bluuebunny/crossref_metadata_2025 huggingface dataset:
The implementation of community‐based crisis services for people with acute psychiatric illness
Authors: Finch Susan J. , Burgess Philip M. , Herrman Helen E.
Published: August 2010

Abstract: This article describes three recently established community‐based crisis services for people with acute psychiatric illness. Data were obtained from local information systems developed in the early phase of service operation. Patterns of service were found to vary among the teams in terms of the frequency of contact with the client, the period of contact with the client and the overall numbers of contacts. Such diversification of services reflects, at least in part, the differences in the service networks within which the new services were set. Such diversification of services is inevitable and creative, and the evaluation of these services must consider not only the short‐term impact of crisis services, but also the impact of the network of care services on longer term outcomes for the client.
Cost efficiency of neonatal nurseries: the significance of unit size
Authors: John Elizabeth , Hind Neville , Roberts Victor , Roberts Sharyn
Published: August 2010

Abstract: The cost of neonatal intensive care is high, and human and financial resources are finite. It is therefore essential to provide such care efficiently in terms of costs while still maintaining standards of care. We looked at the relationship of unit size to cost and determined the optimum and minimum size of the unit in terms of cost efficiency. Our data suggest that units with fewer than 6 ventilator cots were less cost‐efficient than those with more cots while those with 12 ventilator cots were the most efficient. The calculations were done only up to 16 ventilator cots. Similarly, level II units were most cost‐efficient when attached to an intensive care unit and had over 16 cots.
A family study of coronary risk factors in Geelong
Authors: Tienboon Prasong , Rutishauser Ingrid H. E. , Wahlqvist Mark L.
Published: August 2010

Abstract: A study of coronary risk factor relationships was carried out in 213 families with adolescents in Geelong, Victoria, Australia, in 1987. Weight, height, skinfold thicknesses, body circumferences, blood pressure and serum cholesterol were measured in both parents and children and other relevant information was obtained by questionnaire. The study group did not differ significantly from the Geelong population with respect to the proportion of Australian‐born parents but contained a significantly higher proportion than expected of fathers who had a university degree or diploma. Twenty‐five per cent of adolescents, 30% of mothers and 38% of fathers were positive for at least one of the three major established coronary risk factors. Significant correlations between parents and children, but not between parents, were found for total cholesterol and systolic blood pressure, while significant correlations were observed both between parents and children and between parents for measures of body size, body fatness and body fat distribution. The strongest predictors of risk factor status in adolescence were both parents with total cholesterol at or above 5.5 mmol/1, one or more parents who smoked and one or more grandparents with a history of coronary heart disease. Body mass index in adolescence was unrelated to heart disease risk factor status in adolescence or to a family history of heart disease. During early childhood and adolescence, parental risk factor status, rather than anthropometric or risk factor screening of the children themselves, is likely to provide the best guide to those at risk for an adverse coronary risk factor profile.
Measles immunisation compliance: poor impact of Bicentennial measles control campaigns on children under five
Authors: Ferson Mark J. , Christie Doreen
Published: August 2010

Abstract: A measles immunisation survey was conducted among children who enrolled in school kindergarten classes in the Eastern Sydney Area in 1989. Its aims were to determine baseline compliance rates, to identify subpopulations at risk of poor compliance and to evaluate the impact of the bicentennial measles control campaigns on compliance among children under five years. All 73 schools participated, questionnaires were returned by 2230 (81.4%) children, and compliance with immunisation was 91.3%. 89.1% of children attending public schools were immunised, compared to 91.9% of Catholic school pupils and 95.8% of independent school pupils (X2 = 21.4, P < 0.001). Among public school children, 91.6% of pupils from English‐speaking families were immunised in comparison to 81.4% of pupils from non‐English‐speaking backgrounds (X2 = 20.5, P ≤ 0.001). The fraction of previously unimmunised children who were known to have been immunised during each year of the measles control campaigns was 16% in 1986–87,10% in 1987–88 and 9% in 1988–89. These small increments in immunisation uptake suggest that under‐five‐year‐olds were not effectively targeted by the measles control campaigns. However, no control group was evaluated. Immunisation delivery systems must be designed which ensure that all children receive measles‐mumps‐rubella vaccine as soon as possible after the first birthday. Immunisation promotions and service providers will need to target specific language and socioeconomic groups.
Aspirin use in children: heeding the warning?
Authors: Hancock Lynne , Henry David A. , Sanson‐Fisher Robert W.
Published: August 2010

Abstract: In 1986, the Australian Government issued warnings about the use of aspirin for children and adolescents after the link had been established between aspirin use and Reye's syndrome in America. This study questioned a representative community sample of parents in Newcasde, New South Wales, about their awareness of this caution, and their recent aspirin use for children under 18 years. While 65% of women and 47% of men reported that they were aware of the Government recommendations, only 8% of women and 9% of men reported obtaining this information from the printed warning on the medicine container or packet. Despite awareness of the warnings, almost one third of parents reported administering aspirin to their children. When it is necessary to caution patients about the use of over‐the‐counter medications, it is not sufficient to use package labelling as the main site of information.
The public perception of the risks and benefits of alcohol consumption
Authors: Hall Wayne , Flaherty Bruce , Homel Peter
Published: August 2010

Abstract: A survey of the community was undertaken in August 1989 to assess the public's perception of the risks and benefits of alcohol use, and their understanding of recommended levels of safe alcohol consumption. A household sample of 500 men and women (18 to 65 years) in metropolitan and rural New South Wales were asked their opinions about the risks and benefits of alcohol use, the health and social consequences of ‘drinking too much’, and the number of standard drinks that would produce a low, medium and high risk to the health of an adult man and woman. The major perceived benefits of alcohol use were relaxation and medication; the major health and social problems attributed to alcohol abuse were brain and liver damage, and domestic violence and family problems. The quantities of alcohol which respondents thought could be consumed with a ‘low’ risk to health were close to National Health and Medical Research Council recommended levels of safe consumption.
Evaluating the impact of a promotional campaign for screening mammography: women's knowledge and sources of awareness
Authors: Turnbull Deborah , Adelson Pamela , Irwig Les
Published: August 2010

Abstract: The Breast X‐Ray Programme of the Central Sydney Health Service was advertised by generalised strategies aimed at the total community, including poster and pamphlet distribution, and strategies aimed at general practitioners, supplemented by written invitations and recommendation from the general practitioner, invitations for friends, and invitations from the service using the electoral listing. In order to evaluate the reach or impact of the promotional campaign in the Drummoyne local government area, telephone interviews were conducted with women aged 45 to 70 randomly selected from the community. Women's knowledge about breast cancer, screening and the Breast X‐Ray Programme, plus sociodemographic characteristics, were obtained before screening (n = 628), 10 months (n = 93) and 2 years after screening started (n = 206).

While knowledge about risk did not change, significant increases were found in the proportion of women who had heard of mammography, screening mammography specifically and the screening van. In addition there were significant increases in the proportion of women exposed to information about screening mammograms. The campaign generally had an equal effect on different sociodemographic but managed to achieve greater effects in women of non‐English‐speaking backgrounds and lower occupational status. A random sample of program attenders aged 45 to 70 (n = 763) were asked how they found out about the van. ‘Seeing the van’ was the most consistently reported source of awareness. Others included ‘GPs’, ‘newspapers’, ‘other print media’ and ‘personal networks’. Women with additional qualifications since leaving school were more likely to state ‘newspaper’ and ‘other print media’ as a source.
Progress in assessing the quality of Australian nursing home care
Authors: Braithwaite Valerie , Braithwaite John , Gibson Diane , Makkai Toni
Published: August 2010

Abstract: This paper critically examines the clarity, practicality, desirability and validity of the 31 outcome standards that the Commonwealth Government introduced to assess quality of care in Australian nursing homes. Key features of the Australian system in an international context are its focus on outcomes, the limited number of standards used, and the comparatively subjective nature of some standards. Directors of nursing from 410 nursing homes in the Brisbane, Sydney, Melbourne and Adelaide metropolitan areas were interviewed as part of the Nursing Home Regulation in Action Project. The overwhelming majority reported the standards as clear and desirable. In the minority of cases where problems were raised, practicability was the basis for concern. A factor analysis of the ratings given by standards monitoring teams to these 410 homes failed to demonstrate redundancy across standards or grouping of standards by objectives. Nevertheless, the standards were sufficiently highly interrelated to justify summing to produce an overall compliance score. This study shows that the 31 standards hold up well under scrutiny, both from the perspectives of key actors in the monitoring process, and from a psychometric point of view.
Historical trends in road accident types, deaths and casualties in Western Australia
Authors: Harris Anthony H. , Cercarelli L. Rina , Hobbs Michael S. T.
Published: August 2010

Abstract: Road accident casualties are major consumers of health service resources in Australia, using inpatient care, accident and emergency treatment and other facilities. We analysed hospitalisations resulting from road accidents in Western Australia from 1968 to 1987 to examine trends in accident types, deaths and casualties. Data from the Western Australian Health Department's Hospital Morbidity System were used. Although hospitalisations from road accidents generally decreased, they were still higher than the Australian average in 1985. The rate of decline in hospitalisations was similar to that for fatalities and was not generally related to age or sex. There was some evidence of a more rapid decline in the rate of severe injuries than in minor ones. Further steps need to be taken to reduce the number of casualties from road accidents, as road accidents represent a major public health problem in Western Australia.
Cultural identification in Aboriginal and Torres Strait Islander AIDS education
Authors: Hill Peter S. , Murphy G. Joseph
Published: August 2010

Abstract: The emergence of the disease AIDS in the early 1980s has resulted in a unique response. Medical, sociocultural, political, sexual, moral and racial issues have all been raised. This paper examines the way in which participation of Aboriginal and Torres Strait Islander people has resulted in the culturally appropriate and distinctive approaches evident in health education materials produced in Aboriginal and Torres Strait Islander communities. Specific cultural issues relevant to AIDS education are considered, including: the use of visual and narrative communication for AIDS education; the significance of the specific concepts related to communication on sexual issues; perceptions of AIDS as alien and genocidal; the use of the Dreaming in AIDS educational resources; and implications for AIDS education.
Preventive health behaviours among parents of infants aged four months
Authors: Redman Selina , Booth Peggy , Smyth Howard , Paul Christine
Published: August 2010

Abstract:Six preventive health behaviours have been frequently identified as having the potential to reduce mortality and morbidity during infancy: breast‐feeding until the age of six months; no solid food until after four months of age; immunisation against whooping cough, diphtheria, poliomyelitis and tetanus; the use of a baby capsule to restrain the infant when travelling in a motor vehicle; regular attendance at a health care provider for preventive health checks; and no maternal smoking. This study surveyed 191 primiparous women four months after the birth of their babies to explore the proportion of parents who perform the recommended preventive health behaviours and the association among the behaviours. Thirty‐nine per cent of the women reported that they were no longer breast‐feeding by the time their infant was four months old; 35 per cent had introduced solids before 16 weeks of age; 35 per cent did not always use a baby capsule when travelling with their baby in their car; 25 per cent did not regularly attend the early childhood health centres and 22 per cent smoked. Forty‐eight per cent of the sample were performing four or fewer of the six preventive health behaviours and 21 per cent were performing three or fewer. The relationship between performing each preventive health behaviour and a range of demographic variables was investigated. A logistic regression indicated that performing three or fewer of the health behaviours was associated with lower levels of education, having public health insurance and being born in a country other than Australia.
Diarrhoea in Australian Aborigines
Authors: Gracey Michael
Published: August 2010

Abstract: Infectious diarrhoea has been recognised as a serious public health problem for Aboriginal Australians, particularly infants and young children, for more than two decades. These diseases are caused by bacterial, viral and parasitic infections which are spread mainly by the faecal‐oral route and which must be interrupted if prevention is to be effective. This paper reviews published reports on this subject and interventions which have been used elsewhere to reduce the incidence of infectious diarrhoea. These reports have important implications for Aboriginal health but interventions and strategies to overcome this problem must recognise the unique circumstances of Aboriginal people in Australia.
The cost of cervical cancer screening provided by a women's health nurse
Authors: Furber Susan E. , Donaldson Cam
Published: August 2010

Abstract: This study examines the cost of cervical cancer screening provided by a women's health nurse. Methods used to estimate the cost of taking a Pap smear were based on the economic principle of opportunity cost. Techniques for estimating the magnitude of some costs were developed specifically for this study because the cost of taking a Pap smear had to be isolated from the costs of other services provided by the women's health nurse. The cost of taking a Pap smear in 1989 was estimated to be between $17.68 and $17.95. A sensitivity analysis was carried out so that the results of this study could be adapted for practices which differ from the women's health nurse's practice in the Mount Druitt and Hawkesbury area of New South Wales. As a result of this analysis, the cost of taking a Pap smear ranged from $14.16 to $38.88, depending on whether the women's health nurse was a Clinical Nurse Consultant or Clinical Nurse Specialist, the number of Pap smears taken, the proportion of clients who come for postnatal examinations, length of consultations and the distance travelled. It should be noted that the cost of taking a Pap smear would rise considerably above $38.88 for women's health nurses working in remote areas.
Compliance with dietary goals in a Queensland community
Authors: Radimer Kathy L. , Harvey Philip W. J. , Green Adele , Orrell Elizabeth
Published: August 2010

Abstract: Dietary goals designed to improve nutritional health and lower the risk of chronic disease have been drawn up in Australia. Compliance with quantified goals was assessed in a random sample of 91 residents of Nambour, a typical community in southeast Queensland. Compliance was highest for alcohol and cholesterol goals. About three‐quarters of the sample complied with the goal of limiting alcohol intake to five per cent of energy intake, and over half complied with the goal to limit daily cholesterol intake to less than 300mg. Compliance was lower for total fat and fibre goals. About 40% of the sample complied with the goal of consuming less than 33% of energy as fat or the goal of consuming 30g or more fibre per day. Compliance was slightly better for women than for men. Only a small proportion of the sample complied with goals to increase total carbohydrate intake to 55% or more of energy, or to limit saturated fatty acid intake to 10% of energy. For each of the goals, some were far from complying. In general, compliance with goals was lowest for males under 40 and was also low for women under 40.
Hearing loss—an underestimated public health problem
Authors: Wilson David , Xibin Sun , Read Pamela , Walsh Paul , Esterman Adrian
Published: August 2010

Abstract: Estimates of hearing loss in Australia, collected over the last decade and a half, have reported a prevalence rate ranging from 0.1 to 7 per cent. This survey of a random sample of South Australians provides, depending upon definition, two estimates of 15 and 19 per cent. These data suggest that hearing loss has been underestimated as a public health problem. The need for an epidemiological study which measures actual hearing impairment, which can be used to develop an appropriate public health response, is discussed.
Arthritis outpatients: disability, pain and alcohol use
Authors: Blaze‐Temple Debra , Barrett Tanya , Howat Peter , Binns Colin W.
Published: August 2010

Abstract: There is a small body of literature describing investigations into the relationships between pain and disabling conditions and alcohol consumption. Of these few studies, most have concluded that pain and disability are positively associated with alcohol consumption, though these particular studies have not been methodologically rigorous. Arthritis is the most prevalent of the disabling conditions, and one of the major symptoms of arthritis is pain. Several factors associated with the disease are thought to make arthritis sufferers particularly vulnerable to the use of alcohol for its mind‐altering and analgesic properties. In the present study, conducted in 1987, a sample of 154 Perth arthritic outpatients were interviewed to investigate the relationship between pain, disability and alcohol consumption. Results showed that pain and disability scores were very weak predictors of volume of weekly alcohol consumption for males, but the relationship was in a negative direction. Results from a previous study were confirmed in the finding that being an ex‐drinker was a predictor of a higher disability score for females. Fewer patients were drinkers than in the population at large and fewer drank at the level of the highest consumption category. However, the proportions of male and female patients drinking above NHMRC low risk levels were the same as the general population (age‐standardised comparison). Most who considered themselves current drinkers said that alcohol did not help their pain, stiffness or weakness. Various possible explanations are offered for these results and recommendations for future research are presented.
Paying for efficiency: what price the quality of hospital care?
Authors: Shiell Alan
Published: August 2010

Abstract: Economic recession prompts governments and health service ministers to seek increased efficiency in the production of hospital services in order to reconcile increasing demands with scarce resources. As one approach to the problem, the National Health Strategy is recommending pilot schemes, similar to those which have been introduced in both the United Kingdom and the Netherlands, which involve the separation of purchaser from the provider of hospital services. It is argued that such separation, with the introduction of competition between providers of hospital services for contracts placed by publicly funded Area Health Boards, will increase efficiency and accountability in the use of resources. However, this argument ignores the hospital management's ability to keep costs down by altering the quality of hospital care in ways which are difficult to monitor by purchasing agencies. The article considers the effects the introduction of managed competition is likely to have on the quality of hospital services. The outcome is uncertain and competition may improve some dimensions of quality while jeopardising others. If managed competition is tried in Australia, the opportunity should also be taken to examine its impact on the quality and outcomes of hospital care.
Socioeconomic correlates of mortality and hospital morbidity differentials by Local Government Area in Sydney 1985–1988
Authors: Taylor Richard , Quine Susan , Lyle David , Bilton Alan
Published: August 2010

Abstract: Objective: To determine the magnitude of differentials in mortality and hospital morbidity by Local Government Area (LGA) in Sydney (1985–1988), and to correlate these with LGA indicators of socioeconomic status.

Design: Cross‐sectional group‐based comparative study of mortality and hospital separations, and a group‐based correlations analysis in relation to socioeconomic indicators.

Outcome measures: Mortality—life expectancy at birth, infant mortality, 0‐ to 4‐year mortality, age‐standardised 15‐ to 64‐year mortality (all‐cause and various causes), sex‐specific (except infant and 0‐ to 4‐year mortality). Hospital morbidity rates—0‐ to 4‐year hospital separations, age‐standardised 15‐ to 64‐year hospital separations (all‐cause and various causes), sex‐specific.

Study factors: Census‐derived LGA proportions of immigrants, Aborigines, professionals, unskilled workers, unemployed persons, those with a university degree and those having no qualifications, and the composite Ross Indicator.

Results: Considerable differences in mortality and hospital morbidity by LGA in Sydney were found. Males had higher mortality and lower rates of hospital separation than females. LGA differentials were most obvious for adults, with little variation noted for infants or children. Most socioeconomic indicators were highly correlated with adult mortality and hospital morbidity in the expected direction, particularly indicators of low socioeconomic status. The unemployment rate, proportion Aboriginal, proportion unskilled, proportion unqualified, and the Ross Indicator were the most highly correlated variables.

Conclusions: There are persistent differentials by LGA in mortality and hospital morbidity in Sydney which are strongly associated with socioeconomic status. The Ross Indicator was found to be a useful composite indicator. The high correlations of mortality and hospital morbidity with the unemployment rate raise the question of to what extent this is due to illness and premature mortality in the unemployed. Monitoring of health status differentials needs to continue if progress towards Health For All targets is to be evaluated.
A note on sex‐specific mortality and social class in Sydney, 1979 to 1983
Authors: Byth Karen , McIntosh Jean H. , Piper Douglas W.
Published: August 2010

Abstract:Simple indicators such as education, income, occupation, and employment status are often used to adjust for social class in studies of morbidity or mortality. The effect of social class on such outcomes can be different for men and women. In population‐based studies, residential area may be the only means of assessing social class. This study investigated sex differences in the association between mortality between 1979 and 1983 and several area indices of social class—percentage with a degree, percentage professional, percentage blue collar, percentage unemployed, percentage with annual income greater than $40 000, and the composite indicator constructed by the Australian Bureau of Statistics. Thirty‐seven Sydney statistical local areas were ranked for men and women separately according to the indicators and standardised mortality ratios. Correlations between the indicators and mortality were all negative and stronger for men than for women. The composite indicator and percentage unemployed correlated most strongly with mortality. There was a moderate correlation between the remaining indicators and mortality for men, but only a weak correlation for women. The results suggest that the use of simple area indicators may be inadequate to classify the social class of women, and that the unemployment rate in those over 35 years of age may be a reasonable alternative to the composite indicator for the purpose of social class adjustment in mortality studies.
Availability of cigarettes to minors
Authors: Sanson‐Fisher Robert W. , Schofield Margot J. , See Mia
Published: August 2010

Abstract: Legislation banning the sale of cigarettes to minors is potentially a cost‐effective means of reducing smoking rates among adolescents. Such legislation has been in existence in Australia for over 80 years. Two studies examined the retail industry's adherence to the sales ban in two regions of New South Wales in 1990. The first study was a survey of 1 849 12‐ to 15‐year‐old adolescents from 12 high schools in New South Wales, providing data on self‐reported purchasing of cigarettes from retail outlets by minors. In all, 38 per cent reported having purchased cigarettes illegally. A second study was undertaken to determine the proportion of retail shops which sell cigarettes to apparently underage youth. Two 16‐year‐olds who looked young for their age attempted to purchase cigarettes from 101 different retail outlets in one region of New South Wales. No challenge about age was made for 70 per cent of purchases, and proof of age was requested on only 15 per cent of occasions. The results suggest that legislation banning sales of cigarettes to minors requires strong enforcement procedures to be effective.
Public knowledge about characteristics of moles and melanomas
Authors: Borland Ron , Marks Robin , Noy Sue
Published: August 2010

Abstract: In a study aiming to determine public knowledge about moles and melanomas 590 residents of Victoria aged 14 and over were interviewed in a face‐to‐face household survey. The majority believed that moles were primarily raised lesions. Recognition of the term melanoma was high (91 per cent), but many held misconceptions about key characteristics. Many thought an early melanoma was raised (20 per cent) or could be raised (42 per cent), compared with only 10 per cent who thought it was flat. Fifty per cent of respondents thought being ugly was a common characteristic. In response to photographs of skin lesions, a late melanoma, seborrhoeic keratosis and a squamous cell carcinoma were most likely to be identified as needing to be seen by a doctor, while a normal raised mole and two early melanomas were least likely. The data suggest that a large proportion of the community have misconceptions about the early signs of melanoma. Education programs are needed to inform the public that most early melanomas are flat. Strategies which might confuse this message, such as likening melanoma to moles, should be avoided.
A survey of contraceptive use and unplanned pregnancy in Perth, Western Australia
Authors: Webb Sandra , Holman D'Arcy
Published: August 2010

Abstract: Contraceptive use and unplanned pregnancy were studied in a stratified cluster sample of 1 511 couples with women aged 16 to 44 years resident in metropolitan Perth in 1988. Twenty‐one couples were excluded from analysis owing to missing data. The proportion of couples using contraception was 76.8 per cent (1 144 of 1 490), and all but three of the remaining couples gave a reason for nonuse. Among users, surgical sterilisation made up 42.3 per cent (484 of 1 144) of all methods, with a slight predominance of tubal ligation over vasectomy. Oral contraceptives accounted for just over half of nonsurgical methods. Comparisons with a Victorian survey performed in 1978 suggested that surgical methods and condom use may have increased, whereas use of oral contraceptives and intrauterine devices may have fallen. Unplanned pregnancies conceived during the 12 months before the interview affected 3.4 percent (51 of 1 490) of respondents. The incidence of unplanned pregnancy was four times higher in couples with inconsistent usage patterns of contraception.
Occupational injury and disease among patients presenting to general practitioners in a community health centre
Authors: Copeman Dick , Skinner Jill , Burgin Audrey
Published: August 2010

Abstract: A prospective survey was conducted of all patients presenting over a six‐month period to the primary medical care unit of a community health centre in an urban industrial area to determine the number and types of work‐related injuries and disease, the causes, and details of the injured workers and their workplaces. Two‐hundred and eighty‐three patients, 7.2 per cent of the total number of patients attending, were diagnosed as having a work‐related injury or disease; 250 patients had occupational injuries and 33 had occupational diseases. The most common injuries were open wounds, sprains and strains, contusions and eye injuries; the most frequent diseases were musculoskeletal strain syndromes, dermatitis and respiratory conditions. Most of those injured were skilled tradesmen or labourers from small (less than 30 employees) or medium‐sized (30 to 99 employees) manufacturing workplaces. In five of the local medium‐sized workplaces, more than 10 per cent of the workforce presented with occupational injury or disease in the six months. The mechanisms of injury for common injuries such as back strain and eye injuries are described. Most patients were managed totally within the primary care setting. Thirty per cent of all patients surveyed received a worker's compensation certificate. It is possible that occupational diseases were underdiagnosed and that worker's compensation was underutilised. The information obtained from the survey is being used in planning prevention.
General practitioner services under Medicare
Authors: Rosenman Stephen J. , Mackinnon Andrew
Published: August 2010

Abstract: This paper examines how general practitioner numbers, bulk‐billing rates and sociodemographic variables determined usage of general practitioners and services delivered over the period from 1984 to 1990. A 10 per cent sample of patient services, maintained by the Commonwealth Department of Health, Housing and Community Services, provided the data. Data were aggregated into 148 electorates. Separate regression analyses examined the determinants of the proportion of the population attending a general practitioner and of the number of general practitioner services delivered per patient. Determinants of the growth of these levels over the seven‐year period were also examined. Region (metropolitan versus rural), age structure and general practitioner supply were significant factors in these analyses. Bulk‐billing rates explained nine per cent of variance in patient numbers and 22 per cent of variance in service numbers after sociodemographic variables and general practitioner supply had been taken into account. The analyses suggest that bulk‐billing and general practitioner supply influence the behaviour of patients and doctors and that the effect of bulk‐billing is independent of indices of medical need. This implies that bulk‐billing may increase service rates and this increase is not clearly directed to improving access to medically necessary services. Because no measures of treatment outcome are available, it is not possible to decide whether the effects observed represent an improvement in health care or are better seen as overuse by patients and demand inducement by practitioners.
Death certification in Western Australia—classification of major errors in certificate completion
Authors: Weeramanthri Tarun , Beresford Bill
Published: August 2010

Abstract: We aimed to develop a method to classify those errors in the completion of death certificates arising from misunderstanding of the certification process. We reviewed 430 Western Australian death certificates registered in March 1990 using a method devised to differentiate between major and minor errors. Major errors were found in 16 per cent of certificates (95 per cent confidence interval 12 to 20 per cent). The error rate did not vary significantly between city and country areas, nor between teaching hospitals and other locations. The method was validated on a separate sample of 120 certificates. It has potential as a tool to monitor a critical but neglected step in the production of mortality statistics and to assess understanding of the process of death certification.
Antenatal care: a case of the inverse care law?
Authors: Brown Stephanie , Lumley Judith
Published: August 2010

Abstract: As part of a review of maternity services this study assessed satisfaction with antenatal care among 1193 women who gave birth in Victoria during two weeks of 1989, except for those who had a stillbirth or whose infant died between the birth and the survey. The survey questionnaire was mailed to women eight to nine months after the birth. The response rate, excluding duplicates, women who gave birth outside the survey period and those whose questionnaires were returned because of a change of address was 71.5 per cent. Women attending public hospital clinics were the least satisfied with antenatal care and those attending private obstetricians were the most satisfied, with general practitioners intermediate. These differences by provider accounted for almost all the differences by sociodemographic factors (age, marital status, family income, being of non‐English‐speaking background and health insurance status). While the majority of women were happy with their antenatal care, an inverse care law still applied: women whose economic and social circumstances meant they were most likely to need ‘care’ from caregivers were more likely to be limited in their choice of caregiver and to be dissatisfied with the care they received.
Community‐based cholesterol screening and education to prevent heart disease: five‐year results of the North Coast Cholesterol Check Campaign
Authors: van Beurden Eric , James Ray , Montague Denise , Christian Julie , Dunn Thérèse
Published: August 2010

Abstract: A cardiovascular disease screening and education campaign was conducted throughout the North Coast Region of New South Wales from 1987 to 1991. Objectives were: to screen 20 per cent of the adult population for blood cholesterol and other heart disease risk factors; to raise awareness of the risks associated with a high‐fat diet; to provide nutrition counselling and referral advice for those with elevated cholesterol; and to monitor these participants' cholesterol levels with a follow‐up test at three months. During the five years, 42 869 individuals or 18 per cent of North Coast adults participated, with some overrepresentation of women aged 40 to 60 years. Initially, 65 per cent of participants had elevated cholesterol levels (≥5.5 mmol/L) and 46 per cent were overweight (body mass index over 25). A three‐month retest was offered to all participants with elevated cholesterol, of whom 53 per cent attended. Participants who received nutrition counselling generally reported dietary changes which were reflected in significant cholesterol and weight reductions. Of participants who attended retest, 63 to 87 per cent had reduced cholesterol levels and 57 to 71 per cent reduced weight. A stratified random sample of participants was retested at one and three years. Reductions in cholesterol were well maintained for one year but showed signs of relapse after three years. There was a tendency for initially lower cholesterol levels to increase over a three‐year period. Contributing factors included aging, regression to the mean and complacency. Maintenance may be enhanced by regular reinforcement of nutrition changes and development of more supportive environments.
A tentative cost—utility analysis of road safety education
Authors: Shiell Alan , Smith Richard D.
Published: August 2010

Abstract: This paper sets road safety education in a health promotion context and describes the application of cost—utility analysis to the economic evaluation of road safety education in New South Wales. The application is tentative and designed to illustrate the advantages of the approach rather than to demonstrate the cost‐effectiveness of road safety education.
The definition and assessment of physical activity in cardiovascular risk reduction research
Authors: Lee Christina
Published: August 2010

Abstract: Community‐wide promotion of physical activity is becoming increasingly relevant in the development of social, economic, and health‐related policy. Such research raises issues in the assessment of physical activity on a population basis. This paper reviews definitions of physical activity for cardiovascular risk reduction and the assessment techniques which arise from them, and makes some recommendations, firstly for the identification of appropriate levels of physical activity, and secondly for the development and selection of assessment techniques. It seems that a clearer conception of appropriate activity levels for fitness and for health will require further research with a range of population groups and activity types. Greater standardisation of questionnaires, improved validity of measures, and a greater understanding of possible response biases will also improve the quality of the basic information on which interventions and policies are developed.
Comparison of three data collection methodologies for the study of young illicit drug users
Authors: Spooner Catherine , Flaherty Bruce
Published: August 2010

Abstract: Three data collection methods (street‐intercept, telephone ring‐in and focus‐group discussions) were compared for their feasibility, reliability, validity and cost. The subjects of investigation were drug‐related behaviours, attitudes and knowledge among current illicit drug users aged 16 to 21 years in Sydney. All three methods were found to be feasible and to produce reliable and valid information. Few differences in the demographic make‐up and drug‐use profiles of the samples were evident. The main differences between the data collections related to cost and the type of information obtained. The street‐intercept method was the cheapest per completed interview and the focus‐group method was the most expensive. Focus‐group discussions were considered a valuable adjunct to the surveys because they facilitated an understanding of the quantitative survey results. It was concluded that the street‐intercept method is the preferred survey method because of its lower cost and lower susceptibility to volunteer bias compared to the telephone ring‐in. For repeated data collection to monitor changes in drug use patterns, street‐intercept surveys in combination with focus‐group discussions are recommended.
A study of building structural features associated with high indoor air concentrations of organochlorine termiticides
Authors: Pisaniello Dino L. , Gun Richard T. , Tkaczuk Michael N. , Hann Christopher , Crea Joseph
Published: August 2010

Abstract: As part of a two‐year study of post‐treatment residential exposure to the termiticide, aldrin, the building structural features of ten houses with crawl‐space‐type floors were assessed by an independent inspector. Building attributes recorded on a checklist included the age of the dwelling, room characteristics, floor details and the nature of subfloor ventilation. At the end of each inspection, the inspector, who was blinded to data on airborne aldrin concentrations, provided a rating of expected indoor air contamination. Several of the building attributes, including the age of the house, the area of exterior subfloor vents, as well as the inspector's rating, were significantly correlated with airborne aldrin values. No single building variable, however, was highly correlated with every measure of aldrin concentration over a 12‐month period. The observed data are consistent with poor subfloor ventilation and a ‘leaky’ floor being important contributors to indoor air pollution. It is recommended that pest control companies advise householders about any obvious floor and ventilation deficiencies before soil treatment work is undertaken. Pesticide exposure (by analogy with geological radon exposure) may be reduced by sealing gaps in floors and/or by improving subfloor ventilation.
Inequalities in risk factors and cardiovascular mortality among Australia's immigrants
Authors: Bennett Stan A.
Published: August 2010

Abstract: Inequalities in biomedical and life‐style risk factors for cardiovascular disease were examined for 6116 immigrants to Australia and 14941 people born in Australia, using data collected in the 1980, 1983 and 1989 risk‐factor prevalence surveys. After adjusting for age and study design, significant differences were identified between immigrant groups and the Australian‐born reference group, particularly for systolic blood pressure, overall obesity and behavioural risk factors. There were few substantial differences in blood lipid concentrations and little evidence to suggest that total plasma cholesterol has played a major role in lower cardiovascular mortality among immigrants. Overall, the results suggested that profiles of risk factors commonly accepted as determinants of cardiovascular disease are an insufficient explanation of the lower standardised mortality ratios from cardiovascular disease which characterise immigrants in Australia. Systolic blood pressure best explained variation in cardiovascular mortality among male immigrants, and smoking prevalence among female immigrants. The acculturation process affected immigrant groups differently. Generally, systolic blood pressure increased with period in Australia. Body mass index increased among Asian immigrants, as did participation in physical activity during leisure time.
Quality‐adjusted life years: origins, measurements, applications, objections
Authors: Schwartz Steven , Richardson Jeffrey , Glasziou Paul P.
Published: August 2010

Abstract: Quality‐adjusted life years or QALYs are used to combine, in a single measure, information about the quantity and quality of life produced by a health intervention. They have been used as outcome measures in clinical trials and in cost‐effectiveness analyses. This paper describes how QALYs are assessed and how they are used. Methodological and theoretical problems are discussed as are ethical objections to the utilitarian ethos underlying their use. It is concluded that QALYs are part of a technology that is still in development but, because of the lack of alternatives, they will certainly continue to be used. It is important to resolve the outstanding methodological issues and reach an ethical consensus to ensure that QALYs truly reflect community goals.
Acute hepatitis B infection in Aboriginal Australians
Authors: Wan Xinan , Currie Bart , Miller Nan , Mathews John D.
Published: August 2010

Abstract: The apparent incidence of acute hepatitis B infection in the Top End of the Northern Territory was estimated from notification data and hospital data to be 12 per 100 000 per year, with a marked difference between Aborigines (42 per 100 000) and non‐Aborigines (4 per 100 000), and an odds ratio of 9.7 (95 per cent confidence intervals 3 to 33). Sixty percent of Aboriginal cases of acute hepatitis B occurred in children under 10 years of age, whereas non‐Aboriginal cases occurred in adults aged 20 to 29, most with behavioural risk factors. These findings confirm the importance of immunising Aboriginal children to reduce the future incidence of hepatitis B infection and hepatoma.
Blood alcohol levels of patrons leaving licensed premises in Perth, Western Australia
Authors: Rydon Philip , Stockwell Timothy , Syed David A. , Jenkins Evan M.
Published: August 2010

Abstract: We aimed to determine the alcohol consumption, blood alcohol levels (BALs) and subsequent driving of patrons leaving 15 hotels and taverns in Perth, Western Australia. Of the 414 patrons approached by interviewers on Friday and Saturday evenings, 307 (74 per cent) consented to take part. Self‐reported alcohol consumption, driving intentions, perceived levels of fitness to drive and demographic information were collected using an interviewer‐administered questionnaire. Observations of subsequent driving were recorded and BALs were measured by breath‐alcohol meter. The patrons surveyed were predominantly male (76 per cent) and aged between 18 and 35 (87 per cent). Average reported alcohol consumption was 7.6 standard drinks for males and 4.9 drinks for females, around double the daily amount recommended by the National Health and Medical Research Council. Further, 23 per cent of the sample had consumed more than 10 drinks (male) and 6 drinks (female). With respect to BALs, 37 per cent of patrons exceeded the drink‐drive limit then in force of 0.087 and 56 per cent exceeded 0.05. Of greater concern, 23 per cent who were over the 0.08 legal limit were subsequently observed to drive even though they had been informed of their BAL and legal status with respect to driving. The results suggest that most young patrons drinking in Perth metropolitan hotels and taverns consume alcohol on such occasions in excess of limits currently recommended by health authorities and attain blood alcohol levels dangerous for driving. This is likely to remain unchanged without public debate as to the responsibility of licensees in serving a potentially harmful psychotropic drug and effective enforcement of liquor licensing laws.
Local injury information, community participation and injury reduction
Authors: Jeffs David , Booth Diane , Calvert Dennis
Published: August 2010

Abstract: Better injury prevention is now a national health priority in Australia. Applying the health promotion strategies of the Ottawa Charter to injury prevention forms the basis of the World Health Organization's worldwide Safe Communities program. Taking such a community‐focused approach has led to quantifiable reductions in injuries in several overseas countries, particularly in Scandinavia where falls of up to 30 per cent in particular injuries have been reported over a three‐year period. In the Illawarra area of New South Wales, data from local hospital emergency departments have been used as the basis for a ‘community information’ strategy, in an attempt to replicate this overseas experience in an Australian setting. Reductions of 17 per cent in attendances by children for injuries (P < 0.001) and a 14 per cent fall in accident‐related hospital admissions of children (not statistically significant) have been observed over the course of the four‐year intervention. Problems of community definition and external confounding influences outside the control of the project make it difficult to confirm a causal relationship. However, community information forms one important component in a comprehensive local injury‐reduction strategy.