bluuebunny/crossref_metadata_2025 huggingface dataset:
An epidemiological study of falls in older community‐dwelling women: the Randwick falls and fractures study
Authors: Lord Stephen R. , Ward John A. , Williams Philippa , Anstey Kaarin J.
Published: August 2010

Abstract: Seven hundred and four women aged between 65 and 99 years (mean age 74.6 years), who were randomly selected from the community, took part in a study to determine whether health and lifestyle factors were associated with falls. In the 12 months before the survey, 66.1 per cent of the subjects experienced no falls, 19.7 per cent fell once and 14.2 per cent fell on two or more occasions. The proportion of women who fell outside the home decreased with age, with a corresponding increase in the proportion who fell inside the home on a level surface. The most common causes of falls reported were trips, slips and loss of balance. Some (27 per cent) suffered injuries as a result of a fall, and the proportion suffering injuries increased with age. Those who rated their health and balance as impaired, those with a limitation in activities of daily living, those receiving community services, those taking psychoactive drugs, and those taking four or more drugs had significantly more falls. On the other hand, those taking part in planned exercise and those active for seven or more hours per week had fewer falls. Smoking and alcohol consumption were not significantly associated with falls. Stepwise logistic regression analysis revealed poor vision, inactivity and subjective fall risk as variables that were independently and significantly associated with falling. These findings highlight possible intervention strategies for reducing falls risk in older people.
Injuries due to falls from horses
Authors: Buckley Sean M. , Chalmers David J. , Langley John D.
Published: August 2010

Abstract: This study describes the epidemiology of injuries due to falls from horses in New Zealand. There were 54 fatalities from 1977 to 1986 (0.17 per 100 000 persons per year). There were 773 hospitalisations in 1987 (23.7 per 100 000 persons per year). Head injuries were predominant among both fatal and nonfatal injuries. The incidence of nonfatal head injury in the 10 to 19 age group was significantly higher than the incidence in all older groups (P = 0.003). Young people, particularly females, were the segment of the population most affected by the problem of falls from horses. Reference to data on horse‐riding participation rates, however, did not indicate that young people were overrepresented in the series studied. Reference to the same data showed that the rate of hospitalisation due to falls from horses is comparable to the rate for injuries from playing rugby. The magnitude and severity of the problem indicates that there is a need need for helmet use, safe‐riding practices, and further research.
Cardiovascular risk in adult Melbourne Chinese
Authors: Hsu‐Hage Bridget H.‐H. , Wahlqvist Mark L.
Published: August 2010

Abstract: Chinese migrants have low cardiovascular mortality, particularly in their first 10 years of residence in Australia. The apparent increase in cardiovascular deaths among Asian migrants who have lived in Australia for more than 10 years suggests that cardiovascular risk transition may occur soon after migration. In this descriptive study, we found that Melbourne Chinese were not low in cardiovascular risk factors as usually defined. The prevalence of hyperlipidaemia (7.7 per cent for men and 5.2 per cent for women) was similar to the prevalence for other Australians (6.8 per cent for men and 4.4 per cent for women). In spite of low mean blood pressure (systolic blood pressure 114+23 mmHg (mean+standard deviation) and diastolic blood pressure 67.3+10.6 mmHg), Melbourne Chinese women were hypertensive as often as their Australian counterparts. The prevalence of cigarette smoking in men (26.9 per cent) was also comparable to prevalence for Australian males (24.1 per cent). Being slim is the only recognised cardiovascular protection that Melbourne Chinese may have. A high waist‐to‐hip ratio (0.91+0.054 for men and 0.88+0.077 for women), however, may outweigh the potential benefit of a lower prevalence of overweight (17.7 per cent for men and 14.1 per cent for women). Melbourne Chinese men had a multiple risk‐factor profile similar to their Australian counterparts. Differences in multiple risk factors in women were attributable to fewer Chinese women having a single risk factor (15.4 per cent versus 30.1 per cent). While cardiovascular mortality and risk‐factor prevalence is declining in Australia, our study suggests that migrants such as Melbourne Chinese may not share the same health improvement.
Public hospital activity, expenditure and staffing levels for indigenous and nonindigenous settlements in remote Queensland
Authors: Hart Ruth F.G. , Ring Ian , Runciman Claire
Published: August 2010

Abstract: Aborigines and Torres Strait Islanders who live in discrete communities have poor health. Their life expectancy is relatively low and the underlying rates of morbidity, mortality and hospitalisation are much higher than the Australian average. For Aborigines and Torres Strait Islanders in the remote communities, the mortality rate is some three times higher than that of the total population. By comparing remote Aboriginal and Torres Strait Islander communities with similarly remote nonindigenous settlements, the paper shows that there was greater hospital activity per person in remote Aboriginal and Torres Strait Islander communities. Paradoxically, whereas there was greater hospital activity in discrete indigenous communities, there was lower expenditure per person on hospital services. The paper finds also that there were fewer medical and nursing staff per person in remote Aboriginal and Torres Strait communities.
Tobacco in Western Australia: patterns of smoking among adults from 1974 to 1991
Authors: Macfarlane Joan E. , Jamrozik Konrad
Published: August 2010

Abstract: Patterns of smoking in Western Australia since 1974 were examined using four data sets. Consistency between sets of data was high for adults in the various categories of smoker status. Having established consistency, the patterns revealed by the surveys conducted by the Health Department of Western Australia were examined in more detail. According to these data, prevalence fell from 31.2 per cent in 1984 to 23.9 per cent in 1991 but was still higher among males, at 27.3 per cent, than among females, at 23.4 per cent. Although the sex‐specific prevalence levels were converging, the difference was still significant (P = 0.01). While patterns of smoking in Western Australia generally reflected those in Australia as a whole, some differences were detected. The variation in prevalence according to level of education among women became less pronounced: in 1991, prevalence was 25.5 per cent among women who had completed an apprenticeship or trade certificate compared with 21.7 per cent among women who had undertaken some university studies, the corresponding figures for 1984 being 31.1 per cent and 24.8 per cent. Differences in prevalence among young women between state and national data were also noted. Between 1987 and 1991 the prevalence of smoking among women in the 20‐ to 24‐year age group decreased from 41.2 per cent to 29.0 per cent. This is at odds with findings from the data collected by the Anti Cancer Council of Victoria which indicate that, in 1989, the prevalence of smoking among Australian women aged 20 to 24 years was 37.7 per cent, which was higher than the prevalence in any other male or female age group.
Childhood immunisation: factors associated with failure to complete the recommended schedule by two years of age
Authors: Hanna Jeffrey N. , Wakefield Janet E. , Doolan Carmel J. , Messner Janet L.
Published: August 2010

Abstract: This study aimed to determine the immunisation status of preschool‐aged children attending formal child‐care facilities in north Queensland, and to examine factors associated with failure to be completely immunised by two years of age. Child‐care centres and kindergartens within the Cairns City and Mulgrave Shire local government boundaries were selected randomly with probability proportional to size, and 613 children (median age of 47.0 months) were selected randomly from the facilities. Only 60.3 per cent (95 per cent confidence interval (CI) 56.3 to 64.3) of the children were fully immunised by two years of age. Children who had not received any vaccines by three months of age (that is, ‘late starters’) were less likely to be fully up‐to‐date at two years of age than children who started on time (odds ratio (OR) 10.3; CI 5.2 to 20.9). Children without a parent‐held immunisation record were less likely to be up‐to‐date at two years of age than those children with a parent‐held immunisation record (OR 2.8; CI 1.9 to 4.0). With follow‐up of late‐starters, and with the simultaneous administration of overdue vaccines with vaccines given in the second year of life, the percentage of children up‐to‐date at 24 months of age could have increased from 60.3 per cent to 82.3 per cent (CI 79.1 to 85.5). The immunisation coverage rates were inadequate to prevent outbreaks of vaccine‐preventable diseases. Innovative strategies will be required if the vaccine coverage rates are to be improved. The parent‐held immunisation record is of fundamental importance to all these strategies.
Privacy, confidentiality and HIV/AIDS health care
Authors: Magnusson Roger S.
Published: August 2010

Abstract: Privacy and confidentiality are critical issues for people with HIV (human immunodeficiency virus) infection or AIDS (acquired immune deficiency syndrome). This paper reports on a series of 80 detailed interviews conducted in five cities in Australia and New Zealand, within a variety of organisations specialising in the provision of HIV testing and HIV/AIDS treatment services. The aim of the interviews was to survey current practices and procedures relating to the handling of HIV‐related health information, and to sample on an informal basis the attitudes of health professionals and HIV‐positive persons to specific privacy issues arising with respect to HIV/AIDS health care. The interviews revealed numerous practical issues, innovative procedures, and problems that are of direct relevance to the provision of HIV/AIDS health care services, and to medical practice generally. Despite the genuine commitment to privacy evidenced by most interviewees, the range of examples of careless and blatant breaches of confidentiality indicated by interviewees underscores the need for a concerted effort by those handling HIV information to adhere to legal and professional standards.
Towards a direct definition of an alcohol‐related death: an analysis in Aboriginal adults
Authors: Weeramanthri Tarun , D'Abbs Peter , Mathews John D.
Published: August 2010

Abstract: This paper addresses the conceptual and methodological difficulties in obtaining reliable information on alcohol‐related mortality in Aboriginal communities. A working definition is proposed; this requires an alcohol‐positive history together with a consistent mode of death, and is applied retrospectively to a series of 29 adult deaths in a large Aboriginal community. An informant history of alcohol abuse was found to be the most sensitive indicator of an alcohol‐positive history and correlated well with autopsy findings and medical records. Alcohol‐positive histories were found for 17 of 29 deaths by informant history, for 9 of 29 by autopsy findings, and for 12 of 29 by medical record review. These indicators were combined with a mode of death categorisation to arrive at an estimate of 5 of 29 definite, 5 of 29 probable, and 1 of 29 possible alcohol‐related deaths. We conclude by examining the process by which such a definition might be further developed and the context in which resulting information might then be used.
The cost‐effectiveness of different blood‐cholesterol‐lowering strategies in the prevention of coronary heart disease
Authors: Kinlay Scott , O'Connell Dianne , Evans David , Halliday Judith
Published: August 2010

Abstract: We aimed to compare the cost‐effectiveness of two screening strategies and a population strategy for lowering blood cholesterol to prevent coronary heart disease. Census data, known risk‐factor profiles, known coronary heart disease event rates and costs in 1988‐89 Australian dollars for all men aged 35 to 64 in the Lower Hunter region of New South Wales (n = 67 651) were used to compare a high‐risk strategy identifying and treating men with cholesterol levels above 6.5 mmol/L with diet and drug (cholestyramine), a moderate/high‐risk strategy where in addition diet counselling was offered to those with levels 5.5 to 6.5 mmol/L, and a population strategy where the diet of the whole population was changed regardless of blood cholesterol. Costs of implementing strategies, heart disease events saved, discounted and undiscounted cost‐effectiveness ratios and savings in initial treatment costs over five years were measured. For the high‐risk, moderate/high‐risk and population strategies, the costs of implementation were $50.1m, $53.1m and $5.4m respectively; the numbers of events saved were 104, 144, 116 respectively; cost‐effectiveness ratios were $482 224, $369 098, $46 667 (per event saved) respectively. Cost savings for each strategy were approximately half a million dollars. The moderate/high‐risk strategy was more cost‐effective than the high‐risk strategy but the population strategy cost one‐tenth that of the two screening strategies per event saved. More research is required to design and test strategies that alter the eating habits of the whole population.
Mortality trends, 1965 to 1989, in Busselton, the site of repeated health surveys and interventions
Authors: Knuiman Matthew W. , Cullen† Kevin J. , Bulsara Max K. , Welborn Timothy A. , Hobbs Michael S.T.
Published: August 2010

Abstract:The community of Busselton in Western Australia has participated in repeated cross‐sectional health surveys and other health interventions since 1966. Health surveys of adults were conducted every three years from 1966 to 1981. Health interventions, including programs for high blood pressure, smoking, high blood cholesterol levels and obesity, were implemented in the community. Mortality rates for the Busselton area are compared with rates for the remainder of the southwest region of Western Australia in an attempt to determine if the surveys and associated interventions have had any impact on survival. Statistical comparisons via Poisson regression analysis showed that mortality rates for males over the period 1965 to 1989 in Busselton declined at a similar rate to the southwest. However, for females, especially those aged 45 to 74 years, mortality rates declined significantly faster in Busselton than in the southwest, suggesting a beneficial impact on survival of the surveys and associated interventions.
Dementia‐free life expectancy in Australia
Authors: Ritchie Karen , Mathers Colin , Jorm Anthony
Published: August 2010

Abstract: Dementia‐free life expectancy is a synthetic indicator of an important aspect of mental health which may have considerable use in public health decision making. Dementia expectancies were derived from senile dementia prevalence rates in Australia in 1991–1992 in conjunction with national life tables using Sullivan's method. Dementia‐free life expectancy for Australian women aged 70 years was found to be 14 years within a total life expectancy of 15 years, and 11 years for men within a total life expectancy of 12 years. Between 70 and 85 years there is a constant average expectation of about one year of life expectancy with dementia. The age at which the largest number of persons with dementia is found is 82 years. Australians appear to have very similar dementia‐free life expectancies to those reported in the European studies, with small differences probably due to sampling variation or to differences in case‐finding methods.
Age‐specific patterns of mortality from cardiovascular disease and other major causes, 1969 to 1990
Authors: Russell Anne , Dobson Annette J.
Published: August 2010

Abstract: There were substantial reductions in mortality rates for all causes of death and for cardiovascular diseases in all age groups examined and both sexes during the period 1969 to 1990. Among young and middle‐aged women, cardiovascular diseases were no longer the major cause of death; cancers were. In younger men, accidents, poisonings and violence (including suicides) were the leading cause of death. In middle‐aged men, cardiovascular mortality dropped to about the same level as cancer mortality. Only in older people did cardiovascular mortality still dominate. Nevertheless, the proportion of all deaths due to cardiovascular disease remained high and there are opportunities for further reductions. The relative lack of improvement in mortality from cancers suggests that these will form increasing proportions of the burden of disease and treatment costs in the next decades.
Evaluation of the New South Wales Cancer Council Pap Test Reminder Service
Authors: Mills Annie E. , Simpson Judy M. , Shelley Julia M. , Turnbull Deborah A.
Published: August 2010

Abstract: This study aimed to assess the effect of reminder letters on Pap test rates for women enrolled on the New South Wales Cancer Council Pap Test Reminder Service and to identify predictors of response to the letter. Ten weeks after they had received their reminder letter a questionnaire was sent to 3086 women. It was completed by 1525 (49 percent) women, of whom 1393 (91 percent) said they had received their reminder letter. Of these 1393, 48 per cent (95 per cent confidence interval 46 per cent to 51 per cent) reported having had a Pap test within 10 weeks of the reminder letter arriving. The proportion of women having a Pap test in response to the reminder letter did not differ by age, region of residence or language spoken at home. Women were less likely to have had a Pap test if they did not know how they were enrolled, were of low socioeconomic status or had some tertiary education. Women on the reminder service have 15‐month rescreening rates at least 9 per cent higher than other women in New South Wales; for women aged 50 to 69 in nonmetropolitan areas the increase is estimated at 19 per cent. Reminder services may be a cost‐effective way to increase Pap test rescreening rates. Reminder services need accurate records and to follow up changes in address and date of next test.
Mark‐recapture estimates of injecting drug users in Sydney
Authors: Duque‐Portugal Francisco , Martin Andrew J. , Taylor Richard , Ross Michael W.
Published: August 2010

Abstract: The number of injecting drug users in the Central and Eastern Sydney Area Health Services (CSAHS and ESAHS) in 1989–1990 was estimated by applying the Petersen mark‐recapture method to data obtained from the Australian National AIDS and Injecting Drug Use Surveys conducted in 1989 and in 1990. The population estimates for injecting drug users were 8368 (95 per cent confidence interval (CI) 6099 to 11 829) for ESAHS and 1466 (CI 742 to 2841) for CSHS. An estimate was also obtained for the number of injecting opioid users residing within the ESAHS; our figure of 3597 (CI 2731 to 5737) was consistent with previously reported estimates obtained using mark‐recapture but based on different data sets.
Community development in health promotion: empowerment or regulation?
Authors: Petersen Alan R.
Published: August 2010

Abstract: Community development is a concept that currently has wide appeal in public health policy. It has become a central element of population‐based health promotion strategies that purport to involve community groups in determining the form and purpose of resources for advancing the community's health. It has been variously claimed that community development empowers individuals and groups, leads to greater commitment by the community and consumers to change, strengthens community values, promotes greater local accountability in use of resources, and redresses inequalities in health. However, the meanings and implications of community development remain obscure. This paper examines the multiple and conflicting discourses of community development, and suggests that the rhetoric of community development has tended not to be matched by the reality of practice. It concludes that health promoters need to be much more critical in their assessment of the approach, and to clarify the use of basic‐terminology such as ‘community’ and ‘empowerment’, if their actions are to contribute to effective long‐term change.
An outbreak of measles in a highly immunised population: immunisation status and vaccine efficacy
Authors: Herceg Ana , Passaris Irene , Mead Cathy
Published: August 2010

Abstract: An outbreak of 18 cases of measles in a primary school in the Australian Capital Territory in August and September 1993 provided the opportunity to study measles immunisation status and measles vaccine efficacy. Parents of 384 (78 per cent) of 491 children answered a questionnaire on recent illness consistent with measles and measles immunisation. Parents transcribed details of measles immunisation from the personal health record of the child to the questionnaire. Thirty‐three per cent of cases and 3.4 per cent of the other children had not been immunised. Overall, 95 per cent of children had been immunised. The efficacy for all measles vaccines was estimated to be 90 per cent (95 per cent confidence interval (CI) 75 to 96) and for measles‐mumps vaccine 87 per cent (CI 70 to 95). All of the immunised cases had received measles‐mumps vaccine. There was no increased risk of measles infection in those who had been immunised at under 15 months of age compared with those immunised at 15 months or older, or in those who could not provide a date of immunisation compared with those who could. None of the children who had received two doses of vaccine caught measles. The date of immunisation was provided by 65 per cent of the respondents who said their children had been immunised. Asking parents to provide this date instead of viewing the health record is a less expensive way of assessing immunisation status but this method needs to be evaluated. Measles outbreaks still occur in highly immunised populations when vaccine efficacy appears to be acceptable.
Immunisation practices of general practitioners in metropolitan Sydney
Authors: Rixon Gay , March Lyn , Holt Donald A.
Published: August 2010

Abstract: An anonymous postal survey of all known general practitioners in the Northern Sydney Health Area (N = 987) examined the provision of immunisation services in general practice. Questions were asked about knowledge of storage of vaccines, the ages of patients administered measles‐mumps‐rubella vaccine, the use of reminder systems for subsequent vaccinations and whether maternal and family health was discussed at immunisation visits. There were 394 (40 per cent) respondents. Only 30 per cent used temperature monitors in their vaccine refrigerators, and 26 per cent correctly identified the period after opening that Sabin may be used (eight hours). Forty‐one percent correctly injected infants in the anterolateral aspect of the thigh and 40 per cent administered measles‐mumps‐rubella vaccine by the recommended age of 12 months. Forty‐one percent of respondents always used visits for immunisation to discuss other issues of maternal and child health and 16 per cent used reminder systems for follow‐up. Sixty‐six per cent of general practitioners stated that they were more likely to review the immunisation status of adolescents routinely, compared to 55 per cent who reviewed adults and 44 per cent who reviewed senior citizens. Routine review of all three groups was carried out by 43 per cent. These results must be interpreted with caution because of low response rates, and cannot necessarily be generalised to all general practitioners providing immunisation services. Nevertheless, important deficiencies in knowledge and practice of immunisation have been identified.
Differential and spatial aspects of suicide mortality in New South Wales and Sydney, 1980 to 1990
Authors: Burnley Ian H.
Published: August 2010

Abstract: Occupational and marital status dimensions of suicide mortality in New South Wales were examined for the periods 1980 to 1985 and 1986 to 1989‐90 respectively, and marital status and birthplace group mortality profiles were examined in relation to grouped occupations, with a view to identifying the relative influence of these differentiating factors on suicide mortality. Spatial analysis was undertaken for different ages, in major regions of New South Wales and statistical local areas in Sydney for the period 1985 to 1991, and associations with socioeconomic characteristics of geographic areas were investigated. Despite residential revitalisation in inner city areas, higher mortality in several inner city localities has persisted over time while levels have risen in some outer areas. Never‐married and divorced men in manual work were most at risk of committing suicide and never‐married and divorced women had elevated suicide levels. Male suicide levels were elevated among farmers and related workers, and youth and adult male suicide levels were elevated in inland regions of the state. Possible explanations for the variations are discussed.
Homicide victims among Australian immigrants
Authors: Kliewer Erich V.
Published: August 2010

Abstract: The homicide rates for various immigrant groups in Australia were calculated, and the influence of the rate in countries of origin on immigrant rates and the relationship between the birthplace of the accused and victim were examined. Age‐sex standardised mortality ratios (SMRs) for homicide were calculated for the immigrant groups, based on 1984–1988 mortality data and 1986 census data. The Australian‐born homicide rates were used as the standard. Standardised mortality ratios for countries of origin were derived from WHO data. A cross‐tabulation of the birthplaces of the accused and the victim was compiled from 1989–1992 police records. Male SMRs ranged from 0.13 (P < 0.01) for immigrants from Africa and the Americas to 5.83 (P < 0.05) for Koreans. Several female groups had lower SMRs than the Australian‐born, although none of these differences were significant. Indonesian females had the highest SMR (5.32, P < 0.01). There was a positive Spearman correlation between the ranking of homicide rates for the origin populations and the immigrants (males 0.64, P < 0.05; females 0.62, P < 0.05). Overall, 51.3 per cent of immigrants were killed by their compatriots. This ranged from zero for New Zealanders to 100 per cent for immigrants from the Middle East. In order to further identify factors contributing to the large differences in rates it is imperative to have information on the victim, the perpetrator and the circumstances surrounding the murder.
The implications of underreporting in dietary studies
Authors: Smith Wayne T. , Webb Karen L. , Heywood Peter F.
Published: August 2010

Abstract: Dietary data from the Western Sydney Dietary Survey 1989‐90 (n = 512) was used to investigate: 1. the prevalence and predictors of underreporting of energy intake, 2. the effects on results of excluding data from underreporters for analysis of mean nutrient intakes, and 3. the proportion of energy intake supplied by macronutrients and proportions of subjects who met dietary goals. The proportion whose measured energy intakes from a Food Frequency Questionnaire (FFQ) were below cut‐points for biologic plausibility was 28.5 per cent; it was higher for subjects who had BMI > 25 and were female. Point estimates for mean intakes of energy and nutrients were all greater when data from underreporters were excluded, but nutrient intakes expressed as percentages of energy intake remained largely unchanged. Increases in estimated mean population intake for each nutrient ranged from 7 per cent to 14 per cent for males, and 12 per cent to 17 per cent for females. Estimates of the percentages of the sample who did not meet dietary goals were significantly lower for a number of nutrients when underreporters were excluded. We conclude that: 1. results expressed as a percentage of energy intake are not affected by the exclusion of energy underreporters, and 2. estimates of the proportion of populations meeting some nutrient goals and associations between diet and disease are likely to change meaningfully and significantly with the exclusion of data from underreporters.
Cost‐effectiveness of recruitment methods in a population‐based epidemiological study: the Melbourne Visual Impairment Project
Authors: Livingston Patricia M. , Guest Charles S. , Bateman Angela , Woodcock Norman , Taylor Hugh R.
Published: August 2010

Abstract: The cost‐effectiveness of five recruitment methods was evaluated to determine the best method of encouraging eligible persons to participate in the Melbourne Visual Impairment Project (a population‐based epidemiological study). The evaluation was divided into two phases. Phase 1 included one of two types of initial contact, by direct personal contact or by telephone. Phase 2 involved recruiting residents after an attempt had been made by either the telephone or the doorstep approach, and included a second attempt by a field interviewer, subsequent attempts by senior field staff, and finally, financial incentives. The cost‐effectiveness of each method was determined by dividing the approach's cost by the effectiveness ratio. We identified 269 eligible households with 356 eligible residents. An 89 per cent response rate was achieved at the examination centre, comprising 61 per cent from Phase 1 and 28 per cent from Phase 2. Although both recruitment methods in Phase 1 were equally cost‐effective, there was a significant difference in the effectiveness of each method in actually recruiting residents. The doorstep method was more costly per attender but was far more effective at 76 per cent recruitment than the telephone method at 47 percent (P < 0.001). We have demonstrated a practical two‐stage approach (the doorstep method in Phase 1 and follow‐up strategies in Phase 2) to population‐based recruitment involving the middle to elderly age group that should be relevant to many epidemiological studies.
Chiropractic and the politics of health care
Authors: O'Neill Arthur , Willis Evan
Published: August 2010

Abstract: Musculoskeletal disorders remain a common disability suffered by Australians, but the question of who should treat them remains a contentious issue as the first centenary of the original chiropractic adjustment approaches. This paper, part of a longitudinal study of the role of chiropractic in the Australian health system, analyses this ongoing debate. Recent events are analysed here in this commentary on the politics of health care in this field. These include meta‐analysis to evaluate the effectiveness of spinal manipulation for the treatment of lower back pain, recent legal action in the United States, and the recent epistle against Australian chiropractors published by the Australian Medical Association.
Increasing response rates of gynaecologists to a survey: a randomised trial of telephone prompts
Authors: Ward Jeanette , Wain Gerard
Published: August 2010

Abstract: This study used a randomised controlled trial to evaluate the effectiveness of telephone prompts to increase the response rate of gynaecologists to a survey. A nine‐page questionnaire about management of women with abnormal Pap smears was mailed to Fellows of the Royal Australian College of Obstetricians and Gynaecologists. A random sample was contacted in advance by telephone, and nonrespondents received a telephone reminder 14 days after the initial mail‐out. The control group was mailed questionnaires and a reminder letter conventionally. On Day 25, nonresponders in both groups were mailed a second questionnaire. Of the intervention group, 84 per cent responded to the survey compared to 69 per cent of the control group (P = 0.005). A telephone call in anticipation of a mailed questionnaire is highly recommended.
Longitudinal predictors of burnout in HIV/AIDS health professionals
Authors: Bennett Lydia , Kelaher Margaret
Published: August 2010

Abstract: This study examined causes of burnout in doctors, nurses and social workers caring for patients in HIV/AIDS units. There were 84 participants at Time 1 (1990) and 134 at Time 2 (1991). The results focus on the longitudinal subsample of 32 who participated in the study at both times. Path analysis was used to explore relationships between burnout at Time 2 and age, hours per week in HIV/AIDS work, and external coping style at Time 1. Older age was related to lower levels of burnout at Time 2. Hours per week in HIV/AIDS work was related to levels of burnout. Participants using an external coping style were more likely to score highly on burnout at Time 2. Where possible, management should avoid recruiting young, inexperienced staff without addressing burnout issues. Workshops to teach staff internal coping skills are recommended. Units might promote the psychosocial achievements of staff, shifting away from the traditional cure‐based achievement measures.
Will early detection of breast cancer reduce the costs of treatment?
Authors: Salkeld Glenn , Gerard Karen
Published: August 2010

Abstract: A substantial investment in resources is required to provide a population‐based mammography screening program. At the same time, screening may also reduce the costs of treating breast cancer. Empirical evidence to support such cost savings, however, is limited. This paper presents a simulation of the impact on treatment costs of a population‐based mammography screening program in New South Wales. A 1991 cohort of women aged 45 to 69 years is followed for the period 1991 to 2023. With two‐yearly screening, the present value of the total health service costs for this cohort would be approximately $112 million. Primary treatment, at $60 million, would cost $5 million more with screening than without. Treatment for advanced stages of the disease would cost $22 million less. Overall, this analysis suggests that savings in treatment costs are relatively small in relation to the overall resource requirements of organised screening.
Who has Pap smears in New South Wales? Patterns of screening across sociodemographic groups
Authors: Shelley Julia M. , Irwig Les M. , Simpson Judy M. , Macaskill Petra
Published: August 2010

Abstract: The aim of this study was to determine whether Pap smear screening at adequate intervals is associated with area of residence, frequency of consultations with a general practitioner, socioeconomic status and non‐English‐speaking background. A representative 10 per cent sample of women from New South Wales and the Australian Capital Territory, aged 25 to 69 years and registered with the Health Insurance Commission (Medicare) (N = 155 281) was used to obtain age, postcode, frequency of Pap smears and frequency of consultations with general practitioners in the three‐year period from February 1985 to January 1988. Census data for each postcode area were used as an indicator of other sociodemographic characteristics. Age‐specific screening rates did not vary between Sydney, Newcastle/Wollongong, Canberra, and nonmetropolitan areas. In all age groups, having had a smear was most strongly associated with the frequency with which a woman consulted a general practitioner. Women who visited a general practitioner at least four times a year on average were about twice as likely to have had a recent Pap smear as those who averaged less than one visit per year. Screening rates were lowest among women living in areas with the most non‐English‐speakers and the lowest socioeconomic status. Sociodemographic factors and health service usage patterns influence the proportion of women who are currently being screened. Evaluation of interventions to improve Pap smear screening rates should consider whether the percentage of women screened increases overall, and also whether the imbalances in screening rates between different groups are diminishing.
Heterosexual behaviour and HIV risk in New Zealand: data from a national survey
Authors: Paul Charlotte , Dickson Nigel , Davis Peter B. , Yee Roy Lay , Chetwynd Jane , McMillan Natasha
Published: August 2010

Abstract: The pattern of any future major heterosexual epidemic of acquired immunodeficiency syndrome (AIDS) will depend partly on sexual behaviour and condom use among heterosexuals. This survey was designed to provide information on patterns of sexual behaviour in New Zealand. A national sample aged 18 to 54 was selected using a random method and telephone interviews were administered to 2361 people, using a questionnaire based on the protocol developed by the Global Program on AIDS of the World Health Organization. The reported mean lifetime number of partners increased with age up to 25 to 29 years for women and 30 to 34 years for men, and declined at older ages. Fifteen or more lifetime partners were reported by 17 per cent of men and 4 per cent of women. Multiple partnerships in the previous 12 months were commonest in those aged 20 to 24. In this age group, 32 per cent of men and 20 per cent of women reported two or more partners. Recent condom use for contraception was reported by 23 per cent of men and 19 per cent of women. Use was highest amongst those aged 18 to 24, and decreased sharply with age. The true proportion of the population with many sexual partners may be higher than reported. These data will be useful in modelling approaches to estimate the likelihood of future heterosexual spread of AIDS. The data on lifetime numbers of partners suggest that sexual decisions depend not just on age and sex but also on the era, and thus on changing social values about sexual behaviour.
Colorectal cancer and its prevention: prevalence of beliefs, attitudes, intentions and behaviour
Authors: Weller David P. , Owen Neville , Hiller Janet E. , Willson Kristyn , Wilson David
Published: August 2010

Abstract: There is so far only limited evidence from randomised controlled trials that screening for colorectal cancer using the faecal occult blood test produces significant mortality reductions in screened groups, but there is considerable activity and interest in the use of such screening in Australia. Beliefs, attitudes, intentions and behaviour in relation to colorectal cancer and screening were examined among participants 40 years and older (n = 1776) who took part in a representative population survey. While there were high levels of awareness of faecal occult blood test screening, most respondents had not had a test, nor did they intend to take a test in the future. Important determinants of participation in screening were a family history of colorectal cancer, a belief that bowel cancer can be cured if detected at an early stage, a perception of personal susceptibility to bowel cancer and an acceptance of the technique. Factors such as these are likely to influence the success of any future screening program in Australia.
Alcohol consumption and harm in two Western Australian regional centres
Authors: Midford Richard , James Ray , Oddy Wendy , Dyskin Elena V. , Beel Andrea
Published: August 2010

Abstract: The application of national or state alcohol harm‐prevention programs at a regional level can be inappropriate. The involvement of local communities is critical if harm‐prevention responses are to be sensitive to local needs. Unfortunately, individuals and agencies usually have little idea of the impact of alcohol at the local level. Alcohol consumption and harm data have been gathered for Geraldton and Bunbury, two regional centres of comparable size in Western Australia. The indices of harm presented include the nature and cost of hospital morbidity attributable to alcohol, and drink‐driving charges. In Geraldton, the impact of alcohol tends to be acute and affects young adults, particularly young males. In Bunbury, the consequences of alcohol use tend to be more chronic in nature and affect older adults. These findings have been used to inform local harm‐prevention responses, but more than that, this study is a practical example of how available data can be aggregated at a community level to illustrate local alcohol use and harm. This method can be replicated in any community that wants to understand better the effects of alcohol in its own local context.
Skin examination for signs of cancer
Authors: Borland Ron , Meehan James W.
Published: August 2010

Abstract: Doctors sometimes examine or suggest examination of the skin for signs of skin cancer, and self‐examination of the skin has been promoted in some public education materials. A representative sample of 590 residents of Victoria was asked whether they or their doctors had ever deliberately checked for signs of skin cancer, and whether their doctors had ever suggested such a check. Respondents also indicated their skin type by degree of freckling and propensity to sunburn. The results suggest that females have a higher level of skin awareness than males. People prone to sunburn and heavily freckled individuals were more likely to have checked their skin, and doctors were more likely to have suggested a check to highly freckled individuals. Self‐examination, examination by a doctor and recommendations from doctors for self‐examination were all positively associated with each other, indicating that a section of the population was identified by themselves or their doctors as being at risk, but this group was not well defined by the two indices of risk used in the survey.
Smoking in hotels: prevalence, and opinions about restrictions
Authors: Semmonds Alison , Bailey Kirsten , Bentley Sarah , Chase Vicki , Fernando Shane , Guruge Anusha , King Michael , Tan Ong‐Ming , Walsh Raoul
Published: August 2010

Abstract: Exposure to high levels of environmental tobacco smoke can occur in hotels. Controversy exists about smoking regulation on licensed premises. This survey of 138 people attending one of three Newcastle hotels during 1993 found that 57 per cent of respondents were nonsmokers. Fifty‐eight per cent (95 per cent confidence interval (CI) 50 to 66 per cent) of respondents in these hotels believed their health was being adversely affected by other people's smoke in the hotel. Seventy per cent (CI 62 to 78 per cent), including half the smokers, were in favour of restriction of smoking in the hotels. Most preferred the establishment of smoke‐free areas to the introduction of total smoking bans in hotels. The failure of hotels to regulate smoking suggests that a legislative approach is required. The case for legislation would be strengthened by a larger study elsewhere in Australia.
Preference and requests for smoke‐free dining
Authors: Mullins Robyn , Borland Ron
Published: August 2010

Abstract: This study looked at whether people prefer to sit in smoking or smoke‐free areas when they go to cafes and restaurants. It also considered whether those who said they would prefer smoke‐free dining made this known when booking or going to a restaurant. The sample was 2387 Victorians, randomly selected and interviewed in their own homes. Overall, 68 per cent of respondents said they would prefer a nonsmoking area, and only 11 per cent preferred a smoking area. Even among smokers, less than half (42 per cent) wanted to sit in a smoking area. Of those people who wanted smoke‐free dining only 45 per cent said they always made this known. The results demonstrate strong community desire for smoke‐free dining but also point to the need for restaurant managers or the dining public to take the initiative, or for legislative action to ensure the provision of smoke‐free areas.
Smoking in New Zealand: a census investigation
Authors: Easton Brian
Published: August 2010

Abstract: New Zealand may well be unique in that in the 1976 and the 1981 Censuses of Population and Dwellings, persons over the age of 15 were asked about their cigarette smoking habits. The data are available on the basis of age and ethnicity, enabling an examination of the prevalence of ever‐smoking by a cohort born some 80 years before the censuses were taken, at the end of the last century. Thus the effect of ever‐smoking on mortality can be calculated. Ever regularly smoking reduced the life expectation of males by 11.7 years and females by 15.6 years. The corresponding reductions for Maori were 19.3 years and 23.8 years. The effect of smoking on health has been of epidemic proportions, notably for the Maori.
An improved aetiologic fraction for alcohol‐caused mortality
Authors: Holman C. D'Arcy J. , English Dallas R.
Published: August 2010

Abstract: A method is proposed for estimation of alcohol‐caused mortality in which the aetiologic fraction of deaths is derived from an exposure contrast between the ‘unsafe’ drinker and ‘safe’ drinker; not between the drinker and the nondrinker. The method is consistent with the objectives of public health intervention in the alcohol education field. The ‘safe’ drinker is the reference exposure category and aetiologic fractions are obtained for the single categories of a multiple‐level exposure scale, using separate relative risks for the ‘unsafe’ drinker and the nondrinker. Preliminary application of the method to Australian data yields an estimate of the number of deaths caused by misuse of alcohol that is larger than those obtained under the old conceptual model. Thus, the public health importance of unsafe alcohol consumption has been underrepresented.
Injury from assault in New Zealand: an increasing public health problem
Authors: Chalmers David J. , Fanslow Janet L. , Langley John D.
Published: August 2010

Abstract: Injury purposely inflicted by other persons is a significant public health problem accounting for approximately 4 per cent of all injury hospitalisations in New Zealand. National injury morbidity data for the years 1979–1988 were examined. These data were used to identify the characteristics of victims of assault who were hospitalised, the nature of the injuries they sustained, and the circumstances in which the injuries were inflicted. The incidence of hospitalisations in 1988 was 73.7 per 100 000 persons per year. A significant increase in the rate of hospitalisations over the decade 1979–1988 was identified. The rates for males were higher than those for females, with males 20–24 years of age most at risk. Maori had higher rates than non‐Maori. Fights or brawls were the leading cause of hospitalisation. The most common place of occurrence was private homes, followed by streets and highways, and licensed premises. The findings with regard to age, sex, employment status and use of weapons were consistent with earlier studies. A higher proportion of incidents occurring in the home was attributed to differences in selection of cases between studies. An indication of underreporting by women was attributed to concealment of intentionality, possible owing to fear of reprisal. Standard hospital reporting procedures were proposed as a means of improving identification.
Cervical screening in general practice
Authors: Pritchard Douglas A. , Straton Judith A. Y. , Hyndman Jilda
Published: August 2010

Abstract: This study examined the effect of three interventions for encouraging women to have a Pap smear in a general practice: tagging the medical record to remind the doctor to offer a Pap smear, sending an invitation to make an appointment for a Pap smear, and sending an invitation with an appointment to attend for a Pap smear at a special screening clinic staffed by women. The study took place in a university general practice at Lockridge, near Perth. A computerised practice age‐sex register provided 2139 women in the age range 36 to 69 inclusive. Of these, 757 were eligible for inclusion in the study and were allocated randomly to one of three intervention groups or a control group. In total, 177 women had a Pap smear during the study. Significantly more Pap smears were taken for the appointment‐letter and letter‐only groups than the control group (odds ratio (OR) 2.13, 95% confidence interval (CI) 1.34 to 3.57, and OR 1.67, CI 1.01 to 2.77 respectively), but there was no significant difference between the tagged‐notes and the control groups. Women who attended the screening clinic rated the experience positively. Attendance, however, was inadequate for the clinic's viability in a private practice.