P Zimmet

Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia

Are you P Zimmet?

Claim your profile

Publications (341)2040.36 Total impact

  • J.B. Dixon · P. Zimmet · K.G. Alberti · F. Rubino ·
    [Show abstract] [Hide abstract]
    ABSTRACT: De Taskforce Epidemiologie en Preventie van de International Diabetes Federation heeft een consensus-werkgroep bijeengebracht bestaande uit diabetologen, endocrinologen, chirurgen en epidemiologen om te beoordelen welke rol bariatrische chirurgie en andere gastrointestinale interventies horen te krijgen in de behandeling en preventie van type 2 diabetes.
    12/2015; 10(4):195-196. DOI:10.1007/s12467-012-0146-4
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Wallis Island is part of a French Territory in the South Pacific. In 1980 the prevalence of hypertension and type 2 diabetes mellitus (T2DM) was low, consistent with a subsistence economy. Considerable social and economic changes have occurred over the last 30 years. Methods: Survey data from 1980 and 2009 were analysed by sex in 10-year age groups, and 25-64 years age-standardised to the 2008 Census. Means and prevalences were calculated for blood pressure, fasting plasma glucose, body mass index (BMI), blood cholesterol and triglycerides as risk factors contributing to cardiovascular disease. Results: During 1980-2009 there were significant increases (p < 0.05) in age-standardised means and prevalences of blood pressure and hypertension, fasting plasma glucose and T2DM, BMI and obesity, blood cholesterol (men) and triglycerides; and non-significant increases in mean diastolic blood pressure and fasting plasma glucose in women. Mean cholesterol and the prevalence of elevated cholesterol declined in women. Hypertension prevalence increased from 12% to 43% in men and from 15% to 30% in women, with 42% of the increase in men and 33% of the increase in women statistically explained by increases in BMI. T2DM increased from 2.3% to 12.2% in men and from 4.0% to 15.8% in women, with 35% of the increase in men and 26% of the increase in women statistically explained by increases in BMI. Conclusions: Risk factors for cardiovascular disease have increased considerably in Wallis Island over the past 30 years, consistent with modernisation in way of life.
    09/2015; DOI:10.1177/2047487315604833
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Heart failure (HF) is an increasingly recognized complication of diabetes. Cardiac fibrosis is an important causative mechanism of HF associated with diabetes. Recent data indicate that inflammation may be particularly important in the pathogenesis of cardiovascular fibrosis. We sought to determine the mechanism by which cardiac fibrosis develops and to specifically investigate the role of the CXCR4 axis in this process. Animals with type I diabetes (streptozotocin treated mice) or type II diabetes (Israeli Sand-rats) and controls were randomized to treatment with a CXCR4 antagonist, candesartan or vehicle control. Additional groups of mice also underwent bone marrow transplantation (GFP+ donor marrow) to investigate the potential role of bone marrow derived cell mobilization in the pathogenesis of cardiac fibrosis. Both type I and II models of diabetes were accompanied by the development of significant cardiac fibrosis. CXCR4 antagonism markedly reduced cardiac fibrosis in both models of diabetes, similar in magnitude to that seen with candesartan. In contrast to candesartan, the anti-fibrotic actions of CXCR4 antagonism occurred in a blood pressure independent manner. Whilst the induction of diabetes did not increase the overall myocardial burden of GFP+ cells, it was accompanied by an increase in GFP+ cells expressing the fibroblast marker alpha-smooth muscle actin and this was attenuated by CXCR4 antagonism. CXCR4 antagonism was also accompanied by increased levels of circulating regulatory T cells. Taken together the current data indicate that pharmacological inhibition of CXCR4 significantly reduces diabetes induced cardiac fibrosis, providing a potentially important therapeutic approach.
    PLoS ONE 07/2015; 10(7):e0133616. DOI:10.1371/journal.pone.0133616 · 3.23 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: No systematic comparison has been conducted in Fiji using all suitable surveys of type 2 diabetes mellitus (T2DM) and obesity prevalence, after adjusting for differences in methodology, definitions and demographic characteristics. Unit records from 6 cross-sectional surveys of Fiji adults were included. Surveys were variously adjusted for age, ethnicity (Fiji Melanesians, i-Taukei, and Fijians of Asian Indian descent, Indians) and urban-rural by sex to previous censuses to improve national representativeness. Trends were assessed using meta-regression (random effect models) and estimates projected to 2020. Poisson regression of strata was used to assess effect of BMI increases on T2DM period trends. Over 1980-2011, T2DM prevalence increased from 3.2 to 11.1% (1.32%/5yrs) in i-Taukei men; 5.3-13.6% (1.40%/5yrs) i-Taukei women; 11.1-17.9% (1.24%/5yrs) Indian men; 11.2-19.9% (1.71%/5yrs) Indian women. Projected T2DM prevalence in 2020 is 13.3% in i-Taukei men; 16.7% i-Taukei women; 23.4% Indian men; 24.1% Indian women. Obesity prevalence increased 12.6-28.9% (2.99%/5yrs) in i-Taukei men; 30.1-52.9% (3.84%/5yrs) i-Taukei women; 2.8-9.4% (1.21%/5yrs) Indian men; 13.2-26.6% (2.61%/5yrs) Indian women. Projected obesity prevalence in 2020 is 34.0% in i-Taukei men, 60.0% i-Taukei women, 11.4% Indian men and 31.0% Indian women. After age-adjustment, it is estimated that 27% of the T2DM period trend is attributed to BMI in i-Taukei men, 25% i-Taukei women, 16% Indian men and 18% Indian women. T2DM prevalence in Fiji is projected to continue increasing in the near future, driven by increasing obesity, with consequences for premature mortality and life expectancy, especially for women and those of Indian descent. This article is protected by copyright. All rights reserved.
    Journal of Diabetes 07/2015; DOI:10.1111/1753-0407.12326 · 1.93 Impact Factor
  • Source

    International Journal of Pediatric Endocrinology 04/2015; 2015(Suppl 1):P111. DOI:10.1186/1687-9856-2015-S1-P111
  • [Show abstract] [Hide abstract]
    ABSTRACT: The prevalence of diabetes has risen rapidly in the Middle East, and in the Gulf Region in particular. However, some of the prevalence estimates have not fully accounted for the large migrant worker populations, and have focused on the minority indigenous populations. The objectives of the UAE National Diabetes and Lifestyle Study are to: define the prevalence of, and risk factors for, type 2 diabetes; describe the distribution and determinants of risk factors for type 2 diabetes (e.g. obesity, hypertension, physical activity, age, diet, smoking, serum lipids); study health knowledge, attitudes and behaviors, including patterns of health services utilization; identify gene-environment interactions in our multiethnic communities; and develop baseline data for evaluation of future intervention programs. Given the high burden of diabetes in the region and the absence of accurate data on non-UAE nationals in the UAE, a representative sample of the non-UAE nationals was essential. We employed an innovative methodology in which non-UAE nationals were sampled when attending the mandatory bi-annual health check that is required for visa renewal. Such an approach could also be used in other countries in the region. This novel methodology could provide insights for epidemiological studies in the UAE and other Gulf States particularly for expatriates. This article is protected by copyright. All rights reserved.
    Journal of Diabetes 01/2015; 7(5). DOI:10.1111/1753-0407.12270 · 1.93 Impact Factor

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Current computational methods used to analyze changes in DNA methylation and chromatin modification rely on sequenced genomes. Here we describe a pipeline for the detection of these changes from short-read sequence data that does not require a reference genome. Open source software packages were used for sequence assembly, alignment, and measurement of differential enrichment. The method was evaluated by comparing results with reference-based results showing a strong correlation between chromatin modification and gene expression. We then used our de novo sequence assembly to build the DNA methylation profile for the non-referenced Psammomys obesus genome. The pipeline described uses open source software for fast annotation and visualization of unreferenced genomic regions from short-read data.
    Epigenetics: official journal of the DNA Methylation Society 10/2014; 9(10):1329-38. DOI:10.4161/15592294.2014.969610 · 4.78 Impact Factor
  • Source

    BMC Health Services Research 07/2014; 14(Suppl 2):P33. DOI:10.1186/1472-6963-14-S2-P33 · 1.71 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Context: Adipokines actuate chronic, low-grade inflammation through a complex network of immune markers but the current understanding of these networks is incomplete. The soluble isoform of the interleukin-1 receptor accessory protein (sIL1RAP) occupies an important position in the inflammatory pathways involved in obesity. The pathogenetic and clinical influences of sIL1RAP are unknown. Objective: To elucidate whether plasma levels of sIL1RAP are reduced in obesity, using affluent clinical, biochemical and genetic data from two diverse cohorts. Design, Setting and Participants: The study was conducted in two cohorts - the San Antonio Family Heart Study (n = 1,397 individuals from 42 families) and South Asians living in Mauritius n = 230). Main outcome measures: Plasma sIL1RAP levels were measured using an enzyme-linked immunosorbent assay. The genetic basis of sIL1RAP levels were investigated using both a large scale gene expression profiling study and a genome-wide association study. Results: A significant decrease in plasma sIL1RAP levels were observed in obese subjects even after adjustment for age and sex. sIL1RAP levels demonstrated a strong inverse association with obesity measures in both populations. All associations were more significant in females. Plasma sIL1RAP levels were significantly heritable, correlated with IL1RAP transcript levels (NM 134470), showed evidence for shared genetic influences with obesity measures and were significantly associated with the rs2885373 SNP (p=6.7 x 10(-23)) within the IL1RAP gene. Conclusions: Plasma sIL1RAP levels are reduced in obesity and can potentially act as biomarkers of obesity. Mechanistic studies are required to understand the exact contribution of sIL1RAP to pathogenesis of obesity.
    Journal of Clinical Endocrinology &amp Metabolism 06/2014; 99(9):jc20134475. DOI:10.1210/jc.2013-4475 · 6.21 Impact Factor

  • 35th Annual Scientific Meeting of the; 06/2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cardiovascular disease poses a major challenge for the 21st century, exacerbated by the pandemics of obesity, metabolic syndrome and type 2 diabetes. While best standards of care, including high-dose statins, can ameliorate the risk of vascular complications, patients remain at high risk of cardiovascular events. The Residual Risk Reduction Initiative (R3i) has previously highlighted atherogenic dyslipidaemia, defined as the imbalance between proatherogenic triglyceride-rich apolipoprotein B-containing-lipoproteins and antiatherogenic apolipoprotein A-I-lipoproteins (as in high-density lipoprotein, HDL), as an important modifiable contributor to lipid-related residual cardiovascular risk, especially in insulin-resistant conditions. As part of its mission to improve awareness and clinical management of atherogenic dyslipidaemia, the R3i has identified three key priorities for action: i) to improve recognition of atherogenic dyslipidaemia in patients at high cardiometabolic risk with or without diabetes; ii) to improve implementation and adherence to guideline-based therapies; and iii) to improve therapeutic strategies for managing atherogenic dyslipidaemia. The R3i believes that monitoring of non-HDL cholesterol provides a simple, practical tool for treatment decisions regarding the management of lipid-related residual cardiovascular risk. Addition of a fibrate, niacin (North and South America), omega-3 fatty acids or ezetimibe are all options for combination with a statin to further reduce non-HDL cholesterol, although lacking in hard evidence for cardiovascular outcome benefits. Several emerging treatments may offer promise. These include the next generation peroxisome proliferator-activated receptoralpha agonists, cholesteryl ester transfer protein inhibitors and monoclonal antibody therapy targeting proprotein convertase subtilisin/kexin type 9. However, long-term outcomes and safety data are clearly needed. In conclusion, the R3i believes that ongoing trials with these novel treatments may help to define the optimal management of atherogenic dyslipidaemia to reduce the clinical and socioeconomic burden of residual cardiovascular risk.
    Cardiovascular Diabetology 01/2014; 13(1):26. DOI:10.1186/1475-2840-13-26 · 4.02 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess in a single cohort whether annual weight and waist circumference (WC) change has varied over time. Longitudinal cohort study with three surveys (1) 1999/2000; (2) 2004/2005 and (3) 2011/2012. Generalised linear mixed models with random effects were used to compare annualised weight and WC change between surveys 1 and 2 (period 1) with that between surveys 2 and 3 (period 2). Models were adjusted for age to analyse changes with time rather than age. Models were additionally adjusted for sex, education status, area-level socioeconomic disadvantage, ethnicity, body mass index, diabetes status and smoking status. The Australian Diabetes, Obesity and Lifestyle study (AusDiab)-a population-based, stratified-cluster survey of 11247 adults aged ≥25 years. 3351 Australian adults who attended each of three surveys and had complete measures of weight, WC and covariates. Weight and WC were measured at each survey. Change in weight and WC was annualised for comparison between the two periods. Mean weight and WC increased in both periods (0.34 kg/year, 0.43 cm/year period 1; 0.13 kg/year, 0.46 cm/year period 2). Annualised weight gain in period 2 was 0.11 kg/year (95% CI 0.06 to 0.15) less than period 1. Lesser annual weight gain between the two periods was not seen for those with greatest area-level socioeconomic disadvantage, or in men over the age of 55. In contrast, the annualised WC increase in period 2 was greater than period 1 (0.07 cm/year, 95% CI 0.01 to 0.12). The increase was greatest in men aged 55+ years and those with a greater area-level socioeconomic disadvantage. Between 2004/2005 and 2011/2012, Australian adults in a national study continued to gain weight, but more slowly than 1999/2000-2004/2005. While weight gain may be slowing, this was not observed for older men or those in more disadvantaged groups, and the same cannot be said for WC.
    BMJ Open 01/2014; 4(1):e003667. DOI:10.1136/bmjopen-2013-003667 · 2.27 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Diabetes in pregnancy carries an increased risk of adverse pregnancy outcomes for both the mother and foetus, but it also provides an excellent early opportunity for intervention in the life course for both mother and baby. In the context of the escalating epidemic of chronic diseases among Indigenous Australians, it is vital that this risk is reduced as early as possible in the life course of the individual. The aims of the PANDORA Study are to: (i) accurately assess rates of diabetes in pregnancy in the Northern Territory (NT) of Australia, where 38% of babies are born to Indigenous mothers; (ii) assess demographic, clinical, biochemical, anthropometric, socioeconomic and early life development factors that may contribute to key maternal and neonatal birth outcomes associated with diabetes in pregnancy; and (iii) monitor relevant post-partum clinical outcomes for both the mothers and their babies.Methods/design: Eligible participants are all NT women with diabetes in pregnancy aged 16 years and over. Information collected includes: standard antenatal clinical information, diagnosis and management of diabetes in pregnancy, socio-economic status, standard clinical birth information (delivery, gestational age, birth weight, adverse antenatal and birth outcomes). Cord blood is collected at the time of delivery and detailed neonatal anthropometric measurements performed within 72 hours of birth. Information will also be collected regarding maternal post-partum glucose tolerance and cardio-metabolic risk factor status, breastfeeding and growth of the baby up to 2 years post-partum in the first instance. This study will accurately document rates and outcomes of diabetes in pregnancy in the NT of Australia, including the high-risk Indigenous Australian population. The results of this study should contribute to policy and clinical guidelines with the goal of reducing the future risk of obesity and diabetes in both mothers and their offspring.
    BMC Pregnancy and Childbirth 12/2013; 13(1):221. DOI:10.1186/1471-2393-13-221 · 2.19 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: India currently has more than 60 million people with Type 2 Diabetes Mellitus (T2DM) and this is predicted to increase by nearly two-thirds by 2030. While management of those with T2DM is important, preventing or delaying the onset of the disease, especially in those individuals at 'high risk' of developing T2DM, is urgently needed, particularly in resource-constrained settings. This paper describes the protocol for a cluster randomised controlled trial of a peer-led lifestyle intervention program to prevent diabetes in Kerala, India.Methods/designA total of 60 polling booths are randomised to the intervention arm or control arm in rural Kerala, India. Data collection is conducted in two steps. Step 1 (Home screening): Participants aged 30--60 years are administered a screening questionnaire. Those having no history of T2DM and other chronic illnesses with an Indian Diabetes Risk Score value of >=60 are invited to attend a mobile clinic (Step 2). At the mobile clinic, participants complete questionnaires, undergo physical measurements, and provide blood samples for biochemical analysis. Participants identified with T2DM at Step 2 are excluded from further study participation. Participants in the control arm are provided with a health education booklet containing information on symptoms, complications, and risk factors of T2DM with the recommended levels for primary prevention. Participants in the intervention arm receive: (1) eleven peer led small group sessions to motivate, guide and support in planning, initiation and maintenance of lifestyle changes; (2) two diabetes prevention education sessions led by experts to raise awareness on T2DM risk factors, prevention and management; (3) a participant handbook containing information primarily on peer support and its role in assisting with lifestyle modification; (4) a participant workbook to guide self-monitoring of lifestyle behaviours, goal setting and goal review; (5) the health education booklet that is given to the control arm. Follow-up assessments are conducted at 12 and 24 months. The primary outcome is incidence of T2DM. Secondary outcomes include behavioural, psychosocial, clinical, and biochemical measures. An economic evaluation is planned. Results from this trial will contribute to improved policy and practice regarding lifestyle intervention programs to prevent diabetes in India and other resource-constrained settings.Trial registrationAustralia and New Zealand Clinical Trials Registry: ACTRN12611000262909.
    BMC Public Health 11/2013; 13(1):1035. DOI:10.1186/1471-2458-13-1035 · 2.26 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A significant proportion of individuals with diabetes or impaired glucose tolerance have fasting plasma glucose less than 6.1 mmol/L and so are not identified with fasting plasma glucose measurements. In this study, we sought to evaluate the utility of plasma lipids to improve on fasting plasma glucose and other standard risk factors for the identification of type 2 diabetes or those at increased risk (impaired glucose tolerance). Our diabetes risk classification model was trained and cross-validated on a cohort 76 individuals with undiagnosed diabetes or impaired glucose tolerance and 170 gender and body mass index matched individuals with normal glucose tolerance, all with fasting plasma glucose less than 6.1 mmol/L. The inclusion of 21 individual plasma lipid species to triglycerides and HbA1c as predictors in the diabetes risk classification model resulted in a statistically significant gain in area under the receiver operator characteristic curve of 0.049 (p<0.001) and a net reclassification improvement of 10.5% (p<0.001). The gain in area under the curve and net reclassification improvement were subsequently validated on a separate cohort of 485 subjects. Plasma lipid species can improve the performance of classification models based on standard lipid and non-lipid risk factors.
    PLoS ONE 10/2013; 8(10):e76577. DOI:10.1371/journal.pone.0076577 · 3.23 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The relationship between lipid metabolism with prediabetes (impaired fasting glucose and impaired glucose tolerance) and type 2 diabetes mellitus is poorly defined. We hypothesized that a lipidomic analysis of plasma lipids might improve the understanding of this relationship. We performed lipidomic analysis measuring 259 individual lipid species, including sphingolipids, phospholipids, glycerolipids and cholesterol esters, on fasting plasma from 117 type 2 diabetes, 64 prediabetes and 170 normal glucose tolerant participants in the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) then validated our findings on 1076 individuals from the San Antonio Family Heart Study (SAFHS). Logistic regression analysis of identified associations with type 2 diabetes (135 lipids) and prediabetes (134 lipids), after adjusting for multiple covariates. In addition to the expected associations with diacylglycerol, triacylglycerol and cholesterol esters, type 2 diabetes and prediabetes were positively associated with ceramide, and its precursor dihydroceramide, along with phosphatidylethanolamine, phosphatidylglycerol and phosphatidylinositol. Significant negative associations were observed with the ether-linked phospholipids alkylphosphatidylcholine and alkenylphosphatidylcholine. Most of the significant associations in the AusDiab cohort (90%) were subsequently validated in the SAFHS cohort. The aberration of the plasma lipidome associated with type 2 diabetes is clearly present in prediabetes, prior to the onset of type 2 diabetes. Lipid classes and species associated with type 2 diabetes provide support for a number of existing paradigms of dyslipidemia and suggest new avenues of investigation.
    PLoS ONE 09/2013; 8(9):e74341. DOI:10.1371/journal.pone.0074341 · 3.23 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: AimTo assess factors influencing glycaemic control following gastric bypass surgery in patients with Type 2 diabetes and BMI 7%). Analysis was conducted using binary logistic regression, and cut-points obtained from receiver operator characteristics. ResultsExcellent glycaemic control was achieved in 31 (30%) at 1 year. Diabetes duration of 27 kg/m2 provided independent predictors and useful cut-points. Likelihood of excellent glycaemic control for an individual could be estimated using loge (Odds) = –6.7 + (0.26 × BMI) + (–1.2 × diabetes duration). Baseline BMI of 16%) were associated with excellent glycaemic control. Higher BMI was associated with greater percentage weight loss. Conclusion In patients with Type 2 diabetes and BMI
    Diabetic Medicine 04/2013; 30(4). · 3.12 Impact Factor
  • Source
    K George M M Alberti · Paul Zimmet ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Three major studies have made a brave attempt to quantify mortality and disability worldwide from 289 diseases and their sequelae. Striking data are presented that confirm the rising tide of noncommunicable diseases, particularly diabetes mellitus. The predictions for diabetes mellitus are, however, probably underestimated owing to underdiagnosis and under-reporting.
    Nature Reviews Endocrinology 03/2013; 9(5). DOI:10.1038/nrendo.2013.54 · 13.28 Impact Factor

Publication Stats

25k Citations
2,040.36 Total Impact Points


  • 2009-2015
    • Baker IDI Heart and Diabetes Institute
      • Clinical Diabetes and Epidemiology Research Group
      Melbourne, Victoria, Australia
    • Singapore Eye Research Institute
      Tumasik, Singapore
  • 2008-2011
    • University of Vic
      Vic, Catalonia, Spain
    • The George Institute for Global Health
      Sydney, New South Wales, Australia
    • Aintree University Hospital NHS Foundation Trust
      Liverpool, England, United Kingdom
    • University of Wisconsin, Madison
      • Department of Ophthalmology and Visual Sciences
      Mississippi, United States
  • 1982-2008
    • Diabetes Australia, Victoria
      Melbourne, Victoria, Australia
  • 2007
    • Baker College, Australia
      Hornsby, New South Wales, Australia
  • 2006-2007
    • Imperial College Healthcare NHS Trust
      Londinium, England, United Kingdom
    • Imperial College London
      Londinium, England, United Kingdom
  • 1997-2006
    • Deakin University
      • School of Exercise and Nutrition Sciences
      Geelong, Victoria, Australia
    • Melbourne Institute of Technology
      Melbourne, Victoria, Australia
  • 2005
    • Mount Sinai Hospital, Toronto
      Toronto, Ontario, Canada
  • 2003
    • National Institutes of Health
      Maryland, United States
    • Newcastle University
      Newcastle-on-Tyne, England, United Kingdom
    • Melbourne Pathology
      Melbourne, Victoria, Australia
  • 1989-2003
    • Monash University (Australia)
      • • Department of Epidemiology and Preventive Medicine
      • • Department of Biochemistry and Molecular Biology
      Melbourne, Victoria, Australia
    • Papua New Guinea Institute of Medical Research
      New Garoka, Eastern Highlands, Papua New Guinea
  • 2002
    • Sahlgrenska University Hospital
      Goeteborg, Västra Götaland, Sweden
  • 1979-1999
    • Royal Melbourne Hospital
      Melbourne, Victoria, Australia
  • 1986-1996
    • National Public Health Institute
      Helsinki, Southern Finland Province, Finland
  • 1992
    • University of Sydney
      • School of Public Health
      Sydney, New South Wales, Australia
  • 1990
    • World Health Organization WHO
      • Department of Communicable Diseases (CDS)
      Genève, Geneva, Switzerland
  • 1984
    • St. Vincent's Hospital Melbourne
      Melbourne, Victoria, Australia
    • University of Kuopio
      Kuopio, Eastern Finland Province, Finland
  • 1983
    • Royal Victorian Eye and Ear Hospital
      Melbourne, Victoria, Australia
  • 1978-1981
    • Alfred Hospital
      Melbourne, Victoria, Australia