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Abstract

Objectives: To estimate changes in the incidence of clinically diagnosed type 2 diabetes in Australia, overall and by age, sex, socio‐economic disadvantage, geographic remoteness, and country of birth.

Study design: Population‐based study; analysis of National Diabetes Services Scheme (NDSS) data (age–period–cohort models).

Setting, participants: Data were extracted for incident cases of type 2 diabetes, 1 January 2005 to 31 December 2019, in residents of the Australian Capital Territory, New South Wales, Queensland, and Victoria aged 20 years or older registered with the NDSS. The numbers of people at risk were obtained from the Australian Bureau of Statistics.

Main outcome measures: Changes in the incidence of type 2 diabetes, 2005–2019, by age, postcode‐level socio‐economic disadvantage (Index of Relative Socioeconomic Disadvantage) and remoteness (major city, inner regional, outer regional/remote/very remote), and country of birth, stratified by sex.

Results: During 2005–2019, 741 535 people aged 20 years or older with incident type 2 diabetes were registered with the NDSS; 421 190 were men (56.8%). Overall, the incidence of type 2 diabetes increased with age (until about age 70 years) and socio‐economic disadvantage for both sexes; it was higher in inner regional areas than in major cities or outer regional/remote/very remote areas during 2005–2015, but highest among people in major cities after 2015. The age‐standardised incidence of type 2 diabetes increased during 2005–2010, both among men (annual percentage change [APC], 4.4%; 95% confidence interval [CI], 3.6–5.2%) and women (APC, 2.9%; 95% CI, 2.2–3.7%); it declined during 2010–2019 among both men (APC, –5.2%; 95% CI, –5.4% to –4.9%) and women (APC, –6.5%; 95% CI, –6.8% to –6.2%). In general, similar patterns (but of differing magnitude) applied to all age, sex, socio‐economic disadvantage, and remoteness groups. However, the incidence of type 2 diabetes increased during 2011–2019 among people born in Asia, North Africa and the Middle East, and the Pacific Islands.

Conclusions: The incidence of type 2 diabetes in Australian adults declined during 2010–2019 across all age, sex, socio‐economic disadvantage, and remoteness groups, but increased among people from Asia, North Africa and the Middle East, and the Pacific Islands.

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1 Baker Heart and Diabetes Institute, Melbourne, VIC
2 Monash University, Melbourne, VIC
3 Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
4 Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, VIC

Correspondence: dianna.magliano@baker.edu.au

Open access:

Open access publishing facilitated by Monash University, as part of the Wiley ‐ Monash University agreement via the Council of Australian University Librarians.

Data Sharing:

Aggregated NDSS data may be made available upon reasonable request to the corresponding author. Limitations on use of the data may apply, subject to approval from the data custodians.

Acknowledgements:

We analysed data from the National Diabetes Services Scheme (NDSS), an initiative of the Australian government administered by Diabetes Australia. Dianna J Magliano (APP2016668) and Jonathan E Shaw (APP1173952) are supported by National Health and Medical Research Council Investigator Grants. The study was partially supported by a Diabetes Australia Research Program grant and the Operational Infrastructure Support Program of the Victorian government, which had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Competing interests:

Jonathan E Shaw has received consultancy fees from AstraZeneca, Sanofi, Novo Nordisk, Eli Lilly, Mylan, Pfizer, Roche, and Abbott. He has also received payments and honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, and educational events from AstraZeneca, Mylan, Boehringer Ingelheim, Roche, Zuellig, and Eli Lilly.

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Ethics and law

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A community within social and ecological communities: a new philosophical foundation for a just residential aged care sector

Lachlan Green, Bridget Pratt and David Kirchhoffer

Med J Aust || doi: 10.5694/mja2.52472
Published online: 14 October 2024

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Topics

Ethics and law

Gerontology

Health services administration

According to the Royal Commission into Aged Care Quality and Safety (hereafter, the Royal Commission), Australian residential aged care (RAC) inadequately caters to the physical, social and psychological needs of older people. The Royal Commission states that aged care requires “a philosophical shift” that centres on people receiving care and establishes “new foundational principles and core values.”1

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1 Australian Catholic University, Brisbane, QLD
2 Queensland Bioethics Centre, Australian Catholic University, Brisbane, QLD

Correspondence: lachlan.green@acu.edu.au

Open access:

Open access publishing facilitated by Australian Catholic University, as part of the Wiley ‐ Australian Catholic University agreement via the Council of Australian University Librarians.

Competing interests:

Bridget Pratt and David Kirchhoffer are affiliated with the Queensland Bioethics Centre, which receives funding from the Roman Catholic Archdiocese of Brisbane, the Catholic Bishops of Queensland, Mater Misericordiae Limited, Saint Vincent's Health Australia and Southern Cross Care Queensland. Authors’ views are their own.

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Pregnancy, childbirth and the postpartum period: opportunities to improve lifetime outcomes for women with non‐communicable diseases

Jenny A Ramson, Myfanwy J Williams, Bosede B Afolabi, Stephen Colagiuri, Kenneth W Finlayson, Bianca Hemmingsen, Kartik K Venkatesh and Doris Chou

Med J Aust 2024; 221 (7): . || doi: 10.5694/mja2.52452
Published online: 7 October 2024

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Topics

Women's health

Non‐communicable diseases (NCDs), such as cardiovascular disease, malignant neoplasms, chronic respiratory diseases and diabetes, are the primary cause of death and disability among women,1,2 with women remaining susceptible throughout their life spans.3 Estimates indicate that women in most countries (88%) have a higher probability of dying before the age of 70 from an NCD than from communicable, perinatal and nutritional conditions combined.4 Most premature deaths due to NCDs (86%) occur in low and middle‐income countries (LMICs),5 but health inequalities persist in high income countries (HICs) and NCDs affect some population groups more than others.4 In addition, the effects of the pandemic of NCDs on global health are intertwined with effects of climate change.6

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1 Ampersand Health Science Writing, Kalaru, NSW
2 UNDP‐UNFPA‐UNICEF‐WHO‐World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
3 University of Lagos, Lagos, Nigeria
4 Centre for Clinical Trials, Research and Implementation Science, University of Lagos, Lagos, Nigeria
5 World Health Organization Collaborating Centre on Physical Activity, Nutrition and Obesity, University of Sydney, Sydney, NSW
6 University of Central Lancashire, Lancashire, United Kingdom
7 Ohio State University, Columbus, Ohio, United States

Correspondence: choud@who.int

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.

Acknowledgements:

This work was funded by the UNDP‐UNFPA‐UNICEF‐WHO‐World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co‐sponsored program executed by the World Health Organization (WHO) and the Global NCD Platform. Ongoing work on pregnancy and diabetes is additionally supported by the Leona M. and Harry B. Helmsley Charitable Trust. The funding sources did not have any role in the writing of this article. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

Competing interests:

Doris Chou has worked with HRP, Helmsley Foundation and the United States Agency for International Development. She has received a grant from Global NCD Platform, travel reimbursements to attend the Society for Maternal‐Fetal Medicine meeting. Jenny Ramson and Myfanwy Williams are contractors for the World Health Organization (WHO) and have received travel reimbursements from WHO. Bosede Afolabi received funding from the Tertiary Education Trust Fund, Nigeria for a clinical trial (the PIPSICKLE trial examining the effectiveness of low dose aspirin versus placebo in preventing intrauterine growth restriction in pregnant women with sickle cell disease). Bosede received honoraria from the American Society of Hematology for a presentation, and travel reimbursements from the American Society of Hematology and National Heart, Lung, and Blood Institute/National Institutes of Health (USA). Stephen Colagiuri is an honorary board member for the Juvenile Arthritis Foundation Australia Board and the Glycaemic Index Foundation Board. Kenneth Finlayson received consultancy fees from WHO as part of a program of work to support guideline development. Kartik Venkatesh received honoraria from the American Diabetes Association and grants from the US National Institutes of Health, Patient‐Centered Outcomes Research Institute and Agency for Healthcare Research. He is on the Obstetrics and Gynecology (Green Journal) editorial board and is an associate editor of the Society of Maternal Fetal Medicine – American Journal of OG/GYN Special Edition.

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31. Souza J, Tunçalp Ö, Vogel J, et al. Obstetric transition: the pathway towards ending preventable maternal deaths. BJOG 2014; 121: 1‐4.
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35. Hickey S, Roe Y, Ireland S, et al. A call for action that cannot go to voicemail: research activism to urgently improve Indigenous perinatal health and wellbeing. Women Birth 2021; 34: 303‐305.

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Perspective

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30/60/90 National stroke targets and stroke unit access for all Australians: it's about time

Timothy J Kleinig and Lisa Murphy, For the 30/60/90 National Stroke Targets Taskforce

Med J Aust || doi: 10.5694/mja2.52459
Published online: 25 September 2024

ARTICLE
AUTHORS
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Topics

Health services administration

Information science

Nervous system diseases

Vascular diseases

Stroke is the world's second‐leading cause of death and the third‐leading cause of death and disability.1 In Australia, stroke is the third most common cause of death and a leading cause of disability.2 As a result, stroke is costly to the health system, society and the individual.3

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1 Royal Adelaide Hospital, Adelaide, SA
2 University of Adelaide, Adelaide, SA
3 Stroke Foundation, Melbourne, VIC

Correspondence: timothy.kleinig@adelaide.edu.au

Open access:

Open access publishing facilitated by The University of Adelaide, as part of the Wiley ‐ The University of Adelaide agreement via the Council of Australian University Librarians.

Acknowledgements:

Geoff Donnan and Stephen Davis for their helpful manuscript comments. Lachlan Dalli for assistance with the updated AuSCR data trends, and the hospital coordinators who have contributed data via the AuSCR.

Competing interests:

No relevant disclosures for named authors. The Angels Initiative (a non‐promotional healthcare project of Boehringer Ingelheim International to improve stroke care around the world) provided support for the 2023 National Stroke Targets 30/60/90 workshop and logistical support surrounding this. The Angels Initiative is a member of the Australian Stroke Coalition taskforce. The Angels Initiative did not propose any target or amendment to any target, and had no input into this manuscript.

1. GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990‐2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20: 795‐820.
2. Australian Institute of Health and Welfare. Deaths in Australia [website]. Australian Government AIHW, 2023. https://www.aihw.gov.au/reports/life‐expectancy‐deaths/deaths‐in‐australia/contents/leading‐causes‐of‐death (viewed Mar 2024).
3. Deloitte Access Economics. The economic impact of stroke in Australia, 2020. https://www.deloitte.com/content/dam/assets‐zone1/au/en/docs/services/economics/dae‐economic‐impact‐stroke‐report‐061120.pdf (viewed Mar 2024).
4. Langhorne P, Ramachandra S, Stroke Unit Trialists Collaboration. Organised inpatient (stroke unit) care for stroke: network meta‐analysis. Cochrane Database Syst Rev 2020; 4: CD000197.
5. Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta‐analysis of individual patient data from randomised trials. Lancet 2014; 384: 1929‐1935.
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22. Choi PMC, Tsoi AH, Pope AL, et al. Door‐in‐door‐out time of 60 minutes for stroke with emergent large vessel occlusion at a primary stroke center. Stroke 2019; 50: 2829‐2834.
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Research

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Lessons learnt from the first two SARS‐CoV‐2 Omicron waves of the COVID‐19 pandemic in six remote Aboriginal and Torres Strait Islander communities in Queensland, Australia: a retrospective epidemiological review

Allison Hempenstall, Barbara Telfer, Sean Cowley, Shalomie Shadrach, Caroline Taunton, Jay Short, Nicolas Smoll, Roy Rasalam, Oscar Whitehead, Peter Roach, Karen Koko, Josh Stafford, Rittia Matysek, Renarta Whitcombe, Gulam Khandaker, Jason King, Nishila Moodley, Maree Finney, Rica Lacey, Steven Donohue, Richard Gair and Katie Panaretto

Med J Aust || doi: 10.5694/mja2.52426
Published online: 30 September 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Indigenous health

Environment and public health

Abstract

Objective: To describe the preparedness for, epidemiological characteristics of and public health responses to the first and second waves of coronavirus disease 2019 (COVID‐19) in six remote Aboriginal and Torres Strait Islander communities in Queensland from late 2021.

Design: This was a descriptive epidemiological study. Data were collated by each participating public health unit. Case and outbreak characteristics were obtained from the statewide Notifiable Conditions System.

Setting, participants: Six discrete remote First Nations communities across Queensland were selected to represent a broad geographic spread across the state: Badu Island, Cherbourg, Lockhart River, Palm Island, Woorabinda and Yarrabah. People with a positive severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) test result recorded between 13 December 2021 and 12 June 2022 who acquired the infection and isolated in one of the six communities.

Main outcome measures: COVID‐19 vaccination coverage among First Nations people; number of COVID‐19 cases reported; and attack rates for each community.

Results: All six First Nations communities led the COVID‐19 preparedness and planning. COVID‐19 vaccination coverage rates before the first outbreak ranged from 59% to 84% for the first dose and from 39% to 76% for the second dose across the six communities. During the study period, 2624 cases of COVID‐19 in these communities were notified to Queensland Health. Attack rates for each community were: Badu Island, 23%; Cherbourg, 34%; Lockhart River, 18%; and Palm Island, Woorabinda and Yarrabah, 35% each. The 2624 cases included 52 cases (2%) involving hospital admission and two cases (< 1%) in which the person died from COVID‐19.

Conclusions: It is likely that the co‐designed, collaborative partnerships between local councils, community‐controlled health services, state health services and public health units positively impacted the management and outcomes of COVID‐19 in each of the six communities.

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1 James Cook University, Townsville, QLD
2 Torres and Cape Hospital and Health Service, Cairns, QLD
3 Queensland Health, Brisbane, QLD
4 Darling Downs Hospital and Health Service, Toowoomba, QLD
5 Townsville Hospital and Health Service, Townsville, QLD
6 Central Queensland Hospital and Health Service, Rockhampton, QLD
7 Cairns and Hinterland Health Service, Cairns, QLD
8 Gurriny Yealamucka Health Service, Yarrabah, QLD
9 Lockhart River Primary Health Care Centre, Lockhart River, QLD

Correspondence: allison.hempenstall@jcu.edu.au

Data sharing:

No data sharing is available from this study in line with Indigenous data sovereignty.

Acknowledgements:

We acknowledge the people living in the six communities included in our study, and are grateful for the support from and partnerships with the local councils: Torres Strait Island Regional Council, Cherbourg Aboriginal Shire Council, Lockhart River Aboriginal Shire Council, Palm Island Aboriginal Shire Council, Woorabinda Aboriginal Shire Council and Yarrabah Aboriginal Shire Council. We also thank the local public health unit staff, Queensland Health primary health care centres and other stakeholders from these six communities for their support. In addition, we thank Marko Simunovic, Principal Business Analyst, Queensland Health, for his data quality work and Kathy Piotrowski, Data Manager, Queensland Health, for creating the figure in Box 1.

Competing interests:

No relevant disclosures.

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9. Australian Government Department of Health and Aged Care. CDNA national guidance for remote Aboriginal and Torres Strait Islander communities for COVID‐19. Canberra: Australian Government, 2022. https://www.health.gov.au/sites/default/files/documents/2022/02/cdna‐national‐guidance‐for‐remote‐aboriginal‐and‐torres‐strait‐islander‐communities‐for‐covid‐19.pdf (viewed Dec 2022).
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Guideline summary

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Recommendations from the 2024 Australian evidence‐based guideline for unexplained infertility: ADAPTE process from the ESHRE evidence‐based guideline on unexplained infertility

Michael F Costello, Robert J Norman, Luk Rombauts, Cynthia M Farquhar, Lisa Bedson, Marlene Kong, Clare V Boothroyd, Rebecca Kerner, Rhonda M Garad, Trudy Loos, Madeline Flanagan, Ben W Mol, Aya Mousa, Daniela Romualdi, Baris Ata, Ernesto Bosch, Samuel Santos‐Ribeiro, Ksenija Gersak, Roy Homburg, Nathalie Le Clef, Mina Mincheva, Terhi Piltonen, Sara Somers, Sesh K Sunkara, Harold Verhoeve and Helena J Teede, For the Australian NHMRC Centre for Research Excellence in Reproductive Life UI Guideline Network and the ESHRE guideline group for unexplained infertility

Med J Aust || doi: 10.5694/mja2.52437
Published online: 16 September 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

General medicine

Statistics, epidemiology and research design

Abstract

Introduction: The 2024 Australian evidence‐based guideline for unexplained infertility provides clinicians with evidence‐based recommendations for the optimal diagnostic workup for infertile couples to establish the diagnosis of unexplained infertility and optimal therapeutic approach to treat couples diagnosed with unexplained infertility in the Australian health care setting. The guideline recommendations were adapted for the Australian context from the rigorous, comprehensive European Society of Human Reproduction and Embryology (ESHRE) 2023 Evidence‐based guideline: unexplained infertility, using the ADAPTE process and have been approved by the Australian National Health and Medical Research Council.

Main recommendations: The guideline includes 40 evidence‐based recommendations, 21 practice points and three research recommendations addressing:

definition — defining infertility and frequency of intercourse, infertility and age, female and male factor infertility;
diagnosis — ovulation, ovarian reserve, tubal factor, uterine factor, laparoscopy, cervical/vaginal factor, male factor, additional testing for systemic conditions; and
treatment — expectant management, active treatment, mechanical‐surgical procedures, alternative therapeutic approaches, quality of life.

Changes in assessment and management resulting from the guideline: This guideline refines the definition of unexplained infertility and addresses basic diagnostic procedures for infertility assessment not considered in previous guidelines on unexplained infertility. For therapeutic approaches, consideration of evidence quality, efficacy, safety and, in the Australian setting, feasibility, acceptability, cost, implementation and ultimately recommendation strength were integrated across multidisciplinary expertise and consumer perspectives in adapting recommendations to the Australian context by using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework, which had not been used in past guidelines on unexplained infertility to formulate recommendations. The Australian process also included an established data integrity check to ensure evidence could be trusted to guide practice. Practice points were added and expanded to consider the Australian setting. No evidence‐based recommendations were underpinned by high quality evidence, with most having low or very low quality evidence. In this context, research recommendations were made including those for the Australian context. The full guideline and technical report are publicly available online and can be accessed at https://www.monash.edu/medicine/mchri/infertility and are supported by extensive translation resources, including the free patient ASKFertility mobile application (https://www.askfertility.org/).

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1 NHMRC Centre for Research Excellence in Women's Health in Reproductive Life, Sydney, NSW
2 University of New South Wales, Sydney, NSW
3 Robinson Research Institute, University of Adelaide, Adelaide, SA
4 Monash University, Melbourne, VIC
5 University of Auckland, Auckland, New Zealand
6 Repromed, Adelaide, SA
7 Whitsundays Doctors Service, Airlie Beach, QLD
8 Care Fertility, Brisbane, QLD
9 Adelaide, SA
10 Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
11 Monash Health, Melbourne, VIC
12 Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
13 Koç University Hospital, Istanbul, Turkey
14 IVI RMA, Valencia, Spain
15 IVI RMA, Lisbon, Portugal
16 University of Ljubljana and University Medical Centre, Ljubljana, Slovenia
17 Liverpool Women's Hospital, Hewitt Fertility Centre, Liverpool, United Kingdom
18 European Society of Human Reproduction and Embryology, Grimbergen, Belgium
19 London, United Kingdom
20 Oulu University Hospital, Medical Research Centre, University of Oulu, Oulu, Finland
21 Ghent University Hospital, Ghent, Belgium
22 King's College London, London, United Kingdom
23 Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

Correspondence: helena.teede@monash.edu

Open access:

Open access publishing facilitated by Monash University, as part of the Wiley ‐ Monash University agreement via the Council of Australian University Librarians.

Acknowledgements:

The Australian National Health and Medical Research Council (NHMRC) funded the guideline development through the Centre for Research Excellence in Women's Health in Reproductive Life (CRE WHiRL) (APP1171592) administered by Monash University, Australia. The NHMRC was the approver of the Guideline but had no influence on the outcome. This work builds on the work of ESHRE and sections where relevant are reproduced here with permission. Copyright of the original UI Guideline belongs to European Society of Human Reproduction and Embryology (all rights reserved). The content of the original ESHRE guidelines has been published for personal and educational use only and is adapted here with permission. No part of the ESHRE guidelines may be translated or reproduced in any form without prior written permission of the ESHRE communications manager. Monash University is subject to copyright. Monash holds the copyright for the Australian adapted UI Guideline and recommendations. No commercial use is authorised. Apart from any use permitted under the Copyright Act 1968, no part may be reproduced by any process without written permission from ESHRE and Monash University.

Competing interests:

Lisa Bedson is employed by Repromed Fertility Specialists. Claire Boothroyd is on the Merck‐funded male factor infertility guideline, and received speaker fees from Organon, Merck, Da Vinci, Ferring, Besins, Gideon Richter as well as private practice or professional income from Owner Care Fertility (IVF unit offering treatments). Michael Costello has received speaker honoraria from Merck/CREI. Cynthia Farquhar has been funded by Cochrane for evidence synthesis and advisory board roles; she has also been the Chair NZICA and a WHO, task force and infertility guideline member, President elect ASPIRE, and RANZCOG research and guideline lead. Robert Norman declared NHMRC funding via research grants, MRFF funding, advisory board member as Chair of the Clinical Advisory Committee at Westmead Fertility, Chair Board of HOPE Research Institute Vietnam, consulting honoraria past trainer Flinders Fertility, consultant Vinmec Hospital Vietnam and speakers fee or honoraria from several pharmaceutical companies in India. Luk Rombauts declared research grants/contracts with Monash IVF Group and was on an advisory board for Merck with private practice income from LIF Rombauts Pty Ltd. Daniela Romualdi received consulting fees from SICS Editore, UCB Pharmax, honoraria from IBSA and Novo Nordisk. Baris Ata received speakers fees from Merck, Ferring, IBSA, Organon and Abbott. Ernesto Bosch received research grants from Roche diagnostics and IBSA with consulting fees from Merck, Ferring, Gedeon Richter, Mint diagnostics and speaker's fees from Merck, Ferring, Gedeon Richter, IBSA, salary from IVI RMA Valencia, ownership by stock or partnership from IVI RMA Valencia and Mint diagnostics. Samuel Santos‐Ribeiro received research grants from MSD, Ferring, Merck, Abbott, Roche, Obseva and consulting fees from Ferring, MSD and speaker's fees from Ferring, MSD and Besins. Mina Mincheva received consulting fees from Mojo Fertility Ltd. Terhi Piltonen Research received a grant from Roche and speaker's fees from Gedeon Richter, Roche, Exeltis. Helena Teede receives competitive grant funding from government sources and holds unpaid international leadership roles with WHO and professional societies. Natalie Vujovich, Rhonda Garad, Trudy Loos, Marlene Kong, Sara Somers, Roy Homburg, Donia Scicluna, Ksenija Gersak and Nathalie Le Clef have nothing to declare.

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20. Björndahl L, Kirkman Brown J; Editorial Board Members of the WHO Laboratory Manual for the Examination and Processing of Human Semen. The sixth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen: ensuring quality and standardization in basic examination of human ejaculates. Fert Steril 2022; 117: 246‐251.
21. Wessel JA, Mochtar MH, Besselink DE, et al. Expectant management versus IUI in unexplained subfertility and a poor pregnancy prognosis (EXIUI study): a randomized controlled trial. Hum Reprod 2022; 37: 2808‐2816.
22. Lai S, Wang R, van Wely M, et al. IVF versus IUI with ovarian stimulation for unexplained infertility: a collaborative individual participant data meta‐analysis. Hum Reprod Update 2024; 30: 174‐185.
23. Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci 2022; 17: 75.
24. Au LS, Feng Q, Shingshetty L, et al. Evaluating prognosis in unexplained infertility. Fertil Steril 2024; 121(5): 717‐729.
25. Norman RJ. Prophecy, prediction, and prognosis — can we improve the advice we give on the chance of pregnancy and treatment options for infertility? Fertil Steril 2024; 121: 715‐716.
26. Bensdorp AJ, van der Steeg JW, Steures P, et al. A revised prediction model for natural conception. Reprod Biomed Online 2017; 34: 619‐626.

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Updating the diagnosis and management of iron deficiency in the era of routine ferritin testing of blood donors by Australian Red Cross Lifeblood

Gary D Zhang, Daniel Johnstone, Michael F Leahy and John K Olynyk

Med J Aust || doi: 10.5694/mja2.52429
Published online: 16 September 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Hematologic diseases

Iron deficiency is the most common micronutrient deficiency worldwide1 and the predominant cause of anaemia, which affects one‐quarter of the global population.2

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1 Fiona Stanley Hospital, Perth, WA
2 University of Western Australia, Perth, WA
3 University of Newcastle, Newcastle, NSW
4 Royal Perth Hospital, Perth, WA
5 Curtin University, Perth, WA

Correspondence: gary.zhang@health.wa.gov.au

Open access:

Open access publishing facilitated by Curtin University, as part of the Wiley ‐ Curtin University agreement via the Council of Australian University Librarians.

Competing interests:

No relevant disclosures.

1. McLean E, Cogswell M, Egli I, et al. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993‐2005. Public Health Nutr 2009; 12: 444‐454.
2. GBD 2021 Anaemia Collaborators. Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990‐2021: findings from the Global Burden of Disease Study 2021. Lancet Haematol 2023; 10: e713‐e734.
3. Australian Bureau of Statistics. Australian health survey: biomedical results for nutrients. Canberra: ABS, 2013. https://www.abs.gov.au/statistics/health/health‐conditions‐and‐risks/australian‐health‐survey‐biomedical‐results‐nutrients/latest‐release (viewed Sept 2023).
4. Australian Red Cross Lifeblood. Lifeblood stats and snacks 2023 [website]. Australia, 2023. https://www.lifeblood.com.au/news‐and‐stories/vital‐reads/2023‐stats‐and‐snacks (viewed Apr 2024).
5. Australian Red Cross Lifeblood. Ferritin (iron) testing [website]. Australia, 2023. https://www.lifeblood.com.au/blood/learn‐about‐blood/iron‐health/ferritin‐testing (viewed Oct 2023).
6. Snook J, Bhala N, Beales ILP, et al. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut 2021; 70: 2030‐2051.
7. Pasricha SR, Tye‐Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. Lancet 2021; 397: 233‐248.
8. Gastroenterological Society of Australia (GESA). Clinical update for general practitioners and physicians: iron deficiency. Melbourne: GESA, 2022. https://www.gesa.org.au/public/13/files/Education%20&%20Resources/Clinical%20Practice%20Resources/Iron%20Deficiency/Iron%20Deficiency%20Clinical%20Update%202022%20APPROVED.pdf (viewed Feb 2024).
9. Rockey DC, Altayar O, Falck‐Ytter Y, Kalmaz D. AGA technical review on gastrointestinal evaluation of iron deficiency anemia. Gastroenterology 2020; 159: 1097‐1119.
10. World Health Organization. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: WHO, 2020. https://www.who.int/publications/i/item/9789240000124 (viewed Oct 2023).
11. Low MS, Grigoriadis G. Iron deficiency and new insights into therapy. Med J Aust 2017; 207: 81‐87. https://www.mja.com.au/journal/2017/207/2/iron‐deficiency‐and‐new‐insights‐therapy
12. The Royal College of Pathologists of Australasia. Iron studies standardised reporting protocol. Second edition: November 2021. Sydney: RCPA, 2021. https://www.rcpa.edu.au/getattachment/554ba672‐4d34‐4e7c‐b812‐5741359bca78/Iron‐Studies‐Standardised‐Reporting‐Protocol.aspx (viewed Apr 2024).
13. Saunders AV, Craig WJ, Baines SK, Posen JS. Iron and vegetarian diets. Med J Aust 2013; 199 Suppl 4: S11‐16. https://www.mja.com.au/journal/2013/199/4/iron‐and‐vegetarian‐diets
14. Lam JR, Schneider JL, Quesenberry CP, Corley DA. Proton pump inhibitor and histamine‐2 receptor antagonist use and iron deficiency. Gastroenterology 2017; 152: 821‐829.
15. Gowanlock Z, Lezhanska A, Conroy M, et al. Iron deficiency following bariatric surgery: a retrospective cohort study. Blood Adv 2020; 4: 3639‐3647.
16. Mahadev S, Laszkowska M, Sundström J, et al. Prevalence of celiac disease in patients with iron deficiency anemia ‐ a systematic review with meta‐analysis. Gastroenterology 2018; 155: 374‐382.
17. Hershko C, Hoffbrand AV, Keret D, et al. Role of autoimmune gastritis, Helicobacter pylori and celiac disease in refractory or unexplained iron deficiency anemia. Haematologica 2005; 90: 585‐595.
18. Alexandre L, Manning C, Chan SSM. Prevalence of gastrointestinal malignancy in iron deficiency without anaemia: a systematic review and meta‐analysis. Eur J Intern Med 2020; 72: 27‐33.
19. Pennazio M, Spada C, Eliakim R, et al. Small‐bowel capsule endoscopy and device‐assisted enteroscopy for diagnosis and treatment of small‐bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352‐376.
20. Atkin W, Dadswell E, Wooldrage K, et al. Computed tomographic colonography versus colonoscopy for investigation of patients with symptoms suggestive of colorectal cancer (SIGGAR): a multicentre randomised trial. Lancet 2013; 381: 1194‐1202.
21. Moretti D, Goede JS, Zeder C, et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice‐daily doses in iron‐depleted young women. Blood 2015; 126: 1981‐1989.
22. Stoffel NU, Zeder C, Brittenham GM, et al. Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron‐deficient anemic women. Haematologica 2020; 105: 1232‐1239.
23. Stoffel NU, Cercamondi CI, Brittenham G, et al. Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice‐daily split dosing in iron‐depleted women: two open‐label, randomised controlled trials. Lancet Haematol 2017; 4: e524‐e533.
24. Kaundal R, Bhatia P, Jain A, et al. Randomized controlled trial of twice‐daily versus alternate‐day oral iron therapy in the treatment of iron‐deficiency anemia. Ann Hematol 2020; 99: 57‐63.
25. Avni T, Bieber A, Grossman A, et al. The safety of intravenous iron preparations: systematic review and meta‐analysis. Mayo Clin Proc 2015; 90: 12‐23.

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Research

Non‐index hospital re‐admissions after hospitalisation with acute myocardial infarction and geographic remoteness, New South Wales, 2005–2020: a retrospective cohort study

Md Shajedur Rahman Shawon, Jennifer Yu, Art Sedrakyan, Sze‐Yuan Ooi and Louisa Jorm

Med J Aust 2024; 221 (6): . || doi: 10.5694/mja2.52420
Published online: 16 September 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Cardiovascular diseases

General medicine

Health services administration

Abstract

Objectives: To examine the frequency of re‐admissions to non‐index hospitals (hospitals other than the initial discharging hospital) within 30 days of admission with acute myocardial infarction in New South Wales; to examine the relationship between non‐index hospital re‐admissions and 30‐day mortality.

Study design: Retrospective cohort study; analysis of hospital admissions (Admitted Patient Data Collection) and mortality data (Registry of Births, Deaths and Marriages).

Setting, participants: Adults admitted to NSW hospitals with acute myocardial infarction re‐admitted to any hospital within 30 days of discharge from the initial hospitalisation, 1 January 2005 – 31 December 2020.

Main outcome measures: Proportion of re‐admissions within 30 days of discharge to non‐index hospitals, and associations of non‐index hospital re‐admissions with demographic and initial hospitalisation characteristics and with 30‐day and 12‐month mortality, each by residential remoteness category.

Results: Of 168 097 people with acute myocardial infarction discharged alive, 28 309 (16.8%) were re‐admitted to hospital within 30 days of discharge, including 11 986 to non‐index hospitals (42.3%); the proportion was larger for people from regional or remote areas (50.1%) than for people from major cities (38.3%). The odds of non‐index hospital re‐admission were higher for people with ST‐elevation myocardial infarction, for people whose index admissions were to private hospitals, who were transferred between hospitals or had undergone revascularisation during the initial admission, were under 65 years of age, or had private health insurance; the influence of these factors was generally larger for people from regional or remote areas than for those from large cities. After adjustment for potential confounders, non‐index hospital re‐admission did not influence mortality among people from major cities (30‐day: adjusted odds ratio [aOR], 1.09; 95% confidence interval [CI], 0.99–1.20; 12‐month: aOR, 0.98, 95% CI, 0.93–1.03), but was associated with reduced mortality for people from regional or remote areas (30‐day: aOR, 0.81; 95% CI, 0.70–0.95; 12‐month: aOR, 0.88; 95% CI, 0.81–0.96).

Conclusions: The geographically dispersed Australian population and the mixed public and private provision of specialist services means that re‐admission to a non‐index hospital can be unavoidable for people with acute myocardial infarction who are initially transferred to specialised facilities. Non‐index hospital re‐admission is associated with better mortality outcomes for people from regional or remote areas.

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1 Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
2 Prince of Wales Hospital and Community Health Services, Sydney, NSW
3 Eastern Heart Clinic Pty Ltd, Sydney, NSW
4 Weill Cornell Medical College, New York, United States of America
5 Prince of Wales Hospital, Sydney, NSW

Correspondence: s.shawon@unsw.edu.au

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.

Data sharing:

The data underlying this article will be shared upon reasonable request to the corresponding author.

Competing interests:

No relevant disclosures.

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19. Lujic S, Watson DE, Randall DA, et al. Variation in the recording of common health conditions in routine hospital data: study using linked survey and administrative data in New South Wales, Australia. BMJ Open 2014; 4: e005768.

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