Domestic violence in Australia: definition, prevalence and nature of presentation in clinical practice.

Domestic violence is a complex pattern of behaviours that may include, in addition to physical acts of violence, sexual abuse and emotional abuse. Women experience domestic violence at far greater rates than men do, and women and children often live in fear as a result of the abuse that is used by men to maintain control over their partners. Domestic violence is a major public health problem and is very common in women attending clinical practice. Women present most commonly with a range of chronic symptoms to unsuspecting general practitioners, emergency department doctors or medical specialists. Women who have experienced partner abuse want to be asked about it and are more likely to disclose if asked in an empathic, non-judgemental way. Doctors can make a difference.

The outbreak that had to happen: Bordetella pertussis in north-west Western Australia in 1999.

In late 1999, an outbreak of Bordetella pertussis occurred in a small town in North-West Western Australia. We undertook an investigation to describe the outbreak and to identify strategies to minimise the impact of future pertussis outbreaks in Australia. In November, people with respiratory symptoms were reviewed in an emergency pertussis clinic, which provided antibiotic treatment or prophylaxis. We conducted a school survey to enhance case ascertainment and followed up those attending the clinic by telephone. Fifty-nine cases of confirmed or probable B. pertussis infection were identified from 124 households (482 persons). Ages ranged from 5 months to 67 years, with children aged 9 to 11 years comprising 24 cases (41%). Early missed diagnoses and a school camp in September attended by 2 symptomatic children appeared to facilitate spread of infection, with the outbreak peak occurring in November. From immunisation records, childhood vaccine coverage in this sample was estimated at 96 per cent. All 21 cases of pertussis among the group under 10 years of age were at least partially vaccinated. There was only one laboratory confirmed case in the high-risk, under one-year of age category. Even in highly immunised populations periodic pertussis outbreaks are inevitable reflecting a vaccine efficacy of about 80 per cent and waning immunity with increasing age. Prevention of pertussis outbreaks depends not only on high vaccination coverage among young children but also early diagnosis and management of cases and their contacts. Clinicians should consider pertussis in the differential diagnosis of persistent cough illness in people of all ages--even those previously immunised.

Intermittent auscultation for the intrapartum assessment of fetal well-being in Western Australia.

In May 1995, in response to a decision of the Perinatal and Infant Mortality Committee of Western Australia, a survey of Western Australian hospitals was performed to ascertain what policies were in use for the monitoring of the fetal heart rate in labour and what proportion of these hospitals had access to electronic monitoring by cardiotocography. A response was received from 96% of the surveyed hospitals. More than half the births in this State (13,950 of 25,238) were monitored in labour using intermittent auscultation as the primary test; 7.5% of Western Australian births each year occurred in hospitals in which electronic monitoring was not available. Fewer than 50% of hospitals had written protocols describing the method of auscultation of the fetal heart during labour, the indications to contact a doctor or the management of fetal distress. The protocols which did exist displayed considerable variation in the recommended frequency of intermittent auscultation. The lack of standard practice in this field probably results from uncertainties in the literature. Intermittent auscultation has not been subjected to rigorous scientific evaluation as a screening tool and guidelines documenting ideal auscultatory practices need to balance the precision of electronic monitoring and freedom from intervention. Based on this compromise and existing evidence, a protocol for intermittent auscultation in normal labour is proposed.

A community-based cervical screening program in a remote Aboriginal community in the Northern Territory.

We established a culturally appropriate, community-based women's health service in Yuendumu, Northern Territory, to improve women's health and to remedy the low rate of cervical screening. During the 16 months of the program 419 cervical smears were taken, increasing coverage of the women eligible from 51 to 78 per cent. Acceptance of the program was excellent, with only 2 per cent of the women approached refusing to have a smear. Over 70 per cent of the Pap smears were done by the nursing staff in the clinic; quality control was good, with 9 per cent of smears reported as having no endocervical cells. Sixty-four per cent of screened women had normal smears and 0.9 per cent showed evidence of cervical intraepithelial neoplasia (CIN). Three women were referred for treatment of CIN, two for CIN I and one for CIN III. The program illustrates how a combination of community involvement, staff stability, teamwork, and cross cultural understanding can achieve a comprehensive and successful cervical screening service in a remote Aboriginal community.