Journal articles on the topic 'Health risk assessment Victoria'
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J. Mayhew-Rankcom, Vanessa, Melissa A. Lindeman, Keith D. Hill, and Robyn A. Smith. "Who Should Get Personal Alarms? The Development of Instruments for the Assessment of Need." Australian Journal of Primary Health 7, no. 3 (2001): 54. http://dx.doi.org/10.1071/py01047.
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Personal alarms or Personal Response Systems (PRSs) are electronic systems designed to enable frail older people and people with disabilities living at home to summon help in an emergency. The demand for government subsidised PRSs in Victoria (called Personal Alert Victoria) currently exceeds supply (Department of Human Services, 1998) but until now there has been no consistently applied method to ensure that those at highest risk had access to the service. Instruments to aid assessment and determining relative priority for receiving a PRS were developed for the Victorian Department of Human Services (DHS). The development of the instruments was largely informed by the published literature on PRSs and falls risk factors. Three major areas were identified as important in assessing for relative priority to receive a PRS: the client?s assessed risk of being involved in a critical incident requiring immediate assistance, such as a fall; the availability of alternative means of accessing immediate assistance; and the expected impact that a PRS would have on the client?s and/or carer?s wellbeing and their ability to engage in important activities. The process for selecting the items used to determine need in each of these key areas is described, as is the recommended method for determining relative priority. The process for assessing clients to receive a PRS is outlined, emphasising that a PRS is one potential service outcome of an assessment of need.
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Holloway, Frank. "Risk: more questions than answers." Advances in Psychiatric Treatment 10, no. 4 (July 2004): 273–74. http://dx.doi.org/10.1192/apt.10.4.273.
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The rise of the risk industry in psychiatry in England and Wales can be given a precise date: 17 December 1992. That was the day that Christopher Clunis, a man who had been in contact with psychiatric services for some 6 years, murdered Jonathan Zito in an unprovoked attack. This tragedy received enormous publicity and resulted in a flurry of activity within the Department of Health. As a result of the moral panic surrounding Clunis, which crystallised long-term trends, the assessment and management of risk became a central focus of mental health policy and practice (Holloway, 1996). Risk remains a core issue, and indeed mental health services have come to be seen as a key element in a strategy for public protection that aims to keep people who are identified as a potential risk to others off the streets. (We await, with some professional trepidation, the legislation that will provide a sufficiently broad definition of mental illness to fully legitimate this social role.) Mental health staff are now required by government policy and their employers to assess an ever-expanding range of risks – most recently, following the Victoria Climbié Inquiry (House of Commons Health Committee, 2003), risks to dependent children, generally with the aid of unvalidated risk assessment tools. Increasingly, mainstream mental health services are being expected to provide interventions for people whose presenting problems are risky behaviours (or even risky feelings) rather than to offer treatment for mental illness.
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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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Lamb, Katie, Kirsty Forsdike, Cathy Humphreys, and Kelsey Hegarty. "Drawing upon the evidence to develop a multiagency risk assessment and risk management framework for domestic violence." Journal of Gender-Based Violence 6, no. 1 (February 1, 2022): 173–208. http://dx.doi.org/10.1332/239868021x16366281022699.
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Domestic violence poses a threat to the health, safety and wellbeing of women internationally and is associated with a range of physical injuries, chronic mental and physical health issues and death. In recognition of the serious consequences and to guide the allocation of resources, multiple countries have invested in efforts to measure domestic violence risk. This study aimed to determine whether there was an existing validated risk assessment tool with an actuarial element, or a common set of evidence-based risk factors that could be implemented in Victoria, Australia. A tool was sought which would effectively predict risk of severity, lethality and re-assault and support risk management strategies. The tool needed to be suitable for administration by a variety of professionals. Through an audit and analysis of existing tools, the study found an absence of universal standards or guidance for weighting actuarial tools and clear insight into how risk assessments currently inform risk management practice and multidisciplinary responses. However, the literature provides clarity around the key evidence-based risk factors that most commonly form a validated tool for adult victim survivors. The evidence was less definitive in terms of assessing risk of lethality and re-assault for children and young people.
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McEwan, Troy E., Stuart Bateson, and Susanne Strand. "Improving police risk assessment and management of family violence through a collaboration between law enforcement, forensic mental health and academia." Journal of Criminological Research, Policy and Practice 3, no. 2 (June 12, 2017): 119–31. http://dx.doi.org/10.1108/jcrpp-01-2017-0004.
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Purpose Police play an essential role in reducing harms associated with family violence by identifying people at increased risk of physical or mental health-related harm and linking them with support services. Yet police are often poorly trained and resourced to conduct the kind of assessments necessary to identify family violence cases presenting with increased risk. The paper aims to discuss this issue. Design/methodology/approach This paper describes a multi-project collaboration between law enforcement, forensic mental health, and academia that has over three years worked to improve risk assessment and management of family violence by police in Victoria, Australia. Findings Evaluation of existing risk assessment instruments used by the state-wide police force showed they were ineffective in predicting future police reports of family violence (AUC=0.54-0.56). However, the addition of forensic psychology expertise to specialist family violence teams increased the number of risk management strategies implemented by police, and suggested that the Brief Spousal Assault Form for the Evaluation of Risk assessment instrument may be appropriate for use by Australian police (AUC=0.63). Practical implications The practical implications of this study are as follows: police risk assessment procedures should be subject to independent evaluation to determine whether they are performing as intended; multidisciplinary collaboration within police units can improve police practice; drawing on expertise from agencies external to police offers a way to improve evidence-based policing, and structured professional judgement risk assessment can be used in policing contexts with appropriate training and support. Originality/value The paper describes an innovative collaboration between police, mental health, and academia that is leading to improved police practices in responding to family violence. It includes data from the first evaluation of an Australian risk assessment instrument for family violence, and describes methods of improving police systems for responding to family violence.
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Mathers, A. J., and S. Savva. "EFFECTIVE SAFETY CASE DEVELOPMENT." APPEA Journal 43, no. 1 (2003): 805. http://dx.doi.org/10.1071/aj02050.
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Esso Australia Pty Ltd, in Victoria, Australia has recently been involved in the preparation of over 20 safety cases to meet both offshore (Victoria and Western Australia) [Petroleum {Submerged Lands} Act] and onshore [Victorian Occupational Health and Safety Act] regulatory requirements.This paper focusses on the development of the onshore safety cases for both Longford and Long Island Point plants to meet the Victorian Occupational Health and Safety (Major Hazard Facilities) Regulations 2000. Both plants have been granted a five-year unconditional licence to operate.The objectives of the safety case development were to ensure that Esso:addressed major hazard facilities regulatory requirements; maximised benefit from the process, and to maximise benefit from existing work; was consistent with site approach to risk assessment/ safety culture; involved appropriate workforce from all areas— operations, maintenance and technical support; enhanced the effective knowledge and understanding of the workforce; and developed a communication tool to enable ease of understanding by site personnel.Esso’s approach of using qualitative risk assessment techniques (familiar to many site personnel) enabled the process to use tools that provided ease of involvement for the non-technical or safety specialists. This paper will explain this approach in greater detail, demonstrating how this successfully met the stringent requirements of the regulations whilst providing Hazard Register documentation readily understood by the key customer— our site workforce.The hazard register clearly identifies the relevant hazards and their controls, as well as highlighting the linkages to the safety management system and documented performance standards. A comprehensive training program provides all personnel working at site with an overview of the safety case, and the necessary skills and knowledge to be able to use the safety case and hazard register to its maximum advantage. The safety case resource booklet (similar to our offshore approach) is an integral part of the training program, and provides an ongoing reference source for trainees. It continues to receive recognition by both regulators and industry.
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Napwanga, Eluby Sarah Patrick, Sheenagh McShane, and Lucio Naccarella. "Appropriateness of the Asylum Seeker Resource Centre-adapted Refugee Health Assessment Tool." Australian Journal of Primary Health 26, no. 2 (2020): 132. http://dx.doi.org/10.1071/py19059.
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People seeking asylum (PSA) are recommended to undertake a comprehensive risk-based health assessment within 1 month of arrival in Australia. The Asylum Seeker Resource Centre (ASRC) offers health services to PSA in Victoria, through the ASRC nurse-led clinic. A healthcare assessment is conducted by nurses using a Refugee Health Assessment (RHA) tool. A process evaluation was conducted to assess if the adapted 2016 version of the RHA tool was able to appropriately identify, describe and prioritise the needs of PSA. Twelve ASRC nurses who conducted assessments were interviewed. All interviews were audio recorded, transcribed and analysed. The adapted RHA tool was considered as appropriate for identifying, describing and prioritising the needs of PSA. Three key interconnected themes emerged influencing the appropriateness of the tool: the tool; users’ experiences; and the individual characteristics of the PSA undergoing the assessment. Key tool limitations included: the structure not being user-friendly; variability in users’ sensitivity to using the tool; and the limited feedback from PSA on the adapted RHA tool. Given the high number of people seeking asylum in Australia and the complexity of their healthcare needs, this research provides preliminary guidance on ways to improve the appropriateness of the ASRC-adapted RHA tool.
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Baguma, Gabson, Andrew Musasizi, Hannington Twinomuhwezi, Allan Gonzaga, Caroline K. Nakiguli, Patrick Onen, Christopher Angiro, et al. "Heavy Metal Contamination of Sediments from an Exoreic African Great Lakes’ Shores (Port Bell, Lake Victoria), Uganda." Pollutants 2, no. 4 (September 27, 2022): 407–21. http://dx.doi.org/10.3390/pollutants2040027.
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Lake Victoria (L. Victoria) is the largest African tropical and freshwater lake, with one of the highest pollution levels, globally. It is shared among Uganda, Kenya and Tanzania, but it is drained only by the river Nile, the longest river in Africa. Though environmental studies have been conducted in the lake, investigations of the heavy metals (HMs) contamination of sediments from fish landing sites and ports on the Ugandan portion of L. Victoria are limited. In this study, sediments of an urban, industrial and fish landing site (Port Bell) on L. Victoria, Uganda was investigated to establish its HMs pollution levels and potential health risks to humans and ecosystems. Sediment samples were collected in triplicate (n = 9) from three different points of Port Bell, digested and analyzed using atomic absorption spectrometry for the presence of these HMs: copper (Cu), lead (Pb), cadmium (Cd) and chromium (Cr). The average daily dose through dermal contact and hazard quotient (HQ) were calculated to assess the health risk that is associated with dredging works (lake sand mining). Four geochemical enrichment indices: contamination factor (CF), geo-accumulation index (Igeo), pollution load index (PLI) and potential ecological risk (PERI) were used to quantify the contamination of the HMs in the sediments. The results showed that the mean HM content of the samples ranged from: 6.111 ± 0.01 to 7.111 ± 0.002 mg/kg for Cu; from 40.222 ± 0.003 to 44.212 ± 0.002 mg/kg for Pb; from 0.352 ± 0.007 to 0.522 ± 0.010 mg/kg for Cr; from 3.002 ± 0.002 to 3.453 ± 0.003 mg/kg for Cd. Health risk assessments indicated that there are no discernible non-carcinogenic health risks that could arise from the dredging works that are conducted in the study area as the indices were all below one. The contamination factors that were obtained suggest that Cd has reached a state of severe enrichment in the sediments (CF > 6). An assessment using Igeo established that the sediments were not contaminated with regards to Cu and Cr, but they exhibited low-to-median and median contamination with respect to Pb and Cd, respectively. Though the pollution load indices show that the contamination levels raise no serious concerns, the potential ecological risk indices show that there is considerable pollution of the Port Bell sediments, particularly with regard to Cd. Upon examination using multivariate statistical analyses, Cd and Cr showed a strong correlation which alluded to their introduction from anthropogenic sources. Based on the sedimentary HMs concentrations and the environmental indices that are employed in this study, it is recommended that the spatial variations in the concentrations of the HMs in water, sediments and biota should be monitored.
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Saraswat, Nidhi, Rona Pillay, Neeta Prabhu, Bronwyn Everett, and Ajesh George. "Perceptions and Practices of General Practitioners towards Oral Cancer and Emerging Risk Factors among Indian Immigrants in Australia: A Qualitative Study." International Journal of Environmental Research and Public Health 18, no. 21 (October 22, 2021): 11111. http://dx.doi.org/10.3390/ijerph182111111.
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Background: In Australia, Indian immigrants are one of the fastest-growing communities. Since oral cancer is widespread in India, the indulgence of Indians in customs of areca (betel) nut use in Australia may be linked to the recent rise in oral cancer cases. Since GPs (general practitioners) are primary healthcare providers, it is pivotal to ensure the oral cancer awareness of GPs. This study aimed to explore oral cancer risk-related knowledge, beliefs, and clinical practices of GPs in Australia. Methods: Fourteen semi-structured interviews were conducted with GPs practicing across New South Wales and Victoria. Purposive and snowball sampling were used for recruitment. Data were analysed through a directed content analysis approach. Results: All GPs were knowledgeable of major oral cancer causative factors including tobacco and alcohol, but some had limited understanding about the risks associated with areca nut preparations. Positive attitudes were evident, with all participants acknowledging the importance of oral cancer risk assessment. Most GPs recalled not performing oral cancer routine check-ups. Conclusion: GPs presented good oral cancer knowledge except for emerging risk factors such as areca nut use. Varied beliefs and inconsistent clinical practices relating to oral cancer screening is concerning. Accessible oral cancer training around emerging risk factors may benefit GPs.
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Giummarra, Melita J., Rongbin Xu, Yuming Guo, Joanna F. Dipnall, Jennie Ponsford, Peter A. Cameron, Shanthi Ameratunga, and Belinda J. Gabbe. "Driver, Collision and Meteorological Characteristics of Motor Vehicle Collisions among Road Trauma Survivors." International Journal of Environmental Research and Public Health 18, no. 21 (October 29, 2021): 11380. http://dx.doi.org/10.3390/ijerph182111380.
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Road trauma remains a significant public health problem. We aimed to identify sub-groups of motor vehicle collisions in Victoria, Australia, and the association between collision characteristics and outcomes up to 24 months post-injury. Data were extracted from the Victorian State Trauma Registry for injured drivers aged ≥16 years, from 2010 to 2016, with a compensation claim who survived ≥12 months post-injury. People with intentional or severe head injury were excluded, resulting in 2735 cases. Latent class analysis was used to identify collision classes for driver fault and blood alcohol concentration (BAC), day and time of collision, weather conditions, single vs. multi-vehicle and regional vs. metropolitan injury location. Five classes were identified: (1) daytime multi-vehicle collisions, no other at fault; (2) daytime single-vehicle predominantly weekday collisions; (3) evening single-vehicle collisions, no other at fault, 36% with BAC ≥ 0.05; (4) sunrise or sunset weekday collisions; and (5) dusk and evening multi-vehicle in metropolitan areas with BAC < 0.05. Mixed linear and logistic regression analyses examined associations between collision class and return to work, health (EQ-5D-3L summary score) and independent function Glasgow Outcome Scale - Extended at 6, 12 and 24 months. After adjusting for demographic, health and injury characteristics, collision class was not associated with outcomes. Rather, risk of poor outcomes was associated with age, sex and socioeconomic disadvantage, education, pre-injury health and injury severity. People at risk of poor recovery may be identified from factors available during the hospital admission and may benefit from clinical assessment and targeted referrals and treatments.
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Bakyayita, G. K., A. C. Norrström, and R. N. Kulabako. "Assessment of Levels, Speciation, and Toxicity of Trace Metal Contaminants in Selected Shallow Groundwater Sources, Surface Runoff, Wastewater, and Surface Water from Designated Streams in Lake Victoria Basin, Uganda." Journal of Environmental and Public Health 2019 (May 23, 2019): 1–18. http://dx.doi.org/10.1155/2019/6734017.
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The levels, speciation of elements, and toxicity of selected trace metals as well as other parameters in selected surface water, shallow groundwater sources, landfill leachate, and associated surface runoff in the Lake Victoria basin, Uganda, were studied. The WHO guidelines, Ugandan standards, Canadian guidelines and Swedish EPA were used for assessment. The shallow groundwater was acidic with pH values below 6.5. The pH, dissolved organic carbon, flouride, and sulphate levels for all springs were below the guideline values although 52.8% was contaminated with nitrates while 39% was contaminated with chloride ions. Some surface water samples had levels of major elements, such as iron, chromium, aluminium, and manganese, above the guideline values. Speciation studies showed that 74% of the metal ions was bound to dissolved organic matter in surface water, whereas in landfill leachates, the dominant ionic species was metal hydroxides or fulvic acid bound. Risk analysis based on the Swedish EPA showed varied risks of negative effects in 30%–76% of the sample sites ranging from high to increased risk in surface water, whereas the results from modelling sorption data using the Bio-met tool showed potential risk to toxicity effects of Cu2+, Ni2+, Zn2+, and Pb2+ in 15.3%–30.8% surface water samples and 8.3%–62.5% groundwater samples.
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Campbell, Sharon, Paul Fox-Hughes, Penelope Jones, Tomas Remenyi, Kate Chappell, Christopher White, and Fay Johnston. "Evaluating the Risk of Epidemic Thunderstorm Asthma: Lessons from Australia." International Journal of Environmental Research and Public Health 16, no. 5 (March 7, 2019): 837. http://dx.doi.org/10.3390/ijerph16050837.
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Epidemic thunderstorm asthma (ETA) is an emerging public health threat in Australia, highlighted by the 2016 event in Melbourne, Victoria, that overwhelmed health services and caused loss of life. However, there is limited understanding of the regional variations in risk. We evaluated the public health risk of ETA in the nearby state of Tasmania by quantifying the frequency of potential ETA episodes and applying a standardized natural disaster risk assessment framework. Using a case–control approach, we analyzed emergency presentations in Tasmania’s public hospitals from 2002 to 2017. Cases were defined as days when asthma presentations exceeded four standard deviations from the mean, and controls as days when asthma presentations were less than one standard deviation from the mean. Four controls were randomly selected for each case. Independently, a meteorologist identified the dates of potential high-risk thunderstorm events. No case days coincided with thunderstorms during the study period. ETA was assessed as a very low risk to the Tasmanian population, with these findings informing risk prioritization and resource allocation. This approach may be scaled and applied in other settings to determine local ETA risk. Furthermore, the identification of hazards using this method allows for critical analysis of existing public health systems.
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Mullen, P., and J. Ogloff. "Providing mental health services to adult offenders in Victoria, Australia: Overcoming barriers." European Psychiatry 24, no. 6 (September 2009): 395–400. http://dx.doi.org/10.1016/j.eurpsy.2009.07.003.
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AbstractPurposeTo illustrate the development of the interface between general and forensic mental health services in Victoria, Australia.MethodDeveloping effective cooperation between the general and forensic mental health services requires overcoming a number of barriers. The attitude of general services that antisocial behaviour was none of their business was tackled through ongoing workshops and education days over several years. The resistance to providing care to those disabled by severe personality disorders or substance abuse was reduced by presenting and promoting models of care developed in forensic community and inpatient services which prioritised these areas. The reluctance of general services to accept offenders was reduced by involving general services in court liaison clinics and in prisoner release plans. Cooperation was enhanced by the provision of risk assessments, the sharing of responsibility for troublesome patients, and a problem behaviours clinic to support general services in coping with stalkers, sex offenders and threateners.ConclusionsActive engagement with general services was promoted at the level of providing education, specialised assessments and a referral source for difficult patients. This generated a positive interface between forensic and general mental health services, which improved the quality of care delivered to mentally abnormal offenders.
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Fennessy, Paul, and Richard King. "VP40 Robotic Surgery: From Health Technology Assessment To State Health Policy." International Journal of Technology Assessment in Health Care 34, S1 (2018): 169. http://dx.doi.org/10.1017/s0266462318003525.
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Introduction:The aging population means more men are diagnosed with prostate cancer, resulting in greater demand for treatment. Robot-assisted radical prostatectomy (RARP) claims to offer additional benefits to patients and providers. The independent Victorian Health Technology Program Advisory Committee assessed safety, clinical effectiveness and cost effectiveness evidence and financial impact to inform policy, access and reimbursement decision-making by state government policy makers and public hospital providers.Methods:Public and private hospital activity and costs for 2008–09 to 2012–13 from the Victorian Admitted Episodes Database (VAED) and the Victorian Cost Data Collection (VCDC) were identified. Data were extracted and reviewed based on (i) DRGs M01A and B, (ii) primary diagnostic code C61 (ICD-10-AM), and (iii) Australian Classification of Health Interventions procedure codes for open (ORP), laparoscopic (LRP) and RARP, supplemented by Victorian Prostate Cancer Clinical Registry data. English language Health Technology Assessments (HTAs)/systematic reviews published January 2009 to January 2015 were identified and analysed with comparative clinical outcomes data for RARP vs. ORP and RARP vs. LRP analysed. Not all reported the same data and most outcomes data presented were odds ratios and risk ratios.Results:RARP offers patients a shorter length of stay (LOS) compared with ORP or LRP, but the procedure takes longer to perform. While RARP has similar safety and clinical effectiveness profiles compared with ORP and LRP, published data do not unequivocally demonstrate that RARP is superior to ORP or LRP in terms of clinical outcomes. RARP is more expensive than ORP and LRP. The cost differential increases when capital costs are taken into account. Cost offsets from a reduced LOS are insufficient to justify the higher cost.Conclusions:Since RARP produces similar clinical outcomes to ORP and LRP but at a higher cost, the Victorian Health Technology Program Advisory Committee considered the case for public sector support of RARP is weak and provided two recommendations: (i) State Government resources are not used to procure RARP capital equipment; (ii) public hospitals can refer patients to a RARP provider, provided costs are negotiated prior to patient transfer and fully covered by the referring hospital.
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Wallis, Christopher, Hilary L. Nelson, and P. J. Pommerville. "Testosterone deficiency syndrome and cardiovascular health: An assessment of beliefs, knowledge and practice of general practitioners and cardiologists in Victoria, BC." Canadian Urological Association Journal 8, no. 1-2 (February 10, 2014): 30. http://dx.doi.org/10.5489/cuaj.1448.
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Introduction: Testosterone deficiency syndrome (TDS) has been shown to be an independent cardiovascular risk factor and a predisposing factor for metabolic syndrome. As general practitioners and cardiologists primarily care for these patients, we sought to assess their knowledge, beliefs and practice patterns with respect to TDS and cardiac health.Methods: We distributed a questionnaire to all 20 cardiologists and a cohort of 128 family practitioners in Victoria, British Columbia. Of the 13 questions, 10 assessed knowledge and beliefs on TDS and 3 assessed current practice patterns.Results: Most respondents believed that TDS is a medical condition (66.7%) and could negatively affect body composition (62%), buta similar majority was unsure whether it was a cardiac risk factor (66.7%). While most believed that testosterone replacement therapy (TRT) could improve exercise tolerance (62%), most were unsure if it was beneficial in cardiac patients. Cardiologists were significantly less likely to believe that TRT was beneficial in preventing recurrent myocardial infarction and improving myocardial perfusion (p = 0.0133, 0.00186, respectively). The vast majority (88%) did not screen cardiac patients for TDS. If a patient was identified as having TDS, only 10% of those surveyed would refer these patients to a urologist.Conclusion: Despite its prevalence in cardiac patients, TDS is not well-understood by general practitioners and cardiologists; they lack knowledge on its deleterious cardiovascular effects. In their role as men’s health advocates, urologists should educate our colleagues regarding the correlation between TDS and cardiovascular mortality and risk factors. Limitations of this study include small sample size and restricted geographic scope.
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O'Connor, Nicholas A., Aravind Surapaneni, David Smith, and Daryl Stevens. "Occurrence and fate of Ascaris lumbricoides ova in biosolids in Victoria, Australia: a human health risk assessment of biosolids storage periods." Water Science and Technology 76, no. 6 (May 26, 2017): 1332–46. http://dx.doi.org/10.2166/wst.2017.222.
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Reuse of sewage biosolids in Victoria, Australia, typically involves mesophilic anaerobic digestion followed by air-drying and long-term storage to ensure removal of ova of soil-transmitted helminths (STH) such as Ascaris lumbricoides. Long-term storage degrades the biosolids' agronomic quality due to the loss of key plant nutrients and takes up large areas of storage space. The impact of varying biosolids holding times and other processes on STH using Ascaris as the reference STH pathogen was examined in this study using a quantitative risk analysis approach. Risk modelling of the potential human health impacts from the presence of Ascaris ova in biosolids was undertaken for discrete holding periods of 1, 2 and 3 years. Modelling showed that to meet the WHO 1 μDALY·person−1·year−1 disease burdens guideline for limiting exposure category, a biosolids storage period of 1.24 years or 2.1 years would be required, depending on the data source of ova shedding rates per worm (Bangladesh or Nigeria, respectively). The soil exposure and salad/root vegetable consumption models included a number of variables with moderate to high degrees of uncertainty. Monte Carlo simulation was used to assess the effect of uncertainty in model input variables and to assist in highlighting areas for further research.
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Alex, Wenaty, Fromberg Arvid, Mabiki Faith, Chove Bernard, Dalsgaard Anders, and Mdegela Robinson. "Assessment of health risks associated with organochlorine pesticides levels in processed fish products from Lake Victoria." African Journal of Food Science 13, no. 5 (May 31, 2019): 101–10. http://dx.doi.org/10.5897/ajfs2019.1814.
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Pirkis, Jane, Philip Burgess, and Damien Jolley. "Suicide Among Psychiatric Patients: A Case-Control Study." Australian & New Zealand Journal of Psychiatry 36, no. 1 (February 2002): 86–91. http://dx.doi.org/10.1046/j.1440-1614.2002.00993.x.
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Objective: To examine patient- and treatment-based differences between psychiatric patients who do and do not die by suicide. Method: By linking databases of deaths and psychiatric service use in Victoria, we compared 597 cases who suicided over 5 years with individually matched controls. Results: Cases and controls could not be distinguished on the majority of patient- or treatment-based characteristics. The exceptions were that cases were more likely to be male, less likely to be outside the labour force, more likely to have recent contact with inpatient and community services, and more likely to have a registration as their last contact. Conclusions: Patients who suicide ‘look’ similar to those who do not, suggesting prevention approaches should ensure that all psychiatric patients receive optimal care, including appropriate detection, diagnosis, assessment and treatment of mental health problems, and careful, individualised assessment of suicide risk.
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Hall, Martin, and Bradley Christian. "A health-promoting community dental service in Melbourne, Victoria, Australia: protocol for the North Richmond model of oral health care." Australian Journal of Primary Health 23, no. 5 (2017): 407. http://dx.doi.org/10.1071/py17007.
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Despite the best efforts and commitment of oral health programs, there is no evidence that the current surgical output-based model of oral health care is delivering better oral health outcomes to the community. In fact, Australian evidence indicates the oral health of the community could be getting worse. It is now well-understood that this traditional surgical model of oral health care will never successfully manage the disease itself. It is proposed that a health-promoting, minimally invasive oral disease management model of care may lead to a sustainable benefit to the oral health status of the individual and community groups. The aim of this paper is to describe such a model of oral health care (MoC) currently being implemented by the North Richmond Community Health Oral Health (NRCH-OH) program in Melbourne, Victoria, Australia; this model may serve as a template for other services to re-orient their healthcare delivery towards health promotion and prevention. The paper describes the guiding principles and theories for the model and also its operational components, which are: pre-engagement while on the waitlist; client engagement at the reception area; the assessment phase; oral health education (high-risk clients only); disease management; and reviews and recall.
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Maylea, Christopher. "The capacity to consent to sex in mental health inpatient units." Australian & New Zealand Journal of Psychiatry 53, no. 11 (May 22, 2019): 1070–79. http://dx.doi.org/10.1177/0004867419850320.
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Objective: Discussions of capacity to consent in mental health care usually revolve around capacity to consent to treatment. This paper instead explores the issue of capacity to consent to sexual activity in a mental health inpatient setting as a way of exploring capacity from a different perspective. This is not a purely theoretical exercise, with both consensual sexual activity and sexual assault commonplace in mental health inpatient units, current policy and practice approaches are clearly not working and require re-examination. Methods: Four key frameworks are explored: human rights law, mental health law, the criminal law and the law of tort governing the duty of care. These frameworks are explored by highlighting relevant case law and statutes and considering their potential application in practice. This is undertaken using the state of Victoria, Australia, as a case study. Results: The four frameworks are shown to be consistent with each other but inconsistent with contemporary policy. All four legal frameworks explored require clinicians to take a case-by-case assessment to ensure that a person’s right to make their own decisions is preserved ‘ unless the contrary is demonstrably justified’ or where it is ‘ legally demanded’. While Victorian inpatient units attempt to enforce a blanket ban on consensual sexual activity in inpatient settings, this ban may be without legal basis and may be in breach of both human rights and mental health law. Conclusion: In policing the lawful bodily interactions of their patients and pushing sexual activity out of sight, clinicians may be breaching their duty of care to provide sexual health support and risk creating an environment in which the therapeutic relationship will be sacrificed to the enforcement of institutional policy. Clinicians and policymakers must understand the relevant legal frameworks to ensure that they are acting ethically and lawfully.
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MacLachlan, Jennifer H., and Benjamin C. Cowie. "Uptake and trends in ordering of funded hepatitis B immunisation for priority populations in Victoria, Australia, 2013–2014." Sexual Health 14, no. 2 (2017): 188. http://dx.doi.org/10.1071/sh16002.
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Background The Department of Health and Human Services in Victoria provides funded hepatitis B vaccine to many priority groups at risk of acquiring infection. We aimed to determine the uptake of vaccine ordering for at-risk groups over time, to assess any trends and identify any gaps in prevention of hepatitis B for those at risk. Methods: Routinely collected administrative data regarding the indication for vaccine ordered by practitioners were analysed for the period June 2013 to December 2014. Number of doses and courses distributed was determined and compared with the estimated size of the priority populations. Results: During the 18-month period assessed, 20 498 doses of funded hepatitis B vaccine were ordered, equating to ~5700 complete courses, with the overall number of orders per quarter increasing between 2013 and 2014. The most common indication was being a household or sexual contact of people living with hepatitis B (2803 courses, 49.2% of the total), equating to approximately one course per new chronic hepatitis B notification. The remaining doses were largely distributed to people living with HIV (648 courses, 11.4%), people living with hepatitis C (621 courses, 10.9%), and people who inject drugs (594 courses, 10.4%). Conclusions: This analysis demonstrates that access to hepatitis B immunisation among priority populations appears to have increased in Victoria during 2013–14, however it could still be improved. Continued assessment of these data over time will be important to measure the impact of interventions on increasing the reach of the funded vaccine program.
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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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Manirakiza, Wilberforce, Emmanuel Tumwesigye, Kevin Otim, Mary Akurut, and Harrison E. Mutikanga. "Lessons learnt from dealing with climatic extreme events - A case of L. Victoria and the White Nile Cascade." E3S Web of Conferences 346 (2022): 04003. http://dx.doi.org/10.1051/e3sconf/202234604003.
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Lake Victoria storage and water levels are affected by changes in precipitation, evapotranspiration, tributary inflows and outflow in the single Nile River outlet at Owen Falls Dam. In May 1964, the lake reached its first highest recorded level of 13.46 m at the Jinja Pier that resulted into the Nile River outflow of 1910 m3/s. Consequently, the decision to construct Owen falls extension later in year 2000 was motivated by the risk assessment to mitigate the potential of regional hydrology reverting to the 1960s conditions. However, the catchment has consistently had above-normal precipitation coupled with accelerating land use changes that have resulted into higher inflows from the lake tributaries. In May 2020, the lake level surpassed the 1964 record, peaking at 13.47 m towards the end of May. These two occurrences (1964 and 2020) greatly affected hydropower generation, disrupted socio-economic activities around the lake and along the river and posed a threat on the safety of Nile Cascade dams. This paper therefore, presents the integrated multi-sectoral framework that was adopted to assess and mitigate the risks involved. The paper also identifies challenges, opportunities, interventions and lessons learnt from such risks and uncertainties.
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Wagg, Emma, Jane Hocking, and Jane Tomnay. "What do young women living in regional and rural Victoria say about chlamydia testing? A qualitative study." Sexual Health 17, no. 2 (2020): 160. http://dx.doi.org/10.1071/sh19182.
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Background Chlamydia trachomatis is the most commonly notified sexually transmissible infection in Australia, with almost 100000 cases diagnosed in 2018. Chlamydia is easy to diagnose and treat, but infections are underdiagnosed. Eighty per cent of chlamydia cases are asymptomatic. Without testing, infections will remain undetected. Several barriers to testing have been identified in previous research, including cost, privacy concerns for young rural people, knowledge gaps, embarrassment and stigma. The aim of this study was to investigate young regional and rural women’s understanding of chlamydia and factors that may prevent or delay testing. Methods: Semistructured interviews were conducted with 11 women aged between 18 and 30 years residing in north-east Victoria, Australia. Interviews were transcribed verbatim and analysed thematically. Results: Themes were grouped under four categories: (1) chlamydia and stigma; (2) the application of stigma to self and others; (3) factors affecting testing; and (4) knowledge. A chlamydia infection was associated with stigma. The young women in this study anticipated self-stigma in relation to a positive diagnosis, but resisted stigmatising others. Increased knowledge about chlamydia prevalence was associated with reduced self-stigma. The most consistent factor affecting testing decisions was personal risk assessment. Knowledge gaps about symptoms, testing and treatment were also identified, with participants not always accessing information from reputable sources. Conclusion: Chlamydia testing was viewed as a positive activity among this cohort. However, there is considerable perceived stigma about being diagnosed with an infection. Interventions that communicate prevalence, reduce stigma and provide factual information about testing and risk are still needed. Clinicians have an opportunity to convey this information at consultation. Health promotion workers should continue to develop and run campaigns at a community level to encourage regular screening.
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MacMillan, R. A., and T. Ponich. "A114 DEVELOPING AND VALIDATING A PATIENT RISK ASSESSMENT TOOL TO PREDICT POST-ERCP PANCREATITIS." Journal of the Canadian Association of Gastroenterology 4, Supplement_1 (March 1, 2021): 93–94. http://dx.doi.org/10.1093/jcag/gwab002.112.
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Abstract Background Post-ERCP pancreatitis (PEP), the most common complication of ERCP, can lead to significant patient morbidity and even mortality. Both American (ASGE) and European (ESGE) guidelines emphasize the importance of assessing PEP risk among patients about to undergo ERCP so appropriate preventative measures can be initiated. Though multiple PEP risk factors have been identified, an ideal risk assessment tool has not yet been developed that accurately predicts PEP risk among ERCP patients. An ideal PEP risk factor screening tool would be one that most sensitively identifies patients likely to benefit from PEP preventative measures. We have developed a patient PEP risk screening tool based on both ASGE and ESGE guidelines (Table 1) and analyzed its accuracy predicting PEP rates in our clinical practice. Aims We investigated whether the ERCP patient and procedural risk factors listed in the ASGE and ESGE guidelines were linked to PEP rates using a novel PEP risk screening tool in patients undergoing ERCP. Methods Retrospective chart reviews of patients undergoing ERCP were performed within a single clinician’s practice at the London Health Science Centre, Victoria Hospital, between January 2016 and October 2019 to: 1) assess the proportion of patients identified as high PEP risk using our novel PEP risk screening tool; 2) determine whether a high PEP risk score using this tool was linked to higher PEP rates following ERCP; and 3) identify the absolute score threshold that best delineates patients at higher risk. A chi-square test of independence was performed to examine the relationship between high PEP risk identified via screening and the actual PEP rate following ERCP. Results Five hundred sixty-one patients who underwent ERCP were assessed using the new PEP risk screening tool. Among those patients, 6.6% (37/561) developed post-ERCP pancreatitis. Using the screening tool, 79.5% (446/561) were identified as high risk, using a cut-off score of 1; the score with the highest sensitivity (95%) and specificity (22%) combination. Identifying high PEP risk patients at this cut-off was significantly linked to increased PEP rates in patients who underwent ERCP (X2 = 5.5; df = 1, p < .05). Conclusions Using a cut-off score of 1, the PEP risk screening tool was very sensitive, but relatively non-specific at identifying patients who went on to develop post-ERCP pancreatitis. We hope that, based on these findings, high-risk patient identification can be improved, so more aggressive and appropriately-targeted prophylactic measures against PEP can be provided. Funding Agencies None
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Fennessy, Paul, Vanessa Clements, and Olivia Hibbitt. "OP44 Robot-Assisted Surgery: Joint HTA To Inform Australian Policy And Funding." International Journal of Technology Assessment in Health Care 35, S1 (2019): 10. http://dx.doi.org/10.1017/s0266462319001107.
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IntroductionRobot-Assisted Surgery (RAS) has been available in Australia since 2003. There are 50 da Vinci RAS systems in Australia (18 in NSW and 12 in Victoria) with most in the private hospital sector. In Australia the capital cost of a da Vinci RAS system is up to AUD 4 million (USD 2.8 million), which excludes annual maintenance fees of AUD 250,000 (USD 175,000) and consumable costs of AUD 3,500 (USD 2,450) for each procedure.MethodsThe NSW Ministry of Health and Victorian Department of Health and Human Services commissioned a health technology assessment (HTA) to explore the benefits, risks and economic implications of surgical robotics, which involved a review of the peer reviewed literature, a cost benefit analysis of public sector patients who received RAS and broad stakeholder consultation to document current perspectives on RAS applications.ResultsRAS is as safe and effective as other surgical modalities when performed by sufficiently skilled surgeons, although evidence generally comes from small studies with limited follow-up time and few studies report long term mortality, morbidity or patient-reported outcomes. Comparative benefits of RAS are uncertain as most studies conclude little or no difference in procedure related or functional outcomes. While RAS reduces length of stay, which offers patient and health system benefits, this is insufficient to fully offset high capital and consumable costs currently charged to Australian providers. Government and clinical stakeholders identified that establishing an RAS service requires consideration of important factors, including: i) Governance is critical; ii) Higher case volumes may improve financial viability; and iii) a need for state-wide/national standards for surgeon training and credentialing.ConclusionsRAS is as safe and effective as other modalities when performed by skilled surgeons. However, uncertainty remains around long-term outcomes and clinical and cost effectiveness. An accredited training program, monitoring and evaluation will be critical to ensure outcomes data inform ongoing evidence assessment and government policy and investment.
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Bryant, Richard A., Lisa Gibbs, Hugh Colin Gallagher, Phillipa Pattison, Dean Lusher, Colin MacDougall, Louise Harms, et al. "Longitudinal study of changing psychological outcomes following the Victorian Black Saturday bushfires." Australian & New Zealand Journal of Psychiatry 52, no. 6 (June 12, 2017): 542–51. http://dx.doi.org/10.1177/0004867417714337.
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Objectives: To map the changing prevalence and predictors of psychological outcomes in affected communities 5 years following the Black Saturday bushfires in Victoria. Method: Follow-up assessment of longitudinal cohort study in high, medium and non-affected communities in Victoria, Australia. Participants included 1017 respondents (Wave 1) interviewed via telephone and web-based survey between December 2011 and January 2013, and 735 (76.1%) eligible participants were retested between July and November 2014 (Wave 2). The survey included measures of fire-related and subsequent stressful events, probable posttraumatic stress disorder, major depressive episode, alcohol use and severe distress. Results: There were reduced rates of fire-related posttraumatic stress disorder (8.7% vs 12.1%), general posttraumatic stress disorder (14.7% vs 18.2%), major depressive episode (9.0% vs 10.9%) and serious mental illness (5.4% vs 7.8%). Rates of resilience increased over time (81.8% vs 77.1%), and problem alcohol use remained high across Wave 1 (22.1%) and Wave 2 (21.4%). The most robust predictor of later development of fire-related posttraumatic stress disorder (odds ratio: 2.11; 95% confidence interval: [1.22, 3.65]), general posttraumatic stress disorder (odds ratio: 3.15; 95% confidence interval: [1.98, 5.02]), major depressive episode (odds ratio: 2.86; 95% confidence interval: [1.74, 4.70]), serious mental illness (odds ratio: 2.67; 95% confidence interval: [0.57, 1.72]) or diminished resilience (odds ratio: 2.01; 95% confidence interval: [1.32, 3.05]) was extent of recent life stressors. Conclusion: Although rates of mental health problems diminished over time, they remained higher than national levels. Findings suggest that policy-makers need to recognize that the mental health consequences of disasters can persist for many years after the event and need to allocate resources towards those who are most at risk as a result of substantive losses and ongoing life stressors.
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Jones, Julia L., Natalie G. Lumsden, Koen Simons, Anis Ta'eed, Maximilian P. de Courten, Tissa Wijeratne, Nicholas Cox, et al. "Using electronic medical record data to assess chronic kidney disease, type 2 diabetes and cardiovascular disease testing, recognition and management as documented in Australian general practice: a cross-sectional analysis." Family Medicine and Community Health 10, no. 1 (February 2022): e001006. http://dx.doi.org/10.1136/fmch-2021-001006.
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ObjectivesTo evaluate the capacity of general practice (GP) electronic medical record (EMR) data to assess risk factor detection, disease diagnostic testing, diagnosis, monitoring and pharmacotherapy for the interrelated chronic vascular diseases—chronic kidney disease (CKD), type 2 diabetes (T2D) and cardiovascular disease.DesignCross-sectional analysis of data extracted on a single date for each practice between 12 April 2017 and 18 April 2017 incorporating data from any time on or before data extraction, using baseline data from the Chronic Disease early detection and Improved Management in PrimAry Care ProjecT. Deidentified data were extracted from GP EMRs using the Pen Computer Systems Clinical Audit Tool and descriptive statistics used to describe the study population.SettingEight GPs in Victoria, Australia.ParticipantsPatients were ≥18 years and attended GP ≥3 times within 24 months. 37 946 patients were included.ResultsRisk factor and disease testing/monitoring/treatment were assessed as per Australian guidelines (or US guidelines if none available), with guidelines simplified due to limitations in data availability where required. Risk factor assessment in those requiring it: 30% of patients had body mass index and 46% blood pressure within guideline recommended timeframes. Diagnostic testing in at-risk population: 17% had diagnostic testing as per recommendations for CKD and 37% for T2D. Possible undiagnosed disease: Pathology tests indicating possible disease with no diagnosis already coded were present in 6.7% for CKD, 1.6% for T2D and 0.33% familial hypercholesterolaemia. Overall prevalence: Coded diagnoses were recorded in 3.8% for CKD, 6.6% for T2D, 4.2% for ischaemic heart disease, 1% for heart failure, 1.7% for ischaemic stroke, 0.46% for peripheral vascular disease, 0.06% for familial hypercholesterolaemia and 2% for atrial fibrillation. Pharmaceutical prescriptions: the proportion of patients prescribed guideline-recommended medications ranged from 44% (beta blockers for patients with ischaemic heart disease) to 78% (antiplatelets or anticoagulants for patients with ischaemic stroke).ConclusionsUsing GP EMR data, this study identified recorded diagnoses of chronic vascular diseases generally similar to, or higher than, reported national prevalence. It suggested low levels of extractable documented risk factor assessments, diagnostic testing in those at risk and prescription of guideline-recommended pharmacotherapy for some conditions. These baseline data highlight the utility of GP EMR data for potential use in epidemiological studies and by individual practices to guide targeted quality improvement. It also highlighted some of the challenges of using GP EMR data.
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Lee, Lewina. "INNOVATIVE APPROACHES TO EVALUATING THE LIFESPAN ASSOCIATIONS OF STRESS, HEALTH, AND WELL-BEING." Innovation in Aging 6, Supplement_1 (November 1, 2022): 145–46. http://dx.doi.org/10.1093/geroni/igac059.578.
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Abstract Despite widespread agreement on the importance of stress in health and aging, the mechanisms by which psychosocial stressors influence emotional and physical health are not fully understood. Thorough operationalization of stressor exposure and stress response can contribute to a “common language of stress” (Epel et al., 2018) across disciplines, and a lifespan approach can inform the developmental timing of stress-health mechanisms. Guided by these considerations, this symposium presents five studies led by early-career researchers to delineate stress-health associations across the lifespan. Dr. Olivia Atherton will leverage father-offspring data over 25+ years to examine domains of early life stressors that are susceptible to intergenerational transmission and modifiers of such transmission. Drawing from daily diary bursts embedded within a longitudinal study, Dr. Emily Willroth will report on the role of affective reactivity to daily stressors as potential mediators of the association between childhood psychosocial stressors and all-cause mortality risk. Dr. Meaghan Barlow will present on a novel emotion construct – emotion globalizing – by considering the extent to which emotional response to daily stressors influences global assessment of well-being and age differences in these processes. Dr. Soomi Lee will consider job characteristics linked to 10-year stability and change in sleep health profiles in a national adult sample. Dr. Victoria Marino will illustrate a novel approach to assess the flexibility with which individuals select strategies for coping with stressors and describe its association with mortality. Altogether, this symposium contributes evidence on how psychosocial stressors may shape health and well-being across the lifespan.
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Diaper, C., and A. Sharma. "Innovative sewerage solutions for small rural towns." Water Science and Technology 56, no. 5 (September 1, 2007): 97–103. http://dx.doi.org/10.2166/wst.2007.561.
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The development and implementation of alternative wastewater servicing approaches in rural communities in Australia appears more feasible than in larger urban developments as many rural centres rely on septic tanks and surface discharge of greywater. This method of disposal creates many environmental, social and economic issues and is seen to limit potential for growth in many towns. This paper describes a generic methodology for the selection of innovative sewerage options for six regional towns in Victoria, Australia. The method includes consultation with stakeholders, multi-criteria assessment and concept design of the most favourable option. Despite the broad range of initial wastewater servicing options presented which included cluster-scale systems, upgrade of existing systems, greywater reuse and alternative collection, the outcome for five of the six towns was a modified centralised collection system as the preferred option. Lack of robust and reliable data on the human health risks and environmental impacts of alternative systems were identified as the primary data gaps in the sustainability assessment. In addition, biases in the assessment method due to stakeholder perceptions were found to be an additional issue.
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Leggat, Sandra G. "Hospital Planning: The Risks of Basing the Future on Past Data." Health Information Management Journal 37, no. 3 (October 2008): 6–14. http://dx.doi.org/10.1177/183335830803700302.
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Planning for capital development of public hospitals in Victoria is guided by a multi-stage process with comprehensive data analysis and thorough approval processes at each of the stages. The long development timeframes and the limitations in the data available to project service utilisation may negatively impact upon the service planning processes, and in some cases newly developed hospitals have not been sufficiently planned to meet community needs. This paper suggests that service utilisation forecasts derived from administrative databases require a more detailed verification process than currently exists. The process requires consideration of the drivers of demand to document the core assumptions about the future drivers, benchmarks with other jurisdictions, epidemiological, comparative and corporate needs assessment to explain the differences in utilisation rates, and sensitivity analysis. Given the cost of hospital construction and the rate of change in the healthcare sector, it is important that future hospital planning processes do not accept current utilisation trends as valid for future planning without this level of verification.
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Oláh, Csaba, Zsófia Kardos, Mónika Andrejkovics, Enikő Szarka, Katalin Hodosi, Andrea Domján, Mariann Sepsi, et al. "Assessment of cognitive function in female rheumatoid arthritis patients: associations with cerebrovascular pathology, depression and anxiety." Rheumatology International 40, no. 4 (September 25, 2019): 529–40. http://dx.doi.org/10.1007/s00296-019-04449-8.
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Abstract We assessed cognitive function of female rheumatoid arthritis (RA) patients and analyze the determinants, with special focus on cerebrovascular morphology. Sixty methotrexate (MTX-) or biologic-treated RA patients and 39 healthy controls were included in a cross-sectional study. Smoking habits, alcohol intake and time spent in education were recorded. Standard measures were performed to assess cognitive function (Montreal Cognitive Assessment, MOCA; Trail Making Test, TMT; Victoria Stroop Test, VST; Wechsler Adult Intelligence Scale, WAIS; Benton Visual Retention test, BVRT), depression (Beck Depression Inventory, BDI), anxiety (State-Trait Anxiety Inventory, STAIT/S) and general health status (Short Form 36, SF-36). Mean disease activity (28-joint Disease Activity Score, mDAS28; erythrocyte sedimentation rate, mESR; C-reactive protein, mCRP) of the past 12 months was calculated; anti-cyclic citrullinated peptide (CCP) and rheumatoid factor (RF) were assessed. Cerebral vascular lesions and atrophy, carotid intima–media thickness (cIMT) and plaques, as well as median cerebral artery (MCA) circulatory reserve capacity (CRC) were assessed by brain magnetic resonance imaging (MRI), carotid ultrasound and transcranial Doppler, respectively. Cognitive function tests showed impairment in RA vs controls. Biologic- vs MTX-treated subgroups differed in TMT-A. Correlations were identified between cognitive function and depression/anxiety tests. WAIS, STAIS, STAIT and BDI correlated with most SF-36 domains. Numerous cognitive tests correlated with age and lower education. Some also correlated with disease duration, mESR and mDAS28. Regarding vascular pathophysiology, cerebral vascular lesions were associated with VST-A, carotid plaques with multiple cognitive parameters, while MCA and CRC with MOCA, BVRT and BDI. RA patients have significant cognitive impairment. Cognitive dysfunction may occur together with or independently of depression/anxiety. Older patients and those with lower education are at higher risk to develop cognitive impairment. Cognitive screening might be a useful tool to identify subgroups to be further investigated for cerebrovascular pathologies.
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Allinson, Mayumi, Yutaka Kameda, Kumiko Kimura, and Graeme Allinson. "Occurrence and assessment of the risk of ultraviolet filters and light stabilizers in Victorian estuaries." Environmental Science and Pollution Research 25, no. 12 (February 16, 2018): 12022–33. http://dx.doi.org/10.1007/s11356-018-1386-7.
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Tropea, Joanne, Bhasker Amatya, Caroline A. Brand, and The Expert Advisory Group. "Use of consensus methods to select clinical indicators to assess activities to minimise functional decline among older hospitalised patients." Australian Health Review 35, no. 4 (2011): 404. http://dx.doi.org/10.1071/ah09790.
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Objectives. The study aimed to develop a set of clinical indicators to minimise the risk and adverse outcomes of functional decline in older hospitalised people. Methods. Existing Australian and international clinical indicators relevant to cognition and emotional health, mobility, vigour and self care, continence, nutrition, skin integrity, person-centred care, assessment and medication management were identified by literature and electronic website review. A multidisciplinary expert advisory group used modified Delphi methods, including two anonymous voting rounds and a group discussion, to gain consensus for a prioritised set of clinical indicators. For each indicator, experts voted on a scale of 1 (low level of prioritisation) to 9 (high level of prioritisation) based on measurement attributes and utility for use at the level of clinical teams, hospital managers and jurisdictional policy makers. Results. There were 55 existing clinical indicator sets identified, from which 63 relevant indicators were extracted. The final prioritised set covered all domains and included 19 indicators of which 17 were process indicators and 2 were outcome indicators. Scores for scientific measurement attributes and practicality for implementation were only moderate. Conclusion. These clinical indicators offer a consistent basis for monitoring hospital performance and improving care of older people in Victoria and other jurisdictions. What is known about the topic? Older hospitalised patients are at risk of functional decline and associated adverse outcomes such as falls and pressure ulcers. Clinical indicators to measure healthcare structures, processes and outcomes can be used to monitor quality of care among this vulnerable patient group. What does this paper add? This paper describes the process used to identify and select indicators for the Victorian government’s Council of Australian Governments Long Stay Older Persons initiative. It presents the use of a modified Delphi technique to gain group consensus for the indicator selection process; a technique being increasingly used in healthcare. What are the implications for practitioners? The indicators provide a set of measures that can be used by organisations, clinical teams and government level to assess the effect of quality improvement activities and initiatives aimed at minimising functional decline.
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Olaniyi, W. A. "The proposed Eko Atlantic City project, Victoria Island, Lagos: Preliminary impact assessment of land reclamation on the aquatic lives and climate change." Nigerian Journal of Animal Production 48, no. 4 (March 8, 2021): 194–200. http://dx.doi.org/10.51791/njap.v48i4.3014.
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The effects of climate change in the face of land reclamation among other anthropogenic activities are of great concern to aquatic genetic resources and biodiversity. This study was designed to assess the preliminary impact of the proposed Eko Atlantic City (EAC) project on the aquatic lives and/or biodiversity, and the level of development and challenges that have implications on climate change in Victoria Island and its environs in Lagos State, Nigeria. The selected areas such as Lamgbasa, Badore, Ajah and Victoria Island were evaluated using the snowball sampling approach, whereby 111 respondents were assessed. Results showed that land reclamation and construction activities had impacted on the aquatic lives and the primitive fishing occupation (5.5%). Respondents (44.4%) agreed that the on-going EAC had contributed to the development of Lagos State, however, negative impacts of climate change such as ocean surge, sea level rise, flooding among others were high but with low level of adaptive capacity agreement (41.7%). Furthermore, analysis showed varying degrees in the extent of severity of problems encountered from climate change effects such as rainfall, flooding, temperature, health issues among others. The study revealed that these communities were susceptible or vulnerable to the impacts of climate change such as coastal erosion, flooding, storm/ocean surge, sea level rise etc and importantly loss of non- renewable aquatic genetic resources. The government is hereby advised to have sound policies for adaptation and mitigation strategies to protect these non-renewable genetic resources and effect of climate change activities.
Les effets du changement climatique face à la mise en valeur des terres, entre autres activités anthropiques, sont très préoccupants pour les ressources génétiques aquatiques et la biodiversité. Cette étude a été conçue pour évaluer l'impact préliminaire du projet proposé Eko Atlantic City (EAC) sur la vie aquatique et / ou la biodiversité, ainsi que le niveau de développement et les défis qui ont des implications sur le changement climatique dans l'île Victoria et ses environs dans l'État de Lagos, Nigeria. Les zones sélectionnées telles que Lamgbasa, Badore, Ajah et Victoria Island ont été évaluées à l'aide de la méthode d'échantillonnage en boule de neige, qui a permis d'évaluer 111 répondants. Les résultats ont montré que la remise en état des terres et les activités de construction avaient eu un impact sur la vie aquatique et l'occupation de la pêche primitive (5.5%). Les répondants (44.4%) ont convenu que l'EAC en cours avait contribué au développement de l'État de Lagos, cependant, les impacts négatifs du changement climatique tels que la montée des océans, l'élévation du niveau de la mer, les inondations, entre autres, étaient élevés mais avec un faible niveau d'accord de capacité d'adaptation (41.7%). En outre, l'analyse a montré des degrés divers dans l'étendue de la gravité des problèmes liés aux effets du changement climatique tels que les précipitations, les inondations, la température, les problèmes de santé, entre autres. L'étude a révélé que ces communautés étaient sensibles ou vulnérables aux impacts du changement climatique tels que l'érosion côtière, les inondations, les tempêtes / ondes océaniques, l'élévation du niveau de la mer, etc. et surtout la perte de ressources génétiques aquatiques non renouvelables. Il est conseillé au gouvernement de se doter de politiques solides pour les stratégies d'adaptation et d'atténuation afin de protéger ces ressources génétiques non renouvelables et les effets des activités liées aux changements climatiques.
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Williams, A. "70. A NEW SPIN ON 'FOOTY TRAINING' - TAKING SEXUAL ASSAULT TALKS TO THE AFL." Sexual Health 4, no. 4 (2007): 311. http://dx.doi.org/10.1071/shv4n4ab70.
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RESPECTFUL BEHAVIOURS: PEOPLE IN SPORT - ADULT SEXUAL ASSAULT - was a presentation that was developed by Dr Angela Williams and Patrick Tidmarsh in conjunction with the Statewide Steering Committee to Reduce Sexual Assault, (established by the Chief Commissioner of Police in Victoria, Christine Nixon), to address the issue of sexual assault in the broader community. The education package was the first element to be implemented of a broader policy to be announced later this year. The package was designed to best educate men in our community whilst identifying specific needs of AFL elite players. It aimed to air the topics of sexual assault, violence against women and respectful behaviours. The education package was delivered to every club from May through to August 2005. Education of our community on these issues is extremely important and essential to cultural change. This discussion will address one effective way of educating our community as it looks more specifically at educating men on these topics. Style and content of education package What the education package covers Identifiable risk factors and scenarios Assessments and evaluations WHERE TO FROM HERE?
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Sesbreno, Erik, Christine E. Dziedzic, Jennifer Sygo, Denis P. Blondin, François Haman, Suzanne Leclerc, Anne-Sophie Brazeau, and Margo Mountjoy. "Elite Male Volleyball Players Are at Risk of Insufficient Energy and Carbohydrate Intake." Nutrients 13, no. 5 (April 24, 2021): 1435. http://dx.doi.org/10.3390/nu13051435.
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Elite volleyball athletes experience significant physical and psychological demands during the competitive season. The aim was to compare the dietary intake of male volleyball athletes with recommendations for sport and health, and to examine the association of physique traits and knee health on eating behaviours and of eating behaviours on reported dietary intake. Using a retrospective cross-sectional design, 22 male athletes from a national indoor volleyball program underwent anthropometric, dual-energy X-ray absorptiometry and resting metabolic rate testing, 4-day dietary intake and hematological analysis, and also completed the three-factor eating questionnaire–R18 for eating behaviours and the Victorian Institute of Sport Assessment—patellar tendon (VISA-P) questionnaire for knee health. Most players under-consumed energy compared to reference guidelines, secondary to under-consuming carbohydrate for exercise. The primary eating behaviour was cognitive restraint, which was associated with body mass index and ectomorphy. Emotional eating behaviour was associated with VISA-P. Differences in emotional and cognitive restraint eating behaviours did not impact dietary intake. The findings suggest that players are at risk of an impaired ability to adapt to and recover from training during an important segment of the competitive season. Future work should explore the presence of low energy availability in elite male volleyball players.
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Davies, C. M., S. M. Petterson, C. Kaucner, N. J. Ashbolt, V. G. Mitchell, G. D. Taylor, and J. Lewis. "Microbial challenge-testing of treatment processes for quantifying stormwater recycling risks and management." Water Science and Technology 57, no. 6 (March 1, 2008): 843–47. http://dx.doi.org/10.2166/wst.2008.194.
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Pathogenic microorganisms have been identified as the main human health risks associated with the reuse of treated urban stormwater (runoff from paved and unpaved urban areas). As part of the Smart Water initiative (Victorian Government, Australia), a collaborative evaluation of three existing integrated stormwater recycling systems, and the risks involved in non-potable reuse of treated urban stormwater is being undertaken. Three stormwater recycling systems were selected at urban locations to provide a range of barriers including biofiltration, storage tanks, UV disinfection, a constructed wetland, and retention ponds. Recycled water from each of the systems is used for open space irrigation. In order to adequately undertake exposure assessments, it was necessary to quantify the efficacy of key barriers in each exposure pathway. Given that none of the selected treatment systems had previously been evaluated for their treatment efficiency, experimental work was carried out comprising dry and wet weather monitoring of each system (for a period of 12 months), as well as challenging the barriers with model microbes (for viruses, bacteria and parasitic protozoa) to provide input data for use in Quantitative Microbial Risk Assessment.
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Theerthegowda, Akhila Nallur, Pavithra Umashankar, and Nagashri Suresh Iyer. "A Comparative Study between Bedside Index for Severity in Acute Pancreatitis (BISAP) and Acute Physiology and Chronic Health Evaluation (APACHE-II) Scoring System in Assessing the Severity of Acute Pancreatitis at Bangalore Medical College and Research Institute, Bangalore, India." Journal of Evidence Based Medicine and Healthcare 8, no. 36 (September 6, 2021): 3269–75. http://dx.doi.org/10.18410/jebmh/2021/594.
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BACKGROUND Acute pancreatitis (AP) is an inflammatory disease of the pancreas, that results from intrapancreatic activation, release, and digestion of the organ by its own enzymes. The diagnosis of acute pancreatitis can be made when a patient presents with threefold elevated serum levels of amylase or lipase, abdominal pain and vomiting. In this study, we wanted to assess the severity of acute pancreatitis by using BISAP (Bedside index for severity in acute pancreatitis) and APACHE-II (Acute physiology and chronic health evaluation) scoring systems and compare the accuracy of BISAP scores with APACHE-II scores. METHODS A prospective study including 201 patients was conducted from April 2018 to March 2020 in Victoria Hospital, affiliated to BMCRI. RESULTS Among 201 AP patients, 129 were found to have mild acute pancreatitis (MAP), 72 were of severe acute pancreatitis (SAP), 192 survival cases, and 9 death cases. The larger the rating score, the higher the proportion of severe pancreatitis and mortality risk. Two kinds of scoring criteria; BISAP score points and Apache II score points compared in patients with MAP and SAP, In Apache II score to predict severity of organ failure, the sensitivity, specificity, positive predictive value, negative predictive value was 84.72 %, 93.02 %, 87.14 %, 91.60 % and area under the curve was 0.958 (P < 0.0001). In BISAP, the sensitivity, specificity, positive predictive value, negative predictive value was 90.28 %, 80.62 %, 72.22 %, 93.69 % and area under the curve was 0.917 (P < 0.0001). CONCLUSIONS Ability of APACHE II score prediction of AP in severity of organ failure and mortality are stronger than BISAP score, But APACHE II scoring system indicators were cumbersome, complicated assessment. BISAP scoring system is simple, economical, rapid and reliable, and it can effectively predict the severity and mortality of acute pancreatitis, and can be used as a preliminary screening method in accurate risk stratification and initiation of management accordingly at community health care, secondary health care and tertiary health care Hospitals. KEYWORDS Pancreatitis, Severity, Prediction, APACHE II and BISAP
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Wood, Melisa, and James R. P. Ogloff. "Victoria's Serious Sex Offenders Monitoring Act 2005: Implications for the Accuracy of Sex Offender Risk Assessment." Psychiatry, Psychology and Law 13, no. 2 (November 2006): 182–98. http://dx.doi.org/10.1375/pplt.13.2.182.
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Choo, Sanny Zi Lung, Nadzirah Rosli, and Shyh Poh Teo. "14 Individual Environmental Assessment for Older Inpatients in Medical Wards, Ripas Hospital, Brunei Darussalam." Age and Ageing 48, Supplement_4 (December 2019): iv4—iv5. http://dx.doi.org/10.1093/ageing/afz164.14.
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Abstract Introduction Falls in hospital cause significant morbidity and mortality for older patients, with 10-25% inpatient falls resulting in lacerations or fractures [Rubenstein, Age Ageing, 2006 Sep; 35Suppl 2:ii37–41]. In addition to patient individual falls risk factors, such as delirium, visual impairment and poor mobility, environmental factors should also be addressed to reduce inpatient falls risk. Methods An audit of the individual patient's environment or bed space was performed using the Queensland Health Individual Environment Checklist [The Victorian Quality Council Safety and Quality in Health]. Older people aged 65 years and older admitted to the medical wards in Raja Isteri Pengiran Anak Saleha (RIPAS) hospital, Brunei were included. Patients who were bed-bound or immobile were excluded from the audit. Results There were 30 patients included in this audit. 13 (43%) were male and 17 (57%) female. Median age was 74 years (Range 65 to 83 years). Several issues were identified from this audit: Although bedside tables and lockers were wheeled with a braking system, they were not secure enough to support a patient if they leaned against them. While 28 (93%) had functioning call bells, none of the patients were shown how to operate them. 22 (73%) did not have easy access to call-bells or night-lights. 14 (47%) did not have bedside lockers or tables within easy reach. 17 (57%) did not have mobility aids within reach or received education regarding safety with mobility aid use. Conclusion This audit highlighted several aspects of the individual patient environment in hospital that should be improved to reduce falls risk. For the medical wards, we recommend ensuring hospital furniture are sturdy enough in case patients lean on them and frequently checking ease of access to call-bells, night lights, walking aids and locker belongings.
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Oshovskyy, Victor. "The Results of a Prospective Cohort Study of the Effectiveness of the Algorithm for Monitoring Pregnancies in Patients from the Group of High Perinatal Risk to Reduce Perinatal Losses and Improve Neonatal Outcome." Family Medicine, no. 2-3 (July 30, 2021): 86–91. http://dx.doi.org/10.30841/2307-5112.2-3.2021.240773.
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Prenatal prognosis is an important part of obstetric care, which aims to reduce fetal and neonatal losses. A differentiated approach to the management of different risk groups allows you to optimize existing approaches. The objective: сomparison of pregnancy results in the high perinatal risk group using the proposed monitoring algorithms and the traditional method of management in a prospective cohort study. Materials and methods. The prospective cohort study was conducted from 2016 to 2018 on the basis of the medical center LLC «Uniclinica», Medical Genetics Center «Genome», Clinic of Reproductive Genetics «Victoria», Kyiv City Maternity Hospital №2. 580 women were included in the final analysis. Exclusion criteria were: low risk (0–2) according to the adapted antenatal risk scale (Alberta perinatal health program), multiple pregnancy, critical malformations and chromosomal abnormalities of the fetus, lack of complete information about the outcome of pregnancy, lack of results of all intermediate clinical and laboratory surveys. Results. The introduction of a comprehensive differentiated approach has improved the diagnosis of late forms of growth retardation (OR 4,14 [1.42–12.09]; p=0,009), reduced the frequency of urgent cesarean sections (OR 1,61 [1,03–2,49]; p=0,046) and reduced perinatal mortality [1,09–21,3]; р=0,041) due to reduction of antenatal losses (OR 2,2 [1,06–4,378]; р=0,045). There was a significant increase in the frequency of planned cesarean sections (p<0,0001, without affecting the total number of operative deliveries) and statistically insignificant, but tendentiously clear shifts to the increase in the frequency of preterm birth between 34–37 weeks of pregnancy and intensive care unit. The latter observation can be explained by better diagnosis of threatening fetal conditions and an increase in the frequency of active obstetric tactics, which in turn affects the number of premature infants, the involvement of the neonatal service, and thus the intensification of the load on intensive. Conclusions. Adequate enhanced monitoring should combine ultrasound, cardiotocography, actography and laboratory techniques, each of which will have a clearly defined purpose in a combined approach to fetal assessment.
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Sanya, Richard E., Angela Nalwoga, Richard K. Grencis, Alison M. Elliott, Emily L. Webb, and Irene Andia Biraro. "Profiles of inflammatory markers and their association with cardiometabolic parameters in rural and urban Uganda." Wellcome Open Research 6 (October 29, 2021): 291. http://dx.doi.org/10.12688/wellcomeopenres.16651.1.
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Background: Inflammation may be one of the pathways explaining differences in cardiometabolic risk between urban and rural residents. We investigated associations of inflammatory markers with rural versus urban residence, and with selected cardiometabolic parameters previously observed to differ between rural and urban residents: homeostatic model assessment of insulin resistance (HOMA-IR), fasting blood glucose (FBG), blood pressure (BP) and body mass index (BMI). Methods: From two community surveys conducted in Uganda, 313 healthy individuals aged ≥ 10 years were selected by age- and sex-stratified random sampling (rural Lake Victoria island communities, 212; urban Entebbe municipality, 101). Fluorescence intensities of plasma cytokines and chemokines were measured using a bead-based multiplex immunoassay. We used linear regression to examine associations between the analytes and rural-urban residence and principal component analysis (PCA) to further investigate patterns in the relationships. Correlations between analytes and metabolic parameters were assessed using Pearson’s correlation coefficient. Results: The urban setting had higher mean levels of IL-5 (3.27 vs 3.14, adjusted mean difference [95% confidence interval] 0.12[0.01,0.23] p=0.04), IFN-⍺ (26.80 vs 20.52, 6.30[2.18,10.41] p=0.003), EGF (5.67 vs 5.07, 0.60[0.32,0.98] p<0.00001), VEGF (3.68 vs 3.28, 0.40[0.25,0.56] p<0.00001), CD40 Ligand (4.82 vs 4.51, 0.31[0.12, 0.50] p=0.001) and Serpin-E1 (9.57 vs 9.46, 0.11[0.05,0.17] p<0.00001), but lower levels of GMCSF (2.94 vs 3.05, -0.10[-0.19,-0.02] p=0.02), CCL2 (2.82 vs 3.10, -0.45[-0.70,-0.21] p<0.00001) and CXCL10 (5.48 vs 5.96, -0.49[-0.71,-0.27] p<0.00001), compared to the rural setting. In PCA, the urban setting had lower representation of some classical inflammatory mediators but higher representation of various chemoattractants and vasoactive peptides. HOMA-IR, FBG, BP and BMI were positively correlated with several principal components characterised by pro-inflammatory analytes. Conclusions: In developing countries, immunological profiles differ between rural and urban environments. Differential expression of certain pro-inflammatory mediators may have important health consequences including contributing to increased cardiometabolic risk observed in the urban environment.
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Goldfeld, Sharon, Hannah Bryson, Fiona Mensah, Anna Price, Lisa Gold, Francesca Orsini, Bridget Kenny, et al. "Nurse home visiting to improve child and maternal outcomes: 5-year follow-up of an Australian randomised controlled trial." PLOS ONE 17, no. 11 (November 28, 2022): e0277773. http://dx.doi.org/10.1371/journal.pone.0277773.
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Objectives Nurse home visiting (NHV) is widely implemented to address inequities in child and maternal health. However, few studies have examined longer-term effectiveness or delivery within universal healthcare systems. We evaluated the benefits of an Australian NHV program (“right@home”) in promoting children’s language and learning, general and mental health, maternal mental health and wellbeing, parenting and family relationships, at child ages 4 and 5 years. Setting and participants Randomised controlled trial of NHV delivered via universal, child and family health services (the comparator). Pregnant women experiencing adversity (≥2 of 10 risk factors) were recruited from 10 antenatal clinics across 2 states (Victoria, Tasmania) in Australia. Intervention Mothers in the intervention arm were offered 25 nurse home visits (mean 23·2 home visits [SD 7·4, range 1–43] received) of 60–90 minutes, commencing antenatally and continuing until children’s second birthdays. Primary and secondary outcomes measured At 4 and 5 years, outcomes were assessed via parent interview and direct assessment of children’s language and learning (receptive and expressive language, phonological awareness, attention, and executive function). Outcomes were compared between intervention and usual care arms (intention to treat) using adjusted regression with robust estimation to account for nurse/site. Missing data were addressed using multiple imputation and inverse probability weighting. Results Of 722 women enrolled in the trial, 225 of 363 (62%) intervention and 201 of 359 (56%) usual care women provided data at 5 years. Estimated group differences showed an overall pattern favouring the intervention. Statistical evidence of benefits was found across child and maternal mental health and wellbeing, parenting and family relationships with effect sizes ranging 0·01–0·27. Conclusion An Australian NHV program promoted longer-term family functioning and wellbeing for women experiencing adversity. NHV can offer an important component of a proportionate universal system that delivers support and intervention relative to need. Trial registration 2013–2016, registration ISRCTN89962120
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Zengin, Ayse, Cat Shore-Lorenti, Marc Sim, Louise Maple-Brown, Sharon Lee Brennan-Olsen, Joshua R. Lewis, Jennifer Ockwell, Troy Walker, David Scott, and Peter Ebeling. "Why Aboriginal and Torres Strait Islander Australians fall and fracture: the codesigned Study of Indigenous Muscle and Bone Ageing (SIMBA) protocol." BMJ Open 12, no. 4 (April 2022): e056589. http://dx.doi.org/10.1136/bmjopen-2021-056589.
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ObjectivesAboriginal and Torres Strait Islander Australians have a substantially greater fracture risk, where men are 50% and women are 26% more likely to experience a hip fracture compared with non-Indigenous Australians. Fall-related injuries in this population have also increased by 10%/year compared with 4.3%/year in non-Indigenous Australians. This study aims to determine why falls and fracture risk are higher in Aboriginal and Torres Strait Islander Australians.SettingAll clinical assessments will be performed at one centre in Melbourne, Australia. At baseline, participants will have clinical assessments, including questionnaires, anthropometry, bone structure, body composition and physical performance tests. These assessments will be repeated at follow-up 1 and follow-up 2, with an interval of 12 months between each clinical visit.ParticipantsThis codesigned prospective observational study aims to recruit a total of 298 adults who identify as Aboriginal and Torres Strait Islander and reside within Victoria, Australia. Stratified sampling by age and sex will be used to ensure equitable distribution of men and women across four age-bands (35–44, 45–54, 55–64 and 65+ years).Primary and secondary outcome measuresThe primary outcome is within-individual yearly change in areal bone mineral density at the total hip, femoral neck and lumbar spine assessed by dual energy X-ray absorptiometry. Within-individual change in cortical and trabecular volumetric bone mineral density at the radius and tibia using high-resolution peripheral quantitative computed tomography will be determined. Secondary outcomes include yearly differences in physical performance and body composition.Ethical approvalEthics approval for this study has been granted by the Monash Health Human Research Ethics Committee (project number: RES-19–0000374A).Trial registration numberACTRN12620000161921.
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S., Prabhu, and Nishant Patil. "Study correlating lymphocyte to monocyte ratio and platelet to lymphocyte ratio with the severity in COVID-19 patients: a cross sectional study." International Journal of Advances in Medicine 8, no. 2 (January 27, 2021): 201. http://dx.doi.org/10.18203/2349-3933.ijam20210264.
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Background: The objective of this study was to classify COVID-19 patients into severe and non-severe groups and to correlate lymphocyte to monocyte ratio and platelet to lymphocyte ratio with the severity of COVID-19 patients.Methods: It was a cross sectional observational study conducted on hundred patients admitted to Victoria hospital, Department of Medicine, Bangalore Medical College and Research Institute, Bangalore between June 2020 and August 2020. Complete clinical data of the patients were taken and examined thoroughly and cases were diagnosed and severity was classified as per interim guidelines of World Health Organization (WHO) and diagnosis and treatment guidelines of COVID-19 by Ministry of Health and Family Welfare, Government of India. and compared and correlated with lymphocyte-monocyte ratio and platelet-lymphocyte ratio. A p<0.05 was considered significant. All analyses were performed using Statistical package for social sciences (SPSS) software version 10.Results: The sample size in our study was 100 patients. The mean age of patients was 57.5 in severe and 35 in non severe COVID patients. Among these 67% were males and 33% were females. It was noted that, neutrophilia (median-88.5%) and lymphocytopenia (median-6.5) was seen among severe group. Also, the lymphocyte-monocyte ratio (LMR) was significantly low (p value-0.00*) and platelet-lymphocyte ratio (PLR) was high (p value-0.00*) and was statistically significant among severe COVID 19 patients.Conclusions: LMR, PLR were significantly different between severe and non severe patients, so assessment of LMR, PLR may help identify high risk COVID 19 patients at an early stage. In our study LMR showed an acceptable efficiency to separate COVID 19 patients among severe and non severe group with a sensitivity of 82.4% and specificity of 84.8%. Whereas PLR showed high specificity of 93.9% and sensitivity of 64.7%.
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Ko, Violet Man Chi, Ngo Nam Lau, Ji Hong Qiu, Sai-Chuen Fu, Patrick Shu-Hang Yung, and Samuel Ka-Kin Ling. "Cross-Cultural Adaptation of Chinese Victorian Institute of Sports Assessment–Achilles (VISA-A) Questionnaire for Achilles Tendinopathy." Foot & Ankle Orthopaedics 7, no. 1 (January 2022): 247301142210815. http://dx.doi.org/10.1177/24730114221081535.
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Background: Victorian Institute of Sports Assessment (VISA-A) is a patient-reported outcome for assessing symptoms severity associated with Achilles tendinopathy (AT). It is a valid and reliable tool that has been used widely for measuring and monitoring treatment outcomes for AT. This clinical measurement study aims to develop a Chinese version of the VISA-A questionnaire. The study objective is to adapt the VISA-A questionnaire cross-culturally and assess its psychometric property for Chinese-speaking individuals. Methods: VISA-A was translated and adapted cross-culturally according to international guidelines for self-reported questionnaires. During the establishment of Chinese VISA-A, there are 5 stages involved in the creation process, including translation, synthesis, reverse translation, review, and pretesting, which are performed by professionals in various fields, including orthopaedic surgeons, physiotherapists, and professional translators. Results: A total of 60 participants were recruited to complete the Chinese VISA-A and 36-Item Short Form Health Survey (SF-36) questionnaires. The overall test-retest reliability was 0.98 (intraclass correlation coefficient = 0.97-0.99). The correlation between Chinese VISA-A and physical function subscale ( r = 0.70) was strong and statistically significant. There were moderate correlations between Chinese VISA-A, limitations to role of physical function subscale ( r = 0.30), and bodily pain subscale ( r = 0.42), which were also statistically significant. There were statistically significant differences in Chinese VISA-A scores between healthy control and pathologic group ( P < .001), at-risk group, and pathologic group ( P < .001) respectively. Conclusion: Chinese VISA-A demonstrated good reliability and validity for measuring symptom severity in patients with AT. Chinese VISA-A can be recommended as a self-reported measure for monitoring symptoms severity and treatment progress of patients with Achilles tendinopathy. Level of Evidence: Level II, cohort study.
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Fennessy, Paul, and Vanessa Clements. "OP135 CAR T-cell Therapy HTA Informs Australian Policy." International Journal of Technology Assessment in Health Care 35, S1 (2019): 30–31. http://dx.doi.org/10.1017/s0266462319001636.
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IntroductionChimeric antigen receptor (CAR) T-cell therapy is offered as a once-only treatment for patients with certain cancers that are not responsive to standard treatment. While clinicians, patients and their families increasingly seek access to CAR T-cell therapy, there is no revenue stream to support access through public or private health systems.MethodsThe New South Wales (NSW) Ministry of Health and Victorian Department of Health and Human Services oversighted a health technology assessment (HTA) to explore the status and geography of regulatory frameworks supporting delivery of CAR T-cell therapy, evidence for the safety, efficacy and cost, clinical trials conducted or underway and manufacturing aspects.ResultsCAR T-cell therapies are approved in the European Union and United States of America, and being considered in Australia, Canada, China and Japan. Efficacy, safety and cost-effectiveness is limited by the size and single-arm design of early stage trials and variation between them. While overall response ranges from 36–93 percent, early results for some cancers are less favorable. Durability of treatment effect is unknown, adverse events are common and can be life-threatening and risk of delayed onset toxicity remains unknown. Treatment requires access to approved manufacturing facilities (none in Australia) and specialist clinical staff.ConclusionsCAR T-cell therapy is promising and demand is increasing, but the limited safety profile and evidence base should mitigate policy and investment decisions. Broader consideration should be given to developing, or identifying access to, manufacturing and clinical workforce capability and capacity to meet national demand. Australia is likely to encounter similar issues in other jurisdictions, such as limited evidence base and complex safety issues. Factors to be considered on a local and national basis for assessment and implementation include: (i) Regulatory support for industry; (ii) Strategies to manage uncertainties in long-term risks, benefits and costs; (iii) Access to accredited manufacturing facilities; (iv) Developing clinical and manufacturing workforce capability and capacity.
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Kennedy, Amber L., Beverley J. Vollenhoven, Richard J. Hiscock, Catharyn J. Stern, Susan P. Walker, Jeanie L. Y. Cheong, Jon L. Quach, et al. "School-age outcomes among IVF-conceived children: A population-wide cohort study." PLOS Medicine 20, no. 1 (January 24, 2023): e1004148. http://dx.doi.org/10.1371/journal.pmed.1004148.
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Background In vitro fertilisation (IVF) is a common mode of conception. Understanding the long-term implications for these children is important. The aim of this study was to determine the causal effect of IVF conception on primary school-age childhood developmental and educational outcomes, compared with outcomes following spontaneous conception. Methods and findings Causal inference methods were used to analyse observational data in a way that emulates a target randomised clinical trial. The study cohort comprised statewide linked maternal and childhood administrative data. Participants included singleton infants conceived spontaneously or via IVF, born in Victoria, Australia between 2005 and 2014 and who had school-age developmental and educational outcomes assessed. The exposure examined was conception via IVF, with spontaneous conception the control condition. Two outcome measures were assessed. The first, childhood developmental vulnerability at school entry (age 4 to 6), was assessed using the Australian Early Developmental Census (AEDC) (n = 173,200) and defined as scoring <10th percentile in ≥2/5 developmental domains (physical health and wellbeing, social competence, emotional maturity, language and cognitive skills, communication skills, and general knowledge). The second, educational outcome at age 7 to 9, was assessed using National Assessment Program–Literacy and Numeracy (NAPLAN) data (n = 342,311) and defined by overall z-score across 5 domains (grammar and punctuation, reading, writing, spelling, and numeracy). Inverse probability weighting with regression adjustment was used to estimate population average causal effects. The study included 412,713 children across the 2 outcome cohorts. Linked records were available for 4,697 IVF-conceived cases and 168,503 controls for AEDC, and 8,976 cases and 333,335 controls for NAPLAN. There was no causal effect of IVF-conception on the risk of developmental vulnerability at school-entry compared with spontaneously conceived children (AEDC metrics), with an adjusted risk difference of −0.3% (95% CI −3.7% to 3.1%) and an adjusted risk ratio of 0.97 (95% CI 0.77 to 1.25). At age 7 to 9 years, there was no causal effect of IVF-conception on the NAPLAN overall z-score, with an adjusted mean difference of 0.030 (95% CI −0.018 to 0.077) between IVF- and spontaneously conceived children. The models were adjusted for sex at birth, age at assessment, language background other than English, socioeconomic status, maternal age, parity, and education. Study limitations included the use of observational data, the potential for unmeasured confounding, the presence of missing data, and the necessary restriction of the cohort to children attending school. Conclusions In this analysis, under the given causal assumptions, the school-age developmental and educational outcomes for children conceived by IVF are equivalent to those of spontaneously conceived children. These findings provide important reassurance for current and prospective parents and for clinicians.
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Omland, Torbjørn, Jessica Chadwick, Ragnhild Røysland, Geeta Gulati, David Astling, Siri L. Heck, Victoria Vinje, et al. "Abstract LB515: Cardiovascular risk assessed by aptamer-based proteomics is increased in early breast cancer." Cancer Research 82, no. 12_Supplement (June 15, 2022): LB515. http://dx.doi.org/10.1158/1538-7445.am2022-lb515.
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Abstract Background: Cancer patients with a high risk for cardiovascular (CV) disease may be susceptible to cardiotoxic injury during cancer therapy. Accordingly, CV risk assessment may help in identifying candidates for preventive cardioprotective treatment. Since existing CV risk scores may lack the sensitivity and granularity to reflect the changes in CV risk that is associated with early cancer, we hypothesized that a CV risk score based on aptamer-based proteomics would permit discrimination of CV risk between patients with early breast cancer and age-, sex- and risk factor-matched healthy subjects. Moreover, we hypothesized that CV risk as assessed by aptamer-based proteomics first increases during and subsequently decreases after anthracycline-containing chemotherapy. Methods: We included 120 women with early breast cancer participating in the 2x2 factorial, randomized, placebo-controlled Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA) trial who were assigned to candesartan vs placebo and metoprolol vs placebo. Blood samples were obtained serially at: Visit 1 (ie, post-surgery but prior to epirubicin), following the first cycle of epirubicin (Visit 2), after the completion of epirubicin therapy (Visit 3), following adjuvant therapy (Visit 4), and 1-2 years after completion of adjuvant and blinded therapy (Visit 5). Age-, sex-, and risk factor-matched subjects (n = 500) from the Fenland study served as controls. We used highly multiplexed modified aptamer-based proteomics to measure ~5000 plasma proteins. A validated 27-protein CV risk model (CVD) that provides information on absolute risk of myocardial infarction, stroke, heart failure or mortality over a 4-year period was used as the dependent variable. Results: The CVD risk probability was significantly higher at Visit 1 than in the age-, sex- and risk-factor matched control group (p < 0.001). The CVD risk probability increased significantly from baseline to completion of epirubicin therapy (p < 0.001) and dropped below baseline levels for subsequent timepoints after the completion of epirubicin treatment. The mean CVD risk increased from 15.9% at Visit 2 to 24.6% at Visit 3, resulting in the percentage of subjects in the medium-high risk bin increasing from 9% at Visit 2 to 28% at Visit 3. The CVD risk distribution at the end of study was similar to the initial distribution at baseline and Visit 2. Conclusion: Using a novel CVD risk proteomics model, we observed that (1) The CVD risk of patients with early breast cancer is increased compared to age-, sex- and risk factor-matched individuals from the general population; (2) CVD risk increases during adjuvant epirubicin-containing chemotherapy, and (3) after completed adjuvant cancer therapy CVD risk returns to pre-chemotherapy level. Use of the CVD risk score may represent a novel tool to identify and monitor cancer patients who may benefit from preventive cardioprotective therapy. Citation Format: Torbjørn Omland, Jessica Chadwick, Ragnhild Røysland, Geeta Gulati, David Astling, Siri L. Heck, Victoria Vinje, Rachel Ostroff, Peter Ganz, Jürgen Geisler, Steve Williams. Cardiovascular risk assessed by aptamer-based proteomics is increased in early breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr LB515.