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PubMed2005

Improving HIV surveillance in Victoria: the role of the "detuned" enzyme immunoassay.

Between 1999 and 2000, new diagnoses of HIV in Victoria (Australia) rose by 41%, from 140 to 197. In this time period, sera from new HIV diagnoses were tested using the Organon Teknika "detuned" enzyme immunoassay (EIA). We compared the results of the detuned EIA with incident infections defined by surveillance (on the basis of a previous negative or indeterminate HIV test and/or a seroconversion illness within the 12 months preceding HIV diagnosis). Of 317 specimens, 97 (31%) incident infections and 114 (36%) recent infections were detected using surveillance and detuned EIA, respectively. The detuned assay misclassified 11 cases with AIDS and 2 cases with CD4 counts < or = 200 micro3 (probable long-standing infections) as recent infections and was unable to identify 31 (32%) of 97 cases previously classified as incident cases by surveillance. The assay detected an extra 35 recent infections that were previously classified as nonincident by surveillance. By combining the detuned assay and surveillance, 132 (42%) incident infections were identified from 317 specimens, 36% more than surveillance alone. We recommend that a detuned assay or similar test become part of the routine strategy to identify incident infections in Victoria. Incident infections provide important information for targeting prevention strategies and the opportunity to interrupt ongoing viral transmission.

Adolescent↗
PubMed2005

Do health and medical workforce shortages explain the lower rate of rural consumers' complaints to Victoria's Health Services Commissioner?

OBJECTIVE: To identify which explanations account for lower rural rates of complaint about health services--(i) fear of consequences where there is little choice of alternative provider; (ii) a higher complaint threshold for rural consumers; (iii) lack of access to complaint mechanisms; or (iv) reduced access to services about which to complain. DESIGN: Ecological study incorporating consumer complaint, population and workforce distribution data sources. SETTING: All health care providers practising in Victoria. PARTICIPANTS: De-identified records of all closed consumer complaints made to the Health Services Commissioner, Victoria, between March 1988 and April 2001 by Victorian residents (13 856 records). MAIN OUTCOME MEASURES: Differences in the percentage of under-representation in complaint rates in total and for each of four categories of health services providers for different size communities. RESULTS: No consistent relationship was observed between community size and either degree of under-representation of complaints against any category of provider, or the proportion of serious or substantial complaints. Rural under-representation was highest (41%) for dentists, the provider category with the lowest proportion working in rural areas (17%), and lowest (18%) for hospitals, with the highest representation in rural areas (28% of beds). More rural complaints were about access issues (10.7% rural and 8.4% metropolitan). CONCLUSIONS: Reduced opportunity to use health services due to rural health and medical workforce shortages was the best-supported explanation for the lower rural complaint rate. Workforce shortages impact on the quality of rural health services and on residents' opportunities to improve their health status.

Health Services Accessibility↗
PubMed1989

Process evaluation of the bassinet restraint loan scheme in Victoria.

The value of the use of safety restraints for all vehicle occupants has been recognized, and corresponding legislation has been implemented in Australia. However, legislation alone has not been sufficient to increase significantly the use of safety restraints for infants. In an attempt to address this issue, a statewide infant safety restraint loan scheme has been in operation in Victoria since May 1985. At the time of this study, 203 of 210 municipalities in Victoria were participating in the scheme. An operational evaluation of the Bassinet Loan Scheme (BLS) was undertaken after 18 months of operation. Questionnaires were completed by 426 parents attending selected maternal and child health centres. The questionnaire was designed to provide information about the use of safety restraint for infants aged 0-6 months, parental attitudes towards the restraint, and sociodemographic characteristics. The study demonstrated that 81% of the population surveyed used the infant safety restraint, but only 52% were in the BLS. The pattern of usage of safety restraints for infants was related to maternal age and educational level.

Accidents, Traffic↗
PubMed2004

Head lice prevalence in primary schools in Victoria, Australia.

OBJECTIVES: To determine the prevalence of and assess risk factors associated with head lice infections (pediculosis) in children from government primary schools in Victoria, Australia. METHODS: Between May and October 2001, children were selected by clustered random sampling of schools and classes, then examined for head lice using hair conditioner and a fine-toothed head lice comb. There were 1838 children screened from 16 primary schools. Risk factors evaluated included metropolitan or rural residence, school class, gender and hair length. RESULTS: Thirteen percent of children (239/1838) had an active infection (95% CI, 10.9-15.1) and 3.3% (61/1838) had an inactive infection (95% CI, 2.0-4.6). Prevalence of active pediculosis varied between schools from 0 to 28%. Our screening identified no more than one case per class in the majority of classes screened (58.5%). Females were 2.2 times more likely to have active infection than males (95% CI [1.7,2.9]) and there was no significant difference for the other risk factors investigated. CONCLUSIONS: Our study demonstrated the prevalence of head lice varied across Victoria and showed that risk factors commonly attributed to head lice infections did not hold true. Our findings support the premise that traditional ad hoc mass school-based screening may not be the best use of resources when controlling head lice. We suggest a more pragmatic community-based approach.

Adolescent↗
PubMed2005

Nursing and care for the aged in Victoria: 1950s to 1970s.

In the state of Victoria, Australia in the late 1950s and early 1960s, restorative treatment was introduced into the state-subsidized benevolent homes, and they were reclassified as geriatric hospitals. In the process, the nursing care of incapacitated old people was identified in terms of particular skills and knowledge, and specific forms of training were established for nurses at two levels of training: nurses' aides and supervisory nurses with a post-basic qualification. These institutional changes were complemented by the introduction of a nursing role into the body responsible for overseeing care for the aged in Victoria. Little was made of this opportunity to establish a leading role for nurses in the field of care for the aged. However, this episode raises fertile questions for further research into the development of nursing in Australia, as a set of practices divided along the lines of acute and chronic illness.

Aged↗
PubMed1998

Pterygium surgery in Victoria: a survey of ophthalmologists.

AIM: To determine the surgical approaches and adjunctive therapy es currently used by Victorian ophthalmologists for the treatment of primary and recurrent pterygia. METHOD: Ophthalmologists practising in Victoria were asked to complete a written survey relating to their experience with pterygium surgery. RESULTS: Responses were received from 142 of 165 ophthalmologists surveyed (86%). Of these, 107 (75%) had performed at least one pterygium operation during the preceding 2 years. Excision followed by beta irradiation was the most commonly performed procedure for both primary (57%) and recurrent (35%) pterygia. The next most commonly performed procedure for primary pterygia was excision leaving bare sclera (15%) and, for recurrent pterygia, excision with autologous conjunctival transplantation (26%). Considerable variation was observed in surgical technique, choice of adjunctive therapy, postoperative care and in the surgeons' estimates of the frequency of major complications. CONCLUSION: Although there is little consensus regarding the surgical management of pterygium, beta irradiation remains the most commonly used adjunctive therapy in Victoria.

Chemotherapy, Adjuvant↗
PubMed2004

Retinoblastoma in Victoria, 1976-2000: changing management trends and outcomes.

PURPOSE: To describe changes in the management of retinoblastoma in Victoria and to review the effect of newer, conservative treatments on preservation of eyes, visual outcome and mortality by comparing a similar group of patients treated over successive time intervals. METHODS: A retrospective analysis of all cases of retinoblastoma diagnosed and treated in Victoria between 1956 and 2000 was conducted. Historical data on 77 cases previously published by O'Day et al. was used for the period 1956-1976 (series 1). Data on 88 cases recorded in the Royal Children's Hospital (Melbourne) Retinoblastoma Database was used for the period 1976-2000. The latter group was subdivided into those treated between 1976 and 1989 (series 2), prior to the advent of modern eye saving treatments, and those treated subsequent to their introduction from 1990 to 2000 (series 3). RESULTS: In unilateral retinoblastoma, final enucleation rates for 1956-1976 (series 1) and 1976-1989 (series 2) were almost identical, being 98% and 97% of affected eyes, respectively (P = 1.00). Despite the newer treatments used after 1990 (series 3), 88% of affected eyes were still enucleated, representing a statistically similar outcome to series 2 (P = 0.33). In bilateral retinoblastoma, primary enucleation of the more involved eye was similar for series 1 (84%) and 2 (80%) but series 3 (41%) was substantially less than series 2 (P = 0.04) following the increased use of conservative treatments. In series 3, 59% of more involved eyes were treated conservatively compared with 16% (P = 0.007) and 20% (P = 0.04) for series 1 and 2, respectively. Despite attempts at eye salvage, the failure rate was higher in series 3 (29%) yielding a final enucleation rate of 70%, which represented a modest downward trend in the numbers of eyes finally enucleated; 84% (series 1), 73% (series 2) and 70% (series 3) (test for trend, P = 0.33). Bilateral enucleation rates were significantly lower, from 36% and 30% in series 1 and 2, respectively, to 7% in series 3 (test for trend, P = 0.02). As a consequence, more eyes were preserved over time, being 20/50 (40%) in series 1, 15/30 (50%) in series 2 and 21/34 (62%) in series 3. Comparison of visual outcome was hampered by incomplete data in series 1 but it appeared series 2 and 3 achieved better visual acuities with 67% and 62% of preserved eyes in bilateral cases measuring equal to or better than 6/12. Mortality rates in all series were low, being 7.8% in series 1, 4.5% in series 2 and nil in series 3. CONCLUSIONS: Following the introduction of new conservative treatments, there has been an increase in preservation of eyes and improved visual outcome, and a dramatic decrease in numbers of bilateral enucleations without adversely affecting survival.

Antineoplastic Agents↗
PubMed2005

Gender differences in the utilisation of optometric services in Victoria.

Medicare and population data demonstrate clear gender differences in utilisation of health services. There are three broad hypotheses that may explain different utilisation rates of health services by gender: differences in access, differences in incidence and differences in attitudes in seeking health care between the genders. Men are 28 per cent less likely than women to see an optometrist in Victoria. Both women's and men's utilisation of optometric services in Victoria increase with age but there are clear gender differences apparent at every stage of life after childhood. These utilisation rates between genders are tested against incidence rates between genders for eye conditions. There are few noted gender differences apparent in the incidence or prevalence of ocular conditions. The data on the incidence of health conditions often has limitations, either in measurement tools or in differences in incidence between genders. These limitations are not as evident in eye care incidence data. Access and incidence differences do not adequately explain the differences in optometric service utilisation rates. This promotes the hypothesis that attitudinal differences in seeking health care between men and women are significant.

Adolescent↗
PubMed1996

Colorectal resection in Victoria:a comparison of hospital based and individual audit.

BACKGROUND: The results of personal audit have not been tested against a hospital-based audit previously and the results of two such audits of colorectal resection in the State of Victoria have provided this opportunity. In addition, data reflecting the results of colorectal resection across a range of hospitals and surgeons in the Victorian community have been obtained. METHODS: A total of 535 patients undergoing a colorectal resection, with an anastomosis performed, were studied in two serially conducted prospective audits arranged by the Standards Sub-Committee of the Victorian State Committee. One study was public hospital-based and the second was based on voluntary reporting by individual surgeons. RESULTS: Similar results were obtained in each study, demonstrating the accuracy of individual reporting. The combined results (wound infection rate 12.3%, anastomotic leak rate 3.7% and mortality 4.5%) are compared to previously published data. CONCLUSIONS: In the State of Victoria the results of audit by individual surgeons performing colorectal resection were similar to the hospital-based audit. The results obtained compare favourably with previously published data.

Aged↗
PubMed1996

Incidence trends in oesophageal and proximal gastric carcinoma in Victoria.

BACKGROUND: There is clinical evidence that adenocarcinoma of the lower oesophagus is increasing in the Australian society. The population-based cancer registry of Victoria was used to describe the incidence of adenocarcinoma of the oesophagus and gastric cardia. METHODS: Data were obtained from 1982 to 1991 and were analysed using the Poisson regression techniques. RESULTS: In men, a statistically significant annual increase of 9.5% in oesophageal adenocarcinoma and a non-significant increase of 1.6% in adenocarcinoma of the gastric cardia was observed. These increases were balanced by decreases in other histological types found in the oesophagus in men resulting in little change in the overall rate. No significant trends by age or histological type were observed in women. CONCLUSIONS: There is evidence for a rise in adenocarcinoma in men in Victoria. Possible risk factors include Barrett's oesophagus.

Adenocarcinoma↗
PubMed2006

Management of muscle-invasive bladder cancer in Victoria, 1990-1995.

BACKGROUND: The management and outcomes of muscle-invasive bladder cancer are described in this article. METHODS: A retrospective survey of medical practitioners involved in the management of bladder cancer was conducted. The survey obtained at least 5 years of follow-up data on all patients. The sample was taken from the public and private health sectors in Victoria. All were cases of muscle-invasive bladder cancer diagnosed between 1990 and 1995. The main outcome measures included reported management by staging, treatment and survival. RESULTS: Completed questionnaires were returned for 743 (89.6%) of 829 cases. Of these, 523 (70.4%) were men, and the mean age was 72.7 years. More than 75% of the cases (560) presented with macroscopic haematuria. The majority (696, 94%) had transitional cell carcinoma. A variety of treatments were given in various sequences, with 231 cases (31.1%) having initial surveillance. Eventually, 303 cases (40.8%) proceeded to 'definitive' management with either radiotherapy (132, 17.8%) or cystectomy (171, 23.0%). In addition, chemotherapy was given to 254 patients (34.2%) at some time. Most patients (613, 82.5%) have subsequently died; 402 (54%) died from bladder cancer. Crude 5-year survival was 13.0%, and disease-specific survival was 27.7%. Multivariate analysis identified the following predictors of greater disease-specific survival: grade 1 or 2 histopathology (P = 0.0003), T2 primary (P < 0.0001), N0 disease (P = 0.04), M0 disease (P < 0.0001), radiation dose in BED(10) >70 Gy and cystectomy (P < 0.0001). CONCLUSION: Muscle-invasive bladder cancer in Victoria typically occurs in elderly patients, and a notable proportion of these patients do not proceed onto 'definitive' treatment. Disease stage, cystectomy and the use of high doses of radiation are associated with better outcomes. Chemotherapy was given to approximately one-third of patients at some point in their disease management. Our data are similar to population-based data from North America, and provide a baseline against which potential changes in management of bladder cancer can be compared.

Adult↗
PubMed2006

Urban-rural differences in the management of screen-detected invasive breast cancer and ductal carcinoma in situ in victoria.

BACKGROUND: At least one-third of primary breast cancers in Australia are discovered by population-based mammographic screening. The aim of this study was to determine whether there were any differences in the surgical treatment of women diagnosed with breast cancer by BreastScreen Victoria between urban and rural populations and to investigate temporal changes in their pattern of care. METHODS: An analysis of women diagnosed with breast cancer (invasive and non-invasive) by BreastScreen Victoria from 1993 to 2000 was conducted. Descriptive analyses of the proportion of women undergoing each surgical treatment type over time were carried out. Logistic regression was used to assess the effect of urban-rural residence on each treatment outcome while accounting for possible confounding factors. RESULTS: Rural women with invasive breast cancer were less likely to undergo breast-conserving surgery (BCS) compared with urban women (odds ratio, 0.42; 95% confidence interval, 0.35-0.50). The same was also true for rural women with ductal carcinoma in situ (odds ratio, 0.53; 95% confidence interval, 0.29-0.96). This difference was independent of patient and tumour characteristics, including tumour size, surgeon caseload, patient's age and socioeconomic status. It also persisted over time despite a steady overall increase in use of BCS for both invasive and non-invasive cancers over the study period. CONCLUSIONS: Among Victorian women with screen-detected breast cancer, urban women consistently had higher rates of BCS compared with rural women despite increased overall adoption of BCS. Reasons for this disparity are still unclear and warrant further investigation.

Adult↗
PubMed1996

Who works in the sex industry? A profile of female prostitutes in Victoria.

A large-scale survey was conducted to obtain a comprehensive picture of the range of women involved in prostitution in Victoria and to document their concerns about health in relation to sex work. There was considerable diversity in the ages, education levels, family situations and attitudes to sex work among women working mainly in the legal brothels in Victoria. While their practices in client-worker interactions were low-risk for human immunodeficiency virus and other sexually transmitted diseases, many of the women were more at risk from unprotected sex with private partners and some were more at risk from injecting drug use. Most women reported economic reasons for entering the sex industry and cited problems associated with male clients as the worst aspects. Effective health interventions should be devised and aimed at specific sub-populations of these (and other) sex workers.

Adult↗
PubMed1998

HIV positive tests at Coronial Services in Victoria 1989-1996: lessons for HIV surveillance.

Results of routine testing at other sites can supplement surveillance of the HIV epidemic in Australia which is largely based upon voluntary testing. Since 1989, systematic onsite HIV testing has been undertaken on all bodies taken to the Victorian Institute of Forensic Medicine (VIFM). Information was collected on all cases of HIV infection detected at VIFM between 1989 and 1996, and matched to surveillance databases. In 8 years, 75 people were diagnosed with HIV; all except one were male. The age range was 14-70 years, mean 37.4 years. The major causes of death were suicide 35%, AIDS 21%, drug toxicity 16%, natural causes 12% and injury 7%. The major exposure categories were male homosexual 51%, male bisexual 11%, homosexual/bisexual IDU 16%, IDU other 8%, and haemophiliac 7%. For only two was exposure information unavailable. Seropositivity for anti-HCV and HBsAg was 37% and 11% respectively. The deceased was recorded as having HIV/AIDS on the police report in 73% of cases, and at least 90% of subjects had been diagnosed with HIV prior to their death. The study suggests there is relatively little undiagnosed HIV infection in Victoria, that HIV infection has not moved outside traditional risk groups, and that many tests for HIV are undertaken using false namecodes. Many patients could not be matched on the HIV/AIDS databases, identifying a problem with HIV surveillance systems in Victoria, and the need to capture all information on HIV positives detected at VIFM.

AIDS Serodiagnosis↗
PubMed1999

Associations between alcohol related hospital admissions and alcohol consumption in Victoria: influence of socio-demographic factors.

OBJECTIVE: To examine the cross-sectional ecologic associations between apparent per-capita alcohol consumption, alcohol-related hospital admission rates, and the distributions of socio-demographic factors for people residing in 76 Local Government Areas (LGAs) in Victoria, during the 1995-1996 fiscal year. METHOD: Visitor-adjusted per-capita alcohol consumption was obtained from wholesale sales data from the Liquor Licensing Commission Victoria. Alcohol-related hospital admission rates were extracted from the Victorian Inpatient Minimum Dataset, and adjusted by the appropriate aetiologic fractions. Summary socio-demographic measures were derived from the 1996 Census. Their associations were analysed using multiple linear regression. RESULTS: Per-capita alcohol consumption ranged from 4 to 14 litres absolute alcohol/year and alcohol-related hospital admission rates ranged from 5 to 25 per 10,000 residents/year (external-cause diagnoses) and 8-37 per 10,000 residents/year (disease diagnoses). Higher levels of per-capita consumption were associated with higher admission rates (r = 0.45 for external cause diagnoses, r = 0.66 for disease diagnoses, and r = 0.70 for all diagnoses), each per-capita increase of one litre/year corresponding to increased admission rates of 0.6, 1.5 and 2.1 per 10,000 person-years, respectively. Further adjustments by summary socio-demographic measures reduced, but did not modify, the associations between per-capita consumption and admission rates. CONCLUSIONS AND IMPLICATIONS: Summary measures of sales-based per-capita alcohol consumption and socio-demographic environments may provide useful indicators of alcohol-related morbidity in Victorian communities.

Alcohol Drinking↗
PubMed2000

Injury hospitalisation rates in Victoria, 1987-97: trends, age and gender patterns.

OBJECTIVE: To estimate the injury hospitalisation trends and the age and gender patterns in Victoria between 1987/88 and 1996/97. METHOD: The Victorian Injury Surveillance System maintains a collection of injury hospitalisation records in Victoria. We used loglinear models for rates to estimate the temporal trends and patterns by age group and gender of all-injury and cause-specific injury hospitalisation rates. RESULTS: The all-injury hospitalisation rate appeared stable until 1992/93, after which it increased substantially (1993/94 was 1.13 times that of 1987/88). While motor vehicle crash and fire/burn/scald injury hospitalisation rates decreased substantially, suicide attempt and self-inflicted injury hospitalisation rates more than doubled. The all-injury hospitalisation rate was highest for persons 75 years of age and older. Females had a lower all-injury hospitalisation rate than males up to 60-64 years of age and a higher rate thereafter. The cause-specific injury hospitalisation rates showed various age and gender patterns. CONCLUSION: Substantial increases in the all-injury hospitalisation rate were observed after the introduction of the casemix funding policy to public hospitals. There were remarkable variations in temporal trend and age and gender patterns of injury hospitalisation rates by cause of injury. IMPLICATIONS: Hospitalised injuries generally are serious and incur high cost. Certain injury causes and age and gender groups should receive particular attention for prevention efforts. The use of injury surveillance based on hospitalisation records should be improved and further expanded.

Adolescent↗
PubMed2003

Having a baby in Victoria 1989-2000: women's views of public and private models of care.

OBJECTIVE: To assess and contrast women's views of antenatal, intrapartum and postnatal care based on data collected in three state-wide surveys of recent mothers conducted in 1989, 1994 and 2000. METHODS: Postal surveys were mailed to all women who gave birth in Victoria in one week in 1989, and in two weeks in 1993 and 1999, excluding those who had a stillbirth or neonatal death. Questionnaires were sent to women by hospitals and home birth practitioners 5-8 months after the birth. RESULTS: 58.6% of women participating in the 1989 survey rated their antenatal care as 'very good' compared with 62.4% in 1994 and 66.5% in 2000 (chi 2 for trend = 15.01, p < 0.001). In all three surveys, women enrolled in public models of care were significantly more likely to rate their antenatal care as less than 'very good' than women enrolled in private models of care. More than two-thirds of the women in each survey rated their intrapartum care as 'very good' (1989-67%, 1994-71%, 2000-72%). Over the time period there was an improvement in the proportion of women rating their care as 'very good' among women in private care (chi 2 for trend = 33.1, p < 0.001), but no improvement was seen in public care. Only 52% (1994) and 51% (2000) of women rated their postnatal care as 'very good'. CONCLUSIONS: The conduct of three population-based surveys of recent mothers in Victoria over the past 10 years has provided valuable information for charting the impact of organisational changes on women's views and experiences of maternity care.

Birthing Centers↗
PubMed2003

The pattern of notification and testing for genital Chlamydia trachomatis infection in Victoria, 1998-2000: an ecological analysis.

OBJECTIVE: This ecological study analyses routinely collected chlamydia notification and testing data to investigate any patterns. METHODS: Age and sex-specific chlamydia notification and testing rates for Victoria were calculated for the period 1998 to 2000. RESULTS: Chlamydia notification and testing rates rose between 1998 and 2000. Notification rates were higher among women aged 15 to 24 years than men of the same age (p < 0.01) and higher among 25 to 44-year-olds living in metropolitan rather than rural/regional Victoria (p < 0.01). Testing rates were higher for women than men (p < 0.01) and higher in metropolitan rather than rural/regional areas (p < 0.01) in all groups except women aged 15-24 years. CONCLUSIONS: These increasing rates highlight that chlamydia infection represents a substantial public health problem. IMPLICATIONS: Although these data provide useful information showing these rates vary with age and sex, formal epidemiological prevalence and risk factor studies are required.

Adolescent↗