Regular use of sunscreens prevents the development of solar keratoses and, by implication, possibly reduces the risk of skin cancer in the long-term.

Many patients with chronic hepatitis C virus (HCV) infection report disabling fatigue and a reduced sense of well-being. Scores on quality of life (QOL) scales, such as the Sickness Impact Profile or the Short Form 36 (SF-36) scale, have been reported as significantly worse for patients with HCV than for healthy controls. 1-3 These studies could not, however, determine the impact of HCV diagnosis per se on QOL because all patients were aware of their diagnosis at the time of completion of the QOL scales. A recent editorial in HEPATOLOGY highlighted the question of whether subjective health perceptions are influenced by diagnosis with HCV. 4 This study reports the impact of diagnosis of HCV on QOL. We report here QOL scores of a group of patients with long-standing HCV infection, only approximately half of whom were aware that they were HCV seropositive at the time the QOL scores were measured. To investigate the impact of HCV diagnosis on QOL, we compared the scores between those aware of their serostatus and those not aware. PATIENTS AND METHODSThis study is part of a retrospective cohort study investigating the natural history of chronic HCV infection by following up all persons admitted to Fairfield Infectious Diseases Hospital in Melbourne, Australia, who had a clinical and biochemical diagnosis of acute viral hepatitis between 1971 and 1975 and on whom stored frozen sera from that time were available.Stored serum of 238 patients was strongly reactive for antibody to HCV (anti-HCV). Follow-up methods were systematically applied to locate cohort members; these included searches of death registers, electoral rolls, telephone directories, and contact with next-of-kin. By late 1998, 97 (41%) had been located and recruited into the study. Subjects were told at the time of recruitment that the study was looking at the outcome of hepatitis infection in patients who had been admitted to hospital with hepatitis 25 years ago. Health outcomes in subjects were then assessed by a studyspecific questionnaire, clinical examination, repeat serology, virology, and liver function tests using standardized proformas to record results. As well, all subjects completed the SF-36 scale, a generic and widely used QOL instrument, which has been adapted for use in Australia.5 Once all study results were obtained, the process of imparting the diagnosis of chronic HCV infection (to those unaware of serostatus) and the fact that blood had been taken at the time of original admission (in the early 1970s) and tested as part of this study for anti-HCV was commenced. In this way, patients who were unaware of their anti-HCV status at the time of recruitment completed all parts of the study, including the SF-36 questionnaire, without this knowledge. This approach was taken partly to assess the impact of knowledge of HCV diagnosis on QOL and also to obtain current anti-HCV status, HCV polymerase chain reaction (PCR) results, and liver function test results to allow appropriate counseling as to current health status, degree of infectivity, and l...

With availability of antiretroviral treatments, HIV is increasingly recognised as a chronic disease people live with for many years. This paper critically reviews the current literature on fertility desires and reproductive intentions among people living with HIV/AIDS (PLHIV) and critiques the theoretical frameworks and methodologies used. A systematic review was conducted using electronic databases: ISI Web of Knowledge, Science Direct, Proquest, Jstor and CINAHL for articles published between 1990 and 2008. The search terms used were fertility desire, pregnancy, HIV, reproductive decision making, reproductive intentions, motherhood, fatherhood and parenthood. Twenty-nine studies were reviewed. Fertility desires were influenced by a myriad of demographic, health, stigma-associated and psychosocial factors. Cultural factors were also important, particularly in Sub-Saharan Africa and Asia. Future research that examines fertility desires among PLHIV should include cultural beliefs and practices in the theoretical framework in order to provide a holistic understanding and to enable development of services that meet the reproductive needs of PLHIV.

Background: Despite a lower overall incidence, Aboriginal Australians experience poorer outcomes from cancer compared with the non-Aboriginal population as manifested by higher mortality and lower 5-year survival rates. Lower participation in screening, later diagnosis of cancer, poor continuity of care, and poorer compliance with treatment are known factors contributing to this poor outcome. Nevertheless, many deficits remain in understanding the underlying reasons, with the recommendation of further exploration of Aboriginal beliefs and perceptions of cancer to help understand their care-seeking behavior. This could assist with planning and delivery of more effective interventions and better services for the Aboriginal population. This research explored Western Australian (WA) Aboriginal peoples' perceptions, beliefs and understanding of cancer.

Background Indigenous peoples have worse health than non-Indigenous, are over-represented amongst the poor and disadvantaged, have lower life expectancies, and success in improving disparities is limited. To address this, research usually focuses on disadvantaged and marginalised groups, offering only partial understanding of influences underpinning slow progress. Critical analysis is also required of those with the power to perpetuate or improve health inequities. In this paper, using Australia as a case example, we explore the effects of ‘White’, Anglo-Australian cultural dominance in health service delivery to Indigenous Australians. We address the issue using race as an organising principle, underpinned by relations of power. Methods Interviews with non-Indigenous medical practitioners in Western Australia with extensive experience in Indigenous health encouraged reflection and articulation of their insights into factors promoting or impeding quality health care to Indigenous Australians. Interviews were audio-taped and transcribed. An inductive, exploratory analysis identified key themes that were reviewed and interrogated in light of existing literature on health care to Indigenous people, race and disadvantage. The researchers’ past experience, knowledge and understanding of health care and Indigenous health assisted with data interpretation. Informal discussions were also held with colleagues working professionally in Indigenous policy, practice and community settings. Results Racism emerged as a key issue, leading us to more deeply interrogate the role ‘Whiteness’ plays in Indigenous health care. While Whiteness can refer to skin colour, it also represents a racialized social structure where Indigenous knowledge, beliefs and values are subjugated to the dominant western biomedical model in policy and practice. Racism towards Indigenous patients in health services was institutional and interpersonal. Internalised racism was manifest when Indigenous patients incorporated racist attitudes and beliefs into their lived experience, lowering expectations and their sense of self-worth. Conclusions Current health policies and practices favour standardised care where the voice of those who are marginalised is often absent. Examining the effectiveness of such models in reducing health disparities requires health providers to critically reflect on whether policies and practices promote or compromise Indigenous health and wellbeing - an important step in changing the discourse that places Indigenous people at the centre of the problem.

To improve cancer outcomes for Aboriginal people, logistical, infrastructure and cultural safety issues must be addressed. One way of ensuring this could be by dedicated support to better coordinate cancer diagnostic and treatment services with primary healthcare services.

Psychiatric outpatients have a high prevalence of cardiovascular risk factors which may account for the higher rate of cardiovascular mortality among the mentally ill. Further research is needed to trial and evaluate interventions to effectively modify risk factors in this vulnerable population.

Model-based estimates were broadly consistent with other sources of information on the HCV epidemic in Australia. These models suggest that the prevalence of HCV-related cirrhosis and the incidence of HCV-related liver failure and HCC will more than triple in Australia by 2020.