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In This Issue

Ruth Armstrong
Med J Aust 2009; 190 (9): 466.
Published online: 4 May 2009

Fit to drive?

The Austroads fitness-to-drive guidelines do hold some sway in court, but they do not relieve patients of their legal obligation to disclose any medical condition that may affect their driving to the licensing authority. So say Beran and colleagues in their discussion of the case of a man who failed to disclose his epilepsy. His history of nocturnal seizures would not have disqualified him from driving under the guidelines, but both the trial and the appeal judges considered his concealment of his condition to be a more important factor in convicting the man of dangerous driving occasioning death (→ Usefulness of Austroads’ fitness-to-drive guidelines: lessons from the Gillett case).

Antidepressants not hitting the spot

A study using Australian antidepressant prescription data suggests a mismatch between need and provision for people living in remote areas and those with low socioeconomic status in some age groups. Page and colleagues examined antidepressant prescriptions under the Pharmaceutical Benefits Scheme in 2003-2005. Although boys predominated in childhood prescriptions, in all other age groups women had much higher rates of antidepressant use than men, and this increased with age in both sexes. Remote areas had the lowest prescription rates, and regional centres the highest. Use also varied with socioeconomic status. Although the study could not identify individual treatment gaps, the pattern of antidepressant use did not entirely correlate with that expected from known sociodemographic differences in depression rates (→ Sociodemographic correlates of antidepressant utilisation in Australia).

Division of labour

If a study by Robson and colleagues rings a bell, it’s because it was widely reported in the Australian media after being released as an MJA rapid online publication in February (→ Adverse outcomes of labour in public and private hospitals in Australia: a population-based descriptive study). According to the National Perinatal Data Collection, just under a third of births in Australia between 2001 and 2004 occurred in private hospitals. High rates of obstetric interventions in these hospitals are well known, but the study revealed what appeared to be a trade-off — lower rates of severe perineal injury in the mothers and less need for resuscitation, fewer low Apgar scores, and decreased likelihood of intensive care admission and perinatal death in the babies. The study is retrospective and therefore not perfect, warns Pesce in an accompanying editorial, but it does challenge the assumption that high rates of intervention are inherently bad. Two Letters to the Editor (Sutherland et al and Watson et al) are critical of the use of routinely collected data (which do not include some potentially important confounders) to address such an important and emotive issue.

Patient perceptions of health care harm

An Adelaide-based study provides a patient’s perspective on adverse events in health care, with 4.2% of participants reporting that they had experienced an adverse event within the previous year. Adams et al asked 3522 participants in the North West Adelaide Health study, “Have you personally, in the last 12 months, experienced a situation where your health care has led to harm?”, providing examples. One-hundred and forty-eight people answered in the affirmative, most commonly citing medication errors, misdiagnosis or wrong treatment. Some participants reported long-term or permanent harm (22% physical, 32% emotional) (→ Self-reported adverse events in health care that cause harm: a population-based survey).

Vertical Hepatitis B

Perinatal transmission of hepatitis B still occurs in Australia, despite the use of passive and active immunoprophylaxis for babies known to be at risk, say Wiseman et al. While international studies report variable rates of transmission, data have been lacking for Australia, a low- prevalence country. Four cases of transmission were identified among 313 hepatitis B surface antigen-positive women who underwent antenatal care at hospital clinics in south-western Sydney between August 2002 and May 2008: one baby had not received hepatitis B immunoglobulin as recommended at birth, and all four mothers had very high levels of hepatitis B virus DNA and were e-antigen-positive (→ Perinatal transmission of hepatitis B virus: an Australian experience).

Hot topics

If you’re looking for cutting edge, there are a few “don’t miss” items in this issue. As new public hospital initiatives continue to unfold, we have received a number of letters on the fallout from the Garling Inquiry (Matters arising, “In the wake of the Garling inquiry into New South Wales public hospitals: a change of cultures?”); there’s some up-to-the-minute advice on the use of new imaging techniques in breast cancer screening (Houssami et al, “Breast cancer screening: emerging role of new imaging techniques as adjuncts to mammography”); Strong canvasses the issue of “saviour siblings” (→ Informing patients about emerging treatment options: creating “saviour siblings” for haemopoietic stem cell transplant); and Van Nunen et al present a fascinating case series from Sydney’s northern beaches, comprising patients who presented with red meat allergy after experiencing large local reactions to tick bites (→ An association between tick bite reactions and red meat allergy in humans).

Another time . . . another place

Depressions may bring people closer to the church — but so do funerals.

Clarence Darrow

Dr Ruth Armstrong, MJA

  • Ruth Armstrong


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