more_vertHaematologists are breaking new ground to advance patient care: recent advances include broadening therapeutic options for blood cell disorders, personalising immune cells to combat cancer, and addressing challenges in the management of toxicities stemming from the rapidly changing landscape in immunotherapy. Such milestones would not be possible to establish without clinicians and research scientists around the globe working together to do innovative studies that aim to transform clinical practice.
Preference: Statistics, epidemiology and research design
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[Articles] Analysis of clinical benefit, harms, and cost-effectiveness of screening women for abdominal aortic aneurysm
By UK standards, an AAA screening programme for women, designed to be similar to that used to screen men, is unlikely to be cost-effective. Further research on the aortic diameter distribution in women and potential quality of life decrements associated with screening are needed to assess the full benefits and harms of modified options.
2018 AMSA National Convention: Welcome to Perth-fect engagement
BY ALEX FARRELL, PRESIDENT, AUSTRALIAN MEDICAL STUDENTS’ ASSOCIATION
In early July this year, the Australian Medical Students’ Association held our 59th National Convention in Perth. As the world’s largest student-run conference, it hosted more than1000 medical student delegates from across Australia and New Zealand. It was a week of innovative academic and social programs, enhanced by intervarsity competitions, field trips, and workshops. A team of over 100 student volunteers from universities in Western Australia worked for two years to make this huge undertaking possible.
As always, the National Convention was an opportunity for students to showcase their talents, ranging from research with poster presentations and 3 Minute Thesis, Sports Day competitions, debating (won by Monash University), and the Emergency Medical Challenge (won by University of Western Australia).
The academic program was full of motivational Australian and international plenary speakers showcasing contemporary health issues.
The program opened with Burns Specialist, Prof Fiona Wood, speaking to students about harnessing the power of science and technology to strive towards excellence in health care. We were fortunate to be joined by former AMA Presidents, A/Prof Rosanna Capolingua, who spoke on navigating leadership in the medical community, and Dr Michael Gannon, who reflected on his experiences within both AMSA and the AMA, and the advocacy that both groups drive forward. Dr Nikki Stamp spoke on paying attention to detail while not becoming overwhelmed by the minutiae.
There was the opportunity to hear from doctors about working in every context imaginable, from Dr Jeff Ayton’s experiences in Antarctica, Dr Nick Coatsworth travelling from Congo to Darwin with Medecins Sans Frontieres, and A/Prof Gordon Cable’s work in aerospace medicine.
There was also an array of fantastic speakers bringing their expertise from outside the medical world. Steven Bradbury’s recollections of his remarkable Olympic victory included messages that are applicable to all of our daily lives; memory athlete, Daniel Kilov, shared the techniques that make his work possible; and social advocate, Yasmin Abdel-Magied, spoke on challenging stereotypes through personal interactions and navigating a hyper politicised world.
Students left with increased clinical understanding, having battled it out against the hosts of the ‘IM Reasoning’ podcast run by Dr Nic Szecket and Dr Art Nahill in an interactive case reasoning session; heard from Prof Nick Talley on negotiating OSCEs and clinical examination; and participated in workshops on everything from reading ECGs to performing rhomboid skin flaps.
From doctors’ mental health to social issues and innovative medical practice, students learnt about the prominent issues of today’s medical landscape, as well as seeing the endless pathways and opportunities medicine can lead to. Perth Convention 2018 aspired for delegates to discover parts of life and medicine they never knew about before, engage in important issues, meet incredible, like-minded people, and be inspired to leave a lasting positive impression on the field of medicine in Australia.
Climate change and health
According to experts interviewed by ABC News, Australia is missing out on billions in short-term health savings that could come with tougher greenhouse emission targets.
Tony Capon, Professor of Planetary Health at the University of Sydney, says that air pollution can lead to premature deaths and problems such as heart attacks and asthma.
He and others point to ballpark figures suggesting the energy and transport sectors alone cost Australia at least $6 billion a year in health problems.
“They’re conservative figures and we’re not taking account of this information in our public policy,” Professor Capon said.
“We consider these costs external and we don’t look at the full ledger.”
Experts like Professor Capon argue that a move towards less- polluting forms of energy and transport would deliver much- needed savings to Australia’s budget bottom line.
Research suggests cutting emissions can pay for itself through savings on health costs, not only in China but in developed countries too.
Burning fossil fuels produces CO2, which is bad for the climate, but it also tends to produce air pollutants such as sulphur dioxide, nitrogen dioxide and very fine particles that can play havoc with our respiratory and cardiovascular systems, even in countries with good pollution laws.
While air pollution levels in Australia may be low when compared to countries such as China, there is evidence that even low levels can be damaging to health.
Drugs use the source of one in four new hepatitis C infections
Two in five people who have injected illicit drugs in the past year are living with hepatitis C, highlighting the urgent need for prevention and treatment, new Australian research shows.
Researchers from the Kirby Institute at the University of New South Wales and the National Drug and Alcohol Research Centre (NDARC) estimate that 6.1 million people who inject drugs are living with hepatitis C globally, with one-quarter of new infections occurring in people who inject drugs.
It is the first time that researchers have estimated the global, regional, and national numbers of people who inject drugs who are living with hepatitis C.
Lead author, Associate Professor Jason Grebely, said that, in Australia, almost 40,000 people who have recently injected drugs are living with HIV. However, Australia is one of only four countries worldwide with high coverage of both needle and syringe programs and opioid substitution therapies.
“Australia has been an international leader in its response to hepatitis C,” Associate Professor Grebely said.
“The fact that hepatitis C treatments are available for all individuals, without restrictions based on current or previous drug use, means that we are likely to achieve the World Health Organization goal to eliminate hepatitis as a major public health threat by 2030, including among people who inject drugs.”
However, the outlook is not so bright globally, with only one per cent of people who inject drugs living in countries where needle and syringe programs and opioid substitution programs are widely available.
The greatest number of people with hepatitis C who have recently injected drugs live in eastern Europe, east and south- east Asia, and North America, and more than half of them live in just four countries – Russia, the United States, China, and Brazil.
“It is concerning that more than half of all hepatitis C infections among people who have recently injected drugs occur in countries with inadequate coverage of harm reduction services,” Judy Chang, from the International Network of People Who Use Drugs, said.
“The global elimination of hepatitis C as a public health threat will not be achievable unless we improve access to harm reduction services, de-stigmatise drug use and drug users, and improve the overall health of people who use drugs.”
The researchers estimate that about 71 million people world- wide are living with hepatitis C.
The research was published in Addiction on 24 July.
Studies spell double trouble for women
There’s been a double whammy of bad health news for women, with one study finding that women with diabetes are more likely to develop cancer, and a second finding that women are twice as likely as men to be under-treated for heart attack.
In the first study, researchers from The George Institute for Global Health reviewed the health outcomes of almost 20 million people involved in 47 studies.
They discovered that having diabetes – type 1 or type 2 – significantly raises the risk of developing cancer, with a significantly higher risk for women.
Women with diabetes were 27 per cent more likely to develop cancer than women without diabetes. For men, the risk was 19 per cent higher.
Overall, women with diabetes were six per cent more likely to develop any form of cancer than men with diabetes.
“The link between diabetes and the risk of developing cancer is now strongly established,” lead author, Dr Toshiaki Ohkuma, said.
“We have also demonstrated, for the first time, that women with diabetes are more likely to develop any form of cancer, and have a significantly higher chance of developing kidney, oral, and stomach cancers, and leukaemia.
“The number of people with diabetes has doubled globally in the past 30 years, but we still have much to learn about the condition.
“It’s vital that we undertake more research into discovering what is driving this, and for both people with diabetes and the medical community to be aware of the heightened cancer risk for women and men with diabetes.”
The George Institute research was published in Diabetologia, the journal of the European Association for the Study of Diabetes.
In the second study, published in the Medical Journal of Australia, University of Sydney researchers found that women admitted to 41 Australian hospitals with ST-Elevation Myocardial Infarction (STEMI) in the past decade were half as likely as men to receive appropriate diagnostic tests and treatment.
They were also less likely to be referred for cardiac rehabilitation, and prescribed preventive medications, at discharge.
Death rates and serious adverse cardiovascular events among these women were more than double the rates seen in men six months after discharge.
“The reasons for the under-treatment and management of women compared to men in Australian hospitals aren’t clear,” lead author and cardiologist, Professor Clara Chow, said.
“It might be due to poor awareness that women with STEMI are generally at higher risk, or by a preference for subjectively assessing risk rather than applying more reliable, objective risk prediction tools.
“Whatever the cause, these differences aren’t justified. We need to do more research to discover why women suffering serious heart attacks are being under-investigated by health services, and urgently identify ways to redress the disparity in treatment and health outcomes.”
Nicotine wars continue…
E-cigs in China
A study by the Society for Research on Nicotine and Tobacco, and published in Oxford Academic, has found that awareness of e-cigarettes is high among Chinese middle school students, but use remains very low.
The study examined data from the Global Youth Tobacco Survey, which was completed by 155,117 middle school students (51.8 per cent boys, and 48.2 per cent girls) in China.
About 45 per cent of the middle school students had heard of e-cigarettes, but only 1.2 per cent reported using e-cigarettes in the last 30 days. Among those who had never smoked, e-cigarette users were more likely to intend to use a tobacco product in the next 12 months than non-users, and more likely to say that they would enjoy smoking a cigarette.
E-cigarette use was associated with previous experimentation with cigarette smoking, having noticed tobacco advertising in the past 30 days, having close friends who smoke, and thinking tobacco helps people feel more comfortable in social situations and makes young people look more attractive.
The study concluded that e-cigarette use among youth in China remains low, but awareness is high; e-cigarette use was associated with increased intentions to use tobacco; and enhanced prevention efforts are needed to target e-cigarette use among youth.
Chinese youths use e-cigarettes as a tobacco product rather than an aid to quitting. Among never-smokers, e-cigarette users were more likely to have intentions to use a tobacco product in the next 12 months, more likely to use a tobacco product offered by their best friends, and more likely to enjoy smoking a cigarette than non-users.
Plain packs in legal win
Australia has won a landmark ruling on tobacco plain packaging laws, with a panel of judges at the World Trade Organization (WTO) rejecting arguments brought by Cuba, Indonesia, Honduras, and the Dominican Republic against the legislation.
ABC News reported last month that Honduras says it will appeal the decision, claiming that there are errors in the ruling.
The WTO panel said Australia’s plain packaging laws contributed to improving public health by reducing use of and exposure to tobacco products, and rejected claims that alternative measures would be equally effective.
The win for Australia effectively gives a green light for other countries to roll out similar laws. It could also have implications for alcohol and junk food packaging.
Australia’s law goes much further than the advertising bans and graphic health warnings seen in other countries.
Introduced in December 2012 by the Gillard Government, the law bans logos and distinctive-coloured cigarette packaging in favour of drab olive packets that look more like military or prison issue, with brand names printed in small standardised fonts.
Studies have shown that the law is an effective measure in stopping people from smoking.
E-cigs in the USA
An Open Access article published in the British Medical Journal reports that, despite an apparent overall decrease in e-cigarette use in the USA, there are indications that JUUL, a sleekly designed e-cigarette that looks like a USB drive, is increasingly being used by youth and young adults.
However, the extent of JUUL’s growth and its marketing strategy have not been systematically examined.
A variety of data sources were used to examine JUUL retail sales in the USA and its marketing and promotion. Retail store scanner data were used to capture the retail sales of JUUL and other major e-cigarette brands for the period 2011–2017.
A list of JUUL-related keywords was used to identify JUUL-related tweets on Twitter; to identify JUUL-related posts, hashtags, and accounts on Instagram, and to identify JUUL-related videos on YouTube.
In the short three-year period 2015–2017, JUUL has transformed from a little-known brand with minimum sales into the largest retail e-cigarette brand in the USA, lifting sales of the entire e-cigarette category.
Its US$150 million retail sales in the last quarter of 2017 accounted for about 40 per cent of e-cigarette retail market share.
While marketing expenditures for JUUL were moderate, the sales growth of JUUL was accompanied by a variety of innovative, engaging, and wide-reaching campaigns on Twitter, Instagram, and YouTube, conducted by JUUL and its affiliated marketers.
The discrepancies between e-cigarette sales data and the prevalence of e-cigarette use from surveys highlight the challenges in tracking and understanding the use of new and emerging tobacco products.
In a rapidly changing media environment, where successful and influential marketing campaigns can be conducted on social media at little cost, marketing expenditures alone may not fully capture the influence, reach, and engagement of tobacco marketing.
Paris bans smoking in parks
France 24 International News reports that Paris city officials have introduced a new measure to ban smoking in six public parks across the city.
The measure is part of a four-month experiment by the city to reduce smoking in public spaces.
Instead of issuing a ticket or fine, park staff will be tasked with informing tobacco users that smoking is no longer allowed on the premises.
A 2013 study of similar bans in selected parks and beaches in Canada found that, although tobacco use significantly decreased after a 12-month observation period, no venue remained 100 per cent smoke-free.
Funding boost for Indigenous health research programs
The Federal Government has announced $23.2 million in funding for new research projects that tackle Indigenous health challenges, including kidney health and mental wellbeing.
Health Minister Greg Hunt said the National Health and Medical Research Council (NHMRC) funding was aimed at improving Aboriginal and Torres Strait Islander health outcomes.
“Investigation and investment where it is needed is critical to delivering better health outcomes for First Nations Peoples, to protect lives and save lives,” Mr Hunt said.
Monash University will receive more than $320,000 to develop a point-of-care test to diagnose and manage chronic kidney disease, which affects almost one in five Indigenous adults.
A further five projects across five different States will examine social and emotional wellbeing issues affecting Indigenous infants, children, adolescents, and young people.
The direction of future First Nations research will be informed by the NHMRC’s Road Map 3, which will include a yearly report card and a commitment to spend at least 5 per cent of annual NHMRC funding on Aboriginal and Torres Strait Islander health and medical research.
Minister for Indigenous Affairs, Ken Wyatt, said the Road Map 3 had been developed in consultation with communities, First Nation researchers, and the broader health and medical research sector.
[Correspondence] Post-publication peer review and evidence appraisals in primary care
Although the traditional picture of a general practitioner (GP) could omit the contribution of scholarship decades ago,1 there has been a rising need to build research capacity and make it an integral component of the physician’s competencies,2 and to provide crucial frontline feedback as part of the “learning healthcare system”.3 The insights of GPs are pivotal to research, notably for determining the applicability of findings and interventions in clinical settings, identifying future research needs, and closing the feedback loop from evidence generation to application and generalisation.
Research: Software as a Medical Device and Cyber Security for Medical Devices
Opportunity to participate in CSIRO research to inform new Australian medical device industry guidance