MJA
MJA

    The true price of sugar-sweetened disease: political inertia requires renewed, strategic action

    Alessandro Demaio and Alexandra Jones
    Med J Aust 2018; 209 (2): . || doi: 10.5694/mja18.00223
    Published online: 9 July 2018

    Australia can no longer afford to wait for a tax on sugar-sweetened beverages

    Excess free sugars are a major contributor to diet-related diseases, including obesity, type 2 diabetes and tooth decay. Sugar-sweetened beverages (SSBs) provide a significant source of free sugars while offering no other nutritional benefit, making them a reasonable target for public health action.1,2 Governments worldwide are drawing on growing evidence to implement effective pricing policies for SSBs as one cornerstone of a comprehensive policy response.

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      Multimorbidity among Aboriginal people in New South Wales contributes significantly to their higher mortality

      Deborah A Randall, Sanja Lujic, Alys Havard, Sandra J Eades and Louisa Jorm
      Med J Aust 2018; 209 (1): . || doi: 10.5694/mja17.00878
      Published online: 2 July 2018

      Abstract

      Objectives: To compare the prevalence of multimorbidity and its impact on mortality among Aboriginal and non-Aboriginal Australians who had been hospitalised in New South Wales in the previous 10 years.

      Design, setting and participants: Cohort study analysis of linked NSW hospital (Admitted Patient Data Collection) and mortality data for 5 437 018 New South Wales residents with an admission to a NSW hospital between 1 March 2003 and 1 March 2013, and alive at 1 March 2013.

      Main outcome measures: Admissions for 30 morbidities during the 10-year study period were identified. The primary outcome was the presence or absence of multimorbidity during the 10-year lookback period; the secondary outcome was mortality in the 12 months from 1 March 2013 to 1 March 2014.

      Results: 31.5% of Aboriginal patients had at least one morbidity and 16.1% had two or more, compared with 25.0% and 12.1% of non-Aboriginal patients. After adjusting for age, sex, and socio-economic status, the prevalence of multimorbidity among Aboriginal people was 2.59 times that for non-Aboriginal people (95% CI, 2.55–2.62). The prevalence of multimorbidity was higher among Aboriginal people in all age groups, in younger age groups because of the higher prevalence of mental morbidities, and from age 60 because of physical morbidities. The age-, sex- and socio-economic status-adjusted hazard of one-year mortality (Aboriginal v non-Aboriginal Australians) was 2.43 (95% CI, 2.24–2.62), and 1.51 (95% CI, 1.39–1.63) after also adjusting for morbidity count.

      Conclusions: The prevalence of multimorbidity was higher among Aboriginal than non-Aboriginal patients, and this difference accounted for much of the difference in mortality between the two groups. Evidence-based interventions for reducing multimorbidity among Aboriginal and Torres Strait Islander Australians must be a priority.

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      • 1 Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
      • 2 Sax Institute, Baker IDI Heart and Diabetes Institute, Sydney, NSW


      Acknowledgements: 

      This investigation was supported by the National Health and Medical Research Council (573113). We acknowledge the NSW Ministry of Health and NSW Register of Births, Deaths and Marriages for allowing access to the data, and the Centre for Health Record Linkage for conducting the probabilistic linkage of records.

      Competing interests:

      No relevant disclosures.

      • 1. Organisation for Economic Co-operation and Development. Life expectancy at birth (indicator). Paris: OECD, 2015. https://data.oecd.org/healthstat/life-expectancy-at-birth.htm (viewed July 2015).
      • 2. Australian Bureau of Statistics. 3302.0.55.003. Experimental life tables for Aboriginal and Torres Strait Islander Australians 2005–2007. May 2009. http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3302.0.55.003Main+Features12005%E2%80%932007 (viewed Apr 2018).
      • 3. Vos T, Barker B, Begg S, et al. Burden of disease and injury in Aboriginal and Torres Strait Islander peoples: the Indigenous health gap. Int J Epidemiol 2009; 38: 470-477.
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      • 12. Population and Public Health Division. Improved reporting of Aboriginal and Torres Strait Islander peoples on population datasets in New South Wales using record linkage — a feasibility study. Sydney: NSW Ministry of Health, 2012. http://www.health.nsw.gov.au/hsnsw/Publications/atsi-data-linkage-report.pdf (viewed Apr 2018).
      • 13. Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005; 43: 1130-1139.
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      • 16. Australian Institute of Health and Welfare. Measuring the social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples (AIHW Cat. No. 24). Canberra: AIHW, 2009.
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        Closing the gap in cardiovascular risk for Aboriginal and Torres Strait Islander Australians

        Jennifer S Reath and Peter O'Mara
        Med J Aust 2018; 209 (1): . || doi: 10.5694/mja18.00345
        Published online: 2 July 2018

        High absolute cardiovascular risk in young Aboriginal and Torres Strait Islander people urgently requires action

        The recent 10-year review of the Closing the Gap Strategy, which aims to eliminate the difference in life expectancy between Aboriginals and Torres Strait Islanders and other Australians by 2031, found that the life expectancy of both Indigenous and non-Indigenous Australians increased between 2005–2007 and 2010–2012, but the gap has not closed significantly, and is still about 10 years.1 As reiterated by Sir Michael Marmot in his recent MJA editorial,2 the Close the Gap campaign highlights the importance of addressing underlying social determinants of health, engaging with Aboriginal and Torres Strait Islander leaders, increasing the emphasis on chronic disease, enhancing primary health service capacity, and shifting to a preventive health focus.3

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        • 1 Western Sydney University, Penrith, NSW
        • 2 University of Newcastle, Newcastle, NSW


        Acknowledgements: 

        The authors acknowledge the advice provided by Alex Brown (Aboriginal Health Unit, South Australian Health and Medical Research Institute) while drafting this editorial.

        Competing interests:

        No relevant disclosures.

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          The Medical Journal of Australia endorses the Uluru Statement

          Nicholas J Talley AC
          Med J Aust 2018; 209 (1): . || doi: 10.5694/mja18.e0207
          Published online: 2 July 2018

          The Medical Journal of Australia endorses the Uluru Statement from the Heart (https://www.referendumcouncil.org.au/sites/default/files/2017-05/Uluru_Statement_From_The_Heart_0.PDF). The Statement, a consensus from the First Nations National Constitutional Convention held in May 2017, calls for “establishment of a First Nations Voice enshrined in the Constitution” and seeks “a Makarrata Commission to supervise a process of agreement-making between governments and First Nations and truth-telling about our history”. It affirms the connection of Aboriginal and Torres Strait Islander peoples with the land, and highlights the social difficulties and ongoing suffering faced by Aboriginal and Torres Strait Islander peoples. The MJA accepts the invitation of the Aboriginal and Torres Strait Islander peoples to join with them “in a movement of the Australian people for a better future”.

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          • Editor-in-Chief, Medical Journal of Australia, Sydney, NSW


          Correspondence: 
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            Priorities for preventing a concentrated HIV epidemic among Aboriginal and Torres Strait Islander Australians

            James S Ward, Karen Hawke and Rebecca J Guy
            Med J Aust 2018; 209 (1): . || doi: 10.5694/mja17.01071
            Published online: 2 July 2018

            An accelerated HIV prevention and control strategy is necessary to ensure that Aboriginal and Torres Strait Islander people meet local and global suppression targets

            Greater efforts are required to prevent human immunodeficiency virus infection (HIV) escalating among Aboriginal and Torres Strait Islander Australians. Recently released national data highlight a 33% increase in new HIV diagnosis rates among Aboriginal and Torres Strait Islander people, from 4.8 per 100 000 population in 2012 to 6.4 per 100 000 population in 2016.1 In the same period, newly diagnosed HIV rates among Australian-born non-Indigenous people decreased by 22% (from 3.7 per 100 000 population in 2012 to 2.9 per 100 000 population in 2016).1

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            • 1 South Australian Health and Medical Research Institute, Adelaide, SA
            • 2 Flinders University, Adelaide, SA
            • 3 The Kirby Institute, UNSW Sydney, Sydney, NSW


            Correspondence: james.ward@sahmri.com
            Competing interests:

            No relevant disclosures.

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              Closing the vaccination coverage gap in New South Wales: the Aboriginal Immunisation Healthcare Worker Program

              Alexandra J Hendry, Frank H Beard, Aditi Dey, Dennis Meijer, Sue Campbell-Lloyd, Katrina K Clark, Brynley P Hull and Vicky Sheppeard
              Med J Aust 2018; 209 (1): . || doi: 10.5694/mja18.00063
              Published online: 25 June 2018

              Abstract

              Objectives: To assess vaccination coverage and timeliness among Indigenous and non-Indigenous children in New South Wales and the rest of Australia, with a particular focus on changes in the vaccination coverage gaps after the introduction of the Aboriginal Immunisation Healthcare Worker (AIHCW) Program in NSW in 2012.

              Design: Cross-sectional analysis of Australian Immunisation Register data (2008–2016).

              Main outcome measures: Annual estimates of full vaccination coverage at 9, 15 and 51 months of age for Indigenous and non-Indigenous children in NSW and the rest of Australia; differences in coverage between Indigenous and non-Indigenous children at each milestone.

              Results: The proportion of Indigenous and non-Indigenous children classified as fully vaccinated at 9, 15, and 51 months increased significantly in both NSW and the rest of Australia after the introduction of the AIHCW Program. The mean annual difference in full vaccination coverage between Indigenous and non-Indigenous children in NSW aged 9 months declined from 6.6 (95% CI, 5.2–8.0) during 2008–2011 to 3.7 percentage points (95% CI, 2.5–4.8) during 2012–2016; for those aged 15 months it declined from 4.6 (95% CI, 3.1–6.0) to 2.2 percentage points (95% CI, 1.0–3.4), and for those aged 51 months it declined from 8.5 (95% CI, 7.2–9.8) to 0.6 percentage points (95% CI, –0.6 to 1.8). Reductions in the differences in coverage were not as marked in the rest of Australia. In 2016, there was no statistically significant difference in coverage at any of the three milestones in NSW: at 9 months the difference was 1.6 percentage points (95% CI, –1.0 to 4.1); at 15 months, 0.4 percentage points (95% CI, –2.2 to 2.9); and at 51 months, –1.8 percentage points (95% CI, –4.4 to 0.8).

              Conclusion: Our findings suggest that a dedicated program can help overcome barriers to timely vaccination and significantly improve timely vaccination rates in Indigenous Australian children.

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              • 1 National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW
              • 2 University of Sydney, Sydney, NSW
              • 3 Health Protection, New South Wales Ministry of Health, Sydney, NSW


              Acknowledgements: 

              We acknowledge the work and commitment of all past and present Aboriginal health care workers employed under the New South Wales Aboriginal Immunisation Healthcare Worker Program, without whom the progress toward closing the vaccination gap between Indigenous and non-Indigenous children in NSW, as documented in our article, would not have been possible.

              Competing interests:

              No relevant disclosures.

              • 1. Naidu L, Chiu C, Habig A, et al. Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia 2006–2010. Commun Dis Intell Q Rep 2013; 37: S1-S95.
              • 2. Hull BP, McIntyre PB. Timeliness of childhood immunisation in Australia. Vaccine 2006; 24: 4403-4408.
              • 3. O’Grady KA, Krause V, Andrews R. Immunisation coverage in Australian Indigenous children: time to move the goal posts. Vaccine 2009; 27: 307-312.
              • 4. Harris MF, Webster V, Jalaludin B, et al. Immunisation coverage among a birth cohort of Aboriginal infants in an urban community. J Paediatr Child Health 2014; 50: 306-313.
              • 5. Aboriginal and Torres Strait Islander Social Justice Commissioner; Steering Committee for Indigenous Health Equality. Closing the Gap: National Indigenous health equality targets. Canberra: Human Rights and Equal Opportunity Commission, 2008. https://www.humanrights.gov.au/publications/closing-gap-national-indigenous-health-equality-targets-2008 (viewed Dec 2016).
              • 6. Australian Bureau of Statistics. 3101.0. Australian demographic statistics: June quarter 2017. 14 Dec 2017. http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/0DEC5B368C5C2D72CA2581F5001011EB/$File/31010_jun%202017.pdf (viewed Dec 2017).
              • 7. Menzies R, Knox S, Kelaher B, et al. Process evaluation of the New South Wales Aboriginal Immunisation Healthcare Worker Program. Sydney: National Centre for Immunisation Research and Surveillance, 2015. http://www.health.nsw.gov.au/immunisation/Documents/process-evaluation-aihcw-program.pdf (viewed Dec 2016).
              • 8. Tashani M, Dey A, Clark K, Beard F. Stage 2. Evaluation of the NSW Aboriginal Immunisation Healthcare Worker Program. Process evaluation. Sydney: National Centre for Immunisation Research and Surveillance, 2017. http://www.health.nsw.gov.au/immunisation/Documents/stage-2-evaluation-aihcw-program.pdf (viewed Sept 2017).
              • 9. Australian Department of Human Services. Australian Immunisation Register for health professionals. Updated May 2018. https://www.humanservices.gov.au/organisations/health-professionals/services/medicare/australian-immunisation-register-health-professionals (viewed May 2018).
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              • 21. Hull BP, Dey A, Beard FH, et al. Immunisation coverage annual report, 2013. Commun Dis Intell Q Rep 2016; 40: E146-E169.
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              • 24. Australian Government Department of Health. No Jab, No Pay — New Immunisation requirements for Family Assistance Payments. Fact sheet for providers. Dec 2017. https://beta.health.gov.au/resources/publications/no-jab-no-pay-new-requirements-fact-sheet (viewed Apr 2018).
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                Absolute cardiovascular disease risk and lipid-lowering therapy among Aboriginal and Torres Strait Islander Australians

                Bianca Calabria, Rosemary J Korda, Raymond W Lovett, Peter Fernando, Tanya Martin, Leone Malamoo, Jennifer Welsh and Emily Banks
                Med J Aust 2018; 209 (1): . || doi: 10.5694/mja17.00897
                Published online: 25 June 2018

                Abstract

                Objective: To quantify absolute cardiovascular disease (CVD) risk in Aboriginal and Torres Strait Islander people and their use of lipid-lowering therapies.

                Design, participants: Cross-sectional analysis of nationally representative data from 2820 participants aged 18–74 years who provided biomedical data for the National Aboriginal and Torres Strait Islander Health Measures Survey component of the 2012–13 Australian Aboriginal and Torres Strait Islander Health Survey.

                Main outcome measures: Prior CVD and use of lipid-lowering medications were ascertained at interview. 5-year absolute risk of a primary CVD event was calculated with the Australian National Vascular Disease Prevention Alliance algorithm, with categories low (< 10%), moderate (10–15%) and high risk (> 15%).

                Results: Among participants aged 35–74 years, 9.6% (95% CI, 7.2–12.0%) had prior CVD; 15.7% (95% CI, 13.0–18.3%) were at high, 4.9% (95% CI, 3.3–6.6%) at moderate, and 69.8% (95% CI, 66.8–72.8%) at low absolute primary CVD risk. 82.6% of those at high primary risk were identified on the basis of clinical criteria. High primary absolute risk affected 1.1% (95% CI, 0.0–2.5%) of 18–24-year-olds, 4.7% (95% CI, 2.0–7.5%) of 25–34-year-olds, and 44.2% (95% CI, 33.1–55.3%) of 65–74-year-olds. Lipid-lowering therapy was being used by 52.9% (95% CI, 38.2–67.6%) of people aged 35–74 years with prior CVD and by 42.2% (95% CI, 30.5–53.8%) of those at high primary CVD risk.

                Conclusion: Absolute CVD risk is high among Aboriginal and Torres Strait Islander people, and most of those at high risk are undertreated. Substantial proportions of people under 35 years of age are at high risk, but are not targeted by current guidelines for absolute CVD risk assessment, compromising CVD prevention in this population.

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                • 1 National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT
                • 2 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
                • 3 Australian Institute of Aboriginal and Torres Strait Islander Studies, Canberra, ACT
                • 4 Sax Institute, Sydney, NSW
                • 5 Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW


                Correspondence: emily.banks@anu.edu.au
                Acknowledgements: 

                We thank the participants of the AATSIHS 2012–13 and NATSIHMS 2012–13, and the Australian Government and the Australian Bureau of Statistics for supporting biomedical data collection and the NATSIHMS. We thank investigators in the National Health and Medical Research Council (NHMRC) Partnership Project and from the National Heart Foundation for their feedback on preliminary findings, and Cate D’Este for statistical advice. This investigation was supported by an NHMRC and Heart Foundation of Australia Partnership Project (1092674). Emily Banks is supported by an NHMRC grant (1042717). The funding sources had no role in the study design, collection, analysis or interpretation of the data, in the writing of the article, or in the decision to submit it for publication.

                Competing interests:

                No relevant disclosures.

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                • 25. The Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375: 2215-2222.
                • 26. Rapsomaniki E, Timmis A, George J, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet 2014; 383: 1899-1911.
                • 27. Chronic Kidney Disease Prognosis Consortium. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010; 375: 2073-2081.
                • 28. Hua X, McDermott R, Lung T, et al. Validation and recalibration of the Framingham cardiovascular disease risk models in an Australian Indigenous cohort. Eur J Prev Cardiol 2017; 24: 1660-1669.
                • 29. Australian Bureau of Statistics. 4363.0.55.001. Australian Health Survey: users’ guide, 2011–13. June 2013. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/F87826FDF716EB94CA257B8D00229E83?opendocument (viewed Apr 2018).
                • 30. Drieling RL, LaCroix AZ, Beresford SAA, et al. Validity of self-reported medication use compared with pharmacy records in a cohort of older women: findings from the Women’s Health Initiative. Am J Epidemiol 2016; 184: 233-238.
                • 31. Gnjidic D, Du W, Pearson SA, et al. Ascertainment of self-reported prescription medication use compared with pharmaceutical claims data. Public Health Res Pract 2017; 27: 27341702.
                • 32. Australian Institute of Health and Welfare. National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: results from June 2016. (AIHW Cat. No. IHW 177; National Key Performance Indicators for Aboriginal and Torres Strait Islander Primary Health Care Series No. 4). Canberra: AIHW, 2017.
                • 33. Burgess CP, Sinclair G, Ramjan M, et al. Strengthening cardiovascular disease prevention in remote Indigenous communities in Australia's Northern Territory. Heart Lung Circ 2015; 24: 450-457.
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                  Colorectal cancer screening reduces incidence, mortality and morbidity

                  Bilel Jideh and Michael J Bourke
                  Med J Aust 2018; 208 (11): . || doi: 10.5694/mja18.00279
                  Published online: 18 June 2018

                  Adhering to evidence-based surveillance guidelines will optimise the use of health care resources

                  Colorectal cancer (CRC) is the second most commonly diagnosed cancer in Australia in both men and women; there were about 17 000 new cases and more than 4000 deaths during 2017.1 It imposes a tremendous burden of disease, dominated by mortality rather than disability; in the 2011 Australian Burden of Disease Study, almost 86 000 years of life were lost because of CRC.2 The disorder is also a substantial economic burden; it costs more than $100 000 to treat one case of advanced CRC.3


                  • 1 Westmead Hospital, Sydney, NSW
                  • 2 City West Specialist Day Hospital, Sydney, NSW


                  Correspondence: bjid7747@uni.sydney.edu.au
                  Competing interests:

                  No relevant disclosures.

                  • 1. Australian Institute of Health and Welfare. National Bowel Cancer Screening Program: monitoring report 2017 (AIHW Cat. No. CAN 103). Canberra: AIHW, 2017.
                  • 2. Australian Institute of Health and Welfare. Australian Burden Of Disease Study: impact and causes of illness and death in Australia 2011 (AIHW Cat. No. BOD 4). Canberra: AIHW, 2016.
                  • 3. Australian Government Department of Health. National Bowel Cancer Screening Program: key statistics 2017. http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/key-statistics (viewed April 2018).
                  • 4. Zorzi M, Senore C, Turrin A, et al. Appropriateness of endoscopic surveillance recommendations in organised colorectal cancer screening programmes based on the faecal immunochemical test. Gut 2016; 65: 1822-1828.
                  • 5. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993; 329: 1977-1981.
                  • 6. Australian Institute of Health and Welfare. Analysis of bowel cancer outcomes for the National Bowel Cancer Screening Program (AIHW Cat. No. CAN 87). Canberra: AIHW, 2014.
                  • 7. Honein-Abouhaidar GN, Kastner M, Vuong V, et al. Benefits and barriers to participation in colorectal cancer screening: a protocol for a systematic review and synthesis of qualitative studies. BMJ Open 2014; 4: e004508.
                  • 8. Knight JR, Kanotra S, Siameh S, et al. Understanding barriers to colorectal cancer screening in Kentucky. Prev Chronic Dis 2015; 12: E95.
                  • 9. Koo JH, You MY, Liu K, et al. Colorectal cancer screening practise is influenced by ethnicity of medical practitioner and patient. J Gastroenterol Hepatol 2012; 27: 390-396.
                  • 10. Schoen RE, Pinsky PF, Weissfeld JL, et al. Utilization of surveillance colonoscopy in community practice. Gastroenterology 2010; 138: 73-81.
                  • 11. van Heijningen EM, Lansdorp-Vogelaar I, Steyerberg EW, et al. Adherence to surveillance guidelines after removal of colorectal adenomas: a large, community-based study. Gut 2015; 64: 1584-1592.
                  • 12. Bampton PA, Sandford JJ, Young GP. Applying evidence-based guidelines improves use of colonoscopy resources in patients with a moderate risk of colorectal neoplasia. Med J Aust 2002; 176: 155-157. <MJA full text>
                  • 13. Cancer Council Australia Colonoscopy Surveillance Working Party. Clinical practice guidelines for surveillance colonoscopy — in adenoma follow-up; following curative resection of colorectal cancer; and for cancer surveillance in inflammatory bowel disease. Dec 2011. https://wiki.cancer.org.au/australiawiki/images/8/80/Colonoscopy_Surveillance_Guidelines_FINAL_version_NHMRC_approved_Dec2011.pdf (viewed Feb 2018).
                  • 14. Cancer Council Australia Surveillance Colonoscopy Guidelines Working Party. Draft clinical practice guidelines for surveillance colonoscopy. Sydney: Cancer Council Australia. Updated 3 Apr 2018. https://wiki.cancer.org.au/australiawiki/index.php?oldid=183316 (viewed Apr 2018).
                  • 15. Symonds EL, Simpson K, Coats M, et al. A nurse-led model at public academic hospitals maintains high adherence to colorectal cancer surveillance guidelines. Med J Aust 2018; 208: 492-496.
                  • 16. Patel N, Tong L, Ahn C, et al. Post-polypectomy guideline adherence: importance of belief in guidelines, not guideline knowledge or fear of missed cancer. Dig Dis Sci 2015; 60: 2937-2945.
                  Online responses are no longer available. Please refer to our instructions for authors page for more information.

                    Outpatient heart failure programs: time for a new standard

                    Amera Halabi and Derek P Chew
                    Med J Aust 2018; 208 (11): . || doi: 10.5694/mja18.00329
                    Published online: 18 June 2018

                    Effective ambulatory services and community heart failure care may mitigate its impact on our health care system

                    Heart failure imposes a significant burden on the Australian health care system. Driven by the increasing number of patients diagnosed each year, repeated hospitalisations and long inpatient stays result in substantial morbidity and costs to the health care system.1


                    • 1 Southern Adelaide Local Health Network, Adelaide, SA
                    • 2 Flinders University, Adelaide, SA


                    Correspondence: Derek.Chew@flinders.edu.au
                    Competing interests:

                    No relevant disclosures.

                    • 1. Sahle BW, Owen AJ, Mutowo MP, et al. Prevalence of heart failure in Australia: a systematic review. BMC Cardiovasc Disord 2016; 16: 32.
                    • 2. McAlister FA, Stewart S, Ferrua S, McMurray JJ. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol 2004; 44: 810-819.
                    • 3. Holland R, Battersby J, Harvey I, et al. Systematic review of multidisciplinary interventions in heart failure. Heart 2005; 91: 899-906.
                    • 4. Takeda A, Taylor SJ, Taylor RS, et al. Clinical service organisation for heart failure. Cochrane Database Syst Rev 2012; (9): CD002752.
                    • 5. Craig P, Dieppe P, Macintyre S, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008; 337: a1655.
                    • 6. Huynh Q, Negishi K, De Pasquale C, et al. Effects of post-discharge management on rates of early re-admission and death after hospitalisation for heart failure. Med J Aust 2018; 208: 485-491.
                    Online responses are no longer available. Please refer to our instructions for authors page for more information.

                      Burnout in the medical profession: not a rite of passage

                      Michael Baigent and Ruth Baigent
                      Med J Aust 2018; 208 (11): . || doi: 10.5694/mja17.00891
                      Published online: 18 June 2018

                      Establishing mentally healthy workplaces will reduce the risk of burnout

                      It is an attention-demanding tragedy when doctors’ deaths are attributed to their work, which, after all, is in the service of others. “Epidemic”, “crisis” and “urgent need” are words accompanying discussions of burnout and doctor suicides. Yet, despite this bombardment, there has been no sustained approach to achieve an effective national response. Recently, responding to calls for action, the Victorian government launched a workplace mental health strategy and the New South Wales government held a junior doctor wellbeing forum. Some colleges and medical organisations have websites, forums, action plans, conferences and seminars on doctors’ mental health. Doctors develop mental illness for the same reasons as any other person. Yet burnout, which is a risk factor,1 is highly prevalent in doctors. Why not address the burnout? Who should address it?


                      • 1 Flinders University, Adelaide, SA
                      • 2 Norwood General and Family Practice, Adelaide, SA


                      Competing interests:

                      Michael Baigent serves on the Board of Directors for beyondblue, the national depression initiative, a not-for-profit organisation.

                      • 1. Salvagioni DAJ, Melanda FN, Mesas AE, et al. Physical, psychological and occupational consequences of job burnout: a systematic review of prospective studies. PLoS ONE 2017; 12: e0185781.
                      • 2. Freudenberger HJ. The staff burnout syndrome in alternative institutions. Psychother Theory Res Pract 1975; 12: 72-83.
                      • 3. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol 2001; 52: 397-422.
                      • 4. Maslach C. What have we learned about burnout and health? Psychol Health 2001; 16: 607-611.
                      • 5. Hallberg UE, Sverke M. Construct validity of the Maslach Burnout Inventory: two Swedish health care samples. Eur J Psychol Assess 2004; 20: 320-338.
                      • 6. Maslach C, Leiter MP. New insights into burnout and health care: strategies for improving civility and alleviating burnout. Med Teach 2017; 39: 160-163.
                      • 7. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012; 172: 1377-1385.
                      • 8. Imo UO. Burnout and psychiatric morbidity among doctors in the UK: a systematic literature review of prevalence and associated factors. Psychiatrist 2017; 41: 197-204.
                      • 9. beyondblue. National mental health survey of doctors and medical students. Oct 2013. https://www.beyondblue.org.au/docs/default-source/research-project-files/bl1132-report–-nmhdmss-full-report_web (viewed Apr 2018).
                      • 10. Kwarta P, Pietrzak J, Miśkowiec D, et al. Personality traits and styles of coping with stress in physicians. Pol Merkur Lekarski 2016; 40: 301-307.
                      • 11. McManus IC, Keeling A, Paice E. Stress, burnout and doctors’ attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates. BMC Medicine 2004; 2: 29.
                      • 12. Shanafelt TD, Oreskovich MR, Dyrbye LN, et al. Avoiding burnout: the personal health habits and wellness practices of US surgeons. Ann Surg 2012; 255: 625-633.
                      • 13. Halliday L, Walker A, Vig S, et al. Grit and burnout in UK doctors: a cross-sectional study across specialties and stages of training. Postgrad Med J 2017; 93: 389-394.
                      • 14. beyondblue. Developing a workplace mental health strategy: a how-to guide for health services. http://resources.beyondblue.org.au/prism/file?token=BL/1728 (viewed Apr 2018).
                      Online responses are no longer available. Please refer to our instructions for authors page for more information.
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