Tuberculosis is often perceived as a disease of the past in Australia, yet ongoing transmission persists in some jurisdictions and Aboriginal and Torres Strait Islander peoples continue to experience a disproportionate burden. Drawing on lived experience and community perspectives, we highlight challenges navigating tuberculosis care and opportunities to strengthen prevention and care. Achieving tuberculosis elimination requires more than biomedical tools alone. Earlier diagnosis, culturally responsive and community-led approaches, strengthened Aboriginal health workforces and action on social and structural determinants are needed to ensure tuberculosis is addressed rather than forgotten in Australia.
OBJECTIVES:To quantify cardiovascular disease (CVD) risk, and implications for targeting preventive pharmacotherapy, using the 2023 guideline-recommended Australian CVD risk algorithm, and compare this to the previous (2012) algorithm. STUDY TYPE:Application and comparison of two risk prediction algorithms. SETTING AND PARTICIPANTS:Data from 115,873 people aged 45-74 years without existing CVD, who had a clinical encounter between September 2020 and August 2022, recorded within MedicineInsight, a longitudinal primary care database covering 8% of Australian general practices. MAIN OUTCOME MEASURES:CVD risk distribution and risk categorisation into low-, intermediate- and high-risk groups under the 2023 and 2012 algorithms. Cohen's kappa and Bland-Altman plots were used to assess agreement and concordance. RESULTS:Using the 2023 CVD risk algorithm and revised thresholds, 9.7% of participants were at high CVD risk (≥ 10% 5-year risk or clinically determined high risk); 26.4% were at intermediate CVD risk (5% to < 10% 5-year risk) and 63.9% were at low CVD risk (< 5% 5-year risk). Corresponding 2012 figures for CVD risk were 17.6% high (> 15% 5-year risk or clinically determined high risk), 11.6% intermediate (10%-15% 5-year risk) and 70.8% low (< 10% 5-year risk). Differences in proportions at high risk were largely driven by changes to clinically determined criteria for high risk. Overall, there was moderate-to-substantial agreement (linear-weighted kappa = 0.62) and concordance (Kendall's tau-b = 0.74) between algorithms. CONCLUSION:Proportions estimated at low risk and not routinely recommended pharmacotherapy align with international standards and were similar between guidelines. Although fewer people would be recommended pharmacotherapy due to being high risk under the updated versus previous guidelines, this likely reflects more accurate updated CVD risk estimation for the contemporary Australian population. The 2023 guidelines include a discretionary step (untested in our study) allowing adjustment based on additional factors. To ensure continued reduction of CVD burden across the population, we emphasise the use of this reclassification step by clinicians and consideration of the benefits of pharmacotherapy for those at intermediate risk.
Australia's newborn bloodspot screening (NBS) program is offered to every newborn. It screens for 34 rare conditions with the potential for hundreds more to be added using genomics. Despite NBS being available in Australia since the 1960s, there is a lack of evidence regarding the participation and experiences of Aboriginal and Torres Strait Islander peoples in NBS. As Australia considers a future where genomics might be used in NBS, there is a critical window of opportunity to understand and prioritise the perspectives, hopes and fears of Aboriginal and Torres Strait Islander peoples regarding the utility of genomics in NBS.
OBJECTIVES:Long-term and chronic health conditions are associated with a significant burden of disease and economic impact in Australia. Although improving health outcomes requires a multifactorial approach, up-to-date clinical guidelines can optimise healthcare delivery by providing clinicians with evidence-based, actionable recommendations. We aimed to determine the currency and key methodological characteristics of national clinical guidelines published in Australia and focussed on areas of highest prevalence and burden of disease. STUDY DESIGN AND SETTING:We conducted a cross-sectional analysis by searching PubMed, the Guidelines International Network International Guidelines Library and Australian college and society websites in July 2025 for national clinical guidelines in the five areas of highest prevalence and burden of disease, as defined by the Australian Bureau of Statistics and Australian Institute of Health and Welfare, respectively. Information and metrics relating to time since publication, time since last evidence search and methods and processes (e.g., reporting of clinical questions and Population, Intervention, Comparison, Outcome [PICO] criteria and approval of the guideline by the National Health and Medical Research Council [NHMRC]) were tabulated and analysed. RESULTS:Thirty-one guidelines published between 2002 and 2025 were identified, with most relating to diabetes or mental health. The mean times since publication and last search date were 8.6 and 9.8 years, respectively. Most provided details regarding clinical questions (77%), PICO criteria (61%), search strategies (68%) and other methodological considerations, however, fewer than half used Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess certainty of evidence or provided details regarding conflicts of interest (48% each). Of the 18 guidelines approved by the NHMRC, five were developed within the previous 5 years and remain approved. CONCLUSION:For most high-priority clinical conditions in Australia, there are no up-to-date evidence-based guidelines available to support clinical decision-making. Guideline developers and funders should invest more energy and resources into planning for updates and ensuring that methods and processes are optimised to facilitate this, such as considering a living approach.
For over 40 years, First Nations communities in Australia have called for community-controlled birthing and maternal-infant health programs that restore First Nations-led, community-controlled birthing systems grounded in cultural authority and sovereignty. 'Birthing on Country' services have demonstrated improved First Nations maternal-infant health outcomes, more babies kept out of the child protection system, and reduced health system costs. Restoration and expansion of Birthing on Country services across regions has been inconsistent, and has lacked support for national implementation. In 2022, a large national gathering ('Best Start to Life') was co-hosted in Mparntwe (Alice Springs). The focus was Birthing on Country service implementation to address inequities in birthing service provision for First Nations communities. A deliverable of this gathering was the National Roadmap for Birthing on Country Services 2026-2036 (the Roadmap). The co-creation of the Roadmap maintained enhanced engagement from a range of stakeholders, to produce inclusive and democratic solutions to perpetual perinatal inequities in health. A two-phased process facilitated national co-creation where national priorities in the reclamation of First Nations Birth Rights were upheld. The Roadmap builds on an evidence-informed and First Nations knowledge-grounded framework, the RISE Implementation Framework. The formation of the Roadmap contrasts against traditional policy creation, transitioning from an evidence-based proposal to a First Nations-endorsed national framework, ready for implementation and government adoption. This novel, national strategic approach to upscale Birthing on Country services has received formal endorsement nationally. The Roadmap provides detailed strategies to address structural reform, and its foundational co-creation process demonstrates that to change practice, researchers must do more than publish evidence in journals for policy change and knowledge translation. The 10-year key deliverables in the Roadmap are a call to action to recognise Birthing on Country as an inherent sovereign right grounded in First Nations Law and governance.
I collapsed at the gym when a massive pulmonary embolism caused my heart to stop. Unbelievably I survived thanks to a clinical trial delivering an extracorporeal membrane oxygenation (ECMO) heart-lung bypass machine directly to me at the gym. Hopefully out-of-hospital ECMO becomes an accepted emergency strategy to save more lives.
OBJECTIVES:To characterise osteoporosis medicine prescribing patterns following low-trauma fractures and identify predictors of early treatment initiation. STUDY TYPE:Retrospective population-based cohort study. SETTING:New South Wales, Australia, using statewide linked administrative health data. PARTICIPANTS:Adults aged ≥ 50 years with an incident low-trauma fracture between January 2011 and June 2019. MAIN OUTCOME MEASURES:Primary outcomes were osteoporosis treatment prescribing patterns and timing of initiation after incident fracture over 3 years, categorised as early (within 12 months), late (within 1-3 years) or no initiation. Secondary analyses examined predictors of time to treatment initiation within 12 months using Fine-Gray competing-risk regression. RESULTS:Among 132,268 individuals with incident fractures, 63.7% (84,222) were female. Overall, 29,802 (22.5%) initiated osteoporosis medicine, whereas 102,466 (77.5%) remained untreated. Among females (mean [standard deviation] age, 77.7 [10.1] years), 20.1% initiated therapy within 12 months, 7.0% within 1-3 years, and 72.9% remained untreated. Among males (mean [standard deviation] age, 77.2 [10.0] years), the corresponding proportions were 10.8%, 3.7% and 85.6%. After accounting for the competing risk of death, treatment initiation was more likely with non-distal fractures, older age, polypharmacy, prior steroid use, prior dual-energy x-ray absorptiometry and later fracture year, and less likely with greater comorbidity, rural or regional residence and prior hospitalisation for falls. The strongest associations were for hip or vertebral fracture (subdistribution hazard ratio range, 1.90-3.03) and high comorbidity burden (subdistribution hazard ratio range, 0.72-0.75). Almost one in four late initiators had a refracture before starting treatment. Denosumab rapidly replaced oral bisphosphonates as the dominant therapy over time. CONCLUSION:More than three-quarters of individuals remain untreated after fracture, highlighting persistent and substantial gaps in secondary fracture prevention. Treatment initiation is strongly associated with fracture site and multimorbidity burden, and initiation rates are lower in males. Increasing reliance on denosumab underscores the need for careful long-term treatment planning and strategies.
This study identified and characterised 1207 emergency department presentations related to gabapentinoid overdose in Victoria from 2009-2010 to 2023-2024. Presentation rates increased substantially since 2009-2010, and about half (49.5%; 597/1207) of all presentations were classified as intentional. Co-ingestants were common, although 36.2% (437/1207) of presentations were reported to involve gabapentinoids alone.
Computed tomography (CT) of the knee has traditionally had a limited role in routine practice. Recent Medicare data show a rapid increase in CT knee utilisation in Australia, far exceeding growth in other imaging modalities. This divergence is unlikely to reflect clinical need and instead suggests a shift in practice, potentially driven by expansion into non-evidence-based CT-guided procedures. This raises concerns regarding unnecessary radiation exposure, procedure-related harm and escalating costs driven by volume rather than value. The absence of clear differentiation between diagnostic and procedural CT imaging within current Medicare Benefits Schedule item structures limits oversight. Imaging stewardship and policy reform are required to ensure appropriate, evidence-based use.
OBJECTIVE:To leverage the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry (an Australian cancer database) to explore the ideal timing and sequence of therapies and the factors influencing these decisions in colorectal cancer (CRC) patients with liver-only metastases to inform contemporary decision-making and future trials. STUDY TYPE:Retrospective registry-based cohort study using the TRACC registry. SETTING AND PARTICIPANTS:Consecutive patients with liver-only metastatic CRC enrolled in the TRACC registry. MAIN OUTCOME MEASURES:To explore cancer biology, intended treatment at presentation, actual treatment received and the resultant outcomes for early-onset CRC (EOCRC) (≤ 50 years) and late-onset CRC (LOCRC) (> 50 years) patients with liver-only metastases from a real-world perspective. RESULTS:Between 14 January 2009 and 2 September 2024, 1691 patients with liver-only metastatic CRC were enrolled in TRACC. These included 276 EOCRC patients (16.3%) and 1415 LOCRC patients (83.7%). In the EOCRC subset, there were more females (48.2% vs. 34.5%, p < 0.001), less comorbidity (Charlson comorbidity index score 0, 90% vs. 59%, p < 0.001), more left-sided primaries (76.1% vs. 65.7%, p < 0.001), more synchronous disease (53.3% vs. 42.1%, p < 0.001) and BRAF V600E mutations (13.9% vs. 8.1%; p = 0.010). Overall, EOCRC patients had a longer median survival compared with LOCRC patients (3.20 vs. 2.38 years, p < 0.001). For the 662 patients (39.1%) undergoing liver resection, median survival was 5.99 years in EOCRC patients and 5.88 years in LOCRC patients. For all patients and for those undergoing resection, respectively, B-Raf proto-oncogene, serine/threonine kinase (BRAF) (hazard ratio, 1.97 [p < 0.001] and hazard ratio, 2.25 [p < 0.001]) and Kirsten rat sarcoma viral oncogene homologue (KRAS) mutations were associated with worse outcomes (hazard ratio, 1.29 [p < 0.001] and hazard ratio, 1.34 [p = 0.003]). CONCLUSION:Differences in sex distribution, BRAF mutation rates, primary tumour site and overall survival suggest biological differences between EOCRC and LOCRC. Liver resection was associated with improved survival in LOCRC, with the benefits of all therapies varying depending on age, primary tumour site and whether patients presented with synchronous or metachronous liver-only metastases.
OBJECTIVE:To estimate population-level eligibility for glucagon-like peptide-1 receptor agonist (GLP-1RA) medications among adults in Australia, according to Therapeutic Goods Administration-approved indications for chronic weight management and secondary prevention of cardiovascular disease in individuals with overweight or obesity. STUDY TYPE:Cross-sectional analysis of data from the Australian Bureau of Statistics 2022 National Health Survey. SETTING, PARTICIPANTS:Non-pregnant adults aged ≥ 18 years who were residents of Australia living in a private dwelling. MAIN OUTCOME MEASURES:Total number of adults eligible for GLP-1RA medications according to approved indications for chronic weight management and secondary prevention of cardiovascular disease in individuals with overweight or obesity, across subgroups defined by body mass index, weight-related comorbidities and/or sociodemographic factors. RESULTS:Overall, 39.7% (95% confidence interval [CI], 38.4%-41.0%) of adults were eligible for GLP-1RA use for chronic weight management, accounting for 7.8 million (95% CI, 7.6-8.1 million) individuals. Among those eligible, 2.9 million (95% CI, 2.7-3.1 million) adults had no weight-related comorbidities, 3.3 million (95% CI, 3.1-3.4 million) adults had one weight-related comorbidity and 1.7 million (95% CI, 1.6-1.8 million) adults had at least two weight-related comorbidities. The proportion of adults eligible under this indication varied across clinical and sociodemographic factors. Among those eligible under the chronic weight management indication, up to 338.9 thousand (95% CI, 271.3-406.5 thousand) adults also met the indication criteria for secondary prevention of cardiovascular disease. CONCLUSION:About 7.8 million Australian adults are eligible to access GLP-1RAs for chronic weight management, with up to 338.9 thousand adults also qualifying according to the indication for established cardiovascular disease. This study provides a valuable reference for policymakers to understand the number of adults in Australia who may access GLP-1RA medications based on approved indication criteria and under various coverage scenarios.
OBJECTIVE:Determine whether watchful waiting is non-inferior to immediate oral antibiotics for uncomplicated acute otitis media among urban Aboriginal and Torres Strait Islander children. STUDY TYPE:Non-inferiority unblinded randomised controlled trial. SETTING AND PARTICIPANTS:Eight Aboriginal Medical Services across three Australian states and territories between 25 August 2014 and 2 June 2023. Children (aged 1.5-16 years) with type B tympanograms and bulging tympanic membrane or acute pain/irritability were randomised by site and age (1.5-6 years and 7-16 years), with stratification using randomly allocated, permuted blocks of four and six in length. MAIN OUTCOME MEASURES:Watchful waiting compared with immediate oral antibiotics using modified intention-to-treat (using only available data) and per-protocol analyses of Day 7 clinical resolution with non-inferiority threshold set at 10 percentage points. RESULTS:Children were randomly allocated to watchful waiting (134), six of whom were lost to follow-up or immediate antibiotics (129) with three lost to follow-up. Resolution occurred in 57/106 (53.8%) watchful waiting and 68/113 (60.2%) immediate antibiotic group of those with complete Day 7 data (-6.4 percentage points difference; 90% confidence interval [CI], -17.4 to 4.6) (modified intention-to-treat analysis). Per-protocol analysis similarly demonstrated reduced resolution in the watchful waiting group (49/97; 50.5%) compared with immediate antibiotics (67/112; 59.8%) with -9.3 percentage points difference (90% CI, -20.6 to 2.0). There was less Day 3 diarrhoea in watchful waiting (3/90; 3.3%) than in the immediate antibiotic group (13/93 [14.0%]; -10.7 percentage points difference; 95% CI, -18.6 to -2.7) but no other differences in vomiting, diarrhoea or rash (Days 3-14). Day 7 analgesia use was higher in the watchful waiting (53/107 [49.5%]) than immediate antibiotic group (37/116 [31.9%]; 17.6 percentage points difference; 95% CI, 4.9 to 30.1). There were no intervention-related severe adverse events or perforations. CONCLUSION:Although our results are numerically similar to those reported in other low-risk populations and no unexpected safety signals were observed in the watchful waiting arm, non-inferiority was not established. Larger, adequately powered trials are required to determine whether watchful waiting is non-inferior in this population. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry ACTRN#12613001068752.
This is one of the first reported cases of storage mite anaphylaxis in Australia, occurring in an infant who had two episodes of severe anaphylaxis, triggered by previously tolerated foods. Both episodes occurred following extended periods of food storage, and in both instances, the child required two doses of intramuscular adrenaline. Skin prick testing was negative to implicated foods, but demonstrated sensitisation to house dust mite, and serum-specific IgE confirmed storage mite sensitisation. Clinician recognition of this condition is essential for timely diagnosis and implementation of preventive measures to reduce further episodes of life-threatening anaphylaxis in at-risk patients.
OBJECTIVE:To characterise the associations of heat and bushfire smoke with health services utilisation and medication use at a national scale to support Australia's first National Climate Risk Assessment. DESIGN:Cross-sectional, population study, covering health conditions with the highest burden of disease. SETTING AND PARTICIPANTS:People in Australia accessing public health services between 2014 and 2020 for care related to cardiovascular, respiratory and mental health conditions. MAIN OUTCOME MEASURES:Relative risks of heat and bushfire smoke (particulate matter ≤ 2.5 μm in diameter [PM2.5]) on health system utilisation and medication use, measured as emergency department (ED) presentations, hospital inpatient admissions, Medicare Benefits Schedule service claims in primary care and Pharmaceutical Benefits Scheme prescriptions dispensed. Relative risks (RRs) and 95% confidence intervals were estimated for short-term lags between exposure periods and health system usage. RESULTS:Heat was most strongly associated with ED presentations, with a RR of 1.033 (95% CI, 1.023-1.043; p < 0.001) per degree temperature change for respiratory conditions and 1.023 (95% CI, 1.016-1.031; p < 0.001) for mental health conditions. PM2.5 at a 1-day lag had the highest association with hospital admissions, with a RR of 1.014 per 1 μg/m3 change in particulate density for both cardiovascular (p = 0.001) and respiratory (p = 0.002) conditions. Primary care visits for mental health conditions were strongly associated with levels of PM2.5 (RR, 1.049 [95% CI, 1.040-1.058]; p < 0.001) and with temperature (RR, 1.027 [95% CI, 1.014-1.039]; p < 0.001), while medication use increased across respiratory, cardiovascular and mental health categories in response to both exposures, with particulate matter showing stronger effects for cardiovascular, respiratory and mental health prescriptions. Mental health outcomes consistently showed vulnerability across all domains. CONCLUSION:Heat was strongly associated with acute ED presentations, while particulate matter was strongly associated with hospital admissions and medication use. Mental health services are broadly sensitive to both exposures. These findings emphasise the need for integrated air quality management and heat-health polices to reduce system-wide health burdens.
Australia's health information system captures clinical and administrative data with precision but overlooks social determinants of health (SDoH), such as housing and education. This deficiency limits predictive accuracy of clinical and economic models and perpetuates health inequities. Despite significant investment in digital health reforms, Australia's current strategies for data interoperability lack SDoH standards. Drawing on international benchmarks, Australia should pursue a national framework to integrate standardised SDoH measures into electronic health records. Collaborative adoption via a phased approach focused on data sovereignty, interoperability and ethical AI governance has the potential to transform Australia's healthcare into a more person-centred, equitable system.
Observation charts are used to record and prompt responses for acutely deteriorating patients. Compared to non-pregnant observation charts, maternity charts reflect physiological changes of pregnancy and the immediate postpartum period. Maternity observation charts differ across Australian states and territories, resulting in a lack of comparable data, standardised care and optimisation of streamlining education and training. To improve maternity care across the country, we propose that the Australian Commission on Safety and Quality in Health Care, in the upcoming third edition of the National Safety and Quality Health Service Standards, review Standard 8 (recognising and responding to the acutely deteriorating patients) to generate a national Maternity Early Warning System (MEWS) Chart.
Indigenous children are seen as an intrinsic, systematic foundation of hope in Aboriginal conceptualisations of hope, yet are grossly overrepresented in Australian suicide statistics. Despite being a target of the Australian Government's almost 20-year-long Closing the Gap campaign, the numbers are only getting worse. 'It's not depression, it's despair' are words that echo a sentiment so ghastly for parents of Indigenous children who only hope to bestow them with the gift of exactly that: hope. It is only sensible to counteract this with holistic, culturally empowered, strengths-based well-being programs to both develop Cultural strength while concurrently instilling a sense of Cultural pride and identity.
