Research shows need for Q fever vaccination
ADULTS living on farms in remote geographic regions have a clear increased risk of acute Q fever infection, according to a population-based prospective study of the risk and burden of the infection in Australia. The research, published in the MJA, found those living in major cities had the lowest risk of contracting Q fever. Risks were greater for those under 65 years of age and for men. The research was based on 266 906 adults aged 45 years and over (the 45 and Up Study) recruited during 2006‒2009 and followed using linked Q fever notifications, hospital records and death records during 2006‒2012. During the follow-up period, 45 participants had a linked Q fever notification. The incidence of notified Q fever was 3.6 per 100 000 person-years. After adjustments, age (≥ 65 years v 45‒54 years: hazard ratio [HR], 0.39), sex (women v men: HR, 0.48), and area and type of residence remained significantly associated with Q fever. The risk was highest for those living on a farm in outer regional or remote areas (HR, 11.98), followed by those living on a farm in inner regional areas (HR, 4.95). The researchers wrote that the study encompassed a period when no major Q fever outbreaks were reported, so it more accurately assessed the risk and burden of endemic Q fever. Potential limitations included the use of notification data to identify Q fever cases as such data usually underestimated the number of infections and depended on doctors considering a Q fever diagnosis. They wrote that their results “support current recommendations for Q fever vaccination of farmers and add to the existing body of evidence that suggests targeting a broader, geographically based population in regional and remote regions is required to reduce the burden of Q fever in Australia”. 
Don’t worry, being unhappy not risky
AUSTRALIAN researchers have found no robust evidence that happiness itself reduces cardiac, cancer or overall mortality. The research, published in The Lancet, was based on the Million Women Study, a prospective study of UK women recruited between 1996 and 2001 and followed electronically for cause-specific mortality. The researchers included 719 671 women, who had a median age of 59 years, in their main analysis. The women completed a baseline questionnaire, 3 years after being recruited, asking them to self-rate their health, happiness, stress, feelings of control and whether they felt relaxed. The main analyses were of mortality before 2012 from all causes, ischaemic heart disease and cancer in women who did not have heart disease, stroke, chronic obstructive lung disease or cancer when they completed the baseline questionnaire. The research found 39% of the women reported being happy most of the time, 44% were usually happy and 17% were unhappy. During 10 years of follow-up, 4% (31 531) of the women died. The researchers found self-rated poor health at baseline was strongly associated with unhappiness, but after adjustment for self-rated health, treatment for hypertension, diabetes, asthma, arthritis, depression or anxiety, and several sociodemographic and lifestyle factors (including smoking, deprivation and body mass index), they found unhappiness was not associated with mortality from all causes. There were similar findings for related measures such as stress and lack of control. The researchers wrote that there was no perfect or generally agreed way to measure happiness or related subjective indices of wellbeing, which limited comparability between studies. An accompanying commentary said the research provided “extremely valuable and robust information about happiness, health, and mortality”.
Doctors lack knowledge on female genital mutilation
THE first literature review of health professionals’ knowledge, attitudes and practice related to female genital mutilation and cutting (FGM/C), conducted by Australian researchers, has found most are unable to recognise the four types of FGM/C and few could identify women at high risk. The review, published in BMC International Health and Human Rights found that Australia was one of the countries where many women with FMG/C were now living, due to increasing immigration from countries where the procedure is prevalent. The review analysed 18 articles, including eight from low–middle-income countries in Africa and 10 from high-income countries including Australia. It found that knowledge about the FGM/C types varied widely, with few health professionals in high-income countries knowing there were four different types of FGM/C. The review included five surveys in high-income countries where health professionals had provided care to women with FGM/C, including 75.3 % of obstetricians/gynaecologists in Australia and New Zealand. It found some respondents from both high-income and African countries incorrectly believed FGM/C was done for religious reasons. “In four surveys, between 4% and 48% of health professionals indicated that they would agree for their own daughters to undergo FGM/C”, the authors wrote. They acknowledged that the methodological quality of the studies used in the review was poor, they were unlikely to be representative and that no papers specifically studied paediatricians despite female genital mutilation and cutting usually being performed in children aged from 1 month to 15 years. The authors wrote that most health professionals had indicated they wanted more information “about how to speak with families about this culturally sensitive issue, how to recognise children who might be at risk of FGM/C and how to treat women and girls who have undergone FGM/C”. They said the Royal Australasian College of Physicians guidelines on FGM/C provided a short summary of recommendations for paediatricians, but there was “no practical guidance of what to do and what to say when dealing with a child with FGM/C or at risk of FGM/C and her family, often within a complex medical and sociocultural context”. They called for further research, educational materials and policy to prevent the harmful practice, which affects 100‒140 million girls and women and is most likely to be performed in children whose mother has undergone the procedure.
Mass drug campaign effective for scabies control
MASS drug administration, particularly with ivermectin, is efficacious in controlling scabies and impetigo, according to Australian research study published in the New England Journal of Medicine. The 12-month study conducted across three island communities in Fiji, trialed three interventions for scabies control. Of the 2051 participants, 803 received standard care (administration of permethrin to people with scabies and their contacts), 532 received mass administration of permethrin and 716 received mass administration of ivermectin. The prevalence of scabies declined across all groups during the study period, most markedly with ivermectin with a decline from 32.1% prevalence to 1.9%. In the permethrin group, scabies prevalence declined from 41.7% to 15.8% and in the standard care group it declined from 36.6% to 18.8%. The prevalence of impetigo also declined in all groups, particularly in the ivermectin group. “Mass drug administration shows promise as an important control strategy in countries in which scabies is endemic”, the researchers wrote. “Previous single-group studies of the mass administration of permethrin and of ivermectin have shown reductions in disease prevalence but have not determined whether this strategy is superior to an effective application of standard care.” They wrote that their data supported mass administration of ivermectin for scabies control, but acknowledged that key issues still to be evaluated included the number of cycles needed, the model of delivery, and the mechanism for evaluating efficacy, cost effectiveness and acceptability. An accompanying editorial said the study was timely, as “scabies was added to the World Health Organization list of neglected tropical diseases in 2013 and is estimated to affect more than 130 million people globally at any time”.
Add sitting, sleep to mortality risk factors
NEW Australian research has reaffirmed the importance of middle-aged and older people adopting healthy lifestyles. The authors of the large population-based study, published in PLOS Medicine, have also suggested that prolonged sitting and unhealthy sleep duration be added to risk factors associated with all-cause mortality, saying they should be included in scores designed to quantify health risk. Baseline data from a large Australian cohort of middle-aged and older adults from February 2006 to April 2009 were linked to mortality registration data until June 2014. Smoking, high alcohol intake, poor diet, physical inactivity, prolonged sitting and unhealthy (short/long) sleep duration were measured by questionnaires and summed into an index score. The 231 048 participants were followed up for 6 years with 15 635 deaths registered. Of all the participants, 31.2%, 36.9%, 21.4% and 10.6% reported 0, 1, 2 and 3+ risk factors, respectively. A strong relationship was found between the lifestyle risk index score and all-cause mortality. Of 96 mutually exclusive combinations of risk behaviours, the 30 most commonly occurring combinations accounted for more than 90% of all participants. The most common single risk behaviour was prolonged sitting time (9.1%), followed by physical inactivity (7.1%), unhealthy diet (6.9%), short sleep duration (5.7%), high alcohol intake (4.2%), and long sleep duration (2.4%). Of all the single risk behaviours, smoking had the strongest association with all-cause mortality. The researchers wrote that a key finding was that prolonged sitting time alone, as the most common single risk factor, had a small effect on all-cause mortality (hazard ratio [HR], 1.15) but in combination with physical inactivity had a much stronger association with mortality (HR, 2.42). The researchers acknowledged the limitations of their study, including that lifestyle risk behaviours were self-reported. However, they wrote that the prevalent combinations of risk factors found by their analysis “suggest new strategic targeting for chronic disease prevention”.

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