新年、トップ研究記事、そして2040年までにオーストラリアの医療システムを「ネットゼロ」にするための呼びかけ

Unofficial AI-generated summary based on the public title and abstract. Not an official translation.

🏢実務担当者:Healthcare sustainability teams can reference the NHS and Australian examples to build their own decarbonization strategies.

🏛政策担当者:Policy offices should note the call for a 2040 net-zero healthcare target as a model for integrating climate action into health policy.

当我们怀着复杂的心情告别这可怕的一年，共同展望2021年之际，《MJA》将继续努力巩固其作为极具影响力的顶级期刊的地位。欢迎来到2021年的《MJA》。许多人会为2020年终于结束而感到高兴，并期待着一个更好的年份。1, 2 目前已有令人鼓舞的迹象。迄今为止，澳大利亚针对2019冠状病毒病（COVID-19）大流行的公共卫生应对堪称典范，3, 4 尽管挑战依然存在，但多种疫苗已在III期试验中取得成功，澳大利亚预计很快将开始疫苗接种。5 美国总统选举在漫长的争议后终于落幕，对许多人来说这是一种解脱。我将美国政府在应对大流行的公共卫生方面为何会如此惨败的问题留给历史学家去辩论，但我怀疑，在下一次重大传染病暴发之前，全球是否真的能吸取必要的教训——而随着全球变暖，这种风险还在不断增加。6 气候变化对健康（包括死亡率）的严重影响，似乎在英国、欧洲以及最终在美国得到了更认真的对待，尽管令人失望的是，澳大利亚目前仍是落后者。6, 7 作为医疗和健康专业人士，面对气候变化这一健康紧急状况，我们能做些什么？无论是个人还是集体，我们都可以做得更多。6, 8 2020年10月，英国国家医疗服务体系（NHS）发布了一份雄心勃勃的报告，题为《实现“净零”排放的国家医疗服务体系》，这在全球尚属首例。9 NHS承诺，到2040年在其控制的所有碳足迹范围内实现净零碳排放，并在2028年至2032年间减排80%。他们将使所有医院、交通与出行、供暖与照明、药品与供应链脱碳；推动数字化转型与创新；并确保将适应措施作为综合战略的一部分。9 NHS此举鼓舞人心，以身作则，为企业和卫生系统以及个人提供了做得更多的许可。在澳大利亚这里，我认为在各州和领地，正如最近一篇评论所强调的那样，现在是我们集体采取同样行动的时候了。10 每年，《MJA》编辑团队都会挑选该刊发表的顶级原创研究文章，以角逐年度MJA、MDA National医学研究卓越奖（奖金为10,000澳元）；由整个编辑团队投票最多的文章将被纳入候选名单。最终获胜者由外部咨询小组进行独立评审后决定，并将于2021年晚些时候公布。2019年的获奖者是一项关于以人乳头瘤病毒初筛进行常规宫颈筛查的重要研究，11 而2018年的获奖者是一项关于东帝汶在校学生风湿性心脏病（RHD）的研究。12 我们认可《MJA》发表的每一篇研究文章都值得肯定；2020年，《MJA》发表了42篇原创研究文章和28篇研究快报，所有这些文章都经过了严格的内部和外部评审流程。由于篇幅限制，本刊对原创研究文章的拒稿率保持在90%以上，这与《MJA》作为领先医学期刊的地位相符，在全球普通医学期刊中排名前10%。1 我们深知开展研究、分析数据、撰写论文以及根据编辑和同行评审专家的意见（有时不止一次）修改文章需要付出多少努力；我们祝贺所有在2020年于《MJA》发表文章的作者。因此，很荣幸在此公布由编辑选出的《MJA》2020年发表的顶级文章。13-23 《MJA》发表了关于严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的领先研究和观点，包括在澳大利亚分离出的首株SARS-CoV-2，该病毒已上传至GenBank，供全球科学界即时共享。13 2020年1月19日，一名来自武汉的男子在抵达墨尔本5天后因进行性呼吸系统症状入院。在一周内，每天对其鼻咽拭子和痰液进行逆转录聚合酶链反应检测。电子显微照片显示存在带有突出刺突的球形和多形性病毒样颗粒，这是冠状病毒科病毒的典型特征。系统发育分析显示，该分离株（BetaCoV/Australia/VIC01/2020）源自武汉。13 COVID-19期间的远程医疗已被广泛采用。Bladin及其同事14 采用历史对照队列设计，评估了在16家地区医院实施的维多利亚州卒中远程医疗（VST）项目。在项目启动后的前12个月内，VST项目显著改善了卒中诊疗，包括更早提供溶栓治疗，该项目现已由维多利亚州政府全额资助。随着澳大利亚预计将引入SARS-CoV-2疫苗接种，考虑促进疫苗接种率的策略正当其时。在一项对澳大利亚免疫登记处数据的横断面分析中，Hull及其同事15 评估了“不打疫苗，不发补贴”政策实施后的补种疫苗接种情况。他们发现，在该政策实施的最初两年内，5岁至20岁以下儿童和青少年的补种疫苗接种活动显著增加；在10至20岁之间未完全接种的年轻人中，有17.6%接种了第二剂麻疹-腮腺炎-风疹疫苗，使该年龄组的覆盖率从86.6%提高到89.0%。作者承认，补种疫苗接种活动的变化可能并非完全归因于“不打疫苗，不发补贴”政策。15 对实践产生影响的随机对照试验尤为重要。创伤或手术后不适当的阿片类药物处方可能使患者面临慢性使用的风险。一项整群随机对照试验检验了在一家大型教学医院，对初级医生和药剂师进行镇痛药处方教育是否能改善阿片类药物初治手术患者出院时的阿片类药物处方。16 Hopkins及其同事16 发现，被分配到干预组的外科病房患者出院时接受缓释阿片类药物处方的频率低于对照组患者（调整后优势比，0.52；95% CI，0.35–0.77）。《MJA》是澳大利亚领先原住民研究的发表阵地。基于一项前瞻性、横断面超声心动图筛查研究，Maningrida地区5-20岁原住民年轻人中RHD的患病率为每100人中5.4例确诊，17 这是任何人群报告的最高水平。根据北领地RHD登记数据，Maningrida及周边社区中只有10%的原住民接受了二级预防。17 除一级预防外，在澳大利亚RHD负担较高的偏远社区，应考虑使用超声心动图筛查进行主动病例发现。在另一项将澳大利亚和新西兰重症监护学会成人患者数据库与四个人口层面数据集相关联的研究中，Mitchell及其同事18 按原住民身份评估了南澳大利亚四个重症监护病房（ICU）非择期入院后的院内、12个月和8年死亡率。他们发现，尽管入住ICU的原住民澳大利亚人大多更年轻且慢性病负担更重，但调整主要人口统计学和临床因素后，其院内死亡率与非原住民澳大利亚人相似。然而，出院后1年和8年的调整后死亡率更高，这表明社区层面的护理对于解决原住民与非原住民澳大利亚人之间预期寿命的根本差异至关重要。此外，利用西澳大利亚州医院发病率数据收集与西澳死亡登记处之间的数据关联，Nedkoff及其同事19 评估了心房颤动入院后长达10年的卒中和死亡率；他们发现，原住民澳大利亚人心房颤动住院后的卒中发生率和死亡率远高于非原住民澳大利亚人，尤其是在60岁以下的成年人中。这在很大程度上归因于心血管危险因素和疾病患病率更高，凸显了解决这些潜在危险因素的重要性。在澳大利亚和国际上，人们越来越关注在老年人中不当使用精神药物作为“化学约束”的问题。一项全国性回顾性队列研究考察了在澳大利亚进入政府补贴的养老护理机构（RACFs）前后精神药物（抗精神病药、苯二氮䓬类药物和抗抑郁药）的配发情况。20 该研究对322,120名持有优惠卡且年龄在65岁及以上的老年人，在进入RACFs前后各一年内，按季度间隔考察了这些药物的使用情况。在进入RACFs后的前3个月内，21%的人至少接受了一种抗精神病药，30.5%的人至少接受了一种苯二氮䓬类药物，38%的人至少接受了一种抗抑郁药；其中分别有46%、39%和20%的人在进入RACFs前一年内未服用过这些药物。总体发现是，在进入养老护理机构前精神药物的使用率已经很高，但进入后显著增加，尤其是对于痴呆症患者而言，抗精神病药的使用尤为突出。20 可以合理得出结论，RACFs中的处方文化和过度依赖精神药物的问题需要解决。澳大利亚的儿童癌症发病率正在上升，两项重要研究文章强调了关于结局的新证据。21, 22 Youlden及其同事21 对澳大利亚儿童癌症登记处数据的分析发现，1996年至2005年间保持稳定后，儿童癌症的总体发病率每年上升1.2%

AI 翻訳（deepseek-v4-flash）。 正確を期す場合は下の原文を参照してください。

As we all look forward to 2021 after a horror year, the MJA will continue to work to cement its status as a highly influential top-tier journal Welcome to the MJA in 2021. Many will be pleased 2020 is finally over and will be looking forward to a better year.1, 2 There are hopeful signs. The public health response to the coronavirus disease 2019 (COVID-19) pandemic across Australia has been exemplary to date,3, 4 and while challenges remain, multiple vaccines have been successful in phase 3 trials and vaccination is anticipated to commence in Australia soon.5 The United States presidential election is over after a very prolonged dispute, and for many this is a relief. I leave it up to the historians to debate how a US administration could fail so spectacularly in the public health response to a pandemic, but wonder if the necessary lessons will be learned globally before the next major infectious diseases outbreak, the risk of which continues to increase with a warming planet.6 The dire impact of climate change on health, including mortality, appears to be being taken more seriously in the United Kingdom, Europe and, at last, the US, although Australia disappointingly remains a laggard for now.6, 7 As medical and health professionals, what can we do to respond to the health emergency that is climate change? Both individually and collectively, we can do more.6, 8 In October 2020, the UK National Health Service (NHS) released an ambitious report entitled Delivering a “net zero” National Health Service, a world first.9 The NHS is committing to net zero carbon emissions over the entire carbon footprint they control by 2040, with an 80% reduction by 2028–2032. They will decarbonise all hospitals, transport and travel, heating and lighting, and medicine and supply chains; promote digital transformation and innovation; and ensure adaptation as part of an integrated strategy.9 The NHS is inspiring and leading by example and providing businesses, the health system and individuals permission to do more. Here in Australia, in every state and territory, I would argue collectively it is time we do the same, as was highlighted in a recent commentary.10 Each year, the MJA editorial team selects the top original research articles published by the Journal for consideration of the annual MJA, MDA National Prize for Excellence in Medical Research, a $10 000 award; the articles that capture the most votes by the entire editorial team are included. The winner is then decided by independent review by the External Advisory Group, and will be announced later in 2021. The 2019 winner was an important study of routine cervical screening by primary human papillomavirus testing,11 and in 2018, the winner was a study of rheumatic heart disease (RHD) in Timor-Leste school students.12 We recognise every research article published in the MJA is worthy; in 2020, the MJA published 42 original research articles and 28 research letters, all having passed our stringent internal and external review processes. Because of space constraints, the Journal maintains a high rejection rate of over 90% for original research articles, consistent with the position of the MJA as a leading medical journal, ranked in the top 10% of general medical journals globally.1 We recognise how much work is involved in undertaking, analysing and writing up research and in revising articles based on editor and peer reviewer comments, sometimes more than once; we congratulate all the authors whose articles were published in the MJA in 2020. It is therefore a privilege to announce the top articles published by the MJA in 2020 as chosen by the editors.13-23 The MJA published leading research and perspectives on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including the first SARS-CoV-2 isolated in Australia, uploaded to GenBank for immediate sharing with the global scientific community.13 On 19 January 2020, a man from Wuhan was admitted in a hospital due to progressive respiratory symptoms 5 days after arrival in Melbourne. Daily reverse transcription polymerase chain reaction testing of nasopharyngeal swabs and sputum was undertaken over a week. Electron micrographs showed the presence of spherical and pleomorphic virus-like particles with prominent spikes, typical of viruses from the family Coronaviridae. Phylogenetic analysis revealed that this isolate (BetaCoV/Australia/VIC01/2020) originated in Wuhan.13 Telehealth during COVID-19 has been widely embraced. Using a historical controlled cohort design, Bladin and colleagues14 evaluated the Victorian Stroke Telemedicine (VST) program implemented in 16 regional hospitals. During its first 12 months, the VST program demonstrated significant improvements in stroke care including earlier provision of thrombolysis, and the program is now fully funded by the Victorian government. With the anticipated introduction of vaccination for SARS-CoV-2 into Australia, it is timely to consider strategies that promote vaccination uptake. In a cross-sectional analysis of data from the Australian Immunisation Register, Hull and colleagues15 assessed catch-up vaccination following the introduction of the “No jab, no pay” policy. They found substantial catch-up vaccination activity among children and young people aged 5 to less than 20 years during the initial 2 years of the policy; 17.6% of incompletely vaccinated young people aged between 10 and 20 years received their second dose of measles–mumps–rubella vaccine, raising coverage from 86.6% to 89.0% for this age group. The authors acknowledged that changes in catch-up vaccination activity may not be solely related to the “No jab, no pay” policy.15 Randomised controlled trials that have an impact on practice are of particular importance. Inappropriate prescribing of opioids after trauma or surgery may expose patients to risk of chronic use. A cluster randomised controlled trial examined whether educating junior doctors and pharmacists about analgesic prescribing improved opioid prescribing at discharge for opioid-naïve surgical patients at a single major teaching hospital.16 Hopkins and colleagues16 found that patients in surgical units assigned to the intervention were prescribed slow release opioids at discharge less frequently than patients in the control group (adjusted odds ratio, 0.52; 95% CI, 0.35–0.77). The MJA is home to leading Indigenous research in Australia. Based on a prospective, cross-sectional echocardiographic screening study, the prevalence of RHD among young Indigenous people in Maningrida aged 5–20 years was 5.4 definite cases per 100 people,17 the highest reported for any population. According to Northern Territory RHD register data, only 10% of Indigenous people in Maningrida and the surrounding communities received secondary prophylaxis.17 In addition to primary prevention, active case finding using echocardiographic screening should be considered in remote Australian communities with a high burden of RHD. In another study linking data from the Australian and New Zealand Intensive Care Society Adult Patient Database to four population-level datasets, Mitchell and colleagues18 evaluated the in-hospital, 12-month and 8-year mortality after non-elective admission to four South Australian intensive care units (ICUs), by Indigenous status. They showed that while Indigenous Australians admitted to the ICU were mostly younger with more chronic disease burden, the in-hospital mortality, adjusted for major demographic and clinical factors, was similar to non-Indigenous Australians. However, the adjusted mortality was higher at one and 8 years after discharge, suggesting that community-level care is important in addressing the underlying differences in life expectancy between Indigenous and non-Indigenous Australians. Further, using data linkage between the Western Australia Hospital Morbidity Data Collection and the WA Deaths Registry, Nedkoff and colleagues19 evaluated the rates of stroke and mortality up to 10 years after an admission with atrial fibrillation; they found that stroke incidence rates and mortality after hospitalisation for atrial fibrillation were much higher for Indigenous than non-Indigenous Australians, in particular for adults younger than 60 years. This was largely explained by the higher prevalence of cardiovascular risk factors and disease, highlighting the importance of addressing these underlying risk factors. There is growing concern about the inappropriate use of psychotropic medicines for use as a “chemical restraint” in older people in Australia and internationally. A national retrospective cohort study examined dispensing of psychotropic medicine (antipsychotics, benzodiazepines and antidepressants) before and after entry to government-subsidised residential aged care facilities (RACFs) in Australia.20 Use of these medicines was examined at quarterly intervals for one year before and after entry to RACFs in 322 120 people who held concession cards and were aged 65 years and over. In the first 3 months of being in a RACF, 21% received at least one antipsychotic, 30.5% received at least one benzodiazepine, and 38% received at least one antidepressant; 46%, 39% and 20%, respectively, had not been taking these drugs in the year before entry into a RACF. The overall finding was that use of psychotropic medicines is high before entering residential aged care facilities but increases markedly with entry, especially for people with dementia in relation to antipsychotics.20 It is reasonable to conclude the prescribing culture and overreliance on psychotropic medicines in RACFs need to be addressed. Paediatric cancers are increasing in Australia and new evidence about outcomes were highlighted in two important research articles.21, 22 An analysis of data from the Australian Childhood Cancer Registry by Youlden and colleagues21 found that, having been stable between 1996 and 2005, the overall incidence of childhood cancers rose by 1.2% per y

• openalex https://doi.org/10.5694/mja2.50896first seen 2026-08-02 18:59:47