Chromium supplements linked to carcinogens: research

An Australian research team has found concerns with the long-term use of nutritional supplements containing chromium.

UNSW and University of Sydney researchers say chromium partially converts into a carcinogenic form when it enters cells.

The findings are published in the chemistry journal Angewandte Chemie.

There are primarily two forms of chromium: chromium (III) forms such as trivalent chromium (III) picolinate are sold as nutritional supplements. Hexavalent chromium (VI) is its ‘carcinogenic cousin’.

The team was led by Dr Lindsay Wu from UNSW’s School of Medical Sciences and Professor Peter Lay from the University of Sydney’s School of Chemistry. It treated animal fat cells with chromium (III) in a labatory and created a map of every chemical element contained within the cell using a synchrotron’s X-ray beam.

Related: Supplement claims rejected

“The high energy X-ray beam from the synchrotron allowed us to not only see the chromium spots throughout the cell but also to determine whether they were the carcinogenic form,” said Dr Wu.

“We were able to show that oxidation of chromium inside the cell does occur, as it loses electrons and transforms into a carcinogenic form.

“This is the first time this was observed in a biological sample,” Dr Wu said.

Professor Lay said the finding raises concerns over possible cancer causing possibilities of chromium supplements.

“With questionable evidence over the effectiveness of chromium as a dietary supplement, these findings should make people think twice about taking supplements containing large doses of chromium,” Professor Lay said.

“However, additional research is needed to ascertain whether chromium supplements significantly alter cancer risk.”

There is controversy over whether the dietary form of chromium is essential.

Chromium supplements are sometimes used for the treatment of metabolic disorders however they are also commonly used for weight-loss and body building.

Australia’s current National Health and Medical Research Council Nutrient Reference Values, which are currently under review, recommend 25-35 micrograms of chromium daily as an adequate intake for adults.

Trace amounts of chromium (III) can be found in some foods however these findings are unlikely to apply.

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5 hospital presentations that GPs could help prevent

New research suggests over half a million hospitalisations could be avoided if patients had visited their doctor earlier.

The National Health Performance Authority’s report found there were 22 conditions for which hospitalisation was considered to be potentially preventable.

They found that 600,267 hospitalisations in 2013-14 could have potentially been prevented and five conditions specifically account for almost half (47%) of all potentially preventable hospitalisations.

The five conditions are:

Chronic obstructive pulmonary disease (COPD) –10.4% of potentially preventable hospitalisations.
Diabetes complications – 6.8% of potentially preventable hospitalisations.
Heart failure – 8.9% of potentially preventable hospitalisations.
Cellulitis – 9.7% of potentially preventable hospitalisations.
Kidney and urinary tract infections (UTIs) – 10.4% of potentially preventable hospitalisations.

The report found that among the 300 local areas, age standardised rates of potentially preventable hospitalisations were nine time higher in some areas compared to others, “ranging from 1,406 per 100,000 people in Pennant Hills-Epping (NSW) to 12,705 hospitalisations per 100,000 in Barkly (NT).”

It also found that people in regional and remote areas and from a lower socioeconomic status often have higher rates of potentially preventable hospitalisation.

“This may be due to poorer health among people living in these areas and, potentially, poorer access to health care services provided in the community,” the report suggests.

Authors of the report say focusing on these five conditions can help PHNs target efforts on areas where there can be potential for great improvement.

The RACGP declined to comment on the report.

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Women stopped from getting to the top

Women are struggling to make it into the upper echelons of the medical profession despite comprising an increasing majority of those embarking on a medical career.

Australian Institute of Health and Welfare figures show that last year women made up 40 per cent of the medical workforce and 53 per cent of early-career practitioners, including just over half of all specialists in training.

But, despite this, researchers have found that they are failing to progress through to senior positions in representative numbers, comprising less than a third of specialist college board members and medical school deans, 33 per cent of state Chief Medical Officers and just 12.5 per cent of large hospital CEOs.

A study of medical leadership in Australia, published in BMJ Open, has found that women are under-represented in medical leadership roles due to a combination of ill-informed attitudes and inflexible work and career demands.

Through detailed interviews with a sample of 30 medical leaders (22 of whom were men), a team of researchers from Melbourne University, Monash Health and Deakin University found although some thought the representation of women at senior levels would increase because of the pipeline of females entering the profession, the majority – both men and women – identified a series of barriers that prevented women from advancing.

“Most interviewees believed that gender-related barriers were impeding women’s ability to achieve and thrive in medical leadership roles,” the researchers said, and identified three broad impediments – perceptions of capacity, organisational arrangements and professional culture.

The most commonly-cited barrier was parenthood, with several medical leaders referring to an inherent incompatibility between high-level leadership and motherhood.

But several remarked on the tendency of managers, and women themselves, to underestimate their capabilities.

A number of leaders interviewed for the study, Reasons and remedies for under-representation of women in medical leadership roles, reported that women were often “not taken really seriously”, and were consider to be “too feminine” to be an effective leader.

In their findings, the researchers said that, as in other professions, the lack of women in senior leadership positions was justified by a range of explanations including it was “too soon” to see women in these roles, they were too busy with their families, or were not natural leaders.

The researchers said the basis for these explanations was thin, pointing out that women have made up a sizeable proportion of the medical workforce for decades and are still not moving into leadership roles in numbers consistent with their representation in the workforce.

On the career-limiting impact of parenting, they said that “cultural assumptions that childrearing and household responsibilities impede women from entering leadership roles is, at least in part, based on discriminatory social norms”.

They pointed out that inflexible work arrangements made this a structural, rather than inherently biological, barrier. Some of those interviewed for the study suggested that, rather than following a standard linear path, medical careers could be structured to follow a more M-shaped trajectory that would support women to enter, or re-enter, leadership roles at an older age “if that suited their life-course”.

The researchers cited cultural norms and unconscious biases in the medical profession about what a leader should look like, and how they should behave, as another impediment faced by women.

They also identified other institutional impediments. For example, because the responsibilities for childrearing and maintain a household continue to fall disproportionately on women, they tend to gravitate towards specialties that give them the time and flexibility to fulfil these roles, such as general practice and public health medicine.

But these specialties, the report said, tended to have a less influential presence in large health services compared with traditional male-dominated specialities, such as surgery.

“Achieving meaningful change will require us to move beyond ‘fixing the women’ to a systemic, institutional approach that acknowledges and addresses the impact of unconscious, gender-linked biases,” the researchers said. “Revisiting rigid career structures, providing flexible working hours, offering peer support, and ensuring appropriate development opportunities, may all assist women to enter leadership roles.”

Adrian Rollins

[Articles] Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

[Editorial] Primary care is a team sport

Physicians are often called the gatekeepers of primary care, describing the providers at the front lines who orchestrate the steps in the cascade of care. Primary care is the first stop to connect patients—especially those with complex health needs, such as multiple chronic illnesses—with other necessary services, including specialists, after hours or home care, and social services. But a rising number of patients at risk for chronic diseases, an ageing population, and life-prolonging medical interventions have added new financial and capacity stresses on primary care systems, with primary care physicians making decisions from an increasingly challenging position.

Hospitals get just $1 more

The Federal Government spent just an extra $1 for each man, woman and child in the country on hospital funding in 2013-14 as it screwed down hard on its health budget.

As the nation’s leaders meet for the last Council of Australian Governments meeting of the year, figures compiled by the Australian Institute of Health and Welfare show that Commonwealth funding for hospitals reached $892 per person in 2013-14, which was a $132 increase from a decade earlier but just $1 more than in 2012-13.

The miserly increase has contributed to a big shift in the burden of hospital funding from the Commonwealth to the other levels of government.

In the 10 years to 2013-14, spending by the states, territories and local governments on hospitals grew at virtually double the rate of the Federal Government.

Over that time, they expended an extra $10.3 billion on hospitals, after inflation – a 69 per cent increase.

During the same period, the Commonwealth’s contribution grew by just $5.7 billion – a 38 per cent increase.

The result provides a sobering backdrop to the tax reform debate.

Weak growth in GST revenues in recent years has intensified the strain of health spending on State and Territory budgets, driving calls by premiers and chief ministers for access to a more dynamic revenue base. One proposal has been to push the GST to 15 per cent and direct the funds to the Commonwealth. In return, the states and territories would get a share of income tax revenue.

But the Commonwealth flagged it is not interested in increasing the GST and is instead pressuring the states to change their own tax mix.

At the same the Federal Government has been paring back on hospital funding, it has been pulling back on its share of primary health spending, which dropped to 36.7 per cent in 2013-14 from 37.3 per cent the previous year.

Instead, it has picked up its spending on other health goods and services, particularly referred medical services, and to a lesser extent research and health administration.

In the 10 years to 2013-14, Commonwealth spending on these services jumped from $11.6 billion to $19.3 billion – including $12.2 billion on referred medical services alone.

Indicating the increasing importance of this type of spending, in 2003-04, it was 8.4 percentage points lower than Commonwealth spending on hospitals. Ten years later, it was just 2.3 percentage points lower.

The figures underline AMA concerns that the Commonwealth is dumping an increasing share of the health funding burden onto the states and territories, intensifying the strain on public hospitals, which have already reported a downturn in performance.

The Commonwealth’s backsliding on primary health funding also lends weight to fears that the reviews it has initiated into primary care, particularly the MBS Review, are being driven by a cost-cutting agenda.

Adrian Rollins

Oversleeping linked to increased mortality

It’s not just smoking and high alcohol consumption that we should advise our patients to avoid if they want to live a long life.

A Sydney University study has found that regularly sleeping longer than nine hours a night also can increase the risk of mortality.

The study, published in PLOS One, found that on its own, regular oversleeping meant a 44% increase in risk of death over the six-year study period.

It also found that sitting in a chair for more than seven hours in a 24 hour period can be a big no-no for health.

The researchers gave a lifestyle questionnaire to 231,048 Australians aged 45 years or older who were participating in the Sax Institute’s 45 and up study. The participants were asked to score six health behaviours.

The 6 deadly behaviours are

Alcohol consumption
Poor diet
Inactivity
Smoking
Spending more than seven hours a day sitting down
Sleeping for more than nine hours

Over 90% of the participants had one of the 30 most commonly occurring risk factors and combinations including physical inactivity, sedentary behaviour, and/or long sleep duration. Combinations involving smoking and high alcohol consumption were more highly associated with all-cause mortality.

Dr Melody Ding, one of the study authors, told ABC Radio: “The most intriguing was the 44% risk increase of those who are sleeping more than 9 hours a week. When you combine too much sleep with physical inactivity… then you find the risk for death has increased 149%.

“People who are sleeping too much, sitting a lot and also not being physically active then you’re looking at a combined risk increase of four times.”

Another author, Associate Professor Emmanuel Stamatakis told Fairfax Media: “One of the possible explanations is ‘reverse causality’. Long sleeping times could be indicative of an underlying, undiagnosed disease.”

However he also said the way the survey was written could be a possible explanation: “In the survey, people were asked ‘How long did you sleep?’ This most likely elicits an answer to the question: ‘How long were you in bed?’

“This says nothing about the quality of the sleep,” Dr Stamatakis said. “So, reported long sleep duration could in fact be indicative of fragmented, restless and poor-quality sleep.”

The results founds a person who has all six bad habits is more than five times as likely to die during a six-year period as one who is very clean-living.

Interestingly, high alcohol on its own was the least risky behaviour, with just an 8% increased mortality.

Dr Stamatakis said this shouldn’t give people “licence to drink”.

“General population studies show exactly the opposite result. These show that harmful effects from alcohol start from moderate consumption levels,” he said.

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The flabby country

Children are continuing to pack on the pounds even though the pace of weight gain among adults appears to be slowing, underlining concerns that a combination of poor diet and inactivity is putting millions at heightened risk of heart disease, diabetes and other serious lifestyle-related health problems.

There has been a small but notable slowing in weight gain among adults – particularly women – since the global financial crisis struck in 2007-08. The proportion considered overweight or obese increased by just 0.6 of a percentage point to 63.4 per cent in the last three years after jumping more than 6.5 percentage points in the previous 15 years.

But Australian Bureau of Statistics figures show that children are putting on weight much more rapidly. The proportion who are overweight or obese leapt 1.7 percentage points in the last three years.

Overall, the country continues to have a severe weight problem.

Last financial year, more than 63 per cent of adults were overweight or obese, including more than 70 per cent of men, while more than a quarter of all children (27.4 per cent) are carrying too much weight.

The results mean Australia retains the unenviable status of having some of the highest rates of overweight and obesity in the world. By comparison, the World Health Organisation calculates that 39 per cent of adults worldwide are overweight, and 13 per cent obese.

The nation’s waistline has continued to bulge against a background of poor eating and exercise habits.

The ABS found that although half of all adults, and 70 per cent of children, eat two or more serves of fruit a day, Australians are not getting enough vegetables in their diet – just 7 per cent of adults and 5.4 per cent of children meet dietary guidelines for the consumption of vegetables.

Just as concerning, a large proportion of Australians are not getting enough exercise. While 55 per cent of adults reported doing at least two-and-a-half hours of moderate physical activity or 75 minutes of vigorous exercise each week, 30 per cent did not manage to do even this much, and almost 15 per cent said they did none.

AMA Vice President Dr Stephen Parnis said the findings showed much more needed to be done on health prevention.

“The message from this survey is clear – Australians have to get moving,” Dr Parnis said.

He said while it was heartening that rates of smoking and risky drinking were declining, the incidence of preventable disease highlighted the need to do more.

The ABS, which surveyed 19,000 people for its report, found that just 14.5 per cent of adults smoke on a daily basis – down from 16 per cent in 2011-12 – while the proportion who drink excessively has slipped to 17.4 per cent, a 2 percentage point decline over the same period.

Dr Parnis said the results showed the effectiveness of Australia’s tobacco control measures, including its plain packaging laws, but warned that alcohol continued to “wreak havoc” on families and communities.

“We cannot be complacent about alcohol because one in four men and one in 10 women are still exceeding the lifetime risk guidelines [for consumption],” he said.

The effects of excessive drinking, poor diet and relative inactivity are showing up in persistent rates of lifestyle-related illnesses identified in the ABS report, National Health Survey: 2014-15.

It found that rates of diabetes and heart disease (both affecting about 1.2 million people) are continuing to grow, while 2.6 million have hypertension and 1.6 million suffer from high cholesterol.

Dr Parnis said that, amidst the flurry of reviews of Medicare, primary care and private health insurance, the ABS report showed the “urgent need” for greater attention on preventive health measures.

“Investing in prevention pays big dividends. It keeps people healthy and away from costly hospital care,” he said. “We need to do more to make Australians more aware of their diets, their exercise regime, and the serious health risks of smoking and excessive or irresponsible alcohol consumption.”

Adrian Rollins

[Editorial] The death of AIDS—expected or exaggerated?

In advance of World AIDS Day on Dec 1, the US Centers for Disease Control and Prevention highlighted a survey suggesting that 34% of primary care doctors and nurses in the USA were unaware that pre-exposure prophylaxis (PrEP) can prevent HIV infection. Evidence has shown that daily emtricitabine–tenofovir could prevent up to 92% of HIV infections, and this treatment is recommended in the USA for high-risk groups, including some men who have sex with men and injection drug users. The urgent need for broad awareness, provision, and use of PrEP and other preventive interventions is illustrated by the 2 million new HIV infections that are anticipated, worldwide, each year.

What GPs can do to help curb rising STI rates

Despite years of safe sex promotion, rates of sexually transmitted infections continue to rise and there are concerns infections are becoming resistant to antibiotics.

Gonorrhoea notifications have almost doubled between 2008 and 2012, rates of HIV infection have increased and in 2013, the highest number of syphilis cases was ever recorded.

However in good news, chlamydia rates in 2013 decreased for the first time in 15 years and genital warts in young women is also declining thanks to the introduction of the HPV vaccine.

Dr Catriona Ooi and Professor David Lewis from the Western Sydney Sexual Health Centre say that more needs to be done in a primary health setting to prevent, identify and treat these infections.

They say: “GPs have an important role in caring for patients with sexually transmitted infections, in educating patients about unsafe sex, and encouraging regular screening for people at risk of infection. The whole community needs to acknowledge and tackle the rising rates of sexually transmitted infection.”

In an article published in Australian Prescriber, they write a detailed update about STIs and what doctors can do to help diagnose and treat them.

According to NSW STI Unit, people should be offered STI screening if they meet the following criteria:

Anyone requesting a screen
Sexually active people under 29 years
Men who have sex with men
Sex workers
People who inject drugs

Social media campaign for World AIDS day

World AIDS Day was 1st December and Durex used the day to launch a social media campaign “”to create the first official safe sex emoji”, asking users to use #CondomEmoji hashtag.

They said their research had told them that 80% of 16-25-year-olds could express themselves better using Emojis. 84% of young people felt more comfortable using icons when talking about sex.

Durex said it was sending the emoticon to developer Unicode following ‘resounding global support’ for the campaign.

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