College of Medicine and Public Health

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https://hdl.handle.net/2328/26052

The College of Medicine and Public Health deliver clinical, population and lab based research, integrated teaching programs and high quality clinical services.

Our teaching footprint reaches out from our world class teaching hospital at the Flinders Medical Centre in South Australia to multiple rural clinical locations all the way to Darwin in the Northern Territory.

We promote research in health services, systems improvements, public and population health, improved clinical care and laboratory and precision medicine.

This approach has seen us investigate everything from community health problems to the smallest of molecules that influence human disease.

Our research and teaching equips the next generation of leaders and innovators with the skill, commitment and vision to protect vulnerable communities and truly advance health outcomes. It’s at the heart of everything we do.

It’s about improving the health and wellbeing for everyone in society.

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    Indirect assessment of sinus node function in man
    (Flinders University of South Australia, 1983) Heddle, William F
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    The politics of participation
    (Public Health Association of Australia, 1989-03) Dwyer, Judith Margaret
    Community participation in health policy, planning and services is a central theme in the current exploration of community development methods for the promotion of health. Participation is an idea in good currency, but there is no con­sensus about how, when and where to develop participatory structures. This paper analyses the rationales advanced in favour of community participation and describes the main forms that participation has taken in Australia. It uses experience in human services generally as well as in the health area specifically. Examples from women's health are used to illustrate the underlying political value of participation for disadvantaged groups. It is argued that participation, like many other instruments of social policy, can be used towards conflicting ends, and that its value and practice should be assessed in terms of the fundamental question: 'who benefits?'
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    Maxon is an Optimal Suture for Bile Duct Anastomoses in Pigs
    (Hindawi, 1993-03-07) Jeans, Phil ; Hall, Pauline ; Liu, Yong-Feng ; Baker, Robert Ashley ; Holt, Andrew ; Saccone, Gino Tony ; Harvey, John R ; Scicchitano, Jan ; Toouli, James
    Background. Three commonly used sutures were tested in a pig model of bile duct anastomosis to assesstheir relative contributions to inflammation and scarring.Methods. Thirty pigs were randomised to bile duct division and anastomosis with either polyglyconate(Maxon), polyglactin 910 (Vicryl) or polypropylene (Prolene). Half the animals were sacrificed at twoweeks and the remainder at 23 weeks. Anastomoses were assessed by cholangiography, scanningelectron microscopy and light microscopy.Results. There was less short term histological reaction with the two monofilament materials, Proleneand Maxon, compared to the braided suture Vicryl. Maxon was associated with less long terminflammation than Prolene, was found to handle better, and has an advantage over Prolene by beingabsorbable.Conclusion. Maxon is an optimal suture for bile duct anastomoses. Its long term absorptioncharacteristics make it suitable for situations where bile duct healing may be delayed.
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    Detection of Tropheryma whippelii DNA in a patient with AIDS
    (American Society for Microbiology, 1995-05) Maiwald, Matthias ; Meier-Willersen, HJ ; Hartmann, M ; von Herbay, Axel
    A case of an AIDS patient infected with the Whipple's disease bacterium, Tropheryma whippelii, is reported. A DNA fragment with sequence specificity for the 16S rRNA gene of the bacterium was detected by PCR in a duodenal biopsy specimen from a 55-year-old male patient with AIDS and diarrhea. The biopsy specimen contained periodic acid-Schiff stain-positive macrophages which did not, however, resemble the sickleform-particle-containing cells characteristic of Whipple's disease. This observation raises two possibilities: either the patient had a coincidence of AIDS and Whipple's disease or Tropheryma whippelii acted as an opportunistic pathogen in this immunodeficient patient. The latter explanation is of interest in light of the ongoing discussion of immunologic abnormalities as predisposing factors for Whipple's disease.
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    Comparison of urinary bladder and ear biopsy samples for determining prevalence of Borrelia burgdorferi in rodents in central Europe
    (American Society for Microbiology, 1996-05) Petney, Trevor N ; Hassler, D ; Bruckner, M ; Maiwald, Matthias
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    Environmental occurrence of the Whipple's disease bacterium (Tropheryma whippelii).
    (American Society for Microbiology, 1998-02) Maiwald, Matthias ; Schuhmacher, F ; Ditton, H J ; von Herbay, Axel
    Whipple's disease is a systemic disorder in which a gram-positive rod-shaped bacterium is constantly present in infected tissues. After numerous unsuccessful attempts to culture this bacterium, it was eventually characterized by 16S rRNA gene analysis to be a member of the actinomycetes. The name Tropheryma whippelii was proposed. Until now, the bacterium has only been found in infected human tissues, but there is no evidence for human-to-human transmission. Here we report the detection of DNA specific for the Whipple's disease bacterium in 25 of 38 wastewater samples from five different sewage treatment plants in the area of Heidelberg, Germany. These findings provide the first evidence that T. whippelii occurs in the environment, within a polymicrobial community. This is in accordance with the phylogenetic relationship of this bacterium as well as with known epidemiological aspects of Whipple's disease. Our data argue for an environmental source for infection with the Whipple's disease bacterium.
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    Endoscopic and Surgical Management of a Hayes Type III-G Cystic Duct Anomaly Causing a Mirizzi Type I Syndrome
    (Hindawi, 1998-08) Anderson, Paul G ; Toouli, James ; Wilson, Thomas Graham ; Graham, Michael
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    Diversity of Helicobacter pylori vacA and cagA genes and relationship to VacA and CagA protein expression, cytotoxin production, and associated diseases
    (American Society for Microbiology, 1999-06) Rudi, J ; Kolb, C ; Maiwald, Matthias ; Kuck, D ; Sieg, A ; Galle, PR ; Stremmel, W
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    Organization, structure, and variability of the rRNA operon of the Whipple's disease bacterium (Tropheryma whippelii)
    (American Society for Microbiology, 2000) Maiwald, Matthias ; von Herbay, Axel ; Lepp, PW ; Relman, David A
    Whipple's disease is a systemic disorder associated with a cultivation-resistant, poorly characterized actinomycete, Tropheryma whippelii. We determined a nearly complete rRNA operon sequence of T. whippelii from specimens from 3 patients with Whipple's disease, as well as partial operon sequences from 43 patients. Variability was observed in the 16S-23S rRNA spacer sequences, leading to the description of five distinct sequence types. One specimen contained two spacer sequence types, raising the possibility of a double infection. Secondary structure models for the primary rRNA transcript and mature rRNAs revealed rare or unique features.
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    The Umoona Kidney Project
    (Aboriginal and Islander Health Worker Journal, 2000) Shephard, Mark Douglas ; Brown, Michael A ; Hudson, Maryanne ; Riessen, Cissie ; Braun, Janice
    Kidney disease is one of the most serious problems facing Aboriginal Australians. Nationally the number of Aboriginal people with advanced or end-stage kidney disease is six times that of non-Aboriginal Australians. It has recently been predicted that a further 500 Aboriginal people will develop end-stage kidney disease by the year 2004. The only treatment options for Aboriginal people with advanced stage kidney disease are dialysis or transplantation, both of which cause significant social and cultural trauma for the individual and their family. Early detection of renal disease is critical because, if identified early enough, progression to end-stage kidney disease can be slowed or even prevented. As a result, early detection has the potential to significantly reduce the number of Aboriginal people who may ultimately require dialysis or transplantation.
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    Screening for renal disease in a remote Aboriginal community using the Bayer DCA 2000
    (Australian Institute of Medical Scientists, 2001) Shephard, Mark Douglas ; Allen, G G
    End-stage renal disease among Aboriginal Australians has reached alarming proportions during the past decade. The early identification of this disease through community screening programs is a key strategy in reducing the long-term financial and cultural burden of the disease. The small point-of-care Bayer DCA 2000 analyser, which tests for urine albumin:creatinine ratio (ACR), was used as a marker for early renal disease in an adult screening program in a remote South Australian Aboriginal community. Nineteen percent of 149 adults screened had previously undiagnosed persistent microalbuminuria (ACR between 3.4 and 33.9 mg/mmol), while a further 9% had persistent overt albuminuria (ACR greater than or equal to 34 mg/mmol). Aboriginal health workers were trained in the operation of the DCA 2000 to enable screening to be an ongoing, sustainable activity within the community setting. The DCA exhibited excellent analytical performance characteristics and was robust and reliable throughout the study period.
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    Whipple's disease and Tropheryma whippelii: secrets slowly revealed.
    (University of Chicago Press, 2001-02) Maiwald, Matthias ; Relman, David A
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    Point-of-care in Aboriginal hands
    (Aboriginal and Islander Health Worker Journal, 2002) Jones, Richard ; Mazzachi, Beryl C ; Shephard, Mark Douglas
    Diabetes, kidney disease and heart disease (all chronic diseases) are among the most serious health problems facing Aboriginal people today. The point-of-care program has a broad chronic disease focus that (a) looks for early signs of diabetes, kidney disease and heart disease collectively and (b) provides follow-up management for people identified as being at risk for chronic disease.
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    Assessment of the point-of-care Cholestech Lipid Analyser for lipid screening in Aboriginal communities
    (Australian Institute of Medical Scientists, 2002) Shephard, Mark Douglas ; Tallis, George A
    Cardiovascular disease is the leading cause of mortality in Aboriginal Australians. Screening for cardiovascular disease risk factors, notably elevated blood lipids, is urgently needed. The small portable Cholestech machine (Point-of-Care Diagnostics) can enzymatically measure total cholesterol, triglyceride and HDL cholesterol (without the prior need for precipitation of other lipoproteins)on 35 microlitres of capillary or veinous whole blood in under 5 minutes. It also calculates LDL cholesterol. Its suitability for use in Aboriginal communities was assessed. With its simple operation, fully automated nature, sound analytic performance and ability to produce a full lipid profile in under 5 minutes, the Cholestech would be suitable for the Aboriginal health care setting.
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    Microchimerism in systemic sclerosis: comment on the article by Johnson et al.[comment]. [Postprint]
    (Wiley, 2002-09) Roberts-Thomson, Peter John ; Walker, Jennifer Gauld ; Hakendorf, Paul Haylett ; Smith, Malcolm Douglas ; Ahern, Michael John
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    Melioidosis in Northern Australia, 2001-02
    ( 2003) Cheng, Allen C ; Davis, Josh ; Currie, Bart John ; Hanna, Jeffrey N ; Dowse, Gary ; Hills, Susan L ; Krause, Vicki L ; Inglis, Tim J ; Norton, Robert
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    Intensity of rainfall and severity of Melioidosis, Australia
    ( 2003) Jacups, Susan P ; Currie, Bart John
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    Assisting diabetes management through point-of-care HbA1c testing - the QAAMS program for Aboriginal health workers
    (Aboriginal and Islander Health Worker Journal, 2003) Shephard, Mark Douglas ; Mundraby, Kay
    Diabetes has had a devastating impact on the health of Indigenous people throughout the world. In Australia, Aboriginal and Torres Strait Islander people suffer between 12 and 17 times more deaths due to diabetes than non-Indigenous people. In many Aboriginal communities rates of Type 2 diabetes range from 15% to 30%. Diabetes itself is a significant risk factor for heart disease and is the major cause of end-stage renal disease in Aboriginal people. This article describes a national program called QAAMS (or Quality Assurance for Aboriginal Medical Services) that was developed to assist the management of Aboriginal people with diabetes. Aboriginal Health Workers administer the program on a day-to-day basis. The unique feature of the program is that it uses a point-of-care medical instrument (called the DCA 2000) to measure a test for the long-term control of diabetes (called Haemoglobin A1c).
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    Point-of-care testing in the Aboriginal community
    (Australian Institute of Medical Scientists, 2003) Shephard, Mark Douglas
    This article documents experiences working in the field of Aboriginal health. The principle focus of the work is the application of Point-of-Care (POC) technology for the early detection and management of chronic diseases in the Aboriginal community setting. Apart from the well acknowledged advantages of using POC technology such as portability and small sample size, there are other advantages specific, and directly applicable, to the Aboriginal health care setting.
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    Preventive medical care in remote Aboriginal communities in the Northern Territory: a follow-up study of the impact of clinical guidelines, computerised recall and reminder systems, and audit and feedback
    (BioMed Central - http://www.biomedcentral.com, 2003-07-30) Bailie, Ross Stewart ; Togni, Samantha ; Si, Damin ; Robinson, Gary ; d'Abbs, Peter
    Background Interventions to improve delivery of preventive medical services have been shown to be effective in North America and the UK. However, there are few studies of the extent to which the impact of such interventions has been sustained, or of the impact of such interventions in disadvantaged populations or remote settings. This paper describes the trends in delivery of preventive medical services following a multifaceted intervention in remote community health centres in the Northern Territory of Australia. Methods The intervention comprised the development and dissemination of best practice guidelines supported by an electronic client register, recall and reminder systems and associated staff training, and audit and feedback. Clinical records in seven community health centres were audited at regular intervals against best practice guidelines over a period of three years, with feedback of audit findings to health centre staff and management. Results Levels of service delivery varied between services and between communities. There was an initial improvement in service levels for most services following the intervention, but improvements were in general not fully sustained over the three year period. Conclusions Improvements in service delivery are consistent with the international experience, although baseline and follow-up levels are in many cases higher than reported for comparable studies in North America and the UK. Sustainability of improvements may be achieved by institutionalisation of relevant work practices and enhanced health centre capacity.