bluuebunny/crossref_metadata_2025 huggingface dataset:
A sampling framework for rural and remote doctors
Authors: Hays Richard B. , Craig Mark L. , Wise Anne L. , Nichols Anna , Mahoney Mary D. , Adkins Peter B. , Sheehan Mary , Siskind Vic
Published: August 2010

Abstract: A pilot survey by telephone interview, followed by a questionnaire of all rural doctors identified in Queensland, was used develop both a definition of rural practice that distinguishes it from urban general practice and a classification of rural and remote practice which assists in sampling of rural doctors. Questionnaire responses in specific geographic areas were compared using chi‐square and Mantel‐Haenszel chi‐square tests. Several factors were found to differentiate rural from urban general practice consistently, thereby enabling a functional definition of rural practice to be developed. Within the broad group of rural doctors, gradients in practice characteristics were found to differentiate doctors in larger rural centres from those in smaller, more remote communities. These gradients were related to the distance and time of travel from support services. They formed the basis of a complex classification of rural and remote general practice. This functional definition of rural and remote medical practice should be considered by researchers of rural medicine issues when sampling rural and remote doctors. The strategies used in this study could be adapted for use in considering practice characteristics of other rural health professions.
Survival tucker: improved diet and health indicators in an Aboriginal community
Authors: Lee Amanda J. , Bailey Anne P.V. , Yarmirr Daisy , O'Dea Kerin , Mathews John D.
Published: August 2010

Abstract: The poor nutritional status of Aboriginal Australians is a serious and complex public health concern. We describe an unusually successful health and nutrition project initiated by the people of Minjilang, which was developed, implemented and evaluated with the community. Apparent community dietary intake, assessed by the ‘store‐turnover’ method, and biochemical, anthropometric and haematological indicators of health and nutritional status were measured before intervention and at three‐monthly intervals during the intervention year. Following intervention, there was a significant decrease in dietary intake of sugar and saturated fat, an increase in micronutrient density, corresponding improvements in biochemical indices (for example, a 12 per cent decrease in mean serum cholesterol, increases in serum and red cell folate, serum vitamin B6 and plasma ascorbic acid), decrease in mean systolic and diastolic blood pressures, a normalisation of body mass index, and a normalisation of haematologic indices. The success of this project demonstrates that Aboriginal communities can bring about improvements in their generally poor nutritional status, and that the store‐turnover method provides a valid, inexpensive and noninvasive method for evaluating the resultant changes in community diet. Although the project was undoubtedly effective in the short term, further work is in progress to assess individual strategies with respect to sustainability, cost‐effectiveness and generalisability.
Participation in breast cancer screening: randomised controlled trials of doctors' letters and of telephone reminders
Authors: Richardson Ann , Williams Sheila , Elwood J. Mark , Bahr Margaret , Medlicott Tim
Published: August 2010

Abstract: The study used a randomised controlled trial to find out whether supporting letters from general practitioners accompanying the invitations from a screening centre affected participation in a population‐based breast cancer screening program for women aged 50 to 64. A further randomised controlled trial compared the effect of postal reminders with telephone reminders for women who did not respond to an initial invitation to participate in the program. There were 482 women in the first trial and 641 in the second. Excluding women who were ineligible or could not be contacted, participation in screening was 71 per cent in the group which received letters from their general practitioners compared with 62 per cent in the group which did not receive letters (P = 0.059). In the group that received letters, 56 per cent were screened without a reminder compared with 43 per cent of the group that did not receive letters (P = 0.01). Fewer women who received letters from their general practitioners declined the invitation to be screened (P = 0.048). In the second trial, there was no difference in participation between the group receiving telephone reminders and the group receiving postal reminders. As in breast cancer screening programs in other countries, general practitioner endorsement of invitations increased participation in breast cancer screening. Postal reminders were as effective as telephone reminders in encouraging women who did not respond to an initial invitation to participate in screening.
Purchaser/provider separation and managed competition: reform options for Australia's health system
Authors: Street Andrew
Published: August 2010

Abstract: A purchaser/provider separation and managed competition have been recommended as options for reform of Australia's health system. This paper presents the theoretical basis and supposed advantages of each model. The introduction of the purchaser/provider separation in the United Kingdom and New Zealand is described, as are the proposals for implementation of managed competition in the United States and the Netherlands. The potential for either model to deliver its promised benefits is critically evaluated in the light of existing evidence. As yet neither model can command unqualified support but both are worthy of further consideration.
Hospital inpatient costs resulting from road crashes in Western Australia
Authors: Hendrie Delia , Rosman Diana L. , Harris Anthony H.
Published: August 2010

Abstract: The purpose of this study was to estimate the inpatient costs of road crashes in Western Australia, and to investigate factors relating to casualties and their injuries that affect the hospital costs resulting from road crashes. All road crash casualties who were injured severely enough to be hospitalised in Western Australia in 1988 were included. A casemix classification system was used to classify patients into diagnostic related groups. Hospital costs were assigned to individual patients on the basis of their diagnostic related group and length of hospital stay. The annual cost of hospital treatment for road crash casualties was estimated as $13.9 million, and 33 per cent of this was incurred by those with lower extremity injuries and 27 per cent by those with head injuries. Hospital costs per casualty ranged from an average of $1388 for those sustaining minor (Abbreviated Injury Scale severity score of 1 or 2) spinal injuries to $16 580 and $33 424, respectively, for those sustaining severe (Abbreviated Injury Scale severity score of 4 or 5) head and spinal injuries. A multivariate analysis of variance revealed the following factors as having a significant independent effect on the hospital inpatient costs of road crash casualties: type of hospital (teaching or nonteaching), body region of injury, injury severity level and road user group. There were also significant interaction effects between different factors. Since hospital inpatient costs vary considerably across factors, using average cost data in the specific economic evaluation of road safety interventions for groups of road users is inappropriate.
An economic analysis of alternatives for childhood immunisation against Haemophilus influenzae type b disease
Authors: McIntyre Peter , Hall Jane , Leeder Stephen
Published: August 2010

Abstract: Cost‐effectiveness and cost‐utility analyses of immunisation strategies against invasive Haemophilus influenzae type b (Hib) disease in Australia were based on a hypothetical birth cohort of 250 000 non‐Aboriginal Australian children. The model predicted that, without immunisation, 625 cases of invasive Hib disease would occur in under‐five‐year‐olds, with direct costs of $10.2 million. Universal public sector vaccination beginning before six months of age (6MVAC) prevented 80 per cent of cases; vaccination at 12 months (12MVAC) 62 per cent and at 18 months (18MVAC) 46 per cent At a vaccine cost of $15 per dose, 18MVAC gave the lowest cost per quality‐adjusted life year (QALY) over a wide range of model assumptions, with 6MVAC the ‘best’ alternative. The best estimate ($ per QALY) for 6MVAC was $6930 (three doses), for 12MVAC $9136 (two doses) and for 18MVAC $1231 (one dose). The cost per QALY of single dose catch‐up immunisation of older children was estimated at $8630 at two years, $27 000 at three years and $117 000 at four years if done at a scheduled visit; these values were increased if an additional medical visit was included. The threshold cost per vaccine dose at which an immunisation program became cost‐saving was estimated for 6MVAC, 12MVAC and 18MVAC as $11, $10 and $14. Even under a worst‐case scenario, an immunisation program at 6, 12 or 18 months became cost‐saving if indirect costs of death were included. Comparison with previous analyses revealed the importance of the incidence and age distribution of disability and assumptions about vaccine administration costs in determining model outcomes.
Surveillance for sexually transmissible diseases in Victoria, 1983 to 1992
Authors: Crofts Nick , Gertig Dorota M. , Stevenson Elaine , Thompson Sandra C. , Stewart Tony , Lester Rosemary , Forsyth Joc
Published: August 2010

Abstract: Surveillance systems have been developed in Victoria to determine trends in sexually transmissible diseases (STDs). Notifications to the Health Department (including laboratory notification since May 1990) have been supplemented by data about strains of Nasseria gonorrhoeae and cultures for Chlamydia trachomatis processed by the Microbiological Diagnostic Unit, enhanced laboratory surveillance of syphilis, and data on genital herpes and genital warts from the Melbourne Sexual Health Centre. During the period under review the incidence of gonorrhoea declined, rapidly at first, and then more slowly. For women, this trend has continued, while gonorrhoea acquired abroad by men has become relatively more important. Since 1988, gonorrhoea in homosexual men has increased, and rectal isolates have increased concurrently, raising concerns about HIV risk behaviour. Cases of syphilis are likely to be ascertained through STD, antenatal and refugee screening, rather than because of symptoms or contact tracing. Chlamydia is a the most common notifiable STD, despite underreporting and under‐diagnosis. In 1991, 832 cases were notified, increasing to 1377 in 1992. In 1992, of the 73 cases (65 per cent of notifications) where the doctor identified a risk, 15 per cent was attributed to homosexual contact, and 27.4 per cent to heterosexual exposure. Limitations in the data include inadequate standard case definitions for many STDs, changes in the statutory requirement for notifications in 1990, underreporting, changes in diagnostic and screening patterns, and lack of detailed demographic data. Education of general practitioners is needed to improve diagnosis and notification of chlamydia.
The impact of caring upon the health of older women
Authors: Rosenman Linda , Brocque Robyne Le , Carr Susan
Published: August 2010

Abstract: Much community care relies upon the provision of unpaid care by family members. The short‐ and longer‐term effects of providing care upon older women were researched in an interview survey of 286 women aged over 50 in urban and rural areas of Queensland. The findings were validated by reports from the women's general practitioners. The results suggest that providing care has both short‐ and long‐term negative effects upon the physical health and emotional wellbeing of older women. The major predictor of a range of self‐reported health problems was the level of self‐reported stress. Implications are drawn for both community care policy, which needs to focus upon the impact on the carer of continuing to provide care at home, and for health research relating to older women, which has ignored the demands of caring among older people.
Smoking by adolescents: large revenue but little for prevention
Authors: Girgis Afaf , Doran Christopher M. , Sanson‐Fisher Rob W. , Walsh Raoul A.
Published: August 2010

Abstract: The purpose of this paper is to report on the government revenue gained from the sale of cigarettes to minors and the proportion of this revenue that is spent on attempting to prevent adolescents from taking up this habit Prevalence of smoking by minors was extrapolated for the individual states using Australian prevalence data; estimates of annual cigarette consumption were coupled with the respective cost of cigarettes in each state to derive an estimate of the total revenue accumulating from cigarette consumption by minors. From our analysis, approximately 211 000 Australian children under the legal age to purchase cigarettes consumed approximately 11.5 million packets of cigarettes in 1990. The estimated tax revenues to the federal and state governments from these sales were $8.42 million and $12.78 million respectively. While the average state revenue from cigarette consumption by minors during 1990 was just over $60 per under‐age smoker, only $0.11 per under‐age smoker was spent on anti‐smoking campaigns in 1990. This is equivalent to approximately 0.002 per cent of state revenue from cigarette smoking by those under the legal purchase age being spent on discouraging adolescents from taking up this habit Clearly, there is an inequitable expenditure on antismoking activities, given the enormous resources obtained from sales to minors.
A retrospective cohort study of childhood immunisation status in northern Sydney
Authors: Skinner John , March Lyn , Simpson Judy M.
Published: August 2010

Abstract: A survey of their children's immunisation status was conducted among mothers of babies from a three‐month birth cohort (January to March 1990) in the Northern Sydney Area in 1992. Its aims were to determine the uptake of immunisation in the area, to examine factors associated with immunisation status, and to assess agreement between the parent's reporting of this status and records of councils and general practitioners. Fifty‐eight per cent of the questionnaires (1004) were returned. The full immunisation rate was 86 per cent, 14 per cent were partially immunised and only four children had received no immunisations. Between 74 per cent and 82 per cent of vaccinations were on time at two, four and six months; the rate dropped to 21 per cent at 12 months. Logistic regression analysis showed that premature babies are significantly more likely to be fully immunised, whereas children who have had a serious childhood illness, those with a single mother, or whose mothers are more highly educated, are significantly less likely to be fully immunised. There was 60 per cent agreement between the parent's report of immunisation status and a subgroup of 197 council and 82 general practitioner records. Although all councils in the Northern Sydney Area have a reminder system, most immunisations were found to be done in general practices (64 per cent), where reminder systems are not common.
The seasonality of hip fracture and its relationship with weather conditions in New South Wales
Authors: Lau Edith M.C. , Gillespie Bill G. , Valenti Lisa , O'Connell Dianne
Published: August 2010

Abstract: The seasonal pattern in hip fracture rates and its relationship to weather variables was studied using hospital admission data for New South Wales. There was a consistent seasonal pattern for hip fracture, with a trough in the summer and a peak in the winter, for the six years for which data were available: 1981, 1983, 1986, 1988, 1989 and 1990. The seasonal trends for all years were statistically significant (P<0.01) in men and in women, and in people who were 75 years and over. The relationship between the monthly admission rates for hip fracture in Sydney and such weather variables as mean daily minimum temperature, mean cloud cover, number of days with strong wind, number of days of fog, number of days of mist and number of days with 0.1 mm or more rainfall in a month were studied by Poisson regression. The mean daily minimum temperature for each month was the single weather variable independently and consistently associated with the monthly rates of hip fracture in both younger and older people. For the first time, a seasonal pattern for hip fracture and its close association with monthly temperature in Australia has been demonstrated.
Disinfection of drinking water, disinfection by‐products and cancer: what about Australia?
Authors: Pilotto Louis S.
Published: August 2010

Abstract: Chlorine, commonly used to disinfect drinking water, produces by‐products known from animal studies to be carcinogenic and mutagenic. Most epidemiological studies into the possible association between chlorination by‐products in drinking water and cancer have been ecological in nature, or have relied on case‐control designs based on death certificates. Interpretation of results arising from these studies is limited. Individual levels of toxicant exposure and many potential confounders and effect modifiers are unable to be accounted for in the analyses. At best, these studies generate hypotheses that require more definitive investigation. Misclassification of individuals based on inaccurate assessment of the level of exposure is probable. The few analytic studies able to overcome or minimise these problems suggest a clear link between exposure to chlorinated drinking water and the development of urinary bladder cancer. They also suggest a possible link with rectal cancer. However, these studies have classified subjects by exposure to chlorinated drinking water, rather than to levels of chlorine and its by‐products in drinking water. To date, the link between levels of chlorine and its by‐products in water, levels of consumption and cancer has not been made. Information on the levels of chlorine and some by‐products is available in many water jurisdictions in Australia. Further, epidemiological methods can be employed to quantify water consumption. Case‐control studies linking these parameters would help us to understand the magnitude of the risk to human populations and provide a basis to investigate mechanisms for risk reduction.
When you can't ask their names: linking anonymous respondents with the Hogben number
Authors: Honig Frances
Published: August 2010

Abstract: This article describes a method of linking anonymous subjects with a respondent‐generated code using an algorithm based on personal details to produce unique identifiers. It was used to increase confidentiality and statistical power in a yearlong work‐place health promotion evaluation. Subjects were employees of a large retail chain; 80 per cent were female, and the majority educated to high school level. Of the 385 possible, 81 per cent matched; 67 per cent of the codes were matched on all elements and another 14 per cent were accepted as ‘fuzzy’ matches. Linking respondents increased the statistical power of the study from an unacceptable 0.4 to an acceptable 0.8. Other research on linking records is briefly discussed, including sample bias and probabilistic matching. This technique is useful when anonymity is likely to raise response rates, but the ideal code could be further sought.
Increase in the self‐reported prevalence of asthma and hay fever in adults over the last generation: a matched parent–offspring study
Authors: Hopper John L. , Jenkins Mark A. , Carlin John B. , Giles Graham G.
Published: August 2010

Abstract: The study compared current measures on a population‐based cohort of adults with past measures on their parents to determine whether the prevalence of self‐reported asthma and hay fever in adults increased between 1968 and the early 1990s. In 1968, 8585 cohort members (99 per cent of eligible Tasmanian 7‐year‐old school children born in 1961), 16 273 (95 per cent) of their parents (mean age 35 years) and 20 937 siblings completed a questionnaire about asthma and hay fever. In 1991–1993, 1494 members (75 per cent) of a stratified random sample of the cohort (aged 29 to 32 years), 75 per cent resident in Tasmania, were surveyed again. In 1968, the proportion of parents who reported having ever had asthma or attacks of wheezing like asthma was 10.9 per cent, independent of age and sex. In 1991–1993, the estimated adult prevalence of having ever suffered from attacks of asthma or wheezy breathing was 23.2 per cent. The proportion reporting at least one asthma attack within the previous 10 years, 5 years, 2 years, 12 months and 6 months was 17.6 per cent, 16.1 per cent, 14.5 per cent, 13.3 per cent and 10.3 per cent, respectively. For hay fever, the adult prevalence was 19.2 per cent in 1968, and 41.3 per cent in 1991–1993. The self‐reported lifetime prevalence of asthma and hay fever among adults in the 1961 birth cohort of Tasmanians was twice as high in 1991–1993 as in their parents 25 years earlier. The change in disease interpretation necessary to account fully for the change in prevalence provides evidence for a real increase. Nevertheless, unavoidable subtle differences in questioning could account for half the observed change in prevalence.
Quitting smoking: estimation by meta‐analysis of the rate of unaided smoking cessation
Authors: Baillie Andrew J. , Mattick Richard P. , Hall Wayne
Published: August 2010

Abstract: The rates (after 12 months' follow‐up) of unassisted smoking cessation reported in the literature have varied from 13.8 per cent to 8.5 per cent. A meta‐analysis was conducted of the abstinence rates observed in 14 samples of smokers who presented at primary health settings and received either no intervention aimed at smoking or usual care (which involved no deliberate intervention for smoking cessation). The estimated rate of stopping smoking without intervention, over an average 10‐month period, was 7.33 per cent. This rate is consistent with others reported in the literature when motivation to quit is taken into account. The estimate provides a baseline to judge the effects of smoking‐cessation interventions.
The SF‐36 in an Australian sample: validating a new, generic health status measure
Authors: McCallum John
Published: August 2010

Abstract: The SF‐36 is a self‐reported, 36‐item, generic measure of health status that has been validated for adult age groups in the United States, the United Kingdom and in some non‐English‐speaking countries. The Australian Bureau of Statistics used it in the 1995 National Health Survey and it has been used in health status measurement, in monitoring health outcomes and in clinical trials. The validity of the SF‐36 was examined in the National Centre for Epidemiology and Population Health Record Linkage Study using a sample of 555 respondents to the National Heart Foundation Risk Factor Prevalence Survey in 1989; they were followed up in 1992. Items chosen for the scale had been used in health status assessment and had stood the test of time. The health concepts measured demonstrated good internal consistency. The eight scales of the SF‐36 formed factors as predicted in the general health dimensions of physical and mental health. The component scales of the SF‐36 demonstrated good discrimination between people with and without health conditions, including those with medical and those with psychiatric types of conditions. Although the SF‐36 was a valid measure of general health status among Australian respondents, further work is needed to establish clinical validity and to produce population norms for Australia. Use of the SF‐36 will allow Australian and international comparison of health status from the point of view of the users of health services.
A prospective cohort study investigating psychosocial predictors of attendance at a mobile breast screening service
Authors: Turnbull Deborah , Irwig Les , Simpson Judy M. , Donnelly Neil , Mock Philip
Published: August 2010

Abstract: This study aimed to examine whether knowledge, attitudes and concerns predicted attendance at the mobile Breast X‐Ray Programme in Sydney. A cohort study design was used, whereby women were surveyed prior to the implementation of the program, and two years later records were checked to determine whether they had attended for screening. Telephone interviews were sought with randomly selected women aged 45 to 70 years living in the central Sydney area (the screening van's catchment area). A total of 285 women was surveyed (response rate: 50 per cent). Of these, 86 (30 per cent) subsequently attended at the mobile van and 199 did not. Attendance did not appear to be related to any of the following factors: knowledge; attitudes; prior experience; perceived susceptibility and morbid concern in relation to breast cancer; the amount of information about screening mammography to which a woman had been exposed. The results are interpreted in light of methodological considerations plus findings from our other research.
Information for family carers: does it help?
Authors: Murphy Barbara , Schofield Hilary , Herrman Helen
Published: August 2010

Abstract: Family carers in Victoria were identified through a statewide telephone survey in 1993. A total of 976 carers was interviewed and a random sample of approximately one in 10 (n=103) were offered the Carer Support Kit leaflet. The leaflet details the components of the Carer Support Kit (a Federal Government initiative developed in 1992–93) and informs carers how to apply for it through the Victorian Carers' Association. Approximately three‐quarters of these carers accepted the offer, and around a third subsequently applied for the kit. Carers who applied for the kit reported significantly more overload and lower life satisfaction than those who did not apply. Only two‐thirds of those mailed the kit (just 23 per cent of the eligible study sample) went on to use it. Those who had not used it reported significantly more negative emotions and health problems than those who used it, suggesting that stress and crises could preclude utilisation of the information. A brief evaluation of the components of the kit is presented; however, findings need to be treated with caution in view of the small sample size.
Notifying women of the results of their cervical smear tests by mail: does it result in a decreased loss to follow‐up of abnormal smears?
Authors: Del Mar Christopher B. , Wright R. Gordon
Published: August 2010

Abstract: We undertook a prospective randomised intervention study of the proportions of women with abnormal cytology results who were lost to follow‐up in 42 general practices in urban and rural Queensland over 26 weeks. Practices in the intervention group were provided with a redesigned cervical smear request form that allowed patients to provide an address for direct notification from the laboratory by mail. Satisfaction questionnaires sent to the general practitioners in the intervention group showed that most made at least some use of direct notification, and most felt it was worthwhile. For women with an initial result of cervical intraepithelial neoplasia (CIN), there was a loss to follow‐up of 23 per cent (95 per cent confidence interval (CI) 11 to 39) among the control group compared to none in the intervention group (upper CI 7 per cent), a highly significant difference (P < 0.001). Mailing cervical screening results to women may reduce the loss to follow‐up of those with CIN findings.
Assessment of the future impact on health of a proposed freeway development
Authors: Dunt David R. , Abramson Michael J. , Andreassen David C.
Published: August 2010

Abstract: This paper estimates the effect on health of traffic injury and air and noise pollution from a proposed inner‐suburban freeway in Melbourne. We estimated levels of these health problems for the year 2001 using traffic flow projections for the presence and absence of the freeway. For noise and air pollution, it was necessary to use pollutant levels as proxies for levels of associated diseases and health states. In 2001, there will be an increase in all traffic movements in the study area but a decrease of 100 000 vehicle–kilometres per day on major roads, excluding the bypass. This is associated with a projected reduction in the study area of about 100 to 110 injuries of all types. The major air pollution problems associated with motor vehicle emissions are ozone and respirable particulates; sulphur dioxide, nitrogen dioxide and carbon monoxide are unlikely to pose a health hazard. Levels of respirable particulates, lead and polycylic aromatic hydrocarbons are generally low. There should be no detectable increase in average or maximum noise levels adjacent to the freeway if attenuation measures are employed. A reduction in average and maximum noise levels should occur on some main roads in the affected area. The effects of the freeway on the area should be favourable to health, with reduction in traffic injury and noise‐related health problems outweighing any risk of a small deterioration in respiratory health associated with atmospheric pollution.
Exposure to pesticides in ambient air
Authors: Beard John , Westley‐Wise Victoria , Sullivan Geoff
Published: August 2010

Abstract: Ambient air was monitored for pesticides at four sites in Coffs Harbour, a coastal town (population about 50 000) surrounded by banana plantations. Air was sampled continuously for five consecutive months during the peak agricultural spraying period using vacuum pumps set to sample one litre per minute through ORBO‐42 adsorption tubes. Six pesticides were detected: three organochlorines and three organophosphates. The most commonly detected pesticide (14 per cent of all samples) was chlor‐pyrifos (maximum detected level 208.0 ng/m3, mean 3.6 ng/m3). Heptachlor was detected in 7.1 per cent of all samples (maximum detected level 133 ng/m3, mean 2.7 ng/m3). Other pesticides were only rarely detected. The only pesticide applied by air in the district (propiconazole) was not detected. If international health guidelines are used as a yardstick, these levels of exposure appear unlikely to present an appreciable health risk. Chlorpyrifos detection was associated with low wind speed (P = 0.012) and high temperature (P = 0.015), and detection at one site was associated with detection at another (P < 0.001). Chlorpyrifos detection was also associated with domestic applications within the town area as reported by pesticide applicators (P = 0.045). Peak agricultural use of chlorpyrifos did not coincide with peak detection periods. None of the detected organochlorines is registered for agricultural use, although at the time, heptachlor was permitted for use as a domestic termiticide. Even in a semirural town with nearby widespread use of agricultural chemicals, community exposures to pesticides in ambient air may largely relate to their nonagricultural use.
Readmissions to hospital: the contribution of morbidity data to the evaluation of asthma management
Authors: Rushworth R. Louise , Rob Marilyn I.
Published: August 2010

Abstract: We evaluated hospital readmission as an indicator of the quality of management of asthma patients, between July 1989 and June 1990. Using hospital separation data, we constructed a matched data set to identify early (within two weeks of discharge) readmissions. Of over 14 000 admissions for asthma in the 1‐to‐44‐year age group, 2.8 per cent were classified as early readmissions. Admissions and readmissions were more common in rural than metropolitan areas. Admissions were most common during autumn, but early readmissions occurred most often during spring. Patients staving more than one day were 0.5 times (95 per cent confidence interval (CI) 0.37 to 0.68) as likely to have an early readmission than patients staving less than one day. Using the same data set, we identified patients who had the potential for readmission within a six‐month period. Of the 5052 patients, 17.8 per cent were readmitted at least once during the period; 3.7 per cent had at least one early readmission, and 15.8 per cent had at least one late readmission (more than two weeks following discharge). A length of stay of more than one day was associated with 0.41 times (CI 0.24 to 0.70) the risk of early readmission in this cohort A length of stay of more than one day was associated with a higher risk of late readmission (1.52, CI 1.09 to 2.12), which was less likely to occur in rural than metropolitan areas (0.45, CI 0.37 to 0.55). This study showed that hospital data can identify factors associated with readmission for asthma; such readmission may be an indicator of asthma morbidity and/or management in the population.
Recall, retention, utilisation and acceptability of written health education materials
Authors: Newell Sallie , Girgis Afaf , Sanson‐Fisher Rob W.
Published: August 2010

Abstract: The effects of two distribution strategies on the recall of receipt, retention, utilisation and perceived acceptability of written health education materials were investigated in two semirural communities. We randomly selected 512 people, 212 from general practitioners' surgeries, who received the materials from their general practitioners at the end of a routine consultation, and 300 from the electoral register, who received it through the mail in a personally addressed envelope. Of all those who received the materials, 55 (10.7 per cent) were not contactable and 386 (84.5 per cent) of those contacted consented to the survey. Structured interviews were conducted with consenting individuals two weeks after distribution to assess recall of receipt, retention, utilisation and perceived acceptability. Of those receiving the material by mail, 77.4 per cent recalled receiving it, 75.4 per cent reported keeping the booklet and 66.7 per cent reported reading it Of those receiving it from a general practitioner, 90.9 per cent recalled receiving it, 93.3 per cent reported keeping the booklet and 56 per cent reported reading it Perceived acceptability of the material was high, with over 80 per cent of respondents finding it very or fairly eye‐catching, believable, interesting and easy to read. Although general practitioner distribution led to higher rates of receipt and retention, mail‐out distribution led to higher utilisation rates and allowed access to a larger proportion of the population, resulting in more people being exposed to the education message.
Patterns of common drug use in teenagers
Authors: Patton George C. , Hibbert Marienne , Rosier Malcolm J. , Carlin John B. , Caust Joanna , Bowes Glenn
Published: August 2010

Abstract: To ascertain current levels of drug use among teenagers and to examine interrelationships in use, a two‐stage cluster sample of Victorian secondary school students in years 7 (aged 12 to 13 years), 9 (14 to 15 years) and 11 (16 to 17 years) were surveyed using a questionnaire on computer. Tobacco use and alcohol consumption were evaluated by self‐reported frequency of use and seven‐day retrospective diaries. Marijuana and coffee consumption were assessed by self‐reported frequency of recent use. The questionnaire was completed by 2525, a participation rate of 83 per cent Tobacco use rose with year, with 24 per cent of young women and 16 per cent of young men in year 11 being regular smokers. Trends across year level for heavier alcohol consumption were also observed, with just under 10 per cent of year 11 students reporting a weekly consumption higher than the current recommended guidelines for adults. Strong interrelationships in drug use were found, with a pattern of association between smoking and drinking consistent with a mutual elevation of risk. Frequent use of tobacco and alcohol had a high risk for associated marijuana use. Coffee consumption carried a significant independent association with regular smoking. Teenage substance use is common and most occurs at low level and frequency. However, for a substantial and increasing minority across the teenage years, high levels of tobacco and alcohol consumption potentially compromise health. Frequent alcohol or tobacco use rather than heavy intermittent consumption is most likely to be associated with concurrent substance use potentially damaging to health.
Community attitudes to bans on smoking in licensed premises
Authors: Schofield Margot J. , Edwards Kim
Published: August 2010

Abstract: Information about public attitudes to the restriction of smoking in licensed premises could provide an impetus for a campaign to address the failure of the industry to improve the health of its employees and the public. A probability sample of 816 people was surveyed to determine community attitudes to the introduction of bans on smoking in licensed premises. A total ban on smoking was supported by 20 per cent and provision of special smoking areas by 65 per cent, and 15 per cent wanted no bans. More‐educated people, white‐collar workers, nonsmokers and those who went to licensed premises less than weekly were more likely to support bans than were the less educated, blue‐collar workers, smokers, and those who went to licensed premises at least weekly. The less educated, smokers and those who went to licensed premises at least weekly were most likely to perceive that the introduction of smoking bans would reduce their patronage of licensed premises. Nonsmokers and those with more than 12 years of education were more likely to report that their patronage would increase if bans were introduced than were smokers and the less educated. The introduction of bans on smoking in licensed premises would result in only a small loss of patronage after accounting for potential increases from supporters of bans. The effect of the bans is likely to be felt most strongly among the less educated, smokers and regular patrons.
The syringe in the machine
Authors: Dodding Jane , Gaughwin Matt
Published: August 2010

Abstract: This paper is a report on focus‐group discussions with Western Australian and South Australian injecting drug users and South Australian drug workers, about the feasibility of and issues surrounding the introduction of needle‐and‐syringe vending machines in Australia. Injecting drug users and workers supported the idea of introducing vending machines in Australia to complement existing services that provide sterile injecting equipment. The participants emphasised that the machines should be provided in addition to existing services. Possible adverse effects of their introduction included concerns for the safely of minors who are not drug users. The potential benefits to public health includes further reducing that proportion of the sharing of injecting equipment that is related to unavailability of sterile equipment (usually at times when other services do not operate).
Poststructuralism and other ‘species’ in public health—a ‘Darwinian’ view
Authors: Gaughwin Matt
Published: August 2010

Abstract: The concepts and methods of poststructuralism are emerging as useful tools to increase our understanding of public health. This paper discusses poststructuralism within the context of a metaphoric ‘evolutionary ecology’ of knowledge (an epistemecology). It argues that claims for the importance of any programs (such as poststructuralism) are problematic. Using evolutionary and ecological metaphors, it suggests that public health may benefit from its advocates fostering the recombination of elements of knowledge to produce epistemes which adapt us congruently to the general and specific goals of public health, which should include a primary aim of minimising suffering. Choosing to act in an ethical way in regard to our construction and use of knowledge may be one way of achieving those aims. The term ‘ethical fitness’ is a way of conceptualising an evolving epistemic ethic.
Prevalence of cigarette smoking among Australian secondary school students in 1993
Authors: Hill David , White Victoria , Segan Catherine
Published: August 2010

Abstract: The prevalence of cigarette smoking in Australian secondary school students in 1993 was estimated from a survey of 22 696 12‐ to 17‐year‐old students from 332 secondary schools (and feeder schools) in all states and the Northern Territory. Self‐administered questionnaires were answered anonymously by groups of up to 20 students selected randomly from school rolls, a method that replicated previous surveys in 1984, 1987 and 1990. Current smoking (smoking at least one cigarette in the week preceding the survey) at 12 years of age was 8 per cent in boys and 7 per cent in girls, but in those 17 years of age the prevalence was much higher (28 per cent of boys, 31 per cent of girls). Age was also associated with the mean number of cigarettes smoked per week by current smokers (8.6 in boys and 7.0 in girls at age 12 and 43.8 in boys and 32.0 in girls at age 17). After controlling for sex, age, school type and state of residence, the percentage of 12‐ to 15‐year‐olds who were current smokers rose from 15.7 per cent to 17.5 per cent between 1990 and 1993, an effect that was more pronounced in boys. On the other hand, the mean number of cigarettes smoked by 12‐ to 15‐year‐old current smokers dropped from 23 per week to 19.5, and the reduced consumption was greatest in boys. Furthermore, there was no increase in the proportion of students who smoked on three or more days per week, which suggests the increase was limited to occasional, casual or social smoking.
Prevalence and frequency of health service use: associations with occupational prestige and educational attainment
Authors: Wiggers John H. , Sanson‐Fisher Rob W. , Halpin Stephen J.
Published: August 2010

Abstract: The accessibility of health care services has been suggested to be one factor with the potential to ameliorate the health effects of socioeconomic disadvantage. From a randomly selected sample of households in the Lower Hunter Valley region, 2623 adults were surveyed in 1987–88 to identify their reported use of medical, allied and alternative health services during the previous four weeks. There was a higher prevalence of use of the ‘usual’ general practitioner and medical services among educationally disadvantaged respondents only. No significant differences were evident between educational or between occupational groups in the prevalence of use of either alternative services or health services generally. Fewer occupationally disadvantaged respondents reported using allied health services. There was no difference in the number of health services used. Disadvantaged respondents were more likely to use medical services exclusively. Only educationally disadvantaged service users reported using any health, medical or general practitioner services more frequently than expected. In contrast, only occupationally disadvantaged service users reported using allied health services (and allied health services other than dentists) more frequently. The lack of consistent differentials in use across health services in favour of disadvantaged respondents suggests that a number of health care services may not be responding to the greater need for health care among disadvantaged members of the community.
Setting targets: a three‐stage model for determining priorities for health promotion
Authors: Brown Wendy J. , Redman Selina
Published: August 2010

This paper describes a three‐stage model for setting targets for health promotion. The model was developed in 1992 in response to the need to identify priority areas for health promotion for women in the Hunter Region of New South Wales. The approach enabled epidemiological data and views from the community to be synthesised and integrated with those of experts from health and social services (key informants), using a nominal group process. The reliability of the method was investigated by replicating the process with two groups of key informants. There was considerable commonality in the targets generated by the two groups. The process resulted in the identification of seven targets that reflected the concerns of the community and local experts as well as the health priorities suggested by local epidemiological data. The model used could be adapted for determining priorities in a wide range of health and health care settings, where available resources restrict the range of services or activities which can be offered. (Aust J Public Health 1995; 19: 263–9)
The effects of partial decriminalisation on cannabis use in South Australia, 1985 to 1993
Authors: Donnelly Neil , Hall Wayne , Christie Paul
Published: August 2010

In 1987 the Cannabis Expiation Notice scheme decreased penalties for the personal use of cannabis in South Australia. Data from four National Campaign Against Drug Abuse (NCADA) household drug‐use surveys covering the period 1985 to 1993 were analysed to measure the effect of the decriminalisation on cannabis use. The main outcomes used were the self‐reported prevalence rates of having ever used cannabis and current weekly use. Logistic regression was used to control for the potentially confounding effects of age and sex. Other outcomes were rates of having ever been offered cannabis and willingness to use cannabis if offered it. Between 1985 and 1993 the adjusted prevalence rate of ever having used cannabis increased in South Australia from 26 per cent to 38 per cent There were also significant increases in Victoria and Tasmania, and to a lesser extent in New South Wales. The increase in South Australia was not significantly greater than the average increase (P = 0.1). Adjusted rates of weekly use increased between 1988 and 1991 in South Australia, but did not change through 1993. Although the effect was in the direction of a greater increase in Soudi Australia, this was not statistically significant when compared to increases in the rest of Australia (P = 0.07). The greatest increase in adjusted weekly use occurred in Tasmania between 1991 and 1993, from 2 per cent to 7 per cent. Although the NCADA survey data indicate that there were increases in cannabis use in South Australia in 1985–1993, they cannot be attributed to the effects of partial decriminalisation, because similar increases occurred in other states.
Beliefs and behaviour of general practitioners regarding promotion of physical activity
Authors: Bull Fiona C. L. , Schipper Elise C. C. , Jamrozik Konrad , Blanksby Brian A.
Published: August 2010

To assess current practice, perceived desirable practice and barriers related to the promotion of physical activity in general practice, a questionnaire was developed and distributed to all 1228 general practitioners in Perth. From these, 789 valid returns were received (71 per cent response). The mean age of the respondents was 45 years, 69 per cent were male, 52 per cent had postgraduate qualifications and 73 per cent were in full‐time practice. General practitioners most frequently asked patients about their current level of physical activity and discussed physical activity programs when seeing patients with symptoms of conditions that could benefit from exercise, rather than asking all patients, new patients or patients previously seen. Walking specifically for fitness was the activity most likely to be recommended. General practitioners felt more able to offer general advice than specific advice on physical activity. Lack of time was reported most frequently as a barrier to the promotion of physical activity (47 per cent), followed by insufficient educational materials (29 per cent), and preference of patients for drug treatment (27 per cent). There were significant differences between self‐reports of current practice and perceived desirable practice in the promotion of physical activity by general practitioners. Future strategies should aim to increase the frequency of advice to patients with specific health conditions.