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PubMed1993

Perinatal mortality in Greece and Greek-born women in Victoria. What does a 'natural experiment' suggest?

A comparison of perinatal outcome in the Greek perinatal mortality survey of 1983 with the outcome of births to Greek born women who had migrated to Victoria, Australia found marked similarities in maternal age, parity, marital status and cigarette smoking. The birthweight distributions were almost identical in the two groups. Despite these similarities the perinatal mortality was substantially higher in Greece. Analysis by cause of death showed the differences to be marginal in all categories except deaths attributed to intrapartum asphyxia which were eight times as common in Greece.

Birth Weight↗
PubMed1995

Persistence of organochlorines in breast milk of women in Victoria, Australia.

Existing information on the exposure of Australian infants to environmental contaminants through maternal milk is inadequate for assessing the safety of breast feeding. This study was undertaken to determine the extent of organochlorine (OC) contamination in the milk of mothers resident in Victoria, to monitor OC elimination by the nursing mother and to estimate the infant's daily intake of OCs from breast milk. Organochlorines were extracted from the lipophilic fraction of the breast milk samples and analysed by selected ion monitoring on a gas chromatograph-mass spectrometer (GC-MS). There was widespread contamination of milk with dichlorodiphenyltrichloroethane (p,p'-DDT) and its metabolite dichlorodiphenyldichloroethene, hexachlorobenzene (HCB), polychlorinated biphenyls (PCBs), oxychlordane and hexachlorocyclohexane, with p,p'-DDT and HCB being found in nearly all samples. Dieldrin and heptachlor epoxide were detected in 43 and 30% of samples respectively. PCBs were detected in 79% of samples and chlordane in 76%. A number of infants had daily intakes above the acceptable daily intake for total chlordane, total DDT, dieldrin, heptachlor epoxide and total PCBs. These findings have implications for strategies for the reduction of environmental contamination.

Adult↗
PubMed1993

The incidence of colon, breast and prostate cancer in Italian migrants to Victoria, Australia.

The incidence of cancers of the colon, breast and prostate in Australian and Italian born residents of Victoria, Australia were compared with the incidence of these cancers in Italy. Italian migrants' rates were between those of the Australian born and those from Italian cancer registries. Italian migrants' rates for colon cancer (males 23.1 and females 15.8 per 100,000) differed from rates in Ragusa (males 12.1 and females 10.4 per 100,000) but not from rates in Parma or Varese. The migrants' breast cancer rate was similar to the rate in Ragusans (48.7 vs 46.7) and their prostate cancer rate of 27.3 was higher than all Italian registries. Modelling identified that Italian migrants' rates by age were intermediate to Australian and Italian rates, but indistinguishable from cancer rates in Ragusa, except for colon cancer which demonstrated an interaction with age.

Adult↗
PubMed2004

A retrospective assessment of gold mining in the Reedy Creek sub-catchment, northeast Victoria, Australia: residual mercury contamination 100 years later.

The mining of gold can lead to toxic metals such as mercury (Hg) contaminating watercourses as by-products. The Reedy Creek sub-catchment, in northeast Victoria, Australia, was mined for gold in the 1850s. In 1998, samples were taken from six watercourses to measure any remaining toxic metal contamination in sediments and surface waters from two creeks with no previous gold mining (controls) and four that were mined. Although mean concentrations of Hg (measured using an ICP-OES) in sediments were below worldwide background levels, individual sites along Reedy Creek had slightly elevated Hg concentrations. In contrast, the Hg concentrations in the surface waters were above background levels. Temporal fluxes of very high Hg concentrations in the surface waters during periods of first flow and flood events revealed that Hg concentrations in the surface waters may, at certain times of the year, exceed all Australian and New Zealand Environment and Conservation Council (National Water Quality Management Strategy. Australian Water Quality Guidelines for Fresh and Marine Waters, ANZECC, 2000) guidelines for water use and the protection of the aquatic ecosystem.

Environmental Monitoring↗
PubMed2005

The consequences of land use change on nutrient exports: a regional scale assessment in south-west Victoria, Australia.

Estimation of nutrient load production based on multi-temporal remotely sensed land use data for the Glenelg-Hopkins region in south-west Victoria, Australia, is discussed. Changes in land use were mapped using archived Landsat data and computerised classification techniques. Land use change has been rapid in recent history with 16% of the region transformed in the last 22 years. Total nitrogen and phosphorus loads were estimated using an export coefficient model. The analysis demonstrates an increase in modelled nitrogen and phosphorus loadings from 1980 to 2002. Whilst such increases were suspected from past anecdotal and ad-hoc evidence, our modelling estimated the magnitude of such increases and thus demonstrated the enormous potential of using remote sensing and GIS for monitoring regional scale environmental processes.

Environment↗
PubMed2006

Compliance with surgical antibiotic prophylaxis--reporting from a statewide surveillance programme in Victoria, Australia.

A statewide assessment of the compliance of surgical antibiotic prophylaxis (SAP) with guidelines was undertaken for large public hospitals in Victoria, Australia. This was carried out using data collected as part of a surveillance system for hospital-acquired infections. The study population comprised patients in Victorian public hospitals with >100 beds (N=27) undergoing cardiac surgical procedures, hip or knee arthroplasty, cholecystectomy, appendectomy, colon surgery or hysterectomy over a 21-month period. Australian guidelines recommend SAP for all 10 643 surgical procedures included in this study. Combining all procedures, 87% received SAP, the choice of antibiotic was concordant with guidelines for 53.3% of procedures, and the choice of antibiotic was considered to be 'adequate but not concordant' for 23.9% of procedures. SAP was considered to be inadequate for 18.9% of procedures. A large number of antibiotic regimens were utilized for cardiac and orthopaedic surgery. Documentation of timing of administration was not submitted for more than half of all procedures. Timing was concordant with guidelines for 76.4% of procedures when documented. Prophylactic antibiotic choice was generally more concordant with guidelines for cardiac and orthopaedic procedures than for other types of surgery. However, even for these procedures, where infections carry high morbidity, SAP was sometimes inadequate. Regular reporting on SAP compliance from data collected during surveillance for hospital-acquired infections is achievable. This should lead to improvements in both compliance and documentation.

Anti-Bacterial Agents↗
PubMed2006

How is maternal psychosocial health assessed and promoted in the early postnatal period? Findings from a review of hospital postnatal care in Victoria, Australia.

OBJECTIVE: to describe how women's maternal health, particularly at a psychosocial level, is assessed and promoted during the postnatal hospital stay. DESIGN: postal survey of public hospitals providing postnatal care and interviews with care providers. SETTING: all publicly funded maternity units and selected health professionals in Victoria, Australia. PARTICIPANTS: hospital postal survey: sixty six hospital respondents; interviews: 38 maternity unit managers, clinical midwives and medical practitioners. FINDINGS: there was little consistency across the State in relation to routine observations of the mother. Physical checks were much more common than enquiring about how women felt physically. Practice in psychosocial assessment was also diverse, with care plans/maps (clinical pathways) being the main tool to guide assessment. Most participants reported that psychosocial assessment was undertaken during pregnancy. Follow-up after birth also varied. Hospital respondents reported that emotional well-being is assessed postnatally by observation and conversation with women. Participants who were interviewed reported that midwives had mixed skills in assessing and dealing with complex psychosocial issues. Three hospitals administer the Edinburgh Postnatal Depression Scale to women in the days after birth, and three hospitals provide routine sessions of structured debriefing. Survey participants reported that the busy and, at times, chaotic nature of postnatal wards affected the provision of care and the level of psychosocial support offered to women. KEY CONCLUSIONS: although one of the stated aims of early postnatal care is the promotion of maternal well-being, the diversity of practices and the routine nature of many of these practices suggest that care is often not individualised or woman-centred. The reliance of detecting and managing women with particular psychosocial issues during pregnancy results in this aspect of care being given less priority postnatally than may be ideal. IMPLICATIONS FOR PRACTICE: strategies are required to provide health professionals with guidelines and skills to enhance the detection of women who have, or have the potential to develop, health problems after birth. This requires a reorganisation of the way early postnatal care is provided in relation to the use of routine practices; the ability of caregivers to spend time with women in an environment that offers privacy and confidentiality; the structuring of care around individual needs; and opportunities for women to be cared for by caregiver/s with whom they have met before.

Adult↗
PubMed1997

Paediatric slow-speed non-traffic fatalities: Victoria, Australia, 1985-1995.

An important group of fatal incidents are slow-speed pedestrian non-traffic incidents to children, which account for 14% of accidental deaths from all causes in Victorian children under 5 years of age between 1985 and 1995, and 12% of pedestrian deaths of all ages. In Victoria, Australia, the database of the state Consultative Council on Obstetric and Paediatric Morbidity and Mortality was utilised to identify paediatric slow-speed pedestrian non-traffic-accident deaths in the local population. Additional data relating to the car and its driver, the child, and the circumstances of the incident were abstracted from records kept by the State Coroner and the Victorian compulsory third party traffic injury insurance organisation. Twenty eight Victorian children were identified who had died in one of three types of incident (driverless cars, child interacting with the vehicle and driver, and drivers who were unaware of the child's proximity). These incidents were more common in rural areas compared with urban, usually occurring at the child's home. The child was with or near an adult on all occasions. The vehicle was usually being driven by a relative, and was reversing in a higher proportion of 'unaware' incidents compared with the 'interactive' type. The association of 'off-road' family vehicles and trucks with these incidents appears to be increasing, especially in recent years. These findings suggest some countermeasures, including the separation of vehicle driveways from children's play areas, and object vicinity ultrasonic warning devices for vehicles.

Accidents, Home↗
PubMed1996

Transmission of hydatid disease to sheep from wild dogs in Victoria, Australia.

Adult tapeworms and metacestodes of Echinococcus granulosus were found commonly in wildlife on Crown Land (Alpine National Park or State Forest) in the area around Mansfield, Victoria. A total of 756 sheep from 32 farms in the areas were examined at slaughter. Seventeen of the farms (Group A) adjoined Crown Land and wild dogs commonly entered these farms and killed sheep. A high prevalence of hydatid infection was found in sheep from 15 of these farms. Serology and arecoline purging failed to identify infection with E. granulosus in any domestic dogs on these farms, despite some farmers sometimes feeding their dogs with offal of sheep and/or kangaroos. The remaining 15 farms (Group B) were in an area where wild dogs did not occur. Sheep infected with hydatid cysts were present on 2 farms in Group B, but E. granulosus infection was not evident in wildlife species examined from this area. The only sheepdog to have detectable serum antibodies against E. granulosus was a dog from a farm separating the 2 Group B farms where infected sheep were found. Echinococcus granulosus were not found when this dog was purged. The implications of the results of this study are discussed in terms of transmission and control.

Animals↗
PubMed2001

Semi-volatile organic compounds in the Campaspe River system (Victoria, Australia).

The levels of semi-volatile organic compounds (SVOCs) in the Campaspe River system, North Central Victoria, Australia, were monitored from January to September 1995, and the environmental trends and sources of these compounds were determined. The land use within particular catchments dictated the complexity of the SVOCs in run-off water. Run-off from native forest contained the greatest number of SVOCs. Soil and ground litter were shown to contain the greatest complexity of SVOCs, mostly terpenes. However, only a small proportion were leached by run-off with the remainder being tightly bound to the soil or volatilizing to the atmosphere. Under the prevailing drought of early 1995, the rivers contained no detectable SVOCs until the first catchment run-off after significant rainfall in May. The maximum complexity and concentration of the SVOCs coincided with extensive run-off after heavy rainfall in June, effecting a surge of SVOCs with the flood peak. Fatty acids, their amides and hydrocarbons made up the majority of the compounds identified and were in the 1-39 micrograms/l concentration range. The levels then diminished as the catchment was flushed by continual run-off. These results support Lake's 1967 hypothesis that natural floodwaters contain a signature of SVOCs entering from the catchment. The downstream passage of these compounds was obstructed by a man-made storage, Lake Eppalock, with only low concentrations of SVOCs (1-3 micrograms/l) in the outflow, displaying no correlation to run-off.

Amides↗
PubMed2003

Status epilepticus, the grim reaper of the mental health system in early Victoria.

In an era when patients with refractory epilepsy were managed in mental asylums in the colonial days of Victoria, Australia, the opinion of the administration was that such patients seemed to have a benign prognosis. However the decision to collect all female epileptics in the colony and manage them in the Ballarat Mental Hospital, effected in 1901, allowed scrutiny of the progress of a cohort of 96 patients over the first seventeen years of the twentieth century, thereby revealing that under asylum conditions no less than a third of their number died as the result of status epilepticus. The results of this survey and the reasons for such an outcome are discussed.

Anticonvulsants↗
PubMed2002

Planned homebirths in Victoria, 1995-1998.

This paper reports and comments on quantitative aspects of 440 planned homebirths attended by registered midwives in Victoria during the three years studied, 1995-1998. The spontaneous labour rate was 96.4%, and 91.6% of women planning a home birth experienced a spontaneous cephalic birth. The overall transfer to hospital rate was 20%, the most common reason for transfer being delayed progress in labour. 64.2% of women experiencing a vaginal birth had no perineal trauma. Postpartum haemorrhage was noted in 5.5% of participants, and 1.1% had a retained placenta. Infants were an older gestation and heavier than those in the state in general, although the Apgar scores were similar. These data support the claim that planned home birth with a qualified midwife remains a demonstrably safe option for women who choose this model.

Decision Making↗
PubMed2001

Risk-factors for meningococcal disease in Victoria, Australia, in 1997.

In Victoria between 1990 and 1996, meningococcal infections occurred in 1-2/100,000 people each year, with sometimes devastating outcome. In 1997, a typical year, we conducted a case-control study of all cases notified to the State Disease Control Unit, to investigate personal, environmental and lifestyle risk factors. In bivariate analysis many exposures were statistically significantly different (at P = 0.01) in cases and controls. The level of risk, and specific risks, differed between children (under 16) and adults (16 years and over). In multivariate analysis few exposures remained significant (at P = 0.05). However, these included having a smoker amongst close contacts, exposure to construction dust, recent illness, a history of snoring and speech problems, and sharing a bedroom. Besides confirming some previously identified risk factors, this is the first time that snoring and speech problems have been identified as risk factors for meningococcal disease.

Adolescent↗
PubMedDate not supplied

Evaluation of the prehospital management of road traffic fatalities in Victoria, Australia.

INTRODUCTION: This study was undertaken to identify prehospital system and management deficiencies and preventable deaths between 01 January 1997 and 31 December 1998 in 243 consecutive Victorian road crash victims with fatal outcomes. METHODS: The complete prehospital and hospital records, the deposition to the coroner, and autopsy findings were evaluated by computer analysis and peer group review with multidisciplinary discussion. RESULTS: One-hundred eighty-seven (77%) patients had prehospital errors or inadequacies, of which 135 (67%) contributed to death. Three-hundred ninety-four (67%) related to management and 130 (22%) to system deficiencies. Technique errors, diagnosis delays, and errors relatively were infrequent. One of 24 deaths at the crash scene or en route to hospital was considered to be preventable and two potentially preventable. CONCLUSION: The high prevalence of prehospital deficiencies has been addressed by a Ministerial Task Force on Trauma and Emergency Services and followed by the introduction of a new trauma care system in Victoria.

Accidents, Traffic↗
PubMed2002

Derivation of nutrient guidelines for streams in Victoria, Australia.

Human induced increases to nutrient concentrations in streams have led to many agencies developing strategies and criteria for nutrient reduction. National or statewide guidelines are generally inappropriate, due to the natural variability in stream ecosystems within political boundaries. This study used an extant aquatic macroinvertebrate-based regionalisation for the state of Victoria, Australia, as the basis for defining regions of relatively homogeneous environmental character. This enabled the selection of ecologically-based regional reference sites and subsequent characterisation of the nutrient status of these sites. Using an extensive biological and nutrient data base for streams across the State, we calculated 50th and 75th percentile concentrations for reference sites within each region. Using these percentiles in conjunction with 'impact and recovery' studies, we defined nutrient guidelines for each region. Although the nutrient data largely supported the biological regionalisation, patterns in the nutrient data did require some minor modifications for the nutrient regions. Relatively unimpacted regions with reference sites in very good-to excellent-condition were assigned guidelines largely based on the 75th percentiles. The more impacted regions, where 'best available' reference sites were of poorer quality, were assigned guidelines based largely on the 50th percentiles. Professional judgement and known extents of impacts across each region provided important contributions to the decision-making process. The derived guideline concentrations are comparable to several cited in the literature and are proposed for use in monitoring, assessment and restoration targets.

Animals↗
PubMed2004

The development of biological objectives for streams in a single catchment: a case study on the catchment of Western Port Bay, Victoria, Australia.

Government environment protection policies for waterways have traditionally relied on water quality indicators and their objectives. In this paper we describe the development of biological objectives based on invertebrate indicators for inclusion in a government policy for the catchment of Western Port Bay, Victoria. The first step of defining segments (areas with streams in which the same objectives are applied) was problematic, requiring two different approaches, as follows. Site groups initially based on invertebrate community composition derived using multivariate techniques (ordination and classification) proved to be unsuitable for policy segments. Segment boundaries were subsequently defined using topographical (e.g. boundary of foothills and lowland plains), climate (e.g. rainfall) and land-use (e.g. urban) features. We used information and data from reference sites inside as well outside the catchment to derive specific biological objectives based on aquatic invertebrates for these segments. Objectives were specified for the following four indicators--number of invertebrate families, the SIGNAL index, the AUSRIVAS predictive model and the number of key families.

Animals↗
PubMed2003

Use of mouthguards by basketball players in Victoria, Australia.

Basketball is a popular sport in Australia. Although orofacial injuries are common, mouthguard (MG) wear in basketball appears to be low. The purposes of this study were: to measure mouthguard wear by basketball players before and after a promotional intervention; to assess players' knowledge of the value of mouthguards for prevention of injury; and to describe their experience of orofacial injury. Two questionnaires (baseline and follow-up) were administered to a convenience sample of 496 basketball players in Victoria, Australia. Players recruited were youths (12-15-year olds, n = 208) and adults (18 years and over, n = 288), from all basketball levels (social to elite). Completion of the baseline questionnaire was followed immediately by an intervention comprising written and verbal information, a mouthguard blank and instructions on mouthguard construction. The follow-up questionnaire was mailed to all respondents 10-12 weeks later; 135 youths (65%) and 157 adults (54%) completed this. Mouthguard wear at baseline was low but was more frequent at games (62%) than at training (25%). Despite 90% of players acknowledging the protective value of a mouthguard, wear by youths did not increase following the intervention, and wear by adults increased by only 14% for training and 10% at games. Previous orofacial injury was recorded at baseline by 23% of players, but few had requested compensation from Basketball Australia (youths, 17%; adults, 30%). Two predictor variables were statistically identified as related to mouthguard wear: previous orofacial injury and age group. Mouthguard wear was significantly more frequent amongst players with previous injury; such players were 2.76 times more likely to be wearers than those without previous injury. Youths were 2.31 times more likely to wear mouthguards than adults. Only 34 players (12% of respondents at follow-up) had a mouthguard constructed from the blank provided. Although youth and adult groups differed, the overall extent of mouthguard use was disappointingly low. Despite wide recognition of mouthguard value, the intervention had little effect on promoting their use.

Adolescent↗
PubMed1991

Laterality, maldescent, trauma and other clinical factors in the epidemiology of testis cancer in Victoria, Australia.

Clinical factors were studied in a population based survey of 1,116 cases of testicular neoplasms in Victoria, Australia, between 1950 and 1978. The ratio of right to left sided tumours was 54:46, but the left side predominated among sarcomas (P = 0.006), and in older men. The relative risk (RR) for men with unilateral maldescent was 15 (CI 10-23) and for men with bilateral maldescent 33 (CI 20-55) (odds ratio 1.4, CI 0.5-4, P = 0.7). Calculations per testis in men with unilateral maldescent showed an elevated risk for both the maldescended testis (RR 28, CI 19-41, P less than 0.0001) and the normally descended testis (RR 3, CI 1.2-6, P = 0.04). The RR for men with abdominal maldescent was 55 (CI 36-83) compared to 7 (CI 4-11) for those with inguinal maldescent (odds ratio 8, CI 3-20, P less than 0.0001). Seminomas were more common than nonseminomas (NSGCT) in men with a history of maldescent (odds ratio 1.7, CI 1.1-3, P = 0.02) and also among corrected cryptorchids compared to uncorrected (P = 0.005). Seminomas were diagnosed at an earlier median age in men with corrected cryptorchid testes compared to uncorrected (P = 0.03) and in men with corrected cryptorchid testes compared to normally descended (P = 0.001). Maldescent was also associated with hernia (P = 0.04). Twenty-eight per cent of patients recorded a history of trauma with a higher proportion among NSGCT than among seminomas (P = 0.03). Prior malignancies were reported in nine patients, compared to 3.6 expected; prostate cancer (2) and malignant melanoma (2) were the greatest contributors to the excess.

Adolescent↗