Volume 203 Issue 7

The BMJ questions e-cigarettes endorsement The BMJ has questioned the decision by Public Health England — (mission statement: “We protect and improve the nation’s health and wellbeing, and reduce health inequalities”) — to endorse the use of e-cigarettes as an aid to quitting smoking. In a report released at the end of August PHE concluded that e-cigs were “95% less harmful” than conventional cigarettes and described them as a potential “game changer” in tobacco control. In The BMJ Professor Martin McKee and Professor Simon Capewell said the available evidence, including a recent Cochrane review, did not show clearly that e-cigs were as effective as established quitting aids. “We might also expect that the prominently featured ‘95% less harmful’ figure was based on a detailed review of evidence, supplemented by modelling”, wrote McKee and Capewell. “In fact, it comes from a single [sponsored] meeting of 12 people.” The sponsors included a CEO with previous funding from British American Tobacco. One of the 12 was a chief scientific advisor with declared funding from an e-cigarette manufacturer, and Philip Morris International. “None of these links or limitations are discussed in the PHE report”, McKee and Capewell wrote. Dramatic rise in antibiotic use globally Nature reports that “antibiotic use is growing steadily worldwide, driven mainly by rising demand in low- and middle-income countries”, citing the latest report from the Center for Disease Dynamics, Economics and Policy. The organisation used a review of data from scientific literature, and national and regional surveillance systems to calculate and map the rate of antibiotic resistance for 12 types of bacteria in 39 countries, and trends in antibiotic use in 69 countries over the past 10 years or longer. “Global antibiotic consumption grew by 30% between 2000 and 2010. This growth is driven mostly by countries such as South Africa and India, where antibiotics are widely available over the counter and sanitation in some areas is poor.” The report also found that the use of antibiotics in livestock is growing worldwide, particularly in China, which used about 15 000 tonnes of antibiotics for this purpose in 2010, and is projected to double its consumption by 2030. Child mortality under six million for first time A new World Health Organization report says deaths among children aged 5 years and under worldwide have more than halved over the last 25 years, falling from 12.7 million a year in 1990 to 5.9 million in 2015. “While progress has been substantial, a 53% drop in child mortality is far short of the Millennium Development Goal, where countries agreed to reduce child mortality between 1990 and 2015 by two-thirds.” Around 16 000 children under 5 still die every day, most from diseases that are readily preventable or treatable, says the report. Around 50% of global deaths among the under 5s occur in sub-Saharan Africa, while 30% occur in southern Asia. Approximately 45% of deaths among the under 5s occur in the first 28 days of life. One million infants die on the day they are born, and nearly 2 million during the first week following birth. Leading causes of death in this group include complications during labour, premature birth, pneumonia, sepsis, diarrhea and malaria. Most of the remaining deaths among the under 5s are tied to undernutrition. Static electricity next frontline in malaria control Dutch researchers have come up with a way of improving the efficacy of mosquito nets using static electricity, according to a report in The Economist. With the WHO reporting a 60% drop in deaths caused by malaria since 2000, In2Care, a Dutch mosquito-control firm, is finding a way to deliver insecticides embedded in mosquito nets more effectively to the target insect. “Current mosquito nets are woven from fibres impregnated throughout with an insecticide”, The Economist reports. “This permits them to be washed and used for years without loss of potency. But it also means this potency is not as great as it could be, because the insecticide is released only slowly by the fibres. Using static electricity, by contrast, means all of the insecticide is held on the surface of a net’s fibres. Much larger doses can thus be transferred to an insect which blunders into the net. In addition, a wide range of insecticides — and even, possibly, the spores of a fungus harmless to people but lethal to mosquitoes — can be applied to the fibres.”

Cate Swannell

Making sense of the burgeoning evidence included in multiple systematic reviews has become an exercise in itself

Steve McDonald · Tari Turner

Do we need to change the way body-contact sports are played and administered?

John W Orchard MD, PhD, FACSP

In these challenging times, research funding is seen as an investment, and funders expect demonstrable returns in both monetary and societal terms

Claire L Jackson MD, MPH, FRACGP · Trisha Greenhalgh MD

Clinicians using teledermatology services must familiarise themselves with the relevant guidelines, hospital policies and privacy legislation

Anna R Finnane PhD · Greg Siller MB BS, FACD · H Peter Soyer MD

It is possible that the use of skin-lightening creams is becoming more common in Australia with increasing migrant populations

Angela Shiao Ting Lee BSc(Med) MB BS · Nimalie J Perera MB BS(Hons), FRACP, FRCPA · Elizabeth L Chua MB BS, FRACP, PhD

geographical differences in population-adjusted sports injury hospital admissions rates … have persisted over time

Anna Wong Shee BSc(Hons), BAppSci (Phty), PhD · Angela Clapperton BSc, GradDip(EdPsych), MC · Caroline F Finch PhD, ASTAT, FASMF

A range of options are now available for the effective management of type 1 diabetes in different contexts

Mervyn Kyi MB BS(Hons), BMedSci · John M Wentworth MB BS, PhD, FRACP · Alison J Nankervis MB BS, MD, FRACP · Spiros Fourlanos MB BS, PhD, FRACP · Peter G Colman MB BS, MD, FRACP

There is a strong rationale for precautionary measures based on the health and environmental risks identified in the scientific literature

Madelon L Finkel PhD · Jake Hays MA · Adam Law MD, FRCP

Targeted outreach service strategies should account for career stage and practice conditions to help sustain access

Belinda G O’Sullivan BPhysio(Hons), MPH(Hons), GradDipAppEpi · Johannes U Stoelwinder MB BS, MD, FRACMA · Matthew R McGrail BSc(Hons), GradDipIT, PhD

There is room for improvement in the use of transdermal opioid patches in aged care residents

Svetla Gadzhanova PhD, MSc · Elizabeth E Roughead BPharm, MAppSc, PhD · Lisa G Pont PhD, BPharm, BSc

Codeine-related deaths (are increasing as the consumption of codeine-based products increases

Amanda Roxburgh BA(Psych)(Hons), MCrim, MPsychol(Clin) · Wayne D Hall PhD, BSc · Lucinda Burns PhD, MPH, GradDipHPol · Jennifer Pilgrim PhD, BSc(Hons) · Eva Saar PhD(Med), BPharm · Suzanne Nielsen PhD, BPharm, BPharmSc(Hons) · Louisa Degenhardt PhD, MPsych(Clin)

Early surgical intervention can salvage vision in endogenous K. pneumoniae endophthalmitis

Phoebe P Moore BMed, MMed · Gerard F McGowan MB ChB, FRCOphth · Sukhpal S Sandhu MD, FRANZCO · Penelope J Allen MB BS, FRANZCO

This case report provides evidence that the mechanism of pulmonary oedema resulting from funnel-web spider envenoming is cardiogenic

Geoffrey K Isbister MB BS, FACEM, MD · Kate V Sellors BMed, FACEM, GradCertClinToxicol · Ursula Beckmann MD, FRACP, FJFICM · Angela L Chiew BSc(Med), MB BS · Michael A Downes FACEM · Ingrid Berling BMed, FACEM

Does anybody remember that 1999 was the International Year of Older Persons?

John B Best AO, MD BS, PhD, DSc(Hon)

Hear it trickle

Michael J Leach

While living temporarily in Australia, American hand surgeon Dr Mohana Amirtharajah is making the most of her sabbatical from her US practice, volunteering with Médicins Sans Frontières in Jordan and Haiti

Cate Swannell

Six of the University of Melbourne’s leading medical researchers will take their work to the global stage, sharing in $3 million National Health and Medical Research Council funding. The UM researchers will collaborate with leading European and Californian scientists on prolific health problems including heart disease, stroke and breast cancer, and to learning more about lung health, child health, ageing and stem cells. The recipients are Professor Richard Sinnott, Department of Computing and Information Systems in the Melbourne School of Engineering, for work on genomics-based strategies for improved diagnosis and treatment of endocrine hypertension ($461 322); Professor Melissa Southey, Department of Pathology, for breast cancer risk after diagnostic gene sequencing ($471 281); Professor Shyamali Dharmage, Melbourne School of Population and Global Health, for ageing lungs in European cohorts ($470 342); Associate Professor Sharon Goldfeld, at the Murdoch Children’s Research Institute, for models of child health appraised ($321 054); Professor Graham Giles (Honorary), based at the Cancer Council Victoria, for LIFEPATH: life-course biological pathways underlying social differences in healthy ageing ($470 466); Professor Andrew Elefanty (Honorary), based at the Murdoch Children’s Research Institute, for a suite of engineered human pluripotent stem cell lines to facilitate the generation of haematopoietic stem cells ($881 221). http://newsroom.melbourne.edu/news/researchers-share-3-million-international-medical-collaborations Professor Jenny Martin from the University of Queensland’s Institute for Molecular Bioscience is a finalist for a Pride of Australia Medal in the Inspiration category. Across 10 categories, the medals recognise individuals who have made Australia a better place. As a member of the National Health and Medical Research Council Women in Health Sciences, Professor Martin has campaigned for gender equity on peer review panels for funding options and proposed part-time options. Professor Martin has received numerous awards and is a founding member of the Australian Academy of Science’s Science in Australia Gender Equity Forum steering committee. https://www.uq.edu.au/news/article/2015/09/tireless-science-campaigner-line-medal Three James Cook University alumni have been given Chancellor’s Outstanding Alumnus awards. Professor Marc Shaw has made an outstanding contribution to tropical and geographical medicine in Australia and New Zealand, and also internationally through his research and workforce development. After working as a general practitioner in New Zealand for 15 years, he then became New Zealand’s first full-time travel medicine practitioner. Currently, he is Medical Director of Worldwise Travellers’ Health Centres in New Zealand, providing pre- and post-travel advice to travellers, while advising Australasian health professionals on current travel health information. Dr Suman Majumdar is an infectious diseases specialist, and senior fellow at the Burnet Institute in Melbourne. Dr Majumdar has conducted health programs in Myanmar, Papua New Guinea, Timor-Leste, China, India, Mexico, Swaziland and regions of the former Soviet Union, including work with Médecins Sans Frontières. Dr Dylan Morris is a resident medical officer at the Townsville Hospital and a Clinical Research Associate at the Queensland Research Centre for Peripheral Vascular Disease at James Cook University. He works as a full-time medical practitioner, and also contributes to ongoing clinical research on vascular disease. Dr Morris’s main research interests are in peripheral vascular disease, identifying ways to improve the prevention and management of cardiovascular disease. http://www-public.jcu.edu.au/news/JCU_149542 Bond University has established a Tactical Research Unit “to investigate ways to enhance the health and performance of tactical personnel in military, law enforcement, fire-fighting and first responder organisations”. Dr Rob Orr and Dr Rod Pope will lead the team of researchers, building upon their extensive knowledge of collaborative research, practice and military service. In addition to a wide range of ongoing research programs, the unit has a number of new projects in the pipeline including looking at the differences between full-time military personnel and part-time reservists, using metabolic and musculoskeletal fitness as a predictor of injury during police academy training, and investigating the impact of structural fires on hydration in fire-fighters. https://bond.edu.au/news/47128/tactical-research-unit-front-line-research Two University of Sydney professors have been awarded grants totaling more than 4.5 million dollars to further their research into type 1 diabetes, a chronic disease affecting more than 120 000 Australians. The grants were awarded to Professor Philip O’Connell, Director of the Centre for Transplant and Renal Research at the Westmead Millennium Institute and Director of Transplant Medicine and the Clinical Islet Transplant Program at Westmead Hospital; and Professor Alicia Jenkins, Professor of Diabetes and Vascular Medicine at the University of Sydney. Professor O’Connell’s research focuses on human islet transplantation which takes healthy insulin-producing islet cells from a donor pancreas and infuses them into the liver of a patient with type 1 diabetes. Professor Jenkins’s research concentrates on preventing vision loss in type 1 diabetes patients, as damage to the back of the eye is a common complication of the disease, and can lead to blindness. http://sydney.edu.au/news-opinion/news/2015/09/10/university-of-sydney-researchers-awarded-top-grants-for-type-1-d.html

Cate Swannell

This calendar includes conferences based in Australia into the foreseeable future, as far as can be confirmed. If you have an event you would like to add, please include relevant details in an email to cswannell@mja.com.au ALM = active learning module ASM = annual scientific meeting CPD = continuing professional development CT = computed tomography ECHO/echo = echocardiography EMAC = effective management of anaesthetic crises MRI = magnetic resonance imaging OSCE = objective structured clinical examination SAT SET = supervisors and trainers for surgical education and training October 2015 15-18 Societe Internationale d’Urologie Annual Congress, Melbourne, VIC 16 Australasian College of Sports Physicians GP Symposium 2015, Melbourne, VIC 16-18 Society of Obstetric Medicine of Australia and New Zealand ASM 2015, Melbourne, VIC 16-19 RANZCOG ASM, Perth, WA 16-19 Australian Society of Cytology 45th ASM, Brisbane, QLD 17 Women’s Health Matters: Challenges and Changes in 2015, Melbourne, VIC 18-21 HAA 2015 ASM, Adelaide, SA 20-23 Australian and New Zealand Burns Association 39th ASM, Melbourne, VIC 22-23 MIIAA Annual Forum, Sydney NSW 22-24 Rural Medicine Australia 2015, Adelaide, SA 22-24 Australasian Marcé Society for Perinatal Mental Health 2015 Conference, Adelaide, SA 22-25 Australasian Doctors Health Conference 2015, Melbourne, VIC 23-25 36th Annual Meeting, Australasian Dermatopathology Society, Sydney, NSW 24 2015 Joint Airway and Obstetric Anaesthesia Special Interest Group Meeting: The obstetric airway, a game of two halves, Melbourne, VIC 26-27 Safe and Secure Hospitals Conference, Melbourne, VIC 26-27 13th Australasian Biospecimens Network Association Annual Conference, Sydney, NSW 26-27 Future of Health Policy Reform Forum, Sydney, NSW 26-28 7th Australian Rural and Remote Mental Health Symposium, Creswick, VIC 28-30 ACHS/ACHSM Joint Asia-Pacific Congress 2015: Health leadership: odds-on favourite, Melbourne, VIC 29-31 2nd Global Advances and Controversies in Skin Cancer 2015, Brisbane, QLD 29 Oct-1 Nov6 6th ASM Royal Australian and New Zealand College of Radiologists, Adelaide, SA November 2015 1-4 3rd International Conference on Circular Proteins ICCP2015, Brisbane, QLD 2-4 National Primary Health Care Conference, Canberra, ACT 6-7 RANZCP Section of Neuropsychiatry Conference, Melbourne, VIC 6-7 ASBDD Conference, Sydney, NSW 9-13 13th Congress of the World Federation of Interventional and Therapeutic Neuroradiology, Gold Coast, QLD 11-13 Hospital in the Home 8th Annual Scientific Meeting 2015: HITH at 21: Maturity, Responsibility and Quality, Sydney, NSW 13-14 Interdisciplinary Cerebrovascular Symposium, Gold Coast, QLD 14-15 11th National Laser and Cosmetic Medicine Conference, Gold Coast, QLD 16-18 Improving Healthcare International Convention, Melbourne, VIC 17-18 Second National Complex Needs Conference, Canberra, ACT 17-19 Clinical Oncology Society of Australia 42nd ASM, Hobart, TAS 18-20 International Conference on Neurology and Epidemiology, Gold Coast, QLD 19-21 Paediatric Pathology Society and ANZ Paediatric Pathology Group Joint Scientific Meeting, Perth, WA 19-21 Mercy Global Obstetric Update, Melbourne, VIC 20-22 RANZCP Section of Psychotherapy Conference, Sunshine Coast, QLD 21 2015 Sydney Colorectal Surgical Meeting, Sydney, NSW 22 National Fertility Conference Medical Update 2015, Melbourne, VIC 22-26 Australasian College for Emergency Medicine, 32nd ASM, Brisbane, QLD 23-24 Defence Human Sciences Symposium 2015, Melbourne, VIC 24-25 2015 Advance Care Planning and End of Life Care National Conference, Melbourne, VIC 25-26 AOPA Congress 2015: Enhancing quality and performance, Adelaide, SA 25-28 RANZCP Faculty of Forensic Psychiatry Joint Conference with the Australian and New Zealand Association of Psychology, Psychiatry and Law 35th Annual Congress, Canberra, ACT 26-28 RANZCP Faculty of Psychiatry of Old Age and APS Psychology and Ageing Special Interest Group Joint Conference, Adelaide, SA 27-29 International Society for the Study of Trauma and Dissociation 1st ANZ Regional Conference: Broken structures, broken selves: complex trauma in the 21st century, Sydney, NSW December 2015 1-41 4th International Scientific Conference of the Asia Pacific Association of Medical Toxicology, Perth, WA 3-5 Inaugural International Adolescent and Young Adult Oncology Congress, Sydney, NSW 7-8 Livin’ It: Let’s Work With It: People, Employment and Mental Health, Sydney, NSW 7-9 9th Health Services and Policy Research Conference, Melbourne, VIC 9-11 3rd International Conference on UV and Skin Cancer Prevention, Melbourne, VIC 14-16 International Conference on Signal Processing and Communication Systems, Cairns, QLD February 2016 5-6 3rd International Four Corners of Cardiology Meeting, Melbourne, VIC 26-27 Obstetric Intensive Care Symposium, Adelaide, SA 26-28 Pathology Update: A diamond date, Melbourne, VIC March 2016 1 Mar Asian Australasian Society for Stereotactic and Functional Neurosurgery Meeting, Cairns, QLD 3-4 Evidence Review in Emergency Medicine FSM, Wollongong, NSW 3-5 AGES XXVI Annual Scientific Meeting 2016, Brisbane, QLD 11 5th International Medical Symposium: Future challenges for the medical profession, Sydney, NSW 11-13 2016 ANZSNR Meeting, Hunter Valley, NSW 13-16 Australian Pain Society 36th Annual Scientific Meeting: Pain: Meeting the Challenge, Perth, WA 14-17 Trans Tasman Radiation Oncology Group 28th ASM, Brisbane, QLD 19-23 Ottawa and ANZAHPE 2016 Conference, Perth, WA 29 Mar-1 Apr Asia Pacific Orthopaedic Association Congress 2016, Melbourne, VIC April 2016 1-6 Thoracic Society of Australia and New Zealand ASM 2016, Perth, WA 13-16 General Assembly and International Conference on Asian Pacific Organisation of Cancer Prevention, Brisbane, QLD 30 Apr-4 May ANZCA 2016 Annual Scientific Meeting, Auckland, NZ May 2016 14-19 49th Australasian College of Dermatologists ASM, Perth, WA 16-18 Royal Australasian College of Physicians Annual Congress, Adelaide, SA 19-20 ACEM Queensland Autumn Symposium, Brisbane, QLD June 2016 1-3 Australian and New Zealand Society of Geriatric Medicine (ANZSGM) Annual Scientific Meeting 2016, Cairns, QLD 17-18 Emergency South Australia FSM, Adelaide, SA July 2016 1-2 Emergency South Australia (EMSA), Adelaide, SA 21-23 International Conference on Pediatric Dermatology, Brisbane, QLD August 2016 12-14 Emergency Tasmania 2016, Launceston, TAS 21-26 International Congress of Immunology, Melbourne, VIC 26-27 2016 Australian Diabetes in Pregnancy Society ASM, Gold Coast, QLD 26-28 2016 ACD/ASDR/JDA/JSID/NZDSi Combined Meeting, Noosa, QLD September 2016 18-22 International Congress of Tropical Medicine and Malaria, Brisbane, QLD 20 Polio Australia’s 2016 Australasia-Pacific Post-Polio Conference, Sydney, NSW October 2016 16-19 RANZCOG ASM, Perth, WA 21-23 RACS Victorian Annual Surgical Meeting, Melbourne, VIC November 2016 19-23 48th RANZCO Annual Scientific Congress, Melbourne, VIC 20-24 Australasian College of Emergency Medicine ASM, Queenstown, NZ

Cate Swannell