New in Brief: Most young Aussies expect x-rays for low back pain; COVID-19 vax link to menstrual changes should be investigated; Medicare embarks on new round of reviews

Most young Aussies expect x-rays for low back pain

Four out of five young Australian adults with lower back pain have beliefs about the role of medical imaging that don’t align with current evidence and guidelines, according to a survey.

Researchers from the Curtin EnAble Institute at Curtin University reported that around a third of participants in the study indicated that medical imaging results were related to pain intensity and that findings on imaging would change as the pain changed.

Meanwhile, of the 75 participants with LBP and the 85 with no reported LBP, 32% believed that when back pain improves, a repeat medical scan would show improvement. Some 27% of participants believed medical scans are necessary to get the best medical care for low back pain while 29% of participants thought that imaging will identify the cause of back pain.

Such beliefs could drive expectations around the need for medical imaging, suggest investigators who say education campaigns that target young adults are needed to help curb high imaging referral rates.

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COVID-19 vax link to menstrual changes should be investigated

A link between COVID-19 vaccination and menstrual changes is “plausible and should be investigated”, according to Dr Victoria Male, a reproductive specialist at Imperial College London.

In an editorial published in the British Medical Journal, Dr Male said the Medicines and Healthcare products Agency had received 30,000 reports of menstrual and unexpected bleeding post vaccination with both mRNA and adenovirus vectored COVID-19 vaccines.

This number is still considered low given the proportion of people who have received COVID-19 vaccination and the prevalence of menstrual disorders in the general population. Also, in most cases periods have returned to normal by the following cycle, and there is no evidence to suggest that vaccination adversely affects fertility.

However, while menstrual changes and unexpected bleeding are not currently classed as common side effects of COVID-19 vaccination, current data collection methods make it difficult to draw any firm conclusions, Dr Male noted. Instead, she argued that researchers should be using approaches that compare the incidence of menstrual issues across vaccinated and unvaccinated populations.

“Although reported changes to the menstrual cycle after vaccination are short lived, robust research into this possible adverse reaction remains critical to the overall success of the vaccination programme,” she said. “Vaccine hesitancy among young women is largely driven by false claims that COVID-19 vaccines could harm their chances of future pregnancy. Failing to thoroughly investigate reports of menstrual changes after vaccination is likely to fuel these fears.”

While more evidence on a potential link is gathered, clinicians should encourage anybody experiencing menstrual issues post vaccination to report them to the MHRA’s yellow card scheme, Dr Male advised. Any persistent change to periods persisting or new vaginal bleeds post menopause should be managed as per normal clinical guidelines.

Medicare embarks on new round of reviews

Professor Anne Duggan has been announced as the chair of a new Medicare Benefits Schedule (MBS) Review Advisory Committee (MRAC) that will continue the overhaul of MBS items started by the MBS Review Taskforce.

The Department of Health says the advisory committee will  “ensure the MBS continues to support high quality care, and remains flexible and contemporary.” It  follows the MBS Review Taskforce, which from 2015 to 2020 reviewed more than 5,700 items on the MBS and made recommendations to the minister for health to remove or streamline inappropriate and outdated items, including some for colonoscopy.

Professor Duggan is a gastroenterologist in Newcastle, NSW and Chief Medical Officer for the Australian Commission on Safety and Quality in Health Care, where she provides expert clinical advice to the Commission in its role to improve safety and quality of health care nationally.

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