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PubMed1979

Urbanization and mental health: psychiatric morbidity, suicide and violence in the State of Victoria.

Australia is one of the most urbanized countries in the world with over 85% of the population living in metropolitan and other urban areas. More important, the change from a predominantly rural society to an urbanized society has occurred within the last 100 years. To assess the effects of urbanization on mental health, rates of admissions to psychiatric institutions, suicides and violent crime in Victoria have been analysed for the last hundred years. Data on admissions to psychiatric facilities in Victoria from metropolitan, other urban and rural areas, as well as results of community health surveys carried out in metropolitan and rural areas were compared to examine for evidence of urban-rural differences in psychiatric morbidity. The findings do not support the notion that the level of psychiatric and psychosocial disorders in Victoria are related to urbanization or to urban living.

Adolescent↗
PubMed1979

Medical manpower in Victoria, 1977.

A medical manpower survey in Victoria in 1977 revealed that there were 7823 registered medical practitioners, giving an apparent ratio of doctors to population of 1:483. However, only 81% of respondents were working in Victoria, and therefore the ratio of doctors in active practice in the State to population was estimated to be 1:597. Data from the survey revealed that the median age was 40 years. Female doctors comprised 17%, but the proportion of women was much higher amongst younger graduates. Private practitioners accounted for 60% of respondents (general practitioners, 36%; specialists, 24%), full-time hospital staff members for 28%, and practitioners in other salaried appointments for 12%. The ratio of general practitioners to population was estimated to be 1:1560 in the Melbourne statistical division, 1:1780 in the country, and 1:1617 in Victoria as a whole. Long hours of work were reported by the great majority of doctors. The impact of changing numbers and distribution of various categories of medical manpower on future work and postgraduate training is discussed. Early consideration of regulating the number of doctors by reducing the number of undergraduates entering Australian medical schools and by restricting the immigration of doctors from overseas is advocated.

Adult↗
PubMed1999

The resurgence of marvellous Melbourne--trends in population distribution in Victoria, 1991 to 1996.

"Between 1991 and 1996 the population of Melbourne [Australia] grew faster than that of Regional Victoria. During the same period the population of Sydney grew faster than that of Regional New South Wales. Both these developments were unexpected. They occurred during a period of declining net overseas migration. Both developments can be partly explained by fewer people leaving Melbourne and Sydney and moving to the regional areas of their respective states. In Victoria, this development can also be partly explained by an increase in the number of people migrating interstate from Regional Victoria."

Australia↗
PubMed1997

Missed opportunities for prevention of tuberculosis in Victoria, Australia.

SETTING: Victoria, Australia. OBJECTIVE: To ascertain missed opportunities for prevention in all persons notified in 1991 to the state registry with active tuberculosis (TB), and to examine aspects of case management relevant to prevention. DESIGN: A descriptive study. Records were reviewed for 231/236 cases of TB notified in the state of Victoria in 1991. Documentation of past screening for TB, preventive therapy, treatment of active disease and follow up was sought for all cases. Past screening was defined as past contact screening, migrant screening, refugee screening and health undertakings for TB. RESULTS: Of the 231 cases, 13 were not confirmed to have TB. Of the remaining 218 cases, 78% were foreign born, and of these, nearly half were diagnosed within 3 years of arriving in Australia. Nearly half of all cases (97/218) had some form of past screening for TB. The most common type of screening was refugee and migrant screening (45/218, 21%) followed by tuberculosis health undertakings (25/218, 12%) and contact screening (15/218, 7%). Of those with past screening, 70% (68/97) had a positive screening result at the time. Among these, the first screening episode resulted in the diagnosis of active TB in 5/68, and TB infection in 63/68. In the latter group only 5% (3/63) received preventive therapy. CONCLUSION: There are significant missed opportunities for prevention in Victoria, particularly in the foreign born cases who receive screening on entry into the country. For screening to be a meaningful exercise, preventive therapy should be used where medically indicated.

Adolescent↗
PubMed1996

Assessing palliative care educational needs of physicians and nurses: results of a survey. Greater Victoria Hospital Society Palliative Care Committee.

The Greater Victoria Hospital Society (GVHS) Palliative Care Committee surveyed medical and nursing staff from four hospitals and The Victoria Hospice Society in February, 1993. The purpose of the survey was to identify physicians' and nurses' perceived educational needs related to death and dying. Programs that focus on the dying process; patient pain, symptom, and comfort control; and patient and family support were identified as necessary to meet the educational needs of physicians and nurses in providing quality palliative care. Physicians and nurses identified communication skills as being paramount. Communications concerning ethical issues were highlighted as the most difficult to cope with.

Attitude of Health Personnel↗
PubMed2001

The burden of mental disorders in Victoria, 1996.

BACKGROUND: Between 1998 and 1999, a burden of disease assessment was carried out in Victoria, Australia applying and improving on the methods of the Global Burden of Disease Study. This paper describes the methods and results of the calculations of the burden due to 22 mental disorders, adding 14 conditions not included in previous burden of disease estimates. METHODS: The National Survey of Mental Health and Wellbeing provided recent data on the occurrence of the major adult mental disorders in Australia. Data from international studies and expert advice further contributed to the construction of disease models, describing each condition in terms of incidence, average duration and level of severity, with adjustments for comorbidity with other mental disorders. Disability weights for the time spent in different states of mental ill health were borrowed mainly from a study in the Netherlands, supplemented by weights derived in a local extrapolation exercise. RESULTS: Mental disorders were the third largest group of conditions contributing to the burden of disease in Victoria, ranking behind cancers and cardiovascular diseases. Depression was the greatest cause of disability in both men and women. Eight other mental disorders in men and seven in women ranked among the top twenty causes of disability. CONCLUSIONS: Insufficient information on the natural history of many of the mental disorders, the limited information on the validity of mental disorder diagnoses in community surveys and considerable differences between ICD-10 and DSM-IV defined diagnoses were the main concerns about the accuracy of the estimates. Similar and often greater concerns have been raised in relation to the estimation of the burden from common non-fatal physical conditions such as asthma, diabetes and osteoarthritis. In comparison, psychiatric epidemiology can boast greater scientific rigour in setting standards for population surveys.

Adolescent↗
PubMed2006

An ecological study of organochlorine pesticides and breast cancer in rural Victoria, Australia.

A number of studies have suggested that environmental contamination with organochlorine pesticides may be related to risk of breast cancer. To investigate this association in a rural part of Australia, organochlorine contamination data from a breast milk organochlorine study conducted in the state of Victoria in 1993 were used. The state was divided into 11 statistical divisions. Standardized incidence ratios (SIRs) for the 11 regions were calculated using breast cancer incidence data from 1983 to 2002. During that time, 47,250 breast cancer cases occurred in Victoria, which had an average population of 2,147,409 women. The Ovens-Murray region, which was the region most contaminated with organochlorine pesticides, showed an elevated SIR of 1.10 (95%CI, 1.03-1.17), although two other regions with lower organochlorine contamination levels also had elevated SIRs. The rural part of the Ovens-Murray region, where the main pesticide use occurred, had the highest SIR, 1.15 (95%CI, 1.07-1.23). We did not find any significant correlation between organochlorine contamination and the age-standardized rate of breast cancer across all regions. But a positive dose-response relationship using an adjusted negative binomial model was detected for heptachlor epoxide. Our study may provide limited support for the role of environmental contamination with organochlorine pesticides in the development of breast cancer.

Breast Neoplasms↗
PubMed2004

Hydrology or floristics? Mapping and classification of wetlands in Victoria, Australia, and implications for conservation planning.

A national approach to the conservation of biodiversity in Australia's freshwater ecosystems is a high priority. This requires a consistent and comprehensive system for the classification, inventory, and assessment of wetland ecosystems. This paper, using the State of Victoria as a case study, compares two classification systems that are commonly utilized to delineate and map wetlands--one based on hydrology (Victorian Wetland Database [VWD]) and one based on indigenous vegetation types and other natural features (Ecological Vegetation Classes [EVC]). We evaluated the extent of EVC mapping of wetlands relative to the VWD classification system using a number of datasets within a geographical information system. There were significant differences in the coverage of extant EVCs across bioregions, different-sized wetlands, and VWD wetland types. Resultant depletion levels were markedly different when examined using the two systems, with depletion levels, and therefore perceived conservation status, of EVCs being significantly higher. Although there is little doubt that many wetland ecosystems in Victoria are in fact threatened, the extent of this threat cannot accurately be determined by relying on the EVC mapping as it currently stands. The study highlighted the significant impact wetland classification methods have in determining the conservation status of freshwater ecosystems.

Biodiversity↗
PubMed2006

Perceptions of prescribed burning in a local forest community in Victoria, Australia.

The general perceptions of prescribed burning were elicited from forest users for an area that has been subject to this form of land management for at least 20 years. The largest group consisted of local residents living in and around the Wombat State Forest with two smaller groups of students from a nearby university campus and local professional land managers. A questionnaire was given to each participant in order to explore how the forest was used, to determine the level of knowledge of burning in the targeted forest and Victoria and the perception of the appearance, effectiveness of protection, and accessibility to the forest after prescribed burning. Generally all groups had similar responses with community members having stronger views on the effectiveness and practicalities of prescribed burning, whereas students were more neutral in their opinions. All participants claimed knowledge of prescribed burning activities within Victoria, but fewer had experience of planned fires in the Wombat State Forest. All groups agreed that areas that had not been recently burned had a better appearance than those that had, but this result may have included a range of value judgments. Land managers had a greater understanding of the ecological importance of season and timing of burning; however, some students and community members were equally knowledgeable. Prescribed burning did not impede access to the forest, nor did smoke from prescribed burns pose any great problem. The majority of the participants felt that the amount of prescribed burning done in the forest was adequate for engendering a feeling of protection to life and property, yet many were still suspicious of this management practice. These initial findings indicate several areas in which further research would be useful including the efficacy of education programs for community members and improved communication of burn plans by land managers.

Conservation of Natural Resources↗
PubMed2026

Changes in heroin-related ambulance attendances following the introduction of a medically supervised injecting room in Victoria, Australia.

BACKGROUND: Injecting drug use contributes significantly to morbidity, mortality and broader social harms globally. Supervised Injecting Facilities (SIFs) are harm reduction interventions that reduce overdose risk and facilitate access to health services for marginalised individuals. While international evidence supports the effectiveness of SIFs, Australian population-level surveillance data quantifying their impact on emergency medical service utilisation remain limited. METHODS: Using data from the National Ambulance Surveillance System, we conducted a retrospective, interrupted time series analysis of heroin-related ambulance attendances within the local catchment of the Medically Supervised Injecting Room (MSIR) between January 2015 and December 2023. Supplementary analysis included comparisons with central Melbourne suburbs and the broader state of Victoria. Key intervention timepoints, including the opening of the MSIR on 30 June 2018, expansion of its operating hours in July 2019, and the COVID-19 pandemic from April 2020 to October 2021, were examined to assess changes in heroin-related attendances over time. Segmented regression models were used to assess changes in heroin-related ambulance attendance trends over time. RESULTS: At the time the MSIR opened, the model-predicted heroin-related ambulance attendance rate within the MSIR catchment was 123 per 100,000 population per month, equivalent to approximately 48 heroin-related ambulance attendances per month. Prior to implementation, the attendance rate was increasing by an estimated 0.74 per 100,000 population per month. Following the opening of the MSIR, the previously increasing trajectory reversed, with ambulance attendance rates declining by approximately 2.3 per 100,000 population per month relative to the pre-intervention trend. By the end of the study period (December 2023), the predicted monthly heroin-related ambulance attendance rate had declined to 36 per 100,000 population (approximately 14 attendances per month), representing an overall reduction of 70.7% from the time of MSIR implementation. These reductions persisted throughout the COVID-19 lockdown period and were sustained after restrictions lifted. Supplementary analysis showed no comparable reductions in the central Melbourne region or the remainder of Victoria. CONCLUSIONS: The introduction of the MSIR in Richmond was associated with a sustained reduction in heroin-related ambulance attendances within its catchment area. These findings provide strong population-level evidence that SIFs reduce acute heroin-related harms requiring emergency ambulance response, reinforcing their role as an effective harm reduction strategy within the Australian context.

Humans↗
PubMed2005

The evolution of an integrated State Trauma System in Victoria, Australia.

The incidence of major trauma and associated fatalities in the State of Victoria, Australia, have declined over 20 years following the successful implementation of strategies to modify environmental and behavioural factors that contribute to motor vehicle injuries. However, several system deficiencies in the management of major trauma patients had remained unresolved. To investigate these shortfalls the State Government of Victoria established a task force in 1997 to review trauma and emergency services. The task force adopted the principle of "the right patient to the right hospital in the shortest time" and in 2000 began to deploy an integrated State Trauma System. Implementation of such a system required the designation of specific hospitals of various levels to care for trauma patients; the concentration of trauma expertise at these centres; integration and coordination between the service providers; development of agreed triage and transfer protocols and improved education, training and research programs. A statewide major trauma database was established to enable system monitoring and facilitate further enhancements. The Victorian experience with the development of an integrated trauma system should aid in the development of similar systems nationally and internationally and is described in this paper.

Ambulances↗
PubMed1998

Survey findings describing the use of physical restraints in nursing homes in Victoria, Australia.

Directors of Nursing of nursing homes in Victoria, Australia were asked to complete a 48 item survey designed to obtain information about the use of physical restraints. Responses were obtained from 272/420 (64.8%) DONs. Of approximately 10,065 (7326 females; 2739 male) nursing home residents, 25.5% (2568) were physically restrained at the time the survey was completed. Of this group, females comprised the largest number (1840; 71.6%) vs 728 (28.4%) males. Bedrails (39%) and restraining belts (29%) were the most commonly used types of physical restraints. "Preventing falls" (80.9%) and "because no alternative exists" (34.6%) were the main patient-oriented and nurse-oriented reasons respectively, for applying physical restraints. Weak correlations were noted between: the number of residents who were physically restrained and the size of nursing homes (r = 0.3313, alpha < 0.05); the total number of staff (r = 0.3031; alpha < 0.05) and the total number of untrained staff (Assistants in nursing) (0.2885; alpha < 0.05), suggesting that these factors had little predictive influence on physical restraint use. The extent that physical restraints are being used in nursing homes in Victoria is high, particularly in the context of a general view in the literature that their use should be minimised, if not avoided entirely.

Accidental Falls↗
PubMed2001

Cause-specific prevalence of bilateral visual impairment in Victoria, Australia: the Visual Impairment Project.

PURPOSE: To study the cause-specific prevalence of eye diseases causing bilateral visual impairment in Australian adults. DESIGN: Two-site, population-based cross-sectional study. PARTICIPANTS: Participants were aged 40 years and older and resident in their homes at the time of recruitment for the study. The study was conducted during 1992 through 1996. METHODS: The study uses a cluster stratified random sample of 4744 participants from two cohorts, urban, and rural Victoria. Participants completed a standardized interview and eye examination, including presenting and best-corrected visual acuity, visual fields, and dilated ocular examination. The major cause of vision loss was identified for all participants found to be visually impaired. Population-based prevalence estimates are weighted to reflect the age and gender distribution of the two cohorts in Victoria. MAIN OUTCOME MEASURES: Visual impairment was defined by four levels of severity on the basis of best-corrected visual acuity or visual field: <6/18 > or =6/60 and/or <20 degrees > or =10 degrees radius field, moderate vision impairment; severe vision impairment, <6/60 > or =3/60 and/or <10 degrees > or =5 degrees radius field; and profound vision impairment <3/60 and/or <5 degrees radius field. In addition, less-than-legal driving vision, <6/12 > or =6/18, and/or homonymous hemianopia were defined as mild vision impairment. In Australia, legal blindness includes severe and profound vision impairment. RESULTS: The population-weighted prevalence of diseases causing less-than-legal driving or worse impairment in the better eye was 42.48/1000 (95% confidence interval [CI], 30.11, 54.86). Uncorrected refractive error was the most frequent cause of bilateral vision impairment, 24.68/1000 (95% CI, 16.12, 33.25), followed by age-related macular degeneration (AMD), 3.86/1000 (95% CI, 2.17, 5.55); other retinal diseases, 2.91/1000 (95% CI, 0.74, 5.08); other disorders, 2.80/1000 (95% CI, 1.17, 4.43); cataract, 2.57/1000 (95% CI, 1.38, 3.76); glaucoma, 2.32/1000 (95% CI, 0.72, 3.92); neuro-ophthalmic disorders, 1.80/1000 (95% CI, 0, 4.11); and diabetic retinopathy, 1.53/1000 (95% CI, 0.71, 2.36). The prevalence of legal blindness was 5.30/1000 (95% CI, 3.24, 7.36). Although not significantly different, the causes of legal blindness were uncorrected refractive errors, AMD, glaucoma, other retinal conditions, and other diseases. CONCLUSIONS: Significant reduction of visual impairment may be attained with the application of current knowledge in refractive errors, diabetes mellitus, cataract, and glaucoma. Although easily preventable, uncorrected refractive error remains a major cause of vision impairment.

Adult↗
PubMed2001

Heroin-related deaths in Victoria: a review of cases for 1997 and 1998.

The objectives of this paper were to determine the number of heroin-related deaths in Victoria for the years 1997-1998 and to detail the demography and toxicology findings, and also compare heroin death rates for this decade. The number of deaths attributed to the intravenous use of heroin has increased dramatically in Victoria since 1990. The increases were 5-fold. There were 166 deaths in 1997 and 268 in 1998. The heroin death is typified by a median age of 30 for males and 29 for females, although the age range is from children as young as 15 to adults in their sixth decade of life. Over 85% of cases were using other central nervous system depressants, with benzodiazepines (45%) and alcohol (36%) being the most common. Approximately 60% occurred indoors at a private residence, the remainder occurred in public places and other locations. A similar number (60%) died alone. A wide distribution of deaths occurred throughout the metropolitan and regional areas showing a growing spread in the heroin problem in the community.

Adolescent↗
PubMed2002

Increase in meningococcal disease associated with the emergence of a novel ST-11 variant of serogroup C Neisseria meningitidis in Victoria, Australia, 1999-2000.

In the years 1999-2000, there was an increase in the incidence of meningococcal disease in Victoria, largely caused by Neisseria meningitidis serogroup C. This change was associated with a shift in age distribution of cases, with relatively more disease appearing in the 15-29 year age group, and with 40/58 serogroup C isolates in 2000 exhibiting a new macrorestriction pattern (pattern A). Thirty-four of 52 pattern A isolates tested displayed the novel phenotype C:2a:P1.4, and were consistently porA VR type P1.7-2,4 by DNA sequencing. Nine of 10 representative pattern A isolates analysed displayed a housekeeping gene allele profile (ST-11) that is characteristic of the electrophoretic type (ET)-15 variant that has caused outbreaks in Canada, the Czech Republic and Greece. Meningococci belonging to the ST-11 complex that were isolated in Victoria prior to 1999 did not display either restriction pattern A or PorA VR type P1.7-2,4.

Adolescent↗
PubMed2001

HIV seroconverters: using surveillance to characterise people with incident HIV infection in Victoria, Australia.

This paper describes a cohort of people living in Victoria, Australia, diagnosed with incident HIV infection and identified through routine HIV surveillance. All HIV diagnoses notified to the Victorian HIV Registry between January 1997 and September 1998 were included. Infections were classified as incident if there was a prior negative test and/or seroconversion illness within 12 months of the first positive HIV test. During the study period there were 277 notifications received of which 70 (25%) were incident infections (seroconversions). People with incident infection were aged 36 years (+/- 10), from an Anglo background (76%) and living in Melbourne (91%). Seroconverters were more likely to have acquired their infection in Victoria (76%), through male-to-male sexual contact (86%), and from casual or anonymous partners (67%). Cohorts of individuals with incident HIV infection provide a valuable resource for understanding the dynamics of HIV acquisition and natural history of the infection.

Adult↗
PubMed2000

The current scope and future direction of perioperative nursing practice in Victoria, Australia.

The current scope and future direction of perioperative nursing practice in Victoria, Australia Unlike some overseas countries, perioperative nursing roles in Australia are largely undeveloped, and very little research has explored the opinions of perioperative nurses regarding the development of their specialty. This study was undertaken to identify the current scope, possible future directions, and the barriers to developing perioperative nursing practice in the state of Victoria (Australia). The study design was descriptive and utilized survey methodology. An instrument was constructed by the researcher for the specific purposes of the study, and comprised three stages of development: questionnaire development; validation by a panel of experts; and a pilot study. The questionnaire was sent randomly to selected perioperative nurses (n=224) and a response rate of 79% (n=176) was obtained. Data were analysed using the Statistical Package for the Social Sciences (SPSS). Descriptive statistics were used to summarize data, and independent sample t-tests, one-way ANOVA and Wilcoxon signed rank tests were used to test differences between groups. For the purpose of data reduction factor analysis was undertaken. The findings of the study indicated that the perioperative nursing model in its espoused form is not being practised, but a large majority of participants believe that perioperative nursing practice should not be restricted to the intraoperative phase of the perioperative model. Expanded rather than extended activities and functions were perceived as more important for development of the specialty, and perceived barriers to advanced perioperative nursing practice centred predominantly on the current application of the perioperative model. Recommendations include refinement of the perioperative nursing model to reflect changes in the delivery of healthcare, addressing issues of cost associated with further education, and undertaking interpretive research to provide more detailed information on the possible future direction for perioperative nursing.

Adult↗
PubMed2001

Comprehensive nursing education in Victoria: rhetoric or reality?

Significant and widespread changes to the education of the psychiatric nursing workforce in Victoria, Australia are resulting in serious problems in the recruitment of new nursing staff. In reviewing the available literature, it is evident that undergraduate nursing students do not commence their educational program with a strong interest in pursuing a career in psychiatric nursing. In light of this knowledge, the role of education in providing a comprehensive view of the nursing profession becomes paramount. Research investigating the impact of education on the attitudes of students to psychiatric nursing as a career option has produced mixed and often inconclusive results. A longitudinal study was undertaken in Victoria, Australia. Students of the majority of universities in which undergraduate nursing programs were operating participated in this study. The participants were asked to rank nine areas of nursing specialty in order of preference at the commencement and immediately prior to the completion of the nursing program. Despite a significant improvement in the popularity of psychiatric nursing as a career choice, this area was ranked at number 8 at both pre- and post-program test. The analysis of open-ended questions demonstrated a marked change in the overall attitudes towards the mentally ill and psychiatric nursing.

Career Choice↗