Hitting up in the top end: characteristics of needle exchange clients in Darwin

OBJECTIVE: Little is known about injecting drug use (IDU) and blood-borne viral (BBV) infection in rural Australia. METHOD: These repeat cross-sectional studies were conducted during a two-week period in July and October-November 1998 at the Darwin needle exchange, with 129 and 121 respondents respectively. RESULTS: The commonest drug of choice was heroin, but the commonest drug injected was morphine. Self-reported sharing of needles and syringes was uncommon. Self-reported serostatus for HIV was high (8% and 11.4% respectively), but seemingly mostly associated with sexual rather than IDU risk; for hepatitis C (HCV) status, these were 54% and 37%. Among IDUs of Aboriginal or Torres Strait Islander (ATSI) background, who made up 14% of the first round respondents, patterns of IDU and of BBV infection were the same as among non-ATSI respondents. CONCLUSIONS: These surveys reveal patterns of IDU in Darwin that have both similarities and differences with those in the major urban centres in Australia. In the absence of a comprehensive methadone maintenance program, many participate in a more or less informal morphine substitution program. HIV is present among these IDUs, and the risks of further sexual transmission may be high. IMPLICATIONS: These surveys confirm the presence among injecting drug users in Darwin of HIV, HBV and HCV, and of the risk for further spread of these viruses. Control of blood-borne virus transmission among IDUs requires an even greater commitment to abolishing sharing of needles and syringes, and therefore continued support and enhancement of needle and syringe availability.     

From "our world" to the "real world": Exploring the views and behaviour of policy-influential Australian public health researchers

Research and researchers influence the genesis and development of public health policy in limited but essential ways. Surveys and interviews with 36 peer-nominated "highly influential" Australian public health researchers found they engaged in a breadth of strategies that included rigorous but targeted research design, multilateral collaboration, multiple methods of research dissemination and promotion (including tactical use of the media), and purposeful development of bridging relationships. Researchers' ability to understand the worlds of research, policy and the media and to speak their languages (or to work with others who fulfilled this role) was a key factor. Advocacy was seen as fundamental by some but was disparaged by others. Influential behaviours were guided by values and beliefs about the principles underlying traditional science and the contrasting ethos of contemporary research. This study may help researchers consider their own policy-related roles, strategies and relationships in the context of increasing calls for research that serves economic and/or social goals.     

Prevention of opportunistic infections in immunosuppressed patients in the tropical top end of the Northern Territory.

The population of the Top End of the Northern Territory has a high incidence of several infections of particular significance in the immunosuppressed. The following protocol for evaluation and treatment of patients prior to immunosuppression was developed in order to reduce the incidence of serious opportunistic infections. The infections discussed are Strongyloides stercoralis, tuberculosis, scabies, chronic hepatitis B, melioidosis and other bacterial infections. We recommend that all patients planned to receive more than 0.5 mg/kg/day of prednisolone for >14 days, or any more potent immunosuppressive drug, be evaluated and treated according to this protocol. Details of the rationale, evidence base, and proposed investigations and therapy for such patients are discussed.     

Diversity. Race to the top

Ten different providers deliver Breaking Through, including PricewaterhouseCoopers, Hay Management Group and Beacon Organisational Development. The first cohort started in January 2004 with 160 participants. All participants take a development centre module first but then take modules that best meet their needs.     

Making the right moves to get to the top

It's no secret that there are fewer top slots available for healthcare executives in hospitals today. So if you have your sights set on the number one or two spot, it's never too soon to plot your course of action.     

From food databases to dietary assessment: A beginning to an end approach for quality nutrition data

Aim: This paper reviews the historical basis of modern assessment of nutrient composition—from food composition tables and the transition to nutrient databases. Method: A narrative review was formed beginning with the first, very crude printed food composition tables, to electronic food databases and continuing to how dietary assessment is currently impacted by state‐of‐the‐art techniques and what that means for food composition. Results: A plethora of studies, especially international studies, have utilised information from food composition via nutrient databases and software designed to extract food composition data into relevant files for dietary assessment. The United States Department of Agriculture's nutrient data bank is widely used, even internationally, and concerns about its appropriateness in other locales needs to be addressed. A number of countries have developed food composition databases unique to the foods of their population. International studies realised a number of problems related to inconsistencies between countries. Essentially, high‐quality food composition data requires up‐to‐date information on food supply, supplement use and potential food contaminants. Food composition tables form the basis for data published on nutrient intakes of individuals via food diaries, food recalls and surveys and, in addition, nutrient claims for some food products; thus, accuracy and reliability are paramount. New tools in dietary assessment, such as food photography, make nutrient assessment more widely available, requiring even more attention paid to the accuracy of food composition databases. Conclusions: The globalisation of food sources and the need for continuity regarding dietary data present challenges needing reconciliation. International concepts for food composition tables have evolved to address these problems.     

From the biomedical model to the Islamic alternative: a brief overview of medical practices in the contemporary Arab world

Following its climax in the 8th century under the Abbasids of Baghdad, the Arab world entered a prolonged period of division and decadence. "Western" medicine was introduced in the 19th century with the support of the general population. The historical participation of Arabs in the elaboration of that "Western" biomedical model and its apparently consensual re-introduction into the Arab world diffused any sense of cognitive alienation vis-à-vis practices promoted initially by non-Arab doctors. In the late 1960s, Islamist thinkers started proposing "Islamic medicine" as an alternative to the encroachment of the "Western" biomedical model within Arab and Muslim nations. In Islamic medicine, disease is attributed to lack of attention to the spiritual dimension of human beings, yet intermediate causal pathways are not provided. Alongside "orthodox" concepts, Islamic medicine promotes some herbal remedies, in addition to faith-healing through prayer and the recitation of holy verses. While most of those practices may be beneficial, they may cause some harm to patients if they entail delaying or denying timely recourse to "orthodox" medical care. There are currently no Islamic medicine training programs in any Arab country, and Islamic medicine has not emerged as a comprehensive health alternative comparable to other non-Western health models.     

From selfish individualism to citizenship: Avoiding health Economics’ reputed ‘dead end’

Recent interpretations of citizenship are firmly rooted in the value of social membership and social participation. Citizens are described as having a moral right to draw upon the support of the community, but at the same time have a responsibility to contribute to the provision of social services such as health care. In contrast, contemporary health economics has been criticised for taking a narrow and individualistic view of human behaviour. This paper examines the extent to which economic theory and practice have been developed to accommodate a more ‘civic’ view, namely, the notions of mutual concern for community members, social participation and social rights. It is argued that because the provision of health care is often linked to feelings of compassion and social responsibility and not just to individual well-being, this sort of insight may enrich economic analysis and, in turn, provide a way around health economics’ reputed ‘dead end’.