The proposed descriptor bill to change Medicare rebates to general practice patients could have a benefit to general practice preventive medicine. This seems possible through rewarding practitioners who spend more time with their patients and the positive effects of continuing medical education. However, the potential exists for whittling away any rewards for these practitioners by future governments and the audit of general practices could become a method of political control of Australian general practice.
In a recent paper, Kamien highlighted the need for a behavioural science perspective in undergraduate medical education and medical practice. The current article attempts to extend this argument by delineating some of the variables which sustain the current lack of a viable and effective behavioural perspective in medical practice. Suggestions for remedying this deficit are provided.
Some of the current problems with health care in Australia are due to the reluctance of orthodox medicine to incorporate a behavioural science perspective into its biomedical fabric. This narrow view of medicine is partly maintained by the failure of the behavioural scientists to address themselves to the study of mainstream medical practice in Australian society.
The public health problem of head injuries contributes to considerable morbidity in the community and is the commonest cause of death in young adult Australians. However, estimating the incidence of head injury has been difficult, and has varied between countries and over time. This paper critically appraises the methodological issues contributing to head injury/brain injury incidence estimates, in particular case definition, differing data sources, and methods of case ascertainment. The most appropriate definition from a methodological service provider perspective is one which clearly distinguishes between potential and actual brain injury. The results from a study which used the most accurate methods have been extrapolated to NSW, and reduce the estimated brain injury incidence in NSW from a reported 392 to 180 per 100,000 incident cases per year. This revised estimate implies that in 1990 there will be about 10,500 new cases of traumatic brain injury, of which an estimated 400 will result in serious physical or mental disability. These estimates were originally calculated to enable the development of an appropriate level of health service provision for brain-injured persons through the NSW Brain Injury Program.
This study investigates the responses of patients and their carers to the diagnosis of cancer. The reporting of stress by patients, using linear analogue scales, and their psychological distress, as measured by the General Health Questionnaire, indicated benefits for members of a community-based cancer support group. The responses of carers revealed that the impact of the diagnosis was as great on them as on patients. Various mediators were considered and age was found to significantly influence the reporting of stress. The limitations and implications of the findings are discussed.
This study examines the incidence in Australia of “serious” occupational injuries, arbitrarily defined as those which resulted in absence from work for six months or more. The raw data were contained in computer print‐outs specially prepared by the State offices of the Australian Bureau of Statistics (ABS) and the study includes analyses by age, sex, occupation and industry of the injured person. The unexpectedly large total of 14,281 high‐severity injuries cannot be supported with confidence since the principal finding was the large and consistent variation in injury rates between the States. For males, the overall injury rates (per 10,000 persons) for Victoria, South Australia and Tasmania were in the range 11 to 16: those for Queensland and Western Australia were in the high 30s; whilst that for New South Wales exceeded 50. A similar ranking of injury rates prevailed in almost every subset. The highest rates arose in New South Wales, Queensland and Western Australia in six of the seven occupation groups, in nine of the ten industry groups and in all eleven age groups. It is difficult to find any scientific explanation for these variations in terms of levels or extent of exposure to risk. In the opinion of this author, these variations should be attributed to differences in the institutional arrangements for the coverage, collection and/or compilation of compensation data. There is a clear need for a comprehensive and compatible Australia‐wide collection, and the continuing lack of such a collection is deemed a matter for regret.
Access to disability data from a nationwide survey of New Zealanders provides the opportunity to estimate Life Expectancy Free of Disability (LEFD) for the non-institutional adult population. This measure of population health status combines mortality and morbidity data into a single index. The analysis is restricted to the 15-64 age range and results on partial life expectancy free of disability are presented for the key sociodemographic groups. The results conform to the international evidence and highlight the potential impact of disability as a component in a composite measure of population health status: although women live longer than men, almost all this apparent advantage in longevity is spent in some state of disablement; Maori are disadvantaged in comparison with non-Maori both in terms of longevity and in the proportion of the life span spent disability-free; and, social class comparisons show a decline in LEFD with declining social class that is steeper than the corresponding mortality gradient. Despite some technical difficulties and the strong requirements of the data, the LEFD measure has many potential applications in public health research and planning. In particular, it has the potential to direct research and policy towards the enhancement of the active years of life rather than just the postponement of mortality.
Regular participation in a high-quality screening program by all 'at risk' women is necessary if Australia is to be maximally successful in preventing cervical cancer. This paper discusses the use of reminder letters as one method of facilitating participation. Options for the source of the letters are discussed. It is concluded that basing the recall letters on a register of previously screened women is the only feasible approach within the Australian health care system. The impact of reminder letters on achieving regular participation by Australian women remains to be tested.
A series of studies was undertaken in 1989 to validate the data held by the Western Australian Congenital Malformations Registry. Comparison with hospital discharge data identified 1585 children six years of age or younger with malformations discharged from hospitals in Western Australia in 1986, 226 of whom were not already recorded on the Congenital Malformations Register. When the records of a special register for cleft lip and palate were examined, all cases of facial cleft known to the special register were also recorded on the Malformations Register. Comparison of the Western Australian data for major groups of malformations with data from the South Australian Birth Defects Register raised the possibility of under ascertainment in Western Australia of cases of congenital heart disease. Multiple sources of ascertainment and evaluation of the ways in which such sources are tapped are important factors in striving for complete and accurate information on congenital malformations for research and public health purposes.
Birth centres in Australia provide an option for women and their professional advisors when choosing the setting for childbirth. It is important that empirical information about the risks is available to enable informed decisions to be made. The purpose of this study was to compare the obstetric outcomes for women admitted to the Birth Centre at Royal Hospital for Women in Sydney with outcomes for women admitted to the conventional labour ward, controlling for prenatal and intrapartum risk. The findings indicate that, with the existing back-up provided by the conventional service, the outcomes for women admitted to the Birth Centre were at least as good as those of the other women. The study also shows that there are differences between the two settings in the management of the intrapartum period. The rate of intervention is substantially higher for women admitted to the Labour Ward, after risk is taken into consideration. The evaluation indicates that the Birth Centre offers a viable choice for women with relatively low obstetric risk.
1130 dentists surveyed by mail from Australian capital cities (response rate 80%) answered a questionnaire on knowledge of clinical manifestations of AIDS and HIV, attitudes to treatment and referral of AIDS/HIV patients, infection control practices and personal risk factors for HIV. Despite a third of dentists being willing to treat HIV antibody-positive patients and 22% being willing to treat AIDS patients, over 50% believe AIDS to be a major problem for dentists, with two thirds claiming that their staff would not treat AIDS patients and 55% believing they would lose patients if word spread that they were treating HIV/AIDS patients. The perhaps irreconcilable tension between variable willingness to treat and the concerns of staff and other patients suggests that a policy of improving the dental referral network among people with AIDS may be in the best interests of the dental health and well-being of people with AIDS.
The aim of this study was to examine the effectiveness of general practitioner-written invitations to the Breast X-Ray Programme of the Central Sydney Area Health Service. Five out of six randomly selected general practices in Drummoyne participated. Within each practice, women aged 45 to 70 were individually randomised to receive or not receive a letter from their general practitioner (GP). Thirty-two per cent of women attended if invited compared to 7 per cent if they were not sent an invitation. An attendance of 38 per cent was obtained for women whose GP chose to send a letter with an appointment compared to 24 per cent for women whose GP chose to send a general invitation without an appointment. Combining all practices, women who consulted their GP within the previous 6 months were more likely to attend in response to the invitation (38 per cent) than women whose last consultation was more remote, dropping to 15 per cent in those who last attended that GP over 2 years earlier. Women aged 65 to 70 years old were at least as likely to respond to the invitation as women aged 45 to 64. Reminder letters were subsequently sent to a random half of nonrespondents who had attended the practice in the previous 12 months. A further 18 per cent of women attended after the reminder letter was sent (8/45), compared with 2 per cent in the control group (1/48). Twenty-seven per cent of women in Drummoyne had already attended for screening mammography before the trial.(ABSTRACT TRUNCATED AT 250 WORDS)
Two surveys in the same defined population in Sydney's western suburbs in 1986 and 1987 provided the opportunity to compare results obtained from a quota and a probability sample survey. These surveys were designed to provide information for the planning of local health promotion programs. The quota sample survey was conducted in shopping centres and used quota sampling to select 1727 respondents. In the second survey, area probability sampling was used to select 484 respondents. This survey had a response rate of 65 per cent. There were 15 questions common to both surveys; results of only three differed significantly (p less than 0.05) between surveys. None of these differences was important from a public health perspective. The agreement between the results of these two surveys probably reflects the fact that the same selection bias has operated in both. Unless a very high response rate can be achieved, quota sample surveys with age and sex quota controls may be an acceptable alternative to probability sample surveys for gathering local data relevant to the development of health programs.
Less than 25 per cent of eligible Australian women have cervical ('Pap') smear tests in any year. Rates are particularly low (less than 8%) for women over 55 years, the group at highest risk of cervical cancer. A regional program, actively promoting Pap smears by widespread direct community intervention and attention to service needs, targeting women over 55 years and under 25 years, was conducted on the North Coast (population 132,000 women) immediately after a New South Wales State-wide media campaign in February 1988. The number of Pap smears done in the region increased 119 per cent for women over 55 years and 44 per cent for 15-24 year-olds during the promotion (63% overall) compared to New South Wales increases of 58 per cent for women over 55 years and 23 per cent for 15-24 year-olds (31% overall). Differences between the North Coast and New South Wales were statistically significant for all age groups in March and in April for women over 55 years. Differences between New South Wales and Australia (no active promotion) were significant for women over 55 years in March and April. Records from a sample of 152 women attending clinics during the campaign showed 63 per cent had not had a smear test for three or more years, 10 per cent never.(ABSTRACT TRUNCATED AT 250 WORDS)
Comparisons of expired air carbon monoxide levels in non-smoking staff in six licensed clubs (a smoking workplace) were made with those of non-smoking staff of a large public hospital (a smoke-free workplace). There was a significant difference between clubs and hospital in levels of CO at end of work. The average concentration of club workers was 8.7 ppm (Hospital, 5.3 ppm). Approximately one third of these non-smokers in licensed clubs exceeded 10 ppm putting them in the 'light smoker' category according to the manufacturer of the monitoring equipment. Club workers increased their CO level during work time by four times the increase of Hospital staff. This study suggests that there are significant gains to be made in reduction of intake of harmful passive-smoking products by removing tobacco smoke from workplaces.
This paper reports on the second of four regionally-based campaigns co-ordinated in rural Victoria by the Anti-Cancer Council of Victoria. The campaign encompassed community-based activities, general practitioner involvement and screening clinics. The impact of the campaign on Pap test rates and on the profile of women whose tests were reported by the Victorian Cytology Gynaecological Service is examined. We conclude that the campaign was successful in achieving its primary objective of attracting older and relatively underscreened women into having a Pap test. The special screening clinics were considered particularly effective in reaching women in the target audience. As a result of this campaign, new initiatives, were incorporated into subsequent programs.
Previous publications from the Dunedin Multidisciplinary Health and Development Research Unit have reported the prevalence of DSM-III disorders through its longitudinal examination of a New Zealand birth cohort. The present study describes the help-seeking practices of each sample member's parents for their child's behavioural or emotional problems exhibited in childhood (ages 5-11) or adolescence (ages 12-15). Increased help-seeking for boys was evident in childhood. However, this sex difference was not present at adolescence. There was a decline in the frequency with which medically oriented agencies were contacted between childhood and adolescence, and teachers were found to be the most frequently used source of assistance in adolescence. Although there was a strong association between help-seeking and mental health disorder, approximately half of those with disorder had parents who had not sought help for their child's problems. In addition, family characteristics of low SES, low family social support and poorer maternal mental health predicted help-seeking. The results are discussed in terms of service provision for these age groups, within the present restructuring of the public health system in New Zealand.
Community Health StudiesVolume 14, Issue 2 p. 153-161 Free to Read TELEVISION FOOD ADVERTISING: A CHALLENGE FOR THE NEW PUBLIC HEALTH IN AUSTRALIA Heather Morton, Heather Morton Department of Nutrition & Social Health, South Australian College of Advanced Education, Underdale 5032.Search for more papers by this author Heather Morton, Heather Morton Department of Nutrition & Social Health, South Australian College of Advanced Education, Underdale 5032.Search for more papers by this author First published: June 1990 https://doi.org/10.1111/j.1753-6405.1990.tb00036.xCitations: 11AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume14, Issue2June 1990Pages 153-161 RelatedInformation
Concern in the community about the risk of environmental hazards such as pesticides seems widespread. Pesticides have been widely used in agriculture to enhance food production and pesticide residues are now found in most human breast milk samples taken in industrialised countries. A breast milk survey on 158 women in Victoria was carried out during 1985/86 among women attending infant welfare centres. The survey showed that the mean s̀DDT and HCB concentrations had fallen by 62 per cent and 74 per cent respectively since the previous Victorian study in 1978. However dieldrin levels had not decreased significantly and most pesticide levels, as well as those for PCB, were above the acceptable daily intake levels set by the World Health Organisation. The significance of these findings is still unclear. The response of governments and the media to this type of controversy is discussed in the light of the Victorian Breast Milk Survey.
This paper describes the experience of a cohort of elderly patients who were discharged after attending the accident and emergency department of a large Australian teaching hospital. Before-and-after comparisons of aspects of physical functioning revealed a considerable loss of independence in the period immediately after the visit to the hospital. Subsequent hospital admission or death was observed in 30 of the 90 patients studied. It is suggested that elderly patients discharged from the accident and emergency department are at risk and require special consideration and a high index of suspicion in terms of evaluation at the time of presentation. Before discharge, account should be taken of aspects of physical and mental function, social networks, and community supports available to each patient. A lowered threshold for admission is recommended on the basis of the high rate of return found in this study.
