Challenging Traditional Views of Health & Treatments of PAIN

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History has long presented a dominating Medical Model of Health since the 18th Century, and the idea that science could cure all illness and disease has remained a core element of modern medicine. The Medical Model of Health measures health simply by determining if a disease is present or not (Community Development and Heath Network 2018). However, this underlying emphasis on the absence of disease as an indicator of good health ignores the power of other important influences, leaving no room for the social, psychological, and behavioural dimensions of illness (Farre & Rapley 2017).

Developed in 1977 by psychiatrist George Engel, the Biopsychosocial Model of Health instead recognises that many factors affect health. This model acknowledges that deep interactions between biological, psychological, and social factors lead to outcomes of wellness and disease (Community Development and Health Network 2018).

Pain Prevalence in Australia

According to the Australian Institute of Health and Welfare, 1 in 3 (6.9 million) Australians suffer from arthritis and other musculoskeletal conditions such as back pain and osteoporosis, making musculoskeletal conditions the fourth leading contributor to the total disease burden in Australia (AIHW 2018).

Specifically speaking, more than 4 million Australians struggle with back pain on a daily basis, the majority of whom report that the pain interferes with their basic activities of daily living (AIHW 2019). When pain lingers, it can significantly compromise our quality of life by causing us physiological pain and disability as well as psychological distress – suffering we don’t want and can’t afford.

And with an estimation that 70–90% of Australians will suffer from lower back pain in some form at some point in their lives, (AIHW 2019) optimisation of treatment and management of this pain is critical.

The Biopsychosocial Model of Pain Management

When applied to the issue of pain, the Biopsychosocial Model of Health implies that pain cannot simply be seen as a physical experience, but as a social and psychological experience also (Discover the Power of Drug Free Pain Relief 2018). Furthermore, treating pain should not solely focus on medications used to relieve physical pain, but on treatments that effect the holistic and interrelated experience of pain physically, psychologically and socially.

Drug-Free Pain Relief

While analgesia (pain medication) will always have its place in pain relief, drug-free pain relief is a vast and varied subject worthy of exploration. A common theme behind many alternative complementary therapies is the concept of the mind-body connection, recognising wellness on a multi-dimensional and holistic level, and providing remedies responsive to this understanding (Discover the Power of Drug Free Pain Relief 2018).

Drug-Free Pain Relief for Low Back Pain

When it comes to alternate and drug-free pain relief, a recently released E-Book titled, Discover the Power of Drug-Free Pain Relief 2019 (2018), discusses 100 of the latest life-changing drug-free pain relief developments, including;

  • Physical Movement Therapies
  • Dietary Medicine
  • Mind-Body Treatments
  • Energy Healing
  • Electrical Therapies
  • Environmental Therapies

Physical Movement Therapies including staying active (while of course avoiding aggravating movements) and practicing Pilates have been shown to provide relief for lower back pain.

The focus on core strength and correct posture is key, as strong abdominal muscles support the lower back and can assist in decreasing strain on joints and discs (Discover the Power of Drug-Free Pain Relief 2018). A similar focus on core strength, posture and flexibility in the practice of Yoga and Thai Chi have also shown to be beneficial in the relief of lower back pain, joint pain and fibromyalgia (Discover the Power of Drug-Free Pain Relief 2018).

Spinal Decompression Therapy (following assessment by a qualified medical professional) is also commonly used in the treatment of slipped discs, pinched nerves, bulging or herniated and worn discs.

As this is such a vast and varied area, our look into Drug-Free Relief of Pain with a focus on low back pain will continue in our next article which will focus on Dietary Medicine, Mind-Body Treatments and Electrical Therapies.

REFERENCES:

  1. Models of Health – Medical Model – (Community Development and Heath Network 2018). https://www.cdhn.org/sites/default/files/downloads/FACTSHEETS%201_Screen%20View%281%29.pdf
  2. Farre & Rapley 2017 – The New Old (and Old New) Medical Model: Four Decades Navigating the Biomedical and Psychosocial Understandings of Health and Illness https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5746722/
  3. World Health Organisation Definition of Health https://www.who.int/about/who-we-are/frequently-asked-questions
  4. Australia’s Health 2018: in brief https://www.aihw.gov.au/getmedia/fe037cf1-0cd0-4663-a8c0-67cd09b1f30c/aihw-aus-222.pdf.aspx?inline=true
  5. Australian Institute of Health and Welfare – Back Problems 2019 https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems/contents/how-do-back-problems-affect-quality-of-life

COVIDSafe help – Technical support

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How will the COVIDSafe app work?

A user voluntarily downloads the app from the app store. The user registers to use the app by entering a name, phone number and postcode, and selecting their age range. They will receive a confirmation SMS text message to complete the installation of the app. On the basis of this information, an encrypted reference code is generated for the app on that phone. That code is changed every 2 hours to make it even more secure.

The app uses Bluetooth to look for other devices that have the app installed. It takes a note when that occurs, securely logging the other users’ encrypted reference code. The date and time, distance and duration of the contact are generated on the user’s phone and also recorded. The location is not recorded.

This information is securely encrypted and stored on the phone.

The app uses a rolling 21 day window to allow for the maximum 14 day incubation period, and the time taken to confirm a positive test result. The rolling 21 day window allows the app to continuously note only those user contacts that occur during the coronavirus incubation window. Contacts that occurred outside of the 21 day window are automatically deleted from the user’s phone.

The contact information on the phone is not accessible by anyone (including the user of the phone), until the user is diagnosed with coronavirus and they upload the contact information to a highly secure information storage system.

The uploaded information enables state or territory health officials to contact the user and close contacts to provide advice on actions they should take to manage their health.

This cycle continues if a user of the app who was a close contact subsequently tests positive.

What will the app do?

The COVIDSafe app will allow state and territory health officials to contact you if you have been in contact with someone with COVID-19 (coronavirus). They tell you:

  • what to look out for
  • whether you need to quarantine
  • how, when and where to get tested, and
  • how you can protect yourself and your family and friends

 

If you become infected with coronavirus, the app will assist state and territory health officials to notify people with whom you have had close contact and advise them about self-quarantine and getting tested.

This will speed up current manual processes and make it quicker to stop the spread of the virus, particularly if restrictions are eased.

The app operates on a person’s phone as they go about their day.

It securely logs the encrypted reference codes of devices of other people who are using the app who have been in close proximity to you.

The close contact information can only be accessed by relevant health officials if there has been a positive case to help alert those who may need to be tested.

The app will never track your location.

Is there a risk that people may report false positives?

Information collected by the app that is uploaded to the highly secure information storage system will only be accessed by state and territory health officials once a user has a positive diagnosis. This positive diagnosis must be verified by health officials.

Who is a ‘close contact’ for notification purposes?

State and Territory public health officials will have the contact information for other users who have been within approximately 1.5 metres of the infected user for 15 minutes or more.

How does the app know a ‘close contact’ has occurred?

When 2 (or more) app users come into close proximity their phones exchange Bluetooth signals and make a series of ‘digital handshakes’.

The app records the encrypted reference code, time and proximity of 2 users, through the strength of the Bluetooth signals. This allows the approximate distance between the users and the duration the contact occurred to be determined once the data is uploaded to the highly secure information storage system.

The proximity for a close contact is approximately 1.5 metres, for a period of 15 minutes or more.

To be effective, users should have the app running in the background of their phone whenever they are coming into contact with people. Users of the app will receive daily notifications to ensure the app is running.

Why does the app only notify close contacts in the last 21 days?

The average incubation period for someone who contracts COVID-19 is typically 5 to 6 days, however the World Health Organization currently estimate that the incubation period can be up to 14 days.

The app uses a rolling 21-day window to allow for the maximum 14-day incubation period, and the time taken to confirm a positive test result.

The rolling 21-day window allows the app to continuously monitor only those user contacts that occur during the coronavirus incubation window.

Contacts that occurred outside of the 21-day window are automatically deleted from the user’s phone.

What information is captured by the COVIDSafe app?

The app only uses the information that’s needed to alert close contacts and allow health officials to make contact with them.

This information is only the encrypted reference code, date, time, duration and proximity of contacts.

At registration, the user provides their name, phone number and postcode, and selects their age range, which generates an encrypted code

All further information about contacts collected by the app is encrypted and stored within the app on the phone. Users cannot access contact information stored on their phone.

If the user deletes the app, all contact information is deleted.

The contact information on the phone is not accessible by anyone, unless the user is diagnosed with coronavirus and they upload the contact information to a highly secure information storage system.

Can a user or health official view the information stored on the phone including the contact log?

No. All information that is stored on the phone is digitally encrypted and cannot be accessed or viewed by any users or health officials.

Contact information older than 21 days on your phone is automatically deleted.

Can the app be used to track a user or contact?

No. It does not record an individual’s location or movements. The app only records that a contact occurred to allow health officials to contact those users to enable them to quickly self-quarantine and/or seek medical attention.

The app cannot be used to enforce quarantine or isolation restrictions or any other laws.

Commonwealth and state/territory law enforcement agencies will not be allowed to access any information from the app, unless investigating misuse of that information itself.

Do I have to use the COVIDSafe app?

No. Its use is entirely voluntary but using it will help save lives.

For the app to work, it must be running in the background on your phone. Other apps can be used at the same time.

You can delete the app from your phone at any time. This will delete all the app information from your phone.

At the end of the Australian pandemic, users will be prompted to delete the app from their phone. This will delete all app information on a person’s phone. The information contained on the highly secure information storage system will also be destroyed at the end of the pandemic.

If a user receives a close contact notification, will they be advised who the contact was?

No. This will operate in the same way as existing contact processes run by State and Territory health officials.

A phone call will be made to users who have had close contact with another user once that user is independently confirmed as having COVID-19. This phone call will be made by State or Territory health officials.

Close contact information is only available to State and Territory health officials once a user is confirmed as coronavirus positive, and the user securely uploads the information stored on their phone.

These calls will only be made to close contacts that have occurred in the 21 days before the information has been uploaded. This early notification allows users to quickly self-quarantine and seek medical attention.

Why should I use the COVIDSafe app?

Receiving early notification that you may have been exposed to coronavirus means you can be tested or go into quarantine, so your health and others’ is protected.

Without the assistance of technology, finding people who may have been exposed to the virus relies on people being able to recall who they have been around and knowing the details of every individual they have been in close contact with. In many cases, we don’t know the names and contact details of those we’ve been in close contact with (for example, at the supermarket or on the train).

The COVIDSafe app uses technology to make this process faster and more accurate.

The COVIDSafe app has been developed to ensure your information and privacy is strictly protected.

Telehealth services

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Telehealth – Connecting your people to medical specialists – anywhere, anytime.

Now more than ever solutions to connect people to services they need is critical and mlcoa Telehealth aims to do just that.  While our offices are open for in person assessments, our Telehealth service offers you an alternative, allowing a virtual assessment with an independent medical specialist to minimise delays and maintain case progressions in a safe, secure and effective manner.

Learn how Telehealth can assist you, as mlcoa Consultant Occupational Physician Dr Farhan Shahzad takes you through the process in this short video. If you want to know more or access our telehealth toolkit, simply contact mlcoa on 1800 652 621 or email contact@mlcoa.com.au

Occupational Physicians in the Climate of COVID-19

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The unprecedented situation that has been brought upon the world by the rampant spread of COVID-19 has forced hundreds of thousands of frontline medical staff to adapt to new and unfamiliar work routines, procedures and expectations surrounding the provision of health care.

While we take off our hats to medical staff working in hospitals, primary care and ICU units while placing their own health in unchartered territory, other medical staff have essentially been removed from normal healthcare settings to instead perform consultations via virtual offices in order to reduce the chance of transmission of this disastrous and debilitating virus.

Never in our lifetimes have we been faced with such a critical situation that has warranted international border closures, office and community lock-downs, business closures and global concern about the long-term social and economic consequences. But these new rules are necessary and compliance is crucial, as social distancing and enhanced hygiene practices are the most significant ways to slow the spread of COVID-19.

Below is a graph outlining the total confirmed COVID-19 cases by sex and age in Australia.

Across the world, there have been more than half a million confirmed cases of COVID-19 in 201 countries, areas or territories (according to the WHO Coronavirus Disease (COVID-19) Situation Dashboard.)

Occupational Health & Safety and COVID-19 – a Duty of Care

In the most recent RACP (Royal Australasian College of Physicians) President’s message, Associate Professor Mark Lane states,

“In these very difficult times, many members of the community are looking to us for advice and for leadership.”

With so much information surrounding COVID-19 now available, access to timely and accurate health advice from credible sources of information is critical for not only the general public, but for health professionals providing health care and advice regarding COVID-19. Accurate information regarding minimising exposure to COVID-19 in the workplace and early intervention for suspected cases will complement public health measures while reducing disruption to businesses.

Businesses and organisations have a duty of care to reduce the rate of transmission of COVID-19 in the workplace and community. To assist with this need, the RACP has outlined a number of recommendations to guide employers in their response to this global health pandemic including;

  1. Prioritising the health and wellbeing of workers and their families
  2. Showing leadership
  3. Effective two-way communication between employers and workers
  4. Showing empathy and compassion
  5. Applying innovative thinking
  6. Being responsive to the changing situation, and
  7. Planning ahead

When it comes to Planning Ahead, the RACP is urging businesses to continue to ensure the health and safety of their workers in this changing environment, as it is anticipated that this disruption will last for a significant period.  As such, employers are beginning to focus on what their future business might look like, and how to ensure that together with their workers and the nation more broadly, they can survive and thrive once the pandemic ends.

Working from home our new norm

The recommendations outlined in the RACP’s Applying Innovative Thinking specifically emphasise adopting new and innovative solutions that comply with the current official advice including social and physical distancing and self-isolation (i.e. staying at home only with people who usually live in the home, not going to public places including work, school, childcare, university or public gatherings and not seeing visitors).

These innovative solutions include adopting flexible working hours, working from home, or creative use of technology, all of which allow workers to continue to undertake their work roles as far as feasibly possible, whilst limiting contact with their colleagues and the general public as much as possible.

However, it is also highlighted that employers will also need to acknowledge that depending on employees’ personal circumstances, working from home may impact on productivity and there may be an increased need for flexibility in working arrangements.

Occupational Physicians in the Climate of COVID-19

As specialist doctors in the health and wellbeing of workers and the working population more broadly, Occupational Physicians are well placed to assist in this situation.

In order to assist employers in creating work environments and conditions that are beneficial to the health and wellbeing of their employees during this challenging time,

Occupational Physicians can incorporate organisational structures and workplace specifics into each your COVID-19 response.

This insight and guidance will be very useful in helping to provide employers with targeted workplace-specific advice and solutions amidst this unprecedented health crisis marked by hundreds of thousands of worldwide fatalities globally.

For further access to timely and accurate COVID-19 Health Information

CLICK HERE for the central resource that informs all official public health advice in Australia.

CLICK HERE to see the Australian Government’s Department of Health Coronavirus (COVID-19) health alert. This page includes information about how the Australian Government is monitoring and responding to the outbreak, how you can help slow the spread of COVID-19 in Australia, and what to do if you have symptoms. It also includes the latest official medical advice and case numbers.

The Health and Wellbeing Agenda: What Organisations can do to Help their Employees

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Work is needed for psychological and physical health. It offers a prosocial environment where people can build relationships, work towards something greater than themselves, and be a part of a team. It is said that, without work, we become isolated, are predisposed to depression and anxiety, and have less life satisfaction and fulfilment. All in all, work is good for us.

That is, until it is bad for us. In some cases, work can make us ill. We suffer fatigue and exhaustion that can lead to burnout, a group of symptoms that the WHO have just labelled as a syndrome. Work can also lead to physical health problems such as musculoskeletal problems, carpal tunnel and repetitive strain injury. When working in an unsafe or ergonomically unsound environment, the physical health of the workplace can be compromised. Workers are put at risk from toxins, aches and pains, and psychological strain that can cost the organisation and economy billions.

Employees come in all shapes and sizes, so it is important that organisations don’t prescribe a one-size fits all approach to managing health. Organisations must ensure that they meet workplace health and safety requirements; the legislation which is set by each state. This includes adequate health surveillance to ensure that employees are not exposed to hazardous and toxic chemicals, as well as promoting healthy working practices. The new Mental Health First Aid, which trains staff members in how to identify common mental health disorders in the workplace, is an example of a positive change.

What Can Organisations Do?

An organisational well-being manager or consultant can be a helpful addition to any corporation. However, managers can also increase their knowledge of individual differences through ongoing training and development, ensuring they become more aware of the individual needs of their employees.

Employees work best in environments that suit their needs, and this alone should be enough to encourage organisations to make changes. To make the best use of the people in the organisation, I would advise managers to seek feedback from their employees about what works, and how their current practices support or detract from their employees’ ability to function optimally at work.

Fatigue and long hours lower workplace productivity, but so do self-medicating on booze or overeating to manage emotions. All of which many employees are prone to. By providing workplace training on self-care, sleep hygiene and nutrition, organisations can help their employees make healthier choices and take ownership for their wellbeing. That said, it is also important for organisations to work to remove structural level stressors at work, and not simply place the onus on their employees to manage health and wellness.

Fitness and Food and its Impact on Mood

Exercise and healthy eating are of paramount importance. Food is fuel. It also plays a fundamental role in our mental wellbeing. Without adequate nutrition, we’re prone to depression and anxiety, and simply cannot perform at our best. Lack of magnesium and B vitamins, for instance, can leave us feeling anxious and worried. Food, therefore, plays a pivotal role in mood. Without it, we can be prone to the classic case of hanger, turning from little miss nice into the incredible hulk.

Foods rich in the vitamins and minerals such as calcium, chromium, folic acid, iron, magnesium, omega-3 fatty acids, vitamin B16, vitamin B12, vitamin D, and Zinc are known for their happiness-boosting qualities and it is advisable to eat more of these. Exercise is also a good idea, as trials suggest that exercise has the same impact as anti-depressant medication on mild to moderate depression.

Exercise is known to switch on the ‘game on’ mode of our brain, which is linked to enhanced positive emotions, leading to greater productivity. The brain releases endorphins and Brain-Derived Neurotropic Factor (BDNF) is increased, resulting in better brain health, muscle tissue and the alleviation of symptoms associated with depression and anxiety.  Nutrients such as magnesium result in lowered stress and tension and the amino acid, tryptophan, is associated with serotonin synthesis, meaning greater overall levels of happiness.

Helping Staff Make Smarter Choices

Some of the ways you can encourage your staff to make healthier and smarter lifestyle choices are through the following:

Frequent meals: Eat little and often.

Choose friendly carbs: think oats

Protein: we need to ensure daily consumption of essential amino acids.

Eat plenty of fruit and vegetables: the more colourful the better.

Up your probiotic intake: this helps support gut health.

Recent studies have found a link between an unhealthy diet and mental ill health. Bad diets are therefore a risk factor in depression and anxiety, so supporting your staff is imperative to the overall wellbeing of your organisation.

Harsh Reality of the Australian Bushfires

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The unprecedented devastation caused by the Australian 2019/20 summer bushfires are expected to have ongoing effects on the physical and mental health of people from affected communities not just in the immediate future, but for years and possibly decades to come. The tragic widespread loss will also continue to impact our now changed environment, landscape and wildlife, long after the news coverage, social media posts and donations slow down.

Fires this season have burned an estimated 18.6 million hectares.

Fires this season have destroyed over 5,900 buildings including approximately 2,683 homes.

Fires this season have seen at least 34 people lose their lives.

Fires this season are estimated to have killed over 1 billion animals.

Fires continue to burn.

As many affected areas of Australia welcome a long-awaited dose of rainfall over the coming days, the lasting impact of the fires on our country’s environment, health and mental health is yet to be seen. Recovery from the devastation caused by Australia’s summer bushfires will be a mammoth task for those who have been directly affected, the communities of those affected, the Australian people as a whole, the Australian landscape and the Australian Government by way of relief and preparation for next time.

ENVIRONMENTAL IMPACT

With two months still remaining in the Australian bushfire season, the impact of the fires on our environment are already been seen and felt, loud and clear.

  • Carbon dioxide emissions

At no other time in history have we as humans been so focused on our carbon footprint and the results of global climate change. Yet the smoke from the Australian bushfires is travelling around the planet, injecting aerosols and increasing carbon dioxide emissions (one of the greenhouse gases responsible for global climate change) into the upper atmosphere at some of the highest levels ever recorded according to NASA satellites. 

The fires have already released enough carbon dioxide (An estimated 400 million tons) to rival Australia’s annual human-caused emissions (roughly 540 million emitted tons) last year.

  • Biodiversity Loss

With an estimated loss of over 1 Billion animals in the fires so far, and over 18 million hectares of land destroyed, scientists fear an immediate loss of biodiversity and habitat for many animals who’s only home is Australia.

Habitat features needed by wildlife including log hollows, nectar-bearing shrubs and a deep ground layer of fallen leaves have not only been destroyed in a matter of weeks, but may not redevelop for decades. And for those animals that were lucky enough to survive, they have lost their food sources, making the extent of this issue unknown.

But for now, the bushfires are said to have pushed at least 20 threatened Australian species closer to extinction.

  • Water Supply & Quality Threat

While it is only natural to rejoice over falling rain after what we have just witnessed and endured, too much rain could result in major issues for Australia’s water quality and supplies. As rain falls and travels, it collects ash, soot and burnt vegetation with nothing to filter it from entering our catchments, streams, dams and beaches. This clogged runoff ultimately threatens our water quality and strangles fish and other marine life.

Warragamba Dam is of particular concern. With its supplies sitting at already less than half of its capacity, the effects of heavy rain falling on the catchment area (of which 80-90% has burned) will see massive amounts of sooty material filling its waters which may lead to blooms of cyanobacteria, further exacerbating our already low water supplies.

PHYSICAL HEALTH IMPACT

  •  Short Term

Air quality across Australia has suffered significantly as a result of our fire-ravaged country. With Canberra and Melbourne recording the worst air quality in the world in the past few days, and Sydney enduring hazardous air quality levels throughout summer, heightened anxiety levels regarding health issues related to bushfire smoke have also developed across the country.

The majority of air pollution-related health impacts are due to ‘fine particulate matter’; particles and droplets that are less than 2.5 microns in diameter (PM2.5) which enables them to deposit toxic components deep in the lungs.

While poor air quality can be harmful to everyone, vulnerable groups of people including children under 14, people over 65, pregnant women and those with pre-existing medical conditions including asthma and other respiratory conditions, cardiac and cardiovascular conditions and diabetes are encouraged to limit their exposure to the smoke as much as possible.

Healthy people tend to tolerate exposure to bushfire smoke better than more vulnerable people, although it can still cause itchy or burning eyes, throat irritation, runny nose and some coughing. However, these usually pass once the person is no longer exposed to the smoke.

  • Long Term

While the short-term effects of exposure to low air quality or bushfire smoke are clear, less is known about the long-term effects of exposure.

By drawing on data from highly polluted regions such as those in Asia where people are exposed to long-term high levels of air pollution, negative effects on health have been seen with increased risks of several cancers and chronic health conditions including heart disease and respiratory conditions.

A recent study in China reported long-term exposure to high concentrations of ultrafine particles called PM2.5 (which we find in bushfire smoke) is linked to an increased risk of stroke. A smaller study exposed a group of people to 4 x 15 minute periods of wood smoke (which contains over 200 chemicals) over a 2 hour period, and saw each participant experience increased levels of neutrophils, a type of aggressive white blood cell both in their lungs and circulation.

These short-term studies show that bushfire smoke is toxic, and despite the human body’s remarkable capacity to cope with air pollution, it’s this toxicity which is likely to cause long-term effects.

MENTAL HEALTH IMPACT

Mental health effects from bushfires are common, as they typically are when a population experiences significant trauma. These effects can range from short-term anxiety and panic to longer-term depression and PTSD.

After the fires stop burning, people will need to continue paying their mortgages, even on houses that are uninhabitable. Homelessness and bankruptcy become very real threats, insurance claims are made but not always paid, and relationships are thrown under enormous stress overnight.

And while it is common to see resilience in the immediate after events of bushfires, five years following the Black Saturday fires of 2009, rates of mental illness were still elevated. Approximately 1 in 5 people in highly effected communities experienced persistent post-traumatic stress disorder, depression and psychological distress.

The Australian Government has just committed $76 million for distress counselling and mental health support for individuals, families and communities affected by the recent bushfires, but only time will tell if this financial contribution will have any effect on the psychological implications of this shocking summer of disaster.

Preparedness for the future

Last year, many groups including former fire chiefs, fire scientists and meteorological chiefs, tried to communicate the deep urgency for action needed by the government in the lead-up to a summer predicted to be our most challenging ever (Yin 2020). However, despite the warnings and consciousness about climate change and global warming, Australia was hopelessly underprepared for what it has just faced and may continue to face over the coming months.

But at the end of this bushfire season, when the ash settles and those effected begin to piece together their lives, we must all accept the science that is global warming and the challenge it has put before us. We must choose to act and take the necessary measures to tackle climate change to prevent this fire-ravaged summer becoming our new normal.

New Horizons for Telehealth in Occupational Medicine

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While the ‘human element’ will always be a critical factor in the provision of quality healthcare and treatment, the healthcare industry continues to evolve within today’s technologically advancing context with a focus on clinical safety, quality improvement and privacy and confidentiality to ultimately deliver improved healthcare and health outcomes for all.

The Evolving Realm of Digital Health

The term ‘Digital Health’ is becoming widely recognised as representing the technological change that encompasses every aspect of healthcare including prevention, diagnosis, management and treatment, as well as transforming the creation, delivery and measurement of frontline healthcare services (ANDHealth 2018).

Health and technology have already combined their powers to create the likes of surgical robots, medical devices and 3D printing of body parts in recent times (Deakin University 2019). This intersection of health and technology has also brought about exciting opportunities through the emergence of many more digital health categories including;

·        mobile health (mHealth)

·        health information technology (IT)

·        wearable devices

·        telehealth and telemedicine

·        and personalized medicine (ANDHealth 2018).

Our ever-increasing use of technologies such as smartphones, social networks and applications is not only changing the way we communicate, but is also providing the means to enable patients and consumers to better manage and track their health-related activities, ultimately improving their own healthcare and health outcomes (ANDHealth 2018).

What is Telehealth & Telemedicine?

Healthcare consumers are increasingly looking online for solutions to their health queries and in some cases, are using technology to take control of their health. This is making Telehealth a valuable player in the new realm of digital health. (ANDHealth 2018).

“Telehealth” is used as an umbrella term that encompasses;

·        virtual visits

·        remote patient monitoring

·        mobile health applications

·        online patient education

·        follow up visits

·        Store-and-forward (collecting clinical data and sending it electronically to the provider for evaluation)

·        and the use of electronic information and telecommunication technologies to support and promote long-distance clinical healthcare (Norwood 2019).

What Telehealth means for Occupational Health & Medicine

The management of workers’ chronic diseases and varying health issues, an aging workforce, on-the-job injuries and resulting absenteeism presents a volatile and cost-laden environment for employers across all industries (Baker 2018).

Employers are therefore looking to new ways of managing these issues while improving productivity and the health of their workers. As such, Telehealth holds great potential for reducing employee’s time away from work while increasing the speed in which an injury can be evaluated, managed and monitored (Baker 2018).

For example;

  • Warehouse worker experiencing lower back pain – A phone app could record the incident with the worker’s compensation payer while requesting a consultation with a GP or Occupational Physician. The phone app could connect the Doctor and patient in real-time and the video interaction could be recorded and stored.
  • Pipeline worker experiencing a sprained wrist – A smartphone app could connect him or her with a doctor who can assess the situation while referring the worker to have x-rays or other relevant scans done at the nearest healthcare facility.
  • Diabetic truck driver on the road – A telehealth application could help proactively monitor diabetes insulin levels and suggest proactive strategies for better maintaining employee health (Baker 2018).

Telemedicine can be incorporated into policy and practice by employers as a way of educating, motivating, providing and tracking necessary treatment for worker’s in ways that can save on overall employer costs while increasing worker compliance (Baker 2018).

While the virtual management of worker injuries and health issues isn’t appropriate in every case, the use of Telehealth technologies does pose significant potential to coordinate better collaboration between stakeholders regarding patient treatment and the ongoing management of their medical issues.

Getting to the CORE of LOWER BACK PAIN (Part 1)

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More than 4 million Australians struggle with back pain on a daily basis, the majority of whom report that the pain interferes with their basic activities of daily living (AIHW 2019). This could be pain that interferes with focusing at work or attending work at all, pain that takes away from enjoyment of time spent with loved ones, pain that causes sleep disturbances, or pain that prevents us from simply doing things that we want and need to do in our everyday lives.

In short, back pain causes poorer quality of life, psychological distress, physiological pain and disability, making it easy to see that back pain was Australia’s second leading cause of disease burden in 2015.

Regardless of whether one’s back pain is due to injury, posture issues related to jobs that involve prolonged sitting and sedentary work, repetitive lifting tasks at work, degeneration, disc bulging or nerve impingements, treatment and management of the pain can seem like a relentless and result-less cycle of scans, specialist appointments, physiotherapy sessions, pain medication trials, and sheer hope that the pain will just disappear. And while each of these forms of pain management have their place, core strengthening exercises have been shown to play an integral role in preventing/easing/resolving low back pain (RACGP 2016).

As it turns out, abs aren’t just good for their external aesthetic appeal! Good core strength could very well be one of the answers that so many of us are searching for when it comes to resolving or at the very least easing low back pain. And with an estimation that 70–90% of Australians will suffer from lower back pain in some form at some point in their lives (AIHW 2019), core strengthening may assist with prevention for some of us, and management of current conditions for others.

While there is no ‘ideal’ or ‘preferred’ exercise intervention program guaranteed to resolve low back pain (LBP), and exercise programs should, of course, cater to the patients’ unique and specific lower back pain issues as well as patient and clinician preferences, accessibility and costs, core strengthening is a consistent player within many exercise programs which have been shown to be effective for chronic low back pain (RACGP 2016).

Our spines are connected to and dependent upon the complex layers of supporting muscles. Therefore, if we treat those surrounding muscles and structures with respect and attention, our spines and subsequently our lower back pain may feel the positive flow-on effects. This is the underlying concept of core strength.

Motor Control Exercises

Motor control exercises have been shown to be effective for reducing pain and function in patients with LBP (RACGP 2016). These exercises aim to retrain the control and coordination of the deep abdominal muscles, deep spinal muscles and pelvic floor muscles that support the spine. The idea behind this re-training is that those with chronic LBP struggle to control the deep trunk muscles which can result in a lack of strength, timing or coordination which ultimately leads to pain and loss of function. By retraining these muscles allows these patients to regain their ability to reverse these issues and ultimately reduce their LBP.

Pilates

Pilates is another exercise program which also has an extremely strong focus on core strengthening due to its benefits for conditions such as back pain. Again, Pilates concentrates on stabilising core muscles by focusing on the contraction of the deep muscles of the back and abdominals (RACGP 2016).

Sit-to-Stand Desks

While a sit-to-stand desk is not an exercise program, these desks have been shown to be a beneficial way to engage and strengthen core muscles which would otherwise be dormant throughout the workday if remaining exclusively in a sitting-only position.

By switching from a sitting to standing position throughout the day and with prior understanding and experience in activating and engaging your core muscles from perhaps a few sessions with a physiotherapist, a sit-to-stand desk can essentially force your core into doing itself some good through core strengthening.

Solve your CORE issues and EASE your lower back pain

According to the statistics, a whopping 70-90% of us will unfortunately suffer from some type of LBP at some stage in our lives. For those who are currently suffering, ask your GP or relevant care provider about how core strengthening could help you and your back pain, and how you can access the appropriate services.

For those who aren’t currently suffering from LBP, engage that CORE and keep it strong for as long as you can.

And for those of you who may be noticing the beginnings of a niggling low back pain during your workday, a simple rehabilitation evaluation and an ergonomic assessment will go a long way in terms of prevention.

What You Need to Know About Medicinal Cannabis?

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If you haven’t already, you may begin to hear the term, ‘medicinal cannabis’ used more and more often in Australia over the coming months and years. Countries such as the United States, Canada, Israel and the Netherlands (as well as many others) have already passed legislation surrounding the medicinal use of cannabis, and Australia is following closely behind.

Today, medicinal cannabis is now accessible by patients with certain conditions and side-effects of those conditions across the country (Neuroscience Trials Australia 2018).

A Brief History of Cannabis

The World Health Organisation (WHO) states that cannabis is the most widely cultivated, trafficked and abused illicit drug worldwide, with half of all drug-induced seizures being cannabis-related (WHO). Most of us are therefore aware that cannabis, commonly termed as ‘weed,’ or ‘pot,’ is well-known for its psychoactive effects – that is, giving the feeling of being ‘high’ or ‘stoned.’ This major psychoactive constituent in cannabis is called delta-9 tetrahydrocannabinol (THC), (World Health Organisation) and the risks associated with its effects are the reason for cannabis historically being deemed illegal.

However, THC is only one of the cannabinoid chemicals produced by the cannabis plant (Halperin 2018). Another one of the cannabinoids which can be extracted from cannabis is called cannabidiol (CBD), and it is this cannabinoid which is the focus of the positive medicinal attention. Why? Because CBD is not psychoactive; it doesn’t get people high! (Halperin 2018).

Instead, medicinal cannabis has been shown to elicit anti-epileptic effects in humans, is commonly used to manage painful muscle spasms caused by multiple sclerosis, and has been used in the final stages of cancer to combat pain and chemotherapy-induced nausea (Neuroscience Trials Aus 2018).

Barriers and Fears to Cannabis Legalisation

 The primary perception of cannabis focuses mainly on the acute and chronic negative effects of THC on the body, including; impaired cognitive development, impaired psychomotor performance which creates an increased risk of motor vehicle accidents, exacerbation of schizophrenia in those affected, the development of cannabis dependence, and impaired foetal development when used in pregnancy (WHO).

Hesitation also exists regarding the legalisation of medicinal cannabis on the grounds that further clinical trials are still needed to verify its benefits in greater detail, as a gap in knowledge surrounding the particulars of various cannabis-derived compounds, dosage levels, and its effects on conditions and symptoms still remain (Neuroscience Trials Australia 2018).

What’s important to remember however, is that only medicinal cannabis has been legalised in Australia, and that cannabis itself is still illegal in Australia unless you have a valid script that has been government approved under the Special Access Scheme.

Cannabis Prescription in Australia

The Therapeutic Goods Administration (TGA) is responsible for ensuring that therapeutic goods available for supply in Australia are safe and fit for their intended purpose under the Therapeutic Goods Act 1989 (The Act) (Department of Health TGA 2019).  This also includes a number of ways that enable access to unapproved therapeutic goods. For medicinal cannabis products, these include access through:

·        Authorised Prescriber Scheme (AP)

·        Special Access Scheme (SAS)

·        Clinical trials

Special Access Scheme (SAS) (Department of Health TGA 2019)

The TGA has a responsibility to encourage the use of medicines that are included in the Australian Register of Therapeutic Goods (ARTG), which have been evaluated to meet strict standards of safety, quality and effectiveness (Department of Health TGA 2019).

For this reason, medical practitioners (prescribers) are expected to have considered all clinically appropriate treatment options included in the ARTG before applying to access an unapproved medicinal cannabis product under the SAS (Department of Health TGA 2019). Where products in the ARTG are found to not be clinically suitable, the SAS provides a pathway for prescribers to access unapproved products for individual patients on a case-by-case basis (Department of Health TGA 2019).

To date, the TGA has approved SAS applications including, but not limited to the following indications;

  • chemotherapy-induced nausea and vomiting
  • refractory paediatric epilepsy
  • palliative care indications
  • cancer pain
  • neuropathic pain
  • spasticity from neurological conditions
  • anorexia and wasting associated with chronic illness (such as cancer) (Dep of Health TGA 2019).

Potential Benefits of Medicinal Cannabis in the Future

Continuing scientific research in Australia has recently begun to demonstrate the medical benefits of cannabis, with the NSW Government pledging $9M since 2015 towards medical trials using cannabis to treat epilepsy in children, chemotherapy-induced nausea and vomiting in adults and appetite in adults with advanced cancer who are undergoing palliative care (The Cannabis Company 2019).

When it comes to discovering new treatments for illnesses and side-effects of illnesses which have long caused unresolved pain and suffering to individuals, the hope of something new and potentially beneficial is warmly welcomed.

REFERENCES

  1. World Health Organisation, https://www.who.int/substance_abuse/facts/cannabis/en/
  2. Halperin – The Guardian, https://www.theguardian.com/society/2018/may/28/what-is-cbd-cannabidiol-cannabis-medical-uses
  3. Therapeutic Goods Administration – Medicinal Cannabis, https://www.tga.gov.au/medicinal-cannabis-guidance-documents#guidance-docs
  4. Therapeutic Goods Administration – Special Access Scheme, https://www.tga.gov.au/access-medicinal-cannabis-products-1
  5. Special Access Scheme Online application Link – https://www.tga.gov.au/special-access-scheme-and-authorised-prescriber-online-system
  6. Neuroscience Trials Australia, http://www.neurotrialsaustralia.com/legalising-medicinal-cannabis-in-australia/
  7. The Cannabis Company, https://cannabiscompany.com.au/blogs/news/what-is-cannabis-effects-explained

Chronic Fatigue Syndrome and Work Safety

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What are your Symptoms?

Are you experiencing episodes of unexplained fatigue, cognitive and short-term memory issues, headaches, muscle and joint pain, unrefreshed sleep or general muscle weakness? If any of these symptoms sound familiar, you could be exhibiting symptoms of Chronic Fatigue Syndrome (CFS) (Johnson et al 2016).

Or, you could also be suffering from Fibromyalgia, a name given to a group of symptoms specifically characterised by generalised pain and muscle stiffness throughout the body. Common symptoms of Fibromyalgia can also include aching pain, stiffness and tiredness of muscles, extreme fatigue, poor sleep, concentration and memory problems and irritable bowel symptoms (diarrhoea and stomach pain).

Confused? Understandably!!

Unfortunately, both Fibromyalgia and CFS are difficult to diagnose and differentiate due to their similar yet non-specific symptoms, and a specific cause has not been defined for either condition (Johnson et al 2016). However regardless of the unclear pathophysiology surrounding CFS and Fibromyalgia, their symptoms pose significant impacts on our lives physically, mentally, emotionally, socially and financially.

Prevalence of CFS/ME and Fibromyalgia in our busy lives

We live in a day and age of being constantly ‘switched on.’ What is often joked about as being a case of, Eat. Sleep. Work. Repeat, is actually more like wake up, eat, get kids dressed, pack lunches, drop off at school, sit in traffic, work, sit in traffic, think about dinner and lunches, collect groceries, make dinner, eat, clean up, put kids to bed, do the washing, keep house in order, pay bills, maintain social life, sleep, repeat.

Living in this state, it’s no wonder we’re increasingly noticing fatigue, tiredness, concentration issues and poor sleep in ourselves and others.

Fatigue and the Shift Worker

While every industry is affected to some degree by issues surrounding fatigue, some sectors which involve shift work have an inherently higher risk of fatigue amongst workers (Safe Work Australia 2019).  Fatigue is mental and/or physical exhaustion that reduces workers’ ability to perform tasks safely and effectively, ultimately increasing the risk of incidents and injury to themselves and others in the workplace (Safe Work Australia 2019).

In shift-working roles, work-related causes of fatigue can include; (Safe Work Australia 2019)

  1. prolonged or intense mental or physical activity
  2. long commuting times.
  3. sleep loss and/or disruption of your internal body clock
  4. exceptionally hot or cold working environments
  5. excessively long shifts
  6. not enough time to recover between shifts
  7. strenuous jobs

Is there a cure?

Unfortunately, no cure has been found for Fibromyalgia or Chronic Fatigue Syndrome, however there are of course ways to control and manage symptoms.

Seeking support from various healthcare providers, finding ways to manage pain, getting adequate sleep and exercise, maintaining a healthy weight, listening to your body and discussing medicine options with your doctor can all pay a part in the effective management of symptoms of CFS/ME and Fibromyalgia (Arthritis Australia).

Managing Fatigue in the Workplace

Both employers and workers have a work health and safety duty to prevent or at the very least, manage fatigue in the workplace (Safe Work Australia 2019).

Providing information and training to workers regarding factors that can contribute to fatigue and the risks of fatigue, as well as implementing control measures to minimise the risk of fatigue in the workplace can assist workers to safely do their jobs (Safe Work Australia 2019).

Control measures that can minimise fatigue risks include; (Safe Work Australia 2019)

  1. effective work scheduling
  2. informed shift design and rostering
  3. job demands
  4. environmental conditions
  5. non work-related factors
  6. workplace fatigue policy

Once control measures have been implemented in the workplace, they should be monitored and reviewed to make sure they remain effective in minimising the risks of fatigue amongst workers (Safe Work Australia 2019).

What next?

If any of the discussed symptoms sound familiar to you, your best bet is paying your GP a visit for further discussion. Listen to your body as even though there’s no ‘cure’ for Fibromyalgia or Chronic Fatigue Syndrome, establishing an appropriate and personalised management/treatment program can help towards effective control and management of individual symptoms.

REFERENCES if you are interested

Johnson et al 2016 Reference

https://emerge.org.au/wp-content/uploads/2014/10/Johnston-S.-C.-et-al.-Epidemiological-characteristics-of-chronic-fatigue-syndrome-myalgic-encephalomyelitis-in-Australian-patients.-Clin-Epidemiol-2016-8-97-107.pdf

Arthritis Australia Reference

https://arthritisaustralia.com.au/types-of-arthritis/fibromyalgia/

Safe Work Australia – Fatigue Reference 2019

https://www.safeworkaustralia.gov.au/fatigue

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