More is more in remote Central Australia: more provision of primary healthcare services is associated with more acute medical evacuations and more remote telephone consultations.

INTRODUCTION: This study investigated whether increased numbers of primary healthcare clinical consultations in Indigenous communities in some remote areas of Australia are associated with the reduced need for urgent medical evacuations and remote telephone consultations. METHODS: A retrospective comparison study of routinely collected data utilising correlation analysis was conducted. Statistical associations have been measured using Pearson product-moment correlation coefficients. The setting was 20 primary healthcare centres in the Northern Territory servicing ≥5900 residents between July 2008 and June 2010; data were collected from Central Australia Remote Health and the Royal Flying Doctor Service-Central Operations, Alice Springs base. Main outcome measures included number of acute medical evacuations and number of remote telephone consultations relative to number of face-to-face consultations with Aboriginal health workers, remote area nurses and general practitioners. RESULTS: Statistically significant positive correlations were found between numbers of acute medical evacuations and numbers of face-to-face consultations (r = 0.659; 95% confidence interval (CI): 0.305-0.855), remote area nurse consultations (r = 0.481; 95% CI: 0.055-0.765) and general practitioner consultations (r = 0.798; 95% CI: 0.555-0.920). Significant positive correlations were also found between numbers of remote telephone consultations and numbers of face-to-face consultations (r = 0.546; 95% CI: 0.135-0.795) and general practitioner consultations (r = 0.563; 95% CI: 0.163-0.805). CONCLUSIONS: The provision of more frequent healthcare centre face-to-face consultations, including general practitioner consultations, is associated with an increased burden of acute medical evacuations and remote telephone consultation services in this remote setting.

Accuracy of national mortality codes in identifying adjudicated cardiovascular deaths.

OBJECTIVE: This study investigated the sensitivity and specificity of the national mortality codes in identifying cardiovascular disease (CVD) deaths and documents methods of verification. METHODS: A 12-year retrospective case ascertainment of all ICD-coded CVD deaths was performed for deaths between 1990 and 2002 in the Melbourne Collaborative Cohort Study, comprising 41,528 subjects. Categories of non-CVD codes were also examined. Stratified samples of 750 deaths were adjudicated from a total of 2,230 deaths. Expert panels of cardiologists and neurologists adjudicated deaths. RESULTS: Of the 750 deaths adjudicated, 582 were verified as CVD [392 coronary heart disease (CHD) and 92 stroke] and 168 non-CVD. Estimated sensitivity and specificity of national mortality codes for identifying specific causes of death were: CHD 74.2% (95% CI: 69.8-78.5%) and 97.6% (96.0-99.2%), respectively; myocardial infarction 59.9% (50.9-69.0%) and 94.2% (92.4-96.0%), respectively; haemorrhagic stroke 58.9% (46.0-71.7%) and 99.8% (99.4-100.0%), respectively and; ischaemic stroke 38.7% (20.5-56.9%) and 99.9% (99.6-100.0%), respectively. Misclassification was most common for deaths with primary ICD codes for endocrine-metabolic and genito-urinary diseases. CONCLUSIONS: National mortality coding under-estimated the true proportion of CHD and stroke deaths in the cohort by 13.6% and 50.8%, respectively. IMPLICATIONS: Misclassification of cause of death may have implications for conclusions drawn from epidemiological research.

Blood pressure QTLs identified by genome-wide linkage analysis and dependence on associated phenotypes.

Understanding genetic factors that contribute to population-wide variation in blood pressure is likely to benefit prevention and treatment of cardiovascular disease. The aim of the Victorian Family Heart Study is to identify genes for cardiovascular risk in 783 volunteer adult families recruited from the general population. In this preliminary study we sought to identify quantitative trait loci (QTLs) using a genome-wide linkage analysis in 274 adult sibling pairs of average age 24 yr selected without respect to blood pressure. We compared multipoint linkage results for carefully measured systolic (SBP) and diastolic (DBP) pressures before and after statistical adjustment for covariation with sex, oral contraception, age, height, and weight. The average BP was 123/67 (SD: 12/11) mmHg in males (n = 283) and 114/64 (SD: 10/9) mmHg in females (n = 265). Nonparametric Z-scores from multipoint GeneHunter II analysis were "suggestive" (3.1 or more) at four QTLs for SBP (chromosomes 1, 4, 16, and X) but at no QTLs for DBP. Most Z-scores were affected little by adjustment for covariates. However, the SBP QTL on chromosome 16 was obvious only for unadjusted pressures. This population-based quantitative trait analysis has identified more QTLs than any of the eight previous genome-wide scans for blood pressure. Considerable discrepancies between different studies may reflect the presence of false-positive results or real biological differences between populations.