Topics

Women with non‐ST‐elevation acute coronary syndromes remain understudied and undertreated

Ischaemic heart disease is the leading cause of death for women worldwide, and sex‐related disparities continue to characterise its management.1 Despite initiatives addressing this problem, cardiovascular risk in women is still underestimated and guideline recommendations have failed to develop sex‐specific strategies, primarily because women are underrepresented in clinical trials.1,2,3 In particular, sex‐specific pathophysiological mechanisms of ischaemic heart disease have not been fully elucidated; for example, acute coronary syndromes (ACS) are more frequently associated with non‐obstructive coronary artery disease and spontaneous coronary dissection in women than in men.4,5 Further, the symptoms of myocardial infarction may be different in women, and this contributes to its under‐recognition and, ultimately, to delays in appropriate treatment.6

1 Center for Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
2 The Zena and Michael A Wiener Cardiovascular Institute, New York, NY, United States of America
3 Humanitas University, Milan, Italy

Correspondence: roxana.mehran@mountsinai.org

Competing interests:

Roxana Mehran has received institutional research grants from Abbott, Abiomed, Applied Therapeutics, Arena, AstraZeneca, Bayer, Biosensors, Boston Scientific, Bristol‐Myers Squibb, CardiaWave, CellAegis, CERC, Chiesi, Concept Medical, CSL Behring, DSI, Insel Gruppe, Medtronic, OrbusNeich, Philips, Transverse Medical, and Zoll; personal fees from ACC, Boston Scientific, California Institute for Regenerative Medicine (CIRM), Cine‐Med Research, Janssen, WebMD, and SCAI; consulting fees (paid to her institution) from Abbott, Abiomed, AM‐Pharma, Alleviant Medical, Bayer, Beth Israel Deaconess, CardiaWave, CeloNova, Chiesi, CSL Behring, Concept Medical, DSI, Duke University, Idorsia Pharmaceuticals, Medtronic, Novartis, and Philips; and has equity (less than 1%) in Applied Therapeutics, Elixir Medical, and STEL, and her spouse has similarly minor equity in CONTROLRAD. She sits on the scientific advisory boards for the American Medical Association and the Cardiovascular Research Foundation (no fee); her spouse sits on the Biosensors scientific advisory board.

1. Vogel B, Acevedo M, Appelman Y, et al. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021; 397: 2385–2438.
2. Bairey Merz CN, Andersen H, Sprague E, et al. Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: the Women’s Heart Alliance. J Am Coll Cardiol 2017; 70: 123–132.
3. Cushman M, Shay CM, Howard VJ, et al; American Heart Association. Ten‐year differences in women’s awareness related to coronary heart disease: results of the 2019 American Heart Association National Survey. A special report from the American Heart Association. Circulation 2021; 143: e239–e248.
4. Adlam D, Alfonso F, Maas A, Vrints C; ESC‐ACCA Writing Committee. European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection. Eur Heart J 2018; 39: 3353–3368.
5. Collet JP, Thiele H, Barbato E, et al; ESC Scientific Document Group. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST‐segment elevation. Eur Heart J 2021; 42: 1289–1367.
6. Khan NA, Daskalopoulou SS, Karp I, et al; GENESIS PRAXY Team. Sex differences in acute coronary syndrome symptom presentation in young patients. JAMA Intern Med 2013; 173: 1863–1871.
7. Bachelet BC, Hyun K, D'Souza M, et al. Sex differences in the management and outcomes of non‐ST‐elevation acute coronary syndromes. Med J Aust 2021; 215: 153–155.
8. Kunadian V, Chieffo A, Camici PG, et al. An EAPCI expert consensus document on ischaemia with non‐obstructive coronary arteries in collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. Eur Heart J 2020; 41: 3504–3520.
9. Wilkinson C, Bebb O, Dondo TB, et al. Sex differences in quality indicator attainment for myocardial infarction: a nationwide cohort study. Heart 2019; 105: 516–523.
10. Alabas OA, Gale CP, Hall M, et al. Sex differences in treatments, relative survival, and excess mortality following acute myocardial infarction: national cohort study using the SWEDEHEART Registry. J Am Heart Assoc 2017; 6: e007123.

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Editorials

Excessive PSA testing in general practice

Justin J Coleman

Med J Aust 2021; 215 (5): . || doi: 10.5694/mja2.51208
Published online: 6 September 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Diagnostic techniques and procedures

Environment and public health

General medicine

Health services administration

Men's health

Neoplasms

The time for actively recommending the screening of asymptomatic men has passed

There is little doubt that Australian doctors order too many prostate‐specific antigen (PSA) screening tests. The analysis by Franco and colleagues of electronic data for 142 000 Victorian general practice patients, published in this issue of the MJA, found that 46% of men aged 70–74 years had had at least two PSA tests during the preceding two years,1 despite Australian guidelines recommending against PSA screening of asymptomatic men in this age group.2 Indeed, the Royal Australian College of General Practitioners (RACGP) does not recommend PSA screening of most asymptomatic men of any age.3 Some testing might be justified (for example, screening of men at high risk, or prostate disease monitoring), but when Australian general practitioner registrars were asked to record specific reasons for ordering PSA tests, “asymptomatic screening” accounted for three‐quarters of requests.4

1 Top End Health Service, Northern Territory Department of Health, Bathurst Island, NT
2 Flinders University, Darwin, NT

Correspondence: justin.coleman@flinders.edu.au

Competing interests:

No relevant disclosures.

1. Franco GS, Hardie RA, Li L, et al. Prostate‐specific antigen testing of asymptomatic men in Australia: an observational study based on electronic general practice data. Med J Aust 2021; 215: 228–229.
2. Prostate Cancer Foundation of Australia and Cancer Council Australia PSA Testing Guidelines Expert Advisory Panel. PSA testing and early management of test‐detected prostate cancer. Jan 2016. https://wiki.cancer.org.au/australiawiki/images/1/1b/PSA_Testing_and_Early_Management_of_Test‐detected_Prostate_Cancer_‐_Clinical_practice_guidelines_‐_Nov15.pdf (viewed June 2021).
3. Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9th edition. Melbourne: RACGP, 2016. https://www.racgp.org.au/download/Documents/Guidelines/Redbook9/17048‐Red‐Book‐9th‐Edition.pdf (viewed June 2021).
4. Magin P, Tapley A, Davey A, et al. Prevalence and associations of general practitioners’ ordering of “non‐symptomatic” prostate‐specific antigen tests: a cross‐sectional analysis. Int J Clin Pract 2017; 71: e12998.
5. Lowe A, Bennett M, Badenoch S. Research, awareness, support: ten years of progress in prostate cancer. 2012 community attitudes survey. Sydney: Prostate Cancer Foundation of Australia, 2012. https://www.prostate.org.au/media/238805/2012_cas_report_online.pdf (viewed June 2021).
6. Pickles K, Carter SM, Rychetnik L, Entwistle VA. Doctors’ perspectives on PSA testing illuminate established differences in prostate cancer screening rates between Australia and the UK: a qualitative study. BMJ Open 2016; 6: e011932.
7. Movember. We believe that every man has the right to know if he has prostate cancer, and that he deserves the right to treat it rather than suffer from a late‐stage diagnosis. Movember, 13 Oct 2011. https://us.movember.com/story/view/id/2234/movember‐s‐position‐on‐the‐psa‐test (viewed June 2021).
8. Urological Society of Australia and New Zealand. Urological Society of Australia and New Zealand PSA testing policy 2009. http://www.urologysa.com.au/pdf/usanz‐2009‐psa‐testing‐policy‐final1.pdf (viewed June 2021).
9. Ilic D, Djulbegovic M, Jung JH, et al. Prostate cancer screening with prostate‐specific antigen (PSA) test: a systematic review and meta‐analysis. BMJ 2018; 362: k3519.
10. Royal Australian College of General Practitioners. Should I have prostate cancer screening? Aug 2015. https://www.racgp.org.au/download/Documents/Guidelines/prostate‐cancer‐screening‐infosheetpdf.pdf (viewed June 2021).

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Editorials

What is the role of general practice in the Chain of Survival for treating people with cardiac arrest?

Siobhán Masterson and Tomás Barry

Med J Aust 2021; 215 (5): . || doi: 10.5694/mja2.51202
Published online: 6 September 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Emergency medicine

General medicine

Cardiovascular diseases

Patient survival is more likely when general practitioners and their staff are trained in resuscitation and equipped with defibrillators

With increasing appreciation of the importance of post‐resuscitation care and long term patient outcomes, the Chain of Survival for patients with cardiac arrest has evolved.1 However, the first three links have not changed: early recognition and an emergency call for medical help; early cardiopulmonary resuscitation; and early defibrillation. If these steps are not immediately and sequentially activated, further links in the Chain of Survival have little or no impact on survival. The study by Haskins and colleagues2 reported in this issue of the MJA re‐affirms the importance of these three links, and provides direction on how they can be further strengthened in community general practice.

1 HSE National Ambulance Service, Limerick, Ireland
2 National University of Ireland Galway, Galway, Ireland
3 UCD Centre for Emergency Medical Science, University College Dublin, Dublin, Ireland

Correspondence: siobhan.masterson@nuigalway.ie

Competing interests:

No relevant disclosures.

1. Perkins GD, Graesner JT, Semeraro F, et al; European Resuscitation Council Guideline Collaborators. European Resuscitation Council guidelines 2021: executive summary. Resuscitation 2021; 161: 1–60.
2. Haskins B, Nehme Z, Cameron PA, Smith K. Cardiac arrests in general practice clinics or witnessed by emergency medical services: a 20‐year retrospective study. Med J Aust 2021; 215: 222–227.
3. Masterson S, McNally B, Cullinan J, et al. Out‐of-hospital cardiac arrest survival in international airports. Resuscitation 2018; 127: 58–62.
4. Niegsch ML, Krarup NT, Clausen NE. The presence of resuscitation equipment and influencing factors at General Practitioners’ offices in Denmark: a cross‐sectional study. Resuscitation 2014; 85: 65–69.
5. Masterson S, Wright P, Dowling J, et al. Out‐of-hospital cardiac arrest (OHCA) survival in rural Northwest Ireland: 17 years’ experience. Emerg Med J 2011; 28: 437–438.
6. Barry T, Headon M, Glynn R, et al. Ten years of cardiac arrest resuscitation in Irish general practice. Resuscitation 2018; 126: 43–48.
7. Barry T, Headon M, Quinn M, et al. General practice and cardiac arrest community first response in Ireland. Resuscitation Plus 2021; 6: 100127.
8. Bury G, Headon M, Dixon M, Egan M. Cardiac arrest in Irish general practice: an observational study from 426 general practices. Resuscitation 2009; 80: 1244–1247.

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Editorials

Call for emergency action to limit global temperature increases, restore biodiversity, and protect health

Lukoye Atwoli, Abdullah H Baqui, Thomas Benfield, Raffaella Bosurgi, Fiona Godlee, Stephen Hancocks, Richard C Horton, Laurie Laybourn‐Langton, Carlos A Monteiro, Ian Norman, Kirsten Patrick, Nigel Praities, Marcel GM Olde Rikkert, Eric J Rubin, Peush Sahni, Richard SW Smith, Nicholas J Talley, Sue Turale and Damián Vázquez

Med J Aust 2021; 215 (5): . || doi: 10.5694/mja2.51221
Published online: 6 September 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Wealthy nations must do much more, much faster

The UN General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference (COP26) in Glasgow, UK. Ahead of these pivotal meetings, we — the editors of health journals worldwide — call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature, and protect health.

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1 East African Medical Journal, Makhanda, South Africa
2 Journal of Population, Health and Nutrition, UK
3 Danish Medical Journal, Copenhagen, Denmark
4 PLOS Medicine, San Francisco, CA, USA
5 The BMJ, London, UK
6 British Dental Journal, London, UK
7 The Lancet, London, UK
8 UK Health Alliance on Climate Change, London, UK
9 Revista de Saúde Pública, São Paulo, Brazil
10 International Journal of Nursing Studies, London, UK
11 Canadian Medical Association Journal, Ottawa, Canada
12 Pharmaceutical Journal, London, UK
13 Dutch Journal of Medicine, Amsterdam, The Netherlands
14 New England Journal of Medicine, Waltham, MA, USA
15 National Medical Journal of India, New Delhi, India
16 Medical Journal of Australia, Sydney, NSW, Australia
17 International Nursing Review
18 Pan American Journal of Public Health, Washington, DC, USA

Correspondence: laurie.laybourn@ukhealthalliance.org

Competing interests:

Fiona Godlee serves on the executive committee for the UK Health Alliance on Climate Change and is a Trustee of the Eden Project. Richard Smith is the chair of Patients Know Best, has stock in UnitedHealth Group, has done consultancy work for Oxford Pharmagenesis, and is chair of the Lancet Commission on the Value of Death. A complete list of Nicholas Talley's disclosures is available at https://www.mja.com.au/journal/staff/editor-chief-professor-nick-talley

1. In support of a healthy recovery. https://healthyrecovery.net (viewed July 2021).
2. Intergovernmental Panel on Climate Change. Summary for policymakers. In: Global warming of 1.5°C. An IPCC special report on the impacts of global warming of 1.5°C above pre‐industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty. 2018. https://www.ipcc.ch/sr15/ (viewed July 2021).
3. Intergovernmental Science‐Policy Platform on Biodiversity and Ecosystem Services. Summary for policymakers: the global assessment report on biodiversity and ecosystem services. 2019. https://ipbes.net/sites/default/files/2020‐02/ipbes_global_assessment_report_summary_for_policymakers_en.pdf (viewed July 2021).
4. Watts N, Amann M, Arnell N, et al. The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises. Lancet 2021; 397: 129–170.
5. Rocque RJ, Beaudoin C, Ndjaboue R, et al. Health effects of climate change: an overview of systematic reviews. BMJ Open 2021; 11: e046333.
6. Haines A, Ebi K. The imperative for climate action to protect health. N Engl J Med 2019; 380: 263–273.
7. United Nations Environment Programme and International Livestock Research Institute. Preventing the next pandemic: zoonotic diseases and how to break the chain of transmission. 2020. https://72d37324‐5089‐459c‐8f70‐271d19427cf2.filesusr.com/ugd/056cf4_b5b2fc067f094dd3b2250cda15c47acd.pdf (viewed July 2021).
8. Intergovernmental Panel on Climate Change. Summary for policymakers. In: Climate change and land: an IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems. 2020. https://www.ipcc.ch/site/assets/uploads/sites/4/2020/02/SPM_Updated‐Jan20.pdf (viewed July 2021).
9. Lenton TM, Rockström J, Gaffney O, et al. Climate tipping points—too risky to bet against. Nature 2019; 575: 592–595.
10. Wunderling N, Donges JF, Kurths J, Winkelmann R. Interacting tipping elements increase risk of climate domino effects under global warming. Earth Syst Dynam 2021; 12: 601–619.
11. High Ambition Coalition. https://www.hacfornatureandpeople.org (viewed July 2021).
12. Global Climate and Health Alliance. Are national climate commitments enough to protect our health? https://climateandhealthalliance.org/initiatives/healthy‐ndcs/ndc‐scorecards/ (viewed July 2021).
13. Climate strikers: Open letter to EU leaders on why their new climate law is ‘surrender.’ Carbon Brief 2020; 3 Mar. https://www.carbonbrief.org/climate‐strikers‐open‐letter‐to‐eu‐leaders‐on‐why‐their‐new‐climate‐law‐is‐surrender (viewed July 2021).
14. Fajardy M, Köberle A, MacDowell N, Fantuzzi A. BECCS deployment: a reality check. Grantham Institute Briefing Paper 28. January 2019. https://www.imperial.ac.uk/media/imperial‐college/grantham‐institute/public/publications/briefing‐papers/BECCS‐deployment‐‐‐a‐reality‐check.pdf (viewed July 2021).
15. Anderson K, Peters G. The trouble with negative emissions. Science 2016; 354: 182–183.
16. Climate Action Tracker. https://climateactiontracker.org (viewed July 2021).
17. Secretariat of the Convention on Biological Diversity. Global biodiversity outlook 5. https://www.cbd.int/gbo5 (viewed July 2021).
18. Steffen W, Richardson K, Rockström J, et al. Sustainability. Planetary boundaries: guiding human development on a changing planet. Science 2015; 347: 1259855.
19. UK Health Alliance on Climate Change. Our calls for action. http://www.ukhealthalliance.org/cop26/ (viewed July 2021).
20. Climate Action Tracker. Warming projections global update: May 2021. https://climateactiontracker.org/documents/853/CAT_2021‐05‐04_Briefing_Global‐Update_Climate‐Summit‐Momentum.pdf (viewed July 2021).
21. United Nations Environment Programme. Emissions gap report 2020. UNEP, 2020.
22. Markandya A, Sampedro J, Smith SJ, et al. Health co‐benefits from air pollution and mitigation costs of the Paris Agreement: a modelling study. Lancet Planet Health 2018; 2: e126–e133.
23. Paremoer L, Nandi S, Serag H, Baum F. Covid‐19 pandemic and the social determinants of health. BMJ 2021; 372: n129.

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Research letter

Public support for phasing out the sale of cigarettes in Australia

Emily Brennan, Sarah Durkin, Michelle M Scollo, Maurice Swanson and Melanie Wakefield

Med J Aust 2021; 215 (10): . || doi: 10.5694/mja2.51224
Published online: 30 August 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

As smoking rates continue to decline in some countries, including Australia,1 a goal once unthinkable is now being considered: phasing out the retail sale of combustible tobacco products.2,3 In 2009, 72% of Victorian adults and 57% of smokers felt it would be good if there came a time when cigarettes were no longer available for sale.4 In 2019, we assessed support among Victorian adults for phasing out retail sales, and canvassed their views on timeframes for doing so.

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1 Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC
2 The University of Melbourne, Melbourne, VIC
3 Australian Council on Smoking and Health (ACOSH), Perth, WA

Correspondence: emily.brennan@cancervic.org.au

Acknowledgements:

The Victorian Smoking and Health survey was supported by Quit Victoria, with funding from VicHealth, the Victorian Department of Health and Human Services, and Cancer Council Victoria. We acknowledge the contribution of Linda Hayes, Andrea Nathan and Emily Bain (Cancer Council Victoria) to the collection and analysis of the Victorian Smoking and Health Survey data.

Competing interests:

Emily Brennan, Sarah Durkin, Michelle Scollo and Melanie Wakefield received funding from VicHealth, the Victorian Department of Health and Human Services, and Cancer Council Victoria during the study.

1. Australian Institute of Health and Welfare. National Drug Strategy Household Survey 2019 (Cat. no. PHE 270). Data tables, 2. Tobacco smoking supplementary tables. 16 July 2020, https://www.aihw.gov.au/reports/illicit‐use‐of‐drugs/national‐drug‐strategy‐household‐survey‐2019/data (viewed Aug 2020).
2. Daube M, Moodie R. Exit strategy: we can do it for COVID‐19, why not tobacco? InSight+ [online], 18 May 2020. https://insightplus.mja.com.au/2020/19/exit‐strategy‐we‐can‐do‐it‐for‐covid‐19‐why‐not‐tobacco (viewed May 2021).
3. Gartner C. CREATE a new path to a smoke‐free Australia. InSight+ [online], 12 Oct 2020. https://insightplus.mja.com.au/2020/40/create‐a‐new‐path‐to‐a‐smoke‐free‐australia (viewed May 2021).
4. Hayes L, Wakefield MA, Scollo MM. Public opinion about ending the sale of tobacco in Australia. Tob Control 2014; 23: 183–184.
5. Australian Bureau of Statistics. 3101.0. Population by age and sex, Australian states and territories, Dec 2016. June 2017. https://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/432B4729A87614B1CA2581A70015892B?opendocument (viewed May 2021).
6. Swanson M. Time to talk about phasing out sale of tobacco products. The West Australian (Perth), 31 July 2020. https://edition.thewest.com.au/html5/shared/ShowArticle.aspx?doc=WAN%2F2020%2F07%2F31&entity=Ar03202&sk=E3B375CB&mode=text (viewed May 2021). ■

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Research

The influence of the surveillance time interval on the risk of advanced neoplasia after non‐advanced adenoma removal

Zaki Hamarneh, Charles Cock, Graeme P Young, Peter A Bampton, Robert Fraser, Fang LI Ang, Feruza Kholmurodova and Erin L Symonds

Med J Aust 2021; 215 (10): . || doi: 10.5694/mja2.51222
Published online: 30 August 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Digestive system diseases

Statistics, epidemiology and research design

Neoplasms

Abstract

Objectives: To investigate the incidence of advanced neoplasia (colorectal cancer or advanced adenoma) at surveillance colonoscopy following removal of non‐advanced adenoma; to determine whether the time interval before surveillance colonoscopy influences the likelihood of advanced neoplasia.

Design: Retrospective cohort study.

Setting, participants: Patients enrolled in a South Australian surveillance colonoscopy program with findings of non‐advanced adenoma during 1999–2016 who subsequently underwent surveillance colonoscopy.

Main outcome measures: Incidence of advanced neoplasia at follow‐up surveillance colonoscopy.

Results: Advanced neoplasia was detected in 169 of 965 eligible surveillance colonoscopies (18%) for 904 unique patients (median age, 62.0 years; interquartile range [IQR], 54.0–69.0 years), of whom 570 were men (59.1%). The median interval between the initial and surveillance procedures was 5.2 years (IQR, 4.4–6.0 years; range, 2.0–14 years). Factors associated with increased risk of advanced neoplasia at follow‐up included age (per year: odds ratio [OR], 1.03; 95% CI, 1.01–1.05), prior history of adenoma (OR, 1.48; 95% CI, 1.01–2.15), two non‐advanced adenomas identified at baseline procedure (v one: OR, 1.74; 95% CI, 1.18–2.57), and time to surveillance colonoscopy (OR, 1.21; 95% CI, 1.08–1.37). The estimated incidence of advanced neoplasia was 19% five years after non‐advanced adenoma removal, and 30% at ten years.

Conclusions: Increasing the surveillance colonoscopy interval beyond five years after removal of non‐advanced adenoma increases the risk of detection of advanced neoplasia at follow‐up colonoscopy.

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1 Flinders Medical Centre, Adelaide, SA
2 Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA
3 Royal Adelaide Hospital, Adelaide, SA
4 Flinders University, Adelaide, SA
5 College of Medicine and Public Health, Flinders University, Adelaide, SA
6 Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, SA

Correspondence: erin.symonds@sa.gov.au

Acknowledgements:

The study was funded by the Flinders Foundation (Adelaide). Feruza Kholmurodova was supported by a grant provided by the Cancer Council SA Beat Cancer Project.

Competing interests:

No relevant disclosures.

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2. Cole SR, Tucker GR, Osborne JM, et al. Shift to earlier stage at diagnosis as a consequence of the National Bowel Cancer Screening Program. Med J Aust 2013; 198: 327–330. https://www.mja.com.au/journal/2013/198/6/shift‐earlier‐stage‐diagnosis‐consequence‐national‐bowel‐cancer‐screening
3. Hewitson P, Glasziou P, Irwig L, et al. Screening for colorectal cancer using the faecal occult blood test, Hemoccult. Cochrane Database Syst Rev 2007; CD001216.
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22. Lieberman D, Sullivan BA, Hauser ER, et al. Baseline colonoscopy findings associated with 10‐year outcomes in a screening cohort undergoing colonoscopy surveillance. Gastroenterology 2020; 158: 862–874.e8.
23. Hartstein JD, Vemulapalli KC, Rex DK. The predictive value of small versus diminutive adenomas for subsequent advanced neoplasia. Gastrointest Endosc. 2020; 91: 614–621.e6.
24. Sneh Arbib O, Zemser V, Leibovici Weissman Y, et al. Risk of advanced lesions at the first follow‐up colonoscopy after polypectomy of diminutive versus small adenomatous polyps of low‐grade dysplasia. Gastrointest Endosc 2017; 86: 713–721.e2.
25. Chiu HM, Lee YC, Tu CH, et al. Effects of metabolic syndrome and findings from baseline colonoscopies on occurrence of colorectal neoplasms. Clin Gastroenterol Hepatol 2015; 13: 1134–1142.e8.

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Research letters

Estimating the abortion rate in Australia from National Hospital Morbidity and Pharmaceutical Benefits Scheme data

Louise A Keogh, Lyle C Gurrin and Patricia Moore

Med J Aust 2021; 215 (8): . || doi: 10.5694/mja2.51217
Published online: 30 August 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

It is difficult to estimate the abortion rate in Australia, as most states do not routinely report abortion data, and published national data have been incomplete.1 Consequently, some clinicians and academics have been accused of inflating reported rates for political reasons.2 National data have not been published in the peer‐reviewed literature since 2005.3 However, “abortion with operating room procedure” (65 451 procedures) was reported to be the third most frequent surgical procedure in Victorian hospitals during January 2014 ‒ December 2016.4 Prompted by this report, we sought to provide an updated estimate of the national abortion rate for women in Australia. Our study was approved by the University of Melbourne Human Research Ethics Committee (2021‐21757‐16379‐2).

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1 Centre for Health Equity, University of Melbourne, Melbourne, VIC
2 Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC
3 Royal Women’s Hospital, Melbourne, VIC

Correspondence: l.keogh@unimelb.edu.au

Competing interests:

No relevant disclosures.

1. Grayson N, Hargreaves J, Sullivan EA. Use of routinely collected national data sets for reporting on induced abortion in Australia (AIHW cat. no. PER 30; Perinatal Statistics Series no. 17). Sydney: AIHW National Perinatal Statistics Unit, 2005. https://www.aihw.gov.au/reports/mothers‐babies/use‐national‐data‐sets‐reporting‐induced‐abortion/contents/table‐of‐contents (viewed Apr 2021).
2. Black KI, Bateson DJ, Goldstone P. Abortion statistics and long‐acting reversible contraception in Australia [letter]. Aust N Z J Obstet Gynaecol 2018; 58: E6–E7.
3. Chan A, Sage LC. Estimating Australia’s abortion rates 1985–2003. Med J Aust 2005; 182: 447–452. https://www.mja.com.au/journal/2005/182/9/estimating‐australias‐abortion‐rates‐1985‐2003
4. Fehlberg T, Rose J, Guest GD, Watters D. The surgical burden of disease and perioperative mortality in patients admitted to hospitals in Victoria, Australia: a population‐level observational study. BMJ Open 2019; 9: e028671.
5. Australian Institute of Health and Welfare. National Hospitals Data Collection. Updated 14 Apr 2021. https://www.aihw.gov.au/about‐our‐data/our‐data‐collections/national‐hospitals‐data‐collection (viewed Apr 2021).
6. Australian Institute of Health and Welfare. Australian refined diagnosis‐related groups (AR‐DRG) data cubes (Cat. no. WEB 216). Updated 7 Dec 2020. https://www.aihw.gov.au/reports/hospitals/ar‐drg‐data‐cubes/contents/data‐cubes (viewed Apr 2021).
7. Australian Bureau of Statistics. Regional population by age and sex. Statistics about the population by age and sex for Australia’s capital cities and regions. Updated 20 Aug 2020. https://www.abs.gov.au/statistics/people/population/regional‐population‐age‐and‐sex/latest‐release (viewed Apr 2021).
8. Services Australia. Pharmaceutical Benefits Schedule item reports. http://medicarestatistics.humanservices.gov.au/statistics/pbs_item.jsp (viewed Apr 2021).
9. Bearak J, Popinchalk A, Ganatra B, et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. Lancet Global Health 2020; 8: E1152–E1161.
10. Goldstone P, Walker C, Hawtin K. Efficacy and safety of mifepristone–buccal misoprostol for early medical abortion in an Australian clinical setting. Aust N Z J Obstet Gynaecol 2017; 57: 366–371.

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Research letter

Prescribing of direct‐acting antiviral therapy by general practitioners for people with hepatitis C in an unrestricted treatment program

Fergus Stafford, Gregory J Dore, Shawn Clackett, Marianne Martinello, Gail V Matthews, Jason Grebely, Anne C Balcomb and Behzad Hajarizadeh

Med J Aust 2021; 215 (7): . || doi: 10.5694/mja2.51204
Published online: 23 August 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

General medicine

Digestive system diseases

In Australia, highly effective direct‐acting antiviral (DAA) therapy has been available for people with chronic hepatitis C through the Pharmaceutical Benefits Scheme (PBS) since March 2016. All clinicians, including general practitioners, have prescribing authority.1 In many countries, DAA prescribing is restricted to specific medical specialties,2 creating barriers to treatment by disrupting the cascade of care and limiting access for those unable or unwilling to attend specialist services.3 In this study, we characterised DAA prescribing by GPs in the Australian model of DAA access.

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1 The Kirby Institute, UNSW Sydney, Sydney, NSW
2 Centre for Population Health, NSW Health, Sydney, NSW
3 76 Prince Medical, Orange, NSW

Correspondence: bhajarizadeh@kirby.unsw.edu.au

Acknowledgements:

The Kirby Institute is funded by the Australian Department of Health and Ageing. Gregory Dore, Gail Matthews and Marianne Martinello were supported by National Health and Medical Research Council (NHMRC) fellowships. Jason Grebely was supported by an NHMRC Investigator grant.

Competing interests:

Gregory Dore is a consultant/advisor and has received research grants from Gilead, AbbVie, Merck, Bristol‐Myers Squibb, and Cepheid. Jason Grebely is a consultant/advisor and has received research grants from Gilead, AbbVie, Hologic, Indivior, Merck, and Cepheid. Gail Matthews has received research funding, advisory board payments, and speaker payments from Gilead, and research funding and speaker payments from Janssen.

1. Hajarizadeh B, Grebely J, Matthews GV, et al. Uptake of direct‐acting antiviral treatment for chronic hepatitis C in Australia. J Viral Hepat 2018; 25: 640–648.
2. Marshall AD, Cunningham EB, Nielsen S, et al; International Network on Hepatitis in Substance Users (INHSU). Restrictions for reimbursement of interferon‐free direct‐acting antiviral drugs for HCV infection in Europe. Lancet Gastroenterol Hepatol 2018; 3: 125–133.
3. Radley A, Robinson E, Aspinall EJ, et al. A systematic review and meta‐analysis of community and primary‐care‐based hepatitis C testing and treatment services that employ direct acting antiviral drug treatments. BMC Health Serv Res 2019; 19: 765.
4. Iranpour N, Dore GJ, Martinello M, et al. Estimated uptake of hepatitis C direct‐acting antiviral treatment among individuals with HIV co‐infection in Australia: a retrospective cohort study. Sex Health 2020; 17: 223–230.
5. Australian Department of Health. General practice workforce providing primary care services in Australia. Updated 17 June 2020. https://hwd.health.gov.au/resources/data/gp‐primarycare.html (viewed June 2021).

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