Childhood exposure to lead and aggressive crime

Reported in news outlets this week was this Australian study testing the hypothesis that in some communities where children were exposed to high levels of lead emissions (from petrol, industrial and mining activities), there was an increase in subsequent aggressive criminal behaviours.

The study, reported as open access in the journal Environmental Health, involved a regression analysis study at suburb, state and national levels, looking at air lead concentrations 15-24 years earlier and current criminal activity.  The authors found a strong positive relationship between childhood lead exposure and subsequent rates of aggressive crime. "Given the overwhelming evidence that there is no safe lower threshold for lead toxicity, remediation programs are essential to mitigate these effects and should be a clear priority for immediate policy change."

Mark Taylor, Miriam Forbes, Brian Opeskin, Nick Parr, Bruce Lanphear. The relationship between atmospheric lead emissions and aggressive crime: an ecological study. Environmental Health 2016 15:23.  DOI: 10.1186/s12940-016-0122-3.

Interactive data for child immunisation rates

Interactive data for child immunisation rates - This interactive tool from the MyHealthyCommunities site from the National Health Performance Authority, allows you to create graphs using immunisation data for children aged 1, 2 and 5 years across Primary Health Network areas, local areas and postcodes accross Australia.  You can compare rates from previous years and compare rates for indigenous children compared to non-indigenous children.

Consultant-led ward rounds for patient safety

An opinion piece in the February issue of the Medical Journal of Australia argues that multidisciplinary consultant-led ward rounds are extremely valuable, but appear to be declining in NSW hospitals.  The authors cite recent studies showing that consultant-led ward rounds can enhance patient safety and improve outcomes and conclude that that they should be retained in modern hospitals. "In our opinion, they should be conducted daily, and led by senior medical staff capable of making informed decisions in the patients’ best interests; they should involve nurses and other relevant health professionals; and they should be adequately funded."

The value of consultant-led ward rounds for patient safety
E Leslie Bokey, Pierre H Chapuis and Owen F Dent
Med J Aust 2016; 204 (3): 100-101 

Most downloaded Cochrane Reviews and Podcasts

Most Downloaded Cochrane Reviews for 2015

1. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco
2. Water fluoridation for the prevention of dental caries
3. Chondroitin for osteoarthritis
4. Exercise for treating patellofemoral pain syndrome Personalised care planning for adults with chronic or long-term health conditions

Most Popular Cochrane Podcasts of 2015  

1. Presenting Results (Part of the ‘International Clinical Trials Day 2015’ collection) 
2. Pilates para lombalgia (Portuguese translation of Pilates for low back pain) 
3. The power of tea (Part of the ‘International Clinical Trials Day 2015’ collection)  
4. Preventing occupational stress in healthcare workers  
5. Community wide interventions for increasing physical activity

 NSW Health Staff can access more of Cochrane via CIAP

National Maternity Data Development Project

New AIHW reports published this week:
Enhancing maternity data collection and reporting in Australia: National Maternity Data Development Project Stage 2. This report presents findings of Stage 2 of the National Maternity Data Development Project, which was established in response to the National Maternity Services Plan. The aim of the Project is to build a more comprehensive and consistent national data collection for maternal and perinatal health. ISBN 9781742498867; Cat. no. PER 73.
Maternity Care Classification System: Maternity Model of Care Data Set Specification national pilot report November 2014.

This report describes a pilot test that was conducted as part of the data development work on an important element of the MaCCS: the Maternity Model of Care Data Set Specification. Included in the report is a background description of the work, methodology, logistics and the results of the pilot.
ISBN 978-1-74249-890-4; Cat. no. PER 74

What causes autism?

A useful and timely summary of our knowledge so far about autism has been published in The

Hepingting/Flickr, CC BY

Conversation today. Andrew Whitehouse, Winthrop Professor at the Telethon Kids Institute, University of Western Australia has authored What causes autism? What we know, don’t know and suspect.  He discusses some past theories about the cause of the condition - from power lines to cold mothers - and writes that scientists now believe that "A variety of genetic factors are likely to be the ultimate cause of most cases of autism. These may work by themselves, or in combination with environmental factors, to lead a child’s brain to develop differently and result in autistic behaviours."

Whitehouse goes on to explain what we know about the genetics of autism, mainly from twin studies, the complexity of contributing environmental factors, the study of the brain, and some other biological factors such as testosterone in the womb. 

Australia's population reaches 24 million.

According to the population clock at the Australian Bureau of Statistics, Australia's population
reached 24 million on Tuesday this week.

"The population clock is an indication of the current population, based on a projection calculated using births and deaths data (from the ABS) and migration figures (from the Department of Immigration and Border Protection)," said ABS Director of Demography, Beidar Cho.

The ABS has released a 90 second population milestones video to mark the occasion, To 24 million and beyond. 

Global imperative to address vaccine-preventable diseases

An article published in this month's Australian Family Physician discusses the importance of immunisation in global health. This is not time-limited, and one-off immunisation strategies are ineffective.  "The developing world should no longer experience 450,000 preventable deaths each year from rotavirus, nor 145,000 from measles. By the same token, there should no longer be 2000 preventable deaths each year from influenza in Australia. It is time to use our global health efforts to address the most pressing risks, both at home and abroad."

Gary Freed and Erin Turbitt.  The global imperative to address vaccine-preventable diseases Australian Family Physician, February 2016.  45 (1): 14-16. 

Hospitalised injuries in Aboriginal and Torres Strait Islander children

"Injury is a significant health issue for Aboriginal and Torres Strait Islander people of all ages with rates of injury for specific causes many times that of other Australians." The Australian Institute of Health and Welfare has just released a report for the years 2011-13 and found that the most common specific cause of injury among Indigenous children and young people during that time was a fall (24%). 

Assault was the leading cause of hospitalisation for Indigenous people aged 15-17 and 18-24 years, with the rate of assault injury among Indigenous children and young people being 6 times higher than that of other Australians.  The hospitalisation rate for Indigenous infants aged less than 12 months was over 8 times the rate for other Australian infants. In remote and very remote areas over half (51%) of the children and young people hospitalised due to injury were Indigenous, and this trend became more pronounced the older the children. 

Hospitalised injuries in Aboriginal and Torres Strait Islander children and young people: 2011-13 

Translating clinical leadership into quality improvement

The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. This article in the Journal of Healthcare Leadership explores some ways of translating clinical leadership into health care quality improvement. This is achieved by exploring what is clinical leadership and why and how this is important to health care quality improvement, clinical leadership, and a duty of candor.  The article also discusses the importance of clinical leadership in the provision of quality care improvement and outcomes.

McSherry R, Pearce P. (2016). What are the effective ways to translate clinical leadership into health care quality improvement? Journal of Healthcare Leadership, 2016(8), 11-17. 

Download the free article here.

New Joint Virtual Issue: Clinical Nutritional Assessment

A new Virtual Issue from the Journal of Clinical Nursing and the Journal of Human Nutrition and Dietetics has recently been published. You can read for free the editorials and articles on nutritional screening and monitoring, including malnutrition tools in hospitals, nutrition for cancer survivors and undernutrition.

Journal of Clinical Nursing: VI: Clinical Nutritional Assessment.   

1% of physicians account for 32% of Paid Claims

In America the National Practitioner Data Bank analysed 66,426 claims paid against 54,099 physicians from 2005 to 2014. It was found that approximately 1% of all physicians accounted for 32% of paid claims. Risk of recurrence also varied according to specialty - for example, the risk among neurosurgeons was four times that of psychiatrists.

It was shown that physicians who had incurred three paid claims had high risks of recurrence, with a 24% chance of recurrence within 2 years.

David M. Studdert, L.L.B., Sc.D., Marie M. Bismark, M.B., Ch.B., L.L.B., Michelle M. Mello, J.D., Ph.D., Harnam Singh, Ph.D., and Matthew J. Spittal, Ph.D. (2016). Prevalence and Characteristics of Physicians Prone to Malpractice Claims. New England Journal of Medicine, 374(4), 354-362.
(NSW Health Staff can access the full text via CIAP)

Review of volatile substance use among Aboriginal and Torres Strait Islander people

The Australian Indigenous Alcohol and Other Drugs Knowledge Centre have released a comprehensive review of volatile substance use (VSU) among Aboriginal and Torres Strait Islander people. VSU is a major issue to Aboriginal and Torres Strait Islander and non-Indigenous Australians. 

Marel C, MacLean S, Midford R (2015) Review of volatile substance use among Aboriginal and Torres Strait Islander people. Australian Indigenous HealthInfoNet.

Trends in road vehicle traffic crashes, 2001-2010

The AIHW as release its latest report on road crash trends.  It shows that rates for people seriously injured due to a road traffic crash rose from 141.6 to 146.4 per 100,000 population between 2001 and 2010. Over a quarter of these sustained life-threatening injuries. 

Rates of life-threatening injury involving motorcycle riders and pedal cycle riders rose significantly over this period, while rates involving passengers of motor vehicles and pedestrians fell.  

Trends in serious injury due to road vehicle traffic crashes, Australia: 2001-2010 

Family violence and ageism

Briony Dow (Associate Professor of Ageing and Director of the National Ageing Research Institute at the University of Melbourne) has written a short report for the Australian Institute of Family Studies on family elder abuse: Why are we abusing our parents? The ugly facts of family violence and ageism.

Dow argues that there is little public awareness of the extent and nature of elder abuse, which means that it is rarely recognised even by those who may be perpetrating or experiencing it. This form of family violence has the added complication of parental feelings coupled with shame and guilt for having “failed” as a parent, which often stop the parent from seeking help and protecting themselves.  Ageism is a contributing factor as well.

Oral health and dental care in Australia

Oral health and dental care in Australia - Key facts and figures 2015 has been published by the Australian Institute of Health and Welfare.

The report includes statistics such as the fact that in 2010, 55% of 6-year-olds had experienced decay in their baby teeth and 48% of 12-year-olds had experienced decay in their permanent teeth.  In 2013, 16% of adults with natural teeth had experienced toothache in the previous 12 months and 27% reported feeling uncomfortable about their dental appearance.  Also in 2013, approximately 19% of adults aged 65 and over had no natural teeth.  

In 2013, 64% of people aged 5 and over had visited a dental practitioner in the previous year and half had some level of private health insurance with dental cover. Total expenditure on dental services outside hospitals was $8,706 million in 2012-13, an increase from $5,945 million in 2002-03. There were approximately 56 dentists, 5 dental prosthetists, 5 dental hygienists, 3 dental therapists and 3 oral health therapists employed in Australia per 100,000 people.

Becoming a clinician researcher in allied health

Balancing research with clinical demands is difficult and requires a strategic approach. This study in the Australian Health Review involved interviewing research-active allied health professionals at regional health services in Queensland to try to pin down the factors that influence successful research projects integrated into clinical practice. 

The authors concluded that a number of factors enable clinical researcher success, including "Library resources - having a good librarian is really helpful." An understanding of the clinician researcher career trajectory may also help to develop strategies to support research capacity building.

Harvey, D. et al. Becoming a clinician researcher in allied health - Australian Health Review - 28 January 2016.

Preventing falls in hospitals - the 6-PACK program

An Australian study recently published in the BMJ evaluated the 6-PACK falls reduction program in six hospitals, involving 31,000 patients. The intervention included a fall risk tool and the use of one or more of six interventions:  "falls alert" signs, supervision of patients in the bathroom, ensuring walking aids are in easy reach, a toileting regimen, a low-low bed and a bed/chair alarm.  A randomised controlled study allocated patients to either the usual care, or the 6-PACK program.

Barker and her colleagues concluded that "no difference was seen in falls or fall injuries between groups. High quality evidence showing the effectiveness of falls prevention interventions in acute wards remains absent. Novel solutions to the problem of in-hospital falls are urgently needed."

The related editorial, by Frances Healey, examines the results more closely, noting that in the US around one million patients fall in hospitals every year, and over 250,000 in the UK, "numbers that dwarf almost all other problems with patients’ safety."  Healey recommends that local learning can be key, with incident reports being analysed to focus staff efforts where falls typically occur.

Barker, Anna L. et al. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial  BMJ 2016;352:h6781
 
Healey, Frances Preventing falls in hospitals (Editorial) BMJ. 2016; 352:i251  

Health in 2016 Cheat Sheet

Stephen Duckett from the Grattan Institute has published a handy update on Australian health in The Conversation.  Health in 2016: a cheat sheet on hospitals, Medicare and private health insurance reform updates us on the problems in the current systems, reviews currently being undertaken and the likelihood of government action on health reform.  "The health care headaches in 2016 are, in fact, the same ones we faced a decade ago, albeit different in severity and symptoms. They include population growth, ageing and the rise of chronic disease; inequality in access to care and health outcomes; technological change (the good, the bad and the expensive) and the seemingly inexorable rise in health costs."

Zika virus - sources of information

www.cdc.gov/zika

There has been much in the media in the past few weeks about the Zika virus affecting Central and South America.  Here are some authoritative sites with up to date information: 

• World Health Organisation (WHO) - Zika virus disease, Zika Virus Fact sheet, Zika virus disease: Questions and answers, Briefing notes on Zika and Microcephaly  
• U.S. National Library of Medicine (NLM) Zika Virus Health Information Resources
• U.S. National Institutes of Health (NIH) Zika Virus: An Emerging Health Threat 
• Centers for Disease Control & Prevention (CDC) - Zika Virus - various pages, information, fact sheets and posters   
• Australian Department of Foreign Affairs and Trade - Travellers' bulletin - Zika virus

Yesterday's issue of The Conversation included two short articles about the Zika virus:

Suresh Mahlingam and Michael Rolph from Griffith University are the authors of Here's why we don't have a vaccine for Zika (and other mosquito-borne viruses).  They conclude, "Zika causes mild fever in humans that on its own does not make a strong argument for a vaccine. But the possible link to microcephaly in unborn children, even though not yet definitely confirmed, makes vaccine development – and necessary funding – an urgent priority." 

Grant Hill-Cawthorne from the University of Sydney mounts a case for keeping calm about the virus, in Zika emergency status a cause for alert, not alarm. 

Safe management of expressed breast milk

The Sax Institute has published Evidence check: safe management of expressed breast milk. The authors summarise the evidence on this topic in hospitals, the home and in the community and conclude that expressed breast milk can be safely stored at -20 degrees Celsius for up to 12 months, however frozen storage at any temperature will result in degradation of the immunological components of EBM that provide protection against contamination.

An extensive literature review revealed that the main issues were the possible contamination of EBM due to improper handling, the loss of nutritional value during transport and storage and the small risk that the "wrong baby" might receive milk from someone other than their mother.

The results of this review uphold many of the findings and recommendations of the current policy developed by NSW Health (Maternity – Breast Milk: Safe Management) and the latest NHMRC infant feeding guidelines.

Domestic and family violence in specific situations

The Australian Institute of Family Studies has recently released a number of briefing papers and reports on various aspects of domestic and family violence, authored by Monica Campo:

Intimate partner violence in lesbian, gay, bisexual, trans, intersex and queer communities: key issues - looks at this issue within LGBTIQ relationships and notes the absence of acknowledgement in government and policy responses

Domestic and family violence in pregnancy and early parenthood - analyses ABS statistics on the number of pregnant women and young children affected by domestic violence

Domestic and family violence in regional, rural and remote communities - a brief overview of the particular problems faced by people affected by violence away from major cities.

Children's exposure to domestic and family violence: key issues and responses - this paper presents an overview of the effects of domestic and family violence on children, and outlines a range of evidence-based responses.

Predictions on response to anaesthesia

Research on brain activity recently published in PLOS Computational Biology may help doctors track the likelihood of patients waking up during surgery.

One of the researchers, Srivas Chennu, authored an article about the research in The Conversation, which explains the results, which  help us "better understand the transition to unconsciousness during sedation, and how this transition varies from person to person."  They gave a steadily increasing dose of propofol to twenty people who were asked to respond to various stimuli during different levels of sedation as the activity of their brain networks was measured. "We found that it was actually the strength of their brain networks before sedation that predicted why some eventually lost consciousness while others did not."

The original paper: Brain Connectivity Dissociates Responsiveness from Drug Exposure During Propofol-Induced Transitions of Consciousness.  Srivas Chennu, Stuart O’Connor, Ram Adapa, David K. Menon, Tristan A. Bekinschtein.  Published: January 14, 2016 DOI: 10.1371/journal.pcbi.1004669