Worked To Deathp2 - The Australian

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17 — THE WEEKEND

2/12/95

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AUSTRALIAN APRIL 23-24, 2005— 17 +

Health Ebola: virulent killer virus, and there’s no weapon in the doctor’s bag E

BOLA thrives just where you least expect it to — in the hospitals dedicated to stamping out outbreaks of this extraordinarily virulent virus. So rather than destroying the virus, efforts to care for its victims have actually fanned the flames of deadly Ebola outbreaks. Healthcare becomes killer rather than life saver. This is because Ebola is spread from person to person by direct contact with the blood, secretions and other body fluids and tissues of its victims. Contact with soiled bed linen or clothing is also extremely risky, which makes caring for patients, both dead and alive, a highly dangerous pursuit. People with Ebola haemorrhagic fever, the disease the virus causes, need to be isolated and treated with strict barrier

A BUG’S LIFE By Dr Adam Taor nursing, which involves wearing protective clothing: masks, gloves, gowns and goggles. This is hardly practical in remote areas of the African countries where outbreaks have struck, such as the Democratic Republic of Congo, Sudan and Gabon. That’s why when Ebola out-

breaks appear, they are often amplified in hospitals and among those having to dispose of the bodies. Ebola first appeared, seemingly from out of nowhere, in the mid-1970s in Sudan and Zaire (now the Democratic Republic of Congo) and is named after the Ebola River in the latter country. After the first outbreaks the virus laid low for a decade or so only to emerge again, and since then there have been regular outbreaks in which 50-90 per cent of infected patients have died. Ebola’s sporadic nature makes it unpredictable, and it doesn’t help that despite extensive study we still don’t know exactly where the virus comes from. It’s believed it lives naturally in the African rainforests using an animal as a host, but we don’t know which type of

animal. Humans have contracted Ebola via infected chimpanzees, gorillas and monkeys, but it’s thought that these nonhuman primates have been infected directly from the virus’s natural host. Ebola is a type of virus called a filovirus, and it has a long filament-like shape. Once infected people tend to develop symptoms of Ebola haemorrhagic fever two-21 days later. At first they may have a fever and a headache along with severe weakness. Then they may develop vomiting, diarrhoea and abdominal pain with impaired kidney and liver function. Some patients also have bleeding under the skin, or from the gut or orifices such as the eyes. There is no specific therapy or vaccine for Ebola haemorrhagic fever; treatment is aimed at supporting the patient.

Death toll 64: Health workers in Kitwit hospital, Zaire, in 1995

In hospital and worked to death

Doubts over milk’s role in strong bones

From previous page

Milk is rich in calcium, but suggestions it is necessary for bone health are overblown, reports Peta Bee

H

OW COMFORTING it is for parents of the child who won’t eat to know that at least she’s getting calcium from that evening cup of milk. Drinking milk and eating dairy foods as a way to strengthen bones has always been something of a mantra for the layman and nutritionist worried about the risks of developing osteoporosis in later life.

But recent research has raised questions about the benefits of milk, yoghurt and cheese on bone health. A report in a recent issue of the US journal Pediatrics (2005;115(3):736-43) suggests there is ‘‘scant evidence’’ that dairy intake has much effect on promoting strong bones. The report’s authors — researchers on the Physicians’ Committee for Responsible Medicine (PCRM) in Washington — based their findings on a review of 37 studies. Of these, 27 showed no relationship between dairy foods or dietary calcium and bone health in children and young adults, while the remainder found only a small association. This led researchers to conclude that ‘‘under scientific scrutiny, the support for the milk myth crumbles’’. According to Amy Joy Lanou, a nutritionist in the PCRM team, calcium, of which dairy food is a source, does play an important role in the development of bones. But Dr Lanou says their findings showed that physical activity during the peak years of bone growth (between birth and the early twenties) is a far stronger indicator of a strong skeleton in adulthood than dairy consumption. ‘‘It is really important for parents to understand that milk is not a necessary food for young people,’’ she says. ‘‘If children can’t drink milk for health or other reasons, their bones are still going to be just fine.’’ There is no denying that osteoporosis is an increasing problem. According to Osteoporosis Australia 1.9 million people in Australia had the condition in 2002 — a number expected to jump to 2.2 million by 2006, and to 3 million by 2021. Every eight minutes someone is admitted to an Australian hospital with an

THE MILKY WAY Suggested daily calcium intake ■ Australian men and pre-menopausal women 800mg ■ Post-menopausal women 1000mg ■ Pregnant women 1100mg ■ Breastfeeding mothers 1200mg ■ Children aged eight to 11, two to three servings a day of milk, yoghurt and cheese ■ Adolescents aged 12 to 18, three to five servings a day The National Health and Medical Research Council

osteoporotic fracture. This is expected to rise to every three to four minutes by 2021. As many as four out of five people with osteoporosis don’t know they have it, according to Osteoporosis Australia, which could explain the much lower incidence rates recorded in official statistics. The Australian Institute of Health and Welfare estimated that 52,000 Australian men, and 248,000 Australian women, had osteoporosis in 2001 — about 1.6 per cent of the population. Because the condition becomes more common with age much higher incidence rates are recorded among the elderly. According to the 2001 Australian National Health Survey, 10.5 per cent of women aged 65-74 had osteoporosis, increasing to 12.3 per cent among women over 75. The percentages among men were 1.2 per cent and 1.5 per cent respectively. However other experts suggest that the emphasis on dairy foods is overplayed, and point out instead the importance of other factors including weightbearing exercise, genetics, smoking, protein consumption and an adequate intake of vitamin D. Walter Willett, head of nutrition at Harvard University School of Public Health and the principal investigator in the Nurses’ Health Study (which has followed the diet and lifestyle habits of 72,000 women for 25 years), says that there is ‘‘no solid evidence that merely increasing the amount of milk in your diet will protect you from breaking a hip

Milk: Good reasons to drink it, but to grow healthy bones isn’t one of them or crushing a backbone in later years’’. Professor Willett found instead that women who drank a glass of milk twice a day for many years were as likely to a suffer broken bone as those who drank only a glass a week. In a separate study of 43,000 men the Harvard research team also failed to link long-term low-dairy consumption with brittle bones. It has also been suggested that dairy foods and meat can even promote a leaching of calcium from the bones. According to Colin Campbell, of the department of nutritional biochemistry at Cornell University, these foods contain good amounts of animal protein, which makes blood more acidic; the body

tries to neutralise this by drawing calcium from the bones. Professor Campbell argues that the more dairy people eat, the more calcium they will need to consume to balance these losses. His research has shown that in Asian countries, where dairy intakes are low, their populations suffer one fifth fewer broken bones than in Britain or America. ‘‘Those countries that use the most cow’s milk and its related products have the highest fracture rates and the worst bone health,’’ he says. Bridget McKevith, a nutrition scientist for the British Nutrition Foundation, says that adults and children need no more than 0.8g of protein per kilogram of bodyweight every day, about two servings.

‘‘Too high an intake of animal protein is known to affect bone health adversely,’’ she says. ‘‘The same is true of highly processed foods and products that cause high levels of acidity, such as fizzy drinks.’’ But McKevith and the majority of nutritionists remain cautious about the suggestion emerging from this research that it may be time to ‘‘ditch the dairy’’, because full-fat milk is a ‘‘convenient source’’ of fat and calories for children under 12. ‘‘Some calcium is essential in the diet,’’ she adds, ‘‘and dairy remains a useful way to get it, although it is not the only step we should take to protect our bones.’’

The Times

Have doctors, will complain says British research ACCESS to high-quality healthcare simply encourages people to complain about their illnesses, research suggests. A study in the British Medical Journal found that 70 per cent of the UK population was taking medicines to treat or prevent illhealth, or enhance wellbeing. However, studies of people living in Bihar — the poorest state in India — found that rates of self-reported illness were very low, while rates in the United States were very high. Author Iona Heath, a London GP, suggested that the more people are exposed to contemporary health care, the sicker they feel. BMJ 2005;330:954-6 ■ ■ ■ CHANGING shift patterns are bad for the health and lead not only to poor attention spans but potentially harmful physiological effects. Britain’s Health and Safety Executive compared two shift patterns used by offshore oil workers, and found that the more popular shift pattern put workers at higher risk of heart disease and diabetes. One shift pattern for each two-week stint on an oil rig involved working straight day or night shifts for the entire two weeks. The other involved a split roster of seven night shifts followed by seven day shifts. Although more popular with workers because it meant they were more used to normal sleeping patterns by the time they returned home, New Scientist reported that urine tests found the sleep hormone melatonin was not adjusted to the new sleep times. The men also had abnormally high levels of fatty acids in the blood. ■ ■ ■ GIVING emergency doctors specific training in making referrals improves

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The pulse Compiled by Adam Cresswell

patient outcomes, researchers have found. A questionnaire sent to 72 doctors at a hospital in Stevenage, north of London, found 56 per cent initially reported having difficulties with referrals — although further questioning revealed all had had some problems. Many of the emergency doctors were young and relatively inexperienced, and the survey found perceptions of personality clashes with doctors accepting referred patients. The paper in the Emergency Medicine Journal recommended there be formal training in referral techniques, perhaps incorporated into medical school teaching, clear guidelines on the role of emergency medicine doctors, and education of specialists on accepting referrals. Emergency Med J 2005;22:355-358 ■ ■ ■ TAKING antibiotics weekly for a year does not cut heart attack risk for patients with stable coronary artery disease, according to a University of Washington study. The bacterium Chlamydia pneumoniae has been found in the arterial plaque of patients with coronary artery disease, leading some experts to speculate that

Tumour fighter: Broccoli, and read chilli, can slow growth of hard-to-treat cancers

removal of the bug could reduce the risk of subsequent cardiac events. The study, published in the April 22 edition of the New England Journal of Medicine , found no benefit from antibiotic therapy. Researchers randomly assigned 4,012 men and women to receive either onceweekly doses of azithromycin or a placebo for one year. There was no significant reduction of cardiac events — defined as death, heart attack, unstable angina, angioplasty or cardiac surgery — after nearly four years among participants receiving antibiotic compared to those given placebo. NEJM 2005;352:1637-45

■ ■ ■ BROCCOLI and red chilli may help slow tumour growth in hard-to-treat cancers, two new studies suggest. The findings, presented at the annual meeting of the American Association for Cancer Research this week, looked at the effect on cancers that have poor prognoses. One study found that capsaicin, the ‘‘hot’’ ingredient in red chilli that is often associated with antioxidative and anti-inflammatory activities, disrupted the cell function of cancerous pancreas cells and caused their death without affecting normal cells. Pancreatic cancer is one of the most aggressive cancers with poor survival

rates. The second study examined the benefits of phenethyl isothiocyanate (PEITC), a constituent of vegetables such as broccoli, on ovarian cancer. Ovarian cancer cells exposed to PEITC for 24 hours showed significant disruption to their growth processes. PEITC treatment also made the cancer cells more likely to die. ■ ■ ■ OVERWEIGHT people are much more likely to suffer knee damage, researchers have demonstrated. University of Utah School of Medicine researchers found the likelihood of tearing the meniscus, the cartilage that bears much of the load on the knee joint, increases dramatically with body mass index (BMI). Overweight people are at least three times more likely to tear their meniscus, while the most obese men and women are 15 and 25 times, respectively, more likely to tear the cartilage, the researchers report in the May edition of the American Journal of Preventive Medicine . The authors studied 515 patients who underwent meniscal surgery between 1996-2000, and compared them to 9,944 others. Men with a BMI of 27.5 and higher and women with a BMI of 25 or higher were three times more likely to tear their meniscus. Men whose BMI exceeded 40 were found to be 15 times more likely to tear their meniscus; women in that BMI category were 25 times more likely. Want to know more? Items are referenced where possible. A reference such as ‘‘2005;35:18-25’’ means the source article was published on pages 18-25 in volume number 35 of the publication, in 2005. A doi number or website address is used for research published on a journal’s website.

rosters (being on-call every second day for 24 hours),’’ she says. And according to Dr Page a shortage of doctors in rural areas means longer working hours for country GPs as well as hospital doctors. With an average ratio of 3,000 people to one doctor in many parts of Australia, she says rural GPs work long hours and are often expected to be a ‘‘one-stop shop’’ dealing with primary care needs as well as hospital-like emergencies. But while Page says there is no doubt that there are unsafe shift practices in rural hospitals, she says that it can often look worse on paper than it is on the ground. ‘‘The smaller the town the less likely it is that there will be people in the hospital at any given moment. So while you are on-call frequently, you are not necessarily called in,’’ she says. That argument doesn’t persuade Drew Dawson, from the Centre for Sleep Research at the University of South Australia. He says it’s wrong to assume you won’t become fatigued if you’re not physically doing work; instead, it’s lack of sleep and recovery time that are significant. ‘‘What the research shows is that if somebody is on call they sleep with one ear open, and so the recovery value of that sleep is not as good as it would appear,’’ he says. According to Dr Dawson, the biggest gap in doctors’ fatigue research is the correlation between adverse medical events and doctors’ hours. He says one of the biggest stumbling blocks in his attempts to research this topic has been hospital ethics committees. ‘‘The difficulty for many ethics committees is if we actually find that a doctor makes a fatigue-related error, what are the liability implications for the hospital?’’ Dawson says. Lack of funding has also been an issue, with the National Health and Medical Research Council telling Dawson for the three years he has applied that while the topic was an important one, no funding was available. And paradoxically, according to Dawson, attempts to limit or cut doctors’ hours are themselves problematic. ‘‘The problem is that if you cut working hours then you potentially reduce the labour supply and therefore there will be less medical care available,’’ he says. ‘‘And it may be the case that a tired doctor is better than no doctor at all.’’ This is an important point in a climate of widespread medical workforce shortages. He also argues that past attempts to cut junior doctor hours has just shifted the problem to senior doctors, who now find themselves on call at night as well as needing to meet their daytime responsibilities, including surgery. ‘‘What you have done is problemshift, not problem-solve,’’ he says. And solving the problem is what the Australian Council for Safety and Quality in Health Care, which was established by state and territory health departments in 2000, hopes to do. Their recently launched fatigue project — Developing National Principles and Tools for the Recognition, Prevention and Mitigation of Fatigue in Health Workers — may be quite a mouthful, but council and project member Cliff Hughes says the issue ‘‘is too important for an acronym’’. Nor will it be limited to just doctors. After a series of interviews and focus groups with a range of health care professionals, the project will develop guidelines, which will be evaluated in a number of pilot studies across the country later this year. But Professor Hughes says there are no plans at this stage for a legislative approach. ‘‘Something as complex as fatigue and workforce issues will need to remain voluntary because they will depend entirely on local circumstances and those circumstances can vary from day to day, and even from shift to shift,’’ he says.

Contacts Health Editor

Adam Cresswell (02) 9288 2494 Fax (02) 9288 3077 [email protected]

Medical reporter

Clara Pirani (02) 9288 2255 Fax (02) 9288 3077 [email protected]

Science reporter

Leigh Dayton (02) 9288 2333 Fax (02) 9288 3077 [email protected] Advertising bookings 1300 307 287 [email protected] Sydney sales executives Dusan Stamenkovic (02) 9081 3679 Melbourne sales executive Angela Wayling (03) 9292 2349 Queensland sales executive Samantha Andrew (07) 3666 7422

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