more_vertTuberculous meningitis, the most devastating complication of tuberculosis, is a leading cause of death among children with tuberculosis. Those surviving tuberculous meningitis frequently have serious neurological disabilities. This consequence was noted by many early researchers soon after chemotherapy was introduced; Fitzpatrick in 19541 reported the outcome of tuberculous meningitis among patients treated in Denver receiving streptomycin, para-aminosalicylic acid, and isoniazid, the most efficacious regimen then available.
Preference: Statistics, epidemiology and research design
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Breaking bread delivers big health rewards
There has been a significant decline in serious birth defects following the mandatory fortification of bread with folic acid and iodine.
Signalling a major public health success, the Australian Institute of Health and Welfare has found that the rate of neural tube defects has plunged by almost 75 per cent in babies born to Indigenous mothers, and are down by 55 per cent among babies born to teenage mothers, following the mandatory fortification of bread with folic acid and iodine.
Since 2009, millers have been required to add folic acid and iodine to flour following evidence that deficiencies in the diet of mothers was helping prevent neural tubes in foetuses from closing, causing serious birth defects such as spina bifida.
Research has shown that folic acid taken at recommended levels for at least one month before and three months after conception can prevent most neural tube defects.
The AIHW reported that since mandatory folic acid fortification was introduced, the overall incidence of neural tube defects has declined by 14.4 per cent, including major declines among teenagers and the Indigenous community.
It also found that the addition of iodine to bread had addressed the emergence of mild iodine deficiency in the general population.
AIHW spokesperson said these were “promising” results, but said further data collection was required to ensure these findings were accurate and sustained.
The full report is at: http://www.aihw.gov.au/food-and-nutrition/folic-acid-and-iodine/
Adrian Rollins
[Obituary] Robert Charles Strunk
Paediatrician and leading researcher in asthma. He was born in Evanston, IL, USA, on May 29, 1942, and died after a cardiac arrest in Chicago, IL, USA, on April 28, 2016, aged 73 years.
[Perspectives] The Lancet Technology: pharming blood
In 2008, the US Defense Advanced Research Projects Agency (DARPA), whose previous projects have yielded technologies such as the internet, stealth technology, and miniaturised GPS, launched its Blood Pharming programme and called for scientists and clinicians to create a system to manufacture red blood cells for transfusion. “Red blood cells are the most transfused blood product in battlefield trauma care and in civilian clinical settings. The high demand for blood transfusions poses a real challenge”, explains Renee Wegrzyn, DARPA Program Manager.
[World Report] US presidential candidates urged to support health research
Advocates for medical research are eager to hear how the presidential candidates would advance the search for new treatments. Susan Jaffe, The Lancet’s Washington correspondent, reports.
AMA Awards
President’s Award
Dr Paul Bauert OAM and Dr Graeme Killer AO
Two doctors, one a passionate advocate for the disadvantaged and the other a pioneering force in the care of military veterans, have been recognised with the prestigious AMA President’s Award for their outstanding contributions to the care of their fellow Australians.
Dr Paul Bauert, the Director of Paediatrics at Royal Darwin Hospital, has fought for better care for Indigenous Australians for more than 30 years. More recently, he has taken up the battle for children in immigration detention.
Dr Bauert arrived in Darwin in 1977 as an intern, intending to stay for a year or two. In his words: “I’m still here, still passionate about children’s health and what makes good health and good healthcare possible for all children and their families. I believe I may well have the best job on the planet.”
Dr Graeme Killer, a Vietnam veteran, spent 23 years in the RAAF before becoming principal medial adviser to the Department of Veterans’ Affairs. Over the next 25 years, he pioneered major improvements in the care of veterans, including the Coordinated Veterans’ Care project.
Dr Killer has overseen a series of ground-breaking research studies into the health of veterans, including Gulf War veterans, atomic blast veterans, submariners, and the F-111 Deseal and Reseal program. He was also instrumental in turning around the veterans’ health care system from earlier prejudicial attitudes towards psychological suffering.
Dr Bauert and Dr Killer were presented with their awards by outgoing AMA President, Professor Brian Owler, at the AMA National Conference Gala Dinner.
Excellence in Healthcare Award
The Excellence in Healthcare Award this year recognised a 20-year partnership devoted to advancing Aboriginal health in the Northern Territory.
Associate Professor John Boffa and Central Australian Aboriginal Congress CEO Donna Ah Chee were presented with the Award for their contribution to reducing harms of alcohol and improving early childhood outcomes for Aboriginal children.
Associate Professor Boffa has worked in Aboriginal primary care services for more than 25 years, and moved to the Northern Territory after graduating in medicine from Monash University.
As a GP and the Chief Medical Officer of Public Health at the Central Australian Aboriginal Congress, he has devoted his career to changing alcohol use patterns in Indigenous communities, with campaigns such as ‘Beat the Grog’ and ‘Thirsty Thursday’.
Ms Ah Chee grew up on the far north coast of New South Wales and moved to Alice Springs in 1987. With a firm belief that education is the key pathway to wellbeing and health, she is committed to eradicating the educational disadvantage afflicting Indigenous people.
Between them, the pair have initiated major and highly significant reforms in not only addressing alcohol and other drugs, but in collaborating and overcoming many cross-cultural sensitivities in working in Aboriginal health care.
Their service model on alcohol and drug treatment resulted in a major alcohol treatment service being funded within an Aboriginal community controlled health service.
AMA Woman in Medicine Award
An emergency physician whose pioneering work has led to significant reductions in staph infections in patients is the AMA Woman in Medicine Award recipient for 2016.
Associate Professor Diana Egerton-Warburton has made a major contribution to emergency medicine and public health through her work as Director of Emergency Research and Innovation at Monash Medical Centre Emergency Department, and as Adjunct Senior Lecturer at Monash University.
Her just say no to the just-in-case cannula has yielded real change in practice and has cut staff infections in patients, while her Enough is Enough: Emergency Department Clinicians Action on Reducing Alcohol Harm project developed a phone app that allows clinicians to identify hazardous drinkers and offer them a brief intervention and referral if required.
Associate Professor Egerton-Warburton has been passionate about tackling alcohol harm, from violence against medical staff in hospitals to domestic violence and street brawls.
She championed the first bi-annual meeting on public health and emergency medicine in Australia and established the Australasian College of Emergency Medicine’s alcohol harm in emergency departments program.
In addition, she has developed countless resources for emergency departments to facilitate management of pandemic influenza and heatwave health, and has authored more than 30 peer-reviewed publications.
Professor Owler said Associate Professor Egerton-Warburton’s tireless work striving for high standards in emergency departments for patients and her unrelenting passion to improve public health made her a deserving winner of the Award.
AMA Doctor in Training of the Year Award
Trainee neurosurgeon Dr Ruth Mitchell has been named the inaugural AMA Doctor in Training of the Year in recognition of her passion for tackling bullying and sexual harassment in the medical profession.
Dr Mitchell, who was a panellist in the Bullying and Harassment policy session at National Conference, is in her second year of her PhD at the University of Melbourne, and is a neurosurgery registrar at the Royal Melbourne Hospital.
Presenting the award, Professor Owler said Dr Mitchell had played a pivotal role in reducing workplace bullying and harassment in the medical profession and was a tireless advocate for doctors’ wellbeing and high quality care.
MJA/MDA National Prize for Excellence in Medical Research
A study examining the impact of a widely-criticised ABC TV documentary on statin use won the award for best research article published in the Medical Journal of Australia in 2015.
Researchers from the University of Sydney, University of NSW and Australian National University found that tens of thousands of Australians stopped or reduced their use of cholesterol-lowering drugs following the documentary’s airing, with potentially fatal consequences.
In 2013, the science program Catalyst aired a two-part series that described statins as “toxic” and suggested the link between cholesterol and heart disease was a myth.
The researchers found that in the eight months after program was broadcast, there were 504,180 fewer dispensings of statins, affecting more than 60,000 people and potentially leading to as many as 2900 preventable heart attacks and strokes.
AMA/ACOSH National Tobacco Scoreboard Award and Dirty Ashtray
The Commonwealth Government won the AMA/ACOSH National Tobacco Scoreboard Award for doing the most to combat smoking and tobacco use, while the Northern Territory Government won the Dirty Ashtray Award for doing the least.
The Commonwealth was commended for its continuing commitment to tobacco control, including plain packaging and excise increases, but still only received a B grade for its efforts.
The Northern Territory received an E grade for lagging behind all other jurisdictions in banning smoking from pubs, clubs, and dining areas, and for a lack of action on education programs.
State Media Awards
Best Lobby Campaign
AMA NSW won the Best Lobby Campaign award for its long-running campaign to improve clinician engagement in public hospitals.
The campaign started after the Garling Inquiry in 2008, which identified the breakdown of trust between public hospital doctors and their managers as an impediment to good, safe patient care.
It led to a world-first agreement between the NSW Government and doctors, signed in February 2015 by Health Minister Jillian Skinner, AMA NSW and the Australian Salaried Medical Officers’ Federation NSW, to embed clinician engagement in the culture of the public hospital system, and to formally measure how well doctors are engaged in the decision-making processes.
Best Public Health Campaign
AMA NSW also took home the Best Public Health Campaign award for its innovative education campaign on sunscreen use and storage.
The campaign drew on new research which found that many Australians do not realise that sunscreen can lose up to 40 per cent of its effectiveness if exposed to temperatures above 25 degrees Celsius.
The campaign received an unexpected boost with the release of survey results showing that one in three medical students admitted to sunbaking to tan, despite knowing the cancer risk.
Best State Publication
AMA WA won the highly competitive Best State Publication award for its revamped Medicus members’ magazine.
The 80-page publication provides a mix of special features, clinical commentaries, cover articles and opinion pieces to reflect the concerns and interests of WA’s medical community and beyond.
The judges said that with its eye-catching covers, Medicus made an immediate impact on readers.
Most Innovative Use of Website or New Media
AMA WA won the award for its Buildit portal, a mechanism for matching trainee doctors with research projects and supervisors.
The judges described Buildit as taking the DNA of a dating app and applying it to the functional research requirements of doctors in training, allowing for opportunities that may have otherwise been missed.
National Advocacy Award
AMA Victoria won the National Advocacy Award for its courage and tenacity in tackling bullying, discrimination and harassment within the medical profession.
AMA Victoria sought the views and concerns of its members, and made submissions to both the Royal Australasian College of Surgeons’ inquiry and the Victorian Auditor-General’s audit of bullying, harassment and discrimination within state public hospitals.
The judges said that tackling a challenge within your own profession was a particularly difficult task, especially in the glare of public scrutiny, making the AMA Victoria campaign a standout.
Maria Hawthorne
Rebate freeze will cost avg GP almost $110,000
The Medicare rebate freeze will leave a full-time GP $109,000 worse off by the time it is lifted in 2020, and practices will need to charge patients at least an extra $11.40 per visit just to maintain their income, a study on the impact of the policy shows.
Researchers at Sydney University’s Family Medicine Research Centre – which is due to close down on 30 June – have reported that the rebate freeze, which has been in place since 2014 and is due to remain until June 2020, will cost practices hundreds of thousands of dollars in lost income – underlining concerns it will force many to abandon bulk billing and begin charging patients if they are to remain financially viable.
The researchers, Christopher Harrison, Clare Bayram and Helena Britt, estimated that GPs would lose 9.4 per cent of their income if they did not pass the costs of the freeze on to their general patients.
They said that for an average full-time GP, who bills 5680 consultations a year, this would amount to a loss of $40,000 in 2019-20 alone, and total loss of $109,000 over the six years the freeze is due to be in place.
This was likely to result in extra charges for patients, the researchers said.
“The 9.4 per cent reduction in income may force GPs who bulk bill to cover their loss by charging general patients a co-payment,” they said.
They estimated that GPs would need to charge a minimum of $11.40 just to hold their income at 2014-15 levels, but admitted it was likely to be substantially higher because it did not take into account the administrative costs of setting up a billing system, increased bad debts, the impact of previous fee freezes and the income lost when a GP bulk bills a general patient facing financial hardship.
“It’s therefore likely that GPs who opt to charge a co-payment will charge more than our estimates,” they said, and cited the results of an Australian Doctor poll showing a majority would charge $25 or more for a standard consultation.
The findings of the study echo concerns raised by AMA President Dr Michael Gannon that the rebate freeze was pushing many practices to “breaking point”.
“We know that…some are being forced to introduce patient charges for the first time, others are having to increase their fees,” Dr Gannon said. “Either way, patients lose out and health suffers.”
The AMA President said the freeze was “bad policy” because it would cause many patients to consider delaying seeing their doctor, exacerbating their health problems and making it more likely they would eventually need expensive hospital treatment.
The Family Medicine Research Centre academics warned freeze was likely to hit disadvantaged and chronically ill patients the hardest.
“The freeze is likely to have a greater impact on practices that serve socioeconomically disadvantaged people, as the practices would have to absorb the reduction in gross income, which may not be viable,” they said.
Adding to the pressure on patients and doctors, the researchers estimated that the Government’s proposed increases in co-payments for Pharmaceutical Benefit Scheme medicines would hit elderly patients particularly hard.
The increases, which have so far been blocked in the Senate, would push the PBS co-payment for general patients to $43.30, and for concessional patients to $7.
The researchers estimated that aged pensioners would, on average, be left $29.65 a year worse off as a result of the changes.
Adrian Rollins
Nation ‘can’t afford’ barriers to care: King
AMA advocacy was “critical” in convincing Labor to make its $2.4 billion commitment to reinstate Medicare rebate indexation, Shadow Health Minister Catherine King told the AMA National Conference.
Highlighting what she said was a “huge gulf” between the major parties on health policy, Ms King said Labor’s promise to lift formed part of its plan to strengthen primary care, enhance preventive health efforts and reduce health inequality.
The Coalition has seized on figures showing that bulk billing has climbed to record levels to dismiss warnings that the rebate freeze will force many doctors to abandon bulk billing and begin charging patients.
But Ms King said the freeze would eventually result in higher out-of-pocket costs for patients.
“Sooner rather than later we know that the freeze will result in less bulk billing, and more and higher co-payments,” the Labor frontbencher said.
“When one in 20 Australians already skips or delays seeing a GP because of cost, that is not something we can afford to let happen.
“When our population is ageing and chronic disease is growing, we should be investing more in primary care, not less.”
Ms King said similar concerns underpinned Labor’s $971 million plan to scrap increases of between 80 cents and $5 to Pharmaceutical Benefit Scheme co-payments and changes to safety net thresholds.
“Cost is a barrier for access to prescription drugs,” she said. “We know that up to one in eight Australians doesn’t fill their scripts because medicines are already unaffordable for them.”
Ms King admitted that the policies, together with other health measures including an extra $15 million for Indigenous health, more than $25 million for cancer treatment and research and $35 million for palliative care, were expensive.
Labor has said it will fund the measures by axing the Coalition’s $50 billion business tax cut.
Ms King said the decision to fund these health policies had not been easy “given the current fiscal circumstances and competing demands. But in the end, budgets come down to choices and values”.
Adrian Rollins
News briefs
Wearable sensor measures fitness levels, heart function
Researchers from the University of California-San Diego in the US have developed a wearable patch that can measure biochemical and electrical signals in the human body simultaneously, reports Medical News Today. “The device — called the Chem-Phys patch — measures real-time levels of lactate, an indicator of physical activity, as well as the heart’s electrical activity. Put simply, the novel technology monitors a person’s fitness levels and heart function at the same time, and it is the first device that can do so. The patch is made of a thin, adhesive, flexible sheet of polyester, which the researchers manufactured using screen printing. A lactate-sensing electrode is situated in the centre of the patch, and two electrocardiogram electrodes are situated either side. The researchers found that the data collected by the EKG electrodes closely matched the data collected by a commercial heart rate monitor. Furthermore, they found that the information gathered by the lactate sensor closely matched lactate data collected during increasing physical activity in previous studies.”
http://www.nature.com/ncomms/2016/160523/ncomms11650/full/ncomms11650.html
Obesity linked to lower quality of nursing home care
US researchers have found that nursing homes that admitted more morbidly obese residents were also more likely to have more severe deficiencies in care, according to a study published in the Journal of the American Geriatrics Society. Science Daily reports that the study was designed to find out “whether obese older adults were as likely as non-obese elders to be admitted to nursing homes that provided an appropriate level of care”. “The researchers examined 164 256 records of obese people aged 65 or older who were admitted to nursing homes over a 2-year period. They also examined the nursing homes’ total number of deficiency citations and quality-of-care deficiencies to determine the quality of care that the homes provided. The researchers reported that about 22% of older adults admitted to nursing homes were obese. Nearly 4% were considered morbidly obese. Nursing homes that admitted a higher number of obese residents were more likely to have a higher number of deficiencies.”
https://www.sciencedaily.com/releases/2016/05/160531182543.htm
Australians among world’s longest-living: WHO
A new report from the World Health Organization says there have been gains in global life expectancy since 2000, with the overall increase of 5 years to a tick over 71 years the fastest rise since the 1960s, and reverses the declines seen in the 1990s. The World health statistics 2016: monitoring health for the Sustainable Development Goals (SDGs) report shows that the greatest increase in life expectancy during 2000–2015 has been in the African region, where it rose from 9.4 years to 60 years, due to reduction in child deaths, progress in malaria control, and better access to HIV antiretrovirals. Globally, the average lifespan of a child born in 2015 is likely to be 71.4 years — or 73.8 years if it is a girl and 69.1 years if it is a boy. The longest life expectancy is in Japan, where children born in 2015 are expected to live 83.7 years, followed by Switzerland (83.4 years), Singapore (83.1 years), Australia (82.8 years), and Spain (82.8 years). Average life expectancy for the United States is 79.3 years. The report also quantifies the causes of death and ill-health that pose significant challenges in meeting the SDGs.
http://www.who.int/gho/publications/world_health_statistics/2016/en/
Beware barbecue brush bristles
Research published in Otolaryngology — Head and Neck Surgery has investigated the epidemiology of wire-bristle barbecue brush injuries. Between 2002–2014, more than 1600 emergency department visits occurred as a result of wire-bristle brush injuries in the US, some of them requiring surgery. According to Medical News Today: “While wire grill brushes may be an effective cleaning tool prior to or following a cookout, the bristles can easily fall off and make their way into people’s food. If ingested, these little strands of metal can cause some serious injuries to the mouth, throat, and gastrointestinal region. The researchers hope their findings will promote greater awareness among manufacturers, consumers, and healthcare providers of the potential health hazards associated with wire-bristle brushes.”
[Perspectives] George Patton: global leader in adolescent health
“What’s a guy like you doing in a place like this?”, asked a criminologist to George Patton at a meeting on re-engagement for young offenders in Melbourne, Australia, 15 years ago. The colleague was referring to Patton’s background in clinical psychiatry and epidemiology, and his work at the Royal Children’s Hospital Melbourne. Today, Patton is a Professorial Fellow in Adolescent Health Research at the University of Melbourne and the nearby Murdoch Childrens Research Institute, and his eclectic professional positions have been an asset in his role as Chair of the Lancet Commission on adolescent health and wellbeing.