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We administered a questionnaire to 995 people selected randomly from the electoral roll in one coastal region of subtropical Australia. Three-quarters (739) indicated their skin was checked by a physician, by themselves, or both. Among the 15% who were taught to check their skin, 59% learned to do so from physicians. A family physician would be consulted immediately by 40% who found something suspicious, and by 58% after a period of delay. Several factors associated with other indicators of health-seeking behavior, including being told by a physician that there was a special risk of skin cancer, were related to an increased proportion of respondents who were checked by their physicians as well as themselves. In addition to being the main focus of help should a suspicious lesion be found, physicians may have an important role in introducing the public to the process of early detection of skin cancer as well as providing an important function in its actual conduct.

Objective: To describe the quality of general practitioner (GP) medical records., Subjects and Setting: One hundred and fifty fee-for-service GPs in suburban Brisbane. SETTING OF STANDARDS: Standards were set at meetings with general practitioner educators, and refined after circulating drafts to participants. Criteria were established in the 12 areas of: general ease-of-use (legibility; consciousness; and layout); whether certain patient data could be found (date of birth; past medical history; family history; allergies; alcohol and tobacco use; and immunisation status); and whether information about the most recent consultation could be found, (the reason for the consultation; its assessment; and management)., Main Outcome Measures: Ten randomly selected medical records of consultations from each of the GPs scored blind by medical students., Results: The mean weighted score was 11.4 out of a maximum possible of 18. Most records attained the standard with: consciousness (97%); recording date of birth (94%); and immunisation status (92%). Fewest attained the standard with family history (12%); adequate layout (17%); and recording alcohol and tobacco use (31%). Practice size and membership of the Royal Australian College of General Practitioners were not associated with significant differences in score, although sex, (being female) and date of graduation, (recent), were associated with significantly higher scores., Conclusion: There is considerable room for improvement in the quality of the clinical records of Australian GPs.

Focus groups were used to investigate women's perception and experience of menopause, hormone replacement therapy, osteoporosis and doctor-patient relationships. Forty women aged between 45 and 55 years participated in seven focus groups. Most women thought that these topics were not widely or freely discussed in the community. Nevertheless they were able to share their experiences on this occasion. Lack of reliable, accessible and current information on menopause and related topics was identified as a problem. This was compounded by the contradictory nature of the information which was available. Hysterectomy and osteoporosis were identified as specific areas in which information was inadequate and not readily accessible. Solutions suggested by the women included distributing information pamphlets with contact numbers for further information to non-health-related settings such as hairdressing salons. The need to foster open discussion between women and their doctors was highlighted, with contributions required from both parties to develop a more equal partnership. A review of doctors' and women's surveillance practices with regard to hormone replacement therapy may also be warranted. We found focus groups a useful method for accessing women's experiences and perceptions. There was particular benefit in researchers being involved as moderators and scribes, and in an early post-focus group meeting to amplify and clarify records of the discussions. Small group size and an emphasis on confidentiality were, we believe, helpful strategies in encouraging discussion of intimate topics.

Before designing an intervention aimed at improving the quality of after-hour general practice services to the residents of a relatively isolated outer suburb of Brisbane, a survey of 247 residents was conducted to assess the provisions of after-hours care. The results of the survey were presented to the suburb's general practitioners (GPs). Meetings with the GPs led to attempts at improved communication, using patient-held Health Summary Cards and doctor-to-doctor clinical feedback forms. Forty-four per cent of the 27 GPs participated in the co-operative scheme. One year later the community was resurveyed to assess the impact of the changes in medical services. There was a small but insignificant increase in satisfaction with the provision of after-hours care from 45% to 48%.

Incidence rates of six respiratory infections were calculated from sentinel practice data of 33,407 reports coming from 31 general practitioners in Queensland over 34 months in 1986/1988. Upper respiratory tract infection had an annual incidence of 301 per 1000 people, most in children aged under five, and a winter rate twice the summer rate. Sore throat (incidence 112:1000) and Infectious mononucleosis (incidence 2.7:1000) had little seasonal variation and were maximal among those aged 15-19 (in whom there was one case of Infectious mononucleosis for every 14 sore throats). Influenza (incidence 44:1000) underwent a prominent epidemic in the winter of 1988. Measles (incidence 1.9:1000), and pertussis and pertussis-like syndrome (incidence 0.8:1000) were most commonly reported in the under-fives, and rarely among adults. Sentinel practices networks collect useful epidemiological data from which disease incidences can be calculated.

We undertook a prospective randomised intervention study of the proportions of women with abnormal cytology results who were lost to follow-up in 42 general practices in urban and rural Queensland over 26 weeks. Practices in the intervention group were provided with a redesigned cervical smear request form that allowed patients to provide an address for direct notification from the laboratory by mail. Satisfaction questionnaires sent to the general practitioners in the intervention group showed that most made at least some use of direct notification, and most felt it was worthwhile. For women with an initial result of cervical intraepithelial neoplasia (CIN), there was a loss to follow-up of 23 per cent (95 per cent confidence interval (CI) 11 to 39) among the control group compared to none in the intervention group (upper CI 7 per cent), a highly significant difference (P < 0.001). Mailing cervical screening results to women may reduce the loss to follow-up of those with CIN findings.

Objective: To evaluate an intervention designed to reduce the number of benign melanocytic lesions excised from the skin., Design: A randomised controlled field trial based in the medical practices of two cities. Examination of histopathological reports of 5823 melanocytic skin lesions excised over the intervention period and in the preceding six months., Intervention: Medical practitioners were offered an algorithm and use of an instant developing camera., Setting and Subjects: Over 50 medical practitioners, mostly in general practice, in each of two cities in tropical Queensland, Australia., Main Outcome Measures: Percentages of benign (neither malignant nor potentially malignant) melanocytic lesions excised during the two year intervention period., Results: There were no significant differences in the percentages of benign lesions reported in the intervention and control cities before the intervention started (93.6% and 94.0%, respectively), but there was a significant difference afterwards (88.8% and 93.8%, P < 0.001). There was no difference in the percentage of invasive melanomas excised per month in the intervention city (3.4%) compared with control city (3.4%)., Conclusion: Clinical diagnostic accuracy may be enhanced by offering to clinicians managing suspicious melanocytic skin lesions a simple algorithm and a camera with which to record the appearance of lesions objectively.

Six hundred women aged between 45 and 54 were randomly selected from the electoral roll in Brisbane, Australia. A questionnaire addressing their symptoms, hormone status and psycho-social factors was successfully administered to 381 women (64% of the original sample; 83% of those contactable). Although cardiovascular symptoms were experienced by 25% of the sample, the most common (hot flushes) ranked only tenth on a list of recently experienced symptoms. The association of hormone status with symptoms was weak in comparison with other factors. Most symptoms were reported by women who were perimenopausal, had undergone a hysterectomy, or were currently using hormone replacement therapy. A poor mental health index was strongly associated with all groups reporting symptoms. It is concluded that clinicians responding to symptoms from middle-aged women should continue to address psychosocial factors just as vigorously as those related to their hormone status.

Objective: To describe the response of general practitioners (GPs) and patients during the 1991 National Skin Cancer Awareness Week media campaign., Design: Skin examinations in general practices in three representative regional towns in Queensland were monitored for five weeks around the time of the campaign and participating GPs were personally interviewed., Outcome Measures: Number and type of consultations in which the skin was examined for cancer before, during and after the campaign, and GPs' attitudes and beliefs about skin checks., Results: The 46 GPs (47%) who participated, representing 60% of the practices, conducted 1805 consultations in which the skin was examined for cancer. The number of consultations in which skin examinations were conducted by each GP increased by 56% during the campaign. Skin checks were nearly always initiated by the patient (90%), and in only half of all cases was the examination given as the primary reason for the consultation. Sixty-two per cent of lesions were considered to be clinically benign., Conclusion: Public education programs may have an impact on the level of skin examinations requested in general practice consultations. Currently, patients are the principal initiators of such examinations during consultations--there is potential to increase the active role played by GPs in support of patient requests for the early detection of skin cancer.

We estimated the diagnostic skill of clinicians managing melanocytic skin naevi by measuring the percentage of malignant melanomas, premalignant and potentially malignant naevi, in 1896 excised melanocytic lesions submitted to a pathology service over 11 weeks. They comprised 8 per cent. The percentage increased with age: 4 per cent in the under-40s, 17 per cent in those aged 40-59, and 30 per cent in those over 60, (P < 0.001, sex-adjusted). Although the percentage was twice as high in males (11 per cent) as females (6 per cent), after adjustment for age the difference was not significant. Invasive melanomas, 3 per cent of the total, were similar: 1 per cent were from under-40s; 7 per cent from those aged 40-59 years; and 14 per cent from those over 60. They comprised 4 per cent of lesions from males and 2 per cent from females. These trends may indicate poor specificity of clinical diagnosis, notwithstanding other reasons for removal of naevi (cosmetic), particularly among patients under 40, and females.

Evidence of deficiencies in communication skills in general practice abound, despite the importance with which such skills are regarded both within the profession and outside it. A qualitative assessment of associated literature over a 35-year period showed that good communication skills are associated with markers of better care and even of better health. Teaching communication skills to students is regarded as important, but it is not clear what form of education leads to better communication. Sufficient time is one of the most important elements; appropriate attitudes on the part of the clinician are probably important too. General practitioners can improve their care of patients by paying more attention to good communication and to understanding the consultation process.

We questioned 229 general practitioners (GPs), 288 women who had recently delivered babies in public hospitals, 26 public hospital doctors, and 33 midwives in South Brisbane. Shared antenatal care was undertaken by 84% of mothers, and recently provided by 88% GPs. Mothers valued having sufficient time with their antenatal clinician, continuity of care, and short waiting and travel times. They preferred a GP to provide antenatal care, and a hospital midwife to deliver them. GPs were interested in providing even more obstetric care--one third in providing intrapartum care--and in gaining continuing education in obstetrics. Hospital doctors and midwives were supportive of women choosing the personnel to deliver them, and of an increased GP and midwife role in public hospital obstetrics, but unenthusiastic about home deliveries. There is widespread support for an increased role for GPs in public obstetrics.

Alternative strategies for two-sample cross-validation of covariance structure models are described and investigated. The strategies vary according to whether all (tight strategy) or some (partial strategy) of the model parameters are held constant when a calibration sample solution is re-fit to a validation sample covariance matrix. Justification is provided for three partial strategies. Conventional and alternative strategies for cross-validation are discussed as methods for evaluating overall discrepancy of a model fit to a particular sample, where overall discrepancy arises from the combined influences of discrepancy of approximation and discrepancy of estimation (Cudeck & Henly, 1991). Results of a sampling study using empirical data show that for tighter strategies simpler models are preferred in smaller samples. However, when partial cross-validation is employed, a more complex model may be supported even in a small sample. Implications for model comparison and evaluation, as well as the issues of model complexity and sample size are discussed.

A cross-sectional study of the sun-related attitudes and beliefs of 3,655 children in Grades 7 to 11 attending 55 representative Queensland schools was undertaken using a structured questionnaire administered at school. Factors derived from a series of focus groups were incorporated into the questionnaire. Knowledge about risk factors in the aetiology of skin cancer and the role of protective measures was high. Several potential barriers to the use of sun protection were identified, including the desire to be tanned, the perceived attitudes of the peer group to sun protection, and difficulties with the use of specific sun protection measures. In general, these barriers were significantly more prominent among boys and children from older grades than other students. These data will be used to design school-based sun protection interventions which are sensitive to these age and sex differences.

Tested monocularly, young infants classically show directional eye movement asymmetries, with optokinetic nystagmus (OKN) being more readily elicited by stimuli moving in the temporal-to-nasal (T-N) than in the nasal-to-temporal (N-T) direction. Since a counterphase grating is physically identical to two superimposed sinusoidal components moving in opposite directions, we wondered whether or not a counterphase grating would elicit T-N OKN in monocularly tested infants. Two-month-old infants were tested in a motion nulling paradigm. Under monocular test conditions, all infants showed T-N OKN in response to the counterphase grating. The results suggest that the young infant's visual system represents the counterphase grating in terms of its T-N and N-T components, and reduces the effective contrast of the N-T component prior to the generation of OKN. The results are discussed in relation to models of OKN asymmetries and the responses of direction-selective neurons to counterphase gratings.

A clinical activities audit is a method of obtaining interesting information about one's general practice. It is likely to generate improvement in practice, thereby fulfilling the most important requirement of quality assurance, even in the absence of nationally accepted standards of general practice. A five-day audit of clinical activities in one practice is detailed, and some of the changes that this prompted in consultation time management, investigation and referral rates, and conditions managed are frankly discussed.

Infant feeding practices were retrospectively ascertained in a random cohort of parous women (mean age 54.8 years) from Brisbane, Australia. Reported proportions of infants who were ever breast-fed fell from around 90% before 1960 to around 70% in the early 1970s, with some subsequent increase. Similar but stronger trends were reported in proportions of infants breast- but not bottle-fed. Few maternal characteristics were associated with feeding practices, but women with more education appear to have led both the early retreat from and the later return to breast-feeding.

The data on infant temporal contrast sensitivity functions (TCSFs) are scarce and contradictory. Earlier studies suggest that critical flicker frequency (CFF) is adultlike at 2-3 months postnatal (Regal, D. M., 1981 Vision Research, 21, 549-555), while contrast sensitivity at low temporal frequencies remains poor. If both of these findings are true, then infant TCSFs are much flatter than those of adults. In the present study, we have re-investigated 2-month-olds' contrast thresholds at low temporal frequencies. To match the conditions of Regal's CFF study, test fields were embedded in a luminance-matched surround. As in previous studies, low contrast sensitivities were found. Models of infants' flat TCSFs are discussed.

Objective: To assess the justification for the use of antibiotics in the management of sore throat in general practice., Data Sources: The literature from 1945 to 1990 was systematically screened to identify studies that addressed the question whether antibiotics reduce non-suppurative and suppurative complications and symptoms of sore throat. The key-words, "pharyngitis" and "tonsillitis" were used to identify trials of antibiotics for the treatment of sore throat., Study Selection: Studies were included in comparison tables if they involved the trial of one or more antibiotics against a control and there was an outcome in terms of reduction in the incidence of acute rheumatic fever, acute glomerulonephritis, acute otitis media, acute sinusitis, quinsy or any symptoms related to the acute illness., Results: The published literature suggests that antibiotic treatment protects patients with sore throat against acute rheumatic fever and some suppurative complications, but not against acute glomerulonephritis. It does not reduce the symptoms., Conclusions: In Australia, with the exception of socioeconomically deprived Aboriginal communities, the incidence of acute rheumatic fever is probably not high enough to justify the use of antibiotics for sore throat. Protection against suppurative infection seems to be slight and it is difficult to establish the benefit of antibiotic treatment for reducing the symptoms of sore throat. Until more benefits for antibiotic management of sore throat can be demonstrated, it is recommended that infrequent use be adopted.

Objective: To assess the justification for the routine use of investigations in the diagnosis of bacterial causes of sore throat., Data Sources: The literature from 1945 to 1990 was systematically screened to identify studies that addressed diagnosis of bacterial infection and the efficacy of antibiotics in sore throat, using the key-words "pharyngitis" and "tonsillitis"., Results: Difficulties were identified with clinical methods and investigations that identify streptococcal infections. The practice of throat-swab culture--the "gold standard"--appears to have developed as a strategy to protect patients from acute rheumatic fever. However, this method may be limited in its usefulness for protection against acute rheumatic fever because: (i) in many cases in which the streptococcus is isolated from symptomatic patients there is no serological evidence of infection; (ii) there are very high asymptomatic carrier rates of the streptococcus; (iii) even after adequate treatment with penicillin there are high bacteriological failure rates; and (iv) those organisms that can be isolated from the mucosal surface are a poor representation of organisms lying deep in the tissues. Evaluation of other diagnostic techniques such as Gram's stain and rapid antigen testing, as well as decision analysis, has also been hampered by the difficulties encountered with use of this inadequate gold standard., Conclusion: There is little indication from the literature that any routine system of identifying bacterial causes of sore throat is helpful to the clinician.

The need to teach undergraduate medical students the skills of conducting a consultation now seems well established. Several authors have also established the efficacy of using constructive feedback on videotapes of each student's interaction with a patient to enhance such skills. To date, however, students' perceptions of this process have not been reported. Here we present the results of such a study, together with a review of the relevant literature. In our study we found that students felt that their skill at analysing and evaluating consultations had been enhanced, but that they would have liked to have more than one of their consultations taped and reviewed. This last suggestion is discussed in the light of the literature reviewed, as are the advantages and disadvantages of using real or surrogate patients for this kind of training.

The prevalence of antenatal care shared between general practitioner (GP) and public hospital services in Brisbane, and its acceptability to patients was assessed. Responses to questionnaires put to women in the immediate puerperium of the public wards of 2 major teaching hospitals are presented. Antenatal shared-care was undertaken in 54% of pregnancies. Indications of advantages for women to undergo antenatal shared-care were identified with convenience of appointment time, and decreased travel and waiting time. An important cooperation between GP and hospital obstetric services appears to have evolved in the area of antenatal care that provide benefits at least for patients' convenience.

The epidemiology of the common cold is reviewed with the aim of providing helpful advice for patients. Future management will include limiting the spread of the cold virus by attention to the mode of transmission and the development of anti-viral drugs, of which interferon holds the most promise.

The initiation of a Quality Assurance (QA) Programme for general practitioners in Australia was initiated in 1987. It has had to meet the challenges of a diverse and independent group, but participation has been good after the first three years. The theoretical basis for the types of QA activity undertaken is discussed, as well as the political climate under which general practice QA is being established in Australia and abroad.

Public opinion is increasingly opposed to smoking and more and more smokers wish to stop. This article offers a practical, 10 point strategy for general practitioners to use to identify patients who smoke and to help them overcome their addiction.

We describe the simple, rapid turbidimetry of IgM rheumatoid factor in human serum by use of the Cobas-Bio centrifugal analyzer. Heat-aggregated human IgG is used as the antigen. The immunoturbidimetric reaction is monitored at 340 nm for 300 s, and the changes in absorbance after the antigen is added are used to prepare the standard curve. Test results are calculated from the stored curve and reported in int. units/mL, based on comparison with the WHO reference serum for rheumatoid factor. There is no interference from bilirubin (up to 340 mumol/L) or hemoglobin (up to 5600 mg/L). Serum samples with a triglyceride concentration greater than 2.20 mmol/L must be cleared of lipids before analysis. The standard curve is linear from 30 to 500 int. units/mL. Precision, accuracy, linearity, and sensitivity are quite acceptable. The CV was generally less than 5% for different concentrations of rheumatoid factor. Results agree well with those by a rate-nephelometric procedure on the Beckman ICS system (rs = 0.932). However, both correlate poorly with a modified classical Waaler-Rose test. Of 47 patients with rheumatoid arthritis, 34 had IgM rheumatoid factor in their serum, but the measured value did not reflect the activity of the disease.

We studied groups of normal infants and infants with amblyopia and esoropia to determine the incidence of infantile astigmatism. Under cycloplegia, 19% of normal infants had astigmatism; this was at least twice the incidence in adults, but less than one-hale that found by noncycloplegic refractions of infants. During the first three postnatal years the incidence of astigmatism and distributions of spherical equivalents and anisometropia did not distinguish normal patients from most of those with esotropia and amblyopia.

An audit of routine urine testing by dipsticks at a large private provincial hospital analysed 2294 patient records. No result was recorded in 12% of records. Abnormal but expected results were obtained in 9% of cases. Of the 4% of unexpectedly abnormal results, in only one-third of patients was the attending practitioner aware of these results and, in fewer than one-fifth of the patients, were further diagnostic tests performed. In not one case was treatment altered.

Objective: To investigate the perceptions of patients about delivery of their babies., Method: One hundred and forty four out of 200 surveyed women answered consumer orientated questions before and after delivery., Results: They were on the whole satisfied with antenatal classes (there seemed to be a need for more information in the form of an on-the-ward postnatal class), disliked the practice of perineal shaves (but did not object to enemas or rupture of membranes) and felt they had adequate analgesia (although not for after-pains or the discomfort of haemorrhoids in the puerperium). Women who intend to deliver in the more (western) conventional positions are less likely to be disappointed. Women expressed the desire to be more actively involved in some aspects of delivery such as cutting the cord, putting the baby to the breast and being alone with partner and baby immediately after delivery. Cardiotocography (CTG) is more reassuring than frightening. A "Birthing Room" is seen as a satisfactory alternative to home delivery.

A relatively new intravenous opaque medium, Hypaque(R) in 50 per cent solution, was used in 50 consecutive patients. None of them had a serious reaction. Twenty-two had mild reactions which were of no clinical significance. The radiographs obtained seemed to be equal in quality to those obtained with other contrast media.