Topics

Improved, integrated care for older patients with complex medical needs could avert some modifiable causes of readmission

The incidence of peripheral artery disease (PAD) is rising around the world as populations age and the prevalence of diabetes, obesity, and cardiovascular disease increase.1 The clinical manifestations of lower limb PAD range from asymptomatic atherosclerosis and exertional pain caused by intermittent claudication, to chronic limb‐threatening ischaemia with rest pain, ulceration, and necrosis. Long term survival is poorer for patients with PAD than for people with many common cancers,1 and quality of life and patient‐reported outcomes are impaired.2 A recently published analysis of Global Burden of Disease Study data found that lower limb amputation rates were higher in Australia than in eighteen other high income countries, highlighting the need to improve outcomes for people with PAD.3

1 Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
2 Concord Clinical School, University of Sydney, Sydney, NSW, Australia

Correspondence: sarah.aitken@sydney.edu.au

Competing interests:

No relevant disclosures.

1. Fowkes FGR, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet 2013; 382: 1329–1340.
2. Abaraogu UO, Ezenwankwo EF, Dall PM, Seenan CA. Living a burdensome and demanding life: a qualitative systematic review of the patients experiences of peripheral arterial disease. PLoS One 2018; 13: e0207456.
3. Hughes W, Goodall R, Salciccioli JD, et al. Trends in lower extremity amputation incidence in European Union 15+ countries 1990–2017. Eur J Vasc Endovasc Surg 2020; 60: 602–612.
4. Woelk V, Speck P, Kaambwa B, et al. Incidence and causes of early unplanned readmission after hospitalisation with peripheral arterial disease in Australia and New Zealand. Med J Aust 2022; 216: 80–86.
5. Smith SL, Matthews EO, Moxon JV, Golledge J. A systematic review and meta‐analysis of risk factors for and incidence of 30‐day readmission after revascularization for peripheral artery disease. J Vasc Surg 2019; 70: 996–1006.e7.
6. Thillainadesan J, Aitken SJ, Monaro SR, et al. Geriatric comanagement of older vascular surgery inpatients reduces hospital‐acquired geriatric syndromes. J Am Med Dir Assoc 2021; https://doi.org/10.1016/j.jamda.2021.09.037 [online ahead of print].
7. Thillainadesan J, Yumol MF, Hilmer S, et al. Interventions to improve clinical outcomes in older adults admitted to a surgical service: a systematic review and meta‐analysis. J Am Med Dir Assoc 2020; 21: 1833–1843.
8. Vogel TR, Kruse RL. Risk factors for readmission after lower extremity procedures for peripheral artery disease. J Vasc Surg 2013; 58: 90–97.e1‐4.
9. Anand SS, Caron F, Eikelboom JW, et al. Major adverse limb events and mortality in patients with peripheral artery disease: the COMPASS trial. J Am Coll Cardiol 2018; 71: 2306–2315.
10. Paige E, Doyle K, Jorm L, et al. A versatile big data health system for Australia: driving improvements in cardiovascular health. Heart Lung Circ 2021; 30: 1467–1476.
11. Medicare Benefits Schedule Review Taskforce. Vascular Clinical Committee report. Updated 28 May 2021. https://www.health.gov.au/resources/publications/taskforce‐findings‐vascular‐clinical‐committee‐report (viewed Dec 2021).

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Perspectives

High value health care is low carbon health care

Alexandra L Barratt, Katy JL Bell, Kate Charlesworth and Forbes McGain

Med J Aust 2022; 216 (2): . || doi: 10.5694/mja2.51331
Published online: 7 February 2022

Topics

Environment and public health

Health services administration

Diagnostic techniques and procedures

Nutritional and metabolic diseases

Culling low value care will cut health care carbon emissions

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1 University of Sydney, Sydney, NSW
2 Northern Sydney Local Health District, Sydney, NSW
3 Western Health, Melbourne, VIC
4 University of Melbourne, Melbourne, VIC

Correspondence: alexandra.barratt@sydney.edu.au

Acknowledgements:

Alexandra Barratt received funding from the National Health and Medical Research Council (grant no. 1104136).

Competing interests:

No relevant disclosures.

1. Beggs PJ, Zhang Y, McGushin A, et al. The report of the MJA–Lancet Countdown on health and climate change: Australia increasingly out on a limb. Med J Aust 2021; https://doi.org/10.5694/mja2.51302.
2. Cunsolo A, Ellis NR. Ecological grief as a mental health response to climate change‐related loss. Nat Clim Chang 2018; 8: 275–281.
3. Malik A, Lenzen M, McAlister S, et al. The carbon footprint of Australian health care. Lancet Planet Health 2018; 2: e27–e35.
4. Tennison I, Roschnik S, Ashby B, et al. Health care’s response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Health 2021; 5: e84–e92.
5. Brownlee SM, Chalkidou KMD, Doust JP, et al. Evidence for overuse of medical services around the world. Lancet 2017; 390: 156–168.
6. Braithwaite J, Glasziou P, Westbrook J. The three numbers you need to know about healthcare: the 60–30‐10 Challenge. BMC Med 2020; 18: 102–02.
7. Gordon L, Waterhouse M, Reid IR, et al. The vitamin D testing rate is again rising, despite new MBS testing criteria. Med J Aust 2020; 213: 155–155.e1. https://www.mja.com.au/journal/2020/213/4/vitamin‐d‐testing‐rate‐again‐rising‐despite‐new‐mbs‐testing‐criteria
8. Services Australia. Medicare group reports. http://medicarestatistics.humanservices.gov.au/statistics/mbs_group.jsp (viewed Oct 2021).
9. Zhi M, Ding EL, Theisen‐Toupal J, et al. The landscape of inappropriate laboratory testing: a 15‐year meta‐analysis. PLoS One 2013; 8: e78962.
10. McAlister S, Barratt AL, Bell KJL, McGain F. The carbon footprint of pathology testing. Med J Aust 2020; 212: 377–382.e1. https://www.mja.com.au/journal/2020/212/8/carbon‐footprint‐pathology‐testing
11. McGain F, Muret J, Lawson C, et al. Environmental sustainability in anaesthesia and critical care. Br J Anaesth 2020; 125: 680–692.

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Perspectives

3D printing: potential clinical applications for personalised solid dose medications

Liam Krueger, Jared A Miles, Kathryn J Steadman, Tushar Kumeria, Christopher R Freeman and Amirali Popat

Med J Aust 2022; 216 (2): . || doi: 10.5694/mja2.51381
Published online: 7 February 2022

Topics

Pharmaceutical preparations

Three‐dimensional printing or additive manufacturing has the potential to transform personalised medicine

Personalised medicine aims to move gold‐standard care away from empiric prescribing for a typical patient towards tailored treatment for the patient as an individual.1 It is well known that the effect of a medicine on an individual can vary based on factors including sex, genetics and even hormones. Currently, the personalisation of medicines to adjust for factors such as these is limited by the doses and combinations that are commercially available. This inflexibility makes it difficult for clinicians to tailor the medication for individual needs. One technology that could revolutionise personalised medicine is a process called additive manufacturing. In this process, a three‐dimensional (3D) object is produced by fusing thin layers of materials on top of each other until the complete object is formed. This 3D printing method could be applied to medicines to include several drugs in a single tablet at entirely customisable doses set by the clinician, such as the proof of concept five‐in‐one polypill developed in 2015.2

1 University of Queensland, Brisbane, QLD
2 Australian Centre for Nanomedicine, University of New South Wales, Sydney, NSW
3 Metro North Hospital and Health Service, Brisbane, QLD

Correspondence: a.popat@uq.edu.au

Acknowledgements:

Amirali Popat is the recipient of a National Health and Medical Research Council (NHMRC) Career Development Fellowship (GNT1146627) and receives funding from the School of Pharmacy, University of Queensland. Tushar Kumeria pays respect to the Bedegal people who are the traditional owners of the land on which the University of New South Wales Kensington campus is situated. Tushar Kumeria also acknowledges the support from the NHMRC Early Career Fellowship (GNT1143296) and the University of New South Wales for support and Scientia Grant.

Competing interests:

No relevant disclosures.

1. Seyhan AA, Carini C. Are innovation and new technologies in precision medicine paving a new era in patients centric care? J Transl Med 2019; 17: 114.
2. Khaled SA, Burley JC, Alexander MR, et al. 3D printing of five‐in‐one dose combination polypill with defined immediate and sustained release profiles. J Control Release 2015; 217: 308–314.
3. Prasad LK, Smyth H. 3D printing technologies for drug delivery: a review. Drug Dev Ind Pharm 2016; 42: 1019–1031.
4. Okwuosa TC, Pereira BC, Arafat B, et al. Fabricating a shell‐core delayed release tablet using dual FDM 3D printing for patient‐centred therapy. Pharm Res 2017; 34: 427–437.
5. Souto EB, Campos JC, Filho SC, et al. 3D printing in the design of pharmaceutical dosage forms. Pharm Dev Technol 2019; 24: 1044–1053.
6. NPS MedicineWise. Consumer medicine information: Panadol osteo [website]. https://www.nps.org.au/medicine‐finder/panadol‐osteo‐modified‐release‐caplets (viewed Jan 2021).
7. NPS MedicineWise. Consumer medicine information: Pristiq [website]. https://www.nps.org.au/medicine‐finder/pristiq‐extended‐release‐tablets (viewed Jan 2021).
8. Australian Medicines Handbook. Cardiovascular drugs. https://amhonline.amh.net.au/ (viewed Jan 2021).
9. Australian Medicines Handbook. Psychotropic drugs. https://amhonline.amh.net.au/ (viewed Jan 2021).
10. Maher RL, Hanlon JT, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 2014; 13: 57–65.
11. Kuźmińska M, Pereira BC, Habashy R, et al. Solvent‐free temperature‐facilitated direct extrusion 3D printing for pharmaceuticals. Int J Pharm 2021; 598: 120305.
12. Lau ETL, Steadman KJ, Cichero JAY, Nissen LM. Dosage form modification and oral drug delivery in older people. Adv Drug Deliv Rev 2018; 135: 75–84.
13. Wheate N, Schubert E. I’ve heard COVID is leading to medicine shortages. What can I do if my medicine is out of stock? The Conversation 2021, 21 Jan. https://theconversation.com/ive‐heard‐covid‐is‐leading‐to‐medicine‐shortages‐what‐can‐i‐do‐if‐my‐medicine‐is‐out‐of‐stock‐153628 (viewed Feb 2021).
14. Therapeutic Goods Administration. Dipyridamole — medicine shortage information [website]. https://apps.tga.gov.au/Prod/msi/Search/Details/dipyridamole (viewed Jan 2021).
15. Goh GD, Sing SL, Yeong WY. A review on machine learning in 3D printing: applications, potential, and challenges. Artif Intell Rev 2021; 54: 63–94.
16. Coles‐Black J, Chao I, Chuen J. Three‐dimensional printing in medicine. Med J Aust 2017; 207: 102–103. https://www.mja.com.au/journal/2017/207/3/three‐dimensional‐printing‐medicine

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Editorials

E‐liquids and vaping devices: public policy regarding their effects on young people and health

Ira N Advani, Mario Perez and Laura E Crotty Alexander

Med J Aust 2022; 216 (1): . || doi: 10.5694/mja2.51362
Published online: 17 January 2022

Topics

Environment and public health

Poisoning

Knowledge about the composition and physiological effects of e‐liquids is essential for assessing their effects on health

The popularity of electronic cigarettes (e‐cigarettes) has surged in the past few years, and it is estimated that 1.2% of Australians now use them.1 While the main premise in support of e‐cigarettes is that they are safer for smokers than conventional tobacco products, a considerable proportion of users are, unfortunately, never‐smokers or young people.2,3 In 2020, about 3.6 million young people in the United States reported current e‐cigarette use,2 and in 2017, 14% of secondary school students in Australia were reported to have ever used e‐cigarettes.3

1 University of California San Diego, San Diego, CA, United States of America
2 VA San Diego Healthcare System, San Diego, CA, United States of America
3 University of Connecticut, Farmington, CT, United States of America

Correspondence: lcrotty@ucsd.edu

Acknowledgements:

Laura Crotty Alexander was supported by VA Merit, National Heart, Lung, and Blood Institute R01, and Tobacco‐Related Disease Research Program pilot awards.

Competing interests:

No relevant disclosures.

1. Chan G, Leung J, Gartner C, et al. Correlates of electronic cigarette use in the general population and among smokers in Australia: findings from a nationally representative survey. Addict Behav 2019; 95: 6–10.
2. Wang TW, Neff LJ, Park‐Lee E, et al. E‐cigarette use among middle and high school students: United States, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 1310–1312.
3. Greenhalgh EM, Jenkins S, Scollo MM. InDepth 18B: Electronic cigarettes (e‐cigarettes). In: Greenhalgh EM, Scollo MM, Winstanley MH editors. Tobacco in Australia: facts and issues. Melbourne: Cancer Council Victoria; 2021. https://www.tobaccoinaustralia.org.au/chapter‐18‐harm‐reduction/indepth‐18b‐e‐cigarettes/18b‐3‐extent (viewed Nov 2021).
4. Larcombe E, Allard S, Pringle P, et al. Chemical analysis of fresh and aged Australian e‐cigarette liquids. Med J Aust 2022; 216: 27–32.
5. Myers ML; Campaign for Tobacco‐Free Kids. New study shows continuing popularity of Juul and other flavored e‐cigarettes among youth; underscores why FDA and other policymakers must eliminate all flavored e‐cigarettes [media release]. 7 June 2021. https://www.tobaccofreekids.org/press‐releases/2021_06_07_jama‐network‐open‐study (viewed Nov 2021).
6. Diaz MC, Donovan EM, Schillo BA, Vallone D. Menthol e‐cigarette sales rise following 2020 FDA guidance. Tob Control 2021; 30: 700–703.
7. Bitzer ZT, Goel R, Reilly SM, et al. Effect of flavoring chemicals on free radical formation in electronic cigarette aerosols. Free Radic Biol Med 2018; 120: 72–79.
8. Therapeutic Goods Administration (Australian Department of Health). Guidance for Therapeutic Goods (Standard for Nicotine Vaping Products) (TGO 110) Order 2021 and related matters. Updated Sept 2021. https://www.tga.gov.au/resource/nicotine‐vaping‐products‐and‐vaping‐devices (viewed Nov 2021).
9. National Health and Medical Research Council. Electronic cigarettes. 2020. https://www.nhmrc.gov.au/health‐advice/all‐topics/electronic‐cigarettes (viewed Nov 2021).
10. Medicines and Healthcare Products Regulatory Agency. E‐cigarettes: regulations for consumer products. GOV.UK, updated 15 Nov. 2021. https://www.gov.uk/guidance/e‐cigarettes‐regulations‐for‐consumer‐products (viewed Nov 2021).
11. US Food and Drug Administration. Funding opportunities [tobacco science and research]. Updated 11 Sept 2021. https://www.fda.gov/tobacco‐products/research/funding‐opportunities (viewed Nov 2021).

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Editorials

Welcome to 2022: the Year of the Tiger!

Nicholas J Talley

Med J Aust 2022; 216 (1): . || doi: 10.5694/mja2.51366
Published online: 17 January 2022

Topics

Infectious diseases

Environment and public health

Information science

We need strength and courage to live with COVID‐19, and still more to overcome chronic social and planetary neglect

Welcome to 2022! According to the Chinese zodiac, we are entering the Year of the Tiger, a symbol of strength — and danger. Despite nearly two years of the coronavirus disease 2019 (COVID‐19) pandemic, there is much to celebrate, including the huge uptake of vaccination by Australians that has saved many lives and made the return to a more open lifestyle possible. However, the pandemic has not yet passed, and health and medical professionals will need both strength and resilience during the coming year as we navigate the post‐pandemic recovery phase.1 But as I write this editorial (December 2021), it is clear that Europe and the United States will have tough COVID‐19 winters, and the implications of the new Omicron variant of the virus are unclear. We too need to prepare for the possibility of more difficult months ahead as winter approaches. So please get your booster dose of the vaccine when it is due (I have!), celebrate, rest up, re‐charge, and gear up for the year ahead!

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Editor‐in‐Chief, Medical Journal of Australia

Correspondence: ntalley@mja.com.au

Competing interests:

A complete list of disclosures is available at https://www.mja.com.au/journal/staff/editor‐chief‐professor‐nick‐talley

1. Duckett SJ, Sutton B. On entering Australia’s third year with COVID‐19. Med J Aust 2021; 215: 509–510. https://www.mja.com.au/journal/2021/215/11/entering‐australias‐third‐year‐covid‐19
2. Wiley; Council of Australian Universities Librarians. CAUL and Wiley sign transformative open access agreement that represents the largest in the ANZ region by article output [media release]. 4 Nov 2021. https://www.caul.edu.au/news/caul‐and‐wiley‐sign‐transformative‐open‐access‐agreement‐represents‐largest‐anz‐region‐article (viewed Nov 2021).
3. Caly L, Druce J, Roberts J, et al. Isolation and rapid sharing of the 2019 novel coronavirus (SARS‐CoV‐2) from the first patient diagnosed with COVID‐19 in Australia. Med J Aust 2020; 212: 459–462. https://www.mja.com.au/journal/2020/212/10/isolation‐and‐rapid‐sharing‐2019‐novel‐coronavirus‐sars‐cov‐2‐first‐patient
4. COVID‐19 Mental Disorders Collaborators. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID‐19 pandemic. Lancet 2021; 398: 1700–1712.
5. Batterham PJ, Calear AL, McCallum SM, et al. Trajectories of depression and anxiety symptoms during the COVID‐19 pandemic in a representative Australian adult cohort. Med J Aust 2021; 214: 462–468. https://www.mja.com.au/journal/2021/214/10/trajectories‐depression‐and‐anxiety‐symptoms‐during‐covid‐19‐pandemic
6. Burrell AJ, Pellegrini B, Salimi F, et al. Outcomes for patients with COVID‐19 admitted to Australian intensive care units during the first four months of the pandemic. Med J Aust 2021; 214: 23–30. https://www.mja.com.au/journal/2021/214/1/outcomes‐patients‐covid‐19‐admitted‐australian‐intensive‐care‐units‐during‐first; erratum: https://www.mja.com.au/journal/2021/214/10/erratum
7. Grout L, Katar A, Ait Ouakrim D, et al. Failures of quarantine systems for preventing COVID‐19 outbreaks in Australia and New Zealand. Med J Aust 2021; 215: 320–324. https://www.mja.com.au/journal/2021/215/7/failures‐quarantine‐systems‐preventing‐covid‐19‐outbreaks‐australia‐and‐new
8. Hill NT, Witt K, Rajaram G, et al. Suicide by young Australians, 2006–2015: a cross‐sectional analysis of national coronial data. Med J Aust 2021; 214: 133–139. https://www.mja.com.au/journal/2021/214/3/suicide‐young‐australians‐2006‐2015‐cross‐sectional‐analysis‐national‐coronial
9. Negin J, Bell J, Ivancic L, et al. Gun violence in Australia, 2002–2016: a cohort study. Med J Aust 2021; 215: 414–420. https://www.mja.com.au/journal/2021/215/9/gun‐violence‐australia‐2002‐2016‐cohort‐study
10. Freeman CR, Scott IA, Hemming K, et al. Reducing Medical Admissions and Presentations Into Hospital through Optimising Medicines (REMAIN HOME): a stepped wedge, cluster randomised controlled trial. Med J Aust 2021; 214: 212–217. https://www.mja.com.au/journal/2021/214/5/reducing‐medical‐admissions‐and‐presentations‐hospital‐through‐optimising
11. Koczwara B, Meng R, Miller MD, et al. Late mortality in people with cancer: a population‐based Australian study. Med J Aust 2021; 214: 318–323. https://www.mja.com.au/journal/2021/214/7/late‐mortality‐people‐cancer‐population‐based‐australian‐study
12. te Marvelde L, Milne RL, Hornby CJ, et al. Differences in treatment choices for localised prostate cancer diagnosed in private and public health services. Med J Aust 2020; 213: 411–417. https://www.mja.com.au/journal/2020/213/9/differences‐treatment‐choices‐localised‐prostate‐cancer‐diagnosed‐private‐and
13. Yap ML, O’Connell DL, Goldsbury DE, et al. Patterns of care for men with prostate cancer: the 45 and Up Study. Med J Aust 2021; 214: 271–278. https://www.mja.com.au/journal/2021/214/6/patterns‐care‐men‐prostate‐cancer‐45‐and‐study
14. Woo HH, Teh A. Clinically significant localised prostate cancer: deciding what will provide the best clinical outcomes. Med J Aust 2021; 214: 264–265. https://www.mja.com.au/journal/2021/214/6/clinically‐significant‐localised‐prostate‐cancer‐deciding‐what‐will‐provide‐best
15. Hamarneh Z, Cock C, Young GP, et al. The influence of the surveillance time interval on the risk of advanced neoplasia after non‐advanced adenoma removal. Med J Aust 2021; 215: 465–470. https://www.mja.com.au/journal/2021/215/10/influence‐surveillance‐time‐interval‐risk‐advanced‐neoplasia‐after‐non‐advanced
16. Nadlacki B, Horton D, Hossain S, et al. Long term survival after acute myocardial infarction in Australia and New Zealand, 2009–2015: a population cohort study. Med J Aust 2021; 214: 519–525. https://www.mja.com.au/journal/2021/214/11/long‐term‐survival‐after‐acute‐myocardial‐infarction‐australia‐and‐new‐zealand
17. Atwoli L, Baqui AH, Benfield T, et al. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. N Engl J Med 2021; 385: 1134–1137.

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Perspectives

The health impacts of dowry abuse on South Asian communities in Australia

Manjula O'Connor and Amanda Lee

Med J Aust 2022; 216 (1): . || doi: 10.5694/mja2.51358
Published online: 17 January 2022

Topics

Global health

Mental disorders

Social determinants of health

Dowry abuse is fundamentally driven by gender inequality and is a lesser known form of family violence in Australia

Dowry is a cultural tradition maintained by some migrant and refugee communities living in Australia. It has long been practised in India, but with rising materialism in the post‐colonial era, the size of gifts for marriage increased to multiple times that of the annual income of the bride’s family.1 Dowry is also linked to family prestige.2 Rampant dowry abuse associated with significant interpersonal, family and community harm in the newly independent India gave rise to the antidowry movement and laws prohibiting it in 1961.3 Decades later, countries with large South Asian diasporas, such as Canada, the United Kingdom and Australia, continue to experience cases of dowry‐related abuse, including the husband’s confiscation of dowry wealth followed by abandonment of brides.4

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1 University of Melbourne, Melbourne, VIC
2 University of New South Wales, Sydney, NSW
3 Harmony Alliance, Migration Council Australia, Canberra, ACT

Correspondence: manjulao@unimelb.edu.au

Acknowledgements:

The national Survey on Dowry Abuse was designed and conducted by the authors on behalf of Harmony Alliance (https://harmonyalliance.org.au) and the Australasian Centre for Human Rights and Health (www.achrh.org). The survey is published on both websites and forms part of the project National Platform for Prevention of Dowry Abuse — an action research project, which obtained ethics approval from the Human Research Ethics Committee from the Melbourne Clinic — and is funded by the Department of Social Services, Australian Government, through the Community‐led Projects to Prevent Violence Against Women and their Children program. We are grateful to the Indian and the broader South Asian communities for their generous support. We thank Harmony Alliance and the Australasian Centre for Human Rights and Health for supporting the project. We also thank the Department of Social Services for funding the project and Our Watch for providing guidance.

Competing interests:

No relevant disclosures.

1. Banerjee PR. Dowry in 21st‐century India: the sociocultural face of exploitation. Trauma Violence Abuse 2013; 15: 34–40.
2. Biao X. Gender, dowry and the migration system of Indian information technology professionals. Ind J Gend Stud 2005; 12: 357–380.
3. Kumari R. Brides are not for burning: dowry victims in India. New Delhi: Radiant, 1989.
4. Anitha S, Yalamarty H, Anupama R. Changing nature and emerging patterns of domestic violence in global contexts: dowry abuse and the transnational abandonment of wives in India. Womens Stud Int Forum 2018; 69: 67–75.
5. Department of Home Affairs. Country profile: India [website]. Canberra: Commonwealth of Australia, 2020. https://www.homeaffairs.gov.au/research‐and‐statistics/statistics/country‐profiles/profiles/india#:~:text=This%20makes%20the%20Indian%2Dborn,cent%20of%20Australia’s%20total%20population (viewed May 2021).
6. Singh S, Sidhu J. Coercive control of money, dowry and remittances among Indian migrant women in Australia. South Asian Diaspora 2020; 12: 35–50.
7. O’Connor M, Asthana MS. Refusal to comply with dowry demands leads to domestic violence and death in Victoria. Melbourne: Australasian Centre for Human Rights and Health, 2015. http://rcfv.archive.royalcommission.vic.gov.au/getattachment/43B1945E‐83EC‐490D‐B1F9‐73B44B79CC2E/Australasian‐Centre‐for%C2%A0Human‐Rights‐and‐Health.pdf (viewed May 2021).
8. Coroners Court of Victoria. Findings into death with inquest: Deepshikha Godara. Court Reference COR 2014 6332. Melbourne: Coroners Court of Victoria, 2016. https://www.coronerscourt.vic.gov.au/sites/default/files/2018‐12/deepshikhagodara_633214.pdf (viewed May 2021).
9. Smethhurst S. Till death do us part. The Australian 2018; 6 October. https://www.theaustralian.com.au/weekend‐australian‐magazine/dowry‐death‐and‐despair‐in‐australias‐indian‐community/news‐story/b49666d96ac623af5147d6d4edcce09e (viewed May 2021).
10. Ghafournia N, Easteal P. Are immigrant women visible in Australian domestic violence reports that potentially influence policy? Laws 2018; 7: 32.
11. O'Connor M, Ibrahim S. Suicidality and family violence in Australian immigrant women presenting to out‐patient mental health settings. Australas Psychiatry 2018; 26: 224–225.
12. Legal and Constitutional Affairs References Committee. Practice of dowry and the incidence of dowry abuse in Australia. Canberra: Commonwealth of Australia, 2019. https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/DowryAbuse/Report (viewed May 2021).
13. Harmony Alliance. Emerging insights from our national survey on dowry abuse. Canberra: Harmony Alliance, 2020. http://harmonyalliance.org.au/wp‐content/uploads/2020/11/HA‐Dowry‐Abuse‐Survey‐Insights.pdf (viewed May 2021).
14. Vives‐Cases C, La Parra D, Goicolea I, et al. Preventing and addressing intimate partner violence against migrant and ethnic minority women: the role of the health sector — policy brief. Copenhagen: World Health Organization; 2014. https://www.euro.who.int/__data/assets/pdf_file/0018/270180/21256‐WHO‐Intimate‐Partner‐Violence_low_V7.pdf (viewed May 2021).
15. O’Connor M, Colucci E. Exploring domestic violence and social distress in Australian‐Indian migrants through community theater. Transcult Psychiatry 2016; 53: 24–44.
16. Centre of Research Excellence Safer Families. The Readiness Program: primary care's readiness to address domestic and family violence. https://www.saferfamilies.org.au/readiness‐program (viewed Nov 2021).
17. O’Connor M. Dowry‐related domestic violence and complex posttraumatic stress disorder: a case report. Australas Psychiatry 2017; 25: 351–353.
18. Shidhaye R, Patel V. Association of socio‐economic, gender and health factors with common mental disorders in women: a population‐based study of 5703 married rural women in India. Int J Epidemiol 2010; 39: 1510–1521.

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Research letters

Second SARS‐CoV‐2 infections twelve months after initial infections in Australia, confirmed by genomic analysis

The Victorian SARS‐CoV‐2 Reinfection Study Group

Med J Aust 2022; 216 (4): . || doi: 10.5694/mja2.51352
Published online: 13 December 2021

Topics

Infectious diseases

Statistics, epidemiology and research design

Second infections with the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) are thought to affect fewer than 1% of people with resolved coronavirus disease 2019 (COVID‐19).1 Reinfections as soon as 26 days after the initial diagnosis have been reported, in some cases with increased disease severity.1,2 No confirmed cases of second SARS‐CoV‐2 infections have been reported in Australia, but public awareness of the possibility is needed to encourage continued testing and vaccination.

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The Victorian SARS‐CoV‐2 Reinfection Study Group

1 Victorian Department of Health, Melbourne, VIC
2 South East Public Health Unit, Melbourne, VIC
3 Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC

Correspondence: courtney.lane@unimelb.edu.au

Acknowledgements:

This investigation was funded by the Victorian Government, and by the National Health and Medical Research Council through the Medical Research Future Fund (MRF9200006). We acknowledge and thank Australian SARS‐CoV‐2 diagnostic and sequencing laboratories for their contributions to this research.

Competing interests:

No relevant disclosures.

1. Hansen CH, Michlmayr D, Gubbels SM, et al. Assessment of protection against reinfection with SARS‐CoV‐2 among 4 million PCR‐tested individuals in Denmark in 2020: a population‐level observational study. Lancet 2021; 397: 1204–1212.
2. Tillett RL, Sevinsky JR, Hartley PD, et al. Genomic evidence for reinfection with SARS‐CoV‐2: a case study. Lancet Infect Dis 2021; 21: 52–58.
3. Lane CR, Sherry NL, Porter AF, et al. Genomics‐informed responses in the elimination of COVID‐19 in Victoria, Australia: an observational, genomic epidemiological study. Lancet Public Health 2021; 6: e547–e556.
4. Andersson P, Sherry NL, Howden BP. Surveillance for SARS‐CoV‐2 variants of concern in the Australian context. Medical Journal of Australia 2021; 214: 500–502.e1. https://www.mja.com.au/journal/2021/214/11/surveillance‐sars‐cov‐2‐variants‐concern‐australian‐context
5. Hall VJ, Foulkes S, Saei A, et al; SIREN Study Group. COVID‐19 vaccine coverage in health‐care workers in England and effectiveness of BNT162b2 mRNA vaccine against infection (SIREN): a prospective, multicentre, cohort study. Lancet 2021; 397: 1725‐1735.

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Christmas competition
Winner

A guide to the management of atrial fibrillation in Santa Claus

Mark T Mills and David R Warriner

Med J Aust 2021; 215 (11): . || doi: 10.5694/mja2.51341
Published online: 13 December 2021

Topics

Cardiovascular diseases

General medicine

Summary

• In view of his advanced age and risk factors, Santa Claus is at high risk of developing atrial fibrillation. Despite this, no guidelines exist on the subject.
• Following a review of the literature, we present our position on the management of atrial fibrillation in Santa Claus, and propose the use of the SANTA CLAUS mnemonic to aid clinicians: Screen for atrial fibrillation; Anticoagulate; Normalise heart rate; Treat comorbidities; Anti‐arrhythmic drugs; Cardioversion; Lifestyle measures; Ablation treatment; Understand emotional and psychological impact; Save Santa Claus.

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1 University of Sheffield, Sheffield, United Kingdom
2 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
3 Doncaster and Bassetlaw, Teaching Hospitals NHS Foundation Trust, Doncaster, United Kingdom
4 Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom

Correspondence: marktmills1@gmail.com

Disclaimer

The guidance provided in this article is inspired by the National Institute for Health and Care Excellence (NICE),2 the European Society of Cardiology (ESC),3 and the National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand (NHFA)4 guidelines. Our advice applies only to the management of atrial fibrillation (AF) in Santa Claus, and should not be used in other individuals with AF. Important areas of AF management not covered in our guidance include the prevention of AF, left atrial appendage occlusion for stroke prevention, and the surgical treatment of AF in Santa Claus.

Patient and public involvement

No patients or public were asked for input in the creation of this article, but we did send a copy to Santa Claus along with our Christmas list for 2021.

Competing interests:

No relevant disclosures.

1. Weng L, Preis SR, Hulme OL, et al. Genetic predisposition, clinical risk factor burden, and lifetime risk of atrial fibrillation. Circulation 2018; 137: 1027–1038.
2. National Institute for Health and Care Excellence. Atrial fibrillation: diagnosis and management. NICE guideline [NG196]. Published: 27 April 2021; last updated: 30 June 2021. https://www.nice.org.uk/guidance/ng196 (viewed Oct 2021).
3. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio‐Thoracic Surgery (EACTS). Eur Heart J 2020 Aug 29; ehaa612.
4. Brieger D, Amerena J, Attia JR, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018. Med J Aust 2018; 209: 356–362. https://www.mja.com.au/journal/2018/209/8/national‐heart‐foundation‐australia‐and‐cardiac‐society‐australia‐and‐new
5. Engdahl J, Andersson L, Mirskaya M, et al. Stepwise screening of atrial fibrillation in a 75‐year‐old population: implications for stroke prevention. Circulation 2013; 127: 930–937.
6. Yes Santa is Real. How old is Santa Claus? https://yessantaisreal.com/how‐old‐is‐santa‐claus/ (viewed Oct 2021).
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8. Ovesen L, Lyduch S, Idorn ML. The effect of a diet rich in Brussels sprouts on warfarin pharmacokinetics. Eur J Clin Pharmacol 1988; 34: 521–523.
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10. Grafton J. When Santa Got Stuck Up The Chimney [song]. 1953. https://www.discogs.com/artist/2059148‐Jimmy‐Grafton (viewed Oct 2021).
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13. Van Gelder IC, Groenveld HF, Crijns HJGM, et al. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med 2010; 362: 1363–1373.
14. Gumprecht J, Domek M, Lip GYH, et al. Invited review: hypertension and atrial fibrillation: epidemiology, pathophysiology, and implications for management. J Hum Hypertens 2019; 33: 824–836.
15. Huxley RR, Filion KB, Konety S, et al. Meta‐analysis of cohort and case–control studies of type 2 diabetes mellitus and risk of atrial fibrillation. Am J Cardiol 2011; 108: 56–62.
16. Sandle T. If Santa was human he’d have died aged 54. Digital Journal 2019; 20 Dec. http://www.digitaljournal.com/life/health/if‐santa‐was‐human‐he‐d‐have‐died‐aged‐54/article/563947 (viewed Jan 2021).
17. Shapira‐Daniels A, Mohanty S, Contreras‐Valdes FM, et al. Prevalence of undiagnosed sleep apnea in patients with atrial fibrillation and its impact on therapy. JACC Clin Electrophysiol 2020; 6: 1499–1506.
18. Pathak RK, Middeldorp ME, Meredith M, et al. Long‐term effect of goal‐directed weight management in an atrial fibrillation cohort. J Am Coll Cardiol 2015; 65: 2159–2169.
19. Smart NA, King N, Lambert JD, et al. Exercise‐based cardiac rehabilitation improves exercise capacity and health‐related quality of life in people with atrial fibrillation: a systematic review and meta‐analysis of randomised and non‐randomised trials. Open Heart 2018; 5: e000880.
20. University of Leicester. Calculations reveal Santa travels at 0.5% the speed of light. https://le.ac.uk/news/2018/december/21‐calculations‐reveal‐how‐quickly‐santa‐travels (viewed Oct 2021).

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Reflection

Living through a pandemic as an MJA editor and a general practitioner

Aajuli Shukla

Med J Aust 2021; 215 (11): . || doi: 10.5694/mja2.51338
Published online: 13 December 2021

Topics

General medicine

Infectious diseases

The end of 2021 offers many opportunities to look back on the year that was and make predictions about what is to come. At the time of writing, modelling based on vaccination rates and plans for reopening the country are the trends du jour. Yet, in approaching the end of another year in which coronavirus disease 2019 (COVID‐19) has dominated medical, public health and media agendas, it is vital we take an opportunity to reflect on the impacts that the pandemic has had on Australia’s health system, including the way in which the crisis has spurred valuable innovation and reform. For me personally, experiencing this year as an MJA editor and a general practitioner working in Western Sydney, alongside being an expectant mother from a migrant background, has given me intersecting lenses through which to view the impact of the pandemic on medical publishing, clinical practice, and learning to “live with COVID”.

The Medical Journal of Australia , Sydney, NSW

Correspondence: ashukla@mja.com.au

Competing interests:

No relevant disclosures.

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12. Hew A, Arunogiri S, Lubman DI. Challenges in delivering telemedicine to vulnerable populations: experiences of an addiction medical service during COVID‐19. Med J Aust 2021; 215: 237. https://www.mja.com.au/journal/2021/215/5/challenges‐delivering‐telemedicine‐vulnerable‐populations‐experiences‐addiction
13. Rasmussen B, Eleftheriou P, Liu L, et al. Where to next for telehealth in Australia’s health services? Insight+ 2020; 12 Oct. https://insightplus.mja.com.au/2020/40/where‐to‐next‐for‐telehealth‐in‐australias‐health‐services/
14. Woodley M. Longer phone consultations not part of telehealth extension. NewsGP 2021; 27 Apr. https://www1.racgp.org.au/newsgp/professional/longer‐phone‐consultations‐not‐part‐of‐telehealth (viewed Oct 2021).
15. Tsirtsakis A. GP launches petition against ‘unfair’ MBS changes to telehealth. NewsGP 2021; 8 June. https://www1.racgp.org.au/newsgp/professional/gp‐launches‐petition‐against‐unfair‐mbs‐changes‐to (viewed Oct 2021).

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Editorial

Goodbye, 2021: a year of triumphs and failures

Nicholas J Talley

Med J Aust 2021; 215 (11): . || doi: 10.5694/mja2.51345
Published online: 13 December 2021

Topics

Infectious diseases

Environment and public health

Information science

Australians have been challenged in many ways over the past two years: some more than others

Welcome to the December issue of the MJA. It has not been a very jolly year, but I hope that reflecting on what has been and where we are (or should be) going is therapeutic. And I remain optimistic that, despite the challenges, the future is brighter.

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Editor‐in‐Chief

Correspondence: ntalley@mja.com.au

Acknowledgements:

I thank the tireless efforts of the editorial team throughout 2021, without which the quality and timely publication of our Journal would not be possible: deputy medical editors Alisha Dorrigan, Francis Geronimo, Robyn Godding, Tania Janusic, Wendy Morgan, Aajuli Shukla, and Elizabeth Zuccala; our scientific and structural editors, Paul Foley, Graeme Prince, and Laura Teruel; our consultant biostatistician, Elmer Villanueva; our news and online editor, Cate Swannell; our graphic designer, Leilani Widya; our head of publishing content, Ben Dawe; and our senior publishing coordinator, Kerrie Harding.

Competing interests:

A complete list of disclosures is available at https://www.mja.com.au/journal/staff/editor‐chief‐professor‐nick‐talley

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Second SARS‐CoV‐2 infections twelve months after initial infections in Australia, confirmed by genomic analysis

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A guide to the management of atrial fibrillation in Santa Claus

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Disclaimer

Patient and public involvement

Living through a pandemic as an MJA editor and a general practitioner

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Goodbye, 2021: a year of triumphs and failures

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Reducing the number of unplanned returns to hospital after treatment for peripheral artery disease

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High value health care is low carbon health care

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3D printing: potential clinical applications for personalised solid dose medications

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E‐liquids and vaping devices: public policy regarding their effects on young people and health

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Welcome to 2022: the Year of the Tiger!

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The health impacts of dowry abuse on South Asian communities in Australia

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Second SARS‐CoV‐2 infections twelve months after initial infections in Australia, confirmed by genomic analysis

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A guide to the management of atrial fibrillation in Santa Claus

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Disclaimer

Patient and public involvement

Living through a pandemic as an MJA editor and a general practitioner

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Goodbye, 2021: a year of triumphs and failures

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Pagination