INTRODUCTION: Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) are major otitis media pathogens that densely co-colonise the nasopharynx and infect the middle ear of Australian Aboriginal infants from very early in life. Our co-primary hypotheses are that at 18 months of age infants receiving 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) compared with those receiving 13-valent pneumococcal conjugate vaccine (PCV13) as a booster at 12 months of age will have higher antibody levels to Haemophilus influenzae protein D and that infants receiving PCV13 will have higher antibody levels to PCV13-only serotypes 3, 6A and 19A. METHODS AND ANALYSES: Our randomised controlled trial will enrol 270 Aboriginal children at 12 months of age to a booster dose of either PHiD-CV10 or PCV13. Children who completed the three-dose primary course schedules of PHiD-CV10 at 2, 4, 6 months of age; PCV13 at 2, 4, 6 months of age; or a combination schedule of PHiD-CV10 at 1, 2, 4 months of age plus PCV13 at 6 months of age are eligible. The co-primary assessor-blinded outcomes when the infants are 18 months of age are as follows: (a) IgG geometric mean concentration (GMC) and proportion with IgG ≥100 EU/mL for protein D, and (b) IgG GMC and the proportion with IgG ≥0.35 µg/mL for pneumococcal serotypes 3, 6A and 19A. Secondary immunogenicity comparisons of six primary and booster dose schedules of 10 shared serotypes at 18 months of age, nasopharyngeal carriage, all forms of otitis media, hearing loss and developmental milestones at 18, 24, 30 and 36 months of age will be reported. ETHICS AND DISSEMINATION: Ethics committees of NT Department of Health, Menzies, WA Department of Health and WA Aboriginal Health approved the study. Results will be presented to communities, at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT01735084.

Procedure for the treatment of a person with electroconvulsive therapy (ECT) under the Mental Health and Related Services (MHARS) Act

Procedure for the licensing of premises that undertake electroconvulsive therapy (ECT) treatment under the Mental Health and Related Services (MHARS) Act.

The genus Acinetobacter, well known as a nosocomial pathogen, can also cause severe community-onset pneumonia. Previous small case series have suggested fulminant disease and a pooled hospital mortality of > 60%. We conducted a prospective observational study of all episodes of bacteremic, community-onset, and radiologically confirmed pneumonia due to Acinetobacter species at a tertiary referral hospital in tropical Australia from 1997 to 2012 following the introduction of routine empirical treatment protocols covering Acinetobacter. Demographic, clinical, microbiologic, and outcome data were collected. There were 41 episodes of bacteremic community-onset Acinetobacter pneumonia, of which 36 had no indicators suggesting health-care-associated infection. Of these, 38 (93%) were Indigenous Australians, one-half were men, the average age was 44.1 years, and 36 episodes (88%) occurred during the rainy season. All patients had at least one risk factor, with hazardous alcohol intake in 82%. Of the 37 isolates available for molecular speciation, 35 were Acinetobacter baumannii and two were Acinetobacter nosocomialis. All isolates were susceptible in vitro to gentamicin, meropenem, and ciprofloxacin, but only one was fully susceptible to ceftriaxone. ICU admission was required in 80%. All 41 patients received appropriate antibiotics within the first 24 h of admission, and 28- and 90-day mortality were both low at 11%. Community-acquired Acinetobacter pneumonia is a severe disease, with the majority of patients requiring ICU admission. Most patients have risk factors, particularly hazardous alcohol use. Despite this severity, correct initial empirical antibiotic therapy in all patients was associated with low mortality.

A retrospective study of 191 cases of septic arthritis was undertaken at Royal Darwin Hospital in the tropical north of Australia. Incidence was 9.2 per 100,000 overall and 29.1 per 100,000 in Aboriginal Australians (RR 6.6; 95% CI 5.0-8.9). Males were affected more than females (RR 1.6; 95% CI 1.2-2.1). There was no previous joint disease or medical illness in 54%. The commonest joints involved were the knee (54%) and hip (13%). Significant age associations were infected hips in those under 15 years and infected knees in those over 45 years. Seventy two percent of infections were haematogenous. Causative organisms included Staphylococcus aureus (37%), Streptococcus pyogenes (16%) and Neisseria gonorrhoeae (12%). Unusual infections included three melioidosis cases. Polyarthritis occurred in 17%, with N. gonorrhoeae (11/23) more likely to present as polyarthritis than other organisms (22/168) (OR 6.0; 95% CI 2.1-16.7). Univariate and multivariate analysis showed the hip to be at greater risk for S. aureus than other joints. Open arthrotomy was a more successful treatment procedure than arthroscopic washout or needle aspiration.

Visceral leishmaniasis (VL) is the most severe manifestation of the infection caused by the protozoan Leishmania, recently on increase in Italy and Spain. The aim of the study was to describe FDG uptake patterns in VL patients (pts) who underwent 18F-FDG PET/CT. A retrospective monocentric study of pts who underwent FDG PET/CT between 2008 and 2017 and later diagnosed with VL was performed. Semi-quantitative parameters were calculated in FDG-positive lesions: SUVmax, SUVmax spleen/SUVmax liver ratio (SLR), SUVmax focal/diffuse spleen ratio (FDR). Overall, 23 pts were included. PET/CT was negative in 2 immunocompromised pts, positive in 21/23 (91%) [6 spleen only, 2 spleen + nodes, 7 spleen + bone marrow (BM), 4 spleen + BM + nodes, 1 spleen + BM + lung, 1 BM only + nodes, 2 nodes only]. Splenic involvement was demonstrated in 20/23 (87%) pts. Two different splenic patterns were observed: diffuse (13/20 pts, mean spleen SUVmax = 7.3 ± 4.2 [4.0-14.1], mean SLR = 2.2 ± 1.6 [1.3-6.7]) and focal over diffuse (7/20 pts, mean SUVmax = 12.6 ± 4.5 [9.5-20.5], mean SLR = 2.8 ± 0.8 [2.1-4.4], mean FDR = 2.1 ± 0.8 [1.2-3.6]). Extra-splenic FDG-avid findings were detected in 15/21 pts (65%): bone marrow in 13/15 (mean SUVmax = 4.0 ± 1.3 [2.8-6.0]), nodes in 67/15 and lung in 1/15. PET/CT demonstrated splenic FDG uptake in all immunocompetent VL pts; two splenic patterns (diffuse/focal over diffuse) were observed and indistinguishable from splenic involvement by other disorders. The most frequent extra-splenic FDG-positive sites were BM and lymph nodes. Considering the potential disease aggressiveness and recent outbreaks in north-eastern Italy, VL should be considered in the differential diagnosis of FDG-positive splenic findings in pts from endemic areas or reporting travels to endemic countries.

Box Jellyfish, particularly Chironex Fleckeri are dangerous from October to May each year. This is commonly known as "Stinger Season". During the 1988 dry season their were several Box Jellyfish stings reported. It became obvious that there was a need to increase community awareness of the presence of Box Jellyfish in North Australia's coastal waters all year round. Similar campaigns have been co-ordinated by Health Promotion Branch for some years. Two other issues approached during the 1988 campaign were; -relevant warnings to Aboriginal Communities -the placement of new warning signs on beaches and coastal reserves.

This is a series of all the annual reports published by the Northern Territory Department of Health from 1990-2021. Note: 1991-1992 is currently only available in hard copy - please contact Darwin Health Library for access.

The Top Health Fair is a new initiative of the Health Promotion Unit. It addresses a wide variety of common tropical health and lifestyle issues and recognises there are unique issues in the Top End not otherwise dealt with in national or Territory campaigns. For this reason, the Health Promotion Unit began an intense period of consultations with some eighty health and allied professionals in August, 1989 to determine priorities for a tropical health and lifestyle campaign. As a result, the Top Health Fair concept was developed and the document "Top Health Fair" produced and circulated.

Submitted in accordance with the provision of Section 28 of the Public Sector Employment and Management Act and Section 12 of the Financial Management Act. The report summarises activities and outcomes during the year against the government’s framework for action, informs our stakeholders of progress, and future challenges, in improving the health of Territorians.

From November 1990 to June 1991 33 acute cases of melioidosis occurred in the Northern Territory, Australia; 25 cases were reported in the capital city, Darwin. We carried out an epidemiological investigation to exclude a common source outbreak, describe the risk factors for disease, and develop and institute appropriate control measures. We compared population based attack rates among various risk groups using logistic regression, and the demographic, medical and behavioral risk factors for melioidosis by a matched case-control study. Environmental Health Officers collected soil, surface water and cooling tower water specimens for Pseudomonas pseudomallei culture. The crude attack rate of melioidosis during the outbreak was 52 per 100,000. Age, gender, race, diabetes and alcohol abuse were independent risk factors for disease. The relative risk of disease in diabetic patients was 12.9 (95% CI 5.1-32.7; p < 0.001) and 6.7 in alcoholic patients (95% CI 2.9-15.2; p < 0.001). We found no significant difference between cases and controls in matched pair analysis for any of several exposure factors studied. We isolated Pseudomonas pseudomallei from 4% of soil samples and 9% of surface water samples. Our study confirms the importance of host factors in the development of melioidosis, and attempts to quantify the risk of disease during the Darwin epidemic. Pseudomonas pseudomallei is widespread in the soil of urban Darwin.

The Review of Birthing Services in the Northern Territory (the Review) was one of the initial projects funded by the Alternative Birthing Services Program in the NT. The project was commissioned by the Women's Advisory Council, administered by Territory Health Services and funded by the Commonwealth Department of Health and Family Services. Many individual women, community groups and health professionals shared their knowledge and experience and provided input into the review. The project was documented and the recommendations drafted by Cynthia Croft following consultations undertaken by Sue McKinnon. The Review sought to examine and make recommendations on: • the current practices of hospital and non hospital service providers; • models of service delivery; • the role and education of service providers; and • financial and legal issues related to birthing in the NT. The Review of Birthing Services was completed in 1992 and recommendations were forwarded for consideration to Territory Health Services (THS) from the Women's Advisory Council. THS Executive nominated members to a Review Working Party to consider the findings and make recommendations regarding the outcomes of the Review.

Submitted in accordance with the provision of Section 28 of the Public Sector Employment and Management Act and Section 12 of the Financial Management Act. The report summarises activities and outcomes during the year against the government’s framework for action, informs our stakeholders of progress, and future challenges, in improving the health of Territorians.

Submitted in accordance with the provision of Section 28 of the Public Sector Employment and Management Act and Section 12 of the Financial Management Act. The report summarises activities and outcomes during the year against the government’s framework for action, informs our stakeholders of progress, and future challenges, in improving the health of Territorians.

The focus of this conference is to formulate strategies for our key internal support services - feasible, quality strategies that will be reflected through Operational and Business plans over the next eighteen months to two years.

Submitted in accordance with the provision of Section 28 of the Public Sector Employment and Management Act and Section 12 of the Financial Management Act. The report summarises activities and outcomes during the year against the government’s framework for action, informs our stakeholders of progress, and future challenges, in improving the health of Territorians.

Submitted in accordance with the provision of Section 28 of the Public Sector Employment and Management Act and Section 12 of the Financial Management Act. The report summarises activities and outcomes during the year against the government’s framework for action, informs our stakeholders of progress, and future challenges, in improving the health of Territorians.

Submitted in accordance with the provision of Section 28 of the Public Sector Employment and Management Act and Section 12 of the Financial Management Act. The report summarises activities and outcomes during the year against the government’s framework for action, informs our stakeholders of progress, and future challenges, in improving the health of Territorians.

As part of the Commonwealth-State Disability Agreement (CSDA), the Commonwealth, State and Territory governments agreed to provide each other with information about disability programmes and consumers of disability services. This information is to be used for planning purposes, national programme evaluation and to monitor achievement of programme objectives and agreed priorities. Accordingly, a Minimum Data Set (MDS) has been developed by a Commonwealth-State committee with the assistance of the Australian Institute of Health and Welfare (AIHW).

This is the 6th Very Very Very Remote Allied Health Professional (VVV Remote AHP) Workshop to be held in the NT. This gathering of like minded AHPs working in remote Aboriginal communities provides a welcome chance to discuss issues of common concern and to hear from people with innovative ideas in the work area.