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We developed and implemented an integrated workplace mental health promotion intervention combining job stress reduction with a workplace mental health literacy program. The intervention was evaluated using an uncontrolled design, with organizationorganisation-wide census employee surveys of working conditions and mental health literacy pre-intervention, followed by a 1-year action planning and intervention period, then a post-intervention survey. All employees were invited to be surveyed, and all respondents were included in analysis, independent of participation in intervention activities or employment status (44% response rate at baseline, 37% at final). No significant changes were observed in the targeted psychosocial working conditions – job control, job demands, and social support at work. In contrast, significant improvements in some aspects of mental health literacy were observed, particularly in helping behaviours. Acknowledging the limitations of this being an uncontrolled pilot study, our resul...

No author version was obtainable for this article., Interventions to promote mental health in the workplace are rapidly gaining acceptability as a means to prevent, screen, treat and effectively manage the growing disease burden of depression and anxiety among working people. The objective of this study was to identify socio-demographic and work setting correlates of poor mental health to consider alongside other evidence in priority setting for workplace mental health promotion (MHP). Multiple logistic regression was used to model the probability of poor mental health (SF-12) in relation to socio-demographic (gender, age, education, marital status and occupational skill level) and employment factors (workplace size and type, industrial sector, employment arrangement and working hours) in a population-based cross-sectional survey of 1051 working Victorians. As a result, poor mental health was (21% prevalence overall) higher in working females than in males and decreased with increasing age. Only one employment factor was significant in demographically adjusted multivariate analyses, showing an increase in the odds of poor mental health with increasing working hours. It is concluded that based on the prevalence of poor mental health, Victorian work settings with high proportions of younger workers, and younger working women in particular, should be prioritized for workplace MHP. Thus, together with other research demonstrating particularly poor psychosocial working conditions for young working women, sectors with an over-representation of this group (e.g. service sector) could be prioritized for workplace MHP alongside young and blue-collar males (also a priority due to low mental healthcare service use)., Australian National Health & Medical Research Council

To examine seasonal variation in hospital use for five paediatric conditions of the Australian Capital Territory residents.Hospital admissions (1993-2004) and emergency room (ER) presentations (1999-2004) for asthma, croup, bronchiolitis, other respiratory conditions and diarrhoea of children aged5 years were compared by month and season.The five conditions comprised 14% of admissions and 24% of ER presentations of children aged5 years. Bronchiolitis (both admissions and ER presentations) were the highest in the 0-1 year age group (80%) and the other four conditions peaked at 1-2 years. Children aged 0-2 years contributed 66% of diarrhoea, 62% of croup and 44% of other respiratory admissions whereas ER presentations were higher for other respiratory conditions (57%) and lower for croup (47%). Boys showed higher rates of admissions and ER presentations for all conditions except diarrhoea. Strong seasonal associations were apparent. Incident rate ratios of admissions were significantly higher in autumn compared with summer for asthma and croup whereas bronchiolitis and other respiratory conditions admissions were the highest in winter. Diarrhoea admissions were the highest in spring. ER presentations of the five conditions also showed similar associations with season.Hospital admissions and ER presentations of these five conditions showed strong seasonal patterns, knowledge of which could contribute to improved resource planning (staffing) to meet expected increases in demand for services and scheduling of elective admissions. These findings could be extended to develop a model for forecasting hospital use and to explore the causes of these diseases to ameliorate seasonal effects.

Background: This study investigates whether the association of job strain and insecurity with health differs by status. Methods: A cross-sectional study of 2,249 employed workers aged 40–44 years conducted in two regions in south-east Australia in 2000 used a self-completed questionnaire to collect data. Multivariate analyses were used to compare depression, anxiety, physical health and general practitioner (GP) visits over 12 months across categories of job strain and insecurity for three status groups (high, middle and low). Results: High job strain and job insecurity were independently associated with poor mental health, poor physical health and visits to the GP for all status groups when adjusted for confounders. High job strain was associated with depression (OR=2.46, 95% CI 1.96-3.07), anxiety (OR=2.56, 95% Cl 2.05-3.20), lower mean physical health scores (-1.11, 95% Cl-1.98–0.23), and more visits to the GP (IRR=1.20, 95% Cl 1.05-1.37). High job insecurity also showed significant associations with depression (OR=3.03, 95% Cl 2.03–4.53), anxiety (OR=2.66, 95% Cl 1.81-3.91), and GP visits (IRR=1.27, 95% Cl 1.01-1.60). There were no significant differences by status in the associations of job strain and insecurity with outcomes. Conclusion: High-status workers were just as likely as low-status workers to be exposed to adverse work conditions and both status groups showed similar health effects. Implications: Exposure to insecure and high-strain jobs is likely to rise as economies and labour markets respond to globalisation and political change. High status may not protect employees from either exposure or impact, thus widening the population health consequences of adverse work conditions.

Objective: To examine independent associations of job strain (high demands and low control) and job insecurity with mental and physical health outcomes. Design: Cross sectional general population study conducted in 2000 using a self completed questionnaire. Setting: Two adjoining cities in south east Australia. Subjects: 1188 employed professionals, aged 40–44 years, 55% (n = 655) male. Main outcome measures: Depression, anxiety, physical, and self rated health (SRH). Results: Adverse job conditions were relatively prevalent as 23% of the sample reported high job strain, while 7.3% and 23% reported high and moderate job insecurity respectively. Associations between job conditions and health persisted after adjustment for gender, education, marital status, employment status, major life events, and negative affectivity (personality). When adjusted for job strain, high job insecurity was independently associated with a greater than threefold increase in odds for poor SRH, depression and anxiety (OR (95% confidence intervals) poor SRH: 3.72 (1.97 to 7.04) depression: 3.49 (1.90 to 6.41), anxiety: 3.29 (1.71 to 6.33)), and a twofold increase for physical health 2.19 (1.21 to 3.95). High job strain also showed significant independent associations with depression: 2.54 (1.34 to.4.75) and anxiety: 3.15 (1.48 to 6.70). Conclusion: In this relatively privileged socioeconomic group, insecure employment and high job strain showed independent, consistent, and strong associations with physical and mental health. These adverse job conditions are on the increase, particularly insecure employment, and the influence of these two work conditions are an important focus for future public health research and their prevalence and impact should be examined in other occupations.

The role of family health-seeking behaviour in under-five-year child mortality was explored through the combined approach of examining health-seeking behaviour regarding treatment generally, and in specific in relation to illness before death. A population-based case control study was carried out during the period 1993–1994 using 222 deaths from diarrhoea and acute respiratory illness (ARI) in children under five years of age in six slums of Karachi as cases, and 419 controls matched on age, disease (diarrhoea and ARI) and slum. Factors significantly associated (p

Vitamin A deficiency is a recognized risk factor for severe measles. WHO and UNICEF have recommended vitamin A for the treatment of measles but there are children still dying from measles. A systematic review, including the use of meta-analysis was done of randomized controlled trials comparing vitamin A with placebo obtained from a systematic search of the medical literature to determine whether vitamin A prevents mortality and pneumonia-specific mortality in children with measles. We identified five trials conducted in Africa, four in hospitals and one in a community that met the inclusion criteria. There were 445 children aged 6 months to 13 years supplemented with vitamin A and 478 with placebo. There was a 39 per cent reduction in overall mortality when vitamin A was used for the treatment of measles but this was not statistically significant (relative risk 0.61; 95 per cent confidence interval 0.32-1.12). When stratified by dose, 200 000 IU of vitamin A given for 2 days was associated with a reduction in overall mortality (0.36, 0.14-0.82) and pneumonia-specific mortality (0.33, 0.08-0.92) in hospitalized children in areas with high case fatality. Greater reduction in mortality was observed in children under the age of 2 years (0.17, 0.03-0.61). On the other hand, a single dose of 200 000 IU of vitamin A was not associated with reduced mortality (1.25, 0.48-3.1). There were no trials comparing a single dose with two doses of vitamin A. There were not enough studies to separate out the individual effects of age, dose, formulation, hospitalization and case fatality in the study area. We conclude that 200 000 IU of vitamin A repeated on 2 days should be used for the treatment of measles as recommended by WHO in children admitted to hospitals in areas where the case fatality is high.

Pakistan is a male-dominated society and women's status relative to men is worse than that in most other countries. Women have primary responsibility for the health of infants and small children and this is considered to be the women's work. Women are usually secluded from men and have to observe purdah (wearing a veil to cover their face from men). They rarely have a choice of whom they marry, how many children they have, and whether they work. This patriarchal structure greatly limits the possibilities for women to be active outside the home. Two indicators of low female status in Pakistan are limited participation of women in economic activities outside the home and a high percentage of illiterate women (Sathar et al., 1988).

Objectives To investigate the extent improvement or deterioration in employee job security, control or workload is associated with a change in mental health. Design Self-report panel data (2000, 2004) on mental health (symptoms of depression and generalised anxiety) and job demands, control and insecurity. Changes in exposures and outcomes were calculated by subtracting wave 1 from wave 2 scores. Changes in mental health were regressed onto changes in work conditions, adjusting for confounders. Sensitivity analyses assessed reverse causation, floor and ceiling effects. Setting Two adjoining cities in south-east Australia. Participants 1975 employees aged 40–48 years, 50% (n=995) male. Results Improvements and deterioration in each work condition were associated with corresponding improvements or deterioration in mental health. The association between changes in job insecurity and symptoms of depression was B=0.386 (95% CI 0.245 to 0.527) and with anxiety symptoms was B=0.434 (95% CI 0.267 to 0.601). Similarly, changes in job control were associated with changes in depressive (B=−0.548; 95% CI −0.791 to −0.304) and anxiety symptoms (B=−0.608; 95% CI −0.896 to −0.319) as were changes in job demands (B depression=0.386; 95% CI 0.245 to 0.527; B anxiety=0.434; 95% CI 0.267 to 0.601). Excluding people with severe symptoms at baseline did not alter the findings; however, path analyses indicated that depression may precede a worsening of work conditions. Conclusion Among mid-aged employees, deteriorating work conditions may amplify population health burdens, especially anxiety. Furthermore, better quality jobs, combining an array of positive conditions, could alleviate major population health burdens.

In community-based studies of stress and immunity, saliva samples offer a non-intrusive way of gathering biological data. Cotton-based devices are widely used in cortisol research, but some may affect assay results. We compared assay reliability and perceived acceptability of three saliva collection methods: passive, cotton 'salivettes' and cellulose-cotton tip 'eyespears'. Compared to passive collection, salivettes reduced the concentration of cortisol (p = .001) and sIgA (p = .002). Eyespears did not reduce cortisol or sIgA concentration, and showed less interference in the rank ordering of cortisol (r(eyespear with passive) = .90) and sIgA scores (r(eyespear with passive) = .96) compared to salivettes (r cortisol(salivette with passive) = .79; r sIgA(salivette with passive) = .66). The comfort and acceptability of both cotton-based devices were rated positively. Cotton-cellulose eyespears could offer methodological advantages for collecting saliva to measure cortisol and sIgA levels, and, because they can be held during sampling, may be useful for research with children and the frail elderly.

Foodborne illness is a significant public health issue in most countries, including Australia. We examined the association between temperature and salmonellosis notifications, and compared these associations for 5 Australian cities.Log-linear models describing monthly salmonellosis notifications in terms of calendar time and monthly average temperatures were fitted over the period 1991 to 2001 for each city. We used a negative binomial chance model to accommodate overdispersion in the counts.The long-term trend showed an increase in salmonellosis notifications in each of the 5 cities. There was a positive association between monthly salmonellosis notifications and mean monthly temperature of the previous month in every city. Seasonal patterns in salmonellosis notifications were fully explained by changes in temperature.The strength of the association, the consistency across 5 cities, and a plausible biologic pathway suggest that higher ambient temperatures are a cause of higher salmonellosis notifications. The lag of 1 month suggests that temperature might be more influential earlier in the production process rather than at the food preparation stage. This knowledge can help to guide policy on food preparation and distribution. It also suggests a basis for an early warning system for increased risk from salmonellosis, and raises yet another possible health problem with global warming.

Pakistan has an infant mortality rate (IMR) of 90.5/1000 live births, and the country's child mortality level of 117.5 is worse than in other South Asian countries. Rapid population growth combined with rural-to-urban migration has led to the creation of urban slums in which morbidity levels are usually higher than in rural populations. A study was conducted in January 1993 in 6 slums of Karachi where the Aga Khan University has operated primary health care programs since 1985. Researchers recorded the deaths of 347 children under age 5 years old due to diarrhea and acute respiratory infections (ARI) during 1989-93. 235 mothers of these children were interviewed. The following are discussed as risk factors for under-5 child mortality: the use of traditional healers, poor nutritional status, incomplete or no immunization, the quick change of healers, inappropriate child care arrangements, mother's literacy, who decides about outside treatment, short birth interval, bottle feeding, and nuclear family structure. Maternal autonomy, appropriate health-seeking behavior, and child-rearing processes identified in the study point to the need for intervention strategies which go beyond the usual primary health care initiatives and involve communities in developing social support systems for mothers.

About four million cases of foodborne infectious disease occur annually in Australia; new foodborne pathogens, such as enterohaemorrhagic Escherichia coli, are emerging. Climate change, combined with changes in how we produce and distribute food and how we behave as consumers, have the potential to affect foodborne disease in the coming century. Foodborne disease outbreaks are now more far-reaching (and sometimes global) due to modern mass food production and widespread food distribution. There are strong seasonal patterns for Salmonella and Campylobacter infection in Australia. Global warming may increase the incidence of infections, such as salmonellosis, and diseases caused by toxins, such as ciguatera.

The objective of the present study was to determine whether vitamin A prevents pneumonia, diarrhoea and other infections in children with measles. A meta-analysis was carried out of randomized controlled trials identified through a systematic search of the medical literature for studies that used vitamin A to treat measles. A total of 492 children, aged from 6 months to 13 years, were supplemented with vitamin A, and 536 children were given placebo in six trials, five of which were conducted in hospitals and one in a community setting. The main outcome measures were: incidence of pneumonia, diarrhoea, croup, and otitis media; and duration of pneumonia, diarrhoea, fever and hospitalization. There was no significant reduction in the incidence of pneumonia or diarrhoea but there was a 47 per cent reduction in the incidence of croup (RR = 0.53; 95 per cent CI = 0.29-0.89) in children who were treated with 200 000 IU of vitamin A on 2 consecutive days. Only one study reported a 74 per cent reduction in the incidence of otitis media (RR = 0.26 95 per cent CI = 0.05-0.92). There was a statistically significant decrease in the duration of diarrhoea, pneumonia, hospital stay and fever in individual studies. It was concluded that vitamin A does have a beneficial effect on morbidity associated with measles and should be used as a treatment for hospitalized measles cases.

BACKGROUND Measles causes more than a million deaths a year, of which most are children under five years of age who die from pneumonia. OBJECTIVES The objective of this review was to assess the effects of antibiotics given to children with measles on reducing pneumonia or mortality, and to assess whether antibiotics should be given to all children with measles in communities with a high fatality rate. SEARCH STRATEGY We searched MEDLINE (1966 - 1999), EMBASE (1980-1999) and the specialized trials register of the Acute Respiratory Infections Group in August 1999, and all relevant journals in the University of Melbourne medical library for the years 1935-46. SELECTION CRITERIA Randomised or controlled trials of antibiotics for children with measles. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed trial quality. MAIN RESULTS Six trials with 1304 children were included. All but one of the trials were unblinded, and randomisation was either not described or was by alternate allocation. In four studies, the incidence of pneumonia in the control group was similar to that in the antibiotic prophylaxis group; in the other two studies, the incidence of pneumonia was unusually high in the control group so these children had a higher complication rate than the antibiotic group. Four of the 764 children given antibiotics died compared with one of the 637 controls. REVIEWER'S CONCLUSIONS The quality of the trials reviewed was poor, and they provide very weak evidence for giving antibiotics to all children with measles. Available evidence suggests that antibiotics should be given only if a child has clinical signs of pneumonia or other evidence of sepsis.

To examine the association of environmental factors (including housing) with respiratory infections and diarrhoea in children under 5 years of age, a cross-sectional study of 403 families was conducted in a squatter settlement of Karachi. In the 2-week period before the survey prevalence of diarrhoea and respiratory infections was 14.4% and 15.0% respectively. The factors significantly associated (p0.05) with diarrhoea in households in the multivariate analysis were: number of children under 5, regular cleaning of sewers, storage of water in small utensils and cooking inside a one room house. Five households risk factors were identified for respiratory infections: the number of children under 5, poor housing structure, increased household density, humidity inside the house less than the humidity outside house, and frequent cooking inside the house. These results suggest that children under 5 years of age in lower income areas are at additional risk to health because of poor environmental conditions.This article examines the impact of sociodemographic, housing, and environmental conditions on diarrheal and respiratory infections in children under 5 years of age in a Karachi slum in Pakistan. Data were obtained from interviews conducted during October-November 1990 in Essa Nagri slum among 403 families with children under 5 years (698 children). Most adults worked as cleaners in the city. Over 75% of houses had access to communal water taps and indoor toilet facilities. Symptoms were recorded as reported by the mother, and severity and duration of illness was not assessed. 14.4% of children suffered from diarrhea during the 2 weeks prior to the survey. Diarrhea was significantly associated with number of children under 5 years, regular cleaning of sewers, storage of water in small utensils, and cooking in one-room dwellings. 15% of children suffered from respiratory infections. Household risk factors for respiratory infection were poor housing structure, frequent indoor cooking, lower indoor than outdoor humidity, increased household density, and number of children under 5 years. The most prevalent risk was having more than one child aged under 5 years. The least prevalent risk factor was housing structure. Malnutrition was not a risk factor. Income of the household head was not a risk factor, but other housing facilities that were related to income were risk factors. Maternal education was not a risk factor. It is argued, however, that the very contaminated living environments undermine the effect of education. Families should be educated about public health measures such as improved ventilation in houses, hygienic practices, sanitary disposal of wastes after cleaning of the sewers, storage and boiling of water, and home management of diarrhea.

Cardiovascular disease (CVD) is a major health and economic burden worldwide. It is a leading cause of death in Australia and individuals aged ≥65 years account for 60% of CVD hospitalisations. Congestive heart failure (CHF) caused 1.8% of deaths in Australia in 2003 and accounted for 9.2% of hospitalizations due to CVD. It is a major burden on the community due to the costs of care and premature death. This study describes the seasonal pattern of emergency hospital admissions and mortality from CVD and CHF in 3 Australian cities, and the association with weekly temperature.

Introduction The annual summer peak in childhood asthma hospitalizations after school recommences occurs in both northern and southern hemispheres. This study quantifies the timing and magnitude of the effect of school term and returning to school throughout the year on childhood asthma. Methods We analyzed daily emergency asthma hospital admissions (1994–2003) in three climatically diverse Australian cities (Melbourne, Brisbane and Canberra) by age (0–4 years and 5–14 years). Using Poisson regression by week of school term (1–11) with reference to the preceding vacation period, we controlled for seasons and adjusted for temperature, humidity and long-term trends. Results A return-to-school effect was apparent for all three cities and was not limited to summer. Among school-aged children admissions rose from the first week of Term 1, peaking in week 3 in Melbourne (IRR 4.4, 3.8–5.1) and Brisbane (2.5, 2.1–3.0), and week 4 in Canberra (5.4, 3.7–8.0), returning to baseline by the end of term. Smaller significant peaks were apparent in Terms 2, 3 and 4 in Melbourne, Terms 2 and 4 in Canberra, and Term 4 in Brisbane. The same pattern occurred among younger children: in Term 1 for Melbourne (3.8, 3.4–4.2), Brisbane (3.0, 2.6–3.4) and Canberra (4.5, 3.2–6.3). Terms 2 and 4 showed significant peaks in Melbourne and Canberra. Discussion and Conclusions Childhood asthma emergency hospitalizations increased sharply with recommencement of school, peaked at 3–4 weeks, then declined to vacation levels. The return-to-school effect was strongest in Term 1, supporting the hypothesis that exposure to respiratory viruses after a long vacation (6–7 weeks) through mixing at school can be a significant cause of asthma morbidity. Effects were similar but attenuated in younger children, probably due to viruses brought home by older siblings at school and changed childcare arrangements. Seasonal variation in type and number of viruses circulating in the general population could interact with return-to-school effect, and the different climates in the three cities provide for different seasonal profiles of viruses. Return-to-school had least effect in Term 3 (winter); more virus circulating in the general population could mean children are already exposed with little additional exposure from mixing at school. Stress at the commencement of a new school year is unlikely to contribute much to the Term 1 asthma load, as hospitalizations take several weeks to peak. Quantifying the magnitude and timing of asthma hospitalizations in relation to school term could assist in improved hospital planning and better personal asthma management.

Introduction: This paper compares the prevalence estimates of diabetes and cardiovascular disease (CVD) risk factors in the Indigenous and non-Indigenous New South Wales (NSW) prisoner population in 1996 and 2001, and also compares the 2001 prevalence estimates with Australian population data. Methods: In 1996 and 2001, 789 and 916 prisoners, respectively, in NSW underwent a face-to-face interview covering behavioural risks and physical and mental health. Weight, height and blood pressure were recorded and blood was taken for measurement of cholesterol and random blood sugar. Results: The prevalence of hypertension, hypercholesterolaemia and smoking were lower in the 2001 prison survey as compared with the 1996 survey but the prevalence of smoking was extremely high in both the prison surveys (88% in 1996 and 79% in 2001). There were no differences in the age and sex-adjusted prevalence estimates for any condition except that the prison sample had a higher standardised morbidity ratio for angina than the AusDiab population. Conclusion: This study highlights the high prevalence of CVD risk factors, particularly in younger prisoners, when compared with the Australian non-prison population. Implications: Programs should be put in place to routinely screen for chronic disease conditions and to educate Australian prisoners regarding CVD and diabetes risk factors and their long-term management.