Bronwyn Fredericks, Neha Lalchandani, Melissa A Sweet, Alex Cramb, Carmel Williams
<p>Our increasingly unreliable and unsafe news and information environment has profound and wide-ranging implications for the health sector and the health and wellbeing of communities.<span><sup>1, 2</sup></span> Key contributors to this harmful environment include: a tide of misinformation and disinformation that undermines communities’ trust in evidence, health care and public health interventions; the dominance of corporate interests whose business models benefit from the spread of misinformation and disinformation; and the weaponisation of misinformation and disinformation by vested interests, including malicious actors.<span><sup>3</sup></span> At the same time, the capacity of public interest journalism has been greatly diminished. This type of journalism gives people the information they need to take part in the democratic process. It informs and contributes to policy and practice, holds power to account, and amplifies the voices of those who are not well served by the current distribution of power.<span><sup>4</sup></span> The contraction of public interest journalism jobs and newsrooms, and the emergence of “news deserts” mean that many communities, whether geographic- or interest-based, do not have access to reliable news and information relevant to their needs and context, even in times of public health emergency.<span><sup>4</sup></span> Since January 2019, more than 200 contractions have been recorded in Australia’s public interest news landscape, including closures, mergers, and the ending of print editions, with regional and local areas hit hardest. A considerable fall in articles covering local government, courts, health and science issues has been recorded over the past 15 years, indicating a decline in specialist and local reporting, which is essential for community accountability.<span><sup>5</sup></span> Public engagement with public interest journalism is also declining globally, as a result of complex factors, including the power and lack of transparency surrounding “Big Tech” algorithms, which are deprioritising news content.<span><sup>6</sup></span> The weakening of public interest journalism, combined with increasing attacks on press freedom, also undermines the accountability of power holders, whether in the political, commercial or community spheres.<span><sup>7</sup></span> Public interest journalism is also important in scrutinising corporate media power and forms of journalism and communications that undermine public health and wellbeing.</p><p>In this era of polycrisis, efforts to develop a more reliable and constructive news and information environment are urgently needed at local, national and global levels. Given the complexity and connectivity of the issues involved, systems approaches<span><sup>8</sup></span> are more likely to be effective than narrowly framed interventions focused on science communications or health literacy or communications strategy. As the leadership of the Aboriginal Community Controlled
{"title":"Protecting public interest journalism as a public health good","authors":"Bronwyn Fredericks, Neha Lalchandani, Melissa A Sweet, Alex Cramb, Carmel Williams","doi":"10.5694/mja2.70091","DOIUrl":"10.5694/mja2.70091","url":null,"abstract":"<p>Our increasingly unreliable and unsafe news and information environment has profound and wide-ranging implications for the health sector and the health and wellbeing of communities.<span><sup>1, 2</sup></span> Key contributors to this harmful environment include: a tide of misinformation and disinformation that undermines communities’ trust in evidence, health care and public health interventions; the dominance of corporate interests whose business models benefit from the spread of misinformation and disinformation; and the weaponisation of misinformation and disinformation by vested interests, including malicious actors.<span><sup>3</sup></span> At the same time, the capacity of public interest journalism has been greatly diminished. This type of journalism gives people the information they need to take part in the democratic process. It informs and contributes to policy and practice, holds power to account, and amplifies the voices of those who are not well served by the current distribution of power.<span><sup>4</sup></span> The contraction of public interest journalism jobs and newsrooms, and the emergence of “news deserts” mean that many communities, whether geographic- or interest-based, do not have access to reliable news and information relevant to their needs and context, even in times of public health emergency.<span><sup>4</sup></span> Since January 2019, more than 200 contractions have been recorded in Australia’s public interest news landscape, including closures, mergers, and the ending of print editions, with regional and local areas hit hardest. A considerable fall in articles covering local government, courts, health and science issues has been recorded over the past 15 years, indicating a decline in specialist and local reporting, which is essential for community accountability.<span><sup>5</sup></span> Public engagement with public interest journalism is also declining globally, as a result of complex factors, including the power and lack of transparency surrounding “Big Tech” algorithms, which are deprioritising news content.<span><sup>6</sup></span> The weakening of public interest journalism, combined with increasing attacks on press freedom, also undermines the accountability of power holders, whether in the political, commercial or community spheres.<span><sup>7</sup></span> Public interest journalism is also important in scrutinising corporate media power and forms of journalism and communications that undermine public health and wellbeing.</p><p>In this era of polycrisis, efforts to develop a more reliable and constructive news and information environment are urgently needed at local, national and global levels. Given the complexity and connectivity of the issues involved, systems approaches<span><sup>8</sup></span> are more likely to be effective than narrowly framed interventions focused on science communications or health literacy or communications strategy. As the leadership of the Aboriginal Community Controlled ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 10","pages":"512-514"},"PeriodicalIF":8.5,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346102","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}
Kerri Beckmann, Brendon J Kearney, Naranie Shanmuganathan, David Yeung, Tim Hughes
{"title":"Disease-specific survival for people with chronic myeloid leukaemia, South Australia, 1980–2020: a retrospective cohort study","authors":"Kerri Beckmann, Brendon J Kearney, Naranie Shanmuganathan, David Yeung, Tim Hughes","doi":"10.5694/mja2.70078","DOIUrl":"10.5694/mja2.70078","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 11","pages":"643-645"},"PeriodicalIF":8.5,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337432","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>Access to mental health services continues to be a significant problem for most Australians.<span><sup>1</sup></span> This problem has been exacerbated in regional and rural areas.<span><sup>1</sup></span> Most recently though, psychiatrists in the public hospital system in New South Wales threatened to walk off the job en masse due to a myriad reasons, the most prominent being the substantial pay gap for clinicians in NSW compared with other states.<span><sup>1</sup></span> In this issue of the <i>MJA</i>, Huber and colleagues<span><sup>2</sup></span> tried to identify modifiable causes of stress in clinicians and administrators working in NSW psychiatric emergency care centres. The study design was qualitative and 35 participants across 12 sites were interviewed. Systemic challenges at three levels were identified in staff interactions with patients and carers, the broader health system and the hospital. The study found that relational work (the core of clinician–service user interactions) is both meaningful and difficult. Psychiatric Emergency Care Centres (PECC) are the nexus of suicide risk management, with conflicting system expectations of staff to ensure safe care while making risky discharge decisions, which causes anxiety and high turnover. Moreover, there is tension between the model of care and the frequent reality of PECCs being used to manage patient flow, which leads to clinicians feeling professionally undervalued by the hospital. Two protective themes enabling staff to meet these challenges were developed. First, well defined treatment protocols enhanced clinical satisfaction, continuity of care for patients, and supported wellbeing. Second, working in a collaborative team environment with a flattened hierarchy fostered autonomy and robust teamwork.</p><p>On the other end of the spectrum is access to community-based paediatricians and psychiatrists, especially for attention deficit hyperactivity disorder (ADHD) and developmental assessments. Rates of ADHD diagnosis have increased substantially in the past ten years and the reasons for this are complex and multifactorial.<span><sup>3</sup></span> In this issue of the <i>MJA</i>, Bradlow and colleagues<span><sup>4</sup></span> examine adult ADHD in Australia and how its current commercial model for diagnosis and treatment may be encouraging misdiagnosis. The rise in ADHD diagnoses and the most appropriate management approaches are debated. This rise is particularly pronounced among adults, the authors write, and could be in part attributed to growing public awareness, amplified by social media platforms such as TikTok, where ADHD-related content is reported to have had over 36 billion views. The authors note that “most adults with ADHD are diagnosed by private psychiatrists”. The dearth of public services for ADHD raises serious concerns regarding equity of access and the potential that normal behavioural variability is “medicalised”. Their view is that there is a risk that comp
{"title":"Access to mental health services continues to be under duress","authors":"Aajuli Shukla","doi":"10.5694/mja2.70070","DOIUrl":"https://doi.org/10.5694/mja2.70070","url":null,"abstract":"<p>Access to mental health services continues to be a significant problem for most Australians.<span><sup>1</sup></span> This problem has been exacerbated in regional and rural areas.<span><sup>1</sup></span> Most recently though, psychiatrists in the public hospital system in New South Wales threatened to walk off the job en masse due to a myriad reasons, the most prominent being the substantial pay gap for clinicians in NSW compared with other states.<span><sup>1</sup></span> In this issue of the <i>MJA</i>, Huber and colleagues<span><sup>2</sup></span> tried to identify modifiable causes of stress in clinicians and administrators working in NSW psychiatric emergency care centres. The study design was qualitative and 35 participants across 12 sites were interviewed. Systemic challenges at three levels were identified in staff interactions with patients and carers, the broader health system and the hospital. The study found that relational work (the core of clinician–service user interactions) is both meaningful and difficult. Psychiatric Emergency Care Centres (PECC) are the nexus of suicide risk management, with conflicting system expectations of staff to ensure safe care while making risky discharge decisions, which causes anxiety and high turnover. Moreover, there is tension between the model of care and the frequent reality of PECCs being used to manage patient flow, which leads to clinicians feeling professionally undervalued by the hospital. Two protective themes enabling staff to meet these challenges were developed. First, well defined treatment protocols enhanced clinical satisfaction, continuity of care for patients, and supported wellbeing. Second, working in a collaborative team environment with a flattened hierarchy fostered autonomy and robust teamwork.</p><p>On the other end of the spectrum is access to community-based paediatricians and psychiatrists, especially for attention deficit hyperactivity disorder (ADHD) and developmental assessments. Rates of ADHD diagnosis have increased substantially in the past ten years and the reasons for this are complex and multifactorial.<span><sup>3</sup></span> In this issue of the <i>MJA</i>, Bradlow and colleagues<span><sup>4</sup></span> examine adult ADHD in Australia and how its current commercial model for diagnosis and treatment may be encouraging misdiagnosis. The rise in ADHD diagnoses and the most appropriate management approaches are debated. This rise is particularly pronounced among adults, the authors write, and could be in part attributed to growing public awareness, amplified by social media platforms such as TikTok, where ADHD-related content is reported to have had over 36 billion views. The authors note that “most adults with ADHD are diagnosed by private psychiatrists”. The dearth of public services for ADHD raises serious concerns regarding equity of access and the potential that normal behavioural variability is “medicalised”. Their view is that there is a risk that comp","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 8","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145317329","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":"Splenic injury in severe cases of the zoonoses Q fever and rickettsial infection: diagnostic challenges","authors":"Ashleigh Drury, Philippa Harrison, Aiveen Bannan","doi":"10.5694/mja2.70079","DOIUrl":"10.5694/mja2.70079","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 9","pages":"450-453"},"PeriodicalIF":8.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292647","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}
Lisa M Sedger, Vishal Ahuja, Katherine A Lau, Deane L Byers, Torsten Theis, Peter D Kirkland, Catherine Pitman
{"title":"The detection of avian influenza virus in human pathology laboratories in Australia, New Zealand, and South Pacific nations","authors":"Lisa M Sedger, Vishal Ahuja, Katherine A Lau, Deane L Byers, Torsten Theis, Peter D Kirkland, Catherine Pitman","doi":"10.5694/mja2.70076","DOIUrl":"10.5694/mja2.70076","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 9","pages":"492-494"},"PeriodicalIF":8.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292648","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}
Danielle Mazza, Kailash Thapaliya, Sharinne B Crawford, Alissia Hui, Maryam Moradi, Luke E Grzeskowiak
<div> <section> <h3> Objective</h3> <p>To examine the presentation, investigation, and clinical management of women diagnosed with endometriosis in Australian general practices during 2011–2021.</p> </section> <section> <h3> Study design</h3> <p>Open cohort study; analysis of MedicineInsight data.</p> </section> <section> <h3> Setting, participants</h3> <p>Women aged 14–49 years who were active patients at Australian general practices participating in MedicineInsight and were diagnosed with endometriosis at these practices, 1 January 2011 – 31 December 2021.</p> </section> <section> <h3> Main outcome measures</h3> <p>The number of women with first documented diagnoses of endometriosis in general practices and the annual age-standardised prevalence; documented symptoms prior to documented endometriosis diagnosis; time from initial symptoms to diagnosis; general practitioner requests for diagnostic investigations and prescribing of medications.</p> </section> <section> <h3> Results</h3> <p>First diagnoses of endometriosis at their regular general practices were recorded for 19 786 women during 2011–2021; the annual age-standardised prevalence increased from 1.78 per 100 women in 2011 to 2.86 per 100 women in 2021. At least one symptom was documented prior to diagnosis for 13 202 women (66.7%), including 8073 (40.8%) with pelvic pain and 4371 (22.1%) with dysmenorrhea. The median time from first symptom documentation to first documented endometriosis diagnosis was 2.5 years (interquartile range, 0.9–5.6 years). The proportion of women for whom general practitioners requested pelvic ultrasound prior to diagnosis increased from 202 of 1068 of those diagnosed in 2011 (18.9%) to 1099 of 2259 women diagnosed in 2021 (48.6%). The proportions of women who received general practitioner prescriptions were larger during the five years after than the five years preceding endometriosis diagnoses for levonorgestrel intrauterine devices (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.36–1.65) and non-contraceptive progestogens (OR, 1.65; 95% CI, 1.51–1.81), and smaller for oral contraceptive pills (OR, 0.47; 95% CI, 0.45–0.50). The proportions of women prescribed opioids (OR, 1.35; 95% CI, 1.29–1.42), tricyclic antidepressants (OR, 1.93; 95% CI, 1.77–2.11), and gabapentinoids (OR, 2.60; 95% CI, 2.30–2.91) were also larger after endometriosis diagnoses; the proportion for each medication type was highest one year after diagnosis, but then declined.</p>
{"title":"The clinical presentation, investigation, and management of women diagnosed with endometriosis in Australian general practices, 2011–2021: an open cohort study","authors":"Danielle Mazza, Kailash Thapaliya, Sharinne B Crawford, Alissia Hui, Maryam Moradi, Luke E Grzeskowiak","doi":"10.5694/mja2.70062","DOIUrl":"10.5694/mja2.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the presentation, investigation, and clinical management of women diagnosed with endometriosis in Australian general practices during 2011–2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Open cohort study; analysis of MedicineInsight data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Women aged 14–49 years who were active patients at Australian general practices participating in MedicineInsight and were diagnosed with endometriosis at these practices, 1 January 2011 – 31 December 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>The number of women with first documented diagnoses of endometriosis in general practices and the annual age-standardised prevalence; documented symptoms prior to documented endometriosis diagnosis; time from initial symptoms to diagnosis; general practitioner requests for diagnostic investigations and prescribing of medications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>First diagnoses of endometriosis at their regular general practices were recorded for 19 786 women during 2011–2021; the annual age-standardised prevalence increased from 1.78 per 100 women in 2011 to 2.86 per 100 women in 2021. At least one symptom was documented prior to diagnosis for 13 202 women (66.7%), including 8073 (40.8%) with pelvic pain and 4371 (22.1%) with dysmenorrhea. The median time from first symptom documentation to first documented endometriosis diagnosis was 2.5 years (interquartile range, 0.9–5.6 years). The proportion of women for whom general practitioners requested pelvic ultrasound prior to diagnosis increased from 202 of 1068 of those diagnosed in 2011 (18.9%) to 1099 of 2259 women diagnosed in 2021 (48.6%). The proportions of women who received general practitioner prescriptions were larger during the five years after than the five years preceding endometriosis diagnoses for levonorgestrel intrauterine devices (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.36–1.65) and non-contraceptive progestogens (OR, 1.65; 95% CI, 1.51–1.81), and smaller for oral contraceptive pills (OR, 0.47; 95% CI, 0.45–0.50). The proportions of women prescribed opioids (OR, 1.35; 95% CI, 1.29–1.42), tricyclic antidepressants (OR, 1.93; 95% CI, 1.77–2.11), and gabapentinoids (OR, 2.60; 95% CI, 2.30–2.91) were also larger after endometriosis diagnoses; the proportion for each medication type was highest one year after diagnosis, but then declined.</p>\u0000 ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 11","pages":"586-592"},"PeriodicalIF":8.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145301482","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}
Nicole E Kroesche, Tina L Cockburn, Kelly Purser, Karen A Sullivan
{"title":"Medicolegal consequences of doctors accepting bequests and gifts under a patient’s will","authors":"Nicole E Kroesche, Tina L Cockburn, Kelly Purser, Karen A Sullivan","doi":"10.5694/mja2.70077","DOIUrl":"10.5694/mja2.70077","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 9","pages":"454-456"},"PeriodicalIF":8.5,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280498","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}
Shona M Bates, Ben Harris-Roxas, Patricia M Davidson
<p>The World Health Organization has declared that “health systems can only function with health workers.”<span><sup>1</sup></span> In Australia, health practitioners (a subset of health workers) make up 5% of the national workforce, and about half are nurses.<span><sup>2</sup></span> The health workforce is spread across public and private facilities, across primary, secondary and tertiary care, and across states and territories, and overlaps other health-related areas, including disability and aged care.<span><sup>3</sup></span> This workforce is under pressure from rising service demand, environmental, geopolitical, and economic pressures, continual policy reforms, and disparities in pay and conditions,<span><sup>4, 5</sup></span> leading to workforce shortages, some related to maldistribution or deficits in some health care types, and inequity of access.<span><sup>2, 3, 5</sup></span> The size of the health practitioner workforce increased 37% during 2013–2022; growth was greatest for allied health professionals (67%), medical practitioners (41%), dental practitioners (29%), nurses and midwives (26%), and general practitioners (24%).<span><sup>2</sup></span> Relative to population size (fulltime equivalent positions per 100 000 population), the workforce increased by 22% for the same period, the change again varying by profession (general practitioners, 2.7%; nurses and midwives, 13.2%; allied health professionals, 53.1%) and region, but demand continued to outstrip growth, with shortages reported for 82% of occupations in 2023.<span><sup>2</sup></span> Around the world, the health workforce was significantly affected by attrition caused by the COVID-19 pandemic,<span><sup>2, 6</sup></span> the erosion of goodwill (eg, willingness to work unpaid overtime),<span><sup>7</sup></span> and fatigue related to change.<span><sup>8, 9</sup></span> Workforce instability has an impact on the continuity and quality of services, and can vary geographically because of differences in the availability of staff and competition between employers. Recent royal commissions have highlighted the need for a larger, better trained and better paid care workforce, particularly in rural and regional areas.<span><sup>10, 11</sup></span></p><p>The increasing pressure on the health system and its workforce, fiscal constraints, complex professional governance, and interactions with other systems mean that a consolidated workforce policy is needed to align efforts to support and strengthen the health system. In their review of federal health workforce policy in Australia, published in this issue of the <i>MJA</i>, Topp and colleagues<span><sup>3</sup></span> identified a range of policies largely concerned with specific professions, culturally specific workforces, geographic location, career development, specific areas of health care, and the general supply, distribution, and performance of the health care workforce. The authors conclude that such fragmentation undermines c
{"title":"Building a health workforce to meet future population needs","authors":"Shona M Bates, Ben Harris-Roxas, Patricia M Davidson","doi":"10.5694/mja2.70069","DOIUrl":"10.5694/mja2.70069","url":null,"abstract":"<p>The World Health Organization has declared that “health systems can only function with health workers.”<span><sup>1</sup></span> In Australia, health practitioners (a subset of health workers) make up 5% of the national workforce, and about half are nurses.<span><sup>2</sup></span> The health workforce is spread across public and private facilities, across primary, secondary and tertiary care, and across states and territories, and overlaps other health-related areas, including disability and aged care.<span><sup>3</sup></span> This workforce is under pressure from rising service demand, environmental, geopolitical, and economic pressures, continual policy reforms, and disparities in pay and conditions,<span><sup>4, 5</sup></span> leading to workforce shortages, some related to maldistribution or deficits in some health care types, and inequity of access.<span><sup>2, 3, 5</sup></span> The size of the health practitioner workforce increased 37% during 2013–2022; growth was greatest for allied health professionals (67%), medical practitioners (41%), dental practitioners (29%), nurses and midwives (26%), and general practitioners (24%).<span><sup>2</sup></span> Relative to population size (fulltime equivalent positions per 100 000 population), the workforce increased by 22% for the same period, the change again varying by profession (general practitioners, 2.7%; nurses and midwives, 13.2%; allied health professionals, 53.1%) and region, but demand continued to outstrip growth, with shortages reported for 82% of occupations in 2023.<span><sup>2</sup></span> Around the world, the health workforce was significantly affected by attrition caused by the COVID-19 pandemic,<span><sup>2, 6</sup></span> the erosion of goodwill (eg, willingness to work unpaid overtime),<span><sup>7</sup></span> and fatigue related to change.<span><sup>8, 9</sup></span> Workforce instability has an impact on the continuity and quality of services, and can vary geographically because of differences in the availability of staff and competition between employers. Recent royal commissions have highlighted the need for a larger, better trained and better paid care workforce, particularly in rural and regional areas.<span><sup>10, 11</sup></span></p><p>The increasing pressure on the health system and its workforce, fiscal constraints, complex professional governance, and interactions with other systems mean that a consolidated workforce policy is needed to align efforts to support and strengthen the health system. In their review of federal health workforce policy in Australia, published in this issue of the <i>MJA</i>, Topp and colleagues<span><sup>3</sup></span> identified a range of policies largely concerned with specific professions, culturally specific workforces, geographic location, career development, specific areas of health care, and the general supply, distribution, and performance of the health care workforce. The authors conclude that such fragmentation undermines c","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 9","pages":"457-458"},"PeriodicalIF":8.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251640","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}
Firouzeh Noghrehchi, Nicholas A Buckley, Rose Cairns
<div> <section> <h3> Objectives</h3> <p>To estimate the risk of death after hospitalisation with non-fatal intentional self-poisoning in New South Wales, and to estimate the associated number of years of life lost.</p> </section> <section> <h3> Study design</h3> <p>Retrospective observational study; analysis of Poisoning And enVenomation Linkage to evaluate Outcomes and clinical Variation in Australia (PAVLOVA) study data.</p> </section> <section> <h3> Setting, participants</h3> <p>All index admissions to New South Wales public and private hospitals of people after non-fatal intentional self-poisoning (ie, were discharged from the index admission alive), 1 January 2011 – 30 September 2020.</p> </section> <section> <h3> Main outcome measures</h3> <p>Standardised mortality ratio (compared with general population mortality rate; SMR), overall, and by cause of death (data available only for 2011–2018); years of life lost (YLL) overall, and by cause of death (2011–2018), age group, and sex.</p> </section> <section> <h3> Results</h3> <p>Index admissions of people with non-fatal intentional self-poisoning were identified for 48 951 people; their median age was 32.8 years (interquartile range [IQR], 20.8–47.5 years), 30 274 were girls or women (61.8%), and 3449 died during follow-up (median, 4.9 years; IQR, 2.7–7.3 years). The all-cause SMR was 3.1 (95% confidence interval [CI], 3.0–3.2); by cause of death, the SMR was highest for external cause deaths (16.8; 95% CI, 15.9–17.8), including accidental poisoning (30.3; 95% CI, 27.4–33.2) and suicide deaths (25.1; 95% CI, 23.2–27.1). Among natural causes of death, the SMR was highest for infectious and parasitic diseases (5.4; 95% CI, 3.9–6.8), digestive diseases (4.2; 95% CI, 3.4–5.0), and respiratory diseases (3.0; 95% CI, 2.5–3.4). The estimated overall premature mortality burden was 110 301.4 YLL; the median value per death was similar for women (31.1 YLL; IQR, 15.0–43.0 YLL) and men (33.2 YLL; IQR, 19.7–44.9 YLL). During 2011–2018, the total mortality burden was 79 821.6 YLL; by cause of death, the major contributors were deaths from suicide (26 945.2 YLL; 33.8%), accidental poisoning (17 436.1 YLL; 21.8%), other injuries (6026.8 YLL; 7.5%), and natural causes (29 413.5 years; 36.8%).</p> </section> <section> <h3> Conclusions</h3> <p>The risk of death is markedly higher after hospitalisation with intentio
{"title":"The risk of death after hospitalisation following intentional self-poisoning: a retrospective observational study (PAVLOVA-2)","authors":"Firouzeh Noghrehchi, Nicholas A Buckley, Rose Cairns","doi":"10.5694/mja2.70068","DOIUrl":"10.5694/mja2.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To estimate the risk of death after hospitalisation with non-fatal intentional self-poisoning in New South Wales, and to estimate the associated number of years of life lost.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Retrospective observational study; analysis of Poisoning And enVenomation Linkage to evaluate Outcomes and clinical Variation in Australia (PAVLOVA) study data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>All index admissions to New South Wales public and private hospitals of people after non-fatal intentional self-poisoning (ie, were discharged from the index admission alive), 1 January 2011 – 30 September 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Standardised mortality ratio (compared with general population mortality rate; SMR), overall, and by cause of death (data available only for 2011–2018); years of life lost (YLL) overall, and by cause of death (2011–2018), age group, and sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Index admissions of people with non-fatal intentional self-poisoning were identified for 48 951 people; their median age was 32.8 years (interquartile range [IQR], 20.8–47.5 years), 30 274 were girls or women (61.8%), and 3449 died during follow-up (median, 4.9 years; IQR, 2.7–7.3 years). The all-cause SMR was 3.1 (95% confidence interval [CI], 3.0–3.2); by cause of death, the SMR was highest for external cause deaths (16.8; 95% CI, 15.9–17.8), including accidental poisoning (30.3; 95% CI, 27.4–33.2) and suicide deaths (25.1; 95% CI, 23.2–27.1). Among natural causes of death, the SMR was highest for infectious and parasitic diseases (5.4; 95% CI, 3.9–6.8), digestive diseases (4.2; 95% CI, 3.4–5.0), and respiratory diseases (3.0; 95% CI, 2.5–3.4). The estimated overall premature mortality burden was 110 301.4 YLL; the median value per death was similar for women (31.1 YLL; IQR, 15.0–43.0 YLL) and men (33.2 YLL; IQR, 19.7–44.9 YLL). During 2011–2018, the total mortality burden was 79 821.6 YLL; by cause of death, the major contributors were deaths from suicide (26 945.2 YLL; 33.8%), accidental poisoning (17 436.1 YLL; 21.8%), other injuries (6026.8 YLL; 7.5%), and natural causes (29 413.5 years; 36.8%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The risk of death is markedly higher after hospitalisation with intentio","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 11","pages":"634-642"},"PeriodicalIF":8.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251645","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}
Julia K Moore, Cate Rayner, S Rachel Skinner, Katie Wynne, Blake S Cavve, Brodie Fraser, Uma Ganti, Claire McAllister, Gideon Meyerowitz-Katz, Tram Nguyen, Anja Ravine, Brian Ross, Darren B Russell, Liz A Saunders, Aris Siafarikas, Ken C Pang
<p>The <i>Independent review of gender identity services for children and young people</i>, or Cass Review<span><sup>1</sup></span> (the Review), was commissioned by England's National Health Service (NHS) following increased referrals to the NHS Gender Identity Development Service (GIDS), criticisms of GIDS, and the <i>Bell v Tavistock</i> case involving one young person who regretted gender-affirming medical treatment (GAMT).<span><sup>2</sup></span> The Review's April 2024 final report recommended that puberty suppression with gonadotrophin-releasing hormone analogues (GnRHa) should only be available to transgender (trans) adolescents in a clinical trial, which has not commenced. The United Kingdom Government subsequently prohibited the supply of GnRHa as GAMT for minors,<span><sup>3</sup></span> making it unlawful for trans adolescents to commence GnRHa treatment. Other Review recommendations restrict the provision of oestrogen and testosterone for individuals over the age of 16 years, and conceptualise social affirmation of trans children as a potentially harmful intervention.<span><sup>1</sup></span></p><p>Worldwide, the Review has received criticism from expert professional organisations<span><sup>4-7</sup></span> and in the peer-reviewed literature<span><sup>8-12</sup></span> for its disregard of international expert consensus,<span><sup>13</sup></span> methodological problems, and conceptual errors. UK trans community advocates have raised issues of justice and human rights.<span><sup>14</sup></span> The UK Government cited the Review in guidance empowering schools to misgender trans students and breach their confidentiality.<span><sup>15</sup></span> In response, the Royal College of Paediatrics and Child Health stated that this disregarded <i>Gillick</i> competence, contradicted guidance from the National Institute for Health and Care Excellence (NICE) to use chosen name and pronouns,<span><sup>16</sup></span> and placed young people at risk of abuse.<span><sup>15</sup></span></p><p>The Cass Review's internal contradictions are striking. It acknowledged that some trans young people benefit from puberty suppression, but its recommendations have made this currently inaccessible to all. It found no evidence that psychological treatments improve gender dysphoria, yet recommended expanding their provision. It found that NHS provision of GAMT (GnRHa, oestrogen or testosterone) was already very restricted, and that young people were distressed by lack of access to treatment,<span><sup>1</sup></span> yet it recommended increased barriers to oestrogen and testosterone for any trans adolescents aged under 18 years. It dismissed the evidence of benefit from GAMT as “weak”, but emphasised speculative harms based on weaker evidence. The harms of withholding GAMT were not evaluated. The Review disregarded studies observing that adolescents who requested but were unable to access GAMT had poorer mental health compared with those who could access GAMT
{"title":"Cass Review does not guide care for trans young people","authors":"Julia K Moore, Cate Rayner, S Rachel Skinner, Katie Wynne, Blake S Cavve, Brodie Fraser, Uma Ganti, Claire McAllister, Gideon Meyerowitz-Katz, Tram Nguyen, Anja Ravine, Brian Ross, Darren B Russell, Liz A Saunders, Aris Siafarikas, Ken C Pang","doi":"10.5694/mja2.70035","DOIUrl":"https://doi.org/10.5694/mja2.70035","url":null,"abstract":"<p>The <i>Independent review of gender identity services for children and young people</i>, or Cass Review<span><sup>1</sup></span> (the Review), was commissioned by England's National Health Service (NHS) following increased referrals to the NHS Gender Identity Development Service (GIDS), criticisms of GIDS, and the <i>Bell v Tavistock</i> case involving one young person who regretted gender-affirming medical treatment (GAMT).<span><sup>2</sup></span> The Review's April 2024 final report recommended that puberty suppression with gonadotrophin-releasing hormone analogues (GnRHa) should only be available to transgender (trans) adolescents in a clinical trial, which has not commenced. The United Kingdom Government subsequently prohibited the supply of GnRHa as GAMT for minors,<span><sup>3</sup></span> making it unlawful for trans adolescents to commence GnRHa treatment. Other Review recommendations restrict the provision of oestrogen and testosterone for individuals over the age of 16 years, and conceptualise social affirmation of trans children as a potentially harmful intervention.<span><sup>1</sup></span></p><p>Worldwide, the Review has received criticism from expert professional organisations<span><sup>4-7</sup></span> and in the peer-reviewed literature<span><sup>8-12</sup></span> for its disregard of international expert consensus,<span><sup>13</sup></span> methodological problems, and conceptual errors. UK trans community advocates have raised issues of justice and human rights.<span><sup>14</sup></span> The UK Government cited the Review in guidance empowering schools to misgender trans students and breach their confidentiality.<span><sup>15</sup></span> In response, the Royal College of Paediatrics and Child Health stated that this disregarded <i>Gillick</i> competence, contradicted guidance from the National Institute for Health and Care Excellence (NICE) to use chosen name and pronouns,<span><sup>16</sup></span> and placed young people at risk of abuse.<span><sup>15</sup></span></p><p>The Cass Review's internal contradictions are striking. It acknowledged that some trans young people benefit from puberty suppression, but its recommendations have made this currently inaccessible to all. It found no evidence that psychological treatments improve gender dysphoria, yet recommended expanding their provision. It found that NHS provision of GAMT (GnRHa, oestrogen or testosterone) was already very restricted, and that young people were distressed by lack of access to treatment,<span><sup>1</sup></span> yet it recommended increased barriers to oestrogen and testosterone for any trans adolescents aged under 18 years. It dismissed the evidence of benefit from GAMT as “weak”, but emphasised speculative harms based on weaker evidence. The harms of withholding GAMT were not evaluated. The Review disregarded studies observing that adolescents who requested but were unable to access GAMT had poorer mental health compared with those who could access GAMT","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 7","pages":"331-337"},"PeriodicalIF":8.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237075","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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