Letters

A screening checklist has proved successful in Queensland

Jennifer K Broom · Mark D Kelly · Alex F Broom

To the Editor: The article by Segard and Macdonald is interesting but has significant methodological weaknesses and reports data that do not support all of their conclusions.1 Methodologically, retrospective dataset reviews with little demographic or morbidity data to avoid confounding (it is unclear why these were not available) are problematic. Additionally, death certificates were used as a surrogate for improved outcomes from additional diagnosis. Segard and Macdonald ...

David Mountain

In reply: We thank Mountain for his comments. As he points out, it is only possible to infer cause and effect from observational data. The fact that referrals for D-dimer levels and computed tomography pulmonary angiography increased during the same period does not prove that one “drove” the other, although we believe this is a reasonable inference. Importantly, D-dimer testing was introduced as a “rule-out” ...

William B G Macdonald · Tatiana Segard

Hi-tech selfies may save lives

Monika Janda · H Peter Soyer

Children at clandestine drug laboratories are at risk of physical injury as well as exposure to methamphetamine and toxic chemicals

Sharon L Hawkrigg · Peter M Winterton

What is the ideal smoking reduction strategy and who should be targeted

Simon Chapman

In reply: We thank Chapman for his comments and note that our article1 offers support for his proposal for a smartcard smokers licence for retail tobacco sales.2 Recent data from the Australian Health Survey indicate that nearly 6% of 15–17-year-olds are current smokers, and over 4% smoke daily.3 This figure is likely an underestimate.3 Given these statistics, tobacco control policy must continue to embrace adolescents. ...

Roger S Magnusson · David C Currow

The safety and benefits of homebirth remain contentious

Susan Ieraci · Amy B Tuteur

To the Editor: The recent article by Catling-Paull and colleagues1 documents the apparently very low perinatal mortality associated with state-funded homebirth, mostly among women in Western Australia. However, the 2007 triennial report of the WA Government Perinatal and Infant Mortality Committee (PIMC) stated that, for homebirth: The term perinatal mortality rate was 6.7 per 1000 total births, compared with a term perinatal mortality rate of 2.1 per 1000 total births in the ...

Donald M Clark

In reply: We agree that our retrospective review1 did not provide all the details about neonatal morbidity and mortality. There were limited data available on the reasons for hospital transfer and neonatal death. We explained these limitations in the article and have hence embarked on a wider study of birthplace in Australia.2 It was interesting to us that even in this low-risk population, there were 10 breech ...

Christine Catling-Paull · Rebecca L Coddington · Maralyn J Foureur · Caroline S E Homer

Managing birthweight potentially reduces the risk of diabetes, but lifestyle factors are also important

Katherine A Thurber

In reply: We agree with Thurber that analyses were conducted within the framework of the developmental origins of health and disease hypothesis; however, we did not conclude that “interventions to ‘improve’ birthweight would be ineffective in reducing the prevalence of diabetes”. In line with the hypothesis, we included adolescent as well as birth factors, and suggested that strategies to improve lifestyle factors in childhood and ...

Susan M Sayers · Gurmeet R Singh

To the Editor: Despite evidence supporting the safety and benefits of influenza vaccination during pregnancy,1,2 half of pregnant women believe the influenza vaccine to be unsafe or are uncertain about its safety in pregnancy.3 Other studies report confusion among antenatal care providers about the safety of influenza vaccination during pregnancy, and cite the need for more professional education.4 To help address these safety concerns, the Western ...

Annette K Regan · Christopher C Blyth · Paul V Effler

To the Editor: I would like to thank Rintoul and colleagues for bringing together data from varied sources to highlight an important public health issue.1 The 1426% increase in supply of alprazolam they identified over the 20-year period from 1990 to 2010 was particularly striking. Alprazolam is indicated as a second-line treatment for panic disorder where other therapies are ineffective, or for short-term treatment of anxiety disorder. As ...

Tracy W Soh

To the Editor: Rintoul and colleagues showed that alprazolam is being increasingly detected in heroin-related deaths.1 One explanation provided is increased rates of alprazolam misuse among people who inject drugs. My colleagues and I recently reviewed the role of alprazolam in Australian clinical practice,2 focusing on the sole supported Pharmaceutical Benefits Scheme (PBS) indication: treatment of “panic disorder where other treatments have failed or are inappropriate”. ...

Steven Moylan

In reply: We thank Soh for her letter providing further evidence of harm relating to alprazolam misuse, which highlights deficiencies in postmarketing surveillance systems for pharmaceutical drugs. Reports of adverse drug reactions typically originate from therapeutic use; they seldom identify problems arising from misuse. Detection of misuse-related harm currently relies on ad-hoc epidemiological studies such as ours and that of Frei and colleagues, who documented ...

Angela C Rintoul · Malcolm D H Dobbin

To the Editor: Peripheral intravenous catheters (PIVCs) frequently cause Staphylococcus aureus bacteraemia, and a disproportionate number of episodes involve catheters that have been left in place for ≥ 4 days or have been inserted in emergencies.1 Other studies have shown similar results with catheters left in place for > 48 hours or not routinely replaced after emergency placements.2-4 At Canberra Hospital, we have followed all bloodstream infections (BSIs).5 Since 2002, ...

Peter J Collignon · Fiona J Kimber · Wendy D Beckingham · Jan L Roberts

In reply: We thank Collignon and colleagues for their letter regarding our study on peripheral intravenous catheter (PIVC)-associated Staphylococcus aureus bacteraemia.1 We agree with their comments. Both their data and ours support the potential importance of establishing a national standard for the insertion and management of PIVCs in Australia. Such a standard needs to address the basics of PIVC management: not inserting PIVCs unless required;2 ...

Rhonda L Stuart · M Lindsay Grayson · Paul D R Johnson

In reply: It is untrue that new recommendations for clinically indicated peripheral intravenous catheter (PIVC) replacement are based on phlebitis alone. A Cochrane systematic review considered catheter-related bloodstream infection (BSI) data from five randomised controlled trials (4806 patients) and found no evidence for the effectiveness of routine replacement (P = 0.64).1 The largest trial (3283 patients) studied both catheter-related BSIs and all-cause BSIs, finding no disadvantage to clinically ...

Claire M Rickard · Joan Webster · E Geoffrey Playford

To the Editor: In their review, Harris and Buchbinder call for a ban on all spinal injections of steroids.1 These injections are not a singular procedure; they differ by indications, technique, and the evidence that serves each. For the treatment of low back pain, no evidence supports the use of epidural steroids, and intra-articular injections of steroids are clearly no more effective than sham therapy.2 Disavowing ...

Nikolai Bogduk