Notes from the physiological laboratory of the University of Pennsylvania.

Mode of access: Internet.

Major depressive disorder and nutritional medicine : a review of monotherapies and adjuvant treatments

A literature review was conducted to examine the evidence for nutritional interventions in depression. It revealed a number of significant conclusions. Interestingly, more positive clinical trials were found to support adjuvant, rather than monotherapeutic, use of nutrients to treat depression. Much evidence exists in the area of adjuvant application of folic acid, S-adenosyl-methionine, omega-3, and L-tryptophan with antidepressants. Current evidence does not support omega-3 as an effective monotherapy to treat depression. However, this may be due, at least in part, to olive oil being used as the control intervention, some studies using docosahexaenoic acid alone or a higher docosahexaenoic acid to eicosapentaenoic acid ratio, and significant heterogeneity regarding depressive populations. Nevertheless, adjunctive prescription of omega-3 with antidepressants, or in people with dietary deficiency, may be beneficial. Inositol lacks evidence as an effective antidepressant and cannot be currently recommended. Evidence on the use of L-trytophan for depression is inconclusive and additional studies utilizing a more robust methodology are required.

Conducting research in herbal and complementary medicine

This paper outlines information and advice on how a practitioner can formally pursue research pertaining to herbal or complementary medicine. It recommends five practical steps: get advice and acquire skills, find out what other people have done already, consider what research you want to do, decide on a design and finalise a detailed research plan. Enrolling in a postgraduate research degree program is recommended as a way to acquire basic research skills and obtain support for an initial project.

Tesofensine : a novel potent weight loss medicine

Background: The incidence of obesity is increasing; this is of major concern, as obesity is associated with cardiovascular disease, stroke, type 2 diabetes, respiratory tract disease, and cancer. Objectives/methods: This evaluation is of a Phase II clinical trial with tesofensine in obese subjects. Results: After 26 weeks, tesofensine caused a significant weight loss, and may have a higher maximal ability to reduce weight than the presently available anti-obesity agents. However, tesofensine also increased blood pressure and heart rate, and may increase psychiatric disorders. Conclusions: It is encouraging that tesofensine 0.5 mg may cause almost double the weight loss observed with sibutramine or rimonabant. As tesofensine and sibutramine have similar pharmacological profiles, it would be of interest to compare the weight loss with tesofensine in a head-to-head clinical trial with sibutramine, to properly assess their comparative potency. Also, as teso fensine 0.5 mg increases heart rate, as well as increasing the incidence of adverse effects such as nausea, drug mouth, flatulence, insomnia, and depressed mode, its tolerability needs to be further evaluated in large Phase III clinical trials.

Sir Neville Howse (VC), Private John Simpson Kirkpatrick and Private Martin O’Meara (VC) and their contributions to Australian military medicine

Medical personnel serving with the Defence Forces have contributed to the evolution of trauma treatment and the advancement of prehospital care within the military environment. This paper investigates the stories of an Australian Medical Officer, Sir Neville Howse, and two stretcher bearers, Private John Simpson (Kirkpatrick) and Private Martin O’Meara, In particular it describes the gruelling conditions under which they performed their roles, and reflects on the legacy that they have left behind in Australian society. While it is widely acknowledged that conflicts such as World War One should never have happened, as civilian and defence force paramedics, we should never forget the service and sacrifice of defence force medical personnel and their contribution to the body of knowledge on the treatment of trauma. These men and women bravely provided emergency care in the most harrowing conditions possible. However, men like Martin O’Meara may not have been given the same status in society today as Sir Neville Howse or Simpson and his donkey, due to the public’s lack of awareness and acceptance of war neurosis and conditions such as post traumatic stress disorder, reactive psychosis and somatoform disorders which were suffered by many soldiers during their wartime service and on their return home after fighting in war.

Flood fatalities in contemporary Australia (1997-2008) : disaster medicine

Objective: Flood is the most common natural disaster in Australia and causes more loss of life than any other disaster. This article describes the incidence and causes of deaths directly associated with floods in contemporary Australia. ---------- Methods: The present study compiled a database of flood fatalities in Australia in the period of 1997–2008 inclusive. The data were derived from newspapers and historic accounts, as well as government and scientific reports. Assembled data include the date and location of fatalities, age and gender of victims and the circumstances of the death. ---------- Results: At least 73 persons died as a direct result of floods in Australia in the period of 1997–2008. The largest number of fatalities occurred in New South Wales and Queensland. Most fatalities occurred during February, and among men (71.2%). People between the ages of 10 and 29 and those over 70 years are overrepresented among those drowned. There is no evident decline in the number of deaths over time. 48.5% fatalities related to motor vehicle use. 26.5% fatalities occurred as a result of inappropriate or high-risk behaviour during floods. ---------- Conclusion: In modern developed countries with adequate emergency response systems and extensive resources, deaths that occur in floods are almost all eminently preventable. Over 90% of the deaths are caused by attempts to ford flooded waterways or inappropriate situational conduct. Knowledge of the leading causes of flood fatalities should inform public awareness programmes and public safety police enforcement activities.

National health and hospital network for Australia's future : Implications for emergency medicine

The proposals arising from the agreement reached between the Rudd government and the States and Territories (except Western Australia) in April 2010 represent the most fundamental realignment of health responsibilities since the creation of Medicare in 1984. They will change the health system, and the structures that will craft its future direction and design. These proposals will have a significant impact on Emergency Medicine; an impact from not only the system-wide effects of the proposals but also those that derive from the specific recommendations to create an activity-based funding mechanism for EDs, to implement the four hour rule and to develop a performance indicator framework for EDs. The present paper will examine the potential impact of the proposals on Emergency Medicine to inform those who work within the system and to help guide further developments. More work is required to better evaluate the proposals and to guide the design and development of specific reform instruments. Any such efforts should be based upon a proper analysis of the available evidence, and a structured approach to research and development so as to deliver on improved services to the community, and on improved quality and safety of emergency medical care.

Pleasure Consuming Medicine : The Queer Politics of Drugs By Kane Race [Review]

The queer studies field works to deconstruct dominant western discourses which cast gay men as hedonistic partygoers. Concurrently it examines the real social ramifications for some gay men for whom partying, illegal drugs and casual sex is an everyday reality. Another reality of gay male culture is HIV/AIDS and the legal prescribed medicines which accompany these conditions. Pleasure Consuming Medicine: The Queer Politics of Drugs explores these realities and the discourses surrounding them. Exploring the embodiments of illegal and prescription drug users, this book problematises the binary between prescription medicine use, where drug use is configured as a matter of consumer choice, and 'illicit' drug use which is heavily policed and condemned. Returning to the gay community it reviews community approaches to safe sex and drug use, and individual practices, to demonstrate alternative approaches to condemning drug usage.

Pleasure Consuming Medicine : The Queer Politics of Drugs By Kane Race [Review]

The queer studies field works to deconstruct dominant western discourses which cast gay men as hedonistic partygoers. Concurrently it examines the real social ramifications for some gay men for whom partying, illegal drugs and casual sex is an everyday reality. Another reality of gay male culture is HIV/AIDS and the legal prescribed medicines which accompany these conditions. Pleasure Consuming Medicine: The Queer Politics of Drugs explores these realities and the discourses surrounding them. Exploring the embodiments of illegal and prescription drug users, this book problematises the binary between prescription medicine use, where drug use is configured as a matter of consumer choice, and 'illicit' drug use which is heavily policed and condemned. Returning to the gay community it reviews community approaches to safe sex and drug use, and individual practices, to demonstrate alternative approaches to condemning drug usage.

Access to medicine and the dangers of patent linkage : lessons from Bayer Corp v. Union of India

In February 2010, the Delhi High Court delivered its decision in Bayer Corp v Union of India in which Bayer had appealed against an August 2009 decision of the same court. Both decisions prevented Bayer from introducing the concept of patent linkage into India’s drug regulatory regime. Bayer appealed to the Indian Supreme Court, the highest court in India, which agreed on 2 March 2010 to hear the appeal. Given that India is regarded as a global pharmaceutical manufacturer of generic medications, how its judiciary and government perceive their international obligations has a significant impact on the global access to medicines regime. In rejecting the application of patent linkage, the case provides an opportunity for India to further acknowledge its international human rights obligations.

The threat to scientific integrity in environmental and occupational medicine

Over the last century, environmental and occupational medicine has played a significant role in the protection and improvement of public health. However, scientific integrity in this field has been increasingly threatened by pressure from some industries and governments. For example, it has been reported that the tobacco industry manipulated eminent scientists to legitimise their industrial positions, irresponsibly distorted risk and deliberately subverted scientific processes, and influenced many organisations in receipt of tobacco funding. Many environmental whistleblowers were sued and encountered numerous personal attacks. In some countries, scientific findings have been suppressed and distorted, and scientific advisory committees manipulated for political purposes by government agencies. How to respond to these threats is an important challenge for environmental and occupational medicine professionals and their societies. The authors recommend that professional organisations adopt a code of ethics that requires openness from public health professionals; that they not undertake research or use data where they do not have freedom to publish their results if these data have public health implications; that they disclose all possible conflicts; that the veracity of their research results should not be compromised; and that their research independence be protected through professional and legal support. The authors furthermore recommend that research funding for public health not be directly from the industry to the researcher. An independent, intermediate funding scheme should be established to ensure that there is no pressure to analyse data and publish results in bad faith. Such a funding system should also provide equal competition for funds and selection of the best proposals according to standard scientific criteria.

Emergency medicine in China

With the world’s largest population of 1.3 billion, China is a rapidly developing country. In line with this development, China’s enormous health system is experiencing an unprecedented series of reforms. According to a recent official government report, China has 300, 000 health organizations, which include 60, 000 hospitals and a total number of 3.07 million beds (China NBoSoP 2006). To provide health services for the national population, as well as the substantial number of visitors, China has 1.93 million doctors and 1.34 million registered nurses (China NBoSoP 2006). From 1984 to 2004, the number of inpatients grew from about 25 to 50 million, with outpatient figures increasing from 1.1 to 1.3 billion (China MoH 2006). The scale of the health system is likely bigger than in any other countries in the world, but the quality of medical services is still among the levels of developing countries. In 2005, approximately 3.8% of inpatients (about 1.5 million)(China NBoSoP 2006) were admitted because of injury and poisoning, which created significant load for the acute health system. These increased figures are at least partly because of the development of the health system and technological health-care advances but, even with such advances, this rapid change in emergency health-care demand has created a very significant burden on existing systems...