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Despite progress, gender differences persist in many areas of medicine. In the United States, female physicians are paid less, are promoted more slowly, and fewer hold leadership or senior academic positions than male physicians.1
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Correspondence: lkjones@hotmail.co.nz
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The implementation of a national Lung Cancer Screening Program (LCSP), commencing in July 2025, presents a significant opportunity to have an impact on an intractable health problem for Aboriginal and Torres Strait Islander communities.1 Lung cancer is the most common cancer and the leading cause of cancer death for Aboriginal and Torres Strait Islander peoples.2 The Aboriginal and Torres Strait Islander age‐standardised incidence rate was 85.2 cases per 100 000 for 2009–2013 and the mortality rate was 56.8 deaths per 100 000, which are double the rates found in non‐Indigenous populations.2 Lung cancer mortality rates for Aboriginal and Torres Strait Islander peoples are increasing, in contrast to falling rates in non‐Indigenous Australians.2 These diverging trends are expected to increase disparities for many years to come and clearly demonstrate the health system is failing Aboriginal and Torres Strait Islander peoples. The disproportionate lung cancer burden means that an LCSP could deliver greater benefits to Aboriginal and Torres Strait Islander communities and reduce the disparity with non‐Indigenous Australians.
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Open access:
Open access publishing facilitated by The University of Melbourne, as part of the Wiley – The University of Melbourne agreement via the Council of Australian University Librarians.
Lisa Whop is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant (2009380). Gail Garvey is funded by an NHMRC Investigator Grant (1176651). Claire Nightingale is supported by a Mid‐Career Research Fellowship (MCRF21039) from the Victorian Government acting through the Victorian Cancer Agency. Nicole Rankin is funded by an NHMRC Ideas Grant (2019/GA65812) and a Medical Research Future Fund Grant (2019/MRF2008603). The funding sources had no role in the content of this article.
We received funding from Cancer Australia for conducting consultations with Aboriginal and Torres Strait Islander workforce around lung cancer screening but we were not directly funded for the publication of this article.
Adolescent e‐cigarette use (vaping) and its harms are public health concerns.1 A national survey in 2019 found that 10% of 14–17‐year‐old Australians had used e‐cigarettes.2 More recent studies, smaller or non‐representative, have suggested that the rate is rapidly increasing.3,4 Little is known about how e‐cigarette use varies by socio‐demographic factors, such as gender, socio‐economic status, and residential remoteness.
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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.
The Health4Life study was funded by the Paul Ramsay Foundation and the National Health and Medical Research Council (NHMRC; Centre of Research Excellence in the Prevention and Early Intervention in Mental Illness and Substance Use [PREMISE]: APP11349009). Katrina Champion (APP1120641), Maree Teesson (APP1078407), and Nicola Newton (APP1166377) are supported by NHMRC fellowships. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The Health4Life study was led by researchers at the Matilda Centre at the University of Sydney, Curtin University, the University of Queensland, the University of Newcastle, Northwestern University, and UNSW Sydney. We acknowledge all the investigators and research staff who have worked on the study, as well as the participating schools, students, and teachers. The research team also acknowledges the assistance of the New South Wales Department of Education, the Catholic Education Diocese of Bathurst, the Catholic Schools Office Diocese of Maitland–Newcastle, Edmund Rice Education Australia, the Brisbane Catholic Education Committee, and Catholic Education Western Australia for access to their schools.
No relevant disclosures.
We are at a time when there have never been better opportunities to translate health policies, practices and medical research into improvements for Aboriginal and Torres Strait Islander health. Critical to these efforts is a health and research system — including in the publishing sector — that recognises the importance of Indigenous leadership in producing and implementing health care and research in order to magnify research benefits across the communities it serves.1 However, as noted by Michelle Kennedy and Janine Mohamed from the Lowitja Institute, research requires appropriate Aboriginal and Torres Strait Islander ethical governance: “All research involving Aboriginal and Torres Strait Islander peoples should be deemed safe and respectful by Aboriginal and Torres Strait Islander peoples.”2
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Objectives: To examine the severity of coronary artery disease (CAD) in people from rural or remote Western Australia referred for invasive coronary angiography (ICA) in Perth and their subsequent management; to estimate the cost savings were computed tomography coronary angiography (CTCA) offered in rural centres as a first line investigation for people with suspected CAD.
Design: Retrospective cohort study.
Setting, participants: Adults with stable symptoms in rural and remote WA referred to Perth public tertiary hospitals for ICA evaluation during the 2019 calendar year.
Main outcome measures: Severity and management of CAD (medical management or revascularisation); health care costs by care model (standard care or a proposed alternative model with local CTCA assessment).
Results: The mean age of the 1017 people from rural and remote WA who underwent ICA in Perth was 62 years (standard deviation, 13 years); 680 were men (66.9%), 245 were Indigenous people (24.1%). Indications for referral were non‐ST elevation myocardial infarction (438, 43.1%), chest pain with normal troponin level (394, 38.7%), and other (185, 18.2%). After ICA assessment, 619 people were medically managed (60.9%) and 398 underwent revascularisation (39.1%). None of the 365 patients (35.9%) without obstructed coronaries (< 50% stenosis) underwent revascularisation; nine patients with moderate CAD (50–69% stenosis; 7%) and 389 with severe CAD (≥ 70% stenosis or occluded vessel; 75.5%) underwent revascularisation. Were CTCA used locally to determine the need for referral, 527 referrals could have been averted (53%), the ICA:revascularisation ratio would have improved from 2.6 to 1.6, and 1757 metropolitan hospital bed‐days (43% reduction) and $7.3 million in health care costs (36% reduction) would have been saved.
Conclusion: Many rural and remote Western Australians transferred for ICA in Perth have non‐obstructive CAD and are medically managed. Providing CTCA as a first line investigation in rural centres could avert half of these transfers and be a cost‐effective strategy for risk stratification of people with suspected CAD.
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Open access publishing facilitated by Curtin University, as part of the Wiley – Curtin University agreement via the Council of Australian University Librarians.
Abdul Rahman Ihdayhid is supported by a National Heart Foundation postdoctoral scholarship.
Nick S R Lan has received research funding from Sanofi as part of a clinical fellowship in endocrinology and diabetes, education support from Amgen, Bayer, Boehringer Ingelheim, Eli Lilly, and Novartis, and speaker honoraria from Boehringer Ingelheim, Eli Lilly, and Sanofi, and has participated in advisory boards for Eli Lilly. Girish Dwivedi has received lecture fees from AstraZeneca, Pfizer, and Amgen (not related to the topic of this study), and provides consultancy services and has equity interest in Artrya. Abdul Rahman Ihdayhid is a consultant for Abbott Medical, Boston Scientific, and Artrya (including equity interest).
In the management of coronary artery disease, trepidation associated with the risk of future myocardial infarction weighs heavily on the minds of patients and physicians alike, given the well recognised and often publicly highlighted association with premature cardiovascular mortality. In the context of high risk acute coronary syndromes, the practice of early invasive coronary angiography with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is a Level IA (Grading of Recommendations Assessment, Development and Evaluation [GRADE]: Strong) indication for the reduction of recurrent myocardial infarction and cardiovascular mortality.1
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Examining the clinical trials landscape in Australia is important for governance and to expand knowledge about trial activity to health professionals, the public and funders. There is a strong history of Australian trials addressing important health care questions by covering a range of diseases, patient groups, prevention and treatment modalities.1 Trial results can drive change by informing best practice in health care and future research.
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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.
We acknowledge funding from the Australian Government National Collaborative Research Infrastructure Strategy program, administered via Therapeutic Innovation Australia. Anna Lene Seidler, John Simes and Angela Webster are supported by NHMRC investigator grants (1177117, 2009432, 2009800). The funding sources had no role in the planning, writing or publication of the work. We also acknowledge contributions from Lisa Askie, Peta Skeers, Sherrie Liu and Ava Tan.
No relevant disclosures.
Objective: To investigate elective rates of spinal fusion, decompression, and disc replacement procedures for people with degenerative conditions, by funding type (public, private, workers’ compensation).
Design, setting: Cross‐sectional study; analysis of hospitals admissions data extracted from the New South Wales Admitted Patient Data Collection.
Participants: All adults who underwent elective spinal surgery (spinal fusion, decompression, disc replacement) in NSW, 1 July 2001 – 30 June 2020.
Main outcome measures: Crude and age‐ and sex‐adjusted procedure rates, by procedure, funding type, and year; annual change in rates, 2001–20, expressed as incidence rate ratios (IRRs).
Results: During 2001–20, 155 088 procedures in 129 525 adults were eligible for our analysis: 53 606 fusion, 100 225 decompression, and 1257 disc replacement procedures. The privately funded fusion procedure rate increased from 26.6 to 109.5 per 100 000 insured adults (per year: IRR, 1.06; 95% confidence interval [CI], 1.05–1.07); the workers’ compensation procedure rate increased from 6.1 to 15.8 per 100 000 covered adults (IRR, 1.04; 95% CI, 1.01–1.06); the publicly funded procedure rate increased from 5.6 to 12.4 per 100 000 adults (IRR, 1.03; 95% CI, 1.01–1.06), and from 10.5 to 22.1 per 100 000 adults without hospital cover private health insurance (IRR, 1.03; 95% CI, 1.01–1.05). The privately funded decompression procedure rate increased from 93.4 to 153.6 per 100 000 people (IRR, 1.02; 95% CI, 1.01–1.03); the workers’ compensation procedure rate declined from 19.7 to 16.7 per 100 000 people (IRR, 0.98; 95% CI, 0.96–0.99), and the publicly funded procedure rate did not change significantly. The privately funded disc replacement procedure rate increased from 6.2 per million in 2010–11 to 38.4 per million people in 2019–20, but did not significantly change for the other two funding groups. The age‐ and sex‐adjusted rates for privately and publicly funded fusion and decompression procedures were similar to the crude rates.
Conclusions: Privately funded spinal surgery rates continue to be larger than for publicly funded procedures, and they have also increased more rapidly. These differences may indicate that some privately funded procedures are unnecessary, or that the number of publicly funded procedures does not reflect clinical need.
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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.
We thank the NSW Ministry of Health for providing access to the data we analysed, the NSW Centre for Health Record Linkage for conducting record linkage, the State Insurance Regulatory Agency, and the Australian Orthopaedic Association Research Foundation, the Australia and New Zealand Low Back Pain Research Network, and the National Health and Medical Research Council (APP1162833) for financial support. Duong Thuy Tran is supported by the Australia and New Zealand Low Back Pain Research Network. The funding sources were not involved in study design, data collection, analysis, or interpretation, reporting, or publication.
No relevant disclosures.
Australia is the 13th largest economy in the world1 and in 2021 ranked 55th in the world by population with 25.4 million people.2,3 Twenty‐eight per cent of Australians (7 million) live in rural and remote areas.4 The World Health Organization (WHO) recognises 51–67% of the world's rural populations have limited access to essential health services and that “rural populations tend to be poorer and less healthy”.5 This is true in Australia; rural and remote populations have a higher burden of disease4 and generally have higher levels of socio‐economic disadvantage when compared with metropolitan populations.6 The median age at death for Australian men in very remote areas is 14 years younger than that of their metropolitan compatriots; for women that difference is 19 years.4 The rate of potentially avoidable deaths for women in very remote areas is three times as high as that for women in major cities; and for men, the rate of potentially avoidable deaths is two times as high in very remote areas as that in major cities.4 These statistics depict rural and remote areas as poorly served by primary health care in capacity, performance and equity.7 For registered health professions in Australia, the number of employed full‐time equivalent clinicians decreases on a per head of population basis the more remote the location is.8 In short, where the health need is greatest, there is the lowest supply of health professionals.
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Open access publishing facilitated by James Cook University, as part of the Wiley ‐ James Cook University agreement via the Council of Australian University Librarians.
The Australian Government through the Office of the National Rural Health Commissioner funded this MJA supplement.
Ruth Stewart is the National Rural Health Commissioner. This editorial records her independent views of the university training landscape and does not reflect Australian Government policy or views.
Abstract
Introduction: There is a paradigm shift in our understanding of white matter hyperintensities (WMH) found on brain imaging. They were once thought to be a normal phenomenon of ageing and, therefore, warranted no further investigation. However, evidence now suggests these lesions are markers of poor brain and cardiovascular health, portending an increased risk of stroke, cognitive decline, depression and death. Nevertheless, no specific guidelines exist for the management of incidentally found WMH for general medical practitioners and other clinicians ordering brain magnetic resonance imaging scans for diverse clinical indications. Informed by a literature review and expert opinion gleaned from stroke neurologists, medical and imaging specialists, and general practitioners, we present our consensus statement to guide the management of incidentally found WMH in adults.
Main recommendations: When incidental WMH are found on brain imaging:
Changes to management as a result of this consensus statement: A brain health opportunity. We consider the discovery of incidental WMH on brain imaging to represent an opportunity to investigate for common cardiovascular risk factors and to optimise brain health. This can be commenced and monitored by the general practitioner or physician without delay in waiting for an outpatient neurology review.