Health Disparities among Australia's Remote-Dwelling Aboriginal People: A Report from 2020.

BACKGROUND: Australia has 2 distinct indigenous groups, Torres Strait Islanders and Aborigines. The Aborigines, described in this report, first colonized the continent 65 millennia ago. Those still living in the Northern Territory (NT) retain much ancestrally derived genetic complement but also are the most health-challenged by environment and lifestyle in 21st century. Reports providing overviews of these disparities are, as yet, rare. CONTENT: This review defines the studied population and then describes and attempts to explain contemporary clinical findings among Australia's remote-dwelling Aborigines, principally in the NT. The report is structured by life stage and then by organ system. Finally, a brief synthesis is advanced concerning the disparities that Australia's Aboriginals face. SUMMARY: In 2015-2017, NT aboriginal life expectancy for people then born was 66.6 years for men and 69.9 years for women compared with 78.1 and 82.7 years, respectively, among nonindigenous Territorians. Principal causes of the reduced longevity, with nonindigenous comparisons, include adolescent pregnancy, with maternal use of alcohol and tobacco (each 7-fold greater); fetal alcohol spectrum disorder and attention deficit hyperactivity disorder; skin infections, both scabies and impetigo (50-fold greater); rheumatic heart disease (260-fold greater); premature acute myocardial infarction (9-fold greater); bronchiectasis (40-fold greater); lung cancer (2-fold greater); diabetes mellitus (10-fold greater); renal failure (30-fold greater); and suicide (2-fold greater). Some disease has genetic roots, secondary to prolonged genetic drift. Much arises from avoidable stressors and from contemporary environmental disparities in housing. The Europid diet is also not helpful.

Codes of Ethics for Laboratory Medicine: Definition, Structure and Procedures - A Narrative Review Based on Existing National Codes.

BACKGROUND: It behoves every national society of clinical laboratory medicine to have a well formulated and publicly accessible policy concerning the morally acceptable way in which its members should practise their profession; such a policy is published as a Code of Ethics.This Code assists its members in the performance of their duties in relation to the patients they share with other clinicians, within their own particular professional environment and, at large, to the rest of their national society. METHODS AND RESULT: The International Federation of Clinical Chemistry and Laboratory Medicine's (IFCC) Task Force on Ethics here examines a curated selection of extant Codes and provides guidance at the level of definition, structure and procedures to assist national societies and their clinical chemistry and laboratory medicine professionals in the task of crafting their own Ethics Code.

The epidemiology of Staphylococcus aureus skin and soft tissue infection in the southern Barkly region of Australia's Northern Territory in 2017.

The aim of this study was to describe the burden and organism antibiotic resistance patterns of skin and soft tissue infections (SSTI) due to Staphylococcus aureus presenting in a remote Australian Northern Territory community in the Barkly region. We collated reported antibiograms of all skin and superficial soft tissue swab specimens obtained from the town's Indigenous medical clinic from 12 of the 13 months between November 2016 and December 2017. Clinician's notes for the consultation associated with each test request were examined to determine the nature of the clinical problem and to access other relevant data. Amongst 309 tissue swab specimens, S. aureus was cultured in 215 (70%), of which 202 isolations were from Indigenous Australians. Of the 215 S. aureus, 98 [46%, 95% confidence interval (CI) 31-52] were methicillin resistant S. aureus (MRSA) and 117 (54%, 95% CI 48-61) sensitive (MSSA). Significant numbers were also resistant to other frequently used oral antibiotics, with resistance to erythromycin in 52 (24%), clindamycin in 51 (24%), trimethoprim in 22 (10%) and fusidic acid in eight (4%). In the Barkly region of Australia's NT in 2017, community-acquired staphylococcal SSTI needing professional care is equally likely to be caused by MRSA as by MSSA.

Troponin reporting in Australia in 2003.

BACKGROUND AND METHOD: This study uses a cross-sectional survey by questionnaire of Australia's pathology laboratories to describe how they report chemical markers for myocardial necrosis. RESULTS: The questionnaire was sent to 364 laboratories; 346 (95%) responded. Reporting data were obtained for 222 instruments used to analyse markers of myocardial necrosis, some 81% of all those in Australia. All laboratories use a troponin measurement. Reports from 132 analysers (59% of total) provide one cut-off point for the diagnosis of myocardial necrosis and 90 (41%) two cut-off points. The chosen cut-off points vary. The upper limit of 'healthy' is cited, alone, in 40 reports (18%); at this level, in 2002 no analysers predictably met required precision standards. Only 50% of all reports carry some explanatory comment; only 16% of all reports cite the source of the data. CONCLUSIONS: Troponin is used throughout Australia to help diagnose myocardial necrosis, but there is little order in the way the results are reported or interpreted.

Gestational diabetes mellitus: a review from 2004.

Gestational diabetes mellitus (GDM) is carbohydrate intolerance with onset or first recognition in pregnancy. More often than not the intolerance abates between pregnancies but may recur. As well, up to 70% of affected women will manifest type 2 diabetes mellitus within 10 years thereafter. GDM is diagnosed with a glucose challenge at approximately 28 weeks' gestation though there is no universally accepted protocol for the procedure or for interpreting its results. Morbidity increases for both mother and foetus in GDM affected pregnancies. Maternal and early infant morbidity can be ameliorated by returning the maternal glucose economy to within healthy limits. Diet, exercise and, if needed, insulin, are used therapeutically to this end. Beneficial effects later in the affected infant's life are less well established. Thresholds and targets vary from place to place.

Troponin testing: an audit in three metropolitan hospitals.

OBJECTIVE: To audit the appropriateness of use of a troponin I assay in three hospitals. DESIGN: Cross-sectional survey of use of a troponin assay. SETTING: Three hospitals in Melbourne, Victoria, each with an emergency department and a coronary care unit. PARTICIPANTS: Patients for whom a troponin I assay was requested between 1 and 7 May 2002, 27-42 months after introduction of the assay. INTERVENTIONS: User-focused dissemination of relevant information, including protocols for use, from opinion leaders when the assay was introduced; continuous reinforcement of information in pathology reports. MAIN OUTCOME MEASURES: Adherence to protocol for assay use. RESULTS: Troponin assays were requested for 333 patients during 351 symptom episodes. A single assay was used in 194 symptom episodes (55%), and serial assays in 157 (45%); proportions were statistically indistinguishable across all three hospitals (chi(2); P = 0.71). Of the 194 single assays, 13 (7%) diagnosed a myocardial infarction. Serial troponin testing in all three hospitals followed the suggested protocol, with mean time between serial assays being more than 6 hours at all hospitals. CONCLUSIONS: Adherence to the protocol for serial troponin assay intervals was adequate, but single troponin assays were used extensively and probably inappropriately.