eMJA: In Other Journals, 18 September 2006

In the 1950s, five Western Australian children helped out their parents on the family farm by shaking out hessian superphosphate bags before they were returned to a fertiliser supplier for recycling. Today, three of these children, now adults, have asbestos-related disease (calcified pleural plaques); one has no history of any other exposure to asbestos. Musk and colleagues suggest that before the hessian bags got to the fertiliser industry and the farm, some may have been used, contrary to regulations, to transport asbestos from the mine to the coast. They say this family’s experience highlights the potential results of the insidious dissemination of asbestos throughout the Western Australian community in past years.

Educating Rita

Last year’s hurricane season in the United States was followed by much criticism of government response. Now, one unheralded success has been reported which may assist future disaster management. When Hurricane Rita headed for Alexandria, Louisiana, in September 2005, the Louisiana Office of Public Health led a pro-active, cooperative and flexible response to enable effective care for hundreds of evacuees, including bedridden and oxygen-dependent residents of chronic care facilities.

One key to their success was solving logistical problems before they happened, for example, by deploying resources before the hurricane hit, such as alternate sources of oxygen, electricity and water. They also relied on multiple communication facilities — not only mobile phones, landlines and computers but also walkie-talkies, fax machines and digital cameras — this deliberately redundant infrastructure increased reliability. A joint command with state, local and volunteer partners avoided unnecessary duplication; rather, it enabled multiple coordinated, simultaneous interventions.

Ann Intern Med Online, 15 August 2006

Changing China’s children

Many younger women in urban areas of China are now expressing a preference for having a baby girl, according to a 2001 survey of nearly 40 000 Chinese women aged 15 to 49 years. This was a surprise finding among more expected results — a decreased birth rate and an imbalance in the sex ratio of children, favouring boys.

BMJ 2006; 333: 371-373

Home-grown doctors

States or territories that are short of doctors might do well to train up students from within their own borders or from a rural background, suggest Canadian researchers.1 As doctors aren’t conveniently radio-tagged like sea turtles, the researchers trawled through alumni lists and medical registers to determine where 1322 doctors from a single Newfoundland medical school had ended up in 2004.1,2 Just over 85% were working in Canada; about 30% were still in Newfoundland — especially those originally from Newfoundland, who had done some or all of their residency training in Newfoundland, or who had a rural background. Students from rural communities were also, in general, more loyal to Canada, the country that trained them, even if their contribution was not necessarily rural.

1. CMAJ 2006; 175: 357-360
2. CMAJ 2006; 175: 371

Heat shock protein promise

Chaperonin 10, also known as heat shock protein 10, may be effective in treating rheumatoid arthritis, according to Australian research. Vanags and colleagues conducted an exploratory proof-of-principle investigation of chaperonin 10 in 23 patients with moderate to severe active rheumatoid arthritis. The patients, who were also receiving disease-modifying anti-rheumatic drugs, received 5-10 mg intravenous chaperonin twice daily for 12 weeks. Symptoms improved from as early as a fortnight into the trial; and in vitro inhibition of cytokine production was detected. Some adverse events were reported but there were no toxicity or tolerability issues. Chaperonin 10 is thought to exert anti-inflammatory activity by inhibiting a range of cytokines, including tumour necrosis factor-α, and interleukins 1 and 6.

Lancet Online, 23 August 2006

Opt-in v opt-out research

New privacy laws on recruitment for research may lead to increased costs and reduced generalisability, say Australian researchers. Trevena and colleagues recruited two-thirds of 60 of a larger group of randomly selected patients into the pilot phase of a general practice-based randomised trial using an opt-out protocol. To opt out, patients needed to respond to an introductory letter from their doctor, indicating they did not wish to be contacted by researchers. However, an opt-in protocol was used after privacy legislation had been enacted, with just less than half of the remaining 92 randomly selected patients recruited into the main trial. To opt in, patients needed to respond to the introductory letter. As a result, to obtain a similar recruited sample size to that of the pilot phase, the researchers needed to increase the number of eligible participants by 50%. Further, they found that opt-in recruits were more likely to include active, preventive health-seeking participants with a personal motivation to be involved in the trial.

J Med Ethics 2006; 32: 473-477

Dr Ann Gregory, MJA

The Medical Journal of Australia eMJA