Volume 208 Issue 9

A new era of disease modification in the field of neurodegeneration has differing approaches that will hopefully improve outcomes for people with Parkinson disease

Simon JG Lewis

Current permissible use of botulinum toxin in Australia does not match newer understandings of human impairment and functioning

Anupam Datta Gupta · David H Wilson

Recent studies are expanding our understanding of the genetic basis of Parkinson disease

Elaine GY Chew · Jia Nee Foo · Eng-King Tan

Tremor is the most common movement disorder encountered in clinical practice

Andre Loiselle

Commemorating the 200th anniversary of the first specific description of parkinsonism

Nadeem Toodayan

Dementia, 5th edition

Olivier Piguet

Medical neurobiology, 2nd edition

David Mor

Contrary to the stereotype, remote workers in Australia experience high levels of psychological distress

Gordon B Parker AO

Individualised psychosocial interventions are needed as alternatives to pharmacological sedation

Gerard J Byrne

Objectives: To assess the prevalence and correlates of psychological distress in a sample of remote mining and construction workers in Australia. Design, setting: A cross-sectional, anonymous Wellbeing and Lifestyle Survey at ten mining sites in South Australia and Western Australia, administered at meetings held during 2013–2015. Participants: 1124 employees at remote construction, and open cut and underground mining sites completed the survey. Main outcome measures: General psychological distress (Kessler Psychological Distress Scale, K10) and self-reported overall mental health status; work, lifestyle and family factors correlated with level of psychological distress. Results: The final sample comprised 1124 workers; 93.5% were men, 63% were aged 25–44 years. 311 respondents (28%) had K10 scores indicating high/very high psychological distress, compared with 10.8% for Australia overall. The most frequently reported stressors were missing special events (86%), relationship problems with partners (68%), financial stress (62%), shift rosters (62%), and social isolation (60%). High psychological distress was significantly more likely in workers aged 25–34 years (v ≥ 55 years: odds ratio [OR], 3.2; P = 0.001) and workers on a 2 weeks on/1 week off roster (v 4 weeks on/1 week off: OR, 2.4; P < 0.001). Workers who were very or extremely stressed by their assigned tasks or job (OR, 6.2; P = 0.004), their current relationship (OR, 8.2; P < 0.001), or their financial situation (OR, 6.0; P < 0.001) were significantly more likely to have high/very high K10 scores than those not stressed by these factors. Workers who reported stress related to stigmatisation of mental health problems were at the greatest risk of high/very high psychological distress (v not stressed: OR, 23.5; P < 0.001). Conclusions: Psychological distress is significantly more prevalent in the remote mining and construction workforce than in the overall Australian population. The factors that contribute to mental ill health in these workers need to be addressed, and the stigma associated with mental health problems reduced.

Jennifer Bowers · Johnny Lo · Peta Miller · Daveena Mawren · Brooklyn Jones

A multi-strategic, interdisciplinary intervention can reduce inappropriate prescribing of psychotropic agents

Juanita L Westbury · Peter Gee · Tristan Ling · Donnamay T Brown · Katherine H Franks · Ivan Bindoff · Aidan Bindoff · Gregory M Peterson

Key advances include the development of validated tools for holistic measurement and grading of non-motor symptoms, and a focus on multi-modal biomarkers to define non-motor subtypes

Nataliya Titova · K Ray Chaudhuri

Understanding the possible differences in Parkinson disease across ethnic groups may help researchers and clinicians gain new insights into the underlying aetiologies, pathogenesis, expression and treatment response of this disease

Anna Sauerbier · Azman Aris · Ee Wei Lim · Kalyan Bhattacharya · K Ray Chaudhuri

To the Editor: I write to comment on the Perspective by Wolfenden and colleagues1 on e-cigarette use by young people. In the article, the authors make regulatory recommendations for e-cigarettes based on the assertion that vaping causes young people to take up smoking — the so-called gateway theory. However, while many studies have found that adolescents who try vaping are more likely to try smoking, there is no evidence of cause and effect. The longitudinal studies described only show an association and are unable to demonstrate causality.2 An alternative explanation is common liability; that is, that young people who are more attracted to experimentation are more likely to try both products. In fact, international reviews suggest that vaping is diverting adolescents away from smoking and reducing smoking rates.3 As vaping rates have been increasing in young people, smoking rates are rapidly declining — a finding inconsistent with a gateway effect. Real world studies show that most vaping by young people is experimental and short lived and only a minority use nicotine. Regular vaping among teens is almost exclusively confined to those who already smoke. A recent analysis of five national surveys in the United Kingdom of 60 000 adolescents found that regular vaping by never-smoking 11–16-year-olds was 0.1–0.5%.4 Perhaps most important of all, Wolfenden and colleagues1 dismiss the substantial public health benefit that could result from vaping. Population studies have indicated that millions of smokers have quit using e-cigarettes and modelling studies have found a substantial net public health benefit, even using pessimistic scenarios.5 Banning wider access to e-cigarettes on the basis of an unproven risk to adolescents would prevent access to a life-saving quitting aid for millions of smokers. A better solution is to employ strategies to minimise youth access and make vaping available for adult smokers who are otherwise unable to quit smoking with conventional therapies.

Colin P Mendelsohn

To the Editor: Wolfenden and colleagues1 fail to justify the ban on the sale of nicotine-containing e-cigarettes in Australia and do not address the supporting arguments for allowing smokers to access these products.2,3 The concern that e-cigarettes may recruit young smokers justifies a regulatory response but not a ban on sales of nicotine-containing e-cigarettes to adults,3 who are thereby prevented from using these products. The authors cite a meta-analysis of studies that showed an association between the past 30-day use of e-cigarettes and combustible cigarettes;4 however, they ignore the weaknesses in the studies. First, most studies defined an adolescent e-cigarette user or cigarette smoker as one who had used either product in the past 30 days. These studies do not show that adolescents who used e-cigarettes were more likely to become daily smokers than their peers who did not use them. Second, the studies had substantial subject attrition (more than 30% in four out of nine studies) and they often poorly controlled for a shared liability to use drugs. The association was weakest in the largest and best controlled study.5 In addition, Wolfenden and colleagues make no mention of the steep decline in youth smoking rates that has occurred in both the United Kingdom and the United Sates while vaping has increased among young people.5,6 Nor do they mention that the UK’s smoking prevalence is now the same as Australia’s, in the absence of plain packaging or high tobacco tax.6 The authors’ claim that a relaxation of the ban on e-cigarette sales in Australia “has the potential for unintended harm” ignores the direct harms caused by the current ban; for example, the unregulated use of e-cigarettes, a black market, and the criminalisation of e-cigarettes users.6 Finally, even if the evidence for a gateway effect were accepted, it would, at most, justify a tighter regulation of e-cigarettes; it does not justify a prohibition on adult e-cigarette use. If it did, we would be morally obliged to prohibit the sale of cigarettes to smokers because on their argument this would be the most effective way of preventing adolescents from smoking cigarettes.

Wayne D Hall

In reply

Sze Lin Yoong · Emily Stockings · Luke Wolfenden

Simon Lewis has a passion for helping people with neurodegenerative brain diseases that keeps him on the cutting edge of research in the field

Cate Swannell

This calendar will be updated each month. If you have an event you would like to add, please include relevant details in an email to cswannell@mja.com.au

Cate Swannell