Individual and household-level risk factors for sporadic salmonellosis in children.

OBJECTIVES: To explore risk factors for sporadic salmonellosis at the individual and household level in children in tropical Darwin, where animal faeces contaminated with Salmonella is thought to be common. METHODS: A 2-year community based case-control study of children aged 0-4 years residing in Darwin and Palmerston from June 2006. Variables included behaviour, health, food, family and housing characteristics. Environmental samples were taken from houses of case and control children. RESULTS: Of children whose parents were contacted, 59/131 cases and 95/222 controls were included. Salmonella was isolated from 41/56 (73%) case houses and 18/29 (62%) control houses (p = 0.29). Multivariate analyses showed breastfeeding 0.16 (p = 0.02), increasing age (months) 0.89 (p = 0.00) and daily vacuuming 0.18 (p = 0.06) were protective; consuming powdered formula milk 4.88 (p = 0.02), pet ownership 4.86 (p = 0.02), oral contact with animals 7.85 (p = 0.05), recent antibiotic use 10.01 (p = 0.03) and sweeping in the presence of children 3.73 (p = 0.04) were associated with sporadic salmonellosis. CONCLUSIONS: Salmonellosis in children under 5 years of age is associated with potentially modifiable risk factors other than food. Breastfeeding beyond 6 months, careful hygiene when preparing formula milk and around pets, frequent cleaning of infant play areas especially quick removal of animal faeces are behaviours likely to reduce childhood sporadic salmonellosis.

Measles transmission in immunized and partially immunized air travellers.

Most cases of measles in Australia are associated with travel or acquired from travellers from overseas. This study presents a series of three secondary cases of measles acquired through contact with a case of infectious measles acquired in China. Two of the cases were fully immunized siblings sitting eight rows behind the index case on a 4(1/2)-h flight from Singapore. The third case was acquired in the airport where the index case was in transit. The report highlights the travel-associated risk of measles and discusses the heredity of vaccine-induced measles immunity.

Interpersonal predictors of dieting practices among married couples.

The relations between couples' marital quality and dieting behavior were examined. One-hundred eighty-seven married couples' dieting behaviors, marital quality, body mass index, weight concerns, depression, and self-esteem were assessed. Results indicate that the relation between healthy dieting behaviors and marital quality is similar for both husbands and wives. However, among wives, marital discord predicted unhealthy dieting behaviors, even after wives' body mass index, weight concerns, self-esteem, and depression were controlled for. Furthermore, wives' self-esteem interacted with marital quality when predicting unhealthy dieting. These findings suggest gender differences in the relations between marital quality and dieting behaviors and are consistent with previous research suggesting that men and women have differential response patterns to marital disharmony, with women tending to internalize negative affect experienced in their marriage.

Divisions, general practice and continuous quality improvement. What is the connection?

BACKGROUND: Quality improvement in general practice needs to take into account not only the clinical behaviour of individual general practitioners but also the system within which they work. DISCUSSION: Continuous quality improvement (CQI) is an approach to helping clinicians work toward 'best practice' through system wide support. Its emphasis is on the improvement of processes through leadership, a team approach, the use of data, and small scale quality improvement projects. CONCLUSION: CQI may be useful for divisions of general practice to develop and improve their infrastructure and also to support quality improvement in individual general practices.

Promoting evidence-based medicine in general practice-the impact of academic detailing.

BACKGROUND: We undertook a project to promote evidence-based medicine (EBM) within a network of GPs (the Monash Division of General Practice) in Melbourne, Australia. A principal promotional strategy was to conduct practice visits ('academic detailing'). OBJECTIVES: The aim of this study was to measure the impact of academic detailing on GP attitudes and knowledge of EBM. METHODS: All 132 GP members of the division were invited by mail to accept a practice visit about EBM. The GPs had been randomized to one of two groups: to receive academic detailing during the study period or to be visited at a later date. The practice visit consisted of a 30- 45 minute discussion about EBM and the barriers to its practice. Pre- and post-intervention questionnaires were used to measure change in knowledge of and attitudes to EBM over a 3-month period in both groups. RESULTS AND CONCLUSIONS: Academic detailing led to a significant improvement in knowledge scores and self-perceived understanding of EBM, but had little influence on GP attitudes toward it. It is not known whether this would lead to change in clinical behaviour among GPs.

The effectiveness of Haemophilus influenzae type b conjugate vaccines in a high risk population measured using immunization register data.

The Northern Territory of Australia has had historically very high incidence rates of invasive Haemophilus influenzae type b disease in children less than 5 years of age, with the burden of disease greatest among Aboriginal infants less than 12 months. This study documents the impact of conjugate Hib vaccines introduced in 1993. Immunization rates were monitored using an existing immunization register, and case finding was done retrospectively using hospital and laboratory records. Following the vaccine introduction, the incidence fell abruptly to a seventh of its pre-vaccination level, in both Aboriginal and non-Aboriginal children. The effectiveness of PRP-OMPC (PedvaxHIB) was 97.5% and the overall effectiveness of the vaccination programme was 86.3%. The study shows Hib immunization as an effective intervention while discussing continuing needs for Hib control in high risk populations. It also illustrates the benefit of immunization registers in the evaluation of immunization programmes and assessment of vaccine effectiveness.

Changing GPs' clinical behaviour. What can divisions do?

BACKGROUND: The increasingly complex challenge for medical practitioners to keep up to date and use the best available evidence in their clinical decision making has led to important studies on the effectiveness of various strategies to change clinician behaviour. Divisions of General Practice can develop an evidence based framework to support this change. OBJECTIVE: The aims of this paper are to: discuss effective interventions to change clinicians' behaviour describe the theories which underlie these strategies suggest a framework for Divisions of General Practice to design and implement effective programs. DISCUSSION: Continuing medical education and guideline implementation serve to highlight the impact of various change strategies. The interventions and the theories that underlie them, whether they be from a social, behavioural or organisational perspective, offer Divisions of General Practice an opportunity to support GPs in their ongoing professional need for quality improvement.