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Among the many dire consequences of the Israel–Gaza war that began in October 2023, the impact on the mental health of populations living in multicultural Western countries is significant and should not be overlooked1. The psychosocial reverberations of the conflict are felt in societies throughout the world, embodying unique characteristics of trauma and adding to the complexity of the mental health risk for people living in Western countries. The threat to mental health status is higher for those who have had family members killed, harmed or gone missing, and for those with previous exposure to war, including in Lebanon, Iraq and Syria. The level of stress has been exacerbated by its enduring nature, including systematic oppression, economic hardship, violence, human rights violations and national struggle.2,3

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Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW

Correspondence: s.j.rees@unsw.edu.au

Open access:

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

Competing interests:

No relevant disclosures.

1. Murthy RS, Lakshminarayana R. Mental health consequences of war: a brief review of research findings. World Psychiatry 2006; 5: 25‐30.
2. Helbich M, Jabr S. A call for social justice and for a human rights approach with regard to mental health in the occupied Palestinian territories. Health Human Rights J 2022; 24: 305‐318.
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4. Diab M, Veronese G, Abu Jamei Y, et al. Psychosocial concerns in a context of prolonged political oppression: Gaza mental health providers’ perceptions. Transcult Psychiatry 2023; 60: 577‐590.
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6. Rees S, Mohsin M, Moussa B, et al. Cohort profile: intimate partner violence and mental health among women from refugee background and a comparison group of Australian‐born – the WATCH cohort study. BMJ Open 2022; 12: e051887.
7. Rees SJ, Fisher JR, Steel Z, et al. Prevalence and risk factors of major depressive disorder among women at public antenatal clinics from refugee, conflict‐affected, and Australian‐born backgrounds. JAMA Netw Open 2019; 2: e193442.
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12. Lev‐Wiesel R, Amir M. Secondary traumatic stress, psychological distress, sharing of traumatic reminiscences, and marital quality among spouses of Holocaust child survivors. J Marital Fam Ther 2001; 27: 433‐444.
13. Lehrner A, Yehuda R. Trauma across generations and paths to adaptation and resilience. Psychol Trauma 2018; 10: 22‐29.
14. Hensel JM, Ruiz C, Finney C, Dewa CS. Meta‐analysis of risk factors for secondary traumatic stress in therapeutic work with trauma victims. J Trauma Stress 2015; 28: 83‐91.
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16. Silove D, Tay AK, Kareth M, Rees S. The relationship of complex post‐traumatic stress disorder and post‐traumatic stress disorder in a culturally distinct, conflict‐affected population: a study among West Papuan refugees displaced to Papua New Guinea. Front Psychiatry 2017; 8: 73.
17. Schauer M, Schauer E. Trauma‐focused public mental‐health interventions: a paradigm shift in humanitarian assistance and aid work. In: Martz E, editor. Trauma rehabilitation after war and conflict. Springer, 2010; pp. 389‐428.
18. Rees S, Silove D. Sakit hati: a state of chronic mental distress related to resentment and anger amongst West Papuan refugees exposed to persecution. Soc Sci Med 2011; 73: 103‐110.
19. Benjamin R, Haliburn J, King S, editors. Humanising mental health care in Australia: a guide to trauma‐informed approaches. Oxfordshire, UK: Routledge, 2019.
20. Wiederhold BK. A legacy of trauma: how local conflicts can have global implications for mental health. Cyberpsychol Behav Soc Netw 2023; https://doi.org/10.1089/cyber.2023.29296.editorial [Epub ahead of print].
21. Menyhért A. Digital trauma processing in social media groups: transgenerational Holocaust trauma on Facebook. Hungarian Historical Rev 2017; 6: 355‐376.
22. Mollica R. Healing invisible wounds: paths to hope and recovery in a violent world. Nashville, TN: Vanderbilt University Press, 2008.
23. Selod S. Citizenship denied: the racialization of Muslim American men and women post‐9/11. Critical Sociol 2014; 41: 77‐95.
24. Staszewska E. As the Hamas‐Israel war rages, Islamophobia and antisemitism are rising in Australia. SBS News, 28 Oct 2023. https://www.sbs.com.au/news/article/as‐the‐hamas‐israel‐war‐rages‐islamophobia‐and‐antisemitism‐are‐rising‐in‐australia/385jt872y (viewed Nov 2023).

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Editorials

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The Lancet Countdown on health and climate change: Australia a world leader in neglecting its responsibilities

Paul J Beggs and Ying Zhang

Med J Aust || doi: 10.5694/mja2.52152
Published online: 20 November 2023

Topics

Environment and public health

Health services administration

Statistics, epidemiology and research design

Climate is integral to good health and wellbeing, but it can also be a forceful driver of death and disease. Many diseases both here in Australia and globally are climate sensitive — the global magnitude of such diseases was estimated to be 39 503 684 deaths (69.9% of total annual deaths) and 1 530 630 442 disability‐adjusted life years in 2019.1,2 Climate change is the biggest health threat facing humanity.3,4

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1 Macquarie University, Sydney, NSW
2 University of Sydney, Sydney, NSW

Correspondence: paul.beggs@mq.edu.au

Competing interests:

No relevant disclosures.

1. Cissé G, McLeman R, Adams H, et al. Chapter 7: Health, wellbeing and the changing structure of communities. In: Pörtner H‐O, Roberts DC, Tignor MMB, et al, editors. Climate change 2022: impacts, adaptation and vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge: Cambridge University Press, 2022; pp. 1041‐1170.
2. Vos T, Lim SS, Abbafati C, et al., GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396: 1204‐1222.
3. Costello A, Abbas M, Allen A, et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet 2009; 373: 1693‐1733.
4. Health Organization; Regional Office for the Americas of the World Health Organization. Climate change and health. https://www.paho.org/en/topics/climate‐change‐and‐health (viewed October 2023).
5. Beggs PJ, Zhang Y, McGushin A, et al. The 2022 report of the MJA–Lancet Countdown on health and climate change: Australia unprepared and paying the price. Med J Aust 2022; 217: 439‐458. https://www.mja.com.au/journal/2022/217/9/2022‐report‐mja‐lancet‐countdown‐health‐and‐climate‐change‐australia‐unprepared
6. Romanello M, Di Napoli C, Green C, et al. The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health‐centred response in a world facing irreversible harms. Lancet 2023; https://doi.org/10.1016/S0140‐6736(23)01859‐7.
7. Zhang Y, Beggs PJ, McGushin A, et al. The 2020 special report of the MJA–Lancet Countdown on health and climate change: lessons learnt from Australia's “Black Summer”. Med J Aust 2020; 213: 492.e2‐492.e10. https://www.mja.com.au/journal/2020/213/11/2020‐special‐report‐mja‐lancet‐countdown‐health‐and‐climate‐change‐lessons
8. Vicedo‐Cabrera AM, Scovronick N, Sera F, et al. The burden of heat‐related mortality attributable to recent human‐induced climate change. Nat Clim Chang 2021; 11: 492‐500.
9. Australian Government Department of Health and Aged Care. National Health and Climate Strategy. 15 June 2023. https://www.health.gov.au/our‐work/national‐health‐and‐climate‐strategy (viewed July 2023).
10. Heenan M, Rychetnik L, Howse E, et al. Australia's political engagement on health and climate change: the MJA–Lancet Countdown indicator and implications for the future. Med J Aust 2023; 218: 196‐202. https://www.mja.com.au/journal/2023/218/5/australias‐political‐engagement‐health‐and‐climate‐change‐mja‐lancet‐countdown

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Position statement summary

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Cough in Children and Adults: Diagnosis, Assessment and Management (CICADA). Summary of an updated position statement on chronic cough in Australia

Julie M Marchant, Anne B Chang, Emma Kennedy, David King, Jennifer L Perret, Andre Schultz, Maree R Toombs, Lesley Versteegh, Shyamali C Dharmage, Rebecca Dingle, Naomi Fitzerlakey, Johnson George, Anne Holland, Debbie Rigby, Jennifer Mann, Stuart Mazzone, Mearon O'Brien, Kerry‐Ann O'Grady, Helen L Petsky, Jonathan Pham, Sheree MS Smith, Danielle F Wurzel, Anne E Vertigan and Peter Wark

Med J Aust || doi: 10.5694/mja2.52157
Published online: 20 November 2023

Correction(s) for this article:

Erratum | Published online: 13 April 2025

Topics

Statistics, epidemiology and research design

Respiratory tract diseases

Health occupations

General medicine

Abstract

Introduction: Cough is the most common symptom leading to medical consultation. Chronic cough results in significant health care costs, impairs quality of life, and may indicate the presence of a serious underlying condition. Here, we present a summary of an updated position statement on cough management in the clinical consultation.

Main recommendations: Assessment of children and adults requires a focused history of chronic cough to identify any red flag cough pointers that may indicate an underlying disease. Further assessment with examination should include a chest x‐ray and spirometry (when age > 6 years). Separate paediatric and adult diagnostic management algorithms should be followed. Management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns. First Nations adults and children should be considered a high risk group. The full statement from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia for managing chronic cough is available at https://lungfoundation.com.au/resources/cicada‐full‐position‐statement.

Changes in management as a result of this statement:

Algorithms for assessment and diagnosis of adult and paediatric chronic cough are recommended.
High quality evidence supports the use of child‐specific chronic cough management algorithms to improve clinical outcomes, but none exist in adults.
Red flags that indicate serious underlying conditions requiring investigation or referral should be identified.
Early and effective treatment of chronic wet/productive cough in children is critical.
Culturally specific strategies for facilitating the management of chronic cough in First Nations populations should be adopted.
If the chronic cough does not resolve or is unexplained, the patient should be referred to a respiratory specialist or cough clinic.

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1 Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
2 Queensland Children's Hospital, Brisbane, QLD
3 Menzies School of Health Research, Darwin, NT
4 Rural and Remote Health, Flinders University, Darwin, NT
5 University of Queensland, Brisbane, QLD
6 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
7 Wal‐yan Respiratory Research Centre, Perth, WA
8 Perth Children's Hospital, Perth, WA
9 University of Sydney, Sydney, NSW
10 Lung Foundation Australia, Brisbane, QLD
11 Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
12 Alfred Health, Melbourne, VIC
13 Monash University, Melbourne, VIC
14 Institute for Breathing and Sleep, University of Melbourne, Melbourne, VIC
15 Queensland University of Technology, Brisbane, QLD
16 Austin Health, Melbourne, VIC
17 University of Melbourne, Melbourne, VIC
18 Griffith University, Brisbane, QLD
19 Alfred Health, Melbourne, VIC
20 Western Sydney University, Sydney, NSW
21 Royal Children's Hospital, Melbourne, VIC
22 Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
23 John Hunter Hospital, Newcastle, NSW

Correspondence: jm.marchant@qut.edu.au

Open access:

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

Acknowledgements:

We thank Lung Foundation Australia and the Thoracic Society of Australia and New Zealand for their support in the preparation of these guidelines.

Competing interests:

The authors received no specific funding for this work. Julie Marchant is supported by the Lung Foundation Australia Hope Research Fund Andrew Harrison Fellowship in Bronchiectasis Research 2021 and receives personal fees from being an author of two UpToDate chapters, outside of the submitted work. Anne Chang reports multiple grants from the National Health and Medical Research Council (NHMRC) during the conduct of this work; is an independent data monitoring committee member for an unlicensed vaccine (GSK) and an unlicensed monoclonal antibody (AstraZeneca); is an advisory member on the study design for an unlicensed molecule for chronic cough (Merck); and has received personal fees from being an author of two UpToDate chapters, outside the submitted work. Andre Schultz receives salary support from a Medical Research Future Fund Investigator Grant (APP1193796). Danielle Wurzel has received research grants from the NHMRC and GSK, and honoraria from Merck and MSD. Stuart Mazzone has received honoraria from Merck, NeRRe Therapeutics, Reckitt Benckiser and Bellus Health for consultancy on their antitussive programs, and antitussive‐related grant support from Merck, Bellus Health and Reckitt Benckiser, as well as multiple grants from the NHMRC and the Australian Research Council. Shyamali Dharmage has received multiple grants from the NHMRC and the Australian Research Council, including the NHMRC Investigator Grant (APP1193993) that currently supports her. Additionally, Shyamali Dharmage and Jennifer Perret have received independent investigator‐initiated grants from AstraZeneca and GSK for unrelated research. Jennifer Perret is supported by an NHMRC Early Career Fellowship (APP1159090). Johnson George has received honoraria through consultations for AstraZeneca, GSK and Pfizer which have been paid to his employer, and has held research grants from Boehringer Ingelheim, GSK and Pfizer through investigator‐initiated research schemes. All other authors have no conflicts of interest to declare in relation to this work.

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Editorials

The Future Healthy Countdown 2030: holding us to account for children's and young people's health and wellbeing

Sandro Demaio, Sharon R Goldfeld and Susan Maury

Med J Aust 2023; 219 (10): . || doi: 10.5694/mja2.52141
Published online: 20 November 2023

Topics

Pediatric medicine

Health services administration

Environment and public health

Indigenous health

Too many Australian children and young people are faring poorly across key measures of health and wellbeing, and too often these reflect systemic inequities that could be mitigated or eliminated through policy change. Despite Australia's abundant resources and wealth, we are failing a key test of societal progress: that our children have opportunities to live as well or better than their parents.

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1 Victorian Health Promotion Foundation, Melbourne, VIC
2 University of Melbourne, Melbourne, VIC
3 Centre for Community Child Health, Royal Children's Hospital, Melbourne, VIC

Correspondence: smaury@vichealth.vic.gov.au

Acknowledgements:

The Victorian Health Promotion Foundation (VicHealth) has played a convening role in scoping and commissioning the articles contained in the MJA supplement.

Competing interests:

Sandro Demaio and Susan Maury are VicHealth employees.

1. Grudnoff M. Gini out of the bottle. Canberra: The Australia Institute, 2018. https://australiainstitute.org.au/wp‐content/uploads/2020/12/P434‐Gini‐out‐of‐the‐bottle‐Inequality‐in‐Australia‐is‐getting‐worse‐2018.pdf (viewed Oct 2023).
2. Hesketh KD, Booth V, Cleland V, et al. Results from the Australian 2022 report card on physical activity for children and young people. J Exerc Sci Fit 2023; 21: 83‐87.
3. Bowden M. Understanding food insecurity in Australia [CFCA Paper No. 55]. Melbourne: Australian Institute of Family Studies, 2020. https://aifs.gov.au/resources/policy‐and‐practice‐papers/understanding‐food‐insecurity‐australia (viewed Oct 2023).
4. Australian Bureau of Statistics. First insights from the National Study of Mental Health and Wellbeing, 2020–21. Canberra: ABS, 2021; https://www.abs.gov.au/articles/first‐insights‐national‐study‐mental‐health‐and‐wellbeing‐2020‐21 (viewed Sept 2023).
5. Hickman C, Marks E, Pihkala P, et al. Climate anxiety in children and young people and their beliefs about government responses to climate change: A global survey. Lancet Planet Health 2021; 5: e863‐e873.
6. Paradies Y. Colonisation, racism and Indigenous health. J Popul Res 2016; 33: 83‐96.
7. Smallwood R, Woods C, Power T, Usher K. Understanding the impact of historical trauma due to colonization on the health and well‐being of Indigenous young peoples: a systematic scoping review. J Transcult Nurs 2020; 32: 59‐68.
8. Brown L. Indigenous young people, disadvantage and the violence of settler colonial education policy and curriculum. J Sociol 2019; 55: 54‐57.
9. Australia Institute of Health and Welfare. Indigenous health and wellbeing [website]. Canberra: AIHW, 2022. https://www.aihw.gov.au/reports/australias‐health/indigenous‐health‐and‐wellbeing (viewed July 2023).
10. Goodhue R, Dakin P, Noble K. What's in the Nest? Exploring Australia's Wellbeing Framework for Children and Young People. Canberra: ARACY, 2021. https://www.aracy.org.au/documents/item/700 (viewed July 2023).
11. Lycett K, Cleary R, Calder R, et al. A framework for the Future Healthy Countdown 2030: tracking the health and wellbeing of children and young people to hold Australia to account. Med J Aust 2023; 219 (10 Suppl): S3‐S10.
12. Calder R, Dakin P. Valued, loved and safe: the foundations for healthy individuals and a healthier society. Med J Aust 2023; 219 (10 Suppl): S11‐S14.
13. Goldfeld SR, Price AMH, Al‐Yaman F. Having material basics is basic. Med J Aust 2023; 219 (10 Suppl): S15‐S19.
14. Lycett K, Frykberg G, Azzopardi PS, et al. Monitoring the physical and mental health of Australian children and young people: a foundation for responsive and accountable actions. Med J Aust 2023; 219 (10 Suppl): S20‐S24.
15. Sahlberg P, Goldfeld SR. New foundations for learning in Australia. Med J Aust 2023; 219 (10 Suppl): S25‐S29.
16. Kapeke K, Muse K, Rowan J, et al. Who holds power in decision making for young people's future? Med J Aust 2023; 219 (10 Suppl): S30‐S34.
17. Brown N, Azzopardi PS, Stanley FJ. Aragung buraay: culture, identity and positive futures for Australian children. Med J Aust 2023; 219 (10 Suppl): S35‐S39.
18. Sly PD, Stanley FJ. Sustainable environments for Australian children's and young people's health and wellbeing: our young's welfare is threatened. Med J Aust 2023; 219 (10 Suppl): S40‐S43.
19. Australian Government. Measuring What Matters: Australia's first wellbeing framework. Canberra: Commonwealth of Australia, 2023. https://treasury.gov.au/sites/default/files/2023‐07/measuring‐what‐matters‐statement020230721_0.pdf (viewed July 2023).

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Medical history

100 years on: the first use of insulin in Australia

Sophie Templer

Med J Aust 2023; 219 (10): . || doi: 10.5694/mja2.52137
Published online: 20 November 2023

Topics

Endocrine system diseases

History and humanities

A century ago, the only accepted treatment for diabetes in Australia and worldwide was the so‐called “starvation diet” of severely restricted carbohydrate intake. However, near‐starvation only prolonged the natural course of disease, and profound hunger and progressive emaciation would almost inevitably give way to coma and eventually death. The successful isolation of a therapeutic pancreatic extract in the Canadian summer of 1921 by Frederick Banting, Charles Best, James Collip and John Macleod followed numerous less successful attempts by other researchers over preceding decades. The extract, which they named “insulin” (from the Latin insula, meaning island), would become, in the words of medical historian Michael Bliss, “the elixir of life for millions of human beings around the world”.1

Bankstown–Lidcombe Hospital, Sydney, NSW

Correspondence: sophie.templer@health.nsw.gov.au

Competing interests:

No relevant disclosures.

1. Bliss M. The discovery of insulin: special centenary edition. Toronto: University of Toronto Press, 2021; p 11.
2. Martin FI. The introduction of insulin to Australia. Occasional Papers Med Hist Aust 1993; 6: 141‐150.
3. Insulin. The Register (Adelaide); 26 July 1923; p 10. https://trove.nla.gov.au/newspaper/article/64310255 (viewed Oct 2023).
4. Magic insulin tested in Australia. News (Adelaide); 25 July 1923; p 6. https://trove.nla.gov.au/newspaper/article/129820909/11087850 (viewed Oct 2023).
5. Alcohol for insulin. News (Adelaide); 29 Nov 1923; p 1. https://trove.nla.gov.au/newspaper/article/129309778/11080800 (viewed Oct 2023).
6. Robertson TB, Anderson AB. A modified method for the manufacture of “insulin”. Med J Aust 1923; 2: 189‐191. https://doi.org/10.5694/j.1326‐5377.1923.tb118842.x
7. De Crespigny CTC. The treatment of diabetes by “insulin”. Med J Aust 1923; 2: 193‐199. https://doi.org/10.5694/j.1326‐5377.1923.tb118844.x
8. “Insulin”. Med J Aust 1923; 2: 231‐232. https://doi.org/10.5694/j.1326‐5377.1923.tb118875.x
9. “Insulin”. Med J Aust 1923; 2: 316‐317. https://doi.org/10.5694/j.1326‐5377.1923.tb118952.x
10. Insulin. The Sun (Sydney); 26 July 1923; p 10. https://trove.nla.gov.au/newspaper/article/224092670 (viewed Oct 2023).
11. Insulin. Sydney Morning Herald; 10 Jan 1924; p 5. https://trove.nla.gov.au/newspaper/article/16110509/1231016 (viewed Oct 2023).
12. The price of “Insulin”. Med J Aust 1923; 2: 289. https://doi.org/10.5694/j.1326‐5377.1923.tb118933.x
13. Cheaper insulin. Daily Telegraph (Sydney); 4 Dec 1923; p 7. https://trove.nla.gov.au/newspaper/article/246003828/26879251 (viewed Oct 2023).
14. “Insulin”. Med J Aust 1923; 2: 53‐54. https://doi.org/10.5694/j.1326‐5377.1923.tb118696.x
15. Insulin. Advocate (Burnie); 14 Sept 1923; p 3. https://trove.nla.gov.au/newspaper/article/66787696/6695426 (viewed Oct 2023).
16. “Insulin”. Med J Aust 1923; 2: 160. https://doi.org/10.5694/j.1326‐5377.1923.tb118802.x
17. Insulin. News (Adelaide); 12 Nov 1923; p 9. https://trove.nla.gov.au/newspaper/article/129315568/11080650 (viewed Oct 2023).
18. Insulin. Advocate (Burnie); 5 Apr 1924; p 5. https://trove.nla.gov.au/newspaper/article/67133381/5822913 (viewed Oct 2023).
19. Sufferers of diabetes. The Mail (Adelaide); 21 Mar 1925; p 2. https://trove.nla.gov.au/newspaper/article/59711346/5286976 (viewed Oct 2023).
20. Manufacture of insulin. The Register (Adelaide); 28 June 1924; p 8. https://trove.nla.gov.au/newspaper/article/57383160/4543647 (viewed Oct 2023).
21. Cost of insulin. Sydney Morning Herald; 20 Nov 1924; p 10. https://trove.nla.gov.au/newspaper/article/16177657/1224576 (viewed Oct 2023).
22. Cost of insulin. Sydney Morning Herald; 27 Nov 1924; p 5. https://trove.nla.gov.au/newspaper/article/16169558/1224683 (viewed Oct 2023).
23. Hartman LJ. U100 insulin and the general practitioner. Aust Fam Physician 1980; 9: 464‐468.
24. Beauchamp K. Red Alert!: is regulation working for imported and CSL blood products? Canberra: Rupert Public Interest Movement, 1994; p 277.

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Perspectives

Setting the policy agenda for cancer control reform: Australia's first national cancer control plan

Daniel Chaji, Anna Boltong, Carolyn Der Vartanian, Adam Lambert, Cindy Toms, Vivienne Milch, Claire Howlett and Dorothy Keefe

Med J Aust 2023; 219 (10): . || doi: 10.5694/mja2.52120
Published online: 20 November 2023

Topics

Neoplasms

Health services administration

Social determinants of health

Indigenous health

Environment and public health

Cancer outcomes in Australia are among the best in the world;1 however, these outcomes are not experienced equitably. There are significant disparities in cancer outcomes and experience among specific groups in Australia, including Aboriginal and Torres Strait Islander people.2 Such disparities are unacceptable and require whole‐of‐system, coordinated, national level effort, to ensure the future of cancer control in Australia is one where world class cancer outcomes and experiences are within reach for all Australians.

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1 Cancer Australia, Sydney, NSW
2 Kirby Institute, UNSW Sydney, Sydney, NSW
3 Caring Futures Institute, Flinders University, Adelaide, SA
4 Adelaide Medical School, University of Adelaide, Adelaide, SA

Correspondence: Daniel.Chaji@canceraustralia.gov.au

Acknowledgements:

This work was funded by Cancer Australia and the Department of Health and Aged Care – Australian Government. Cancer Australia owes a debt of gratitude to the numerous stakeholder organisations and people who contributed to the Australian Cancer Plan either by way of submissions and/or by attendance at workshops and other public forums. We give particular thanks to all the cancer consumers who generously gave their time and experience to help us ensure the patient is at the very centre of this Plan.

Competing interests:

No relevant disclosures.

1. Arnold M, Rutherford MJ, Bardot A, et al. Progress in cancer survival, mortality, and incidence in seven high‐income countries 1995‐2014 (ICBP SURVMARK‐2): a population‐based study. Lancet Oncol 2019; 20: 1493‐1505.
2. Peng Y, Baade P. Survival disparities among recently diagnosed Aboriginal and Torres Strait Islander cancer patients in Australia remain. Cancer Causes Control 2021; 32: 1315‐1320.
3. Romero Y, Trapani D, Johnson S, et al. National cancer control plans: a global analysis. Lancet Oncol 2018; 19: e546‐e555.
4. Torode JS, Tittenbrun Z, Romero Y, et al. Ten years of the International Cancer Control Partnership: promoting national cancer control plans to shape the health system response for cancer control. JCO Glob Oncol 2023; 9: e2200232.
5. Australian Institute of Health and Welfare. Cancer in Australia 2021 (Cat. no. CAN 144). Canberra: AIHW, 2021. https://www.aihw.gov.au/reports/cancer/cancer‐in‐australia‐2021 (viewed Apr 2023).
6. Australian Institute of Health and Welfare. Cancer in Aboriginal and Torres Strait Islander people of Australia (Cat. no. CAN 109). Canberra: AIHW, 2018. https://www.aihw.gov.au/reports/cancer/cancer‐in‐indigenous‐australians (viewed Apr 2023).
7. Anderson K, Gall A, Butler T, et al. Development of key principles and best practices for co‐design in health with First Nations Australians. Int J Environ Res Public Health 2022; 20: 147.
8. Sørensen K. Health literacy is an emerging strategic priority in national cancer control plans in the EU. J Cancer Pol 2020; 26: 100255.
9. Bourque JM, Tittenbrun Z, Hohman K, et al. Why cancer control is fundamental during a pandemic. Int J Cancer 2021; 148: 2362‐2363.
10. Edge R, Meyers J, Tiernan G, et al. Cancer care disruption and reorganisation during the COVID‐19 pandemic in Australia: a patient, carer and healthcare worker perspective. PLoS One 2021; 16: e0257420.
11. Milch V, Nelson AE, Austen M, et al. Conceptual framework for cancer care during a pandemic incorporating evidence from the COVID‐19 pandemic. JCO Glob Oncol 2022; 8: e2200043.
12. Nogueira LM, Yabroff KR, Bernstein A. Climate change and cancer. CA Cancer J Clin 2020; 70: 239‐244.
13. Vineis P, Huybrechts I, Millett C, et al. Climate change and cancer: converging policies. Mol Oncol 2021; 15: 764‐769.
14. Oar A, Moraes FY, Romero Y, et al. Core elements of national cancer control plans: a tool to support plan development and review. Lancet Oncol 2019; 20: e645‐e652.
15. World Health Assembly, World Health Organization. Cancer prevention and control in the context of an integrated approach. WHA70.12. 31 May 2017. https://apps.who.int/iris/handle/10665/275676 (viewed April 2023).
16. Duncan K, Cira MK, Barango P, et al. Challenges and opportunities in the creation and implementation of cancer‐control plans in Africa. Ecancermedicalscience 2019; 13: 938.
17. Vinson CA, Staples C, Shafir S, et al. Collaborating to conquer cancer: the role of partnerships in comprehensive cancer control. Cancer Causes Control 2018; 29: 1173‐1180.

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Perspectives

The complex impact of COVID‐19 on cancer outcomes in Australia

Karen Canfell, Karen Chiam, Carolyn Nickson and G Bruce Mann

Med J Aust 2023; 219 (9): . || doi: 10.5694/mja2.52125
Published online: 6 November 2023

Topics

Neoplasms

Infectious diseases

Health services administration

In 2019, before the coronavirus disease 2019 (COVID‐19) pandemic, about 145 000 new cases of cancer (excluding non‐melanoma skin cancer) were diagnosed, and there were nearly 50 000 cancer‐related deaths in Australia.1 The cancer burden is expected to remain substantial over the next quarter‐century, with an estimated cumulative 4.56 million new cases and 1.45 million cancer deaths in that period.2 The impact of the pandemic on cancer care and outcomes is multifaceted and expected to be heterogenous across settings and subpopulations. This is partly due to differences in the stringency of public health controls, and thus the extent and timing of health services disruptions, which varied greatly between jurisdictions during the pandemic. The effect on specific cancer types also depends on their natural history, cancer control measures already in place, and susceptibility of those measures to broader public health controls. This article summarises the known data on the impact of the pandemic on cancer services, identifies gaps in current knowledge, and discusses the implications for future research priorities.

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1 The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW
2 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
3 Breast Service, Royal Melbourne and Royal Women's Hospitals, Melbourne, VIC

Correspondence: karen.canfell@sydney.edu.au

Open access:

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.

Acknowledgements:

Karen Canfell receives salary funding from the National Health and Medical Research Council Australia (NHMRC Leadership Fellowship APP1194679). The funding source had no role in the work described in this article. We also acknowledge the International Cancer Benchmarking Partnership for commissioning related international work which has informed this article.

Competing interests:

Karen Canfell is co‐principal investigator (PI) of an investigator‐initiated trial of HPV screening in Australia (Compass), which is conducted and funded by the Australian Centre for the Prevention of Cervical Cancer (ACPCC), a government‐funded health promotion charity. The ACPCC has previously received equipment and a funding contribution for the Compass trial from Roche Molecular Systems USA. She is also co‐PI on a major implementation program, “Elimination of Cervical Cancer in the Western Pacific”, which receives support from the Minderoo Foundation and equipment donations from Cepheid Inc.

1. Australian Institute of Health and Welfare. Cancer in Australia 2019 (Cancer series no.119; Cat. no. CAN 123). Canberra: AIHW, 2019. https://www.aihw.gov.au/reports/cancer/cancer‐in‐australia‐2019/summary (viewed Aug 2023).
2. Luo Q, O'Connell DL, Yu XQ, et al. Cancer incidence and mortality in Australia from 2020 to 2044 and an exploratory analysis of the potential effect of treatment delays during the COVID‐19 pandemic: a statistical modelling study. Lancet Public Health 2022; 7: e537‐e548.
3. Nickson C, Smith MA, Feletto E, et al. A modelled evaluation of the impact of COVID‐19 on breast, bowel, and cervical cancer screening programmes in Australia. Elife 2023; 12: e82818.
4. Australian Institute of Health and Welfare. Cancer screening programs: quarterly data. Last updated: 14 July 2023. https://www.aihw.gov.au/reports/cancer‐screening/national‐cancer‐screening‐programs‐participation/contents/summary (viewed Sept 2023).
5. Jayakody AA, Ren K, Walton RJ, et al. The impact of the 2020 COVID‐19‐related suspension of BreastScreen NSW on breast cancer tumour size and treatment. Public Health Res Pract 2022; 33: e32342217.
6. Australian Institute of Health and Welfare. Cancer screening and COVID‐19 in Australia (Cat. no. CAN 137). Canberra: AIHW, 2021. https://www.aihw.gov.au/reports/cancer‐screening/cancer‐screening‐and‐covid‐19‐in‐australia‐inbrief/contents/what‐was‐the‐impact‐of‐covid‐19‐in‐australia (viewed Aug 2023).
7. de Jonge L, Worthington J, van Wifferen F, et al. Impact of the COVID‐19 pandemic on faecal immunochemical test‐based colorectal cancer screening programmes in Australia, Canada, and the Netherlands: a comparative modelling study. Lancet Gastroenterol Hepatol 2021; 6: 304‐314.
8. Australian Institute of Health and Welfare. National Bowel Cancer Screening Program: monitoring report 2023 (Cat no. CAN 154). Canberra: AIHW, 2023. https://www.aihw.gov.au/reports/cancer‐screening/nbcsp‐monitoring‐2023/summary (viewed Aug 2023).
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10. Cancer Council Australia. Campaign Hub. Resources for the National Bowel Cancer Screening Program Campaign. https://www.cancer.org.au/get‐involved/campaign‐hub/bowel‐screening (viewed Aug 2023).
11. Australian Centre for the Prevention of Cervical Cancer. Development of a National Cervical Cancer Elimination Strategy: technical paper. Melbourne: ACPCC, 2022. https://acpcc.org.au/wp‐content/uploads/2022/08/TECHNICAL‐PAPER_v1.0_PUBLISH.pdf (viewed Sept 2023).
12. Smith MA, Sherrah M, Sultana F, et al. National experience in the first two years of primary human papillomavirus (HPV) cervical screening in an HPV vaccinated population in Australia: observational study. BMJ 2022; 376: e068582.
13. Cancer Australia. The impact of COVID‐19 on cancer‐related medical services and procedures in Australia in 2020: examination of MBS claims data for 2020, nationally and by jurisdiction. Sydney: Cancer Australia, 2021. https://www.canceraustralia.gov.au/the‐impact‐of‐COVID‐19‐on‐cancer‐related‐medical‐services‐and‐procedures‐in‐Australia‐in‐2020 (viewed Aug 2023).
14. Hanna TP, King WD, Thibodeau S, et al. Mortality due to cancer treatment delay: systematic review and meta‐analysis. BMJ 2020; 371: m4087.
15. Freeman V, Hughes S, Carle C, et al. Are patients with cancer at higher risk of COVID‐19‐related death? A systematic review and critical appraisal of the early evidence. J Cancer Policy 2022; 33: 100340.
16. Soerjomataram I, Bray F, Lansdorp‐Vogelaar I, et al. COVID‐19 and Cancer Global Modelling Consortium (CCGMC): a global reference to inform national recovery strategies. J Cancer Policy 2022; 32: 100328.
17. Cancer Council Queensland. Queensland Cancer Statistics Online (QCSOL). https://cancerqld.org.au/research/queensland‐cancer‐statistics/queensland‐cancer‐statistics‐online‐qcsol/ (viewed Aug 2023).
18. Wellbeing SA. Data about cancer in South Australia. https://www.wellbeingsa.sa.gov.au/evidence‐data/explore‐and‐request‐data/open‐data‐portal/data‐about‐cancer (viewed Aug 2023).
19. Cancer Institute NSW. Cancer incidence and mortality. https://www.cancer.nsw.gov.au/research‐and‐data/cancer‐data‐and‐statistics/data‐available‐now/cancer‐statistics‐nsw/cancer‐incidence‐and‐mortality (viewed Aug 2023).
20. Te Marvelde L, Wolfe R, McArthur G, et al. Decline in cancer pathology notifications during the 2020 COVID‐19‐related restrictions in Victoria. Med J Aust 2021; 214: 281‐283. https://www.mja.com.au/journal/2021/214/6/decline‐cancer‐pathology‐notifications‐during‐2020‐covid‐19‐related‐restrictions
21. Victorian Cancer Registry. Cancer in Victoria 2021. Melbourne: Cancer Council Victoria, 2022. https://www.cancervic.org.au/research/vcr/fact‐sheets‐and‐annual‐reports (viewed Aug 2023).
22. Actuaries Institute. COVID‐19 Mortality Working Group: High excess mortality continues into June 2022. https://www.actuaries.digital/2022/10/06/covid‐19‐high‐excess‐mortality‐continues‐into‐june‐2022/ (viewed Aug 2023).
23. Cancer Council Victoria. Cancer, COVID‐19 + You. Experiences of cancer care during the pandemic. Melbourne: Cancer Council Victoria, 2022. https://www.cancervic.org.au/about/policy‐and‐advocacy/cancer‐covid‐19‐you‐2022‐research (viewed Aug 2023).
24. Edge R, Mazariego C, Li Z, Canfell K, et al. Psychosocial impact of COVID‐19 on cancer patients, survivors, and carers in Australia: a real‐time assessment of cancer support services. Support Care Cancer 2021; 29: 5463‐5473.

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Narrative review

Online first

Hepatocellular carcinoma surveillance in Australia: current and future perspectives

Samuel Hui, Sally Bell, Suong Le and Anouk Dev

Med J Aust || doi: 10.5694/mja2.52124
Published online: 23 October 2023

Topics

Digestive system diseases

Statistics, epidemiology and research design

Neoplasms

Infectious diseases

Health services administration

Summary

Hepatocellular carcinoma (HCC) is a leading cause of cancer‐related death worldwide, and is increasing in incidence in Australia.
For most people with cirrhosis and chronic hepatitis B, HCC screening and surveillance is recommended with 6‐monthly ultrasound. However, most patients with HCC are still diagnosed outside of surveillance with incurable disease.
While HCC surveillance almost certainly reduces cancer‐related mortality, the potential harms of surveillance are incompletely understood.
Surveillance uptake remains suboptimal in many contexts, and stems from a combination of patient, clinician and system level barriers.
Improved case‐finding strategies may be required to identify high risk individuals in need of surveillance, as cirrhosis and viral hepatitis are often asymptomatic.
HCC prediction models and novel surveillance tools such as biomarker panels, computed tomography and magnetic resonance imaging may have a future role in personalised HCC surveillance.
Analyses suggest surveillance may be cost‐effective, but Australian data remain limited.
A centralised HCC surveillance program may ultimately have a role in delivering improved and more equitable care.

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1 School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC
2 Department of Gastroenterology and Hepatology, Monash Health, Melbourne, VIC

Correspondence: samuel.hui@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:

Samuel Hui is supported by a Research Training Program stipend from Monash University.

Competing interests:

No relevant disclosures.

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52. Barocas JA, Tasillo A, Eftekhari Yazdi G, et al. Population‐level outcomes and cost‐effectiveness of expanding the recommendation for age‐based hepatitis c testing in the United States. Clin Infect Dis 2018; 67: 549‐556.
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54. Tan C‐K, Goh GB‐B, Youn J, et al. Public awareness and knowledge of liver health and diseases in Singapore. J Gastroenterol Hepatol 2021; 36: 2292‐2302.
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59. Thurnheer MC, Schulz TR, Nguyen T, et al. Regional challenges: evaluation of a hepatitis outreach programme using transient elastography (FibroScan) in Victoria. Intern Med J 2016; 46: 273‐281.
60. Ma X, Yang Y, Tu H, et al. Risk prediction models for hepatocellular carcinoma in different populations. Chin J Cancer Res 2016; 28: 150‐160.
61. Voulgaris T, Papatheodoridi M, Lampertico P, et al. Clinical utility of hepatocellular carcinoma risk scores in chronic hepatitis B. Liver Int 2020; 40: 484‐495.
62. Papatheodoridis G, Dalekos G, Sypsa V, et al. PAGE‐B predicts the risk of developing hepatocellular carcinoma in Caucasians with chronic hepatitis B on 5‐year antiviral therapy. J Hepatol 2016; 64: 800‐806.
63. Tahata Y, Sakamori R, Yamada R, et al. Prediction model for hepatocellular carcinoma occurrence in patients with hepatitis C in the era of direct‐acting anti‐virals. Aliment Pharmacol Ther 2021; 54: 1340‐1349.
64. Semmler G, Meyer EL, Kozbial K, et al. HCC risk stratification after cure of hepatitis C in patients with compensated advanced chronic liver disease. J Hepatol 2022; 76: 812‐821.
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72. Johnson PJ, Pirrie SJ, Cox TF, et al. The detection of hepatocellular carcinoma using a prospectively developed and validated model based on serological biomarkers. Cancer Epidemiol Biomarkers Prev 2014; 23: 144‐153.
73. Chan H, Vogel A, Berg T, et al. A comparative analysis of Elecsys GALAD and Elecsys GAAD score to detect early‐stage hepatocellular carcinoma in an international cohort. J Hepatol 2022; 77: S937.
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75. Yang JD, Addissie BD, Mara KC, et al. GALAD score for hepatocellular carcinoma detection in comparison with liver ultrasound and proposal of GALADUS score. Cancer Epidemiol Biomarkers Prev 2019; 28: 531‐538.
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77. Yoon JH, Lee JM, Lee DH, et al. A comparison of biannual two‐phase low‐dose liver CT and US for HCC surveillance in a group at high risk of HCC development. Liver Cancer 2020; 9: 503‐517.
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82. Carter HE, Jeffrey GP, Ramm GA, et al. Cost‐effectiveness of a serum biomarker test for risk‐stratified liver ultrasound screening for hepatocellular carcinoma. Value Health 2021; 24: 1454‐1462.

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Editorials

The National Indigenous Kidney Transplantation Taskforce: changing systems to achieve equitable access to kidney transplantation

Jaquelyne T Hughes, Katie Cundale, Kelli J Owen and Stephen P McDonald

Med J Aust 2023; 219 (8): . || doi: 10.5694/mja2.52107
Published online: 16 October 2023

Topics

Urologic diseases

Indigenous health

Social determinants of health

Aboriginal and Torres Strait Islander people with chronic kidney disease seek good health, good kidney health, and good experiences of health care at all stages of their kidney journeys.1,2,3 Kidney replacement therapy is crucial for people with kidney failure, so needs to be accessed regularly, safely and sustainably alongside high quality cultural and clinical support. However, access to kidney transplantation, often the best kidney replacement therapy option, is not equally available to Aboriginal and Torres Strait Islander people in Australia.4

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1 Rural and Remote Health, Flinders University, Darwin, NT
2 Royal Darwin Hospital, Darwin, NT
3 National Indigenous Kidney Transplantation Taskforce (NIKTT), South Australian Health and Medical Research Institute, Adelaide, SA
4 Adelaide Medical School, University of Adelaide, Adelaide, SA
5 Central and Northern Adelaide Renal and Transplantation, Royal Adelaide Hospital, Adelaide, SA
6 Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute, Adelaide, SA

Correspondence: katie@anzdata.org.au

Acknowledgements:

We acknowledge and thank the Australian Government, represented by the Department of Health and Aged Care, for their funding of the National Indigenous Kidney Transplantation Taskforce (NIKTT) through an Indigenous Australians’ Health Programme grant. This funding enabled the work described here to be undertaken, as well as the publication of the supplement that accompanies this issue of the MJA. We thank the Aboriginal and Torres Strait Islander people living with kidney disease and transplantation who have worked with the NIKTT. We acknowledge that Aboriginal and Torres Strait Islander people in Australia face inequities in accessing transplantation because of the barriers that exist within our health care system due to the lasting and ongoing impacts of colonisation. We thank everyone who has helped us to work towards improving access to transplantation. We thank and acknowledge the dedicated members of the NIKTT who have walked with us for the past few years, as well as the partner organisations and societies with whom we work on advancing access to kidney transplantation.

Competing interests:

No relevant disclosures.

1. Devitt J, Anderson K, Cunningham J, et al. Difficult conversations: Australian Indigenous patients’ views on kidney transplantation. BMC Nephrol 2017; 18: 1‐14.
2. Hughes JT, Dembski L, Kerrigan V, et al. Gathering perspectives – finding solutions for chronic and end stage kidney disease. Nephrology (Carlton) 2017; 23: 5‐13.
3. Cormick A, Owen K, Turnbull D, et al. Renal healthcare: voicing recommendations from the journey of an Aboriginal woman with chronic kidney disease. Ren Soc Australas J 2022; 18: 88‐100.
4. Wyld ML, Wyburn KR, Chadban SJ. Global perspective on kidney transplantation: Australia. Kidney360 2021; 2: 1641.
5. Hughes, JT. Kidney health equity for Indigenous Australians: an achievable goal. Nat Rev Nephrol 2021; 17: 505.
6. Mick‐Ramsamy L, Kelly J, Duff D, et al. Catching some air: asserting Aboriginal and Torres Strait Islander information rights in renal disease – the final report. Darwin: Menzies School of Health Research, 2019. https://www.menzies.edu.au/icms_docs/307210_Catching_Some_Air.pdf (viewed Dec 2022).
7. Hoy WE, Mott SA, McDonald SP. An update on chronic kidney disease in Aboriginal Australians. Clin Nephrol 2020; 93: 124‐128.
8. Garrard E, McDonald SP. Improving access to and outcomes of kidney transplantation for Aboriginal and Torres Strait Islander People in Australia: performance report. Sydney: TSANZ, 2019. https://tsanz.com.au/storage/NIKTT/TSANZ‐Performance‐Report‐‐‐Improving‐Indigenous‐Transplant‐Outcomes‐Final‐edited‐1.pdf (viewed Dec 2022).
9. Tiong MK, Thomas S, Fernandes DK, Cherian S. Examining barriers to timely waitlisting for kidney transplantation for Indigenous Australians in Central Australia. Intern Med J 2022; 52: 288‐294.
10. Sypek MP, Clayton PA, Lim W, et al. Access to waitlisting for deceased donor kidney transplantation in Australia. Nephrology (Carlton) 2019; 24: 758‐766.
11. Hughes JT, Cundale K, Owen K, McDonald SP. Advancing accessible kidney transplantation for Aboriginal and Torres Strait Islander peoples: the National Indigenous Kidney Transplantation Taskforce. Med J Aust 2023; 219 (8 Suppl): S3‐S6.
12. Cundale K, McDonald SP, Irish A, et al. Improving equity in access to kidney transplantation: implementing targeted models of care focused on improving timely access to waitlisting. Med J Aust 2023; 219 (8 Suppl): S7‐S10.
13. Hughes JT, Owen K, Kelly J, et al. Cultural bias in kidney care and transplantation: review and recommendations to improve kidney care for Aboriginal and Torres Strait Islander people. Med J Aust 2023; 219 (8 Suppl): S11‐S14.
14. Owen K, Cundale K, Hughes JT, et al. From talk to action: Indigenous reference groups drive practice change in kidney transplantation care. Med J Aust 2023; 219 (8 Suppl): S15‐S18.
15. Hughes JT, Cundale K, Webster AC, et al. Towards equity in kidney transplantation: the next steps. Med J Aust 2023; 219 (8 Suppl): S19‐S22.

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Perspectives

Dietary management of eosinophilic oesophagitis

Jessica Fitzpatrick, Sarah L Melton and Rebecca E Burgell

Med J Aust 2023; 219 (8): . || doi: 10.5694/mja2.52101
Published online: 16 October 2023

Topics

Digestive system diseases

Nutritional and metabolic diseases

Immune system diseases

Eosinophilic oesophagitis is a chronic inflammatory disease characterised by eosinophilic inflammation of the oesophagus and sometimes scarring, and is associated with difficulty swallowing, dyspepsia and choking. Since spontaneous resolution is rare, therapeutic options have centred around use of medication or dietary manipulation. First described in the mid‐1990s, the condition is now recognised to affect about 42 per 100 000 of the adult population and 34 per 100 000 of the paediatric population.1 These data may be an underestimate of the true prevalence of eosinophilic oesophagitis due to the diagnosis requiring oesophageal biopsies and a high index of suspicion. Up to 12–23% of patients undergoing endoscopy for dysphagia and 50% of those presenting with food bolus obstruction have eosinophilic oesophagitis as the cause of their symptoms.2,3 The prevalence of eosinophilic oesophagitis has steadily (and in some populations exponentially) increased, and although prevalence data from Australia are lacking, anecdotally a similar phenomenon has been observed.2,4

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

Correspondence: jessica.fitzpatrick1@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:

Jessica Fitzpatrick and Sarah Melton are supported by a Crohn's Colitis Australia PhD Scholarship.

Competing interests:

Rebecca Burgell has received speaker fees from Falk Pharmaceutical. Jessica Fitzpatrick has received speaker fees from Pepsi Co.

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2. Dellon ES, Hirano I. Epidemiology and natural history of eosinophilic esophagitis. Gastroenterology 2018; 154: 319‐332.
3. Kerlin P, Jones D, Remedios M, Campbell C. Prevalence of eosinophilic esophagitis in adults with food bolus obstruction of the esophagus. J Clin Gastroenterol 2007; 41: 356‐361.
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6. Dellon ES, Liacouras CA, Molina‐Infante J, et al. Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE Conference. Gastroenterology 2018; 155: 1022‐1033.
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8. Dhar A, Haboubi HN, Attwood SE, et al. British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults. Gut 2022; 71: 1459‐1487.
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10. Rank MA, Sharaf RN, Furuta GT, et al. Technical review on the management of eosinophilic esophagitis: a report from the AGA Institute and the Joint Task Force on Allergy‐Immunology Practice Parameters. Gastroenterology 2020; 158: 1789‐1810.
11. Arias A, González‐Cervera J, Tenias JM, Lucendo AJ. Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta‐analysis. Gastroenterology 2014; 146: 1639‐1648.
12. Kagalwalla AF, Sentongo TA, Ritz S, et al. Effect of six‐food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol 2006; 4: 1097‐1102.
13. Spergel JM, Beausoleil JL, Mascarenhas M, Liacouras CA. The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol 2002; 109: 363‐368.
14. Molina‐Infante J, Arias Á, Alcedo J, et al. Step‐up empiric elimination diet for pediatric and adult eosinophilic esophagitis: the 2‐4‐6 study. J Allergy Clin Immunol 2018; 141: 1365‐1372.
15. Eckmann JD, Ravi K, Katzka DA, et al. Efficacy of atopy patch testing in directed dietary therapy of eosinophilic esophagitis: a pilot study. Dig Dis Sci 2018; 63: 694‐702.
16. Wechsler JB, Schwartz S, Arva NC, et al. A single‐food milk elimination diet is effective for treatment of eosinophilic esophagitis in children. Clin Gastroenterol Hepatol 2022; 20: 1748‐1756.
17. Teoh T, Mill C, Chan E, et al. Liberalized versus strict cow's milk elimination for the treatment of children with eosinophilic esophagitis. J Can Assoc Gastroenterol 2019; 2: 81‐85.
18. de Rooij WE, Vlieg‐Boerstra B, Warners MJ, et al. Effect of amino acid‐based formula added to four‐food elimination in adult eosinophilic esophagitis patients: a randomized clinical trial. Neurogastroenterol Motil 2022; 34: e14291.
19. Kliewer KL, Gonsalves N, Dellon ES, et al. One‐food versus six‐food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open‐label trial. Lancet Gastroenterol Hepatol 2023; 8: 408‐421.
20. Sheedy K, Patel N, Porter J, Silva H. Cost and accessibility of empiric food elimination diets for treatment of eosinophilic oesophagitis. Nutr Diet 2022; 79: 238‐246.
21. Wang L, Mara KC, Ravi K, et al. Predictors of histologic response to dietary therapy in eosinophilic oesophagitis. Aliment Pharmacol Ther 2022; 56: 1444‐1452.
22. Egan M, Atkins D. What is the relationship between eosinophilic esophagitis (EoE) and aeroallergens? Implications for allergen immunotherapy. Curr Allergy Asthma Rep 2018; 18: 43.
23. Safroneeva E, Straumann A, Coslovsky M, et al. Symptoms have modest accuracy in detecting endoscopic and histologic remission in adults with eosinophilic esophagitis. Gastroenterology 2016; 150: 581‐590.
24. Philpott H, Dellon E. Histologic improvement after 6 weeks of dietary elimination for eosinophilic esophagitis may be insufficient to determine efficacy. Asia Pac Allergy 2018; 8: e20.
25. Chang JW, Kliewer K, Haller E, et al. Development of a practical guide to implement and monitor diet therapy for eosinophilic esophagitis. Clin Gastroenterol Hepatol 2023; 21: 1690‐1698.
26. Katzka DA, Smyrk TC, Alexander JA, et al. Accuracy and safety of the cytosponge for assessing histologic activity in eosinophilic esophagitis: a two‐center study. Am J Gastroenterol 2017; 112: 1538‐1544.
27. Philpott H, Nandurkar S, Royce SG, Gibson PR. Ultrathin unsedated transnasal gastroscopy in monitoring eosinophilic esophagitis. J Gastroenterol Hepatol 2016; 31: 590‐594.

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