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

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

Background The misnamed ‘vitamin’ D is actually the hormone calcitriol (1,25 dihydroxyhydroxyvitamin D). It has a central regulatory role in calcium metabolism, and more widely in the immune system. The prohormone calcifediol (25 hydroxyvitamin D) is more easily measured in the laboratory and is the analyte used in reference interval formulation. Being highly lipid soluble, both calcifediol and calcitriol travel in the bloodstream on carriage proteins, principally on vitamin D-binding protein. Summary This review reports our current understanding of vitamin D-binding protein. Its genetic determinants and their effect on it and secondarily on calcifediol concentrations and assays are described. Its complex interplay with parathyroid hormone is considered. The analytical state of the art is translated into the challenge it imposes clinically, in the formulation of reference intervals and in their use in advising and managing patients. Several recent challenges thrown up to laboratories by percipient clinicians highlight the dilemma vitamin D-binding protein poses. A way forward is suggested.

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

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

Objective To assess the ability of an algorithm for thyroid-function testing (based on assay of thyroid-stimulating hormone [TSH]) to discern euthyroidism in patients with and without conditions affecting thyroid function. Design The Australian Health Insurance Commission (HIC) specifies clinical categories for which Medicare rebate is given for assay of both TSH and free thyroxine (FT4), but otherwise rebates for thyroid function testing are given for TSH assay only. A prospective study was made of paired TSH and FT4 results of 1000 consecutive assays categorised by indication for testing. An FT4 value within the reference range was accepted as indicating euthyroidism; the reliability of an initial TSH measurement as the sole indicator of thyroid disease was assessed against this criterion standard. Setting A large suburban teaching hospital. Outcome measure Success or failure of the algorithm, with failure defined as an abnormal FT4 level missed because the TSH level was normal. Results The algorithm failure rate both overall and in the patients not in the HIC clinical categories was 2.7%, and there was no significant difference in algorithm failure rate in the patients in the various HIC clinical categories. The categories and failure rates were: patients being monitored for thyroid disease, 3.4%; patients with the "sick euthyroid" syndrome, nil; patients with psychosis or dementia, 1.1%; patients taking drugs affecting thyroid function, 2.1%; and patients with pituitary dysfunction, one of six cases. The range of FT4 values in patients in whom the algorithm failed was 6.4-29.5 pmol/L in those without thyroid disease and 3.4-27.4 pmol/L in those with thyroid disease. In patients being monitored for thyroid disease, the proportion of abnormal values of TSH alone was significant (P Conclusion We have shown that the HIC's imposition of a TSH-based algorithm by financial fiat is also scientifically acceptable. Use of this algorithm in hospitals (including psychiatric hospitals) will result in substantial savings.

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

Summary High level vancomycin resistance in enterococci (VRE) is increasing in Australia. If the spread of VRE is to be checked, then it is vital for laboratories to be able to detect it promptly and accurately. We have established a rapid and accurate screening method using Enterococcosel agar supplemented with 6 mg/l vancomycin. It can recover VRE from spiked feces, it may be used to screen feces for carriage of VRE and it is not subject to the confounding effects which feces introduce to broth enrichment culture.

Four independent studies, three in the U.S. and one in Norway, have recently examined 254,481 persons to find a relationship between each individual’s own birth weight and his or her risk of subsequently developing diabetes (1–4). The first two studies used type 2 diabetes as the …

Nitrofurantoin, one of the antimicrobial agents which should be chosen for the prophylactic treatment of recurrent urinary tract infection, may be prescribed in the conventional form or, alternatively, as macrocrystals. The latter form (Macrodantin) is reported to engender less gastrointestinal intolerance but it can produce the same adverse effects as the conventional form--liver damage, acute and chronic pulmonary reactions, peripheral neuropathy, blood dyscrasias and allergic reactions--and does so just as rapidly and floridly; one such case is reported here.