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HNEPH Research Papers
Feel welcome to contact us for further HNE Population Health publications.
Green S, Campbell E, Barnett L, Mitchell R, Radvan D, Van Beurden. Promoting a team ball game (Lifeball) to older people: who does the game attract, and who continues? Health Promotion Journal of Australia 2009; 20(2): 120-126.
Pending
http://www.healthpromotion.org.au/journal/about_journal.php
Osborne M, Foletti C. Nurse led project improves refugee immunisation. Australian Nursing Journal 2009; 17(2):21.
Hunter New England Area Health Service employed 2 refugee health nurses in 2007 to improve the health of refugee families’ and their access to health services. Immunisation completion for both children and adults had been identified as an issue. The reason for poor completion is complex as refugees face major adaption in their new country. A multi disciplinary team targeted approach improved immunisation rates in the area. It is important to continue the specific role of refugee health nurse to ensure equity and access to services for newly arrived refugee families.
Merritt TD, Massey PD. Isoniazid Hypersensitivity in a child. Medical Journal of Australia 2009; 190(7): 397.
We report a likely hypersensitivity reaction to isoniazid in a young child, aged 21 months, that required cessation of treatment. Isoniazid is used extensively for the management of tuberculosis and on this occasion was commenced following a potential exposure to tuberculosis while awaiting definitive evidence of infection. The reaction included a maculopapular skin rash and vesicular tongue lesions. Such reactions are well documented in adults but there is very published on skin reactions in children. The Therapeutic Goods Administration in Australia had received no other reports of suspected hypersensitivity in children under 10 years of age.
Tuyl F "Conditional Probability and HIV Testing: A Real-World Example" The American Statistician 2009; 63(3): 294-295.
"This Letter to the Editor suggests a slight improvement to Bhatti & Wightman (2008), who considered the positive predictive value (PPV) in the context of diagnostic testing, i.e. the probability that a positive test result is correct. The improvement describes the simplicity of updating the PPV when successive tests are applied."
http://0-www.amstat.org.library.newcastle.edu.au/publications/tas.cfm
Tzelepis F, Paul C, Walsh RA, Wiggers J, Knight J, Lecathelinais C, Daly J, Neil A Telephone Recruitment into a Randomized Controlled Trial of Quitline Support American Journal of Preventive Medicine 2009; 37(4): 324-329.
Background: Given many smokers want to quit but few actually seek help pro active telephone contact offering support to quit may be useful in helping smokers to get help to quit. Aims: This study aimed to (1) determine the proportion of adult daily smokers who agree to quitline support when pro actively contacted by phone; (2) calculate the cost per smoker recruited. Methods: Over an 8 month period 1562 adult daily smokers randomly selected from the electronic NSW telephone directory agreed to be in a study where they would receive some form of support to quit smoking. The proportion of smokers and the cost per smoker recruited were examined. Results: More than half (52%) of eligible smokers contacted by telephone were recruited into cessation support. The cost per smoker recruited was AU$71 (US$59). So what: These results suggest that proactively phoning smokers and offering them support to quit is acceptable. Even if small quit rates result such a strategy has the potential to be widely applied and any could have a population effect on smoking prevalence. The smokers contacted in this study will receive either telephone support or self help materials. Follow up contact at 4,7 and 13 months will be used to assessed the effectiveness of these interventions among the smokers
http://linkinghub.elsevier.com/retrieve/pii/S0749379709004206
Tuyl F, Gerlach R, Mengerson K. "A Comparison of Bayes-Laplace, Jeffreys's, and other Priors: The Case of Zero Events" The American Statistician; 63(2): 197-198.
"This minor publication is a response to a Letter to the Editor, which refers to Tuyl, Gerlach & Mengersen (2008). The response provides further support for the uniform (“Bayes-Laplace”) prior as the correct representation of prior ignorance in the context of Bayesian estimation of the binomial parameter."
http://0-www.amstat.org.library.newcastle.edu.au/publications/tas.cfm
Paterson B, Durrheim DN, Tuyl F. Influenza: H1N1 Goes to School Science 2009; 325: 1071-1072
A secondary analysis of the influenza A (H1N1) outbreak amongst secondary school students at St. Francis Preparatory School outbreak in the United States allowed calculation of an effective reproduction number in a school-based setting of 2.69 [95% CI: 2.20 to 3.22]. This may explain the apparent amplification role of schools during the first wave of the H1N1 pandemic
http;//0-sciencemag.org.library.newcastle.edu.au/
Massey PD, Pearce G, Taylor KA, Orcher L, Saggers S, Durrheim DN. Reducing the risk of pandemic influenza in Aboriginal communities Rural and Remote Health Published Online 2009; 9 (Article 1290): 1-7.
Aboriginal people have borne the brunt of severe disease during previous pandemics and this has also been the case during the first wave of the H1N109 pandemic in Australia. This paper describes the process and findings from preliminary community consultations into reducing influenza risk, including pandemic H1N1(09) swine influenza, in six Aboriginal communities in the Hunter New England area of northern New South Wales, Australia. The consultations further developed shared understanding between health services and Aboriginal communities about appropriate and culturally safe ways to reduce the influenza risk in communities.
http://www.rrh.org.au/articles/showarticlenew.asp?ArticleID=1290
Eastwood K, Durrheim DN, Massey PD, Kewley C. Australia's pandemic 'Protect' strategy: the tension between prevention and patient management Rural and Remote Health Published Online 2009; 9(Article1288): 1-7
Since the first case of the pandemic influenza strain, H1N109 was identified in Australia on 7 May 2009 there have been valuable opportunities to gain experience and learnings for future emergencies. The early response involved an intense containment effort lasting 7 weeks but this was unable to prevent local community transmission in some areas of Australia. However, despite outbreaks in densely populated areas of New South Wales (NSW) and Victoria, much of the outback was unaffected. By the end of the Containment Phase, most parts of rural NSW had only recorded low rates of confirmed H1N109 infection. As rural areas of Australia often provide poorer access to health services than their urban counterparts, they are likely to be more affected by an extended emergency, even one as moderate as the present H1N109 swine influenza pandemic. It is possible that extending containment measures in less affected areas could have had significant benefits that would have been especially useful for communities where large numbers of vulnerable people such as Indigenous Australians reside. Although containment is worthwhile in limiting the spread of disease in specific situations it is unlikely to change the course of a pandemic unless it can be sustained until a large proportion of the population is vaccinated. Significant advantages can be gained by encouraging strenuous containment efforts in outbreaks of severe disease, particularly those caused by novel infectious agents with a low reproductive rate. As advances in vaccine manufacture reduce the time taken to produce a new vaccine, the benefits of investing in containment will be even more worthwhile.
http://www.rrh.org.au/articles/showarticlenew.asp?ArticleID=1288
Tzelepis F, Paul CL, Walsh RA, Wiggers J, Duncan SL, Knight J Active telephone recruitment to quitline services: Are nonvolunteer smokers receptive to cessation support? Nicotine & Tobacco Research Advance Access 2009; 1-11.
Pending
http://ntr.oxfordjournals.org/cgi/content/abstract/ntp125
Huppatz C, Durrheim DN, Levi C, Dalton C, Williams D, Clements MS, Kelly PM. Etiology of Encephalitis in Australia, 1990-2007. Emerging Infectious Diseases 2009; 15(9): 1359-1365.
Rates of hospitalization for patients with encephalitis in Australia’s most populous state, New South Wales, were reviewed from January 1990 through December 2007 and encephalitis accounted for an average annual hospitalization rate of 5.2/100,000 population. During this period Toxoplasma encephalitis and subacute sclerosing panencephalitis showed notable declines. The high proportion of encephalitis with no known etiology may conceal emergence of novel pathogens. Unexplained encephalitis should be investigated, and encephalitis hospitalizations should be subject to statutory notification in Australia.
http://www.cdc.gov/eid/content/15/9/pdfs/EID_Vol15No9.pdf
Guimont C, Hullick C, Durrheim DN, Ryan N, Ferguson J, Massey P. Invasive meningococcal disease-improving management structured review of cases in the Hunter New England area, Australia. Journal of Public Health Advance Access 2009; 1-6.
All notified invasive meningococcal disease (IMD) cases over a 2 year period (24 in total) in the HunterNew England Health area were reviewed by an expertpanel to identify key correctable issues in themanagement of IMD. Amongst the avoidable factors identified, length of delay in initiating antibiotic therapywas a particularly important issue to address.
jpubhealth.oxfordjournals.org/cgi/content/abstract/fdp075
Eastwood K, Durrheim DN, Francis JL, Tursan d'Espaignet E, Duncan S, Islam F, Speare R. Knowledge about pandemic influenza and compliance with containment measures among Australians. World Health Organisation Bulletin 2009; 87(8): 588-594
Objective To explore the willingness of the Australian public to comply with public health directives during an influenza pandemic event. Methods Information was gathered from a representative sample of Australians regarding their knowledge of pandemic influenza and willingness to comply with public health control measures. Following initial data collection, respondents were provided with a detailed description of pandemic influenza to ensure they understood the significance of the issue. The questions on compliance were repeated and changes in responses were analysed with McNemar’s test for paired data. Findings Less than a quarter of the 1166 respondents demonstrated a clear understanding of the term “pandemic influenza”. Stated willingness to comply with control measures was high with 94.1% reporting compliance with home quarantine; 94.2% expressed willingness to avoid public events; and 90.7%, were prepared to postpone social gatherings. After the meaning of “pandemic” was explained to all respondents, stated compliance increased significantly (to 97.5%, 98.3% and 97.2% respectively). Those less familiar with the term “pandemic influenza,” males and employed people not able to work from home were less willing to comply. Conclusion In Australia, compliance with containment measures against pandemic influenza is likely to be high, should a pandemic arise, yet it could be further enhanced through a public education programme conveying just a few key messages. A basic understanding of pandemic influenza is associated with reported willingness to comply with containment measures. Investing in promoting measures to prepare for a pandemic or other health emergency will have considerable value for future eventualies.
http://www.who.int/bulletin/volumes/87/08-060772.pdf
Massey PD, Durrheim DN, Way A. Q-fever vaccination-Unfinished business in Australia
PENDING
www.ncbi.nlm.nih.gov/pubmed/19393710
Massey PD, Durrheim DN, Way A. Q-fever vaccination-Unfinished business in Australia Vaccine 2009; 27(29): 3801.
Q fever notifications suggest that the short-lived national Q fever vaccination program in Australia had a positive impact in certain at-risk populations at the time of the program, particularly abattoir workers. However, Australia’s Q fever immunisation challenge is not yet completed. There has been a shift in the epidemiology of Q fever notifications in NSW with the ongoing burden being borne by rural people who live and work in close contact with farm animals. There is a need for a sustainable program in Australia to ensure that non-abattoir workers at risk from this serious disease can access the protection offered by the available vaccine.
www.ncbi.nlm.nih.gov/pubmed/19393710
Massey PD, Irwin M, Durrheim DN Enchanced Q Fever risk exposure surveillance may permit better informed vaccination policy Communicable Diseases Intelligence 2009; 33(1): 41-45.
A review of New South Wales notifications from 1993 to 2007 and a retrospective case series were conducted using acute Q fever cases notified during 2007 from a rural area of New South Wales. Occupation was recorded for less than 50% of Q fever notifications and there was a significant increase in the ‘Farmer/Livestock’ category. In the month prior to illness onset 78% of notified cases reported direct contact with animals. Newly introduced livestock appeared to be of particular importance. 93% of cases required time off work or school, with a median of 21 days due to their Q fever disease. Improved surveillance fields are required to better describe risk exposures to inform vaccine policy.
http://www.ncbi.nlm.nih.gov/pubmed/19618770
Roberts-Witteveen AR, Campbell BA, Merritt TD, Massey PD, Shadbolt CT, Durrheim DN. Egg-associated Salmonella outbreak in an aged care facility, New South Wales, 2008. Communicable Diseases Intelligence 2009; 33(1): 49-52.
An outbreak of Salmonella Typhimurium phage type 44 (Stm 44) in an Aged Care Setting affecting 8/45 residents is described. Onset followed consumption of a dessert containing raw eggs supplied from a local farm. Stm 44 was detected on an egg in an unopened box from this supplier. The raw-egg dessert was epidemiologically implicated as the likely source of the Salmonella. Inadequate cooking of eggs continues to pose a risk for Salmonella infection in settings with vulnerable populations and advocate for food safety regulations and further measures to reduce the risks associated with the distribution, storage and preparation of shell eggs.
www.ncbi.nlm.nih.gov/pubmed/19618772
Osborn M, McPhie KA, Ratnamohan VM, Dwyer DE, Durrheim. Outbreak of Human Metapneumovirus infection in a residential aged care facility. Communicable Diseases Intelligence 2009; 33(1): 38-40.
Human metapneumovirus (hMPV) was detected by polymerase chain reaction assay in 3 specimens during a respiratory illness outbreak in an aged care facility during summer 2008. No other respiratory pathogens found. This is the first reported outbreak of hMPV in an aged care facility in Australia and this pathogen should be considered as the possible cause of outbreaks in aged care facilities when influenza and respiratory syncytial virus have been excluded.
www.health.gov.au/internet/main/publishing.nsf/.../cdi3301h.pdf
Wolfenden L, Wiggers J, Campbell E, Knight J, Kerridge K, Spigelman A Providing comprehensive smoking cessation care to surgical patients: The case for computers. Drug and Alcohol Review 2009; 28(1): 60-65.
Introduction and Aims. Providing smoking cessation care to surgical patients before admission can reduce operative risk and promote long-term smoking cessation. Our aim was to show how a comprehensive computer-based smoking cessation intervention addresses barriers to care provision by preoperative clinic staff. Design and Methods. Consultations with staff and reviews of the literature identified a number of barriers to the provision of effective smoking cessation care. Based on these findings and a small pilot trial, a comprehensive computer-based smoking cessation intervention was developed and implemented in a preoperative clinic. Data from previous evaluations of the intervention were used to assess the extent to which the intervention addressed clinician barriers to care. Results. The computer-based intervention was found to accurately identify smokers, require little clinical staff time, was considered an acceptable form of care by staff and patients, was effective in encouraging patient cessation and inexpensive to deliver relative to other surgical costs. Discussion and Conclusions.The implementation of such a model of care should be considered by clinical services interested in reducing the smoking related morbidity and mortality of patients.
http://0-www3.interscience.wiley.com.library.newcastle.edu.au/cgi-bin/fulltext/121640588/PDFSTART
Freund M, Campbell E, Paul C, Sakrouge R, McElduff P, Walsh RA, Wiggers J, Knight J, Girgis A Increasing smoking cessation care provision in hospitals: A meta-analysis of intervention effect Nicotine & Tobacco Research 2009; 11(6): 650-662
Levels of hospital smoking cessation care are less than optimal. This study aimed to examined the evidence regarding the effectiveness of interventions in increasing smoking cessation care provision in hospitals. A review identified studies published in 1994-2006. Intervention effectiveness in increasing smoking cessation care practices was examined for controlled studies using meta-analysis. The methodological qulaity of the identified studies was also examined. Of the 25 identifi ed studies, 18 were U.S. based and in inpatient settings. Of the 10 controlled trials, 4 addressed car-diac patients, 5 measured one smoking cessation care practice, and 9 implemented multistrategic interventions. The methodology described in these studies was generally of poor quality. Meta-analysis of controlled trials demonstrated a signifi cant intervention effect for provision of assistance and counseling to quit (pooled risk difference = 16.6, CI = 4.9 – 28.3) but not for assessment of smoking status, advice to quit, or the provision or discussion of NRT. Statistical heterogeneity was indicated for all smoking cessation care practices. An insufficient number of studies precluded examination of follow-up or referral for further assistance. The study concluded that interventions can be effective in increasing the routine provision of hospital smoking cessation care. Future research should use more rigorous study design, examine a broader range of smoking cessation care practices, and focus on hospital-wide intervention implementation.
http://ntr.oxfordjournals.org/cgi/reprint/11/6/650
Huppatz C, Capuano C, Palmer K, Kelly PM, Durrheim DN. Lessons from the Pacific programme to eliminate lymphatic filariasis: a case study of 5 countries BMC Infectious Diseases 2009; 9(92): 1-6
The Global Programme to Eliminate Lymphatic Filariasis aims to eliminate LF as a public health problem by the year 2020. By June 2007, five of the eleven countries classified as endemic had completed five Mass Drug Administration campaigns and post-MDA prevalence surveys to assess their progress. Of the five countries in this case study, three countries (Tonga, Niue and Vanuatu) reached the target prevalence of <1% antigenaemia following five rounds of MDA. Limitations in the data preclude identification of key determinants of this achievement.
Wolfenden L, Kypri K, Freund M, Hodder R Obtaining active parental consent for school-based research: a guide for researchers Australian and New Zealand Journal of Public Health 2009; 33(3): 270-275
The aim of the study was to identify effective strategies for the recruitment of child research participants through schools. We conducted a search of Medline, PsycINFO, Educational Resources Information Center, ProQuest 5000 and the Cochrane Library electronic databases for the period 1988 to 2008.The review found evidence that the following strategies may be effective in increasing active parental consent: promotion of the research to school principals, teachers, parents and students; dissemination of study information using methods allowing direct contact with parents; provision of incentives; reminder contacts; and having a member of the research team co-ordinate and closely monitor the recruitment process. Application of these strategies should reduce the risk of non-response and other biases that result from selective non-participation.
http://www3.interscience.wiley.com/cgi-bin/fulltext/122423660/PDFSTART
Pholi K, Black D, Richards C. Is 'Close the Gap' a useful approach to improving the health and wellbeing of Indigenous Australians? Australian Review of Public Affairs 2009; 9(2): 1-13.
" A thought provoking article on closing the health gap between Indigenous and non-Indigenous Australians"
http://www.australianreview.net/journal/v9/n2/pholi_etal.html
Freund M, Campbell E, Paul C, Sakrouge R, Lecathelinais, Knight J, Wiggers J, Walsh RA, Jones T, Girgis A, Nagle A. Increasing hospital-wide delivery of smoking cessation care for nicotine-dependent in-patients: a multi-strategic intervention trial Addiction 2009; 104(5): 839-849
Smoking care provision to in-patients is important in assisting smoking cessation and for management of nicotine withdrawal. A controlled trial, involving two intervention and two control hospitals in NSW, Australia, investigated whether a multi-strategic intervention increased hospital-wide smoking care provision. Patient surveys , medical notes audits and health professional surveys used to collect outcome data. Greater increases in intervention hospitals compared to control hospitals were found for patient-reported offer of nicotine replacement therapy (NRT) (intervention 34% versus control 12%), provision of NRT (16% versus 4%) and provision of written resources (11% versus 2%), and for the recording in medical notes of smoking management discussion (13% versus 3%), offer of NRT (24% versus 3%) and provision of NRT (21% versus 5%). Intervention group clinicians reported greater increases in the mean estimate of patients who: had their smoking management discussed (30% versus 17%); were offered or provided with NRT (30% versus 18%); were asked their intention to smoke post-discharge (22% versus 10%); and were provided with discharge NRT (21% versus 4%). The outcomes of this research suggest implementation of a multi-strategic intervention is effective in increasing hospital smoking care delivery, particularly the provision of NRT. Further research is required to identify methods to enhance the delivery of this and other forms of smoking care.
http://www3.interscience.wiley.com/journal/122309351/issue
Coleman Marlize, Coleman Michael, Mabuza AM, Kok G, Coetzee M, Durrheim DN. Using the SaTScan method to detect local malaria clusters for guiding malaria control programmes. Malaria Journal 2009; 8:68.
SaTScan software using the Kulldorf method of retrospective space-time permutation and the Bernoulli purely spatial model was used to identify malaria clusters using definitively confirmed individual cases in seven towns over three malaria seasons. SaTScan detected five space-clusters and two space-time clusters during the study period.
http://www.malariajournal.com/content/8/1/68
Durrheim DN, Freeman P, Roth I, Hornitzky M. Epidemiologic Questions fron Anthrax Outbreak, Hunter Valley, Australia. Emerging Infectious Diseases 2009; 15(5): 840-842.
A contemporaneous anthrax outbreak on multiple properties in the Hunter Valley, NSW, 69 years after the last recorded anthrax-related stock losses, raised important epidemiological questions including the source of the outbreak, transmission route/s and local characteristics to explain the nature of the outbreak.
http://www.cdc.gov/eid/content/15/5/840.htm
Massey PD, Miller A, Durrheim DN, Speare R, Saggers S, Eastwood K. Pandemic influenza containment and the cultural and social context of Indigenous communities Rural and Remote Health 2009; 9:1179. 1-3.
The needs of marginalized communities have often been neglected in pandemic planning. For containment strategies to succeed genuine and respectful partnerships with Indigenous people are essentail.
http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=1179
Edmiston N, Ooi C, Otton G, Boyle M. Vulval Crohn's Disease Sexual Health 2009; 6(1): 87-89.
A case of Vulval Crohn's disease is presented, the features of which were complicated by the presence of sexually transmissible infections.
http://www.publish.csiro.au/nid/166/issue/5048.htm
Tuyl F, Gerlach R, Mengersen Posterior predictive arguments in favor of the Bayes-Laplace prior as the consensus prior for binomial and multinomial parameters Bayesian Analysis 2009; 4(1): 151-158.
This article supports estimation of the binomial parameter based on Bayes (1763) who in the absence of prior information argued for a uniform prior. This is in contrast with more recent Bayesian methods, aimed at finding "noninformative" priors, that tend to lead to U-shaped priors. A new argument, based on the posterior predictive distribution, is supported by studying variations on an example by Fisher, and complements Bayes' original argument, which is based on the prior predictive distribution. The fact that both arguments lead to equivalent inference under transformation (e.g. when considering odds) is also discussed.
http://ba.stat.cmu.edu/journal/2009/vol04/issue01/tuyl.pdf
Wolfenden L, Wiggers J, Campbell L, Knight J, Kerridge R, Moore K, Spigelman A, Harrison M. Feasibility, acceptability, and cost of referring surgical patients for postdischarge cessation support from a quitline Nicotine and Tobacco Research 2008; 10(6): 1105-1108.
The aim of the study was to assess the feasibility, acceptability, and cost of referral of smoking patients to a proactive quitline service for cessation support following discharge. Participants were recruited from the preoperative clinic. The study found that 64% of participants accepted an offer of referral to the quitline by preoperative clinic staff, 74% of which were contacted by the quitline after discharge. Smokers and preoperative clinic staff reported that the Quitline service and the referral process was appropriate and acceptable. Referral to the quitline service cost less than US$2 per patient. Referral of patients to a quitline represents a feasible means of ensuring surgical patients are provided with smoking cessation care following hospital discharge.
Sanson-Fisher R, Campbell L, Htun AT, Bailey L, Millar C. We Are What We Do Research Outputs of Public Health American Journal of Preventive Medicine 2008; 35(4): 380-385.
If public health research does not progress beyond descriptive research to testing interventions, its contribution to evidence based practice will not be realized. This paper examined the number and percentage of public health research publications over three time periods (1987-1988, 1997-1998,2005-2006) for three issues: tobacco use, alcohol use, and physical inactivity. Methods: A literature search located a random sample of 1000 abstracts for each issue, per time period. The abstracts were first categorized as public health or not, then as data-based or non-data-based public health research. Data-based publications were classified as measurement research, descriptive/epidemiologic-research, or intervention-oriented research. Results: The number of data-based public health research publications examined for each topic was between 180 and 346 in 1987-1988, 199 and 322 in 1997-1998, and 302 and 364 in 2005-2006. Despite a significant increase over time in the percentage of intervention publications for tobacco (from 10% in 1987-1988 to 18% in 2005-2006, p 0.008), the majority of publications in all three time periods were descriptive/epidemiologic for all topics (62%-87% in 1987-1988, 64%-85% in 1997-1998, 78%-79% in 2005-2006). Conclusions: Descriptive research does not provide optimal evidence for how to reduce preventable illness. Reasons for the lack of measurement and intervention public health research are suggested.
Barnett L, Green S, van Beurden E, Campbell E, Radvan D. Older people playing ball: What is the risk of falling and injury? Journal of Science and Medicine in sport 2009;12(1):177-183.
Increasing physical activity amongst older people is an important public health initiative, yet guidance is needed to minimise the risk of injury. This paper is a prospective cohort study, which describes the incidence of falls/injuries in a walking team ball game (Lifeball). Participants were community dwelling adults from NSW Australia, who completed two telephone surveys: soon after commencing playing (2004); and 12 months later (2005). Attendance and incident records were also audited. Subjects joined a Lifeball group which played at least once per week. The baseline survey was completed by 284 players aged between 40 and 96 years (mean 67 years), with most (83.8%, 238/284) female. Average attendance for the 263 players followed up was 25 sessions, with 19.3% attending fewer than 4 sessions and 14.3% attending 52 or more sessions. No injuries requiring medical attention were reported by most (93.9%). Sixteen (6.1%) reported injuries requiring medical attention, with their 27 injuries represent an injury rate of 3.3 per 1000 hours of participation. Twenty participants (7.6%) reported a Lifeball fall equating to a fall rate of 2.8 per 1000 hours of participation. Measured predictors (age, gender, falls history, perceived falls risk or hours played) were not associated with Lifeball falls. Incident reports showed common causes of falls were a trip/stumble involving rushing, walking backwards, or overextending (all against rules). Lifeball is not ‘risk free’, although a lack of comparative data makes it is difficult to compare Lifeball injury rate to other relevant activities. Injury prevention should concentrate on enforcing safety rules.
Munnoch SA, Ward K, Sheridan S, Fitzsimmons GJ, Shadbolt CT, Piispanen JP, Wang Q, Ward TJ, Worgan TL, Oxenford C, Musto JA, McAnulty J, Durrheim DN. A multi-state outbreak of Salmonella Saintpaul in Australia associated with cantaloupe consumption Journal of Epidemiology and Infection 2008; 18: 1-8
A case-control study was conducted in NSW, Victoria and ACT in response to a multi-state outbreak of Salmonella enterica serovar Saintpaul infection. Consumption of cantaloupe (rockmelon) was strongly associated with illness (adjusted OR 23.9 95%, 95% CI 5.1-112.4). S. Saintpaul, with the outbreak MLVA profile, was detected on the skin of two cantaloupes obtained from an implicated retailer and multiple Salmonella spp. were detected in environmental samples from farms and packing plants investigated during the trace-back operation. Rockmelon production and processing practices pose a potential public health threat.
Byleveld PM, Cretikos M, Leask SD, Durrheim DN. Ensuring safe drinking water in regional NSW: the role of regulation. NSW Public Health Bulletin 2008; 19(11-12):203-207.
The NSW Health Drinking Water Monitoring Program provides guidance to water utilities on implementing elements of the Australian Drinking Water Guidelines, including drinking water monitoring. The NSW Health Water Unit, local public health units and local water utilities work together to improve the management of regional and rural water supplies. Since the introduction of the current NSW Health Drinking Water Monitoring Program to regional NSW in 2001, there has been a significant improvement in microbial compliance and adequacy of microbial sampling.
http://0-www.publish.csiro.au.library.newcastle.edu.au/nid/226.htm
Sutherland R, Finch M, Harrison M, Collins C Higher prevalence of childhood overweight and obesity in association with gender and socioeconomic status in the Hunter region of New South Wales Nutrition and Dietetics 65(4): 192-197
To determine the prevalence of overweight and obesity in primary school-aged children in the Hunter region and examine the associations with gender, age, socioeconomic status (SES) and geographical location. The prevalence of childhood obesity is high and appears more prevalent in girls and in children residing in low-income areas and at specific ages. Determinants of the observed differences will need to be investigated in order to address the higher prevalence of childhood obesity in high-risk population groups.
http://www3.interscience.wiley.com/journal/121382001/issue
Durrheim DN E-surveillance: don't neglect sentinels in developing countries The Lancet 327(96): 2021-2022
The promise of e-surveillance for alerting us to emerging infectious diesease epidemics is being fulfilled. The power of HealthMap, ProMed-mail, and the Global Public Health Intelligence Network to interrogate available global electronic and print data for infectious disease surveillance.
Leask J, Quinn H, Macartney K, Trent M, Massey P, Carr C, Turahui J Immunisation attitudes, knowledge and practices of health professionals in regional NSW Australian and New Zealand Journal of Public Health 32(3): 224-229
This study investigated that immunisation knowledge,attitudes and practices among health professional in two regional Area Health Services of NSW with low and high immunisation rates. It also compared these factors between the areas and between the health professional groups. Health professional in this study had overall confidence in the vaccines but had specific concerns about the number of vaccines given to the children and the vaccine content. These unfounded concerns may reduce parental confidence in immunisation.
http://www3.interscience.wiley.com/cgi-bin/fulltext/120091621/PDFSTART
Moses N, Wiggers J, Nicholas N Persistence of unmet need for care among people with systemic lupus erythematosus: a longitudinal study Quality of Life Research 17(6): 867-876
The extent and variability of unmet care needs over time of people with systemic lupus erythematosus (SLE) has not previously been reported. A prospective study has been undertaken to determine the variability over time of such needs. The results of the study suggest there is unacceptable persistence of care needs not being met. There is an ongoing need to identify mechanisms to help enhance care delivery so that the care needs of people with SLE are more effectively addressed.
http://www.springerlink.com/content/g3l0w41h111l0280/
Knight J, Slatter C, Green S, Porter A, Valentine M, Wolfenden L. Smoke-free hospitals: an opportunity for public health Journal of Public Health 30(4): 516
Although reported levels of enforcement activity were low and compliance with the policy less than perfect, it seems that these levels were adequate to motivate and sustain increases in withdrawal management and smoking cessation care. However, the challenge remains to achieve and maintain visible reductions in tobacco use on health service grounds and across all sites to prompt the continued provision of withdrawal management and smoking cessation care to help manage the imposed period of abstinence.
http://jpubhealth.oxfordjournals.org/cgi/content/citation/30/4/516
Unicomb LE, Dalton CB, Gilbert GL, Becker NG, Patel MS. Age-Specific Risk Factors for Sporadic Campylobacter Infection in Regional Australia. Foodborne Pathogens and Disease 2008; 5(1): 79-85.
In a case–control study in the Hunter region of New South Wales, Australia, 354 cases and 593 controls were recruited to investigate meat, other food, and environmental exposures as potential risk factors for the domestically acquired Campylobacter illness. In a multivariable model, illness was significantly associated with household exposure to the diarrheal illness, consumption of restaurant chicken or beef, eating two or more ‘‘fast’’ food meals in a week, and overseas travel. Comparing exposures for the 0- to 4-year and 5-year and the older age groups allowed detection of some additional risk factors. Eating restaurant-prepared red meat and swimming were significantly associated with Campylobacter illness in the older group only. These findings demonstrate age-specific differences in risk factors for campylobacteriosis.
http://www.liebertonline.com/toc/fpd/5/1
Unicomb LE, O'Reilly LC, Kirk MD, Stafford RJ, Smith HV, Becker NG, Patel MS, Gilbert GL. Risk factors for infection with Campylobacter jejuni flaA genotypes. Epidemiology and Infection 2008; 136(11): 1480-1491.
pending
Ewald BD, Webb CE, Durrheim DN, Russell RC Is there a risk of malaria transmission in NSW? NSW Public Health Bulletin 19(7-8): 127-131
Although Anopheles annulipes occurs in NSW it has been many years since the local transmission was documented. The factors known to influence malaria transmission are critically reviewed to determine current risk of introduction and transmission, and appropriate public health strategies to address this risk.
http://www.publish.csiro.au/nid/226/issue/4238.htm
Williams C. Spa Baths in Motel Accomodation and Pseudomonas Risk Environmental Health 2008; 8(2): 22-27
Few people realise when they fill a spa and lie back to enjoy the relaxing hydrotherapeutic effects of the warm, agitated water, that they are potentially exposing themselves to a dangerous bacteria. The accumulation of soap film, hair, dead skin, body oil, dirt and faeces in the piping system increases the nutrient load and creates ideal conditions for the bacterial survival and for multiplication. The almost universal presence of bacterial coliforms and widespread occurrence of P. aeruginosa in this survey of motel spa baths indicates an inherent problem with maintaining the standards of hygiene and sterilisation of spa baths within the motel and the bed and breakfast industry. Regular maintenance and cleaning with appropriate disinfectants between each use is critical to ensuring the safety of these facilities.
http://journal.eh.org.au/index.php?display=254
Hanson D, Hanson J, Vardon P, McFarlane K, Speare R, Durrheim D. Documenting the development of social capital in a community Safety Promotion Network: It's not what you know but who you know Health Promotion Journal of Australia 2008;19(2): 144-151
The Mackay Whitsunday Safe Communities project aimed to coordinate a network of community groups working in community safety promotion. Social Network Analysis was used to analyse the social capital mobilised by the network. The project doubled the bonding social capital and increased the bridging social capital by 160%, while linking social capital increased by 280% over a five year period. Social network analysis proved effective in describing and analysing relationships within the project.
Vellama SC, Durrheim D, Smith Je. Diagnosing childhood tuberculosis in rural clinics in Mpumalanga Province, South Africa Curationis 2008; 31(1): 52-58
Tuberculosis is a severe disease in young children and diagnosing tuberculosis in children is complex particularly challenging in developing countries where resources and access to sophisticated facilities are limited. As relatively low rates of childhood tuberculosis notification suggested tuberculosis may have been under-diagnosed in Mpumalanga Province, South Africa a study was conducted to determine the ability of the primary health care nurses to diagnose childhood tuberculosis in primary care public health facilities in Gert Sibande District, Mpumalanga Province. The study found limited use of complementary clinical and epidemiological features and diagnostic approaches to diagnose childhood tuberculosis. Child contacts screening was performed relatively infrequently and the diagnostic score chart advocated by the World Health Organization was rarely used. Nurses specifically trained on tuberculosis were more knowledgeable about diagnostic approaches and all respondents who were using the score chart had received specific tuberculosis training.
http://www.ncbi.nlm.nih.gov/pubmed/18592949
Hope K, Durrheim D, Muscatello D, Merritt T, Zheng W, Massey P, Cashman P, Eastwood K. Identifying pneumonia outbreaks of public health importance: can emergency department data assist in earlier identification? Australian and New Zealand Journal of Public Health 2008; 32(4): 361-363
We reviewed the performance of a near real-time Emergency Department (ED) Syndromic Surveillance System for identifying pneumonia outbreaks of public health importance. Retrospective data from a rural hospital that has experienced a cluster of pneumonia diagnoses among teenage males was used. With current thresholds, the ED syndromic surveillance system would have trigged a signal for pneumonia syndrome in children aged 5-16 years four days earlier than the notification by a paediatrician and this signal was maintained for 14 days.
http://www3.interscience.wiley.com/journal/117969397/home
Main K, Ansell N, Durrheim DN, Herlihy C, Porigneaux P, Tange K, Williams C Environmental Health Emergency Response to a Natural Storm Disaster in NSW, Australia Environmental Health Journal 8(1): 44-50
In June 2007, severe storms and flash flooding resulted in a natural disaster in the Hunter Valley region of NSW, Australia. We describe the magnitude of this disaster, the resultant public health threats and the environmental health response. The disaster highlights the unique contribution that the environmental health profession can make at the forefront of the response and recovery phases of a natural disaster.
http://journal.eh.org.au/archive.php
Esler D, Ooi C, Merritt T Sexual health care for sex workers Australian Family Physician 37(7): 590-592
36 sex industry workers at registered brothels in the Newcastle area of Hunter New England were interviewed in 2007 to assess current service delivery and barriers to accessing sexual health care. The majority of participants sought sexual health advice from a general practitioner (74%) compared to 37% who attended the sexual health unit. Seventy-seven percent of participants reported having their sexual health screening carried out according to guidelines. The inconvenience of clinic opening times was the most frequently reported reason for not using the sexual health unit. This study reinforces the important role that GPs play in providing sexual health care to sex industry workers.
http://www.racgp.org.au/afp/200807/25594
Dalton CB, Durrheim DN, Conroy MA Likely impact of school and childcare closures on Public Health workforce during an Influenza Pandemic: A survey Communicable Disease Intelligence 32(2): 261-262
An influenza pandemic, is likely to result in public health staff not reporting to work due to illness, transport disruptions or care responsibilities. A survey of public health staff found that 38% of staff may be absent due to the impact of childcare and school closure, however 73% of these staff would be able to work from home with most having broadband Internet access (71%).
http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3202i.htm
Wolfenden L, Wiggers J, Campbell E, Knight J Pilot of a preoperative smoking cessation intervention incorporating post-discharge support from a Quitline Health Promotion Journal of Australia 19(2): 78-80
The preoperative period has been identified as an opportune time to provide smoking cessation care to patients. Surgical patients are highly motivated to quit and are also receptive to smoking cessation intervention. However, evidence of effective intervention strategies to capatalise on this opportunity and encourage permanent smoking cessation is limited. A recent review of the past 20 years of all English language publications identified just one randomised controlled trial examining the efficacy of the intervention on long-term cessation (6-12 months post-discharge). The multi-component intervention significantly increased cessation at the six, but not the 12- month follow-up. Given the limited available evidence, the aim of this pilot study was to assess the potential efficacy of an intensive, multi-component, smoking cessation intervention.
http://www.healthpromotion.org.au/journal/August_articles/article13.php
Eastwood K, Osbourn M, Francis L, Merritt T, Nicholas N, Cashman P, Durrheim DN, Wiggers J Improving communicable disease outbreak preparedness in residential aged care facilities using an interventional interview strategy Australasian Journal of Ageing 27(3): 143-149
A study was conducted in 2005/6 to improve the capacity of residential aged care facilities (RACFs) to respond to communicable disease outbreaks. Three computer-assisted telephone interviews were conducted. The first survey gathered baseline information and then outbreak prevention resources were offered to address any perceived weaknesses. Subsequent surveys enabled the facilities’ progress to be monitored. Before the third survey, RACFs were sent a scorecard providing their standing against 19 readiness criteria. The number of RACFs with an outbreak management plan increased from 58 to 98%, and facilities reporting 16 or more of the 19 readiness criteria rose from 24 to 43% (P< 0.0006) at the second interview and 73% at the third interview (P< 0.0001). The strategy resulted in a substantial improvement in reported outbreak readiness.
http://www3.interscience.wiley.com/journal/117981049/home
Ewald B, Durrheim DN Australian Bat Lyssavirus: examination of post-exposure treatment in NSW NSW Public Health Bulletin 19(5-6): 104-107
This review of the literature ten years after the identification of Australian Bat Lyssavirus (ABL), provides best practice evidence for management and control of this recently emerged lyssavirus. The review provided the evidence for bringing post-exposure treatment against ABL in line with international approaches to lyssavirus 1 (classical rabies).
http://www.publish.csiro.au/?act=view_file&file_id=NB07050.pdf
Massey P, Durrheim DN Aboriginal and Torres Strait Islander peoples at higher risk of invasive meningococcal disease in NSW NSW Public Health Bulletin 19(5-6): 100-103
A review of NSW invasive meningococcal disease notifications between 1991 and 2005 found that reporting on Aboriginal and Torres Strait Islander status had improved significantly over this period. A significantly higher rate of invasive disease was found in Aboriginal and Torres Strait Islander children aged 0–4 years compared with their non-Aboriginal counterparts.
http://www.publish.csiro.au/?act=view_file&file_id=NB07047.pdf
Cashman P, Hueston L, Durrheim DN, Massey P, Doggett S, Russell R Barmah Forest Virus Serology: Implications For Diagnosis And Public Health Action Communicable Disease Intelligence 32(2): 263-265
Barmah Forest notifications diagnosed by a single positive IgM serology test have been increasing in the lower mid north coast of New South Wales. A prospective review of all routine notifications of BFV that 19% of patient sera contained no BFV antibodies, while 16% had BFV IgG only. A clinical presentation of fever with either rash or joint pain was associated with confirmation of recent BFV infection. Caution is advised in the interpretation of a single positive IgM for Barmah Forest disease.
http://www.health.gov.au/internet/main/publishing.nsf/content/cda-pubs-cdi-cdicur.htm
Barnes KI, Little F, Mabuza A, Mngomezulu N, Govere J, Durrheim DN, Roper C, Watkins B, White N Increased Gametocytemia after Treament: An Early Parasitological Indicator of Emerging Sulfadoxine-Pyrimethamine Resistance in Falciparum Malaria The Journal of Infectious Disease 197(11): 1605-1613
Reducing the carriage of Plasmodium falciparum gametocytes is critical for limiting malaria transmission and the spread of resistance. Biannual assessment of clinical and parasitological responses to the fixed-dose combination of sulfadoxine and pyrimethamine in patients with uncomplicated falciparum malaria provided evidence that increased duration and density of gametocyte carriage after sulfadoxine pyrimethamine treatment was an early indicator of drug resistance. This increased gametocytemia among patients who have primary infections with drug-resistant Plasmodium falciparum fuels the spread of resistance even before treatment failure rates increase significantly.
http://www.journals.uchicago.edu/toc/jid/2008/197/11
Huppatz C, Durrheim DN, Lammie P, Kelly P, Melrose M Eliminating lymphatic filariasis - the surveillance challenge Tropical Medicine and International Health Journal 13(3): 292-294
Lymphatic filariasis is one of the leading causes of disability worldwide. In 1997, the WHO launched the Global Programme to Eliminate Lymphatic Filariasis, which aims to eliminate LF from 80 countries in which it is endemic, by the year 2020 using a primary strategy of annual mass drug administration for five years. Now that a number of countries have completed their planned number of MDA rounds important decisions are required about future surveillance needs. This paper reviews the challenges of surveillance of an infection that is often asymptomatic for an extended period, has relatively poor surveillance diagnostic tests available and which is becoming increasingly rare.
Dalton C, Cretikos M, DN Durrheim A food "lifeboat": food and nutrition considerations in the event of a pandemic or other catastrophe Medical Journal of Australia 188(11): 679
Rather than providing nutritional guides as to what foods should be stockpiled for household disaster preparedness, it is more useful to encourage families to increase the amount and rotation of the non-perishables they currently purchase.
http://www.mja.com.au/public/issues/188_11_020608/letters_020608_fm-5.html
Hopewell S, Wolfenden L, Clarke M Reporting of adverse events in systematic reviews can be improved: survey results Journal of Clinical Epidemiology 2008; 61(6): 597-602
Objective: To assess reporting of adverse events in systematic reviews. Study Design and Setting: Cochrane reviews and reviews (2003e2004) in the Database of Abstracts of Reviews of Effects (DAREs) were included. Results: Over 50% of Cochrane (44/78) and DARE (46/79) reviews assessed drug interventions. Seventy-six percent (59/78) of Cochrane reviews mentioned adverse events as an outcome compared with 48% (38/79) of DARE reviews. Of reviews mentioning adverse events, 95% (56/59) of Cochrane reviews included only randomized trials and 73% (43/59) compared with, 58% (22/38) of DARE reviews. Conclusions: Most Cochrane reviews of drug interventions considered adverse events. This was not the case for DARE reviews and for Cochrane reviews of nondrug interventions.
http://www.ncbi.nlm.nih.gov/pubmed/18411039
Cretikos M, Eastwood K, Dalton C, Merritt T, Tuyl F, Winn L, Durrheim DN Household disaster preparedness and information sources: Rapid cluster survey after a storm in New South Wales, Australia Biomed Central Public Health Journal 2008; 8(195): 1:16
Background A storm-related disaster in the Hunter and Central Coast area of New South Wales, Australia in June 2007 caused infrastructure damage, interrupted essential services and presented significant public health risks. Household disaster preparedness and information sources used before and during the disaster was investigated using a survey tool. Methods A rapid cluster survey was conducted within a fortnight of the storm and included 320 randomly selected households in Newcastle and Lake Macquarie. Results 227 households (71%) completed to the survey. By the day before the storm, 48% (95%CI 40-57%) of households reported that they were aware of a storm warning, principally through television (67%; 58-75%) and radio (57%; 49-66%). Storm preparations were made by 42% (28-56%) of these households. Storm information sources included: radio (78%; 68-88%); family, friends, colleagues and neighbours (50%; 40-60%); and television (41%; 30-52%). Radio was considered more useful than television (62%; 51-73% vs. 29%; 18-40%), even in households where electricity supply was uninterrupted (52%; 31-73% vs. 41%; 20-63%). Awareness that radio networks had a designated communication role during disasters with only 23% (16-30%) of households were aware of this important source of information. A battery-operated household radio and appropriate batteries were available in 42% (34-50%) of households, while only 23% (16-29%) maintained what is regarded as a complete basic set of survival gear: a torch, battery-operated radio, appropriate batteries, mobile phone, emergency contact list and first aid equipment. Conclusion Broadcast media are important information sources immediately before and during disasters. Health services should promote awareness of broadcast networks’ disaster role, especially the role of radio, and encourage general household disaster preparedness. They also have a role in promoting the maintenance of basic survival gear. A rapid cluster survey conducted shortly after a natural disaster provided practical, robust information for disaster planning.
http://www.biomedcentral.com/1471-2458/8/195
Freund M, Campbell E, Paul C, McElduff P, Walsh RA, Sakrouge R, Wiggers J, Knight J Smoking care provision in hospitals: A review of prevalence Nicotine and Tobacco Research Journal 2008; 10(5): 757-774
Despite hospitals being an important settings for the provision of smoking, limited evidence has described the prevalence such care delivered routinely in hospitals. We reviewed studies conducted in hospitals that were published between 1994 and 2005 and reported levels of smoking care delivery. This review describes the proportion of patients receiving, and the proportion of clinical staff providing, various smoking cessation care practices. Both descriptive and meta-analytic approaches were used. Meta-analytic outcomes demonstrated smoking status was assessed in 60% of patients, 42% were advised or counseled to quit, 14% were provided with or advised to use nicotine replacement therapy (NRT), and 12% received referrals or follow-up. Approximately 81% of clinical staff reported they assessed smoking status, 70% advised or counseled patients to quit, 13% provided NRT or advised its use, and 39% provided referrals or follow-up. Statistical heterogeneity was indicated for all smoking care practices. It was concluded the level of smoking cessation care currently provided in hospitals is less than optimal. Research should endeavour to identify effective methods for increasing smoking care provision in hospitals. Hospitals should enhance and continue to monitor their delivery of smoking care.
http://www.informaworld.com/smpp/content~content=a793512112~db=all~jumptype=rss
Stafford R, Schluter P, Wilson A, Kirk M, Hall G, Unicomb L Population-Attributable Risk Estimates for Risk Factors Associated with Campylobacter Infection, Australia Emerging Infectious Diseases Journal 2008; 14(6): 895-901
Among foodborne risk factors, an estimated 50,500 (95% credible interval 10,000-105,500) cases of Campylobacter infection in persons >5 years of age could be directly attributed each year to the consumption of chicken in Australia. Our statistical technique could be applied more widely to the other communicable diseases that are subject to routine surveillance. Foodborne gastroenteritis is a major public health concern in many countries, including Australia.
http://www.cdc.gov/eid/content/14/6/pdfs/895.pdf
Tuyl F, Gerlach R, Mengersen K A Comparison of Bayes-Laplace, Jeffreys, and Other Priors: The Case of Zero Events The American Statistician Journal 2008; 62(1): 40-44
This paper concerns the Bayesian approach to estimation of the binomial parameter, which is different from the classical or frequentist approach. Bayesian intervals are less conservative than the so-called exact interval, and generally similar to e.g. Wald and Score intervals, except for extreme data outcomes. Here Bayesian intervals based on different "noninformative" prior distributions can be quite different also. This paper shows that when a sample is comprised of successes or failures only, the uniform prior originally recommended by Bayes (1763) performs better than various alternative noninformative priors. Specifically, it is shown that when adopting the usual beta(a,b) prior, which is uniform when a=b=1, use of a<1 and/or b<1 leads to overinformative inference when data are extreme.
http://www.ingentaconnect.com/content/asa/tas/2008/00000062/00000001;jsessionid=glbabj88sn3ji.alice
Freund M, Campbell E, Paul C, Wiggers J, Knight J, Mitchell E Provision of smoking care in NSW hospitals: opportunities for further enhancement NSW Public Health Bulletin 2008; 19(3-4): 50-55
The provision of smoking care is an important part of overall care for hospitalised patients, however, levels of smoking care delivery in hospitals are reported to be inadequate. Increasing smoking care across multiple units and hospitals within NSW Health will be challenging. This paper examines smoking care delivery levels in NSW hospitals, and potential strategies to increase such care. It also reviews NSW Health initiatives designed to enhance the delivery of smoking care and suggests further strategies that may facilitate this.
http://www.publish.csiro.au/?act=view_file&file_id=NB07102.pdf
Coleman M, Coleman M, Kok e G, Coetzee M, Durrheim D Evaluation of an operational malaria outbreak identification and response system in Mpumalanga Province, South Africa Malaria Journal 2008; 7(69): 1-26
Pending
http://www.malariajournal.com/content/7/1/69
Huppatz C, Munnoch S, Worgan T, Merritt T, Dalton C, Kelly P, Durrheim D A norovirus outbreak associated with consumption of NSW oysters: implications for quality assurance systems Communicable Disease Intelligence Journal 2008; 32(1): 88-91
Pending
Hope K, Merritt T, Eastwood K, Main K, Durrheim D, Muscatello D, Todd K, Zheng W The Public Health value of Emergency Department Syndromic Surveillance following a Natural Disaster Communicable Disease Intelligence Journal 2008; 32(1): 92-93
Pending
Ng J, Eastwood K, Durrheim DN, Massey P, Walker B, Armson A, Ryan U Evidence supporting zoonotic transmission of Cryptosporidium in rural New South Wales Experiemental Parasitology Journal 2008; 119(1): 192-195
Cryptosporidium hominis and Cryptosporidium parvum are the two species primarily responsible for causing infection in humans. The study took Cryptosporidium in 7 human and 15 cattle cases of sporadic cryptosporidiosis in rural western NSW during the period from November 2005 to January 2006 and identified them to the level of species/genotype and subgenotypes. This was determined by PCR sequence analysis of the 18S rRNA and C. parvum and C. hominis isolates were subgenotyped by sequence analysis of the GP60 gene. Fourteen of 15 cattle-derived isolates were identified as C. parvum and 1 as a C. bovis/C. parvum mixture. Four of the human isolates were C. parvum and 3 were C. hominis. Two different subgenotypes were identified with the human C. hominis isolates and six different subgenotypes were identified within the C. parvum species from humans and cattle. All of the C. parvum subtypes found in humans were also found in the cattle, suggesting that zoonotic transmission may be an significant contributor to sporadic human cases of cryptosporidiosis in rural NSW.
http://0-www.sciencedirect.com.library.newcastle.edu.au/science
Cretikos M, Eastwood K, Durrheim DN Exercise Paton: A simulation exercise to test New South Wales Emergency Departments' Response to Pandemic Influenza Communicable Disease Intelligence Journal 2008; 31(4): 419-419
The short report on the influenza pandemic exercise, Exercise Paton, clearly demonstrates Australia’s commitment to preparing for an influenza pandemic. The exercise focused on containment activities, which forms the first phase of any Australian response. In order for containment to be effective, public health staff need to be able to rapidly identify suspected cases of pandemic influenza. Furthermore, successful home quarantine for contacts of pandemic influenza cases will depend on their ability to reliably monitor themselves for symptoms of influenza, including fever. The interim case definition for pandemic influenza includes a specific criterion for fever of ≥38ºC. The assumption that most community contacts of pandemic influenza will have a thermometer at home may be misguided as there is scant information regarding the availability of thermometers in Australian households. Data we collected during the storms in the Hunter region of NSW in June 2007 showed that only 48% (95% confidence interval 41-54%) of households had a thermometer available at home.
Wolfenden L, Campbell E, Wiggers J, Walsh RA, Bailey L Helping hospital patients quit: What the evidence supports and what guideliens recommend Preventive Medicine Journal 2008; 46(4): 346-357
The study aimed to review the Cochrane meta-analytic evidence for, and clinical practice guidelines recommendations regarding smoking cessation interventions for hospital patients. The review found that there was limited evidence from Cochrane reviews to assess the effectiveness of specific smoking cessation strategies for hospital patients. Clinical practice guidelines were found to provide recommendations for a variety of smoking cessation practices, such as the provision of brief advice, counselling, NRT and follow-up support. However at times, the clinical practice guideline recommendations were unsupported by, or conflicted with evidence from Cochrane meta-analyses.
http://www.sciencedirect.com/science/journal/00917435
WolfendenL. Smoke-free licensed premises: what will be the broader public health benefits? Australian and New Zealand Journal of Public Health 2008; 32(1): 88.
While supporting the pre-legislation assertions of the industry, the findings may be indicative of broader social and public health benefits of the ban. A rigorous evaluation of the effect of the legislation on other social and health-related behaviours may also strengthen the case for other governements to adopt such a strong public policy.
http://www.blackwell-synergy.com/toc/azph/32/1
Durrheim DN, Wenitong M, Huppatz C, Rubin G. The first 100 days: an open letter to the new Minister for Health and Ageing. Medical Journal of Australia 2008; 188(3): 188-189.
The greatest health challenge to the newly elected Federal Government is to effectively address the deplorable backlog in Aboriginal Health experience as a matter of urgency. This needs real investment in addressing the broad determinants of health status and the specific measures should be determined in consultation with Aboriginal leaders. The new Health Minister is challenged to serve as the champion of this issue amongst her Cabinet colleagues.
http://www.mja.com.au/public/issues/188_03_040208/letters_040208_fm.pdf
Mehta U, Durrheim DN, Blockman M, Kredo T, Gounden R, Barnes KI. Adverse drug reactions in adult medical inpatients in a South African hospital serving a community with a high HIV/AIDS prevalence: prospective observational study British Journal of Clinical Pharmacology 2007; Epub ahead of print: 1-12.
The first Sub-Saharan African study in the HIV/AIDS era describing the contribution of Adverse Drug Reactions (ADRs) to patient morbidity, hospitalisation and mortality found that cardiovascular medicines and antiretroviral therapy contributed the most to community-acquired ADRs at the time of hospital admission, while medicines used for opportunistic infections (such as antifungals, antibiotics and antituberculosis medicines) were most frequently implicated in hospital acquired ADRs. Many of the HIV-related admissions were among patients not receiving Anti Retroviral Therapy, and many ADRs were associated with medicines used for managing opportunistic infections.
http://www.blackwellpublishing.com/journals/BJCP
Huppatz C, Durrheim DN. Control of Neglected Tropical Diseases. New England Journal of Medicine 2007; 357(23): 2407-2408.
The need for surveillance for the neglected tropical diseases is advocated. Despite resource and methodological challenges, without adequate surveillance the ultimate success of programmes will not be able to be established, nor ongoing elimination confirmed.
http://content.nejm.org/cgi/content/extract/357/23/2407
Cretikos MA, Merritt TD, Main K, Eastwood K, Winn L, Moran L, Durrheim DN. Mitigating the health impacts of a natural disaster- the June 2007 long-weekend storm in the Hunter region of New South Wales Medical Journal of Australia 2007; 187(11-12): 670-673.
A severe storm affecting Newcastle and the Hunter Valley during June 2007 caused widespread flooding and damage to houses, businesses, schools and health care facilities, and damaged critical infrastructure, resulting in a natural disaster being declared in 19 local government areas. Interruption of the electricity supply to over 200 000 homes and businesses, interruption of water and gas supplies, and sewerage system pump failures presented substantial public health threats. The activities conducted by the public health emergency operations centre coordinating surveillance activities, responding to acute public health issues and preventing disease outbreaks are presented.
Massey P, Durrheim DN, Speare R. Inadequate chemoprophylaxis and the risk of malaria Australian Family Physician 2007; 36(12): 1058-1060.
BACKGROUND Malaria is an important disease for Australian travellers, particularly to Papua New Guinea. Chemoprophylaxis along with mosquito-bite prevention strategies are effective in preventing malaria in travellers. During 2007, six people were diagnosed with malaria from a group of 38 who had travelled to Papua New Guinea. This cluster of cases prompted a public health investigation. METHOD A retrospective cohort investigation into malaria risk in a group of adult Australians that trekked the Kokoda trail in Papua New Guinea was undertaken. RESULTS All of the group members were contacted and agreed to be a part of the investigation. Of the 12 individuals who took chemoprophylaxis for the recommended period post-travel none developed malaria compared to 4/24 travellers who terminated prophylaxis prematurely, and 2/2 developed malaria who had taken no chemoprophylaxis for the trip. DISCUSSION Chemoprophylaxis is effective if taken for the full recommended period following travel to a malaria endemic area. The recommendations for the post-travel period are: 4 weeks for doxycycline and mefloquine, and 7 days for atovaquone+proguanil.
http://www.afp.racgp.org.au/afp/200712/21099
Massey P, Durrheim DN. Income inequality and health status: A nursing issue Australian Journal of Advanced Nursing 2007; 25(2): 84-88.
Objective To review the association between income inequality and health status, and consider an appropriate nursing response. Results There is an incontrovertible association between population health status, absolute income levels and income inequality. In a review of the social determinants of health, the World Health Organisation concluded that relative poverty, as well as absolute poverty and social exclusion, had major impacts on health. Relative poverty denies people access to housing, education, transport and other societal benefits. Health experiences are often poorer when people are treated as less than equal and excluded from society. Discussion Nursing practice must apply justice as one of the key principles to resolve the tension between the health of individuals and the health of communities and populations. It is easy to focus on the health of individuals and neglect the socio-economic challenges at a wider population level. Nursing has a central role in advocating for changes in area that would improve the health of the population. These areas include improved access to and quality of schooling, health care, social welfare and working conditions. Conclusion There is a definite relationship between income inequality and health. This relationship appears to be determined both by relative access to resources for health and relative social position. Improved social cohesion may explain the health differences in communities and populations where there is less income inequality. As social factors are at the base of much health inequality, this understanding needs to invoke political action and advocacy from the nursing profession.
http://www.ajan.com.au/ajan_25.2.html
Sanigorski AM, Bell AC, Kremer PJ, Swinburn BA High Childhood Obesity in an Australian Population Obesity 2007; 15(8): 1908-1912.
Over weight and obesity in Australia is well documented. The aim of this study was to determine the prevalence of overweight and obesity in regional Australian children and to examine the likelihood of these children being overweight/obese by area- and individual-level indicators of household socioeconomic status.
Scragg R, Sowers M, Bell C. Serum 25-hydroxyvitamin D, Ethnicity, and Blood Pressure in the Third National Health and Nutrition Survey American Journal of Hypertension 2007; 20(7): 713-719.
Populations with low vitamin D status, such as blacks living in the US or UK, have increased blood pressure (BP) compared with whites. We analyzed the association between serum 25-hydroxyvitamin D (25OHD) and BP to determine whether low 25OHD explains any of the increased BP in blacks. The Third US National Health and Nutrition Examination Survey (NHANES III) is a cross-sectional survey representative of the US civilian population during 1988 to 1994. Analyses were restricted to 12,644 people aged ≥20 years with measurements of BP and 25OHD, after excluding those on hypertensive medication. Adjusted mean serum 25OHD was lowest in non-Hispanic blacks (49 nmol/L), intermediate in Mexican Americans (68 nmol/L), and highest in non-Hispanic whites (79 nmol/L). When participants were divided into 25OHD quintiles, mean (standard error) systolic BP was 3.0 (0.7) mm Hg lower (P = .0004) and diastolic BP was 1.6 (0.6) mm Hg lower (P = .011) for participants in the highest quintile (25OHD ≥85.7 nmol/L) compared with the lowest (25OHD ≤40.4 nmol/L), adjusting for age, sex, ethnicity, and physical activity. Further adjustment for body mass index (BMI) weakened the inverse association between 25OHD and BP, which remained significant for systolic BP (P < .05). Ethnic differences in 25OHD explained about half of the increased hypertension prevalence in non-Hispanic blacks compared with whites. Vitamin D status, which can be increased by safely increasing sun exposure or by supplementation, was associated inversely with BP in a large sample representative of the US population.
www.elsevier.com/wps/product/cws_home/505742
Swinburn B, Bell C, King L, Magarey A, O'Brien K, Waters E. Obesity prevention programs demand high-quality evaluations Australia and New Zealand Journal of Public Health 2007; 31(4): 305-307.
Obesity prevention programs are springing up in response to growing concerns about childhood obesity. This is a very welcome development following more than a decade of inaction since the epidemic was recognised in the mid-1990s. Another welcome development has been the increased emphasis on using evidence to inform public health practice, programs and policies. Unfortunately, knowing what works and what does not work for obesity prevention is difficult because the evidence base is so limited and the settings in which interventions have been tested are so few (mainly primary schools). The Primary Prevention Group of the Australian Childhood and Adolescent Obesity Research Network (ACAORN) is concerned that some obesity prevention programs are being planned or implemented with insufficient priority being placed on appropriate designs or sufficient funding for rigorous evaluation. Expensive programs with weak evaluations waste precious resources, fail to contribute to their own quality enhancement, and also fail to contribute much-needed effectiveness evidence to the literature. These exact concerns have also recently been raised about the United Kingdom (UK) response to childhood obesity by the UK Audit Office. This article proposes opportunities to lift the quality of evaluation of obesity prevention programs in the region.
http://www.blackwellpublishing.com/journal.asp?ref=1326-0200
Measey M, Charles A, Tursan d'Espaignet E, Nicholas deKlerk CH, Douglass C. Aetiology of stillbirth: unexplored is not unexplained Australia and New Zealand Journal of Public Health 2007; 31(5): 444-449.
To describe the rate of and demographic factors associated with fetal postmortem investigation and to classify the cause of all fetal deaths that underwent postmortem investigation. To compare the proportion of deaths remaining unexplained after postmortem investigation with estimates derived from death certificates. Method: All fetal deaths in Western Australia (WA) from 1990 to 1999 were identified. These data were used to calculate postmortem rates and describe the characteristics of women consenting to postmortems. A multidisciplinary team classified the cause of all deaths that underwent postmortem investigation using the Perinatal Society of Australia and New Zealand Perinatal Death Classification System. The proportion of deaths that were unexplained was compared with estimates based on death certificates.
http://blackwell-synergy.com/toc/azph/31/5
Todd K, Durrheim DN, Pickles R, Eastwood K, Merritt T, Tapsall J, Sanghamitra R, Limnios A. Using epidemiological and molecular methods to investigate an outbreak of gonorrhoea associated with heterosexual contact in Newcastle, NSW, Australia Sexual Health 2007; 4(4): 233-236
Gonorrhoea is a laboratory-notifiable condition in NSW under the NSW Public Health Act 1991. The Hunter New England Health Area in NSW, with its population of 840 000, has an average of 49 notifications of gonococcal infection per annum (range 27-69 based on notifications for 1996-2004). By the third week of October 2005, it was noted that 16 cases of gonorrhoea had already been notified for that month. A retrospective epidemiological investigation of all notified cases and to prospectively followup all new notifications to determine risk factors for transmission and explore possible links between cases with a view to defining and interrupting the outbreak.
http://www.publish.csiro.au/nid/166/issue/3767.htm
Merritt T, Durrheim DN, Hope K, Byron P. General practice intervention to increase opportunistic screening for chlamydia Sexual Health 2007; 4(4): 249-251
We describe an intervention in 6 General Practices over an 18-month period that was designed to improve opportunistic screening for chlamydia. Key strategies included engaging and informing general practitioners, adopting a simplified screening protocol, providing feedback on practice testing performance and developing resources for use with patients. The overall impact on testing was modest and largely transient, and was insufficient to impact on the current chlamydia epidemic. Major additional measures would be required to further substantially increase testing levels. These could include financial incentives linked to screening performance and increased community awareness to increase patient demand for testing.
http://www.publish.csiro.au/nid/166/issue/3767.htm
Durrheim D. A clarion call for greater investment in global sanitation The Lancet 2007; 370(9599): 1592-1593.
Thousands of people worldwide continue to die from cholera and other infections spread through faecally contaminated drinking water supplies. This reflects intolerable inequity at a global level. The Millennium Development Goals (MDGs) aim to halve the proportion of people without access to basic sanitation by 2015. Work from rural Brazil provides evidence for the impact of sanitation schemes on reducing the impact of diarrhoea in childhood. Rigorous science is a valuable method for persuasive advocacy.
Kremer PJ, Bell AC, Swinburn BA. Calibration and reliability of a school food checklist: a new tool for assessing school food and beverage consumption. Asia Pacific Journal of Clinical Nutrition 2006;15(4): 465-472
The prevalence of childhood obesity is increasing in Australia and it is likely that inappropriate eating patterns are a major contributor. However, capturing childrens eating behaviours is difficult because of a lack of tools to assess the intake of food
hec.server101.com/APJCN/loginpast.htm
Govere JM, Durrheim DN. (Debboun M, Frances SP, Strickman DA. Insect Repellents: Principles, Methods, and Uses Chapter Techniques for Evaluating Insect repellents Taylor & Francis CRC Press 2007; 084371961: Chapter 8:147-159
Evaluation of insect repellents should be as simple and practical as possible to encourage standard comparison and universal acceptance. Although candidate repellents should be taken to the field to determine protection time and effectiveness under field
Wells V, Gillham K, Licata M, Kempton A. An equity-focussed social impact assessment of the Lower Regional Strategy. NSW Public Health Bulletin 2007; 18(9-10): 166-168.
This paper reports on an equity-focused social impact assessment (SIA) of the Lower Hunter Regional Strategy, which was released by the Hunter Department of Planning. The aim of the SIA was to document the proposed social and health impacts of the Strategy. The SIA was undertaken in collaboration with representatives of the Hunter Regional Coordination Management Group and managed by NSW Premier's Department, Hunter Branch and Hunter New England Population Health.
http://www.publish.csiro.au/nid/226.htm
Cashman P, Durrheim D, Massey P, Islam F, Merritt T, Eastwood K. Pneumonia cluster in a boarding school- implications for influenza control. Communicable Diseases Intelligence 2007; 31(3): 296-298. Communicable Disease Intelligence Journal 2008; 31(3): 296-298
An outbreak of community acquired pneumonia affected 25 previously well students in a New South Wales boarding school, with Streptococcus pneumoniae 1 confirmed in two cases. The school experienced a concurrent influenza outbreak with a high influenza-lik
http://www.health.gov.au/internet/wcms/publishing.nsf/Content/cda-pubs-cdi-cdiintro.htm
Chui C, Durrheim D. A review of the efficacy of human Q fever vaccine registered in Australia. NSW Public Health Bulletin 2007; 18(7-8):133-136
Australia has a registered Q fever vaccine that is recommended in high risk occupational groups. A literature review found that its efficacy ranged from 83-100% but study designs limitations hampered a precise estimate. The Q fever vaccine available in Au
http://www.publish.csiro.au/nid/226.htm
Irwin M, Lloyd A, Massey P. Bug Breakfast in the Bulletin: Q fever. NSW Public Health Bulletin 2007; 18(7-8): 137-138.
Q fever remains a significant public health concern, particularly for rural communities. Australia has access to the only licensed vaccine against Q fever available worldwide (QVax, CSL Ltd). Immunisation of high-risk occupational groups has been the majo
http://www.publish.csiro.au/nid/226.htm
Mehta U, Durrheim D, Mabuza A, Blumberg L, Allen E, Barnes K. Malaria Pharmacovigilance in Africa Lessons from a Pilot Project in Mpumalanga Province, South Africa. Drug Safety 2007; 30(10): 899-910.
A pharmacovigilance strategy consisting of five methods of detecting serious adverse drug reactions (ADRs) and signals related to artesunate plus sulfadoxine/pyrimethamine was implemented in rural Mpumalanga province, South Africa. The evaluation demonstr
http://drugsafety.adisonline.com/
Wolfenden L, Wiggers J. Addressing the heath costs of the Iraq war: the role of the health organisations. Medical Journal of Australia 2007; 186(7): 380-381.
The purpose of the letter was to describe the effects of the Iraq war on the health of the civilian population. The letter calls on health professionals, health associations and Governments to do more to alleviate the burden of a war which has already cla
Monaghan K, Durrheim D, Arzey G, Branley J. Human Psittacosis Associated with Purchasing Birds from, or Visiting, a Pet Store in Newcastle, Australia. Environmental Health 2007; 7(2): 52-61.
Over an 18 month period five confirmed and one probable notified human psittacosis cases were linked to exposure to caged birds from the same pet store. A public health investigation identified a number of high risk practices at the implicated pet shop. T
http://journal.aieh.org.au/index.php
van Zutphen M, Bell AC, Kremer PJ, Swinburn BA. Association between the family environment and television viewing in Australian children. Journal of Paediatrics and Child Health, 2007; 43(6): 458-463.
Aim: To describe the time children spend watching television (TV) and to assess associations between TV viewing time, the family environment and weight status. Methods: As part of a large cross-sectional study conducted in 2002/3, parents in the Barwon
http://www.blackwellpublishing.com/submit.asp?ref=1034-4810
Sanigorski AM, Bell AC, Swinburn BA. Association of key foods and beverages with obesity in Australian schoolchildren. Public Health Nutrition, 2007; 10(2): 152-157.
Objective: To examine the pattern of intake of key foods and beverages of children aged 4–12 years and the association with weight status. Parents/guardians of 2184 children from Barwon South Western region of Victoria, were interviewed to find out
http://www.nutritionsociety.org/index.asp?nsm=3&page=63
Byles J, Parkinson L, Nair B, Watson J, Valentine M Determining priorities for research in ageing: A community survey Australasian Journal of Ageing 2007; 26(2): 71-76.
This paper reports the findings of a community survey undertaken as the last step in local priority settings for ageing research. Four research factors were identified: age-related diseases, symptoms and the problems of ageing, lifestyle factors, mental
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1741-6612.2007.00218.x
Wiggers J Reducing alcohol-related violence and improving community safety: the Alcohol Linking Program NSW Public Health Bulletin 2007; 18(5-6): 83-85.
Harm associated with the consumption of alcohol on licensed premises is an issue of increasing community concern. This paper reports on a decade-long research initiative that involved the development and the implementation of police systems designed to e
http://www.publish.csiro.au/?act=view_file&file_id=NB07061.pdf
Durrheim D, Kelly H, Ferson M, Featherstone D Remaining measles challenges in Australia Medical Journal of Australia 2007; 187(3): 181-184.
Measles is now rare in Australia, and cases are usually linked to importation from endemic countries. To prevent measles outbreaks in Australia, high vaccination coverage with two doses of the vaccine must be sustained.
http://www.mja.com.au/public/issues/187_03_060807/dur10061_fm.html
Wynd S, Durrheim D, Carron J, Selve B, Chaine JP, Leggat P, Melrose W Socio-cultural insights and lymphatic filariasis control - lessons from the Pacific Filaria Journal 2007; 6(3): 1-4.
The increasing interest in socio-cultural LF research presents a unique opportunity for coupling socio-cultural and bio-medical understandings of LF. To address the backlog in the socio-cultural sphere it will require the investment of time and effort to
http://www.filariajournal.com/content/pdf/1475-2883-6-3.pdf
Vally H, Dowse G, Eastwood K, Cameron S An outbreak of chickenpox at a child care centre in Western Australia. Costs to the community and implications for vaccination policy Australian and New Zealand Journal of Public Health 2007; 31(2): 113-119.
Between May and June 2002 an outbreak of chickenpox occurred at the child care centre in Perth, Western Australia. An epidemiological study was undertaken in order to determine the characteristics of the outbreak, assess vaccine effectiveness, and to als
http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1753-6405.2007.00027.x
Finch M, Begley A, Sutherland R, Harrison M, Collins C Development and reproducibility of a tool to assess school food-purchasing practices and lifestyle habits of Australia primary school-aged children Nutrition and Dietetics 2007; 64(2): 86-92.
The School Eating Habits and Lifestyle Survey has been developed and pilot-tested in primary school-aged children and has shown to have moderate stability over time. The results show that each phase of development, particularly those spent in consultatio
http://www.ingentaconnect.com/content/bsc/ndi/2007/00000064/00000002/art00005
Mehta U, Durrheim D, Blumberg L, Donohue S, Hansford F, Mabuza A, Kruger P, Gumede K, Immelman E, Canal Sanchez A, Hugo J, Swart G, Barnes K Malaria deaths as sentinel events to monitor healthcare delivery and antimalarial drug safety Tropical Medicine and International Health 2007; 12(5): 617-628.
To identify case management, health system and antimalarial drug factors contributing to malaria deaths. A confidential enquity into malaria-related deaths is a useful tool for identifying the preventable factors, health system failures and also adverse
http://www.blackwell-synergy.com/toc/tmi/12/5
Wolfenden L, Dalton A, Bowman J, Knight J, Burrows S, Wiggers J Computerized assessment of surgical patients for tobacco use: accuracy and acceptability Journal of Public Health 2007; 29(2): 183-185.
Despite increased risks of postoperative complications among patients who use tobacco, a number of barriers hinder the systematic identification of the surgical patients who smoke. The study investigated the accuracy and the acceptability of a patient-co
http://jpubhealth.oxfordjournals.org/cgi/reprint/fdm015v1.pdf
Merritt T, Sintchenko V, Jelfs P, Worthing M, RObinson B, Durrheim D, Gilbert G An outbreak of pulmonary tuberculosis in young Australians Medical Journal of Australia 2007; 186(5): 240-242.
Clinicians should maintain a high index of suspicion for pulmonary TB in a person presenting with a cough lasting more than 3 weeks, weight loss, haemoptysis, night sweats and also chest pain, even if the person is not an overseas-born or elderly. A comp
http://www.mja.com.au/public/issues/186_05_050307/mer10787_fm.html
Dalton C Business Continuity Management and Pandemic Influenza NSW Public Health Bulletin 2006; 17(9-10): 138-141.
Pandemic influenza planning presents challenges for both government and businesses. Effective cooperation and communication before and also during a pandemic will help mitigate the major threats to societal function. The major challenges for governement
http://www.publish.csiro.au/?act=view_file&file_id=NB06035.pdf
Muscatello D, Cretikos M, Bartlett M, Churches T, Carter I, Eastwood K, Heron L, McPhie K Planning for pandemic influenza surveillance in NSW NSW Public Health Bulletin 2006; 17(9-10): 146-149.
Early detection of the novel strain of influenza virus in NSW population is the key to controlling a pandemic. If this occurs, then ongoing surveillance will help determine the epidemiology and risk factors of the virus as well as its impact on essential
http://www.health.nsw.gov.au/pubs/date/2007.html
Sharp B, Kleinschmidt I, Streat E, Maharaj R, Barnes K, Durrheim D, Ridl F, Morris N, Seocharan I, Kunene S, Grange J, Mthembu J, Maartens F, Martin C, Barreto A Seven Years of Regional Malaria control collaboration - Mozambique, South Africa, and Swaziland Americal Journal of Tropical Medicine and Hygiene 2007; 76(1): 42-47.
The Lubombo Spatial Development Initiative is a joint development program between governments of Mozambique, Swaziland, and South Africa which includes malaria control as a core component .
http://www.ajtmh.org/cgi/content/abstract/76/1/42
Wynd S, Carron J, Selve B, Leggat P, Melrose P, Durrheim D Qualitative analysis of the impact of a lymphatic filariasis elimination programme using mass drug administration on Misima Island, Papua New Guinea Filaria Journal 2007; 6(1): 1-1.
Although interim evaluation indicates the programme has been parasitologically successful, an appreciation that sustainable health gains depend on the understanding and accommodating of local beliefs prompted this qualitative study.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1770912
Ferson MJ, Durrheim DN Investing in capacity to meet the challenge of an Influenza Pandemic NSW Health Bulletin 2006; 17: 129-130.
Further developments and improvements in systems, including the staged introduction of electronic transfer of laboratory notifications and the linking of influenza diagnostic data from animal to human sources, will place NSW in a good position to provide
http://www.health.nsw.gov.au/public-health/phb/phb.html
Moses N, Wiggers J, Nicholas C, Cockburn J Development and psychometric analysis of the systemic lupus erythematosus needs questionnaire Quality of Life Research 2007; 16(3): 461-466.
This study aims to develop a self-administered needs assessment questionnaire for people with systemic lupus erythematosus (SLE), assess its face, content and also construct validity and test reliability of the instrument. Eighty-four people with SLE, re
Eastwood K, Massey P, Durrheim D Pandemic planning at the coal face: responsibilities of the Public Health Unit NSW Public Health Bulletin 2006: 17(7-8): 117-120.
Responding to an infectious disease pandemic requires a coordinated approach from all the essential services. Public health units across NSW will plan an important role in a range of control activities. These include: surveillance, education, communicati
http://www.health.nsw.gov.au/public-health/phb/phb.html
Durrheim D, Ferson M Preparing for the inevitable - An Influenza Pandemic NSW Public Health Bulletin 2006; 17(7): 97-98.
The world is currently at 'Global Phase 3' of the World Health Organisation's influenza pandemic alert phases. Given instability of the influenza virus, the world is waiting for the first influenza pandemic of the twenty-first century. It is thus timely
http://www.health.nsw.gov.au/public-health/phb/phb.html
Durrheim D, Massey P, Kelly H Re-emerging poliomyelitis - is Australia's surveillance adequate? Communicable Diseases Intelligence 2006; 30(3): 275-277.
In the past two years there has been a resurgence of polio, 21 previously polio-free countries importing wild poliovirus. Wild poliovirus importations into polio-free areas continue to occur until endemic transmission is interrupted globally. Australias
http://www.health.gov.au/internet/wcms/publishing.nsf/Content/cda-cdi3003a.htm
Burkot TR, Durrheim D, Melrose WD, Speare R, Ichimori K The argument for integrating vector control with multiple drug administration campaigns to ensure elimination of lymphatic filariasis Filaria Journal 2006; 5(10): 1-7.
Although the global lymphatic filariasis elimination programme is based on repeated annual mass drug therapy there are indications that this will not be adequate to ensure elimination in all environments. Vector control has been demonstrated to eliminate
http://www.filariajournal.com/content/5/1/10
Johnstone E, Knight J, Gillham K, Campbell E, Nicholas C, Wiggers J System-wide adoption of health promotion practices by schools: evaluation of a telephone and mail-based dissemination strategy in Australia Health promotion International Oxford Journals 2006; 21(3).
Schools can potentially benefit from system-wide approaches to the dissemination of health promotion practices. This intervention study undertaken in the Hunter Region of NSW, Australia used a pre-post design to assess whether the phone and mail interven
http://heapro.oxfordjournals.org/cgi/reprint/dal020v1
Finch M, Sutherland R, Harrison M, Collins C Canteen purchasing practices of year 1-6 primary school children and association with SES and weight status Australian and New Zealand Journal of Public Health 2006; 30(3): 247-251.
This cross-sectional study was conducted in the Hunter region of New South Wales. Primary schools were randomly selected from a list of government schools and 5,206 students from years 1-6, 16 schools were invited to participate. Findings show the ma
http://www.phaa.net.au/members_only/journalpdf_2006/june_2006/ANZJPH%202006-3%20-%20Finch.pdf
Unicomb L, Ferguson J, Stafford R, Ashbolt R, Kirk M, Becker N, Patel M, Gilbert G, Valcanis M, Mickan L Low-Level Fluoroquinolone Resistance among Campylobacter jejuni Isolates in Australia Clinical Infectious Diseases 2006; 42:1368-1374.
Ciprofloxacin-resistant Campylobacter jejuni isolates obtain from the infected patients in Australia have not been detected in studies of isolates from specific geographic areas. The Australian government prohibited the use of fluoroquinolone in food-pro
http://www.journals.uchicago.edu/CID/journal/issues/v42n10/38489/38489.web.pdf
Speare R, Latasi F, Nelesone T, Harmen S, Melrose W, Durrheim D, Heukelbach J Prevalence of soil transmitted nematodes on Nukufetau, a remote Pacific Island in Tuvalu BMC Infectious Diseases 2006; 6:110-110.
Nukufetau is a remote coral atoll island in the nation of Tuvalu in the Western Pacific. Annual mass drug administration with diethylcarbamazine and albendazole occurred in 2001, 2002 and 2003 for lymphatic filariasis elimination. A cross-sectional surve
http://www.biomedcentral.com/1471-2334/6/110
Kypri K, Donaldson A, Johnstone E The Physical Inactivity Matrix: Lessons from the classifications of physical inactivity interventions Journal of Science and Medicine in Sport 2006; 9: 98-102.
The aims of this study were to (1) develop a system for classifying physical inactivity intervention studies, (2) examine the distribution of the PI interventions published in the peer-reviewed health literature using a developed system, and (3) consider
Campbell E, Walsh RA, Sanson-Fisher R, Burrows S, Stojanovski E A group randomised trial of two methods for disseminating a smoking cessation programme to public antenatal clinics: Effects on patient outcomes Tobacco Control 2006; 15(2): 97-102.
The intervention was directed at the clinic with the intention of changing patient outcomes. Public antenatal clinics were allocated at random to either the SD or ID condition. Outcome data was collected using two independent cross sectional surveys of wo
http://tc.bmjjournals.com/cgi/reprint/15/2/97
Dalton CB, Bates LI Impact of closure of a large lead-zinc smelter on elevated blood lead levels of children in adjacent suburbs, Boolaroo, Australia Environmental Exposure and Health 2005; 85: 377-387.
A 1991 study of children living near a lead-zinc smelter, which had been established in 1897, found that 84% of children under 5 years of age had blood lead levels >10 µg/dl. An Environmental Health Centre was established to provide free blood lead tes
http://library.witpress.com/pages/listPapers.asp?q_bid=338#15811
Durrheim D, Muller R, Saunders V, Speare R, Lowe J. A population survey: Would Australian general practice be the first point of contact during an anthrax bioterrorism event? Australian family Physician 2006; 35(3): 172-174.
To explore how the Australian population might respond to an anthrax bioterrorism event, a national telephone survey was conducted. Sixty percent of respondents indicated that with a suspected anthrax bioterrorism event general practitioners would be the
http://www.racgp.org.au/document.asp?id=20092
Adams RJ, Wilson DH, Taylor AW, Daly A, d'Espaignet Tursan E, Grande Dal E, Ruffin R Coexistent Chronic Conditions and Asthma Quality of Life Chest Journal 2006; 129(2): 285-291.
Reports of the prevalence and impact of comorbid conditions among people with asthma have been limited to certain population groups and or convenience samples. Our aim was to examine the prevalence of major comorbidity in asthma and associations with qua
http://www.chestjournal.org/cgi/content/full/129/2/285
Williams K, Leonard H, d'Espaignet Tursan E, Colvin L, Slack-Smith L, Stanley F Hospitalisation from birth to 5 years in a population cohort of Western Australian children with intellectual disability Archives if Disease in Childhood 2005; 90: 1243-1248.
Although intellectual disability (ID) comprises about 7% of all disabling conditions in Australia, relatively little is known about its causes and sequelae. A similar situation applies in other economically developed countries. The US Surgeon General re
http://adc.bmjjournals.com/cgi/reprint/90/12/1243
Oxenford CJ, Black AP, Bell RJ, Munnoch SA, Irwin MJ, Hanson RN, Owen RL Investigation of a multi-state outbreak of Salmonella Hvittingfoss using a web-based case reporting form Communicable Diseases Intelligence 2005; 29(4): 379-381.
Hvittingfoss is a serovar often isolated from human, animal and environmental sources in northern Queensland, but is rarely identified in other parts of Australia. OzFoodNet used NetEpi to investigate this outbreak on behalf of the Communicable Disease Ne
http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/cda-cdi2904f.htm
Wright A, Harris M, Wiggers J, Jorm A, Cotton S, Harrigan S, Hurworth R, McGorry P Recognition of depression and psychosis by young Australians and their beliefs about treatment Medical Journal of Australia 2005; 183(1): 18-23.
A survey was conducted as a baseline measure for the community awareness campaign. The survey identified gaps in mental health literacy which may help to improve community educations and the responsiveness of the health care system, thus ensuring that yo
http://www.mja.com.au/public/issues/183_01_040705/wri10870_fm.html
Mabuza A, Govere J, la Grange K, M ngomezulu N, Allen E, Zitha A, M bokazi M, Durrheim D, Barnes K Therapeutic efficacy of sulfadoxine-pyrimethamine for Plasmodium falciparum malaria South African Medical Journal 2005; 95(5): 346-349.
The therapeutic efficacy of sulfadoxine pyrimethamine (SP) was determined 5 years after introduction as first-line treatment of uncomplicated Plasmodium falciparum malaria in Mpumalanga, South Africa. As gametocyte carriage has increased significantly, a
Ho Y, Muller R, Veitch C, Rane A, Durrheim D Faecal incontinence: an unrecognised epidemic in rural North Queensland? Results of a hospital-based outpatient study Australian Journal of Public Health 2005; 13(1): 28-34.
The prevalence of faecal incontinence (FI) in a referral hospital outpatient population in North Queensland was determined as 20.7%. The median duration of FI was 2 years with more than half of those affected soiling themselves at least once a month with
http://www.blackwell-synergy.com/doi/full/10.1111/j.1440-1854.2004.00642.x
Nelesone T, Durrheim D, Speare R, Kiedrzynski T, Melrose W. Strengthening sub-national communicable disease surveillance in a remote Pacific Island country by adapting a successful African outbreak surveillance model Tropical Medicine and International Health 2006; 11(1): 17-21.
The SARS pandemic proved that global communicable disease surveillance was only as robust as sub-national surveillance in each developing country. Effective sub-national surveillance depends on effective bidirectional information flow to and from the peri
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-3156.2005.01534.x
Barnett F, Durrheim D, Speare R, Muller R. Management of Irukandji Syndrome in Northern Australia Rural & Remote Health 2005; 5(36): 1-10.
Irukandji syndrome is a potentially life-threatening condition that follows the sting of small carybdeid jellyfish. It was considered important to document current management practices throughout coastal northern Australia to assess the availability of m
http://rrh.deakin.edu.au/articles/showarticlenew.asp?ArticleID=369
Kypri K, Voas R, Langley J, Stephenson S, Begg D, Tippetts S, Davie G. Lowering the Minimum Purchase Age for Alcohol Increased Traffic Crash Injuries among 15-19 year olds in New Zealand American Journal of Public Health 2006; 96: 126-131.
In 1999, New Zealand lowered the minimum purchasing age for alcohol by two years. This age was reduced from 20 to 18 years. Significantly more alcohol-involved crashes had occurred among 15-19 years olds than would have occurred if the purchase age was
Durrheim D, Muller R, Saunders V, Speare R, Lowe J. Australian Public and Smallpox Emerging Infectious Diseases 2005; 11(11): 1748-1750.
Small pox and anthrax is a potential bioterrorism agent and although small pox response guidelines have been prepared, the level of community awareness is unknown. A cross-sectional national survey of 1001 Australians was conducted to assess knowledge and views about smallpox, vaccination, and other mitigation strategies. Participants were unclear about their personal smallpox vaccination status and had many false beliefs relating to smallpox and appropriate prevention and management measures.
www.cdc.gov/ncidod/EID/vol11no11/04-1129.htm
Hanson D, Hanson J, McFarlane K, Lloyd J, Muller R, Durrheim D. The injury iceberg: an ecological approach to planning sustainable community safety interventions Health Promotion Journal of Australia 2005; 16(1): 5-10.
A literature review of 143 English-language articles addressing the topics of 'ecological injury prevention or safety promotion', 'ecological health promotion', 'sustainable economic, health or ecological systems', and 'steady state' found that injury pre
www.healthpromotion.org.au/journal
Unicombe L, Simmon G, Merritt T, Gregory J, Nicol C, Jelfs P, Kirk M, Tan A, Thomson R, Adamopoulos J, Little C, Currie A, Dalton C. Sesame seed products contaminated with Salmonella: three outbreaks associated with tahini. Epidemiology and Infection 2005; 133(6): 1065-1072.
The association of salmonellosis with consumption of tahini has resulted in a policy change with the introduction of routine testing of imported sesame-based products in Australia. In New Zealand, under an emergency food standard, all sesame seed-based p
Baratiny G, Campbell E, Sanson-Fisher R, Cockburn J. Hospital patients receptive to quit smoking advice Health Promotion Journal of Australia 2003; 14(1): 69-69.
Public hospitals are well positioned to play an active role in encouraging patients to quit smoking. Bans on smoking in hospital precincts make attending a public hospital an opportune trigger to motivate smokers to quit. As smokers are not allowed to smo
www.healthpromotion.org.au/journal
Corkrey R, Parkinson L, Bates L. Pressing the key pad: Trial of a novel approach to health promotion advice. Preventive Medicine 2005; 41(2): 657-666.
BACKGROUND.: The Pap test is relatively simple procedure which is effective in detecting early changes in the cervix; despite this many at-risk women do not have regular Pap tests. METHODS.: This paper describes a randomized controlled trial of an int
Corkrey R, Parkinson L, Bates L, Green S, Htun A. Pilot of a novel cervical screening intervention: interactive voice response. Australian and New Zealand Journal of Public Health 2005; 29(3): 261-264.
THE IVR call was successful used by a large number of women who obtained information about cervical cancer screening, with higher use by recognised risk groups. The results suggest that an IVR reminder could be useful to increase cervical screening rates
http://www.phaa.net.au/anzjph/anzjph.htm
Freund M, Campbell E, Paul C, Sakrouge R, Wiggers J. Smoking care provision in smoke-free hospitals in Australia. Preventive Medicine 2005; 41(1): 151-158.
Background: The study aimed to (1) measure the current routine smoking care that public hospitals in New South Wales (NSW), Australia, provide to inpatient smokers; (2) determine current strategies supporting such care; and (3) examine the association be
Freund M, Campbell E, Paul C, Sakrouge R, Wiggers J. Smoking care provision in smoke-free hospitals in Australia. Preventive Medicine 2005; 41(1): 151-158.
Background: The study aimed to (1) measure the current routine smoking care that public hospitals in New South Wales (NSW), Australia, provide to inpatient smokers; (2) determine current strategies supporting such care; and (3) examine the association be
Wolfenden L, Wiggers J, Knight J, Campbell E, Spigelman A, Kerridge R, Moore K. Increasing smoking cessation care in a preoperative clinic: a randomized controlled trial. Preventive Medicine 2005; 41(1): 284-290.
Background: Evidence suggests that preoperative clinics fail to systematically provide smoking cessation care to patients having planned surgery. Methods: The aim of the study was to assess the efficacy, acceptability, and cost of a multifaceted inte
Monaghan, K A Country's Hidden and Untapped Resource: Exploring Attitudes, Beliefs, Perceptions and Knowledge of Hygiene in Kandahar, Afghanistan. Environmental Health 2005; 5(1): 62-72.
A qualitative study using participatory action research was used to explore attitudes, beliefs, perceptions and knowledge of hygiene and hygiene related behaviour involving 122 women and 89 men in Kandahar, Afghanistan over a four-week period in Dec/Jan 2
http://www.aieh.org.au/journal/index.php
Moses N, Wiggers J, Nicholas C and Cockburn J. Prevalence and correlates of perceived unmet needs of people with systemic lupus erythematosus. Patient Education and Counselling 2005; 57: 30-38.
The prevalence and correlates of perceived unmet need among people with systemic lupus erythematosus (SLE) was assessed for 386 people with SLE, recruited from a support association in NSW, Australia. The mail-back survey included 97 items measuring perc
http://www.elsevier.com/wps/find/journaldescription.cws_home/505955/description#description
Dürrheim DN, Williams HA. Assuring effective malaria treatment in Africa: Drug efficacy is necessary but not sufficient. Journal of Epidemiology and Community Health 2005; 59(3): 178-179.
Malaria drug resistance has resulted in dramatic increases in malaria prevalence and mortality during the past decade in sub-Saharan Africa. The early results from field trials of artemisinin containing combination therapy (ACT) have been promising. A n
http://0-jech.bmjjournals.com.library.newcastle.edu.au/contents-by-date.0.shtml
Daly J, Licata M, Gillham K, Wiggers J. Increasing the health promotion practices of workplaces in Australia using a proactive telephone based intervention. American Journal of Health Promotion 2005; 19(3): 163-166.
The efficacy of a proactive telephone-based intervention aimed at increasing workplace adoption of health promotion initiatives in Australia was examined. Of the 320 eligible worksites in the region, 227 (71%) provided data at baseline and again 4 years
http://www.healthpromotionjournal.com/
Wolfenden L, Wiggers J, Knight J, Campbell E, Rissel C, Kerridge R, Spigelman AD, Moore KA. A programme for reducing smoking in pre-operative surgical patients: randomised controlled trial. Anaesthesia 2005; 60(2): 172-9.
The primary aim of the study was to assess the efficacy of a comprehensive smoking cessation intervention in increasing the smoking abstinence rates of surgical patients. Two hundred and ten smoking patients attending a preoperative clinic were randomly
http://www.blackwell-synergy.com/links/doi/10.1111/j.1365-2044.2004.04070.x
Wiggers J, Jauncey M, Considine R, Daly J, Kingsland M, Purss K, Burrows S, Nicholas C, Waites B. Strategies and outcomes in translating alcohol harm reduction research into practice: The Alcohol Linking Program. Drug and Alcohol Review. 2004 Sep 13; 23: 355-364.
This paper reports on a system intervention to enhance police enforcement of liquor laws by providing data-based feedback to police and licensees about alcohol-related crime following drinking on specific licensed premises. As a result of its success in r
http://www.tandf.co.uk/journals/titles/09595236.asp
Sutherland R, Gill T, Binns C. Do parents, teachers and health professionals support school-based obesity prevention. Nutrition and Dietetics 2004; 61(3): 65-72.
This paper explores parents', teachers' and health professionals' attitudes to factors leading to childhood obesity and the role of the school in preventing obesity in children.
Wolfenden L, Freund M, Campbell E, Wiggers J, Paul C, Mitchell E. Managing nicotine dependence in hospital patients: Meeting the ongoing challenges in NSW. NSW Public Health Bulletin 2004; 15(5-6): 98-101.
This article describes the implications of the NSW Smoke-Free Workplace Policy on hospitals and discusses the development and utility of the Guide in the context of the ongoing challenge of improving care for patients who are dependent on nicotine.
http://www.health.nsw.gov.au/public-health/phb/phb.html
Kypri K, Saunders J, Williams S, McGee R, Langley J, Cashell-Smith M, Gallagher S. Web-based screening and brief intervention for hazardous drinking: A double blind randomized controlled trial. Addiction 2004; 99(11): 1410-1417.
This paper discussed a double blind randomised controlled trial in which the efficacy of using web based screening and brief intervention (e-SBI) to reduce hazardous drinking was evaluated. Results revealed that e-SBI offers promise as a strategy to red
http://www.addictionjournal.org/
Radvan D, Wiggers J, Hazell T. HEALTH C.H.I.P.s: Opportunistic community use of computerized health information programs. Health Education Research 2004; 19: 581-590.
This paper describes two studies which investigate the potential of using touchscreen computer kiosks for health education in a range of community settings.
Donaldson A, Forero R, Finch C. The first aid policies and practices of community sports clubs in northern Sydney, Australia. Health Promotion Journal of Australia 2004;15(2): 155-161.
Although first aid is a recommended sports injury prevention and management strategy, few community sports clubs have policies or implemented practices to address this issue comprehensively. This paper provides baseline data which compares first aid poli
http://www.healthpromotion.org.au/journal.php
Kypri K, Gallagher S, Cashell-Smith M. An internet-based survey method for college student drinking research. Drug and Alcohol Dependence 2004; 76: 45-53.
The purpose for the study was to describe and assess the utility of an internet-based survey method for characterizing the alcohol consumption of college students. The paper discusses research methods and reviews and discusses the results. The researcher
http://users.tpg.com.au/kypri/Downloads/Publications/Web survey Kypri et al 2004.pdf
Kypri K, Langley J, Stephenson S. Assessment of nonresponse bias in an internet survey of alcohol use. Alcoholism Clinical and Experimental Research, 28(4) 630-4.
The purpose of the study was to assess nonresponse bias in Internet surveys of alcohol use. 1910 university students with a response rate of 82% (N=1564) conducted the study. The aim was to identify nonresponse bias and to quantify its effects on estim
http://users.tpg.com.au/kypri/Downloads/Publications/Nonresponse Kypri et al 2004.pdf
Green S, Parkinson L, Bonevski B, Considine R. Community health needs assessment for health service planning: Realising consumer participation in the health service setting. Health Promotion Journal of Australia 2004; 15(2): 137-145.
The aims of this paper are to describe a four-step process for community health needs assessment used in one community, to discuss satisfaction with the community consultation process, and to examine the cost and usefulness of the process for guiding heal
http://www.healthpromotion.org.au/journal.php
Paul C, Wiggers J, Daly J, Green S, Walsh R, Knight J, Girgis A. Direct telemarketing of smoking cessation interventions: Will smokers take the call? Addiction 2004; 99: 907-913.
This paper explores the views of current adult smokers regarding the acceptability, likely uptake and barriers to update of smoking cessation services offered by direct telemarketing. The data suggests there is support for this method of marketing smoki
http://www.addictionjournal.org/
Dalton C. Food borne disease surveillance in New South Wales. NSW Public Health Bulletin 2004;15(1-2): 1-2.
This is a review of articles on food borne disease surveillance in NSW.
http://www.health.nsw.gov.au/public-health/phb/phb.html
Johnson N, Fisher J, Nagle A, Inder K, Wiggers J. Factors associated with referral to outpatient cardiac rehabilitation services. Journal of Cardiopulmonary Rehabilitation 2004; 24(3): 165-170.
The purpose of the study was to determine what factors were associated with referring patients to cardiac rehabilitation outpatient services. The paper concludes that additional strategies are required to increase cardiac rehabilitation referral rates fo
http://www.lww.com/product/?0883-9212
Oberdorfer A, Wiggers J, Bowman J, Burrows S, Cockburn J, Considine R. Monitoring and educational feedback to improve the compliance of tattooists and body piercers with infection control standards: A randomized controlled trial. American Journal of Infection Control 2004; 32(3): 147-154.
A randomised control trial was conducted amongst 37 tattooists and body-piercing premises in Sydney, NSW Australia. The findings demonstrate the efficacy of an audit and feedback strategy in increasing tattooists and piercers' infection control complianc
http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&searchDBfor=home&ID=ic
Dalton C. Food borne disease surveillance in NSW: Moving towards performance standards. NSW Public Health Bulletin 2004;15(1-2): 2-5.
This article describes the evolution of the recent investment in food borne disease surveillance and control in NSW and discusses the opportunities to produce measurable enhancements of food safety from these investments.
http://www.health.nsw.gov.au/public-health/phb/phb.html
Bates L, Sinclair D, MacKenzie A. Attitudes to routine testing of blood lead levels of children near a lead smelter in North Lake Macquarie Environmental Health 2004 Mar 1;4(1): 45-52
This paper reports on a self administered, pencil and paper questionnaire conducted with participating North Lake Macquarie families on their knowledge of blood lead testing program, satisfaction and opportunities for improvement. The results reveal that
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