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The origins of Healthed

Healthed, unlike many medical education providers, was not originally established with the intention of becoming a business venture. Rather, it was originally established as a fund-raiser to support my PhD research activities. It came as a surprise to all of us that our efforts to provide GPs with timely and cost effective one-day education had actually tapped into a shift in the GP education zeitgeist. GPs no longer wanted prolonged educational events, interspersed with large meals, leisure activities or other non-educational components but instead were seeking high quality education that was structured to allow for their time-poor schedules. As a result Healthed rapidly became the most popular face-to-face educator of GPs in Australia. It outgrew the ability of a single administrative person and now employs the equivalent of 7 full time staff to meet the needs of its national delegate-base. Over the years we have refined our operations and content, with a focus on high quality, practically relevant information and an ongoing effort directed at continuous improvement of our content and delivery methods. We aim to ensure that Healthed’s content is the best available at the time that it is delivered to our delegates.

Dr Ramesh Manocha, MBBS, BSc(med) PhD, Convenor.

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Welcome

Welcome to the Healthed blog. Its aim is  to keep you updated about our events and their content, with a particular focus on issues and information of practical importance. Take the time to visit the Healthed website and feel free to contact me at any time if you have any questions, feedback or issues!

Dr Ramesh Manocha, MBBS, BSc(med) PhD, Convenor.

Managing menstrual problems in women with PCOS

Menstrual problems, including amenorrhoea, oligomenorrhoea and anovulatory cycles with dysfunctional uterine bleeding, are common in women with PCOS – and manageable.

The combined oral contraceptive (COC) pill is generally safe to use in patients with PCOS, despite their increased risk of diabetes, and there is no clear evidence of negative metabolic effects such as increased insulin resistance.

The COC is highly effective at regulating menstrual cycles. Additionally, it is likely to reduce the long term risk of endometrial hyperplasia.

Other treatment options include:

  • progestogens – cyclical oral medroxyprogesterone (Provera) or the levonorgestrel releasing intrauterine implant (Mirena)
  • metformin, and
  • lifestyle modification.

SOURCE: Dr Rob Lahoud, Healthed Annual Women’s Health Update, Sydney 2010

Editor Dr Ramesh Manocha

Is the flu vaccine safe in pregnant women?

Several studies have looked at whether flu vaccine is safe in pregnancy.

Are there serious side effects?

The American Centers for Disease Control VAERS database (2006) contains information about approximately 2 million pregnant women vaccinated between 2000 and 2003. It found no serious adverse effects, either immediately or in infants up to 6 months old. A Bangladeshi study likewise found no nil significant problems.

How common are side effects?

A review of UK ‘Yellow card’ reports from 1994 to 2004 uncovered 1366 adverse reactions of which only 8 occurred in pregnant women.

What about thiomersal?

Traces of the mercury-based preservative thiomersal are found in some Australian flu vaccines. However, an American Institutes of Medicine (IOM) review concluded this did not pose a health risk, including autism.

SOURCE: Dr Nick Wood, Healthed Annual Women’s Health Update, Sydney 2010

Editor Dr Ramesh Manocha

The National Centre Against Bullying: latest recommendations

Early intervention

There is a need to identify early (at preschool and early primary school), those who may have peer relationship issues and implement appropriate programs. Additional focus is needed on preschool education to prevent bullying and promote wellbeing. There is a need to raise awareness among schools and parents of the emerging evidence that children are using social networking sites at young ages.

Training teachers

There is a need for pre-service teacher education programs to include a mandatory component which addresses awareness of and skills for preventing and managing bullying situations. Teachers need to know how to respond effectively to bullying. This education should include information as to the possible effects of criminal and civil law on the use of communications technology for bullying purposes.

An appropriate legal framework

There is a need to legally define the rights and responsibilities of schools in responding to bullying and cyberbullying situations and cyber defamation. Legal remedies are not a solution to bullying but are a necessary part of the solution. There is a need to clarify the role of criminal and civil law in both bullying and cyberbullying.

Increased focus on school transition

Bullying peaks at times of transition between preschool and primary school, and primary and secondary. Consequently, institutions need to increase their focus on bullying, including cyberbullying, at these times.

A whole school approach

Schools need to use evidence-informed strategies and include teachers, parents and students and the wider community to enhance cybersafety and wellbeing and reduce bullying.

A whole community approach

Solutions need to go beyond the school gate, given that bullying in schools is often a reflection of the whole community.

Young people need to be part of the solution

Young people are essential to the solution and must be involved in policy development, parent education and development of multimedia material.

Technology to be part of the solution

Adults, including parents and teachers, need to break down the digital divide by becoming savvy about technology. We must all recognise the creative use of technology as a powerful teaching and socialising tool. The focus needs to be on behaviours and relationships, and it is counterproductive to ban technology.

Support for ongoing research

There is a need for research into cybersafety and wellbeing, including effective strategies for engaging parents, keeping up to date with changes in technology, and providing appropriate interventions in schools.

SOURCE: Dr Michael Carr-Gregg, consultant psychologist

Editor: Dr Ramesh Manocha

New bug identified in teen pharyngitis

A review article in the Annals of Internal Medicine has concluded that the gram-negative anaerobe Fusobacterium necrophorum is as common as group A strep in teenagers with sore throats.

Up to 1 in 400 of these cases develop complications, such as abscess formation, septicaemia with septic pulmonary emboli, and Lemierre syndrome (septic thrombophlebitis of the internal jugular vein). The death rate has been reported to be as high as 5%.

Penicillin or a cephalosporin is the treatment of choice, and clindamycin is added if there is evidence of sepsis or neck swelling or used as the primary agent if the patient is allergic to penicillin. F. necrophorum is not sensitive to macrolides, author Robert A. Centor concluded.

SOURCE: Ann Intern Med 2009;151:812.

Editor Dr Ramesh Manocha

Gestational diabetes, not obesity, causes congenital anomalies

US researchers have calculated that 71% of congenital anomalies in children of obese women are attributable to maternal diabetes.

They looked at weight, pregestational diabetes and major congenital anomalies in 42,000 singleton pregnancies at various time intervals between 1991 and 2004.

With time, average maternal weight, BMI, the proportion of obese mothers and the prevalence of pregestational diabetes increased – as did the prevalence of major anomalies (from 0.43% to 0.84%). However, multivariate analysis showed that pregestational diabetes was associated with an almost fourfold higher risk of congenital abnormalities. 

SOURCE: Obstet Gynecol 2009;114:1179, 1170

Editor Dr Ramesh Manocha

What are the 5 most common psychological traits in resilient teens?

 

  1. Presence of a charismatic adult in their lives
  2. Social emotional competencies (anger management, conflict resolution, problem solving, ability to name and recognise one’s own and other’s emotions, ability to display empathy)
  3. Sense of meaning, purpose and belonging
  4. Optimistic self talk
  5. Islands of competence 

SOURCE: Dr Michael Carr-Gregg, Healthed Annual Women’s Health Update, Sydney 2010

Editor Dr Ramesh Manocha.

Osteoporosis treatment

How can you impreove compliance and persistence?

  • Patient education of the seriousness of the disease
  • More convenient treatments with less frequent dosing: once-monthly oral and IV bisphosphonate formulations

SOURCE: Professor Philip Sambrook, Healthed Annual Women’s Health Update, Sydney 2010

Editor Dr Ramesh Manocha.

What is acne excoriée?

Although acne itself can cause scarring, the constant picking of otherwise minor pimples can also lead to permanent damage to the skin. This is known as acne excoriée, or ‘picker’s acne’.

Acne excoriée is usually associated with significant anxiety or depression, and it is an important outward sign of a person’s underlying emotional state. This form of acne may require treatment with oral medications to prevent scarring, but it is also important to assess the need for psychological counselling.

Other acne variants include drug-induced acne and ‘endocrine acne’.

Drugs that can cause acne include topical or oral corticosteroids, anabolic steroids, lithium, TB medications and cyclosporin.  Endocrine disorders associated with acne may include polycystic ovarian syndrome, Cushing’s disease, acromegaly, late-onset adrenal hyperplasia and androgen-secreting tumours.

SOURCE: Dr Adrian Mar, Melbourne Women’s & Children’s Health Update & Education Day 2009

Editor Dr Ramesh Manocha

What do you know about ecstacy?

1. How much does an ecstasy tablet currently cost in Sydney?

a) $20       b) $30       c) $40       d) $50

2. Which of these drugs are usually sold on the street in a liquid form?

a) LSD     b) Ketamine (‘Special k’)     c) GHB     d) Nitrous oxide

3. How many 14-19 year olds have used ecstasy within the last year?

a) none     b) 0.3%     c) 3.3%     d) 5%

4. Which of these best describes the changes in prevalence of ecstasy use in Australia in the past decade?

a) use has halved     b) use has stayed the same     c) use has doubled     d) use has quadrupled

ANSWERS

1. a (down from $60 a decade ago)

2. c (also known as ‘fantasy’, GBH, liquid ecstasy)

3. d (this still means that 95% have not)

4. d (no other drug has similar rates of increase)

SOURCE: Mr Paul Dillon, Healthed Annual Women’s Health Update, Sydney

Editor Dr Ramesh Manocha.