Burden of disease and injury in Aboriginal and non-Aboriginal populations in the Northern Territory

Objective:
To quantify the burden of disease and injury for the Aboriginal and non-Aboriginal populations in the Northern Territory.

Design and setting:
Analysis of Northern Territory data for 1 January 1994 to 30 December 1998 from multiple sources.

Main outcome measures:
Disability-adjusted life-years (DALYs), by age, sex, cause and Aboriginality.

Results:
Cardiovascular disease was the leading contributor (14.9%) to the total burden of disease and injury in the NT, followed by mental disorders (14.5%) and malignant neoplasms (11.2%). There was also a substantial contribution from unintentional injury (10.4%) and intentional injury (4.9%). Overall, the NT Aboriginal population had a rate of burden of disease 2.5 times higher than the non-Aboriginal population; in the 35-54-year age group their DALY rate was 4.1 times higher. The leading causes of disease burden were cardiovascular disease for both Aboriginal men (19.1%) and women (15.7%) and mental disorders for both non-Aboriginal men (16.7%) and women (22.3%).

Conclusions:
A comprehensive assessment of fatal and non-fatal conditions is important in describing differentials in health status of the NT population. Our study provides comparative data to identify health priorities and facilitate a more equitable distribution of health funding.

Acting at the Nexus : integration of research, policy and practice

This report is the result of an exciting journey of discovery. As with all journeys, we have been to many exotic places, have met extraordinary people, and at times have been challenged to keep going ahead rather than retreating. Good journeys are also enjoyed best in good company. We would like to thank VicHealth for giving us the opportunity to embark on our voyage, but also specifically to some great VicHealth staff: John Biviano, Siân Lloyd, Barb Mouy and Ali Barr have all been travelers along the way, providing us with encouragement, directions and nourishment. We know that our Project Advisory Committee and the then Chief Executive of VicHealth, dr. Rob Moody, have followed our progress on the journey with great interest. A special word of thanks to professor David Hill, chair of our advisory committee and member of the VicHealth Board of Governance, to sit down with us and critically review our navigation procedures. But we could not have reached our destination without the great assistance of the people and agencies that gave us their time, energy, and sometimes precious resources, to engage in data collection for our case studies. Again, a particular word of appreciation, to professor Brian Head, and to Ruth Belben for her incredibly efficient assistance, in organising the ARACY workshop on 24 November, 2006 in which we were given an opportunity to triangulate our position with colleagues from research, policy and practice.

Studies on dietary fibre : analysis, epidemiological and physiological aspects

This thesis involves an investigation in three areas; first, a study of an enzymatic-gravimetric method for the analysis of dietary fibre; second, a survey of dietary fibre intake in an area of a developing country, and finally, some observations on the functional aspects of gel-forming dietary fibre in the rat. A simple and rapid enzymatic-gravimetric assay for both soluble and insoluble dietary fibre has been critically investigated. Reference samples were also analysed by a more comprehensive, enzymatic gas chromatographic method to allow testing of the relative accuracy of the enzymatic-gravimetric method. The enzymatic-gravimetric method was found to be highly reproducible but gave a slightly higher value for total dietary fibre than the more comprehensive method. This discrepancy is probably due to the presence of small quantities of resistant starch and protein residue which are recovered in the enzymatic-gravimetric method. In the enzymatic-gas chromatographic method, protein residue is not measured, and resistant starch is estimated, but not counted as dietary fibre. The enzymatic-gravimetric method was applied to the analysis of foods commonly consumed in the Padang region of West Sumatra in Indonesia, in order to estimate dietary fibre intake in the region. Daily intakes of usual foods were estimated by use of a 24-hour recall procedure aided by food photographs to assist in the estimation of portion size. Samples of approximately 60 of the most commonly consumed foods were collected and analysed for dietary fibre. These appear to be the first data which report values for dietary fibre in Indonesion foods and they represent a significant improvement upon the existing data on crude fibre content. Knowledge of the amounts of foods usually consumed and their dietary fibre content allowed an estimation of usual intakes of dietary fibre. Fibre intake was found to be lower than in the developing countries of Africa and was comparable to intakes measured in the U.K. This is the first study to show that in this part of South East Asia, a developing country area using polished rice as a staple food, dietary fibre intakes are as low as in Western countries. Low intakes of fibre are believed to be related to the prevalence of a range of diseases and, in this study, preliminary data on the rates of non-infective, chronic diseases were collected from the two main hospitals in West Sumatra. Chronic, non-infectious diseases such as inguinal hernia, appendicitis, haemorrhoids, diabetes mellitus, hypertension and malignant neoplasms of the rectum are relatively frequent in West Sumatra. While no firm conclusions can be drawn from these data, they do show the possibility of a relationship between low intakes of dietary fibre and the prevalence of these diseases, and suggest that further investigation is necessary. Some observations were made of the effect of gel-forming dietary fibre on stomach emptying and intestinal transit rate in the rat. Xanthan gum was added to iso-osmotic solutions to produce increased viscosity and phenol sulphonphthalein (phenol red) was used as a non-absorbable marker. Gavage feeding of solutions with a range of viscosities was used to study the effect of viscosity on the rate of stomach emptying and intestinal transit. Increased viscosity was observed to slow gastro-intestinal transit and this provides one mechanism by which dietary fibre of the gel-forming type ray improve glucose tolerance.

Monaural sound localization : mechanisms and processes

A review of the literature established that localization acuity measured during monaural listening conditions was directly related to various methodological considerations. These included method of attenuation, segment of auditory space where monaural localization was measured, and the presence or absence of head movements. An extensive measurement of monaural localization was made with due consideration of these factors, allowing a more comprehensive evaluation of monaural acuity and the underlying processes that were involved. Establishing a monaural condition is dependent both on the attenuation level of the occluded ear and the signal level, both of which are clearly inter-related since the attenuation level of the occluded ear sets the maximum level of die stimulus. In a series of experiments it was established that there was a minimum signal level for accurate localization. Testing on both sides of the head revealed that there were three regions of monaural localization acuity. The first was about the interaural axis on the ipsilateral ear where monaural localization was relatively accurate, the second a region either side of the MSP where there was some loss of localization, and a third about the interaural axis on the ipsilateral side where virtually no monaural localization ability existed. In the final series of experiments it was established that head-movements allowed subjects to extend the accuracy of the first region by minimizing the distance between the sound and the ipsilateral interaural axis, thus compensating for the loss of localization ability in the second and third regions. This was determined from changes recorded in the error data, and also the extent and direction of measured head-movements. The results of this series of experiments demonstrated the relationship between spectral cues and monaural localization. Firstly, monaural localization was not possible in the absence of accurate spectral information. Thus large errors were observed in the third region where there was blockage of the high-frequencies by the head, and in all regions during the presentation of low signal levels where the high-frequencies fell below threshold. Secondly, the inaccuracy of the second region due to the loss of information from the second pinna suggested that there was a binaural component with relation to pinna cues. It seems that for sounds in this region the spectral modifications from both pinnae are processed to determine a sound's location in space.

Variation of fibre diameter coefficient of variation and fibre curvature across mohair fleeces: Implications for animal selection, genetic selection and fleece evaluation

The presentwork aimed to determine howthe average fibre diameter coefficient of variation (CVD) and fibre curvature (FC) differences between nine sampling sites vary between sex and flock, to identify differences in variability between sampling sites as a result of between animal and between sire variability and to determine correlations between sampling sites in between animal and between sire variability. Australian Angoras (n = 313) from two farms in southern Australia were sampled at 12 and 18 months of age at nine sites (mid side, belly, brisket, hind flank, hip, hock, mid back, neck, shoulder). Staples were taken prior to shearing at skin level and CVD and FC determined. For each shearing, differences in CVD and FC between sampling sites, how these differences were affected by farm, sex, and sire, and the covariance between sites for sire and individual animal effects were investigated by restricted maximum likelihood (REML) analyses. The median mid side CVD at 12 and 18 months of age ranged from 23.6 to 25.1% but the actual range was 16.8–34.2%. The median mid side FC at 12 and 18 months of age ranged from 14.4 to 18.6◦/mm but the actual range was 10.5–26.3◦/mm. The general pattern for CVDwas for the mid back, hip and neck sites to have similar CVD, the brisket, hind flank and hock sites to have larger CVD and the belly to have smaller CVD than the mid side site. The between animal variation for CVD was lowest at the mid back site. This implies that the mid back would be the most effective site for between animal selection for CVD. Heritabilities for CVD (range at 18 months 0.18–0.30) were only about half the heritabilities for mean fibre diameter in the same study. There was a marked anterior–posterior increase in FC at both farms and with both ages. The results give no clear indication of the best site for between animal selection for FC, other than that the hock should be avoided. Heritabilities for FC are moderate to high (range at 18 months 0.44–0.77) and the genetic correlations are high except for the hock. Thus genetic selection for FC at any site, other than the hock, should be effective for changing FC over the entire fleece. There was more variability between animals than between sites and sires. These results are put into context with associated research on variation in mean fibre diameter and staple length.

Neck strength recovery after a single bout of specific strengthening exercise

Objective : To determine the level of neck strength decrement and the rate of strength recovery of the neck muscles after a single bout of specific neck conditioning exercise in both males and females.

Hypothesis : A decrement in neck strength may be evident after a bout of strengthening exercise.

Design : Intervention study with pre-and-post design.

Setting : Biomechanics laboratory.

Participants : Twenty healthy participants (10 male and 10 female, mean ± standard deviation age 22 ± 1.2 years).

Main Outcome Measures : Participants performed a single bout of neck strengthening exercise. Neck strength testing using an isokinetic dynamometer was performed pre and at five time points (1 h, one, three, five and seven days) post-exercise to assess the level of neck strength decrement and neck strength recovery rate from pre-exercise levels.

Results : Statistically significant (p ≥ 0.036) decreases in neck extension strength were recorded in all participants 1 h and one day post-exercise. The level of neck extension strength returned to pre-exercise levels three days post-exercise and surpassed pre-exercise levels five and seven days post-exercise. The male participants' neck flexion strength decrement and recovery followed a similar pattern to that displayed in neck extension but more variability in neck flexion strength recovery rates were recorded in the female participants in this study.

Conclusion : The consistent strength recovery times for the male participants recorded in this study idealise the prescription of neck strengthening exercises in a periodised fashion. More investigation needs to be instigated for the female neck musculature as consistent strength recovery rates were not identified in this study.

Predicting neck pain in Royal Australian Air Force fighter pilots

Objective: Fighter pilots frequently report neck pain and injury, and although risk factors have been suggested, the relationships between risk factors and neck pain have not been quantified. The aim of this study was to identify personal and work behaviors that are significantly associated with neck pain in fighter pilots.
Methods: Eighty-two Royal Australian Air Force fighter pilots were surveyed about their flying experience, neck pain prevalence, and prevention. Multinomial logistic regressions were used to fit models between pilots' neck pain during and after flight and a range of personal and work characteristics.
Results: In-flight neck pain was very weakly, yet positively associated with flight hours. Duration of postflight pain was positively associated with the weekly desktop work hours and the sum of preventative actions taken in flight. The duration pilots were considered temporarily medically unfit for flying was positively associated with pilots' age and their weekly desktop work hours.
Discussion: The risk factors identified by the current study should guide neck pain prevention for fighter pilots. In particular, reducing desktop working hours as well as incorporating specific neck-strengthening exercises and in-flight bracing actions should be considered by agencies to help alleviating neck pain in their pilots

Gaze behavior among experts and trainees during optic disc examination : does how we look affect what we see?

Purpose. The authors compared the visual gaze behaviors of glaucoma subspecialists with those of ophthalmology trainees during optic disc and retinal nerve fiber layer (RNFL) examination.

Methods. Seven glaucoma subspecialists and 23 ophthalmology trainees participated in the project. Participants were shown eight glaucomatous optic disc images with varied morphology. Eye movements during examination of the optic disc photographs were tracked. For each disc image, graders were asked to assign a presumptive diagnosis for probability of glaucoma. There was no time restriction.

Results. Overall, trainees spent more time looking at disc images than glaucoma subspecialists (21.3 [13.9–37.7] vs. 16.6 [12.7–19.7]) seconds; median [interquartile range (IQR)], respectively; P < 0.01) and had no systematic patterns of gaze behavior, and gaze behavior was unaltered by disc morphology or topographic cues of pathology. Experienced viewers demonstrated more systematic and ordered gaze behavior patterns and spent longer times observing areas with the greatest likelihood of pathology (superior and inferior poles of the optic nerve head and adjacent RNFL) compared with the trainees. For discs with focal pathology, the proportion of total time spent examining definite areas of pathology was 28.9% (22.4%–33.6%) for glaucoma subspecialists and 13.5% (12.2%–19.2%) for trainees (median [IQR]; P < 0.05). Furthermore, experts adapted their viewing habits according to disc morphology.

Conclusions. Glaucoma subspecialists adopt systematic gaze behavior when examining the optic nerve and RNFL, whereas trainees do not. It remains to be elucidated whether incorporating systematic viewing behavior of the optic disc and RNFL into teaching programs for trainees may expedite their acquisition of accurate and efficient glaucoma diagnosis skills.

Estimating the number of green and loggerhead turtles nesting annually in the Mediterranean

Most species of marine turtle breed every two or more years and it is the norm for females to lay more than one clutch of eggs within a nesting season. Knowing the interval between breeding seasons and the clutch frequency (number of clutches laid by an individual in a breeding season) of females allows us to assess the status of a nesting population. At Alagadi Beach, Northern Cyprus, over a period of 6 years (1995–2000), we attributed 96% of green Chelonia mydas and 80% of loggerhead Caretta caretta turtle clutches to known individual females. This intensive level of monitoring enabled us to estimate the clutch frequency for both species. Using four different methods we estimated clutch frequency to be 2.9–3.1 clutches per female for green turtles and 1.8–2.2 clutches per female for loggerhead turtles. The median interval between nesting seasons for green turtles was 3 years, and for loggerhead turtles it was 2 years. Utilizing these parameters and available data from other beaches that are monitored regularly, we estimate that there are 2,280–2,787 logger-head and 339–360 green turtles nesting annually at these sites in the Mediterranean. This highlights the Critically Endangered status of this population of green turtles. Furthermore, as conventional beach patrols underestimate clutch frequency, these population estimates are likely to be optimistic.

Community-onset Staphylococcus aureus infections presenting to general practices in South-eastern Australia

Community-acquired Staphylococcus aureus infections are a public health concern, yet little is known about infections that do not present to hospital. We identified community-onset S. aureus infections via specimens submitted to a community-based pathology service. Referring doctors confirmed eligibility and described infection site, severity and treatment. Isolates were characterized on antibiotic resistance, PFGE, MLST/SCCmec, and Panton–Valentine leukocidin (PVL), representing 106 community-onset infections; 34 non-multiresistant methicillin-resistant S. aureus (nmMRSA) (resistant to <3 non-β-lactam antibiotics), 15 multiply antibiotic-resistant MRSA (mMRSA) and 57 methicillin-sensitive S. aureus (MSSA). Most (93%) were skin and soft tissue infections. PVL genes were carried by 42% of nmMRSA isolates [95% confidence interval (CI) 26–61] and 15% of MSSA (95% CI 8–28). PVL was associated with infections of the trunk, head or neck (56·4% vs. 24·3%, P= 0·005) in younger patients (23 vs. 52 years, P< 0·001), and with boils or abscesses (OR 8·67, 95% CI 2·9–26·2), suggesting underlying differences in exposure and/or pathogenesis.

Femoroacetabular impingement osteoplasty is any resected amount safe? A laboratory based experiment with sawbones

There is an increased risk of fracture following osteoplasty of the femoral neck for cam-type femoroacetabular impingement (FAI). Resection of up to 30% of the anterolateral head–neck junction has previously been considered to be safe, however, iatrogenic fractures have been reported with resections within these limits. We re-evaluated the amount of safe resection at the anterolateral femoral head–neck junction using a biomechanically consistent model.In total, 28 composite bones were studied in four groups: control, 10% resection, 20% resection and 30% resection. An axial load was applied to the adducted and flexed femur. Peak load, deflection at time of fracture and energy to fracture were assessed using comparison groups.There was a marked difference in the mean peak load to fracture between the control group and the 10% resection group (p < 0.001). The control group also tolerated significantly more deflection before failure (p < 0.04). The mean peak load (p = 0.172), deflection (p = 0.547), and energy to fracture (p = 0.306) did not differ significantly between the 10%, 20%, and 30% resection groups.Any resection of the anterolateral quadrant of the femoral head–neck junction for FAI significantly reduces the load-bearing capacity of the proximal femur. After initial resection of cortical bone, there is no further relevant loss of stability regardless of the amount of trabecular bone resected.Based on our findings we recommend any patients who undergo anterolateral femoral head–neck junction osteoplasty should be advised to modify their post-operative routine until cortical remodelling occurs to minimise the subsequent fracture risk.

View of Geelong: ruin and viewin', transpanorama

Eugene von Guerard’s View of Geelong is iconic for a number of reasons, including its detailed interpretation of the landscape and its special place in the imagining of the region. Bishop and Reis seek to honour this by manipulating the science behind the view and at the same time question the viewer’s relationship to the scene and the work. We use the husk of a ruined fireplace to house a camera obscura and stereoscope – pressed concaved metal into which the viewer puts their head and looks through a divided hole into the unit. The camera obscura mimics the mechanics of the eye, and is able to capture the scene perfectly while the stereoscope splits the scene, makes it partial, layered and temporal. In doing this we layer von Guerard’s view with change, acknowledging the effects of European civilization and, peculiar to this historical panorama, suburbanization of the landscape. The creeping suburbs will be seen on the left side of the stereoscope through a camera obscura, which presents a real-time view of the scene from the point at which von Guerard allegedly painted it. On the right side, we again catch the light, but only to light a transparency of von Guerard’s original work. The technologies we draw upon – the camera obscura, stereoscope and landscape painting – create a confluence of images, both real and imagined.

View of Geelong: ruin and viewin', transpanorama

Public Art installation by Cam Bishop and Simon Reis. Eugene von Guerard’s View of Geelong is iconic for a number of reasons, including its detailed interpretation of the landscape and its special place in the imagining of the region. Bishop and Reis seek to honour this by manipulating the science behind the view and at the same time question the viewer’s relationship to the scene and the work. We use the husk of a ruined fireplace to house a camera obscura and stereoscope – pressed concaved metal into which the viewer puts their head and looks through a divided hole into the unit. The camera obscura mimics the mechanics of the eye, and is able to capture the scene perfectly while the stereoscope splits the scene, makes it partial, layered and temporal. In doing this we layer von Guerard’s view with change, acknowledging the effects of European civilization and, peculiar to this historical panorama, suburbanization of the landscape. The creeping suburbs will be seen on the left side of the stereoscope through a camera obscura, which presents a real-time view of the scene from the point at which von Guerard allegedly painted it. On the right side, we again catch the light, but only to light a transparency of von Guerard’s original work. The technologies we draw upon – the camera obscura, stereoscope and landscape painting – create a confluence of images, both real and imagined. The iconic View of Geelong Painting can be seen at the Geelong Gallery.