List of Records in Centre for Military and Veterans' Health Publications - UQ eSpace

A cluster of melioidosis cases from an endemic region is clonal and is linked to the water supply using molecular typing of Burkholderia pseudomallei isolates

2007-08-14T17:00:11Z

Nine cases of melioidosis with four deaths occurred over a 28-month period in members of a small remote Aboriginal community in the top end of the Northern Territory of Australia. Typing by pulsed-field gel electrophoresis showed isolates of Burkholderia pseudomallei from six of the cases to be clonal and also identical to an isolate from the community water supply, but not to soil isolates. The clonality of the isolates found in this cluster contrasts with the marked genetic diversity of human and environmental isolates found in this region which is hyperendemic for B. pseudomallei. It is possible that the clonal bacteria persisted and were propagated in biofilm in the water supply system. While the exact mode of transmission to humans and the reasons for cessation of the outbreak remain uncertain, contamination of the unchlorinated community water supply is a likely explanation.

A community-based approach to evaluation of health outcomes and costs for telepsychiatry in a rural population: preliminary results

Yellowlees, Peter M. og Kennedy, Craig — 2008-06-06T15:04:33Z

A pilot trial was established to support visiting psychiatric services and local public and private practitioners through the use of videoconferencing. The purpose of the trial was to determine whether people in the community received better health-care with telemedicine. A community-based approach was used to evaluate health outcomes, costs, utilization, accessibility, quality and needs for such services in a rural community in Queensland. Over a two-year period data were collected from 124 subjects who met the criteria of having a mental health problem or mental disorder. Nine further subjects refused to participate in the study. Only 32 subjects used videoconferencing to receive mental health services. Preliminary results did not show any significant improvements in wellbeing or quality of life, although the time span was relatively short. However, the results confirmed that the people were no worse off from a consumer or a practitioner perspective from using videoconferencing. Most consumers found that videoconferencing with a psychiatrist moderately or greatly helped them in managing their treatment, with 98% of them preferring to be offered videoconferencing in combination with local services. Overall, videoconferencing is a crucial part of enhancing psychiatry services in rural areas. However, it is not necessarily cost-effective for all consumers, general practitioners, psychiatrists, or the public mental health service.

A comparison of family functioning, temperament, and childhood conditions in monozygotic twin pairs discordant for lifetime bulimia nervosa

2007-08-14T15:13:14Z

Objective: The authors investigated differences between twins in nine pairs of female monozygotic twins in the Australian Twin Registry who were discordant for lifetime bulimia nervosa. Method: The twins affected and unaffected by lifetime bulimia nervosa were compared on self-report measures, including a measure of parental bonding, four measures of temperament, and six early-childhood medical conditions. Results: No twins had current bulimia nervosa, and there was no difference in weight or eating status between the affected and unaffected twins. The affected twins reported significantly lower self-esteem and less warmth but more overprotection by their mothers during childhood. Conclusions: Although limited by the small number of discordant twin pairs and the inability to detect causal relationships, these results suggest that environmental influences that promote low self-esteem may also increase the risk for bulimia nervosa. These temperamental differences may explain the discrepancies in parenting or perceived parenting.

Adequate primaquine for vivax malaria

2007-08-15T06:58:22Z

Background. Treatment of vivax malaria with primaquine prevents the relapse of infection from residual liver stages of the parasite. Inadequate dosage is related to a higher relapse risk. Methods: A comparison was made of vivax malaria relapse-prevention treatments with primaquine 22.5 mg or 30 mg daily for 14 days on 146 reports to the Australian Army Central Malaria Register. Results: The lower dose of primaquine was found to carry a relative risk of 6.63 for a relapse of vivax malaria compared with the higher dose. Conclusions:The available data presented here suggest that vivax malaria in this region is increasingly tolerant of the 22.5 mg daily treatment regimen of primaquine and that the greater dose of at least 30 mg daily is more effective.

An analysis of why telehealth systems in Australia have not always succeeded

Yellowlees, P. M. — 2007-08-14T16:07:20Z

Telehealth programmes are rather similar to humans in the way that they are planned, develop, grow and ultimately die or disappear. To achieve good life expectancy for a telehealth programme there appear to be three major needs: nurturing, which includes the provision of money, ideas, education, training and innovation; experience, which involves an integrated management process, the achievement of long and wide patterns of usage, the development of updated policies and procedures and the involvement of multiple disciplines; success, which involves evidence of outcomes, evaluation and research, and, most important, the sharing of information through scientific and popular press publications, and conferences and collaborations with internal and external groups. The future of telehealth in Australia is at a watershed. There are now a substantial number of programmes, and there has been a large amount of financial and human investment in telehealth around the nation. There is, however, no forum for national leadership, no national association and little support at federal government level.

An Evaluation of the Effect of Military Service on Mortality: Quantifying the Healthy Soldier Effect

2009-03-25T13:48:08Z

PURPOSE: The healthy soldier effect denotes the proposition that military populations are likely to be healthier than other populations. A systematic review was conducted which aimed to quantify the magnitude of the healthy soldier effect. METHODS: Studies containing mortality rates of military personnel were identified from multiple electronic databases. Studies were included in the meta-analyses if they reported all-cause, cancer, or externalcause mortality in a military population and compared the rates to the general population. Fifty-nine studies were initially identified and 12 were included in the meta-analyses. RESULTS: The overall meta-standardized mortality ratios (SMRs) for all-cause mortality for deployed veterans was 0.76 (95% confidence interval [CI]: 0.65–0.89) and 0.73 (95% CI: 0.56–1.97) for nondeployed veterans based on a mean follow-up of 7.0 and 2.4 years, respectively; for cancer mortality, the SMRs were 0.78 (95% CI: 0.63–0.98) for deployed veterans and 0.75 (95% CI: 0.50–1.14) for non-deployed veterans based on 6.7 and 3.1 years follow-up, respectively; for external-cause mortality, the SMRs were 0.90 (95% CI: 0.72–1.13) for deployed veterans and 0.80 (95% CI: 0.63–1.01) for non-deployed veterans based on 4.8 and 2.0 years follow-up, respectively. CONCLUSION: Military personnel do display a healthy soldier effect that decreases their risk of mortality compared to the general population. The overall healthy soldier effect estimated ranges from 10% to 25%, depending on the cause of death studied and the period of follow-up.

An HPLC assay for carbamazepine Phase I metabolites and their glucuronides in urine

Reith, D. M. og Cannell, G. R. — 2008-06-10T14:02:21Z

A binary gradient HPLC assay was developed for the separation and quantitation of carbamazepine (CBZ), carbamazepine-epoxide (CBZ-ep), carbamazepine-10,11-transdiol (CBZ-diol), carbamazepine-2-hydroxide (CBZ-OH), carbamazepine-3-hydroxide (CBZ-3OH) and carbamazepine-acridan (CBZ-acr) extracted from patient urine. The internal standard was 10-methoxy-carbamazepine. The initial phase was 70:15:15 phosphate buffer-methanol-acetonitrile followed by a linear gradient commencing at 13 minutes to 50:35:15 phosphate buffer-methanol-acetonitrile at 24 minutes. The flow rate was constant at 2 mL/min. The UV absorbance detector wavelength was changed at 18 minutes from 240 nm to 280 nm. Typical retention times for CBZ-diol, CBZ-2OH, CBZ-ep, CBZ-3OH, CBZ-acr, CBZ and internal standard were 5.26, 8.36, 10.46, 12.51, 14.2, 23 and 27.53 minutes respectively. The minimum quantifiable limit (MQL) for all of the analytes was 0.2 mu g/mL except for CBZ-2OH where the MQL was 2 mu g/mL. Precision and accuracy of the assay was 1.3 to 19.4% for the 6 analytes. Liquid-liquid extraction with ethyl acetate resulted in recovery of the analytes from urine greater than 74% except for CBZ-diol where recovery was 40%. The concentrations of the glucuronides of CBZ and metabolites were calculated by measuring their concentrations before and after hydrolysis.

Association between polymorphisms in the progesterone receptor gene and endometriosis

2007-08-15T07:11:10Z

The progesterone receptor (PR) is a candidate gene for the development of endometriosis, a complex disease with strong hormonal features, common in women of reproductive age. We typed the 306 base pair Alu insertion (AluIns) polymorphism in intron G of PR in 101 individuals, estimated linkage disequilibrium (LD) between five single-nucleotide polymorphisms (SNPs) across the PR locus in 980 Australian triads (endometriosis case and two parents) and used transmission disequilibrium testing (TDT) for association with endometriosis. The five SNPs showed strong pairwise LD, and the AluIns was highly correlated with proximal SNPs rs1042839 ({Delta}2 = 0.877, D9 = 1.00, P < 0.0001) and rs500760 ({Delta}2 = 0.438, D9 = 0.942, P < 0.0001). TDT showed weak evidence of allelic association between endometriosis and rs500760 (P = 0.027) but not in the expected direction. We identified a common susceptibility haplotype GGGCA across the five SNPs (P = 0.0167) in the whole sample, but likelihood ratio testing of haplotype transmission and non-transmission of the AluIns and flanking SNPs showed no significant pattern. Further, analysis of our results pooled with those from two previous studies suggested that neither the T2 allele of the AluIns nor the T1/T2 genotype was associated with endometriosis.

A study of Gleason score interpretation in different groups of UK pathologists; techniques for improving reproducibility

2009-04-03T11:36:33Z

Aims: To test the effectiveness of a teaching resource (a decision tree with diagnostic criteria based on published literature) in improving the proficiency of Gleason grading of prostatic cancer by general pathologists. Methods: A decision tree with diagnostic criteria was developed by a panel of urological pathologists during a reproducibility study. Twenty-four general histopathologists tested this teaching resource. Twenty slides were selected to include a range of Gleason score groups 2–4, 5–6, 7 and 8–10. Interobserver agreement was studied before and after a presentation of the decision tree and criteria. The results were compared with those of the panel of urological pathologists. Results: Before the teaching session, 83% of readings agreed within ± 1 of the panel's consensus scores. Interobserver agreement was low (κ = 0.33) compared with that for the panel (κ = 0.62). After the presentation, 90% of readings agreed within ± 1 of the panel's consensus scores and interobserver agreement amongst the pathologists increased to κ = 0.41. Most improvement in agreement was seen for the Gleason score group 5–6. Conclusions: The lower level of agreement among general pathologists highlights the need to improve observer reproducibility. Improvement associated with a single training session is likely to be limited. Additional strategies include external quality assurance and second opinion within cancer networks.

Book Review: Eugenics in Australia: Striving for national fitness

Ellis, N. — 2007-08-15T07:00:44Z

Chloroquine or sulfadoxine-pyrimethamine for the treatment of uncomplicated, Plasmodium falciparum malaria during an epidemic in Central Java, Indonesia

2007-08-14T18:49:00Z

A recent malaria epidemic in the Menoreh Hills of Central Java has increased concern about the re-emergence of endemic malaria on Java, which threatens the island's 120 million residents. A 28-day, in-vivo test of the efficacy of treatment of malaria with antimalarial drugs was conducted among 16 7 villagers in the Menoreh Hills. The treatments investigated, chloroquine (CQ) and sulfadoxine pyrimethamine (SP), constitute, respectively, the first- and second-line treatments for uncomplicated malaria in Indonesia. The prevalence of malaria among 1389 residents screened prior to enrollment was 33%. Treatment outcomes were assessed by microscopical diagnoses, PCR-based confirmation of the diagnoses, measurement of the whole-blood concentrations of CQ and desethylchloroquine (DCQ), and identification of the Plasmodium falciparum genotypes. The 28-day cumulative incidences of therapeutic failure for CQ and SP were, respectively, 47% (N = 36) and 22% (N = 50) in the treatment of P. falciparum, and 18% (N = 77) and 67% (N = 6) in the treatment of P. vivax. Chloroquine was thus an ineffective therapy for P. falciparum malaria, and the presence of CQ-resistant P. vivax and SP-resistant P. falciparum will further compromise efforts to control resurgent malaria on Java.

Clinical pathways in mental health

2008-06-06T16:55:40Z

Comparative safety and efficacy of subcutaneous and intradermal administration of Inactivated Japanese Encepalitis Vaccine during predeployment predeployment preparations in the Australian Defence Force

2007-08-15T10:23:24Z

Compensation and wellness: a conflict for veterans' health

Ellis, N. og Mackenzie, A. og Mobbs, R. — 2009-03-25T14:29:25Z

In Australia greater attention is being given to health determinants, and the dominance of treatment in health policy and budgets is giving away some ground to prevention, health promotion, rehabilitation and disability management. This creates 11 dilemma for compensation systems:should the inclusion criteria be broadened to match the new thinking or should a narrower definition of "disease, injury or death" be retained? This issue is explored in the context of war syndromes among veterans. While veterans experience symptoms more frequently and more severely than military and community controls, their patterns of symptoms are not unique, Current compensation and benefit programs can create iatrogenic effects. It is concluded that compensation systems should be kept as safety nets while resources are provided to improve the capacity of primary health care caregivers, community organisations and veterans with war syndromes and their families to better deal with these problems. Adapting compensation systems to promote wellness through self-management health partnerships is one way of directing resources to individuals and their fammes. Action research at the comrnunlty level with veterans, their families, their organisations, primary health care organisations, policy makers and researchers would allow this sector to work out the best way to apply existing efficacious tools to these modern health problems.

Conceptual issues in continuing professional development of health professionals

Carlton, N og Cherry, M — 2007-08-15T10:31:06Z

Cybermedicine: how computing empowers doctors and patients for better health care

Yellowlees, P. M. — 2008-06-10T15:43:52Z

Dose-response relationship between physical activity and psychological health outcomes

2009-01-13T10:34:11Z

Our aim was to explore the prospective associations between physical activity and psychological health in mid-age and older women who completed mail surveys for the Australian Longitudinal Study on Women’s Health. Health outcomes in study 1 were depressive symptoms and mental health in mid-age women. Health outcomes in study 2 were anxiety and depressive symptoms in older women. Multivariable logistic regression models were used to examine associations between activity reported at an early survey and symptoms reported at a later survey (three and five years later for the mid-age cohort; three years later for the older cohort). At follow-up, mean depressive symptoms scores decreased and mental health scores increased with increasing levels of activity in the mid-age women, and there were risk eductions for women active for 60-150 mins/week (OR 0.79, 95% CI 0.66-0.85). Sedentary women who increased their activity by >60 mins/week had a reduced risk of developing poor mental health (OR 0.69, 95%CI 0.58-0.82). Compared with those who remained sedentary, older women who maintained a high activity level or who increased activity over three years had lower symptom scores (p <0.01). Those who decreased their activity had higher scores (p <0.05). Sedentary women who increased their activity by >60mins/week had reduced risk compared with those who remained sedentary (p <0.001). These findings suggest that psychological health benefits can be derived from relatively low levels of activity and when sedentary women increase their activity by as little as one hour per week.

Effect of mammographic screening from age 40 years on breast cancer mortality at 10 years' follow-up: a randomised controlled trial

2009-04-03T15:43:54Z

Employer attitudes to ethics in occupational health

Ellis, N. — 2007-08-14T12:19:03Z

Evaluating the prevalence and impact of domestic violence

Roberts, G. L. — 2008-06-06T12:08:18Z

Genetic analysis of the age at menopause by using estimating equations and Bayesian random effects models

2008-06-10T11:27:56Z

Multi-wave self-report data on age at menopause in 2182 female twin pairs (1355 monozygotic and 827 dizygotic pairs), were analysed to estimate the genetic, common and unique environmental contribution to variation in age at menopause. Two complementary approaches for analysing correlated time-to-onset twin data are considered: the generalized estimating equations (GEE) method in which one can estimate zygosity-specific dependence simultaneously with regression coefficients that describe the average population response to changing covariates; and a subject-specific Bayesian mixed model in which heterogeneity in regression parameters is explicitly modelled and the different components of variation may be estimated directly. The proportional hazards and Weibull models were utilized, as both produce natural frameworks for estimating relative risks while adjusting for simultaneous effects of other covariates. A simple Markov chain Monte Carlo method for covariate imputation of missing data was used and the actual implementation of the Bayesian model was based on Gibbs sampling using the freeware package BUGS. Copyright (C) 2000 John Wiley & Sons, Ltd.

Genetic and environmental risk factors shared between disordered eating, psychological and family variables

2008-06-10T11:28:18Z

The aim of this paper is to examine the sources and structure of covariation between disordered eating, neuroticism, parental care and protection, self-esteem and emotional reliance on other people. The eating, personality and family functioning measures, obtained from 537 MZ and 344 DZ female twin pairs aged 30-45 years, were examined using multivariate biometrical genetic modeling techniques. The best-fitting independent pathway model suggested that the measure of disordered eating shared unique environmental risk factors with neuroticism and perceptions of parental care. Neuroticism, self-esteem and emotional reliance on others shared genetic risk factors. The specific sources of individual variation for the six variables included a mixture of: (a) genetic, common and unique environment (disordered eating and the parental perception variables), (b) genetic and unique environment (neuroticism) and (c) unique environment only (self-esteem and emotional reliance on others); Disordered eating did not share genetic risk factors with any of the measured variables. The implications of these findings for our understanding of disordered eating are discussed, (C) 2000 Elsevier Science Ltd. All rights reserved.

Genomewide linkage study in 1,176 affected sister pair families identifies a significant susceptibility locus for endometriosis on chromosome 10q26

2007-08-15T07:17:55Z

Endometriosis is a common gynecological disease that affects up to 10% of women in their reproductive years. It causes pelvic pain, severe dysmenorrhea, and subfertility. The disease is defined as the presence of tissue resembling endometrium in sites outside the uterus. Its cause remains uncertain despite 150 years of hypothesis-driven research, and thus the therapeutic options are limited. Disease predisposition is inherited as a complex genetic trait, which provides an alternative route to understanding the disease. We seek to identify susceptibility loci, using a positional-cloning approach that starts with linkage analysis to identify genomic regions likely to harbor these genes. We conducted a linkage study of 1,176 families ( 931 from an Australian group and 245 from a U. K. group), each with at least two members-mainly affected sister pairs-with surgically diagnosed disease. We have identified a region of significant linkage on chromosome 10q26 ( maximum LOD score [MLS] of 3.09; genomewide P = .047) and another region of suggestive linkage on chromosome 20p13 MLS p 2.09). Minor peaks with MLS > 1.0) were found on chromosomes 2, 6, 7, 8, 12, 14, 15, and 17. This is the first report of linkage to a major locus for endometriosis. The findings will facilitate discovery of novel positional genetic variants that influence the risk of developing this debilitating disease. Greater understanding of the aberrant cellular and molecular mechanisms involved in the etiology and pathophysiology of endometriosis should lead to better diagnostic methods and targeted treatments.

Influence of annual mammography from age 40 on breast cancer pathology

2009-03-31T17:54:10Z

The objective of this study was to determine the influence of annual mammography on pathology features of breast cancers in an invited population. We conducted a randomized trial of 53,890 invited and 106,971 control United Kingdom women who were recruited only from those aged 40 years, with central review of cancer histology. We compare the invasive cancer distribution for the categories of size, histological type, grade, and node status in subgroups of the invited population with that of controls. Among 1287 cancers identified in the total population through the end of December 1999, there are major differences among prevalence, incidence, interval, and lapsed-attender and nonattender subgroups for the distribution of cancer numbers in categories of chosen qualitative histological features. These reflect the biases known to affect a population exposed to screening. Comparing cancers from the unbiased group of the invited population with controls shows significant differences in distributions for size, grade, and node status but not histological type. Multivariate logistic regression shows significant reduction (odds ratio, 0.73; P = 0.043) in node-positive status for the unbiased group. We conclude that annual mammography from age 40 years significantly reduces size and positive-node status of invasive cancers in the invited population. The potential for phenotypic drift of grade emphasizes the relevance of screen detection of all grades at sizes smaller than 10 mm.

Initiating an Australian Deployment Health Surveillance Program

2008-04-03T15:55:08Z

Investigating genetic discrimination in Australia: a large-scale survey of clinical genetics clients

2009-03-10T12:21:19Z

We report first results from the Australian Genetic Discrimination Project of clinical genetics services clients’ perceptions and experiences regarding alleged differential treatment associated with having genetic information. Adults (n ¼ 2667) who had presented from 1998 to 2003 regarding predictive or presymptomatic testing for designated matureonset conditions were surveyed; 951/1185 respondents met inclusion criteria for current asymptomatic status. Neurological conditions and familial cancers were primary relevant conditions for 87% of asymptomatic respondents. Specific incidents of alleged negative treatment, reported by 10% (n ¼ 93) of respondents, occurred in life insurance (42%), employment (5%), family (22%), social (11%) and health (20%) domains. Respondents where neuro-degenerative conditions were relevant were more likely overall to report incidents and significantly more likely to report incidents in the social domain. Most incidents in the post-test period occurred in the first year after testing. Only 15% of respondents knew where to complain officially if treated negatively because of genetics issues. Recommendations include the need for increased community and clinical education regarding genetic discrimination, for extended clinical genetics sector engagement and for co-ordinated monitoring, research and policy development at national levels in order for the full benefits of genetic testing technology to be realised.

Iron status among Australian adults: findings of a population based study in Queensland, Australia

2008-08-28T18:16:28Z

Objectives: To describe the concentrations of serum ferritin among Australian adults by age and sex. Further, the relationships of various social, lifestyle and health factors with serum ferritin concentrations were explored. Design: A total of 1634 adults aged ::::25 years from six randomly selected urban centres in Queensland, Australia participated in the study that was conducted between October and December 2000. Results: Prevalence of depleted iron stores, based on low serum ferritin concentration, was 10.6% among females aged <50 years, 2.8% among females aged ::::50 years and virtually nil among males. In contrast, 16% of the males and 20% of the females aged ::::50 years had elevated serum ferritin concentrations. Significantly higher serum ferritin concentrations were found among females of both age groups who consumed alcohol at a rate of >60 drinks/month, and females aged <50 years who were obese. Lower serum ferritin concentrations were found only among females aged <50 years, with higher education attainment. In multivariable analysis, only the association between higher serum ferritin and obesity was consistent across age-sex groups and statistically significant. Conclusion: Iron deficiency may be a problem among Australian females of reproductive age. Further research is needed to identify the determinants of low iron concentrations in younger females and elevated concentrations of serum ferritin in males and older females in order to develop preventive measures.

Lack of in vitro effect of Ivermectin on Plasmodium Falciparum

2007-08-15T02:55:03Z

Mental health service models Queensland style

2008-06-10T15:43:39Z

Physician Assistants:Utilisation In The United States And Internationally - An Update

Liebich, G. — 2007-08-06T07:21:55Z

The contemporary physician assistant (PA) concept emerged in the United States in the mid- 1960s and now has a four decade record of changing health care throughout the country. This achievement has been remarkable in a number of areas but the military use of PAs has been one of the most dramatic. PAs are now in all aspects of medicine in the three branches of the US military, as well as the US Coast Guard, and the US Public Health Service. As the Americans have developed their cadre of PAs the Canadians have done so as well but utilizing a tri-service form of PA. Both these countries offer remarkable models of adaptation and innovation in extending the career performance of their medical support services.

Public health policy: the new professionalism?

Ellis, N. M. — 2008-04-09T11:12:54Z

Radiological and pathological findings of interval cancers in a multi-centre, randomized, controlled trial of mammographic screening in women from age 40–41 years

2009-04-01T17:03:04Z

Rainy-season prevalence of malaria in Bobonaro district, East Timor

2007-08-14T18:48:56Z

Randomised controlled trial of mammographic screening in women from age 40: predicted mortality based on surrogate outcome measures

2009-04-03T11:04:33Z

A trial in the UK to study the effect on mortality from breast cancer of invitation for annual mammography from the age of 40–41, has randomised a total of 160 921 women in the ratio 1 : 2 to the intervention and control arms. All breast cancers diagnosed in the two arms have been identified, and the histology reviewed. This paper presents the results of an interim analysis using surrogate outcome measures to compare predicted breast cancer mortality in the two arms based on 1287 cases diagnosed to 31.12.1999. Due to earlier diagnosis, there is currently an 8% excess of invasive breast cancers in the intervention arm. The ratio of predicted deaths at 10 years in the intervention arm relative to the control arm, adjusted for this excess diagnosis, ranges from 0.89 (95% confidence interval (CI) 0.78–1.01) to 0.90 (95% CI 0.80–1.01). Screening from age 40 may result in a lower reduction in breast cancer mortality than that observed in other trials including women below age 50. This analysis based on surrogate outcome measures suggests that a reduction in breast cancer mortality may be observed in this trial. However, a number of assumptions have been necessary and firm conclusions must await the analysis of observed mortality from breast cancer.

Randomized, double-blind, Phase 111, pivotal field trial of the comparative immunogenicity, safety, and tolerability of two yellow fever 17D vaccines (ARILVAXTMand YF-VAX) in healthy infants and children in Peru

2007-08-15T06:43:48Z

Report on the pilot study in Dental Risk Management in the Australian Defence Force

2007-08-14T13:43:48Z

Review of Health & Work Productivity: making the business case for quality health care

Ellis, N. M. — 2008-04-09T10:49:26Z

Short report: Lack of sex effect on the pharmacokinetics of primaquine

2007-08-15T10:31:09Z

The pharmacokinetics of primaquine have been well defined in male volunteers, but there is little data on the disposition of the drug in women. We compared the kinetics of primaquine in nine male and nine female healthy Australian volunteers after the administration of a single oral dose (30 mg base) of primaquine. No statistical differences were observed in the following kinetic parameters of primaquine between men and women, respectively: maximum plasma concentration (93 +/- 26 and 115 +/- 38 ng/mL; 95% confidence interval [CI] of the mean difference: -55 to 10 ng/mL; P = 0.16), area under the curve (1.1 +/- 0.5 and 1.2 +/- 0.4 mu g.h/mL; 95% CI: -0.6 to 0.3 mu g.h/mL; P = 0.54), and clearance (0.34 +/- 0.12 and 0.39 +/- 0.14 L/h/kg; 95% CI: -0.17 to 0.08 L/h/kg; P = 0.46). The clinical relevance of such findings would suggest that sex does not have to be taken into account as a factor when prescribing primaquine for radical cure or terminal prophylaxis of Plasmodium vivax malaria.

Short Report: Tafenoquine for the treatment of recurrent Plasmodium Vivax Malaria

2008-04-08T15:17:32Z

Tafenoquine was used to treat Plasmodium vivax malaria cases who had previously failed treatment with chloroquine and primaquine. Chloroquine was followed by a loading dose of tafenoquine (200 mg base/day for 3 days) and 200 mg a week was given for 8 weeks. One of 27 treated patients relapsed after 6 months of observation. A standard course of chloroquine administered with 8 weeks of tafenoquine may be more effective than chloroquine with primaquine (22.5 mg/day for 14 days) in preventing additional P. vivax relapses. Larger studies are required to optimize the combination, but our findings suggest that an extended use of tafenoquine may be required to prevent relapses of primaquine-tolerant strains of P. vivax malaria.

Short Report: The activity of Pamaquine, an B-aminoquiloline drug, against sporozoite-induced infections of Plasmodium vivax (New Guinea strains)

2007-08-15T05:04:36Z

Skin cancer medicine in primary care: towards an agenda for quality health outcomes

2007-08-15T09:14:12Z

The number of skin cancer clinics functioning within Australia's primary care environment is increasing rapidly, and significant concerns have been raised about the type and quality of work done by some doctors in some clinics. Mainstream general practice is threatened by perceived fragmentation, and specialist practice in dermatology and plastic surgery is threatened by encroachment into their domains of practice. We propose an agenda of training, standards, accreditation, audit and research to ensure that skin cancer clinics provide optimal health outcomes for patients.

Spontaneous Activity Responses to Exercise in Males and Females

2009-03-30T15:51:57Z

Successfully developing a telemedicine system

Yellowlees, P. M. — 2008-06-06T12:31:51Z

The B’Active programme for overweight primary school children in Glasgow: determining the prevalence of overweight and obesity and piloting an activity intervention

2009-04-01T10:39:03Z

The aim of this study was to determine the prevalence of overweight and obesity in primary school children in Glasgow and to evaluate a pilot activity programme for overweight and obese children. BMI was measured in 1548 children. Overweight, obesity and severe obesity were defined as BMI ≥ 85th, 95th and 98th centile, respectively. Overweight and obese children were then invited to participate in a 10-week school-based activity programme. The programme was evaluated by recording weekly attendance, intensity (using the Children's Effort Rating Scale) and enjoyment (scale 1–10). Focus groups were used to explore the experiences and views of the children, teachers, coaches and parents. Of the 1548 children, 31·4 % were overweight, 19·1 % were obese and 12·4 % were severely obese; 38 % of those invited attended the activity programme. Weekly programme attendance was 83 % (range 56–99 %). Mean enjoyment rating (scale 1–10) was 8 for boys and 9 for girls. The intensity of activity sessions were rated ‘very easy’ by boys and ‘just feeling a strain’ by girls. Common themes emerging from the focus groups related to perceived positive and negative aspects of the programme (fun, concerns about stigmatising children); physical and psychological outcomes (fitter, more confident); and future recommendations (involve parents). In summary, the prevalence of overweight and obesity was high. The activity programme was successful in terms of attendance and enjoyment, and overall views of the initiative were positive and there was compelling support for its continuation

The "c" word and Telehealth International

Yellowlees, P. M. — 2008-06-10T13:18:43Z

The Deployment Health Surveillance Program: vision and challenges of health surveillance for Australian military cohorts

2009-02-19T16:14:55Z

The Australian Government has supported the establishment of a Deployment Health Surveillance Program for the Australian Defence Force. Although some health screening mechanisms already exist for Australian Defence Force personnel, until now health data have been used largely for clinical management at an individual level and have not been aggregated to identify trends in health and risk factors in the shorter or longer term. We identify challenges for and potential benefits of health surveillance in the military context, describe features of the Program and progress to date. Retrospective and cross-sectional projects based on deployments to the Near North Area of Influence since 1997 are under way. A planned prospective model of health surveillance for those deploying to the Middle East promises more timely attention to any emerging health problems for military personnel and veterans.

The development of a quality assurance programme for HPV testing within the UK NHS cervical screening LBC/HPV studies

2009-04-03T10:22:35Z

Background: Cervical screening by cytology is effective but lacks sensitivity. The addition of human papillomavirus (HPV) testing can improve the effectiveness of screening for early identification of cervical disease. As HPV testing represents a new technology, a quality assurance (QA) programme is necessary to confirm the accuracy of results. Objective: Our main objective was to design a QA programme for use in the English NHS liquid-based cytology (LBC) and HPV Cervical Screening Pilot Study. Our second objective was to use the knowledge gained to design a QA scheme for future general use within cervical screening and HPV testing programmes. Study design: Four elements were included in the programme: provision of clinical samples of known HPV status for internal quality control (IQC), distribution of panels of unknown samples for external quality assessment (EQA), resubmission of aliquots of samples to the reference laboratory for repeat testing and resubmission to reference laboratory to check for transport problems. Three sites took part in the QA programme using PreservCyt® medium and ThinPrep® for LBC preparation. The assay used at test sites was HPV hybrid capture (hc2) while the quality assurance laboratory used a combination of hc2, in-house HPV polymerase chain reaction (PCR) tests and HPV linear array (LA). Results: Four negative, three low positive and 11 positive pools were used in 22 distributions of IQC samples. Seven distributions each of five ‘unknown’ EQA samples were sent out. Over 400 samples underwent repeat testing. Discrepant samples were further assessed to provide an explanation. Inter- and intra-laboratory consistency was high as measured by Kappa statistics and 96% agreement for EQA samples was obtained. Conclusions: The validity of the QA programme was established and reproducibility in different lab settings was reassuring. These results support the use of hc2 as a potential screening test in diagnostic laboratories. The need for robust quality assurance of HPV testing in cervical screening programmes was confirmed and lessons learnt from this pilot study will be incorporated in future schemes.

The Effect of Mammographic Screening and Hormone Replacement Therapy Use on Breast Cancer Incidence in England and Wales

2009-04-07T13:25:12Z

Design: An extended age-period-cohort model was used to estimate the effect of mammographic screening and hormone replacement therapy on breast cancer incidence in England and Wales between 1971 and 2001. Results: Incidence of breast cancer increased noticeably in women attending screening for the first time compared with nonattenders [rate ratio (RR), 1.73; 95% confidence interval (95% CI), 1.67-1.80]. Incidence was also 18% to 35% higher in attenders relative to nonattenders in subsequent screening rounds. In the first 3 years after women left the screening program, rates of breast cancer were reduced (RR, 0.88; 95% CI, 0.86-0.90), but by 7 to 9 years after screening, the rates had returned to the expected level (RR, 0.97; 95% CI, 0.94-1.00). The estimated RR of hormone replacement therapy on breast cancer incidence was 1.55 (95% CI, 1.37-1.75). Screening is estimated to increase a woman's lifetime risk of being diagnosed with breast cancer from 7.8% to 8.6%. Conclusions: It is estimated that in the absence of screening, rates of breast cancer incidence would have continued to increase. A study at the individual subject level would be beneficial to assess the level of overdiagnosis associated with breast cancer screening. (Cancer Epidemiol Biomarkers Prev 2007;16(11):2257–61)

The measurement of a case manager's worload burden

Meldrum, L. og Yellowlees, P. M. — 2008-06-10T13:17:20Z

The Royal Australian and New Zealand College of Psychiatrists 35th Annual Congress

2008-06-06T11:27:16Z