Disease and wounds get Ministerial attention

Health Minister Greg Hunt used his AMA National Conference address to commit funding towards wound management and Human T-cell Lymphotropic Virus-1 (HTLV-1) programs.

As the keynote speaker at conference’s opening day, Mr Hunt praised the AMA, gave thanks to outgoing President Dr Michael Gannon, and repeated the Federal Government’s long-term health plan for the nation.

He wound up his remarks by announcing the new funding initiatives.

The Federal Government will provide $8 million to form a taskforce, in collaboration with the States and Territories, to combat emerging communicable diseases such as HTLV-1 in remote communities, he said.

Led by the Commonwealth’s Chief Medical Officer, Professor Brendan Murphy, the taskforce will bring together Aboriginal communities, relevant health providers, researchers, clinicians and all levels of Government.

The taskforce will investigate enhanced responses to communicable diseases, including the drivers behind the emerging prevalence of HTLV-1, a blood-borne virus, in remote communities.

It will do this in close collaboration with Aboriginal communities and develop a roadmap to respond to this issue, the Minister said.

“In terms of Indigenous health, one thing that is an unacceptable national shame is the level of transmissible sexual diseases,” Mr Hunt said.

“So the STIs and infections are at an unacceptable level. We will be investing $8 million to ensure that there is a response to the HTLV-1 virus. That’s working with Indigenous communities, under the leadership of the Chief Medical Officer and (Indigenous Heath Minister) Ken Wyatt.”

In relation to wound management, Mr Hunt recognised that it was a personal passion of many doctors.

He told conference delegates that the Government would embark on a comprehensive wound management program.

“I am referring wound management to the Medicare Taskforce for consideration,” he said.

“Secondly, there will be $1 million in relation to a wound management pilot program under the primary healthcare system. And thirdly, it will be the first priority of the new health system’s translation program under the MRFF (Medical Research Future Fund).”

The Minister also committed to legislating in the coming months with regards to medical indemnity, to ensure universal coverage and a level playing field.

That comment was received with instant applause from the conference floor.

Another welcome remark was his insistence on ending the mandatory reporting practice.

“Our doctors… are under stress, under challenge and always facing difficult issues that affect their own mental health,” he said.

“We will continue to work, and I am utterly committed, to ending the mandatory reporting practice.

“We have worked together. There are one or two States who still have some issues, but on our watch, in our time, that will become a reality that every doctor who wants and needs help will be able to seek that help without fear.”

In closing, the Minister thanked Dr Gannon for his work as the AMA President.

Calling him a friend, Mr Hunt described Dr Gannon in terms of Olympic sports.

“More a decathlete meets Greco-Roman wrestler,” he said.

“He is skilled at close quarters grappling and he usually ends up pinning his opponent.

“But at the end of the day, he’s a fine doctor, a fine leader, and above all else, a fine person.”

CHRIS JOHNSON

[Perspectives] Abortion narratives: moving from statistics to stories

A Nigerian obstetrician once asked me why I didn’t—as he did in his campaigning work—display photographs of haemorrhaging teenage girls, perforated uteri, and prolapsed bowels: the images from the front-line of his daily battle against death from unsafe abortion. In high-income countries with permissive legal regimes and fairly easy access to safe abortion services, people are protected from the bloody consequences of illegal abortion. It has been an easy badge of honour for pro-choice advocates that we draw on research and avoid mirroring the inflammatory language and graphic imagery used by some anti-abortion groups.

[Obituary] Ruth Nussenzweig

Immunologist and malaria researcher. She was born in Vienna, Austria, on June 20, 1928, and died in Manhattan, NY, USA, of a pulmonary embolism on April 1, 2018, aged 89 years.

[Perspectives] Kenneth Fleming: making the global case for pathology

Some years ago, and while still occupying a senior post in the administration of medical training and research at the UK’s University of Oxford, pathologist Kenneth Fleming was at a meeting in Bangkok. He got talking to a fellow Oxford academic who was living and working in Thailand. On enquiring if he could help locally in any way, Fleming learned that the country had a pressing need for more staff and resources in pathology. This was the first time he realised that the provision of pathology services was a major but neglected problem not only in that part of Asia but also over much of the globe.

Risk of fragility fracture among patients with gout and the effect of urate-lowering therapy [Research]

BACKGROUND:

Previous studies that quantified the risk of fracture among patients with gout and assessed the potential effect of urate-lowering therapy have provided conflicting results. Our study aims to provide better estimates of risk by minimizing the effect of selection bias and confounding on the observed association.

METHODS:

We used data from the Clinical Practice Research Datalink, which records primary care consultations of patients from across the United Kingdom. We identified patients with incident gout from 1990 to 2004 and followed them up until 2015. Each patient with gout was individually matched to 4 controls on age, sex and general practice. We calculated absolute rate of fracture and hazard ratios (HRs) using Cox regression models. Among patients with gout, we assessed the impact of urate-lowering therapy on fracture, and used landmark analysis and propensity score matching to account for immortal time bias and confounding by indication.

RESULTS:

We identified 31 781 patients with incident gout matched to 122 961 controls. The absolute rate of fracture was similar in both cases and controls (absolute rate = 53 and 55 per 10 000 person-years, respectively) corresponding to an HR of 0.97 (95% confidence interval 0.92–1.02). Our finding remained unchanged when we stratified our analysis by age and sex. We did not observe statistically significant differences in the risk of fracture among those prescribed urate-lowering therapy within 1 and 3 years after gout diagnosis.

INTERPRETATION:

Overall, gout was not associated with an increased risk of fracture. Urate-lowering drugs prescribed early during the course of disease had neither adverse nor beneficial effect on the long-term risk of fracture.

[Comment] Offline: John E Fogarty and the defeat of Donald J Trump

If President Trump had had his way, the Fogarty International Center would now be a footnote in history. Targeted for elimination in 2017, the Trump administration viewed the Fogarty mission—to support and facilitate global health research—as contrary to the spirit of America First. Yet last week, the Fogarty Center celebrated its 50th birthday in a stronger and more stable position than at any time in its short existence. Francis Collins, Director of the National Institutes of Health (NIH), underlined the importance of Fogarty to the US scientific enterprise.

[Comment] Taking aim at cholera

In 1854, John Snow’s work on cholera in London immortalised the power of mapping as a tool for disease prevention and control.1 Over 160 years later, a more ambitious effort to map cholera has been reported in The Lancet.2 Forgoing so-called shoe leather epidemiology in favour of big data, Justin Lessler and colleagues2 used 279 cholera datasets covering 2283 locations in 37 countries, and cluster-level maps of access to improved water and sanitation in 41 countries, to map cholera incidence across sub-Saharan Africa at a 20 km × 20 km grid scale.

World study proves exercise good for mental health

Everyone knows exercise is good for your health, physical and mental.

New findings from an international collaboration of researchers, however, has revealed that physical activity can protect against the emergence of depression, regardless of age and geographical region.

Researchers from Brazil, Belgium, Australia, USA, UK and Sweden pooled data from 49 unique cohort studies of people free from mental illness that examined if physical activity is associated with a decreased risk of developing depression.

In total, 266,939 individuals were included, with a gender distribution of 47 per cent males, and on average the individuals were followed up after 7.4 years.

Once the data was extracted they found that compared with people with low levels of physical activity, those with high levels had lower odds of developing depression in the future.

Physical activity had a protective effect, they found, against the emergence of depression in youths, in adults, and in the elderly and across geographical regions.

The geographic regions studied were in Europe, North America, and Oceania.

Australians researchers involved in the study were from Western Sydney University’s NICM Health Research Institute, the Black Dog Institute and UNSW Sydney.

Dr Felipe Barreto Schuch, from Universidade La Salle in Brazil, was the lead author and said the study was the first global meta-analysis to establish that engaging in physical activity is beneficial for protecting the general population from developing depression.

“The evidence is clear that people that are more active have a lesser risk of developing depression,” Dr Barreto Schuch said.

“We have looked at whether these effects happen at different age groups and across different continents and the results are clear. Regardless your age or where you live, physical activity can reduce the risk of having depression later in life.”

Co-author Dr Simon Rosenbaum, Senior Research Fellow at UNSW Sydney and the Black Dog Institute, said: “The challenge ahead is ensuring that this overwhelming evidence is translated into meaningful policy change that creates environments and opportunities to help everyone, including vulnerable members of our society, engage in physical activity.”

The findings in Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies were first published in the American Journal of Psychiatry.

The researchers say further studies are warranted to evaluate the minimum physical activity levels required and the effects of different types and lengths of activity on subsequent risk for depression.

CHRIS JOHNSON

Candidate profile – Dr Janice Fletcher MBBS (Hons 1), MD, BSc, FRACP, FRCPA

Nominating for the position of AMA Vice President

My decision to nominate for Vice President came about after careful consideration about what I could offer the role, and, importantly, if I had the time to commit to the requirements of the position.

After a recent (second) knee replacement I also had to make sure I was fit to run. I, only half jokingly, credit my orthopaedic surgeon for this decision.

Having served as President of the AMA SA I have been exposed to the rigours of such a role.

I believe strongly in the role of the AMA, recognising the issues both at Federal and State level, having worked in South Australia, New South Wales, and Victoria. Coming from a small state, I bring geographic diversity to the executive table.

My professional background is diverse; paediatrics, genetics, pathology and medical administration. I was proud to be the fourth female President of the AMA SA.

As a strongly influential organisation, the AMA must be at the forefront of setting the health agenda for Australia. As experts in evidence-based medicine, we need an evidence-based approach to our profession.

We need to advocate for, and evaluate, research which will give us a true picture of the health needs of the Australian community and the workforce requirements in the next five, ten, twenty years and beyond. And we need to know who is currently being trained, and in what areas.

This will give our next generation of doctors a much better insight into where the jobs will be in the coming years.

In taking this proactive role the AMA will be re-established as the key decision maker, ensuring that the right policies are in place to steer the right course.

I have extensive experience in the public domain, with the media and have worked with all sides of politics.

I have been given a ‘sensible’ tag, which I wear proudly. This role is not about me, but more about the decisions the AMA makes. I bring to the table a considered approach, objectively looking at all sides of an issue. I know when to ‘keep my powder dry’ and when to go in, guns blazing.

Also of benefit to the AMA leadership team is my expertise in the field of genetics. As evidenced by the 2018 Federal Budget, this area of medicine is a key driver of our future and the impact it will have across all fields of medicine is significant. I am an Emeritus Member of the Human Genetics Society of Australasia, with professional respect across the country and internationally.

I am passionate about improving nutrition in our community, particularly in childhood. We must improve nutritional literacy for all Australians. We must also improve genomic literacy for the community, patients and all healthcare professionals.

A focus on the future is what is driving me to nominate for Vice President. As a teacher and researcher, I continue to work with many young doctors and students. If we don’t advocate strongly for them, they will not have a profession, but a mere job.

I am not running on a ‘ticket’ as I know I can represent the interests of all States and Territories and work alongside all President nominees.

If you would like further information or to contact me, please visit my website:

https://janicefletcher0.wixsite.com/aboutjanicefletcher I would love to hear from you.

* See other candidate profiles on this site.

[Series] Origins of lifetime health around the time of conception: causes and consequences

Parental environmental factors, including diet, body composition, metabolism, and stress, affect the health and chronic disease risk of people throughout their lives, as captured in the Developmental Origins of Health and Disease concept. Research across the epidemiological, clinical, and basic science fields has identified the period around conception as being crucial for the processes mediating parental influences on the health of the next generation. During this time, from the maturation of gametes through to early embryonic development, parental lifestyle can adversely influence long-term risks of offspring cardiovascular, metabolic, immune, and neurological morbidities, often termed developmental programming.