Australian Family Physician January/February 2008 - Lifestyle changes
Vol 37, (1/2) 1-96
The theme for the January/February issue of AFP
is lifestyle changes. This month's articles include smoking cessation,
encouraging physical activity, helping patients lose weight, alcohol
intervention, abnormal PSA tests, managing falls in the elderly and
dementia management.
Improving the health of Australians
Todd Harper
By international standards, Australians enjoy good health. Life expectancy in Australia is among the highest in the world, and has increased significantly over the past 20 years. Between 1983 and 2003, the health of Australian males had increased by 6 years, to 78 years, and the life expectancy of Australian females had increased by 4 years, to 83 years.
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.
Lifestyle matters
Janice Charles, Helena Britt, Lisa Valenti
In 2005–2006 there were 101 993 patient encounters recorded in BEACH by 1017 general practitioners. At least one lifestyle advice/counselling was provided at 5.3 per 100 encounters. Advice/counselling about nutrition/weight was the most common followed by exercise.
Smoking cessation - What works?
Nicholas Zwar
Prevalence of tobacco smoking in the Australian community has fallen. However, tobacco smoking remains a major cause of illness and death. General practitioners play an important role in assisting their patients to quit smoking.
Alcohol intervention – what works?
Nicole K Lee, Elizabeth Moore
The majority of alcohol related problems in the community are managed in general practice. Screening and provision of brief interventions by general practitioners can impact on morbidity and mortality. General practitioners also play a central role in the management of alcohol dependence.
Helping patients lose weight – what works?
Garry Egger
Over one in two Australians are now overweight or obese. Weight loss is difficult for patients to achieve and maintain in the current 'obesogenic' environment. However, new developments have resulted in a number of strategies and methods with a good evidence base. A 5–10% reduction in weight can result in a 35% decrease in health risk.
Encouraging physical activity – five steps for GPs
Ben J Smith, Hidde P van der Ploeg, Laurien M Buffart, Adrian E Bauman
Over half of Australians do not meet physical activity recommendations. General practitioners can play an important role in encouraging physical activity, which would significantly reduce the burden of chronic disease.
Glucocorticoids in early rheumatoid arthritis
Maureen Davey, Rachelle Buchbinder
Rheumatoid arthritis (RA) is a chronic inflammatory disease
of unknown aetiology that according to self reported data from
the Australian Bureau of Statistics affects 2.4% of the
Australian population.
Cyclic nausea and vomiting in childhood
David Forbes, Susan Fairbrother
Cyclic vomiting syndrome (CVS) is an under-recognised functional
gastrointestinal disorder of childhood. Despite failure of recognition
by many health practitioners, it is relatively common and frequently
disabling.
Lipid lowering therapy for adults with diabetes
Leslie Jackowski, Josephine Crockett, Debra Rowett
The number of adults in Australia with diabetes has trebled
over the past 2 decades. Diabetes confers an increased risk
of cardiovascular disease (CVD) and CVD is the leading cause
of morbidity and mortality in patients with diabetes.
Pitfalls in managing falls
Linda S Appiah-Kubi, Mahesan Anpalahan
Falls are common in the elderly and one of the most common reasons
for older people to seek medical help. To illustrate the diagnostic
dilemmas of this common clinical problem, we present a case study
of a woman with a history of recurrent falls.
Beyond chemotherapy - Demystifying the new ‘targeted’ cancer treatments
Rachel Dear, Nicholas Wilcken, Jenny Shannon
Until recently, cancer treatments, ie. surgery, radiotherapy and cytotoxic
chemotherapy, although effective, have been relatively nonspecific
in their actions.
Clinical challenge
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.
AFP in Practice
AFP in Practice questions are designed to get you started in a small group learning (SGL) activity in your practice or with colleagues. Requirements to earn 30 Category 1 CPD points for a SGL activity are: minimum of four and a maximum of 10 people, minimum of 8 hours of discussion in a year, and at least two GPs.
EBM journal clubs in general practice
Jenny Doust, Chris B Del Mar, Brett David Montgomery, Clare Heal
Evidence based medicine (EBM) changes the way
medicine is practised by integrating individual clinical
expertise with the best available external clinical evidence
and patient values.
Caring for patients with opioid dependence
Jeremy Bunker, Adam Winstock, Nicholas A Zwar
Australian general practitioners have a pivotal role in
helping their patients with problems of alcohol and tobacco
dependence, but have been less likely than their peers in the
United Kingdom to be involved in the management of opioid
dependence.
Defibrillators - Their use in general practice
Lynton Hudson, Ian Jacobs
During the development of The Royal Australian College of
General Practitioners Standards for general practices (3rd
edition) in 2005, the unflagged (nonessential) indicator ‘the
practice has a defibrillator’ was tested in a survey of 200
practices Australia wide.
GP supervisors - Their professional development and involvement in assessment
Patrick Kinsella, Jean Wood
The general practitioner supervisor is commonly described
as the most important person involved in Australian GP training,
but is someone who is all too often forgotten when credit is
given for training our next generation of GPs.
Professional Practice Book Reviews
Bianca Cannon, Sue Cherry, Adrian Bauman, Marlene Tham, Matthew Naughton, C Bridges-Webb
Books reviewed this month are Patient-Centred Diagnosis by Nicholas Summerton, Australasian Contact Tracing Manual, 3rd edn by B Donovan, D Bradford, S Cameron, C Conway, E Coughlan, L Doyle, F Franklin, Good Health in the 21st Century – a Family Doctors Unconventional Guide by Carole Hungerford, Living with Your Looks by Roberta Honigman, David J Castle, The Pocket Guide to Lung Function Tests by Bob Hancox, Ken Whyte & Geriatric Clinical Advisor: Instant Diagnosis and Treatment by Tom J Watchel
Gastro-oesophageal reflux disease - Impact of guidelines on GP management
Catherine N Kirby, Leon Piterman, Mark R Nelson, John Dent
Gastro-oesophageal reflux disease (GORD) is a highly
prevalent condition characterised by regular and frequent
‘heartburn’ and/or acid regurgitation.
Influences on the prescribing of new drugs
Luke Tobin, Abelio C de Almedia Neto, Sonia Wutzke, Craig Patterson
The aim of this study was to identify the factors that influence
prescribing of new drugs among general practitioners,
endocrinologists and psychiatrists.
General practice patients - Their readiness to quit smoking
Nicholas Zwar, Robyn L Richmond, Mark Harris
This
article examines the prevalence of smoking among general practice patients and assesses their stage of readiness to quit.
Abnormal PSA tests - Delays in referral
Alan MF Stapleton, Richard L Johns, Tina Kopsaftis, David J Tamblyn
The main benefit of prostate specific antigen (PSA) testing is to help
detect prostate cancer at an early, curable stage. Delays between
the first abnormal PSA test and biopsy can undermine that benefit,
but have not yet been studied.
GP management of dementia - A consumer perspective
Fiona Millard
As the population ages, the general practitioner is likely to
have an increasingly important role in diagnosing and
managing dementia. Many people in the community dealing
with dementia have little help until a diagnosis is made, and
their experiences produce a profile of their met and unmet
needs.
Youth vouchers for GP services - A pilot project
Robert Trigger, Dan Ewald, Anita Mansfield
Identified barriers to young people accessing a general practitioner
include cost, communication, confidentiality issues, and knowledge
of Medicare.