Letters

To the Editor: Harris and colleagues report failure to obtain reduction in several important risk factor-based intermediate outcomes for vascular disease from their lifestyle intervention in the Health Improvement and Prevention Study (HIPS).1 Using intention-to-treat analysis, if only 117 of 384 participants completed at least two of six group sessions, a positive result could not be expected. We know that interventions for prevention of cardiovascular disease (CVD) ...

James A Dunbar · Edward D Janus · Erkki Vartiainen

In reply: The Health Improvement and Prevention Study (HIPS) and the Greater Green Triangle study are not comparable. HIPS was a cluster randomised controlled trial of a pragmatic intervention that was delivered by general practitioners (through Divisions of General Practice) and was analysed on an intention-to-treat (ITT) basis.1 The Greater Green Triangle study was a pre–post study of patients recruited in GP waiting rooms who ...

Mark F Harris

DMAA was recently banned in Australia and other countries owing to toxicity, lack of health benefits, and concerns about long-term safety and potential for misuse. A trawl of the NSW Poisons Information database confirms the wisdom of the ban and suggests an expanded role for the database in future.

Jared A Brown · Nick A Buckley

Trauma registry data on patients admitted to Sydney hospitals following bicycle or motorcycle accidents reveal the protective effect of wearing a helmet.

Michael M Dinh · Kate Curtis · Rebecca Ivers

To the Editor: Surfboard riding is an iconic pastime in Australia. Injuries to the head and face constitute a considerable proportion of surfing injuries;1-5 26% of acute surfing injuries are to the head and face, and these make up 42% of emergency department presentations by surfers.3 We conducted a retrospective review at our tertiary referral hospital of patients who underwent medical imaging for injuries sustained to ...

Simon J Dimmick · Patrick V Sheehan · Mark Gillett · Suzanne E Anderson

A national survey found that many respondents were under the false impression that solariums are safer since regulations were introduced to ban their use by certain vulnerable groups of people, backing calls for a complete nationwide ban on solariums.

Suzanne J Dobbinson · Angela Volkov · Melanie A Wakefield

To the Editor: We would like to add a cautionary note to O’Neil’s support for the inclusion of “depression and other psychosocial factors” in the updated National Vascular Disease Prevention Alliance guidelines for assessing cardiovascular disease (CVD) risk. Her statement “it is now clear that depression is also an important risk factor for CVD” is premature.1 Different authors have challenged the suggested relationship and, given ...

Hans G Stampfer · Dana A Hince · Simon B Dimmitt

In reply: I thank Stampfer, Hince and Dimmitt for their response. While I acknowledge that there are aspects of the relationship between cardiovascular disease (CVD) and depression that remain undetermined, recent evidence clearly supports the role of depression as an independent risk factor for CVD and is indeed convincing.1-3 This is especially true in studies that assess depression using diagnostic criteria.4 We know that the ...

Adrienne E O’Neil

Given the link between high sodium intake and hypertension, gathering information on salt consumption among Indigenous Australians should be a public health priority.

Christopher G Lawrence*

Improved education and support for patients and general practitioners and, preferably, active follow-up by health departments of all notifications is needed in place of the current haphazard approach to contact tracing for hepatitis B notifications.

Karin Leder

To the Editor: I share Mahar’s concern regarding any future screening of prospective medical students for signs that they are likely to develop mental or physical impairment.1 Although Wilson and colleagues do acknowledge that screening may not be ethical, the separate issue of their seeming conflation of likelihood of illness with impaired ability to practise in the long term is problematic.2 Mental illness, and particularly ...

Dev A Kevat

Public health posters about flu transmission prevention need to reflect current best practice: cough or sneeze into your sleeve rather than your hands if tissues are not available.

Guy D Eslick

Australia must continue to support learning in emergency medicine through sufficient resourcing for emergency departments — the most appropriate setting for such training — and via robust accreditation standards.

Andrew D Gosbell · Rob D Mitchell · Victoria A Brazil · Alana M Killen

To the Editor: In 2009, the RE-LY (Randomized Evaluation of Long-Term Anticoagulant Therapy) trial compared dabigatran etexilate with warfarin for prevention of stroke and systemic embolism in 18 113 patients with non-valvular atrial fibrillation (AF) and at least one additional risk factor for stroke.1 In April 2011, it became accessible in Australia (Pradaxa; Boehringer Ingelheim) under a product familiarisation program funded by the manufacturer; however, the Pharmaceutical ...

Sueh-li A Lim · Ellen Maxwell

To the Editor: The Australian Government’s recently completed Review of anticoagulation therapies in atrial fibrillation (AF) identified that the quality of international normalised ratio (INR) control was one of a number of factors creating uncertainty regarding the cost-effectiveness of novel anticoagulants in the Australian setting.1 INR control, usually expressed as the percentage of time in the therapeutic range (TTR), is critical in determining the relative efficacy, ...

Luke R E Bereznicki · Alexandra R Madden · Gregory M Peterson

Funding such a recommendation would lead to little overall cost but would possibly save several Australian lives each year

D Ashley R Watson

To the Editor: We commend the clinical update of Bergin and colleagues on the management of diabetes-related foot ulceration.1 We agree that a multidisciplinary approach is the best way to manage these complex wounds. However, we believe that the use of hyperbaric oxygen treatment (HBOT) for ulcers which have failed to respond to 3 months’ standard treatment justifies more prominent consideration. The actions of HBOT are diverse, ...

Glen C Hawkins · Michael H Bennett · David R Smart

To the Editor: Following two articles in the Journal,1,2 I wish to provide an update on the pricing of statins in Australia and the implications for Pharmaceutical Benefits Scheme (PBS) expenditure. I was prompted to do so by a recent review by the Pharmaceutical Benefits Advisory Committee (PBAC), which was instigated by the Senate when it passed legislation enabling the current pharmaceutical pricing arrangements.3 The ...

Philip M Clarke

To the Editor: Neovascular age-related macular degeneration (NVAMD) is the most common cause of blindness in Australia.1 Current treatment to prevent further deterioration in vision, and an improvement in some, involves the antivascular endothelial growth factor (anti-VEGF) agents ranibizumab (Lucentis, listed on the Pharmaceutical Benefits Scheme [PBS] since August 2007) or bevacizumab (Avastin, used off-label for NVAMD).2 The Australian Macular Degeneration Foundation estimated the annual number ...

Robert P Finger · Robyn H Guymer

Do the CSL snake venom detection kit dose recommendations need updating?

Alan Paul

In reply: A low-volume, polyvalent antivenom for brown and tiger snake envenoming would make treatment simpler and safer. Since 2001, when information cited by Paul was published, there have been over 15 peer-reviewed research publications addressing the issue of antivenom dosing.1-3 There is now consistent evidence that one vial is equivalent to larger doses, and there have been no cases of active venom being present after one ...

Geoffrey K Isbister · Nicholas A Buckley · Simon GA Brown

To the Editor: Caplan et al1 include in their meta-analysis a trial by Mather et al that compared home care with intensive care management of patients with acute myocardial infarction (AMI) between 1966 and 1968.2 A joint working party of the Royal College of Physicians and British Cardiac Society dismissed the results of this study because of design defects.3,4 Kalra et al5 performed a randomised trial with ...

Hugh G Dickson

In reply: Dickson argues for exclusion of randomised controlled trials (RCTs) if treatments have changed, but treatments are constantly changing so, following this rule, meta-analysis would be impossible. Similarly, diagnosis has changed — stroke was a clinical diagnosis, then computed tomography was required, and now magnetic resonance imaging is needed. Equipoise is not a requirement for inclusion in a meta-analysis. Complaints about research being simplistic because ...

Gideon A Caplan

A common injury in a popular sport that requires early referral and management

Mohammed Baba · Jason N Harvey · Anthony J Beard · Richard D Lawson

To the Editor: The impact of population ageing on health care expenditure was a hot topic in the late 1990s in Australia.1 Previous studies have adopted various modelling approaches to estimate age- and sex-specific health care costs to inform population health care expenditure projections.2-4 Medicare funds about 3800 medical services, including consultations provided by general practitioners and specialists, medical diagnostic services (such as medical imaging and ...

Catherine L Keating