Research

Objective: To use patient-level data, clinical information and linked Medicare records to assess the distribution of benefits (rebates) across income groups, including benefits relating to chronic conditions such as the Chronic Disease Dental Scheme (CDDS).Design, setting and participants: Nationally representative, cluster-stratified survey (the Australian Hypertension and Absolute Risk Study) involving 322 general practitioners who each collected clinical data on 15–20 patients aged ≥ 55 years ...

Rachel J Knott BEcon(Hons I), BCom · Alan Cass MB BS, FRACP, PhD · Emma L Heeley BSc(Hons), MSc, PhD · John P Chalmers MD, PhD, FRACP · David P Peiris MB BS, PhD, FRACGP · Philip M Clarke BEc, MEc, PhD

New South Wales data from the 45 and Up study indicate that bariatric surgery for severe obesity is largely available to those who can afford private health insurance and associated out-of-pocket costs, with poor access in populations who are most in need.

Rosemary J Korda PhD · Grace Joshy BSc(Mathematics), MSc(Biostatistics), PhD · Louisa R Jorm BVSc, MSc(Epidemiology), PhD · James RG Butler BEcon, MPolEcon, PhD · Emily Banks MB BS(Hons), PhD, FAFPHM

An analysis of administrative data shows rapid increases in both notifications and substantiated cases of maltreatment in the NT Aboriginal population, suggesting a need for further expansion of services to address both immediate safety and the wider determinants of maltreatment.

Steven L Guthridge MB BS, MTH, FAFPHM · Philip Ryan MB BS, FAFPHM · John R Condon PhD, FAFPHM · Leah M Bromfield BAppSci(Psych)(Hons), PhD · John R Moss MSocSci, MB BS, FPHAA · John W Lynch PhD, MPH

Objectives: To assess notification trends for chlamydia and gonorrhoea infections in Indigenous Australians compared with non-Indigenous Australians in 2000–2009.Design and setting: We assessed trends in national notification rates using univariate Poisson regression and summary rate ratios.Main outcome measures: Crude notification rates and summary rate ratios, by Indigenous status, sex, age and area of residence.Results: Over the 10-year ...

Simon Graham BIS, MAppEpi · Rebecca J Guy BAppSc, MAppEpi, PhD · Basil Donovan MB BS, MD · Hamish McManus BEcon, BAcTS, MBIOS · Jiunn-Yih Su MB, MPH · Carol El-Hayek BSc, MEpi · Kellie S H Kwan BA(Hons), GradCertAppEpi · Amalie Dyda BHSc(Hons), MAppEpi · Handan C Wand MA, MSc, PhD · James S Ward BA

A retrospective study of the extent and management of pelvic inflammatory disease in remote-living Aboriginal women reveals that it occurs frequently, but is underdiagnosed and poorly treated.

Bronwyn J Silver BNurs, GradDipMID, MPH · Janet Knox MMed(STD/HIV), DTM · Kirsty S Smith GDipCommNurs, GDipEd, MPH · James S Ward BA · Jacqueline Boyle FRANZCOG, MPH, PhD · Rebecca J Guy BAppSc, MAppEpid, PhD · John Kaldor PhD · Alice R Rumbold BSc(Hons), MPH, PhD

Objectives: To evaluate the outcomes of preconception screening of Jewish Australians for Tay Sachs disease (TSD) carrier status on Jewish TSD-affected births.Design, participants and setting: Epidemiological observational study involving a complete retrospective audit of infantile and intermediate TSD cases diagnosed in Sydney and Melbourne between 1 January 1995 and 31 December 2011 (Royal Children’s Hospital Melbourne; Pacific Laboratory Medicine Services, Pathology North, NSW Health Pathology, Sydney; ...

Raelia M Lew MB BS(Hons) MMed · Anne L Proos MSc, FFSc(RCPA) · Leslie Burnett MB BS, PhD, FRCPA · Martin Delatycki MB BS, FRACP, PhD · Agnes Bankier MB BS, FRACP · Michael J Fietz PhD

Using a multiplatform approach, the authors identify 156 potentially ineffective and/or unsafe services listed on the Australian Medicare Benefits Schedule that warrant further consideration. Reducing the use of existing services that offer little or no benefit relative to the cost of their public subsidy would allow funding to be reallocated to more beneficial or cost-effective services.

Adam G Elshaug MPH, PhD · Amber M Watt MPH · Linda Mundy MPH · Cameron D Willis PhD

Data collected before and after the H1N1 2009 influenza pandemic indicate significant shifts in public threat perception and anticipated response to a future pandemic. The H1N1 2009 pandemic has altered public perceptions of the probability of a pandemic in the future, but has left the public feeling less vulnerable.

Melanie R Taylor BSc(Hons), PhD, CPsychol · Garry J Stevens BSc(Hons), MClinPsych · Kingsley E Agho MSc, MPH, PhD · Sheree A Kable BMed, PhD · Beverley Raphael MB BS, MD, FRANZCP

Non-melanoma skin cancer treatments increased by 86% between 1997 and 2010. The authors anticipate that the number and the total cost without inflation of non-melanoma skin cancer treatments will increase by a further 22% between 2010 and 2015.

Marloes Fransen MB BS · Amalia Karahalios BSc, MPH · Niyati Sharma MB BS · Dallas R English BSc, MSc, PhD · Graham G Giles BSc, MSc, PhD · Rodney D Sinclair MB BS, MD, FACD

Objectives: To measure the frequency and content of electronic handover before and after implementation of the Blue BARRWUE handover system, and to measure its effect on patient safety and hospital efficiency over weekends.Design, setting and participants: Point-prevalence study comparing outcomes for general medical inpatients present over weekends before implementation (1 May 2008 to 30 April 2009) and after implementation (1 May 2009 to 30 April 2010) of ...

Boloor S Rao MB BS, DNB · Gail O Lowe RN, BN, MHA · Andrew J Hughes MB BS, FRACP

H1N1-containing vaccines were not statistically associated with Guillain-Barré syndrome, but this study could not exclude smaller increases in the relative incidence. Active surveillance of adverse events following immunisation is required to maintain public and health care professional confidence in mass vaccine implementation programs.

Nigel W Crawford MB BS, MPH, PhD · Allen Cheng MPH, PhD, FRACP · Nick Andrews MSc · Patrick G Charles MB BS, PhD, FRACP · Hazel J Clothier MAppEpid, MscID, FIBMS · Bruce Day MB BS · Timothy Day MB BS · Peter Gates MB BS · Richard Macdonell MB BS · Les Roberts MB BS · Victoria Rodriguez-Casero MB BS · Tissa Wijeratne MB BS · Lynette Kiers MB BS

Using cases as their own controls potentially provides stronger evidence for analysing adverse events following vaccinationMMaintaining public confidence in vaccines requires having effective postmarketing vaccine safety surveillance systems in place to rapidly address emerging concerns about vaccine safety. However, conducting studies of vaccine safety presents several challenges for traditional observational study designs. Important differences may exist between vaccinated and unvaccinated individuals that could confound the ...

Steven Hawken MSc · Kumanan R Wilson MD

GP referrals had the highest level of appropriateness, and healthdirect- and self-referrals had similar levels of appropriateness. More than half the healthdirect-referred patients attended the ED despite a contrary recommendation, probably due to difficulty accessing after-hours health services.

Joseph Y Ng MB BS, FANZCA · Daniel M Fatovich MB BS, FACEM, PhD · Valendar F Turner MB BS, FRACS, FACEM · Jennifer A Wurmel RN · Sally A Skevington BWS(Hons) · Michael R Phillips BSc(Hons), MMedSci

Together with reports of the decreasing prevalence of smoking among Indigenous people, this first report of a significant reduction in heavy smoking by Indigenous smokers is good news. Reducing smoking intensity and prevalence will lead to fewer deaths and less illness due to smoking. Reducing the number of heavy smokers will also assist smoking cessation among Indigenous people. These changes in smoking intensity occurred before the recent increase in attention to and investment in tobacco control in Indigenous communities, but at a time of significant mainstream anti-tobacco public health activity. Similar trends in smoking intensity have been reported in the total Australian population.

David P Thomas MB BS, PhD, FAFPHM

There is a mismatch between the high proportion of registered trials in advanced colorectal cancer and the areas of priority identified. The development of specific trials in these priority areas depends on the availability of funding and the existence of plausible interventions likely to improve patient outcomes.

Rachel F Dear MB BS, PhD, FRACP · Alexandra L Barratt MB BS, MPH, PhD · Alison Evans PhD · John Simes MD, PhD · John Newsom BA · Dan Kent GDM · Sally Crossing BEc · Catherine Holliday PhD · Eva Segelov MB BS, FRACP, PhD · George Hruby MB ChB · Martin HN Tattersall MD

Objective: To determine whether international medical graduates (IMGs) have more complaints made against them to medical boards and experience more adverse disciplinary findings than Australian-trained doctors.Design and setting: Data on all complaints made against doctors to medical boards in Victoria and Western Australia over 7.5 years and 5.25 years, respectively, were extracted and linked with information on all doctors registered in those states over the ...

Katie Elkin LLB, BSc · Matthew J Spittal PhD, MBio · David M Studdert LLB, ScD, MPH

These data show a sustained and substantial decline in severe rotavirus disease and all-cause AGE since the introduction of rotavirus vaccination, most pronounced in the target age group, but with evidence of herd immunity. The impact of rotavirus vaccination in Indigenous children in hyperendemic settings was less remarkable.

Aditi Dey MB BS, MPH, PhD · Han Wang MStats · Robert Menzies BAppSc, MPH, PhD · Kristine Macartney MB BS, MD, FRACP

Objective: To estimate the risk of active tuberculosis (TB) in immigrants to Victoria, Australia, as a function of time since arrival and stratified by age group and region of origin.Design, setting and subjects: Longitudinal study of the incidence of active TB in Victorian immigrants, excluding New Zealanders, who arrived in Australia between 1975 and 2007. Victorian immigration data were used to describe annual arrival ...

Emma S McBryde MB BS, PhD, FRACP · Justin T Denholm BMed, MPHTM, FRACP

In Australia, chronic vascular diseases such as heart disease and diabetes are the leading causes of death and disability. Intensive lifestyle interventions have been shown to prevent vascular disease and diabetes in high-risk patients ...

Mark F Harris MB BS, MD, FRACGP · Mahnaz Fanaian BSc, MSc, PhD · Upali W Jayasinghe GradDipAppStat, MSc, PhD · Megan E Passey BMed, MPH, MSc · Suzanne H McKenzie MB BS, MMedSci, FRACGP · Gawaine Powell Davies BA(Hons), MHP · David M Lyle MB BS, PhD, FAFPHM · Rachel A Laws BSc(Nutrition), MSc(Nutrition · Heike Schütze BSc, MPH · Qing Wan MB BS, MPH, PhD

Objective: To evaluate a partnership model of care for patients with a diagnosis of chronic obstructive pulmonary disease (COPD).Design, setting and participants: Cluster randomised controlled trial with blinded outcome assessment of 44 general practices in south-western Sydney comprising 451 people with a diagnosis of COPD, conducted between 2006 and 2009.Intervention: Participants from intervention group practices were visited at their home by a ...

Nicholas A Zwar MPH, PhD, FRACGP · Oshana Hermiz MB BS · Elizabeth Comino BVSc, PhD · Sandy Middleton PhD · Sanjyot Vagholkar MB BS, MPH · Wei Xuan PhD · Stephen F Wilson PhD, FRACGP, FAFRM · Guy B Marks MB BS, PhD, FRACP

Objective: To assess the use of elective knee arthroscopy procedures for all adults 20 years and older, and for adults with a concomitant diagnosis of osteoarthritis (OA) in Victoria.Design, setting and patients: Retrospective, longitudinal cohort study of 807 030 elective orthopaedic admissions using routinely collected public and private hospital data from 1 July 2000 to 30 June 2009.Main outcome measure: Trends in rates of elective ...

Megan A Bohensky PhD, MPH, BA · Vijaya Sundararajan MD, MPH · Nick Andrianopoulos MB BS, MBiostat · Richard N de Steiger MB BS, FRACS, FAOrthA · Andrew Bucknill MSc, MB BS, FRACS · Christos M Kondogiannis MB BS, FRACS · Geoffrey McColl MB BS, PhD, MEd · Caroline A Brand MB BS, MPH

International and Australian studies show that well structured approaches to diabetes care can improve short-term and intermediate patient outcomes ...

Julia V Marley PgDipSc, PgDipPolSt, PhD · Carmel Nelson MPHandTM, FACRRM, FRACGP · Vicki O’Donnell DipBusMgt · David Atkinson MB BS, MPH

Workplace aggression is a worldwide concern that has been linked to impaired physical and mental health. There is limited international research describing the extent and impact of workplace aggression in medicine, however, and the few Australian studies have primarily focused on general practitioner experiences of patient aggression ...

Danny J Hills BN, GradCertMgt, MN(Hons) · Catherine M Joyce BA(Hons), MPsych, PhD · John S Humphreys BA(Hons), DipEd, PhD

Objective: To examine trends in hospitalisation for alcohol-attributable conditions in the Northern Territory Aboriginal and non-Aboriginal populations between the financial years 1998–99 and 2008–09.Design and setting: Retrospective descriptive analysis of inpatient discharge data from NT public hospitals.Main outcome measures: Alcohol-attributable hospitalisation by age, sex, Aboriginality, region of residence and medical conditions, with annual time trends.Results: Annual rates of ...

Shu Qin Li MPH, MB, BNursing · Sabine L M Pircher MPH, BNutrDiet · Steven L Guthridge MB BS, MPH, FAFPHM

One of the key goals of health reform is to drive hospital quality improvement by creating greater transparency in health services performance. With the launch of the MyHospitals website in December 2010, quality indicators for individual hospitals across Australia were publicly ...

Jessica Greene PhD · Jane Hall PhD