Volume 198 Issue 9

With the release of the fifth edition of the Diagnostic and statistical manual of mental disorders, it is timely to consider whether a refinement to traditional diagnostic practice — clinical staging — will improve clinical care and inform future research into the causes of mental disorders.

Ian B Hickie MB BS, MD, FRANZCP · Jan Scott MB BS, MD, FRCPsych · Patrick D McGorry MD, PhD, FRANZCP

Comprehensive suicide risk assessment is usually suggested as a way of determining who, among patients presenting in psychological crisis, should be offered different or more intensive treatment. But is there really a magic combination of risk factors that makes it possible to predict who will suicide?

Christopher J Ryan MB BS, MHL, FRANZCP · Matthew M Large BSc(Med), MB BS, FRANZCP

New guidelines from the National Health and Medical Research Council outline best-practice management for people with borderline personality disorder. With the use of effective evidence-based treatments, the prognosis for this disorder has improved for most patients.

Brin F S Grenyer BA(Hons), MSc, PhD

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

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

United States Surgeons-General wield very little actual power, but the late “Chick” Koop nevertheless drove surprising progress in public health.

Mike Daube BA(Hons), HonDSci

Media reporting about suicide may lead to increased suicidal behaviour in at-risk people, or it may operate positively and reduce the risk of suicide. But media representations of suicide are distinct from community discussions. It is time to have a much richer, more honest and more open public discussion about suicide.

Scott J Fitzpatrick BA(Hons) · Ian H Kerridge BA, MPhil, BMed

Suicide prevention can be improved by implementing effective interventions, optimising public health strategies and prioritising innovationSuicide has overtaken motor vehicle accidents as the leading cause of death among young adults aged 15–44 years in Australia. In 2011, 410 Australians aged 25–34 years took their own lives, with a total of 2273 deaths from suicide reported across all age groups.1 In terms of funding allocations, the Australian Government’s investment in ...

Helen Christensen BA(Hons), MPsych, PhD · Katherine Petrie BSc(Psych)(Hons)

What are the potential health benefits and risks of population social–emotional screening of children as young as 3 years of age, and are there other options for ensuring kids’ social and emotional development?

Michael F Daubney MB BS, FRANZCP · Cate M Cameron PhD, MPH, BSocWork(Hons) · Paul A Scuffham PhD, BA

To the Editor: For several years, the Australian Bureau of Statistics (ABS) has cautioned data users of likely underreporting of suicide statistics due to delays in coronial processes and (since 2006) exclusive reliance on the National Coronial Information System, which often contains incomplete information on cause of death.1 In 2009, the ABS introduced data revision processes that allowed additional information received to be added in ...

Jerneja Sveticic · Samara McPhedran · Diego De Leo

To the Editor: There is significant concern about drinking patterns and alcohol-related harm among young people. A comprehensive approach to preventing harm from alcohol is needed, with population approaches including curbs on alcohol promotion.1 The National Preventative Health Taskforce has recommended phasing out alcohol promotions “from times and placements which have high exposure to young people”.1 Exposure to alcohol advertising influences young people; research consistently shows ...

Hannah L Pierce · Julia M Stafford · Mike Daube

To the Editor: The recent study by Thomas1 documents the change in smoking intensity of Australian Indigenous people between 1994 and 2008. A significant overall reduction in heavy smoking was observed with a corresponding increase in the proportion of light smoking. This is an interesting epidemiological observation but it should not be misinterpreted as a public health achievement or as a desirable goal in itself. As Thomas ...

Colin P Mendelsohn · Gillian S Gould

In reply: Nowhere in my article do I promote reducing the number of cigarettes patients smoke, rather than smoking cessation, as a goal for clinicians. Mendelsohn and Gould have created their own straw man with which to argue. I explain in the third paragraph of the Discussion that the population changes in smoking intensity may have been caused by previously heavy smokers cutting down (with only ...

David P Thomas

To the Editor: Cyclones, floods and bushfires are experienced in Australia every year, and Australia’s management of natural disasters centres on prevention, preparedness, response and recovery.1 Although access to safe food is a basic human need, during the 2010–2011 Queensland floods there was minimal information available to guide household food preparedness and food supply to communities.2 To ensure that Queensland is better prepared for future natural ...

Elizabeth J Good · Amanda J Lee · Fiona L McKenzie Lewis

To the Editor: It is pleasing to see Curtis and colleagues report injury trends and mortality across New South Wales,1 but the data are old and precede major changes to the NSW trauma system. We are concerned that the conclusions of this study will be misapplied by policymakers, leading to unnecessary out-of-area transport of injured patients. The authors concluded that there is a survival benefit when ...

Stuart G Stapleton · Rod O Bishop · James L Mallows

In reply: In our study,1 we allocated the numbers and type of trauma centres according to New South Wales Department of Health terminology and the Royal Australasian College of Surgeons Trauma Verification Committee model resource criteria. The latter reflected the resource availability of 24-hour, 7-day per week specialty services such as plastic surgery, cardiothoracic surgery and neurosurgery at those centres during the study period,2,3 as ...

Kate A Curtis*

In recognition of Palliative Care Week (19–25 May), we are reminded that, “Palliative care is everyone’s business”. It is a timely and relevant slogan.

Ian Maddocks · Yvonne Luxford

A fan of our “Stamps of greatness” series takes the connection between philately and medicine a step further, with an account of a chance moment in history.

Robert M Parker

The 2003 National Heart Foundation of Australia position statement on “stress” and coronary heart disease found depression to be an important risk factor. This consensus statement updates the evidence on depression in patients with coronary heart disease, and provides guidance for health professionals on screening and treatment.

David M Colquhoun MB BS, FRACP, FCSANZ · Stephen J Bunker RN, PhD · David M Clarke PhD, FRACGP, FRANZCP · Nick Glozier MB BS, FRANZCP, PhD · David L Hare DPM, FRACP, FCSANZ · Ian B Hickie MD, FRANZCP, FASSA · James Tatoulis MB BS, MD, FRACS · David R Thompson MA, PhD, FRCN · Geoffrey H Tofler MB BS, MD, FRACP · Alison Wilson MBA · Maree G Branagan MPH

A data-linkage study reveals that, between 1990 and 2005, the prevalence of parents with mental health disorders increased in Western Australia. While factors such as broader service availability may have contributed to this finding, the data highlight high-risk groups that should be a focus for intervention and prevention.

Melissa O’Donnell PhD, MPysch, GradDipEd · Denise Anderson BSc · Vera A Morgan PhD, MSocSc, BA · Natasha Nassar PhD, MPH, BEc · Helen M Leonard MB ChB, MPH · Fiona J Stanley MD, MSc, FAFPHM

Consistent with studies from the United States, this study provides the first strong Australian evidence that areas of low socioeconomic status have a higher density of tobacco retail outlets. The findings have broad public health implications and raise the question of whether we should move to regulate the number of outlets licensed to sell tobacco products.

Lisa J Wood BCom, GradDipHlthProm, PhD, · Gavin Pereira PhD · Nick Middleton BSc(Hons) · Sarah Foster BSc, MPH, PhD

A cross-sectional survey of Tasmanian students aged 8–13 years finds that mandatory iodine fortification of bread appears to have achieved the goal of significantly improving iodine status in this population. However, further research is needed to assess the effects of mandatory fortification in pregnant and breastfeeding women.

Kate M DePaoli BSc(Hons)(Diet) · Judy A Seal BAppSci, GradDipDiet, MPH · John R Burgess FRACP, MD, PhD · Roscoe Taylor MB BS, FAFPHM, GradDipEpid

What doctors should know about do-it-yourself mail-order genetic tests

Ronald J Trent FRACP, FRCPA, FTSE

What policy measures are actually needed and appropriate?

Timothy Caulfield LLM, FRSC, FCAHS · Pascal Borry PhD

Will Australia’s current regulatory framework protect consumers?

Dianne Nicol PhD(Biology), LLM · Meredith Hagger LLB(Hons)

Alarge military truck slowly rolls up to the small emergency unit in Mullaitivu, a remote town on the north-eastern coast of Sri Lanka. In the back of the truck are two bodies. A young man and woman still entwined. Tied to each other with muddied strips of saree cotton, once vibrant and colourful. A double suicide pact outlined in a simple letter in the hands ...

Ruth Y Lim MB BS

Someone once told me that during his life, Winston Churchill would often refer to his depression as a “black dog” — a vile, loathsome creature that would shadow every decision and thought in his mind. But to me, it was not just a dog, but something more sinister and predatory. The beast followed me in the same way that a lapdog would follow its master, though ...

Anonymous

A 72-year-old woman with type 2 diabetes mellitus presented with sudden-onset back pain, fever, rigors and suprapubic tenderness. An abdominal x-ray and pelvic computed tomography scan (Figure) confirmed the diagnosis of emphysematous cystitis. Klebsiella pneumoniae was cultured from blood and urine samples, and the patient was treated with intravenous cephazolin followed by oral cephalexin. She had a complete recovery. Emphysematous cystitis is an uncommon but severe infection ...

Mohammad Bagherirad · Hasan Al-Khayyat

Damien Jolley was born in Melbourne on 23 March 1954. He graduated from the University of Melbourne in 1976 with a combined Bachelor of Science (Honours) and Diploma of Education. After a short period teaching mathematics, he moved to Papua New Guinea with Australian Volunteers International and began his epidemiological studies. Five years later, he returned to Melbourne and completed a Master of Science in statistics while ...

Judy A Lowthian · John J McNeil

THIS BOOK is by a doctor with an abiding interest in the philosophy of medicine. Paul Biegler is an Australian Research Council Postdoctoral Fellow at the Centre for Human Bioethics, Monash University, and a recipient of the 2011 Australian Museum Eureka Prize for Research in Ethics.The book describes the therapeutic use of antidepressant medication (ADM) versus cognitive behaviour therapy (CBT), and concludes that it is unethical ...

Kay A Wilhelm

WHEN ONCE ASKED about the qualities of a good clinician, I replied that, as well as a fundamental interest in the human condition and the skills to fully appreciate the meaning of people’s stories, good clinicians should be good storytellers themselves. Why good storytellers? History-taking requires much more than a few words jotted down or typed out — it needs compassion and understanding, informed by ...

John D G Watson

What to look out for when setting your fees

Annabel McGilvray

Pay a visit to Google and type in the words “Prof Montage”. What you will find is a quirky, effective learning resource suitable for everyone from first-year medical students to interns, residents and fellows. It’s all the creation of an Australian cardiologist on a mission to make learning practical and fun.

Cate Swannell