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This article discusses the implementation of a safety bundle for operative vaginal birth (OVB) and its impact on birth outcomes. The bundle includes routine intrapartum ultrasound, a structured time-out, and a procedural checklist. A retrospective cohort study was conducted, comparing births where the bundle was and was not used. The study found that the use of the bundle was associated with fewer neonates delivered in an unexpected position and a trend towards reduced neonatal morbidity. The authors conclude that the use of a safety bundle for OVB may improve perinatal outcomes. [Extracted from the article]

This article, titled "A systematic review of prediction models for intrapartum fetal hypoxia," aims to evaluate existing prediction models for intrapartum fetal hypoxia (IFH) and determine the predictor variables that were incorporated into these models. The review identified 41 eligible prediction models from 22 studies, but none of these models are currently ready for clinical application in the general population. The frequently reported predictor variables included parity, cerebroplacental ratio, and oxytocin use. The study concludes that further external validation of existing models or development of new, reliable models applicable to all pregnant women is needed. [Extracted from the article]

OBJECTIVES: This study aimed to evaluate a specifically designed hepatitis B education/promotion curriculum package as part of a successful hepatitis B vaccination delivery system to adolescents. METHODS: A randomised-controlled trial was used to evaluate the effect of the curriculum package (or intervention) on uptake of vaccine. Schools were randomly selected from the metropolitan region of Melbourne to intervention (66 schools or 7,588 students) or control groups (69 schools or 9,823 students). Class teachers administered the intervention to students over 4 class periods before the vaccination course. RESULTS: The difference in mean school uptake between intervention and control was small at 1-2% per dose. 95% confidence intervals around the differences were -5% to 2% per dose and not significant. Intervention schools taught an average of 7 items out of 12 from the curriculum package, immunisation rates increased by 4-10% per dose between low and high implementation schools, but this trend was not significant. Impact evaluation demonstrated significantly greater knowledge of hepatitis B and vaccination among students in the intervention than the control group. CONCLUSION: Hepatitis B vaccination of preadolescents was not increased by the implementation of a curriculum package that successfully increased knowledge and awareness of hepatitis B in a school-based vaccination program. Additional strategies directed at the education of parents, the cooperative role of schools and pro-active providers might also be required to maximise vaccine uptake in this age group. Page 305 A randomised controlled trial of the costs of hospital as compared with hospital in the home for acute medical patients OBJECTIVE: To test the cost effectiveness of Hospital in the Home compared to hospital admission for acute medical conditions. METHOD: Randomised controlled trial at the Prince of Wales Hospital, Sydney, from October 1995 to February, 1997; 100 patients with acute medical conditions admitted through the Emergency Department. RESULTS: The Hospital in the Home (HITH) group costs per separation ($1,764, CI95% $1,416 - $2,111, n:50) were significantly lower (p < 0.0001, Mann-Whitney U - Wilcoxon Rank Sum) than the control group hospital separation ($3,614, CI 95% $2,881.37 - $4,347.27, n=47) with no significant difference in clinical outcomes, and comparable or better user satisfaction. CONCLUSION: Given the favourable clinical outcomes the HITH model produces at a lower cost, the cost-effectiveness of the care mode is high, and the allocative efficiency favourable. IMPLICATIONS: As a care model and critical pathway, HITH offers hospitals real bed day savings that can either be used to rationalise resource usage for a given level of activity, or increase throughput. Page 312 Dissemination of responsible service of alcohol initiatives to rugby league clubs OBJECTIVES: To determine the acceptability of intervention strategies that increase the responsible service of alcohol by nonmetropolitan rugby league clubs. METHOD: Rugby league clubs were provided an information kit and advice by local public health workers, police and a lead agency regarding their responsible service of alcohol practices. Rugby League clubs and public health workers completed an acceptability survey at the conclusion of the study. RESULTS: Data were collected from 160 contactable clubs (100% consent) and 12 of 14 participating public health workers. Almost all clubs reported of contact with the lead agency, public health workers and police to be acceptable. Fifty-nine percent of clubs reported contact with public health workers to be useful. One-third of the public health workers considered that they were not the most suitable professional group to be involved in delivering the intervention. CONCLUSIONS: In spite of a suggested culture of harmful alcohol consumption among rugby league participants and spectators, non-metropolitan rugby league clubs appear receptive to public health strategies that increase their responsible service of alcohol. IMPLICATIONS: The ability of the public health sector to meet this opportunity appears limited, and may require additional strategies to increase the capacity of public health workers to develop/deliver inter-sectoral interventions in this setting. Page 316 Trends in birth rates for teenagers in Queensland, 1988 to 1997: an analysis by economic disadvantage and geographic remoteness OBJECTIVE: To investigate trends in the birth rate for teenagers in Queensland, stratified by geographic remoteness and economic disadvantage. METHOD: This was an analysis of routine data for the period 1988 to 1997. The number of births were obtained from the Queensland Perinatal Data Collection. Population data (the denominators for the rates) were obtained from the Australian Bureau of Statistics. Economic disadvantage was based on place of usual residence of the mother. Because of differences in physical, social and psychological development, the data were analysed in three age groups: 13 to 14 years, 15 to 17 years and 18 to 19 years. RESULTS: Birth rates to teenagers who live in disadvantaged areas were 2 to 4 times higher than the rates for all of Queensland and 10 to 20 times higher than the rates in affluent areas. The trend analysis showed that the rates are decreasing in urban-affluent areas (about 2.5% per year), while they have remained stable, but extremely high in disadvantaged-remote areas, and are increasing (about 5% per year)in disadvantaged-urban areas. CONCLUSIONS: The relatively low and stable rates for all of Queensland have hidden marked variations in the trends for areas defined according to economic disadvantage and remoteness. The rates were especially high and showed no improvement over time in remote disadvantaged areas, which have a large Indigenous population. IMPLICATIONS: In some areas of Queensland births to teenagers is a pressing problem, especially because it can perpetuate a cycle of limited educational opportunities, social isolation and reliance on welfare. Page 320 Prevalence and acceptability of public health initiatives in licensed premises OBJECTIVES: To determine the prevalence and acceptability of public health initiatives in licensed premises. METHODS: Licensees/managers of all 333 licensed premises in the Hunter Region of NSW were interviewed to assess the practice of, and interest in undertaking public health initiatives relating to: responsible service of alcohol; environmental tobacco smoke; healthy-food choices; skin, breast and cervical cancer prevention; and the prevention of HIV/AIDS. RESULTS: Ninety eight percent of contacted premises participated in the study. Approximately two-thirds of premises reported having a responsible service of alcohol policy and training their staff in responsible service. One third of premises reported the provision of healthy food choices and smoke-free areas. Initiatives concerned with the prevention of cancer and HIV/AIDS were practised by less than 25% of premises. Between 41% and 85% of premises expressed an interest in undertaking all but two initiatives. Almost all interested premises accepted the offer of resources to facilitate adoption of public health initiatives. CONCLUSIONS: The study suggests that licensed premises are already involved in a number of public health initiatives, and that they appear willing to consider the introduction of a wide range of such initiatives. IMPLICATIONS: The prevalence of public health initiatives in licensed premises, and the extent of interest expressed by licensees/managers in undertaking such initiatives suggests that both a need and an opportunity exist for public health and other agencies to be more actively involved in disseminating appropriate services in this setting. Page 323 Alcohol consumption in a community sample of older people OBJECTIVE: To examine the prevalence and pattern of alcohol use among community-living elderly Australians. METHODS: A survey was conducted of randomly selected non-institutionalised people aged 75 years and older living in the inner western suburbs of Sydney. Personal interviews by trained interviewers covered background demographic information and self-reported alcohol use. RESULTS: 72% of men and 54% of women drank alcohol. The median usual daily volume of ethanol consumed by drinkers was 10 grams for men and 1.3 grams for women. However 11% of male drinkers and 6% of female drinkers consumed at defined hazardous or harmful levels. CONCLUSIONS AND IMPLICATIONS: Although a sizeable majority of these older people were either non-drinkers or very light drinkers, a small but important proportion drank in the hazardous to harmful range. Despite increasing evidence of the health benefits of alcohol consumption it remains important to be alert for potentially harmful alcohol use among older people. Page 327 An analysis of resources for Indigenous women in NSW about cervical screening OBJECTIVE: To examine resources about cervical screening made available to Indigenous women in NSW. METHOD: An Aboriginal woman, on behalf of another Aboriginal woman, telephoned 47 NSW based organisations in May 1998 for information about cervical screening. Received materials were analysed for format, content and readability and then submitted to a panel of Indigenous women for their feedback. RESULTS: Of those 34 organisations agreeing to send resources, only 20 (59%) did so. After removing duplicates, 12 cervical screening resources were available for review of which six were designed and printed in NSW and the other six originated outside NSW. Of the six resources developed in NSW, two (33%) were for Aboriginal women. Of the six resources originating from outside of NSW, another two (33%) also were for Aboriginal women. The Flesch readability scores for resources ranged from 58.6 to 87.27. Those developed in NSW had a significantly lower readability score than those from outside of NSW (p = 0.025). Despite lower education levels among the target group, there was no difference in the readability scores of resources designed for Indigenous women (p=l). CONCLUSIONS: Most resources obtained by us were not tailored for Indigenous women. IMPLICATIONS: This study has set a base line for resources available for Indigenous women. Our method could be replicated in the future to evaluate and monitor improvement. Page 331 Too fat to exercise? Obesity as a barrier to physical activity OBJECTIVE: To describe perceptions of being 'too fat' as a barrier to physical activity by gender and body mass index, and to examine the associations between feeling fat and other weight-related barriers to physical activity. METHODS: Analyses of cross-sectional self-report data from a representative population survey of 2,298 Australian adults. RESULTS: Overall, 4.4% of respondents reported being too fat as a barrier to physical activity; this being more common among women (6.2%), and among the obese (22.6%). Associations were found between being too fat as a barrier, and being too shy or embarrassed to exercise; being too lazy or not motivated; having an injury or disability (males only); and being not the sporty type (females only). There was no association between feeling too fat and poor health. CONCLUSIONS: Feeling too fat to exercise is a common barrier among the overweight, particularly for women. Results suggest gender differences in weight-related barriers to physical activity. IMPLICATIONS: A better understanding of the nature of weight-related physical activity barriers can help inform public health strategies designed to increase physical activity among those who are obese.

The article offers information on the General Practitioners (GP) having an important role in supporting adolescent vaccination, including ensuring vaccinations are up to date and in promoting health literacy among parents and adolescents. It highlights that they can opportunistically prioritise vaccination during routine consultations and ensure the adolescent is up to date with the vaccination schedule recommended in the National Immunisation Program.