The gut overfloweth
Helicobacter pylori infection is thought to be uncommon in Australia’s Indigenous community. However, a new study in this issue may turn this belief on its head. The findings of Windsor and colleagues (including Barry Marshall, who first described the association between this organism and gastritis two decades ago) suggest that the infection rate may be even higher in Indigenous than in non-Indigenous Australians (→ Prevalence of Helicobacter pylori in Indigenous Western Australians: comparison between urban and remote rural populations). If this is really the case, what does it mean? Talley outlines the cause for concern (→ Helicobacter pylori infection in Indigenous Australians: a serious health issue?).
While some of the factors leading to health inequalities in Indigenous Australians are depressingly complex, control of vaccine-preventable diseases is something that is within our grasp. The immunisation community has been doing some soul-searching of late, looking at the outcomes of its programs to reduce morbidity and mortality from vaccine-preventable diseases in Indigenous communities. In "Immunisation: reducing health inequality for Indigenous Australians", McIntyre and Menzies give some insights, gained from a recent report and a conference, on what we are doing, what works and how we can do better.
Travels with my kidney
It was 50 years last December since the world’s first successful kidney transplant, and, in many ways, this procedure is a 20th-century success story: Australian transplant recipients now have a greater than 80% chance of surviving 5 years. Unfortunately, however, demand for kidneys far exceeds supply. Fewer than 10% of those on dialysis awaiting a transplant receive one each year. This has given rise to the situation, described by Kennedy et al, whereby some patients have travelled overseas to commercial kidney transplant centres (→ Outcome of overseas commercial kidney transplantation: an Australian perspective). While embarrassing and dangerous, say Mathew et al, such desperate actions are understandable. A more pro-active approach to recruiting donors may bring us closer to the numbers we need (→ The shortage of kidneys for transplantation in Australia).
You may be able to quell stormy board meetings or command operating theatres, but are you any match for a baby with sleep problems? There is a theory that sleep behaviour can be "learned" and that we can actually prevent some sleep problems. Symon and colleagues tested this with a randomised controlled trial: parents in the intervention group met with a nurse who advised them on "normal" infant sleep patterns and behavioural techniques to help babies sleep. They report their findings, many sleeps later, in "Effect of a consultation teaching behaviour modification on sleep performance in infants: a randomised controlled trial".
Joining the class
Proton-pump inhibitors are high on the list of top-selling drugs in Australia, so many of your patients will be taking them. In Lessons from Practice, Geevasinga et al remind us that, as useful as these drugs are, they've been associated with interstitial nephritis — and esomeprazole is the latest drug to join the list in what appears to be a class effect (→ Acute interstitial nephritis secondary to esomeprazole).
Women who feel they've been left high and dry by the current cautious approach to oestrogen replacement therapy might enquire about using transdermal progesterone creams to relieve their menopausal symptoms. What is the evidence for the efficacy of this treatment? Wren’s Clinical Update might help you formulate an answer (→ Transdermal progesterone creams for postmenopausal women: more hype than hope?).
Ageing in Dubbo
Over the years, the MJA has published several research articles on the findings of the "Dubbo Study", an epidemiological study in which more than three-quarters of this central western NSW town’s "over-60" population was enrolled in 1988. Fifteen years down the track, Simons et al have taken the opportunity to study the impact of individual risk factors (and combinations of risk factors) on mortality (→ Impact of smoking, diabetes and hypertension on survival time in the elderly: the Dubbo Study).
In the fifth of our Practice Essentials – Paediatrics series, Catto-Smith’s guide to the best approach to constipation and soiling should stand you in good stead for the long haul of dealing with these problems in children (→ 5. Constipation and toileting issues in children).
A matter of standards
Within the next few years there will be 17 medical schools in Australia, and, while our standard of medical education is regarded as high, curriculum content is highly variable. Our oncology community has been very active in monitoring curriculum content. In "Achieving equal standards in medical student education: is a national exit examination the answer?", the members of the Oncology Education Committee put forward a radical suggestion for ensuring that all medical graduates meet minimum standards.
Another time ... another place
I have often asked myself why it is that medical education is so discussed by the profession, why this never-ceasing upheaval. We do not see the education in law, we do not see the eduction in theology, a matter of constant dispute and agitation. And I have concluded that the keen interest, the deep feeling, which it engenders is really due to the state of medicine itself. The agitation is but a sign of the unrest in medicine we see everywhere.
Da Costa, Jacob M. Speech given to the Harvard Medical Alumni Association, June 27, 1893. Boston
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.