Ear and hearing health in Aboriginal and Torres Strait Islander people aged 15 years and older: A scoping review.

OBJECTIVE: Review empirical research investigating the prevalence, experiences and management of hearing loss and ear disease in Aboriginal and Torres Strait Islander adults. DESIGN: Scoping review. STUDY SAMPLES: Searches of four electronic databases, Advanced Google, and key webpages identified 16,373 studies - 21 met inclusion criteria: original research relating to hearing/ear health and Aboriginal and Torres Strait Islander adults. RESULTS: Fourteen studies measured prevalence of hearing loss or middle-ear dysfunction, with a rate of hearing loss at an estimated 50% (reports ranging from 8% to 100%). Five studies reported views, attitudes, and experiences of hearing loss, with results showing hearing loss negatively impacted individual experiences in health and justice systems, and health professionals had limited understanding of the socioeconomic risk factors of middle ear disease. No articles directly reported on hearing loss management. CONCLUSIONS: There is a lack of research into the hearing health of Aboriginal and Torres Strait Islander adults, despite its critical importance in addressing health and social inequities. Given the widely varying and imprecise estimated rates of hearing loss detected, urgent action is needed to obtain accurate prevalence estimates and, in partnership with Aboriginal and Torres Strait Islander communities, identify the best methods of screening and managing hearing loss.

Reducing inter-rater variability in the assessment of nuchal translucency image quality.

INTRODUCTION: Standardization of first-trimester nuchal translucency (NT) image acquisition is crucial to the success of screening for Down syndrome. Rigorous audit of operator performance and constructive feedback from assessors maintain standards. This process relies on good inter-rater agreement on image assessment. We describe the Australian approach to NT image assessment and evaluate the impact of a targeted intervention on inter-rater agreement. METHODS: Between 2002 and 2008 a group of experienced practitioners met nine times to compare their assessment of a series of NT images. Each assessor had previously scored the images according to a system described in 2002. Inter-rater agreement was evaluated before and after an intervention where the assessors were required to refer to a detailed resource manual designed to reduce the subjectivity inherent in image assessment. RESULTS: There was a statistical improvement in inter-rater agreement for all elements of image assessment (original scores and individual component scores) after the intervention, apart from horizontal fetal position. However, even after the intervention, inter-rater agreement levels generally remained moderate (kappa range: 0.14-0.58). CONCLUSIONS: This study has shown that provision of detailed resource documentation to experienced assessors can significantly improve inter-rater agreement in all facets of NT image assessment. It also highlights areas of image assessment that require critical review. It is recommended that all audit bodies regularly review their inter-rater agreement to ensure consistent feedback to operators who submit images for expert peer review.

Work/life balance and health: the Nurses and Midwives e-cohort Study.

BACKGROUND: Nursing and midwifery are demanding professions. Efforts to understand the health consequences and workforce needs of these professions are urgently needed. Using a novel electronic approach, the Nurses and Midwives e-cohort Study (NMeS) aims to investigate longitudinally Australian and New Zealand nurses' and midwives' work/life balance and health. This paper describes NMeS participation; provides key baseline demographic, workforce and health indicators; compares these baseline descriptions with external norms; and assesses the feasibility of the electronic approach. METHODS: From 1 April 2006 to 31 March 2008, nurses in Australia and New Zealand, and midwives in Australia were invited to participate. Potential participants were directed to a purpose-built NMeS Internet site, where study information was provided and consent sought. Once obtained, a range of standardized tools combined into one comprehensive electronic questionnaire was elicited. RESULTS: Overall, 7633 (2.3%) eligible nurses and midwives participated (6308 from Australia and 1325 from New Zealand) from a total pool of 334,400. Age, gender, occupational and health profiles were similar between countries and to national figures. However, some differences were noted; for instance, Queensland participants were over-represented, while Victorian and South Australian participants were under-represented, and 28.2% of Australians were in high strain positions compared with 18.8% of New Zealanders. CONCLUSIONS: Using an internationally novel web-based approach, a large cohort, which appears generally similar to population norms, has been established. Provided participant retention is adequate, the NMeS will provide insight into understanding the drivers of nurses' and midwives' workforce retention and work-related factors associated with their health.

Melatonin dispensing among New Zealand children aged 0-18 years with autism: a nationwide cross-sectional study.

OBJECTIVE/BACKGROUND: Sleep problems in children on the autism spectrum are prevalent and persistent. Such problems are the result of a combination of biopsychosocial factors, including abnormal melatonin secretion. Exogenous melatonin is an empirically supported and popular treatment for sleep problems. However, we know little about rates of melatonin dispensing and associated variables. This study investigated rates of melatonin dispensing and the sociodemographic and child characteristics associated with its use in New Zealand. METHODS: This nationwide cross-sectional study used linked administrative health data obtained via the Integrated Data Infrastructure (IDI). Data were obtained for 11,202, 0-18 year old children on the autism spectrum. Descriptive data, and adjusted and unadjusted risk ratios, were calculated for sociodemographic and child characteristics. RESULTS: Melatonin is accessed by almost one quarter of children on the autism spectrum in New Zealand, with higher observed rates among females and those aged between 5 and 11 years, of European ethnicity, and presenting with co-occurring mental health conditions. CONCLUSIONS: Findings are largely consistent with research investigating both sleep disturbances and psychotropic drug use among children on the autism spectrum. High rates of melatonin use, age- and sex-related differences in its use, and the complexity associated with the presence of co-occurring conditions necessitates development of practice guidelines for melatonin dispensing. Further investigation into the duration of melatonin use and the interaction between child characteristics, co-occurring conditions, sociodemographic variables and melatonin dispensing is warranted.

First-trimester fetal nasal bone audit: evaluation of a novel method of image assessment.

OBJECTIVES: Absence of the nasal bone has been recognized to be a strong ultrasound marker for Down syndrome and its inclusion in combined first-trimester screening would increase the sensitivity and specificity of this test. We describe the development of a method of image scoring that should allow reliable assessment of practitioners submitting themselves to peer review for nasal bone imaging. METHODS: Twenty sonographers submitted 20 images demonstrating the presence of the nasal bone for quality assurance audit. Image quality was compared with the criteria described by The Fetal Medicine Foundation. Three raters scored the images on four separate occasions. On the first two occasions all 400 images were assessed qualitatively and given a simple pass/fail score. On the third and fourth occasions, five images from each of the 20 sets were scored objectively for five criteria by each of the three raters, with a cut-off applied to the scores generated. The reliability of these image assessment techniques was compared statistically. RESULTS: Through quantitative assessment, 84% of images were judged in the same manner by three raters on two separate occasions and in 94% of cases five of these six ratings drew the same conclusion. Rates of intrarater and inter-rater agreement were significantly better using quantitative rather than qualitative techniques. CONCLUSIONS: This study has shown that clearly defined assessment criteria together with a quantitative scoring method improve the reliability of expert peer review. The quantitative method is recommended as the basis for future nasal bone image audit.

Point of sale tobacco displays and smoking among 14-15 year olds in New Zealand: a cross-sectional study.

OBJECTIVE: To examine the association between exposure to tobacco displays at the point of sale and teenage smoking and susceptibility to the uptake of smoking. DESIGN: The sample comprised a national cross-section of 14-15 year olds with two measures of exposure to tobacco displays at the point of sale and three outcome measures. The outcome measures were susceptibility to smoking initiation, experimenting with smoking or current smoking. RESULTS: Compared with visiting stores less often than weekly, a greater frequency of store visits was related to increased odds of being susceptible to smoking (daily visits, adjusted OR 1.8, 95% CI 1.6 to 2.2) and experimenting with smoking (daily visits, adjusted OR 2.7, 95% CI 2.4 to 3.1). The likelihood of being a current smoker increased with a greater frequency of store visits among students of medium and high socioeconomic status, but not among those of low socioeconomic status. CONCLUSION: Although these findings are cross-sectional in nature, they are consistent with the notion that greater exposure to tobacco displays at the point of sale increases youth smoking, and suggest display bans are needed.

Aboriginal and Torres Strait Islander oral health and its impact among adults: A cross-sectional study.

BACKGROUND: Robust oral health epidemiological information for Aboriginal and Torres Strait Islander adults is scant. Set within a large urban population, this study describes self-reported oral health behaviours, status and impact assessed through computerized health checks (HC), stratified by age groups and sex, and identifies associations with dental appearance satisfaction. METHODS: This was a cross-sectional study of Aboriginal and Torres Strait Islander adults (aged ≥20 years) attending the Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care between 1 January 2014 and 31 December 2015 who had HC and provided research consent. RESULTS: There were 945 patients, 466 (49.3%) female, with an average age of 41.3 years (range, 20-82). Overall, 97.3% owned a toothbrush and 56.2% brushed two or more times/day. Despite self-reporting a significant oral health burden, only 28.8% visited a dentist within 12 months, mostly due to problems (84.3%). Surprisingly, only 28.4% reported dental appearance dissatisfaction, likely a result of community normalization whereby people are resigned to poor oral health. CONCLUSIONS: Under-utilization of dental services remains problematic for Aboriginal and Torres Strait Islander adults. To close the oral heath gap, culturally appropriate, acceptable and safe integrated primary health systems, with co-located dental services, demand consideration.

How well do anatomical-based injury severity scores predict health service use in the 12 months after injury?

There is an acknowledged need for valid and reliable injury scores, suitable for use at the population level, which can accurately predict the long-term outcome of injury. The objective was to quantify the extent to which the abbreviated injury severity score (AIS) and the functional capacity index score (FCI) predict use of health services in the 12 months following an injury event. A cohort of injured people (ICD-9-CM 800-995) aged 18 - 64 years was identified from Manitoba hospital discharge abstracts from January 1988 to December 1991. For each member of the cohort whose injuries could be mapped to an abbreviated injury scale unique identifier, a maximum AIS (maxAIS) and a maximum FCI (maxFCI) were obtained. The cohort was linked with hospital discharge abstracts, physicians' claims and deaths from the population registry for the 12 months following injury. Negative binomial regression was used to model the relationships between the severity scores and the three outcome measures, while controlling for potential confounding variables. In total, 20 677 (97%) eligible cases were identified, of which 16 834 (81%) could be assigned a maxAIS and 15 823 (77%) a maxFCI. MaxAIS and maxFCI were significantly associated with total days in hospital following injury, but explained little of the variation in any of the health service use outcome variables (maxAIS, partial pseudo r2 ranging from < 0.001 to 0.041; and maxFCI, partial pseudo r2 ranging from < 0.001 to 0.018). It was concluded that anatomical damage is only partly responsible for long-term injury outcome. Additional variables would need to be included in predictive models of health outcomes of injury before these models could be reliable.

Effect of central venous catheter type on infections: a prospective clinical trial.

This study reports on a block clinical trial of two types of central venous catheters (CVCS): antiseptic-impregnated catheters (AIC) and non-impregnated catheters (non-AIC), on catheter tip colonization and bacteraemia. In total, 500 catheters were inserted in 390 patients over the 18 month study period, 260 (52.0%) AIC and 240 (48.0%) non-AIC. Of these, 460 (92.0%) tips (237 AIC and 223 non-AIC) were collected. While significantly fewer AIC, 14 (5.9%), than non-AIC, 30 (13.5%), catheters were colonized (P<0.01), there was no difference in the rates of bacteraemias in the two groups (0.8% vs. 2.7%, respectively, P=0.16). There were 6.87 (95% CI 3.38-14.26) and 16.92 (95% CI 10.61-27.12) colonized AIC and non-AIC catheters, respectively, per 1000 catheter days, a difference that was significant (P<0.01). However, no difference emerged between bacteraemias in AIC and non-AIC catheters per 1000 catheter days measured at 0.98 (95% CI 0.24-5.54) and 3.38 (95% CI 1.29-9.34), respectively (P=0.10). Of the 444 CVCs that were sited in the subclavian or jugular veins and had tips collected, significantly more catheters were colonized in the jugular group, 19 (20%), compared with the subclavian group, 24 (6.9%; P< or =0.01). Overall, the low rates of colonization and bacteraemia may be explained by the population studied, the policies used and the employment of a clinical nurse dedicated to CVC management.

Weather temperatures and sudden infant death syndrome: a regional study over 22 years in New Zealand.

STUDY OBJECTIVE: To examine and identify relationships between the sudden infant death syndrome (SIDS) and environmental temperature in Canterbury, New Zealand. DESIGN: A retrospective epidemiological study combining details of regional hourly temperature and reported SIDS cases. SETTING: Canterbury, New Zealand, between 1968 and 1989 inclusively. PARTICIPANTS: All infants reported as dying from SIDS within the Canterbury region. MAIN RESULTS: The SIDS incidence increased after months with prolonged colder minimum temperatures, confirming the seasonality of SIDS. After adjusting for this seasonality, days that showed little change in hourly temperature and days with warmer minimum temperatures recorded were seen to have a significantly increased the incidence of SIDS. No evidence was found for other relationships between the SIDS incidence and various measures of daily temperatures on the day of death, over the preceding eight days or between these days. Infants aged 12 weeks and over were more susceptible to SIDS on days when small hourly temperature changes were recorded than their younger counterparts; no other age differences emerged. CONCLUSIONS: This study confirmed that the incidence of SIDS is affected by seasonality and temperature on the day of death. In particular, after a prolonged period of cold minimum temperatures, infants were most at risk from SIDS on days on which either a warmer minimum temperature or little hourly variation in temperature were recorded. No other daily or lagged daily temperature factor (lagged up to eight days before the day of death) was statistically associated with the SIDS incidence. It is suspected that the inconsistent previously published lag effect findings actually describe some other phenomenon such as parental behaviour or infant thermoregulation.

Weather and the risk of sudden infant death syndrome: the effect of wind.

STUDY OBJECTIVE: To examine and identify relations between sudden infant death syndrome (SIDS) and wind, particularly the föhn wind, in Christchurch, New Zealand. DESIGN: A retrospective epidemiological study combining details of regional hourly meteorological variables and reported SIDS cases. SETTING: Christchurch, New Zealand, between 1968 and 1997 inclusively. PARTICIPANTS: All 646 infants reported as dying from SIDS within the greater Christchurch region. MAIN RESULTS: Analysis of 1968-1989 data revealed nine wind variables significantly related to SIDS. When compared with corresponding variables calculated over the 1990-1997 period, only the northerly wind on the day of death and the southerly wind three days before a SIDS death had estimated associations with similar effect size and sign. However, both these variables had confidence intervals that included unity. CONCLUSIONS: No evidence was found to suspect that föhn winds influenced SIDS occurrence. The relations identified between SIDS incidence and wind, after controlling for the effects of temperature and trend, were tenuous and relatively small. More data are necessary to substantiate whether northerly winds on the day of death or southerly winds occurring three days before a death are truly associated with SIDS. It seems that wind has little, if any effect on SIDS incidence in Christchurch.

Smoking during pregnancy: how reliable are maternal self reports in New Zealand?

OBJECTIVE: To determine the reliability of self reports of smoking during pregnancy. METHODS: Residual sera from early and late antenatal blood samples were tested for cotinine for all pregnancies over a six month period. Over an overlapping 12 month period, a postal questionnaire on smoking was also sent to all new mothers (n = 4857) when their baby was 4-8 weeks old. Smoking status from obstetric booking notes was also obtained. RESULTS: The cotinine-validated smoking prevalence was 31.3% for the first trimester and 27.7% for the third trimester. Questionnaire self reported prevalences were 19.2% and 15.7% for the first and third trimesters respectively, and 18.9% for obstetric booking. Of cotinine-validated smokers, 22% denied smoking-self deceivers. Of mothers who replied to the questionnaire, a half appeared to systematically under report the amount they smoked. CONCLUSIONS: Nearly a quarter of smoking pregnant women did not report smoking. Moreover, of those who did, the amount smoked was often under reported. This tendency to under report may rise as pressures to stop smoking increase. Accurate measures of smoking prevalence in pregnant women will require objective testing.

A biochemical prevalence study of smoking in pregnancy for a cross-section of women in Christchurch, New Zealand.

OBJECTIVE: To biochemically measure and compare the prevalence of maternal smoking by trimester in a cross-section of pregnant women residing in Christchurch, New Zealand, during 1997. METHODS: Residual sera from routinely collected blood samples drawn in early and late pregnancy over a 12-month period, 1 January 1997 to 31 December 1997, was accumulated and anonymously assayed. Cotinine levels were measured by an ELISA test with a result greater than 14 ng/mL indicative of active smoking. RESULTS: Analysis was conducted upon 4,178 samples collected from 3,082 women. Adjusted cotinine validated smoking rates in the first, second and third trimesters were 26.8% (95% CI 24.5-29.2%), 25.0% (95% CI 22.3-27.8%) and 23.0% (95% CI 20.8-25.2%), respectively. This represents an absolute reduction in smoking rates of 4.7% (p = 0.02), 6.6% (p = 0.04) and 3.8% (p = 0.04) for the first, second and third trimesters, respectively, among pregnant women in Christchurch since 1994. CONCLUSION: Smoke reduction and cessation programs implemented locally and nationally have been effective in significantly reducing the biochemically measured prevalence of maternal smoking in pregnancy within a three-year period. IMPLICATIONS: Cigarette smoking during pregnancy is an important yet preventable factor affecting rates of prenatal, perinatal and paediatric morbidity and mortality. Reliable and repeated surveys of pregnant women are necessary to accurately measure changes in the maternal smoking prevalence and determine the efficacy of smoke reduction and cessation programs.

Valerian does not appear to reduce symptoms for patients with chronic insomnia in general practice using a series of randomised n-of-1 trials.

OBJECTIVE: To investigate the effectiveness of valerian for the management of chronic insomnia in general practice. DESIGN: Valerian versus placebo in a series of n-of-1 trials, in Queensland, Australia. RESULTS: Of 42 enrolled patients, 24 (57%) had sufficient data for inclusion into the n-of-1 analysis. Response to valerian was fair for 23 (96%) participants evaluating their "energy level in the previous day" but poor or modest for all 24 (100%) participants' response to "total sleep time" and for 23 (96%) participants' response to "number of night awakenings" and "morning refreshment". As a group, the proportion of treatment successes ranged from 0.35 (95% CI 0.23, 0.47) to 0.55 (95% CI 0.43, 0.67) for the six elicited outcome sleep variables. There was no significant difference in the number (P=0.06), distribution (P=1.00) or severity (P=0.46) of side effects between valerian and placebo treatments. CONCLUSIONS: Valerian was not shown to be appreciably better than placebo in promoting sleep or sleep-related factors for any individual patient or for all patients as a group.

Immunisation timeliness for a birth cohort in Christchurch. Christchurch Immunisation Coordination Study Group.

AIMS: To determine whether New Zealand's goals for immunisation coverage are being met in Christchurch and to assess whether scheduled vaccinations are being delivered in a timely fashion. METHODS: A cohort of all infants born in Christchurch during June, July and August 1995 were matched with immunisation benefit claim information for the 6-week, 3-month, 5-month and 15-month immunisation events. Those with incomplete reports were traced for amendment or verification of their immunisation status. RESULTS: The cohort contained 1002 infants. The full complement of scheduled immunisations was delivered to an estimated 95.8% (95% CI: 94.5, 97.2) of infants within the cohort by two years of age. Infants who presented late for their 6-week immunisation visits were significantly more likely to be late for their next visits (chi 2 log rank = 8.2, df = 1, p < 0.01), as were those late for their 3-month visits (chi 2 = 20.9, df = 1, p < 0.01), and their 5-month visits (chi 2 = 52.5, df = 1, p < 0.01). Infants were significantly less likely to receive their full complement of immunisations by two years of age if they presented late for their 6-week (Fisher's exact test, p = 0.01), 3-month (p < 0.01) or 5-month (p = 0.01) immunisation visits. CONCLUSIONS: The Immunisation 2000 target of 95% full immunisation coverage by two years of age was met by this cohort. However, infants who were late for any immunisation visits were more likely to be late for subsequent visits and incompletely vaccinated by two years of age, compared to those infants who presented on time.

Changes to infant sleep practices in Canterbury.

AIM: "Reducing the risk" is a public health primary initiative to minimise the incidence of Sudden Infant Death Syndrome (SIDS) in New Zealand. A number of SIDS risks relate to infant sleep practices. We describe current prevalences of these practices. METHODS: A cohort of Canterbury mothers delivering live infants during May 1997 (n = 411) were mailed a questionnaire in July surveying their infant's sleep practices. Survey results were compared to results derived from the Canterbury control infant component of the 1987-90 New Zealand Cot Death Study (NZCDS) (n = 174). Those mothers using either plastic or rubber mattress covers (n = 63) were issued a subsequent questionnaire pertaining to this mattress-wrapping practice. RESULTS: Completed questionnaires were returned by 274 (66.7%) mothers. Room sharing with mother was usual for 133 (48.5%) infants, no different from the 94 (54.0%) recorded in the NZCDS (chi 2 = 5.6, df = 2, p = 0.06). However, of those infants sharing a room with their mother, 101 (75.9%) slept in their own bed compared to 46 (48.9%) in the NZCDS (chi 2 = 57.0, df = 2, p < 0.01). Only 8 (2.9%) infants were regularly placed prone to sleep, considerably fewer than the 69 (39.7%) reported in the NZCDS (chi 2 = 100.1, df = 1, p < 0.01). Mattress-wrapping with plastic (14.6% vs. 4.0%; chi 2 = 12.8, df = 1, p < 0.01) and rubber (8.4% vs. 3.4%; chi 2 = 4.4, df = 1, p = 0.04) has significantly increased since the NZCDS. Results from the subsequent questionnaire, completed by 42 (66.7%) respondents, indicated that most, 25 (59.5%), wrapped their infant's mattress to stop soiling. Less than half, 18 (42.9%), wrapped the mattress for the "safety of their baby". CONCLUSION: The "non-prone sleeping" campaign has been successful in Canterbury. Most infants are now routinely placed non-prone for sleep. Of those infants sharing a room with their mothers, an increased proportion is sleeping in separate beds. The use of "drycot" under-blankets and sheepskins has diminished. While impermeable mattress-wrapping usage has significantly increased, over three-quarters of Canterbury mothers did not use plastic or rubber mattress-covers on their infant's beds.

Breastfeeding in Canterbury over three decades.

AIM: To document breastfeeding levels in Canterbury between 1968 to 1994. METHODS: The method of feeding at discharge from hospital, at 4 weeks and at 3 months of age was obtained from maternal obstetric records, Plunket nursing notes, parent interviews or by self completed questionnaires. Data were compiled for the years 1968 to 1994. RESULTS: In 1968, only half of all mothers were breastfeeding when discharged. However, rates have steadily increased since then so that by 1990, 90% of infants were recorded as being breastfed at discharge. Levels of exclusive breastfeeding have also increased. By 1992-4, 82.2% of babies were being exclusively breastfed at discharge from hospital, 72.4% at 4 weeks and 62.5% at 3 months. CONCLUSION: Levels of breastfeeding in Canterbury are now relatively high. The Public Health Commission has set a target for 75% of infants to be fully breastfed at 3 months of age by the year 2000. To achieve this the circumstances that hinder breastfeeding need to be addressed.

Smoking during pregnancy measured by population cotinine testing.

AIM: To establish a baseline cross-sectional prevalence of maternal smoking, measured by antenatal serum cotinine testing, in a population of pregnant women. METHODS: Residual sera from first and second routine antenatal blood samples were collected anonymously over a six-month period for pregnancies within the Canterbury region. Cotinine levels were measured by an ELISA test with a result of > 14 ng/mL indicative of active smoking. Only pregnancies ending in a confirmed live birth were considered in smoking prevalence calculations. There was a total of 1948 eligible residual blood samples. RESULTS: Of the 414 residual blood samples available for the first two months of pregnancy, 146 (35.3%) were found to be positive for cotinine. Smoking prevalence decreased over pregnancy so that by the third trimester 225 (26.8%) of 838 samples were cotinine positive. Infants born from smoking mothers had significantly lower birth weights. CONCLUSIONS: In 1994, a third of women tested in early pregnancy and a quarter of women tested in late pregnancy were identified as being smokers. Repeated objective cross-sectional surveys will allow accurate assessment of the efficacy of smokefree interventions both before and during pregnancy.

Prevalence of childhood asthma symptoms in an industrial suburb of Christchurch.

AIM: In response to community concern about the possible respiratory effects of emissions from a fertiliser plant, a study was carried out to determine whether the prevalence of asthma symptoms in 5-8 yr old children in an industrial suburb of Christchurch (Hornby) was the same as in the rest of Christchurch. METHODS: A sample of 646 children aged 5-8 years in Hornby was compared with 1183 6-7 year old children randomly selected from schools throughout the Christchurch metropolitan area. The Christchurch sample was part of the International Study of Asthma and Allergies in Childhood (ISAAC) carried out during 1993. ISAAC questionnaires on respiratory symptoms with some additional questions about smoking and pets were answered by the caregivers of the children sampled. RESULTS: Response rates were 97% in Hornby and 94% in Christchurch. Of the sample, 29% (Hornby) and 27% (Christchurch) had 'wheeze in the last 12 months' while 45% of Hornby and 44% of Christchurch children had 'ever wheezed', 28% had 'ever had asthma'. Significantly more children in Hornby (44%) were exposed to passive smoking compared to Christchurch (29%). Indoor pets were present in 73% and 67% of homes, respectively. CONCLUSION: There was no evidence of an increase in asthma symptoms reported in children in the industrial area of Hornby.

The length of the referral chain after failing preschool tympanometry.

AIMS: To describe the time intervals during the process of detection and management of chronic secretory otitis media/glue ear. METHOD: Tympanometry records of 508 preschool children who failed both tympanometry screening and the subsequent retest were examined. Additional information was obtained from 205 parents/caregivers by telephone interview. RESULTS: Calculations of time intervals between tympanometry screening and retesting showed that 75% of children had been retested within 20 weeks and 95% by 40 weeks. Two-thirds (67%) of children had visited their general practitioner within 4 weeks of failing their retest, although 13% had still yet to be seen by 20 weeks. The mean time interval between the initial general practitioner visit and subsequently being seen by an ENT specialist was 20 weeks in the public system compared to 5 weeks if seen privately (p < 0.001). CONCLUSION: The preschool tympanometry screening programme functioned well, although there were delays in retesting 25% of preschoolers. There were substantial time intervals for some children for each link in the referral chain. The reasons for these delays needs investigation to determine how much it is a part of the treatment process and how much due to waiting list problems.