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THOMAS, E. G., J. M. McCAW, H. A. KELLY, K. A. GRANT, and J. McVERNON. "Quantifying differences in the epidemic curves from three influenza surveillance systems: a nonlinear regression analysis." Epidemiology and Infection 143, no. 2 (April 23, 2014): 427–39. http://dx.doi.org/10.1017/s0950268814000764.
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SUMMARYInfluenza surveillance enables systematic collection of data on spatially and demographically heterogeneous epidemics. Different data collection mechanisms record different aspects of the underlying epidemic with varying bias and noise. We aimed to characterize key differences in weekly incidence data from three influenza surveillance systems in Melbourne, Australia, from 2009 to 2012: laboratory-confirmed influenza notified to the Victorian Department of Health, influenza-like illness (ILI) reported through the Victorian General Practice Sentinel Surveillance scheme, and ILI cases presenting to the Melbourne Medical Deputising Service. Using nonlinear regression, we found that after adjusting for the effects of geographical region and age group, characteristics of the epidemic curve (including season length, timing of peak incidence and constant baseline activity) varied across the systems. We conclude that unmeasured factors endogenous to each surveillance system cause differences in the disease patterns recorded. Future research, particularly data synthesis studies, could benefit from accounting for these differences.
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Lee, Matthew Hao, Robin Geoffrey Abell, Biswadev Mitra, Merv Ferdinands, and Rasik B. Vajpayee. "Risk factors, demographics and clinical profile of Acanthamoeba keratitis in Melbourne: an 18-year retrospective study." British Journal of Ophthalmology 102, no. 5 (August 27, 2017): 687–91. http://dx.doi.org/10.1136/bjophthalmol-2017-310428.
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PurposeTo assess incidence, risk factors, presentation and final visual outcome of patients with Acanthamoebakeratitis (AK) treated at the Royal Victorian Eye and Ear Hospital (RVEEH), Melbourne, Australia, over an 18-year period.MethodsA retrospective review of all cases of AK managed at RVEEH between January 1998 and May 2016 was performed. Data collected included age, gender, affected eye, signs and symptoms, time between symptoms and diagnosis, risk factors, presenting and final visual acuity (VA), investigations, medical treatment, surgical interventions and length of follow-up.ResultsA total of 36 eyes affected by AK in 34 patients were identified. There were 26 cases diagnosed early (<30 days) and 10 were diagnosed late (≥30 days). There were 31 (86.1%) cases associated with contact lens (CL). Signs associated with early AK included epithelial infiltrates, while signs of late AK included uveitis, ring infiltrate, endothelial plaque and corneal thinning (p<0.05). Surgical treatment was required in seven cases (19.4%). There were 29 (80.6%) cases that reported improved VA. Median best corrected final VA was worse in patients with late diagnosis (logarithm of minimal angle of resolution (logMAR) 0.5, IQR: 0.2–0.8), compared with patients with early diagnosis (logMAR 0.0, IQR: 0.0–0.3; p=0.01). Late diagnosis was associated with a prolonged disease period.ConclusionAK was an uncommon cause of severe keratitis and was associated commonly with CL. Patients with late diagnosis had worse presenting and final VAs as well as a prolonged disease period, indicating need for early recognition and management.
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Vodstrcil, Lenka A., Christopher K. Fairley, Deborah A. Williamson, Catriona S. Bradshaw, Marcus Y. Chen, and Eric P. F. Chow. "Immunity to hepatitis A among men who have sex with men attending a large sexual health clinic in Melbourne, Australia, 2012–2018." Sexually Transmitted Infections 96, no. 4 (March 13, 2020): 265–70. http://dx.doi.org/10.1136/sextrans-2019-054327.
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BackgroundOutbreaks of hepatitis A are being reported more commonly among men who have sex with men (MSM) globally. Australia has also reported a sharp increase in the number of cases of hepatitis A in 2017. This study aimed to determine the level of immunity to hepatitis A among MSM attending a large urban sexual health clinic in Victoria in the lead up to recent outbreak.MethodsThis was a retrospective audit of serological testing data from first-time MSM attendees at Melbourne Sexual Health Centre (MSHC) in Australia from 1 January 2012 to 31 December 2018. We determined the proportion of MSM who were tested and who had serological detection of hepatitis A IgG, stratified by age and calendar year. We used univariable and multivariable logistic regression to investigate factors associated with testing for and detection of hepatitis A IgG.ResultsThere were 16 609 first-time MSM attendees at MSHC over the 7-year period, of which 9718 (59%, 95% CI 58% to 60%) were tested for hepatitis A IgG. There was a 2% annual increase in the proportion of men tested (from 60% in 2012 to 69% in 2018; OR=1.02, 95% CI 1.00 to 1.03, p=0.025). Men born outside of Australia/New Zealand, and younger men <30 years had higher odds of being tested. Of those tested, 44% (n=4304, 95% CI 43% to 45%) had hepatitis A IgG detected at their first visit, with no change over time (OR=1.01, 95% CI 0.99 to 1.03, p=0.210). Detection of hepatitis A IgG was associated with being aged 30 years or older (adjusted OR=2.06, 95% CI 1.89 to 2.24, p<0.001) or being born overseas versus Australia/New Zealand (AOR=1.21, 95% CI 1.11 to 1.31, p<0.001).ConclusionHepatitis A immunity among MSM remains below the estimated 70% required to prevent outbreaks. Measures including increased testing and higher vaccination coverage are needed to prevent outbreaks and to limit the number of cases and deaths.
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Zhang, Hua, Bridget H.-H. Hsu-Hage, and Mark L. Wahlqvist. "Longitudinal changes in nutrient intakes in the Melbourne Chinese Cohort Study." Public Health Nutrition 5, no. 3 (June 2002): 433–39. http://dx.doi.org/10.1079/phn2001259.
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AbstractObjective:To assess longitudinal changes in the consumption of nutrients and the impact of socio-economic factors on diet transition in the Melbourne Chinese Health Study (MCHS) cohort.Design:Longitudinal study including two phases: baseline (1989/90) and follow-up (1995/97).Settings:Melbourne metropolitan areas in Victoria, Australia.Study subjects and method:Two hundred and sixty-two Chinese men and women aged 25 years and over, recruited at baseline, who had completed the both baseline and follow-up food-frequency questionnaires.Results:Women increased their daily intakes of energy (+549 kJ), protein (+7.8 g), fat (+7.3 g) and dietary fibre (+5.6 g) whereas men decreased their daily consumption of carbohydrate (-38.5 g) over an average period of 8 years. Energy contributions from protein and fat rose while that from carbohydrate dropped for all cohort subjects. Increased intakes of riboflavin, β-carotene and iron were observed in men, while an increased consumption of thiamine, riboflavin, niacin and minerals (except sodium) was observed in women. Socio-economic factors such as education, family income levels and occupational categories appeared to have a far more powerful influence on changes in individual daily nutrient intakes than age or length of stay in Australia. Changes in nutrient intake in women were less affected by sociodemographic variables.Conclusion:The observed changes in nutrient intakes indicated a progressive approach towards the Australian Recommended Dietary Intakes within this Chinese cohort population.
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Wong, Nicole X., Nigel W. Crawford, Jane Oliver, Alissa McMinn, Natasha S. Ching, Ciara Baker, Pierre R. Smeesters, Andrew J. Daley, and Andrew C. Steer. "A Cluster of Pediatric Invasive Group A Streptococcus Disease in Melbourne, Australia, Coinciding with a High-Burden Influenza Season." Journal of Pediatric Infectious Diseases 14, no. 04 (March 7, 2019): 213–18. http://dx.doi.org/10.1055/s-0038-1677456.
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Background Invasive group A streptococcal disease (IGAS) carries significant morbidity and mortality in children. Fluctuations in disease incidence are well documented. However, the modulating factors that contribute to these changes remain unclear. Prospective monitoring of IGAS cases in Victoria, Australia, showed an increased number of cases in 2017, coinciding with a peak of influenza illness. Methods Children identified to have IGAS are prospectively monitored in Melbourne through a disease surveillance network. Data on their presentation, investigations, and clinical course are collected. An increased number of cases identified between June 1, 2017, and October 31, 2017, have been retrospectively analyzed. Results We identified 22 cases of pediatric IGAS during the study period. Increased case detection occurred during a period of increased influenza disease. Of 11 children in our cohort who underwent respiratory viral testing, 4 were confirmed to have concurrent respiratory tract illnesses, and 2 were confirmed to have influenza.
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Dawson, Luke P., Justin A. Cole, Terase F. Lancefield, Andrew E. Ajani, Nick Andrianopoulos, Amanda G. Thrift, David J. Clark, et al. "Incidence and risk factors for stroke following percutaneous coronary intervention." International Journal of Stroke 15, no. 8 (April 4, 2020): 909–22. http://dx.doi.org/10.1177/1747493020912607.
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Background Stroke rates and risk factors may change as percutaneous coronary intervention practice evolves and no data are available comparing stroke incidence after percutaneous coronary intervention to the general population. Aims This study aimed to identify the incidence and risk factors for inpatient and subsequent stroke following percutaneous coronary intervention with comparison to age-matched controls. Methods Data were prospectively collected from 22,618 patients undergoing percutaneous coronary intervention in the Melbourne Interventional Group registry (2005–2015). The cohort was compared to the North-East Melbourne Stroke Incidence Study population-based cohort (1997–1999) and predefined variables assessed for association with inpatient or outpatient stroke. Results Inpatient stroke occurred in 0.33% (65.3% ischemic, 28.0% haemorrhagic, and 6.7% cause unknown), while outpatient stroke occurred in 0.55%. Inpatient and outpatient stroke were associated with higher rates of in-hospital major adverse cardiovascular outcomes ( p < 0.0001) and mortality ( p < 0.0001), as well as 12-month mortality ( p < 0.0001). Factors independently associated with inpatient stroke were renal impairment, ST-elevation myocardial infarction, previous stroke, left ventricular ejection fraction 30–45%, and female sex, while those associated with outpatient stroke were previous stroke, chronic lung disease, previous myocardial infarction, rheumatoid arthritis, female sex, and older age. Compared to the age-standardized population-based cohort, stroke rates in the 12 months following discharge were higher for percutaneous coronary intervention patients <65 years old, but lower for percutaneous coronary intervention patients ≥65 years old. Conclusions Risk of inpatient stroke following percutaneous coronary intervention appears to be largely associated with clinical status at presentation, while outpatient stroke relates more to age and chronic disease. Compared to the general population, outpatient stroke rates following percutaneous coronary intervention are higher for younger, but not older, patients.
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Martín-Sánchez, Mario, Christopher K. Fairley, Catriona S. Bradshaw, Marcus Y. Chen, and Eric P. F. Chow. "Meningococcal vaccine uptake among men who have sex with men in response to an invasive meningococcal C disease outbreak in Melbourne, Australia." Sexually Transmitted Infections 96, no. 4 (January 9, 2020): 246–50. http://dx.doi.org/10.1136/sextrans-2019-054318.
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ObjectiveIn 2017, there was an outbreak of invasive meningococcal disease (IMD) serogroup C among men who have sex with men (MSM) in Victoria, Australia. A government-funded free meningococcal (MenACWY) vaccination programme targeting all MSM living in Victoria was launched between December 2017 and December 2018. The aim of this study was to examine the vaccine uptake among MSM attending a sexual health clinic in Melbourne.MethodsThis was a retrospective clinical audit of MSM attending the Melbourne Sexual Health Centre (MSHC) during the vaccination programme. We calculated the proportion of MSM who received the meningococcal vaccine on their first visit and at any time during the programme. We performed univariable and multivariable logistic regression to identify the factors associated with the vaccine uptake on the first visit.ResultsOf the 10 370 MSM who attended MSHC, 55.5% received the vaccine on their first visit and 67.4% at any time during the programme. MSM had higher odds of receiving the vaccine on the first visit if they were aged 16–25 years (adjusted OR (aOR) 1.21; 95% CI 1.08 to 1.35) or 26–35 years (aOR 1.17; 95% CI 1.07 to 1.29) in comparison with MSM older than 35 years; were HIV-negative and not on pre-exposure prophylaxis (aOR 1.80; 95% CI 1.56 to 2.09); had more than four male partners in the last 12 months (aOR 1.16; 95% CI 1.06 to 1.27); had male partners only (aOR 2.24; 95% CI 1.96 to 2.55); or were born overseas (aOR 1.11; 95% CI 1.03 to 1.21).ConclusionsTwo-thirds of the MSM attending a sexual health clinic received at least one dose of meningococcal vaccine. The vaccination programme coincided temporally with a dramatic reduction in the incidence of IMD. Vaccination should be further promoted among MSM and men who have sex with both men and women.
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Burns, Cate, Rebecca Bentley, Lukar Thornton, and Anne Kavanagh. "Reduced food access due to a lack of money, inability to lift and lack of access to a car for food shopping: a multilevel study in Melbourne, Victoria." Public Health Nutrition 14, no. 6 (February 22, 2011): 1017–23. http://dx.doi.org/10.1017/s136898001000385x.
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AbstractObjectiveTo describe associations between demographic and individual and area-level socio-economic variables and restricted household food access due to lack of money, inability to lift groceries and lack of access to a car to do food shopping.DesignMultilevel study of three measures of restricted food access, i.e. running out of money to buy food, inability to lift groceries and lack of access to a car for food shopping. Multilevel logistic regression was conducted to examine the risk of each of these outcomes according to demographic and socio-economic variables.SettingRandom selection of households from fifty small areas in Melbourne, Australia, in 2003.SubjectsThe main food shoppers in each household (n 2564).ResultsA lack of money was significantly more likely among the young and in households with single adults. Difficultly lifting was more likely among the elderly and those born overseas. The youngest and highest age groups both reported reduced car access, as did those born overseas and single-adult households. All three factors were most likely among those with a lower individual or household socio-economic position. Increased levels of area disadvantage were independently associated with difficultly lifting and reduced car access.ConclusionsIn Melbourne, households with lower individual socio-economic position and area disadvantage have restricted access to food because of a lack of money and/or having physical limitations due difficulty lifting or lack of access to a car for food shopping. Further research is required to explore the relationship between physical restrictions and food access.
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Voo, Veronica Tsin Fong, Jim Stankovich, Terence J. O’Brien, Helmut Butzkueven, and Mastura Monif. "Vitamin D status in an Australian patient population: a large retrospective case series focusing on factors associated with variations in serum 25(OH)D." BMJ Open 10, no. 3 (March 2020): e032567. http://dx.doi.org/10.1136/bmjopen-2019-032567.
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ObjectivesTo investigate whether sex, age, medical specialty and seasonal variations in serum concentration of 25-hydroxy vitamin D (25(OH)D) are evident among an Australian patient population.DesignRetrospective study analysing the results of serum 25(OH)D lab tests and vitamin D supplementation from Royal Melbourne Hospital (RMH) between 2014 and 2017.SettingTertiary healthcare centre in Victoria, Australia.Participants30 023 patients (inpatient and outpatient) who had their serum 25(OH)D levels measured at RMH between 2014 and 2017.Main outcome measuresSerum 25(OH)D levels stratified according to patients’ sex, age and medical specialty admitted to, as well as the season and year (2014 to 2017) 25(OH)D level was measured.ResultsMean serum 25(OH)D level of study population was 69.9 nmol/L (95% CI 69.5 to 70.2). Only 40.2% patients in this cohort were sufficient in vitamin D (>75 nmol/L). On average, 25(OH)D levels in male patients were 6.1 units (95% CI 5.4 to 6.9) lower than in females. Linear regression analysis found that 25(OH)D levels increased by 0.16 unit (95% CI 0.14 to 0.18) for every year increase in age. One-way analysis of variance showed patients from neurology had the highest average 25(OH)D level, 76.8 nmol/L (95% CI 74.2 to 79.3) compared with other medical specialties. Mean 25(OH)D level during winter, 64.9 nmol/L (95% CI 64.2 to 65.6) was significantly lower compared with other seasons despite supplementation. Average 25(OH)D level measured in 2014, 71.5 nmol/L (95 CI% 70.8 to 72.2) was significantly higher than levels measured in 2016–2017.ConclusionsThere is a sex, age, medical specialty, seasonal and yearly variation in vitamin D status in an Australian patient population. The association between low vitamin D status and winter despite supplementation suggests other interventions are required to boost serum 25(OH)D levels.
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Pilcher, David V., Graeme Duke, Melissa Rosenow, Nicholas Coatsworth, Genevieve O’Neill, Tracey A. Tobias, Steven McGloughlin, et al. "Assessment of a novel marker of ICU strain, the ICU Activity Index, during the COVID-19 pandemic in Victoria, Australia." Critical Care and Resuscitation 23, no. 3 (September 6, 2021): 300–307. http://dx.doi.org/10.51893/2021.3.oa7.
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OBJECTIVES: To validate a real-time Intensive Care Unit (ICU) Activity Index as a marker of ICU strain from daily data available from the Critical Health Resource Information System (CHRIS), and to investigate the association between this Index and the need to transfer critically ill patients during the coronavirus disease 2019 (COVID-19) pandemic in Victoria, Australia. DESIGN: Retrospective observational cohort study. SETTING: All 45 hospitals with an ICU in Victoria, Australia. PARTICIPANTS: Patients in all Victorian ICUs and all critically ill patients transferred between Victorian hospitals from 27 June to 6 September 2020. MAIN OUTCOME MEASURE: Acute interhospital transfer of one or more critically ill patients per day from one site to an ICU in another hospital. RESULTS: 150 patients were transported over 61 days from 29 hospitals (64%). ICU Activity Index scores were higher on days when critical care transfers occurred (median, 1.0 [IQR, 0.4–1.7] v 0.6 [IQR, 0.3–1.2]; P < 0.001). Transfers were more common on days of higher ICU occupancy, higher numbers of ventilated or COVID-19 patients, and when more critical care staff were unavailable. The highest ICU Activity Index scores were observed at hospitals in north-western Melbourne, where the COVID-19 disease burden was greatest. After adjusting for confounding factors, including occupancy and lack of available ICU staff, a rising ICU Activity Index score was associated with an increased risk of a critical care transfer (odds ratio, 4.10; 95% CI, 2.34–7.18; P < 0.001). CONCLUSIONS: The ICU Activity Index appeared to be a valid marker of ICU strain during the COVID-19 pandemic. It may be useful as a real-time clinical indicator of ICU activity and predict the need for redistribution of critical ill patients.
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Turkovic, Lidija, Daan Caudri, Tim Rosenow, Oded Breuer, Conor Murray, Harm A. W. M. Tiddens, Fiona Ramanauskas, Sarath C. Ranganathan, Graham L. Hall, and Stephen M. Stick. "Structural determinants of long-term functional outcomes in young children with cystic fibrosis." European Respiratory Journal 55, no. 5 (March 5, 2020): 1900748. http://dx.doi.org/10.1183/13993003.00748-2019.
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BackgroundAccelerated lung function decline in individuals with cystic fibrosis (CF) starts in adolescence with respiratory complications being the most common cause of death in later life. Factors contributing to lung function decline are not well understood, in particular its relationship with structural lung disease in early childhood. Detection and management of structural lung disease could be an important step in improving outcomes in CF patients.MethodsAnnual chest computed tomography (CT) scans were available from 2005 to 2016 as a part of the AREST CF cohort for children aged 3 months to 6 years. Annual spirometry measurements were available for 89.77% of the cohort (167 children aged 5–6 years) from age 5 to 15 years through outpatient clinics at Perth Children's Hospital (Perth, Australia) and The Royal Children's Hospital in Melbourne (Melbourne, Australia) (697 measurements, mean±sd age 9.3±2.1 years).ResultsChildren with a total CT score above the median at age 5–6 years were more likely to have abnormal forced expiratory volume in 1 s (FEV1) (adjusted hazard ratio 2.67 (1.06–6.72), p=0.037) during the next 10 years compared to those below the median chest CT score. The extent of all structural abnormalities except bronchial wall thickening were associated with lower FEV1 Z-scores. Mucus plugging and trapped air were the most predictive sub-score (adjusted mean change −0.17 (−0.26 – −0.07) p<0.001 and −0.09 (−0.14 – −0.04) p<0.001, respectively).DiscussionChest CT identifies children at an early age who have adverse long-term outcomes. The prevention of structural lung damage should be a goal of early intervention and can be usefully assessed with chest CT. In an era of therapeutics that might alter disease trajectories, chest CT could provide an early readout of likely long-term success.
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LANTSBERG, Daniel, Yossi MIZRACHI, and Darren KATZ. "Micro-TESE Outcomes for Non-Obstructive Azoospermia — The First Australian Series." Fertility & Reproduction 04, no. 03n04 (September 2022): 140. http://dx.doi.org/10.1142/s2661318222740528.
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Background: Micro-dissection testicular sperm extraction (micro-TESE) for non-obstructive azoospermia (NOA) was shown to achieve the best sperm retrieval rate (SRR) compared to other techniques. However, to date there is no large series of published Australian data. Aim: To study the incidence and predicting factors of successful sperm extraction in men with NOA undergoing micro-TESE in Victoria. Method: We retrospectively analyzed the clinical data of all consecutive patients with confirmed NOA who were treated between August 2014 and April 2020 in a single medical centre in Melbourne, Victoria. None were excluded. Patients underwent micro-TESE and upon a successful sperm retrieval, sperm was either frozen for fertility preservation or used fresh for ICSI. Results: During the study period, 85 men with NOA underwent micro-TESE in our centre. The overall sperm retrieval rate (SRR) was 61.2% (52/85). All patients with a history of surgically treated cryptorchidism or childhood diseases had a successful sperm retrieval. Patients with Kleinfelter syndrome had a 75% SRR. Patients with Idiopathic NOA and patients with a history of chemotherapy had a 50% and 40% SRR, respectively. Among the different types of testicular pathology, the highest SRR was found in men with complete hyalinization (100%). Hypospermatogenesis was associated with a high SRR of 93.3%, while Sertoli-cell-only histology was associated with only 46.3% SRR. The SRR has significantly increased from 33.3% in 2015-2016 to 73.6% in 2019-2020 (p=0.003). On Multivariate logistic regression analysis, baseline FSH levels <20 IU and history of childhood disease or Klinefelter syndrome were significantly associated with successful sperm retrieval. The cumulative pregnancy rate was 23.7%. Conclusion: This first report from Australia indicates that micro-TESE is an effective method for the treatment of NOA with high SRR and pregnancy rate. Our results can help patient management and counseling.
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Wang, Jennifer, Zyg Chapman, Emma Cole, Satomi Koide, Eldon Mah, Simon Overstall, and Dean Trotter. "Use of Closed Incision Negative Pressure Therapy (ciNPT) in Breast Reconstruction Abdominal Free Flap Donor Sites." Journal of Clinical Medicine 10, no. 21 (November 5, 2021): 5176. http://dx.doi.org/10.3390/jcm10215176.
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Background: Closed incision negative pressure therapy (ciNPT) may reduce the rate of wound complications and promote healing of the incisional site. We report our experience with this dressing in breast reconstruction patients with abdominal free flap donor sites. Methods: A retrospective cohort study was conducted of all patients who underwent breast reconstruction using abdominal free flaps (DIEP, MS-TRAM) at a single institution (Royal Melbourne Hospital, Victoria) between 2016 and 2021. Results: 126 female patients (mean age: 50 ± 10 years) were analysed, with 41 and 85 patients in the ciNPT (Prevena) and non-ciNPT (Comfeel) groups, respectively. There were reduced wound complications in almost all outcomes measured in the ciNPT group compared with the non-ciNPT group; however, none reached statistical significance. The ciNPT group demonstrated a lower prevalence of surgical site infections (9.8% vs. 11.8%), wound dehiscence (4.9% vs. 12.9%), wound necrosis (0% vs. 2.4%), and major complication requiring readmission (2.4% vs. 7.1%). Conclusion: The use of ciNPT for abdominal donor sites in breast reconstruction patients with risk factors for poor wound healing may reduce wound complications compared with standard adhesive dressings; however, large scale, randomised controlled trials are needed to confirm these observations. Investigation of the impact of ciNPT patients in comparison with conventional dressings, in cohorts with equivocal risk profiles, remains a focus for future research.
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Cheong, Jeanie L. Y., John D. Wark, Michael M. Cheung, Louis Irving, Alice C. Burnett, Katherine J. Lee, Suzanne M. Garland, et al. "Impact of extreme prematurity or extreme low birth weight on young adult health and well-being: the Victorian Infant Collaborative Study (VICS) 1991–1992 Longitudinal Cohort study protocol." BMJ Open 9, no. 5 (May 2019): e030345. http://dx.doi.org/10.1136/bmjopen-2019-030345.
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IntroductionInfants born extremely preterm (EP, <28 weeks’ gestation) or with extremely low birth weight (ELBW,<1000 g) in the era when surfactant has been available clinically are at high risk of health and developmental problems in childhood and adolescence. However, how their health and well-being may be affected in adulthood is not well known. This study aims to compare between EP/ELBW and normal birthweight (NBW) controls: (1) physical health, mental health and socioemotional functioning at 25 years of age and (2) trajectories of these outcomes from childhood to adulthood. In addition, this study aims to identify risk factors in pregnancy, infancy, childhood and adolescence for poor physical health and well-being in EP/ELBW young adults.Methods and analysisThe Victorian Infant Collaborative Study (VICS) is a prospective geographical cohort of all EP/ELBW survivors to 18 years of age born in the State of Victoria, Australia, from 1 January 1991 to 31 December 1992 (n=297) and contemporaneous term-born/NBW controls (n=262). Participants were recruited at birth and followed up at 2, 5, 8 and 18 years. This 25-year follow-up includes assessments of physical health (cardiovascular, respiratory and musculoskeletal), mental health and socioemotional functioning. Outcomes will be compared between the birth groups using linear and logistic regression, fitted using generalised estimating equations (GEEs). Trajectories of health outcomes from early childhood will be compared between the birth groups using linear mixed-effects models. Risk factors for adult outcomes will be assessed using linear and logistic regression (fitted using GEEs).Ethics and disseminationThis study was approved by the Human Research Ethics Committees of the Royal Women’s Hospital, Mercy Hospital for Women, Monash Medical Centre and the Royal Children’s Hospital, Melbourne. Study outcomes will be disseminated through conference presentations, peer-reviewed publications, the internet and social media.
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Shoeb, Mohammad Fazelul Rahman, Anil Reddy Pinate, and Poonam Prakash Shingade. "Breast cancer, Clinical presentations, Risk factors, Staging." International Surgery Journal 4, no. 2 (January 25, 2017): 645. http://dx.doi.org/10.18203/2349-2902.isj20170207.
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Background: Breast cancer is most common cause of cancer related mortality and second most common cause of cancer in females in India. Hence study aims to evaluate the clinical profile and risk factors of the breast cancer.Methods: This is cross sectional study done at Victoria hospital and Bowring and Lady Curzon Hospital between January 2012 to October 2012 among 50 females patients more than 18 years of age, presented with breast cancer irrespective of tumour stage, size and location and for whom preliminary diagnosis of carcinoma breast was confirmed on fine needle aspiration cytology. Preformed, pretested semi-structured questionnaire was used to collect the data regarding the risk factors and clinical presentations of the patients.Results: Maximum participants 18 (36%) were in the age group of 41-50 years, 32 (64%) patients belonged to lower class with mean age at menarche of 13.3 years. About 26 (52%) patients were in premenopausal state. In present study, 48 (96%) of the total patients were multiparous and 47 (94%) women practiced breast feeding for more than 4 months. None of the patients in this study had a family history of breast cancer. Most breast cancer patients presented with history of lump followed by pain 14 (28%) and nipple retraction 9(18%). Most of the patients 29(58%) had upper outer quadrant involvement followed by upper inner quadrant in 7 (14%).In about 26 (52%)patients, tumour size was more than 5 cm and 32 (64 %) patients had axillary lymph nodes.Conclusions: Breast cancer was predominantly a disease of middle aged, lump in breast is commonest mode of presentation with upper outer quadrant involvement and 26 (52%) patients were in stage II of TNM classification.
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Hufschmid, J., K. A. Handasyde, and I. Beveridge. "The role of host and environmental factors in the epidemiology of rumpwear in brushtail possums." Australian Journal of Zoology 58, no. 4 (2010): 250. http://dx.doi.org/10.1071/zo10030.
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Rumpwear is a common, but poorly defined and understood disease of brushtail possums (Trichosurus spp.) in Australia and New Zealand, resulting in varying degrees of fur loss. Populations of Trichosurus cunninghami (mountain brushtail possum) and T. vulpecula (common brushtail possum) were studied over two years at Boho South (Victoria), to describe the disease, investigate its prevalence and explore its epidemiology. The main type of lesion observed was coat damage in the lumbo-sacral region, and increased severity of rumpwear was related to decreased coat length and increased hair breakage. Significant skin lesions were rare and hair breakage patterns suggested mechanical damage. Rumpwear was very prevalent in both T. cunninghami and T. vulpecula, but very severe rumpwear was rare. There was no true seasonal pattern to the prevalence of rumpwear in T. cunninghami and sex and habitat did not affect prevalence or severity. Prevalence and severity of rumpwear did, however, increase with age. There were no significant relationships between the number of previous captures or body condition index with rumpwear.
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Xie, Ouli, Ee Tay, and Justin Denholm. "Trends in Tuberculosis Incidence in the Australian-Born in Victoria: Opportunities and Challenges to Elimination." Tropical Medicine and Infectious Disease 3, no. 4 (October 11, 2018): 112. http://dx.doi.org/10.3390/tropicalmed3040112.
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Australia is a low tuberculosis incidence country. In the setting of increasing migration, we aimed to investigate the epidemiology and trends of tuberculosis in the Australian-born population in the state of Victoria between 1992 and 2017. We performed a retrospective descriptive analysis of demographic, clinical and outcome data extracted from a centralized notifiable disease database. The mean incidence of tuberculosis was 1.19 cases per 100,000 population per year with a small but significant reduction of 0.98% per year. The median age of cases decreased from 67.5 years in 1994 to 17 years in 2017. Among 0–14 year-olds, there was an increase from 0.13 cases per 100,000 population in 1996 to 2.15 per 100,000 population in 2017. Data for risk factors were available from 2002 onwards. The most common risk factor in the 0–14 year age group was a household contact with tuberculosis (85.1%), followed by having a parent from a high tuberculosis incidence country (70.2%). We found the rate of tuberculosis in the Australian-born population in Victoria is low. However, there has been an increase in incidence in children, particularly among those with links to countries with high tuberculosis incidence. This could threaten progress towards tuberculosis elimination in Australia.
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Hunter, Barbara, Ruby Biezen, Karyn Alexander, Natalie Lumsden, Christine Hallinan, Anna Wood, Rita McMorrow, Julia Jones, Craig Nelson, and Jo-Anne Manski-Nankervis. "Future Health Today: codesign of an electronic chronic disease quality improvement tool for use in general practice using a service design approach." BMJ Open 10, no. 12 (December 2020): e040228. http://dx.doi.org/10.1136/bmjopen-2020-040228.
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ObjectiveTo codesign an electronic chronic disease quality improvement tool for use in general practice.DesignService design employing codesign strategies.SettingGeneral practice.ParticipantsSeventeen staff (general practitioners, nurses and practice managers) from general practice in metropolitan Melbourne and regional Victoria and five patients from metropolitan Melbourne.InterventionsCodesign sessions with general practice staff, using a service design approach, were conducted to explore key design criteria and functionality of the audit and feedback and clinical decision support tools. Think aloud interviews were conducted in which participants articulated their thoughts of the resulting Future Health Today (FHT) prototype as they used it. One codesign session was held with patients. Using inductive and deductive coding, content and thematic analyses explored the development of a new technological platform and factors influencing implementation of the platform.ResultsParticipants identified that the prototype needed to work within their existing workflow to facilitate automated patient recall and track patients with or at-risk of specific conditions. It needed to be simple, provide visual snapshots of information and easy access to relevant guidelines and facilitate quality improvement activities. Successful implementation may be supported by: accuracy of the algorithms in FHT and data held in the practice; the platform supporting planned and spontaneous interactions with patients; the ability to hide tools; links to Medicare Benefits Schedule; and prefilled management plans. Participating patients supported the use of the platform in general practice. They suggested that use of the platform demonstrates a high level of patient care and could increase patient confidence in health practitioners.ConclusionStudy participants worked together to design a platform that is clear, simple, accurate and useful and that sits within any given general practice setting. The resulting FHT platform is currently being piloted in general practices and will continue to be refined based on user feedback.
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Subedi, Rajan, Sabitra Kaphle, Manju Adhikari, Yamuna Dhakal, Mukesh Khadka, Sabina Duwadi, Sunil Tamang, and Sonu Shakya. "First call, home: perception and practice around health among South Asian migrants in Melbourne, Australia." Australian Journal of Primary Health 28, no. 1 (January 11, 2022): 40–48. http://dx.doi.org/10.1071/py21036.
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The socio-cultural context of populations has a significant effect on health outcomes across every stage of life. In Australia, South Asian migrants have a comparatively higher incidence of chronic disease and less use of health services. Often overlooked are community views of health, cultural traits and belief systems. This study aimed to explore the factors that influence health perception and practice of South Asian migrants. The study used a mixed method approach with both a survey and interviews. A total of 62 participants between the age of 18 and 64 years were surveyed and 14 participants completed interviews. Data were analysed descriptively and thematically. South Asians share a common perception and practice around health and illness. This paper highlights two key findings. First, these groups take a broad view of health encompassing physical, mental, emotional, social and economic aspects of life. Second, these cultural groups do not seek medical help as their first choice, but have a high level of trust in family for providing health advice and share a belief in the effectiveness of home remedies for managing health conditions. Participants shared their expectation that the Australian health system should consider their socio-cultural construct to make services culturally safe and engaging to enhance service utilisation.
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Thakur, Sameer, Daniel Florisson, Stacy Telianidis, Nima Yaftian, Jean Lee, Simon Knight, Stephen Barnett, et al. "Pulmonary carcinoid tumours: A multi-centre analysis of survival and predictors of outcome following sublobar, lobar, and extended pulmonary resections." Asian Cardiovascular and Thoracic Annals 29, no. 6 (April 14, 2021): 532–40. http://dx.doi.org/10.1177/02184923211010090.
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Background Pulmonary carcinoids are rare neoplasms, accounting for approximately 1%–2% of all lung malignancies. A retrospective analysis was undertaken of all patients who underwent surgical resection of pulmonary carcinoid tumours across multiple institutions in Melbourne, Australia. Methods From May 2000 through April 2020, 241 patients who underwent surgical resection of pulmonary carcinoid tumours were retrospectively reviewed. Patient demographics, pathologic data, and long-term outcomes were recorded. Results Median age was 57.7 years and the majority of patients were female (58.9% vs. 41.1%). Typical carcinoid was present in 77.1%. Histological subtype was associated with several factors. Atypical carcinoid was more likely to have larger tumour size and nodal involvement. Overall survival for typical carcinoid at 5, 10, and 15 years was 98%, 95%, and 84%, and for atypical carcinoid was 88%, 82%, and 62%, respectively. Histological subtype and age were found to be independent predictors of overall survival, with worse outcomes for atypical and those above 60 years of age. Disease-free survival was related to sublobar resection (p < 0.001, sub-hazard ratio (SHR): 6.89), lymph node involvement (p = 0.022, SHR: 3.18), and atypical histology (p < 0.001, SHR: 9.89). Conclusion Excellent long-term outcomes can be achieved following surgical resection of pulmonary carcinoids. Atypical histology and lymph node involvement are significant prognostic factors, and sublobar resection should not be considered in patients with either of the above features. Typical carcinoid tumour without nodal involvement may be appropriate for sublobar resection. Typical and atypical carcinoid tumours should be considered distinct disease entities, and as such treated accordingly.
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AHMED, SHAFIQUE, MUHAMMAD BILAL AHSAN, EHSAN ULLAH, and Raees Abbas. "STABLE ANGINA." Professional Medical Journal 16, no. 01 (March 10, 2009): 94–99. http://dx.doi.org/10.29309/tpmj/2009.16.01.2989.
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Objective: To see the frequency of coronary artery stenosis in the patients of stable angina having left bundle branchblock, and to see the effects of gender and age on this correlation. Design: Experimental case series. Setting: Bahawal Victoria Hospital,Bahawalpur. Period: June 2006 to May 2008. Methods: One hundred and forty one (141) patients of Stable Angina presenting with atypicalchest pain, both male and female of 30—70 years age, positive for LBBB and with normal Cardio-Thoracic Ratio, normal echocardiographyand negative for conventional risk factors and family history of Coronary Artery Disease were taken. All patients were angiographied .Results: A total of 141 patients were investigated through coronary angiogram to see the frequency of coronary artery stenosis in thesepatients. Ninety five (67.4%) patients proved to have coronary artery stenosis. The male patients showed higher frequency (87.4%) ofharboring coronary vessel blockade as compared to that (35.2%) in females (P value <0.0005). There was no relation between age and thefrequency of coronary stenosis (P value >0.05). Conclusions: There is significant difference (P value <0.0005) in coronary artery stenosisamong men and women having LBBB.
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Cardoso, Barbara, Ewa Szymlek-Gay, Blaine Roberts, Melissa Formica, Jenny Gianoudis, Stella O’Connell, Caryl Nowson, and Robin Daly. "Selenium Status Is Not Associated with Cognitive Performance: A Cross-Sectional Study in 154 Older Australian Adults." Nutrients 10, no. 12 (December 1, 2018): 1847. http://dx.doi.org/10.3390/nu10121847.
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Selenium was suggested to play a role in modulating cognitive performance and dementia risk. Thus, this study aimed to investigate the association between selenium status and cognitive performance, as well as inflammatory and neurotrophic markers in healthy older adults. This cross-sectional study included 154 older adults (≥60 years) from Victoria, Australia. Participants were assessed for cognitive performance (Cogstate battery), dietary selenium intake (two 24-h food recalls), plasma selenium concentration, inflammatory markers (interleukin (IL)-6, -8, -10, tumor necrosis factor-alpha and adiponectin) and neurotrophic factors (brain-derived neurotrophic factor, vascular endothelial growth factor and insulin-like growth factor 1). Dietary selenium intake was adequate for 85% of all participants. The prevalence of selenium deficiency was low; only 8.4% did not have the minimum concentration in plasma required for optimization of iodothyronine 5′ deiodinases activity. Multiple linear regression analysis revealed that plasma selenium was not associated with cognitive performance, inflammatory markers nor neurotrophic factors, independent of age, sex, body mass index (BMI), habitual physical activity, APOE status, education, and history of cardiovascular disease. The lack of association might be due to the optimization of selenoproteins synthesis as a result of adequate selenium intake. Future prospective studies are recommended to explore potential associations of selenium status with age-associated cognitive decline.
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Prathivadi, Pallavi, Chris Barton, and Danielle Mazza. "Qualitative insights into the opioid prescribing practices of Australian GP." Family Practice 37, no. 3 (November 26, 2019): 412–17. http://dx.doi.org/10.1093/fampra/cmz083.
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Abstract Background Over the last three decades, Australian opioid-prescribing rates and related morbidity and mortality have dramatically increased. Opioids are frequently prescribed by general practitioners (GPs) to manage chronic non-cancer pain, despite evidence-based recommendations from the Centre for Disease Control, National Institute for Health and Care Excellence and World Health Organization widely cautioning their use. Little is known about the factors influencing the opioid prescribing decisions of Australian GPs, especially when not evidence based. Objective To explore the opioid prescribing knowledge, attitudes and practices of Australian GPs. Methods Semi-structured interviews with 20 GPs recruited from the Monash University practice-based research network in metropolitan, southeastern Melbourne. Thematic analysis was used to identify emergent themes. Data were managed using QSR NVivo. Ethics approval was granted by Monash University. Results Three key themes emerged. GP attitudes towards opioid use for chronic pain varied by age of patient and goals for therapy. Use of opioids for elderly patients was positively perceived. GPs were reluctant to use opioids in younger patients due to fears of addiction and difficulty weaning. GPs felt obliged to prescribe opioids recommended by specialists, even if they believed the opioids were unsafe. Conclusion This study identified and described the patient-centred nature of GP opioid prescribing decisions. Patient age and perceived age-related opioid harm were important factors influencing prescribing decisions. Future work should inform interventions that value GP autonomy while still encouraging a collaborative inter-speciality approach to managing chronic pain patients with opioids.
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Loi, Samantha M., Anita M. Goh, Dhamidhu Eratne, Ramon Mocellin, Sarah Farrand, Andrew Evans, Charles Malpas, Wendy Kelso, Mark Walterfang, and Dennis Velakoulis. "404 - Factors associated with diagnostic delay in younger-onset dementia iagnostic delay in younger-onset dementia." International Psychogeriatrics 33, S1 (October 2021): 31. http://dx.doi.org/10.1017/s1041610221001630.
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Background:Younger-onset dementia (YOD) is a dementia of which symptom onset occurs at 65 years or less. There are approximately 27000 people in Australia with a YOD and the causes can range from Alzheimer’s dementia (AD), frontotemporal dementia (FTD), metabolic and genetic disorders. It is crucial to obtain a definitive diagnosis as soon as possible in order for appropriate treatment to take place and future planning. Previous research has reported 4-5 years to get a diagnosis (Draper et al. 2016) and factors associated with delay include younger age (van Vliet et al. 2013) and psychiatric comorbidity (Draper et al. 2016). We report on our experience of diagnostic delay.Methods:This was a retrospective file review of 10 years of inpatients from Neuropsychiatry, Royal Melbourne Hospital, Australia. Neuropsychiatry is a tertiar service which provides assessment of people with cognitive, psychiatric, neurological and behavioural symptoms. Factors such as age of onset, number of services/specialists seen were extracted and analysed using multivariate regression.Results:Of the 306 individual patients who had a YOD, these were grouped into the major dementia groups (such as AD, FTD, Huntington’s disease, vascular dementia, alcohol-related dementia). The most commonly occurring dementia was AD (24.2%), followed by FTD (23%). There was an average of 3.7 years (SD=2.6), range 0.5-15 years, of delay to diagnosis. Cognitive impairment, as measured using the Neuropsychiatry Unit Cognitive Assessment (NUCOG) was moderate, with a mean score of 68.9 (SD=17.9). Within the groups of dementia, patients with Niemann-Pick type C (NPC) had the longest delay to diagnosis F(11,272)=3.677, p<0.0001, with 6.3 years delay. Age of symptom onset and number of specialists/services seen were the significant predictors of delay to diagnosis F(7, 212)=3.975, p<0.001, R211.6.Discussion and conclusions:This was an eclectic group of people with YOD. The results of regression suggests that there are other factors which contribute to the delay, which are not just demographic related. Rarer disorders, such as NPC which present at an early age, and present with symptoms that are not cognitive in nature, can contribute to diagnostic delay.
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Grinsted Tate, L., L. Johnson, G. Jones, and A. Lobo. "P438 Maladaptive decision-making is associated with psychological morbidity in people with Inflammatory Bowel Disease." Journal of Crohn's and Colitis 15, Supplement_1 (May 1, 2021): S438—S439. http://dx.doi.org/10.1093/ecco-jcc/jjab076.562.
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Abstract Background Inflammatory Bowel Disease (IBD) is a chronic relapsing-remitting inflammatory condition. Due to its long-term, multifaceted nature, patients will need to make many complex decisions during their treatment. The Melbourne Decision Making Questionnaire (MDMQ) assesses the use of four decision-making styles. Vigilance is the only style considered adaptive, with a thorough, analytical approach. Buck-passing (avoiding responsibility), procrastination and hypervigilance (a hurried, anxious approach) are considered maladaptive. This study aimed to assess the impact of psychological morbidity, health-related quality of life (HRQoL) and demographic/disease factors on decision-making in IBD. Methods People over the age of 16 with IBD completed the MDMQ. Psychological morbidity was assessed by the DASS-21 questionnaire, and HRQoL by the EQ-5D-3L/EQ-5D-Y. Demographic data included age, gender, ethnicity, Index of Multiple Deprivation quintile, educational level and employment status. Diagnosis, disease duration and age at diagnosis were also recorded. Exploratory analysis of all variables against scores for each of the four decision-making styles was conducted. Significant results were used to perform multivariate analysis. All statistical analysis was performed using IBM SPSS Statistics software (v26). Results 172 patients were studied (94 CD, 75 UC, 3 IBD-U, 68 (39.5%) male), median age 46.5 (16-83). Median MDMQ scores for vigilance, buck-passing, procrastination and hypervigilance were 10/12, 3/12, 2/10 and 3/10 respectively. Multivariate analysis showed strong positive associations between psychological morbidity scores and all three maladaptive decision-making styles: buck-passing (F(1, 95)=12.512, p=0.001), procrastination (F(1, 115)=35.009, p<0.001) and hypervigilance (F(1, 114)=34.342, p<0.001). Age and duration of disease were not associated with decision making style. Current employment and higher HRQoL scores were significantly associated with greater degrees of buck-passing (F(3,95)=5.100, p=0.003; and F(1, 95)=6.351, p=0.013 respectively). A diagnosis of CD was associated with lower vigilance score (F(2, 133)=3.224, p=0.043). Conclusion People with IBD are likely to have an adaptive decision-making style, demonstrated by a high median vigilance score. However, psychological morbidity is associated with maladaptive decision-making – an important consideration for clinicians and in shared decision making. Further studies are required to determine whether interventions for psychological morbidity can improve maladaptive decision-making.
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Millar, Jeremy L., Susan M. Evans, Mark Frydenberg, Declan G. Murphy, Damien M. Bolton, Graham G. Giles, and Ian D. Davis. "Quality-of-life outcomes for prostate cancer treatment in Australia." Journal of Clinical Oncology 31, no. 6_suppl (February 20, 2013): 143. http://dx.doi.org/10.1200/jco.2013.31.6_suppl.143.
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143 Background: We aimed to use a population based quality registry established in Australia, to review patient-reported health-related QOL after the diagnosis of Prostate Cancer (PCa). Methods: Prospective registry of men with PCa from statutory notifications to the canonical population-based cancer registry in Victoria. An "opt-off" mechanism used. Coverage expanded from 30%-80% of State population over time. Demographics and disease features, management, and outcomes from medical record; men phoned at 12 and 24 months (m), interviewed with script including SF12 and items from standard form (UCLA PCI) for specific QOL outcomes. Urinary, rectal, and sexual function bother (UB, RB, and SB) scores where analysed by univariate and multivariable modelling for relationship of these with presentation or management factors, adjusting for risk. Results: Men from 8/2008 - 2/2011; 1.9% of eligible opted out. Followed 1172 to 12 & 24 m. Median diagnosis age 65 yr; median PSA 6.8 ng/mL; 97.3% clinically localised with 47.7% having NCCN intermediate risk. 520 had treatment with Radical Prostatectomy (RP) (89 also with external beam-EBRT), 171 had EBRT (with or without HDR brachy), and 211 seed implant (SI). 226 had no treatment (NT) in the first 12 m. 52.5% managed in public hospitals, rest private. Univariate analysis: UB associated with management type, and hospital type, and RB and SB associated with these factors, as well as age and disease stage. On multivariate regression SB at 12 m was associated with increasing age (p=0.002) and radical treatment types (RP and EBRT/HDR, p<0.001 and 0.003 respectively)—except SI—compared to NT; RB was associated with SI (0.02) and EBRT/HDR (0.007) and treatment in a public hospital (0.006); and UB was associated with public hospital (<0.001). All associations at 12 m remained significant at 24 m. SF12 physical score had a positive association with RP vs NT (0.014), hospital type (0.001) and younger age. SF12 mental health also showed associations. Conclusions: A large scale registry in Australia assessing patient-reported quality of life outcomes after prostate cancer treatment shows patterns similar to that seen in North American reports.
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Muhammad Najam Iqbal, Shahbaz Ahmad, Aliya Shaima, and M. Rehman Gulzar. "Correlation of HBA 1C and duration of diabetes mellitus with grades of diabetic foot." Professional Medical Journal 29, no. 02 (January 31, 2022): 155–59. http://dx.doi.org/10.29309/tpmj/2022.29.02.6724.
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Objective: To find the correlation of HbA 1c and duration of diabetes mellitus with grades of diabetic foot according to Wagner classification. Study Design: Cross-sectional study. Setting: Bahawal Victoria Hospital Bahawalpur. Period: May 2020 to April 2021. Material & Methods: 100 patients of 25-65 years of age with diabetic foot who presented in OPD or emergency department were included in study. Wounds of the diabetic foot were graded according to Wagner classification. HbA1c (Glycosylated haemoglobin) level was measured and duration of diabetes mellitus was calculated. SPSS Version 20 was used to analyze the data. Correlation of HbA1c and duration of diabetes mellitus with grades of diabetic foot was calculated and the chi- square test was applied, and results were considered significant where p value was ≤ 0.05. Results: The mean age was 51.46 ± 10.51. There were 70 male patients and 30 female patients. Mean value of HbA1c was 8.31±2.02. Neuropathy (52%) was the most common among risk factors for diabetic foot. Correlation between level of HbA1c and grades of diabetic foot was not significant (p value of 0.346). There was significant correlation between duration of disease and Wagner grades (p value was 0.003). Conclusion: Severity of diabetic foot is not correlated with HbA1c level but it is significantly related with duration of DM. Peripheral neuropathy is the main risk factor for diabetic foot.
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Ting, Darren Shu Jeng, Mohamed Galal, Bina Kulkarni, Mohamed S. Elalfy, Damian Lake, Samer Hamada, Dalia G. Said, and Harminder S. Dua. "Clinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011–2020: A 10-Year Study." Journal of Fungi 7, no. 11 (November 12, 2021): 966. http://dx.doi.org/10.3390/jof7110966.
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Fungal keratitis (FK) is a serious ocular infection that often poses significant diagnostic and therapeutic dilemmas. This study aimed to examine the causes, clinical characteristics, outcomes, and prognostic factors of FK in the UK. All culture-positive and culture-negative presumed FK (with complete data) that presented to Queen’s Medical Centre, Nottingham, and the Queen Victoria Hospital, East Grinstead, between 2011 and 2020 were included. We included 117 patients (n = 117 eyes) with FK in this study. The mean age was 59.0 ± 19.6 years (range, 4–92 years) and 51.3% of patients were female. Fifty-three fungal isolates were identified from 52 (44.4%) culture-positive cases, with Candida spp. (33, 62.3%), Fusarium spp. (9, 17.0%), and Aspergillus spp. (5, 9.4%) being the most common organisms. Ocular surface disease (60, 51.3%), prior corneal surgery (44, 37.6%), and systemic immunosuppression (42, 35.9%) were the three most common risk factors. Hospitalisation for intensive treatment was required for 95 (81.2%) patients, with a duration of 18.9 ± 16.3 days. Sixty-six (56.4%) patients required additional surgical interventions for eradicating the infection. Emergency therapeutic/tectonic keratoplasty was performed in 29 (24.8%) cases, though 13 (44.8%) of them failed at final follow-up. The final corrected-distance-visual-acuity (CDVA) was 1.67 ± 1.08 logMAR. Multivariable logistic regression analyses demonstrated increased age, large infiltrate size (>3 mm), and poor presenting CDVA (<1.0 logMAR) as significant negative predictive factors for poor visual outcome (CDVA of <1.0 logMAR) and poor corneal healing (>60 days of healing time or occurrence of corneal perforation requiring emergency keratoplasty; all p < 0.05). In conclusion, FK represents a difficult-to-treat ocular infection that often results in poor visual outcomes, with a high need for surgical interventions. Innovative treatment strategies are urgently required to tackle this unmet need.
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Hallinan, Christine M., and Kelsey L. Hegarty. "Advanced training for primary care and general practice nurses: enablers and outcomes of postgraduate education." Australian Journal of Primary Health 22, no. 2 (2016): 113. http://dx.doi.org/10.1071/py14072.
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The aims of the present study were to understand enablers to participation in postgraduate education for primary care nurses (PCNs), and to explore how postgraduate education has advanced their nursing practice. Cross-sectional questionnaires were mailed out in April 2012 to current and past students undertaking postgraduate studies in primary care nursing at The University of Melbourne, Victoria, Australia. Questionnaires were returned by 100 out of 243 nurses (response rate 41%). Ninety-one per cent (91/100) of the respondents were first registered as nurses in Australia. Fifty-seven per cent were hospital trained and 43% were university educated to attain their initial nurse qualification. The respondents reported opportunities to expand scope of practice (99%; 97/98), improve clinical practice (98%; 97/99), increase work satisfaction (93%; 91/98) and increase practice autonomy (92%; 89/97) as factors that most influenced participation in postgraduate education in primary care nursing. Major enablers for postgraduate studies were scholarship access (75%; 71/95) and access to distance education (74%; 72/98). Many respondents reported an increased scope of practice (98%; 95/97) and increased job satisfaction (71%; 70/98) as an education outcome. Only 29% (28/97) cited an increase in pay-rate as an outcome. Of the 73 PCNs currently working in general practice, many anticipated an increase in time spent on the preparation of chronic disease management plans (63%; 45/72), multidisciplinary care plans (56%; 40/72) and adult health checks (56%; 40/72) in the preceding 12 months. Recommendations emerging from findings include: (1) increased access to scholarships for nurses undertaking postgraduate education in primary care nursing is imperative; (2) alternative modes of course delivery need to be embedded in primary care nursing education; (3) the development of Australian primary care policy, including policy on funding models, needs to more accurately reflect the educational level of PCNs, PCN role expansion and the extent of interprofessional collaboration that is evident from research undertaken to date. Nurses with postgraduate education have the potential to increase their scope of practice, take on a greater teaching role and provide more preventive and chronic disease services in primary care. Policies aimed at increasing access to education for nurses working in primary care would strengthen the primary care nursing profession, and enhance the delivery of primary health care services in Australia.
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Dawson, Samantha L., Jeffrey M. Craig, Gerard Clarke, Mohammadreza Mohebbi, Phillip Dawson, Mimi LK Tang, and Felice N. Jacka. "Targeting the Infant Gut Microbiota Through a Perinatal Educational Dietary Intervention: Protocol for a Randomized Controlled Trial." JMIR Research Protocols 8, no. 10 (October 21, 2019): e14771. http://dx.doi.org/10.2196/14771.
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Background The early life gut microbiota are an important regulator of the biological pathways contributing toward the pathogenesis of noncommunicable disease. It is unclear whether improvements to perinatal diet quality could alter the infant gut microbiota. Objective The aim of this study is to assess the efficacy of a perinatal educational dietary intervention in influencing gut microbiota in mothers and infants 4 weeks after birth. Methods The Healthy Parents, Healthy Kids randomized controlled trial aimed to recruit 90 pregnant women from Melbourne, Victoria, Australia. At week 26 of gestation, women were randomized to receive dietary advice from their doctor (n=45), or additionally receive a dietary intervention (n=45). The intervention included an educational workshop and 2 support calls aiming to align participants’ diets with the Australian Dietary Guidelines and increase intakes of prebiotic and probiotic foods. The educational design focused on active learning and self-assessment. Behavior change techniques were used to support dietary adherence, and the target behavior was eating for the gut microbiota. Exclusion criteria were age under 18 years, diagnosed mental illnesses, obesity, diabetes mellitus, diagnosed bowel conditions, exclusion diets, illicit drug use, antibiotic use, prebiotic or probiotic supplementation, and those lacking dietary autonomy. The primary outcome measure is a between-group difference in alpha diversity in infant stool collected 4 weeks after birth. Secondary outcomes include evaluating the efficacy of the intervention in influencing infant and maternal stool microbial composition and short chain fatty acid concentrations, epigenetic profile, and markers of inflammation and stress, as well as changes in maternal dietary intake and well-being. The study and intervention feasibility and acceptance will also be evaluated as secondary outcomes. Results The study results are yet to be written. The first participant was enrolled on July 28, 2016, and the final follow-up assessment was completed on October 11, 2017. Conclusions Data from this study will provide new insights regarding the ability of interventions targeting the perinatal diet to alter the maternal and infant gut microbiota. If this intervention is proven, our findings will support larger studies aiming to guide the assembly of gut microbiota in early life. Trial Registration Australian Clinical Trials Registration Number ACTRN12616000936426; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370939 International Registered Report Identifier (IRRID) DERR1-10.2196/14771
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Marshall, Kate H., Yves d’Udekem, David S. Winlaw, Kim Dalziel, Susan R. Woolfenden, Diana Zannino, Daniel S. J. Costa, et al. "The Australian and New Zealand Fontan Registry Quality of Life Study: Protocol for a population-based assessment of quality of life among people with a Fontan circulation, their parents, and siblings." BMJ Open 12, no. 9 (September 2022): e065726. http://dx.doi.org/10.1136/bmjopen-2022-065726.
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IntroductionAdvances in the care of patients with single-ventricle congenital heart disease have led to a new generation of individuals living with a Fontan circulation. For people with Fontan physiology, physical, psychological and neurodevelopmental challenges are common. The objective of this study is to describe and develop a deeper understanding of the factors that contribute to quality of life (QOL) among children, adolescents and adults living with a Fontan circulation across Australia and New Zealand, their parents and siblings.Methods and AnalysisThis article presents the protocol for the Australian and New Zealand Fontan Registry (ANZFR) QOL Study, a cross-sectional, population-based study designed to examine QOL among people of all ages with a Fontan circulation, their parents and siblings. Study eligibility criteria includes (1) individuals with a Fontan circulation aged ≥6 years, at least 12 months post-Fontan procedure and enrolled in the ANZFR; (2) parents of individuals enrolled in the ANZFR; and (3) siblings aged ≥6 years of an individual enrolled in the ANZFR. A novel, online research platform is used to distribute personalised assessments tailored to participant age and developmental stage. A suite of validated psychometric self-report and parent-proxy report instruments capture potential correlates and predictors of QOL, including symptoms of psychological distress, personality attributes, coping and cognitive appraisals, family functioning, healthcare experiences and costs, access to emotional support and socioeconomic factors. Clinical characteristics are captured via self-report and parent-proxy report, as well as the ANZFR. Descriptive analyses and multilevel models will be used to examine QOL across groups and to investigate potential explanatory variables.Ethics and DisseminationApproval has been obtained from all relevant Human Research Ethics Committees (HRECs), including the Sydney Children’s Hospitals Network and the Royal Children’s Hospital Melbourne HRECs. Study findings will be published in peer-reviewed journals and presented at national and international meetings and seminars.
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MacMillan, R. A., and T. Ponich. "A170 VITAMIN D IN IBD PATIENTS – A RETROSPECTIVE REVIEW." Journal of the Canadian Association of Gastroenterology 3, Supplement_1 (February 2020): 35–36. http://dx.doi.org/10.1093/jcag/gwz047.169.
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Abstract Background Vitamin D is a critical factor in bone remodelling, calcium absorption and may promote anti-inflammatory cytokines in the gut. Inflammatory bowel disease (IBD) is associated with a reduction in serum Vitamin D levels and a chronic inflammatory state, both of which are strong risk factors for bone density loss affecting IBD patients. Despite European and North American IBD maintenance guidelines for Vitamin D monitoring and bone density scans, there are limited North American investigations into factors influencing serum Vitamin D levels in the IBD patient population specifically. Aims We investigated whether patient demographics, disease severity indexes and/or inflammatory markers were linked to low serum Vitamin D levels in our IBD patients. We also established the extent of Vitamin D serum deficiencies and supplementation rates in our IBD patients. Methods A retrospective chart review of a single clinician’s practice at London Health Science Centre, Victoria Hospital, over the past 20 months, was performed to: 1) assess the frequency of low serum 25-OH Vitamin D (25-OH D) in the IBD patient population and 2) determine whether patient disease severity was linked to lower 25-OH D levels. A multivariate regression analysis was performed assessing Crohn’s Disease (CD) or Ulcerative Colitis (UC) patient factors: age, sex, disease duration, seasonality, current pharmacologic treatments, past surgeries, CD Activity Index, UC Mayo score, C-reactive protein, and fecal calprotectin (Fcal) level. Results 175 IBD patients had at least one 25-OH D measurement with 71 patients actively on Vitamin D therapy. Of UC and CD patients who were not on Vitamin D therapy, 63% (17/27) and 79% (61/77) were 25-OH D deficient, respectively. 25-OH D levels in the CD population was associated with Vitamin D supplementation (regression coefficient [RC] 23.99, 95% confidence interval [CI] 14.54 to 33.45), summer season ([RC] 9.90, [CI] 0.56 to 19.24), and past bowel resection ([RC] -10.61, [CI] -20.48 to -0.76). 25-OH D levels in the UC population was associated with Vitamin D supplementation (regression coefficient [RC] 47.23, 95% confidence interval [CI] 27.62 to 66.83), and Mayo severity scores ([RC] -23.01, [CI] -41.82 to -4.20). Fcal (78 patients) was inversely associated with 25-OH D levels but the trend was not significant. Conclusions Overall, 25-OH D levels were lower in both the UC and CD patient populations relative to the already deficient Canadian population. However, IBD patients are responsive to Vitamin D supplementation. Tools with more objective evidence of disease severity such as UC Mayo score and fcal should be prioritized for identifying the IBD population requiring supplementation. Funding Agencies None
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Chinnappa, Gayathri Devi, Venugopal S., Meera Varadarajan, Mallesh Kariyappa, and Smitha R. "Nutritional status and growth of children with hemophilia: a cross-sectional study." International Journal of Contemporary Pediatrics 7, no. 6 (May 22, 2020): 1232. http://dx.doi.org/10.18203/2349-3291.ijcp20202026.
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Background: Haemophilia A and B are the most common severe bleeding disorders and are inherited as X linked recessive pattern. The main clinical manifestations include bleeding into musculoskeletal sites or soft tissues mainly causing joint impairment and thus resulting in various morbidities. Prophylaxis therapy and inhibitor management have contributed a lot to the management of haemophilia cases. However in resource poor setting countries, like India, availability of factors, prophylactic therapy is farfetched leading to joint abnormalities, decreased physical activity and thus leading to different nutritional states. Studies from developed countries reveal obesity and overweight instances in children with Hemophilia. However not many studies have been undertaken to evaluate the nutritional status of such children in India.Methods: This study was conducted in the Comprehensive hemophilia Care Centre, Victoria Hospital, attached to Bangalore Medical College. A total of 50 children were included in the study. Children aged between 4 and 18 years attending the hemophilia Clinic were included in the study. Observations and review of relevant documents were done.Results: Among 50 children of haemophilia, 18(36%) children were aged less than 10 years and 32(64%) children were aged more than 10 years. The mean age of onset of disease in haemophilia A was 27.5 months (SD of 24.84; range 6-120) and in haemophilia B was 8 months (SD of 2.72; range 3-12). The mean BMI among children aged more than 10 years was more (21.35; SD= 4.02) compared to the children less than 10 years (16.87; SD= 3.41).Conclusions: The prevalence of overweight and obesity among children with Haemophilia is more in adolescent age group compared to children in the first decade.
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Islam, Tasneem, Beverly O'Connell, and Mary Hawkins. "Factors associated with transfers from healthcare facilities among readmitted older adults with chronic illness." Australian Health Review 38, no. 3 (2014): 354. http://dx.doi.org/10.1071/ah13133.
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Objective Because chronic illness accounts for a considerable proportion of Australian healthcare expenditure, there is a need to identify factors that may reduce hospital readmissions for patients with chronic illness. The aim of the present study was to examine a range of factors potentially associated with transfer from healthcare facilities among older adults readmitted to hospital within a large public health service in Melbourne, Australia. Methods Data on readmitted patients between June 2006 and June 2011 were extracted from hospital databases and medical records. Adopting a retrospective case-control study design, a sample of 51 patients transferred from private residences was matched by age and gender with 55 patients transferred from healthcare facilities (including nursing homes and acute care facilities). Univariate and multivariate logistic regression analyses were used to compare the two groups, and to determine associations between 46 variables and transfer from a healthcare facility. Results Univariate analysis indicated that patients readmitted from healthcare facilities were significantly more likely to experience relative socioeconomic advantage, disorientation on admission, dementia diagnosis, incontinence and poor skin integrity than those readmitted from a private residence. Three of these variables remained significantly associated with admission from healthcare facilities after multivariate analysis: relative socioeconomic advantage (odds ratio (OR) 11.30; 95% confidence interval (CI) 2.62–48.77), incontinence (OR 7.18; 95% CI 1.19–43.30) and poor skin integrity (OR 18.05; 95% CI 1.85–176.16). Conclusions Older adults with chronic illness readmitted to hospital from healthcare facilities are significantly more likely to differ from those readmitted from private residences in terms of relative socioeconomic advantage, incontinence and skin integrity. The findings direct efforts towards addressing the apparent disparity in management of patients admitted from a facility as opposed to a private residence. What is known about the topic? Older adults with chronic disease require ongoing medical care in both community and healthcare settings. They may frequently require emergency admission to hospital for management of exacerbations of their chronic disease. Previous Australian research has found that transfer from a healthcare facility may be associated with likelihood of readmission among older adults. What does this paper add? This research addresses the shortage of research on the link between transfer from a healthcare facility and likelihood of readmission within Australia. Older adults with chronic illness readmitted to hospital from healthcare facilities were found to be significantly more likely to differ from those readmitted from private residences in terms of relative socioeconomic advantage, incontinence and skin integrity. What are the implications for practitioners? The findings may be used to identify older readmitted patients with chronic diagnoses at greater risk of presenting with poor skin integrity or incontinence, and direct efforts towards addressing the apparent disparity in management of patients admitted from facilities as opposed to private residences. Sound discharge planning and clear channels of communication between healthcare facilities are particularly important for patients transferred between facilities.
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Khokhar, Durreajam, Caryl Nowson, Claire Margerison, Bruce Bolam, and Carley Grimes. "Comparison of salt-related knowledge, attitudes and behaviours between parents and caregivers of children under 18 years of age and other adults who do not care for children under 18 years of age in Victoria, Australia." BMJ Nutrition, Prevention & Health 2, no. 2 (July 16, 2019): 51–62. http://dx.doi.org/10.1136/bmjnph-2018-000018.
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Background/AimsSalt intake among Australian adults exceeds recommendations, increasing the risk of cardiovascular disease. Knowledge, attitudes and behaviours (KABs) are modifiable factors that may influence salt consumption. It is not known whether salt-related KABs among parents and caregivers of children under 18 years of age differ from other adults who do not care for children under 18 years of age. Therefore, we aimed to determine whether salt-related KABs differed between parents and caregivers and other adults. This information can be used to inform messages included in salt reduction consumer awareness campaigns.MethodsAdults, aged 18–65 years, were recruited from four shopping centres, Facebook and a consumer research panel in the state of Victoria, Australia. Participants indicated if they were a parent or a caregiver of a child/children <18 years (‘parents/caregivers’) or not (‘other adults’). Regression models, adjusted for covariates, assessed differences in KABs between the two groups. Construct scores for KABs were developed, with high scores for knowledge indicative of high salt-related knowledge, for attitude indicative of lower importance of using salt to enhance the taste of food, and for behaviours indicative of higher frequency of engaging in behaviours to reduce salt in the diet.ResultsA total of 840 parents/caregivers and 1558 other adults completed the survey. Just over half of the parents/caregivers and other adults were female, with a mean (SD) age of 41.1 (10.3) years and 44.3 (15.3) years, respectively. Mean construct scores for salt-related KABs were similar between the two groups. Parents/caregivers were less likely to be aware of the relationship between salt and sodium (OR=0.73, p=0.002) and more likely to report difficulty in interpreting sodium information displayed on food labels (OR=1.36, p=0.004). Parents/caregivers were more likely to be concerned about a range of food-related issues, including the amount of saturated fat, sugar and salt in food. Parents/caregivers were more likely to report that they were trying to reduce their salt intake (OR=1.27, p=0.012) and more likely to report adding salt at the table (OR=1.28, p=0.008).ConclusionsThere were some differences in salt-related KABs between parents/caregivers and other adults. These findings provide insight into particular messages that could be focused on in consumer awareness campaigns that seek to improve parents’/caregivers’ KABs related to salt intake. Specifically, messages targeted at parents/caregivers should include practical guidance to reduce table salt and resources to assist in interpreting sodium information on food labels and the relationship of sodium to salt.
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Jois, A., S. Perera, P. Simm, and G. Alex. "P416 Use of DXA in children with Inflammatory Bowel Disease – a large single centre study." Journal of Crohn's and Colitis 15, Supplement_1 (May 1, 2021): S422—S423. http://dx.doi.org/10.1093/ecco-jcc/jjab076.540.
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Abstract Background Low bone mineral density (BMD) is a complication in children with Inflammatory Bowel Disease (IBD). Dual-energy X-ray absorptiometry (DXA) is an established screening tool for BMD, yet there are limited data to guide its use in children with IBD. We performed a single site retrospective analysis of the use of DXA and evaluated factors associated with low BMD. Methods Children 3-18 years with IBD diagnosed between 2013-2018 at The Royal Children’s Hospital, Melbourne, Australia, were included. Patient, disease and treatment demographics were collected alongside vitamin D, calcium, CRP, ESR, albumin and faecal calprotectin (FCP) (averaged over 6 months before and after DXA). Rates of corticosteroid use, vitamin D and calcium supplementation, bisphosphonate use and fractures were also collected. Mann-Whitney and Fisher exact tests were used for continuous and categorical group comparison, respectively. Data are presented as median (interquartile range). Results 239 children diagnosed at a median age of 12 (9.1-14.2) were followed for 5.1 (4-6.4) years. 72/239 (30%) children had at least one DXA at 11 (1.25-28.8) months post diagnosis. 28/72 (39%) children had a follow-up DXA 2.3 (1.9-2.9) years post diagnosis. Children referred for DXA had a lower weight centile (48.7 (17.1-78.2) vs 59.7 (31.4-84.7), p=0.03), and were more likely to have Crohn’s disease (OR 2.18, p=0.01). At first DXA, median lumbar spine (LS) Z score was -0.80 (-1.65-0.08), height adjusted LS Z score was -0.65 (-1.18-0.10), hip Z score was -1.30 (-1.80--0.35) and total body less head Z score was -1.40 (-2.55--0.70). 18/72 children had LS Z score > 0. Children with LS Z score < -2.0 (n=14) had lower weight (6.57 (1.78-23.7) vs 51.1 (26.5-68.7), p=0.0002) and height centiles (3.62 (1.17-17.1) vs 42 (16.9-67.1), p<0.0001), higher FCP (3041 (1182-4192) vs 585 (139-2419), p=0.009) (Figure 1), and higher odds of calcium supplementation (OR 16 (95% CI 2.93-89.1), p=0.003) and endocrinology review (OR 9.61 (95% CI 2.65-31.0), p=0.001). No fractures were reported. Of the 28 children with serial DXAs, there was no significant change in Z scores. When comparing children with a worse (16/28) Z score at second DXA to those with improvement (12/28), there was a trend toward lower vitamin D levels (37 (25.2-58.3) vs 62 (46.3-87), p=0.06) at first DEXA, and higher ESR at second DEXA (23.4 (19.3-29) vs 8.20 (3.5-21.9), p=0.02). Conclusion Almost one third of children with IBD at a tertiary referral centre underwent DXA, with lower BMD than age and sex matched controls. Disease activity markers FCP and ESR were associated with lower BMD. There was no significant change in DXA score over time. No fractures were identified over the study period.
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Davis, M., L. Hochberg, R. Zetterberg, and V. Pridmore. "Can Cross-Sector Partnerships Increase Breast Cancer Screening in Hard-to-Reach Migrant Populations?" Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 142s. http://dx.doi.org/10.1200/jgo.18.20500.
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Background and context: BreastScreen Victoria (BSV) provides free breast screening to women aged 40+; targeting women aged 50-74. The program reduces breast cancer-related deaths by up to 28%. BSV aims to ensure equitable participation for all women in the target age; however there are large disparities in screening rates for different subpopulations. Emerging migrant women participate in breast screening at lower rates than the general population. These women face complex barriers including cultural factors, low health literacy, and access. BSV identified cross-sector partnerships, with local trusted organizations who engage with emerging migrant women, as an approach to tackle the multidimensional problems in screening inequalities. Aim: Through cross-sector partnerships BSV aims to bring together diverse skills, knowledge and resources for more effective health promotion outcomes, including: 1. Increasing awareness of breast screening in emerging migrant communities, 2. Providing a culturally safe environment for women to access breast screening. Strategy/Tactics: BSV partnered with organizations beyond the traditional health sector. One key partnership is with AMES Australia, who provide settlement services for refugees and migrants. The main approach of this model is two-way capacity building between organizations. BSV built the capacity of AMES to deliver BreastScreen's key messages, and promote screening to eligible women accessing their service. This included training for staff, resource development/sharing, and support. AMES built the capacity of BSV by providing insight into barriers for women they engage, and guidance adapting traditionally clinical environments ensuring cultural safety. To date BSV has undertaken screening initiatives with AMES in 2 Melbourne locations. Outcomes: - Migrant women are introduced to breast screening by a trusted organization - BSV's key messages are delivered in a culturally appropriate manner - Development of sustainable skills, structures and resources in both organizations - Utilization of AMES relationship with their clients to engage women who BSV may not reach -not on the Victorian Electoral Roll - 6 group bookings with specific languages groups - Familiar case worker and in person translator supporting group bookings - Engaging mainly first time screeners who may not have accessed a breast screen - Overcoming cultural, language, and health literacy barriers - Tailored appointments for groups and walk-ins. What was learned: A lack of tailored strategies to engage women in breast screening compounds barriers for migrant women. Cross-sector partnerships increase the efficiency of systems that impact health by making the best use of different but complementary resources. Collaborations, joint resourcing and planned action should be considered ongoing practice, particularly for disengaged populations, to address the many determinants of health that lie outside the reach of the health system.
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JABEEN, SALMA, BUSHRA S. ZAMAN, AFZAAL AHMED, and SHER-UZ-ZAMAN BHATTI. "MATERNAL MORTALITY." Professional Medical Journal 17, no. 04 (December 10, 2010): 679–85. http://dx.doi.org/10.29309/tpmj/2010.17.04.3024.
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Objectives: To estimate maternal mortality ratio (MMR), obstetrical causes and determinants of maternal mortality. Study Design: A descriptive study. Place & Duration of Study: The study was conducted in Obstetrics & Gynaecology Department at Bahawal Victoria Hospital, affiliated with Quaid-e-Azam Medical College, Bahawalpur. This was a 3 years study conducted from January 2006 to December 2008. Patients & Methods: All direct and indirect maternal deaths during pregnancy, labor and perpeurium were included. The patients who expired after arrival were analyzed on specially designed Performa from their hospital records and questions asking from their attendants. The reason for admission, condition at arrival, cause of death and possible factors responsible for death were identified. The other information including age, parity, booking status, gestational age and relevant features of index pregnancy, along with the distance from hospital was recorded on Performa and analyzed by SPSS version 11. Results: There were a total of 21501 deliveries and 19462 live births with 2039 peri-natal moralities. Total 133 maternal deaths occurred during last 3 consecutive years revealed MMR 683 per 100000 live births. Majority of the women who died were un-booked (91%). The highest maternal mortality age group was 20-30 years in which 54.2% deaths were observed. Out of 133 maternal deaths, 21% were primigravida. Obstetrical hemorrhage (44.4%) was the most frequent cause followed by hypertensive disorders (21.8%) & sepsis (15%). There were 33.8% of patients who were brought at compromised stage and 52.6% brought critical, only 13.5% died were stable at the time of arrival at hospital. Conclusions: Obstetrical haemorrhage was the leading cause of maternal deaths. Thisdreadful cause is preventable and manageable if steps are taken in time during antenatal period for risk detection and in postnatal period. Community awareness, training of traditional birth attendants to recognize the severity of disease and importance of being in time and improving referral can reduce the maternal deaths.
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Ulyukin, I. M., V. V. Rassokhin, A. A. Sechin, and E. S. Orlova. "Decision-making style and emotional intelligence in post-COVID young people." Marine Medicine 8, no. 2 (July 28, 2022): 61–69. http://dx.doi.org/10.22328/2413-5747-2022-8-2-61-69.
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OBJECTIVES: To study the interrelationships of decision-making style as a reflection of individual differences in coping with uncertainty and emotional creativity as a factor of self-realization in young people who have had COVID-19.MATERIALS AND METHODS: We examined 100 convalescents aged 18.2±2.25 years, including 50 men (Group M) and 50 women (Group G) (the age difference between the groups is not significant). The main transferred clinical forms of COVID-19 were the inapparent form — 42.0% (group M — 32 people, group G — 10 people), acute respiratory viral infection — 56.0% (group M — 17 people, group G — 39 people) according to the Russian versions of the Melbourne Decision Making Questionnaire (MDMQ) and the Emotional Creativity Inventory (ECI).RESULTS AND DISCUSSION: In both groups of examined individuals after suffering COVID-19 in all clinical forms of the disease, the «vigilance” strategy, considered as productive, is of the greatest importance in the decision- making process; unproductive strategies are not expressed, which is important for the subsequent medical and psychological support of convalescents. It is noted that the interaction between the factors of emotional creativity is expressed not only in an increase in creativity when high values coincide on two or more faces, but also in the fact that low values of one component can be compensated by high values of another.CONCLUSION: The data obtained are important for conducting medical and psychological support for convalescents and for preventing the formation of professional burnout, and for quick adaptation to various life situations, and for motivation to prevent the occurrence of changes in functional states after suffering COVID-19.
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Xia, Ting, Ross Iles, Sharon Newnam, Dan Lubman, and Alex Collie. "O2C.4 Patterns of health care use following work-related injury and illness in australian truck drivers: a latent class analysis." Occupational and Environmental Medicine 76, Suppl 1 (April 2019): A17.1—A17. http://dx.doi.org/10.1136/oem-2019-epi.44.
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PurposeTo identify patterns of health care use in truck drivers with work-related injury or illness and to identify demographic, occupation, injury/condition, claim and geographic factors associated with patterns of care.Method13 371 accepted workers compensation claims from truck drivers lodged between 2004 and 2013 in the state of Victoria were included. Episodes of health care were categorised according to practitioner type as General Practitioner (GP), Specialist Physician, Mental Health, Surgery, Return to Work, or Physical Therapy. Latent class analysis was used to identify and characterise the distinct profiles of users with different patterns of health service use. Multinomial logistic regression was used to examine the associations between latent class and predictors including demographic, claim and injury-related factors.ResultsFour profiles of heath service use were identified: (1) Low Service Users (55% of the sample) were more likely to be younger, have an injury that did not result in time off work and have conditions other than a musculoskeletal injury; (2) High Service Users (10%) tended to be those who were aged between 45 and 64 years, lived in major cities and had musculoskeletal conditions that resulted in time off work; (3) Physical Therapy Users (25%) were more likely to be aged between 45 and 64 years, live in major cities and have non-traumatic injuries that resulted in time off work; and (4) GP/Mental Health Users (10%) were more likely to be over 24 years of age, from the lowest socio-economic band, be employed by smaller organisations and be claiming benefits for a mental health condition.ConclusionsIt is possible to identify distinct patterns of health care use following work-related injury and disease using workers’ compensation claims data. Nature of injury/disease, sociodemographic characteristics and geographic proximity to health services affect patterns of care.
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Garrido-Cumbrera, M., D. Poddubnyy, C. Bundy, L. Christen, R. Mahapatra, S. Makri, C. J. Delgado-Domínguez, S. Sanz-Gómez, P. Plazuelo-Ramos, and V. Navarro-Compán. "POS0244 PATIENT JOURNEY WITH AXIAL SPONDYLOARTHRITIS: CRITICAL ISSUES FROM THE PATIENT PERSPECTIVE. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 343.2–344. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2426.
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Background:The journey of axial spondyloarthritis (axSpA) for most patients is slow and arduous.Objectives:The goal of this analysis is to describe the journey to diagnosis and further management in axSpA patients.Methods:2,846 unselected patients participated in EMAS, a cross-sectional study (2017-2018) across 13 European countries. Descriptive analysis of sociodemographic factors, insurance scheme, diagnostic journey and post diagnosis healthcare utilization was performed. Mann-Whitey test was used to analyse possible differences between BASDAI (>4 v ≤4) and the number of visits to healthcare professionals and follow-up tests undertaken.Results:Mean age was 43.9 years, 61.3% were female, 48.1% university educated, 67.9% married, 53.9% employed and 81.7% had public health insurance. Mean age at symptoms onset was 26.6 (11.1), while mean age at diagnosis was 33.7 (11.5) and mean diagnostic delay was 7.4 years. Over 50% had a diagnostic delay of ≥4 years. Prior to receiving a diagnosis, patients visited on average 2.6 specialists. The most commonly performed diagnostic tests were x-rays (72.3%), HLA B27 tests (65.4%) and MRIs (64.3%). 78.4% were diagnosed by a rheumatologist while 14.9% received their diagnosis by a GP. Patients who experienced a diagnostic delay of more than a year (n= 2,208) undertook a considerable number of visits to specialists and medical tests in the year prior to participating in EMAS, which increased with disease activity. Patients with active disease (BASDAI >4) reported a higher number of visits to rheumatologists (3.7±3.5 vs 2.9±2.6), general practitioners (6.6±10.0 vs 3.5±4.1), physiotherapists (19.3±25.0 vs 11.7±17.0), and psychologists/psychiatrists (3.4±10.7 vs 1.9±7.7). Patients with active disease also undertook more x-rays (1.8±2.8 vs. 1.3±1.9), MRI scans (0.9±1.2 vs. 0.6±1.1), and blood tests (4.7±4.4 vs 3.6±3.2). However, one in five patients visited the rheumatologist only once in the year prior to EMAS (21.1%).Conclusion:Diagnostic delay continues to be a key challenge in the axSpA patient journey, with patients waiting an average of 7.4 years and visiting multiple doctors prior to diagnosis. Once diagnosed, disease management presents a further challenge, as patients with higher disease activity reported more healthcare professional visits as well as medical tests. Safeguarding health and controlling healthcare utilization requires effective disease management, greater education for non-specialists, rapid referral routes for diagnosis and collaborative care between specialists and non-specialists.Figure 1.axSpA Patient journey according to EMASAcknowledgements:This study was supported by Novartis Pharma AG. The authors would like to thank all participants who participated in this study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis and Pfizer, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB
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Garrido-Cumbrera, M., C. Bundy, V. Navarro-Compán, L. Christen, R. Mahapatra, S. Makri, C. J. Delgado-Domínguez, D. Gálvez-Ruiz, P. Plazuelo-Ramos, and D. Poddubnyy. "POS0989 FACTORS ASSOCIATED WITH INABILITY TO WORK AND DISABILITY IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 762.2–763. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2450.
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Background:Axial spondyloarthritis (axSpA) is associated with a high burden of disease, which may lead to inability to work and disability.Objectives:This analysis aims to identify factors associated with inability to work and disability among European axSpA patients.Methods:Data from 2,846 unselected patients participating in EMAS, a cross-sectional study (2017-2018) across 13 European countries were analysed. The sample was divided into those on permanent sick leave or with a recognised disability (Group 1) and those with neither permanent sick leave nor a recognized disability (Group 2). Mann-Whitney and Pearson’s χ2 tests were used to analyse possible differences between groups regarding sociodemographic characteristics, patient-reported outcomes [BASDAI (0-10), GHQ-12 (0-12), functional limitation (0-54) and spinal stiffness (3-12)], lifestyle habits, working life, and comorbidities). Univariable and multivariable binary logistic regression were used to analyse variables possibly explaining being on permanent sick leave and disability, for which 1,657 patients were included.Results:Mean age was 43.9 years, 61.3% were female, 48.1% had a university degree, and 67.9% were married. Patients in Group 1 (34.4%; n=978) were more likely to be women (54.3%), married (71.1%), with higher disease activity (BASDAI 5.9 vs. 5.3), functional limitation (25.1 vs. 18.0), spinal stiffness (8.6 vs. 7.3; all p<0.001), and longer diagnostic delay (8.1 vs 7.1 years; p = 0.01) than those in Group 2 (65.6%; n=1,868). In addition, 88.0% of Group 1 (n=728) had difficulties in finding a job due to axSpA throughout life; and more than 30.0% reported a diagnosis of anxiety, depression, or sleep disorders. Moreover, being in Group 1 was associated with higher functional limitation in all daily activities. In the multivariable binary logistic regression, the qualitative variables associated with permanent sick leave or disability were: difficulties finding work (OR= 2.52), belonging to a patient organisation (OR= 1.54) and work choice determined by axSpA (OR= 1.38). The quantitative variables associated with permanent sick leave or disability were: higher spinal stiffness (OR= 1.09), older age (OR= 1.03), longer disease duration (OR= 1.03), shorter diagnostic delay (OR= 0.98), and higher functional limitation (OR= 1.01) (Table 1).Table 1.Regression analysis for variables explaining being on permanent sick leave or disability (n=1,657)Univariable logistic analysisMultivariable logistic analysisQualitative variablesOR95% CI3OR95% CI3Gender11.571.34, 1.831.240.97, 1.57Educational level21.711.46, 2.001.080.86, 1.35Member of a patient organisation. Yes1.961.67, 2.291.541.23, 1.94Smoking. Yes1.281.08, 1.511.220.96, 1.55Difficulty finding job due to axSpA. Yes3.712.89, 4.772.521.83, 3.47Work choice determined by axSpA. Yes1.691.43, 1.991.381.09, 1.75Anxiety diagnosis. Yes1.271.07, 1.510.980.72, 1.34Depression diagnosis. Yes1.581.33, 1.891.250.92, 1.69Sleep disorder diagnosis. Yes1.331.13, 1.560.950.73, 1.23Quantitative variablesOR95% CI3OR95% CI3Age. Years1.041.03, 1.041.031.01, 1.04BASDAI (0-10)1.181.13, 1.241.060.98, 1.13Functional limitation (0-54)1.031.02, 1.031.011.00, 1.02Spinal stiffness (3-12)1.251.20, 1.291.091.03, 1.15Diagnostic delay1.011.01, 1.020.980.96, 0.99Disease duration1.041.03, 1.051.031.01, 1.041Male vs Female; 2No university studies vs university studies. 395% CI for test H0: OR=1Conclusion:One third of patients reported being on permanent sick leave or having a recognised disability. They were more likely to have higher spinal stiffness scores, were older in age, experiencing difficulty finding a job, and belonged to a patient organisation. Increased efforts in relation to early access to effective treatments and the creation of flexible working environments are essential for axSpA patients to continue working and remain active, which benefits their quality of life.Acknowledgements:This study was supported by Novartis Pharma AG.The authors would like to thank all patients who participated in this study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, David Gálvez-Ruiz: None declared, Pedro Plazuelo-Ramos: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.
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Garrido-Cumbrera, M., V. Navarro-Compán, E. Collantes-Estevez, P. Zarco-Montejo, S. Sanz-Gómez, C. Sastré, P. Plazuelo-Ramos, and J. Gratacos-Masmitja. "POS0992 PREVALENCE AND ASSOCIATED FACTORS OF SLEEP DISORDERS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE SPANISH ATLAS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 764–65. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2537.
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Background:Sleep is an essential aspect of health that is commonly disrupted in patients with axial spondyloarthritis (axSpA).Objectives:This analysis aims to assess the prevalence and associated factors of sleep disorders in a large sample of axSpA patients.Methods:In 2016, a sample of 680 unselected patients with axSpA participated in the Atlas of Axial Spondyloarthritis in Spain through an online survey. The sample was divided into: 1) Patients with sleep disorders and 2) Patients without sleep disorders. Disease activity through BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54) and, mental health through a 12-item General Health Questionnaire GHQ-12 (0-12) were assessed. The Mann-Whitney and Pearson’s chi-square tests were used to analyse possible relationships between independent sociodemographic characteristics, employment, lifestyle, patient-reported outcomes and comorbidity variables with sleep disorders. Univariate and multivariate binary logistic regression was used to determine the possible association of the independent variables on sleep disorders.Results:Mean age was 45.7 years, 52.5% female, 36.9% had a university degree, and 71.5% were married. The prevalence of sleep disorders was 19.7%. Those who reported sleep disorders presented higher disease activity (6.3 vs 5.4, p<0.001), worse mental health (7.7 vs 5.0, p<0.001), greater functional limitation (45.7 vs 41.4, p<0.001), greater spinal stiffness (8.0 vs 7.3, p=0.008), and longer diagnostic delay (10.5 vs 7.9, p=0.021). 29.9% of the patients on sick leave had sleep disorders, compared to only 15.4% of employees (p=0.013). In addition, 23.0% of those who were physically active had sleep disorders compared to only 7.1% of those not physically active (p<0.001). Sleep disorders were more prevalent in patients with other comorbidities such as anxiety (60.0% vs 9.7%, w/o anxiety, p<0.001) and depression (66.0% vs 11.7% w/o depression, p<0.001). In the multivariate binary logistic regression, depression (OR= 3.89), anxiety (OR= 3.84), and a longer diagnostic delay (B=0.034) remained significantly associated with sleep disorders. Excluding mental comorbidity parameters from the model, physical activity (OR= 3.52) and disease activity (B= 0.175) remained significantly associated with sleep disorders (Table 1).Table 1.Logistic regression to analyses factor associated with sleep disorders (N= 366)Univariate logistic analysisMultivariate logistic analysisMultivariate logistic analysis*ORp-value1ORp-value1ORp-value1Qualitative factorsEmployment. Sick leave1.9370.0031.5540.1801.5400.131Physical activity. Yes3.914<0.0012.4100.1963.5160.048Anxiety diagnosis13.925<0.0013.840<0.001----Depression diagnosis14.616<0.0013.886<0.001----Quantitative factorsBp-value2Bp-value2Bp-value2BASDAI (0-10)0.238<0.0010.0360.6730.1750.015GHQ-120.141<0.0010.0450.204----Functional Limitation (0-54)0.049<0.001-0.0110.5600.0220.166Spinal Stiffness (3-12)0.1040.0080.0160.7750.0200.683Diagnostic Delay0.0410.0010.0340.0440.0250.083*Excluding mental health factors. 1p-value for test H0: OR = 1 2p-value for test H0: B = 0Conclusion:One of five patients with axSpA reported sleep disorders. The presence of mental comorbidities such as anxiety and depression increases the likelihood of sleep disorders. Moreover, physical activity and disease activity also seem to increase the probability on sleep disorders. Referral to mental health specialists together with optimal healthcare management should be key for the reduction of sleep disorders in axSpA.Acknowledgements:This study was supported by Novartis Spain. The authors would like to thank all patients who participated in this study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Eduardo Collantes-Estevez Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Pedro Zarco-Montejo: None declared, Sergio Sanz-Gómez: None declared, Carlos Sastré Employee of: Novartis Farmacéutica Spain, Pedro Plazuelo-Ramos: None declared, Jordi Gratacos-Masmitja Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.
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Balasubramanian, Adithya, Adrian Pick, Beena Kumar, Zdenka Prodanovic, Prashant Joshi, and Muhammad Alamgeer. "Treatment outcomes in malignant pleural mesothelioma: A single center experience of systemic therapies and biomarkers." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e20070-e20070. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e20070.
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e20070 Background: Malignant Pleural Mesothelioma (MPM) is a rare but fatal disease related to asbestos exposure, with historic survival in the order of 9 to 17 months. Chemotherapy is associated with only a modest benefit. The advent of immunotherapy has heralded significantly improved outcomes using checkpoint inhibitors in an as yet ill-defined cohort. We aim to identify predictive and prognostic biomarkers in a series of patients (pts) with MPM and describe survival data. Methods: A retrospective audit was undertaken of pts with MPM diagnosed between 2013 and 2017 at a single tertiary centre in Melbourne, Australia (Monash Health). Data relating to patient outcomes and clinicopathological features were obtained through medical reports. Further immunostains are being performed on archived tissue for PDL-1 status. Results: 65 pts were identified, of whom 52 (80.0%) were male. Median age was 73 years (range 44-90). 52 pts were noted to be ECOG 0-1. 42 pts (64.6%) were noted to have suspected asbestos exposure. Epithelioid MPM was the most common subtype, noted in 41 pts (63.1%) (table 1). 8 pts (12.3%) presented with stage IV disease. 16 pts (24.6%) received checkpoint inhibitor therapy, with 10 (63 %) in the second/third line setting. Median overall survival (OS) was 19.8 months (95% CI 13.3-26.3) in the whole cohort.Patient characteristics associated with poor OS were: presence of weight loss (P = 0.001), chest pain (p = 0.08) and ECOG 2 (p = 0.04). Pts with sarcomatoid histology who received immune checkpoint inhibitors in any line of treatment had significantly prolonged OS compared to other histologies. 3-year survival was 80% in this group while median OS was not reached (p = 0.04). This difference was not seen with other histologies. Conclusions: The evolving landscape of treatment in MPM appears to show promise in improving OS. In this unselected case series, our data is consistent with historic controls in terms of survival and prognostic factors. The finding of significantly improved survival with immune checkpoint inhibitors in the sarcomatoid histology is exciting and warrants further exploration. Further data on PDL1 status will be presented.
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Arévalo, M., M. Moreno, V. Navarro-Compán, F. U. Pilar, E. De Miguel, T. Clavaguera, L. F. Linares Ferrando, B. Joven-Ibáñez, J. Gratacos-Masmitja, and X. Juanola-Roura. "AB0655 IMPACT OF BIOLOGIC THERAPY ON WORK IMPAIRMENT IN REAL LIFE IN AXIAL SPONDYLOARTHRITIS PATIENTS: DATA FROM REGISPONSERBIO." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1621.2–1622. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3150.
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Background:Biologic therapy (BT) has demonstrated its effect in improving work impairment in axial Spondyloarthritis (axSpA) patients in clinical trials, however there is few data of these effects in clinical practice.Objectives:-To assess the influence of BT in work status using the WPAI questionnaire in patients with axSpA in real life.-To compare work status between incident and prevalent cases with BT.-To evaluate factors related to changes in work status in these patients.Methods:REGISPONSERBIO is an observational, prospective and multicentric Spanish registry of SpA patients under biologic treatment recruited between September 2013 and December 2014. The study includes demographic, radiologic and disease data from both incident (starting biological therapy at the inclusion) and prevalent (already under biologic therapy at the inclusion) patients. WPAI (Work Productivity and Activity Impairment) questionnaire was used to assess work status (employment, lost hours, absenteeism and presenteeism) in both groups of patients at six months after study inclusion. Patients more than 65 years old who were not working were excluded from the analysis, as no changes in work impairment are expected in these individuals.A descriptive study of work status and related factors was performed using mean and standard deviation as appropriate. Work status was compared between both time-points in incidents and between incidents and prevalents. Uni and multivariate analysis for factors related to baseline work status were assessed, and correlation for change at six months.Results:The study included 75 incident and 134 prevalent axSpA patients. After start of BT, incident patients presented an increase in the number of patients who affirmed to be actively working and an improvement in absenteeism, lost hours and presenteeism, however statistical significance was only reached in the number of hours lost. Comparing incident and prevalent cases, incident patients showed worse data on work status compared to prevalent ones, but only presenteeism reached statistical significance. Factors related to absenteeism and presenteeism at study inclusion were disease activity variables (PGA, BASDAI, ASDAS-CRP), ASQoL and BASFI. Best correlation with improvement in absenteeism at six months was with change in BASDAI (0.84 p 0.07) and age (-0.56 p 0.11), and with improvement in presenteeism were BASFI (0.59 p 0.002), ASQoL (0.57 p 0.002), BASDAI (0.54 p 0.04), PGA (0.51 p 0.01) and ASDAS-CRP(0.51 p 0.01).Conclusion:Biologic therapy is associated to an improvement in work status in axSpA patients. The results suggest that the fast and high improvement in disease activity and disability observed after start of BT is not directly translated to an improvement in work status at short time. Disease activity, disability and quality of life were the main factors influencing both, work status at inclusion and improvement in absenteeism and presenteeism after BT was started.Disclosure of Interests:Marta Arévalo: None declared, Mireia Moreno: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Font Ugalde Pilar: None declared, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Teresa Clavaguera Speakers bureau: novartis, BMS, Faes, Luis F. Linares Ferrando: None declared, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Jordi Gratacos-Masmitja Grant/research support from: a grant from Pfizzer to study implementation of multidisciplinary units to manage PSA in SPAIN, Consultant of: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Speakers bureau: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Xavier Juanola-Roura: None declared
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Garrido-Cumbrera, M., V. Navarro-Compán, L. Christen, C. Bundy, R. Mahapatra, S. Makri, C. J. Delgado-Domínguez, J. Correa-Fernández, S. Sanz-Gómez, and D. Poddubnyy. "POS0960 PRESENCE AND ASSOCIATED FACTORS OF FATIGUE IN PATIENTS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 744.2–745. http://dx.doi.org/10.1136/annrheumdis-2021-eular.968.
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Background:Fatigue/tiredness is an essential aspect of disease for patients with axial spondyloarthritis (axSpA). However, little is known about its prevalence and associated factors.Objectives:The aim is to assess the prevalence of fatigue and associated factors in a large sample of patients with axSpA patients from 13 European countries.Methods:Data from 2,846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 European countries were analyzed.The presence of fatigue/tiredness was evaluated using the Visual Analogue Scale from the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI): “How would you describe the overall level of fatigue/tiredness you have experienced? (0-10)”. Risk of poor mental health was assessed using the 12-Item General Health Questionnaire (GHQ-12; 0-12).Possible associated factors included: Socio-demographic and disease characteristics, disease activity and function and mental health disorders.The Mann-Whitney test was used to compare the means of variables of two categories vs. the numerical variables, the χ2 test was used to compare the distribution between the categorical variables. Binary logistic regression and multiple linear regression were used to identify possible predictors.Results:A total of 2,846 axSpA patients participated in the EMAS survey: mean age was 43.9 years, 61.3% female, 48.1% had a university degree, 67.9% were married and 71.3% were HLA-B27 positive. Fatigue/tiredness was associated with younger age (6.4±2.3 vs 5.5±2.4), being female (6.6±2.2 vs 5.7±2.4), lower educational level (6.9±2.4 vs 6.0±2.0) and separated or divorced persons (6.8±2.2 vs 6.2±2.3; all p<0.001). Those reporting work impact (6.8±2.1 vs 5.8±2.4), physically inactive (6.9±2.2 vs 6.1±2.3) or those with sleep disorders (7.0±2.0 vs 5.8±2.4), anxiety (7.0 ± 2.0 vs 5.9±2.4) or depression (7.2±1.9 vs 5.9±2.4; all p<0.001) also presented greater fatigue, as did those with higher morning stiffness (r=0.499) and functional limitation (r=0.257), and poorer mental health GHQ-12 (r=0.419). Finally, the variables independently associated with fatigue were female gender (B=0.427), being physical inactive (B=-0.395) and those with greater morning stiffness severity (B=0.349; see Table 1). In addition, those on temporary and permanent sick leave, along with the unemployed, presented greater fatigue (7.1, 6.8 and 7.1 respectively).Table 1.Linear regression analysis to predict presence of fatigue/tiredness (N = 2052)SimpleMultivariateB95% CIp-valueB95% CIp-valueAge-0.018-0.025, -0.011<0.001*-0.015-0.022, -0.008<0.001Gender (female)0.8380.659, 1.017<0.001*0.4270.264, 0.590<0.001Marital status (married)0.1900.042, 0.3390.012*0.1620.021, 0.3020.024*Educational level (university)-0.274-0.402, -0.146<0.001*-0.128-0.245, -0.0120.031*BMI (Overweight/Obesity)0.151-0.026, 0.3280.094NANANAMorning stiffness severity (0-10) *0.4730.442, 0.505<0.001*0.3490.314, 0.385<0.001*Functional limitation (0-54)0.0380.032, 0.044<0.001*0.0140.008, 0.019<0.001*Reported Work impact (yes)0.9360.753, 1.119<0.001*0.2280.068, 0.3890.005*Physical activity (yes)-0.726-0.968, -0.485<0.001*-0.395-0.611, -0.178<0.001*Sleep disorder (yes)1.1911.013, 1.368<0.001*0.2760.095, 0.4580.003*Anxiety (yes)1.1390.950, 1.327<0.001*0.002-0.215, 0.2200.982Depression (yes)1.2741.079, 1.469<0.001*0.2230.001, 0.4460.049*GHQ-12 (0-12) **0.2340.215, 0.254<0.0010.1100.088, 0.132<0.001**As measured by the respective item of the BASDAI scale**12-item General Health Questionnaire. A value of 3 or above indicates a risk of poor mental healthConclusion:Fatigue/tiredness was highly prevalent among axSpA European patients with female gender, engage in physical activity and those with greater morning stiffness severity most strongly associated, and the unemployed presenting greatest fatigue.Acknowledgements:This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Laura Christen Employee of: Novartis Pharma AG, Christine Bundy Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer., Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Denis Poddubnyy Speakers bureau: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB., Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.
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Buddhdev, Pranai, Frederico Vallim, David Slattery, and Jitendra Balakumar. "Acetabular retroversion is prevalent and proportional to the severity of slipped upper femoral epiphysis." Bone & Joint Open 3, no. 2 (February 1, 2022): 158–64. http://dx.doi.org/10.1302/2633-1462.32.bjo-2021-0189.r1.
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Aims Slipped upper femoral epiphysis (SUFE) has well documented biochemical and mechanical risk factors. Femoral and acetabular morphologies seem to be equally important. Acetabular retroversion has a low prevalence in asymptomatic adults. Hips with dysplasia, osteoarthritis, and Perthes’ disease, however, have higher rates, ranging from 18% to 48%. The aim of our study was to assess the prevalence of acetabular retroversion in patients presenting with SUFE using both validated radiological signs and tomographical measurements. Methods A retrospective review of all SUFE surgical cases presenting to the Royal Children’s Hospital, Melbourne, Australia, from 2012 to 2019 were evaluated. Preoperative plain radiographs were assessed for slip angle, validated radiological signs of retroversion, and standardized postoperative CT scans were used to assess cranial and mid-acetabular version. Results In all, 116 SUFEs presented in 107 patients who underwent surgical intervention; 47 (52%) were male, with a mean age of 12.7 years (7.5 to 16.6). Complete radiological data was available for 91 patients (99 hips) with adequate axial CT imaging of both hips. Overall, 82 patients (82%) underwent pinning in situ (PIS), with subcapital realignment surgery (SRS) performed in 17 patients (18%) (slip angles > 75°). Contralateral prophylactic PIS was performed in 72 patients (87%). On the slip side, 62 patients (68%) had one or more radiological sign of retroversion. Tomographical acetabular retroversion was more pronounced cranially than caudally of the acetabulum on both the affected side and the contralateral side (p < 0.001) as expected in the normal population. Increasing severity of the slip was found to be directly proportional to the degree of reduction in cranial and central acetabular version (p < 0.05) in the SUFE hips. Conclusion Acetabular retroversion is more prevalent in patients with SUFE than previously reported, and have been shown be correlated to the severity of the slip presentation. The presence of radiological signs of acetabular retroversion could be used to justify prophylactic contralateral pinning. Cite this article: Bone Jt Open 2022;3(2):158–164.
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Ngere, Sarah Hawi, Victor Akelo, Ken Ondeng’e, Renee Ridzon, Peter Otieno, Maryanne Nyanjom, Richard Omore, and Beth A. Tippett Barr. "Traditional Medicine Beliefs and Practices among Caregivers of Children under Five Years—The Child Health and Mortality Prevention Surveillance (CHAMPS), Western Kenya: A qualitative study." PLOS ONE 17, no. 11 (November 2, 2022): e0276735. http://dx.doi.org/10.1371/journal.pone.0276735.
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Background Approximately 80% of the population residing in sub-Saharan Africa relies on Traditional Medicine (TM). However, literature on factors motivating the use of TM for children under the age of five in these settings is limited. Such information can guide policy formulation for integration of TM into mainstream health care services. This study aimed to describe the motivation on use of TM among caregivers of children residing in rural and urban communities in western Kenya. Methods The socio-behavioral sciences (SBS) arm of the Child Health and Mortality Prevention Surveillance (CHAMPS) program in western Kenya, conducted a cross-sectional qualitative study in Manyatta—an urban informal settlement located in Kisumu town and Karemo—a rural setting in Siaya County. We performed 29 in-depth interviews, 5 focus group discussions and 11 semi-structured interviews with community representatives (n = 53), health workers (n = 17), and community leaders (n = 18). All the participants were purposively sampled. We performed thematic analysis using both inductive and deductive approaches. Data management was completed on Nvivo 11.0 software (QSR International, Melbourne, Australia). Results Our findings reveal that some caregivers prefer TM to treat some childhood diseases. Use of TM was informed by illness beliefs about etiology of disease. We observed an appreciation from the study participants that malaria can effectively be treated by Conventional Medicine (CM) while TM was preferred to treat measles and diseases believed to be associated with supernatural etiology such as witchcraft, evil spirit or breaching cultural taboos. TM was also used in instances where CM failed to provide a diagnosis or when CM was ‘slow’. TM in such cases was used as a last resort. Conclusion We observed varied beliefs that motivate caregivers’ choice of TM use among children in western Kenya. It is therefore crucial to consider perceptions and socio-cultural beliefs about illnesses when formulating interventions that are geared towards child health.
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Garrido-Cumbrera, M., D. Poddubnyy, C. Bundy, L. Christen, R. Mahapatra, S. Makri, C. J. Delgado-Domínguez, D. Gálvez-Ruiz, P. Plazuelo-Ramos, and V. Navarro-Compán. "POS0990 FACTORS ASSOCIATED WITH ENGAGING IN PHYSICAL ACTIVITY IN AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 763.1–763. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2469.
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Background:Physical activity is an essential component in axial spondyloarthritis (axSpA) care, improving physical and mental well-being.Objectives:This analysis aims to identify factors associated with engaging in physical activity among axSpA patients.Methods:Data from 2,424 unselected patients participating in EMAS (N=2,846), a cross-sectional study (2017-2018) across 13 European countries, were analysed. Engaging in physical activity was assessed by the following item: “Do you do any physical or sporting activity?” for which participants could report at least 1 physical activity or that they did not do any physical activity. BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), and mental health using General Health Questionnaire GHQ-12 (0-12) were assessed. Mann-Whitney and Pearson’s χ2 tests were used to analyse relationships between engaging in physical activity and sociodemographic factors, patient-reported outcomes, employment, lifestyle and comorbidities. Univariable and multivariable binary logistic regression were used to analyse variables possibly explaining engagement in physical activity.Results:Mean age was 43.9±12.3 years, 61.3% were female, 48.1% had a university degree and 67.9% were married. 81.8% (n= 2,329) engaged in at least one kind of physical activity. Those physically active were typically male (85.3% vs 79.7% female, p<0.001), university educated (86.0% vs 78.0%, p<0.001), married (83.1% vs 79.2% unmarried, p=0.046), and members of a patient organisation (86.4% vs 78.9% non-member, p<0.001). 25.1% of obese patients (n=533) did not engage in physical exercise (v. 16.6% not obese, p<0.001). Those not engaging in physical activity reported greater disease activity (6.0 vs 5.4 BASDAI, p<0.001), functional limitation (21.6 vs 20.2, p=0.010), spinal stiffness (8.3 vs 7.6, p<0.001), and poorer mental health (5.9 vs 4.8 GHQ-12, p<0.001). Furthermore, 83.9% of those employed (n=1,457) were physically active, versus 73.7% unemployed (n=205; p<0.001). In the multivariable binary logistic regression, the qualitative variables associated with engaging in physical activity were belonging to a patient organisation (OR= 1.91), not being obese (OR= 1.58), being university educated (OR= 1.54), and being male (OR= 1.39). The quantitative variables associated with engaging in physical activity were lower spinal stiffness (OR=0.90), better mental health (OR=0.96), and one-year age increase (OR=1.02). (Table 1).Table 1.Regression analysis for variables explaining engagement in physical activity (n=2,424)Univariable logistic analysisMultivariable logistic analysisQualitative variablesOR95% CI7OR95% CI7Gender. Male11.481.21, 1.811.391.06, 1.82Educational level. University21.731.42, 2.111.541.18, 2.00Marital Status. Married31.731.06, 1.581.180.91, 1.54Patient organization. Member41.71)1.39, 2.101.911.43, 2.55Body Mass Index. Not Obese51.691.35, 2.121.581.17, 2.13Employment status. Employed61.281.06, 1.561.000.76, 1.32Quantitative variablesOR95% CI7OR95% CI7Age1.011.00, 1.021.021.01, 1.03BASDAI (0-10)0.860.82, 0.910.960.89, 1.04GHQ-12 (0-12)0.940.92, 0.960.960.93, 0.99Functional Limitation (0-54)0.990.99, 1.001.000.99, 1.01Spinal Stiffness (3-12)0.900.86, 0.940.900.84, 0.95Proportion of life with axSpA (0-1)2.831.50, 5.352.000.91, 4.391Male vs Female; 2University vs no university; 3Married vs unmarried; 4Member vs not; 5Not obese (underweight, normal and overweight) vs obese; 6Employed vs not (unemployed, sick leave, retirement, housework and student).795% CI for test H0: OR=1Conclusion:These results show that increasing age, being male, university educated, member of a patient organisation, not obese, having lower spinal stiffness, and better mental health increase the probability of engaging in physical activity. Physical activity is an important part of axSpA care and patient organizations play a critical role in enhancing access to and participation in physical activity.Acknowledgements:This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB., Grant/research support from: Abbvie, MSD, Novartis, and Pfizer, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, David Gálvez-Ruiz: None declared, Pedro Plazuelo-Ramos: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.
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Reid, Pankti, David Liew, Rajshi Akruwala, Anne Bass, and Karmela Chan. "817 Activated osteoarthritis following immune checkpoint inhibitor treatment: an observational study." Journal for ImmunoTherapy of Cancer 9, Suppl 2 (November 2021): A854. http://dx.doi.org/10.1136/jitc-2021-sitc2021.817.
Full textAbstract:
BackgroundImmune checkpoint inhibitors (ICIs) have revolutionized cancer therapy but can result in toxicities, known as immune-related adverse events (irAEs), due to a hyperactivated immune system. ICI-related inflammatory arthritis has been described in literature, but herewith we introduce and characterize post-ICI activated osteoarthritis (ICI-aOA).MethodsWe conducted a multi-center, retrospective, observational study of patients with cancer treated with ICIs and diagnosed with ICI-aOA by a rheumatologist. ICI-aOA was defined by (1) an increase in non-inflammatory joint pain after ICI initiation, (2) in joints characteristically affected by osteoarthritis and (3) lack of inflammation on exam. Cases were graded using the CTCAE (Common Terminology Criteria for Adverse Events) V6.0 rubric for arthralgia. RECIST (Response evaluation criteria in solid tumors) V.1.1 (v.4.03) guidelines determined tumor response. Results were analyzed using Chi-squared tests of association and multivariate logistic regression.ResultsThirty-six patients had ICI-aOA with mean age at time of rheumatology presentation of 66 years (51–81yrs). Most patients had metastatic melanoma (10/36, 28%) and had received a PD1/PDL1 inhibitor monotherapy (31/36, 86%) with 5/36 (14%) combination therapy. Large joint involvement (hip/knee) was noted in 53% (19/36), small joints of hand 25% (9/36), and spine 14% (5/36). Two-thirds (24/36) suffered multiple joint involvement. Three of 36 (8%) had CTCAE grade 3, 14 (39%) grade 2 and 19 (53%) grade 1 manifestations. Symptom onset ranged from six days to 33.8 months with median of 5.2 months after ICI initiation; 5 patients suffered ICI-aOA after ICI cessation (0.6, 3.5, 4.4, 7.3 and 15.4 months after ICI cessation) (figure 1). Most common form of therapy was intra-articular corticosteroid injections only (15/36, 42%) followed by NSAIDs only (7/36, 20%) (figure 2). Twenty patients (56%) experienced other irAEs, with rheumatic and dermatologic being the most common. All three patients with high-grade ICI-aOA also had another irAE diagnosis at some point after ICI initiation.ConclusionsICI-aOA should be recognized as an adverse event of ICI immunotherapy. Early referral to a rheumatologist can facilitate the distinction between ICI induced inflammatory arthritis from post-ICI mechanical arthropathy, the latter of which can be managed with local therapy that will not compromise ICI efficacy.Ethics ApprovalCollection of patient data was approved by local Institutional Review Boards at respective institutions: Hospital for Special Surgery in New York (HSS IRB # 2017–1898), University of Chicago in Chicago, Illinois (IRB150837) and Austin Health in Melbourne, Victoria, Australia (HREC/18/Austin/102).Abstract 817 Figure 1Incidence of ICI-aOA (activated osteoarthritis after immune-checkpoint inhibitor) ranged from the first month after ICI initiation up until month 22 after ICI initiation, with most cases occurring in the first 6 months after start of ICI. Five of 36 patients experienced ICI-aOA after ICI cessation (0.6, 3.5, 4.4, 7.3 and 15.4 months after ICI cessation), corresponding to presentation after ICI initiation as follows: 2.0, 9.6, 19.1, 8.7 and 16.1 months after ICI initiation, respectively (as denoted in darker color). ICI: Immune-checkpoint inhibitor, NSAIDs: Non-steroidal anti-inflammatory drugs, DMARDs: Disease modifying anti-rheumatic drugsAbstract 817 Figure 2Therapeutic option most used was local or intra-articular corticosteroid therapy, followed by conservative management with physical therapy only then NSAIDs. Most patients experienced improvement in signs and symptoms with treatment. ICI: Immune-checkpoint inhibitor, NSAIDs: Non-steroidal anti-inflammatory drugs, DMARDs: Disease modifying anti-rheumatic drugs