C. S. Guest

Methods for a population-based study of eye disease: the Melbourne Visual Impairment Project.

The methodology of the Melbourne Visual Impairment Project, a major population-based survey of eye disease on 3,500 randomly selected individuals aged 40 years of age and over in the Melbourne metropolitan region, is presented. The aims of the study are to determine the distribution and determinants of eye disease in an urban population; the impact of eye disease on visual function and the activities of daily living; and the accessibility of eye health care services in the community. All procedures are conducted according to a standardised protocol to allow for comparison with other population-based studies, both in Australia and overseas. Information collected from this study will be employed in the development of recommendations related to eye health care service delivery and establishment of priorities for future public education programmes and health research.

A population-based estimate of cataract prevalence: the Melbourne Visual Impairment Project experience

©1994 Karger. Publisher PDF version is restricted access in accordance with the Karger policy.

Cancer of the Uterine Cervix and Screening of Aboriginal Women

Summary: Carcinoma of the cervix has not been widely reported as an important health problem for Aboriginal women. From four sources, we have studied cervical cancer death rates, abnormalities detected by cervical cytology screening, and the proportion of women who had been screened. First, from the Northern Territory for the years 1979–1983, we present a relative risk of 6.3 (95% confidence interval, 3.0–11.6) for cervical cancer deaths in Aboriginal women compared with all Australian women. Second, the screening and disease rates in Aboriginal women were profiled within a large laboratory in Victoria. Since 1984, a fourfold increase in the number of smears taken at Aboriginal health services is apparent. In women attending these services, a high rate of significantly abnormal smears is evident. Third, to study the extent of screening, we interviewed Aboriginal women in a Victorian country setting and fourth, we examined a random sample of medical records from an Aboriginal Health Service. The proportion screened at least once rose from 5/47 (11%) among women whose most recent consultation with the Health Service was during the years 1974–1980 to 51/170 (31%) women who attended from 1981–1987 (p<0.01). Aboriginal communities may interpret these trends favourably as they encourage their women to be screened regularly to reduce cervical cancer mortality.

Tropospheric ozone: respiratory effects and Australian air quality goals.

OBJECTIVE--To review the health effects of tropospheric ozone and discuss the implications for public health policy. DESIGN--Literature review and consultation with scientists in Australia and overseas. Papers in English or with English language abstracts were identified by Medline search from the international peer reviewed published reports. Those from the period 1980-93 were read systematically but selected earlier papers were also considered. Reports on ozone exposures were obtained from environmental agencies in the region. RESULTS--Exposure to ozone at concentrations below the current Australian air quality goal (0.12 ppm averaged over one hour) may cause impaired respiratory function. Inflammatory changes in the small airways and respiratory symptoms result from moderate to heavy exercise in the presence of ozone at levels of 0.08-0.12 ppm. The changes in respiratory function due to ozone are short lived, vary with the duration of exposure, may be modified by levels of other pollutants (such as sulphur dioxide and particulates), and differ appreciably between individuals. Bronchial lavage studies indicate that inflammation and other pathological changes may occur in the airways before reductions in air flow are detectable, and persist after respiratory function has returned to normal. It is not known whether exposures to ozone at low levels (0.08-0.12 ppm) cause lasting damage to the lung or, if such damage does occur, whether it is functionally significant. At present, it is not possible to identify confidently population subgroups with heightened susceptibility to ozone. People with asthma may be more susceptible to the effects of ozone than the general population but the evidence is not consistent. Recent reports suggest that ozone increases airway reactivity on subsequent challenge with allergens and other irritants. Animal studies are consistent with the findings in human populations. CONCLUSION--A new one hour air quality ozone goal of 0.08 ppm for Australia, and the introduction of a four hour goal of 0.06 ppm are recommended on health grounds.

Design Concepts in Nutritional Epidemiology

The valuable contribution of the 1946 birth cohort study to the understanding of factors affecting health, educational achievement, and the relation between childs health and risk of ill health in adulthood is widely recognised. The eligible population in the study included all who were born in England, Wales, or Scotland during the week starting the 3rd March 1946. The author presents the main results and interpretations from this study in a social and historical context. The book is divided into eight chapters, five of which cover a period of life: birth, the preschool years, the school years, adolescence, and adulthood. Another chapter compares the study sample with their offspring and occasionally with their parents, covering in this manner a large part of the 20th century. The first and last chapters are the introduction and conclusions. Each ofthe chapters has a vivid description of the main events occurring when the cohort went through that period of life. The reader is helped to remember the changing characteristics of postwar Britain that may have influenced the group. The author is concerned with giving the range of results in a variety of topics: health, growth, emotional problems, home circumstances, education, and their interrelations. There is less concern with discussing alternative interpretations of the results and the weaknesses and strengths of the research methods. By using this approach the book is accessible to lay people and any specialist would be able to consult the original papers given in the list of references (unfortunately not always proof read). Ifone has to find a criticism of the book it is the repetitive assertion that social class differences in health have not changed over time, although a table provided by the author (table 2.1) challenges this viewpoint. The interpretation is misleading as occupational classification is fraught with difficulties in a period characterised by profound changes in work division that the author himself recognises. The book is plentiful in information, some predictable, some surprising and interesting. I have been hearing to satiety that children nowadays perform worse than their parents three decades ago. Wadsworth shows, comparing the cohort group and their offspring, that this assertion is so much thin air. Test attainment in the study group and their children showed that the offspring group are much better in reading skills and vocabulary than their parents, especially in the manual social classes. So much for intuition.