Australian Family Physician audio

Cancer is a major cause of disability and death in Australia, with three government funded screening programs now in place nationally. As cancer screening tests are performed on healthy asymptomatic members within the community, one needs to consider whether the potential gains will outweigh possible harms. There are challenges for both practitioners and consumers in communicating about screening in practice.

David Forbes, Associate Professor, Australian Centre for Posttraumatic Mental Health, University of Melbourne, discusses the assessment and management of post traumatic stress syndrome (in particular the role of trauma focussed psychological therapy) with Dr Jenni Parsons. GPs can assist patients who have experienced trauma within the past 2 weeks by providing psychological first aid, and monitoring and assessment for the development of acute stress disorder and symptoms of PTSD. Trauma focused psychological treatment is the first line of treatment for PTSD, and in this interview David Forbes outlines what is involved in this specialised form of cognitive behavioural therapy.

Approximately 50–65% of Australians are exposed to a traumatic event during their lifetime. Approximately 250 000 Australians suffer from post-traumatic stress disorder (PTSD) at any given time, making it one of the most common anxiety disorders. In May 2007, the Australian guidelines for the treatment of adults with acute stress disorder and posttraumatic stress disorder was published. In order to facilitate translation of evidence regarding PTSD into busy clinical practice, and particularly for general practitioners, a more succinct version of the guidelines has been developed.

Dr Linda Foreman talks about the bowel cancer screening, including the National Bowel Cancer Screening Program. She discusses the role of the GP in the program and also reminds us to consider patients who may not be in the program.

Current Australian guidelines recommend regular screening with faecal occult blood tests (FOBT) in asymptomatic people over 50 years of age in order to reduce mortality from bowel cancer. After assessing the feasibility, acceptability and cost effectiveness of bowel cancer screening using FOBTs in an Australian setting, the Australian Government commenced the National Bowel Cancer Screening Program (NBCSP) in August 2006 among certain age groups.

Dr Nancy Huang, National Manager – Clinical Programs, Heart Foundation, talks about the article "Heart health: CHD management gaps in general practice". She discusses the concept of assessing absolute risk for all people over 45 years of age, and also the 3 key management gaps identified in CHD management relevant to general practice.

For many years, the Heart Foundation has been involved in the development of evidence based clinical practice guidelines for the management of cardiovascular diseases and conditions, including coronary heart disease (CHD). However, the production of guidelines does not ensure the uptake of evidence based recommendations in practice.

Dr Nancy Huang, National Manager – Clinical Programs, Heart Foundation, talks about the article “Heart health: CHD management gaps in general practice.” She discusses the concept of assessing absolute risk for all people over 45 years of age, and also the 3 key management gaps identified in CHD management relevant to general practice.

Dr Linda Foreman talks about the bowel cancer screening, including the National Bowel Cancer Screening Program. She discusses the role of the GP in the program and also reminds us to consider patients who may not be in the program.

Dr Lyndal Trevena discusses some of the principles and controversies in cancer screening.

Kay Wilhelm, Conjoint Professor of Psychiatry, University of New South Wales, discusses the differences in presentations of depression between men and women with Dr Jenni Parsons. Men often display irritability and withdrawal in response to depression and are less likely than women to talk about their depression or how they feel. They tend to experience anxiety disorders less frequently than women. However, men’s greater risk taking and substance abuse have significant adverse physical and mental health outcomes. While men are usually wary about talking about their depression, they will discuss their feelings if provided with a safe environment in which to do so.Men are more generally accepting of ‘learning new tools to deal with stress’ than ‘support for emotional needs’, and men who are not psychologically literate will respond to psychoeducation that focuses on ‘need for change in lifestyle risk factors’. Men often do well with cognitive behavioural therapy (CBT) and problem solving techniques. Evidence about effects of depression on health, especially cardiac disease, can assist in gaining agreement for the use of antidepressants.

Kay Wilhelm, Conjoint Professor of Psychiatry, University of New South Wales, discusses the differences in presentations of depression between men and women with Dr Jenni Parsons. Men often display irritability and withdrawal in response to depression and are less likely than women to talk about their depression or how they feel. They tend to experience anxiety disorders less frequently than women. However, men’s greater risk taking and substance abuse have significant adverse physical and mental health outcomes. While men are usually wary about talking about their depression, they will discuss their feelings if provided with a safe environment in which to do so.Men are more generally accepting of ‘learning new tools to deal with stress’ than ‘support for emotional needs’, and men who are not psychologically literate will respond to psychoeducation that focuses on ‘need for change in lifestyle risk factors’. Men often do well with cognitive behavioural therapy (CBT) and problem solving techniques. Evidence about effects of depression on health, especially cardiac disease, can assist in gaining agreement for the use of antidepressants.

Darren Russell, Director of Sexual Health, Cairns Sexual health Service, discusses health issues of the newly single man with Dr Jenni Parsons. For men who are newly single there are a range of health issues that may arise including sexual health, alcohol and drug use, stress and mood disorders. The spectrum of health concerns varies with the age of the man and his individual circumstances. Importantly, when a newly single man presents to a GP, it provides a window of opportunity to begin a dialogue on preventative health strategies.

Darren Russell, Director of Sexual Health, Cairns Sexual health Service, discusses health issues of the newly single man with Dr Jenni Parsons. For men who are newly single there are a range of health issues that may arise including sexual health, alcohol and drug use, stress and mood disorders. The spectrum of health concerns varies with the age of the man and his individual circumstances. Importantly, when a newly single man presents to a GP, it provides a window of opportunity to begin a dialogue on preventative health strategies.

Edith Weisberg, Director of Research, Sydney Centre for Reproductive Health Research, Family planning New South Wales, discusses research into young women’s attitudes to and uptake of HPV vaccination with Dr Jenni Parsons. Two hundred and ninety-four women aged 15–26 years attending Family Planning NSW clinics completed the a questionnaire. Over 70% of the women had visited a GP in the previous 6 months but 40% were unaware that they could obtain free vaccination through a GP. Women 26 years old and under are eligible for free catch up HPV vaccination in 2009 but must have their first vaccination by 30 June 2009. After the end of 2009 women wanting HPV vaccination will need to pay for them themselves at a cost of approximately $140 for each of the 3 doses. General practitioners should use opportunistic visits by young women and recall and reminder systems to encourage women 26 years and under to commence vaccination by 30th June 2009.