Margaret S. Lesjak

Managing environmental lead in Broken Hill: a public health success.

OBJECTIVES To describe locality-specific changes in blood lead levels of 1-4-year-old children in Broken Hill, NSW between 1991 and 2007. METHODS Annual age-sex standardised mean blood lead levels, blood lead screening clinic attendance rates and lead-dust levels for five lead-risk zones were calculated from routinely collected data. RESULTS Blood lead levels were similar in all localities in 2002, 2003, 2005 and 2006, after having been consistently higher in localities with highest environmental lead since 1991. CONCLUSIONS Combining health promotion with a targeted clean-up has reduced the effect of locality on blood lead levels. Results are consistent with reduced contamination due to effective soil stabilisation and storm-water control.

Screening for abdominal aortic aneurysm: does it affect men’s quality of life?

A prospective study investigated the psychological wellbeing and quality of life of older rural men after a community-based screening for abdominal aortic aneurysm (AAA). Five hundred and sixteen men aged 65-74 years attended the screening program; 53 had an abnormal aorta detected. These and a subsample of men with a normal aorta were followed up 6 months post-screening. All men completed a pre-screening questionnaire including the Medical Outcomes Short Form 36v 2 (MOSF36) and Hospital Anxiety and Depression Scale (HADS). Six months after screening all 53 men with an abnormal and 130 with a normal aorta were sent a questionnaire including MOSF36 and HADS. Baseline and 6 month scores for both MOSF36 and HADS scores were compared between the two groups and within each group. Baseline scores for both MOSF36 and HADS were not significantly different between men who were subsequently diagnosed with an abnormal aorta and those with a normal aorta. After 6 months there was no difference in HADS scores but a significant increase in the MOSF36 dimension of general health. Those with a normal aorta reported better general health, social functioning and greater freedom from bodily pain. AAA screening appears highly acceptable to men in the target age group and future research should focus on implementation, cost effectiveness and collateral benefits of AAA screening.

Evaluation of a mobile screening service for abdominal aortic aneurysm in Broken Hill, a remote regional centre in far western NSW

OBJECTIVES To evaluate the feasibility of a mobile screening service model for abdominal aortic aneurysm (AAA) in a remote population centre in Australia. DESIGN Screening test evaluation. SETTING A remote regional centre (population: 20 000) in far western NSW. PARTICIPANTS Men aged 65-74 years, identified from the Australian Electoral roll. INTERVENTIONS A mobile screening service using directed ultrasonography, a basic health check and post-screening consultation. MAIN OUTCOME MEASURES Attendance at the screening program, occurrence of AAA in the target population and effectiveness of screening processes. RESULTS A total of 516 men without a previous diagnosis of AAA were screened, an estimated response rate of 60%. Of these, 463 (89.7%) had a normal aortic diameter, 28 (5.4%) ectatic and 25 (4.9%) a small, moderate or significant aneurysm. Two men with AAA were recommended for surgery. Feedback from participants indicated that the use of a personalised letter of invitation helped with recruitment, that the screening process was acceptable and the service valued. CONCLUSIONS It is feasible to organise and operate a mobile AAA screening service from moderate sized rural and remote population centres. This model could be scaled up to provide national coverage for rural and remote residents.

A day at the races: does alcohol strength make a difference?

St Pat’s picnic race weekend is the major tourism and sporting event in Broken Hill in far west NSW. It is held two weeks before Easter and 2009 was its 43rd year. Accompanying the races held on the Saturday, Friday is games night and Sunday ‘recovery’ day held at Silverton, 25 km away. The weekend attracts local and interstate visitors and has been growing in popularity with an estimated 7,500 to 8,000 attending in the past two years. While it is a race meeting, many attend for the picnic atmosphere, the fashions and social occasion. For the 2009 races a voluntary agreement was made between the organising committee and the police licensing officer, to sell only low or mid strength beer or spirits and no full strength beer or spirits. Wine and champagne were not restricted. This differed from previous St Pat’s races where full-strength beer and spirits were sold. Consumers view the taste of beer as important and race patrons were reported to prefer full strength beer. Similarly, Segal & Stockwell reported that while sessions with (unlabelled) lowstrength beer were enjoyed as much as or preferred to (unlabelled) full-strength, the taste of the stronger beer was preferred. A simple comparison of the number of alcohol-related (AR) incidents over the past six race weekends, at the races, at other licensed premises and in the wider community is reported using routine data collected by police, health and race security. The National Alcohol Strategy 2006-09 recommends integrating data sources to develop a better understanding of the extent of alcohol related harm. As in previous years, both uniformed and plain clothes police were present; wristbands identified attendees aged 18-25; the crowd in marquees and picnic sites were separated and the number of drinks purchased in each transaction was limited. The local Barrier Liquor Accord also suggested any promotional advertisements by local licensees over the St Pat’s week should be for mid-strength products. Letters

Influencing population health performance: introduction of standards for area health services in New South Wales

Standards are a yardstick against which performance can be assessed and improved. Standards are well established in healthcare settings; however, population health standards have only recently been developed for area health services in NSW. This paper describes international and Australian population health standards, and presents the results of a pilot evaluation of the NSW Population Health Standards for Area Health Services against the Greater Western Area Health Service performance requirements. The findings revealed that the standards relating to the work of specialist population health staff feature in performance requirements; however the standards requiring the contribution of other health service staff do not. Population health standards have the potential to guide the health system towards population health goals.

Influencing population health performance: feedback from managers, population health staff and clinicians on the NSW Population Health Standards for Area Health Services.

The NSW Population Health Standards for Area Health Services have recently been introduced in NSW to assist area health services assess and improve performance in population health. Greater Western Area Health Service was the pilot site for trialling the Standards as a self-assessment tool. Following self-assessment, managers, population health staff and clinicians were asked for feedback. Staff were either interviewed or participated in a group discussion. Consulting with staff who would be required to use the Standards in the long term was seen as important for facilitating implementation across the area health service. The Standards were seen as credible and potentially beneficial, especially in raising the profile of population health work and encouraging population-based and integrated approaches.