News in brief

Mask threat increases flu vax rates
A PROGRAM that mandated health care workers (HCW) at a Melbourne hospital either wear a mask or have a flu vaccination was associated with an increase in vaccination rates — from 47% in 2012 to 92.8% in 2013 — according to a research letter published in the MJA. In a bid to increase flu vaccination rates in the department of nephrology at Monash Health, where annual flu vaccinations is offered to staff, the 208 HCWs were informed that, throughout the 2013 influenza season, unvaccinated staff members would be asked to wear a surgical mask during patient care. Overall, 193 (92.8%) of the HCWs opted to be vaccinated compared with 52.1% for the remainder of Monash Health staff. The authors wrote that the mask mandate was not only beneficial in preventing the spread of influenza, but acted as an incentive to get vaccinated. They said the program had “contributed to a vaccination rate far exceeding our expectations”. Flu vaccination rates for HCWs across Australia varied from 16.3% to 58.7%. The authors noted that the HCWs in the nephrology department were mandated to have hepatitis B vaccination “to protect themselves and patients, and this is not controversial”.

Impulse disorders linked to diabetes
A STUDY evaluating the associations of a wide range of mental disorders with diabetes has found depression and impulse control disorders, particularly eating disorders, are independently associated with diabetes diagnosis. The research published in Diabetologia, found most studies to date investigating mental disorder associations with diabetes had been restricted to depression. The researchers used data from 19 of the World Mental Health surveys, including from New Zealand, which involved more than 50 000 participants including 2580 who had a history of diabetes. “The inclusion of a wide range of disorders and the large sample size enabled us to reliably adjust for mental disorder comorbidity and thus estimate the unique association of each of the mental disorders with diabetes”, they wrote. They found significant associations only for depression and impulse control disorders (intermittent explosive disorder and eating disorders in particular). “By far the strongest prospective associations were found with respect to eating disorders and diabetes”, the researchers wrote. “From a mechanistic point of view, this association seems to point to the importance of glucose dysregulation and obesity-associated eating disorders, which may eventually result in later diabetes.” They said their findings suggested that the focus on depression in predicting diabetes was warranted, “but may be extended to impulse control disorders”.

Call to revise “dangerous” weight-loss surgery guidelines
GUIDELINES that include advice on nutritional care for patients after weight-loss surgery are not evidence-based, are “potentially dangerous” and should be revised, says the author of a Perspective article published in the MJA. The NHMRC’s Clinical practice guidelines for the management of overweight and obesity, released in June 2013, suggest “nutritional issues should be assessed through clinically manifest disease”, including neuropathy, muscle weakness and wasting, bone pain and oral lesions. Professor John Dixon, director of the Baker IDI Heart and Diabetes Institute’s Weight Assessment and Management Clinic, wrote in the MJA that many of the problems the guidelines suggested as markers did not become symptomatic until it was too late to reverse them, including progressive nerve damage, metabolic bone disease, and neural tube defects in the babies of women who had undergone surgery. Weight-loss surgery often impaired the absorption of micronutrients and could cause protein malnutrition and other deficiencies, Professor Dixon wrote. “All bariatric procedures require excellent nutritional support, mentoring and supplementation”, he wrote. Professor Dixon said he had recommended to the NHMRC that they revisit and revise the section of the guidelines on nutrition and supplementation, which they had agreed to do. In the meantime, he suggested, bariatric surgeons should follow high-quality US guidelines, and give individualised advice to their post-surgical patients. “Nutritional issues are a critical downside to bariatric surgery and should be front of mind whenever doctors, nurses, dieticians or any other health professionals interact with a patient after surgery”, he wrote.

Vocal disorders treatment questioned
A US study has found that most family physicians treat vocal disorders such as hoarseness with reflux medication, even when symptoms of gastroeosphageal reflux disease (GERD) are not present. The research, published in JAMA Otolaryngology-Head & Neck Surgery, was based on a 16-question web survey completed by 314 physicians about the management and treatment options used for patients with dysphonia. The researchers found that 64% of respondents preferred to treat a patient with chronic hoarseness (symptoms persisting for more than 6 weeks) of unclear origin rather than to immediately refer to a specialist. Of those who decided to initially treat patients, 16.6% would treat for longer than 4 weeks and 51.2% would treat for 3–4 weeks before referral. The most commonly selected medications prescribed routinely for patients with chronic hoarseness of unknown origin included reflux medication (85.8%) and antihistamines (54.2%). “Across all respondents, 41.0% reported prescribing both reflux medication and antihistamines routinely”, the researchers wrote. “When physicians were asked whether or not they would treat chronic hoarseness with reflux medication in a patient without symptoms consistent with GERD, 79.2% reported the affirmative.” They wrote that there was growing concern that physicians were overemphasising the role of laryngopharyngeal reflux as a cause of dysphonia. In the case of laryngeal carcinoma, there was evidence showing a delay in diagnosis was a prognostic indicator associated with increased morbidity and more advanced disease. “Therefore, incorrect empirical treatment by [primary care physicians] could delay necessary interventions for more serious laryngeal pathologic conditions”, they wrote.

HRT link to pancreatitis
THE use of hormone replacement therapy (HRT), particularly for longer than 10 years, is associated with an increased risk of pancreatitis, according to research published in CMAJ. The prospective cohort study of 31 494 postmenopausal women aged 48–83 years included 42% current HRT users and 12% past users. During follow-up of more than 10 years, 237 cases of incident acute pancreatitis were identified, including 71 cases per 100 000 person-years among women who had ever used HRT and 52 cases among those who had never used such hormones. “Ever users had a multivariable-adjusted RR [relative risk] ratio of acute pancreatitis of 1.57 (95% confidence interval [CI] 1.20–2.05) compared with never users”, the researchers wrote. “Physicians should consider this potential increase in risk when prescribing this type of therapy”, they wrote.

Burns treatments under fire
TOOTHPASTE, yoghurt and tea tree oil are among the inadequate and inappropriate treatments used on burns despite public health campaigns and professional guidelines, say the authors of a letter published in the MJA. The authors looked at the first aid treatment for 4368 children who presented to Westmead Children’s Hospital’s Burns Unit in Sydney over a 5-year period. Nearly a third (34% of inpatients and 30% of outpatients) received “inadequate, inappropriate or no first aid, irrespective of the size of the burn”, they wrote. Inadequate treatments included cold compresses or wet wraps (9.5%) and Burnaid (5.4%). Inappropriate treatments included ice (5.2%), food, creams and oils. Toothpaste was the most common bathroom product used, while dairy products, usually yoghurt, were also popular. The Australian and New Zealand Burns Association defines adequate first aid for acute burns as “20 minutes of cold running water within the first 3 hours of a burn injury”. “There remains a need to educate health practitioners and the wider community about appropriate first aid for burns”, the authors wrote. “While most children in our study eventually received appropriate first aid, 31.1% did not”.