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Despite a year of floods, fires and pestilence, we approach 2021 with optimism
It has been a strange and disturbing year. Here in Australia, we would usually now be looking forward to the long summer break, the barbeques and the parties, the leisure time at home. Many would be traveling overseas to visit friends and family. But these have not been normal times.
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I thank the tireless efforts of the Editorial team throughout 2020, without which the quality and timely publication of our Journal in print and online would not be possible: our departing Head of Publishing Content, Lilia Kanna; our former Senior Deputy Medical Editor, Christine Gee; Deputy Medical Editors Francis Geronimo, Robyn Godding, Tania Janusic, Selina Lo, Wendy Morgan, Aajuli Shukla, and Zoë Silverstone; 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; and our Senior Publishing Coordinator, Kerrie Harding.
A complete list of disclosures is available at https://www.mja.com.au/journal/staff/editor-chief-professor-nick-talley
Researchers who live and work in community can respond to local clinical questions and provide feedback to community on their findings
Australians enjoy some of the best health outcomes in the world1 and those benefits are concentrated in our urban centres. Australians who live in rural and remote Australia have poorer health than their urban peers. The more remote your residence, the shorter your life span and the greater the burden of disease carried by your community.2
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In Australia, colorectal cancer is the second most frequently diagnosed cancer and one of the most common causes of cancer‐related death.1 Evidence that bowel cancer screening reduces mortality through early detection and treatment2 led to the introduction in 2006 of the Australian National Bowel Cancer Screening Program (NBCSP), offering faecal occult blood testing. The NBCSP has been progressively rolled out, from covering those aged 55 or 65 years in 2006 to screening every two years for all Australians aged 50–74 years by 2020.3 During 2016–17, 41% of people invited to participate in screening did so.4 A recent review of the NBCSP found that the risk of death from colorectal cancer was lower for invitees, and that those who had cancer were diagnosed at an earlier stage of disease.5
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The Binational Colorectal Cancer Audit is supported by the Colorectal Surgical Society of Australia and New Zealand (CSSANZ).
No relevant disclosures.
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We thank Robert Fawcett, John Nairn, and Elizabeth Ebert (from the Australian Bureau of Meteorology) for indicators 1.1 and 1.2. We thank Yang Liu (Emory University) and Bryan Vu (Emory University) for the Australian data used for indicator 1.3. Finally, we thank Marina Romanello (University College London) and Bradley Graves (Macquarie University) for assistance with visualisation of the indicator 1.3 data.
No relevant disclosures.
Controlling the exit from work and accumulating multiple resources early predict adjustment to retirement
The traditional approach to leaving a career in medicine has been informal. The fact that about 10% of medical practitioners in Australia are aged 65 years or over1 — a seemingly natural consequence of increased life expectancy, improved quality of life and fluctuations in financial markets — highlights the need for a more methodical process for leaving medicine.
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We have received funding from the Avant Foundation to develop an online educational program for medical practitioners transitioning to retirement. The funding source has had no role in the planning or writing of this article.
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Lifting lockdown when numbers are low but not zero means that superspreaders may remain, leading to a further wave of the epidemic
Superspreaders are a well known feature of some infectious diseases.1,2 Clearly, differing social roles will mean some infected people are more likely than others to spread a disease.3 For coronavirus disease 2019 (COVID‐19), biological factors are also important, as there may be a million‐fold variation in the viral load in secretions.4 Measurement of the number of secondary cases from a given primary case has shown that superspreading may be more important in COVID‐19 than in many other infections.5,6,7,8
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Children may be more susceptible than originally thought and could play a role in community transmission
An early cause for hope in the coronavirus disease 2019 (COVID‐19) pandemic was the observation that children are much less likely to experience severe illness than adults.1 This remains true, but has created a perception that children are less susceptible to infection and do not play a substantial role in transmission. In Australia, this perception has been reinforced by assurances from the Prime Minister that schools are safe and that physical distancing is unnecessary in this setting.2 However, emerging research suggests greater caution is needed.
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I am supported by funding from an Australian competitive grant (National Health and Medical Research Council grant 1150337).
The pandemic is a vast, expanding disaster with no end in sight, producing chronic stress, disruption, and multiple losses
The coronavirus disease 2019 (COVID‐19) pandemic has been a once‐in‐100‐years event. The scale of the disaster overshadows all others in living memory. Most disasters are focal and time‐limited. This one will span a considerable period of time and the economic impact will last years. This means the mental health effects will be deeper and more sustained than in other disasters. A survey during the first month of the pandemic in Australia assessed the nation's “temperature” early, as reported in this issue of the Journal.1 This survey and other information2,3 confirm that the initial mental health impact has been severe, and worse may be coming. Scientific models predicted that Australia would face a second curve of mental ill health and suicide,4,5 and this has now clearly arrived. We have been willing to turn our society and lives upside down to flatten the COVID‐19 curve. The same commitment is now required to flatten the mental health curve.
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I am supported by a National Health and Medical Research Council Senior Principal Research Fellowship (1155508).
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Abstract
Objective: To characterise the working arrangements of medical research scientists and support staff in Australia during the COVID‐19 pandemic, and to evaluate factors (in particular: wearing pyjamas) that influence the self‐assessed productivity and mental health of medical institute staff working from home.
Design: Prospective cohort survey study, 30 April – 18 May 2020.
Setting, participants: Staff (scientists and non‐scientists) and students at five medical research institutes in Sydney, New South Wales.
Main outcome measures: Self‐assessed overall and task‐specific productivity, and mental health.
Results: The proportions of non‐scientists and scientists who wore pyjamas during the day were similar (3% v 11%; P = 0.31). Wearing pyjamas was not associated with differences in self‐evaluated productivity, but was significantly associated with more frequent reporting of poorer mental health than non‐pyjama wearers while working from home (59% v 26%; P < 0.001). Having children in the home were significantly associated with changes in productivity. Larger proportions of people with toddlers reported reduced overall productivity (63% v 32%; P = 0.008), and reduced productivity in writing manuscripts (50% v 17%; P = 0.023) and data analysis (63% v 23%; P = 0.002). People with primary school children more frequently reported reduced productivity in writing manuscripts (42% v 16%; P = 0.026) and generating new ideas (43% v 19%; P = 0.030). On a positive note, the presence of children in the home was not associated with changes in mental health during the pandemic. In contrast to established researchers, early career researchers frequently reported reduced productivity while working at home.
Conclusions: Our findings are probably applicable to scientists in other countries. They may help improve work‐from‐home policies by removing the stigma associated with pyjama wearing during work and by providing support for working parents and early career researchers.