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    Integrating palliative care and symptom relief into responses to humanitarian crises

    Eric L Krakauer, Bethany‐Rose Daubman and Tammam Aloudat
    Med J Aust 2019; 211 (5): . || doi: 10.5694/mja2.50295
    Published online: 2 September 2019

    The medical and moral imperative that palliative care be integrated into standard responses to humanitarian crises can be fulfilled by basic training and an essential set of medicines, equipment, social support and protocols

    Humanitarian crises often cause both extensive loss of life and widespread suffering. Yet humanitarian crisis response virtually never fully integrates palliative care, the discipline devoted to preventing and relieving suffering. Recently, the World Health Organization (WHO) recognised the necessity of integrating palliative care and symptom relief into responses to humanitarian crises of all types and published a guide to this integration.1 In this article, we summarise the WHO recommendations, explain why inclusion of palliative care as an essential part of humanitarian response is medically and morally imperative, and describe how to ensure that palliative care is accessible for those affected by humanitarian crises.

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      Adolescent immunisation in young people with disabilities in Australia

      Jenny O'Neill, Fiona Newall, Giuliana Antolovich, Sally Lima and Margie H Danchin
      Med J Aust 2019; 211 (5): . || doi: 10.5694/mja2.50293
      Published online: 2 September 2019

      More research is needed to understand the barriers to optimal adolescent immunisation for students with disabilities

      The benefits of immunisation in preventing or reducing the severity of vaccine‐preventable diseases and eliminating or reducing the risk of associated complications have been well documented. Importantly, immunisation is also a powerful means by which the inequity of poor health can be reduced, particularly in vulnerable groups that have a high burden of infectious diseases. This has been illustrated in immunisation research in refugees and other migrants, as well as in Aboriginal and Torres Strait Islander Australians, and in low income or resource poor settings.1,2,3,4,5 However, there is a paucity of research about immunisation for people with disabilities, another medically at‐risk and socially marginalised group.


      • 1 University of Melbourne, Melbourne, VIC
      • 2 Royal Children's Hospital, Melbourne, VIC
      • 3 Murdoch Children's Research Institute, Melbourne, VIC
      • 4 Bendigo Health, Bendigo, VIC


      Correspondence: jenny.oneill@rch.org.au
      Competing interests:

      No relevant disclosures.

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        The Australian Aboriginal Birth Cohort study: socio‐economic status at birth and cardiovascular risk factors to 25 years of age

        Markus Juonala, Pauline Sjöholm, Katja Pahkala, Susan Ellul, Noora Kartiosuo, Belinda Davison and Gurmeet R Singh
        Med J Aust 2019; 211 (6): . || doi: 10.5694/mja2.50285
        Published online: 26 August 2019

        Abstract

        Objectives: To determine whether socio‐economic status at birth is associated with differences in risk factors for cardiovascular disease — body mass index (BMI), blood pressure, blood lipid levels — during the first 25 years of life.

        Design: Analysis of prospectively collected data.

        Setting, participants: 570 of 686 children born to Aboriginal mothers at the Royal Darwin Hospital during 1987–1990 and recruited for the Aboriginal Birth Cohort Study in the Northern Territory. Participants resided in 46 urban and remote communities across the NT. The analysed data were collected at three follow‐ups: Wave 2 in 1998–2001 (570 participants; mean age, 11 years), Wave 3 in 2006–2008 (442 participants; mean age, 18 years), and Wave 4 in 2014–2016 (423 participants; mean age, 25 years).

        Main outcome measures: Cardiovascular disease risk factors by study wave and three socio‐economic measures at the time of birth: area‐level Indigenous Relative Socioeconomic Outcomes (IRSEO) index score and location (urban, remote) of residence, and parity of mother.

        Results: Area‐level IRSEO of residence at birth influenced BMI (P < 0.001), systolic blood pressure (P = 0.024), LDL‐cholesterol (P = 0.010), and HDL‐cholesterol levels (P < 0.001). Remoteness of residence at birth influenced BMI (P < 0.001), HDL‐cholesterol (P < 0.001), and triglyceride levels (P = 0.043). Mother's parity at birth influenced BMI (P = 0.039).

        Conclusions: Our longitudinal life course analyses indicate that area‐level socio‐economic factors at birth influence the prevalence of major cardiovascular disease risk factors among Indigenous Australians during childhood and early adulthood.

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        • 1 Turun Yliopisto (University of Turku), Turku, Finland
        • 2 Turku University Hospital, Turku, Finland
        • 3 Murdoch Children's Research Institute, Melbourne, VIC
        • 4 Research Centre of Applied and Preventive Cardiovascular Medicine, Turun Yliopisto, Turku, Finland
        • 5 Menzies School of Health Research, Darwin, NT


        Correspondence: mataju@utu.fi
        Acknowledgements: 

        We acknowledge past and present study team members, particularly the late Susan Sayers AO, founder of the Aboriginal Birth Cohort study. We especially thank the young adults in the Aboriginal Birth Cohort and their families and communities for their cooperation and support, and all the individuals who helped in urban and rural locations. The investigation was supported by the National Health and Medical Research Council, the Channel 7 Children's Research Foundation of South Australia, the National Heart Foundation, a Northern Territory Government Research and Innovation Grant, the Juho Vainio Foundation, the Turku University Hospital, and the Finnish Foundation for Cardiovascular Research. The sponsors had no role in preparing the manuscript.

        Competing interests:

        No relevant disclosures.

        • 1. Capewell S, O'Flaherty M. What explains declining coronary mortality? Lessons and warnings. Heart 2008; 94: 1105–1108.
        • 2. Australian Institute of Health and Welfare. The health and welfare of Australia's Aboriginal and Torres Strait Islander Peoples: 2015 (Cat No. IHW 147). Canberra: AIHW, 2015.
        • 3. Naska A, Katsoulis M, Trichopoulos D, Trichopoulou A. The root causes of socioeconomic differentials in cancer and cardiovascular mortality in Greece. Eur J Cancer Prev 2012; 21: 490–496.
        • 4. Pujades‐Rodriguez M, Timmis A, Stogiannis D, et al. Socioeconomic deprivation and the incidence of 12 cardiovascular diseases in 1.9 million women and men: implications for risk prediction and prevention. PLoS One 2014; 9: e104671.
        • 5. Diez Roux AV, Merkin SS, Arnett D, et al. Neighborhood of residence and incidence of coronary heart disease. New Engl J Med 2001; 345: 99–106.
        • 6. Halonen JI, Stenholm S, Pentti J, et al. Childhood psychosocial adversity and adult neighborhood disadvantage as predictors of cardiovascular disease: a cohort study. Circulation 2015; 132: 371–379.
        • 7. Kivimäki M, Vahtera J, Tabák AG, et al. Neighbourhood socioeconomic disadvantage, risk factors, and diabetes from childhood to middle age in the Young Finns Study: a cohort study. Lancet Public Health 2018; 3: e365–e373.
        • 8. Sayers SM, Mackerras D, Singh G, et al. An Australian Aboriginal birth cohort: a unique resource for a life course study of an Indigenous population. A study protocol. BMC Int Health Hum Rights 2003; 3: 1.
        • 9. Sayers S, Singh G, Mackerras D, et al. Australian Aboriginal Birth Cohort study: follow‐up processes at 20 years. BMC Int Health Hum Rights 2009; 9: 23.
        • 10. Biddle N. Socioeconomic outcomes (CAEPR Indigenous Population Project 2011 census papers, paper 13). Canberra: Centre for Aboriginal Economic Policy Research, Australia National University, 2013. http://caepr.cass.anu.edu.au/research/publications/socioeconomic-outcomes (viewed June 2019).
        • 11. Kakinami L, Serbin LA, Stack DM, et al. Neighbourhood disadvantage and behavioural problems during childhood and the risk of cardiovascular disease risk factors and events from a prospective cohort. Prev Med Rep 2017; 8: 294–300.
        • 12. O'Neal DN, Piers LS, Iser DM, et al. Australian Aboriginal people and Torres Strait Islanders have an atherogenic lipid profile that is characterised by low HDL‐cholesterol level and small LDL particles. Atherosclerosis 2008; 201: 368–377.
        • 13. McCarthy K, Cai LB, Xu FR, et al. Urban–rural differences in cardiovascular disease risk factors: a cross‐sectional study of schoolchildren in Wuhan, China. PLoS One 2015; 10: e0137615.
        • 14. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 2012; 70: 3–21.
        • 15. Brimblecombe JK, O'Dea K. The role of energy cost in food choices for an Aboriginal population in northern Australia. Med J Aust 2009; 190: 549–551. https://www.mja.com.au/journal/2009/190/10/role-energy-cost-food-choices-aboriginal-population-northern-australia
        • 16. Saiz AM, Aul AM, Malecki KM, et al. Food insecurity and cardiovascular health: findings from a statewide population health survey in Wisconsin. Prev Med 2016; 93: 1–6.
        • 17. Shin JI, Bautista LE, Walsh MC, et al. Food insecurity and dyslipidemia in a representative population‐based sample in the US. Prev Med 2015; 77: 186–190.
        • 18. Wycherley TP, Pekarsky BA, Ferguson MM, et al. Fluctuations in money availability within an income cycle impacts diet quality of remote Indigenous Australians. Public Health Nutr 2017; 20: 1431–1440.
        • 19. Brimblecombe J, Maypilama E, Colles S, et al. Factors influencing food choice in an Australian Aboriginal community. Qual Health Res 2014; 24: 387–400.
        • 20. Sjöholm P, Pahkala K, Davison B, et al. Early life determinants of cardiovascular health in adulthood. The Australian Aboriginal Birth Cohort study. Int J Cardiol 2018; 269: 304–309.
        • 21. Smith KB, Humphreys JS, Wilson MG. Addressing the health disadvantage of rural populations: how does epidemiological evidence inform rural health policies and research? Aust J Rural Health 2008; 16: 56–66.
        • 22. Lyons JG, O'Dea K, Walker KZ. Evidence for low high‐density lipoprotein cholesterol levels in Australian indigenous peoples: a systematic review. BMC Public Health 2014; 14: 545.
        • 23. Shaw JT, Tate J, Kesting JB, et al. Apolipoprotein E polymorphism in indigenous Australians: allelic frequencies and relationship with dyslipidaemia. Med J Aust 1999; 170: 161–164.
        • 24. Lewington S, Clarke R, Qizilbash N, et al. Age‐specific relevance of usual blood pressure to vascular mortality: a meta‐analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–1913.
        • 25. Emerging Risk Factors Collaboration; Di Angelantonio E, Sarwar N, Perry P, et al. Major lipids, apolipoproteins, and risk of vascular disease. JAMA 2009; 302: 1993–2000.
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          Adherence to screen time recommendations for Australian children aged 0–12 years

          Leigh Tooth, Katrina Moss, Richard Hockey and Gita D Mishra
          Med J Aust 2019; 211 (4): . || doi: 10.5694/mja2.50286
          Published online: 19 August 2019

          Australian Department of Health guidelines recommend that children under 2 years of age have no screen time, a limit of one hour per day for 2–5‐year‐old children, and a limit of 2 hours of recreational screen time per day for 5–17‐year‐old children.1 As it has not been assessed in a nationally representative study, we examined adherence to these recommendations among children aged 0–12 years, as well as the characteristics of children, their mothers, and their homes associated with non‐adherence.

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          • University of Queensland, Brisbane, QLD


          Correspondence: l.tooth@sph.uq.edu.au
          Acknowledgements: 

          This investigation was part of the Australian Longitudinal Study on Women's Health by the University of Queensland and the University of Newcastle. We thank the Australian Department of Health for funding and the women who provided the survey data. The MatCH study is funded by the National Health and Medical Research Council (NHMRC) (1059550); Gita Mishra has an NHMRC Principal Research Fellowship (1121844).

          Competing interests:

          No relevant disclosures.

          • 1. Australian Department of Health. Australia's Physical Activity and Sedentary Behaviour Guidelines and the Australian 24‐Hour Movement Guidelines. Updated Apr 2019. http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines#npa05 (viewed June 2019).
          • 2. Dobson A, Hockey R, Brown W, et al. Cohort profile update: Australian Longitudinal Study on Women's Health. Int J Epidemiol 2015; 44: 1547, 1547a–1547f.
          • 3. Mishra GD, Moss K, Loos C, et al. MatCH (Mothers and their Children's Health) profile: offspring of the 1973–78 cohort of the Australian Longitudinal Study on Women's Health. Longitudinal and Life Course Studies 2018; 9: 351–375; https://doi.org/10.14301/llcs.v9i3.491 (viewed June 2019).
          • 4. Madigan S, Browne D, Racine N. Association between screen time and children's performance on a developmental screening test. JAMA Pediatr 2019; 173: 244–250.
          • 5. Stiglic N, Viner RM. Effects of screen time on the health and well‐being of children and adolescents: a systematic review of reviews. BMJ Open 2019; 9: e023191.
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            Antibiotic use in animals and humans in Australia

            Freya Langham and Allen C Cheng
            Med J Aust 2019; 211 (4): . || doi: 10.5694/mja2.50258
            Published online: 19 August 2019

            Developing strategies to reduce both the transmission of important pathogens and antimicrobial resistance is of paramount importance

            Since the 1960s, there has been concern about the use of antibiotics in food animals and its contribution to antibiotic resistance in humans. The increasing intensification of modern food animal production has resulted in an increase in antimicrobial use in livestock, for both therapeutic and non‐therapeutic purposes. There are a number of mechanisms by which antimicrobial use in animals affects resistance in human pathogens, such as transmission by direct contact and, indirectly, through food consumption and environmental contamination.1 Moreover, there is emerging literature stating that limiting antimicrobial use in animals leads to reduced resistance in humans.2


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


            Correspondence: f.langham@alfred.org.au
            Competing interests:

            No relevant disclosures.

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              Controversies in medicine: redefining the diagnosis of type 1 diabetes

              Jennifer J Couper and Leonard C Harrison
              Med J Aust 2019; 211 (4): . || doi: 10.5694/mja2.50284
              Published online: 19 August 2019

              Diagnosis of autoimmune β-cell disorder before end-stage clinical type 1 diabetes is a key step towards the prevention of this disease


              • 1 Women's and Children's Hospital, Adelaide, SA
              • 2 University of Adelaide, Adelaide, SA
              • 3 Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC


              Acknowledgements: 

              We acknowledge the contributions to the manuscript of Megan Penno and the community support and perspective provided by Juvenile Diabetes Research Foundation Australia, the recipient of the Australian Research Council Special Research Initiative in Type 1 Diabetes. Leonard Harrison was supported by a National Health and Medical Research Council Senior Principal Research Fellowship (1080887).

              Competing interests:

              No relevant disclosures.

              • 1. Haynes A, Bulsara MK, Bower C, et al. Regular peaks and troughs in the Australian incidence of childhood type 1 diabetes mellitus (2000–2011). Diabetologia 2015; 58: 2513–2516.
              • 2. Phelan H, Clapin H, Bruns L, et al. The Australasian Diabetes Data Network: first national audit of children and adolescents with type 1 diabetes. Med J Aust 2017; 206: 121–125. https://www.mja.com.au/journal/2017/206/3/australasian-diabetes-data-network-first-national-audit-children-and-adolescents
              • 3. Ziegler AG, Rewers M, Simell O, et al. Seroconversion to multiple islet autoantibodies and risk of progression to diabetes in children. JAMA 2013; 309: 2473–2479.
              • 4. Raab J, Haupt F, Scholz M, et al. Capillary blood islet autoantibody screening for identifying pre‐type 1 diabetes in the general population: design and initial results of the Fr1da study. BMJ Open 2016; 6: e11144.
              • 5. Insel RA, Dunne JL, Atkinson MA, et al. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society and the American Diabetes Association. Diabetes Care 2015; 38: 1964–1974.
              • 6. Colman PG, McNair P, Margetts H, et al. The Melbourne Pre‐Diabetes Study: prediction of type 1 diabetes mellitus using antibody and metabolic testing. Med J Aust 1998; 169: 81–84.
              • 7. Bonifacio E, Mathieu C, Nepom GT, et al. Rebranding asymptomatic type 1 diabetes: the case for autoimmune beta cell disorder as a pathological and diagnostic entity. Diabetologia 2017; 60: 35–38.
              • 8. Department of Health. Australian National Diabetes Strategy 2016–2020. Canberra: Commonwealth of Australia, 2015. http://www.health.gov.au/internet/main/publishing.nsf/Content/nds-2016-2020 (viewed Jan 2019).
              • 9. King BR, Howard NJ, Verge CF, et al. A diabetes awareness campaign prevents diabetic ketoacidosis in children at their initial presentation with type 1 diabetes. Pediatr Diabetes 2012; 13: 647–651.
              • 10. Duca LM, Wang B, Rewers M, Rewers A. Diabetic ketoacidosis at diagnosis of type 1 diabetes predicts poor long‐term glycemic control. Diabetes Care 2017; 4: 1249–1255.
              • 11. Winkler C, Schober E, Ziegler AG, Holl RW. Markedly reduced rate of diabetic ketoacidosis at onset of type 1 diabetes in relatives screened for islet autoantibodies. Pediatr Diabetes 2012; 13: 308–313.
              • 12. Steck AK, Larsson HE, Liu X, et al. Residual beta‐cell function in diabetes children followed and diagnosed in the TEDDY study compared with community controls. Pediatr Diabetes 2017; 18: 794–802.
              • 13. Gesualdo PD, Bautista KA, Waugh KC, et al. Feasibility of screening for T1D and celiac disease in a pediatric clinic setting. Pediatr Diabetes 2016; 17: 441–448.
              • 14. Smith LB, Liu X, Johnson SB, et al. Family adjustment to diabetes diagnosis in children: can participation in a study on type 1 diabetes genetic risk be helpful? Pediatr Diabetes 2018; 19: 1025–1033.
              • 15. Herold KC, Bundy BN, Long A, et al. An anti‐CD3 antibody, teplizumab, in relatives with type 1 diabetes. N Engl J Med 2019. https://doi.org/10.1056/nejmoa1902226. [Epub ahead of print]
              • 16. Bingley PJ, Bonifacio E, Williams AJ, et al. Prediction of IDDM in the general population: strategies based on combinations of autoantibody markers. Diabetes 1997; 46: 1701–1710.
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                Primary prevention implantable cardioverter defibrillators in non‐ischaemic cardiomyopathy: challenging the Australian heart failure guidelines

                Dennis H Lau, Jonathan M Kalman and Prashanthan Sanders
                Med J Aust 2019; 211 (4): . || doi: 10.5694/mja2.50248
                Published online: 19 August 2019

                The 2018 Australian guidelines recommendations require further clarification to ensure eligible patients will receive appropriate ICD therapy

                The implantable cardioverter defibrillator (ICD) has been shown to be a cost‐effective option for primary prevention of sudden cardiac death (SCD) in patients with heart failure with reduced ejection fraction (HFrEF). However, in the recently published 2018 guidelines for the prevention, detection and management of heart failure in Australia, the National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand Heart Failure Guidelines Working Group downgraded the recommendation for primary prevention ICD to decrease mortality in patients with HFrEF and left ventricular ejection fraction (LVEF) 35% or below associated with non‐ischaemic cardiomyopathy (NICM).1,2 In particular, the level of recommendation and quality of evidence for primary prevention ICD was deemed weak and low for NICM versus strong and moderate for ischaemic cardiomyopathy, respectively. The document cited the lack of single randomised controlled trials demonstrating mortality benefits with primary prevention ICD in patients with NICM. It also highlighted recent prospective randomised controlled data of 1116 patients with HFrEF and LVEF 35% or below associated with non‐ischaemic causes from the DANISH trial — a Danish study to assess the efficacy of ICD in patients with non‐ischaemic systolic heart failure on mortality — whereby primary prevention ICD did not reduce mortality compared with usual clinical care over a median follow‐up duration of 67.6 months (interquartile range, 49–85 months).3


                • 1 Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA
                • 2 Royal Adelaide Hospital, Adelaide, SA
                • 3 University of Melbourne, Melbourne, VIC
                • 4 Royal Melbourne Hospital, Melbourne, VIC


                Acknowledgements: 

                Dennis Lau is supported by the Robert J Craig Lectureship from the University of Adelaide. Jonathan Kalman and Prashanthan Sanders are supported by Practitioner Fellowships from the National Health and Medical Research Council. Prashanthan Sanders is supported by the National Heart Foundation of Australia.

                Competing interests:

                The University of Adelaide reports receiving on behalf of Dennis Lau lecture and/or consulting fees from Abbott, Bayer, Biotronik and Pfizer. Prashanthan Sanders reports having served on the advisory board of Biosense‐Webster, Medtronic, Abbott, Boston Scientific and CathRx. The University of Adelaide reports receiving on behalf of Prashanthan Sanders lecture and/or consulting fees from Biosense‐Webster, Medtronic, Abbott, and Boston Scientific. The University of Adelaide reports receiving on behalf of Prashanthan Sanders research funding from Medtronic, Abbott, Boston Scientific, Biotronik and Liva Nova.

                • 1. Atherton JJ, Sindone A, De Pasquale CG, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of heart failure 2018. Med J Aust 2018; 209: 363–369. https://www.mja.com.au/journal/2018/209/8/national-heart-foundation-australia-and-cardiac-society-australia-and-new-0
                • 2. Atherton JJ, Sindone A, De Pasquale CG, et al; NHFA CSANZ Heart Failure Guidelines Working Group. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: guidelines for the prevention, detection, and management of heart failure in Australia 2018. Heart Lung Circ 2018; 27: 1123–1208.
                • 3. Kober L, Thune JJ, Nielsen JC, et al. Defibrillator implantation in patients with nonischemic systolic heart failure. N Engl J Med 2016; 375: 1221–1230.
                • 4. Bennett M, Parkash R, Nery P, et al. Canadian Cardiovascular Society/Canadian Heart Rhythm Society 2016 implantable cardioverter‐defibrillator guidelines. Can J Cardiol 2017; 33: 174–188.
                • 5. Al‐Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2018; 15: e73–e189.
                • 6. Haugaa KH, Tilz R, Boveda S, et al. Implantable cardioverter defibrillator use for primary prevention in ischaemic and non‐ischaemic heart disease‐indications in the post‐DANISH trial era: results of the European Heart Rhythm Association survey. Europace 2017; 19: 660–664.
                • 7. Al‐Khatib SM, Fonarow GC, Joglar JA, et al. Primary prevention implantable cardioverter defibrillators in patients with nonischemic cardiomyopathy: a meta‐analysis. JAMA Cardiol 2017; 2: 685–688.
                • 8. Golwala H, Bajaj NS, Arora G, Arora P. Implantable cardioverter‐defibrillator for nonischemic cardiomyopathy: an updated meta‐analysis. Circulation 2017; 135: 201–203.
                • 9. Luni FK, Singh H, Khan AR, et al. Mortality effect of ICD in primary prevention of nonischemic cardiomyopathy: a meta‐analysis of randomized controlled trials. J Cardiovasc Electrophysiol 2017; 28: 538–543.
                • 10. Shun‐Shin MJ, Zheng SL, Cole GD, et al. Implantable cardioverter defibrillators for primary prevention of death in left ventricular dysfunction with and without ischaemic heart disease: a meta‐analysis of 8567 patients in the 11 trials. Eur Heart J 2017; 38: 1738–1746.
                • 11. Bristow MR, Saxon LA, Boehmer J, et al; Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac‐resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350: 2140–2150.
                • 12. Felker GM, Thompson RE, Hare JM, et al. Underlying causes and long‐term survival in patients with initially unexplained cardiomyopathy. N Engl J Med 2000; 342: 1077–1084.
                • 13. Elming MB, Nielsen JC, Haarbo J, et al. Age and outcomes of primary prevention implantable cardioverter‐defibrillators in patients with nonischemic systolic heart failure. Circulation 2017; 136: 1772–1780.
                • 14. Thavapalachandran S, Leong DP, Stiles MK, et al. Evidence‐based management of heart failure in clinical practice: a review of device‐based therapy use. Intern Med J 2009; 39: 669–675.
                • 15. Munawar DA, Mahajan R, Linz D, et al. Predicted longevity of contemporary cardiac implantable electronic devices: a call for industry‐wide “standardized” reporting. Heart Rhythm 2018; 15: 1756–1763.
                • 16. Pathak RK, Sanders P, Deo R. Primary prevention implantable cardioverter‐defibrillator and opportunities for sudden cardiac death risk assessment in non‐ischaemic cardiomyopathy. Eur Heart J 2018; 39: 2859–2866.
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                  The future of academic publishing: disruption, opportunity and a new ecosystem

                  Virginia Barbour
                  Med J Aust 2019; 211 (4): . || doi: 10.5694/mja2.50265
                  Published online: 19 August 2019

                  Academic publishing is on an irreversible path to change

                  It is not a hyperbole to say that the foundations of academic publishing are in a state of large‐scale disruption. That this disruption remains largely under the surface is primarily because the main users of academic research — those who work at universities — rarely suffer the consequences of lack of access due to the substantial payments universities make for subscription journals (about $281 million in total in Australia in 2017).1 Outside of universities, however, gaining online access to published research legally is neither easy nor affordable. Furthermore, as we move towards an interconnected digital future, it is becoming increasingly obvious that a system whose core business model rests on controlling access is an anachronism.

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                  • Queensland University of Technology, Brisbane, QLD


                  Correspondence: Ginny.Barbour@qut.edu.au
                  Competing interests:

                  Virginia Barbour is member of the NHMRC Research Quality Steering Committee and is employed by the Australasian Open Access Strategy Group. She was previously employed by PLOS, was Chair of the Committee on Publication Ethics, and is currently Chair of the DORA international advisory committee and a Plan S ambassador.

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                    Advancing women in medical leadership

                    Helena J Teede
                    Med J Aust 2019; 211 (9): . || doi: 10.5694/mja2.50287
                    Published online: 12 August 2019

                    Equity underpins workforce diversity, embraces and values differences, harnesses talents and skills, and represents and responds to community needs


                    • Monash Partners Academic Health Sciences Centre, Monash University and Monash Health, Melbourne, VIC


                    Correspondence: helena.teede@monash.edu
                    Acknowledgements: 

                    I have held National Health Medical and Research Council fellowship funding throughout my clinical academic career and have been employed and supported through leadership training and career development opportunities by both Monash University and Monash Health. I acknowledge the many women and men who have provided mentorship throughout my career. I thank Heidi Burgmeier for critical input into the manuscript and Anjali Dhulia for her role in the Monash Health Women in Leadership initiatives.

                    Competing interests:

                    Helena Teede runs and facilitates Women in Leadership training programs with Monash Health and Monash University with all funds going to the institution.

                    • 1. International Labour Office. ABC of women workers’ rights and gender equality. 2nd ed. Geneva: International Labour Organization, 2007. https://www.ilo.org/wcmsp5/groups/public/-dgreports/-gender/documents/publication/wcms_087314.pdf (viewed Oct 2018).
                    • 2. American College of Healthcare Executives. A comparison of the career attainments of men and women healthcare executives [website]. https://www.ache.org/learning-center/research/about-the-workplace/gender-studies/a-comparison-of-the-career-attainments-of-men-and-women-healthcare-executives; (viewed Oct 2018).
                    • 3. Bismark M, Morris J, Thomas L, et al. Reasons and remedies for under‐representation of women in medical leadership roles: a qualitative study from Australia. BMJ Open 2015; 5: e009384.
                    • 4. Ibarra H, Ely R, Kolb D. Women rising: the unseen barriers. Harvard Business Review 2013; Sept. https://hbr.org/2013/09/women-rising-the-unseen-barriers (viewed Oct 2018).
                    • 5. Clark J, Zuccala E, Horton R. Women in science, medicine, and global health: call for papers. Lancet 2017; 390: 2423–2424.
                    • 6. Weiss A, Lee KC, Tapia V, et al. Equity in surgical leadership for women: more work to do. Am J Surg 2014; 208: 494–498.
                    • 7. Carnes M, Bairey Merz CN. Women are less likely than men to be full professors in cardiology. Circulation 2017; 135: 518–520.
                    • 8. Santen RJ, Joham A, Fishbein L, et al. Career advancement: meeting the challenges confronting the next generation of endocrinologists and endocrine researchers. J Clin Endocrinol Metab 2016; 101: 4512–4520.
                    • 9. Australian Institute of Health and Welfare. Medical workforce 2011. [National Health Workforce Series; Cat. No. HWL49] Canberra: AIHW, 2011. https://www.aihw.gov.au/reports/workforce/medical-workforce-2011/contents/table-of-contents (viewed June 2019).
                    • 10. Hauser MC. Leveraging women's leadership talent in healthcare. J Healthc Manag 2014; 59: 318–322.
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                      Infections in pregnancy

                      Caitlin L Keighley, Hannah JM Skrzypek, Angela Wilson, Michael A Bonning and Gwendolyn L Gilbert
                      Med J Aust 2019; 211 (3): . || doi: 10.5694/mja2.50261
                      Published online: 5 August 2019

                      Summary

                      • Infections in pregnancy represent a challenging and often underappreciated area of concern for many specialists and general practitioners and can cause serious sequelae.
                      • Antenatal status should be highlighted on pathology request forms, as this serves to alert the laboratory of the need to store serum for an extended period. Prior antenatal specimens can be forwarded to other laboratories to enable testing in parallel with the more recent sample.
                      • Women with a confirmed, potentially vertically transmissible infection should be referred to a specialist with expertise in the management of perinatal infections.
                      • Cytomegalovirus infection is the most common congenital infection. Women who care for young children are at greater risk of exposure to the virus. Preventive steps including hand hygiene and avoiding contact with children's urine, mucous and saliva are recommended for all pregnant women.
                      • The incidence of parvovirus B19 infection in pregnancy is unknown. This infection is highly contagious and may result in fetal loss; particularly in the first half of pregnancy, pregnant women should avoid contact with adults or children who may have an infection.

                      • 1 Institute for Clinical Pathology and Medical Research, NSW Health Pathology Centre for Infectious Diseases and Microbiology, Sydney, NSW
                      • 2 University of Sydney, Sydney, NSW
                      • 3 Mercy Hospital for Women, Melbourne, VIC
                      • 4 Alice Springs Hospital, Alice Springs, NT
                      • 5 GP Synergy, Sydney, NSW
                      • 6 Macquarie University, Sydney, NSW
                      • 7 Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW
                      • 8 Sydney Health Ethics, University of Sydney, Sydney, NSW


                      Competing interests:

                      No relevant disclosures.

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