Inbox and Environment News: Issue 369
July 29 - August 4, 2018: Issue 369
Women Under-Treated For Heart Attack Die At Twice The Rate Of Men
July 23, 2018: University of Sydney
University of Sydney research reveals that women admitted to Australian hospitals with serious heart attacks are half as likely as men to get proper treatment and to die at twice the rate of men six months after discharge.
Published in today’s Medical Journal of Australia, the study of 2898 patients (2183 men, 715 women) reveals that women admitted to 41 Australian hospitals with ST-Elevation Myocardial Infarction (STEMI) in the past decade were half as likely as men to receive appropriate diagnostic tests and treatment, and less likely to be referred for cardiac rehabilitation and prescribed preventive medications at discharge.
Six months after hospital discharge, death rates and serious adverse cardiovascular events among these women were more than double the rates seen in men.
Sex differences in the management and outcomes of patients with acute coronary syndromes such as STEMI have been reported in the medical literature, but most studies fail to adjust for ‘confounding’ factors that can affect the accuracy of findings.
This new study, authored by leading cardiac specialists and researchers from across Australia, offers robust insights into this life-threatening condition by adjusting for factors that could affect treatment and health outcomes.
“We focused on patients with ST-Elevation Myocardial Infarction because the clinical presentation and diagnosis of this condition is fairly consistent, and patients should receive a standardised management plan,” said the University of Sydney’s Professor Clara Chow who is a cardiologist at Westmead hospital, the study’s senior author.
“The reasons for the under-treatment and management of women compared to men in Australian hospitals aren’t clear.
“It might be due to poor awareness that women with STEMI are generally at higher risk, or by a preference for subjectively assessing risk rather than applying more reliable, objective risk prediction tools.
“Whatever the cause, these differences aren’t justified. We need to do more research to discover why women suffering serious heart attacks are being under-investigated by health services and urgently identify ways to redress the disparity in treatment and health outcomes.”
Professor David Brieger, co-author of the study and leader of the CONCORDANCE registry from which the findings were extracted, agrees: “While we have long recognised that older patients and those with other complicating illnesses are less likely to receive evidence based treatment, this study will prompt us to refocus our attention on women with STEMI.”
What is STEMI or ST-elevation myocardial infarction?
A STEMI or ST-elevation myocardial infarction (heart attack) happens when a fatty deposit on an arterial wall causes a sudden and complete blockage of blood to the heart, starving it of oxygen and causing damage to the heart muscle.
A STEMI diagnosis is typically made initially by administering an electrocardiogram (ECG) that reveals a tell-tale ECG signature (see image above). These heart attacks can cause sudden death due to ventricular fibrillation (a serious heart rhythm disturbance) or acute heart failure (when the heart can’t pump enough blood to properly supply the body).
STEMI represents about 20 percent of all heart attack presentations. In 2016, an average of 22 Australians died from a heart attack each day.
About the study
Researchers collected data from 41 hospitals across all Australian states and territories between February 2009 and May 2016. Twenty-eight hospitals (68 percent) are in metropolitan regions and 13 are in rural locations.
Data was sourced from the CONCORDANCE (Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events) registry, intended for use by clinicians to help improve the quality of patient care in line with treatment guidelines.
Main outcome measures: the primary outcome was total revascularisation, a composite endpoint encompassing patients receiving PCI (percutaneous coronary intervention), thrombolysis, or coronary artery bypass grafting (CABG) during the index admission.
Secondary outcomes: timely vascularisation rates; major adverse cardiac event rates; clinical outcomes and preventive treatments at discharge; mortality in hospital and 6 months after admission.
The average age of women presenting with STEMI was 66.6 years; the average age of men was 60.5 years.
More women than men had hypertension, diabetes, a history of prior stroke, chronic kidney disease, chronic heart failure, or dementia. Fewer had a history of previous coronary artery disease or myocardial infarction, or of prior PCI or CABG.
Dr Clara Chow is Professor of Medicine at Sydney Medical School, a Consultant Cardiologist at Westmead Hospital and Academic Director of the Westmead Applied Research Centre (WARC). Her principal research interests are in cardiovascular disease prevention in Australia and internationally.
Differences in management and outcomes for men and women with ST-elevation myocardial infarction. Ehsan Khan, David Brieger, John Amerena, John J Atherton, Derek P Chew, Ahmad Farshid, Marcus Ilton, Craig P Juergens, Nadarajah Kangaharan, Rohan Rajaratnam, Amy Sweeny, Darren L Walters and Clara K Chow. Med J Aust || doi: 10.5694/mja17.01109 Published online: 23 July 2018
Top UNSW Academic To Head National Endometriosis Action Plan
July 27, 2018: by Lucy Carroll, UNSW
Professor Jason Abbott will lead a major clinical trial program as part of Australia’s first national action plan on a condition that affects 1 in 10 women.
Michael Still, Chair of the South Eastern Sydney Local Health District (SESLHD) board, Professor Jason Abbott, Health Minister Greg Hunt, Kim Olesen, Acting Chief Executive SESLHD, and Vanessa Madunic, General Manager of the Royal Hospital for Women.
UNSW Sydney’s Professor of Gynaecological Surgery Jason Abbott will chair the first National Endometriosis Steering Group in Australia over the next five years, following a major funding boost for debilitating disease announced yesterday.
Health Minister Greg Hunt has released Australia’s first National Action Plan for Endometriosis to improve the quality of life of patients through better treatment, diagnosis and providing an outline for the path to ultimately find a cure.
The government yesterday committed a further $1.2 million in funding to the plan, taking the total investment to $4.7 million. Of the funding, $2.5 million will be dedicated to rolling out the National Endometriosis Clinical and Scientific Trials Network (NECST network), allowing patients to take part in a coordinated national research program to improve diagnosis and treatment plans. Professor Abbott will lead the national trials network, which will include an online capability, matching biological samples and databases to facilitate the roll out of large-scale clinical trials.
“Ten percent of women have endometriosis. It is a substantial cause of morbidity and lost productivity,” Professor Abbott said.
“It has a major impact on fertility and often occurs when women are establishing careers, further education and family. One of the most difficult things is it can stop women reaching their full potential. The spotlight on the disease makes it easier for women to talk about and helps debunk the myth that endometriosis is just bad period pain.”
Professor Abbott said endometriosis patients often endured pain worse than women who had cancer, and many frontline primary carers “don’t know enough about it to clock it as a substantial disease”.
Endometriosis is an inflammatory menstrual health disorder that affects around 700,000 Australian women and girls. It occurs when tissue that normally lines the uterus grows in other parts of the body. It can cause severe abdominal pain and organ damage, and can lead to mental health complications, social and economic stress and infertility.
Professor Abbott, from School of Women’s and Children’s Health at UNSW Medicine, said the National Endometriosis Steering Group will oversee the implementation of the action plan, which includes awareness and education, clinical management and the implementation of personal plans and clinical trial research.
“The illness costs the community up to $6 billion a year. At the moment the only way to diagnose endometriosis is to undergo a laparoscopy and have a biopsy taken.
“It's absolutely imperative that we have a better way to diagnose it and do not have to go to that invasive stage,” Professor Abbott said at a joint press conference with Mr Hunt.
Professor Abbott is the director of Endometriosis Australia, an associate editor for ANZJOG, Human Reproduction and the Journal of Minimally Invasive Gynaecology and has more than 120 publications including textbooks, book chapters and large-scale RCTs in gynaecological surgery.
A release by Mr Hunt said that $1 million had already been committed to supporting GPs and other frontline health professionals through better access to educational resources about endometriosis, to help reduce diagnostic delay, and ensure that the right clinical care is provided to the right patients at the right time. This will include the development of a short course in endometriosis for primary healthcare professionals.
Software Cuts Through Costly Hospital Pharmaceutical Procurement
July 24, 2018: University of Sydney
The University of Sydney has developed a software program which could significantly reduce the amount spent by the nation's hospitals currently estimated at more than three billion dollars a year.
The ground-breaking software, which streamlines the pharmaceutical purchasing process, is also expected to free up hospital staff for activities more closely related to patient care.
The software was developed in conjunction with Sydney’s Westmead Hospital by Dr Aldo Saavedra, a Senior Research Scientist with the University’s Faculty of Health Sciences, and Dr Erick Li, a senior lecturer in the Business School’s Discipline of Business Analytics.
The new system will replace a laborious and time consuming process of selecting the most cost effective pharmaceuticals by manually comparing spreadsheet information on thousands of products with prices that sometimes vary on a monthly basis.
“There are several thousand lines of pharmaceuticals that are procured and managed across Westmead, and pricing for each is influenced by market dynamics i.e. competition, patent expiry, supply chain and government policy,” said the hospital’s head pharmacist, David Ng.
“With a monthly spend of around $ 3 million, the objective of our pharmaceutical procurement is to ensure that essential medicines are available uninterrupted and at the most cost-efficient price,” Dr Ng said. “Given the number of product lines and pricing variances, we needed a decision support tool.”
Dr Ng and his team turned to the University of Sydney because of its established business, technical and analytical expertise as well as its commitment to the development of what has become known as the Westmead precinct.
The University’s Dr Saavedra and Dr Li, found a manual purchasing process made highly complex by constantly changing supplier discounts, government subsidies and competing branded and generic products.
As an example of this complexity, Dr Li pointed to the trade-offs staff were forced to make when choosing between rebate brands and the non-rebate brands. “In some cases, the hospital stayed with the rebate brand to avoid losing an accumulated rebate reward; whereas in other cases, the hospital was able to capitalise on low prices offered by non-rebate brands.”
“Our system is able to organise all the information from the wholesaler’s price books, quickly run the data for a particular medication and determine the lowest price on the market,” Dr Li said. “Importantly, we can take into consideration the complexity of the rebate contracts.”
One estimate puts Westmead’s cost savings at nearly 5 per cent.
The University team sees the new system as an example of how data can be better utilised in hospitals for the benefit of patients and staff.
“This project became a good flagship for showing how we can actually use data to improve something very simple like choosing the best medication, which was very laborious with a procurement officer literally sitting there and comparing excel spreadsheets to find the best value,” said Dr Saavedra.
“When I started working at the hospital everyone talked about keeping the lights on. That’s all the budget allowed for. Nobody was trying to introduce better practices. So with our little tool we have been able to show the value of data,” he said.
With some modification, Dr Saavedra and Dr Li say that their procurement software could be installed in any hospital in the country potentially saving Australian taxpayers many millions of dollars.
Birth Study Empowers Pregnant Women
July 23, 2018: Queensland University of Technology
Research led by QUT Associate Professor Yvette Miller, from the Institute of Health and Biomedical Innovation, asked almost 6000 women about their birthing experiences in Queensland, Australia.
Professor Miller said many women were not aware that their choice of maternity care provider, birth facility, the way their baby is monitored in labor and positioning during labor and birth would all affect their labor and birth experience.
"We do this kind of research primarily to give women the information they need to make informed decisions about their maternity care," Professor Miller said.
"'Normal' birth was defined as an unassisted vaginal birth without induction of labor, epidural or general anaesthetic, forceps or episiotomy.
"We partnered with the Queensland Registry of Births, Deaths and Marriages to survey almost 6000 women who gave birth over a four-month period in Queensland. Women reported features of their experience alongside the four aspects of normal birth: onset of labor, use of anaesthetics, mode of birth, and use of episiotomy.
"Only 28.7 per cent of the women experienced a 'normal' birth.
"Our analysis found that those who had received GP shared care, standard public care, public midwifery continuity care or private midwifery care were all more likely to have a 'normal' birth than women in private obstetric care.
"We also found that women had a higher chance of a 'normal' birth if:
- they lived outside major cities
- could move freely throughout labor
- received continuity of care in labor and birth
- did not have procedures to augment their labor (such as having their "waters broken" or an Oxytocin drip)
- did not have their baby continuously electronically monitored during labor
- or gave birth not lying flat."
Professor Miller said research from Australia and several other countries indicated the majority of women report the desire for minimal medical intervention during birth.
"Rates of medical intervention in labor and birth have steadily increased in most middle- and high-income countries over the past few decades contrary to most women's preferences," she said.
"Analysis of 23 studies published from around the world found that only 13.8 per cent of women expressed a preference for caesarean birth over vaginal birth."
"Our other research has shown that many women in Queensland are not informed or not involved in decisions about the use of medical procedures that can affect their birth experience and outcomes.
"Women are especially uninformed about how the type of maternity care they choose early on in their pregnancy can affect their chances of having the type of labor and birth they want."
"Queensland has published the Qld Maternity and Neonatal Clinical Guideline: Normal birth, and other states have similar guidelines. Australia, the UK, Canada, are among those countries which have recently published policy directives to increase normal births.
"The underlying ethos of current policy directives is that birth is a normal physiological process and not a medicalised 'problem'."
Samantha J. Prosser, Adrian G. Barnett, Yvette D. Miller. Factors promoting or inhibiting normal birth. BMC Pregnancy and Childbirth, 2018; 18 (1) DOI: 10.1186/s12884-018-1871-5
Sunscreen Reduces Melanoma Risk By 40 Percent In Young People
July 2018: University of Sydney
Melanoma is the most common cancer diagnosed in Australian men aged 25-49 years and the second most common cancer in women aged 25-49 years, after breast cancer.
A world-first study led by University of Sydney has found that Australians aged 18-40 years who were regular users of sunscreen in childhood reduced their risk of developing melanoma by 40 percent, compared to those who rarely used sunscreen.
Melanoma is the most common cancer diagnosed in Australian men aged 25-49 years and second most common cancer in women aged 25-49 years, after breast cancer. Approximately two in three Australians will be diagnosed with melanoma or other types of skin cancer by the time they are 70 years old.
Published today in JAMA Dermatology, this is the first study to examine the association between sunscreen use with melanoma risk in young people under 40 years. The study analysed data collected from nearly 1700 people who participated in the Australian Melanoma Family Study.
“Our study shows that sunscreen use in childhood and adulthood was protective against melanoma in young people 18-40 years old, with their risk reduced by 35 to 40 percent for regular sunscreen users compared to people who rarely used it,” said lead researcher Associate Professor Anne Cust, who heads the Cancer Epidemiology and Prevention Research group at the University of Sydney’s School of Public Health and Melanoma Institute Australia.
“The association of sun exposure and sunburn with melanoma risk, particularly in childhood, is well established and this study showed that regularly using sunscreen was protective against the harmful effects of sun exposure.
“Regular users of sunscreen were more likely to be female, younger, of British or northern European ancestry, and have higher education levels, lighter skin pigmentation, and a strong history of blistering sunburn.
“People were less likely to use sunscreen if they were male, older, less educated, or had skin that was darker or more resistant to sunburn.
“Despite sunscreen being widely available and recommended for sun protection, optimising the use of sunscreens remains a challenge and controversies continue to surround its use.
“This study confirms that sunscreen is an effective form of sun protection and reduces the risk of developing melanoma as a young adult. Sunscreen should be applied regularly during childhood and throughout adulthood whenever the UV Index is 3 or above, to reduce risk of developing melanoma and other skin cancers.
“Some population subgroups such as people with sun-sensitive skin or with many moles might get a stronger benefit from using sunscreen,” she said.
The Australian Melanoma Family Study was conducted in collaboration with Cancer Council Queensland and University of Melbourne and funded by the National Health and Medical Research Council (NHMRC), Cancer Council NSW, Cancer Council Victoria, Cancer Council Queensland, and the US National Institutes of Health.
Sunscreen Use and Melanoma Risk Among Young Australian Adults. Caroline G. Watts, Martin Drummond, M Biost; Chris Goumas, Helen Schmid, Bruce K. Armstrong, Joanne F. Aitken, Mark A. Jenkins, Graham G. Giles, John L. Hopper, Graham J. Mann, Anne E. Cust. JAMA Dermatol. Published online July 18, 2018.doi:10.1001/jamadermatol.2018.1774
Big Foot Was A Dinosaur
July 24, 2018
The Black Hills region of the United States is famous today for tourist attractions like Deadwood and Mount Rushmore, but around 150 million years ago it was home to one of the largest dinosaurs known. This dinosaur was a member of the sauropod family with long necks and tails. These giant plant-eating dinosaurs like Brontosaurus and Diplodocus were the largest land animals that ever lived on this planet.
Photograph from the excavations in 1998, with the brachiosaur foot bones below a tail of a Camarasaurus. University of Kansas expedition crew member as a scale. Credit: Photo courtesy of the KUVP archives
The foot described in a new scientific paper recently published in the open-access journal PeerJ -- the Journal of Life and Environmental Sciences was excavated in 1998 by an expedition from the University of Kansas, with Anthony Maltese, lead author of the study, as member of the crew. As he writes, it was immediately apparent that the foot, nearly a meter wide, was from an extremely large animal -- so the specimen was nicknamed "Bigfoot."
Now, after detailed preparation and study, Maltese and his international team of researchers from the USA, Switzerland, and Germany identified it as belonging to an animal very closely related to Brachiosaurus, famous for its appearance in the 1993 film Jurassic Park.
Anthony Maltese, Emanuel Tschopp, Femke Holwerda, and David Burnham used 3D scanning and detailed measurements to compare Bigfoot to sauropod feet from numerous species. Their research confirmed that this foot was unusually large. According to Holwerda, a Dutch PhD student at the Ludwig Maximilians University of Munich, Germany, comparisons with other sauropod feet showed that Bigfoot was clearly the largest dinosaur foot discovered to date.
It also confirmed that brachiosaurs inhabited a huge area from eastern Utah to northwestern Wyoming, 150 million years ago. "This is surprising," says Tschopp, a Swiss paleontologist working at the American Museum of Natural History in New York, "many other sauropod dinosaurs seem to have inhabited smaller areas during that time."
According to Maltese, who was part of the original University of Kansas team in 1998 but is now at the Rocky Mountain Dinosaur Resource Center in Woodland Park, Colorado, the rock outcrops that produced this fossil hold many more "fantastic dinosaur skeletons," and the research team hopes to continue their studies on fossils from there.
Anthony Maltese, Emanuel Tschopp, Femke Holwerda, David Burnham. The real Bigfoot: a pes from Wyoming, USA is the largest sauropod pes ever reported and the northern-most occurrence of brachiosaurids in the Upper Jurassic Morrison Formation. PeerJ, 2018; 6: e5250 DOI: 10.7717/peerj.5250
Unwrapping The Brewing Secrets Of Barley
July 24, 2018: University of Adelaide
University of Adelaide researchers have uncovered fundamental new information about the malting characteristics of barley grains. They say their finding could pave the way to more stable brewing processes or new malts for craft brewers.
Published in the Nature publication Scientific Reports, the researchers discovered a new link between one of the key enzymes involved in malt production for brewing and a specific tissue layer within the barley grain.
The most important malting enzymes come from a layer of tissue in the barley grain called the aleurone, a health-promoting tissue full of minerals, antioxidants and dietary fibre. The researchers showed that the more aleurone present in the barley grain, the more enzyme activity the grain produced.
Barley is the second most important cereal crop for South Australia and contributes over $2.5 billion to the national economy. Much of its value comes from its use in beer and beverage production.
"Barley grains possess impressive features that make them ideal for creating the malt required by the brewing industry," says project leader Associate Professor Matthew Tucker, ARC Future Fellow in the University's School of Agriculture, Food and Wine.
"During the malting process, complex sugars within the barley grain are broken down by enzymes to produce free sugars, which are then used by yeast for fermentation.
"The levels of these enzymes, how they function and where they are synthesised within the barley grain are therefore of significant interest for the brewing industry.
"Until now, it was not known that this key ingredient in the beer brewing process was influenced by the amount of aleurone within the grain, or that the aleurone was potentially a storage site for the enzyme."
The researchers examined the aleurone in a range of barley cultivars used by growers and breeding programs in Australia and found remarkable variation in the aleurone layer between varieties.
PhD student Matthew Aubert used this variation to examine levels of enzymes involved in malt production. He discovered that barley grains possessing more aleurone had noticeably more activity in one of the key enzymes that breaks down starch and determines malt quality of barley, an enzyme called free beta-amylase.
"Grains with more aleurone may have an advantage that allows them to break down complex sugars faster or more thoroughly than grains with less aleurone," says Matthew Aubert.
Associate Professor Tucker says: "We think our findings show that it might be possible for breeders and geneticists to make use of this natural variation to select for barley varieties with different amounts of aleurone and hence different malting characteristics.
"This will be of potential interest to large brewers who depend on stable and predictable production of malt, and also the craft brewers that seek different malts to produce beer with varying characteristics."
The researchers are now trying to find the genes that explain this natural variation.
Matthew Aubert's research was supported by the Australian Research Council Centre of Excellence in Plant Cell Walls and the Grains Research and Development Corporation.
Matthew K. Aubert, Stewart Coventry, Neil J. Shirley, Natalie S. Betts, Tobias Würschum, Rachel A. Burton, Matthew R. Tucker.Differences in hydrolytic enzyme activity accompany natural variation in mature aleurone morphology in barley (Hordeum vulgare L.). Scientific Reports, 2018; 8 (1) DOI: 10.1038/s41598-018-29068-4
Disclaimer: These articles are not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of Pittwater Online News or its staff.