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A comprehensive and coordinated approach to overdose prevention by national and state governments and professional groups is needed
Opioid prescribing in Australia has increased steadily over the past three decades.1,2 Each time a new opioid formulation becomes available, it is enthusiastically prescribed. Ten opioids are currently approved by the Therapeutic Goods Administration for pain management, and there are more than 126 different formulations.3
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Buddhima Lokuge holds a Hunter New England Local Health District/University of Newcastle General Research Fellowship.
Nicholas Lintzeris has served on the advisory boards for GW Pharmaceuticals, Indivior, and Mundipharma, received speaker’s honoraria from Chiesi Pharmaceuticals and Mundipharma, and received research‐related funding from Braeburn Pharmaceuticals/Camurus.
Adrian Dunlop has served (in an honorary capacity) on the advisory board for Mundipharma; his organisation has received research‐related funding from Braeburn Pharmaceuticals/Camurus (manufacturers of buprenorphine), and he served as an honorary investigator in an Indivior‐funded study of buprenorphine‒naloxone products.
More research is needed to ensure safe and unimpeded access for eligible applicants and to inform practice
We now have two years’ experience in providing voluntary assisted dying to terminally ill patients in Victoria. Western Australian legislation will come into force on 1 July 2021; Tasmanian legislation has received Royal assent, and the early stages of implementation are underway. The South Australian Voluntary Assisted Dying Bill has been passed by both Houses and may have been sent for Royal assent by the time this article is published. The Queensland Law Reform Commission report and draft bill1 were tabled in parliament on 18 May 2021; a bill is expected to be tabled in the New South Wales parliament in late 2021. There have been calls for the Commonwealth to repeal the Euthanasia Laws Act 1997 to reinstate Australian territories’ rights to debate voluntary assisted dying legislation.
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No relevant disclosures.
Annual audits of practice, national guidelines, specialist diabetes care teams, and increased patient participation are all needed
Diabetes inpatient care is broken and, given the disease burden, it requires urgent attention. The Queensland Impatient Diabetes Survey reported by Donovan and colleagues in this issue of the Journal1 found that care for hospital patients with diabetes is suboptimal. The authors report that rates of medication error and hospital‐acquired diabetic ketoacidosis are high and that peri‐operative planning is inadequate. This is a major problem, as many hospital inpatients have diabetes.
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No relevant disclosures.
The coronavirus disease 2019 (COVID‐19) pandemic reduced routine vaccination activity in many countries.1,2,3 Strict physical distancing and movement restrictions (stage 3 lockdown measures) were implemented in Australia from 23 March 2020, with many health care providers moving to telehealth‐based models of care. Earlier analyses found the first pandemic wave did not affect childhood vaccination activity at the national or state/territory levels to July 2020.4 But vaccination activity has not been assessed during the more stringent stage 4 lockdowns during the second epidemic wave in Victoria (early August ‒ late October 2020). Further, the effects of the shift to remote learning on the vaccination of adolescents, usually delivered in schools, have not been assessed, nor the impact of the epidemic on vaccinations for older adults. We therefore compared vaccination activity in Victoria in 2019 and 2020 by analysing de‐identified Australian Immunisation Register (AIR) surveillance data (status: 28 February 2021). The Sydney Children’s Hospitals Network Human Research Ethics Committee exempted our analysis of AIR data, approved by the Australian Department of Health, from formal ethics approval.
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In Australia, there is a paucity of coordinated strategies for preventing, detecting, and managing NAFLD
Despite being the most frequent cause of chronic liver disease in Australia, the prevalence and clinical consequences of non‐alcoholic fatty liver disease (NAFLD) remain uncertain.1 Accurate population‐based data on the burden of NAFLD are crucial for guiding public health strategies and directing health care resources to reducing the incidence of NAFLD and associated metabolic conditions.
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Lucy Gracen is supported by a PA Research Foundation research award (2021).
Elizabeth Powell has received an unrestricted grant from Siemens Healthineers.
Developing a pathway to prioritise clinical research and prepare for future pandemics remains an urgent need
The emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), sparking a global pandemic,1 has driven an imperative to quickly design and conduct treatment studies. We strongly propose a national, coordinated approach for randomised controlled trials (RCTs) for coronavirus disease 2019 (COVID‐19), future pandemics and inter‐pandemic periods in Australia. Our reflections represent those of the Australasian COVID‐19 Trial (ASCOT)2 steering committee, as we have considered the challenges of conducting a clinical trial during the COVID‐19 pandemic in Australia.
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All authors are members of the ASCOT steering committee.
Objective: To quantify the burden of invasive group A Streptococcus (GAS) disease in Western Australia during 2000–2018.
Design, setting: Population‐based data linkage study: Hospital Morbidity Data Collection (HMDC; all WA public and private hospital records), PathWest pathology data (government‐owned pathology services provider), and death registrations.
Participants: People with invasive GAS disease, defined by an isolate from a normally sterile site (PathWest) or a hospital‐based principal ICD‐10‐AM diagnosis code (HMDC).
Main outcome measures: Incidence of invasive GAS disease; median length of hospital stay; all‐cause mortality.
Results: We identified 2237 cases of GAS disease during 2000‒2018; 1283 were in male patients (57%). 1950 cases had been confirmed by GAS isolates from normally sterile tissues (87%; including 1089 from blood [56% of cases] and 750 from tissue [38%]). The age‐standardised incidence increased from 2.0 (95% CI, 1.4–2.7) cases per 100 000 population in 2000 to 9.1 (95% CI, 7.9–10.2) cases per 100 000 in 2017 (by year, adjusted for age group and sex: incidence rate ratio [IRR], 1.09; 95% CI, 1.08–1.10). Incidence was consistently higher among Indigenous than non‐Indigenous Australians (year‐adjusted IRR, 13.1; 95% CI, 11.3–15.1). All‐cause 30‐day mortality was 5% (116 deaths), and 90‐day mortality 7% (156 deaths); 30‐day mortality, adjusted for age group and sex, was not statistically significantly different for cases involving Indigenous or non‐Indigenous patients (adjusted odds ratio, 0.8; 95% CI, 0.6–1.1).
Conclusions: The incidence of invasive GAS disease in WA increased between 2000 and 2018, particularly among Indigenous Australians. Mandatory notification of invasive GAS disease would therefore be appropriate. The social determinants of differences in incidence should be addressed, and other relevant host, pathogen, and health system factors investigated.
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Data acquisition costs for this study were jointly funded by the Telethon Kids Institute and the Department of Infectious Diseases, the Fiona Stanley Fremantle Hospitals Group. We acknowledge the WA Data Linkage Branch for providing the linked data, Ryan Shave (WA Department of Health) for assistance with research governance approvals, Brett Cawley (PathWest) for assisting with identifying PathWest cases, Susan Benson (Curtin University, University of Western Australia) for assisting with blood culture results interpretation, and the people whose data were analysed in this study. Cameron Wright completed this work as part of scholarly activity for his Doctor of Medicine degree from the University of Western Australia.
No relevant disclosures.
Supporting physicians to practise rurally is complex and should be part of a multifaceted strategy to provide more health care in the bush
The distribution of health professionals between metropolitan, regional, rural and remote areas is a key issue for access to health care for rural populations. Increasing reliance on domestically trained doctors rather than international medical graduates, the backbone of medical care provision in rural areas, is expensive and will require effort over decades. Clear short term policy solutions do not exist,1 and long term solutions rely on fundamental changes to the way doctors are recruited, trained and supported,2 which require a high level of coordination between the many stakeholders involved in medical training.
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Jennifer May is Co‐Chair of the National Medical Workforce Strategy and received sitting fees.
Responses to the health care needs of this vulnerable group have improved, but further progress is needed
Finding good measures of the effectiveness of health care in the community is challenging, and this problem certainly applies to care for Australians with intellectual disability. The study by Weise and colleagues,1 reported in this issue of the MJA, underscores the extent of health care disadvantage experienced by people with intellectual disability in Australia.
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Abstract
Objectives: To estimate the annual burden of mortality and the associated health costs attributable to air pollution from wood heaters in Armidale.
Design: Health impact assessment (excess annual mortality and financial costs) based upon atmospheric PM2.5 measurements.
Setting: Armidale, a regional Australian city (population, 24 504) with high levels of air pollution in winter caused by domestic wood heaters, 1 May 2018 – 30 April 2019.
Main outcome measures: Estimated population exposure to PM2.5 from wood heaters; estimated numbers of premature deaths and years of life lost.
Results: Fourteen premature deaths (95% CI, 12–17 deaths) per year, corresponding to 210 (95% CI, 172–249) years of life lost, are attributable to long term exposure to wood heater PM2.5 pollution in Armidale. The estimated financial cost is $32.8 million (95% CI, $27.0–38.5 million), or $10 930 (95% CI, $9004–12 822) per wood heater per year.
Conclusions: The substantial mortality and financial cost attributable to wood heating in Armidale indicates that effective policies are needed to reduce wood heater pollution, including public education about the effects of wood smoke on health, subsidies that encourage residents to switch to less polluting home heating (perhaps as part of an economic recovery package), assistance for those affected by wood smoke from other people, and regulations that reduce wood heater use (eg, by not permitting new wood heaters and requiring existing units to be removed when houses are sold).