Unsettled infant behaviour and health service use: a cross-sectional community survey in Melbourne, Australia.

AIMS: To investigate factors associated with health service use by women and their infants in Victoria, Australia. METHODS: Cross-sectional screening survey of 875 women with 4-month-old infants attending immunisation clinics in five local government areas in Melbourne between May 2007 and August 2008. The self-report instrument assessed socio-demographic characteristics, unsettled infant behaviour, maternal mood (Edinburgh Postnatal Depression Scale) and, the outcome, health service use during the first 4 months post-partum. RESULTS: Mothers and their infants used on average 2.8 different health services in the first 4 months post-partum (range 0-8). After adjustment for other factors, high health service use (defined as >3 different services) was more common in mothers whose infants were unsettled with persistent crying, resistance to soothing and poor sleep. A one-point increase on the unsettled infant behaviour measure was associated with an 8% (2-14%) increase in the use of >3 services, 9% (3-16%) in use of emergency departments, 7% (2-13%) in use of telephone helplines and 9% (3-14%) of parenting services. Poorer maternal mental health was also implicated with a one-point increase on the Edinburgh Postnatal Depression Scale associated with a 4% (0.4-8%) increase in the likelihood of using more than three services. CONCLUSIONS: Unsettled infant behaviour is associated with increased use of multiple health services. The high use of emergency departments by families with unsettled infants found in this study suggests that enhancement of primary health-care capacity might be required.

Is uptake of genetic testing for colorectal cancer influenced by knowledge of insurance implications?

OBJECTIVE: To assess whether knowledge of insurance implications influenced uptake of genetic testing by participants in a research study of the causes of colorectal cancer. DESIGN, SETTING AND PARTICIPANTS: Analysis of uptake of genetic testing by participants in the population-based Victorian Colorectal Cancer Family Study during two periods: from 1999 to 2003, when participants were not informed of any potential effect of genetic testing conducted during the study on their eligibility for new insurance policies; and from 2003 to 2006, when the protocol was changed to provide participants with information on the potential effect of genetic testing on insurance eligibility. MAIN OUTCOME MEASURE: Uptake of genetic testing for germline mutations in DNA mismatch repair (MMR) genes at a family cancer clinic. RESULTS: The proportion of participants who declined genetic testing among those informed of insurance implications was more than double the proportion among those without this knowledge (29/59 [49%] v 9/47 [19%]; P = 0.002). This difference could not be explained statistically by adjusting for measured putative predictors. CONCLUSION: Identification of people with a mutation in an MMR gene has clinical importance, and such screening may be a cost-effective way to reduce the burden of colorectal cancer in the community. If people are choosing not to obtain genetic information because of how it will affect their eligibility for insurance, reforms to existing insurance practices are indicated.

Considering abortion: a 12-month audit of records of women contacting a Pregnancy Advisory Service.

OBJECTIVE: To characterise the demographic and psychosocial circumstances of women contacting Victoria's largest public pregnancy advisory service (PAS). DESIGN AND SETTING: Audit of PAS electronic records for the 12 months from 1 October 2006 to 30 September 2007. De-identified data were extracted from a comprehensive electronic database used for recording consultations. MAIN OUTCOME MEASURES: Summary statistics and measures of association. RESULTS: During the 12 months, 5462 women contacted PAS; records were created for 3827 women, and data were available in more than 80% of records for 77% (13/17) of items. Over half of the women receiving pregnancy support from PAS (60%) were 18-29 years old; 12% lived outside the metropolitan area; 51% held a health care card, and smaller percentages faced housing, financial, or drug and alcohol problems; 16% reported violence, but 71% described partners as involved and supportive. Most (79%) made contact within 2 weeks of discovering pregnancy, and 72% were referred by a general practitioner. Later gestation at contact was associated with younger age (P < 0.001), having a health care card (P < 0.001), and living outside the metropolitan area (P < 0.001). The most common reasons for seeking abortion were the desire to delay pregnancy (23%) and family completion (18%); 42% already had at least one child. Twenty-three women reported that the pregnancy was the result of rape. Ten per cent had mental health problems, and smaller numbers faced access barriers and had special needs. CONCLUSIONS: This PAS responds to demand from women with diverse social and personal circumstances. Findings provide evidence for policy, prevention and service development.

Knowledge and awareness of human papillomavirus (HPV): attitudes towards HPV vaccination among a representative sample of women in Victoria, Australia.

BACKGROUND: A vaccine program is underway to protect women against human papillomavirus (HPV) and thus cervical cancer. Previous studies have reported very low levels of HPV knowledge and there has been concern that preventative vaccines might not be readily accepted, given that HPV is transmitted sexually and the optimal time for vaccination is before sexual debut. METHODS: A computer-assisted telephone survey was carried out with a representative sample of 1100 women aged 18 to 61 years, randomly selected from households in Victoria, Australia, to investigate knowledge and attitudes about HPV and attitudes towards HPV vaccination. RESULTS: Half of the participants (51%) had heard of HPV; most reported learning about it from the media. Most women indicated they would trust their general practitioner (96.3%), a gynaecologist or specialist doctor (99.6%), or a women's health service (97.0%) for information about HPV. Few women (11.9%) had ever sought information about HPV and only 14.8% of the total sample had ever discussed HPV with a friend. Strong support was found for vaccination in general and there was also significant support for a HPV vaccine. CONCLUSION: The present study documents ways in which women learn about HPV and indicates the potential for success of a vaccination program.