Australian Family Physician September 2006 - Mother and baby
Vol 35, (9) 657 - 752
The theme for the September issue of AFP is
mother and baby. This month's articles include breastfeeding, postnatal
and perinatal depression, gestational diabetes, stem cells and skin
cancer.
AFP - the first 50 years
Steve Trumble, Jenni Parsons
Fifty years is a long time for anything to survive, let alone flourish. Yet it is 50 years since the RACGP (which
was then an offshoot of the Royal College in Britain, known here as the College of General Practitioners in
Australia) decided to provide a forum for its members to publish their professional observations. Originally
named Annals of General Practice, the fledgling journal set out to be independent and thought provoking. As the inaugural editorial concluded: 'Who seeks to please all will end by pleasing none'.
Letters to the editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editors or The Royal Australian College of General Practitioners.
Postnatal depression in Australian general practice
Janice Charles, Stephanie Knox, Helena Britt
The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of encounters at which postnatal depression was managed. This provides a backdrop against which the articles in this issue of Australian Family Physician can be further considered.
Perinatal depression - Assessment and management
Anne Buist
Depression and anxiety often begin in pregnancy, particularly third trimester, therefore 'perinatal' rather than postnatal depression might be a better term to describe this disorder.
The postpartum visit - Why wait 6 weeks?
Ewa Piejko
In many western countries, the traditional '6 week check' is a routine medical review of a mother and her baby 6 weeks after the birth. In Australia, general practitioners perform the majority of postpartum assessments.
The crying baby
Harriet Hiscock
Up to 20% of parents report a problem with their infant crying in the first 3 months of life. The majority of babies have no
organic cause of crying and most crying subsides by 3-4 months.
Breastfeeding - Managing ‘supply’ difficulties
Lisa Helen Amir
Many breastfeeding women have concerns about their milk supply; 'not enough milk' is the most common reason women give for stopping breastfeeding, however their concern is often unwarranted.
What about dad? Psychosocial and mental health issues for new fathers
John Condon
Although motherhood and the mother-infant bond have been extensively researched, the same is not true for fatherhood
and the father-infant bond.
Complementary medicine for pregnancy complications
Michelle Woolhouse
For some women, pregnancy can bring a myriad of
distressing symptoms. Nausea affects up to 85% of women during early pregnancy and about half of these women also experience vomiting. For some women,
it can be very debilitating.
Self induction of abortion with instrumentation
Sonu R Thapa,
Debesh Rimal MD, Jane Preston
In underdeveloped countries, where abortion is still illegal and not easily accessible, the number of unsafe abortions is soaring, as are the associated complications. However, in developed countries, where termination of pregnancy is legal and freely accessible, unsafe methods are uncommonly seen and reported.
The abortion debate in Australia
Christine Margaret Read
I recently watched a fascinating documentary about the crusade of Dr Bertram Wainer in the 1960s to bring the practice of illegal abortion in Victoria to an end. It documented the profound horror of the backyard abortion that so often ended in infection, sterility or death, and served as a potent reminder of a practice to which we must never return. Of course that can't happen again, abortion is legal now, isn't it?
Gestational diabetes - Worth finding and actively treating
Patrick J Phillips, Bill Jeffries
Gestational diabetes affects around 5% of pregnant women, however the value of screening women for gestational
diabetes has been hotly debated. On the positive side there has been potential benefits for the baby and, on the
negative side, the costs of managing gestational diabetes to the mother.
Managing acne vulgaris effectively
Greg Goodman
The management of acne is a gratifying experience. Available treatments are effective, relatively nontoxic and generally safe. However, there is no quick fix. Antibiotics, hormone therapies and topical therapies are maintenance treatments.
Sleep disturbances in the disabled child - A case report and literature review
Krista Adlington, Anthony JW Liu, Ralph Nanan
Sleep disturbances in children are common. In children with intellectual disabilities sleeping problems are more common. This may result in increased burden of illness, additional parental stress, and day time behavioural difficulties. This article illustrates the problems that sleep disturbances create for children with disabilities and discusses methods for managing sleep problems.
Skin cancer in patients with multiple health problems
Anthony Dixon
Case history:
Mrs OL, 84 years of age, and living in an aged care facility, developed a nodule on her left cheek. She had a history of numerous past skin cancers, dementia, hypertension, epilepsy, and cerebrovascular accidents.
Stem cells - A clinical update
Bernard Edward Tuch
Stem cells of adult origin have been used clinically for 40 years in the treatment of haematological neoplasms such as leukaemia. These cells were originally obtained from bone marrow, but are now also being derived from umbilical cord blood.
The skin and the mind
Antonio Chuh, William Wong, Vijay Zawar
The intimate relationship of the skin and the mind illustrates the importance of a holistic approach in caring for patients
with skin problems. Habits related to psychological problems may lead to skin problems such as lichen simplex
chronicus and acne excoriée. Emotional stress may affect skin diseases such as atopic dermatitis, perioral dermatitis,
pompholyx, and plaque psoriasis.
Fever, rash and thrombocytopenia
Keng Yin Loh, Siang Tong Kew
Case history: A woman, 30 years of age, who returned 3 days ago from a trip
to Malaysia, presented with
sudden onset of high grade
fever associated with headache,
myalgia and periorbital pain of 5
days duration. On the third day
of the fever, she noticed a rash
appearing on her trunk and both
her lower limbs. She also had
thrombocytopenia (platelet count:
90 x 103/uL).
Clinical challenge
Jenni Parsons
Questions for this month's clinical challenge are based on articles in this issue. The style and scope of questions is
in keeping with the MCQ of the College Fellowship exam. The quiz is endorsed by the RACGP Quality Assurance and
Continuing Professional Development Program and has been allocated 4 CPD points per issue. Answers to this clinical challenge will be published next month, and are available immediately following successful completion online
Hippocrates’ tree
Michael Kidd
The writings attributed to Hippocrates have influenced
medical education for the past 2400 years. Our own
teaching is still based on their high ethical traditions and
their principles continue to guide our work as clinicians
and our responsibilities to our patients and to society.
Medication errors: immunisation
Sara Bird
Case histories are based on actual medical negligence claims or medicolegal referrals, however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. This article outlines a medication error involving childhood immunisation and examines the underlying causes of the incident. Advice about how to deal with a patient and their family when things go wrong is provided.
Book reviews
Delma Mullins, Heinz Tilenius
Books reviewed this month are Paediatrics and Child Health (2nd edition) by Mary Rudolf and Malcolm Levene and Clinical examination:
A Systematic Guide to Physical Diagnosis (5th edition) Nicholas J Talley and Simon O'Connor.
Screening for chlamydia with the Pap test
Helen Toyne, Nicholas Glasgow, Clare McGuiness, Francis J Bowden, Marian J Currie
The implementation of the recent National Health and Medical Research Council Guidelines for the management of asymptomatic women with screen detected abnormalities is welcome and should address the current practice of unnecessary repeated investigation of young women infected with human papilloma virus (HPV). It is timely to consider the overall benefit of the Pap test in this group for whom
rates of cervical cancer are extremely low.
Women’s experience of lactational mastitis - ‘I have never felt worse’
Lisa Helen Amir, Judith Lumley
Mastitis is a common problem for breastfeeding women in the postpartum period.
GP wellbeing and general practice issues
Amanda Murfett, Denise Charman
Studies of general practitioner wellbeing have demonstrated remarkably consistent findings. However, the implications for day-to-day general practice have been unclear. This study was based on a survey comprising items extracted from transcripts of interviews with GPs and designed to link general practice issues with self reported wellbeing.
Managing shoulder pain in general practice - The value of academic detailing
Norman A Broadhurst, Christopher A Barton, Lisa N Yelland, David K Martin, Justin J Beilby
After low back pain and neck pain, shoulder pain is
the third musculoskeletal reason for presentation to general practice, with a self reported prevalence of
16-26%. Approximately 1% of the adult population is expected to visit a general practitioner annually for shoulder pain. Shoulder complaints are more common in women and despite the fact that 50% of acute shoulder pain resolves in 8-10 weeks, many patients present with the anticipation of being referred for imaging.