Australian women’s health needs awareness

A recent study published in PLOS ONE revealed the long-term health picture of Australian women to be deeply concerning.

About 80 per cent of women are not eating enough fruit and vegetables, 70 per cent are not getting enough weekly physical activity and more than half are overweight.

The ongoing Women’s Healthy Ageing Project, undertaken at the University of Melbourne, obtained data on more than 20,000 women aged between 18 and 98 from around Australia for the published study.

Professor Cassandra Szoeke, the Director of the Women’s Healthy Ageing Project, said there was a lack of awareness about women’s health, even among women themselves.

“The recent Alzheimer’s Association report showed that of all cases of dementia, two thirds are women,” Prof Szoeke said.

“And last year the Hidden Hearts report showed heart disease was more common in women than men. Yet when asked, women most feared getting breast cancer despite the fact they had twice the lifetime chance of getting dementia – a terminal disease.”

The top leading cause of death in women is heart disease, followed by dementia. According to the Australian Heart Foundation, heart disease claims 24 female lives every day, more than three times as many women as breast cancer. Fifty Australian women have a heart attack each day.

The Heart Foundation believes that awareness is central to address the heart disease in Australian women. This can start with GPs.

They found in their own research that only 27 per cent of women have spoken to a GP about heart disease and are considerably less likely than men to have a heart attack check.

Other recent research also highlights the importance of raising awareness to women’s long term health.

University of Queensland’s research published in the journal of Paediatric and Perinatal Epidemiology, showed that years of gradual weight gain more than doubles the risk of blood pressure disorders in pregnancy.

The research suggests a gradual weight gain during a woman’s reproductive years can more than double her risk of hypertensive disorders during pregnancy.

UQ Researcher Akilew Adane said this builds on earlier evidence that parents and clinicians should think of pre-pregnancy health across the entire reproductive stage of women’s lives – “not just the year before starting a family”.

“High blood pressure in pregnancy can progress to pre-eclampsia, a potentially fatal complication and one of the leading causes of pre-term birth and low birth weight due to intra-uterine growth restriction,” Mr Adane said.

The research also showed that gradual weight change does have long-term consequences. Previously little was known about the relationship between hypertensive disorders and weight changes in the years leading up to pregnancy.

“We found that women who were obese just prior to pregnancy tripled their risk of developing hypertensive disorders (HDP) compared to women in the healthy BMI category,” Mr Adane said.

“In the years leading up to pregnancy, women with moderate to high annual weight gains of more than 2.5 per cent of their body weight had a 2.3 times greater risk of developing HDP than those whose weight remained stable.

The good news is that women who lost more than 1.5 per cent of body weight between the ages of 20 to 24 years were 46 per cent less likely to develop hypertensive disorders.

Meredith Horne

Handgrip exercise can help with blood pressure

New research from the University of New England suggests a simple handgrip exercise might be a safe way to help people at risk of cardiovascular disease to manage blood pressure.

Those who can’t perform the recommended levels of aerobic exercise could use an isometric handgrip (IHG) as an effective alternative method for lowering blood pressure.

Debra Carlson from the university’s School of Science and Technology said the research found that simple exercises with isometric handgrip dynamometers were enough to lower blood pressure.

Reductions in systolic blood pressure after eight weeks were comparable to those seen in aerobic exercise studies.

Ms Carlson’s team conducted a randomised trial involving 40 participants training at two different intensities of isometric handgrip exercise.

Participants attended three times a week for eight weeks to determine the effect on blood pressure during IHG, and after eight weeks of training.

Researchers took continual blood pressure measurements prior to participants starting the study, during IHG exercise, and again at the end to see the effect of the exercise on their blood pressure.

The study demonstrated that eight weeks of IHG exercise lowers blood pressure, with minimal effect on Rate Pressure Product in pre-mild hypertensive participants during the handgrip exercise.

“The participants sat in a chair and squeezed a hand dynamometer for two minutes and then would rest for three minutes, then squeeze again, until they had completed four isometric handgrip repetitions,” Ms Carlson said.

“Rate pressure product during IHG wasn’t as substantial as those seen during moderate and vigorous aerobic exercise in previous studies. The data does show that there is a positive relationship between blood pressure and intensity of isometric handgrip exercise.

“We would recommend for future research would be to conduct Isometric Resistance Training and aerobic exercise with participants to get a direct comparison in the two exercise modalities within the same cohort.”

Cardiovascular disease remains the leading cause of death, representing about 31 per cent of global mortality. High blood pressure is the biggest risk factor, with almost 34 per cent of Australian adults having hypertension or taking anti-hypertensive medications.

Chris Johnson

[Comment] Respiratory medicine and critical care: a call for papers for ERS

The Lancet and The Lancet Respiratory Medicine would like to hear from authors of research papers in the fields of respiratory medicine and critical care, as the two journals are planning special issues to coincide with the 2017 European Respiratory Society (ERS) International Congress that will take place in Milan, Italy, on Sept 9–13, 2017.

[Editorial] Purdah and the gagging of science

The UK’s National Institute for Health Research (NIHR) has issued guidance discouraging publication of—and commentary on—NIHR-funded research for the remainder of the country’s General Election purdah. Purdah is a controlled period restricting public-facing activity, intended to prevent influence on election outcomes (currently enforced from April 22 to June 8). Using purdah to control science communication is an abuse of its intended purpose, and is not part of the original code. The guidance prevents dissemination and commentary on all NIHR-funded research covering public health, social care, health-system finance and workforce, and “any other areas where there is a risk of political interpretation”.

PM shares the love

Prime Minister Malcolm Turnbull put down his script while addressing the AMA’s National Conference to express his appreciation for the medical profession.

After telling conference delegates that his Government was committed to delivering good health policy – and after outlining what he considered to be the best bits of what the Federal Budget had delivered for the health sector – he said doctors were committed to love.

“I know that all you – all of your years of academic training, all of your years of clinical experience, all of the science and studying that’s dominated your lives – above all else what drives you is love for your fellow men and women. Love for your patients,” he said.

“You’ve committed yourselves to a life of service – undiluted. A commitment. A compassion. We thank you for it.”

The Prime Minister continued to leave his notes aside as he wound up his speech praising the state of Australia’s medical workforce.

“Our health system is the envy of the world,” Mr Turnbull said.

“Our skilled doctors, our nurses, all your allied professionals, work tirelessly to give the best possible care and your Government thanks you for that.

“Thank you for your dedication, thank you for your professionalism, thank you for your compassion.

“We will match you with a commitment to ensure that you have the resources at every level to continue to deliver the practical love that keeps Australians well.”

The Prime Minister’s speech was warmly received by a receptive audience. AMA President Dr Michael Gannon said it was indicative of the respect and influence the AMA has that the PM eagerly accepted an invitation to address the conference.

Peanut allergies in children

Earlier in his speech, Mr Turnbull committed a $10 million investment towards a research project for a new treatment for children with peanut allergies.

“That has the potential to benefit the people who deserve the highest level of support – our children,” he said.

“The research will help develop a new therapy for our children with peanut allergies to help incorporate peanut products as a regular part of their diet.

“What a difference that will make to children everywhere. It’s an example of innovative projects the Government is backing.”

Chris Johnson

Funding to help tackle resistant bugs

Health Minister Greg Hunt used his address to the AMA’s National Conference to announce a $5.9 million investment from the Medical Research Future Fund (MRFF) to help address the growing threat of superbugs.

With the number of microorganisms such as bacteria, viruses or parasites becoming increasingly resistant to standard medical treatments such an investment was warranted, the Minister said.

Resistance results in standard medical treatments such as antibiotics, antivirals or anti-malarials becoming ineffective, allowing infections to persist and possibly spread.

“Infections are becoming increasingly difficult to treat, leaving healthcare professionals with limited – or in some instances zero – treatment options,” Mr Hunt told conference delegates.

“Australia has one of the highest rates of antibiotic use in the world and rates of resistance to some common antibiotics are increasing globally.

“Commercial returns on the discovery and development of new antibiotics is relatively low, so it is an area of research that doesn’t attract sufficient private sector investment.

“The research will be consistent with the achievement of the objectives of the National Antimicrobial Resistance Strategy 2015-2019, which was developed by the Australian Government in partnership with states and territories, academics, research organisations and industry.”

The strategy will include a focus on knowledge gaps in relation to the development and spread of resistance; and the development of new products, including diagnostic technologies and therapies, policies and approaches to prevent, detect and respond to resistance.

“The Coalition’s $20 billion MRFF provides a long-term sustainable source of funding for research that aims to improve health outcomes, quality of life and health system sustainability,” the Minister said.

“This investment in critical antimicrobial resistance research is part of the $65.9 million in MRFF disbursements announced in the Budget.

“The Turnbull Government is committed to supporting Australia’s talented researchers to find solutions to challenges that make a difference to patients’ lives.”

Chris Johnson

[Perspectives] Brain Diaries: two hemispheres of interest

“Understanding the brain and its diseases is one of the key challenges of the 21st century”, said Professor of Clinical Neurology Christopher Kennard at the launch of Oxford University Museum of Natural History’s Brain Diaries. “I’ve said that is like climbing Everest, but I don’t even think we’ve got to base camp”, Kennard explained, citing the growing “problem of dementia: the longer we live, the more likely we are to develop Alzheimer’s”. Incorporating research from more than 50 neuroscientists, Brain Diaries explores the passage of a healthy brain from conception to old age.

Malaria expert to head up WHO

Internationally recognised malaria researcher, Dr Tedros Adhanom Ghebreyesus from Ethiopia, will be the next Director-General of the World Health Organisation (WHO).

He will be the first African to lead the United Nations agency and will replace Dr Margaret Chan who steps down from the role at the end of June.

He will also be the first non-physician to lead WHO – holding a PhD in community health. His leadership of WHO is for a five-year term.

Dr Tedros, aged 52, was previously the Ethiopian Health Minister and the Foreign Affairs Minister, and was also the chairman of the Global Fund to Fights Aids, Tuberculosis and Malaria.

He has been elected to the Director-General’s post after winning the most votes from WHO’s 194 Member States during three rounds of secret ballots that began in January and culminated on May 23.

In a three-way face-off during the final vote, he first knocked off Pakistan’s Dr Sania Nishtar then defeated Britain’s Dr David Nabarro 133 votes to 50 (with some abstentions).

The agency has been criticised for its response to the Ebola epidemic in West Africa – particularly for missing warning signs of just how bad 2013 outbreak that went on to kill more 11,000 would be.

Before being elected, Dr Tedros committed WHO to responding to future emergencies more rapidly and effectively.

And he has promised to champion the health rights of the world’s poor.

“All roads should lead to universal health coverage. I will not rest until we have met this,” he said while campaigning for the role.

“(My vision as the new Director-General is of a) world in which everyone can lead health and productive lives, regardless of who they are or where they live.

“I promise I will get up every day, determined to make a difference. I am ready to serve.”

The campaign was controversial at times, with Dr Tedros being accused of covering up cholera epidemics in Ethiopia – accusations that have been vigorously denied.

His candidacy was also greeted by Ethiopian opposition groups as an attempt to improve the country’s profile and smooth over accusations of human rights abuses by its government.

Dr Tedros has listed his top priorities in the new role as: advancing universal health coverage; ensuring WHO responds rapidly and effectively to disease outbreaks and emergencies; putting the wellbeing of women, children and adolescents at the centre of global health and development; helping nations address the effects of climate change on health; and making the agency transparent and accountable

Chris Johnson

[Comment] Offline: Israel and Palestine—a joint search for the truth

In July, 2014, amid the tragedy of a war between Israel and Hamas-controlled Gaza—a conflict in which thousands of rockets and missiles were fired, leaving hundreds of children and women dead—The Lancet published a letter by Paola Manduca and colleagues. We had been working with Palestinian health professionals since 2007 to help advance their health and health care through research collaboration. The intention of publishing the letter from Manduca et al was to signal a cry of anguish for a people we had come to know well.

[Correspondence] Health economics – Authors’ reply

As Theodore Papaioannou and colleagues point out, projecting long-term health spending is challenging.1 Our Article2 and extensions of this research3 made health spending projections for 184 countries and extends through 2040. Many factors—environmental, epidemiological, demographic, cultural, political, economic, and scientific—influenced the creation and evolution of complex health systems, and have coalesced to determine current health spending levels. These same factors will undoubtedly also influence health spending in the future, although how these factors will interact and determine precise spending is difficult to predict.