Australian Family Physician September - Child development
Vol 40, (9) 649-744
The theme for the September issue of AFP is child
development. This month's articles include problem behaviour in
children, is my child normal?, autism spectrum disorders, breastfeeding
and medicines, proton pump inhibitors, and fibromyalgia and vitamin D
deficiency.
Autism spectrum disorders
Janice Charles, Christopher Harrison, Helena Britt
In this article we use BEACH data to examine changes in
the management rate of autism spectrum disorders (ASDs)
from 2001 to 2011 in children aged <18 years. We also look at
encounters where autism was managed during 2006–2011.
Is my child normal? Milestones and red flags for referral
Frank Oberklaid, Kim Drever
Developmental problems in young children are common
and have lifelong implications for health and wellbeing.
Early detection of developmental problems provides
an opportunity for early intervention to shift a child’s
developmental trajectory and optimise their potential.
Autism spectrum disorders
Bruce Tonge, Avril Brereton
Autism spectrum disorders (ASDs) are serious
neurodevelopmental disorders affecting approximately
one in 160 Australians. Symptoms are apparent during
the second year of life causing impairments in social
interaction, communication and behaviour with restricted
and stereotyped interests.
Problem behaviour in children - An approach for general practice
Angela Luangrath, Harriet Hiscock
Around 12% of Australian children aged 4–12 years
experience externalising behavioural problems such
as aggression and hyperactivity. Similarly, around 12%
experience internalising problems such as anxiety and
depression. Other common behaviour problems, such
as temper tantrums, arise as the child strives to achieve
developmental milestones.
Vision in a changing world
Nyoli Valentine
General Practice Education and Training
recently announced a record number
of 1329 eligible applicants for general
practice training in 2012.
A fistful of prescriptions - is there a better way?
Oliver Frank, Chris Alderman
Since the inception of the Pharmaceutical
Benefits Scheme (PBS) in the late 1940s
there has been a dramatic increase
in the range of medicines that are
available to the Australian community.
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
Breastfeeding - Evidence based guidelines for the use of medicines
Lisa H Amir, Marie V Pirotta, Manjri Raval
General practitioners may consider prescribing medicines for breastfeeding women
during the postpartum period. Most medicines can be used safely during breastfeeding
at the recommended dose, however there are exceptions that necessitate caution.
Nerve conduction studies
William Huynh, Matthew C Kiernan
This article forms part of our ‘Tests and results’ series for 2011 which aims to provide information
about common tests that general practitioners order regularly. It considers areas such as indications,
what to tell the patient, what the test can and cannot tell you, and interpretation of results.
Patient information - Nerve conduction studies
Dr Rachel Lee
Nerve conduction studies investigate how
the nerves in your arms and legs are working.
Nerves allow messages to pass as electrical
impulses between your brain and the rest of
your body.
Hyperpigmentation - a case study
Jennifer L Pecina, Mark R Pittelkow
A man, 70 years of age, presented with a
history of hyperpigmentation on his lower
extremities. The rash was asymptomatic and
the patient was uncertain how long it had
been present. However, he recalled that it was
definitely not present at his last appointment
10 months prior.
Proton pump inhibitors - uncommon adverse effects
Stephen Oh
Proton pump inhibitors (PPIs) are one of the most popularly prescribed drugs in Australia
for conditions such as gastro-oesophageal reflux disease, peptic ulcer disease and
functional dyspepsia. Despite their good safety profile, PPIs have potential adverse
effects, yet they are often overprescribed and without a clear indication.
Decision support systems – a general practice research journey
Siaw-Teng Liaw
‘Mr Jones has a high cardiovascular disease
(CVD) risk based on the online calculator
you used a few months ago. You now have
a CVD risk calculator embedded in your
desktop clinical information system, which
surprisingly calculates that Mr Jones is
now ‘low risk’. Even with risk assessment
involving many variables, and allowing for
rounding and assumptions, this difference is
disconcerting. You start to wonder about the
automated computer system prompts…’
Fibromyalgia – should we be testing and treating for vitamin D deficiency?
Deepa Daniel, Marie V Pirotta
Internationally, interest in vitamin D
is high, due to increased detection of
vitamin D insufficiency, combined with
better knowledge of the role of vitamin D
in health outcomes.1 With the explosion
of ordering of vitamin D assays in recent
years (Table 1), and questions about the
appropriateness of screening, general
practitioners should target vitamin D
testing and supplementation to specific
populations with evidence of health
benefit.
Traditional Chinese medicine – women’s experiences in the treatment of infertility
Ann Alfred, Karin Ried
Having a child is not always easy,
with about one in 6 Australian couples
currently struggling with impaired
fertility.1 Infertility, usually defined as
the failure to conceive after 1 year of
unprotected intercourse or the inability
to achieve a live birth, can be caused
by male or female factors, and about
22% of cases are unexplained.1 Couples
seeking help are usually referred to
assisted reproductive technology (ART),
and ART use is growing, with 62 000 in
vitro fertilisation (IVF) cycles undertaken
in Australia in 2008, an increase of 50%
since 2004.
Medical journal covers – an analysis of gendered images and how these might influence best practice
Jan Coles, Susan P Phillips, Lyn Clearihan, Kymm Feldman
Images convey a concept or message to
their audience, and images of people can
offer us ideas of who and what we are and
who and what we might become. Image can
also play a role in ‘maintaining or subverting
established forms of social practice’
Workers’ compensation forms – a guide for GPs
Catherine Dodgshun, John Malios
Workers’ compensation provides financial benefits for injured workers.
The general practitioner has a pivotal role in the completion of necessary
documents such as medical certificates, medical reports and treating
practitioner questionnaires. Before completing such documents, the GP
must complete a thorough medical assessment. This article describes
the important elements of this assessment, the information required in
workers’ compensation documents, and the responsibilities of the GP and
worker (patient) in completing these documents.
A competency history – an additional model of history taking
Simon Bridge
Taking a medical history is centred on a presenting problem and includes assessing
and describing the problem according to a learned protocol. After an examination, the next step is usually for the doctor to suggest solutions. In many cases this process is very
successful. However, if the solution requires behavioural change, other factors can come into play, affecting the likelihood of change.
Erratum
Table 3, on page 581 of the article Problem drinking: management in general practice by Demirkol A, et al, (AFP August 2011) contains an error, made in the process of preparing the paper for publication.
Book reviews
Books reviewed this month are Anterior Eye Disease and Therapeutics A–Z, 2nd edition by Adrian Bruce and Michael Loughnan and The Panic Virus: Fear, Myth and the Vaccination Debate by Seth Mnookin.
Clinical challenge
Nyoli Valentine
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 multiple choice questions of the RACGP Fellowship
exam. The quiz is endorsed by the RACGP Quality Improvement and Continuing Professional
Development Program and has been allocated 4 Category 2 points per issue.