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Objective: To explore the policies of key organisations in Australian health and medical research on defining, collecting, analysing, and reporting data on sex and gender, and to identify barriers to and facilitators of developing and implementing such policies.
Study design: Mixed methods study: online planning forum; survey of organisations in Australian health and medical research, and internet search for policies defining, collecting, analysing, and reporting data by sex and gender in health and medical research.
Setting, participants: Australia, 19 May 2021 (planning forum) to 12 December 2022 (final internet search).
Main outcome measures: Relevant webpages and documents classified as dedicated organisation‐specific sex and gender policies; policies, guidelines, or statements with broader aims, but including content that met the definition of a sex and gender policy; and references to external policies.
Results: The online planning forum identified 65 relevant organisations in Australian health and medical research; twenty participated in the policy survey. Seven organisations reported at least one relevant policy, and six had plans to develop or implement such policies during the following two years. Barriers to and facilitators of policy development and implementation were identified in the areas of leadership, language and definitions, and knowledge skills and training. The internet search found that 57 of the 65 organisations had some form of sex and gender policy, including all ten peer‐reviewed journals and five of ten research funders; twelve organisations, including eight peak body organisations, had published dedicated sex and gender policies on their websites.
Conclusion: Most of the organisations included in our study had policies regarding the integration of sex and gender in health and medical research. The implementation and evaluation of these policies is necessary to ensure that consideration of sex and gender is adequate during all stages of the research process.
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Correspondence: c.carcel@unsw.edu.au
Open access:
Open access publishing facilitated by University of New South Wales, as part of the Wiley – University of New South Wales agreement via the Council of Australian University Librarians.
Data sharing:
To request access to de‐identified data, please contact the corresponding author.
We acknowledge the contributions of Jacqui Webster, Colman Taylor, and Elizabeth Duck‐Chong to this study as part of our Advisory Group (https://www.sexandgenderhealthpolicy.org.au/our‐team). Cheryl Carcel is supported by a Heart Foundation Postdoctoral Fellowship (102741) and a National Health and Medical Research Council (NHMRC) Investigator grant (Emerging Leadership 1; APP2009726), Kelly Thompson by an NHMRC Investigator grant (Emerging Leadership 1, APP1194058), and Mark Woodward by an NHMRC Investigator grant (APP1174120), and program grant (APP1149987). An anonymous philanthropic donor provided monetary support for the study but had no role in the design, analysis, interpretation, or write‐up of the study.
No relevant disclosures.
A 72‐year‐old man with a history of well controlled type 2 diabetes was admitted to a tertiary metropolitan hospital for investigation of fevers, night sweats and unintentional weight loss of 18 kg over six months. He had pancytopenia with no symptoms or signs to suggest a focal infection, malignancy or rheumatological disease. Prior outpatient investigation findings revealed mild splenomegaly, with a normal bone marrow aspirate and positron emission tomography scan. At its nadir, the haemoglobin level was 106 g/L (reference interval [RI], 125–175 g/L), white cell count 1.9 × 109/L (RI, 4.0–11.0 × 109/L), neutrophil count 1.2 × 109/L (RI, 2.00–8.00 × 109/L) and platelets 120 × 109/L (RI, 150–450 × 109/L). Notably, liver function test results were mildly elevated in a mixed pattern with alkaline phosphatase 138 U/L (RI, 30–110 U/L), γ‐glutamyl transferase 605 U/L (RI, 5–50 U/L) and alanine aminotransferase 78 U/L (RI, 5–40 U/L), with associated antinuclear antibody titre of more than 1280 (RI, < 160), and an elevated immunoglobulin G level of 38.6 g/L (RI, 7.5–15.6 g/L). Pertinent negative results included negative human immunodeficiency virus (HIV) and viral hepatitis serology, and negative anti‐smooth muscle and anti‐liver–kidney microsomal antibodies. Given these findings and the ongoing diagnostic dilemma, a liver biopsy was performed, showing mild interface hepatitis and lymphoplasmacytic infiltrate in the portal tracts (Box 1), and leading to a probable diagnosis of autoimmune hepatitis. Administration of azathioprine 25 mg and prednisolone 40 mg daily was initiated and the patient was discharged following improvement of his liver function test results.
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We thank infectious disease physicians Dr Ouli Xie and Dr Sabine De Silva for their diagnosis and management of visceral leishmaniasis, pathologist Dr Sukhpal Dayan for reporting the patient’s histopathology slides and reviewing the written case report, and microbiology scientist Pei Vern Fong for acquiring the microbiology slides.
No relevant disclosures.
Loneliness has been described as an epidemic and is one of the most pressing public health concerns in Australia and internationally.1,2 In contrast to social isolation, which is an objective measure of social interactions and relationships, loneliness is defined as a subjective experience where one perceives a discrepancy between desired and actual social relationships in terms of quality or quantity.3 Although it is common and natural to feel lonely at times, prolonged and intense periods of loneliness have been linked to adverse health outcomes.4 Older adults are more prone to loneliness and social isolation compared with other age groups.5 Reasons for this include significant life transitions and events, such as retiring from work, increased financial difficulties, loss of friends and widowhood, changes in living arrangements (eg, transitioning to residential aged care), increase in solitary living, and a decline in both health and independence.5,6 Older people at particular risk of loneliness include those living on low incomes, living with a disability, living in rural areas or with housing stress, who are single, childless or living alone, who are vulnerable or at risk of elder abuse, and those with low levels of literacy or communication technology skills (Box).7 A growing body of evidence has highlighted the significant health burden associated with loneliness, with more recent studies also suggesting that loneliness has become an economic problem due to an increase in service use and demand for institutional care. This development requires both effective and cost‐effective strategies to tackle loneliness.11,12
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No relevant disclosures.
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We would like to acknowledge Forbes McGain (Western Health, Melbourne) for his invaluable knowledge and support on this research.
No relevant disclosures.
Much evidence exists showing the very real threats to human survival, premature deaths and poor health outcomes from the nexus between the impacts of climate change and economic and social inequities.1,2 Given this crisis of planetary health equity — defined here as the equitable enjoyment of good health in a stable Earth system — preventive action is needed to address the common underlying drivers of climate change and health inequities. These drivers are located within the consumptogenic system, which is the web of institutions, actors, policies, commercial activities and norms that encourages and rewards the exploitation of natural resources, production of fossil fuels, and hyperconsumerism of fossil fuel‐reliant goods and services, which results in environmental degradation, climate change, and social and health inequities.2 In this perspective article, we relay the urgency — identified by researchers, senior bureaucrats, politicians, former business leaders and civil society groups in a Planetary Health Equity Hothouse Policy Symposium3 — for transforming the consumptogenic system, with a focus on economic models, policy coherence, and advocacy. We highlight the opportunities for the health sector to provide leadership in these issues.
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Sharon Friel receives funding through an Australian Research Council Laureate Fellowship.
No relevant disclosures.
Every year, about 1800 Australians die of hepatocellular carcinoma (HCC), the most common type of primary liver cancer.1
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Open access:
Open access publishing facilitated by Monash University, as part of the Wiley ‐ Monash University agreement via the Council of Australian University Librarians.
Jessica Howell's salary is supported by an NHMRC Investigator Fellowship, NHMRC Program grant, Burnet Institute Program grant and University of Melbourne strategic grant. We gratefully acknowledge First Nations Australians as the original custodians of this land, who have generously shared their wisdom and stories that led to and informed this work.
Jessica Howell has received speaker fees and participated in advisory boards for Eisai, Astra Zeneca, Roche and Gilead; and received competitive grant funds from Gilead Sciences and Eisai. Troy Combo has participated in an advisory board for Astra‐Zeneca. Paula Binks has participated in advisory boards for Eisai and Astra‐Zeneca. Kylie Bragg has participated in an advisory board for Astra‐Zeneca. Kate Muller has participated in an advisory board for Astra‐Zeneca. Alan Wigg has participated in advisory boards for Eisai. Jacob George has participated in advisory boards and received honoraria for talks from Novo Nordisk, Astra‐Zeneca, Roche, BMS, Pfizer, Cincera, Pharmaxis, Boehringer Mannheim. Stuart Roberts has participated in advisory boards for Eisai, Astra‐Zeneca and Roche.
Objectives: To estimate notification rates for infectious syphilis in women of reproductive age and congenital syphilis in Australia.
Study design: Retrospective cohort study; analysis of national infectious syphilis and enhanced congenital syphilis surveillance data.
Setting, participants: Women aged 15–44 years diagnosed with infectious syphilis, and babies with congenital syphilis, Australia, 2011–2021.
Main outcome measures: Numbers and rates of infectious syphilis notifications, by Indigenous status and age group; numbers and rates of congenital syphilis, by Indigenous status of the infant; antenatal care history for mothers of infants born with congenital syphilis.
Results: During 2011–2021, 5011 cases of infectious syphilis in women aged 15–44 years were notified. The notification rate for Aboriginal and Torres Strait Islander women rose from 56 (95% confidence interval [CI], 45–65) cases per 100 000 in 2011 to 227 (95% CI, 206–248) cases per 100 000 population in 2021; for non‐Indigenous women, it rose from 1.1 (95% CI, 0.8–1.4) to 9.2 (95% CI, 8.4–10.1) cases per 100 000 population. The notification rate was higher for Aboriginal and Torres Strait Islander women than for non‐Indigenous women (incidence rate ratio [IRR], 23.1; 95% CI, 19.7–27.1), lower for 15–24‐ (IRR, 0.7; 95% CI, 0.6–0.9) and 35–44‐year‐old women (IRR, 0.6; 95% CI, 0.5–0.7) than for 25–34‐year‐old women, and higher in remote regions than in major cities (IRR, 2.7; 95% CI, 2.2–3.8). During 2011–2021, 74 cases of congenital syphilis were notified, the annual number increasing from six in 2011 to a peak of 17 in 2020; the rate was consistently higher among Aboriginal and Torres Strait Islander infants than among non‐Indigenous infants (2021: 38.3
Conclusions: The number of infectious syphilis notifications for women of reproductive age increased in Australia during 2011–2021, as did the number of cases of congenital syphilis. To avert congenital syphilis, antenatal screening of pregnant women, followed by prompt treatment for infectious syphilis when diagnosed, needs to be improved.
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Open access:
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Data sharing:
Applications for access to the data we analysed for this study should be directed to the Australian Department of Health and Aged Care.
We acknowledge the contribution and valuable insights of the Kirby Institute Aboriginal and Torres Strait Islander Reference Group, and State and Territory Health Department surveillance officers.
No relevant disclosures.
In August 2023, an otherwise healthy 54‐year‐old woman presented to hospital with acute onset fevers and sweats, followed by four days of nausea, vomiting, generalised severe abdominal pain and diarrhoea. The diarrhoea was non‐bloody, with more than ten bowel motions per day. The patient worked as a support worker for older people, and denied previous diarrhoeal illness, sick contacts, consumption of undercooked food, and recent travel.
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Patient consent:
The patient provided written consent for publication.
We thank the Microbial Genomics Laboratory, NSW Health Pathology – Institute of Clinical Pathology and Medical Research, for genomic analysis of the isolate.
No relevant disclosures.
The early detection of adverse events following immunisation (AEFI) is essential to protect public health and to maintain confidence in vaccination. Vaccine pharmacovigilance — the monitoring, detection, investigation and actioning of vaccine safety signals — occurs across a collaborative landscape that includes the Therapeutic Goods Administration (TGA), the nationally funded surveillance initiative AusVaxSafety, and state and territory health departments.
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AusVaxSafety surveillance is funded under a contract with the Australian Department of Health and Aged Care. The authors acknowledge the participants and staff at the surveillance sites, state and territory health departments, and Telethon Kids Institute, and the contribution of the surveillance tools SmartVax, Vaxtracker, and Microsoft COVID Vaccine Management System. The authors also wish to thank the Therapeutic Goods Administration staff of the Vaccines Surveillance Section, Adverse Event and Medicine Defects Section, and Technical and Safety Improvement Section, who support the safety surveillance of influenza vaccines.
No relevant disclosures.
Abstract
Objectives: To examine the frequency of re‐admissions to non‐index hospitals (hospitals other than the initial discharging hospital) within 30 days of admission with acute myocardial infarction in New South Wales; to examine the relationship between non‐index hospital re‐admissions and 30‐day mortality.
Study design: Retrospective cohort study; analysis of hospital admissions (Admitted Patient Data Collection) and mortality data (Registry of Births, Deaths and Marriages).
Setting, participants: Adults admitted to NSW hospitals with acute myocardial infarction re‐admitted to any hospital within 30 days of discharge from the initial hospitalisation, 1 January 2005 – 31 December 2020.
Main outcome measures: Proportion of re‐admissions within 30 days of discharge to non‐index hospitals, and associations of non‐index hospital re‐admissions with demographic and initial hospitalisation characteristics and with 30‐day and 12‐month mortality, each by residential remoteness category.
Results: Of 168 097 people with acute myocardial infarction discharged alive, 28 309 (16.8%) were re‐admitted to hospital within 30 days of discharge, including 11 986 to non‐index hospitals (42.3%); the proportion was larger for people from regional or remote areas (50.1%) than for people from major cities (38.3%). The odds of non‐index hospital re‐admission were higher for people with ST‐elevation myocardial infarction, for people whose index admissions were to private hospitals, who were transferred between hospitals or had undergone revascularisation during the initial admission, were under 65 years of age, or had private health insurance; the influence of these factors was generally larger for people from regional or remote areas than for those from large cities. After adjustment for potential confounders, non‐index hospital re‐admission did not influence mortality among people from major cities (30‐day: adjusted odds ratio [aOR], 1.09; 95% confidence interval [CI], 0.99–1.20; 12‐month: aOR, 0.98, 95% CI, 0.93–1.03), but was associated with reduced mortality for people from regional or remote areas (30‐day: aOR, 0.81; 95% CI, 0.70–0.95; 12‐month: aOR, 0.88; 95% CI, 0.81–0.96).
Conclusions: The geographically dispersed Australian population and the mixed public and private provision of specialist services means that re‐admission to a non‐index hospital can be unavoidable for people with acute myocardial infarction who are initially transferred to specialised facilities. Non‐index hospital re‐admission is associated with better mortality outcomes for people from regional or remote areas.