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PubMed1997

The effect of mode of delivery on neonatal mortality in very low birthweight infants born in Victoria, Australia: Caesarean section is associated with increased survival in breech-presenting, but not vertex-presenting, infants.

To determine whether the improved survival of very low birthweight (VLBW) infants (< 1500 g) born in Australia can be attributed to currently high rates of Caesarean section, we examined the associations between neonatal mortality and Caesarean section in singleton liveborn VLBW infants (500-1499 g) born during 1986-93 in Victoria, Australia, using data from the Victorian Perinatal Collection Unit. The infants included in this study had completed > 23 weeks of gestation, had no life-threatening malformations and had not been delivered by a repeat Caesarean without a trial of labour (n = 2763). For infants weighing 500-749 g, 750-999 g, 1000-1249 g and 1250-1499 g, the neonatal mortality rates were 56.1%, 25.7%, 13.0% and 4.3% respectively, and the Caesarean section rates were 33.1%, 42.3%, 54.8% and 55.8%. Nearly half of these births (n = 1269) were associated with one or more obstetric indications for Caesarean section (non-breech malpresentation, fetal distress, prolapsed cord, placenta praevia, pre-eclampsia and hypertension). Overall, the odds ratio (OR) for neonatal death associated with Caesarean section was 0.92 [95% confidence interval 0.60-1.41], after adjustment for gestational age, birthweight, year of birth, type of hospital, presence or absence of labour, presentation and obstetric indications for Caesarean section. However, when the vertex-presenting (n = 1702) and breech-presenting (n = 746) infants were considered separately, the adjusted ORs for neonatal death were 1.98 [0.96-4.10] and 0.52 [0.29-0.96] respectively. For those infants without obstetric indications for Caesarean section, the adjusted ORs for neonatal death in vertex-presenting (n = 950) and breech-presenting (n = 446) infants were 3.80 [1.11-13.0] and 0.47 [0.23-0.6]. These recent population-based data support the view that Caesarean section does not enhance the neonatal survival of VLBW babies when obstetric complications are absent.

Birth Weight↗
PubMed2000

General practitioners leaving rural practice in Western Victoria.

The West Vic Division of General Practice, working with the Department of General Practice, The University of Queensland conducted a qualitative study of GPs who had left western Victoria over the previous 10 years to examine issues relating to the decision to leave rural practice. This study was conducted as part of a project to explore the role of rural Divisions in assisting with general practitioner recruitment and retention. The study supported the conclusions of a similar study in North Queensland and proposed a model that regards rural retention as an interplay of influences both positive and negative with acute trigger factors that can precipitate the decision to leave. Conflict and dissatisfaction with aspects of rural GP hospital work appeared to be a relatively frequent trigger factor that is immediately amenable to intervention from Divisions of general practice and through improvement in negotiation and conflict resolution skills for rural general practitioners.

Conflict, Psychological↗
PubMed2002

Amalgamation of health services in south-west Victoria: reinvention or survival?

In Australia "the hospital" has long been considered the cornerstone of small, rural health services. However, this premise has been altered significantly by the introduction of casemix loading and diagnostic-related groups that promote a rationalised output-based model of management. In the light of these changes, many rural health services have struggled to reinvent themselves by establishing a range of service models such as Multi-purpose Service (MPS) and Health Streams, while maintaining traditional models (i.e. bush nursing centres, nursing homes and aged-care facilities). These changes are about survival. This paper analyses one such case in south-west Victoria, the Macarthur and District Community Outreach Service, and compares the outcomes with other similar Victorian rural health research projects. Particular attention is paid to the nature of the health services, the management of change and the proposed health outcomes for the local rural communities. In conclusion, it is argued that this study adds to the body of knowledge surrounding the construction of models of community health and development programming, These models impact upon future rural and remote area initiatives throughout Australia.

Health Planning↗
PubMed1998

Documentation of children's vaccination status in child care centres in Victoria.

OBJECTIVE: To assess the record-keeping of child care centres in Victoria with respect to children's vaccination status. METHODOLOGY: A random sample of 113 centres from a list of over 800 registered Victorian child care centres received a mailed questionnaire on characteristics and policies of the centre, including documentation of attending children's vaccination status. RESULTS: The response rate was 86.7%; more than 95% of centres had children under two in care. Only 85% of centres kept any record of children's immunisation status, with smaller centres and class 2 centres (occasional care centres) significantly less likely to keep records. Records were updated irregularly. Fewer than half of the centres studied kept a record of whether children had been vaccinated against Haemophilus influenzae type b. CONCLUSIONS: Despite the importance of documenting children's vaccination status, many child care centres have failed to develop adequate systems to record or update records of children's immunisation. This makes exclusion during outbreaks of a vaccine-preventable disease difficult. The ongoing process of accreditation may eventually improve performance, but both legislation and a better educational strategy to improve practice in this area are needed.

Child Day Care Centers↗
PubMed1998

Congenital malformations in Victoria, Australia, 1983-95: an overview of infant characteristics.

OBJECTIVE: To provide an overview of the characteristics of Victorian infants born between 1983 and 1995 who are affected by one or more of 27 sentinel birth defects. METHODOLOGY: Using data on congenital malformations supplied to the Victorian Perinatal Data Collection Unit from multiple sources between 1983 and 1995, information was summarised for 25231 infants (born at 20 weeks or more) and 1566 terminations of pregnancy before 20 weeks' gestation. RESULTS: During the 13-year study period in Victoria, 3.2% of babies had at least one malformation. Congenital dislocation of the hip was the most common defect with a prevalence of 28.9 per 10000 pregnancies or 1/346. Increase in birth prevalence between 1983 and 1995 is greatest in obstructive defects of the renal pelvis, hypospadias and the trisomies 21,13 and 18. Nearly 50% of pregnancies affected by anencephaly were terminated before 20 weeks compared to 26% affected by spina bifida. The perinatal mortality of infants born at 20 weeks or more with congenital malformations is more than 10 times greater than that of infants without any malformations. Males are more at risk of being born with a malformation than females. Congenital malformations are more common in infants of multiple pregnancies and those of low birthweight. CONCLUSION: This large data collection is a valuable source of information for perinatal epidemiologists, for providers of prenatal diagnostic services and for the care of the disabled. In addition, the continued reporting and monitoring of birth defects will allow for targeted research that may lead to a better understanding of their aetiology.

Abnormalities, Multiple↗
PubMed1998

Child rearing and cultural beliefs and practices amongst Thai mothers in Victoria, Australia: implications for the sudden infant death syndrome.

OBJECTIVE: To examine the perceptions of sudden infant death syndrome (SIDS) and to describe the role of cultural beliefs and practices on child rearing amongst Thai mothers in Victoria, Australia. METHODOLOGY: In-depth interviews and participant observation conducted with 30 Thai mothers during 1995-96. RESULTS: SIDS was not known amongst these Thai mothers prior to migration to Australia. However, they were aware of SIDS when they gave birth here and all of them expressed fear about their baby's death. Due to this fear, most mothers tended to follow Thai beliefs and practices strictly to prevent death. These included breast-feeding, not leaving the infant alone at nighttime, placing the infant on the side or back to sleep, and bedsharing. It is considered that there are numerous evil spirits who may harm the infant, but some are benevolent and protect the newborn, such as ancestral spirits and the guardian angel of a child. Several Thai rituals are carried out to protect the newborn from ill health and death, including inviting the soul of the infant to reside in his or her body, and ritual clipping and shaving the hair of the newborn within the first month of life. CONCLUSIONS: Cultural beliefs, rituals and child-rearing practices help Thai parents to overcome their fear of SIDS. Hypotheses derived from Asian parents' child rearing practices may be useful in further SIDS research.

Adult↗
PubMed1999

Prevalence of emotional and physical health concerns amongst young people in Victoria.

OBJECTIVE: To describe the emotional and physical health concerns of young people, and identify the concerns for which young people are more likely to seek help. METHODS: We surveyed a representative cross-sectional samples of students from 11 to 18 years of age from 24 Victorian secondary schools in late 1997 within the Health of Young Victorians Study. Included in this survey were items describing worries or concerns of physical and emotional health. Prevalence rates, Chi-square, and logistic regression analyses were used to describe relationships. RESULTS: 2361 questionnaires were completed (53% male, response rate 70%). Overall, most frequent reports concerned feelings of depression (40%), worries about weight (37%), worries about self confidence (34%), and trouble falling or staying asleep (30%). Females tended to report a greater range of health concerns. The most frequent reports, by gender, were worries about their weight (52% females), and feelings of depression (30% males). Feelings of being bullied (20%), and concerns about sex, drugs and alcohol (7-11%) were reported equally frequently by males and females. In contrast to the high levels of health concerns reported, few students also reported seeing someone about them other than parents or friends. This finding appeared consistent across ages and for both sexes; with higher rates of seeking help for their physical rather than emotional health concerns. DISCUSSION: These results show that adolescents across Victoria are reporting high levels of concerns or worries about their health which differ across age and gender. They are more likely to report concerns about emotional health, but less likely to seek professional help than for physical concerns.

Adolescent↗
PubMed2001

Cerebral palsy in Victoria, Australia: mortality and causes of death.

OBJECTIVE: To study the causes of death and the characteristics of children with cerebral palsy that had died over a 25-year period in Victoria, Australia. METHODOLOGY: Names of children that had died were collected from the Victorian Cerebral Palsy Register. Their hospital records were studied and information was gathered about age of death, motor impairment, the presence or absence of associated disabilities and cause of death. RESULTS: One hundred and fifty-five children had died during the period 1970-95. The majority of children had severe spastic quadriplegia, intellectual disability and epilepsy. The predominant cause of death was pneumonia, although for many children who died at home the cause was unknown. CONCLUSIONS: Children with cerebral palsy are a diverse group and those with a severe motor deficit have a reduced life expectancy. Lung disease remains an important cause of morbidity and mortality for this group. Further information about the causes of death is needed, particularly for those children that die at home.

Cause of Death↗
PubMedDate not supplied

Vitamin D status of chronically ill or disabled children in Victoria.

OBJECTIVE: To establish the percentage prevalence of hypovitaminosis D in chronically ill or disabled children in Melbourne, Australia. METHODOLOGY: A group of inpatients at the Royal Children's Hospital, Melbourne, Victoria, as identified by the primary unit, were sampled to measure serum vitamin D and parameters of bone turnover. A second group of disabled children (outpatients) were also measured to establish vitamin D status. RESULTS: Of the total population, 54.9% were found to have low serum 25 hydroxy (25OH) vitamin D levels. Of the inpatient group, 25.4% were vitamin D deficient (<30 nM/L), and 27.1% were vitamin D insufficient (30-50 nM/L). The mean 25OH vitamin D was 52.1 nM/L. Of the outpatient group, 15.4% were vitamin D deficient, whilst 42.3% were found to be insufficient. The mean vitamin D level was 41.2 nM/L. No difference attributable to intellectual versus physical disability was found. Anticonvulsant use and ambulatory status was not predictive of vitamin D status in the children examined. Of the total population, 0.05% were found to have secondary hyperparathyroidism. The mean 25OH vitamin D level of this subgroup was 30.6 nM/L. Dark skin tone was found to be significantly associated with hypovitaminosis D (P = 0.001), where all five children with dark skin tone were found to have serum 25OH vitamin D levels <50 nM/L. Of the seven disabled children (outpatients) found to be iron deficient, four had coexistent hypovitaminosis D. CONCLUSION: The percentage prevalence of hypovitaminosis D is high in both chronically ill, and physically/intellectually disabled children in Melbourne, Australia. Increased vigilance and recognition of this deficiency state is needed as an important health prevention strategy.

Child↗
PubMed2000

Asthma is more prevalent in rural New South Wales than metropolitan Victoria, Australia.

OBJECTIVE: The aim of this study was to compare the prevalence of adult respiratory symptoms and conditions in a rural setting with a metropolitan setting. METHODOLOGY: We used cross-sectional population surveys of respiratory health using the European Respiratory Health Survey screening questionnaire. A random sample of 4455 eligible young adults aged 20-44 years, from electoral rolls in south-eastern metropolitan Melbourne, Victoria, and 4521 from rural south-western New South Wales were surveyed. RESULTS: Response rates of 72% (n=3194) and 69% (n=3121) were achieved in Melbourne and the Riverina, respectively. Respondents from the Riverina reported significantly higher prevalences of nocturnal dyspnoea (P<0.01), chronic bronchitis (P=0.03), an asthma attack in the previous 12 months (P<0.001), ever having had asthma (P<0.001) and doctor-diagnosed asthma (P<0.001) compared to those from Melbourne. However, among those with 'asthma attacks in the last 12 months', Melbourne respondents experienced a higher frequency of attacks (P<0.05). Riverina respondents reported a higher prevalence of smoking (P<0.05) and smoked more cigarettes on average (P<0.001) than Melbourne respondents. However, annoyance from air pollution was higher in Melbourne than in the Riverina. CONCLUSIONS: These results suggest that asthma is more prevalent in rural southern New South Wales than in Melbourne but follows a different pattern of exacerbations.

Adult↗
PubMed2001

Management of diabetic retinopathy by general practitioners in Victoria.

PURPOSE: To compare the self-reported management of diabetic retinopathy by general practitioners to the National Health and Medical Research Council of Australia (NHMRC) Guidelines for the Management of Diabetic Retinopathy. METHODS: In 1994, a stratified (by urban/rural practice location) sample of 500 general practitioners in Victoria was surveyed in regard to their management of diabetic retinopathy. Following the release of the NHMRC Guidelines for the Management of Diabetic Retinopathy in 1997, these same general practitioners were sent a two-page questionnaire related to their management of diabetic retinopathy. RESULTS: Completed questionnaires were received from 228 general practitioners (59% of original participants). Only 37% (79/216) of the general practitioners reported that they had received a copy of the guidelines. Of the general practitioners who had received the guidelines, 18% (14/79) said that they had not read them at all, while 65% (51/79) had read them partially and 18% (14/79) had read them in their entirety. At follow up, less than half (98/214) of general practitioners reported examining 50% or more of their patients for diabetic retinopathy, compared with 104/214 at baseline. General practitioners who had read the guidelines were more likely to report that not being sure what to do when changes were detected was a minor barrier or was not a barrier to them performing dilated ophthalmoscopy (93% vs 83%, chi2(1) = 3.67, P = 0.055). Nearly all of the general practitioners reported that they refer their patients with diabetes to an ophthalmologist or optometrist at least every 2 years as recommended. Seventy-six per cent (170/224) of the general practitioners felt that 70% or more of their patients complied with their instructions to visit an ophthalmologist or optometrist. CONCLUSION: The NHMRC guidelines for diabetic retinopathy appear to have had a positive effect on some of the attitudes of general practitioners who have read them, but more effort is needed to disseminate the guidelines to all general practitioners and to increase their uptake.

Diabetic Retinopathy↗
PubMed2003

Toxocara canis: egg presence in Melbourne parks and disease incidence in Victoria.

PURPOSE: Toxocara canis can cause blinding eye disease. This study assessed the presence of T. canis eggs in soil from parks in Melbourne and also the incidence of presumed ocular toxocariasis in Victoria. METHODS: One hundred and eighty soil samples were collected from nine suburban locations in Melbourne, Australia. These were analyzed for the presence of T. canis eggs. A search of laboratory records of T. canis serology requests from Victorian patients over an 8-year period was performed. RESULTS: Only one soil sample was positive for T. canis eggs. Positive T. canis serology was reported in 13 samples from patients. These patients all had ocular features suggestive of T. canis infection. CONCLUSION: Toxocara canis eggs are rare in public parks in Melbourne and symptomatic ocular toxocariasis is uncommon in the Victorian population. The acquisition of the disease is unlikely to be from public parks.

Adolescent↗
PubMed2003

Clinical categorization for elective surgery in Victoria.

AIM: The aim of the present paper was to assess trends in clinician's utilization of urgency categories for elective surgery. METHODS: The present paper reviews the additions to the Victorian elective surgery waiting list for hip replacement and prostatectomy as recorded by the Elective Surgery Information System database. Review of general trends in utilization over two separate 12 month periods were undertaken. RESULTS: There is inconsistency in categorization of patients referred to the waiting list for hip joint replacement and prostatectomy. An increasing trend to categorize patients as semi-urgent (category 2) in preference to non-urgent (category 3) emerged over this period (category creep). Semi-urgent cases might be competing for access within the category 2 band with less urgent cases. CONCLUSIONS: There seems to be an increasing imbalance between demand for and availability of elective surgery for lower urgency elective surgical procedures. This imbalance, characterized by lengthening waiting times, means that not all patients will receive treatment within the clinically recommended waiting times. The variable approach to categorization of urgency suggests that the process lacks objectivity and consensus. Simple clinical tools to assist prioritization are currently being evaluated in Victoria (Australia) and other countries.

Arthroplasty, Replacement, Hip↗
PubMed2000

Reforming Victoria's primary health and community service sector: rural implications.

In 1999 the Victorian primary care and community support system began a process of substantial reform, involving purchasing reforms and a contested selection process between providers in large catchment areas across the State. The Liberal Government's electoral defeat in September 1999 led to a review of these reforms. This paper questions the reforms from a rural perspective. They were based on a generic template that did not consider rural-urban differences in health needs or other differences including socio-economic status, and may have reinforced if not aggravated rural-urban differences in the quality of and access to primary health care in Victoria.

Catchment Area, Health↗
PubMed2002

Assistive devices: self-reported use by older people in Victoria.

A qualitative study was conducted in Victoria to explore factors affecting the acceptability and use of assistive devices by older people. Four focus groups and fifteen home-based interviews were conducted with older people (mean age 77 years) who had been issued with 2 or more assistive devices. Analysis of the data indicated that almost all participants were content to be advised by professionals on suitable equipment. Most considered the equipment and home modifications safe and easy to use, and appreciated the benefits for mobility, confidence and independence. Reasons for non-use were commonly related to changes in functional ability. Cost was a major deterrent for a small number who opted to 'make do'. Recommendations are made for improvements to the existing system of equipment provision and use, including review and development of consistency of provision and payment policy among service providers; flexibility of payment options; adequate education and follow-up support for clients.

Aged↗
PubMed2004

Tensions in maternal and child health policy in Victoria: looking back, looking forward.

Since the late 1980s, Maternal and Child Health Services (MCHS) in Victoria have undergone significant change. This paper provides an historically-informed analysis of the complex intersection of policy, administrative restructuring and stakeholder interests. It draws on and extends the authors' previous research into MCH Service policy directions and administration, including the impact of Compulsory Competitive Tendering (CCT) on MCH nurses in the 1990s. Historically there has been little explicit debate about either organisational arrangements, or the policy objectives of the MCHS. The dominant focus on health surveillance of infants never adequately reflected nurses' wider role in the community and was not consistent with a wider social model of health. Tensions between professional, consumer and administrative stakeholders became heightened by the implementation of the 1990s neoliberal political agenda. During this period, when restructuring linked funding to service delivery through tendering arrangements, a political and policy settlement further institutionalised surveillance as the basis of the MCHS. The restructured Service has remained constrained by the dominance of health surveillance as the primary program goal even after more varied contracting arrangements replaced CCT. Although recent initiatives indicate signs of hange, narrow surveillancebased guidelines for Victorian MCH Services are not consistent, we argue, with recent early years of life policy which calls for approaches derived from socio-ecological models of health.

Child↗
PubMed1996

The utilisation of public and private hospitals in Victoria: an issue of access?

Consumers regard access to hospital services as one of the key components of quality in health care delivery. A mixed public/private system operates in Victoria, but a morbidity collection from private hospitals was commenced only relatively recently. In 1993-94 the collection covered 82 per cent of private hospital separations, and it was considered timely to examine the utilisation patterns in the private system and compare them with those in the public system. Medical and surgical emergencies and other complex conditions and procedures are serviced largely in the public sector, whereas private hospitals are utilised for elective and less complex surgery and non-urgent conditions. Occupancy rates are around 79 per cent in public hospitals and 67 per cent in private hospitals. Elective surgery waiting list data suggest that while urgent cases are treated within a month, significant proportions wait six months or more for non-urgent surgery. Private health insurance is the main factor in determining access to and the utilisation private hospitals. The current Medicare Agreement and the move to separate the role of purchaser and provider may allow the maximal utilisation of private hospitals and diminish the burden of chronic illness.

Adolescent↗
PubMed2006

A chlamydia prevalence survey of young women living in Melbourne, Victoria.

BACKGROUND: To estimate the population-based chlamydia prevalence among women aged 18 to 35 years living in Melbourne, Victoria, and to assess the feasibility of using mailed urine specimens to test women. METHODS: A simple random sample of 11,001 households in Melbourne was selected from the telephone directory. Participants completed telephone interviews and provided urine specimens through the mail for chlamydia testing. Urines were tested using polymerase chain reaction. RESULTS: 11,001 households were contacted, with 1532 households identified as including eligible women; telephone interviews were completed, with 979 women giving a response rate of 64%. Six hundred and fifty-seven women provided a urine specimen with a response rate of 43%. Among sexually active women aged 18-24 years, the chlamydia prevalence was 3.7% (95% CI: 1.2%, 8.4%) and 0.2% (95% CI: 0.0%, 1.1%) among 25-35 year olds. Chlamydia prevalence increased significantly with an increasing number of male sexual partners. CONCLUSIONS: This is the first study of its kind in Australia and shows that chlamydia prevalence increases with an increasing number of male sexual partners in the last 12 months. Mailed urine specimens are feasible for conducting population-based chlamydia-prevalence surveys but it is difficult to obtain high response rates with this methodology. Public health resources should now be directed towards investigating how to reach young women at increased risk of infection, ensuring that they are tested for chlamydia.

Adolescent↗