A fat lot of indifference
In general, the nutritional status of young children is in the hands of their parents, so interventions targeting the grown-ups make sense in trying to reduce childhood obesity. A study published in this issue by Campbell et al raises the interesting issue of mothers’ insight into their children’s weight problems (→ Maternal concern and perceptions of overweight in Australian preschool-aged children).
Whether or not they are concerned about their children’s weight, most parents will have got the message that drinking soft drink causes children to become overweight. How strong is the link? Gill et al have searched for the evidence behind this strident public health message (→ The weight of evidence suggests that soft drinks are a major issue in childhood and adolescent obesity).
More than a quarter of Australian children reach the age of 18 having spent time living in a single-parent household — the corollary of this is a lot of sole mothers! Sole mothers are known to have poorer psychological health than the rest of the community and to be worse off financially, but the interplay between these two factors is difficult to determine. The Australian Longitudinal Study on Women’s Health provides some opportunity for Loxton et al to tease the two issues apart, with results that suggest a solution to many single mums’ misery (→ The psychological health of sole mothers in Australia).
Low-dose aspirin is worthwhile for secondary prevention of cardiovascular disease in men and women, and has also been recommended for primary prevention in higher-than-average-risk men. Until recently there was little evidence either way for primary prevention in women, but a newly published 10-year randomised controlled trial of nearly 40 000 healthy women has provided some answers. Hung explains why aspirin’s effect on men and women may differ, and why there is no substitute for assessing individual risk when prescribing preventively (→ Aspirin for primary prevention of cardiovascular disease in women: does sex matter?).
Research ethics and outcomes
If the MJA’s letters and opinion pages are anything to go by, the current processes and guidelines for conducting ethical medical research in Australia are not without their critics. As highlighted by Anderson et al (→ Strengthening Australia’s framework for research oversight), the two key Australian guidelines for ethical conduct in research are currently under review. New areas, including research governance and the need for research induction and education are covered in the draft revised guidelines, which are now open for comment.
Much of the funding for medical research in Australia comes from the National Health and Medical Research Council: in 2005, for instance, NHMRC grants amounted to $412 million. In 2003, to determine what returns the government is getting for its money in terms of not only publications and knowledge but also health and wealth gains, the NHMRC established an Evaluation and Outcomes Working Committee, whose report on the last decade or so of NHMRC-funded research can be found in “Evaluation of NHMRC funded research completed in 1992, 1997 and 2003: gains in knowledge, health and wealth”.
Making it mutual
As the government and Indigenous com-munities forge on with shared responsibility agreements, many stakeholders are still trying to get their heads around the complex issues involved in creating mutuality where there is so much difference. Kowal adds thoughtfully to the debate in “Mutual obligation and Indigenous health: thinking through incentives and obligations”.
When Kirkwood et al established a nurse-led cataract clinic at their hospital in 2003, waiting times were a median of 115 days for a clinic appointment and a further 44 days for cataract extraction. The clinic’s operation was carefully defined, safely run and ultimately successful in substantially reducing waiting times — surely a worthy prototype for working in teams with nurse practitioners (→ The efficacy of a nurse-led preoperative cataract assessment and postoperative care clinic).
Patients with rheumatoid arthritis have an increased risk of cardiovascular disease, which is now thought to be at least partly due to systemic inflammation. Given this, it is not surprising that treatment with disease-modifying antirheumatic drugs seems to modulate the risk. In “Reducing the cardiovascular disease burden in rheumatoid arthritis”, Van Doornum et al show how to combine our knowledge about traditional risk factors and treatments with the newer therapies to reduce cardiovascular disease in this special group of patients.
Inflammation was also the culprit causing middle lobe syndrome in the patient described by Chen et al (→ Middle lobe syndrome as the pulmonary manifestation of primary Sjögren’s syndrome). This disorder has not been previously described as a manifestation of Sjögren’s syndrome, and is thus a Notable Case.
Read on the web
Every month, via a mysterious and no doubt cyber-sneaky process, MJA staff receive a “stats report” on the page accesses to articles published on the eMJA in the previous month. We’ve decided that it’s time to share some of this information, so at the end of this issue you’ll find a list of the January “top 10”. Look out for the February statistics in the second issue in April.
Another time . . . another place
Lancet 2000; 355: 1218
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