Disease surveillance and epidemiological investigations in Australian fur seals

This study is the first systematic investigation into the disease status of Australian fur seals and one of very few conducted on Southern Hemisphere pinnipeds. It contributes to the understanding of Australian fur seal disease ecology and so informs the conservation management of this species

Laboratory enhanced surveillance for meningococcal disease in Victoria

Objective: To describe the epidemiological and microbiological characteristics and notification patterns of invasive meningococcal disease (IMD) in Victoria between 1990 and 1999.

Methods: Cases of IMD occurring between 1990 and 1995 identified in any of three databases were combined, matching where possible. Statistical modelling provided estimates of cases missing from all datasets. Notification sources for 1999 and 2000 cases were identified. Cases identified from notification and laboratory results provided the data to describe IMD epidemiology between 1990 and 1999.

Results: Between 1990 and 1995, 479 cases of IMD were identified. Three individual datasets each identified between 62 and 82% of cases and 47% of cases were identified in all three datasets. Statistical modelling estimated that between 37 and 83 additional cases were not identified by any dataset. Serogroup B and C strains caused 63 and 33% of culture-positive cases, respectively, with a substantial rise in serogroup C cases in 1999. Epidemiological characteristics remained relatively constant between 1990 and 1998, but an increase in patient age was seen in cases with serogroup C disease in 1999. In addition to three clonal strains seen elsewhere, an additional strain was identified that was unique to Victoria. Since January 1999, only 72% of notifications have come from treating doctors.

Conclusions: Meningococcal disease is of increasing public health significance in Victoria. Laboratory enhanced notification has improved case identification and detailed microbiological information has improved our understanding of the changing epidemiology of this disease. Collaboration with laboratories and other agencies, active investigation of putative cases and microbiological monitoring are important elements in supporting public health decisions about the control of IMD.

A Critical Review of the Harm Minimization Ideology in Australia

Harm minimization as a drug-policy approach represents a major step forward in Australian society's method of dealing with the myriad problems associated with illicit drug use. However, harm minimization lacks a substantial theoretical underpinning and there has been little debate about harm minimization at the sociological level. This article investigates a number of the assertions made within the harm minimization literature and the assumptions on which they are based. These assumptions are critically deconstructed from a number of points of view, including a Foucauldian perspective. Areas investigated include: the use of epidemiological data as a foundation for many harm-reduction strategies, the failure of harm minimization theories to deal adequately with the role of discourse in the drug policy arena, the harm minimization claim to amorality, the use of a utilitarian set of values, the supposed popularity of harm reduction and the idea that the current harm-reduction paradigm clearly acts as an extension of 'surveillance medicine' through the vehicle of governmentality. It is concluded that, whilst harm minimization represents the most promising advance in drug policy in the past, the lack of theoretical rigour in the development of these initiatives results in many of the claims made by proponents of harm-reduction strategies being either overly optimistic or fundamentally flawed.

Dusting off the epidemiological triad: could it work with obesity

The search for effective ways of dealing with obesity has centred on biological research and clinical management. However, obesity needs to be conceptualized more broadly if the modern pandemic is to be arrested. The epidemiological triad (hosts, agent/vectors and environments) has served us well in dealing with epidemics in the past, and may be worth re-evaluating to this end. Education, behaviour change and clinical practices deal predominantly with the host, although multidisciplinary practices such as shared-care might also be expected to impact on other corners of the triad. Technology deals best with the agent of obesity (energy imbalance) and it's vectors (excessive energy intake and/or inadequate energy expenditure), and policy and social change are needed to cope with the environment. The value of a broad model like this, rather than specific isolated approaches, is that the key players such as legislators, health professionals, governments and industry can see their roles in attenuating and eventually reversing the epidemic. It also highlights the need to intervene at all levels in obesity control and reduces the relevance of arguments about nature vs. nurture.


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Growing Up as Risky Business? Risks, Surveillance and the Institutionalized Mistrust of Youth

This paper will argue that a major problem for young people today is that they increasingly cause adults anxiety. This anxiety translates into a raft of interventions and strategies and programmes that target young people. These imaginings reflect and constitute a range of anxieties about the dangers posed by some young people, or to some young people, and how these risks might be economically and prudently managed. These institutionalized relationships of mistrust can have a range of often negative consequences (intended or otherwise) for individuals and populations of young people. I argue that Foucault's work on disciplinary, sovereign and governmental forms of power provides a generative framework for analysing what I refer to as the institutionalized mistrust, surveillance and regulation of contemporary populations of young people.

The use of injury surveillance databases to identify emerging injury hazards

Among the many valuable uses of injury surveillance is the potential to alert health authorities and societies in general to emerging injury trends, facilitating earlier development of prevention measures. Other than road safety, to date, few attempts to forecast injury data have been made, although forecasts have been made of other public health issues. This may in part be due to the complex pattern of variance displayed by injury data. The profile of many injury types displays seasonality and diurnal variance, as well as stochastic variance. The authors undertook development of a simple model to forecast injury into the near term. In recognition of the large numbers of possible predictions, the variable nature of injury profiles and the diversity of dependent variables, it became apparent that manual forecasting was impractical. Therefore, it was decided to evaluate a commercially available forecasting software package for prediction accuracy against actual data for a set of predictions. Injury data for a 4-year period (1996 to 1999) were extracted from the Victorian Emergency Minimum Dataset and were used to develop forecasts for the year 2000, for which data was also held. The forecasts for 2000 were compared to the actual data for 2000 by independent t-tests, and the standard errors of the predictions were modelled by stepwise hierarchical multiple regression using the independent variables of the standard deviation, seasonality, mean monthly frequency and slope of the base data (R = 0.93, R² = 0.86, F_{(3, 27)} = 55.2, p < 0.0001). Significant contributions to the model included the SD (β = 1.60, p < 0.001), mean monthly frequency (β =  - 0.72, p < 0.002), and the seasonality of the data (β = 0.16, p < 0.02). It was concluded that injury data could be reliably forecast and that commercial software was adequate for the task. Variance in the data was found to be the most important determinant of prediction accuracy. Importantly, automated forecasting may provide a vehicle for identifying emerging trends.

Agreement between adolescent self-report and parent reports of health and well-being: results of an epidemiological study.

Objective To examine parent and adolescent agreement on physical, emotional, mental and social health and well-being in a representative population.
Methodology An epidemiological design was used to obtain parent–child/adolescent dyad data on comparable items and scales of a generic measure of health and well-being, the Child Health Questionnaire (parent/proxy report 50 item, self-report 80 item). Scale analysis included intraclass correlations (ICCs) to examine strength of parent–child associations and independent t-tests for differences between adolescents (with or without an illness). Where there were significant differences in scale scores, analysis of variance and two sample t-tests were used to examine the influence of social, demographic, health concern and school variables. Single items were examined for trends in response categories.
Results 2096 parent–adolescent dyads (adolescent mean age of 15.1 years, males 50%, maternal parent 83.2%, biological parent 93.5%). ICCs were strong. Overall, adolescents reported poorer emotional and social health, and clinically significant differences were observed for perceptions of general health (mean difference 8.1/100), frequency and amount of body pain (5.94/100), experience of mental health (5.14/100), and impact of health on family activities (12.43/100), which widen significantly for adolescents with illness. Social, health and school enjoyment and performance significantly widened parent–child differences.
Conclusions All adolescents were much less optimistic about their health and well-being than their parents, and were only in close agreement on aspects of health and well-being they rated highly. Adolescent reports are more likely to be sensitive to pain, mental health problems, health in general and the impact of their health on family activities.

A review of epidemiological studies on children`s health and wellbeing

New epidemiological studies on children's health and wellbeing are essential to guide policy development. To ensure that these studies are based on the current conceptualisation of health, they should have a theoretical rationale for the selection of their domains. The scales used to measure each domain must be psychometrically sound, and also reflect the current conceptualisation of the domain. When selecting scales for each domain, child questionnaires must be considered, in addition to adult proxy measures. Through following these recommendations, researchers can ensure that their studies have theoretical and practical relevance. (non-author abstract)

Nutrition surveys or surveillance : one-night stands or a long-term commitment?

Many disparate groups in Australia now concur about the need for continuous food and nutrition monitoring.