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Monkeypox information
Updated 18 August 2022

Department of Health and Aged Care – health alert – Monkeypox (MPX) resources

Updated ATAGI clinical guidance on vaccination against Monkeypox

UpToDate – Monkeypox  if accessing outside of the SA Health computer network you will need to use your personal UpToDate account

SA Health – health alert – Monkeypox

World Health Organization Health alert

Journal articles

Audio interview: Responding to Monkeypox
In this audio interview conducted on August 16, 2022, the editors are joined by White House National Monkeypox Response Deputy Coordinator Demetre Daskalakis to discuss the new public health emergency and what HIV and Covid-19 have taught us. NEJM 18 August 2022

Update on the Monkeypox Outbreak
The current monkeypox outbreak illustrates why global health cannot be ignored. Despite monkeypox being endemic in Africa for decades, clinical trials on treatments and vaccines were not done. Now more than 3 months into the global monkeypox outbreak, there is much to learn. While test capacity has been increased, more is needed. Contact tracing is not happening, and data systems are not informing the response in rapid fashion. Many individuals at risk for monkeypox may not be engaged with the health care system, making diagnosis, containment, and prevention challenging. The demand for vaccines far exceeds availability. Although the supply of tecovirimat has increased, this drug must still be used under an IND protocol, which limits access. In addition, a decentralized and wholly underresourced public health infrastructure is even more strained as officials must now respond to both COVID-19 and monkeypox. JAMA 11 August 2022

The changing face of monkeypox
What should patients and clinicians look out for? BMJ 10 August 2022

Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study
In this cohort, monkeypox caused genital, perianal, and oral lesions and complications including proctitis and tonsillitis. Because of the variability of presentations, clinicians should have a low threshold for suspicion of monkeypox. Lesion swabs showed the highest viral loads, which, combined with the history of sexual exposure and the distribution of lesions, suggests close contact is probably the dominant transmission route in the current outbreak. The Lancet 8 August 2022

Ophthalmic manifestation of monkeypox infection
Despite mucosal localisation of vesicles being not uncommon in monkeypox, the diagnosis might be overlooked. During the ongoing monkeypox outbreak, monkeypox should be included in the differential diagnosis of patients with vesicular and pustular eye lesions, especially in the presence of epidemiological links or risk factors. The Lancet infectious diseases 29 July 2022

Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series
These findings confirm the ongoing unprecedented community transmission of monkeypox virus among gay, bisexual, and other men who have sex with men seen in the UK and many other non-endemic countries. A variable temporal association was observed between mucocutaneous and systemic features, suggesting a new clinical course to the disease. New clinical presentations of monkeypox infection were identified, including rectal pain and penile oedema. These presentations should be included in public health messaging to aid early diagnosis and reduce onward transmission. BMJ 28 July 2022

Monkeypox virus infection in humans across 16 countries — April–June 2022
In this case series, monkeypox manifested with a variety of dermatologic and systemic clinical findings. The simultaneous identification of cases outside areas where monkeypox has traditionally been endemic highlights the need for rapid identification and diagnosis of cases to contain further community spread. NEJM 21 July 2022

Is Australia ready for monkeypox?
Disease control efforts can draw on lessons from the past and prevent the epidemic from becoming established in Australia MJA 18 July 2022

Monkeypox emerges on a global scale: a historical review and dermatological primer
The current monkeypox outbreak reawakens the concern that poxviridae have high potential of zoonotic spillover and for causing pandemic.1 Much fieldwork and research has been done by healthcare and public health workers in Africa during previous human outbreaks, and their knowledge should inform our global response to the current outbreak. However, unusual clinical presentations now have potential implications in recognizing disease. Infections from poxviridae such as monkeypox have common cutaneous signs that occur early, may be related to periods of transmissibility, and can leave scarring. Therefore, dermatologists will play a key role in recognizing and diagnosing infections, and in educating and preparing front-line healthcare workers for early detection of new cases and clusters of monkeypox. Journal of the American Academy of Dermatology 8 July 2022

Efficacy of biocidal agents and disinfectants against the monkeypox virus and other orthopoxviruses
As orthopoxviruses may stay infectious on inanimate surfaces under laboratory conditions for up to 42 days, disinfection may be relevant in the surroundings of confirmed cases. The aim of this review was to evaluate published data on the antiviral efficacy of biocidal agents and disinfectants against the monkeypox virus and other orthopoxviruses. Journal of hospital infection 28 June 2022

The outbreak of monkeypox 2022: An overview
On May 6, 2022 an outbreak of monkeypox (MPX) was confirmed in the United Kingdom, originating from a British resident who had travelled to Nigeria. As of May 21, 2022, 92 cases have been confirmed worldwide, from 13 countries where monkeypox virus (MPXV) is not endemic. Reported cases thus far have mainly but not exclusively been identified among gay and bisexual men aged 20–50. MPXV is a viral zoonosis transmitted to humans via contacting or eating an infected animal, and direct connect with natural host’s blood and body fluids. In addition to contacting with a patient’s respiratory droplets, lesions, body fluids and polluted personal objects. Symptoms including shivers, headaches, fainting, backaches, and myodynia do not have any specific characteristics making it difficult to establish a proper diagnosis. Nevertheless, lymphatic hyperplasia, one of the most common symptoms of monkeypox, can be useful for diagnosing the disease. Clinical symptoms help establish the suspicion of monkeypox. However, in the absence of confirmed diagnostic tests it is very difficult to verify the disease and determine its cause based on clinical symptoms alone. There are numerous methods for detecting MPX, involving genetic, phenotypic, immunological methods, and electron microscopy. These tests require modern equipment and expert hands, which may not be available in developing countries where this disease is prevalent. Currently, there is no definite treatment for MPX. CDC recommends administering the smallpox vaccine within 4 days of exposure which may prevent the disease from happening, and within 2 weeks to reduce symptoms severity. To promptly identify patients and prevent further spreading, physicians should be aware of the travel or contact history of the patient with compatible symptoms. Annals of medicine and surgery 24 June 2022

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SA Health Library Service 12/8/2022

Bulletin for 12 August 2022


Cochrane library

Cochrane clinical answers

Evidently Cochrane





Other journals

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Visual and vestibular assessments in children with concussion
The American Academy of Pediatrics has released a new policy that highlights vision symptoms in children and adolescents with concussion [25]. The policy provides guidance on the components of a complete evaluation of the visual system after concussion. It also reviews the importance of identifying visual and vestibular deficits during assessment of concussion to confirm the diagnosis and to identify patients at risk for prolonged symptoms who may benefit from specific academic adjustments or specialist referral. (See "Concussion in children and adolescents: Clinical manifestations and diagnosis", section on 'Physical examination'.)

Frequency of transfusion reactions in children and adults
Transfusion reactions range from bothersome to life threatening. A new meta-analysis of >1.3 million transfusion reactions has documented a nearly twofold higher frequency of acute transfusion reactions in children than in adults [2]. Children were more likely than adults to have reactions to red blood cells and platelets, but not to plasma. Allergic and febrile nonhemolytic transfusion reactions were most common. The only type of reactions seen more frequently in adults were delayed hemolytic and delayed serologic reactions. Early signs and symptoms may not distinguish between benign and more serious events, and all acute transfusion reactions must be considered potentially serious until fully evaluated. (See "Approach to the patient with a suspected acute transfusion reaction", section on 'Frequency of reactions'.)

Pharmacogenetic testing in treatment-resistant depression
Although preliminary evidence suggests that pharmacogenetic tests may be useful for selecting an antidepressant in treatment-resistant depression, their clinical utility remains unknown. As an example, a 24-week, open-label randomized trial in nearly 2000 patients with treatment-resistant unipolar major depression compared pharmacogenetic testing with usual care to guide selection of a new antidepressant [3]. The testing examined genes that affect antidepressant metabolism and mechanism of action. Remission at week 12 was greater with testing-guided care, but the clinical effect was small, and at week 24, remission rates in the two groups were nearly identical. We recommend not obtaining pharmacogenetic tests to guide management of treatment-resistant depression. (See "Unipolar depression in adults: Choosing treatment for resistant depression", section on 'Antidepressants'.)

Thrombotic microangiopathy after gene therapy for spinal muscular atrophy
Spinal muscular atrophy is a rare genetic disorder characterized by progressive muscle weakness and atrophy; treatment is mainly supportive. Onasemnogene abeparvovec is an approved gene therapy that has demonstrated promising results in infants <2 years of age. Several recent reports have described thrombotic microangiopathy, with severe thrombocytopenia and microangiopathic hemolysis, following administration of this therapy. One case was fatal [15]. Further study is needed to determine the mechanisms, risk factors, and optimal treatment of this complication. (See "Drug-induced thrombotic microangiopathy (DITMA)", section on 'Gene therapy (mechanism unclear)'.)

Intravenous magnesium in severe COPD exacerbation
Intravenous magnesium has short-acting bronchodilator activity that is helpful for severe asthma attacks, but it has not previously been recommended for chronic obstructive pulmonary disease (COPD). A new systematic review and meta-analysis found a decrease in hospitalization rates with emergency department intravenous magnesium administration compared with placebo [5]. The effect size is similar to or better than that seen in the setting of asthma exacerbation. Based on these data, we now suggest intravenous magnesium for patients with severe COPD exacerbations who are not improving with inhaled bronchodilator therapy. (See "COPD exacerbations: Management", section on 'Magnesium sulfate'.)

Methotrexate for prevention of rheumatoid arthritis
Various medical therapies have been evaluated for the prevention of rheumatoid arthritis (RA) among patients considered to be at high risk for developing clinically active disease. In the TREAT EARLIER trial that included 236 patients with arthralgias who were suspected of progressing to RA based on magnetic resonance imaging (MRI)-detected subclinical joint inflammation, patients who were randomly assigned to receive a one-year course of oral methotrexate had similar rates of developing clinical arthritis compared with those who took placebo (19 versus 18 percent, respectively) [3]. However, there were greater improvements in self-reported measures of physical function, pain, and morning stiffness, as well as MRI-detected joint inflammation, in the methotrexate-treated group, which supports the role of methotrexate as an effective disease-modifying treatment among patients in the early phases of the disease. (See "Epidemiology of, risk factors for, and possible causes of rheumatoid arthritis", section on 'Clinical trials examining preventive therapies'.)


Cochrane library

Hydrogel dressings for venous leg ulcers
There is inconclusive evidence to determine the effectiveness of hydrogel dressings compared with gauze and saline, alginate dressing, manuka honey or hydrocolloid on venous leg ulcer healing. Practitioners may, therefore, consider other characteristics such as costs and symptom management when choosing between dressings. Cochrane Database of Systematic Reviews – Intervention 5 August 2022

Interventions to increase COVID‐19 vaccine uptake: a scoping review
The authors were able to identify and map a variety of heterogeneous interventions for increasing COVID‐19 vaccine uptake or decreasing vaccine hesitancy. Our results demonstrate that this is an active field of research with 61 published studies and 35 studies still ongoing. This review gives a comprehensive overview of interventions to increase COVID‐19 vaccine uptake and can be the foundation for subsequent systematic reviews on the effectiveness of interventions to increase COVID‐19 vaccine uptake. Cochrane Database of Systematic Reviews – Prototype 3 August 2022

Tocolytics for delaying preterm birth: a network meta‐analysis
Compared with placebo or no tocolytic treatment, all tocolytic drug classes that we assessed (betamimetics, calcium channel blockers, magnesium sulphate, oxytocin receptor antagonists, nitric oxide donors) and their combinations were probably or possibly effective in delaying preterm birth for 48 hours, and 7 days. Tocolytic drugs were associated with a range of adverse effects (from minor to potentially severe) compared with placebo or no tocolytic treatment, although betamimetics and combination tocolytics were more likely to result in cessation of treatment. The effects of tocolytic use on neonatal outcomes such as neonatal and perinatal mortality, and on safety outcomes such as maternal and neonatal infection were uncertain. Cochrane Database of Systematic Reviews – Intervention 11 August 2022


Cochrane clinical answers

For women with heavy menstrual bleeding, what are the effects of medical treatments?
Moderate‐certainty evidence shows that antifibrinolytics probably reduce menstrual blood loss (MBL) (by 80 mL/cycle, all results on average). Low‐certainty evidence suggests that levonorgestrel intrauterine device (LNG‐IUS) may result in a large reduction of MBL (by 106 mL/cycle), and long‐cycle progestogen may reduce MBL (by 77 mL/cycle). The effect of the remaining interventions on MBL is uncertain. Cochrane clinical answers 9 August 2022

In adults with multiple sclerosis, what are the effects of cannabis and cannabinoids for symptomatic treatment?
Moderate‐certainty evidence shows that cannabis and cannabinoids probably lead to a reported reduction of 30% in spasticity in people with refractory spasticity in varying stages of multiple sclerosis (454 vs 249 per 1000 people; all results on average). More people also experienced a pain reduction of 50% or greater with cannabis and cannabinoids when compared with placebo, but the evidence was of very low certainty (458 vs 167 per 1000 people). Cochrane clinical answers 4 August 2022


Evidently Cochrane

COVID tests: how accurate are LFTs?
In this blog for anyone interested in LFTs (lateral flow tests, also called rapid antigen tests) for diagnosing COVID-19 infection, Jac Dinnes from University of Birmingham discusses the latest evidence in her Cochrane Review and what it tells us about the accuracy of these tests. Evidently Cochrane 5 August 2022

Talking about dying: better conversations at the end of life
In this blog, Sarah Chapman, whose Mum died during the first lockdown, reflects on the text conversations she had with her Mum’s carer about her dying. She also talks about recent evidence on effective communication between health professionals, those who are dying and their families and about our need for knowledge of ordinary dying when many of us don’t witness a death until we are older adults ourselves. The blog also contains sources of information and support for non-medical people and health professionals. Evidently Cochrane 11 August 2022

Painful nipples in breastfeeding women: what helps?
In a blog for breastfeeding women affected by painful nipples, and people supporting them, Sarah Chapman looks at the evidence behind various treatment options and the benefits of support. Evidently Cochrane 9 August 2022

Hip protectors: can they help break your fall and not your hip?
A blog about hip protectors for reducing the risk of fractures in older people who fall. Is there evidence about the benefits and harms, and do people like them? Evidently Cochrane 4 August 2022

Timed intercourse: can it help you get pregnant?
A blog about timed intercourse for those who are trying to get pregnant, with evidence and resources. Evidently Cochrane 3 August 2022



The ambulatory glucose profile and its interpretation
Continuous glucose monitoring (CGM) is rapidly becoming an integral adjunct in diabetes management. With increasing government recognition and federal funding, the ambulatory glucose profile (AGP) report will be increasingly utilised and clinicians will need to know how to interpret the AGP. The AGP report displays the key CGM metrics agreed on by multiple international consensus statements, as well as summary and daily glucose profiles. Components of the AGP including TIR and GMI will be increasingly used in trials. The AGP allows clinicians and people with diabetes to understand, assess and optimise diabetes management. MJA 8 August 2022



Role of human papillomavirus (HPV) vaccination on HPV infection and recurrence of HPV related disease after local surgical treatment: systematic review and meta-analysis
human papillomavirus (HPV) vaccination might reduce the risk of recurrence of CIN, in particular when related to HPV16 or HPV18, in women treated with local excision. GRADE assessment for the quality of evidence indicated that the data were inconclusive. Large scale, high quality randomised controlled trials are required to establish the level of effectiveness and cost of HPV vaccination in women undergoing treatment for diseases related to HPV infection. BMJ 3 August 2022

Which treatments are safe and effective to reduce intracranial pressure following severe traumatic brain injury?
What you need to know

  • A tiered approach using multiple interventions to reduce raised intracranial pressure and maintain adequate cerebral perfusion pressure is reasonable in severe traumatic brain injury
  • The effectiveness and safety of several common interventions is not known, because of a paucity of data from adequately powered, randomised controlled trials
  • Use your clinical judgment to balance the possible benefits and potential risks of treatments, and explore with patients and their loved ones what an acceptable outcome is, to guide decision making

BMJ 3 August 2022

A short course of antibiotics is effective for treating pneumonia in children
A three day course of amoxicillin was as effective as a seven day course for treating children with pneumonia. Children on the short course had a mild cough for longer than those on the long course, but the cough did not interfere with the child’s normal activities. This finding may prompt more widespread use of short courses of antibiotics for children with pneumonia. This will reduce antibiotic usage, which is needed to help prevent antibiotic resistance. The low dose was as effective as the high dose. But the researchers caution that the effective dose depends on whether bacteria are resistant to antibiotics. This finding might be more difficult to implement in practice, especially in countries which have higher levels of antibiotic resistance than in the UK. BMJ 3 August 2022

Heat illnesses in clinical practice
What you need to know

  • Increased frequency and intensity of heatwaves are leading to greater incidence of heat illness and exacerbations of heat sensitive disease (eg, cardiac, respiratory, renal, and mental health conditions) globally
  • People over 65, pregnant women, infants, young children, athletes, outdoor workers, those living in urban environments, patients with comorbidities, and those on certain medications are particularly at risk of heat related illness
  • The foundations of managing heat illnesses include recognising heat as a cause, removing patients from hot environments, and rapid cooling

BMJ 9 August 2022



Once-weekly Dulaglutide for the treatment of youths with Type 2 Diabetes
Treatment with dulaglutide at a once-weekly dose of 0.75 mg or 1.5 mg was superior to placebo in improving glycemic control through 26 weeks among youths with type 2 diabetes who were being treated with or without metformin or basal insulin, without an effect on BMI. NEJM 4 August 2022

Spina Bifida
Prevention and management of spina bifida have benefited from public health policy, modern surgical and imaging technology, and multidisciplinary approaches in partnership with the patient, family, and advocacy groups. Surgical correction of the defect is coupled with comprehensive care to achieve good clinical results and quality of life for affected patients as they progress from childhood to adulthood. NEJM 4 August 2022

Removal of small, asymptomatic kidney stones and incidence of relapse
The removal of small, asymptomatic kidney stones during surgery to remove ureteral or contralateral kidney stones resulted in a lower incidence of relapse than nonremoval and in a similar number of emergency department visits related to the surgery. NEJM 11 August 2022

Bronchiectasis — A clinical review
Clinical bronchiectasis is a heterogenous condition that manifests as a chronic cough in patients across the spectrum of age and sex. Areas for future work include the development of more rapid diagnostic methods and improved algorithms for the evaluation and treatment of patients with bronchiectasis. NEJM 11 August 2022



Cost-effectiveness of screening for Atrial Fibrillation using wearable devices
This economic evaluation of AF screening using a microsimulation decision-analytic model suggests that screening using wearable devices is cost-effective compared with either no screening or AF screening using traditional methods. JAMA 5 August 2022

Effectiveness of early time-restricted eating for weight loss, fat loss, and cardiometabolic health in adults with obesity : A randomized clinical trial
In this randomized clinical trial, eTRE was more effective for losing weight and improving diastolic blood pressure and mood than eating over a window of 12 or more hours at 14 weeks. JAMA 8 August 2022

Patient-centered pain care using artificial intelligence and mobile health tools : A randomized comparative effectiveness trial
The findings of this randomized trial indicated that AI-CBT-CP can achieve noninferior and possibly better outcomes relative to standard CBT-CP while increasing access and reducing therapist costs. JAMA 8 August 2022

Global prevalence and incidence of tinnitus: A systematic review and meta-analysis
This study suggests that the global burden of tinnitus is large, similar to migraine and pain, and the lack of effective treatment options justifies a major investment in research in this area. JAMA 8 August 2022


Other journals

Effect of lidocaine perioperative infusion on chronic postsurgical pain in patients undergoing thoracoscopic radical pneumonectomy
Perioperative infusion lidocaine significantly reduced the number of PCA triggers and the incidence of chronic postoperative pain at 3 months after the thoracoscopic radical pneumonectomy. BMC Anesthesiology 9 August 2022

Patient-controlled intravenous analgesia with opioids after thoracoscopic lung surgery: a randomized clinical trial
Given clinically relevant benefits detected, patient-controlled intravenous analgesia (PCIA) with oxycodone or hydromorphone is superior to sufentanil for achieving satisfactory analgesia with minimal emesis (SAME) as a supplement to multimodal analgesia in patients undergoing thoracoscopic lung surgery. BMC Anesthesiology 8 August 2022

A case study to investigate the impact of overcrowding indices in emergency departments
The effectiveness of both Emergency Department Working Index (EDWIN) and National Emergency Department Overcrowding Scale (NEDOCS) in measuring ED crowding and overcrowding was investigated, and the main differences and relationships in the use of the indices are highlighted. While both indices are useful ED performance metrics, they are not always interchangeable, and their combined use could provide more details in understanding ED dynamics and possibly predicting future critical conditions, thus enhancing ED management. BMC Emergency Medicine 9 August 2022

Long-haul COVID: healthcare utilization and medical expenditures 6 months post-diagnosis
This study found that COVID-19 diagnosis was associated with increased healthcare utilization and costs over a six-month post-diagnosis period. These findings imply a prolonged burden to the US healthcare system from medical encounters of COVID-19 patients and increased spending. BMC Health Services Research 8 August 2022

Oral lactase for infantile colic: a randomized double-blind placebo-controlled trial
Oral lactase treatment in infantile colic results in symptomatic relief in terms of shortening of duration of crying or fussing, and better parental satisfaction. BMC Pediatrics 3 August 2022

Clinical sepsis phenotypes in critically ill COVID-19 patients
Classification of critically ill COVID-19 patients into clinical phenotypes may aid prognostication, prediction of treatment efficacy, and facilitation of personalized medicine. Critical care 9 August 2022

Time-varying intensity of oxygen exposure is associated with mortality in critically ill patients with mechanical ventilation
PaO2 and FiO2 should be carefully monitored in patients with mechanical ventilation, especially during the early-middle course after ICU admission. Cumulative exposure to higher intensities of oxygen exposure was associated with an increased risk of death. Critical care 5 August 2022

Reducing the risk of viral contamination during the coronavirus pandemic by using a protective curtain in the operating room
The novel method of using a protective curtain can increase the safety of the surgical team during the surgery with a COVID-19 patient in the operating room. Patient safety in surgery 6 August 2022

The prevalence of perioperative iron deficiency anaemia in women undergoing caesarean section—a retrospective cohort study
Over one in three women were iron deficient at their first hospital appointment. 62% of women with moderate anaemia (Hb 80–109 g/L) also had iron deficiency. At least four in 10 women were anaemic (Hb < 130 g/L) on hospital discharge. Less than half of the women with anaemia were treated. Our data suggests that 30% of postoperative anaemia may be prevented with intensive treatment of iron deficiency in early pregnancy. Large prospective studies, are needed to determine outcomes after caesarean section in women, stratified by preoperative Hb and ferritin levels. The prevalence of anaemia in this data suggests it is a moderate public health problem. Perioperative medicine 4 August 2022

Machine learning-based prediction of emergency neurosurgery within 24 h after moderate to severe traumatic brain injury
Machine learning-based models could predict the need for emergency neurosurgery within 24 h after moderate and severe head injury. Potential clinical benefits of such models as a decision-making tool deserve further assessment. The performance in real-life setting and the impact on clinical decision-making of the model requires workflow integration and prospective assessment. World Journal of Emergency Surgery 3 August 2022


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Reporting on the health of culturally and linguistically diverse populations in Australia: An exploratory paper
This report explores the use of linked data to report on the health of CALD populations, including it’s benefits, challenges and limitations. It investigates each of the available CALD variables individually, using 3 health outcomes to explore differences between CALD groups within each CALD variable. AIHW 4 August 2022


Mental Health  I Bulletin for August 2022



Webinars (pre-recorded)

Spanish mental health nurses' experiences of mechanical restraint: A qualitative descriptive study
Journal of psychiatric and mental health nursing 20 July 2022
The use of restrictive practices, which can be perceived as counter-therapeutic, exposes nurses to risks such as moral injury and service users to broken trust in the therapeutic nurse patient relationship. Avoiding empathy in order to use mechanical restraint is counterproductive, in the understanding that empathy is key to reducing this intervention.

How do general hospitals respond to people diagnosed with a personality disorder who are distressed: A qualitative study of clinicians in mental health liaison Journal of psychiatric and mental health nursing 27 July 2022
This study identified unjust and avoidable differences in the care and treatment received by people diagnosed with a “personality disorder” in general hospitals. People with a “personality disorder” diagnosis were discriminated against and over- and under-medicated. Mental health liaison clinicians reported limited understanding and skills among general hospital clinicians. People working in general hospitals were fearful of the “personality disorder” diagnosis. Poor care was accepted because general hospital clinicians did not consider themselves to be “mental health trained.” 

Experience of antidepressant use and discontinuation: A qualitative synthesis of the evidence Journal of psychiatric and mental health nursing 17 June 2022
Those seeking treatment for depression need to be provided with treatment options and evidence-based information about anti-depressants to provide them with the opportunity to make informed choices. 

Humanization of care in acute psychiatric hospitalization units. Scoping Review Journal of psychiatric and mental health nursing 13 July 2022
Only one of the articles mentions the concept analyzed, although all of them contribute with key aspects of healthcare humanization, such as the empowerment of the patient, the care model, the staff ratio, the therapeutic relationship, the nursing time of direct dedication to the patient, the therapeutic environment, safety and patient and staff perception of feeling safe. The present study can help to improve the care offered in acute mental health units. 

Effects of peer‐delivered self‐management, recovery education interventions for individuals with severe and enduring mental health challenges: A meta‐analysis Journal of psychiatric and mental health nursing 18 July 2022 
With peer-delivered self-management interventions, individuals with severe and enduring mental health challenges could self-direct their care and reduce their reliance on service providers. 

Getting help as a depressed dad: A lived experience narrative of paternal postnatal depression, with considerations for healthcare practice Journal of psychiatric and mental health nursing 18 July 2022 
The needs of fathers are unmet. They require support which considers their gender role expectations. Partners are key to their help seeking. The language and sensitivity used by nurses is key to encouraging fathers to share their depression and reduce stigma around the condition. 

“My life isn't my life, it's the systems”: A qualitative exploration of women's experiences of day-to-day restrictive practices as inpatients Journal of psychiatric and mental health nursing 30 June 2022 
Although restrictive practices were found to provide the women with a sense of safety, they were also found to impact upon the women's well-being, leading to increases in self-harm and over-reliance on restrictions. This research highlights the importance of gender-informed inpatient services for women that foster independence, empowerment and allow women to have their voices heard. Safewards interventions such as clear mutual expectations and soft words could contribute to mitigating the impact of restrictive practices. 

Virtual reality-based training for mental health staff: a novel approach to increase empathy, compassion, and subjective understanding of service user experience Advances in simulation 19 July 2022
Virtual reality-based training has great potential for mental health staff, which could have important consequences in terms of improved staff empathy and reductions in harmful restrictive practices. Further research and funding for such training is necessary so that it can be more widely available. 

Occupational Therapy 
Different in so many ways: exploring consumer, health service staff, and academic partnerships  in a research advisory group through rapid ethnography
Australian journal of occupational therapy 24  July 2022 
Key Points for Occupational Therapy

  • Engagement with a research advisory group (RAG) is one way for occupational therapists to incorporate meaningful consumer and community involvement in research.
  • Authentic collaboration in a short-term RAG was a novel experience for consumers, health service staff, and academics and resulted in many individual, partnership, and study benefits.
  • Key success factors included careful RAG planning and recruitment, capable facilitation with support of a committed research team (inclusive of consumers), and empowering meeting processes and structures. 

How are you getting by? Coping in developmental coordination disorder versus attention-deficit/hyperactivity disorder British journal of occupational therapy 19 July 2022
Coping profiles highlight several noteworthy differences between Developmental Coordination Disorder (DCD) and ADHD which may be relevant for treatment. 

Psychotherapy within occupational therapy literature: A scoping review Canadian journal of occupational therapy 26 July 2022 
Occupational therapists have been writing about and practicing psychotherapy for nearly a century, yet there remains an important opportunity to develop and evaluate occupation-based psychotherapy approaches. Effectiveness studies are needed 

Adapt or die: how the pandemic made the shift from EBM to EBM+ more urgent BMJ evidences based medicine 19 July 2022
The authors propose that the tools and frameworks of mechanistic evidence, sometimes known as ‘EBM+’ when combined with traditional EBM, might be used to develop and evaluate the interdisciplinary evidence base needed to take us out of this protracted pandemic. Further articles in this series will apply pluralistic methods to specific research questions. 

The serotonin theory of depression: a systematic umbrella review of the evidence Molecular psychiatry 20 July 2022
The main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations. Some evidence was consistent with the possibility that long-term antidepressant use reduces serotonin concentration. 

Response to acute monotherapy for major depressive disorder in randomized, placebo controlled trials submitted to the US Food and Drug Administration: individual participant data analysis BMJ 2 August 2022
The trimodal response distributions suggests that about 15% of participants have a substantial antidepressant effect beyond a placebo effect in clinical trials, highlighting the need for predictors of meaningful responses specific to drug treatment. 

Impact of the COVID-19 pandemic on suicidal attempts and death rates: a systematic review BMC psychiatry 28 July 2022
Unexpected behavior changes during the COVID-19 pandemic may have contributed to the increasing trend of suicidal attempts reported. Domestic conflicts and violence, financial loss, anxiety and depression, and pre-existing mental health condition/s should be considered in preventing suicidal attempts and deaths secondary to the COVID 19 pandemic. Early detection and timely intervention for individuals with suicidal behavior is crucial and collated recommendations in the current study can be utilized for those preventive interventions. More systematic suicide risk screening process should be introduced who are at risk, along with an evidence base prevention approach. 

The evolution of charcoal-burning suicide: A systematic scoping review Australian and New Zealand journal of psychiatry 5 July 2022
More research is required to update the development and dynamic changes of charcoal burning suicide and the contributing factors. The evidence from this review may assist in detecting and intervening early for future novel suicide methods. 

Neural signatures of pain modulation in short-term and long-term mindfulness training: A randomized active-control trial The American journal of psychiatry 28 July 2022
Mindfulness training showed associations with pain reduction that implicate differing neural pathways depending on extent and context of practice. Use of neural pain signatures in randomized trials offers promise for guiding the application of mindfulness interventions to pain treatment.

Racial and ethnic differences in alcohol, cannabis, and illicit substance use treatment: a systematic review and narrative synthesis of studies done in the USA Lancet psychiatry 22 June 2022 
This Review explains the need for optimisation of RCTs to inform the design, delivery, and dissemination of treatment to historically excluded communities. 

Reliability of the term “Serious mental illness”: A systematic review Psychiatric services 27 July 2022 

  • This systematic review of 788 studies of samples of individuals with “serious mental illness” or “severe mental illness” (SMI) found that most studies did not provide any operational definition for these terms.
  • Among the 122 (15%) studies that defined SMI, substantial variation was found regarding criteria applied and diagnoses included.
  • This review demonstrates that the term “SMI” has poor reliability and validity across the empirical literature, and its use should be consistently defined in future research or suspended in the absence of clear operational definitions. 

The impact of the COVID-19 pandemic on the mental health of children with psychiatric diagnoses – multidimensional CCPCA Model BMC psychiatry 23 July 2022 
There is a need for further research in children and adolescents to develop effective strategies for protecting their mental well-being when faced with social isolation or disease. 

Non-genetic factors associated with psychotic experiences among UK biobank participants exposome-wide analysis and Mendelian randomization analysis JAMA psychiatry 20 July 2022
The findings of this study underscore the need for systematic approaches and triangulation of evidence to build a knowledge base from ever-growing observational data to guide population-level prevention strategies for psychosis. 

Effectiveness of interventions to improve medication adherence in adults with depressive disorders: a meta-analysis BMC psychiatry 20 July 2022 
These findings indicate that interventions aimed at improving adherence to medication among adults with depressive disorders are effective up to six months. However, the evidence on the effectiveness of long-term adherence is insufficient and supports the need for further research efforts. 

Web-based treatment for depression in pregnancy: a feasibility study of Mum2BMoodBooster BMC psychiatry 16 July 2022 
Findings paralleled the magnitude of symptom reductions seen in randomised trials of the postnatal MumMoodBooster program, suggesting that Mum2BMoodBooster is an effective treatment for depressed pregnant women. Effective internet therapies are likely to become increasingly important as the COVID-19 pandemic continues to make face-to-face access to health care problematic during ‘lockdowns’. 

Antipsychotics for schizophrenia spectrum disorders with catatonic symptoms Cochrane Database of Systematic Reviews 12 July 2022
The authors found only one small, short‐term trial suggesting that risperidone may improve catatonic and positive symptoms scale scores amongst people with schizophrenia spectrum disorders and catatonic symptoms, but that ECT may result in greater improvement in the first three weeks of treatment. Due to small sample size, methodological shortcomings and brief duration of the study, as well as risk of bias, the evidence from this review is of very low quality. The authors are uncertain if these are true effects, limiting any conclusions that can be drawn from the evidence. No cases of neuroleptic malignant syndrome were reported, but we cannot rule out the risk of this or other rare adverse events in larger population samples. 

Feasibility and effectiveness of deprescribing benzodiazepines and Z-drugs: systematic review and meta-analysis Addiction 11 July 2022 
It may be feasible to deprescribe benzodiazepines depending on the process and support mechanisms employed. 

A systematic review and meta-analysis of treatments for rapid cycling bipolar disorder Acta psychiatrica Scandinavica 20 July 2022 
While many interventions appeared efficacious, there was a lack of robust evidence for most treatments. Given the limited and heterogeneous evidence base, the optimal treatment strategies for people with RCBD are yet to be established. 

Review of the unprecedented impact of the COVID-19 pandemic on the occurrence of eating disorders Current opinion in psychiatry 25 July 2022
Although the ongoing COVID-2019 pandemic affected mental health globally, research shows that it particularly affected individuals with an ED diagnosis or at risk for an ED, especially women, children and adolescents, and those with anorexia nervosa.

The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review British Journal of psychiatry 11 July 2022
Sustained reductions in numbers of self-harm presentations were seen into the first half of 2021, although this evidence is based on a relatively small number of higher-quality studies. Evidence from low- and middle-income countries is lacking. Increased numbers of presentations among adolescents, particularly girls, into 2021 is concerning. Findings may reflect changes in thresholds for help-seeking, use of alternative sources of support and variable effects of the pandemic across groups. 

Post-COVID syndrome and adults with intellectual disability: another vulnerable population forgotten? British Journal of Psychiatry 29 June 2022
An area of interest presently is the lingering symptoms after COVID-19, i.e. post-COVID-19 syndrome (PCS). Specifics of diagnosis and management of PCS are emerging. However, vulnerable populations such as those with intellectual disabilities, who were disproportionately affected by the pandemic, risk being ‘left behind’ from these considerations. 

Predictors of longer-term depression trajectories during the COVID-19 pandemic: a longitudinal study in four UK cohorts Evidence based mental health journal July 28 2022 
Feeling lonely and isolated had a large effect on depression trajectories across all generations, while social distancing measures did not. 

How to measure mental pain: a systematic review assessing measures of mental pain Evidenced-based mental health 28 July 2022
There is not enough evidence of validity to recommend using one measure over others in research or clinical practice. Heterogeneous use of disparate measures across studies limits comparison and combination of their results in meta-analyses. Development by all stakeholders (especially patients) of a consensual patient-reported measure for mental pain is needed. 

Important adverse events to be evaluated in antidepressant trials and meta-analyses in depression: a large international preference study including patients and healthcare professionals  Evidenced-based mental health 29 July 2022 
These most important Non-serious adverse events  (NSAEs) should be systematically reported in antidepressant trials. 

Maternal Schizophrenia and the risk of a childhood chronic condition Schizophrenia Bulletin 28 July 2022
A child exposed to maternal schizophrenia is at elevated risk of chronic health conditions including mental and physical subtypes. Future research should examine what explains the increased risk  particularly for physical health conditions, and what pre-ventive and treatment efforts are needed for these children 

Changing the antipsychotic in early non-improvers to Amisulpride or Olanzapine: randomized, double-blind trial in patients with Schizophrenia Schizophrenia Bulletin 20 July 2022
Switching “non-improvers” from amisulpride to olanzapine or vice-versa increased remission rates and was safe. The superiority in the primary outcome was, however, not paralleled by significant differences in most secondary efficacy outcomes and the effect was only apparent at the last visit making replications of longer duration necessary.

Psychiatric emergencies during, after, and before the COVID-19 lockdown: what happened to our patients? A naturalistic observational study Annals of General Psychiatry 30 July 2022 
The present study aimed to analyze differences in ED admission for psychiatric consultation during three different phases of the COVID-19 health crisis in Italy. 

Metabolic and clinical profiles of young people with mood or psychotic disorders who are prescribed metformin in an inpatient setting Australasian Psychiatry 19 July 2022 
While metformin is prescribed to some youth with mood or psychotic disorders displaying markers of cardiometabolic disturbance, there is a need to develop clearer treatment guidelines for metformin in these youth. 

Health service use for mental health reasons in a cohort of people who use Methamphetamine experiencing moderate to severe anxiety or depression
International Journal of Mental Health and Addiction 25 July 2022
This study examined health service use for mental health reasons in a cohort of people who use methamphetamine and experience anxiety or depression. 

Mindfulness training in schools does not improve children’s mental health BMJ 25 July 2022
Teaching children mindfulness in schools seems like such a good idea. Surveys repeatedly show that mental health in children and young people is declining, so why not try to help build resilience at a crucial time in development, before problems arise? But an eight year study involving 28 000 children across 100 schools found that mindfulness had no effect on mental health and wellbeing across a range of measures. 

An empirical evaluation of The Resilience Shield model BMC Psychology 23 July 2022 
These results broadly support the multidimensional structure proposed by The Resilience Shield model and suggest that (at least in the population in which it was tested) this may be an acceptable model to index individuals’ performance on a range of indicators that contribute to resilience. 

Public health emergency and psychological distress among healthcare workers: a scoping review BMC public health 23 July 2022
There is a distinct lack of research examining organizational interventions addressing mental resilience and well-being in healthcare workers in disaster settings. A systematic review in this area would be low yield. There is a clear need for further research in this area. 

Bereavement & mental health: The generational consequences of a grandparent's death SSM mental health early view 2022 
Adjusted regression models show no elevated depression risk associated with a grandfather's death—neither for adolescents nor their mothers. A grandmother's death within the previous seven years is associated with a higher likelihood of adolescents having a depressed mother compared to both non-bereaved adolescents and those whose grandmother died more than seven years ago.. Furthermore, adolescent boys have a 50% increase in their depressive symptoms following a grandmother's death relative to their non-bereaved peers—an increase that operates independently from the influence of the death on their mother. Together, the results show the death of a grandmother is an underappreciated, persistent risk factor for adolescents experiencing maternal major depressive disorder, and for adolescent boys experiencing depressive symptoms personally 

Effects of group mindfulness-based cognitive therapy and group cognitive behavioural therapy on symptomatic generalized anxiety disorder: a randomized controlled noninferiority trial BMC psychiatry 19 July 2022 
These data indicate that Mindfulness-based cognitive therapy (MBCT-A) was noninferior to cognitive behavioural therapy (CBT-A) in reducing anxiety symptoms in generalized anxiety disorder (GAD) patients. Both interventions appeared to be effective for long-term benefits. 

Developing good practice indicators to assist mental health practitioners to converse with young people about their online activities and impact on mental health: a two-panel mixed-methods Delphi study BMC psychiatry 19 July 2022
Mental health practitioners could empower young people to exercise agency in relation to online safety and capitalise on positive features. Findings also identify training needs for practitioners. Further research should explore real-world application of the GPIs and transferability to underrepresented groups within our panels, such as males and younger children. Ethnicity and deprivation were not recorded. 

Predictive factors of Quality of Life in older adults during the COVID-19 pandemic BMC psychology 17 July 2022
It is recommended to pay close attention to divorced, lonely, and illiterate older people and those with low economic situation during the COVID-19 pandemic. 

The psychological and subjective experience of catatonia: a qualitative study BMC psychology 15 July 2022
The common themes that emerged from this study were overwhelming anxiety, fear, and depression. These were found to occur frequently in patients with catatonia when describing their psychological experience. These experiences may possibly relate to the flight, fight, freeze and fawn response, as described in prior studies on the subjective experience of catatonia. 

The use of borderline personality disorder severity index-iv feedback in adjusting borderline personality disorder treatment: therapists and patients perspectives BMC psychology 14 July 2022
Experiences of both patients and therapists with the Borderline Personality Disorder Severity Index-IV (BPDSI-IV) were positive. It seems to be valuable and promising for healthcare institutions to evaluate treatment with a disorder specific ROM instrument. 

Adolescent experience of radically open dialectical behaviour therapy: a qualitative study BMC psychiatry 14 July 2022
Radically Open Dialectical Behaviour Therapy (RO DBT) is perceived as a relevant and beneficial new treatment for adolescents with maladaptive overcontrol. The broad treatment focus is perceived as unique and of particular benefit. It is reported to help with general and social functioning and foster cognitive and behavioural flexibility. Nevertheless, the amount and complexity of material was felt to be very large by some and may suggest the need for modified adolescent-specific materials.

Goal setting with young people for anxiety and depression: What works for whom in therapeutic relationships? A literature review and insight analysis BMC psychology 14 July 2022
Whilst the resultant sample is small, emphasis on the voices of young people in the research is both prominent and of paramount importance. Several key literature gaps are identified, including evidenced links to the reduction in symptoms. Priority must be given to researching unhelpful mechanisms of goal setting for young people experiencing anxiety and/or depression, to avoid any potential iatrogenic effects. 

Cognitive behavioural therapy (group) for schizophrenia Cochrane Database of Systematic Reviews  – Intervention 12 July 2022 
Group CBTp appears to be no better or worse than standard care or other psychosocial interventions for people with schizophrenia in terms of leaving the study early, service use and general quality of life. Group CBTp seems to be more effective than standard care or other psychosocial interventions on overall mental state and global functioning scores. These results may not be widely applicable as each study had a low sample size. Therefore, no firm conclusions concerning the efficacy of group CBTp for people with schizophrenia can currently be made. More high‐quality research, reporting useable and relevant data is needed. 

The role of sense of coherence and loneliness in borderline personality disorder traits: a longitudinal twin study Borderline personality disorder and emotion dysregulation 1 August 2022
These findings indicate that the weaker sense of coherence (SOC), the stronger feelings of loneliness, and the negative life events associated with BPD traits are mainly consequences of the genetic aspects of BPD traits, rather than having direct effects on levels of BPD symptoms. 

Social work
Teaching mental health social work: What are we preparing students for? Australian social work 17 July 2022 

  • International calls for transformative approaches to mental health present opportunities for enhanced recognition of the social justice orientation of social work.
  • The absence of an accreditation requirement to address social work practice with people who live with severe mental distress or low prevalence mental health conditions might prove a regrettable gap in Australian Social Work Education Accreditation Standards 2021.
  • Further collegial discussion and debate about the beneficial outcomes of mental health social work curricula are desirable.

Telehealth for social interventions with adolescents and young adults: diverse perspectives Australian social work 17 July 2022

  • Perspectives of adolescents, young adults, and youth workers intersect to provide a unique understanding of telehealth in a specific context.
  • There is scant literature on the use of telehealth as a social work practice modality, specifically with adolescents, young adults and their families. This article attempts to fill this gap by providing an early look at the experiences of telehealth during the first two waves of the COVID-19 pandemic in Québec, Canada. 

Aboriginal cultural safety: A case study of collaborative practice at the intersection of family violence and child protection Australian social work 17 July 2022 

  • Collaboration between Aboriginal services and child protection organisations can be complex and challenging, especially due to the historical and continued discrimination experienced by Aboriginal people.
  • ulturally safe collaboration is enabled through building sustainable relationships; shared understandings and accountability between agencies; redressing of unequal relationships, structures, and outcomes; and respect for Aboriginal ways of working. 

The lived experience of severe mental illness and long-term conditions: a qualitative exploration of service user, carer, and healthcare professional perspectives on self-managing co-existing mental and physical conditions BMC psychiatry 17 July 2022
The demands of living with severe mental illness (SMI) present a substantial barrier to self-management for multiple co-existing long-term conditions (LTCs). It is important that people with SMI can access person-centred, tailored support for their LTCs that takes into consideration individual circumstances and priorities. 

Service needs of clients before and after short term community mental health case management Community mental health journal 17 July 2022
This study evaluated level of service need before and after a short-term community mental health case management intervention from the perspective of both clients and case managers. 

Perspectives regarding medications for opioid use disorder among individuals with mental illness Community mental health journal 29 July 2022
Most people with co-occurring opioid use disorder (OUD) and mental illness do not receive effective medications for treating OUD. 

Experiences of mental health care among women treated for postpartum psychosis in England: A qualitative study Community mental health journal 28 July 2022
Postpartum psychosis has been found to affect 0.89–2.6 per 1000 women. Onset is typically rapid and severe. Early recognition and appropriate treatment are crucial for a good prognosis. The aim in this study was to understand women’s experiences of mental health care and services for psychosis in the postnatal period. 

Social workers’ attitudes toward evidence-based practice: The mediating role of work-related self-efficacy Social work research 23 July 2022
The aim of the current study was to explore the mediating role of work-related self-efficacy in the association between organizational context variables (workplace social support, accessibility of work-related data and information resources, and role ambiguity) and social workerss’ attitudes toward adoption of evidence-based practice (EBP). 

National study of mental health and wellbeing
Key statistics

  • Over two in five Australians aged 16-85 years (43.7% or 8.6 million people) had experienced a mental disorder at some time in their life
  • One in five (21.4% or 4.2 million people) had a 12-month mental disorder
  • Anxiety was the most common group of 12-month mental disorders (16.8% or 3.3 million people)
  • Almost two in five people (39.6%) aged 16-24 years had a 12-month mental disorder 

Suicide & self-harm monitoring (AIHW)
The National Suicide and Self-harm Monitoring System (the System) has been established as part of the national effort to address suicide and self-harm in Australia. The system will improve the quality, accessibility and timeliness of data on deaths by suicide and on self-harming and suicidal behaviours. It aims to provide a better understanding of suicide and self-harm in Australia by:

  • explaining the nature and extent of suicidal and self-harming behaviours
  • improving the quality and breadth of data available to help identify trends, emerging areas of concern and to inform responses
  • highlighting those at increased risk. 

Mental health services in Australia (AIHW) 
Mental health services in Australia (MHSA) provides a picture of the national response of the health and welfare service system to the mental health care needs of Australians. MHSA is updated progressively throughout each year as data becomes available. 

Webinars (pre-recorded) 
Psychological safety and window of tolerance (Turning point)

  • Understand the nervous system from a Polyvagal Theory perspective
  • Learn strategies to support window of tolerance awareness in self and others
  • Learn the basic principles of Psychological Safety and how to practice in your workplace 

The factors influencing mental health diversion in the NSW Local Courts (NDARC)
Synopsis This webinar presented results from three studies examining factors magistrates consider when diverting people from court into treatment

How science has offered hope for treatment-resistant depression (National Institute of Mental Health – US)
Synopsis: In 2019, FDA approved esketamine – a potent, intranasal form of ketamine – which has been shown to act almost immediately to relieve depressive symptoms in many patients with this type of treatment-resistant depression.


Bulletin for July 2022


Online resources 
Significant dates 
Webinars (pre-recorded)


Addiction and support

Review of cannabis use among Aboriginal and Torres Strait Islander people Journal of Australian Indigenous Healthinfonet Vol 3(3) 2022
While generalising findings about cannabis use for Aboriginal and Torres Strait Islander people is problematic due to limited data, high rates of cannabis use have been found in some remote communities. The review highlights the protective factors that reduce harms from cannabis use and suggests future directions for a collaborative approach to addressing cannabis related harms in communities

Doing “deadly” communitybased research during COVID19: the Which Way? Study MJA 18 July 2022 
An Indigenousled study aims to empower and support Aboriginal and Torres Strait Islander women to be smokefree

Closing the gap

Strategies to support sustained participant engagement in an oral health promotion study for Indigenous children and their families in Australia International journal environmental research and public health 1 July 2022 
Creating partnerships between researchers and Indigenous communities is key in developing research studies that are culturally appropriate, acceptable and relevant to the needs of Indigenous peoples. Baby Teeth Talk was a randomised controlled trial conducted with Indigenous children and their mothers in South Australia that tested an intervention involving dental care, anticipatory guidance on oral health and dietary intake, and motivational interviewing

The role of chronic disease in the disparity of influenza incidence and severity between indigenous and non-indigenous Australian peoples during the 2009 influenza pandemic BMC public health 5 July 2022
Higher rates of influenza infection was observed amongst those Indigenous compared to non-Indigenous Australians, and this difference was preserved amongst those with a chronic condition. However, there was no further increase in prevalence of more severe influenza outcomes amongst Indigenous Australians with a chronic condition. This suggests that the prevalence of chronic disease, rather than Indigenous status, affected influenza severity. Other factors may be important, including presence of multiple morbidities, as well as social and cultural determinants of health.

Oral health promotion and programming provided by Aboriginal Community Controlled Health Organisations in South Australia Health promotion journal of Australia 17 July 2022 
The evidence explored highlights the integral role ACCHOs play in oral health promotion and service delivery. It is critically important that ACCHOs are involved in development and implementation of oral health services to ensure programming reflects community knowledge and is effective in improving oral health equity.

Improving access to cancer treatment services in Australia’s Northern Territory—history and progress International journal environmental research and public health 23 June 2022 
Future efforts in the NT should focus on increasing and improving travel assistance and support and increasing the availability of appropriate accommodation; ongoing implementation of strategies to improve recruitment and retention of health professionals working in cancer care, particularly Indigenous health professionals; and expanding the use of telehealth as a means of delivering cancer care and treatment.

Models and interventions to promote and support engagement of First Nations women with maternal and child health services: An integrative literature review Children 28 April 2022
Timely, effective, holistic engagement with First Nations women during their child’s first 2000 days, which respects their culture and facilitates genuine partnerships built on co-design and shared decision making with the indigenous community, needs to be an essential part of the MCH service model if health care providers seek to practice within First Nations communities. Conclusion: Improving engagement with MCH services is important for First Nations families, nursing practice, and public health.

Holistic antenatal education class interventions: a systematic review of the prioritisation and involvement of Indigenous Peoples’ of Aotearoa New Zealand, Australia, Canada and the United States over a 10-year period 2008 to 2018 Archives of public health 14 July 2022
Given that Indigenous Peoples were absent from the majority of studies examined in this review, it is clear little consideration is afforded to the antenatal health needs and aspirations of Indigenous Peoples of Aotearoa New Zealand, Australia, Canada and the United States. To address the stark antenatal health inequities of Indigenous Peoples, targeted Indigenous interventions that consider culture, language, and wider aspects of holistic health must be privileged.

Aboriginal patients driving kidney and healthcare improvements: recommendations from South Australian community consultations ANZ journal of public health 7 July 2022
Aboriginal community members have strong and clear recommendations for improving the quality and responsiveness of health care generally, and kidney care specifically. Implications for public health: Aboriginal people with lived experience of chronic conditions wish to significantly inform the way care is organised and delivered.

Interrogating the intentions for Aboriginal and Torres Strait Islander health: a narrative review of research outputs since the introduction of Closing the Gap MJA 10 June 2022

  • Despite the “best of intentions”, Australia has fallen short of federal targets to close the gap in disproportionate health outcomes between Aboriginal and non-Aboriginal Australians.
  • The authors examined 2150 original research articles published over the 12-year period (from 2008 to 2020), of which 58% used descriptive designs and only 2.6% were randomised controlled trials. There were few national studies. Studies were most commonly conducted in remote settings (28.8%) and focused on specific burdens of disease prevalent in remote areas, such as infectious disease, hearing and vision. Analytic observational designs were used more frequently when addressing burdens of disease, such as cancer and kidney and urinary, respiratory and endocrine diseases.
  • The largest number of publications focused on mental and substance use disorders (n = 322, 20.5%); infectious diseases (n = 222, 14.1%); health services planning, delivery and improvement (n = 193, 33.5%); and health and wellbeing (n = 170, 29.5%).
  • This review is timely given new investments in Aboriginal health, which highlights the importance of Aboriginal researchers, community leadership and research priority. The authors anticipate future outputs for Aboriginal health research to change significantly from this review, and join calls for a broadening of our intellectual investment in Aboriginal health.


A comparison of rural Australian First Nations and Non-First Nations survey responses to COVID-19 risks and impacts: implications for health communications BMC public health 30 June 2022 
Health risk communication in pandemic response should include an equitable focus on rural areas, recognising that First Nations Australians are a significant proportion of the rural population with different risk factors and concerns than those of non-First Nations Australians. This principle of First Nations-led design is critical to all health policy and planning. The Australian Government should include rural areas in planning pandemic responses, recognising that First Nations populations are a significant proportion of the rural population creating syndemic conditions.


Prevalence and incidence of diabetes among Aboriginal people in remote communities of the Northern Territory, Australia: a retrospective, longitudinal data-linkage study BMJ open 15 May 2022
he burden of diabetes in the remote Aboriginal population of the NT is among the highest in the world. Strengthened systems of care and public health prevention strategies, developed in partnership with Aboriginal communities, are needed.

Population health and research

Establishing an enduring co-production platform in Aboriginal health Public health research and practice Vol 32(2) 2022
This paper highlights three initiatives driven through the co-production platform: 1) examining how local mental health service systems are working for Aboriginal children and young people and how they can be improved; 2) understanding how the cancer care system is working for older Aboriginal people to develop scalable and sustainable approaches to improving cancer care; and 3) finding effective ways to measure the impact of innovative, Aboriginal-led primary health care programs. These initiatives represent co-produced, fit-for-purpose research aimed at driving tangible improvements in Aboriginal health.

Applying collective impact in Aboriginal health services and research: three case studies tell an important story Public health research and practice Vol 32(2) 2022 
Aboriginal and Torres Strait Islander health is an important public policy priority that requires new and different approaches to service delivery and research. This study adapted the collective impact approach and developed the Rambaldini model through three translational health research case studies and found that a modified collective impact approach is an effective tool for engagement and outcomes.

Climate, housing, energy and Indigenous health: a call to action MJA 4 July 2022
Indigenous leadership at all levels, from community to state to federal, is fundamental to ensuring that housing solutions are designed and controlled by the people who will call these dwellings home. Health professionals are well positioned to advocate for Indigenous
led multisectoral approaches to comprehensively address the need for healthy and safe living conditions in a warming climate.

Clinical yarning with Aboriginal and/or Torres Strait Islander peoples—a systematic scoping review of its use and impacts Systematic reviews 24 June 2022
Whilst clinical yarning may be a culturally appropriate intervention in healthcare, there are limited studies that have measured the impact of this intervention. Further research may be needed to ascertain the true benefits of this intervention.

Early childhood development practices in a remote Aboriginal Community Controlled Health Services setting The Australian Journal of Rural Health 9 July 2022
This study provides insight into ECD practices in an ACCHS setting, highlighting the potential of primary health care to have an enhanced role in ECD if appropriate systems, training and tools are provided. A lack of role clarity across services, combined with poor communication between services, creates a potential risk for missed opportunities to support ECD.

Online resources
Climate, housing, energy and Indigenous health
MJA Podcasts  Episode 26  2022 

Dr Simon Quilty is a public health physician from the National Centre for Epidemiology and Population Health at ANU. Mr Norman Jupurrurla is a Warumungu Elder and Director of the Julalikari Council Aboriginal Corporation in Tennant Creek, in the Northern Territory. They talk about climate, housing, energy and their impacts on Indigenous health

National Aboriginal and Torres Strait Islander health worker Association (NAATSIHWP) preferred terminology 
This document outlines the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP’s) preferred terminology when writing about the members of their organisation or the Aboriginal and Torres Strait Islander peoples and communities they provide care for.

National best practice unit for tackling Indigenous smoking (Factsheet) 
This factsheet provides key information for Tackling Indigenous Smoking (TIS) Workers about how to assess the strength of partnerships. TIS funded organisations report on collaborations and partnerships under Program Indicator 2.

The factsheet includes:

  • a template for a partnership survey that TIS teams and their partner organisations can use to identify their strengths and how they can improve their partnerships
  • questions that can be used to discuss partnerships with partner organisations.

Supporting Aboriginal and Torres Strait Islander women to live smoke-free (MJA podcasts) 
Dr Michelle Kennedy from the University of Newcastle, and Dr Raglan Maddox from ANU are coauthors, codesigners and co-owners of research published in the MJA Supplement, Indigenous-led evidence to inform smoking cessation care for Aboriginal and Torres Strait Islander women.

Protect your mob
Protect your mob is an online resource for Aboriginal and Torres Strait Islander people that provides information about the risk of influenza (the flu), COVID-19 and pneumonia over winter.

The resource provides answers to the following questions:

  • What is the flu?
  • What are symptoms of the flu?
  • Am I eligible for a free flu vaccine?
  • When should I get a flu vaccine?
  • Why do I need the flu vaccine every year?
  • What type of flu vaccine will I get?
  • When can I get a COVID-19 vaccine?
  • Where do I get a COVID-19 vaccine?
  • What is pneumococcal pneumonia (pneumonia)?
  • Am I eligible for a free pneumonia vaccine?
  • Do I need a pneumonia vaccine every year?

The resource additionally provides information on:

  • symptoms of the flu
  • symptoms of pneumonia
  • COVID-19 for Aboriginal and Torres Strait Islander people
  • steps that can be taken to reduce the spread of the flu, COVID-19 and the common cold
  • accessing Lung Foundation Australia‘s Lung health checklist.

Racism. It stops with me 
Racism. It Stops With Me is a national campaign that provides tools and resources to help people and organisations learn about racism and take action to create change.


Protective and risk factors for suicide among Indigenous Australians (AIHW) 
This report outlines protective and risk factors that contribute to suicide among Aboriginal and Torres Strait Islander people, as well as the existing data collections and methods used for measuring protective and risk factors for suicide.

National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework and Implementation Plan 2021–2031 
Co-designed with Aboriginal and Torres Strait Islander people, this plan's target is for First Nations people to be fully represented in the health workforce by 2031. It includes actions to attract, recruit and retain workers across all roles, levels and locations within the health sector.

Justice policy partnership work plan 2021-2022 (Australian Government Attorney-General’s Department) 
The Justice Policy Partnership work plan 2021-2022 details the actions to be taken to build a foundation for Aboriginal and Torres Strait Islander justice policy partners (JPPs) to work together with governments in genuine partnership.

Cultural safety in health care for Indigenous Australians: monitoring framework (AIHW) 
The Cultural safety in health care for Indigenous Australians: monitoring framework brings together available data to assess progress in achieving cultural safety in the health system for Indigenous Australians. The framework includes measures on culturally respectful health care services; Indigenous patient experience of health care; and access to health care services. The data are presented at the national, state and regional levels.

Aboriginal homelessness: An Aboriginal cultural safety framework for the specialist homelessness sector (Council to Homeless Persons) 
This report responds to the priorities of Manan-na worn-tyeen maar-takoort and the Specialist Homelessness Services (SHS) Transition Plan.  The SHS Framework provides an organisational planning framework, program logic and reflection tool that enable a systematic way of working toward Aboriginal and Torres Strait Islander cultural safety.

Ear and hearing health of Aboriginal and Torres Strait Islander people 2021 (AIHW)
This is the first national report on the ear and hearing health of Aboriginal and Torres Strait Islander children and adults. The report brings together information on the prevalence of ear and hearing problems together with an understanding of key protective and risk factors.

Significant dates

National Aboriginal and Torres Strait Islander Children’s Day
4 August 2022 

Synopsis: Children’s Day is a celebration of Aboriginal and Torres Strait Islander children’s strength and culture and is held annually on 4 August. It is an opportunity to show support for Aboriginal and Torres Strait Islander children, as well as learn about the crucial impact that culture, family and community play in the life of every Aboriginal and Torres Strait Islander child.

International Day of the World’s Indigenous People 
When: 9 August 2022 
Synopsis The International Day of the World’s Indigenous People was first proclaimed by the United Nations (UN) General Assembly by resolution (A/RES/49/214) of 23 December 1994 and shall be observed on 9 August each year. The date marks the day of the first meeting held in 1982 of the UN Working Group on Indigenous Populations of the Sub-Commission on the Promotion and Protection of Human Rights.


Ethical Research and Aboriginal Community Controlled Organisations
 Thu., 4 August 2022 2:00 pm – 3:00 pm AEST 

Synopsis In this webinar, the first in the Yuwaya Ngarra-li Webinar Series, you will hear from key Yuwaya Ngarra-li partnership staff and Aboriginal researchers who collaborate with us across UNSW and Walgett. The themes and questions explored in this discussion will illustrate the importance of working with Aboriginal Community-Controlled Organisations in conducting ethical research with Aboriginal Communities in the context of the Yuwaya Ngarra-li partnership with the Dharriwaa Elders Group.

Webinars (Pre-recorded)
Deadly Liver Mob: engaging Aboriginal people in viral hepatitis, HIV and sexual health services (University of New South Wales Social Policy Research Centre)
Synopsis: This is a recording of the webinar Deadly Liver Mob: engaging Aboriginal people in viral hepatitis, HIV and sexual health services which aims to provide an overview of the Deadly Liver Mob program.

It covers:

  • how the Deadly Liver Mob program started
  • the impact it has for Aboriginal communities
  • the government’s involvement
  • how it has been adapted to various settings
  • evaluation
  • how to implement it.

Self-determination by First Nations Australians in alcohol policy (NDRI) 
Synopsis: First Nations Australians have a strong history of developing community-controlled responses to alcohol and other drug issues. Growing evidence shows that inclusion in decisions over one’s life – self-determination – can contribute to improved wellbeing; while decisions that are imposed have detrimental impacts and contribute to the cycle of poorer health and wellbeing. This study has explored how First Nations Australians’ self-determination can be recognised and evidenced in the development of alcohol policy in the Northern Territory.


Bulletin for 1 August 2022



Webinars (pre-recorded)



Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020 The Lancet 16 July 2022 
There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. 

How alcohol makes the epigenetic clock tick faster and the clock reversing effect of abstinence Addiction biology 30 June 2022 
This study investigated the recently reported association between alcohol dependence and accelerated ageing and the potential effects of abstinence and relapse on DNA methylation status using Levine's epigenetic clock to estimate DNA methylation age in two independent cohorts. 

Scoping review of managed alcohol programs Harm reduction journal 25 July 2022
The growing literature showcases several outcomes of interest, with increasing efforts aimed at systematic measures by which to determine the effectiveness and potential risks of managed alcohol program (MAP). Based on a harm reduction approach, MAPs offer a promising, targeted intervention for individuals with severe AUD and experiencing homelessness. Research designs that allow for longitudinal follow-up and evaluation of health- and housing-sensitive outcomes are recommended. 

WHO concludes there’s “no place for cheap alcohol” BMJ 22 July 2022 
Minimum unit pricing is an effective tool against alcohol harms 

Associations between moderate alcohol consumption, brain iron, and cognition in UK Biobank participants: Observational and mendelian randomization analyses Plos one 14 July 2022 
To the best of the author’s knowledge, this study represents the largest investigation of moderate alcohol consumption and iron homeostasis to date. Alcohol consumption above 7 units weekly associated with higher brain iron. Iron accumulation represents a potential mechanism for alcohol-related cognitive decline 

Impact of wine bottle and glass sizes on wine consumption at home: a within and between households randomised controlled trial Addiction 18 July 2022
Using smaller glasses to drink wine at home may reduce consumption. Greater uncertainty remains around the possible effect of drinking from smaller bottles. 

Predicting severe alcohol use disorders in primary care using number of heavy drinking days Addiction 18 July 2022
Five or more heavy drinking days in a 3-month period may indicate heightened risk of future severe alcohol use disorder in an adult primary care population. The optimal thresholds are lower for women than for men, and thresholds decrease as women age but increase as men age. 

Pain catastrophizing is associated with increased alcohol cue-elicited neural activity among individuals with alcohol use disorder Alcohol and alcoholism 5 July 2022
Greater pain catastrophizing is associated with greater cue-induced neural activation in brain regions sub-serving habits and compulsive alcohol use. These findings provide initial support for a neural mechanism by which pain catastrophizing may drive alcohol craving among individuals with AUD. 

Written information and health professionals are the information sources about alcohol use in pregnancy most often used by pregnant women Drug and alcohol review 11 July 2022 
Antenatal providers should routinely provide information on alcohol use in pregnancy, including for women least likely to access available information. 


Use of electronic cigarettes among cannabis-naive adolescents and Its association with future cannabis use JAMA 22 July 2022
This cohort study’s findings suggest a strong association between adolescent e-cigarette use and subsequent cannabis use. However, despite the strong association at the individual level, e-cigarette use seems to have had a minimal association with the prevalence of youth cannabis use at the population level. 

Online information on medical cannabis is not always aligned with scientific evidence and may raise unrealistic expectations Journal of cannabis research 11 July 2022 
The authors conclude that the information that can be found online is not always aligned in terms of the therapeutic areas for which science-based evidence is often still weak. 

Medical cannabis use in Australia: consumer experiences from the online cannabis as medicine survey 2020 (CAMS-20) Harm reduction journal 30/7/2022
There has been a notable shift from illicit to prescribed MC by many consumers compared to prior surveys. Consumers using prescribed MC reported a range of advantages compared to illicit MC, including safer routes of administration, and greater certainty regarding access and composition of products. 

Emotion regulation in substance use disorders: A systematic review and meta-analysis Addiction 19 July 2022
People with substance use disorders appear to have greater difficulties in emotion regulation than people without substance use disorders. 

Posttraumatic stress disorder strengthens the momentary associations between emotion dysregulation and substance use: a micro-longitudinal study of community women experiencing intimate partner violence Addiction 6 July 2022
Women experiencing intimate partner violence with higher levels of negative dysregulation relative to others may use more alcohol and be more likely to use drugs. Women experiencing intimate partner violence with higher levels of positive dysregulation relative to others may use more cigarettes. Women experiencing intimate partner violence who also have posttraumatic stress disorder may be more likely to use drugs when experiencing momentary elevated levels of positive emotion dysregulation than those who do not also have posttraumatic stress disorder. 


Parents of adult children with drug addiction dealing with shame and courtesy stigma Drugs, education prevention and policy 19 July 2022
The study aims to provide insight into the lives of parents to adult children with drug addiction. 

“Just be there”: Desired partner behaviors among pregnant people living with opioid use disorder, a qualitative study Journal of addiction medicine early view 2022 
Additional input from pregnant people and partners in future projects can build on these findings and guide the creation and assessment of comprehensive interventions to improve care for pregnant people with OUD. 

Harm reduction

Implementation and sustainability of safe consumption sites: a qualitative systematic review and thematic synthesis Harm reduction journal 5 July 2022 
This thematic synthesis of qualitative literature identified engagement of people who use drugs (PWUD) and additional factors that appear to support safe consumption sites (SCS) planning and operations and are critical to implementation success. However, the existing qualitative literature largely lacked perspectives of SCS staff and other community members who might be able to provide additional insight into factors influencing the implementation and sustainability of this promising public health intervention. 

The challenges, opportunities and strategies of engaging young people who use drugs in harm reduction: insights from young people with lived and living experience Harm reduction journal 26 July 2022
In this paper, the authors identify and discuss issues in youth engagement, and offer recommendations for the future of harm reduction. 

Are you tripping comfortably? Investigating the relationship between harm reduction and the psychedelic experience Harm reduction journal 25 July 2022
This research helps to understand how engagement in harm reduction may increase with experience. The mixed methods data shed light on the perceived importance of different harm reduction practices and examine their association with the psychedelic experience itself. Together, this research has important implications for the development of psychedelic harm reduction advice and provides opportunities for future research to explore the importance of these different practices in more detail. 

Responding to a surge in overdose deaths: perspectives from US syringe services programs Harm reduction journal 19 July 2022
Syringe services programs (SSPs) remain essential in preventing overdose deaths amid record numbers likely driven by increased fentanyl use and COVID-19-related impacts. These findings can inform efforts to support SSPs in this work. In the face of ongoing barriers, support for SSPs—including increased resources, political support, and community partnership—is urgently needed to address the worsening overdose crisis. 

Population health

Illicit drug use and male barroom aggression among members of the Australian construction industry: Associations with personality and masculinity factors Drug and alcohol review 14 June 2022 
The use of amphetamine-type stimulants is a risk-factor for MBA perpetration, as are key personality traits such as aggressiveness and narcissism. Most aspects of masculinity, including male honour, were either unrelated to or protective against involvement in physical violence in bars, clubs or pubs. 

Impact of COVID-19 among people who use drugs: A qualitative study with harm reduction workers and people who use drugs Harm reduction journal 3 July 2022
This study highlighted critical systemic failures that contributed to the rise in overdose deaths during the COVID-19 pandemic. Addressing these challenges through policy reform and improved funding models will ensure the sustainability of harm reduction services and increase access to substance use treatment among highly vulnerable people who use drugs. 

Familial associations in adolescent substance use disorder: a population-based cohort study Addiction 29 June 2022
A family history of substance use disorder in parents or older siblings appears to be associated with increased SUD risk in adolescents. 

Substance use in the emergency department: Screening for risky drug use, using the ASSIST-Lite Drug and alcohol review 22 July 2022
The rate of risky illicit and polysubstance use found here highlight the need more focused research in ED settings. The findings also provide support for more routine screening, and early intervention approaches; and suggest the need for active referral pathways through an alcohol and other drug consultation liaison service. 


Association between exposure to tobacco content on social media and tobacco use: A systematic review and meta-analysis JAMA 11 July 2022
Findings suggest that a comprehensive strategy to reduce the amount of tobacco content on social media should be developed by federal regulators; such actions may have downstream effects on adolescent and young adult exposure to protobacco content, and ultimately tobacco use behaviors. 

What differentiates youths who use e-cigarettes from those who smoke traditional tobacco products? BMC public health 15 July 2022 
Adolescents who only used e-cigarettes had intermediate levels of risk compared to nonusers and those who used tobacco and/or e-cigarettes, suggesting that e-cigarettes use extends to young people at low-risk of using tobacco products. 

Failure to enforce e-cigarette regulation now will fail us all MJA Insight 18 July 2022
(Opinion piece) If we fail to act now – as a matter of urgency – to enforce the regulation designed to support prescription access to e-cigarettes, we will fail to protect the health of current and future generations of Australians

Assessment of formal tobacco treatment and smoking cessation in dual users of cigarettes and e-cigarettes BMJ Thorax 20 July 2022
These results suggest that dual users of cigarettes and e-cigarettes benefit from formal tobacco treatment. Clinicians should consider offering formal tobacco treatment to such patients, though future trials are needed.

Impact of vaping on respiratory health BMJ 18 July 2022 
The aurthors review the clinical manifestations of vaping related lung injury, including the EVALI outbreak, as well as the effects of chronic vaping on respiratory health and covid-19 outcomes. They conclude that vaping is not without risk, and that further investigation is required to establish clear public policy guidance and regulation. 

Standardised cigarettes: the next step for tobacco policy? Tobacco control 29 June 2022
As tobacco marketing restrictions intensify, tobacco companies increasingly turn to the cigarette product itself as a marketing medium with new flavours, capsules, novelty filter features and attractive cigarette stick designs. This paper considers a ‘standardised cigarettes’ policy as a potential next step in restricting tobacco marketing. This policy would remove from cigarette products all the elements that increase their appeal and addictiveness: added flavours, nicotine, and visual designs and branding. The result would be a cigarette that is flavourless, not especially addicting, and visually off-putting. This paper discusses what a standardised cigarettes policy might look like from a regulatory standpoint, and how it fits into current policy obligations under the WHO Framework Convention on Tobacco Control. 

Smoking is associated with increased risk of cardiovascular events, disease severity, and mortality among patients hospitalized for SARS-CoV-2 infections Plos one 15 July 2022
Independent of sociodemographic characteristics and medical history, smoking was associated with a higher risk of severe COVID-19, including death. 


The right to health and the right to tobacco harm reduction (Global State of Tobacco Harm Reduction (GSTHR) – UK)
This Briefing Paper highlights the importance of developing a right to health and a right to harm reduction narrative and indicates the opportunities for human rights challenges. It argues that international human rights law supports tobacco harm reduction. 

Australia’s attitudes and perceptions towards drugs by region, 2019 (AIHW) 
This report presents new analysis from the 2019 National Drug Strategy Household Survey (NDSHS) that focuses on the attitudes and perceptions of people across Australia on various drug-related issues. The interactive data map allows people to select a region to see what people who responded to the survey thought about tobacco smoking, alcohol use, cannabis, and other illicit drugs in 2019. 

National Drug Strategy Household Survey 2019 (AIHW) 
The 2019 National Drug Strategy Household Survey report showed that:

  • fewer Australians are smoking tobacco daily, while the use of e-cigarettes is increasing
  • more Australians are giving up or reducing their alcohol intake, driven by health concerns
  • rates of substance use are falling among younger generations (less likely to smoke, drink and use illicit drugs)
  • non-medical pharmaceutical use is down, driven by a fall in the use of pain-killers. 

Brazil in the regional and transatlantic cocaine supply chain: The impact of COVID-19 (UNODC)
The cocaine market presents a clear threat at global level. Well-defined locations of production in South America and large consumer markets in the Americas and Europe lead to trafficking routes from a circumscribed origin to specific, even if far-flung, destinations. While some parts of the world play a crucial role as transit regions, the routes, modalities and networks employed by criminal actors continue to evolve, diversify and become more efficient 

No place for cheap alcohol: the potential value of minimum pricing for protecting lives (WHO) 
There has been growing interest in recent years in a relatively new form of pricing policy to decrease alcohol affordability and consequently consumption – minimum pricing. This report discusses this (as yet) not widely used policy and its potential for improving public health and examines how minimum pricing policies should be applied alongside alcohol taxation measures. It reviews the status of implementation of minimum pricing globally, provides an overview of the most recent evidence behind the policy, addresses its main strengths and limitations and offers practical considerations for countries. 

The 1964 US Surgeon General’s report on Smoking and Health 
The 1964 report of the US Surgeon General on smoking and health made an authoritative case that tobacco smoking was a cause of premature deaths from lung cancer and chronic bronchitis. It justified the practice of drawing causal inferences from epidemiological studies, specified influential criteria for doing so, and made use of an early form of meta-analysis. 

Webinars (pre-recorded)

Learning from alcohol policy reforms in the Northern Territory: radical interventions for radical problems (Turning Point)
Synopsis: The social costs and harms of alcohol consumption in the Northern Territory equate to $1.38 billion annually. Harmful levels of alcohol consumption – both binge drinking and sustained high and moderate levels of drinking – increase the propensity for risk taking associated with violence, crime, drink driving, unsafe sex, alcoholic poisoning, drinking while pregnant and a wide raft of anti-social behaviours and chronic or acute alcohol related health conditions. The impacts of alcohol also extend to family and friends, with harms relating to domestic violence, child neglect, diminished industry productivity and other third party harm. These understandings, alongside an independent review of NT alcohol policies and legislation, have led the Northern Territory Government to invest in a series of alcohol policy measures as part of its approach to alcohol harm minimisation, this included:

  • the reintroduction of the Banned Drinker Register (BDR). The current BDR is an explicit alcohol supply reduction measure that involves placing people that consume alcohol at harmful levels to themselves or others, onto a register which prohibits the consumption, possession or purchase of alcohol. This intervention is unique in its focus on individualised control of problems around packaged liquor, and;
  • the introduction of a Minimum Unit Price (MUP) for alcohol, sometimes referred to as the ‘minimum floor price’, to minimise the harms associated with high-alcohol, low-cost alcoholic beverages. From 1 October 2018 the minimum floor price was set at $1.30 per standard drink contained in the alcohol product.
  • investing in an additional 75 police auxiliaries to be trained as Liquor Inspectors and capable of delivering full lockdown of bottle shops in Alice Springs, Tennant Creek and Katherine freeing up Police to return to the frontline.

The presentation contains preliminary findings and discuss some of the ramifications of these findings. 

Implications of the revival of therapeutic research on psychedelic drugs (NDARC) 
This webinar explored factors that explain the revival of interest in the therapeutic use of psychedelic drugs.


Updated 18 August 2022 

Randomized trial of Metformin, Ivermectin, and Fluvoxamine for Covid-19
None of the three medications that were evaluated prevented the occurrence of hypoxemia, an emergency department visit, hospitalization, or death associated with Covid-19. NEJM 18 August 2022

Risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy: population based retrospective cohort study
The findings suggest that vaccination against covid-19 during pregnancy is not associated with a higher risk of preterm birth, small for gestational age at birth, or stillbirth. BMJ 17 August 2022

Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including 1 284 437 patients
This analysis of 2-year retrospective cohort studies of individuals diagnosed with COVID-19 showed that the increased incidence of mood and anxiety disorders was transient, with no overall excess of these diagnoses compared with other respiratory infections. In contrast, the increased risk of psychotic disorder, cognitive deficit, dementia, and epilepsy or seizures persisted throughout. The differing trajectories suggest a different pathogenesis for these outcomes. Children have a more benign overall profile of psychiatric risk than do adults and older adults, but their sustained higher risk of some diagnoses is of concern. The fact that neurological and psychiatric outcomes were similar during the delta and omicron waves indicates that the burden on the health-care system might continue even with variants that are less severe in other respects. Our findings are relevant to understanding individual-level and population-level risks of neurological and psychiatric disorders after SARS-CoV-2 infection and can help inform our responses to them. The Lancet psychiatry 17 August 2022

Awareness of SARS-CoV-2 Omicron variant infection among adults with recent COVID-19 seropositivity
Results of this study suggest that more than half of adults with recent Omicron variant infection were unaware of their infectious status and that awareness was higher among health care employees than nonemployees, yet still low overall. Unawareness may be a highly prevalent factor associated with rapid person-to-person transmission within communities. JAMA 17 August 2022

HIV viremia is associated with compromised SARS-CoV-2 Beta variant neutralization
HIV viremia was associated with reduced Beta variant neutralization. This highlights the importance of HIV suppression in maintaining an effective SARS-CoV-2 neutralization response. Journal of infectious diseases 17 August 2022

COVID-19 vaccine effectiveness against omicron (B.1.1.529) variant infection and hospitalisation in patients taking immunosuppressive medications: a retrospective cohort study
People taking immunosuppressive DMARDs or glucocorticoids are at substantially higher risk of hospitalisation due to COVID-19 than the general population. However, the mRNA-1273 and BNT162b2 vaccines remain effective within this group, and it is important that patients taking these medications remain up to date with vaccinations to mitigate their risk. The Lancet rheumatology 16 August 2022

Clinical practice guidelines from the Association for the Advancement of Blood and Biotherapies (AABB): COVID-19 Convalescent Plasma
These guidelines provide recommendations for clinicians who are treating persons infected with SARS-CoV-2 and who are candidates for CCP transfusion. Annals of internal medicine 16 August 2022

Tobacco product use and the risks of SARS-CoV-2 infection and COVID-19: current understanding and recommendations for future research
Findings pertaining to the effects of tobacco product use on the incidence of SARS-CoV-2 infection are inconsistent. However, evidence supports a role for cigarette smoking in increasing the risk of poor COVID-19 outcomes, including hospital admission, progression in disease severity, and COVID-19-related mortality. The authors discuss the potential effects of tobacco use behaviour on SARS-CoV-2 transmission and infection, and highlight the pathophysiological changes associated with cigarette smoking that could promote SARS-CoV-2 infection and increased disease severity. The Lancet respiratory medicine 16 August 2022

Association of COVID-19 vs Influenza with risk of arterial and venous thrombotic events among hospitalized patients
Hospitalization with COVID-19 both before and during vaccine availability was significantly associated with a higher risk of venous thromboembolism, but not arterial thromboembolism, vs hospitalization with influenza in 2018-2019. JAMA 16 August 2022

Risk of SARS-CoV-2 acquisition in health care workers according to cumulative patient exposure and preferred mask type
In this study, SARS-CoV-2 positivity in HCWs was associated with cumulative COVID-19 patient exposure. The odds of being SARS-CoV-2–positive were reduced by more than 40% in individuals using respirators irrespective of cumulative exposure, even after adjusting for multiple work- and nonwork-related covariables. JAMA 15 August 2022

Virologic efficacy of Casirivimab and Imdevimab COVID-19 antibody combination in outpatients with SARS-CoV-2 infection: A phase 2 dose-ranging randomized clinical trial
These findings, combined with the results from additional studies examining clinical efficacy, justify lowering the dose of casirivimab and imdevimab from 2400 mg to 1200 mg and suggest that subcutaneous administration is a viable alternative to intravenous administration. JAMA 15 August 2022

Comparison of severe maternal morbidities associated with delivery during periods of circulation of specific SARS-CoV-2 variants
This cohort study found that the SARS-CoV-2 Delta variant was associated with higher rates of SMM events compared with other strains. Given the potential of new strains, these findings underscore the importance of preventive measures. JAMA 12 August 2022

Comparison of pregnancy and birth outcomes before vs during the COVID-19 pandemic
During the COVID-19 pandemic, there were increased odds of maternal death during delivery hospitalization, cardiovascular disorders, and obstetric hemorrhage. Further efforts are needed to ensure risks potentially associated with the COVID-19 pandemic do not persist beyond the current state of the pandemic. JAMA 12 August 2022

Health care utilization in the 6 months following SARS-CoV-2 infection
These findings suggest that health care systems should consider long-term strategic resource allocation in response to the expected elevated health care utilization experienced by patients with SARS-CoV-2 infection for at least 6 months following the acute stage of infection. JAMA 12 August 2022 

Tolerability of COVID-19 infection and Messenger RNA vaccination among patients with a history of Kawasaki Disease
These findings suggest that the mRNA vaccines may be safe and COVID-19 may not be severe for patients with a history of KD. JAMA 12 August 2022

Antibody response in immunocompromised patients with hematologic cancers who received a 3-dose mRNA-1273 vaccination schedule for COVID-19
Results of this cohort study support that the primary schedule for immunocompromised patients with hematologic cancers should be supplemented with a delayed third vaccination. Patients with B-cell lymphoma and allogeneic HCT recipients need to be revaccinated after treatment or transplantation. JAMA 11 August 2022

Audio interview: Combating Covid-19 today and tomorrow
In this audio interview conducted on August 9, 2022, the editors discuss the shifting benefits of preventive and therapeutic interventions against Covid-19 and what the future might bring. NEJM 11 August 2022

Effectiveness of BNT162b2 vaccine against Omicron in children 5 to 11 years of age
During a period when the omicron variant was predominant, BNT162b2 vaccination reduced the risks of SARS-CoV-2 infection and Covid-19–related hospitalization among children 5 to 11 years of age. . NEJM 11 August 2022

Immunogenicity of ChAdOx1-nCoV-19 vaccine in solid malignancy patients by treatment regimen versus healthy controls: A prospective, multicenter observational study
Suboptimal and heterogeneous immunologic responses were observed in cancer patients being treated with different systemic treatments. Immunotherapy or chemotherapy significantly suppressed the antibody response. eClinicalMedicine 10 August 2022

Covid-19 vaccination in pregnancy
This review examines the evidence supporting the effectiveness, immunogenicity, placental transfer, side effects, and perinatal outcomes of maternal covid-19 vaccination. Additionally, it describes factors associated with vaccine hesitancy in pregnancy. Overall, studies monitoring people who have received covid-19 vaccines during pregnancy have not identified any pregnancy specific safety concerns. Additional information on non-mRNA vaccines, vaccination early in pregnancy, and longer term outcomes in infants are needed. To collect this information, vaccination during pregnancy must be prioritized in vaccine research. BMJ 10 August 2022

Safety and immunogenicity following a homologous booster dose of a SARS-CoV-2 recombinant spike protein vaccine (NVX-CoV2373): a secondary analysis of a randomised, placebo-controlled, phase 2 trial
Administration of a booster dose of NVX-CoV2373 resulted in an incremental increase in reactogenicity. For both the prototype strain and all variants evaluated, immune responses following the booster were similar to or higher than those associated with high levels of efficacy in phase 3 studies of the vaccine. These data support the use of NVX-CoV2373 in booster programmes. The Lancet infectious diseases 10 August 2022

Post-COVID-19 condition 3 months after hospitalisation with SARS-CoV-2 in South Africa: a prospective cohort study
Most participants in this cohort of individuals previously hospitalised with COVID-19 reported persistent symptoms 3 months after hospital discharge and a significant impact of Post COVID-19 condition (PCC) on their functional and occupational status. The large burden of PCC symptoms identified in this study emphasises the need for a national health strategy. This should include the development of clinical guidelines and training of health-care workers for identifying, assessing, and caring for patients affected by PCC; establishment of multidisciplinary health services; and provision of information and support to people who have PCC. The Lancet global health 10 August 2022

Assessment of heterologous and homologous boosting with inactivated COVID-19 vaccine at 3 months compared with homologous boosting of BNT162b2 at 6 months
In this cohort study, for individuals who received the CoronaVac primary series and a booster dose of BNT162b2 or CoronaVac at 3 months, the observed odds of symptomatic SARS-CoV-2 infection were similar to individuals who received the BNT162b2 primary series plus a third dose of BNT162b2 at 6 months. Heterologous booster is recommended for individuals aged 60 years or older who received the CoronaVac primary series, given the lower observed odds against symptomatic SARS-CoV-2 infection among those who received a BNT1612b2 booster. JAMA 10 August 2022

Durability of heterologous and homologous COVID-19 vaccine boosts
Heterologous Ad26.COV2.S boosting was associated with durable humoral and cellular immune responses in individuals who originally received the BNT162b2 vaccine. These data suggest potential benefits of heterologous prime-boost vaccine regimens for SARS-CoV-2. JAMA 10 August 2022

Intensity and longevity of SARS-CoV-2 vaccination response in patients with immune-mediated inflammatory disease: a prospective cohort study
People with immune-mediated inflammatory diseases show a lower and less durable SARS-CoV-2 vaccination response and are at risk of losing humoral immune protection. Adjusted vaccination schedules with earlier booster doses or more frequent re-doses, or both, could better protect people with immune-mediated inflammatory diseases. The Lancet rheumatology 9 August 2022

Menstrual irregularities and vaginal bleeding after COVID-19 vaccination reported to v-safe active surveillance, USA in December, 2020–January, 2022: an observational cohort study
Reports of heterogeneous symptoms related to menstruation or vaginal bleeding after COVID-19 vaccination are being submitted to v-safe, although this study is unable to characterise the relationship of these symptoms to COVID-19 vaccination. Methods that leverage pretrained models to interpret and classify unsolicited signs and symptoms in free-text reports offer promise in the initial evaluation of unexpected adverse events potentially associated with use of newly authorised or licensed vaccines. The Lancet digital health 9 August 2022

Covid-19: What we know about the BA.4 and BA.5 omicron variants
Two omicron subvariants have come to dominate infections worldwide. Elisabeth Mahase summarises what we know about them so far. BMJ 9 August 2022

Efficacy and safety of Ensovibep for adults hospitalized with COVID-19: A randomized controlled trial
Compared with placebo, ensovibep did not improve clinical outcomes for hospitalized participants with COVID-19 receiving standard care, including remdesivir; no safety concerns were identified. Annals of internal medicine 9 August 2022

Respiratory syncytial virus prevention within reach: the vaccine and monoclonal antibody landscape
This review gives an overview of respiratory syncytial virus vaccines and monoclonal antibodies in clinical development highlighting different target populations, antigens, and trial results. The Lancet infectious diseases 8 August 2022

Omicron update with Professor Brendan Crabb AC
Professor Brendan Crabb AC is the Director and CEO of the Burnet Institute in Melbourne. He talks about the latest evidence about the Omicron variant of COVID-19, including long COVID, reinfection, rebounding, and the new modelling from the Burnet about the benefits of mask use. MJA podcasts 8 August 2022

Myocarditis after COVID‐19 mRNA vaccination in Australia
This vaccine‐associated myocarditis study is the largest reported for a single children’s hospital. Only one of our participants had a history of prior SARS‐CoV‐2 infection, so background immunity is unlikely to have influenced the adverse event profile of vaccination. COVID‐19 mRNA vaccine‐associated myocarditis has a mild, self‐resolving clinical course, in contrast to reported complications and long term sequelae associated with COVID‐19, such as multisystem inflammatory syndrome in children, and other forms of myocarditis. The long term consequences of myocardial injury with vaccine‐associated myocarditis nevertheless warrant further investigation. MJA 8 August 2022

COVID‐19 in New South Wales children during 2021: severity and clinical spectrum
Most SARS-CoV-2 infections (Delta variant) in children were asymptomatic or associated with mild disease. Hospitalisation was relatively infrequent, and most common for infants, adolescents, and children with other medical conditions. More children were hospitalised for social than for medical reasons. MJA 8 August 2022

Long COVID: which symptoms can be attributed to SARS-CoV-2 infection?
Current evidence supports the view that long COVID is common and can persist for at least 2 years after SARS-CoV-2 infection, although severe debilitating disease is present in a minority. The long COVID case definition needs to be further improved, potentially to describe different types of long COVID, of which better mechanistic understanding is crucial. This will lead to personalised multimodality treatments that can be implemented to manage the increasingly high number of people with long COVID. The Lancet 6 August 2022

Enhanced severe acute respiratory syndrome Coronavirus 2 Antigen–specific systemic immune responses in multisystem inflammatory syndrome in children and reversal after recovery
The data suggest that MIS-C is characterized by an enhanced production of cytokines and chemokines that may be associated with disease pathogenesis. Journal of infectious diseases 6 August 2022

Seroprevalence and infection fatality rate of the SARS-CoV-2 Omicron variant in Denmark: A nationwide serosurveillance study
Screening for anti-N IgG and linkage to national registers allowed the authors to detect recent infections and accurately assess assay sensitivity in vaccinated or previously infected individuals during the Omicron outbreak. The IFR was lower than during previous waves. The Lancet regional health – Europe 5 August 2022

SARS-CoV-2 infections and pre-symptomatic Type 1 Diabetes autoimmunity in children and adolescents from Colorado, USA, and Bavaria, Germany
Screening of more than 50 000 youths in diverse populations of Colorado and Bavaria found no association of SARS-CoV-2 infection with autoimmunity related to development of type 1 diabetes. JAMA 5 August 2022

Examination of SARS-CoV-2 in-class transmission at a large urban university with public health mandates using epidemiological and genomic methodology
In this cohort study, the data suggested that under robust transmission abatement strategies, in-class instruction was not an appreciable source of disease transmission. JAMA 5 August 2022

Dysregulation of the kallikrein-kinin system in bronchoalveolar lavage fluid of patients with severe COVID-19
These observations support the hypothesis that dysregulation of the kallikrein-kinin system might occur in mechanically ventilated patients with severe pulmonary disease, which might help to explain the clinical presentation of patients with severe COVID-19 developing pulmonary oedema and thromboembolic complications. Therefore, targeting the kallikrein-kinin system should be further explored as a potential treatment option for patients with severe COVID-19. eBioMedicine 4 August 2022

Two-year prevalence and recovery rate of altered sense of smell or taste in patients with mildly symptomatic COVID-19
In this cohort study, 88.2% of patients reporting a COVID-19–related smell or taste dysfunction completely recovered within 2 years. JAMA 4 August 2022

Hyperimmune globulin for severely immunocompromised patients hospitalized with COVID-19: a randomized, controlled trial
The aim of this randomized, controlled trial is to determine whether anti-SARS-CoV-2 hyperimmune globulin protects against severe COVID-19 in severely immunocompromised, hospitalized, COVID-19 patients. Patients were randomly assigned to receive anti-SARS-CoV-2 hyperimmune globulin (COVIG) or intravenous immunoglobulin without SARS-CoV-2 antibodies. Severe COVID-19 was observed in two out of ten (20%) patients treated with COVIG compared to seven out of eight (88%) in the IVIG control group (p = 0.015, Fisher’s exact test). COVIG may be a valuable treatment in severely immunocompromised, hospitalized, COVID-19 patients and should be considered when no monoclonal antibody therapies are available. The journal of infectious diseases 4 August 2022

Maintaining genomic surveillance using whole-genome sequencing of SARS-CoV-2 from rapid antigen test devices
This data show that whole-genome sequencing of SARS-CoV-2 can be done using material obtained from rapid antigen test devices collected as part of clinical care, with real-world storage and transport conditions. The Lancet infectious diseases 4 August 2022

Efficacy of antibodies and antiviral drugs against Omicron BA.2.12.1, BA.4, and BA.5 subvariants
Overall, the  data suggest that the three small-molecule antiviral drugs remdesivir, molnupiravir, and nirmatrelvir may have therapeutic value against the sublineages BA.2.12.1, BA.4, and BA.5 of SARS-CoV-2 omicron variants. This data also indicates that bebtelovimab is effective against BA.2.12.1, BA.4, and BA.5. However, in clinical use, these variants may be less susceptible to combination therapy with casirivimab and imdevimab and with tixagevimab and cilgavimab. In addition, sotrovimab may not provide effective treatment against BA.2.12.1, BA.4, or BA.5. These findings show that the selection of monoclonal antibodies to treat patients who are infected with omicron variants should be carefully considered. NEJM 4 August 2022

Audio interview: Updated Covid-19 vaccines and a look at Monkeypox
In this audio interview conducted on August 2, 2022, the editors discuss soon-to-be-released Covid-19 vaccines against BA.4/BA.5 strains, as well as the current state of therapeutics for monkeypox. NEJM 4 August 2022

Efficacy of antibodies and antiviral drugs against Omicron BA.2.12.1, BA.4, and BA.5 subvariants
Overall, the  data suggest that the three small-molecule antiviral drugs remdesivir, molnupiravir, and nirmatrelvir may have therapeutic value against the sublineages BA.2.12.1, BA.4, and BA.5 of SARS-CoV-2 omicron variants. This data also indicates that bebtelovimab is effective against BA.2.12.1, BA.4, and BA.5. However, in clinical use, these variants may be less susceptible to combination therapy with casirivimab and imdevimab and with tixagevimab and cilgavimab. In addition, sotrovimab may not provide effective treatment against BA.2.12.1, BA.4, or BA.5. These findings show that the selection of monoclonal antibodies to treat patients who are infected with omicron variants should be carefully considered. NEJM 4 August 2022

Hyperimmune globulin for severely immunocompromised patients hospitalized with COVID-19: a randomized, controlled trial
The aim of this randomized, controlled trial is to determine whether anti-SARS-CoV-2 hyperimmune globulin protects against severe COVID-19 in severely immunocompromised, hospitalized, COVID-19 patients. Patients were randomly assigned to receive anti-SARS-CoV-2 hyperimmune globulin (COVIG) or intravenous immunoglobulin without SARS-CoV-2 antibodies. Severe COVID-19 was observed in two out of ten (20%) patients treated with COVIG compared to seven out of eight (88%) in the IVIG control group (p = 0.015, Fisher’s exact test). COVIG may be a valuable treatment in severely immunocompromised, hospitalized, COVID-19 patients and should be considered when no monoclonal antibody therapies are available. Journal of infectious diseases 4 August 2022

COVID-19 vaccine effectiveness against SARS-CoV-2 infection in the United States prior to the Delta and Omicron-associated surges: a retrospective cohort study of repeat blood donors
To inform public health policy, it is critical to monitor COVID-19 vaccine effectiveness (VE), including against acquiring infection. We estimated VE using self-reported vaccination in a retrospective cohort of repeat blood donors who donated during the first half of 2021, demonstrating a viable approach for monitoring of VE via serological surveillance. Using Poisson regression, we estimated an overall VE of 88.8% (95% CI: 86.2–91.1), adjusted for demographic covariates and variable baseline risk. Time since first reporting vaccination, age, race-ethnicity, region, and calendar time were statistically significant predictors of incident infection. Journal of infectious diseases 4 August 2022

SARS-CoV-2 evolution and patient immunological history shape the breadth and potency of antibody-mediated immunity
The author’s results suggest that the interplay between host immunity and SARS-CoV-2 evolution will shape the antigenicity and subsequent transmission dynamics of SARS-CoV-2, with important implications for future vaccine design. Journal of infectious diseases 3 August 2022

Potent neutralizing activity of Polyclonal Equine Antibodies against SARS-CoV-2 variants of concern
Several monoclonal anti-SARS-CoV-2 antibodies (mAbs) have received emergency authorization for COVID-19 treatment. However, most of these mAbs are not active against the highly mutated Omicron SARS-CoV-2 subvariants. The authors have tested a polyclonal approach of equine anti-SARS-CoV-2 F(ab’)2 antibodies that achieved a high level of neutralizing potency against all SARS-CoV-2 VoCs tested including Omicron BA.1, BA.2, BA.2.12 and BA.4/5. A repertoire of antibodies targeting conserved epitopes in different regions of the spike protein could plausibly account for this remarkable breadth of neutralization. These results warrant the clinical investigation of equine polyclonal F(ab’)2 antibodies as a novel therapeutic strategy against COVID-19. Journal of infectious diseases 3 August 2022

Assessing and improving the validity of COVID-19 autopsy studies - A multicentre approach to establish essential standards for immunohistochemical and ultrastructural analyses
Since detection of SARS-CoV-2 in human autopsy tissues by immunohistochemistry (IHC) and electron microscopy (EM) is difficult and frequently incorrect, we propose criteria for a re-evaluation of available data and guidance for further investigations of direct organ effects by SARS-CoV-2. eBioMedicine 2 August 2022

Risk of covid-19 related deaths for SARS-CoV-2 omicron (B.1.1.529) compared with delta (B.1.617.2): retrospective cohort study
The results support earlier studies showing a reduction in severity of infection with omicron BA.1 compared with delta in terms of hospital admission. This study extends the research to also show a reduction in the risk of covid-19 death for the omicron variant compared with the delta variant. BMJ 2 August 2022

Association of receiving a fourth dose of the BNT162b vaccine with SARS-CoV-2 infection among health care workers in Israel
In this cohort study, the fourth BNT162b2 vaccine dose resulted in a reduced breakthrough infection rate among hospital staff. This reduction was lower than that observed after the third dose; nevertheless, considering the high infectivity of the Omicron variant, which led to critical medical staff shortages, a fourth vaccine dose should be considered to mitigate the infection rate among HCWs. JAMA 2 August 2022

Evaluating the performance of Centers for Disease Control and prevention COVID-19 community levels as leading indicators of COVID-19 mortality
Designing metrics for public health decision making involves tradeoffs between identifying early signals for action and avoiding undue restrictions when risks are modest. Explicit frameworks for evaluating surveillance metrics can improve transparency and decision support. Annals of internal medicine 2 August 2022

Risk factors for severe COVID-19 in hospitalized children in Canada: A national prospective study from March 2020–May 2021
While severe outcomes were detected at all ages and among patients with and without comorbidities, neurologic and pulmonary conditions as well as technology dependence were associated with increased risk of severe COVID-19. These findings may help guide vaccination programs and prioritize targeted COVID-19 therapies for children. The Lancet – regional health – Americas 1 August 2022

Long covid and disability: a brave new world
Nicholas Evans and colleagues argue that long covid needs to be better recognised, understood, and supported, and should stimulate a rethink of our approach to disability BMJ 1 August 2022

COVID-19 mRNA vaccine effectiveness against hospitalisation and death in veterans according to frailty status during the SARS-CoV-2 delta (B.1.617.2) variant surge in the USA: a retrospective cohort study
Compared with non-frail patients (pre-frail and robust), those with frailty had lower levels of vaccination protection against COVID-19-associated hospitalisation and all-cause death. Future studies investigating COVID-19 vaccine effectiveness should incorporate frailty assessments and actively recruit older adults with frailty. The Lancet – healthy longevity 1 August 2022

Development of resistance-associated mutations after Sotrovimab administration in high-risk individuals infected with the SARS-CoV-2 Omicron variant
This study found rapid development of sotrovimab resistance–associated mutations at positions S:E340 and S:P337 in a large proportion of high-risk patients infected with the Omicron variant after treatment with sotrovimab, which was associated with a delay in viral clearance. These results are in line with a report describing the occurrence of resistance mutations 6 to 13 days after treatment with sotrovimab in patients infected with the Delta variant. JAMA 1 August 2022

Do we care enough about COVID?
The COVID-19 myth is now presenting its puzzles to true believers. If you imagined we all pulled together for the common good, and because we have the good sense to look after our own health, you are likely to find it strange that we are now apparently prepared to tolerate dozens of deaths in a day. The total COVID death toll is now above 11 000. More than tolerate: there has been a preparedness to pretend nothing out of the ordinary is happening. All of this seems a far cry from those days when we hung on the daily premiers’ media conferences and experienced horror as the number of new infections rose above a few dozen a day, a few hundred, and then a thousand or so. Have our senses been blunted, our consciences tamed? MJA insight 1 August 2022

100 updates to living COVID guidelines: where to now
Now that it’s been shown to be possible to have up-to-date, evidence-based clinical guidelines in COVID-19, it’s perhaps becoming less palatable that guidelines in other areas of clinical uncertainty may be updated only every 3–5 years. Similarly, now that we’ve seen how powerful a sector-wide collaboration of this type can be, it’s an increasingly attractive option to take this approach and apply it to other clinical areas of importance to the sector. MJA insight 1 August 2022