Award winner highlights importance of community
THE winner of this year’s MJA Dr Ross Ingram Memorial Prize says the aim of her essay is to explain how community development within Aboriginal communities promotes health equity and access for Indigenous peoples. Sharnee Townsend, a policy analyst with NSW Health’s Kids and Families, won the $4000 prize with her essay, “My journey from suit to skin”. In her acceptance speech, Ms Townsend said her article was “intended to create a dialogue nationally and even internationally, about the wearing of a possum skin cloak and its cultural significance”. The Dr Ross Ingram Memorial Prize is named after the first Indigenous person to be accepted into the University of Newcastle’s Medical School and the first Wiradjuri person to become a doctor. The annual competition is open to Aboriginal or Torres Strait Islander people working, researching or training in a health-related field. Ms Townsend’s article details her involvement in the Wrapture project, a photographic exhibition for Aboriginal women in the Hunter region of NSW, and other community projects. She told MJA InSight the community projects detailed in her essay were based on the journey of “self” around capacity building through knowledge and the pursuit of self-healing. The essay details her journey from a small country town to become the first member of her family to attend university and subsequent  career as an Aboriginal health worker. She is the mother of two children aged 8 and 3 years and still studies part-time to complete postgraduate qualifications. Ms Townsend said the support of her family had given her the opportunity to pursue her career. In her essay, she says that by acknowledging cultural aspects of health, “community development facilitates the building of relationships outside the traditional models of health care, leading to empowerment and capacity building in knowledge”.
 
Significant drop in alcohol-related injuries after law change
RESEARCHERS have reported a significant decrease in the number of patients presenting to a major trauma and teaching hospital with alcohol-related critical or serious injuries following NSW Government changes to liquor licensing regulations in inner-city Sydney in 2014. The research, published in the MJA found the reduction in injuries was most marked in the period after midnight, the time targeted by the change in regulations. Doctors at St Vincent’s Hospital, Darlinghurst, conducted the blinded retrospective analysis of data from the hospital’s emergency department, based on Australasian triage categories 1 (immediately life-threatening) and 2 (imminently life-threatening, important time-critical treatment, very severe pain), in the 12 months before and the 12 months after the changes to the regulations. Overall, 13 110 triage category 1 and 2 presentations to the emergency department were recorded — 6467 before and 6643 after the regulation changes. Of these, 1564 (4.3%) were serious alcohol-related injuries — 318 (4.9%) before and 246 (3.7%) after. The proportion of these presentations was much higher (9.1%) during the “high alcohol time” (HAT) of 6 pm Friday to 6 am Sunday than during the rest of the week (3.1%). After the introduction of the regulatory changes, the number of seriously injured patients during HAT dropped from 140 presentations (10.4% of presentations) before the change to 106 (7.8%) after, a relative reduction of 24.8%. The study authors acknowledged limitations of their study that they said would be addressed in future by the introduction of an Australia-wide research and data collection initiative and collaboration between researchers, health organisations and the Australasian College of Emergency Medicine.
 
Low-fat diets do not help in long-term weight loss
A COMPREHENSIVE meta-analysis has found low-fat dietary interventions do not lead to greater weight loss than low-carbohydrate and other higher-fat diets of a similar intensity, irrespective of weight loss intention. The systematic review, published in The Lancet Diabetes & Endocrinology, included 68 128 participants in 53 randomised controlled trials with at least 1 year follow-up. It found low-carbohydrate weight loss diets led to an average 1·15 kg greater long-term weight loss than low-fat diets, with minimal between-study heterogeneity. The researchers found no difference between low-fat and other higher-fat dietary interventions (0·36 kg). Compared with groups only following their usual diet, low-fat diets led to a 5·41 kg greater weight loss. The researchers wrote that their findings “do not support the efficacy of low-fat diet interventions over higher-fat diet interventions of similar intensity for significant, long-term, clinically meaningful weight control”. They said previous trials that compared low-fat diets with usual diets or minimal intensity control groups had resulted in misperceptions of the efficacy of reducing fat intake as a strategy for long-term weight loss. “In fact, comparisons of similar intervention intensity conclude that dietary interventions that aim to reduce total fat intake lead to significantly less weight loss compared with higher-fat, low-carbohydrate diets”, the researchers wrote. “Health and nutrition guidelines should cease recommending low-fat diets for weight loss in view of the clear absence of long-term efficacy when compared with other similar intensity dietary interventions.” An accompanying commentary said more research was needed to determine the factors that affect diet adherence to help maintain weight loss over the long term. “What seems to be clear is that long-term diet adherence is abysmal, irrespective of whether low-fat or other diets, such as low-carbohydrate diets, are prescribed.”
 
Acupuncture benefits for neonatal abstinence syndrome
ADJUVANT laser acupuncture has the potential to reduce the duration of morphine therapy and hospital stay in newborns with neonatal abstinence syndrome (NAS), according to a pilot study published in Pediatrics. The randomised control trial, which the researchers described as the first of its kind, included 28 newborns with NAS. The study found that babies who received oral morphine therapy and laser acupuncture required 35 days in hospital, which represented a “significant reduction” on the 50-day hospitalisation required by newborns in the control group, who received morphine but no acupuncture. Babies in the acupuncture group required oral morphine therapy for 28 days compared with 39-day morphine treatment required by babies in the no acupuncture group. “We believe this is of clinical significance, as less pharmacological treatment and reduced hospital stay have the potential to reduce side effects of oral morphine therapy and improve bonding with parents”, the authors wrote, noting the reduced costs of hospital treatments associated with a shorter stay. Daily laser acupuncture was performed at five ear and four body acupuncture points, bilaterally. All infants tolerated the acupuncture well, with none showing skin changes or signs of distress or discomfort. “Laser acupuncture appears to be safe, feasible, efficient, and well accepted by parents”, the authors wrote. However, they said controversy surrounded optimal points, output power and duration of stimulation. They said the impact of NAS was concerning, because the number of newborns showing symptoms of withdrawal after intrauterine drug exposure to opioids is increasing worldwide. The study was conducted in Austria, which has a low incidence of NAS.
 
Cannabis use associated with stroke in young adults
A PROSPECTIVE comparison of cannabis users and non-users among young adults after an ischaemic stroke has found users were significantly younger, more frequently men and more frequently exposed to lifestyle risk factors such as using tobacco and alcohol than non-users. In a letter to the Journal of the American College of Cardiology, the researchers wrote that the study was conducted over 9 years to 2014 and included 334 consecutive patients aged less than 45 years who were hospitalised for an acute ischaemic stroke. The use of illicit drugs (cannabis, cocaine, and amphetamines) and the protocol of investigations were specifically assessed. Neurological symptoms were reported on admission, and the prognosis evaluated 3 months later. Of the study participants, 17.4% were cannabis users (n = 58, including two who were also cocaine users). Among users, the main aetiology of the stroke was intracranial arterial stenosis in 45% of cases (15% in non-users), and they displayed visual disorders more frequently and less aphasia compared with non-users. Functional independence was similar in both subgroups. Of all participants, 18% retained significant disability, and five died. The researchers wrote that fighting stroke must remain a priority. “The first step may be to inform the public regarding the potential occurrence of stroke associated with cannabis use and other life-style risk factors, particularly nowadays when cannabis use is encouraged by new legislations worldwide”, they wrote.
 
Autism improvements with oxytocin
A SMALL Australian study has found that the synthetic hormone oxytocin, given as a nasal spray to young children with autism, led to significant improvements in caregiver-rated social responsiveness. The 5-week double-blind, placebo-controlled trial, published in Molecular Psychiatry, randomly allocated 31 children aged 3‒8 years to receive oxytocin during phase 1 of treatment and then placebo during phase 2, or to receive placebo during phase 1 of treatment and then oxytocin during phase 2. The researchers found that following oxytocin treatment, parents reported their child to be more socially responsive at home, and independent clinician ratings supported improved social responsiveness. However, caregivers reported no influence of oxytocin on the severity of repetitive behaviour or other secondary outcome measures. Caregiver reports indicated that the children experienced slightly more adverse events, including increased thirst, urination and constipation, when receiving oxytocin as opposed to placebo, but these were not statistically significant. The researchers acknowledged the limitations of their study, including the small sample size, including participants on other psychotropic medications, and the reliance on caregiver reports as the main outcome measures. “The development of sensitive observational and other markers of change for use in autism clinical trials remains an ongoing priority”, they wrote. “Future studies will need to employ larger samples that include a broad representation of autism patients in the community.”
 
US death data reveals impacts of lifestyle diseases 
AN analysis of death certificate data in the US has revealed a 42.9% reduction in the age-standardised death rate over the 44 years to 2013. The study, published in JAMA, shows the most dramatic relative reductions were in deaths caused by stroke (down 77%) and heart disease (down 67.5%). Unintentional injuries fell by 39.8%, cancer by 17.9% and diabetes by 16.5%. However, the researchers said the rate of decrease seemed to have slowed for heart disease, stroke and diabetes, which “may reflect the lagged consequences of increased obesity prevalence since the 1980s”. They noted that in Australia there had been a similar levelling off in declining death rates for coronary heart disease among young adults. An accompanying editorial said rapidly emerging mental health challenges, such as Alzheimer disease, weren’t reported in the study due to data limitations. Alzheimer disease had moved from the eighth to the sixth leading cause of death in the US between 2000 and 2013. Similarly, suicide had increased by a third between 2000 and 2013. The study also revealed reductions in age-standardised years of potential life lost before 75 years (down 52.4%). Death rates for chronic obstructive pulmonary disease (COPD) dramatically increased by 100.6% in the analysis. However, the researchers found the rate for potential years lost did not decrease for COPD. The editorial said this was expected, given the “lag in the decline in years of potential life lost for COPD as smoking rates have declined”. The editorial said limitations in available data meant the research did not capture disturbing health disparities among population groups, which should be shaping health strategies. “In 2013, death rates among black people were approximately double those for white people for infant mortality, heart disease, diabetes, and prostate cancer, and death rates among black people exceeded those for white people by about 40% for stroke, 30% for breast cancer and colon cancer, and nearly 20% for all-cause mortality”, the editorial said.
 

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