Measuring area-level disadvantage in Australia : Development of a locally sensitive indicator

Background In Australia, the Socio-Economic Indexes for Areas (SEIFA), which includes the Index of Relative Socioeconomic Disadvantage (IRSD), captures the socioeconomic characteristics of areas. Because SEIFA rankings are relative to the country or state, the decile categorisations may not reflect an area’s socioeconomic standing relative to areas nearby. Aims The aim of the research was to explore whether IRSD rankings could be re-ranked to become locally sensitive. Data and methods Using existing SEIFA data to redistribute the membership of current decile IRSD groups, we tested three methods to re-rank all SA1 areas relative to the nearest areas capped at: (1) the nearest 99 neighbours, (2) a population threshold of 50,000 (3) a distance threshold of 10 km. Results The reclassification of SEIFA IRSD deciles was largest (up to 8 decile points of change) when comparing the nearest neighbour and population threshold local methods to current state-based rankings. Moreover, compared to using current national and state SEIFA IRSD rankings, the use of local rankings resulted in more evenly distributed deciles between cities, regional, and remote areas. Conclusions Because SEIFA IRSD rankings are used to allocate resources and health services, we encourage the combined use of a state and local ranking to refine areas considered the most disadvantaged

Cardiac Screening of Young Athletes: a Practical Approach to Sudden Cardiac Death Prevention.

PURPOSE OF REVIEW: We aim to report on the current status of cardiovascular screening of athletes worldwide and review the up-to-date evidence for its efficacy in reducing sudden cardiac death in young athletes. RECENT FINDINGS: A large proportion of sudden cardiac death in young individuals and athletes occurs during rest with sudden arrhythmic death syndrome being recognised as the leading cause. The international recommendations for ECG interpretation have reduced the false-positive ECG rate to 3% and reduced the cost of screening by 25% without compromising the sensitivity to identify serious disease. There are some quality control issues that have been recently identified including the necessity for further training to guide physicians involved in screening young athletes. Improvements in our understanding of young sudden cardiac death and ECG interpretation guideline modification to further differentiate physiological ECG patterns from those that may represent underlying disease have significantly improved the efficacy of screening to levels that may make screening more attractive and feasible to sporting organisations as a complementary strategy to increased availability of automated external defibrillators to reduce the overall burden of young sudden cardiac death

Shrinking areas and mortality: An artefact of deprivation effects in the West of Scotland?

A number of studies have shown that mortality rates are highest in areas that are experiencing population decline. A recent study suggests that this relationship disappears when area deprivation is accounted for. We extend this research to consider the relationship between population change and mortality in five Health Boards in the West of Scotland-a region with some of the worst mortality rates in Europe. For the area as a whole and all five Health Boards separately, we find a significant negative association between population change and mortality, but in each case this relationship disappears when small area deprivation is accounted for. This confirms our previous conclusion that it is more important to account for deprivation than population decline in health resource allocation

Clustering of childhood asthma hospital admissions in New Zealand, 1999-2004

The context for this study is public concern about aerial spraying of biological insecticides over Auckland, New Zealand between January 2002 and May 2004. We analysed childhood asthma hospital admissions for the whole of New Zealand, July 1999 – December 2004 using a spatial scan statistic. We found spatial clustering of asthma admissions in many New Zealand cities, and spatiotemporal clustering in a few cities. We hypothesize that many of the purely spatial clusters might be explained by characteristics of the local population or health services. This explanation is less plausible in the case of the observed space-time clusters of asthma admissions, which we consider more likely to be related to local exposures. In spatiotemporal models, there were significant clusters in Auckland, Palmerston North, Lower Hutt, Christchurch and Invercargill. Two of the four Auckland clusters overlap biological insecticide spray zones, and two do not; the majority of the observed spatiotemporal clusters are unrelated to aerial spraying of biological insecticides in space and time. While the present results do not allow us to identify which local exposures are most relevant in explaining the observed spatiotemporal clusters, we hypothesize that air pollution, including fine particles of biological and non-biological origin, might play a role