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Quinn, Emma, Travers Johnstone, Zeina Najjar, Toni Cains, Geoff Tan, Essi Huhtinen, Sven Nilsson, Stuart Burgess, Matthew Dunn, and Leena Gupta. "Lessons Learned From Implementing an Incident Command System During a Local Multiagency Response to a Legionnaires’ Disease Cluster in Sydney, NSW." Disaster Medicine and Public Health Preparedness 12, no. 4 (September 5, 2017): 539–42. http://dx.doi.org/10.1017/dmp.2017.102.
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AbstractThe incident command system (ICS) provides a common structure to control and coordinate an emergency response, regardless of scale or predicted impact. The lessons learned from the application of an ICS for large infectious disease outbreaks are documented. However, there is scant evidence on the application of an ICS to manage a local multiagency response to a disease cluster with environmental health risks. The Sydney Local Health District Public Health Unit (PHU) in New South Wales, Australia, was notified of 5 cases of Legionnaires’ disease during 2 weeks in May 2016. This unusual incident triggered a multiagency investigation involving an ICS with staff from the PHU, 3 local councils, and the state health department to help prevent any further public health risk. The early and judicious use of ICS enabled a timely and effective response by supporting clear communication lines between the incident controller and field staff. The field team was key in preventing any ongoing public health risk through inspection, sampling, testing, and management of water systems identified to be at-risk for transmission of legionella. Good working relationships between partner agencies and trust in the technical proficiency of environmental health staff aided in the effective management of the response. (Disaster Med Public Health Preparedness. 2018;12:539–542)
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Steele, Trevor W. "Legionnaires' disease in South Australia, 1979–1988." Medical Journal of Australia 151, no. 6 (September 1989): 322–28. http://dx.doi.org/10.5694/j.1326-5377.1989.tb128470.x.
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Hayes-Phillips, Deanna, Richard Bentham, Kirstin Ross, and Harriet Whiley. "Factors Influencing Legionella Contamination of Domestic Household Showers." Pathogens 8, no. 1 (February 26, 2019): 27. http://dx.doi.org/10.3390/pathogens8010027.
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Legionnaires’ disease is a potentially fatal pneumonia like infection caused by inhalation or aspiration of water particles contaminated with pathogenic Legionella spp. Household showers have been identified as a potential source of sporadic, community-acquired Legionnaires’ disease. This study used qPCR to enumerate Legionella spp. and Legionella pneumophila in water samples collected from domestic showers across metropolitan Adelaide, South Australia. A survey was used to identify risk factors associated with contamination and to examine awareness of Legionella control in the home. The hot water temperature was also measured. A total of 74.6% (50/68) and 64.2% (43/68) showers were positive for Legionella spp. and L. pneumophila, respectively. Statistically significant associations were found between Legionella spp. concentration and maximum hot water temperature (p = 0.000), frequency of shower use (p = 0.000) and age of house (p = 0.037). Lower Legionella spp. concentrations were associated with higher hot water temperatures, showers used at least every week and houses less than 5 years old. However, examination of risk factors associated with L. pneumophila found that there were no statistically significant associations (p > 0.05) with L. pneumophila concentrations and temperature, type of hot water system, age of system, age of house or frequency of use. This study demonstrated that domestic showers were frequently colonized by Legionella spp. and L. pneumophila and should be considered a potential source of sporadic Legionnaires’ disease. Increasing hot water temperature and running showers every week to enable water sitting in pipes to be replenished by the municipal water supply were identified as strategies to reduce the risk of Legionella in showers. The lack of public awareness in this study identified the need for public health campaigns to inform vulnerable populations of the steps they can take to reduce the risk of Legionella contamination and exposure.
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Gupta, Sabrina, Rosalie Aroni, Siobhan Lockwood, Indra Jayasuriya, and Helena Teede. "South Asians and Anglo Australians with heart disease in Australia." Australian Health Review 39, no. 5 (2015): 568. http://dx.doi.org/10.1071/ah14254.
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Objectives The aim of the present study was to determine cardiovascular disease (CVD) risk factors and compare presentation and severity of ischaemic heart disease (IHD) among South Asians (SAs) and Anglo Australians (AAs). Methods A retrospective clinical case audit was conducted at a public tertiary hospital. The study population included SA and AA patients hospitalised for IHD. Baseline characteristics, evidence of diabetes and other CVD risk factors were recorded. Angiography data were also included to determine severity, and these were assessed using a modified Gensini score. Results SAs had lower mean (± s.d.) age of IHD presentation that AAs (52 ± 9 vs 55 ± 9 years, respectively; P = 0.02), as well as a lower average body mass index (BMI; 26 ± 4 vs 29 ± 6 kg/m2, respectively; P = 0.005), but a higher prevalence of type 2 diabetes (57% vs 31%, respectively; P = 0.001). No significant differences were found in coronary angiography parameters. There were no significant differences in the median (interquartile range) Gensini score between SAs and AAs (43.5 (27–75) vs 44 (26.5–68.5), respectively), median vessel score (1 (1–2) vs 2 (1–3), respectively) or multivessel score (37% (33/89) vs 54% (22/41), respectively). Conclusions The findings show that in those with established IHD, cardiovascular risk factors, such as age at onset and BMI, differ between SAs and AAs and these differences should be considered in the prevention and management of IHD. What is known about the topic? There is much evidence on CVD and SAs, it being a leading cause of mortality and morbidity for this population both in their home countries and in countries they have migrated to. Studies conducted in Western nations other than Australia have suggested a difference in the risk profiles and presentations of CVD among SA migrants compared with the host populations in developed countries. Although this pattern of cardiovascular risk factors among SAs has been well documented, there is insufficient knowledge about this population, currently the largest population of incoming migrants, and CVD in the Australian setting. What does this paper add? This paper confirms that a similar pattern of CVD exists in Australia among SAs as does in other Western nations they have migrated to. The CVD pattern found in this population is that of an earlier age of onset at lower BMI compared with the host AA population, as well as a differing cardiovascular risk profile, with higher rates of type 2 diabetes and lower smoking rates. In addition, this study finds similar angiographic results for both the SAs and AAs; however, the SAs exhibit these similar angiographic patterns at younger ages. What are the implications for practitioners? SAs in Australia represent a high cardiovascular risk group and should be targeted for more aggressive screening at younger ages. Appropriate preventative strategies should also be considered bearing in mind the differing risk factors for this population, namely low BMI and high rates of type 2 diabetes. More intensive treatment strategies should also be regarded by practitioners. Importantly, both policy makers and health professionals must consider that all these strategies should be culturally targeted and tailored to this population and not assume a ‘one-size fits all’ approach.
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Sinka, Victoria, Pamela Lopez‐Vargas, Allison Tong, Michelle Dickson, Marianne Kerr, Noella Sheerin, Katrina Blazek, Armando Teixeira‐Pinto, Jacqueline H. Stephens, and Jonathan C. Craig. "Chronic disease prevention programs offered by Aboriginal Community Controlled Health Services in New South Wales, Australia." Australian and New Zealand Journal of Public Health 45, no. 1 (February 2021): 59–64. http://dx.doi.org/10.1111/1753-6405.13069.
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Ali, Hammad, Basil Donovan, Bette Liu, Jane S. Hocking, Paul Agius, James Ward, Christopher Bourne, John M. Kaldor, and Rebecca J. Guy. "Chlamydia prevention indicators for Australia: review of the evidence from New South Wales." Sexual Health 9, no. 5 (2012): 399. http://dx.doi.org/10.1071/sh11183.
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Background: Annual notifications of chlamydia (Chlamydia trachomatis) diagnoses have increased steadily in Australia in the last decade. To guide public health programs, we developed 10 national chlamydia prevention indicators and report on each indicator for New South Wales (NSW). Methods: Using systematic methods, we reviewed the literature to report on the 10 health and behaviour indicators for 15- to 29–year-old heterosexuals in NSW from 2000. We included data with two or more time points. Results: Chlamydia notification rates (Indicator 1) in 15- to 29–year-olds have increased by 299%, from 237 per 100 000 population in 2001 to 946 per 100 000 population in 2010; and the percent of 15- to 34-year-olds with an annual Medicare-rebated chlamydia test (Indicator 2) increased by 326%, from 1.9% in 2001 to 8.1% in 2010. Since 2004, sentinel surveillance showed a 28% increase in chlamydia prevalence (Indicator 3) in 15- to 29-year-old females tested at their first sexual health service visit (from 8.5% in 2004 to 10.9% in 2010) but no significant increase in males. No NSW-specific chlamydia incidence (Indicator 4) was available. Pelvic inflammatory disease hospitalisation separations rate decreased from 0.58 per 1000 in 2001 to 0.44 per 1000 in 2010 in 15- to 29-year-old females (Indicator 5).Secondary school surveys in 2002 and 2008 showed chlamydia knowledge increased in males. The sexual risk-taking behaviour of young people remained unchanged (Indicators 6–10). Conclusions: Although notifications have risen steeply, the modest increase in chlamydia prevalence maybe a more realistic reflection of transmission rates. Strategies are needed to increase testing and to modify sexual risk behaviour. Crucial gaps in epidemiological data were identified.
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Quinn, Emma, Kai Hsiao, George Truman, Nectarios Rose, and Richard Broome. "Lessons Learnt From Exercise Celestial Navigation: The Application of a Geographic Information System to Inform Legionnaires’ Disease Control Activity." Disaster Medicine and Public Health Preparedness 13, no. 02 (May 2, 2018): 372–74. http://dx.doi.org/10.1017/dmp.2018.40.
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AbstractGeographic information systems (GIS) have emerged in the past few decades as a technology capable of assisting in the control of infectious disease outbreaks. A Legionnaires’ disease cluster investigation in May 2016 in Sydney, New South Wales (NSW), Australia, demonstrated the importance of using GIS to identify at-risk water sources in real-time for field investigation to help control any immediate environmental health risk, as well as the need for more staff trained in the use of this technology. Sydney Local Health District Public Health Unit (PHU) subsequently ran an exercise (based on this investigation) with 11 staff members from 4 PHUs across Sydney to further test staff capability to use GIS across NSW. At least 80% of exercise participants reported that the scenario progression was realistic, assigned tasks were clear, and sufficient data were provided to complete tasks. The exercise highlighted the multitude of geocoding applications and need for inter-operability of systems, as well as the need for trained staff with specific expertise in spatial analysis to help assist in outbreak control activity across NSW. Evaluation data demonstrated the need for a common GIS, regular education and training, and guidelines to support the collaborative use of GIS for infectious disease epidemiology in NSW. (Disaster Med Public Health Preparedness. 2019;13:372–374)
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CLARKE, M. F., K. RASIAH, J. COPLAND, M. WATSON, A. P. KOEHLER, K. DOWLING, and H. S. MARSHALL. "The pertussis epidemic: informing strategies for prevention of severe disease." Epidemiology and Infection 141, no. 3 (May 17, 2012): 463–71. http://dx.doi.org/10.1017/s095026881200091x.
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SUMMARYTo assess the impact of Bordetella pertussis infections in South Australia during an epidemic and determine vulnerable populations, data from notification reports for pertussis cases occurring between July 2008 and December 2009 were reviewed to determine the distribution of disease according to specific risk factors and examine associations with hospitalizations. Although the majority (66%) of the 6230 notifications for pertussis occurred in adults aged >24 years, the highest notification and hospitalization rate occurred in infants aged <1 year. For these infants, factors associated with hospitalization included being aged <2 months [relative risk (RR) 2·3, 95% confidence interval (CI) 1·60–3·32], Indigenous ethnicity (RR 1·7, 95% CI 1·03–2·83) and receiving fewer than two doses of pertussis vaccine (RR 4·1, 95% CI 1·37–12·11). A combination of strategies aimed at improving direct protection for newborns, vaccination for the elderly, and reducing transmission from close contacts of infants are required for prevention of severe pertussis disease.
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BI, P., J. E. HILLER, A. S. CAMERON, Y. ZHANG, and R. GIVNEY. "Climate variability and Ross River virus infections in Riverland, South Australia, 1992–2004." Epidemiology and Infection 137, no. 10 (March 19, 2009): 1486–93. http://dx.doi.org/10.1017/s0950268809002441.
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SUMMARYRoss River virus (RRV) infection is the most common notifiable vector-borne disease in Australia, with around 6000 cases annually. This study aimed to examine the relationship between climate variability and notified RRV infections in the Riverland region of South Australia in order to set up an early warning system for the disease in temperate-climate regions. Notified data of RRV infections were collected by the South Australian Department of Health. Climatic variables and monthly river flow were provided by the Australian Bureau of Meteorology and South Australian Department of Water, Land and Biodiversity Conservation over the period 1992–2004. Spearman correlation and time-series-adjusted Poisson regression analysis were performed. The results indicate that increases in monthly mean minimum and maximum temperatures, monthly total rainfall, monthly mean Southern Oscillation Index and monthly flow in the Murray River increase the likelihood, but an increase in monthly mean relative humidity decreases the likelihood, of disease transmission in the region, with different time-lag effects. This study demonstrates that a useful early warning system can be developed for local regions based on the statistical analysis of readily available climate data. These early warning systems can be utilized by local public health authorities to develop disease prevention and control activities.
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McMorrow, Claire, Allan J. Gunn, Shahid Khalfan, Marta Hernandez-Jover, and Victoria J. Brookes. "Veterinarians’ Knowledge, Attitudes and Practices Associated with Bovine Viral Diarrhoea Virus Control and Prevention in South-East Australia." Animals 10, no. 9 (September 11, 2020): 1630. http://dx.doi.org/10.3390/ani10091630.
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In Australia, the responsibility and associated costs for the control and prevention of Bovine Viral Diarrhoea Virus (BVDV) rest solely with producers. Veterinarians provide producers with farm-specific options for BVDV management and support BVDV control and elimination in their region. We surveyed veterinarians to determine their knowledge, attitudes and practices (KAP) associated with BVDV control in south-east Australia. We found that veterinarians’ recommendations do not always align with producers’ control measures. Veterinarians were uncertain about BVDV prevalence and the proportion of producers using BVDV control measures in their regions. Veterinarians generally promoted biosecurity and vaccination, and were concerned about the welfare and additional disease risks associated with persistently infected (PI) cattle. Veterinarians highlighted concerns about disease risks associated with a previously undocumented practice in which producers collect blood from PI cattle to administer to BVDV naïve cattle; termed “vampire vaccination” in this study. A greater understanding of the burden, impact and economics of BVDV is needed to align veterinarians’ and producers’ KAP to improve BVDV management on farms, and more appreciation of veterinarians’ and producers’ values is needed before BVDV control could be implemented at a regional or country level.
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Waldron, Liette S., Borce Dimeski, Paul J. Beggs, Belinda C. Ferrari, and Michelle L. Power. "Molecular Epidemiology, Spatiotemporal Analysis, and Ecology of Sporadic Human Cryptosporidiosis in Australia." Applied and Environmental Microbiology 77, no. 21 (September 9, 2011): 7757–65. http://dx.doi.org/10.1128/aem.00615-11.
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ABSTRACTParasites from theCryptosporidiumgenus are the most common cause of waterborne disease around the world. Successful management and prevention of this emerging disease requires knowledge of the diversity of species causing human disease and their zoonotic sources. This study employed a spatiotemporal approach to investigate sporadic human cryptosporidiosis in New South Wales, Australia, between January 2008 and December 2010. Analysis of 261 human fecal samples showed that sporadic human cryptosporidiosis is caused by four species;C. hominis,C. parvum,C. andersoni, andC. fayeri. Sequence analysis of thegp60gene identified 5 subtype families and 31 subtypes.Cryptosporidium hominisIbA10G2 andC. parvumIIaA18G3R1 were the most frequent causes of human cryptosporidiosis in New South Wales, with 59% and 16% of infections, respectively, attributed to them. The results showed that infections were most prevalent in 0- to 4-year-olds. No gender bias or regional segregation was observed between the distribution ofC. hominisandC. parvuminfections. To determine the role of cattle in sporadic human infections in New South Wales, 205 cattle fecal samples were analyzed. FourCryptosporidiumspecies were identified,C. hominis,C. parvum,C. bovis, andC. ryanae. C. parvumsubtype IIaA18G3R1 was the most common cause of cryptosporidiosis in cattle, with 47% of infections attributed to it.C. hominissubtype IbA10G2 was also identified in cattle isolates.
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Nguyen, Dalton, Vanessa R. Barrs, Mark Kelman, and Michael P. Ward. "Feline upper respiratory tract infection and disease in Australia." Journal of Feline Medicine and Surgery 21, no. 10 (November 22, 2018): 973–78. http://dx.doi.org/10.1177/1098612x18813248.
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Objectives The aim of this study was to conduct a comprehensive assessment of feline infectious upper respiratory tract infection (URTI) and disease (URTD) in Australian cats. Methods Laboratory data demonstrating URTI from feline URTD multiplex PCR panel (feline herpesvirus 1 [FHV-1], feline calicivirus [FCV], Bordetella bronchiseptica, Chlamydophila felis, Mycoplasma felis and H1N1 influenza) submissions in Australia (2013–2015) were obtained. For comparison, reports of feline URTD during the same time period were sourced from a voluntary companion animal disease surveillance system. Results A total of 3126 samples were submitted for testing; 1533 (49%) were positive. Of these, the most commonly detected agents were M felis (21.5%) and FCV (16.0%) alone, followed by FCV and M felis (13.4%) together as a respiratory infection complex, then FHV-1 (7.0%) alone. During the study period, there were 262 reports of 320 clinical feline URTD cases. Most cases (69%) were reported from New South Wales, <1 year of age (41%) and equally distributed between the sexes. Infection was more common in entire cats (69%) and most cases (55%) involved domestic shorthair cats. Of the 90 reports that had a known vaccination status, 63 had a vaccination history, 40 of which were recently vaccinated. Most (72%) feline URTD cases recovered from clinical disease. Both feline URTI and URTD were more common during winter months. Conclusions and relevance Feline URTI and URTD cause substantial impact in Australia, being most commonly associated with M felis and FCV infection. This information can be used by veterinarians to educate clients about prevention and management of this important infectious disease of cats.
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Peiris, David, Lachlan Wright, Madeline News, and Katherine Corcoran. "Community-Based Chronic Disease Prevention and Management for Aboriginal People in New South Wales, Australia: Mixed Methods Evaluation of the 1 Deadly Step Program." JMIR mHealth and uHealth 7, no. 10 (October 21, 2019): e14259. http://dx.doi.org/10.2196/14259.
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Background Chronic diseases account for over 70% of health gaps between Aboriginal people and the rest of the Australian population. The 1 Deadly Step program involves community-based events that use a sporting platform and cultural ambassadors to improve chronic disease prevention and management in New South Wales (NSW). Objective This study aimed to evaluate the feasibility and acceptability of a community-based chronic disease screening program for Aboriginal people. Methods In 2015, the program was enhanced to include an iPad app for screening assessments, a results portal for nominated care providers, and a reporting portal for program administrators and implemented in 9 NSW community events. A mixed methods evaluation comprising survey data, analytics obtained from iPad and Web portal usage, and key informant interviews was conducted. Results Overall, 1046 people were screened between April 2015 and April 2016 (mean age 40.3 years, 640 (61.19%) female, 957 (91.49%) Aboriginal or Torres Strait Islander). High chronic disease rates were observed (231 [22.08%] participants at high cardiovascular disease (CVD) risk, 173 [16.54%] with diabetes, and 181 [17.30%] with albuminuria). A minority at high risk of CVD (99/231 [42.9%]) and with diabetes (73/173 [42.2%]) were meeting guideline-recommended management goals. Overall, 297 participants completed surveys (response rate 37.4%) with 85.1% reporting satisfaction with event organization and information gained and 6.1% experiencing problems with certain screening activities. Furthermore, 21 interviews were conducted. A strong local working group and processes that harnessed community social networks were key to implementation success. Although software enhancements facilitated screening and data management, some technical difficulties (eg, time delays in processing blood test results) impeded smooth processing of information. Only 51.43% of participants had a medical review recorded postevent with wide intersite variability (10.5%-85.6%). Factors associated with successful follow-up included clinic managers with overall program responsibility and availability of medical staff for immediate discussion of results on event day. The program was considered highly resource intensive to implement and support from a central coordinating body and integration with existing operational processes was essential. Conclusions 1 Deadly Step offers an effective and acceptable strategy to engage Aboriginal communities in chronic disease screening. High rates of risk factors and management gaps were encountered, including people with no previous knowledge of these issues. Strategies to improve linkage to primary care could enhance the program’s impact on reducing chronic disease burden.
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Jansen, Jesse, Shannon McKinn, Carissa Bonner, Danielle Marie Muscat, Jenny Doust, and Kirsten McCaffery. "Shared decision-making about cardiovascular disease medication in older people: a qualitative study of patient experiences in general practice." BMJ Open 9, no. 3 (March 2019): e026342. http://dx.doi.org/10.1136/bmjopen-2018-026342.
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ObjectivesTo explore older people’s perspectives and experiences with shared decision-making (SDM) about medication for cardiovascular disease (CVD) prevention.Design, setting and participantsSemi-structured interviews with 30 general practice patients aged 75 years and older in New South Wales, Australia, who had elevated CVD risk factors (blood pressure, cholesterol)orhad received CVD-related lifestyle advice. Data were analysed by multiple researchers using Framework analysis.ResultsTwenty eight participants out of 30 were on CVD prevention medication, half with established CVD. We outlined patient experiences using the four steps of the SDM process, identifying key barriers and challenges: Step 1. Choice awareness: taking medication for CVD prevention was generally not recognised as a decision requiring patient input; Step 2. Discuss benefits/harms options: CVD prevention poorly understood with emphasis on benefits; Step 3. Explore preferences: goals, values and preferences (eg, length of life vs quality of life, reducing disease burden vs risk reduction) varied widely but generally not discussed with the general practitioner; Step 4. Making the decision: overall preference for directive approach, but some patients wanted more active involvement. Themes were similar across primary and secondary CVD prevention, different levels of self-reported health and people on and off medication.ConclusionsResults demonstrate how older participants vary widely in their health goals and preferences for treatment outcomes, suggesting that CVD prevention decisions are preference sensitive. Combined with the fact that the vast majority of participants were taking medications, and few understood the aims and potential benefits and harms of CVD prevention, it seems that older patients are not always making an informed decision. Our findings highlight potentially modifiable barriers to greater participation of older people in SDM about CVD prevention medication and prevention in general.
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Panegyres, Peter K., and Victoria Gray. "Dementia risk factors for Australian baby boomers." Neurology International 2, no. 1 (July 1, 2010): 13. http://dx.doi.org/10.4081/ni.2010.e13.
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Baby boomers are individuals born in the years 1946 to 1965. The objective of this paper was to define the risk factors for dementia and Alzheimer’s disease (AD) and their relevance to Australian baby boomers, with the aim of providing evidence-based guidelines for dementia prevention. A series of PubMed searches (1994-2010) were conducted with relevant key words. Data was included from the Australian Bureau of Statistics (ABS) in relation to baby boomers in Australia. Article titles and abstracts were assessed by two reviewers for inclusion. Searches through ABS revealed no specific study on baby boomers at a national level; information was only available for Western Australia, South Australia and Queensland. A number of genetic and non-genetic risk factors for dementia were identified most of which remain controversial and require further study. We did not identify significant differences in the prevalence and incidence of dementia in those under 65 years in Queensland, South Australia and Western Australia. There were no correlations of risk factors and dementia between the Australian states. Modification of risk factors has not been proven to reduce the incidence and prevalence of dementia and AD in baby boomers. Nevertheless, on available evidence, we recommend: i) active management of cardiovascular risk factors such as hypertension; ii) the encouragement of a healthy lifestyle (eg, weight reduction, exercise) as offering the best pathways to reduce the emerging dementia risk for baby boomers. The implications are that activities promoting a healthy heart might lead to a healthy brain and help to prevent dementia.
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Guy, Rebecca J., Ann M. McDonald, Mark J. Bartlett, Jo C. Murray, Carolien M. Giele, Therese M. Davey, Ranil D. Appuhamy, et al. "Characteristics of HIV diagnoses in Australia, 1993-2006." Sexual Health 5, no. 2 (2008): 91. http://dx.doi.org/10.1071/sh07070.
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Objective: To describe recent trends in the diagnosis of HIV infection in Australia. Methods: National HIV surveillance data from 1993 to 2006 were analysed with a focus on geographic differences by HIV exposure route and late presentation (HIV within 3 months of a first AIDS-defining illness or a CD4 count of less than 200 cells μL–1). Results: In 1993–99, the number of HIV diagnoses declined by 32%, and then increased by 39% from 1999 to 2006. From 2000 onwards, rates increased significantly in Victoria, Queensland, South Australia and Western Australia. The most frequently reported routes of HIV exposure were male to male sex (71%) and heterosexual contact (18%), and the population rate of diagnoses have increased in both categories. Among the cases reported as heterosexually acquired (n = 2199), 33% were in people born in a high-prevalence country and 19% in those with partners from a high-prevalence country. Late presentation was most frequent in heterosexually acquired infections in persons who had a partner from a high-prevalence country: 32% compared with 20% overall. Conclusions: Recent increases in annual numbers of HIV diagnoses in Australia underline the continuing need for HIV-prevention programs, particularly among men having male to male sex. Early diagnosis and access to care and treatment should also be emphasised, as a substantial proportion of people with HIV infection are unaware of their status until late in the course of disease.
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Yang, Genyan, Robert F. Benson, Rodney M. Ratcliff, Ellen W. Brown, Arnold G. Steigerwalt, W. Lanier Thacker, Maryam I. Daneshvar, Roger E. Morey, Atsushi Saito, and Barry S. Fields. "Legionella nagasakiensis sp. nov., isolated from water samples and from a patient with pneumonia." International Journal of Systematic and Evolutionary Microbiology 62, no. 2 (February 1, 2012): 284–88. http://dx.doi.org/10.1099/ijs.0.027193-0.
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A novel Legionella species was identified based on analysis of 16S rRNA and mip (macrophage infectivity potentiator) gene sequences, cellular fatty acids, isoprenoid quinones, biochemical reactions, antigens and quantitative DNA–DNA hybridization. Strain CDC-1796-JAP-ET was isolated from well water at the Nagasaki Municipal Medical Center, Japan. Two strains, CDC-3041-AUS-E and CDC-3558-AUS-E, were isolated from water samples during an outbreak of legionellosis in South Australia. Strain CDC-5427-OH-H was isolated from a 66-year-old female patient diagnosed with Legionnaires’ disease in the US. Cells from these four strains were Gram-negative, non-fluorescent, rod-shaped, and positive for alkaline phosphatase, esterase, leucine arylamidase, catalase, gelatinase, β-lactamase and tyrosine browning assay. Phylogenetic analysis of 16S rRNA and mip genes revealed that the four strains formed a distinct cluster within the genus Legionella. The bacteria contained branched-chain fatty acids and quinones that are typical of members of the genus Legionella. Slide agglutination tests demonstrated no cross-reaction with 52 previously described members of the Legionellaceae. DNA–DNA hybridization studies indicated that DNAs from the four strains were highly related (78–84 %) but they showed 29 % relatedness to Legionella oakridgensis ATCC 33761T and less than 10 % to strains of other Legionella species tested. These characterizations suggest that the isolates represent a novel species, for which the name Legionella nagasakiensis sp. nov. is proposed; the type strain is CDC-1796-JAP-ET ( = ATCC BAA-1557T = JCM 15315T).
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Lawan, Zaharaddeen, Jamilu Abubakar Bala, Alhaji Modu Bukar, Krishnan Nair Balakrishnan, Hassana Kyari Mangga, Faez Firdaus Jesse Abdullah, Mustapha Mohamed Noordin, and Mohd Lila Mohd-Azmi. "Contagious ecthyma: how serious is the disease worldwide?" Animal Health Research Reviews 22, no. 1 (May 21, 2021): 40–55. http://dx.doi.org/10.1017/s1466252320000018.
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AbstractContagious ecthyma (CE) is an infectious disease of small ruminants caused by a parapoxvirus of family Poxviridae subfamily Chordopoxvirinae. The disease is obviously distinguished by an establishment of scabby lesions and ulcerative formation on less hairy areas including muzzle, ears, nostril, and sometimes on genitalia. The disease is endemic in sheep and goats. The virus is transmissible to other ruminants and is a public health concern in humans. Although the disease is known as self-limiting, it may cause a significant economic threat and financial losses due to lower productivity in livestock production. Information with regard to the risk of the disease and epidemiology in most parts of the world is underreported. This paper aims to provide relevant information about the epidemiology of CE in selected regions of Europe, South America, North America, Asia, Africa, and Australia. An in-depth comprehension of virus infection, diagnoses, and management of the disease will enable farmers, researchers, veterinarians, abattoir workers, health personnel, and border controllers to improve their measures, skills, and effectiveness toward disease prevention and control, toward reducing unnecessary economic loss among farmers. A herd health program for significant improvement in management and productivity of livestock demands a well planned extension program that ought to encourage farmers to equip themselves with adequate skills for animal healthcare.
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Lea, Emma, and Anthony Worsley. "Benefits and barriers to the consumption of a vegetarian diet in Australia." Public Health Nutrition 6, no. 5 (August 2003): 505–11. http://dx.doi.org/10.1079/phn2002452.
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AbstractObjective:The aim of this study was to examine consumers' perceived benefits and barriers to the consumption of a vegetarian diet.Design:Survey (written questionnaire) that included questions on perceived benefits and barriers to the consumption of a vegetarian diet.Setting:South Australia.Subjects:Six hundred and one randomly selected South Australians.Results:The main perceived barriers to adopting a vegetarian diet were enjoying eating meat and an unwillingness to alter eating habits. This was the case for men, women and all age groups, although there were sex and age differences present in over half of the barrier items. For example, family food preferences were a greater problem for women than for men, while the oldest group was more likely to agree that humans are ‘meant’ to eat meat than the younger groups. The main benefits associated with vegetarian diets were health benefits: increased fruit and vegetable intake, decreased saturated fat intake, weight control. Animal welfare-related benefits and disease prevention were also important. Age and sex differences were apparent, although age differences were more important than sex differences.Conclusions:The majority of respondents perceived there to be health benefits associated with the consumption of a vegetarian diet, but also, predictably, enjoyed eating meat. Given this, it is likely that interest in plant-based diets that contain some meat is higher than that in no-meat diets. An understanding of the perceived benefits and barriers of consuming a vegetarian diet will allow the implementation of strategies to influence meat and vegetarianism beliefs, dietary behaviour and, hence, public health.
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Forssman, Bradley, Leena Gupta, and Graham Burgess. "A case study of the evaluation of a public health intervention." Australian Health Review 30, no. 4 (2006): 458. http://dx.doi.org/10.1071/ah060458.
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Large public health interventions to control infectious disease outbreaks are common, but rigorous evaluation to improve the quality and effectiveness of these is rarely undertaken. Following a large community-based clinic to prevent a hepatitis A outbreak, a multifaceted and multidisciplinary evaluation was conducted involving consumers, health professionals and industry partners. The results of this evaluation were used to produce practical operational guidelines for the planning and conduct of future interventions. These guidelines have been distributed to all public health units in New South Wales and may be included in the next edition of the NSW Health notifiable diseases manual. The evaluation approach can be applied to all public health interventions across NSW and Australia to assist in the development of operational guidelines, in order to increase the quality of public health action in outbreak prevention.
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Yuan, Gauthier, Hungerford, Ouwerkerk, Fletcher, and Laycock. "Modelling the Controlled Release of Toxins in a Rumen Environment." Proceedings 36, no. 1 (February 12, 2020): 89. http://dx.doi.org/10.3390/proceedings2019036089.
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Pimelea poisoning in grazing cattle, also known as St George or Marree Disease, has been a long-time pestilence for the pastoral industry throughout arid regions of inland Australia. The causative species Pimelea (Thymelaeaceae), native to Queensland, New South Wales and South Australia, have been confirmed, with the secondary metabolite simplexin, a daphnane orthoester, being extracted and identified as the principal toxin. Despite the lack of effective prevention or treatment for Pimelea poisoning, naïve calves have previously been demonstrated to develop detoxification capability following prolonged low-dose simplexin intake. A variety of composites are being fabricated by encapsulating Pimelea plant material or a crude extract in biodegradable and biocompatible polyesters, aiming to develop a sustained toxin release mechanism. Studies on screening potential rumen microflora able to decompose simplexin during rumen-fluid fermentation are being conducted simultaneously. In this project, a quantification method for simplexin within these biocomposites was developed and validated utilising solid-phase extraction combined with UHPLC-Q-Orbitrap MS/MS. Reliable simplexin measurement in matrices will allow investigations into the material composition, geometry and rumen microorganism’s effects on the controlled release kinetics of simplexin in vitro. The degradation patterns of toxin delivery systems when exposed to simulated rumen environments will also be thoroughly assessed on both microscopic and chemical scales. Mathematical models of the underlying mass transport mechanisms will ultimately be established through approaches ranging from simple empirical correlations to stochastic simulations, which hold the potential to facilitate future design, optimisation, and prediction of other intra-ruminal devices based on biodegradable polymers.
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Goubar, Thomas, David J. Torpy, Shaun McGrath, and R. Louise Rushworth. "Prehospital Management of Acute Addison Disease: Audit of Patients Attending a Referral Hospital in a Regional Area." Journal of the Endocrine Society 3, no. 12 (September 17, 2019): 2194–203. http://dx.doi.org/10.1210/js.2019-00263.
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Abstract Context Adrenal crisis (AC) causes morbidity and mortality in patients with Addison disease [primary adrenal insufficiency (PAI)]. Patient-initiated stress dosing (oral or parenteral hydrocortisone) is recommended to avert ACs. Although these should be effective, the continued incidence of ACs remains largely unexplained. Methods Audit of all attendances between 2000 and 2017 of adult patients with treated PAI to one large regional referral center in New South Wales, Australia. Measurements were those taken on arrival at hospital. Results There were 252 attendances by 56 patients with treated PAI during the study period. Women comprised 60.7% (n = 34) of the patients. The mean age of attendees was 53.7 (19.6) years. Nearly half (45.2%, n = 114) of the patients had an infection. There were 61 (24.2%) ACs diagnosed by the treating clinician. Only 17.9% (n = 45) of the hospital presentations followed any form of stress dosing. IM hydrocortisone was used prior to presentation 7 (2.8%) attendances only. Among patients with a clinician-diagnosed AC, only 32.8% (n = 20) had used stress dosing before presentation. Vomiting was reported by 47.6% (n = 120) of the patients but only 33 (27.5%) of these attempted stress dosing and 5 patients with vomiting used IM hydrocortisone. The number of prior presentations was an independent predictor of use of stress doses [1.05 (1.01, 1.09)]. Conclusion Dose-escalation strategies are not used universally or correctly by unwell patients with PAI; many patients do not use IM or subcutaneous hydrocortisone injections. Previous hospital treatment increases the likelihood of stress dosing, and hospital attendance offers the opportunity for reinforcement of prevention strategies.
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Jin, Xingzhong, Stuart A. Kinner, Robyn Hopkins, Emily Stockings, Ryan J. Courtney, Anthony Shakeshaft, Dennis Petrie, Timothy Dobbins, and Kate Dolan. "Brief intervention on Smoking, Nutrition, Alcohol and Physical (SNAP) inactivity for smoking relapse prevention after release from smoke-free prisons: a study protocol for a multicentre, investigator-blinded, randomised controlled trial." BMJ Open 8, no. 10 (October 2018): e021326. http://dx.doi.org/10.1136/bmjopen-2017-021326.
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IntroductionSmoking remains the leading risk factor for disease burden and mortality worldwide. Heavy Smoking is often associated with poor Nutrition, Alcohol abuse and Physical inactivity (known as ‘SNAP’). Australia’s first prison smoking ban was introduced in the Northern Territory in July 2013. However, relapse to smoking after release from prison is normative. Holistic and cost-effective interventions are needed to maintain post-release abstinence to realise the potential public health impact of smoke-free prison policies. Rigorous, large-scale trials of innovative and scalable interventions are crucial to inform tobacco control policies in correctional settings.Methods and analysisThis multicentre, investigator-blinded, randomised parallel superiority trial will evaluate the effectiveness of a brief intervention on SNAP versus usual care in preventing smoking relapse among people released from smoke-free prisons in the Northern Territory, Australia. A maximum of 824 participants will be enrolled and randomly assigned to either SNAP intervention or usual care at a 1:1 ratio at baseline. The primary endpoint is self-reported continuous smoking abstinence three months after release from prison, verified by breath carbon monoxide test. Secondary endpoints include seven-day point prevalence abstinence, time to first cigarette, number of cigarettes smoked post release, Health Eating Index for Australian Adults, Alcohol Use Disorder Identification Test-Consumption and International Physical Activity Questionnaire scores. The primary endpoint will be analysed on an intention-to-treat basis using a simple log binomial regression model with multiple imputation for missing outcome data. A cost-effectiveness analysis of the brief intervention will be conducted subsequently.Ethics and disseminationThis study was approved by the University of New South Wales Human Research Ethics Committee (HREC), Menzies HREC and Central Australia HREC. Primary results of the trial and each of the secondary endpoints will be submitted for publication in a peer-review journal.Trial registration numberACTRN12617000217303; Pre-results.
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Bernal, Henrique de Moraes, Carlos Eduardo Siqueira, Fernando Adami, and Edige Felipe de Sousa Santos. "Trends in case-fatality rates of COVID-19 in the World, between 2019 - 2020." Journal of Human Growth and Development 30, no. 3 (October 15, 2020): 344–54. http://dx.doi.org/10.7322/jhgd.v30.11063.
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Introduction: CoV infections can potentially cause from a simple cold to a severe respiratory syndrome, such as the Severe Acute Respiratory Syndrome and the Middle East Respiratory Syndrome (MERS-CoV). The COVID-19 created a new reality for global healthcare models. Objetive: To evaluate trends in case fatality rates of COVID-19 in the World. Methods: We conducted a population based time-series study using public and official data of cases and deaths from COVID-19 in Argentina, Australia, Brazil, Chile, China, Colombia, France, Germany, India, Iran, Italy, Japan, Mexico, Morocco, New Zealand, Nigeria, Peru, Saudi Arabia, South Africa, South Korea, Spain, Switzerland, United Kingdom, United States and Russian, between December, 2019 and August, 2020. Data were based on reports from European Centre for Disease Prevention and Control. COVID-19 was defined by the International Classification of Diseases, 10th revision (U07.1). A Prais-Winsten regression model was performed and the Daily Percentage Change (DPC) calculated determine rates as increasing, decreasing or flat. Results: During the study period, trends in case-fatality rates in the world were flat (DPC = 0.3; CI 95% [-0.2: 0.7]; p = 0.225). In Africa, Morocco had decreasing trends (DPC = -1.1; CI 95% [-1.5: -0.7]; p < 0.001), whereas it were increasing in South Africa (p < 0.05) and flat in Nigeria (p > 0.05). In the Americas, Argentina showed a decreasing trend in case-fatality rates (DPC = -0.6; CI 95% [-1.1: -0.2]; p = 0.005), the U.S. had flat trends (p > 0.05) and all other American countries had increasing trends (p < 0.05). In Asia, Iran had decreasing trends (DPC = -1.5; CI 95% [-2.6 : -0.2]; p = 0.019); China and Saudi Arabia showed increasing trends (p < 0.05), while in India, Japan and South Korea they were flat (p > 0.05). European countries had mostly increasing trends (p < 0.05): Germany, Italy, Spain, the UK and Russia; France and Switzerland had flat trends (p > 0.05). Finally, in Oceania, trends in case-fatality rates were flat in Australia (p > 0.05) and increasing in New Zealand (p < 0.05). Conclusion: Trends in case-fatality rates of COVID-19 in the World were flat between December, 31 and August, 31. Argentina, Iran and Morocco were the only countries with decreasing trends. On the other hand, South Africa, Brazil, Canada, Chile, Colombia, Mexico, Peru, China, Saudi Arabia, Germany, Spain, United Kingdom, Russian and New Zealand had increasing trends in case-fatality rate. All the other countries analyzed had flat trends. Based on case-fatality rate data, our study supports that COVID-19 pandemic is still in progress worldwide.
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Zhou, Fei, Qinning Wang, Vitali Sintchenko, Gwendolyn L. Gilbert, Matthew V. N. O’Sullivan, Jonathan R. Iredell, and Dominic E. Dwyer. "Use of the 5′ untranslated region and VP1 region to examine the molecular diversity in enterovirus B species." Journal of Medical Microbiology 63, no. 10 (October 1, 2014): 1339–55. http://dx.doi.org/10.1099/jmm.0.074682-0.
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Human enteroviruses evolve quickly. The 5′ untranslated region (UTR) is fundamentally important for efficient viral replication and for virulence; the VP1 region correlates well with antigenic typing by neutralization, and can be used for virus identification and evolutionary studies. In order to investigate the molecular diversity in EV-B species, the 5′ UTR and VP1 regions were analysed for 208 clinical isolates from a single public-health laboratory (serving New South Wales, Australia), representing 28 EV-B types. Sequences were compared with the 5′ UTR and VP1 regions of 98 strains available in GenBank, representing the same 28 types. The genetic relationships were analysed using two types of software (mega and BioNumerics). The sequence analyses of the 5′ UTR and VP1 regions of 306 EV-B strains demonstrated that: (i) comparing the two regions gives strong evidence of epidemiological linkage of strains in some serotypes; (ii) the intraserotypic genetic variation within each gene reveals that they evolve distinctly largely due to their different functions; and (iii) mutation and possible recombination in the two regions play significant roles in the molecular diversity of EV-B. Understanding the tempo and pattern of molecular diversity and evolution is of great importance in the pathogenesis of EV-B enteroviruses, information which will assist in disease prevention and control.
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Valsa, Gjovalin, and Enkelejda Shkurti. "Universal Epidemiology of Insidious Meningococcal Syndrome." European Journal of Interdisciplinary Studies 1, no. 1 (April 30, 2015): 25. http://dx.doi.org/10.26417/ejis.v1i1.p25-36.
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Neisseria meningitidis is one of the principal sources of bacterial meningitis worldwide and can as well cause sepsis, pneumonia, and further expressions. In states with elevated widespread rates, the illness load puts a huge tension on the public health structure. The universal epidemiology of persistent meningococcal disease (IMD) diverges distinctly by area and in due course. This appraisal summarizes the burden of IMD in diverse states and recognizes the highest-incidence countries where habitual preventive programs aligned with Neisseria meningitidis would be essentially profitable in offering security. Accessible epidemiological figures from the past 20 years in World Health Organization and European Centre for Disease Prevention and Control assortments and available articles are comprised in this review, in addition to straight statements with important specialists in the area. The nations were clustered into high-, moderate-, and low-occurrence states. The mainstream of countries in the elevated-occurrence set are located in the African meningitis belt; several reasonable-occurrence states are located in the European and African areas, and Australia, whereas low-occurrence countries comprise numerous from Europe and the Americas. Precedence nations for vaccine involvement are high- and restrained-incidence nations where vaccine-avoidable serogroups prevail. Epidemiological records on burden of IMD are required in nations where this is not distinguished, predominantly in South- East Asia and Eastern Mediterranean areas, so evidence-based assessments concerning the application of meningococcal vaccines can be created.
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Manekk, Roshani S., and Aditya Mehta. "Recurrence of Primary Pulmonary Hydatidosis in the Left Lung with No Hepatic Involvement." Journal of Evolution of Medical and Dental Sciences 10, no. 10 (March 8, 2021): 746–48. http://dx.doi.org/10.14260/jemds/2021/160.
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Echinococcus granulosus is the most common cause of hydatid disease of the lung. Hydatid disease is endemic to the Mediterranean countries, Middle East, South America and Australia. After liver, lung is the 2nd most common organ involved in this disease.1 The main route of infection is infestation of the embryo which after passing through the duodenal wall enters into the portal vein or the peri duodenal and perigastric lymphatics. The pulmonary cysts develop through this route, secondary to hepatic lesions. 1 Pulmonary hydatidosis is most commonly seen in men during the 2nd and 3rd decades of life. An intact cyst can be defined as “simple or closed cyst”, and a ruptured and / or infected cyst“ can be defined as “complicated cyst”.2 Recurrence has been defined as new active cysts appearing after therapy, which includes reappearance with continual growth of live cysts at the site of a previously treated cyst or new distant disease appearing as a result of spillage.3 The diagnosis of hydatid cyst diagnosis is often delayed because patients are asymptomatic for years during the period of growth of the parasite.2 Surgical goals in a case of hydatid cyst are: A - total eradication of the parasite; B - the prevention of the cyst 's rupturing on the operative field and its consequent dissemination; and C - the extirpation of the residual cavity.4 In this article, we report a rare case of male patient with multiple daughter cysts in the left lung at pleura-parenchymal junction and mediastinum who presented to us with recurrent pulmonary hydatidosis, which has caused complication of expectoration of multiple daughter cyst of small size.
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Ferdous, Most Zannatul, Lakshmi Rani Kundu, Marjia Sultana, and Sheikh Jafia Jafrin. "Regional differences in COVID-19 attack and case fatality rates in the first quarter of 2020: a comparative study." IMC Journal of Medical Science 14, no. 2 (April 5, 2021): 1–10. http://dx.doi.org/10.3329/imcjms.v14i2.52825.
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Background and Objective: The COVID-19 (Coronavirus disease 2019) outbreak has become a public health threat all over the world. From December 31, 2019 to March 19, 2020, 146 countries were affected. Evidence on the management approaches of current COVID-19 pandemic is still limited though the numbers of affected countries are increasing as the days go by. This study was aimed at determining the attack rate (AR) and case fatality rate (CFR) of Covid-19 in six different regions around the world in the first quarter of 2020. An attempt was also made to provide an overview of the ongoing situation of COVID-19.
Methods: The design of the study was mixed approach where a retrospective analysis of surveillance data of six different regions around the world were collected from COVID-19 dashboard of World Health organization, between 31 December 2019 to 19 March 2020 (Time: 2:00 pm. BST [CET: 9 am]). Besides, other different validated sources (example: Worldometer, Center for Disease Control and Prevention) were used to assess the ongoing situation regarding COVID-19. A statistical software SPSS version 26 was used to analyze the data.
Results: There were a total of 207,860 confirmed cases and 8779 deaths across six different regions around the world from 31 December 2019 to 19 March 2020, with the highest AR of 9.92/100,000 population in Europe region, followed by Asia (2.7/ 100,000), Australia (1.75/100,000), North America (1.42/100,000), South America (0.23/100,000) and Africa (0.06/100,000) regions. Study results revealed statistically significant association between attack rates and the six regions of the world (p=0.002), meaning that AR varied in the regions around the world. The CFR was high in Europe region (4.81%), followed by Asia (4.06%), Africa (2.72%), South America (1.41%), Australia (1.12%), and North America (0.69%) regions. Data reviewed from different countries revealed that the highest number of cases was confirmed in the United States, followed by Spain and Italy. The findings revealed that the reported confirmed cases varied widely in different regions of the world.
Conclusion: The severity and variation in -geographical distribution of COVID-19 cases and deaths suggest that urgent response from various government and public health authorities should be taken and research regarding underlying factors determining this severity should be sought for.
Ibrahim Med. Coll. J. 2020; 14(2): 1-10
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Katzenellenbogen, Judith M., Daniela Bond-Smith, Anna P. Ralph, Mathilda Wilmot, Julie Marsh, Ross Bailie, and Veronica Matthews. "Priorities for improved management of acute rheumatic fever and rheumatic heart disease: analysis of cross-sectional continuous quality improvement data in Aboriginal primary healthcare centres in Australia." Australian Health Review 44, no. 2 (2020): 212. http://dx.doi.org/10.1071/ah19132.
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ObjectiveThis study investigated the delivery of guideline-recommended services for the management of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in Australian primary healthcare centres participating in the Audit and Best Practice for Chronic Disease (ABCD) National Research Partnership project. MethodsARF and RHD clinical audit data were collected from 63 Aboriginal centres in four Australian jurisdictions using the ABCD ARF/RHD audit tool. Records of up to 30 patients treated for ARF and/or RHD were analysed per centre from the most recent audit conducted between 2009 and 2014. The main outcome measure was a quality of ARF and RHD care composite indicator consisting of nine best-practice service items. ResultsOf 1081 patients, most were Indigenous (96%), female (61%), from the Northern Territory and Queensland (97%) and <25 years of age (49%). The composite indicator was highest in the 0–14 year age group (77% vs 65–67% in other age groups). Timely injections and provision of client education are important specific areas for improvement. Multiple regression showed age >15 years to be a significant negative factor for several care indicators, particularly for the delivery of long-acting antibiotic injections and specialist services in the 15–24 year age group. ConclusionsThe results suggest that timely injection and patient education are priorities for managing ARF and RHD, particularly focusing on child-to-adult transition care. What is known about the topic?The burden of rheumatic fever and RHD in some Aboriginal communities is among the highest documented globally. Guideline-adherent RHD prevention and management in primary health care (PHC) settings are critically important to reduce this burden. Continuous quality improvement (CQI) is a proven strategy to improve guideline adherence, using audit cycles and proactive engagement of PHC end users with their own data. Previously, such CQI strategies using a systems approach were shown to improve delivery of ARF and RHD care in six Aboriginal health services (three government and three community controlled). What does this paper add?This paper focuses on the variation across age groups in the quality of ARF and/or RHD care according to nine quality of care indicators across 63 PHC centres serving the Aboriginal population in the Northern Territory, Queensland, South Australia and Western Australia. These new findings provide insight into difference in quality of care by life stage, indicating particular areas for improvement of the management of ARF and RHD at the PHC level, and can act as a baseline for monitoring of care quality for ARF and RHD into the future. What are the implications for practitioners?Management plans and innovative strategies or systems for improving adherence need to be developed as a matter of urgency. PHC professionals need to closely monitor adherence to secondary prophylaxis at both the clinic and individual level. RHD priority status needs to be assigned and recorded as a tool to guide management. Systems strengthening needs to particularly target child-to-adult transition care. Practitioners are urged to keep a quick link to the RHDAustralia website to access resources and guidelines pertaining to ARF and RHD (https://www.rhdaustralia.org.au/arf-rhd-guideline, accessed 3 October 2019). CQI strategies can assist PHC centres to improve the care they provide to patients.
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Kwon, Jisoo A., Georgina M. Chambers, Fabio Luciani, Lei Zhang, Shamin Kinathil, Dennis Kim, Hla-Hla Thein, et al. "Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis." PLOS ONE 16, no. 2 (February 11, 2021): e0245896. http://dx.doi.org/10.1371/journal.pone.0245896.
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In Australian prisons approximately 20% of inmates are chronically infected with hepatitis C virus (HCV), providing an important population for targeted treatment and prevention. A dynamic mathematical model of HCV transmission was used to assess the impact of increasing direct-acting antiviral (DAA) treatment uptake on HCV incidence and prevalence in the prisons in New South Wales, Australia, and to assess the cost-effectiveness of alternate treatment strategies. We developed four separate models reflecting different average prison lengths of stay (LOS) of 2, 6, 24, and 36 months. Each model considered four DAA treatment coverage scenarios of 10% (status-quo), 25%, 50%, and 90% over 2016–2045. For each model and scenario, we estimated the lifetime burden of disease, costs and changes in quality-adjusted life years (QALYs) in prison and in the community during 2016–2075. Costs and QALYs were discounted 3.5% annually and adjusted to 2015 Australian dollars. Compared to treating 10% of infected prisoners, increasing DAA coverage to 25%, 50%, and 90% reduced HCV incidence in prisons by 9–33% (2-months LOS), 26–65% (6-months LOS), 37–70% (24-months LOS), and 35–65% (36-months LOS). DAA treatment was highly cost-effective among all LOS models at conservative willingness-to-pay thresholds. DAA therapy became increasingly cost-effective with increasing coverage. Compared to 10% treatment coverage, the incremental cost per QALY ranged from $497-$569 (2-months LOS), -$280–$323 (6-months LOS), -$432–$426 (24-months LOS), and -$245–$477 (36-months LOS). Treating more than 25% of HCV-infected prisoners with DAA therapy is highly cost-effective. This study shows that treating HCV-infected prisoners is highly cost-effective and should be a government priority for the global HCV elimination effort.
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Van Laar, Emily S., Charlotte Warren, Jayashri Desai, and Patrick F. Fogarty. "Knowledge Gaps in the Management of Hemophilia Among Hematologists/Oncologists." Blood 124, no. 21 (December 6, 2014): 4831. http://dx.doi.org/10.1182/blood.v124.21.4831.4831.
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Abstract Hemophilia is an orphan disease whose management requires specialized knowledge of complications and treatments, which adds to the challenge of caring for patients. Knowledge gaps among hematologists, hematologist-oncologists and pediatric oncologists regarding management of hemophilia could negatively impact patient outcomes. Utilizing the National Hemophilia Foundation and the World Federation of Haemophilia guidelines and best practices, a global, hemophilia-specific continuing medical education-accredited clinical practice assessment survey was developed and completed by unselected hematologists and oncologists in order to define current education gaps and assess areas of deviation from guideline and best practices. The assessment included both knowledge- and case -based, multiple-choice questions that healthcare providers completed confidentially on-line between March 21, 2014 and July 2, 2014. Topics ranging from hemophilia severity to management/prevention of bleeds were assessed. Responses from clinicians were de-identified and aggregated prior to analyses. 354 hematologist (51%), hematologist/oncologist (34%) or pediatric oncologists (14%) completed the survey, from the following locales: North America (30%), Europe (25%), Asia (18%), Central/South America (9%), Middle East (7%), Africa (8%), and Australia (2%). Practice settings of participants were academic (53%), community hospital (22%), private practice (12%), hemophilia treatment center (HTC) (5%), community clinic (3%), and other (5%). Respondents demonstrated knowledge (> 88% correct responses) in topics such as: definition of severe hemophilia, identifying life-threatening bleeds, primary prophylaxis dose/schedule, adolescence transitioning, and monitoring after initiating prophylaxis. In contrast, knowledge gaps included: prophylaxis duration; incidence of inhibitors; role of physiotherapy; managing joint bleeds (Table 1). For most responses, the proportion of correct responses appeared to be consistent regardless of physician specialty (hematologists (Group A) versus hematologists/oncologists + pediatric oncologists (Group B)) or practice setting (academic + HTC (Group C) versus community (Group D)). A low level of confidence in ability to identify when to use prophylaxis was reported among 20% [95% CI: 16.74% to 23.26%] of all respondents. Knowledge gaps permeate clinical practice in the care of persons with hemophilia. Most significant gaps were related to incidence of inhibitor development, continuance of prophylaxis, and use of physiotherapy for hemophiliac joint disease. These data support the development and implementation of educational tools for clinicians involved in hemophilia care across a range of practice settings. Abstract 4831. Table 1. Hemophilia Knowledge Gaps for Hematologists, Hematologist/Oncologists, Pediatric Oncologists (% Correct Responses) Survey Assessment Topic All Group A Group B Group A vs Group B p-value Group C Group D Group C vs Group D p-value Prophylaxis Duration 35.9% 34.8% 38.3% 0.55 42.0% 28.4% 0.03 Incidence of Inhibitors 48.3% 51.4% 44.0% 0.20 43.4% 54.3% 0.08 Physiotherapy for Joint Disease 47.4% 50.4% 45.2% 0.40 51.0% 43.3% 0.27 Managing Joint Bleeds 74.2% 73.1% 75.6% 0.64 75.8% 72.2% 0.60 Disclosures Van Laar: Medscape LLC: Employment. Warren:Medscape LLC: Employment. Desai:Medscape LLC: Employment. Fogarty:CSL Behring: Research Funding; Biogen Idec Inc.: Research Funding; Baxter: Research Funding; Pfizer Inc: Consultancy; Chugai Pharma USA: Consultancy; Biogen Idec Inc.: Consultancy; Baxter: Consultancy; Bayer HealthCare Pharmaceuticals: Consultancy; Amgen Inc: Consultancy; Pfizer Inc: Research Funding; Medscape LLC: Honoraria; VindicoMed: Honoraria.
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Cheung, K. Katherine, Masoud Mirzaei, and Stephen Leeder. "Health policy analysis: a tool to evaluate in policy documents the alignment between policy statements and intended outcomes." Australian Health Review 34, no. 4 (2010): 405. http://dx.doi.org/10.1071/ah09767.
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Objective. Health policy analysis remains surprisingly undeveloped in Australia given the power that policy exercises over the direction of public health. This paper describes the use of a policy analysis tool to evaluate the alignment between policy statements and intended outcomes of principal chronic illness policy documents in New South Wales (NSW) from 1999 to 2008. In doing so, it demonstrates the utility of a set of predefined criteria for use in retrospective policy analysis and potential for use in reviewing policy proposals and making future health policies. Methods. We analysed the major health policy for the care of people with chronic disease in NSW, the Chronic Care Program, using a modified set of existing criteria derived from the logic of events theoretical framework, which conceptualises the connection between policy determinants and outcomes. A document map was also developed to identify linkages between the policy documents analysed. Results. Internal validity, the alignment between policy statements and intended outcomes, was highest for policy background and goal-setting criteria, and lowest for accessibility, resources, public opportunities and monitoring and evaluation criteria. The use of document mapping was vital in determining linkages between the closely related policy documents of this complex initiative. Conclusions. The use of predefined criteria to identify in policy documents where policy statements are not consistent with intended outcomes, in conjunction with policy mapping, are useful methods of analysing complex policy initiatives. In the Australian context, the use of a validated policy-analysis tool might help achieve greater consistency. Implications. The use of a tool during policy development to identify in policy documents where statements are not consistent with intended outcomes may increase the likelihood of the successful implementation of future health policy. The tool can also assist those who make and review future policies. What is known about the topic?Chronic diseases are an increasing burden on the Australian community and effective policy is required for their prevention and management. Evidence-based policy making has much potential in effecting policy impact yet there is very little Australian research into policy making. Health policy analysis has been conducted in the past but there has not been an attempt to evaluate or analyse the documents that communicate policy in NSW. What does this paper add?This is the first attempt to analyse the policy documentation of a major health initiative for internal validity, that is, the alignment between policy statements and intended outcomes. It offers a framework that may be used to assess policy documents and demonstrates the utility of document maps to identify policy linkages. What are the implications for practitioners?The use of a predefined set of criteria highlights opportunities where policies such as the NSW Chronic Care Program can potentially be strengthened. The criteria can be used by reviewers of policy proposals to find where policy documents can be improved to better reflect their intention. This may increase the chance of successful implementation. Document maps may clarify the relationships between policy documents in policy-rich programs and improve their accessibility to target audiences.
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Anjali, Anjali, and Manisha Sabharwal. "Perceived Barriers of Young Adults for Participation in Physical Activity." Current Research in Nutrition and Food Science Journal 6, no. 2 (August 25, 2018): 437–49. http://dx.doi.org/10.12944/crnfsj.6.2.18.
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This study aimed to explore the perceived barriers to physical activity among college students Study Design: Qualitative research design Eight focus group discussions on 67 college students aged 18-24 years (48 females, 19 males) was conducted on College premises. Data were analysed using inductive approach. Participants identified a number of obstacles to physical activity. Perceived barriers emerged from the analysis of the data addressed the different dimensions of the socio-ecological framework. The result indicated that the young adults perceived substantial amount of personal, social and environmental factors as barriers such as time constraint, tiredness, stress, family control, safety issues and much more. Understanding the barriers and overcoming the barriers at this stage will be valuable. Health professionals and researchers can use this information to design and implement interventions, strategies and policies to promote the participation in physical activity. This further can help the students to deal with those barriers and can help to instil the habit of regular physical activity in the later adult years.
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Meena, Sonali, Joel Chan, Tuong-Vi Phan, Samantha Butenko, Jenny Hurley, Paul McGowen, Emily Kirkpatrick, et al. "Repatriation operation in South Australia during the COVID-19 pandemic: initial planning and preparedness." Communicable Diseases Intelligence 45 (July 27, 2021). http://dx.doi.org/10.33321/cdi.2021.45.29.
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With COVID-19 affecting millions of people around the globe, quarantine of international arrivals is a critical public health measure to prevent further disease transmission in local populations. This measure has also been applied in the repatriation of citizens, undertaken by several countries as an ethical obligation and legal responsibility. This article describes the process of planning and preparing for the repatriation operation in South Australia during the COVID-19 pandemic. Interagency collaboration, development of a COVID-19 testing and quarantining protocol, implementing infection prevention and control, and building a specialised health care delivery model were essential aspects of the repatriation operational planning, with a focus on maintaining dignity and wellbeing of the passengers as well as on effective prevention of COVID-19 transmission. From April 2020 to mid-February 2021, more than 14,000 international arrivals travellers have been repatriated under the South Australian repatriation operations. This paper has implications to inform ongoing repatriation efforts in Australia and overseas in a pandemic situation.
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Tannous, Wadad Kathy, Phillipa Hay, Federico Girosi, Andreea I. Heriseanu, Moin Uddin Ahmed, and Stephen Touyz. "The economic cost of bulimia nervosa and binge eating disorder: a population-based study." Psychological Medicine, May 17, 2021, 1–15. http://dx.doi.org/10.1017/s0033291721000775.
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Abstract Background The most common eating disorders (EDs) are bulimia nervosa (BN) and binge eating disorder (BED), serious psychiatric illnesses that have devastating effects on the physical and psychological wellbeing of sufferers. EDs range in complexity and severity but can be life-threatening without appropriate treatment. Although it is well-known that quality of life impacts is high for ED sufferers, research regarding fiscal and related costs is severely limited. The aim of this study was to understand economic and other costs of EDs at the community level. Method Data were derived from 2017 household community representative structured interview of 2977 people aged ⩾ 15 years in South Australia. ED diagnoses, health systems, productivity, transaction, out-of-pocket expenses and other related costs of BN and BED were used to estimate the economic burden of EDs in South Australia. Results The annual total economic cost of EDs in 2018 was estimated at $84 billion for South Australia. This included $81 billion from the burden of disease as the result of years lived with disability (YLD) ($62 billion) and years of life lost ($19 billion). The health system costs, productivity and tax revenue loss to the Australian economy were estimated at $1 billion, $1.6 billion and $0.6 billion, respectively. Conclusions The YLD average cost in 2018 in South Australia was $296 649 per person. This is two-thirds of the costs borne by individuals and the wider economy. Prevention and management initiatives for EDs need to take into account these costs when assessing their potential benefits.
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Zajaczkowski, P., S. Mazumdar, S. Conaty, J. T. Ellis, and S. M. Fletcher-Lartey. "Epidemiology and associated risk factors of giardiasis in a peri-urban setting in New South Wales Australia." Epidemiology and Infection 147 (September 28, 2018). http://dx.doi.org/10.1017/s0950268818002637.
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AbstractGiardiasis is one of the most important non-viral causes of human diarrhoea. Yet, little is known about the epidemiology of giardiasis in the context of developed countries such as Australia and there is a limited information about local sources of exposure to inform prevention strategies in New South Wales. This study aimed to (1) describe the epidemiology of giardiasis and (2) identify potential modifiable risk factors associated with giardiasis that are unique to south-western Sydney, Australia. A 1:2 matched case-control study of 190 confirmed giardiasis cases notified to the South-Western Local Health District Public Health Unit from January to December 2016 was employed to investigate the risk factors for giardiasis. Two groups of controls were selected to increase response rate; Pertussis cases and neighbourhood (NBH) controls. A matched analysis was carried out for both control groups separately. Variables with a significant odds ratio (OR) in the univariate analysis were placed into a multivariable regression for each matched group, respectively. In the regression model with the NBH controls, age and sex were controlled as potential confounders. Identified risk factors included being under 5 years of age (aOR = 7.08; 95% confidence intervals (CI) 1.02–49.36), having a household member diagnosed with a gastrointestinal illness (aOR = 15.89; 95% CI 1.53–164.60) and having contact with farm animals, domestic animals or wildlife (aOR = 3.03; 95% CI 1.08–8.54). Cases that travelled overseas were at increased risk of infection (aOR = 19.89; 95% CI 2.00–197.37) when compared with Pertussis cases. This study provides an update on the epidemiology and associated risk factors of a neglected tropical disease, which can inform enhanced surveillance and prevention strategies in the developed metropolitan areas.
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Kaufman, Marc J., and Garrett M. Fitzmaurice. "Temporal patterns of suicide and circulatory system disease-related mortality are inversely correlated in several countries." BMC Psychiatry 21, no. 1 (March 16, 2021). http://dx.doi.org/10.1186/s12888-021-03159-5.
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Abstract Background Nearly 800,000 suicides occur worldwide annually and suicide rates are increasing faster than population growth. Unfortunately, the pathophysiology of suicide remains poorly understood, which has hindered suicide prevention efforts. However, mechanistic clues may be found by studying effects of seasonality on suicide and other mortality causes. Suicides tend to peak in spring-summer periods and nadir in fall-winter periods while circulatory system disease-related mortality tends to exhibit the opposite temporal trends. This study aimed to determine for the first time whether monthly temporal cross-correlations exist between suicide and circulatory system disease-related mortality at the population level. If so and if common biological factors moderate risks for both mortality types, such factors may be discoverable and utilized to improve suicide prevention. Methods We conducted time series analyses of monthly mortality data from northern (England and Wales, South Korea, United States) and southern (Australia, Brazil) hemisphere countries during the period 2009–2018 (N = 41.8 million all-cause mortality cases). We used a Poisson regression variant of the standard cosinor model to determine peak months of mortality. We also estimated cross-correlations between monthly mortality counts from suicide and from circulatory system diseases. Results Suicide and circulatory disease-related mortality temporal patterns were negatively correlated in Australia (− 0.32), Brazil (− 0.57), South Korea (− 0.32), and in the United States (− 0.66), but no temporal correlation was discernable in England and Wales. Conclusions The negative temporal cross-correlations between these mortality types we found in 4 of 5 countries studied suggest that seasonal factors broadly and inversely moderate risks for circulatory disease-related mortality and suicide, but not in all regions, indicating that the effect is not uniform. Since the seasonal factors of temperature and light exert opposite effects on suicide and circulatory disease-related mortality in several countries, we propose that physiologically-adaptive circulatory system responses to heat and light may increase risk for suicide and should be studied to determine whether they affect suicide risk. For example, heat and light increase production and release of the bioactive gas nitric oxide and reduce circulatory system disease by relaxing blood vessel tone, while elevated nitric oxide levels are associated with suicidal behavior, inverse effects that parallel the inverse temporal mortality patterns we detected.
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Liu, Bette, Paula Spokes, Wenqiang He, and John Kaldor. "High risk groups for severe COVID-19 in a whole of population cohort in Australia." BMC Infectious Diseases 21, no. 1 (July 16, 2021). http://dx.doi.org/10.1186/s12879-021-06378-z.
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Abstract Background Increasing age is the strongest known risk factor for severe COVID-19 disease but information on other factors is more limited. Methods All cases of COVID-19 diagnosed from January–October 2020 in New South Wales Australia were followed for COVID-19-related hospitalisations, intensive care unit (ICU) admissions and deaths through record linkage. Adjusted hazard ratios (aHR) for severe COVID-19 disease, measured by hospitalisation or death, or very severe COVID-19, measured by ICU admission or death according to age, sex, socioeconomic status and co-morbidities were estimated. Results Of 4054 confirmed cases, 468 (11.5%) were classified as having severe COVID-19 and 190 (4.7%) as having very severe disease. After adjusting for sex, socioeconomic status and comorbidities, increasing age led to the greatest risk of very severe disease. Compared to those 30–39 years, the aHR for ICU or death from COVID-19 was 4.45 in those 70–79 years; 8.43 in those 80–89 years; 16.19 in those 90+ years. After age, relative risks for very severe disease associated with other factors were more moderate: males vs females aHR 1.40 (95%CI 1.04–1.88); immunosuppressive conditions vs none aHR 2.20 (1.35–3.57); diabetes vs none aHR 1.88 (1.33–2.67); chronic lung disease vs none aHR 1.68 (1.18–2.38); obesity vs not obese aHR 1.52 (1.05–2.21). More comorbidities was associated with significantly greater risk; comparing those with 3+ comorbidities to those with none, aHR 5.34 (3.15–9.04). Conclusions In a setting with high COVID-19 case ascertainment and almost complete case follow-up, we found the risk of very severe disease varies by age, sex and presence of comorbidities. This variation should be considered in targeting prevention strategies.
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"BioBoard." Asia-Pacific Biotech News 11, no. 07 (April 15, 2007): 390–99. http://dx.doi.org/10.1142/s0219030307000419.
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Australia — Sydney Researchers Unveil the Structure of Cancer Enzyme. Australia — Australian University Aids in the Establishment of a Biotech Center in Vietnam. Australia — Australian Researchers Work on Biofuel. Australia — Queensland's New Wesley Research Institute Tissue Bank for Cancer Tissue Collection. Australia — LCT Successful in Transplanting Pig Cells in Humans for Insulin Production. China — China Establishes Medical Insurance Research Institute. China — AstraZeneca Sets Up Research Base in Shanghai. China — Industrial Biotechnology Research Center Newly Opened at the Shanghai Institutes for Biological Sciences. China — China Science Association Publishes Moral Code for Academics. China — China's Health Ministry to Cooperate with Merieux Alliance for TB Prevention. China — China to Tighten Supervision of Albumin Medicine. China — Research Center Set Up for a New Approach to TCM Research. China — Chinese Scientist Announces Breakthrough in Cancer Research. Indonesia — Indonesia to Support WHO in Influenza Prophylaxis. Indonesia — Indonesian Agency for Agricultural Research and Development Collaborates with Philippines-Based IRRI. Indonesia — Indonesian President Calls to Distribute Bird Flu Vaccines Equally. India — JIVAS Launches 'Project Padasamrakshane' with Funding from World Diabetes Foundation. India — CIMAP to Tie Up with Pharmexcil for Promotion of Herbal Plants. India — Central Drugs Research Institute Develops Three New Anti-diabetic Molecules. India — Indian Government to Invest in Nanotech. India — Wyeth to Relocate Operations from China to India. India — Prices of Generic Medicine to Drop in India. India — ORBIS Plans 30 Eye Centers in India. India — Indian Researchers Discovers New Genetic Markers for Coronary Heart Disease. Japan — Flu Virus Mutants Resist Two Popular Drugs. Singapore — Therapeutic Antibodies Likely to be Used to Prevent Infectious Diseases. Singapore — Singapore Stem Cell Bank Ready for Business. Singapore — Asia Generic Medicines Congress in Singapore Celebrates the Rise of Asian Generics. Singapore — Singapore and Cambodia Sign Health Pact. Singapore — New Leadership Appointments at A*STAR's Biomedical Research Council. South Korea — South Korea to Ban Use of Tamiflu by Teenagers.
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Gebru, Addis Adera, Tadesse Birhanu, Eshetu Wendimu, Agumas Fentahun Ayalew, Selamawit Mulat, Hussen Zakir Abasimel, Ali Kazemi, et al. "Global burden of COVID-19: Situational analyis and review." Human Antibodies, November 4, 2020, 1–10. http://dx.doi.org/10.3233/hab-200420.
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BACKGROUND: The novel Coronavirus Diseases 2019 (COVID-19) is the major public health burden in the world. The morbidity and mortality of global community due to this disease is dramatically increasing from time to time. OBJECTIVE: This situational analysis is aimed to analysis prevalence, and incidence of COVID-19 and to provide clear information about this disease for the scientific community, stakeholders and healthcare practitioners and decision-makers. METHODS: The literatures were identified by searching the key relevant and officially known online databases: medRxiv, Google scholar and PubMed. The online databases contain archives of most English biomedical journals and scientific papers published online from 31 December to 3 April 2020 were included. After the literature search, articles were screened independently by two reviewers for eligibility. RESULTS: The world continents have confirmed a total of 1,202,320 confirmed COVID-19 cases: (51.2%) in Europe, (27.7%) in North America, (17.9%) in Asia, (1.96%) in South America and at less number of confirmed COVID-19 cases in Africa and Australia which was accounted 0.8% and 0.5%, respectively. However, this review showed that there was significantly increased the confirmed COVID-19 cases by 109,555 in Asia, 8,658 in Africa, 332,866 in North America, 20,269 in South America, 568,894 in Europe, 5,051 in Australia and 1,045,403 in the whole world continent except Antarctica during the review period. The overall results showed that there were 1,098,762 cases and 59,172 deaths have recorded from during the review period. The result zero number of deaths with COVID-19 was observed in 66 countries. CONCLUSION: The review concluded that COVID-19; SARS-CoV-2 is the major public health burden in the world, the morbidity and mortality of global community is dramatically increasing from time to time. Strongly collaboration among all sectors and then design effective prevention and control strategies which include staying home, social/physical distancing, quarantine, testing of suspected patients, isolation and managing of the confirmed cases. Therefore, the world continents countries should have to implement five major COVID-19 prevention and control programmes as soon as possible at community level.
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Tavella, Rosanna, Margaret Arstall, Matthew Worthley, Derek Chew, Christopher Zeitz, and John Beltrame. "Abstract 214: Determinants of Cardiac Rehabilitation Referral Following Acute Myocardial Infarction In Australia." Circulation: Cardiovascular Quality and Outcomes 8, suppl_2 (May 2015). http://dx.doi.org/10.1161/circoutcomes.8.suppl_2.214.
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Background: Despite the known benefits of cardiac rehabilitation (CR) and widespread endorsement of its use, CR is vastly underutilised, with less than 30% of eligible patients participating in a CR program after a cardiac event. The current study assessed the factors independently associated with referral to CR following acute myocardial infarction (AMI). Methods: The CR referral rate and factors associated with referral were assessed among all consecutive patients undergoing coronary angiography for AMI and surviving to hospital discharge, attending South Australian public hospitals from January 2012 [[Unable to Display Character: –]] December 2013. Data was maintained by the Coronary Angiogram Database of South Australia (CADOSA), a comprehensive registry compatible with the NCDR ® CathPCI ® Registry. Results: Among 3,212 patients undergoing angiography for AMI, CR referral occurred in 1,530 patients (48%). Compared to patients without CR referral, these patients were younger (62±13 vs. 64±14, p<0.01) and less likely to be female (25% vs. 34%, p<0.01). Following age-adjusted analysis, the cardiovascular risk factors were similar between CR referral and non-CR referral patients including: diabetes (29% vs. 30%, p>0.5), hypertension (61% vs. 64%, p>0.5), and dyslipidaemia (59% vs. 60%, p>0.5), but CR referral patients were more likely to be active smokers (40% vs. 33%, p<0.01). CR referral patients were less likely to have additional comorbidities including current dialysis (0.9% vs. 2.2%, p<0.01) and cerebrovascular disease (6.0% vs. 8.8%, p<0.01). In multivariable analyses, factors associated with increased CR referral were (c statistic 0.68): presentation with ST-elevation MI (STEMI) (1.4, 1.2-1.7, p<0.01), undergoing percutaneous coronary intervention (PCI) following angiography (1.6, 1.4-1.9, p<0.01) and younger age (1.0, 0.98-1.0, p<0.01). Prior CABG (0.6, 0.5-0.8, p<0.01) and absence of significant coronary artery disease, defined by stenosis <50%, (0.2, 0.1-0.3, p<0.01) were associated with decreased referral. Lastly, secondary prevention therapies were more often prescribed at discharge in patients with CR referral compared to patients without referral including: aspirin (93% vs. 82%, p<0.01), beta-blockers (64% vs. 61%, p<0.05), statin (92% vs. 78%, p<0.01), and ACE-inhibitor/angiotensin receptor blocker (84% vs. 74%, p<0.01). Conclusion: This study highlights a significant disparity in cardiovascular care with approximately half of AMI patients not referred to CR, despite it being a key performance measure. STEMI presentation, younger age and undergoing PCI are associated with increased referral. Alarmingly, AMI patients not referred to CR are also less likely to receive other guideline-based therapies. Increased physician awareness about the benefits of CR is required and initiatives to overcome barriers to referral may improve the delivery of evidence-based care.
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Pasupathy, Sivabaskari, Rosanna Tavella, Margaret Arstall, Derek Chew, Matthew Worthley, Christopher Zeitz, and John Beltrame. "Abstract 273: Myocardial Infarction with Non Obstructive Coronary Artery Disease: Prevalence, Clinical Features and Outcomes." Circulation: Cardiovascular Quality and Outcomes 8, suppl_2 (May 2015). http://dx.doi.org/10.1161/circoutcomes.8.suppl_2.273.
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Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is an enigma that is being increasingly recognized with the frequent use of angiography following Acute Myocardial Infarction (AMI). The current study is a prospective, contemporary analysis of MINOCA vs. Myocardial Infarction with obstructive coronary artery disease (MI-CAD) in regards to prevalence, clinical features, and in-hospital outcomes. Methods: All consecutive patients undergoing coronary angiography for AMI (as per the Third Universal AMI Definition) in South Australian public hospitals from January 2012 - December 2013 were included. Data was captured by Coronary Angiogram Database of South Australia (CADOSA), a comprehensive registry compatible with the NCDR® CathPCI® Registry. The AMI patients were classified as MI-CAD or MINOCA on the basis of the presence or absence of a significant stenosis (≥50%) on angiography. Results: From 4,189 angiography procedures undertaken for AMI, 468 (11%) were classified as MINOCA. Patients with MINOCA were younger (59±15 vs. 64±13 years, p <0.01) and more likely to be female (53% vs. 26%, p <0.01), compared to those with MI-CAD. Age-adjusted analysis comparing patients with MINOCA to MI-CAD revealed differences in: (1) cardiovascular risk factors including hypertension (52% vs. 66%, p<0.01), diabetes (19% vs. 32%, p<0.01), dyslipidemia (46% vs. 62%, p<0.01), and current smoker status (27% vs. 37% p<0.01); (2) AMI type and size with fewer ST elevation myocardial infarcts (27% vs. 41%, p<0.01) and lower peak troponin values (180 ng/L, IQR 353 vs. 264 ng/L, IQR 680, p<0.01) amongst MINOCA patients. Furthermore, the GRACE Score for acute coronary syndrome risk stratification was lower for the MINOCA patients compared to MICAD (150±34 versus 160±35, p <0.01). Despite fewer cardiovascular risk factors, the absence of obstructive coronary artery disease, smaller infarcts, and a lower GRACE score, the in-hospital mortality was similar for MINOCA and MI-CAD patients (2.2% vs. 3.0%, p=0.22). Moreover, MINOCA patients were less likely to receive secondary prevention therapies at discharge including antiplatelet therapy (60% vs. 92%, p<0.01) beta-blockers (41% vs. 65%, p<0.01), statin (55% vs. 88%, p<0.01), ACE-inhibitor/angiotensin receptor blocker (59% versus 81%, p<0.01), or referral to cardiac rehabilitation (15% versus 52%, p<0.01). Conclusions: In contemporary cardiology practice, MINOCA may be more frequent than previously appreciated and has a guarded prognosis despite its apparent lower risk profile. Improving the use of secondary prevention therapies in these patients may improve their prognosis.
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Hanley, Sharon. "973Eliminating Cervical Cancer in the Asia Pacific- From Research to Policy and Practice." International Journal of Epidemiology 50, Supplement_1 (September 1, 2021). http://dx.doi.org/10.1093/ije/dyab168.260.
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Abstract Focus and outcomes for participants Rationale for the symposium, including for its inclusion in the Congress Cervical cancer, caused by persistent infection with oncogenic human papillomavirus (HPV), is one of the most preventable and treatable forms of cancer, yet more than 300,000 women die from the disease annually and over 500,000 cases are diagnosed. Modelling has shown that effective integration of HPV immunization programmes, HPV-based screening, and access to high-quality cancer treatment and palliative care services has the potential to eliminate cervical cancer in most countries in the world over the next century. In 2018, the Director-General of WHO made a global call to action for the elimination of cervical cancer as a public health problem. As a result, WHO has developed a global strategy towards eliminating cervical cancer as a public health problem due for endorsement at the World Health Assembly in May 2020, which proposes an elimination threshold of four cases per 100 000 women and includes 2030 triple-intervention coverage targets for scale-up of HPV vaccination of 90%, twice-lifetime cervical screening of 70%, and treatment of pre-invasive lesions and invasive cancer of 90%. As the first country to establish a national HPV immunization programme and one of the first countries to move to an HPV based screening programme, Australia has played a leading role in the global battle against cervical cancer and is on course to eliminate the disease within the next decade. However, while the burden of disease and the highest mortality from cervical cancer occur in lower income countries, factors such as the inequitable cervical cancer burden in Indigenous populations and vaccine hesitancy mean that significant barriers to the elimination of cervical cancer also exists within high-income countries. This session will have seven experts working in four countries within the Asia Pacific region. By sharing experiences and providing evidence-based guidance on key technical and strategic issues, we hope to generate a comprehensive understanding and new knowledge on factors impacting participation in, and the potential for effective scale up of, cervical cancer control programmes within the region. Presentation program Names of presenters -Dr Kate Simms is a Postdoctoral Research Fellow at Cancer Council NSW, Australia. Her research focusses on modelling the impact of HPV vaccination and cervical cancer screening across a range of settings, including predictions for the potential elimination of cervical cancer across 181 countries. -Associate Professor Julia Brotherton is a public health physician and Medical Director of VCS Population Health. She is involved in research and policy development informing the implementation and evaluation of HPV vaccination programs in Australia and is member of the WHO Director General's Expert Advisory Group on Cervical Cancer Elimination. -Assistant Professor Sharon Hanley is a cancer epidemiologist at Hokkaido University, Japan. Her research interests include HPV vaccine hesitancy and HPV self-sampling to increase cervical screening uptake in never/under screened Japanese women. - Associate Professor Lisa Whop is an Indigenous Senior Research Fellow at the Australian National University, Canberra, Australia. Her research focuses on improving health outcomes for Aboriginal and Torres Strait Islander people with cancer, with a key focus on equity. - Dr Megan Smith is a Postdoctoral Research Fellow whose research focuses on optimizing and successfully implementing cervical cancer prevention, at the population level and in different population subgroups. She has contributed to a large number of reports to government, including several evaluations that have directly informed policy in Australia, New Zealand and England. -Professor Andrew Vallely is a clinical epidemiologist at the Kirby Institute, University of New South Wales, Australia. He recently completed a field evaluation comparing point-of-care Xpert HPV testing using self-collected specimens with visual inspection of the cervix with acetic acid (VIA), to detect high-grade cervical disease. - Professor Woo Yin Ling is a Consultant Obstetrician and Gynaecologist at the University of Malaya. She is the programme designer of Project ROSE (Removal of Obstacles to Cervical Screening), a novel cervical screening research programme which employs HPV self-sampling and digital technology to increase access to cervical screening in Malaysia. Names of facilitator or chair Assistant Professor Sharon J.B. Hanley, Hokkaido University and Professor John Kaldor, Kirby Institute, University of New South Wales?
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Ju, Xiangqun, Karen Canfell, Kirsten Howard, Gail Garvey, Joanne Hedges, Megan Smith, and Lisa Jamieson. "Population-based utility scores for HPV infection and oropharyngeal squamous cell carcinoma among Indigenous Australians." BMC Public Health 21, no. 1 (July 26, 2021). http://dx.doi.org/10.1186/s12889-021-11496-z.
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Abstract Background Oropharyngeal squamous cell carcinoma (OPSCC) is associated with high mortality. Human papillomavirus (HPV) infection is a significant risk factor for OPSCC. Utilities are fundamental values representing the strength of individuals’ preferences for specific health-related outcomes. Our study aim was to work in partnership with Indigenous communities in South Australia to develop, pilot test and estimate utility scores for health states related to HPV, HPV vaccination, precursor OPSCC and its treatment, and early stage OPSCC among Indigenous Australians. Methods Development and pilot testing of hypothetical HPV and OPSCC health states, specifically through the lens of being Indigenous Australian, was conducted with an Indigenous Reference Group. Six health states were decided upon, with utility scores calculated using a two-stage standard gamble approach among a large convenience sample of Indigenous Australians aged 18+ years residing in South Australia. The rank, percentage of perfect health and utility score of each health state was summarised using means, and medians at 12 months and lifetime duration. Potential differences by age, sex and residential location were assessed using the Wilcox Rank Sum test. Results Data from 1011 participants was obtained. The mean utility scores decreased with increasing severity of health states, ranging from 0.91–0.92 in ‘screened, cytology normal, HPV vaccination’ and ‘screened, HPV positive, endoscopy normal’, to less than 0.90 (ranging from 0.87–0.88) in lower grade conditions (oral warts and oral intraepithelial neoplasia) and less than 0.80 (ranging from 0.75–0.79) in ‘early stage throat cancer’. Higher utility scores were observed for ‘screened, cytology normal and HPV vaccination’ among younger participants (18–40 years), for ‘early stage invasive throat cancer’ among females, and for ‘oral intraepithelial neoplasia’ and ‘early stage invasive throat cancer’ among metropolitan-dwelling participants. Conclusion Among a large sample of Indigenous Australians, utility for oral HPV infection and OPSCC decreased with severity of health states. Older participants, as well as males and those residing in non-metropolitan locations, had decreased utility for high-grade cytology and early invasive cancer states. Our findings are an important contribution to cost-utility and disease prevention strategies that seek to inform policies around reducing HPV infection and OPSCC among all Australians.
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Brass, Amanda, Andrew P. Shoubridge, Maria Crotty, Lidia Morawska, Scott C. Bell, Ming Qiao, Richard J. Woodman, et al. "Prevention of SARS-CoV-2 (COVID-19) transmission in residential aged care using ultraviolet light (PETRA): a two-arm crossover randomised controlled trial protocol." BMC Infectious Diseases 21, no. 1 (September 17, 2021). http://dx.doi.org/10.1186/s12879-021-06659-7.
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Abstract Background SARS-CoV-2 poses a considerable threat to those living in residential aged care facilities (RACF). RACF COVID-19 outbreaks have been characterised by the rapid spread of infection and high rates of severe disease and associated mortality. Despite a growing body of evidence supporting airborne transmission of SARS-CoV-2, current infection control measures in RACF including hand hygiene, social distancing, and sterilisation of surfaces, focus on contact and droplet transmission. Germicidal ultraviolet (GUV) light has been used widely to prevent airborne pathogen transmission. Our aim is to investigate the efficacy of GUV technology in reducing the risk of SARS-CoV-2 infection in RACF. Methods A multicentre, two-arm double-crossover, randomised controlled trial will be conducted to determine the efficacy of GUV devices to reduce respiratory viral transmission in RACF, as an adjunct to existing infection control measures. The study will be conducted in partnership with three aged care providers in metropolitan and regional South Australia. RACF will be separated into paired within-site zones, then randomised to intervention order (GUV or control). The initial 6-week period will be followed by a 2-week washout before crossover to the second 6-week period. After accounting for estimated within-zone and within-facility correlations of infection, and baseline infection rates (10 per 100 person-days), a sample size of n = 8 zones (n = 40 residents/zone) will provide 89% power to detect a 50% reduction in symptomatic infection rate. The primary outcome will be the incidence rate ratio of combined symptomatic respiratory infections for intervention versus control. Secondary outcomes include incidence rates of hospitalisation for complications associated with respiratory infection; respiratory virus detection in facility air and fomite samples; rates of laboratory confirmed respiratory illnesses and genomic characteristics. Discussion Measures that can be deployed rapidly into RACF, that avoid the requirement for changes in resident and staff behaviour, and that are effective in reducing the risk of airborne SARS-CoV-2 transmission, would provide considerable benefit in safeguarding a highly vulnerable population. In addition, such measures might substantially reduce rates of other respiratory viruses, which contribute considerably to resident morbidity and mortality. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12621000567820 (registered on 14th May, 2021).
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Harvey, Lara, Rebecca Mitchell, Henry Brodaty, Brian Draper, and Jacqueline Close. "The impact of dementia and other comorbidities on increased risk of subsequent hip fracture following hip fracture in Australia: a competing risk approach." International Journal of Population Data Science 1, no. 1 (April 18, 2017). http://dx.doi.org/10.23889/ijpds.v1i1.160.
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ABSTRACT
ObjectivesOlder people with hip fracture are at increased risk of subsequent hip fracture. This study evaluates the relative impact of dementia, osteoporosis and other comorbidities on the increased risk of sustaining a subsequent fall-related hip fracture within ten years of a fall-related hip fracture, accounting for the competing risk of death.
ApproachLinked hospital and mortality data for all individuals aged 65 years and older admitted to a hospital in New South Wales, Australia, with a fall-related hip fracture over a ten year period between 1 January 2003 and 31 December 2013 were analysed. Dementia, osteoporosis and comorbidities contributing to the Charlson Comorbidity Index (CCI) were identified using up to 40 additional diagnosis codes recorded in the hospitalisation data and a 1 year lookback period. A competing risk approach was used to account for the high mortality inherent in this older population. Cause-specific hazard ratios (CSHRs) were calculated with age, sex and comorbidities included as covariates in the models. To account for the relatively long time frame of the study, dementia, osteoporosis and other CCI comorbidities were treated as time-dependent covariates.
Results Of the 50,290 individuals who sustained a fall-related hip fracture during the study period, 7.6% (4,102) had a subsequent fall-related hip fracture. Compared to people without dementia, people with dementia were more likely to die within 30 days of initial fracture (12.6% vs 6.4%, p<0.0001) and to sustain a subsequent hip fracture (9.8% compared to 6.6%, p<0.0001). In the multivariate hazards regressions, people with dementia had a 2.5 fold (CSHR 2.48, 99.9%CI 2.38-2.58, p<0.0001) increased risk of death and two fold (CSHR 2.02, 99.9%CI 1.81-2.26, p<0.0001) increased risk of second hip fracture. Of the comorbidities, metastatic cancer (CSHR 3.48, 99.9%CI 3.12-3.88, p<0.0001) and severe liver disease (CSHR 3.24, 99.9%CI 2.62-4.01, p<0.0001) were most strongly associated with death. Renal disease (CSHR 1.53, 99.9%CI 1.24-1.88, p<0.0001), osteoporosis (CSHR 1.44, 99.9%CI 1.28-1.62, p<0.0001), congestive heart failure (CSHR 1.42, 99.9%CI 1.24-1.64, p<0.0001), and acute myocardial infarction (CSHR 1.22, 99.9%CI 1.03-1.44, p<0.0001) were associated with increased risk of subsequent hip fracture.
Conclusions Hip fractures are costly injuries in terms of health care resources and the impact on the individual and their families. People with dementia are at twice the risk of sustaining a second hip fracture and death compared to people without dementia. Interventions including known effective treatments for osteoporosis as well as falls prevention should be targeted to this vulnerable population.
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Zhang, L., D. Ding, and R. Gallagher. "P202 Are Chinese immigrants with CVD ready to use web-based health information: a comparative study in Australia." European Heart Journal 41, Supplement_1 (January 1, 2020). http://dx.doi.org/10.1093/ehjci/ehz872.073.
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Abstract Background Immigrant populations often have poor access to cardiovascular disease (CVD) secondary prevention due to linguistic and cultural barriers. Web-based interventions are effective in risk reduction and lifestyle modification and may reach those hard-to-reach populations such as Chinese immigrants. However, less is known about the current use of web-based health information and confidence in use. Purposes We compared the use of web-based health information and confidence in use between Chinese immigrants with CVD to those with and without another chronic condition; and explored the factors associated with the confidence in utilization. Methods Chinese immigrants with CVD, musculoskeletal conditions, or no chronic condition were recruited from Chinese communities across New South Wales, Australia. E-health literacy scale was used to explore the perceptions of web-based health information and confidence in use. Demographic, clinical data and use of web-based health information were collected and health literacy was measured using a validated single screening question. Results Participants (n = 90 CVD, n = 87 musculoskeletal, n = 154 no chronic conditions) were aged mean 59 ± 16 years, mostly female (69%), 75% reported fair to poor English proficiency, and 51% had completed university. The most accessed web-based health information concerned lifestyle (60%), health resources (45%), diseases (35%), and medications (30%). More than half (54%) were confident in using web-based health information. Participants with CVD were the oldest (71 vs 65 vs 49 years, p<.001) and participants with any chronic condition had less education (p<.001) and English proficiency (p<.001) than the healthy group. Approximately half of the participants with CVD perceived web-based health information as useful (48%) and important (46%), and the most accessed information concerned lifestyle and medication (56% and 32%). Participants with CVD accessed medication information more often than musculoskeletal group (32% vs 23%), but there was no difference in accessing other information. Both chronic groups showed no difference in accessing web-based medication and lifestyle information compared with the healthy group. Confidence in using web-based health information was similar for CVD and musculoskeletal groups and lower than the healthy group (p<.001). Participants with the least confidence to use web-based health information were older (p=.016), female (p=.014), had less than university level education (p<.001), and lower health literacy (p=.001) after adjusting for age, gender, education, English proficiency, employment status, social support, health literacy, and number of chronic conditions. Conclusions There is a strong potential to provide web-based medication and lifestyle information for Chinese immigrants with CVD if support is provided to improve confidence in this technology for older, women, and those with less education and/or health literacy.
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Bailey, Jacqueline M., Tim W. Regan, Kate M. Bartlem, John H. Wiggers, Paula M. Wye, and Jenny A. Bowman. "A survey of the prevalence of modifiable health risk behaviours among carers of people with a mental illness." BMC Public Health 19, no. 1 (September 9, 2019). http://dx.doi.org/10.1186/s12889-019-7577-4.
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Abstract Background Family carers provide significant support to people with a mental illness; yet may experience poor mental and physical health themselves. Among limited research addressing the physical health of carers, studies of carers of people with dementia and young people with psychosis suggest increased risk of chronic diseases in conjunction with higher levels of potentially modifiable lifestyle risk behaviours. This exploratory study, conducted with carers of people with various mental illnesses, aimed to determine: carer prevalence of health risk behaviours (inadequate fruit and vegetable consumption, inadequate physical activity, harmful alcohol consumption, and tobacco smoking); interest in changing ‘at risk’ behaviours; and potential associations of socio-demographic characteristics with risk status and interest in change. Methods A cross-sectional survey was conducted among family carers of people with a mental illness (N = 144) residing in New South Wales, Australia. Analyses explored risk behaviour prevalence and interest in change, and associations with socio-demographic variables. Results Inadequate fruit and vegetable consumption was most prevalent (74.8%), followed by engaging in inadequate amounts of physical activity (57.6%); harmful alcohol consumption (36.3%) and smoking (11.8%). The majority of carers were interested in improving ‘at risk’ behaviours (56.3–89.2%), with the exception of alcohol consumption (41.5%). Previously or never married participants were more likely to consume inadequate amounts of fruits and/or vegetables compared to those married or cohabiting (Odds Ratio [OR]: 4.1, 95% Confidence Interval [CI]: 1.3–12.9, p = .02). Carers in the workforce were more likely to be engaging in inadequate physical activity (OR: 2.6, 95% CI: 1.2–5.7, p = .02); and male participants were more likely to engage in harmful alcohol consumption (OR: 2.9, 95% CI: 1.1–7.9, p = .03). Working carers were approximately five times more likely to report interest in improving their alcohol consumption (OR: 5.1, 95% CI: 1.3–20.5, p = .02) compared to those not currently in the workforce. Conclusions Results suggest high engagement in health risk behaviours among carers of people with a mental illness, particularly with regards to harmful alcohol consumption. Findings suggest a need to develop and implement chronic disease prevention strategies. Further research with larger representative samples is needed to confirm findings.
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"O83: COMPASS – MANAGEMENT OF COMPLICATED INTRA-ABDOMINAL COLLECTIONS AFTER COLORECTAL SURGERY, A EUROSURG COLLABORATIVE INTERNATIONAL STUDY." British Journal of Surgery 108, Supplement_1 (March 1, 2021). http://dx.doi.org/10.1093/bjs/znab117.083.
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Abstract Presenting Author Email: ruthblancocolino@gmail.com Research question To explore current practices on the use of prophylactic postoperative drains in colorectal surgery and whether it influences 30-day postoperative outcomes. Background and aim Traditionally, postoperative drains have been used in colorectal surgery for the prevention or early detection of intraabdominal collections. However, current evidence suggests there is no clear clinical benefit to prophylactic drain placement following colorectal surgery, and Enhanced Recovery After Surgery (ERAS) guidelines recommend against their routine use. Nevertheless, a previous international audit by Eurosurg (Ileus Management International) found more than a third of participating centres routinely placed a drain in more than half of their patients. Therefore, this study aims to audit compliance to ERAS guidelines regarding the use of postoperative drains in colorectal surgery. Design Patients Adult patients undergoing elective and emergency colorectal surgery will be included. Procedures under any surgical approach including any formation of colostomy or ileostomy, resection of large bowel, or reversal of stoma will be eligible. Patients undergoing appendicectomy, transanal surgery, primarily urological, gynaecological or vascular procedure, surgery involving multivisceral resection, diagnostic laparotomy or laparoscopy or hernia surgery without colorectal resection, will be excluded. Comparator Group of patients receiving a prophylactic drain after surgery. Main explanatory variable will be intrabdominal collections rate including anastomotic leak. Outcomes The primary outcome measure will be the adherence to selected ERAS guidelines regarding rate of routine prophylactic drain insertion in colorectal surgery. As Secondary outcome measures we will assess: • Rate of intra-abdominal postoperative collections, defined as collections which alter the normal postoperative course (e.g. requiring either medical, radiological, endoscopic or surgical intervention). • Time-to-diagnosis (days) of intra-abdominal postoperative collections defined as collections which alter the normal postoperative course. • Rate of drain-related complications defined as: surgical site infection by Centers for Disease Control and Prevention definition; cutaneous irritation at the drain insertion site; small bowel evisceration and herniation of omentum, bowel injury (defined as intraoperative identification of or CT-proven drain-related iatrogenic bowel perforation); time (measured in whole days) until drain removal and drain output (quantity and contents) on day of removal; and overall 30-day adverse event rate as defined by the Clavien-Dindo scale of postoperative complications and length of stay (days). Study design This is a prospective, multicentre, audit that will be conducted through the student- and trainee-led EuroSurg collaborative network across Europe, South Africa and Australasia. Data will be collected on consecutive 14-day periods, from 3rd February to 26th April 2020, with 30-day follow-up on included patients. Data will be collected online on REDCap database based on Birmingham University. Team and infrastructure The study will be run by the European Student Research Collaborative. EuroSurg is a pan-European student- and trainee-led surgical which also counts with international collaboration from Australia, New Zealand and South Africa. The study will be coordinated by the International Study Management Group and at each participating country, there will be a core of national leads or national collaborative in charge of organising the study locally. Each hospital will count with a Local Lead who will coordinate the mini-teams based at their centre and will be in contact with its corresponding National Leads. A mini-team will be composed by three collaborators collecting data and a supervising consultant per centre. As infrastructure for leading the project, we will use social media for study diffusion including Twitter, Facebook, Instagram and LinkedIn, and emails through Gmail official account and Mailchimp. Management group communications will be held through WhatsApp, Slack and Skype.
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Ding, H., M. Gonzalez-Garcia, M. Varnfield, A. Krumins, Y. Martin, F. Bourke, L. Gilroy, L. Collins, and M. Karunanithi. "P6215Limited functional capacity and physical activity associated with patient withdrawals from cardiac rehabilitation." European Heart Journal 40, Supplement_1 (October 1, 2019). http://dx.doi.org/10.1093/eurheartj/ehz746.0820.
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Abstract Background Cardiac rehabilitation (CR) assists patients with cardiovascular disease (CVD) in improving physical activity and effectively managing their health conditions. With numerous clinical benefits including reduced risks of mortality (by 25%) and all-cause hospitalizations (by 18% - 25%), CR has been strongly recommended by evidence-based clinical guidelines for secondary prevention of CVD. However, many CR participant withdraw and hence fail to fully benefit from their CR programme. To address this issue, knowledge on risk stratification of patients' characteristics to appropriate CR care pathways is important. Purpose The purpose of this study is to identify clinical baseline characteristics associated with patients who withdraw from a CR programme. Methods We retrospectively analysed patients who participated in the centre-based CR programmes of a research study in Queensland, Australia. The CR programmes provided structured sessions (training and education) once or twice a week for six weeks in community care centres. We compared the patients who withdrew from their CR programme (Group-W) with those who did not withdraw (or simply completion) (Group-C). Withdrawal was defined as discontinuing within the first four weeks of the CR programme. In the comparison, the one-way analysis of variance (ANOVA) and Fisher's exact test were used for analysing age and sex respectively. The analysis of covariance (ANCOVA) with an adjustment for age and sex was used for the body mass index (BMI), six-minute walk test (6WMT), and health-related quality of life (HeartQoL, ESC 2012), comprising physical (HeartQoL-Phy), emotional (HeartQoL-Emo), and global (HeartQoL-Glo) subscales. The study was approved by the Human Research Ethics Committee (Reference: HREC/16/QPAH/636). Results From Dec 2016 to Dec 2017, 600 outpatients with CVD were consented, and enrolled in the study. Seventy participants withdrew. Between the two groups (Group-W vs Group-C), no significant differences were found in age (64±12 years vs 65±10 years; p=0.4221), sex (Female, 31% vs 25%; p=0.2461) and BMI (30.5±6.2 vs 30.1±11.2; p=0.8211). The 6MWT distance was significantly lower in Group-W than Group-C (346±103 m vs 394±92 m; p=0.001). Significantly lower scores of HeartQoL-Phy (1.66±0.86 vs 1.93±0.74; p=0.0072) and HeartQoL-Glo scores (1.80±0.78 vs 2.02±0.67; p=0.0205) were found in Group-W. HeartQoL-Emo scores were lower in Group-W but the difference was not significant (2.19±0.73 vs 2.28±0.72; p=0.4550). Conclusions The levels of functional capacity measured by 6MWT and physical activity related quality of life were found to be significantly lower in withdrawal patients than those who completed their CR programme. The finding indicates that new care strategies, especially for patients with limited functional capacity and physical activity, are needed to improve the adherence and effectiveness of CR intervention in future studies. Acknowledgement/Funding CSIRO and Metro South Health