from its basis in data from population-based cerebral palsy registers with near complete case ascertainment. The power of such registers to capture the current status of the condition cannot be overstated. Epidemiologists and clinician scientists rely on registry data to inform effective research, stimulating questions about interventions for optimising outcomes for those at greatest risk of specific medical conditions. The researchers who manage registers spend vast amounts of time seeking funding for the ongoing employment of qualified staff to enter, manage, and analyse the data. The potential of registers to improve patient outcomes is enormous. For example, guidelines for hip screening and early interventions to reduce hip displacement in children with cerebral palsy were developed because register data identified risk factors and the natural history of this painful and debilitating condition.<span><sup>4</sup></span> Funding for these valuable registers must be secure and sustained so that those managing them can undertake the research that will further improve treatment and patient outcomes.</p><p>Smithers-Sheedy and colleagues note that a major limitation of their study was that their birth prevalence analysis included data from only three state registers; data from New South Wales were excluded from the birth prevalence analyses, but will be included in future analyses as complete case ascertainment data become available.<span><sup>1</sup></span> That said, it is unlikely that the situation in South Australia, Victoria, or Western Australia (the included registers) differ significantly from that in NSW or the Australian Capital Territory. State-based cerebral palsy registers often operate ethically with an opt-out arrangement, whereby families are automatically included but are offered the choice of opting out. When families do opt out, ethics may still allow for a small minimum dataset to be collected from which prevalence can be estimated. Smithers-Sheedy and colleagues did
{"title":"Cerebral palsy in Australia: optimism and challenges","authors":"Rod W Hunt","doi":"10.5694/mja2.52492","DOIUrl":"10.5694/mja2.52492","url":null,"abstract":"<p>In this issue of the <i>MJA</i>, Smithers-Sheedy and colleagues<span><sup>1</sup></span> report that rates of cerebral palsy in Australia are declining in a sustained and significant manner, and are among the lowest in the world. During 1995–2016, the overall cerebral palsy incidence rate declined by about 40%.<span><sup>1</sup></span> This change was accompanied by a reduction in the severity of the condition; the incidence of children who required assistive mobility equipment declined from 0.8 per 1000 live births in 1997–1998 to 0.5 per 1000 live births in 2015–2016.<span><sup>2</sup></span> Not only is this incredibly exciting, but the major improvements in the rates and severity of cerebral palsy will have a substantial economic benefit: in 2018, the financial costs of cerebral palsy in Australia were $3.03 billion, not including $2.15 billion in lost wellbeing.<span><sup>3</sup></span></p><p>The strength of the study by Smithers-Sheedy and colleagues stems from its basis in data from population-based cerebral palsy registers with near complete case ascertainment. The power of such registers to capture the current status of the condition cannot be overstated. Epidemiologists and clinician scientists rely on registry data to inform effective research, stimulating questions about interventions for optimising outcomes for those at greatest risk of specific medical conditions. The researchers who manage registers spend vast amounts of time seeking funding for the ongoing employment of qualified staff to enter, manage, and analyse the data. The potential of registers to improve patient outcomes is enormous. For example, guidelines for hip screening and early interventions to reduce hip displacement in children with cerebral palsy were developed because register data identified risk factors and the natural history of this painful and debilitating condition.<span><sup>4</sup></span> Funding for these valuable registers must be secure and sustained so that those managing them can undertake the research that will further improve treatment and patient outcomes.</p><p>Smithers-Sheedy and colleagues note that a major limitation of their study was that their birth prevalence analysis included data from only three state registers; data from New South Wales were excluded from the birth prevalence analyses, but will be included in future analyses as complete case ascertainment data become available.<span><sup>1</sup></span> That said, it is unlikely that the situation in South Australia, Victoria, or Western Australia (the included registers) differ significantly from that in NSW or the Australian Capital Territory. State-based cerebral palsy registers often operate ethically with an opt-out arrangement, whereby families are automatically included but are offered the choice of opting out. When families do opt out, ethics may still allow for a small minimum dataset to be collected from which prevalence can be estimated. Smithers-Sheedy and colleagues did ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 10","pages":"529-530"},"PeriodicalIF":6.7,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52492","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546283","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}
Hayley Smithers-Sheedy, Emma Waight, Shona Goldsmith, Sue Reid, Catherine Gibson, Heather Scott, Linda Watson, Megan Auld, Fiona Kay, Clare Wiltshire, Gina Hinwood, Annabel Webb, Tanya Martin, Nadia Badawi, Sarah McIntyre, the ACPR Group
<div> <section> <h3> Objective</h3> <p>To examine recent changes in the birth prevalence of cerebral palsy in Australia; to examine the functional mobility of children with cerebral palsy by residential remoteness.</p> </section> <section> <h3> Study design</h3> <p>Population-based register study; analysis of Australian Cerebral Palsy Register (ACPR) data.</p> </section> <section> <h3> Setting, participants</h3> <p>Children with cerebral palsy born in Australia, 1995–2016, and included in the ACPR at the time of the most recent state/territory data provision (31 July 2022).</p> </section> <section> <h3> Main outcome measures</h3> <p>Change in birth prevalence of cerebral palsy, of cerebral palsy acquired pre- or perinatally (<i>in utero</i> to day 28 after birth), both overall and by gestational age group (less than 28, 28–31, 32–36, 37 or more weeks), and of cerebral palsy acquired post-neonatally (day 29 to two years of age); gross motor function classification by residential remoteness.</p> </section> <section> <h3> Results</h3> <p>Data for 10 855 children with cerebral palsy born during 1995–2016 were available, 6258 of whom were boys (57.7%). The birth prevalence of cerebral palsy in the three states with complete case ascertainment (South Australia, Victoria, Western Australia) declined from 2.1 (95% confidence interval [CI], 1.9–2.4) cases per 1000 live births in 1995–1996 to 1.5 (95% CI, 1.3–1.7) cases per 1000 live births in 2015–2016. The birth prevalence of pre- or perinatally acquired cerebral palsy declined from 2.0 (95% CI, 1.7–2.3) to 1.4 (95% CI, 1.2–1.6) cases per 1000 live births; statistically significant declines were noted for all gestational ages except 32–36 weeks. The decline in birth prevalence of post-neonatally acquired cerebral palsy, from 0.15 (95% CI, 0.11–0.21) to 0.08 (95% CI, 0.05–0.12) cases per 1000 live births, was not statistically significant. Overall, 3.4% of children with cerebral palsy (307 children) lived in remote or very remote areas, a larger proportion than for all Australians (2.0%); the proportion of children in these areas who required wheelchairs for mobility was larger (31.3%) than that of children with cerebral palsy in major cities or regional areas (each 26.1%).</p> </section> <section> <h3> Conclusions</h3> <p>The birth prevalence of cerebral palsy declined markedly in Australia during 1995–201
{"title":"Cerebral palsy in Australia: birth prevalence, 1995–2016, and differences by residential remoteness: a population-based register study","authors":"Hayley Smithers-Sheedy, Emma Waight, Shona Goldsmith, Sue Reid, Catherine Gibson, Heather Scott, Linda Watson, Megan Auld, Fiona Kay, Clare Wiltshire, Gina Hinwood, Annabel Webb, Tanya Martin, Nadia Badawi, Sarah McIntyre, the ACPR Group","doi":"10.5694/mja2.52487","DOIUrl":"10.5694/mja2.52487","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine recent changes in the birth prevalence of cerebral palsy in Australia; to examine the functional mobility of children with cerebral palsy by residential remoteness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Population-based register study; analysis of Australian Cerebral Palsy Register (ACPR) data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Children with cerebral palsy born in Australia, 1995–2016, and included in the ACPR at the time of the most recent state/territory data provision (31 July 2022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Change in birth prevalence of cerebral palsy, of cerebral palsy acquired pre- or perinatally (<i>in utero</i> to day 28 after birth), both overall and by gestational age group (less than 28, 28–31, 32–36, 37 or more weeks), and of cerebral palsy acquired post-neonatally (day 29 to two years of age); gross motor function classification by residential remoteness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data for 10 855 children with cerebral palsy born during 1995–2016 were available, 6258 of whom were boys (57.7%). The birth prevalence of cerebral palsy in the three states with complete case ascertainment (South Australia, Victoria, Western Australia) declined from 2.1 (95% confidence interval [CI], 1.9–2.4) cases per 1000 live births in 1995–1996 to 1.5 (95% CI, 1.3–1.7) cases per 1000 live births in 2015–2016. The birth prevalence of pre- or perinatally acquired cerebral palsy declined from 2.0 (95% CI, 1.7–2.3) to 1.4 (95% CI, 1.2–1.6) cases per 1000 live births; statistically significant declines were noted for all gestational ages except 32–36 weeks. The decline in birth prevalence of post-neonatally acquired cerebral palsy, from 0.15 (95% CI, 0.11–0.21) to 0.08 (95% CI, 0.05–0.12) cases per 1000 live births, was not statistically significant. Overall, 3.4% of children with cerebral palsy (307 children) lived in remote or very remote areas, a larger proportion than for all Australians (2.0%); the proportion of children in these areas who required wheelchairs for mobility was larger (31.3%) than that of children with cerebral palsy in major cities or regional areas (each 26.1%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The birth prevalence of cerebral palsy declined markedly in Australia during 1995–201","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 10","pages":"533-539"},"PeriodicalIF":6.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52487","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546282","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>Recent events have reignited debate over whether social media is the root cause of increasing youth self-harm and suicide. Social media is a fertile ground for disseminating harmful content, including graphic imagery and messages depicting gendered violence and religious intolerance. This proliferation of harmful content makes social media an unwelcoming space, especially for women, minority groups, and young people, who are more likely to be targeted by such content, strengthening the narrative that social media is at the crux of a youth mental health crisis.</p><p>However, the parallel rise in social media use and youth mental health problems does not imply a causal relationship. Increased social media use may be a correlate, exacerbating factor, or a consequence of rising trends in youth self-harm, which may have entirely separate causes. Despite its potential negative impacts, social media is also a source of information and support for young people experiencing mental health problems.<span><sup>1</sup></span> Restricting young people's access to social media could impede pathways for help-seeking. This complexity highlights the need for a considered approach.</p><p>Rising self-harm over recent decades coincides with the advent of smartphones. Research shows an 8–11% increase in self-harm among young people,<span><sup>2</sup></span> along with increases in depression and anxiety. This increase became apparent around 2010–12,<span><sup>3</sup></span> affecting those born after 1995 who entered adolescence during the ascendence of social media and smartphones. In his book <i>The anxious generation</i>,<span><sup>3</sup></span> Jonathan Haidt argues that widespread adoption of social media, coupled with overly restrictive parenting practices, is the cause of increasing self-harm, brought about via “a new way of growing up”. Others suggest that sharing of content depicting suicide methods or romanticising self-harm might contribute to an increase in self-harm behaviours through a process of social contagion.<span><sup>4</sup></span> These trends have raised concerns among parents and politicians, leading to calls for restricting access to digital platforms.<span><sup>5</sup></span></p><p>Technological innovations have historically influenced social norms and societal structures, so it is crucial to take these concerns seriously. However, the argument that social media is the cause of rising trends in youth self-harm is relatively weak.</p><p>First, the effect is not universal. Although some studies indicate that rates of anxiety, depression and self-harm have indeed increased among young people, these trends have been disputed by some and may not be universal.<span><sup>6</sup></span> Second, associations are weak in longitudinal studies and meta-analyses. The Black Dog Institute's Future Proofing Study, which followed over 6000 Australian adolescents, revealed only small associations between social media use and future depression,<span><sup>7
{"title":"Social media: the root cause of rising youth self-harm or a convenient scapegoat?","authors":"Helen Christensen, Aimy Slade, Alexis E Whitton","doi":"10.5694/mja2.52503","DOIUrl":"10.5694/mja2.52503","url":null,"abstract":"<p>Recent events have reignited debate over whether social media is the root cause of increasing youth self-harm and suicide. Social media is a fertile ground for disseminating harmful content, including graphic imagery and messages depicting gendered violence and religious intolerance. This proliferation of harmful content makes social media an unwelcoming space, especially for women, minority groups, and young people, who are more likely to be targeted by such content, strengthening the narrative that social media is at the crux of a youth mental health crisis.</p><p>However, the parallel rise in social media use and youth mental health problems does not imply a causal relationship. Increased social media use may be a correlate, exacerbating factor, or a consequence of rising trends in youth self-harm, which may have entirely separate causes. Despite its potential negative impacts, social media is also a source of information and support for young people experiencing mental health problems.<span><sup>1</sup></span> Restricting young people's access to social media could impede pathways for help-seeking. This complexity highlights the need for a considered approach.</p><p>Rising self-harm over recent decades coincides with the advent of smartphones. Research shows an 8–11% increase in self-harm among young people,<span><sup>2</sup></span> along with increases in depression and anxiety. This increase became apparent around 2010–12,<span><sup>3</sup></span> affecting those born after 1995 who entered adolescence during the ascendence of social media and smartphones. In his book <i>The anxious generation</i>,<span><sup>3</sup></span> Jonathan Haidt argues that widespread adoption of social media, coupled with overly restrictive parenting practices, is the cause of increasing self-harm, brought about via “a new way of growing up”. Others suggest that sharing of content depicting suicide methods or romanticising self-harm might contribute to an increase in self-harm behaviours through a process of social contagion.<span><sup>4</sup></span> These trends have raised concerns among parents and politicians, leading to calls for restricting access to digital platforms.<span><sup>5</sup></span></p><p>Technological innovations have historically influenced social norms and societal structures, so it is crucial to take these concerns seriously. However, the argument that social media is the cause of rising trends in youth self-harm is relatively weak.</p><p>First, the effect is not universal. Although some studies indicate that rates of anxiety, depression and self-harm have indeed increased among young people, these trends have been disputed by some and may not be universal.<span><sup>6</sup></span> Second, associations are weak in longitudinal studies and meta-analyses. The Black Dog Institute's Future Proofing Study, which followed over 6000 Australian adolescents, revealed only small associations between social media use and future depression,<span><sup>7","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 10","pages":"524-526"},"PeriodicalIF":6.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52503","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522282","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}
Yuejen Zhao, Jo Wright, Renu Unnikrishnan, Ramakrishna Chondur, Danielle Green
Objectives: To assess the adequacy of the Northern Territory health workforce with respect to population size and burden of disease, overall and by selected health specialties; to assess its sustainability by investigating changes in workforce numbers.
Study design: Analysis of Australian Health Practitioner Regulation Agency (AHPRA) health workforce data (2013-2021) and burden of disease data (disability-adjusted life-years, DALYs) drawn from national and NT burden of disease studies (and projected for 2019-2021).
Setting, participants: NT and Australian health workforces, 2009-2021.
Main outcome measures: Adequacy of the NT health workforce, assessed as the ratio of the mean annual numbers of NT health workers per 1000 population or health workers per 1000 DALYs (2009-2013 and 2014-2018) to those of the Australian workforce (2013 and 2018); sustainability of the NT health workforce, defined as the number of health workers per 1000 population or per 1000 DALYs increasing between 2013 and 2021.
Results: The number of health workers per 1000 population was slightly higher in the NT than for Australia in both time periods (2009-2013 v 2013: 23.30 v 21.79 per 1000 population, 6.9% larger; 2014-2018 v 2018: 25.79 v 23.47 per 1000 population, 9.9% larger); however, it was smaller with respect to burden of disease (2009-2013 v 2013: 82.6 v 107.4 health workers per 1000 DALYs, 23.1% fewer; 2014-2018 v 2018: 91.5 v 117.1 per 1000 DALYs, 21.8% fewer). In particular, 464 more nurses and midwives (11.4% more than the mean for 2013-2021), 196 more physiotherapists (115%), 189 more psychologists (102%), 152 more pharmacists (79%), and 144 more dentists (106%) are needed in the NT to match the corresponding numbers of health workers by disease burden for Australia as a whole. The number of Aboriginal health practitioners per 100 000 DALYs fell during the study period.
Conclusion: Health worker population density alone does not reliably assess health workforce needs; burden of disease information is important for workforce planning that meets population health needs. The NT health workforce needs to be increased by about 28% to reflect the population burden of disease and injury. Shortages in the NT health workforce must be eliminated to close health gaps between Indigenous and non-Indigenous Australians.
{"title":"Assessing the adequacy and sustainability of the Northern Territory health workforce with respect to burden of disease and injury, 2009-2021: an analysis of administrative data.","authors":"Yuejen Zhao, Jo Wright, Renu Unnikrishnan, Ramakrishna Chondur, Danielle Green","doi":"10.5694/mja2.52507","DOIUrl":"https://doi.org/10.5694/mja2.52507","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the adequacy of the Northern Territory health workforce with respect to population size and burden of disease, overall and by selected health specialties; to assess its sustainability by investigating changes in workforce numbers.</p><p><strong>Study design: </strong>Analysis of Australian Health Practitioner Regulation Agency (AHPRA) health workforce data (2013-2021) and burden of disease data (disability-adjusted life-years, DALYs) drawn from national and NT burden of disease studies (and projected for 2019-2021).</p><p><strong>Setting, participants: </strong>NT and Australian health workforces, 2009-2021.</p><p><strong>Main outcome measures: </strong>Adequacy of the NT health workforce, assessed as the ratio of the mean annual numbers of NT health workers per 1000 population or health workers per 1000 DALYs (2009-2013 and 2014-2018) to those of the Australian workforce (2013 and 2018); sustainability of the NT health workforce, defined as the number of health workers per 1000 population or per 1000 DALYs increasing between 2013 and 2021.</p><p><strong>Results: </strong>The number of health workers per 1000 population was slightly higher in the NT than for Australia in both time periods (2009-2013 v 2013: 23.30 v 21.79 per 1000 population, 6.9% larger; 2014-2018 v 2018: 25.79 v 23.47 per 1000 population, 9.9% larger); however, it was smaller with respect to burden of disease (2009-2013 v 2013: 82.6 v 107.4 health workers per 1000 DALYs, 23.1% fewer; 2014-2018 v 2018: 91.5 v 117.1 per 1000 DALYs, 21.8% fewer). In particular, 464 more nurses and midwives (11.4% more than the mean for 2013-2021), 196 more physiotherapists (115%), 189 more psychologists (102%), 152 more pharmacists (79%), and 144 more dentists (106%) are needed in the NT to match the corresponding numbers of health workers by disease burden for Australia as a whole. The number of Aboriginal health practitioners per 100 000 DALYs fell during the study period.</p><p><strong>Conclusion: </strong>Health worker population density alone does not reliably assess health workforce needs; burden of disease information is important for workforce planning that meets population health needs. The NT health workforce needs to be increased by about 28% to reflect the population burden of disease and injury. Shortages in the NT health workforce must be eliminated to close health gaps between Indigenous and non-Indigenous Australians.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522280","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>A nine-year-old female patient presented with a two-week history of vomiting, diarrhoea, abdominal pain, and a one-week history of dysuria with macroscopic haematuria. There was no recent history of pharyngitis or a skin infection. Her past medical history included medication for attention deficit hyperactivity disorder, but no other significant conditions. On examination in the emergency department, the patient was tachycardic with heart rate 155 beats/minute (reference interval [RI], 70–130 beats/minute), febrile with temperature 38.8°C (RI, 36.4–37.4°C) and her abdomen was soft with generalised tenderness. There was no hypertension or evidence of oedema. Blood results showed leucocytosis with a white cell count of 15.7 × 10<sup>9</sup>/L (RI, 4.5–13.5 × 10<sup>9</sup>/L) and C-reactive protein level of 110 mg/L (RI, < 3 mg/L). There was no associated evidence of toxic shock syndrome. Bedside urine analysis before antibiotic therapy showed leucocytes, blood and protein. The urine sample, as well as a blood and faecal samples were sent for microscopy and culture. Ultrasound scan of the kidneys, ureters and urinary bladder was unremarkable. The patient was admitted for presumed cystitis given little clinical evidence of glomerular nephritis and started on 750 mg intravenous cefazolin.</p><p>Overnight, the patient developed worsening abdominal pain, further vomiting and had ongoing fever. Abdominal examination revealed generalised peritonitis.</p><p>An abdominal ultrasound scan was reported as “suggestive for acute appendicitis”. The patient underwent diagnostic laparoscopy and appendicectomy. Intra-operatively, the appendix appeared normal; however, throughout the abdomen there was turbid fluid and multiple fibrin deposits. The fallopian tubes and ovaries were erythematous (Box) but an intra-operative gynaecological review yielded no concern for pelvic inflammatory disease. In/out catheterisation pre-operatively drained urine with sediment, pus and blood and was again sent for microscopy and culture.</p><p>Both pre- and post-antibiotic therapy urine microscopy and culture showed no significant bacterial growth. The patient had received two doses of 750 mg cefazolin intravenously before operative management. Post-operatively, antimicrobial therapy was escalated to intravenous 4 g piperacillin/0.5 g tazobactam every 8 hours. The post-operative course was uneventful; the patient received five days of intravenous antibiotics and was discharged on Day 5 with no further antimicrobial treatment.</p><p>The patient was well when reviewed two weeks after discharge. On review, the surgical histopathology reported “peri-appendicitis with normal mucosa, moderate acute serositis and underlying neutrophil infiltrate involving the adventitia and muscularis propria only mildly”. Polymerase chain reaction and 16-S molecular testing was not completed but would have been useful for the diagnosis. However, serum anti-DNase B and antistreptolysin O titres were e
{"title":"Primary peritonitis in a previously healthy prepubertal female patient","authors":"Danjel Miladinovic, Warren Hargreaves","doi":"10.5694/mja2.52502","DOIUrl":"10.5694/mja2.52502","url":null,"abstract":"<p>A nine-year-old female patient presented with a two-week history of vomiting, diarrhoea, abdominal pain, and a one-week history of dysuria with macroscopic haematuria. There was no recent history of pharyngitis or a skin infection. Her past medical history included medication for attention deficit hyperactivity disorder, but no other significant conditions. On examination in the emergency department, the patient was tachycardic with heart rate 155 beats/minute (reference interval [RI], 70–130 beats/minute), febrile with temperature 38.8°C (RI, 36.4–37.4°C) and her abdomen was soft with generalised tenderness. There was no hypertension or evidence of oedema. Blood results showed leucocytosis with a white cell count of 15.7 × 10<sup>9</sup>/L (RI, 4.5–13.5 × 10<sup>9</sup>/L) and C-reactive protein level of 110 mg/L (RI, < 3 mg/L). There was no associated evidence of toxic shock syndrome. Bedside urine analysis before antibiotic therapy showed leucocytes, blood and protein. The urine sample, as well as a blood and faecal samples were sent for microscopy and culture. Ultrasound scan of the kidneys, ureters and urinary bladder was unremarkable. The patient was admitted for presumed cystitis given little clinical evidence of glomerular nephritis and started on 750 mg intravenous cefazolin.</p><p>Overnight, the patient developed worsening abdominal pain, further vomiting and had ongoing fever. Abdominal examination revealed generalised peritonitis.</p><p>An abdominal ultrasound scan was reported as “suggestive for acute appendicitis”. The patient underwent diagnostic laparoscopy and appendicectomy. Intra-operatively, the appendix appeared normal; however, throughout the abdomen there was turbid fluid and multiple fibrin deposits. The fallopian tubes and ovaries were erythematous (Box) but an intra-operative gynaecological review yielded no concern for pelvic inflammatory disease. In/out catheterisation pre-operatively drained urine with sediment, pus and blood and was again sent for microscopy and culture.</p><p>Both pre- and post-antibiotic therapy urine microscopy and culture showed no significant bacterial growth. The patient had received two doses of 750 mg cefazolin intravenously before operative management. Post-operatively, antimicrobial therapy was escalated to intravenous 4 g piperacillin/0.5 g tazobactam every 8 hours. The post-operative course was uneventful; the patient received five days of intravenous antibiotics and was discharged on Day 5 with no further antimicrobial treatment.</p><p>The patient was well when reviewed two weeks after discharge. On review, the surgical histopathology reported “peri-appendicitis with normal mucosa, moderate acute serositis and underlying neutrophil infiltrate involving the adventitia and muscularis propria only mildly”. Polymerase chain reaction and 16-S molecular testing was not completed but would have been useful for the diagnosis. However, serum anti-DNase B and antistreptolysin O titres were e","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 10","pages":"527-528"},"PeriodicalIF":6.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52502","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522281","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}
Carmen Pace, Alessandra Chinsen, Ada S Cheung, S. Rachel Skinner, Ken W Knight, Michelle A Tollit, Michelle M Telfer, Ken C Pang
<p>Transgender (hereafter referred to as trans) people have a gender that is different from the sex assigned to them at birth (Box 1). It is estimated that globally, 1.2–2.7% of people under 19 years identify as trans.<span><sup>1</sup></span> In recent years, there has been a rise in anti-trans campaigns in Australia and overseas. As a result, young trans people are subject to increasing vitriol and discrimination, which represents a clear and present danger to an already marginalised population. The current pattern of public discourse represents a public health risk and poses similar concerns to the debate surrounding marriage equality in Australia several years ago, which had a negative impact on the mental health of LGBTQIA+ people of all ages.<span><sup>2</sup></span></p><p>In this perspective article, we take a health equity, social justice and minority stress lens to the evidence, examine the barriers to health care arising from the politicisation and marginalisation of trans youth, and call for urgent action to safeguard the health and wellbeing of young trans people.</p><p>Despite the documentation of gender diversity in Indigenous cultures over thousands of years,<span><sup>3</sup></span> its existence in Western societies has remained hidden until recently. As trans people have become more visible, societal awareness of gender diversity has improved and more individuals have felt empowered to live authentically as trans. However, this increase has been accompanied by claims of social contagion and fears that trans people represent a threat to fairness in sport, public safety and equality for women.</p><p>This shift in public discourse has been fuelled primarily by disinformation and by accompanying negative and inflammatory media coverage and political debate about young trans people. Media outlets frequently scrutinise trans youth, question their right to socially or medically affirm their gender,<span><sup>4</sup></span> and sensationalise trans identities for “clickbait” (an enticing internet hyperlink, often misleading) and financial gain.<span><sup>4</sup></span> Politicians have similarly engaged in debates questioning the legitimacy of gender-affirming medical treatment for trans youth, inciting division, particularly during election campaigns.<span><sup>5</sup></span> This trend in anti-trans discourse recently culminated in a series of prominent anti-trans rallies across Australia.<span><sup>6</sup></span></p><p>These campaigns have largely been powered by anti-trans groups seeking to restrict the rights of trans people internationally. Broadly united by their view that binary sex and gender are immutable and that trans people are a threat to societal values and safety, this diverse range of groups identifies with trans-exclusionary, radical feminist, religious or simply anti-“gender ideology” causes.<span><sup>7</sup></span> Importantly, they are often funded and supported by religious and right-wing organisations, who have s
{"title":"Safeguarding the health and wellbeing of transgender young people","authors":"Carmen Pace, Alessandra Chinsen, Ada S Cheung, S. Rachel Skinner, Ken W Knight, Michelle A Tollit, Michelle M Telfer, Ken C Pang","doi":"10.5694/mja2.52504","DOIUrl":"10.5694/mja2.52504","url":null,"abstract":"<p>Transgender (hereafter referred to as trans) people have a gender that is different from the sex assigned to them at birth (Box 1). It is estimated that globally, 1.2–2.7% of people under 19 years identify as trans.<span><sup>1</sup></span> In recent years, there has been a rise in anti-trans campaigns in Australia and overseas. As a result, young trans people are subject to increasing vitriol and discrimination, which represents a clear and present danger to an already marginalised population. The current pattern of public discourse represents a public health risk and poses similar concerns to the debate surrounding marriage equality in Australia several years ago, which had a negative impact on the mental health of LGBTQIA+ people of all ages.<span><sup>2</sup></span></p><p>In this perspective article, we take a health equity, social justice and minority stress lens to the evidence, examine the barriers to health care arising from the politicisation and marginalisation of trans youth, and call for urgent action to safeguard the health and wellbeing of young trans people.</p><p>Despite the documentation of gender diversity in Indigenous cultures over thousands of years,<span><sup>3</sup></span> its existence in Western societies has remained hidden until recently. As trans people have become more visible, societal awareness of gender diversity has improved and more individuals have felt empowered to live authentically as trans. However, this increase has been accompanied by claims of social contagion and fears that trans people represent a threat to fairness in sport, public safety and equality for women.</p><p>This shift in public discourse has been fuelled primarily by disinformation and by accompanying negative and inflammatory media coverage and political debate about young trans people. Media outlets frequently scrutinise trans youth, question their right to socially or medically affirm their gender,<span><sup>4</sup></span> and sensationalise trans identities for “clickbait” (an enticing internet hyperlink, often misleading) and financial gain.<span><sup>4</sup></span> Politicians have similarly engaged in debates questioning the legitimacy of gender-affirming medical treatment for trans youth, inciting division, particularly during election campaigns.<span><sup>5</sup></span> This trend in anti-trans discourse recently culminated in a series of prominent anti-trans rallies across Australia.<span><sup>6</sup></span></p><p>These campaigns have largely been powered by anti-trans groups seeking to restrict the rights of trans people internationally. Broadly united by their view that binary sex and gender are immutable and that trans people are a threat to societal values and safety, this diverse range of groups identifies with trans-exclusionary, radical feminist, religious or simply anti-“gender ideology” causes.<span><sup>7</sup></span> Importantly, they are often funded and supported by religious and right-wing organisations, who have s","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 10","pages":"516-519"},"PeriodicalIF":6.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52504","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503245","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}
Oliver J Watkeys, Kimberlie Dean, Kristin R Laurens, Vaughan J Carr, Melissa J Green
<p>Each year, one in seven Australian children and adolescents experience a mental disorder, but only half receive treatment.<span><sup>1</sup></span> The Australian Institute of Health and Welfare (AIHW) reported that 6% of children aged 5–11 years and 13% of those aged 12–17 years used Medicare-subsidised mental health services during 2021–22.<span><sup>2</sup></span></p><p>We investigated the annual and cumulative incidence of Medicare-subsidised mental health services for children during their first 15 years of life, and the demographic characteristics associated with the types of services used. We analysed Medicare Benefits Schedule (MBS) data for 86 759 children born during 1 January 2002 – 31 December 2005 and included in the New South Wales Child Development Study,<span><sup>3</sup></span> or 94.7% of the record linkage cohort; 4848 children were excluded because information for socio-demographic indices were not recorded in the 2009 NSW Australian Early Development Census.<span><sup>4</sup></span> Record linkage was performed by the NSW Centre for Health Record Linkage (CHeReL) and the AIHW Data Integration Services Centre.</p><p>MBS records for mental health services (1 January 2002 – 31 December 2018) were categorised as being delivered by general practitioners (Better Access treatment plans), psychologists, psychiatrists, occupational therapists or social workers, or other (group therapy, psychological services provided by general practitioners or paediatricians) (Supporting Information, table 1). We assessed associations between demographic factors — sex, Indigenous status, socio-economic position (Index of Relative Socioeconomic Disadvantage),<span><sup>5</sup></span> geographic remoteness (Accessibility/Remoteness Index of Australia)<span><sup>6</sup></span> — and each MBS-subsidised mental health service type in univariable and multivariable logistic regression analyses; we report odds ratios with 99.924% confidence intervals (Bonferroni-adjusted for multiple testing). The NSW Population and Health Services Research Ethics Committee and ACT Health Human Research Ethics Committee (HREC/18/ciphs/49) and the Australian Institute of Health and Welfare Ethics Committee (EO2020/4/1026) approved the study. We report the study in accordance with the STROBE reporting guidelines for observational studies.<span><sup>7</sup></span></p><p>A total of 23 330 of 86 759 children (26.9%) had used MBS-subsidised mental health services prior to their 15th birthdays: 21 535 had received Better Access plans (24.8%), 15 693 had received care from psychologists (18.1%), 2306 had consulted psychiatrists (2.7%), 1844 had received psychological therapy from occupational therapists or social workers (2.1%), and 2391 had received other mental health service types (2.8%) (Box 1). The annual and cumulative incidence of mental health service use each increased exponentially with age for Better Access plans and psychologist care, and more gradually for care from
{"title":"Medicare-subsidised mental health service use during the first 15 years of life in New South Wales: a population cohort study","authors":"Oliver J Watkeys, Kimberlie Dean, Kristin R Laurens, Vaughan J Carr, Melissa J Green","doi":"10.5694/mja2.52498","DOIUrl":"10.5694/mja2.52498","url":null,"abstract":"<p>Each year, one in seven Australian children and adolescents experience a mental disorder, but only half receive treatment.<span><sup>1</sup></span> The Australian Institute of Health and Welfare (AIHW) reported that 6% of children aged 5–11 years and 13% of those aged 12–17 years used Medicare-subsidised mental health services during 2021–22.<span><sup>2</sup></span></p><p>We investigated the annual and cumulative incidence of Medicare-subsidised mental health services for children during their first 15 years of life, and the demographic characteristics associated with the types of services used. We analysed Medicare Benefits Schedule (MBS) data for 86 759 children born during 1 January 2002 – 31 December 2005 and included in the New South Wales Child Development Study,<span><sup>3</sup></span> or 94.7% of the record linkage cohort; 4848 children were excluded because information for socio-demographic indices were not recorded in the 2009 NSW Australian Early Development Census.<span><sup>4</sup></span> Record linkage was performed by the NSW Centre for Health Record Linkage (CHeReL) and the AIHW Data Integration Services Centre.</p><p>MBS records for mental health services (1 January 2002 – 31 December 2018) were categorised as being delivered by general practitioners (Better Access treatment plans), psychologists, psychiatrists, occupational therapists or social workers, or other (group therapy, psychological services provided by general practitioners or paediatricians) (Supporting Information, table 1). We assessed associations between demographic factors — sex, Indigenous status, socio-economic position (Index of Relative Socioeconomic Disadvantage),<span><sup>5</sup></span> geographic remoteness (Accessibility/Remoteness Index of Australia)<span><sup>6</sup></span> — and each MBS-subsidised mental health service type in univariable and multivariable logistic regression analyses; we report odds ratios with 99.924% confidence intervals (Bonferroni-adjusted for multiple testing). The NSW Population and Health Services Research Ethics Committee and ACT Health Human Research Ethics Committee (HREC/18/ciphs/49) and the Australian Institute of Health and Welfare Ethics Committee (EO2020/4/1026) approved the study. We report the study in accordance with the STROBE reporting guidelines for observational studies.<span><sup>7</sup></span></p><p>A total of 23 330 of 86 759 children (26.9%) had used MBS-subsidised mental health services prior to their 15th birthdays: 21 535 had received Better Access plans (24.8%), 15 693 had received care from psychologists (18.1%), 2306 had consulted psychiatrists (2.7%), 1844 had received psychological therapy from occupational therapists or social workers (2.1%), and 2391 had received other mental health service types (2.8%) (Box 1). The annual and cumulative incidence of mental health service use each increased exponentially with age for Better Access plans and psychologist care, and more gradually for care from ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 10","pages":"554-557"},"PeriodicalIF":6.7,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52498","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503244","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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