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Cancer awareness in the community. A community survey.

Introduction

Although the prevention and control of cancer requires a number of approaches, it is recognized that well designed preventive strategies and increased early detection play an important role.  The areas in which prevention might significantly reduce the number of cancers are reduced smoking which will affect the incidence of lung cancer, and sun protection which should decrease the incidence of malignant melanoma.  With regard to early detection, self examination and mammography of the breast and cervical smears may detect cancer at an early stage and result in significantly improved survival.

The efficacy of these methods depend to a large extent on promoting a change in behaviour, and on high level of public awareness of the issues surrounding cancer.

In consequence a primary aim of cancer societies for some time has been to promote public education programmes about the risks for, and treatment of, cancer.  Although cancer societies have been very active in promoting these educational aims, it is unclear how well the public has assimilated the message.

Although some work had been carried out in Britain and Australia, non surveys of public awareness of cancer had been carried out in New Zealand.

The group therefore decided to assess the level of cancer knowledge in a randomly selected sample of Dunedin residents.

Authors of Report

John Ah Chan, Tabwe Bio, Simon Bugden, Cameron Dickson, Beheshteh Khoshaeen, Joseph Kizito, Julie Lincoln, Mark Lawrence.

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Is medicine hazardous to your health

Abstract

What can possibly be called the “myth of being a doctor” has, up until recent times, prevailed.  Being a doctor was surrounded by notions of power, status and wealth.

More recently, television series and documentaries have portrayed the “doctor’s life” with more realism.  Pressures experienced by doctors, especially those recently graduated, are being more openly discussed in terms of the resulting symptoms of stress, depression, drug abuse and suicide.  It is becoming apparent world-wide that doctors can be less healthy than the people they care for (eg. King et al., 1992).

Medicine itself is forever experiencing change.  Today’s patients are better informed and are demanding higher standards of care.  There is increasing recourse to litigation, and in New Zealand in particular, political reforms have led to stressful organizational changes.  These pressures and the demands of personal obligations, such as marriage, parenthood and financial independence put strain on many doctors.

In New Zealand the Medical Council has recently raised concerns about personal difficulties encountered by some doctors, including divorce, alcohol and substance abuse, “burn-out”, financial problems and suicide (personal communication, 1995).  In Australia, Pullen et al. (1005) found that few doctors had their own GP, and many self prescribed a variety of medications.  Firth-Cozen (1987) found that stress in junior house officers in Britain was higher than other occupational groups, and that evidence of depression and problem drinking was significantly greater than the general population.

Some studies in the literature point to relatively higher rates of suicide in doctors then in the general population.  Arnetz et al.  (1987) for example, found that female Swedish doctors were more likely than both male Swedish doctors and the general Swedish population to commit suicide between 1961 and 1970 (P<0.10).  Similarly, a United Kingdom study (Rucinski et al., 1985)( reviewed the occupational mortality figures for England and Wales and found that doctors were 1.5 times more likely to die of suicide than those of the same socioeconomic group.

There are few studies, however, regarding the health and lifestyle of the majority of New Zealand doctors, ie. those who do not come ot the notice of the Medical Council.  Perkins et al. (1995) surveyed consultant doctors in three CHE’s.  They identified a number of stressful factors, such as keeping up to date, carrying a heavy clinical workload, time pressure, and a number of satisfying factors, such as doing the job properly, having a job that seems worthwhile and having control of one’s professional life.

Booth and Smith (1990) studied job satisfaction amongst resident medical officers in New Zealand.  They found that registrars were significantly more satisfied than house surgeons, and that over a third of all respondents would not have enrolled in medical school given prior knowledge of their working conditions.  They concluded that poor morale was endemic amongst junior doctors.

Durham et al. (1989) conducted a study of three cohorts of women and men in medicine, focusing upon gender difference in lifestyle and career choices.  They found that women who had never married were less likely to experience career difficulties, and that female doctors were more likely to have small families than males.

It has been stated that doctors may have 30 to 100 times the risk of developing alcohol dependence than the general population (Keeve, 1984).  Some overseas studies have concurred with this (Juntunen et al., 1988; Lewy, 1986), while others suggest that doctors are at no increased risk (Niven et al., 1984).  Unfortunately there is no available data regarding alcohol consumption by New Zealand doctors.  Most of this work has been done in Britain and the United States.

Doctors are also thought to be 30 to 100 more likely to be addicted to narcotics than the general population (Brewster, 1986).  Again there is no data available looking at the recreational substance use of New Zealand doctors.  Data from the US suggests that doctors are more likely than the general population to use prescription drugs such as benzodiazepines and opiates, but less likely to use illicit substances such as marijuana and hallucinogens (Hughes et al., 1992).

The purpose of this study was to gain information through a postal questionnaire from a population of New Zealand doctors with respect to their work and lifestyle, financial burden, general health, and tobacco, alcohol and drug use.  Participants in the study were also asked for their ideas on improving the health and coping strategies of New Zealand doctors.

Authors of Report

Annabel Begg, Brigid Connor, Maureen Dingwall, Deborah Gardiner, Craig Gedye, Julia Given, Matthew Reid.

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Needle stick injury in general practice

Abstract

We undertook this survey as our final year Community Health Evaluation Project.  The primary aim of this study was to evaluate the occupational hazards and risk of needle stick injury faced by health care workers in general practice exposed to contaminated sharps.  This was accomplished by means of an anonymous self addressed questionnaire send to general practitioners and practice nurses in the Wairarapa, Taranaki, Nelson and Bays, Marlborough, Greymouth, West Coast and Southland regions.  The response rate was 82% overall, with 95% of practice nurses and 75% of general practitioners responding.  Needle stick injuries were found to be a significant problem in general practice, with 22% reporting one or more needle stick injuries in the last six months.  “Universal precautions” when dealing with sharps were variably applied by health care workers.  Alarmingly, over 50% recapped needles and more than 15% of needle stick injuries were sustained while recapping needles.  These are easily preventable.  Practice nurses were more likely to take precautionary measures when compared to general practitioners.  Lower levels of exposure to sharps, training, and taking more precautionary measures did not seem to reduce levels of needle stick injuries.  The majority of practices had a formal policy dealing with the use and disposal of sharps, however, many lacked a policy regarding the actions to be taken and documentation following a needle stick injury.  Knowledge of transmission rates of blood borne pathogens was poor in both general practitioners and practice nurses.  Immunisation rates were encouraging with 85% having been immunized against Hepatitis B.

Recommendations included are:

  • improve awareness among general practitioners and practice nurses that needle stick injuries are a significant occupational health risk.
  • health care workers should perceive every patient to be of the high risk category and protect themselves accordingly.
  • all needle stick injuries should be formally documented and followed up.
  • all health care workers need to be immunised against Hepatitis B and to have regular antibody status checks every 5 years.

Authors of Report

Dennis Lum, Zara Mason, Goswin Meyer-Rochow, Bridget Neveldsen, Maithri Siriwardena, Perry Turner

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Patient satisfaction with the Queen Mary Maternity Centre

Introduction

Patient satisfaction and a custom focus are becoming increasingly important in health services which are attempting to become competitive.  Patient satisfaction is also being viewed as a valid and important outcome measure when evaluating health care, the organization of services and the allocation of funds.

The Queen Mary maternity centre has been surveying patients on their satisfaction with the centre since 1992.  This has been in the form of a set of standardized questions given to all women who give birth at the centre.  The form is given to mothers when they arrive at Queen Mary to give birth, along with other separate information on birthing, services provided at Queen Mary, and how to care for their newborn baby.  The survey form was designed to be anonymously completed and placed into collection boxes at discharge.  The questions asked were on specific issues pertaining to aspects of care associated with the Queen Mary centre received during pregnancy, birth and in the postpartum period.  To date little or no use has been made of the information that has been collected.

The aims of this project are to review the results of the completed satisfaction surveys from 1993, to identify the issues in patient care which are a source of ongoing dissatisfaction and which may need to be addressed, and also make recommendations for the future use of patient satisfaction surveys in the Queen Mary centre.

In order to comment on the satisfaction survey conducted at Queen Mary, it is necessary to explore the concept of patient satisfaction, how to interpret and analyse the results of such surveys, and what uses can be made of the results.

Authors of Report

Lauren McCormack, Mary McDevitt, Andrew Miller, Grant Rogers, Andrew Woollons.

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Public perception of the risks and benefits of alcohol consumption

Introduction

It has been well established for many years now that there are many negative effects, both social and medical, that result from the regular use of alcohol, be it in moderation or excess.

More recently, there has been the emergency of evidence that small quantities of alcohol, taken regularly, may reduce the risk of developing ischaemic heart disease and in some studies there is the suggestion that total mortality may itself be reduced.

Alcohol use is a complicated issue involving many medical and social factors, yet it is widely used in society to varying degrees by a public that may not be aware of all the risks that alcohol poses or some of the benefits that may be possible.  There is also the possibility that the public has misinterpreted the popular interpretation of “a drink a day being good for you” and is using alcohol as a health measure without proper regard for the wider risks of alcohol use.

This study aims to assess what the public perception of the risks and benefits of alcohol use are, and thereby provide some direction for future educational public health drives.

Authors of Report

Lee Anderson, Dilprasan De Silva, David Langston, Matthew Leaper, Frederick Phillips, Jeremy Sharr, Terence Yang.

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STD in the Community

Introduction

Prince Morrow, an early American dermatologist, once said of STD’s that, “Preventive medicine presents no more pressing problem than the prophylaxis of a class of diseases which have such important relations to public health” (1).  In spite of the fact that this statement was made at the turn of the century, it has never been more applicable than in today’s’ society.

Since 1989 the total number of new patients attending NZ STD clinics has dramatically increased from 12,650 to 28,672 in 1993 (2).  Disease trends have also undergone a significant change since the 1970s.  The major emphasis at that time was placed on diagnosis and treatment of gonorrhoea and syphilis.  Now Chlamydia, non-specific genital infections, ano-genital warts and genital herpes comprise the most commonly seen STDs in practice (32).  In addition the 1980s saw the recognition of two further STDs that were potentially lethal, these being human immunodeficiency virus (HIV) and hepatitis B.

Diagnosis, treatment and prevention strategies have become increasingly important, to reduce the significant morbidity and mortality associated with STD.  The long term sequelae of STDs encompasses a broad spectrum of health problems, including, infertility, ectopic and other adverse pregnancy outcomes, neonatal morbidity and mortality, secondary psychological disorders, certain types of cancers and acquired immunodeficiency syndrome (AIDS).

Many still attach a stigma to visiting a Sexual Health clinic and would prefer to see their own family physician.  General Practitioners (GPs) are, therefore, in a prime position to institute measures which could effectively improve control and outcome of STDs.  A GP consultation can provide a setting facilitating both, frank discussion of sexual practices, and individually targeted advice on reducing risks for acquiring an STD.  Opportunity also exists for health care worker to screen, counsel and initiate contact tracing as part of the community management of STDs.

Authors of Report

Gordon Faulds, Lindy Fookes, Hui Chiong Lau, Dale Fox, John Jarvis, Stephen Carran.

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The prevalence of post-operative problems in day care surgery

Aims:

  1. To identify post discharge problems in patients undergoing day surgery.
  2. To assess the level of social impact caused by day surgery.
  3. To determine the level of patient satisfaction with day surgery procedures.

Authors of Report

Kirsty Bennett, Juliet Berkeley, James Berryman, Robyn Carey, Simon Hendl, Stephanie Jones, Jorian Kippax, Hayden McRobbie.

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Women of child-bearing age and their knowledge and practices in relation to folic acid and vitamin A supplementation

Introduction

In 1993 the Public Health Commission released recommendations that all women who may become pregnant should be taking folic acid supplements.  Research has shown that the periconceptional use of folic acid supplements reduce the risk of neural tube defects in the baby.  Over this three year period no follow-up has been made to establish whether there is widespread public knowledge of this benefit, or whether these recommendations are being practiced by women contemplating pregnancy.

Excess consumption of vitamin A in the form of retinol (as opposed to beta-carotene), has been shown to have teratogenic effects on the unborn child.  Many multivitamins as well as foods such as liver contain high levels of vitamin A, and hence their use before and during pregnancy is potentially harmful to the child.

It is important to establish the depth of public awareness of these issues and the practices of women of child-bearing age in respect to the recommendations in order to evaluate the effectiveness of the public health policy and the general public educated as necessary.

Authors of Report

Amanda Aveling-Rowe, Stephanie Bardsley, Rebecca Chalmers, Shirley Chan, Angela Craig, Phillip Davis, Lawrence Ng, Dyanne Wilson.

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