Connect
MJA
MJA

    Slower increase in life expectancy in Australia than in other high income countries: the contributions of age and cause of death

    Alan D Lopez and Tim Adair
    Med J Aust 2019; 210 (9): . || doi: 10.5694/mja2.50144
    Published online: 20 May 2019

    Abstract

    Objectives: To compare life expectancy at birth in Australia during 1980–2016 with that in other high income countries; to estimate the contributions of age at death and cause of death to differences between Australia and these countries.

    Design, setting, participants: Data on deaths by age, sex, and cause in Australia and 26 other high income countries obtained from the Global Burden of Disease study.

    Main outcome measures: Contributions of age, cause of death, and birth cohort to differences in life expectancy between Australia and other high income countries and to changes in the differences.

    Results: From 1981 to 2003, life expectancy at birth increased rapidly in Australia, both in absolute terms and in comparison with other high income countries. The main contributor to greater increases for males in Australia than in western Europe was lower mortality from ischaemic heart disease; compared with the United States, mortality from ischaemic heart disease, cerebrovascular disease, and transport‐related injuries was lower. Since 2003, life expectancy has increased more slowly for both sexes than in most other high income countries, mainly because declines in mortality from cardiovascular disease and cancer have slowed. Age‐specific mortality for people born since the 1970s is higher in Australia than in most high income countries.

    Conclusions: Recent declines in mortality in Australia have been relatively modest. Together with the high prevalence of obesity and the limited scope for further increasing life expectancy by reducing the prevalence of smoking, this suggests that future life expectancy increases will be smaller than in other high income countries. Improved control of health risk factors will be required if further substantial life expectancy increases in Australia are to be achieved.

    Please login with your free MJA account to view this article in full

    LOGIN
    CREATE AN ACCOUNT

    Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

    View on Wiley Online Library

    • Melbourne School of Population and Global Heath, University of Melbourne, Melbourne, VIC


    Correspondence: alan.lopez@unimelb.edu.au
    Acknowledgements: 

    We acknowledge Mohsen Naghavi of the Institute of Health Metrics and Evaluation, University of Washington, for supplying the data analysed in our study.

    Competing interests:

    No relevant disclosures.

    • 1. Uemura K, Pisa Z. Trends in cardiovascular disease mortality in industrialized countries since 1950. World Health Stat Q 1988; 41: 155–178.
    • 2. GBD Mortality Collaborators. Global, regional, and national under‐5 mortality, adult mortality, age‐specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1084–1150.
    • 3. Adair T, Hoy D, Dettrick Z, Lopez AD. Reconstruction of long‐term tobacco consumption trends in Australia and their relationship to lung cancer mortality. Cancer Causes Control 2011; 22: 1047–1053.
    • 4. Taylor R, Dobson A, Mirzaei M. Contribution of changes in risk factors to the decline of coronary heart disease mortality in Australia over three decades. Eur J Cardiovasc Prev Rehabil 2006; 13: 760–768.
    • 5. Taylor R, Page A, Danquah J. The Australian epidemic of cardiovascular mortality 1935–2005: effects of period and birth cohort. J Epidemiol Community Health 2012; 66: e18.
    • 6. Australian Institute of Health and Welfare. National Drug Strategy Household Survey 2016: detailed findings (PHE 214). Canberra: AIHW, 2017.
    • 7. Hayes AJ, Lung TW, Bauman A, Howard K. Modelling obesity trends in Australia: unravelling the past and predicting the future. Int J Obes (Lond) 2017; 41: 178–185.
    • 8. O'Flaherty M, Allender S, Taylor R, et al. The decline in coronary heart disease mortality is slowing in young adults (Australia 1976–2006): a time trend analysis. Int J Cardiol 2012; 158: 193–198.
    • 9. Prospective Studies Collaboration; Whitlock G, Lewington S, Sherliker P, et al. Body‐mass index and cause‐specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009; 373: 1083–1096.
    • 10. GBD Causes of Death Collaborators. Global, regional, and national age‐sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1151–1210.
    • 11. GBD Mortality Causes of Death Collaborators. Global, regional, and national life expectancy, all‐cause mortality, and cause‐specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1459–1544.
    • 12. Arriaga EE. Measuring and explaining the change in life expectancies. Demography 1984; 21: 83–96.
    • 13. Pollard J. The expectation of life and its relationship to mortality. J Inst Actuar 1982; 109: 225–240.
    • 14. Preston S, Heuveline P, Guillot M. Demography: measuring and modeling population processes. Oxford: Blackwell, 2001.
    • 15. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 2004; 328: 1519.
    • 16. Pirie K, Peto R, Reeves GK, et al; Million Women Study Collaborators. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet 2013; 381: 133–141.
    • 17. Thun MJ, Carter BD, Feskanich D, et al. 50‐year trends in smoking‐related mortality in the United States. N Engl J Med 2013; 368: 351–364.
    • 18. Walker RB. Under fire: a history of tobacco smoking in Australia. Melbourne: Melbourne University Press, 1984.
    • 19. Forey B, Hamling J, Hamling J, et al. International smoking statistics; web edition. Sutton (UK): PN Lee Statistics & Computing; updated Dec 2016. www.pnlee.co.uk/iss.htm (viewed Feb 2019).
    • 20. Institute for Health Metrics and Evaluation. Tobacco Viz. Seattle (WA): University of Washington, 2017. http://vizhub.healthdata.org/tobacco (viewed Feb 2019).
    • 21. Peto R, Lopez AD, Boreham J, et al. Mortality from tobacco in developed countries: indirect estimation from national vital statistics. Lancet 1992; 339: 1268–1278.
    • 22. Jackson R, Beaglehole R. Trends in dietary fat and cigarette smoking and the decline in coronary heart disease in New Zealand. Int J Epidemiol 1987; 16: 377–382.
    • 23. Ezzati M, Obermeyer Z, Tzoulaki I, et al. Contributions of risk factors and medical care to cardiovascular mortality trends. Nat Rev Cardiol 2015; 12: 508–530.
    • 24. Australian Bureau of Statistics. 4364.0.55.002. Health service usage and health related actions, Australia, 2014–15. Mar 2017. http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.002 (viewed Feb 2019).
    • 25. Australian Institute of Health and Welfare. A picture of overweight and obesity in Australia 2017 (PHE 216). Canberra: AIHW, 2017.
    • 26. Global BMI Mortality Collaboration; Di Angelantonio E, Bhupathiraju SN, Wormser D, et al. Body‐mass index and all‐cause mortality: individual‐participant‐data meta‐analysis of 239 prospective studies in four continents. Lancet 2016; 388: 776–786.
    • 27. Case A, Deaton A. Rising morbidity and mortality in midlife among white non‐Hispanic Americans in the 21st century. Proc Natl Acad Sci USA 2015; 112: 15078–15083.
    • 28. Foreman KJ, Marquez N, Dolgert A, et al. Forecasting life expectancy, years of life lost, and all‐cause and cause‐specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories. Lancet 2018; 392: 2052–2090.
    • 29. Naghavi M, Makela S, Foreman K, et al. Algorithms for enhancing public health utility of national causes‐of‐death data. Popul Health Metr 2010; 8: 9.

    Author
    remove_circle_outline Delete Author
    add_circle_outline Add Author
    Comment
    Do you have any competing interests to declare? *
    I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
    I/we agree to the Terms of use of the Medical Journal of Australia *
    Email me when people comment on this article
    Online responses are no longer available. Please refer to our instructions for authors page for more information.

      Scale‐up of hepatitis C treatment in prisons is key to national elimination

      Timothy Papaluca, Margaret E Hellard, Alexander J V Thompson and Andrew R Lloyd
      Med J Aust 2019; 210 (9): . || doi: 10.5694/mja2.50140
      Published online: 20 May 2019

      Prison‐based antiviral treatment for chronic hepatitis C is a critical element of the national elimination goal

      In 2016, it was estimated 227 000 Australians had chronic hepatitis C virus (HCV) infection, with the majority infected through unsafe injecting drug use.1 The advent of direct‐acting antiviral (DAA) therapies for HCV infection, and their subsequent listing on the Pharmaceutical Benefits Scheme in March 2016, means that all Australians with chronic HCV, including prisoners, can access well tolerated, short course, highly curative treatments, regardless of how they acquire their infection or their disease stage. This universal access approach is supported by modelling that shows that increasing treatment uptake among people who inject drugs is an effective public health measure to reduce community prevalence due to the interruption of HCV transmissions.2 These elements underpin Australia's efforts to meet the World Health Organization goal to eliminate HCV as a public health threat by 2030, including key targets of a 90% decline in new infections, a reduction in HCV‐related mortality by 65%, and HCV treatment provision for 80% of those infected.3


      • 1 St Vincent's Hospital, Melbourne, VIC
      • 2 Centre for Population Health, Burnet Institute, Melbourne, VIC
      • 3 Kirby Institute, UNSW, Sydney, NSW


      Correspondence: a.lloyd@unsw.edu.au
      Acknowledgements: 

      The manuscript of this article was prepared on behalf of the National Prisons Hepatitis Network and has been approved by the Network members. Margaret Hellard and Alexander Thompson are supported by National Health and Medical Research Council (NHMRC) Research Fellowships. Andrew Lloyd is supported by an NHMRC Practitioner Fellowship.

      Competing interests:

      Timothy Papaluca has received speaker fees from MSD. Margaret Hellard has received investigator‐initiated support for hepatitis‐related research from Gilead Sciences, AbbVie and GSK. Alexander Thompson has received investigator‐initiated support for hepatitis‐related research from Gilead Sciences, AbbVie and Merck. He is a member of advisory boards for Gilead Sciences, AbbVie, MSD, Bristol‐Myers Squibb and Eisai, and has received speaker fees from Gilead Sciences, AbbVie, MSD and Bristol‐Myers Squibb. Andrew Lloyd has received investigator‐initiated support for prisons hepatitis‐related research from Gilead Sciences and MSD.

      Author
      remove_circle_outline Delete Author
      add_circle_outline Add Author
      Comment
      Do you have any competing interests to declare? *
      I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
      I/we agree to the Terms of use of the Medical Journal of Australia *
      Email me when people comment on this article
      Online responses are no longer available. Please refer to our instructions for authors page for more information.

        Biology and therapy of multiple myeloma

        Douglas E Joshua, Christian Bryant, Caroline Dix, John Gibson and Joy Ho
        Med J Aust 2019; 210 (8): . || doi: 10.5694/mja2.50129
        Published online: 6 May 2019

        Summary

        • Genetic sequencing of the myeloma genome has not revealed a specific disease‐determining genetic alteration.
        • Multiple disease subclones exist at diagnosis and vary in clinical importance with time and drug sensitivity.
        • New diagnostic criteria have identified indications for early introduction of therapy.
        • Autologous stem cell transplantation remains an essential component of therapy in young and fit patients.
        • The use of continual suppressive (maintenance) therapy has been established as an important component in therapy.
        • Immune therapies and the harnessing of the innate immune system offer great promise for future treatments.
        • Since 2005, quality of life, supportive therapies, and survival have dramatically improved over a decade of remarkable progress.
        • The common manifestations of multiple myeloma, such as bone pain, fatigue and weight loss, may be non‐specific and are often initially ignored or missed by patients and medical practitioners.

        • Royal Prince Alfred Hospital, Sydney, NSW


        Competing interests:

        No relevant disclosures.

        • 1. Joshua DE. Multiple myeloma: the present and the future. Med J Aust 2005 Oct 3; 183: 344. https://www.mja.com.au/journal/2005/183/7/multiple-myeloma-present-and-future
        • 2. Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014; 15: e538–e548.
        • 3. Rajkumar SV. Multiple myeloma: 2016 update on diagnosis, risk‐stratification, and management. Am J Hematol 2016; 91: 719–734.
        • 4. Kyle R, Gertz M, Witzig T, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003; 78: 21–33.
        • 5. Landgren O, Gridley G, Turesson I, et al. Risk of monoclonal gammopathy of undetermined significance (MGUS) and subsequent multiple myeloma among African American and white veterans in the United States. Blood 2006; 107: 904–906.
        • 6. Kyle R, Therneau T, Rajkumar S, et al. A long‐term study of prognosis in monoclonal gammopathy of undetermined significance. N Engl J Med 2002; 346: 564–569.
        • 7. Kyle R, Therneau T, Rajkumar S, et al. Prevalence of monoclonal gammopathy of undetermined significance. N Engl J Med 2006; 354: 1362–1369.
        • 8. Blimark CH, Turesson I, Genell A, et al. Outcome and survival of myeloma patients diagnosed 2008–2015. Real‐world data on 4904 patients from the Swedish Myeloma Registry. Haematologica 2018; 103: 506–513.
        • 9. Libby E, Garcia D, Quintana D, et al. Disease‐specific survival for patients with multiple myeloma: significant improvements over time in all age groups. Leuk Lymphoma 2014; 55: 2850–2857.
        • 10. Chapman MA, Lawrence MS, Keats JJ, et al. Initial genome sequencing and analysis of multiple myeloma. Nature 2011; 471: 467–472.
        • 11. Treon SP, Xu L, Yang G, et al. MYD88 L265P somatic mutation in Waldenstrom's macroglobulinemia. N Engl J Med 2012; 367: 826–833.
        • 12. Walker BA, Mavrommatis K, Wardell CP, et al. Identification of novel mutational drivers reveals oncogene dependencies in multiple myeloma. Blood 2018; 132: 587–597.
        • 13. Lohr JG, Stojanov P, Carter SL, et al. Widespread genetic heterogeneity in multiple myeloma: implications for targeted therapy. Cancer Cell 2014; 25: 91–101.
        • 14. Bolli N, Biancon G, Moarii M, et al. Analysis of the genomic landscape of multiple myeloma highlights novel prognostic markers and disease subgroups. Leukemia 2018; 32: 2604–2616.
        • 15. Bahlis NJ. Darwinian evolution and tiding clones in multiple myeloma. Blood 2012; 120: 927–928.
        • 16. Egan JB, Shi CX, Tembe W, et al. Whole‐genome sequencing of multiple myeloma from diagnosis to plasma cell leukemia reveals genomic initiating events, evolution, and clonal tides. Blood 2012; 120: 1060–1066.
        • 17. Keats JJ, Chesi M, Egan JB, et al. Clonal competition with alternating dominance in multiple myeloma. Blood 2012; 120: 1067–1076.
        • 18. Miller A, Asmann Y, Cattaneo L, et al. High somatic mutation and neoantigen burden are correlated with decreased progression‐free survival in multiple myeloma. Blood Cancer J 2017; 7: e612.
        • 19. Benson DM. Checkpoint inhibition in myeloma. Hematology Am Soc Hematol Educ Program 2016; 2016: 528–533.
        • 20. Chng WJ, Dispenzieri A, Chim CS, et al. IMWG consensus on risk stratification in multiple myeloma. Leukemia 2014; 28: 269–277.
        • 21. Palumbo A, Avet‐Loiseau H, Oliva S, et al. Revised International Staging System for multiple myeloma: a report from International Myeloma Working Group. J Clin Oncol 2015; 33: 2863–2869.
        • 22. Palumbo A, Avet‐Loiseau H, Oliva S, et al. Revised international staging system for multiple myeloma: a report from International Myeloma Working Group. J Clin Oncol 2015; 33: 2863–2869.
        • 23. Zhan F, Huang Y, Colla S, et al. The molecular classification of multiple myeloma. Blood 2006; 108: 2020–2028.
        • 24. Mateos MV, San Miguel JF. Smoldering multiple myeloma: when to observe and when to treat? Am Soc Clin Oncol Educ Book 2015: e484–e492.
        • 25. Rajkumar SV, Landgren O, Mateos MV. Smoldering multiple myeloma. Blood 2015; 125: 3069–3075.
        • 26. Mateos MV, Hernandez MT, Giraldo P, et al. Lenalidomide plus dexamethasone for high‐risk smoldering multiple myeloma. N Engl J Med 2013; 369: 438–447.
        • 27. Terpos E. Multiple myeloma: clinical updates from the American Society of Hematology Annual Meeting, 2017. Clin Lymphoma Myeloma Leuk 2018; 18: 321–334.
        • 28. Joshua D, Suen H, Brown R, et al. The T cell in myeloma. Clin Lymphoma Myeloma Leuk 2016; 16: 537–542.
        • 29. Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003; 78: 21–33.
        • 30. Martinez‐Lopez J, Lahuerta JJ, Pepin F, et al. Prognostic value of deep sequencing method for minimal residual disease detection in multiple myeloma. Blood 2014; 123: 3073–3079.
        • 31. Paiva B, Puig N, Garcia‐Sanz R, San Miguel JF. Is this the time to introduce minimal residual disease in multiple myeloma clinical practice? Clin Cancer Res 2015; 21: 2001–2008.
        • 32. Rawstron AC, Gregory WM, de Tute RM, et al. Minimal residual disease in myeloma by flow cytometry: independent prediction of survival benefit per log reduction. Blood 2015; 125: 1932–1935.
        • 33. Moreau P, Zamagni E. MRD in multiple myeloma: more questions than answers? Blood Cancer J 2017; 7: 639.
        • 34. Mateos MV, Dimopoulos MA, Cavo M, et al. Daratumumab plus bortezomib, melphalan, and prednisone for untreated myeloma. N Engl J Med 2018; 378: 518–528.
        • 35. Dimopoulos MA, Lonial S, Betts KA, et al. Elotuzumab plus lenalidomide and dexamethasone in relapsed/refractory multiple myeloma: extended 4‐year follow‐up and analysis of relative progression‐free survival from the randomized ELOQUENT‐2 trial. Cancer 2018; 124: 4032–4043.
        • 36. Richardson PG, Attal M, Campana F, et al. Isatuximab plus pomalidomide/dexamethasone versus pomalidomide/dexamethasone in relapsed/refractory multiple myeloma: ICARIA Phase III study design. Future Oncol 2018; 14: 1035–1047.
        • 37. Hipp S, Tai YT, Blanset D, et al. A novel BCMA/CD3 bispecific T‐cell engager for the treatment of multiple myeloma induces selective lysis in vitro and in vivo. Leukemia 2017; 31: 1743–1751.
        • 38. Suen H, Bryant C, Hart D, Joshua D. Novel T cell therapies in multiple myeloma. Ann Hematol Oncol 2016; 3: 1120.
        • 39. Bu DX, Singh R, Choi EE, et al. Pre‐clinical validation of B cell maturation antigen (BCMA) as a target for T cell immunotherapy of multiple myeloma. Oncotarget 2018; 9: 25764–25780.
        • 40. Rosenblatt J, Avivi I, Vasir B, et al. Vaccination with dendritic cell/tumor fusions following autologous stem cell transplant induces immunologic and clinical responses in multiple myeloma patients. Clin Cancer Res 2013; 19: 3640–3648.
        • 41. Larocca A, Dold SM, Zweegman S, et al. Patient‐centered practice in elderly myeloma patients: an overview and consensus from the European Myeloma Network (EMN). Leukemia 2018; 32: 1697–1712.
        • 42. Quach H, Joshua D, Ho J, et al. Treatment of patients with multiple myeloma who are eligible for stem cell transplantation: position statement of the Myeloma Foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2015; 45: 94–105.
        • 43. Quach H, Joshua D, Ho J, et al. Treatment of patients with multiple myeloma who are not eligible for stem cell transplantation: position statement of the myeloma foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2015; 45: 335–343.
        • 44. Quach H, Prince HM; Medical Scientific Advisory Group. Clinical practice guideline — multiple myeloma. Myeloma Australia, 2014. http://myeloma.org.au/wp-content/uploads/2017/10/MSAG-Clinical-Practice-Guideline-Myeloma-V4-March-2017.pdf (viewed Feb 2019).
        • 45. Gibson J, Ho PJ, Joshua D. Evolving transplant options for multiple myeloma: autologous and nonmyeloablative allogenic. Transplant Proc 2004; 36: 2501–2503.
        • 46. Mahajan S, Tandon N, Kumar S. The evolution of stem‐cell transplantation in multiple myeloma. Ther Adv Hematol 2018; 9: 123–133.
        • 47. Krishnan A, Pasquini MC, Logan B, et al. Autologous haemopoietic stem‐cell transplantation followed by allogeneic or autologous haemopoietic stem‐cell transplantation in patients with multiple myeloma (BMT CTN 0102): a phase 3 biological assignment trial. Lancet Oncol 2011; 12: 1195–1203.
        • 48. McCarthy PL, Holstein SA, Petrucci MT, et al. Lenalidomide maintenance after autologous stem‐cell transplantation in newly diagnosed multiple myeloma: a meta‐analysis. J Clin Oncol 2017; 35: 3279–3289.
        • 49. Facon T, Dimopoulos MA, Dispenzieri A, et al. Final analysis of survival outcomes in the phase 3 FIRST trial of up‐front treatment for multiple myeloma. Blood 2018; 131: 301–310.
        • 50. Moreau P, Masszi T, Grzasko N, et al. Oral ixazomib, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med 2016; 374: 1621–1634.
        • 51. Varga C, Maglio M, Ghobrial IM, Richardson PG. Current use of monoclonal antibodies in the treatment of multiple myeloma. Br J Haematol 2018; 181: 447–459.
        • 52. Zamagni E, Tacchetti P, Pantani L, Cavo M. Anti‐CD38 and anti‐SLAMF7: the future of myeloma immunotherapy. Expert Rev Hematol 2018; 11: 423–435.
        • 53. Kumar SK, Berdeja JG, Niesvizky R, et al. Safety and tolerability of ixazomib, an oral proteasome inhibitor, in combination with lenalidomide and dexamethasone in patients with previously untreated multiple myeloma: an open‐label phase 1/2 study. Lancet Oncol 2014; 15: 1503–1512.
        • 54. Kumar SK, Lee JH, Lahuerta JJ, et al. Risk of progression and survival in multiple myeloma relapsing after therapy with IMiDs and bortezomib: a multicenter international myeloma working group study. Leukemia 2012; 26: 149–157.
        • 55. Dimopoulos MA, Goldschmidt H, Niesvizky R, et al. Carfilzomib or bortezomib in relapsed or refractory multiple myeloma (ENDEAVOR): an interim overall survival analysis of an open‐label, randomised, phase 3 trial. Lancet Oncol 2017; 18: 1327–1337.
        • 56. Mateos MV, Goldschmidt H, San‐Miguel J, et al. Carfilzomib in relapsed or refractory multiple myeloma patients with early or late relapse following prior therapy: a subgroup analysis of the randomized phase 3 ASPIRE and ENDEAVOR trials. Hematol Oncol 2018; 36: 463–470.
        • 57. Stewart AK, Rajkumar SV, Dimopoulos MA, et al. Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma. N Engl J Med 2015; 372: 142–152.
        • 58. Bringhen S, Mina R, Cafro AM, et al. Once‐weekly carfilzomib, pomalidomide, and low‐dose dexamethasone for relapsed/refractory myeloma: a phase I/II study. Leukemia 2018; 32: 1803–1807.
        • 59. Scott A, Weber N, Tiley C, et al. “Real‐world” Australian experience of pomalidomide for relapsed and refractory myeloma. Leuk Lymphoma 2018; 59: 1514–1516.
        • 60. Ailawadhi S, Mikhael JR, LaPlant BR, et al. Pomalidomide‐dexamethasone in refractory multiple myeloma: long‐term follow‐up of a multi‐cohort phase II clinical trial. Leukemia 2018; 32: 719–728.
        • 61. Henry DH, Costa L, Goldwasser F, et al. Randomized, double‐blind study of denosumab versus zoledronic acid in the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma. J Clin Oncol 2011; 29: 1125–1132.
        • 62. Terpos E, Berenson J, Raje N, Roodman GD. Management of bone disease in multiple myeloma. Expert Rev Hematol 2014; 7: 113–125.
        • 63. Dimopoulos MA, Roussou M, Gavriatopoulou M, et al. Bortezomib‐based triplets are associated with a high probability of dialysis independence and rapid renal recovery in newly diagnosed myeloma patients with severe renal failure or those requiring dialysis. Am J Hematol 2016; 91: 499–502.
        • 64. Dimopoulos MA, Terpos E, Chanan‐Khan A, et al. Renal impairment in patients with multiple myeloma: a consensus statement on behalf of the International Myeloma Working Group. J Clin Oncol 2010; 28: 4976–4984.
        • 65. Scheid C, Sonneveld P, Schmidt‐Wolf IG, et al. Bortezomib before and after autologous stem cell transplantation overcomes the negative prognostic impact of renal impairment in newly diagnosed multiple myeloma: a subgroup analysis from the HOVON‐65/GMMG‐HD4 trial. Haematologica 2014; 99: 148–154.
        • 66. Bridoux F, Carron PL, Pegourie B, et al. Effect of high‐cutoff hemodialysis vs conventional hemodialysis on hemodialysis independence among patients with myeloma cast nephropathy: a randomized clinical trial. JAMA 2017; 318: 2099–2110.
        • 67. Vacca A, Melaccio A, Sportelli A, et al. Subcutaneous immunoglobulins in patients with multiple myeloma and secondary hypogammaglobulinemia: a randomized trial. Clin Immunol 2018; 191: 110–115.
        • 68. Australian Institute of Health and Welfare. Cancer in Australia 2017 (Cat. No. CAN 100; Cancer Series No. 101). Canberra: AIHW; 2017. https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2017/contents/table-of-contents (viewed Feb 2019).
        • 69. Bergin K, Moore E, McQuilten Z, et al. Design and development of the Australian and New Zealand (ANZ) myeloma and related diseases registry. BMC Med Res Methodol 2016; 16: 151.
        • 70. Bergin K, Moore E, McQuilten Z, et al. Design and development of the Australian and New Zealand (ANZ) myeloma and related diseases registry. BMC Med Res Methodol 2016; 16: 151.

        Author
        remove_circle_outline Delete Author
        add_circle_outline Add Author
        Comment
        Do you have any competing interests to declare? *
        I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
        I/we agree to the Terms of use of the Medical Journal of Australia *
        Email me when people comment on this article
        Online responses are no longer available. Please refer to our instructions for authors page for more information.

          Advances in stroke medicine

          Bruce CV Campbell
          Med J Aust 2019; 210 (8): . || doi: 10.5694/mja2.50137
          Published online: 6 May 2019

          Summary

          • In recent years, reperfusion therapies such as intravenous thrombolysis and endovascular thrombectomy for ischaemic stroke have dramatically reduced disability and revolutionised stroke management.
          • Thrombolysis with alteplase is effective when administered to patients with potentially disabling stroke, who are not at high risk of bleeding, within 4.5 hours of the time the patient was last known to be well. Emerging evidence suggests that other thrombolytics such as tenecteplase may be even more effective. Treatment may be possible beyond 4.5 hours in patients selected using brain imaging.
          • Endovascular thrombectomy (via angiography) effectively reduces risk of death or dependency in patients with large vessel occlusion (internal carotid, proximal middle cerebral and basilar arteries) if applied within 6 hours of the time they were last known to be well.
          • Endovascular thrombectomy is also beneficial 6–24 hours from the last known well time in selected patients with favourable brain imaging. Thus, some patients with wake‐up stroke are now treatable, and protocols for stroke need to include computed tomography (CT) perfusion scan and CT angiography as routine, in addition to the non‐contrast CT brain scan.
          • Optimised pre‐hospital and emergency department systems (eg, code stroke response teams, pre‐notification by ambulance, direct transport from triage to CT scanner) are essential to maximise the benefit of these strongly time‐dependent therapies. Telemedicine is increasingly providing specialist guidance for these more complex treatment decisions in rural areas.
          • Important developments in secondary stroke prevention include the use of direct oral anticoagulants or left atrial appendage occlusion for atrial fibrillation, and endovascular closure of patent foramen ovale.

          • Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC


          Correspondence: Bruce.Campbell@mh.org.au
          Competing interests:

          Bruce Campbell has received research support from the National Health and Medical Research Council (GNT1043242, GNT1035688), the Royal Australasian College of Physicians, the Royal Melbourne Hospital Foundation, the National Heart Foundation and the Stroke Foundation. He has received unrestricted grant funding for the EXTEND‐IA trial to the Florey Institute of Neuroscience and Mental Health from Medtronic. He co‐chaired the 2017 Australian Stroke Guidelines content working party.

          • 1. Deloittte Access Economics. The economic impact of stroke in Australia. Deloittte Access Economics, 2013. https://strokefoundation.org.au/What-we-do/Research/Economic-impact-of-stroke-in-Australia (viewed Aug 2018).
          • 2. Stroke Unit Trialists’ Collaboration. Collaborative systematic review of the randomised trials of organised inpatient (stroke unit) care after stroke. BMJ 1997; 314: 1151–1159.
          • 3. CAST (Chinese Acute Stroke Trial) Collaborative Group. CAST: randomised placebo‐controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. Lancet 1997; 349: 1641–1649.
          • 4. International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. Lancet 1997; 349: 1569–1581.
          • 5. Vahedi K, Hofmeijer J, Juettler E, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 2007; 6: 215–222.
          • 6. The National Institute of Neurological Disorders and Stroke rt‐PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: 1581–1587.
          • 7. Thomalla G, Simonsen CZ, Boutitie F, et al. MRI‐guided thrombolysis for stroke with unknown time of onset. N Engl J Med 2018; 379: 611–622.
          • 8. Ma H, Campbell BCV, Parsons MW, et al. Thrombolysis up to 9 hours after stroke onset guided by perfusion imaging. N Engl J Med 2019. In press.
          • 9. Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372: 11–20.
          • 10. Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion‐imaging selection. N Engl J Med 2015; 372: 1009–1018.
          • 11. Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372: 1019–1030.
          • 12. Saver JL, Goyal M, Bonafe A, et al. Stent‐retriever thrombectomy after intravenous t‐PA vs. t‐PA alone in stroke. N Engl J Med 2015; 372: 2285–2295.
          • 13. Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372: 2296–2306.
          • 14. Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018; 378: 11–21.
          • 15. Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018; 378: 708–718.
          • 16. Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta‐analysis of individual patient data from randomised trials. Lancet 2014; 384: 1929–1935.
          • 17. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large‐vessel ischaemic stroke: a meta‐analysis of individual patient data from five randomised trials. Lancet 2016; 387: 1723–1731.
          • 18. Chen ZM, Sandercock P, Pan HC, et al. Indications for early aspirin use in acute ischemic stroke: a combined analysis of 40 000 randomized patients from the Chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups. Stroke 2000; 31: 1240–1249.
          • 19. Anderson CS, Heeley E, Huang Y, et al. Rapid blood‐pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med 2013; 368: 2355–2365.
          • 20. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359: 1317–1329.
          • 21. Stroke Foundation. Clinical guidelines for stroke management 2017 [website]. https://informme.org.au/Guidelines (viewed Aug 2018).
          • 22. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49: e46–e110.
          • 23. Casaubon LK, Boulanger JM, Blacquiere D, et al. Canadian stroke best practice recommendations: hyperacute stroke care guidelines, update 2015. Int J Stroke 2015; 10: 924–940.
          • 24. Ringleb P, Schellinger PD, Hacke W, Europaischen S. European Stroke Organisation 2008 guidelines for managing acute cerebral infarction or transient ischemic attack. Part 1 [German]. Nervenarzt 2008; 79: 936–957.
          • 25. Stroke Foundation. National stroke audit acute services 2017 [website]. https://informme.org.au/stroke-data/Acute-audits (viewed Aug 2018).
          • 26. Lees KR, Bluhmki E, von Kummer R, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 2010; 375: 1695–1703.
          • 27. Wahlgren N, Ahmed N, Davalos A, et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke‐Monitoring Study (SITS‐MOST): an observational study. Lancet 2007; 369: 275–282.
          • 28. Myslimi F, Caparros F, Dequatre‐Ponchelle N, et al. Orolingual angioedema during or after thrombolysis for cerebral ischemia. Stroke 2016; 47: 1825–1830.
          • 29. Cheong E, Dodd L, Smith W, Kleinig T. Icatibant as a potential treatment of life‐threatening alteplase‐induced angioedema. J Stroke Cerebrovasc Dis 2018; 27: e36–e37.
          • 30. Smith EE, Abdullah AR, Petkovska I, et al. Poor outcomes in patients who do not receive intravenous tissue plasminogen activator because of mild or improving ischemic stroke. Stroke 2005; 36: 2497–2499.
          • 31. Khatri P, Kleindorfer DO, Devlin T, et al. Effect of alteplase vs aspirin on functional outcome for patients with acute ischemic stroke and minor nondisabling neurologic deficits: the PRISMS randomized clinical trial. JAMA 2018; 320: 156–166.
          • 32. Coutts SB, Modi J, Patel SK, et al. CT/CT angiography and MRI findings predict recurrent stroke after transient ischemic attack and minor stroke: results of the prospective CATCH study. Stroke 2012; 43: 1013–1017.
          • 33. Parsons M, Spratt N, Bivard A, et al. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke. N Engl J Med 2012; 366: 1099–1107.
          • 34. Campbell BCV, Mitchell PJ, Churilov L, et al. Tenecteplase versus alteplase before thrombectomy for ischemic stroke. N Engl J Med 2018; 378: 1573–1582.
          • 35. Huang X, Cheripelli BK, Lloyd SM, et al. Alteplase versus tenecteplase for thrombolysis after ischaemic stroke (ATTEST): a phase 2, randomised, open‐label, blinded endpoint study. Lancet Neurol 2015; 14: 368–376.
          • 36. Logallo N, Novotny V, Assmus J, et al. Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR‐TEST): a phase 3, randomised, open‐label, blinded endpoint trial. Lancet Neurol 2017; 16: 781–788.
          • 37. Mair G, von Kummer R, Adami A, et al. Arterial obstruction on computed tomographic or magnetic resonance angiography and response to intravenous thrombolytics in ischemic stroke. Stroke 2017; 48: 353–360.
          • 38. Furlan A, Higashida R, Wechsler L, et al. Intra‐arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 1999; 282: 2003–2011.
          • 39. Broderick JP, Palesch YY, Demchuk AM, et al. Endovascular therapy after intravenous t‐PA versus t‐PA alone for stroke. N Engl J Med 2013; 368: 893–903.
          • 40. Ciccone A, Valvassori L, Nichelatti M, et al. Endovascular treatment for acute ischemic stroke. N Engl J Med 2013; 368: 904–913.
          • 41. Kidwell CS, Jahan R, Gornbein J, et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 2013; 368: 914–923.
          • 42. Campbell BCV, van Zwam WH, Goyal M, et al. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta‐analysis of individual patient data. Lancet Neurol 2018; 17: 47–53.
          • 43. Lowhagen Henden P, Rentzos A, Karlsson JE, et al. General anesthesia versus conscious sedation for endovascular treatment of acute ischemic stroke: the AnStroke trial (Anesthesia During Stroke). Stroke 2017; 48: 1601–1607.
          • 44. Schonenberger S, Uhlmann L, Hacke W, et al. Effect of conscious sedation vs general anesthesia on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy: a randomized clinical trial. JAMA 2016; 316: 1986–1996.
          • 45. Simonsen CZ, Yoo AJ, Sorensen LH, et al. Effect of general anesthesia and conscious sedation during endovascular therapy on infarct growth and clinical outcomes in acute ischemic stroke: a randomized clinical trial. JAMA Neurol 2018; 75: 470–477.
          • 46. Roman LS, Menon BK, Blasco J, et al. Imaging features and safety and efficacy of endovascular stroke treatment: a meta‐analysis of individual patient‐level data. Lancet Neurol 2018; 17: 895–904.
          • 47. Campbell BCV, Majoie C, Albers GW, et al. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta‐analysis of individual patient‐level data. Lancet Neurol 2018; 18: 46–55.
          • 48. Saver JL, Goyal M, van der Lugt A, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta‐analysis. JAMA 2016; 316: 1279–1288.
          • 49. Mistry EA, Mistry AM, Nakawah MO, et al. Mechanical thrombectomy outcomes with and without intravenous thrombolysis in stroke patients: a meta‐analysis. Stroke 2017; 48: 2450–2456.
          • 50. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST‐elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127: e362–e425.
          • 51. Meretoja A, Strbian D, Mustanoja S, et al. Reducing in‐hospital delay to 20 minutes in stroke thrombolysis. Neurology 2012; 79: 306–313.
          • 52. 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.
          • 53. Campbell BCV. Stroke imaging: do it right the first time. JAMA Neurol 2017; 74: 1298–1300.
          • 54. Ng FC, Low E, Andrew E, et al. Deconstruction of interhospital transfer workflow in large vessel occlusion: real‐world data in the thrombectomy era. Stroke 2017; 48: 1976–1979.
          • 55. Perez de la Ossa N, Carrera D, Gorchs M, et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale. Stroke 2014; 45: 87–91.
          • 56. Zhao H, Pesavento L, Coote S, et al. Ambulance clinical triage for acute stroke treatment: paramedic triage algorithm for large vessel occlusion. Stroke 2018; 49: 945–951.
          • 57. Fassbender K, Grotta JC, Walter S, et al. Mobile stroke units for prehospital thrombolysis, triage, and beyond: benefits and challenges. Lancet Neurol 2017; 16: 227–237.
          • 58. Murray CJ, Vos T, Lozano R, et al. Disability‐adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990‐2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2197–2223.
          • 59. Zhang LF, Yang J, Hong Z, Yuan GG, Zhou BF, Zhao LC, Huang YN, Chen J, Wu YF; Collaborative Group of China Multicenter Study of Cardiovascular Epidemiology. Proportion of different subtypes of stroke in China. Stroke 2003; 34: 2091–2096.
          • 60. Qureshi AI, Palesch YY, Barsan WG, et al. Intensive blood‐pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med 2016; 375: 1033–1043.
          • 61. Sanna T, Diener HC, Passman RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 2014; 370: 2478–2486.
          • 62. Group SR, Wright JT, Jr., Williamson JD, et al. A randomized trial of intensive versus standard blood‐pressure control. N Engl J Med 2015; 373: 2103–2116.
          • 63. Arima H, Chalmers J, Woodward M, et al. Lower target blood pressures are safe and effective for the prevention of recurrent stroke: the PROGRESS trial. J Hypertens 2006; 24: 1201–1208.
          • 64. Amarenco P, Bogousslavsky J, Callahan A, et al. High‐dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006; 355: 549–559.
          • 65. Rothwell PM, Algra A, Chen Z, et al. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time‐course analysis of randomised trials. Lancet 2016; 388: 365–375.
          • 66. Wang Y, Zhao X, Liu L, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013; 369: 11–19.
          • 67. Johnston SC, Easton JD, Farrant M, et al. Clopidogrel and aspirin in acute ischemic stroke and high‐risk TIA. N Engl J Med 2018; 379: 215–225.
          • 68. Nishimura M, Sab S, Reeves RR, Hsu JC. Percutaneous left atrial appendage occlusion in atrial fibrillation patients with a contraindication to oral anticoagulation: a focused review. Europace 2017; 20: 1412–1419.
          • 69. Hart RG, Sharma M, Mundl H, et al. Rivaroxaban for stroke prevention after embolic stroke of undetermined source. N Engl J Med 2018; 378: 2191–2201.
          • 70. Mas JL, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med 2017; 377: 1011–1021.
          • 71. Sondergaard L, Kasner SE, Rhodes JF, et al. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med 2017; 377: 1033–1042.
          • 72. Saver JL, Carroll JD, Thaler DE, et al. Long‐term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med 2017; 377: 1022–1032.

          Author
          remove_circle_outline Delete Author
          add_circle_outline Add Author
          Comment
          Do you have any competing interests to declare? *
          I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
          I/we agree to the Terms of use of the Medical Journal of Australia *
          Email me when people comment on this article
          Online responses are no longer available. Please refer to our instructions for authors page for more information.

            Blindness and acute pancreatitis: Purtscher‐like retinopathy

            Anthony Yao and Bob Wang
            Med J Aust 2019; 210 (8): . || doi: 10.5694/mja2.50135
            Published online: 6 May 2019


            • Austin Health, Melbourne, VIC


            Correspondence: anthony.yao@gmail.com
            Competing interests:

            No relevant disclosures.

            • 1. Miguel AIM, Henriques F, Azevedo LFR, et al. Systematic review of Purtscher's and Purtscher‐like retinopathies. Eye 2013; 27: 1–13.

            Author
            remove_circle_outline Delete Author
            add_circle_outline Add Author
            Comment
            Do you have any competing interests to declare? *
            I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
            I/we agree to the Terms of use of the Medical Journal of Australia *
            Email me when people comment on this article
            Online responses are no longer available. Please refer to our instructions for authors page for more information.

              Mycobacterial mimicry in a man from Myanmar

              David WJ Griffin, G Khai Lin Huang, Philippe Lachapelle, Steven YC Tong and Siddhartha Mahanty
              Med J Aust 2019; 210 (8): . || doi: 10.5694/mja2.50133
              Published online: 6 May 2019

              A 26‐year‐old refugee from Myanmar was referred to the infectious diseases unit of an Australian teaching hospital for assessment of suspected recurrent pulmonary tuberculosis (TB). He had arrived in Australia 3 months earlier, after spending the preceding 5 years in Malaysia. He was diagnosed with presumed pulmonary TB in Malaysia in 2013, in the context of a productive cough and suspicious chest x‐ray findings, without microbiological confirmation. He completed treatment with 6 months of first line anti‐TB therapy (2 months of rifampicin, isoniazid, pyrazinamide and ethambutol, followed by 4 months of rifampicin and isoniazid).


              • 1 Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC
              • 2 Royal Melbourne Hospital, Melbourne, VIC
              • 3 Menzies School of Health Research and Royal Darwin Hospital, Darwin, NT


              Correspondence: davidwjgriffin@gmail.com
              Acknowledgements: 

              David Griffin and Khai Huang contributed equally to the authorship of this manuscript. We would like to thank the staff in the Department of Microbiology at Melbourne Health.

              Competing interests:

              No relevant disclosures.

              • 1. Foodborne Diseases Burden Epidemiology Reference Group 2007‐2015. WHO estimates of the global burden of foodborne diseases. Geneva: World Health Organization, 2015. http://www.who.int/foodsafety/publications/foodborne_disease/fergreport/en/ (viewed Oct 2018).
              • 2. Procop GW. North American paragonimiasis (caused by Paragonimus kellicotti) in the context of global paragonimiasis. Clin Microbiol Rev 2009; 22: 415–446.
              • 3. Barennes H, Slesak G, Buisson Y, Odermatt P. Paragonimiasis as an important alternative misdiagnosed disease for suspected acid‐fast bacilli sputum smear‐negative tuberculosis. Am J Trop Med Hyg 2014; 90: 384–385.
              • 4. Seon HJ, Kim YI, Lee JH, et al. Differential chest computed tomography findings of pulmonary parasite infestation between the paragonimiasis and nonparagonimiatic parasite infestation. J Comput Assist Tomog 2015; 39: 956–961.
              • 5. Rozenshtein A, Hao F, Starc MT, Pearson GD. Radiographic appearance of pulmonary tuberculosis: dogma disproved. Am J Roentgenol 2015; 204: 974–978.
              • 6. Centers for Disease Control and Prevention. DPDx ‐ Laboratory Identification of Parasites of Public Health Concern. Paragonimiasis. https://www.cdc.gov/dpdx/paragonimiasis/index.html (viewed Oct 2018).
              • 7. Udonsi JK. Clinical field trials of praziquantel in pulmonary paragonimiasis due to Paragonimus uterobilateralis in endemic populations of the Igwun Basin, Nigeria. Trop Med Parasitol 1989; 40: 65–68.

              Author
              remove_circle_outline Delete Author
              add_circle_outline Add Author
              Comment
              Do you have any competing interests to declare? *
              I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
              I/we agree to the Terms of use of the Medical Journal of Australia *
              Email me when people comment on this article
              Online responses are no longer available. Please refer to our instructions for authors page for more information.

                Acute kidney injury in Indigenous Australians in the Kimberley: age distribution and associated diagnoses

                Joseph V Mohan, David N Atkinson, Johan B Rosman and Emma K Griffiths
                Med J Aust 2019; 211 (1): . || doi: 10.5694/mja2.50061
                Published online: 29 April 2019

                Abstract

                Objective: To describe the frequencies of acute kidney injury (AKI) and of associated diagnoses in Indigenous people in a remote Western Australian region.

                Design: Retrospective population‐based study of AKI events confirmed by changes in serum creatinine levels.

                Setting, participants: Aboriginal and Torres Strait Islander residents of the Kimberley region of Western Australia, aged 15 years or more and without end‐stage kidney disease, for whom AKI between 1 June 2009 and 30 May 2016 was confirmed by an acute rise in serum creatinine levels.

                Main outcome measures: Age‐specific AKI rates; principal and other diagnoses.

                Results: 324 AKI events in 260 individuals were recorded; the median age of patients was 51.8 years (IQR, 43.9–61.0 years), and 176 events (54%) were in men. The overall AKI rate was 323 events (95% CI, 281–367) per 100 000 population; 92 events (28%) were in people aged 15–44 years. 52% of principal diagnoses were infectious in nature, including pneumonia (12% of events), infections of the skin and subcutaneous tissue (10%), and urinary tract infections (7.7%). 80 events (34%) were detected on or before the date of admission; fewer than one‐third of discharge summaries (61 events, 28%) listed AKI as a primary or other diagnosis.

                Conclusion: The age distribution of AKI events among Indigenous Australians in the Kimberley was skewed to younger groups than in the national data on AKI. Infectious conditions were common in patients, underscoring the significance of environmental determinants of health. Primary care services can play an important role in preventing community‐acquired AKI; applying pathology‐based criteria could improve the detection of AKI.

                Please login with your free MJA account to view this article in full

                LOGIN
                CREATE AN ACCOUNT

                Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

                View on Wiley Online Library

                • 1 The University of Western Australia, Perth, WA
                • 2 Rural Clinical School of Western Australia, University of Western Australia, Broome, WA
                • 3 Curtin University, Perth, WA
                • 4 Kimberley Aboriginal Medical Services, Broome, WA


                Acknowledgements: 

                We thank Julia Marley (Kimberley Research, University of Western Australia) for critically reviewing our manuscript.

                Competing interests:

                No relevant disclosures.

                • 1. Chawla LS, Eggers PW, Star RA, Kimmel PL. Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med 2014; 371: 58–66.
                • 2. Australian Institute of Health and Welfare. Acute kidney injury in Australia: a first national snapshot (Cat. No. PHE 190). Canberra: AIHW, 2015.
                • 3. Cerda J, Bagga A, Kher V, Chakravarthi RM. The contrasting characteristics of acute kidney injury in developed and developing countries. Nat Clin Pract Nephrol 2008; 4: 138–153.
                • 4. Lewington AJ, Cerda J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int 2013; 84: 457–467.
                • 5. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2: 1–138.
                • 6. Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta‐analysis. Kidney Int 2012; 81: 442–448.
                • 7. Chawla LS, Kimmel PL. Acute kidney injury and chronic kidney disease: an integrated clinical syndrome. Kidney Int 2012; 82: 516–524.
                • 8. Parr SK, Matheny ME, Abdel‐Kader K, et al. Acute kidney injury is a risk factor for subsequent proteinuria. Kidney Int 2017; 93: 460–469.
                • 9. Ishani A, Nelson D, Clothier B, et al. The magnitude of acute serum creatinine increase after cardiac surgery and the risk of chronic kidney disease, progression of kidney disease, and death. Arch Intern Med 2011; 171: 226–233.
                • 10. Ponte B, Felipe C, Muriel A, et al. Long‐term functional evolution after an acute kidney injury: a 10‐year study. Nephrol Dial Transplant 2008; 23: 3859–3866.
                • 11. Australian Institute of Health and Welfare. Chronic kidney disease. Dec 2017. https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/chronic-kidney-disease/overview (viewed Jan 2019).
                • 12. Wyld MLR, Lee CMY, Zhuo X, et al. Cost to government and society of chronic kidney disease stage 1–5: a national cohort study. Intern Med J 2015; 45: 741–747.
                • 13. Australian Institute of Health and Welfare. Chronic kidney disease in Aboriginal and Torres Strait Islander people, 2011 (Cat. No. PHE 151). Canberra: AIHW, 2011.
                • 14. Hoy WE, Mott SA, McDonald SP. An expanded nationwide view of chronic kidney disease in Aboriginal Australians. Nephrology (Carlton) 2016; 21: 916–922.
                • 15. Marley JV, Dent HK, Wearne M, et al. Haemodialysis outcomes of Aboriginal and Torres Strait Islander patients of remote Kimberley region origin. Med J Aust 2010; 193: 516–520. https://www.mja.com.au/journal/2010/193/9/haemodialysis-outcomes-aboriginal-and-torres-strait-islander-patients-remote
                • 16. Levin A, Tonelli M, Bonventre J, et al; ISN Global Kidney Health Summit participants. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet 2017; 390: 1888–1917.
                • 17. Australian Bureau of Statistics. 2016 Census QuickStats: Kimberley. Updated 13 Dec 2018. http://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/51001?opendocument (viewed Jan 2019).
                • 18. Levey AS, Stevens LA, Schmid CH, et al; CKD‐EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604–612.
                • 19. Australia and New Zealand Dialysis and Transplant Registry. End stage kidney disease among Indigenous Peoples of Australia and New Zealand. In: 38th annual ANZDATA report (2015). Adelaide: ANZDATA Registry, 2016; pp. 12/1–12/23. http://www.anzdata.org.au/anzdata/AnzdataReport/38thReport/c12_anzdata_indigenous_v3.0_201600128_web.pdf (viewed Jan 2018).
                • 20. Hendrickx D, Bowen AC, Marsh JA, et al. Ascertaining infectious disease burden through primary care clinic attendance among young Aboriginal children living in four remote communities in Western Australia. PLoS One 2018; 13: e0203684.
                • 21. Abdalla T, Hendrickx D, Fathima P, et al. Hospital admissions for skin infections among Western Australian children and adolescents from 1996 to 2012. PLoS One 2017; 12: e0188803.
                • 22. Aung PTZ, Cuningham W, Hwang K, et al. Scabies and risk of skin sores in remote Australian Aboriginal communities: a self‐controlled case series study. PLoS Negl Trop Dis 2018; 12: e0006668.
                • 23. Melody SM, Bennett E, Clifford HD, et al. A cross‐sectional survey of environmental health in remote Aboriginal communities in Western Australia. Int J Environ Health Res 2016; 26: 525–535.
                • 24. Hoy WE, White AV, Dowling A, et al. Post‐streptococcal glomerulonephritis is a strong risk factor for chronic kidney disease in later life. Kidney Int 2012; 81: 1026–1032.
                • 25. White A, Wong W, Sureshkumur P, Singh G. The burden of kidney disease in indigenous children of Australia and New Zealand, epidemiology, antecedent factors and progression to chronic kidney disease. J Paediatr Child Health 2010; 46: 504–509.
                • 26. Rewa O, Bagshaw SM. Acute kidney injury: epidemiology, outcomes and economics. Nat Rev Nephrol 2014; 10: 193–207.
                • 27. May PJ, Bowen AC, Carapetis JR. The inequitable burden of group A streptococcal diseases in Indigenous Australians. Med J Aust 2016; 205: 201–203. https://www.mja.com.au/journal/2016/205/5/inequitable-burden-group-streptococcal-diseases-indigenous-australians
                • 28. Mehta RL, Burdmann EA, Cerdá J, et al. Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross‐sectional study. Lancet 2016; 387: 2017–2025.

                Author
                remove_circle_outline Delete Author
                add_circle_outline Add Author
                Comment
                Do you have any competing interests to declare? *
                I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
                I/we agree to the Terms of use of the Medical Journal of Australia *
                Email me when people comment on this article
                Online responses are no longer available. Please refer to our instructions for authors page for more information.

                  Traumatic spinal cord injury in Victoria, 2007–2016

                  Ben Beck, Peter A Cameron, Sandra Braaf, Andrew Nunn, Mark C Fitzgerald, Rodney T Judson, Warwick J Teague, Alyse Lennox, James W Middleton, James E Harrison and Belinda J Gabbe
                  Med J Aust 2019; 210 (8): . || doi: 10.5694/mja2.50143
                  Published online: 29 April 2019

                  Abstract

                  Objective: To investigate trends in the incidence and causes of traumatic spinal cord injury (TSCI) in Victoria over a 10‐year period.

                  Design, setting, participants: Retrospective cohort study: analysis of Victorian State Trauma Registry (VSTR) data for people who sustained TSCIs during 2007–2016.

                  Main outcomes and measures: Temporal trends in population‐based incidence rates of TSCI (injury to the spinal cord with an Abbreviated Injury Scale [AIS] score of 4 or more).

                  Results: There were 706 cases of TSCI, most the result of transport events (269 cases, 38%) or low falls (197 cases, 28%). The overall crude incidence of TSCI was 1.26 cases per 100 000 population (95% CI, 1.17–1.36 per 100 000 population), and did not change over the study period (incidence rate ratio [IRR], 1.01; 95% CI, 0.99–1.04). However, the incidence of TSCI resulting from low falls increased by 9% per year (95% CI, 4–15%). The proportion of TSCI cases classified as incomplete tetraplegia increased from 41% in 2007 to 55% in 2016 (P < 0.001). Overall in‐hospital mortality was 15% (104 deaths), and was highest among people aged 65 years or more (31%, 70 deaths).

                  Conclusions: Given the devastating consequences of TSCI, improved primary prevention strategies are needed, particularly as the incidence of TSCI did not decline over the study period. The epidemiologic profile of TSCI has shifted, with an increasing number of TSCI events in older adults. This change has implications for prevention, acute and post‐discharge care, and support.

                  Please login with your free MJA account to view this article in full

                  LOGIN
                  CREATE AN ACCOUNT

                  Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

                  View on Wiley Online Library

                  • 1 Monash University, Melbourne, VIC
                  • 2 The Alfred Hospital, Melbourne, VIC
                  • 3 Victorian Spinal Cord Service, Austin Hospital, Melbourne, VIC
                  • 4 National Trauma Research Institute, Melbourne, VIC
                  • 5 Royal Melbourne Hospital, Melbourne, VIC
                  • 6 University of Melbourne, Melbourne, VIC
                  • 7 Royal Children's Hospital, Melbourne, VIC
                  • 8 Murdoch Children's Research Institute, Melbourne, VIC
                  • 9 Kolling Institute, University of Sydney, Sydney, NSW
                  • 10 Agency for Clinical Innovation, Sydney, NSW
                  • 11 Research Centre for Injury Studies, Flinders University, Adelaide, SA
                  • 12 Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, United Kingdom


                  Correspondence: ben.beck@monash.edu
                  Acknowledgements: 

                  We thank the Victorian State Trauma Outcome Registry and Monitoring (VSTORM) group for providing Victorian State Trauma Registry data. We also thank Sue McLellan for her assistance with providing the data. The VSTR is funded by the Department of Health and Human Services, Victoria and the Transport Accident Commission. Ben Beck was supported by an Australian Research Council Discovery Early Career Researcher Award Fellowship (DE180100825). Peter Cameron was supported by a National Health and Medical Research Council Practitioner Fellowship (545926). Warwick Teague's role as director of trauma services was supported by a grant from the Royal Children's Hospital Foundation. Belinda Gabbe was supported by an Australian Research Council Future Fellowship (FT170100048).

                  Competing interests:

                  No relevant disclosures.

                  • 1. Bickenbach JR, Officer A, Shakespeare T, et al. International perspectives on spinal cord injury. Geneva: World Health Organization; International Spinal Cord Society, 2013. http://apps.who.int/iris/bitstream/10665/94190/1/9789241564663_eng.pdf?ua=1 (viewed May 2017).
                  • 2. O'Connor PJ. Prevalence of spinal cord injury in Australia. Spinal Cord 2005; 43: 42–46.
                  • 3. Access Economics, for the Victorian Neurotrauma Initiative. The economic cost of spinal cord injury and traumatic brain injury in Australia. June 2009. http://www.spinalcure.org.au/pdf/Economic-cost-of-SCI-and-TBI-in-Au-2009.pdf (viewed May 2017).
                  • 4. Australian Institute of Health and Welfare. Spinal cord injury, Australia, 2014–15 (Cat. No. INJCAT 193; Injury Research and Statistics Series No. 113). Canberra: AIHW, 2018.
                  • 5. Department of Health and Human Services (Victoria). Victorian State Trauma System. 2018. https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/acute-care/state-trauma-system (viewed Jan 2019).
                  • 6. Cameron PA, Gabbe BJ, Cooper DJ, et al. A statewide system of trauma care in Victoria: effect on patient survival. Med J Aust 2008; 189: 546–550. https://www.mja.com.au/journal/2008/189/10/statewide-system-trauma-care-victoria-effect-patient-survival
                  • 7. Australian Bureau of Statistics. The Australian statistical geography standard (ASGS) remoteness structure. Updated Mar 2018. http://www.abs.gov.au/websitedbs/d3310114.nsf/home/remoteness+structure (viewed Jan 2019).
                  • 8. Australian Bureau of Statistics. 2033.0.55.001. Census of population and housing: Socio‐Economic Indexes for Areas (SEIFA), Australia, 2016: IRSAD. Mar 2018. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2033.0.55.001~2016~Main%20 (viewed Jan 2019).
                  • 9. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–383.
                  • 10. Australian Institute of Health and Welfare. Age‐standardised rate. METeOR Metadata Online Registry; Mar 2005. http://meteor.aihw.gov.au/content/index.phtml/itemId/327276 (viewed Sept 2016).
                  • 11. Australian Bureau of Statistics. 3101.0. Australian demographic statistics, Mar 2013. Sept 2013. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Mar%202013?OpenDocument (viewed Aug 2016).
                  • 12. Nijendijk JH, Post MW, Van Asbeck FW. Epidemiology of traumatic spinal cord injuries in The Netherlands in 2010. Spinal Cord 2014; 52: 258–263.
                  • 13. Bjørnshave Noe B, Mikkelsen EM, Hansen R, et al. Incidence of traumatic spinal cord injury in Denmark, 1990–2012: a hospital‐based study. Spinal Cord 2015; 53: 436–440.
                  • 14. Ahoniemi E, Alaranta H, Hokkinen E, et al. Incidence of traumatic spinal cord injuries in Finland over a 30‐year period. Spinal Cord 2008; 46: 781–784.
                  • 15. Jain NB, Ayers GD, Peterson EN, et al. Traumatic spinal cord injury in the United States, 1993–2012. JAMA 2015; 313: 2236–2243.
                  • 16. Lee B, Cripps R, Fitzharris M, et al. The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate. Spinal Cord 2014; 52: 110–116.
                  • 17. Chapman S, Alpers P, Jones M. Association between gun law reforms and intentional firearm deaths in Australia, 1979–2013. JAMA 2016; 316: 291–299.
                  • 18. DeVivo MJ, Chen Y. Trends in new injuries, prevalent cases, and aging with spinal cord injury. Arch Phys Med Rehabil 2011; 92: 332–338.
                  • 19. Bárbara‐Bataller E, Méndez‐Suárez JL, Alemán‐Sánchez C, et al. Change in the profile of traumatic spinal cord injury over 15 years in Spain. Scand J Trauma Resusc Emerg Med 2018; 26: 27.
                  • 20. Kehoe A, Smith J, Edwards A, et al. The changing face of major trauma in the UK. Emerg Med J 2015; 32: 911–915.
                  • 21. Australian Institute of Health and Welfare. Trends in hospitalised injury, Australia 1999–00 to 2014–15 (Cat. No. INJCAT 190; Injury Research and Statistics Series No. 110). Canberra: AIHW, 2018.
                  • 22. Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas 2013; 75: 51–61.
                  • 23. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012; CD007146.
                  • 24. Beck B, Cameron P, Lowthian J, et al. Major trauma in older persons. BJS Open 2018; 2: 310–318.
                  • 25. Fehlings MG, Tetreault L, Nater A, et al. The aging of the global population: the changing epidemiology of disease and spinal disorders. Neurosurgery 2015; 77 (Suppl 1): S1–S5.
                  • 26. Heffernan DS, Thakkar RK, Monaghan SF, et al. Normal presenting vital signs are unreliable in geriatric blunt trauma victims. J Trauma 2010; 69: 813–820.
                  • 27. Kehoe A, Smith J, Bouamra O, et al. Older patients with traumatic brain injury present with a higher GCS score than younger patients for a given severity of injury. Emerg Med J 2016; 33: 381–385.
                  • 28. Beck B, Cameron P, Fitzgerald MC, et al. Road safety: serious injuries remain a major unsolved problem. Med J Aust 2017; 207: 244–249. https://www.mja.com.au/journal/2017/207/6/road-safety-serious-injuries-remain-major-unsolved-problem
                  • 29. Ackland HM, Pilcher DV, Roodenburg OS, et al. Danger at every rung: epidemiology and outcomes of ICU‐admitted ladder‐related trauma. Injury 2016; 47: 1109–1117.
                  • 30. Cabilan C, Vallmuur K, Eley R, et al. Impact of ladder‐related falls on the emergency department and recommendations for ladder safety. Emerg Med Australas 2018; 30: 95–102.
                  • 31. Gabbe BJ, Nunn A. Profile and costs of secondary conditions resulting in emergency department presentations and readmission to hospital following traumatic spinal cord injury. Injury 2016; 47: 1847–1855.
                  • 32. Munce SE, Wodchis W, Guilcher SJ, et al. Direct costs of adult traumatic spinal cord injury in Ontario. Spinal Cord 2013; 51: 64–69.
                  • 33. Braaf SC, Lennox A, Nunn A, et al. Experiences of hospital readmission and receiving formal carer services following spinal cord injury: a qualitative study to identify needs. Disabil Rehabil 2018; 40: 1893–1899.

                  Author
                  remove_circle_outline Delete Author
                  add_circle_outline Add Author
                  Comment
                  Do you have any competing interests to declare? *
                  I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
                  I/we agree to the Terms of use of the Medical Journal of Australia *
                  Email me when people comment on this article
                  Online responses are no longer available. Please refer to our instructions for authors page for more information.

                    Early success with room for improvement: influenza vaccination of young Australian children

                    Frank H Beard, Alexandra J Hendry and Kristine Macartney
                    Med J Aust 2019; 210 (11): . || doi: 10.5694/mja2.50141
                    Published online: 29 April 2019
                    Correction(s) for this article: Erratum | Published online: 3 February 2020

                    Immunisation providers should offer annual influenza vaccination for children aged 6 months to 5 years and report it to the Australian Immunisation Register


                    • 1 National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Sydney, NSW
                    • 2 University of Sydney, Sydney, NSW


                    Competing interests:

                    No relevant disclosures.

                    Author
                    remove_circle_outline Delete Author
                    add_circle_outline Add Author
                    Comment
                    Do you have any competing interests to declare? *
                    I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
                    I/we agree to the Terms of use of the Medical Journal of Australia *
                    Email me when people comment on this article
                    Online responses are no longer available. Please refer to our instructions for authors page for more information.

                      Qualified privilege legislation to support clinician quality assurance: balancing professional and public interests

                      Susannah Ahern, Ingrid Hopper and Erwin Loh
                      Med J Aust 2019; 210 (8): . || doi: 10.5694/mja2.50124
                      Published online: 22 April 2019

                      A review of the legislation may be warranted to assess the balance between professional and public interests

                      Patient health‐related datasets are protected by national and state‐based privacy laws which establish requirements for data security that safeguard identified patient information.1,2,3 Nevertheless, these data may potentially be accessed by third parties in accordance with the law — for example, in connection with freedom of information requests or legal proceedings — by statutory bodies such as the Australian Health Practitioner Regulatory Agency, or by jurisdictional health complaints commissions. Patient information from health service medical records is regularly used in medico‐legal proceedings, a recent significant example of which was the Bawa‐Garba case in the United Kingdom,4 discussed below.


                      • Monash University, Melbourne, VIC


                      Correspondence: susannah.ahern@monash.edu
                      Competing interests:

                      No relevant disclosures.

                      Author
                      remove_circle_outline Delete Author
                      add_circle_outline Add Author
                      Comment
                      Do you have any competing interests to declare? *
                      I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
                      I/we agree to the Terms of use of the Medical Journal of Australia *
                      Email me when people comment on this article
                      Online responses are no longer available. Please refer to our instructions for authors page for more information.
                      Subscribe to