26 April 2017

Economic cost of dementia 2016-2056

There are currently over 413,000 people in Australia with dementia and the cost to the community is estimated to be $14.6 billion in 2017.  This is one of the findings of a study commissioned by Alzheimer's Australia, Economic cost of dementia 2016-2056 ,which also estimated that the cost would be $18 billion per year by 2025 and $36 billion by 2056 if nothing is done to reduce the incidence of the disease.

The report includes a printable pdf version, as well as some infographics including the main statistics. The number of people with dementia is expected to be 1.1 million by 2056.  The report provides suggestions on ways the prevalence of the disease could be reduced and projects the substantial cost savings this would make.

Youth Mental Health Report

Mission Australia and the Black Dog Institute have published Youth mental health report : youth survey 2012-16 which presents data collected from young people across Australia about their levels of psychological distress and where they go for help. Their findings confirm that one in four are at risk of serious mental illness and that they seek help reluctantly. Other findings were:

  • In 2016 20.8% of 15 year olds meet the criteria for having a serious mental illness, rising to 27.4% of 18/19 year olds
  • 31.6% of Aboriginal and Torres Strait Islander respondents met this same criteria, compared to 22.2% of the rest of the population
  • The main issues of personal concern were coping with stress, school or study problems and depression
  • From 2012-16, females were around twice as likely as males to meet the criteria for serious mental illness
  • Young people with a probable serious  mental illness are most likely to go to their friends, parents and the Internet to seek help.

Impact of overweight and obesity

It has been estimated by the Australian Institute of Health and Welfare that nearly 2 in 3 adults and 1 in 4 children in Australia are considered overweight or obese.  The AIHW's current report, Impact of overweight and obesity as a risk factor for chronic conditions updates and extends the findings reported in the Australian Burden of Disease Study 2011 to include burden in people aged under 25, revised diseases linked to overweight or obesity and estimates by socioeconomic group.  

22 diseases resulting from overweight and obesity are included in this analysis. These include 11 types of cancer, 3 cardiovascular conditions, chronic kidney disease, diabetes, dementia, gallbladder disease, gout, back pain and problems, osteoarthritis and asthma.  The authors conclude that 7% of the total health burden in Australia in 2011 was due to overweight and obesity, with 63% of this burden being fatal. They estimate that 6% of future disease burden in 2020 due to overweight and obesity could be avoided if current increases in overweight and obesity in the population were halted.

Seven deadly sins of statistical misinterpretation

A handy summary published in The Conversation recently reminds us of The seven deadly sins of statistical misinterpretation and how to avoid them. Authors Winnefred Louis and Cassandra Chapman, from the University of Queensland explain the problem with:

  • Assuming small differences are meaningful
  • Equating statistical significance with real-world significance
  • Neglecting to look at extremes
  • Trusting coincidence
  • Getting causation backwards
  • Forgetting to consider outside causes, and
  • Deceptive graphs
All very useful when critically appraising original studies in health.

Life expectancy and disabiity in Australia

‘Life expectancy’ measures how many years, on average, a person of a given age can expect to live if current death rates do not change.  This fact sheet from the Australian Institute of Health and Welfare compares life expectancies of people with and without a disability.

Life expectancy and disability in Australia: expected years living with and without disability shows that at birth, Australians can expect to live on average one fifth of their lives with some form of disability. People aged 65 will, on average, spend over half their remaining lives with a level of disability.

Lower limb amputations due to diabetes

Burden of lower limb amputations due to diabetes in Australia: Australian Burden of Disease Study 2011 has been released by the Australian Institute of Health and Welfare. Patients with diabetes accounted for 3,570 lower limb amputations in Australia in 2012-13.

For 2011, it was found that the rate of non-fatal burden due to lower limb amputations as a result of the complications of diabetes was
  • three time higher for males as females
  • four times higher in the Northern Territory as the national rate
  • highest for people living in very remote areas and the lowest socioconomic group
  • 3.8 times higher for Indigenous Australians as non-Indigenous Australians.
The good news was that the lower limb amputation rate did decline between 2003 and 2011, despite significant increases in the diagnosis of diabetes. 

Patients' reports of adverse events

Patients' reports of adverse events: a data linkage study of Australian adults aged 45 years and over has been published in BMJ Quality & Safety recently.  The researchers surveyed 20,000 patients who had been in hospital in the previous six months.  They were asked if they had had an adverse event (AE) and whether they had received honest communication about it.

7% (474) of the respondees reported having an AD, mostly related to clinical processes or medications. Country of birth and admission through the Emergency Department were significan predictors of these events.  

Walton MM, Harrison R, Kelly P, Smith-Merry J, Manias E, Jorm C, et al. BMJ Quality & Safety. 2017.

Organisation and quality of stroke services

The National Institute for Health Research in the UK has identified that stroke is the fourth largest cause of death in the UK and costs the NHS 5% of its budget. Although mortality rates from stroke have halved over the last twenty years, challenges still remain for those planning and delivering stroke services.

Roads to Recovery: Organisation and Quality of Stroke Services is a themed review that brings together evidence for the treatment and care of people with stroke. It reviews studies on acute management as well as recovery and rehabilitation.

Vaccine myopia for adults

A recent article in the Medical Journal of Australia highlights the vast numbers of undervaccinated adults in Australia - a fact that has largely been ignored in the arguments about childhood vaccinations.

The authors of Vaccine myopia: Adult vaccination also needs attention estimate that there are over 4 million undervaccinated Australians each year; that is, people who are eligible to receive free vaccine(s) under the National Immunisation Program (NIP) but do not receive them. "Of these, the children of parents with ideological objections to vaccination are a small subset; the vast majority are adults."
Robert I Menzies, Julie Leask, Jenny Royle, C. Raina MacIntyre, Med J Aust 2017; 206 (6): 238-239. doi:10.5694/mja16.00811.  Open Access.

20 April 2017

Affirmative Treatments with Transgender Clients

Psychiatric Clinics of North America latest issue titled "Clinical Issues and Affirmative Treatment with Transgender Clients" is available to NSW Health staff via CIAP. Subjects covered in the articles include barriers, hormonal and surgical treatment options, cognitive behaviour therapy, family therapy and standards of care.

Clinical Issues and Affirmative Treatment with Transgender Clients. (2017). Psychiatric Clinics of North America, 40(1).

Global Initiative for Chronic Obstructive Lung Disease

The latest 2017 COPD GOLD guidelines address advancements in COPD management and
incorporate evidence from recent landmark clinical trials. There are a number of important changes:
  •  Severity of airflow obstruction via spirometry is no longer part of the severity classification system. 
  • Dual bronchodilatation with LABA/LAMA therapy is recommended for GOLD grades B and C.
  •  Inhaled corticosteroids should no longer be used as monotherapy in COPD.
  •  Pharmacotherapy for secondary pulmonary hypertension in the setting of COPD is not recommended. 
  • Oxygen therapy is also not recommended for COPD patients with no evidence of severe resting hypoxaemia.

Treatment and Management of Chronic Fatigue Syndrome

The condition known as chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME), also recently renamed systemic exertion intolerance disease (SEID), is a complex, heterogeneous and extremely debilitating medical condition with no known specific cause and for which no clinically established diagnostic tests are available. Its symptoms are characterized by an extreme disabling fatigue that does not improve with rest; it persists for more than 6 months, and cannot be explained by any underlying medical condition.
This review explores the current evidence on benefits and harms of therapeutic interventions in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and makes recommendations.

Castro-Marrero, J., Saez-Francas, N., Santillo, D., Alegre, J. (2017). Treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis: all roads lead to Rome.  British Journal of Pharmacology, 174(5), 345–369. (free online)

New Australian Injury Titles

The Australian Institute of Health and Welfare has released 5 Injuries publications: 

Hospitalised assault injuries among women and girls fact sheet 

AIHW catalogue number INJCAT 184

Dog-related injuries fact sheet AIHW catalogue number INJCAT 186

Firearm injuries and deaths fact sheet AIHW catalogue number INJCAT 187

DIY injuries fact sheet AIHW catalogue number INJCAT 185

Serious unintentional injury involving a railway train or tram, Australia, 2009-10 to 2013-14 report AIHW catalogue number INJCAT 177

All are available free to download.

11 April 2017

New Grad Nurse on a Toxic Ward

In an all to familiar story, new grad registered nurse Alexa struggled to stay afloat when she landed in a toxic environment on her first ward. But she did not break. Read on the blog Nurse Uncut as she tells the story of that ward, the stress, tension and tears. She wants nursing students and other new grads to know that she survived and still loves nursing. In part 2 of her story, Alexa describes how she was able to cope and the advice she’d give to other new grads.

Alexa's story on Nurse Uncut:
Part 1New grad nurse: ‘My first ward tested every part of me’
Part 2.  New grad nurse: ‘Nursing is a tough gig but I wouldn’t do anything else’  

Self Harm and Suicide: Review of Services in the ADF

Australia’s defence community must change its culture and end negative stereotypes about mental health to ensure members and veterans get the help they need, a national report has found.

The National Mental Health Commission has released a review of suicide and self-harm by veterans and members of the Australian Defence Force (ADF), and made 23 recommendations. 
Some aspects of  Defence culture are reinforcing negative stereotypes about mental health, the commission's chief executive Dr Peggy Brown said. The report also revealed that many ADF members and veterans have not sought assistance because they fear doing so may restrict their career opportunities.

National Mental Health Commission. (2017). Review of Services Available to Veterans and Current Serving Members of the Australian Defence Force in Relation to the Prevention of Self-harm and Suicide.