bluuebunny/crossref_metadata_2025 huggingface dataset:
Protecting human research from an invasion of privacy: the unintended results of the Commonwealth Privacy Act 1988
Authors: Bentley‐Cooper Josephine E.
Published: August 2010

Abstract: In accordance with the Privacy Act 1988 (Cth), interim guidelines for the protection of privacy in the conduct of medical research have been issued by the National Health and Medical Research Council (NHMRC) with the approval of the Privacy Commissioner. The guidelines are intended to ensure that the privacy of the individual is not interfered with when a researcher seeks the release of personal information held by a Commonwealth agency, or when a Commonwealth agency conducts medical research, and to ensure that the conduct of medical research is not inhibited by the privacy legislation. However, the procedures established by the guidelines and the responsibilities placed upon researchers and institutional ethics committees could themselves have the effect of inhibiting research. In considering amendment, NHMRC and the Privacy Commissioner are urged to produce final guidelines which do not act as the straw to break the back of the current system of institutional ethics committees, which seeks to ensure proper ethical scrutiny and the facilitation of human research.
Local food and nutrition policy
Authors: Grossman Jason , Webb Karen
Published: August 2010

Abstract: Local food and nutrition policies (small‐scale efforts to create food systems that respond to nutritional needs) are becoming more and more fashionable as a way of improving public health in Australia. Opportunities for local food and nutrition policies include urban planning, institutional catering, the private sector and local government. These policies are only feasible in organisational environments that are ready to receive them, although their chances of improving the population's food supply can be maximised by copying some aspects of successful policy programs of the past.
Who eats what? A comparison of dietary patterns among men and women in different occupational groups
Authors: Steele Paula , Dobson Annette , Alexander Hilary , Russell Anne
Published: August 2010

Abstract: Dietary data were obtained during a community‐based study of risk factors for heart disease in 1983. Results were compared for men and women in broadly defined socioeconomic groups based on occupation and education. People in higher status occupation groups and with more education, and women more than men, had food consumption patterns more consistent with current health promotion messages. For example, they reported eating more wholemeal or brown bread and more fresh fruit and vegetables, drinking more skim or low‐fat milk, eating fewer eggs and having less sugar in hot drinks or on cereals. There was some evidence, however, of an interplay of influences of cost and health awareness. For example, retired men were less likely than employed men to eat butter, cream, fresh fruit and vegetables, while men in the upper socioeconomic groups reported relatively higher consumption of butter and cream. The results emphasise the need for a range of strategies aimed at specific subgroups in order to improve national dietary patterns in Australia.
Prevalences and perceptions of licit and illicit drugs among New South Wales secondary school students, 1989
Authors: Donnelly Neil , Quine Susan , Oldenburg Brian , Macaskill Petra , Lyle David , Flaherty Bruce , Spooner Catherine
Published: August 2010

Abstract: This paper presents findings on drug prevalences for licit and illicit drugs among New South Wales secondary school students (n = 3753) in late 1989. It also considers the accuracy of students' perceptions of the drug causing the most and fewest drug‐related deaths. Data were analysed by age and gender, using logistic regression for the prevalence data. Findings indicate that licit drugs (tobacco, alcohol and analgesics) were the most frequently and widely used. Rates for illicit drugs were low, although there was some degree of experimental use of cannabis which increased amongst older males. Perceptions were found to be inaccurate in emphasising the dangers of the illicit drug heroin over those of the licit drugs tobacco and alcohol. Reasons for these findings are discussed, and more in‐depth research recommended into the relationship between drug prevalences and perceptions for different age groups, and its relevance for planning drug prevention initiatives.
The impact of a screening mammography program on Sydney general practitioners
Authors: Roberts Christine , Turnbull Deborah , Irwig Les
Published: August 2010

Abstract:The aim of this study was to determine changes in Sydney general practitioners' (GPs) knowledge about, attitude towards and intention to recommend screening mammography over the two years since a screening mammography program was first implemented in the Central Sydney Health Service (CSHS) area. 123 GPs from the CSHS area were selected from a list maintained by the Breast X‐ray Programme, while 127 GPs from the rest of Sydney were selected from the Yellow Pages telephone directory. The overall response rate was 84 per cent. Outcomes were assessed by a self‐administered questionnaire covering knowledge, attitudes and beliefs, self‐report of recent referral practice, intention to recommend, and sources of information about mammography screening. Demographic data were also collected. Results showed that overall knowledge has increased both inside and outside the CSHS area, but important deficiencies in knowledge remain in both areas. Attitudes to screening mammography have improved in the CSHS area, especially regarding the efficacy of screening mammography and patient compliance. Importantly, positive views of screening mammography have declined outside the CSHS area, especially about whether screening mammography can save women's lives. GPs in both areas remain concerned about costs. The presence and strategies of the Breast X‐ray Programme have had some positive effect on the attitudes of GPs towards, but not knowledge of, screening mammography.
The national cot death prevention program in New Zealand
Authors: Mitchell E. A. , Aley P. , Eastwood J.
Published: August 2010

Abstract: A case‐control study examining the risk factors for sudden infant death syndrome (SIDS) in New Zealand identified three risk factors that are potentially amenable to modification: prone sleeping position of the infant, maternal smoking and lack of breastfeeding. In total these three risk factors may account for 79 per cent of deaths from SIDS in New Zealand. We describe the planning and implementation of the cot death prevention program, which has involved a wide range of groups and different strategies. The outcome of the prevention program is being evaluated.
Self‐help smoking cessation materials
Authors: Brown Stephen L. , Owen Neville
Published: August 2010

Abstract: Smoking‐cessation campaigns and services use printed self‐help materials as a major medium for assisting smokers to quit. Such materials are associated with abstinence rates of up to 20% at 12‐month follow‐ups. Adherence to the specific content of self‐instructional programs can be poor, but higher levels of reported adherence may be associated with a greater likelihood of cessation. Personalised cessation materials do not enhance cessation rates, but social support and minimal levels of personal contact do. Research is needed to identify which specific components of these programs are effective, how adherence may be promoted and how materials may be used in conjunction with other interventions—particularly cost‐effective forms of counselling and social support.
Sunglasses and clothing—an unhealthy correlation?
Authors: Threlfall Timothy J.
Published: August 2010

Abstract: Increasing awareness of health effects of solar ultraviolet radiation has focused attention on protection measures, including sunglasses. Sunglasses, or fashion glasses with tinted lenses, may be associated with some risks, and quality is not evident from casual inspection. This study investigates one possible ‘hazard’ of sunglasses—that they may induce behavioural changes which reduce the wearer's tendency to use adequate sun protection for the rest of the body.

Findings consistent with such a proposition were shown in a photographic survey of 373 people in the summer of 1991 in Perth, Western Australia. This revealed maladaptive associations between the wearing of sunglasses and a high degree of leg or arm exposure as recorded by length of sleeves or trouser legs. This was significant for the arms and the legs in males (P < 0.05), but approached significance only for the arms in females (P < 0.10). There was no significant association between degrees of arm and leg exposure in either sex.

The health implications of these maladaptive behaviours, and some advantages and disadvantages of the survey technique, are discussed. The results suggest that promotion of sun‐protective behaviour should encourage the use of both sunglasses and protective clothing, as subjects' behaviours with respect to these do not appear to be correlated in a rational manner. If public awareness of links between skin cancer and eye disease could be increased, promotion of sunglasses might lead to a reduction in the incidence of skin cancers in general, not just those in the periorbital area.
Human factors in rural road crashes
Authors: Ryan G. Anthony , Barker Jennifer M. , Wright John N. , McLean A. Jack
Published: August 2010

Abstract:An in‐depth study of 79 vehicle crashes on rural roads in an area of about 100 km radius around Adelaide examined sociodemographic and psychophysiological characteristics of the drivers and riders involved. In many respects this sample of crashes was similar to a much larger number of police‐reported crashes in the same area but included: relatively more crashes with severe or fatal injuries; more crashes on divided roads, on sealed roads and on curves; and more crashes involving trucks. Alcohol and lack of seat belt use were shown to be major problems in these rural crashes. The drivers and riders most strongly associated with these particular problems were males, in blue collar occupations and with limited education; they tended to be aged 30 years or more in the case of alcohol abuse, and were likely to be under 30 years in the case of restraint misuse. The attitudes of these drivers and riders, and other characteristics likely to have contributed to their involvement in a crash, are discussed. There is a need to develop specific and effective countermeasures to reduce drink‐driving and increase seat belt wearing in rural areas.
Patterns of service utilisation following the 1989 Newcastle earthquake: findings from Phase 1 of the Quake Impact Study
Authors: Carr Vaughan J. , Lewin Terry J. , Carter Gregory L. , Webster Rosemary A.
Published: August 2010

Abstract: A screening questionnaire was distributed to 5 000 adult members of the community six months after the 1989 Newcastle earthquake, with a response rate of 63 per cent (n = 3 007). The mean age of respondents was 46.7 years and 58 per cent were female. Subjects' earthquake experiences were rated in terms of weighted indices of exposure to threat and disruption. Psychological morbidity was measured using the General Health Questionnaire and the Impact of Event Scale. Subjects were asked to indicate which of a range of general and disaster‐related support services they had used in dealing with the stressful effects of the earthquake. It was estimated that 21.3 per cent of the adult population used general and/or disaster‐related support services. Users of these services reported greater exposure to threat and/or disruption and had higher levels of psychological distress than nonusers. However, a high level of use of general services and reliance on medical services were related more to psychological morbidity than degree of exposure to earthquake‐related events. Overall, the Newcastle community's needs for assistance in the aftermath of the earthquake were effectively absorbed by the existing support services and the resources marshalled to supplement those services. Individuals and organisations mobilised following natural disasters need to be strengthened by enhancing the capacity of support service workers to identify and manage psychological distress in their clients.
A survey of infertility, surgical sterility and associated reproductive disability in Perth, Western Australia
Authors: Webb Sandra , Holman D'Arcy
Published: August 2010

Abstract: Infertility, surgical sterility and associated reproductive disability were studied in a stratified cluster sample of 1511 couples with women aged 16 to 44 years resident in metropolitan Perth in 1988. Sixteen couples were omitted from analysis because of missing data. The proportion of couples affected by current infertility was 3.5 per cent (53 of 1 495), and 67.9 per cent of these (36 of 53) had a reproductive disability, meaning that they were unable to achieve their desired level of reproductive function. Those affected by surgical sterility accounted for 37.1 per cent (555 of 1 495), and of these couples 2.0 per cent (11 of 555) had a reproductive disability. Empirically, the prevalence of both infertility and reproductive disability peaked at ages 30 to 34 years in the female partner. Of the factors studied, infertility was associated with surgery for a ruptured appendix, a history of pelvic inflammatory disease and number of sexual partners. In 10 of the 47 couples with reproductive disability, contraceptive sterilisation had been a cause of later regret. Most other cases were due to infertility. Almost one half of couples with reproductive disability had sought treatment. The affected couples had at least one child from the current union in 23 of the 47 cases of reproductive disability. The results support the need for development of a strategy to prevent infertility and other causes of reproductive disability.
Factors associated with heroin users' AIDS risk‐taking behaviours
Authors: Caplehorn John R.M. , Saunders John B.
Published: August 2010

Abstract: A survey was undertaken in Sydney in 1989 to identify factors associated with behaviour involving risk for human immunodeficiency virus infection. Self‐report data on needle‐sharing and sexual practices were collected from 91 heroin users entering a residential, drug‐free detoxification unit. Data were analysed using polytomous and ordinal logistic regressions. Heroin‐dependent subjects who also had a current alcohol problem were significantly more likely than others to report high risk needle‐sharing behaviour. Subjects with more than one sexual partner in the last three months were significantly more likely to use condoms while those with a current benzodiazepine problem were significantly less likely to use condoms. Qualitative data suggest that high risk needle‐sharing behaviour most often occurred around the time of relapse to injecting drug use and among homeless drug users occupying derelict buildings in inner‐city suburbs.
Medication use and its correlates among the elderly
Authors: Gilbert Andrew , Luszcz Mary , Owen Neville
Published: August 2010

Abstract:Medication use and its correlates were examined in a randomly selected sample of 178 urban‐dwelling elderly people: 89 per cent were currently using medication and 44 per cent were using four or more medications concurrently. Forty percent were using at least one nonprescription medication, usually in combination with prescription medication. The treatment of hypertension was the most commonly given reason for medication use. Respondents demonstrated good knowledge of their medication and how to take it, and good compliance with prescribing instructions. Multiple medication use was associated with advanced age, living in supervised accommodation, and a range of measures indicative of reduced wellbeing. There was no association between cognitive functioning and multiple medication use. These findings suggest that stereotypical images of older people as being poor compilers and having little knowledge about their medication should be treated with caution. However, the extensive use of medication and of multiple medications and concerns about the appropriateness of use of some classes of medication highlight the need for more detailed study of medication use among the elderly.
Testing for HIV infection among heterosexual, bisexual and gay men
Authors: Waddell Charles
Published: August 2010

Abstract:This paper answers the questions: who is and is not tested for human immunodeficiency virus (HIV) antibodies, why, where are they tested, and what do they find difficult about the testing process? The data came from two samples of sexually active heterosexual, bisexual and gay men in Perth (N= 545). Bisexual and gay men were much more likely to be tested than heterosexual men, although the commonest reason for testing for all three groups was risky sex. The three groups differed on reasons for not having the HIV antibody test: heterosexual men most commonly claimed that they were not at risk; bisexual men explained that they had been meaning to go but kept putting it off; and gay men primarily feared a positive test result and lacked trust in the confidential treatment of results. Gay men were more likely to trust their regular doctors than were heterosexual and bisexual men who had more trust in state health clinics. Waiting for test results was the most difficult part of the testing process for all respondents. Few respondents agreed that employers and the police should be notified by a doctor of an antibody‐positive test result; nearly all agreed that those who had contracted HIV should be notified; notification of surgeons received moderate support. Knowing one's HIV infection status appears to be strongly associated with safer sex practices, and therefore the HIV antibody test could be promoted as part of a preventive health care program.
An outbreak of Norwalk‐like gastroenteritis associated with contaminated drinking water at a caravan park
Authors: McAnulty Jeremy M. , Rubin George L. , Carvan C. Terence , Huntley E. John , Grohmann Gary , Hunter Rob
Published: August 2010

Abstract: During the 1989 Christmas holiday period, a large outbreak of gastroenteritis occurred among persons staying at a caravan park in southern New South Wales. Review of local hospital records found that 77 per cent of patients presenting with infective diarrhoea between 29 December and 3 January had stayed at the caravan park. In a retrospective cohort study we compared rates of illness among caravan park patrons exposed to different water sources. Stools were tested for pathogens and convalescent sera for viral antibodies. Rain and reticulated river water sampled from the caravan park were tested for bacteria and viruses. Of 351 persons interviewed at the caravan park, 305 (87 per cent) reported an illness characterised by diarrhoea, vomiting and abdominal pain. Of 196 persons who used reticulated river water for drinking or ablutions, 175 (89 per cent) became ill compared with 47 of 72 persons (65 per cent) who did not use this water (relative risk 1.4, 95 per cent confidence interval 1.2 to 1.6). The outbreak was probably caused by a 27–28 nm small round structured virus found in the stool from one ill person. High levels of faecal coliforms in the reticulated river water and enterovirus in sediment samples suggest that the outbreak was caused by sewage contaminating the reticulated river water through a break in the pipe directly over the underground water tanks. To prevent such outbreaks, poor water and sewerage system layouts should be avoided and nonpotable water should be clearly labelled. Where feasible, all camping‐ground water should stem from town supplies.
The costs and experiences of caring for sick and disabled geriatric patients—Australian observations
Authors: Smith Betty , O'Malley Sandra , Lawson James
Published: August 2010

Abstract: The costs and experiences of caring for geriatric patients and the effectiveness of a geriatric assessment team have been reviewed in this study from the New South Wales Central Coast. The findings were: that some clients who are referred for placement in nursing homes and who meet standard criteria for admission can be maintained in the community; the cost to the taxpayer of persons admitted to nursing homes was at least $449 to $776 per week (1991 prices), compared to an average cost of $89 per week to maintain at home those whose original assessment met all the criteria for nursing home placement; assessments of needs of some clients were being conducted by five or more separate agencies which led to increased costs and created distrust and confusion for the client; a key factor in the decision to maintain a client in the community was found to be the availability and motivation of carers. A geriatric assessment team has an essential role in mobilising expert assessment and facilitates access to community‐based support services to obviate or delay admissions to nursing homes.
Assessment of dioxin‐related health risks for the Melbourne metropolitan area
Authors: Carlo George L. , Sund Kelly G. , Baller James
Published: August 2010

Abstract: A community health risk assessment was conducted during 1990 in Melbourne for polychlorinated dibenzo‐para‐dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) released in Laverton North by Nufarm Limited, an agricultural chemicals manufacturer. This risk assessment incorporated current scientific knowledge into hazard identification, dose‐response assessment, exposure assessment and risk characterisation sections, according to the four‐step framework used by the United States Environmental Protection Agency. The hazard identification showed that health effects are unlikely to result from general population exposures to PCDDs and PCDFs. The dose‐response assessment supported a safety‐factor approach for PCDD and PCDF risk assessment. The exposure assessment incorporated exaggerated assumptions to estimate both total daily exposure (203 pg total toxic equivalents of PCDDs and PCDFs, or 2.9 pg/kg body weight) and daily exposure attributable to Nufarm (56.4 pg, or 0.80 pg/kg body weight) under a worst‐case scenario. The risk characterisation section found that exposures under 20 pg/kg body weight per day should not induce the aryl hydrocarbon hydroxylase system, which appears to be the starting point for PCDD and PCDF toxicity. We concluded that the general population exposure to PCDDs and PCDFs in Melbourne was within the range of acceptable daily intakes used by European and Canadian governments and the World Health Organization, as well as within the range of acceptable daily intakes derived using current scientific knowledge.
Hepatitis B vaccination of high‐risk neonates in the South West Region of New South Wales: evaluation of program coverage
Authors: Riley Roslyn , Maher Christopher , Kolbe Anthony
Published: August 2010

Abstract: The authors evaluated the high‐risk neonate hepatitis B vaccination program in the South West Region of New South Wales. Infants from ethnic groups with a high rate of chronic hepatitis B virus (HBV) infection and infants of HBV carrier mothers were targeted. The program identified 323 infants born between October 1987 and December 1990 who were at high risk of HBV infection, of whom 68.7 per cent were Aboriginal. Overall, 194 infants (60.1 per cent) received three doses of vaccine. Although the number of infants identified increased from 46 in 1988 to 119 in 1990, the proportion fully vaccinated each year did not increase, remaining at around 60 per cent. The authors stress the importance of promoting the program and educating the high‐risk groups and health professionals involved, in order to improve vaccination coverage.
Solar protection behaviours: a study of beachgoers
Authors: Foot Glenda , Girgis Afaf , Boyle Catherine A. , Sanson‐Fisher Rob W.
Published: August 2010

Abstract: This study explored the prevalence and predictors of solar protection behaviour in a community sample of beachgoers. A total of 670 participants was randomly selected from six beaches in the Newcastle district. The solar protection behaviour of each participant was assessed by direct observation and interview. A subsample was also asked to complete a written questionnaire to assess attitudes to solar protection use, knowledge of skin cancer and awareness of recommended solar protection behaviours. Forty‐five per cent of the beachgoers in this sample were using a high level of solar protection, and a substantial proportion (16 per cent) of the sample was not using any kind of solar protection. Sunscreen with SPF 15+ was applied to at least one body region by 69 per cent of the sample, 17 per cent of the sample were wearing a recommended hat, 15.1 per cent were using shade, and 3.4 per cent were wearing a recommended style of shirt at the time of observation. Chi‐square analyses of the data for under‐15‐year‐olds indicated that a significantly greater proportion of 0‐ to 9‐year‐olds were well protected compared to 11‐ to 14‐year‐olds, but there was no difference in use of protection by boys and girls under 15 years of age. Stepwise regression analysis of the adult sample (15 years and over) showed that the predictors of overall level of solar protection were marital status and frequency of skin self‐examination in the past 12 months. The practical implications of these findings for future community‐based skin cancer prevention programs are discussed.
Control of a community outbreak of measles which started in a poorly immunised high school population
Authors: Merianos Angela , Miller Nan C. , Patel Mahomed S.
Published: August 2010

Abstract: An outbreak of measles occurred in Darwin from February to March 1991. The first case was in a 13‐year‐old high school student who had returned from a holiday overseas. She was symptomatic on the second day of the new school term. She infected an infant while both waited in a doctor's surgery. Outbreak control measures were instituted 18 days later when the Communicable Diseases Centre was first alerted of cases through the laboratory notification scheme. Through active surveillance, we identified 76 cases of measles, of whom 92 per cent (70 cases) were under 20 years of age. Of these, 46 were students at the index high school in which the attack rate was 39.2 per 1000. They transmitted the disease to six unvaccinated siblings aged 11 to 18 years, resulting in a secondary attack rate of 113 per 1000 in this age group (relative risk of disease in siblings 2.8, 95 per cent confidence interval 1.2 to 6.2). The outbreak affected one other high school, a number of primary schools, one tertiary institution, and nine children under five years. Only four of the cases had a verified history of previous immunisation against measles. The outbreak was arrested within two weeks of instituting community‐wide control measures. Inadequate immunisation coverage among school‐aged children and delays in notification contributed to the severity of the outbreak. Improved measles surveillance systems, including telephone notification of clinical cases are needed so that control measures can be instituted immediately within the household and in the community.
Perceptions of unmet need in four community services for elderly people
Authors: Baume Peter , Isaacson Beverley , Hunt Jennie
Published: August 2010

Abstract: Home‐care services particularly, and food services to a lesser extent, are seen by elderly people as being critically important for their capacity to live independently in western Sydney. Home nursing and transport services are valued but are less critical. Consumers, providers of services and referral agents all identify significant levels of unmet need for community services. The home care service particularly is stretched by pressures which are likely to be exacerbated by demographic change and by cost‐shifting between state governments and the Commonwealth Governments.
QALYs for resource allocation: probably not and certainly not now
Authors: Burrows Colin , Brown Kaye
Published: August 2010

Abstract: Quality‐adjusted life years (QALYs) have the attractive characteristic of combining morbidity and mortality into a single index which purports to measure the outcomes of health interventions. Their primary aim, when combined with cost, is to permit comparisons across candidate spending programs and thereby promote economic efficiency in the use of rationed funds. QALYs, in fact, comprise a family of measures with major differences in approach and many variations in construction, process and methods of measurement. A necessary unifying characteristic is the ethical assumption of utilitarianism. The paper examines the state of the art in the development of QALY measures. It concludes that they fall far short of requirements for their advocated use in resource allocation decisions. Furthermore, their demands on measurement for this purpose are such that it is unlikely that methodological problems can be solved.
Falling incidence of HIV infection in a cohort of clinic attenders
Authors: Kaldor John , Williamson Paula , Guinan James J. , Imrie Alison , Gold Julian
Published: August 2010

Abstract: It is widely accepted that changes in sexual behaviour in the mid‐1980s drastically reduced the spread of human immunodeficiency virus (HIV) through male homosexual contact in Western countries, but documentation of changes in infection rates has been based on observation of subjects enrolled in cohort studies, who may be highly selected and motivated. In this study, the incidence of HIV seroconversion was investigated among people attending a major site of HIV testing, counselling and patient care in Sydney. Over the period March 1985 to June 1990, 2 301 people were tested for HIV antibody on more than one occasion, following a negative result at the first test. On the basis of subsequent tests, 107 were found to have seroconverted during the study period, including 91 men who reported homosexual or bisexual contact as their only exposure to HIV. Overall, the incidence rate of HIV infection among men reporting homosexual or bisexual contact was 404 per 100 person‐years of follow‐up. Under various methods of calculation, the incidence was estimated to have declined between 1985 and 1989–1990. However, there was continuing HIV seroconversion in 1989–1990 and no indication of declining incidence in younger men. The fall in HIV incidence documented in this study supports the role of HIV prevention programs aimed at homosexual and bisexual men.
Risks of premature death from smoking in 15‐year‐old Australians
Authors: Taylor Richard
Published: August 2010

Abstract: This cross‐sectional actuarial analysis of 1990 mortality data aimed to estimate absolute risk of premature death from all causes, and from lung cancer, ischaemic heart disease and chronic bronchitis/emphysema due to tobacco smoking in the Australian population, and to estimate the number of current 15‐year‐old smokers in the 1990 Australian population who will die prematurely due to smoking. Competing risks were allowed for in the calculations. In males, conditional life expectancy for 15‐year‐olds was 78.0 years in nonsmokers, 73.3 years in ever‐smokers, and 71.5 years in smokers of more than one packet a day. For 15‐year‐old females, life expectancy was 82.0 years in nonsmokers, 78.4 years in eversmokers, and 76.9 years in smokers of more than one packet a day. The risk of premature death due to smoking in ever‐smokers was estimated as 14.6 per cent in males (before 75 years) and 11.9 per cent in females (before 80 years), with lung cancer (male: 4.2 per cent; female: 3.4 per cent), ischaemic heart disease (male: 3.7 per cent; female: 1.7 per cent) and chronic bronchitis/emphysema (male: 2.4 per cent; female: 2.5 per cent) as the major contributors. From one year of 15‐year‐old male smokers (26 713), 3 916 premature deaths due to tobacco can be expected; this includes 1 106 lung cancer deaths, 991 ischaemic heart disease deaths and 641 chronic bronchitis/emphysema deaths. From one year of 15‐year‐old female smokers (32 355), 3 861 premature deaths can be expected; this includes 1 086 lung cancer deaths, 559 ischaemic heart disease deaths and 798 chronic bronchitis/emphysema deaths.
Is there a rural suicide problem?
Authors: Cantor Christopher H. , Coory Michael
Published: August 2010

Abstract: Suggestions that youth suicide rates are disproportionately higher in rural areas were explored using Queensland cause‐of‐death data supplied by Queensland Health for the years 1986 to 1990. Standardised mortality ratios (SMRs) were compared across three zones: urban, provincial and rural, for three age bands: all ages, 15 to 19 years and 20 to 29 years, for each sex. This Queensland study did not find a statistically significant excess of rural youth suicides. Further study of this phenomenon involving other states is called for.
Surveillance for Bordetella pertussis infection in Victoria
Authors: MacIntyre Raina , Hogg Geoff
Published: August 2010

Abstract: Our aims were to describe the epidemiology of Bordetella pertussis infection in Victoria during the last decade and to evaluate surveillance of B. pertussis by comparing notifications with laboratory isolations and hospital diagnoses. Whooping cough was once a leading cause of childhood morbidity and mortality but there was a dramatic reduction in the 1940s because of immunisation. During the last two decades, controversy about the vaccine's toxicity has resulted in waning immunisation rates and outbreaks of the disease. The notification system in Victoria has undergone changes which make interpretation of surveillance data difficult. We compared notifications of B. pertussis with laboratory data from the Royal Children's Hospital and hospital separations with B. pertussis from all hospitals in Victoria. The latter sources revealed epidemic years of infection in 1982, 1985 and 1989. This was not apparent from notifications alone and highlights the importance of using multiple sources of surveillance data. We also found a higher rate of notification from Geelong than rural Victoria and metropolitan Melbourne. The fluctuating incidence of B. pertussis infection in the last decade may reflect changing immunisation practices. Unfounded fears that pertussis vaccine causes serious neurological sequelae have inappropriately influenced individual practice and legislation. The increased notification of B. pertussis in the early 1980s may have reflected the omission of the fourth dose of pertussis vaccine from the Australian schedule in 1979. Surveillance data should be used not only for descriptive epidemiology, but for public health action, and efforts should be made to ensure that immunisation rates remain high.
Effects of publicity and a warning letter on illegal cigarette sales to minors
Authors: Chapman Simon , King Madeleine , Andrews Bruce , McKay Elizabeth , Markham Peter , Woodward Stephen
Published: August 2010

Abstract: The study aimed to assess rates of illegal cigarette sales to children and the impact on these rates of publicity and a warning letter threatening prosecution. Children aged 12 and 13 made two repeat purchasing attempts, three months apart, at 255 randomly selected tobacco retail outlets in Sydney. A randomly selected 50 per cent of retail outlets which sold cigarettes illegally at the first attempt were sent warning letters threatening prosecution. Publicity about the undercover buying operation was organised between the attempts. At the first attempts, 39 per cent of shops sold cigarettes to the children and 32 per cent sold them at the second attempt. Shops which sold on the first occasion and received warning letters reduced selling by 69 per cent compared to the 40 per cent reduction in shops which sold cigarettes on the first attempt and were not sent warning letters, a net reduction of 29 per cent seemingly attributable to the warning letters (95 per cent confidence interval 8 per cent to 50 per cent). It is extremely easy for children as young as 12 to buy cigarettes. The combined effects of publicity about undercover buying operations and warning letters threatening prosecution seem capable of reducing selling by about 29 per cent. Because of inconsistencies in selling or refusals, future attempts to measure selling rates to children should use repeat purchasing attempts and classify outlets as ‘selling’, ‘not selling’ or ‘sometimes selling’.
Food‐purchasing behaviour in an Aboriginal community. 2. Evaluation of an intervention aimed at children
Authors: Scrimgeour David , Rowse Tim , Knight Sabina
Published: August 2010

Abstract: The previously described survey of food‐purchasing behaviour in a central‐Australian Aboriginal community demonstrated that children have sufficient disposable income to provision themselves directly from food outlets. Subsequently, a community‐based intervention project developed strategies to provide healthier choices for these children. Two years after the initial survey, a follow‐up survey was conducted in which all food purchases by children under the age of 15 in the community were recorded over a two‐week period. The results demonstrate an improvement in the quality of foods and beverages purchased by children at the time of the second survey.
Mortality and coronary heart disease in diabetes mellitus
Authors: McCann Vincent J. , Knuiman Matthew W. , Stanton Kim G. , Winter Michael G.
Published: August 2010

Abstract:A clinic‐based study of 1063 patients with Type 2 diabetes recruited from 1973 to 1982 identified 533 deaths (attributed to coronary heart disease in 268 cases) by 31 December 1989. When compared to the general population of Australia the overall standardised mortality ratio was 1.42 (95 per cent confidence interval (CI) 1.26 to 1.58) for females and 1.19 (CI 1.03 to 1.35) for males. Cox regression analysis showed that having coronary heart disease or absence of foot pulses at the time of entrance to the study were the major independent risk factors for overall mortality after adjustment for initial age. Elevated cholesterol and blood pressure were found to be major independent risk factors for death from coronary heart disease.
Assessing utilisation of health technologies: coronary artery bypass graft surgery in New South Wales
Authors: Rushworth R. Louise , Rob Marilyn I. , Rubin George L.
Published: August 2010

Abstract:The New South Wales health system aims to provide the most effective and efficient health care in a context of scarce resources and increasing availability of expensive technologies. The aging of the population and the management of chronic disease place further demands on the health system. Examination of the pattern of provision of services over time and between groups can serve to illustrate trends in clinical management practices which may affect other elements of the health system. In this paper we report an evaluation of the patterns of coronary artery bypass graft surgery (CABG) in New South Wales, within subgroups of the population and over time. The results demonstrate increased utilisation of this procedure in the population over recent years, particularly among the older age groups. We found differences in procedure rates between geographic areas which suggest that there are differences in the management of ischaemic heart disease between population subgroups. These patterns are examined in the context of the available literature on the health outcomes of CABG relative to other management options for ischaemic heart disease.
Legionnaires' disease outbreak, Fairfield 1992: public health aspects
Authors: Levy Michael , Westley‐Wise Victoria , Blumer Charles , Frommer Michael , Rubin George , Lyle David , Brown John , Stewart Greg
Published: August 2010

Abstract: An investigation of an outbreak of Legionnaires' disease in 1992 in Fairfield, a municipality of Sydney, was carried out to determine the source of the outbreak. Cases of Legionnaires' disease with onset of symptoms between 11 and 20 April 1992 were included. Definite cases were individuals with a history consistent with Legionnaires' disease, confirmed by direct fluorescent antibody testing plus serology or culture. There were two control groups: patients admitted to the same hospital as the cases, matched for age and sex, and patients admitted to hospital with a presumptive diagnosis of Legionnaires' disease, in whom the diagnosis was subsequently excluded. There were 26 definite cases with onset of symptoms between 11 and 20 April 1992. Six (23 per cent) died. Twenty‐two cases (85 per cent) reported visiting the Fairfield business district during the ten days prior to the onset of symptoms. They were 20 times more likely to have visited Fairfield than were matched controls. Matching of Legionella pneumophila serogroup 1 from environmental and clinical samples was achieved by cytogenetic fingerprinting. Fourteen cases were linked to a single environmental sample. The epidemiological findings were consistent with a point source of Legionella in the Fairfield business district. It is most likely that the exposure occurred on 10 April 1992.
The behavioural epidemiology of weight control
Authors: Crawford David , Owen Neville
Published: August 2010

Abstract:Excess body weight is associated with increased health risk, but there are also risks to health related to weight‐control practices. While representative population data are available on the anthropometry of body weight and its sociodemographic correlates in Australia, less is known about the population prevalence and correlates of weight‐control behaviours. We examine the prevalence of overweight and obesity, and low body weight, in the Australian population, using data from studies in which height and weight have been objectively measured; we describe the sociodemographic correlates of overweight and obesity; we outline relevant aspects of Australian health‐system and private‐sector approaches to body weight control; and we describe the findings of Australian studies of weight‐control practices and related beliefs and attitudes. These findings relate mainly to women, particularly younger women, and little is known about the weight‐control practices of Australian men. We suggest research which may promote a better understanding of weight‐control practices in the Australian population.
Cost‐effectiveness analysis of hormone replacement therapy and lifestyle intervention for hip fracture
Authors: Geelhoed Elizabeth , Harris Anthony , Prince Richard
Published: August 2010

Abstract: We compared the cost‐effectiveness of interventions to prevent osteoporosis using a decision analytic model for a hypothetical cohort of 100 000 healthy perimenopausal women. The interventions were: oestrogen from age 50 for life, oestrogen from age 50 for 15 years, oestrogen from age 65 years for life, and a lifestyle regime of calcium supplements and exercise. The four interventions were compared with the case of no intervention by examining the effects on medical and nursing home costs, life years gained, quality‐adjusted life years (QALYs) gained and costs per QALY gained. Lifetime oestrogen therapy from age 65 years achieved the lowest cost per life year gained and the lowest cost per QALY gained. The lifestyle intervention was the most expensive intervention by all measures but was sensitive to the cost of exercise and to the effects of exercise on cardiovascular mortality. Conventionally, oestrogen therapy begins at the menopause to avoid the rapid decline in bone mass that occurs with normally decreasing oestrogen levels. These results indicate that there is evidence, both in terms of fracture prevention and cost, to justify introduction of treatment at a later age. If a lifestyle intervention regimen can reduce cardiovascular mortality as well as hip fracture, this may provide an alternative means of reducing osteoporotic hip fracture at a reasonable cost.
Preventing child pedestrian injury: pedestrian education or traffic calming?
Authors: Roberts Ian , Ashton Toni , Dunn Roger , Lee‐Joe Trevor
Published: August 2010

Abstract: The traditional approach to the prevention of child pedestrian injuries in New Zealand is pedestrian education. However, none of the programs currently being implemented in New Zealand have ever been shown to reduce injury rates. The allocation of scarce resources to pedestrian education must therefore be questioned. In this paper we estimate the number of serious child pedestrian injuries which might be prevented if the resources allocated to pedestrian education were allocated instead to environmental approaches, in particular, to traffic calming. It is estimated that approximately 18 hospitalisations of child pedestrians could be prevented each year under this alternative resource allocation, disregarding any other benefits of traffic calming. These results emphasise the need to consider the potential sacrifices involved in the allocation of scarce resources to child pedestrian education.
What causes basal cell carcinoma to be the commonest cancer?
Authors: Gilbody John S. , Aitken Joanne , Green Adèle
Published: August 2010

Abstract: We conducted a hospital‐based case‐control study in Brisbane, Queensland, to investigate the specific determinants of basal cell carcinoma (BCC), as distinct from squamous cell carcinoma (SCC), with emphasis on ancestry, residential history, pigmentary characteristics, sun sensitivity and other constitutional factors. The sample was recruited from a dermatology outpatient clinic during an eight‐week period in 1991, and comprised 51 incident or recently diagnosed cases of BCC, and 112 randomly selected controls with no known history of BCC or SCC. Twenty‐six cases with both BCC and SCC were analysed separately. We found no risk factor specific to BCC which might explain its extremely high prevalence. The strongest risk factors for BCC were advanced age, male sex and a propensity to freckle (independent of skin colour and tendency to burn), all of which have previously been observed for SCC. A finding not previously reported was an apparent protective effect of increasing body mass, specific to BCC alone.
The NSW health outcomes initiative and economic analysis
Authors: Mooney Gavin , Jan Stephen , Seymour Janelle
Published: August 2010

Abstract: The New South Wales Health Department's initiative on health outcomes promises some important advances in the planning and priority setting of health services. However, the potential to promote better health care will not be realised unless resources are redeployed to the programs where health outcomes (and other benefits) can be purchased most cheaply. The initiative reflects firmly the economic concept of efficiency but leaves less certainty about how concerns for equity are to be handled. This paper proposes that program budgeting and marginal analysis be used to create a framework for redeploying resources to follow the good buys—in terms of health and other outcomes. Additionally, the paper argues for creating the right incentives to promote efficiency, and expressly argues against the use of diagnostic related groups or casemix funding, as such funding is concerned, by definition, with cases and not with health per se. The goal of the initiative of trying to maximise health outcomes implies that there are no other valued gains to be had from health care. This is challenged. In reaching decisions about how best to deploy resources, more account should be taken, in a structured way, of community values.