more_vertThe multi-component whole-school SEHER health promotion intervention had substantial beneficial effects on school climate and health-related outcomes when delivered by lay counsellors, but no effects when delivered by teachers. Future research should focus on the evaluation of the scaling up of the SEHER intervention in diverse contexts and delivery agents.
Preference: Statistics, epidemiology and research design
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Thank you letters from recipients of the AMA Indigenous Medical Scholarship
It has made a huge difference
I am writing to you today to inform you that I have officially completed my studies at the University of Newcastle in the Bachelor of Medicine program as of the 7th December 2018, and I would like to take this opportunity to say thank you to the Australian Medical Association for their support throughout my time at Newcastle University that made this endeavour possible with the Indigenous Peoples’ Medical Scholarship 2016.
I can still remember the day I received the phone call that I had been awarded the scholarship. I was studying in the library, trying to finish off that week’s ‘Working Problem’. I saw it was a Canberra phone number, and instantly became nervous. I can still remember saying to myself ‘is this real?’ as I never expected to be even considered for such an award, but nonetheless, it has made a huge difference to where I am today.
As a mature aged student with a family, the scholarship took the pressure off the financial strain of attending university, and allowed me to focus more on my studies at the time when it was needed the most. Previous to the scholarship, my usual routine was to attend university Monday to Friday, then work Friday and Saturday night shifts in as a Registered Nurse in the Intensive Care Unit at the Newcastle Mater Hospital. This left me with one day to spend time with my family, and catch up on any extra reading. The scholarship enabled me to scale back work, spend more time studying, but it also allowed me to spend extra time with my boys.
I was fortunate enough to secure a position as a Junior Medical Officer in the Hunter New England Local Health District, commencing on the 21st January in 2019. This will keep me close to home at the present time, and I am looking forward to the challenge. Being an active member of the Wollotuka Institute at the University of Newcastle, I am also now looking forward to mentoring and tutoring Indigenous medical students in a new capacity so as to foster the next generation of Indigenous medical graduates.
Thank you once again to all the staff at the Australian Medical Association for making this dream possible.
Regards
Dr Darren Hartnett
*******************************
Continues to be the source of support that facilitates my passion to pursue medicine
This year was my first clinical year of medicine, where I was placed in Wagga-Wagga NSW. I have always been sure about pursuing rural and remote medicine – but being immersed in clinical medicine in rural NSW has only reaffirmed this more and made me more motivated!
Reading about the UNSW medicine program before I even gained entry, I was always very keen to be placed in Wagga. I placed it as my first preference and was lucky enough to get it [Wagga is becoming very popular among students!].
The relocation to Wagga from Wollongong was always going to be an expensive exercise; however, it was very comforting knowing that the transition would be supported by the AMA Indigenous medical scholarship. Throughout various placements this year, both within the hospital and the community, I have been exposed to the spectrum of health – and in particular health issues common in rural Australia such as Indigenous health and mental health.
An interest of mine has always been obstetrics, and I have made sure that this year I have had as much exposure as possible. As part of the UNSW medicine program, students are required to complete a 30-week independent learning project in their 4th year of study. I have been fortunate enough to have my proposal approved and will also be completing my research project in Wagga during 2019.
My research has an obstetric focus and will be assessing Indigenous foetal-maternal outcomes. I have not had much exposure to research however I am excited to learn more about rural obstetric medicine and am looking forward to the challenge next year! This year has also seen the budget allocate funding of a new medical school in Wagga-Wagga. I firmly believe this is a great opportunity to increase Indigenous medical student numbers as well as improving retention. As this has involved the current Wagga-Wagga rural clinical school I have been lucky enough to share my thoughts with the Dean of rural medicine.
This is something I have become quite passionate about as I truly believe that increasing the amount of Indigenous medical and allied health professionals will only aid in closing the gap between Indigenous and non-Indigenous health status. This is a passion which I will continue to lobby for. The AMA Indigenous scholarship has, and continues to be, the source of support that facilitates my passion to pursue medicine. Medicine is a challenging experience and sometimes a little daunting and overwhelming. Being a recipient of the AMA Indigenous Medical Scholarship is a constant source of motivation and an opportunity I am and will always be grateful for! Thank you again for your support and in assisting me throughout my medical studies and I look forward to 2019 as a proud recipient of the AMA Indigenous Scholarship.
Regards
James Chapman
indigenous-medical-scholarship-2019
[Correspondence] Canada’s global health role – Authors’ reply
Karlee Silver and colleagues highlight two reports about Canadian funding programmes for global health research that we did not include in our analysis of Canada’s role in global health.1 We thank them for bringing attention to these two reports. One report assesses the Teasdale-Corti Global Health Research Partnership Program (in a largely negative light)2 and the other assesses Grand Challenges Canada (in a largely positive light).3 We note the Teasdale-Corti programme as one of many Canadian contributions to global health, and outline the history and mission of Grand Challenges Canada in a single paragraph.
[Correspondence] Canada’s global health role
The Lancet Series on Canada’s global health role1 provides an analysis of Canada’s global health leadership, including in research and innovation. However, the authors do not cite the available evaluations of the programmes they compare, particularly the Global Health Research Initiative2 and Grand Challenges Canada.3 The evidence from these evaluations reach a different conclusion than the authors’ opinion that suggested the Global Health Research Initiative had initial success that should have been continued, and that there were mixed views about Grand Challenges Canada’s impact (appendix).
A letter of thanks: the bright side of medicine
BY DR BERNADETTE WILKS, DEPUTY CO-CHAIR AMA COUNCIL OF DOCTORS-IN-TRAINING
Much has been written about negative experiences of doctors in training (DiT). This reflects a harsh and true reality. But there are still many doctors whose treatment of DiTs is inspiring and ought to be celebrated as evidence that all is not bullying and harassment in medicine.
These are my stories, many of which are small and seem too insignificant to write. But I still feel a wave of gratitude towards these colleagues. Stories that illustrate how very simple support structures and actions by others can work as safe guards against bullying and harassment and improve well-being. I hope these stories empower other doctors in their ability to make dramatic changes in the lives of their colleagues with just small acts and not to be discouraged by the frequently and well publicised stories about the dark side of medicine.
Internship Bullying
During a general medical rotation I worked to my full capacity but it was to no avail. I was still belittled by my registrar; scolded not taught. I was on the verge of tears most days and my heart raced in my chest, unable to eat. Medical registrars from other teams asked if I was okay, having noticed a change in my demeanour. These questions of concern were crucial as they validated how I was feeling.
Day three of the rotation and I was at a loss as to how I would survive another three months. It was then that I remembered my hospital had a Royal Australasian College of Medical Administrators (RACMA) Consultant in charge of intern welfare, Rob*, along with two medical workforce personal tasked with the same duty. Rob had provided us with his mobile number during orientation. I did not have the courage to call so I texted Rob instead. Within an hour Rob had actioned a plan that saw me moved to another medical team, who were informed about my vulnerable state. The medical work force unit called me throughout the remainder of the term to ensure I was okay and my new registrar spent the next three months rebuilding my confidence.
Pre-Vocational Nurturing
During an anaesthetic rotation, I was rostered to a list that was cancelled. Instead of my consultant going back to his office to complete his mountain of non-clinical work, he spent the remaining three hours going through the basics of anaesthetics, setting up anaesthetic drills with mock patients and had me problem solve anaesthetic machine faults. I was made to feel like I was of value, even if not in training, and he applauded my progress in the coming weeks after I continued to practise his lessons.
My smooth transition onto a training program was the result of supportive colleagues, without whom I may have taken many years to gain College entry. This support started at the medical workforce level, where the staff did their best to allocate HMO2 rotations to meet my career aspirations. This was followed by anaesthetic consultants and registrars who read (and re-read and re-read) cover letters and resumes, facilitated access to courses, championed research opportunities and dedicated hours to interview practice.
Vocational Training Humanisation
My non-science background has proven a challenge to my educators as my method of learning and reasoning are not standard. But during training, belittlement turned into nurturing and a recognition of different versus wrong ways of learning and reasoning. This requires extra effort and time as my consultants navigated how my brain works to best form their explanations. There are increasing numbers of graduate-entry doctors with diverse backgrounds and the challenge for the system is to work with and not against these differences.
Life does not stop because you have an exam, job application or Masters essay. And our humanity is not immune to the impact of failures. The acknowledgment of this human reality is crucial to balance work and life. Each time a consultant anticipated the impact of life events, humbly shared their stories of struggles, sent a text message to check in, took time out to have a chat over coffee, altered a roster to ease work pressures, stayed back hours unpaid to help me pass exams, offered me time off, or showed an interest in me outside medicine; untenable situations become moments of gratitude.
(*name changed)
Smoking fathers, low sperm sons
A new study has linked low sperm count in some men to the fact that their fathers smoked while their mothers were pregnant.
Research has long shown the link between maternal smoking during pregnancy and reduced sperm count in male offspring, but Sweden’s Lund University has now made a link to smoking fathers.
The research team has found that men whose fathers smoked at the time of pregnancy had half as many sperm as those with non-smoking fathers.
This is independent of nicotine exposure from the mother.
News Medical reports that the study was conducted on 104 Swedish men aged between 17 and 20.
“Once the researchers had adjusted for the mother’s own exposure to nicotine, socioeconomic factors, and the sons’ own smoking, men with fathers who smoked had a 41 per cent lower sperm concentration and 51 per cent fewer sperm than men with non-smoking fathers,” the report states.
The research team at Lund University claim discovery of this point and is the first to publish.
Researcher Jonatan Axelsson, specialist physician in occupational and environmental medicine, said he was “very surprised” that, regardless of the mother’s level of exposure to nicotine, the sperm count of the men whose fathers smoked was so much lower.
“Unlike the maternal ovum, the father’s gametes divide continuously throughout life and mutations often occur at the precise moment of cell division,” he said.
“We know that tobacco smoke contains many substances that cause mutations so one can imagine that, at the time of conception, the gametes have undergone mutations and thereby pass on genes that result in reduced sperm quality in the male offspring.
“We know there is a link between sperm count and chances of pregnancy, so that could affect the possibility for these men to have children in future. The father’s smoking is also linked to a shorter reproductive lifespan in daughters, so the notion that everything depends on whether the mother smokes or not doesn’t seem convincing. Future research could perhaps move us closer to a causal link.”
News Medical states: The biomarker cotinine is a metabolite from nicotine which can be measured in the blood. By measuring the level of cotinine, researchers can see whether the parents themselves smoke or whether they have been exposed to passive smoking. Many previous studies have shown that it is harmful to the fetus if the mother smokes but, in this study, the link between the father’s smoking habit and the son’s sperm count is even clearer.
Most newly occurring mutations (known as de novo mutations) come via the father and there are also links between the father’s age and a number of complex diseases. In addition, researchers have observed that smoking is linked to DNA damage in sperm and that smokers have more breaks in the DNA strand. Children of fathers who smoke have been reported to have up to four times as many mutations in a certain repetitive part of the DNA as children of non-smoking fathers.
Brain mapper finds hidden region
World-renowned cartographer of the brain, Scientia Professor George Paxinos AO from Neuroscience Research Australia (NeuRA), has discovered a hidden region of the human brain.
The region is found near the brain-spinal cord junction and Professor Paxinos has named it the Endorestiform Nucleus.
Professor Paxinos suspected the existence of the Endorestiform Nucleus 30 years ago but has only now been able to see it with better staining and imaging techniques. Commenting on this discovery, Professor Paxinos said it’s like finding a new star.
“There is nothing more pleasant for a neuroscientist than identifying a hitherto unknown area of the human brain. In this case, there is also the intrigue that this area is absent in monkeys and other animals,” said Professor Paxinos, adding, “there have to be some things that are unique about the human brain besides its larger size, and this may be one of them.”
The discovery of new brain regions helps researchers to explore cures for diseases including Alzheimer’s, Parkinson’s disease and motor neuron disease.The Endorestiform Nucleus was noticed when Professor Paxinos introduced the use of chemical stains, combined with imaging techniques, in the production of his latest atlas.
The Endorestiform Nucleus is located within the inferior cerebellar peduncle, an area that integrates sensory and motor information to refine our posture, balance and fine movements.
“I can only guess as to its function, but given the part of the brain where it has been found, it might be involved in fine motor control,” said Professor Paxinos.
Many neuroscientists researching neurological or psychiatric diseases, in humans or animal models, use Professor Paxinos’ maps as guides for their work.
An increasingly detailed understanding of the architecture and connectivity of the nervous system has been central to most major discoveries in neuroscience in the past 100 years.
“Professor Paxinos’ atlases, showing detailed morphology and connections of the human brain and spinal cord, provide a critical framework for researchers to test hypotheses from synaptic function to treatments for diseases of the brain,” said Professor Peter Schofield, CEO at NeuRA.
“It is truly an honour for Elsevier to be continuing Professor Paxinos’ legacy of publishing with us,” said Natalie Farra, Senior Editor at Elsevier. “His books are world-renowned for their expertise and utility for brain mapping, and for their contributions to our understanding of the structure, function and development of the brain.”
Professor Paxinos is the author of the most cited publication in neuroscience and another 52 books of highly detailed maps of the brain. The maps chart the course for neurosurgery and neuroscience research, enabling exploration, discovery and the development of treatments for diseases and disorders of the brain.
The discovery of the Endorestiform Nucleus, is detailed in Professor Paxinos latest book titled Human Brainstem: Cytoarchitecture, Chemoarchitecture, Myeloarchitecture.
Call for global bipolar research volunteers
Australian researchers are seeking 5,000 adults who have been treated for bipolar disorder to volunteer for the world’s largest genetic investigation into the chronic illness that can prove devastating.
The Australian Genetics of Bipolar Disorder Study aims to identify the genes that predispose people to bipolar disorder in order to develop more effective, personalised treatments, and ultimately, find a cure for the illness.
QIMR Berghofer Medical Research Institute (QIMR Berghofer) is the base for the Australian arm of the international study, with collaborating centres throughout North America and Europe.
The study aims to recruit 100,000 participants, with Australian researchers hoping to contribute five per cent of the overall study population.
Approximately one in 50 Australians (1.8 per cent) will experience bipolar disorder during their lifetime.
The complex disorder, which occurs commonly in families, typically results from a combination of genetic and environmental influences. Those living with bipolar disorder may be at higher risk of developing other health issues, including alcohol and drug abuse, anxiety, cardiovascular disease, diabetes and obesity. They also carry a 15 times greater risk of suicide than the general population, accounting for up to 25 per cent of all suicides.
Researchers are seeking 5,000 male and female Australian volunteers aged 18 and older, who are currently being, or have been, treated in the past for bipolar disorder. Their involvement will allow researchers to shed light on the genes that predispose people to the illness to ultimately develop more personalised treatments.
Globally, about one in 50 of the population experiences bipolar disorder during their lifetime. In Australia, it is estimated that 1.8 per cent of males and 1.7 per cent of females have experienced bipolar disorder in the previous 12 months.
Participation in the study is free and simple. Volunteers complete a 20-minute online survey, and those who qualify will be asked to donate a saliva sample. Study researchers will analyse DNA from saliva samples to identify specific genes associated with bipolar disorder. The knowledge will be used to improve current, and develop new treatments for bipolar disorder.
Anyone wishing to volunteer for the Australian Genetics of Bipolar Disorder Study should head to www.geneticsofbipolar.org.au, email gbp@qimrberghofer.edu.au or call 1800 257 179.
[Comment] Transforming the landscape of liver disease in the UK
In 2014, The Lancet published the inaugural report of the Lancet Commission on Liver Disease in the UK.1 With mortality from liver diseases having risen four-fold over the previous four decades, the report was timely and urgently needed. Led by Roger Williams of the UK’s Foundation for Liver Research, Institute of Hepatology, King’s College London, the Commission provided a comprehensive analysis of the disease burden in the UK and carefully examined access to, and quality of, care for patients with liver disease.
Research into HIV stigma revealing
Australia marked World AIDS Day on Saturday December 1, just as new research was released to reveal the enduring challenge of tackling stigma surrounding HIV.
The Stigma Indicators Monitoring Project: People living with HIV by the UNSW Sydney Centre for Social Research in Health (CSRH) was jointly released with The Australian Federation of AIDS Organisation (AFAO).
The new research is part of an overall project tracking social stigma among populations including people living with HIV, men who have sex with men, injectable drug users and people who engage in sex work.
The results of the Stigma Indicators Monitoring Project: People living with HIV are based on a survey of 181 Australians living with HIV. Despite an increase in knowledge and education about HIV/AIDS, research found many people living with HIV/AIDS still face stigma in their day-to-day lives.
“One of the great successes of Australia’s community-led HIV response has been the mobilisation of those most affected, to mount highly effective treatment and prevention programs,” said Professor Carla Treloar, Director of the Centre for Social Research in Health.
“However, our research shows that we still have a long way to go before people living with HIV, sex workers, people who inject drugs, and men who have sex with men are free from the burden of stigma.”
Key findings from Stigma Indicators Monitoring Project: People living with HIV include:
- 74 per cent of participants surveyed have experienced stigma or discrimination in relation to their HIV status in the last year;
- 19 per cent of participants surveyed experienced stigma or discrimination ‘rarely’, 37 per cent experienced it ‘sometimes’, 11 per cent experienced it ‘often’ and seven per cent experienced it ‘always’; and
- More than half of respondents living with HIV reported negative or different treatment by health workers (52 per cent). Most indicated this happened ‘rarely’ or ‘sometimes’ (44 per cent).
The UNSW research also shows the persistence of stigma toward people most likely to be exposed to HIV. In a parallel survey of 1000 members of the general public, 86 per cent indicated they would behave negatively toward people who inject drugs with 28 per cent indicating this would ‘often’ or ‘always’ be the case. The overall level of stigma toward sex workers was 64 per cent. And despite progress against homophobia, 38 per cent of participants said they would behave negatively toward someone based on sexual orientation.
Darryl O’Donnell, CEO of the Australian Federation of AIDS Organisations said: “Advances in medicine, technology and health promotion have powered strong progress against HIV. However, stigma is still with us and it presents a high barrier to HIV prevention.
“The sad truth is that many people do not get tested for HIV because of the stigma that surrounds it. There is a gulf between the modern reality of HIV as an entirely manageable condition and the way people perceive it.
“As we mark World AIDS Day we should challenge the stereotypes that hold back the HIV prevention effort. It’s time to treat HIV as a disease like any other and dispense with judgemental tropes.”