Topics

The fascinating history of the multichannel cochlear implant and its inventor, Professor Graeme Clark

A cochlear implant is a surgically implanted device for converting sounds into an electrical current that directly stimulates the cochlear nerve.1 It consists of external (microphone, speech processor, transmitter) and internal components (receiver/stimulator, electrode array in the cochlea) and can be implanted in both children and adults.

1 Westmead Hospital, Sydney, NSW
2 Westmead Clinical School, University of Sydney, Sydney, NSW
3 Ear Nose & Throat Sydney, Sydney, NSW

Correspondence: joycepuikiu.ho@health.nsw.gov.au

Acknowledgements:

All images provided courtesy of Cochlear Limited.

Competing interests:

No relevant disclosures.

1. Mudry A, Mills M. The early history of the cochlear implant: a retrospective. JAMA Otolaryngol Head Neck Surg 2013; 139: 446-453.
2. National Institute on Deafness and Other Communication Disorders (NIDCD). Cochlear implants [webpage]. Updated Mar 2017. https://www.nidcd.nih.gov/health/cochlear-implants (viewed Dec 2017).
3. Sparrow R. Defending deaf culture: the case of cochlear implants. J Polit Philos 2005; 13: 135-152.
4. Simmons FB. Electrical stimulation of the auditory nerve in man. Arch Otolaryngol 1966; 84: 2-54.
5. Seitz PR. French origins of the cochlear implant. Cochlear Implants Int 2002; 3: 77-86.
6. O’Leary S. Professor Graeme Clark, otolaryngologist. Australia. Australian Academy of Science; 2011. https://www.science.org.au/learning/general-audience/history/interviews-australian-scientists/professor-graeme-clark (viewed Dec 2017).
7. Clark GM. A hearing prosthesis for severe perceptive deafness: experimental studies. J Laryngol Otol 1973; 87: 929-945.
8. Clark GM. Responses of cells in the superior olivary complex of the cat to electrical stimulation of the auditory nerve. Exp Neurol 1969; 24: 124-136.
9. Clark GM, Hallwoeth RJ, Zdanius K. A cochlear implant electrode. J Laryngol Otol 1975; 89: 787-792.
10. Clark GM. Personal reflections on the multichannel cochlear implant and a view of the future. J Rehabil Res Dev 2008; 45: 651-693.
11. Clark GM, Pyman, BC, Bailey QR. The surgery for multiple-electrode cochlear implantations. J Laryngol Otol 1979; 93: 215-223.
12. Tong YC, Black RC, Clark GM, et al. A preliminary report on a multiple-channel cochlear implant operation. J Laryngol Otol 1979; 93: 679-695.

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Perspective

The MJA–Lancet Countdown on health and climate change: Australian policy inaction threatens lives

Ying Zhang, Paul J Beggs, Hilary Bambrick, Helen L Berry, Martina K Linnenluecke, Stefan Trueck, Robyn Alders, Peng Bi, Sinead M Boylan, Donna Green, Yuming Guo, Ivan C Hanigan, Elizabeth G Hanna, Arunima Malik, Geoffrey G Morgan, Mark Stevenson, Shilu Tong, Nick Watts and Anthony G Capon

Med J Aust 2018; 209 (11): . || doi: 10.5694/mja18.00789
Published online: 29 November 2018

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Mental disorders

Health services administration

Summary

Climate plays an important role in human health and it is well established that climate change can have very significant impacts in this regard. In partnership with The Lancet and the MJA, we present the inaugural Australian Countdown assessment of progress on climate change and health.
This comprehensive assessment examines 41 indicators across five broad sections: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement.
These indicators and the methods used for each are largely consistent with those of the Lancet Countdown global assessment published in October 2017, but with an Australian focus. Significant developments include the addition of a new indicator on mental health.
Overall, we find that Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In a number of respects, Australia has gone backwards and now lags behind other high income countries such as Germany and the United Kingdom. Examples include the persistence of a very high carbon-intensive energy system in Australia, and its slow transition to renewables and low carbon electricity generation. However, we also find some examples of good progress, such as heatwave response planning.
Given the overall poor state of progress on climate change and health in Australia, this country now has an enormous opportunity to take action and protect human health and lives. Australia has the technical knowhow and intellect to do this, and our annual updates of this assessment will track Australia’s engagement with and progress on this vitally important issue.

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1 School of Public Health, University of Sydney, Sydney, NSW
2 Department of Environmental Sciences, Macquarie University, Sydney, NSW
3 School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD
4 Department of Applied Finance, Macquarie University, Sydney, NSW
5 International Rural Poultry Centre, Kyeema Foundation, Brisbane, QLD
6 Centre for Global Health Security, Chatham House, London, UK
7 School of Public Health, University of Adelaide, Adelaide, SA
8 Climate Change Research Centre, ARC Centre of Excellence for Climate Extremes, University of New South Wales, Sydney, NSW
9 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
10 University Centre for Rural Health, University of Sydney, Sydney, NSW
11 Climate Change Institute, Australian National University, Canberra, ACT
12 School of Physics, University of Sydney, Sydney, NSW
13 University Centre for Rural Health, University of Sydney, Lismore, NSW
14 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
15 Department of Clinical Epidemiology and Biostatistics, Shanghai Jiao Tong University, Shanghai, China
16 Institute of Environment and Population Health, Anhui Medical University, Hefei, China
17 Institute of Global Health, University College London, London, UK

Correspondence: ying.zhang@sydney.edu.au

Acknowledgements:

We thank Dr Elizabeth Ebert (Australian Bureau of Meteorology) for contributing indicator 2.4 (Climate information services for health). We also thank Dr Luke Knibbs (University of Queensland) who provided assistance with the PM monitor data for indicator 3.5.1 (Exposure to air pollution in cities). Indicator 3.9 (Health care sector emissions) builds on Malik et al ( 2018; 2: e27–e35) and we would like to acknowledge the co-authors of that publication: Prof Manfred Lenzen, Dr Forbes McGain and Scott McAlister. We would also like to acknowledge Fabiola Barba Ponce (Macquarie University).

Competing interests:

Anthony Capon directs the human health and social impacts research node of the NSW Adaptation Research Hub.

1. Thien F, Beggs PJ, Csutoros D, et al. The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors. Lancet Planet Health 2018; 2: e255-e263.
2. Hanna EG, McIver LJ. Climate change: a brief overview of the science and health impacts for Australia. Med J Aust 2018; 208: 311-315. <MJA full text>
3. Costello A, Abbas M, Allen A, et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet 2009; 373: 1693-1733.
4. Watts N, Adger WN, Agnolucci P, et al. Health and climate change: policy responses to protect public health. Lancet 2015; 386: 1861-1914.
5. Watts N, Amann M, Ayeb-Karlsson S, et al. The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health. Lancet 2018; 391: 581-630.
6. United Nations Framework Convention on Climate Change. The Paris Agreement. Bonn: UNFCCC, 2018. https://unfccc.int/process-and-meetings/the-paris-agreement/the-paris-agreement (viewed June 2018).
7. Zhang Y, Beggs PJ. The Lancet Countdown down under: tracking progress on health and climate change in Australia. Med J Aust 2018; 208: 285-286. <MJA full text>
8. Watts N, Amann M, Arnell N, et al. The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come. Lancet 2018; doi: 10.1016/S0140-6736(18)32594-7.
9. Guo Y, Li S, Liu DL, et al. Projecting future temperature-related mortality in three largest Australian cities. Environ Pollut 2016; 208: 66-73.
10. Xiang J, Bi P, Pisaniello D, Hansen A. The impact of heatwaves on workers’ health and safety in Adelaide, South Australia. Environ Res 2014; 133: 90-95.
11. Zander KK, Botzen WJW, Oppermann E, et al. Heat stress causes substantial labour productivity loss in Australia. Nat Clim Chang 2015; 5: 647-651.
12. Maloney SK, Forbes CF. What effect will a few degrees of climate change have on human heat balance? Implications for human activity. Int J Biometeorol 2011; 55: 147-160.
13. Kar-Purkayastha I, Clarke M, Murray V. Dealing with disaster databases – what can we learn from health and systematic reviews? PLoS Currents Disasters 2011; 3: RRN1272. doi: 10.1371/currents.RRN1272.
14. Blanchi R, Leonard J, Haynes K, et al. Environmental circumstances surrounding bushfire fatalities in Australia 1901-2011. Environ Sci Policy 2014; 37: 192-203.
15. Bi P, Hiller JE, Cameron AS, et al. Climate variability and Ross River virus infections in Riverland, South Australia, 1992-2004. Epidemiol Infect 2009; 137: 1486-1493.
16. Tong S, Bi P, Donald K, McMichael AJ. Climate variability and Ross River virus transmission. J Epidemiol Community Health 2002; 56: 617-621.
17. Tong S, Dale P, Nicholls N, et al. Climate variability, social and environmental factors, and Ross River virus transmission: research development and future research needs. Environ Health Perspect 2008; 116: 1591-1597.
18. Bannister-Tyrrell M, Williams C, Ritchie SA, et al. Weather-driven variation in dengue activity in Australia examined using a process-based modeling approach. Am J Trop Med Hyg 2013; 88: 65-72.
19. D’Souza RM, Becker NG, Hall G, Moodie KBA. Does ambient temperature affect foodborne disease? Epidemiology 2004; 15: 86-92.
20. Milazzo A, Giles LC, Zhang Y, et al. Heatwaves differentially affect risk of Salmonella serotypes. J Infect 2016; 73: 231-240.
21. Milazzo A, Giles LC, Zhang Y, et al. The effects of ambient temperature and heatwaves on daily Campylobacter cases in Adelaide, Australia, 1990–2012. Epidemiol Infect 2017; 145: 2603-2610.
22. Lake IR, Hooper L, Abdelhamid A, et al. Climate change and food security: health impacts in developed countries. Environ Health Perspect 2012; 120: 1520-1526.
23. Hochman Z, Gobbett DL, Horan H. Climate trends account for stalled wheat yields in Australia since 1990. Glob Change Biol 2017; 23: 2071-2081.
24. Australian Bureau of Statistics. Australian Health Survey: Nutrition - State and Territory results, 2011-12 (ABS Cat. No. 4364.0.55.009). Canberra: ABS, 2015. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4364.0.55.009main+features12011-12 (viewed June 2018).
25. Australian Bureau of Statistics. Australian Aboriginal and Torres Strait Islander Health Survey: Nutrition Results - Food and Nutrients, 2012–13. Canberra: ABS, 2015. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0052012-13?OpenDocument (viewed June 2018).
26. Gallegos D, Booth S, Kleve S, et al. Food insecurity in Australian households: from charity to entitlement. In: Germov J, Williams L, editors. A sociology of food and nutrition: the social appetite. 4th ed. Melbourne: Oxford University Press, 2017: 55-74.
27. Friel S, Berry H, Dinh H, et al. The impact of drought on the association between food security and mental health in a nationally representative Australian sample. BMC Public Health 2014; 14: 1102.
28. Australian Bureau of Statistics. Media release: more than half of adults are overweight and the numbers are increasing: ABS. Canberra: ABS, 2008. http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4719.0Media%20Release12004-05?opendocument&tabname=Summary&prodno=4719.0&issue=2004-05&num=&view= (viewed June 2018).
29. Australian Bureau of Statistics. National Health Survey: First Results, 2014-15 (ABS Cat. No. 4364.0.55.001). Canberra: ABS, 2015. http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001 (viewed June 2018).
30. Australian Bureau of Statistics. Consumption of Food Groups from the Australian Dietary Guidelines - a Comparison of 1995 to 2011-12 (ABS Cat. No. 4364.0.55.012). Canberra: ABS, 2017. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.012∼2011-12∼Main%20Features∼Consumption%20of%20Food%20Groups%20from%20the%20Australian%20Dietary%20Guidelines%20-%20a%20comparison%20of%201995%20to%202011-12∼10003 (viewed June 2018).
31. Quiggin J. Drought, climate change and food prices in Australia. 2007. https://d3n8a8pro7vhmx.cloudfront.net/auscon/pages/1345/attachments/original/1474000113/Climate_change_and_food_prices_in_Australia.pdf (viewed Oct 2018).
32. Myers SS, Zanobetti A, Kloog I, et al. Increasing CO2 threatens human nutrition. Nature 2014; 510: 139-142.
33. Dong J, Gruda N, Lam SK, et al. Effects of elevated CO2 on nutritional quality of vegetables: a review. Front Plant Sci 2018; 9: 924.
34. McMichael C. Climate change-related migration and infectious disease. Virulence 2015; 6: 548-553.
35. McMichael C, Barnett J, McMichael AJ. An ill wind? Climate change, migration, and health. Environ Health Perspect 2012; 120: 646-654.
36. Schwerdtle P, Bowen K, McMichael C. The health impacts of climate-related migration. BMC Med 2018; 16: 1.
37. Maxwell SL, Venter O, Jones KR, Watson JEM. Integrating human responses to climate change into conservation vulnerability assessments and adaptation planning. Ann N Y Acad Sci 2015; 1355: 98-116.
38. Tasmanian Government Department of Premier and Cabinet. Climate Action 21: Tasmania’s Climate Change Action Plan 2017–2021. Hobart: Tasmanian Climate Change Office, 2017. http://www.dpac.tas.gov.au/__data/assets/pdf_file/0015/332106/Climate_Action_21_Tasmanias_Climate_Action_Plan_20172021_June_2018.pdf (viewed June 2018).
39. Berry HL, Waite TD, Dear KBG, et al. The case for systems thinking about climate change and mental health. Nat Clim Chang 2018; 8: 282-290.
40. Ding N, Berry H, O’Brien L. The effect of extreme heat on mental health – evidence from Australia. Int J Epidemiol 2015; 44: i64.
41. Williams MN, Hill SR, Spicer J. Do hotter temperatures increase the incidence of self-harm hospitalisations? Psychol Health Med 2016; 21: 226-235.
42. ACT Government, Environment and Planning Directorate. ACT climate change adaptation strategy: living with a warming climate. Canberra: ACT, 2016. https://www.environment.act.gov.au/__data/assets/pdf_file/0004/912478/ACT-Climate-Change-Adaptation-Strategy.pdf (viewed June 2018).
43. Australian Government. National Climate Resilience and Adaptation Strategy. Canberra: Commonwealth of Australia, 2015. http://www.environment.gov.au/climate-change/adaptation/strategy (viewed June 2018).
44. Government of South Australia. Towards a resilient state: the South Australian Government’s climate change adaptation action plan. Adelaide: Government of South Australia, 2018.
45. New South Wales Office of Environment and Heritage, Local Government NSW. NSW Local Government progress and needs in adapting to climate change: Final report. 2015. http://climatechange.environment.nsw.gov.au/∼/media/9DA9CAA0C3F3478087B6C39BA88324C4.ashx (viewed June 2018).
46. Western Australian Government Department of Environment and Conservation. Adapting to our changing climate. 2012. https://www.der.wa.gov.au/images/documents/your-environment/climate-change/adapting-to-our-changing-climate-october-2012.pdf (viewed June 2018).
47. Victorian Government. Victoria’s Climate Change Adaptation Plan: 2017–2020. Melbourne: State of Victoria, Department of Environment, Land, Water and Planning, 2016. https://www.climatechange.vic.gov.au/__data/assets/pdf_file/0024/60729/Victorias-Climate-Change-Adaptation-Plan-2017-2020.pdf (viewed June 2018).
48. Armstrong F, Cooke S, Rissik D, Tonmoy F. Queensland Climate Adaptation Strategy: Human Health and Wellbeing Climate Change Adaptation Plan for Queensland. Brisbane; Queensland Government, 2018.
49. Commonwealth Government. Protecting human health and safety during severe and extreme heat events: a national framework. PricewaterhouseCoopers, 2011.
50. Bureau of Meteorology. Indigenous Weather Knowledge: Map 2. Sub divisions within the key climate groups. Melbourne: Commonwealth of Australia, 2014. http://www.bom.gov.au/iwk/climate_zones/map_2.shtml (viewed June 2018).
51. Bureau of Meteorology. Indigenous Weather Knowledge: Map 1. The key climate groups. Melbourne: Commonwealth of Australia, 2014. http://www.bom.gov.au/iwk/climate_zones/map_1.shtml (viewed June 2018).
52. Victorian Government Department of Environment, Land, Water and Planning. Victoria’s Climate Change Framework. Melbourne: DELWP, 2018. https://www.climatechange.vic.gov.au/victorias-climate-change-framework (viewed June 2018).
53. Queensland Government Department of Environment and Heritage Protection. Queensland climate change response. 2018. https://www.qld.gov.au/environment/climate/response (viewed June 2018).
54. Western Australia Department of Water and Environmental Regulation. Adapting to climate change. 2018. https://www.der.wa.gov.au/your-environment/climate-change/254-adapting-to-climate-change (viewed June 2018).
55. Tasmanian Government Department of Premier and Cabinet. Climate change priorities. Hobart: Tasmanian Climate Change Office, 2018. http://www.dpac.tas.gov.au/divisions/climatechange/Climate_Change_Priorities (viewed June 2018).
56. New South Wales Government, Office of Environment and Heritage. Adapt NSW. Sydney: NSWOEH, 2018. http://climatechange.environment.nsw.gov.au/ (viewed June 2018).
57. Government of South Australia, Department of Environment, Water and Natural Resources. South Australia’s Climate Change Strategy 2015-2050: towards a low carbon economy. no date. https://www.environment.sa.gov.au/files/sharedassets/public/climate-change/sa-climate-change-strategy-2015-2050-towards-low-carbon-economy.pdf (viewed June 2018).
58. Australian Capital Territory (ACT) Government, Environment, Planning and Sustainable Development Directorate. Climate change adaptation and resilience. Canberra: EPSDD, 2017. http://www.environment.act.gov.au/cc/what-government-is-doing/climate-change-adaptation-and-resilience (viewed June 2018).
59. Tasmania Government Department of Premier and Cabinet. Adapting to climate change in Tasmania: issues paper. Hobart: Tasmanian Climate Change Office, 2012.
60. New South Wales Government, Office of Environment and Heritage. Towards a resilient Sydney: urban adaptation research synthesis. Sydney: NSWOEH, 2014.
61. Western Australia Department of Health. Health impacts of climate change: adaptation strategies for Western Australia. Perth: Department of Health, 2008. http://ww2.health.wa.gov.au/∼/media/Files/Corporate/general%20documents/Environmental%20health/Climate%20change/Health-impacts-of-climate-change.pdf (viewed June 2018).
62. City of Adelaide. Climate Change Adaptation: Action Plan 2013-2015. https://www.cityofadelaide.com.au/assets/documents/REPORT-Energy_Efficiency_Reports_Climate_Change.pdf (viewed Oct 2018).
63. Brisbane City Council. Brisbane. Clean, green, sustainable: 2017-2031. Brisbane: Brisbane City Council, 2017.
64. City of Darwin. Climate Change Action Plan 2011-2020. Darwin: Darwin City Council, 2011.
65. Hobart City Council. Hobart City Council Corporate Climate Change Adaptation Plan 2013-2016. Hobart: Southern Tasmanian Councils Authority, 2012.
66. City of Melbourne. City of Melbourne Climate Change Adaptation Strategy. Melbourne: Maunsell Australia Pty Ltd, 2008.
67. City of Perth. Towards an energy resilient city: strategic directions paper. Perth: City of Perth, 2014.
68. City of Sydney. Adapting for Climate Change: A long term strategy for the City of Sydney. Sydney: City of Sydney, https://www.cityofsydney.nsw.gov.au/__data/assets/pdf_file/0013/250123/2016-022571-Adapting-to-Climate-Change_accessible.pdf (viewed Oct 2018).
69. World Health Organization. International Health Regulations (2005) Monitoring framework - country profiles. Geneva: WHO, 2018. http://apps.who.int/gho/tableau-public/tpc-frame.jsp?id=1100 (viewed July 2018).
70. Nairn JR, Fawcett RJB. The Excess Heat Factor: a metric for heatwave intensity and its use in classifying heatwave severity. Int J Environ Res Public Health 2015; 12: 227-253.
71. Australian Red Cross. Telecross REDi (SA): calling vulnerable and isolated people during extreme weather events [website]. https://www.redcross.org.au/get-help/community-services/telecross/telecross-redi (viewed June 2018).
72. Nitschke M, Tucker G, Hansen A, et al. Evaluation of a heat warning system in Adelaide, South Australia, using case-series analysis. BMJ Open 2016; 6: e012125.
73. Coates L, Haynes K, O’Brien J, et al. Exploring 167 years of vulnerability: an examination of extreme heat events in Australia 1844–2010. Environ Sci Policy 2014; 42: 33-44.
74. Garnaut R. The Garnaut climate change review: final report. Cambridge: Cambridge University Press, 2008.
75. Stern N. The economics of climate change: the Stern review. Cambridge: Cambridge University Press, 2007.
76. Garnaut R. The Garnaut review 2011: Australia in the global response to climate change. Cambridge: Cambridge University Press, 2011.
77. Steffen W. The critical decade: climate science, risks and responses. Canberra: Climate Commission Secretariat, 2011.
78. Steffen W, Hughes L. The critical decade 2013: climate change science, risks and responses. Canberra: Climate Commission Secretariat, 2013.
79. Steffen W, Hughes L, Karoly D. The critical decade: extreme weather. Canberra: Climate Commission Secretariat, 2013.
80. Flannery T, Beale R, Hueston G (Climate Commission). The critical decade: international action on climate change. Canberra: Commonwealth of Australia, 2012.
81. Flannery T, Sahajwalla V (Climate Commission). The critical decade: generating a renewable Australia. Canberra: Commonwealth of Australia, 2012.
82. Flannery T, Beale R, Hueston G (Climate Commission). The critical decade: global action building on climate change. Canberra: Commonwealth of Australia, 2013.
83. Hughes L, McMichael T (Climate Commission). The critical decade: climate change and health. Canberra: Climate Commission Secretariat (Department of Climate Change and Energy Efficiency), 2011.
84. Cifuentes L, Borja-Aburto VH, Gouveia N, et al. Hidden health benefits of greenhouse gas mitigation. Science 2001; 293: 1257-1259.
85. Haines A, McMichael AJ, Smith KR, et al. Public health benefits of strategies to reduce greenhouse-gas emissions: overview and implications for policy makers. Lancet 2009; 374: 2104-2114.
86. International Energy Agency. Energy policies of IEA countries. Australia: 2018 review. IEA, 2018. http://www.iea.org/publications/freepublications/publication/EnergyPoliciesofIEACountriesAustralia2018Review.pdf (viewed June 2018).
87. International Energy Agency. IEA atlas of energy. http://energyatlas.iea.org (viewed June 2018).
88. CSIRO, Energy Networks Australia. Electricity network transformation roadmap: final report. Melbourne: ENR, 2017.
89. Clean Energy Council. Clean Energy Australia: report 2018. Melbourne: Clean Energy Council, 2018. https://www.cleanenergycouncil.org.au/policy-advocacy/reports/clean-energy-australia-report.html (viewed June 2018).
90. Australian Government, Department of the Environment and Energy. The Renewable Energy Target (RET) scheme. Canberra: Commonwealth of Australia, 2017. http://www.environment.gov.au/climate-change/government/renewable-energy-target-scheme (viewed June 2018).
91. Infrastructure Australia. Remote and Indigenous communities: Australian infrastructure plan. Canberra: Australian Government, 2016. http://infrastructureaustralia.gov.au/policy-publications/publications/files/IA_J16-2330_Fact_Sheet_Remote_and_Indigenous_v1.1.pdf (viewed June 2018).
92. Indigenous Business Australia. Renewable energy transition to benefit Indigenous Australians. Canberra: Australian Government, 2017. https://www.iba.gov.au/2017/06/renewable-energy-transition-benefit-indigenous-australians/ (viewed June 2018).
93. Pope III CA, Dockery DW. Health effects of fine particulate air pollution: lines that connect. J Air Waste Manage Assoc 2006; 56: 709-742.
94. van Donkelaar A, Martin RV, Brauer M, et al. Global estimates of fine particulate matter using a combined geophysical-statistical method with information from satellites, models, and monitors. Environ Sci Technol 2016; 50: 3762-3772.
95. World Health Organization. Health risks of air pollution in Europe – HRAPIE project: Recommendations for concentration–response functions for cost–benefit analysis of particulate matter, ozone and nitrogen dioxide. Copenhagen: WHO Regional Office for Europe, 2013.
96. ClimateWorks Australia. The state of electric vehicles in Australia. Melbourne: ClimateWorks Australia, 2017.
97. International Energy Agency. Global EV outlook 2017: two million and counting. Paris: IEA, 2017.
98. New South Wales Government, Transport for NSW. Open data: household travel survey. https://opendata.transport.nsw.gov.au/search?query=household%20travel%20survey (viewed July 2018).
99. Xia T, Nitschke M, Zhang Y, et al. Traffic-related air pollution and health co-benefits of alternative transport in Adelaide, South Australia. Environ Int 2015; 74: 281-290.
100. Wiedmann T. A review of recent multi-region input–output models used for consumption-based emission and resource accounting. Ecol Econ 2009; 69: 211-222.
101. Lenzen M. Errors in conventional and input-output-based life-cycle inventories. J Ind Ecol 2000; 4: 127-148.
102. Monger HC, Kraimer RA, Khresat S, et al. Sequestration of inorganic carbon in soil and groundwater. Geology 2015; 43: 375-378.
103. Sanderman J. Can management induced changes in the carbonate system drive soil carbon sequestration? A review with particular focus on Australia. Agric Ecosyst Environ 2012; 155: 70-77.
104. Australian Government. Australia: State of the Environment. Land (2016): Soil: carbon dynamics. Canberra: Commonwealth of Australia, 2017. https://soe.environment.gov.au/theme/land/topic/soil-carbon-dynamics (viewed June 2018).
105. New South Wales Government Department of Primary Industries. Increasing soil organic carbon of agricultural land. Orange: DPI, 2008. https://www.dpi.nsw.gov.au/agriculture/soils/soil-carbon/increasing-soil-organic-carbon-of-agricultural-land (viewed June 2018).
106. CSIROpedia. The Soil Carbon Research Program (SCaRP). http://csiropedia.csiro.au/soil-carbon-research-program/ (viewed June 2018).
107. Hohmeyer OH, Bohm S. Trends toward 100% renewable electricity supply in Germany and Europe: a paradigm shift in energy policies. Wiley Interdisciplinary Rev Energy Environ 2015; 4: 74-97.
108. Australian Energy Regulator. State of the energy market, May 2017. Melbourne: AER, 2017. https://www.aer.gov.au/publications/state-of-the-energy-market-reports/state-of-the-energy-market-may-2017 (viewed June 2018).
109. Australian Energy Market Operator. Generation Information Page. Melbourne: AEMO, 2018. http://aemo.com.au/Electricity/National-Electricity-Market-NEM/Planning-and-forecasting/Generation-information (viewed June 2018).
110. Arabella Advisors. The global fossil fuel divestment and clean energy investment movement. Washington, DC: Arabella Advisors, 2016. https://www.arabellaadvisors.com/wp-content/uploads/2016/12/Global_Divestment_Report_2016.pdf (viewed June 2018).
111. Hasson AEA, Mills GA, Timbal B, Walsh K. Assessing the impact of climate change on extreme fire weather events over southeastern Australia. Clim Res 2009; 39: 159-172.
112. Murphy BF, Timbal B. A review of recent climate variability and climate change in southeastern Australia. Int J Climatol 2008; 28: 859-879.
113. Australian Bureau of Statistics. Employment in renewable energy activities, Australia, 2016-17. (ABS Cat. No. 4631.0). Canberra: ABS, 2018. http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4631.0Main+Features12016-17?OpenDocument (viewed June 2018).
114. Australian Government, Clean Energy Regulator. 2015-2016 Annual report: accelerating carbon abatement for Australia. Canberra: CER, 2016. http://www.cleanenergyregulator.gov.au/DocumentAssets/Documents/Clean%20Energy%20Regulator%20Annual%20report%20201516.pdf (viewed June 2018).
115. Coady D, Parry I, Sears L, Shang B. How large are global fossil fuel subsidies? World Dev 2017; 91: 11-27.
116. Schwanitz VJ, Piontek F, Bertram C, Luderer G. Long-term climate policy implications of phasing out fossil fuel subsidies. Energy Policy 2014; 67: 882-894.
117. Independent Pricing and Regulatory Tribunal New South Wales. Registry user guide. Energy savings scheme. Greenhouse gas reduction scheme. Sydney: IPART, 2014. https://www.ipart.nsw.gov.au/files/sharedassets/website/trimholdingbay/ggas_registry_-_registry_user_guide_-_26_february_2014.pdf (viewed June 2018).
118. Australian Government. Clean Energy Act 2011. No.131, 2011 as amended. Canberra: Federal Register of Legislation, 2011. https://www.legislation.gov.au/Details/C2013C00372 (viewed June 2018).
119. Australian Government. Carbon Credits (Carbon Farming Initiative) Rule 2015 made under section 308 of the Carbon Credits (Carbon Farming Initiative) Act 2011. Canberra: Federal Register of Legislation, 2017. https://www.legislation.gov.au/Details/F2017C00670 (viewed June 2018).
120. Australian Government. Part 1: Australian Government Budget Outcome. Table 4. Canberra: Commonwealth of Australia, 2013. http://www.budget.gov.au/2012-13/content/fbo/html/part_1.htm (viewed June 2018).
121. Australian Government. Part 1: Australian Government Budget Outcome. Fiscal Balance. Table 4. Canberra: Commonwealth of Australia, 2014. http://www.budget.gov.au/2013-14/content/fbo/html/01_part_1-03.htm (viewed June 2018).
122. Australian Government, Clean Energy Regulator. Regulatory deliverables. Annual report 2011-12. Canberra: CER, 2012. http://www.cleanenergyregulator.gov.au/About/Accountability-and-reporting/Annual-Reports/Annual%20report%202011–12/Regulatory-deliverables (viewed June 2018).
123. Lyster R. Australia’s Clean Energy Future Package: are we there yet? Legal Studies Research Paper No. 11/85. Sydney: University of Sydney, 2011. http://ssrn.com/abstract=1954238 (viewed June 2018).
124. National Climate Change Adaptation Research Facility. NCCARF Phase 2 project plan. Gold Coast: NCCARF, 2014.
125. O’Neill S, Williams HTP, Kurz T, et al. Dominant frames in legacy and social media coverage of the IPCC Fifth Assessment Report. Nat Clim Chang 2015; 5: 380-385.
126. Bain PG, Milfont TL, Kashima Y, et al. Co-benefits of addressing climate change can motivate action around the world. Nat Clim Chang 2016; 6: 154-157, 538.
127. Gasparrini A, Guo Y, Hashizume M, et al. Mortality risk attributable to high and low ambient temperature: a multicountry observational study. Lancet 2015; 386: 369-375.
128. McMichael A, Woodruff R, Whetton P, et al. Human health and climate change in Oceania: a risk assessment 2002. Canberra: Commonwealth Department of Health and Ageing, 2003.
129. Talberg A, Hui S, Loynes K. Australian climate change policy to 2015: a chronology. Department of Parliamentary Services Research Paper Series, 2015–16. Canberra: Parliament of Australia, 2016. http://parlinfo.aph.gov.au/parlInfo/download/library/prspub/4590624/upload_binary/4590624.pdf; fileType=application/pdf (viewed June 2018).
130. Climate and Health Alliance. National Consultation regarding a National Strategy on Climate, Health and Well-being for Australia: final consultation report. Melbourne: Climate and Health Alliance, 2017.

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Editorials

Reducing cardiovascular risk in people with diabetes and kidney disease

Brendon L Neuen and Vlado Perkovic

Med J Aust 2018; 209 (10): . || doi: 10.5694/mja18.00929
Published online: 19 November 2018

ARTICLE
AUTHORS
REFERENCES

Topics

Endocrine system diseases

Urologic diseases

Cardiovascular diseases

General medicine

We need to move beyond managing end organ complications to reducing cardio-renal risk across the spectrum of kidney function

Type 2 diabetes mellitus is one of the greatest challenges facing the Australian health care system. The number of Australians living with diabetes has tripled over the past 25 years, and by 2025 it is expected that 3 million adults will have been diagnosed with the disease, one of the most rapid rises for any chronic condition in Australia.1

The George Institute for Global Health, Sydney, NSW

Correspondence: VPerkovic@georgeinstitute.org.au

Acknowledgements:

Brendon Neuen is funded by a John Chalmers PhD Scholarship from the George Institute for Global Health and a University Postgraduate Award from UNSW Sydney. Vlado Perkovic receives research support from the National Health and Medical Research Council (Senior Research Fellowship and Program Grant).

Competing interests:

The George Institute for Global Health provides contract research services to Janssen for trials of sodium/glucose cotransporter 2 (SGLT2) inhibitors. Brendon Neuen receives travel support from Janssen. Vlado Perkovic is the chair of a steering committee for a renal outcome study of an SGLT2 inhibitor (canagliflozin), serves on steering committees for AbbVie, Boehringer Ingelheim, GlaxoSmithKline, Janssen and Pfizer, and serves on advisory boards or speaks at scientific meetings for AbbVie, Astellas, AstraZeneca, Bayer, Baxter, Bristol-Myers Squibb, Boehringer Ingelheim, Durect, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Novo Nordisk, Pfizer, Pharmalink, Relypsa, Roche, Sanofi, Servier and Vitae; all honoraria for these activities are paid to the George Institute for Global Health. 

1. Baker IDI Heart and Diabetes Institute, Diabetes Australia, Juvenile Diabetes Research Foundation. Diabetes: the silent pandemic and its impact on Australia. 2012. https://baker.edu.au/-/media/documents/impact/diabetes-the-silent-pandemic.ashx?la=en (viewed Sept 2018).
2. Thomas MC, Cooper ME, Zimmet P. Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease. Nat Rev Nephrol 2016; 12: 73-81.
3. Kidney Health Australia. The economic impact of end-stage kidney disease in Australia: projections to 2020. 2010. https://kidney.org.au/cms_uploads/docs/kha-economic-impact-of-eskd-in-australia-projections-2020.pdf (viewed Sept 2018).
4. Lim WH, Johnson DW, Hawley C, et al. Type 2 diabetes in patients with end-stage kidney disease: influence on cardiovascular disease-related mortality risk. Med J Aust 2018; 209: 440-446.
5. Lascar N, Brown J, Pattison H, et al. Type 2 diabetes in adolescents and young adults. Lancet Diabetes Endocrinol 2018; 6: 69-80.
6. Wanner C, Tonelli M. KDIGO clinical practice guideline for lipid management in CKD: summary of recommendation statements and clinical approach to the patient. Kidney Int 2014; 85: 1303-1309.
7. Heerspink HJL, Ninomiya T, Zoungas S, et al. Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials. Lancet 2009; 373: 1009-1015.
8. Palmer SC, Di Micco L, Razavian M, et al. Effects of antiplatelet therapy on mortality and cardiovascular and bleeding outcomes in persons with chronic kidney disease: a systematic review and meta-analysis. Ann Intern Med 2012; 156: 445-459.
9. O’Lone E, Viecelli AK, Craig JC, et al. Cardiovascular outcomes reported in hemodialysis trials. J Am Coll Cardiol 2018; 71: 2802-2810.
10. Tong A, Manns B, Hemmelgarn B, et al. Establishing core outcome domains in hemodialysis: report of the Standardized Outcomes in Nephrology–Hemodialysis (SONG-HD) consensus workshop. Am J Kidney Dis 2017; 69: 97-107.
11. American Diabetes Association. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes — 2018. Diabetes Care 2018; 41: S73-S85.
12. Diabetes Canada Clinical Practice Guidelines Expert Committee; Lipscombe L, Booth G, Butalia S, et al. Pharmacologic glycemic management of type 2 diabetes in adults. Can J Diabetes 2018; 42: S88-S103.

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Editorials

Deprescribing proton pump inhibitors: why, when and how

Peter Bytzer

Med J Aust 2018; 209 (10): . || doi: 10.5694/mja18.00674
Published online: 12 November 2018

ARTICLE
AUTHORS
REFERENCES

Topics

Pharmaceutical preparations

Digestive system diseases

The focus should primarily be on avoiding unnecessary long term prescribing of PPIs

For more than 25 years, proton pump inhibitors (PPIs) have been the mainstay of therapy for acid-related disorders, particularly peptic ulcer disease and gastro-oesophageal reflux disease (GORD). In recent decades, prescribing of PPIs has increased considerably around the world. According to a recent national drug utilisation study, prescribing of PPIs increased fourfold in Denmark between 2002 and 2014, with the increase particularly marked among older patients; 7% of all adults and 14% of adults over 60 were covered by PPI prescriptions.1 The increased prescribing of PPIs is driven primarily by the accumulation of existing users rather than by new users; inappropriate prescribing and long term use, rather than genuine clinical need for ulcer prophylaxis, appear to underlie the high prevalence of PPI prescribing.2 Changes to public subsidisation of PPI costs and interventions for improving adherence to guidelines and promoting the rational use of PPIs have not had a substantial influence on prescribing patterns.

University of Copenhagen, Køge, Denmark

Correspondence: pmby@regionsjaelland.dk

Competing interests:

No relevant disclosures.

1. Pottegård A, Broe A, Hallas J, et al. Use of proton-pump inhibitors among adults: a Danish nationwide drug utilization study. Therap Adv Gastroenterol 2016; 9: 671-678.
2. Batuwitage BT, Kingham JG, Morgan NE, Bartlett RL. Inappropriate prescribing of proton pump inhibitors in primary care. Postgrad Med J 2007; 83: 66-68.
3. Vaezi, MF, Yang YX, Howden CW. Complications of proton pump inhibitor therapy. Gastroenterology 2017; 153: 35-48.
4. Reimer C. Safety of long-term PPI therapy. Best Pract Res Clin Gastroenterol 2013; 27: 443-454.
5. Lødrup AB, Reimer C, Bytzer P. Systematic review: symptoms of rebound acid hypersecretion following proton pump inhibitor treatment. Scand J Gastroenterol 2013; 48: 515-522.
6. Haastrup P, Paulsen MS, Begtrup LM, et al. Strategies for discontinuation of proton pump inhibitors: a systematic review. Fam Pract 2014; 31: 625-630.
7. Reimer C, Bytzer P. Discontinuation of long-term proton pump inhibitor therapy in primary care patients: a randomized placebo-controlled trial in patients with symptom relapse. Eur J Gastroenterol Hepatol 2010; 22: 1182-1188.
8. Murie J, Allen J, Simmonds R, de Wet C. Glad you brought it up: a patient-centred programme to reduce proton-pump inhibitor prescribing in general medical practice. Qual Prim Care 2012; 20: 141-148.
9. Björnsson E, Abrahamsson H, Simrén M, et al. Discontinuation of proton pump inhibitors in patients on long-term therapy: a double-blind, placebo-controlled trial. Aliment Pharmacol Ther 2006; 24: 945-954.
10. Inadomi, JM, Jamal R, Murata GH, et al. Step-down management of gastroesophageal reflux disease. Gastroenterology 2001; 121: 1095-1100.
11. National Prescribing Service. Reviewing PPIs for GORD. June 2018. https://cdn0.scrvt.com/08ab3606b0b7a8ea53fd0b40b1c44f86/c052d66150fd152a/df9dd3c72fab/Reviewing-PPIs-for-GORD-algorithm-June-2018.pdf (viewed July 2018).
12. Bytzer P. Goals of therapy and guidelines for treatment success in symptomatic gastroesophageal reflux disease patients. Am J Gastroenterol 2003; 98(3 Suppl): S31-S39.

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Research letter

Gluten in “gluten-free” manufactured foods in Australia: a cross-sectional study

Emma P Halmos, Dean Clarke, Catherine Pizzey and Jason A Tye-Din

Med J Aust 2018; 209 (10): . || doi: 10.5694/mja18.00457
Published online: 12 November 2018

ARTICLE
AUTHORS
REFERENCES

Topics

Digestive system diseases

Environment and public health

Patients with coeliac disease must strictly adhere to a gluten-free diet. Two potential sources of inadvertent gluten exposure are meals provided when dining out and manufactured “gluten-free” foods. A recent study1 found that 9% of gluten-free food samples from Melbourne food businesses failed to meet the national standard of “no detectable gluten”2. As no data on gluten levels in manufactured “gluten-free” foods in Australia have been published, we measured the gluten content of a broad sample of these foods.

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1 Royal Melbourne Hospital, Melbourne, VIC
2 Monash University Central Clinical School, Melbourne, VIC
3 National Measurement Institute, Melbourne, VIC
4 Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC

Correspondence: tyedin@wehi.edu.au

Acknowledgements:

Emma Halmos was funded by a research grant from Coeliac Australia. We thank the Nielsen Company for their data on the most commonly purchased foods; and Martina Koeberl, Jasmit Khangurha and Rasika Wijerathne (National Measurement Institute) for conducting the food analyses.

Competing interests:

Jason Tye-Din is a co-inventor on patents pertaining to applications of gluten peptides in therapeutics, diagnostics, and non-toxic gluten; he is a shareholder in Nexpep and a consultant to ImmusanT (USA).

1. Halmos EP, Di Bella CA, Webster R, et al. Gluten in “gluten-free” food from food outlets in Melbourne: a cross-sectional study. Med J Aust 2018; 209: 42-43. <MJA full text>
2. Food Standards Australia New Zealand. Standard 1.2.7. Nutrition, health and related claims. Nov 2017. https://www.legislation.gov.au/Details/F2017C01048 (viewed Apr 2018).
3. Forbes GM, Dods K. Gluten content of imported gluten-free foods: national and international implications. Med J Aust 2016; 205: 316. <MJA full text>
4. Catassi C, Fabiani E, Iacono G, et al. A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease. Am J Clin Nutr 2007; 85: 160-166.
5. Zurzolo GA, Peters RL, Koplin JJ, et al. The practice and perception of precautionary allergen labelling by the Australasian food manufacturing industry. Clin Exp Allergy 2017; 47: 961-968.

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Narrative review

Preventing ovarian failure associated with chemotherapy

Wanyuan Cui, Catharyn Stern, Martha Hickey, Fiona Goldblatt, Antoinette Anazodo, William S Stevenson and Kelly-Anne Phillips

Med J Aust 2018; 209 (9): . || doi: 10.5694/mja18.00190
Published online: 5 November 2018

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

Neoplasms

General medicine

Skin and connective tissue diseases

Summary

Alkylating chemotherapy is often used to treat pre-menopausal women for various malignancies and autoimmune diseases. Chemotherapy-associated ovarian failure is a potential consequence of this treatment which can cause infertility, and increases the risk of other long term adverse health sequelae.
Randomised trials, predominantly of women undergoing alkylating chemotherapy for breast cancer, have shown evidence for the efficacy of gonadotropin-releasing hormone agonists (GnRHa) in preventing chemotherapy-associated ovarian failure.
The European St Gallen and United States National Comprehensive Cancer Network guidelines recommend the use of concurrent GnRHa to reduce the risk of ovarian failure for pre-menopausal women undergoing chemotherapy for breast cancer.
The GnRHa goserelin, a monthly 3.6 mg depot subcutaneous injection, has recently been listed on the Australian Pharmaceutical Benefits Scheme to reduce risk of ovarian failure for pre-menopausal women receiving alkylating therapies for malignancy or autoimmune disease.
The first dose of goserelin should ideally be administered at least 1 week before commencement of alkylating treatment and continued 4-weekly during chemotherapy.
Concurrent goserelin use should now be considered for all pre-menopausal women due to commence alkylating chemotherapy (except those with incurable cancer), regardless of their childbearing status, in an effort to preserve their ovarian function. For women who have not completed childbearing, consideration of other fertility preservation options, such as cryopreservation of embryos or oocytes, is also important.

1 Peter MacCallum Cancer Centre, Melbourne, VIC
2 University of Melbourne, Melbourne, VIC
3 Royal Women's Hospital, Melbourne, VIC
4 Flinders Medical Centre and Flinders University, Adelaide, SA
5 Kids Cancer Centre, Sydney Children's Hospital, Randwick, Sydney, NSW
6 Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW
7 Royal North Shore Hospital, Sydney, NSW
8 Northern Clinical School, University of Sydney, Sydney, NSW

Correspondence: kelly.phillips@petermac.org

Acknowledgements:

Kelly-Anne Phillips is a National Breast Cancer Foundation Practitioner Fellow. Martha Hickey is a National Health and Medical Research Council Practitioner Fellow. Antoinette Anazodo’s research is supported by Kids Cancer Alliance, Cancer Institute NSW Translational Cancer Research Centre (15/TRC/1-04), and CanTeen funding from the federal Department of Health.

Competing interests:

No relevant disclosures.

1. Australian Government Cancer Australia. Lymphoma statistics. https://lymphoma.canceraustralia.gov.au/statistics (viewed Jan 2018).
2. Australian Government Cancer Australia. Breast cancer statistics. https://breast-cancer.canceraustralia.gov.au/statistics (viewed Apr 2018).
3. Colvin M. Alkylating agents. In: Kufe DW, Pollock RE, Weichselbaum RR, et al, editors. Holland-Frei Cancer Medicine. 6th ed. Hamilton, ON: BC Decker, 2003.
4. Sklar CA, Mertens AC, Mitby P, et al. Premature menopause in survivors of childhood cancer: a report from the childhood cancer survivor study. J Natl Cancer Inst 2006; 98: 890-896.
5. Logan S, Perz J, Ussher JM, et al. A systematic review of patient oncofertility support needs in reproductive cancer patients aged 14 to 45 years of age. Psychooncology 2017; 27: 401-409.
6. Howard-Anderson J, Ganz PA, Bower JE, Stanton AL. Quality of life, fertility concerns, and behavioural health outcomes in younger breast cancer survivors: a systematic review. J Natl Cancer Inst 2012; 104: 386-405.
7. Jackisch C, Harbeck N, Huober J, et al. 14th St Gallen International Breast Cancer Conference 2015: Evidence, Controversies, Consensus – Primary Therapy of Early Breast Cancer: opinions expressed by German experts. Breast Care 2015; 10: 211-219.
8. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology. Fort Washington, PA: NCCN, 2017. https://www.nccn.org/professionals/physician_gls/pdf/aya.pdf (viewed Oct 2017).
9. Australian Government Department of Health. The Pharmaceutical Benefits Scheme. Goserelin. www.pbs.gov.au/medicine/item/1454M www.pbs.gov.au/medicine/item/1454M (viewed Dec 2017).
10. Demeestere I, Brice P, Peccatori FA, et al. Gonadotropin-releasing hormone agonist for the prevention of chemotherapy-induced ovarian failure in patients with lymphoma: 1-year follow-up of a prospective randomized trial. J Clin Oncol 2013; 31: 903-909.
11. Mar Fan HG, Houede-Tchen N, Chemerynsky I, et al. Menopausal symptoms in women undergoing chemotherapy-induced and natural menopause: a prospective controlled study. Ann Oncol 2010; 21: 983-987.
12. Shapiro CL, Manola J, Leboff M. Ovarian failure after adjuvant chemotherapy is associated with rapid bone loss in women with early-stage breast cancer. J Clin Oncol 2001; 19: 3306-3311.
13. Ryan J, Scali J, Carriere I, et al. Impact of a premature menopause on cognitive function in later life. BJOG 2014; 121: 1729-1739.
14. Rocca WA, Grossardt BR, De Andrade M, et al. Survival patterns after oophorectomy in premenopausal women: a population based cohort study. Lancet Oncol 2006; 7: 821-828.
15. Roness H, Kalich-Philosoph L, Meirow D. Prevention of chemotherapy induced ovarian damage: possible roles for hormonal and non hormonal attenuating agents. Hum Reprod Update 2014; 20: 759-774.
16. Millar RP, Lu Z, Pawson AJ, et al. Gonadotropin-Releasing Hormone Receptors. Endocr Rev 2004; 25: 235-275.
17. West CP, Baird DT. Suppression of ovarian activity by zoladex depot (ICI 118630), a long acting luteinizing hormone releasing hormone agonist analogue. Clin Endocrinol 1987; 26: 213-220.
18. Kerr JB, Hutt KJ, Michalak EM, et al. DNA damage-induced primordial follicle oocyte apoptosis and loss of fertility require TAp63-mediated induction of Puma and Noxa. Mol Cell 2012; 48: 343-352.
19. Ataya K, Rao LV, Lawrence E, Kimmel R. Luteinizing hormone- releasing hormone agonist inhibits cyclophosphamide induced ovarian follicular depletion in Rhesus monkeys. Biol Reprod 1995; 52: 365-372.
20. Munhoz RR, Pereira AA, Sasse AD, et al. Gonadotropin-releasing hormone agonists for ovarian function preservation in premenopausal women undergoing chemotherapy for early stage breast cancer: a systematic review and meta-analysis. JAMA Oncol 2016; 2: 65-73.
21. Moore HC, Unger JM, Phillips K, et al. Goserelin for ovarian protection during breast-cancer adjuvant chemotherapy. N Engl J Med 2015; 372: 923-932.
22. Del Mastro L, Boni L, Michelotti A, et al. Effect of the gonadotropin-releasing hormone analogue triptorelin on the occurrence of chemotherapy-induced early menopause in premenopausal women with breast cancer: a randomized trial. JAMA 2011; 306: 269-276.
23. Lambertini M, Boni L, Michelotti A, et al. Ovarian suppression with triptorelin during adjuvant breast cancer chemotherapy and long-term ovarian function, pregnancies, and disease-free survival: a randomized clinical trial. JAMA 2015; 314: 2632-2640.
24. Leonard RC, Adamson DJ, Bertelli G, et al. GnRH agonist for protection against ovarian toxicity during chemotherapy for early breast cancer: the Anglo Celtic Group OPTION trial. Ann Oncol 2017; 28: 1811-1816.
25. Garrido-Oyarzun MF, Castelo-Branco C. Controversies over the use of GnRH agonists for reduction of chemotherapy-induced gonadotoxicity. Climacteric 2016; 19: 522-525.
26. Giuseppe L, Attilio G, Edoardo DN, Loredana G, Cristina L, Vincenzo L. Ovarian function after cancer treatment in young women affected by Hodgkin disease (HD). Hematology 2007; 12: 141-147.
27. Waxman JH, Ahmed R, Smith D, et al. Failure to preserve fertility in patients with Hodgkin’s disease. Cancer Chemother Pharmacol 1987; 19: 159-162.
28. Demeestere I, Brice P, Peccatori FA, et al. No evidence for the benefit of gonadotropin-releasing hormone agonist in preserving ovarian function and fertility in lymphoma survivors treated with chemotherapy: Final long-term report of a prospective randomized trial. J Clin Oncol 2016; 34: 2568-2574.
29. Lambertini M, Falcone T, Unger JM, et al. Correspondence: Debated role of ovarian protection with gonadotrophin-releasing hormone agonists during chemotherapy for preservation of ovarian function and fertility in women with cancer. J Clin Oncol 2017; 35: 804-805.
30. Zhang Y, Xiao Z, Wang Y, et al. Gonadotropin-releasing hormone for preservation of ovarian function during chemotherapy in lymphoma patients of reproductive age: a summary based on 434 patients. PLoS One 2013; 8: e80444.
31. Salooja N, Szydlo RM, Socie G, et al. Pregnancy outcomes after peripheral blood or bone marrow transplantation: a retrospective survey, Lancet 2001; 358: 271-276.
32. Anazodo AC, Stern C, McLachlan RI, et al. A study protocol for the Australasian oncofertility registry: monitoring referral patterns and the uptake, quality and complications of fertility preservation strategies in Australia and New Zealand. J Adolesc Young Adult Oncol 2016; 5: 215-225.
33. Boumpas DT, Austin H, Vaughan EM, et al. Risk for sustained amenorrhea in patients with systemic lupus erythematosus receiving intermittent pulse cyclophosphamide therapy. Ann Intern Med 1993; 119: 366-369.
34. Blumenfeld Z. Preservation of fertility and ovarian function and minimising gonadotoxicity in young women with systemic lupus erythematosus treated by chemotherapy. Lupus 2000; 9: 401-405.
35. Clowse M, Behera M, Anders CK, et al. Ovarian preservation by GnRH agonists during chemotherapy: a metaanalysis. J Womens Health 2009; 18: 311-319.
36. Somers EC, Marder W, Christman GM, et al. Use of a gonadotropin-releasing hormone analog for protection against premature ovarian failure during cyclophosphamide therapy in women with severe lupus. Arthritis Rheum 2005; 52: 2261-2767.
37. Goldhirsch A, Gelber RD, Castiglione M. The magnitude of endocrine effects of adjuvant chemotherapy for premenopausal breast cancer patients. Ann Oncol 1990; 1: 183-188.
38. Katsifis GE, Tzioufas AG. Ovarian failure in systemic lupus erythematosus patients treated with pulsed intravenous cyclophosphamide. Lupus 2004; 13: 673-678.
39. United States Food and Drug Administration. Zoladex (goserelin acetate implant) 3.6 mg. https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/019726s059,020578s037lbl.pdf (viewed Sept 2018).

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Guideline summary

Updated clinical practice guidelines on pregnancy care

Caroline SE Homer, Jeremy Oats, Philippa Middleton, Jenny Ramson and Samantha Diplock

Med J Aust 2018; 209 (9): . || doi: 10.5694/mja18.00286
Published online: 5 November 2018

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

Digestive system diseases

Nutritional and metabolic diseases

Abstract

Introduction: The clinical practice guidelines on pregnancy care have been developed to provide reliable and standardised guidance for health professionals providing antenatal care in Australia. They were originally released as the Clinical Practice Guidelines: Antenatal Care in two separate editions (modules 1 and 2) in 2012 and 2014. These modules have now been combined and updated to form a single set of consolidated guidelines that were publicly released in February 2018 as the Clinical Practice Guidelines: Pregnancy Care. Eleven topics have been updated and new guidance on substance use in pregnancy has been added.

Main recommendations: The updated guidelines include the following key changes to practice:

recommend routine testing for hepatitis C at the first antenatal visit;
recommend against routine testing for vitamin D status in the absence of a specific indication;
recommend discussing weight change, diet and physical activity with all pregnant women; and
recommend offering pregnant women the opportunity to be weighed at every antenatal visit and encouraging women to self-monitor weight gain.

Changes in management as a result of the guidelines: The guidelines will enable pregnant women diagnosed with hepatitis C to be identified and thus avoid invasive procedures that increase the risk of mother-to-baby transmission. Women can be treated postpartum, reducing the risk of liver disease and removing the risk of perinatal infection for subsequent pregnancies. Routine testing of all pregnant women for vitamin D status and subsequent vitamin D supplementation is not supported by evidence and should cease as the benefits and harms of vitamin D supplementation remain unclear. The recommendation for health professionals to provide advice to pregnant women about weight, diet and physical activity, and the opportunity to be weighed will help women to make changes leading to better health outcomes for themselves and their babies.

1 Centre for Midwifery, Child and Family Health, UTS Sydney, Sydney, NSW
2 Burnet Institute, Melbourne, VIC
3 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
4 Robinson Research Institute, University of Adelaide, Adelaide, SA
5 Ampersand Health Science Writing, Tanja, NSW
6 Department of Health, Canberra, ACT

Correspondence: caroline.homer@uts.edu.au

Acknowledgements:

The review of the guidelines was jointly funded by the Australian Government and the states and territories. The review was project managed by the Australian Government Department of Health. The authors acknowledge the engagement and support of the Australian College of Midwives, the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, the Royal Australian College of General Practitioners and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. EWG members who have supported the review of the guidelines: Professor Jeremy Oats, University of Melbourne (co-chair); Professor Caroline Homer, University of Technology Sydney and the Australian College of Midwives (co-chair); Associate Professor Philippa Middleton, South Australian Health and Medical Research Institute Adelaide; Dr Martin Byrne, Royal Australian College of General Practitioners; Ann Catchlove, consumer representative; Lisa Clements, migrant and refugee women representative; Dr Anthony Hobbs, Commonwealth Deputy Chief Medical Officer; Tracy Martin, WA Health; Professor Sue McDonald, La Trobe University; Dr Sarah Jane McEwan, Western Australian Country Hedland Service; Professor Michael Permezel, Royal Australian College of Obstetricians and Gynaecologists; Adjunct Professor Debra Thoms, Commonwealth Chief Nursing and Midwifery Officer; Louis Young, Department of Health (Secretariat); Samantha Diplock, Department of Health (Secretariat); Anita Soar, Department of Health (Secretariat); and Jenny Ramson, Ampersand Health Science Writing (technical writer).

Competing interests:

No relevant disclosures.

1. World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO, 2016. http://apps.who.int/iris/bitstream/handle/10665/250796/9789241549912-eng.pdf?sequence=1 (viewed Jan 2017).
2. Australian Institute of Health and Welfare. Australia’s mothers and babies 2016—in brief. (AIHW Cat. No. PER 97; Perinatal Statistics Series No. 34). Canberra: AIHW, 2018. https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies-2016-in-brief/contents/table-of-contents (viewed Aug 2018).
3. Australian Government Department of Health. Clinical practice guidelines: pregnancy care. Canberra: Department of Health, 2018. www.health.gov.au/pregnancycareguidelines (viewed June 2018).
4. Australian Health Ministers’ Advisory Council. Clinical practice guidelines: antenatal care — module 1. Canberra: Department of Health and Ageing, 2012.
5. Australian Health Ministers’ Advisory Council. Clinical practice guidelines: antenatal care — module 2. Canberra: Commonwealth of Australia, 2014.
6. Guyatt G, Oxman A, Vist G, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924-926.
7. Guyatt G, Oxman A, Kunz R, et al. Going from evidence to recommendations. BMJ 2008; 336(7652): 1049-1051.
8. Australian Government Department of Health. Hep C medicines: the facts. June 2017. http://www.pbs.gov.au/publication/factsheets/hep-c/files/hepc-factsheet-consumers-what-is-hep-c.pdf (viewed Mar 2018).
9. Australian Bureau of Statistics. 4364.0.55.006 - Australian Health Survey: biomedical results for nutrients, 2011-12. Canberra: ABS, 2014. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4364.0.55.006Chapter2002011-12 (viewed June 2016).
10. McDonald S, Zhen H, Sohail M, Joseph B. Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses BMJ 2010; 341: c3428.
11. Magro-Malosso E, Saccone G, Di Mascio D, et al. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials. Acta Obstet Gynecol Scand 2017; 96: 263-273.

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Editorials

Pre-conception care: an important yet underutilised preventive care strategy

Deborah J Bateson and Kirsten I Black

Med J Aust 2018; 209 (9): . || doi: 10.5694/mja18.00769
Published online: 5 November 2018

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

Environment and public health

Parental health prior to conception is increasingly recognised as being important for the health of future generations

Pre-conception care is the provision of health recommendations to women of reproductive age with the goal of improving short and long term health outcomes for both the mothers and their children. It includes an assessment of medical conditions, vaccination status, and lifestyle factors.1 While pre-conception care will benefit any woman contemplating pregnancy, it is particularly important for women with medical conditions such as diabetes and obesity. Nevertheless, it is often underutilised.2 In this article, we describe strategies for overcoming challenges to providing pre-conception care and provide guidance for time-poor clinicians.

1 Family Planning New South Wales, Sydney, NSW
2 University of Sydney, Sydney, NSW
3 Royal Prince Alfred Hospital, Sydney, NSW

Correspondence: deborahb@fpnsw.org.au

Competing interests:

No relevant disclosures.

1. Royal Australian College of General Practitioners. Preventive activities prior to pregnancy. In: Guidelines for preventive activities in general practice. 9th edition. Melbourne: RACGP, 2017. https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/red-book/preventive-activities-prior-to-pregnancy (viewed Sept 2018).
2. McElduff A, Ross GP, Lagstrom JA, et al. Pregestational diabetes and pregnancy: an Australian experience. Diabetes Care 2005; 28: 1260-1261.
3. Rassi A, Wattimena J, Black K. Pregnancy intention in an urban Australian antenatal population. Aust N Z J Public Health 2013; 37: 568-573.
4. Mazza D, Chapman A, Michie S. Barriers to the implementation of preconception care guidelines as perceived by general practitioners: a qualitative study. BMC Health Serv Res 2013; 13: 36.
5. Bellanca HK, Hunter MS. ONE KEY QUESTION: preventive reproductive health is part of high quality primary care. Contraception 2013; 88: 3-6.
6. Tommy’s. Planning for pregnancy [website]. 2018. https://www.tommys.org/pregnancy-information/planning-pregnancy/planning-for-pregnancy-tool (viewed Sept 2018).
7. De-Regil LM, Peña-Rosas JP, Férnandez-Gaxiola AC, Rayco-Solon P. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev 2015; (12): CD007950.
8. Harding KB, Peña-Rosas JP, Webster AC, et al. Iodine supplementation for women during the preconception, pregnancy and postpartum period. Cochrane Database Syst Rev 2017; (3): CD011761.
9. Schummers L, Hutcheon JA, Bodnar LM, et al. Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population-based study to inform prepregnancy weight loss counseling. Obstet Gynecol 2015; 125: 133-143.
10. Boggess KA, Edelstein BL. Oral health in women during preconception and pregnancy: implications for birth outcomes and infant oral health. Matern Child Health J 2006; 10: 169-174.
11. Blatt K, Moore E, Chen A, et al. Association of reported trimester-specific smoking cessation with fetal growth restriction. Obstet Gynecol 2015; 125: 1452-1459.
12. Lassi ZS, Imam AM, Dean SV, Bhutta ZA. Preconception care: caffeine, smoking, alcohol, drugs and other environmental chemical/radiation exposure. Reprod Health 2014; 11: S6.
13. Conde-Agudelo A, Rosas-Bermúdez A, Kafury-Goeta AC. Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. JAMA 2006; 295: 1809-1823.
14. Hanley GE, Hutcheon JA, Kinniburgh BA, Lee L. Interpregnancy interval and adverse pregnancy outcomes: an analysis of successive pregnancies. Obstet Gynecol 2017; 129: 408-415.
15. Guerin A, Nisenbaum R, Ray JG. Use of maternal GHb concentration to estimate the risk of congenital anomalies in the offspring of women with prepregnancy diabetes. Diabetes Care 2007; 30: 1920-1925.
16. Lassi ZS, Imam AM, Dean SV, Bhutta ZA. Preconception care: screening and management of chronic disease and promoting psychological health. Reprod Health 2014; 11: S5.
17. Australian Government Department of Health. Immunisation for pregnancy. https://beta.health.gov.au/health-topics/immunisation/immunisation-throughout-life/immunisation-for-pregnancy (viewed Sept 2018).
18. Zaballa K, Liu A, Peek MJ, et al. Association between World Health Organization categories of body mass index and relative risks for weight-related pregnancy outcomes: a retrospective cohort study. Obstet Med 2012; 5: 112-118.
19. Oteng-Ntim E, Mononen S, Sawicki O, et al. Interpregnancy weight change and adverse pregnancy outcomes: a systematic review and meta-analysis. BMJ Open 2018; 8: e018778.

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Pagination