Volume 208 Issue 7

High quality care depends on addressing the social and environmental determinants of health and disease

David Pencheon

Australia is set to join a global initiative to track progress on health and climate change

Ying Zhang · Paul J Beggs

Understanding the risk factors for Buruli ulcer is key to developing a health care intervention

Daniel P O'Brien · Eugene Athan · Kim Blasdell · Paul De Barro

About 80-90% of patients with Buruli ulcer acquired in Far North Queensland present with an ulcer

Michael J Loftus · Nicola Kettleton-Butler · Denton Wade · R Michael Whitby · Paul DR Johnson

Building a medical workforce that understands the impact of climate change on health and health services and will create change

Diana L Madden · Michelle McLean · Graeme L Horton

Adverse event-free care or complaint-free care does not necessarily mean harm-free care for our patients

Rosemary Aldrich

Textbook of global health, 4th edition

Mieke L van Driel

1. rubor (“redness”, cf. fervour, liquor, raptor)

Ian Gibbins

A planetary health approach in medical practice necessitates a focus on the health and wellbeing of future generations

Anthony G Capon · Nicholas J Talley AC · Richard C Horton

Global warming has consequences for our health, and the impact will only be exacerbated by inaction

Peter D Sly · Patrick G Holt

Strategies for reducing exposure should be communicated to parents of children at risk of asthma

Luke D Knibbs · Solomon Woldeyohannes · Guy B Marks · Christine T Cowie

The rates of RHD are among the highest in the world, particularly in girls and young women

Kimberly Davis · Bo Remenyi · Anthony DK Draper · Januario Dos Santos · Noel Bayley · Elizabeth Paratz · Benjamin Reeves · Alan Appelbe · Andrew Cochrane · Timothy D Johnson · Laura M Korte · Ivonia M Do Rosario · Inez T Da Silva Almeida · Kathryn V Roberts · Jonathan R Carapetis · Joshua R Francis

Recognising early the potential causes of angioedema is important for averting fatal outcomes

Raymond J Mullins · Brynn K Wainstein · Elizabeth H Barnes · Dianne E Campbell

The health risks of fire smoke pollution should be explicitly factored into managing fires

Joshua A Horsley · Richard A Broome · Fay H Johnston · Martin Cope · Geoffrey G Morgan

Global warming is associated with intensifying climatic extremes and disruption to human society and human health

Elizabeth G Hanna · Lachlan J McIver

Tick bite-induced allergies are often severe, should be largely avoidable and give fascinating insights into allergies

Sheryl A van Nunen

To the Editor: Carey and colleagues are to be applauded for drawing attention to the potential impacts of extreme hot weather on the health of vulnerable groups in the community, particularly older people.1 However, in addition to the public health effects they covered, it is important to highlight the health impacts of high ambient temperature on Australian workers. The working population, ranging widely in age, is subject to many of the factors described in the article that influence vulnerability to heat illness, including chronic diseases and medications used to manage these. In addition, workers are often exposed to other heat stress factors, such as requirements to wear restrictive, impermeable personal protective clothing or to operate heavy machinery. Occupational circumstances may limit opportunity for acclimatisation, rest breaks, maintenance of adequate hydration or access to assistance if heat illness arises. A growing body of evidence shows associations between high ambient temperature and the risk of work-related injury.2,3 Importantly, this increased risk is not just observed among outdoor workers. Studies set in Adelaide2 and Melbourne3 have identified young workers (< 25 years of age) and male workers as being at increased risk of injury in association with increasing ambient daytime temperatures. Associations have also been observed between daily maximum temperature and risk of injury for workers engaged in occupations with the heaviest physical strength requirements (such as plumbers, paramedics and bricklayers).3 Moreover, a relationship has been observed between overnight temperatures and risk of injury for younger workers and female workers.3 In spite of climate projections for more frequent hot days and more severe heatwaves, there is currently a lack of specific and consistent policy and guidance targeting the work-related health impacts of hot weather.4 It is important that the health of workers and factors that influence their vulnerability to injury and illness are included in heat health discussions and are considered in the development of adaptive strategies.

Judith A McInnes · Peter Smith · Malcolm R Sim

In reply

Marion G Carey · Mark P Monaghan

To the Editor:Ahern and colleagues1 explore the potential benefits and pitfalls of benchmarked reporting in the Australian context. As a binational registry of patients on renal replacement therapy in Australia and New Zealand, the Australia and New Zealand Dialysis and Transplant Registry has been producing and distributing centre-specific performance reports to renal units for over 20 years; these share many of the challenges faced by clinician-level reporting. In the past few years, this has extended to provision of an abridged version of the report on our website, containing unit-specific risk-adjusted outcome data for each dialysis and transplant unit (http://www.anzdata.org.au/v1/hospitalreport.html). The authors highlight the challenges of low case numbers resulting in statistical models that are underpowered to detect poor performance and require long observation periods that will limit timely detection of outliers and opportunities for remedial action. Co-opting statistical techniques used for quality control in other industries may present an opportunity to address these issues in the health care sector. Cumulative sum control charts2 provide a method for sequentially monitoring cumulative performance over time, which may permit early detection of poor performance and account for varying activity levels by including the number of procedures performed, rather than just a fixed time frame. Similarly, Bayesian approaches that involve updating prior probability distributions within a dynamic model may address these concerns3 and offer the conceptual advantage of explicitly testing not just the statistical difference from average but the likelihood of performance falling into a defined poor performance category. Finally, there are systems that use differing criteria for smaller and larger units.4 Ahern and colleagues discuss the potential consequences of poor performance, but omit any reference to exactly who should oversee this process. We assert that the relevant specialty or subspecialty body has a crucial role in overseeing the interpretation of reports. The detection of an outlier is dependent on the nature of the boundaries set for acceptable performance, and the vulnerability of the statistical adjustment model to bias and unmeasured confounders. Such interpretation requires detailed knowledge of the relevant field, an appreciation of the variation between centres, and substantial epidemiological knowledge.

Matthew P Sypek · Matthew D Jose · Stephen P McDonald

In reply

Susannah Ahern · Sue M Evans · Ingrid Hopper · Arul Earnest

Dr Janet Hall is an Australian emergency physician who has just returned from Bangladesh after a stint with the Red Cross

Cate Swannell

Bond University research fellow Dr Amanda McCullough has been awarded the Emerging Health Researcher Award for 2017. The $25 000 prize will go towards furthering Dr McCullough’s research career and help drive her crucial work that aims to stop the spread of antibiotic resistant bacteria by reducing antibiotic prescription among general practitioners. Her research has shown that Australian GPs prescribe nearly 6 million antibiotics annually, which Dr McCullough has demonstrated is four to nine times higher than what is recommended by Australian guidelines. As part of her research, Dr McCullough has been reviewing the evidence on why GPs and members of the public use antibiotics, and how this could be reduced for common conditions such as coughs, colds, flus and ear infections. To help change prescribing behaviour, she is also involving a psychologist in her work. In addition to Dr McCullough, five additional outstanding health researchers were acknowledged as finalists and awarded $5000 each to continue their research that is driving changes in health policy and practice in Australia. They are: Dr Bridianne O’Dea from the Black Dog Institute, for her research into using technology and social media to identify, treat and prevent mental illness and promote wellbeing in youth; Dr Emma Beckett from the University of Newcastle, for her research into gene-nutrient-environment interactions; Dr Jaquelyne Hughes from the Menzies School of Health Research, for her research into reducing rates of chronic kidney disease in Indigenous communities; Dr Rae-Anne Hardie from the Australian Institute of Health Innovation at Macquarie University, for her research into enhancing quality of pathology testing in general practice; and, Dr Thushara Perera from the Bionics Institute, for his research into precise instrumentation to measure hand tremor, balance, posture, rigidity, and gait in movement disorder patients. https://media.bupa.com.au/researcher-focused-on-reducing-the-threat-of-antibiotic-resistance-wins-bupa-health-foundation-award/ A new regional training hub will help Flinders University Rural Health SA to work closely with stakeholders in the Limestone Coast and Riverland regions to instigate and coordinate more medical training programs, expanding its undergraduate program to junior doctor and postgraduate internships and education. For the past 20 years, Flinders Rural Health SA has built a network of high-quality educational facilities which support medical, nursing and allied health students in primary care, community, emergency, inpatient, aged care, research and allied health settings. The network already supports rural clinical programs in the Riverland, Limestone Coast, Adelaide Hills-Mallee-Fleurieu and Barossa regions. The new training hub will focus on future strategies for the Rural Health Multidisciplinary Training program (RHMT). It coincides with Flinders University gaining accreditation for the new workplace-based assessment program which is open for international medical graduates to commence a 12-month program at the Mount Gambier Hospital and then obtain full-time work at health sites around the Limestone Coast. http://news.flinders.edu.au/blog/2018/03/23/sa-country-health-improve-training/ Flinders University alumna Kirsty Boden, a nurse who was killed in the 2017 London Bridge terrorist attack, has been honoured with the awarding of a scholarship for rural nurses in her name. Vice-Chancellor Professor Colin Stirling honoured Kirsty Boden with a posthumous Flinders University Distinguished Alumni Award during a special ceremony. Received by Kirsty’s family, the award acknowledges her selfless role to care for others in a terrible incident, and the bravery which cost this dynamic young woman her life. It is a legacy which will have immediate significance for the two inaugural recipients of the Kirsty Boden Memorial Nursing Scholarship. In September 2017, the Government of South Australia announced a $100 000 grant to establish the Kirsty Boden Memorial Nursing Scholarship at Flinders University, comprising 10 scholarships to be awarded to final year nursing students from regional South Australia over the next 5 years. The first recipients of $10 000 scholarships for 2018 studies are Rita Amyan and James Cheeseman. http://news.flinders.edu.au/blog/2018/03/05/scholarship-award-honours-kirsty-boden/ Monash University’s Associate Professor Diana Egerton-Warburton has been inducted onto the Victorian Honour Roll of Women for 2018 in recognition of her achievements and commitment to the field of emergency medicine. Associate Professor Egerton-Warburton is Director of Emergency Medicine Research, Monash Medical Centre ED and an emergency physician with a passion for patient and community advocacy. She is an Associate Professor at the School of Clinical Sciences at Monash health (SCS) and the National Drug Research Institute, Curtin University. Associate Professor Egerton-Warburton has led and participated in a number of multi-site clinical trials and clinical research projects, with an emphasis on focused on pragmatic, patient-centered research, to influence practice and policy. She has received numerous research grants including NHMRC, AMA and VicHealth. Associate Professor Egerton-Warburton was the president of the Australasian Society for Emergency Medicine from 1997 to 2000. She was chair of the Australasian College for Emergency Medicine Public Health Committee for almost a decade and has led an international project to highlight and reduce the harmful effects of alcohol. She has been awarded numerous prizes including VicHealth and Australian Medical Association’s Women in Medicine Award 2016 for an “outstanding contribution to emergency medicine with a strong passion for public health”. She is a member of the Australian National Advisory Council on Alcohol and other Drugs, providing policy advice to the Commonwealth Government. She has provided policy advice to the Victorian Minister for Health. https://www.monash.edu/medicine/news/latest/articles/monash-emergency-physician-and-researcher-inducted-onto-victorian-honour-roll-of-women

Cate Swannell