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Biomedical subjects

S R Leeder

Publications and source records attributed to S R Leeder.

At least 19 recordsLinked to original sources
PubMed1992

Asthma morbidity in Australia: an epidemiological study.

OBJECTIVE: To examine the prevalence and management of asthma in adults and children in a population sample in eastern Australia. SETTING: A random sample of children from 33 primary schools in Sydney, Melbourne, Brisbane, and the Upper Hunter Valley (New South Wales), and their parents. DESIGN: A cross-sectional analytic survey of 8753 primary school children aged between 5 and 12 years, and their parents (n = 13,945 adults). Asthma prevalence and management practices were determined by parental responses to a questionnaire, and spirometry was performed in children with "probable asthma". RESULTS: Of 8753 children whose parents responded, the prevalence of current wheeze was 19.5% and diagnosed asthma was 17.1%. Of the children with "probable asthma", 30% had their lung function measured in the previous year, and 6% possessed both a peak flow meter and an action plan for their asthma. Undertreatment was likely, as preventive asthma medications (inhaled corticosteroids or sodium cromoglycate) were used regularly by only 25.5% of these children and by 44.3% of children who had asthma symptoms more than twice per week. Children with the diagnosis of asthma reported higher rates of preventive medication use and ventilatory function measurement than children with frequent symptoms without the diagnosis. In the 13,945 adults, the reported prevalence of asthma was 7%, of whom 39% were using preventive medications, 34% had their ventilatory function assessed in the previous year, and 7% had both a peak flow meter and an asthma action plan. CONCLUSIONS: The study illustrated the gap between the current level of asthma management in the community and the standards set by the Thoracic Society of Australia and New Zealand. Undertreatment and suboptimal management of asthma remain important problems in Australia.

Administration, Inhalation↗
PubMed1991

The validity of parental report of vaccination as a measure of a child's measles immunisation status.

OBJECTIVE: To determine the validity of parental report of vaccination as a measure of a child's measles immunisation status. DESIGN: Cross-sectional survey. SETTING: Four 24-hour medical centres in western Sydney. PATIENTS: Parents of children aged 12-36 months were approached in the clinic waiting room. Of the 160 parents approached, 137 agreed to be interviewed and a successful venepuncture to yield a 2 mL blood sample was achieved with 128 children. MAIN OUTCOME MEASURES: Measles IgG antibody, determined by means of an indirect ELISA, was compared with parental report of measles vaccination status by McNemar's chi 2 test. RESULTS: Parental report significantly over-estimates the immunisation status of children. Eighty-four per cent of the parents in the sample stated that their child had been vaccinated, but only 74% were immune (95% confidence interval, 65%-81%). A positive predictive value of 84% meant that only 84% of children who were reported to have been vaccinated were immune to measles. Further, of all those who were not immune to measles, only one half would have been identified by asking the parents. Failed seroconversion may have accounted for up to 70% of cases of non-immunity in children reported to have been vaccinated. CONCLUSIONS: Parental report is limited as a measure of a child's measles immunisation status.

Child, Preschool↗
PubMed1991

Invasive Haemophilus influenzae type b disease in Sydney children 1985-1987: a population-based study.

OBJECTIVE: To determine the incidence and age distribution of invasive Haemophilus influenzae type b (Hib) disease in children (0-14 years) in the Sydney Statistical Division (SSD). DESIGN: Retrospective ascertainment from a defined population, 1985-1987. Eligible cases had Hib isolated from a normally sterile site or endoscopically proven epiglottitis. SETTING: Sydney Statistical Division, which had a population of children aged 0-4 years of 229 165 in 1986. PATIENTS: Cases were identified from all potential sources of relevant recorded information. MAIN OUTCOMES: There were 292 eligible cases. Among 284 previously well children, those under 18 months of age contributed 81 of 143 cases (57%) of meningitis and 22 of 71 (71%) of cellulitis/arthritis but only 8 of 91 (11%) of epiglottitis and 4 of 18 (22%) of infection in other foci. Overall, 9% of cases had occurred by 6 months of age, 42% by 18 months and 55% by 24 months. The annual incidence of invasive Hib disease was 38.5 per 100,000 children aged 0-4 years. In areas with the lowest proportion of young children (less than 5.5%), the incidence of Hib disease in the first 12 months of life was significantly lower than in the remainder of Sydney, although there were no differences in overall disease incidence in the age group 0-4 years. CONCLUSIONS: This study indicates that approximately 1 in 500 urban Australian children develop invasive Hib disease by their fifth birthday. Vaccination of children in Sydney with a conjugate Hib vaccine at 18 months of age would result in a greater potential reduction in Hib disease than in the United States, where universal vaccination at this age is current policy.

Adolescent↗
PubMed1989

Cardiovascular disease-related knowledge and attitudes in a high-risk Australian population.

The population of Sydney's western suburbs has higher-than-average mortality rates of heart disease and has raised prevalence rates of the associated risk factors. To enquire into the cardiovascular disease-related knowledge, attitudes and behaviours of this population, a survey that used a multistage area-probability sampling method was conducted in May 1987. A total of 484 subjects was interviewed. The self-reported prevalence rates of angina, heart attacks, strokes and diabetes all were high compared with the rates from the Australia-wide National Heart Foundation's Risk Factor Prevalence Study in 1983. The rates of smoking, hypertension, high blood-lipid levels and sedentary life-style also were raised. Awareness of cardiovascular disease-related issues was high but detailed knowledge often was deficient. The majority of respondents reported having attempted to change their health-related behaviours. Of special note was the finding that 80% of current smokers had tried to quit smoking. The high level of awareness of the importance of making life-style changes, and the frequency with which attempts at behavioural changes were reported, suggest that improvements in the health of the population of Sydney's western suburbs will require two complementary strategies: the teaching of the skills that are needed to maintain healthy behaviours successfully and environmental changes to facilitate healthy life-style choices.

Adolescent↗
PubMed1989

General practitioners' detection of patients' smoking status.

We examined the detection of smoking by 50 randomly-selected general practitioners. The practitioners said that they should detect smokers among their patients with a high degree of accuracy: a median of 100% of smokers under ideal conditions, and a median of 80% of smokers given the realities of practice. Practitioners actually identified 56.2% of their patients who were smokers--360 of 641 smokers among 2044 patients in the study. Some 65% of patients with a smoking-caused or smoking-exacerbated disease were detected, and this degree of detection was not related to age. For smokers of greater than 50 years of age and without any obvious smoking-related condition, the detection rates were similar to those of patients with smoking-related disease; however, in those patients who were less than 30 years of age, only 41% of smokers were detected--although the prevalence of smoking was higher in the younger than it was in the older patients. For all age-groups, the prevalence of smoking in men was about 15% higher than it was in women, but there was no significant difference between the detection rates in the sexes. In spite of their higher risks from smoking, the detection rates for pregnant women, or women who were taking oral contraceptive agents, were no higher than those for other women of less than 35 years of age. The doctors said that they had treated for smoking 78% of the detected smokers who had smoking-caused disease, compared with 35% of detected smokers with no smoking-related condition. They rated the value of such treatment higher in the former group than in those patients who had not yet developed smoking-related problems. Doctors appear to respond to the evidence of disease that is caused by smoking more than to the habit itself, which is a handicap in the prevention of smoking-related disease.

Adult↗
PubMed1989

Medical practitioners and health promotion: results from a community survey in Sydney's western suburbs.

A health survey of 484 persons aged 14 to 89 years was conducted in Sydney's western suburbs in May 1987. Its aims included a description of preventive activities undertaken by medical practitioners and an assessment of the community's perception of the doctor's role in health promotion. Ninety-three per cent reported visiting a doctor in the previous year and 31 per cent of respondents reported having contact with a general practitioner the fortnight before the survey, either for their own health or that of another. Eighty per cent of respondents reported having had their blood pressure measured in the previous year and 63 per cent of female respondents aged 18 years and over who had not had a hysterectomy reported having had a Pap smear in the last five years. However, few respondents reported receiving any lifestyle-related advice at their most recent doctor visit and 77 per cent said that the food they ate was rarely or never discussed with their doctor. Despite this low level of advice, doctors and nurses were perceived to be the most important source of health information by nearly half the respondents. Strategies for increasing the involvement of doctors in health promotion are discussed.

Adolescent↗
PubMed1988

A cost-effectiveness analysis of alternative strategies for the prevention of heart disease.

The identification of risk factors, such as a raised cholesterol level, hypertension, cigarette smoking, and obesity, permits the prediction of the possible development of ischaemic heart disease and has led to attempts at its prevention through modification of these factors. A high risk of developing ischaemic heart disease is also associated with age, specific socioeconomic groups, a family history of ischaemic heart disease, and preexisting evidence of the disease. Preventive strategies have either sought to reduce the average levels of risk in the general population or to identify by population screening individuals or groups who are at particular risk and to reduce their level of risk. Differing methods of risk-factor identification and modification are appropriate for each of the high-risk groups. For a number of strategies that are directed at either the whole population or high-risk groups we have estimated the costs of identification and risk-factor modification and the probable benefits of undertaking such a strategy. A strategy which educates the whole population by way of the media costs considerably less than does any strategy that involves the identification of individuals at high risk. At a medium cost estimate, with a reduction in risk of only 1%, such an approach costs approximately $8000 per case that is prevented; when risk reduction approaches 3% it actually results in a saving of health-care expenditure within five years. The costs of the other strategies vary between $12,000 and $26,000 per case that is prevented in a five-year period.

Adult↗
PubMed1988

The Western Sydney Health Study: results of the shopping-centre survey.

The Western Sydney Health Study is a two-phase descriptive study that is designed to provide data on the health-related knowledge, attitudes and behaviour of persons in the Western Metropolitan health region, which has higher-than-average death rates of many disorders that are associated with life-style. In the first phase of the study, 2164 respondents were interviewed in six shopping centres in the region. The prevalence rates of self-reported cardiovascular disease and diabetes were about twice those that were found in the Australia-wide National Heart Foundation Risk Factor Prevalence Study in 1983. The prevalence rates of smoking and self-reported raised blood lipid levels were also high. Doctors and nurses were the main sources of health information, and the media was less important as a source of health information than was found in the Better Health Commission's national survey in 1985. Over 80% of respondents believed that a lowering of the dietary fat intake and an increase in exercise were health-enhancing behaviours. Given this high level of health knowledge, the major aims for health promotion in the region should be a social change to facilitate choices towards healthy behaviour and the provision of skills to enable individual behavioural changes.

Adolescent↗
PubMed1988

Frequency of cervical smear-tests among patients of general practitioners.

Eight hundred and thirty-eight women who attended 36 general practitioners were asked when they had last undergone a cervical smear-test. Only 6% of women who were between 25 and 54 years of age had never undergone a smear-test, but in women who were younger and older than this age range the proportion was one-third. We estimated from this pattern of use of cervical smear-tests that only 60% of invasive cervical cancer is being prevented, and the major contribution to the remaining risk factors comes from women of over 55 years of age who either have not undergone a smear-test or had undergone one a long time previously. This information suggests that general practitioners and the public-health system should be more active in ensuring that all at-risk women undergo cervical smear-tests.

Adolescent↗
PubMed1988

Ischemic heart disease in the Hunter Region of New South Wales, Australia, 1979-1985.

In Australia, mortality rates from ischemic heart disease have declined by more than 40 per cent in the last 20 years. To investigate the reasons for this trend, detailed studies are being conducted in the Hunter Region of New South Wales, an area with high heart disease rates. Data on death rates and attack rates from 1979 to 1984-1985 were obtained from three sources: national mortality records, local hospital statistics, and heart disease registers conducted in 1979 and 1984-1985 using World Health Organization protocols. Age-standardized death rates from ischemic heart disease, hospitalization rates for acute myocardial infarction, and attack rates from myocardial infarction determined from the disease registers all showed declines of approximately 3-4 per cent per year from 1979 to 1985. The results differ from findings in New Zealand, where the decrease in ischemic heart disease mortality has been attributed to fewer sudden deaths. These discrepancies demonstrate the need for carefully standardized studies to gain insight into evolving patterns of heart disease in different populations.

Adult↗