Research Activities 2001-2002

Communicable Diseases

Lymphatic Filariasis

Evaluation of a new dipstick for Brugia antibodies (in collaboration with University of Malaysia and WHO East Timor). A dipstick developed by the University of Malaysia was field tested in East Timor and compared with conventional antibody ELISA. Preliminary results indicate that it is as sensitive and specific as the ELISA gold-standard.
Investigator: W Melrose.
Evidence of filarial exposure and infection in Australian Defence personnel returning from East Timor (In collaboration with Army Malaria Institute, Queensland Institute of Medical Research and National Institutes of Health USA). Lymphatic filariasis was a major problem for the armed forces in the central Pacific during World War II but little has been done to estimate the threat it poses to military forces on deployment today. Filarial serology is being conducted on troops before and after deployment.
Investigator: W Melrose.
Prevalence of Glucose 6 phosphate dehydrogenase deficiency (G6PD), lymphatic filariasis and intestinal helminths in East Timor (WHO Collaborative project). No information is available on the prevalence of G6PD in East Timor - an important consideration when introducing anti-malarial medication for case management and malaria control. In addition there is no recent information on important human parasites in East Timor and this had to be addressed as the national Ministry of Health has decided to introduce control programs for intestinal helminths and lymphatic filariasis in the near future. Blood samples were collected from local military recruits and three communities in different parts of the country. Stool samples were obtained from school children in the communities studied. The prevalence of G6PD deficiency was less than 2% and lymphatic filariasis approximately 10%. Almost all children were infected with intestinal helminths and protozoa.
Investigator: W Melrose.
Filarial imunological profiles in populations with and without elephantiasis. Study results demonstrated that in a population where there is a high prevalence of elephantiasis the "chronic" immunopathological profile began developing in filarial antigen positive older children and teenagers who had no clinical evidence of lymphodema or elephantiasis. This was not seen in the population where elephantiasis is extremely rare. It appears that the "path towards chronic filarial pathology" begins early in life and is "steered" by an as yet unknown mechanism.
Investigator: W Melrose.

Ectoparasites

Pediculosis

Transmission of head lice (Pediculus capitis). Although the global increase in pediculosis is well recognised, little is known about the exact nature of head lice (Pediculus capitis) transmission. Several mechanisms have been proposed such as head-to-head and fomite transmission, but some contention remains concerning the primary transmission route. This study investigated spatial and kinetic factors influencing the dynamics of hair-to-hair transfer to further clarify how head lice transmit from head to head. Forty-eight factorial experimental trials, with 10 replicates each, were conducted using 480 freshly caught P. capitis from primary school children. In the trials, each louse was placed on a stationary suspended hair or a mobile hair and was presented with mobile or stationary hairs for transmission. All hair passes involved contact between the uninhabited hair and the lice. Hairs without a louse were presented dorsally, laterally and ventrally to the louse. They were also passed from head to tail or from tail to head and were moved at speeds of 8 m and 4 m per min. The proportion of P. capitis transmission was highly dependent on the specific setting. The tail-to-head direction, slow movement and a parallel direction all proved favorable for transmission. The highest transfer proportion of P. capitis (85%) was observed in the setting where the presented hair was laterally slow moving in a parallel way from tail to head. No transmission was observed under an angle of 90 degrees. Hair-to-hair P. capitis transmission occurred more frequently when hairs were in particular physical and kinetic relationships. This suggests that head lice are less likely to take advantage of many proposed fomite transmission scenarios and are most likely to rely on head-to-head contact for transmission. Lice survived immersion for 30 minutes in fresh and salt water and in chlorinated water from fresh and saltwater swimming pools. In a survey of dust vacuumed from the carpets in 118 primary school classrooms we found no lice. The children using those classrooms had 14,033 lice on their heads. These studies showed that lice used specific cues in transferring between hairs. Potentially they could survive in a swimming pool, but may not actually become dislodged. The risk of acquiring lice from carpets in school classrooms and, by extrapolation, homes, is zero.
Investigators: D Canyon, R Speare.
Control of head lice, Pediculus humanus capitis. A major aim of the Head Lice Research Centre has been to improve the evidence base on the effectiveness of strategies to treat and control head lice at the level of the individual, small groups and the community. Prevalence studies on pediculosis showed that it is a common infection in North Queensland and Victorian primary school children, with point prevalences of active pediculosis of 19% and 13% respectively. A study of head lice on pillow slips found small numbers of lice on 4% of pillow slips indicating that pillows posed a potential risk for transmission, but a minor one. The Head Lice Research Centre has demonstrated that lice on pillow slips can be killed by heat in a hot wash, a hot dryer or immersion in water at 60°C. Insecticide resistance is common. Studies at JCU in collaboration with the University of Queensland found 70% of lice resistant to permethrin and pyrethroids, and less than 10% resistant to malathion.
Investigators: R Speare, D Canyon, C Cahill, M Counahan.

Intestinal nematode parasites

Srongyloidiasis

Fatal strongyloidiasis - a structured review of the literature. This study on the intestinal parasitic nematode, Strongyloides stercoralis, is a structured literature review of fatal cases of strongyloidiasis in the published literature to determine what non-clinical management factors failed to prevent the terminal event. Approximately 125 papers with 250 eligible cases have been identified. The results of this structured review will highlight common errors and omissions that led to the fatal hyperinfective syndrome.
Investigators: R Speare, D Dürrheim, S White.
Behaviour of infective larvae of Strongyloides in the soil. This detailed study of behaviour of infective larvae of Strongyloides in different soil types and with different moisture levels aims to identify high risk microenvironments in tropical rural communities, and facilitate design of environmental health strategies to reduce the survival of infective larvae.
Investigators: R Speare, D Canyon, W Melrose.

Vectors and vector-borne diseases

Malaria

South East African Combination Antimalarial Therapy evaluation. The South East African Combination Antimalarial Therapy (SEACAT) evaluation is currently working together with five participating African Malaria Control Programmes to comprehensively evaluate the feasibility and impact of the phased implementation at provincial and district level of Artemisinin-based Combination Therapies (ACT) as first-line malaria therapy in Mozambique, South Africa and potentially Swaziland. The SEACAT evaluation includes monitoring of therapeutic efficacy, molecular markers of resistance, drug safety, treatment seeking, drug utilisation (especially drug availability and patient drug use), distribution and intensity of malaria transmission, and the costs and cost effectiveness of implementing ACT. This evaluation was initiated in 2000 and will be completed in 2005, by which stage it is intended that the malaria control programmes involved will have the capacity to continue to conduct these evaluations on a regular basis for implementation of future treatment policy changes. The evaluation is nested within the Lebombo Spatial Development Initiative, a multilateral initiative for ensuring economic growth in the study area through improving infrastructure and malaria control. There was a great deal of research activity in all aspects of the SEACAT research program during 2002, including extended in vivo efficacy studies of first-line malaria therapy in KwaZulu-Natal, Mpumalanga and Limpopo Provinces of South Africa, and Maputo Province, Mozambique. Unique clonal molecular markers of resistance were elucidated with collaborators from the London School of Hygiene and Tropical Medicine. Detailed baseline treatment seeking, drug utilization and economic evaluations were conducted in KwaZulu-Natal, Mpumalanga and southern Mozambique. Following the demonstration of high levels of sulphadoxine-pyrimethamine (SP) resistance in KwaZulu Natal and marked increases in morbidity and mortality, artemether-lumefantrine was implemented as first line treatment early in 2001. This is the first time that this combination has been utilized in an African malaria control program. The SEACAT study team demonstrated significant improvements in morbidity and mortality, and a 78% reduction in notified cases, 82% reduction in hospital admissions and an 87% reduction in notified malaria deaths. A 42-day in vivo artemether-lumefantrine therapeutic efficacy study conducted in 2002 demonstrated only one parasitological failure (1/100) at day 28. These preliminary results show an increase of >61% in the clinical and parasitological cure rate, and a 68% decrease in gametocyte carriage when compared to SP monotherapy results in 2000. A pilot antimalarial drug safety evaluation was conducted in Mpumalanga and KwaZulu Natal to develop a feasible and sustainable method for ensuring that data is routinely collected and analyzed for suspected serious adverse drug reactions. The activities piloted included an intensive spontaneous reporting system, follow up of the outcomes of most notified patients, confidential enquiry into all malaria related deaths and a sentinel hospital based active surveillance programme.
Investigators: K Barnes, D Dürrheim, B Sharp.
Factors influencing malaria treatment policy change. There is very little information on the decision-making process preceding malaria therapy policy changes or subsequent success in implementing policy changes in sub-Saharan Africa. In collaboration with colleagues from the Centers for Disease Prevention and Control, Atlanta and the University of Cape Town, a retrospective case-study into the differential implementation of a policy change from chloroquine to sulphadoxine-pyrimethamine for first-line treatment of malaria in two South African Provinces, Mpumalanga and Limpopo Province, was conducted. Focus group discussions, in-depth interviews, participatory exercises and archival documentary analysis were used to explore the change from the perspective of national and provincial policy-makers and programme managers. All national and provincial stakeholders mentioned the need for local efficacy data as an essential pre-requisite for changing malaria treatment policy. However, this was not sufficient alone to ensure a successful change. In both provinces, it was recognized that, for a policy change to be effective and implemented at peripheral levels of the health system, the proposed change had to have official sanctioning from credible sources. An effective strategy used to promote change was emphasizing the potential negative consequences, particularly excess mortality, of failure to implement a treatment change. Physical removal of all previously recommended treatment from public health care facilities appeared to be a key factor in ensuring successful implementation.
Investigators: D Dürrheim, H Williams, K Barnes, B Sharp, R Speare.
Infectivity of Plasmodium falciparum gametocytes to Anopheles arabiensis after treatment with sulphadoxine-pyrimethamine. Two in vivo studies of the efficacy of the first-line antimalarial treatment, sulphadoxine-pyrimethamine (SP) conducted in Mpumalanga Province, South Africa revealed increasing gametocyte rates in treated patients peaking at 14 days post-treatment. As this could have important implications for transmission of disease, a study was conducted to determine the infectivity of Plasmodium falciparum gametocytes to Anopheles arabiensis post-SP treatment. This study built on the findings of an earlier study in this population, which demonstrated oocysts in the midguts of mosquitoes fed with gametocyte-containing blood. After a single dose of SP was administered to each consenting patient, follow-up was conducted on day 14 to coincide with the peak gametocytemia previously documented. Three to 4 day old laboratory reared An. arabiensis mosquitoes, starved for 12 hours were fed for 30 minutes with the venous blood of ten patients demonstrating increased post-therapy gametocytemia, using a membrane feeder. Fed mosquitoes were maintained in the insectary at 25-280C and 70-85% relative humidity on a daily supply of sucrose for 14 days and then sacrificed. The head and thorax of 613 mosquitoes were assayed for the infective form of P. falciparum, sporozoites, by ELISA. All assays were negative. Thus, simply determining gametocyte density in blood smears after treatment or demonstrating oocysts in mosquito midgets, does not equate with infectivity of gametocytes to mosquitoes.
Investigators: J Govere, D Dürrheim.

Control

Biochemical mechanisms of insecticide resistance in mosquitoes. Organophosphate and synthetic pyrethroid insecticides are critical to the day-to-day control of Aedes aegypti, particularly during dengue fever epidemics. Researchers from the Anton Breinl Centre used the WHO kill-assay for populations of insects, to show that some populations of A. aegypti in North Queensland are resistant to organophosphate and synthetic pyrethroid insecticides. However, the WHO kill-assay is a blunt tool that has been replaced by biochemical and DNA tests in other parts of the world. These biochemical and DNA tests allow individual insects to be genotyped for resistance and thus allele frequencies to be determined precisely. Thus, the development of resistance can be monitored closely and effective control ensured. Currently, pure field strains of A. aegypti that are resistant to temephos (organophosphate) and bioresmethrin (synthetic pyrethroid) are being generated and biochemical tests for determining resistance to temephos and bioresmethrin in individual mosquitoes are under development.
Investigator: D Canyon.
Novel larvicidal botanical extracts. Many mosquitoes transmit important diseases such as malaria, filariasis and several viral diseases. Due to the ecological and human hazards of insecticides, attention has been directed towards bio-pesticides, which include entemopathogenic fungi, bacteria, botanical extracts, nematoda and protozoa, and insect growth regulators. Present research aims to investigate the efficiency of predatory insects in biological control of specific vector mosquitoes and to evaluate the susceptibility of Culex mosquito larvae to bio-pesticides. Other factors that govern mosquito susceptibility, including larval instar, exposure period, temperature, joint action of binary mixtures and non-target effects are being investigated.
Investigators: D Canyon, E Shaalan.

Veterinary Public Health

Management of diseases of amphibians. The Amphibian Diseases Research Group has conducted a series of research projects aimed to provide evidence that can assist wildlife managers to make informed decisions on management of threatened species of native amphibians. The group has continued retrospective surveys in Australia, Venezuela, Ecuador and South Africa to determine the origin of the amphibian chytrid fungus, Batrachochytrium dendrobatidis. South Africa currently has the earliest record, more than 30 years prior to the next earliest record in USA. Other projects have provided data on frogs and chytridiomycosis in banana plantations in North Queensland, causes of amphibian deaths, disinfection techniques for B. dendrobatidis, and survival of B. dendrobatidis in the environment. Training scientists and veterinarians in the diagnosis of chytridiomycosis has been an important educational activity of the group.
Investigators: R Speare, L Berger, D Mendez, M Johnson.
Leptospires in rats and frogs in banana plantations. Leptospirosis has a higher incidence in workers in the banana industry in North Queensland than in other regions of Australia. In the Tully region 25 rats were trapped in banana plantations and surrounding grassland and rain forest, and 63 frogs were collected from bananas coming into packing sheds. They were sacrificed and their kidneys cultured for leptospires. Leptospires were cultured from 12% of rodents and none of the frogs. This was a collaborative project between Queensland Parks and Wildlife Service and Scientific Services, Queensland Health.
Investigators: R Speare, D Mendez, M Johnson.

Surveillance in Developing Settings

Polio eradication - the validity of surveillance indicators. A major prerequisite for polio-free certification by the World Health Organization is that the local surveillance system successfully detects 1 case of non-polio Acute Flaccid Paralysis (AFP) per 100,000 children below 15 years of age per annum, and that no cases of polio occur for three consecutive years. In 1998, Mpumalanga, a rural province in the northeast of South Africa, implemented a rapid reporting system for nine infectious disease syndromes, including AFP, with infection control nurses at all hospitals were trained as the primary surveillance agents for immediately reporting any patients meeting the case definitions to the Provincial AFP Surveillance Officer. Weekly zero reporting is a component of the system. We participated in a comprehensive review of the surveillance system between 1997 and 2001 inclusive, with particular attention to the relevance of polio eradication surveillance indicators. The non-polio AFP reporting rate per 100,000 children below the age of 15 years increased from 0.56 in 1997 to 0.91 during 1998 after introduction of the enhanced surveillance system. There was 100% reporting completeness from April 1999 to December 2001. Although non-polio AFP reporting rates were 0.27 (1999), 1.18 (2000) and 0.87 (2001), the 95% binomial exact confidence intervals for all years included 1 per 100,000. A review of paediatric admissions from January 1998 to December 2001 at all hospitals revealed that only five AFP cases had been missed by the enhanced surveillance system. The low international AFP reference rate and attendant variation expected due to chance, particularly in areas with relatively small populations, is an important factor that has not previously enjoyed any attention. The global eradication program is now considering the implications of these study's results.
Investigators: B Harris, D Dürrheim, G Ogunbanjo.
Effective leprosy surveillance post-elimination. In South Africa, leprosy has been a notifiable condition since 1921. Although the WHO elimination target of less than one case per 10,000 population has been achieved at country level, the distribution of leprosy in the country is distinctly heterogeneous, with a prominent 'leprosy belt' of greater prevalence stretching across Mpumalanga Province into northern Kwa-Zulu Natal. The highest prevalence in this 'belt' has historically been Ermelo District, Mpumalanga. Recent trends of few newly detected leprosy patients in this district raised concerns that health system changes may have resulted in failure to detect leprosy cases. Thus a large-scale community awareness campaign was conducted followed by an intensively advertised screening programme of three months duration at schools and central gathering points in villages and farms. One thousand one hundred and seventy-seven people presented for clinical screening at designated points, while 790 scholars were screened at schools and an additional 1433 people were screened at their homes by the field team. Forty-four people with skin or nervous system lesions compatible with leprosy were referred for specialized assessment and biopsy where indicated. Four new leprosy patients were diagnosed, including an elderly lady with pronounced disability. Two of these patients had prior contact with the health service due to dermatological manifestations of leprosy without diagnosis being made. All patients provided a history of close prolonged contact with known leprosy patients. Ongoing intense tracing and follow-up of close contacts of proven leprosy cases may be a more efficient method of detecting leprosy cases in areas with relatively stable populations that have accomplished 'leprosy elimination', than resource intensive community surveys.
Investigators: D Dürrheim, A Fourie, E Balt, B Harris, R Speare.

Cancer

Agreement between self-assessment of melanocytic naevi (moles) by patients compared to counts of naevi conducted by dermatologists and counts conducted from photographs. The parents of 421 schoolchildren (6-15 years) from Townsville were asked to mark the melanocytic naevi (MN) 2mm and 5mm on their child's back on an anatomical diagram prior to being examined by a dermatologist: 324 responded. Standardized slide photographs of the back were taken and MN were counted by an experienced non-medical examiner on projection. An assessment of the agreement of counts of MN between parents, a dermatologist, and photographs was undertaken. Parental MN counts were similar to dermatologist counts (2mm rc = 0.507) and counts from photographs (2mm rc = 0.682). Few parents reported false positive lesions. Parents tended to underestimate MN of 2mm (mean difference: versus dermatologist -3.2 versus photo -1.1), particularly when MN density was high. Agreement between dermatologist and photograph counts was high (2mm rc = 0.801; 5mm rc = 0.868). Thus, parents are capable of counting MN on their children's skin with some validity. In epidemiologic studies of children, standardized photographs have the potential to replace physician counting of MN.
Investigators: S Harrison, P Büttner, R MacLennan, J Rivers, J Kelly.
An educational intervention to change risky beliefs and practices of midwives and related nursing staff who recommend therapeutic sun exposure during infancy and the post-partum period The purpose of this project is to develop, pilot and evaluate a targeted educational intervention that will address risky beliefs about therapeutic sun exposure held by a considerable proportion of the nursing staff working in Queensland maternity hospitals. The project was developed in response to earlier research that identified the nature and extent of such risky beliefs. Pre and post intervention comparisons involve structured interviews and self-administered questionnaires.
Investigators: S Harrison, S Devine, V Saunders.
An investigation of maternal beliefs about the therapeutic use of sun exposure during infancy and the post-partum period. The use of sunlight for medicinal purposes dates back to ancient Rome and Greece. However, it is assumed that our more recently acquired knowledge of the detrimental effects of sun exposure, such as skin neoplasia have put an end to such practices. Post-partum North Queensland women were interviewed to investigate the spectrum of beliefs and attitudes regarding the therapeutic use of sun exposure in infancy. Half the women had at least one risky belief about the perceived benefits of sunning their baby; 36% were in favour of using sunlight to treat neonatal jaundice; 20% believed it was necessary to intentionally sun their baby to prevent vitamin D deficiency and 11% thought sunlight was a good remedy for nappy rash. Independent predictors of one or more of these beliefs included having another child that had been treated for jaundice.
Investigators: S Harrison, M Nowak.
An investigation of professional advice advocating therapeutic sun exposure. Health professionals (midwives, medical officers in post-natal wards, paediatricians) in Queensland and ACT who deal predominantly with post-partum women were surveyed to determine the prevalence of professional advice advocating therapeutic sun exposure for the common ailments of infancy. The results will now be translated into recommendations.
Investigators: S Harrison, L Hutton, M Nowak.
An investigation of the association between squamous cell carcinoma and human papilloma virus. Human papilloma virus (HPV) appears to be associated with skin cancer, particularly squamous cell carcinoma (SCC). If HPV is related to SCC, preventive vaccines or anti-viral medications could be developed for use in high-risk patients to reduce the skin cancer burden. A collaborative (QIMR) case-control study is being conducted with an anticipated recruitment in Townsville of 50 to 80 cases with sex and age matched controls. Cases are being recruited from The Townsville Hospital and private practitioners, with controls being recruited from community groups. Data collection includes a questionnaire, count of solar keratoses and samples of SCC lesions, normal skin, blood and eyebrow hairs. To date, 23 cases and 6 controls have been recruited in Townsville.
Investigators: S Harrison, P Büttner, B Raasch, A Green, R Neale, M Glasby.
An open-label study to evaluate the safety and long-term clinical efficacy of Imiquimod 5% cream applied once daily 7 days a week for 6 weeks in the treatment of superficial Basal Cell Carcinoma. The objective of this study is to determine whether this treatment regime is effective in the clearance of superficial Basal Cell Carcinomas (BCC) (2cm in diameter (at least one dimension) and to determine the safety and cosmetic outcome of this treatment. All nine participants successfully completed the treatment phase of the protocol and continue to participate in the 5-year follow-up review schedule. In addition, an open-label study to evaluate the safety and long-term clinical efficacy of Imiquimod 5% cream applied once daily 5 days a week for 6 weeks in the treatment of large superficial multifocal BCC is being conducted. The objective of this study is to determine whether this treatment regime is effective in the clearance of superficial BCC (2cm in diameter (at least one dimension) and to determine the safety and cosmetic outcome of this treatment. All 6 participants have successfully completed the protocol and data are currently being analysed.
Investigators: B Reid, B Raasch, J Maguire, R Miller, M Glasby.
Randomized controlled intervention trial to determine whether it is possible to prevent or delay the development of a significant proportion of the melanocytic naevi (moles) that develop in early childhood through the rigorous use of sun-protective clothing. A randomised controlled intervention trial is underway in 26 of the daycare centres in Townsville, which have separate baby units (n=13 control centres; n=13 intervention centres). The study aims to determine if it is possible to prevent or delay the development of a significant proportion of the moles that develop in early childhood. All intervention centres have been provided with sun-protective clothing for children in their baby units. Naevus development (number, size, and location of naevi) will be monitored regularly for 3 years. Total and site-specific naevus frequencies in the two groups will then be compared.
Investigators: S Harrison, P Büttner, R MacLennan, J Woosnam.
Baseline survey of sun protection knowledge, practices and policy in early childhood settings throughout Queensland. This research was initiated to provide baseline data about sun protection knowledge, practices and policies currently in use in all early childhood services operating in Queensland. This information, together with a second evaluation to be conducted in 2006-7, will be used to assist the Skin Cancer Research Group at ABC in conjunction with the Early Childhood Implementation Group (Committee formed under the auspices of Queensland Health) to evaluate the effectiveness of any educational interventions that are directed at this target group over the life of the Queensland Skin Cancer Prevention Strategic Plan 2001-2005. Data was collected using a self-administered questionnaire, with 54% of Queensland early childhood services responding. Survey responses highlighted areas for the Early Childhood Implementation Group to target in their interventions. These areas include the need for: * improved knowledge of the relationship between moles and melanoma, the UV index, and the meaning and measurement of SPF factors; * in-service training about sun protection; * improved sun protection practices; and * targeted resources for early childhood services.
Investigators: S Harrison, V Saunders.
Development of melanocytic naevi in a cohort followed since birth. In 1994, a cohort of 115 Caucasian neonates born in Townsville were recruited for a longitudinal study of naevus development. Professor Rona MacKie (Dept. Dermatology, University of Glasgow) recruited a similar birth cohort (n=157) and the results have been compared. The proportion of Australian children with melanocytic naevi increased rapidly in the first 2 years of life from 2.3% at birth to 10.8% at 6 months, 65.2% at 12 months, 92% at 18 months and 100% at 24 months. Corresponding proportions for the Scottish cohort were similar at birth, but considerably less at 12, 24 and 36 months when 30.5%, 61.7% and 83.6% of children presented with naevi (p less than 0.001, respectively). The results of this study provide further evidence for the role of sun exposure in naevus development and suggest that age of naevi onset may influence the risk of developing melanoma in later life.
Investigators: S Harrison, R MacLennan, R MacKie.
Three year review of shade provision in 27 daycare centres in Townsville. A shade audit was undertaken in all of the daycare centres in Townsville that enroll infants under one year of age. All shade structures were mapped, and the proportion of shaded play area calculated. UV measurements were also performed under many shade structures at each centre. This project was conducted as a preparatory phase of the intervention trial to assess whether the use of sun-protective clothing can reduce or delay the development of melanocytic naevi in young children. A second shade audit is currently being conducted to assess changes in the shade provision and UV exposure at these centres.
Investigators: A Moise, S Harrison.
Sun related behaviour of adult males. Men living in Northern Australia were found to have the highest rates of skin cancer in the world, with rates 2 to 3 times higher than those found in women. This research aims to discover why men have higher rates, and to trial strategies to reduce their sun damage in the short term, and skin cancer in the longer term. Both quantitative and qualitative research methods were used to obtain relevant data and to develop strategies to reduce men's sun damage and, therefore, skin cancer. These studies found that, even after experiencing skin cancer, men generally lack adequate knowledge about the causes of skin cancer, have poor attitudes to using sun protection, enjoy sun exposure, and have difficulty using sun protection because of seasonal heat. Three separate interventions have been designed to improve men's knowledge and overcome their attitudinal barriers. These include enforcing the use of sun protection at work, and trialling light-weight and light-coloured work clothing to reduce heat stress in the summer months.
Investigator: T Woolley.
Sun screen thickness as applied by Townsville beach visitors. In order to receive the maximum protection from sunscreens (i.e. the SPF labeled on the container), adequate amounts must be applied. One hundred and ten beach visitors at the Townsville Strand were asked to supply their weight and height, and to apply SPF-15 sunscreen in their usual fashion. This allowed calculation of the thickness of the sunscreen layer applied. The median thickness was found to be 50% of that required, thus this cohort of Townsville beach visitors were only half as protected as they believed.
Investigator: A Moise.

Indigenous Health

Breast Cancer in Aboriginal and Torres Strait Islander women in North Queensland. Generally cancer is not considered a priority in Aboriginal health. However, recent reports suggest that cancer is the third most frequent cause of death in Aboriginal women, after death from cardiovascular and respiratory diseases, and that cancer death rates are generally higher for Aboriginal Australians than for non-Aboriginal Australians. Therefore, the aim of this project was to explore the incidence of breast cancer of Aboriginal and Torres Strait Islander women in North Queensland over a ten period (1988-1998). A questionnaire design was used and the expanded project methodology includes data-matching between Queensland Cancer Registry and the North Queensland Hospital data, and the use of a snow-ball sampling technique with the cooperation of the North Queensland Aboriginal and Torres Strait Islander Women's Cancer Reference Group.
Investigators: J Elston, V Saunders, H Gennat, I Ring.
Development of an environmental health simulator for the planning of remote Indigenous settlements. This project describes the historical and current use of educational problem-solving software in relation to postgraduate education of the public health workforce. Educational simulation software capable of providing an advanced contribution to the health workforce learning experience has been developed and is currently being evaluated in terms of educational outcomes, and goals achieved by internal and distance students.
Investigators: D Canyon, D Podger.
Implementation of evidence-based guidelines for hypertension. The aim of this project is to adapt the NHMRC guideline implementation strategies to enable Aboriginal and Torres Strait Islander health services to provide a high standard of care. A high level of community involvement in the implementation process will enhance the community's control of its health and well-being. Key activity areas included assisting health services to improve their health care delivery systems for Indigenous communities by improving access to and uptake of evidence based medicine, and enhancing the health workforce through education and training. A key outcome expected from the project is the development of a framework that will assist in the uptake and implementation of guidelines in primary care Aboriginal and Torres Strait Islander health services. Two Aboriginal Community Controlled Health Organisations and one State Health Service providing primary care services to the Aboriginal and Torres Strait Islander population were selected to participate in the study. Audits of existing practice in hypertension management and a control health area were undertaken as a baseline indicator against which to measure the impact of implementation. In addition, a brief structured interview was developed by the project team to assess knowledge, attitudes and practices of the health team staff and administrators regarding evidence based guidelines. Using audit and interview results barriers to implementation were identified, options for implementation selected and relevant materials to aid implementation developed.
Investigators: J Elston, T Cheffins, B Daly, H Gennat, I Ring.
Improving diabetes care in remote TSI and Aboriginal communities in Far North Queensland, 2001-3. A two year program to improve use of registers, evidence-based care plans and recall systems for chronic disease management, following on from a successful trial in the Torres Strait, was initiated in 2001. The method used was a quality improvement approach, including clinical audit and feedback, community focus groups, financial analysis and process mapping for improved management. Results suggest that care processes and intermediate patient outcomes have improved since 1999.
Investigator: R McDermott.
Improving diabetes self-care in the Torres Strait: a randomized cluster trial of a four-pronged behavioural intervention, 2002-3. A one-year intervention which aims to improve the capacity of local health care workers to change four health behaviours among Torres Strait Islander (TSI) diabetics: smoking (currently about 35% of diabetics are smokers), wearing shoes (high rates of infected foot ulcers and amputations), walking/exercise and improved nutrition. Progress to date includes baseline data collection and health staff training.
Investigator: R McDermott.
Indigenous Health Worker (IHW) Pap Smear Provider Project. The overall aim of the IHW Pap Smear Provider Project was to explore the issues surrounding the provision of Pap smear services, including: workforce development for IHWs in Queensland; the inequity in health outcomes of Aboriginal and Torres Strait Islander women; and increasing Pap smear provision to Aboriginal and Torres Strait Islander women. The data gathered from this project will be used to inform future projects including the development of a policy statement which recognises the Pap smear provision role of IHWs; the development of appropriate, competency-based, accredited training and other quality assurance mechanisms for this area of clinical practice. The project identified the number and characteristics of female IHWs in Queensland who currently provide Pap smear services and the type and extent of training they have acquired; assessed the needs of the IHWs who are currently practicing, or wish to practice, in a specialised area of women's health; and compiled a database of contact details for consenting IHWs, interested in providing Pap smear services in Queensland. Despite interest and training in Pap smear provision by IHWs, IHWs are not the primary deliverers of cervical screening to Aboriginal and Torres Strait Islander women. Key issues impacting on IHW capacity to train in, and provide Pap smear services include: training is not always delivered in a culturally appropriate or sensitive way; lack of support, community perception and acceptance; and lack of clarity about the role of the IHW, as perceived by IHWs and other Queensland Health staff.
Investigators: J Elston, L Geia, H Gennat, V Saunders, I Ring.
Interactive touchscreens for infectious disease health promotion in remote Indigenous communities. This project will implement touch screen computer technology and its associated resources in a number of remote Indigenous communities in Far North Queensland and will attempt to demonstrate the effectiveness and acceptability of the method, and benefits in terms of health outcomes and increased local capacity.
Investigators: D Canyon, R Speare.
National investigation of retention strategies for Indigenous nursing students. In-depth interviews are being conducted with Aboriginal and Torres Strait Islander nursing students to investigate retention strategies for Aboriginal and Torres Strait Islander nursing students from Nursing Schools around the county. Appropriate Indigenous Research protocols are being prepared to address sensitivities and cultural appropriateness issues for the research.
Investigators: A Miller, K Usher, J Sellen, M Miller, D Lindsay, T O'Connor.
North Queensland Well Persons' Health Check (WPHC), 1999-2002. A community-based adult health check for Cardiovascular Disease (CVD) risk factors and Sexually Transmitted Infections (STIs) in remote and rural Indigenous communities in North Queensland was conducted with more than 3,000 Indigenous participants in 26 communities included. The survey documented very high rates of STIs in young people, with a clear socio-economic risk-gradient. Survey results have prompted the introduction of routine annual adult screening into the Chronic Disease Strategy in North Queensland from 2002.
Investigator: R McDermott.
Improving early detection and management of Sexually Transmitted Infections (STIs) in remote communities, 1999-2002. A high community prevalence of asymptomatic and undiagnosed Chlamydia and Gonorrhoea was found in the WPHC. Studies from elsewhere suggest that repeated screening and treatment can reduce the community burden of bacterial STIs as well as reduce the sequelae, particularly pelvic inflammatory disease. Early results of follow-up testing suggest that this strategy is working in North Queensland communities.
Investigator: R McDermott.
The policy response to Indigenous petrol sniffing - and how to improve it. In the 1980s and 1990s, Commonwealth and State/Territory governments in Australia made a number of attempts to formulate policies for the prevention and treatment of petrol sniffing, and funded several innovative programs. Despite evidence that the latter achieved some successful outcomes, these efforts have failed to generate sustained, evidence-based policies or programs. This project uses a number of case studies of policy formation and implementation to examine why this is so, and to identify changes that will make the development of evidence-based policies and programs more likely in the future. This research is ongoing.
Investigator: P d'Abbs.
HC Giese and the administration of the Northern Territory Welfare Branch, 1954-1972. Australian policy with respect to Indigenous Australians during the period 1951-1972 was dominated by the objective of assimilation. For most of this period, implementation of this policy in the Northern Territory was the responsibility of HC Giese, Director of Welfare from 1954-1972. This study examines the influence of HC Giese's education, training and experiences prior to taking up the position as Director of Welfare on his perception of his role as Director of Welfare, the ways in which he administered the Welfare Branch, and the ways in which he set about implementing Commonwealth Government policy. The project involves interviewing contemporaries and colleagues of HC Giese, and examining archival sources in Darwin, Perth and Canberra. This research is ongoing.
Investigator: P d'Abbs.

Injury

Workplace environment and health. Western Mining Corporation (WMC) is currently funding a major study of the workplace environment and health of their workforce at the fertilizer plants in Phosphate Hill and Mt Isa. The study will continue for several years and consists of several phases. Phase 1 started in November 2001 with a baseline detailed assessment of the workplace environment and health of staff. Individual substance-specific exposure profiles necessary for defining effective biological monitoring (Phase 2) and identifying areas of potential concern for occupational exposure have been defined. Phase 3 will see ongoing biological monitoring and the implementation of quasi-experimental studies to evaluate the efficacy of risk minimizing measures. The baseline health survey conducted comprised:
- full blood count, liver function and urine test;
- full respirometry;
- basic physical examination; and
- detailed health questionnaire.
A total of 218 completed questionnaires and physical assessments were obtained from an estimated workforce of 360 employees on-site at Phosphate Hill and Mount Isa (61% response rate) Sixty-two percent had occupational exposure to dust prior to their employment by WMC. More than one-quarter of subjects had a high-risk Body Mass Index. Hypertension was found in 42%. More than one third of subjects with breathing difficulty had a prior diagnosis of asthma. Plans have been implemented to tackle the problems identified of obesity, asthma and hypertension. Enhanced pre-employment screening has been initiated and visual acuity testing introduced for all staff as a result of the baseline study. In addition smoking cessation programmes and improved hydration strategies and facilities have been implemented to counteract hypohydration documented during the health survey.
Investigators: R Müller, A Carter, D Hanson.
Non-fatal injury presentations to the Mackay Base Hospital Emergency Department 1998-2000. Patterns and causes of non-fatal injury in the Mackay/Whitsunday region were studied to develop specific injury prevention programs and obtain a baseline measurement of injury frequency for evaluation of strategies developed by the Safe Community Project. The Mackay Base Hospital Emergency Department (MBHED) has collected Level 2 National Data Standard for Injury Surveillance (NDS-IS) data for all injury presentations during the years 1998 to 2000. Data of demographic variables, circumstances and nature of injuries have been recorded. A total of 26,104 injuries presented to the MBHED in 1998 to 2000, resulting in a direct standardised injury presentation rate of 8,218 per 100,000 persons per year. The overall male to female ratio is 2.1:1. In the 15 to 29 years age category, males are nearly three times more likely than females to be injured. The majority of injuries (71.4%) are assessed at presentation as semi-urgent. Nearly half (41%) of all injuries occurred in the home. The main target groups identified by this study for surveillance and intervention by the Mackay/Whitsunday Safe Community initiative are:
- workplace injuries in 15 to 54 year old males;
- falls in the home in 0 to 4 and over 55 year olds;
- injuries in 15 to 29 year old males;
- injuries in over 55 year old females; and
- sport and recreational injuries in 5 to 29 year old males.
Investigators: D Hanson, A Carter, R Müller.
Process and impact evaluations of a bicycle education trial in Mackay, North Queensland. Bicycle related injury is a significant source of child morbidity in Queensland. Rates in Mackay (males 129/10,000/yr; females 54/10,000/yr) are almost double those observed in South Brisbane (males 75/10,000/yr; females 31/10,000/yr). Queensland Transport, in conjunction with the Mackay Police Citizens Youth Club (PCYC), is conducting a bicycle education trial (Bike Ed) for primary school aged children as part of the World Health Organization Mackay/Whitsunday Safe Communities Project. Queensland Transport and the Mackay PCYC aim to deliver the 10 hour Bike Ed course to 50% of the Year 4 school population between September 2002 and June 2003. The three-stage course encompasses cycling skills and simulations, pathway cycling and on-road cycling. The Injury Research Group is conducting process and impact evaluations of the Bike Ed strategies implemented by Queensland Transport in Mackay. This will determine the reach of the program, resource quality and participant satisfaction. The impact evaluation aims to measure the immediate effects of the program on knowledge, attitudes, skills and behaviours.
Investigators: R Müller, A Carter, D Hanson, S Devine.

Travel Medicine

Trends in antimalarial drugs prescribed in New Zealand 1993-1998. Previous research has suggested considerable variability in the patterns of antimalarial drug prescription. The aim of this study was to investigate the trends in use of antimalarial drugs prescribed in New Zealand from 1993-1998. The study confirmed that travel health advisers extensively prescribed antimalarials other than those recommended in official guidelines during this period in New Zealand. Withdrawal from the market of less effective antimalarials, such as Maloprim(r), appears to have been an effective means of influencing the prescription of antimalarials, together with the issuing of updated National travel health guidelines.
Investigators: P Leggat, J Heydon.
Illness in returned travellers presenting at GeoSentinel sites in New Zealand. GeoSentinel is an emerging infections sentinel network, established in 1995, funded through a cooperative agreement between the US Centers for Disease Control and Prevention (CDC) and the International Society of Travel Medicine (ISTM). It is based on the concept that travel and tropical medicine clinics are ideally situated to detect geographical and temporal trends in morbidity among mobile populations. It studies information maintained by a network of 25 travel and/or tropical medical clinics throughout the world, which see post-travel patients. This study aimed to describe illnesses of returned travellers presenting at GeoSentinel sites in Auckland and Hamilton, New Zealand, between November 1997 and December 2001. Two hundred and five patients were identified with 262 diagnoses. About two-fifths of patients reported a pre-travel health consultation. The commonest diseases diagnosed were diarrhoeal illnesses, dermatological diagnoses), animal bites, and non-specific viral illnesses many of which manifest as respiratory infections. Tropical diseases, such as schistosomiasis, malaria and dengue fever, were not common. Although the frequency of tropical disease is low, it remains important to prevent these potentially fatal diseases.
Investigators: M Shaw, P Leggat, L Wald, M Cetron, M Williams.
Health advice provided to hostelers from Australia: Influence of a travelers' information evening. Little is known about the health advice provided to hostelers, and the role and influence of hosteling organizations' travelers information evenings in providing travel health advice. This study was designed to investigate this in the Australian context. Most hostelers attending an international hosteling organization's travelers health information session were in the younger age groups and were predominantly female. Most had sought travel health advice from general practitioners, travel agents and books. The information provided by the healthy travel session appeared to be of some benefit to hostelers, particularly as it prompted those who had not yet sought travel health advice to do so.
Investigator: P Leggat.
Travel insurance claims made by travelers from Australia. Little is known about travel insurance claims made by travelers returning from abroad. This study was designed to investigate travel insurance claims made by travelers from Australia. A random sample of approximately one in five claims reported during the period 1996-1998 to a major Australian travel insurance company were examined. Claims for medical and dental conditions represent the majority of travel insurance claims made by Australian travelers returning from abroad, although travel insurance also covers against contingencies such as loss, theft and cancellation. The most common medical conditions claimed were respiratory, musculoskeletal and gastrointestinal disorders. Findings have led to important recommendations.
Investigators: P Leggat, F Leggat.
Trends in malaria chemoprophylaxis prescription in South Africa 1994-2000. Previous research in a number of countries has suggested considerable variability in prescribing patterns of antimalarial drugs. The aim of this study was to investigate the trends in prescription of antimalarial drugs recommended for chemoprophylaxis in South Africa from 1994-2000. IMS Health provided retrospective data on drugs prescribed by the private sector. No malaria chemoprophylaxis is supplied by government health services. A combination pack containing chloroquine and proguanil was only marketed in South Africa from January 1997 and from this point there was a monotonic rapid decrease in the use of chloroquine and proguanil as monoprophylaxis. With the decrease in chloroquine use, there was a simultaneous increase in the use of mefloquine with an increase from 10% to 72% of prophylaxis distributed. The introduction of generic mefloquine saw a decrease in the original product to 26% of mefloquine distributed in the first six months following introduction. Chemoprophylaxis prescription in South Africa is largely consistent with recommendations contained in national Guidelines, except chloroquine, which appears to be more widely used as monotherapy than expected.
Investigators: P Leggat, D Dürrheim, L Blumberg.

Tropical Public Health

Food, nutrition, weight and shape related beliefs, behaviours and concerns of North Queensland adolescents. This study was commenced to investigate whether impressions from clinical experience were correct, as local adolescents appear to have weight-related health problems, poor dietary intakes and inadequate nutrition knowledge. Data were collected by questionnaire from 791 year 8 students from Townsville, Cairns and Charters Towers, and from 902 Townsville High School students in years 9-12. The study confirmed that poor body image and inadequate nutrition knowledge are widespread and that food intake recommendations were not adhered to by the majority of these adolescents. The problems were widespread and not confined to the clinical population.
Investigators: M Nowak, R Speare, P Büttner, D Crawford.
Impact of mining in PNG communities. The longitudinal multidisciplinary study of the impact of mining on Papua New Guinea communities is now in its 20th year. The study group consists of the Ok Tedi landowners and a comparison group from the Mt Obree area where there is no economic activity. The two sites have been visited every six months with ninety variables monitored, including environmental, social, demographic, economic, physical growth, sanitation, vaccination, nutrition, and common diseases. The study commenced in 1982 before mining began and will continue for five years after mining ceases.
Investigator: T Taufa.
Investigation of 'mysterious disease' in the Strickland areas of Papua New Guinea. An outbreak of 'mysterious disease' with high mortality was investigated by ABC staff. A cross-sectional survey was done with retrospective collection of information. Villagers were clinically examined, and specimens for laboratory tests collected from subjects and the environment. No clinical cases were observed. A high prevalence of positive serological tests to dengue, Japanese Encephalitis (JE), scrub typhus and spotted fever were found. Rickettsial infection was last reported in PNG during World War II amongst Allied troops. Health authorities were thus alerted to dengue and JE activity of which they were not aware, and rickettsial infection that has been reported for the first time in the PNG highlands. Feedback was provided to villagers and appropriate treatment stocks left at clinics.
Investigators: T Taufa, P Spicer, A Benjamin.
Optimisation of asthma control in the Wulguru area of Townsville. The research "Optimisation of asthma control in the Wulguru area of Townsville" by Drs Sekkadde Kiyingi and Tukutau Taufa has been approved for funding by the PHCRED GP Fellowship of the JCU Medical School and MICRRH for 2003 & 2004.
Investigators: S Kiyingi, T Taufa.
Health Benefit Groups (HBGs) for chronic disease in North Queensland, 2001-2. HBGs are a way of mapping investments across the health care continuum among different risk groups. A costing study for diabetes in three North Queensland health service districts was conducted. This showed large differentials in health services investment in different districts that partially reflected logistical difficulties. This mapping exercise is being combined with clinical audit data to estimate cost-effectiveness of different service models, particularly in remote areas.
Investigator: R McDermott, I Northcott.
The Northern Territory Living With Alcohol Program: a policy analysis. In 1991, the Northern Territory introduced a ten-year, public-health based program aimed at reducing alcohol-related harm in the NT. The program, known as the Living With Alcohol Program (LWAP), comprised three elements: an education strategy that included both media campaigns and educational services targeting specific groups; a series of measures designed to impose greater controls on availability of alcohol, and an expanded program of treatment and rehabilitation services. In order to fund the LWAP, the government also imposed a special levy on sales of all alcoholic beverages containing more than 3% alc./vol, with the income generated held in an account for programs and services auspiced by LWAP. The study traces the origins, objectives and outcomes of LWAP over the ten years of its operation, and examines the influence of social, economic, political and cultural factors on the program. It is hoped that lessons from the NT experience will be drawn for other governments planning to develop harm-minimisation alcohol policies.
Investigator: P d'Abbs.
Evaluation of alcohol restrictions in Mt Isa. In May 2002 the Liquor Licensing Division (LLD), Queensland Department of Tourism, Racing and Fair Trading, announced the introduction of a set of restrictions on liquor sales in Mt Isa, for a 12-month trial period commencing 1 August 2002. The purpose of the restrictions is to reduce alcohol-related harm and community concerns about alcohol misuse in Mt Isa. The evaluation utilises both qualitative and quantitative data to assess the impact of the restrictions on alcohol consumption patterns, public drunkenness and other public order offences, problems associated with health and welfare, such as alcohol-related injuries, and on commercial activities. It will also include a survey to assess the extent of community support for/opposition to the restrictions.
Investigator: P d'Abbs.
Knowledge of North Queensland island ferry passengers about Irukandji jellyfish. Severe Irukandji jellyfish stings in North Queensland, with two associated deaths, led to calls for increased public awareness of the dangers of these marine creatures. However, little was known about the knowledge of tourists and locals at risk of contact with these jellyfish to enable the development of targeted educational strategies. During April 2002, 224 passengers travelling on Sun Ferries to Magnetic Island were approached for interview and 93% agreed to participate. Eighty-eight percent of locals, 70% of domestic tourists, and 34% of international tourists knew what an Irukandji was. Half the international tourists, 20% of domestic tourists and 3.9% of locals with this knowledge incorrectly assumed it was safe to swim inside stinger-resistant enclosures or were unsure. Those visitors to Magnetic Island who had swum or intended to swim in the sea (47%) knew less about Irukandji than other visitors. Only 42% of respondents realised that Irukandji posed a risk to swimmers on the outer reefs. There was a greater awareness of box jellyfish (Chironex) risk than Irukandji in all groups. These findings are being used to design targeted educational strategies, including encouraging reef charter/tour operators to provide clients to outer reefs with personal protective clothing to minimise the risk of stings and education on appropriate first aid techniques.
Investigators: S Harrison, P Leggat, D Dürrheim, P Fenner, A Swinbourne.

Development Projects

Lymphatic Filariasis. The Lymphatic Filariasis Support Centre is providing active support for the global filariasis elimination project, especially in the Pacific and East Timor. This encompasses operational, technical and scientific expertise, training and basic, applied and operational research.
Collaborators: D Dürrheim, W Melrose, A Hauquitz, S Wynd, P Leggat, D Canyon, R Speare.
Malaria Treatment and Prevention in South Africa. The Anton Breinl Centre assisted the national Ministry of Health, South Africa in critically reviewing national policy documents on malaria prophylaxis and treatment.
Collaborator: D Dürrheim.
Australia-South Africa Institutional Links Program. AusAID funded an Australia-South Africa Institutional Links Program to increase the capacity of South Africa's post-compulsory educational institutions to participate in the reconstruction and development of the country by developing linkages with Australian institutions. Twenty projects focusing on community development were funded in the first and second rounds of the program. A third round of the program focused on effective policy, planning and management. The Mpumalanga Communicable Disease Control Coordinator (CDCC) training project received funding in the first and third rounds. The first round project focussed on training in skills required for control of communicable diseases in Mpumalanga Province. The third round project provided training in management skills for middle level health managers in rural South Africa and, although maintaining a focus on the original cohort of CDCCs, it extended beyond this group to include other health managers from Mpumalanga and other provinces of South Africa. The ABC was the Australian institutional partner in both rounds, while the South African partners were the Mpumalanga Ministry of Health and the University of the Witwatersrand (WITS) in the first round and the Medical University of Southern Africa (MEDUNSA) in the third round. The project was completed with a comprehensive review at the beginning of 2002 that demonstrated unequivocally that the program had been very successful in building the capacity of CDCCs to effectively plan, manage and evaluate disease control programs. Training had impacted significantly on outbreak detection, control and containment in Mpumalanga. Inclusion of participants from the national Ministry of Health and North-West Province had ensured greater impact. Collaboration in teaching and research continues to flourish between the ABC and both South African academic institutions. Professor Gboyega Ogunbanjo from MEDUNSA signed a Memorandum of Understanding with James Cook University during a visit to Townsville during which he taught on the Communicable Disease Control intensive block. Professor Mary Ross from WITS presented the Sydney Sax Oration during October 2002. The final formal activity of the Joint Links Program was a training workshop on emerging infectious diseases and bioterrorism for district CDCCs conducted in Mpumalanga during April 2002.
Collaborators: R Speare, D Dürrheim, G Ogunbanjo, P Leggat.

Other Research

Cardiology: Doppler and laboratory markers for acute cardiac events. The value of Doppler Ultrasound in determining left ventricular filling pressures studied by a team from ABC and Stuttgart, Germany has been proven. The methodology is being used to study left ventricular hemodynamics in a variety of groups from heavy smokers to marathon runners. A study is currently underway to ascertain the benefit of Troponin as a marker for acute myocardial events. In the last two years a multi-centre study has been conducted in Germany (NOWIS) on the diagnostic value and the benefit for risk stratification of Troponin in patients with acute coronary syndromes. Boehringer Mannheim is funding a major international multi-centre study as a follow up to the NOWIS project. This project will focus on the relative diagnostic values of quantitatively measured CK (creatine kinase), Myoglobin and Troponin under "field" conditions.
Investigators: R Müller, T Stoerk.
Backpain: The multidisciplinary approach. The Anton Breinl Centre has been involved extensively in multi-disciplinary randomised studies of the relative benefit of different treatment regimens for managing chronic back pain in collaboration with Dr Lynton Giles (Director of the National Unit of Multi Disciplinary Studies on Spinal Pain) since 1998. Back pain is an important public health burden in Australia with considerable attendant cost to the health system and individuals. During the past three years a randomised trial was conducted which is currently being analysed.
Investigators: R Müller, L Giles.
An investigation of post-partum women's knowledge and beliefs regarding adequate dietary intake. This is the nutrition-related component of a larger study examining the health beliefs of women in the immediate post-partum period. The purpose of the study was to identify gaps in knowledge and beliefs that should be addressed in prenatal education material. Data were collected using a structured interview, from 168 mothers in the post natal period in hospitals in Brisbane and Canberra. The data collection and data entry have been completed; data analysis and manuscript preparation are in progress.
Investigators: M Nowak, S Harrison, P Büttner.
Nutrition-related knowledge, beliefs and practices of Australian nursing staff. This work is the nutrition-related component of a larger study examining the health beliefs and related practices of health professionals attending women in the immediate post partum period. The purpose of the study was to establish current beliefs and behaviours, determine how often nutrition-related advice was given by these nursing staff, and identify any knowledge gaps that could be addressed to improve the quality of the information these health professionals provide to their patients. Data were collected by questionnaire from 362 nursing staff from 11 hospitals in Queensland and the ACT. The data collection and data entry have been completed; data analysis and manuscript preparation are in progress.
Investigators: M Nowak, S Harrison, L Hutton.
Lifestyle measures in the treatment of Gastro-oesophageal Reflux Disease (GORD) - a case series. Gastro-oesophageal Reflux Disease (GORD) is a common disorder with the classical symptoms being heartburn and regurgitation. It affects about 40% of adults and is most often treated with medication. Such treatment is long-term and expensive. Lifestyle modification is considered to be helpful, but the effectiveness of this treatment has not been established. This study retrospectively examined the treatment outcomes from 23 consecutive GORD patients attending a dietetic clinic for lifestyle modification counselling. The data have been collected and analysed, and results are currently being prepared for publication.
Investigators: M Nowak, S Harrison, B Raasch, K Daniell, P Büttner.
An investigation of the treatment of Gastro-oesophageal Reflux Disease (GORD) as currently practiced by Australian Practicing Dietitians. This study examines the beliefs of dietitians about lifestyle modification in the treatment of GORD and collates the anecdotal experience of these health professionals. Data were collected from 808 Accredited Practicing Dietitians throughout Australia using the Dietitians Association of Australia mailing house. Data entry is almost complete with analysis to begin shortly.
Investigators: M Nowak, S Harrison, P Büttner, C McCutchan.
An investigation of the treatment of Gastro-oesophageal Reflux Disease (GORD) as currently practiced by General Practitioners in North Queensland. This study was designed to determine whether and to what extent local general practitioners use lifestyle modification in the treatment of this disease, and to ascertain their assessment of its effectiveness. Data were collected by questionnaire from 136 general practitioner members of the Townsville Division of General Practice and the Northern Queensland Rural Division of General Practice. Data entry has been completed and data analysis is underway.
Investigators: M Nowak, B Raasch, K Daniell, S Harrison, P Büttner, C McCutchan.

Faculty of Medicine, Health & Molecular Sciences

Anton Breinl Centre

Research Activities 2001-2002

Communicable Diseases

Lymphatic Filariasis

Ectoparasites

Pediculosis

Intestinal nematode parasites

Srongyloidiasis

Vectors and vector-borne diseases

Malaria

Control

Veterinary Public Health

Surveillance in Developing Settings

Cancer

Indigenous Health

Injury

Travel Medicine

Tropical Public Health

Development Projects

Other Research