RESUMEN
BACKGROUND: The Bayley-III is widely used as an assessment tool in young children; however, its standard composite scores appear to under-estimate delay, severe and profound delay cannot be identified, and the lack of an overall score makes it difficult to compare results with later assessments. AIMS: To explore the use of Bayley-III quotient subtest and average scores, compared with composite subtest and average scores for both clinical and research purposes, comparing their ability to predict performance on the Griffiths Mental Development Scales (Griffiths) before school entry. METHOD: One hundred preschoolers referred for a diagnosis were assessed on the Bayley-III before 3.5 years. They were reassessed before school entry on the Griffiths. Composite and quotient scores were calculated and their ability to predict outcome compared across the score range. RESULTS: Averaging the three subscale quotient scores (Bayley-AQS) gave a similar mean score for this sample (61.1, SD 16.2) as for the Griffiths general quotient (Griffiths-GQ) (61.1, SD 19.6). The average composite scores (Bayley-ACS) had a significantly higher mean (74.2, SD 12.1). Correlations between the average scores on the Bayley-III and the Griffiths-GQ (0.8) were at least as strong as any of the individual subscale scores. Kappa coefficients showed that Bayley-AQS was superior to Bayley-ACS for predicting moderate and severe delay. Average change in scores was -0.1 for Bayley-AQS, and -13.2 for Bayley-ACS. Improvement in category of delay was seen in 28% of children using Bayley-AQS, and deterioration in 22%. In contrast, 5% improvement was seen using Bayley-ACS, and 65% deterioration. CONCLUSIONS: The three directly assessed subscales of the Bayley-III can be averaged to give an overall score. Bayley-AQS are a better measure of development in young children with delay than Bayley-ACS, and most children maintain their developmental classification using this method of scoring when re-assessed before school entry.
Asunto(s)
Desarrollo Infantil , Discapacidades del Desarrollo/diagnóstico , Pruebas Neuropsicológicas , Preescolar , Femenino , Humanos , Masculino , Pronóstico , Psicometría , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVES: The aim of this study was to evaluate access of resident immigrant families from a non-English speaking background to Maternal and Infant Services operated by Community Health Services in south-western Sydney. METHODS: An ecological study compared the demographic characteristics of mothers with an infant aged less than 12 months in three separate data collections. These were a 3-month Community-based Health Services Census, the 1996 Midwives Data Collection and the ABS 1996 Census of Population and Housing. RESULTS: Information was collected from 2048 infants and their families who were newly registered with Maternal and Infant Services. Approximately 75% of newborn infants were registered with services. Women who were born in a non-English-speaking country were over-represented in the data. For both overseas and Australian-born women those who left school aged less than 17 years were under-represented compared with analysis of the related data systems. CONCLUSIONS: The data suggest that migrant women from non-English-speaking backgrounds are accessing Maternal and Infant Services. However, innovative approaches for service delivery are indicated for women who may be considered socially disadvantaged, irrespective of their ethnic or cultural backgrounds.
Asunto(s)
Diversidad Cultural , Accesibilidad a los Servicios de Salud , Cuidado del Lactante/organización & administración , Servicios de Salud Materna/organización & administración , Adulto , Australia , Protección a la Infancia , Preescolar , Barreras de Comunicación , Intervalos de Confianza , Emigración e Inmigración , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Lactante , Cuidado del Lactante/normas , Cuidado del Lactante/estadística & datos numéricos , Masculino , Servicios de Salud Materna/normas , Servicios de Salud Materna/estadística & datos numéricos , Embarazo , Probabilidad , Valores de Referencia , Sistema de Registros , Características de la Residencia , Factores de Riesgo , Factores Socioeconómicos , Salud de la MujerRESUMEN
AIM: The study aimed to evaluate what effect the introduction of the enhanced primary care (EPC) health assessments has on the management of elderly patients. METHOD: The study was conducted across five Divisions of General Practice in South West Sydney. Twenty-one general practitioners participated in the study following response to an initial faxed questionnaire survey. An audit of patients' health assessments in conjunction with their records was conducted between June and August 2000. RESULTS: There were significant increase in the documentation of nonmedical problems and of patients' immunisation status. However, there was no increase in plans to refer patients to psychologists, mental health teams or social workers. Also no assessments resulted in a case conference and very few in a care plan. DISCUSSION: Health assessments are unlikely to improve clinical outcomes if they do not result in multidisciplinary care, including care plans, for patients with psychosocial and functional needs. CONCLUSION: Support strategies need to be implemented which assist general practitioners' management of psychosocial and functional problems.
Asunto(s)
Evaluación Geriátrica , Evaluación de Necesidades , Atención Primaria de Salud/normas , Anciano , Anciano de 80 o más Años , Australia , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Persona de Mediana Edad , Planificación de Atención al Paciente , Examen Físico , Servicios Preventivos de Salud , Atención Primaria de Salud/tendenciasRESUMEN
OBJECTIVE: To investigate the issues for general practitioners surrounding the implementation of the Enhanced Primary Care (EPC) Medicare items for health assessments, care planning and case conferencing. DESIGN: Qualitative study of GPs' responses to a semistructured face-to-face interview. PARTICIPANTS AND SETTING: 30 GPs in the South Western Sydney Area. MAIN OUTCOME MEASURES: GPs' perceptions regarding barriers to coordination of care; use of the EPC items; difficulties with implementation; suggestions for improving EPC implementation; and coordination of care in general practice. RESULTS: Five main categories of response were identified to each area of questioning: time, organisation, communication, education, and resources. GPs expressed difficulties incorporating use of the items into their daily practice without support. CONCLUSIONS: Implementation of the EPC items not only facilitates integration between GPs and other healthcare professionals, it also depends upon other forms of integration to succeed. A facilitator and a structured framework to address issues are required to assist their implementation.
Asunto(s)
Actitud del Personal de Salud , Manejo de Caso/legislación & jurisprudencia , Medicina Familiar y Comunitaria/legislación & jurisprudencia , Implementación de Plan de Salud/legislación & jurisprudencia , Programas Nacionales de Salud/legislación & jurisprudencia , Servicios Preventivos de Salud/legislación & jurisprudencia , Anciano , Femenino , Evaluación Geriátrica , Servicios de Salud para Ancianos/legislación & jurisprudencia , Humanos , Masculino , Persona de Mediana Edad , Nueva Gales del Sur , Grupo de Atención al Paciente/legislación & jurisprudencia , Rol del MédicoRESUMEN
BACKGROUND: Few studies have focused specifically on the role of ethnicity in the identification and treatment of anxiety and depressive symptoms among patients consulting GPs. METHODS: A survey was conducted of 4753 patients aged 18-90 years attending general practices in Sydney, Australia. Three methods of case detection were used: a GHQ-12 score (> or = 3), self-report symptoms (using a checklist) and GP detection of symptoms. Four regional groupings based on country of birth [other English speaking countries (ESB), European, Asian (predominantly south east Asian) and other non-English speaking (other NESB)] were compared with Australian (AB) patients. RESULTS: Compared with AB patients, Asian patients had a lower mean GHQ-12 score (2.04 versus 2.54) and a lower rate of GP detection (10.4% versus 20.5%) but they recorded a similar rate of self-report symptoms (16.7% versus 20.1%). For Asian patients, 24.6% of all cases identified by self-report or by GP detection were identified by both methods, compared with 44% for AB patients. Similar patterns of treatment and referral were observed for detected cases. Compared with AB patients, Asian and other NESB patients were more likely to desire more time to discuss their problems with their GP (18.5% versus 42.0%, 37.3%) and receive an explanation of medications prescribed (18.9% versus 46%, 40.0%). CONCLUSION: These results suggest that there are substantial variations in the rates of detection of anxiety and depressive symptoms in GP patients depending on the screening methods used and the broad ethnic background of patients. Such symptoms may be under-diagnosed in Asian patients in particular.
Asunto(s)
Ansiedad/diagnóstico , Ansiedad/etnología , Depresión/diagnóstico , Depresión/etnología , Médicos de Familia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/tratamiento farmacológico , Asia/etnología , Australia , Distribución de Chi-Cuadrado , Estudios Transversales , Depresión/tratamiento farmacológico , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Satisfacción del Paciente , Derivación y Consulta , Encuestas y CuestionariosRESUMEN
OBJECTIVE: The aim of this study was to compare the prevalence of adult respiratory symptoms and conditions in a rural setting with a metropolitan setting. METHODOLOGY: We used cross-sectional population surveys of respiratory health using the European Respiratory Health Survey screening questionnaire. A random sample of 4455 eligible young adults aged 20-44 years, from electoral rolls in south-eastern metropolitan Melbourne, Victoria, and 4521 from rural south-western New South Wales were surveyed. RESULTS: Response rates of 72% (n=3194) and 69% (n=3121) were achieved in Melbourne and the Riverina, respectively. Respondents from the Riverina reported significantly higher prevalences of nocturnal dyspnoea (P<0.01), chronic bronchitis (P=0.03), an asthma attack in the previous 12 months (P<0.001), ever having had asthma (P<0.001) and doctor-diagnosed asthma (P<0.001) compared to those from Melbourne. However, among those with 'asthma attacks in the last 12 months', Melbourne respondents experienced a higher frequency of attacks (P<0.05). Riverina respondents reported a higher prevalence of smoking (P<0.05) and smoked more cigarettes on average (P<0.001) than Melbourne respondents. However, annoyance from air pollution was higher in Melbourne than in the Riverina. CONCLUSIONS: These results suggest that asthma is more prevalent in rural southern New South Wales than in Melbourne but follows a different pattern of exacerbations.
Asunto(s)
Asma/epidemiología , Salud Rural , Salud Urbana , Adulto , Contaminación del Aire , Bronquitis/epidemiología , Enfermedad Crónica , Estudios Transversales , Disnea/epidemiología , Femenino , Humanos , Masculino , Nueva Gales del Sur/epidemiología , Prevalencia , Factores de Riesgo , Fumar/epidemiología , Encuestas y Cuestionarios , Victoria/epidemiologíaRESUMEN
INTRODUCTION: This study examined the detection and management of anxiety and depressive symptoms among unemployed patients attending general practitioners (GPs). METHOD: A cross-sectional study was undertaken of anxiety and depressive symptoms in general practice using measures completed by patients and GPs. Eligible patients were adults aged 18 to 64 years either working (n = 2273) or unemployed (n = 392). RESULTS: Eighty per cent of patients were attending their regular GP at the time of the study. Unemployed patients were found to have a higher mean general health questionnaire (GHQ-12) score than employed patients (3.8 compared with 2.4, p < 0.001); were more likely to report symptoms of anxiety and depression which required medical treatment during the previous 4weeks (30.9% compared with 14.6%, p < 0.001); and were more likely to have been treated for anxiety and depression by the GP (27.8% compared with 15.7%, p < 0.001). Among patients who the GPs reported treating for anxiety and depression, unemployed patients were 3.3 times (95% CI: 2.0-5.4) more likely to be prescribed medication than employed patients when severity was controlled but were no more likely to be referred to other health services. Unemployed patients identified increased use of services and were less satisfied with the care that they had received. CONCLUSIONS: Unemployed patients attending GPs have an increased risk of anxiety and depressive symptoms. Increased prescription of medication as opposed to referral suggests that GPs may treat their unemployed patients differently to employed patients. GPs need to be aware of the higher risk and severity of anxiety and depressive symptoms among unemployed patients and their desire to be more actively involved in their treatment. General practice is an important setting for addressing the health needs of unemployed people.
Asunto(s)
Ansiedad/epidemiología , Depresión/epidemiología , Grupo de Atención al Paciente , Desempleo/psicología , Adolescente , Adulto , Ansiedad/diagnóstico , Ansiedad/terapia , Estudios Transversales , Depresión/diagnóstico , Depresión/terapia , Medicina Familiar y Comunitaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Gales del Sur , Satisfacción del Paciente , Factores de RiesgoAsunto(s)
Asma/mortalidad , Adolescente , Adulto , Distribución por Edad , Australia/epidemiología , Niño , Preescolar , Femenino , Humanos , Masculino , Mortalidad/tendenciasRESUMEN
INTRODUCTION: The National Asthma Campaign (NAC) was formed in 1990 as a coalition of the key professional organizations concerned with asthma and its management in Australia. It has conducted multifaceted educational activities targeting health care professionals, people with asthma, and the general public. Between November 1991 and March 1993, an educational mass media campaign was developed to inform people about new approaches to preventive asthma therapy and how people with symptoms of asthma should talk to their doctor or pharmacist about new management and monitoring strategies. Evaluation was based on McGuire's communication/persuasion model for assessing the impact of mass media campaigns. METHODS: Four serial cross-sectional population surveys of persons over the age of 18 years were conducted in four major Australian cities using structured telephone interviews. Information was sought on asthma campaign awareness and knowledge or use of appropriate asthma management practices. RESULTS: There was an increasing trend in awareness of asthma messages in the media and of appropriate message recall across the two-year period. Knowledge about the need to use preventive therapy for asthma improved significantly. Among those with asthma there was a significant upward trend in the proportion who discussed asthma with their doctor or pharmacist and who used peak flow meters and written asthma management plans. CONCLUSIONS: The net impact of the NAC and other activities has been an increase in awareness about asthma in Australia. These campaigns relied on the relatively nonselective medium of television to raise awareness and to start to change attitudes to asthma. The challenge is to build on these trends to further reduce morbidity and mortality due to asthma.
Asunto(s)
Asma/terapia , Educación en Salud/métodos , Conocimientos, Actitudes y Práctica en Salud , Medios de Comunicación de Masas , Adulto , Asma/prevención & control , Australia , Estudios Transversales , Humanos , Educación del Paciente como Asunto/métodos , Evaluación de Programas y Proyectos de SaludRESUMEN
OBJECTIVE: To compare the prevalence and management of asthma before and after institution of the National Asthma Campaign. DESIGN: Repeat population-based cross-sectional analytic surveys. SETTING: Eastern Australia (Sydney, Brisbane, Melbourne, and the Hunter Valley, New South Wales) in September 1990 and 1993. SUBJECTS: Primary school children and their parents from 33 schools (8746 children) in 1990 and 40 schools (10 106 children) in 1993. OUTCOME MEASURES: Frequency of respiratory symptoms; diagnoses of asthma; medications; lung function measurements; possession of a peak flow meter and a written action plan. RESULTS: Age and sex distribution of the subjects and the reported prevalence of asthma were similar in 1990 and 1993. The frequency of reported episodes of wheezing and troublesome cough increased significantly in children between 1990 and 1993. Asthma management improved in accordance with current recommendations, with significantly decreased use of regular inhaled bronchodilator medication in children and increased use of preventive medication, monitoring of lung function by doctors and use of peak flow meters and written action plans in both children and adults. CONCLUSION: There is evidence that the National Asthma Campaign may have contributed to increased awareness and improved management of asthma in children and adults in eastern Australia.
Asunto(s)
Asma/epidemiología , Asma/prevención & control , Promoción de la Salud , Adulto , Antiasmáticos/uso terapéutico , Asma/diagnóstico , Asma/tratamiento farmacológico , Asma/fisiopatología , Australia/epidemiología , Broncodilatadores/uso terapéutico , Niño , Preescolar , Tos/epidemiología , Tos/fisiopatología , Estudios Transversales , Femenino , Humanos , Masculino , Registros Médicos , Evaluación de Resultado en la Atención de Salud , Ápice del Flujo Espiratorio , Vigilancia de la Población , Prevalencia , Pruebas de Función Respiratoria , Ruidos Respiratorios/fisiopatologíaRESUMEN
BACKGROUND: Controversy has existed about the benefits and disadvantages associated with the availability of inhaled bronchodilators over the counter (OTC). AIMS: To compare sociodemographic features, use of preventive medications, use of medical services and control of asthma in adults who purchased inhaled bronchodilators OTC with those who purchased on prescription (script). METHODS: A cross-sectional telephone survey of 772 adults 18 years and over who used inhaled bronchodilators for their asthma. Symptoms, asthma medications, and management practices were determined by a structured questionnaire administered by trained telephone interviewers. RESULTS: Two hundred and thirty adults purchased their bronchodilator OTC and 542 on script. OTC purchasers were more likely to be male (OR: 1.5), have had tertiary education (1.5) and be in paid employment (2.8); they were less likely to report frequent symptoms (wheeze, nocturnal symptoms or EIA more than once a week) (0.71); were less likely to use preventive medications more than twice a day (0.57) and were less likely to have consulted a general practitioner in the previous year (0.38). However, poor control of asthma symptoms was evident in both OTC and script groups. Forty per cent of the OTC group who had symptoms more than two to three times a week and 34% of the script group were not using preventive medication. CONCLUSIONS: Undertreatment and suboptimal management of asthma were apparent in both OTC and script groups.
Asunto(s)
Asma/tratamiento farmacológico , Broncodilatadores/uso terapéutico , Medicamentos sin Prescripción , Adulto , Asma/prevención & control , Estudios Transversales , Femenino , Humanos , Masculino , Factores SocioeconómicosRESUMEN
OBJECTIVE: To examine the prevalence and management of asthma in adults and children in a population sample in eastern Australia. SETTING: A random sample of children from 33 primary schools in Sydney, Melbourne, Brisbane, and the Upper Hunter Valley (New South Wales), and their parents. DESIGN: A cross-sectional analytic survey of 8753 primary school children aged between 5 and 12 years, and their parents (n = 13,945 adults). Asthma prevalence and management practices were determined by parental responses to a questionnaire, and spirometry was performed in children with "probable asthma". RESULTS: Of 8753 children whose parents responded, the prevalence of current wheeze was 19.5% and diagnosed asthma was 17.1%. Of the children with "probable asthma", 30% had their lung function measured in the previous year, and 6% possessed both a peak flow meter and an action plan for their asthma. Undertreatment was likely, as preventive asthma medications (inhaled corticosteroids or sodium cromoglycate) were used regularly by only 25.5% of these children and by 44.3% of children who had asthma symptoms more than twice per week. Children with the diagnosis of asthma reported higher rates of preventive medication use and ventilatory function measurement than children with frequent symptoms without the diagnosis. In the 13,945 adults, the reported prevalence of asthma was 7%, of whom 39% were using preventive medications, 34% had their ventilatory function assessed in the previous year, and 7% had both a peak flow meter and an asthma action plan. CONCLUSIONS: The study illustrated the gap between the current level of asthma management in the community and the standards set by the Thoracic Society of Australia and New Zealand. Undertreatment and suboptimal management of asthma remain important problems in Australia.