<div> <section> <h3> Objective</h3> <p>To explore how redesigning learner recognition systems can value First Nations students’ diverse knowledges and skills, facilitating systemic educational reform aligned with Indigenous definitions of success, wellbeing, and sense of belonging.</p> </section> <section> <h3> Design</h3> <p>Social lab methods employing iterative co-design, guided by First Nations-led frameworks aligned with the United Nations Declaration on the Rights of Indigenous Peoples, ensuring community accountability and Indigenous self-determination.</p> </section> <section> <h3> Setting</h3> <p>This study was part of the Learner’s Journey Social Lab facilitated by Learning Creates Australia, which was conducted from 1 October 2020 to 31 October 2021. The First Nations team was co-convened in partnership with the National Indigenous Youth Education Coalition.</p> </section> <section> <h3> Participants</h3> <p>Seventy-two participants from First Nations communities, including students and young people (aged 14–25 years), educators, community representatives, allied health professionals, policy makers, and academics.</p> </section> <section> <h3> Process</h3> <p>Development of an Indigenous Nation-led learning charter model, informed by thematic analysis of interviews and a focus group exploring First Nations students’ learning journeys, ambitions, and social and cultural determinants of wellbeing.</p> </section> <section> <h3> Values</h3> <p>Recognition and validation of Indigenous learning journeys; alignment of educational practices with cultural determinants of social and emotional wellbeing through the development of an Indigenous Nation-led learning charter; and enhanced agency, belonging and First Nations-defined success in educational environments.</p> </section> <section> <h3> Results</h3> <p>The Indigenous Nation-led learning charter was developed to support student sense of belonging; facilitate wellbeing-centred relationships and partnerships between schools, communities, and custodians; and increase student engagement and agency through recognition of cultural, community, and identity-related learning. The charter model is supported and implemented through a place-based community of practice and learner wellbeing recognition to
{"title":"Sharing custodianship of learning: development of an Indigenous Nation-led learning charter model centring self-determination and wellbeing","authors":"Hayley McQuire, Melinda Mann","doi":"10.5694/mja2.70081","DOIUrl":"https://doi.org/10.5694/mja2.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore how redesigning learner recognition systems can value First Nations students’ diverse knowledges and skills, facilitating systemic educational reform aligned with Indigenous definitions of success, wellbeing, and sense of belonging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Social lab methods employing iterative co-design, guided by First Nations-led frameworks aligned with the United Nations Declaration on the Rights of Indigenous Peoples, ensuring community accountability and Indigenous self-determination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>This study was part of the Learner’s Journey Social Lab facilitated by Learning Creates Australia, which was conducted from 1 October 2020 to 31 October 2021. The First Nations team was co-convened in partnership with the National Indigenous Youth Education Coalition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Seventy-two participants from First Nations communities, including students and young people (aged 14–25 years), educators, community representatives, allied health professionals, policy makers, and academics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Process</h3>\u0000 \u0000 <p>Development of an Indigenous Nation-led learning charter model, informed by thematic analysis of interviews and a focus group exploring First Nations students’ learning journeys, ambitions, and social and cultural determinants of wellbeing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Values</h3>\u0000 \u0000 <p>Recognition and validation of Indigenous learning journeys; alignment of educational practices with cultural determinants of social and emotional wellbeing through the development of an Indigenous Nation-led learning charter; and enhanced agency, belonging and First Nations-defined success in educational environments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The Indigenous Nation-led learning charter was developed to support student sense of belonging; facilitate wellbeing-centred relationships and partnerships between schools, communities, and custodians; and increase student engagement and agency through recognition of cultural, community, and identity-related learning. The charter model is supported and implemented through a place-based community of practice and learner wellbeing recognition to","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 S9","pages":"S27-S33"},"PeriodicalIF":8.5,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426221","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}
Pasi Sahlberg, Angelica Ojinnaka-Psillakis, Sharon R Goldfeld
<p>Around the world, the outlook for children and young people is troubling: health outcomes are declining, inequities are widening, and opportunities for a good life are narrowing.<span><sup>1-3</sup></span> The 2024 Australian Early Development Census shows that one in four children start school developmentally vulnerable, the highest level ever recorded. Alarmingly, 23.5% of children are developmentally vulnerable on one or more domains. There were 12.5% of children vulnerable on two or more domains, which is the highest ever recorded with substantial inequities (20.3% of children in the most socio-economically disadvantaged communities are developmentally vulnerable on two or more domains compared with 7.6% in the least disadvantaged communities).<span><sup>4</sup></span></p><p>Globally, there has been virtually no improvement in the learning outcomes of students in the Western world since 2010.<span><sup>5</sup></span> For example, the Organisation for Economic Co-operation and Development (OECD) reports that the average reading literacy performance of 15-year-olds has fallen by the equivalent of a year of schooling since 2018, while learning and employment gaps between advantaged and disadvantaged students continue to widen.<span><sup>6</sup></span> These findings tell the same story: children’s wellbeing is deteriorating, their sense of belonging in school is declining, and inequities are deepening.</p><p>Yet in Australia, there is still no Minister for Children, and national approaches to wellbeing and safety remain fragmented. Although there are some positive signs for a brighter future, such as commitments to properly fund all public schools and compelling public support for government action on more equitable education and health outcomes for the young, the need for greater clarity on these commitments and actions is needed for lasting change. Against this backdrop, the Future Healthy Countdown 2030 progress report<span><sup>7</sup></span> lands with urgency, showing both the cost of inaction and the opportunity for change.</p><p>We begin this <i>Medical Journal of Australia</i> (<i>MJA</i>) supplement with the first Future Healthy Countdown 2030 progress report.<span><sup>7</sup></span> This is an important culmination of effort that began with a rigorous and pragmatic approach, developed through a consensus-building process with input from academics, policy experts, and young people.<span><sup>8</sup></span> The approach has resulted in 22 outcome measures spanning seven interconnected domains, with one practical policy action recommended per domain. If implemented before 2030, these policy actions could deliver substantial and lasting improvements in the health and wellbeing of children, young people, and future generations of Australians. To align these policy actions with political reality, each one is accompanied by a measure of community sentiment to identify where momentum for change is growing.</p><p>For this Future Healthy Co
{"title":"Addressing the unnatural divide: why health and education are the necessary foundations of equitable child outcomes","authors":"Pasi Sahlberg, Angelica Ojinnaka-Psillakis, Sharon R Goldfeld","doi":"10.5694/mja2.70072","DOIUrl":"https://doi.org/10.5694/mja2.70072","url":null,"abstract":"<p>Around the world, the outlook for children and young people is troubling: health outcomes are declining, inequities are widening, and opportunities for a good life are narrowing.<span><sup>1-3</sup></span> The 2024 Australian Early Development Census shows that one in four children start school developmentally vulnerable, the highest level ever recorded. Alarmingly, 23.5% of children are developmentally vulnerable on one or more domains. There were 12.5% of children vulnerable on two or more domains, which is the highest ever recorded with substantial inequities (20.3% of children in the most socio-economically disadvantaged communities are developmentally vulnerable on two or more domains compared with 7.6% in the least disadvantaged communities).<span><sup>4</sup></span></p><p>Globally, there has been virtually no improvement in the learning outcomes of students in the Western world since 2010.<span><sup>5</sup></span> For example, the Organisation for Economic Co-operation and Development (OECD) reports that the average reading literacy performance of 15-year-olds has fallen by the equivalent of a year of schooling since 2018, while learning and employment gaps between advantaged and disadvantaged students continue to widen.<span><sup>6</sup></span> These findings tell the same story: children’s wellbeing is deteriorating, their sense of belonging in school is declining, and inequities are deepening.</p><p>Yet in Australia, there is still no Minister for Children, and national approaches to wellbeing and safety remain fragmented. Although there are some positive signs for a brighter future, such as commitments to properly fund all public schools and compelling public support for government action on more equitable education and health outcomes for the young, the need for greater clarity on these commitments and actions is needed for lasting change. Against this backdrop, the Future Healthy Countdown 2030 progress report<span><sup>7</sup></span> lands with urgency, showing both the cost of inaction and the opportunity for change.</p><p>We begin this <i>Medical Journal of Australia</i> (<i>MJA</i>) supplement with the first Future Healthy Countdown 2030 progress report.<span><sup>7</sup></span> This is an important culmination of effort that began with a rigorous and pragmatic approach, developed through a consensus-building process with input from academics, policy experts, and young people.<span><sup>8</sup></span> The approach has resulted in 22 outcome measures spanning seven interconnected domains, with one practical policy action recommended per domain. If implemented before 2030, these policy actions could deliver substantial and lasting improvements in the health and wellbeing of children, young people, and future generations of Australians. To align these policy actions with political reality, each one is accompanied by a measure of community sentiment to identify where momentum for change is growing.</p><p>For this Future Healthy Co","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 S9","pages":"S3-S5"},"PeriodicalIF":8.5,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426220","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}
Charlie Connell-Tobin, Linh Dang, Mietta Symmons-Joyce, Annette C Cairnduff, Andrew P R Kellett, Lauren Langley, Philippa Collin
<div> <section> <h3> Objectives</h3> <p>To investigate how young people’s experiences of recognition in learning influence their wellbeing and to identify practical strategies for a more holistic and equitable educational approach that values diverse competencies beyond traditional academic measures.</p> </section> <section> <h3> Design</h3> <p>The project used a youth co-research and participatory design. Young people with recent experience of secondary education led the study alongside university and industry-based researchers.</p> </section> <section> <h3> Setting</h3> <p>Data were collected between 13 May and 27 June 2024, through five participatory workshops and 10 in-depth interviews, conducted online and in person. Workshops were conducted across four contexts: two school settings (one mainstream school, one flexible learning school), one university setting (with students admitted through non-Australian Tertiary Admission Rank pathways), and one online context.</p> </section> <section> <h3> Participants</h3> <p>60 young people aged 15–29 years from Tasmania, Victoria, South Australia and New South Wales.</p> </section> <section> <h3> Main outcome measures</h3> <p>Subjective and qualitative expression of knowledge and skills, wellbeing, and social connection.</p> </section> <section> <h3> Results</h3> <p>Young people reported that the current education system values conformity over creativity and forces them to follow prescribed pathways through learning, rather than pursue interests, curiosities and passions. This contributes considerably to poor sense of self, heightened anxiety and stress. Comparatively, when young people experience broader forms of recognition, they have greater understanding of themselves, feel safe, are engaged, can identify knowledge and skills they have acquired, have developed social connections and have a sense of subjective wellbeing. Forms of broader recognition that acknowledge non-formal learning, adopt alternative assessment and credentialing, foster supportive relationships and assert a commitment to overcoming disadvantage are essential to educational experiences that promote wellbeing.</p> </section> <section> <h3> Conclusions</h3> <p>Broader recognition of learning, through non-formal learning, trusted rela
{"title":"The power of recognising more: a qualitative study of young people’s perspectives on broader recognition for learning and wellbeing","authors":"Charlie Connell-Tobin, Linh Dang, Mietta Symmons-Joyce, Annette C Cairnduff, Andrew P R Kellett, Lauren Langley, Philippa Collin","doi":"10.5694/mja2.70071","DOIUrl":"https://doi.org/10.5694/mja2.70071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate how young people’s experiences of recognition in learning influence their wellbeing and to identify practical strategies for a more holistic and equitable educational approach that values diverse competencies beyond traditional academic measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>The project used a youth co-research and participatory design. Young people with recent experience of secondary education led the study alongside university and industry-based researchers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Data were collected between 13 May and 27 June 2024, through five participatory workshops and 10 in-depth interviews, conducted online and in person. Workshops were conducted across four contexts: two school settings (one mainstream school, one flexible learning school), one university setting (with students admitted through non-Australian Tertiary Admission Rank pathways), and one online context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>60 young people aged 15–29 years from Tasmania, Victoria, South Australia and New South Wales.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Subjective and qualitative expression of knowledge and skills, wellbeing, and social connection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Young people reported that the current education system values conformity over creativity and forces them to follow prescribed pathways through learning, rather than pursue interests, curiosities and passions. This contributes considerably to poor sense of self, heightened anxiety and stress. Comparatively, when young people experience broader forms of recognition, they have greater understanding of themselves, feel safe, are engaged, can identify knowledge and skills they have acquired, have developed social connections and have a sense of subjective wellbeing. Forms of broader recognition that acknowledge non-formal learning, adopt alternative assessment and credentialing, foster supportive relationships and assert a commitment to overcoming disadvantage are essential to educational experiences that promote wellbeing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Broader recognition of learning, through non-formal learning, trusted rela","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 S9","pages":"S34-S41"},"PeriodicalIF":8.5,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426171","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}
Karen M Barlow, Jennie L Ponsford, Alice Theodom, Gill Cowen, Gavin A Davis, Vicki Anderson, Franz E Babl, David Cole, Jennifer Cullen, Stuart R Dalziel, Melinda Fitzgerald, Howard Flavell, Caroline Yates, Rebecca Kimble, John H Olver, Rhonda Orr, Mark Ralfe, Michael Rose, Nick Rushworth, Julia Treleaven, Gary Browne, Nathan Delang, Sarah Harris, Gary Mitchell, Sean Tweedy
{"title":"Mild traumatic brain injury and concussion and persisting post-concussion symptoms: new guidelines to support evidence-based assessment and management in Australia and Aotearoa New Zealand","authors":"Karen M Barlow, Jennie L Ponsford, Alice Theodom, Gill Cowen, Gavin A Davis, Vicki Anderson, Franz E Babl, David Cole, Jennifer Cullen, Stuart R Dalziel, Melinda Fitzgerald, Howard Flavell, Caroline Yates, Rebecca Kimble, John H Olver, Rhonda Orr, Mark Ralfe, Michael Rose, Nick Rushworth, Julia Treleaven, Gary Browne, Nathan Delang, Sarah Harris, Gary Mitchell, Sean Tweedy","doi":"10.5694/mja2.70082","DOIUrl":"https://doi.org/10.5694/mja2.70082","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 9","pages":"446-449"},"PeriodicalIF":8.5,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426207","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}
Tyson Arapali, Sarah Warzywoda, Anthony K J Smith, Curtis Chan, Timothy R Broady, Erin Sullivan, Catherine MacPhail, Mohamed A Hammoud, Alexander Dowell-Day, Benjamin R Bavinton
{"title":"Differentiated and simplified oral HIV pre-exposure prophylaxis (PrEP) models hold the key to virtually eliminating HIV transmission in Australia by 2030","authors":"Tyson Arapali, Sarah Warzywoda, Anthony K J Smith, Curtis Chan, Timothy R Broady, Erin Sullivan, Catherine MacPhail, Mohamed A Hammoud, Alexander Dowell-Day, Benjamin R Bavinton","doi":"10.5694/mja2.70097","DOIUrl":"10.5694/mja2.70097","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 11","pages":"556-559"},"PeriodicalIF":8.5,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145431699","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}
Georgie Frykberg, Angelica Ojinnaka-Psillakis, Planning Saw, Kevin Kapeke, Cham Kim, Amie Furlong, Susan Maury, Anna M H Price, Peter D Sly, Taylor Dee Hawkins, Khalid Muse, Pasi Sahlberg, Prue Warrilow, Fiona J Stanley, Jordan Cory, Carolyn Wallace, Adam Valvasori, Ngiare Brown, Craig A Olsson, Yichao Wang, Sharon R Goldfeld, Rosemary Calder, Kate Lycett
{"title":"The First Future Healthy Countdown 2030 progress report: tracking Australian children and young people’s health and wellbeing to drive accountability","authors":"Georgie Frykberg, Angelica Ojinnaka-Psillakis, Planning Saw, Kevin Kapeke, Cham Kim, Amie Furlong, Susan Maury, Anna M H Price, Peter D Sly, Taylor Dee Hawkins, Khalid Muse, Pasi Sahlberg, Prue Warrilow, Fiona J Stanley, Jordan Cory, Carolyn Wallace, Adam Valvasori, Ngiare Brown, Craig A Olsson, Yichao Wang, Sharon R Goldfeld, Rosemary Calder, Kate Lycett","doi":"10.5694/mja2.70075","DOIUrl":"https://doi.org/10.5694/mja2.70075","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 S9","pages":"S6-S16"},"PeriodicalIF":8.5,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"What fully funded public schools could do","authors":"Pasi Sahlberg, Trevor Cobbold","doi":"10.5694/mja2.70073","DOIUrl":"https://doi.org/10.5694/mja2.70073","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 S9","pages":"S17-S21"},"PeriodicalIF":8.5,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426048","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 strong and agile health workforce and evidence-based practice are two important elements that sustain our health system. These elements do not operate alone — obviously funding and resource allocation and infrastructure, among others, are also of great importance. Together, however, they are important elements that shape both the experience of the patient and the practitioner.</p><p>The Australian health workforce continues to face considerable challenges, including shortages, geographic maldistribution, burnout and attrition, demographic pressures and training issues. For our health system to function optimally, our health workforce must meet these challenges. Despite previous recommendations, there is no current national health workforce policy in Australia to provide overarching guidance and direction.<span><sup>1</sup></span> In this issue of the <i>MJA</i>, Topp and colleagues<span><sup>2</sup></span> present their review of policy documents relevant to the Australian federal health workforce, which they undertook as a starting point for improving policy coordination and reform. Their review included 121 relevant policy documents, and enabled them to describe the fragmentation that exists within federal health workforce policies. In their associated editorial, Bates and colleagues<span><sup>3</sup></span> reinforce the importance of the health workforce within a sustainable health system, and the importance of a policy framework that facilitates the availability of workers in the areas in which they are required.</p><p>In addition to this evidence synthesis of policy documents, this issue of the <i>MJA</i> also includes evidence syntheses that will inform practice across two diverse areas of medicine: assessment and management of mild traumatic brain injury and concussion, and genetic testing for monogenic diabetes.</p><p>Public awareness of the health effects of concussion, and particularly repeated concussions, has increased markedly over the past 25 years. This increased awareness appears to be mostly driven by sports-related concussions, although falls are the leading cause of concussion hospitalisations in Australia.<span><sup>4, 5</sup></span> Nonetheless, many people with concussion do not receive appropriate care, with management varying across health care settings. In this issue of the <i>MJA</i>, Barlow and colleagues<span><sup>6</sup></span> discuss the recent, and first, Australian and Aotearoa New Zealand guidelines for the management of concussion, mild traumatic brain injury and persisting post-concussion symptoms. These guidelines provide over 100 recommendations to inform the management of both acute presentations and longer term persisting symptoms, and should provide greater clarity and confidence for clinicians across diverse health care settings.</p><p>As indicated by its name, monogenic diabetes describes cases of diabetes caused by a single gene variant. Although relatively rare — monogenic diabetes accounts for l
{"title":"Evidence synthesis for stronger health systems — necessary but not sufficient","authors":"Michael Skilton","doi":"10.5694/mja2.70083","DOIUrl":"https://doi.org/10.5694/mja2.70083","url":null,"abstract":"<p>A strong and agile health workforce and evidence-based practice are two important elements that sustain our health system. These elements do not operate alone — obviously funding and resource allocation and infrastructure, among others, are also of great importance. Together, however, they are important elements that shape both the experience of the patient and the practitioner.</p><p>The Australian health workforce continues to face considerable challenges, including shortages, geographic maldistribution, burnout and attrition, demographic pressures and training issues. For our health system to function optimally, our health workforce must meet these challenges. Despite previous recommendations, there is no current national health workforce policy in Australia to provide overarching guidance and direction.<span><sup>1</sup></span> In this issue of the <i>MJA</i>, Topp and colleagues<span><sup>2</sup></span> present their review of policy documents relevant to the Australian federal health workforce, which they undertook as a starting point for improving policy coordination and reform. Their review included 121 relevant policy documents, and enabled them to describe the fragmentation that exists within federal health workforce policies. In their associated editorial, Bates and colleagues<span><sup>3</sup></span> reinforce the importance of the health workforce within a sustainable health system, and the importance of a policy framework that facilitates the availability of workers in the areas in which they are required.</p><p>In addition to this evidence synthesis of policy documents, this issue of the <i>MJA</i> also includes evidence syntheses that will inform practice across two diverse areas of medicine: assessment and management of mild traumatic brain injury and concussion, and genetic testing for monogenic diabetes.</p><p>Public awareness of the health effects of concussion, and particularly repeated concussions, has increased markedly over the past 25 years. This increased awareness appears to be mostly driven by sports-related concussions, although falls are the leading cause of concussion hospitalisations in Australia.<span><sup>4, 5</sup></span> Nonetheless, many people with concussion do not receive appropriate care, with management varying across health care settings. In this issue of the <i>MJA</i>, Barlow and colleagues<span><sup>6</sup></span> discuss the recent, and first, Australian and Aotearoa New Zealand guidelines for the management of concussion, mild traumatic brain injury and persisting post-concussion symptoms. These guidelines provide over 100 recommendations to inform the management of both acute presentations and longer term persisting symptoms, and should provide greater clarity and confidence for clinicians across diverse health care settings.</p><p>As indicated by its name, monogenic diabetes describes cases of diabetes caused by a single gene variant. Although relatively rare — monogenic diabetes accounts for l","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 9","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426206","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 has long been recognised as a world leader in tobacco control. A suite of evidence-based tobacco control measures over recent decades has resulted in substantial reductions in the proportion of adults who report smoking daily and concomitant increases in the proportion of those who report having never smoked.<span><sup>1</sup></span> Rates of daily smoking among adolescents are impressively low at less than 2%.<span><sup>1</sup></span></p><p>Research published in this issue of the <i>Medical Journal of Australia</i> suggests these outcomes have been put in jeopardy by the emergence of vapes in Australia. Egger and colleagues<span><sup>2</sup></span> explored trends in adolescent smoking prevalence before and after the introduction of vapes on the Australian market. Using data from eight Australian Secondary Students’ Alcohol and Drug Surveys administered between 1999 and 2022–2023, they conducted an interrupted time series analysis on the smoking behaviours of over 170 000 adolescents (12–17-year-olds).</p><p>Substantial declines in the prevalence of tobacco smoking were observed, a testament to Australia’s continuing tobacco control efforts. Between 1999 and 2022–2023, the proportion of adolescents who had ever tried smoking decreased by 74.4% (from 52.7% to 13.5%), while the proportion who reported smoking in the past month or past week decreased by 85.5% (from 23.4% to 3.4%) and 89.1% (from 19.2% to 2.1%) respectively. By contrast, the results related to vaping are sobering: between 2017 and 2022–2023, the proportion of adolescents who reported they had ever vaped more than doubled, increasing from 13.5% to 29.9%. The proportion of those who reported vaping in the past month increased from 4.2% to 15.7% over the same period. This increase is consistent with findings from research conducted internationally<span><sup>3-5</sup></span> and coincides with the emergence of cheap, disposable vape products. Made with nicotine salts rather than freebase nicotine, these products have a lower pH, reducing the harshness of the inhaled aerosol and making them highly palatable, addictive, and easy to inhale.<span><sup>6, 7</sup></span> Throw in a flavour of some sort (eg, watermelon ice crush, unicorn milk, gummy bear) and make them easy to conceal, and you have a product that is highly appealing to young people, especially those who were previously nicotine naïve.</p><p>A particularly concerning finding of Egger and colleagues is the slowing in the rate of decline in smoking-related behaviours, with results indicating that there would be fewer adolescents smoking today had vapes not entered the Australian market — a trend that has also been observed in New Zealand.<span><sup>8</sup></span> Specifically, results suggest that the emergence of vapes may have contributed to an extra 74 adolescents out of every 1000 having tried smoking, and an extra 16 out of every 1000 smoking weekly. Although the cross-sectional nature of the data means causalit
{"title":"Vaping may be slowing Australia’s tobacco control progress","authors":"Michelle I Jongenelis, Mike Daube AO","doi":"10.5694/mja2.70096","DOIUrl":"10.5694/mja2.70096","url":null,"abstract":"<p>Australia has long been recognised as a world leader in tobacco control. A suite of evidence-based tobacco control measures over recent decades has resulted in substantial reductions in the proportion of adults who report smoking daily and concomitant increases in the proportion of those who report having never smoked.<span><sup>1</sup></span> Rates of daily smoking among adolescents are impressively low at less than 2%.<span><sup>1</sup></span></p><p>Research published in this issue of the <i>Medical Journal of Australia</i> suggests these outcomes have been put in jeopardy by the emergence of vapes in Australia. Egger and colleagues<span><sup>2</sup></span> explored trends in adolescent smoking prevalence before and after the introduction of vapes on the Australian market. Using data from eight Australian Secondary Students’ Alcohol and Drug Surveys administered between 1999 and 2022–2023, they conducted an interrupted time series analysis on the smoking behaviours of over 170 000 adolescents (12–17-year-olds).</p><p>Substantial declines in the prevalence of tobacco smoking were observed, a testament to Australia’s continuing tobacco control efforts. Between 1999 and 2022–2023, the proportion of adolescents who had ever tried smoking decreased by 74.4% (from 52.7% to 13.5%), while the proportion who reported smoking in the past month or past week decreased by 85.5% (from 23.4% to 3.4%) and 89.1% (from 19.2% to 2.1%) respectively. By contrast, the results related to vaping are sobering: between 2017 and 2022–2023, the proportion of adolescents who reported they had ever vaped more than doubled, increasing from 13.5% to 29.9%. The proportion of those who reported vaping in the past month increased from 4.2% to 15.7% over the same period. This increase is consistent with findings from research conducted internationally<span><sup>3-5</sup></span> and coincides with the emergence of cheap, disposable vape products. Made with nicotine salts rather than freebase nicotine, these products have a lower pH, reducing the harshness of the inhaled aerosol and making them highly palatable, addictive, and easy to inhale.<span><sup>6, 7</sup></span> Throw in a flavour of some sort (eg, watermelon ice crush, unicorn milk, gummy bear) and make them easy to conceal, and you have a product that is highly appealing to young people, especially those who were previously nicotine naïve.</p><p>A particularly concerning finding of Egger and colleagues is the slowing in the rate of decline in smoking-related behaviours, with results indicating that there would be fewer adolescents smoking today had vapes not entered the Australian market — a trend that has also been observed in New Zealand.<span><sup>8</sup></span> Specifically, results suggest that the emergence of vapes may have contributed to an extra 74 adolescents out of every 1000 having tried smoking, and an extra 16 out of every 1000 smoking weekly. Although the cross-sectional nature of the data means causalit","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 10","pages":"515-516"},"PeriodicalIF":8.5,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70096","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409573","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}
In this perspective article, the author Penelope A Bryant was accidentally left off the authors list. The complete authors list should read: Mya Cubitt, Penelope Bryant, Seok Lim.
Affiliations for Penelope Bryant: The Royal Children’s Hospital Melbourne, Melbourne, VIC; University of Melbourne, Melbourne, VIC; Murdoch Children’s Research Institute, Melbourne, VIC
Penelope Bryant declares no conflicts of interest.
在这篇透视图文章中，作者Penelope A Bryant意外地从作者列表中删除了。完整的作者名单应该是：Mya Cubitt， Penelope Bryant, Seok Lim。佩内洛普·布莱恩特的附属机构：墨尔本皇家儿童医院，墨尔本，维多利亚州；墨尔本大学，墨尔本，维多利亚州；墨尔本默多克儿童研究所，VICPenelope Bryant声明没有利益冲突。
{"title":"Cubitt, M, Lim, S. A future for the hospital-in-the-home (HITH) deteriorating patient: shifting the paradigm. Med J Aust 2025; 222: 168-171. https://doi.org/10.5694/mja2.52588","authors":"","doi":"10.5694/mja2.70098","DOIUrl":"10.5694/mja2.70098","url":null,"abstract":"<p>In this perspective article, the author Penelope A Bryant was accidentally left off the authors list. The complete authors list should read: Mya Cubitt, Penelope Bryant, Seok Lim.</p><p>Affiliations for Penelope Bryant: The Royal Children’s Hospital Melbourne, Melbourne, VIC; University of Melbourne, Melbourne, VIC; Murdoch Children’s Research Institute, Melbourne, VIC</p><p>Penelope Bryant declares no conflicts of interest.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 11","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145390878","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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