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Objective: To determine long-term trends in emergency contraception (EC) management by general practitioners in Australia., Design, Setting and Participants: Data from April 2000 to March 2012 were drawn from the BEACH (Bettering the Evaluation and Care of Health) program, a continuous cross-sectional survey of GP activity. We analysed consultations involving EC management, unwanted pregnancy management and emergency contraceptive pill (ECP) prescribing per 1000 GP encounters with women aged 14-54 years. Summary statistics were calculated with 95% confidence intervals., Results: In 2000-2001, GPs managed EC problems at a rate of 5.50 per 1000 encounters (95% CI, 4.37-6.63). From 2004, after the ECP became available over the counter (OTC) in pharmacies, EC management, which includes ECP prescription, progressively declined. By 2011-2012, only 1.43 EC problems were managed per 1000 encounters (95% CI, 0.84-2.02) and only 0.48 ECP prescriptions were provided per 1000 encounters (95% CI, 0.14-0.82). Yet the management rate of unwanted pregnancy problems stayed relatively constant (rate in 2000-2001, 0.95 per 1000 encounters; 95% CI, 0.40-1.50; rate in 2011-2012, 0.88 per 1000 encounters; 95% CI, 0.41-1.36)., Conclusion: Low rates of EC management by GPs since ECP became available OTC suggest that women may be obtaining information on EC elsewhere. Further investigation is needed to uncover the sources of this information and its acceptability and application by Australian women.

Objective: To determine current contraceptive management by general practitioners in Australia., Design, Setting and Participants: Analysis of data from a random sample of 3910 Australian GPs who participated in the Bettering the Evaluation and Care of Health (BEACH) survey, a continuous cross-sectional survey of GP activity, between April 2007 and March 2011. Consultations with female patients aged 12-54 years that involved all forms of contraception were analysed., Main Outcome Measures: GP and patient characteristics associated with the management of contraception; types of contraception used; rates of encounters involving emergency contraception., Results: Increased age, ethnicity, Indigenous status and holding a Commonwealth Health Care Card were significantly associated with low rates of encounters involving management of contraception. The combined oral contraceptive pill was the most frequently prescribed method of contraception, with moderate prescription of long-acting reversible contraception (LARC), especially among women aged 34-54 years. Rates of consultations concerned with emergency contraception were low, but involved high rates of counselling, advice or education (48%) compared with encounters for general contraception (> 20%)., Conclusion: A shift towards prescribing LARC, as recommended in clinical guidelines, has yet to occur in Australian general practice. Better understanding of patient and GP perspectives on contraceptive choices could lead to more effective contraceptive use.

Objective: To determine general practitioners' attitudes to randomised clinical trials for women with breast cancer., Design: Cross-sectional survey with structured face-to-face interviews conducted between December 1997 and May 1998., Participants: A random sample of GPs in central Sydney., Main Outcome Measures: GPs' attitudes to referring women with breast cancer to specialists who enrol patients in randomised clinical trials, and to randomised clinical trials in general., Results: 85 of 158 GPs (54%) consented to be interviewed. Of these 85 GPs, 47% stated that they would refer a woman with breast cancer to a specialist who was likely to enrol the woman in a clinical trial; 50% believed that clinical trials increase knowledge about treatment options; and 15% thought that randomised trials may make a valuable scientific contribution. However, 43% of GPs expressed concerns that their patients may be disadvantaged, 39% said that they wanted optimum treatment for their patients, 18% that they would want to know what the trial was about, and 12% were worried about ethical considerations., Conclusions: Many of the GPs in this survey have concerns about randomised clinical trials for women with breast cancer. Improved communication between specialists and GPs about the conduct of and treatments offered in clinical trials for breast cancer may change this attitude.

Objectives: To describe the categories of people being approved for admission to nursing homes; to consider whether any alternatives would have been more appropriate; and to outline the care needed for each category., Participants and Setting: Patients in acute-care facilities in metropolitan Perth for whom a request had been made for nursing home admission., Design: Patients were interviewed (by R B L and M D) and records in the acute hospital were examined. A second interview of those patients still available was conducted after their transfer to the nursing home., Results: Nursing care was considered necessary for 123 of the 201 people seen in the acute hospitals; domestic care in a standard hostel for 24 people; care in a special dementia unit (SDU) hostel for 26 people; and care in a psychiatric institution for 16 people. Twelve others had various specific needs. Several different categories were identified in the group needing nursing care., Conclusions: Applicants for nursing home admission do not form a homogeneous group; there are several categories with different needs. SDU hostels should be added to the available facilities. In addition to undertaking the assessment of nursing home applicants, personnel from geriatric services should be encouraged to become involved in their continuing care.

Objective: To examine the medical care received by patients following discharge from hospital after acute myocardial infarction (AMI)., Setting and Design: Community-based cross-sectional survey., Patients: 2836 consecutive patients aged 25-64 years living in the Perth Statistical Division who were admitted to hospital with AMI during 1984-1988. After one reminder the response rate was 71%., Results: Half of all respondents were in full-time employment at the time of their AMI. At follow-up this had fallen to a third. Over 80% of patients visited a cardiologist after AMI, with half remaining under consultant care to the time of survey. However, one in five patients reported no follow-up care at the time of survey. Seventy-three per cent of patients reported undergoing at least one exercise stress test after AMI, with 61% undergoing angiography, 16% angioplasty and 24% coronary bypass surgery. Large proportions of the patients accurately reported being prescribed beta-blockers and antiplatelet agents. The pattern of prescribing at discharge corresponded closely with the use of cardioactive agents at the time of survey and with drugs reported to have been taken continuously since discharge to the time of survey., Conclusions: These data suggest that follow-up care after AMI is both comprehensive and widespread. Such care may have contributed significantly to the overall decline in mortality from ischaemic heart disease.

Type of Study: Descriptive study of trends in the drug therapy for acute myocardial infarction., Setting: Population-based register of acute coronary events compiled for the years 1984 to 1990 in the course of the Perth MONICA project., Cases: 5294 cases meeting clinical criteria for acute myocardial infarction., Results: Striking changes were seen in the use of aspirin before admission to hospital (from 4% to 18%). During the stay in hospital the use of beta-blockers increased steadily from 52% to 76%, while the use of aspirin increased 3.5-fold from 25% to 88% and the use of streptokinase increased 13.5-fold from 2.4% to 32.4%. The proportion of patients prescribed beta-blockers on discharge from hospital increased from 46% to 65% and that for aspirin rose from 16% to 83%. There were also major relative increases in the use of lipid-lowering agents and declines in the use of antiarrhythmic drugs., Conclusion: These trends in the pharmacological management of myocardial infarction mirror the emerging evidence from clinical trials, although the increases in the use of certain types of drugs antedated publication of the results of major randomised studies. The changes in therapy would partly explain observed improvements in case fatality and may have contributed to the decline in coronary mortality observed in the Perth community.

Objective: To confirm the existence of regional differences in coronary death rates in Australia and New Zealand and to determine whether or not these are associated with parallel differences in the incidence of acute myocardial infarction., Design: Descriptive epidemiological study., Setting: Community based study., Subjects: Residents of Auckland, Newcastle and Perth aged 25-64 years admitted to hospital for acute myocardial infarction or dying from coronary heart disease between 1983 and 1987., Main Outcome Measures: Definite acute myocardial infarction or coronary death classified according to the criteria of the World Health Organization MONICA project., Results: This study confirms the marked variation, evident from official statistics, in mortality rates from ischaemic heart disease between Newcastle (high), Auckland and Perth (low). A different pattern is observed for the incidence of acute myocardial infarction and there are also obvious differences between centres in the case fatality ratios for all acute coronary events combined. Newcastle has the highest rate for all coronary events, particularly in women. Auckland is characterised by substantially higher case fatality ratios compared with the two Australian cities. This is due especially to higher rates of coronary death outside hospital. Perth, which has the lowest mortality rates and case fatality ratios in both men and women, has rates for admission to hospital for acute myocardial infarction and all cases of ischaemic heart disease that are disproportionately high in relation to the corresponding mortality rates., Conclusion: The differences in case fatality ratios between these three centres are not readily explained by artefacts related to enumeration or classification. Rather, they are most likely related to differences in the natural history of ischaemic heart disease in the three populations. Differences in medical management may also contribute to the substantial variation in mortality rates.

Crocidolite was mined and milled at Wittenoom Gorge in Western Australia from 1943 to 1966. Between 1960-1964 and 1980-1982, the estimated incidence of malignant mesothelioma in Western Australia rose from 0.6/100 000 in men and less than 0.1/100 000 in women, aged 35 years or older, to 6.6/100 000 in men and 0.7/100 000 in women in this age group. Overall, 97 (70%) of 138 patients with malignant mesothelioma had definite or probable exposure to asbestos; 76 of these (55%) to Western Australian crocidolite. Of the latter 76 patients, 56 had worked in the mine or mill at Wittenoom and 4 had non-occupational exposure in the Wittenoom area; the remaining 16 had been exposed to crocidolite elsewhere in the State. There were only 4 (3%) patients with malignant peritoneal mesothelioma, of whom three had been exposed to crocidolite.

From a cohort of all 5760 male and 4979 female patients who were admitted to WA hospitals and were discharged with a diagnosis of asthma between 1976 and 1980, 265 deaths in men and 189 deaths in women were identified by the end of 1982. The standardized mortality ratio (SMR) for all causes of death for this cohort was 1.6 for men (P less than 0.001) and 1.7 for women (P less than 0.001). Both sexes showed a significant increase in deaths that were attributable to asthma (SMR, 57.9), chronic airflow obstruction (SMR, 9.3) and ischaemic heart disease (SMR, 1.3). The excess death rates for asthma were observed in all age groups, but those for chronic airflow obstruction and ischaemic heart disease were present in older age groups only. These findings indicate that asthma remains a potentially fatal disease in the Australian community. The excess mortality ratios for chronic airflow obstruction that were observed in patients who were admitted to hospital with asthma also suggest that asthma may result in irreversible airflow obstruction.

Trends in perinatal mortality and low birth-weight in Western Australia were analysed by means of a linked file of perinatal death and birth registration papers for the years 1968 to 1975. Stillbirth rates fell only slightly, and there was no improvement in low birthweight stillbirth rates. There was increased ascertainment of low birthweight stillbirths after 1968 when the definition changed. Neonatal mortality fell markedly after 1971, much of the fall being due to a shift in the birthweight distribution towards heavier babies, particularly in males. The proportion of babies with birthweights of less than 2500 g fell from nearly 6% to 5.3%. The impact of changes in the obstetric care of premature labour were minimal up to 1975, with rural (away from specialist care) low birthweights rates differing only slightly from metropolitan rates. Social and demographic differences probably account for the major differences in stillbirth rates between areas. Neonatal mortality rates in low birthweight babies showed a definite advantage for babies living close to neonatal intensive care facilities. However, decisions to expand neonatal intensive care facilities to rural areas need to take into account other adverse perinatal risk factors.

Details of patients with malignant mesothelioma that was diagnosed in Australia before 1981 were obtained by searching all possible sources throughout Australia as far into the past as possible and up to and including 1980. The earliest patient with mesothelioma who was identified was diagnosed in Victoria in 1947. By 1980, 535 (81%) men and 123 (19%) women had been diagnosed with the disease; only 14 persons were aged less than 35 years at the time of diagnosis (the youngest person was 15 years of age). The incidence rate in subjects who were 35 years or older at diagnosis was less than 1.0 cases per million person-years until 1964-1968, and then it rose progressively to 15.5 cases per million person-years in 1979-1980. The highest rate (69.7 cases per million person-years) was observed in 65- to 74-year-old men in 1979-1980. The incidence rate in Western Australia was greater than were the rates in other states of Australia after the mid 1960s. Pleural mesotheliomas accounted for 88% of cases in which the site of the tumour was known; peritoneal mesotheliomas accounted for 10% of such cases and "other" sites for 2% of such cases. In 6% of cases the site was not specified. The exposure to asbestos was stated as "definite" in 59% of the cases with a recorded history of exposure: 8% of all the cases in the study had been exposed to crocidolite (blue asbestos) from Wittenoom Gorge in Western Australia. The age at diagnosis of patients with known exposure to asbestos was similar to that in those without known exposure. The increases in the incidence of malignant mesothelioma in Australia follow the published trends in the production and use of the amphibole varieties of asbestos in this country after a lag period of between 20 and 30 years.

In a cohort of 6502 male and 410 female former workers from the crocidolite (blue asbestos) mining and milling works at Wittenoom, Western Australia, there were 94 cases of malignant mesothelioma (12 cases of peritoneal mesothelioma), 141 cases of lung cancer and 356 successful compensation claims for asbestosis to the end of 1986. After adjusting for measured covariate effects by means of proportional hazards regression analysis, smooth curves were fitted to the resulting "underlying" incidence rates for malignant mesothelioma, lung cancer and asbestosis, separately, and for mortality of any cause. By the use of these curves and individual risk estimates, predictions have been made of the future incidence of these diseases to the year 2020. With the assumption that all subjects who were not known to be dead or departed overseas still were alive at December 31, 1986, and excluding persons of more than 85 years of age, the number of new cases of mesothelioma is expected to rise to a peak of around 25 cases per year in 2010, with an expected total number of 692 cases of mesothelioma (95% confidence interval [CI], 394-990 cases) between 1987 and 2020. A total of 2898 deaths (95% CI, 2284-3511 deaths) of any cause is expected in the same period. New cases of lung cancer and asbestosis are expected to continue at roughly the current rates of eight and 17 cases per year, respectively, before declining after the year 2000, leading to totals of 183 cases (95% CI, 34-335 cases) and 482 cases (95% CI, 236-728 cases), respectively, being expected by the year 2020. Predictions that were based on the censoring of subjects at the date that they last were known to be alive resulted in slightly higher, but probably less accurate, estimates.