Atypical outbreak of Q fever affecting low-risk residents of a remote rural town in New South Wales.

We investigated an outbreak of Q fever in a remote rural town in New South Wales, Australia. Cases identified through active and passive case finding activities, and retrospective laboratory record review were interviewed using a standard questionnaire. Two sets of case-case analyses were completed to generate hypotheses regarding clinical, epidemiological and exposure risk factors associated with infection during the outbreak. Laboratory-confirmed outbreak cases (n=14) were compared with an excluded case group (n=16) and a group of historic Q fever cases from the region (n=106). In comparison with the historic case group, outbreak cases were significantly more likely to be female (43% vs. 18% males, P = 0.04) and identify as Aboriginal (29% vs. 7% non-Aboriginal, P = 0.03). Similarly, very few cases worked in high-risk occupations (21% vs. 84%, P < 0.01). Most outbreak cases (64%) reported no high-risk exposure activities in the month prior to onset. In comparison with the excluded case group, a significantly increased proportion of outbreak cases had contact with dogs (100% vs. 63%, P = 0.02) or sighted kangaroos on their residential property (100% vs. 60%, P = 0.02). High rates of tick exposure (92%) were also reported, although this was not significantly different from the excluded case group. While a source of this outbreak could not be confirmed, our findings suggest infections likely occurred via inhalation of aerosols or dust contaminated by Coxiella burnetii, dispersed through the town from either an unidentified animal facility or from excreta of native wildlife or feral animals. Alternatively transmission may have occurred via companion animals or tick vectors.

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.

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.

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.

Alcohol harm and cost at a community level: data from police and health.

INTRODUCTION: The Australian National Alcohol Strategy 2006-2009 recommends strengthening data collection at the local level, gathering information from emergency department (ED) attendees and, by integrating data sources, to develop a better understanding of alcohol- related harm. We piloted a method to estimate the number of alcohol-related presentations to ED and alcohol-related police incidents in a remote regional centre. We explore the practicality and benefits of integrating such alcohol related police and health data. SUBJECTS AND SETTING: Broken Hill Hospital is the district hospital that serves Broken Hill and surrounds in far west New South Wales, a population of approximately 20 000, over 90% of whom live in the town itself. Computerised records of all attendances are available. The Barrier police command is based in Broken Hill with 56 police. METHOD: Over two one-week periods a combination of a short patient questionnaire, nurses' assessment and concordance with Broken Hill police records were used to determine alcohol-related presentations. RESULTS: Both health and police data showed seasonal variation, with alcohol-related incidents and costs doubling in warmer weather. Altogether 32 people (5% of all 602 presentations) were recorded as having consumed alcohol prior to the event that brought them to ED. From 765 events, police attended 118 (15%) alcohol-related incidents. While the two groups were essentially independent, they were very similar demographically. The majority (68%) were males aged in their 30s who came to ED/ police notice in the late evening/early morning, mainly in the weekend. By integrating police data, routine ED data and an ED survey, a more comprehensive picture of alcohol-related harms emerged. CONCLUSION: Future research would benefit from the use of project officers in ED and in the police force, to improve compliance and data completeness. A more comprehensive local picture would also include data from other agencies dealing with alcohol. A longer study is necessary to confirm the preliminary data on seasonal variation. Key words: alcohol, emergency department, injury prevention/ early intervention, intoxication, police incidents/crime.

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.