General practitioners' role in preventive medicine: scenario analysis using alcohol as a case study

The purpose of this analysis is threefold: first, to extract from the literature, current levels of GP detection of at-risk drinking by their patients, rates at which general practitioners (GPs) offer an intervention; and the effectiveness of these interventions; secondly, to develop a model based on this literature to be used in conjunction with scenario analysis; and thirdly, to consider the cost implications of current efforts and various scenarios. This study deals specifically with Australian general practice. A two-step procedure is used in the scenario analysis, which involves identifying opportunities for detection, intervention, effectiveness and assigning probabilities to outcomes. The results suggest that increasing rates of GP intervention achieves greatest benefit and return on resource use. For every 5% point increase in the rate of GP intervention, an additional 26 754 at-risk drinkers modify their drinking behaviour at a cost of $231.45 per patient. This compares with a cost per patient modifying drinking behaviour of $232.60 and $208.31 for every 5% point increase in the rates of detection and effectiveness, respectively. The knowledge, skill and attitude of practitioners toward drinking are significant, and they can be the prime motivators in persuading their patients to modify drinking behaviour.

Northern wing, General Purpose North 3, University of Queensland, St Lucia

As seen from Blair Road.

Northern wing, General Purpose North 3, University of Queensland, St Lucia

As seen from Balir Road.

West elevation, General Purpose North 3, University of Queensland, St Lucia

Formal elevation facing University of Queensland entrance roads.

Eastern edge, General Purpose North 3, University of Queensland, St Lucia

As seen from informal courtyard; Duhig Tower beyond.

West elevation, General Purpose North 3, University of Queensland, St Lucia

Formal elevation facing University of Queensland entrance roads.

West elevation, General Purpose North 3, University of Queensland, St Lucia

Formal elevation facing University of Queensland entrance roads.

West elevation, General Purpose North 3, University of Queensland, St Lucia

Formal elevation facing University of Queensland entrance roads.

Interactive health communication in preventive medicine - Internet-based strategies in teaching and research

Interactive health communication using Internet technologies is expanding the range and flexibility of intervention and teaching options available in preventive medicine and the health sciences. Advantages of interactive health communication include the enhanced convenience, novelty, and appeal of computer-mediated communication; its flexibility and interactivity; and automated processing. We outline some of these fundamental aspects of computer-mediated communication as it applies to preventive medicine. Further, a number of key pathways of information technology evolution are creating new opportunities for the delivery of professional education in preventive medicine and other health domains, as well as for delivering automated, self-instructional health behavior-change programs through the Internet. We briefly describe several of these key evolutionary pathways, We describe some examples from work we have done in Australia. These demonstrate how we have creatively responded to the challenges of these new information environments, and how they may be pursued in the education of preventive medicine and other health care practitioners and in the development and delivery of health behavior change programs through the Internet. Innovative and thoughtful applications of this new technology can increase the consistency, reliability, and quality of information delivered.

Effect of removing user fees on attendance for curative and preventive primary health care services in rural South Africa

User fees are used to recover costs and discourage unnecessary attendance at primary care clinics in many developing countries. In South Africa, user fees for children aged under 6 yea rs and pregnant women were removed in 1994, and in 1997 all user fees at all primary health care clinics were abolished. The intention of these policy changes was to improve access to health services for previously disadvantaged communities. We investigated the impact of these changes on clinic attendance patterns in Hlabisa health district. Average quarterly new registrations and total attendances for preventive services (antenatal care, immunization, growth monitoring) and curative services (treatment of ailments) at a mobile primary health care unit were studied from 1992 to 1998. Regression analysis was undertaken to assess whether trends were statistically significant. There was a sustained increase in new registrations (P = 0.0001) and total attendances (P = 0.0001)for curative services, and a fall in new registrations (P = 0.01) and total attendances for immunization and growth monitoring (P = 0.0002) over the study period. The upturn in demand for curative services started at the time of the first policy change. The decreases in antenatal registrations (P = 0.07) and attendances (P = 0.09) were not statistically significant The number of new registrations for immunization and growth monitoring increased following the first policy change but declined thereafter. We found no evidence that the second policy change influenced underlying trends. The removal of user fees improved access to curative services but this may have happened at the expense of some preventive services. Governments should remain vigilant about the effects of new health policies in order to ensure that objectives are being met.

Epidemiological modelling (including economic modelling) and its role in preventive drug therapy

In contrast to curative therapies, preventive therapies are administered to largely healthy individuals over long periods. The risk-benefit and cost-benefit ratios are more likely to be unfavourable, making treatment decisions difficult. Drug trials provide insufficient information for treatment decisions, as they are conducted on highly selected populations over short durations, estimate only relative benefits of treatment and offer little information on risks and costs. Epidemiological modelling is a method of combining evidence from observational epidemiology and clinical trials to assist in clinical and health policy decision-making. It can estimate absolute benefits, risks and costs of long-term preventive strategies, and thus allow their precise targeting to individuals for whom they are safest and most cost-effective. Epidemiological modelling also allows explicit information about risks and benefits of therapy to be presented to patients, facilitating informed decision-making.

A multi-purpose rainfall simulator for field infiltration and erosion studies

This paper describes a rainfall simulator developed for field and laboratory studies that gives great flexibility in plot size covered, that is highly portable and able to be used on steep slopes, and that is economical in its water use. The simulator uses Veejet 80100 nozzles mounted on a manifold, with the nozzles controlled to sweep to and from across a plot width of 1.5 m. Effective rainfall intensity is controlled by the frequency with which the nozzles sweep. Spatial uniformity of rainfall on the plots is high, with coefficients of variation (CV) on the body of the plot being 8-10%. Use of the simulator for erosion and infiltration measurements is discussed.

Age-related lifecycles - Purpose variations

By describing and discussing Australian data on outbound tourism, this paper investigates the bimodal (double peaked) lifecycle pattern predicted and observed in the literature. These theories are primarily based on demand for holiday tourism, but tourists do not just go overseas for this purpose, with visiting friends and relatives, business, convention and conference, employment and educational tourism relevant purposes also. Trips overseas by Australians are split into these groups, enabling the age-related lifecycles of each to be examined separately. Unlike holiday tourism, all other purposes are unimodal, although they vary with respect to the age groups at which they peak and their relative positions.