MJA
MJA

    Understanding the proportion of cervical cancers attributable to HPV

    Julia ML Brotherton, Alison C Budd and Marion Saville
    Med J Aust 2020; 212 (2): . || doi: 10.5694/mja2.50477
    Published online: 3 February 2020

    Most cervical cancers can be prevented with HPV vaccination and screening

    Since Walboomers and colleagues1 published their findings in 1999, citing that 99.7% of cervical cancers are related to the human papillomavirus (HPV), this has become the standard understanding of the proportion of cervical cancers attributable to HPV.

    Online responses are no longer available. Please refer to our instructions for authors page for more information.

      Victoria's Voluntary Assisted Dying Act: navigating the section 8 gag clause

      Bryanna Moore, Courtney Hempton and Evie Kendal
      Med J Aust 2020; 212 (2): . || doi: 10.5694/mja2.50437
      Published online: 20 January 2020

      Section 8 is an unwarranted infringement on communication between health practitioners and their patients

      In November 2017, the state of Victoria passed the Voluntary Assisted Dying Act 2017 (Vic), legalising a model of voluntary physician‐assisted death for adults at the end of life who meet a number of criteria, including rigorously assessed diagnostic and prognostic requirements. The Act came into effect on 19 June 2019. Its implementation raises a host of challenges.1 Here we focus on one aspect of the new law that has been largely overlooked in ethico‐legal debates thus far — the section 8 gag clause.


      • 1 Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
      • 2 Monash Bioethics Centre, Monash University, Melbourne, VIC
      • 3 Deakin University, Melbourne, VIC


      Correspondence: bryannasuemoore@gmail.com
      Acknowledgements: 

      Courtney Hempton receives funding from an Australian Government Research Training Program Scholarship.

      Competing interests:

      No relevant disclosures.

      Online responses are no longer available. Please refer to our instructions for authors page for more information.

        Gastro‐oesophageal reflux disease in infancy: a review based on international guidelines

        Robert N Lopez and Daniel A Lemberg
        Med J Aust 2020; 212 (1): . || doi: 10.5694/mja2.50447
        Published online: 13 January 2020

        Summary

        • Gastro‐oesophageal reflux (GOR) in infancy is common, physiological and self‐limiting; it is distinguished from gastro‐oesophageal reflux disease (GORD) by the presence of organic complications and/or troublesome symptomatology.
        • GORD is more common in infants with certain comorbidities, including history of prematurity, neurological impairment, repaired oesophageal atresia, repaired diaphragmatic hernia, and cystic fibrosis.
        • The diagnosis of GORD in infants relies almost exclusively on clinical history and examination findings; the role of invasive testing and empirical trials of therapy remains unclear.
        • The assessment of infants with vomiting and regurgitation should seek out red flags and not be attributed to GOR or GORD without considered evaluation.
        • Investigations should be considered to exclude other pathology in infants referred with suspected GORD, and occasionally to confirm the diagnosis.
        • Management of GORD should follow a step‐wise approach that uses non‐pharmacological options where possible and pharmacological interventions only where necessary.

        • 1 Queensland Children's Hospital, Brisbane, QLD
        • 2 Sydney Children's Hospital, Sydney, NSW


        Competing interests:

        No relevant disclosures.

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          Migraine: a brain state amenable to therapy

          Michael Eller and Peter J Goadsby
          Med J Aust 2020; 212 (1): . || doi: 10.5694/mja2.50435
          Published online: 13 January 2020

          Summary

          • Migraine affects over a billion people worldwide in any year and is the second most common cause of years lost due to disability. Not “just a headache”, morbidity washes though society and carries a substantial economic and social cost.
          • Understanding of migraine pathophysiology has progressed significantly. Animal models and functional neuroimaging have yielded significant insight into brain structures that mediate migraine symptoms. The role of small peptides as neurotransmitters within this network has been elucidated, allowing the generation of novel therapeutic approaches that have been validated by randomised placebo‐controlled trials.
          • Migraine is underdiagnosed and undertreated. Treatment of migraine should be proactive. An acute and, when indicated, preventive strategy should be formulated with the patient. Comorbid medication overuse must be supportively managed.
          • Migraine‐specific medications are making their way from bench to bedside. They promise an improved safety profile and ease of use in comparison to older, repurposed medications. Devices promise a non‐drug alternative should patients prefer. The migraine understanding and treatment landscape is changing rapidly.

          • 1 Monash Medical Centre, Melbourne, VIC
          • 2 UCSF Headache Center, San Francisco, CA, USA


          Correspondence: peter.goadsby@ucsf.edu
          Competing interests:

          No relevant disclosures.

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            Changing practice: incidence of non‐reconstructive arthroscopic knee surgery in people over 50 years of age, Australia, 2008–2018

            So Mang (Simon) Lee, Wasim Awal and Christopher Vertullo
            Med J Aust 2020; 212 (1): . || doi: 10.5694/mja2.50436
            Published online: 13 January 2020

            The results of low bias randomised controlled trials over the past 6 years have suggested that the outcomes of arthroscopic partial meniscectomies in people with non‐obstructive degenerative medial meniscal tears are similar to those of sham surgery1 or structured rehabilitation.2 Further, older randomised trials found that arthroscopic lavage and debridement is no more beneficial for patients with uncomplicated osteoarthritis than placebo treatments.3 As this evidence cast doubts upon the efficacy of arthroscopic meniscectomy for degenerative meniscal pathology, we investigated the 10‐year incidence of non‐reconstructive, non‐reparative arthroscopic knee procedures in Australia in people over 50 years of age.

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            • 1 Griffith University, Gold Coast, QLD
            • 2 Knee Research Australia, Gold Coast, QLD
            • 3 Gold Coast Orthopaedic Research and Education Alliance, Griffith University, Gold Coast, QLD


            Competing interests:

            No relevant disclosures.

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            • 4. Australian Institute of Health and Welfare. Procedures data cubes, 2008–09 to 2017–18. Updated May 2019. https://www.aihw.gov.au/reports/hospitals/procedures-data-cubes/contents/data-cubes (viewed Oct 2019).
            • 5. Harris IA, Madan NS, Naylor JM, et al. Trends in knee arthroscopy and subsequent arthroplasty in an Australian population: a retrospective cohort study. BMC Musculoskelet Disord 2013; 14: 143.
            • 6. Feeley B, Liu S, Garner AM, et al. The cost‐effectiveness of meniscal repair versus partial meniscectomy: a model‐based projection for the United States. Knee 2016; 23: 674–680.
            • 7. Barlow T, Plant CE. Why we still perform arthroscopy in knee osteoarthritis: a multi‐methods study. BMC Musculoskelet Disord 2015; 16: 85.
            • 8. The Royal Australian College of General Practitioners. Guidelines for management of knee and hip osteoarthritis Second edition. Melbourne: RACGP, 2018. https://www.racgp.org.au/download/Documents/Guidelines/Musculoskeletal/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf (viewed Oct 2019).
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              Prospective data confirm the lasting effects of maltreatment on children

              Steve Kisely and Jake Najman
              Med J Aust 2020; 212 (1): . || doi: 10.5694/mja2.50445
              Published online: 13 January 2020

              Child protection services in Australia require fundamental workforce and organisational reform

              The numbers of recorded cases of child maltreatment in Australia have risen sharply in recent years, accompanied by a substantial increase in the number of children placed in out‐of‐home care.1 The article by Green and colleagues2 in this issue of the MJA reports a linkage study of prospectively recorded contacts of children with child protection services during early childhood and subsequent mental health service visits between 6 and 13 years of age, based on administrative data for a representative population sample of 74 500 New South Wales children commencing school in 2009.3


              • University of Queensland, Brisbane, QLD


              Correspondence: s.kisely@uq.edu.au
              Competing interests:

              Jake Najman has received grants from the Australian Research Council and the National Health and Medical Research Council for a longstanding birth cohort study on which some of this editorial is based.

              • 1. Australian Institute of Health and Welfare. Child protection Australia 2010–11 (Cat No. CWS 41; Child Welfare Series No. 52). Canberra: AIHW, 2012.
              • 2. Green MJ, Hindmarsh G, Kariuki M, et al. Mental disorders in children known to child protection services during early childhood. Med J Aust 2020; 212: 22–28.
              • 3. Carr VJ, Harris F, Raudino A, et al. New South Wales Child Development Study (NSW‐CDS): an Australian multiagency, multigenerational, longitudinal record linkage study. BMJ Open 2016; 6: e009023.
              • 4. Coles J, Lee A, Taft A, et al. Childhood sexual abuse and its associations with adult physical and mental health: results from a national cohort of young Australian women. J Interpers Violence 2015; 30: 1929–1244.
              • 5. Kisely S, Abajobir AA, Mills R, et al. Child maltreatment and mental health problems in adulthood: birth cohort study. Br J Psychiatry 2018; 213: 698–703.
              • 6. Scott KM, Smith DR, Ellis PM. Prospectively ascertained child maltreatment and its association with DSM‐IV mental disorders in young adults. Arch Gen Psychiatry 2010; 67: 712–719.
              • 7. Abajobir AA, Kisely S, Williams G, et al. Risky sexual behaviors and pregnancy outcomes in young adulthood following substantiated childhood maltreatment: findings from a prospective birth cohort study. J Sex Res 2018; 55: 106–119.
              • 8. Mills R, Kisely S, Alati R, et al. Child maltreatment and cannabis use in young adulthood: a birth cohort study. Addiction 2017; 112: 494–501.
              • 9. Abajobir AA, Kisely S, Williams G, et al. The association between substantiated childhood maltreatment, asthma and lung function: a prospective investigation. J Psychosom Res 2017; 101: 58–65.
              • 10. Abajobir AA, Kisely S, Williams G, et al. Height deficit in early adulthood following substantiated childhood maltreatment: a birth cohort study. Child Abuse Negl 2017; 64: 71–78.
              • 11. Lonne B, Harries M, Lantz S. Workforce development: a pathway to reforming child protection systems in Australia. Brit J Soc Work 2013; 43: 1630–1648.
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                Estimating the lifetime risks of cancer: the best measure depends on your purpose

                Elizabeth Buckley and David M Roder
                Med J Aust 2020; 212 (1): . || doi: 10.5694/mja2.50444
                Published online: 13 January 2020

                Estimates adjusted for competing risks of mortality can be more meaningful, but make some comparisons more difficult

                The Australian Institute of Health and Welfare began collecting cancer incidence statistics at the population level during the mid‐1980s, based on state and territory registry data that are now collated by the Australian Cancer Database, supplemented by mortality data from the Australian Bureau of Statistics.1 These data inform Australian policy makers, researchers, and the general public about cancer profiles and trends.1


                • Cancer Research Institute, University of South Australia, Adelaide, SA


                Correspondence: david.roder@unisa.edu.au
                Acknowledgements: 

                This editorial was prepared with the financial support of the Cancer Council SA Beat Cancer Project on behalf of its donors and SA Health.

                Competing interests:

                David Roder receives funding from the Cancer Council SA Beat Cancer Project for his position as Cancer Research Chair at the University of South Australia.

                • 1. Jelfs P, Coates M, Giles G, et al. Cancer in Australia 1989–1990 (with projections to 1995) (AIHW 32). Canberra: Australian Institute of Health and Welfare, 1996.
                • 2. Australian Institute of Health and Welfare. Australian Cancer Database, 2014; quality statement. Dec 2017. https://meteor.aihw.gov.au/content/index.phtml/itemId/687104 (viewed Oct 2019).
                • 3. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394–424.
                • 4. Koller MT, Raatz H, Steyerberg EW, Wolbers M. Competing risks and the clinical community: irrelevance or ignorance? Stat Med 2012; 31: 1089–1097.
                • 5. Bach AC, Lo KSE, Pathirana T, et al. Is the risk of cancer in Australia overstated? The importance of competing mortality for estimating lifetime risk. Med J Aust 2020; 212: 17–22.
                • 6. Sasieni PD, Shelton J, Ormiston‐Smith N, et al. What is the lifetime risk of developing cancer?: the effect of adjusting for multiple primaries. Br J Cancer 2011; 105: 460–465.
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                  Addressing inequity in acute stroke care requires attention to each component of regional workflow

                  Tayler Watson, Jeigh Tiu and Ben Clissold
                  Med J Aust 2020; 212 (1): . || doi: 10.5694/mja2.50440
                  Published online: 13 January 2020

                  A multifaceted approach will enable equitable stroke care for regional communities

                  About 56 000 strokes occur in Australia annually1 at an estimated economic cost of $5 billion per year.2 Inequity continues to separate regional and metropolitan populations with respect to incidence and management of acute ischaemic stroke. Risk factors for acute ischaemic stroke disproportionately burden regional Australia and this is reflected in the high rate of strokes in regional compared with metropolitan areas (250 v 210 per 100 000 population per year respectively).1 Of the 12 electorates with highest stroke incidence nationally, nine are in regional areas.1


                  • 1 Monash Health, Melbourne, VIC
                  • 2 Goulburn Valley Base Hospital, Shepparton, VIC
                  • 3 Barwon Health, Geelong, VIC


                  Competing interests:

                  No relevant disclosures.

                  • 1. Deloitte Access Economics. No postcode untouched report: stroke in Australia 2017. Melbourne: National Stroke Foundation, 2017. https://strokefoundation.org.au/What-we-do/Research/No-postcode-untouched (viewed Nov 2019).
                  • 2. Deloitte Access Economics. The economic impact of stroke in Australia: Scoping cost effective prevention. Melbourne: National Stroke Foundation, 2013. https://www2.deloitte.com/au/en/pages/economics/articles/economic-impact-stroke-australia.html (viewed Nov 2019).
                  • 3. National Stroke Foundation. National stroke audit: acute services report. Melbourne: National Stroke Foundation, 2017. https://informme.org.au/-/media/7D1480925C2046BA914F3F66D392B83A.ashx?la (viewed Nov 2019).
                  • 4. Bray JE, Johnson R, Trobbiani K, et al. Australian public's awareness of stroke warning signs improves after national multimedia campaigns. Stroke 2013; 44: 3540–3543.
                  • 5. Ambulance Victoria. Ambulance Victoria performance — 2017/18 quarter 4. Melbourne: Ambulance Victoria, 2018. https://www.ambulance.vic.gov.au/wp-content/uploads/2018/07/2017-18-Q4-Ambulance-Response-Quarter-4-FY2017-18.pdf (viewed Nov 2019).
                  • 6. Walter S, Zhao H, Easton D, et al. Air‐Mobile Stroke Unit for access to stroke treatment in rural regions. Int J Stroke 2018; 13: 568–575.
                  • 7. Leyden JM, Chong WK, Kleinig T, et al. A population‐based study of thrombolysis for acute stroke in South Australia. Med J Aust 2011; 194: 111–115. https://www.mja.com.au/journal/2011/194/3/population-based-study-thrombolysis-acute-stroke-south-australia
                  • 8. Regenhardt RW, Mecca AP, Flavin SA, et al. Delays in the air or ground transfer of patients for endovascular thrombectomy. Stroke 2018; 49: 1419–1425.
                  • 9. Silbergleit R, Scott PA, Lowell MJ, Silbergleit R. Cost‐effectiveness of helicopter transport of stroke patients for thrombolysis. Acad Emerg Med 2003; 10: 966–972.
                  • 10. O'Brien W, Crimmins D, Donaldson W, et al. FASTER (Face, Arm, Speech, Time, Emergency Response): experience of Central Coast Stroke Services implementation of a pre‐hospital notification system for expedient management of acute stroke. J Clin Neurosci 2012; 19: 241–245.
                  • 11. Meretoja A, Weir L, Ugalde M, et al. Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months. Neurology 2013; 81: 1071–1076.
                  • 12. Wardlaw JM, Seymour J, Cairns J, et al. Immediate computed tomography scanning of acute stroke is cost‐effective and improves quality of life. Stroke 2004; 35: 2477–2483.
                  • 13. Wardlaw JM, Murray V, Berge E, del Zoppo GJ. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2014; (7): CD000213.
                  • 14. Kepplinger J, Barlinn K, Deckert S, et al. Safety and efficacy of thrombolysis in telestroke: a systematic review and meta‐analysis. Neurology 2016; 87: 1344–1351.
                  • 15. Switzer J, Demaerschalk B, Xie J, Fan L, Villa K, Wu E. Cost‐effectiveness of hub‐and‐spoke telestroke networks for the management of acute ischemic stroke (P05.243). Neurology 2012; 78(Suppl): P05.243.
                  • 16. Bagot KL, Bladin CF, Vu M, et al. Exploring the benefits of a stroke telemedicine programme: an organisational and societal perspective. J Telemed Telecare 2016; 22: 489–494.
                  • 17. Moffatt JJ, Eley DS. The reported benefits of telehealth for rural Australians. Aust Health Rev 2010; 34: 276–281.
                  • 18. Australian Institute of Health and Welfare. Australia's health 2016 [Australia's health series No. 15; Cat. No. AUS 199]. Canberra: AIHW, 2016. https://www.aihw.gov.au/getmedia/9844cefb-7745-4dd8-9ee2-f4d1c3d6a727/19787-AH16.pdf.aspx (viewed Nov 2019).
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                    Symbolic sexism: superficial or serious bias? An investigation into images on patient call bells

                    Laura RE Chapman, Sara Mellow and Hannah Coombridge
                    Med J Aust 2019; 211 (11): . || doi: 10.5694/mja2.50418
                    Published online: 9 December 2019

                    Abstract

                    Objectives: To determine whether gendered symbols on patient call bells are restricted to our hospital or are examples of an international practice that perpetuates gender stereotypes and occupational segregation.

                    Setting: Multicentre, international study of hospital equipment, 2018.

                    Main outcome measure: Types of symbols on patient call bells.

                    Results: We received 56 responses from 43 hospitals in eight countries across five continents: 37 devices included female‐specific images, nine included gender‐neutral images, and ten did not use imagery (for example, button‐only devices). No call bells included male‐specific images.

                    Conclusion: Female symbols on patient call bells are an international phenomenon. Only female or gender‐neutral images are used, indicating bias in their design, manufacture, and selection. Female symbols may reinforce gender stereotypes and contribute to occupational segregation and reduced equity of opportunity. We suggest alternative symbols. Individual action with coloured marker pens may provide a pragmatic short term, albeit provocative, solution. While call bell design has only a minor impact on patients, everyday bias affects all staff and society in general.

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                    • 1 University of Auckland, Auckland, New Zealand
                    • 2 Waitematā District Health Board, Auckland, New Zealand


                    Correspondence: l.chapman@auckland.ac.nz
                    Competing interests:

                    No relevant disclosures.

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                      Predictors of ManuScript Rejection sYndrome (MiSeRY): a cohort study

                      Hui‐Chen Han, Anoop Ninan Koshy, Tina Lin, Matias Yudi, David Clark, Andrew W Teh and Omar Farouque
                      Med J Aust 2019; 211 (11): . || doi: 10.5694/mja2.50414
                      Published online: 9 December 2019

                      Abstract

                      Objectives: To assess whether specific factors predict the development of ManuScript Rejection sYndrome (MiSeRY) in academic physicians.

                      Design: Prospective pilot study; participants self‐administered a questionnaire about full manuscript submissions (as first or senior author) rejected at least once during the past 5 years.

                      Setting: Single centre (tertiary institution).

                      Participants: Eight academic physician‐authors.

                      Main outcome measures: Duration of grief. MiSeRY was pre‐specified as prolonged grief (grief duration longer than the population median).

                      Results: Eight participants provided data on 32 manuscripts with a total of 93 rejections (median, two rejections per manuscript; interquartile range [IQR], 1–3 rejections per manuscript). Median age at rejection was 37 years (IQR, 33–45 years); 86% of 80 rejections involved male authors (86%), 56 of the authors providing data about these rejections were first authors (60%). The median journal impact factor was 5.9 (IQR, 5.2–17). In 48 cases of rejection (52%), pre‐submission expectations of success had been high, and in 54 cases (58%) the manuscripts had been sent for external review. Median grief duration was 3 hours (IQR, 1–24 h). Multivariate analysis indicated that higher pre‐submission expectation (adjusted odds ratio [aOR], 5.0; 95% CI, 1.5–18), first author status (aOR, 9.5; 95% CI, 1.1–77), and external review (aOR, 19.0; 95% CI 2.9–126) were independent predictors of MiSeRY.

                      Conclusions: To help put authors out of their MiSeRY, journal editors could be more selective in the manuscripts they send for external review. Tempering pre‐submission expectations and mastering the Coping and reLaxing Mechanisms (CaLM) of senior colleagues are important considerations for junior researchers.

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                      • 1 Austin Health, Melbourne, VIC
                      • 2 Eastern Health, Melbourne, VIC


                      Correspondence: huichenhan@gmail.com
                      Acknowledgements: 

                      We acknowledge the various medical journals that have rejected our manuscripts and provided inspiration for this study. To quote a contemporary poet: “thank u, next”.

                      Competing interests:

                      All but one of the rejected authors in this study are co‐authors of this article. We are uncertain whether referencing Tinder or quoting Ariana Grande infringes any copyright laws. We have no other relevant disclosures.

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