{"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}
<p>Cardiovascular disease in women is under-recognised, under-diagnosed, and under-treated.<span><sup>1</sup></span> In 1991, Bernadine Healy highlighted sex bias in the management of coronary artery disease, noting that, to receive similar management, women with heart disease must present “just like a man.”<span><sup>2</sup></span> Concerted efforts to improve the recognition and treatment of coronary artery disease in women have since been undertaken both in the community and by medical professionals. Nevertheless, 34 years later there are still sex-based differences in the management and outcomes of coronary artery disease in Australia and around the world. The reasons for these differences are complex and probably include both sex-specific biological mechanisms in the pathophysiology of cardiac disease and gender-related health disparities.<span><sup>1</sup></span> A 2018 <i>MJA</i> research article based on national data for people with ST-elevation myocardial infarction (STEMI) reported that female patients received less invasive management and less guideline-directed preventive therapy, and that their outcomes during follow-up were poorer than for male patients.<span><sup>3</sup></span> In this issue of the <i>MJA</i>, Kazi and colleagues<span><sup>4</sup></span> provide further evidence of differences in the treatment of male and female patients with STEMI in Australia, as well as providing some hope that we may be slowly closing the gender heart gap.</p><p>Kazi and colleagues retrospectively reviewed treatment and outcomes for adults who presented with first episode STEMI to New South Wales hospitals during 2011–2020, including rates of revascularisation within seven days of presentation and major adverse cardiovascular events and mortality during the twelve months following admission. The authors were particularly interested in assessing whether sex differences in treatment and outcomes had changed over time.<span><sup>4</sup></span></p><p>Consistent with previous reports,<span><sup>3</sup></span> Kazi and colleagues found that female STEMI patients were older a presentation and had higher levels of comorbidity than male patients. Female STEMI patients were also more likely to live in areas of socio-economic disadvantage. Female patients were less likely to undergo timely angiography, percutaneous coronary intervention, and coronary artery bypass grafting, and adverse event and mortality rates during 12-month follow-up were higher for female than male patients. Angiography and percutaneous coronary intervention rates increased for both male and female patients during 2011–2020, but the increase was more rapid for female patients. Similarly, the decline in both cardiovascular death and all-cause mortality was slightly more rapid for female patients.<span><sup>4</sup></span></p><p>The reasons for sex differences in the treatment of and the prognosis for patients with STEMI, both in Australia and overseas, are complicated and require furth
{"title":"Closing the gender gap in the diagnosis and treatment of heart disease","authors":"Esther Davis","doi":"10.5694/mja2.70054","DOIUrl":"https://doi.org/10.5694/mja2.70054","url":null,"abstract":"<p>Cardiovascular disease in women is under-recognised, under-diagnosed, and under-treated.<span><sup>1</sup></span> In 1991, Bernadine Healy highlighted sex bias in the management of coronary artery disease, noting that, to receive similar management, women with heart disease must present “just like a man.”<span><sup>2</sup></span> Concerted efforts to improve the recognition and treatment of coronary artery disease in women have since been undertaken both in the community and by medical professionals. Nevertheless, 34 years later there are still sex-based differences in the management and outcomes of coronary artery disease in Australia and around the world. The reasons for these differences are complex and probably include both sex-specific biological mechanisms in the pathophysiology of cardiac disease and gender-related health disparities.<span><sup>1</sup></span> A 2018 <i>MJA</i> research article based on national data for people with ST-elevation myocardial infarction (STEMI) reported that female patients received less invasive management and less guideline-directed preventive therapy, and that their outcomes during follow-up were poorer than for male patients.<span><sup>3</sup></span> In this issue of the <i>MJA</i>, Kazi and colleagues<span><sup>4</sup></span> provide further evidence of differences in the treatment of male and female patients with STEMI in Australia, as well as providing some hope that we may be slowly closing the gender heart gap.</p><p>Kazi and colleagues retrospectively reviewed treatment and outcomes for adults who presented with first episode STEMI to New South Wales hospitals during 2011–2020, including rates of revascularisation within seven days of presentation and major adverse cardiovascular events and mortality during the twelve months following admission. The authors were particularly interested in assessing whether sex differences in treatment and outcomes had changed over time.<span><sup>4</sup></span></p><p>Consistent with previous reports,<span><sup>3</sup></span> Kazi and colleagues found that female STEMI patients were older a presentation and had higher levels of comorbidity than male patients. Female STEMI patients were also more likely to live in areas of socio-economic disadvantage. Female patients were less likely to undergo timely angiography, percutaneous coronary intervention, and coronary artery bypass grafting, and adverse event and mortality rates during 12-month follow-up were higher for female than male patients. Angiography and percutaneous coronary intervention rates increased for both male and female patients during 2011–2020, but the increase was more rapid for female patients. Similarly, the decline in both cardiovascular death and all-cause mortality was slightly more rapid for female patients.<span><sup>4</sup></span></p><p>The reasons for sex differences in the treatment of and the prognosis for patients with STEMI, both in Australia and overseas, are complicated and require furth","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 7","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In their 2024 work <i>Who's afraid of gender?</i>, Judith Butler<span><sup>1</sup></span> charts the rise of an international so-called anti-gender ideology movement, in which the concept of gender operates as “phantasm”. That is, a site where disparate contemporary fears — be they around the future of work, family life, or other aspects of the world — gather and become weaponised for political ends. This weaponisation of gender is having far-reaching impacts across the globe, including on public health policy and the practice of medicine.<span><sup>2</sup></span> In one of the most striking recent examples, the United States under the Trump Administration is undertaking extraordinary attacks on sexual and reproductive health and rights, in part under the guise of “defending women from gender ideology extremism and restoring biological truth”.<span><sup>3, 4</sup></span> Australia too is seeing its share of backlash against gender equity in the sphere of health, including use of anti-gender ideology discourse to mobilise opposition to health care access for transgender (trans) people.<span><sup>5, 6</sup></span></p><p>It is against this backdrop that the <i>Medical Journal of Australia</i> dedicates a special issue to the topic of gender and health. In doing so, we do not seek to prescribe specific definitions of “sex” or “gender” for adoption across health and medicine. These are often contested terms subject to evolving and varied scholarship, including growing recognition that they might defy efforts to map them neatly onto a “biological” and “cultural” binary.<span><sup>1</sup></span> In line with the Sex and Gender Equity in Research (SAGER) guidelines,<span><sup>7</sup></span> which the journal endorses, these terms should be clearly defined by authors and used with precision and consistency throughout their work. The goal of this special issue is to provide a platform for research and analysis that engage with what gender means for Australian health care in a manner informed by evidence, scientific rigour, a quest for equity and justice and, fundamentally, respect for the rights, dignity and perspectives of affected populations. Its curation was premised on an understanding of gender as “the structure of social relations and practices that are organised in relation to reproductive bodies”.<span><sup>8</sup></span></p><p>The articles in this issue cover diverse ground. Harsha Ananthram and colleagues<span><sup>9</sup></span> seek to unpack the term “obstetric violence” in the context of findings from recent inquiries into birth trauma in Australia and the United Kingdom. In Australia, practitioners who refuse to participate in abortion care should refer their patients onwards to a willing provider. Shelly Makeleff and colleagues<span><sup>10</sup></span> argue that not enough attention has been given to how these referrals are carried out and propose strategies to promote person-centred abortion referrals. The potential to improve the ca
{"title":"Special issue on gender and health: listening to the voices of patients","authors":"Elizabeth Zuccala","doi":"10.5694/mja2.70064","DOIUrl":"https://doi.org/10.5694/mja2.70064","url":null,"abstract":"<p>In their 2024 work <i>Who's afraid of gender?</i>, Judith Butler<span><sup>1</sup></span> charts the rise of an international so-called anti-gender ideology movement, in which the concept of gender operates as “phantasm”. That is, a site where disparate contemporary fears — be they around the future of work, family life, or other aspects of the world — gather and become weaponised for political ends. This weaponisation of gender is having far-reaching impacts across the globe, including on public health policy and the practice of medicine.<span><sup>2</sup></span> In one of the most striking recent examples, the United States under the Trump Administration is undertaking extraordinary attacks on sexual and reproductive health and rights, in part under the guise of “defending women from gender ideology extremism and restoring biological truth”.<span><sup>3, 4</sup></span> Australia too is seeing its share of backlash against gender equity in the sphere of health, including use of anti-gender ideology discourse to mobilise opposition to health care access for transgender (trans) people.<span><sup>5, 6</sup></span></p><p>It is against this backdrop that the <i>Medical Journal of Australia</i> dedicates a special issue to the topic of gender and health. In doing so, we do not seek to prescribe specific definitions of “sex” or “gender” for adoption across health and medicine. These are often contested terms subject to evolving and varied scholarship, including growing recognition that they might defy efforts to map them neatly onto a “biological” and “cultural” binary.<span><sup>1</sup></span> In line with the Sex and Gender Equity in Research (SAGER) guidelines,<span><sup>7</sup></span> which the journal endorses, these terms should be clearly defined by authors and used with precision and consistency throughout their work. The goal of this special issue is to provide a platform for research and analysis that engage with what gender means for Australian health care in a manner informed by evidence, scientific rigour, a quest for equity and justice and, fundamentally, respect for the rights, dignity and perspectives of affected populations. Its curation was premised on an understanding of gender as “the structure of social relations and practices that are organised in relation to reproductive bodies”.<span><sup>8</sup></span></p><p>The articles in this issue cover diverse ground. Harsha Ananthram and colleagues<span><sup>9</sup></span> seek to unpack the term “obstetric violence” in the context of findings from recent inquiries into birth trauma in Australia and the United Kingdom. In Australia, practitioners who refuse to participate in abortion care should refer their patients onwards to a willing provider. Shelly Makeleff and colleagues<span><sup>10</sup></span> argue that not enough attention has been given to how these referrals are carried out and propose strategies to promote person-centred abortion referrals. The potential to improve the ca","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 7","pages":"329-330"},"PeriodicalIF":8.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237329","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> Objective</h3> <p>To review reporting on a case series of “inpatient therapy” administered to pre-pubertal children presenting with gender expansive behaviours previously published in the <i>MJA</i> and to compare this reporting to the adulthood recollections and past contemporaneous medical records of a person who had received such treatment.</p> </section> <section> <h3> Design</h3> <p>Retrospective analysis of autoethnography, archived mental health records, and patient details published in a 1987 <i>MJA</i> case series of eight children.</p> </section> <section> <h3> Setting</h3> <p>Stubbs Terrace Hospital, a Western Australian state-funded child and adolescent psychiatric hospital, no longer in operation.</p> </section> <section> <h3> Participant</h3> <p>Jayne McFadyen (J), a transgender woman whose recollections align with the clinical details supplied for Case 5 in the case series, and an author of this article.</p> </section> <section> <h3> Main outcome measures</h3> <p>Concordance and discordance among details documented in the published case series, J's autoethnography of her hospital treatment, and archived childhood psychiatric records obtained through freedom of information.</p> </section> <section> <h3> Results</h3> <p>J's recollections align closely with details in the archived records. Both align with many, but not all, published details, most notably the following published statement: “No conscious attempt was made by the staff members to encourage masculine or feminine role behaviours.” Some of the verified recollections are of psychologically coercive and aversive practices typical of sexual orientation and gender identity and expression change or suppression efforts (SOGICE). Despite inpatient treatment aimed at suppressing or changing her transgender identity and expression, J's sense of whom she understood herself to be remained steadfast.</p> </section> <section> <h3> Conclusion</h3> <p>A retrospective review of “inpatient treatment” intended to re-direct gender expansive identity formation revealed pseudo-psychological strategies reliant on denial and repression. These were directed towards extinguishing childhood behaviours deemed to be socially undesirable. These practices are indistinguishable from th
{"title":"An autoethnographic critique of a past report of inpatient psychiatric treatment for gender diverse children","authors":"Jayne McFadyen, Timothy W Jones, Rowena Koek, Fintan Harte, Brendan Jansen, Megan Galbally, Warren Kealy-Bateman, Catherine Wall, Quinnehtukqut McLamore, Anja Ravine","doi":"10.5694/mja2.70037","DOIUrl":"https://doi.org/10.5694/mja2.70037","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To review reporting on a case series of “inpatient therapy” administered to pre-pubertal children presenting with gender expansive behaviours previously published in the <i>MJA</i> and to compare this reporting to the adulthood recollections and past contemporaneous medical records of a person who had received such treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective analysis of autoethnography, archived mental health records, and patient details published in a 1987 <i>MJA</i> case series of eight children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Stubbs Terrace Hospital, a Western Australian state-funded child and adolescent psychiatric hospital, no longer in operation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participant</h3>\u0000 \u0000 <p>Jayne McFadyen (J), a transgender woman whose recollections align with the clinical details supplied for Case 5 in the case series, and an author of this article.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Concordance and discordance among details documented in the published case series, J's autoethnography of her hospital treatment, and archived childhood psychiatric records obtained through freedom of information.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>J's recollections align closely with details in the archived records. Both align with many, but not all, published details, most notably the following published statement: “No conscious attempt was made by the staff members to encourage masculine or feminine role behaviours.” Some of the verified recollections are of psychologically coercive and aversive practices typical of sexual orientation and gender identity and expression change or suppression efforts (SOGICE). Despite inpatient treatment aimed at suppressing or changing her transgender identity and expression, J's sense of whom she understood herself to be remained steadfast.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A retrospective review of “inpatient treatment” intended to re-direct gender expansive identity formation revealed pseudo-psychological strategies reliant on denial and repression. These were directed towards extinguishing childhood behaviours deemed to be socially undesirable. These practices are indistinguishable from th","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 7","pages":"359-364"},"PeriodicalIF":8.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237330","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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