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As one of the world's most urbanised nations, Australia1 is particularly vulnerable to diseases causally linked with urban living.2 Further urban growth requires systemic health policy solutions. Urban green spaces (UGS) are dynamic contributors to the wellbeing of our cities, offering benefits to the health of humans, society, and natural and managed ecosystems. Here we define UGS to encompass planned and intentional green spaces such as parks, curated gardens, sports and recreation areas as well as urban forests and nature reserves, and unconventional green zones such as easements, road and infrastructure routes, streetscapes and commercial precincts.
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We acknowledge the HEAL (Healthy Environments And Lives) National Research Network, which receives funding from the National Health and Medical Research Council Special Initiative in Human Health and Environmental Change (Grant No. 2008937). Support was also provided by the Environment Institute at the University of Adelaide. The funding source was not involved in the authoring of this work. The work of the Dynamic State Summit (2022) in catalysing this work is acknowledged.
No relevant disclosures.
Japanese encephalitis is caused by the Japanese encephalitis virus (JEV). JEV is the main cause of viral encephalitis in Asia,1 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.2 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.2,3 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.3 Sentinel animal use was replaced by a general mosquito trap‐based surveillance system.3 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.
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We acknowledge the HEAL (Healthy Environments And Lives) National Research Network, which receives funding from the National Health and Medical Research Council (NHMRC) Special Initiative in Human Health and Environmental Change Initiative (Grant No. 2008937). Caroline Dowsett is funded by a Queensland University of Technology Post‐graduate Research Award (QUTPRA). We also acknowledge the National Foundation for Australia‐China Relations (Grant No. 220011), the Australian Department of Foreign Affairs and Trade.
No relevant disclosures.
In Australia, 24.4% of newborn Aboriginal or Torres Strait Islander infants were admitted to neonatal intensive care units (NICUs) or special care nurseries during 2022, compared with 16.3% of non‐Indigenous infants.1 For Aboriginal and Torres Strait Islander people, culture is a protective factor for strong health and wellbeing,2 but neonatal care can disrupt usual parent–infant care and cultural care practices. Understanding the characteristics of Aboriginal and Torres Strait Islander families receiving neonatal care is important for supporting their needs. Routinely collected national and state data do not typically provide detailed information about Aboriginal and Torres Strait Islander infants admitted to NICUs,1 leading to gaps in knowledge about how to optimise care, particularly at the local level.
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Data Sharing:
In line with Indigenous data sovereignty and Aboriginal and Torres Strait Islander ethical research principles, data sharing is available for this study.
This study was funded by an Ikara–Flinders Ranges Challenge Grant. We respectfully acknowledge all Aboriginal and Torres Strait Islander people whose data were included in our analysis, and the governing services (Tamworth Aboriginal Medical Service, Tamworth Aboriginal Land Council, Walgett Aboriginal Medical Service, and the Aboriginal Advisory Group) for the leadership, knowledge, and wisdom shared with the investigators.
No relevant disclosures.
Untangling the complex interplay between eating disorders, gut–brain disorders and motility disorders is challenging. Nationally and internationally, there has been a concerning increase in patients receiving artificial nutrition that may be unnecessary.1 This places patients at risk of iatrogenic harm and results in considerable economic burden to health services. There is a clear need for high quality research to guide care, but in its absence, now more than ever, we require a national treatment consensus to support clinicians working in this field. This article aims to highlight the current status, knowledge, and service limitations in treating this difficult cohort of patients, and make recommendations on future strategies within Australia to move forward for better patient outcomes.
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Nicholas Talley is the Emeritus Editor‐In‐Chief of the MJA. We confirm that he was not involved in any review, decision making, or editorial processes for this manuscript.
Cystic fibrosis, an autosomal recessive disease, causes premature mortality with a current life expectancy of 56 years.1 Variations in a single gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR), an anion channel, cause this multisystemic disease.2 Bronchiectasis remains the most significant contributor to mortality, with other affected systems including the gastrointestinal, pancreatic, hepatobiliary, sweat glands and reproductive systems.3 Clinical manifestations of cystic fibrosis vary widely, leading to diverse phenotypic expressions.
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LF is supported by the Rotary Club of Sydney Cove/Sydney Children's Hospital Foundation and UNSW postgraduate award scholarships. SW is supported by the UNSW Scientia program and the Australian National Health and Medical Research Council. There was no role of the funding sources in the planning, writing or publication of the work. Colman Taylor provided feedback on a draft manuscript regarding health technology assessment pathways.
AJ is chair of the scientific and medical advisory committee of Rare Voices Australia and has received speaker payments from Vertex Pharmaceuticals. LF has been a sub‐investigator on Vertex clinical trials and received sponsorship of travel costs to attend educational meetings. SW has received competitive funding sponsored by Vertex Pharmaceuticals. Vertex Pharmaceuticals had no involvement in the planning, writing or publication of this article.
Objectives: To review studies of interventions for reducing the impact of type 2 diabetes in Aboriginal and Torres Strait Islander people. The primary aim was to review and summarise the characteristics and findings of the interventions. The secondary aims were to assess their effects on diabetes and cardiometabolic risk factors, and the proportions of people with type 2 diabetes who achieved therapeutic targets with each intervention.
Study design: We searched eight electronic databases for publications of studies including Aboriginal or Torres Strait Islander people aged 15 years or older with diagnoses of type 2 diabetes, describing one or more diabetes interventions, and published in English during 1 January 2000 – 31 December 2020. Reference lists in the assessed articles were checked for further relevant publications.
Data sources: MEDLINE (Ovid), Web of Science (Clarivate), the Cochrane Library, Global Health (EBSCO), Indigenous Collection and Indigenous Australia (Informit), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the World Health Organization International Clinical Trials Registry Platform (WHO‐ICTRP).
Results: The database searches yielded 1424 unique records; after screening by title and abstract, the full text of 55 potentially relevant articles were screened, of which seventeen met our eligibility criteria: eleven cohort studies (seven retrospective audits and four prospective studies), three randomised controlled trials, and three observational, non‐randomised follow‐up studies. Twelve publications reported site‐based (Aboriginal or Torres Strait Islander health service or diabetes clinic) rather than individual‐based diabetes interventions. Interventions with statistically significant effects on mean glycated haemoglobin (HbA1c) levels were laparoscopic adjustable gastric banding, a 5‐day diabetes self‐management camp, treatment of
Conclusions: Few interventions for Aboriginal and Torres Strait Islander people with type 2 diabetes have been reported in peer‐reviewed publications. Improving diabetes care services resulted in larger proportions of people achieving therapeutic HbA1c targets. Outcomes were better when Aboriginal and Torres Strait Islander communities were involved at all levels of an intervention. High quality studies of holistic, culturally safe and accessible interventions should be the focus of research.
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We thank Anita Horvath (Medical Education, University of Melbourne) for her support and advice in the standard structure and format of the review.
Elif I Ekinci has received payment for sitting on an advisory panel for Eli Lilly Australia; and donated the money to her institution for diabetes research. She has received research support from Eli Lilly Australia, Novo Nordisk, Boehringer Ingelheim, the Eli Lilly Alliance, Versanis, Endogenex Insulet Corporation, and Medtronic.
New insights into post‐acute sequelae of coronavirus disease 2019 (PASC) or long COVID are emerging at great speed. Proposed mechanisms driving long COVID include the overlapping pathologies of immune and inflammatory dysregulation, microbiota dysbiosis, autoimmunity, endothelial dysfunction, abnormal neurological signalling, reactivation of endogenous herpesviruses, and persistence of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2).1,2 In this commentary, we describe some of these advances that indicate that long COVID may be driven by “long infection” and that persistent replicating SARS‐CoV‐2 may be the potentially mechanistically unifying driver for long COVID.
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The Burnet Institute is supported by an Operational Infrastructure Grant from the State Government of Victoria, Australia, and the Independent Research Institutes Infrastructure Support Scheme of the NHMRC of Australia.
No relevant disclosures.
Objective: To examine recent changes in the birth prevalence of cerebral palsy in Australia; to examine the functional mobility of children with cerebral palsy by residential remoteness.
Study design: Population‐based register study; analysis of Australian Cerebral Palsy Register (ACPR) data.
Setting, participants: Children with cerebral palsy born in Australia, 1995–2016, and included in the ACPR at the time of the most recent state/territory data provision (31 July 2022).
Main outcome measures: Change in birth prevalence of cerebral palsy, of cerebral palsy acquired pre‐ or perinatally (
Results: Data for 10 855 children with cerebral palsy born during 1995–2016 were available, 6258 of whom were boys (57.7%). The birth prevalence of cerebral palsy in the three states with complete case ascertainment (South Australia, Victoria, Western Australia) declined from 2.1 (95% confidence interval [CI], 1.9–2.4) cases per 1000 live births in 1995–1996 to 1.5 (95% CI, 1.3–1.7) cases per 1000 live births in 2015–2016. The birth prevalence of pre‐ or perinatally acquired cerebral palsy declined from 2.0 (95% CI, 1.7–2.3) to 1.4 (95% CI, 1.2–1.6) cases per 1000 live births; statistically significant declines were noted for all gestational ages except 32–36 weeks. The decline in birth prevalence of post‐neonatally acquired cerebral palsy, from 0.15 (95% CI, 0.11–0.21) to 0.08 (95% CI, 0.05–0.12) cases per 1000 live births, was not statistically significant. Overall, 3.4% of children with cerebral palsy (307 children) lived in remote or very remote areas, a larger proportion than for all Australians (2.0%); the proportion of children in these areas who required wheelchairs for mobility was larger (31.3%) than that of children with cerebral palsy in major cities or regional areas (each 26.1%).
Conclusions: The birth prevalence of cerebral palsy declined markedly in Australia during 1995–2016, reflecting the effects of advances in maternal and perinatal care. Our findings highlight the need to provide equitable, culturally safe access to antenatal services for women, and to health and disability services for people with cerebral palsy, across Australia.
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Data Sharing:
The authors had access to all raw data, statistical reports, and tables. The de‐identified data are not publicly available, but requests to the corresponding author will be considered on a case‐by‐case basis.
The Australian Capital Territory, New South Wales, and Australian cerebral palsy registers are funded by the Cerebral Palsy Alliance Research Foundation, the Northern Territory register by Women, Children and Youth, Royal Darwin Hospital, the Queensland register by Choice, Passion, Life, the South Australian register by the Women's and Children's Health Network (with additional support from Novita), and the Tasmanian register by St Giles and the Tasmanian Department of Health. The Victorian register received funding from the Victorian Department of Health and Human Services and the Cerebral Palsy Alliance Research Foundation, and infrastructure support from the Victorian Government Operational Infrastructure Support Program. The Western Australian Register of Developmental Anomalies: Cerebral Palsy is funded by the Western Australian Department of Health. The funding sources support the work of the cerebral palsy registers, which included the preparation of this report.
The ACPR Group acknowledge all the children with cerebral palsy and their families, and the clinicians who support them. We thank the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) for providing access to Victorian denominator data for this analysis and for the assistance of Safer Care Victoria staff. The conclusions, findings, opinions, and views or recommendations expressed in this article are those of the authors, and do not necessarily reflect those of CCOPMM.
No relevant disclosures.
First described in the mid‐1970s, “burnout” has elicited continued interest among occupational health specialists.1,2 The World Health Organization3 defines burnout as a triadic syndrome that comprises: (i) feelings of energy depletion or exhaustion; (ii) increased mental distance from one's job, or feelings of negativism or cynicism towards one's job; and (iii) a sense of ineffectiveness and lack of accomplishment. This definition closely aligns with the conceptualisation of burnout in the Maslach Burnout Inventory, the most prominent measure of the entity.2,4 Although burnout has become a popular indicator of job‐related distress, persistent controversies surround the construct. As burnout reaches its half‐century of existence, this article offers an overview of key research developments that have prompted investigators to revamp their views of the syndrome.
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Abstract
Objectives: To assess the impact of the transition from film to digital mammography in the Australian national breast cancer screening program.
Study design: Retrospective linked population health data analysis (New South Wales Central Cancer Registry, BreastScreen NSW); interrupted time series analysis.
Setting: New South Wales, 2002–2016.
Participants: Women aged 40 years or older with breast cancer diagnosed during 2002–2017 who had been screened by BreastScreen NSW and for whom complete follow‐up information until the end of the recommended re‐screening interval was available.
Intervention: Transition from film to digital mammography; 2009 defined as transition year (digital mammography becomes dominant screening modality).
Main outcome measures: Population rates of screen‐detected cancer, interval cancer, recalls, and false positive findings.
Results: The study cohort comprised 967 573 women; of the 2 741 555 screens, 1 535 184 used film mammography (2002–2010) and 1 206 371 used digital mammography (2006–2016). The screen‐detected cancer rate was 4.86 (95% confidence interval [CI], 4.75–4.97) cases per 1000 screens with film mammography and 6.11 (95% CI, 5.97–6.24) cases per 1000 screens with digital mammography (unadjusted difference, 1.24 [95% CI, 1.06–1.41] cases per 1000 screens). The interval cancer rate was 2.56 (95% CI, 2.48–2.64) cases per 1000 screens with film mammography and 2.84 (95% CI, 2.75–2.94) cases per 1000 screens with digital mammography (unadjusted difference, 0.27 [95% CI, 0.15–0.40] cases per 1000 screens). With the transition to digital mammography, the screen‐detected cancer rate increased by 0.07 per 1000 screens, the sum of the decline in the invasive cancer rate (–0.21 cases per 1000 screens) and the rise in the ductal carcinoma in situ detection rate (0.28 cases per 1000 screens); during 2009–2015, it increased by 0.18 cases per 1000 screens per year. With the transition to digital mammography, the interval cancer rate increased by 0.75 cases per 1000 screens (invasive cancer: by 0.69 cases per 1000 screens); during 2009–2015, it declined by 0.13 cases per 1000 screens per year. The recall rate increased by 8.02 per 1000 screens and the false positive rate by 7.16 per 1000 screens following the transition; both rates subsequently declined to pre‐transition levels.
Conclusions: The increased screen‐detected cancer rate following the transition to digital mammography was not accompanied by a reduction in interval cancer detection rates.