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Funding no brainer

Funding cuts have left untouched hundreds of brains donated for medical research in Australia untouched, according to a recent exclusive report in the Weekend Australian.

The brains were collected from donors since 2005 when a national network of brain banks was set up from a $4.5 million 10-year funding allocation from the National Health and Medical Research Council.

But when that funding ended in 2014, individual States had to fund and maintain their own collections of brains.

This has proved to be more difficult than anticipated, with State brain banks struggling to keep their collections and progress their research into neurological diseases.

Some State banks are close to shutting down, but a more permanent source of federal funding is being sought for the national network so all the banks can keep operating.

Chris Johnson

Move more, spend less time in hospital

A new study has found that older Australians can reduce their time spent in hospital by walking an extra 4,300 steps a day.

The epidemiologists from the University of Newcastle found that an increase in step count from 4,500 to 8,800 a day was associated with 0.36 fewer hospital bed days per person per year.

They noted that the cost of a day in hospital in Australia in 2012-13 was $1,895, so $550 can potentially be saved annually for each person who increases their physical activity by 4,300 steps a day.

“These steps can be accumulated as many brief activities throughout the day, or as steady walking for about three kilometres,” Dr Ben Ewald and colleagues wrote in the Medical Journal of Australia.

The 10-year study of people aged 55-plus found that the overall estimated number of bed-days per year of follow-up decreased by 9 per cent for each 1,000-step increase in daily step count.

Participants wore pedometers for one week during 2005-2007. The researchers then analysed the hospital data of all participants from the time of their recruitment until 31 March 2015.

Complete data was available from 2,110 people, aged 55 or more.

The researchers found that there was more benefit in moving from 3,000 to 5,000 steps daily than there was in moving from 8,000 to 10,000.

“Health interventions and urban design features that encourage walking could have a substantial effect on the need for hospital care, and should be features of health policy,” they said.

In a linked editorial, Alfred Deakin Professor Jo Salmon and Dr Nicky Ridgers from the Institute for Physical Activity and Nutrition at Deakin University suggested encouraging older patients to invest in wearable activity monitors, such as Fitbit, Garmin, and the Apple Watch.

“Further investigation of wearable technology is needed, particularly in different population groups, with the aim of identifying the key factors for enhancing sustained changes in physical activity,” they wrote.

“We need to identify how these devices can be integrated into clinical practice in order to improve health outcomes.

“But for health practitioners with sedentary patients looking for assistance with becoming more active, a wearable activity monitor would be a good first step.”

You can read the study here (https://www.mja.com.au/journal/2017/206/3/daily-step-count-and-need-hospital-care-subsequent-years-community-based-sample?0=ip_login_no_cache%3D35edc06435791ffbc0d09693c6bb1448) and the commentary here (https://www.mja.com.au/journal/2017/206/3/wearable-technology-activity-motivator-or-fad-wears-thin).

Maria Hawthorne

 

Brexit could lead to med-exit in UK

European-trained doctors are considering leaving the United Kingdom because they don’t feel welcome following the Brexit vote, according to research undertaken by the British Medical Association.

The survey of 1,193 European Economic Area doctors working in the UK revealed about two in five might leave the UK due to the referendum result.

That equates to a possible 12,000 doctors who qualified in the EEA leaving the UK because of Brexit.

With an already struggling National Health Service in Britain and a growing personnel shortage problem in its hospitals, fears have been raised a health care disaster could sweep the nation if so many EEA doctors leave.

The research found European doctors now feel significantly less appreciated by the UK Government than they did before the Brexit vote.

Many feel uncertain about their futures in Britain, with some already making plans to return to their countries of origin.

Among other questions, the survey asked how committed the doctors were to working in the UK. Before the Brexit vote, the average response to that question rated nine out of ten. That has fallen to six out of ten in this latest survey.

On the question of how appreciated they felt working in the UK, the average response has fallen from seven out of ten to less than four out of ten.

On the latest figures, there are 280,932 doctors on the UK medical register, with 30,733 having attained their qualifications in another EEA country.

 The EEA includes all 28 members of the European Union as well as Iceland, Norway and Liechtenstein.

Chris Johnson

 

Vaccinations debate gets a shot in the arm

One Nation leader Pauline Hanson has sparked outrage and ignited a fresh debate over vaccinations by saying the Government was blackmailing parents into immunising their children.

Reinforcing her belief that vaccinations have links to autism and can cause other ill effects, Senator Hanson suggested parents have their children tested first to determine if they will react adversely to the shots.

“I’ve heard from parents and their concerns about it and what I have said is I advise parents to go out and do their own research with regards to this,” she told the ABC’s Insiders program.

“Look, there is enough information out there. No-one is going to care any more about the child than the parents themselves. Make an informed decision.

“What I don’t like about it is the blackmailing that’s happening with the Government. Don’t do that to people. That’s a dictatorship. I think people have a right to investigate themselves. If having vaccinations and measles vaccinations is actually going to stop these diseases, fine, no problems.

“Some of these – parents are saying – vaccinations have an effect on some children. Go and have your tests first. You can have a test on your child first.

“Have a test and see if you don’t have a reaction to it first. Then you can have the vaccination. I hear from so many parents. Where are their rights? Why aren’t you prepared to listen to them? Why does it have to be one way?”

Senator Hanson did not stipulate what test she was referring to and some days later apologised, saying she was wrong about it.

She has also stated that her comments were only a personal opinion and admitted that she had had her own children vaccinated.

But she maintains her distaste for the current Government policy to withhold some welfare payments and childcare fee rebates from parents who don’t fully immunise their children.

“I’m not saying to people don’t get your children vaccinated. I’m not a medical professional” she said while campaigning in the WA State election.

“I had my children vaccinated. I never told my children not to get their children vaccinated. All I’m saying is get your advice.”

Her initial remarks, however, have caused a backlash from a host of experts, commentators and politicians – including Prime Minister Malcolm Turnbull.

“If parents choose not to vaccinate their children, they are putting their children’s health at risk and every other person’s children’s health at risk too,” Mr Turnbull said.

Health Minister Greg Hunt described Senator Hanson’s comments as “incorrect in fact” and not what a Member of Parliament should be making.

He also acknowledged that the so-called No Jab, No Pay policy is a strong and tough policy, but one he backed 100 per cent.

“I take a very clear, strong view of this. Vaccination is fundamental to protecting not just our own children, but everybody else’s children,” Mr Hunt said.

“There are decades and decades of different sources of evidence and practise and simply reduced incidences of conditions such as mumps and measles, rubella, whooping cough.

 “So the evidence is clear, overwhelming and very broadly accepted.”

 The AMA has provided much of that evidence over a long period of time.

 Responding to Senator Hanson’s controversial remarks, AMA President Dr Michael Gannon praised the national immunisation program.

 “The false claims, the mistruths, the lies that you can find on the internet are of a great concern to doctors,” Dr Gannon said.

 “The national immunisation program is a triumph. There is good news in this story – 95 per cent of one-year-olds in Australia are fully vaccinated, 93 per cent of five-year-olds are fully vaccinated.

 “But we know that a lot of parents are doing this with some reservations, and that’s of great concern.

 “The person to give you the most accurate information about the benefits of vaccination to allay your concerns is your local immunisation provider. In many cases, that’s your family GP.

 “I can assure you that there is some absolutely galling rubbish available to parents on the internet.

 “They need to be taught how to find credible sources of information. Anything which weakens this most important of public health measures really needs to be stepped on.”

 Meanwhile, a new national survey has revealed that health care providers are refusing to treat one in six children who are not up to date with their vaccinations.

 The sixth Australian Child Health Poll was conducted and released by the Royal Children’s Hospital Melbourne and published in March under the title Vaccination: Perspectives of Australian Parents.

 It also found that 95 per cent of parents kept their children up to date with vaccines, but that almost a third of parents held concerns about vaccination safety.

 Dr Gannon labelled it an interesting and important study.

 “It refers to health care providers. I would be surprised if we were talking about doctors. It’s not ethical to deny treatment to unvaccinated children,” he said.

 “I suspect we would hear many, many complaints if this was the fact, that these were doctors refusing to treat these kids.

 “Certainly legally they can refuse treatment, but ethically they shouldn’t. Parents who deny their children the individual benefits of vaccination against preventable and infectious disease are already doing their child a disservice. Doctors would not seek to enhance that disadvantage.

 “This study is a good news story in many ways. It shows the overwhelming support that the vaccination program enjoys amongst Australian parents.”

 Director of the Child Health Poll, paediatrician Dr Anthea Rhodes, said the survey suggested a worrying pattern of practice not previously identified in Australia.

 “All children, regardless of their vaccination status, have an equal right to health care,” Dr Rhodes said.

 Chris Johnson

 

 

 

 

 

News briefs

Genes found linked to autism and intellectual disability

Researchers from the University of Adelaide have helped identify 91 genes, 38 of which are completely new, linked to autism and intellectual disabilities. Most of the gene mutations (65%) were inherited, suggesting not all of them were sufficient on their own to cause disease. The researchers had hoped data from 11 730 cases would allow them to distinguish between genes linked to autism and those linked to intellectual disability, but found that most of the 91 genes were affected in both conditions. Only eight gene mutations linked to autism were not present in the group with intellectual disabilities, while 17 mutations linked to intellectual disabilities were absent in the group with autism. The researchers also found that the pattern of mutations in high functioning autism differs from the pattern seen in autism with intellectual disability — an important finding for diagnostic, prognostic and therapeutic reasons, said the authors. The study, published in Nature Genetics, commenced in 2009 and was conducted with the support of an international consortium, the Autism Spectrum/Intellectual Disability network. The network involves 15 centres across seven countries and four continents; 11 730 autism spectrum disorder, intellectual disability and developmental disability cases were tested and, from these, 2383 cases with intellectual disability came from Adelaide.

Dormant breast stem cells linked to pregnancy growth

Researchers from Walter and Eliza Hall Institute have used advanced imaging technology to find a long-lived type of breast stem cell that is responsible for the growth of the mammary glands during pregnancy, enabling lactation. The newly discovered stem cells, which respond to progesterone and oestrogen, may also be linked to a high risk form of breast cancer. The discovery was made by Dr Nai Yang Fu, Dr Anne Rios, Professor Jane Visvader and Professor Geoff Lindeman as part of a 20-year research program into how the breast develops from stem cells and how breast cancers can arise from stem cells and developing breast tissue. The research has been published in Nature Cell Biology. The research also revealed that the stem cells with high levels of two proteins called tetraspanin8 and Lgr5 have many similarities to a subtype of “triple negative” breast cancers known as claudin-low cancers. “Compared to other types of breast cancer, claudin-low cancers have a high chance of recurrence after treatment, leading to a poor prognosis for patients,” Professor Visvader said.

News briefs

NSAIDs don’t stop back pain

A systematic review from the George Institute for Global Health has found that non-steroidal anti-inflammatory drugs (NSAIDs) commonly used to treat back pain provide little benefit, but cause side effects. Published in the Annals of Rheumatic Disease, the review, which examined 35 trials involving more than 6000 people, found that only one in six patients treated with NSAIDs achieved any significant reduction in pain. Patients taking NSAIDs were 2.5 times more likely to suffer from gastro-intestinal problems such as stomach ulcers and bleeding. Most clinical guidelines currently recommend NSAIDs as the second line analgesics after paracetamol, with opioids coming at third choice. Lead author Associate Professor Manuela Ferreira said the review highlighted an urgent need to develop new therapies to treat back pain. “When you factor in the side effects which are very common, it becomes clear that these drugs are not the answer to providing pain relief to the many millions of Australians who suffer from this debilitating condition every year.”

Gene discovery could prevent onset of MD

An international group including researchers from the Walter and Eliza Hall Institute of Medical Research has found that mutations in a gene called SMCHD1 can cause a rare syndrome called bosma arhinia microphthalmia syndrome (BAMS), in which the nose fails to form during embryonic development. The same gene is also faulty in people with an inherited form of muscular dystrophy called facioscapulohumeral muscular dystrophy type 2 (FSHD2). Published in Nature Genetics, the research compared the genetic changes in SMCHD1 causing BAMS and FSHD. They found that FSHD2 was caused when the protein SMCHD1 was damaged and can no longer function normally. They also found that in children with BAMS the opposite happened – the nose fails to develop in instances where SMCHD1 is activated. “This is really exciting because it gives us clues about how to design medicines that boost SMCHD1’s activity to protect the body from the development of FSHD2,” one of the authors said.

In-hospital mortality after hip fracture by treatment setting [Research]

Background:

Where patients with hip fracture undergo treatment may influence their outcome. We compared the risk of in-hospital death after hip fracture by treatment setting in Canada.

Methods:

We examined all discharge abstracts from the Canadian Institute for Health Information with diagnosis codes for hip fracture involving patients 65 years and older who were admitted to hospital with a nonpathological first hip fracture between Jan. 1, 2004, and Dec. 31, 2012, in Canada (excluding Quebec). We compared the risk of in-hospital death, overall and after surgery, between teaching hospitals and community hospitals of various bed capacities, accounting for variation in length of stay.

Results:

Compared with the number of deaths per 1000 admissions at teaching hospitals, there were an additional 3 (95% confidence interval [CI] 1–6), 14 (95% CI 10–18) and 43 (95% CI 35–51) deaths per 1000 admissions at large, medium and small community hospitals, respectively. For the risk of in-hospital death overall, the adjusted odds ratios (ORs) were 1.05 (95% CI 0.99–1.11), 1.16 (95% CI 1.09–1.24) and 1.44 (95% CI 1.31–1.57) at large, medium and small community hospitals, respectively, compared with teaching hospitals. For the risk of postsurgical death in hospital, the adjusted ORs were 1.06 (95% CI 1.00–1.13), 1.13 (95% CI 1.04–1.23) and 1.18 (95% CI 0.87–1.60) at large, medium and small community hospitals, respectively.

Interpretation:

Compared with teaching hospitals, the risk of in-hospital death among patients with hip fracture was higher at medium and small community hospitals, and the risk of in-hospital death after surgery was higher at medium community hospitals. No differences were found between teaching and large community hospitals. Future research should examine the role of volume, demand and bed occupancy for observed differences.

[Correspondence] Estimating the burden of hepatitis

Jeffrey Stanaway and colleagues (Sept 10, p 1081)1 published a study giving an estimation of 1·45 million deaths per year worldwide for hepatitis. The research was based on Global Burden of Disease 2013 data from the Institute of Health Metrics and Evaluation (IHME), indicating a higher mortality rate from hepatitis than from HIV in 2016.

[Comment] India’s new health systems knowledge platform—making research matter

The recent decision by the Government of India’s Ministry of Health and Family Welfare to set up the National Knowledge Platform (NKP) for health systems and public health research1 could be a watershed in how key decisions get made in India’s complex, federal health system. The NKP aims to support health systems research and its uptake in policy. It has been established after consultations involving the central government, the Alliance for Health Policy and Systems Research, WHO’s country office in India, and national-level technical organisations.

[Editorial] Alzheimer’s disease: expedition into the unknown

The topline results from EXPEDITION3, a trial of the amyloid β antibody solanezumab in patients with mild Alzheimer’s disease, announced on Nov 23, 2016, sent shares in Eli Lilly (and other companies working on drugs to reduce amyloid β, such as Biogen and Merck) plummeting. But the dementia research community was more phlegmatic. “Clearly, if all the stars aligned then the trial would have been positive”, said Lon Schneider of the California Alzheimer’s Disease Center. The announcement was disappointing, but perhaps not surprising.