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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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No relevant disclosures.
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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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.
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.
Objectives: To estimate rates of screen‐detected and interval breast cancers, stratified by risk factor, to inform discussions of risk‐stratified population screening.
Design: Retrospective population‐based cohort study; analysis of routinely collected BreastScreen WA program clinical and administrative data.
Setting, participants: All BreastScreen WA mammography screening episodes for women aged 40 years or more during 1 July 2007 ‒ 30 June 2017.
Main outcome measures: Cancer detection rate (CDR) and interval cancer rate (ICR), by risk factor.
Results: A total of 323 082 women were screened in 1 026 137 screening episodes (mean age, 58.5 years; SD, 8.6 years). The overall CDR was 68 (95% CI, 67‒70) cancers per 10 000 screens, and the overall ICR was 9.7 (95% CI, 9.2‒10.1) cancers per 10 000 women‐years. Interactions between the effects on CDR of age group and five risk factors were statistically significant: personal history of breast cancer (P = 0.039), family history of breast cancer (P = 0.005), risk‐relevant benign conditions (P = 0.012), hormone‐replacement therapy (P = 0.002), and self‐reported symptoms (P < 0.001). The influence of these risk factors (except personal history) increased with age. For ICR, only the interaction between age and hormone‐replacement therapy was significant (P < 0.001), although weak interactions between age and family history of breast cancer or having dense breasts were noted (each P = 0.07). The influence of family history on ICR was significant only for women aged 40‒49 years.
Conclusions: Screening CDR and (for some risk factors) ICR were higher for women in some age groups with personal histories of breast cancer or risk‐relevant benign breast conditions or first degree family history of breast cancer, women with dense breasts or self‐reported breast‐related symptoms, and women using hormone‐replacement therapy. Our findings could inform the evaluation of risk‐based screening.
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Nehmat Houssami is supported by the National Breast Cancer Foundation (NBCF) Chair in Breast Cancer Prevention program (EC‐21‐001) and by a National Health and Medical Research Council Investigator (Leader) grant (1194410). Michael Marinovich is supported by a National Breast Cancer Foundation Investigator Initiated Research Scheme grant (IIRS‐20‐011). We thank Sonia El‐Zaemey and Kim Kee Ooi (BreastScreen WA) for extracting and cleaning the data for our analysis.
No relevant disclosures.
Fragmented patient care can lead to missed diagnoses, inappropriate prescribing and failure of preventive medicine
“Continuity of care” refers to the holistic management of a patient by a single practitioner, or a well integrated network of practitioners in close communication. The definition of fragmented care is not established, but here we consider it to be three or more different general practitioners managing the same underlying condition or presenting complaint.
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Objectives: To examine the epidemiological and clinical characteristics of SARS‐CoV‐2‐positive children in Australia during 2020.
Design, setting: Multicentre retrospective study in 16 hospitals of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network; eleven in Victoria, five in four other Australian states.
Participants: Children aged 0‒17 years who presented to hospital‐based COVID‐19 testing clinics, hospital wards, or emergency departments during 1 February ‒ 30 September 2020 and who were positive for SARS‐CoV‐2.
Main outcome measures: Epidemiological and clinical characteristics of children positive for SARS‐CoV‐2.
Results: A total of 393 SARS‐CoV‐2‐positive children (181 girls, 46%) presented to the participating hospitals (426 presentations, including 131 to emergency departments [31%]), the first on 3 February 2020. Thirty‐three children presented more than once (8%), including two who were transferred to participating tertiary centres (0.5%). The median age of the children was 5.3 years (IQR, 1.9‒12.0 years; range, 10 days to 17.9 years). Hospital admissions followed 51 of 426 presentations (12%; 44 children), including 17 patients who were managed remotely by hospital in the home. Only 16 of the 426 presentations led to hospital medical interventions (4%). Two children (0.5%) were diagnosed with the paediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2 (PIMS‐TS).
Conclusion: The clinical course for most SARS‐CoV‐2‐positive children who presented to Australian hospitals was mild, and did not require medical intervention.
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This study was unfunded, but was supported by a National Health and Medical Research Council (NHMRC) Centre of Research Excellence grant for paediatric emergency medicine (GNT1171228) and the Victorian Government Infrastructure Support Program. The participation of Franz Babl was partly funded by an NHMRC Practitioner Fellowship (GNT1124466) and by the Royal Children’s Hospital Foundation. Laila Ibrahim was supported by a Clinician‐Scientist Fellowship from the Murdoch Children’s Research Institute.
We acknowledge the staff who assisted with data retrieval: Visakan Krishnananthan and Caoimhe Basquille (emergency medicine, Eastern Health); Rebecca Gormley (Sunshine Hospital, Western Health); Gaby Nieva (Women’s and Children’s Hospital, Adelaide); and Rebecca Hughes (Royal Children’s Hospital Melbourne).
No relevant disclosures.
We need to consider offering vaccination to adolescents and young adults
The generally mild course of coronavirus disease 2019 (COVID‐19) in children, as observed during the early phase of the pandemic, may not continue to be typical as the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) mutates. In this issue of the MJA, Ibrahim and colleagues1 describe the characteristics of children positive for SARS‐CoV‐2 who presented to 16 Australian hospitals during February – September 2020, when the Wuhan strain of the virus was circulating in Australia. Reassuringly, most of the 393 children did not need hospital care, and there were no deaths.1 However, 44 children were admitted to hospital (11%), including two who developed paediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2 (PIMS‐TS), and 17 were managed with hospital in the home care.1
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This work was supported by a National Health and Medical Research Council Centres of Research Excellence program of research, aiming to position primary care at the centre of sleep health management in Australia (GNT1134954).
Leon Lack and Nicole Lovato have received research funding from Re‐Timer Pty Ltd.
If suitable mosquito vectors are present in a region, returning infected travellers can initiate local transmission
Dengue outbreaks outside their usual geographic distribution — the subtropics and tropics of Asia, Africa, and Latin America — always attract media attention. The first major autochthonous dengue outbreaks in Europe were in Madeira (Portugal) in 2012;1 smaller clusters have been reported in France, Croatia,2 and Italy.3 Despite suitable mosquito vectors, the seasonal window for the establishment of dengue in Europe is short and the risk of its propagation, even in southern Europe, is low.4 It could, however, increase with global warming;5 for example, importation of dengue into more temperate climate zones in China has resulted in local outbreaks in cities such as Shanghai.6
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We urgently need a national strategy to reduce overreliance on hospital services for functional recovery treatments
In this issue of the Journal, Soh and colleagues report their study of the outcomes of inpatient rehabilitation for older people.1 Their findings can be interpreted in a variety of ways. Most participants (396 of 618, 60%) recovered pre‐admission levels of functional performance (as measured with the Activities of Daily Living [ADL] scale), but cognitive impairment (64% of participants) and frailty (the median Clinical Frailty Score at admission was 6 = “moderately frail”) were confirmed as negative prognostic factors. Within three months of discharge from inpatient rehabilitation, 160 of the 618 had been newly institutionalised (26%) and 75 of the 693 initially included patients had died (11%). Recovery of ADL function was, as expected, more frequent than recovery of the more complex functioning assessed by the Instrumental Activities of Daily Living scale (35%). But 110 of the 192 people living at home prior to admission who made no functional gains on the ADL during rehabilitation (57%) were still at home at the three‐month follow‐up and had probably received some benefit from the coordinated rehabilitation program. While the investigation by Soh and colleagues was a single centre study, their findings are broadly similar to those of an older Australian multicentre study.2
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Susan Kurrle is the Clinical Director, Rehabilitation and Aged Care Network, in the Northern Sydney Local Health District (NSLHD). Ian Cameron is employed by the NSLHD. Maria Crotty is the Unit Head of Rehabilitation in the Southern Adelaide Local Health Network (SAHLN). The opinions expressed in this editorial do not reflect the policy of NSLHD or SAHLN.
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.