Comparison of rural and non-rural students undertaking a voluntary rural placement in the early years of a medical course.

OBJECTIVE: The experiences of rural and non-rural students undertaking a voluntary rural placement in the early years of a medical course were compared. METHOD: Eighty percent (28) of the rural and 70% (114) of the non-rural students completed a post-placement questionnaire. RESULT: The two groups did not differ on their overall rating of the placement, whether they felt welcome, adequacy of the time with doctors or their rating of the accommodation provided. However, 46% (13) of the rural students reported the placement had changed their feelings towards rural practice to the maximum/almost maximum extent compared with only 24% (27) of the non-rural students.

Health and safety problems and lack of information among international visitors backpacking through North Queensland.

BACKGROUND: International visitors to tropical Australia may be exposed to health and safety problems. Because they are younger, stay longer and participate in more activities, backpackers have a greater exposure to such problems than other visitors. METHOD: The study's aim was to determine how many backpackers experience problems and lack health and safety information. Four hundred and thirty-one international visitors staying in a random sample of youth hostels and backpacker accommodation in Townsville were surveyed over the summer. RESULTS: Sixty two percent experienced a health and safety problem, commonly, insect bites, sunburn, headaches, lacerations, coral cuts, ear infections and diarrhea. Seventeen percent resolved only with professional help. Only 54% of backpackers had been offered health and safety information prior to departure, mainly vaccination advice. CONCLUSION: The proportion of backpackers offered health and safety information about tropical Australia, and the breadth of that information, needs to be increased.

Preventing fractures in large rural centres: sociodemographic sub-groups at risk of osteoporosis from their lifestyle.

Middle-aged people living in non-metropolitan Victoria have higher hospitalisation rates from osteoporotic fractures than those in metropolitan areas. This may reflect a higher prevalence of lifestyle risk factors for osteoporosis. One-fifth of Victoria's non-metropolitan population live in 'large rural centres'. The aim of the present study was to identify the sociodemographic sub-groups in a 'large rural centre' at risk of osteoporosis because of their lifestyle. Adults on Ballarat's electoral rolls were invited to complete a questionnaire and have their height and weight measured. A total of 335 eligible people participated in the present study (67% response). The sub-groups at risk of osteoporosis were identified using logistic regression analyses. Among women, being single/separated/divorced/widowed was associated with being underweight and having low dietary calcium. A lack of exercise was associated with not completing high school and smoking with being aged 25-44 years. Among men, low dietary calcium was associated with not completing high school and smoking was associated with being employed in a non-professional/non-managerial occupation. These sub-groups must be considered when planning preventative strategies for people in 'large rural centres'.

Hospital separation rates from osteoporotic and non-osteoporotic fractures in metropolitan and rural Australia.

Rural populations of the United Kingdom and Scandinavia have lower hospital discharge and incidence rates for hip fractures than urban ones. We compared hospital separations from fractures in rural health regions of Victoria, Australia, with those in metropolitan regions. Fractures were grouped into those commonly (1A), often (1B) or not often (2) associated with osteoporosis. For group 1A fractures, we found rural separation rates were significantly higher among both men and women who were aged either 20-24 or 45-64. The rural separation rates for group 1B fractures were also significantly higher in these age groups but only among men. For group 2 fractures, rural separation rates were significantly higher among young adults. Fractures of the neck, trunk, radius and ulna, but not neck of the femur, contributed to the rural excess of group 1A fractures. If rural adults are not hospitalised more often, risk factors for group 1 and group 2 fractures, which in the middle aged includes osteoporosis, may be more prevalent in rural Victoria. Our findings suggest that international studies of rural-urban differences in fracture rates are needed which include a range of anatomical sites.

Prevalence and sociodemographic determinants of cardiovascular risk in a rural area.

Non-metropolitan areas have a higher mortality from cardiovascular disease than metropolitan areas. The study's aim was to establish the prevalence of cardiovascular disease risk factors in a rural area and identify their sociodemographic determinants. Adults, randomly selected from Ballarat's electoral rolls, were invited to complete a questionnaire and have their height, weight, blood pressure and fasting lipids measured. Three hundred and thirty-eight eligible persons participated (67% response). The data were analysed using logistic and multiple regression analyses. Increasing age was associated with hypertension, high plasma cholesterol, overweight/obesity, high plasma triglyceride levels and increasing plasma fibrinogen. Women were less likely to be overweight/obese and have a high plasma triglyceride. Not having completed high school was associated with hypertension, high plasma cholesterol and triglyceride levels and physical inactivity. Smoking was associated with employment and being in a non-professional/managerial occupation. Rural health promotion initiatives should take account of the needs of these population subgroups.

Helicobacter pylori infection is not a correlate of plasma fibrinogen in the Australian population.

Plasma fibrinogen concentration is an important independent risk factor for cardiovascular disease. Studies into whether Helicobacter pylori infection and fibrinogen are associated have yielded inconsistent results. Despite the geographical variation in fibrinogen and prevalence of H. pylori infection, all studies to date have been undertaken in the United Kingdom or Italy. The association between H. pylori infection and fibrinogen was investigated in 324 adults, 65% of a random sample, in an Australian regional city. The mean plasma fibrinogen concentration in 98 infected participants (2.52 g/l) was similar to that in 226 non-infected subjects (2.58 g/l, P = 0.51); 95% confidence interval on the difference was -0.23-0.11 g/l. After including all potential confounding factors in a backward multiple linear regression analysis, H. pylori was still not associated with fibrinogen (P = 0.084). Any association between H. pylori and cardiovascular disease in Australia is not mediated through fibrinogen.

Post-test probability that men in the community with raised plasma ferritin concentrations are hazardous drinkers.

BACKGROUND: Raised plasma ferritin concentrations occur unexpectedly during iron studies done by primary care physicians. Plasma ferritin concentration has been positively associated with alcohol use among men. AIM: To determine the post-test probability that men in the community with raised plasma ferritin concentrations are hazardous drinkers. METHODS: The subjects were 152 men, randomly selected from a city's electoral roll. Nineteen (12.5 (2.7)%, mean (SEM)) admitted to drinking hazardously. The pretest probability of a man being a hazardous drinker was 0.125. This was converted to pretest odds of 0.14. The likelihood ratio (the ratio of the probability of obtaining a raised plasma ferritin concentration in a hazardous drinker (sensitivity) to the probability of obtaining a raised plasma ferritin concentration in a non-hazardous drinker (1-specificity)) was calculated for different plasma ferritin cut off points. RESULTS: A plasma ferritin level of > 652 micrograms/l gave the largest likelihood ratio, 4.16. Post-test odds were obtained by multiplying the pretest odds (0.14) by the likelihood ratio (4.16). A plasma ferritin level of > 652 micrograms/l had a post-test odds for a man being a hazardous drinker of 0.58. This was converted to a post-test probability of 0.37. CONCLUSIONS: Inquiries could usefully be made into the alcohol consumption of men with a plasma ferritin concentration > 652 micrograms/l, as approximately one in three would admit to drinking hazardously.

Helicobacter pylori infection: an added stressor on iron status of women in the community.

OBJECTIVE: To explore a possible association between Helicobacter pylori infection and iron status. DESIGN: Cross-sectional study. SETTING: Ballarat (a major regional city in Victoria), population 78000, October November 1997. PARTICIPANTS: 160 women and 152 men, a subsample of participants in a cardiovascular disease risk factor prevalence survey for whom frozen plasma was available. MAIN OUTCOME MEASURES: H. pylori IgG antibody status by enzyme immunoassay; iron intake; plasma iron, transferrin and ferritin concentrations. RESULTS: 28% of women and 33% of men were infected with H. pylori. The mean (SEM) plasma ferritin concentration of infected women (59.3 [7.6] microg/L) was significantly lower than for non-infected women (88.8 [7.9] microg/L; P=0.002), after adjusting for age. Mean daily dietary iron intakes were similar in infected and non-infected women. CONCLUSIONS: H. pylori infection appears to be an additional stressor on women's iron status, but the mechanism remains to be determined.

Comparison of unsafe drinking between a rural and metropolitan area.

Factors associated with unsafe drinking in a rural area were identified and the prevalence of unsafe drinking and alcohol related mortality compared with a metropolitan area. Alcohol consumption data were collected from a random sample of adults in Greater Ballarat. Odds ratios of demographic factors associated with unsafe drinking were estimated by logistic regression. Compared with males and 20-29-year-olds, females and 30-59-year-olds had a significantly lower prevalence of 'intermediate' or higher risk drinking and binge-only drinking. Rural-metropolitan ratios for the prevalence of unsafe drinking and alcohol related mortality were also greatest in young adults. Young adults must adopt safer drinking habits if the rural excess in mortality is to be reduced.

Predictive value of MCV for hazardous drinking in the community.

A recent study suggested that general practitioners (GPs) do not see the necessity of investigating MCVs which unexpectedly and only slightly exceed the reference limit, despite the association between MCV and alcohol abuse. Because a literature search could not find a study of the predictive value of the MCV for hazardous drinking in the community, such a study was undertaken among a random sample of 338 adults living in a regional Australian city. Twenty-nine of the adults admitted drinking hazardously. The MCV with the optimum sensitivity and specificity for identifying the hazardous drinkers was determined. An MCV of > 94 fl identified as many as 35% of the hazardous drinkers whilst misclassifying only 6% of the non-hazardous drinkers. The predictive value was even greater among males, 67%. We conclude that inquiring into MCVs > 94 fl will lead to GPs identifying a significant proportion of adults in the community admitting to hazardous drinking.