MEDICINE IN THE MOUNTAINS by alicejenny

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									                                                                                          MeDeFacts
MeDeFacts
h t t p : //cms.meddent.uwa.edu.au/
                                                                                                 MeDeFa


                                                                              volume 14 number 2 june 2008
                                                                                                          cts




                               MEDICINE IN THE MOUNTAINS




                         Sixth-year medical student Adam Mossenson spent a month in
                    inhospitable terrain in the Himalayas as part of a team providing medical
                   and dental care to almost 3000 patients. His account of his experience won
                                        him a Faculty prize. Story page 12.




NEw DENTAl ClINIC A kNOCkOUT                                       A NEw CAb IN THE rESEArCH
P     ublic dental patients who can’t sit still in the dentist’s
      chair because of their fear of the dentist can now avoid     prIOrITy rANkS
                                                                   T
      unnecessary general anaesthetics, thanks to an innovative           he early origins of chronic disease, harking back
clinic set up by the Oral Health Centre of WA.                            to our life as an embryo and before that to our
The IV (Intravenous) Sedation Clinic will result in the added             parents’ lives, is the latest vast health topic to join
benefit of saving many thousands of dollars for the State          the ranks of the research priority areas of the Faculty.
Government. And it will reduce waiting times for people who        The Developmental Origins of Health and Disease
require general anaesthesia for clinical reasons.                  (DOHaD) was the subject of an international congress
OHCWA Business Manager Stephen Home said it was                    held in Perth last November and worldwide research is
estimated up to 10 per cent of public patients attending the       gaining momentum.
operating theatre at Sir Charles Gairdner Hospital for oral        DOHaD now sits beside the other four research priority
surgery under a general anaesthetic were referred there because    areas, which are genomic medicine (pharmaco-genomics
they suffered from dental phobia, not because their treatment      and pharmaco-epidemiology), Aboriginal health,
was complex. Other non-complex treatment is provided under         management of chronic diseases (cancer, cardiovascular
general anaesthesia to children and disabled patients who          diseases and respiratory diseases), and mental health.
cannot sit still for long enough in a dentist’s chair.             Two years ago, Faculty Dean Professor Ian Puddey
Dental phobia is defined as an extreme and persistent fear         established a strategic research advisory committee
which results in the individual’s avoidance of attending           chaired by Associate Dean (Research) Professor George
                                          continued page 10                                               continued page 4

                  Editions of mEdEfacts can bE viEwEd onlinE at www.mEddEnt.uwa.Edu.au
    lEArNINg ON THE rUN
    M         any people will be familiar with
              Teaching on the Run, a staff
              development program for clinical
    teachers, but have you heard about Learning
    on the Run?
    Learning on the Run is a new educational
    program for junior doctors, aimed to
    optimise learning in the workplace.
    The program focuses on junior doctors,
    equipping them with skills so they can take
    control of their learning and make use of
    opportunities that may otherwise be lost
    in the busy work setting. The program
    addresses learning opportunities, learning
    outcomes, time management, organising
    resources and gathering useful feedback. It
    encourages doctors to identify barriers and
    to create learning opportunities.                            (from left) Associate Professor Fiona Lake,
    The program has been developed by                  Dr Margaret Potter and Dr Gerard Ryan take a break during
    Associate Professor Fiona Lake, Head of the                          work on the LOTR program
    School of Medicine and Pharmacology, and
    Dr Margaret Potter, LOTR project manager,
    in conjunction with Dr Gerard Ryan, a respiratory physician at Sir Charles Gairdner Hospital. It consists of three one-
    hour modules that engage junior doctors in discussion, self-reflection, and problem-solving scenarios. In addition, a
    44-page resource book that provides tips for junior doctors has been developed to complement the modules.
    The developers are refining the program with the aim of wide implementation across Australia.
    The Learning on the Run program was piloted with junior doctors at Royal Perth Hospital, SCGH and Toowoomba
    Hospital, Queensland late last year and early this year with funding provided through the Postgraduate Medical Council
    (WA). In addition, a similar program funded by a grant from the University is being run by Dr Lisa Caputo, lecturer
    in medical education in the School of Medicine and Pharmacology, in conjunction with Fiona Lake for Year 4 medical
    students just entering the clinical years.
    Evaluation shows the pilot program was generally well received with indications that it has potential to equip junior
    doctors to take control of their learning. It dovetails with the Teaching in the Run program, so now both teachers and
    learners can be equipped to make the most of a busy work environment - “on the run”.




               INCrEASINg THE rUrAl wOrkfOrCE
              T      he Rural Clinical School of WA is proving so popular and successful that more than 150 applicants are
                     expected next year for 75 places.
                     “I think it is a good indication that we have got a very good reputation for a good course and the numbers
              are going up,” Professor Campbell Murdoch, former RCS Head, said.
              “The good thing is that the people who come to the Rural Clinical School seem to maintain that interest through
              to their post-graduate years.”
              In a letter to the Medical Journal of Australia, published on 4 February, he and co-authors furnished the first data
              on the return of WA RCS graduates to rural internship positions relative to the intern year cohort as a whole.
              They showed that of two cohorts entering postgraduate year 1 (PGY1) positions in 2004 and 2005, 14 of 28
              RCS graduates requested and completed the one rural rotation allowed during their intern year.
              “Given the limited rural rotations available in WA, some sought rural experience as far afield as Queensland and
              New South Wales,” the authors wrote.
              RCS students were three times more likely than other graduates to take a rural rotation.
              Furthermore, postgraduate contact with the RCS students has revealed that 23 of 28 graduates have elected to
              spend some time in the country during their PGY1-3 years and that some will sign up for a rural vocational
              training pathway.
              “These results provide initial evidence that the WA RCS program will increase the rural workforce,” the authors
              wrote.
              Professor Murdoch’s co-authors were Dr Denese Playford, Senior Lecturer in Medical Education, Dr Harriet
              Denz-Penhey, Senior Research Fellow, and Dr Lesley Skinner, Senior Lecturer in Postgraduate Medical
              Education, all of the RCS.
                                                                                                         continued on page 13



2                                  MeDeFacts UWA Faculty of Medicine, Dentistry and Health Sciences         June 2008
                                                                                                                             The
by prOfESSOr IAN pUDDEy, DEAN
                                                                                                                            Dean ’s
A       pologies to all for the late
        arrival of this June edition
        of Medefacts. I have been
travelling since late April which
delayed the penning of this editorial.
                                            is fully accredited by the Australian
                                            Medical Council. The increase in
                                            medical student numbers, the pressure
                                            of clinical training places, a growing
                                            paucity of clinical academics in
                                                                                                                              Desk

It began with an Australian Medical         the tertiary setting, the upgrading
Council accreditation visit to one of       of our outer urban hospitals, the
the newest of Australia’s 19 medical        flagged federal move to establish GP
schools at the University of Western        superclinics and an ageing population
Sydney. I was deeply impressed by           with a shift from the management of
their achievements to date but even         acute to chronic medical problems are
more by the way they have developed a       among some of the drivers to rethinking
mission to see their Medical School as      how much of our teaching needs to be
a major force in meeting the needs of       carried out in tertiary hospitals and
the local Western Sydney community.         how much should now take place in
That they are achieving this mission        community-based and primary care
was evident from the moment I               environments. Five of the current
stepped into a taxi at the hotel en route   deans of Australian medical schools
to the university. The taxi driver, an      now hail from the ranks of general
Iraqi refugee and previously a high         practitioners reflecting such a shift
school teacher in his home country, on      nationally. At Florida State University,
hearing where I wanted to be taken,         the first new medical college to be
very proudly announced that his             accredited in North America for
daughter was now a medical student          over 20 years, their entire four-year
at UWS. This reflected the selection        programme is community-based. A
process which has attempted to provide      wider international move towards both
priority entry to locals who it is hoped    interdisciplinary collaborative health
will ultimately choose to serve in          and medical research and the delivery            how to lead innovations in medical
their home community, a community           of integrated medical curricula that             education conducted by the Harvard
with one of the largest immigrant and       provide early clinical exposure have             Medical School. It was a stimulating
indigenous constituencies in Australia.     been further drivers in breaking down            week conducted in the context of the
From week one of the course students        traditional medical school structures            many North American universities
are already being tutored at the bedside    and teaching that have been discipline-          which are now considering large scale
in local hospitals and in the second        based and undertaken largely within              curricular reform in their own medical
year of this new five-year course there     tertiary institutions. The ongoing               schools together with the development
is a “Medicine in Context” program          Course Structure Review at UWA,                  of several new medical schools in
which immerses students in the              with a report due this August, may yet           that region. There was a careful
community for a semester with the aim       deliver us a catalyst for large scale and        analysis of how to lead organisational
of developing a deeper understanding        innovative change at UWA.                        change in the hybrid environment that
of the social and cultural context of                                                        characterises universities, with their
health and disease. Finally the research    Leading organisational innovation                sometimes conflicting imperatives for
priorities of the School are being                                                           a collegiate management culture versus
constructed, at least in part, around       Of 19 Australian medical schools,                a business management approach. We
local community needs and expertise.        five have undergraduate courses                  both came away asking whether this
It is clear that being able to write        alone and three (like UWA) have                  Medical School, through the Course
from a new script allows considerable       both undergraduate and graduate                  Structure Review, was now being
creative and contemporary input into a      entry. The remaining 11 are graduate             provided with an opportunity to move
new medical school with a chance to         medical schools, all of which have               from a good medical school to a great
seriously re-evaluate what constitutes      four-year courses. We remain one of              medical school. If we are to seize such
the optimal approach in defining            only four medical schools in Australia           an opportunity we hope all members
selection procedures, curriculum            with a six-year course (the others               of the school and the wider profession
content and pedagogy, and research          being UNSW, James Cook University                will not only embrace further change
strengths and priorities which will best    and the University of Adelaide). In              and innovation but be inspired by it,
address community needs in the 21st         an era where accelerated training                and become the leaders in re-laying
century.                                    pathways for medical graduates                   the bricks and mortar of our current
                                            are being encouraged in order to                 learning environment.
Change needed?                              assist our unmet medical workforce
                                            demands, UWA needs to seriously
Is there any imperative to redefine the     question the rationale for continuing
Medical School at the University of         with its six-year program. With the
Western Australia? After all, it is not     potential for such a change in the air,
yet a decade since we last introduced       our Professor of Medical Education,
our “new” curriculum in 1999 and            Geoff Hamdorf, and I, have just
we have an excellent program that           returned from attending a course on




    June 2008                        MeDeFacts UWA Faculty of Medicine, Dentistry and Health Sciences                                  3
    DOHaD
                                                 rESEArCH prIOrITIES

                            A NEw CAb IN THE rANkS CONTINUED frOM pAgE 1
      Yeoh, with members including the Deputy Vice-Chancellor (Research) Professor Doug McEachern, Heads of Schools
      and Centres or their representatives, and senior Faculty researchers.
      The committee selected the priority areas so they could be incorporated into the Faculty’s operational priority plan for
      the 2006-8 triennium.
      Their choices are areas that reflect a skill base within the Faculty, the health priorities of the WA Department of Health,
      and priority areas for national research, making them more competitive for research funding.
      In practical terms, the Faculty prioritises research support from its bequests for research grants and fellowships and for
      research infrastructure towards these priority areas, which will be reviewed for the next triennium of 2009-11.
      The Federal Health Department’s seven priority areas are cardiovascular health, cancer, injury prevention, mental
      health, diabetes, asthma and arthritis.



     AbNOrMAl “flIgHT Or fIgHT rESpONSE” MAy TrIggEr HEAlTH prOblEMS

     M
                uch of our predisposition to health and response to stress is programmed
                by early life events – and that is the subject of a major research area, the
                Developmental Origins of Health and Disease (DOHaD).
     Professor Newnham, Head of the School of Women’s and Infants’ Health, said
     early life events included exposure to stress hormones before birth.
     “These are then modified by our early life experiences, in other words, mothering,
     social support and so on,” he said.
     A research group at the School has been focusing on pre-natal events and the
     primary stress hormone, cortisol, which triggers the “fight-or-flight” response.
     “If we have an abnormal responsiveness, we believe that predisposes us to a host
     of childhood and adult conditions including behavioural problems in childhood
     and adolescence, chronic diseases and perhaps depression in later life,” Professor
     Newnham said.
     The researchers are trying to tease out the mechanism acting on a fetus if it is
     exposed to excessive cortisol levels before birth.
     An opportunity for study arose because pregnant women at risk of premature birth
     are injected with a synthetic form of cortisol to mature the lungs and other organs
     of the fetus.
     Professor Newnham’s previous work demonstrated that the former practice of
     giving such women weekly injections may affect the baby’s developing brain. As
     a result, clinical practice worldwide was changed and regular injections are no
     longer administered.
     The Professor’s team is now looking at whether a 48-hour burst of cortisol on a
     fetus very early in pregnancy might have effects in adulthood.
     Evidence from rat studies conducted by Canadian researchers has shown that
     short-term exposure can be damaging and two bouts of 20 minutes of cortisol is
     all that is required to alter the animal’s adult behaviour.
     In addition, recent research from Melbourne shows that 48-hour exposure
     of a sheep fetus to cortisol early in pregnancy results in that offspring having
     hypertension as an adult.
     Now Faculty PhD student Shaofu Li is trying to determine the enzyme changes
     that occur to cause this.
     “He is looking at how exposure to cortisol early in pregnancy modifies the adrenal
     glands and the genes working within the adrenal glands…so we can get to the
     absolute origins of conditions such as ADHD, altered behaviour and potentially
     obesity and diabetes,” Professor Newnham said.                                           Professor John Newnham and Shaofu                   Li
     The next step will be to translate the information from the animal studies to humans,
     to see how exposure of a fetus to a stressed mother affects the baby as an adult
     – and that is to be the focus of separate studies by the group.
     “How our research group loves to operate and how we get our great strength at an international level is that we run studies in parallel,”
     Professor Newnham said.
     “We run studies in the sheep model to investigate the details of mechanisms which cannot be investigated in humans for obvious reasons and
     we run human studies in parallel, using what methodology we can, to observe what happens in the human. And then we put the two results
     together to try to work out the full story.”
     Mr Li said he was very pleased to be doing his PhD in the School. “I hope my research can contribute in some way to improving the health
     of children in the future,” he said.
                                               -By Cathy Saunders


4                                            MeDeFacts UWA Faculty of Medicine, Dentistry and Health Sciences              June 2008
                                                        rESEArCH prIOrITIES                                                             DOHaD




  CHIlDHOOD prECUrSOrS Of ADUlT ObESITy, DIAbETES AND HEArT DISEASE
By Professor Lawrie Beilin, School of Medicine and Pharmacology                                                WA and Canadian collaborators in


T      easing out the pre- and postnatal factors predisposing to adult disease                                  the Canadian Institute for Health
       is the aim of numerous investigations being carried out on the back of                            Research met to lay the groundwork for
       Raine Childhood cohort data.                                                                      a successful grant to study genetic and
The data provide an enormous resource for studying the factors leading to adult
obesity, the metabolic syndrome, diabetes, hypertension and cardiovascular                             environmental influences on the metabolic
disease.                                                                                                   syndrome, using the Raine Study’s
The School of Medicine and Pharmacology and others are investigating the                              children’s cohort and experimental models.
influences of intra-uterine stress and programming, intrauterine and postnatal                        The grant was awarded by UWA and the WA
growth, early postnatal and childhood environment, and family and psychosocial
status.                                                                                                       Institute for Medical Research.
In collaboration with Dr Craig Pennell, Professor Lyle Palmer and Canadian,                              The group’s members (from left) are Dr
British and South American colleagues, plans are underway for studies of gene                         Trevor Mori, of the School of Medicine and
environment interactions on the risk of obesity, the metabolic syndrome and                            Pharmacology, Associate Professor Garth
high blood pressure. The longitudinal nature of the Raine study and the unique
intrauterine measures means it is possible to look for very early influences on                          Kendall of Curtin University, Dr Dorota
different trajectories of growth, blood pressure and other measures of health.                           Doherty, of the School of Women’s and
The School has been working on the Raine Childhood cohort studies with                                Infants’ Health, Professor Lawrie Beilin, of
colleagues from the Telethon Institute for Child Health Research (TICHR),
the Womens and Childrens Research Foundation at King Edward Memorial                                  the School of Medicine and Pharmacology,
Hospital, the WA Institute for Medical Research and colleagues from Curtin                            Dr Craig Pennell, of the School of Women’s
and Notre Dame Universities.                                                                           and Infants’ Health, Nick Sloan, a former
The studies come under the umbrella of the Faculty priority of research into                              Raine Study Co-ordinator, Professor
Developmental Origins of Health and Disease (DOHaD).
The Raine cohort of just under 3000 children was originally part of a study of                           Fiona Stanley, Director of the Telethon
the effect of ultrasound at 16 weeks of pregnancy on pregnancy outcome. The                             Institute for Child Health Research, Rae-
study was initiated by Professors John Newnham, Fiona Stanley, Con Michael                             Chi Huang, of the School of Medicine and
and Lou Landau and supported by the Raine Foundation. The children have                                  Pharmacology, Professor John Challis
subsequently been studied at birth and every three years since to the current
survey at the age of 17. At each visit, extensive demographic, psycho-social,                            and Professor Stephen Lye, both of the
lifestyle and phenotypic data has been obtained on the children and their families                     University of Toronto, and Professor John
including anthropometry, blood pressures and more recently pedometry to                               Newnham, Head of the School of Women’s
assess physical activity, and food frequency questionnaires to assess food and                                      and Infants’ Health
nutrient intake. Blood samples were taken at 8, 14 and now 17 years of age and
have been analysed for lipids, glucose and insulin metabolism, inflammatory
markers and liver function. DNA is available from the majority of the children                        continued page 15
         June 2008                                   MeDeFacts UWA Faculty of Medicine, Dentistry and Health Sciences                            5
genomi
       c                                             rESEArCH prIOrITIES
         e
Medicin
                          gENE rEvElATIONS SpArk gENOMICS rEvOlUTION
                          by Professor Lyle Palmer, Foundation Chair in Genetic Epidemiology
       We are in the midst of a genomics revolution that is transforming epidemiology,
 medicine and drug discovery.
 Recently, our field has had unprecedented success in discovering genes underlying
 common diseases. We are a genetic epidemiology group focused on the application
 of genomic knowledge to complex human disease and translational research and have
 close collaboration with multiple clinical groups.
 Over the last 4.5 years, we and our colleagues have been awarded more than $15
 million of National Health and Medical Research and other funding to create a series
 of key national resources designed to underpin large-scale gene discovery and medical
 genomics projects.
 These resources include core facilities in medical informatics (WA Genetic
 Epidemiology Resource or WAGER); the national training facility in medical
 informatics (Australian Medical Bioinformatics Resource or AMBeR), core
 genotyping facilities on the QEII Medical Centre site, a community outreach and
 bioethics team (Genomics Outreach or GenREACH) and core DNA banking facilities
 (WA DNA Bank).
 We are confident that these core facilities, together with our population-based resources,
 will comprise one of the pre-eminent resources for human genome epidemiology in
 the world. These resources are also increasingly underpinning the national research
 effort, and with the assistance of our National Advisory Board chaired by Professor
 Tony McMichael of the ANU, we are rapidly moving to make these a truly national
 infrastructure.
 The very substantial investments in our research and vision by national and state
 bodies have led to extraordinary opportunities, including the creation of a new UWA
 Centre in Genetic Epidemiology and Biostatistics.
 Our group is very grateful for the extensive support we have received from the WA
 Institute for Medical Research and the Wind Over Water Foundation, which funds
 conservation, medical research, arts and social programs.
 The Centre in Genetic Epidemiology and Biostatistics will maintain the strong                                    Professor Lyle Palmer
 collaborative links already fostered with WAIMR and will also provide the opportunity
 for wider links within the University and to nationally and international networks and
                                                                                  continued page 15




                                                                                   Professor Lyle Palmer’s genetic epidemiology group


 6                                            MeDeFacts UWA Faculty of Medicine, Dentistry and Health Sciences         June 2008
fACUlTy prOfESSOr wINS HIgH AwArD

I
    nternationally            renowned     of the National Research Centre for
    respiratory physician Professor        Asbestos Related Diseases, has a
    Bruce Robinson, of the School          reputation worldwide for his work in
of Medicine and Pharmacology, has          the field of asbestos-induced cancer
been awarded this year’s prestigious       and was awarded the Wagner Medal
Research Medal of the Thoracic             by the International Mesothelioma
Society of Australia and New Zealand       Interest Group in 2004.
(TSANZ).                                   The medal is presented to the individual
This medal is given in recognition         voted as having made the greatest
of outstanding contributions to            contribution to mesothelioma research
the advancement of knowledge in            internationally.
respiratory medicine or science            In the same year, Professor Robinson
carried out primarily in Australia or      won the WA Premier’s Science Award,
New Zealand. Made to one recipient         presented to the person judged by
each year by a competitive nomination      the Premier’s Science Council as
process, it honours an individual          having the greatest achievements and
who has demonstrated sustained             leadership in science.
excellence in their field of research.
The award was made at TSANZ’s
annual     scientific    meeting      in
Melbourne in March.
Professor Robinson, who is Director
                                                     Professor Bruce Robinson



                                           AIMINg TO IMprOvE HOSpITAl SUrgEry STAyS

                                           A
                                                   joint Faculty and hospital               Postgraduate Studies in the School of
                                                   project aimed ultimately at              Population Health, said the study built
                                                   reducing the length of hospital          on similar work that the team had been
                                           stay for surgical patients and improving         involved with, in conjunction with other
                                           satisfaction with the discharge process          nursing and medical colleagues, in the
                                           has won a grant from a new fund.                 cardiovascular areas of the hospital.
                                           Professor Judith Finn, the founding              “I am sure that one of the factors
                                           Chair in Nursing Research – a joint              underpinning our success in this round
                                           professorial appointment between                 of funding…is the multidisciplinary
                                           the Faculty and Sir Charles Gairdner             nature of our research team,” she said.
                                           Hospital - leads the team that was               The team brings together expertise in
                                           awarded one of only two successful               research methods, medical and nursing
                                           funding applications from the North              project management, clinical practice,
                                           Metropolitan Area Health Service for             administration and health economics.
                                           the WA Health Department’s newly-                The members are Professor Finn, Ms
                                           established Innovation Fund.                     Jeanne Young, Dr Paul Woods, Ms
                                           The Centre for Nursing Research                  Marie Baxter, Ms Lynda Harrison, Ms
                                           team, in conjunction with clinical               Claire Kennedy and Dr Liz Geelhoed.
                                           staff, will undertake a prospective              “Such collaboration has been facilitated
                                           interventional study to evaluate the             through the successful partnership
                                           criteria-led discharge model for                 between SCGH Nursing Services and
                                           patients undergoing specific short stay          the UWA School of Population Health,”
                                           surgical procedures such as simple               Professor Finn said.
                                           tendon repairs, simple mastectomy                The new fund was established by
                                           and bladder biopsies at SCGH.                    the Department of Health to make
                                           The aims of the study are to improve             seed funding available for innovative
                                           patient flow, reduce length of stay and          projects or initiatives that will deliver
                                           improve patient, medical and nursing             better services, efficiencies and/or cost
                                           satisfaction with the hospital discharge         savings in the overall process of health
                                           process.                                         care.
  Professor Judith Finn                    Professor Finn, who is also Director of

 June 2008                        MeDeFacts UWA Faculty of Medicine, Dentistry and Health Sciences                                      7
ESIA                  fACUlTy TAkES EAr SCrEENINg OvErSEAS TO
                      HElp UNDErprIvIlEgED kIDS




    L      ocal researchers have taken part in a comprehensive ear                      The makeshift shelter doubling as a
           screening program of formerly homeless children in India, with                 hearing clinic at Dapha-Durgapur
           pleasing results.                                                               village on the outskirts of Kolkata
    Project leader Adjunct Associate Professor Rob Eikelboom, research
    manager at the Ear Science Institute Australia (ESIA), said only 20 per
    cent of those screened had normal hearing.
    ESIA collaborated with overseas charity organisation Calcutta Stations Mission (CSM) to establish an ear screening facility
    in Kolkata. The week-long screening ran during May last year and was designed to identify hearing disorders and ear
    disease in a 70-strong group consisting mainly of children.
    Students aged six to 21 were chosen for screening based on a self-assessment of their hearing ability and the school nurses’
    appraisal of their condition.
    About 1400 formerly homeless children from two schools required screening. “We touched on five per cent of those kids
    who needed attention, or even less,” Dr Eikelboom said.
    “It was quite obvious that at least one quarter of the kids had otitis media - an infected middle ear.
    “We wanted to identify the kids who had problems and give the report to school nurses, who could then use their existing
    networks to refer them on for medical attention.”
    The children were fascinated with the technology but keeping them still during the otoscopy was sometimes a challenge,
    Adjunct Associate Professor Eikelboom said. As a diversionary tactic, the clinicians encouraged them to watch images of
    their ear on a computer screen.
    CSM draws the majority of its funding from Perth, with local iron ore businessman Mr George Jones funding the Kolkata
    screening project to the tune of $25,000.
    CSM is continuing to build on its initial screening efforts and is progressively screening the rest of the children at the
    schools.
    It has been estimated that there are at least a few million
    deaf people in India and one of the major causes is
    chronic ear infection.
    Adjunct Associate Professor Eikelboom said he believed
    recruiting ear specialists was important to expand the
    potential of the existing program.
    The long-term aim of the project is to provide advice
    online from ear specialists and audiologists in India and
    other countries.
    “It would be really great if we had even 10 doctors, who
    said ‘I’ll do 10 cases a month and give some advice’,”
    he said.
                                         continued page 9

 Hearing screening underway in the Loreto School
   for Girls. The young girl was unable to use the
               press button so she showed she had
               heard a sound with a hand squeeze.


8                                   MeDeFacts UWA Faculty of Medicine, Dentistry and Health Sciences          June 2008
fACUlTy TAkES EAr SCrEENINg OvErSEAS                                                              CONTINUED frOM pAgE 8
The incidence of ear disease in India is mirrored in some
parts of rural and remote Australia, where 40-50 per cent
of children have ear problems. ESIA has telemedicine
clinics set up in several remote WA communities and is
working to expand its presence in a number of places
around Australia.
“Telemedicine is not really a major technological issue any
more, but it’s about changing work practices and referral
pathways to deliver effective health services to people
in rural and remote areas,” Adjunct Associate Professor
Eikelboom said.
“It has been expected for a long time that there would be
sufficient doctors, nurses and allied health professionals
to service the rural and remote areas. However, with
increasing pressure on human resources in the city and
regional centres, health services are now starting to adopt
systems such as telemedicine to provide services to remote
areas. “                                                                            The CSM and Ear Science Institute Australia
                                        -By Amanda Saunders                       team. Adjunct Associate Professor Rob Eikelboom
                                                                                               is fourth from the left.




IMprOvINg COMMUNICATION IN CANCEr CArE
-By Aimee Nichevich, Research Officer, School of Surgery


A       national initiative to build the communication skills of health professionals working
        in oncology has been supported by the School of Surgery.
        The School recently hosted a communication skills workshop for a group of trainees
in a wide variety of oncology-related disciplines, including general surgeons, gynaecological
oncologists and haematologists.
The half-day workshops have been designed and are backed by the National Breast and
Ovarian Cancer Centre (NBOCC) as part of its national initiative. They are seen as highly
beneficial and have positive flow-on effects to patients and their families.
Training in communication skills is an essential part of the educational needs of trainees
for their post-graduate training, making these sessions an ideal learning forum for young
doctors.
The Perth-based workshops were led by Professor Phyllis Butow, an internationally                    Professor Christobel
recognised expert in psycho-oncology and communication from the University of Sydney.                       Saunders
They were co-facilitated by three local leaders in cancer care - Professor Christobel
Saunders, of the UWA School of Surgery, Mr Paul Katris, of the WA Cancer Council, and
Dr Lisa Miller, a psychiatrist with a cancer background.
Trainees participated in the module, Effectively Communicating Prognosis in Cancer Care. This module has been designed
to help health professionals, when discussing cancer prognosis with patients and families, to improve understanding,
psychological adjustment and decision-making. The interactive sessions provided the registrars with the chance to
undertake role play with a professional actor in a small group setting.
The feedback was very positive and the trainees said they had gained practical skills which they could use to more
effectively communicate with cancer patients in a clinical setting.
“Doctors at all levels need to be able to get across often very complex information to patients and their families to help
them make life and death decisions, and cancer is a good example of this,” Professor Saunders said. “All of us vary in our
styles and abilities to communicate in this setting but this course has shown that in fact most of our trainees are fantastic
communicators. However, we can all learn tips and techniques to improve on this.”
The workshop modules have been successfully implemented at the national level on the basis that effective communication
is a critical component in the management of patients with cancer.
The NBOCC initiative provides invaluable training for health professionals at a time when communication is being
increasingly recognised as a core clinical skill in medicine and in cancer care in particular. Medical and professional
Colleges in Australia acknowledge the importance of achieving high level communication skills and demonstrate support
of such training for their members. However, only a few Colleges formally include these skills as an essential component
of their training curriculum.
The NBOCC have developed Australia’s first communication skills training website for health professionals, outlining
their Better Communication, Better Care approach at www.nbocc.org.au.



June 2008                                   MeDeFacts UWA Faculty of Medicine, Dentistry and Health Sciences                    9
O H C wA                  NEw DENTAl ClINIC A kNOCkOUT CONTINUED frOM pAgE 1

     a dentist at all costs, unless a physical problem
     becomes overwhelming.
     The regular session of oral surgery under anaesthesia
     at SCGH is run every morning on weekdays and is
     always booked out.
     “These are patients referred from our general dental
     clinic or the government dental clinics, primarily
     because they have complex oral surgery needs
     such as impacted wisdom teeth and really difficult
     extractions,” Mr Home said.
     “Also, in some cases for orthodontics, a patient may
     have up to eight teeth to be extracted and this will
     normally be done under general anaesthetic.”
     However, the treatment of patients with such
     needs has been delayed due to the requirement to
     accommodate referrals of dental phobics whose
     treatment is clearly within the range of a general
     dentist.
     “These public dental patients with a phobia have
     been subjecting themselves to an undesirable risk
     in having their dental treatment and the government
     has been paying a lot more than it needs to,” Mr
     Home said.
     “In addition, you have very valuable theatre time
     being used for non-complex cases and other
     patients are probably having their treatment delayed
     needlessly.”
     After talks with the government, OHCWA
     established the IV Sedation Clinic to divert patients
     with routine needs from the theatre to treatment
     in a chair, with a dental sedationist providing the
     IV sedation and a general dentist carrying out the
     treatment.
     The patient remains conscious throughout the
     procedure but sedated sufficiently to be comfortable                     (From left) Dental clinic assistant Hazel
     in the chair. A registered nurse is present to monitor                   Smithers, dental surgeon and sedationist
     the patient in the recovery period, generally for up
                                                                             Misagh Habibi and Associate Professor Ray
     to one hour after their treatment.
     The WA Health Department has provided set-up                                           Williamson.
     funding for the clinic, including the purchase of
     specialised monitoring equipment.
     Mr Home said the overall savings were substantial.
     The cost of providing general anaesthesia for the
     average patient is approximately double that of
     providing sedation.
     The first clinic was run on 18 March with two
                                                                           Medical student Meghan Mitchell has been
     patients and another was held in May, also with two
                                                                           awarded an Indigenous Youth Leadership
     patients.
                                                                           Programme (IYLP) tertiary scholarship of $6,000
     The clinic will be held once a month for a morning
                                                                           annually for two years. The Federally-funded IYLP
     session and is expected to cater for up to four
                                                                           aims to create opportunities for young Indigenous
     patients each time. The clinic is located in the
                                                                           people who have shown academic excellence and
     OCHWA annexe at SCGH.
                                                                           potential leadership prowess.



10                                       MeDeFacts UWA Faculty of Medicine, Dentistry and Health Sciences          June 2008
DONOrS SUppOrT SCHOl-
ArSHIp prOgrAM
The Medical School would like to thank all
donors for their generous contributions to The
Foundation Professors Bachelor of Medical
Science Scholarship program. By the end of
last month we had received a total commitment
of $221,840.
We would like to thank and acknowledge the
following donors for their generous donations:
                                                       pAyINg
Carsten Broeze
Ulli and Carsten Broeze
Patricia Charmer
                                                       bACk THE                                                                     eR i d
                                                                                                                                          o
                                                                                                                                               ary
                                                                                                                                            sem ays
Michael Davis                                                                                                                   wif thefr
Simon Dimmitt
Louise Farrell
                                                       fAvOUr –                                                       w
                                                                                                                             is       n wi e
                                                                                                                         th h io t a i is
                                                                                                                        iman winh h nd Fiona
                                                                                                                   an ar d F Tim a
                                                                                                                   Pe
                                                                                                                rn
                                                                                                           r Johm d canldren 979
Geoffrey Gee
John Harriott                                          AND ENCOUrAgINg                                   D Pea nim hi
                                                                                                         n ary aT
                                                                                                      Jooseildrenin Eng
                                                                                                       Rh m              land i
                                                                                                                                n1
Robert Hillman                                                                                      Dr ch
Anne Hillman
John Hobday                                            NEw SCIENTISTS                                and



                                                       A
Gary Hoffman
Peter Hurst                                                    retired medical Professor who was the recipient of a Medical School
Alan James                                                     scholarship 30 years ago has shown his continuing gratitude by making
Fiona Lake                                                     a generous donation with his family to the Foundation Professors
Louis Landau                                           Bachelor of Medical Science Scholarship program.
Jan and David Lord                                     Professor John Pearman, his wife Rosemary and children Timothy and Fiona
Marion Lugg                                            have given $120,000 in honour of Professor Neville Stanley, Foundation
Judith Macdonald                                       Professor of Microbiology, who was a mentor and friend to Professor
Robert Macdonald                                       Pearman. They will take up naming rights in perpetuity for this scholarship.
Patricia Martinez                                      Professor Pearman was working at Royal Perth Hospital as a junior consultant
Michael McCall                                         in 1978 when he was awarded a P. F. Sobotka scholarship from UWA that
Marilyn McCutcheon                                     aimed to help recipients to undertake studies overseas.
Paul McMenamin                                         The funds paid for return airfares to London for the 39-year-old UWA medical
Robert Allan Milne                                     graduate and his family, a subsistence allowance for him and his family for
Fiona Osborne                                          1.5 yrs in London, and for his tuition at the London School of Hygiene and
Fiona Pearman                                          Tropical Medicine and the Royal Postgraduate Medical School, so that he
John and Rosemary Pearman                              could complete the Master of Science degree in Medical Microbiology from
Timothy Pearman                                        the University of London.
Ian Puddey                                             “That course then cost 925 pounds Sterling but courses now are over 30,000
School of Medicine and Pharmacology                    pounds or about $62,000,” Professor Pearman said.
Ralph Simmonds                                         He now wants to pay back the scholarship, with interest, and is keen for it to
David Sinclair                                         be in honour of Professor Stanley.
The Stanley Family                                     “I would like it to be for the field I was involved in and I would like it to give
Ann and Ralph ten Seldam                               the recipient some study in science,” he said.
Fabienne Vonarburg                                     “The medical course is fairly didactic - it has to be - whereas doing science,
Rukshen Weerasooriya                                   particularly research in science, you really have to have an unremitting
Jiake Xu                                               willingness to admit that your hypothesis might be wrong, otherwise you
George Yeoh                                            won’t find out the truth.”
                                                       Professor Pearman said Professor Neville Stanley was a man who loved
The University of Western Australia aims to            young people and was very encouraging. “He was a very good mentor for
award four of the 11 Bachelor of Medical               me and he was a friend,” he said.
Science scholarships in honour of the                  Professor Pearman, former Head of Microbiology and Infectious Diseases at
Foundation Professors within the next two              Royal Perth Hospital, developed a combined clinical and laboratory program
years. In order to reach that target, additional       which prevented people with acute spinal cord injury from developing
donations of $258,160 are required.                    urinary tract infections. He was awarded an MD degree from UWA for his
You can help us.
                                                       thesis.
The Medical School invites you to contribute to
                                                       He also played a leading role in developing the infection control program
the development of medical researchers of the
future by donating to the scholarship program.
                                                       which prevented methicillin-resistant Staphylococcus aureus (MRSA) from
All donations are important, regardless of their
                                                       becoming established in any surgical ward in WA hospitals.
size, and are greatly appreciated. Donations to        Also, he was the clinical microbiologist on laboratory duty when the RPH
UWA are tax deductible and pledges can be              microbiology laboratory grew Helicobacter pylori from a gastric biopsy sent
made over a period of five years.                      by Dr Barry Marshall. It was the first time in the world that H. pylori had
If you wish to inquire about the program or            been cultured by a laboratory.
make a donation, please contact Fabienne               Dr Marshall, now a Professor, went on to show with Dr Robin Warren that
Vonarburg on 08 6488 4211 or email fabienne.           H. pylori is the cause of duodenal ulcers.
vonarburg@uwa.edu.au                                   “I was in the laboratory when we first grew the organism,” Professor Pearman
                                                       said.

      June 2008                          MeDeFacts UWA Faculty of Medicine, Dentistry and Health Sciences                                      11
    MEDICINE IN THE MOUNTAINS
   D
            escribing the work of volunteer        of terrain makes the provision of health
            medicos in the isolated Outer          care to some sectors of the community
            Himalayas has won a sixth year         almost impossible for the local health care
   medical student the sought-after Alan           authorities,” Mr Mossenson says.
   Charters Elective Prize.                        The Himalayan Health Exchange enlists
   Adam Mossenson was awarded the                  foreign medical personnel to volunteer
   first prize of $1000 last month for his         their time and travel on medical
   presentation “Doctors on Tour: On               expeditions to provide health care to these
   the Road with the Himalayan Health              most isolated communities.
   Exchange”.                                      The team that Mr Mossenson joined
   The runners-up, who each received               consisted of 24 medical personnel and
   $250, were Stephanie Breen for “A               another 15 local support staff.
   Little Bit Fine: A Zambian Perspective”                                                                     Adam Mossenson
                                                   “We travelled overland and in a month’s
   and Timothy Lin for “Between borders;           period provided free medical and dental           his long career, continuing to do so even
   slipping through the gaps on the Thai-          care to just under 3000 patients,” he says.       into his nineties.
   Burma border”.                                  “The range of patients seen was vast              Faculty Co-ordinator of Electives
   Mr Mossenson says the Himalayan                 and the learning experience was unique.           Leanne Lind said the judges looked
   Health Exchange is a non-government,            Medically, I was forcibly made to rely on         for the presenter who demonstrated an
   not-for-profit organisation that works          my clinical skills and judgment and was           understanding of the social and public
   in conjunction with the local health            given a lot more responsibility than back         health issues beyond the strictly medical,
   authorities to provide free medical care        in Perth. A steep personal learning curve         who presented in a thought-provoking,
   and medicines to the most isolated and          also occurred.”                                   illuminating, enthusiastic and entertaining
   underserved populations in the north            The Alan Charters award was established           way, and who illustrated the talk with
   Indian state of Himachal Pradesh. The           in 1998 and named in honour of Dr Alan            good quality and relevant slides or other
   region, neighboured by Tibet to the East,       Charters (1903-1996), who practised and           visuals.
   and Kashmir to the West, forms part of the      taught medicine in East Africa and WA,            Dr Miles Beaman of Western Diagnostic
   Outer Himalayas and for much of the year        and had a lifelong special interest in            Pathology sponsored the winner’s prize
   has heavy snowfall. More than 90 per cent       tropical medicine and parasitology. He is         of $1000 and Olivia Watson of MDA
   of the population lives outside the urban       fondly remembered by generations of WA            National sponsored the runners-up prizes
   centres. “The isolation and uniqueness          medical students whom he taught through           of $250 each.



               frOM SCHIzOpHrENIA TO ANxIETy - NEw rESEArCH IN MENTAl HEAlTH
CCrN                                                                            Associate                                     Associate
                                        Mr                                      Professor                                     Professor
                                        Richard                                 Nicholas                                      Christer
                                        Bell                                    Stefanis                                      Allgulander



   E
           xciting new developments in mental     He also questioned the often-competing            in triggering psychotic episodes in the
           health diagnosis and treatment were    agendas of integration versus streaming           general population.
           explored during three seminars         of services to young people experiencing          And last month, Associate Professor
   hosted recently by The Centre for Clinical     psychosis.                                        Christer Allgulander, of the Karolinska
   Research in Neuropsychiatry (CCRN).            Also in April, Associate Professor Nicholas       Institutet in      Stockholm, spoke on
   CCRN, a statewide specialised research         Stefanis, of the Mental Health Research           Generalized Anxiety Disorder (GAD) –
   facility run jointly by the School of          Institute at the University of Athens             new findings and treatments. He presented
   Psychiatry and Clinical Neurosciences and      Medical School, gave a seminar titled Do          a history of GAD, tools for diagnosis, and
   North Metropolitan Area Health Service         susceptibility schizophrenia genes affect         a range of therapies that helped produce
   Mental Health, attracts a wide range of        apparently healthy individuals?                   an 80 per cent remission rate after one
   national and international speakers.           Exploring the massive subclinical potential       year of treatment.
   Richard Bell, a clinical psychologist from     for schizophrenia diagnosis in the general        People experiencing major anxiety may
   the Youth Early Psychotic Service (YEPS)       population, Stefanis’ project has studied a       constitute the second-largest primary care
   in Victoria, presented a workshop in April     group of over 2000 male Greek air force           group, but only 13 per cent present with
   on Revisiting the Vision for Early Episode     conscripts, undertaking eight assessments         anxiety as the primary complaint. Instead,
   Psychosis Services in WA, which was            over a two-year period.                           they may describe a range of related issues
   attended by about 40 people.                   The project, which examined each                  such as sleeplessness, pain, or depression.
   Mr Bell challenged existing frameworks of      individual’s “schizotypy” (or atypical            Left untreated, GAD may also be a critical
   clinical service delivery, focusing on the     experiences), cognitive abilites and              factor in somatic conditions such as heart
   cognitive behavioural approach which has       genetic profile, has produced results             disease, diabetes, chronic pain and chronic
   enhanced psychosis treatment at all stages.    indicating that stress is a significant factor    obstructive pulmonary disease.



  12                                   MeDeFacts UWA Faculty of Medicine, Dentistry and Health Sciences               June 2008
                   pHD rESEArCH ON MISCArrIAgE gETS glObAl COvErAgE

  R
          esearch by a recent Faculty                                                        filtered out of the atmosphere, for an
          graduate revealing the risk                                                        hour or more a week, were almost 2.5
          of miscarriage to female                                                           times more likely to miscarry than
  vets exposed to anaesthetic gases                                                          those who did not.
  and pesticides has been published                                                          Female vets who used pesticides
  in a British Medical Journal (BMJ)                                                         during the course of their work were
  publication and received worldwide                                                         also twice as likely to miscarry. And
  coverage.                                                                                  those who performed more than five
  Dr Adeleh Shirangi, a postdoctoral                                                         X- rays a week were about 80 per
  research fellow at the Imperial College                                                    cent more likely to miscarry than
  of London, was working in the School                                                       those performing fewer procedures.
  of Population Health when she won                                                          The study was based on a survey
  a $374,000 Sidney Sax Overseas                                                             of women taking part in the Health
  Fellowship from the National Health                                                        Risks of Australian Veterinarians
  and Medical Research Council last                                                          Project, conducted by the School of
  year.                                                                                      Population Health.
  Findings from her PhD, which was co-
                                                          Dr Adeleh Shirangi
                                                                                             The authors warn that female vets of
  authored by her supervisors Professor                                                      childbearing age and all workers in
  D’Arcy Holman and Associate                                                                these areas should be fully informed
  Professor Lin Fritschi, have been                                                          of the possible reproductive effects
  featured as one of the top health news                                                     of ionising radiation, unscavenged
  on the BBC website and featured on                                                         anaesthetic gases, and exposure
  numerous websites, TV and radio                                                            to pesticides and take protective
  stations in the UK and US.                                                                 measures.
  Her      research,      published    in                                                    Dr Shirangi will return to Perth after
  Occupational and Environmental                                                             two years of study to work at the WA
  Medicine, revealed that women                                                              Telethon Institute for Child Health
  carrying out surgery and exposed                                                           Research.
  to anaesthetic gases that were not




INCrEASINg THE rUrAl wOrkfOrCE CONTINUED frOM pAgE 2
WA RCS students spend a whole year in the country at one of the 10 School sites, which are based around rural
hospitals.
Professor Murdoch said more rural training places were needed now to cater for the growing numbers of medical graduates
interested in pursuing training for a country career.
The RCS is working with the Postgraduate Medical Council, Country Health Services, Rural Health West and WA
General Practice Education and Training to secure more internships in rural hospitals and places in rural general practices
to cater for trainees.
“The problem we have got is that because all the training places are in tertiary hospitals, people settle in Perth and then it
is very difficult to get them unsettled and get them to go to the country,” Professor Murdoch said.
“The theoretical aim is to get maybe half of the people who went to the Rural Clinical School doing their training in the
country and coming back to Perth for some things, and so reversing that order.
“The trouble is that once people are in Perth and get married and buy houses and whatnot, it is very difficult to get them
shoe-horned out and into the country.”
Royal Perth Hospital and Fremantle Hospital have been offering an option for medical students to go for 10 weeks to
country areas such as Kalgoorlie, Broome, Porth Hedland and Bunbury.
“But they only do one or possibly two of these in a year so the idea is to create a Primary Allocation Centre in Country
Health Services so that they have an allocated group of interns who are hopefully doing most of their training in rural
hospitals,” Professor Murdoch said.
                                            -By Cathy Saunders


       June 2008                        MeDeFacts UWA Faculty of Medicine, Dentistry and Health Sciences                              13
Quoted               THE wOrD IS OUT -
   As                                                                           MEMOIrS Of A SUrgICAl
  Saying            fACUlTy IN THE NEwS
                                                                                   INvESTIgATOr
  Australian Doctor:                                                      By Emeritus Professor Bernard Catchpole, the second Professor of Surgery appointed
                                                                          to the Faculty

                                                                          W
  Professor Peter Sly, Head of Clinical Sciences at the
  Telethon Institute for Child Health Research, is QAS air                          hen I came out of the army to a University
  quality standards should be based on children rather than                         appointment of Surgical Tutor, I was worked on
  adults because they are more susceptible to pollution levels.                     by colleagues to acquire the Fellowship of the
  He said pollution levels in Australia were associated with              Royal College of Surgeons of England. I achieved this in
  impaired fetal growth and increased childhood respiratory               1950 on my 27th birthday. The Surgical Department I was
  illness.                                                                in had a main interest in vascular disease. Many patients
                                                                          with swollen legs and gross varicose veins crowded the out-
  The West Australian:                                                    patient clinics. “My legs do ache, doctor”, was a common
                                                                          cry.
  Ear Science Institute of Australia Director Professor Marcus            Why the aching? Were distended veins the cause? Who knew?
  Atlas is QAS the creation of a tissue-engineered eardrum                No one!
  would have huge application, particularly in Aboriginal                 Anatomists did know that blood vessels were innervated by tiny
  communities where ear disease and infections were in                    fibres running through their layers in both veins and arteries.
  plague proportions. The Institute has made a world-first                Patients having arteriograms at that time complained of a
  breakthrough by growing a new eardrum from human skin                   sensation of liquid fire being injected into them. Those having
  cells, an achievement expected to open new frontiers in the             organic iodide venograms did not seem to notice anything
  treatment of middle ear disease and perforated eardrums.                however. We had already developed the technique of measuring
                                                                          static and exercise venous pressure by cannulating a vein on the
  Professor Nicola Lautenschlager, of the WA Centre for                   dorsum of the foot and recording it while the patient stood still
  Health and Ageing, is QAS vitamin D supplements might                   or marked time. Normally, static venous pressure is equivalent
  be able to help prevent and treat memory loss and improve               to a column of blood to heart level- almost 100mm of mercury,
  wellbeing in the elderly. Her team is conducting a trial                but it should fall to 20 or less on exercise. I wanted to know if
  of about 100 people aged 65 or older who have memory                    local distension of veins with varicosities caused discomfort. I
  problems but not Alzheimer’s and will be given one vitamin              needed some little balloon catheters.
  D tablet or a placebo daily for 18 months. Previous research            One day, an old school friend who worked in the research
  showed mice performed poorly in memory tests when they                  department of the Dunlop Rubber Company visited us. I asked
  had low levels of vitamin D, Professor Lautenschlager said.             him if he could make me a little balloon at the end of a catheter.
                                                                          Yes, that was quite possible. Now, I needed some money for
  Professor Peter Sly, Head of Clinical Sciences at the                   them. Shortly afterwards, the hospital offered small sums to
  Telethon Institute for Child Health Research, is QAS new                finance research projects within its walls. So, I applied and soon
  regulations making parents get a doctor’s prescription for              I was off for an interview. Sitting on the panel was the Vice
  popular cough and cold medicines for their babies and                   Chancellor of the University with two physicians. The V.C. had
  toddlers were welcome as the drugs were linked to serious               been an anatomist, a specialist on formalinised specimens. I
  side effects such as convulsions but could lead to parents              explained what I wanted to do. A look of horror came on his
  using watered-down versions of strong adult medicines.                  face! “You want to push balloons into the veins of sick patients
  “They may try to dilute them or give them as they are, so               to induce pain?” “Well, not exactly…..”, but the die was cast.
  it’s extremely important that pharmacists counsel parents               I left without any money, but with a tarnished reputation -- if I
  against doing that,” he said.                                           ever had one!
                                                                            Well, I made a mercury manometer which would register
  Associate Professor Ruth Ganss, of the WA Institute for                 600mm pressure--five times average systolic blood pressure. I
  Medical Research, is QAS a discovery by her team of a                   isolated, by local pressure, a segment of vein on the back of my
  way to halt rapid growth of blood vessels that feed deadly              hand and got a colleague to insert a needle into it. We injected
  tumours by switching off a master gene could lead to more               saline at pressure until the manometer was at its peak. The vein
  effective therapies with fewer side effects. “What we’ve                became as hard as bone! But pain? Not a vestige!
  shown is that RGS5 is a master gene in angiogenesis and                 From arteriography experience, perhaps there was a chemical
  that when it is removed, angiogenesis reverses and the blood            method of inducing discomfort. The hospital made up many
  vessels in tumours appear more normal,” she said.                       sterile solutions and I picked a bottle of sodium citrate which
                                                                          would fix calcium ions in the vessel walls. Dripping this into
  Clinical Professor Graeme Hankey, of the School of                      a vein on the back of my hand might be interesting. It was!
  Medicine and Pharmacology, is QAS new drug treatments                   It produced an almost immediate intense ache which became
  are reducing the risk of stroke patients dying or being left            agonisingly severe as it spread up my arm, until I tore the needle
  severely disabled. American research showed giving small                out! Later, I discovered that this pain is mediated by somatic
  amounts of the anti-clotting drug tissue plasminogen                    nerves and that sympathectomy does not modify it at all. Was
                                                                          this the elusive aching pain I was trying to track down?
  activator to patients with intracerebral haemorrhage could
                                                                          But alas, I had to leave further studies. Doubtless vascular
  improve survival. Another study showed clopidogrel, and                 surgeons now know all about the genesis of vascular pain -
  combined dipyridamole and aspirin, were more effective in               - 55 years after my efforts, and it is too late to tell that Vice
  warding off a second stroke than aspirin alone.                         Chancellor that balloon catheters are now frequently passed into
                                                                          blood vessels, even those of the heart!



  14                                MeDeFacts UWA Faculty of Medicine, Dentistry and Health Sciences                       June 2008
                   CHIlDHOOD prECUrSOrS Of ADUlT ObESITy, DIAbETES
                        AND HEArT DISEASE CONTINUED frOM pAgE 5
and their parents. At the current 17-year survey additional measures of vascular structure and
function are being recorded and liver ultrasound measurements are being obtained to assess
fatty liver.
PhD student Rae-Chi Huang, working with Professor Lawrie Beilin, Dr Trevor Mori, Dr
Valerie Burke, Dr Wendy Oddy and colleagues at TICHR and Women and Infants Research
Foundation on the data up to 14-year survey, has shown that by the ages of eight and 14
years, 25-30 per cent of the children exhibit features of the metabolic syndrome cluster of
obesity, dyslipidaemia, insulin resistance and higher blood pressure. Factors predisposing
to the metabolic syndrome cluster included both low and high birthweight, lack of breast
feeding, maternal smoking in pregnancy and, dominantly, excess postnatal weight gain. At
14 years of age, these children also show evidence of increased circulating inflammatory
markers and liver dysfunction. Rae-Chi has received young investigator awards for her
work from the Asian Pacific Society for Hypertension, the Australian Atherosclerosis Society,
the Australian Council for High Blood Pressure Research and the recent international DOHaD
meeting.
PhD student Oyekoya Ayonrinde, along with supervisors Dr Leon Adams and Professor John Olynyk,
has preliminary ultrasound data from the 17-year-olds suggesting a high incidence of fatty liver in
adolescents with the metabolic syndrome cluster.                                                                    Rae-Chi Huang
Dr Wendy Oddy and Dr Gina Ambrosini are studying food patterns in relation to health and disease risk.                  receiving
Using factor analysis, they have differentiated two main eating groups of healthy and unhealthy diet
patterns which they are studying in relation to cardiovascular and mental health outcomes.                             best Young
Dr Eugen Mattes and Professor Sven Silburn and colleagues are finding influences of family psycho-                    Investigator
social dysfunction and mental health and the likelihood of developing the metabolic syndrome cluster.
Associate Professor Beth Hands at Notre Dame University is evaluating factors predisposing to childhood               award from
physical activity and fitness and the way these interrelate to obesity.                                              the President
Other groups are investigating musculo-skeletal development, asthma, allergy and immune function                      of the High
(Adjunct Professor Pat Holt and Professor Peter Sly et al), the onset of puberty and the menarche and
the polcystic ovarian syndrome (Professor Martha Hickey and colleagues) and cognitive neuroscience,                 Blood Pressure
behaviour and neuro-endocrine function (Dr Anke van Ekelen, Dr Eugen Mattes, Adjunct Associate                          Research
Professor Eve Blair and colleagues).                                                                                   Council of
The Raine Childhood cohort has attracted great interest from scientific groups worldwide and international
collaborations are growing. The database is a major resource for research into the Developmental Origins             Australia, Dr
of Health and Disease and will be increasingly so as the cohort ages in the coming decades. Support for             Stephen Harrap
the work in progress includes, among others, grants from the Raine Medical Research Foundation of
UWA, the NHMRC, Healthway WA and the Canadian Institute for Health Research.


       gENE rEvElATIONS SpArk gENOMICS rEvOlUTION CONTINUED frOM pAgE 6

 centres.                                    of new research networks, including              human genomic epidemiology
 The flagship “big vision” science           the Australasian Sleep Trials Network,           in the world, enhancing the
 project that we plan to initiate is the     the National Research Centre for
 Joondalup Family Health Study, which        Asbestos-related Diseases, and the
                                                                                              reputation of UWA in new,
 will be the most extensive community-       Australian Genomics and Clinical                 innovative and rapidly growing
 based cohort study ever undertaken.         Outcomes of High Grade Glioma                    discipline areas.”
 We have also supported and helped in        Project.                                         The current challenges for genetic
 enabling many existing exceptional WA       Our group also plays key leadership              epidemiology are to continue
 cohort resources for genetics research,     roles in international bodies such as            discovering new genes for disease
 including the Busselton Health Study,       the International Public Population              susceptibility, natural history and
 the Health-in-Men Study and the Raine       Program in Genomics (P3G). Our                   treatment response in general
 Cohort Study.                               group has recently been asked by                 population samples and to translate
 Together with our clinical collaborators,   the National Institutes of Health and            this knowledge into significant public
 we have been pro-active in developing       the Centers for Disease Control and              health and clinical impacts.
 and      leading   new,      world-class    Prevention (CDC) in the US to lead               The challenge ahead is translating from
 resources in national priority and other    the Australasian Human Genome                    population-level risk to individual
 disease areas. These include the WA         Epidemiology Network (HuGENET)                   (patient) level risk.
 Cardiovascular Disease Consortium,          Coordinating Centre – the 5th such               Pharmacogenomics is an area where
 the WA Sleep Health Study, the WA           centre internationally.                          major paradigm shifts in the way that
 Melanoma Health Study, and the WA           “We anticipate the composite                     we deliver healthcare are possible by
 Twin Register. Nationally, we have                                                           developing the effective targeting of
                                             WA resources will become one                     therapies.
 been active in leading the development
                                             of the pre-eminent resources for

   June 2008                        MeDeFacts UWA Faculty of Medicine, Dentistry and Health Sciences                                    15
Health
        s
Science




                  A group of Health Science students at the launch of their Alumni Association



     HEAlTH SCIENCE lAUNCHES ITS AlUMNI ASSOCIATION
T      he first cohort of Health Science students embarked on their studies of a newly formed degree in 2000. Only five years
       after that first year-group graduated, Health Science has formed its own Alumni Association.
       The UWA Health Science Alumni (HSA) was launched with a cocktail party at The University Club of WA in April.
The evening marked the first official reunion for all graduates and staff of the Health Science degree and introduced the
newly created HSA.
Sub-Dean of Health Science Dr Jane Heyworth and Faculty Dean Professor Ian Puddey both said a few words to mark the
historic event, which was attended by an overwhelming 80 people – an illustration of the spirit of what is a relatively small
group of graduates.
Similar to the student-run Health Science Society (HSS), the UWA HSA was initiated through a third-year student project
for a Health Science Professional Practice unit. The students presented their report as a proposal to the School of Population
Health late last year, which was then taken up by a group of graduates to turn a great idea into reality.
The UWA HSA will be both a professional networking medium and a chance for graduates to keep in touch with past
classmates. Anticipated activities include both social and professional development events, development of a website, a
member newsletter, and collaboration with the UWA Careers Centre to involve the Alumni with student mentor programs.
The UWA HSA is grateful to Dr Jane Heyworth, the School of Population Health, Faculty Development Officer Ms Fabienne
Vonarburg, the Office of Development, Professor Ian Puddey and past and present Health Science students for their kind
support.
To get involved with the HSA or for more information email uwahealth.science.alumni@gmail.com or contact the Office of
Development www.development.uwa.edu.au.

                 THE FACULTY OF MEDICINE, DENTISTRY AND HEALTH SCIENCES
                       The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009
                  Ph: (08) 9346 7323 Fax: (08) 9346 2369 Web site: http://cms.meddent.uwa.edu.au/
                          Dean - Professor Ian Puddey - Deputy Dean - Professor Paul Abbott
         Faculty Manager/Assistant Editor - Susan Henshall (08) 9346 2680 - email: susan.henshall@uwa.edu.au
           Editor/Writer - Cathy Saunders (08) 9349 8190 or 0403 813 830 - email: catscan@optusnet.com.au
CONTRIBUTIONS: We aim to make the newsletter relevant to as many members of the Faculty as possible, and to achieve this we welcome
          contributions of articles, photographs, letters, feedback, story ideas and humorous medical or dental anecdotes.
                            Please email your contributions to the editor at: catscan@optusnet.com.au

								
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