Voula Stathakis

Descriptive epidemiology of acne vulgaris in the community

Acne is a common skin condition. No universally accepted standardized classification system for acne vulgaris exists, although there is a strong need for it Thus, the clinical definition of acne has been unclear in many studies. The reported prevalence of acne varies from 35 to over 90% of adolescents at some stage. In some studies the prevalence of comedones approaches 100% in both sexes during adolescence. The prevalence of acne varies between sexes and age groups, appearing earlier in females than in males, possibly reflecting the earlier onset of puberty. There is a greater severity of acne in males than in females in the late teens, which is compatible with androgens being a potent stimulus to sebum secretion. The prevalence of acne at a given age has been shown to be highly dependent on the degree of sexual maturity. Acne commonly shows a premenstrual increase in women. Some studies have detected seasonal variability in acne vulgaris, with the colder months associated with exacerbation and the warmer months showing improvement. Other studies have not confirmed these findings. Several studies that have investigated the psychosocial impact of acne have had conflicting results. The prevalence of severe acne has decreased over the past 20 years due to improved treatment. The general prevalence figure for acne may be confounded by treatment and this factor needs to be accounted for when collecting data.

Dog bite and injury prevention--analysis, critical review, and research agenda

Objectives—To analyze Australian dog bite injury data and make international comparisons; to review risk and protective factors relating to the dog, injured person, and environment; and to recommend action for prevention and research. Methods—Australian dog bite injury data, complemented by detailed Victorian and regional data from routine health records and vital statistics, were analyzed to determine incidence, severity, nature, circumstances, and trends. International comparison data were extracted from published reports. Risk and protective factor studies were selected for review from electronic and bibliographic searches where data were recent, sample sizes substantial, and bias limited. Results—The Australian dog bite death rate (0.004/100 000) is lower than both the United States (0.05–0.07/100 000) and Canadian rates (0.007/100 000). Victorian hospitalized trend rates were stable between 1987 and 1998, but there was a decline for children <5 years (p=0.019) corresponding with a reduction in dog ownership. Children 0–4 years have the highest rate of serious injury, particularly facial. Adults have longer hospitalizations, most frequently for upper extremity injury. Risk factors include: child, males, households with dogs, certain breeds, male dogs, home location, and leashed dog. Conclusions—Dog bite rates are high and it may therefore be assumed that current preventative interventions are inadequate. Responsible dog ownership, including separating young children from dogs, avoiding high risk dogs, neutering, regulatory enforcement, and standardized monitoring of bite rates are required. Controlled investigations of further risk and protective factors, and validated methods of breed identification, are needed.

Firearm related deaths: the impact of regulatory reform

Objectives: To examine trends in rates of firearm related deaths in Victoria, Australia, over 22 years in the context of legislative reform and describe and investigate impact measures to explain trends. Design: Mortality data were extracted from vital statistics for 1979–2000. Data on firearm related deaths that were unintentional deaths, assaults, suicides, and of undetermined intent were analyzed. Rates were calculated with population data derived from estimates by the Australian Bureau of Statistics. A quasi-experimental design that used a Poisson regression model was adopted to compare relative rates of firearm related deaths for Victoria and the rest of Australia over three critical periods of legislative reform. The Wilcoxon signed ranks test was used to assess changes in the types of firearm related deaths before and after 1998. Results: In Victoria, two periods of legislative reform related to firearms followed mass shooting events in 1988 and 1996. A national firearm amnesty and buyback scheme followed the latter. Victorian and Australian rates of firearm related deaths before reforms (1979–86) were steady. After initial Victorian reforms, a significant downward trend was seen for numbers of all firearm related deaths between 1988 and 1995 (17.3% in Victoria compared with the rest of Australia, p<0.0001). A further significant decline between 1997 and 2000 followed the later reforms. After the later all state legislation, similar strong declines occurred in the rest of Australia from 1997 (14.0% reduction compared with Victoria, p = 0.0372). Victorian reductions were observed in frequencies of firearm related suicides, assaults, and unintentional deaths before and after the 1988 reforms, but statistical significance was reached only for suicide. Conclusion: Dramatic reductions in overall firearm related deaths and particularly suicides by firearms were achieved in the context of the implementation of strong regulatory reform.

Controlled evaluation of a community based injury prevention program in Australia

Objective: To evaluate the effects of a community based, all age, all injury prevention program, the Safe Living Program, on injury risk and injury rates. Design: A quasiexperimental population based evaluation using an intervention and comparison community design. Setting: The intervention community (Shire of Bulla, n=37 257) is an outer metropolitan area of Melbourne, Australia. The demographically matched comparison community (Shire of Melton, n=33 592) is located nearby. Subjects and methods: The Safe Living Program in the Shire of Bulla targeted injury reduction in all settings with a focus on high risk groups. Strategies included program publicity, education and training, injury hazard reduction, and environmental change. Baseline and follow up measures of program reach, risk factors, and injury rates in both communities were used to evaluate program process, impact, and outcome. Results: Increase in program awareness was moderate and similar to other community based programs. The program achieved injury hazard reduction on the road, in schools, and, to a more limited extent, in the home. Other changes in injury risk factors could not necessarily be attributed to the program as similar changes were observed in the comparison community. No significant changes were found in rates of injury deaths, hospitalisations, or emergency department presentations in the Shire of Bulla after six years. Self reported household injuries, mostly minor, were reduced in the intervention community, but had been higher at program launch than in the comparison community. Conclusions: The Safe Living Program was unable to replicate the significant reductions in injuries reported in other community based interventions. Replication of apparently successful community based injury prevention programs in different settings and populations requires evidence based interventions, sustained and effective program penetration, reliable data systems to measure change, at least one control community, and sufficient budget and time for effects to be observable.

Maryborough skin health survey: Prevalence and sources of advice for skin conditions

A computer‐assisted telephone interview survey was carried out in the City of Maryborough to determine the prevalence and sources of advice for self‐reported skin conditions. Of the 443 adults contacted, 416 (94%) agreed to participate in the study. One hundred and fourteen people (27%) reported having one or more skin conditions over the past 2 weeks, which included eczema/dermatitis 25.5% (range, 18.1‐32.8%; 95% CI), warts 16.1% (9.8‐22.4%), acne 16.2% (9.6‐22.7%), cold sores 15.1% (7.3‐18.9%) and tinea 11.2% (5.9‐16.5%). Medical practitioners were the most common source of advice for 49% of skin conditions, followed by family and friends or self‐prescribed (25%). Advice from a pharmacist was sought for 19% of skin conditions. Logistic regression analysis showed that those people who reported a moderate to severe inflammatory skin condition, such as dermatitis, urticaria or psoriasis, were most likely to seek advice from their medical practitioner. The type and severity of skin condition were factors which determined where a person sought advice on diagnosis and management.

Challenges of recruiting farm injury study participants through hospital emergency departments

Background: Hospital emergency departments are common recruitment sites for injury studies. Yet recruitment method details, capture rates and response fractions are not consistently reported. As privacy legislation increasingly impinges on research activity, these parameters become even more important. The authors describe their experience with recruitment via emergency departments and outline subsequent adjustments to the recruitment approach. Methods: The FIRM study was an Australian case-control study of serious farm work-related injury. Cases were identified prospectively by hospital staff on presentation to emergency departments. Consistent with the Victorian Health Records Act, potential cases were initially approached by hospital staff, and full recruitment was subsequently undertaken by study staff. Manual hospital record audits were conducted at five recruitment sites to determine the proportion of eligible cases approached. Results: Among 660 medical records audited, 19 eligible cases were confirmed, 9 of whom were approached by hospital staff (47%, 95% CI 25 to 70%). In response, an additional process was established to capture missed cases, who were sent a letter from the hospital providing the opportunity to opt out of telephone contact by study staff. Early indications were that 34% (41/122) of missed cases actively declined to be contacted. Among those who were contacted and eligible, 84% (21/25) agree to study participation. Conclusions: Recruitment of injury research participants via hospital emergency departments is challenging, particularly where authorities require an intermediary to make the initial contact. Removal of some constraints imposed by privacy legislation would considerably simplify recruitment and enhance scientific rigour in conducting epidemiological research.

Impact of Tai Chi on impairment, functional limitation, and disability among preclinically disabled older people: a randomized controlled trial

Background Integration of falls prevention with promotion of independence for older people will enhance uptake of effective programs. Objective To test the effect of tai-chi on both progression of disability and falls prevention in the elderly. Methods Multi-site parallel group individually randomised controlled trial. Participants were pre-clinically disabled community-dwelling people 70+ yrs (n=503), without major medical conditions or moderate to severe cognitive impairment. Intervention was modified Sun style tai-chi compared with seated flexibility exercise, both programs delivered in groups for 60 minutes twice weekly for 24 weeks. Disability was measured with the Late Life Function and Disability Instrument (LLFDI). Falls were reported using a monthly post-card calendar system. Results There was little effect on disability or falls outcomes. The largest disability difference was in the Disability Limitation Score: mean change was -0.1 and -0.04 points for intervention and control groups respectively (adjusted difference -0.6 95% CI -2.31 to 1.11). Multiple imputation of missing data did not change the result. Falls per 100 person years were 57.7 and 59.6 for intervention and control groups respectively (rate ratio 0.96, 95% CI 0.67 to 1.41). A higher proportion of intervention participants ceased attending the exercise program (difference=17.9%, 95% CI 9.6 to 25.8). Significance Modified Sun style tai-chi did not impact on disability or falls in pre- clinically disabled older people when delivered for 24 weeks. Withdrawal from the exercise classes was high but did not explain the null result. It is not clear whether improved compliance or a longer or more intensive program would have achieved a better result.