NSW Public Health Research Articles

Erratum to: Chronic disease and climate change: understanding co-benefits and their policy implications

The NSW Public Health Bulletin is published by CSIRO PUBLISHING on behalf of the Population Health Division of the NSW Department of Health. Its purpose is to enable the timely communication of information on public health issues and contribute to the development of a well-trained and informed public health workforce in NSW. Although the Bulletin core audience includes the public health workforce within NSW Health and throughout NSW, it also has readers in the other states and territories of Australia and overseas who have an interest in public health.

Investigation of an outbreak of acute illness in a school group visiting Sydney, September 2006

We describe the investigation into an outbreak of acute illness in approximately 40 people attending Darling Harbour in Sydney during a school music camp. We used three methods, including the Public Health Realtime Emergency Department Surveillance System, to obtain information on the food and travel history of the group and symptoms of the cases rapidly. Forty-five cases of gastroenteritis were identified in people on the bus trip. Most dates of onset of illness were obtained from triage text fields in the NSW Public Health Real Time Emergency Department Surveillance System, and were verified through medical record review and interviews. No causative agent was identified. The investigation suggested person-to-person transmission rather than a point source, and demonstrates how the NSW Public Health Real Time Emergency Department Surveillance System can assist with case finding in public health investigations.

Good progress in tobacco control in NSW

In response to the NSW Tobacco Action Plan 2005–2009, Greater Southern Area Health Service (GSAHS) has developed a local plan. This short report describes how activities promoted in the state plan were prioritised and six outcomes identified as the focus for the GSAHS Tobacco Control Plan 2006–2009. Andrew J. GowA, Kylie M. WeirA,D and Andrew J. N. MarichA,B,C APopulation Health, Greater Southern Area Health Service BNSW Public Health Officer Training Program, NSW Department of Health CCentre for Health Protection, NSW Department of Health DCorresponding author. kylie.weir@gsahs.health.nsw.gov.au • the intervention or activity builds on existing programs and models of service delivery • the intervention or activity addresses health inequities. The resulting GSAHS Tobacco Control Plan 2006–2009 has identified the following six key outcome areas: 1. Achieve totally smoke-free status at all NSW Health sites within the GSAHS 2. Support health workers to deliver brief interventions for smoking cessation to GSAHS clients, support inpatients and outpatients with smoking-cessation treatment and nicotine-dependence management 3. Reduce smoking in pregnant women and environmental tobacco smoke exposure for infants and children 4. Reduce smoking rates in at-risk population groups including Aboriginal and Torres Strait Islander peoples and people on low incomes 5. Reduce the inappropriate sale of tobacco by retailers 6. Reduce the impact of environmental tobacco smoke within the hospitality industry and in public places. To date, action under the GSAHS Tobacco Control Plan 2006–2009 has occurred to varying extents in most of the key outcome areas. Significant effort has been directed to achieving totally smoke-free status at all GSAHS sites, with a self-imposed deadline of 1 July 2007. This process has given impetus to the second key outcome area, particularly with regard to establishing procedures to manage nicotine-dependant inpatients and encouraging participation in cessation training. Good progress is also being made in key outcome areas 5 and 6, with GSAHS environmental health staff maintaining a rigorous program of education combined with inspection to ensure compliance with the law by the retail and hospitality industries. Key outcome areas 3 and 4 continue to provide challenges. The slower progress here reflects the complexity of these tasks. Tobacco control initiatives with these subpopulations must address layers of determinants, including social norms and socioeconomic disadvantage. In contrast, the achievement of totally smoke-free environments and restrictions on the sale of tobacco are more easily addressed through legislation and policy enforcement. The clarity of focus provided by the GSAHS Tobacco Control Plan 2006–2009 has encouraged concerted effort on specified priorities. In a context of close competition for resources, with a dispersed population over a large 10.1071/NB07081 48 | Vol. 19(3–4) NSW Public Health Bulletin Vol. 19(3–4) NSW Public Health Bulletin | 49 Tobacco Control Plan 2006–2009 geographical area, clearly articulating a limited number of priorities that are realistic and achievable has been beneficial.

Volume 18 Number 9 & 10

The NSW Public Health Bulletin is published by CSIRO PUBLISHING on behalf of the Population Health Division of the NSW Department of Health. Its purpose is to enable the timely communication of information on public health issues and contribute to the development of a well-trained and informed public health workforce in NSW. Although the Bulletin core audience includes the public health workforce within NSW Health and throughout NSW, it also has readers in the other states and territories of Australia and overseas who have an interest in public health.

The NSW Health routine screening for domestic violence program

Routine questioning of women about abuse by their intimate partner has been progressively introduced in NSW in antenatal, early childhood, alcohol and other drug and mental health services since 2001. This was done because of the serious health consequences of domestic violence and the low identification rate of abuse by health services. Following a pilot that found strong support from female patients, this strategy is now well established in NSW public health services. Recent data indicate that approximately 10,000 women a month are asked these questions and that 7.3% of them report experiences of physical abuse or fear caused by their partner or ex-partner within the past 12 months.

Results from the 2000 fax-back survey to readers about the NSW Public Health Bulletin

Publications must regularly reflect on their performance to ensure that they remain relevant to their readership and are fulfilling their objectives. In 2000 the 'NSW Public Health Bulletin Discussion Paper 2000'was released, with recommendations regarding all aspects of the Bulletin content, distribution and editorial management. A copy was sent to 1200 people with a fax-back survey seeking general feedback on the Bulletin and the recommendations. There was a response rate of 11 per cent. The survey identified broad support for the Bulletin and the recommendations. Findings included strong support for encouraging electronic access but maintaining the distribution of the printed copy. Subsequent changes to production of the Bulletin have included expanding the number of reviewers of articles and making improvements to the website.

A web log analysis of the online NSW Public Health Bulletin for 2001–2003

The web logs of the online version of the NSW Public Health Bulletin were analysed to understand the patterns of use. Twenty-nine months of data, for the period January 2001 to May 2003, were extracted from archived files stored by the NSW Department of Health. HTML and PDF hits were included; other types of hits, for example image hits, were not. Five potentially useful variables were identified: Internet protocol address; date of access; time of access; document accessed; and means of access. There were 384,887 hits during the period, approximately 442 per day. The rate of hits per month increased from 8288 in 2001 to 21,288 in 2003. The PDF version was used more than the HTML version. Examination of HTML hits revealed how different parts of the Bulletin were being used. This information provides evidence to inform planning.

Review of the NSW Public Health Bulletin: A qualitative survey of stakeholders

In 2005, the NSW Department of Health commissioned an external review of the NSW Public Health Bulletin. This article describes the methods and findings of the qualitative survey. Participants included people working in population health from within the Department of Health, area health services, the tertiary sector and non-government organisations. There were fifty interviews, two focus groups and eight written surveys. The review found substantial support and respect for the Bulletin. It described the features of the Bulletin that stakeholders valued and provided suggestions to strengthen the publication. These findings will guide developments in the Bulletin's purpose, presentation, content and distribution for its readership.

The new subject index for the NSW Public Health Bulletin

This article describes the rationale and methods for reindexing all 17 years of the NSW Public Health Bulletin. The Bulletin is a valuable resource for researchers, however over time the subject index had become cumbersome with long lists of articles under broad headings. To facilitate searching the index was revised to include narrower terms, sub-headed terms, more cross-references and new terms reflecting changes in public health practice. Regular reports and surveys now have their own subject headings, and greater recognition has been given to public health history and organisations. The index appears annually in printed form. The full cumulated index is available online and in 2007 will be updated with each issue.

Tailoring the Bulletin to meet readership needs

Commencing with the January–February 2007 issue, the NSW Public Health Bulletin will have a new look. This coincides with CSIRO PUBLISHING becoming responsible for producing the print and electronic versions of the Bulletin. The Bulletin editorial team at the NSW Department of Health retains responsibility for strategic direction, the management of the peer-review process and the selection of articles for publication. Consequently, this issue will be the last to appear in the design that has identified the Bulletin since it began in May 1990. At this appropriate moment for reflection, four articles in this issue describe recent developments that have informed the evolution and future directions of the Bulletin.

Investing in capacity to meet the challenge of an influenza pandemic

We welcome you to the second issue of the NSW Public Health Bulletin that is devoted to aspects of influenza pandemic planning and response. Recent simulation exercises designed to test preparedness for pandemic influenza, Exercise Cumpston 06 on a national scale and Exercise Paton in NSW, have shown that the public health system in NSW has made substantial progress in preparing for what many consider to be an inevitable event. Of equal, if not greater, importance is a recognition that the work done has strengthened the health system’s capacity to meet a much wider range of challenges. This work is the focus of this issue of the Bulletin.

Introducing the NSW Centre for Public Health Nutrition

The NSW Centre for Public Health Nutrition was established in 2000, as an initiative of the NSW Department of Health in collaboration with the Nutrition Research Foundation of the University of Sydney. The purpose of the Centre is to assist and support NSW Health and public health practitioners to plan and implement high quality policies and programs that improve the nutrition of the NSW population. The Centre is a small team of public health professionals with expertise in population nutrition. Karen Webb, Ian Caterson, and Tim Gill are the academic directors of the Centre, which is located at the University of Sydney.

Foodborne disease surveillance in NSW: moving towards performance standards.

NSW Health has sole responsibility for the surveillance of foodborne disease in humans, through the receipt of notifications for a range of conditions that are predominantly or potentially foodborne in transmission. These conditions include: salmonellosis, listeriosis, shigellosis, typhoid, Verotoxin producing E. coli infection, cholera, hepatitis A, giardiasis, and cryptosporidiosis. In addition, outbreaks of foodborne disease affecting two or more people are notifiable. Surveillance methods used in NSW are described in detail in this issue of the NSW Public Health Bulletin by Neville and McAnulty. This article describes the evolution of, and recent investments in, foodborne disease surveillance and control in NSW, and discusses the opportunities to produce measurable enhancements to food safety from these investments.

Notifiable Diseases Database system: review and development strategy.

The Communicable Diseases Branch of the NSW Department of Health recently undertook a review of the existing notification system, to determine its effectiveness and guide future development of the system. This report briefly outlines the nature of the review, its recommendations, and the progress to date in addressing the recommendations. A more complete description of the nature and outcome of this process will be presented in a future edition of the NSW Public Health Bulletin.

Foodborne disease surveillance in New South Wales

The major objectives of the surveillance of foodborne disease are to identify emerging threats to human health and to monitor prevention interventions. This issue of the NSW Public Health Bulletin examines current surveillance activities and identifies areas of development.

Monitoring health behaviours and health status in New South Wales: release of the Adult Health Survey 2002.

In 2002, the NSW Department of Health, in conjunction with the 17 area health services, completed the first year of the New South Wales Continuous Health Survey. This is an ongoing survey of the health of people in NSW that uses computer-assisted telephone interviewing (CATI). The main aims of the Continuous Health Survey are to provide detailed information on the health of the people of NSW, and to support the planning, implementation, and evaluation of health services and programs in NSW. Following the 1997 and 1998 health surveys, this is the third survey that has collected data on the health of adults in NSW. This article announces the release of the report of the New South Wales Adult Health Survey 2002 as a supplementary issue of the NSW Public Health Bulletin, and summarises changes in health behaviour, health status, and satisfaction with health services, which have occurred between 1997 and 2002.

WATERBORNE DISEASE OUTBREAKS ATTRIBUTED TO PRIVATE WATER SUPPLIES IN NSW

Waterborne disease outbreaks attributed to private water supplies in NSW Introduction There is little evidence in NSW to indicate that reticulated potable drinking water supplies are associated with disease. However, NSW has experienced several waterborne outbreaks associated with drinking water provided to the public through private establishments, the largest of these affecting 129 people. Examples of such establishments include caravan parks, school camps and holiday facilities, ‘bed & breakfast’ properties, and similar facilities that are not serviced by a town water supply. By charging fees for the use of these types of facilities, proprietors have an obligation to ensure that drinking water provided is safe to consume, or alternatively, that patrons are advised otherwise, through signage or provision of boiled or bottled water. The definition of a water supplier under the NSW Public Health Act, 1991, extends to a person supplying water in the course of a commercial undertaking (other than bottled or packaged water). Investigation of outbreaks Information on disease outbreaks associated with consumption of drinking water provided through private water supplies was collected by the Water Unit. In broad terms, the Water Unit's role, within the NSW Department of Health, is to provide policy advice and implement programs related to the safety of drinking water, reuse of effluent and sewage management, and recreational water quality. Five outbreaks were reported to the Water Unit as a result of investigations conducted by Public Health Units located in regional centres throughout NSW. There were, however, anecdotal reports of other similar incidents that have occurred, but have passed largely undocumented. Information on the water supply systems collected included: size of the population served by each commercial establishment; type of source water; level of treatment if any; likely cause of breakdown in water quality; whether water samples were taken; evidence of faecal contamination of the water; and, recommended actions. Results Where epidemiological data was collected, the results indicate increased odds ratios or relative risks for consumption of tap water. Analysis of the data for these incidents excluded food borne transmission as a possible cause of illness. All outbreaks reported gastrointestinal illness, with typical symptoms and case definitions including vomiting, diarrhoea, nausea, stomach pain, fever and headaches. However, the probable causal agent was identified in only one of the outbreaks. Four of five of the systems provided untreated water sourced from rivers; while another system that sourced river water was not effectively chlorinated. Conclusions The outbreaks indicate the need for the Department to provide clear advice to proprietors on management of private water supplies, given the potertial for a large number of people to be affected due to the nature of visitation to such premises. The Water Unit's current activities are focussed on developing recommendations for monitoring of supplies and/or the implementation of alternative risk management strategies, such as declaring a supply to be non-potable or providing appropriate signage. A statewide survey of private water supplies is also being considered to better define the magnitude of the problem of poorly managed supplies.

Index Medicus and MEDLINE recognise NSW Public Health Bulletin

We are very proud to announce that the NSW Public Health Bulletin will be indexed in Index Medicus and MEDLINE. This follows a successful review in February by the Literature Selection Technical Review Committee (LSTRC) of the National Library of Medicine, which is part of the National Institutes of Health, situated in Maryland, USA.

Building the evidence base to address health inequalities.

The Australian Health Inequalities Research Collaboration (HIRC) was established by the Commonwealth Government in 1999. In the July 2001 issue of the NSW Public Health Bulletin (Volume 12, Number 7), Dixon and Sibthorpe, from the National Centre for Epidemiology and Population Health, reviewed the work of HIRC in its first 18 months. Here we provide an update of its activities.

Summary and recommendations

In November 2000, the Program for Enhanced Population Health Infostructure (PEPHI) Discussion Paper was distributed both internally and externally throughout the NSW public health system. Thank you to all those who provided responses. A summary of the distribution strategy appears at the end of this document, along with a list of organisations that responded.