Serum ferritin and cardiovascular disease: a 17-year follow-up study in Busselton,Western Australia

The association between serum ferritin level and coronary heart disease (CHD) and stroke events was evaluated in a long-term Western Australia prospective study in 1981-1998. The cohort consisted of the 1612 men and women aged 40-89 years who participated in the 1981 Busselton Health Survey and who were free of cardiovascular disease at that time. Serum ferritin levels were obtained from serum samples stored frozen since 1981. The outcomes of interest were time to first CHD event (hospital admission or death) and time to first stroke event. Case-cohort sampling was used to reduce costs and preserve serum but still allow efficient analysis. Ferritin assays were performed for 217 CHD cases, 118 stroke cases, and a random sample of 450 of the total cohort. Proportional hazards regression models were used to obtain age-adjusted and multivariate-adjusted hazard ratios for ferritin level in relation to CHD and stroke. The hazard ratio for the highest tertile group compared with the lowest group was 0.96 (95% confidence interval: 0.60, 1.53) for CHD and 1.43 (95% confidence interval: 0.78, 2.64) for stroke. Little or no evidence was found that ferritin level was a risk factor for cardiovascular disease.     

Folate levels and cancer morbidity and mortality: prospective cohort study from Busselton, Western Australia

PURPOSE: To test a community population for the hypothesis that carcinogenesis is related to blood folate levels. METHODS: Prospective analysis of cancer mortality data for a cohort of 964 men (person-time follow up: 20,254 years) and 1024 women (person-time follow up: 24,970 years) and morbidity data for a subcohort, all of whom participated in the 1969 Busselton (Western Australia) Health survey. Outcome measures were adjusted hazard ratios according to baseline folate levels for total cancer mortality and morbidity and site specific mortality and morbidity for colorectal, lung, breast, and prostate cancers. RESULTS: In total, there were 278 cancer deaths--45 from colorectal cancer, 44 from lung cancer, 15 from breast cancer, and 31 from prostate cancer. Decreased serum folate levels showed an independent association with increased prostate cancer mortality risk, the adjusted hazard ratio per decrease of 2 microg/L was 1.56 (CI: 1.05, 2.38), men whose levels were in the lowest quartile had an adjusted hazard ratio of 4.79 (CI: 1.56, 14.43) for subsequent death from prostate cancer. The morbidity subcohort data showed that decreased red blood-cell folate was significantly associated with increased events due to breast cancer, the adjusted hazard ratio per decrease of 100 mug/L was 1.96 (CI: 1.22, 3.12), women in the lowest quartile of red cell folate levels had an adjusted hazard ratio of 6.46 (CI: 1.19, 35.07) for a subsequent breast cancer event. Mortality and morbidity from colorectal or lung cancers were not associated with folate levels. CONCLUSIONS: Independent associations, assessed over periods greater than 20 years, were demonstrated between decreased folate levels and increased risks of prostate cancer mortality and breast cancer morbidity.     

Correlates of hysterectomy in Australia.

With around one in five women undergoing hysterectomy by the age of 50, the prevalence of hysterectomy in Australia is greater than in Europe but less than in the United States. In this paper, data from a nationally representative sample survey of 2547 Australian women aged 20-59 years are employed to identify correlates of hysterectomy and tubal sterilization over the last 30 years. Physiological, socio-economic and supply-side factors all influence the propensity to undergo hysterectomy, and a comparison with the correlates of tubal sterilization reveals parallels and contrasts between the determinants of the two operations. Age and parity are important predictors of hysterectomy. In addition, use of oral contraceptives for at least five years reduces the risk of hysterectomy, as do tubal sterilization, tertiary education and birthplace in Southern Europe. Conversely, risk increases after experiencing side effects with the IUD or repeated foetal losses, or after bearing a third child before the age of 25.     

合肥市错牙合畸形儿童中习惯性打鼾现状调查

目的探讨合肥市3～16岁错殆畸形儿童习惯性打鼾情况,以期为儿童睡眠呼吸障碍防治提供新的途径。方法2011年1月～2012年9月,合肥市4个行政区内随机整群抽取2800名3—16岁错牙合畸形少年儿童为调查对象,以问卷形式进行儿童睡眠、呼吸和日常行为等资料评估,运用SPSS17．0进行统计分析。结果发放问卷2800份,有效应答2642份,回收率为94．36％。其中男性1278名,女性1364名,平均年龄（11．0±2．5）岁,男女习惯性打鼾差异具统计学意义（Z=2．84,P=0．005）。Logistic回归结果认为错牙合畸形儿童习惯性打鼾危险因素与睡眠状况、变应性鼻炎、腺样体大小、口呼吸以及父母打鼾相关。结论合肥市3～16岁错牙合畸形儿童习惯性打鼾检出率为3．2％,提醒家长对该类儿童睡眠障碍各相关因素关注,做到早期发现、早期干预,确保其健康成长。     

Prediction of coronary heart disease mortality in Busselton, Western Australia: an evaluation of the Framingham, national health epidemiologic follow up study, and WHO ERICA risk scores.

STUDY OBJECTIVES: To evaluate the performance of the Framingham, national health epidemiologic follow up study, and the WHO ERICA risk scores in predicting death from coronary heart disease (CHD) in an Australian population. DESIGN: Cohort follow up study. SETTING AND PARTICIPANTS: The cohort consisted of 1923 men and 1968 women who participated in health surveys in the town of Busselton in Western Australia over the period 1966-81. Baseline assessment included cardiovascular risk factor measurement. Mortality follow up to 31 December 1994 was used. MAIN RESULTS: Risk scores for death from CHD within 10 years based on age, systolic blood pressure, cholesterol, smoking, and BMI were derived from the Busselton study data using logistic regression analysis. Similar risk scores developed from the Framingham, the national health epidemiologic follow up study, and the WHO ERICA cohorts were found to perform just as well in Busselton as the Busselton-derived scores, both before and after controlling the effect of age. There was considerable overlap across the different risk scores in the identification of individuals in the highest quintile of risk. Those in the top 20% of scores included about 41% of deaths from CHD among men and about 63% of deaths from CHD among women. CONCLUSION: Although there is variation in risk score coefficients across the studies, the relative risk predictive performance of the scores is similar. The use of Framingham and other similar risk scores will not be misleading in white Australian populations.     

Outbreak of sporotrichosis, Western Australia

A cluster of sporotrichosis cases occurred in the Busselton-Margaret River region of Western Australia from 2000 to 2003. Epidemiologic investigation and mycologic culture for Sporothrix schenckii implicated hay initially distributed through a commercial hay supplier as the source of the out-break. Declining infection rates have occurred after various community measures were instigated.     

Rickettsia felis in fleas, Western Australia

This study is the first confirmation of Rickettsia felis in Australia. The organism was identified from 4 species of fleas obtained from dogs and cats in Western Australia, by using polymerase chain reaction amplification and DNA sequencing of the citrate synthase and outer membrane protein A genes.     

中国30~79岁成年人习惯性打鼾的分布特征及相关因素分析

目的 描述中国慢性病前瞻性研究10个项目地区成年人习惯性打鼾的地区和人群分布特征。方法 本研究于2004-2008年开展基线调查,收集了人口学特征、行为生活方式、睡眠情况、体格检查指标等信息。采用logistic回归比较不同地区、不同特征人群习惯性打鼾的差异并分析打鼾的相关因素。结果 研究共纳入512 713名研究对象,习惯性打鼾标化后报告率为21.2%,男性（27.0%）高于女性（15.3%）,南方地区高于北方地区（男性：南方31.5%,北方24.7%;女性：南方18.0%,北方16.4%）,城市高于农村（男性：城市32.1%,农村26.1%;女性：城市18.5%,农村16.4%）。调整年龄、项目地区、BMI、腰围和生活方式因素后,不同社会经济状态人群的习惯性打鼾率无明显差异,男性、吸烟和既往吸烟者、饮酒和既往饮酒者中习惯性打鼾率较高。BMI每增加1 kg/m²,腰围每增加1 cm,习惯性打鼾风险分别增加19%和6%（BMI：P<0.001;腰围：P<0.001）。BMI相近的人群中,中心性肥胖者中习惯性打鼾率高于非中心性肥胖者;腰围相近的人群中,全身性肥胖/超重者习惯性打鼾率高于正常BMI者。结论 我国30~79岁成年人习惯性打鼾存在明显的地区和人群差异。     

Methicillin-resistant Staphylococcus aureus, Western Australia

Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a notable cause of hospital-acquired infections. A statewide screening and control policy was implemented in Western Australia (WA) after an outbreak of epidemic MRSA in a Perth hospital in 1982. We report on statutory notifications from 1998 to 2002 and review the 20-year period from 1983 to 2002. The rate of reporting of community-associated Western Australia MRSA (WAMRSA) escalated from 1998 to 2002 but may have peaked in 2001. Several outbreaks were halted, but they resulted in an increase in reports as a result of screening. A notable increase in ciprofloxacin resistance during the study period was observed as a result of more United Kingdom epidemic MRSA (EMRSA) -15 and -16. WA has seen a persistently low incidence of multidrug-resistant MRSA because of the screening and decolonization program. Non-multidrug-resistant, community-associated WAMRSA strains have not established in WA hospitals.     

Symptoms of inattention and hyperactivity in children with habitual snoring: evidence from a community-based study in Istanbul

BACKGROUND: Neurobehavioural symptoms of inattention and hyperactivity are common in children with sleep-disordered breathing (SDB). Prevalence rates of habitual snoring and attention deficit hyperactivity disorder (ADHD) are very similar and both have a substantial negative effect on children's behavioural health. OBJECTIVE: We examined the differences for subjective attentional and hyperactivity measures reported by parents and teachers among primary school children with habitual snoring and age- and sex-matched controls in a community-based case-control study in Istanbul. Methods In 2002, a survey was carried out to determine the prevalence of snoring in 2147 primary school children. After one year, in 2003, 151 children with habitual snoring and 302 controls from this survey were studied with parental SDB questionnaire, Conners' Parent (Conners-P) and Teacher Scales, and an inattention hyperactivity scale (IHS). Exclusion criteria included history of ADHD diagnosis, controls who started to snore and habitual snorers (HS) who no longer snored in this follow-up study. RESULTS: Ninety-six HS and 190 control subjects (mean age: 9.4 +/- 1.3) were evaluated. HS had significantly more symptoms of hyperactivity (Conners-ADHD index) (P: 0.033), attentional (P: 0.019), and conduct and oppositional defiant in subscales (P: 0.001) of Conners-P and IHS-Parents. A pooled score of Conners-P ADHD Index > 60 and IHS-Parent score > 1.25 showed considerable difference in HS when compared with controls (5.1% vs. 1.4%) (P < 0.0001). Daytime hyperactivity and excessive daytime sleepiness reported by parents correlated with scores of Conners-P and IHS-P (P < 0.01). Teachers' observations showed significant correlations with learning disability and the level of academic performance in HS (P < 0.01). Other behavioural parameters related to SDB were not significantly correlated with teachers' ADHD ratings in HS. CONCLUSION: Increased rates of moderate hyperactivity as well as conduct and oppositional defiant symptoms in HS reported by the parents might reflect a negative impact on overall neurobehavioural health. The teachers' scores yielded no significant results among HS and controls. This may be caused by the limitation due to shared method variance. The negative effect of crowded classes on teachers' evaluations must be also taken into consideration. After exclusion of a diagnosis of ADHD in children presenting with hyperactivity and inattention, children with habitual snoring with prominent scores of behavioural measures should be considered as candidates for further assessment by a sleep specialist.     

Trends and patterns of drug-caused mortality in Australia and Western Australia

OBJECTIVE: To estimate the number of drug-caused deaths and compare patterns and trends of drug-caused mortality in Western Australia (WA) and Australia. METHOD: Aetiologic fractions were applied to mortality data for WA (1985-96) and Australia (1991-96) to estimate the number of deaths due to alcohol, tobacco and other drugs. RESULTS: Age-standardised rates (ASR) for smoking and alcohol-caused deaths fell significantly, while the ASR for deaths caused by other drugs increased significantly. About 85% of drug-caused deaths occurred among people aged 50 years and above. Tobacco-caused deaths mainly occurred among the elderly. Alcohol-caused death rates showed a minor peak in those aged 20-24 years then, from middle age, began to rise steadily, peaking in the oldest age group. However, deaths due to other drugs occurred mainly among young people, particularly those aged 25-34 years. These age differences were reflected in the person years of life lost (PYLL). People who died from other drugs lost, on average, about 31 years of life, twice as many as people who died from alcohol-caused conditions and about six times the average number of PYLL per tobacco-caused death. CONCLUSIONS: Nearly a fifth of all deaths were due to drugs and 80% of drug-caused deaths were due to tobacco smoking. The patterns and trends of drug-caused mortality in WA were similar to those Australia wide. IMPLICATIONS: Strategies highlighting the negative impact of tobacco and alcohol on health need to be maintained as well as programs which target illicit drug use.     

Methicillin-resistant Staphylococcus aureus clones, Western Australia

Community-associated methicillin-resistant Staphylococcus aureus (MRSA) was first reported in Western Australia in the early 1990s from indigenous peoples living in remote areas. Although a statewide policy of screening all hospital patients and staff who have lived outside the state for MRSA has prevented the establishment of multidrug-resistant epidemic MRSA, the policy has not prevented SCCmec type IV and type V MRSA clones from becoming established. Of the 4,099 MRSA isolates analyzed (referred to the Gram-positive Bacteria Typing and Research Unit) from July 2003 to December 2004, 77.5% were community-associated MRSA (CA-MRSA). Using multilocus sequence/staphylococcal chromosome cassette mec typing, 22 CA-MRSA clones were characterized. Of these isolates, 55.5% were resistant to >1 non-beta-lactam antimicrobial drug. Five Panton-Valentine leukocidin (PVL)-positive CA-MRSA clones were identified. The emergence of multidrug-resistant CA-MRSA clones and the detection of PVL toxin genes in clones previously reported as PVL negative is a major public health concern.     

Deaths in Broome, Western Australia, 1883 to 1994

Abstract: We examined all records of deaths held in the Derby Courthouse (1883 to 1895) and the Broome Courthouse (from 1896). Records of 3409 deaths (2659 males, 750 females) were analysed. Race of origin was ascertained from >99 per cent of records: 35.9 per cent of deaths were of Aboriginals, 42.8 per cent of Asians and 21.3 per cent were among other races. In the early decades (1880s to 1920s) most deaths were of young Asian males and related to deep-sea diving in the pearling industry; many other deaths were caused by homicide and suicide. Pearling deaths declined after World War I and the number of Aboriginal deaths increased. The 80 to 100 deaths caused by the Japanese air raid in March 1942 were not entered into the Broome register. After World War II deaths among young males and Asians decreased and reported Aboriginal deaths increased; many were of malnourished infants and young children with infections. In the 1970s and 1980s deaths of young adults in motor vehicle accidents and of young adults from homicide and suicide increased; some occurred in custody. The pearling industry caused hundreds of deaths in the late nineteenth century and in the first two decades of this century, particularly among young Asian divers. Many were recorded in the Derby and Broome Death Registries but others were not recorded. These official records show changing patterns of mortality, for example, mortality associated with violence, infection and undernutrition (in young Aboriginal children), and more recently, motor vehicle accidents.     

Haemolytic-uraemic syndrome in Western Australia, 1980 to 1994

Abstract: A retrospective, population-based study of patients hospitalised with the haemolytic-uraemic syndrome in Western Australia from 1980 to 1994 was undertaken to describe the epidemiology of the disease in this state. We identified 41 patients. Episodes were commonest in children under five years of age (63.4 per cent) and were more frequent in females (58.5 per cent) than in males; only one Aboriginal patient was detected. More than 90 per cent of episodes had a gastrointestinal prodrome lasting from one to 22 days; in 47.6 per cent of these episodes patients had bloody diarrhoea. The average hospital stay was 26 days, and 63.4 per cent of patients required dialysis (mean 10 days). More than 20 per cent of patients developed chronic renal failure, 9.7 per cent died, two patients developed hypertension and one child became epileptic; three of the 10 patients over 16 years of age (30 per cent) died. The haemolytic-uraemic syndrome is potentially fatal, affects mostly young children, and is usually preceded by a gastrointestinal illness. Episodes can occur in common-source outbreaks but, with the exceptions of related cases in families, that appears not to have been so in Western Australia since 1980. There is a need for increased awareness of the haemolytic-uraemic syndrome to enhance prospects for earlier detection and better clinical outcomes. Improved public health surveillance is also needed to reduce the risks of the syndrome in the community.     

Talipes equinovarus in Western Australia

In Western Australia (WA), talipes equinovarus is a notifiable birth defect and, since 1980, has been ascertained by the population-based Birth Defects Registry (BDR). Talipes equinovarus deformities were classified as two distinct and distinguishable types, viz. isolated talipes equinovarus (no other birth defects present) and associated talipes equinovarus (other birth defects present). The birth prevalence of associated talipes in WA between 1980 and 1994 was 0.90 per 1000 births, and of isolated talipes was 1.25 per 1000 births. The rate of the isolated deformity was higher in Aboriginal infants (3.49 per 1000 births) than in Caucasian infants (1.11 per 1000 births) and non-Aboriginal non-Caucasian infants (0.73 per 1000 births). The sex differential in the rate of the isolated deformity was greatest among Aboriginal infants, with the rate in males being almost four times that in females. The birth prevalence of both types of the deformity remained stable over the 15-year study period. The rate of caesarean and breech deliveries and the proportion of bilaterally affected feet was greater among infants with associated talipes equinovarus deformity. An accurate and complete identification of cases of isolated talipes equinovarus in the 1980-94 WA birth cohort provides a basis for furthering the understanding of the epidemiology and hence the aetiology of the deformity.     

Blood lead levels in children in Perth,Western Australia

Abstract: This study reports on an analysis of the lead concentrations in 123 venous blood samples collected from Perth children aged between two months and 17 years attending Princess Margaret Hospital. The overall geometric mean was 6.9 μg lead per 100 ml whole blood, with 95 per cent of results lying between 3.2 and 14.8 μg/100 ml. Among children under five years of age, those aged between 18 months and two years had the highest geometric mean blood lead (11.1 μg/100 ml). There were no consistent associations between geometric mean blood lead and area of residence, age group or sex. In this sample of Perth children, the mean blood lead concentration was lower than those reported in other studies. Less than 0.1 per cent of children of the age range studied would have been expected to have lead levels exceeding the NHMRC ‘level of concern’ (25 μg/100 ml) current at the time of the study. However, the recent adoption of goal of less than 10 μg/100 ml could mean that lead levels in up to 21 per cent of Perth children would now be regarded as excessive.     

Cetacean Morbillivirus in Coastal Indo-Pacific Bottlenose Dolphins,Western Australia

Cetacean morbillivirus (CeMV) has caused several epizootics in multiple species of cetaceans globally and is an emerging disease among cetaceans in Australia. We detected CeMV in 2 stranded coastal Indo-Pacific bottlenose dolphins (Tursiops aduncus) in Western Australia. Preliminary phylogenetic data suggest that this virus variant is divergent from known strains.     

The Influenza Surveillance Program in Western Australia, 2003.

In the winter of 2003 Western Australia experienced its largest epidemic of influenza for at least five years, with activity peaking in August and September. The season was short resulting in very high numbers of cases during the peak weeks. Activity in country areas followed the peak of Metropolitan activity. Influenza A virus was detected in 28.3 per cent of the sentinel samples, and influenza B in less than one per cent. Both routine and sentinel detections and the overall estimates of influenza-like illnesses (ILI) seen by general practitioners at sentinel practices peaked in August and September 2003. The combination of influenza detections and an increase in ILI seemed to be the most accurate predictor of the beginning of winter influenza activity. There was a shift in age distribution for influenza A compared with 2003. Both the sentinel surveillance and routine samples demonstrated an increase of influenza in children and young adults. The majority of influenza A isolates were identified as A/Fujian/411/2002-like, a variant of the A/Moscow strain included in the vaccine. Despite this mismatch there did not seem to have been any noticeable increase in the risk of influenza infection in the vaccinated populations from the sentinel practices, nor was there a relative increase in disease among the highly vaccinated elderly population. A number of other respiratory viruses were identified as causes of influenza-like illness in the sentinel samples. Rhinoviruses and human metapneumovirus were the most common, the latter occurring mainly in adults.