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University departments of rural health are Commonwealth‐funded to improve recruitment and retention of the rural allied health and nursing (including midwifery) workforce, primarily through student placements.We examined publications by university departments of rural health that were focused on allied health and nursing students undertaking placements in rural Australia, to understand the characteristics, main findings and implications of the research conducted.Interprofessional learning was a key feature of placements and placement education, although other activities such as community engagement added to placement experiences.Factors such as quality supervision and being involved in the community contributed to a positive placement experience and increased rural practice intention. Tracking studies showed a relationship between rural placements, rural practice intention and rural practice.Rural placements occurred across a variety of settings and in locations consistent with the policy framework. Embedding university departments of rural health in rural communities enabled staff to build relationships and increase placement capacity.

Objectives: This research aimed to gain insights into the reporting of family violence (FV) and to explore any changes in FV reporting associated with a FV primary prevention initiative in Geraldton, Western Australia. Methods: An in‐depth analysis of articles published by the Geraldton Guardian in 2019 examined the nature of FV reporting. Analysis was based on deductive coding from existing literature and inductive identification of new themes. A comparative analysis examined articles from the Geraldton Guardian and Albany Advertiser over the same three‐month period in 2015, 2017 and 2019 to analyse trends in FV reporting. Results: Of 135 articles analysed, there was alignment with five previously reported themes and two new themes were identified: FV as a public health issue; and community responses to reduce FV. Episodic framing was overwhelmingly associated with court reporting. There was more reporting of efforts at primary prevention of FV over time in both newspapers. Conclusions: Local media can contribute to the promotion of community and public health issues related to FV. Efforts are needed to improve court reporting to situate FV in a broader context. Implications for public health: Concerted efforts to educate the public and journalists can support FV being recognised as a public health issue.

Several Western Australian notification data are examined to compare tendencies and rates of HIV and sexually transferred infections among indigenous and non-indigenous people. Findings reveal that indigenous Western Australians are more vulnerable to HIV transmission than non-indigenous Australians, hence suggesting to incorporate the control of sexually transferred diseases in procedures to inhibit further HIV infections.

In Australia, risk, vaccine uptake and vaccination status are factors in concern about juvenile offenders and hepatitis B. Research has been carried out to determine the hepatitis B vaccination status of juvenile offenders in custodial care, perceived risk of the infection and vaccine uptake factors. The program studied did not adequately protect the group, which has a high lifetime risk of hepatitis B. Lack of contact with healthcare services, overlooking offering of vaccine and reluctance to participate in preventive healthcare measures. Often the young offenders do not see themselves as being at risk. Universal approaches to vaccination may be helpful.

Background and Objectives: Although regulations in Victoria require notification of chlamydia infection by both clinician and laboratory, review found many reports that were notified only by one source (i.e., were unmatched). Goals: To identify problems with the notification system and to improve the quality of surveillance for this disease. Study Design: All notified cases of chlamydia diagnosed in January or February 1995 were followed up by contacting diagnosing doctors. Identified noncompliant laboratories were asked to provide a list of all diagnoses for the period and institute ongoing reporting. Notification data were reviewed for timeliness and completeness. Results: Clinicians never notified without laboratory confirmation. Soliciting laboratory reports increased total notifications by 30%, and there was a highly significant improvement in reporting by both clinicians and laboratories. Reasons for failure to notify by clinicians included an assumption by some clinicians that laboratories would notify and ignorance that notification was required. Conclusions: Notified cases generally are now accompanied by a laboratory report, and although nonnotification by clinicians continues, notification has improved. Further improvements in clinician notification may depend on doctors knowing that public health action results from reporting. An alternative to requiring doctors' time to be spent in duplicate notification would be to strengthen laboratory reporting and then check that adequate treatment and partner notification has occurred through contact with the diagnosing doctor., Several changes in the administrative process may improve the Australian Health Department's ability to track Chlamydia infections. The notification patterns of laboratories and primary doctors were analyzed during a two-month period in Victoria, Australia. Few laboratories or doctors notified the Health Department within the required seven days following infection identification. However, nearly all of the doctors but only 48% of the laboratories had notified the department within three weeks of identification. Reminder calls to the laboratories resulted in the most significant response rate improvement. Many doctors were unclear about the reporting procedures.

Background: Data quality is fundamental to the integrity of quantitative research. The role of external researchers in data quality assessment (DQA) remains ill-defined in the context of secondary use for research of large, centrally curated health datasets. In order to investigate equity of palliative care provided to Indigenous Australian patients, researchers accessed a now-historical version of a national palliative care dataset developed primarily for the purpose of continuous quality improvement.Objectives: (i) To apply a generic DQA framework to the dataset and (ii) to report the process and results of this assessment and examine the consequences for conducting the research.Method: The data were systematically examined for completeness, consistency and credibility. Data quality issues relevant to the Indigenous identifier and framing of research questions were of particular interest.Results: The dataset comprised 477,518 records of 144,951 patients (Indigenous N= 1515; missing Indigenous identifier N= 4998) collected from participating specialist palliative care services during a period (1 January 2010–30 June 2015) in which data-checking systems underwent substantial upgrades. Progressive improvement in completeness of data over the study period was evident. The data were error-free with respect to many credibility and consistency checks, with anomalies detected reported to data managers. As the proportion of missing values remained substantial for some clinical care variables, multiple imputation procedures were used in subsequent analyses.Conclusion and implications: In secondary use of large curated datasets, DQA by external researchers may both influence proposed analytical methods and contribute to improvement of data curation processes through feedback to data managers.

Objective: To synthesise the evidence for effectiveness of initiatives aimed at improving food retail environments and consumer dietary behaviour in rural, regional and remote populations in Australia and comparable countries, and to discuss the implications for future food environment initiatives for rural, regional and remote areas of Australia. Study design: Rapid review of articles published between January 2000 and May 2020. Data sources: We searched MEDLINE (EBSCOhost), Health and Society Database (Informit) and Rural and Remote Health Database (Informit), and included studies undertaken in rural food environment settings in Australia and other countries. Data synthesis: Twenty‐one articles met the inclusion criteria, including five conducted in Australia. Four of the Australian studies were conducted in very remote populations and in grocery stores, and one was conducted in regional Australia. All of the overseas studies were conducted in rural North America. All of them revealed a positive influence on food environment or consumer behaviour, and all were conducted in disadvantaged, rural communities. Positive outcomes were consistently revealed by studies of initiatives that focused on promotion and awareness of healthy foods and included co‐design to generate community ownership and branding. Conclusion: Initiatives aimed at improving rural food retail environments were effective and, when implemented in different rural settings, may encourage improvements in population diets. The paucity of studies over the past 20 years in Australia shows a need for more research into effective food retail environment initiatives, modelled on examples from overseas, with studies needed across all levels of remoteness in Australia. Several retail initiatives that were undertaken in rural North America could be replicated in rural Australia and could underpin future research. Objective: To explore and evaluate health and social care interventions delivered to rural and remote communities experiencing natural disasters in Australia and other high income countries. Study design: We used systematic rapid review methods. First we identified a test set of citations and generated a frequency table of Medical Subject Headings (MeSH) to index articles. Then we used combinations of MeSH terms and keywords to search the MEDLINE (Ovid) database, and screened the titles and abstracts of the retrieved references. Data sources: We identified 1438 articles via database searches, and a further 62 articles via hand searching of key journals and reference lists. We also found four relevant grey literature resources. After removing duplicates and undertaking two stages of screening, we included 28 studies in a synthesis of qualitative evidence. Data synthesis: Four of us read and assessed the full text articles. We then conducted a thematic analysis using the three phases of the natural disaster response cycle. Conclusion: There is a lack of robust evaluation of programs and interventions supporting the health and wellbeing of people in rural communities affected by natural disasters. To address the cumulative and long term impacts, evidence suggests that continuous support of people’s health and wellbeing is needed. By using a lens of rural adversity, the complexity of the lived experience of natural disasters by rural residents can be better understood and can inform development of new models of community‐based and integrated care services. Objective: To investigate the impact of bushfire events on the wellbeing of children living in rural and remote Australia. Study design: Literature review completed using rapid realist review methods, and taking into consideration the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) statement for systematic reviews. Data sources: We sourced data from six databases: EBSCOhost (Education), EBSCOhost (Health), EBSCOhost (Psychology), Informit, MEDLINE and PsycINFO. We developed search terms to identify articles that could address the research question based on the inclusion criteria of peer reviewed full text journal articles published in English between 1983 and 2020. We initially identified 60 studies and, following closer review, extracted data from eight studies that met the inclusion criteria. Data synthesis: Children exposed to bushfires may be at increased risk of poorer wellbeing outcomes. Findings suggest that the impact of bushfire exposure may not be apparent in the short term but may become more pronounced later in life. Children particularly at risk are those from more vulnerable backgrounds who may have compounding factors that limit their ability to overcome bushfire trauma. Conclusion: We identified the short, medium and long term impacts of bushfire exposure on the wellbeing of children in Australia. We did not identify any evidence‐based interventions for supporting outcomes for this population. Given the likely increase in bushfire events in Australia, research into effective interventions should be a priority. Objective: Maldistribution of the health workforce between rural, remote and metropolitan communities contributes to longstanding health inequalities. Many developed countries have implemented policies to encourage health care professionals to work in rural and remote communities. This scoping review is an international synthesis of those policies, examining their effectiveness at recruiting and retaining nursing, dental and allied health professionals in rural communities. Study design: Using scoping review methods, we included primary research — published between 1 September 2009 and 30 June 2020 — that reported an evaluation of existing policy initiatives to address workforce maldistribution in high income countries with a land mass greater than 100 000 km2. Data sources: We searched MEDLINE, Ovid Embase, Ovid Emcare, Informit, Scopus, and Web of Science. We screened 5169 articles for inclusion by title and abstract, of which we included 297 for full text screening. We then extracted data on 51 studies that had been conducted in Australia, the United States, Canada, United Kingdom and Norway. Data synthesis: We grouped the studies based on World Health Organization recommendations on recruitment and retention of health care workers: education strategies (n= 27), regulatory change (n= 11), financial incentives (n= 6), personal and professional support (n= 4), and approaches with multiple components (n= 3). Conclusion: Considerable work has occurred to address workforce maldistribution at a local level, underpinned by good practice guidelines, but rarely at scale or with explicit links to coherent overarching policy. To achieve policy aspirations, multiple synergistic evidence‐based initiatives are needed, and implementation must be accompanied by well designed longitudinal evaluations that assess the effectiveness of policy objectives. Objective: Many data sources are used in Australia to inform health workforce planning, but their characteristics in terms of relevance, accessibility and accuracy are uncertain. We aimed to identify and appraise publicly available data sources used to describe the Australian health workforce. Study design: We conducted a scoping review in which we searched bibliographic databases, websites and grey literature. Two reviewers independently undertook title and abstract screening and full text screening using Covidence software. We then assessed the relevance, accessibility and accuracy of data sources using a customised appraisal tool. Data sources: We searched for potential workforce data sources in nine databases (MEDLINE, Embase, Ovid Emcare, Scopus, Web of Science, Informit, the JBI Evidence‐based Practice Database, PsycINFO and the Cochrane Library) and the grey literature, and examined several pre‐defined websites. Data synthesis: During the screening process we identified 6955 abstracts and examined 48 websites, from which we identified 12 publicly available data sources — eight primary and four secondary data sources. The primary data sources were generally of modest quality, with low scores in terms of reference period, accessibility and missing data. No single primary data source scored well across all domains of the appraisal tool. Conclusion: We identified several limitations of data sources used to describe the Australian health workforce. Establishment of a high quality, longitudinal, linked database that can inform all aspects of health workforce development is urgently needed, particularly for rural health workforce and services planning. Objective: To describe interventions, barriers and enablers associated with opioid tapering for patients with chronic non‐cancer pain in rural primary care settings. Study design: Rapid realist review registered on the international register of systematic reviews (PROSPERO) and conducted in accordance with RAMESES standards. Data sources: English language, peer‐reviewed articles reporting qualitative, quantitative and mixed method studies, published between January 2016 and July 2020, and accessed via MEDLINE, Embase, CINAHL Complete, PsycINFO, Informit or the Cochrane Library during June and July 2020. Grey literature relating to prescribing, deprescribing or tapering of opioids in chronic non‐cancer pain, published between January 2016 and July 2020, was identified by searching national and international government, health service and peek organisation websites using Google Scholar. Data synthesis: Our analysis of reported approaches to tapering conducted across rural and non‐rural contexts showed that tapering opioids is complex and challenging, and identified several barriers and enablers. Successful outcomes in rural areas appear likely through therapeutic relationships, coordination and support, by using modalities and models of care that are appropriate in rural settings and by paying attention to harm minimisation. Conclusion: Rural primary care providers do not have access to resources available in metropolitan centres for dealing with patients who have chronic non‐cancer pain and are taking opioid medications. They often operate alone or in small group practices, without peer support and access to multidisciplinary and specialist teams. Opioid tapering approaches described in the literature include regulation, multimodal and multidisciplinary approaches, primary care provider support, guidelines, and patient‐centred strategies. There is little research to inform tapering in rural contexts. Our review provides a synthesis of the current evidence in the form of a conceptual model. This preliminary model could inform the development of a model of care for use in implementation research, which could test a variety of mechanisms for supporting decision making, reducing primary care providers’ concerns about potential harms arising from opioid tapering, and improving patient outcomes.

Hepatitis C in patients admitted with acute hepatitis has been studied in a retrospective cross-sectional study at the Fairfield Infectious Diseases Hospital, 1971-1975. It takes 20-30 years to get liver disease after infection with hepatitis. In the decade following 1998 Australia will probably have significant liver-related morbidity. Prevalence increased over the years of the study, suggesting rapid spread of hepatitis C virus through susceptible groups, especially injection drug users.

There are ongoing health workforce shortages in rural Australia with nurses a major component of the provision of health care. Training for nursing students in rural areas is one strategy to overcome this.

To assess the risks of stroke and cardiovascular mortality for Aboriginal and non‐Aboriginal Australians with atrial fibrillation. Retrospective data linkage cohort study. All people aged 20–84 years hospitalised with atrial fibrillation in Western Australia during 2000–2012. Stroke incidence rates and mortality after hospitalisation for atrial fibrillation, and 10‐year risks of stroke and of cardiovascular and all‐cause mortality. Among 55 482 index admissions with atrial fibrillation, 7.7% of 20–59‐year‐old patients and 1.3% of 60–84‐year‐old patients were Aboriginal Australians. A larger proportion of Aboriginal patients aged 20–59 years had CHA2DS2‐VASc scores of 2 or more (59.8% v21.8%). In 20–59‐year‐old Aboriginal patients, the incidence during follow‐up (maximum, 10 years; median, 7.1 years) of stroke (incidence rate ratio [IRR], 3.2; 95% CI, 2.5–4.1) and fatal stroke (IRR, 5.7; 95% CI, 3.9–8.9) were markedly higher than for non‐Aboriginal patients. Stroke incidence was higher for 60–84‐year‐old patients, but the difference between Aboriginal and non‐Aboriginal patients was smaller (IRR, 1.6; 95% CI, 1.3–2.0). Cardiovascular mortality during follow‐up was also higher for 20–59‐year‐old Aboriginal patients (IRR, 4.4; 95% CI, 4.3–5.9). The hazards of stroke (adjusted HR[aHR], 1.67; 95% CI, 1.22–2.28) and cardiovascular mortality (aHR, 1.47; 95% CI, 1.18–1.83) in younger Aboriginal patients remained significantly higher after multivariable adjustment; age/sex, principal diagnosis of atrial fibrillation, and CHA2DS2‐VASc score were the most influential factors. Stroke risk and cardiovascular mortality are markedly higher for Aboriginal than non‐Aboriginal patients with atrial fibrillation, particularly for patients under 60. Strategies for providing evidence‐based therapies and cardiovascular prevention to Aboriginal people with atrial fibrillation must be improved.

To illuminate the enablers and challenges of implementing a communication strategy designed to support Community, Respect, Equality (CRE) and a family and domestic violence (FDV) primary prevention plan in a regional Western Australian town.

A study examines Aboriginal patientsE views of the barriers to effective communication between health service providers and patients affected by cancer in Western Australian hospital settings. It is suggested that health service providers should adopt better cultural sensitivity, and understand and respect Aboriginal way of life and family structures, so as to enable better communication with them and provide effective cancer treatment.

The article discusses a number of strategies that must be and are being applied to meet the cancer menace. Greater integration of care by a multidisciplinary team of professionals, peer support groups and general health practitioners offering better practical and psychosocial supportive care for patients and their families is the need of the hour.

The cross-sectional baseline audit to describe delivery of child health services in Australian Aboriginal communities and find the shortcomings in services needed to enhance the health of Aboriginal children is described. The development of systems for immediate and long-term consistent response to problems is emphasized, as the present systems are not sufficient for effective flow-up of identified medical and social problems for the children of remote Aboriginal communities.

Objective: Examine the feasibility and acceptability of an electrocardiogram (ECG) attached to a mobile phone (iECG) screening device for atrial fibrillation (AF) in Aboriginal Controlled Community Health Services (ACCHS) and other community settings. Methods: Semi‐structured interviews were conducted with ACCHS staff in urban, rural and remote communities in three Australian states/territories. Quantitative and qualitative questions identified the enabling factors and barriers for staff and Aboriginal patients' receptiveness to the device. Mean quantitative scores and their standard deviation were calculated in Microsoft Excel and qualitative questions were thematically analysed. Results: Eighteen interviews were conducted with 23 staff across 11 ACCHS. Quantitative data found staff were confident in providing iECG screening and managing the referral pathway, and thought the process was beneficial for patients. Qualitative data highlighted the usefulness of the device to undertake opportunistic screening and acceptability in routine practice, and provided opportunities to engage patients in education around AF. Conclusion: The iECG device was well accepted within ACCHSs and was feasible to use to screen for AF among Aboriginal patients. Implications for public health: The device can be used in clinical and community settings to screen Aboriginal people for atrial fibrillation to help reduce rates of stroke and other cardiovascular diseases.

ObjectivesImproving Indigenous people’s access to palliative care requires a health workforce with appropriate knowledge and skills to respond to end-of-life (EOL) issues. The Indigenous component of the Program of Experience in the Palliative Approach (PEPA) includes opportunities for Indigenous health practitioners to develop skills in the palliative approach by undertaking a supervised clinical placement of up to 5 days within specialist palliative care services. This paper presents the evaluative findings of the components of an experiential learning programme and considers the broader implications for delivery of successful palliative care education programme for Indigenous people.MethodsSemistructured interviews were conducted with PEPA staff and Indigenous PEPA participants. Interviews were recorded, transcribed and key themes identified.ResultsParticipants reported that placements increased their confidence about engaging in conversations about EOL care and facilitated relationships and ongoing work collaboration with palliative care services. Management support was critical and placements undertaken in settings which had more experience caring for Indigenous people were preferred. Better engagement occurred where the programme included Indigenous staffing and leadership and where preplacement and postplacement preparation and mentoring were provided. Opportunities for programme improvement included building on existing postplacement and follow-up activities.ConclusionsA culturally respectful experiential learning education programme has the potential to upskill Indigenous health practitioners in EOL care.

Objective:To examine where Indigenous Australians undergo cancer treatment and learn about specific service initiatives that have been implemented to meet their needs. Methods:Public cancer treatment centres across Australia were invited to participate in an online survey about various characteristics of their centre, including the type of service provided, Indigenous patient numbers and policy, and implementation of Indigenous‐specific initiatives. Results:Surveys were completed for 58 of 125 public cancer treatment centres. Almost half (47%) of the services saw more than 10 Indigenous patients per year, although Indigenous patients generally represented a small minority of patients. The most commonly reported initiatives were “having links with Indigenous health organisations in the community” (74% of services), “making a dedicated effort to address the needs of Indigenous patients” (69%) and proactively “creating partnerships with Indigenous communities and health organisations” (69%). Conclusions:The majority of respondents indicated that they were working to meet the needs of Indigenous patients and were interested in learning strategies from others to improve their services. More work is needed to describe and evaluate the specific initiatives that have been implemented. Implications for public health:Information from this study can assist cancer service providers to identify gaps in current services, plan new service delivery initiatives and ultimately improve Indigenous cancer outcomes.

Study background Increasing cultural safety in health settings is essential to address stark health disparities between Indigenous and non-Indigenous Australians. Respect for cultural knowledge, better communication, and recognition of racism as a determinant of health are required for improved service delivery. How this knowledge is acquired in health professional training and translated to clinical settings is poorly understood.Purpose Impacts of an innovative Indigenous health unit and remote clinical placements on knowledge acquisition and attitude change were explored among midwifery students to inform cultural competency initiatives in health professional training.Methods A multiphased, mixed methods research design used surveys, observations, and interviews. Qualitative analysis was strengthened through triangulation with quantitative data.Results A unit conceived with substantial Indigenous Australian input and which privileged these voices enhanced knowledge and shifted attitudes in a positive direction; however, immediate gains diminished over time. Remote placements had a profound effect on student learning. Exposure to Indigenous Australians in classrooms and communities, and the self-reflection generated, helped dispel stereotypes and challenge assumptions based on limited cultural knowledge and contact.Conclusion Optimization of receptivity to Indigenous Australian content and opportunities for remote placements contributed to students’ developing cultural capabilities with implications for all health professional training. Whether this heightened awareness is enough to address institutional racism identified in health service delivery remains unanswered. The focus must include those established health practitioners and administrators who influence organizational culture if real systemic change is to occur. Given appropriate on-going support, graduates can play a vital role in expediting this process.

To examine a) the implementation and use of a DVD developed to educate Aboriginal people about bowel cancer and bowel cancer screening; and b) broader aspects of Aboriginal participation in the National Bowel Cancer Screening Program.

To determine inequities in clinical adherence to national diagnostic and management guidelines for acute coronary syndrome (ACS) for Aboriginal and non‐Aboriginal ACS patients at a regional hospital.

Preferences for topics and means of access to health information among newly arrived, culturally and linguistically diverse women in Perth, Western Australia, were explored. A mixed-methods approach was adopted. Qualitative material obtained from focus groups and interviews with 22 service providers and 26 migrant women was used to develop a questionnaire, which was then administered to 268 newly arrived migrant and refugee women from 50 countries. Participants' information and support priorities were ascertained from a ranking exercise conducted in a non-threatening context. Responses of migrant and refugee women were compared quantitatively. Women's top priorities for information and support included employment advice, as well as information regarding mental health issues, women's health, exercise and nutrition, family violence and alcohol and other drug issues. Their preferred methods for receiving information were interactive talks or presentations, with written material support. Audiovisual and Web-based material were also considered useful. There were differences between refugee women's and other migrants' preferences for means of receiving information and topics of most concern. The use of a non-threatening ranking process encouraged women to prioritise sensitive topics, such as family violence, and revealed a need for such topics to be incorporated within general health information presentations. Internet-based technologies are becoming increasingly important methods for disseminating information to migrant women. Differences between migrant and refugee women's priority health issues and their preferred methods for receiving information highlight the desirability of tailoring information to particular groups. Although advice on employment pathways and mental health concerns were top priorities, the study revealed a need for more discussion on other sensitive topics, such as family violence and alcohol-related issues, and that ideally these should be incorporated into general information sessions to destigmatise attendance The increasing relevance of computer technology and social media for information dissemination was also of note. The preferences for topics and means of access to health information among 268 newly arrived culturally and linguistically diverse women in Perth, Western Australia, were explored, with some differences noted between refugee women's and other migrant's preferences. An interactive talk or presentation, with supplementary written material, was the most popular format for receiving information, but increasing interest in computer-based learning suggests health education providers should consider including computer or social media information options. Interest in employment pathways and mental health concerns were high priorities; however, a need for more discussion on sensitive topics, such as family violence and alcohol-related issues, was revealed, with women suggesting such topics be included in general health information sessions to destigmatise attendance.

Objective:To examine the resettlement experiences and provide data of well being and psychological distress for Afghan and Kurdish refugees settled between eight and 20 years in New Zealand and Australia.

The analysis aimed to assess the Indigenous status of an increasing number of deaths not coded with a useable Indigenous status from 1997 to 2002 and its impact on reported recent gains in Indigenous mortality.

Objective:Cancer among Indigenous populations in the developed world appears to have increased over past few decades. This article explores issues related to cancer among the Indigenous populations of Australia, Canada, New Zealand and the US and examines variations in the epidemiology, Indigenous peoples' perceptions about cancer and potential effects on care‐seeking behaviour. Methods:A search of peer‐reviewed journal articles, government reports, published and unpublished theses and other grey literature was undertaken using electronic databases and citation snowballing. Both epidemiological and qualitative studies were included. Results:Cancer in Indigenous populations in these four countries is characterised by high incidence and mortality rates for specific cancers and lower survival rates as a result of late diagnosis, lower participation and poorer compliance with treatment. A higher prevalence of many cancer risk factors occurs across these populations. Fear of death, fatalism, payback, shame and other spiritual and cultural issues are reported in the few qualitative studies examining Indigenous beliefs and understanding of cancer which undoubtedly influences participation in cancer screening and treatment. Conclusions and implications:The holistic approach (physical, mental, emotional and spiritual) to healing and well‐being, and the concept that individual, family and community are inseparable underpin Indigenous care‐seeking behaviour. Further community‐based research is needed to increase understanding of the needs of Indigenous people with cancer, and to guide policy and practice towards more supportive and effective care.

As in other developed countries, the Australian population is ageing, and cancer rates increase with age. Despite their substantially lower life expectancy, Indigenous Australians are also experiencing concerning cancer statistics, characterised by increasing rates, later diagnosis, higher mortality, and lower participation in screening than the non-Indigenous population. Eighteen months after the first national Indigenous Cancer Control Forum, this environmental scan within the statebased Cancer Councils was undertaken to map activities in service provision in Indigenous cancer control with a view to sharing the lessons learned. The findings show that although most of the organisations had tried to work with Indigenous communities on cancer issues, there have been difficulties in building and sustaining relationships with Indigenous organisations. Lack of having Indigenous staff internally, few Indigenous-specific resources, and few planned, long-term commitments were some of the major impediments. Some of these limitations can easily be overcome by building and improving regional or local partnerships, providing cultural awareness training to internal staff, and by building the capacity of Indigenous organisations. Health promotion projects of the Cancer Councils directed at Indigenous people could be more effectively implemented with such considerations.

Background: To investigate the nature of, and trends in, Australian print media coverage of sexually transmissible infections (STI) in indigenous Australians. Methods: Newspaper articles from January 1986 to June 2004 were downloaded from the Factiva database. Of 164 articles examined based on our search criteria, 100 were included for analysis. An assessment of the tone and content of each article was made by two reviewers, and data were entered and analysed using EpiInfo (Centers for Disease Control and Prevention, Atlanta, GA) Results: Most articles were serious (89%), matter of fact and information dense (50%) and critical of the subject of the article (44%). Of the articles that were emotive, 78% evoked a sense of shock or frustration. The stimulus for the article was government related in 65%; a purely academic opinion was presented in 82%; and only one viewpoint was presented in 73%. The papers publishing the greatest number of articles were The Sydney Morning Herald (31%) and The Age (18%). From 1996 there was an increase in the number of articles and improvements in the voice given to indigenous informants. This may reflect initiatives in journalism education and release of a protocol on how STI in indigenous communities should be reported. Conclusion: Overall, the style of reporting was heavy, dry and critical, written in an academic style and failed to critically examine or challenge government initiatives. The potential for print media to educate the general public is poorly utilised. Further exploration of how sensitive indigenous issues can be presented to avoid stereotyping, stigma and nihilism, while initiating more effective action, is needed.

Objective:To provide practical advice to health care providers and public health practitioners regarding screening and management of sexually transmitted infections (STIs) in sex workers, and to examine the effectiveness of condoms in reducing transmission of STIs.

Background: More than 30 million needle syringes are distributed per year in Australia as a component of harm‐reduction strategies for injecting drug users (IDU). Discarded needle syringes create considerable anxiety within the community, but the extent of needlestick injuries and level of blood‐borne virus transmission risk is unclear. We have undertaken a review of studies of blood‐borne virus survival as the basis for advice and management of community needlestick injuries. Methods: A Medline review of published articles on blood‐borne virus survival and outcome from community injuries. Results: Hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) can all survive outside the human body for several weeks, with virus survival influenced by virus titer, volume of blood, ambient temperature, exposure to sunlight and humidity. HBV has the highest virus titers in untreated individuals and is viable for the most prolonged periods in needle syringes stored at room temperature. However, prevalence of HBV and HIV are only 1–2% within the Australian IDU population. In contrast, prevalence of HCV is 50–60% among Australian IDUs and virus survival in needle syringes has been documented for prolonged periods. There have been no published cases of blood‐borne virus transmission following community needlestick injury in Australia. Conclusion: The risk of blood‐borne virus transmission from syringes discarded in community settings appears to be very low. Despite this, procedures to systematically follow up individuals following significant needlestick exposures sustained in the community setting should be developed.

There are concerns in Australia about inadequate rates of childhood immunisation, an important preventive measure to reduce infectious diseases. The population passing through the Melbourne Juvenile Justice Centre (MJJC) comes from a background at high risk for inadequate immunisation and outbreaks can occur in residential institutions. MJJC residents were invited to participate in a study by completing a medical officer-administered risk behaviour questionnaire and/or giving a blood sample. Ninety residents completed the questionnaire; 83 gave blood samples. Sera were tested for measles, mumps, rubella and hepatitis A, B and C markers using standard commercial assays. Diphtheria and tetanus were tested with an ELISA in a public health laboratory familiar in the technique. Sixty four per cent (53/83) of participants were non-immune to at least one component of MMR and 44.6% (37/83) non-immune to either tetanus or diphtheria. Despite 61.1% of participants reporting injecting drug use, only 28.2% had protective levels of anti-HBs, 6.1% were positive for anti-HBc (2.4% equivocal), 22.9% were anti-HCV positive and 9.6% had markers of exposure to hepatitis A virus. These results show suboptimal levels of immunity in this institutional setting with the potential for disease outbreaks. Many residents miss adolescent school-based programs for immunisation because of truancy and early school leaving. Despite considerable risk of blood-borne viruses, many MJJC residents are inadequately vaccinated against hepatitis B.

Results of routine testing at other sites can supplement surveillance of the HIV epidemic in Australia which is largely basec upon voluntary testing. Since 1989, systematic onsite HIV testing has been undertaken on all bodies taken to the Victorian Institute of Forensic Medicine (VIFM). Information was collected on all cases of HIV infection detected at VIFM between 1989 and 1996, and matched to surveillance databases. In 8 years, 75 people were diagnosed with HIV; all except one were male. The age range was 14-70 years, mean 37.4 years. The major causes of death were suicide 35%, AIDS 21%, druc toxicity 16%, natural causes 12% and injury 7%. The major exposure categories were male homosexual 51%, male bisexual 11%, homosexual/bisexual IDU 16%, IDU other 8%, and haemophiliac 7%. For only two was exposure information unavailable. Seropositivity for anti-HCV and HBsAg was 37% and 11% respectively. The deceased was recorded as having HIV/AIDS on the police report in 73% of cases, and at least 90% of subjects had been diagnosed with HIV prior to their death. The study suggests there is relatively little undiagnosed HIV infection in Victoria, that HIV infection has not moved outside traditional risk groups, and that many tests for HIV are undertaken using false namecodes. Many patients could not be matched on the HIV/A|DS databases, identifying a problem with HIV surveillance systems in Victoria, and the need to capture all information on HIV positives detected at VIFM.

AbstractObjective:To examine the policies and practices in hospitals within the state of Victoria, Australia, with respect to vaccination of staff against hepatitis B infection.Design:A written self-administered questionnaire to be completed by the infection control officer (or designated officer for hepatitis B vaccination) within each hospital.Setting:Public (teaching and nonteaching) and private hospitals, including metropolitan and rural institutions in Victoria.Participants:A random sample of 30% of Victorian hospitals were asked to participate in the survey. Of 78 eligible institutions, 69 (88%) completed and returned questionnaires.Results:There was no consistent hepatitis B prevention policy in place across Victoria. Of the 69 responding hospitals, 63 (91%) offered hepatitis B vaccination to staff, and 58 (84%) of these also paid all costs of vaccination. Of the 63 hospitals offering vaccination to staff, 39 offered vaccination to all staff, 23 offered vaccination based on job title, and one offered vaccination based on anticipated exposure. In many institutions, postexposure protocols were recalled more readily than preexposure vaccination guidelines. Numerous respondents indicated a need for clear guidelines on policy and clarification on practical matters of management, such as acceptable immune levels, management of nonresponders to the primary series, and the need for, and timing of, booster doses of vaccine. Eleven (18%) of the 63 hospitals offering hepatitis B vaccination to staff undertook routine prevaccination screening, a practice not generally regarded as cost-effective in Australia. Fifty-five of these hospitals (91%) also undertook postvaccination screening.Conclusions:It is evident from this study that a considerable number of potentially susceptible healthcare personnel in Victorian hospitals remain unprotected against hepatitis B infection. A more reliable and consistent approach to preexposure hepatitis B vaccination is recommended

Abstract: Examination of testing patterns for human immunodeficiency virus (HIV) in a population is important because it affects interpretation of surveillance data on new HIV diagnoses and can guide the targeting and evaluation of campaigns to encourage appropriate antibody testing. This report describes a relatively inexpensive mechanism of collecting information on who is being tested for HIV in Victoria (other than at the Blood Bank). The annual number of HIV tests performed in Victoria increased steadily throughout the 1980s but the rate of increase slowed in the early 1990s. By 1993, women accounted for almost half of HIV tests, although they made up only 8 per cent of positive tests. There were marked differences in the volume of testing and testing profiles of different laboratories. The information available on personal risk category and the reasons for HIV tests show that many people of low risk are tested, although conclusions are limited by inadequate information elicited or provided by many requesting doctors. For better information on what is occurring with respect to HIV testing, the fundamental requirement is better compliance from requesting doctors in supplying basic information on who they test and why.

Abstract: From the start of clinical testing for human immunodeficiency virus (HIV) antibody in 1985 until the end of June 1994, the Microbiological Diagnostic Unit tested 134 346 serum samples from 109 391 individuals, identifying 672 as infected. A suitable database, using coded identities, was established from the beginning. Because the sera came from a variety of clinical settings, it was possible to extract information about patterns of requests for tests and about the yield of seropositive cases. The data were able to highlight factors associated with high rates of positive tests that can be lost in amalgamated statewide data. The discovery of HIV‐positive females was sporadic and there was a much lower detection rate than from testing males. While males were most commonly diagnosed through specialist venereology services, 61 per cent of diagnoses in females were through nonspecialised practices, often those without previous experience in diagnosis and management of HIV infection. Despite some individual exceptions, the requesting of HIV tests appears generally to have been justifiable (particularly in view of the direction of official preventive campaigns) and not profligate. Overall, where practice was unsatisfactory, this lay less in thoughtless ordering of tests than in failing to include with the specimen the elementary, but vital, epidemiological information requested.

Objectives: Patients with chronic mental illnesses constitute an important risk group for HIV infection overseas. This study aimed to determine the prevalence of risk behaviours associated with HIV transmission and factors associated with HIV testing in psychiatric patients in Melbourne.Methods: Inpatients and outpatients completed an interviewer-administered questionnaire which covered demographics, psychiatric diagnosis, risk behaviour, and HIV education and testing.Results: Of 145 participants, 60% were male and 55.2% had schizophrenia. Injecting drug use (IDU) was reported by 15.9%, a figure approximately 10 times that found in other population surveys. Most patients reported sex in the last decade and over 20% had multiple sexual partners in the last year. Of males, 12.6% reported sex with another male (9.2% anal sex); 19.0% of females reported sex with a bisexual male. Nearly half of the males reported sex with a prostitute, 2.5 times that in a population sample. Only 15.9% reported ever having someone talk to them specifically about HIV and its transmission, although one-third had been tested for HIV. In multivariate analysis, male-male sex, paying for sex, and IDU were associated with HIV testing, but those whose primary language was not English were less likely to be tested. Those who had received HIV education were more likely to have used a condom last time they had sex (OR 4.52, 95%C11.49–14.0).Conclusions: This study provides evidence that those with serious mental illness in Victoria have higher rates of participation in risk behaviour for HIV infection than those in the general community. Attention to HIV education and prevention in this group has been inappropriately scant; strategies to encourage safer behaviour are urgently needed.

Objective: To review the published literature in relation to prevalence of HIV infection and risk behaviours for HIV among the mentally ill to assist in the development of appropriate strategies for public health policy, surveillance and clinical management of HIV and HIV risk in these groups.Method: A search of published literature was carried out using ‘Medline’, in association with following up appropriate papers cited in the References of journals identified.Results: The North American literature shows an increased risk of HIV infection in psychiatric patients receiving treatment in both inpatient or community settings. HIV infection is associated with a number of risk behaviours, particularly male homosexual sex and injecting drug use, and being the sexual partner of a person with a history of these. Impulsivity, high levels of sexual activity during acute exacerbations of psychiatric illness, poor skills at negotiating safe sex, homelessness and drug abuse are all risk behaviours common among those affected by some mental illnesses. The mentally ill also have a comparatively poorer knowledge of HIV/AIDS. There is a dearth of published Australian data addressing the question of HIV seroprevalence or risk in the mentally ill. Although there has been development and implementation of HIV risk-reduction programs overseas, the development and evaluation of any programs in Australia has not been published.Conclusions: Arguably, Australia has developed a comprehensive program of national surveillance for HIV infection and has been relatively successful in its response to the HIV epidemic, with the high rates of infection in the early to mid-1980s substantially reduced to around 600 new diagnoses per year. However, while risk behaviours which exposed those infected with the virus are recorded, underlying conditions which predispose them to these behaviours are not. Nevertheless, there is HIV infection amongst mentally ill and intellectually disabled people in Australia. Examination of the North American experience reveals opportunities to prevent a high rate of HIV infection in those with mental illness in Australia. Such a program would require adequate risk behaviour assessment, appropriate diagnostic testing and management, and development of specific educational interventions which are properly evaluated to ensure their effectiveness.

Objectives: To improve the quality of surveillance data for HIV in Victoria by following up all cases with an unknown exposure category; and to determine whether those with no exposure category included cases of transmission other than via the conventionally recognised routes. Methods: The Victorian HIV database records data on all people diagnosed with HIV in Victoria, including information on route of exposure to the virus. We identified all HIV diagnoses to which no exposure category had been attributed and, with the permission of the State Minister for Health, obtained access to namecoded testing records. Exposure categories, where possible, were obtained directly from these records. Otherwise, cases were checked against the namecoded AIDS database and, if necessary, an intensive process of call‐back to laboratories, diagnosing doctors and HIV treatment centres was undertaken. Results: The database initially contained records for 289 people with unknown exposure categories (9.1% of Victorian people with HIV infection). We identified exposure categories for 155 of these people. Conclusions: Exposure categories for those cases previously without data were similar to those for cases where exposure category was known. No instances of HIV transmission by previously unrecognised means were detected.

BACKGROUND AND DESIGN: Studies published have suggested a possibility that regular use of sunscreen to prevent skin cancer may put the population, particularly elderly people, at risk of vitamin D deficiency. We aimed to determine whether regular use of sunscreens in the normal adult population, as recommended by public health authorities for the prevention of skin cancer, may put individuals at risk of vitamin D deficiency. A randomized double-blind control trial of the daily use of a broad-spectrum sunscreen (sun protection factor [SPF] 17) vs placebo cream over a summer period in Australia was conducted in 113 people aged 40 years and over, with sampling stratified by age. All participants had at least one solar keratosis. Serum samples taken at the beginning and at the end of the study were analyzed for 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3. RESULTS: Mean levels of 25-hydroxyvitamin D3 rose significantly by the same amount in both groups over the period of the study (placebo, +12.8 mmol/L; sunscreen, + 11.8 mmol/L). Mean levels of 1,25-dihydroxyvitamin D3 increased significantly in the pla- cebo group only (placebo, +10.8 pmol/L; sunscreen, +1.3 pmol/L), but for no subject in either group was the level of 1,25-dihydroxyvitamin D3 outside the reference range either at the start or at the end of the study. There were no significant differences by age, sex, and skin type in the change in 25-hydroxyvitamin D3 or 1,25-dihydroxyvitamin D3 over the study period. CONCLUSIONS: No person, including those aged 70 years and over, developed any vitamin D levels outside the normal reference range during the period of the study. The data suggest that over an Australian summer sufficient sunlight is received, probably through both the sunscreen itself and the lack of total skin cover at all times, to allow adequate vitamin D production in people who are recommended to use sunscreens regularly. More work is required to elucidate the relationship between 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3, particularly during the different seasons of the year.(Arch Dermatol. 1995;131:415-421)

We evaluated legislation introduced into Victoria in 1991 requiring that all children enrolling in primary school certify their immunisation status. Information was requested from all local councils. All primary schools in two local government areas were followed up, providing an indication of the validity of the analysis obtained from data collected during the mid‐year census. From 166 of 210 local councils in Victoria, 48 422 documents relating to school entry immunisation certificates were issued for children entering their preparatory year. At least 522 children were enrolled in school on an undertaking to complete immunisation, and were likely to have had their immunisation completed as a result of the legislation. Only 170 statutory declarations of conscientious objection to immunisation were made, indicating that few parents are willing to express firm anti‐vaccine sentiments. Compliance with the immunisation certificate legislation is overestimated by the mid‐year census because many schools have accepted nonstatutory evidence of immunisation. Mobile and immigrant families find it particularly difficult to achieve certification. Local councils are inconsistent in the way in which they issue certificates. Further follow‐up and feedback is essential to better inform schools and parents about the legislation. Such follow‐up can improve the certification rates of children then and in subsequent years. The legislation has imposed a considerable workload on councils, but without efforts to improve compliance with the legislation and to develop practical guidelines for documentation of immunisation and appropriate guidelines regarding transfer, many inadequately immunised children may remain at risk from vaccine‐preventable diseases.

In 1982 the National Health and Medical Research Council recommended that every state introduce legislation requiring immunisation certificates at school entry. Victoria was the first state to enact such legislation. This paper explores the process and difficulties encountered in achieving this legal requirement, describes the requirements under the legislation as it was finally introduced, and examines the early data available to the state health department regarding its implementation. Compliance with the legislation and immunisation status of children enrolling in government primary schools were ascertained from mid‐year census data. In 1992 almost 90 per cent of children complied with the legislation, but because 10.2 per cent of children did not present a certificate it was possible to estimate only the lower limit of statewide coverage at 85 per cent against the prescribed diseases. School entry immunisation legislation may provide an important safety net to identify children with incomplete immunisation. However, the effectiveness of the legislation in Victoria remains unproven, and the requirements of the legislation are demanding for parents, local councils, and schools. The failure to document immunisation status in over 10 per cent of children indicates that further efforts to increase compliance are needed. This will require information on the vaccination status of those without certificates and the reasons they have not complied. The impact of the legislation needs further evaluation, although it may be years before its effectiveness can be gauged. Its effectiveness may depend upon enforcement of the requirement to exclude unimmunised children in disease outbreaks.

Surveillance systems have been developed in Victoria to determine trends in sexually transmissible diseases (STDs). Notifications to the Health Department (including laboratory notification since May 1990) have been supplemented by data about strains of Nasseria gonorrhoeaeand cultures for Chlamydia trachomatisprocessed by the Microbiological Diagnostic Unit, enhanced laboratory surveillance of syphilis, and data on genital herpes and genital warts from the Melbourne Sexual Health Centre. During the period under review the incidence of gonorrhoea declined, rapidly at first, and then more slowly. For women, this trend has continued, while gonorrhoea acquired abroad by men has become relatively more important. Since 1988, gonorrhoea in homosexual men has increased, and rectal isolates have increased concurrently, raising concerns about HIV risk behaviour. Cases of syphilis are likely to be ascertained through STD, antenatal and refugee screening, rather than because of symptoms or contact tracing. Chlamydia is a the most common notifiable STD, despite underreporting and under‐diagnosis. In 1991, 832 cases were notified, increasing to 1377 in 1992. In 1992, of the 73 cases (65 per cent of notifications) where the doctor identified a risk, 15 per cent was attributed to homosexual contact, and 27.4 per cent to heterosexual exposure. Limitations in the data include inadequate standard case definitions for many STDs, changes in the statutory requirement for notifications in 1990, underreporting, changes in diagnostic and screening patterns, and lack of detailed demographic data. Education of general practitioners is needed to improve diagnosis and notification of chlamydia.

Abstract: The study aimed to estimate the prevalence of risk factors for liver disease, particularly hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, in a population–based series of hepatocellular carcinoma, and to assess the feasibility of retrospective surveys in determining risk factors for hepatocellular carcinoma. A survey of all cases of hepatocellular carcinoma diagnosed in 1991 and 1992 documented the high contribution of alcoholic cirrhosis, particularly in Australian–born men. Low levels of testing for HBV and HCV made their contribution to hepatocellular carcinoma uncertain. No cases of hepatocellular carcinoma due to HBV or HCV were reported in Australian–born subjects. Higher rates of HBV carriage in those tested were found in Asian and Mediterranean immigrants. Testing for HCV was known to have occurred for less than a quarter of subjects, and assessment for multiple aetiological risk factors was rare. The burgeoning epidemic of HCV will require improved surveillance for the sequelae of long–term infection. Satisfactory surveillance will require cooperation from clinicians in regard to the completeness of medical records and adequate resources for cancer registries to supplement their passive reporting system with exposure data. (Aust N Z J Public Health 1997; 21: 626–30)

Abstract: Tattooists at a random sample of registered tattooing premises were surveyed for self–reported compliance with infection–control practices specified in the Victorian Standards of practice for tattooing, and some were observed while tattooing. Of 35 respondents, 94 per cent reported that they believed their practice fully met the standards, yet 19 per cent of tattooists did not have a copy of the standards at their premises. Most believed the standards could be improved. There was considerable discrepancy between reported practice and that observed. Few tattooists understood or implemented universal precautions, and while most wore gloves, there was low level of use of eye and clothing protection. Tattooists touched many surfaces that had not been cleaned or disinfected between clients. Ultrasonic cleaners were generally operated without lids. Because of this, they were a danger both to operators and their clients. At no premises was equipment used that had been both cleaned according to the standards and sterilised in an autoclave that had passed a sterilisation test. The situation in Victoria is similar to that identified in other states. There is an urgent need for training of tattooists and the environmental health officers who supervise them.

Abstract: Historically, the relationship between health authorities and tattooists has been marked by suspicion and mutual distrust, with tattooists being stereotyped as having little concern for hygiene, and considered largely ineducable about infection control. In this study, a random sample of tattooists working at one–third of the 65 registered tattooing premises in Victoria completed a questionnaire that recorded demographic information and knowledge and attitudes to Standards of practice for tattooing1990, which specifies guidelines for infection control in Victorian tattooing premises. Of these premises, 89 per cent participated and 36 of 37 tattooists working therein (22 metropolitan, 14 country) completed the questionnaire; 81 per cent were male. Reports by the tattooists indicated that: 50 per cent had not commenced immunisation for hepatitis B; that 78, 42 and 34 per cent either had not been tested or were unsure whether they had been tested for hepatitis C, hepatitis B and human immunodeficiency virus (HIV); and that no tattooist was a hepatitis B carrier or was positive for hepatitis C or HIV. Respondents acknowledged the potential for transmission of infectious diseases through tattooing, endorsed formal training in tattooing and infection control for new tattooists, and supported continuing education in infection control for existing tattooists. Most were critical of environmental health officers, particularly for inaction in not closing and prosecuting unregistered tattooists. Despite deficiencies in the knowledge and training of tattooists in infection control, they recognise its importance and are willing to attend appropriate training.

The possibility of using xenogeneic islets for transplantation in insulin-dependent diabetes mellitus (IDDM) necessitates characterization of their potential for growth and functional differentiation. Fetal pig pancreas (FPP) of various gestational ages was examined with respect to morphology, ability to produce insulin before and during culture, and development and function in nude mice. Insulin-containing beta cells were present, but distinct islets were not apparent in FPP even in late gestation, and did not develop during culture. FPP remained viable and produced insulin for up to 30 days in vitro. Mitotic figures were seen in cultured tissue. Culture on a gelfoam raft resulted in more viable tissue than free-floating culture. Culture in a high concentration of O2(90O2/10CO2) was detrimental compared with culture in 10 CO2in air. Responses to static incubation in secretagogues showed that IMBX, theoph-ylline, and tolbutamide all stimulated insulin secretion, but high glucose concentration (5 g/L), arginine, and leucine did not. The potential of this tissue for growth and its ability to regulate blood glucose levels appropriately were tested in athymic (nu/nu) mice. Pancreatic tissue from fetuses as young as 4 weeks gestation showed growth after transplantation into athymic mice, with representation of the major pancreatic endocrine cells demonstrated by selective immunochemical staining. The increase in the size of the grafts showed an impressive proliferative capacity, and histology confirmed mitotic activity and islet structure in the graft. The amount of endocrine tissue in grafts reflected the condition of the expiants at the time of grafting, and prolonged culture times were detrimental to eventual graft size. Functional capability of the grafted FPP to release insulin in response to hyperglycemia was tested by transplantation into mice made diabetic with streptozotocin. Blood glucose levels, animal weights and survival, and the histological appearance of the tissue after graft nephrectomy indicated that either fresh tissue or tissue cultured for up to 8 days (Gelfoam; 10 CO2in air) had better eventual graft function then FPP grown in 90 O2or transplanted as a secondary graft following an interim period to allow gestational maturation in a nondiabetic nu/nu host. Return to euglycemia took 3—4 months after transplantation of FPP. The in vitro characteristics of FPP are similar to those reported for human fetal tissue, and since FPP is capable of growth and proliferation in vivo and has the ability to normalize hyperglycemia, further investigation of FPP to establish its suitability.

To examine the anamnestic response to hepatitis B vaccine in previously vaccinated subjects. Subjects who had received a course of hepatitis B vaccine at least two years previously had a sample of blood taken before and seven days after a low‐dose booster of hepatitis B vaccine. A pilot group of laboratory scientists in the Microbiological Diagnostic Unit; fifth year medical students, University of Melbourne; and a group of ambulance officers from the Geelong Ambulance Depot (Victoria). All participants volunteered after having been informed of the study. Serum levels of antibody to hepatitis B surface antigen (HBsAg) were measured before and after the booster dose of vaccine and, when available, in serum taken a month after the end of the primary course of vaccine, and the changes in antibody level were studied. Although some individuals with a restricted antibody response were identified, most showed a quick response. There was limited evidence that this rise peaked early and began to fall within weeks. In many subjects, levels of antibody to HBsAg peak early after booster doses of vaccine but the rapid anamnestic response to small amounts of antigen make it probable that effective protection from symptomatic Illness may be long lasting, when there has been a satisfactory primary response. This provides an argument for testing for adequate seroconversion after vaccination.

To determine whether intradermal hepatitis B vaccination is an effective procedure. A study of antibody responses to hepatitis B vaccine in 753 medical students. Routine vaccination of medical students with intradermal doses of hepatitis B vaccines of various origins. Rates of seroconversion and geometric mean levels of antibody achieved. Seroconversion rates, indicated by antibody to hepatitis B surface antigen (anti‐HBs) levels of 10 mIU/mL or more, varied between 82% and 94.7% with different preparations of the vaccine. With a four‐dose intradermal schedule over two successive cohorts, Engerix‐B (SmithKline Beecham) gave better responses, in this context, than H‐B‐Vax II (Merck Sharp & Dohme). Any reactions to the vaccination were mild and local. The intradermal route is a practical method of vaccination against hepatitis B in healthy young adults when the cost of the vaccine is an inhibiting factor.