Article Types
Letters
Hormone treatment of gender identity disorder in a cohort of children and adolescents
To the Editor: In describing 8 years of experience in managing adolescent gender identity disorder (GID) at a paediatric hospital clinic, Hewitt and colleagues highlight a small group of patients who require momentous life-long clinical decisions made in a timely manner.1 However, the rarity of this condition means that experience in any centre is limited. The authors state that authorisation from the Family Court of Australia is ...
Ann J Conway · Julie C Hamblin · David J Handelsman
Hormone treatment of gender identity disorder in a cohort of children and adolescents
To the Editor: I welcome the article by Hewitt and colleagues,1 but their protocol is problematic. Suppression of puberty improves mental health and general functioning, but not body image and dysphoria.2 For this, cross-sex hormones and/or surgery are the only effective treatments.2 Withholding cross-sex hormones until children are 16 years of age may worsen their mental health,3 cause resentment, and encourage self-medication. Increasingly, young transsexual people are ...
Zoë Hyde
Hormone treatment of gender identity disorder in a cohort of children and adolescents
In reply: We thank Hyde and Conway and colleagues for their correspondence following our report on treatment for young people with gender identity disorder (GID).1 We follow current international consensus recommendations for management,2,3 but accept that as more research is performed, there may be future adjustments to endorsed protocols. At present, patients can apply to the Family Court of Australia for authorisation of treatment that ...
Jacqueline K Hewitt · Campbell Paul · Louise K Newman
Listening to what Indigenous people in remote communities say about alcohol restrictions and cannabis use: “Good thing that the alcohol’s gone, but the gunja has kept going”
In Cape York Indigenous communities, alcohol restrictions started in 2002–2003, with local prohibition in some communities since 2008. These restrictions may have halved alcohol-related injuries, a historically important change. However, residents of Cape York Indigenous communities suggest that there has been an accompanying rise in cannabis use over this period. During consultations in 2011 for Minister Macklin’s controversial Stronger Futures in ...
Cape York Cannabis Project Team
The value of a support group for doctors with substance use disorders
To the Editor: The Victorian Doctors Health Program (VDHP) was established in 2001. It is the only full-time doctors’ health program in Australia. Based on similar programs in North America and Europe, the VDHP provides a comprehensive, supportive service to medical students and doctors suffering from mental health and/or substance use issues. The lifetime prevalence of substance use disorders in Australian doctors has been estimated at ...
Cheryl Wile · Kym Jenkins
Support for parents following stillbirth
Cunningham’s perspective provides a timely review of the literature relating to the maternal psychological outcomes of holding stillborn babies, which remains controversial. It is unfortunate that some popular media sources reported it incorrectly as saying that seeing and holding stillborn babies may cause harm. The correct conclusion is that the literature is inconclusive. The Australian and New Zealand Stillbirth Alliance strongly supports Cunningham’s ...
Vicki J Flenady · Christine Carroll · Ros M Richardson
The Jarisch–Herxheimer reaction in a patient with leptospirosis: a foreseeable problem in managing spirochaete infections
To the Editor: A 60-year-old male farmer presented to the Gold Coast Hospital Emergency Department with a 2-day history of fever (38.5°C), retro-orbital pain, photophobia and confusion. In the preceding 2 weeks he had been working on a farm that had cattle and horses and which was infested with rats. The property had been flooded in the 2011 Queensland flood disaster, about a month before he worked ...
Ryan Markham · Andrew Slack · John Gerrard
Does it take too long to become a doctor?
To the Editor: We read with interest McNamara’s pieces on the length of Australian medical training. The current training system is more a crude result of historical evolution than the outcome of a strong evidence base. The extra time taken by Australian doctors to become competent at a procedure is likely mirrored in other areas of medical knowledge and skill because of both internal (doctor) ...
Dev A S Kevat · James M Hillis
Problematic linkage of publicly disclosed hand hygiene compliance and health care-associated Staphylococcus aureus bacteraemia rates
To the Editor: We read with interest the letter by Playford and colleagues, but important questions remain about the authors’ methods and conclusions.1 First, not only do the data periods for assessing hand hygiene (HH) compliance and for rates of health care-associated Staphylococcus aureus bacteraemia (HCA-SAB) not overlap, but the data period for HCA-SAB rates precedes the HH compliance data period. Second, the study design ...
M Lindsay Grayson · Philip L Russo
Problematic linkage of publicly disclosed hand hygiene compliance and health care-associated Staphylococcus aureus bacteraemia rates
In reply: We thank Grayson and Russo for their interest and comments. Clearly our intent was to stimulate much-needed debate about the presentation and interpretation of publicly disclosed infection control data. Given that no study has shown a reduction in the rate of methicillin-susceptible Staphylococcus aureus bacteraemia (SAB) through increased compliance with hand hygiene (HH), we again question why the MyHospitals interpretive comments for these data ...
Elliott G Playford · David McDougall · Mary-Louise McLaws
The 2011 Brisbane floods affected residents’ health
To the Editor: The frequency and intensity of floods and other weather-related disasters is likely to increase with climate change. These disasters may affect both the physical and mental health of people who are directly affected. The extensive rainfall and subsequent flooding experienced throughout Queensland in December 2010 and January 2011 had significant impacts on large sections of the population. To assess the health impacts of the ...
Lyle R Turner · Katarzyna Alderman · Shilu Tong
Consistently high incidence of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes
To the Editor: The incidence of type 1 diabetes (T1D) in children is rising globally, including in Australia.1 Diabetic ketoacidosis (DKA) is the leading cause of diabetes-related deaths in children.2 Clinical manifestations of DKA include dehydration; rapid, deep, sighing (Kussmaul respiration); nausea; vomiting; abdominal pain and a reduced level of consciousness.2 There is an inverse relationship between the frequency of presentation with DKA and background incidence ...
Femke M A P Claessen · Kim Donaghue · Maria Craig
A screening program to detect aminoglycoside- induced ototoxicity
To the Editor: We note Ahmed and colleagues’ extensive case series of patients with severe vestibulopathy due to aminoglycosides. We attempted to develop a hospital-based screening program to detect vestibulopathy in inpatients that may be informative for others considering similar programs. We established a pilot project involving student pharmacists. Patients who received more than a single dose of any aminoglycoside antibiotic were identified by therapeutic drug ...
Maryam Teimoori · Gina Mistry · Carmela Corallo · Allen C Cheng
Hospitalisation with confirmed influenza in a sentinel surveillance system in 2010 and 2011
To the Editor: Influenza is a common respiratory infection that is infrequently associated with severe disease requiring hospitalisation. We have conducted hospital-based surveillance in the Influenza Complications Alert Network (FluCAN) since 20091 and report on our findings in 2010 and 2011. In 2010, 15 hospitals based in capital cities or large regional centres were involved, as previously described.1,2 In 2011, eight hospitals in Victoria, South Australia, Western Australia ...
on behalf of the FluCAN Investigators
Medical student-initiated anatomy education: an extracurricular experience at a regional medical school
To the Editor: The paucity of human anatomy teaching at Australian medical schools is well established. Recently, a number of 4-year graduate-entry medical schools have sought to improve anatomy knowledge among students by introducing cadaver-dissection electives and extracurricular anatomy courses. Currently, 6-year undergraduate medical programs, such as at James Cook University (JCU), incorporate more anatomy education than their graduate-entry counterparts. However, even 6-year programs offer ...
Andrew T Hattam · Claudia M Diaz
Is the non-medical use of prescription stimulants a problem in Australia?
To the Editor: There have been claims that the non-medical use of prescription stimulants is widespread and increasing in the United States and other developed countries, particularly among university students.1 In the context of rising education and general living costs, economic uncertainty and high rates of anxiety and depression among young people,2 it is plausible that some students may cope with study demands by using ...
Jayne C Lucke · Wayne D Hall
Does it take too long to become a doctor?
To the Editor: On a similar topic to the recent series by McNamara on the length of medical education, a provocative piece published earlier in the Journal of the American Medical Association suggested that medical training could be shortened by 30% in the United States, without detriment to clinical skills. The reality is that there is a paucity of evidence for the ideal duration of ...
Matthew H Anstey
Headache sufferers need to be heard too
To the Editor: The 2 April issue of the Journal contained several articles on pain, but no mention of patients who suffer with head pain. Headache is one of the commonest acute and chronic pain conditions. Studies have shown that episodic migraine affects 18% of women and 8% of men.1 Daily headache afflicts 4% of people worldwide, and half have chronic migraine.2 According to data from ...
Alessandro S Zagami
The need to tackle concussion in Australian football codes
To the Editor: I read with interest the recent article on concussion in Australian football by Gilbert and Partridge, and although it is well written, and I agree with virtually all that was said, there is a significant glaring error. In discussing the guidelines on return to play after concussion, they give the impression that the National Rugby League (NRL) is somehow lagging behind the ...
Ron Muratore
No more excuses: fracture liaison services work and are cost-effective
To the Editor: In their letter, Spencer, Howe and Manolios call for investment in fracture liaison services.1 Our own business plan showed that for an investment of $55 000 to hire a nurse, the dividend is $1.5 million in second surgeries prevented. This plan has failed to impress successive chief executive officers or their finance managers, and for good reason. The obstacle is a financial paradox. If a chief ...
Nikolai Bogduk
Nutrition competencies for the prevention and treatment of disease in Australian medical courses
To the Editor: In Australia, cancer, heart disease, stroke and diabetes mellitus contribute to 56% of all deaths,1 and have a significant nutrition-related lifestyle component. In 2008, 68% of men and 55% women were classified as overweight or obese,1 and of those in residential aged care, 50% were moderately or severely malnourished.2 Accreditation standards for medical schools (currently under review) specify that medical graduates have ...
Caryl Nowson · Marjo Roshier-Taks · Brendan Crotty
Emergency department overcrowding and mortality after the introduction of the 4-hour rule in Western Australia
To the Editor: I refer to Geelhoed and de Klerk’s article1 and related correspondence.2,3 While concerned with the rise in the overall rate of emergency department (ED) presentations, I am alarmed by the disproportionate increase in the ED admission rate (24% increase, from 3960 admissions per 10 000 ED presentations in July 2007 to June 2008, to 4910 admissions per 10 000 ED presentations in July 2010 to June 2011) since the introduction of ...
Shyan L Goh
Allergy to topical and oral goat products
To the Editor: A woman was assessed after an episode of goat cheese anaphylaxis. She had been using goat milk soap (various brands) to treat dry skin and mild eczema since 2009. In 2010, she experienced itchy mouth while eating goat cheese, and later in the year, she had contact urticaria after applying goat milk moisturiser (use discontinued). In early 2011, she developed tongue and ...
Raymond J Mullins
Testing the golden rules of infectious diseases: staphylococcal bacteriuria is predictive of staphylococcal bacteraemia
To the Editor: Medical students around the world are taught that staphylococcal bacteriuria may be indicative of concurrent bacteraemia.1 Yet there is little published evidence to support this “golden rule” of infectious diseases, and a retrospective review has suggested that no such relationship exists.2 To determine the relationship between Staphylococcus aureus (SA) bacteriuria and bacteraemia, we performed a retrospective review of microbiology results at the Alfred ...
Janine M Trevillyan · Denis Spelman
Opportunistic serological surveillance for Murray Valley encephalitis virus in Victoria, February–May 2011
To the Editor: Murray Valley encephalitis virus (MVEV) is rarely seen in south-eastern Australia, as described in the recent review in the Journal by Knox and colleagues.1 During the MVEV transmission period in early 2011, there was extensive flooding, and high notification rates were reported for other mosquito-transmitted infections, including flavivirus infection among horses. MVEV seroconversion was detected in sentinel chicken flocks. However, despite concerns ...
Joseph S Doyle · Suellen Nicholson · Jennifer A Leydon · Rodney J Moran · Michael G Catton