Dr Antigone Kouris-Blazos

Qualifications

Bachelor of Science (double major, Biochemistry & Microbiology), Melbourne University (1984)
Honours degree (Research on Diabetic Diet), Deakin University, 1985, supervisor Prof Mark Wahlqvist
Post Graduate Diploma of Dietetics, Deakin University, 1986
PhD (Public Health Nutrition), Faculty of Medicine, Monash Uni, 1993, supervisor Prof Mark Wahlqvist
APD Accredited Practising Dietitian 1987-

Currrent Positions

2003 - 2006 Managing editor, Asia Pacific Journal of Clinical Nutrition (on medline)
Managing editor and publisher of an established (since 1992) and reputable Medical Journal "Asia Pacific Journal of Clinical Nutrition" indexed on Medline and available as hard copy and on-line (www.healthyeatingclub.org/APJCN/
chief editor, Professor Mark Wahlqvist). During her involvement with the jounral, she helped double the impact factor of the journal from 0.48 (2003) to 1.01 (2005).

2002 - 2006 Honorary Research Fellow, Asia Pacific Health&Nutrition Centre, Monash Asia Institute
Supervised 4 PhD students (see below)

2001-2006 Managing editor, nutrition website www.healthyeatingclub.org (editor-in-chief, Prof Wahlqvist)
Managing editor of a nutrition website for the general public and health professionals (www.healthyeatingclub.org) owned by a medical nutritionist, Professor Mark Wahlqvist. The website is widely used, especially by students, media and health professionals. In 2002 the website had around 5,000 visitors per week and 1000 newsletter subscribers. In 2006 it has has over 20,000 visitors per week and over 9000 newsletter subscribers

2005 - Clinical Nutritionist, 3 Melbourne medical clinics, working with Enhanced Primary Care Program
(paid by Medicare), in Oakleigh and Clayton.

2003- Food product development - involved in the development of a nutritious biscuit (Dr Soo's most nutritious biscuits) with HEC Foods and Healthy Eating Club P/L. Involved is all aspects of development - ingredients, recipe/taste, packaging, nutrition information panel, marketing.

Past Positions

Academic
1999-2001, Deputy-Director of the International Health and Development unit and Lecturer in Nutrition, Faculty of Medicine, Monash University.
1995-2001, Lecturer and Nutrition Course Coordinator, 2nd & 4th year Medical students at Monash University; the Nutrition course was reformatted and delivered via the internet 2000/2001.
2001-2005 Nutrition course development for Mede-Serv/Primed (provision of on-line continuing education courses to General Medical Practitioners)
1987-1994, Assistant Lecturer, Faculty of Medicine, Monash University

Research and Post Graduate Supervision
1999-2000, Director of the Healthy Eating Healthy Living Program and Managing editor of Healthy Eating Information Web-Centre (funded by the Victorian Health Promotion Foundation from 1998-2000).
1987 to 2001, Research dietitian and Coordinator of an international mortality follow-up study "Food Habits in Later Life" of 2,000 elderly in Australia, Greece, Sweden, Japan. The main objectives were to document the food habits of elderly people from disparate cultures and to identify dietary and lifestyle predictors of survival. As part of the study, she also studied the food habits and health of 50 elderly Aboriginal Australians in the Kimberleys, Western Australia and 400 elderly Greek-born and Anglo-Celtic Australians and Greeks in a traditional village in Greece which formed the basis for her PhD.
1987-1993, Completed a PhD in 1993 from the Faculty of Medicine at Monash University, under the supervision of Professor Mark Wahlqvist. The PhD investigated dietary contributors to the low mortality, but paradoxically high morbidity rates of elderly Greek-born Australians. Findings were published in British Medical Journal 1995, American Journal Clinical Nutrition 1995, Age & Ageing 1996, Australian Journal Nutrition & Dietetics 1999.

The findings of the research turned nutrition science on its head. It showed, for the first time, that the Mediterranean (Greek) diet promotes longevity not only in elderly Greeks but also in elderly non-Greeks. The results were published in the British Medical Journal, British Journal of Nutrition, newspapers around the world and even mentioned on Greek National TV news. The paradoxical findings, however, were that elderly Greeks in Melbourne lived longer than the slimmer and fitter Anglo-Celts in Melbourne, Swedes in Sweden, Japanese in Japan and Greeks in Greece. The elderly Greek Australians lived longer (having 30% lower death rates from heart disease and cancer) despite being fatter, less fit and having a higher prevalence of common disorders like diabetes, hypertension and heart disease. They also had the least wrinkly skin of all the cohorts we studied (which was attributed statistically to their plant and olive oil rich diet). Further studies by PhD students that have been supervised by Dr Kouris have shown that Greek migrants gained weight and ate unhealthily (too much fatty meat, butter, sweets) in the first 15-20 years in Australia. In old age, however, they return to their traditional antioxidant-rich Greek diet which helped to reduce the risks associated with being overweight, having diabetes and high cholesterol (levels of cardio-protective and cancer protective antioxidants in the blood have been found to be higher in Greeks than in Anglo-Celts).

PhD supervision
1997-2001 Dr Martalena Purba: "Cross-cultural comparisons of nutrition and ageing in Indonesia and
other communities"
1997-2001 Dr Irene Darmadi "Long-lived elderly populations: food habits, health and lifestyle
predictors of survival"
2001-2005 Dr Azizah Omar - Development and Evaluation of an on-line wellness program (www.healthyeatingclub.org)
2005-2006 Dr Verena Raschke - Development of an on-line data base on African Food Habits (www.healthyeatingclub.org)

Hospital and Private Practice Dietitian
1987 Hospital Dietitian, Moorabbin and Frankston Hospital
1988-2000 worked privately as an Accredited Practising Dietitian (APD) at several Doctors' surgeries around Melbourne e.g Dr Drakopoulos, Dr Piterman, Dr Gingold, Dr Perkoulides, Dr Paxemanidis, Dr Lolatgis/ Dr Malios (free dietetic service as part of the federally funded demonstration grant for general practitioners)
2000-2005 worked privately as an Accredited Practising Dietitian from home
2005 - Clinical Nutritionist, 3 Melbourne clinics, working with Enhanced Primary Care Program
(paid by Medicare), in Oakleigh and Clayton.

Publications

Summary
Over 30 papers in peer-reviewed journals (25 articles appeared in Australian/ US/European newspapers as a result of study findings)
7 consultancy reports for Australian/Victorian Government on diet-related disorders, healthy eating program interventions for prevention of obesity, healthy eating programs for schools, food and nutrient intakes of food insecure/socially disadvantaged groups
2 consultancy reports for World Health Organisation on food based dietary guidelines
12 chapters for 2 editions of a leading Australian Nutrition text book "Food & Nutrition" (1997, 2002 editions)
chapter for a leading British textbook (Nutrition & Metabolism, ed. Gibney), 2001
chapters for 3 Encyclopedias, including encyclopedia of Human Nutrition (1998) and encyclopedia of Life support systems (1999)

Refereed Journals

Wahlqvist ML, Darmadi-Blackberry I, Kouris-Blazos A, Jolley D, Steen B, Lukito W, Horie Y. Does diet matter for survival in long-lived cultures? Asia Pacific Journal of Clinical Nutrition 2005; 14(1):2-6.

Darmadi-Blackberry I, Wahlqvist ML, Kouis-Blazos A, Steen B, Lukito W, Horie Y, Horie K. Legumes: the most important dietary predictor of survival in older people of different ethnicities. Asia Pacific Journal of Clinical Nutrition 2004; 13(2):217-220.

Wood B, Kouris-Blazos A. The 1995 national nutrition survey - date for persons 16 years and over, by socio-economic index of disadvantage for areas (SEIFA). Asia Pac J Clin Nutr 2002; 11 (Supp): S231-S322.

Wahlqvist M, Kouris-Blazos A. Nutrition - is diet enough? Complementary Medicine 2002; 1(3): 46-48.

Kouris-Blazos A. Morbidity Mortality paradox of 1st generation Greek Australians. Asia Pac J Clin Nutr 2002: 11 (suppl): S569-S575. Dowmloadable pdf

Wahlqvist ML, Setter TL, Savige GS, Kouris-Blazos A. Role of Physical Activity in Ensuring Nutritional Well-being in the elderly. World Rev Nutr Diet, 2001.

Kouris-Blazos A, Setter TL, Wahlqvist ML. Nutrition and Health Informatics. Nutrition Research 2001; 21: 269-278.

Purba M, Kouris-Blazos A, Wattanapenpaiboon N, Lukito W, Rothenberg E, Steen B, Wahlqvist ML . Can skin wrinkling in a limited sun exposed site be used as a marker of health status and biological age in the elderly ? Age Ageing, 2001; May 30 (3): 227-234.

Purba M, Kouris-Blazos A, Wattanapenpaiboon N, Lukito W, Rothenberg E, Steen B, Wahlqvist ML. Skin Wrinkling: Can food make a difference. Am Coll Nutr, 2001: 20 (1); 71-80 on-line abstract and for citation and International health reuter.

Wahlqvist ML, Kouris-Blazos A, Darmadi I, Purba M. Nutrition and the elderly a global perspective. South African J Clin Nutr 2000; Feb Vol. 13 (1); on-line full text article

Darmadi I, Horie Y, Wahlqvist ML, Kouris-Blazos A, Horie K, Sugase K & Wattanapenpaiboon N. Food and nutrition intakes and overall survival of elderly Japanese. Asia Pacific Journal of Clinical Nutrition 2000; 9: 7-11.

Kouris-Blazos A & Wahlqvist ML. Indigenous Australian food culture on cattle stations prior to the 1960s and Food Intake of Older Aborigines in a community studied in 1988. Asia Pacific Journal of Clinical Nutrition 2000; 9(3): 224-231.

Wahlqvist ML, Kouris-Blazos A, Darmadi I & Purba M. Nutrition and the elderly: a global perspective. South African Journal of Clinical Nutrition 2000: 13 (1) Suppl: S28-S31.

Wahlqvist ML & Kouris-Blazos A. International Union of Nutritional Sciences Committee II/4 on Nutrition and Ageing: Food Habits in Later Life (FHILL) Program. Asia Pacific Journal of Clinical Nutrition 1999; 8(4): 282-284.

Horwath C, Kouris-Blazos A, Savige GS, Wahlqvist ML. Eating your way to a successful old age, with special reference to older women. Asia Pacific Journal of Clinical Nutrition. 1999; 8(3): 216-225. Part 1, Part 2

Purba M, Lukito W, Wahlqvist ML, Kouris-Blazos A, Hadisaputro S, Lestiani L, Wattanapenpaiboon N, Kamso S. Food intake and eating patterns of Indonesian elderly before the economic crisis in 1998. Asia Pacific Journal of Clinical Nutrition 1999; 8(3): 200-206.

Kouris-Blazos A, Gnardellis C, Wahlqvist ML, Trichopoulos D, Lukito W, Trichopoulou A. Are the advantages of the Mediterranean diet transferable to other populations? A cohort study in Melbourne, Australia. British Journal Nutrition 1999; 82: 57-61; online abstract

Wahlqvist ML, Kouris-Blazos A & Wattanapenpaiboon N. The significance of eating patterns: an elderly Greek case study. Appetite 1999; 32: 23-32.

Kouris-Blazos A, Wahlqvist ML, Wattanapenpaiboon N. Morbidity mortality paradox of elderly Greek Australians: possible dietary contributors. Australian Journal of Nutrition and Dietetics. 1999; 56: 97-107. Part 1, Part 2

Wahlqvist ML & Kouris-Blazos A. Food-based Dietary Guidelines (FBGDs): Traditional cuisines, modern foods and the environment. The Indian Journal of Nutrition and Dietetics.1999; 36 (9): 398-404.

Kouris-Blazos A & Wahlqvist ML. The traditional Greek food pattern and overall survival in elderly people. Australian Journal of Nutrition and Dietetics 1998; 55(4 Suppl): S20-S23.

Wahlqvist ML, Wattanapenpaiboon N, Kannar D, Dalais F & Kouris-Blazos A. Phytochemical deficiency disorders: Inadequate intake of protective foods. Current Therapeutics 1998; July: 53-60.

Wahlqvist ML, Kouris-Blazos A & Hsu-Hage BH-H. Ageing, food culture and health. Asian J Trop Med Pub Health 1997; 28 (Supplement 2): 100-112.

Kouris-Blazos A, Wahlqvist ML, Trichopoulou A, Polychronopoulos E & Trichopoulos D. Health and nutritional status of elderly Greek migrants to Melbourne, Australia. Journal Age and Aging 1996; 25: 177-189. Part 1, Part 2

Trichopoulou A, Kouris-Blazos A, Vassilakou T, Gnardellis Ch, Polychronopoulos E, Venizelos M, Lagiou P, Wahlqvist ML & Trichopoulos D. The diet and survival of elderly Greeks: A link to the past. Am J Clin Nutr 1995; 61 (6S): 1346-1350; on-line abstract

Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis Ch, Lagiou P, Polychronopoulos E, Vassilakou T, Lipworth L, & Trichopoulos D. Diet and overall survival in elderly people. British Medical Journal 1995; 311 (7018): 1457-1460 (on-line full text article)

Wahlqvist ML, Hsu-Hage BH-H, Kouris-Blazos A, Lukito W & IUNS Study Centre Investigators. Food habits in later life: an overview of key findings. Asia Pacific Journal of Clinical Nutrition 1995; 4(2): 233-243. Part 1, 2 , 3, 4 , 5 , 6 , 7

Lukito W, Hutchinson PE, Wahlqvist ML, Boyce NW, Hsu-Hage BH-H, Strauss BJG, Kouris-Blazos A & Bainbridge R. Body composition and lymphocyte subsets in an Anglo-Celtic elderly population. Asia Pacific Journal of Clinical Nutrition 1995; 4(1):69-72.

Wahlqvist ML, Hsu-Hage B, Kouris-Blazos A, Lukito W. Food Habits in Later Life: A Cross-Cultural Study. Preliminary Results from communities in Australia, Greece, China & Sweden. Age & Nutrition 1992; 3: 151-154.

Wahlqvist ML, Kouris-Blazos A, Trichopoulos A, Polychronopoulos E. The wisdom of the Greek cuisine and way of life. Comparison of the food and health beliefs of elderly Greeks in Greece and Australia. Age and Nutrition 1991; 2(3):163-173.

Kouris A, Wahlqvist ML, Trichopoulos A & Polychronopoulos E. Use of combined methodologies in assessing food beliefs and habits of elderly Greeks and in Greece. Food and Nutrition Bulletin 1991; 13(2):139-144.

Wahlqvist ML, Kouris A, Gracey M & Sullivan H. An anthropological approach to the study of food and health in an indigenous population. Food and Nutrition Bulletin 1991; 13(2):145-149.

Wahlqvist ML & Kouris A. Trans-Cultural Aspects of Nutrition in Old Age. Age Ageing 1990; 19 (supp): 43-52.

Kouris A, Wahlqvist ML & Worsley A. Characteristics that enhance adherence to high carbohydrate/high fibre diets by persons with diabetes. J Amer Diet Assoc 1988; 88 (11): 1422-25; on-line abstract

Books

Wahlqvist ML, Kouris-Blazos A, Crotty P, Worsley T, Harvey P, Tieru H, Cavalli-Sforza LT. Development of Food-Based Dietary Guidelines for the Western Pacific Region. World Health Organisation, Regional Office for the Western Pacific, Manila, 1999
Short on-line article or publication on WHO website

Wahlqvist ML, Kouris-Blazos A, Savige G. Food-based Dietary Guidelines for Older Adults. In: Ageing and Nutrition: a growing global challenge. A Joint WHO/Tufts University Consultation, Boston, USA 26-29 May 1998; 2002. http://www.who.int/nut/age.htm

Wahlqvist ML (ed). Food & Nutrition: Australasia, Asia and the Pacific. Allen & Unwin, 1997. Dr Kouris-Blazos provided editorial and technical assistance. Nominated 1 of 4 Australian "Academic books of the Year" in 1997.

Wahlqvist ML, Hsu-Hage BH-H, Kouris-Blazos A, Lukito W, eds. Food Habits in Later Life: A Cross-Cultural Study. Melbourne: Asia Pac J Clin Nut & United Nations University Press, 1995 (CD Rom) .

Kouris-Blazos A. Elderly Greeks in Spata, Greece and Melbourne, Australia: Food Habits, Health and Lifestyle. PhD thesis. Monash University, Melbourne, Australia, 1994.

Chapters in Books & Text Books

Wahlqvist ML, Ross K, Setter T, Tienboon T, Kouris-Blazos A. Growth and Ageing. In: Nutrition and Metabolism. Ed M.Gibney. British Nutrition Society. Chapter 9. (in press).

Kouris-Blazos A. Dietary Advice & Food Guidance Systems. In: ML Wahlqvist (ed). Food & Nutrition: Australia & New Zealand. 2nd edition. Allen & Unwin, Sydney: 2002.

Kouris-Blazos A. Evaluating the reliability of Nutrition Information. In: ML Wahlqvist (ed). Food & Nutrition: Australia & New Zealand. 2nd edition. Allen & Unwin, Sydney: 2002.

Read R, Kouris-Blazos A. Nutrition for activity, sport and survival. In: ML Wahlqvist (ed). Food & Nutrition: Australia & New Zealand. 2nd edition. Allen & Unwin, Sydney: 2002.

Read R, Kouris-Blazos A. Overweight, obesity and eating disorders. In: ML Wahlqvist (ed). Food & Nutrition: Australia & New Zealand. 2nd edition. Allen & Unwin, Sydney: 2002.

Wahlqvist ML, Kouris-Blazos A, Requirements in maturity and ageing. In: ML Wahlqvist (ed). Food & Nutrition: Australia & New Zealand. 2nd edition. Allen & Unwin, Sydney: 2002

Wahlqvist ML, Kouris-Blazos A, Nutrition and Cancer. In: ML Wahlqvist (ed). Food & Nutrition: Australia & New Zealand. 2nd edition. Allen & Unwin, Sydney: 2002.

Wahlqvist ML, Kouris-Blazos A, Genetic individuality, diet and disease. In: ML Wahlqvist (ed). Food & Nutrition: Australia & New Zealand. 2nd edition. Allen & Unwin, Sydney: 2002.

Wahlqvist ML, Kouris-Blazos A, Immune function, infection and diseases of affluence. In: ML Wahlqvist (ed). Food & Nutrition: Australia & New Zealand. 2nd edition. Allen & Unwin, Sydney: 2002.

Wahlqvist ML, Kouris-Blazos A, Food and Nutrition Policies in the Asia Pacific region: Nutrition in transition. In: ML Wahlqvist (ed). Food & Nutrition: Australia & New Zealand. 2nd edition. Allen & Unwin, Sydney: 2002.

Wahlqvist ML, Kouris-Blazos A, Ross K, Setter T, Tienboon T. Growth and Ageing. In: Nutrition and Metabolism. Ed M.Gibney. British Nutrition Society. Chapter 9, Oxford, 2002.

Wahlqvist ML, Kouris-Blazos A, Savige G . Food Security and the Aged in Development: Its Governance. In: Not by Bread Alone. Food Security and Governance in Africa. Editors A. Ogunrinade, R Oniango, J May. Toda Institute for Global Peace and Policy Research. Witwatersrand University Press. 1999. On-line Chapter.

Wahlqvist ML, Kouris-Blazos A. Dietary Advice & Food Guidance Systems. In ML Wahlqvist (ed). Food & Nutrition: Australasia, Asia and the Pacific. Allen & Unwin, Sydney: 1997.

Read R, Kouris-Blazos A. Overweight & Obesity. In ML Wahlqvist (ed). Food & Nutrition: Australasia, Asia and the Pacific. Allen & Unwin, Sydney: 1997.

Read R, Kouris-Blazos A. Food, Physical Activity & Exercise. In ML Wahlqvist (ed). Food & Nutrition: Australasia, Asia and the Pacific. Allen & Unwin, Sydney: 1997.

Kouris-Blazos A. Overview of Protocol. In: Cross-cultural study of food habits and health status in later life: Description of elderly communities and lessons learnt. Ed M. Wahlqvist, B Hsu-Hage, A Kouris-Blazos, W Lukito & IUNS Study Centre Investigators. United Nations University Press & Asia Pacific Journal of Clinical Nutrition, Melbourne, 1995.

Lukito W and Kouris-Blazos A. Food Beliefs. In: Cross-cultural study of food habits and health status in later life: Description of elderly communities and lessons learnt. Eds M. Wahlqvist, B Hsu-Hage, A Kouris-Blazos, W Lukito & IUNS Study Centre Investigators. United Nations University Press & Asia Pacific Journal of Clinical Nutrition, Melbourne, 1995.

Kouris-Blazos A, Hsu-Hage B. Predicting later life status from food habits in communities of elderly Greeks. In: Cross-cultural study of food habits and health status in later life: Description of elderly communities and lessons learnt. Eds M. Wahlqvist, B Hsu-Hage, A Kouris-Blazos, W Lukito & IUNS Study Centre Investigators. United Nations University Press & Asia Pacific Journal of Clinical Nutrition, Melb, 1995.

Scrimshaw N, Kouris-Blazos A, Taub B, Wahlqvist ML, Davies L. Rapid Assessment Procedures for use in the elderly. In: Cross-cultural study of food habits and health status in later life: Description of elderly communities and lessons learnt. Eds M. Wahlqvist, B Hsu-Hage, A Kouris-Blazos, W Lukito & IUNS Study Centre Investigators. United Nations University Press & Asia Pacific Journal of Clinical Nutrition, Melbourne, 1995.

Wahlqvist ML, Kouris-Blazos A, Lukito W, Hsu-Hage B. Water soluble vitamin intakes in the elderly: Cross-cultural findings in the IUNS study. In: Nutritional Assessment of Elderly Populations: Measure and Function. Ed IH Rosenberg. Raven Press, New York, 1994: 225-233.

Chapters in Encyclopedias

Wahlqvist ML, Dalais F, Kouris-Blazos, Savige G, Semenova G, Wattanapenpaiboon N. Nutrition and Human Life Stages.. Encyclopedia of Life Support Systems, EOLSS Publishers Co, Oxford, UK, 2001.

Wahlqvist ML, Kouris-Blazos A, Savige G. Older people - Physiological changes. In: Encyclopedia of Human Nutrition: 1998.

Wahlqvist ML, Kouris-Blazos A. Olive oil - Nutrition and Biological value. In: World Encyclopedia of the Olive. International Olive Oil council, Madrid, 1996, pp 349-354.

Consultancy Papers/Reports

Wood B, Wattanapenpaiboon N, Ross, K, Kouris-Blazos A. 1995 National Nutrition Survey: All persons 16 years of age and over and all persons 16 years of age and over, by food security. Healthy Eating Healthy Living Program, Monash University, Victoria 2000.

Wood B, Wattanapenpaiboon N, Ross, K, Kouris-Blazos A. 1995 National Nutrition Survey: All persons 16 years of age and over and all persons 16 years of age and over, by SEIFA (index of relative socio-economic disadvantage for area). Healthy Eating Healthy Living Program, Monash University, Victoria 2000.

Wood B, Wattanapenpaiboon T, Ross, K, Kouris-Blazos A. 1995 National Nutrition Survey. Data for persons 16 years of age and over grouped by index of socio-economic disadvantage for area. The SEIFA report. Coles-Rutishauser IHE (ed). Melbourne, Monash University: Healthy Eating Healthy Living Program; 2000.

Wood B, Wattanapenpaiboon T, Ross, K, Kouris-Blazos A. 1995 National Nutrition Survey. Data for persons 16 years of age and over grouped by socio-economic disadvantaged area. Executive Summary for the SEIFA Report. Coles-Rutishauser IHE (ed). Melbourne, Monash University: Healthy Eating Healthy Living Program; 2000.

Wood B, Wattanapenpaiboon N, Ross, K, Kouris-Blazos A. 1995 National Nutrition Survey: All persons 16 years of age and over and all persons 16 years of age and over, by equivalent income (EQI). Healthy Eating Healthy Living Program, Monash University, Victoria 2000.

Wood B, Ross K, Kouris-Blazos A. Healthy Eating for Nutritionally Vulnerable Groups. Some Health Promotion Initiatives. Healthy Eating Healthy Living Program, Monash University, Victoria 2000.

Setter T, Kouris-Blazos A, Wahlqvist M. School-based Healthy Eating Initiatives: Recommendations for Success. Healthy Eating Healthy Living Program, Monash University, Victoria 2000.

Setter T, Gill T, Kouris-Blazos A, Wahlqvist M. Healthy weight and physical activity interventions in Victoria: the current situation, and recommendations for the future. Healthy Eating Healthy Living Program, Monash University (Victoria) and International Obesity Taskforce (NSW), 2000.

Wahlqvist ML, Kouris-Blazos A. Diet related disorders - state of play. Food and Nutrition Policy, Department of Community Services and Health, Canberra, Australia, 1991.