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Part of Englemed's international health news services
Put news on your site! News provider to - exclusively for Australian doctors Reports by Austramed editor
Charisse Ede
News Special from
the Royal Australasian College of Physicians
Brisbane, May 6-8 2002

Tuesday May 7th

Asylum children neglected
May 7 - There is compelling evidence that Australia is not effectively helping the children of asylum seekers or refugees, according to an immigrant health expert.

Dr James Rice said there remained too many barriers to health for immigrants, including language and culture.

He said almost half of the parents attending his immigrant health centre at the Royal Children's Hospital in Melbourne did not speak English, more than one third did not have a GP and there was a lack of interpreters.

As a result, they did not persist with their children's vaccinations and treatments, causing ongoing illness.

Speaking at the conference yesterday, Dr Rice also revealed the centre had discovered an alarming trend of Vitamin D deficiency among immigrant children.

He said a survey of more than 100 children found 53 per cent with the deficiency, mostly in those who had come from hot and sun-soaked countries such as the Middle East and countries from the Horn of Africa.

"By the time they had been here (in Australia) for more than 12 months, their serum 2 level had halved," he said.

Dr Rice said the clinic now faced a number of treatment dilemmas, including cost, compliance, safety and efficacy.

And he said a number of new issues were emerging, including female circumcision, nutrition and poor dental health.

Meanwhile, the medical officer in clinical audit at the Prince Charles Hospital in Queensland, Dr Helen Ward, revealed autopsy rates had been significantly affected by last year's "body parts scandal".

Giving a presentation yesterday, she said the refusal rate for autopsy increased to 30 per cent for the four months to May 2001 - directly after the negative press coverage.

Tuesday May 7th

Fatigue syndrome guidelines
May 7 - The RACP's Clinical Practice Guidelines for Chronic Fatigue Syndrome have been officially launched this week.

The guidelines have been under development for almost six years and follow an intensive review of scientific literature, expert submissions and widespread comment.

Primarily aimed at assisting general practitioners, they are also relevant to specialists physicians and healthcare professionals involved in managing people with fatigue states.

The term CFS is used to define a recognisable pattern of symptoms that cannot be attributed to any alternative condition.

The symptoms are currently believed to result from disturbed brain function, but the underlying pathology is not know. As a result, CFS cannot be designed as a specific disease at present.

According to the report, prolonged and disabling fatigue is present in 10-25 per cent of patients presenting to GPs, and predominantly affects young adults.

Tuesday May 7th

Cards to cut teen deaths
May 7 - MEDICARE cards should be issued to all young Australians when they reach the age of 15, as part of a strategy to reduce youth suicide rates.

The proposal is one of more than 30 wide-ranging recommendations made by the Royal Australasian College of Physicians Cottrell Conference 2001, which focused on youth suicide within the wider sphere of youth health.

Releasing its draft recommendations at this week's JSM, the conference delegates have identified needs in three categories - those for the RACP, those to be done with RACP collaboration, and initiatives for the general community.

The recommendations were developed from the two-day conference involving 33 experts from Australia and New Zealand across a wide range of disciplines.

Youth suicide rates in Australia and New Zealand lead those in OECD countries.

The conference identified an overall deficit in the provision of health services in both countries, with the majority of youth services delivered by practitioners from various other disciplines.

"Funding for and access to youth and adolescent services were major considerations. There was a recognition that adolescent health needed to be on an agenda which applied to training, assessment and advocacy.

Among the recommendations was a proposal for adolescent health and practise training for all health care workers, guidelines for suicide prevention and universal health care for young people.

The report calls for the RACP to hold a scientific meeting on adolescent health involving other key organisations and for revival of the college's three-year training programme in adolescent health.

Other recommendations include RACP collaboration with universities to include adolescent medicine training for undergraduate medicine students, development of key learning indicators for health workers and determining priorities for research where gaps exist.

In its conclusion, the report says the conference enabled the development of many useful networks between people working in similar yet diverse geographical and discipline settings.

"The RACP is pleased to have facilitated a meeting of an export group that focussed on promoting policy, research and health services," it says.

"It is important to make a real difference in reducing the tragic loss of young lives."

Monday May 6th

Winning the fire ant war
May 6 - QUEENSLAND authorities are on track to eradicate the deadly fire ant, which has spread through 37,000 hectares of land in Brisbane and has the potential to ruin Australia's quality of life.

Last year the first Australian case of an anaphylactic reaction to bites from the aggressive ants was recorded in Brisbane, about six years after the ants were believed to have arrived in Australia on a cargo ship from South America.

Yesterday Dr Greg Knight, a consultant occupational physician for the Port of Brisbane Corporation, outlined the damage a colony of fire ants could do, the extent of its invasion in Australia and government efforts to eradicate them.

"The potential magnitude of this is that 30-60 per cent per annum of the public living in infested areas are likely to be attacked," he told delegates.

"Within six years, there will be no such thing as a local national park. You won't have picnics, you won't have backyard barbecues, because they are dreadful beasts."

Dr Knight said deaths usually resulted from overwhelming toxicity from 100,000s of stings inflicted on a victim.

He said the anaphylactic reaction happened in a 47-year-old man who had been bitten by the ants on a number of separate occasions over about 18 months.

Dr Knight said occupational medicine had a pivotal role in working with clinical, environmental and public health in Australia and globally.

He said the last report on the government's $150 million eradication project indicated a high possibility of successful eradication.

"If this war is not successful then it will change our quality of life enormously," he said.

Monday May 6th

Bioterrorism alert
May 6 - The world's medical professionals must be aware of the advances in bioterrorism in order to contain the "most irrational of irrational acts", Sir Gustav Nossal said yesterday.

Bioterrorism alert from Sir Gus Giving the Cottrell Memorial lecture to a packed audience, Sir Gustav said between 10 and 17 countries have or have recently had offensive bioterrorism weapon research capabilities. While Russia was a major player in the field, the three most active countries were now Iraq, Iran and North Korea, he said.

Sir Gustav outlined some of the potential pathogens that are being used or could be used in bioterrorism attack, including smallpox, anthrax, the Ebola Virus and Lassa Fever.

While anthrax has already emerged as a highly sophisticated weapon, Sir Gustav said smallpox was the most dangerous for a number of reasons.

He said noone under the age of 30 had been immunised against the disease - putting the soldiers on the front line at risk - and was easy to grow.

As a result, he said the United States was stockpiling 300 million doses of smallpox vaccines - enough for every person in the country - while the United Kingdom was gathering stores of the vaccine on a lesser scale.

Sir Gustav said anthrax was easy to grow and "weaponise", and the highly sophisticated versions sent via mail in the US must have been developed by an expert using the latest technology.

But the vaccine is not as effective as that for smallpox, although antibiotics work very well if given early on, he said.

Sir Gustav questioned the need for countries to spend billions of dollars on defending themselves from potential bioterrorism weapons, when nothing may ever happen.

"I think here in Australia, our Foreign Affairs Department would be best served by keeping a watching brief ," he said. "But I do not think that we are a target of bioterrorism here."

Sir Gustav also spoke about the connection between health and economic development, with countries slowly recognising the link between sickness and losses in productivity.

Global interventions against infections and nutritional deficiencies would cost an extra $30 billion - equal to 0.1 per cent of world Gross Domestic Product, he said.

But he said the returns on that investment would far outweigh the costs - saving 8 million lives and a direct economic benefit of $186 billion per year in improved productivity.

"So you would be saving six times as much as you would be spending," he said.

Sir Gustav gave an overview of the status of vaccination and world efforts to improve vaccination.

Monday May 6th

Getting women into medicine
May 6 - FEMALE mentors, professional development and leadership courses and a more visible presence on editorial and research grant boards would help to improve the career options for women in medicine, a forum found today.

The Women in Medicine forum, chaired by the incoming deputy president of the RACP, Dr Jill Sewell, found family responsibility and rigidity of career structure remained the greatest hurdles for female physicians and researchers.

Dr Judy Savage, of the Austin and Repatriation Medical Centre in Melbourne, said gaining research grants, having research published and sitting on research and editorial boards was one of the best ways of advancing a medical career.

But she said the odds were often stacked against women, with boards often dominated by men and the selection process for editorial boards unclear, and few women sought career advancement in the way men did.

"Women don't network as well," she told the lunchtime gathering.

She says a greater range of female-specific courses from institutional bodies such as the RACP would help inspire more women to seek higher goals.

At the same forum, Melbourne paediatrician Katie Heathershaw shared her experience of setting up her own practice - turning her dream into a reality.

Ms Heathershaw, who started a multi-disciplinary practice to enable her to work part-time, said there was a need for business development to be included in medical degrees to arm professionals with the skills to venture out on their own.

Dr Sewell, who is also the outgoing president of the Paediatrics and Child Health Division, said she would use the recommendations from both talks in an action plan looking at ways the college can further support women in medicine.

Monday May 6th

Focus on developing world health
May 6 - The September 11 terrorist attacks in the United States may have devastated communities, but it threw the health issues of the third world into the global arena for the first time, according to one of Australia's leading world health experts.

Sir Gustav Nossal, who has and continues to stand on a number of world health bodies, says September 11 has placed a new spotlight on global inequities and huge disparities in living standards, and global communities are finally taking them seriously.

"Naturally, the seeds of the hatreds that breed terrorism are deeply rooted in history, but being left behind in the global march of progress constitutes a common thread," he says.

"Building north-south partnerships for greater social justice represents an indirect yet very powerful counterbalancing force."

Sir Gustav will outline the impacts of the September 11 events on world health in the Cottrell Memorial lecture at the annual conference of the Royal Australasian College of Physicians.

The conference is being held in Brisbane, jointly with the Royal College of Physicians of Thailand.

A formidable authority on the issue, Sir Gustav has been the chair of the World Health Organization's vaccines and biologicals program since 1993, and is the chairman of the strategic advisory council of the Bill and Melinda Gates Children's Vaccine Program.

He was the president of the world body of immunology, the International Union of Immunological Societies, president of the Australian Academy of Science and a member of the Prime Minister's Science, Engineering and Innovation Council from 1989 to 1998.

On top of that, he was named Australian of the Year in 2000, has won numerous honours from 11 countries, was knighted in 1977 and made a Companion of the Order of Australia in 1989.

Sir Gustav says education and health are equally important in building global partnerships and social justice.

He says three international programmes are spending billions of dollars on the treatment of diseases in some of the world's poorest nations, including the Global Fund for AIDS, TB and malaria and the Global Alliance for Vaccines and Immunization.

In the lecture, he will discuss the initiatives and point to the importance of joint private and public sector funding for progress of the programs.

Monday May 6th

Tobacco threat to world
May 6 - Unless there is a dramatic change in the world's smoking habits, tobacco is projected to cause 8.5 million deaths a year by 2020 - most of them in developing countries.

By the same date, the five leading causes of global disease burden are projected to be ischaemic heart disease, depression, traffic accidents, cerebrovascular disease and COPD.

These startling figures have been projected in the Global Burden of Disease Study, launched in 1992 by the World Health Organization and other bodies to help determine the world's health needs both now and in the future.

One of the instigators of the study and one of the world's foremost experts in the field, Dr Alan Lopez, will outline the study and how it will impact setting priorities in health at today's Redfern Oration at 11am.

Dr Lopez is the coordinator of the Epidemiology and Burden of Disease Unit of the World Health Organization in Geneva, Switzerland, and is responsible for directing and managing WHO's epidemiology and biostatistics activities.

Started in 1992 but back dated to 1990, the GBD study prepared global and regional estimates of incidence, prevalence, mortality, duration and severity for more than 100 diseases and injuries, and projected illnesses to 2020.

It is regarded as the major global evidence-based data set for setting priorities in the health sector.

Dr Lopez says the study found major regional differences in disease burden, with more than 40 per cent of all fatal and non-fatal diseases (Disability Adjusted Life Years: DALYs) in India and Sub-Sahara Africa alone.

This compares with 10 per cent in the developed regions.

Dr Lopez says the most significant change to disease burden rankings since 1990 is for HIV/AIDs, which is now estimated to cause eight times more DALYs than in 1990, and accounting for one in five deaths in Africa in 2000.

Monday May 6th

Medical crisis discussed
May 6 - The provisional liquidation of Australia's largest medical insurer, United Medical Protection, has brought home to all Australians the need for changes in the medical indemnity industry.

Industry groups have been warning of the impending crisis in the industry for months, which eventually led to a meeting of state and federal ministers and health and insurance experts to discuss solutions.

Prime Minister John Howard has already outlined what he believes is at the core of the problem: hefty compensations claims that he says are leading Australia down the litigious path of the United States.

Many doctors and hospitals agree, saying just one large compensation claim could ruin them.

Today the Health Care Complains Commissioner of New South Wales, Amanda Adrian, and Fiona Tito of Enduring Solutions, will skirt around these issues, offering advice on how to "stay out of the legal line of fire".

Outlining the duty of care of physicians, they will present three key clinical risk management and quality improvement strategies that health consumers, medical indemnity organisations and health complaints commissions can recommend.

These include providing patients with complete information, communicating with them at all times and keeping comprehensive documentation.

"Our focus will be looking at the ways of enhancing trust between consumers and health care providers and the challenging nature of real partnerships in decision-making," they said.

Writing in a recent RACP News article, Amanda Adrian said: "While often seen as matters extrinsic to clinical practice, adoption of these three strategies can make the difference between a practitioner who becomes 'known' to their indemnity organisation, registration authority and one who is on the books and on the register but has a 'no claims, no complaints' record."

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