Topics

Summary

There has been a global increase in the burden of invasive infections in people who inject drugs (PWID).
It is essential that patient‐centred multidisciplinary care is provided in the management of these infections to engage PWID in care and deliver evidence‐based management and preventive strategies.
The multidisciplinary team should include infectious diseases, addictions medicine (inclusive of alcohol and other drug services), surgery, psychiatry, pain specialists, pharmacy, nursing staff, social work and peer support workers (where available) to help address the comorbid conditions that may have contributed to the patient’s presentation.
PWID have a range of antimicrobial delivery options that can be tailored in a patient‐centred manner and thus are not limited to prolonged hospital admissions to receive intravenous antimicrobials for invasive infections. These options include discharge with outpatient parenteral antimicrobial therapy, long‐acting lipoglycopeptides (dalbavancin and oritavancin) and early oral antimicrobials.
Open and respectful discussion with PWID including around harm reduction strategies may decrease the risk of repeat presentations with injecting‐related harms.

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1 Alfred Health, Melbourne, VIC
2 Monash University, Melbourne, VIC
3 Burnet Institute, Melbourne, VIC
4 La Trobe University, Melbourne, VIC

Correspondence: lucy.attwood@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 authors acknowledge the work of Thuy Bui and Kelly Cairns for their assistance reviewing the pharmacology in this article. The Burnet Institute acknowledges support from the Victorian Government Operational Infrastructure Fund. Lucy Attwood receives postgraduate support from the Australian National Health and Medical Research Council (NHMRC). Joseph Doyle and Andrew Stewardson receive Fellowship support from the NHMRC.

Competing interests:

Peter Higgs has received investigator‐driven research funding from Gilead Sciences and AbbVie for work on hepatitis C unrelated to this manuscript. Martyn Lloyd‐Jones has received honoraria for giving lectures and educational sessions organised by Indivior. Joseph Doyle’s institution has received investigator‐initiated research funding from Gilead Sciences and AbbVie and honoraria from Gilead Sciences and AbbVie.

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Editorials

Doing “deadly” community‐based research during COVID‐19: the Which Way? study

Michelle Kennedy and Hayley Longbottom

Med J Aust 2022; 217 (2): . || doi: 10.5694/mja2.51624
Published online: 18 July 2022

Topics

Indigenous health

Environment and public health

Women's health

An Indigenous‐led study aims to empower and support Aboriginal and Torres Strait Islander women to be smoke‐free

Aboriginal and Torres Strait Islander people have long advocated for a voice on issues that involve them. Aboriginal Community Controlled Health Services are recognised as playing a critical role in mitigating and addressing social and structural determinants of health.1 The Close the Gap campaign report 2022 made recommendations to governments to improve health outcomes, including structural reform, innovation driven by cultural intellect and cultural safety, and empowering communities.2 Real change requires our voice, our rights to sovereignty, self‐determination and agency to transform health systems and beyond, including acknowledging, addressing and mitigating coloniality and systemic racism.

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1 University of Newcastle, Newcastle, NSW
2 Waminda South Coast Women’s Health and Welfare Aboriginal Corporation, Nowra, NSW

Correspondence: michelle.kennedy11@newcastle.edu.au

Acknowledgements:

Michelle Kennedy is funded by NHMRC Early Career Fellowship #1158670. The Which Way? study was funded by National Heart Foundation Aboriginal and Torres Strait Islander Award #102458. The funding source was not involved in the conduct of this research. We acknowledge the partnering services and staff including: Dhanggan Gudjagang team, Yerin Eleanor Duncan Aboriginal Health Centre, Tamworth Aboriginal Medical Centre, Nunyara Aboriginal Health Unit and Waminda South Coast Women’s Health and Welfare Aboriginal Corporation for their time and commitment to this long term project.

Competing interests:

No relevant disclosures.

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2. Lowitja Institute. Close the Gap campaign report 2022 – Transforming power: voices for generational change. Lowitja Institute, 2022. https://www.lowitja.org.au/page/services/resources/Cultural‐and‐social‐determinants/culture‐for‐health‐and‐wellbeing/close‐the‐gap‐campaign‐report‐2022‐‐‐transforming‐power‐voices‐for‐generational‐change (viewed Jan 2022).
3. Smith LT. Decolonizing methodologies: research and Indigenous peoples. London: Zed Books, 1999.
4. Maddox R, Thurber KA, Calma T, et al. Deadly news: the downward trend continues in Aboriginal and Torres Strait Islander smoking 2004–2019. Aust N Z J Public Health 2020; 44: 449‐450.
5. Kennedy M, Barrett E, Heris C, et al. Smoking and quitting characteristics of Aboriginal and Torres Strait Islander women of reproductive age: findings from the Which Way? study. Med J Aust 2022; 217: S6‐S18.
6. Kennedy M, Heris C, Barrett E, et al. Smoking cessation support strategies of interest to Aboriginal and Torres Strait Islander women of reproductive age: findings from the Which Way? study. Med J Aust 2022; 217: S19‐S26.
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9. Walter M, Andersen C. Indigenous statistics: a quantitative research methodology. New York: Routledge, 2013.

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Medical education
Lessons from practice

Cutaneous manifestations of COVID‐19: diagnosis and management

Nicole Seebacher, Julie Kirkham and Saxon D Smith

Med J Aust 2022; 217 (2): . || doi: 10.5694/mja2.51621
Published online: 18 July 2022

Topics

Infectious diseases

Health occupations

A 48‐year‐old female health care worker of European descent, who was otherwise well and on no regular medications, developed cough symptoms the day before testing positive for coronavirus disease 2019 (COVID‐19). Five days after after symptom onset, she developed rhinorrhoea followed by loss of taste and smell (anosmia and ageusia). On day 7, she developed headaches, palpations, subjective fevers and an eruption on the dorsum of her hands; on day 8, the eruption became pruritic and had spread to her elbows, the dorsum of her feet, and chest (Box 1). The pruritus was successfully treated with an oral antihistamine on the advice of a dermatologist after topical moisturiser failed. The rash completely resolved by day 12 without further management, while other influenza‐like symptoms remained. The loss of taste and smell persisted for ten weeks.

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1 University of Oxford, Oxford, UK
2 St James’s Hospital, Dublin, Ireland
3 Australian National University, Canberra, ACT

Correspondence: nicole.seebacher@conted.ox.ac.uk

Competing interests:

No relevant disclosures.

1. Guan WJ, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708‐1720.
2. Jia JL, Kamceva M, Rao SA, Linos E. Cutaneous manifestations of COVID‐19: a preliminary review. J Am Acad Dermatol 2020; 83: 687‐690.
3. Jamshidi P, Hajikhani B, Mirsaeidi, M, et al. Skin manifestations in COVID‐19 patients: are they indicators for disease severity? A systematic review. Front Med (Lausanne) 2021; 8: 634208.
4. Galván Casas C, Català A, Carretero Hernández G, et al. Classification of the cutaneous manifestations of COVID‐19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol 2020; 183: 71‐77.
5. Sharma S, Raby E, Kumarasinghe SP. Cutaneous manifestations and dermatological sequelae of Covid‐19 infection compared to those from other viruses. Australas J Dermatol 2021; 62: 141‐150.
6. Visconti A, Bataille V, Rossi N, et al. Diagnostic value of cutaneous manifestation of SARS‐CoV‐2 infection. Br J Dermatol 2021; 184: 880‐887.
7. Freeman EE, McMahon DE, Hruza GJ, et al. Timing of PCR and antibody testing in patients with COVID‐19‐associated dermatologic manifestations. J Am Acad Dermatol 2021; 84: 505‐507.
8. Cevik M, Tate M, Lloyd O, et al. SARS‐CoV‐2, SARS‐CoV, and MERS‐CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta‐analysis. Lancet Microbe 2021; 2: e13‐e22.
9. Sanders JM, Monogue ML, Jodlowski TZ, et al. Pharmacologic treatments for coronavirus disease 2019 (COVID‐19): a review. JAMA 2020; 323: 1824‐1836.
10. Genovese G, Moltrasio C, Berti E, Marzano AV. Skin manifestations associated with COVID‐19: current knowledge and future perspectives. Dermatology 2021; 237: 1‐12.
11. Martinez‐Lopez A, Cuenca‐Barrales C, Montero‐Vilchez T, et al. Review of adverse cutaneous reactions of pharmacologic interventions for COVID‐19: a guide for the dermatologist. J Am Acad Dermatol 2020; 83: 1738‐1748.
12. Türsen Ü, Türsen B, Lotti T. Cutaneous side‐effects of the potential COVID‐19 drugs. Dermatol Ther 2020; 33: e13476.

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Narrative review

Interrogating the intentions for Aboriginal and Torres Strait Islander health: a narrative review of research outputs since the introduction of Closing the Gap

Michelle Kennedy, Jessica Bennett, Sian Maidment, Catherine Chamberlain, Kate Booth, Romany McGuffog, Bree Hobden, Lisa J Whop and Jamie Bryant

Med J Aust 2022; 217 (1): . || doi: 10.5694/mja2.51601
Published online: 4 July 2022

Topics

Indigenous health

Information science

Statistics, epidemiology and research design

Summary

Despite the “best of intentions”, Australia has fallen short of federal targets to close the gap in disproportionate health outcomes between Aboriginal and non‐Aboriginal Australians.
We examined 2150 original research articles published over the 12‐year period (from 2008 to 2020), of which 58% used descriptive designs and only 2.6% were randomised controlled trials. There were few national studies. Studies were most commonly conducted in remote settings (28.8%) and focused on specific burdens of disease prevalent in remote areas, such as infectious disease, hearing and vision. Analytic observational designs were used more frequently when addressing burdens of disease, such as cancer and kidney and urinary, respiratory and endocrine diseases.
The largest number of publications focused on mental and substance use disorders (n = 322, 20.5%); infectious diseases (n = 222, 14.1%); health services planning, delivery and improvement (n = 193, 33.5%); and health and wellbeing (n = 170, 29.5%).
This review is timely given new investments in Aboriginal health, which highlights the importance of Aboriginal researchers, community leadership and research priority. We anticipate future outputs for Aboriginal health research to change significantly from this review, and join calls for a broadening of our intellectual investment in Aboriginal health.

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1 University of Newcastle, Newcastle, NSW
2 Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
3 Centre for Health Equity, University of Melbourne, Melbourne, VIC
4 Judith Lumley Centre, La Trobe University, Melbourne, VIC
5 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT

Correspondence: michelle.kennedy11@newcastle.edu.au

Open access

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

Acknowledgements:

Michelle Kennedy is funded by the National Health and Medical Research Council (NHMRC) Early Career Researcher (ECR) Grant (#1158670). Catherine Chamberlain receives an NHMRC Career Development Fellowship (#1161065). Lisa Whop is funded by an NHMRC ECR Grant (#1142035). Bree Hobden is supported by an Australian Rotary Health Colin Dodds Postdoctoral Fellowship (#1801108). Jamie Bryant holds an NHMRC–Australian Research Council Dementia Research Development Fellowship (#APP1105809). This project did not receive funding.

Competing interests:

No relevant disclosures.

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10. Russell LM. Reports indicate that changes are needed to close the gap for Indigenous health. Med J Aust 2013; 199: 737‐738. https://www.mja.com.au/journal/2013/199/11/reports‐indicate‐changes‐are‐needed‐close‐gap‐indigenous‐health
11. Australian Human Rights Commission. Indigenous health funding not enough to Close the Gap [news]. 11 May 2017. https://humanrights.gov.au/about/news/indigenous‐health‐funding‐not‐enough‐close‐gap (viewed Aug 2021).
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13. National Indigenous Australians Agency. Closing the Gap — Prime Minister’s Report 2018. Canberra: Commonwealth of Australia, 2018. https://www.niaa.gov.au/resource‐centre/indigenous‐affairs/closing‐gap‐prime‐ministers‐report‐2018 (viewed Aug 2021).
14. Eades SJ, Taylor B, Bailey S, et al. The health of urban Aboriginal people: insufficient data to close the gap. Med J Aust 2010; 193: 521‐524. https://www.mja.com.au/journal/2010/193/9/health‐urban‐aboriginal‐people‐insufficient‐data‐close‐gap
15. de la Barra SL, Redman S, Eades S. Health research policy: a case study of policy change in Aboriginal and Torres Strait Islander health research. Aust New Zealand Health Policy 2009; 6: 2.
16. Closing the Gap in Partnership. National Agreement of Closing the Gap, July 2020. Commonwealth of Australia, 2020. https://www.closingthegap.gov.au/national‐agreement/national‐agreement‐closing‐the‐gap (viewed July 2021).
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18. Kinchin I, McCalman J, Bainbridge R, et al. Does Indigenous health research have impact? A systematic review of reviews. Int J Equity Health 2017; 16: 52.
19. Jennings W, Spurling G, Shannon B, et al. Rapid review of five years of Aboriginal and Torres Strait Islander health research in Australia – persisting under‐representation of urban populations. Aust N Z J Public Health 2021; 45: 53‐58.
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21. Australian Institute of Health and Welfare. Rural and remote health [Cat. No. PHE 255]. Canberra: AIHW, 2020. https://www.aihw.gov.au/reports/rural‐remote‐australians/rural‐remote‐health/contents/health‐status‐and‐outcomes (viewed Sept 2021).
22. Centre for Evidence‐Based Medicine. Study designs [website]. University of Oxford, 2021. https://www.cebm.ox.ac.uk/resources/ebm‐tools/study‐designs (viewed July 2021).
23. Griffin B, Watts K, Kimble R, et al. Incidence and characteristics of low‐speed vehicle run‐over events in Australian Aboriginal and/or Torres Strait Islander Children and other Australian children aged 0 to 14 years in Queensland: an 11‐year (1999–2009) retrospective analysis. Compr Child Adolesc Nurs 2018; 41: 165‐180.
24. Australian Institute of Health and Welfare. Australian Burden of Disease Study: methods and supplementary material 2015 [Cat. No. BOD 23]. Canberra: AIHW, 2019. https://www.aihw.gov.au/reports/burden‐of‐disease/australian‐burden‐disease‐study‐methods‐2015/summary (viewed Aug 2021).
25. Harper L, Kalfa N, Beckers GMA, et al. The impact of COVID‐19 on research. J Pediatr Urol 2020; 16: 715‐716.
26. Finlay S, Keed V, Kelly D, et al. Aboriginal Human Research Ethics Committees ensuring culturally appropriate research. Eur J Public Health 2020; 30 (Suppl): v593.
27. Bradley C, Hengel B, Crawford K, et al. Establishment of a sentinel surveillance network for sexually transmissible infections and blood borne viruses in Aboriginal primary care services across Australia: the ATLAS project. BMC Health Serv Res 2020; 20: 769.
28. Bond CJ, Singh D. More than a refresh required for closing the gap of Indigenous health inequality. Med J Aust 2020; 212: 198‐199. https://www.mja.com.au/journal/2020/212/5/more‐refresh‐required‐closing‐gap‐indigenous‐health‐inequality
29. Australian Institute of Health and Welfare. Profile of Indigenous Australians [website]. Canberra: AIHW, 2019. https://www.aihw.gov.au/reports/australias‐welfare/profile‐of‐indigenous‐australians (viewed Sept 2021).
30. National Health and Medical Research Council. Road Map 3: a strategic framework for improving Aboriginal and Torres Strait Islander health through research. Canberra: NHMRC, 2018. https://www.nhmrc.gov.au/about‐us/publications/road‐map‐3‐strategic‐framework (viewed July 2021).
31. Australian Institute of Health and Welfare. Eye health in Aboriginal and Torres Strait Islander people [Cat. No. IHW 49]. Canberra: AIHW, 2011. https://www.aihw.gov.au/reports/indigenous‐australians/eye‐health‐in‐aboriginal‐and‐torres‐strait‐islande/contents/table‐of‐contents (viewed Aug 2021).
32. Flint SM, Davis JS, Su JY, et al. Disproportionate impact of pandemic (H1N1) 2009 influenza on Indigenous people in the Top End of Australia’s Northern Territory. Med J Aust 2010; 192: 617‐622. https://www.mja.com.au/journal/2010/192/10/disproportionate‐impact‐pandemic‐h1n1‐2009‐influenza‐indigenous‐people‐top‐end#:~:text=In%20conclusion%2C%20pandemic%20(H1N1),of%20comorbidities%20in%20this%20population
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34. Bond CJ, Whop LJ, Singh D, Kajlich H. “Now we say Black Lives Matter but … the fact of the matter is, we just Black matter to them”. Med J Aust 2020; 213: 248‐250. https://www.mja.com.au/journal/2020/213/6/now‐we‐say‐black‐lives‐matter‐fact‐matter‐we‐just‐black‐matter‐them1
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Perspectives

Climate, housing, energy and Indigenous health: a call to action

Simon Quilty, Norman Frank Jupurrurla, Ross S Bailie and Russell L Gruen

Med J Aust 2022; 217 (1): . || doi: 10.5694/mja2.51610
Published online: 4 July 2022

Topics

Indigenous health

Social determinants of health

Environment and public health

The convergence of excessive heat, poor housing, energy insecurity and chronic disease has reached critical levels

Most Australians take safe housing and uninterrupted electricity for granted. Yet in remote Indigenous communities, low quality poorly insulated housing and energy instability are common.1 Most houses require prepaid power cards, resources are meagre, financial literacy is low, and people often have to choose between power and food. New evidence reveals extreme rates of prepaid electricity meters’ disconnection in these communities,2 making people with chronic diseases who depend on cool storage and electrical equipment particularly vulnerable. The convergence of excessive heat, poor housing, energy insecurity and chronic disease has reached critical levels in many parts of northern Australia, and a multisectoral response is needed to avert catastrophe. Medical professionals have a key role to play.

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1 Australian National University, Canberra, ACT
2 Julalikari Council Aboriginal Corporation, Tennant, Creek, NT
3 University Centre for Rural Health, Lismore, NSW

Correspondence: simon.quilty@anu.edu.au

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.

Acknowledgements:

We thank Pandora Hope (Bureau of Meteorology) for her work on the climate maps.

Competing interests:

No relevant disclosures.

1. Lea T, Grealy L, Moskos M, et al. Sustainable Indigenous housing in regional and remote Australia — final report No. 368. Melbourne: Australian Housing and Urban Research Institute, 2021. https://www.ahuri.edu.au/research/final‐reports/368 (viewed Oct 2021).
2. Longden T, Quilty S, Riley B, et al. Energy insecurity during temperature extremes in remote Australia. Nature Energy 2022; 7: 43‐54.
3. Bureau of Meteorology. Annual Climate Summary for Northern Territory — Northern Territory in 2019: a very warm and dry year [9 Jan 2020]. http://www.bom.gov.au/climate/current/annual/nt/archive/2019.summary.shtml (viewed Oct 2021).
4. Abram M, Garrick M. Outback town smashes temperature records with 28 days above 40°C in one month. ABC News 2018; 27 Dec. https://www.abc.net.au/news/2018‐12‐27/bureau‐of‐meteorology‐says‐heat‐records‐broken‐in‐outback/10670438 (viewed Oct 2021).
5. Alice has hottest day on record. Alice Springs News 2018; 31 Dec. https://alicespringsnews.com.au/2018/12/31/alice‐has‐hottest‐day‐on‐record/ (viewed Oct 2021).
6. Layton JB, Li W, Yuan J, et al. Heatwaves, medications, and heat‐related hospitalization in older Medicare beneficiaries with chronic conditions. PLoS One 2020; 15: e0243665.
7. Gasparrini A, Armstrong B, Kovats S, Wilkinson P. The effect of high temperatures on cause‐specific mortality in England and Wales. Occup Environ Med 2012; 69: 56‐61.
8. Foster T, Hall NL. Housing conditions and health in Indigenous Australian communities: current status and recent trends. Int J Environ Health Res 2019; 31: 325‐343.
9. Bailie N, Main N. Environmental health survey year 2 evaluation. Indigenous housing authority of the Northern Territory. Casuarina: Cooperative Research Centre for Aboriginal and Tropical Health, 2002.
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16. Gruen RL. Evidence‐based advocacy: the public roles of health care professionals. Med J Aust 2008; 188: 684‐685. https://www.mja.com.au/journal/2008/188/12/evidence‐based‐advocacy‐public‐roles‐health‐care‐professionals
17. Evans EJ. The no‐wrong‐door approach: antidote to boundaries within the American welfare state. Health Soc Work 2019; 44: 8‐12.

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Perspectives

Birthing on Country for the best start in life: returning childbirth services to Yolŋu mothers, babies and communities in North East Arnhem, Northern Territory

Sarah Ireland, Yvette Roe, Suzanne Moore, Elaine Ḻäwurrpa Maypilama, Dorothy Yuŋgirrŋa Bukulatjpi, Evelyn Djota Bukulatjpi and Sue Kildea

Med J Aust 2022; 217 (1): . || doi: 10.5694/mja2.51586
Published online: 4 July 2022

Topics

Health occupations

Women's health

General medicine

First Nations Yolŋu women are speaking up to reclaim control and return of childbirth services

Over the millennia, First Nations women across Australia have given birth on their Country, supported by family and cultural caring practices, until recent disruption from European colonisation.1 Today, First Nations women, babies and families experience profound health inequities when comparing health outcomes to their Australian counterparts. A disproportionate number of First Nations women experience adverse outcomes in pregnancy and birth. For the past ten years, there has been little or no improvement in perinatal indicators. Maternal death for First Nations mothers is 3.7 times higher than for other Australian women,2 and perinatal deaths, largely driven by complications of pregnancy, are twice as high, although slightly improved between 2008 and 2018.3

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1 Molly Wardaguga Research Centre, Charles Darwin University, Darwin, NT
2 Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, QLD
3 Yalu Aboriginal Corporation, Galiwin'ku, NT

Correspondence: sarah.ireland@cdu.edu.au

Open access

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

Acknowledgements:

Our work was supported by the Birthing on Country Centre for Research Excellence at the Molly Wardaguga Research Centre, Charles Darwin University (APP 1197110), a Lowitja Institute Seeding Grant (20‐SG‐12), and Yalu Aboriginal Corporation. Funding contributed to researcher salaries and costs associated with traveling to and hosting the regional workshop. We acknowledge Raisa Brozalevskaia from Charles Darwin University and Alice McCarthy from Yalu Aboriginal Corporation for their dedication and support of Yolŋu researchers.

Competing interests:

No relevant disclosures.

1. Ireland S, Maypilama EL, Roe Y, et al. Caring for Mum on Country: exploring the transferability of the Birthing on Country RISE framework in a remote multilingual Northern Australian context. Women Birth 2020; 34: 487‐492.
2. Australian Institute of Health and Welfare. Maternal deaths in Australia 2009–2018. Canberra: Australian Institute of Health and Welfare, 2020. https://www.aihw.gov.au/reports/mothers‐babies/maternal‐deaths‐in‐australia/contents/maternal‐deaths‐in‐australia (viewed Dec 2021).
3. Commonwealth of Australia. Closing the Gap report 2020. Canberra: Australian Government, 2020. https://ctgreport.niaa.gov.au/ (viewed Dec 2021).
4. Msall ME, Sobotka SA, Dmowska A, et al. Life course health development outcomes after prematurity: developing a community, clinical, and translational research agenda to optimize health, behaviour, and functioning. In: Halfon N, Forrest CB, Lerner RM, Faustman EM, editors. Handbook of life course health development. Cham: Springer International Publishing, 2018: pp. 321‐348. https://doi.org/10.1007/978‐3‐319‐47143‐3_14 (viewed Oct 2020).
5. Li L, O’Neil L. Mothers and babies 2017: Northern Territory Midwives’ Collection. Darwin: Department of Health, 2020. https://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/11647/1/Mothers%20and%20Babies%20Report_2017.pdf (viewed Dec 2021).
6. Longman J, Kornelsen J, Pilcher J, et al. Maternity services for rural and remote Australia: barriers to operationalising national policy. Health Policy 2017; 121: 1161‐1168.
7. Rolfe MI, Donoghue DA, Longman JM, et al. The distribution of maternity services across rural and remote Australia: does it reflect population need? BMC Health Serv Res 2017; 17: 163.
8. Barclay L, Kornelsen J, Longman J, et al. Reconceptualising risk: Perceptions of risk in rural and remote maternity service planning. Midwifery 2016; 38: 63‐70.
9. Kildea S, McGhie AC, Gao Y, et al. Babies born before arrival to hospital and maternity unit closures in Queensland and Australia. Women Birth 2015; 28: 236‐245.
10. Maypilama L, Josse P, Ireland S. Djäkamirr: caretaker of pregnancy and birth [documentary film]. ONE20 Productions, 2021. https://www.birthingoncountry.com/djakamirr (viewed Dec 2021).
11. Kildea S, Lockey R, Roberts J, et al. Guiding principles for developing a Birthing on Country service model and evaluation framework, phase 1. Brisbane: Mater Medical Research Unit and the University of Queensland on behalf of the Maternity Services Inter‐Jurisdictional Committee for the Australian Health Ministers’ Advisory Council, 2016. https://www.researchgate.net/publication/309584016_Guiding_Principles_for_Developing_a_Birthing_on_Country_Service_Model_and_Evaluation_Framework_Phase_1 (viewed July 2021).
12. Kildea S, Gao Y, Hickey S, et al. Effect of a Birthing on Country service redesign on maternal and neonatal health outcomes for First Nations Australians: a prospective, non‐randomised, interventional trial. Lancet Glob Health 2021; 9: e651‐e659.
13. Kildea S, Hickey S, Barclay L, et al. Implementing Birthing on Country services for Aboriginal and Torres Strait Islander families: RISE framework. Women Birth 2019; 32: 466‐475.
14. Roberts L. NT Health Minister Natasha Fyles on returning birthing to remote and regional locations. ABC News 2021; 3 June. https://www.abc.net.au/news/health/2021‐06‐03/health‐nt‐health‐minister‐commits‐to‐birthing‐on‐country/100180990 (viewed May 2022).
15. Molly Wardaguga Research Centre. To be born upon a pandanus mat. https://www.birthingoncountry.com/to‐be‐born‐upon‐a‐pandanus‐mat (viewed May 2022).
16. Charles Darwin University. Molly Wardaguga Research Centre secures $5 million to support First Nations maternal health. 6 Apr 2022. https://www.cdu.edu.au/news/molly‐wardaguga‐research‐centre‐secures‐5‐million‐support‐first‐nations‐maternal‐health (viewed May 2022).
17. Kildea S, Gao Y, Hickey S, et al. Reducing preterm birth amongst Aboriginal and Torres Strait Islander babies: a prospective cohort study, Brisbane, Australia. EClinicalMedicine 2019; 12: 43‐51.

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Narrative review

Management of atopic dermatitis: a narrative review

Michelle SY Goh, Jenny SW Yun and John C Su

Med J Aust 2022; 216 (11): . || doi: 10.5694/mja2.51560
Published online: 20 June 2022

Topics

Skin and connective tissue diseases

Summary

Atopic dermatitis (atopic eczema) is the most common inflammatory skin disease and has a significant burden on the quality of life of patients, families and caregivers.
Its pathogenesis is a complex interplay between genetics and environment, involving impaired skin barrier function, immune dysregulation primarily involving the Th2 inflammatory pathway, itch, and skin microbiome.
Restoration of skin barrier integrity with regular emollients and prompt topical anti‐inflammatory therapies are mainstays of treatment. Systemic therapy is considered for moderate to severe disease.
New understanding of inflammatory pathways and developments in targeted systemic immunotherapies have significantly advanced atopic dermatitis management. Dupilumab is a safe and effective treatment that is now available in Australia. Other promising agents for atopic dermatitis include Janus kinase, interleukin (IL)‐13 and IL‐31 inhibitors.

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1 Peter MacCallum Cancer Centre, Melbourne, VIC
2 St Vincent’s Hospital Melbourne, Melbourne, VIC
3 Royal Melbourne Hospital, Melbourne, VIC
4 Eastern Health, Monash University, Melbourne, VIC
5 Murdoch Children’s Research Institute, Melbourne, VIC

Correspondence: michelle.goh@petermac.org

Competing interests:

John Su has been a consultant/speaker/investigator for AbbVie, Amgen, Bioderma, Bristol Myers Squibb, Ego Pharmaceuticals, Eli‐Lilly, Janssen, LEO Pharma, L’Oreal, Mayne, Novartis, Pfizer, Pierre‐Fabre, and Sanofi.

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43. Siegfried EC, Jaworski JC, Kaiser JD, et al. Systematic review of published trials: long‐term safety of topical corticosteroids and topical calcineurin inhibitors in pediatric patients with atopic dermatitis. BMC Pediatrics 2016; 16: 75.
44. Martins JC, Martins C, Aoki V, et al. Topical tacrolimus for atopic dermatitis. Cochrane Database Syst Rev 2015; (7): CD009864.
45. Schlessinger J, Shepard JS, Gower R, et al. Safety, effectiveness, and pharmacokinetics of crisaborole in infants aged 3 to < 24 months with mild‐to‐moderate atopic dermatitis: a phase IV open‐label study (CrisADe CARE 1). Am J Clin Dermatol 2020; 21: 272‐284.
46. Sidbury R, Davis DM, Cohen DE, et al. Guidelines of care for the management of atopic dermatitis. Section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol 2014; 71: 327‐349.
47. Majewski S, Bhattacharya T, Asztalos M, et al. Sodium hypochlorite body wash in the management of Staphylococcus aureus‐colonized moderate‐to‐severe atopic dermatitis in infants, children, and adolescents. Pediatr Dermatol 2019; 36: 442‐447.
48. Matterne U, Böhmer MM, Weisshar E, et al. Oral H1 antihistamines as ‘add‐on’ therapy to topical treatment for eczema. Cochrane Database Syst Rev 2019; (1): CD012167.
49. Fitzsimons R, van der Poel L, Thronhill W, et al. Antihistamine use in children. Arch Dis Child Educ Pract Ed 2015; 100: 122‐131.
50. Sawangjit R, Dilokthornsakul P, Lloyd‐Lavery A, et al. Systemic treatments for eczema: a network meta‐analysis. Cochrane Database Syst Rev 2020; (9): CD013206.
51. Halling A, Loft N, Silverberg JI, et al. Real‐world evidence of dupilumab efficacy and risk of adverse events: A systematic review and meta‐analysis. J Am Acad Dermatol 2021; 84: 139‐147.
52. Eichenfield LF, Bieber T, Beck LA, et al. Infections in Dupilumab clinical trials in atopic dermatitis: A Comprehensive Pooled Analysis. Am J Clin Dermatol 2019; 20: 443‐456.
53. Drucker AM, Eyerich K, de Bruin‐Weller MS, et al. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement. Br J Dermatol 2018; 178: 768‐775.
54. Rademaker M, Agnew K, Andrews M, et al. Managing atopic dermatitis with systemic therapies in adults and adolescents: An Australian/New Zealand narrative. Australas J Dermatol 2020; 61: 9‐22.
55. Siegels D, Heratizadeh A, Abraham S, et al. Systemic treatments in the management of atopic dermatitis: a systematic review and meta‐analysis. Allergy 2020; 76: 1053‐1076.
56. Chapman S, Kwa M, Gold LS, Lim HW. Janus kinase inhibitors in dermatology: Part I. A comprehensive review. J Am Acad Dermatol 2022; 86: 406‐413.

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Research letters

Effect of a financial incentive on responses by Australian general practitioners to a postal survey: a randomised controlled trial

Alison C Zucca, Mariko Carey, Rob W Sanson‐Fisher, Joel Rhee, Balakrishnan (Kichu) R Nair, Christopher Oldmeadow, Tiffany‐Jane Evans and Simon Chiu

Med J Aust 2022; 216 (11): . || doi: 10.5694/mja2.51523
Published online: 20 June 2022

Topics

Statistics, epidemiology and research design

General medicine

General practitioners view health and medical research positively, but their participation in postal surveys is typically low.1 Poor response rates reduce the sample size and consequently the generalisability of survey results.

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1 College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW
2 Hunter Medical Research Institute (HMRI), Newcastle, NSW
3 University of Wollongong, Wollongong, NSW
4 Illawarra Health and Medical Research Institute, Wollongong, NSW

Correspondence: alison.zucca@newcastle.edu.au

Trial registration

Open Science Framework, doi: 10.17605/OSF.IO/VZMWJ; 30 September 2021 (retrospective).

Open access

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

Acknowledgements:

This study was supported by the National Health and Medical Research Council (NHMRC) with a Dementia Research Team grant (APP1095078) and by infrastructure funding from the Hunter Medical Research Institute. Mariko Carey is supported by an NHMRC Boosting Dementia Research Leadership Fellowship (APP1136168). We acknowledge Grace Norton for research assistance and^, Sandra Dowley for data entry (both University of Newcastle and Hunter Medical Research Institute), and Lucy Leigh for statistical analysis (Hunter Medical Research Institute).

Competing interests:

No relevant disclosures.

1. Cook JV, Dickinson HO, Eccles MP. Response rates in postal surveys of healthcare professionals between 1996 and 2005: an observational study. BMC Health Serv Res 2009; 9: 160.
2. Parkinson A, Jorm L, Douglas KA, et al. Recruiting general practitioners for surveys: reflections on the difficulties and some lessons learned. Aust J Prim Health 2015; 21: 254‐258.
3. Carey M, Zucca A, Rhee, J, et al. Essential components of health assessment for older people in primary care: a cross‐sectional survey of Australian general practitioners. Aust N Z J Public Health 2021; 45: 506‐511.
4. Pit SW, Vo T, Pyakurel S. The effectiveness of recruitment strategies on general practitioner’s survey response rates: a systematic review. BMC Med Res Methodol 2014; 14: 76.
5. Edwards PJ, Roberts I, Clarke MJ, et al. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev 2009; 2009:MR000008.
6. Campbell MK, Weijer C, Goldstein CE, Edwards SJ. Do doctors have a duty to take part in pragmatic randomised trials? BMJ 2017; 357: j2817.

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Editorials

Beyond rural clinical schools to “by rural, in rural, for rural”: immersive community engaged rural education and training pathways

Roger P Strasser

Med J Aust 2022; 216 (11): . || doi: 10.5694/mja2.51525
Published online: 20 June 2022

Topics

Medical education

General medicine

Health services administration

Cradle‐to‐grave regional programs featuring immersive community engaged education are needed to ensure a sustainable rural medical workforce

In this issue of the MJA, Seal and colleagues1 report a multi‐university investigation that found that extended rural clinical school (RCS) placements have a positive impact on rural workforce recruitment and the retention of both rural and metropolitan origin medical graduates. The authors examined the practice locations of medical graduates, as listed in the Australian Health Practitioner Regulation Agency (AHPRA) register, five and eight years after graduation; many doctors were probably still registrars in training locations five years after graduation. The authors considered a limited range of variables in their study, and did not adjust their analyses for registrars who had received bonded or other scholarships, nor for factors such as incentives to relocate and employment opportunities for partners. Nevertheless, there is merit in their conclusion that their “findings reinforce the importance of longitudinal rural and regional training pathways, and the role of RCSs, regional training hubs, and the rural generalist training program in coordinating these initiatives.”1

1 Northern Ontario School of Medicine University, Sudbury, ON, Canada
2 Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand

Correspondence: roger.strasser@nosm.ca

Competing interests:

No relevant disclosures.

1. Seal AN, Playford D, McGrail MR, et al. Influence of rural clinical school experience and rural origin on practising in rural communities five and eight years after graduation. Med J Aust 2022; 216: 572‐577.
2. Australian Department of Health. National medical workforce strategy 2021–2031. 2021. https://www.health.gov.au/resources/publications/national‐medical‐workforce‐strategy‐2021‐2031 (viewed Apr 2022).
3. Strasser R. Will Australia have a fit‐for‐purpose medical workforce in 2025? Med J Aust 2018; 208: 198‐199. https://www.mja.com.au/journal/2018/208/5/will‐australia‐have‐fit‐purpose‐medical‐workforce‐2025
4. Strasser R, Strasser S. Reimagining primary health care workforce in rural and underserved settings [discussion paper: Health, Nutrition, and Population Global Practice of the World Bank]. Aug 2020. https://openknowledge.worldbank.org/handle/10986/34906 (viewed Apr 2022).
5. Strasser R. Immersive community engaged education: more community engaged learning than work‐integrated learning. In: Pretti J, Stirling A (ed). The practice of co‐op and work‐integrated learning in the Canadian context. Canada: World Association for Co‐op and Work‐Integrated Education (WACE), Co‐operative Education and Work‐Integrated Learning (CEWIL), 2021; pp. 72‐81.
6. Worley P, Couper I, Strasser R, et al; CLIC Research Collaborative. A typology of longitudinal integrated clerkships. Med Educ 2016; 50: 922‐932.
7. Strasser R. Students learning medicine in general practice in Canada and Australia. Aust Fam Physician 2016; 45: 22‐25.
8. Strasser R, Worley P, Cristobal F, et al. Putting communities in the driver’s seat: the realities of community engaged medical education. Acad Med 2015; 90: 1466‐1470.
9. Strasser R. Recruiting and retaining a rural medical workforce: the value of active community participation. Med J Aust 2017; 207: 154‐158. https://www.mja.com.au/journal/2017/207/4/recruiting‐and‐retaining‐rural‐medical‐workforce‐value‐active‐community
10. Abelsen B, Strasser R, Heaney D, et al. Plan, recruit, retain: a framework for local healthcare organizations to achieve a stable remote rural workforce. Hum Res Health 2020; 18: 63.

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Research

Selective personality‐targeted prevention of suicidal ideation in young adolescents: post hoc analysis of data collected in a cluster randomised controlled trial

Lucinda R Grummitt, Jennifer Debenham, Erin Kelly, Emma L Barrett, Katrina Champion, Patricia Conrod, Maree Teesson and Nicola Newton

Med J Aust 2022; 216 (10): . || doi: 10.5694/mja2.51536
Published online: 6 June 2022

Topics

Mental disorders

General medicine

Abstract

Objective: To assess the efficacy of a selective, personality‐targeted intervention for reducing suicidal ideation in adolescents.

Design: Post hoc analysis of survey data collected in the Climate and Preventure (CAP) study, a cluster randomised controlled trial that compared strategies for reducing alcohol misuse by adolescents, 2012–2015.

Setting, participants: Year 8 students at 16 New South Wales non‐government schools and one Victorian non‐government school.

Intervention: Preventure, a selective, personality‐targeted intervention designed to help adolescents with personality risk factors for alcohol misuse, comprising two 90‐minute sessions, one week apart. For our post hoc analysis, we combined data from the two CAP trial groups in which Preventure was offered (the Preventure and the Preventure/Climate Schools [a non‐selective prevention strategy] groups) as the intervention group; and data from the two groups in which Preventure was not offered (usual health education only [control] and Climate Schools groups) as the control group.

Main outcome measure: Difference between post hoc control and intervention groups in the change in proportions of students reporting suicidal ideation during the preceding six months (single item of Brief Symptom Inventory depression subscale) over three years.

Results: A total of 1636 students (mean age at baseline, 13.3 years; standard deviation, 0.5 years) were included in our analysis, of whom 1087 (66%) completed the suicidal ideation item in the three‐year follow‐up assessment. The post hoc control group included 755 students (nine schools), the intervention group 881 students (eight schools). After adjusting for nesting of students in schools and sex, reporting of suicidal ideation by students who had received Preventure had declined over three years, compared with the control group (per year: adjusted odds ratio, 0.80; 95% CI, 0.66–0.97).

Conclusion: Personality‐targeted selective prevention during early secondary school can have a lasting impact on suicidal ideation during adolescence.

Trial registration (CAP study only): Australian and New Zealand Clinical Trials Registry, ACTRN12612000026820 (prospective).

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1 The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW
2 University of Montreal, Montreal, Canada
3 Sainte Justine Hospital Research Centre, University of Montreal, Montreal, Canada

Correspondence: lucinda.grummitt@sydney.edu.au

Acknowledgements:

The Climate and Preventure (CAP) study was funded by the National Health and Medical Research Council (APP1004744). We acknowledge the schools, students, teachers, and research assistants who were involved in the study. We also acknowledge the assistance of the New South Wales Department of Education and Communities for access to their schools (reference, SERAP 2011201).

Competing interests:

No relevant disclosures.

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Effect of a financial incentive on responses by Australian general practitioners to a postal survey: a randomised controlled trial

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Beyond rural clinical schools to “by rural, in rural, for rural”: immersive community engaged rural education and training pathways

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Selective personality‐targeted prevention of suicidal ideation in young adolescents: post hoc analysis of data collected in a cluster randomised controlled trial

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Review of management priorities for invasive infections in people who inject drugs: highlighting the need for patient‐centred multidisciplinary care

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Summary

Doing “deadly” community‐based research during COVID‐19: the Which Way? study

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Cutaneous manifestations of COVID‐19: diagnosis and management

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Interrogating the intentions for Aboriginal and Torres Strait Islander health: a narrative review of research outputs since the introduction of Closing the Gap

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Climate, housing, energy and Indigenous health: a call to action

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Birthing on Country for the best start in life: returning childbirth services to Yolŋu mothers, babies and communities in North East Arnhem, Northern Territory

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Management of atopic dermatitis: a narrative review

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Effect of a financial incentive on responses by Australian general practitioners to a postal survey: a randomised controlled trial

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Beyond rural clinical schools to “by rural, in rural, for rural”: immersive community engaged rural education and training pathways

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Selective personality‐targeted prevention of suicidal ideation in young adolescents: post hoc analysis of data collected in a cluster randomised controlled trial

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