Menzies School of Health Research Postal address: Location: Phone: (+61) 08-8922 8196 PO Box 41096 John Mathews Building (58) Fax: (+61) 08-8927 5187 Casuarina NT 0811 Nightingale Road Website: www.menzies.edu.au Australia Royal Darwin Hospital Campus Tiwi NT 0810 Australia

Our mission To improve the health of people of northern and central Australia and regions to the near north through multidisciplinary research and education by: Promoting a broad understanding of health that reflects underlying socioeconomic, environmental, health system and biological factors as determinants of health and disease. Conducting high-quality multidisciplinary research, research training and public health education with a focus on Indigenous, remote and tropical health. Advancing the local, national and international application of research findings to improve health. Advocating for research that will contribute to better health for people of the region. Building strong partnerships with community groups, service providers, policy-makers, and other academic organisations.

Our logo The Menzies School of Health Research logo reflects the School’s broad research agenda. The warm and fluid circle shapes symbolize both the sun — representing the School’s physical location — and a human cell, the building block of life and the basis of MSHR’s work. The rhythmic edge of dots suggests the School’s many Indigenous clients and collaborations. The precise lines underscoring the ‘m’of Menzies illustrates MSHR’s rigorous scientific standards. Menzies School of Health Research 2003 Annual Report

2003 has been a year of success, opportunity, challenge and change. We have continued to strengthen and grow at an exciting rate and have been increasingly recognised as a leader in PHOTO COURTESY GALIWIN’KU PHOTO MSHR LIFESTYLE PROJECT, HEALTHY Indigenous, remote and tropical health issues and education — both nationally Contents and internationally. Our 2003 Annual Report highlights In Celebration of Excellence: 2003 Highlights ...... 2 areas of research excellence, giving a Chairperson’s Report ...... 4 brief overview of our research priorities Director’s Report ...... 5 and achievements, our mutually MSHR: Leaders in Indigenous, remote and tropical health research ...... 6 supportive training and education Infectious Diseases Division ...... 7 programs, and our strong governance Ear & Respiratory Health ...... 8 Skin Health ...... 9 practices for the year ending Malaria & International Health ...... 10 31 December 2003. Melioidosis & Emerging Infectious Diseases ...... 12 We encourage you to visit our website Tropical Toxinology ...... 12 www.menzies.edu.au to view detailed Population Health & Chronic Diseases Division ...... 13 information on our work and Chronic Diseases ...... 14 operations. Comprehensive reports Environmental Health & Health Services ...... 16 available online include: Foetal and Early Life Origins of Chronic Disease ...... 17 Social Determinants of Health ...... 18 2003 Research & Education Community-based Interventions ...... 19 Report: detailed listing of MSHR Education & Training Division ...... 20 research projects and education Indigenous Forum ...... 22 programs Corporate Services Division ...... 23 2003 Financial Statements: Collaborations & Major Partners ...... 24 complete audited financial Governance ...... 25 statements Patrons & Members ...... 27 MSHR Honorary Appointments ...... 27 Publications ...... 28 Research Funding ...... 31 Financial Overview ...... 32 For Further Information ...... inside back cover in celebration of excellence:

Grants & fellowships Awards & recognition Assoc Prof Nick Anstey was awarded Prof Kerin O’Dea was $3.1 million over five years from the awarded a Centenary Medal Wellcome Trust and NHMRC for for services to research in collaborative work with the Australian Indigenous health. Indonesian Ministry of Health in The medal was created to Papua and the University of PNG on honour those who have made studies to reduce morbidity and Australia’s first hundred mortality from malaria in Papua and years as a federal nation a PNG. This is the largest grant ever success and those who have awarded to MSHR, and one of only laid solid foundations for eleven projects to receive funding in Australia’s future. an initiative which aims to help Dr Alan Cass and co-authors won the Prof Kerin O’Dea and Dr Sandra improve the health of people prestigious Medical Journal of Eades were honoured in this year’s throughout the Asia–Pacific region. Australia/Wyeth Award for the best Australia’s 100 Smartest People in research paper published in the MJA International Health team was the October edition of The Bulletin during 2002. awarded $1 million over five years magazine. They were chosen for their from the US National Institutes of extraordinary contributions to MSHR Indigenous researcher (and TV Health to work with the Indonesian research in the area of Indigenous chef!) Geoffrey (Jacko) Angeles was Ministry of Health in understanding health. invited to be a member of the how and why people get severe editorial board for the US-based Dr Malcolm McDonald’s rheumatic malaria, with a focus on continuing Pimatziwin Journal, a publication fever project won the top Heart our Papuan field studies on the role highlighting Aboriginal and Foundation award for ‘Best Project’. of nitric oxide. Indigenous community health. Menzies researcher, Dr Sandra Eades, NHMRC awarded MSHR research Dr Allen Cheng, PhD student at was honoured with an appointment team, led by Assoc Prof Joan MSHR, was awarded the Murray-Will to the NHMRC’s prestigious Research Cunningham and Assoc Prof Ross Fellowship for Rural Physicians by Committee. Bailie, a $2.4 million research grant the Royal Australasian College of to improve research into the health Dr Peter Morris was awarded the Rue Physicians. Wright Memorial Award for his study of Indigenous Australians. Dr Graeme Maguire was awarded ‘Additional training in recommended Assoc Prof Ross Bailie was awarded Best Public Health Paper at the hygiene practices for the prevention an NHMRC Senior Research Thoracic Society of Australia and of bacterial cross-infection and Fellowship to commence in January New Zealand (TSANZ) conference respiratory illness in Australian child 2004. held in Adelaide in April. care centres: A randomised PHERP (Public Health Education and controlled trial’ at the Annual Assoc Prof Joan Cunningham and Research Program) funding was Scientific Meeting of the Royal Dr Amanda Leach both received granted for our Master of Public Australasian College of Physicians. NHMRC Career Development Awards. Health course for a further two PhD student, Yin Paradies was MSHR research projects involving years. During 2003, MSHR had 65 awarded a Fulbright Scholarship for scabies and skin health, and research students enrolled each semester in one year’s study at the University of into reversing Indigenous renal the MSHR Public Health Coursework California, Berkeley, USA. failure, were highlighted as examples program. of projects that made it ‘From Bench to Bedside’ in the December 2003 edition of the Medical Journal of Australia.

2| 2003 Highlights | Menzies School of Health Research 2003 Annual Report 2003 highlights PHOTO COURTESY PRIORiTI PROJECT, MSHR COURTESY PRIORiTI PROJECT, PHOTO

Special events Important visitors & partnerships The new look Menzies School of MSHR formed a historic partnership International Expert on climate Health Research website with Charles Darwin University (CDU) change, Professor Tony McMichael, (www.menzies.edu.au) was launched to strengthen the health research Director of the National Centre for in May in a ceremony featuring and education capacity of CDU. The Epidemiology and Population Health dancers from the Galiwin'ku relationship allows Menzies to retain at the Australian National University, community. The website is an its autonomy, while at the same time was invited to teach students innovative interactive framework to being a Foundation School within enrolled in MSHR’s Public Health communicate with researchers, Charles Darwin University’s Institute Coursework program. research participants, policy-makers, of Advanced Studies. Prof Paul Zimmet, renowned service providers, students and the Renewed Commonwealth funding of international diabetes expert, who general community. $23 million over seven years for the was in Darwin for the launch of the The Menzies School of Health new Cooperative Research Centre for DRUID project, presented a seminar Research Building was officially Aboriginal Health (CRCAH) has which delivered a powerful message named in honour of inaugural MSHR allowed us to enhance our strategic on diabetes to a packed audience. Director, Prof John Mathews AM, in alliances with other organisations Dr Barbara Starfield and Dr Neil appreciation of his leadership in with an interest in Indigenous Holtzman from John Hopkins building nationally and internation- health. University, USA, presented seminars ally recognised health research Signing of a Memorandum of on ‘Achieving Equity in Clinical capacity in the Northern Territory. Understanding with the University of Practice’ and ‘Genetic Myths of The ceremony held in August was Queensland to facilitate the Social Class and Race’. The officiated by then Commonwealth recruitment of high-quality research presentations were co-hosted by Minister for Health and Ageing, students. MSHR and Charles Darwin University. Senator The Hon Kay Patterson. The International Health team As one of his last official The DRUID study, a study to renewed their Memorandum of appointments, The Hon John determine the prevalence of diabetes Understanding with their principal Anictomatis, Administrator of the and related conditions in an urban partner, Indonesia’s National Northern Territory, visited Menzies Indigenous population, was launched Institute of Health Research and School of Health Research in October in September. Fifteen new staff, Development in Jakarta. The Director to meet staff and tour our facilities. including 11 Indigenous people, were and the Secretary of NIHRD signed employed to work on the project. the five-year MOU during a visit to Darwin in June 2003, enabling collaborative malaria and tuberculosis health research and OPPOSITE PAGE: MSHR officially named training to continue in Papua its research facilities ‘The John Mathews province, with the potential to Building’ at a ceremony in August. Left expand to other communicable and to right: MSHR Director Prof Kerin non-communicable diseases. O’Dea, inaugural MSHR Director Prof John Mathews AM, Federal Minister for Health & Ageing Senator The Hon Kay Patterson, and MSHR Chairman Mr Richard Ryan AO. THIS PAGE: Left: Torres Strait Islander dancers featured in the launch of the DRUID study in September, weaving through the crowd.

Menzies School of Health Research 2003 Annual Report | 2003 Highlights | 3 chairperson’s report

n my final year as Chairman of the has retained its independent Act of MSHR Board, I am honoured to Parliament which guarantees MSHR’s I present this Annual Report which autonomy into the future. The changes highlights the achievements of the to MSHR’s status, which came into Menzies School of Health Research, an effect from 1 January 2004, will, in the organisation which continues to be at medium- to long-term, ensure MSHR the forefront of remote, Indigenous and gains the benefits of increased access tropical health research. to funding for research infrastructure I am also proud to say that this Annual from the Commonwealth. The changes Report is the first of a new format have also meant the establishment of a where MSHR has implemented its new Governing Board. commitment to utilising technology by I would like to acknowledge the using the MSHR website in conjunction continuing support of the Menzies with the printed Annual Report. There Foundation and the Northern Territory are many highlights in this report and Government, whose ongoing financial on the website (www.menzies.edu.au). commitment to MSHR allows the I urge you to take the time to read organisation to have a stable core further about the health research and funding base. Thanks also to the former education which is carried out at Minister for Health and Community MSHR. Services, The Hon Jane Aagaard MLA 2003 has been a year of challenge and and her successors late in the year, The great success. Under the leadership of Hon Dr Peter Toyne MLA and The Hon Director Prof Kerin O’Dea and other Marion Scrymgour MLA. talented staff, the number of research I would also like to thank my fellow projects continues to grow. Highly Board members, the Director of MSHR, competitive national and international Prof Kerin O’Dea, and all the staff and funding has been awarded across a students for their hard work, broad range of medical research, commitment and support for the including scabies, rheumatic fever, organisation through this challenging tuberculosis, diabetes, malaria, kidney period of change whilst continuing to disease, lung disease and melioidosis, as achieve significant research success. well as research into a variety of social and economic factors affecting Whilst I have finished my term as Indigenous health. Chairman of the MSHR Board, I look forward to maintaining contact with 2003 has also brought many challenges MSHR in a different role. I know the as discussions took place around a organisation is in good hands and is controlled entity model to formalise destined for further future success. I links between MSHR and Charles also wish the new Board well in its Darwin University (CDU). Both the endeavours. Board and staff were involved and consulted during this process. MSHR Richard Ryan AO

4| Chairperson’s Report | Menzies School of Health Research 2003 Annual Report director’s report

Among this success, Assoc Prof Joan I am grateful to those MSHR academic Cunningham and Assoc Prof Ross Bailie and administrative staff who were were awarded an NHMRC Capacity- actively involved during the extensive Building Grant of $2.4 million over five negotiations with Charles Darwin years to build capacity in policy University and the Northern Territory relevant to quantitative, social analysis Government. I would also like to thank t is no secret that the health of and research in Indigenous health. In the MSHR Board for their support Indigenous Australians is among the addition, the NHMRC awarded Assoc during this challenging time. poorest in the country. Indigenous Prof Ross Bailie a prestigious NHMRC I Whilst 2003 has been a year of populations suffer enormous social and Senior Research Fellowship. economic disadvantage. In both remote significant research success for MSHR, and urban Indigenous communities the MSHR has also increased its our challenge is to maintain this people are affected by chronic and commitment to international health momentum. We are determined to infectious diseases and general poor research and a number of international improve our fundraising capacity so as health related to a range of factors, collaborations have been fostered to better support our hardworking and including poverty, overcrowded living during the year. The MSHR International talented researchers and maintain our conditions, and inadequate nutrition. Health team, led by Assoc Prof Nick position as a national leader in Anstey was awarded $3.1 million from Indigenous, remote and tropical health Australia’s awareness of these the Wellcome Trust and NHMRC for research and education. important issues continues to grow and collaborative work with the Indonesian This 2003 Annual Report features our governments, as well as funding bodies, Ministry for Health and the University research progress, and highlights a year are now firmly acknowledging the vital of PNG to undertake research to help of exciting new grants, prestigious importance of improving Indigenous prevent and treat the most severe forms awards and recognitions, and numerous health. MSHR is the only independent of malaria. This is the largest grant ever special events and visitors. medical research institute in Australia awarded to MSHR. with a primary focus on Indigenous I hope you enjoy the Annual Report in I am pleased to report the MSHR health. Since being established in 1985, its new format and I urge you to also Education and Training Division was a major goal of MSHR has been to visit our website for a closer look at the successful in gaining Commonwealth conduct research and education that work carried out at the Menzies School funding for a further two years to makes a difference to people’s lives, as of Health Research. well as promoting new findings which support the Master of Public Health course though the PHERP program. influence health policy and practice. Professor Kerin O’Dea Sixty-five students were enrolled at 2003 has been a very successful year MSHR each semester in 2003 and this for MSHR as staff and students have course continues to attract high-quality built on past success and obtained students who are interested in a career significant funding for several new in public health. major research projects in Indigenous and tropical health. 2003 also saw the introduction of legislation to formalise links between During the year, MSHR was awarded MSHR and Charles Darwin University almost $10 million in NHMRC funding (CDU) with the primary incentive for for project grants, scholarships and MSHR being access to future fellowships which will commence in Commonwealth research infrastructure 2004. This is a new record for MSHR funding. Notwithstanding this new link and demonstrates the institution’s with CDU, MSHR retains an reputation for excellence in research. As independent Act of Parliament which Director, I am very proud of this preserves MSHR’s autonomy and achievement. independence.

Menzies School of Health Research 2003 Annual Report | Director’s Report | 5 MSHR | leaders in indigenous, remote & tropical health research

uring 2003 there has been much health of Indigenous people and our media attention on the state of neighbours to the near north in D health of Australians and the countries such as Papua New Guinea, health system within Australia. It is not East Timor and Indonesia. Located on enough that Australians are living the Royal Darwin Hospital Campus in longer than ever — we now expect to Darwin’s northern suburbs, MSHR also live long and healthy lives. operates small units in Alice Springs and Gove. Yet, while most Australians can reasonably expect to live well into their Since commencing operations in 1985, seventies and eighties, Indigenous MSHR has developed a successful track Australians, and those living in remote record in producing high-quality communities, cannot expect such research spanning infectious and non- longevity. communicable diseases, the social and and remote communities to ensure environmental determinants of health, research projects are of priority and In the words of an Indigenous young health systems and information relevance. Through our Indigenous person featured in an article by systems. Forum, Indigenous staff and colleagues journalist Philip Adams: at MSHR are invaluable in ‘Superannuation is irrelevant to We recognise the greatest health gains communicating health priorities and Indigenous people. We don’t live that are to be made through exploring the values of Indigenous people to non- long.’ (The Weekend Australian intersections between priority heath Indigenous researchers, facilitating Magazine, May 24-25, 2003) issues, determinants of health, and research projects in a culturally translation of research into practice and With our focus on Indigenous, tropical appropriate manner, and determining policy. and remote health, MSHR is uniquely how research findings can be taken positioned to conduct research which MSHR prides itself on its ability to work back to the communities in the form of can underpin improvements in the in close partnership with Indigenous practical health benefits.

Governing Board

Director

Executive Executive Officer Administration Officer

Corporate Population Health & Tropical & Emerging Education & Indigenous Staff Forum* Services Division Chronic Diseases Division Infectious Diseases Division Training Division

Operations Research Programs Research Programs Chronic Diseases Ear & Respiratory Health Finance & Accounts Social Determinants of Skin Health Health Malaria & International Early Life Origins of Health Information Technology Chronic Disease Melioidosis & Emerging Community-based Infectious Diseases Human Resources Interventions Tropical Toxinology * Indigenous Forum staff are Environmental Health employed across all divisions & Health Services

Research Administration

6| MSHR: Leaders in Indigenous, Remote & Tropical Health Research | Menzies School of Health Research 2003 Annual Report infectious diseases division

he Infectious Diseases Division comprises five

PHOTO COURTESY PRIORiTI PROJECT, MSHR COURTESY PRIORiTI PROJECT, PHOTO T research programs investigating health issues important for our region.

Studies are targeted at improving prevention and treatment of specific illnesses, generally through seeking a better understanding of the underlying disease processes. Epidemiology, clinical observations and basic laboratory work are involved, with evidence-based approaches undertaken when possible.

The emphasis for the division is on collaboration with local health colleagues and experts outside the Northern Territory, in addition to cooperation between disciplines and across professional and cultural boundaries.

Division Leader | Professor Bart Currie

Menzies School of Health Research 2003 Annual Report | Infectious Diseases Division | 7 Ear & Respiratory Health The Ear and Respiratory Health program 25% of these children presented is made up of researchers from a variety with perforated eardrums, and only of backgrounds, including Aboriginal 7% of children were identified as health workers, doctors, nurses, having normal middle ear status. In laboratory scientists, and postgraduate 2003 that rate had only fallen to students committed to researching 21%, despite pneumococcal causes, methods of prevention and conjugate vaccination. treatment of severe respiratory It is not clear how many Aboriginal conditions, particularly middle ear adults suffer significant hearing infections and chronic lung disease. loss, (estimates range up to 40% in Middle ear infections (otitis media) some communities), but childhood are common among children in all middle ear infections from populations. While the World Health pneumococcal bacteria are Organization indicate that ear drum considered the main cause. emphysema) is a progressive disease, perforation greater than 4% represents Ongoing trials into the effectiveness of with limited treatments available once a massive public health problem, the a new pneumococcal conjugate vaccine lung damage becomes severe. rate in most remote Aboriginal to prevent middle ear infection are communities is dramatically higher. currently an important focus of the Ear Although smoking, overcrowding and Team’s work. Several research projects growth in early life are recognised In these children middle ear infection evaluating the impact of the vaccine factors contributing to COPD, repeated follows nasopharyngeal colonisation Prevenar™ are continuing in Aboriginal bacterial respiratory infections may also and persists throughout childhood, communities from Central Australia to be an important, preventable factor in often progressing to perforation of the Katherine West, East Arnhem Land and the establishment and progress of COPD ear drum. Up to 60% of Aboriginal the Tiwi Islands. within Aboriginal communities. babies have perforations in the first year of life. Research conducted in 2001 Chronic obstructive pulmonary disease ABOVE: Certainly not shy, young Marie by our Ear Team, spanning 29 (COPD) affects nearly 15% of Aboriginal Assumpta shows the Menzies PRIORiTI communities in the Northern Territory, Australians living in remote Ear Team how saliva swabs should be revealed further alarming results in communities. COPD (often used to taken! (Photo courtesy PRIORiTI Project, children aged six months to 2.5 years: describe chronic bronchitis and MSHR)

Key achievements A Territory-wide surveillance project wide controlled trial in a study communities in the diagnosis and has been established to monitor drug evaluating the best treatment for management of middle ear infection. resistance to antibiotics traditionally Aboriginal children diagnosed with Instigated community consultation used to treat pneumococcal middle ear infection — single dose and preliminary research in an infections. The study will also Azithromycin versus seven days Arnhem Land community in a project measure antibiotic prescription rates Amoxycillin. to gain a local perspective of how to and pneumococcal conjugate Completed our second Territory-wide make tuberculosis (TB) control vaccination uptake. survey of ear disease as part of our intervention programs more Commenced a study to determine if studies investigating the impact of effective. The aim of the project is to antibiotic treatment or vaccine the new 7-valent conjugate reduce the incidence of TB infection effectiveness is compromised by high pneumococcal vaccine Prevenar™. in this community where periodic TB levels of respiratory bacterial Completion of the first phase of an outbreaks still occur. It is also pathogens. The first phase of this assessment of herd immunity anticipated this project will help project has confirmed important following infant vaccination increase local capacity to deal with differences in the density (or (pneumococcal vaccine Prevenar™) other public health problems in concentration) and diversity of on pneumococcal carriage within an Aboriginal communities. bacteria carried in the noses of entire Aboriginal community. children with severe ear disease. Developed a ‘Train the Trainer’ MSHR 2003 Research & Education Report Successful randomisation of over workshop for the Ear Video training provides detail on all research projects and 150 children in our first Territory- package to assist Aboriginal is available online at www.menzies.edu.au

8| Infectious Diseases Division | Menzies School of Health Research 2003 Annual Report TOP: Phase contrast micrograph of an adult male Sarcoptes scabiei collected Skin Health from an agile wallaby in the Northern Territory. Skin infections are quite common, and although they can cause unsightly, BELOW: The scabies mite burrows under inconvenient and uncomfortable health the skin, causing intense itching which results in open lesions and allows a problems, they are usually treatable with point for infections to enter the body. readily available medications. (Photos courtesy of Skin Health Program, Skin infections in Indigenous populations MSHR) are far more insidious. Up to 60% of children in remote Aboriginal communi- ties in northern and central Australia, are Key achievements estimated to be infected with scabies — Forty-three thousand scabies mite outline of immune responses a skin disease caused by a tiny mite. The cDNA clones have been sequenced important in normal scabies and to scabies mite burrows under the skin and so far from a goal of 50,000 in an assess differences in those with breeds, often transmitted to others ongoing gene discovery project that severe infestation (crusted scabies). before diagnosis. aims to significantly advance the Recent studies reveal tea tree oil Scabies cause intense itching, resulting limited amount of molecular could be used as a new topical in open skin lesions. These sores often information available about the treatment for scabies. Results become infected with group A strepto- scabies mite. demonstrated that tea tree oil was coccus (GAS) — a group of bacteria that Molecules of interest identified so highly effective in killing the scabies thrive in the tropical environment of the far include similarities between mite in the laboratory. Northern Territory and cause a massive scabies mite and house dust mite MSHR research team, in range of diseases, including pharyngitis allergens, potential vaccine collaboration with international (strep throat), rheumatic fever, glomeru- candidates, genes associated with researchers in America, England and lonephritis (a major kidney disease) and drug resistance and potential drug Germany have demonstrated that invasive diseases such as streptococcal targets in therapeutic studies. the group A streptococcus toxic shock syndrome. Extended research using DNA population in tropical Northern The Skin Health program focuses on fingerprinting techniques continued Australia is more diverse than researching skin infections and infesta- to identify the biological species elsewhere in the temperate world. tions endemic to Indigenous communi- classification of the scabies mite. An important study to determine if ties in the NT, such as scabies and topi- Previous studies suggest a single group A streptococcus (GAS) skin cal streptococcal infections, and their gene pool, however, our molecular infection leads to acute rheumatic relationship to kidney disease and rheu- study demonstrated genetic fever (ARF) is under way in two matic fever. This relationship is of inter- differences between mites obtained Aboriginal communities. est as some remote communities in the from northern Australian dogs and Northern Territory suffer the highest those on people. This discovery had GAS throat infections are rates of rheumatic fever and kidney dis- important implications in scabies traditionally thought to be the only ease in the world. control programs for Aboriginal cause of ARF. However, GAS is communities. uncommonly found in the throat of Our Skin Health team are also involved in Indigenous people in the NT, even an innovative collaboration with the Further clarification of genetic though Aboriginal communities Cooperative Research Centre for variation and understanding of the suffer the highest reported rate of Aboriginal Health (CRCAH), in a number of interbreeding between mite ARF in the world. Results of this laboratory, clinical and public health proj- populations is important for disease study could therefore have ects known as the Healthy Skin initiative. and resistance control. important implications for Publication of seven papers and an prevention and vaccine development additional two invited reviews in of ARF around the world. press resulting from our study into Exciting preliminary results suggest antigens, allergens and immune new diagnostic blood tests may responses to normal and crusted improve the accuracy of diagnosis of scabies. rheumatic fever. Recent developments leading to expression and purification of scabies mite recombinant antigens MSHR 2003 Research & Education Report now provides an exceptional provides detail on all research projects and opportunity to obtain a clearer is available online at www.menzies.edu.au

Menzies School of Health Research 2003 Annual Report | Infectious Diseases Division | 9 Malaria & International Health

Each year, malaria affects over 300 and the Indonesian Ministry of Health’s million people internationally, with up to National Institute of Health Research two million deaths. Children and and Development. This collaborative pregnant women are particularly program addresses the prevention and vulnerable. Malaria is a major cause of management of tropical diseases of morbidity and mortality in Eastern importance to the region, with a number Indonesia and Papua New Guinea. of studies being undertaken in Eastern The social consequences of this tropical Indonesia. A new collaboration has also disease are enormous. In countries been established with Papua New where malaria occurs, the burden Guinea. extends beyond the individual and their Our research aims to improve the family, it impedes economic diagnosis, treatment and prevention of development. malaria and tuberculosis. Skills An international health collaboration exchange and training are an important was established in 1996 between MSHR part of the research.

LEFT: MSHR International Health Program Clinician Dr Enny Kenangalem explains lung function testing to a patient with severe malaria at RSMM Hospital, Timika, Papua. BELOW: Mimika TB Program Director Dr Ardian Muhammad demonstrates his X-ray reading skills to (from left) Dr Graeme Maguire (MSHR), Assoc Prof Nick Anstey (MSHR), Dr Paul Kelly (MSHR), Pak Erens (Depkes Timika) and Dr Tjandra Handojo (RSMM). (Photos courtesy of International Health Program, MSHR)

10 | Infectious Diseases Division | Menzies School of Health Research 2003 Annual Report Key achievements

Renewal of our Memorandum of Preparation of studies to evaluate Work in a study that aims to Understanding (MOU) with our whether widespread deployment of investigate the genetic mechanisms principal partner in international artemisinin-combination therapies in the malaria parasite that are health research, Indonesia’s National can reduce the rate of incidence and assumed to result in drug resistance, Institute of Health Research and death from multidrug resistant has found that the Pfmdr1 gene is Development (NIHRD) in Jakarta. The malaria in Eastern Indonesia. the most important determinant of Director and the Secretary of NIHRD response to selected antimalarial Patient enrolment commenced in a signed the five-year MOU during a drugs. Studies are now investigating multicentre trial coordinated by the visit to Darwin in June 2003. This will the relevance of this gene to Wellcome Unit in Thailand to enable collaborative malaria and resistance of other antimalarial discover if artesunate treatment can tuberculosis health research and drugs, and seek to determine factors reduce mortality from severe malaria. training to continue in Eastern that facilitate and prevent the Artesunate is known to kill malaria Indonesia. emergence of resistance. This work is parasites faster than quinine (the of particular importance as the Award of a major five-year grant to traditional treatment for malaria), formidable rise of multidrug resistant MSHR, NIHRD and University of PNG but it is not yet known if it can strains of malaria pose a major threat from the Wellcome Trust and NHMRC reduce the risk of death from severe to tropical countries, with some of to undertake research and training to malaria. The trial is expected to enrol the worst multidrug resistance found reduce morbidity and mortality from 2000 patients at sites in South and in South-East Asia. malaria in Papua (Indonesia) and PNG. South-East Asia, making it the largest severe malaria trial ever performed. Significant progress in a new project MSHR’s International Health team, as aiming to determine if tuberculosis part of a collaboration with the A study investigating how malaria (TB) contributes to permanent lung University of Utah and Duke affects the lungs has shown that gas damage in patients in countries with University in the USA, and Herbert transfer in the lungs of patients with a high rate of TB and a lack of Kariuki University in Tanzania, severe malaria is lower than that in healthcare resources. Both TB discovered that a natural substance uncomplicated malaria, due to patients and a control group of may help fight the most severe forms reduced lung blood flow and reduced patients from the Mimika district in of malaria. It is believed arginine, a gas transfer across the air sac PNG have been enrolled in the study simple amino acid found in the body membranes. with examinations to occur over 12 and in some foods, may have Tens of thousands of adults with months. potential as a new treatment for severe malaria die as a result of malaria by increasing the amount of Drug resistance is one of the major malaria making their lungs ‘leaky’ — a protective molecule, nitric oxide. threats of TB globally, with multiple- causing them to fill with fluid. Trials of arginine as an adjunctive drug-resistant TB practically Knowledge gained from this study treatment of malaria are planned to incurable in poorly resourced will better inform attempts to design commence in 2004. countries due to the cost of specific treatments for this grave alternative treatments. Studies of Assembled a collaborative network in complication of severe malaria. drug resistance in our region aim to a new study to evaluate the extent of assist public health authorities to antimalarial drug resistance and its better plan and manage TB impact on malaria morbidity and treatment. mortality in the Timika region of Papua.

MSHR 2003 Research & Education Report provides detail on all research projects and is available online at www.menzies.edu.au

Menzies School of Health Research 2003 Annual Report | Infectious Diseases Division | 11 Melioidosis & Emerging Infectious Diseases

Melioidosis is a potentially fatal disease rate being halved in northern Australia and control of melioidosis, to further caused by infection from the bacterium — from 40% to 18%. The work of our improve preventative measures, early Burkholderia pseudomallei. The bacteria team will continue to advance diagnosis and effective treatment can be found in soil and surface water knowledge of the incidence, distribution methods. in tropical areas, usually after heavy rainfall. Reported incidence of melioidosis is on Key achievements the rise within endemic regions of Demonstrated a strong link between Research in the Top End into the South-East Asia and throughout heavy monsoonal rain and increased importance of potable water as a Australia’s Top End. In the Northern severity of melioidosis. The study, source of melioidosis has confirmed Territory, up to 40 people are infected which examined rainfall data and that melioidosis bacteria is not each year, usually during the monsoonal cases of melioidosis that occurred in uncommonly present in bore water. wet season, causing death in one-fifth the Top End over a 12-year period, Use of new DNA fingerprinting of all cases. found that patients admitted with methods developed specifically for melioidosis one to two weeks after Those most likely to contract the melioidosis bacteria to better heavy monsoonal rainfall and high melioidosis have specific risk factors understand why melioidosis can be winds were more ill and 2.5 times which affect their immunity. The most such a severe disease and how it more likely to die. important risk factor is diabetes, spreads from the environment to followed by heavy alcohol intake, This same study suggests that the humans and animals. This new chronic lung disease, such as seen in more severe cases of melioidosis seen project will hopefully result in new heavy smokers, and chronic kidney after heavy rains and winds may be primary preventative measures. disease. from people inhaling the bacteria Continued research in the use of G- directly into their lungs, resulting in The high mortality rate from this CSF (a naturally occurring substance pneumonia and blood poisoning. This disease, combined with the increase in produced by humans and animals in is of particular interest as most cases the number of diagnosed cases, makes response to infections) for use as an of melioidosis are thought to be it vitally important that our adjunct to antibiotics in the acquired when the bacteria enters understanding of this serious tropical treatment of severe melioidosis. the body through soil or surface disease is improved. water contamination of cuts and Publication of a proposed scoring Better recognition and treatment of sores. system to help clinicians identify melioidosis through our research over patients at risk of death from recent years has resulted in the death melioidosis.

Tropical Toxinology The climate, landscape and lifestyle of jellyfish in the waters of the Top End of Key achievements the tropics lures residents and visitors the Northern Territory. This data is A new treatment for Irukandji to enjoy the great outdoors. While important to ensure distribution of jellyfish stings using intravenous enjoying our land and coast, it’s impor- timely public health warnings. magnesium has been successfully tant to remember we share this envi- We also continue to update our collec- used at the Royal Darwin Hospital ronment with some of the deadliest tion of snakes and document all following its first use in Queensland. wildlife in the world. snakebite envenomings in the Top End. Description of stings from a new Toxinology research at MSHR is current- Clinical symptoms of each of the Top jellyfish species found on the Gove ly undertaking work involving jellyfish End’s dangerous snake species have Peninsula. and venomous snakes which are com- been defined to allow accurate and mon to Australia’s Top End. expedite identification of snakebites. Elucidation of the ‘brown snake paradox’ – why neurotoxicity is With the assistance of Royal Darwin uncommon despite the presence of a Hospital Emergency Department and MSHR 2003 Research & Education Report potent neurotoxin in brown snakes. Gove Surf Life Saving Club, we continue provides detail on all research projects and to monitor the occurrence and type of is available online at www.menzies.edu.au

12 | Infectious Diseases Division | Menzies School of Health Research 2003 Annual Report population health & chronic diseases division

he Population Health and Chronic Diseases T Division undertake collaborative research involving a wide range of disciplines, including epidemiology, biostatistics, sociology, anthropology,

PHOTO COURTESY GALIWIN’KU PHOTO MSHR LIFESTYLE PROJECT, HEALTHY biochemistry, nutrition and clinical medicine.

There is a strong focus on Indigenous populations and health problems which impose a significant burden of disease. We are interested in better understanding the causal pathways to diseases such as diabetes, kidney and heart disease, including the impact of social disadvantage across the life course.

Through developing an understanding of the scientific basis of these lifestyle-related chronic diseases, we seek to develop community-based interventions to improve health outcomes.

Division Leader Assoc Prof Joan Cunningham (until April 2003) Prof Kerin O’Dea (from April 2003)

Menzies School of Health Research 2003 Annual Report | Population Health & Chronic Diseases Division | 13 Chronic Diseases

In an alarming trend, rates of lifestyle- heart and kidney disease, are major In short, Indigenous people are dying at related chronic diseases, such as contributors to this reduced longevity. a younger age from diseases which are diabetes, continue to soar throughout Disturbing statistics reveal Indigenous mainly preventable. Australia, particularly in Indigenous people experience up to four times The Chronic Diseases program focuses communities. greater prevalence of cardiovascular on investigating lifestyle-related disease, more than 10 times the Relative to the overall Australian chronic diseases, largely in Indigenous prevalence of diabetes in the 20 to 50 population, Indigenous Australians have populations, to contribute evidence on years age group, and develop end-stage 15 to 20 years shorter life expectancy. which to build positive models of renal disease at up to 30 times the rate Diabetes and related conditions, such as health. of non-Indigenous people.

THIS PAGE: MSHR Project Officer Maria Scarlett prepares serums for transportation from Galiwin’ku to MSHR for further testing. OPPOSITE PAGE: Richard Batumang has his blood pressure and pulse rate recorded by MSHR Project Officer Joe Fitz as part of the Galiwin’ku Healthy Lifestyle Project. (Photos courtesy Galiwin’ku Healthy Lifestyle Project, MSHR)

14 | Population Health & Chronic Diseases Division | Menzies School of Health Research 2003 Annual Report Key achievements

Diabetes, kidney and heart disease Comparison of diabetes and heart Clinical studies of diabetes and in the Indigenous people of Darwin disease in different Australian heart disease in Indigenous Commenced a five-year study that populations populations aims to identify how many Recently completed a 10-year Detailed clinical assessment of the Aboriginal and Torres Strait Islander follow-up of deaths from complications of diabetes in a people living in Darwin, Palmerston cardiovascular disease among remote East Arnhem Land and the Darwin rural area have Australian-born Melbourne residents community indicated very high rates diabetes and related conditions (such and migrants from Mediterranean of heart disease risk (smoking, high as heart and kidney disease). countries. In contrast to Indigenous blood pressure, kidney disease, and Australians, Greek migrants have a high blood fats). However, in this Known as DRUID (Diabetes and lower than average death rate from remote clinic there was also very Related conditions among Urban coronary heart disease. Given that good primary care in detection and Indigenous people in the Darwin they have maintained important follow-up clinical management. region), this project also seeks to aspects of their traditional discover which people are at greatest We are investigating the use of a Mediterranean diet, we are risk of getting diabetes and its number of non-invasive techniques examining whether this diet gives associated conditions, and how to look for early signs of heart protection from heart disease and prevention strategies and health disease in Indigenous and non- stroke by lessening the impact of risk services for these conditions might Indigenous people with diabetes — factors, such as diabetes, high blood be improved. We are also planning a estimating thickening and stiffness pressure and high cholesterol. These lifestyle intervention for those who of artery walls. The work is helping findings could have important do not yet have clear-cut disease but us gain insight into how diabetes implications for Indigenous are deemed to be at high risk. and other risk factors contribute to populations. the onset of heart disease. The Kidney disease Commenced collaboration with the technique may also be used to Completed and published a national AusDiab Study Group at the monitor whether interventions, such cohort study of all patients starting International Diabetes Institute in as exercise, diet or medications, are dialysis treatment in Australia during Melbourne to look at the relationship having a positive effect on the 1993–98. This study revealed that of body mass index to health in cardiovascular health of those with Indigenous patients received kidney different Australian populations. diabetes or high blood fats. transplants at approximately one- A study examining the third of the rate of non-Indigenous associations between body mass patients. We also found Indigenous index and mortality rates in patients faced barriers to get onto Aboriginal people in the Northern waiting lists and in moving from a Territory has found an excess risk waiting list to receiving a transplant. of death related to low body This is highly significant as, weight. These findings are of compared to long-term dialysis, great public health concern and transplantation usually results in will need to be thoroughly better quality of life, longer life investigated in future research. expectancy and lower cost to the They highlight the different health care system. pathways to ill health in very poorly nourished communities. We are currently developing protocols for a study aimed at We are using our extensive uncovering key barriers to accessing database to identify the range of kidney transplants for Indigenous body mass index most consistent people with end-stage renal disease. with prevention of diabetes and related conditions in Aboriginal and Torres Strait Islander populations. MSHR 2003 Research & Education Report provides detail on all research projects and is available online at www.menzies.edu.au

Menzies School of Health Research 2003 Annual Report | Population Health & Chronic Diseases Division | 15 Environmental Health & Health Services

Inadequate housing and health Key achievements infrastructure in remote Indigenous communities is distressingly common, Assessed health centre systems and Continued our study into the and a serious underlying cause of ill clinical services in 12 health centres feasibility, cost and impact of health. across the Top End in the first stage introducing small-scale water of a project aimed at improving the fluoridation technology into two The Environmental Health and Health quality of primary care for people remote communities. Plants were Services team focus on the organisation with chronic disease living in remote installed in late 2003 with changes and delivery of primary health care communities. in children’s dental health over a services, including environmental health two-year period to be monitored. and health-related infrastructure, to Work over the next three years will meet the immediate and ongoing needs focus on developing systems with This project also continues to map of people living in Indigenous health centre staff to support levels of natural fluoride and the communities. chronic disease care and introduce a status of dental health in remote process of continuous quality communities across the Northern The team’s research is generally improvement of these systems. Territory. conducted in close collaboration with community organisations, service Established agreement with 10 Preliminary analysis of data collected providers and policy-makers. We place remote communities across the from a wide range of organisations high importance on addressing issues of Northern Territory to participate in a that hold administrative, census and high priority for community residents project aimed at assessing the survey data pertaining to Indigenous and service providers and on making our impact of household infrastructure people living in communities in the research findings directly relevant to improvements on child health in Northern Territory. remote Aboriginal communities. government and non-government This project is drawing together a service and policy agencies. While housing is widely recognised wide range of routinely collected as an important data to examine data quality and determinant of explore the relationship between a health, there is range of socio-economic and currently a lack of environmental factors (such as information on how health service access and utilisation) to get the best value, and health outcomes. It will aid in health terms, from government and non-government housing programs. agencies to focus efforts on the Information gathered most important underlying from this project over determinants of health and the next two years determine the relative need of will be essential in communities and regions. developing housing Final analysis is under way in a programs to ensure quality audit involving records of they have the over 1500 children aged less than greatest possible five years in the NT Department of impact on health. Health and Community Services Growth Action and Assessment surveillance system. Improved data quality is important for health Housing is widely recognised as an program evaluation and to important determinant of health. This accurately plan for future health year, MSHR commenced the Housing care needs. Improvement and Child Health Study in remote Indigenous communities to evaluate aspects of housing that affect child health. (Photo courtesy of HICH MSHR 2003 Research & Education Report Project, MSHR) provides detail on all research projects and is available online at www.menzies.edu.au

16 | Population Health & Chronic Diseases Division | Menzies School of Health Research 2003 Annual Report Foetal & Early Life Origins of Chronic Disease

The Aboriginal Birth Cohort (ABC) Study was the first birth cohort of an Indigenous population in the world. The ABC was established between 1987 and 1990 by neonatologist Dr Sue Sayers who was concerned about the long- term risks to the health of the small babies being born to many Aboriginal mothers. It was established before David Barker’s research on the foetal origins of adult disease had ignited world-wide interest in this field. The children in this cohort come from a wide range of backgrounds, from both urban and remote populations. Thus, the ABC allows for exploration of the causal pathways to diabetes, renal disease and cardiovascular disease in this high-risk population. Over time, it will also enable examination of intergenerational effects.

Key achievements Ongoing analysis of Wave 2 data is continuing in the ABC Study — a prospective longitudinal study examining the influences of maternal health and birth size on childhood growth, nutrition, morbidity and risk factors for chronic diseases in childhood. Initial findings from follow-up examinations of children aged 10 to 12 years show this birth cohort had poor postnatal growth with no relationship between birth weight TOP: With the majority of MSHR research conducted throughout and the potential markers of chronic remote communities of the Northern Territory, it’s important to adult disease. understand that if you can’t carry it — don’t take it! Here MSHR staff of the ABC Study carry research equipment from an airstrip to a community. Most of their field trips require the equivalent of four large suitcases of research equipment. ABOVE: MSHR PhD student Gurmeet Singh performs a renal ultrasound on the verandah of a local clinic as part of the ABC Study. (Photos courtesy ABC Study, MSHR)

MSHR 2003 Research & Education Report provides detail on all research projects and is available online at www.menzies.edu.au

Menzies School of Health Research 2003 Annual Report | Population Health & Chronic Diseases Division | 17 Social Determinants of Health

It is increasingly accepted that health Our research seeks to meet the growing and wellbeing are not merely demand from policy-makers and determined by biological and genetic government bodies to build an evidence factors, but through a complex base for policy and practice. interaction of these factors and a range of economic, environmental and social determinants.

Key achievements Awarded a $2.4 million grant from Data collection involving 180 NHMRC to improve research into the participants in a study examining health of Indigenous Australians. Led heavy cannabis use in two remote by Assoc Prof Joan Cunningham, this Aboriginal communities in Arnhem project will mentor young Land was completed early in 2003. researchers to create a critical mass Findings include diverse and dynamic of Indigenous health specialists to patterns of substance use in the advance the quality and capacity of region and a recent rise in cannabis research aimed at improving the use. Education interventions are now health of Indigenous people. under way with follow-up interviews of participants planned for 2004. A report was submitted to the Australian Sports Commission A review of literature concerning identifying indicators to monitor the stress in Indigenous people and impact of sport and recreation people in lower socio-economic programs in Indigenous communities. circumstances is continuing. The Indicators which reflect program final report aims to identify available viability and sustainability, literature which relates specifically community participation and health to stress and the development and and social outcomes were developed. management of chronic disease, and will summarise interventions taking place at an individual and population level.

MSHR 2003 Research & Education Report provides detail on all research projects and is available online at www.menzies.edu.au

18 | Population Health & Chronic Diseases Division | Menzies School of Health Research 2003 Annual Report Community-based Interventions

Poor nutrition is one of the main factors diet derived from a wide variety of causing high rates of diabetes and heart highly palatable, minimally processed disease in Aboriginal and Torres Strait plant and animal foods, with physical Islander people. Obesity is one of the activity built into daily routines, and main risk factors for diabetes and with strong community support and a cardiovascular disease and it is rich spiritual life. The interventions need associated with poor diet, lack of to be directed not only at improving exercise and many social factors. knowledge of what constitutes a This program aims to develop a healthy diet and lifestyle, but also at framework for the implementation and the environmental determinants of evaluation of sustainable and chronic diseases (food supply, transferable community-based opportunities for exercise, smoke-free interventions to reduce the risk and/or areas/policies). There is strong evidence impact of diabetes, and renal and that interventions can only be vascular disease in Indigenous successful over the long term if they are communities. The focus of the fully embedded in community interventions is to improve the quality structures. This requires building of diets, increase physical activity and capacity at the community level. reduce smoking, and to provide comprehensive TOP: Maintaining traditional food primary health care, sources and practices (in this case including hunting for fish) creates opportunities pharmacotherapy of for exercise, and of course, can net quite a catch! people with, or at risk of, chronic disease. LEFT: MSHR, Prof Kerin O’Dea, takes a walk around Timmy Galulingu’s garden. The interventions are The Burwa Natha Home Garden project based on a culturally is just one of the interventions under acceptable model of a way in Galiwin’ku as part of the Healthy traditional hunter- Lifestyle Project. (Photos courtesy of gatherer diet and Galiwin’ku Healthy Lifestyle Project, MSHR) lifestyle: a high quality

Key achievements

Community-based interventions to year follow-up screening planned for Work is currently under way to address health problems in the East June 2004. assess how perceived mastery and Arnhem Land community of control of one’s destiny within a Continued investigations into the Galiwin’ku are currently being trialed community affects the role of diet in protecting against in the Galiwin’ku Healthy Lifestyle implementation, success and cardiovascular disease as part of a Project. This project has the primary sustainability of diabetes project studying biochemical markers aim of identifying ways of reducing intervention strategies. This study of dietary intake and their links to the risk of cardiovascular disease and seeks to understand how risk of chronic disease. The study has diabetes in Indigenous Australians. psychological and social responses to discovered high levels of markers Interventions under way include a intervention programs affect indicating blood vessel damage in household garden project, exercise behavioural changes. association with very low blood programs and a collaboration with levels of antioxidants in a number of the local store and takeaway outlet Indigenous communities — indicative to increase availability of fresh fruit of very low intakes of fresh fruit and and vegetables. Baseline screening MSHR 2003 Research & Education Report vegetables. was conducted in 2002, with two- provides detail on all research projects and is available online at www.menzies.edu.au

Menzies School of Health Research 2003 Annual Report | Population Health & Chronic Diseases Division | 19 education & training division

he Education and Training public health institutes delivering public Master of Public Health. In 2003, two Division provides postgraduate health coursework programs. students were undertaking their treatise education and training in the Master of Public Health, and T Although the majority of our students opportunities to health professionals. three students graduated from the are Territorians, the coursework MSHR expertise in Aboriginal, remote Master of Public Health (Coursework program continues to attract high- and tropical health is reflected in the and Treatise). quality public health practitioners to education and training offered by or the Territory. As many local students are supported through the Division. Postgraduate research study employed by the NT Department of Health and Community Services, the Postgraduate research students are The Division is responsible for: Education and Training Division fulfils a supervised by senior academic staff at coordination of the Public Health significant professional development MSHR in collaboration with researchers Coursework program comprising the role for health service providers in the at other institutions when appropriate. Graduate Certificate, Graduate NT. MSHR is also well placed to attract Student research topics span the wide Diploma, Master’s and Professional Indigenous students and support study research interests of MSHR from Doctorate; molecular biology to population health opportunities through our partnerships and health services research. oversight of postgraduate research with the Cooperative Research Centre students studying at MSHR and for Aboriginal Health and Charles In 2003, there were 14 new students, providing specific skills training to Darwin University. including three international students postgraduate research students; and with a total of 36 students enrolled at There was consistent growth in the seven Australian universities. There were organisation of short courses for the coursework program with an increase in five PhD graduates and two graduates benefit of MSHR staff, students and enrolments overall, particularly at the from the Honours program in 2003. the wider community of health Graduate Certificate level and in the professionals. international (full-fee paying) category. Short courses Sixty-five students were enrolled in the Public Health Coursework coursework program, including 27 new Organisation and delivery of short courses continues to be streamlined and The Public Health Coursework program enrolments in semester 1 and 19 in improved. In addition to attracting is accredited through Charles Darwin semester 2. Of the eight international participants from the wider health University (formerly Northern Territory students, four are studying full time in professional community, short courses University) and enjoys an excellent Darwin with the remainder studying play an important role in MSHR staff reputation, with particular emphasis on part time from their home country. recruitment and retention, and the support given to students. MSHR is Thirty students graduated in 2003, professional development. also a member of the Australian including a record 18 graduands at the Network of Academic Public Health end of semester 1. Four successful and well attended short Institutions (ANAPHI), a national courses were offered during 2003. MSHR offers both coursework and organisation of 19 universities and coursework-plus-treatise options for the

20 | Education & Training Division | Menzies School of Health Research 2003 Annual Report Key achievements

Awarded a further $210,000 to Involvement in a collaboration with Developed a database to record support innovation and flexible the University of Melbourne, student evaluations of units and delivery of the Public Health Queensland University of Technology short courses. This allows evaluation Coursework program in 2004–05 and Flinders University to develop an forms to be scanned into the from Public Health Education & appropriate methodology for database, ensuring easy access to Research Program Innovations. evaluating the Population Health records and the production of reports Funding from this source to MSHR Education & Research Program with summarised student comments. covering the period 2001–05 now (PHERP). In providing a feedback Such reports are invaluable to the stands at $1.79 million. mechanism to the Commonwealth planning of education activities. Government, this project considers Ms Annie Villeseche was awarded Offered a series of three data the impact of ANAPHI as a larger MSHR Val Asche Prize for academic management workshops to research network, comprising many diverse excellence in 2003. students for professional institutions and individual academics development. Conducted induction session for new and researchers. It will also research students. This annual contribute to informing the next Commenced negotiations with session provides new students with review of PHERP as well as providing Charles Darwin University for access relevant institutional information a useful tool for advocacy. to the student record system Callista. and introduces key MSHR staff. Introduction of the system in 2004 Continued use of online facilities, will allow MSHR to fully manage the Finalised Memoranda of with the coursework program admissions and enrolment processes Understanding with University of offering seven units online through for coursework students. Queensland, Centre for Remote the Charles Darwin University Health and Flinders University to Learnline (Blackboard) system. All Initiated changes to education address key financial arrangements units will be enhanced by online timetables and course structures as a and academic processes, including teaching in 2004. result of formalised links between coursework teaching and research MSHR and Charles Darwin University. Four course units were re-written for activities. A similar agreement is delivery in 2003. being finalised with Charles Darwin University.

ABOVE: Students participate in tutorial sessions during residential week, as part of the Public Health Coursework program. Sixty-five students were enrolled in the program in 2003 (photo MSHR 2003 Research & Education Report courtesy of Education & Training Division, provides detail on all research projects and MSHR). is available online at www.menzies.edu.au

Menzies School of Health Research 2003 Annual Report | Education & Training Division | 21 indigenous forum

Norma Benger, Interim Convenor of the Indigenous Forum.

enzies School of Health knowledge of distinct cultural, Research established the language, environmental and economic M Indigenous Forum to provide a differences between remote Aboriginal framework for enhanced representation, communities and urban Australia. support and participation of its Instead, Indigenous people tend to be Indigenous staff and students. The viewed as ‘non-compliant’ to certain Forum meets regularly to promote the available treatments that have been involvement of Indigenous staff in all used effectively in urban settings — MSHR activities, and provides targeted whereas, in reality, different cultural professional development opportunities for its members. values and lifestyles means the delivery of these treatments may not work as The group provides an understanding of effectively in an Indigenous setting. local Indigenous history and culture to ensure our research outcomes will be Through the Indigenous Forum, MSHR readily accepted by Indigenous actively fosters participation and communities, and ultimately, to improve collaboration with Indigenous people the health of Aboriginal people. throughout the research process. Our aim is to have optimal Indigenous This is particularly important, as despite involvement in the design, conduct and numerous initiatives and programs to participation of research projects that improve the health of Indigenous focus on Aboriginal health. Indigenous people living in remote communities, employees, particularly in research there are still major ongoing health roles, and strong linkages with problems and disadvantages in health Indigenous communities are key care. components of what makes MSHR a This failure to improve Aboriginal health unique research organisation. often stems from a lack of awareness or

22 | Indigenous Forum | Menzies School of Health Research 2003 Annual Report corporate services division

n a year that generated over 20% increase in research grant income, I the Corporate Services Division’s challenge was to underpin research efforts with innovative, robust and cost-effective administrative and support services. Our finance, human resources, information technology and operations staff rose to this task to Key achievements ensure the ongoing operational In addition to a significant increase Introduction of IPOS: an electronic effectiveness of MSHR. in competitive grant income, careful purchase-ordering module. management of funds resulted in a Development of a number of 42% increase in income from information technology policies to interest and dividends. effectively manage IT requirements. Streamlined organisation ensured Management of the ever-present administration and operational virus threat within MSHR computer expenses as a percentage of total systems. expenditure were maintained. Development and rollout of a Accurate and timely account cyclical replacement strategy for processing and production of desktop, server, network and storage financial status reports for over 100 hardware. research projects to all users of financial information, including Implementation of a new payroll and research staff and various agencies. human resources system, Aurion, to enhance MSHR’s ability to manage Commenced decommissioning of our growing complex workforce. selected laboratory space to increase scarce office space for Improved processes for recruitment accommodation of project teams. and management of workforce. Full- time staff equivalents grew from 79 Installation of new uninterrupted to 95 in 2003 with employment power supply to manage the power expenses representing 65% of total requirements of server/ expenditure. communications equipment.

Menzies School of Health Research 2003 Annual Report | Corporate Services Division | 23 collaborations & major partners

n order to advance our research interstate and overseas. and health education programs, Collaborations strengthen the capacity MSHR fosters collaborative links I of MSHR to carry out laboratory and partnerships with numerous Indigenous stakeholders, health studies, community-based lifestyle services, Territory and Commonwealth intervention studies, develop effective Governments, as well as other strategies for training health staff and research institutions and universities. improving health promotion, as well We collaborate with colleagues and as work towards prevention and organisations located locally, treatment strategies.

MSHR major partners and affiliations include: Charles Darwin University The Sir Robert Menzies Memorial Charles Darwin University (CDU), Foundation based in Darwin, is a university The Sir Robert Menzies Memorial which addresses issues of particular Foundation is a non-profit, non- relevance to the Northern Territory. political organisation created in As of 1 January 2004, MSHR will 1979 to promote excellence in formalise links with CDU and become health research, education and a school within the CDU Institute of postgraduate scholarships for Advanced Studies, and a controlled Australians. The Menzies Foundation entity of the University. played a major role in the establishment of MSHR and Cooperative Research Centre for continues to provide ongoing Aboriginal Health financial support as well as MSHR is a core partner and Centre representation on the MSHR Board. Agent of the CRC for Aboriginal Health (CRCAH), a major Northern Territory Government — Commonwealth Government–funded Department of Health and initiative. The CRCAH aims to Community Services promote high quality research The NT Government provides through the development of research substantial core funding support to partnerships, increased Aboriginal MSHR as well as being an important participation and control, as well as collaborator on research projects and offering formal research training in the education program. opportunities for Aboriginal people.

Acknowledgement of MSHR collaboration partners may also be found on our website at www.menzies.edu.au.

24 | Collaborations & Major Partners | Menzies School of Health Research 2003 Annual Report governance

enzies School of Health Simon Maddocks Robert Griew Research was established as a BAgSc(Hons) PhD (Nominee of the NT MAIAST M cooperative endeavour Minister for Health & between the Menzies Foundation, Deputy Chair Community Services, Northern Territory Government and the (Nominee of the from February 2003) University of Sydney. Menzies Foundation) In November 1985 the Northern Professor Maddocks is the South Mr Griew is Chief Executive Officer of Territory Parliament passed the Menzies Australian Chief Scientist, SARDI the Northern Territory Department of School of Health Research Act. This Livestock Systems, Roseworthy Campus, Health and Community Services and legislation established the School as an University of Adelaide. His research was previously Deputy Director General independent body corporate, under the interests are in reproductive of the NSW Department of Ageing, control of a governing board. In immunology and cell biology. Disability and Home Care. accordance with the Act, MSHR accounts are subject to audit by the Professor Maddocks is a Director of the His public service background spans Auditor General of the Northern Board of the Sir Robert Menzies both health and community services — Territory. MSHR also reports to the Memorial Foundation, and is the Deputy from children’s services, disability and Northern Territory Legislative Assembly Chief Executive Officer of the aged care to public health and through the Minister for Health and Cooperative Research Centre for Pest Aboriginal health. He has worked Community Services and to an Annual Animal Control and a member of its extensively in the Commonwealth General Meeting of the School. As board. Departments of Community Services already noted, the Act was amended in and Health. 2003 to reflect formal links with Peter Plummer BSc Charles Darwin University, as a GDipMgt GAICD Andrew Coats controlled entity. MADM (Oxon.) MBBChir Treasurer (Cantab.) FRACP FRCP (Nominee of the NT FESC FACC FAHA MBA Governing Board Minister for Health & (Nominee of Community Services ) University of Sydney Richard Ryan AO from March 2003) Chair Mr Plummer was appointed Chief Executive Officer of the Northern Professor Coats is currently the Dean of (Nominee of the Territory Department of Education, Medicine at the University of Sydney. Governing Board) Employment and Training in May 2000. He is also Chair of the NSW Ministerial Prior to that Peter was CEO of Territory Advisory Council on Medical and Health Health Services for three and a half Research and Chair of the Australian Mr Ryan is a Fellow of the Institute of years. He was previously CEO of NT Health Information Council. His most Chartered Accountants in Australia, and Mines and Energy after having held recent previous appointments are a Companion of the Institution of senior executive positions in two other Director of Cardiology at Royal Engineers, Australia. He is Chancellor of economic development departments in Brompton Hospital, London, and Charles Darwin University, Chairman of the NT. Before coming to the NT he Viscount Royston Professor of Clinical the Northern Territory Tourist lived and worked in Papua New Guinea Cardiology at the National Heart and Commission Board and a Director of a for 16 years in the secondary and Lung Institute, Imperial College of number of public companies. tertiary education sectors. Science, Technology and Medicine, London. Professor Coats was a member of the

Menzies School of Health Research 2003 Annual Report | Governance | 25 Council, British Society of Heart Failure, Bruce Armstrong Professor at the University of member of the Cardiology Training AM, FAA, B Med Sc Melbourne, the University of Committee, North Thames (West), and (Hons), MB BS (Hons), Queensland, Monash University, and DPhil (Oxon), FRACP, part of the Medical Subcommittee of FAFPHM Flinders University. She graduated the Hypertrophic Cardiomyopathy initially in biochemistry and (Ex-officio, Nominee Association. pharmacology (University of of the Vice Chancellor Melbourne). Her current research on of University of lifestyle-related chronic diseases L Valerie Asche AM Sydney) MSc PhD FASM MAIBiol (diabetes, obesity, cardiovascular disease CBiol Professor Armstong is Associate Dean, and renal disease) extends from the (Nominee of the Faculty of Medicine, Head of the School laboratory to the population, and has a Governing Board) of Public Health, and a Medical strong emphasis on early intervention. Foundation Fellow at The University of At the national level, she is a member Sydney. Dr Asche, a microbiologist, has been a of numerous committees, including the university academic, an industrial He graduated in biochemistry and Council of the National Health and consultant and head of a diagnostic medicine from the University of Medical Research Council, Food unit. In the Northern Territory she was Western Australia, trained as a Standards Australia and New Zealand Head of the Microbiology Unit at the physician at the Royal Perth Hospital Board, the Diabetes Research Menzies School of Health Research and as an epidemiologist with Sir Consultative Committee, the National from 1986–94, a consultant for the Richard Doll at the University of Oxford. Diabetes Strategy Group, CSIRO Health Northern Territory Department of Health Bruce Armstrong has variously been Sector Advisory Council, and the and Community Services, and is at Professor of Epidemiology and Cancer Consultative Committee for the present editor of Recent Advances in Research at the University of Western National Centre for Epidemiology and Microbiology. Australia, Commissioner of Health for Population Health at the Australian National University. She is also a Board Member of the Western Australia, Deputy Director of National Heart Foundation, member of the International Agency for Research Observers on the Board the Darwin Region Institutional on Cancer, Director of the Australian Biosafety Committee, Commissioner of Institute of Health and Welfare, and SECRETARY TO THE BOARD Legal Aid, member of the Council of the Director of Cancer Research and Mr Keith White (from Nov 2003) Ageing, President of ASEA-Rehab, and Registers at The Cancer Council NSW. Mr David Morgan (until Nov 2003) President of CWA NT. She was CRCAH DIRECTOR Ron McKay BSc PhD previously Chair of the Taskforce into Prof Tony Barnes Illicit Drugs in the NT. GDIPCOMP GDIPBUS FAIM STAFF REPRESENTATIVE (Nominee of the NT Ros Anne Moriarty Dr Peter Fagan Minister for (Nominee of the Education) Governing Board) Professor McKay was Vice-Chancellor of the Northern Territory University from 1996–2002, following a six-year term Ms Moriarty is Managing Director of as Deputy Vice-Chancellor. The Jumbana Group, an Indigenous design and brand strategy consultancy. Kerin O’Dea BSc PhD Previous career positions include (ex-officio, Director research and administrative posts with of Menzies School of the Department of Aboriginal Affairs, Health Research) The Overseas Service Bureau and Radio Australia. She has held Board positions with the Professor O’Dea is the Director of the National Gallery of Australia, the Menzies School of Health Research and Australian Academy of Design and holds the Chair of Robert Menzies Australian Major Events. Professor at the University of Sydney. She also has appointments as Honorary

26 | Governance | Menzies School of Health Research 2003 Annual Report Board committees Patrons & members The Governing Board was assisted by the following committees: Official Patron MSHR Medallion Finance Committee Darwin Region Dr Shelley Walton His Honour Mr John Recipients Dr Valerie Asche Mrs Jane Large (Chair) Institutional Mr Bob Whitehead Anictomatis AO, Mrs Sue Bradley Biosafety Committee Miss Gabrielle Falls Administrator of the Miss Margaret Brewster Mr Peter Plummer Mrs Susan Hutton (Secretary) Northern Territory Father Frank Flynn MSC AC* Mr Brian Slatter (Chair) Mr Jack McTaggart Mr Harry Giese AM MBE* AO Mr Richard Ryan AO Dr Valerie Asche (until June 2003) Patrons Prof Richard Gye Dr John Hargrave AO MBE Prof Kerin O’Dea Asoc Prof Karen Gibb Ms Brydget Barker- NORTHERN TERRITORY Prof David Kemp FAA Mr David Morgan Mr Lodi Hoeben Hudson (until Aug The Hon Austin Asche AC QC Prof John Mathews AM (Secretary until Dr Gary Lum 2003) Mr Djerrkura OAM* Sept 2003) Dr Lorna Melville Rev Richard Wallace Mr Ray Norman AM Mr Keith White Dr Anna Padovan (until Dec 2003) QUEENSLAND Dr KS Sriprakash Mr Ron Archer AM (Secretary from Ms Claire Streten Nov 2003) (proxy for Karen Aboriginal Ethics VICTORIA Life Members Dr Keith Fleming Gibb) Subcommittee Sir Gustav Nossal AC CBE Audit Committee Ms Pamela Trotman Mr Peter Thomsen Mr Charles Goode Dr Ella Stack CBE Mrs Sue Bradley Dr Shelley Walton (Chair) (Chair) Miss Gabrielle Falls Mrs Norma Benger SOUTH AUSTRALIA The Hon John Dawkins Mr Richard Ryan AO (Secretary) Mrs Terry Dunbar *Deceased Prof Kerin O’Dea Dr Sandra Eades (from Prof Lowitja O’Donoghue Mr Peter Plummer Human Research Nov 2003) CBE AM Mr Brian Slatter Ethics Committee of Mr Shane Houston Mr William Scammell CBE (from Oct 2003) Mr David Morgan DHCS and MSHR TASMANIA Mr Shane Motlap (Secretary until Ms Jill Huck (Chair) Dr John Hargrave AO MBE Sept 2003) Ms Jenny Abdilla (from Sept 2003) Mr Keith White Assoc Prof Nick Ms Joanne (Secretary from Anstey Garnggulkpuy Nov 2003) Prof David Brewster Dr Michael Lowe Ms Robyn Cooke Ms Sandy Kitching Mr Ian Hillock (until April 2003) Dr Murray Seiffert Ms Allison Mr Peter Thomsen Chamberlain (until Ms Denise Walsh April 2003)

MSHR honorary appointments

Name Years Dates Details Level Bastian, Dr Ivan 3 1/12/2002–1/11/2005 IMVS facilities and expertise in research projects in East SRF Timor and Indonesia Cass, Dr Alan 3 5/12/2003–4/12/2006 Research into renal disease in Indigenous populations SRF d’Abbs, Dr Peter 3 1/03/2002–1/02/2005 Collaboration on substance abuse SRF Daniel, Assoc Prof Mark 3 1/01/2002–1/12/2004 Collaborative links on community-based diabetes project SRF Hoy, Prof Wendy 3 5/09/2003–1/08/2006 Renal disease and Indigenous populations Prof Fellow Lumb, Mr Richard 3 1/12/2002–1/11/2005 Mycobacteriology at IMVS and IMVS Laboratories for RF Research in East Timor Maguire, Dr Graeme 3 1/12/2002–1/11/2005 Continuing collaboration RF Price, Dr Ric 3 1/06/2002–1/05/2005 Tropical infectious diseases SRF Sayers, Dr Sue 3 1/10/2001–1/09/2004 Aboriginal birth cohort study SRF Sriprakash, Dr KS 3 1/06/2001–1/05/2004 Streptococcal vaccine SRF Tjitra, Dr Emiliana 3 1/03/2002–1/02/2005 Strengthen ties with Indondesia on infectious diseases SRF Wang, Dr Zhiqiang 3 1/02/2003–1/01/2006 Collaborative research on epidemiology SRF Weeramanthri, Dr Tarun 3 1/12/2002–1/11/2005 Preventable chronic diseases program in the NT SRF White, Dr Neville 3 1/10/2001–1/09/2004 Research Yolngu people of East Arnhem Land SRF Yonovitz, Dr Al 3 1/03/2001–1/02/2004 Audiology RF

Menzies School of Health Research 2003 Annual Report | Governance | 27 publications 1 January – 31 December 2003

Refereed journal articles J, Currie BJ. Saccade and cognitive impairment Currie BJ. Editorial: Snakebite in Australia: associated with kava intoxication. Human Moving from anecdotes to prospective studies. Ambrosini GL, Mackerras D, de Klerk NH, Musk Psychopharmacology: Clinical & Experimental Emerg Med 2003;15:406–8. AW. Comparison of an Australian food-fre- 2003;18:525–33. Currie BJ, Jacups SP. Intensity of rainfall and quency questionnaire to diet records: Cass A, Cunningham J, Snelling P, Wang Z, Hoy severity of melioidosis, Australia. Emerg Infect Implications for nutrition surveillance. Public W. Renal transplantation for Indigenous Dis 2003;9:1538–42. Health Nutrition 2003;6:415–22. Australians: Identifying the barriers to equi- Currie BJ, Clough AR. Kava hepatotoxicity with Bailie RS, Togni SJ, Si D, Robinson GS, d’Abbs table access. Ethnicity & Health Western herbal products: Does it occur with PHN. Preventive medical care in remote 2003;8:111–19. traditional kava use? Med J Aust Aboriginal communities in the Northern Cass A, Cunningham J, Snelling P, Ayanian JZ. 2003;178:421–2. Territory: A follow-up study of the impact of Late referral to a nephrologist reduces access clinical guidelines, computerised recall and Currie BJ. Marine Antivenoms. J Toxicol-Clin to renal transplantation. Am J Kidney Dis reminder systems, and audit and feedback. Toxicol 2003;41:301–8. 2003;42:1043–9. BMC Health Services Research 2003;3:15. Currie BJ. Melioidosis: An important cause of Cass A, Cunningham J, Snelling P, Wang Z, Hoy Binks M, McMillan DJ, Sriprakash KS. Genomic pneumonia in residents of and travellers W. Urban disadvantage and delayed nephrolo- location and variation of the gene for CRS, a returned from endemic regions. European Resp gy referral in Australia. Health and Place complement binding protein in the M57 J 2003;22:542–50. 2003;9:175–82. strains of Streptococcus pyogenes. Infect Davis JS, Currie BJ, Fisher DA, Huffam SE, Immun 2003;71:6701–6. Cheng AC, Stephens DP, Currie BJ. Granulocyte Anstey NM, Price R, Krause VL, Zweck N, colony stimulating factor as an adjunct to Boutlis CS, Hobbs MR, Marsh RL, Misukonis Lawton PD, Snelling PL, Selva-Nayagam S. antibiotics in the treatment of pneumonia in MA, Tkachuk AN, Lagog M, Booth J, Granger Prevention of opportunistic infectious in adults (Protocol). Cochrane Database of DL, Bockarie MJ, Mgone CS, Levesque MC, immunosuppressed patients in the tropical Top Systematic Reviews 2003;issue 3. Weinberg JB, Anstey NM. Inducible nitric oxide End of the Northern Territory. Communicable synthase (NOS2) promoter CCTTT repeat poly- Cheng AC, Hanna J, Norton R, Hills SL, Davis J, Diseases Intelligence 2004;27:526–32. morphism: relationship to in vivo NO produc- Krause VL, Dowse G, Inglis TJ, Currie BJ. d’Espaignet ET, Measey M, Carnegie M, tion/NOS activity in a malaria-endemic popu- Melioidosis in northern Australia, 2001–02. Mackerras D. Monitoring the ‘Strong Women, lation. Am J Trop Med Hyg 2003;69:569–73. Communicable Diseases Intelligence Strong Babies, Strong Culture Program’: The 2003;27:272–7. Boutlis C, Tjitra E, Maniboey H, Misukonis MA, first eight years. J Paediatr Child Health Saunders JR, Suprianto S, Weinberg JB, Anstey Cheng AC. ‘Self-experimentation’ in vulnerable 2003;39:668–72. NM. Nitric oxide production and mononuclear populations. Med J Aust 2003;178:471. Edwards ML, Fagan PK, Smith-Vaughan H, cell nitric oxide synthase activity in malaria- Cheng AC, Hanna J, Norton R, Hills SL, Davis J, Currie BJ, Sriprakash K. Strains of tolerant Papuan adults. Infect Immun Krause VL, Dowse G, Inglis TJ, Currie BJ. Streptococcus pyogenes from severe invasive 2003;71:3682–9. Melioidosis in northern Australia, 2001-02. infections bind HEp2 and HaCaT cells more avidly than strains from uncomplicated infec- Boutlis CS, Lagog M, Chaisavaneeyakorn S, Communicable Diseases Intelligence tions. J Clin Microbiol 2003;41:3936–8. Misukonis MA, Bockarie MJ, Mgone CS, Wang 2003;27:272–7. Z, Morahan G, Weinberg JB, Udhayakumar V, Clough AR, Wang Z, Bailie RS, Burns CB, Currie Elliott JH, Currie BJ. Burkholderia pseudomallei Anstey NM. Plasma interleukin-12 in malaria- BJ. Case-control study of the association mycotic aneurysm. Int J Med 2003;33:323–4. tolerant Papua New Guineans: Inverse correla- between kava use and pneumonia in eastern Elliott JH, Carson P, Currie BJ. Images In tion with Plasmodium falciparum parasitemia Arnhem Land Aboriginal communities Medicine: Burkholderia pseudomallei mycotic and peripheral blood mononuclear cell nitric (Northern Territory, Australia). Epidemiol Infect aneurysm. Intern Med J 2003;33:323–4. oxide synthase activity. Infect Immun 2003;133:627–35. Fischer K, Holt DC, Wilson P, Davis J, Hewitt V, 2003;71:6354–7. Clough AR, Jacups SP, Wang Z, Burns CB, Johnson M, McGrath A, Currie BJ, Walton SF, Boutlis CS, Fagan PK, Gowda DC, Lagog M, Bailie RS, Cairney SJ, Collie A, Guyula T, Kemp DJ. Normalization of a cDNA library Mgone CS, Bockarie MJ, Anstey NM. McDonald SP, Currie BJ. Health effects of kava cloned in lambda ZAP by a long PCR and cDNA Immunoglobulin G (IgG) responses to use in an eastern Arnhem Land Aboriginal reassociation procedure. Biotechniques Plasmodium falciparum glycosylphosphatidyli- community. Internal Medicine Journal 2003;34:250–4. nositols are short-lived and predominantly of 2003;33:336–40. Fischer K, Holt DC, Harumal P, Currie BJ, the IgG3 subclass. J Infect Dis Clough AR, Bailie RS, Currie BJ. Liver function Walton SF, Kemp DJ. Generation and charac- 2003;187:862–5. tests abnormalities in users of aqueous kava terization of cDNA clones from Sarcoptes sca- Cairney S, Clough AR, Maruff P, Collie A, Currie extracts. J Toxicol-Clin Toxicol 2003;41:821–9. biei var hominis for an expressed sequence tag BJ. Saccade and cognitive function in chronic Condon JR, Armstrong BK, Barnes A, library: Identification of homologues of house kava users. Neuropsychopharm-acology Cunningham J. Cancer in Indigenous dust mite allergens. Am J Trop Med Hyg 2003;28:389–96. Australians: A review. Cancer Causes and 2003;68:61–4. Cairney S, Maruff P, Clough AR, Collie A, Currie Control 2003;14:109–21. Harumal P, Morgan M, Walton SF, Holt DC,

28 | Publications | Menzies School of Health Research 2003 Annual Report Rode J, Arlian LG, Currie BJ, Kemp DJ. monounsaturated fat in a 4-week diet affects Cheng AC, Mayo MJ, Gal D, Currie BJ. Identification of a homologue of a house dust body weight and composition of overweight Chlorination and pH of drinking water do not mite allergen in a cDNA library from Sarcoptes and obese men. Brit J Nutr 2003;90:717–27. correlate with rates of melioidosis in the scabiei var hominis and evaluation of its vac- Piers LS, Rowley KG, Soares MJ, O’Dea K. Northern Territory, Australia. Trans Royal Soc cine potential in a rabbit/S scabiei var canis Relationship of adiposity and body fat distri- Trop Med Hyg. model. Am J Trop Med Hyg 2003;68:54–60. bution to body mass index in Australians of McCarthy JS, Kemp DJ, Walton SF, Currie BJ. Hoy WE, Douglas-Denton RN, Hughson MD, Aboriginal and European ancestry. Eur J Clin Scabies: More than just an irritation. Postgrad Cass A, Johnson K, Bertram JF. A stereological Nutr 2003;57:956–63. Med J. study of glomerular number and volume: Robinson G, d’Abbs P, Togni S, Bailie RS. Walton SF, McKinnon M, Pizzutto S, Dougall A, Preliminary findings in a multiracial study of Aboriginal participation in health service deliv- Williams E, Currie BJ. Acaricidal activity of kidneys at autopsy. Kidney Int Suppl ery: Coordinated Care Trials in the Northern Melaleuca alternifolia (tea tree) oil: In vitro 2003;S31–S37. Territory of Australia. Int J Healthcare sensitivity of Sarcoptes scabiei var hominis to Koh KJ, Parker CJ, Ellis D, Pruim B, Leysley L, Technology & Management 2003;5:45–62. terpinen-4-ol. Arch Dermatol. Currie BJ. Use of terbinafine for tinea in Rowley KG, O’Dea K, Best JD. Association of Australian Aboriginal communities in the Top albuminuria and the metabolic syndrome. End. Australas J Dermatol 2003;44:243–49. Current Diab Reports 2003;3:80–6. Books Kukuruzovic RH, Brewster D, Gray E, Anstey N. Rowley KG, Lee AJ, Yarmirr D, O’Dea K. Robinson G, Bailie R, Wang Z, Snelling P, Increased nitric oxide production in acute Homocysteine concentrations lowered follow- Kondalsamy-Chennakesavan S. A Follow-up diarrhoea is associated with abnormal gut per- ing community-based dietary intervention Study of Outcomes of the Tiwi Renal meablity, hypokalemia and malnutrition in among Aboriginal people. Asia Pacific J Clin Treatment Program. Darwin: NTUniprint, Aboriginal children in tropical Australia. Trans Nutr 2003;12:92–5. Northern Territory University, 2003. Royal Soc Trop Med Hyg 2003;97:115–20. Rowley K, Walker KZ, Cohen J, Jenkins AJ, Li S, Cass A, Cunningham J. Cause of death in O’Neal D, Su Q, Best JD, O’Dea K. Inflammation Book chapters and vascular endothelial activation in an patients with end stage renal disease: Currie B, Couzos S. Skin Infections. In: Couzos Aboriginal population: Relationships to coro- Assessing concordance of death certificates S, Murray R eds. Aboriginal Primary Health nary disease risk factors and nutritional mark- with registry reports. Aust NZ J Public Health Care: An Evidence-based Approach. 2nd edn. ers. Med J Aust 2003;178:495–500. 2003;27:419–24. Melbourne: Oxford University Press, Lopansri BK, Anstey NM, Weinberg JB, Smith-Vaughan HC, Gal D, Lawrie PM, 2003;251–80. Winstanley C, Sriprakash KS, Currie BJ. Stoddard GJ, Hobbs MR, Levesque MC, Currie BJ, McGougan BK. Skin infections and Ubiquity of putative type III secretion genes Mwaikambo ED, Granger DL. Low plasma argi- infestations. In: Couzos S, Murray R eds. among clinical and environmental nine concentrations in children with cerebral Aboriginal Primary Health Care: An Evidence- malaria and decreased nitric oxide production. Burkholderia pseudomallei isolates in Northern Australia. J Clin Microbiol 2003;41:883–85. Based Approach, Melbourne: Oxford University Lancet 2003;361:676–8. Press, 2003;369–83. Mackerras DEM. Does a combined program of Stout JE, Engemann JJ, Cheng AC, Fortenberry dietary modification and physical activity or ER, Hamilton CD. Safety of two months of In press rifampin and pyrazinamide for treatment of the use of metformin reduce the conversion Currie BJ. Melioidosis and Glanders. In: from impaired glucose tolerance to type 2 dia- latent tuberculosis. Am J Respir Crit Care Med 2003;167:824–7. Mandell Bennett P, Dolin Elsevier D eds. betes? Med J Aust 2003;178:180–1. Principles and Practice of Infectious Diseases. Mackerras DEM. Does dietary modification Whelan PI, Jacups SP, Melville L, Broom A, and/or physical activity reduce the progression Currie BJ, Krause VL, Brogan B, Smith F, from impaired glucose tolerance to type 2 dia- Porigneaux P. Rainfall and vector mosquito Reports betes? Med J Aust 2003;178:346–7. numbers as risk indicators for mosquito borne Clark LA, Bettison PK. Connecting Youth: disease in Central Australia. Communicable Snapshot of Vocational Education Participation Mackerras DEM, Reid A, Sayers SM, Singh GR, Diseases Intelligence 2003;27:110–16. Bucens IK, Flynn KA. Growth and morbidity in by Indigenous Youth in Remote NT. Darwin: White J, Warrell D, Eddleston M, Currie BJ, children in the Aboriginal Birth Cohort Study: Menzies School of Health Research, 2003. Whyte IM, Isbister GK. Clinical toxinology: the urban-remote differential. Med J Aust Hii J, Anstey NM, D'Souza L. The Agusan del Where are we now? J Toxicol-Clin Toxicol 2003;178:56–60. Sur Malaria Control and Prevention Project: 2003;41:263–76. McDonald SP, Maguire GP, Hoy WE. Renal Report of IV Project Review. AusAID, Canberra, function and cardiovascular risk markers in a In press November 2003. remote Australian Aboriginal community. Cheng AC, Jacups SP, Anstey NM, Currie BJ. A Thomsen P. Using Your Senses . . . to Make Nephrol Dial Transplant 2003;18:1555–61. proposed scoring system for predicting mortal- Sense. Darwin: Cooperative Research Centre Piers LS, Walker KZ, Stoney RM, Soares MJ, ity in melioidosis. Trans Royal Soc Trop Med for Aboriginal and Tropical Health, 2003;1-20. O’Dea K. Substitution of saturated with Hyg. Currie B. Tropical Health in the Top End: An

Menzies School of Health Research 2003 Annual Report | Publications | 29 introduction for health practitioners. Top End Condon J. Cancer in Indigenous Australians. malaria. 9th National Congress of Tropical and Division of General Practice, 2003. First Nations Cancer Research and Surveillance Infectious Diseases, Manado, Indonesia, Walton SF. Sarcoptes scabiei var hominis Workshop, Ottowa, Canada, October, 2003. 10 August, 2003. Acaricide Sensitivity Testing: A report for Currie B. Antibiotic prescribing in the Top End: Cawarra Cosmetics Pty Ltd. Darwin: Menzies Why is it different? Antimicrobials 2003 Other major conference School of Health Research, 2003. Conference, Melbourne, 2 May, 2003. Currie B. Global warming, environmental presentations Letters change and infectious disease in tropical north- Currie BJ. Marine Envenoming in Tropical ern Australia. Public Health Department Grand Australia. Australian College for Emergency Laming A, Currie BJ. Letter: Trachoma: Rounds, Emory University, Atlanta Georgia, USA, Medicine: Winter Symposium: Clinical risk Response to Ewald et al. (Med J 8 October, 2003. management toxicology update. Melbourne, Aust;178:65–8). Med J Aust 2003;179:117. Currie B. An update of melioidosis and the Hotel Sofitel, 19–21 June, 2003. Gruen R. Letter: Indigenous surgical admis- Darwin prospective melioidosis study. Currie BJ. The molecular epidemiology of sions. ANZ J Surg 2003;73:1061. Meningitis and Special Pathogens Branch, melioidosis in tropical Australia. 58th Hobbs MR, Levesque MC, Anstey NM, Granger National Centre for Infectious Diseases, Centres International Conference on Diseases in Nature DL, Weinberg JB. Letter: Increased nitric oxide for Disease Control, Atlanta, Georgia, USA, 9 Communicable to Man, Northern Arizona production and protection from malaria October, 2003. University, 2–6 August, 2003. [authors’ reply]. Lancet 2003; 361:610–11. Currie B. Melioidosis, cryptococcosis and tigers Gruen RL, McDonald EL, Morris PS, Bailie RS. in tropical northern Australia. Infectious Global evidence and global relevance: The Non-refereed journal Diseases Grand Rounds, Duke University double-bind in systematic reviews. Annual Medical Centre, Durham, North Carolina, USA, Cochrane Colloquium, Barcelona, Spain, articles 3 November, 2003. October, 2003. McDonald M. Rheumatic fever and streptococ- Currie B. Infectious diseases, Indigenous health Mackerras D, Singh GR. Are haemoglobin and cal pyoderma: Searching for a link. The and global warming in tropical Australia. haematocrit interchangeable indicators of Northern Territory Disease Control Bulletin Grand Rounds, University of Minnesota anaemia prevalence in Australian Aboriginal 2003;10:11–12. Medical School, Minneapolis, USA, November, adolescents? INACG Symposium, Marrakech, Currie B. Environmental hazards and the field 2003. Morocco, 6–7 June, 2003. naturalist. Northern Territory: Newsletter. Currie B. Emerging infectious diseases in tropi- Maguire G, Gal D, Dasari P, Pond J, Nasir M, Nature Territory–NT Field Naturalists Club June cal Australia. Grand Rounds, Walter Reed Army Currie B. The role of bacterial infection in 2003:8–10. Medical Center, Washington DC, USA, 12 Indigenous Australians with COPD living in December, 2003. remote communities. Thoracic Society of Significant invited Fagan P. Shifting sands: Problems in under- Australia and New Zealand, 4–9 April, 2003. standing group A streptococcal disease in Morris PS, Leach AJ, Wilson C, Bailie RS. The presentations tropical Australia. MicroNZ 2003, Auckland, effect of additional hygiene practices on rates Anstey N. The drug resistance crisis: What New Zealand, September 2003. of bacterial cross-infection and respiratory ill- treatment regimens are affordable in the Asia- O’Dea K. Approaches to risk reduction and pre- ness in Australian child care centres: A ran- Pacific region? Annual Scientific Meeting: vention: Australia and Asia. International domised controlled trial. 15th Conference of Australasian Society for Infectious Diseases, Diabetes Federation Workshop, Type 2 Diabetes the International Society for Environmental Canberra, March 2003. in the Adolescent: the evolving epidemic, Epidemiology, Perth, Western Australia, 23–26 Anstey N. Arginine: A new treatment for Santa Monica, California, USA, 7–9 February, September, 2003. malaria? Institute of Child Health Research, 2003. Morris PS, Leach AJ, Wilson C, Bailie R. Adelaide, December 2003. O’Dea K. Diet and the prevention of vascular Additional training in recommended hygiene Anstey N. Nitric Oxide NOS2, arginine and disease. National Endocrinologist and practices for the prevention of bacterial cross- malaria. Victorian Malaria Research Network, Nephrologists Meeting, Sydney, 25–27 July, infection and respiratory illness in Australian Melbourne, November 2003. 2003. child care centres: A randomised controlled trial. 8th International Symposium on Otitis Anstey N. Lung injury in malaria. Department O’Dea K. Guidelines for the prevention of type Media, Hobart, October, 2003. of Medicine, University of Melbourne, 2 diabetes: Gaps in the knowledge. Australian Melbourne, November 2003. Centre for Diabetes Strategies, Guidelines Gaps Schupp J, Cardon M, Pearson T, Huynh L, Smith K, Robinson R, Currie B, Okinaka R, Deschazer Anstey N. Recent advances in the pathophysi- Workshop, Sydney, 3 February, 2003. D, Keim, P. Burkholderia pseudomallei multilo- ology and treatment of severe malaria. O’Dea K. Epidemiology of diabetes in the cus VNTR analysis: Development and analysis National Institute of Health Research and Aboriginal population. University of Manitoba of globally and locally distributed isolates. Development, Jakarta, Indonesia, August 2003. Diabetes Symposium, Winnipeg, Manitoba, Canada, 13–17 May, 2003. 58th International Conference on Diseases in Anstey N. Recent advances in the pathophysi- Nature Communicable to Man, Northern ology of severe malaria. IX National Congress Price R. What is new in the chemoprophylaxis Arizona University, 2–6 August, 2003. of the Indonesian Association Tropical and of malaria? Annual Meeting of the Infectious Diseases, Mando Indonesia, August Australasian Society for Infectious Disease, 2003. Canberra, 23 March, 2003. Bailie RS. IHousing improvements and child Price R. Artemisinin derivatives: The role of health in remote Indigenous communities. combination therapy. 8th Conference of the International Meeting on Housing and Health International Society of Travel Medicine, New Research, University of Otago Medical School, York, USA, 8 May, 2003. Wellington, New Zealand, 12 February, 2003. Price R. Therapeutic options in malaria treat- Brown A. The context of Indigenous cardiovas- ment. Symposia on ‘Malaria Insurance for the cular diseases. Reducing time to care for World’s Travellers’. 8th Conference of the patients with AMI. Cardiac Society of Australia International Society of Travel Medicine, New and New Zealand/National Heart Foundation York, USA, 9 May, 2003. of Australia, Melbourne, November, 2003. Price R. New drugs and drug combinations in

30 | Publications | Menzies School of Health Research 2003 Annual Report research funding Competitive Research Grants awarded during 2003

Details of ongoing MSHR funding is available online at www.menzies.edu.au

Funder Chief investigator(s) Grant type Title Term funded Total funds Australian Tuberculosis GRACE Jocelyn; Project Reasons for non-starting, non-acceptance and non-compliance 1/07/2003– $17,003 Research Group KRAUSE Vicki with latent tuberculosis infection (LTBI) treatment in a remote 30/06/2004 Aboriginal community in the Northern Territory CardioVascular Lipid (Pfizer) BROWN Alex; Project Comparison of the quality and outcomes of secondary prevention 1/01/2004– $50,000 CURRIE Bart; for Indigenous and non-Indigenous patients after acute coronary 3/12/2004 WEERAMANTHRI, Tarun syndromes in the Northern Territory Channel 7 Children's FAGAN Peter; Project Screening of a human heart cDNA library using sera from a 1/07/2003– $38,000 Research Foundation of SA CURRIE Bart patient with rheumatic fever 30/06/2004 Community Health and KELLY Paul M; Project The Mimika pulmonary disability in TB patients study (Year 2) 1/01/2004– $42,550 Tuberculosis Australia ANSTEY Nicholas M; 31/12/2004 MAGUIRE Graeme Department of Health & BAILIE Ross S Project Housing Improvement and Child Health Study (HICH) 20/04/2004– $59,344 Community Services 16/04/2004 National Health & Medical BAILIE Ross S Fellowship Fellowship in Indigenous Environmental Health and Health 1/01/2004– $571,250 Research Council Services Research 31/12/2008 National Health & Medical CAIRNEY Sheree Training The development of culturally appropriate cognitive assessments with 1/07/2004– $259,000 Research Council Fellowship applications in substance abuse and mental health with Indigenous clients 30/06/2008 National Health & Medical CUNNINGHAM Joan; Capacity Building capacity in policy relevant, quantitative, social analysis 1/01/2004– $2,437,000 Research Council ANDERSON Ian; BAILIE Building and research in Indigenous health 31/12/2008 Ross; LEWIS Jennifer; BARNES Anthony National Health & Medical CUNNINGHAM Joan Career Develop- Social and system determinants of Indigenous health 1/01/2004– $467,500 Research Council ment Award 31/12/2008 National Health & Medical EADES, Sandra Training Utilisation of complex epidemiological studies and advanced 1/01/2004– $291,000 Research Council Fellowship statistical methods, to explore causal pathways to illness and 31/12/2007 health among Indigenous children and adolescents National Health & Medical GADIL Edna Scholarship Chronic suppurative otitis media in Aboriginal children: 1/01/2004– $58,978 Research Council Opportunities for improved health outcomes 31/12/2005 National Health & Medical LEACH Amanda J Career Develop- Reducing the burden of infectious disease in young Aboriginal 1/03/2004– $426,250 Research Council ment Award children: An evidence-based, multidisciplinary approach 28/02/2009 National Health & Medical LLOYD Jane Scholarship Designing and trialling health interventions with an urban 1/01/2004– $61,452 Research Council Indigenous population 31/12/2006 National Health & Medical MAPLE-BROWN Louise Scholarship Non-invasive assessment of vascular function in urban, rural and remote- 1/07/2003– $56,864 Research Council dwelling Indigenous Australians: Impact of diabetes and dyslipidaemia 30/06/2004 National Health & Medical NAGEL Tricia Scholarship Development of a relapse prevention protocol for Indigenous people 1/01/2004– $88,467 Research Council with chronic mental illness in remote communities 31/12/2006 National Health & Medical O'DEA Kerin; SNELLING Project A randomised trial of fish and fruit to improve survival of Aboriginal 1/01/2004– $487,500 Research Council Paul; CASS Alan people with end-stage renal disease 31/12/2006 National Health & Medical SMITH-VAUGHAN Training Applying molecular public health in Indigenous communities: 1/01/2004– $129,500 Research Council Heidi C Fellowship Linking research to outcomes 31/12/2007 National Health & Medical WALTON Shelley; Project Investigating the molecular basis of emerging drug resistance in 1/01/2004– $506,625 Research Council McCARTHY James; CURRIE scabies mites 31/12/2006 Bart; HOLT Deborah National Health & Medical WALTON Shelley; Project Characterisation of immune responses to Sarcoptes scabiei cysteine 1/01/2004– $465,750 Research Council O’HEHIR Robyn; KEMP proteases, group 1 allergen homologues, in scabies 31/12/2006 David; CURRIE Bart; ROLLAND Jennifer National Health & Medical ANSTEY Nicholas M; Collaborative Research and training to reduce morbidity and mortality from 1/01/2004– $1,649,830 Research Council TJITRA Emiliana; PRICE Research malaria in Papua (Indonesia) and Papua New Guinea 31/12/2008 &Ric; HARIJANTO Paul; Wellcome Trust SLY Peter; KEVAU Isi $1,502,089 National Heart Foundation McDONALD Malcolm; Project Towards a new prevention strategy for rheumatic fever: The role of 1/01/2004– $100,000 CARAPETIS, Jonathon; streptococcal skin infection in the pathogenesis of rheumatic 31/12/2005 BENGER Norma; heart disease CURRIE Bart National Heart Foundation BROWN Alex Scholarship Men, hearts and minds: Exploring the links between psychosocial stress, 1/01/2004– $60,609 depression and coronary heart disease in Indigenous men from Central Australia 31/12/2005 The Clive and Vera CUNNINGHAM Joan Equipment DRUID equipment package 1/01/2004– $22,822 Ramaciotti Foundations 31/12/2004

Menzies School of Health Research 2003 Annual Report | Research Funding | 31 financial overview 1 january 2003 – 31 december 2003

2003 2002 % Change Notes Income $11,968,593 $9,941,384 20.39% 1 Expenditure $9,983,649 $8,425,127 18.49% 2 Net surplus $1,984,944 $1,516,257 30.91% 3 Net assets $7,900,364 $5,818,042 35.79% Staff (full-time equivalents) 95 79 20.25% 2

1 Increase in income is attributable to a 21.5% increase in grant income. In accord with our accounting policy, all income is recognised in the year of receipt, not the year in which it is to be expended. 2 Increase is directly related to increase in grant income. 3 Audited net surplus includes revenue received for research projects that have a life beyond the end of the financial year.

Income Expenditure

Reimbursements Sundry income $518,818 (4%) Operational $670,364 (6%) CRCAH $2,178,268 (22%) $1,252,967 (10%) Commonwealth Overseas grants grants $152,133 (1%) $4,170,019 (35%)

Non-government grants $1,650,560 (14%)

Menzies Foundation Administration $100,000 (1%) $1,318,119 (13%)

Employment $6,487,261 (65%)

NT Government grants $3,447,526 (29%)

Donations Estate of the late Mr Charles McKay $20,000 Tudor Foundation $15,175 Mr & Mrs Maple-Brown $5,000 Mrs Sheila Frey $1,000 Copies of the Menzies School of Health Reserve Bank of Austalia $1,000 Research audited 2003 Financial Statements Dr Val Asche $150 are available at our website: Anne Hayward $100 www.menzies.edu.au or by phoning Menzies School of Health Research on 08 8922 8196 Dr Ella Stack $100

32 | Financial Overview | Menzies School of Health Research 2003 Annual Report For further information

Professor Kerin O’Dea Director (08) 8922 8605

Administration and Public Relations Mr David Morgan Financial Controller (08) 8922 8053 Mrs Sue Hutton Operations Manager (08) 8922 8025 Ms Annette Heathwood Executive Officer (08) 8922 8854 Ms Nicki Crute Human Resources Officer (08) 8922 7832 Ms Alison Ellis Fundraising & Corporate Relations Officer (08) 8922 8989

Research Administration and Ethical Issues Ms Gabrielle Falls Senior Research Administrator (08) 8922 8624

Population Health and Chronic Diseases Division Professor Kerin O’Dea Division Leader (08) 8922 8605 Assoc Professor Ross Bailie Assoc Professor Public Health (08) 8922 8196 Assoc Professor Joan Cunningham Principal Research Fellow (08) 8922 8797 Ms Tracey Burke Research Administration Officer (08) 8922 7833

Tropical and Emerging Infectious Diseases Division Professor Bart Currie Division Leader (08) 8922 8056 Assoc Professor Nick Anstey Principal Research Fellow (08) 8922 8932 Mrs Jill Albion Research Administration Officer (08) 8922 7837

Central Australian Unit Dr Alex Brown Senior Research Fellow (08) 8951 4740

Education and Training Division Dr Paul Kelly Division Leader (08) 8922 8837 Dr Richard Chenhall Public Health Educator (08) 8922 7860 Ms Catherine Richardson Academic Administrator (08) 8922 7873

Indigenous Forum Mrs Norma Benger Interim Convenor (08) 8922 7877

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Acknowledgements Written by Menzies School of Health Research Designed and produced by Bruderlin MacLean Publishing Services (www.brumac.com.au) Photography by Menzies School of Health Research, unless otherwise credited Cover painting by Amelia Turner (Untitled, 2003, acrylic on canvas, 400 x 510 mm, Irrkerlantye Arts, © artist, photo Karina Menkhorst) Printed by Greg Tapp Printing Cover Amelia Turner, Untitled, 2003, acrylic on canvas, 400 x 510 mm, Irrkerlantye Arts, © artist, photo Karina Menkhorst

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