Screening for familial hypercholesterolaemia in primary care: Time for general practice to play its part

Fifty per cent of first-degree relatives of index cases with familial hypercholesterolemia (FH) inherit the disorder. Despite cascade screening being the most cost-effective method for detecting new cases, only a minority of individuals with FH are currently identified. Primary care is a key target area to increase identification of new index cases and initiate cascade screening, thereby finding close relatives of all probands. Increasing public and health professional awareness about FH is essential. In the United Kingdom and in Australia, most of the population are reviewed by a General Practitioner (GP) at least once over a three-year period, offering opportunities to check for FH as part of routine clinical consultations. Such opportunistic approaches can be supplemented by systematically searching electronic health records with information technology tools that identify high risk patients. GPs can help investigate and implement results of this data retrieval. Current evidence suggests that early detection of FH and cascade testing meet most of the criteria for a worthwhile screening program. Among heterozygous patients the long latent period before the expected onset of coronary artery disease provides an opportunity for initiating effective drug and lifestyle changes. The greatest challenge for primary care is to implement an efficacious model of care that incorporates sustainable identification and management pathways

Mental Disorders and Medical Comorbidity

Presents findings on factors behind the prevalence of patients with both mental and medical conditions; mortality, quality of care, and cost burdens; and evidence-based treatment approaches, including self-management support. Outlines policy implications

Tackling methamphetamine: indicators and progress report October 2012

This report provides a progress update on the records changes against the Action Plan\u27s baseline data, and details progress on the Action Plan\u27s activities.When the Action Plan was launched, Chief Executives from DPMC, Health, Customs, Justice, Police, Corrections and Te Puni Kokiri were charged with reporting on progress every six months from October 2009 to October 2012. DPMC coordinates the reporting process and the Methamphetamine Steering Group, made up of senior officials from the relevant agencies, meets to approve the reports. This is the sixth and final of the originally scheduled progress reports

The relative clinical effectiveness and cost-effectiveness of three contrasting approaches to partner notification for curable sexually transmitted infections: a cluster randomised trial in primary care

Since 1998 there has been a substantial increase in reported cases of sexually transmitted infection (STI), most strikingly in the 16–24 years age group.1 Across genitourinary medicine (GUM) clinics in the UK in 2007, young people accounted for 65% of chlamydia cases, 50% of cases of genital warts and 50% of gonorrhoea infections.1 Chlamydia is the most common STI in under-25s. Since 1998, the rate of diagnosed chlamydia has more than doubled in the 16–24 years age group (from 447 per 100,000 in 1998 to 1102 per 100,000 in 2007). This may be because of a combination of a higher proportion of young people testing, improved diagnostic methods and increased risk behaviour.1 Chlamydia infection can frequently go undetected, particularly in women, as it is often asymptomatic.1 If left untreated, chlamydia can lead to pelvic inflammatory disease and infertility in women. This highlights the importance of testing this higher-risk age group to ensure prompt diagnosis and treatment. It is estimated that 11–12% of 16- to 19-year-olds presenting at a GUM clinic with an acute STI will become reinfected within a year.2 In order to minimise reinfection, preventative measures are required, including effective methods of notifying partners to ensure rapid diagnosis and treatment and reduce the likelihood of index patients being reinfected from the same source

Impact of introducing an HIV-PCR test at birth to attendance at follow-up early infant diagnosis (EID) services for HIV-exposed infants in Cape Town

Introduction: PCR testing at birth ('birth-testing') is conditionally advised by new World Health Organization guidelines for rapid diagnosis of infants infected with HIV in utero. Prompt diagnosis and early introduction of antiretroviral therapy (ART) can dramatically reduce mortality in HIV-infected infants. However, a negative result at birth must be followed by engagement in subsequent routine early infant diagnosis (EID) services (recommended at 6-10 weeks of age) to rule out intra-partum infection. There are few data on the implementation of this approach in sub-Saharan Africa and whether birth-testing affects the uptake of subsequent routine EID testing is unknown. Methods: We conducted a retrospective cohort study using routine clinical and laboratory data from a large obstetric hospital in Cape Town. All infants suspected to be at high risk of HIV-transmission, underwent birthtesting between July 2013-August 2015. Infants with a negative birth-test were matched to HIV-exposed infants who did not receive birth-testing. Maternal antenatal and obstetric characteristics of neonates were abstracted via folder review. Primary outcome was any subsequent HIV-PCR test before the end of follow-up, ascertained from the National Health Laboratory Service database. Data were analyzed using logistic regression models, examining independent predictors of presentation at follow-up EID testing. Results: Overall, 575 neonates underwent birth-testing, with 22 positive (3.8%) and 551 negative results. At follow-up EID presentation (n=871), 4 infected infants were identified (0.4%). Fewer infants who underwent birth-testing presented for later EID compared to infants who did not receive a birth-test (73% vs 85%), (Odds Ratio, 0.46; 95% confidence interval, 0.34-0.62). Infants who underwent birth-testing, also presented for later EID at a significantly older age (mean age 60 days vs.50 days, p<0.001). The significantly lower rate of EID presentation among birth-tested children persisted in multivariable analyses adjusting for maternal age, nadir CD4 cell count, ART use during pregnancy, gestation, infant sex, birthweight and infant feeding modality (Adjusted odds ratio, 0.60 95% confidence interval, 0.40-0.88). Conclusions: Neonates undergoing HIV testing at birth may be less likely to present for subsequent EID testing than those not birth-tested. Emphasis must be placed on appropriate counseling provided to caregivers on the need for further HIV testing after negative birth-test results

Crop Updates 2010 - Farming Systems

This session covers twenty papers from different authors: Pests and Disease 1. Preserving phosphine for use in Grain Storage Industry, Christopher R Newman, Department of Agriculture and Food Farming Systems Research 2. Demonstrating the benefits of grazing canola in Western Australia, Jonathan England, Stephen Gherardi and Mohammad Amjad, Department of Agriculture and Food 3. Buloke barley yield when pasture-cropped across subtropical perennial pastures, David Ferris, Department of Agriculture and Food, Phil Ward and Roger Lawes, CSIRO 4. Is pasture cropping viable in WA? Grower perceptions and EverCrop initiatives to evaluate, David Ferris, Tim Wiley, Perry Dolling, Department of Agriculture and Food, Philip Barrett-Lennard, Evergreen farming 5. Best-bet management for dual-purpose canola, John Kirkegaard, Susan Sprague, Hugh Dove and Walter Kelman, CSIRO, Canberra, Peter Hamblin, Agritech Research, Young, NSW 6. Pasture in cropping systems – with and without sheep, Brad Nutt and Angelo Loi, Department of Agriculture and Food 7. Can technology substitute for a lupin break? Wayne Parker, Department of Agriculture and Food 8. Canola row spacing with and without long term stubble retention on a sandy clay loam at Merredin, Glen Riethmuller, Department of Agriculture and Food 9. Impact of stubble retention on water balance and crop yield, Phil Ward1, Ken Flower2,3, Neil Cordingley2 and Shayne Micin1, 1CSIRO, Wembley, Western Australia, 2Western Australian No-Till Farmers Association, 3University of Western Australia Analysis and Modelling 10. Using POAMA rainfall forecasts for crop management in South-West WA, Senthold Asseng1, Peter McIntosh2,3, Mike Pook2,3, James Risbey2,3, Guomin Wang3, Oscar Alves3, Ian Foster4, Imma Farre4 and Nirav Khimashia1, 1CSIRO Plant Industry, Perth, 2CSIRO Marine and Atmospheric Research, Hobart, 3Centre for Australian Weather and Climate Research (CAWCR), A partnership between the Australian Bureau of Meteorology and CSIRO, Melbourne, 4Department of Agriculture and Food 11. Adaption to changing climates and variability – results of the Agribusiness Changing Climates regional workshop, Anderson W3, Beard D3, Blake J3, Grieve R1, Lang M3, Lemon J3, McTaggart R3, Gray D3, Price M2 and Stephens D3, 1Roderick Grieve Farm Management Consultants, 2Coffey International P/L, 3Department of Agriculture and Food 12. Farmers’ management of seasonal variability and climate change in WA, DA Beard, DM Gray, P Carmody, Department of Agriculture and Food 13. Is there a value in having a frost forecast for wheat in South-West WA? Imma Farre1, Senthold Asseng2, Ian Foster1 and Doug Abrecht3, 1Department of Agriculture and Food, CSIRO, Floreat, 2CSIRO Plant Industry, Perth 3Department of Agriculture and Food, Centre for Cropping Systems 14. Does buying rainfall pay? Greg Kirk, Planfarm Agricultural Consultants 15. Which region in the WA wheatbelt makes best use of rainfall? Peter Rowe, Bankwest Agribusiness 16. POAMA – the Predictive Ocean-Atmosphere Model for Australia, Guomin Wang and Oscar Alves, Centre for Australian Weather and Climate Research (CAWCR), A partnership between the Australian Bureau of Meteorology and CSIRO, Melbourne 17. Exploring the link between water use efficiency and farm profitability, Cameron Weeks, Planfarm and Peter Tozer, PRT Consulting Precision Agriculture 18. A plethora of paddock information is available – how does it stack up? Derk Bakker, Department of Agriculture and Food 18. Variable rate prescription mapping for lime inputs based on electromagnetic surveying and deep soil testing, Frank D’Emden, Quenten Knight and Luke Marquis, Precision Agronomics, Australia 19. Trial design and analysis using precision agriculture and farmer’s equipment, Roger Lawes, CSIRO Sustainable Ecosystems, Centre for Environment and Life Sciences, Floreat 20. Farmer perspectives of precision agriculture in Western Australia: Issues and the way forward, Dr Roger Mandel, Curtin Universit

Community Involvement in TB Research

While communities at risk have been both drivers and partners in HIV research, their important role in TB research is yet to be fully realized. Involvement of communities in tuberculosis care and prevention is currently on the international agenda. This creates opportunities and indicates the urgency to also engage communities in TB research