Please login with your free MJA account to view this article in full
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
Objectives: To assess the commitment of the ten largest pharmaceutical companies operating in Australia to achieving net zero emissions by evaluating their accountability metrics, ambitions, and quantifiable actions taken.
Study design: Cross‐sectional study; analysis of publicly available company reports published during 12 December 2015 – 31 December 2023.
Setting, participants: Ten largest pharmaceutical companies operating in Australia, defined by total pharmaceutical costs (to patients and Pharmaceutical Benefits Scheme) for PBS‐subsidised medications, as reported in PBS expenditure and prescriptions reports for 2020–21 and 2022–23.
Main outcome measures: Content analysis of publicly available documents for the ten companies using modified criteria from the PricewaterhouseCoopers
Results: Three groups could be defined by evidence of their commitment to emissions reductions. The first — companies leading emissions reduction efforts, with SBTi‐approved near term targets, consistent emissions monitoring, well defined commitments, and quantified evidence of action — includes AstraZeneca, Novartis, Johnson & Johnson, Bayer, and Merck & Co. The second group — companies that had made commitments to SBTi‐approved targets but their disclosure records are limited — includes AbbVie and Roche. The third group — without public commitments to achieving net zero emissions, minimal or no SBTi‐approved targets, and minimal disclosure or monitoring of emissions — includes Viatris, Vertex, and Arrotex.
Conclusions: The ten largest pharmaceutical companies in Australia are moving towards net zero greenhouse gas emissions at different rates. Gaps in standardised reporting processes should be closed, and further qualitative research on industry‐wide environmental sustainability policy and practice is needed.
Please login with your free MJA account to view this article in full
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
Open access:
Open access publishing facilitated by The University of Melbourne, as part of the Wiley – the University of Melbourne agreement via the Council of Australian University Librarians.
Data Sharing:
We confirm that the data supporting the findings of this study were derived from public domain sources and are available in the article and its supplementary materials.
Open access publishing facilitated by The University of Melbourne, as part of the Wiley – the University of Melbourne agreement via the Council of Australian University Librarians.
All authors are members of Doctors for the Environment Australia.
Climate change — driven primarily by the extraction and burning of fossil fuels — is profoundly affecting our health. Some impacts are direct and immediate, such as from worsening heatwaves and extreme weather events.1 Others are indirect and more complex, including changes to the social determinants of health and the distribution of infectious diseases, and increased water and food insecurity. The risks associated with climate change are not being felt equally, and it is the most disadvantaged people and countries (who have generally contributed the least to climate change) that are disproportionately exposed and vulnerable.2
Please login with your free MJA account to view this article in full
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
Open access:
Open access publishing facilitated by The University of Sydney, as part of the Wiley ‐ The University of Sydney agreement via the Council of Australian University Librarians.
We would like to acknowledge the Climate and Health Foundation for providing financial support for the development of this manuscript. The Climate and Health Foundation had no role in the planning, writing or publication of the work.
Philomena Colagiuri received funding from the Climate and Health Foundation for her role as Lancet Countdown Oceania Fellow. The Climate and Health Foundation also provided funding for her to attend COP29 in Baku, Azerbaijan in 2024 (airfare, accommodation, daily stipend). Jake Williams received funding from the Climate and Health Foundation for his role as Lancet Countdown Oceania Fellow. The Climate and Health Foundation also provided funding for him to attend COP29 in Baku, Azerbaijan in 2024. Jake Williams received funding from the Wiser Healthcare Research Collaboration for the 2024 EMCR Seed Grant, and funding from HEAL (Healthy Environments And Lives) National Research Network (National Health and Medical Research Council Grant No. 2008937) for the 2024 Travel Award and 2023 Travel Award. Paul Beggs received funding from the Lancet Countdown for in‐kind support (payment of airfare, accommodation etc.) to attend the Lancet Countdown Annual Meeting, London, 2024. He also received funding from the Climate and Health Foundation for in‐kind support (payment of airfare, accommodation etc.) to attend UNFCCC COP28, Dubai, 2023. Paul Beggs is the Director of Oceania Regional Centre for the Lancet Countdown. Ying Zhang has received funding from the Climate and Health Foundation for in‐kind support (payment of airfare, accommodation etc.) to attend UNFCCC COP28, Dubai, 2023. Ying Zhang is a Co‐Director of Oceania Regional Centre for the Lancet Countdown and is on the Editorial Board for the Journal of Climate Change and Health.
In Australia, little prevalence data around vision impairment exist. However, self‐reported data from the Australian Bureau of Statistics 2017–18 National Health Survey1 suggest that around 800 000 people have a vision impairment or are blind (excluding uncorrected refractive errors).2 The leading cause of vision impairment in working‐age adults are inherited retinal diseases (IRDs)3 — a group of genetic conditions that primarily affect the retina. Other than one particular gene therapy for biallelic RPE65‐associated retinal dystrophy, there are no other clinically available treatments to safely prevent vision loss or restore vision for someone with an IRD.4
Please login with your free MJA account to view this article in full
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
Open access:
Open access publishing facilitated by University of New South Wales, as part of the Wiley – University of New South Wales agreement via the Council of Australian University Librarians.
Eden Robertson and Anai Gonzalez‐Cordero are supported by a 2021 Medical Research Future Fund Stem Cell Therapies Mission (APP2016039). Consumers (Meredith Prain, Leighton Boyd, Emily Shepard, Hollie Feller, Sally Karandrews, and Kanae Yamamoto) are also supported by a 2021 Medical Research Future Fund Stem Cell Therapies Mission (APP2016039). Kate Hetherington is supported by the Cancer Institute Translational Program Grant (2021/TPG2112) as well as Luminesce Alliance and the Zero Childhood Cancer National Personalised Medicine Program for children with high risk cancer, a joint initiative of Children's Cancer Institute and Kids Cancer Centre, Sydney Children's Hospital, Randwick.
No relevant disclosures.
Attacks on health care in conflict zones are increasing, depriving civilians of urgently needed care, putting the lives of patients and health care workers at risk, and contributing to the deterioration in the health of affected populations.1 Health care is protected under international humanitarian law but there are challenges faced with its enforcement. Consequently, we opine that physicians and medical societies have a moral imperative to advocate for the enduring protection of health care workers, patients, and health care infrastructure in conflict zones.
Please login with your free MJA account to view this article in full
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
Correspondence: lussier.sandra1@gmail.com
The statements and opinions in this manuscript reflect the authors’ views alone and do not represent the official policies or views of our institutions.
No relevant disclosures.
Objective: To examine the accuracy of the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), the population‐based clinical quality registry for people with kidney failure, in identifying Aboriginal and/or Torres Strait Islander people.
Design: Population‐based cohort study of reporting accuracy.
Setting: New South Wales, 2006–2020.
Participants: Incident kidney failure patients.
Main outcome measures: Sensitivity and specificity of identification of Aboriginal and/or Torres Strait Islander people in ANZDATA compared with identification with Enhanced Reporting of Aboriginality (ERA) methods using linked health datasets.
Results: Of 11 708 patients, 693 (5.9%) were identified as Aboriginal and/or Torres Strait Islander people using ERA methods, with 484 recognised in ANZDATA. Overall ANZDATA sensitivity was 67.0% (95% CI, 63.3–70.5%), with high specificity (99.8%; 95% CI, 99.7–99.9%). Sensitivity was lowest for males (63.8%; 95% CI, 58.7–68.6), people aged under 18 years (45.0%; 95% CI, 23.1–68.5%) or over 65 years (61.7%; 95% CI, 53.8–69.2%), and those with greater socio‐economic advantage (56.6%; 95% CI, 46.6–66.2%), living in major cities (53.8%; 95% CI, 48.0–59.5%) and with no comorbidities (47.7%; 95% CI, 37.0–58.6%). Aboriginal and/or Torres Strait Islander people identified in ANZDATA had lower rates of waitlisting for kidney transplantation (17.8%
Conclusion: Aboriginal and/or Torres Strait Islander people were under‐reported in ANZDATA. There were multiple biases in characteristics and outcomes for people identified in ANZDATA compared with those identified by ERA using linked data. This highlights the importance of data integration as a quality improvement mechanism and identifying barriers to disclosure.
Please login with your free MJA account to view this article in full
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
Open access:
Open access publishing facilitated by The University of Sydney, as part of the Wiley – the University of Sydney agreement via the Council of Australian University Librarians.
Data sharing:
The data for this study will not be shared, as we do not have permission from the data custodians or ethics approval to do so. Data may be available upon request from the data custodians.
Angela Webster is supported by a National Health and Medical Research Council Leadership Fellowship (1177117). This study was supported by a University of Sydney External Research Collaboration Seed Funding Grant (CT34675). We thank ANZDATA and the NSW Ministry of Health for access to registry and population health data, and the Centre for Health Record Linkage for linking the datasets. We are grateful to the MHLL Aboriginal Sovereign Steering Committee, Samantha Bateman and the ANZDATA Aboriginal and Torres Strait Islander Health Working Group for helpful feedback and guidance.
No relevant disclosures.
Introduction: Opioid use and dependence are prevalent among incarcerated people, contributing to elevated rates of overdose and other harms in this population. Opioid agonist treatment (OAT) has been shown to be an effective intervention to mitigate these risks. However, challenges to health care implementation in the custodial sector result in suboptimal and variable access to OAT in prisons nationally.
Main recommendations: Among a national multidisciplinary expert panel, we conducted a modified Delphi study that yielded 19 recommendations to government, relevant health authorities and custodial health services. These recommendations cover five core domains: induction or continuation of OAT, OAT options and administration, transition of care to the community, special populations, and organisational support. Key recommendations include prompt recognition and treatment of opioid withdrawal, active linkage to community‐based OAT providers upon release, and ensuring appropriate organisational support through local protocols, adequate funding, and monitoring of key program indicators.
Changes in management as a result of this statement: This consensus statement addresses a significant gap in national policy on OAT in Australian prisons. The recommendations, finalised in July 2024, set forth best practice standards grounded in evidence and expert consensus. We expect that implementing these recommendations will enhance the quality, consistency and continuity of OAT both within prison and upon release. Optimising OAT provision is crucial for improving health outcomes and addressing the risk of overdose, which is the leading cause of death among people released from prison.
Please login with your free MJA account to view this article in full
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
Open access:
Open access publishing facilitated by Curtin University, as part of the Wiley ‐ Curtin University agreement via the Council of Australian University Librarians.
The Consensus statement was prepared on behalf of the National Prisons Addiction Medicine Network (NPAMN). We acknowledge the time and contributions from everyone on the expert panel: Adrian Dunlop, Andrew Wiley, Bianca Davidde, Christine Watson, David Onu, Ele Morrison, Jeremy Hayllar, Jocelyn Chan, Katerina Lagios, Kevin Fontana, Mark Stoove, Peter Thompson, Rebecca Winter, Shalini Arunogiri, Suzanne Nielsen, Thileepan Naren, and Tom Turnbull. The author(s) received no financial support for the research, authorship, and/or publication of this article.
Rebecca Winter has received investigator‐initiated funding from Gilead Sciences for research unrelated to this work. Thileepan Naren has received speaking honoraria from Camarus. All other authors report no relevant disclosures.
Australia's health care system is grappling with a mismatch of demand and capacity, with bottlenecks in access to, and transitions of, care and rising costs.1 Hospital‐in‐the‐home (HITH) models of care are suggested as sustainable patient‐centred, value‐based solutions.2
Please login with your free MJA account to view this article in full
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
Open access:
Open access publishing facilitated by The University of Melbourne, as part of the Wiley ‐ The University of Melbourne agreement via the Council of Australian University Librarians.
We acknowledge the work of The Austin Hospital‐in‐the‐Home (HITH) team and creators of the flowcharts in the Box, supplied and included with permission. Our thanks to: Angela Sullivan, Nurse Unit Manager, HITH and Virtual Care; Mark Horrigan, Medical Director HITH and Virtual Care; Danielle Panaccio, HITH Consultant; and Daniel Thuys, HITH Case Manager.
No relevant disclosures.
Benzathine benzylpenicillin G (BPG) is the most effective treatment for syphilis and prevention of rheumatic heart disease (RHD), both of which disproportionately affect Aboriginal and Torres Strait Islander people. The ongoing syphilis epidemic in Australia1 highlights the importance of a reliable supply of high quality BPG in achieving Australia's commitments to ending RHD and preventing new cases of congenital syphilis.2
Please login with your free MJA account to view this article in full
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
Open access:
Open access publishing facilitated by Australian National University, as part of the Wiley ‐ Australian National University agreement via the Council of Australian University Librarians.
Laurens Manning is supported by a Medical Research Future Fund Investigator Grant (2020 Better penicillins, better hearts: improving secondary prevention of rheumatic heart disease; Emerging Leadership 2 APP1197177). Rosemary Wyber is supported by a National Health and Medical Research Council Emerging Leadership 2 Fellowship (GNT2025252). No funding agency had any role in study design, data collection, analysis or interpretation, reporting or publication.
No relevant disclosures.
Since the launch of ChatGPT in 2022,1 people have had easy access to a generative artificial intelligence (AI) application that can provide answers to most health‐related questions. Although ChatGPT could massively increase access to tailored health information, the risk of inaccurate information is also recognised, particularly with early ChatGPT versions, and its accuracy varies by task and topic.2 Generative AI tools could be a further problem for health services and clinicians, adding to the already large volume of medical misinformation.3 Discussions of the benefits and risks of the new technology for health equity, patient engagement, and safety need reliable information about who is using ChatGPT, and the types of health information they are seeking.
Please login with your free MJA account to view this article in full
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
Open access:
Open access publishing facilitated by the University of Sydney, as part of the Wiley – the University of Sydney agreement via the Council of Australian University Librarians.
Data Sharing:
The data underlying this report are available on reasonable request.
Julie Ayre and Kirsten McCaffery are supported by National Health and Medical Research Council fellowships (APP2017278, APP2016719). The funders were not involved in study design, data collection, analysis or interpretation, reporting or publication. We acknowledge the contribution of Tara Haynes (Sydney Health Literacy Lab, University of Sydney) to the preparation of the ethics application for this study.
No relevant disclosures.
Abstract
Objectives: To investigate the frequency, timing, and characteristics of cardiovascular collapse after snakebite in Australia, and the complications of collapse following envenoming.
Study design: Observational study; analysis of prospectively collected demographic and clinical data.
Setting, participants: People with confirmed snake envenoming recruited to the Australian Snakebite Project at one of 200 participating Australian hospitals, 1 July 2005 – 30 June 2020.
Main outcome measures: Time from snakebite to collapse; post‐collapse complications (cardiac arrest, seizures, death).
Results: Of 1259 envenomed people, 157 (12%) collapsed within 24 hours of the snakebite; venom‐induced consumption coagulopathy (VICC) was determined in all 156 people for whom coagulation testing could be performed. The exact time between bite and collapse was known for 149 people (median, 20 min; interquartile range, 15–30 min; range, 5–115 min); the time exceeded 60 minutes for only two people, each after releasing tight bandages 60 minutes after the bite. The collapse preceded hospital arrival in 132 cases (84%). Brown snake (Pseudonaja spp.) envenoming was the leading cause of collapse (103 cases, 66%). Forty‐two collapses (27%) were followed by cardiac arrest, 49 (31%) by seizures (33 without cardiac arrest), and five by apnoea; collapse was associated with hypotension in all 24 people whose blood pressure could be measured at or close to the time of collapse. Twenty‐five people who collapsed died (16%), and seven of the envenomed people who did not collapse (0.6%; difference: 15 percentage points; 95% confidence interval, 8–21 percentage points). The deaths of 21 of the 25 people who collapsed were immediately associated with the cardiac arrest that followed the collapse; three people who did not have cardiac arrests died later of intracranial haemorrhage, and one of hyperthermia. The proportion of people who had collapsed before reaching hospital was larger for people who died of post‐collapse cardiac arrest (13 of 21, 62%) than for those who survived (6 of 21, 28%).
Conclusion: Collapse after Australian snake envenoming almost always occurred within 60 minutes of the bite, was always accompanied by VICC, and most frequently followed brown snake bites. Poorer outcomes, including cardiac arrest, seizures, and death, were more frequent for people who collapsed than for those who did not. Outcomes for people who collapsed before medical care arrived were poorer than for those who collapsed in hospital or in an ambulance.