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Warts are common skin infections caused by human papillomavirus (HPV) and affect most people sometime in their life. A number of epidemiological studies on the prevalence of warts have been completed in schools, various occupational groups, general practices and hospitals. All studies have relied on a subjective measure for the diagnosis of warts. Cross-sectional studies completed in schools have shown the prevalence in children to vary from 2 to 20%. Occupational handlers of meat, poultry and fish have a higher prevalence than other workers. Children and young adults are the groups most affected. Future studies are needed to investigate the true frequency of warts in the community and the likelihood of an individual developing these lesions during his/her lifetime.

Objective: To determine whether there has been an improvement in ascertainment of malformations in the Victorian Congenital Malformations Register (VCMR). Methodology The medical records of 500 children under 4 years of age admitted consecutively to two paediatric teaching hospitals in Victoria in 1992 were viewed to determine whether these cases had been notified to the Register. Results Over three-quarters of the defects recorded had been notified to VCMR. There was 100% ascertainment of chromosomal anomalies and a high proportion of major structural malformations were notified. Conclusion This study repeats the validation study completed in 1986 and shows marked improvement in ascertainment of malformations in the VCMR by 1992.

Summary. In order to describe ethnic differences in the incidence of the sudden infant death syndrome (SIDS) records of all livebirths in the State of Victoria, Australia, 1985–1989, excluding those who died in the first month of life, were linked to death certificates. Cases were defined as infants dying with a diagnosis of SIDS between 1 month and 1 year of age (n= 601) from the cohort of 308052 neonatal survivors. Ethnicity was defined by the mother's country of birth. The SIDS incidence was 2.04/1000 in infants of Australian-born mothers. The relative risk of SIDS was 0.28 (95% confidence interval (CI) 0.15,0.55) in infants whose mothers had been born in Southern Europe and 0.48 (95% CI 0.29, 0.78) in infants whose mothers had been born in Asia. SIDS in infants of Australian-born mothers was associated with low maternal age, high parity, marital status other than married, male sex, multiple birth, low birthweight and preterm birth. After adjustment for those factors in a case-control analysis using a logistic regression model the adjusted odds ratio for SIDS was 0.34 (95% CI 0.17, 0.69) comparing infants whose mothers were born in Southern Europe with infants of Australian-born mothers, and 0.60 (95% CI 0.35, 1.04) for infants whose mothers were born in Asia, compared with infants of the Australian-born. Thus there are substantial ethnic differences in SIDS which are not explained by the classic social and perinatal risk factors.

Dominique A Cadilhac1,2, Monique Kilkenny1,2, Leonid Churilov1,2, Dawn Harris3, Erin Lalor3, on behalf of the National Stroke Foundation1National Stroke Research Institute, Heidelberg Heights 3081, Vic, Australia; 2Department of Medicine, The University of Melbourne 3010, Australia; 3National Stroke Foundation, Melbourne 3000, AustraliaAbstract: In 2007, the National Stroke Foundation (Australia) conducted the first national audit of acute inpatient services for stroke with >30 indicators. Routine collection of many variables can be a burden for clinicians, and methods to identify practical subsets are needed.Purpose: To identify a subset of indicators to facilitate meaningful longitudinal comparisons, and to reliably represent the full suite of indicators.Methods: 3-steps were taken:1) Value-based judgments to establish a subset were made by the National Advisory Committee (of the National Stroke Foundation) given: level of evidence, clinical relevance, consumer importance, and ability for international comparisons2) Statistical analyses were used to identify subsets that could predict patient outcome and total process score3) Comparisons of steps 1 and 2: logistic regression and estimation of agreement using intraclass correlation coefficient and Lin’s concordance coefficient.Results: Value-based judgments resulted in 14 indicators being selected; parametric methods identified 12. Six indicators were consistently selected: stroke unit care; aspirin, physiotherapy assessment, and speech pathology assessment within 48 hours; a care plan; and ­antihypertensive medication at discharge. The scoring method based on the value-based indicator subset ­demonstrated excellent agreement with total process scores of hospitals.Conclusion: Selection of an indicator subset requires consideration of several factors. ­Indicators selected by experts were robust.Keywords: stroke, processes of care, performance, acute care, Australia

SUMMARY A survey was undertaken in the central Victorian city of Maryborough to investigate the use of pharmacies and general practitioners as sources of advice about skin problems. In a 2 week period consumers purchasing either prescription or over the counter (OTC) products for skin, hair and nails in pharmacies were approached for interview. Simultaneously, each of the city's general practitioners (GP) completed questionnaires on all patients presenting with conditions of skin, hair and nails. Seventy per cent of the 315 consumers interviewed were purchasing OTC products and 30% prescription items. Of the OTC products, 42% were originally recommended by pharmacy staff and 18% by doctors. Over one-third of consumers buying OTC products described symptoms to pharmacy staff and in about half of the cases it was to the pharmacy assistant. One-third of people describing symptoms had already seen a doctor. Problems most frequently reported were dermatitis, skin dryness, acne and tinea. General practitioners recorded 265 conditions (of which 54% were new) in patients. The most common condition treated was solar keratosis, and GP wrote a prescription for 43% and recommended OTC products for 7% of conditions. People in Maryborough are seeking advice for their skin conditions from a variety of sources including GP, pharmacies and others.

The very rapid worldwide increase in mobile phone use in the last decade has generated considerable interest in the possible health effects of exposure to radio frequency (RF) fields. A multinational case-control study, INTERPHONE, was set-up to investigate whether mobile phone use increases the risk of cancer and, more specifically, whether the RF fields emitted by mobile phones are carcinogenic. The study focused on tumours arising in the tissues most exposed to RF fields from mobile phones: glioma, meningioma, acoustic neurinoma and parotid gland tumours. In addition to a detailed history of mobile phone use, information was collected on a number of known and potential risk factors for these tumours. The study was conducted in 13 countries. Australia, Canada, Denmark, Finland, France, Germany, Israel, Italy, Japan, New Zealand, Norway, Sweden, and the UK using a common core protocol. This paper describes the study design and methods and the main characteristics of the study population. INTERPHONE is the largest case-control study to date investigating risks related to mobile phone use and to other potential risk factors for the tumours of interest and includes 2,765 glioma, 2,425 meningioma, 1,121 acoustic neurinoma, 109 malignant parotid gland tumour cases and 7,658 controls. Particular attention was paid to estimating the amount and direction of potential recall and participation biases and their impact on the study results.

Background Establishing a stroke unit (SU) in every hospital may be infeasible because of limited resources. In Australia, it is recommended that hospitals that admit ≥100 strokes per year should have a SU. We aimed to describe differences in processes of care and outcomes among hospitals with and without SUs admitting at least 100 patients/year. Methods National stroke audit data of 40 consecutive patients per hospital admitted between 1/7/2010-31/12/2010 and organizational survey for annual admissions were used. Descriptive analyses and multilevel regression were used to compare patient outcomes. Sensitivity analysis including only hospitals meeting all of the Australian SU criteria (e.g., co-location of beds; inter-professional team; weekly meetings; regular training) was performed. Results Two thousand eight hundred ninety-eight patients from 72/108 eligible hospitals completing the audit (SU = 60; patients: 2,481 [mean age 76 years; 55% male] and non-SU patients: 417 [mean age 77; 53% male]). Hospitals with SUs had greater adherence to recommended care processes than non-SU hospitals. Patients treated in a SU hospital had fewer new strokes while in hospital (OR: 0.20; 95% CI 0.06, 0.61) and there was a borderline reduction in the odds of dying in hospital compared to patients in non-SU hospitals (OR 0.57 95%CI 0.33, 1.00). Among SU hospitals meeting all SU criteria (n = 59; 91%) the adjusted odds of having a poor outcome was further reduced compared with patients attending non-SU hospitals. Conclusion Hospitals annually admitting ≥100 patients with acute stroke should be prioritized for establishment of a SU that meet all recommended criteria to ensure better outcomes.

Tinea pedis is a common inflammatory skin condition due to infection by dermatophyte fungi. A number of epidemiological studies have been completed on the frequency of tinea pedis in the community, particularly sporting and occupational groups and schools. Most studies have focused on small, high-risk populations. These include occupational groups involving manual labour, sporting groups such as swimmers, and those working or living in confined conditions with shared washing facilities, which favour the opportunity for cross-infection. Most studies show that the frequency of tinea pedis is higher in males than females. Tinea pedis infections appear to be least common among children, but do occur, and are commonly misdiagnosed. The difference between clinical disease and confirmed diagnosis by culture is not always clear when statistics of disease frequency have been presented. Clear diagnosis criteria indicating the level of mycologically confirmed diagnosis should be reported in future studies that include statistics on disease frequency. Future epidemiological studies should also aim to be population-based in order to obtain a more complete picture of disease frequency.

Summary Although seborrhoeic keratoses (SKs) appear to be very common, there are very few studies reporting details of age-specific prevalence, distribution or possible cause. We report details on the frequency, nature and distribution of SKs in 100 Australian adults in the age groups 15–25, 26–50, 51–75 and those aged more than 75 years. There was an increase in prevalence of SKs from 12% of 15–25 year olds to 100% of those aged more than 50 years. The median number of lesions in those with them also increased with age from six per person in 15–25 year olds to 69 per person in those aged more than 75 years. There was no difference in prevalence or numbers of lesions/person between males and females. SKs on exposed areas were more often flat and more than 3mm in diameter than those on the non-exposed areas. There was a higher prevalence of SKs on the exposed areas than non-exposed areas when taking into account the surface area. The data in this study demonstrate an increased frequency of SKs compared with those reported from the United Kingdom recently and from Australasia in the past, a phenomenon paralleling the changing frequency of skin cancer in these populations. This fact, plus the finding that SKs were more common as a function of skin surface area on the exposed areas of the body, suggests that sunlight may play a part in their development in those people who are predisposed to develop them.

A computer-assisted telephone interview survey was carried out in the City of Maryborough to determine the prevalence and sources of advice for self-reported skin conditions. Of the 443 adults contacted, 416 (94%) agreed to participate in the study. One hundred and fourteen people (27%) reported having one or more skin conditions over the past 2 weeks, which included eczema/dermatitis 25.5% (range, 18.1-32.8%; 95% CI), warts 16.1% (9.8-22.4%), acne 16.2% (9.6-22.7%), cold sores 13.1% (7.3-18.9%) and tinea 11.2% (5.9-16.5%). Medical practitioners were the most common source of advice for 49% of skin conditions, followed by family and friends or self-prescribed (25%). Advice from a pharmacist was sought for 19% of skin conditions. Logistic regression analysis showed that those people who reported a moderate to severe inflammatory skin condition, such as dermatitis, urticaria or psoriasis, were most likely to seek advice from their medical practitioner. The type and severity of skin condition were factors which determined where a person sought advice on diagnosis and management.

SUMMARY A dermatology diagnostic database was established in order to determine the frequency and nature of skin conditions in a private dermatological practice in Central Victoria, Australia. Between August 1991 and June 1995, a total of 3346 dermatological diagnoses were recorded for 3000 new patient presentations. More women (58.9%) were seen than men (41.1%). Dermatitis and tumours of the skin accounted for 50% of new consultation(s), the highest attendance being for solar keratoses (11.9%). The frequency of patients seen was comparable to the previous 1970s survey of private dermatological practice in Australia, with the exception of melanocytic naevi, which was seen with twice the frequency compared to previously. The proportion of patients presenting with dermatitis was higher in the colder seasons of the year (winter and spring compared with summer and autumn). The proportion of people seen with melanocytic naevi was higher in summer and autumn compared with winter and spring. These results illustrate the usefulness of recording clinical patient data in practice as a way of recording patterns of referral as well as having a role in determining causation of disease.