Growing pains
St John of God Subiaco Hospital is expanding its pain management service to meet growing patient demand, with a doubling of the number of interventional pain procedures currently performed.
The expansion has been helped by a capital upgrade of an operating theatre in the hospital’s short stay unit, which was recently re-opened following a period of works.
The upgraded operating theatre is now primarily dedicated to interventional pain procedures and has been fitted with state-of-the-art equipment, including a new operating table designed to allow superior imaging for proceduralists.
CEO Tina Chinery said chronic pain was a significant social and economic burden in the community, affecting about 3.4 million Australians – or one in five people.
SJOG Subiaco is the only private hospital in WA with a pain service that operates seven days a week, allowing patients needing urgent pain management to be admitted to the hospital by their pain specialist for an interventional procedure or acute care on short notice.
It is also the only private hospital in the State to employ a pain nurse practitioner who works in an extended clinical nursing role and is qualified to request diagnostic investigations, prescribe medications and receive and make referrals.
The hospital’s pain service was set up in 2008.
Tick for pertussis vax
A Telethon Kids Institute and Curtin University-led study has found the maternal whooping cough vaccine given to pregnant mothers in the second or third trimester significantly reduces babies’ risk of infection.
Published in the journal Pediatrics, the results showed maternal vaccines were beneficial to babies, protecting them up to six months of age – the most susceptible period for infection, with whooping cough accounting for 70-90% of hospitalisations and deaths in babies.
The severity of the disease prompted calls for government-funded interventions, with a State vaccination program forming in 2014 which evolved into a federally-funded National Immunisation Program in 2018 for pregnant mothers, with a vaccine recommended at 28 weeks gestation.
Bumping up vaccination numbers to 52% meant whooping cough cases dropped 66% in babies up to six months of age in the first three years of the program.
Despite the program’s success, further research was needed to evaluate the best time for maternal vaccination and to measure any interference from the mother’s antibodies when babies received their standard infant whooping cough vaccines.
The study, funded by the National Health and Medical Research Council and the WA Health Department, examined data from 279,418 mother-and-infant pairs – representing a third of all births in Australia over four years – using health records from WA, Queensland and the Northern Territory.
Of the sample, 51% of women received their whooping cough vaccine around their late second trimester or third trimester of pregnancy.
No wrong door in Peel
The Wandjoo Gateway pilot will start in late January for youth accessing mental health services in the Peel region.
The program seeks to provide support and advice for workers when referring and navigating young people (12-25 years) with mental health concerns.
It embodies a ‘no wrong door’ approach where every door is the right door for young people. The model works by ensuring that if the young person’s condition is not appropriate for a particular service, they are held by that service and helped to navigate the system to find the right one for their needs.
The program is designed for any worker who may interact with young people in their usual activities, such as teachers, youth workers and GPs.
The pilot will run for six months and currently has six agencies from different sectors confirmed to participate.
As 34% of referrals to acute public mental health services for young people in the Peel region come from medical practitioners, the pilot is seeking interest from local GPs to trial the approach.
Those interested can email PeelMHTaskforce@health.wa.gov.au
GPs – more patients than ever
General practice remains the cost-effective engine of the health system, but more needs to be done to improve sustainability, the recent 2023 Health of the Nation report found.
The seventh edition of the Royal Australian College of General Practitioner’s report focused on attraction and retention of the general practice workforce, drawing on reflections and experiences of GPs and GPs-in-training via the nation-wide RACGP Health of the Nation survey.
It found that GPs were seeing more patients than ever, with less than 1% of people reportedly being unable to see a GP when they needed to, and the average time GPs spent with patients increasing.
It found the GP workforce needed an urgent boost, because fewer medical students were choosing general practice training, while more GPs were looking to reduce their hours or leave the profession. Almost three in 10 GPs signalled their intention to retire in the next five years.
The report also found mental health was a growing issue, and the proportion of GPs reporting psychological issues in their top three reasons for patient presentations had increased from 61% in 2017 to 72% in 2023.
General practice sustainability needed to be addressed to prevent practice closures, with four out of five practice owners concerned about the viability of their practice.
Help for diverse Indigenous youth
Funding for the first ever elder-led intervention to support young Aboriginal LGBTQA+ people brings new hope for the youth group most at risk of suicide in the nation.
Edith Cowan University has received a NHMRC/Medical Research Future Fund grant of $624,000 to develop and test the intervention, which has been developed from the Pride Yarns with Mob pilot project that provided opportunities for Aboriginal LGBTQA+ young people to connect meaningfully with elders.
The pilot resulted in young people expressing an increased level of cultural connection and feelings of acceptance and social inclusion within Noongar culture.
The study will be led by ECU Deputy Vice-Chancellor (Students, Equity and Indigenous) Professor Braden Hill and involve researchers from ECU, Murdoch University and the Telethon Kids Institute.
About 10% of Aboriginal young people aged 16-29 years report being lesbian, gay or bisexual and 4% as trans and gender diverse.
Professor Hill said despite a comparatively high rate of suicide and mental health difficulties among LGBTQA+ youth, they remained one of the most under-served groups of youth in Australia in terms of tailored psychological support.
While they had strong pride in their identities, they reported low levels of mental wellbeing, feelings of belonging to country and culture, connection to spirit and ancestors, family and kinship, and poor physical health.
“The urgency for interventions such as this cannot be underestimated,” he said. “Recent survey data shows that 45% of Aboriginal LGBTQA+ participants had attempted suicide in their lifetime, and 19% in the past 12 months. This suggests there is a real risk that Aboriginal LGBTQA+ youth may not make it past young adulthood.”
Glass half full
New WA research shows hard-hitting campaigns can help prevent drinking during pregnancy.
The new study, published in the Australian and New Zealand Journal of Public Heath, analysed adults’ views on alcohol and pregnancy to evaluate the impact of a public education campaign that aired in WA from January 2021 to May 2022.
The One Drink campaign, developed by the WA Mental Health Commission and Cancer Council WA, features a video of a baby-shaped glass being filled with red wine to illustrate that any amount of alcohol a mother drinks, the baby drinks too. The campaign has recently recommenced airing in WA.
Public health experts say the research findings suggest many Australians of childbearing age do not understand the risks associated with alcohol use during pregnancy but are much more likely to abstain when informed of the risks.
Lead author Professor Simone Pettigrew from The George Institute for Global Health says there is no safe level of alcohol use during pregnancy, and the community has a right to know the facts so they can make an informed decision.
“Previous research has found that around 35% of Australian women use alcohol at some stage during their pregnancy,” she said.
“Similarly, in this study we found that before seeing the campaign, almost one-third of men and women aged 18 to 45 were confused about the risks and thought it was okay for women to drink some alcohol during pregnancy.”
To evaluate the campaign, researchers surveyed male and female West Australians of childbearing age, both before and after the campaign ran.
“We found that 76% of survey respondents recalled seeing the campaign. We also uncovered positive signs that the campaign would help dissuade pregnant women from drinking,” Professor Pettigrew said.
“Additionally, we found that after the campaign had aired, 95% of women reported intending to abstain from drinking when pregnant – and both males and females were more likely to agree that pregnant women shouldn’t drink any alcohol.”
Price of menopause
A Senate inquiry is set to examine the impact of menopause, and is due to report in September next year.
The terms of reference cover issues relating to perimenopause and menopause, including awareness, economic cost, physical impacts, mental and emotional wellbeing, caregiving responsibilities, government policies and programs, and cultural and societal factors.
Professor Jayashri Kulkarni, Professor of Psychiatry at The Alfred Hospital and Monash University, and director of HER Centre Australia, welcomed the move.
She said depression and anxiety caused by hormone changes during the menopause transition were still under-recognised and treated poorly.
“As a result, many women suffer for years,” she said. “This Senate Inquiry will hopefully assist in raising awareness and developing new approaches for women’s mental health issues.”
Baby brain waves
New technology being used by the Newborn Emergency Transport Service based at Perth Children’s Hospital is helping to ensure that families from even the most remote WA communities can benefit from advanced intensive care techniques.
The portable, wireless, cloud-based equipment, funded by Perth Children’s Hospital Foundation, allows brain wave information to be viewed in real-time via an internet uplink and reviewed by medical staff up to 1800km away.
The first newborn to undergo brain wave recording while in transit was flying to PCH from Kalgoorlie late last year. During that journey, a Perth-based neonatology expert 600km away could review the baby’s brain waves in real time.
Dr Jonathan Davis, medical director for NETS WA, said that for every 1000 live births, up to three babies could develop abnormal brain function ranging from mild to severe due to lack of oxygen.
Hypoxic-ischaemic encephalopathy is diagnosed soon after birth and can result in life-long consequences, including disabilities such as cerebral palsy.
To improve long-term survival and reduce the incidence and severity of disability, babies diagnosed with moderate or severe HIE receive cooling therapy. It reduces a newborn’s body temperature to between 33.5 and 34.5C over 72 hours.
Each year, up to 50 babies across the state are diagnosed with HIE and require cooling.
Tailoring antidepressants for youth
Pharmacogenetic testing might help optimise antidepressant treatment for young people, according to WA researchers.
In Australia, two in five people under the age of 24 suffer from a mental health condition. While antidepressants are widely prescribed for mood disorders such as depression and anxiety, there is significant variability in patient response and side effects.
But pharmacogenetics may offer a promising way to tailor a patient’s prescription based on their ability to metabolise drugs.
Researchers at the Perron Institute, UWA, Notre Dame and Murdoch universities and the WA Health Department looked at the use of pharmacogenetics testing in treating mental health issues, with a strong focus on youth depression and anxiety. Their review paper was published recently in the journal Frontiers in Pharmacology.
Authors Bradley Roberts, a PhD candidate at the Perron Institute and UWA, and Zahra Cooper from Perron, said their examination of literature found that understanding a young person’s genetic traits provided the potential to tailor treatment to each individual, reducing side effects and improving treatment outcomes.
“However, there are hurdles to overcome, including a lack of evidence-based guidelines for primary care physicians, limited awareness and experience of GPs around genetic intervention, and community concerns around data privacy, equity and economic value,” Mr Roberts said.
“By understanding the barriers faced, we are one step closer to giving more young people taking antidepressants the opportunity to receive effective care.”