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ANZSERCH/APHA, NEW ZEALAND BRANCH, ABSTRACTS OF PAPERS PRESENTED TO THE ANNUAL CONFERENCE, MAY 1981

ANZSERCH/APHA, NEW ZEALAND BRANCH, ABSTRACTS OF PAPERS PRESENTED TO THE ANNUAL CONFERENCE, MAY 1981 COMMUNITY HEALTH STUDIES VOLUME V, NUMBER 3, 1981 ANZSERCH/APHA, NEW ZEALAND BRANCH, ABSTRACTS OF PAPERS PRESENTED TO THE ANNUAL CONFERENCE, MAY 1981. EVALUATION OF SERVICE DEVELOP- STROKES IN AUCKLAND : THE ARCOS MENT GROUPS IN NORTH CANTERBURY STUDY - PROGRESS REPORT R. Bonita and J.D.K. North P. Barnett Department of Medicine, University of Auckland, Health Planningand Research Unit, Christchurch. Auckland. Considerable resources have been devoted to Cerebrovascular disease in New Zealand is the promoting the service development planning third ranking cause of death accounting for 12% of approach in the pilot areas of Northland and all deaths in 1978, and an important cause of Wellington and, more informally, elsewhere. In morbidity, disability and stress, involving high North Centerbury service planning groups have utilization rates of medical and social services. been operating for several years. If service Despite some evidence for a decline in mortality planning is to be effective and well-accepted an since the 1920s, the absolute number of victims is understanding of the circumstances in which it is increasing as the population ages. likely to succeed is necessary. The Auckland Region Coronary or Stroke The purpose of.this study is to develop an Study (ACROS) is investigating the incidence, approach to evaluating service development group natural history and management of strokes in activity in terms of both process and outcome. Two Auckland. In a time of increasing economic complementary strategies are used: a difficulty, the study will provide information questionnaire to participants and an analysis of which will form the basis for the more efficient and documents (minutes of meetings, reports, etc.). effective allocation of limited resources. Results indicate that in North Canterbury service development groups are broadly-based with high An analysis of the first 70 cases registered levels of participation sustained over several years. reveals that 20 died within the first week. Of the 50 Satisfaction is generally high and there are cases who survived one week, 70% were 65 years differences in participants’ objectives depending and over, 50% were males, 74% were treated in a on type of agency affiliation (statutory or public or private hopsital, and 76% were voluntarylprivate). The most important independent in activities of daily living prior to the facilitating influences on group activity are related stroke. A high proportion, 76% had had blood to the organizational environment, clarity of pressure taken within the previous three months mandate and the quality of the reporting and 36% were currently being treated for relationship between the group and its “parent” hypertension. ’ body. Development of a classification of outcomes of service development and methods of identifying them is in progress. VOLUME V, NUMBER 3.1981 COMMUNITY HEALTH STUDIES MATERNAL AND INFANT CARE IN Statistical Area, and will contain statistical WELLINGTON, 1972 and 1978 information on demographic, social, economic and health characteristics of the region along with J.A. Briggs and G.C. Salmond national figures for comparative purposes. Department of Health, Wellington. Major topics planned for inclusion are : Population characterics and trends; Social and A health care consumer study carried out in economic characteristics; Health Status : 1972 was replicated in 1978. The two sets of results indicators, special health problems; Health are compared and discussed. Changes in the use of Factors/ risks. Further information, such as an and attitudes towards maternal and infant health ipventory of health services, to gathered at the services over time and between residential areas are regional level, may also be included in the discussed in the light of demographic and socio- handbook. economic change. The improvement in infant nursing services between 1972 and 1978 to mothers The process of selecting, collecting, collating and in one low socioeconomic status area is examined using the information is discussed. in detail. EVALUATION OF A SCHOOL-BASED FACTORS INFLUENCING GENERAL PRACTITIONER PRESCRIBING ALCOHOL EDUCATION PROGRAM J. Ishemood', L. Makolm+ and A Hornblow+ s. Cascwell Alcohol Research Unit, School of Medicine, *&partment of Preventive and Community Medicine, Christchurch Clinical School of University of Auckland. Auckland. Medicine. +Health Planning and Research Unit. Christchurch. An education program with objectives of promoting 'moderate' use of alcohol, and Using multivariate methods the data from 520 appropriate methods of behaving in drinking situations was evaluated three months after patients of eight doctors in a city group practice were analy sed to identify the collective and teaching took place. The alcohol education was separate contributions of selected patient and presented in the context of a high school social studies course dealing with social and medical drug doctor factors to script item numbers and cost variations. Results confirmed that variance in cost use. and item numbers was directly related to diagnosis. The outcome evaluation measures are A principal diagnosis of hypertension or diabetes/endocrine/ hormonal problems, or a students' self-reports of attitudes, behavioural intentions and past behaviour. The effects of both multiple of diagnoses was most associated with high cost scripts, and other patient descriptors, the treatment and the administration of a questionnaire before teaching are discussed. such as gravity of illness, accounted for a much smaller, but still significant variance. Although there were only minor differences REGIONAL HEALTH DATA HANDBOOKS between male and female subjects, the older age groubs in both sexes were over-represented in the J.E. Hickling and J. Davey higher item and cost categories. Which doctor the patient saw accounted for only 0.5% of the total variance, which was statistically non-significant. Department of Health. Wellington. The results not only indicated that doctor To assist in regional health planning a pilot prescribing behaviour was rationally related to exercise has been undertaken, preparing regional patient diagnosis, but also suggested that peer health data handbooks. Initially handbooks are review, as practised by these eight doctors, was being prepared for four areas; Northland operating to reduce both variance between doctor Statistical Area Auckland Statistical Area, factors and prescribing costs. Wellington Statistical Division and Southland COMMUNITY HEALTH STUDIES VOLUME V, NUMBER 3, 1981 SOCIAL ISOLATION : AN INDEPENDENT RUBELLA ANTIBODY SCREENING IN A CHD RISK FACTOR? FAMILY PLANNING CLINIC J.G. Joseph and S.L. Syme C.E. Paul Epidemiology Unit, Wellington Hospital, Department of Health, Dunedin Wellington The study was designed to investigate the Examination data from 3809 Japanese- feasibility of rubella antibody testing in a family American men aged 30-74 were analysed to planning clinic population. All women born in the estimate the relationship between social isolation years 1957-62 who attended the clinic over two and CHD, independent of known risk factors. months in 1980 were questioned about a history of Social isolation was defined by an index of marital rubella immunisation and illness. The intention status, group membership, and religious was that all women not already screened for participation. Serum cholesterol, blood pressure, antibody or imunised in the previous five years smoking, exercise and family history or heart should be referred for antibody testing. The results disease were ,also documented. Prevalent CHD of rubella haemaglutination inhibition (HAI) tests was established by use of ECG and Rose Angina showed that 13% had HA1 titre of11:16. This Questionnaire criteria. ranged from 8% for those women born in 1957-58 (too early to be immunised at school), to 16% for Initial univariate analyses estimated the those women born 1961-62 who should have been relative risk (RR) 4s 2.19 when the most and least immunised at school. isolated were compared. Multiple logistic analyses produced an estimated relative risk of 1.90 (p Of all the women whose susceptibility to ~003) for the association between social isolation rubella was uncertain (93% of 330), only half the and CHD, independent of physical risk factors. expected number of susceptibles were identified Only age and physical activity were more strongly and not all of these were subsequently immunised. associated with CHD in this study group. The reasons for this lack of effectiveness are discussed and some suggestions are made for improving the effectiveness of all rubella antibody testing for women in the child-bearing years. COMPUTER SIMULATION OF THE SUPPLY ACCIDENT AND EMERGENCY All”DANCES OF DOCTORS IN NEW ZEALAND ONE YEAR’S EXPERIENCE AT WAIKATO HOSPITAL N. Pearce, A. Smith and K.W. Newell S. McRae and M. Topping Department of Community Health, Clinical School of Medicine Wellington Hospital. Woikato Hospital and Waikato University, Hamilton. A considerable amount of literature has been generated abut what has been referred to as ‘the The following variables were considered for coming crisis in medical manpower’ with most each of all 25,707 first casualty attendances at the current analyses predicting a large surplus of Waikato Hospital in 1979: time, day and date of doctors in the late 1980s. However, predictions can arrival; age, sex, occupation and place of residence be complex and risky because of potential fluctuations in the input variables due to political of attender; location and nature of accident; and social factors. Variables affecting doctor diagnosis and disposal. supply include graduate numbers, immigration, Most attendances occurred outside of normal emigration, sex-ratios, retirement and part-time work. working hours, involved young males and were because of injury rather than illness. These and A computer simulation is described which other results are examined in more detail and enables the relative effects of these variables to be various cross-tabluations presented. Similar studies in New Zealand and abroad are reviewed in measured. Examples of the effects of changes in the variables are given together with several the context of our findings. The role of the casualty department in the community is argued. predictions of doctor numbers up to the year 2001. COMMUNITY HEALTH STUDIES 307 VOLUME V, NUMBER 3, 1981 PESTICIDE EXPOSURE AND SOFT TISSUE GENERAL PRACTICE: WHO GOES? SARCOMAS: A CASE-CONTROL STUDY DESIGN 1. Scott, L. Gilmore, J. Madarasz A.H. Smith and D.O. Fisher Department of Community Health, University of Auckland, Auckland. Department of Community Health, Wellington The objective of the Community Medical Clinical School of Medicine. Wellington Hospital, Wellington. Care (CoMedCa) project is the development of appropriate means for the collection, Recent case-control studies in Sweden have classification, handling and presentation of data suggested that persons occupationally exposed to from general practice so as to provide statistically pesticides, including, 2,4,5-T, are at increased risk valid information for the purposes of policy of soft tissue sarcomas, a variety of rare cancers. formation and review, administration, education and research. Epidemiological finding such as this require careful assessment of study design implications, This paper describes the methodology and also replication in other settings. A case- developed and its application in a year long survey control study design being used in New Zealand is of general practice in the Hamilton Health presented which involves comparing work District. 90% of the 128 general practitioners in the histories of male soft tissue sarcoma patients district participated in the survey. A total of 9468 identified by the Cancer Registry, with that of survey forms on doctorlpatient contacts occurring other male cancer patients identified in the same in the doctors’ surgeries were completed and this Registry, matched according to age and year of data is now under analysis. registration. Differences in the utilisation of general The implications of this study design are practitioner services are apparent on the basis of discussed with regard to two major types of bias in age, sex and race. The latter part of this paper case control studies, selection bias and recall bias. examines these differences and suggests they have In addition, the use of ‘other’ cancers as controls is implications for the organisation and management examined in the light of the fact that some of them of general practice. could possibly also be induced by pesticides. It is concluded that the relative protection in the study design against problems of selection and, in particular, recall bias; more than compensate for any study power reduction from the potential THE ACCESSIBILITY OF HEALTH aetiological relationship between some of the ‘other’ cancer group and pesticide exposure. FACILITIES AX. Smith Department of Health, Wellington The proximity or remoteness of health facilities to members of the community affects the resources used in travelling to them. A case study is presented in which alternative locations for hospitals were considered. A means of valueing the differences in community travel arising from alternative location of facilities is indicated. It is demonstrated that such differences could be as important as other kinds of differences, such as those in capital costs, that traditionally have been measured. VOLUME V, NUMBER 3, 1981 308 COMMUNITY HEALTH STUDIES http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

ANZSERCH/APHA, NEW ZEALAND BRANCH, ABSTRACTS OF PAPERS PRESENTED TO THE ANNUAL CONFERENCE, MAY 1981

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Publisher
Wiley
Copyright
"Copyright © 1981 Wiley Subscription Services, Inc., A Wiley Company"
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1753-6405.1981.tb00341.x
Publisher site
See Article on Publisher Site

Abstract

COMMUNITY HEALTH STUDIES VOLUME V, NUMBER 3, 1981 ANZSERCH/APHA, NEW ZEALAND BRANCH, ABSTRACTS OF PAPERS PRESENTED TO THE ANNUAL CONFERENCE, MAY 1981. EVALUATION OF SERVICE DEVELOP- STROKES IN AUCKLAND : THE ARCOS MENT GROUPS IN NORTH CANTERBURY STUDY - PROGRESS REPORT R. Bonita and J.D.K. North P. Barnett Department of Medicine, University of Auckland, Health Planningand Research Unit, Christchurch. Auckland. Considerable resources have been devoted to Cerebrovascular disease in New Zealand is the promoting the service development planning third ranking cause of death accounting for 12% of approach in the pilot areas of Northland and all deaths in 1978, and an important cause of Wellington and, more informally, elsewhere. In morbidity, disability and stress, involving high North Centerbury service planning groups have utilization rates of medical and social services. been operating for several years. If service Despite some evidence for a decline in mortality planning is to be effective and well-accepted an since the 1920s, the absolute number of victims is understanding of the circumstances in which it is increasing as the population ages. likely to succeed is necessary. The Auckland Region Coronary or Stroke The purpose of.this study is to develop an Study (ACROS) is investigating the incidence, approach to evaluating service development group natural history and management of strokes in activity in terms of both process and outcome. Two Auckland. In a time of increasing economic complementary strategies are used: a difficulty, the study will provide information questionnaire to participants and an analysis of which will form the basis for the more efficient and documents (minutes of meetings, reports, etc.). effective allocation of limited resources. Results indicate that in North Canterbury service development groups are broadly-based with high An analysis of the first 70 cases registered levels of participation sustained over several years. reveals that 20 died within the first week. Of the 50 Satisfaction is generally high and there are cases who survived one week, 70% were 65 years differences in participants’ objectives depending and over, 50% were males, 74% were treated in a on type of agency affiliation (statutory or public or private hopsital, and 76% were voluntarylprivate). The most important independent in activities of daily living prior to the facilitating influences on group activity are related stroke. A high proportion, 76% had had blood to the organizational environment, clarity of pressure taken within the previous three months mandate and the quality of the reporting and 36% were currently being treated for relationship between the group and its “parent” hypertension. ’ body. Development of a classification of outcomes of service development and methods of identifying them is in progress. VOLUME V, NUMBER 3.1981 COMMUNITY HEALTH STUDIES MATERNAL AND INFANT CARE IN Statistical Area, and will contain statistical WELLINGTON, 1972 and 1978 information on demographic, social, economic and health characteristics of the region along with J.A. Briggs and G.C. Salmond national figures for comparative purposes. Department of Health, Wellington. Major topics planned for inclusion are : Population characterics and trends; Social and A health care consumer study carried out in economic characteristics; Health Status : 1972 was replicated in 1978. The two sets of results indicators, special health problems; Health are compared and discussed. Changes in the use of Factors/ risks. Further information, such as an and attitudes towards maternal and infant health ipventory of health services, to gathered at the services over time and between residential areas are regional level, may also be included in the discussed in the light of demographic and socio- handbook. economic change. The improvement in infant nursing services between 1972 and 1978 to mothers The process of selecting, collecting, collating and in one low socioeconomic status area is examined using the information is discussed. in detail. EVALUATION OF A SCHOOL-BASED FACTORS INFLUENCING GENERAL PRACTITIONER PRESCRIBING ALCOHOL EDUCATION PROGRAM J. Ishemood', L. Makolm+ and A Hornblow+ s. Cascwell Alcohol Research Unit, School of Medicine, *&partment of Preventive and Community Medicine, Christchurch Clinical School of University of Auckland. Auckland. Medicine. +Health Planning and Research Unit. Christchurch. An education program with objectives of promoting 'moderate' use of alcohol, and Using multivariate methods the data from 520 appropriate methods of behaving in drinking situations was evaluated three months after patients of eight doctors in a city group practice were analy sed to identify the collective and teaching took place. The alcohol education was separate contributions of selected patient and presented in the context of a high school social studies course dealing with social and medical drug doctor factors to script item numbers and cost variations. Results confirmed that variance in cost use. and item numbers was directly related to diagnosis. The outcome evaluation measures are A principal diagnosis of hypertension or diabetes/endocrine/ hormonal problems, or a students' self-reports of attitudes, behavioural intentions and past behaviour. The effects of both multiple of diagnoses was most associated with high cost scripts, and other patient descriptors, the treatment and the administration of a questionnaire before teaching are discussed. such as gravity of illness, accounted for a much smaller, but still significant variance. Although there were only minor differences REGIONAL HEALTH DATA HANDBOOKS between male and female subjects, the older age groubs in both sexes were over-represented in the J.E. Hickling and J. Davey higher item and cost categories. Which doctor the patient saw accounted for only 0.5% of the total variance, which was statistically non-significant. Department of Health. Wellington. The results not only indicated that doctor To assist in regional health planning a pilot prescribing behaviour was rationally related to exercise has been undertaken, preparing regional patient diagnosis, but also suggested that peer health data handbooks. Initially handbooks are review, as practised by these eight doctors, was being prepared for four areas; Northland operating to reduce both variance between doctor Statistical Area Auckland Statistical Area, factors and prescribing costs. Wellington Statistical Division and Southland COMMUNITY HEALTH STUDIES VOLUME V, NUMBER 3, 1981 SOCIAL ISOLATION : AN INDEPENDENT RUBELLA ANTIBODY SCREENING IN A CHD RISK FACTOR? FAMILY PLANNING CLINIC J.G. Joseph and S.L. Syme C.E. Paul Epidemiology Unit, Wellington Hospital, Department of Health, Dunedin Wellington The study was designed to investigate the Examination data from 3809 Japanese- feasibility of rubella antibody testing in a family American men aged 30-74 were analysed to planning clinic population. All women born in the estimate the relationship between social isolation years 1957-62 who attended the clinic over two and CHD, independent of known risk factors. months in 1980 were questioned about a history of Social isolation was defined by an index of marital rubella immunisation and illness. The intention status, group membership, and religious was that all women not already screened for participation. Serum cholesterol, blood pressure, antibody or imunised in the previous five years smoking, exercise and family history or heart should be referred for antibody testing. The results disease were ,also documented. Prevalent CHD of rubella haemaglutination inhibition (HAI) tests was established by use of ECG and Rose Angina showed that 13% had HA1 titre of11:16. This Questionnaire criteria. ranged from 8% for those women born in 1957-58 (too early to be immunised at school), to 16% for Initial univariate analyses estimated the those women born 1961-62 who should have been relative risk (RR) 4s 2.19 when the most and least immunised at school. isolated were compared. Multiple logistic analyses produced an estimated relative risk of 1.90 (p Of all the women whose susceptibility to ~003) for the association between social isolation rubella was uncertain (93% of 330), only half the and CHD, independent of physical risk factors. expected number of susceptibles were identified Only age and physical activity were more strongly and not all of these were subsequently immunised. associated with CHD in this study group. The reasons for this lack of effectiveness are discussed and some suggestions are made for improving the effectiveness of all rubella antibody testing for women in the child-bearing years. COMPUTER SIMULATION OF THE SUPPLY ACCIDENT AND EMERGENCY All”DANCES OF DOCTORS IN NEW ZEALAND ONE YEAR’S EXPERIENCE AT WAIKATO HOSPITAL N. Pearce, A. Smith and K.W. Newell S. McRae and M. Topping Department of Community Health, Clinical School of Medicine Wellington Hospital. Woikato Hospital and Waikato University, Hamilton. A considerable amount of literature has been generated abut what has been referred to as ‘the The following variables were considered for coming crisis in medical manpower’ with most each of all 25,707 first casualty attendances at the current analyses predicting a large surplus of Waikato Hospital in 1979: time, day and date of doctors in the late 1980s. However, predictions can arrival; age, sex, occupation and place of residence be complex and risky because of potential fluctuations in the input variables due to political of attender; location and nature of accident; and social factors. Variables affecting doctor diagnosis and disposal. supply include graduate numbers, immigration, Most attendances occurred outside of normal emigration, sex-ratios, retirement and part-time work. working hours, involved young males and were because of injury rather than illness. These and A computer simulation is described which other results are examined in more detail and enables the relative effects of these variables to be various cross-tabluations presented. Similar studies in New Zealand and abroad are reviewed in measured. Examples of the effects of changes in the variables are given together with several the context of our findings. The role of the casualty department in the community is argued. predictions of doctor numbers up to the year 2001. COMMUNITY HEALTH STUDIES 307 VOLUME V, NUMBER 3, 1981 PESTICIDE EXPOSURE AND SOFT TISSUE GENERAL PRACTICE: WHO GOES? SARCOMAS: A CASE-CONTROL STUDY DESIGN 1. Scott, L. Gilmore, J. Madarasz A.H. Smith and D.O. Fisher Department of Community Health, University of Auckland, Auckland. Department of Community Health, Wellington The objective of the Community Medical Clinical School of Medicine. Wellington Hospital, Wellington. Care (CoMedCa) project is the development of appropriate means for the collection, Recent case-control studies in Sweden have classification, handling and presentation of data suggested that persons occupationally exposed to from general practice so as to provide statistically pesticides, including, 2,4,5-T, are at increased risk valid information for the purposes of policy of soft tissue sarcomas, a variety of rare cancers. formation and review, administration, education and research. Epidemiological finding such as this require careful assessment of study design implications, This paper describes the methodology and also replication in other settings. A case- developed and its application in a year long survey control study design being used in New Zealand is of general practice in the Hamilton Health presented which involves comparing work District. 90% of the 128 general practitioners in the histories of male soft tissue sarcoma patients district participated in the survey. A total of 9468 identified by the Cancer Registry, with that of survey forms on doctorlpatient contacts occurring other male cancer patients identified in the same in the doctors’ surgeries were completed and this Registry, matched according to age and year of data is now under analysis. registration. Differences in the utilisation of general The implications of this study design are practitioner services are apparent on the basis of discussed with regard to two major types of bias in age, sex and race. The latter part of this paper case control studies, selection bias and recall bias. examines these differences and suggests they have In addition, the use of ‘other’ cancers as controls is implications for the organisation and management examined in the light of the fact that some of them of general practice. could possibly also be induced by pesticides. It is concluded that the relative protection in the study design against problems of selection and, in particular, recall bias; more than compensate for any study power reduction from the potential THE ACCESSIBILITY OF HEALTH aetiological relationship between some of the ‘other’ cancer group and pesticide exposure. FACILITIES AX. Smith Department of Health, Wellington The proximity or remoteness of health facilities to members of the community affects the resources used in travelling to them. A case study is presented in which alternative locations for hospitals were considered. A means of valueing the differences in community travel arising from alternative location of facilities is indicated. It is demonstrated that such differences could be as important as other kinds of differences, such as those in capital costs, that traditionally have been measured. VOLUME V, NUMBER 3, 1981 308 COMMUNITY HEALTH STUDIES

Journal

Australian and New Zealand Journal of Public HealthWiley

Published: Oct 1, 1981

There are no references for this article.