Megan Kay Young

Opportunities for health promotion in the Queensland women's prison system

Objective: To compare the health of Queensland women prisoners with that of community women using the target areas of public health promotion identified by Health Determinants Queensland as a framework.

Preventing Australian Bat Lyssavirus: Community Knowledge and Risk Perception of Bats in South East Queensland

OBJECTIVES Ongoing potential exposure of members of the public to Australian bat lyssavirus (ABLV) in South East Queensland, Australia, prompted investigation of community knowledge, risk perception, and intention to handle bats to inform future prevention efforts. METHODS After pilot testing, a computer-assisted telephone survey of a representative sample of 700 adults without previous potential exposure to ABLV was undertaken in the defined geographic region. RESULTS Twenty-four percent of eligible contacted individuals participated. Basic knowledge of bats and ABLV was generally high, with 65% of participants answering nine or more of 12 knowledge questions correctly. The perceived risk that bats pose to human health was also high, with 93% indicating some degree of risk. Although 88% of participants indicated they would handle bats in one or more of the scripted situations, overall intention to handle bats was low, with 59% indicating they would handle a bat in four or less of the 12 scenarios. Younger males with lower risk perception of bats most frequently indicated intention to handle bats in varying situations. Knowledge score was not associated with intention to handle bats on multivariate modeling. CONCLUSIONS Future public health prevention efforts, both in Australia and overseas, should focus further on conveying the risk to humans and to bats when nontrained, nonvaccinated people attempt to handle bats rather than attempting to purely convey knowledge about bats and ABLV or rabies. Suitable alternative measures to handling should be included. Younger adult males are a particular target group for prevention efforts.

Passive immunization for the public health control of communicable diseases: Current status in four high-income countries and where to next

The practice of passive immunization with human immune globulin (IG) for the control of communicable diseases (measles, rubella and hepatitis A) differs somewhat between Australia, the United States of America, the United Kingdom, and New Zealand despite the many similarities of these countries, including disease incidence rates and population immunity. No minimum effective dose of IG has been identified for protecting susceptible contacts of measles or hepatitis A. Recommended passive immunization practice for susceptible pregnant contacts of rubella is based on limited evidence in all countries. We suggest that gaps in the evidence base need to be addressed to appropriately inform the role of passive immunization in public health practice into the future.

Fluoride content of powdered infant formula meets Australian Food Safety Standards

Objectives: To identify the fluoride content of powdered formula for infants 0‐12 months in products available from Brisbane stores in 2006/07 and compare this with the fluoride content of infant formula products available in Australia 10 years earlier.

Do Australian immunoglobulin products meet international measles antibody titer standards

ABSTRACT The effectiveness of passive immunisation post-exposure to measles appears subject to a dose-response effect. New Zealand and the United Kingdom have increased the recommended dose of polyclonal human immunoglobulin for post-exposure prophylaxis within the last decade in response to concerns about decreasing levels of measles antibodies in these products. This study used the plaque-reduction neutralization test (PRNT) to measure the titer of measles-specific antibodies in Australian immunoglobulin products for post-exposure prophylaxis and compared the utility of an enzyme-linked immunosorbent assay (ELISA) to the PRNT in available Australian and international samples: Australian intramuscular (n = 10), Australian intravenous (n = 28), New Zealand intramuscular (n = 2), Hizentra (subcutaneous)(USA) (n = 3), and Privigen (intravenous)(USA) (n = 2). Measles titres in Australian IM and IV immunoglobulins ranged from 51 to 76 IU/mL and 6 to 24 IU/mL respectively, as measured by PRNT calibrated to the WHO 3rd international standard. ELISA titres were variable but higher than PRNT titres in all tested samples. Measles antibody titres in Australian immunoglobulin products meet consensus-prescribed international thresholds. Development of a convenient, standardized, readily accessible assay for determination of measles titres in immunoglobulin products would be useful for future studies and facilitate international comparisons.

Health partnerships: perspectives of medical practitioners in general practice, health systems and hospital settings

Thepressureformedicalpractitionerstoworkcollaborativelyhasintensifiedoverthelastfewdecades in most industrialised countries, including Australia. However, many barriers prevent doctors from engaging in macro- level health partnerships. If these partnership initiatives are to succeed, it is essential to understand how and why doctors participate. This paper explored the views of eighteen medical practitioners, including general practitioners (in both small and large practices), division representatives, hospital-based doctors and health system managers. The findings revealed eight key themes, which were dominated by scepticism about partnerships based on previous experiences, but juxtaposed against a strong enthusiasm for the approach. There was a significant cost for medical practitioners to engage in partnerships, either financially or in terms of workload. Their enthusiasm was based on the belief that partnerships could achieve their vision for an ideal service system. They highlighted the importance of ongoing consultation, feedback and monitoring and the need for evidence to balance enthusiasm. Partnership initiatives need to engage local medical champions to increase the profile of this approach and enlist the enthusiasm of the diverse medical community.

Rubella antibodies in Australian immunoglobulin products

ABSTRACT Rubella antibodies are not routinely measured in immunoglobulin products and there is a lack of information on the titer in Australian products. To facilitate future studies of the effectiveness of passive immunisation for preventing rubella and congenital rubella syndrome, this study measured the concentration of rubella-specific antibodies in Australian intramuscular (IM) and intravenous (IV) human immunoglobulin products suitable for post-exposure prophylaxis using a chemiluminescent immunoassay. The GMT ± GSD for the IM product was 19 ± 1.2 IU/mg (2980 ± 1.2 IU/mL). The GMT ± GSD for the IV product was 12 ± 1.5 IU/mg (729 ± 1.5 IU/mL). At present, Australian guidelines recommend offering non-immune pregnant women exposed to rubella 20 mL of intramuscular immunoglobulin within 72 hours of exposure. This equates to 42,160 IU of rubella antibodies if the lowest titer obtained for the Australian IM product is considered. The same dose would be delivered by 176 mL of the Australian IV product at the lowest measured rubella-specific antibody titer.

Post-exposure passive immunisation for preventing measles (Protocol)

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness and safety of intramuscular injection or intravenous infusion of immunoglobulins for preventing measles when administered to exposed susceptible people before the onset of symptoms.

SF-36: not the tool to monitor the health of subpopulations within the Queensland women's prison system.

The Short Form 36 (SF-36)1 is a widely used measure of health status based on well-being and functioning in physical and mental health contexts. It has been validated across numerous settings and has been used to compare the health of populations,2 to investigate the associations between conditions and health within a population,3 and to compare the health of the same population before and after an intervention.4 In a broad health survey, mean scores for Queensland women prisoners ranged from 0.5 to 17.5 below female community Australian norms across the eight dimensions of the SF-36.5 In all but one of the dimensions (physical functioning), the difference was statistically significant. The 1995 National Health Survey reported associations between lower SF-36 scores and overweight and obesity, unemployment, and overall socio-economic disadvantage.6 These are prevalent in Queensland women prisoners.5 The National Health Survey also reported associations with smoking, diabetes and asthma. Eightythree per cent of Queensland women prisoners were current smokers at the time of the survey, and the prevalence of asthma (36.3%) and diabetes (8.5%) was higher than that of community women.5 We explored the usefulness of the SF-36 as a comparative healthmonitoring tool in Queensland women prisoners by using oneway analysis of variance to examine the relationships between mean scores and categories of body mass index, employment, smoking, diabetes and asthma. Body mass index was associated with the physical functioning, role limitations due to physical problems and the general health perceptions dimensions in Queensland women prisoners. Those who were obese had the lowest mean scores. The dimensions of physical functioning and general health perceptions were associated with previous employment status. Those not in the workforce had the lowest mean score for general health perceptions, with the unemployed also scoring lower than those who were employed prior to imprisonment. Those not in the workforce also had the lowest mean score for the physical functioning dimension; however, the unemployed had the highest mean score for this dimension. SF-36 scores were not significantly associated with smoking status in this group of women prisoners. Diabetes was associated with a lower score for general health perceptions, and asthma was associated with a lower score for role limitations due to physical problems in Queensland women prisoners. Thus, in this group of women prisoners there were few significant associations with SF-36 score. Obesity was associated with most of the physical dimensions, but none of the mental dimensions. Employment demonstrated an unexpected relationship with the physical functioning dimension. This may have been due to a possible discrepancy between the time of employment status (before imprisonment) and the time relating to the SF-36 questions (the four weeks prior to survey). With regards to smoking, as 83% of the study population were current smokers, the non-smoking group consisted of 36 members. This high prevalence may therefore have contributed to a lack of statistical power to differentiate between smokers and nonsmokers. Similarly, while the prevalence of diabetes in this group was higher than that of the community, the diabetics numbered 18. Alternatively, because of the youth of the study population (median age 30.5 years), smoking and diabetes may not yet have demonstrably affected their health. As the SF-36 relates to the participants’ health in the four weeks prior to interview, the lack of association with asthma may have reflected appropriate treatment and close monitoring in the prison environment. We have concluded that with the exception of obesity, SF-36 scores were not associated with the factors examined here in the Queensland women’s prison population. We would suggest, therefore, that the SF-36 is not a useful tool to comparatively monitor the health of these subgroups.

Potential exposure to Australian bat lyssavirus is unlikely to prevent future bat handling among adults in South East Queensland

Despite ongoing public health messages about the risks associated with bat contact, the number of potential exposures to Australian bat lyssavirus (ABLV) due to intentional handling by members of the general public in Queensland has remained high. We sought to better understand the reasons for intentional handling among these members of the public who reported their potential exposure to inform future public health messages. We interviewed adults who resided in a defined geographic area in South East Queensland and notified potential exposure to ABLV due to intentional handling of bats by telephone between 1 January 2012 and 31 December 2013. The participation rate was 54%. Adults who reported they had intentionally handled bats in South East Queensland indicated high levels of knowledge and perception of a moderately high risk associated with bats with overall low intentions to handle bats in the future. However, substantial proportions of people would attempt to handle bats again in some circumstances, particularly to protect their children or pets. Fifty‐two percent indicated that they would handle a bat if a child was about to pick up or touch a live bat, and 49% would intervene if a pet was interacting with a bat. Future public health communications should recognize the situations in which even people with highrisk perceptions of bats will attempt to handle them. Public health messages currently focus on avoidance of bats in all circumstances and recommend calling in a trained vaccinated handler, but messaging directed at adults for circumstances where children or pets may be potentially exposed should provide safe immediate management options.