Research

Objective: To test the claim that pet ownership reduces cardiovascular risk.Design: Community survey.Participants: 2528 adults aged 40–44 years and 2551 aged 60–64 years who lived in the Australian Capital Territory and Queanbeyan, New South Wales, and were drawn randomly from the Australian electoral roll in 2000 and 2001.Main outcome measures: Sociodemographic measures, including pet ownership, and measures of physical health (including body mass index [BMI], alcohol and cigarette consumption, and levels of physical activity). Two readings of diastolic and systolic blood pressure were also taken.Results: While pet owners and non-pet owners had similar levels of systolic blood pressure, those with pets had significantly higher diastolic blood pressure. Pet owners also had higher BMI and were more likely to smoke. While those with pets undertook more mild physical activity, they continued to have significantly higher diastolic blood pressure after controlling for hypertensive risk factors.Conclusions: In this study, we found no evidence that pet ownership per se is associated with cardiovascular health benefits. Rather, pet owners had higher diastolic blood pressure than those without pets. It is likely that this increased health risk is linked to other hypertensive risk factors that are only indirectly associated with pet ownership.

Ruth A Parslow MPH, PhD · Anthony F Jorm PhD, DSc

Objective: To assess trends in the first two years of prescribing of COX-2-selective non-steroidal anti-inflammatory drugs (C2SNs) by Australian general practitioners.Design: Retrospective analysis of deidentified electronic patient records from GPs enrolled in the General Practice Research Network (GPRN).Setting and participants: Overall prescription rates for C2SNs and NSAIDs were assessed for all GPRN participants (437 GPs) between 1 September 1999 and 30 September 2002. Also, three cohorts of patients, with at least 12 months of prescription data, who received their first prescription for celecoxib between August and October 2000 (Cohort 1, 2366 patients), celecoxib between February and April 2001 (Cohort 2, 640 patients), and rofecoxib between February and April 2001 (Cohort 3, 608 patients) were selected for further analysis.Main outcome measures: Age and sex of patients; reason for prescription; previously prescribed pain medications and concomitant use of medications that could predispose to an adverse renal or bleeding event.Results: Prescriptions for C2SNs increased dramatically after they were listed on the Pharmaceutical Benefits Scheme (PBS). C2SN prescriptions for patients aged less than 65 years accounted for 52.6%, 59.5% and 50.7% of those in Cohorts 1, 2 and 3, respectively; large numbers of patients in the study cohort had reasons recorded for prescription that did not comply with PBS restrictions, and between 36.7% and 61.3% of patients in the three cohorts had not received a prescription for any pain medication in the year before being prescribed a C2SN. Between 4.7% and 7.9% were coprescribed drugs that could cause renal complications.Conclusions: Rapid, early adoption of C2SNs by Australian GPs has resulted in prescribing and drug use patterns that were not in accord with quality use of medicine (QUM) principles.

Stephen J Kerr BPharm, PhD · Andrea Mant MD, MA · Fiona E Horn BSc, MPH · Kevin McGeechan BSc · Geoffrey P Sayer BSc(Psychol), MCH

Objectives: To determine the 12-month prevalence of substance-use disorders and psychological morbidity in an Australian arrestee population.Design: Cross-sectional descriptive study.Participants and setting: 288 police arrestees at the Brisbane City Police Watch House in February and March 2001.Outcome measures: Prevalence of drug and alcohol disorders; psychological “caseness” according to the 28-item General Health Questionnaire; demographics and index offences.Results: 86% of the arrestees had at least one substance-use disorder; most had multiple disorders. More than 80% were substance dependent. The predominant substances used were amphetamines, marijuana, opioids and alcohol. 82% of the men and 94% of the women were suffering significant psychological distress.Conclusions: Development of services for detoxification and treatment of this population is a pressing need. The findings provide crucial information for the planning and implementation of drug courts and court diversion systems.

Edward B Heffernan BSc(Hons), FRANZCP · John B Saunders FRACP, FAFPHM, FRCP · Gerard Byrne PhD, FRANZCP · Joe Finn BN

Objective: To determine the biochemical screening rate of newborns in South Australia and the factors associated with babies not being screened.Design: Matching of data in the SA Newborn Screening Centre database (acquired from Guthrie cards) with the SA perinatal data collection (compiled from supplementary birth records) to determine how many newborns missed screening. Risk factors for missed screening were identified from sociodemographic and clinical variables recorded in the perinatal data collection and analysed by multivariable unconditional logistic regression analysis.Patients and setting: All live births (n = 18 426) in South Australia in 1999, in the 63 hospitals assisting deliveries or in the home.Main outcome measures: Rates of biochemical screening and missed screening in all newborns and among various subgroups; adjusted odds ratios (after multivariable logistic regression analysis) for risk factors for missed screening.Results: The newborn screening rate in South Australia in 1999 was 97.8%. Babies born at home, born to an Aboriginal mother, or born to a mother who normally resided in another state were at higher risk of missed screening. Other factors associated with missed screening were having fewer than seven antenatal visits, prematurity (gestational age at birth < 32 weeks), congenital abnormality in the baby, use of paediatric intensive care, early discharge from hospital before 3 days (but especially after less than 1 day), and death of the baby during the neonatal period.Conclusion: In South Australia, while 2.2% of all newborns missed screening in 1999, in certain high-risk groups the proportions of unscreened babies were significantly higher. With a 2% missed screening rate, one might expect one newborn with a screening-detectable disorder to elude detection every other year in South Australia.

Michael P Metz MD, MAACB · Enzo Ranieri BSc(Hons), MSc · Rosemarie L Gerace BSc · Kevin R Priest BSc · Colin G Luke MPH, FAFPHM · Annabelle Chan DPH, FAFPHM

Objectives: To determine patient participation rates in outpatient cardiac rehabilitation (OCR) programs; ascertain the barriers to participation; and evaluate the quality of OCR programs. Design and setting: Retrospective cohort study of patient separations from selected public and private Queensland hospitals; questionnaire survey of hospitals and all registered OCR programs. Participants: Patients discharged with cardiac diagnoses between 1 July 1999 and 30 June 2000 from 31 hospitals (24 public; 7 private). Main outcome measures: Rates of referral of hospitalised patients to OCR programs; rates of program attendance and completion; barriers to OCR referral and attendance. Results: 15 186 patients were discharged with cardiac diagnoses from participating hospitals, of whom 4346 (29%) were referred to an OCR program after discharge, compared with an estimated 59% (8895/15 186) of patients who were eligible for such a program. Proportionately more patients were referred from secondary (38% [1720/4500]) and private (52% [2116/4031]; P < 0.001) hospitals than from tertiary (25% [2626/10 686]) and public (20% [2230/11 155]) hospitals. Patients undergoing coronary revascularisation procedures comprised 35% of discharges, but accounted for 56% of all program attendances. Fewer than a third of all referred patients completed OCR programs, and only 39% of available OCR program places were fully utilised. Catchment populations of programs with unused places had excess coronary mortality. Conclusion: There is significant underutilisation of facility-based OCR programs in Queensland. Procedures are required for identifying and referring eligible patients to existing programs and improving program compliance. Alternative OCR models are also required.

Ian A Scott FRACP, MHA, MEd · Kylie A Lindsay BN, GradCertManag · Hazel E Harden BSc

Objective: To determine the prevalence of iodine deficiency in primary school children in an Australian urban population.Design and setting: A cross-sectional survey of school children aged 5–13 years attending a public school on the Central Coast of New South Wales in November 2000.Participants: 324 (70%) of the 465 children enrolled in the school (180 boys; 144 girls).Main outcome measures: Thyroid volumes compared with World Health Organization/International Council for the Control of Iodine Deficiency Disorders (WHO/ICCIDD) thyroid volume reference values. Iodine status based on WHO/ICCIDD urinary iodine concentration (UIC) categories (normal, ≥ 100 μg per litre of urine [μg/L]; mild iodine deficiency, 50–99 μg/L; moderate deficiency, 20–49 μg/L; severe deficiency, < 20 μg/L); not more than 20% of the population should have a UIC below 50 μg/L.Results: Median UIC for school children was 82 μg/L, and 14% of children had UICs below 50 μg/L. Thyroid volume reference values indicated a prevalence of goitre of zero. In girls, only four (3%) and one (1%) had thyroid volumes above the WHO/ICCIDD medians by age and body surface area (BSA), respectively (P < 0.001). In boys, three (2%) and one (1%) had thyroid volumes above WHO/ICCIDD medians by age and BSA, respectively (P < 0.001).Conclusion: Despite the median UIC being less than ideal, most children were not goitrous. This underscores the importance of using physiological outcome measures in areas where iodine deficiency is marginal before concluding the need for iodine supplementation based purely on median UIC. We call for a systematic national survey to determine iodine status using a combination of iodine deficiency indicators.

Kamala Guttikonda MB BS, FRACP · Steven Boyages FRACP, PhD · Cheryl A Travers BSc · Peter R Lewis MB BS, FAFPHM

Objective: To determine the effect on cardiac arrests and overall hospital mortality of an intensive care-based medical emergency team.Design and setting: Prospective before-and-after trial in a tertiary referral hospital.Patients: Consecutive patients admitted to hospital during a 4-month “before” period (May–August 1999) (n = 21 090) and a 4-month intervention period (November 2000 –February 2001) (n = 20 921).Main outcome measures: Number of cardiac arrests, number of patients dying after cardiac arrest, number of postcardiac-arrest bed-days and overall number of in-hospital deaths.Results: There were 63 cardiac arrests in the “before” period and 22 in the intervention period (relative risk reduction, RRR: 65%; P < 0.001). Thirty-seven deaths were attributed to cardiac arrests in the “before” period and 16 in the intervention period (RRR: 56%; P = 0.005). Survivors of cardiac arrest in the “before” period required 163 ICU bed-days versus 33 in the intervention period (RRR: 80%; P < 0.001), and 1353 hospital bed-days versus 159 in the intervention period (RRR: 88%; P < 0.001). There were 302 deaths in the “before” period and 222 in the intervention period (RRR: 26%; P = 0.004).Conclusions: The incidence of in-hospital cardiac arrest and death following cardiac arrest, bed occupancy related to cardiac arrest, and overall in-hospital mortality decreased after introducing an intensive care-based medical emergency team.

Rinaldo Bellomo MD, FJFICM · Donna Goldsmith RN · Shigehiko Uchino MBBS · Jonathan Buckmaster FJFICM, FANZCA · Graeme K Hart FJFICM, FANZCA · Helen Opdam FJFICM, FRACP · William Silvester FJFICM, FRACP · Laurie Doolan FANZCA · Geoffrey Gutteridge FJFICM, FANZCA

Objective: To determine the factors influencing survival among patients admitted to Western Australian hospitals for the first time with stroke or transient ischaemic attack (TIA).Design, setting and patients: Linked hospitalisation and death records of 7784 patients admitted to hospital for first-ever stroke or TIA between July 1995 and December 1998 were retrieved retrospectively to determine survival; effects of risk factors on death due to stroke were assessed using the Cox proportional hazards regression model.Main outcome measures: All-cause stroke survival; short- and long-term stroke survival probabilities.Results: Survival at 28 days was lowest for haemorrhagic stroke. However, following the first month after admission survival after haemorrhagic stroke was similar to, if not higher than, after ischaemic stroke. Among all patients, significant predictors of death were age (all subtypes of stroke), atrial fibrillation (intracerebral haemorrhage and ischaemic stroke), other cardiac conditions (ischaemic stroke and TIA), and sex and diabetes (TIA). Further predictors of death were residence in rural or remote areas (ischaemic stroke), and Aboriginality (TIA). Among 28-day survivors of ischaemic stroke, additional predictors of death were sex, diabetes and urinary incontinence still present 7 days after admission.Conclusion: Use of linked hospitalisation and death data allowed us to increase the scope and size of our study compared with previous studies of survival after stroke and TIA in WA. We confirmed the importance of type of stroke, age and comorbidities to this survival, and found that Aboriginality and place of residence are also important.

Andy H Lee PhD · Peter J Somerford BSc · Kelvin K W Yau PhD, AStat

Objective: To determine whether high maternal parity has any effect on pregnancy outcome independent of other maternal characteristics.Design and setting: Retrospective observational study using the database of a referral obstetric unit in a 280-bed regional hospital in far north Queensland.Participants: All 15 908 women who had singleton births between 1992 and 2001, comprising 653 women with grand multiparity (≥ 5 previous births at gestation ≥ 20 weeks) and 15 255 women with lower parity.Main outcome measures: Spontaneous vaginal birth, postpartum haemorrhage (estimated blood loss > 500 mL), placental retention requiring manual removal, blood transfusion associated with the birth, and perinatal death.Results: Women with grand multiparity were significantly older than those with lower parity, more likely to be Indigenous, not to have had antenatal care, to have smoked during pregnancy and to have had one or more previous caesarean sections. On univariate analysis, women with grand multiparity were more likely to have a postpartum haemorrhage (9.2% v 5.3%) and blood transfusion (2.8% v 1.5%). However, multivariate logistic regression analysis of women who began labour (ie, did not have an elective caesarean section) showed that grand multiparity was not significantly associated with postpartum haemorrhage or blood transfusion when other maternal characteristics were included in the model (regression coefficients [95% CI], 1.36 [0.99–1.87] and 1.09 [0.59–2.02], respectively). However, they remained more likely to have a spontaneous vaginal birth (regression coefficient [95% CI], 2.10 [1.56–2.74]).Conclusions: Women with grand multiparity do not have an increased likelihood of poor pregnancy outcomes. Birth-suite protocols which dictate extra interventions as routine during labour in these women should be revised.

Michael D Humphrey PhD, FRANZCOG, FRCOG

Objectives: To compare the characteristics of complementary and alternative medicine (CAM) users and non-users among Australian women.Design: Cross-sectional postal questionnaire conducted during 1996, forming the baseline survey of the Australian Longitudinal Study on Women’s Health.Participants: Women aged 18–23 years (n = 14 779), 45–50 years (n = 14 099) and 70–75 years (n = 12 939), randomly selected from the Health Insurance Commission database, with over-sampling of women from rural and remote areas of Australia.Main outcome measures: Consultation with an alternative health practitioner in the 12 months before the survey.Results: Women in the mid-age cohort were more likely to have consulted an alternative health practitioner in the previous year (28%) than women in the younger cohort (19%) or older cohort (15%). In all age groups, CAM users were more likely than CAM non-users to reside in non-urban areas, to report poorer health, have more symptoms and illness, and be higher users of conventional health services.Conclusions: Women in non-urban Australia are more likely to use CAM but do so in in parallel with conventional health services.

Jon Adams PhD · David W Sibbritt PhD · Gary Easthope PhD · Anne F Young PhD

Objectives: To compare the effectiveness of ototopical ciprofloxacin (0.3%; CIP) with framycetin (0.5%), gramicidin, dexamethasone (FGD) eardrops (5 drops twice daily for 9 days) together with povidone-iodine (0.5%) ear cleaning as treatments for chronic suppurative otitis media (CSOM) in Aboriginal children.Design and participants: Aboriginal community-controlled, community-based, multicentre, double-blind, randomised controlled trial in eight Aboriginal Community Controlled Health Services across northern Australia, involving 147 Aboriginal children with CSOM.Main outcome measures: Resolution of otorrhoea (clinical cure), proportion of children with healed perforated tympanic membrane (TM) and improved hearing, 10–21 days after starting treatment.Results: 111 children aged 1–14 years (CIP, 55; FGD, 56) completed treatment. CSOM cures occurred in 64% (CIP, 76.4%; FGD, 51.8%), with a significantly higher rate in the ciprofloxacin group (P = 0.009, absolute difference of 24.6% [95% CI, 15.8%–33.4%]). TM perforation size and the level of hearing impairment did not change. Pseudomonas aeruginosa was the most common bacterial pathogen (in 47.6%), while respiratory pathogens were rare (in 5.7%).Conclusions: Twice-daily ear cleaning and topical ciprofloxacin is effective at community-level in achieving cure for CSOM. Healthcare providers to Aboriginal children with CSOM should be given special access to provide ototopical ciprofloxacin as first-line treatment.

Sophie Couzos FRACGP, FACRRM, FAFPHM · Traven Lea MAEIH, DipPHTM · Margaret Culbong · Reinhold Mueller MSc, PhD · Richard Murray FRACGP, MPH

Objective: To assess the reported rate of local reactions after administration of acellular pertussis vaccine (DTPa) according to dose number and type of pertussis vaccine (whole-cell or acellular) used for the primary course, and to document the severity and outcome of fourth-dose local reactions.Design and setting: Retrospective review. Reports of adverse events after vaccination in South Australia between 1 January 1997 and 31 December 2000 were reviewed, and a questionnaire administered to all parents who reported a local reaction after the fourth dose of DTPa.Main outcome measures: The number, and rate per 100 000 administered doses, of local reactions following the primary and booster doses of DTPa, and of local reactions after the fourth-dose in cohorts of children whose primary vaccinations were with either DTPw or DTPa. Redness and/or swelling at the injection site as reported by parents.Results: Of 581 reported adverse events after vaccination, 138 were local reactions after a pertussis-containing vaccine. Primary vaccinations with DTPa was a significant risk factor for a fourth-dose local reaction (relative risk, 6.7; 95% CI, 2.4–18.5). Parental questionnaires were completed for 45 of the 71 children (63%) with reported local reactions after the fourth dose of DTPa; extensive limb swelling was reported in 8 children (18%) and all except one child had recovered by the time of review.Conclusions: Parents should be informed that children receiving booster doses of DTPa vaccine, after primary doses with DTPa, are at increased risk of local reactions (which tend to resolve spontaneously) but not of systemic effects. Studies should be initiated to investigate the pathogenesis and the risk of recurrence of local reactions to further improve vaccination schedules.

Michael S Gold MD, FRACP · Sara Noonan RN · Maggi Osbourn RN · Stella Precepa RN · Ann E Kempe RN, MPH, BSc

Objectives: To provide detailed projections for the prevalence of disability and associated common health conditions for older Australians for the period 2006–2031.Design: Secondary analyses of datasets (national 1998 Survey of Disability, Ageing and Carers; and projections of Australia’s population from 2006–2031) collected by the Australian Bureau of Statistics.Outcome measures: (i) The projected number of people with differing levels of disability (core activity restrictions in self-care, mobility or communication) up to 2031; (ii) The projected number of people with the main health conditions associated with disability in 2006 and 2031.Results: Projections indicate a 70% increase in the number of older people with profound disability over the next 30 years. The main conditions associated with profound or severe core activity restriction in older Australians are musculoskeletal, nervous system, circulatory and respiratory conditions and stroke.Conclusions: In the future, there will be many more older Australians requiring assistance because of disability. This will present a challenge to families, friends, volunteers and paid service providers. The Australian planning ratio for residential aged-care services and community aged care services should be changed to take account of the shift to an older population with greater need of support.

Lynne C Giles MPH, AStat · Maria Crotty PhD, FAFRM (RACP) · Ian D Cameron PhD, FAFRM (RACP)

Objective: To measure the prevalence of untreated hypertension in Australian adults, and examine the associations with clinical and lifestyle factors.Design: AusDiab, a cross-sectional survey conducted between May 1999 and December 2000, involved participants from 42 randomly selected census districts throughout Australia.Participants: Of 20 347 eligible people aged ≥ 25 years who completed a household interview, 11 247 attended a physical examination (response rate, 55%).Main outcome measures: The prevalence of hypertension (blood pressure ≥ 140/90 mmHg or self-reported use of antihypertensive drugs) and its treatment; associations of clinical and lifestyle factors with the treatment of hypertension; and adequacy of treatment for primary and secondary prevention of cardiovascular disease.Results: The prevalence of hypertension was 28.6 per 100 (95% CI, 25.0–32.3), and the prevalence of untreated hypertension was 15.2 per 100 (95% CI, 13.2–17.2). Of those with untreated hypertension, 80.8% (95% CI, 74.7%–85.0%) had had a blood pressure check within the preceding 12 months. At least one modifiable lifestyle factor was present in 71.7% (95% CI, 68.5%–74.8%) of participants with untreated hypertension. Although lower risk clinical characteristics of younger age and lack of hyperlipidaemia were independently associated with untreated hypertension, 53.5% warranted treatment based on current cardiovascular disease prevention guidelines and multivariable absolute risk assessment.Conclusions: Considerable scope remains for reducing the burden of cardiovascular disease through lifestyle modification and rational treatment of hypertension.

Esther M Briganti MB BS, MClinEpi · John J McNeil MB BS, PhD · Jonathan E Shaw MD · Paul Z Zimmet MB BS, PhD · Steven J Chadban MB BS, PhD · Robert C Atkins MB BS, DSc · Timothy A Welborn MB BS, PhD

Objective: To determine the factors associated with general practitioners' current practice location, with particular emphasis on rural location.Design: Observational, retrospective, case–control study using a self-administered questionnaire.Setting: Australian general practices in December 2000.Participants: 2414 Australian-trained rural and urban GPs.Main outcome measure: Current urban or rural practice location.Results: For Australia as a whole, rural GPs were more likely to be male (odds ratio [OR], 1.42; 95% CI, 1.17–1.73), Australian-born (OR, 1.95; 95% CI, 1.55–2.45), and to report attending a rural primary school for "some" (OR, 2.21; 95% CI, 1.69–2.89) or "all" (OR, 2.79; 95% CI, 1.94–4.00) of their primary schooling. Rural GPs' partners or spouses were also more likely to report "some" (OR, 2.75; 95% CI, 2.07–3.66) or "all" (OR, 2.86; 95% CI, 2.02–4.05) rural primary schooling. A rural background in both GP and partner produced the highest likelihood of rural practice (OR, 6.28; 95% CI, 4.26–9.25). For individual jurisdictions, a trend towards more rural GPs being men was only significant in Tasmania. In all jurisdictions except Tasmania and the Northern Territory, rural GPs were more likely to be Australian-born.Conclusions: GPs' and their partners' rural background (residence and primary and secondary schooling) influences choice of practice location, with partners' background appearing to exert more influence.

Gillian A Laven BHSc · Justin J Beilby MB BS, MD · Heather J McElroy BSc(Hons) · David Wilkinson MB ChB, MD, PhD

Objective: To audit the appropriateness of use of a troponin I assay in three hospitals.Design: Cross-sectional survey of use of a troponin assay.Setting: Three hospitals in Melbourne, Victoria, each with an emergency department and a coronary care unit.Participants: Patients for whom a troponin I assay was requested between 1 and 7 May 2002, 27–42 months after introduction of the assay.Interventions: User-focused dissemination of relevant information, including protocols for use, from opinion leaders when the assay was introduced; continuous reinforcement of information in pathology reports.Main outcome measures: Adherence to protocol for assay use.Results: Troponin assays were requested for 333 patients during 351 symptom episodes. A single assay was used in 194 symptom episodes (55%), and serial assays in 157 (45%); proportions were statistically indistinguishable across all three hospitals (χ2; P = 0.71). Of the 194 single assays, 13 (7%) diagnosed a myocardial infarction. Serial troponin testing in all three hospitals followed the suggested protocol, with mean time between serial assays being more than 6 hours at all hospitals.Conclusions: Adherence to the protocol for serial troponin assay intervals was adequate, but single troponin assays were used extensively and probably inappropriately.

Richard X Davey FRCPA, FACB

Objectives: To describe the clinical features, antecedents and impact of chronic pain.Design: Telephone survey of randomly selected household respondents.Setting: Northern Sydney Health Area, metropolitan Sydney, July to September 1998.Participants: 2092 English-speaking residents aged 18 years or over.Main outcome measures: Age- and sex-adjusted prevalence of chronic pain (pain experienced every day for 3 months in the previous 6 months), pain-related disability, and use of health services and analgesic medications.Results: Chronic pain affected 474/2092 respondents (22.1%; 95% CI, 20.2%–24.0%), with high levels of pain-related disability in 129/439 (27%). Nominated causes of chronic pain were injury in 173 (38%), most commonly sports injury (54; 13%), and a health problem in 132 (29%). Pain was work-related in 62 (14%). A musculoskeletal condition was the leading diagnosis (127; 26%). Of the 474 with chronic pain, 374 (78%) had consulted at least one health practitioner for pain in the previous 6 months, comprising medical practitioners (consulted by 292 [60%] and including general practitioners [55%]), allied health professionals (245; 50%), and alternative practitioners (99; 21%). Current or recent use of oral analgesic medications (often over-the-counter preparations) was common (339; 70%). Higher levels of pain-related disability were associated with greater use of medications and health services.Conclusions: Our study shows that chronic pain is common and often results from injury. It highlights the importance of timely interventions to prevent progression from acute to chronic pain and the need for a coordinated approach to managing pain-related disability.

Fiona M Blyth PhD, FAFPHM · Michael J Cousins MD, FANZCA · Lyn M March PhD, FRACP

Objectives: To determine the utility of capsule endoscopy in patients referred for investigation of suspected disease of the small intestine.Design and setting: Single centre, prospective, cohort study from 4 July 2001 to 8 September 2002.Patients: Sixty consecutive patients who underwent capsule endoscopy for investigation of suspected disease of the small intestine.Main outcome measures: Abnormal findings at capsule endoscopy.Results: ...

André K H Chong FRACP · Andrew C F Taylor MD, FRACP · Ashley M Miller PhD, FRACP · Paul V Desmond FRACP

Objective: To test whether critical incident stress debriefing after childbirth reduces the incidence of postnatal psychological disorders.Design: Randomised single-blind controlled trial stratified for parity and delivery mode.Setting: Two large maternity hospitals in Perth.Participants: 1745 women who delivered healthy term infants between April 1996 and December 1997 (875 allocated to intervention and 870 to control group).Intervention: An individual, ...

Susan R Priest M Psych, PhD · Jenni Henderson BSc, MPH · Sharon F Evans MSc, PhD · Ronald Hagan MB BCh, MBA

Objectives: To determine whether infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) occurred after two potential episodes of exposure through needle- and syringe-sharing in Australian prisons, and to examine use of post-exposure prophylaxis (PEP) against HIV infection in the prison setting.Design: Cohort study of potential contacts of two prisoners infected with HIV, HBV and HCV ...

Belinda G O'Sullivan MPH, GradDipAppEpi · Michael H Levy MB MS, MPH · Sharon G Barton DipApplSc · Kate A Dolan PhD · John M Kaldor PhD · Andrew E Grulich PhD · Jeffrey J Post FRACP · Dominic E Dwyer MD, FRACP, FRCPA

Objectives: To assess trends in the prevalence of self-reported doctor-diagnosed asthma, associated asthma related morbidity, and the uptake of written asthma action plans in South Australia, 1990–2001.Design, setting and participants: Surveys by telephone interview of the South Australian population between 1990 and 2001, and interview of participants in their own homes by trained health interviewers.Main outcome measures: Asthma prevalence, percentage of patients with written action plans, and asthma associated morbidity.Results: The reported prevalence of doctor-diagnosed asthma has increased from 8% (95% CI, 6.4%–9.6%) in 1990 to 12.8% (95% CI, 11.4%–14.2%) in 2001. Morbidity, as measured by wakening at night (daily or weekly) and days lost from normal activities because of asthma, has remained constant over the decade. The percentage of patients with written asthma action plans increased to a peak of 42.3% (95% CI, 40.3%–44.3%) in 1995, but then declined to 22.2% (95% CI, 20.7%–23.7%) in 2001.Conclusions: The prevalence of asthma has increased while morbidity has remained constant, indicating that the burden of asthma has increased. The associated decline in the percentage of patients with asthma action plans in recent years is cause for concern.

David H Wilson PhD · Robert J Adams MD · Sarah L Appleton BSc · Graeme Hugo PhD · Janet Hiller PhD · Philip Ryan MD · Richard E Ruffin MD · David Wilkinson MD, PhD · Julianne Cheek PhD

Objective: To assess the effect of adding 1 mg dexamethasone to syringe drivers on the viability time of subcutaneous cannulation sites in palliative care patients.Design: Prospective, double-blind, randomised, controlled trial in which patients received half their daily infused medications plus 1 mg dexamethasone in 1 mL saline through one subcutaneous site (test site) and the other half of their medications plus 1 mL saline through another symmetrically placed site (control site).Participants and setting: Palliative care patients from the inpatient units at two hospices, recruited between 1999 and 2002.Main outcome measure: Difference in time that the test and control sites remained viable.Results: 38 patients consented and were randomised. Twenty did not complete the trial because their participation in the study finished before either site broke down. Eighteen patients either partially completed (at least one site broke down) or fully completed (both sites broke down) the trial. In these 18 patients, test sites lasted 3.6 days longer than control sites (95% CI, 1.5–5.8 days; P = 0.002). Twelve patients fully completed the trial. In this group, test sites lasted 3.9 days longer than control sites (95% CI, 0.6–7.2 days; P = 0.025).Conclusions: The addition of 1 mg dexamethasone to syringe drivers significantly extends the viability time of subcutaneous cannulation sites in palliative care patients.

Liz Reymond FRACGP, PhD · Pat Treston MPHC(Palliat Care), FAChPM · Margaret A Charles PhD, MAPS · Jan Bowman MPHC(Palliat Care), FAChPM

Objective: To measure the prevalence of obesity in Australian adults and to examine the associations of obesity with socioeconomic and lifestyle factors.Design: AusDiab, a cross-sectional study conducted between May 1999 and December 2000, involved participants from 42 randomly selected districts throughout Australia.Participants: Of 20 347 eligible people aged > 25 years who completed a household interview, 11 247 attended the physical examination at local survey sites (response rate, 55%).Main outcome measures: Overweight and obesity defined by body mass index (BMI; kg/m2) and waist circumference (cm); sociodemographic factors (including smoking, physical activity and television viewing time).Results: The prevalence of overweight and obesity (BMI > 25.0 kg/m2; waist circumference > 80.0 cm [women] or > 94.0 cm [men]) in both sexes was almost 60%, defined by either BMI or waist circumference. The prevalence of obesity was 2.5 times higher than in 1980. Using waist circumference, the prevalence of obesity was higher in women than men (34.1% v 26.8%; P < 0.01). Lower educational status, higher television viewing time and lower physical activity time were each strongly associated with obesity, with television viewing time showing a stronger relationship than physical activity time.Conclusions: The prevalence of obesity in Australia has more than doubled in the past 20 years. Strong positive associations between obesity and each of television viewing time and lower physical activity time confirm the influence of sedentary lifestyles on obesity, and underline the potential benefits of reducing sedentary behaviour, as well as increasing physical activity, to curb the obesity epidemic.

Adrian J Cameron MPH · Paul Z Zimmet MD, FRACP, FAFPHM · David W Dunstan PhD · Marita Dalton GradDipEpidemiol · Jonathan E Shaw MD, MRCP · Timothy A Welborn MB BS, PhD · Neville Owen PhD · Jo Salmon PhD · Damien Jolley MSc

Objective: To determine whether warming or rubbing adult diphtheria tetanus (ADT) vaccine immediately before administration affects its temperature and reduces the incidence of pain.Design: Double-blind, randomised controlled trial and in-vitro temperature study.Setting: Emergency department (ED) of a regional hospital between April and December 2001.Patients: Convenience sample of 150 patients aged 16 years or over who presented to the ED requiring ADT booster vaccination.Intervention: Patients were randomised to receive vaccine that was "cold" (no deliberate warming), "rubbed" between the palms for 1 minute, or "warmed" in a 37°C incubator; vaccine was administered as recommended in Australian guidelines.Main outcome measures: Incidence of pain and pain score on McGill Present Pain Intensity Questionnaire at 5 minutes, 24 hours and 48 hours after injection; and temperature of vaccine after preparation for simulated administration.Results: The "cold" vaccine had significantly lower temperature (mean, 19.1°C; 95% CI, 17.5–20.7°C) than the "warmed" vaccine (mean, 28.9°C; 95% CI, 28.4–29.4oC) and "rubbed" vaccine (mean, 26.9°C; 95% CI, 24.5–29.3°C). There was no significant difference in incidence of pain between the groups who received vaccine prepared in different ways at any follow-up (5 min: P = 0.62; 24 h: P = 0.58; 48 h: P = 0.61) or overall (P = 0.99). Among those who completed follow-up, incidence of pain at any time was 77/138 (56%); there was no difference in their time-averaged pain scores (P = 0.63) or peak pain scores (P = 0.60).Conclusions: Warming or rubbing ADT vaccine does not reduce the incidence of pain after administration. Regardless of how ADT vaccine is prepared, its temperature approaches ambient by the time it is injected.

Matthew J Maiden BSc, BM BS, DRANZCOG · Gregory N Benton RN, CCRN · Russell A Bourne MB BS(Hons), FANZCA

Objective: To identify any association between asthma and depression and quality of life.Design and setting: A face-to-face Health Omnibus Survey of a random and representative sample of the South Australian population in August 1998.Participants: 3010 randomly selected participants aged 15 years and over.Main outcome measures: Prevalence of doctor-diagnosed asthma, and scores for depression (measured by PRIME-MD instrument) and quality of life (measured by SF-36) in affected participants.Results: The prevalence of asthma was 9.9%. The prevalence of major depression was significantly higher for those who experienced dyspnoea, wakening at night with asthma, and morning symptoms of asthma. Quality-of-life scores were also lower for the same groups.Conclusions: Depression is a serious but potentially remediable comorbidity with asthma that may affect appropriate diagnosis and outcome.

Robert D Goldney MD, FRANZCP · Richard Ruffin MD, FRACP · David H Wilson MPH, PhD · Laura J Fisher BA(Hons)