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To the Editor: The Perspectives article by William1 states that medical assistance in dying may disrupt therapeutic relationships and will challenge beliefs.

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Perth, WA

Correspondence: pbeahan@optusnet.com.au

Competing interests:

No relevant disclosures.

1. Leeroy William. Medical assistance in dying: a disruption of therapeutic relationships. Med J Aust 2018 209: 286–287. https://www.mja.com.au/journal/2018/209/7/medical-assistance-dying-disruption-therapeutic-relationships
2. Callinan K. Allow modern medicine to relieve agonizing end‐of‐life experiences. The Hill 2017; 25 Dec. https://thehill.com/opinion/healthcare/366374-allow-modern-medicine-to-relieve-agonizing-end-of-life-experiences (viewed Oct 2018).

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Research letters

Increased incidence of community‐associated Staphylococcus aureus bloodstream infections in Victoria and Western Australia, 2011–2016

Nabeel Imam, Simone Tempone, Paul K Armstrong, Rebecca McCann, Sandra Johnson, Leon J Worth and Michael J Richards

Med J Aust 2019; 210 (2) || doi: 10.5694/mja2.12057
Published online: 21 January 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Statistics, epidemiology and research design

Standardised national surveillance of health care‐associated Staphylococcus aureus bloodstream infections (HA‐SABs)1 has found that rates are declining in Australia.2 The incidence of community‐associated SABs (CA‐SABs), however, has not been investigated. These infections frequently have complicated courses (eg, metastatic sites of infection)3 and high mortality (about 20%).4

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1 Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
2 Western Australia Department of Health, Perth, WA
3 Royal Melbourne Hospital, Melbourne, VIC

Correspondence: nabeel.imam@mh.org.au

Acknowledgements:

We acknowledge the infection control consultants in Victorian and Western Australian hospitals who collected the data we analysed. VICNISS is fully funded by the Victorian Department of Health and Human Services; HISWA is a program in the Public Health Division of the Department of Health Western Australia.

Competing interests:

No relevant disclosures.

1. Australian Commission on Safety and Quality in Health Care. Implementation guide for surveillance of Staphylococcus aureus bacteraemia. Sydney: ACSQHC, 2013. https://www.safetyandquality.gov.au/wp-content/uploads/2012/02/SAQ019_Implementation_guide_SAB_v10.pdf (viewed June 2018).
2. Worth LJ, Spelman T, Bull AL, Richards MJ. Staphylococcus aureus bloodstream infection in Australian hospitals: findings from a Victorian surveillance system. Med J Aust 2014; 200: 282–284. https://www.mja.com.au/journal/2014/200/5/staphylococcus-aureus-bloodstream-infection-australian-hospitals-findings
3. Tong SYC, Davis JS, Eichenberger E, et al. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28: 603–661.
4. Turnidge JD, Kotsanas D, Munckhof W, et al. Staphylococcus aureus bacteraemia: a major cause of mortality in Australia and New Zealand. Med J Aust 2009; 191: 368–373. https://www.mja.com.au/journal/2009/191/7/staphylococcus-aureus-bacteraemia-major-cause-mortality-australia-and-new
5. Agostino JW, Ferguson JK, Eastwood K, Kirk MD. The increasing importance of community‐acquired methicillin‐resistant Staphylococcus aureus infections. Med J Aust 2017; 207: 388–393. https://www.mja.com.au/journal/2017/207/9/increasing-importance-community-acquired-methicillin-resistant-staphylococcus

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Research letters

Nicotine and other potentially harmful compounds in “nicotine‐free” e‐cigarette liquids in Australia

Emily Chivers, Maxine Janka, Peter Franklin, Benjamin Mullins and Alexander Larcombe

Med J Aust 2019; 210 (3) || doi: 10.5694/mja2.12059
Published online: 14 January 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Respiratory tract diseases

Awareness and use of e‐cigarettes is increasing in Australia.1 The thousands of available e‐liquids contain various excipients, nicotine, flavourings, and other additives. There is little to no regulation of their manufacture, and potentially dangerous ingredients and incorrect nicotine levels have been identified.2 Of particular concern is the frequency with which nicotine is detected in e‐liquids labelled “nicotine‐free”.2 E‐liquids containing nicotine cannot legally be sold in Australia,3 but inaccurate labelling means that users may unwittingly inhale this addictive substance, or retailers may sell incorrectly labelled nicotine‐containing e‐liquids to willing customers. The aim of our investigation was to assess the chemical composition of a range of e‐liquids available in Australia, focusing on nicotine and other potentially harmful compounds. Formal ethics approval was not required for this study.

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1 Telethon Kids Institute, Perth, WA
2 University of Western Australia, Perth, WA
3 Curtin University, Perth, WA

Correspondence: alexander.larcombe@telethonkids.org.au

Acknowledgements:

We acknowledge funding from the Australian Competition and Consumer Commission, Health Department of Western Australia, and from the National Health and Medical Research Council (APP1128231).

Competing interests:

No relevant disclosures.

1. Yong HH, Borland R, Balmford J, et al. Trends in e‐cigarette awareness, trial, and use under the different regulatory environments of Australia and the United Kingdom. Nicotine Tob Res 2015; 17: 1203–1211.
2. Trehy ML, Ye W, Hadwiger ME, et al. Analysis of electronic cigarette cartridges, refill solutions, and smoke for nicotine and nicotine related impurities. J Liq Chromatogr R T 2011; 34: 1442–1458.
3. Douglas H, Hall W, Gartner C. E‐cigarettes and the law in Australia. Aust Fam Physician 2015; 44: 415–418.
4. Goniewicz ML, Gupta R, Lee YH, et al. Nicotine levels in electronic cigarette refill solutions: a comparative analysis of products from the US, Korea, and Poland. Int J Drug Policy 2015; 26: 583–588.
5. Abdel‐Gawad H, Hegazi B. Fate of ¹⁴C‐ethyl prothiofos insecticide in canola seeds and oils. J Environ Sci Health B 2010; 45: 116–122.

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Guideline summary

The Australasian Society of Clinical Immunology and Allergy infant feeding for allergy prevention guidelines

Preeti A Joshi, Jill Smith, Sandra Vale and Dianne E Campbell

Med J Aust 2019; 210 (2) || doi: 10.5694/mja2.12102
Published online: 14 January 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Immune system diseases

Skin and connective tissue diseases

Environment and public health

Pediatric medicine

Abstract

Introduction: The Australasian Society of Clinical Immunology and Allergy, the peak professional body for clinical immunology and allergy in Australia and New Zealand, develops and provides information on a wide range of immune‐mediated disorders, including advice about infant feeding and allergy prevention for health professionals and families. Guidelines for infant feeding and early onset allergy prevention were published in 2016, with additional guidance published in 2017 and 2018, based on emerging evidence.

Main recommendations:

When the infant is ready, at around 6 months, but not before 4 months, start to introduce a variety of solid foods. (This is not a strict window of introduction but rather a recommendation not to delay the introduction of solid foods beyond 12 months.)
Introduce peanut and egg in the first year of life in all infants, regardless of their allergy risk factors.
Hydrolysed (partially and extensively) formula is no longer recommended for the prevention of allergic disease.

Changes in management a result of the guidelines: The guidelines specifically recommend introducing solid foods at around 6 months of age and introducing peanut and egg in the first year of life in all infants to prevent allergy development. Hydrolysed formula is no longer recommended for prevention of allergic disease. A new document outlining the reasons for and the method of peanut introduction to high risk infants is available for health professionals.

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1 Australasian Society of Clinical Immunology and Allergy, Sydney, NSW
2 The Children's Hospital at Westmead, Sydney, NSW
3 University of Sydney, Sydney, NSW

Correspondence: preeti.joshi@health.nsw.gov.au

Competing interests:

Preeti Joshi is currently the chair of the ASCIA paediatric committee and the deputy chair of the National Allergy Strategy allergy prevention project. Sandra Vale is coordinator of the National Allergy Strategy. Jill Smith is the ASCIA CEO and company secretary. Dianne Campbell was chair of the ASCIA paediatric committee from 2011 to 2017, has received funding for unrelated research from the NHMRC, the Allergy and Immunology Foundation of Australasia and the Australian Food Allergy Foundation, and has received travel expenses to attend investigator meetings from DBV Technologies.

1. Odhiambo JA, Williams HC, Clayton TO, et al. Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. J Allergy Clin Immunol 2009; 124: 1251–1258.e23.
2. Prescott SL, Pawankar R, Allen KJ, et al. A global survey of changing patterns of food allergy burden in children. World Allergy Organ J 2013; 6: 21.
3. Osborne NJ, Koplin JJ, Martin PE, et al. Prevalence of challenge‐proven IgE‐mediated food allergy using population‐based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol 2011; 127: 668–676.e2.
4. Mullins RJ, Dear KB, Tang ML. Time trends in Australian hospital anaphylaxis admissions in 1998‐1999 to 2011‐2012. J Allergy Clin Immunol 2015; 136: 367–375.
5. Mullins RJ, Wainstein BK, Barnes EH, et al. Increases in anaphylaxis fatalities in Australia from 1997 to 2013. Clin Exp Allergy 2016; 46: 1099–1110.
6. Australasian Society of Clinical Immunology and Allergy. ASCIA guidelines – infant feeding and allergy prevention. Sydney: ASCIA, 2016. https://www.allergy.org.au/health-professionals/papers/infant-feeding-and-allergy-prevention (viewed Nov 2018).
7. National Asthma Council Australia. Australian asthma handbook. Infant feeding and asthma prevention. http://www.asthmahandbook.org.au/prevention/primary/infant-feeding (viewed Nov 2018).
8. BI Nwaru ME, S. Ahonen, M. Kaila, et al. Age at the introduction of solid foods during the first year and allergic sensitization at age 5 years. Pediatrics 2010; 125: 50–59.
9. Netting MJ, Campbell DE, Koplin JJ, et al. An Australian consensus on infant feeding guidelines to prevent food allergy: outcomes from the Australian Infant Feeding Summit. J Allergy Clin Immunol Pract 2017; 5: 1617–1624.
10. Grade Working Group. What is GRADE? http://www.gradeworkinggroup.org/ (viewed Nov 2018).
11. Australasian Society of Clinical Immunology and Allergy. ASCIA guide for introduction of peanut to infants with severe eczema and/or food allergy. https://www.allergy.org.au/health-professionals/papers/ascia-guide-peanut-introduction (viewed Nov 2018).
12. Du Toit G, Roberts G, Sayre PH, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 2015; 372: 803–813.
13. Du Toit G, Katz Y, Sasieni P, et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol 2008; 122: 984–991.
14. Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev 2012; (9): CD000133.
15. Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Evid Based Child Health 2014; 9: 447–483.
16. Gunaratne AW, Makrides M, Collins CT. Maternal prenatal and/or postnatal n‐3 long chain polyunsaturated fatty acids (LCPUFA) supplementation for preventing allergies in early childhood. Cochrane Database Syst Rev 2015; (7): CD010085.
17. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Vitamin and mineral supplementation and pregnancy. https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27sHealth/Statementandguidelines/Clinical-Obstetrics/Vitamin-andmineral-supplementation-in-pregnancy-(C-Obs-25)-Review-Nov-2014,-Amended-May-2015.pdf?ext=.pdf (viewed Nov 2018).
18. United States Food and Drug Administration. Eating fish: what pregnant women and parents should know. https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm393070.htm (viewed Nov 2018).
19. Fiocchi A, Pawankar R, Cuello‐Garcia C, et al. World Allergy Organization‐McMaster University Guidelines for Allergic Disease Prevention (GLAD‐P): probiotics. World Allergy Organ J 2015; 8: 4.
20. Foolad N, Brezinski EA, Chase EP, Armstrong AW. Effect of nutrient supplementation on atopic dermatitis in children: a systematic review of probiotics, prebiotics, formula, and fatty acids. JAMA Dermatol 2013; 149: 350–355.
21. Osborn DA, Sinn JK. Probiotics in infants for prevention of allergic disease and food hypersensitivity. Cochrane Database Syst Rev 2007; (4): CD006475.
22. National Health and Medical Research Council. Infant feeding guidelines: information for health workers. Canberra: NHMRC, 2012. https://www.nhmrc.gov.au/guidelines-publications/n56 (viewed Nov 2018).
23. Victora CG, Bahl R, Barros AJ, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387: 475–490.
24. Grimshaw K, Logan K, O'Donovan S, et al. Modifying the infant's diet to prevent food allergy. Arch Dis Child 2017; 102: 179–186.
25. Osborn DA, Sinn J. Soy formula for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev 2006; (4): CD003741.
26. Boyle RJ, Ierodiakonou D, Khan T, et al. Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta‐analysis. BMJ 2016; 352: i974.
27. Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev 2006; (4): CD003664.
28. Osborn DA, Sinn JK, Jones LJ. WITHDRAWN: Infant formulas containing hydrolysed protein for prevention of allergic disease and food allergy. Cochrane Database Syst Rev 2017; (5): CD003664.
29. von Berg A, Filipiak‐Pittroff B, Schulz H, et al. Allergic manifestation 15 years after early intervention with hydrolyzed formulas–the GINI Study. Allergy 2016; 71: 210–219.
30. Australasian Society of Clinical Immunology and Allergy. ASCIA information on how to introduce solid foods to babies for allergy prevention. https://www.allergy.org.au/patients/allergy-prevention/ascia-how-to-introduce-solid-foods-to-babies (viewed Nov 2018).
31. Perkin MR, Logan K, Tseng A, et al. Randomized trial of introduction of allergenic foods in breast‐fed infants. N Engl J Med 2016; 374: 1733–1743.
32. Fleischer DM, Spergel JM, Assa'ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. J Allergy Clin Immunol Pract 2013; 1: 29–36.
33. FR Greer SHS, A. W Burks. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas Pediatrics 2008; 121: 183–191.
34. Muraro A, Halken S, Arshad SH, et al. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy 2014; 69: 590–601.
35. World Health Organization. Global strategy on infant and young child feeding. Geneva: WHO, 2003. https://www.who.int/nutrition/topics/infantfeeding_recommendation/en/ (viewed Nov 2018).
36. Palmer DJ, Sullivan TR, Gold MS, et al. Randomized controlled trial of early regular egg intake to prevent egg allergy. J Allergy Clin Immunol 2017; 139:1600–1607.e2.
37. Perkin MR, Lack G. Introducing allergenic foods in infants. N Engl J Med 2016; 375: e16.
38. Du Toit G, Roberts G, Sayre PH, et al. Identifying infants at high risk of peanut allergy: the Learning Early About Peanut Allergy (LEAP) screening study. J Allergy Clin Immunol 2013; 131: 135–143.e12.
39. Du Toit G, Sayre PH, Roberts G, et al. Effect of avoidance on peanut allergy after early peanut consumption. N Engl J Med 2016; 374: 1435–1443.
40. Togias A, Cooper SF, Acebal ML, et al. Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases‐sponsored expert panel. J Allergy Clin Immunol 2017; 139: 29–44.
41. Turner PJ, Campbell DE, Boyle RJ, Levin ME. Primary prevention of food allergy: translating evidence from clinical trials to population‐based recommendations. J Allergy Clin Immunol Pract 2018; 6: 367–375.
42. Turner PJ CD. Implementing primary prevention for peanut allergy at a population level. JAMA 2017; 317: 1111–1112.
43. Levin M, Goga A, Doherty T, et al. Allergy and infant feeding guidelines in the context of resource‐constrained settings. J Allergy Clin Immunol 2017; 139: 455–458.

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Research letter

Baby boomers and booze: we should be worried about how older Australians are drinking

Ann M Roche and Victoria Kostadinov

Med J Aust 2019; 210 (1) || doi: 10.5694/mja2.12025
Published online: 14 January 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Substance‐related disorders

Gerontology

Alcohol research has traditionally focused on younger age groups; consumption patterns and predictors for older people have received only limited attention. However, the number of older Australians has increased substantially in recent years, accompanied by unprecedented changes in their alcohol consumption patterns. Older people are vulnerable to a range of alcohol‐related adverse effects, including falls and other injuries, diabetes, cardiovascular disease, cancer, mental health problems, obesity, liver disease, and early onset dementia and other brain injury.1,2,3 These vulnerabilities are a cause for clinical concern.

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National Centre for Education and Training on Addiction, Flinders University, Adelaide, SA

Correspondence: ann.roche@flinders.edu.au

Competing interests:

No relevant disclosures.

1. Crome I, Dar K, Janikiewicz S, et al. Our invisible addicts: first report of the Older Persons’ Substance Misuse Working Group of the Royal College of Psychiatrists. Second edition (College Report CR211). London: Royal College of Psychiatrists, 2018. https://www.rcpsych.ac.uk/files/pdfversion/CR211.pdf (viewed Aug 2018).
2. Scoccianti C, Cecchini M, Anderson AS, et al. European Code against Cancer 4th edition. Alcohol drinking and cancer. Cancer Epidemiol 2015; 39: S67–S74.
3. Schwarzinger M, Pollock BG, Hasan OSM, et al. Contribution of alcohol use disorders to the burden of dementia in France 2008–13: a nationwide retrospective cohort study. Lancet Public Health 2018; 3: e124–e132.
4. Australian Institute of Health and Welfare. National drug strategy household survey 2016: detailed findings. Canberra: AIHW, 2017. https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/data (viewed Sept 2018).
5. National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol (Cat. No. DS10). Canberra: NHMRC, 2009. https://www.nhmrc.gov.au/guidelines-publications/ds10 (viewed Sept 2018).
6. Wadd S, Lapworth K, Sullivan M, et al. Working with older drinkers. Bedford: Tilda Goldberg Centre, University of Bedfordshire, 2011. http://alcoholresearchuk.org/downloads/finalReports/FinalReport_0085 (viewed Aug 2018).
7. Barry KL, Blow FC. Drinking over the lifespan: focus on older adults. Alcohol Res 2016; 38: 115–120.

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Research

Screening for perinatal depression and predictors of underscreening: findings of the Born in Queensland study

Macarena A San Martin Porter, Kim Betts, Steve Kisely, Gino Pecoraro and Rosa Alati

Med J Aust 2019; 210 (1) || doi: 10.5694/mja2.12030
Published online: 14 January 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Health services administration

Women's health

Mental disorders

Abstract

Objectives: To investigate screening with the Edinburgh Postnatal Depression Scale (EPDS) as part of Queensland prenatal care services, as well as maternal and socio‐demographic factors associated with not being screened.

Design, setting: Cross‐sectional retrospective analysis of data from the Queensland population‐based Perinatal Data Collection for July 2015 – December 2015.

Participants: All women giving birth in Queensland during the second half of 2015.

Main outcome measures: Screening with the EPDS, with the values “yes” (health professional recorded an EPDS score), “no” (health professional reported it was not performed), and “not stated”.

Results: Of 30 468 women who gave birth in Queensland, 21 735 (71.3%) completed the EPDS during pregnancy; 18 942 pregnant women were enrolled as public patients (91.0%) and 2762 as private patients (28.8%). After adjusting for other socio‐demographic factors, screening was less likely for women who were aged 36 years or more (v 25 years or younger: adjusted odds ratio [OR], 0.69; 95% CI, 0.60–0.79), enrolled as private patients (aOR, 0.05; 95% CI, 0.05–0.06), born overseas (aOR, 0.75; 95% CI, 0.68–0.82), Indigenous Australians (aOR, 0.47; 95% CI, 0.39–0.56), single or separated (aOR, 0.83; 95% CI, 0.73–0.94), or of higher socio‐economic status.

Conclusions: Four years after clinical guidelines recommending universal screening with the EPDS were published, screening rates for private and public health care patients differed markedly. Our results may inform future comparisons and analyses of the impact on screening of recent changes to Medicare definitions intended to increase that of women in private health care.

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1 Institute for Social Science Research, University of Queensland, Brisbane, QLD
2 University of Queensland, Brisbane, QLD
3 Curtin University, Perth, WA

Correspondence: m.sanmartinporter@uq.edu.au

Competing interests:

No relevant disclosures.

1. Australian Institute of Health and Welfare. Australia's mothers and babies 2015: in brief (Perinatal statistics series no. 33; Cat no. PER 91). Canberra: AIHW. 2017.
2. Gavin NI, Gaynes BN, Lohr KN, et al. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 2005; 106: 1071–1083.
3. Dennis C‐L, Falah‐Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta‐analysis. Br J Psychiatry 2018; 210: 315–323.
4. Eastwood J, Ogbo F, Hendry A, et al. The impact of antenatal depression on perinatal outcomes in Australian women. PLoS One 2017; 12: e0169907.
5. Leigh B, Milgrom J. Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry 2008; 8: 24.
6. Gentile S. Untreated depression during pregnancy: short‐ and long‐term effects in offspring. A systematic review. Neuroscience 2017; 342: 154–166.
7. Kingston D, Austin MP, Heaman M, et al. Barriers and facilitators of mental health screening in pregnancy. J Affect Disord 2015; 186: 350–357.
8. Buist A. National program for depression associated with childbirth: the Australian experience. Best Pract Res Clin Obstet Gynaecol 2007; 21: 193–206.
9. Austin MP, Kingston D. Psychosocial assessment and depression screening in the perinatal period: benefits, challenges and implementation. In: Sutter‐Dallay AL, Glangeaud‐Freudenthal NMC, Guedeney A, Riecher‐Rössler A, editors. Joint care of parents and infants in perinatal psychiatry. Cham: Springer International Publishing, 2016; pp. 167–195.
10. O'Connor E, Rossom RC, Henninger M, et al. Primary care screening for and treatment of depression in pregnant and postpartum women: evidence report and systematic review for the US Preventive Services Task Force. JAMA 2016; 315: 388–406.
11. Venkatesh KK, Nadel H, Blewett D, et al. Implementation of universal screening for depression during pregnancy: feasibility and impact on obstetric care. Am J Obstet Gynecol. 2016; 215: 517.e1–517.e8.
12. Austin M‐P, Highet N. Depression and related disorders — anxiety, bipolar disorder and puerperal psychosis — in the perinatal period. A guideline for primary care health professionals providing care in the perinatal period. Melbourne: beyondblue, 2011. http://resources.beyondblue.org.au/prism/file?token=BL/0891 (viewed Jan 2018).
13. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10‐item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987; 150: 782–786.
14. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Mental health care in the perinatal period (College Statement: C‐Obs‐48). Mar 2012; revised July 2018. https://www.ranzcog.edu.au/Statements-Guidelines/Obstetrics/Perinatal-Anxiety-and-Depression-(C-Obs-48)) (viewed Sept 2018).
15. Australian Institute of Health and Welfare. Perinatal depression: data from the 2010 Australian National Infant Feeding Survey (Cat. No PHE 161). Canberra: AIHW, 2012.
16. Reilly N, Harris S, Loxton D, et al. Disparities in reported psychosocial assessment across public and private maternity settings: a national survey of women in Australia. BMC Public Health 2013; 13: 632.
17. Yelland J, Brown SJ. Asking women about mental health and social adversity in pregnancy: results of an Australian population‐based survey. Birth 2014; 41: 79–87.
18. Betts KS, Soares Magalhaes RJ, Alati R. The role of neonatal pulmonary morbidity in the longitudinal patterns of hospitalisation for respiratory infection during the first year of life. Epidemiol Infect 2018; 146: 1–8.
19. Australian Bureau of Statistics. 1270.0.55.005. Australian Statistical Geography Standard (ASGS): volume 5. Remoteness structure 2016. http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/1270.0.55.005Main%20Features1July%202016?opendocument&tabname=Summary&prodno=1270.0.55.005&issue=July%202016&num=&view= (viewed Feb 2018).
20. Pink B. Socio‐Economic Indexes for Areas (SEIFA) 2011: technical paper. Mar 2013. http://www.ausstats.abs.gov.au/Ausstats/subscriber.nsf/0/22CEDA8038AF7A0DCA257B3B00116E34/$File/2033.0.55.001%20seifa%202011%20technical%20paper.pdf (viewed Feb 2018).
21. Kohlhoff J, Hickinbotham R, Knox C, et al. Antenatal psychosocial assessment and depression screening in a private hospital. Aust N Z J Obstet Gynaecol 2016; 56: 173–178.
22. Ogbo FA, Eastwood J, Hendry A, et al. Determinants of antenatal depression and postnatal depression in Australia. BMC Psychiatry 2018; 18: 49.
23. Leddy MA, Lawrence H, Schulkin J. Obstetrician‐gynecologists and women's mental health: findings of the Collaborative Ambulatory Research Network 2005–2009. Obstet Gynecol Surv 2011; 66: 316–323.
24. Kingston D, Austin M‐P, McDonald SW, et al. Pregnant women's perceptions of harms and benefits of mental health screening. PLoS One 2015; 10: e0145189.
25. Australian Government Department of Health. Changes to MBS Items for obstetrics services. Updated Oct 2017. http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-ObstetricsServices (viewed Feb 2018).
26. Austin MP, Highet N, the Expert Working Group. Mental health care in the perinatal period: Australian clinical practice guideline. Melbourne: Centre of Perinatal Excellence, 2017. http://cope.org.au/wp-content/uploads/2018/05/COPE-Perinatal-MH-Guideline_Final-2018.pdf (viewed Feb 2018).

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Research

Access to rehabilitation for patients with stroke in Australia

Elizabeth A Lynch, Shylie Mackintosh, Julie A Luker and Susan L Hillier

Med J Aust 2019; 210 (1) || doi: 10.5694/mja2.12034
Published online: 14 January 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Nervous system diseases

Rehabilitation

Health services administration

Abstract

Objective: To identify factors associated with receiving acute goal‐directed treatment, being assessed for ongoing rehabilitation, and receiving post‐acute rehabilitation after having a stroke.

Design: Retrospective analysis of National Stroke Audit data for patients with acute stroke treated at Australian hospitals during 1 September 2014 – 28 February 2015.

Setting, participants: 112 Australian hospitals that admit adults with acute stroke.

Main outcomes: Associations between patient‐related and organisational factors and the provision of rehabilitation interventions.

Results: Data for 3462 patients were eligible for analysis; their median age was 74 years, 1962 (57%) were men, and 2470 (71%) had received care in a stroke unit. 2505 patients (72%) received goal‐directed treatment during their acute admission; it was not provided to 364 patients (10.5%) who were responsive, had not fully recovered, and did not refuse treatment. Factors associated with higher odds of receiving goal‐directed treatment included goal‐setting with the patient and their family (odds ratio [OR], 6.75; 95% CI, 5.07–8.90) and receiving care in a stroke unit (OR, 2.08; 95% CI, 1.61–2.70). 1358 patients (39%) underwent further rehabilitation after discharge from acute care; factors associated with receiving post‐acute rehabilitation included care in a stroke unit (OR, 1.73; 95% CI, 1.34–2.22) and having an arm or speech deficit. Dementia was associated with lower odds of receiving acute goal‐directed treatment (OR, 0.49; 95%, 0.33–0.73) and post‐acute rehabilitation (OR, 0.43; 95%, 0.30–0.61).

Conclusions: Access to stroke units and to early and ongoing rehabilitation for patients after stroke can be improved in Australia, both to optimise outcomes and to reduce the burden of care on underresourced community and primary care providers.

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1 Adelaide Nursing School, University of Adelaide, Adelaide, SA
2 NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, VIC
3 Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC
4 University of South Australia, Adelaide, SA

Correspondence: elizabeth.lynch@adelaide.edu.au

Acknowledgements:

Elizabeth Lynch is supported by a National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery grant (1077898) and an NHMRC Early Career Fellowship (1138515). The audit data, initially collected with the Australian Stroke Data Tool (AuSDaT), were provided by the Stroke Foundation of Australia. We thank Kelvin Hill for valuable feedback when reviewing drafts of the manuscript.

Competing interests:

No relevant disclosures.

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Perspective

Regulatory and other responses to the pharmaceutical opioid problem

Gabrielle Campbell, Nicholas Lintzeris, Natasa Gisev, Briony Larance, Sallie Pearson and Louisa Degenhardt

Med J Aust 2019; 210 (1) || doi: 10.5694/mja2.12047
Published online: 12 December 2018

ARTICLE
AUTHORS
REFERENCES

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Pharmaceutical preparations

Substance‐related disorders

Anesthesia, analgesia and pain

How is Australia responding to the trends in pharmaceutical opioid utilisation and opioid harms?

In the past 20 years, there have been substantial increases in the use of pharmaceutical opioids in many countries including Australia, which has one of the highest levels of opioid utilisation globally.1 Almost 15 million opioid prescriptions were dispensed in 2015 and our use of high potency opioids has also increased.2 One of the main drivers is the higher use of prescription opioids for chronic non‐cancer pain (CNCP).3 In parallel to escalating use, opioid‐related harms have also increased. Since 2000, there has been a shift in hospitalisations due to opioid poisonings and opioid‐related deaths from predominantly heroin to pharmaceutical opioids.4 Extramedical use — defined as any use of a medication outside the formal medical system or inconsistent with a doctor's prescription5 — is also relatively common; the most recent household survey indicates that “non‐medical use” was reported by 4.8% of the Australian population.4

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1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
2 University of Sydney, Sydney, NSW
3 Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
4 University of Wollongong, Wollongong, NSW
5 Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
6 Menzies Centre for Health Policy, University of Sydney, Sydney, NSW

Correspondence: G.Campbell@unsw.edu.au

Acknowledgements:

Gabrielle Campbell, Natasa Gisev, Briony Larance and Louisa Degenhardt are supported by National Health and Medical Research Council fellowships (No. 1119992, 1091878, 1073858, and 1135991). The National Drug and Alcohol Research Centre at the University of New South Wales is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvements Grant Fund.

Competing interests:

Some of the authors have received investigator‐initiated untied educational grants from Reckitt Benckiser and Indivior for studies of buprenorphine–naloxone (Briony Larance, Louisa Degenhardt and Nicholas Lintzeris), buprenorphine depot (Briony Larance, Louisa Degenhardt and Nicholas Lintzeris), naloxone (Louisa Degenhardt), the development of an opioid‐related behaviour scale (Briony Larance, Louisa Degenhardt and Nicholas Lintzeris), projects regarding opioid dependence treatment (Nicholas Lintzeris), and a study of opioid substitution therapy uptake among patients with CNCP (Briony Larance, Louisa Degenhardt, Gabrielle Campbell and Nicholas Lintzeris). Louisa Degenhardt and Briony Larance have also received an untied educational grant from Seqirus for studies of tapentadol. None of these are directly relevant to the current manuscript.

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Regulatory and other responses to the pharmaceutical opioid problem

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