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PubMed1988

Rehabilitation of refugee victims of torture and trauma: principles and service provision in New South Wales.

A number of recently-arrived refugees who are suffering from psychological disturbances and physical injuries that have resulted from torture or severe trauma has come to the attention of welfare workers and health personnel in New South Wales. A tentative estimate of more than 2000 refugees in New South Wales who are so affected, and clear evidence of extensive human rights abuses in the countries from which they came, indicate an urgent need for specialized care for the victims. Organized violence, including detention, torture and severe deprivation, is a tool of governments in many countries of the world. The varied forms of torture are all designed to destroy the trust, personality and self-esteem of the victims and to foster dependency, debility and dread, both in the victims and in the societies in which they live. Those persons who survive torture and detention often are affected severely in body, mind and spirit. Many victims exhibit acute and chronic symptoms that are described commonly by the diagnostic categories "post-traumatic stress disorder" and "torture syndrome". Their kin, especially spouses and children, also suffer psychological and familial disturbances frequently, as a result of the arrest, detention and torture of the victim. Their suffering is compounded by the distress of fleeing their home country and the stresses of adjusting to a new country and way of life. In Europe and North America, services have been established to treat and to rehabilitate sufferers of these disorders. Treatment programmes differ in structure and size, but include commonly psychotherapy, physiotherapy, specialized medical care and parallel assistance with resettlement and social adjustment for both the patients and their families. This article cites illustrative case material from New South Wales and summarizes the recommendations for a community-based rehabilitation service for victims both of torture and of other forms of organized violence, such as detention in "re-education" camps or the genocide in Kampuchea.

Health Services↗

PubMed1990

Services and cost of hospitalization for children and adolescents with insulin-dependent diabetes mellitus in New South Wales.

Data on services for Australian children and adolescents with diabetes are limited. The purpose of the present study was to examine the availability, utilization and some of the costs of services for persons of less than 20 years of age with insulin-dependent diabetes mellitus in New South Wales, and to make recommendations for future services. The numbers of prevalent and incident cases of insulin-dependent diabetes mellitus in the zero- to 19-years' age-group in each of the health regions of the State were estimated using data from the insulin-dependent diabetes mellitus register of the Southern Metropolitan Health Region. Information on the available services for young persons with diabetes was obtained from doctors and diabetes educators around the State, and on the utilization of services in the Southern Metropolitan Health Region from interviewing the families of persons whose names are listed in the diabetes register. An estimated range of the annual direct cost of hospital admissions for diabetes in the zero- to 19-years' age-group in New South Wales was calculated by use of the data collected from the diabetes register, the hospital separation data from the NSW Department of Health, the NSW Department of Health estimated bed-day cost and the estimated average cost of a bed day for diabetic patients at The Children's Hospital Camperdown. Services for children and adolescents with insulin-dependent diabetes mellitus in this State are most comprehensive in central Sydney. However, even these excellent services are not utilized fully by the children and their families. The annual cost of hospitalization for diabetes in the zero- to 19-years' age-group in New South Wales is estimated to be approximately +1.5 million. There needs to be an equally high standard of care for all diabetic children in the State; however, the utilization of services, as well as the services themselves, need to be improved and the cost-effectiveness of new services needs to be evaluated.

Adolescent↗

PubMed1991

Tuberculosis in New South Wales.

Surveillance of tuberculosis in New South Wales depends on notification of cases by medical practitioners and careful follow-up by public health nurses dedicated to the control of tuberculosis. Evaluation of tuberculosis surveillance data enables identification of patterns of infection, highlighting areas requiring specific interventions. In 1986, 290 cases of tuberculosis were notified to the Department of Health, New South Wales. The majority of patients (72.8%) were diagnosed as having pulmonary disease. The highest rates of infection were in people from Southeast Asian countries. Whereas 5.2% of cases were identified when the patients entered Australia, a substantial proportion of diagnoses (23.1%) were made in people who had been resident in Australia for 10 or more years. This article highlights the need to continue efforts to improve tuberculosis surveillance and control programmes in New South Wales.

Adolescent↗

PubMed1991

The cost of asthma in New South Wales.

OBJECTIVE: To determine the economic cost of asthma to the New South Wales community. DESIGN: Direct costs (both health-care and non-health-care) plus indirect costs (loss of productivity) were estimated from various sources to assess retrospectively the dollar costs of asthma. Intangible costs (such as quality of life) were not included. SETTING: Estimates of costs were made at all levels of medical care of asthma patients, including inpatient and outpatient hospitalisations, emergency department visits, and visits to general practitioners and specialist physicians, plus costs of pharmaceuticals, nebulisers and home peak-flow monitoring devices. The cost of time lost by the patient attending for medical visits and loss of productivity due to absence from employment as a result of asthma were also included. RESULTS: The total cost of asthma in New South Wales was $209 million in 1989. This was made up of $142 million in direct health-care costs, $19 million in direct non-health-care costs and $48 million in indirect costs. CONCLUSION: Although we believe that our estimate is an underestimate of the true dollar cost of this disease to the community, it represents $769 per asthmatic person per year, assuming a current prevalence rate for asthma in New South Wales of 6%. The cost effectiveness of any new treatment of asthma should be estimated to ensure that the economic cost to the community does not rise unnecessarily.

Adult↗

PubMed1992

Underreporting of AIDS, New South Wales, 1988-1989.

OBJECTIVE: To determine the completeness of medical practitioner reporting of patients with acquired immunodeficiency syndrome (AIDS) in New South Wales and the reasons for underreporting. DESIGN: We compared the number of patients with AIDS reported to the National AIDS Register by medical practitioners from 1 July 1988 to 23 November 1989 with numbers detected from the National Zidovudine Register, AIDS specialist medical practitioner records, death certificates and the Sydney AIDS Prospective Study database. We asked the AIDS specialist medical practitioners to suggest why some patients may not be reported. MAIN OUTCOME MEASURE: The number of persons known to have AIDS and the source from which they were detected. RESULTS: We found 457 recorded cases of AIDS in which the diagnosis was made during the study period. Of these 457 cases, 373 (81.6%) had been reported by medical practitioners and 84 had not. Of these 84 cases, 40 were detected from the National Zidovudine Register, 24 from the records of AIDS specialist medical practitioners, 18 from death certificates and two from the Sydney AIDS Prospective Study. Reporting rates among hospitals ranged from 38.5% to 95.7%. We estimated that the true number of persons diagnosed with AIDS in New South Wales over the study period was 476. The main reasons given by the doctors for not reporting persons with AIDS were difficulties with reporting procedures and the complicated AIDS case definition, concerns about maintaining patient confidentiality and inadequate Health Department feedback on AIDS surveillance data. CONCLUSIONS: At least 18.4% of the AIDS cases we detected were not reported by medical practitioners in New South Wales. More accurate information on the incidence of AIDS could be obtained if the Health Department regularly contacted AIDS specialist medical practitioners for unreported cases, simplified the reporting process, stressed the confidentiality provisions for AIDS reporting and provided feedback to reporting medical practitioners.

Acquired Immunodeficiency Syndrome↗

PubMed1992

Air quality and respiratory disease in Newcastle, New South Wales.

OBJECTIVE: To investigate respiratory illnesses in the Newcastle region, their change over time, and their geographic relationship to industrialised areas. DESIGN: We analysed admissions to public hospitals by postcode area in the Newcastle region, for all causes and for all the various respiratory causes, for the years 1979-1988. Comparisons were made between the State of New South Wales and the Newcastle area, and between geographic areas within Newcastle. Changes over the 10-year period were noted. RESULTS: For both all causes and respiratory causes, admission rates to Newcastle hospitals, 1979-1988, were significantly lower than those for the rest of New South Wales in 1986. There was a correlation between living in the industrial part of the city and hospital admission for all causes and respiratory causes. There was also a correlation between mean disposable family income and hospital admissions, with those areas with the higher incomes having lower admission rates. Over the 10 years studied there was a statistically significant decline in admissions for respiratory causes, both in absolute terms and after controlling for changes in admissions for all causes. In children aged 0-14 years a significant increase in admissions for asthma occurred between 1979 and 1988, which could not be explained by diagnostic shift. CONCLUSIONS: On the basis of hospital statistics, the members of the Newcastle population seem little different from those in the remainder of New South Wales. From 1979-1988, the efforts by industry, with the support of the community, to reduce industrial pollution have been accompanied by a reduction in hospital admission rates for respiratory diseases in general and for chronic obstructive lung disease in older people. Other contributing factors include reduced smoking rates and improved medical management. Correlations between geographic location and respiratory admission rates may be a manifestation of social class rather than poor air quality, although a contribution from the latter cannot be discounted. A concomitant rise in asthma admission rates in children aged 0-14 is likely to be unrelated to any change in air quality.

Adolescent↗

PubMed1999

Antenatal hospitalisations in New South Wales, 1995-96.

OBJECTIVES: To provide a population-based estimate of the prevalence of antenatal hospitalisations and to determine the reasons for admission. DESIGN: Descriptive study. Data sources were primarily the New South Wales inpatient Statistics Collection (ISC) and also the linked population-based New South Wales Midwives Data Collection. SETTING AND PATIENTS: All women resident in New South Wales (NSW) admitted to public and private hospitals in NSW for pregnancy complications from 1 July 1995 to 30 June 1996. MAIN OUTCOME MEASURE: Antenatal hospitalisations for pregnancy complications per 100 confinements. RESULTS: There were a total of 25,710 antenatal non-delivery admissions in NSW hospitals among 86,263 confinements, yielding a ratio of 30 antenatal admissions per 100 confinements (21 per 100 excluding day-stay admissions). Women without private health insurance, Aboriginal women and women under the age of 20 had significantly higher rates of antenatal admissions. The principal admitting diagnoses were hypertension (17.6%), threatened preterm labour (14.1%), antepartum haemorrhage (14.0%), threatened labour (after 37 weeks' gestation) (11.1%) and excessive vomiting in pregnancy (9.4%). A majority (58%) of antenatal admissions (including admissions to day-stay facilities) were for one day. CONCLUSIONS: Significant pregnancy-related morbidity, as measured by high ratios of antenatal admissions, is evident in NSW. Sociodemographic factors and health service management protocols appear to account for some of the variability in antenatal admissions.

Adolescent↗

PubMed2000

Cyclospora infections in England and Wales: 1993 to 1998.

The coccidian protozoon Cyclospora cayetanensis is a treatable cause of prolonged, watery diarrhoea in humans. Microbiology laboratories in England and Wales often restrict testing to those who have recently travelled abroad. Only 44 to 66 laboratory reports of C. cayetanensis are made in England and Wales each year and a large proportion are found to have visited developing countries. Large foodborne outbreaks of infection have arisen in North America among people who have not travelled abroad but no such outbreaks have been identified in the United Kingdom. Public health laboratories in England and Wales were surveyed in 1998 to investigate their procedures for identifying C. cayetanensis. Sixty-eight per cent actively looked for the protozoon, but only half used a recommended method of direct microscopy of formol ether concentrates. National external quality assurance results for all participating UK laboratories were reviewed to assess laboratory proficiency in identification. C. cayetanensis was correctly identified in a wet preparation by 58% of laboratories, the lowest rate for specimens containing a single parasite species. Cyclosporiasis could be acquired in the UK from imported food, but current laboratory procedures might fail to identify it. Ascertainment must improve and awareness needs to be raised among food handlers, public and environmental health workers, laboratory staff, and general practitioners. We recommend that laboratories test all patients with watery diarrhoea for > 1 week for cyclospora, use formol ether concentration and microscopy with a calibrated eyepiece graticule, and confirm diagnoses with the help of a reference laboratory.

Animals↗

PubMed2000

The temporal and spatial epidemiology of lip cancer in England and Wales.

OBJECTIVE: To examine trends in lip cancer mortality and incidence during the 20th century, and its geographical distribution, in England and Wales as a prerequisite to establishing any essential differences in the aetiology of lip and intra-oral cancer. METHOD: Age-standardised rates for lip cancer mortality by gender from 1901 to 1991 were derived from archived OPCS data. Standardised incidence rates from 1962 to 1986 were also calculated. Registrations of lip cancer between 1979 and 1983 in the 15 RHAs covering England and Wales were obtained from the same source and standardised incidence ratios (SIR) computed. RESULTS: Progressive and sustained falls in lip cancer mortality and incidence were recorded in the period covered. In males, these related particularly to cohorts born after 1856. In addition, the incidence of lip cancer in both genders was found to be raised in a band stretching from East Anglia to the South West and also in the Trent and Wales RHAs. CONCLUSIONS: The findings support an hypothesis that employment in the agriculture, forestry and fishing industries, and also pipe smoking, were the major risk factors for lip cancer in the 20th century. Further research is required to differentiate between the aetiological risk factors for lip and intra-oral cancer.

Adult↗

PubMed1999

The New South Wales Fire Brigades' critical incident stress management response to the Thredbo Landslide.

The Thredbo Landslide occurred just before midnight on Wednesday, July 30th, 1997. The first call was received by the Regional Fire Communications and subsequently to Sydney where a multiagency response to the first Urban Search and Rescue (USAR) incident in Australia occurred. After ten days, eighteen bodies had been recovered and one survivor rescued, with one of those victims a member of the Thredbo Fire Brigade. Although some 2000 emergency service personnel were involved in the overall operation, 120 firefighters were at the forefront of the "hands on" rescue throughout the incident. In New South Wales the emergency services each have their own Critical Incident Stress Management (CISM) programs which operate independently from each other, and this was the case at Thredbo. This paper will describe how the New South Wales Fire Brigades CISM Program managed the Thredbo incident for the 120 New South Wales Fire Brigades firefighters and officers who attended the rescue operation. We are pleased to share this experience and what we have learned in the hope that it might be helpful to others.

Crisis Intervention↗

PubMed2001

Inequalities in treated heart disease and mental illness in England and Wales, 1994-1998.

BACKGROUND: Current government policy is directed towards reducing inequalities in health. General practice is increasingly the focus for health care provision in the United Kingdom and it is therefore important to understand the relationship between socioeconomic factors and health at the general practice level. A deprivation measure was used for the area in which the practice is located and two key priority areas were focused upon: mental health and heart disease. AIM: To explore the relationship between area deprivation and the prevalence of treated heart disease and mental illness in England and Wales. DESIGN OF STUDY: Analysis of data from medical records from practices contributing to the General Practice Research Database. SETTING: A total of 211 practices located in England and Wales. METHOD: The data from the practices were used to examine deprivation differentials in treated disease prevalence rates. RESULTS: There are strong deprivation gradients (highest prevalence in the most deprived category) for treated depression, anxiety, schizophrenia, coronary heart disease and non-insulin-treated diabetes. In general the deprivation differentials are wider in the middle of the age range. Women aged 35 to 64 years in the most deprived areas had rates of treated coronary heart disease two to three times those in the least deprived areas. Men aged 25 to 44 years in the most deprived areas had rates of treated depression 50% higher than those in the least deprived areas. CONCLUSIONS: This study has identified wide deprivation differentials in the prevalence of treated mental illness and heart disease. If all of England and Wales experienced the rates of the least deprived fifth of the population then the number of people being treated for depression, anxiety, and coronary heart disease would fall by 10%, 16%, and 11% respectively.

Adolescent↗

PubMed2001

Development of odour assessment criteria in New South Wales and application of the criteria for the assessment of a major public works project.

The introduction of the forthcoming Australian and New Zealand standard on odour measurement has led to the review of odour regulation in most Australian states. In New South Wales the regulator has drafted an odour impact assessment policy for point source emissions. The policy is based on the new odour measurement standard and defines regulatory dispersion modelling procedures. The New South Wales odour assessment policy was initially drafted on the basis of a literature review and has since been developed in consultation with various industry and government groups, including sewerage authorities. The policy, while still officially regarded as a draft, has already been used as the basis for the assessment of a number of sewerage projects that have been characterised by point source emissions. The application of modelling-based assessment procedures requires careful judgement concerning the selection of input data and close scrutiny on behalf of the assessor. This paper examines the assumptions underlying the development of the New South Wales draft odour assessment policy and draws important universal lessons from its application for the assessment of a major sewerage project. The introduction of peak to mean factors based on one second nose response times has been controversial and alternative procedures are proposed.

Air Pollutants↗

PubMed2003

The Welsh Food Microbiological Forum and the All-Wales Shopping Basket Sampling Program: a model for the surveillance of microbiological quality in ready-to-eat foods.

In the United Kingdom, the monitoring of microbiological food quality and the prevention of foodborne disease are the responsibility of a number of different organizations. In 1993, to develop and extend ongoing local collaborations within selected local food groups in Wales (comprising local authorities and the Public Health Laboratory Service), the Welsh Office invited all local food groups in Wales to create a forum to coordinate the sampling and examination of ready-to-eat foods and the centralized collection of results for the whole of Wales. This paper describes the development, structure, and aims of the forum. It also discusses the outcomes of the first nine years of activities, describes the randomized sampling program for ready-to-eat foods that has been developed; and assesses the benefits that have resulted.

Food Contamination↗

PubMed2003

Mortality of migrants from the Indian subcontinent to England and Wales: effect of duration of residence.

BACKGROUND: Few studies have examined mortality of migrants by duration of residence in the country of destination. METHODS: I examined mortality of South Asian migrants by duration of residence in England and Wales. The cohort (N = 2,272, age 25-54 years in 1971) was followed from 1971 to 2000. RESULTS: All-cause mortality of South Asian migrants increased with increasing duration of residence in England and Wales. A yearly increase in duration of residence was associated with a hazard ratio of 1.07 (95% confidence interval [CI] = 1.02-1.13) among persons ages 25-34 years in 1971, 1.03 (1.00-1.07) among those ages 35-44 years, and 1.02 (1.00-1.05) among those ages 45-54. Cardiovascular disease mortality was the main component of this trend. Yearly increases in duration of residence were associated with cardiovascular disease mortality hazard ratios of 1.09 (1.03-1.16), 1.04 (1.00-1.09) and 1.02 (1.00-1.05) for the youngest, middle and oldest age groups, respectively. Comparable results were seen for coronary heart disease and for cancer mortality. Age at migration was positively related to mortality independent of duration of residence but the confidence intervals were wide. Adjusting for socioeconomic position did not alter these patterns. CONCLUSIONS: Cardiovascular and cancer mortality of South Asian migrants increased with duration of residence in England and Wales.

Adult↗

PubMed2005

Geographical variations in fatal poisoning due to antidepressant drugs in England and Wales 1993-2003.

This article examines geographical variations in fatal poisoning due to antidepressant drugs in England and Wales between 1993 and 2003. The analysis looks at mortality rates for Government Office Regions and Wales and Strategic Health Authorities in England. Mortality rates were also considered in relation to antidepressant prescribing and deprivation. Throughout England and Wales, mortality rates due to antidepressant poisoning varied by area (Government Office Region and Strategic Health Authority), and were positively associated with area deprivation.

Antidepressive Agents↗

PubMed2006

A survey of school dental screening practise in community dental services of England and Wales in 2003.

OBJECTIVE: To describe the school dental screening process in Community Dental Services across England and Wales. BASIC RESEARCH DESIGN: Cross-sectional study using a postal questionnaire. CLINICAL SETTING: Community Dental Services. PARTICIPANTS: Clinical Directors of Community Dental Services in England and Wales. MAIN OUTCOME MEASURES: Respondents answers about the objectives of school dental screening, criteria used for referring a child, methods of informing parents of screening results, and methods used to confirm subsequent dental attendance. RESULTS: The response rate for this study was 92.1%. Respondents identified dental registration (75.2%) and attendance at a dentist (82.9%) as objectives of school dental screening. Less than one third (29.5%) saw the activity as having a preventive role. Caries in the primary and secondary dentitions and soft tissue lesions were reported as key criteria for referral. Methods of follow-up of screened positive children differed and were often inadequate; approximately one third of respondents used a letter carried home by the child that did not allow parents to inform the CDS of action taken. Half of the respondents routinely collected data on the number of screened positive children who subsequently visit a dentist. CONCLUSIONS: School dental screening is delivered in a similar fashion throughout England and Wales but methods of informing parents of a positive screen and follow-up mechanisms for children with positive screens vary. Most school dental screening programmes do not collect sufficient data to evaluate the impact of their programmes on children's oral health.

Child↗

PubMed1989

Mortality from cardiovascular diseases in Chinese, Malays and Indians in Singapore, in comparison with England and Wales, USA and Japan.

Age-standardised death rates, for ages 35-64 years in both sexes, from ischaemic heart disease, cerebrovascular disease, and hypertensive disease for Chinese, Malays, and Indians in Singapore (1980-84) have been compared with those in England and Wales, USA and Japan (1982). For ischaemic heart disease Indians have the highest mortality, then Malays, with Chinese less than the Western countries but more than Japan. For cerebrovascular disease the Malays have highest mortality, then Indians, then Chinese, followed by Japan, England and Wales, and USA in that order. For hypertensive disease it is again Malays, then Indians, then Chinese, but followed by the different order of USA, England and Wales, and Japan. The differences are discussed in the light of declining trends in mortality from these disease in Singapore over the preceding 25 years. The special problems of ischaemic heart disease in Indians and hypertension and it's sequelae in Malays are highlighted.

Adult↗

PubMed1969

Heart disease mortality in cities of Latin America and in cities and regions of England and Wales.

Death rates from heart disease in cities and regions of England and Wales, based on death certificates for 1963, are compared with death rates from the same causes in 10 Latin American cities, San Francisco, USA, and Bristol, England, derived from the Inter-American Investigation of Mortality which obtained histories and clinical records of fatal illnesses for the years 1962-64 by a sampling method. Death rates in Bristol derived from the 2 sources showed an agreement close enough to justify comparisons between official rates for England and Wales and the data for the Latin American cities.Comparing standardized death rates for males in the Latin American cities with those for the corresponding populations in the English conurbations and cities, the ratio for coronary disease was found to be 0.4; for other degenerative heart disease it was 1.0; for hypertensive heart, 2.2; for other heart disease, 1.5. The corresponding ratios for females were: 0.55, 1.0, 3.0, and 1.7, respectively. When the hospital regions of England and Wales were included, a geographical pattern could be seen, particularly for males, the highest rates for coronary and degenerative heart disease being found in northern England and the lowest rates in central and western cities of Latin America. For hypertensive and other heart disease the pattern was different.Standardized sex ratios for total heart disease mortality at ages from 45 to 74 years in 30 countries are largely affected by the proportions of deaths attributed to arteriosclerotic and degenerative disease but they suggest that geography, country of origin and possibly climate are also factors that differentially affect the sexes and, in consequence, affect the sex ratios.

Adolescent↗