Increasing diversity at the cost of decreasing equity? Issues raised by the establishment of Australia's first religiously affiliated medical school

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Ian H Kerridge, Rachel A X Ankeny, Christopher F C Jordens and Wendy L Lipwort

Crossing professional boundaries in medicine: the slippery slope to patient sexual exploitation

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.While some cases of sexual exploitation involve predatory doctors, many other cases represent the culmination of a series of boundary crossings (non-exploitative departures from usual practice). The deliberate move to reduce formality in medicine has increased the likelihood of boundary crossings and violations. There are also individual doctor risk factors; boundary violations appear more likely when doctors are under stress, with insufficient emotional support. Preventive strategies include continuing education about ethics and the management of professional boundaries, along with appropriate psychological support structures for doctors. Doctors are often involved in other professional relationships as teachers, supervisors and team leaders; inappropriate sexual behaviour in these relationships is harassment. Public pressure for more punitive responses is likely if the profession is not seen to be doing all it can to deal with these issues effectively, and to be cooperating with other responsible agencies.Cherrie A Galletl

Disparities exist between National food group recommendations and the dietary intakes of women

<p>Abstract</p> <p>Background</p> <p>Preconception and pregnancy dietary intakes can influence the health of future generations. In this study we compared the food intakes of reproductive-aged women by pregnancy status, to current Australian recommendations.</p> <p>Methods</p> <p>Data are from the Australian Longitudinal Study on Women's Health, younger cohort aged 25-30 years in 2003, with self-reported status as pregnant (n = 606), trying to conceive (n = 454), given birth in the last 12 months (n = 829) or other (n = 5597). Diet was assessed using a validated 74-item food frequency questionnaire. Food group servings and nutrient intakes were compared to the Australian Guide to Healthy Eating (AGHE) and Australian Nutrient Reference Values (NRVs).</p> <p>Results</p> <p>No women met all AGHE food group recommendations. Highest adherence rates [mean (95% CI) servings/day] were for meat [85%, 1.9(1.8-1.9)], fruit [44%, 2.1(2.1-2.2)] and dairy [35%, 1.8(1.8-1.9)], with < 14% meeting remaining recommendations. Women who achieved NRVs (folate, iron, calcium, zinc, fibre) for pregnancy, breastfeeding and adult life stages were 1.5%, 3.3% and 13.7%, respectively. Compared to AGHE, women consumed more servings of fruit (4.9 vs 4.0;<it>P </it>= 0.034) and dairy (3.4 vs 2.0;<it>P </it>= 0.006) to achieve pregnancy NRVs; more dairy (2.9 vs 2.0;<it>P </it>= 0.001), less fruit (3.9 vs 5.0;<it>P </it>< .001) and vegetables (3.4 vs 7.0;<it>P </it>< .001) to achieve breastfeeding NRVs; more fruit (3.6 vs 3.0;<it>P </it>< .001), dairy (2.5 vs 2.0;<it>P </it>< .001), meat (1.8 vs 1.5;<it>P </it>= 0.015), less vegetables (3.6 vs 5.0;<it>P </it>< .001) to achieve adult NRVs.</p> <p>Conclusions</p> <p>The AGHE does not align with contemporary diets of Australian women or enable them to meet all NRVs. Current tools to guide food consumption by women during pregnancy require revision.</p

Shaping public opinion on the issue of childbirth; a critical analysis of articles published in an Australian newspaper

<p>Abstract</p> <p>Background</p> <p>The Australian government has announced a major program of reform with the move to primary maternity care, a program of change that appears to be at odds with current general public perceptions regarding how maternity care is delivered.</p> <p>Methods</p> <p>A critical discourse analysis of articles published in 'The Age', a newspaper with national distribution, subsequent to the release of the discussion paper by the Australian Government in 2008 was undertaken. The purpose was to identify how Australian maternity services are portrayed and what purpose is served by this representation to the general public.</p> <p>Results</p> <p>Findings from this critical discourse analysis revealed that Australian maternity services are being portrayed to the general public as an inflexible outdated service struggling to meets the needs of pregnant women and in desperate need of reform. The style of reporting employed in this newspaper involved presenting to the reader the range of expert opinion relevant to each topic, frequently involving polarised positions of the experts on the issue.</p> <p>Conclusions</p> <p>The general public are presented with a conflict, caught between the need for changes that come with the primary maternity model of care and fear that these change will undermine safe standards. The discourse; 'Australia is one of the safest countries in which to give birth or be born, what is must be best', represents the situation where despite major deficiencies in the system the general public may be too fearful of the consequences to consider a move away from reliance on traditional medical-led maternity care.</p

Exercise therapy, manual therapy, or both, for osteoarthritis of the hip or knee: a factorial randomised controlled trial protocol

<p>Abstract</p> <p>Background</p> <p>Non-pharmacological, non-surgical interventions are recommended as the first line of treatment for osteoarthritis (OA) of the hip and knee. There is evidence that exercise therapy is effective for reducing pain and improving function in patients with knee OA, some evidence that exercise therapy is effective for hip OA, and early indications that manual therapy may be efficacious for hip and knee OA. There is little evidence as to which approach is more effective, if benefits endure, or if providing these therapies is cost-effective for the management of this disorder. The MOA Trial (Management of OsteoArthritis) aims to test the effectiveness of two physiotherapy interventions for improving disability and pain in adults with hip or knee OA in New Zealand. Specifically, our primary objectives are to investigate whether:</p> <p>1. Exercise therapy versus no exercise therapy improves disability at 12 months;</p> <p>2. Manual physiotherapy versus no manual therapy improves disability at 12 months;</p> <p>3. Providing physiotherapy programmes in addition to usual care is more cost-effective than usual care alone in the management of osteoarthritis at 24 months.</p> <p>Methods</p> <p>This is a 2 × 2 factorial randomised controlled trial. We plan to recruit 224 participants with hip or knee OA. Eligible participants will be randomly allocated to receive either: (a) a supervised multi-modal exercise therapy programme; (b) an individualised manual therapy programme; (c) both exercise therapy and manual therapy; or, (d) no trial physiotherapy. All participants will continue to receive usual medical care. The outcome assessors, orthopaedic surgeons, general medical practitioners, and statistician will be blind to group allocation until the statistical analysis is completed. The trial is funded by Health Research Council of New Zealand Project Grants (Project numbers 07/199, 07/200).</p> <p>Discussion</p> <p>The MOA Trial will be the first to investigate the effectiveness and cost-effectiveness of providing physiotherapy programmes of this kind, for the management of pain and disability in adults with hip or knee OA.</p> <p>Trial registration</p> <p>Australian New Zealand Clinical Trials Registry ref: ACTRN12608000130369.</p

What's law got to do with it Part 2: Legal strategies for healthier nutrition and obesity prevention

This article is the second in a two-part review of law's possible role in a regulatory approach to healthier nutrition and obesity prevention in Australia. As discussed in Part 1, law can intervene in support of obesity prevention at a variety of levels: by engaging with the health care system, by targeting individual behaviours, and by seeking to influence the broader, socio-economic and environmental factors that influence patterns of behaviour across the population. Part 1 argued that the most important opportunities for law lie in seeking to enhance the effectiveness of a population health approach

Formulated meal replacements: a comparison of the nutritional adequacy of available products

Objective: To assess the nutritional compliance of formulated meal replacements available in Australian pharmacies with the Food Standards Australia and New Zealand guidelines; and to assess the nutritional adequacy of formulated meal replacements recommended diets based on meal replacement or total diet replacement (very low energy diets). Design: Products available at major pharmacies as of November 2007 were identified and nutritional information and instructions for use were obtained from the product packaging and/or the manufacturing company. Main Outcome Measures: Individual serves, prepared as directed, were compared to Standards Australia and New Zealand standard 2.9.3 of the food standards code. Nutritional adequacy was assessed by comparing the nutritional composition to the Nutrient Reference Values for average obese adult males and females, using Foodworks 2007. Results: Results demonstrated that while most products were compliant with the Standards Australia and New Zealand standard for formulated meal replacements composition the majority of the products and/or programs were deficient in one or more nutrients. Of the 17 products from 11 brands, no very low energy diets programs (of seven) were found to be nutritionally complete. Only two meal replacement programs (of 16) were nutritionally complete in comparison to the recommended dietary intakes and AIs for both a representative obese man and woman. Conclusion: The results highlight the important role of clinicians in ensuring programs followed by patients are nutritionally adequate and implemented and supervised as intended, in order to minimise side-effects and risks. There is a need for Standards Australia and New Zealand regulations governing very low energy diets, where formulated meal replacements are recommended for total diet replacement