ORCID Profile
0000-0001-9941-7161
Current Organisation
University of Tasmania
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2022
DOI: 10.1161/CIRCGEN.121.003429
Abstract: The use of a polygenic risk score (PRS) to improve risk prediction of coronary heart disease (CHD) events has been demonstrated to have clinical utility in the general adult population. However, the prognostic value of a PRS for CHD has not been examined specifically in older populations of in iduals aged ≥70 years, who comprise a distinct high-risk subgroup. The objective of this study was to evaluate the predictive value of a PRS for incident CHD events in a prospective cohort of older in iduals without a history of cardiovascular events. We used data from 12 792 genotyped, healthy older in iduals enrolled into the ASPREE trial (Aspirin in Reducing Events in the Elderly), a randomized double-blind placebo-controlled clinical trial investigating the effect of daily 100 mg aspirin on disability-free survival. Participants had no previous history of diagnosed atherothrombotic cardiovascular events, dementia, or persistent physical disability at enrollment. We calculated a PRS (meta-genomic risk score) consisting of 1.7 million genetic variants. The primary outcome was a composite of incident myocardial infarction or CHD death over 5 years. At baseline, the median population age was 73.9 years, and 54.9% were female. In total, 254 incident CHD events occurred. When the PRS was added to conventional risk factors, it was independently associated with CHD (hazard ratio, 1.24 [95% CI, 1.08–1.42], P =0.002). The area under the curve of the conventional model was 70.53 (95% CI, 67.00–74.06), and after inclusion of the PRS increased to 71.78 (95% CI, 68.32–75.24, P =0.019), demonstrating improved prediction. Reclassification was also improved, as the continuous net reclassification index after adding PRS to the conventional model was 0.25 (95% CI, 0.15–0.28). A PRS for CHD performs well in older people and improves prediction over conventional cardiovascular risk factors. Our study provides evidence that genomic risk prediction for CHD has clinical utility in in iduals aged 70 years and older. URL: www.clinicaltrials.gov Unique identifier: NCT01038583
Publisher: American College of Physicians
Date: 05-0060
DOI: 10.7326/M21-3823
Publisher: JMIR Publications Inc.
Date: 24-01-2022
DOI: 10.2196/34369
Abstract: The model of trauma in Vietnam has changed significantly over the last decade and requires reforming medical education to deal with new circumstances. Our aim is to evaluate this transition regarding the new target by analyzing trauma and the medical training system as a whole. This study aimed to establish if medical training in the developing country of Vietnam has adapted to the new disease pattern of road trauma emerging in its economy. A review was performed of Vietnamese medical school, Ministry of Health, and Ministry of Education and Training literature on trauma education. The review process and final review paper were prepared following the guidelines on scoping reviews and using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The current trauma training at the undergraduate level is minimal and involves less than 5% of the total credit. At the postgraduate level, only the specialties of surgery and anesthesia have a significant and increasing trauma training component ranging from 8% to 22% in the content. Trauma training, which focuses on practical skills, accounts for 31% and 32% of the training time of orientation courses for young doctors in “basic surgery” and “basic anesthesia,” respectively. Other relevant short course trainings, such as continuing medical education, in trauma are available, but they vary in topics, facilitators, participants, and formats. Medical training in Vietnam has not adapted to the new emerging disease pattern of road trauma. In the interim, the implementation of short courses, such as basic trauma life support and primary trauma care, can be considered as an appropriate method to compensate for the insufficient competency-related trauma care among health care workers while waiting for the effectiveness of medical training reformation.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.ORCP.2018.07.003
Abstract: General practitioners (GPs) can positively impact upon patient intentions to lose weight and weight management, and are important in the referral pathway to specialist weight-loss programs and surgical interventions. The aim of this study was to investigate the characteristics and proportions of Australians who report talking to a GP about weight management. Cross-sectional data from 15,329 participants aged 15 years and over in the 2014-15 Australian National Health Survey were used. Proportions (with 95% confidence intervals (95%CI)) of respondents who reported discussing reaching a healthy weight with a GP in the previous 12 months were estimated, categorised by demographic, social and health characteristics. We found that 10.8% (95%CI:9.8-11.8) of overweight participants, 24.4% (95%CI:22.7-26.4) with Class 1 obesity (30≤BMI <35kg/m While discussions are more likely with increasing BMI and comorbidities, most Australians with overweight and obesity appear to be missing opportunities to discuss reaching a healthy weight with their GP. Policies, training and education programs to encourage this dialogue could lead to earlier and more beneficial weight-related interventions.
Publisher: Cold Spring Harbor Laboratory
Date: 06-09-2023
Publisher: S. Karger AG
Date: 2020
DOI: 10.1159/000506646
Abstract: b i Background: /i /b Blood collection and blood pressure (BP) measurements are routinely performed during the same consultation to assess absolute cardiovascular disease (CVD) risk. This study aimed to determine the effect of blood collection on BP and subsequent calculation of the absolute CVD risk. b i Methods: /i /b Forty-five participants aged 58 ± 9 years (53% male) had systolic BP (SBP) measured using clinical guideline methods (clinic SBP). Then, on a separate visit, BP was measured immediately before, during, and after blood collection. Absolute CVD risk scores were calculated (Framingham equation) using SBP from each measurement condition and compared. b i Results: /i /b The prevalence of low (& #x3c %), moderate (10–15%), and high (≥15%) absolute CVD risks among the participants was 67%, 22%, and 11%, respectively, using clinic SBP. SBP values before and during blood collection were significantly higher compared to values after blood collection (130 ± 18 and 132 ± 19 vs. 126 ± 18 mm Hg i /i = 0.010 and i /i = 0.003, respectively). However, there were no significant differences between clinic SBP (128 ± 18 mm Hg) and blood collection SBP ( i /i = 0.99) or the absolute CVD risk scores (7.3 ± 6.5 7.6 ± 5.9 7.7 ± 6.1 and 7.1 ± 5.7%, respectively i /i = 0.995 for all). The mean intraclass correlation (95% CI) indicated good agreement between absolute CVD risk scores calculated with clinic SBP and each blood collection SBP (0.86 [95% CI 0.74–0.92], 0.85 [95% CI 0.71–0.91], and 0.87 [95% CI 0.76–0.93], respectively i /i & #x3c 0.001, for all). b i Conclusion: /i /b Absolute CVD risk calculation is not affected by use of SBP measurements recorded at the time of blood collection. Therefore, it is acceptable to collect blood and measure BP during the same consultation for absolute CVD risk assessment.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 25-10-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2023
DOI: 10.1161/HYPERTENSIONAHA.122.19883
Abstract: Real-world evidence is limited on whether antihypertensive medications help avert major adverse cardiovascular events (MACE) after stroke without increasing the risk of falls. We investigated the association of adherence to antihypertensive medications on the incidence of MACE and falls requiring hospitalization after stroke. A retrospective cohort study of adults who were newly dispensed antihypertensive medications after an acute stroke (Australian Stroke Clinical Registry 2012–2016 Queensland and Victoria). Pharmaceutical dispensing records were used to determine medication adherence according to the proportion of days covered in the first 6 months poststroke. Outcomes between 6 and 18 months postdischarge included: (i) MACE, a composite outcome of all-cause death, recurrent stroke or acute coronary syndrome and (ii) falls requiring hospitalization. Estimates were derived using Cox models, adjusted for confounders using inverse probability treatment weights. Among 4076 eligible participants (median age 68 years 37% women), 55% had a proportion of days covered ≥80% within 6 months postdischarge. In the subsequent 12 months, 360 (9%) participants experienced a MACE and 337 (8%) experienced a fall requiring hospitalization. After achieving balance between groups, participants with a proportion of days covered ≥80% had a reduced risk of MACE (hazard ratio: 0.68 95% CI: 0.54–0.84) and falls requiring hospitalization (subdistribution hazard ratio: 0.78 95% CI: 0.62–0.98) than those with a proportion of days covered %. High adherence to antihypertensive medications within 6 months poststroke was associated with reduced risks of both MACE and falls requiring hospitalization. Patients should be encouraged to adhere to their antihypertensive medications to maximize poststroke outcomes.
Publisher: JMIR Publications Inc.
Date: 05-04-2023
Abstract: he Primary Trauma Care (PTC) course was originally developed to instruct healthcare workers in the management of the severely injured patients in low and middle income countries with limited medical resources. The PTC has now been taught for more than 25 years. Many studies have demonstrated that the two-day Primary Trauma Care (PTC) workshop is a useful and informative to front-line health staff and has helped improve knowledge and confidence in trauma management but there is little evidence showing that it leads to changes in clinical practice. The Kirkpatrick (KM) and Knowledge Attitude Practice (KAP) models are effective methods to evaluate this approach. Our study aimed to combine 2 models to evaluate the impact of the PTC program for healthcare staff in two Vietnamese hospitals. o investigate how the “2 day PTC course” impacts on the level of clinical practice in healthcare staff in the emergency departments of two Vietnamese provincial hospitals. e conducted the PTC course over 2 days in the emergency departments (ED) of Thanh Hoa and Ninh Binh hospitals in February and March 2022 respectively. Sequential cross-sectional surveys using validated instruments were conducted immediately pre- and post-course and at 6 months after course delivery. The questionnaires were analysed by simple frequency analysis. t level 1 of KM, nearly 100 % participant were satisfied with the course. At level 2 (knowledge), the multiple-choice question (MCQ) and confident matrix (CM) improved significantly from 60% to 77% and 59.3% to 71.3% respectively (p .01), these improvements were seen in both nurse and doctor subgroups. The focus of Level 3 was on practice and saw a significant incremental change with scenarios checklist (SC) points jumping from 5.9 1.9 to 9.0 0.9 and bedside clinical checklist (BCC) points increased from 5 1.5 to 8.3 0.8 (p .01). At 6-months follow up, MCQ, CM and SC all remained unchanged (p .05) except MCQ score in the nurse subgroup (p .01). he PTC course undertaken in 2 local hospitals of Vietnam was successful in improving 3 levels of KM for ED healthcare staff. This improvement was maintained for at least 6 months post course. The PTC courses are effective in providing improvement and sustainment in 3 Levels for low- and middle-income countries like Vietnam. he trial is registered in ANZCTR with trial ID is ACTRN12621000371897.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-07-2021
Abstract: Blood pressure variability (BPV) in midlife increases risk of late‐life dementia, but the impact of BPV on the cognition of adults who have already reached older ages free of major cognitive deficits is unknown. We examined the risk of incident dementia and cognitive decline associated with long‐term, visit‐to‐visit BPV in a post hoc analysis of the ASPREE (Aspirin in Reducing Events in the Elderly) trial. ASPREE participants (N=19 114) were free of dementia and significant cognitive impairment at enrollment. Measurement of BP and administration of a standardized cognitive battery evaluating global cognition, delayed episodic memory, verbal fluency, and processing speed and attention occurred at baseline and follow‐up visits. Time‐to‐event analysis using Cox proportional hazards regression models were used to calculate hazard ratios (HR) and corresponding 95% CI for incident dementia and cognitive decline, according to tertile of SD of systolic BPV. In iduals in the highest BPV tertile compared with the lowest had an increased risk of incident dementia and cognitive decline, independent of average BP and use of antihypertensive drugs. There was evidence that sex modified the association with incident dementia (interaction P =0.02), with increased risk in men (HR, 1.68 95% CI, 1.19–2.39) but not women (HR, 1.01 95% CI, 0.72–1.42). For cognitive decline, similar increased risks were observed for men and women (interaction P =0.15 men: HR, 1.36 95% CI, 1.16–1.59 women: HR, 1.14 95% CI, 0.98–1.32). High BPV in older adults without major cognitive impairment, particularly men, is associated with increased risks of dementia and cognitive decline. URL: www.clinicaltrials.gov Unique identifier: NCT01038583 isrctn.com . Identifier: ISRCTN83772183.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2023
DOI: 10.1161/STROKEAHA.122.041355
Abstract: Untreated poststroke mood problems may influence long-term outcomes. We aimed to investigate factors associated with receiving mental health treatment following stroke and impacts on long-term outcomes. Observational cohort study derived from the Australian Stroke Clinical Registry (AuSCR Queensland and Victorian registrants: 2012–2016) linked with hospital, primary care billing and pharmaceutical dispensing claims data. Data from registrants who completed the AuSCR 3 to 6 month follow-up survey containing a question on anxiety/depression were analyzed. We assessed exposures at 6 to 18 months and outcomes at 18 to 30 months. Factors associated with receiving treatment were determined using staged multivariable multilevel logistic regression models. Cox proportional hazards regression models were used to assess the impact of treatment on outcomes. Among 7214 eligible in iduals, 39% reported anxiety/depression at 3 to 6 months following stroke. Of these, 54% received treatment (88% antidepressant medication). Notable factors associated with any mental health treatment receipt included prestroke psychological support (odds ratio [OR], 1.80 [95% CI, 1.37–2.38]) or medication (OR, 17.58 [95% CI, 15.05–20.55]), self-reported anxiety/depression (OR, 2.55 [95% CI, 2.24–2.90]), younger age (OR, 0.98 [95% CI, 0.97–0.98]), and being female (OR, 1.30 [95% CI, 1.13–1.48]). Those who required interpreter services (OR, 0.49 [95% CI, 0.25–0.95]) used a health benefits card (OR, 0.73 [95% CI, 0.59–0.92]) or had continuity of primary care visits (ie, with a consistent physician OR, 0.78 [95% CI, 0.62–0.99]) were less likely to access mental health services. Among those who reported anxiety/depression, those who received mental health treatment had an increased risk of presenting to hospital (hazard ratio, 1.06 [95% CI, 1.01–1.11]) but no difference in survival (hazard ratio, 0.86 [95% CI, 0.58–1.27]). Nearly half of the people living with mood problems following stroke did not receive mental health treatment. We have highlighted subgroups who may benefit from targeted mood screening and factors that may improve treatment access.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 25-07-2023
Publisher: JMIR Publications Inc.
Date: 20-10-2021
Abstract: he model of trauma in Vietnam has changed significantly over the last decade and requires reforming medical education to deal with new circumstances. Our aim is to evaluate this transition regarding the new target by analyzing trauma and the medical training system as a whole. his study aimed to establish if medical training in the developing country of Vietnam has adapted to the new disease pattern of road trauma emerging in its economy. review was performed of Vietnamese medical school, Ministry of Health, and Ministry of Education and Training literature on trauma education. The review process and final review paper were prepared following the guidelines on scoping reviews and using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. he current trauma training at the undergraduate level is minimal and involves less than 5% of the total credit. At the postgraduate level, only the specialties of surgery and anesthesia have a significant and increasing trauma training component ranging from 8% to 22% in the content. Trauma training, which focuses on practical skills, accounts for 31% and 32% of the training time of orientation courses for young doctors in “basic surgery” and “basic anesthesia,” respectively. Other relevant short course trainings, such as continuing medical education, in trauma are available, but they vary in topics, facilitators, participants, and formats. edical training in Vietnam has not adapted to the new emerging disease pattern of road trauma. In the interim, the implementation of short courses, such as basic trauma life support and primary trauma care, can be considered as an appropriate method to compensate for the insufficient competency-related trauma care among health care workers while waiting for the effectiveness of medical training reformation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2021
DOI: 10.1161/STROKEAHA.120.033670
Abstract: Polygenic risk scores (PRSs) can be used to predict ischemic stroke (IS). However, further validation of PRS performance is required in independent populations, particularly older adults in whom the majority of strokes occur. We predicted risk of incident IS events in a population of 12 792 healthy older in iduals enrolled in the ASPREE trial (Aspirin in Reducing Events in the Elderly). The PRS was calculated using 3.6 million genetic variants. Participants had no previous history of cardiovascular events, dementia, or persistent physical disability at enrollment. The primary outcome was IS over 5 years, with stroke subtypes as secondary outcomes. A multivariable model including conventional risk factors was applied and reevaluated after adding PRS. Area under the curve and net reclassification were evaluated. At baseline, mean population age was 75 years. In total, 173 incident IS events occurred over a median follow-up of 4.7 years. When PRS was added to the multivariable model as a continuous variable, it was independently associated with IS (hazard ratio, 1.41 [95% CI, 1.20–1.65] per SD of the PRS P .001). The PRS alone was a better discriminator for IS events than most conventional risk factors. PRS as a categorical variable was a significant predictor in the highest tertile (hazard ratio, 1.74 P =0.004) compared with the lowest. The area under the curve of the conventional model was 66.6% (95% CI, 62.2–71.1) and after inclusion of the PRS, improved to 68.5 ([95% CI, 64.0–73.0] P =0.095). In subgroup analysis, the continuous PRS remained an independent predictor for large vessel and cardioembolic stroke subtypes but not for small vessel stroke. Reclassification was improved, as the continuous net reclassification index after adding PRS to the conventional model was 0.25 (95% CI, 0.17–0.43). PRS predicts incident IS in a healthy older population but only moderately improves prediction over conventional risk factors. URL: www.clinicaltrials.gov Unique identifier: NCT01038583.
Publisher: JMIR Publications Inc.
Date: 07-03-2017
DOI: 10.2196/RESPROT.7195
Publisher: JMIR Publications Inc.
Date: 09-2017
DOI: 10.2196/RESPROT.8362
Publisher: Elsevier BV
Date: 06-2017
Publisher: American College of Physicians
Date: 07-2023
DOI: 10.7326/M23-0675
Publisher: Wiley
Date: 13-04-2021
DOI: 10.1111/JEP.13569
Abstract: Absolute cardiovascular disease (aCVD) risk assessment is recommended in CVD prevention guidelines. Yet, General Practitioners (GPs) often focus on single risk factors, including blood pressure (BP). Pathology services may be suitable to undertake high‐quality automated unobserved BP (AOBP) measurement and aCVD risk assessment. This study explored GP attitudes towards AOBP measurement via pathology services and the role of BP in aCVD risk management. A brief survey was completed, after which a focus group (n = 8 GPs) and interviews (n = 10 GPs) explored attitudes to AOBP and aCVD risk via pathology services with an ex le pathology report discussed. Verbatim transcripts were thematically coded. GPs predominantly used doctor‐measured BP despite low levels of confidence. High BP measured by AOBP reported with aCVD risk via pathology services, would prompt a follow‐up response. However, GPs focused on BP management. GPs were concerned about AOBP equivalency to routine BP measurements. After protocol explanation, GPs reported AOBP could value‐add to care delivery. GPs lacked familiarity of AOBP and maintained a focus on BP management in the context of absolute CVD risk. Targeted education on AOBP and BP management as part of absolute CVD risk is needed to support guideline‐directed care in practice.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2022
DOI: 10.1161/STROKEAHA.122.038829
Abstract: Evidence is growing on anticancer effects of statins. We investigated whether the effectiveness of treatment with statins after ischemic stroke on mortality is influenced by a history of cancer. Analyses of 90-day survivors of ischemic stroke (2012–2016 45 hospitals) using linked registry and administrative data. Dispense of statins within 90 days postdischarge was determined from pharmaceutical records. Participants were followed from 91 days postdischarge until death or June 30, 2018. History of cancer was determined from hospital data. Propensity score–adjusted Cox proportional hazards regression model was used to determine the association between being dispensed statins and survival. The influence of history of cancer on this association was assessed based on the concepts of (1) statistical interaction and (2) biological interaction using 3 indices: relative excess risk due to interaction , attributable proportion due to interaction , or synergy index . Among 9948 eligible participants (median age=72 years, 42% female), there were 1463 deaths. In adjusted analyses, there was no statistical interaction between being dispensed statins and history of cancer on mortality ( P =0.156). However, being dispensed statins had a significant positive biological interaction with having a history of cancer on mortality: relative excess risk due to interaction, 2.80 (95% CI, 1.56–5.05), attributable proportion due to interaction, 0.45 (95% CI, 0.23–0.66), and synergy index, 2.14 (95% CI, 1.32–3.49). Treatment with statins after ischemic stroke may confer additional survival benefits for people who also have had cancer.
Publisher: JMIR Publications Inc.
Date: 06-02-2023
DOI: 10.2196/40883
Abstract: Despite significant improvement in the last decade, road trauma remains a substantial contributor to deaths in Vietnam. The COVID-19 pandemic necessitated public health measures that had an unforeseen benefit on road trauma in high-income countries. We investigate if this reduction was also seen in a low- to middle-income country like Vietnam. Our aim was to investigate how the COVID-19 pandemic and the government policies implemented in response to it impacted road trauma fatalities in Vietnam. We also compared this impact to other government policies related to road trauma implemented in the preceding 14 years (2007-2020). COVID-19 data were extracted from the Vietnamese Ministry of Health database. Road traffic deaths from 2007 to 2021 were derived from the Vietnamese General Statistical Office. We used Stata software (version 17 StataCorp) for statistical analysis. Poisson regression modeling was used to estimate trends in road fatality rates based on annual national mortality data for the 2007-2021 period. The actual change in road traffic mortality in 2021 was compared with calculated figures to demonstrate the effect of COVID-19 on road trauma fatalities. We also compared this impact to other government policies that aimed to reduce traffic-related fatalities from 2007 to 2020. Between 2007 and 2020, the number of annual road traffic deaths decreased by more than 50%, from 15.3 to 7 per 100,000 population, resulting in an average reduction of 5.4% per annum. We estimated that the road traffic mortality rate declined by 12.1% (95% CI 8.9-15.3%) in 2021 relative to this trend. The actual number of road trauma deaths fell by 16.4%. This reduction was largely seen from August to October 2021 when lockdown and social distancing measures were in force. In 2021, the road traffic–related death reduction in Vietnam was 3 times greater than the trend seen in the preceding 14 years. The public health response to the COVID-19 pandemic in Vietnam was associated with a third of this reduction. It can thus be concluded that government policies implemented to address the COVID-19 pandemic resulted in a 4.3% decrease in road traffic deaths in 2021. This has been observed in high-income countries, but we have demonstrated this for the first time in a low- and middle-income country.
Publisher: Elsevier BV
Date: 09-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2022
Publisher: Elsevier BV
Date: 12-2021
Publisher: S. Karger AG
Date: 10-11-2021
DOI: 10.1159/000520823
Abstract: b i Introduction: /i /b Treatment with several therapeutic classes of medication is recommended for secondary prevention of stroke. We analyzed the associations between the number of classes of prevention medications supplied within 90 days after discharge for ischemic stroke (IS)/transient ischemic attack (TIA) and survival. b i Methods: /i /b This is a retrospective cohort study of adults with first-ever IS/TIA (2010–2014) from the Australian Stroke Clinical Registry in idually linked with data from national pharmaceutical and Medicare claims. Exposure was the number of classes of recommended medications, i.e., blood pressure-lowering, antithrombotic, or lipid-lowering agents, supplied to patients within 90 days after discharge for IS/TIA. The longitudinal association between the number of classes of medications and survival was evaluated with Cox proportional hazards regression models using the landmark approach. A landmark date of 90 days after hospital discharge was used to separate exposure and outcome periods, and only patients who survived until this date were included. b i Results: /i /b Of 8,429 patients (43% female, median age 74 years, 80% IS), 607 (7%) died in the year following 90 days after discharge. Overall, 56% of patients were supplied all 3 classes of medications, 28% 2 classes of medications, 11% 1 class of medications, and 5% no class of medications. Compared to patients supplied all 3 medication classes, adjusted hazard ratios for all-cause mortality ranged from 1.43 (95% confidence interval [CI]: 1.18–1.72) in those supplied 2 medication classes to 2.04 (95% CI: 1.44–2.88) in those supplied with no medication class. b i Discussion/Conclusion: /i /b Treatment with all 3 classes of guideline-recommended medications within 90 days after discharge was associated with better survival. Ongoing efforts are required to ensure optimal pharmacological intervention for secondary prevention of stroke.
No related grants have been discovered for Mark Nelson.