Childhood asthma diagnosis and use of asthma medication.

Aim: To determine the burden of asthma in children.

Methods: A cross sectional, randomised, computer assisted telephone survey of a community based sample of 2020 children aged 5-14 years in western Sydney (New South Wales) over a 20 day period from June 2000 to July 2000.

Results: Main outcome measures were carer reported history of asthma diagnosis, hospital presentation/admission for asthma, recent use of anti-asthma medications, and recent respiratory symptoms.

A population based study of the impact of corticosteroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis.

Background: Despite an extensive literature, the impact of both adjunctive steroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis is controversial.

Aim: To determine the independent contribution of corticosteroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis in a representative population with good access to medical services.

Methods: Data were obtained from laboratories and hospital records to assemble a population register in Sydney, Australia, 1994-99.

Patient knows best: blinded assessment of nonadherence with antituberculous therapy by physicians, nurses, and patients compared with urine drug levels.

Background: Adherence with therapy is a wide spectrum of behavior rather than a categorical state. While extreme nonadherence is readily apparent, it is rare compared to lesser degrees of nonadherence, which are difficult to predict.

Aims: To compare the accuracy of doctor, nurse, and patient prediction of adherence with antituberculous therapy with urine isoniazid levels.

Reasons for incomplete immunisation among Australian children. A national survey of parents.

Background: Incomplete immunisation among Australian children may be due to parents disagreeing with immunisation rather than medical contraindications or access issues.

Setting And Methods: The parents of 1338 children recorded on the ACIR as incompletely immunised were telephoned and interviewed.

Results: Of the 462 parents who confirmed their child was incompletely immunised, 270 (58%) disagreed with or were concerned about immunisation; 190 (70%) of these were concerned about vaccine side effects.

Effectiveness of the linkage of child care and maternity payments to childhood immunisation.

In 1998, Australia enacted comprehensive national legislation making receipt of the maternity immunisation allowance (MIA) and the child care benefit (CCB) conditional on evidence of age-appropriate immunisation. We assessed the impact of this policy on immunisation status using a nationally representative population-based case-control study of 589 fully immunised controls and 190 incompletely immunised cases, aged 28-31 months. Immunisation status was significantly associated with parent awareness of the MIA (adjusted odds ratio (aOR) = 3.

The cost-effectiveness of pneumococcal conjugate vaccination in Australia.

Background: Pneumococcal conjugate vaccine, 7 valent (PCV7) is the most costly vaccine yet considered for publicly funded programs. In mid 2001, Australia funded PCV7 for high-risk groups only (indigenous children and children with certain underlying medical conditions). World wide, non-industry-funded studies and studies using cost-utility measures are sparse.

Community-based estimates of incidence and risk factors for childhood pneumonia in Western Sydney.

The aim was to estimate the community incidence and risk factors for all-cause pneumonia in children in Western Sydney, Australia. A cross-sectional randomized computer-assisted telephone interview was conducted in July 2000, in Western Sydney. Parents of 2020 children aged between 5 and 14 years were interviewed about their child's respiratory health since birth.

The seroepidemiology and transmission dynamics of varicella in Australia.

To enhance our understanding of the epidemiology and transmission dynamics of varicella in the pre-vaccine era we performed a serosurvey using opportunistically collected sera submitted to diagnostic laboratories across Australia during 1997-1999. A representative sample by state and sex of 2027 sera from persons aged 1-49 years was tested using an enzyme immunoassay method. The average age of infection and age-specific forces of infection (the probability that a susceptible individual acquires infection) were calculated using published methodologies.

Is low immunisation coverage in inner urban areas of Australia due to low uptake or poor notification?

Introduction: The Australian Childhood Immunisation Register (ACIR) consistently reveals pockets of lower immunisation coverage in inner urban areas. We investigated whether low uptake or poor notification of immunisation is the main reason for this difference.

Methods: We estimated under reporting by telephone surveying the parents of 640 children recorded as incompletely immunised on the ACIR at 12 months of age.

Measles vaccination coverage among five-year-old children: implications for disease elimination in Australia.

Objectives: To (i) assess under-reporting of measles-mumps-rubella (MMR) vaccinations to the Australian Childhood Immunisation Register (ACIR); (ii) estimate MMR coverage among five-year-old children and the proportion immune to measles infection; (iii) identify factors related to non-uptake of MMR vaccination.

Methods: We analysed ACIR data for a birth cohort of approximately 64,000 children aged five years. The parents of a sample of 506 children with no ACIR record for the second MMR vaccination (MMR2), due at four years of age, were interviewed by telephone to assess under-reporting to the ACIR and reasons for non-uptake of MMR vaccination.

Immunisation coverage in Australia corrected for under-reporting to the Australian Childhood Immunisation Register.

Objective: To assess the level of under-reporting to the Australian Childhood Immunisation Register (ACIR) and the resulting underestimation of national immunisation coverage using ACIR data, and to correct national immunisation estimates for under-reporting.

Methods: A national population-based telephone survey was conducted in May-July 2001 of two random samples of children born in 1998 and 1999 who were recorded on the ACIR as incompletely immunised at either 12 months or 24 months of age. Parents were asked whether and when their child had received the vaccinations required to qualify as fully immunised.

Estimating immunisation coverage: is the 'third dose assumption' still valid?

Immunisation coverage is calculated from Australian Childhood Immunisation Register (ACIR) data using the 'third dose assumption'. This assumes that if the third in a series of vaccine doses has been recorded on the ACIR, the previous two doses have been received, whether or not they are recorded. The objectives of this study were to validate the 'third dose assumption', and measure the impact of the assumption on immunisation coverage estimates at 12 months of age.

A randomised controlled clinical trial of the efficacy of family-based direct observation of anti-tuberculosis treatment in an urban, developed-country setting.

Setting: A randomised, controlled clinical trial of the effectiveness of a family-based programme of directly observed treatment (DOT) for tuberculosis.

Methods: TB patients seen in Victoria, Australia, were randomly allocated to DOT observed by a family member (FDOT), or to standard supervised but non-observed therapy (ST). The outcome measure was compliance, measured by blinded testing of isoniazid levels in urine.

Immunization myths and realities: responding to arguments against immunization.

As vaccination programs continue to successfully control more and more infectious diseases, and the effects of these diseases become less visible, there has been increased focus on adverse events following immunization. Vaccines have been falsely implicated in the causation of a range of conditions, especially those which affect infants and young children, and whose aetiology is unknown, poorly understood or multifactorial. This paper explores some of the common immunization myths that clinicians may face.

Use of hospitalization and pharmaceutical prescribing data to compare the prevaccination burden of varicella and herpes zoster in Australia.

The aims of the study were to compare the burden of varicella and herpes zoster in Australia. No national surveillance exists for varicella or herpes zoster. We used hospital morbidity data from 1993-9 and pharmaceutical prescribing data from 1995-9.

A mathematical model to measure the impact of the Measles Control Campaign on the potential for measles transmission in Australia.

Background: The aims of this study were to determine the impact of the Australian Measles Control Campaign (MCC) on the transmission dynamics of measles by calculating the reproductive number (R) before and after the MCC, and to predict measles control in Australia in the future.

Methods: A national serosurvey was conducted before and after the MCC. Sera were tested for anti-measles IgG using enzyme immunoassay (EIA).

Hepatitis A vaccination options for Australia.

The epidemiology of hepatitis A is changing, with an increasing proportion of the population becoming susceptible to infection. The burden of hepatitis A is comparable to that of other vaccine-preventable diseases for which new vaccines are available. Options for vaccination include selective programmes for high-risk groups, which could involve screening prior to vaccination, or universal programmes for infants and/or adolescents.

A randomised, clinical trial comparing the effectiveness of hospital and community-based reminder systems for increasing uptake of influenza and pneumococcal vaccine in hospitalised patients aged 65 years and over.

Hospitalisation represents an opportunity to identify unimmunised people at risk for the complications of influenza and pneumococcal disease. We conducted a randomised controlled trial of two strategies to increase uptake of influenza and pneumococcal vaccines in eligible, hospitalised subjects aged 65 years or more, admitted between May and September 1998 to a Melbourne hospital. Unvaccinated participants were allocated randomly to alert systems for hospital staff or community general practitioners (GPs).

Hospital in the home is cost saving for appropriately selected patients: a comparison with in-hospital care.

Background: As the cost of acute care in hospitals increases, there is an increasing need to find alternative means of providing acute care. Hospital in the home (HITH) has developed in response to this challenge. Current evidence is conflicting as to whether HITH provides cost savings compared with in-hospital care (IHC).

Chronic Strongyloides stercoralis infection in Laotian immigrants and refugees 7-20 years after resettlement in Australia.

During the period 1974-91 large numbers of Southeast Asian immigrants and refugees were resettled in Western countries, including Australia. Health screening during this period demonstrated that intestinal parasite infections were common. A cross-sectional survey of 95 Laotian settlers who arrived in Australia on average 12 years prior to the study was conducted to determine if chronic intestinal parasite infections were prevalent in this group.

Seasonality of coronary artery deaths in New South Wales, Australia.

Background: Complex temporal variations in coronary deaths, including diurnal, weekly, and seasonal trends, have been reported worldwide.

Objective: To describe the magnitude of seasonal changes in coronary artery deaths in New South Wales, Australia.

Design: Hospital morbidity data, mortality statistics, and meteorological data were modelled using time series techniques to determine seasonality of coronary deaths.

The epidemiology of cardiac arrests in a Sydney hospital.

Aim: To examine the epidemiology of cardiac arrest (CA) in New South Wales (NSW), Australia, and a large teaching hospital in Sydney and to identify predictors of survival.

Methods: Data from the 1996/97 NSW inpatient statistics collection were analysed. Logistic regression was used to determine predictors of mortality from CA.

School immunisation certificates--a review over time in a disadvantaged community.

Objectives: To compare proportions of kindergarten children in Auburn presenting School Immunisation Certificates (SIC) or other school-entry immunisation documentation over time, and to examine the immunisation status of these children.

Methods: Immunisation records of kindergarten children enrolled in all primary schools in the Auburn local government area were reviewed in 1994 and 1998.

Results: Eight hundred and thirty-three and 737 school entry records of children enrolled in kindergarten were reviewed in 1998 and 1994 respectively.

Risk factors for colonization with vancomycin-resistant enterococci in a Melbourne hospital.

Objective: To determine risk factors for colonization with vancomycin-resistant enterococci (VRE) in a hospital outbreak.

Design: Outbreak investigation and case-control study.

Setting: A referral teaching hospital in Melbourne, Australia.