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Open access publishing facilitated by Monash University, as part of the Wiley ‐ Monash University agreement via the Council of Australian University Librarians.
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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
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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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.
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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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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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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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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.
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In‐hospital clinical artificial intelligence (AI) encompasses learning algorithms that use real‐time electronic medical record (EMR) data to support clinicians in making treatment, prognostic or diagnostic decisions. In the United States, the implementation of hospital‐based clinical AI, such as sepsis or deterioration prediction, has accelerated over the past five years,1 while in Australia, outside of digital imaging‐based AI products, nearly all hospitals remain clinical AI‐free zones. Some would argue this is a good thing, both prudent and sensibly cautious given the wide ranging ethical, privacy and safety concerns;2,3 others contend our consumers are missing out on important interventions that save lives and improve care.4,5 In this perspective article, we argue that in‐hospital clinical AI excluding imaging‐based products (herein referred to as “clinical AI”) can improve care and we examine what is preventing clinical AI uptake in Australia and how to start to remedy it.
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Anton van der Vegt is supported by the Advance Queensland Industry Research Fellowship granted by the Queensland Government. The funder played no role in the writing or publication of this study.
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Colorectal cancer (CRC) is the third most common cancer in Australia, with almost 16 000 new cases in 2022 accounting for 10% of new cancer diagnoses and 11% of cancer‐related deaths.1 There has been a well documented increase in the incidence of CRC in people under the age of 50 years in Australia in recent decades, while the incidence in those older than 50 years has decreased over the same period.2 Treatment of CRC has evolved dramatically in the 21st century, particularly for patients with advanced disease. Advances in medical imaging and peri‐operative medicine, as well as refinement of surgical techniques, have facilitated radical resection in selected patients with advanced or recurrent local disease, as well as those with limited metastases, who would otherwise be considered incurable. Improvements in systemic therapy mean that, in contemporary practice, many patients with metastatic (stage IV) CRC who historically had few systemic treatment options and a poor anticipated survival may now be afforded durable disease control and have a life expectancy measured in years rather than months. CRC is increasingly understood to be a biologically heterogenous disease. As the behaviour of individual tumours is better characterised by their molecular profiles, targeted systematic therapy combined with ablative techniques and radical surgery in selected patients can be expected to further improve outcomes. This article describes recent developments in the management of advanced CRC and how these advances are reflected in contemporary Australian practice.
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Open access publishing facilitated by The University of Sydney, as part of the Wiley – The University of Sydney agreement via the Council of Australian University Librarians.
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In a world where sexual and reproductive injustice continues, Australia has been quietly making changes for the better. Australian sexual and reproductive health law reforms have been prodigious in recent years: we have seen more changes in the past six years than in the previous 60. Alongside Australia's progression, however, sexual and reproductive rights have been considerably eroded in other countries. How does the global context of reproductive rights affect Australia? And how can we protect not only our hard‐fought liberties but also ensure they are equitable and clinically fit for purpose?
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Objectives: To investigate the relationship between access to fluoridated drinking water and area‐level socio‐economic status in Queensland.
Study design: Ecological, geospatial data linkage study.
Setting: Queensland, by statistical area level 2 (SA2), 2021.
Main outcome measures: Proportion of SA2s and of residents with access to fluoridated drinking water (natural or supplemented); relationship at SA2 level between access to fluoridated water and socio‐economic status (Index of Relative Socio‐economic Advantage and Disadvantage, IRSAD; Index of Economic Resources, IER).
Results: In 2021, an estimated 4 050 168 people (79.4% of the population) and 397 SA2 regions (72.7%) in Queensland had access to fluoridated water. Access was concentrated in the southeastern corner of the state. After adjusting for SA2 population, log area, and population density, the likelihood of access to fluoridated drinking water almost doubled for each 100‐rank increase in IRSAD (adjusted odds ratio [aOR], 1.93; 95% confidence interval [CI], 1.59–2.36) or IER (aOR, 1.77; 95% CI, 1.50–2.11).
Conclusions: The 2012 decision to devolve responsibility for water fluoridation decisions and funding from the Queensland government to local councils means that residents in lower socio‐economic areas are less likely to have access to fluoridated water than those in more advantaged areas, exacerbating their already greater risk of dental disease. Queensland water fluoridation policy should be revised so that all residents can benefit from this evidence‐based public health intervention for reducing the prevalence of dental caries.
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We acknowledge Queensland Health for providing access to the water fluoridation data for this article.
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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.