Rubella, mumps could soon be history

Rubella has been all-but eliminated and the country may be close to getting rid of mumps amid evidence of an increase in vaccination rates.

Research published by the Commonwealth Health Department in its latest Communicable Diseases Intelligence report suggests that rubella, a mild infection in adults that can nonetheless cause severe congenital abnormalities in unborn babies, is no longer endemic, while the country is close to eliminating mumps despite a recent upsurge in notifications of the disease.

Four years after the Americas were declared rubella-free, researchers from the National Centre for Immunisation Research and Surveillance said it was now so rare in Australia – aside from cases involving infections imported from overseas – that arguably the country met all the criteria for the World Health Organisation to declare it eliminated.

To be declared rubella-free, a country or region must have a low incidence of infection, with only sporadic imported cases with limited spread, high levels of immunity and a robust immunisation program.

Between the mid-1990s and 2005 the average annual notification rate for the disease tumbled from 14.8 per 100,000 to 0.23 per 100,000 by 2005, and there have been just two reported cases of congenital rubella syndrome since 2008. The proportion of imported rubella cases, meanwhile, climbed from 9 to 27 per cent between 2005 and 2012, and the immunisation rate has held above 91 per cent.

The researchers said it only remained to improve surveillance, including genotyping infections to establish their origin, to demonstrate the absence of endemic strains and have Australia declared rubella-free.

Researchers have also held out hope that mumps may soon be eliminated from Australia, if it is not already.

Mumps became a notifiable disease in 2001, and its incidence peaked at 2.8 per 100,000 in 2007 before slipping below 1 per 100,000 by 2012.

As with other countries, there has been an increase in the average age of people with mumps following the introduction of universal child vaccination in 1989. Between 2008 and 2012, it was much more common among 25 to 34-year-olds (1.7 cases per 100,000) than among young children. Those aged one to four years had the lowest incidence, just 0.5 per 100,000.

But researchers admitted that, despite high vaccination coverage against mumps (94 per cent for the first dose of the measles, mumps, rubella vaccine and 90 per cent for the second dose), there was an increasing trend in mumps notifications and the likelihood its incidence was being under-reported.

Nevertheless, that said it was possible that Australia was among those countries to have achieved, or come close to, eliminating the disease, adding that, “sporadic outbreaks in highly vaccinated populations may be due to the force of infection after virus introduction from an endemic area into high-density, high contact environments”.

They concluded that the trend toward increased notifications required careful monitoring.

The possibility that rubella and mumps may soon be eliminated, if they are not already, has come amid evidence that the nation’s vaccination rate is increasing.

The Federal Government has mounted a crackdown on parents who refuse or fail to ensure their children are vaccinated, threatening to withhold benefits worth thousands of dollars from families and abolishing all but medical exemptions.

But even before these latest measures were announced, figures from the Australian Childhood Immunisation Register show vaccination rates were rising in mid-2014, reaching 91.5 per cent of one-year-olds (up 0.6 of a percentage point), 92.8 per cent of two-year-olds (up 0.2 of a percentage point) and 92.2 per cent of five-year-olds (up 0.3 of a percentage point).

Adrian Rollins

Data sharing in Indigenous health research: guidelines needed

We need to share data to enable efficient and timely research

Data sharing maximises the value of collected data, minimises duplicative data collection, and promotes follow-up studies of secondary research questions using existing data.1 The importance of data sharing in advancing health is becoming increasingly recognised. The funders of health research around the world, including the National Health and Medical Research Council (NHMRC), have endorsed the call to increase the availability to the scientific community of public health research data from the research projects that they fund.2,3 Recently, cohort profiles and data source profiles have increasingly been published to facilitate data sharing.4,5 From the publications using the shared data, we have learned that data sharing increases the productivity of both original data collectors and subsequent data users.4

Why the urgent need?

Health data linkage, such as that done in Western Australia and the Northern Territory, has made it possible for researchers to use administrative data for Indigenous health research. However, there are no national guidelines for sharing de-identified data that are specifically collected from Indigenous communities for publicly funded individual research projects. With limited research funding, expertise and access to study participants for data collection for Indigenous health research, data sharing is urgently needed for three reasons.

Cost savings

First, the cost of collecting population-based data from Indigenous communities is generally much higher than that for the general Australian population because of a relatively small Indigenous population scattered throughout communities across a vast geographic area. With limited research funding, a relatively small group of Indigenous health researchers is trying to tackle a large number of health issues among heterogeneous communities. Therefore, unnecessary duplication in data collection from Indigenous communities could be avoided through data sharing and would provide savings in terms of the limited research resources.

Ethical obligations

Second, in addition to our obligation to protect the privacy and dignity of Indigenous patients who have provided personal information, we have an ethical obligation to maximise public health benefits to Indigenous community members. Since a single research project is generally funded for up to 5 years, and most of those years are allocated to data collection, original data collectors often do not have sufficient time and capacity to analyse and disseminate all the data collected within such a time frame.

Replicating findings

Third, replicability is one of the fundamental tenets of the scientific process. Public health researchers can only report fractional and selective findings of a research project. Due to the scarcity of comparable data in Indigenous health research, the chances for the findings from such data to be independently scrutinised are often lower than those from non-Indigenous health research. In addition, the complexity of the widely used multivariable statistical techniques for adjusting for potential confounders makes it even more difficult to reproduce published findings without access to the original data.

Barriers to data sharing

We face a challenging task due to barriers to data sharing in public health research.6 For original data collectors, possible reasons for not sharing include: ethics of data sharing; fear of being scooped; inadequate levels of recognition of the original data collectors; and lack of time, data-sharing standards, and financial, technical and infrastructure support.7–9

In terms of ethics, sharing health data that contain personal information in Australia should legally adhere to two sets of NHMRC guidelines approved under section 95 and section 95A of the Privacy Act 1998 (Cwlth). Although personal information data are generally collected in most original projects, often only de-identified data are used at the data sharing stage, and de-identified information is not “personal information” protected under the Privacy Act. There is no legislation and there are no guidelines to specifically regulate and guide the sharing of such de-identified data.

According to the NHMRC funding rules 2015, the NHMRC “encourages researchers to share and deposit research data arising from NHMRC supported research projects through an open access database.”10 Original collectors are still reluctant to share the de-identified data, some with the perceived fear of being scooped by others using their data before they can. This fear is perhaps unfounded because of the increased productivity that is enabled by data sharing.4 The lack of recognition of the original data collectors’ contribution may also discourage them from sharing. It is a common perception that those who make their research data available to others receive inadequate levels of recognition, in terms of funding decisions, career advancement and assessment of research performance.11,12

The priorities

Obtaining valuable data from Indigenous communities, particularly remote communities, requires the ongoing commitment and hard work of original data collectors. Their contribution to research outputs should be adequately recognised by funding agencies, journals and research institutions. Appropriate resources, including technical and financial support, should also be allocated for sharing de-identified data. Importantly, legislation and guidelines are needed to make the sharing de-identified data a routine practice.

Celebrating 10 years of collaboration: the Australian Indigenous Doctors’ Association and Medical Deans Australia and New Zealand

Closing the gap by growing the Aboriginal and Torres Strait Islander medical workforce

This year marks the 10th anniversary of the collaboration between the Australian Indigenous Doctors’ Association (AIDA), the professional association for Aboriginal and Torres Strait Islander doctors and medical students,1 and Medical Deans Australia and New Zealand (Medical Deans), the peak body representing professional entry-level medical education, training and research in Australia and New Zealand.2 In October 2005, AIDA and Medical Deans established an inaugural collaboration agreement formalising our shared commitment to achieving health equality for Aboriginal and Torres Strait Islander people, with a focus on growing the Indigenous medical workforce.

Over the past 10 years, AIDA and Medical Deans have reaffirmed this strong and sustained commitment to achieving our shared objectives through three successive collaboration agreements. Notable milestones have been achieved since 2005, including:

a growth in the Aboriginal and Torres Strait Islander medical student cohort;
co-auspicing of the biennial Leaders in Indigenous Medical Education (LIME) Connection, which brings together a range of key health and medical education stakeholders to share innovative approaches in Indigenous medical education;3
implementation of the Capacity Building for Indigenous Medical Academic Leadership Project to support more Aboriginal and Torres Strait Islander people becoming medical academic leaders;4 and
the National Medical Education Review,5 which highlighted best practice for Australian medical schools in implementing the Indigenous Health Curriculum Framework.6

While all our achievements are significant, we are particularly pleased with the marked growth in the number of Aboriginal and Torres Strait Islander medical students. In 2005, Aboriginal and Torres Strait Islander medical students represented just 0.8% of first-year domestic enrolments. In 2011, this increased substantially to 2.5%, reaching population parity for the first time. In 2014, a record number of about 30 Indigenous medical students completed their degrees, and three universities celebrated their first Aboriginal and Torres Strait Islander medical graduates. These achievements reflect the importance of partnership in supporting Aboriginal and Torres Strait Islander medical students along the education and training pathway, to contribute to a growth in the Indigenous medical workforce.

Although there has been real progress in growing Aboriginal and Torres Strait Islander doctor and medical student numbers, there is still much work to be done in this area, particularly in regards to strengthening recruitment and retention. We envision a future where Aboriginal and Torres Strait Islander doctors and medical students reach a critical mass in the Australian medical workforce; and one in which all doctors are trained to deliver equitable, accessible, high-quality and culturally safe services to Aboriginal and Torres Strait Islander people.

The success of the AIDA and Medical Deans partnership has provided the impetus for similar arrangements to be developed across the medical education and training continuum, such as AIDA’s collaboration agreements with the Committee of Presidents of Medical Colleges and the Confederation of Postgraduate Medical Education Councils. Our achievements have been recognised in Australia and internationally, through presentations on our successes at forums such as the Pacific Region Indigenous Doctors’ Congress (PRIDoC) Conference. PRIDoC provides a culturally safe environment for health and medical professionals of the Pacific region to share and promote culturally safe research and clinical practices for Indigenous peoples.7

The current AIDA–Medical Deans collaboration agreement is due to expire at the end of 2015.8 To ensure that our partnership continues, AIDA and Medical Deans are in the process of developing a new collaboration agreement for 2016–2018. We anticipate launching the new collaboration agreement around the time of the 6th biennial LIME Connection, which will be held in Townsville on 11–13 August 2015. The development of the new AIDA–Medical Deans collaboration agreement is timely, as it coincides with the theme of AIDA’s 2015 conference — “Collaborate, communicate and celebrate” — which will be held in Adelaide on 16–19 September 2015.

We look forward to extending our partnership to continue our work in growing the Indigenous medical workforce and improving health and life outcomes for Aboriginal and Torres Strait Islander people.

The link between health and wellbeing and constitutional recognition

The Lowitja Institute is Australia’s national institute for Aboriginal and Torres Strait Islander health research. It is an Aboriginal and Torres Strait Islander organisation, named in honour of its patron Dr Lowitja O’Donoghue, AC, CBE, DSG. The Institute was established in 2010, emerging from a 14-year history of cooperative research centres.

The Lowitja Institute has led an initiative called Recognise Health, which promotes understanding of the important link between health and wellbeing and constitutional recognition of Aboriginal and Torres Strait Islander people. The initiative has brought together a coalition of 125 leading non-government organisations across the Australian health system in support of constitutional recognition. These organisations have signed the following statement (https://www.lowitja.org.au/recognisehealth/statement).

We call on all Australians to support recognition of Aboriginal and Torres Strait Islander peoples in the Australian Constitution.

We look forward to a time when all Aboriginal & Torres Strait Islander people can fully participate in all that Australia has to offer, enjoying respect for our country’s first cultures and leadership, and the dignity and benefits of long healthy lives.

Australia’s First Peoples continue to die far earlier and experience a higher burden of disease and disability than other Australians. This is a result of long term economic disadvantage and social exclusion, among other factors. Constitutional recognition would provide a strong foundation for working together towards better health and social wellbeing in the hearts, minds and lives of all Australians.

Recognise Health was launched at Parliament House in Canberra on 5 March 2015, with parliamentarians, medical and health leaders and community representatives present, in a strong show of commitment to the initiative.

The Australian Constitution, the main law that guides the operation of the Commonwealth of Australia, took effect in 1901. At that point in time, Aboriginal and Torres Strait Islander people had lived on this land for thousands of generations, keeping alive the world’s oldest living continuous cultures. However, Australia’s founding document does not recognise this first chapter of our national story.

Following the 2012 report of the Expert Panel on Constitutional Recognition of Indigenous Australians, all major political parties declared their support for recognition. Subsequently, the Prime Minister announced that the government intends to work towards a referendum. For the referendum to pass, the people of Australia need to understand and support the case for change, and there needs to be strong leadership from across the political spectrum, business and community sectors, and, of course, by Aboriginal and Torres Strait Islander leaders. Part of the work required for a successful referendum is to engage key community organisations — such as health organisations — in the national dialogue, thereby engaging their membership and the broader public to support the referendum.

Recognition of Aboriginal and Torres Strait Islander people would acknowledge their powerful sense of identity, pride, history and belonging to this land. It would promote opportunities for full participation in all that Australia has to offer and would be a significant step towards equity between Indigenous and non-Indigenous Australia.

Recognition, participation and equity would, in turn, have profound positive consequences for wellbeing, and therefore health. There is significant evidence from health research to indicate that being connected to the wider community, having a strong identity and feeling socially supported all have significant positive impacts on health.

The role of social and economic factors in determining health status is well understood; health does not exist within a vacuum. It is intricately connected to education, employment, housing, and more. Cultural factors also have a profound impact. Having a strong sense of identity and pride — individually and communally — has a supportive, protective and healing influence. Unfortunately, how we experience the great benefits of modern medical science has become disconnected from cultural, community, social and economic contexts.

As Aboriginal singer and performer Archie Roach stated at the launch of Recognise Health: “I really believe that being recognised within the Constitution has a lot to do with how we feel about ourselves, that we are worthy and we can be proud of my people” (http://www.recognise.org.au/blogs/ourstory).

The Institute has worked closely with Recognise (http://www.recognise.org.au), the people’s movement to recognise Aboriginal and Torres Strait Islander people in the Australian Constitution, on this initiative. More information, including a short film featuring five health leaders, is available at https://www.lowitja.org.au/recognisehealth.

Energy drinks deliver deadly jolt

Young people turning to heavily-caffeinated energy drinks to fuel themselves for partying, sport or just to get through the day are putting themselves at heightened risk of heart attacks and chronic heart problems.

In a finding that suggests the marketing and consumption of so-called energy drinks should be much more tightly regulated, a detailed American study of their use has found they are associated with “adverse cardiovascular events”, including sudden and deadly heart attacks, ruptured arteries, heart arrhythmia, tachycardia and elevated blood pressure, particularly among adolescents and young adults.

“By unleashing the new ‘beast’ of energy drinks, we have now seen significant morbidity and mortality in susceptible patients,” the study’s authors said. “Young consumers are at a particularly high risk of complications due to hazardous consumption patterns, including frequent and heavy use.”

The study, Cardiovascular complications of energy drinks, published in the latest edition of the journal Beverages, documented numerous cases where people died or suffered serious cardiovascular problems after consuming energy drinks.

These include a 28-year-old man who collapsed while playing basketball after drinking three cans of energy drink five hours before the match. He was rushed to hospital suffering ventricular tachycardia and died three days later.

In another case, a 25-year-old woman with a pre-existing heart valve problem died from intractable ventricular fibrillation after drinking a 55 millilitre bottle of Race 2005 Energy Blast with Guarana and Ginseng. Subsequent tests found the drink contained caffeine at a concentration of 10 grams a litre – more than 60 times that in cola drinks – and the caffeine in the woman’s bloodstream was concentrated at 19 milligrams a litre, around double the level found in regular coffee drinkers.

The drinks have also been associated with potentially fatal spasms of coronary arteries. One case involved a man, 28, who drank between seven and eight cans of energy drink over a seven-hour period before and during motocross racing. Soon after he stopped he suffered a cardiac arrest, and was found to have had a coronary artery vasospasm doctors believe was precipitated by high levels of caffeine and taurine in his blood.

In addition to heart attacks and arterial spasms, energy drinks have also been associated with surges in blood pressure that can lead to rupture of arteries, and with the impairment blood vessel linings.

The authors said that while some of the cases involved people with pre-existing and underlying cardiac condition, many others did not. They reported the results of a review of 17 cases where people suffered heart attacks or other cardiac “events” after consuming energy drinks and found almost 90 per cent were younger than 30 years of age, and the majority did not have a cardiac abnormality.

While energy drinks advertise high concentrations of caffeine – around 80 milligrams in cans of Red Bull, Monster and Rockstar, and more than 200 milligrams in a 60 millilitre can of 5-Hour Energy compared with around 35 milligrams in a can of cola – researchers said other common ingredients, particularly taurine, which can interfere with the regulation of the cardiovascular system, could also have potentially severe consequences.

The researchers admitted that “confounding variables”, such as strenuous exercise, genetic predispositions and the simultaneous use of alcohol or recreational drugs meant that many deaths could not be attributed to energy drinks alone.

But they said it was clear that consuming energy drinks was associated with “cardiovascular events including death”, and urged much greater attention be paid to their use.

The US Food and Drug Administration reported 18 deaths associated with energy drinks between 2004 and 2012, and the researchers said that because the FDA reporting system typically captured between 1 and 10 per cent of actual adverse events, it was likely there were at least 180 deaths associated with energy drinks during that period.

Given the widespread consumption of energy drinks – Australia’s Food Regulation Standing Committee found that sales of energy drinks in Australia and New Zealand jumped from 34.5 million litres in 2001 to 155.6 million litres in 2010 – the study’s authors have called for greater awareness of the danger they present, particularly for young people, who are typically the biggest consumers.

“Children, young adults and their parents should be aware of the potential hazards of energy drinks,” the authors said. “Physicians should routinely inquire about energy drink consumption in relevant cases, and vulnerable consumers such as young persons should be advised against heavy consumption, especially with concomitant alcohol or drug ingestion.”

The researchers said there was no rigorous scientific evidence that energy drinks boosted energy or improved physical or cognitive performance, and there needed to be public education campaigns to highlight the hazards and dispel the myths about their benefits.

They called for eventual limits on the caffeine content of energy drinks and restrictions on their sale to young people, echoing calls from the AMA and the Country Women’s Association.

The AMA has for several years raised concerns about the health effects of energy drinks and their heavy consumption among young people, including children.

In 2013, the-then AMA President Dr Steve Hambleton demanded that the caffeine content of energy drinks be reduced, or their sale restricted to adults, following evidence linking them to serious effects in young people, including tachycardia and agitation.

In 2009, the death of a young woman was linked to caffeine from energy drinks, and a study published in the Medical Journal of Australia found 297 calls relating to caffeinated energy drinks were made to the NSW Poisons Information Centre between 2004 and 2010, 128 of which resulted in hospitalisation.

Two years ago the Country Women’s Association of New South Wales submitted a petition with 13,600 signatures to Federal Parliament calling for a ban on energy drink sales to everyone younger than 18 years.

Both the AMA and the CWA have highlighted inconsistencies in food standards that limit the amount of caffeine in soft drinks to a maximum of 145 milligrams per kilogram, but impose no similar limit on energy drinks.

Adrian Rollins

Image by Au Kirk on Flickr, used under Creative Commons licence

[Perspectives] Constructing Scientific Communities: Citizen Science

The usual story of medicine in the past couple of centuries is one of growing professionalisation, and increasing distance between patients and practitioners. But is a new era of public participation in medicine upon us? Clinicians and patients are moving towards shared decision making in many areas, whilst some medical journals now invite patients to take part in peer review. Citizen Science projects, such as Cell Slider, run by Cancer Research UK, and Zooniverse, have enabled the public to contribute to medical research.

Detention whistleblowers with ‘legitimate’ concerns have nothing to fear – Dutton

Immigration Minister Peter Dutton has tried to hose down concerns doctors could face two years imprisonment for speaking out about shortcomings in the health care of detained asylum seekers under controversial new laws that came into effect on 1 July.

In a statement issued earlier today, Mr Dutton said the new Australian Border Force 2015 Act would “not restrict anyone’s ability to raise genuine concerns about conditions in detention, should they wish to do so through appropriate channels”.

Critics, including leading medical practitioners and barristers, have complained the laws, which threaten all detention centre staff – including health workers – with imprisonment for any unauthorised disclosure of information, target whistleblowers and will further deepen the secrecy surrounding the operation of immigration detention centres.

The AMA and other medical groups have called for an amendment to the law to explicitly protect health workers and allow them to advocate on behalf of their patients.

AMA President Professor Brian Owler said an Australian Human Rights Commission documenting cases of child sexual abuse at Australian-run detention centres demonstrated the need for greater transparency in their operation.

“One of the problems that we’ve got here is an issue of transparency. I think there are a lot of people, particularly doctors, that have been very concerned about the provision of health care.

“The standard of health care, particularly in offshore centres such as Nauru and Manus Island, is well below that we would expect on the mainland, and I think having some sort of independent health group as there used to be, indeed, to actually oversee that and provide some sort of transparency, that gives the Australian people the reassurance that we’re actually fulfilling at least the obligations of providing good health care to people that are in detention, is something that we really want to carry through.”

Dr Ai-Lene Chan, a GP who worked at the Nauru detention centre, together with colleagues Dr Peter Young and Dr David Isaacs, has warned that the new laws place doctors working in detention centres in an increasingly invidious position.

“The restrictions placed on doctors working in immigration detention results in health care that cannot be consistent with Australian codes and clinical standards,” the doctors said, noting that pathology tests frequently go missing, IT communications are regularly disrupted and the supply of medicines is underdeveloped.

The doctors warned that the Australian Border Force 2015 Act would only serve to compromise care even further.

It said the restrictions it put in place would fundamentally compromise vital aspects practice like sharing clinical information and research, and engaging in professional discussion.

“The Australian Border Force Act directly challenges professional codes of ethical conduct, including the safeguard of clinical independence and professional integrity from demands of third parties and governments,” they wrote. “The legislation aims to silence health professionals and others who advocate for their patients.”

But Mr Dutton said claims the Government wanted to gag whistleblowers with “legitimate” concerns were wrong.

“Any person who makes a public interest disclosure, as defined within the Public Interest Disclosure Act 2013, will not be subject to any criminal prosecution under the ABF Act,” the Minister said. “While the Government will take action to protect operationally sensitive information, such as personal information or information which compromises the operational effectiveness or response of our officers, the airing of general claims about conditions in immigration facilities will not breach the ABF Act.”

Mr Dutton said the Australian Border Force would investigate leaks of “operationally sensitive” information, but added “the public can be assured that it will not prevent people from speaking out about conditions in immigration detention facilities”.

Adrian Rollins

Whistleblower doctors face jail threat from today

Controversial laws under which doctors could face two years imprisonment for speaking out about shortcomings in the health care of detained asylum seekers come into effect today.

In a measure critics complain targets whistleblowers and will further deepen the secrecy surrounding the operation of immigration detention centres, the new Australian Border Force 2015 Act legislation, passed by Parliament in May, demands that all detention centre staff – including health workers – take an oath, and threatens two years imprisonment for any unauthorised disclosure of information.

Introducing the legislation, Immigration Minister Peter Dutton told Parliament the measure was necessary to “provide assurance to industry and our domestic and international law enforcement and intelligence partners that sensitive information provided to the Australian order Force and my department…will be appropriately protected”.

But the new legislation has fuelled concerns about a lack of scrutiny and accountability in the operation of immigration detention centres, particularly given the disbandment of the independent Immigration Health Advisory Group in late 2013.

Calls by the AMA and other medical groups for an amendment to the law to protect health workers and allow them to advocate on behalf of their patients have so far fallen on deaf ears.

The Government has also ignored suggestions that responsibility for the administration of asylum seeker health services be transferred to the Health Department, and that a body to provide independent oversight of care be reinstated.

Doctors warn the legislation contravenes clinical independence, which is a fundamental tenet of medical practice, by seeking to make medical practitioners and other health workers subject to the demands of the Government.

Dr Ai-Lene Chan, Dr Peter Young and Dr David Isaacs said the new laws placed doctors working in detention centres in an increasingly invidious position.

“The restrictions placed on doctors working in immigration detention results in health care that cannot be consistent with Australian codes and clinical standards,” they said, noting that pathology test frequently go missing, IT communications are regularly disrupted and the supply of medicines is underdeveloped.

The doctors warned that the Australian Border Force 2015 Act would only serve to compromise care even further.

It said the restrictions it put in place would fundamentally compromise vital aspects practice like sharing clinical information and research, and engaging in professional discussion.

The focus on the treatment of detained asylum seekers is intensifying amid allegations that some detainees, including children, have been sexually assaulted and physically abused.

AMA President Professor Brian Olwer earlier this year highlighted an Australian Human Rights Commission report documenting disturbing cases of sexually and physical assault on children in detention.

Professor Owler said the findings underlined the need to get children out of detention.

“Detention is not a safe place for children and this report clearly defines that by the number of assaults, including sexual assaults, unfortunately, that have happened to children, but also the effects on children’s health, particularly mental health,” he said at the time.

Professor Owler said the issue demonstrated the need for greater transparency in the operation of detention centres, rather than deeper secrecy.

“One of the problems that we’ve got here is an issue of transparency. I think there are a lot of people, particularly doctors, that have been very concerned about the provision of health care.

Adrian Rollins

[Comment] Donor heart preservation: straight up, or on the rocks?

Donor heart preservation using cold static storage is associated with ischaemic injury that restricts the safe preservation interval, contributes to the low utilisation rate of available donor organs, and significantly affects post-transplant survival.1,2 The pioneering work of Oscar Langendorff,3 in 1895, led to the realisation that an excised heart could be reanimated and maintained in a beating state with isolated perfusion.4 Subsequent research has sought to refine the technique of ex-vivo heart perfusion to minimise ischaemic injury, extend the safe preservation interval, optimise organ allocation, resuscitate dysfunctional hearts, and enable viability assessments before transplantation.

[Editorial] Reforming public and global health in Germany

Germany is not fulfilling its full potential in public and global health, according to a new statement from three of the country’s leading scientific academies. Their report—Public health in Germany: structures, developments and global challenges—was produced by an international working group of scientists who assessed what is needed to better the health of the population from the perspectives of academic public health, global health research, supporting institutions and structures, and the translation of science.