Research

Increased awareness of the risks for all who swim and dive can prevent this type of death

Richard C Franklin · Amy E Peden · John H Pearn

None of the five cricket-related deaths over the past 30 years were caused by head injuries

Peter Brukner · Thomas J Gara · Lauren V Fortington

Smoking rates in the Busselton community have declined and lung function has improved over the past 50 years

Arthur (Bill) Musk · Michael Hunter · Jennie Hui · Matthew W Knuiman · Mark Divitini · John P Beilby · Alan James

Recognising early the potential causes of angioedema is important for averting fatal outcomes

Raymond J Mullins · Brynn K Wainstein · Elizabeth H Barnes · Dianne E Campbell

Objectives: To estimate the efficacy of selection tools employed by medical schools for predicting the binary outcomes of completing or not completing medical training and passing or failing a key examination; to investigate the potential usefulness of selection algorithms that do not allow low scores on one tool to be compensated by higher scores on other tools. Design, setting and participants: Data from four consecutive cohorts of students (3378 students, enrolled 2007–2010) in five undergraduate medical schools in Australia and New Zealand were analysed. Predictor variables were student scores on selection tools: prior academic achievement, Undergraduate Medicine and Health Sciences Admission Test (UMAT), and selection interview. Outcome variables were graduation from the program in a timely fashion, or passing the final clinical skills assessment at the first attempt. Main outcome measures: Optimal selection cut-scores determined by discriminant function analysis for each selection tool at each school; efficacy of different selection algorithms for predicting student outcomes. Results: For both outcomes, the cut-scores for prior academic achievement had the greatest predictive value, with medium to very large effect sizes (0.44–1.22) at all five schools. UMAT scores and selection interviews had smaller effect sizes (0.00–0.60). Meeting one or more cut-scores was associated with a significantly greater likelihood of timely graduation in some schools but not in others. Conclusions: An optimal cut-score can be estimated for a selection tool used for predicting an important program outcome. A “sufficient evidence” selection algorithm, founded on a non-compensatory model, is feasible, and may be useful for some schools.

Boaz Shulruf · Warwick Bagg · Mathew Begun · Margaret Hay · Irene Lichtwark · Allison Turnock · Emma Warnecke · Timothy J Wilkinson · Phillippa J Poole

High rates of substance use and mental disorder among homeless people in inner Sydney confirms the need for increased access to treatment for these conditions in this setting

Olav B Nielssen · William Stone · Naidene M Jones · Sarah Challis · Amelia Nielssen · Gordon Elliott · Nicholas Burns · Astrid Rogoz · Lucy E Cooper · Matthew M Large

Objectives: To describe the retail availability of tobacco and to examine the association between tobacco outlet density and area-level remoteness and socio-economic status classification in Tasmania. Design: Ecological cross-sectional study; analysis of tobacco retail outlet data collected by the Department of Health and Human Services (Tasmania) according to area-level (Statistical Areas Level 2) remoteness (defined by the Remoteness Structure of the Australian Statistical Geographical Standard) and socio-economic status (defined by the 2011 Australian Bureau of Statistics Index of Relative Socioeconomic Advantage and Disadvantage). Main outcome measure: Tobacco retail outlet density per 1000 residents. Results: On 31 December 2016, there were 1.54 tobacco retail outlets per 1000 persons. The density of outlets was 79% greater in suburbs or towns in outer regional, remote and very remote Tasmania than in inner regional Tasmania (rate ratio [RR], 1.79; 95% confidence Interval [CI], 1.29–2.50; P < 0.001). Suburbs or towns in Tasmania with the greatest socio-economic disadvantage had more than twice the number of tobacco outlets per 1000 people as areas of least disadvantage (RR, 2.30; 95% CI, 1.32–4.21; P = 0.014). Conclusions: A disproportionate concentration of tobacco retail outlets in regional and remote Tasmania and in areas of lowest socio-economic status is evident. Our findings are consistent with those of analyses in New South Wales and Western Australia. Progressive tobacco retail restrictions have been proposed as the next frontier in tobacco control. However, the intended and unintended consequences of such policies need to be investigated, particularly for socio-economically deprived and rural areas.

Shannon M Melody · Veronica Martin-Gall · Ben Harding · Mark GK Veitch

Numbers of violence-related orbital fractures and fractures requiring surgery are lower, saving an estimated $464 000

Ryan F Holmes · Thomas Lung · Gordian WO Fulde · Clare L Fraser

Additional health care, particularly for chronic diseases, is provided at most GP administrative encounters

Lyndal J Trevena · Christopher Harrison · Helena C Britt

Ongoing monitoring of population iodine nutrition is needed to prevent a return to iodine deficiency

Kristen L Hynes · Judy A Seal · Petr Otahal · Monique A Reardon · John R Burgess

Objective: To examine the prevalence across 25 years of overweight and obesity among nulliparous Australian women during early pregnancy; to estimate the proportions of adverse perinatal outcomes attributable to overweight and obesity in this population. Design: Cohort study; retrospective analysis of electronic maternity data. Setting, participants: 42 582 nulliparous women with singleton pregnancies giving birth at the Royal Prince Alfred Hospital, an urban teaching hospital in Sydney, January 1990 – December 2014. Main outcome measures: Maternal body mass index (BMI), socio-demographic characteristics, and selected maternal, birth and neonatal outcomes; the proportion of adverse perinatal outcomes that could be averted by reducing the prevalence of overweight and obesity in women prior to first pregnancies (population attributable fraction, PAF). Results: The prevalence of overweight among nulliparous pregnant women increased from 12.7% (1990–1994) to 16.4% (2010–2014); the prevalence of obesity rose from 4.8% to 7.3% in the same period, while the proportion with normal range BMIs fell from 73.5% to 68.2%. The PAFs for key adverse maternal and neonatal outcomes increased across the study period; during 2010–2014, 23.8% of pre-eclampsia, 23.4% of fetal macrosomia, and 17.0% of gestational diabetes were attributable to overweight and obesity. Were overweight and obese women to have moved down one BMI category during 2010–2014, 19% of pre-eclampsia, 15.9% of macrosomia, 14.2% of gestational diabetes, 8.5% of caesarean deliveries, 7.1% of low for gestational age birthweight, 6.8% of post partum haemorrhage, 6.5% of admissions to special care nursery, 5.8% of prematurity, and 3.8% of fetal abnormality could have been averted. Conclusions: Over the past 25 years, the proportions of adverse perinatal outcomes attributable to overweight and obesity have risen with the increasing prevalence of maternal overweight and obesity. A substantial proportion of these outcomes might be averted with obesity prevention strategies that reduce pre-pregnancy maternal weight.

Kate Cheney · Rachel Farber · Alexandra L Barratt · Kevin McGeechan · Bradley de Vries · Robert Ogle · Kirsten I Black

The rates of surgical intervention are rising, but the evidence for benefit is limited

Vishal Kapoor · Pamela S Douglas · Peter S Hill · Laurence J Walsh · Marc Tennant

Some patients may derive greater benefit from such a program than from health education and positive attention

Richard L Reed · Leigh Roeger · Sara Howard · Jodie M Oliver-Baxter · Malcolm W Battersby · Malcolm Bond · Richard H Osborne

NOACs could improve the convenience of anticoagulation therapy for patients in remote locations

Jamie W Bellinge · Jarrad J Paul · Liam S Walsh · Lokesh Garg · Gerald F Watts · Carl Schultz

Appropriate models of care are needed to manage the multiple comorbidities of breast cancer survivors

Huah Shin Ng · Bogda Koczwara · David M Roder · Theo Niyonsenga · Agnes I Vitry

Objectives: To review the accuracy of diagnoses of chronic obstructive pulmonary disease (COPD) in primary care in Australia, and to describe smokers’ experiences with and preferences for smoking cessation. Design, setting and participants: Patients were invited to participate if they were at least 40 years old and had visited participating general practice clinics in Melbourne at least twice during the previous 12 months, reported being current or ex-smokers with a smoking history of at least 10 pack-years, or were being managed for COPD. Interviews based on a structured questionnaire and case finding (FEV1/FEV6 measurement) were followed, when appropriate, by spirometry testing and assessment of health-related quality of life, dyspnoea and symptoms. Results: 1050 patients attended baseline interviews (February 2015 – April 2017) at 41 practices. Of 245 participants managed for COPD, 130 (53.1%) met the spirometry-based definition (post-bronchodilator FEV1/FVC < 0.7) or had a clinical correlation; in 37% of cases COPD was not confirmed, and no definitive result was obtained for 9.8% of patients. Case finding and subsequent spirometry testing identified 142 new COPD cases (17.6% of participants without prior diagnosis; 95% CI, 15.1–20.5%). 690 participants (65.7%) were current smokers, of whom 360 had attempted quitting during the previous 12 months; 286 (81.0% of those attempting to quit) reported difficulties during previous quit attempts. Nicotine replacement therapy (205, 57.4%) and varenicline (110, 30.8%) were the most frequently employed pharmacological treatments; side effects were common. Hypnotherapy was the most popular non-pharmacological option (62 smokers, 17%); e-cigarettes were tried by 38 (11%). 187 current smokers (27.6%) would consider using e-cigarettes in future attempts to quit. Conclusions: COPD was both misdiagnosed and missed. Case finding and effective use of spirometry testing could improve diagnosis. Side effects of smoking cessation medications and difficulties during attempts to quit smoking are common. Health professionals should emphasise evidence-based treatments, and closely monitor quitting difficulties and side effects of cessation aids. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12614001155684.

Jenifer Liang · Michael J Abramson · Nicholas A Zwar · Grant M Russell · Anne E Holland · Billie Bonevski · Ajay Mahal · Kirsten Phillips · Paula Eustace · Eldho Paul · Sally Wilson · Johnson George

Current recommendations to titrate oxygen administration are confirmed

Janine Pilcher · Michael Richards · Leonie Eastlake · Steven J McKinstry · George Bardsley · Sarah Jefferies · Irene Braithwaite · Mark Weatherall · Richard Beasley

Sensitivity to rye grass may predict susceptibility to thunderstorm-related asthma

Michael F Sutherland · Emma Le Portelli · Allison L Collins · Muhammad Aziz Rahman · Christine F McDonald

Priorities include all children aged 2 months–5 years, Indigenous children under 10, and adolescents (15–19 years)

on behalf of the Australian Technical Advisory Group on Immunisation (ATAGI) Meningococcal Working Party

Other factors, particularly rainfall patterns, play more significant roles

James D Stewart · Simon Smith · Josh Hanson

The burden of severe herpes zoster among Indigenous Australians in their 60s is higher than for non-Indigenous Australians

Meru Sheel · Frank H Beard · Aditi Dey · Kristine Macartney · Peter B McIntyre

As the epidemiology of MRSA changes, so must strategies for containing it

Jason W Agostino · John K Ferguson · Keith Eastwood · Martyn D Kirk

Public health campaigns should emphasise the detection of suspicious de novo lesions, as well as of changing lesions

Yan Pan* · Nikki R Adler* · Rory Wolfe · Catriona A McLean · John W Kelly