Letters

doi: 10.1111/1753-6405.12230

Author Response Simon Chapman School of Public Health, University of Sydney, New South Wales

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lves-Pereira and Castelo Branco describe themselves as “lead researchers in vibroacoustic disease” (VAD).1 As we showed,2 they are almost the only researchers who were ever active on this topic, with self-citation rates seldom seen in research. We fully agree with their understatement that “difficulty in recognising the significance of our scientific findings reported over the past three decades is entirely understandable”. Castelo Branco et al. appear to have a propensity for sweeping statements about VAD (“VAD is today a well-established and easily diagnosed entity.”)3 and that its association with wind farms is “irrefutably demonstrated”.2 But we are not the first to question their scientific facts. In a review, Leventhall writes: “The evidence which has been offered [by them] is so weak that a prudent researcher would not have made it public”;4 von Gierke that: “‘vibroacoustic disease’ remains an unproven theory belonging to a small group of authors and has not found acceptance in the medical literature”;5 and the UK’s Health Protection Agency: the “disease itself has not gained clinical recognition”.6 Castelo Branco has been candid about his goal in promoting this non-disease: “we have an on-going commitment to establish VAD as an occupational disease, reimbursable by worker’s compensation.”3 However, researchers in military and aviation medicine research have found no evidence for the symptoms of vibroacoustic disease among aircraft ground crews7 and helicopter crews.8,9 In one of these reports,9 helicopter pilots and office worker controls were CT scanned. The blinded results were assessed by radiologists who found no significant differences for any anatomical location between the pilots and the controls. They noted that these were comparable to those various other studies of reference populations and that the Portuguese group had provided no reference population data on which to base their claims for abnormal pericardial thickness. Jet engine ground crew and helicopter pilots are subject to massively greater sound than anyone living near a wind farm, so the suggestion that low frequency wind turbine

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Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia

2014 vol. 38 no. 2

Letters

sound might have comparable effects is more than implausible when these heavily noiseexposed occupational groups show none of the claimed adverse effects. The 10-year-old boy in Portugal said to have wind-turbine-caused pericardial thickening, claimed to be the principal indicator of VAD, had a lifetime history of poor health of unknown cause. Pericardial thickening has a variety of known causes as well sometimes having an idiopathic aetiology.10 Yet AlvesPereira and Castelo Branco assume the boy must have acquired his problems through wind turbine noise exposure, and for no other reason, despite people living in cities being surrounded by often much higher levels of noise and vibration. We described the VAD group’s method of investigation of this case and its comparison with another as being methodologically abject, listing eight elementary problems. Their response aimed to address two of these: acknowledging that different noise monitoring instruments and procedures were used to measure the two cases, and arguing that the severity of the boy’s health problems made them incomparable to normal school inattention. The other six problems were unaddressed. Leventhall4 concludes his review thus: “One is left with a very uncomfortable feeling that the work of the VAD group, as related to the effects of low levels of infrasound and low frequency noise exposure, is on an extremely shaky basis and not yet ready for dissemination. The work has been severely criticised when it has been presented at conferences. It is not backed by peer reviewed publications and is available only as conference papers which have not been independently evaluated prior to presentation.” Meanwhile, wind farm opponents continue to highlight this n=1 “irrefutably proved” association as credible.

References 1. Alves-Pereira M, Castelo Branco NA. Letter to the Editor: “How the factoid of wind turbines causing ‘vibroacoustic disease’ came to be ‘irrefutably demonstrated’” Aust NZ J Public Health 2014; 38:191-2 2. Chapman S, St George A. How the factoid of wind turbines causing “vibroacoustic disease” came to be “irrefutably demonstrated”. Aust NZ J Public Health 2013; 33:244-9. 3. Castello Branco NA. A unique case of vibroacoustic disease: a tribute to an extraordinary patient. Aviat Space Environ Med. 1999;70(3 Pt 2):A27-31.

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4. Leventhall G. Vibroacoustic disease (VAD) and wind turbines. Critique by Geoff Leventhall. Exhibit 20. Public Service Commission of Wisconsin PSC Ref#:121879 20 Oct 2009. [cited 2014 Mar 3]. Available from: http:// tobacco.health.usyd.edu.au/assets/pdfs/publications/ Leventhallreview-VAD.PDF 5. von Gierke HE. “Vibroacoustic Disease”. Aviat Space Env Med. 2002; 73, 828. 6. Health Protection Agency. Health Effects of Exposure to Ultrasound and Infrasound [Internet]. Report of the Independent Advisory Group on Non-ionising Radiation. London (UK): Public Health England; 2010. [cited 2014 Mar 3]. Available from: http://www.hpa.org. uk/web/HPAwebFile/HPAweb_C/1265028759369 7. Jensen A, Lund SP, Lucke TH, Clause OV, Svendsen JT. Non-auditory health effects among air force crew chiefs exposed to high level sound. Noise & Health .2009;11(44):176-181. 8. Kåsin JI, Kjekshus J, Aukrust P, Mollnes TE, Wagstaff A. A helicopter flight does not induce significant changes in systemic biomarker profiles. Scand J Clin & Lab Invest .2009;69(4)462–474. 9. Kåsin JI, Kjellevand TO, Kjekshus J, Nesheim GB, Wagstaff A. CT Examination of the pericardium and lungs in helicopter pilots exposed to vibration and noise. Aviat Space Environ Med. 2012;83(9):858-64 10. Roberts WC. Pericardial heart disease: its morphologic features and its causes. Proc Bayl Univ Med Center 2005; 18(1):38–55.

Correspondence to: Professor Simon Chapman, School of Public Health, University of Sydney, New South Wales 2006; e-mail: [email protected]

doi: 10.1111/1753-6405.12182

Trial of mailed specimen collection for HIV testing in regional Queensland William Rutkin, Joseph Debattista, Patrick Martin, John Hooper Sexual Health & HIV Service, Queensland

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arly detection of HIV is an important prevention strategy, enabling timely interventions that facilitate behaviour modification and access to treatment.1-3 Encouraging testing among populations that are at high risk of acquiring or transmitting HIV, e.g. men who have sex with men (MSM) is a key strategy and studies suggest that options for non-invasive and convenient testing will encourage greater uptake.4-6 We would like to report on a study that sought to provide confidential, accessible HIV testing to MSM across the rural areas of south west Queensland, Australia by utilizing a postal kit for non invasive oral fluid collection incorporating the OraSure oral fluid collection swab (OraSure Technologies, Beaverton, Oregon USA). Though HIV notification rates among rural MSM have not been reported as higher than their urban counterparts in Queensland, less geographic proximity to HIV testing, health promotion resources, and gay social networks, small communities and perceptions of greater marginalisation for those disclosing MSM behaviour, may contribute to a greater reluctance or inability to test by rural MSM.7-9 We undertook this study to assess the usefulness of a postal HIV testing service within this context. Attempts to recruit participants were made through: • key informants within the gay community engaged as peer recruiters outreaching through selected venues • key informants invited to transmit messages by sms, twitter or email to their network of sexual contacts, inviting their participation in the study • web sites utilised by men in the local area for establishing sexual contacts • gay and local newspaper advertising and posters displayed in community venues and places where public sexual contact may occur (beats). An outreach worker employed by a gay men’s peer organisation, Queensland Association for Healthy Communities (QAHC,) was enlisted to conduct on-line, venue and beat outreach. Persons contacted were offered the opportunity for HIV testing in their homes or discrete community settings. Collection kits

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