Synthetic drugs in South-East Asia and Oceania

The challenge of synthetic drugs in East and South-East Asia and Oceania : Trends and patterns of amphetamine-type stimulants and new psychoactive substances 2015 has been published by the United Nations Office on Drugs and Crime. The authors warn of the increase in demand for synthetic drugs in the region, as well as opportunities for transnational criminal groups to expand the illicit drug trade.

The report looks at the trends and developments in the market for both amphetamine-type stimulants (ATS) and new psychoactive substances (NPS), It also looks at the challenges for governments in their efforts to respond to the threat.

E-cigarettes: regulatory and policy options

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A briefing paper just published by the NSW Parliamentary Research Office offers an overview of the legal position in respect to e-cigarettes, as well as a summary of research findings and an overview of the current debate.  

 

E-cigarettes: regulatory and policy options by Gareth Griffith, begins with a description of e-cigarettes and the various forms they come in - with or without nicotine. The author goes on to look at the health risks, while acknowledging that the body of evidence is still small, and then looks at regulations and policies in the United States, the United Kingdom, Canad and New Zealand.  

'The downward trend in smoking ... is a public health success story. It is understandable that public health professionals and others should seek to guard against any new innovation that might jeopardise the advances that have been made in this field. It is in that context that much of the debate about e-cigarettes occurs.  In essence, the question is not whether e-cigarettes should be regulated or not; rather, it is about the degree of regulation required for e-cigarettes of all kinds, those containing and those not containing nicotine.”

Contraceptive pill and venous thromboembolism

A study published this week in the BMJ adds to the body of research supporting the theory that the

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newer contraceptive pills pose an increased risk of serious blood clots.  The authors of  the study, Use of combined oral contraceptives and risk of venous thromboembolism, looked at a series of population based, case-control studies of over 10,000 women aged 15-49 years with a first diagnosis of venous thromboembolism in 2001-13.  Their conclusion was that "risks of venous thromboembolism associated with combined oral contraceptives were, with the exception of norgestimate, higher for newer drug preparations than for second generation drugs."

Putting that study into perspective is a useful article in The Conversation today by Terri Foran from the University of New South Wales. In Don't panic about the pill – it's safer than driving to work, Foran points out that the risk of blood clots has been know for many years, even with older contraceptive preparations, and while the figures in the BMJ study are true, the risk is still very small.  "Although a doubling of clotting risk sounds alarming, it actually translates to an additional four to six cases per 10,000 users of the newer pills a year." and that "the risk of a woman dying from a road accident is approximately 25 times that of death from a pill-related clot."

Find the fulltext of the BMJ article on CIAP if you are a NSW Health employee.  Otherwise, contact your librarian.

Vinogradova, Y., Coupland, C. & Hippsley-Cox, J. Use of combined oral contraceptives and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases  BMJ 2015;350:h2135.

Australian Clinical Trials website

The Australian government and the National Health and Medical Research Council have recently launched the Australian Clinical Trials website.  The aim is to make it easier for patients to participate in clinical trials, and boost current flagging recruitment targets.  Minister for Health, Sussan Ley, has indicated that not being able to recruit enough participants is one of the main reasons for a seven per cent decline in the number of trials conducted in Australia from 2012 to 2013.

The website includes information for patients, healthcare providers, industry and researchers.  It provides a search engine for trials with information on who can enrol, what is required of participants and contact information to the head researcher.  There are also e-learning modules for both consumers and researchers about the mechanisms and benefits of clinical trials.

Musculoskeletal fact sheets

Two new fact sheets have been published by the Australian Institute of Health and Welfare:

Back problems - musculoskeletal fact sheet - about 3 million Australians (13,.6% of the population) reported having back problems according to 2011-12 ABS data.  This fact sheet explains exactly what back problems are, who gets them, how to prevent and manage them and the cost of back problems in Australia.

Osteoporosis - musculoskeletal fact sheet.  Similar information is provided on this fact sheet, which explains that about 625,500 Australians aged 50 and over (9.4%) reported having osteoporosis or osteopenia (low bone density). These conditions are more common for women (15.1%) than men (3.3%) of this age.

Obesity 2015 from The Lancet

The Lancet's special issue, Obesity 2015, includes a number of articles about obesity today, how the current food environment makes it too easy for people to eat unhealthy foods.  The editors stress the need for government regulatory action to break the cycle.

There are articles here on government and health policy, on prevention and management of obesity, and on childhood and adolescent obesity.  There is also an article on combating global obesity issues by creating healthy food environments.  The full text of all the articles in this special issue can be accessed from CIAP if you are a NSW Health employee.

Safer hospital care for dementia patients

A recent Australian study examined the impact of implementing a clinician-carer communication tool for hospitalised patients with dementia. The results indicated that the use of this simple, low-cost "Top 5" communication tool for patient care is associated with improvements in both the clinician and the care experience, with a potential benefit for patient safety.

Improving clinician–carer communication for safer hospital care: a study of the ‘TOP 5’ strategy in patients with dementia examined 21 Australian hospitals over a year, after which clinicians and carers reported high levels of acceptability and perceived benefits for patients.  

Karen Luxford , Anne Axam , Fiona Hasnip , John Dobrohotoff , Maureen Strudwick , Rebecca Reeve , Changhao Hou , Rosalie Viney.  International Journal for Quality in Health Care. 2015. DOI: http://dx.doi.org/10.1093/intqhc/mzv026. 

Full-text available through CIAP for NSW Health employees.

Incidence of Type 1 Diabetes in Australia

In 2013, there were 2,323 new cases of type 1 diabetes in Australia, equating to 11 cases per 100,000 population. This rate has remained relatively stable between 2000 and 2013, fluctuating between 10 and 13 cases per 100,000 population each year. The incidence was higher for males than for females, and more than half of all new cases were in people aged under 18 years.  

From 2001–2013, the rate of type 1 diabetes was lower in remote and very remote areas compared with other areas of Australia, with the Northern Territory having the lowest instance of all the states and territories.

Read all the statistic relating to this lifelong autoimmune disease in this AIHW report, Incidence of Type 1 Diabetes in Australia 2000-2013.  

Rheumatoid arthritis statistics updated

The Australian Institute of Health and Welfare has just updated its Rheumatoid Arthritis web pages These are part of the AIHW's new web-based musculoskeletal conditions compendium and provide the latest statistics on the condition from a wide variety of sources, as well as fact sheets and powerpoint presentations on who gets rheumatoid arthritis, how many people are hospitalised, the use of medications and quality of life of sufferers.

In 2011-12, around 2% of the population (more than 445,000 Australians), reported having rheumatoid arthritis, with 5 out of every 8 being women. In the past 10 years, the rate of hospitalisation has increased 55%.

The role of emulsifiers in chronic disease risk

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A recent article in The Conversation, by nutrition and dietetics experts Melinda Coughlan and Nicole Kellow, looks at the results of a recent study on mice which found that emulsifiers have the potential to damage the intestinal barrier, leading to inflammation and increasing our risk of chronic disease. 

Food additives and chronic disease risk: what role do emulsifiers play? is a very readable explanation of the effects of emulsifiers on the digestive system and connections with metabolic disease.  The authors are clear that the study (published in Nature Immunology) was only on mice and the results may not transfer to humans, but they conclude with the sensible advice, "these studies drive home the importance of cooking using fresh ingredients and avoiding or minimising the use of processed foods".

Diet and diabetes

An article recently published in the Australian Family Physician, Diet and diabetes, provides current evidence regarding the differing diets in diabetes prevention and management once type 2 diabetes arises. Various diets are examined, and possible complications such as hypoglycaemia are considered.

The authors maintain that diets should incorporate weight maintenance or loss, along with increases in physical activity in order to optimise the metabolic effects of dietary advice. "Using a structured, team-care approach supports pragmatic and sustainable individualised plans, while incorporating current evidence-based dietary approaches."

Deed, G., et al. (2015). Diet and diabetes.  Australian Family Physician 44(5): 288-292. 

Statins and diabetes

As a cholesterol-lowering medication, statins have been proven to be effective at reducing cardiovascular risk, if it is significantly raised.  Rethinking Statins, a program on ABC Radio National's Health Report, discusses emerging suspicions that statins may actually increase the risk of developing diabetes.

Norman Swan interviewed Naveed Sattar, Professor of Metabolic Medicine at the University of Glasgow.  Sattar and his colleagues looked at a range of randomised clinical trials and related the risk of diabetes in those who were given a statin versus a placebo.  They found that if you take any statin your risk for diabetes increases about 10% to 12%. For those on a higher dose of statin, the risk increases another 10% to 15%.

But Sattar cautions against people stopping taking statins, "We can use this new evidence in a positive way. When patients are prescribed statins, we would suggest to them that the statin might protect their heart but that doesn't necessarily mean that they can forego lifestyle changes. And in fact, the fact the statins increase diabetes risk ever so slightly suggests that actually they have more reason to take lifestyle seriously and not less."

Listen online, or read the transcript, at the link above.

Work-related injuries - changes over time

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A recent article in The Conversation highlights the changes in workplace injuries over the past fifteen
years.  While musculoskeletal injuries are becoming less prevalent, work related mental health conditions and workplace stress are becoming much more common.

Dying for work: the changing face of work-related injuries was written by Alex Collie, CEO at the Institute for Safety, Compensation and Recovery Research at Monash University.  He presents comprehensive statistics on the types of injuries over time, who pays for them and the long-term effects, and makes a compelling argument for the need for more support for mental health problems.  "Current systems of injury prevention and compensation were established in the 1970s and 1980s to address the problems of the time. But the world of work is changing."

Aboriginal and Torres Strait Islander health organisations

The Australian Institute of Health & Welfare has released Aboriginal and Torres Strait Islander health organisations: online services report - key results 2013-14, providing an overview of 269 Australian Government-funded organisations that aim to improve the health of Aboriginal and Torres Strait Islander people, including the health services and activities provided by these organisations, staffing levels and client numbers, as well as health service gaps and challenges faced by the communities they serve.

In 2013-14, 62% of these organisations were Aboriginal Community Controlled Health Organisations, 14% were other non-government organisations and 24% were government-run organisations.  76% provided primary health-care services to Aboriginal and Torres Strait Islander people and they employed 7,108 full-time equivalent staff with 53% being Indigenous.

61% of all organisations reported a service delivery gap in their communities for mental health and social and emotional health and wellbeing. 

Annual Alcohol Poll 2015

The Foundation for Alcohol Research and Education has released the Annual Alcohol Poll, 2015  which aims to assess Australians’ attitudes towards alcohol, alcohol consumption behaviours and various alcohol policies. 79% of those surveyed indicated that they consume alcohol.  34% of these drink to get drunk and 33% choose wine as their preferred alcoholic drink.   

The Poll has indicated that 75% of the almost 2000 respondents agreed that Australia has a problem with excess drinking or alcohol abuse, with 71% believing that alcohol-related problems in Australia will get worse or remain the same over the next five to ten years and 73% believing that more needs to be done to reduce the harm caused by alcohol.

Community perceptions about the alcohol industry indicated that the majority of Australians believe that the alcohol industry targets people under 18 (59%), that it has too much influence with governments (51%) and that it makes political donations to influence policy (54%).   

Pressure injury in Australian public hospitals

Pressure injuries are largely preventable within hospitals, and an adverse outcome of healthcare, but they affect millions of people.  This study, published in Australian Health Review, sought to examine in detail the economic costs of pressure injuries. In 2012–13, treatment for pressure injuries in Australian public hospitals cost A$983 million.  The severe cases (Stages III and IV) accounted for 12% of the cases and 30% of the total cost.

The authors concluded that there is an enormous economic waste for the Australian health system associated with this largely avoidable injury. One way wastage can be reduced is by preventing moderate injuries from developing into severe cases.

Pressure injury in Australian public hospitals: a cost-of-illness study
Nguyen K-H, Chaboyer W, Whitty JA Australian Health Review. 2015 [epub]. http://dx.doi.org/10.1071/AH14088
Contact your health library for the full text of this article.

Respiratory medication use in Australia 2003-2013

A report just published by the Australian Institute of Health and Welfare describes the patterns of dispensing of respiratory medications in Australia through a detailed analyses of Pharmaceutical Benefits Scheme (PBS) data, as well as other sources, to draw inferences about respiratory medication use among patients with asthma and COPD. 

Respiratory medication use in Australia 2003-2013: treatment of asthma and COPD provides evidence of "substantial over- and under-use of certain classes of medications for management of asthma and COPD. ...Our findings indicate the potential both for better health outcomes and for cost savings to patients and governments by better targeting of treatment for asthma and COPD."

Polypharmacy in older Australians

A study just published in Medical Journal of Australia has revealed that about 24% of patients aged 70 years or over had 10 or more routinely prescribed medicines on hospital admission.  The authors of Polypharmacy among inpatients aged 70 years or older in Australia examined records from 2005 to 2010 and compared the number of medicines recorded at hospital admission to the number recorded at hospital discharge.  They found there was no change in either the number or type of medicines prescribed to the patient. The authors concluded that treating clinicians could be doing more to rationalise the number of drugs prescribed during that patient's hospital stay.

Polypharmacy among inpatients aged 70 years or older in Australia.
Ruth E Hubbard, Nancye M Peel, Ian A Scott, Jennifer H Martin, Alesha Smith, Peter I Pillans, Arjun Poudel and Leonard C Gray

Med J Aust 2015; 202 (7): 373-377. doi:10.5694/mja13.00172

Communicating public health messages

Public Health Research & Practice is the first online open access public health journal.  It was launched by the Sax Institute in November 2014 and the second issue is now out and focusing on communicating public health messages to a society inundated with information. 

The guest editor for the new issue is Professor Simon Chapman, a public health advocate well known for his work in tobacco control, gun control and wind farms. His editorial gives practical advice on being an effective advocate.  There are also articles on vaccination, foetal alcohol spectrum disorders, hepatitis C and steroids, using various promotional methods.