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Should clinicians and the general population be concerned about seasonal affective disorder in Australia?

Adriana G Nevarez Flores, Emmanuelle CS Bostock and Amanda L Neil
Med J Aust 2022; 216 (10): . || doi: 10.5694/mja2.51518
Published online: 6 June 2022

Seasonal affective disorder, a well documented syndrome in northern latitudes, has limited credence in Australia

Seasonal affective disorder (SAD), also known as “winter depression”, refers to the recurrence of major depressive episodes (for a minimum of 2 consecutive years) during a particular season, typically winter.1 While the construct is widely acknowledged,1,2,3 the condition is not recognised as a stand‐alone mental disorder by current classification systems. Rather, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM‐5) includes “seasonal pattern” as a specifier for recurrent major depressive disorder,4 and the International Classification of Diseases, 11th revision (ICD‐11) has included “seasonal depressive disorder” under the category of “recurrent depressive disorder”.5 As such, the validity of the construct as an individual mental disorder remains debatable,6,7 with some suggesting the syndrome is a “temporary expression of a mood disorder rather than a specific disorder”.8 However, the condition’s potential as a stand‐alone disorder remains extant given both its continuous identification2,3,9,10 and the ongoing inclusion of seasonal pattern specifiers in diagnostic classification systems.


  • 1 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
  • 2 University of Tasmania, Hobart, TAS



Competing interests:

No relevant disclosures.

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The impact of COVID‐19 on chronic disease management in primary care: lessons for Australia from the international experience

Anne Parkinson, Sethunya Matenge, Jane Desborough, Sally Hall Dykgraaf, Lauren Ball, Michael Wright, Elizabeth A Sturgiss and Michael Kidd
Med J Aust 2022; 216 (9): . || doi: 10.5694/mja2.51497
Published online: 16 May 2022

The continuation of chronic disease management in primary care remains essential during the COVID‐19 pandemic

International primary care responses to the coronavirus disease 2019 (COVID‐19) pandemic have seen the prioritisation of acute and urgent services for people with COVID‐19 as well as seeing many practitioners involved in COVID‐19 vaccination counselling and delivery.1,2 This prioritisation has often resulted in partial or complete disruption to chronic disease management (CDM),1 including care for conditions such as hypertension, diabetes and cancer.2 CDM in Australian primary care has been similarly disrupted, with reports of decreased time spent on CDM activities and preventive care,3 particularly for elements of care that require in‐person examination or testing,4 and delays in investigation, diagnosis, referred appointments and elective procedures, resulting in prolonged pain, anxiety and deterioration for patients.5 The introduction of telehealth items under the Medicare Benefits Schedule (MBS) may have both alleviated and contributed to disruption.5,6,7 Although early data suggested that there was little reduction in the total volume of services provided against the MBS, when accounting for telehealth services, and little change in medications used to manage chronic diseases,8 these data paint a complex and dynamic picture with differential changes in certain service types, such as allied health and referred and non‐referred services. A recent study from the United Kingdom has suggested that few studies have reported the impact of increases in COVID‐19‐related respiratory consultations in primary care and that these consultations might mask other reductions in service volume.9

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  • 1 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
  • 2 Australian National University, Canberra, ACT
  • 3 Centre for Health Practice Innovation, Griffith University, Brisbane, QLD
  • 4 Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW
  • 5 Monash University, Melbourne, VIC
  • 6 COVID‐19 Primary Care Response Group, Australian Government Department of Health, Canberra, ACT


Correspondence: anne.parkinson@anu.edu.au

Competing interests:

No relevant disclosures.

  • 1. Matenge S, Sturgiss E, Desborough J, et al. Ensuring the continuation of routine primary care during the COVID‐19 pandemic: a review of the international literature. Fam Pract 2021; doi: https://doi.org/10.1093/fampra/cmab115 [Epub ahead of print].
  • 2. World Health Organization. Rapid assessment of service delivery for NCDs during the COVID‐19 pandemic 2020 https://www.who.int/publications/m/item/rapid‐assessment‐of‐service‐delivery‐for‐ncds‐during‐the‐covid‐19‐pandemic (viewed Dec 2021).
  • 3. Halcomb E, McInnes S, Williams A, et al. The experiences of primary healthcare nurses during the COVID‐19 pandemic in Australia. J Nurs Scholarsh 2020; 52: 553‐563.
  • 4. Dimopoulos‐Bick T, Walsh L, Sutherland K. Indirect impacts of COVID‐19: a case study of evidence, advice and representation from consumer and community members in New South Wales Australia. J Patient Exp 2021; 8: 2374373521998628.
  • 5. Douglas K, O’Brien, Hall S, et al. Quick COVID Clinician Survey Summary (Australia), Series 9‐13 [preprint]. Ann Fam Med 2021; https://doi.org/10.7302/385.
  • 6. Royal Australian College of General Practitioners. General practice: health of the nation 2020. https://www.racgp.org.au/health‐of‐the‐nation/health‐of‐the‐nation (viewed Dec 2021).
  • 7. Javanparast S, Roeger L, Reed RL. Experiences of patients with chronic diseases of access to multidisciplinary care during COVID‐19 in South Australia. Aust Health Rev 2021; https://doi.org/10.1071/AH20328 [Epub ahead of print].
  • 8. Australian Institute of Health and Welfare. Impacts of COVID‐19 on Medicare Benefits Scheme and Pharmaceutical Benefits Scheme service use [updated 17 Dec 2021]. https://www.aihw.gov.au/reports/health‐care‐quality‐performance/covid‐impacts‐on‐mbs‐and‐pbs/contents/impact‐on‐mbs‐service‐use (viewed Dec 2021).
  • 9. Dambha‐Miller H, Hounkpatin HO, Morgan‐Harrisskitt J, et al. Primary care consultations for respiratory tract symptoms during the COVID‐19 pandemic: a cohort study including 70 000 people in South West England. Fam Pract 2021; https://doi.org/10.1093/fampra/cmab127 [Epub ahead of print].
  • 10. Beran D, Aebischer Perone S, Castellsague Perolini M, et al. Beyond the virus: ensuring continuity of care for people with diabetes during COVID‐19. Prim Care Diabetes 2021; 15: 16‐7.
  • 11. Mobula LM, Heller DJ, Commodore‐Mensah Y, et al. Protecting the vulnerable during COVID‐19: treating and preventing chronic disease disparities. Gates Open Res 2020; 4: 125.
  • 12. Brey Z, Mash R, Goliath C, Roman D. Home delivery of medication during coronavirus disease 2019, Cape Town, South Africa: short report. Afr J Prim Health Care Fam Med 2020; 12: e1‐e4.
  • 13. Haldane V, Zhang Z, Abbas RF, et al. National primary care responses to COVID‐19: a rapid review of the literature. BMJ Open 2020; 10: e041622.
  • 14. Desborough J, Hall Dykgraaf S, de Toca L, et al. Australia’s national COVID‐19 primary care response. Med J Aust 2020; 213: 104‐106. https://www.mja.com.au/journal/2020/213/3/australias‐national‐covid‐19‐primary‐care‐response
  • 15. Danhieux K, Buffel V, Pairon A, et al. The impact of COVID‐19 on chronic care according to providers: a qualitative study among primary care practices in Belgium. BMC Fam Pract 2020; 21: 255.
  • 16. van Weert H. After the first wave: what effects did the COVID‐19 measures have on regular care and how can general practitioners respond to this? Eur J Gen Pract 2020; 26: 126‐128.
  • 17. Franzosa E, Gorbenko K, Brody AA, et al. “At home, with care”: lessons from New York City home‐based primary care practices managing COVID‐19. J Am Geriatr Soc 2020; 69: 300‐306.
  • 18. Williams R, Jenkins DA, Ashcroft DM, et al. Diagnosis of physical and mental health conditions in primary care during the COVID‐19 pandemic: a retrospective cohort study. Lancet Public Health 2020; 5: 543‐550.
  • 19. Donohue D. A primary care answer to a pandemic: keeping a population of patients safe at home through chronic care management and remote patient monitoring. Am J Lifestyle Med 2020; 14: 595‐601.
  • 20. Wright A, Salazar A, Mirica M, et al. The invisible epidemic: neglected chronic disease management during COVID‐19. J Gen Intern Med 2020; 35: 2816‐2817.
  • 21. Royal Australian College of General Practitioners. Home‐care guidelines for patients with COVID‐19. https://www.racgp.org.au/clinical‐resources/covid‐19‐resources/other‐health‐issues/covid‐19‐home‐care‐guidelines (viewed Dec 2021).
  • 22. Hall Dykgraaf S, Desborough J, de Toca L, et al. “A decade’s worth of work in a matter of days”: the journey to telehealth for the whole population in Australia. Int J Med Inform 2021; 151: 104483.
  • 23. Bhaskar S, Bradley S, Chattu VK, et al. Telemedicine across the globe — position paper from the COVID‐19 Pandemic Health System Resilience PROGRAM (REPROGRAM) International Consortium (Part 1). Front Public Health 2020; 8: 556720.
  • 24. Spelman JF, Brienza R, Walsh RF, et al. A model for rapid transition to virtual care, VA Connecticut primary care response to COVID‐19. J Gen Intern Med 2020; 35: 3073‐3076.
  • 25. Copp T, Isautier JMJ, Nickel B, et al. COVID‐19 challenges faced by general practitioners in Australia: a survey study conducted in March 2021. Aust J Prim Health 2021; 27: 357‐363.
  • 26. Modenese A, Gobba F. Increased risk of COVID‐19‐related deaths among general practitioners in Italy. Healthcare (Basel) 2020; 8: 155.
  • 27. Barrett E, Hingle ST, Smith CD, Moyer DV. Getting through COVID‐19: keeping clinicians in the workforce. Ann Intern Med 2021; 174: 1614‐1615.
  • 28. Sullivan EE, Phillips RS. Sustaining primary care teams in the midst of a pandemic. Isr J Health Policy Res 2020; 9: 77.
  • 29. Anderson M, O’Neill C, Macleod Clark J, et al. Securing a sustainable and fit‐for‐purpose UK health and care workforce. Lancet 2021; 397: 1992‐2011.
  • 30. Wright M, Versteeg R. Introducing general practice enrolment in Australia: the devil is in the detail. Med J Aust 2021; 214: 400‐402. https://www.mja.com.au/journal/2021/214/9/introducing‐general‐practice‐enrolment‐australia‐devil‐detail
  • 31. Australian Government Department of Health. Consultation draft — Primary Health Care 10 Year Plan. https://consultations.health.gov.au/primary‐care‐mental‐health‐division/draft‐primary‐health‐care‐10‐year‐plan/ (viewed Dec 2021).

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It is time to reinvest in quality improvement collaboratives to support Australian general practice

Andrew W Knight, John Fraser and C Dimity Pond
Med J Aust 2022; 216 (9): . || doi: 10.5694/mja2.51502
Published online: 16 May 2022

Supporting improved general practice is urgent, and quality improvement collaboratives are an effective Australian strategy

Australia faces serious challenges to the effectiveness and sustainability of its health system, including barriers to access, rising costs, chronic disease rates, an ageing population, and overstretched hospitals.1,2 High quality primary care is recognised to underpin effective and efficient health systems.2,3,4 The coronavirus disease 2019 (COVID‐19) pandemic has starkly illuminated the problems and demonstrated the importance of supporting general practice for health care delivery in Australia.

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  • 1 South Western Sydney Local Health District, Sydney, NSW
  • 2 UNSW Sydney, Sydney, NSW
  • 3 University of New England, Armidale, NSW
  • 4 University of Newcastle, Newcastle, NSW


Correspondence: awknight@aapt.net.au

Acknowledgements: 

Andrew Knight is a general practitioner who has written about the Australian Primary Care Collaboratives (APCC) as a participant, academic and leader. He is completing a PhD on the impact of the APCC. Dimity Pond is a GP researcher and educator with a special interest in dementia. John Fraser is a rural GP researcher and educator with a special interest in public health. We thank Michael Tam for providing advice on this manuscript.

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.

Competing interests:

Andrew Knight received payment from the Improvement Foundation Australia in his role as Chair of the Expert Reference Panel on Access during the Australian Primary Care Collaboratives Program.

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Access to abortion services in Australia: we must do better

Andrew F Pesce and Gayathri Jayasinghe
Med J Aust 2022; 216 (9): . || doi: 10.5694/mja2.51509
Published online: 16 May 2022

Clinicians should be mindful of the importance of post‐abortion contraception counselling for preventing further unintended pregnancies

Unintended pregnancy has significant adverse effects on both mother and child,1,2 as well as social and financial costs.3 As South Australia is the only Australian state to collect abortion data, we rely on secondary sources for national information. For example, the most recent estimated national annual abortion rate — 17.3 per 1000 Australian women aged 15–44 years — was derived from Pharmaceutical Benefits Scheme (PBS) and National Hospital Morbidity Database (NHMD) data.4


  • Westmead Hospital, Sydney, NSW



Competing interests:

No relevant disclosures.

  • 1. Bahk J, Yun SC, Kim YM, Khang YH. Impact of unintended pregnancy on maternal mental health: a causal analysis using follow up data of the Panel Study on Korean Children (PSKC). BMC Pregnancy Childbirth 2015; 15: 85.
  • 2. Singh A, Chalasani S, Koenig MA, Mahapatra B. The consequences of unintended births for maternal and child health in India. Popul Stud (Camb) 2012; 66: 223‐239.
  • 3. Yazdkhasti M, Pourreza A, Pirak A, Abdi F. Unintended pregnancy and its adverse social and economic consequences on health system: a narrative review article. Iran J Public Health 2015; 44: 12‐21.
  • 4. Keogh LA, Gurrin LC, Moore P. Estimating the abortion rate in Australia from National Hospital Morbidity and Pharmaceutical Benefits Scheme data. Med J Aust 2021; 215: 375‐376. https://www.mja.com.au/journal/2021/215/8/estimating‐abortion‐rate‐australia‐national‐hospital‐morbidity‐and
  • 5. Grzeskowiak LE, Rumbold AR, Subasinghe A, et al. Long‐acting reversible contraception use after medical abortion is associated with reduced likelihood of a second medical abortion. Med J Aust 2022; 216: 476‐477.
  • 6. Schmidt‐Hansen M, Hawkins JE, Lord J, et al. Long‐acting reversible contraception immediately after medical abortion: systematic review with meta‐analyses. Hum Reprod Update 2020; 26: 141‐160.
  • 7. Boesen HC, Rørbye C, Norgaard M, Nilas L. Sexual behavior during the first eight weeks after legal termination of pregnancy. Acta Obstet Gynecol Scand 2004; 83: 1189‐1192.
  • 8. Donnet ML, Howie M, Cooper W, Lewis M. Return of ovarian function following spontaneous abortion. Clin Endocrinol (Oxf) 1990; 33: 13‐20.
  • 9. Duijkers IJM, Heger‐Mahn D, Drouin D, et al. Maintenance of ovulation inhibition with a new progestogen‐only pill containing drospirenone after scheduled 24‐h delays in pill intake. Contraception 2016; 93: 303‐309.
  • 10. Weisberg E. Progestogen‐only methods of contraception. Aust Prescr 1999; 22: 6‐8.

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Achieving continuity of care in general practice: the impact of patient enrolment on health outcomes

Mark F Harris and Joel Rhee
Med J Aust 2022; 216 (9): . || doi: 10.5694/mja2.51508
Published online: 16 May 2022

The search for a cost‐effective Australian model of comprehensive, coordinated patient‐centred care that improves outcomes continues

Continuity of care has long been regarded as a core characteristic of general practice.1 It is thought important because it encourages more appropriate and proactive use of health care services (including hospital care), improves communication between doctors and patients, reduces inconsistency of care, and increases the chances of early diagnosis and effective management of long term conditions. Continuity of care is also associated with greater patient satisfaction, self‐management, and chronic disease management, as well as with fewer hospitalisations and lower mortality.2,3


  • 1 Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW
  • 2 University of New South Wales, Sydney, NSW


Correspondence: m.f.harris@unsw.edu.au

Competing interests:

No relevant disclosures.

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Poor achievement of lipid targets after acute coronary syndrome: what can we improve?

Sher May Ng, Jiliu Pan and Ajay K Gupta
Med J Aust 2022; 216 (9): . || doi: 10.5694/mja2.51507
Published online: 16 May 2022

Overcoming problems that impede the delivery of evidence‐based care is needed to bridge gaps between science and improving health

The benefits of lipid‐lowering therapy for the secondary prevention of atherosclerotic cardiovascular disease, including its effect on mortality, have been recognised since the publication of the seminal 4S trial in 1994.1 Recent clinical trials of novel lipid‐lowering therapies in people taking statins have found that the lower the low‐density lipoprotein cholesterol (LDL‐C) level achieved, the lower the risk of adverse cardiovascular events.2 It is beyond doubt that people at high risk of adverse cardiovascular events, including those with a history of acute coronary syndrome, benefit most from aggressive lipid‐lowering therapy. Accordingly, the recommended LDL‐C targets are lowest for such people, and have been continually reduced in international guidelines over time.3


  • 1 Barts Health NHS Trust, London, United Kingdom
  • 2 Harefield Hospital, Harefield, United Kingdom
  • 3 Centre for Clinical Pharmacology, Queen Mary University of London, London, United Kingdom


Correspondence: ajay.gupta@qmul.ac.uk

Competing interests:

No relevant disclosures.

  • 1. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383‐1389.
  • 2. Sabatine MS, Giugliano RP, Keech AC, et al; FOURIER Steering Committee and Investigators. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Eng J Med 2017; 376: 1713‐1722.
  • 3. The task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41: 111‐188.
  • 4. Alsadat N, Hyun K, Boroumand F, et al. Achieving lipid targets within 12 months of an acute coronary syndrome: an observational analysis. Med J Aust 2022; 216: 463‐468.
  • 5. Gitt AK, Lautsch D, Ferrières J, et al. Cholesterol target value attainment and lipid‐lowering therapy in patients with stable or acute coronary heart disease: results from the Dyslipidemia International Study II. Atherosclerosis 2017; 266: 158‐166.
  • 6. Gupta A, Thompson D, Whitehouse A, et al; ASCOT Investigators. Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo‐Scandinavian Cardiac Outcomes Trial – Lipid‐Lowering Arm (ASCOT‐LLA): a randomised double‐blind placebo‐controlled trial and its non‐randomised non‐blind extension phase. Lancet 2017; 389: 2473‐2481.
  • 7. Harris DE, Lacey A, Akbari A, et al. Achievement of European guideline‐recommended lipid levels post‐percutaneous coronary intervention: a population‐level observational cohort study. Eur J Prev Cardiol 2021; 28: 854‐861.
  • 8. Billimek J, Malik S, Sorkin DH, et al. Understanding disparities in lipid management among patients with type 2 diabetes: gender differences in medication nonadherence following treatment intensification. Womens Health Issues 2015; 25: 6‐12.
  • 9. Zhang Y, Cui Y, Shen M, et al; the medical team from Xiangya Hospital to support Hubei, China. Association of diabetes mellitus with disease severity and prognosis in COVID‐19: a retrospective cohort study. Diabetes Res Clin Pract 2020; 165: 108227.
  • 10. Rodriguez F, Olufade TO, Ramey DR, et al. Gender disparities in lipid‐lowering therapy in cardiovascular disease: insights from a managed care population. J Womens Health (Larchmt) 2016; 25: 697‐706.

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Hip fracture surgery: the importance of evidence‐based practice

Peter FM Choong
Med J Aust 2022; 216 (8): . || doi: 10.5694/mja2.51493
Published online: 2 May 2022

Registries are invaluable assets that not only benefit medical research, but also health care for all

During 2015–16, almost 18 700 hip fractures were recorded in Australia; the incidence rate was nearly 200 times as high among people aged 45 years or more than among younger people, and 1.7 times as high for women as men.1 As longevity increases and the prevalence of osteoporosis, sarcopaenia, obesity, and dementia rise in Western countries,2 the numbers of people at risk of fractures will continue to climb.


  • 1 University of Melbourne, Melbourne, VIC
  • 2 St Vincent's Hospital, Melbourne, VIC


Correspondence: pchoong@unimelb.edu.au

Acknowledgements: 

I am supported by a National Health and Medical Research Council Practitioner Fellowship.

Competing interests:

I have received consultancy fees and support for travel to designer surgeon meetings related to tumour prostheses from Stryker and Johnson & Johnson.

  • 1. Australian Institute of Health and Welfare. Hip fracture incidence and hospitalisations in Australia (Cat. no. PHE 226). Canberra: AIHW, 2018. https://www.aihw.gov.au/getmedia/296b5bb1‐0816‐44c6‐bdce‐b56e10fd6c0f/aihw‐phe‐226.pdf.aspx?inline=true (viewed Mar 2022).
  • 2. Gandham A, Zengin A, Bonham MP, et al. Incidence and predictors of fractures in older adults with and without obesity defined by body mass index versus body fat percentage. Bone 2020; 140: 115546.
  • 3. Australian Institute for Health and Welfare. Hospitals at a glance 2017–18. Updated 23 Aug 2019. https://www.aihw.gov.au/reports/hospitals/hospitals‐at‐a‐glance‐2017‐18/contents/surgery‐in‐australias‐hospitals (viewed Mar 2022).
  • 4. van Staa TP, Dennison EM, Leufkens HG, Cooper C. Epidemiology of fractures in England and Wales. Bone 2001; 29: 517‐522.
  • 5. Pasco JA, Sanders KM, Hoekstra FM, et al. The human cost of fracture. Osteoporos Int 2005; 16: 2046‐2052.
  • 6. Lystad RP, Cameron CM, Mitchell RJ. Mortality risk among older Australians hospitalised with hip fracture: a population‐based matched cohort study. Arch Osteoporos 2017; 12: 67.
  • 7. Turesson E, Ivarsson K, Thorngren KG, Hommel A. The impact of care process development and comorbidity on time to surgery, mortality rate and functional outcome for hip fracture patients: a retrospective analysis over 19 years with data from the Swedish National Registry for hip fracture patients, RIKSHÖFT. BMC Musculoskelet Disord 2019; 20: 616.
  • 8. Johansen A, Golding D, Brent L, et al. Using national hip fracture registries and audit databases to develop an international perspective. Injury 2017; 48: 2174‐2179.
  • 9. Sambrook PN, Seeman E, Phillips SR, Ebeling PR. Preventing osteoporosis: outcomes of the Australian Fracture Prevention Summit. Med J Aust 2002; 176 (8 Suppl): S1‐S16. https://www.mja.com.au/journal/2002/176/8/preventing‐osteoporosis‐outcomes‐australian‐fracture‐prevention‐summit
  • 10. Tan AC, Armstrong E, Close J, Harris IA. Data quality audit of a clinical quality registry: a generic framework and case study of the Australian and New Zealand Hip Fracture Registry. BMJ Open Qual 2019; 8: e000490.
  • 11. Harvey L, Harris IA, Mitchell RJ, et al. Improved survival rates after hip fracture surgery in New South Wales, 2011–2018. Med J Aust 2022; 216: 420‐421.
  • 12. Australian and New Zealand Hip Fracture Registry Steering Group. Australian and New Zealand guideline for hip fracture care: improving outcomes in hip fracture management of adults. Sept 2014. https://anzhfr.org/wp‐content/uploads/sites/1164/2021/12/ANZ‐Guideline‐for‐Hip‐Fracture‐Care.pdf (viewed Mar 2022).
  • 13. Baroni M, Serra R, Boccardi V, et al. The orthogeriatric comanagement improves clinical outcomes of hip fracture in older adults. Osteoporos Int 2019; 30: 907‐916.
  • 14. Porter ME. Value‐based health care delivery. Ann Surg 2008; 248: 503‐509.
  • 15. Australian Orthopaedic Association National Joint Replacement Registry. 2019 Annual Report: hip, knee, shoulder arthroplasty, September 1999 – December 2018. 2019. https://aoanjrr.sahmri.com/documents/10180/668596/Hip%2C+Knee+&+Shoulder+Arthroplasty/c287d2a3‐22df‐a3bb‐37a2‐91e6c00bfcf0 (viewed Mar 2022).
  • 16. de Steiger RN, Hang JR, Miller LN, et al. Five‐year results of the ASR XL Acetabular System and the ASR hip resurfacing system: an analysis from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am 2011; 93: 2287‐2293.

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The need for improved Australian data on social determinants of health inequities

Joanne Flavel, Martin McKee, Toby Freeman, Connie Musolino, Helen Eyk, Fisaha H Tesfay and Fran Baum
Med J Aust 2022; 216 (8): . || doi: 10.5694/mja2.51495
Published online: 2 May 2022

Australia needs better data on health inequities to support building back fairer from the pandemic

The coronavirus disease 2019 (COVID‐19) pandemic has shone a light on longstanding inequities in societies.1 Yet, too often, these inequities are effectively invisible,1 and we can only know if we are tackling them if we can measure them. A lack of appropriate data is an important reason why research that has helped our understanding of health inequities is unevenly distributed internationally, with much concentrated in Europe and North America. Although Australia has some leading global centres for population health research, a lack of appropriate data creates a barrier to undertaking such research here. However, the available evidence indicates that socio‐economic health inequities have increased since the 1980s.2

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  • 1 Stretton Institute, University of Adelaide, Adelaide, SA
  • 2 London School of Hygiene and Tropical Medicine, London, UK
  • 3 Institute for Health Transformation, Deakin University, Melbourne, VIC



Acknowledgements: 

This work was supported by a Flinders Foundation Health Seed Grant. The funder had no role in the conduct of any aspect of producing this article.

Competing interests:

No relevant disclosures.

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Emerging evidence for the use of colchicine for secondary prevention of coronary heart disease

Stefan M Nidorf, Jamie Layland, Philip C Robinson, Sanjay Patel, Peter J Psaltis and Peter L Thompson
Med J Aust 2022; 216 (8): . || doi: 10.5694/mja2.51488
Published online: 2 May 2022

Colchicine is an inexpensive new treatment for coronary heart disease that is both safe and effective in select patients

Cardiovascular disease imposes a major burden on Australians and the Australian health care system. Due to campaigns to reduce smoking and the widespread use of effective lipid‐lowering therapy, there has been a significant decline in the death rate from cardiovascular disease over several decades.1 However, nearly 600 000 patients are hospitalised each year with cardiovascular disease, at a cost to the community of over $4 billion in 2018–19.1 Patients with coronary heart disease face an ongoing risk of cardiovascular events even when their lipid‐lowering and antithrombotic therapy is optimal. Thus, to reduce morbidity in these patients, there is a need for doctors to employ additional therapies that are effective, safe, readily available and cost‐efficient for this purpose. In the past decade, increasing evidence has accrued suggesting that there are cardiovascular benefits associated with adding colchicine 0.5 mg daily to lipid‐lowering and antithrombotic therapy for secondary prevention of coronary heart disease.2

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  • 1 Genesis Care, Perth, WA
  • 2 Heart and Vascular Research Institute, Harry Perkins Institute of Medical Research, Perth, WA
  • 3 Monash University, Melbourne, VIC
  • 4 University of Queensland, Brisbane, QLD
  • 5 Royal Brisbane Hospital, Brisbane, QLD
  • 6 Royal Prince Alfred Hospital, Sydney, NSW
  • 7 University of Sydney, Sydney, NSW
  • 8 Royal Adelaide Hospital, Adelaide, SA
  • 9 Vascular Research Centre, Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA
  • 10 Sir Charles Gairdner Hospital, Perth, WA
  • 11 University of Western Australia, Perth, WA



Acknowledgements: 

We have received funding from the Australian Government Department of Health, the National Health and Medical Research Council (GNT0211980, GNT0353669, GNT1088455, GNT1127159, GNT1187193), and the Sir Charles Gairdner Hospital Research Advisory Committee (NM 2014). Open access publishing facilitated by The University of Western Australia, as part of the Wiley ‐ The University of Western Australia agreement via the Council of Australian University Librarians.

Competing interests:

Aspen Pharmacare Australia provided colchicine and matching placebo for the Australian arm of the LoDoCo2 trial.

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The influence of socio‐economic conditions on the epidemiology of COVID‐19 in Australia

Joanne Flavel and Fran Baum
Med J Aust 2022; 216 (7): . || doi: 10.5694/mja2.51470
Published online: 18 April 2022

Supporting people with COVID‐19 should look beyond medical management and take into account their social and economic situation

Coronavirus disease 2019 (COVID‐19) has exposed socio‐economic inequalities in many countries; people living with disadvantage are more susceptible to infection, hospitalisation, and death.1,2 Until recently, COVID‐19 infection and death rates in Australia were relatively low, but the ecological study by Roder and colleagues in this issue of the MJA suggests that social and economic factors also influenced the distribution of infections here.3 A socio‐economic gradient in COVID‐19 cases was predicted early in the pandemic.4,5 Ecological studies provide some evidence of this gradient, and are vital for informing disease prevention policy and clinical practice.

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  • 1 Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA
  • 2 Stretton Institute, University of Adelaide, Adelaide, SA



Competing interests:

No relevant disclosures.

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