MJA
MJA

    Mainstreaming genomic testing: pre‐test counselling and informed consent

    Michaela Cormack, Kathryn B Irving, Fiona Cunningham and Andrew P Fennell
    Med J Aust || doi: 10.5694/mja2.52254
    Published online: 8 April 2024

    There is unprecedented, increasing demand for genomic testing in Australia.1,2 Recent developments in paediatric neurology alone include Medical Benefits Schedule, industry and research sponsored testing for monogenic causes of epilepsy, neuromuscular disorders, and syndromic intellectual disability, among others. To be ethically and legally valid, patients must undergo pre‐test counselling before they consent to genomic testing.

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      Medicare‐funded reproductive genetic carrier screening in Australia has arrived: are we ready?

      Alice P Rogers, Lara Fitzgerald, Jan Liebelt and Christopher Barnett
      Med J Aust || doi: 10.5694/mja2.52261
      Published online: 8 April 2024

      Reproductive genetic carrier screening (RGCS) is a preventive health strategy performed to identify healthy couples and individuals who are at increased chance of having a child affected by a serious, childhood onset autosomal recessive or X‐linked genetic condition (Box 1).

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      • 1 SA Clinical Genetics Service, Women's and Children's Hospital, Adelaide, SA
      • 2 University of Adelaide, Adelaide, SA
      • 3 Repromed (Adelaide Fertility Centre), Adelaide, SA



      Open access:

      Open access publishing facilitated by The University of Adelaide, as part of the Wiley ‐ The University of Adelaide agreement via the Council of Australian University Librarians.

      Competing interests:

      Jan Liebelt and Lara Fitzgerald are employed by Repromed, whose laboratory offers preconception RGCS. They also provide genetic counselling services.

      • 1. Kaback MM, Nathan TJ, Greenwald S. Tay‐Sachs disease: heterozygote screening and prenatal diagnosis—US experience and world perspective. Prog Clin Biol Res 1977; 18: 13‐36.
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      • 3. Srinivasan BS, Evans EA, Flannick J, et al. A universal carrier test for the long tail of Mendelian disease. Reprod Biomed Online 2010; 21: 537‐551.
      • 4. Grody WW, Thompson BH, Gregg AR, et al. ACMG position statement on prenatal/preconception expanded carrier screening. Genet Med 2013; 15: 482‐483.
      • 5. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Genetic carrier screening. Mar 2019. https://ranzcog.edu.au/wp‐content/uploads/2022/05/Genetic‐carrier‐screeningC‐Obs‐63New‐March‐2019_1.pdf (viewed Nov 2023).
      • 6. Haque IS, Lazarin GA, Kang HP, et al. Modeled fetal risk of genetic diseases identified by expanded carrier screening. JAMA 2016; 316: 734‐742.
      • 7. Archibald AD, Smith MJ, Burgess T, et al. Reproductive genetic carrier screening for cystic fibrosis, fragile X syndrome, and spinal muscular atrophy in Australia: outcomes of 12,000 tests. Genet Med 2018; 20: 513‐523.
      • 8. Fridman H, Yntema HG, Mägi R, et al. The landscape of autosomal‐recessive pathogenic variants in European populations reveals phenotype‐specific effects. Am J Hum Genet 2021; 108: 608‐619.
      • 9. Best S, Long J, Theodorou T, et al. Health practitioners’ perceptions of the barriers and enablers to the implementation of reproductive genetic carrier screening: a systematic review. Prenat Diagn 2021; 41: 708‐719.
      • 10. Goldberg JD, Pierson S, Johansen Taber K. Expanded carrier screening: what conditions should we screen for? Prenat Diagn 2023; 43: 496‐505.
      • 11. Gregg AR, Aarabi M, Klugman S, et al. Screening for autosomal recessive and X‐linked conditions during pregnancy and preconception: a practice resource of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2021; 23: 1793‐1806.
      • 12. Henneman L, Borry P, Chokoshvili D, et al. Responsible implementation of expanded carrier screening. Eur J Hum Genet 2016; 24: e1‐e12.
      • 13. Committee Opinion No. 690 summary: Carrier screening in the age of genomic medicine. Obstet Gynecol 2017; 129: e35‐e40.
      • 14. Grody WW, Cutting GR, Klinger KW, et al. Laboratory standards and guidelines for population‐based cystic fibrosis carrier screening. Genet Med 2001; 3: 149‐154.
      • 15. Massie J, Petrou V, Forbes R, et al. Population‐based carrier screening for cystic fibrosis in Victoria: the first three years experience. Aust N Z J Obstet Gynaecol 2009; 49: 484‐489.
      • 16. Kerem B, Rommens JM, Buchanan JA, et al. Identification of the cystic fibrosis gene: genetic analysis. Science 1989; 245: 1073‐1080.
      • 17. Savant A, Lyman B, Bojanowski C, Upadia J. Cystic fibrosis. In: Adam MP, Feldman J, Mirzaa GM, et al, editors. GeneReviews. Initial posting: 26 Mar 2001; last revision: 9 Mar 2023. https://www.ncbi.nlm.nih.gov/books/NBK1250/ (viewed Nov 2023).
      • 18. Prior TW, Leach ME, Finanger E. Spinal muscular atrophy. In: Adam MP, Feldman J, Mirzaa GM, et al, editors. GeneReviews. Initial posting: 24 Feb 2000; last revision: 3 Dec 2020. https://www.ncbi.nlm.nih.gov/books/NBK1352/ (viewed Nov 2023).
      • 19. D'Silva AM, Kariyawasam DST, Best S, et al. Integrating newborn screening for spinal muscular atrophy into health care systems: an Australian pilot programme. Dev Med Child Neurol 2022; 64: 625‐632.
      • 20. Schofield D, Lee E, Parmar J, et al. Economic evaluation of population‐based, expanded reproductive carrier screening for genetic diseases in Australia. Genet Med 2023; 25: 100813.
      • 21. Delatycki MB, Laing NG, Moore SJ, et al. Preconception and antenatal carrier screening for genetic conditions: The critical role of general practitioners. Aust J Gen Pract 2019; 48: 106‐110.
      • 22. Sparks TN. Expanded carrier screening: counseling and considerations. Hum Genet 2020; 139: 1131‐1139.
      • 23. Archibald AD, McClaren BJ, Caruana J, et al. The Australian Reproductive Genetic Carrier Screening Project (Mackenzie's Mission): design and implementation. J Pers Med 2022; 12: 1781.
      • 24. Mackenzie's Mission. Outcomes of the Mackenzie's Mission study. https://www.mackenziesmission.org.au/outcomes/ (viewed Nov 2023).
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        The 2023 report of the MJA–Lancet Countdown on health and climate change: sustainability needed in Australia's health care sector

        Paul J Beggs, Stefan Trueck, Martina K Linnenluecke, Hilary Bambrick, Anthony G Capon, Ivan C Hanigan, Nicolas Borchers Arriagada, Troy J Cross, Sharon Friel, Donna Green, Maddie Heenan, Ollie Jay, Harry Kennard, Arunima Malik, Celia McMichael, Mark Stevenson, Sotiris Vardoulakis, Tran N Dang, Gail Garvey, Raymond Lovett, Veronica Matthews, Dung Phung, Alistair J Woodward, Marina B Romanello and Ying Zhang
        Med J Aust || doi: 10.5694/mja2.52245
        Published online: 25 March 2024

        Summary

        • The MJA–Lancet Countdown on health and climate change in Australia was established in 2017 and produced its first national assessment in 2018 and annual updates in 2019, 2020, 2021 and 2022. It examines five broad domains: health hazards, exposures and impacts; adaptation, planning and resilience for health; mitigation actions and health co‐benefits; economics and finance; and public and political engagement. In this, the sixth report of the MJA–Lancet Countdown, we track progress on an extensive suite of indicators across these five domains, accessing and presenting the latest data and further refining and developing our analyses.
        • Our results highlight the health and economic costs of inaction on health and climate change. A series of major flood events across the four eastern states of Australia in 2022 was the main contributor to insured losses from climate‐related catastrophes of $7.168 billion — the highest amount on record. The floods also directly caused 23 deaths and resulted in the displacement of tens of thousands of people.
        • High red meat and processed meat consumption and insufficient consumption of fruit and vegetables accounted for about half of the 87 166 diet‐related deaths in Australia in 2021. Correction of this imbalance would both save lives and reduce the heavy carbon footprint associated with meat production.
        • We find signs of progress on health and climate change. Importantly, the Australian Government released Australia's first National Health and Climate Strategy, and the Government of Western Australia is preparing a Health Sector Adaptation Plan. We also find increasing action on, and engagement with, health and climate change at a community level, with the number of electric vehicle sales almost doubling in 2022 compared with 2021, and with a 65% increase in coverage of health and climate change in the media in 2022 compared with 2021.
        • Overall, the urgency of substantial enhancements in Australia's mitigation and adaptation responses to the enormous health and climate change challenge cannot be overstated. Australia's energy system, and its health care sector, currently emit an unreasonable and unjust proportion of greenhouse gases into the atmosphere. As the Lancet Countdown enters its second and most critical phase in the leadup to 2030, the depth and breadth of our assessment of health and climate change will be augmented to increasingly examine Australia in its regional context, and to better measure and track key issues in Australia such as mental health and Aboriginal and Torres Strait Islander health and wellbeing.

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        • 1 Macquarie University, Sydney, NSW
        • 2 University of Technology Sydney, Sydney, NSW
        • 3 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
        • 4 Monash Sustainable Development Institute, Monash University, Melbourne, VIC
        • 5 Curtin University, Perth, WA
        • 6 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
        • 7 University of Sydney, Sydney, NSW
        • 8 Australian National University, Canberra, ACT
        • 9 Climate Change Research Centre and ARC Centre of Excellence for Climate Extremes, UNSW, Sydney, NSW
        • 10 Australian Prevention Partnership Centre, Sax Institute, Sydney, NSW
        • 11 The George Institute for Global Health, Sydney, NSW
        • 12 Thermal Ergonomics Laboratory, University of Sydney, Sydney, NSW
        • 13 Center on Global Energy Policy, Columbia University, New York, NY, USA
        • 14 University of Melbourne, Melbourne, VIC
        • 15 Transport, Health and Urban Design (THUD) Research Lab, University of Melbourne, Melbourne, VIC
        • 16 University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
        • 17 University of Queensland, Brisbane, QLD
        • 18 Australian Institute of Aboriginal and Torres Strait Islander Studies, Canberra, ACT
        • 19 University Centre for Rural Health, University of Sydney, Sydney, NSW
        • 20 University of Auckland, Auckland, NZ
        • 21 Institute for Global Health, University College London, London, UK


        Correspondence: paul.beggs@mq.edu.au


        Open access:

        Open access publishing facilitated by Macquarie University, as part of the Wiley ‐ Macquarie University agreement via the Council of Australian University Librarians.

        Acknowledgements: 

        We thank Robert Fawcett, Justin Peter, and John Nairn (all from the Australian Bureau of Meteorology) for indicators 1.1 Exposure of vulnerable populations to heatwaves and 2.2 Climate information for health. Ivan Hanigan's access to data for indicators 1.4 and 3.3 was supported by the Centre for Air Pollution, Energy, and Health Research Data Platform funded by the NHMRC Centre for Safe Air (https://www.car‐cre.org.au/; https://cardat.github.io), which received funding from the Australian Research Data Commons for the Integrated National Air Pollution and Health Data project (https://doi.org/10.47486/PS022), and he acknowledges the HEAL (Healthy Environments And Lives) National Research Network, which receives funding from the NHMRC (grant no. 2008937). The Bushfires indicator was generated with support from NASA Applied Sciences Program (grant no. 80NSSC21K0507) and we thank Yang Liu and Qiao Zhu (Emory University) as well as Yun Hang (now at University of Texas Health Science Center) for the Australian data used for this indicator (1.3). We also thank Fay Johnston for assistance with this indicator. We thank Carole Dalin (University College London) for assistance with indicator 3.5 Emissions from agricultural production and consumption. We thank the Lancet Countdown for providing the results for indicators 3.6 Diet and health co‐benefits, and 3.7 Health care sector emissions. We thank the NHMRC for providing the data for indicator 5.4 Health and climate change research funding.

        Competing interests:

        No relevant disclosures.

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          Call to end shackling of hospitalised palliative prisoner patients

          Lara Pemberton, Stacey Panozzo and Jennifer Philip
          Med J Aust || doi: 10.5694/mja2.52240
          Published online: 18 March 2024

          In the face of an ageing prison population, there is growing pressure for correctional health staff to provide end‐of‐life care for the incarcerated.1 This article evaluates the literature and examines the practices surrounding the use of shackles and restraints in palliative prisoner patients cared for in the hospital setting. Although we recognise that the use of restraints is a reasonable strategy in certain circumstances to maintain community safety, it is not clear that age, illness or immobility are always factored into these decisions.

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          • 1 Biomedicine Discovery Institute, Monash University, Melbourne, VIC
          • 2 St Vincent's Hospital Melbourne, Melbourne, VIC
          • 3 University of Melbourne, Melbourne, VIC


          Correspondence: stacey.panozzo@svha.org.au


          Open access:

          Open access publishing facilitated by The University of Melbourne, as part of the Wiley ‐ The University of Melbourne agreement via the Council of Australian University Librarians.

          Competing interests:

          No relevant disclosures.

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            Expanding access to fracture liaison services in Australia for people with minimal trauma fractures: a system dynamics modelling study

            Alicia R Jones, Danielle Currie, Cindy Peng, Peter R Ebeling, Jackie R Center, Gustavo Duque, Sean Lybrand, Greg Lyubomirsky, Rebecca J Mitchell, Sallie Pearson, Markus J Seibel and Jo‐An Occhipinti
            Med J Aust 2024; 220 (5): . || doi: 10.5694/mja2.52241
            Published online: 18 March 2024

            Abstract

            Objectives: To project how many minimal trauma fractures could be averted in Australia by expanding the number and changing the operational characteristics of fracture liaison services (FLS).

            Study design: System dynamics modelling.

            Setting, participants: People aged 50 years or more who present to hospitals with minimal trauma fractures, Australia, 2020–31.

            Main outcome measures: Numbers of all minimal trauma fractures and of hip fractures averted by increasing the FLS number (from 29 to 58 or 100), patient screening rate (from 30% to 60%), and capacity for accepting new patients (from 40 to 80 per service per month), and reducing the proportion of eligible patients who do not attend FLS (from 30% to 15%); cost per fracture averted.

            Results: Our model projected a total of 2 441 320 minimal trauma fractures (258 680 hip fractures; 2 182 640 non‐hip fractures) in people aged 50 years or older during 2020–31, including 1 211 646 second or later fractures. Increasing the FLS number to 100 averted a projected 5405 fractures (0.22%; $39 510 per fracture averted); doubling FLS capacity averted a projected 3674 fractures (0.15%; $35 835 per fracture averted). Our model projected that neither doubling the screening rate nor reducing by half the proportion of eligible patients who did not attend FLS alone would reduce the number of fractures. Increasing the FLS number to 100, the screening rate to 60%, and capacity to 80 new patients per service per month would together avert a projected 13 672 fractures (0.56%) at a cost of $42 828 per fracture averted.

            Conclusion: Our modelling indicates that increasing the number of hospital‐based FLS and changing key operational characteristics would achieve only moderate reductions in the number of minimal trauma fractures among people aged 50 years or more, and the cost would be relatively high. Alternatives to specialist‐led, hospital‐based FLS should be explored.

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            • 1 Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
            • 2 Monash Health, Melbourne, VIC
            • 3 Sax Institute, Sydney, NSW
            • 4 Monash University, Melbourne, VIC
            • 5 Garvan Institute of Medical Research, Sydney, NSW
            • 6 St Vincent's Hospital Sydney, Sydney, NSW
            • 7 Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, Melbourne, VIC
            • 8 Western Health, Melbourne, VIC
            • 9 Amgen Europe, Rotkreuz, Switzerland
            • 10 Healthy Bones Australia, Sydney, NSW
            • 11 Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
            • 12 Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
            • 13 Centre of Research Excellence in Medicines Intelligence, University of New South Wales, Sydney, NSW
            • 14 Concord Clinical School, University of Sydney, Sydney, NSW
            • 15 ANZAC Research Institute, University of Sydney, Sydney, NSW
            • 16 Brain and Mind Centre, University of Sydney, Sydney, NSW
            • 17 Computer Simulation and Advanced Research Technologies (CSART), Sydney, NSW


            Correspondence: alicia.jones@monash.edu


            Open access:

            Open access publishing facilitated by Monash University, as part of the Wiley – Monash University agreement via the Council of Australian University Librarians.

            Acknowledgements: 

            This investigation was funded by Amgen Australia. It was overseen by an expert advisory panel, including a representative from the funder, with an independent chair. The funder contributed to the scope and design of this study, and preparation and review of the manuscript, but did not influence the collation, management, analysis, and interpretation of the data, or the decision to submit the manuscript for publication.

            We thank Janet Sluggett (University of South Australia, Adelaide), Cathie Sherrington (Institute for Musculoskeletal Health, University of Sydney, Sydney), Matthew Jennings (Liverpool Hospital, Sydney), Henry Cutler (Centre for Health Economy, Macquarie University, Sydney), Jacqueline Close (Prince of Wales Hospital, Sydney), and Mark Heffernan (Western Sydney University, Sydney) for their contributions to the advisory group and modelling.

            Competing interests:

            Jo‐An Occhipinti is managing director of Computer Simulation and Advanced Research Technologies. Alicia Jones holds a National Health and Medical Research Council (NHMRC) postgraduate research scholarship (1169192). Markus J Seibel holds an NHMRC Investigator Grant for research into secondary fracture prevention (APP1196062). Sean Lybrand is an employee of Amgen Australia.

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            • 3. Australian Institute of Health and Welfare. Estimating the prevalence of osteoporosis in Australia (Cat. no. PHE 178). Canberra: AIHW, 2014. https://www.aihw.gov.au/reports/chronic‐musculoskeletal‐conditions/estimating‐the‐prevalence‐of‐osteoporosis‐in‐austr/summary (viewed Mar 2021).
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              The provision of general surgery in rural Australia: a narrative review

              Jessica Paynter, Kirby R Qin, Janelle Brennan, David J Hunter‐Smith and Warren M Rozen
              Med J Aust || doi: 10.5694/mja2.52232
              Published online: 4 March 2024

              Summary

              • Rural surgery is most commonly provided by general surgeons to the 29% of people (7 million) living in rural Australia.
              • The provision of rural general surgery to enable equitable and safe surgical care for rural Australians is a multifaceted issue concerning recruitment, training, retention, surgical procedures and surgical outcomes.
              • Sustaining the rural general surgical workforce will be dependent upon growing an increased number of resident rural general surgeons, as well as changed models of care, with a need for ongoing review to track the outcomes of these changes.
              • To increase recruitment, rural general surgical training must improve to be less stressful for trainees and to be incorporated alongside a rural‐facing generalist curriculum.
              • Rural general surgical outcomes (excluding some oncology conditions) achieve comparable results to metropolitan centres.
              • Access to, and outcomes of, surgical oncology services continues to be inequitable for rural Australians and should be a major focus for improved service delivery.

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              • 1 Monash Rural Health — Bendigo, Monash University, Bendigo, VIC
              • 2 Bendigo Health, Bendigo, VIC
              • 3 Monash University, Melbourne, VIC


              Correspondence: jess.paynter@monash.edu


              Open access:

              Open access publishing facilitated by Monash University, as part of the Wiley ‐ Monash University agreement via the Council of Australian University Librarians.

              Competing interests:

              No relevant disclosures.

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              • 2. Royal Australasian College of Surgeons. Train for Rural: Rural Health Equity Strategy. Melbourne: RACS, 2021. https://www.surgeons.org/‐/media/Project/RACS/surgeons‐org/files/interest‐groups‐sections/Rural‐Surgery/2‐Train‐for‐Rural.pdf?rev=2e53ad7ecb3e4864be9dcc69e0556bb1&hash=6EF8D4FD8F5C13332C8C625D920E42C6 (viewed May 2023).
              • 3. Royal Australasian College of Surgeons. Activities report 2021. Melbourne: RACS, 2022. https://www.surgeons.org/‐/media/Project/RACS/surgeons‐org/files/reports‐guidelines‐publications/workforce‐activities‐census‐reports/2021‐12‐31_RACS_ActivitiesReport_2021_V4_Final.pdf?rev=7dced14774fa449e8a74b1023013998e&hash=528EC8EDAD1B41E0B2757EEECEAC97DF (viewed May 2023).
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                The effectiveness of maternal pertussis vaccination for protecting Aboriginal and Torres Strait Islander infants against infection, 2012–2017: a retrospective cohort study

                Lisa McHugh, Heather A D’Antoine, Mohinder Sarna, Michael J Binks, Hannah C Moore, Ross M Andrews, Gavin F Pereira, Christopher C Blyth, Paul Van Buynder, Karin Lust and Annette K Regan
                Med J Aust 2024; 220 (4): . || doi: 10.5694/mja2.52220
                Published online: 4 March 2024

                Abstract

                Objectives: To evaluate the effectiveness of maternal pertussis vaccination for preventing pertussis infections in Aboriginal and Torres Strait Islander infants under seven months of age.

                Study design: Retrospective cohort study; analysis of linked administrative health data.

                Setting, participants: Mother–infant cohort (Links2HealthierBubs) including all pregnant women who gave birth to live infants (gestational age ≥ 20 weeks, birthweight ≥ 400 g) in the Northern Territory, Queensland, and Western Australia during 1 January 2012 – 31 December 2017.

                Main outcome measures: Proportions of women vaccinated against pertussis during pregnancy, rates of pertussis infections among infants under seven months of age, and estimated effectiveness of maternal vaccination for protecting infants against pertussis infection, each by Indigenous status.

                Results: Of the 19 892 Aboriginal and Torres Strait Islander women who gave birth to live infants during 2012–2017, 7398 (37.2%) received pertussis vaccine doses during their pregnancy, as had 137 034 of 259 526 non‐Indigenous women (52.8%; Indigenous v non‐Indigenous: adjusted odds ratio, 0.66; 95% confidence interval [CI], 0.62–0.70). The annual incidence of notified pertussis infections in non‐Indigenous infants declined from 16.8 (95% CI, 9.9–29) in 2012 to 1.4 (95% CI, 0.3–8.0) cases per 10 000 births in 2017; among Aboriginal and Torres Strait Islander infants, it declined from 47.6 (95% CI, 16.2–139) to 38.6 (95% CI, 10.6–140) cases per 10 000 births. The effectiveness of maternal vaccination for protecting non‐Indigenous infants under seven months of age against pertussis infection during 2014–17 was 68.2% (95% CI, 51.8–79.0%); protection of Aboriginal and Torres Strait Islander infants was not statistically significant (36.1%; 95% CI, –41.3% to 71.1%).

                Conclusions: During 2015–17, maternal pertussis vaccination did not protect Aboriginal and Torres Strait Islander infants in the NT, Queensland, and WA against infection. Increasing the pertussis vaccination rate among pregnant Aboriginal and Torres Strait Islander women requires culturally appropriate, innovative strategies co‐designed in partnership with Indigenous organisations and communities.

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                • 1 The University of Queensland, Brisbane, QLD
                • 2 National Aboriginal and Torres Strait Islander Research Network, University of Queensland, Brisbane, QLD
                • 3 Curtin University, Perth, WA
                • 4 Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
                • 5 Menzies School of Health Research, Darwin, NT
                • 6 Telethon Institute for Child Health Research, University of Western Australia, Perth, WA
                • 7 Office of the Chief Health Officer, Queensland Health, Brisbane, QLD
                • 8 Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
                • 9 The University of Western Australia, Perth, WA
                • 10 Griffith University, Gold Coast, QLD
                • 11 Royal Brisbane and Woman's Hospital Health Service District, Brisbane, QLD
                • 12 University of San Francisco, San Francisco, CA, United States of America


                Correspondence: l.mchugh@uq.edu.au


                Open access:

                Open access publishing facilitated by The University of Queensland, as part of the Wiley – The University of Queensland agreement via the Council of Australian University Librarians.

                Acknowledgements: 

                This investigation was supported by a National Health and Medical Research Council (NHMRC) Project Grant (GNT1141510) and operational funds provided by the Western Australia Department of Health. Lisa McHugh is supported by an NHMRC EL1 Investigator Grant (GNT2016407) at the University of Queensland. Annette K Regan was supported by an NHMRC Early Career Fellowship (GNT1138425). Hannah C Moore was supported by a Stan Perron Charitable Foundation People Fellowship. Christopher C Blyth was supported by an NHMRC Career Development Fellowship (GNT1111596) and NHMRC Investigator award (APP1173163). Michael J Binks was supported by an NHMRC Early Career Fellowship (GNT1088733) and an NHMRC‐funded Hot North (Improving Health Outcomes in the Tropical North) Fellowship (1131932). Gavin F Pereira was supported by NHMRC Project (GNT1099655) and Investigator Grants (GNT1173991), and by the Research Council of Norway through its Centres of Excellence funding scheme (GNT262700). The funding sources had no role in the planning, study design, data collection, analysis or interpretation, reporting or publication.

                We thank the Linkages Services Branch of Queensland Health and the data custodians of the Perinatal, Notifications and Other Communicable Infectious Diseases, and Immunisation Data collections; the Linkage and Client Services Teams at the Data Linkage Branch of the Western Australia Department of Health and the data custodians of the Midwives Notification System, the WA Antenatal Vaccination Database, and the WA Notifiable Infectious Diseases Database; and SA‐NT DataLink and the NT Centre for Disease Control, and the data custodians of the NT Perinatal Trends, Communicable Infectious Diseases, and Immunisation Databases.

                Competing interests:

                No relevant disclosures.

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                  Equitable access to abortion care is still not a reality in Australia

                  Asvini K Subasinghe and Seema Deb
                  Med J Aust 2024; 220 (3): . || doi: 10.5694/mja2.52210
                  Published online: 19 February 2024

                  The 2023 Senate inquiry into universal access to reproductive health care identified major structural barriers to abortion care in Australia.1 However, in the absence of a national abortion registry, it is unclear whether access is equitable and what factors influence the provision of abortion care. In two articles published in this issue of the MJA, researchers report large population‐based studies that investigated these questions in Victoria.

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                  • 1 Monash University, Melbourne, VIC
                  • 2 Eastern Health, Box Hill Hospital, Melbourne, VIC


                  Competing interests:

                  No relevant disclosures.

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                    The participation of Aboriginal and Torres Strait Islander parents in Australian trials of parenting programs for improving children's health: a scoping review

                    Jake MacDonald, Myles Young, Briana Barclay, Stacey McMullen, James Knox and Philip Morgan
                    Med J Aust || doi: 10.5694/mja2.52198
                    Published online: 12 February 2024

                    Abstract

                    Objectives: To assess the inclusion of Aboriginal and Torres Strait Islander parents in trials of parenting programs in Australia; the involvement of Indigenous fathers in such studies; and whether parenting programs are designed to be culturally appropriate for Aboriginal and Torres Strait Islander people.

                    Study design: Scoping review of peer‐reviewed journal publications that report quantitative outcomes for Australian randomised control trials of parenting programs in which the participants were parents or caregivers of children under 18 years of age, and with at least one outcome related to children's health, health behaviour, or wellbeing.

                    Data sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus databases.

                    Data synthesis: Of 109 eligible publications, nine reported how many participants were Aboriginal or Torres Strait Islander people; three specified whether they were Aboriginal, Torres Strait Islander, or both. Two publications described specific interventions for Aboriginal and Torres Strait Islander children; both reported consultation with Indigenous people regarding program design. Of the 15 559 participating parents in all included publications, 93 were identified as Aboriginal or Torres Strait Islander people. No publications noted as study limitations the absence of consultation with Indigenous people or the low participation rate of Aboriginal and Torres Strait Islander families.

                    Conclusions: The specific needs and interests of Aboriginal and Torres Strait Islander families have not generally been considered in Australian trials of parenting programs that aim to improve the mental and physical health of children. Further, Indigenous people are rarely involved in the planning and implementation of the interventions, few of which are designed to be culturally appropriate for Indigenous people. If parenting research in Australia is to support Aboriginal and Torres Strait Islander families, it must include consultation with local communities, adapt interventions and research methods to the needs of the participating parents and their communities, and improve the recruitment and retention of Aboriginal and Torres Strait Islander participants.

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                    • 1 Office of Indigenous Strategy and Leadership, University of Newcastle, Newcastle, NSW
                    • 2 The University of Newcastle, Newcastle, NSW
                    • 3 Centre for Active Living and Learning, University of Newcastle, Newcastle, NSW



                    Open access:

                    Open access publishing facilitated by The University of Newcastle, as part of the Wiley ‐ The University of Newcastle agreement via the Council of Australian University Librarians.

                    Competing interests:

                    No relevant disclosures.

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                      Baby steps in lobbying reform: opportunities and challenges in Queensland

                      Jennifer Lacy‐Nichols and Katherine B Cullerton
                      Med J Aust 2024; 220 (2): . || doi: 10.5694/mja2.52187
                      Published online: 5 February 2024

                      Australia is lacklustre in its political transparency. This makes it challenging to see if commercial actors have undue influence over policy decisions, which is a risk for public health.

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                      • 1 University of Melbourne, Melbourne, VIC
                      • 2 University of Queensland, Brisbane, QLD


                      Acknowledgements: 

                      Jennifer Lacy‐Nichols is the recipient of a fellowship to research the commercial determinants of health from the Victorian Health Promotion Foundation (VicHealth). VicHealth had no role in the planning, writing or publication of the work.

                      Competing interests:

                      No relevant disclosures.

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