Volume 197 Issue 11

The medical profession has a key role in advocating for a humane response to asylum seekers, with greater emphasis on protective frameworks and provision of health and mental health services.

Louise K Newman BA(Hons), MB BS(Hons), FRANZCP

Extreme rates of gonorrhoea in remote areas must be reducedIn this issue of the Journal, there are two important articles highlighting the disadvantages experienced by Indigenous Australians, and offering important practical suggestions for improving health care.1,2 The article by Graham and colleagues analyses the notification rates for chlamydia and gonorrhoea in Australia by Indigenous status.1 Their findings are stunning. Compared with non-Indigenous Australians, Indigenous Australians have ...

Christopher K Fairley FRACP, PhD, FACSHP · Jane S Hocking MPH, MHlthSc, PhD

Medicare has reduced inequity in access to primary care, but inequities remain for low socioeconomic groups in rural areas, and in access to specialist, psychological and dental care.

Mark F Harris MB BS, FRACGP, MD

A status update on tweets, podcasts, prizes, news . . . and some darn good researchOne of the joys — and one of the problems — of a socially oriented online world is the range of publishing possibilities and demands that modern medical journal editors now face. As the MJA approaches its 100th birthday, how do we take advantage of this new environment, while maintaining ...

Medical Journal of Australia

The full content of this article is available by downloading the PDF.

The full content of this article is available by downloading the PDF.

Australia should use its influence as a United Nations Security Council member to advance a clear global strategy to tackle HIV, says the Honourable Michael Kirby.

The Honourable Michael D Kirby AC, CMG

Participant engagement and careful planning are key to a successful cohort studyIn the beginning there was an idea ... and funding. The project might never have started if not for a serendipitous meeting between an accountant for the Raine Medical Research Foundation and a young obstetrician. The Foundation had been established 30 years earlier by the bequest of Mary Raine (Box 1), a successful businesswoman who ...

Charlotte M McKnight MB BS · John P Newnham MB BS, MD, FRANZCOG · Fiona J Stanley MB BS, MD, MSc · Jenny A Mountain MBA, MClinEpi · Louis I Landau MB BS, MD, FRACP · Lawrence J Beilin MB BS, MD, FRACP · Ian B Puddey MB BS, MD, FRACP · Craig E Pennell MB BS, PhD, FRANZCOG · David A Mackey MB BS, MD, FRANZCO

Less harmful forms of nicotine have harm reduction potential that is worth investigatingConcern has been expressed about the possible increased use of smokeless forms of tobacco, such as low-nitrosamine smokeless tobacco (SLT) and electronic nicotine delivery systems (ENDS), also known as e-cigarettes (Box).1 Domestic sale of SLT was banned pre-emptively in 1991 in response to overseas marketing of these products to youth. Currently, Australians are permitted ...

Coral E Gartner PhD · Wayne D Hall PhD · Ron Borland PhD

Indigenous Australians have six times more blindness than the national average, but 94% of the vision loss is preventable with eye examinations and timely access to treatment. The Roadmap emphasises regional needs-based planning for service delivery and accountability.

Hugh R Taylor MD, FRANZCO, AC · Andrea I Boudville MIH · Mitchell D Anjou MScOptom

To the Editor: It is truly difficult to understand by what standard the University of Melbourne defines its MD degree, which it commenced in 2011 to replace its previous MB BS degree. Several things are abundantly clear, however. The educational standard is distinctly short of the traditional British and Australasian higher doctorate degree. The University of Melbourne clearly recognises this itself, as it has renamed its own ...

Richard M Hanney

In reply: The Melbourne Medical School is celebrating its 150th anniversary this year. However, the University of Melbourne awarded medical degrees as early as 1856, including the award of the MD degree ad eundem gradum to the acknowledged founder of the Medical School, Anthony Colling Brownless, on the basis of his MD from St Andrews University, Scotland, obtained by examination in 1847. The MD is ...

James D Best · Geoffrey J McColl

To the Editor: In their recent article on emergency department (ED) waiting time performance data, Greene and Hall1 proposed that “assigning patients to a less urgent triage category than is appropriate” is a possible explanation for observed variations in waiting time performance. In Australia, triage decisions are made on the basis of clinical urgency. The Australasian Triage Scale is underpinned by a robust body of research ...

Julie Considine · Ramon Z Shaban · Marie F Gerdtz · Dianne Crellin

In reply: We thank Considine and colleagues for their interest in our recent article. Our research documented a relationship between the reported urgency mix of patients in emergency departments and waiting time performance, and we discussed possible explanations for the relationship, including “undertriaging”.1 We were explicit that the study did not provide evidence of undertriaging, but argued that it was a possibility worthy of consideration, ...

Jessica Greene · Jane Hall

To the Editor: The recent Australian Institute of Health and Welfare (AIHW) statistics on emergency department (ED) care show that 38% of attendances from 1 July 2011 to 30 June 2012 were potential general practice presentations.1 This indicator is reported under the National Healthcare Agreement. Both the AIHW and Council of Australian Governments acknowledge that this method is flawed and have agreed to review this indicator.2 To date, this ...

Yusuf Nagree · Andrew D Gosbell · Daniel M Fatovich · Peter A Cameron · Sally M McCarthy · David Mountain

To the Editor: Harrison and colleagues present data which confirm that inequitable distribution of mental health care is increasing under the Better Access program.1 They discount our promotion of the central role of general practitioners in the more restricted Better Outcomes program2 and our advocacy for GPs to resume those key activities despite lack of support under the Better Access program.3 The fatal decision that accompanied ...

Sebastian P Rosenberg · Ian B Hickie

In reply: We share Rosenberg and Hickie’s belief that general practitioners should play a central role in mental health care. We showed with Bettering the Evaluation and Care of Health (BEACH) data that GPs have played this role in both Better Outcomes and Better Access.1 Rosenberg and Hickie rely on administrative data to make inferences about clinical practice. They assume that GPs not claiming review items ...

Christopher M Harrison · Graeme C Miller · Helena C Britt

To the Editor: Beatson and Rao’s article1 appeared in the MJA Open supplement subtitled “A guide to management in primary care”. Despite acknowledging that it “can be difficult to distinguish between [borderline personality disorder] and [major depressive disorder]”, the authors offer no specific guidance for general practitioners on how to do this. Beatson and Rao cite no primary care research, although admittedly there is a dearth ...

Darryl L Lacey

In reply: Lacey suggests that the Dimensional Assessment of Personality Pathology – Basic Questionnaire (DAPP-BQ)1 can be a useful tool for the assessment of personality problems by academic general practitioners. We agree. Significant elevations on the DAPP-BQ’s affective lability, identity problems, insecure attachment, and self-harm scores would alert the practitioner to the probable — if not certain — presence of borderline personality disorder (BPD). However, the ...

Josephine A Beatson · Sathya Rao

To the Editor: We congratulate Kwan and colleagues on their evaluation of an online chlamydia testing program (OLC) in Western Australia. However, their study does not demonstrate OLC to be a “highly effective means of increasing access to testing among young people at risk of STIs [sexually transmitted infections]”.1 Adolescents account for 30% of chlamydia notifications in WA,2 yet only 37 of the 377 people (10%) who were ...

Peter S Azzopardi · Elissa C Kennedy · Alex D Brown

In reply: Azzopardi and colleagues seem to equate “young” with “adolescent”. We defined “young” as less than 30 years of age; 84% of chlamydia notifications in Western Australia occur in this age group,1 and they comprised 71% of online chlamydia testing program (OLC) users.2 This group accesses the internet frequently, with about 90% of Australians under 35 years of age using the internet at least once a ...

Lewis J Marshall · Edwina A Jachimowicz · Lisa Bastian · Donna B Mak

As the debate about older drivers continues, an observant reader notes another danger for car occupants lurking in an MJA illustration.

Paul Gerber

Deaths from hypothermia are not limited to colder climates or to the winter months. Older people who live alone without adequate heating are especially vulnerable.

Fiona Bright · Calle Winskog · Roger W Byard

To the Editor: We describe a case of unilateral central retinal vein occlusion (CRVO) in a 29-year-old woman during exposure to high altitude. She complained of blurred vision in her left eye, first noted when trekking to a maximum altitude of 6189 metres in Nepal 2 months earlier. She was not hypertensive and was not taking any medication, and had no previous history of thrombosis. Examination using a ...

Holly L Hutton · Randev Mendis · Lyndell L Lim

To the Editor: In London in the late 1960s, one of my chiefs regularly used a diathermy clamp (Med J Aust 2012; 197: 193) for the management of third and fourth degree piles. The patient was anaesthetised, placed in the lithotomy position, and draped. Meanwhile, the clamp was brought to red heat on a Bunsen burner in a side room and fetched into theatre by ...

William E M Renton-Power

Objective: To use patient-level data, clinical information and linked Medicare records to assess the distribution of benefits (rebates) across income groups, including benefits relating to chronic conditions such as the Chronic Disease Dental Scheme (CDDS).Design, setting and participants: Nationally representative, cluster-stratified survey (the Australian Hypertension and Absolute Risk Study) involving 322 general practitioners who each collected clinical data on 15–20 patients aged ≥ 55 years ...

Rachel J Knott BEcon(Hons I), BCom · Alan Cass MB BS, FRACP, PhD · Emma L Heeley BSc(Hons), MSc, PhD · John P Chalmers MD, PhD, FRACP · David P Peiris MB BS, PhD, FRACGP · Philip M Clarke BEc, MEc, PhD

New South Wales data from the 45 and Up study indicate that bariatric surgery for severe obesity is largely available to those who can afford private health insurance and associated out-of-pocket costs, with poor access in populations who are most in need.

Rosemary J Korda PhD · Grace Joshy BSc(Mathematics), MSc(Biostatistics), PhD · Louisa R Jorm BVSc, MSc(Epidemiology), PhD · James RG Butler BEcon, MPolEcon, PhD · Emily Banks MB BS(Hons), PhD, FAFPHM

An analysis of administrative data shows rapid increases in both notifications and substantiated cases of maltreatment in the NT Aboriginal population, suggesting a need for further expansion of services to address both immediate safety and the wider determinants of maltreatment.

Steven L Guthridge MB BS, MTH, FAFPHM · Philip Ryan MB BS, FAFPHM · John R Condon PhD, FAFPHM · Leah M Bromfield BAppSci(Psych)(Hons), PhD · John R Moss MSocSci, MB BS, FPHAA · John W Lynch PhD, MPH

Objectives: To assess notification trends for chlamydia and gonorrhoea infections in Indigenous Australians compared with non-Indigenous Australians in 2000–2009.Design and setting: We assessed trends in national notification rates using univariate Poisson regression and summary rate ratios.Main outcome measures: Crude notification rates and summary rate ratios, by Indigenous status, sex, age and area of residence.Results: Over the 10-year ...

Simon Graham BIS, MAppEpi · Rebecca J Guy BAppSc, MAppEpi, PhD · Basil Donovan MB BS, MD · Hamish McManus BEcon, BAcTS, MBIOS · Jiunn-Yih Su MB, MPH · Carol El-Hayek BSc, MEpi · Kellie S H Kwan BA(Hons), GradCertAppEpi · Amalie Dyda BHSc(Hons), MAppEpi · Handan C Wand MA, MSc, PhD · James S Ward BA

A retrospective study of the extent and management of pelvic inflammatory disease in remote-living Aboriginal women reveals that it occurs frequently, but is underdiagnosed and poorly treated.

Bronwyn J Silver BNurs, GradDipMID, MPH · Janet Knox MMed(STD/HIV), DTM · Kirsty S Smith GDipCommNurs, GDipEd, MPH · James S Ward BA · Jacqueline Boyle FRANZCOG, MPH, PhD · Rebecca J Guy BAppSc, MAppEpid, PhD · John Kaldor PhD · Alice R Rumbold BSc(Hons), MPH, PhD

Objectives: To evaluate the outcomes of preconception screening of Jewish Australians for Tay Sachs disease (TSD) carrier status on Jewish TSD-affected births.Design, participants and setting: Epidemiological observational study involving a complete retrospective audit of infantile and intermediate TSD cases diagnosed in Sydney and Melbourne between 1 January 1995 and 31 December 2011 (Royal Children’s Hospital Melbourne; Pacific Laboratory Medicine Services, Pathology North, NSW Health Pathology, Sydney; ...

Raelia M Lew MB BS(Hons) MMed · Anne L Proos MSc, FFSc(RCPA) · Leslie Burnett MB BS, PhD, FRCPA · Martin Delatycki MB BS, FRACP, PhD · Agnes Bankier MB BS, FRACP · Michael J Fietz PhD

In a week when the presidential election was imminent, but Americans were more concerned with Hurricane Sandy and Halloween, an Australian visiting professor in New Orleans shares his observations of life and health in the United States and the ongoing recovery from Hurricane Katrina.

Charles S Guest Visiting Professor

You were only 2 months old. I met you in the children’s intensive care unit one night, almost 3 years ago. Intracranial haemorrhage, they said. What happened? We were trying to keep you alive. You were tiny in that large hospital cot, dwarfed by technology and oversized pyjamas, your bedtime lullaby the hissing of the ventilator and suction machines. We calculated fluid requirements, made your blood pressure and electrolytes look ...

Alison M Snodgrass MB BS, MRCPCH(UK) · Hong Liang Tey MB BS, MRCP(UK)

PETER DOHERTY’s ability to span the gap between the most abstract basic science and the everyday world is once again evident in this, his third popular science paperback. Put it on your Christmas gift list. It will intrigue the nerdiest high school student, stimulate the most militant environmentalist and give pleasure to anyone who has worked in the biological sciences or medicine during the past ...

Yvonne E Cossart

FOR MOST AUSTRALIAN DOCTORS, a child dying from malnutrition, malaria or tuberculosis is something you read about in textbooks, not see in your day-to-day practice. Yet for doctors like Damien Brown, a volunteer with humanitarian organisation Médecins sans Frontières (MSF), it is an all too regular reminder of the impact that conflict, weak governance, and a lack of essential services have on the health of ...

Natalie J Gray

The detention of children seeking asylum is an issue that greatly concerns me as a psychiatrist and a fellow human being. It crosses all ethnic boundaries, so I have chosen the medium of Chinese painting to tell the story. The children are each confined in their own frame but share the same dark background, fringed by the thin blue line representing the sea. A viewer approaching ...

Richard C Wu MB BS, FRANZCP

This piece deals with the social disruption associated with mining and its latest iteration — fracking. I chose to create an image based on a carving by the Yimam people of Papua New Guinea because I found their carving style intriguing, but it could refer to any community group. The figure is constructed of strata representing geology, but also layers of history and community. It ...

Marc Grunseit MB BS

A festive season dietary indiscretion precipitated hospital admission for one patient who was on anticoagulation therapy.

Stephen J Pettit MB BS, PhD, MRCP · Alan G Japp MB ChB, PhD, MRCP · Roy S Gardner MB ChB, MD, MRCP

An analysis of emergency department databases in Australia’s victorious rugby league football state reveals a dip in presentations of State of Origin game days. Do the findings have broader implications for workforce planning, and could a spate of losses have spurned different results?

Jeremy S Furyk MB BS, MPHTM, MSc(CT) · Jenine M Lawlor BPsych, MPsych · Richard Franklin BSc, MSocSci, PhD · Carl J O’Kane BSc(Med), MB BS, MClinEd · David A Kault BSc, MB BS, PhD · Colin J Banks MB BS, FACEM · Peter J Aitken MB BS, EMDM, MClinEd

Christmas may be a state of mind or a memory, to carry with you wherever you are“What is Christmas?” a 3-year-old boy eagerly asked his father. “Christmas, my son, is the time of the year when we celebrate the birth of Jesus Christ”, answered the father with a smile on his face. “But”, he then continued, “we also celebrate how wonderful life is by showing ...

Manda Kaled

In an “informal survey”, anatomical pathologists spill their guts on what irks them most in their day-to-day interactions with clinical colleagues.

Admire Matsika MB ChB · Bhuvana Srinivasan MB BS, MD, FRCPA

A tale of anxiety, innocence and trust in the anaesthetic roomAs I entered the busy paediatric ward, I scanned the room for my patient — they’re often not easy to find among the other children, the visiting parents and siblings, and the staff, and are rarely anywhere near, let alone in, their assigned beds. I was eventually directed to a small child sitting quietly on his ...

Geoffrey C Mullins MB BS, FANZCA, FRCPC

A reflection on surgical life in a public hospitalThe fluorescent tubes in the corridor shine with a watery blue light, casting dappled shadows from the newly hung Christmas decorations. The surgeon opens the door to the operating theatre, but it catches on the tinsel, unsticking it from the ceiling. 8 am. Already the day is in chaos: no breakfast, delayed clinic, unhappy administrators, and now this ...

Rosalind L Jeffree MB BS, MSc

To the Editor: This year, evidence-based medicine celebrated its 20th birthday.1 However, it remains difficult to translate research findings to the bedside,2 and many medical diagnoses and treatments are unable to meet the five levels of clinical evidence currently recognised in the United Kingdom (http://evidence basedmedicine.com.au/?page_id=30). This year, we also learned that what was previously believed to be junk DNA actually does something.3 A plausible translation ...

Peter D Jones

To the Editor: Puzzles, like alcohol consumption, are a time-honoured mode of entertainment used by humankind for having a jolly time. Yet, while most people are well versed in the dangers associated with alcohol misuse, the dark side of brainteasers is underappreciated. Indeed, the hazardous nature of this common and seemingly inconspicuous pastime is gravely misjudged. Allow me to elaborate. Not long ago, when I published ...

Rick Mutsaers

To the Editor: I hoped that looking after cats might reduce my anxiety over retiring. That was until I spotted pouches at the base of the cats’ ears. I had to find out why cats had ear pouches. Texts on veterinary anatomy were not helpful. I found other people had been asking the same question on the internet without much success. Someone had suggested ear pouches ...

Hedley G Peach MB BCh, PhD, FFPHM

Doctors reflect on 2012 and their plans for the New Year

Karen Burge

After a 10-year career with Médecins Sans Frontières (MSF), the closest thing to normal for Dr Tonia Marquardt was working in a remote Aboriginal community and taking to the skies with the Royal Flying Doctor Service (RFDS). Dr Marquardt received the 2012 Rural Registrar of the Year award. Here she shares her winding path to general practice and describes how her mentor, Dr Jane Barry, helped to keep her grounded.

Interviews by Karen

Dr Mitchell Smith took a working holiday overseas and found himself venturing into new medical territory

Amanda Bryan

With Christmas approaching, it’s a good time to think about rewarding your practice staff for their hard work during the year. What is the most effective way to reward them?

Heather Wiseman