In This Issue

Harsh reality

Cringe-worthy as they may be to the generations of viewers who grew up with the carefully scripted products of 1970s and ’80s television, “reality” programs depicting fallible humans grappling with their own inane conversations, family dysfunction, weight problems and physical defects have become increasingly popular in Australia and abroad. According to Petrie et al, there is evidence that people who watch body improvement shows may end up feeling worse about themselves or having unrealistic expectations of the effects of cosmetic procedures (→ Influence of television on demand for cosmetic surgery). And, as for the participants, they add, if we are going to treat them like laboratory animals we should at least have an ethical framework for doing so.

Accurate TFTs in early pregnancy

Using non-pregnant reference ranges for thyroid function testing in women in the first trimester of pregnancy could result in misclassification of thyroid status for more than one in five, say Gilbert et al (→ Assessment of thyroid function during pregnancy: first-trimester (weeks 9-13) reference intervals derived from Western Australian women). Maternal thyroid function is particularly important in the first trimester, but it is also difficult to measure because of interference from circulating pregnancy hormones. In answer to this problem, the Western Australian researchers used serum from more than 2000 women having antenatal testing to derive their own reference ranges. They urge others to do likewise.

Infant feeding: mind the gap

While the rates of breastfeeding have remained fairly static in Australia, the overall statistics hide a growing socioeconomic gap in the duration, with more advantaged groups managing to breastfeed for longer, say Amir and Donath (→ Socioeconomic status and rates of breastfeeding in Australia: evidence from three recent national health surveys). Comparing three national health surveys (1995, 2001 and 2004-05), there were no significant changes in breastfeeding initiation (9/10 babies) or feeding at 3 months (6/10), 6 months (5/10) and 1 year (2/10). When the rates were examined using the Socio-Economic Indexes for Areas (SEIFA) classification, the likelihood of breastfeeding at 6 months was always greater in more advantaged women but, between the first and third surveys, the difference rose from 13% per SEIFA quintile to 26%.

Vaccine safety monitoring: all hands on deck

With Australia’s program of universal human papillomavirus vaccination for young women now almost 18 months old, a recent letter to the MJA reported a case of pancreatitis temporally associated with receiving the vaccine, and in this issue, Buttery et al detail the investigation of a mass psychogenic response to vaccination in a group of girls at a Melbourne school (→ Mass psychogenic response to human papillomavirus vaccination). Brotherton and Gold ask how we tread the fine line between good postmarketing surveillance (which is the only way to detect rare adverse events) and undermining the success of an important public health initiative (→ Monitoring vaccine safety: a critical component of every immunisation program). With our current passive surveillance system, which relies on reports from vaccine providers, it will take a combination of stringent observation and reporting, and good risk communication to consumers, to maintain an effective program.

Health care reform: past and future

As our series on health care reform continues, and we await the findings and initiatives of the federal government’s two newly formed commissions, Leeder and Lewis remind us that we’ve been here (or somewhere very like it) in the past (→ Learning from past commissions). Preventive health care, of course, is all about better health in the future. The government seems poised for sustained investment in this, but could well heed the advice of Oldenburg and Harper and provide more resources and political will to attack our future health problems at the source (→ Investing in the future: prevention a priority at last).

Updates, letters and more

No matter how time-poor you are, don’t leave this content-rich issue without reading our updates on chronic myeloid leukaemia (Joske, “Chronic myeloid leukaemia: the evolution of gene-targeted therapy”) and migraine prophylaxis (Stark and Stark, “Migraine prophylaxis”). In “Contemporary management of type 2 diabetes: blood glucose-lowering therapies and glycaemic targets”, Davis provides clear direction for managing your patients’ diabetes in the light of some confusing recent research findings. And don’t skip the Letters, which include studies revealing deficiencies in hospital use of chest computed tomography scans (→ Inappropriate use of computed tomography chest scanning in hospital patients), how to pick an intra-abdominal injury in a cyclist who has collided with his bike’s handlebars (→ Bicycle handlebar injuries in Western Australia: from imprints to abdominal wall hernias), and a case series of adults with cerebral palsy who derived benefit from an unexpected source (→ Unexpected benefits of bethanechol in adults with cerebral palsy). Finally, in honour of Father’s Day on September 7, we’ve included a poem by US obstetrician Richard Bronson, dedicated to his doctor dad (→ Father’s Day).

Another time . . . another place

That no one dies of migraine seems, to someone deep into an attack, an ambiguous blessing.