Worldwide trends in diabetes since 1980

Worldwide trends in diabetes since 1980 : A pooled analysis of 751 population-based studies with 4·4 million participants has recently been published in The Lancet as an open access article. A global target is to keep the incidence of adult diabetes at 2010 levels by 2025. This analysis aimed to see if this target was likely to be achieved, and whether population growth and ageing are affecting the numbers of people living with this disease. 

The researchers looked at data on diabetes in 200 countries from 1980-2014 and found that since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. This has led to a near quadrupling of the number of adults with diabetes worldwide and is much worse in low-income and middle-income countries. 

NCD Risk Factor Collaboration. The Lancet Vol. 387, No. 10027, p 1513–1530, 9 April 2016 http://dx.doi.org/10.1016/S0140-6736(16)00618-8

Reducing discharge against medical advice

An issues brief from the Deeble Institute (AHHA) looks at the role of Aboriginal Health Workers and Liaison Officers in trying to reduce instances of self-discharge, particularly in rural and remote communities.

An evidence-based approach to reducing discharge against medical advice amongst Aboriginal and Torres Strait Islander patients by Caitlin Shaw, makes a number of recommendations, including:

• Improving cultural competency training and cultural safety frameworks in hospitals 
• Developing a nationally recognised scope of practice for Aboriginal Health Workers (AHWs) and Aboriginal Liaison Officers (ALOs) 
• Developing more flexible community-based care models to provide culturally appropriate care for Aboriginal and Torres Strait Islander patients. 

Chronic disease risk factors

Another useful web report from the AIHW presents the relationship between selected chronic diseases and behavioural and biomedical risk factors. Behavioural risk factors include poor diet, smoking and excessive alcohol consumption. Biomedical risk factors include obesity and high blood pressure. Many chronic diseases have common behavioural and biomedical risk factors, so modifying these can reduce an individual's risk of developing a chronic disease.

Access the chronic disease risk factors pages here

Chronic kidney disease facts

One in ten Australian adults suffer from chronic kidney disease, which is associated with several other chronic diseases, such as diabetes and cardiovascular disease.  It is a significant contributor to mortality in Australia, contributing to 10% of all deaths in 2013. The Australian Institute of Health and Welfare has provided a web report with all the latest information, facts and figures associated with this condition.

Access the CKD site here

Health risks from electronic cigarette vapour

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A recent paper in the journal Public Health Research & Practice aimed to summarise and review all studies that have examined potential adverse health effects of passive exposure from inhaling e-cigarette vapour. 

A systematic review of the health risks from passive exposure to electronic cigarette vapour looked at both the absolute and relative impact of exposure to vapour, as compared to the passive exposure of inhaling ordinary cigarette smoke. The systematic review, which included 16 studies, found that those passively exposed to the vapours of e-cigarette users are exposed to numerous pollutants that are associated with potential adverse health effects.  However, this risk is likely to be less than the risk from passive exposure to conventional cigarette smoke.

Isabel M.R. Hess et al, Public Health Research & Practice 2016;26(2):e2621617 doi: http://dx.doi.org/10.17061/phrp2621617

Allied Health: Integral to transforming health

An article in the Australian Health Review this month looks at the way allied health professionals have been used in the South Australian healthcare system to improve the quality of patient outcomes and "offer innovative solutions for future sustainable healthcare".

Allied Health ; Integral to transforming health reported on a survey of allied health clinicians, educators, researchers, policy makers and managers, and layered the results with a review of the literature. The authors concluded that allied health practitioners are in a position to implement strategies to slow down the growth in healthcare expenditure and improve the patient experience, assisting in the transformation of healthcare in Australia. In order for this to happen, there should be concerted efforts to increase recognition of and support for the use of allied health services, which are often undervalued.

Lucylynn Lizarondo, et al. Australian Health Review, 40(2), 194-204 dx.doi.org/10.1071/AH15044

EU drug markets report

The European Monitoring Centre for Drugs and Drug Addiction has published the 2016 EU Drug Markets Report: an in-depth Analysis which provides a "unique insight into the operation of illicit drug markets in the EU". 

The report assesses the impact of the drug market on society and the factors driving it. It explores the market for cannabis, heroin, cocaine, amphetamines, MDMA and new psychoactive substances. "Understanding these hidden markets, and the actors involved, is essential to making sound policy decisions with lasting impact."  

Indigenous health issue of ANZ Journal of Public Health

The Australian and New Zealand Journal of Public Health has released a special indigenous health issue this month.  All articles are available in full text on open access and include:

• Accuracy of patient self-report of screening for diabetes, high cholesterol and cervical cancer
• Insights into nutritionists' practices and experiences in remote Australian Aboriginal communities
• Legally invisible: stewardship for Aboriginal and Torres Strait Islander health  
• Economic feasibility of price discounts to improve diet in Australian Aboriginal remote communities
• The effect of nutrition education on nutrition-related health outcomes of Aboriginal and Torres Strait Islander people: a systematic review
• Trachoma in remote Indigenous Australia: a review and public health perspective 

Australian and New Zealand Journal of Public Health. Special Issue: Indigenous Health

April 2016. Volume 40, Issue S1

Support for people with chronic and complex conditions

"Australia is experiencing increasing rates of chronic and complex conditions, which challenge our current primary health care system and its connection to secondary care. 35% of Australians, over 7 million people, have a chronic condition, and an increasing number have multiple conditions, making care more complex and requiring input from a number of health providers or agencies". This is from the Primary Health Care Advisory Group's report to the government about the improved management of people with complex and chronic diseases, Better outcomes for people with chronic and complex health conditions. 

In August 2015 a comprehensive national consultation process was undertaken, with the public, peak organisations and health professionals all contributing to the Advisory Group’s development of options for primary health care reform. The Advisory Group has recommended a Health Care Home model to deal with conditions comprehensively on an ongoing basis.

WHO Global Report on Diabetes

The World Health Organization has published it's first Global Report on Diabetes the week. It shows there are four times as many diabetics in the world now as there were 30 years ago and the disease was responsible for the deaths of 3.7 million people in 2012.

"There are no simple solutions for addressing diabetes but coordinated, multicomponent intervention can make a significant difference. Everyone can play a role in reducing the impact of all forms of diabetes. Governments, health-care providers, people with diabetes, civil society, food producers and manufacturers and suppliers of medicines and technology are all stakeholders. Collectively, they can make a significant contribution to halt the rise in diabetes and improve the lives of those living with the disease."

Influence of pharmaceutical sales reps

Two articles in The Conversation this week examine the influence of drug companies in prescribing patterns in health professionals.

Barbara Mintzes from the University of Sydney's article, We can't trust drug companies to wine, dine and educate doctors about the drugs they prescribe refers to a Sydney Morning Herald exposé last week which cited $43 million worth of industry spending on health professionals in Australia over just six months. Mintzes links to evidence that despite doctors' claims that their prescribing is not effected by this spending, it actually seems to be. 

Another University of Sydney author, Quinn Grundy argues that nurses are also influenced by drug company representatives, even though they don't actually prescribed.  Nurses have a great deal of influence in decisions affecting patient care. Invisible influence: why sales reps are forming relationships with nurses. 

Global obesity report from the Lancet

An open-access report published in The Lancet this week predicts that if trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women. Severe obesity will surpass 6% in men and 9% in women.

The report from the NCD Risk Factor Collaboration included 19.2 million people in 200 countries, where the researchers estimated trends in mean BMI. Although underweight remains prevalent in the world ’s poorest regions, especially in south Asia, more people in the world are now obese than underweight. Australian men rank 5th in the world with 27.6% obese, and Australian women rank 9th, with 27.9%.

A useful interpretation of the results, including graphs and an interview with one of the major researchers can be found in the Sydney Morning Herald (April 2, 2016) article, Obesity a bigger problem than world hunger, Lancet study says by Catherine Armitage and Inga Ting.

NCD Risk Factor Collaboration. (2016). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19· 2 million participants. The Lancet, 387(10026), 1377-1396.

Rapid Response Teams in hospitals

The April 2016 issue of Intensive Care Medicine includes an article and a series of editorials on rapid response teams (RRT) and their impacts. Do they improve patient outcomes?  All the authors call for further research to determine ideal RRT staffing, factors that contribute to the need for an RRT, and how rapid response affects the safety of patients. 

The primary article by Jung et al is Rapid response team and hospital mortality in hospitalised patients.  The study in France showed that RRT “was associated with a significant decrease in unexpected and overall mortality of inpatients.”

The editorials present different sides of the issue. Rapid response teams improve outcome: yes, by Jones et al, supports RRTs. Maharaj and Stelfox in Rapid response teams improve outcome: no argue the opposite. In Rapid response teams improve outcome: we are not sure, Wendon and colleagues say the evidence is inconclusive. 

NSW Health employees can access Intensive Care Medicine through CIAP, or contact your librarian. 

Climate change and health in Australia fact sheets

Doctors for the Environment Australia has developed fact sheets to outline the effects of climate change on human health particularly in Australia. There is a two-page "mini" fact sheet, and a four-page "full" fact sheet.

Some of the issues discussed include natural disasters framed by climate change (such as bushfires, floods, storms and cyclones) and how they affect health, as well as extreme heat, an increase in infectious diseases and mental health issues, and the effects of climate change on allergens, air pollution and food production.  There is a useful and very up to date reference list included on the longer fact sheet.

Links to the fact sheets are on the top right hand side of this page.

Patterns of use of mental health services and prescriptions, 2011

the Australian Bureau of Statistics has released a new dataset anaysis: Patterns of Use of Mental Health Services and Prescription Medications, 2011.  It explores patterns of use of Medicare Benefits Schedule (MBS) subsidised mental health-related services and Pharmaceutical Benefits Scheme (PBS) subsidised mental health-related medications in 2011,  

In 2011 there were 3.2 million people (15.0% of all Australians) who accessed at least one MBS or PBS subsidised mental health-related treatment (either a service such as a consultation with a psychologist, or medication, or both). Overall, females were more likely to have used a mental health-related treatment than males: almost one in five females (18.2%) compared with around one in nine males (11.7%).