more_vertMitochondria are dynamic bioenergetic organelles whose maintenance requires around 1500 proteins from two genomes. Mutations in either the mitochondrial or nuclear genome can disrupt a plethora of cellular metabolic and homoeostatic functions. Mitochondrial diseases represent one of the most common and severe groups of inherited genetic disorders, characterised by clinical, biochemical, and genetic heterogeneity, diagnostic odysseys, and absence of disease-modifying curative therapies. This Review aims to discuss recent advances in mitochondrial biology and medicine arising from widespread use of high-throughput omics technologies, and also includes a broad discussion of emerging therapies for mitochondrial disease.
Preference: Infectious Diseases and Parasitology
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Is oral health the unspoken determinant?
BY AMA PRESIDENT DR TONY BARTONE
According to the Australian Institute of Health and Welfare’s (AIHW) report Australia’s Health 2012, most people will experience oral health issues at some point in their life. In fact, oral diseases are recurrently among the most frequently reported health problems by Australians.
Considered a disease of affluence up until the late 20th century, poor oral health outcomes have now become an indicator of disadvantage, highlighting a lack of access to preventative services. Insufficient access to, high cost of, or long waiting periods for dental services; and low oral care education, have all been associated with patients not seeking dental care when it is needed. Of course, non-fluoridised water supplies also has a role in explaining the prevalence.
However, more recently, it is the modifiable risk factors like poor nutrition, smoking, substance use, stress, and poor oral hygiene that are considered to have the greatest impacts on periodontal diseases.
Dental conditions frequently rank in the top 10 potentially preventable acute condition hospital admissions for Aboriginal and Torres Strait Islander people and were the third leading cause of all preventable hospitalisations in 2013-14, with 63,000 admissions.
Like most other health conditions, Aboriginal and Torres Strait Islander people have poorer oral health outcomes. While Indigenous people currently have most of the same oral health risk factors as non-Indigenous people, they are less likely to have the same access to preventative measures, leading to marked disparities in oral health between Indigenous people and other Australians.
While the majority of oral health concerns are often considered inconsequential, such as avoiding certain foods, or cosmetic with people embarrassed about their physical appearance, there is a significant body of evidence which suggests that oral health may be the undiscussed determinant of health.
More than two decades ago, population-based studies identified possible links between oral health status and chronic diseases such as cardiovascular disease (CVD), diabetes, respiratory diseases, stroke, and kidney diseases, as well as pre-term low birthweight. And the relationship appears to lie with inflammation.
It is clear more research is needed to determine the exact links (if any), between periodontal disease and chronic disease condition, however, the growing body of evidence links poor oral health to major chronic illnesses.
The Government has made numerous financial commitments to improving access to dental services, however, oral health data will continue to demonstrate that without equitable access to dental services, Australians, and particularly Aboriginal and Torres Strait Islander people, will continue to suffer poorer oral health outcomes, and potentially poorer health outcomes, as a result.
The AMA supports improved Doctor/Dentist collaborations if such partnerships could lead to increased early identification of both chronic disease and oral health conditions, particularly for Aboriginal and Torres Strait Islander peoples, for whom oral health services are less frequently accessed.
Dental Health Week is 6-12 August 2018.
Europe’s digital highway changing the future of health care
The European Commission continues to strategically progress digital changes to modernise its healthcare system, with significant funding announced in their June EU Budget.
The budget announcement proposes to create the first ever Digital Europe program and invest €9.2 billion to align the next long-term EU budget 2021-2027 with tackling increasing digital challenges.
Andrus Ansip, the European Commissioner’s Vice-President for the Digital Single Market, said the announcement would ensure the EU budget was fit for the future.
“Digital transformation is taken into account across all proposals, from transport, energy and agriculture to health care and culture. We are proposing more investment in artificial intelligence, supercomputing, cybersecurity, skills and eGovernment – all identified by EU leaders as the key areas for the future competitiveness of the EU,” Mr Ansip said.
The European Commission’s legislative framework is based on new technologies enabling cross-border access of data to create more personalised, accurate and patient-oriented health care in a safe environment.
The framework is designed to overcome three challenges; ageing population and chronic diseases putting pressure on health budgets; unequal healthcare quality; and shortage of health professionals.
Currently EU citizens have the right to access health care in any EU country and to be reimbursed for care abroad by their home country.
The Commission’s digital health goal is to reduce administrative costs, avoid human errors, optimise the use of medical data and increase quality of services by systematically aligning healthcare IT systems and implement systems that support open standards-based data exchange.
The Commission recently established a set of measures to increase the availability of data in the EU, building on previous initiatives to boost the free flow of non-personal data in the Digital Single Market.
Thirteen European countries signed a declaration in April for delivering cross-border access to their genomic information. This is a game changer for European health research and clinical practice: sharing more genomic data will improve understanding and prevention of disease, allowing for more personalised treatments (and targeted drug prescription), in particular for rare diseases, cancer and brain related diseases. The target of the EU is to make one million genomes accessible in the EU by 2022.
The European Commissioner for the Digital Economy and Society, Ms Mariya Gabriel, said the agreement was founded in the understanding modern health relies on digital innovation and cross-border interoperability.
“Secure access to genomic and other health data among Member States is essential for better health and care delivery to European citizens and to ensure that the EU will remain at the forefront of health research.”
MEREDITH HORNE
Active commuting might not be that hard
More than two in three Australians drive to work, according to the latest 2016 Census data. An active commute, where physical activity forms a significant part of the way people travel to and from work, is far easier than often thought – and it could even be a lifesaver.
One of the main hurdles for the uptake of active commuting could be based in an overestimation of the length of time people believe it would take to walk or ride to work, a recent study suggests.
Associate Professor Melissa Bopp, one of the study’s co-authors from Pennsylvania State University, said: “Often people indicate that the reason they choose to drive is that it’s much quicker than walking or biking when, in reality, that may not be the case.”
When the study’s participants were asked to estimate how long it would take them to bike or walk to a common location in town, they found that the majority of people estimated incorrectly. Ninety-one per cent of study participants incorrectly estimated how long it would take to commute with walking, and 93 per cent mis-estimated how long it would take to bike.
In Australia, rates of walking and cycling remain constant and low – even in smaller centres such as Hobart, Darwin and Canberra. Even in the most ‘cycling-oriented’ places (Darwin and Canberra), only about three per cent of commuters cycle.
The World Health Organisation (WHO) launched in June this year its first Global Action Plan for Physical Activity 2018-2030, to encourage an increased participation in physical activity by people of all ages and abilities across the world.
WHO recommends that adults aged between 18 and 65 should do at least 150 minutes of moderate-intensity physical activity throughout the week, or do at least 75 minutes of vigorous-intensity physical activity throughout the week, or an equivalent combination of moderate- and vigorous-intensity activity. For additional health benefits, adults should increase their moderate-intensity physical activity to 300 minutes per week, or equivalent. Muscle-strengthening activities should be done involving major muscle groups on two or more days a week.
Active commuting offers an extremely effective health solution to modern sedantry lifestyles as supported by findings from the University of Glasgow published earlier this year in the British Medical Journal, a study that investigated the health benefits of cycling to work.
The Scottish-based researchers observed the incidences of heart disease, cancer, accidents and death, adjusting the study to consider other factors contributing to their health, such as sex, age, smoking, and time spent sitting down.
Cyclists had a 52 per cent lower risk of dying from heart disease, and a 40 per cent lower risk of dying from cancer. In terms of developing the disease at all, they had a 46 per cent lower risk of getting heart disease and a 45 per cent lower risk of getting cancer.
The commuters who walked to work also enjoyed some benefits, such as a 27 per cent lower risk of heart disease and a 36 per cent lower risk of dying from it. However, they did not have a lower risk of dying from any of the causes.
People who cycled combined with other modes of transport had 24 per cent lower risk of death from all causes, a 32 per cent lower risk of developing cancer and a 36 per cent lower risk of dying from cancer.
The Australian Heart Foundation estimates the cost of being inactive in Australia is $805 million each year, with much of the costs relating to healthcare spending ($640 million). The cost of physical inactivity to households is $124 million each year, due to diseases related to lack of exercise.
World leaders will meet later this year to take action on physical inactivity and other causes of NCDs, and mental disorders, when they take part in the Third United Nations General Assembly High-level Meeting on Non-Communicable Diseases (NCDs), being held on September 27 in New York.
The World Health Organisation’s Global Action Plan for Physical Activity 2018-2030 can be found here: http://www.who.int/ncds/prevention/physical-activity/gappa/
MEREDITH HORNE
[Perspectives] Understanding, preventing, and stopping epidemics
Public health was born from crises. Before the influenza pandemic of 1918, many diseases were seen as something that mostly affected the poor, to be blamed on those who had not pulled themselves out of poverty. The 1918 influenza pandemic is estimated to have killed up to 50 million people, infecting rich and poor alike. Viruses were just beginning to be recognised, and doctors had no vaccines, no antivirals, no antibiotics. The pandemic revealed that disease is a population-wide issue, not simply an individual burden.
[Editorial] ICD-11: a brave attempt at classifying a new world
The 11th version of the International Classification of Diseases (ICD) launched on June 18 is the latest attempt at systematically describing and categorising all human mortality and morbidity. Designed for the global digital age, it is an onscreen, multipurpose, multilingual database interconnecting with other operating systems—including electronic hospital records. It is a quantum leap forward from the ICD-10, which, although revised several times over the past two decades, was originally published in 1992, when internet use was minimal, smartphones were unheard of, and patient records were paper based.
[Comment] New-generation JAK inhibitors: how selective can they be?
Almost 20 years into the biologics era, an unmet need exists for treating patients with rheumatoid arthritis and other inflammatory diseases who either do not tolerate, do not respond to, or cannot afford effective but costly biologic medicines. Also 20 years ago, the small family of Janus kinases (or tyrosine-protein kinase JAK; JAKs) were discovered, and have since been harnessed for treating and understanding both malignancies and inflammatory diseases.
[Perspectives] Teeth and inequality: from past to present
Teeth matter. Despite being largely preventable, oral diseases are common chronic conditions. Indeed, findings from the 2013 Global Burden of Disease Study show that untreated caries (decay) is the most prevalent and severe periodontal (gum) disease, the sixth most common disease in the world. From early childhood to old age, oral diseases have a negative impact on quality of life and social functioning. Pain, infection, and difficulties eating and speaking are all common consequences of oral disease.
[Perspectives] Chen Wang: new President of CAMS and PUMC
Professor Chen Wang, Director of the Centre for Respiratory Medicine at Beijing’s China–Japan Friendship Hospital, is the new President of the Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC). Of the several reasons for welcoming the appointment, the most obvious is Wang’s expertise in the respiratory diseases that are a leading cause of morbidity and mortality in his country and impose a great socioeconomic burden. Moreover, he makes no secret of his enthusiasm for curbing tobacco use, which, while now recognised by the Chinese Government as a key public health issue, remains high.
[Comment] Offline: NCDs, WHO, and the neoliberal utopia
The WHO Independent High-Level Commission on Non-Communicable Diseases presented an important opportunity. Yet, by common consensus, it failed to deliver. The Guardian newspaper reported that, “An independent panel advising the World Health Organisation has stopped short of recommending taxing sugary drinks to reduce obesity after failing to reach a consensus.” WHO scrambled to reassure critics that the agency “still supported taxing” sugar-sweetened beverages. The Commission was left unhappily advocating a set of recommendations substantially weaker than those already existing.