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Objective: To determine the proportion of the national childhood asthma burden associated with exposure to dampness and gas stoves in Australian homes.
Design: Comparative risk assessment modelling study.
Setting, participants: Australian children aged 14 years or less, 2011.
Main outcome measures: The population attributable fractions (PAFs) and number of disability-adjusted life years (DALYs) for childhood asthma associated with exposure to damp housing and gas stoves.
Results: 26.1% of Australian homes have dampness problems and 38.2% have natural gas as the main energy source for cooktop stoves. The PAF for childhood asthma attributable to damp housing was 7.9% (95% CI, 3.2–12.6%), causing 1760 disability-adjusted life years (DALYs; 95% CI, 416–3104 DALYs), or 42 DALYs/100 000 children. The PAF associated with gas stoves was 12.3% (95% CI, 8.9–15.8%), corresponding to 2756 DALYs (95% CI, 1271–4242), or 67 DALYs/100 000 children. If all homes with gas stoves were fitted with high efficiency range hoods to vent gas combustion products outdoors, the PAF and burden estimates were reduced to 3.4% (95% CI, 2.2–4.6%) and 761 DALYs (95% CI, 322–1199).
Conclusions: Exposure to damp housing and gas stoves is common in Australia, and is associated with a considerable proportion of the childhood asthma burden. Strategies for reducing exposure to indoor dampness and gas combustion products should be communicated to parents of children with or at risk of asthma.
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This work was supported by the National Health and Medical Research Council (Luke Knibbs: Early Career Fellowship [APP1036620]; Guy Marks: Centres of Research Excellence grant [APP1030259]), the Centre for Air Quality and Health Research and Evaluation (Luke Knibbs, Christine Cowie: postdoctoral fellowships), and the New South Wales Ministry of Health (funding to Christine Cowie and Guy Marks).
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Planetary health is the business of the medical profession because the health of our patients is at risk
During the lifetime of many MJA readers, there have been remarkable improvements in human health. Since 1950, global average life expectancy has risen 25 years to its current level of 72 years, and global infant mortality rates have decreased substantially from around 210 per 1000 live births to just over 30 per 1000 now.1-3
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Anthony Capon is a member of the Editorial Advisory Committee. Anthony Capon and Richard Horton are members of the Commission on Planetary Health.
Building a medical workforce that understands the impact of climate change on health and health services and will create change
The Lancet has described action to address climate change as the greatest public health opportunity before us.1 However, to grasp this opportunity, health professionals, including doctors, must understand the impact of climate change on health and be competent to take action and advocate for change. Otherwise it will be a missed opportunity when an urgent and scaled response to mitigate and adapt to climate change is required if society is to avoid the most harmful consequences. Medical degrees (primary medical programs) in Australia and New Zealand are responsible for preparing doctors for entry into clinical practice and to care for patients and their communities. In response to the health threats posed by climate change, Medical Deans of Australia and New Zealand (MDANZ) has formed a working group, representing medical schools and medical student associations across both countries, to work collaboratively to develop curricula and resources to address this within primary medical programs. This article summarises this initiative.
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Understanding risk factors is key to defining the source and transmission route of Mycobacterium ulcerans
Mycobacterium ulcerans causes an infectious disease known internationally as Buruli ulcer, and also as Bairnsdale ulcer or Daintree ulcer in Australia. It causes severe destructive lesions of skin and soft tissue, resulting in significant morbidity, in attributable mortality and often in long term disability and cosmetic deformity.1 All age groups, including young children, are affected, and the emotional and psychological impact on patients and their carers is substantial (Box 1). Although treatment effectiveness has improved in recent years, with cure rates approaching 100% using combination antibiotic regimens such as rifampicin and clarithromycin,2 these antibiotics are not covered by the Pharmaceutical Benefits Scheme for this condition and are, therefore, expensive to patients. Moreover, these antibiotics have severe side effects in up to one-quarter of patients,1 and many people also require reparative plastic surgery, sometimes with prolonged hospital admissions. The disease thus results in substantial costs, averaging $14 000 per patient including direct3 and indirect costs (eg, transport, lost productivity and dressings) — it had an estimated cost to Victoria in 2016 of $2 548 000 (Paul Mwebaze, Research Scientist, Adaptive Urban and Social Systems, Land and Water, CSIRO, Australia, personal communication, June 2017).
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Australia is set to join a global initiative to track progress on health and climate change
When it comes to climate change and human health, Australia has, in many respects, an impressive track record. The late Professor Tony McMichael led the international community in research and advocacy on this issue.1,2 In 2016, the Royal Australasian College of Physicians Climate Change and Health Working Party released position statements on climate change and health and the health benefits of mitigating climate change.3,4 Scientific articles on Australian health and climate change have been published since the mid-1990s, including in the MJA.5
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We acknowledge the current team members who are developing the Australian countdown report.
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The integration of genome sequencing with clinical records and data from the internet of things will transform health care
There is a great deal of optimism about the potential of genomics to transform medicine and health care. That optimism is justified. Indeed, it is hard to imagine a future where personal genomic information is not consulted routinely at the point of care. Every one of us is different, with personal genetic idiosyncrasies and risks — of cancer, cardiac arrest, blood clots, emphysema, diabetes, arthritis or toxic reactions to medications, among many others; the list will only continue to grow. Knowledge of individual genetic variation will change medicine from the art of crisis response to the science of health management, with huge benefits, both individually and systemically. It will also create new enterprises at a time of rapid change in the largest and fastest growing industry in the world.
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We thank Howard Jacob for his comments on the manuscript. This work was supported by funding from the Kinghorn Foundation, the New South Wales State Government and the National Health and Medical Research Council of Australia.
The Garvan Institute of Medical Research is the owner of Genome.One, which is clinically accredited (ISO15189) to provide whole human genome sequencing and analysis.
Introduction: Research in the past decade supports some major changes to the primary care management of non-specific low back pain (LBP). The present article summarises recommendations from recently published United Kingdom, Danish, Belgian and United States guidelines to alert readers to the important changes in recommendations for management, and the recommendations from previous guidelines that remain unchanged.
Main recommendations: Use a clinical assessment to triage patients with LBP. Further diagnostic workup is only required for the small number of patients with suspected serious pathology. For many patients with non-specific LBP, simple first line care (advice, reassurance and self-management) and a review at 1–2 weeks is all that is required. If patients need second line care, non-pharmacological treatments (eg, physical and psychological therapies) should be tried before pharmacological therapies. If pharmacological therapies are used, they should be used at the lowest effective dose and for the shortest period of time possible. Exercise and/or cognitive behavioural therapy, with multidisciplinary treatment for more complex presentations, are recommended for patients with chronic LBP. Electrotherapy, traction, orthoses, bed rest, surgery, injections and denervation procedures are not recommended for patients with non-specific LBP.
Changes in management as a result of the guidelines: The major changes include:
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Matheus Almeida is supported by a São Paulo Research Foundation grant. Chris Maher holds a fellowship funded by the National Health and Medical Research Council.
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Hypoxic blackout, also called apnoeic hypoxia or shallow water blackout,1 is a distinct and largely preventable cause of drowning.2 This fatal syndrome is often the consequence of voluntary pre-submersion hyperventilation, which downregulates CO2 brainstem chemoreceptors, with the result that consciousness may be lost (because of apnoeic hypoxia) before protective breakpoints (driven by CO2 and O2 chemoreceptors) are reached.3 Inspiration thus begins while the person is submerged and unconscious. Given the paucity of population-level analyses,4 in this study we examined hypoxic blackout-related fatal drownings in Australia to in order to inform development of prevention strategies.
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This research was supported by Royal Life Saving Society – Australia as part of its core role in promoting safety in all forms of aquatic activity. Research at Royal Life Saving Society – Australia is supported by the Australian Government.
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Abstract
Objective: To evaluate population trends in presentations for mental health problems presenting to emergency departments (EDs) in New South Wales during 2010–2014, particularly patients presenting with suicidal ideation, self-harm, or intentional poisoning.
Design, setting and participants: This was a retrospective, descriptive analysis of linked Emergency Department Data Collection registry data for presentations to NSW public hospital EDs over five calendar years, 2010–2014. Patients were included if they had presented to an ED and a mental health-related diagnosis was recorded as the principal diagnosis.
Main outcome measures: Rates of mental health-related presentations to EDs by age group and calendar year, both overall and for the subgroups of self-harm, suicidal ideation and behaviour, and intentional poisoning presentations.
Results: 331 493 mental health-related presentations to 115 NSW EDs during 2010–2014 were analysed. The presentation rate was highest for 15–19-year-old patients (2014: 2167 per 100 000 population), but had grown most rapidly for 10–14-year-old children (13.8% per year). The combined number of presentations for suicidal ideation, self-harm, or intentional poisoning increased in all age groups, other than those aged 0–9 years; the greatest increase was for the 10–19-year-old age group (27% per year).
Conclusions: The rate of mental health presentations to EDs increased significantly in NSW between 2010 and 2014, particularly presentations by adolescents. Urgent action is needed to provide better access to adolescent mental health services in the community and to enhance ED models of mental health care. The underlying drivers of this trend should be investigated to improve mental health care.