MJA
MJA

Closing the Gap: where to now?

Talila Milroy and Lilon G Bandler
Med J Aust 2021; 214 (5): . || doi: 10.5694/mja2.50959
Published online: 15 March 2021

Let us move our focus to building health care relationships and partnerships that optimise care for every Indigenous patient

In 1978, the International Conference on Primary Health Care declared that “governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures.”1 In 2007, Closing the Gap was heralded by the Australian government as a shift in health policy for Indigenous Australians, proposing drastic action that would be measured against clear benchmarks.2 The flaw in this policy was the assumption that a homogenous approach, unaccompanied by deep, meaningful engagement with Indigenous people, communities, and health care services would be sufficient. Fourteen years later, the goal of closing the gap in life expectancy between Indigenous and non‐Indigenous Australians by 2031 “is not on track”.3 In 2020, the incorporation of Indigenous perspectives into health care, and greater control of health‐related targets and programs by Indigenous‐led organisations promised change, despite risks, including peak Indigenous health care bodies being “held responsible for any future policy failings.”4

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Hepatocellular carcinoma in Indigenous Australians: a call to action

Jessica Howell, James S Ward, Jane Davies, Paul J Clark and Joshua S Davis
Med J Aust 2021; 214 (5): . || doi: 10.5694/mja2.50961
Published online: 15 March 2021

Liver disease and liver cancer incidence and mortality are unacceptably high among Indigenous Australians

Hepatocellular carcinoma (HCC) is an urgent public health issue in Australia.1 Indigenous Australians are disproportionately affected by liver disease and HCC,2 and suffer substantially greater HCC‐related mortality than non‐Indigenous Australians.2,3 With the release of the Australian national consensus statement on hepatocellular carcinoma in December 20204 and international focus on equity and the rights of Indigenous peoples, it is timely to reflect upon the key actions that must be taken to reduce HCC incidence and mortality for Indigenous Australians.

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  • 1 St Vincent’s Hospital, Melbourne, VIC
  • 2 University of Queensland, Brisbane, QLD
  • 3 Poche Centre for Indigenous Health, University of Queensland, Brisbane, QLD
  • 4 Menzies School of Health Research, Darwin, NT
  • 5 John Hunter Hospital, Newcastle, NSW


Correspondence: jessica.howell@svha.org.au

Acknowledgements: 

Jessica Howell is supported by a University of Melbourne CR Roper Faculty Fellowship and a National Health and Medical Research Council Program Grant.

Competing interests:

Jessica Howell has received an Australia Fellowship from Gilead Sciences in 2017 and 2019, and investigator‐initiated grant funds and speaker fees from Gilead Sciences.

  • 1. Wallace MC, Preen DB, Short MW, et al. Hepatocellular carcinoma in Australia 1982–2014: increasing incidence and improving survival. Liver Int 2019; 39: 522–530.
  • 2. Parker C, Tong SY, Dempsey K, et al. Hepatocellular carcinoma in Australia’s Northern Territory: high incidence and poor outcome. Med J Aust 2014; 201: 470–474. https://www.mja.com.au/journal/2014/201/8/hepatocellular-carcinoma-australias-northern-territory-high-incidence-and-poor
  • 3. Banham D, Roder D, Keefe D, et al. Disparities in cancer stage at diagnosis and survival of Aboriginal and non‐Aboriginal South Australians. Cancer Epidemiol 2017; 48: 131–139.
  • 4. Lubel JS, Roberts SK, Strasser SI, et al. Australian recommendations for the management of hepatocellular carcinoma: a consensus statement. Med J Aust 2020; https://www.mja.com.au/journal/2020/214/10/australian-recommendations-management-hepatocellular-carcinoma-consensus [online ahead of print].
  • 5. Condon JR, Zhang X, Dempsey K, et al. Trends in cancer incidence and survival for Indigenous and non‐Indigenous people in the Northern Territory. Med J Aust 2016; 205: 454–458. https://www.mja.com.au/journal/2017/207/1/trends-cancer-incidence-and-survival-indigenous-and-non-indigenous-people
  • 6. Graham S, Guy RJ, Cowie B, et al. Chronic hepatitis B prevalence among Aboriginal and Torres Strait Islander Australians since universal vaccination: a systematic review and meta‐analysis. BMC Infect Dis 2013; 13: 403.
  • 7. Graham S, Harrod ME, Iversen J, Hocking JS. Prevalence of hepatitis C among Australian Aboriginal and Torres Strait Islander people: a systematic review and meta‐analysis. Hepat Mon 2016; 16: e38640.
  • 8. Li M, Roder D, McDermott R. Diabetes and smoking as predictors of cancer in Indigenous adults from rural and remote communities of North Queensland – a 15‐year follow up study. Int J Cancer 2018; 143: 1054–1061.
  • 9. Dyer SM, Gomersall JS, Smithers LG, et al. Prevalence and characteristics of overweight and obesity in indigenous Australian children: a systematic review. Crit Rev Food Sci Nutr 2017; 57: 1365–1376.
  • 10. Valery PC, McPhail S, Stuart KA, et al. Changing prevalence of aetiological factors and comorbidities among Australians hospitalised for cirrhosis. Intern Med J 2020; https://doi.org/10.1111/imj.14809 [online ahead of print].
  • 11. Clark PJ, Stuart KA, Leggett BA, et al. Remoteness, race and social disadvantage: disparities in hepatocellular carcinoma incidence and survival in Queensland, Australia. Liver Int 2015; 35: 2584–2594.
  • 12. Howell J, Pedrana A, Cowie BC, et al. Aiming for the elimination of viral hepatitis in Australia, New Zealand, and the Pacific Islands and Territories: where are we now and barriers to meeting World Health Organization targets by 2030. J Gastroenterol Hepatol 2019; 34: 40–48.
  • 13. Davies J, Bukulatjpi S, Sharma S, et al. Development of a culturally appropriate bilingual electronic app about hepatitis B for Indigenous Australians: towards shared understandings. JMIR Res Protoc 2015; 4: e70.
  • 14. Davies J, Li SQ, Tong SY, et al. Establishing contemporary trends in hepatitis B sero‐epidemiology in an Indigenous population. PLoS One 2017; 12: e0184082.
  • 15. Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander Health Performance Framework 2020 summary report (Cat. No. IHPF 2). Canberra: AIHW, 2020. https://www.aihw.gov.au/reports/indigenous-health-welfare/health-performance-framework/contents/overview (viewed Feb 2021).
  • 16. Hosking K, Stewart G, Mobsby M, et al. Data linkage and computerised algorithmic coding to enhance individual clinical care for Aboriginal people living with chronic hepatitis B in the Northern Territory of Australia – is it feasible? PLOS One 2020; 15: e0232207.
  • 17. Bradley C, Hengel B, Crawford K, et al. Establishment of a sentinel surveillance network for sexually transmissible infections and blood borne viruses in Aboriginal primary care services across Australia: the ATLAS project. BMC Health Serv Res 2020; 20: 769.
  • 18. Sullivan RP, Davies J, Binks P, et al. Point of care and oral fluid hepatitis B testing in remote Indigenous communities of northern Australia. J Viral Hepat 2019; 27: 407–414.
  • 19. Hla TKBS, Binks P, Gurruwiwi GG, et al. A “one stop liver shop” approach improves the cascade‐of-care for Aboriginal and Torres Strait Islander Australians living with chronic hepatitis B in the Northern Territory of Australia: results of a novel care delivery model. Int J Equity Health 2020; 19: 64.
  • 20. Treloar C, Hopwood M, Cama E, et al. Evaluation of the Deadly Liver Mob program: insights for roll‐out and scale‐up of a pilot program to engage Aboriginal Australians in hepatitis C and sexual health education, screening, and care. Harm Reduct J 2018; 15: 5.
  • 21. Ivers R, Jackson B, Levett T, et al. Home to health care to hospital: Evaluation of a cancer care team based in Australian Aboriginal primary care. Aust J Rural Health 2019; 27: 88–92.
  • 22. Mohsen W, Chan P, Whelan M, et al. Hepatitis C treatment for difficult to access populations: can telementoring (as distinct from telemedicine) help? Intern Med J 2019; 49: 351–357.
  • 23. Herman A, Bullen C, Finau S, Ofanoa M. Mobilising Pacific people for health: insights from a hepatitis B screening programme in Auckland, New Zealand. Pac Health Dialog 2006; 13: 9–15.
  • 24. Becker DM, Tafoya CA, Becker SL, et al. The use of portable ultrasound devices in low‐ and middle‐income countries: a systematic review of the literature. Trop Med Int Health 2016; 21: 294–311.
  • 25. Ladep NG, Dona AC, Lewis MR, et al. Discovery and validation of urinary metabotypes for the diagnosis of hepatocellular carcinoma in West Africans. Hepatology 2014; 60: 1291–1301.
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The indirect impacts of COVID‐19 on Aboriginal communities across New South Wales

David Follent, Cory Paulson, Phillip Orcher, Barbara O'Neill, Debbie Lee, Karl Briscoe and Tara L Dimopoulos‐Bick
Med J Aust 2021; 214 (5): . || doi: 10.5694/mja2.50948
Published online: 1 March 2021

Evidence to inform conversations on Aboriginal health issues — in response to COVID‐19 and beyond

Nearly everyone has been affected in some way by the coronavirus disease 2019 (COVID‐19) pandemic, and it is a public health risk for Aboriginal peoples and communities.1 The impacts of the pandemic are pervasive, wide‐ranging and continue to affect people and communities differently. Concerns about the indirect impacts of COVID‐19, caused by missed, delayed and avoided health care — not as a direct consequence of COVID‐19 infections — are shared internationally.2,3,4

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  • 1 Agency for Clinical Innovation, Sydney, NSW
  • 2 Far West Mental Health Drug and Alcohol Service, Broken Hill, NSW
  • 3 Junction Neighbourhood Centre, Sydney, NSW
  • 4 First Peoples Disability Network, Sydney, NSW
  • 5 National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners, Canberra, ACT



Acknowledgements: 

We acknowledge the contributions of everyone who participated in these important conversations. We acknowledge that as the host of these conversations, NSW Health was privy to the ancient and traditional process of yarning and the respect and sharing of knowledge that this involves. We acknowledge the lands on which these conversations took place, the lands of an ancient and continuing culture, and we acknowledge and pay respect to the elders past, present and emerging of these Aboriginal lands. These lands always were and always will be Aboriginal land. We thank Kim Sutherland and Jean‐Frederic Levesque from the Agency for Clinical Innovation and the Critical Intelligence Unit for their ongoing support.

Competing interests:

No relevant disclosures.

  • 1. Crooks K, Casey D, Ward JS. First Nations peoples leading the way in COVID‐19 pandemic planning, response and management. Med J Aust 2020; 213: 151–152. https://www.mja.com.au/journal/2020/213/4/first-nations-peoples-leading-way-covid-19-pandemic-planning-response-and
  • 2. Sud A, Jones ME, Broggio J, et al. Collateral damage: the impact on outcomes from cancer surgery of the COVID‐19 pandemic. Ann Oncol 2020; 31: 1065–1074.
  • 3. Newby JM, O’Moore K, Tang S, et al. Acute mental health responses during the COVID‐19 pandemic in Australia. PLoS One 2020; 15: e0236562.
  • 4. Power T, Wilson D, Best O, Brockie T, et al. COVID‐19 and Indigenous peoples: an imperative for action. J Clin Nurs 2020; 29: 2737–2741.
  • 5. McAnulty JM, Ward K. Suppressing the epidemic in New South Wales. N Engl J Med 2020; 382: e74.
  • 6. Sutherland K, Chessman J, Zhao J, et al. Impact of COVID‐19 on healthcare activity in NSW. Australia. Public Health Res Pract 2020; 30: 3042030.
  • 7. Moynihan R, Sanders S, Michaleff ZA, et al. Pandemic impacts on healthcare utilisation: a systematic review [preprint]. medRxiv 2020; 2020.10.26.20219352.
  • 8. Yashadhana A, Pollard‐Wharton N, Zwi AB, Biles B. Indigenous Australians at increased risk of COVID‐19 due to existing health and socioeconomic inequities. Lancet Regional Health Western Pacific 2020; 1: 100007.
  • 9. Eades S, Eades F, McCaullay D, et al. Australia’s First Nations’ response to the COVID‐19 pandemic. Lancet 2020; 396: 237–238.
  • 10. Carson B, Dunbar T, Chenhall R, Bailie R editors. Social determinants of Indigenous health. London: Routledge, 2007.
  • 11. World Health Organization. Social determinants of health. https://www.who.int/social_determinants/en/ (viewed Oct 2020).
  • 12. Kingsley J, Munro‐Harrison E, Jenkins A, Thorpe A. “Here we are part of a living culture”: understanding the cultural determinants of health in Aboriginal gathering places in Victoria, Australia. Health Place 2018; 54: 210–220.
  • 13. Abrams EM, Szefler SJ. COVID‐19 and the impact of social determinants of health. Lancet Resp Med 2020; 8: 659–661.
  • 14. Shah GH, Shankar P, Schwind JS, Sittaramane V. The detrimental impact of the COVID‐19 crisis on health equity and social determinants of health. J Public Health Manag Pract 2020; 26: 317–319.
  • 15. Australian Health Practitioner Regulation Agency. Aboriginal and Torres Strait Islander Health Strategy – statement of intent. https://www.ahpra.gov.au/About-Ahpra/Aboriginal-and-Torres-Strait-Islander-Health-Strategy/Statement-of-intent.aspx (viewed Jan 2021).
  • 16. Child Family Community Australia. LGBTIQA+ communities: glossary of common terms. CFCA resource sheet – Nov 2019. https://aifs.gov.au/cfca/publications/lgbtiq-communities (viewed Jan 2021).
  • 17. Hindman L. COVID‐19: ethical decision‐making for First Peoples living with disability. First Peoples Disability Network Australia, 2020. https://fpdn.org.au/covid-19-ethical-decision-making-for-first-peoples-living-with-disability/ (viewed Jan 2021).
  • 18. Katz I, Jones A, Newton B, Reimer E. Life journeys of victim/survivors of child sexual abuse in institutions: an analysis of Royal Commission private sessions. Royal Commission into Institutional Responses to Child Sexual Abuse. Canberra: Commonwealth of Australia. 2017. https://www.arts.unsw.edu.au/sites/default/files/documents/Life_journeys_of_victims_survivors_of_child_sexual_abuse_in_institutions.pdf (viewed Jan 2021).
  • 19. Dudgeon P, Derry K, Wright M. A national COVID‐19 pandemic issues paper on mental health and wellbeing for Aboriginal and Torres Strait Islander Peoples. Perth: University of Western Australia, 2020. https://apo.org.au/sites/default/files/resource-files/2020-06/apo-nid306661.pdf (viewed Jan 2021).
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Seroprevalence of SARS‐CoV‐2‐specific antibodies in Sydney after the first epidemic wave of 2020

Heather F Gidding, Dorothy A Machalek, Alexandra J Hendry, Helen E Quinn, Kaitlyn Vette, Frank H Beard, Hannah S Shilling, Rena Hirani, Iain B Gosbell, David O Irving, Linda Hueston, Marnie Downes, John B Carlin, Matthew VN O'Sullivan, Dominic E Dwyer, John M Kaldor and Kristine Macartney
Med J Aust 2021; 214 (4): . || doi: 10.5694/mja2.50940
Published online: 1 March 2021

Abstract

Objectives: To estimate SARS‐CoV‐2‐specific antibody seroprevalence after the first epidemic wave of coronavirus disease 2019 (COVID‐19) in Sydney.

Setting, participants: People of any age who had provided blood for testing at selected diagnostic pathology services (general pathology); pregnant women aged 20–39 years who had received routine antenatal screening; and Australian Red Cross Lifeblood plasmapheresis donors aged 20–69 years.

Design: Cross‐sectional study; testing of de‐identified residual blood specimens collected during 20 April – 2 June 2020.

Main outcome measure: Estimated proportions of people seropositive for anti‐SARS‐CoV‐2‐specific IgG, adjusted for test sensitivity and specificity.

Results: Thirty‐eight of 5339 specimens were IgG‐positive (general pathology, 19 of 3231; antenatal screening, 7 of 560; plasmapheresis donors, 12 of 1548); there were no clear patterns by age group, sex, or location of residence. Adjusted estimated seroprevalence among people who had had general pathology blood tests (all ages) was 0.15% (95% credible interval [CrI], 0.04–0.41%), and 0.29% (95% CrI, 0.04–0.75%) for plasmapheresis donors (20–69 years). Among 20–39‐year‐old people, the age group common to all three collection groups, adjusted estimated seroprevalence was 0.24% (95% CrI, 0.04–0.80%) for the general pathology group, 0.79% (95% CrI, 0.04–1.88%) for the antenatal screening group, and 0.69% (95% CrI, 0.04–1.59%) for plasmapheresis donors.

Conclusions: Estimated SARS‐CoV‐2 seroprevalence was below 1%, indicating that community transmission was low during the first COVID‐19 epidemic wave in Sydney. These findings suggest that early control of the spread of COVID‐19 was successful, but efforts to reduce further transmission remain important.

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  • 1 National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Sydney, NSW
  • 2 Northern Clinical School, University of Sydney, Sydney, NSW
  • 3 Women and Babies Research, Kolling Institute, Sydney, NSW
  • 4 The Kirby Institute, University of New South Wales, Sydney, NSW
  • 5 The University of Sydney, Sydney, NSW
  • 6 Centre for Women’s Infectious Diseases, Royal Women’s Hospital, Melbourne, VIC
  • 7 Australian Red Cross Lifeblood, Sydney, NSW
  • 8 Western Sydney University, Sydney, NSW
  • 9 University of Technology Sydney, Sydney, NSW
  • 10 NSW Health Pathology–Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, NSW
  • 11 Murdoch Children’s Research Institute, Melbourne, VIC
  • 12 The University of Melbourne, Melbourne, VIC
  • 13 Centre for Infectious Disease and Microbiology, Westmead Hospital, Sydney, NSW
  • 14 Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW



Acknowledgements: 

This study was funded by the NSW Ministry of Health. The National Centre for Immunisation Research and Surveillance is supported by the Australian Department of Health, the NSW Ministry of Health, and the Children’s Hospital at Westmead. Heather Gidding and John Kaldor are supported by National Health and Medical Research Council fellowships. Australian governments fund Australian Red Cross Lifeblood to provide blood, blood products and services to the Australian community.

We thank everyone who contributed to this investigation, especially the laboratory staff who collected the specimens and the scientific staff who performed the IFA and neutralisation assays, including Katherine Tudo, Melanie Lograsso and Bassam Al Zahroon (NSW Health Pathology–Institute of Clinical Pathology and Medical Research); Andrew Cullen, Ian Chambers, Annabelle Farnsworth, Karen Wagner and Daniel Clifford (Douglass Hanly Moir Pathology); Agustin Franco, Pratibha James and Michael Mark (4Cyte Pathology); Juliette Holland and Kartik Naidu (Laverty Pathology); Rebecca Burrell, Philip Britton and Alex Micati (Children’s Hospital at Westmead); Elizabeth Knight (Australian Red Cross Lifeblood); and Darren Croese (NSW Health Pathology incident management team). We are grateful to Lucy Armstrong (National Centre for Immunisation Research and Surveillance) for her help with coordinating the study; Heather Whitaker and Nick Andrews (Public Health England) for their statistical advice and sharing their analysis code; James McCaw and Jodie McVernon (Peter Doherty Institute) for their advice on the initial study design; and Michelle Cretikos, Roy Byun, Sheena Adamson and Laura Collie (NSW Ministry of Health) for their helpful advice.

Competing interests:

No relevant disclosures.

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Preventing suicide by young people requires integrative strategies

Michael J Dudley and Ping-I Lin
Med J Aust 2021; 214 (3): . || doi: 10.5694/mja2.50939
Published online: 15 February 2021
Correction(s) for this article: Erratum | Published online: 13 April 2025

We need more robust strategies with targeted, customised approaches, and funding for evidence‐based interventions

Suicide is the leading cause of death of young people in Australia,1 despite extensive research into risk factors for self‐harm. In this issue of the MJA, Hill and colleagues2 report their analysis of National Coronial Information System (NCIS) data for the 3365 young people (10–24 years old) who died by suicide in Australia during 2006–2015. Most were boys or young men (74%); many had diagnosed or possible mental health problems (57%), but fewer than one in three had been in contact with mental health services. A large proportion (38%) were not employed or in education or training at the time of their deaths; 14% were Indigenous Australians, 8% resided in remote locations, and 38% lived in the socio‐economically most disadvantaged regions of Australia.2 Although Hill and her co‐authors could not assess causal relationships between these factors and suicide, their statistics suggest potential targets for focused prevention.


  • 1 Adolescent Service, Prince of Wales and Sydney Children's Hospitals, Sydney, NSW
  • 2 University of New South Wales, Sydney, NSW
  • 3 South Western Sydney Local Health District, Sydney, NSW


Correspondence: m.dudley@unsw.edu.au

Competing interests:

No relevant disclosures.

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Biosimilars: is interchangeability the proof of the pudding?

Gregory T Moore and Charlotte Keung
Med J Aust 2021; 214 (3): . || doi: 10.5694/mja2.50912
Published online: 15 February 2021

While apparently non‐inferior to originator biologics, other factors need to be considered before switching

Biologic drugs are large monoclonal antibodies or genetically engineered proteins produced by live organisms. With highly specific targets, they have revolutionised the treatment of inflammatory, endocrine, and malignant conditions. However, these drugs are expensive, partly because of the complex and costly manufacturing processes required, partly because long periods of therapy are often needed.


  • 1 Monash Health, Melbourne, VIC
  • 2 Monash University, Melbourne, VIC


Correspondence: gregory.moore@monash.edu

Competing interests:

Gregory Moore has received payment for advisory boards from AbbVie, BMS, Chiesi, Emerge, Gilead, Hospira, Janssen, Orphan, MSD, Pfizer, Shire, Takeda; speaker’s fees from AbbVie, Ferring, Janssen, Orphan, Pfizer, Roche, Shire, and Takeda; and research and educational support from AbbVie, Janssen, Pfizer, Shire, and Takeda.

  • 1. Australian Department of Health. Which biosimilar medicines are available in Australia? Updated 10 Sept 2020. https://www1.health.gov.au/internet/main/publishing.nsf/Content/biosimilar-which-medicines-are-available-in-australia (viewed Nov 2020).]
  • 2. Therapeutic Goods Administration (Australian Department of Health). Biosimilar medicines regulation, version 2.2. Apr 2018. https://www.tga.gov.au/publication/biosimilar-medicines-regulation (viewed Nov 2020).
  • 3. Park W, Hrycaj P, Jeka S, et al. A randomised, double‐blind, multicentre, parallel‐group, prospective study comparing the pharmacokinetics, safety, and efficacy of CT‐P13 and innovator infliximab in patients with ankylosing spondylitis: the PLANETAS study. Ann Rheum Dis 2013; 72: 1605–1612.
  • 4. Yoo DH, Hrycaj P, Miranda P, et al. A randomised, double‐blind, parallel‐group study to demonstrate equivalence in efficacy and safety of CT‐P13 compared with innovator infliximab when coadministered with methotrexate in patients with active rheumatoid arthritis: the PLANETRA study. Ann Rheum Dis 2013; 72: 1613–1620.
  • 5. Haifer C, Srinivasan A, An YK, et al. Switching Australian patients with moderate to severe inflammatory bowel disease from originator to biosimilar infliximab: a multicentre, parallel cohort study. Med J Aust 2021; 214: 128–133.
  • 6. Jørgensen KK, Olsen IC, Goll GL, et al. NOR‐SWITCH study group. Switching from originator infliximab to biosimilar CT‐P13 compared with maintained treatment with originator infliximab (NOR‐SWITCH): a 52‐week, randomised, double‐blind, non‐inferiority trial. Lancet 2017; 389: 2304–2316.
  • 7. Jørgensen KK, Goll GL, Sexton J, et al. Efficacy and safety of CT‐P13 in inflammatory bowel disease after switching from originator infliximab: exploratory analyses from the NOR‐SWITCH main and extension trials. BioDrugs 2020; 34: 681–694.
  • 8. Ye BD, Pesegova M, Alexeeva O, et al. Efficacy and safety of biosimilar CT‐P13 compared with originator infliximab in patients with active Crohn’s disease: an international, randomised, double‐blind, phase 3 non‐inferiority study. Lancet 2019; 393: 1699–1707.
  • 9. Ben‐Horin S, Yavzori M, Benhar I, et al. Cross‐immunogenicity: antibodies to infliximab in Remicade‐treated patients with IBD similarly recognise the biosimilar Remsima. Gut 2016; 65: 1132–1138.
  • 10. Goncalves J, Myung G, Park M, et al. SB5 shows cross‐immunogenicity to adalimumab but not infliximab: results in patients with inflammatory bowel disease or rheumatoid arthritis. Therap Adv Gastroenterol 2019; 12: 1756284819891081.
  • 11. Strik AS, van de Vrie W, Bloemsaat‐Minekus JPJ, et al. SECURE study group. Serum concentrations after switching from originator infliximab to the biosimilar CT‐P13 in patients with quiescent inflammatory bowel disease (SECURE): an open‐label, multicentre, phase 4 non‐inferiority trial. Lancet Gastroenterol Hepatol 2018; 3: 404–412.
  • 12. Australian Department of Health. Biosimilar uptake drivers. 2018. https://www.pbs.gov.au/general/biosimilars/biosimilar-uptake-drivers-q-and-a.pdf (viewed Nov 2020).
  • 13. Glintborg B, Loft AG, Omerovic E, et al. To switch or not to switch: results of a nationwide guideline of mandatory switching from originator to biosimilar etanercept. One‐year treatment outcomes in 2061 patients with inflammatory arthritis from the DANBIO registry. Ann Rheum Dis 2019; 78: 192–200.
  • 14. Lauret A, Moltó A, Abitbol V, et al. Effects of successive switches to different biosimilars infliximab on immunogenicity in chronic inflammatory diseases in daily clinical practice Semin Arthritis Rheum 2020; 50: 1449–1456.
  • 15. Zarrin AA, Bao K, Lupardus P, Vucic D. Kinase inhibition in autoimmunity and inflammation. Nat Rev Drug Discov 2021; 20: 39–63.
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What are people saying on social networking sites about the Australian alcohol consumption guidelines?

Benjamin C Riordan, Daniel T Winter, Paul S Haber, Carolyn A Day and Kirsten C Morley
Med J Aust 2021; 214 (3): . || doi: 10.5694/mja2.50902
Published online: 15 February 2021

Posts provide valuable feedback during public consultation for health guidelines

Guidelines provide important information on key health behaviours that can influence the population, with public consultation forming an important part of guideline development.1 Public consultation provides transparency, while improving the quality, legitimacy and acceptability of guidelines to the public.1 Although the public are encouraged to provide formal feedback, they may also discuss and provide valuable feedback on popular social networking sites such as Twitter and Reddit. Social networking sites are universal, with 5.8 million Australians using Twitter and 110 000 using Reddit each month.2 Given that a number of these posts are publicly available, they can be used to answer research questions and track health behaviours,3,4,5 and may be an informative source of feedback on health guidelines during public consultation.6


  • 1 University of Sydney, Sydney, NSW
  • 2 Royal Prince Alfred Hospital, Sydney, NSW



Competing interests:

No relevant disclosures.

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Modelling the impact of relaxing COVID‐19 control measures during a period of low viral transmission

Nick Scott, Anna Palmer, Dominic Delport, Romesh Abeysuriya, Robyn M Stuart, Cliff C Kerr, Dina Mistry, Daniel J Klein, Rachel Sacks‐Davis, Katie Heath, Samuel W Hainsworth, Alisa Pedrana, Mark Stoove, David Wilson and Margaret E Hellard
Med J Aust 2021; 214 (2): . || doi: 10.5694/mja2.50845
Published online: 1 February 2021

Abstract

Objectives: To assess the risks associated with relaxing coronavirus disease 2019 (COVID‐19)‐related physical distancing restrictions and lockdown policies during a period of low viral transmission.

Design: Network‐based viral transmission risks in households, schools, workplaces, and a variety of community spaces and activities were simulated in an agent‐based model, Covasim.

Setting: The model was calibrated for a baseline scenario reflecting the epidemiological and policy environment in Victoria during March–May 2020, a period of low community viral transmission.

Intervention: Policy changes for easing COVID‐19‐related restrictions from May 2020 were simulated in the context of interventions that included testing, contact tracing (including with a smartphone app), and quarantine.

Main outcome measure: Increase in detected COVID‐19 cases following relaxation of restrictions.

Results: Policy changes that facilitate contact of individuals with large numbers of unknown people (eg, opening bars, increased public transport use) were associated with the greatest risk of COVID‐19 case numbers increasing; changes leading to smaller, structured gatherings with known contacts (eg, small social gatherings, opening schools) were associated with lower risks. In our model, the rise in case numbers following some policy changes was notable only two months after their implementation.

Conclusions: Removing several COVID‐19‐related restrictions within a short period of time should be undertaken with care, as the consequences may not be apparent for more than two months. Our findings support continuation of work from home policies (to reduce public transport use) and strategies that mitigate the risk associated with re‐opening of social venues.

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  • 1 Burnet Institute, Melbourne, VIC
  • 2 University of Copenhagen, Copenhagen, Denmark
  • 3 Institute for Disease Modeling, Bellevue, WA, United States of America


Correspondence: nick.scott@burnet.edu.au

Acknowledgements: 

We thank Allan J Saul, Angela Davis, Joseph Doyle, Sherrie Kelly and Suman Majumdar (Burnet Institute) for their contributions to parameter estimates, and additional members of the Institute for Disease Modelling team who contributed to the base Covasim model.

Competing interests:

No relevant disclosures.

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Putting the “good” into Good Clinical Practice

Tanya Symons, Steve Webb and John R Zalcberg
Med J Aust 2021; 214 (2): . || doi: 10.5694/mja2.50908
Published online: 1 February 2021

Current Good Clinical Practice guidelines are bureaucratic and should align with less burdensome examples of international trial policy

Clinical trials must be conducted in ways that protect participants and produce reliable results. Both are central tenets of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) Good Clinical Practice (GCP) guideline.1 The ICH GCP guideline was developed to harmonise the conduct of trials across world regions and, since the mid‐1990s, its core principles have provided the bedrock for trial conduct. However, the devil is in the detail and, in the case of the ICH GCP guideline, that detail (and the interpretation of each word) has far‐reaching consequences.


  • 1 University of Sydney, Sydney, NSW
  • 2 Royal Perth Hospital, Perth, WA
  • 3 Monash University, Melbourne, VIC


Correspondence: tanya.symons@sydney.edu.au

Competing interests:

No relevant disclosures.

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Unprofessional behaviour in Australian hospitals

Anthony Scott and Danny Hills
Med J Aust 2021; 214 (1): . || doi: 10.5694/mja2.50891
Published online: 18 January 2021

Inappropriate behaviour harms health workers and patients, and evidence‐based solutions are needed

Health care is the largest employment sector in Australia, more than 1.7 million workers (14% of all employees).1 Incivility, bullying, aggression, and negative workplace cultures seem endemic and have repeatedly been associated with poor workforce and clinical outcomes, but high quality evaluation of interventions for eliminating these behaviours are rare.2,3,4


  • 1 Melbourne Institute: Applied Economic and Social Research, Melbourne, VIC
  • 2 Federation University Australia, Ballarat, VIC


Correspondence: a.scott@unimelb.edu.au

Competing interests:

No relevant disclosures.

  • 1. Australian Bureau of Statistics. 6291.0.55.003. Labour force, Australia, detailed (May 2020). June 2020. https://www.abs.gov.au/statistics/labour/employment-and-unemployment/labour-force-australia-detailed/may-2020 (viewed Sept 2020).
  • 2. Westbrook J, Sunderland N, Atkinson V, et al. Endemic unprofessional behaviour in health care: the mandate for a change in approach. Med J Aust 2018; 209: 380–381. https://www.mja.com.au/journal/2018/209/9/endemic-unprofessional-behaviour-health-care-mandate-change-approach
  • 3. Mannion R, Davies H. Understanding organisational culture for healthcare quality improvement. BMJ 2018; 363: k4907.
  • 4. Choo EK, Byington CL, Johnson NL, et al. From #MeToo to #TimesUp in health care: can a culture of accountability end inequity and harassment? Lancet 2019; 393: 499–502.
  • 5. Westbrook J, Sunderland N, Li L, et al. The prevalence and impact of unprofessional behaviour among hospital workers: a survey in seven Australian hospitals. Med J Aust 2021; 214: 31–37.
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  • 7. Hills D, Lam L, Hills S. Workplace aggression experiences and responses of Victorian nurses, midwives and care personnel. Collegian 2018; 25: 575–582.
  • 8. Fear NT, Seddon R, Jones N, et al. Does anonymity increase the reporting of mental health symptoms? BMC Public Health 2012; 12: 797.
  • 9. Edwards P, Roberts I, Clarke M, et al. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev 2009; MR000008.
  • 10. Joyce CM, Scott A, Jeon SH, et al. The “Medicine in Australia: Balancing Employment and Life (MABEL)” longitudinal survey: protocol and baseline data for a prospective cohort study of Australian doctors’ workforce participation. BMC Health Serv Res 2010; 10: 50.
  • 11. Saini V, Garcia‐Armesto S, Klemperer D, et al. Drivers of poor medical care. Lancet 2017; 390: 178–190.
Online responses are no longer available. Please refer to our instructions for authors page for more information.

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