May 19 - 25, 2024: Issue 626

UTI pharmacy trial now permanent in NSW

The NSW Government announced on Tuesday May 14 that thousands of women across NSW will have expanded access to treatment for uncomplicated urinary tract infections (UTIs) following the successful completion of the 12-month NSW pharmacy trial.

From 1 June, all pharmacists with suitable facilities in NSW who have undergone the required training will be able to provide consultations and prescriptions for these medications.
More than 1000 pharmacies across the state have been participating in the trial and more than 16,000 women have benefited from using this service in the year the trial has been in place.

The NSW Government’s $6 million statewide community pharmacy trial has helped more than 16,000 women access UTI treatment quickly and conveniently from their local community pharmacist.

During the trial, the NSW Government committed to providing $20 per patient consultation compensation for pharmacies participating in the trial, however with the UTI service becoming a normal service offering, consumers should be aware that pharmacies may set their own fee for the service, in addition to medication costs.

Pharmacies offering the UTI service will need to ensure they are listed on the National Health Directory Service so consumers can easily find their nearest pharmacy by checking online or by phoning HealthDirect on 1800 022 022.

Women will continue to be eligible for UTI treatment at a participating pharmacy provided they are:
  • aged 18 to 65 years (inclusive)
  • displaying symptoms consistent with an uncomplicated urinary tract infection
  • have not had other recent UTIs or have a high risk of complications.
A comprehensive evaluation of the trial is underway, including looking at the number of women who were satisfied with the service, how often antibiotics were supplied, how often women were referred to other services and what, if any, medical and pharmacy services the trial participants required after the consultation.

Minister for Health Ryan Park stated:
“The NSW Government is committed to taking pressure off GPs and primary care services and we are constantly evaluating ways we can deliver healthcare more efficiently as well as safely.

“Enabling pharmacists to do more will mean many women will get timely access to the care they need.

“Ensuring continuity of care will be crucial as pharmacy service offerings increase, including strengthened communications between pharmacists and doctors about a patient’s treatment.”

Pharmacy Guild of Australia NSW Branch President David Heffernan said:
“Women across NSW will benefit from easy access to treatment for painful UTIs.

“This UTI trial has been a success in providing affordable, accessible everyday healthcare with over 16,000 women treated across the state.

“Pharmacists are ready to step up take some of the pressure off of GP clinics and hospitals.”

Pharmaceutical Society of Australia NSW President Luke Kelly stated:
“The Pharmaceutical Society of Australia and pharmacists across NSW thank Minister Park and the NSW Government for the confidence they have shown in pharmacists.

“Thousands of NSW women will now have timely access to effective treatment for painful and uncomfortable urinary tract infections.”

Chief Investigator at the University of Newcastle Dr Sarah Dineen-Griffin said:
“The UTI trial has seen incredible demand.
“It is pleasing to see the service continue while we undertake an independent evaluation of the data collected during the trial, with a final report to be provided to the NSW Ministry of Health in early 2025.”

Locate your closest participating pharmacist here:

Relief on energy bills for all in a federal budget that bets on lower inflation

Wes Mountain/The Conversation, CC BY-ND
Michelle Grattan, University of Canberra

A $300 energy rebate for all households from July 1 and a 10% increase in Commonwealth Rent Assistance are key measures in a budget targeting cost-of-living relief that put downward pressure on inflation.

Delivered by Treasurer Jim Chalmers on Tuesday night, the budget also freezes the maximum cost of Pharmaceutical Benefits Scheme (PBS) prescriptions for everyone for the year of 2025 and concession card holders for five years.

As Chalmers told federal parliament, “this is a budget for the here and now and it’s a budget for the decade to come”.

After an estimated surplus of $9.3 billion this financial year, a deficit of $28.3 billion is forecast for next financial year, before rising to $42.8 billion in 2025-26. The projected deficits then reduce to smaller but still substantial amounts in the following two years. Across the budget period, deficits total $112.8 billion.

The various cost-of-living measures are expected to take 0.5 of a percentage point off inflation over the coming year, as the government tries to boost the prospect of an interest rate fall before the election.

Looking to boost growth in the longer term, the budget invests $22.7 billion in a Future Made in Australia package over a decade to “help make us an indispensable part of the global economy”. This funding is loaded into the latter stages of the decade.

This includes $13.7 billion for production tax incentives for green hydrogen and processed critical minerals “so industries are rewarded for scale and success”.

A $1.7 billion Future Made in Australia Innovation Fund aims to “develop new industries like green metals and low carbon fuels” and $520 million is allocated “to deepen net zero trade and engagement with our region”.

‘Rigor’ for Future Made in Australia Fund

The policy will have a National Interest Framework to impose “rigour” on government decisions.

The energy relief, which will be provided through the states and providers, costs $3.5 billion over three years and will also extend to one million small businesses, which will get $325.

Households will benefit from the energy help at the same time as all taxpayers receive a tax cut, which is worth an average of $36 a week.

The boost in Commonwealth Rent Assistance – coming after a 15% rise in last year’s budget – will cost $1.9 billion over five years. New investment in housing is $6.2 billion.

Chalmers said the budget showed the government was “realistic about the pressures people face now – and optimistic about the future”.

Treasurer Jim Chalmers told his news conference that on inflation it was “not mission accomplished because people are still hurting.”

International uncertainty combined with cost-of-living pressures and high interest rates will slow the economy, with growth forecast at 1.75% this financial year and 2% in the next.

Unemployment is set to rise to 4.5% by the June quarter next year. Unemployment is currently at 3.8%

“I want Australians to know that despite everything coming at us, we are among the best placed economies to manage these uncertainties and maximise our opportunities,” Chalmers said.

He said the government was limiting real spending to an average of 1.4% a year since it came to office. It will be an estimated 3.6% in the coming financial year.

The budget contains earlier announced changes to the indexation arrangements for HELP student debt and placement payments for teaching, social work and nursing students.

There is $2.2 billion to deliver more key reforms in aged care. The budget also includes unspecified provisions for wage rises in aged care and child care.

Shadow treasurer Angus Taylor said: “In this budget, Labor has added $315 billion of new spending, at a time when we need restraint.

"After two years in office and three Labor budgets, the government is no closer to dealing with its homegrown inflation crisis – which means more pressure on cost of living and interest rates higher for longer.”

Greens leader Adam Bandt said: “This band-aid budget is a betrayal of renters, women, students and mortgage holders. Labor’s offering a future for coal and gas that will wreck the climate, unleash corporate greed, and throw ordinary people to the wolves”.

The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Budget a missed opportunity to tackle health system issues: AMA

May 14, 2024
After laying a strong groundwork in last year’s budget and reaching an important agreement at the December 2023 National Cabinet meeting, this budget is a lost opportunity to make further progress in addressing key health system challenges, including greater funding and support for patients to access care in general practice. 

Australian Medical Association President Professor Steve Robson said there was little that was new in this year’s budget, and this represented a real loss of momentum towards a more efficient and sustainable health system.  

“MyMedicare provides the government with a real platform to reform general practice and improve access and affordability for patients, but the extra funding needed to build on this initiative was missing in tonight’s budget,” Professor Robson said. 

“More urgent care clinics is not a long-term strategic solution, and the government keeps looking to fund more of them without proper evaluation of their impact. What we need is reform that enables general practice to deliver the primary care that our patients need, not piecemeal announcements and changes that further fragment the system.” 

Professor Robson said every general practice has the capacity to provide urgent care and the AMA would have liked to see the government improve funding arrangements for general practice so patients can see their usual GP when they need to, including out of normal business hours, along with changes to encourage more doctors to take up general practice.  

“Australia has a GP shortage that will only get worse. We need to encourage more doctors to take up general practice by ensuring GP trainees are offered equitable employment conditions in comparison to their hospital counterparts. And we need an independent planning agency to ensure that the future health workforce meets community need.”  

Professor Robson said the AMA was disappointed the federal government, together with the states and territories, had not detailed how they would tackle the blowout in planned surgery waitlists in public hospitals.  

“Just weeks ago, we released a report showing planned surgery wait times in our public hospitals are now the longest on record, and emergency departments remain strangled by access block,” he said. 

“The additional investment through the next hospital agreement is very welcome but we have hundreds of thousands of Australians waiting in pain for planned surgery. Unless the Commonwealth and the state and territories come up with a funded plan to address this, patients will continue to suffer, with their conditions getting worse, their quality of life significantly impacted and the long-term cost to the health system being higher.”  

Modest relief for patients through the freezing of the PBS co-payment is very welcome, although the decision to phase out the optional $1 discount on patient copayments will further entrench the anticompetitive arrangements in the pharmacy sector that review after review has called out. 

The budget sends some welcome signals on women’s health with the announcement of new Medicare items for longer consultations for complex conditions such as endometriosis and pelvic pain and a commitment to review the adequacy of Medicare funding for long-acting reversible contraceptives and diagnostic imaging procedures. 

An additional 24,100 home care packages for 2024/25 is also a welcome measure to help support older Australians remain in their homes for longer.  

The budget details some additional funding for mental health services but we are concerned to see that the critical role of general practice in caring for patients with complex physical and mental health needs will be undermined by the removal of specific Medicare items for the review of a mental health care plan, which is often undertaken as part of a broad assessment of a patient’s physical and mental health needs. 

The decision to introduce indexation of Medicare funding for some pathology services is a step in the right direction and we are pleased to see additional funding for nuclear medicine. 

Meanwhile, Professor Robson said preventive health was again the loser in this year’s budget, with the government missing an opportunity to raise billions of dollars for preventive health by introducing a sugar tax on sugary drinks.  

“This is a win-win policy, with an approximate 20 per cent health levy on sugary drinks raising around $1 billion each year ― money that could be invested into measures that reduce pressure on our stretched health system. 

“Research shows there could be 4,400 fewer cases of heart disease, 16,000 fewer cases of type 2 diabetes, and 1,100 fewer strokes over 25 years if the government takes this step but we’ve not seen a government brave enough to tackle the industry groups opposed to this measure.” 

Reform was also needed in the private health insurance sector, with the increased cost-of-living and perceived lack of value in insurance, potentially leading to people dropping insurance and putting further strain on the public hospital system.  

“Patients are being hit with rising private health insurance bills as their providers funnel significantly more money into management expenses, dwarfing any increase in rebates and benefits,” Professor Robson said.  

“We need a 'value mandate' for private health insurers to return a minimum 90 per cent, on average, of premium dollars paid each year back to the consumer in the form of rebates and benefits. And we need an independent Private Health Insurance Authority to ensure the system is fair and balances everyone’s interests.” 

It’s so hard to see a doctor right now. What are my options?

David Fuentes Prieto/Shutterstock
Anthony Scott, Monash University

Deciding whether to wait and see if your health condition improves or go to a GP can be a difficult task. You might be unsure about where to go, whom to see, how much it will cost and whether you’ll need to take time off work.

These choices can create significant barriers to accessing health care in Australia. There is often limited information available about the pros and cons of the different options. Often, we stick to what we know, unaware of better alternatives.

But making the wrong decision about how to access care can impact both your health and finances. So what are your options? And what policy reforms are needed to improve affordable access to care for all Australians?

How quickly can I be seen?

Access depends on how long it takes you to speak to a GP, or be seen in an emergency department, or by a community pharmacist, or a nurse practitioner whom you can see directly. Access depends on where you live and the time of day.

The rise of telehealth means GPs now get paid to talk to you on the phone, which is great for many minor ailments, medical certificates, repeat scripts or getting test results. Call centres such as Healthdirect have been available for some time and now virtual emergency departments can also see you online.

There are even GPs who only provide their services online if you can pay. A phone call can save you valuable time. Before COVID, you needed to take half a day off work to see a GP, now it takes five to ten minutes and the GP even calls you.

Things get more tricky outside of normal working hours and at weekends – appointments are harder to come by, it is unlikely you will be able to see a GP whom you know, and out-of-pocket costs might be higher.

If you can’t wait, your local emergency department is likely to be more accessible, or you might be lucky enough to live near a bulk-billed Medicare urgent care clinic, where you don’t need an appointment. Tomorrow’s federal budget will include funding for another 29 urgent care clinics, on top of the 58 already operating.

Family waits in emergency department
Sometimes medical issues can’t wait until the next business day. Hananeko_Studio/Shutterstock

But things are much worse if you live if a rural or remote area, where choice is limited and you need to wait much longer for GP appointments or travel long distances. Telehealth helps but can be expensive if it is not with your usual doctor.

Who will I see?

Access depends on who you will see. At the moment, this will usually be your GP (or, depending on the severity of your health concern, your community pharmacist or local emergency department staff). But to see your preferred GP you might need to wait as they are usually very busy.

But a review of “scope of practice” in primary care aims to free up GPs’ time and use their skills more effectively.

So in future, you could receive more of your health care from qualified nurses, nurse practitioners, pharmacists and other health professionals.

But which tasks can be delegated to other health professionals is a significant bone of contention for GPs. For GP practices facing significant cost pressures, safely delegating tasks to other less costly health professionals also makes good business sense.

How much will it cost?

Access depends on out-of-pocket costs. Bulk billing of GP services reached a peak of 89.6% in the September quarter of 2022 but plummeted to 76.5% by the September quarter of 2023.

Last November, bulk billing incentives for children under 16 and those on concession cards were tripled, and between November and December 2023 bulk billing had increased from 76.5% to 77.7%.

They key issue for patients is that it remains uncertain whether a GP will bulk bill you. You often don’t know this until you get into the consultation, at which point you can’t back out. Unless the whole practice bulk bills and so it is guaranteed, it’s entirely up to the GP whether you are bulk billed. It’s difficult to think of any other service where you don’t know how much you will pay until after you have used it.

Clinician types on laptop
It’s difficult to assess your options if you don’t know how much you’ll have to pay or whether you’ll be bulk-billed. National Cancer Institute/Unsplash

How can policymakers improve access to care?

Government policies to strengthen primary care have focused on giving patients improved access through telehealth, urgent care clinics and Strengthening Medicare initiatives, which are currently being developed.

But uncertainty surrounding out-of-pocket costs can deter people from seeking medical attention, or delay care or go instead to the emergency department or urgent care clinic where there is no out-of-pocket cost.

Cost is a factor that leads to 20% of those with a mental health problem and 30% of those with chronic disease to delay or avoid visiting a health professional. Those most in need are more likely to miss out on necessary visits and prescriptions, sometimes with disastrous consequences. A recent study shows people can die if they stop heart medications due to increased out-of-pocket costs.

The next task for policymakers should be developing policies to guarantee there are no out-of-pocket costs for those on low incomes. This could be a worthwhile investment in our health and should be included in tomorrow’s budget.The Conversation

Anthony Scott, Professor of Health Economics, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Binge drinking is a growing public health crisis − a neurobiologist explains how research on alcohol use disorder has shifted

Since Amy Winehouse’s death in 2011, professionals have learned a great deal more about alcohol use disorder. Kevin Mazur/WireImage via Getty Images
Nikki Crowley, Penn State

With the new Amy Winehouse biopic “Back to Black” in U.S. theaters as of May 17, 2024, the late singer’s relationship with alcohol and drugs is under scrutiny again. In July 2011, Winehouse was found dead in her flat in north London from “death by misadventure” at the age of 27. That’s the official British term used for accidental death caused by a voluntary risk.

Her blood alcohol concentration was 0.416%, more than five times the legal intoxication limit in the U.S. – leading her cause of death to be later adjusted to include “alcohol toxicity” following a second coroner’s inquest.

Nearly 13 years later, alcohol consumption and binge drinking remain a major public health crisis, not just in the U.K. but also in the U.S.

Roughly 1 in 5 U.S. adults report binge drinking at least once a week, with an average of seven drinks per binge episode. This is well over the amount of alcohol thought to produce legal intoxication, commonly defined as a blood alcohol concentration over 0.08% – on average, four drinks in two hours for women, five drinks in two hours for men.

Among women, days of “heavy drinking” increased 41% during the COVID-19 pandemic compared with pre-pandemic levels, and adult women in their 30s and 40s are rapidly increasing their rates of binge drinking, with no evidence of these trends slowing down. Despite efforts to comprehend the overall biology of substance use disorders, scientists’ and physicians’ understanding of the relationship between women’s health and binge drinking has lagged behind.

I am a neurobiologist focused on understanding the chemicals and brain regions that underlie addiction to alcohol. I study how neuropeptides – unique signaling molecules in the prefrontal cortex, one of the key brain regions in decision-making, risk-taking and reward – are altered by repeated exposure to binge alcohol consumption in animal models.

My lab focuses on understanding how things like alcohol alter these brain systems before diagnosable addiction, so that we can better inform efforts toward both prevention and treatment.

Full color cross-section side view of a child's brain with labels.
Signaling molecules in the prefrontal cortex are altered by repeated exposure to excessive alcohol consumption in animal models. jambojam/iStock via Getty Images

The biology of addiction

While problematic alcohol consumption has likely occurred as long as alcohol has existed, it wasn’t until 2011 that the American Society of Addiction Medicine recognized substance addiction as a brain disorder – the same year as Winehouse’s death. A diagnosis of an alcohol use disorder is now used over outdated terms such as labeling an individual as an alcoholic or having alcoholism.

Researchers and clinicians have made great strides in understanding how and why drugs – including alcohol, a drug – alter the brain. Often, people consume a drug like alcohol because of the rewarding and positive feelings it creates, such as enjoying drinks with friends or celebrating a milestone with a loved one. But what starts off as manageable consumption of alcohol can quickly devolve into cycles of excessive alcohol consumption followed by drug withdrawal.

While all forms of alcohol consumption come with health risks, binge drinking appears to be particularly dangerous due to how repeated cycling between a high state and a withdrawal state affect the brain. For example, for some people, alcohol use can lead to “hangxiety,” the feeling of anxiety that can accompany a hangover.

Repeated episodes of drinking and drunkenness, coupled with withdrawal, can spiral, leading to relapse and reuse of alcohol. In other words, alcohol use shifts from being rewarding to just trying to prevent feeling bad.

It makes sense. With repeated alcohol use over time, the areas of the brain engaged by alcohol can shift away from those traditionally associated with drug use and reward or pleasure to brain regions more typically engaged during stress and anxiety.

All of these stages of drinking, from the enjoyment of alcohol to withdrawal to the cycles of craving, continuously alter the brain and its communication pathways. Alcohol can affect several dozen neurotransmitters and receptors, making understanding its mechanism of action in the brain complicated.

Work in my lab focuses on understanding how alcohol consumption changes the way neurons within the prefrontal cortex communicate with each other. Neurons are the brain’s key communicator, sending both electrical and chemical signals within the brain and to the rest of your body.

What we’ve found in animal models of binge drinking is that certain subtypes of neurons lose the ability to talk to each other appropriately. In some cases, binge drinking can permanently remodel the brain. Even after a prolonged period of abstinence, conversations between the neurons don’t return to normal.

These changes in the brain can appear even before there are noticeable changes in behavior. This could mean that the neurobiological underpinnings of addiction may take root well before an individual or their loved ones suspect a problem with alcohol.

Researchers like us don’t yet fully understand why some people may be more susceptible to this shift, but it likely has to do with genetic and biological factors, as well as the patterns and circumstances under which alcohol is consumed.

Image of hormone receptors in the prefrontal cortex of the brain, lit up in varying colors.
Work in the author’s lab explores how alcohol use can alter the way neurons communicate in the prefrontal cortex brain region. Estrogen receptors are labeled in purple and receptors for somatostatin, a key regulatory hormone, in blue. Victora Nudell

Women are forgotten

While researchers are increasingly understanding the medley of biological factors that underlie addiction, there’s one population that’s been largely overlooked until now: women.

Women may be more likely than men to have some of the most catastrophic health effects caused by alcohol use, such as liver issues, cardiovascular disease and cancer. Middle-aged women are now at the highest risk for binge drinking compared with other populations.

When women consume even moderate levels of alcohol, their risk for various cancers goes up, including digestive, breast and pancreatic cancer, among other health problems – and even death. So the worsening rates of alcohol use disorder in women prompt the need for a greater focus on women in the research and the search for treatments.

Yet, women have long been underrepresented in biomedical research.

It wasn’t until 1993 that clinical research funded by the National Institutes of Health was required to include women as research subjects. In fact, the NIH did not even require sex as a biological variable to be considered by federally funded researchers until 2016. When women are excluded from biomedical research, it leaves doctors and researchers with an incomplete understanding of health and disease, including alcohol addiction.

There is also increasing evidence that addictive substances can interact with cycling sex hormones such as estrogen and progesterone. For instance, research has shown that when estrogen levels are high, like before ovulation, alcohol might feel more rewarding, which could drive higher levels of binge drinking. Currently, researchers don’t know the full extent of the interaction between these natural biological rhythms or other unique biological factors involved in women’s health and propensity for alcohol addiction.

Adult woman faces away from the camera, holding a glass of white wine in one hand and pressing her left hand against her neck.
Middle-aged women are at the highest risk for some of the most severe health consequences of binge drinking. Peter Dazeley/The Image Bank via Getty Images

Looking ahead

Researchers and lawmakers are recognizing the vital need for increased research on women’s health. Major federal investments into women’s health research are a vital step toward developing better prevention and treatment options for women.

While women like Amy Winehouse may have been forced to struggle both privately and publicly with substance use disorders and alcohol, the increasing focus of research on addiction to alcohol and other substances as a brain disorder will open new treatment avenues for those suffering from the consequences.

For more information on alcohol use disorder, causes, prevention and treatments, visit the National Institute on Alcohol Abuse and Alcoholism.The Conversation

Nikki Crowley, Assistant Professor of Biology, Biomedical Engineering and Pharmacology, Penn State

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Longer appointments are just the start of tackling the gender pain gap. Here are 4 more things we can do - Yuri A/Shutterstock
Michelle O'Shea, Western Sydney University; Hannah Adler, Griffith University; Marilla L. Druitt, Deakin University, and Mike Armour, Western Sydney University

Ahead of today’s federal budget, health minister Mark Butler last week announced an investment of A$49.1 million to help women with endometriosis and complex gynaecological conditions such as chronic pelvic pain and polycystic ovary syndrome (PCOS).

From July 1 2025 two new items will be added to the Medicare Benefits Schedule providing extended consultation times and higher rebates for specialist gynaecological care.

The Medicare changes will subsidise $168.60 for a minimum of 45 minutes during a longer initial gynaecologist consultation, compared to the standard rate of $95.60. For follow-up consultations, Medicare will cover $84.35 for a minimum of 45 minutes, compared to the standard rate of $48.05.

Currently, there’s no specified time for these initial or subsequent consultations.

But while reductions to out-of-pocket medical expenses and extended specialist consultation times are welcome news, they’re only a first step in closing the gender pain gap.

Chronic pain affects more women

Globally, research has shown chronic pain (generally defined as pain that persists for more than three months) disproportionately affects women. Multiple biological and psychosocial processes likely contribute to this disparity, often called the gender pain gap.

For example, chronic pain is frequently associated with conditions influenced by hormones, among other factors, such as endometriosis and adenomyosis. Chronic pelvic pain in women, regardless of the cause, can be debilitating and negatively affect every facet of life from social activities, to work and finances, to mental health and relationships.

The gender pain gap is both rooted in and compounded by gender bias in medical research, treatment and social norms.

The science that informs medicine – including the prevention, diagnosis, and treatment of disease – has traditionally focused on men, thereby failing to consider the crucial impact of sex (biological) and gender (social) factors.

When medical research adopts a “male as default” approach, this limits our understanding of pain conditions that predominantly affect women or how certain conditions affect men and women differently. It also means intersex, trans and gender-diverse people are commonly excluded from medical research and health care.

Minimisation or dismissal of pain along with the normalisation of menstrual pain as just “part of being a woman” contribute to significant delays and misdiagnosis of women’s gynaecological and other health issues. Feeling dismissed, along with perceptions of stigma, can make women less likely to seek help in the future.

Inadequate medical care

Unfortunately, even when women with endometriosis do seek care, many aren’t satisfied. This is understandable when medical advice includes being told to become pregnant to treat their endometriosis, despite no evidence pregnancy reduces symptoms. Pregnancy should be an autonomous choice, not a treatment option.

It’s unsurprising people look for information from other, often uncredentialed, sources. While online platforms including patient-led groups have provided women with new avenues of support, these forums should complement, rather than replace, information from a doctor.

Longer Medicare-subsidised appointments are an important acknowledgement of women and their individual health needs. At present, many women feel their consultations with a gynaecologist are rushed. These conversations, which often include coming to terms with a diagnosis and management plan, take time.

A young woman sitting on a bed clutching her pelvic area in pain.
Women are more likely to experience chronic pain than men. New Africa/Shutterstock

A path toward less pain

While extended consultation time and reduced out-of-pocket costs are a step in the right direction, they are only one part of a complex pain puzzle.

If women are not listened to, their symptoms not recognised, and effective treatment options not adequately discussed and provided, longer gynaecological consultations may not help patients. So what else do we need to do?

1. Physician knowledge

Doctors’ knowledge of women’s pain requires development through both practitioner education and guidelines. This knowledge should also include dedicated efforts toward understanding the neuroscience of pain.

Diagnostic processes should be tailored to consider gender-specific symptoms and responses to pain.

2. Research and collaboration

Medical decisions should be based on the best and most inclusive evidence. Understanding the complexities of pain in women is essential for managing their pain. Collaboration between health-care experts from different disciplines can facilitate comprehensive and holistic pain research and management strategies.

3. Further care and service improvements

Women’s health requires multidisciplinary treatment and care which extends beyond their GP or specialist. For example, conditions like endometriosis often see people presenting to emergency departments in acute pain, so practitioners in these settings need to have the right knowledge and be able to provide support.

Meanwhile, pelvic ultrasounds, especially the kind that have the potential to visualise endometriosis, take longer to perform and require a specialist sonographer. Current rebates do not reflect the time and expertise needed for these imaging procedures.

4. Adjusting the parameters of ‘women’s pain’

Conditions like PCOS and endometriosis don’t just affect women – they also impact people who are gender-diverse. Improving how people in this group are treated is just as salient as addressing how we treat women.

Similarly, the gynaecological health-care needs of culturally and linguistically diverse and Aboriginal and Torres Strait islander women may be even less likely to be met than those of women in the general population.

Challenging gender norms

Research suggests one of the keys to reducing the gender pain gap is challenging deeply embedded gendered norms in clinical practice and research.

We are hearing women’s suffering. Let’s make sure we are also listening and responding in ways that close the gender pain gap.The Conversation

Michelle O'Shea, Senior Lecturer, School of Business, Western Sydney University; Hannah Adler, PhD candidate, health communication and health sociology, Griffith University; Marilla L. Druitt, Affiliate Senior Lecturer, Faculty of Health, Deakin University, and Mike Armour, Associate Professor at NICM Health Research Institute, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A minute’s silence is fine but when it comes to violence against women, being quiet isn’t enough

Catherine Ordway, University of Canberra and Ginger Gorman, University of Canberra

Sport has a role to play in creating a culture of respect, yet women in sport are often seen as “less than” on almost every measure: salaries, sponsorship, broadcasting, leadership, access, media, coaching, officiating, uniforms and support.

Research shows three out of four Australian men are gender equality supporters, but very few (17%) prioritise taking any action.

As Australia grapples with a “national crisis” of violence against women, what can men in sport do to help?

What does the research tell us?

Rigid gender norms can play a part in fuelling male violence against women and children. And sport is an arena, excuse the pun, where rigid gender norms flourish.

When it comes to sport and gendered violence, a special level of toxic attack and misogyny is reserved for women who “dare” to play, watch and work in sport, and this is particularly heightened for women of colour and/or presumed to be from the LGBTQI+ community, whether identifying or not.

Sport also regularly promotes alcohol and gambling, with evident impacts on women and children – whenever there are big sporting events, violence against women by spectators increases.

Players, coaches, commentators and officials repeatedly avoid sanctions, or get a slap on the wrist, and go on to secure leadership roles in sport, sometimes despite allegations of serious gender-based offences.

The message this sends to younger players and fans is that misogyny is acceptable and that “heroes” are beyond reproach. This green-lights sexism, and completely undermines any messages around equality.

Tracey Gaudry has held a trifecta of roles relevant to this discussion. Not only was she previously a former champion cyclist, and former CEO of Hawthorn Football Club, she has also been Respect Victoria’s CEO.

Back in 2020 she nailed the confluence of issues:

“Gender inequality is a driver of violence against women and it can start out small. Because sport comes from a male-dominant origin, those things build up over time and become a natural part of the sporting system and an assumed part.”

What are sports codes and teams doing?

Professional sport organisations and clubs have been trying to address abusive behaviour towards women for decades. Both the AFL and NRL began developing respect and responsibility programs and policies 20 years ago, yet the abuse, and the headlines, continue – against both women in the game, and at home.

The NRL partnered with Our Watch to try to reduce violence against women and children in Australia.

There are also opportunities for clubs to take action even if their governing bodies don’t. Semi-professional rugby league club the Redfern All Blacks, for example, are showing leadership: players who are alleged to be perpetrators are banned from playing until they’re prepared to talk about it openly, and prove they are committed to changing their behaviour.

Education is also vital.

At the elite level, most codes are trying to educate those within their sports – the NRL’s Voice Against Violence program, led by Our Watch, is the same organisation the AFL has recently partnered with.

The NRL also implements the “Change the Story” framework in partnership with ANROWS and VicHealth, which includes a zero tolerance education program for juniors transitioning into seniors.

What more should be done?

The AFL’s recent minute silence gesture to support women affected by violence does not go far enough.

Men, especially those in leadership positions, can take action by actively dishonouring the men who have abused women.

Some of the men we celebrate around the country for their service as players, presidents, life members and coaches have been abusive towards women and children.

Recently, the AFL demanded Wayne Carey – who has a long history of domestic violence allegations and assault convictions – be denied his NSW Hall of Fame Legend status. The next step is to see Carey struck off his club and AFL honour rolls.

The same treatment should apply to other convicted abusers such as Jarrod Hayne and Ben Cousins – the list goes on.

To take a stand on violence against women, award winners who have been convicted for, or admitted to, abuse against women should be explicitly called out with an asterisk next to their names – “dishonoured for abuse against women”.

And current and future awards must be ineligible to abusers. Serious crimes should mean a life ban for all roles in sport.

If there is a criminal conviction, or an admission of disrespectful behaviour (abuse, sexism, racism, ableism or homophobia), then action must immediately be taken to strip them of their privileges.

What about the grey area of allegations?

One tricky challenge for sport organisations is how to deal with allegations that don’t result in criminal convictions.

The legal system has systematically failed to protect women from sexual predators, so we can’t rely solely on a conviction to act.

In 2019, the NRL introduced a discretionary “no fault, stand down” rule for players charged with serious criminal offences, and/or offences involving women and children. Under this rule, players must stand down from matches until the matter is resolved.

All sports should, as a baseline starting point, be following suit.

Where to from here?

It’s time sport organisations and fans acknowledged two things can be true: good, even great, athletes, coaches or administrators can be bad humans.

Sporting codes need a zero-tolerance approach for abuse of women which should apply to fans, players, coaches, umpires, referees and administrators.

All codes should strongly consider implementing the “no fault, stand down” rule similar to the NRL. Perpetrators should not be allowed back into high-profile roles. Supporters must also be held to account – if fans can be banned for racism, they can be banned for sexism.

At all levels and across all sports, we must send the message from the ground up: misogyny is unacceptable and the consequence for your bad behaviour is that you are no longer welcome.The Conversation

Catherine Ordway, Associate Professor Sport Management and Sport Integrity Lead, University of Canberra and Ginger Gorman, Editor of the feminist academic blog BroadAgenda at the Faculty of Business, Government and Law at University of Canberra., University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

David McBride goes to prison – and Australian democracy takes a hit

Peter Greste, Macquarie University

Governments and their agencies wield awesome power. At times, it is quite literally the power over life and death. That is why in any functioning democracy, we have robust checks and balances designed to make sure power is exercised responsibly and with restraint.

So, what message does a sentence of more than five years in prison for someone who exposed credible allegations of war crimes by Australian soldiers send?

On Tuesday, ACT Supreme Court Justice David Mossop despatched the former military lawyer David McBride to prison for five years and eight months, for passing classified military documents to journalists. Those documents formed the basis of the ABC’s explosive “Afghan Files” investigation, revealing allegations that Australian soldiers were involved in the unlawful executions of unarmed civilians.

It is hard to think of any whistleblowing more important.

McBride’s case forced us to confront the way our own troops had been conducting the war in Afghanistan, as well as the government’s ongoing obsession with secrecy over the public interest.

McBride had been concerned about what he saw as systemic failures of the SAS commanders, and their inconsistency in dealing with the deaths of “non-combatants” in Afghanistan. In an affidavit, he said he saw the way frontline troops were being

improperly prosecuted […] to cover up [leadership] inaction, and the failure to hold reprehensible conduct to account.

He initially complained internally, but when nothing happened he decided to go public. In 2014 and 2015, McBride collected 235 military documents and gave them to the ABC. The documents included 207 classified as “secret” and others marked as cabinet papers.

It is hard to deny the truth of what McBride exposed. The Brereton Inquiry later found what a parliamentary briefing described as “credible information” of 23 incidents in which non-combatants were unlawfully killed “by or at the direction of Australian Special Forces”. The report said these “may constitute the war crime of murder”.

Brereton went on to recommended prosecutions of the soldiers who were allegedly responsible. Yet, the first person to face trial and be sent to prison in the whole debacle is not any of those who might have been responsible for alleged killings, but the man who exposed “misconduct” in the Australian Defence Force.

Much has been made of McBride’s reasons for going to the media, but this focus on motives is a form of misdirection. Whistleblowers take action for a host of reasons – some of them less honourable than others. But ultimately, what matters is the truth of what they expose, rather than why.

That is why we recognise media freedom as an essential part of a healthy democracy, including the right – indeed the responsibility – of journalists to protect confidential sources. Unless sources who see wrongdoing can confidently expose it without fear of being exposed and prosecuted, the system of accountability falls apart and gross abuses of power remain hidden.

It is also why the formal name for Australia’s whistleblower protection law is the “Public Interest Disclosure Act”.

This law is designed to do what it says on the tin: protect disclosures made in the public interest, including those made through the media. It recognises that sometimes, even when the law imposes certain obligations of secrecy on public servants, there may be an overriding interest in exposing wrongdoing for the sake of our democracy.

As a highly trained and experienced military lawyer, McBride knew it was technically illegal to give classified documents to the media. The law is very clear about that, and for good reason. Nobody should be able to publish government secrets without a very powerful justification.

But nor should the fact that a bureaucrat has put a “secret” stamp on a document be an excuse for covering up serious crimes and misdemeanours.

In McBride’s case, the judge accepted the first premise, but rejected the second.

This is why my organisation, the Alliance for Journalists’ Freedom, is advocating for a Media Freedom Act. The act would oblige the courts to weigh up those competing public interests – the need for secrecy in certain circumstances against the sometimes more compelling need to publish and expose wrongdoing – rather than assume secrecy as a given.

It is hard to overstate the impact this case is likely to have on anybody with evidence of government misdeeds. Do they stay quiet and live with the guilt of being complicit, or do they speak up like McBride and others, and risk public humiliation, financial ruin and possibly even prison?

Attorney-General Mark Dreyfus has committed to reforming the whistleblower protection regime, and before the last election, promised to set up an independent Whistleblower Protection Authority. Those commitments are laudable, but they ring hollow while McBride sits in prison and another prominent whistleblower, Richard Boyle from the Australian Taxation Office, faces trial later this year.

It is hard to see the former military lawyer being locked in a cell, and say Australia is either safer, or better because of it.The Conversation

Peter Greste, Professor of Journalism and Communications, Macquarie University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Whistleblower David McBride sentenced to almost six years’ prison for helping to expose wrongdoing: Human rights law centre

May 14 2024: Human Rights Law Centre - Commentary
David McBride was given a sentence of five years and eight months, with a non-parole period of two years and three months for leaking documents to the ABC which exposed war crimes in Afghanistan.

David McBride speaking to press pack before heading into ACT Supreme Court. Photo: HRLC

Whistleblowers make Australia a better place, ensuring accountability and justice by exposing government wrongdoing and corporate misdeeds. They are vital to our democracy.

This is why the Human Rights Law Centre advocates for an end to the unjust treatment of whistleblowers and launched the Whistleblower Project, Australia's only dedicated legal service for whistleblowers.

But on 14 May 2024, military whistleblower David McBride was sentenced to almost six years’ imprisonment by the ACT Supreme Court. It is a dark day for truth and justice in Australia. 

David leaked documents to the ABC, which led to the Afghan Files reporting - which showed credible evidence of war crimes committed by Australian forces in Afghanistan. It was public interest journalism at its finest. And yet on Tuesday, the first person imprisoned in relation to Australia’s war crimes was not a war criminal, but the whistleblower. 

McBride is the first whistleblower to be imprisoned in recent memory in Australia. Witness K, who exposed Australia’s spying against Timor-Leste, was given a suspended sentence; the prosecution of his lawyer, Bernard Collaery, was rightly dropped after the Albanese Government took office. Tax office whistleblower Richard Boyle will face trial in September. 

We have been vocal advocates against these prosecutions, because we see first-hand the chilling effect of prosecuting rather than protecting whistleblowers.  

As Australia’s only legal service for whistleblowers, we hear from our clients about their fears of speaking up, fuelled by these high-profile prosecutions. And all of us suffer as a result, when people can’t speak up about wrongdoing they witness. 

With your support, we will continue calling out the prosecution of whistleblowers, advocating for law reform (including the establishment of a whistleblower protection authority) and providing expert legal advice to whistleblowers.  

An NRL player died at training due to exertional heat stroke. What is it and what should coaches and athletes know?

Samuel Chalmers, University of South Australia and Orlando Laitano, University of Florida

The tragic death of Manly rugby league player Keith Titmuss in 2020 due to exertional heat stroke is a reminder of the life-threatening nature of the condition.

Titmuss died after a pre-season training session which was “more likely than not inappropriate”, according to the magistrate who oversaw a recent inquest.

Deputy NSW coroner Derek Lee made several recommendations in reviewing Titmuss’ death in the hope of reducing the chance of it happening again.

So, what is exertional heat stroke, and what should athletes and coaches know about it?

What is exertional heat stroke?

Exertional heat stroke is the most severe form of a spectrum of conditions classified as exertional heat illness.

During sport and exercise, the body is challenged to maintain an ideal core temperature of about 36-38°C.

This is because exercise produces a massive amount of internal heat, which needs to be released from the body to avoid overheating. Hot and humid conditions stress the ability of an person to release this internal heat, as well as potentially adding to the heat load.

If someone’s body is unable to control the rise in core temperature during physical activity, it may ultimately display central nervous system dysfunction. Signs of this include loss of muscle control in the arms and legs, combativeness, seizures, or loss of consciousness.

A highly elevated core temperature (typically, but not always, above 40°C) and multi-organ damage and failure are also characteristics of exertional heat stroke.

In one study, 27% of people suffering severe exertional heat illness died. But even those who survive often face long-term negative health consequences, such as an increased risk of cardiovascular disease later in life.

The human body needs to be cooled down if someone is suffering from exertional heat stroke.

How often does exertional heat stroke occur?

Less severe forms of exertional heat illness (termed as heat exhaustion and heat injury) are more common during sport and exercise than exertional heat stroke. However, the life-threatening nature of the condition means precautions must be considered, especially for summer sports.

The condition strikes “weekend warriors” through to elite athletes and military personnel. A recent paper published in the Journal of Science and Medicine in Sport reported there were 38 deaths in Australia from exertional heat stroke from sport and exercise between 2001 to 2018.

However, exertional heat illness cases are thought to be broadly underreported.

In an effort to reduce the risk of future cases of exertional heat stroke in rugby league, Coroner Lee made recommendations following the inquest into the death of Titmuss.

1) Mandatory 14-day heat acclimatisation training

The human body can adapt quickly (in one to two weeks) to repeated gradual exposure to hot and humid environments, which ultimately reduces the risk of heat illness.

Research shows that pre-season heat acclimatisation protocols reduce the risk of heat illness in team sport athletes.

2) Consider screening and classifying players for exertional heat stroke risk

The United States National Athletic Trainer’s Association recommends players be screened for heat illness when competing in hot and humid conditions.

This process seems intuitive, but we lack a standardised and validated questionnaire.

Other important risk factors include hydration status, prior history of heat illness and/or recent viral illness or infection, body composition (high body fat percentage), and age (older people).

3) Identify cooling strategies that are relevant and effective

Cooling interventions that serve both as a prevention (during play) and treatment (for a victim) should be considered in hot and humid conditions.

In terms of cooling interventions, the evidence suggests cold water immersion, cold water or ice ingestion, cooling garments (such as ice vests or ice towels), portable fans (with or without additional wetting of the skin), or additional breaks in play can help.

The type of sport will influence the decision about which cooling intervention/s are possible.

Other considerations include the level of resourcing (amount of finances and support staff), type of sport (the number of athletes who need an intervention will differ between team vs individual sports) and game demands (continuous exercise vs sports that have regular breaks).

Is there anything else that athletes and coaches can consider?

Many elite sport organisations in Australia and abroad are working with researchers to develop modernised heat policies that look to reduce the risk of heat illness for elite competition.

An example is the revamped Australian Open tennis heat policy.

At the community level, coaches and athletes can consult Sports Medicine Australia’s online tool. This provides an estimation of risk according to the type of sport and current geographical location.

Sporting and educational organisations should also consider better education for administrators, staff, and athletes to reduce the risk of exertional heat stroke in players.The Conversation

Samuel Chalmers, Senior Lecturer in Human Movement, University of South Australia and Orlando Laitano, Assistant Professor, University of Florida

This article is republished from The Conversation under a Creative Commons license. Read the original article.

154 million lives saved in 50 years: 5 charts on the global success of vaccines

Meru Sheel, University of Sydney and Alexandra Hogan, UNSW Sydney

We know vaccines have been a miracle for public health. Now, new research led by the World Health Organization has found vaccines have saved an estimated 154 million lives in the past 50 years from 14 different diseases. Most of these have been children under five, and around two-thirds children under one year old.

In 1974 the World Health Assembly launched the Expanded Programme on Immunization with the goal to vaccinate all children against diphtheria, tetanus, pertussis (whooping cough), measles, polio, tuberculosis and smallpox by 1990. The program was subsequently expanded to include several other diseases.

The modelling, marking 50 years since this program was established, shows a child aged under ten has about a 40% greater chance of living until their next birthday, compared to if we didn’t have vaccines. And these positive effects can be seen well into adult life. A 50-year-old has a 16% greater chance of celebrating their next birthday thanks to vaccines.

What the study did

The researchers developed mathematical and statistical models which took in vaccine coverage data and population numbers from 194 countries for the years 1974–2024. Not all diseases were included (for example smallpox, which was eradicated in 1980, was left out).

The analysis includes vaccines for 14 diseases, with 11 of these included in the Expanded Programme on Immunization. For some countries, additional vaccines such as Japanese encephalitis, meningitis A and yellow fever were included, as these diseases contribute to major disease burden in certain settings.

The models were used to simulate how diseases would have spread from 1974 to now, as vaccines were introduced, for each country and age group, incorporating data on increasing vaccine coverage over time.

Children are the greatest beneficiaries of vaccines

Since 1974, the rates of deaths in children before their first birthday has more than halved. The researchers calculated almost 40% of this reduction is due to vaccines.

The effects have been greatest for children born in the 1980s because of the intensive efforts made globally to reduce the burden of diseases like measles, polio and whooping cough.

Some 60% of the 154 million lives saved would have been lives lost to measles. This is likely due to its ability to spread rapidly. One person with measles can spread the infection to 12–18 people.

The study also found some variation across different parts of the world. For example, vaccination programs have had a much greater impact on the probability of children living longer across low- and middle-income countries and settings with weaker health systems such as the eastern Mediterranean and African regions. These results highlight the important role vaccines play in promoting health equity.

Vaccine success is not assured

Low or declining vaccine coverage can lead to epidemics which can devastate communities and overwhelm health systems.

Notably, the COVID pandemic saw an overall decline in measles vaccine coverage, with 86% of children having received their first dose in 2019 to 83% in 2022. This is concerning because very high levels of vaccination coverage (more than 95%) are required to achieve herd immunity against measles.

In Australia, the coverage for childhood vaccines, including measles, mumps and rubella, has declined compared to before the pandemic.

This study is a reminder of why we need to continue to vaccinate – not just against measles, but against all diseases we have safe and effective vaccines for.

The results of this research don’t tell us the full story about the impact of vaccines. For example, the authors didn’t include data for some vaccines such as COVID and HPV (human papillomavirus). Also, like with all modelling studies, there are some uncertainties, as data was not available for all time periods and countries.

Nonetheless, the results show the success of global vaccination programs over time. If we want to continue to see lives saved, we need to keep investing in vaccination locally, regionally and globally.The Conversation

Meru Sheel, Associate Professor and Epidemiologist, Infectious Diseases, Immunisation and Emergencies Group, Sydney School of Public Health, University of Sydney and Alexandra Hogan, Mathematical epidemiologist, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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.