Volume 199 Issue 7

New president of the World Organization of Family Doctors, Australian professor Michael Kidd AM, recently spoke about leading the response to the health and wellbeing needs of communities around the world.

Michael R Kidd AM, MD, FRACGP

The importance of gut microflora in human health and immunity is just beginning to be realised.

Nicholas J Talley MB BS(Hons), MD, PhD · Marjorie M Walker BMedSci, BM BS, FRCPath

We need to develop a process for assessing the social value of health care interventions, and to subsidise those services that provide more value relative to the societal willingness to pay.

Jane P Hall PhD, FASSA

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 needs to ensure that it can implement a health warnings scheme for wine and spirit containers that reflects the best available evidence.

Paula L O’Brien BA/LLB(Hons), LLM · Deborah H Gleeson BHSc, MPH, PhD

In the wake of recent huge changes to the media workforce, the health professions should take an active interest in ongoing debates about the goals and values of journalism.

Christopher F C Jordens BA(Hons), MPH, PhD · Wendy L Lipworth MB BS, PhD · Ian H Kerridge MPhil, FRACP, FRCPA

Airway surgery represents an important part of contemporary treatment paradigms in adult obstructive sleep apnoeaSurgery in adult obstructive sleep apnoea (OSA) is an option used when continuous positive airway pressure (CPAP) therapy, the gold standard treatment, fails. CPAP failure usually occurs because of poor adherence or significant complications from CPAP or related devices such as a mandibular advancement splint. The best available evidence indicates that ...

Stuart G MacKay BSc, MB BS(Hons), FRACS · Edward M Weaver MD, MPH

MERS-CoV has reached nine countries, and the risk to Australian Hajj pilgrims should not be underestimated.

Harunor Rashid · Osamah Barasheed · Robert Booy

More than half of female Australian GPs experience sexual harassment from patients, while less than 7% report ever receiving training on this issue.

Peter A Bratuskins · Heather A McGarry · Stephen J Wilkinson

To the Editor: We agree with Selvey and Carey1 that minimising the environmental impact of the food supply chain is vital. However, we disagree with recommendations that target some food categories. Variation in environmental footprint within a food category can be more important than the variation between categories.2 Research on environmental modelling systems needs to address complex trade-offs between factors such as carbon emissions, water, land ...

Manny Noakes · Bradley G Ridoutt · Gilly Hendrie · Brian A Keating

To the Editor: We agree that nutritious food choices should also be sustainable, but Selvey and Carey’s portrayal of seafood production1 is incorrect. The 2012 assessment of Australia’s fisheries found that only two of the 111 fish stocks classified (1.8%) were overfished, rather than the 40% claimed by Selvey and Carey, and one of these (bluefin tuna) is rebuilding rapidly.2 Assuming 15 million Australians eat two 100 g portions of seafood every week, our annual seafood requirements are 156 000 tonnes from the 241 100 tonnes of current sustainable fishing and aquaculture production. Globally, current fishing pressure is sustainable in 70% of world fish stocks.3 Demonising seafood based on discredited science claiming the world will run out of fish by 20484 does not help in making nutritious food choices. All food production has an environmental impact. We and others have applied the life-cycle analysis methods advocated by Selvey and Carey to several seafood industries. The amount of carbon dioxide produced by fisheries is lower than that from chicken, pork or beef production.5 Wild fisheries use little water and no fertilisers, pesticides or antibiotics,5,6 which makes seafood a healthy and sustainable choice for people and the environment.

Bridget S Green · Anna K Farmery · Colin D Buxton

To the Editor: We agree that nutritious food choices should also be sustainable, but Selvey and Carey’s portrayal of seafood production1 is incorrect. The 2012 assessment of Australia’s fisheries found that only two of the 111 fish stocks classified (1.8%) were overfished, rather than the 40% claimed by Selvey and Carey, and one of these (bluefin tuna) is rebuilding rapidly.2 Assuming 15 million Australians eat two 100 g portions ...

Caleb Gardner

To the Editor: Selvey and Carey infer that the consumption of imported seafood by Australian consumers is evidence that Australian seafood production is unsustainable.1 However, trade in canned and frozen seafood is extensive because these products are stable and because of the comparative advantage of production between countries. The same process results in Australia’s reliance on imported electronics, clothes and cars — it does not ...

Alexandra McManus

To the Editor: Selvey and Carey1 cite an article by Srinivasan and colleagues2 to support their claim that “Forty per cent of Australia’s managed fish stocks have been deemed overfished”. However, the data in that article were misquoted from the Australian Government’s Fishery status reports 2006, which actually stated that 14 of the 97 fish stocks reviewed were overfished3 — 14%, not 40%. More recent evidence from ...

Linda A Selvey

To the Editor: The two contributions by Gray and colleagues1 and Loblay and colleagues2 on the topic of salicylate intolerance illustrate that absence of evidence does not equate to evidence of absence.3 Neither paper quotes the admittedly sparse European peer-reviewed literature on the topic, including an understanding of the basic biochemistry,4,5 a diagnostic test, and clinical prevalence studies of intolerance to dietary salicylate.5-7 A wealth ...

Richard F Heller · C Ann Heller · Jane Heller

To the Editor: I am concerned that the recent articles on salicylate diets in the Journal1,2 may be seen as a current position statement on the usefulness of a low-chemical elimination diet. An elderly psychiatrist colleague said in 1976, “In 20 years time many parents will not be giving their children red cordial but scientists will still be discussing the issue!” The discussion continues, not because ...

Joan C Breakey

In reply: We are pleased that our publication has generated discussion regarding the benefits of low salicylate diets. However, the correspondence and references from Heller and colleagues and Breakey do not provide any further evidence for the use of such diets and simply reaffirm the lack of good-quality data in this area. Until such data are available, the use of salicylate elimination diets remains an ...

Paul E A Gray*

To the Editor: Despite concerns about suspected reductions in general practitioner visits for Australian children,1,2 there has been a lack of research to investigate trends in GP visits over the past decade. We explored trends in GP visits using linked data between the Medicare Benefits Schedule (MBS) database and the consecutive biannual survey (2004–2010) of two cohorts — the infant cohort (aged 0–1 years in 2004) and ...

Lixin Ou · Jack Chen · Kenneth Hillman

Serotype 15A’s abrupt appearance in the Victorian population, along with its high-level antimicrobial resistance and increased mortality rate show the importance of continued enhanced surveillance of invasive pneumococcal disease.

Janet E Strachan · Stacey L Rowe · Eileen M Dunne · Geoffrey G Hogg

To the Editor: The National Human Papillomavirus Vaccination (HPV) Program Register was established in June 2008 as Australia’s first national adult vaccination register.1 School-based HPV vaccination is now in its 7th year, and from February 2013 includes boys. States and territories report information about HPV vaccination at schools to the Register. This information is used to prepare coverage reports for program management, to provide completion statements to ...

Julia M L Brotherton · Michael Batchelor · Karen Winch

New South Wales prisons data add to previous findings which show that Indigenous and non-Indigenous Australians achieve similar hepatitis C treatment outcomes.

Jeffrey J Post · Andrew R Lloyd · Denise Monkley

To the Editor: Leptospirosis in Victoria can be acquired locally or overseas. The clinical manifestations range from asymptomatic disease to multiorgan failure. We performed a retrospective case review of 147 notifications of leptospirosis to the Victorian Department of Health during the period 2002–2012. We aimed to investigate the epidemiology, clinical features and outcomes of leptospirosis in this population and identify any differences between patients who acquired ...

Jason A Trubiano · Brett A Sutton · Lucinda J Franklin

The tragic death of a child from complications of severe atopic dermatitis represents an extreme outcome of parental neglect due to alternative health beliefs and fear of using topical corticosteroids.

Saxon D Smith MB ChB, MHL, FACD · Amanda M Stephens BA, MB BS, PhD · Julia C Werren BA, LLB, MHlthMedLaw · Gayle O Fischer MB BS, MD, FACD

Does the current evidence-based medicine model for assessing the clinical and cost-effectiveness of personalised therapies need revision?

Jan R R Lewis BPharm(Hons) · Wendy L Lipworth MB BS, MSc, PhD · Ian H Kerridge MPhil, FRACP, FRCPA · Richard O Day MD, FRACP

Out-of-pocket expenses account for almost a quarter of the total health care costs in Australia, with older households spending slightly more than younger households despite the older households having significantly lower income and more access to health care cards.

Farhat Yusuf BSc(Hons), MA, PhD · Stephen R Leeder MD, PhD, FRACP

In Victoria, a high proportion of medical certificates recommend complete absence from work, particularly for patients with mental health conditions. These trends present major challenges in terms of return to work and issues such as viability of the compensation system, and are important given the growing evidence on the health benefits of work.

Alex Collie BA, BAppSc(Hons), PhD · Rasa Ruseckaite BSc, MSc, PhD · Bianca Brijnath BA(Hons), PhD · Agnieszka A Kosny BA, MA, PhD · Danielle Mazza MD, FRACGP

GPs disclose a range of factors influencing why they might follow or disregard guidelines recommending the use of absolute risk assessment.

Carissa Bonner MPH · Jesse Jansen PhD · Shannon McKinn MIPH · Les Irwig MB BS, PhD · Jenny Doust MB BS, PhD · Paul Glasziou MB BS, PhD · Andrew Hayen PhD · Kirsten McCaffery PhD

A simple design modification to standard wheelie bins could prevent serious and painful hand injuries in older people.

Rui Niu MB BS · Adam B Woodbridge MB BS · Belinda J Smith BAppSc · Stephen J Ruff MB BS, FRACS · Richard D Lawson MB BS, FRACS

This uncommon complication of upper neck inflammation in an eight-year-old child is the first reported case in Australia and only the second report worldwide.

Anna J Wood BCom, BA, MB BS · Davinder Singh-Grewal MB BS, FRACP, PhD · Sukanya De MB BS, FRACP · Hasantha Gunasekera MB BS, FRACP, PhD

We report a case of khat-associated hepatitis in a 32-year-old Somali man living in Australia. This is the first case of hepatoxicity related to khat ingestion reported in Australia.Clinical recordA 32-year-old Somali man with no prior medical history presented to the emergency department with a 1-week history of dark urine, pruritus and jaundice, on a background of a month of malaise and reduced appetite. He ...

Malcolm P Forbes MB BS · Ashok S Raj MB ChB, FRACP · Jennifer Martin MB ChB, FRACP, PhD · Guy Lampe MB BS, FRCPA · Elizabeth E Powell FRACP, FRCP, PhD

Manipulation of climate settings on a planetary scale is increasingly proposed as a safety valve in the event of runaway climate change. Understanding the potential effects on human health is urgent and necessary.

Costa S Boyages BArts(Hons), LLB

Before I migrated to Australia, I had my darkest years working in a community mental health service, in a deprived area in the north-west of England. Our senior psychiatrist was a sociopathic bully from the mean streets of inner Belfast and he must have survived by trying to be one of the tough kids. He was rumoured to have once headbutted an aggressive patient in ...

Sandra F Armstrong

I can’t remember when my brother and I decided to kill you, small fish with no school, bright and happy at the bottom slipping through the gate of your fake castle. I think it was winter. A part of us aware of the death outside, the leaves being burned up and the squirrels starving inside the oaks, the sky knocking its clouds into the ashtray of the city. And it might have been me who ...

Matthew Dickman

John Pickering was born on 16 April 1938 in Egypt and graduated in medicine from the University of Sheffield, England, in 1961.In 1964, he came to Australia to work as a resident medical officer at Wimmera Base Hospital in Horsham, Victoria. The following year, he moved to nearby Dimboola, working in general practice with the revered Alister Hinchley.John moved to New South Wales in 1970, working as ...

Alan M Wolff

Into a fourth edition — and my, how it’s grown! Having started life in 1998 at a portable (but hardly pocket-sized) 500 pages, it is now a hefty 1200. Most of the growth comes from the doubling in size of the chapters, with a few entirely new sections for this edition, most notably some cautionary tales about emerging biotechnologies. Sexuality and reproduction has received much greater attention, ...

Peter W Saul

Australia’s medical apprenticeship system is undergoing dramatic growing pains and more is being demanded from our clinical teachers, trainers and supervisors than ever before.

Annabel McGilvray

The field of remote medicine will be the focus when the second World Extreme Medicine Conference and Expo convenes at Harvard Medical School in Boston at the end of this month.

Cate Swannell

Professor Gail Risbridger has a particular skill, and she worked out early how best to apply it in a field of research that is at a very exciting stage ­— prostate cancer

Cate Swannell

Med J Aust 2013; 199 (7 Suppl).