Measles, mumps, and rubella: the need for a change in immunisation policy

There is growing evidence that the present policy of childhood immunisation in the United Kingdom is inadequate. It is unlikely ever to achieve complete eradication of the congenital rubella syndrome and measles, and the problem of mumps has not even begun to be addressed. After a coordinated campaign to increase uptake of immunisation in Fife the uptake of rubella immunisation in teenage girls increased from 75% in 1981 to 94% in 1985 and the uptake of measles vaccination in preschool children from 55% in 1981 to 81% in 1985. There are a few girls each year who do not accept rubella immunisation, whose immune state is unknown, and who are consequently at risk of rubella during future pregnancies. Despite the increased uptake of measles vaccine over the past four years there is currently an epidemic of measles in Fife, with 544 notified cases in the first quarter of 1986. In 1984, 19 Fife residents were admitted to hospital because of complications of mumps. The time is ripe for a complete reassessment of the national immunisation policy.     

社区中老年群体10年间糖尿病患病率分析

目的 本文总结一组中老年群体１０年糖尿病（ＤＭ）发病及追踪情况。方法 每年度平均受检２４３０人。年龄４０～９８岁（平均６３岁）。男女之比为１７：１。按照ＷＨＯ诊断标准，对确认为Ⅱ型糖尿病患者，进行了长期门诊治疗并追踪观察。结果 １０年间本组糖尿病患病率由５．９％升至１６．８％。糖尿病患病率以６１～７０岁组最高（２０．０％）。糖尿病新患率以４１～５０岁年龄段最高（２９．２％）。追踪了糖尿病并发心血管     

全民普惠制的澳大利亚药品目录制度

本文对澳大利亚药品报销目录制度的遴选、目录内药品的定价、目录决策程序等问题进行阐释,得出澳大利亚药品报销目录制度具有以下重要特征：一是为目录内药品和医疗手段制定质量标准;二是保证药品费用上的可承担性;三是确保药品使用上的安全性。     

"Operation South East Asia Tsunami Assist": an Australian team in the Maldives

The NHMRC is at a fork in the road - which route will the government take?     

Prevalence and incidence of urinary incontinence in the elderly: a longitudina l study in South Australia

目的：调查老年人两年时间里尿失禁的发病率、患病率及其预后变化。方法：在南澳选民库中随机抽取4187位老年人,于1992年进行问卷调查,应答率为53.4％。之后1年和2年后分别追踪调查1次。共2087位老年人完成了3轮调查。结果：紧迫型尿失禁的患病率较高,36.6％-41.6％的老年人曾经发生过紧迫型尿失禁,7.5％-9.6％的老年人经常发生紧迫型尿失禁。压力型尿失禁的患病率为23.4％-28.8％,3.3％-5％的老年人经常发生压力型尿失禁。紧迫型与混合型尿失禁的构成比较压力型尿失禁高。紧迫型尿失禁和压力型尿失禁的发病率分别为19.8％（3.1％为经常发生）和14.5％（1.9％为经常发生）。老年人尿失禁患病率在2年内有上升趋势。结论：尿失禁是老年人中常见的重要健康问题,其患病率在今后有上升趋势。     

Snakebite in tropical Australia: a prospective study in the "Top End" of the Northern Territory

OBJECTIVE: To describe the epidemiology of snakebite in the "Top End" of the Northern Territory, and the envenoming syndromes of individual snake species. STUDY DESIGN: Prospective collection of clinical data and snake identity. SETTING: Royal Darwin Hospital (RDH), a 300-bed tertiary hospital servicing a population of 140,000 spread over 522 561 km2. PATIENTS: All patients with bites by confirmed snake species between September 1989 and March 2003, and all suspected snakebite cases between September 1989 and March 1998. OUTCOME MEASURES: Incidence rates of definite snakebite and envenoming. Clinical features of bites from defined snake species. RESULTS: There were 348 suspected snakebites over 8.6 years, with 114 aerial evacuations to RDH, 216 patients (62%) definitely bitten (23.2/100,000 per year) and 79 (23%) envenomed (7.6/100,000 per year). There were 156 bites from confirmed species over 13.6 years: 31 (20%) from western brown snakes (Pseudonaja nuchalis), with early collapse in 14 (45%), consumptive coagulopathy in 26 (84%) and 25 (81%) given antivenom; 21 from death adders (Acanthophis spp.), with neurotoxicity in 8 (38%) and 6 (29%) given antivenom; and 20 from mulga snakes (Pseudechis australis), with local swelling in 19 (95%), myotoxicity in 12 (60%) and 15 (75%) given antivenom. In 34 bites from less venomous species, there was no life-threatening envenoming. There were no deaths. CONCLUSIONS: Snakebite still causes morbidity in tropical Australia, but, with access to hospital and antivenom, deaths are rare. This study has enabled further definition of the envenoming syndromes of three highly venomous Australasian elapids.     

Reduced waiting times for the GP: two examples of "advanced access" in Australia

"Advanced access" is a set of change principles for improved scheduling in office-based health care, widely applied in the United States and in the United Kingdom. Examination of advanced access in two Australian general practices indicates it is feasible in this country and may offer improvements in patient access to care, practice income and workplace conditions. Rigorous evaluations of advanced access are lacking, but in the Australian National Primary Care Collaborative, 300 practices will implement advanced access, providing an opportunity for a rigorous evaluation of these principles.     

MPOWER综合战略与澳大利亚控烟策略对我国控烟工作的借鉴意义

烟草使用是当今世界八大死因中六种死因的危险因素,控制、减少、直至消除烟草污染已成为国际社会的共同意愿,也是我国刻不容缓的战略任务.2003年5月,第56届世界卫生大会通过了<世界卫生组织烟草控制框架公约>(简称<公约>),2008年2月,世界卫生组织提出了控制烟草流行的MPOWER综合战略,本文根据<公约>和MPOWER综合战略的主要内容,结合澳大利亚,特别是维多利亚州的控烟策略,旨在探讨控烟手段,推广控烟经验,并为我国的控烟工作提供借鉴.     

Overweight and obesity in Australia: the 1999-2000 Australian Diabetes,Obesity and Lifestyle Study (AusDiab)

OBJECTIVE: To measure the prevalence of obesity in Australian adults and to examine the associations of obesity with socioeconomic and lifestyle factors. DESIGN: AusDiab, a cross-sectional study conducted between May 1999 and December 2000, involved participants from 42 randomly selected districts throughout Australia. PARTICIPANTS: Of 20,347 eligible people aged > or = 25 years who completed a household interview, 11,247 attended the physical examination at local survey sites (response rate, 55%). MAIN OUTCOME MEASURES: Overweight and obesity defined by body mass index (BMI; kg/m(2)) and waist circumference (cm); sociodemographic factors (including smoking, physical activity and television viewing time). RESULTS: The prevalence of overweight and obesity (BMI > or = 25.0 kg/m(2); waist circumference > 80.0 cm [women] or > or = 94.0 cm [men]) in both sexes was almost 60%, defined by either BMI or waist circumference. The prevalence of obesity was 2.5 times higher than in 1980. Using waist circumference, the prevalence of obesity was higher in women than men (34.1% v 26.8%; P < 0.01). Lower educational status, higher television viewing time and lower physical activity time were each strongly associated with obesity, with television viewing time showing a stronger relationship than physical activity time. CONCLUSIONS: The prevalence of obesity in Australia has more than doubled in the past 20 years. Strong positive associations between obesity and each of television viewing time and lower physical activity time confirm the influence of sedentary lifestyles on obesity, and underline the potential benefits of reducing sedentary behaviour, as well as increasing physical activity, to curb the obesity epidemic.     

Cervical cancer in Australia and the United Kingdom: comparison of screening policy and uptake, and cancer incidence and mortality

OBJECTIVE: To compare cervical screening policy, screening uptake, and changes in cervical cancer incidence and mortality between Australia and the United Kingdom. DESIGN: Analysis of screening registry data and national cancer statistics. SETTING: In Australia, organised cervical screening was initiated in 1991 for sexually active women aged 18-69 years, with a recommended 2-yearly interval. In the UK, organised screening began in 1988 for women aged 20-64 years, with a recommended 3-yearly interval in most regions. RESULTS: Estimated lifetime screening participation rates in 2001 were similar in the two countries, at 88% in Australia and 90% in the UK. For women who were screened and had a negative result, the median time to the next screen was 27 months in Australia and 38 months in the UK. At 39 months, equivalent proportions (74%) had been re-screened in the two countries, and by 60 months the re-screened proportions were 81% in Australia and 94% in the UK. From 1991-1993 to 1998-2000, the incidence of cervical cancer in women aged 20-69 years fell by 33% in Australia and 33% in the UK, and mortality from cervical cancer fell by 36% in both countries. CONCLUSIONS: After the introduction of organised screening, similar reductions in cervical cancer incidence and mortality were achieved in Australia and the UK. Therefore, the 2-yearly screening policy in Australia and the predominantly 3-yearly screening policy in the UK appear to have been of broadly similar effectiveness.     

"Let's not talk about sex": reconsidering the public health approach to sexually transmissible infections in remote Indigenous populations in Australia

Sexually transmissible infections (STIs) are hyperendemic in some remote Indigenous populations in Australia. Screening programs have had some success in reducing the prevalence of STIs in specific populations, but there has been little overall improvement in the past 10 years. We question the usefulness of current practice and urge consideration of a new and radical approach. Instead of a "screen, treat and contact trace" strategy, we suggest adopting the same approach as currently accepted for trachoma control: populations reaching a threshold prevalence for a set of marker STIs (identified through sentinel surveillance) should be offered a treatment program aimed at the entire sexually active population. We also recommend a parallel program of health promotion and "life skills" education and outline the arguments for such a departure from currently accepted public health policy.     

"Folate before pregnancy": the impact on women and health professionals of a population-based health promotion campaign in South Australia

OBJECTIVES: To evaluate a South Australian campaign to promote and implement knowledge that taking adequate folate/folic acid in the periconceptional period can reduce the risk of having a baby with a neural tube defect. DESIGN AND SETTING: The campaign, conducted in October 1994--August 1995, targeted women of reproductive age and health professionals. Evaluation was by computer-assisted telephone interviews undertaken by random dialling throughout the State before and after the campaign, and by self-administered questionnaires to health professionals and women in the postnatal period. PARTICIPANTS: Women of reproductive age and four groups of health professionals. MAIN OUTCOME MEASURES: Knowledge about folate, folate-rich foods and the periconceptional period; participation of health professionals in advising women about folate; use of periconceptional folic acid supplements; sales of folic acid tablets; and prevalence of neural tube defects. RESULTS: Significant increases in knowledge about folate followed the campaign. Health professionals and women in the postnatal period had higher initial levels of knowledge about folate, which also increased significantly. The proportions of women taking periconceptional folic acid supplements, and of health professionals advising women planning a pregnancy about folate, also increased significantly, and folic acid tablet sales doubled. Total prevalence of neural tube defects declined between 1966 and 1999 from a baseline of 2.0 per 1,000 births to 1.1 per 1,000 births (Poisson regression, P= 0.03; average decline of 1.0% per year). CONCLUSIONS: A short educational campaign with a limited budget ($40,000) can promote folate successfully, but alternative strategies such as food fortification are likely to be needed to achieve adequate periconceptional folate intake for a very high proportion of women.