ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00380.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00381.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00382.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00383.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:Although mortality from coronary heart disease (CHD) in Australia has fallen dramatically since the 1960s, it still remains the major cause of death in Australia and poses a significant burden on the economy. Even though a number of studies have concluded that prevention has been the main determinant of the declines in CHD, a disproportionate amount of health‐care expenditure is devoted to treatment rather than prevention. This paper reviews the international literature on the economic appraisal (costs and benefits) of alternative interventions for the treatment and prevention of CHD with the view of assessing whether there is sufficient evidence to justify a reallocation of resources away from treatment to prevention. First, few studies on the economic evaluation of CHD prevention and treatment programs have been undertaken in Australia, with most being from the United States and Europe. Second, assumptions about the specification, measurement and valuation of costs, and the epidemiological evidence on program effectiveness have varied. Third, health promotion and prevention programs are not necessarily more cost‐effective than drug or surgical treatments for CHD. Individual interventions must be judged on their own merits. There is a need for a systematic evaluation of interventions for CHD using primary Australian data to better inform decision making on resource‐allocation priorities. Such an evaluation should incorporate economic evaluation techn

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00384.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:This paper estimates the effect on health of traffic injury and air and noise pollution from a proposed inner‐suburban freeway in Melbourne. We estimated levels of these health problems for the year 2001 using traffic flow projections for the presence and absence of the freeway. For noise and air pollution, it was necessary to use pollutant levels as proxies for levels of associated diseases and health states. In 2001, there will be an increase in all traffic movements in the study area but a decrease of 100 000 vehicle–kilometres per day on major roads, excluding the bypass. This is associated with a projected reduction in the study area of about 100 to 110 injuries of all types. The major air pollution problems associated with motor vehicle emissions are ozone and respirable particulates; sulphur dioxide, nitrogen dioxide and carbon monoxide are unlikely to pose a health hazard. Levels of respirable particulates, lead and polycylic aromatic hydrocarbons are generally low. There should be no detectable increase in average or maximum noise levels adjacent to the freeway if attenuation measures are employed. A reduction in average and maximum noise levels should occur on some main roads in the affected area. The effects of the freeway on the area should be favourable to health, with reduction in traffic injury and noise‐related health problems outweighing any risk of a small deterioration in respiratory health associated with atmospheric poll

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00385.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:Ambient air was monitored for pesticides at four sites in Coffs Harbour, a coastal town (population about 50 000) surrounded by banana plantations. Air was sampled continuously for five consecutive months during the peak agricultural spraying period using vacuum pumps set to sample one litre per minute through ORBO‐42 adsorption tubes. Six pesticides were detected: three organochlorines and three organophosphates. The most commonly detected pesticide (14 per cent of all samples) was chlor‐pyrifos (maximum detected level 208.0 ng/m3, mean 3.6 ng/m3). Heptachlor was detected in 7.1 per cent of all samples (maximum detected level 133 ng/m3, mean 2.7 ng/m3). Other pesticides were only rarely detected. The only pesticide applied by air in the district (propiconazole) was not detected. If international health guidelines are used as a yardstick, these levels of exposure appear unlikely to present an appreciable health risk. Chlorpyrifos detection was associated with low wind speed (P= 0.012) and high temperature (P= 0.015), and detection at one site was associated with detection at another (P<0.001). Chlorpyrifos detection was also associated with domestic applications within the town area as reported by pesticide applicators (P= 0.045). Peak agricultural use of chlorpyrifos did not coincide with peak detection periods. None of the detected organochlorines is registered for agricultural use, although at the time, heptachlor was permitted for use as a domestic termiticide. Even in a semirural town with nearby widespread use of agricultural chemicals, community exposures to pesticides in ambient air may largely relate to their nonagricultural

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00386.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:We evaluated hospital readmission as an indicator of the quality of management of asthma patients, between July 1989 and June 1990. Using hospital separation data, we constructed a matched data set to identify early (within two weeks of discharge) readmissions. Of over 14 000 admissions for asthma in the 1‐to‐44‐year age group, 2.8 per cent were classified as early readmissions. Admissions and readmissions were more common in rural than metropolitan areas. Admissions were most common during autumn, but early readmissions occurred most often during spring. Patients staving more than one day were 0.5 times (95 per cent confidence interval (CI) 0.37 to 0.68) as likely to have an early readmission than patients staving less than one day. Using the same data set, we identified patients who had the potential for readmission within a six‐month period. Of the 5052 patients, 17.8 per cent were readmitted at least once during the period; 3.7 per cent had at least one early readmission, and 15.8 per cent had at least one late readmission (more than two weeks following discharge). A length of stay of more than one day was associated with 0.41 times (CI 0.24 to 0.70) the risk of early readmission in this cohort A length of stay of more than one day was associated with a higher risk of late readmission (1.52, CI 1.09 to 2.12), which was less likely to occur in rural than metropolitan areas (0.45, CI 0.37 to 0.55). This study showed that hospital data can identify factors associated with readmission for asthma; such readmission may be an indicator of asthma morbidity and/or management in the pop

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00387.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:The effects of two distribution strategies on the recall of receipt, retention, utilisation and perceived acceptability of written health education materials were investigated in two semirural communities. We randomly selected 512 people, 212 from general practitioners' surgeries, who received the materials from their general practitioners at the end of a routine consultation, and 300 from the electoral register, who received it through the mail in a personally addressed envelope. Of all those who received the materials, 55 (10.7 per cent) were not contactable and 386 (84.5 per cent) of those contacted consented to the survey. Structured interviews were conducted with consenting individuals two weeks after distribution to assess recall of receipt, retention, utilisation and perceived acceptability. Of those receiving the material by mail, 77.4 per cent recalled receiving it, 75.4 per cent reported keeping the booklet and 66.7 per cent reported reading it Of those receiving it from a general practitioner, 90.9 per cent recalled receiving it, 93.3 per cent reported keeping the booklet and 56 per cent reported reading it Perceived acceptability of the material was high, with over 80 per cent of respondents finding it very or fairly eye‐catching, believable, interesting and easy to read. Although general practitioner distribution led to higher rates of receipt and retention, mail‐out distribution led to higher utilisation rates and allowed access to a larger proportion of the population, resulting in more people being exposed to the education mess

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00388.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:Mortality rates from heart disease and stroke in Australia have been falling for more than 20 years. No completely satisfactory explanations for this trend exist However, it is believed to be due, at least in part, to changes in the incidence of cardiovascular disease arising from changes in the prevalence and severity of risk factors for cardiovascular disease. The adult community of Busselton in Western Australia participated in cross‐sectional health surveys every three years from 1966 to 1981. This paper describes secular trends from 1966 to 1981 and age trends from 25 to 80 years for cardiovascular risk factors in Busselton men and women. Downwards secular trends were observed for mean blood pressure and smoking for men and women, upwards trends were observed for body mass index in men, and mean cholesterol was approximately constant over this period. The age and secular trends were consistent with other Australian studies conducted in the 1980s and with overseas studies. An estimated 67 per cent of the decline in cardiovascular mortality rates among Busselton men and 22 per cent of the decline among Busselton women may be attributed to changes in the prevalence of risk factors for cardiovascular diseas

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00389.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY