Masculinity and preventing falls: insights from the fall experiences of men aged 70 years and over.

PURPOSE: To explore men's fall experiences through the lens of masculine identities so as to assist health professionals better engage men in fall prevention programs. METHODS: Twenty-five men, aged 70-93 years who had experienced a recent fall, participated in a qualitative semi-structured interview. Men's willingness to engage in fall prevention programs taking account of individual contexts and expressions of masculinity, were conceptualised using constant comparative methods. RESULTS: Men's willingness to engage in fall prevention programs was related to their perceptions of the preventability of falls; personal relevance of falls; and age, health, and capability as well as problem-solving styles to prevent falls. Fall prevention advice was rarely given when men accessed the health system at the time of a fall. CONCLUSIONS: Contrary to dominant expectations about masculine identity, many men acknowledged fall vulnerability indicating they would attend or consider attending, a fall prevention program. Health professionals can better engage men by providing consistent messages that falls can be prevented; tailoring advice, understanding men are at different stages in their awareness of fall risk and preferences for action; and by being aware of their own assumptions that can act as barriers to speaking with men about fall prevention. Implications for rehabilitation Men accessing the health system at the time of the fall, and during rehabilitation following a fall represent prime opportunities for health professionals to speak with men about preventing falls and make appropriate referrals to community programs. Tailored advice will take account of individual men's perceptions of preventability; personal relevance; perceptions of age, health and capability; and problem-solving styles.

Incidence of invasive pneumococcal disease in Sydney children, 1991-96.

OBJECTIVE: Few data are available on invasive disease due to Streptococcus pneumoniae in representative Australian childhood populations. This study aimed to determine the age-specific incidence of invasive pneumococcal disease in Sydney children. METHODOLOGY: Population-based prospective study where isolates of Streptococcus pneumoniae from normally sterile sites were identified through an established laboratory surveillance network. Isolates came from children aged under 15 years living within the boundaries of Central, Eastern. Southern, Western and South-western Sydney Area Health Services from 1 July 1991 to 30 June 1996. RESULTS: Invasive pneumococcal disease was identified in 320 children during a 5-year period, of whom 193 (60%) were under 2 years of age. The incidence per 100,000 children was 12.7 per 100,000 (95% CI: 11.4-14.2/100,000) under 15 years; 31.7 (95% CI 28.1-35.7) under 5 years, and 45.5 (95% CI 38.9-53.3) under 2 years. The incidence of pneumococcal meningitis in children aged under 2 years was 10.5 per 100,000 (95% CI: 7.4-14.5/100,000). CONCLUSIONS: The incidence of childhood invasive pneumococcal disease in Sydney was stable during 1991-96 and comparable to rates reported from other industrialized countries. There was no evidence of any change in pneumococcal disease incidence with reduction in invasive Haemophilus influenzae type b (Hib) disease following introduction of Hib immunization.

Rotavirus gastroenteritis: impact on young children, their families and the health care system.

OBJECTIVE: To assess the impact of rotavirus gastroenteritis on young children attending a paediatric hospital, their families and the health care system. DESIGN: Cross-sectional descriptive survey. SETTING: New Children's Hospital (Royal Alexandra Hospital for Children), Sydney, New South Wales, 15 July to 4 October 1996. PARTICIPANTS: Children aged under three years attending the Emergency Department with acute diarrhoea as the presenting symptom. OUTCOME MEASURES: Cases of rotavirus infection confirmed by enzyme-linked immunosorbent assay by age; rotavirus serotype; gastroenteritis severity score; estimated costs to parents (lost pay or leave, travel, medication and other expenses) and to the health care system (visits to Emergency Department and other health care workers, hospital admissions). RESULTS: 280 children were recruited (73% of 384 children who met the inclusion criteria and 27% of the 1037 aged under three years with acute gastroenteritis). Rotavirus was detected in 188 of the 280 (67%); most isolates were serotype G1 (86% of the 174 serotyped). Of the 188 children with confirmed rotavirus infection 78% were aged 7-24 months and 82% visited at least one other health care worker, usually a general practitioner. Seventy (37% of the 188) were admitted to hospital; 33 of these (47%) were aged 13-24 months. Estimated mean total cost per episode of rotavirus gastroenteritis was $1744 for children admitted to hospital and $441 for children not admitted. The mean cost to families was $493 for children admitted to hospital and $228 for children not admitted. CONCLUSIONS: Rotavirus gastroenteritis has a significant impact on young children, their families and the health care system. Prevention of severe disease through routine infant vaccination would be potentially cost-effective.

Measuring health outcome in paediatrics: development of the RAHC measure of function.

OBJECTIVE: To develop a genetic measure of health outcome (the RAHC Measure of Function) for paediatric health services. METHODOLOGY: The RAHC Measure of Function (MOF) was modified from the Child Global Assessment Scale. The utility and reliability of the MOF was then tested by inter-clinician agreement on case scenarios, by inter-clinician agreement in outpatients, by parent-clinician agreement in outpatients and by responsiveness to change in acute admissions. RESULTS: The inter-clinician agreement on MOF ratings for case scenarios was moderately good, with an overall kappa of 0.42; P < 0.0001. Clinicians at respiratory and child psychiatry clinics nominated the same or adjacent MOF category to describe 100% (95% CI: 71.5-100) and 90% (95% CI: 68.3-98.8%) of 11 and 20 cases assessed, respectively. Parents nominated the same or adjacent MOF category as the attending clinician for 89.7% (95% CI: 72.7-97.8) and 82.9% (95% CI: 67.9-92.9) of 29 and 41 children in the same two clinics. Twenty-eight inpatient children had an MOF assessed on admission and discharge, and the median MOF score improved from 50.5 to 79 points (z = 4.53; P < 0.0001). CONCLUSIONS: The MOF is easy to use and provides a valuable description of health outcome that parents are able to understand. The MOF is moderately reliable, is likely to be sufficiently reliable to compare groups of paediatric patients and is responsive to change.

How general practitioners store vaccines. A survey in south-western Sydney.

OBJECTIVE: To describe how general practitioners store vaccines. DESIGN: A cross-sectional descriptive survey of general practices and observation of storage procedures for vaccines. SETTING: South-western Sydney between September and December 1993. PARTICIPANTS: 232 randomly selected general practitioners working in south-western Sydney, of whom 76% responded to a questionnaire. Vaccine storage was observed in 20 general practices. RESULTS: At 80% of practices, one person was responsible for vaccine storage. Only 30% of respondents used a vaccine-only refrigerator. Only 16% of respondents had a means of measuring temperature, while 5% kept a record of refrigerator temperature. Of the general practices that were monitored, the measured temperature of 70% of the refrigerators used for storing vaccines was within the recommended range of 2 degrees C-8 degrees C. CONCLUSIONS: Vaccine storage would improve in general practices in south-western Sydney if vaccine-only refrigerators were used and temperature was monitored with maximum-minimum thermometers.