bluuebunny/crossref_metadata_2025 huggingface dataset:
Living near a lead smelter: an environmental health risk assessment in Boolaroo and Argenton, New South Wales
Authors: Galvin Judy , Stephenson John , Wlodarczyk John , Loughran Robert , Waller Graeme
Published: August 2010

Abstract: This paper outlines a risk assessment of a lead‐contaminated residential site in Lake Macquarie, New South Wales, near the Pasminco Metals‐Sulphide lead and zinc smelter. The assessment includes a hazard identification and a dose‐response assessment based on recent research findings; an exposure assessment based on two interrelated indicators, soil/dust lead and blood lead; a risk characterisation; and finally, a discussion of environmental and behavioural options for the management of risk. The exposure assessment showed lead concentrations of 20 to 21 460 parts per million in soil survey samples, 23 to 35 870 parts per million in household dust, and a range of mean values for blood lead concentration of 11 μg/dl to 17 μg/dl, in four study groups. The proportions of children within these groups having blood lead concentrations of 10 μg/dl or greater, the current level of known health effect, ranged from 57 per cent to 85 per cent. The decision by the National Health and Medical Research Council in June 1993 to set a goal for blood lead of below 10 μg/dl has important implications for the definition and the management of the environmental health risk from ‘living with lead’ in the area assessed.
Food‐purchasing behaviour in an Aboriginal community. 1. Results of a survey
Authors: Rowse Tim , Scrimgeour David , Knight Sabina , Thomas David
Published: August 2010

Abstract: Attempts to improve the nutritional status of Aboriginal people through nutritional education programs should be informed by an understanding of contemporary patterns of food procurement, preparation and distribution. This paper describes the results of a survey of food‐purchasing behaviour in a central‐Australian Aboriginal community. Every transaction occurring in each food outlet in the community over a two‐week period was recorded and the data analysed. The results show that women play a much greater role than men in food purchasing, that there is a significant recourse to takeaway foods, that there is a cycle of expenditure determined by distribution of pension and Community Development Employment Project cheques, and that children have sufficient disposable income to be able to provision themselves from the food outlets, so that much of their food consumption is not determined by adult members of their family.
Blood pressure, lipids and other risk factors for cardiovascular disease in Aborigines and persons of European descent of southeastern Australia
Authors: Guest Charles S. , O'Dea Kerin , Larkins Richard G.
Published: August 2010

Abstract: Based on a survey in two country towns of southeastern Australia, cardiovascular risk‐factor prevalence data from Aborigines and persons of European descent are presented. The mean diastolic blood pressure in 123 Aboriginal males was 83.2 mmHg, compared with 79.2 mmHg in 272 European males (P= 0.005). In 178 Aboriginal females, mean diastolic pressure was 79.2 mmHg, compared with 76.3 mmHg in 281 European females (P = 0.006). Mean plasma total cholesterol was higher in Europeans (both males and females: 5.7 mmol/L) than in Aborigines (in males 5.2 and females 5.0 mmol/L) (male comparison, P = 0.02, female comparison, P < 0.001). The prevalence in participants aged 25 to 64 years of at least one major risk factor (diastolic blood pressure 95 mmHg or higher, plasma cholesterol 6.5 mmol/L or higher, or smoking more than one cigarette daily) was higher in both these samples of Aborigines (94 per cent in males, 89 per cent in females) and Europeans (70 per cent in males, 59 per cent in females) than in the 1989 urban sample of the National Heart Foundation (47 per cent in males, 36 per cent in females). Multivariate analyses showed statistically significant independent contributions of body mass index and the variable ‘ethnicity’ (unidentified genetic and environmental differences between the groups) to blood pressure and other risk factors. The higher cardiovascular mortality of Aborigines may be explained partly by the higher prevalence of risk factors in this group compared with other Australians. Further, the risk‐factor profile may be worse among rural compared with urban Europeans.
Influence of socioeconomic status, ethnicity and an educational brochure on compliance with a postal faecal occult blood test
Authors: King Julie , Fairbrother Gregory , Thompson Cristina , Morris David L.
Published: August 2010

Abstract:The study aimed to determine if socioeconomic status and ethnicity affect compliance with postal faecal occult blood test screening, and if compliance can be increased by adding an educational brochure. A pilot intervention study was used in socioeconomically defined postcodes and defined census collection districts of the Southern Sydney Area Health Service. The study population of men and women aged 45 to 75 years was selected from general practice lists in the defined postcodes. Samples were comparable for age, sex, and socioeconomic indices. Compliance, using a general practitioner letter alone, was: for the Australian middle‐socioeconomic status sample, 65.8 per cent (95 per cent confidence interval (CI) 59.5 to 72.1), the Australian low‐socioeconomic status sample, 63.9 per cent (CI 57.3 to 70.5), the Arabic low‐socioeconomic status sample, 33.3 per cent (CI 27.2 to 39.4). With the general practitioner letter plus brochure, compliance was: Australian middle‐socioeconomic status sample, 67.0 per cent (CI 60.5 to 73.5), Australian low‐socioeconomic status sample, 62.1 per cent (CI 55.3 to 68.9) and Arabic low‐socioeconomic status sample, 36.8 per cent (CI 30.6 to 43.0). Compliance was higher in all Australian samples than in Arabic samples. A brochure, designed to increase compliance with testing, had no significant effect in Australian samples. Australian samples of different socioeconomic status complied almost equally. Results suggest that advice from the local doctor is very effective in motivating patients to screen with faecal occult blood testing. Low compliance to an invitation in Arabic and English in an Arabic low‐socioeconomic status population suggests that low literacy in one or both languages may preclude compliance with screening in this group.
A cost analysis of early discharge and domiciliary visits versus standard hospital care for low‐risk obstetric clients
Authors: Scott Anthony
Published: August 2010

Abstract: This paper presents an economic analysis of three obstetric early discharge schemes operating in western Sydney. The primary objective was to examine the net economic value of health service resources released due to each early discharge scheme. Conventional postnatal obstetric care comprised an inpatient stay of four to five days. Early discharge provided an alternative location. Clients who chose to participate in the scheme were discharged two to three days earlier than usual and visited at home by a midwife for up to seven days. Other studies of early discharge schemes have shown that resulting maternal and infant morbidity were no higher than with conventional care. This study took the form of a cost analysis. The early discharge schemes at Blacktown and Westmead Hospitals used more resources than they released, whereas the scheme at Auburn Hospital released resources in excess of those it used. Sensitivity analysis showed that the results for Westmead and Auburn Hospitals were sensitive to changes in key assumptions used in the analysis. The number of domiciliary visits per client was an important determinant of the ability of schemes to release resources in excess of their costs. The existence of early discharge provides an extra choice to clients in the location of postnatal care. The question for decision makers is whether this choice is worth the extra cost of early discharge schemes.
Access to health care for children in low‐income families
Authors: Taylor Janet
Published: August 2010

Abstract: This paper draws on data from the Health Care for Children Project to consider issues of access to health care for children in low‐income families in three geographic areas. Group and individual interviews were held with mothers in an innercity area and two outlying suburbs. Financial, geographic, sociocultural and other barriers to use of health services are discussed. Major obstacles to access to health care for their children identified by the mothers included cost of medication, hours of opening, transport and language. The paper highlights the impact of even quite small charges for health services on low‐income families.
Land, body and spirit—talking about adult mortality in an Aboriginal community
Authors: Weeramanthri Tarun , Plummer Clifford
Published: August 2010

Abstract: The aim of this article is to describe a classificatory framework, ‘Land, body and spirit’, which addresses the underlying causes of disease and which has proved useful in discussing with Northern Territory Aboriginal communities the causes and possible responses to premature adult deaths. Pie charts displaying proportional mortality ratios according to underlying cause of death, age and sex have also proved useful in such discussions.
Melanocytic lesions excised from the skin: what percentage are malignant?
Authors: Del Mar Christopher , Green Adèle , Cooney Tim , Cutbush Ken , Lawrie Steven , Adkins Graeme
Published: August 2010

Abstract: We estimated the diagnostic skill of clinicians managing melanocytic skin naevi by measuring the percentage of malignant melanomas, premalignant and potentially malignant naevi, in 1896 excised melanocytic lesions submitted to a pathology service over 11 weeks. They comprised 8 per cent. The percentage increased with age: 4 per cent in the under‐40s, 17 per cent in those aged 40–59, and 30 per cent in those over 60, (P < 0.001, sex‐adjusted). Although the percentage was twice as high in males (11 per cent) as females (6 per cent), after adjustment for age the difference was not significant. Invasive melanomas, 3 per cent of the total, were similar: 1 per cent were from under‐40s; 7 per cent from those aged 40–59 years; and 14 per cent from those over 60. They comprised 4 per cent of lesions from males and 2 per cent from females. These trends may indicate poor specificity of clinical diagnosis, notwithstanding other reasons for removal of naevi (cosmetic), particularly among patients under 40, and females.
Legislation for school entry immunisation certificates in Victoria
Authors: Thompson Sandra C. , Goudey Ramon E. , Stewart Tony
Published: August 2010

Abstract: In 1982 the National Health and Medical Research Council recommended that every state introduce legislation requiring immunisation certificates at school entry. Victoria was the first state to enact such legislation. This paper explores the process and difficulties encountered in achieving this legal requirement, describes the requirements under the legislation as it was finally introduced, and examines the early data available to the state health department regarding its implementation. Compliance with the legislation and immunisation status of children enrolling in government primary schools were ascertained from mid‐year census data. In 1992 almost 90 per cent of children complied with the legislation, but because 10.2 per cent of children did not present a certificate it was possible to estimate only the lower limit of statewide coverage at 85 per cent against the prescribed diseases. School entry immunisation legislation may provide an important safety net to identify children with incomplete immunisation. However, the effectiveness of the legislation in Victoria remains unproven, and the requirements of the legislation are demanding for parents, local councils, and schools. The failure to document immunisation status in over 10 per cent of children indicates that further efforts to increase compliance are needed. This will require information on the vaccination status of those without certificates and the reasons they have not complied. The impact of the legislation needs further evaluation, although it may be years before its effectiveness can be gauged. Its effectiveness may depend upon enforcement of the requirement to exclude unimmunised children in disease outbreaks.
An evaluation of school entry immunisation certificates in Victoria
Authors: Thompson Sandra C. , Cocotsi Litsa , Goudey Ramon E. , Murphy Adrian
Published: August 2010

Abstract: We evaluated legislation introduced into Victoria in 1991 requiring that all children enrolling in primary school certify their immunisation status. Information was requested from all local councils. All primary schools in two local government areas were followed up, providing an indication of the validity of the analysis obtained from data collected during the mid‐year census. From 166 of 210 local councils in Victoria, 48 422 documents relating to school entry immunisation certificates were issued for children entering their preparatory year. At least 522 children were enrolled in school on an undertaking to complete immunisation, and were likely to have had their immunisation completed as a result of the legislation. Only 170 statutory declarations of conscientious objection to immunisation were made, indicating that few parents are willing to express firm anti‐vaccine sentiments. Compliance with the immunisation certificate legislation is overestimated by the mid‐year census because many schools have accepted nonstatutory evidence of immunisation. Mobile and immigrant families find it particularly difficult to achieve certification. Local councils are inconsistent in the way in which they issue certificates. Further follow‐up and feedback is essential to better inform schools and parents about the legislation. Such follow‐up can improve the certification rates of children then and in subsequent years. The legislation has imposed a considerable workload on councils, but without efforts to improve compliance with the legislation and to develop practical guidelines for documentation of immunisation and appropriate guidelines regarding transfer, many inadequately immunised children may remain at risk from vaccine‐preventable diseases.
Knowledge and practice of sexual safety in Melbourne gay men in the nineties
Authors: Ridge Damien T. , Plummer David C. , Minichiello Victor
Published: August 2010

Abstract: Despite the impact of education programs, the ability of gay men to sustain sexual safety still comes under public scrutiny. A self‐administered questionnaire was distributed in 1990 to a convenience sample of 284 gay‐identified Melbourne men recruited from gay groups, health clinics, gay pubs and nightclubs, sex‐on‐premises venues, and the social networks of these men. The questionnaire measured the perceived safety of various sexual practices and the practice of unprotected anal intercourse over the previous three months. These results were compared with results from other Australian studies. Whereas nearly all the men were sexually active, only a small proportion considered activities such as oral sex without ejaculation and anal sex with condoms to be‘totally safe’. The majority considered these activities to be ‘more safe than unsafe’, suggesting a risk‐reduction rather than a ‘no‐risk’ approach to sex. Comparisons with other Australian studies suggest that gay men are becoming more confident in the safety of sexual activities labelled as ‘safe’ by the AIDS Council. There was no elevated practice of unprotected anal sex at ‘sex‐on‐premises’ venues. Most men who had anal sex used condoms all of the time, whether sexual partnerships were ‘once only’ or were ‘ongoing’, suggesting that ‘condoms always’ is still a viable option in various partnerships. There was some evidence that a minority of men abandoned condoms in ongoing partnerships. If specific education campaigns are developed to promote ‘negotiated safety’ in partnerships, then such campaigns should not contradict the ‘condoms always’ strategy.
Australian breastfeeding rates: the challenge of monitoring
Authors: Lund‐Adams Margaret , Heywood Peter
Published: August 2010

Abstract: The Australian Bureau of Statistics has published national breastfeeding summary data collected in the 1989‐90 National Health Survey. Despite expectations that these data would give, for the first time ever, national age‐specific breastfeeding rates and would allow monitoring towards national breastfeeding targets, they did not. Secondary analysis has been conducted to expand the usefulness of these data. The results, presented in this paper, suggest that breastfeeding rates have fallen since the mid‐1980s, and if confirmed, suggest that the national targets set for the year 2000 may be out of reach. Limitations of the 1989‐90 National Health Survey breastfeeding questions and published results are highlighted and suggestions for future national breastfeeding surveys are given.
Religiosity, sexual intercourse and condom use among university students
Authors: Dunne Michael P. , Edwards Rod , Lucke Jayne , Donald Maria , Raphael Beverley
Published: August 2010

Abstract: There is strong evidence that religiosity among adolescents is associated with delayed onset of sexual activity. However, research on relationships between religiosity and contraceptive practices is limited and inconsistent. This paper provides data from a survey of 374 students aged between 16 and 21 at two Brisbane universities (72.4 per cent response rate). Those who perceived religion to be important in their lives were less likely to have had intercourse. Among the sexually active sample, religious youth did not differ from their peers in recent condom use, the age at which they first used condoms or the rate of partner change. Contrary to several recent assertions in review articles, this and other empirical studies do not show that religious youth are less likely than nonreligious youth to take precautions during sex.
Improving our self‐episteme
Authors: Leeder Stephen
Published: August 2010

Tell us where you'd like to see public health in the new curriculum. It's problem‐based, disciplinarily integrated and behaviourally sensitive. It is based on the principles of self‐directed adult learning and we'd love it to be community‐orientated! We assume you'll want to integrate your stuff with ours, but do you need any separate sessions as well?
Enhancing the early detection of melanoma within current guidelines
Authors: Balanda Kevin P. , Lowe John B. , Stanton Warren R. , Gillespie Amaya M.
Published: August 2010

Abstract: Queensland has the highest reported incidence of malignant melanoma in the world, and early detection offers the possibility of reducing the burden of this cancer in the short term. We report on a survey of 995 residents of the Gold Coast, Queensland, regarding behavioural aspects of the early detection of skin cancer. Survey results suggest that although many people report some form of skin examination behaviour, by either checking their own skin, having another nonmedical person check their skin, or by going to their general practitioner for a skin check, much of this activity may be inadequate. They indicate that current early detection could be enhanced by encouraging individuals and general practitioners to extend the coverage of the examinations they already conduct.
True believers? Characteristics of general practitioners in Victorian community health centres
Authors: Montalto Michael , Dunt David , Young Doris
Published: August 2010

Abstract: General practitioners have been part of multidisciplinary services in Victorian Community Health Centres (CHCs) for 20 years. This model institutionalises a high degree of integration between general practitioners and other primary care and community service personnel. Of 51 eligible full‐time general practitioners in Victorian CHCs, 46 were interviewed, using a structured questionnaire. General practitioners in CHCs were younger less experienced and more likely to be female than other general practitioners. Nearly three‐quarters were salaried. The philosophy of practice and the conditions of employment were the commonest reasons for entering CHC practice. Teamwork and the conditions of employment were felt to be the biggest advantages of CHC practice, while difficulties with management and the perceived loss of professional ownership and control were the commonest disadvantages. None reported interference from the CHC management in their clinical practice. Nearly a quarter of full‐time CHC general practitioners do not undertake any formal community health promotion activities. Forty‐five per cent of respondents intended to leave their CHC within the next five years. Universal health insurance has diminished the impact of CHC general practice. The philosophy of CHCs and the salaried nature of the employment continues to attract general practitioners. High staff turnover is a feature of CHC general practice, in part related to young doctors making an initial, but not long‐term commitment to CHC practice. However, the loss of professional control and management difficulties should be addressed, as these may contribute to the high turnover.
Development of sample size models for national general practice surveys
Authors: Meza R. Angelli , Angelis Maria , Britt Helena , Miles David A. , Seneta Eugene , Bridges‐Webb Charles
Published: August 2010

Abstract: The most cost‐effective method to measure the morbidity managed and treatments provided in general practice is from records of a cluster of consultations (encounters) from each general practitioner (GP) in a random sample. A cluster sampling method is proposed for future surveys for analysis of encounter‐based general practice data. The sample sizes needed to measure the most common problems managed and drugs prescribed were estimated using ratio‐estimator models for cluster sample surveys. Morbidity and treatment rates were estimated from the Australian Morbidity and Treatment Survey in General Practice 1990–1991 (AMTS). The 20 most common problems in the AMTS were managed at estimated rates of 1.5 to 9.5 per 100 encounters. The 20 most common drugs were prescribed at estimated rates of 0.7 to 3.6 per 100 problems. These rates were used to determine precision as a percentage of each true value for future surveys, that is, as relative precision. If we want to be 95 per cent confident that these rates will be within 5 per cent of each true rate, sample sizes of 552 to 5675 GPs are needed. If we fix the sample size at 1000 GPs, relative precision lies within 12 per cent of these rates. If the sample size is increased to 1500 GPs, relative precision improves only marginally. The differences in sample size for each of the most frequent morbidity and treatment data are largely due to their variable distributions and relatively infrequent occurrence in general practice. A sample size of 1000 GPs will enable measurement of the most common morbidity and treatments at 95 per cent confidence.
Work‐related deaths of children and adolescents in Australia, 1982 to 1984
Authors: Mandryk John , Harrison James
Published: August 2010

Abstract: Work‐related deaths of children and adolescents up to the age of 19 years were studied as part of a larger investigation into all work‐related fatalities in Australia in the three‐year period, 1982 to 1984. This study aimed to characterise the circumstances which led to the deaths of these children. Of 1738 work‐related fatalities identified over the three years in the larger investigation, 67 (4 per cent) were aged under 15 years, and 117 (7 per cent) were aged 15 to 19 years. The fatalities were characterised by a number of variables, the most important being age, sex, bystander status, location (farm or other) and vehicle involvement (especially tractors). The causes of death differed between subgroups. Although existing controls may be reasonably effective in minimising child deaths in most work places, farms are an exception. On farms, home and work activities overlap, and informal participation in work by the young is quite common. Preventive efforts should give special attention to farms and tractors, to toddlers and male children, and to measures (such as safety devices and other external control measures) which do not rely on behavioural change in the young people at risk. Adults responsible for young children should be educated to anticipate dangerous situations and thus ensure children are protected from injury hazards.
Homicide in New Zealand: an increasing public health problem
Authors: Fanslow Janet L. , Chalmers David J. , Langley John D.
Published: August 2010

Abstract: Injury purposely inflicted by other persons is a significant public health problem as well as a criminal problem. It accounts for approximately 3 per cent of all deaths from injury in New Zealand. National injury mortality data for the period 1978 to 1987, supplemented by reference to files of the Coroner's Court and the High Court, were used to identify the characteristics of victims of homicide, the nature of the injuries they sustained, and the circumstances in which the injuries were inflicted. The mortality rate from homicide for the 10‐year period was 1.6 per 100 000 persons per year. A significant increase in the rate of homicide was identified. The rates for males were higher (2.0) than those for females (1.2), with those 20 to 24 years of age most at risk. Maori had higher rates than non‐Maori. Homicides were most frequently committed with cutting and piercing instruments, and most commonly occurred in private homes. Homicides were most likely to occur on Fridays or Saturdays, between the hours of 6 p.m. and 6 a.m. In 55 per cent of homicides the victim and assailant were known to one another. Unemployment, membership of ethnic minority groups, availability of weapons, the private nature of interactions in the home, alcohol consumption, and stress in personal relationships were all identified as factors associated with homicide in the decade under study. The implications of these findings for the prevention of injury from assault are discussed.
Dietary behaviours of volunteers for a nutrition education program, compared with a population sample
Authors: Smith Alison M. , Baghurst Katrine I. , Owen Neville
Published: August 2010

Abstract: The dietary behaviours of and recent dietary change by volunteers for a nutrition education program were compared with those of a more population‐representative sample. The population sample was randomly selected from the electoral rolls of three Australian cities. Those selected received questionnaires which were to be completed and returned by mail. The sample of volunteers was recruited from the electoral rolls of suburbs of either high or low social status in one of these cities. Volunteers were posted a questionnaire, to be returned in person. A quantified food frequency questionnaire was used to estimate relative intake of 19 nutrients, plus energy intake. Occupation, age, sex, reported recent dietary change and diet‐related beliefs were also assessed. The population sample was weighted to the age and occupational distribution of the education program sample. Compared to the 874 respondents in the population sample (70.4 per cent response rate), the 487 volunteers (24.2 per cent response rate) for the nutrition education program had healthier nutrient intakes and reported more dietary behaviour changes. Recruitment in the education program was greater in areas of higher social status (32 per cent) than in areas of lower social status (20 per cent). The potential effect of such a program on the whole population was demonstrated by the proportions that volunteered and the characteristics of these volunteers. The need to provide a range of opportunities for changing dietary behaviour, according to the health‐related behaviours and beliefs of target groups and their socioeconomic circumstances, was highlighted.
Leisure‐time physical activity and other health behaviours: are they related?
Authors: Johnson Natalie A. , Boyle Catherine A. , Heller Richard F.
Published: August 2010

Abstract: Data on the associations between leisure‐time physical activity and other health behaviours are conflicting. The National Heart Foundation 1989 Risk Factor Prevalence Survey data were analysed to examine the associations between leisure‐time physical activity and other life‐style health behaviours in a national representative sample with adjustment for potential confounders. Multivariate stepwise logistic regression analysis using data from 9054 respondents aged 20 to 69 years showed that participation in leisure‐time physical activity, even when it was not vigorous, was weakly associated with not smoking, following a special diet and moderate consumption of alcohol; it was inversely associated with obesity. These weak associations could influence health practices at a population level if, as has been hypothesised, the adoption of leisure activity promotes the adoption of other good health practices. Confirmation of earlier findings of cross‐sectional associations between activity and other positive health practices justifies future prospective or experimental studies to determine the behavioural response to adoption of leisure‐time physical activity.
Inpatient cervical screening: a survey of patient acceptability
Authors: Ruge Annette , Lee Christina , Brown Wendy J.
Published: August 2010

Abstract: Offering Pap tests to hospital inpatients could increase cervical screening rates. A survey to examine the acceptability of this concept was conducted with female inpatients in a rural public hospital. A large majority reported that they would find hospital Pap tests acceptable. Acceptability was not related to Pap test status, attitudes, or knowledge of cervical cancer. This strategy may provide access to cervical screening for underscreened groups.
A controlled trial of educational visiting to improve benzodiazepine prescribing in general practice
Authors: de Burgh Simon , Mant Andrea , Mattick Richard P. , Donnelly Neil , Hall Wayne , Bridges‐Webb Charles
Published: August 2010

Abstract:A randomised controlled trial studied the effect of an educational visit on benzodiazepine prescribing. An approximately representative sample of 286 general practitioners was allocated to an intervention or a control group. Rates of benzodiazepine prescriptions were derived from two comprehensive self‐report surveys seven months apart. Two months after the first survey the intervention group received an educational visit and supporting material from a doctor or pharmacist, ostensibly unconnected with the surveys. The overall benzodiazepine prescribing rate fell by 23.7 per cent from the first to the second surveys, from 4.93 to 3.76 prescriptions per 100 encounters (P< 0.001). Anxiety and insomnia diagnosis rates also declined from 4.68 to 3.76 per 100 encounters (19.7 per cent). After adjusting for confounders, there was a differential downward trend in prescriptions per diagnosis of insomnia but not to a statistical level. The same was true of initial prescriptions per insomnia diagnosis. In a subsidiary analysis selecting only new insomnia diagnoses, the intervention had a strong effect in reducing initial prescriptions (odds ratio 0.18, 95 per cent confidence interval 0.04 to 0.73). No effect was seen on prescribing for anxiety diagnoses. Educational practice visiting for benzodiazepine prescribing in anxiety, as we conducted it, is not justified in an unselected population of general practitioners. Specific education on prescribing for insomnia is probably useful. Our interpretation of the reduction in benzodiazepine prescribing is that probably there was an effect from self‐monitoring alone which overwhelmed a main‐analysis intervention effect. Retrospective diagnosis may also have obscured a real intervention effect.
Critical path analysis for the management of fractured neck of femur
Authors: Tallis Graham , Balla John I.
Published: August 2010

Abstract: The aim of this study was to determine the effect of a critical path analysis, used as a management tool, on the efficiency of clinical service delivery for patients with a fractured neck of femur. It is a before‐and‐after study of the medical records of all patients admitted between October 1992 and October 1993 with a primary diagnosis of fractured neck of femur, but excluding patients under 50 years old and those with multiple fractures or metastatic disease. Patients fell into two groups: those admitted in the six months before the introduction of a clinical management program based on a critical path analysis, and those admitted after the introduction of the program in April 1993 (88 program cases and 90 nonprogram cases). A medical records administrator blinded to the program category of the patients independently coded diagnostic data, while other data were abstracted from the clinical notes. The length of stay for a fractured neck of femur declined from a mean of 19.3 days to a mean of 11.0 days (P < 0.0001). The outcome measures were: the distance walked just before discharge from hospital, the discharge destination, and unplanned readmission. These did not change significantly, and the wound infection rate declined during the period of the intervention. The implementation of a clinical management pathway based on a critical path analysis dramatically reduced the length of stay for patients admitted with a fractured neck of femur while maintaining quality of outcomes. Critical path analysis is a useful management tool to improve the efficiency of certain clinical services.
Cost‐effectiveness of alternative interventions for the prevention and treatment of coronary heart disease
Authors: Crowley Steven , Dunt David , Day Neil
Published: August 2010

Abstract: Although mortality from coronary heart disease (CHD) in Australia has fallen dramatically since the 1960s, it still remains the major cause of death in Australia and poses a significant burden on the economy. Even though a number of studies have concluded that prevention has been the main determinant of the declines in CHD, a disproportionate amount of health‐care expenditure is devoted to treatment rather than prevention. This paper reviews the international literature on the economic appraisal (costs and benefits) of alternative interventions for the treatment and prevention of CHD with the view of assessing whether there is sufficient evidence to justify a reallocation of resources away from treatment to prevention. First, few studies on the economic evaluation of CHD prevention and treatment programs have been undertaken in Australia, with most being from the United States and Europe. Second, assumptions about the specification, measurement and valuation of costs, and the epidemiological evidence on program effectiveness have varied. Third, health promotion and prevention programs are not necessarily more cost‐effective than drug or surgical treatments for CHD. Individual interventions must be judged on their own merits. There is a need for a systematic evaluation of interventions for CHD using primary Australian data to better inform decision making on resource‐allocation priorities. Such an evaluation should incorporate economic evaluation techniques.
Use of hormone replacement therapy by Melbourne women
Authors: Shelley Julia M. , Smith Anthony M. A. , Dudley Emma , Dennerstein Lorraine
Published: August 2010

Abstract: Hormone replacement therapy (HRT) is used for relief of symptoms related to the menopause and for the prevention of postmenopausal osteoporosis and cardiovascular disease. Patterns of use of HRT are thought to be changing rapidly, but little is known about who is using the therapy, for what purpose or for what period of time. Telephone interviews were conducted in May 1991 with a randomly selected sample of 2001 Australian‐born women aged 45 to 55 years living in Melbourne, as part of the Melbourne Women's Midlife Health Project. Questions related to use of HRT, health status, use of health services, sexual functioning, attitudes to menopause and aging, and sociodemographic characteristics. Twenty‐one per cent of the sample were using HRT. Use was more prevalent among women 50 years and over (28 per cent) than those under 50 (15 per cent). Seventeen per cent of nonhysterectomised women, 31 per cent of hysterectomised women and 49 per cent of women who had undergone hysterectomy and bilateral oophorectomy were current users. Almost 60 per cent had been using the therapy for two years or less, and 34 per cent for one year or less. Just over half reported control of hot flushes as a benefit, and 10 per cent mentioned prevention of bone loss as a benefit Logistic regression analysis identified differences between users and nonusers in experience of hot flushes, health status, use of preventive and treatment services, sexual functioning, wellbeing, attitudes to menopause and aging, and sociodemographic characteristics. These differences may relate to risk of later cardiovascular disease.
Socioeconomic indices and suicide rate in Queensland
Authors: Cantor Christopher H. , Slater Penelope J. , Najman Jake M.
Published: August 2010

Abstract: Suicides identified from a suicide register were classified according to socioeconomic indices of statistical local areas. Suicide rates were correlated with socioeconomic disadvantage, as measured by the proportion of persons of low income, low education and high unemployment living in an area. Suicide rates were inversely related to the proportion of families on high income, who owned their homes and who had large houses. Suicide rates of older people (55 years and over) were least influenced by these factors. For females, only the most disadvantaged areas had higher suicide rates. In other age and sex groupings, relationships were mostly linear.
Public health aspects of tattooing among Australian adults
Authors: Houghton Stephen , Durkin Kevin , Turbett Yasmin
Published: August 2010

Abstract: Medical, criminological and psychiatric literatures have pointed to risks associated with tattooing, but most of this work has been conducted with samples which have other known risk factors or disturbances. This paper investigates the reasons, experiences, methods, and perceived consequences of obtaining tattoos among a sample of Australian adults. The findings complement, extend and in some respects contrast with earlier research. Like other researchers, we found that most people acquire tattoos when they are relatively young. Unlike earlier research, we did not find widespread dissatisfaction and regret. Sex differences emerged in location and design of tattoos. A majority of tattooed people report awareness of others' negative stereotypes of them.
Food consumption of parents on low incomes
Authors: Buchhorn Des
Published: August 2010

Abstract: In the Redfern area in metropolitan Sydney, there are many people on low incomes living in public housing. To investigate their nutritional status, a sample of 60 parents in this area was interviewed; 51 participants completed a food frequency questionnaire. Participants also completed weighed food records. The weighed food records showed energy intakes lower than expenditure calculated as necessary to maintain body weight (as estimated by the Schofield equation and activity factor). Therefore, the data are unlikely to be accurate and are not reported here. The food‐frequency questionnaire indicated energy intakes close to those required to maintain body weight. Recorded nutrient intakes were similar to those recorded in other Australian studies. Fat supplied 35.6 per cent of the energy in the diets of the sample, compared to 37.3 per cent in the National Dietary Survey. Although the results were obtained by convenience sampling and may not be representative, the results do suggest that some parents on low incomes are able to maintain nutrient intake similar to that of the wider community.
The cost‐effectiveness of compulsory bicycle helmets in New Zealand
Authors: Hansen Paul , Scuffham Paul A.
Published: August 2010

Abstract: This paper examines the cost‐effectiveness for primary school children (age 5–12 years), secondary school children (13–18 years) and adults (over 18 years) of the legislation enacted on 1 January 1994 requiring road‐cyclists in New Zealand to wear helmets. The cost to cyclists not in possession of a helmet before they became compulsory of either obtaining one or quitting cycling was compared with the number of deaths and hospitalisations expected to be prevented over the average life of a helmet. Corresponding to Victorian and United States estimates of the efficacy of cycle helmets at preventing serious head injuries, the cost per life saved was $88 379 to $113 744 for primary school children, $694 013 to $817 874 for secondary school children, and $890 041 to $1 014 850 for adults (New Zealand dollars = approximately 0.95 Australian dollars). The cost per hospitalisation avoided was $3304 to $4252, $17 207 to $20 278, and $49 143 to $56 035 respectively. These estimates are extremely sensitive to the estimated efficacy of helmets at protecting cyclists. Mainly anecdotal evidence for New Zealand suggests that they are not be very effective at preventing serious head injuries; future research into the change in injury patterns as a result of the helmet regulation would be valuable. Nonetheless, the ranking of the above mentioned estimates does not contradict the policy in some parts of the world requiring helmets for children and/or teenagers, but not adults.
Declining blood lead levels in Victorian children
Authors: Taylor Roscoe , Bazelmans Jeff , Golec Robert , Oakes Simon
Published: August 2010

Abstract: To investigate the distribution of blood lead levels in a sample of Victorian children, and to compare current levels with those from a similar survey in 1979, blood was tested for lead in 252 children (123 under five years) attending Royal Children's Hospital as outpatients and having venepuncture blood samples for medical reasons. Blood lead levels were determined by graphite furnace atomic absorption spectrophotometer. The mean blood lead level was 0.26 μmol/L (5.4 μg/dL). In the under‐five age group, the mean was 0.28 μmol/L (5.7 μg/dL). Only 1.6 per cent of this group exceeded the National Health and Medical Research Council action level of 0.72 μmol/L (15 μg/dL). Levels in this age group have declined significantly since 1979, when the mean was 0.54 μmol/L (11.1 μg/dL) and 12.9 per cent exceeded 0.72 μmol/L (15 μg/dL). Average blood lead levels have halved since 1979, with likely contributing factors being reduced exposure from lead in diet, reduced access to lead in paint and reduced lead in ambient air. Children with elevated levels had identifiable risk factors such as pica or exposure to lead‐based paint, suggesting the need for ongoing public health action to prevent exposure in these groups.
Increasing attendance at immunisation clinics: lessons from a trial program that failed
Authors: Bazeley Pat , Kemp Lynn
Published: August 2010

Abstract: Previous studies suggested that the use of a baby‐enrolment and reminder system for early childhood immunisation increased public immunisation clinic attendance. It was decided to run a trial to assess the effects of introducing a baby‐enrolment program on attendances at local government immunisation clinics. Enrolment leaflets were distributed to each mother of a new child in six areas of greater Sydney while the mother was in the postnatal ward of the local hospital. Clinic attendance figures were monitored, interviews were conducted with mothers as well as professionals involved in early childhood health services, and the conduct of clinics was observed. The trial failed to increase attendance at public clinics. Mothers' reasons for choice of service, particularly their desire for what they believed to be a more personalised service, and the attitude of the professionals (particularly community nurses) with whom they came in contact were considered to be more influential in determining their use (or lack of use) of public immunisation services. Baby enrolment may be effective in increasing attendance at public immunisation clinics only where there is willing cooperation of all stakeholders in supporting public immunisation services.
Injury morbidity in Victoria among adults 25 to 64 years of age: implications for prevention
Authors: Sherrard Jennifer , Day Lesley M.
Published: August 2010

Abstract: The aim of this retrospective study was to complete the baseline descriptive epidemiology of hospital‐treated injury for all ages in Victoria, by focusing on the age group, 25 to 64 years, to identify major categories of injury and the potential for prevention. We analysed injury databases for hospital admissions and emergency department presentations for major variables influencing injury frequency and rates. We found that nearly 40 per cent (158 537) of all hospitalisations for injury occurred in the study age range. The major causes of injury were health‐care related causes (32 per cent), falls (15 per cent), transport (14 per cent), and intentional causes (10 per cent). The leading reason for emergency department presentation (excluding admission) was unintentional cutting or piercing injury. The home was the major location of injury. Vehicles, man‐made and natural surfaces, knives, and floors and flooring materials were among the leading five factors potentially associated with both admissions and presentations. Injury prevention in this age range will be largely addressed by the injury‐prevention strategy being implemented in Victoria. However, specific additional issues were identified, including falls from ladders and scaffolds, pedestrian and female passenger injury, and injury associated with power tools, chain saws, and knives.
High mortality from renal disease and infection in Aboriginal central Australians with diabetes
Authors: Phillips Christine B. , Patel Mahomed S. , Weeramanthri Tarun S.
Published: August 2010

Abstract: Few studies have examined the consequences of the high prevalence of diabetes in Aboriginal communities. We aimed to determine the rates and causes of mortality in all Aboriginal central Australians with diagnosed diabetes, identified by a previous study (n = 374). Cohort members were followed from 1 January 1984, or the date of diagnosis (to 31 December 1986), to 31 December 1991 or death. Death certificates, medical notes and autopsy reports were examined for cause of death. There were 130 deaths in 2280.7 person–years of follow‐up. Standardised mortality ratios for Aboriginal people with diabetes, compared to the Northern Territory Aboriginal population, were 209 (95 per cent confidence interval (CI) 158 to 273) for men and 169 (CI 129 to 218) for women. The difference in ratios for men and women was not statistically significant when adjusted for age (P = 0.2). The eight‐year survival rates for men and women diagnosed between 1984 and 1986 were 55.8 per cent (CI 32.6 to 73.7) for men and 80.3 per cent (CI 64.8 to 89.5) for women. Renal disease was the direct cause of death in 22.3 per cent Infection accounted for 20.8 per cent of deaths and ischaemic heart disease for 13.8 per cent Forty‐four per cent of death certificates made no mention of diabetes. Diabetes confers an additional risk of death on a population whose mortality is already markedly worse than that of other Australians. Unlike Western diabetic populations, infections and renal disease were more common causes of death than macrovascular disease. Diabetes amplifies the effect of the community prevalence of infection and renal disease.