Iodine deficiency in urban primary school children: a cross-sectional analysis

OBJECTIVE: To determine the prevalence of iodine deficiency in primary school children in an Australian urban population. DESIGN AND SETTING: A cross-sectional survey of school children aged 5-13 years attending a public school on the Central Coast of New South Wales in November 2000. PARTICIPANTS: 324 (70%) of the 465 children enrolled in the school (180 boys; 144 girls). MAIN OUTCOME MEASURES: Thyroid volumes compared with World Health Organization/International Council for the Control of Iodine Deficiency Disorders (WHO/ICCIDD) thyroid volume reference values. Iodine status based on WHO/ICCIDD urinary iodine concentration (UIC) categories (normal, >/= 100 microg per litre of urine [microg/L]; mild iodine deficiency, 50-99 microg/L; moderate deficiency, 20-49 microg/L; severe deficiency, < 20 microg/L); not more than 20% of the population should have a UIC below 50 microg/L. RESULTS: Median UIC for school children was 82 microg/L, and 14% of children had UICs below 50 microg/L. Thyroid volume reference values indicated a prevalence of goitre of zero. In girls, only four (3%) and one (1%) had thyroid volumes above the WHO/ICCIDD medians by age and body surface area (BSA), respectively (P < 0.001). In boys, three (2%) and one (1%) had thyroid volumes above WHO/ICCIDD medians by age and BSA, respectively (P < 0.001). CONCLUSION: Despite the median UIC being less than ideal, most children were not goitrous. This underscores the importance of using physiological outcome measures in areas where iodine deficiency is marginal before concluding the need for iodine supplementation based purely on median UIC. We call for a systematic national survey to determine iodine status using a combination of iodine deficiency indicators.     

Are Australian children iodine deficient? Results of the Australian National Iodine Nutrition Study

OBJECTIVE: To document the population iodine nutritional status in Australian schoolchildren. DESIGN AND SETTING: Cross-sectional survey of schoolchildren aged 8-10 years, based on a one-stage random cluster sample drawn from all Year 4 school classes in government and non-government schools in the five mainland Australian states of New South Wales, Victoria, South Australia, Western Australia and Queensland. The study was conducted between July 2003 and December 2004. PARTICIPANTS: 1709 students from 88 schools (881 boys and 828 girls), representing 85% of the estimated target number of students. The class participation rate was 65%. MAIN OUTCOME MEASURES: (i) Urinary iodine excretion (UIE) levels (compared with the criteria for the severity of iodine deficiency of the World Health Organization/International Council for the Control of Iodine Deficiency Disorders: iodine replete, UIE > or = 100 microg/L; mild iodine deficiency, UIE 50-99 microg/L; moderate iodine deficiency, UIE 20-49 microg/L; severe iodine deficiency, UIE < 20 microg/L); (ii) Thyroid volumes measured by ultrasound (compared with new international reference values). RESULTS: Overall, children in mainland Australia are borderline iodine deficient, with a national median UIE of 104 microg/L. On a state basis, NSW and Victorian children are mildly iodine deficient, with median UIE levels of 89 microg/L and 73.5 microg/L, respectively. South Australian children are borderline iodine deficient, with a median UIE of 101 microg/L. Both Queensland and Western Australian children are iodine sufficient, with median UIE levels of 136.5 microg/L and 142.5 microg/L, respectively. Thyroid volumes in Australian schoolchildren are marginally increased compared with international normative data obtained from children living in iodine sufficient countries. There was no significant association between UIE and thyroid volume. CONCLUSION: Our results confirm the existence of inadequate iodine intake in the Australian population, and we call for the urgent implementation of mandatory iodisation of all edible salt in Australia.     

Recent trends in aboriginal mortality

Mortality is an important measure of the extent of the health disadvantages experienced by Australia's Aborigines. In the absence of routinely available data on Aboriginal deaths, this paper has collated information from a number of sources. In addition to published reports and theses, it also includes unpublished data provided to the Australian Institute of Health by State and Territory health authorities. The review also draws on data on maternal deaths, collated on a triennial basis and published by the National Health and Medical Research Council. Despite improvements in some indices of mortality, the death rates of Aborigines, particularly for young and middle-aged adults, are unacceptably higher than those of non-Aboriginal Australians. Without substantial reductions in death rates, the expectation of life of Aborigines will remain comparable with that of people living in developing countries.     

Legislation for smoking control in Western Australia

This historical analysis of public issues relating to smoking control in Western Australia examines relevant Western Australian state and Australian federal laws, their introduction, and their consequences. Public and political support and opinion led by the health professions resulted in two attempts to legislate against all forms of cigarette advertising in 1982 and 1983. Both attempts failed, and public support for such measures has been seen to be affected by the campaigns mounted in opposition by the tobacco and advertising industries. Other smoking control measures which have been successfully introduced in 1983 and 1984 are higher tobacco taxes and a comprehensive coordinated public education and information programme. The activities associated with the legislative initiatives resulted in a greatly increased level of community awareness of the dangers of smoking and acceptance of the need for some action on this major health problem.     

Primary care research--what in the world is going on?

Primary care research has been described as a "lost cause", and, although this claim has been strongly refuted, general practitioners publish less research than their colleagues in surgery, medicine and public health. Despite a fivefold increase in Australian general practice research papers from the 1980s to the 1990s, fewer than half of these focused on clinical topics. Trying to establish a global figure for expenditure on general practice and primary care research is difficult, but data show that public expenditure for primary care research is minimal in Australia, New Zealand, the Netherlands and the United Kingdom--fewer than 1.50 dollars per capita in 2002-2003. Compared with hospital- and laboratory-based research, primary care receives significantly fewer resources, ranging from 3.2% of total public expenditure on health and medical research in the Netherlands to 6.8% in New Zealand. Government-led investment in interventions such as strengthening primary care departments and colleges and supporting primary care academics, establishing practice-based networks, fostering international initiatives for cross-national efforts, and engaging individual primary care practitioners in research projects, are all required to build research capacity in primary care.     

A case for universal salt iodisation to correct iodine deficiency in pregnancy: another salutary lesson from Tasmania

OBJECTIVE: To assess the impact of iodine fortification of bread on the iodine status of pregnant women, and to determine if studies of iodine levels in school-age children were indicative of women's gestational iodine status. DESIGN: Urinary iodine surveys of pregnant Tasmanian women before and after bread was fortified with iodine in October 2001. PARTICIPANTS AND SETTING: 285 women attending the Royal Hobart Hospital (RHH) antenatal clinic from 1 October 2000 to 30 September 2001 and 517 women attending the RHH antenatal clinic or primary health care centres in 2003-2006. MAIN OUTCOME MEASURES: Median urinary iodine concentration (UIC) for comparison against the World Health Organization recommendation of of 150-249 microg/L for pregnant women. RESULTS: Before supplementation, the median UIC of the 285 women attending the RHH antenatal clinic was 76 microg/L. After supplementation, median UICs were 81 microg/L for 288 women attending primary health care centres and 86 microg/L for 229 women attending the RHH antenatal clinic. Differences in mean UIC were not significant for either the antenatal clinic group (P=0.237) or the primary health care group (P=0.809) compared with the pre-supplementation group. CONCLUSIONS: Iodine deficiency in pregnancy persists despite being corrected in Tasmanian children. Successful iodine supplementation must target reproductive-age and pregnant women and be substantiated by ongoing monitoring during pregnancy and lactation. A robust national program for correcting iodine deficiency is urgently needed. Mandatory universal salt iodisation has international endorsement, and should be considered the preferred strategy for eliminating iodine deficiency in Australia.     

Prisons, hepatitis C and harm minimisation

Australian prisons have been identified as a focus of the ongoing hepatitis C epidemic. Harm minimisation is the major strategy directed to community-based public health measures to control hepatitis C. Harm-minimisation strategies to protect inmates and workers are incompletely and inconsistently applied in Australian prisons. Overseas experience has demonstrated that introducing injecting-equipment exchange programs and professional tattoo parlours in prisons could at least partially reduce the risks of ongoing hepatitis C transmission, and would support prevention and treatment programs. A two-stage approach is suggested: firstly, implementing programs of proven effectiveness consistently across the eight Australian jurisdictions, and, secondly, expanding current initiatives in the light of international "best practice".     

Patterns of alcohol consumption in the Kimberley aboriginal population.

OBJECTIVE: To estimate patterns of alcohol consumption and alcohol-related problems among adult Aborigines in the Kimberley region of Western Australia. DESIGN: A community survey of adult Aborigines. PARTICIPANTS: A stratified random sample of 516 Aboriginal men and women over the age of 15 years in the Kimberley. MAIN OUTCOME MEASURES: Participants' reports of their frequency and quantity of alcohol consumption, and their lifetime experience of alcohol-related problems; and the laboratory measure gamma-glutamyltranspeptidase. RESULTS: Aborigines in the Kimberley were more likely to be non-drinkers than non-Aborigines in the Australian population, but the majority of drinkers consumed hazardous amounts of alcohol: 85% (95% Cl, 82% to 88%) of drinkers in the population were estimated to be drinking above the level defined by the National Health and Medical Research Council (NHMRC) as harmful. CONCLUSION: Alcohol abuse among Aborigines in the Kimberley is a major public health problem which requires urgent action.     

Status of iodine nutriture and universal salt iodisation at beneficiaries levels in Kerala State, India

Iodine deficiency disorders are an important public health problem in India. It is wrongly believed that populations residing in coastal areas do not suffer from iodine deficiency as they consume sea foods which are rich in iodine. A high prevalence of iodine deficiency has been reported in 11 districts of Kerala ranging between 9.3 and 44.5%. In spite of the high prevalence of iodine deficiency, the state government of Kerala has not banned the sale of non-iodised salt in the state. Thus, the present study was conducted to assess the current status of iodine nutriture and level of salt iodisation in Kerala state. The study was conducted in all the 14 districts in the state by utilising the uniform sampling methodology. A total of 2110 salt samples were collected randomly from children. On the spot casual urine samples were collected from 689 children. The results revealed that overall 43.8% of the families in the state were consuming salt with 15ppm and more of iodine. It was found that three districts namely Kasargod, Idukki and Kottayam had median urinary iodine excretion level < 100.0 microg/l and also more than 20% of the samples had urinary iodine excretion levels less than 50 microg/l. The findings of the present study revealed continued iodine deficiency amongst the three districts identified as endemic earlier. This indicates the need of immediate ban on the sale of non-iodised salt for the edible purposes and intensive information, education and communication activities for promotion of consumption of iodised salt.     

Child health in the Third World

While most infant-related health problems in the Third World can be attributed to commonplace diseases, the lack of resources necessary to implement Western styles of medicine suggests the need for new strategies -- those that rely less on technology and more on grass roots efforts. Most illnesses in the developing world are the result of the top 5-10 diseases. Of the 4 million deaths from pneumonia each year, 97% take place in the Third World. Measles causes the yearly deaths of 1.6 million. Many of these diseases have been eradicated in the West; the others can be easily treated. But in the 3rd World, health problems are compounded by the fact that attention is often sought late, as well as the lack of doctors and nurses. Most of those with Western-style medical training rarely practice in rural or urban slum areas. One strategy to meet these difficulties is to train personnel on how to diagnose and treat these 5-10 common diseases without them having to go through Western-style training -- reminiscent of the famous "barefoot doctors" of China. These local health workers can more easily meet the health needs of isolated areas, since they can be trained to carry out immunization, and teach nutrition and family planning. Furthermore, this strategy does not rely on high technology, following instead the scheme laid out by acronym GOBI -- Growth monitoring. Oral rehydration therapy, Breast feeding, and Immunization. Developed nations can help in this effort by supporting WHO, UNICEF and other international organizations, as well as sending personnel to work in 3rd World countries. While individual 3rd World nations must confront these problems, worldwide social, political, and economic changes will be necessary.     

Newborn bloodspot screening policy framework for Australia

Background

The aim of newborn bloodspot screening (NBS) is to identify rare genetic and non-genetic conditions in children soon after birth in order to commence therapies that prevent the development of progressive, serious, and irreversible disabilities. Universal NBS programmes have been implemented in most countries, with minor adaptations to target conditions most relevant to the local healthcare environment.

Aims

In this article, we describe the initiatives of international and Australian governments to develop policies to address the expansion of NBS in their healthcare systems.

Methods

We have reviewed published public policies and literature to formulate recommendations based on clinical, social, legal, and ethical principles to inform a national governance and policy framework for Australia.

Results

Australian policy makers have been slow to develop a coordinated plan. While the experience from other governments can guide our national policy, there are specific areas that require further consideration by Australian health experts. Key reforms involve the separation of policy and operational activities, multidisciplinary decision-making and oversight by the Australian Health Ministers’ Advisory Council for policy direction.

Conclusion

A formal national policy framework will guide the coordination of NBS services that can adapt to the needs of Australian children and families.     

HLA and disease in Oceania

HLA-A, -B and -DR gene frequency distributions in populations of Australia, Melanesia, Micronesia and Polynesia are examined in relationship to known HLA and disease associations in other populations. With the exception of a correlation between Reiter's syndrome and B27, other HLA and disease associations are markedly absent. Recombinant DNA and cellular subtyping analyses suggest that the HLA-DR subtypes predominating in susceptibility to several autoimmune disorders in Caucasoids are rare in Oceania. The high frequency of serum complement component C4A deficiency in Australian Aborigines may explain the high prevalence of systemic lupus erythematosus in this group.     

Bound for Sydney town: health surveillance on international cruise vessels visiting the Port of Sydney

A program for routine health surveillance on international cruise ships visiting the Port of Sydney has been developed since 1998. Before introduction of this program, ships only reported quarantinable diseases and were not aware of the Australian requirement to report other infectious diseases. Voluntary routine reporting, developed in partnership with the cruise ship industry, provides timely information on all infectious diseases of public health interest during every cruise. During 1999-2003, the program resulted in detection of and response to 14 outbreaks of gastroenteritis or acute respiratory infection, affecting more than 1400 passengers and crew. The program has improved preventive action, and risk communication and management by cruise ship operators, and led to more timely investigation and support by public health authorities.     

Cooperation not confrontation: the imperative of a nuclear age

Dyer, a member of the Medical Campaign Against Nuclear Weapons, reports on the Fifth Congress of International Physicians for the Prevention of Nuclear War (IPPNW), held in Budapest from 28 June to 1 July 1985. The main themes of the Congress were the current health costs of the arms race, and the role of a comprehensive test ban treaty in preventing nuclear proliferation. Officials from the World Health Organization and UNICEF lectured on diverting money from excessive arms spending to meet public health goals, such as making childhood immunization available worldwide by 1990. Delegates also were reminded of the dangers of allowing nuclear weapons to proliferate "vertically" into space and "horizontally" into presently non-nuclear nations, and of the need to revive negotiations for a test ban treaty. The conference concluded with messages to the leaders of the United States and the Soviet Union.     

Westernisation, insulin resistance and diabetes in Australian aborigines

OBJECTIVE: To examine the published data on the impact of westernisation on obesity, non-insulin dependent diabetes mellitus (NIDDM), and coronary heart disease (CHD) in Australian Aborigines. DATA SOURCES: Fifty-five articles from Australian and international sources (primarily peer-reviewed journals) are cited. STUDY SELECTION: Twenty-eight reports providing data on the diet, lifestyle, health and "lifestyle diseases" of Australian Aborigines before and after westernisation are included in this review. A further 27 articles on obesity, NIDDM, CHD, insulin resistance, and the impact of diet and exercise were used to help interpret the Aboriginal data. DATA EXTRACTION: Information on dietary composition, anthropometry, disease and risk factor prevalence, and relevant biochemical measurements were used for comparative and interpretive purposes. DATA SYNTHESIS: The traditional hunter-gatherer lifestyle of Australian Aborigines, characterised by high physical activity and a diet of low energy density (low fat, high fibre), promoted the maintenance of a very lean body weight and minimised insulin resistance. In contrast, for most Aborigines a Western lifestyle is characterised by reduced physical activity and an energy-dense diet (high in refined carbohydrate and fat) which promotes obesity and maximises insulin resistance. When they make the transition from their traditional hunter-gatherer lifestyle to a westernised lifestyle, Aborigines develop high prevalence rates for obesity (with an android pattern of fat distribution), non-insulin dependent diabetes, impaired glucose tolerance, hypertriglyceridaemia, hypertension and hyperinsulinaemia. The striking improvements in carbohydrate and lipid metabolism in diabetic and non-diabetic Aborigines after a temporary reversion to a traditional hunter-gatherer lifestyle highlight the potentially reversible nature of the detrimental effects of lifestyle change, particularly in young people who have not yet developed diabetes. CONCLUSION: It is suggested that insulin resistance was important to the survival of Aborigines as hunter-gatherers, but is also the underlying metabolic characteristic predisposing them to obesity, NIDDM and CHD after westernisation. Intervention strategies to prevent chronic diseases related to insulin resistance should be directed at lifestyle modification. To be effective such programmes will have to be developed and implemented at the community level.     

Perinatal and infant mortality

Australia's infant mortality rate fell below 10/1000 live births for the 1st time in 1983 (9.6/1000). Internationally, Australia ranks 12th in infant mortality among countries with populations over 2.5 million. Contributing to this relatively poor international standing has been the high incidence of low birthweight infants, high postneonatal mortality in disadvantaged population groups such as the Aborigines, and the completeness of registration of infant mortality in Australia. There is a legal requirement that perinatal deaths from at least 20 weeks gestation or 400 gm birthweight be registered. In 1983, the national perinatal mortality rate was 12.2/1000 births. The greatest reduction in neonatal mortality has been among infants weighing 1000-2499 gms. Most of the recent improvement in the low birthweight component of the neonatal death rate is attributable to the better survival of these infants, not a major reduction in the incidence of low birthweight. Several proposals are made for improving the data on perinatal and infant mortality in Australia. These deaths should be routinely linked to the maternal and fetal or neonatal data in the perinatal morbidity data collections to facilitate identification of risk factors. Also, pregnancies terminated after diagnosis of fetal abnormalities should be included in these perinatal data collections. Steps such as educating the community about the adverse effects of alcohol and smoking in pregnancy, increased planning of pregnancy, better detection of high risk pregnancies, and regionalization of the care of pregnant women at high risk of complications could contribute to further reductions in infant and perinatal mortality in Australia.     

Thiamin deficiency and prevention of the Wernicke-Korsakoff syndrome. A major public health problem

There has been long-standing debate in Australia about the role of thiamin deficiency in the aetiology of the Wernicke-Korsakoff syndrome, the prevalence of the syndrome itself and the preventive measures that might be undertaken to reduce the prevalence rates. A literature review, and the results of a study of the follow-up arrangements of patients who were admitted with Korsakoff's syndrome to the two major South Australian psychiatric hospitals indicate that the syndrome is a major public health problem which requires immediate political intervention. Recommendations are made that a national policy of the fortification of flour and bread with thiamin, as well as of alcoholic beverages, should be implemented.     

中澳合作的中国的医学院校认证

2008年,中国根据国际标准与指南建立了临床医学专业认证制度.截至2013年,中国已经认证20所院校,并计划至2020年认证所有137所医学院校.为了实现这一目标,中国的医学教育工作者与澳大利亚同行开展了合作.中国和澳大利亚同为世界医学教育联合会的区域性机构西太平洋地区医学教育协会的成员,双方的合作始于2000年区域性会议上的非正式讨论,之后主要开展了3个方面的合作：在中国为潜在的认证专家和准备接受认证的院校举办培训会;中国的认证专家赴澳大利亚访问,考察澳大利亚医学理事会开展的认证活动;澳大利亚专家参与中国医学院校的认证（本文中所用的“医学院校认证”等同于中国“本科临床医学专业认证”.本文中方作者注）.本文论述了在国际医学教育认证的大背景下,双方逐步开展合作,形成今天独特的双边合作模式.同时,本文对具有中国特色的标准和指南的制定、试点实施进行了说明.最后,讨论了迄今为止所取得的成果和面临的挑战。     

The Australian e-Health Research Centre: enabling the health care information and communication technology revolution

The CSIRO (Commonwealth Scientific and Industrial Research Organisation) and the Queensland Government have jointly established the Australian e-Health Research Centre (AEHRC) with the aim of developing innovative information and communication technologies (ICT) for a sustainable health care system. The AEHRC, as part of the CSIRO ICT Centre, has access to new technologies in information processing, wireless and networking technologies, and autonomous systems. The AEHRC's 50 researchers, software engineers and PhD students, in partnership with the CSIRO and clinicians, are developing and applying new technologies for improving patients' experience, building a more rewarding workplace for the health workforce, and improving the efficiency of delivering health care. The capabilities of the AEHRC fall into four broad areas: smart methods for using medical data; advanced medical imaging technologies; new models for clinical and health care interventions; and tools for medical skills development. Since its founding in 2004, new technology from the AEHRC has been adopted within Queensland (eg, a mobile phone-based cardiac rehabilitation program), around Australia (eg, medical imaging technologies) and internationally (eg, our clinical terminology tools).