more_vertThe Global Burden of Disease Study 2016 estimated that oral diseases affected half of the world’s population.1 Nonetheless, oral health is a neglected area of global health that could make a contribution to achieving universal health coverage (UHC).2 UHC can help frame policy dialogue to address weak and fragmented primary oral health services, and address substantial out-of-pocket expenses associated with oral health care in many countries, which in turn would help to achieve UHC.
Preference: Infectious Diseases and Parasitology
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Push to reduce unnecessary colonoscopies
A new Colonoscopy Clinical Care Standard has been launched by the Australian Commission on Safety and Quality in Health Care and will benefit millions of Australians seeking treatment.
It is the first nationally agreed standard of care for patients undergoing a colonoscopy.
The number of Australian who have a colonoscopy each year is approaching one million. Despite it being frequently performed, it is a complex medical procedure and should only be offered if the benefits outweigh the risks.
Undergoing the procedure unnecessarily doesn’t make sense and may extend the wait time for those who do need it, according to the new standard.
In launching the new standard in Brisbane during Australian Gastroenterology Week in September, the Commission said patients with a positive bowel cancer screening result should consult their general practitioner to discuss further investigation. In many cases this will be a colonoscopy.
The procedure examines the large bowel (colon) to diagnose and treat a range of bowel diseases including bowel cancer, the second most common cancer diagnosed in both men and women in Australia. Bowel cancer is expected to claim more than 4,000 lives in Australia in 2018.
The Commission’s Clinical Director Professor Anne Duggan said the new standard offers guidance to patients, clinicians and health services at each stage of a colonoscopy, with the goal of ensuring high-quality and timely colonoscopies for patients who need them. The standard will also help to reduce the number of unnecessary colonoscopies being carried out.
“The Commission’s Australian Atlas of Healthcare Variation 2015 found stark differences across the country in rates of colonoscopies being performed, with some areas having colonoscopy rates 30 times higher than others,” Professor Duggan said.
“Colonoscopy rates were significantly higher in capital cities and lower in remote areas. In major cities, rates were lower in areas of low socioeconomic status. The clinical care standard supports clinician certification and recertification as requirements for colonoscopy services, and will bring increased rigour to the procedure and shine a light on when and how these procedures are done.
“We asked experts in colonoscopy about how to look after people in the best possible way and used this information to develop guidelines for everyone involved.”
Gastroenterological Society of Australia (GESA) spokesman Dr Iain Skinner is a colorectal surgeon and advanced colonoscopist who co-chaired the Commission’s working group that developed the new standard. He said the guidelines were much needed.
“The clinical care standard further enhances care, focusing on bowel preparation, sedation, the colonoscopy and recovery. The standard also clarifies appropriate use of the procedure based on evidence,” Dr Skinner said.
“This is an advanced procedure and we don’t want it being performed unnecessarily. Fewer unnecessary colonoscopies will free up access to more timely colonoscopies for those who are at moderate or high risk, such as those with a history of polyps or a significant family history of bowel cancer, or those who return a positive bowel screening test.”
The Colonoscopy Clinical Care Standard and separate fact sheets for consumers and clinicians can be found on the Commission’s website at: https://www.safetyandquality.gov.au/our-work/clinical-care-standards/colonoscopy-clinical-care-standard/
[Perspectives] Anne Chang: a champion of childhood lung health
At a health centre in Melbourne for Aboriginal and Torres Strait Islanders in the late 1980s, medical student Anne Chang had her eyes opened to Indigenous disadvantage in Australia. “The patients there had diseases not seen in mainstream medicine”, she says. “Pus from the children’s ears and chronic cough with purulent nasal discharge were common.” It was one of many experiences of health inequities that helped drive her passion for improving the health of disadvantaged groups. “People who are worse off should be given the best care”, says Chang, now Professor and Head of the Child Health Division at Menzies School of Health Research in Darwin and Consultant Paediatric Respiratory Physician at Children’s Health Queensland Hospital in Brisbane.
New taskforce to battle HTLV-1
BY AMA PRESIDENT DR TONY BARTONE
The Federal Government recently announced the formation of a new taskforce consisting of relevant health care providers, researchers, clinicians, and all levels of government to combat HTLV-1 in remote Indigenous communities.
Human T-cell lymphotropic virus (HTLV) – an oncogenic virus first discovered in 1979, and the first retrovirus to be discovered – predominantly affects CD4+T cells, which play an important role in the body’s immune system.
HTLV-1 infects up to 20 million people globally, with the virus prevalent in south-western Japan and the developing countries of the Caribbean basin, South Americ, and sub-Saharan Africa.
HTLV-1 was first detected in 1988 in Central Australia in the Indigenous population, and recent studies indicate that 45 per cent of Indigenous adults who reside in remote communities in Central Australia have been infected with HTLV-1.
Commonly transmitted through contaminated blood, unprotected sex, and breast milk, the virus is associated with a fatal haematological malignancy – Adult T cell Leukemia/Lymphoma (ATLL) – and inflammatory diseases involving organs including the spinal cord, eyes, and lungs.
In Indigenous Australians, the most typical clinical manifestation of HTLV-1 is bronchiectasis (a condition in which the airways of the lungs become damaged).
The extent and seriousness of the disease is dependent on the viral load in the blood stream.
Uveitis (inflammation of the middle layer of tissue in the eye) is another serious complication of HTLV-1, which was found through a case study done in Central Australia.
It can result in blindness, so it is important for treating professionals to be well informed about HTLV-1.
Unfortunately, there are no treatments currently available for HTLV-1 infection, but the following prevention strategies could result in the reduction of transmission and, ultimately, the eradication of the virus:
- Encourage the use of condoms among the sexually active population, and routine testing for HTLV-1 in areas where the virus is prevalent.
- Organ donors and blood transfusion products should be tested, and transfusions and transplantations avoided where testing shows a positive result. Monitoring and follow-up are vital in these instances.
- Mothers who test positive to HTLV-1 should be advised to avoid breastfeeding or reduce it to three to six months, and alternative methods of infant feeding should be advised.
- Injecting drug users should be educated and advised to use sterile needles, and regular testing for HTLV-1 should be available.
- Evidence-based and up-to-date information regarding HTLV-1 should be available to health care providers so they can educate their clients on how to protect themselves.
The AMA supports an enhanced focus on Aboriginal and Torres Strait Islander people at risk of blood-borne viruses, including specific resourcing of management and research to address HTLV-1.
This is consistent with the AMA’s active participation in the Close the Gap strategy, and our series of Indigenous Health Report Cards, which have highlighted diseases such as rheumatic heart disease and otitis media, and which later this year will provide an audit of success or failure in Indigenous health policy over the past decade.
On top of this, the AMA supports other policies and initiatives that aim to reduce preventable diseases, many of which have an unacceptably high prevalence in remote Indigenous communities.
The AMA remains committed to working in partnership with Aboriginal and Torres Strait Islander groups to advocate for Government investment and cohesive and coordinated strategies to improve health outcomes for Indigenous people.
Expert Panel for Life Saving Drugs Program
The Government has appointed Australia’s former Deputy Chief Medical Officer Dr Tony Hobbs as chairman of the Life Saving Drugs Program Expert Panel.
In announcing the appointment, Health Minister Greg Hunt said the panel was being established to help improve access to lifesaving medicines for rare diseases.
The Life Saving Drugs Program (LSDP) provides free medicines to treat patients with rare and life-threatening diseases.
Medicines funded through on the LSDP include some high cost medicines that do not meet the criteria to be funded on the Pharmaceutical Benefits Scheme.
Currently, the Government funds 13 different medicines for nine very rare diseases through the LSDP, providing physical, emotional and financial relief for people and families in need.
The LSDP supported 393 patients in 2016-17 at a cost of $116 million and over the past six years the number of patients accessing these medicines through the program has grown over 65 per cent.
“The new expert panel will support the evaluation of medicines for funding and provide advice to the Chief Medical Officer,” Mr Hunt said.
“The diverse experience of the appointees will ensure that the program is supported by some of the very best minds in evidence evaluation and health technology assessment.”
Other members of the six-member panel will include clinical experts Professor Jonathan Craig and Professor Elizabeth Elliott, health economist Adjunct Professor Jim Butler, consumer nominee Nicole Millis and industry nominee Liliana Bulfone.
Dr Hobbs’ appointment is for four years, with the new expert panel members’ terms varying from two to four years.
“Highly respected in their fields, this group will make a major contribution in considering the suitability of new medicines for inclusion on the LSDP through advice to the Commonwealth Chief Medical Officer,” Mr Hunt said.
Other recent changes to the LSDP include clearer eligibility criteria for inclusion on the LSDP, a more transparent and timely assessment process, new pricing policies similar to those that apply to PBS medicines, and the review all of the currently funded LSDP medicines.
The changes follow the Government response to a review of the LSDP chaired by Professor Andrew Wilson.
[Viewpoint] Outrageous prices of orphan drugs: a call for collaboration
Few instances of a single act of legislation have shifted industrial policy in the pharmaceutical industry like the Orphan Drugs Act did when it was signed in the USA in 1983. The Act was written to facilitate the development of drugs for rare diseases and health conditions,1 and the incentives provided by the Act, such as 7 year exclusivity, tax credits of up to 50% of research and development costs, and access to research and development grants, resulted in the US Food and Drug Administration2 (FDA) approving 575 drugs and biological products for rare diseases between 1983 and 2017—a real success.
[Articles] Burden of disease in Brazil, 1990–2016: a systematic subnational analysis for the Global Burden of Disease Study 2016
Health improved from 1990 to 2016, but improvements and disease burden varied between states. An epidemiological transition towards non-communicable diseases and related risks occurred nationally, but later in some states, while interpersonal violence grew as a health concern. Policy makers can use these results to address health disparities.
[World Report] 41 000 measles cases in Europe since the beginning of 2018
The high numbers of measles cases reported in the first two quarters of 2018 are alarming public health experts, who fear this highly infectious disease will spread. Ed Holt reports.
[Seminar] HIV
The benefits of combination antiretroviral therapy (cART) for HIV replication and transmission control have led to its universal recommendation. Many people living with HIV are, however, still undiagnosed or diagnosed late, especially in sub-Saharan Africa, where the HIV disease burden is highest. Further expansion in HIV treatment options, incorporating women-centred approaches, is essential to make individualised care a reality. With a longer life expectancy than before, people living with HIV are at an increased risk of developing non-AIDS comorbidities, such as cardiovascular diseases and cancers.
[Comment] Pneumonia: a global cause without champions
Every 2 min three children will die from pneumonia, the leading infectious cause of child mortality globally, killing more children than diarrhoea and malaria combined.1 In 2016, the disease killed an estimated 880 000 children.2 Most were younger than 2 years old. Almost all pneumonia deaths could be prevented through vaccination or early diagnosis and treatment with antibiotics costing less than US$0·50. Yet childhood pneumonia deaths are falling far more slowly than other major killers. On current trends, there will be 735 000 pneumonia deaths in 20303—the target date for achieving Sustainable Development Goal (SDG) 3 target 3.2 of ”ending preventable child deaths”.