<p>Each serum creatinine pathology test result in Australia is routinely returned with a report on the estimated glomerular filtration rate (eGFR). The equation for calculating the eGFR has been updated, and Australian practitioners may be curious to know why this might concern them.</p><p>The eGFR equations were derived from multiple studies that used direct measurements of kidney function with accurate but intensive methods that are generally reserved for research, such as the clearance of the exogenous filtration markers inulin, iothalamate, or iohexol.<span><sup>1</sup></span> The Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)<sub>2009</sub> equations included serum creatinine concentration, age, sex, and race (Black or non-Black) as variables.<span><sup>1</sup></span> A new, race-free equation was developed after concerns in the United States regarding the validity, accuracy, and implications of including a binary or non-binary race component.<span><sup>2</sup></span> In 2021 the CKD-EPI published a newly derived and validated race-free equation (CKD-EPI<sub>2021</sub>), and reported that the new equations produced estimates of measured kidney function that were within the accepted 30% margin of error.<span><sup>3</sup></span> The CKD-EPI confirmed that equations based on creatinine and cystatin concentrations consistently produce more accurate estimates than equations based on creatinine alone. It also reconfirmed the clinical relevance of eGFR, reporting a strong inverse linear association with the risk of kidney failure, adverse cardiovascular events, and death. The association of lower eGFR with adverse event risk is the underlying rationale for risk-based categories in the widely used KDIGO classification of chronic kidney disease.<span><sup>4</sup></span> Using the new equation without a race coefficient is now the recommended standard.<span><sup>5</sup></span></p><p>Practitioners may wonder about the implications of the change for Australia. At the individual level, the difference is mostly a minor, one-off change in eGFR that might only be apparent in people who are being frequently monitored at the time of the equation change. At the population level, even small changes in the calculated eGFR could affect how health systems anticipate and plan for chronic kidney disease (CKD)-associated health care.</p><p>CKD has a large impact on community health and on health budgets. It affects an estimated one in ten Australian adults, and one in five Aboriginal and Torres Strait Islander adults.<span><sup>6</sup></span> The association of CKD with adverse outcomes<span><sup>4</sup></span> is reflected by the prediction that CKD-associated death will be the fifth leading cause of years of lost life globally by 2040.<span><sup>7</sup></span> Even now, it has been estimated that CKD costs the Australian economy $9.9 billion each year.<span><sup>8</sup></span></p><p>How the CKD-EPI<s
{"title":"Re-thinking kidney function: a new approach to kidney function estimation and the identification of chronic kidney disease","authors":"Jessica Dawson, Meg Jardine","doi":"10.5694/mja2.52560","DOIUrl":"10.5694/mja2.52560","url":null,"abstract":"<p>Each serum creatinine pathology test result in Australia is routinely returned with a report on the estimated glomerular filtration rate (eGFR). The equation for calculating the eGFR has been updated, and Australian practitioners may be curious to know why this might concern them.</p><p>The eGFR equations were derived from multiple studies that used direct measurements of kidney function with accurate but intensive methods that are generally reserved for research, such as the clearance of the exogenous filtration markers inulin, iothalamate, or iohexol.<span><sup>1</sup></span> The Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)<sub>2009</sub> equations included serum creatinine concentration, age, sex, and race (Black or non-Black) as variables.<span><sup>1</sup></span> A new, race-free equation was developed after concerns in the United States regarding the validity, accuracy, and implications of including a binary or non-binary race component.<span><sup>2</sup></span> In 2021 the CKD-EPI published a newly derived and validated race-free equation (CKD-EPI<sub>2021</sub>), and reported that the new equations produced estimates of measured kidney function that were within the accepted 30% margin of error.<span><sup>3</sup></span> The CKD-EPI confirmed that equations based on creatinine and cystatin concentrations consistently produce more accurate estimates than equations based on creatinine alone. It also reconfirmed the clinical relevance of eGFR, reporting a strong inverse linear association with the risk of kidney failure, adverse cardiovascular events, and death. The association of lower eGFR with adverse event risk is the underlying rationale for risk-based categories in the widely used KDIGO classification of chronic kidney disease.<span><sup>4</sup></span> Using the new equation without a race coefficient is now the recommended standard.<span><sup>5</sup></span></p><p>Practitioners may wonder about the implications of the change for Australia. At the individual level, the difference is mostly a minor, one-off change in eGFR that might only be apparent in people who are being frequently monitored at the time of the equation change. At the population level, even small changes in the calculated eGFR could affect how health systems anticipate and plan for chronic kidney disease (CKD)-associated health care.</p><p>CKD has a large impact on community health and on health budgets. It affects an estimated one in ten Australian adults, and one in five Aboriginal and Torres Strait Islander adults.<span><sup>6</sup></span> The association of CKD with adverse outcomes<span><sup>4</sup></span> is reflected by the prediction that CKD-associated death will be the fifth leading cause of years of lost life globally by 2040.<span><sup>7</sup></span> Even now, it has been estimated that CKD costs the Australian economy $9.9 billion each year.<span><sup>8</sup></span></p><p>How the CKD-EPI<s","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 2","pages":"72-73"},"PeriodicalIF":6.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52560","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854474","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}
<div> <section> <h3> Objectives</h3> <p>To examine bulk-billing rates and out-of-pocket costs for non-bulk-billed general practitioner services in Australia at the Statistical Area 3 (SA3) level; to assess differences by area-level socio-economic disadvantage and remoteness.</p> </section> <section> <h3> Study design</h3> <p>Retrospective analysis of administrative data (Medicare claims data).</p> </section> <section> <h3> Setting, participants</h3> <p>All Medicare claims for non-referred general practitioner services in Australia during the 2022 calendar year, as recorded in the Person Level Integrated Data Asset (PLIDA).</p> </section> <section> <h3> Main outcome measures</h3> <p>Mean proportions of general practitioner services that were bulk-billed and mean patient out-of-pocket costs for non-bulk-billed general practitioner visits by SA3 region, adjusted for area-level age and sex, both overall and by area-level socio-economic disadvantage (Index of Relative Socioeconomic Disadvantage quintile) and remoteness (simplified Modified Monash Model category).</p> </section> <section> <h3> Results</h3> <p>During 2022, 82% (95% confidence interval [CI], 80–83%) of general practitioner services in Australia were bulk-billed; the mean out-of-pocket cost for non-bulk-billed visits was $43 (95% CI, $42–44). By SA3, mean bulk-billing rates ranged between 46% and 99%, mean out-of-pocket costs for non-bulk-billed general practitioner visit between $16 and $99. Bulk-billing rates were higher in regions in the most socio-economically disadvantaged quintile (86%; 95% CI, 84–88%) than those in the least disadvantaged quintile (73%; 95% CI, 70–76%); the mean rate was not significantly different for remote (86%; 95% CI, 79–92%) and metropolitan areas (81%; 95% CI, 79–83%). Out-of-pocket costs for non-bulk-billed general practitioner services were higher in remote ($56; 95% CI, $46–66) than in metropolitan areas ($43; 95% CI, $42–44), and lower in areas in the most socio-economically disadvantaged quintile ($42; 95% CI, $40–45) than in those in the least disadvantaged quintile ($47; 95% CI, $45–49).</p> </section> <section> <h3> Conclusion</h3> <p>Although most general practitioner services are bulk-billed, out-of-pocket costs for non-bulk-billed services are relatively high, particularly for people in remote and socio-economically disadvantaged areas of Australia.
{"title":"Bulk-billing rates and out-of-pocket costs for general practitioner services in Australia, 2022, by SA3 region: analysis of Medicare claims data","authors":"Karinna Saxby, Yuting Zhang","doi":"10.5694/mja2.52562","DOIUrl":"10.5694/mja2.52562","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To examine bulk-billing rates and out-of-pocket costs for non-bulk-billed general practitioner services in Australia at the Statistical Area 3 (SA3) level; to assess differences by area-level socio-economic disadvantage and remoteness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Retrospective analysis of administrative data (Medicare claims data).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>All Medicare claims for non-referred general practitioner services in Australia during the 2022 calendar year, as recorded in the Person Level Integrated Data Asset (PLIDA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Mean proportions of general practitioner services that were bulk-billed and mean patient out-of-pocket costs for non-bulk-billed general practitioner visits by SA3 region, adjusted for area-level age and sex, both overall and by area-level socio-economic disadvantage (Index of Relative Socioeconomic Disadvantage quintile) and remoteness (simplified Modified Monash Model category).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During 2022, 82% (95% confidence interval [CI], 80–83%) of general practitioner services in Australia were bulk-billed; the mean out-of-pocket cost for non-bulk-billed visits was $43 (95% CI, $42–44). By SA3, mean bulk-billing rates ranged between 46% and 99%, mean out-of-pocket costs for non-bulk-billed general practitioner visit between $16 and $99. Bulk-billing rates were higher in regions in the most socio-economically disadvantaged quintile (86%; 95% CI, 84–88%) than those in the least disadvantaged quintile (73%; 95% CI, 70–76%); the mean rate was not significantly different for remote (86%; 95% CI, 79–92%) and metropolitan areas (81%; 95% CI, 79–83%). Out-of-pocket costs for non-bulk-billed general practitioner services were higher in remote ($56; 95% CI, $46–66) than in metropolitan areas ($43; 95% CI, $42–44), and lower in areas in the most socio-economically disadvantaged quintile ($42; 95% CI, $40–45) than in those in the least disadvantaged quintile ($47; 95% CI, $45–49).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although most general practitioner services are bulk-billed, out-of-pocket costs for non-bulk-billed services are relatively high, particularly for people in remote and socio-economically disadvantaged areas of Australia.","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 3","pages":"144-148"},"PeriodicalIF":6.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52562","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837190","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}
Elisa K Bongetti, Rory Wolfe, James B Wetmore, Anne M Murray, Robyn L Woods, Michelle A Fravel, Mark R Nelson, Nigel P Stocks, Suzanne G Orchard, Kevan R Polkinghorne
<div> <section> <h3> Objectives</h3> <p>To assess the clinical impact on generally healthy older Australians of changing from the 2009 CKD-EPI (CKD-EPI<sub>2009</sub>) to the 2021 CKD-EPI (CKD-EPI<sub>2021</sub>) equation for calculating the estimated glomerular filtration rate (eGFR).</p> </section> <section> <h3> Study design</h3> <p>Secondary analysis of data from the prospective ASPirin in Reducing events in the Elderly (ASPREE) cohort study.</p> </section> <section> <h3> Setting, participants</h3> <p>Australians aged 70 years or older living in the community and without life-limiting medical conditions, recruited 1 March 2010 – 31 December 2014 for the ASPREE trial.</p> </section> <section> <h3> Main outcome measures</h3> <p>Baseline characteristics and long term health outcomes for participants classified to different chronic kidney disease (CKD) stages by CKD-EPI<sub>2021</sub> and CKD-EPI<sub>2009</sub>, and for those classified to the same CKD stage by both equations.</p> </section> <section> <h3> Results</h3> <p>Complete data were available for 16 244 Australian ASPREE trial participants. At baseline, their mean age was 75.3 years (standard deviation, 4.4 years), and 8938 were women (55%); the median eGFR (CKD-EPI<sub>2009</sub>) was 74 mL/min/1.73 m<sup>2</sup> (interquartile range [IQR], 64–85 mL/min/1.73 m<sup>2</sup>), the median urine albumin-to-creatinine ratio 0.8 mg/mmol (IQR, 0.5–1.4 mg/mmol). eGFR values were higher for most participants with CKD-EPI<sub>2021</sub> than with CKD-EPI<sub>2009</sub> (median difference, 3.8 mL/min/1.73 m<sup>2</sup>; IQR, 3.3–4.4 mL/min/1.73 m<sup>2</sup>), and 3274 participants (20%) were classified to less advanced CKD stages by CKD-EPI<sub>2021</sub>. The proportion of participants with eGFR values below 60 mL/min/1.73 m<sup>2</sup> (clinical CKD) was 17% (2770 participants) with CKD-EPI<sub>2009</sub> and 12% (1994 participants) with CKD-EPI<sub>2021</sub>. Participants were followed up at a median of 6.5 years (IQR, 5.4–7.9 years); the risks of reaching the disability-free survival composite endpoint (adjusted hazard ratio [aHR], 0.94; 95% confidence interval [CI], 0.84–1.05), all-cause mortality (aHR, 0.90; 95% CI, 0.78–1.03), major cardiac events (aHR, 0.94; 95% CI, 0.79–1.13), and hospitalisations with heart failure (aHR, 1.00; 95% CI, 0.67–1.49) were each similar for participants reclassified or not reclassified by CKD-EPI<sub>2021</sub>.</p> </section>
{"title":"Classification of chronic kidney disease in older Australian adults by the CKD-EPI 2009 and 2021 equations: secondary analysis of ASPREE study data","authors":"Elisa K Bongetti, Rory Wolfe, James B Wetmore, Anne M Murray, Robyn L Woods, Michelle A Fravel, Mark R Nelson, Nigel P Stocks, Suzanne G Orchard, Kevan R Polkinghorne","doi":"10.5694/mja2.52559","DOIUrl":"10.5694/mja2.52559","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the clinical impact on generally healthy older Australians of changing from the 2009 CKD-EPI (CKD-EPI<sub>2009</sub>) to the 2021 CKD-EPI (CKD-EPI<sub>2021</sub>) equation for calculating the estimated glomerular filtration rate (eGFR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Secondary analysis of data from the prospective ASPirin in Reducing events in the Elderly (ASPREE) cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Australians aged 70 years or older living in the community and without life-limiting medical conditions, recruited 1 March 2010 – 31 December 2014 for the ASPREE trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Baseline characteristics and long term health outcomes for participants classified to different chronic kidney disease (CKD) stages by CKD-EPI<sub>2021</sub> and CKD-EPI<sub>2009</sub>, and for those classified to the same CKD stage by both equations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Complete data were available for 16 244 Australian ASPREE trial participants. At baseline, their mean age was 75.3 years (standard deviation, 4.4 years), and 8938 were women (55%); the median eGFR (CKD-EPI<sub>2009</sub>) was 74 mL/min/1.73 m<sup>2</sup> (interquartile range [IQR], 64–85 mL/min/1.73 m<sup>2</sup>), the median urine albumin-to-creatinine ratio 0.8 mg/mmol (IQR, 0.5–1.4 mg/mmol). eGFR values were higher for most participants with CKD-EPI<sub>2021</sub> than with CKD-EPI<sub>2009</sub> (median difference, 3.8 mL/min/1.73 m<sup>2</sup>; IQR, 3.3–4.4 mL/min/1.73 m<sup>2</sup>), and 3274 participants (20%) were classified to less advanced CKD stages by CKD-EPI<sub>2021</sub>. The proportion of participants with eGFR values below 60 mL/min/1.73 m<sup>2</sup> (clinical CKD) was 17% (2770 participants) with CKD-EPI<sub>2009</sub> and 12% (1994 participants) with CKD-EPI<sub>2021</sub>. Participants were followed up at a median of 6.5 years (IQR, 5.4–7.9 years); the risks of reaching the disability-free survival composite endpoint (adjusted hazard ratio [aHR], 0.94; 95% confidence interval [CI], 0.84–1.05), all-cause mortality (aHR, 0.90; 95% CI, 0.78–1.03), major cardiac events (aHR, 0.94; 95% CI, 0.79–1.13), and hospitalisations with heart failure (aHR, 1.00; 95% CI, 0.67–1.49) were each similar for participants reclassified or not reclassified by CKD-EPI<sub>2021</sub>.</p>\u0000 </section>\u0000 \u0000 ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 2","pages":"74-81"},"PeriodicalIF":6.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52559","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837224","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}
Georgia Behrens, Madeleine Skellern, Alice McGushin, Paul Kelly, The Hon Ged Kearney
<p>Climate change poses profound and urgent challenges to the health and wellbeing of people in Australia. With an average of 1.51°C of warming since records began,<span><sup>1</sup></span> the health impacts of climate change are already being felt across Australia.<span><sup>2</sup></span> Meanwhile, the health system itself is responsible, either directly or indirectly, for around 5.3% of Australia's greenhouse gas emissions.<span><sup>3</sup></span> There is a clear need for Australia to achieve “healthy, climate-resilient communities, and a sustainable, resilient, high-quality, net zero health system.”<span><sup>3</sup></span> This vision is outlined in Australia's first National Health and Climate Strategy (hereafter, the Strategy), proudly launched in December 2023 by the Honourable Ged Kearney MP, Assistant Minister for Health and Aged Care. In this perspective article, we review the Strategy's origins, development, and key features; discuss the challenges that must be tackled in the coming years; and highlight the leadership role that health professionals can play in the response to climate change.</p><p>The National Health and Climate Strategy is built on decades of outstanding Australian work on climate change and human health. Australians have been at the forefront of climate and health research for more than thirty years, and have been pioneers in drawing the global health community's collective attention to the impacts of climate change on human health and wellbeing. We acknowledge the many individuals and organisations who have persistently advocated for human and planetary health for over a decade, and welcome their ongoing contributions and leadership in this space.<span><sup>4, 5</sup></span></p><p>Consultation also highlighted the need to enable and embrace leadership on climate and health policy by First Nations people. Stakeholders spoke of the opportunities inherent in holistic partnerships with First Nations communities to improve health, reduce emissions and foster climate resilience. They also highlighted that First Nations peoples’ deep and nuanced knowledge — developed over tens of thousands of years of close observation and sustained custodianship of Country — is not only crucial in addressing the impacts of climate change on First Nations peoples’ health, but also can improve health and build climate resilience for all people in Australia.</p><p>At the heart of the Strategy is an ambitious agenda to transform Australia's health system into one that is sustainable and climate resilient while improving care quality and health outcomes. The Australian Government recognises that insights and leadership from health professionals will be crucial to achieving this agenda.</p><p>On health system decarbonisation, at the time of writing the Australian Government was working to publish baseline emissions estimates for the Australian health system, and to develop a net zero implementation guide for the Australian health system in
{"title":"Making climate change a national health priority: Australia's first National Health and Climate Strategy","authors":"Georgia Behrens, Madeleine Skellern, Alice McGushin, Paul Kelly, The Hon Ged Kearney","doi":"10.5694/mja2.52552","DOIUrl":"10.5694/mja2.52552","url":null,"abstract":"<p>Climate change poses profound and urgent challenges to the health and wellbeing of people in Australia. With an average of 1.51°C of warming since records began,<span><sup>1</sup></span> the health impacts of climate change are already being felt across Australia.<span><sup>2</sup></span> Meanwhile, the health system itself is responsible, either directly or indirectly, for around 5.3% of Australia's greenhouse gas emissions.<span><sup>3</sup></span> There is a clear need for Australia to achieve “healthy, climate-resilient communities, and a sustainable, resilient, high-quality, net zero health system.”<span><sup>3</sup></span> This vision is outlined in Australia's first National Health and Climate Strategy (hereafter, the Strategy), proudly launched in December 2023 by the Honourable Ged Kearney MP, Assistant Minister for Health and Aged Care. In this perspective article, we review the Strategy's origins, development, and key features; discuss the challenges that must be tackled in the coming years; and highlight the leadership role that health professionals can play in the response to climate change.</p><p>The National Health and Climate Strategy is built on decades of outstanding Australian work on climate change and human health. Australians have been at the forefront of climate and health research for more than thirty years, and have been pioneers in drawing the global health community's collective attention to the impacts of climate change on human health and wellbeing. We acknowledge the many individuals and organisations who have persistently advocated for human and planetary health for over a decade, and welcome their ongoing contributions and leadership in this space.<span><sup>4, 5</sup></span></p><p>Consultation also highlighted the need to enable and embrace leadership on climate and health policy by First Nations people. Stakeholders spoke of the opportunities inherent in holistic partnerships with First Nations communities to improve health, reduce emissions and foster climate resilience. They also highlighted that First Nations peoples’ deep and nuanced knowledge — developed over tens of thousands of years of close observation and sustained custodianship of Country — is not only crucial in addressing the impacts of climate change on First Nations peoples’ health, but also can improve health and build climate resilience for all people in Australia.</p><p>At the heart of the Strategy is an ambitious agenda to transform Australia's health system into one that is sustainable and climate resilient while improving care quality and health outcomes. The Australian Government recognises that insights and leadership from health professionals will be crucial to achieving this agenda.</p><p>On health system decarbonisation, at the time of writing the Australian Government was working to publish baseline emissions estimates for the Australian health system, and to develop a net zero implementation guide for the Australian health system in","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 2","pages":"63-65"},"PeriodicalIF":6.7,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52552","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829210","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}
Berhe W Sahle, Emily Banks, Robyn Williams, Grace Joshy, Garry Jennings, Jonathan C Craig, Nicholas G Larkins, Francine Eades, Rebecca Q Ivers, Sandra Eades
<div> <section> <h3> Objective</h3> <p>To assess the distribution of blood pressure levels and the prevalence of hypertension and pre-hypertension in young Indigenous people (10–24 years of age).</p> </section> <section> <h3> Study design</h3> <p>Prospective cohort survey study (Next Generation: Youth Wellbeing Study); baseline data analysis.</p> </section> <section> <h3> Setting, participants</h3> <p>Aboriginal and Torres Strait Islander people aged 10–24 years living in regional, remote, and urban communities in Central Australia, Western Australia, and New South Wales; recruitment: March 2018 – March 2020.</p> </section> <section> <h3> Main outcome measures</h3> <p>Blood pressure categorised as normal, pre-hypertension, or hypertension using the 2017 American Academy of Pediatrics guidelines (10–17 years) or 2017 American College of Cardiology/American Heart Association guidelines (18–24 years); associations of demographic characteristics and health behaviours with hypertension and pre-hypertension, reported as relative risk ratios (RRRs) with 95% confidence intervals (CIs).</p> </section> <section> <h3> Results</h3> <p>Complete data were available for 771 of 1244 study participants (62%); their mean age was 15.4 years (standard deviation [SD], 3.9 years), 438 were girls or young women (56.8%). Mean systolic blood pressure was 111.2 mmHg (SD, 13.7 mmHg), mean diastolic blood pressure 66.3 mmHg (SD, 11.0 mmHg). Mean systolic blood pressure was higher for male than female participants (mean difference, 6.38 mmHg; 95% CI, 4.60–8.16 mmHg), and it increased by 1.06 mmHg (95% CI, 0.76–1.36 mmHg) per year of age. Mean systolic blood pressure increased by 0.42 mmHg (95% CI, 0.28–0.54 mmHg) and diastolic blood pressure by 0.46 mmHg (95% CI, 0.35–0.57 mmHg) per 1.0 kg/m<sup>2</sup> increase in body mass index. Ninety-one participants (11.8%) had blood pressure readings indicating pre-hypertension, and 148 (19.2%) had hypertension. The risks of pre-hypertension (RRR, 4.22; 95% CI, 2.52–7.09) and hypertension (RRR, 1.93; 95% CI, 1.27–2.91) were higher for male than female participants; they were greater for people with obesity than for those with BMI values in the normal range (pre-hypertension: RRR, 2.39 [95% CI, 1.26–4.55]; hypertension: RRR, 3.20 [95% CI, 1.91–5.35]) and for participants aged 16–19 years (pre-hypertension: 3.44 [95% CI, 1.88–6.32]; hypertension: RRR, 2.15 [95% CI, 1.29–3.59]) or 20–24 years (pre-hypertension: 4.12 [95% CI, 1.92–8.85]; hy
{"title":"Blood pressure in young Aboriginal and Torres Strait Islander people: analysis of baseline data from a prospective cohort study","authors":"Berhe W Sahle, Emily Banks, Robyn Williams, Grace Joshy, Garry Jennings, Jonathan C Craig, Nicholas G Larkins, Francine Eades, Rebecca Q Ivers, Sandra Eades","doi":"10.5694/mja2.52558","DOIUrl":"10.5694/mja2.52558","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the distribution of blood pressure levels and the prevalence of hypertension and pre-hypertension in young Indigenous people (10–24 years of age).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Prospective cohort survey study (Next Generation: Youth Wellbeing Study); baseline data analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Aboriginal and Torres Strait Islander people aged 10–24 years living in regional, remote, and urban communities in Central Australia, Western Australia, and New South Wales; recruitment: March 2018 – March 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Blood pressure categorised as normal, pre-hypertension, or hypertension using the 2017 American Academy of Pediatrics guidelines (10–17 years) or 2017 American College of Cardiology/American Heart Association guidelines (18–24 years); associations of demographic characteristics and health behaviours with hypertension and pre-hypertension, reported as relative risk ratios (RRRs) with 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Complete data were available for 771 of 1244 study participants (62%); their mean age was 15.4 years (standard deviation [SD], 3.9 years), 438 were girls or young women (56.8%). Mean systolic blood pressure was 111.2 mmHg (SD, 13.7 mmHg), mean diastolic blood pressure 66.3 mmHg (SD, 11.0 mmHg). Mean systolic blood pressure was higher for male than female participants (mean difference, 6.38 mmHg; 95% CI, 4.60–8.16 mmHg), and it increased by 1.06 mmHg (95% CI, 0.76–1.36 mmHg) per year of age. Mean systolic blood pressure increased by 0.42 mmHg (95% CI, 0.28–0.54 mmHg) and diastolic blood pressure by 0.46 mmHg (95% CI, 0.35–0.57 mmHg) per 1.0 kg/m<sup>2</sup> increase in body mass index. Ninety-one participants (11.8%) had blood pressure readings indicating pre-hypertension, and 148 (19.2%) had hypertension. The risks of pre-hypertension (RRR, 4.22; 95% CI, 2.52–7.09) and hypertension (RRR, 1.93; 95% CI, 1.27–2.91) were higher for male than female participants; they were greater for people with obesity than for those with BMI values in the normal range (pre-hypertension: RRR, 2.39 [95% CI, 1.26–4.55]; hypertension: RRR, 3.20 [95% CI, 1.91–5.35]) and for participants aged 16–19 years (pre-hypertension: 3.44 [95% CI, 1.88–6.32]; hypertension: RRR, 2.15 [95% CI, 1.29–3.59]) or 20–24 years (pre-hypertension: 4.12 [95% CI, 1.92–8.85]; hy","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 2","pages":"91-101"},"PeriodicalIF":6.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52558","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812955","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}
Claire Greenwell, Angela Webster, Ian A Harris, David Beard, Angie Barba, Sarah J Lord
<p>Randomised controlled trials (RCTs) support clinical practice by generating high quality evidence about the safety and effectiveness of medical interventions. However, RCTs are not required for the regulatory approval of new surgical procedures or devices.<span><sup>1</sup></span> Surgical RCTs are subject to distinct practical challenges,<span><sup>2</sup></span> and the quality of surgical trials has been criticised,<span><sup>3</sup></span> although it appears to be improving.<span><sup>4</sup></span> Few studies have directly compared the design features of surgical and non-surgical trials, or examined differences between surgical clinical trials by specialty. We therefore determined the proportion of surgical clinical trials in Australia relative to all clinical trials and examined their characteristics, and compared surgical trial activity by specialty.</p><p>We reviewed all randomised and non-randomised clinical trials registered with the Australian New Zealand Clinical Trials Registry (ANZCTR; https://anzctr.org.au) or ClinicalTrials.gov (https://clinicaltrials.gov) during 1 January 2010 – 29 February 2020 that included recruitment of adult participants (18 years or older) in Australia. We defined a surgical trial as one in which the intervention was delivered by surgeons with the aim of improving surgical outcomes for patients (further details: Supporting Information, methods). We used information in trial registration records to assess trial activity (number of trials, planned recruitment size), design (randomisation, masking), and industry involvement. For surgical trials, we compared these characteristics by specialty (cardio-thoracic surgery; otolaryngology, head and neck surgery; general [including colorectal] surgery; neurosurgery; orthopaedic surgery; plastic and reconstructive surgery; urological surgery; vascular surgery; ophthalmology surgery; transplantation surgery). We characterised trial activity by specialty as the ratio of its proportion of all surgical trials to the proportion of in-hospital surgical procedures for the specialty during 1 July 2010 – 30 June 2020, as recorded by the Australian Institute of Health and Welfare.<span><sup>5</sup></span> If interventions or procedures could be performed in more than one specialty, we initially classified it under one specialty for the primary analysis, then remapped it to the alternative specialty in a sensitivity analysis (further details: Supporting Information, methods). Statistical analyses were performed in RStudio 2022.7.2.576. We did not seek formal ethics approval for our analysis of publicly available data.</p><p>Of 12 775 clinical trials with planned recruitment of adults in Australia registered during 2010–20, 435 were surgical trials (3.4%); 311 surgical (71%) and 8802 non-surgical trials (72%) were RCTs, and industry involvement was recorded for 128 surgical (29%) and 5531 non-surgical trials (45%) (Box 1). The annual number of surgical trial registrations ros
{"title":"Surgical clinical trial activity in Australia, 2010–20, by specialty: analysis of trial registration data","authors":"Claire Greenwell, Angela Webster, Ian A Harris, David Beard, Angie Barba, Sarah J Lord","doi":"10.5694/mja2.52555","DOIUrl":"10.5694/mja2.52555","url":null,"abstract":"<p>Randomised controlled trials (RCTs) support clinical practice by generating high quality evidence about the safety and effectiveness of medical interventions. However, RCTs are not required for the regulatory approval of new surgical procedures or devices.<span><sup>1</sup></span> Surgical RCTs are subject to distinct practical challenges,<span><sup>2</sup></span> and the quality of surgical trials has been criticised,<span><sup>3</sup></span> although it appears to be improving.<span><sup>4</sup></span> Few studies have directly compared the design features of surgical and non-surgical trials, or examined differences between surgical clinical trials by specialty. We therefore determined the proportion of surgical clinical trials in Australia relative to all clinical trials and examined their characteristics, and compared surgical trial activity by specialty.</p><p>We reviewed all randomised and non-randomised clinical trials registered with the Australian New Zealand Clinical Trials Registry (ANZCTR; https://anzctr.org.au) or ClinicalTrials.gov (https://clinicaltrials.gov) during 1 January 2010 – 29 February 2020 that included recruitment of adult participants (18 years or older) in Australia. We defined a surgical trial as one in which the intervention was delivered by surgeons with the aim of improving surgical outcomes for patients (further details: Supporting Information, methods). We used information in trial registration records to assess trial activity (number of trials, planned recruitment size), design (randomisation, masking), and industry involvement. For surgical trials, we compared these characteristics by specialty (cardio-thoracic surgery; otolaryngology, head and neck surgery; general [including colorectal] surgery; neurosurgery; orthopaedic surgery; plastic and reconstructive surgery; urological surgery; vascular surgery; ophthalmology surgery; transplantation surgery). We characterised trial activity by specialty as the ratio of its proportion of all surgical trials to the proportion of in-hospital surgical procedures for the specialty during 1 July 2010 – 30 June 2020, as recorded by the Australian Institute of Health and Welfare.<span><sup>5</sup></span> If interventions or procedures could be performed in more than one specialty, we initially classified it under one specialty for the primary analysis, then remapped it to the alternative specialty in a sensitivity analysis (further details: Supporting Information, methods). Statistical analyses were performed in RStudio 2022.7.2.576. We did not seek formal ethics approval for our analysis of publicly available data.</p><p>Of 12 775 clinical trials with planned recruitment of adults in Australia registered during 2010–20, 435 were surgical trials (3.4%); 311 surgical (71%) and 8802 non-surgical trials (72%) were RCTs, and industry involvement was recorded for 128 surgical (29%) and 5531 non-surgical trials (45%) (Box 1). The annual number of surgical trial registrations ros","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 2","pages":"102-103"},"PeriodicalIF":6.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52555","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801467","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 Smith, Silja Schrader, Hannah Morgan, Priya Shenton, Annette Alafaci, Nicholas Cox, Andrew J Taylor, James Hare, Bryn Jones, Nigel W Crawford, Jim P Buttery, Hazel J Clothier, Daryl R Cheng
<div> <section> <h3> Objectives</h3> <p>To describe myocarditis as an adverse event after coronavirus disease 2019 (COVID-19) vaccination, including a detailed description of clinical phenotypes and diagnostic test results and differences by age, sex, and degree of troponin level elevation.</p> </section> <section> <h3> Study design</h3> <p>Retrospective cross-sectional study.</p> </section> <section> <h3> Setting, participants</h3> <p>Cases of suspected myocarditis following the administration of a COVID-19 vaccine in Victoria during 22 February 2021 – 30 September 2022 reported to Surveillance of Adverse Events Following Vaccination In the Community (SAEFVIC), with symptom onset within 14 days of vaccination, and deemed to be confirmed myocarditis according to the Brighton Collaboration Criteria.</p> </section> <section> <h3> Main outcome measures</h3> <p>Demographic (sex, broad age group), vaccine, and clinical presentation characteristics; cardiac investigation results (troponin levels, electrocardiography, echocardiography, cardiac magnetic resonance imaging [cMRI]).</p> </section> <section> <h3> Results</h3> <p>Of 454 SAEFVIC reports of suspected COVID-19 vaccine-associated myocarditis, 206 were deemed confirmed cases. The median age of people with confirmed myocarditis was 21 years (interquartile range [IQR], 16–32 years; range, 10–76 years); 129 were aged 24 years or younger (63%), 155 were male (75%). The median time from vaccination to symptom onset was two days (IQR, 1–4 days); 201 cases (98%) followed the administration of mRNA vaccines; five cases followed vaccination with AZD122. Forty-six cases followed first vaccine doses (22%), 138 second doses (67%), and 22 cases third vaccine doses (11.0%). In 201 cases, people initially presented to emergency departments; 129 people were admitted to hospital (63%; median length of stay, two days; IQR, 1–3 days). Five people were admitted to intensive care. Echocardiographic abnormalities were identified in 26 of 200 patients (13%); electrocardiographic abnormalities were identified in 105 of 206 patients (51%; less frequently in female than male patients: adjusted odds ratio, 0.75; 95% confidence interval, 0.64–0.89). Troponin levels were elevated in 205 of 206 patients; the median increase was greater in male (95.3-fold; IQR, 5.8–273-fold) than female patients (9.9-fold; IQR, 4.7–50-fold). No cMRI abnormalities were found in patients for whom the troponin increase was threefold or less.</p>
{"title":"Clinical phenotype of COVID-19 vaccine-associated myocarditis in Victoria, 2021–22: a cross-sectional study","authors":"Julia Smith, Silja Schrader, Hannah Morgan, Priya Shenton, Annette Alafaci, Nicholas Cox, Andrew J Taylor, James Hare, Bryn Jones, Nigel W Crawford, Jim P Buttery, Hazel J Clothier, Daryl R Cheng","doi":"10.5694/mja2.52557","DOIUrl":"10.5694/mja2.52557","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To describe myocarditis as an adverse event after coronavirus disease 2019 (COVID-19) vaccination, including a detailed description of clinical phenotypes and diagnostic test results and differences by age, sex, and degree of troponin level elevation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Retrospective cross-sectional study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Cases of suspected myocarditis following the administration of a COVID-19 vaccine in Victoria during 22 February 2021 – 30 September 2022 reported to Surveillance of Adverse Events Following Vaccination In the Community (SAEFVIC), with symptom onset within 14 days of vaccination, and deemed to be confirmed myocarditis according to the Brighton Collaboration Criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Demographic (sex, broad age group), vaccine, and clinical presentation characteristics; cardiac investigation results (troponin levels, electrocardiography, echocardiography, cardiac magnetic resonance imaging [cMRI]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 454 SAEFVIC reports of suspected COVID-19 vaccine-associated myocarditis, 206 were deemed confirmed cases. The median age of people with confirmed myocarditis was 21 years (interquartile range [IQR], 16–32 years; range, 10–76 years); 129 were aged 24 years or younger (63%), 155 were male (75%). The median time from vaccination to symptom onset was two days (IQR, 1–4 days); 201 cases (98%) followed the administration of mRNA vaccines; five cases followed vaccination with AZD122. Forty-six cases followed first vaccine doses (22%), 138 second doses (67%), and 22 cases third vaccine doses (11.0%). In 201 cases, people initially presented to emergency departments; 129 people were admitted to hospital (63%; median length of stay, two days; IQR, 1–3 days). Five people were admitted to intensive care. Echocardiographic abnormalities were identified in 26 of 200 patients (13%); electrocardiographic abnormalities were identified in 105 of 206 patients (51%; less frequently in female than male patients: adjusted odds ratio, 0.75; 95% confidence interval, 0.64–0.89). Troponin levels were elevated in 205 of 206 patients; the median increase was greater in male (95.3-fold; IQR, 5.8–273-fold) than female patients (9.9-fold; IQR, 4.7–50-fold). No cMRI abnormalities were found in patients for whom the troponin increase was threefold or less.</p>\u0000 ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 1","pages":"23-29"},"PeriodicalIF":6.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52557","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801459","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}
Shea Spierings, Victor M Oguoma, Anthony Shakeshaft, Jim Walker, Maree Toombs, James S Ward
Objectives
To assess Aboriginal and Torres Strait Islander people's knowledge about coronavirus disease 2019 (COVID-19) vaccines, and their attitudes to and behaviours regarding COVID-19 and influenza vaccinations.
Study design
Web-based survey.
Setting
Australia (excluding the Northern Territory), 1 October 2021 to 31 May 2022.
Participants
Convenience sample of Aboriginal and Torres Strait Islander people aged 16 years or older living in Australia.
Main outcome measures
Proportions of respondents who reported knowledge about COVID-19 vaccines, and attitudes to and behaviours regarding COVID-19 and influenza vaccinations.
Results
A total of 530 people provided valid survey responses; their median age was 27 years (interquartile range, 23–38 years), 255 (48%) were from urban areas, and 309 (58%) were men. Of the 480 participants (91%) who provided complete survey questions (including sex and location information), larger proportion of men than women believed COVID-19 vaccines were very or extremely trustworthy (219, 79% v 124, 61%) and very or extremely effective (212, 76% v 138, 68%). The prevalence of COVID-19 vaccination was lower among respondents aged 60 years or older than among those aged 16–29 years (adjusted prevalence ration [PR], 0.81; 95% confidence interval [CI], 0.66–0.99). After adjusting for socio-demographic factors, the association between intention to receive the influenza vaccine and receiving the COVID-19 vaccine was statistically significant (adjusted PR, 1.18; 95% CI, 1.09–1.27).
Conclusion
The high levels of trust in COVID-19 vaccines and their effectiveness indicate that Aboriginal and Torres Strait Islander people are confident about their safety and efficacy and understand the importance of vaccination. The findings also highlight a positive attitude to vaccination and a commitment to preventive health measures among Aboriginal and Torres Strait Islander people.
{"title":"Knowledge about COVID-19 vaccines among Aboriginal and Torres Strait Islander people, and attitudes to and behaviours regarding COVID-19 and influenza vaccination: a survey","authors":"Shea Spierings, Victor M Oguoma, Anthony Shakeshaft, Jim Walker, Maree Toombs, James S Ward","doi":"10.5694/mja2.52551","DOIUrl":"10.5694/mja2.52551","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess Aboriginal and Torres Strait Islander people's knowledge about coronavirus disease 2019 (COVID-19) vaccines, and their attitudes to and behaviours regarding COVID-19 and influenza vaccinations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Web-based survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Australia (excluding the Northern Territory), 1 October 2021 to 31 May 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Convenience sample of Aboriginal and Torres Strait Islander people aged 16 years or older living in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Proportions of respondents who reported knowledge about COVID-19 vaccines, and attitudes to and behaviours regarding COVID-19 and influenza vaccinations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 530 people provided valid survey responses; their median age was 27 years (interquartile range, 23–38 years), 255 (48%) were from urban areas, and 309 (58%) were men. Of the 480 participants (91%) who provided complete survey questions (including sex and location information), larger proportion of men than women believed COVID-19 vaccines were very or extremely trustworthy (219, 79% <i>v</i> 124, 61%) and very or extremely effective (212, 76% <i>v</i> 138, 68%). The prevalence of COVID-19 vaccination was lower among respondents aged 60 years or older than among those aged 16–29 years (adjusted prevalence ration [PR], 0.81; 95% confidence interval [CI], 0.66–0.99). After adjusting for socio-demographic factors, the association between intention to receive the influenza vaccine and receiving the COVID-19 vaccine was statistically significant (adjusted PR, 1.18; 95% CI, 1.09–1.27).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The high levels of trust in COVID-19 vaccines and their effectiveness indicate that Aboriginal and Torres Strait Islander people are confident about their safety and efficacy and understand the importance of vaccination. The findings also highlight a positive attitude to vaccination and a commitment to preventive health measures among Aboriginal and Torres Strait Islander people.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 1","pages":"30-37"},"PeriodicalIF":6.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801464","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}
Alyssa Pradhan, David Pham, Alexander Brennan, Jen Kok, Priya Garg
<p>A 39-year-old woman underwent bilateral sequential lung transplantation for fibrotic hypersensitivity pneumonitis in May 2022. Her immunosuppression treatment included prednisolone, tacrolimus and mycophenolate. She received one dose of Comirnaty (Pfizer) pre-transplant and tixagevimab–cilgavimab in June 2022.</p><p>Her first severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed on 14 December 2022 and she was treated with molnupiravir for five days. On Day 11 of illness, she presented to hospital in respiratory distress with hypoxia (SpO2; 73% on room air). SARS-CoV-2 RNA was detected by polymerase chain reaction (PCR) with a cycle threshold of 21.8 (cobas SARS-CoV-2 and Influenza A/B, Roche). A chest computed tomography scan demonstrated extensive bilateral ground-glass opacification (Box 1). She required intensive care unit admission for high-flow nasal oxygen (FiO<sub>2</sub> 60%, flow rate 50 litres) and received tocilizumab, ten days of remdesivir, increased prednisolone, and piperacillin–tazobactam. Three days of pulsed methylprednisolone was prescribed for possible transplant rejection. Despite clinical improvement, SARS-CoV-2 RNA remained detectable with a cycle threshold of 16.2 (VIASURE SARS-CoV-2, flu and RSV, Certest Biotec) and SARS-CoV-2 was isolated from a cell culture.<span><sup>1</sup></span> Whole genome sequencing identified Omicron BR.2 (variant of concern B.1.1.529) lineage, with molnupiravir-associated mutational signatures,<span><sup>2</sup></span> (sequence available on GISAID [Global Initiative of Sharing All Influenza Data]; 26/12/22: hCoV-19/Australia/NSW_ICPMR_40135/2022 and 03/03/23: hCoV-19/Australia/NSW_ICPMR_43136/2023).</p><p>The patient was transferred to a high acuity respiratory ward after three weeks, but over the ensuing six weeks, became severely deconditioned and continued to require high-flow nasal oxygen (FiO<sub>2</sub> 30–35%, 35 litres). Chest imaging was stable, demonstrating fibrosis but minimal progressive inflammation. The persistent detection of SARS-CoV-2 RNA and isolation of SARS-CoV-2 by culture (Box 2) from upper respiratory tract samples prevented participation in enhanced inpatient pulmonary rehabilitation beyond her single room, as per local infection prevention guidelines and hospital policy.<span><sup>3</sup></span> The policy, based on national guidelines,<span><sup>3</sup></span> dictated that for coronavirus disease 2019 (COVID-19) de-isolation, immunocompromised hosts need to be 21 days post-infection, asymptomatic, and without detectable SARS-CoV-2 RNA. In individuals with persistent RNA detection, a cycle threshold greater than 30 with either positive spike antibody, negative rapid antigen test (RAT) or culture is sufficient for de-isolation.</p><p>The patient received a further dose of tixagevimab–cilgavimab, regular intravenous immunoglobulin and ten further days of remdesivir. Repeat whole genome sequencing did not identify infection with anothe
{"title":"Prolonged SARS-CoV-2 shedding in a lung transplant recipient: time for flexibility in infection prevention?","authors":"Alyssa Pradhan, David Pham, Alexander Brennan, Jen Kok, Priya Garg","doi":"10.5694/mja2.52556","DOIUrl":"10.5694/mja2.52556","url":null,"abstract":"<p>A 39-year-old woman underwent bilateral sequential lung transplantation for fibrotic hypersensitivity pneumonitis in May 2022. Her immunosuppression treatment included prednisolone, tacrolimus and mycophenolate. She received one dose of Comirnaty (Pfizer) pre-transplant and tixagevimab–cilgavimab in June 2022.</p><p>Her first severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed on 14 December 2022 and she was treated with molnupiravir for five days. On Day 11 of illness, she presented to hospital in respiratory distress with hypoxia (SpO2; 73% on room air). SARS-CoV-2 RNA was detected by polymerase chain reaction (PCR) with a cycle threshold of 21.8 (cobas SARS-CoV-2 and Influenza A/B, Roche). A chest computed tomography scan demonstrated extensive bilateral ground-glass opacification (Box 1). She required intensive care unit admission for high-flow nasal oxygen (FiO<sub>2</sub> 60%, flow rate 50 litres) and received tocilizumab, ten days of remdesivir, increased prednisolone, and piperacillin–tazobactam. Three days of pulsed methylprednisolone was prescribed for possible transplant rejection. Despite clinical improvement, SARS-CoV-2 RNA remained detectable with a cycle threshold of 16.2 (VIASURE SARS-CoV-2, flu and RSV, Certest Biotec) and SARS-CoV-2 was isolated from a cell culture.<span><sup>1</sup></span> Whole genome sequencing identified Omicron BR.2 (variant of concern B.1.1.529) lineage, with molnupiravir-associated mutational signatures,<span><sup>2</sup></span> (sequence available on GISAID [Global Initiative of Sharing All Influenza Data]; 26/12/22: hCoV-19/Australia/NSW_ICPMR_40135/2022 and 03/03/23: hCoV-19/Australia/NSW_ICPMR_43136/2023).</p><p>The patient was transferred to a high acuity respiratory ward after three weeks, but over the ensuing six weeks, became severely deconditioned and continued to require high-flow nasal oxygen (FiO<sub>2</sub> 30–35%, 35 litres). Chest imaging was stable, demonstrating fibrosis but minimal progressive inflammation. The persistent detection of SARS-CoV-2 RNA and isolation of SARS-CoV-2 by culture (Box 2) from upper respiratory tract samples prevented participation in enhanced inpatient pulmonary rehabilitation beyond her single room, as per local infection prevention guidelines and hospital policy.<span><sup>3</sup></span> The policy, based on national guidelines,<span><sup>3</sup></span> dictated that for coronavirus disease 2019 (COVID-19) de-isolation, immunocompromised hosts need to be 21 days post-infection, asymptomatic, and without detectable SARS-CoV-2 RNA. In individuals with persistent RNA detection, a cycle threshold greater than 30 with either positive spike antibody, negative rapid antigen test (RAT) or culture is sufficient for de-isolation.</p><p>The patient received a further dose of tixagevimab–cilgavimab, regular intravenous immunoglobulin and ten further days of remdesivir. Repeat whole genome sequencing did not identify infection with anothe","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 2","pages":"69-71"},"PeriodicalIF":6.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52556","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801466","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}
Caroline K Dowsett, Francesca Frentiu, Gregor J Devine, Wenbiao Hu
<p>Japanese encephalitis is caused by the Japanese encephalitis virus (JEV). JEV is the main cause of viral encephalitis in Asia,<span><sup>1</sup></span> and is endemic in many countries on that continent and islands of the Pacific region. Although only a small percentage of cases are symptomatic, 20–30% are fatal and 30–50% develop significant neurological sequelae.<span><sup>2</sup></span> Australia has escaped relatively unscathed, with only a few cases detected in the late 1990s, mostly from international travellers, with local transmission limited to the Torres Strait and Cape York.<span><sup>2, 3</sup></span> The last detection of JEV in Cape York was from feral pigs and an isolate of mosquitoes in 2005. Sentinel animal surveillance in Australia was phased out in 2011 due to costs and labour-intensive maintenance, potential occupational health and safety issues, and concerns about the potential public health risk of using amplifying hosts (pigs), which may contribute to transmission when they become viremic.<span><sup>3</sup></span> Sentinel animal use was replaced by a general mosquito trap-based surveillance system.<span><sup>3</sup></span> The Box provides a timeline of JEV milestones in Australia from the 1990s to 2023, with details on animal and human cases, and corresponding changes in surveillance.</p><p>JEV emerged again in 2021 with a fatal case in the Tiwi Islands, and shortly after was detected on an unprecedented scale and geographical spread in 2022: cases in humans and piggeries were detected across four states in south-eastern Australia (New South Wales, Victoria, Queensland, South Australia). On 4 March 2022, the Australian Government declared the JEV outbreak a communicable disease incident of national significance.<span><sup>4</sup></span> Over the following months, a total of 46 cases (including 7 deaths) were identified in humans (as of 13 February 2023).<span><sup>5</sup></span> The end of the JEV emergency response was announced on 16 June 2023,<span><sup>6</sup></span> although concern remains regarding potential endemicity in Australian waterbird, pig and mosquito populations.</p><p>JEV is maintained in an enzootic cycle between wading waterbirds and <i>Culex</i> spp mosquitoes and, in some cases, pigs, with spillover to humans and horses.<span><sup>7</sup></span> Birds act as maintenance hosts and can harbour the virus without overt signs of disease. Humans and horses are dead-end hosts and may become infected through the bite of an infectious mosquito. However, dead-end hosts cannot produce virus levels high enough to infect feeding mosquitoes. In Asia, pigs commonly act as amplifying hosts, rapidly multiplying the virus to high levels that can be passed on to susceptible mosquito species, resulting in spillover to humans. There is no evidence of pigs acting as amplifying hosts during the 2021–2023 outbreak in Australia.</p><p>The dominant JEV vector in Australia and parts of the Western Pacific (such as Papua New
{"title":"Japanese encephalitis transmission in Australia: challenges and future perspectives","authors":"Caroline K Dowsett, Francesca Frentiu, Gregor J Devine, Wenbiao Hu","doi":"10.5694/mja2.52550","DOIUrl":"10.5694/mja2.52550","url":null,"abstract":"<p>Japanese encephalitis is caused by the Japanese encephalitis virus (JEV). JEV is the main cause of viral encephalitis in Asia,<span><sup>1</sup></span> and is endemic in many countries on that continent and islands of the Pacific region. Although only a small percentage of cases are symptomatic, 20–30% are fatal and 30–50% develop significant neurological sequelae.<span><sup>2</sup></span> Australia has escaped relatively unscathed, with only a few cases detected in the late 1990s, mostly from international travellers, with local transmission limited to the Torres Strait and Cape York.<span><sup>2, 3</sup></span> The last detection of JEV in Cape York was from feral pigs and an isolate of mosquitoes in 2005. Sentinel animal surveillance in Australia was phased out in 2011 due to costs and labour-intensive maintenance, potential occupational health and safety issues, and concerns about the potential public health risk of using amplifying hosts (pigs), which may contribute to transmission when they become viremic.<span><sup>3</sup></span> Sentinel animal use was replaced by a general mosquito trap-based surveillance system.<span><sup>3</sup></span> The Box provides a timeline of JEV milestones in Australia from the 1990s to 2023, with details on animal and human cases, and corresponding changes in surveillance.</p><p>JEV emerged again in 2021 with a fatal case in the Tiwi Islands, and shortly after was detected on an unprecedented scale and geographical spread in 2022: cases in humans and piggeries were detected across four states in south-eastern Australia (New South Wales, Victoria, Queensland, South Australia). On 4 March 2022, the Australian Government declared the JEV outbreak a communicable disease incident of national significance.<span><sup>4</sup></span> Over the following months, a total of 46 cases (including 7 deaths) were identified in humans (as of 13 February 2023).<span><sup>5</sup></span> The end of the JEV emergency response was announced on 16 June 2023,<span><sup>6</sup></span> although concern remains regarding potential endemicity in Australian waterbird, pig and mosquito populations.</p><p>JEV is maintained in an enzootic cycle between wading waterbirds and <i>Culex</i> spp mosquitoes and, in some cases, pigs, with spillover to humans and horses.<span><sup>7</sup></span> Birds act as maintenance hosts and can harbour the virus without overt signs of disease. Humans and horses are dead-end hosts and may become infected through the bite of an infectious mosquito. However, dead-end hosts cannot produce virus levels high enough to infect feeding mosquitoes. In Asia, pigs commonly act as amplifying hosts, rapidly multiplying the virus to high levels that can be passed on to susceptible mosquito species, resulting in spillover to humans. There is no evidence of pigs acting as amplifying hosts during the 2021–2023 outbreak in Australia.</p><p>The dominant JEV vector in Australia and parts of the Western Pacific (such as Papua New","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 2","pages":"58-62"},"PeriodicalIF":6.7,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52550","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794431","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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