Issues
Volume 208 Issue 8
News
News briefs
Higher cigarette prices could help millions A substantial increase in cigarette prices could help millions of people around the world avoid poor health and extreme poverty, according to research published by the BMJ. The findings show that people on low incomes have the most to gain. Researchers from the Global Tobacco Economics Consortium and the University of Toronto set out to predict the effect of a 50% increase in cigarette prices on health, poverty and financial protection in 13 middle income countries with a total of 500 million male smokers. The authors used a simple compartmental model, developed by the Disease Control Priorities Project and building on an earlier poverty and tobacco taxation analysis by the Asian Development Bank, to measure the impact of quitting, by age and income group, on life years gained, treatment costs averted, catastrophic medical costs and poverty avoided, and additional tax revenue. Prices were assumed to have been raised by increasing tobacco excise rates to reach the target price in each country. The investigators found that a 50% price increase would lead to about 450 million years of life being gained in the 13 countries as the result of quitting, half of them in China. Across all countries, men in the lowest income group (poorest 20% of the population) would gain seven times as many life years as men in the top income group (richest 20% of the population; 155 v 23 million life years). The average number of life years gained as the result of quitting by smokers in the lowest income group was five times that of those in the top group (1.46 v 0.23 life years). Of the $157 billion in averted treatment costs, the savings were almost five times as great in the lowest as in than the top income group ($46 billion v $10 billion). In seven countries without universal health coverage, about 15.5 million men would avoid catastrophic medical costs. As a result, 8.8 million men, half in the lowest income group, would avoid falling below the World Bank definition of extreme poverty. Overall, 31% of the life years saved and 29% of the averted disease costs and medical costs would be in the lowest income group, which would, however, contribute only 10% of the additional $122 billion in taxes collected. https://www.bmj.com/content/361/bmj.k1162 Mental disorders leading cause of illness in children globally Researchers from the Université Paris–Saclay in France have found that although global rates of mental disorders in children have remained stable over time, they will become the main causes of disease in children aged 4–15 years as a consequence of the decline in the prevalence of infectious diseases. The study, published in Child and Adolescent Psychiatry and Mental Health, described the prevalence of mental disorders among children aged 5–14 years in each of the six regions of the World Health Organization – Africa, the Americas, South-East Asia, Europe, the East Mediterranean, and the West Pacific Region. They found that even in emerging regions, the prevalence of mental disorders was high and constant over time. In 2000, mental disorders ranked third among the causes of disability-adjusted life-years (DALYs) — years of healthy life lost because of disease or disability — in the Americas and Europe; by 2015, mental disorders were the second greatest cause of DALYs here as the impact of infectious diseases decreased. This change from infectious diseases to mental disorders as the main cause of DALYs in children is termed an epidemiological transition. The impact of mental disorders on child health will increase in importance as more countries undergo this transition from infectious diseases to mental disorders as major causes of ill health. In most WHO regions, four mental disorders ranked among the 20 diseases associated with the most DALYs: conduct disorders, anxiety disorders, major depressive disorders, and autism–Asperger syndrome. Among boys, the most common mental disorders associated with DALYs were conduct disorders, autism–Asperger syndrome and anxiety disorders; among girls, they were anxiety disorders, conduct disorders and major depressive disorder. In addition to the change over time, the authors also noted the effect of income: regions with the highest gross domestic product had fewer problems with infectious diseases and more with mental disorders. https://capmh.biomedcentral.com/articles/10.1186/s13034-018-0225-4
Cate Swannell
Perspective
Cord clamping in term and pre-term infants: how should clinicians proceed?
Evidence favours delayed cord clamping in most newborns, but further studies are needed
Graeme R Polglase · Michael Stark
Medical education
Understanding statistical principles in linear and logistic regression
Introducing the concept of multivariable regression
Alice M Richardson · Grace Joshy · Catherine A D'Este
Ethics and law
Children as haematopoietic stem cell donors: ethically challenging and legally complex
Clinicians should be aware of the particular physical and psychological risks of haematopoietic stem cell donation in the paediatric setting, and the varying laws between states and territories
Shih-Ning Then · Ian H Kerridge · Michael Marks
Book/media/app reviews
An authoritative reference for trainees and experienced paediatric nephrologists
Clinical pediatric nephrology, 3rd edition
Steven J McTaggart
Editorials
Why are so many more adolescents presenting to our emergency departments with mental health problems?
New data on the rise in presentations should be seen as canaries in the coalmine
Susan M Sawyer · George C Patton
The rate of anterior cruciate ligament reconstruction in Australia is high: a national registry is needed
Support for a registry is an investment in the long term health of our nation
John W Orchard · Lars Engebretsen · Julian A Feller
Research
Paediatric mental and physical health presentations to emergency departments, Victoria, 2008–15
The number of children presenting to EDs for mental health problems is rising
Harriet Hiscock · Rachel J Neely · Shaoke Lei · Gary Freed
Presentations to NSW emergency departments with self-harm, suicidal ideation, or intentional poisoning, 2010–2014
Adolescent mental health services in the community and ED models of mental health care must each be improved
Jayashanki Perera · Timothy Wand · Kendall J Bein · Dane Chalkley · Rebecca Ivers · Katharine S Steinbeck · Robyn Shields · Michael M Dinh
Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000–2015
A national injury prevention program and an ACL reconstruction registry would improve outcomes for active young Australians
David Zbrojkiewicz · Christopher Vertullo · Jane E Grayson
Narrative review
Developmental dysplasia of the hip: addressing evidence gaps with a multicentre prospective international study
International studies are necessary to provide high quality evidence to guide DDH treatment and management
Emily K Schaeffer · IHDI Study Group · Kishore Mulpuri
Parechovirus: an important emerging infection in young infants
Parechoviruses generally cause mild illness in children, but a current genotype 3 epidemic has been associated with severe complications, particularly in children aged under 3–6 months
Philip N Britton · Cheryl A Jones · Kristine Macartney · Allen C Cheng
Letters
Giving older people the opportunity to optimise their quality of life
To the Editor:There are some populations for whom unequal health cannot be overcome and a preoccupation with preserving health detrimentally affects their quality of life.1 Imagine you live in residential aged care, your health is irreversibly poor and you have days left to live. You want to go for a walk in the sunshine, but are prevented from doing so in case you fall and harm yourself. Your health cannot improve; yet, you are denied the opportunity to enjoy life. Quality of life is influenced by health, as well as social support, autonomy and spiritual fulfilment.2 Society encourages younger people to take risks to fulfil their potential and enjoy life; however, we prevent older people from doing the same. By denying this population the “dignity of risk”,3 we are denying them an opportunity to optimise their quality of life. This optimisation requires recognising that focusing on inequality in health will not always overcome an unequal quality of life, especially for vulnerable older people. Most residents of aged care facilities have multiple comorbidities contributing to poorer health, but this need not equate to a suboptimal quality of life. The goal should be to enable older people to enjoy their life by supporting them to fulfil their potential. People with a similar stage of dementia who live at home report a higher quality of life than those in residential aged care.4 Living at home provides greater independence, illustrating the importance of considering a multifaceted quality of life. If professionals focus only on improving health and not all factors contributing to quality of life, then inadvertently, neither health nor quality of life will improve. Enabling individuals to make choices, even those with a risk of harm, is a pathway to improving quality of life for everyone, including people with irreversible poor health.
Alice L Holmes · Marta H Woolford · Joseph E Ibrahim
Eye injury from toxic chemical mistaken for eye drops
To the Editor:A 49-year-old man, with a history of occasional red eye self-treated with over-the-counter naphazoline eye drops, accidentally self-administered a drop of “fibreglass resin catalyst”, containing concentrated (approximately 33%) methyl ethyl ketone peroxide (MEKP), to his left eye. The MEKP bottle was purchased at a local hardware store. The patient had previously placed the MEKP bottle on his bedside table and mistook it for his regular eye drops the following morning. Upon instillation, he felt immediate pain and irrigated his eye with water at home before presenting to the emergency department (ED). After appropriate ED irrigation and treatment, he was managed in the hospital’s ophthalmology department. After 13 days, his cornea had healed and his vision had returned to normal. However, there was residual evidence of limbal ischaemia — a poor prognostic sign in ocular chemical injuries.1,2 Ocular chemical injuries are a major source of preventable morbidity and blindness. Strongly oxidative compounds, such as MEKP, especially at high concentrations, cause rapid oxidative damage to corneal epithelium leading to cell death.3 MEKP in particular has been associated with long term symptoms and ocular surface dysfunction in patients who delay primary irrigation.4 The injury reported herein was particularly deleterious as it involved the direct administration of MEKP to the eye, because the patient mistook it for his regular eye drops (Box). This confusion was due to the similar packaging of MEKP to many common eye drops used in ophthalmology. Similar injuries have been reported previously in the literature4 in patients who mistook MEKP for their regular eye drops. Often, patients’ underlying vision is poor, making it difficult for them to differentiate the products without careful inspection.4,5 Packaging MEKP in this medically familiar format poses a significant danger to the general public. We urge manufacturers to reconsider the presentation of this product by obvious colouring of the entire bottle (eg, bright orange with a black lid) so it is impossible to mistake MEKP for regular eye drops. Such a change could significantly reduce the number of preventable vision-threatening injuries sustained in this manner. Box – Package similarity between naphazoline eye drops (left) and methyl ethyl ketone peroxide (right) bottles
Richard T Parker · Dominic P McCall · Chameen Samarawickrama
Careers
A sporting life
Dr Laura Lallenec is living a life tending to the medical needs of some of the country’s best professional athletes
Cate Swannell
Calendar of conferences in Australia and New Zealand
f you have an event you would like to add, please include relevant details in an email to cswannell@mja.com.au
Cate Swannell
News briefs
Cate Swannell
Disease-modifying approaches for Parkinson disease
Simon JG Lewis
Botulinum toxin for spasticity: a case for change to the Pharmaceutical Benefits Scheme
Anupam Datta Gupta · David H Wilson
Identifying genes in Parkinson disease: state of the art
Elaine GY Chew · Jia Nee Foo · Eng-King Tan
News briefs
Cate Swannell
The Lancet Countdown down under: tracking progress on health and climate change in Australia
Ying Zhang · Paul J Beggs
Tackling the worsening epidemic of Buruli ulcer in Australia in an information void: time for an urgent scientific response
Daniel P O'Brien · Eugene Athan · Kim Blasdell · Paul De Barro