Jan 27

Back to school to outwit the nits

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With Australia Day celebrations now just a memory, most Australian families – certainly those with school-age children – are looking forward to another school year; possibly with mixed feelings.

Children will be meeting old friends and making some new friends too. Probably “sleep-overs” will again become part of the school-year landscape. But beware, you could be entertaining some uninvited guests as well.

Statistics indicate that more than 20% of primary school students are likely to have head lice.

However, the fact is anyone with a head can catch head lice – regardless of age, sex, background or how clean your hair is. Head lice spread anywhere that people work, play and live together. Most often children get them at school – often at the start of school. Indeed, it takes only one infested head to infest a whole classroom full of heads; then our children so unselfishly pass the infestation on to the rest of the family.

The medical term of head lice is pediculus humanus capitis. But whichever way you describe them, these tiny wingless insects are extremely common. Head lice are endemic in Australia. They cannot jump or fly but they certainly get around; and they live their entire life (about a month or so) on the head of their host.

Their favourite hiding places are behind the ears and at the back of the neck. Female lice lay their eggs (known as nits) close to the scalp, where they remain firmly stuck to the base of the hair shaft until they hatch in about a week’s time.

Head lice feed exclusively on human blood; but unlike mosquitoes, another group of little blood suckers, it appears that head lice do not carry disease. They can, however, cause severe itching and this can lead to scratching and skin infections.

Of course an itchy scalp may be due to many other causes – among them dandruff, psoriasis and so-called seborrhoeic dermatitis. So, before you start shampooing with insecticide, it’s best to get an accurate diagnosis. The recently revised Pharmacy Self Care fact card titled Head Lice will help confirm the problem and find the solution as well.

The good news is that if you or your children have head lice, there are simple, safe and effective strategies to send them on their way. Various shampoos, lotions, cream rinses and conditioners are available. Many chemical treatments are based on the chrysanthemum-type pyrethrin insecticides; some contain malathion; and there are several remedies available based on essential oils such as anise, lavender, rosemary and the Australian favourite melaleuca (tea tree) oil. When used as indicated in some studies these natural treatments have been shown to be more effective even than the chemical treatments.

If live lice are found in the combings after treatment, it’s possible that the head lice are resistant to the particular product, and the person should be retreated as soon as possible using a product from a different group. Nevertheless, most treatment failures are due to inadequate time in contact with hair and scalp, inappropriate application methods, or the use of ineffective products. Ask your pharmacist to recommend an evidence-based product – that is: one that is proven to be effective.

Remember whatever head lice treatment you choose, a fine toothcomb is essential to get the nits out and a good hair conditioner will get rid of the knots.

Despite symptoms of tickling, itching and scratching, head lice can sometimes be difficult to find. The answer is to indulge in a little “detection combing”. You apply to dry hair, enough hair conditioner to cover each hair from root to tip. Starting at the scalp and working carefully in sections, you comb the conditioner through the hair with a special lice comb.

Head lice treatments can kill living lice and eggs, but they don’t protect people from getting head lice. Regular inspection, and detection, and persistence and perseverance with an effective product used appropriately are the keys to success. Of course, it helps if you can convince all the parents of your children’s classmates to put in place similar procedures.

For information on where to find a Head Lice fact card, phone the Pharmaceutical society on 1 300 369 772 or go to the Pharmaceutical Society website at www.psa.org.au and click on Self Care Pharmacy Finder.

©2010 Pharmaceutical Society of Australia

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Jan 20

Ready to quit? Anytime’s a good time

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We may not officially complete the first decade of the third millennium until the end of this year, but as we approach February 2010, the noughties are well and truly gone.

No doubt also gone is all that cold turkey remaining with some of the other left-overs from Christmas dinner or New Year’s Eve celebrations.

Of course, cold turkey is one of the strategies used to fulfil one of the more common New Year’s resolutions – that is: to quit smoking.

As with all lifestyle and behaviour changes such as exercising more, drinking in moderation and modifying our diet, being able to stop smoking can be really difficult at the best of times. During January when parties or paying bills (or both) make life especially stressful, these kinds of resolutions can be really hard to keep.

Nevertheless, when it comes to smoking, any time is a good time to quit; and it’s never too late. Recent studies have shown that for smokers who quit at age 50 the risk of a tobacco related death is reduced by about two thirds; and for those who stop before middle age the risk is little more than for non-smokers.

Now less than 20% of the Australian adult population smokes; and a significant proportion of this 20% would like to join the other 80% non-smokers. No surprise really that many (maybe most) would quit if they could. We all know the dangers of tobacco smoking.

However, becoming and staying a non-smoker doesn’t happen by accident. Smokers who plan before they quit are significantly more successful than those who don’t; and planning can be done quickly and easily. The decision to quit must be yours and yours alone, but to help you plan for long term success you should enlist the support of family and friends. Your pharmacist can also offer you valuable support.

Nicotine replacement therapy (NRT) could be an option worth considering. These nicotine substitutes help to treat the withdrawal symptoms and cravings which can make it so difficult to quit.

When you do stop smoking, your body will most likely still have a need for nicotine – the addictive component of cigarettes – and this is what creates the urge to smoke again. By taking nicotine in a “clean form” – that is without the dangerous carbon monoxide and tar ingredients – the physical withdrawal symptoms are reduced, allowing you to focus your energies on breaking the smoking habit.

The effectiveness of NRT in aiding cessation is well established and is supported by the highest level of clinical evidence. Nevertheless, some people have concerns – unfounded concerns – about the continued use of nicotine to help smokers quit.

The reality is using NRT to quit is always safer than smoking.

Four NRT products are currently available in Australia: patches, gum, inhaler and lozenges. All these medications are now available from pharmacies without prescription; and two prescription-only products (bupropion and varenicline) may also be useful for some smokers who want to become committed quitters.

To help you quit for good, your pharmacist can help you choose the most appropriate product.

For more self help strategies have a look at the fact cards titled Smoking and Staying a Non-smoker available at all Self Care pharmacies. Call 1 300 369 772 for the nearest location or visit the Pharmaceutical Society website at www.psa.org.au and click on Self Care Pharmacy Finder.

©2010 Pharmaceutical Society of Australia

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Jan 13

Which sunscreen and how much?

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Australia has the highest rate of skin cancer in the world; and the use of sunscreen is an important strategy to help reduce the risk of skin cancer and premature aging.

Sun protection factor (SPF) labelling provides a reasonable indication of the effectiveness of sunscreens. The higher the number, the more time we can spend in the sun before burning – well that’s the theory anyway. The reality is that the protection will depend on a number of factors such as how well the sunscreen is applied and the formulation of the product itself (e.g., degree of water resistance).

Since 1998 the highest SPF label permitted has been 30+ (previously it had been 15+). It is now likely that a new maximum level of 50+ will be approved this year.

It’s a somewhat controversial move, because although it will allow us to more clearly differentiate between different sunscreens, the extra protection provided between 30+ and 50+ is minimal.

Perhaps more important for adequate protection is that sunscreens be applied in sufficient quantity and reapplied every two hours .It’s also important that we choose a sunscreen that has protection from the broad spectrum of ultraviolet (UV) rays. SPF ratings are measured on the burning UVB rays, but other wavelengths of ultraviolet light (e.g., UVA) can be carcinogenic too. Sunscreens are usually made up of a combination of chemical and physical UV filters. The physical filters zinc oxide and titanium dioxide are particularly valuable because of their ability to filter both UVA and UVB light.

When incorporated into sunscreens in their coarse powder form zinc oxide and titanium dioxide give the skin a white colour; so they are now generally used in microfined, so-called nanoparticle form. Despite some concerns expressed about the use of nanoparticles in industry, there is currently no evidence to suggest that use of nanoparticles in sunscreens causes damage to skin cells.

Remember the adverse effects of sunlight on the skin are cumulative. The damage on and beneath the skin is building up, even without burning.

Research undertaken by the Cancer Council and the Australian Department of Health and Aging shows that it’s not just the day, or even several days, at the beach that causes the most sun damage to our skin. The many days spent involved with everyday activities, without adequate protection from the sun, might be even more dangerous. And with most states in Australia now “saving daylight”, there is the possibility we will have more usable leisure time in the sunshine.

If you’re 55 years old or more, you were probably in your 30s when the need for skin protection became well recognised; and most of the damage to your skin had already taken place.

Of course, it’s not too late to look after your skin now; but you also need to check your skin regularly for any new spots or a change in appearance of those existing spots.

If you must have a tan, a fake tan is the best option. There are a number of products your pharmacist can recommend which offer a much safer alternative to the sun-induced variety. But, remember, the colour from a fake tan does not provide protection against UV radiation. And fake tan products that contain a sunscreen only provide protection for a few hours after application – not for the duration of the tan.

You can get more advice and a Sense in the Sun Fact Card on how to stay sun smart this summer, from pharmacies providing the Pharmaceutical Society’s Self Care health information. Phone 1300 360 772 for the location of your nearest Self Care pharmacy or check out the Pharmaceutical Society website at www.psa.org.au and click on Self Care Pharmacy Finder.

©2010 Pharmaceutical Society of Australia

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Jan 06

Help with medicine costs

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Health care costs sometimes occur at the most unexpected times; and with the medicines which might be prescribed, we don’t always anticipate what the cost might be and make appropriate allowance in our budget.

For those of us required to take medicines regularly – perhaps for a chronic condition like arthritis, asthma, depression, diabetes, epilepsy or heart disease – the costs might seem a burden, even at the best of times.

As well, each year on 1 January there is an increase in the cost of Pharmaceutical Benefit (PBS) prescriptions. In fact, the total cost of the prescription item may not have increased; it’s actually the so-called patient co-payment which increases – generally in line with the CPI (consumer price index).

Nevertheless, successive Australian governments have maintained policies which have ensured we have access to prescription medicines, proven to be both safe and effective, at the best possible price. And there are ways we can reduce the personal cost of our medicines even further.

At the maximum of now $33.30 per item, the Pharmaceutical Benefits Scheme still offers us pretty good value for money. Some medicines actually cost many hundreds (occasionally even thousands) of dollars more than the co-payment. The full cost of PBS medicines is now printed on the dispensed label, so an indication of the real cost of each medicine is there for us all to see.

And $33.30 is the maximum you should have to pay. Many medicines cost less than this; and if you have a concession card issued by Centrelink (Department of Social Security) or the Department of Veterans Affairs, the maximum amount payable is $5.40 per prescription item.

It is now well known that some brands of medicines cost more than others and the government subsidises up to the cost of only the lowest-priced brand. A doctor or pharmacist can give more advice about this brand price premium and how to avoid any extra charge. At your request the pharmacist can often substitute a less expensive brand. Remember all medicines in Australia are required to meet the Therapeutic Goods Administration’s high standards of quality, safety and effectiveness. The standards are exactly the same for the less expensive and the more expensive brands.

In any event, another way of curbing the cost of prescription medicines is for you to keep a record of spending on PBS prescriptions on a Prescription Record Form (PRF). If you have all or most of your prescriptions dispensed at the same pharmacy, the pharmacist will be able to keep a computer record of these transactions. You can use the PRF to keep a record of items occasionally dispensed elsewhere. Your regular pharmacist can then add items to the computer list.

When you have a record of spending $1281.30 on PBS medicines for yourself and your dependents in a calendar year, the cost of all subsequent items during the year comes back to $5.40 each. This is called the PBS Safety Net. It gives reasonable financial protection for patients and their families if they require a large number of medicines.

For concession card holders, the Safety Net threshold is $324.00 – equivalent to 60 items at $5.40 each – after which there is no charge for any PBS item, provided one of the lowest-priced brands is dispensed.

The Government has also introduced a modification to the Safety Net procedures. It’s called the “20 day rule”. This means that, for certain medicines, if you need a repeat dispensing within 20 days of the previous supply, the cost may not count towards your Safety Net contributions; or if you’ve already reached your Safety Net level, you may have to pay the pre-Safety Net co-payment amount.

The aim of this regulation is to reduce medicine wastage as a result of hoarding or inappropriate use. Your pharmacist can provide you with a brochure with more information about the 20 day rule.

If you want some more advice about the savings you can make with the PBS Safety Net and by choosing the less expensive brands of PBS medicines, ask for the Help with Medicine Costs Fact Card at your local Self Care Pharmacy. Call 1300 369 772 for the nearest location or check out the pharmacy-finder on the Pharmaceutical Society website: www.psa.org.au

©2010 Pharmaceutical Society of Australia

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