Stopping the juggernaut
Recently, in his regular column, our Editor wondered where all Australia’s “obesity champions” were. In this issue’s lead editorial (→ The unstoppable Australian obesity and diabetes juggernaut. What should politicians do?), Zimmet and James take up the champion challenge, urging all medical leaders to use their influence to force the fat cats in Canberra to give obesity the urgent attention it deserves.
In its 40-year history, the National Heart Foundation of Australia (NHF) has contributed more than $170 million to cardiovascular research. In terms of returns on investment, how has the NHF performed? Clay et al present the results of a recent evaluation in “The returns from cardiovascular research: the impact of the National Heart Foundation of Australia’s investment”.
As health care becomes more complex and expensive, there are calls for the government to increase its investment. But the money will only be well spent if we step back and consider the bigger picture, says Scott (→ Is modern medicine at risk of losing the plot?). No one will profit if medicine loses the plot.
Sneeze, wheeze, scratch ...
The constellation of images on this issue’s front cover should give you a clue to the topic of our new Practice Essentials series. Sufferers and doctors know that allergy is not trivial. Series editors Kemp, Mullins and Weiner remind us in their introductory editorial that it also still seems to be increasing in Australia, with new problems continually being recognised (→ The allergy epidemic: what is the Australian response?). In the first article of the series, Douglass and O’Hehir provide the basics for diagnosing, preventing and treating allergic disease (→ 1. Diagnosis, treatment and prevention of allergic disease: the basics) — and don’t miss Weiner’s single page Focus (a trademark of this series) on allergen injection immunotherapy (→ Allergen injection immunotherapy).
Not in vein
Non-surgical techniques for treating varicose veins are increasingly replacing the time-honoured procedures of surgical ligation and stripping. In 2002, Myers and colleagues adopted a new technique for treating saphenous vein reflux — endovenous laser therapy (in which the vein is thermally ablated by a laser under ultrasound guidance). They present their early results in “Treatment of varicose veins by endovenous laser therapy: assessment of results by ultrasound surveillance”.
Delivering vitamin D
The poor vitamin D nutritional status of many aged-care residents is well known, as is the difficulty of delivering effective supplements. Recently, Wigg et al assessed the feasibility of using a new oral vitamin D preparation for aged-care residents in South Australia. They present the results of their prospective, controlled trial in “A system for improving vitamin D nutrition in residential care”.
Although the Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommends that HIV screening be offered to all pregnant women, the national policy devised by the former Australian National Council on AIDS and Related Diseases adopts a risk-based approach. With the policy currently under review, Giles et al (→ The evidence for a change in antenatal HIV screening policy in Australia) use the Wilson and Jungner criteria for population-based screening programs to make the argument for universal screening.
Preparing for pandemic
If there is an avian influenza pandemic, say Cameron et al, one of the most important fronts for limiting its spread will be hospitals. In “The impending influenza pandemic: lessons from SARS for hospital practice”, these authors draw lessons for hospital infection control and other strategic measures from their experience with controlling the SARS outbreak.
In contrast to Australia’s medical indemnity arrangements, New Zealand has a no-fault compensation system for patients who are injured while undergoing medical treatment. The ultimate goal of any such system is to deliver compensation to those who are eligible. The New Zealand Quality of Healthcare Study, published in 2002, provided Bismark et al with an opportunity to match patients with potentially compensable events with those who actually claimed (→ Claiming behaviour in a no-fault system of medical injury: a descriptive analysis of claimants and non-claimants), revealing similar gaps to those that exist elsewhere.
Failing failure patients?
About one in five people who have an acute myocardial infarction (AMI) will experience some degree of heart failure in the days following the event, and these patients have a much poorer prognosis. The benefits of taking ACE inhibitors and β-blockers after AMI have been established but, as Krum et al found in a multicentre Australian survey, this vulnerable group of patients may be missing out (→ Does the presence of heart failure alter prescribing of drug therapy after myocardial infarction? A multicentre study).
Besides making food taste better, herbs and spices have been touted over the years as preventing everything from the common cold to depression, cancer, arthritis and infertility! The supplement included with this issue examines the evidence for some of these effects, as well as providing some interesting history, a bit of a culinary guide, and a look at how we might view herbs and spices in the future. Enjoy!
Another time . . . another place
Some men also have strange antipathies in their natures against that sort of food which others love and live upon. I have read of one that could not endure to eat either bread or flesh; of another that fell into a swoonding fit at the smell of a rose. . . . There are some who, if a cat accidentally come into the room, though they neither see it, nor are told of it, will presently be in a sweat, and ready to die away.
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