ORCID Profile
0000-0001-5172-3004
Current Organisation
University of Sydney School of Public Health
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Publisher: Springer Science and Business Media LLC
Date: 06-2004
Publisher: Elsevier BV
Date: 11-2005
DOI: 10.1016/J.JOCN.2005.03.016
Abstract: Most primary brain cancers are associated with a dismal prognosis because of their aggressive behaviour and high mortality. Surgical resection with adjuvant radiotherapy is a major treatment for these cancers but little has been published about their surgical management in Australia. To determine changes since 1977 in demographic characteristics, tumour frequencies, surgical management, morbidity and survival for 1,339 patients discharged with astrocytoma (A) and oligodendroglioma (O), which comprise the majority of primary brain cancers, recorded prospectively in northern Sydney neurosurgery databases. Discharges were grouped into eras reflecting changes in diagnostic and surgical technology. Between eras 1977-79 and 1999-2002, mean age increased by 9.5 years, and inpatient stay fell from 21 to 9 days. The proportion of O rose as A fell. Of 144 re-biopsies, 16% had less anaplastic pathology, 54% the same and 30% more anaplastic pathology than the first biopsy. Stereotactically assisted surgery increased, with overall rates of burr hole for biopsy decreasing and of craniotomy rising. Between 1980-86 and 1999-2002, inpatient mortality declined from 7.3 to 2.3% of discharges, reopening of craniotomy and wound complication rates fell, while postoperative neurological deficit rose. Deep vein thrombosis and pulmonary embolism rates for discharges increased significantly. Age and histopathologic grade were predictors of survival from 1980. Sex and era of diagnosis did not influence survival. After adjustment for age using proportional hazards regression, survival improved only for anaplastic A, with a 60% improvement for patients diagnosed in era 3, and a 50% improvement for patients diagnosed in era 4 relative to those in era 1. Although markers of inpatient care have improved since the 1980s, age-adjusted survival has not increased except for patients with anaplastic A.
Publisher: Wiley
Date: 02-2006
DOI: 10.1359/JBMR.051014
Publisher: Informa UK Limited
Date: 28-01-2013
DOI: 10.3109/10428194.2013.763396
Abstract: This population registry-based study followed all cases of myeloma diagnosed in New South Wales, Australia, during 2002-2005 and compared survival outcomes of those who proceeded to autologous hematopoietic cell transplant (HCT) with those who did not. Data available consisted of demographic details and survival, and did not include disease details or treatment type or response. Of 708 patients, 270 (38%) had a HCT. The 5-year overall survival (OS) of HCT recipients was significantly better than for those who did not proceed to HCT (62% vs. 54%, p = 0.003). HCT was a significant favorable risk factor for OS, while age over 60 was an adverse risk factor. However, for patients alive at 1 year from diagnosis, there was no significant difference in survival between HCT and non-HCT patients, suggesting that worse disease biology and/or coexisting morbidities were likely to be major reasons for the poorer outcome for non-HCT patients.
Publisher: Wiley
Date: 04-2010
DOI: 10.1359/JBMR.091029
Abstract: An increasing risk of death after hip fracture has been well documented, but the duration and causes remain unclear, especially in very frail older people. This is a nested case-control study of 229 hip fracture cases and 229 controls matched by age, gender, institution type, and follow-up period from a cohort of 2005 institutionalized older people. The residents were assessed at baseline and followed up for hip fracture and death for at least 5 years. Time to death was measured from the same time for each case (time of the hip fracture) and the matched control. The study s le consisted of 90 males and 368 females with a mean age of 86 years (range 67 to 102 years). The hazard ratio (HR) of death for the cases compared with the controls was 3.09 [95% confidence interval (CI) 1.83-5.22, p < .001] for the first 3 months, 1.99 (95% CI 1.13-3.51, p = .02) for the period of 3 to 9 months, and 0.88 (95% CI 0.64-1.22, p = .46) for the period beyond 9 months following a fracture, after adjusting for age, gender, institution type, weight, immobility, cognitive function, comorbidities, and number of medications. The main causes of the excess mortality in the first 9 months were infections (HR = 6.66, 95% CI 1.95-22.77, p = .002) for females and cardiac disease (HR = 2.68, 95% CI 1.39-5.15, p = .003) for both males and females. Bisphosphonate use was associated with a reduction in mortality after hip fracture (p = .002). Intensive medical supervision to reduce cardiovascular and infective complications should be provided for frail older people with recent hip fracture to reduce mortality.
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/SH14122
Abstract: Background The aim of this study is to describe homosexual experience and characteristics of recent homosexual encounters among Australian adults and identify changes between 2001–02 and 2012–13. Methods: Computer-assisted telephone interviews were completed by a representative s le of 20 094 men and women aged 16–69 years and the participation rate among eligible people was 66.2%. Respondents indicated the number of same-sex partners they had had in their lifetime and in the last 12 months. Those who reported any homosexual experience were asked the age at which this first occurred and about characteristics of the first and most recent homosexual encounter. Results: Reporting ever having same-sex experience was more common in women (13.5%) than in men (6.5%, P 0.001). Among these people, men reported more lifetime and recent same-sex partners than women (P 0.001). Same-sex experience was associated with some but not all indices of higher socioeconomic status. In men, it was associated with living in a major city (P = 0.02) and in women, it was associated with younger ( years) age and with very low income (P 0.001). Men were younger than women at their first homosexual encounter (P = 0.005). Women were more likely than men to have their first same-sex encounter with a regular partner. For women but not men, there was a significant increase in the proportion reporting same-sex experience since 2001–02. Conclusion: Same-sex experience is not uncommon and is increasing in prevalence in young Australian women. The high number of same-sex partners among homosexual and bisexual men places them at greater risk of sexually transmissible infection.
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/SH14121
Abstract: Background Sexually transmissible infections (STIs) present a substantial public health burden, and are related to modifiable sexual behaviours. Methods: Computer-assisted telephone interviews were completed by a population-representative s le of 20 094 men and women aged 16–69 years. The overall participation rate among eligible people was 66.2%. Respondents were asked questions regarding their knowledge about, self-reported history of, and testing for STIs. Results: STI knowledge was better in women, the young, people of higher socioeconomic status, those with a variety of indicators of being at high STI risk and those with a history of receiving sex education in school. Approximately one in six men and women reported a lifetime history of an STI. A history of STI testing in the last year was reported by ~one in six (17%) women and one in eight men (13%) and higher rates of testing in women were reported in most high-risk groups. The highest rates of STI testing (61%) and HIV testing (89%) were reported in homosexual men. Conclusion: Knowledge of STI-related health consequences and transmission is improving in Australians, and rates of STI testing were relatively high but were higher in women than in men. Further increases in testing rates in both sexes will be required to facilitate the early diagnosis and treatment of STIs, which is a cornerstone of STI control.
Publisher: SAGE Publications
Date: 09-2004
DOI: 10.1080/J.1440-1614.2004.01446.X
Abstract: Objective: There are suggestions of a secular increase in the prevalence of depression, self-harm and suicidal behaviour in young people. This study aims to examine changes in prevalence of psychological disturbance over time in adolescents referred for treatment. Method: Data on the type and severity of emotional and behavioural problems was measured using the Youth Self-Report and Child Behaviour Checklist in 4495 clinic-referred adolescents aged 12–17 years, born in a 21-year period (1966–1986). Results: After taking into account the confounding effects of age and gender, there were significant increases in reports of self-harm and suicidal ideation (5% and 4% increase in odds per year, respectively) according to parents, but there was no change in parental ratings of depression (anxious/depressed scale). There were no changes in ratings of self-harm, suicidal ideation or anxiety/depression when adolescent reports were considered. The mean age at the time of referral decreased with increasing year of birth, from 14.6 years in those born in 1966–1971, to 13.1 years in those born in 1981–1986. Conclusions: Parents of referred adolescents reported increasing self-harm and suicidal behaviour with increasing year of birth. In contrast, there were no changes over time in the adolescents' reports. Neither parents nor children reported an increase in depressive symptoms. Perceptions of a secular increase may reflect increasing parental awareness of some behaviours, particularly self-harm and suicidal ideation. Interpretation of these results needs to be cautious given the clinical origin of the s le.
Publisher: American Medical Association (AMA)
Date: 05-2003
Publisher: Elsevier BV
Date: 11-2004
DOI: 10.1016/J.OPHTHA.2004.05.025
Abstract: To determine whether an intravitreal injection of triamcinolone acetonide for persistent diabetic macular edema after adequate laser treatment improves visual acuity. Prospective, double-masked, placebo-controlled, randomized clinical trial. Sixty-nine eyes of 43 patients were entered into the study, with 34 eyes randomized to receive active treatment and 35 randomized to receive a placebo injection. Sixty-five of 69 eyes (94%) completed the 3-month study visit. Using a 27-gauge needle, 0.1 ml of triamcinolone acetonide was injected through the pars plana. The procedure was performed in a minor procedures area in the outpatient clinic under sterile conditions and using topical and subconjunctival anesthesia. Eyes randomized to placebo received a subconjunctival saline injection using the identical procedure for preparation. The main outcome measures were improvement of best-corrected logarithm of the minimum angle of resolution visual acuity by 5 or more letters and incidence of moderate or severe adverse events. Eighteen of 33 eyes (55%) treated with triamcinolone gained 5 or more letters of best-corrected visual acuity compared with 5 of 32 eyes (16%) treated with placebo (P = 0.002). Macular edema was reduced by 1 or more grades as determined by masked semiquantitative contact lens examination in 25 of 33 treated eyes (75%) versus 5 of 32 untreated eyes (16% P<0.0001). Optical coherence tomography showed a mean reduction of central retinal thickness of 152 mum in the 21 treated eyes that were examined compared with a reduction of 36 mum in 20 placebo-treated eyes. Infectious endophthalmitis developed in 1 triamcinolone-treated eye that was treated adequately without loss of visual acuity. In the short term, intravitreal triamcinolone is an effective and relatively safe treatment for eyes with diabetic macular edema that have failed laser treatment. Although it will be essential to study longer-term outcomes, the use of intravitreal triamcinolone may be considered in 1 eye of patients who continue to lose vision from diabetic macular edema despite conventional management.
Publisher: Elsevier BV
Date: 03-2009
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.YPMED.2013.02.007
Abstract: To explore the effects of an innovative school-based intervention for increasing physical activity. 226 children (5-7 years old) randomly selected from 12 Australian primary schools were recruited to a cluster randomised trial with schools randomly allocated to intervention or control conditions. The 13-week intervention comprised: (1) altering the school playground by introducing loose materials and (2) a teacher-parent intervention exploring perceptions of risk associated with children's free play. The primary outcomes were total accelerometer counts and moderate-vigorous physical activity during break times. Testing took place in Sydney, 2009-2010. 221 participants were tested at baseline. Mixed-effect multilevel regression revealed a small but significant increase from the intervention on total counts (9400 counts, 95% CI 3.5-15.2, p=0.002) and minutes of MVPA (1.8 min, 95% CI 0.5-3.1, p=0.006) and a decrease in sedentary activity (2.1 min, 95% CI 0.5-3.8, p=0.01) during break times. We retested children in one intervention school after 2 years they maintained the gains. Capturing children's intrinsic motivations to play while simultaneously helping adults reconsider views of free play as risky provided increases in physical activity during break times. Using accelerometry as the sole measure of physical activity may underestimate the effect. ACTRN12611000089932.
Publisher: Wiley
Date: 20-01-2011
DOI: 10.1002/JBMR.216
Abstract: This study aims to investigate the risk of subsequent fractures after low-trauma fracture in frail older people. A total of 1412 elderly residents (mean age 86.2 years, SD 7.0 years, female 77%) were recruited from aged care facilities in Australia. Residents were assessed and then followed for any fracture for 2 years and hip fractures for at least 5 years. Residents with and without a newly acquired fracture in the first 2 years were compared for risk of subsequent hip fracture. Residents with a nonhip fracture in the first 2 years had an increased risk of subsequent hip fracture for about 2.5 years, whereas those with a hip fracture had a similar risk over the whole period compared with those with no fracture. During these 2.5 years, 60, 28, and 6 subsequent hip fractures occurred in the nonfracture group (n = 953), the nonhip fracture group (n = 194), and the hip fracture group (n = 101), respectively, resulting in the probability of subsequent hip fracture of 8.0%, 19.9%, and 10.4%, respectively. Compared with the nonfracture group, the hazard ratio (HR) was 2.82 [95% confidence interval (CI) 1.73-4.59 p < .001] for the nonhip fracture group and 1.48 (95% CI 0.63-3.49, p = .37) for the hip fracture group after adjusting for age, sex, residence type, calcaneal broadband ultrasound attenuation, fracture history, weight, lower leg length, immobility, cognitive function, and medications. Frail institutionalized older people with newly acquired fractures are at increased risk of subsequent hip fracture for the next few years. Accordingly, despite their advanced age, they are a high-priority target group to investigate interventions that might reduce the risk of hip fracture.
Publisher: Springer Science and Business Media LLC
Date: 10-05-2007
Publisher: BMJ
Date: 03-09-2014
Publisher: Elsevier BV
Date: 09-2006
DOI: 10.1016/J.OPHTHA.2006.02.065
Abstract: To report 2-year safety and efficacy outcomes from a trial of intravitreal triamcinolone acetonide (TA) injections (4 mg) in eyes with diabetic macular edema and impaired vision that persisted or recurred after laser treatment. Prospective, double-masked, placebo-controlled, randomized clinical trial. Sixty-nine eyes of 43 patients were entered into the study, with 34 eyes randomized to receive active treatment and 35 placebo. Two-year data were available for 60 of 69 (87%) eyes of 35 of 41 (85%) patients 9 eyes of 6 patients were lost to follow-up, of which 6 received a placebo and 3 received intravitreal TA. Triamcinolone acetonide (0.1 ml) was injected through the pars plana using a 27-gauge needle. Eyes randomized to placebo received a subconjunctival injection of saline. Improvement of best-corrected logarithm of the minimum angle of resolution visual acuity (VA) by > or =5 letters after 2 years and incidence of moderate or severe adverse events. Improvement of > or =5 letters' best-corrected VA was found in 19 of 34 (56%) eyes treated with intravitreal TA, compared with 9 of 35 (26%) eyes treated with the placebo (z(generalized estimating equation) = 2.73, P = 0.006). The mean improvement in VA was 5.7 letters (95% confidence interval, 1.4-9.9) more in the intravitreal TA-treated eyes than in those treated with the placebo. An increase of intraocular pressure (IOP) of > or =5 mmHg was observed in 23 of 34 (68%) treated versus 3 of 30 (10%) untreated eyes (P<0.0001). Glaucoma medication was required in 15 of 34 (44%) treated versus 1 of 30 (3%) untreated eyes (P = 0.0002). Cataract surgery was performed in 15 of 28 (54%) treated versus 0 of 21 (0%) untreated eyes (P<0.0001). Two eyes in the intravitreal TA-treated group required trabeculectomy. There was one case of infectious endophthalmitis in the treatment group. Intravitreal TA improves vision and reduces macular thickness in eyes with refractory diabetic macular edema. This beneficial effect persists for up to 2 years with repeated treatment. Progression of cataract and elevation of IOP commonly occur but appear manageable. Spontaneous improvement over years can still occur in eyes that are apparently severely affected by diabetic macular edema.
Publisher: Elsevier BV
Date: 2013
DOI: 10.1016/J.AAP.2012.08.002
Abstract: Child restraints protect a young child against injury in crashes but best practice child restraint use is low in Australia, particularly among lower socio-economic groups. We investigated factors associated with restraint use to inform the development of education and distribution programmes to support new Australian legislation on child passengers among families in low socio-economic areas of metropolitan Sydney. We interviewed a parent or carer of 1160 children aged 2-5 years enrolled at one of 28 early childhood centres in low socio-economic areas of urban Sydney. Appropriate child restraint use was defined as a forward facing child restraint (FFCR) for 2-3 year olds and a FFCR or booster seat for children aged 4 years or more. Predictors of self-reported appropriate use were explored using logistic regression. Analysis was conducted on one child from each family in the target age range (2-5 years): 586 (51%) were male and the mean age was 3.5 (Standard Deviation 0.8) years. There were 432 (45%) families with annual income below $60,000, 248 (22%) spoke a language other than English at home and 360 (33%) had 3 or more children. Fifty-four percent of carers indicated that their 2-3 year old children travelled in a FFCR. Inappropriate use among children in this age group was more likely when the carer was <36 years (odds ratio (OR) 1.62, 95% confidence interval (CI) 1.08-2.45), in families with ≥3 children (OR 1.64, 95% CI 1.10-2.44) and when the carer believed that a booster seat was just as safe as a FFCR (OR 2.98, 2.05-4.32). Eight-eight percent of carers of 4-5 year olds reported use of a booster seat or FFCR. Non-use was associated with low household income (OR 3.10, 95% CI 1.67-5.75), in families with ≥3 children (OR 2.03, 95% CI 1.09-3.76) and families where a language other than English is spoken at home (OR 2.39, 95% CI 1.10-5.21). Non-English speaking families had less awareness of the new law and poorer knowledge of safety benefits of child restraints. They also had lower household incomes and more concerns about cost of child restraints and booster seats. These findings can inform development of interventions to promote best practice child restraint use, which will reach non-English speaking families in this region. They also confirm the importance of economic and logistic barriers to best practice child restraint use.
Publisher: Elsevier BV
Date: 07-2008
DOI: 10.1111/J.1524-4733.2007.00311.X
Abstract: To determine the feasibility, acceptability, discriminative validity, responsiveness, and minimal important difference (MID) of the SF-6D for people with spinal cord injury (SCI). A total of 305 people with SCI completed the SF-36 health status questionnaire at baseline and at subsequent occurrence of a urinary tract infection (UTI) or 6-month follow-up. Normative SF-36 data were obtained from the Australian Bureau of Statistics. SF-36 scores were transformed to SF-6D utility values using Brazier's algorithm. We used UTI as the external criterion of clinically important change to determine responsiveness and two categories of the SF-36 transition question ("somewhat worse" and "somewhat better") as the external criterion to determine the MID. Derived SF-12 responsiveness was also assessed. The mean SF-6D values were: 0.68 (SD 0.21, n = 305) all patients 0.66 (SD 0.19, n = 167) tetraplegia 0.72 (SD 0.26, n = 138) paraplegia 0.57 (SD 0.15, n = 138) with UTI. The Australian normative SF-6D mean value was 0.80 (SD 0.14, n = 18,005). The SF-6D was able to discriminate between SCI and the Australian normative s le (effect size [ES] = 0.86), tetraplegia-paraplegia (ES = 0.23), and it was responsive to UTI (ES = 0.86 SF-36 variant, ES = 0.92 SF-12 variant). The MID for respondents who reported being somewhat worse or somewhat better at follow-up was 0.03 (SD 0.17, n = 108/305), while the MID for only those who were somewhat worse was 0.10 (SD 0.14, n = 58). The content of the SF-6D is more appropriate than that of the SF-36 for this physically impaired population. The SF-6D has discriminative power and is responsive to clinically important change because of UTI. The MID is consistent with published estimates for other disease groups.
Publisher: Oxford University Press (OUP)
Date: 02-2010
DOI: 10.1111/J.1743-6109.2009.01453.X
Abstract: Cannabis is the most commonly used illicit substance worldwide. Despite this, its impact on sexual health is largely unknown. The aim of this article is to examine the association between cannabis use and a range of sexual health outcomes. The main outcome measures include the number of sexual partners in the past year, condom use at most recent vaginal or anal intercourse, diagnosis with a sexually transmissible infection in the previous year, and the occurrence of sexual problems. Method used in this article includes a computer-assisted telephone survey of 8,656 Australians aged 16-64 years resident in Australian households with a fixed telephone line. Of the 8,650 who answered the questions about cannabis use, 754 (8.7%) reported cannabis use in the previous year with 126 (1.5%) reporting daily use, 126 reported (1.5%) weekly use, and 502 (5.8%) reported use less often than weekly. After adjusting for demographic factors, daily cannabis use compared with no use was associated with an increased likelihood of reporting two or more sexual partners in the previous year in both men (adjusted odds ratio 2.08, 95% confidence interval 1.11-3.89 P = 0.02) and women (2.58, 1.08-6.18 P = 0.03). Daily cannabis use was associated with reporting a diagnosis of a sexually transmissible infection in women but not men (7.19, 1.28-40.31 P = 0.02 and 1.45, 0.17-12.42 P = 0.74, respectively). Frequency of cannabis use was unrelated to sexual problems in women but daily use vs. no use was associated with increased reporting among men of an inability to reach orgasm (3.94, 1.71-9.07 P < 0.01), reaching orgasm too quickly (2.68, 1.41-5.08 P < 0.01), and too slowly (2.05, 1.02-4.12 P = 0.04). Frequent cannabis use is associated with higher numbers of sexual partners for both men and women, and difficulties in men's ability to orgasm as desired.
Publisher: Informa UK Limited
Date: 26-07-2020
Publisher: Elsevier BV
Date: 04-2009
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1111/J.1753-6405.2010.00529.X
Abstract: To assess mothers' awareness of their weight status and to investigate whether this awareness influences mothers' concerns about their child being overweight or obese. An analysis of cross-sectional baseline survey data from the Healthy Beginnings Trial conducted in south-west Sydney, NSW. A total of 667 first-time mothers at 24-36 weeks of pregnancy or within one month after giving birth, who participated in the Healthy Beginnings Trial. Forty per cent of first-time mothers were overweight (24%) or obese (16%). Of these women 49% considered their weight acceptable and 21% had little or no concern about their child being overweight and obese. Concern about her child's weight was not dependent on the mother's age, marital status, education, employment, ethnicity or weight status. The only factor associated with concern about children being overweight was the mother's awareness of her own weight status. Mothers who were unaware of being overweight were twice as likely to be unconcerned about their children being overweight as those who were aware of their weight status (RR 1.98, 95% CI 1.19 to 3.29, p=0.009). There was a low level of awareness of mothers' own weight status, in particular among mothers who were young and less educated. This could lead to a lack of concern about their child being overweight. Early interventions to prevent childhood overweight and obesity need to improve mothers' awareness of their own weight status and appropriate concerns about children being overweight or obese.
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.PEC.2012.07.009
Abstract: To describe a theoretical framework for assessing knowledge about the possible outcomes of participating in bowel cancer screening for the faecal occult blood test. The content of the knowledge measure was based on the UK General Medical Council's screening guidelines and a theory-based approach to assessing gist knowledge (Fuzzy Trace Theory). It comprised conceptual and numeric questions to assess knowledge of the underlying construct (e.g. false positive concept) and the approximate numbers affected (e.g. likelihood of a false positive). The measure was used in a randomised controlled trial involving 530 adults with low education, to compare the impact of a bowel screening decision aid with a screening information booklet developed for the Australian Government National Bowel Cancer Screening Program. The numeric knowledge scale was particularly responsive to the effects of the decision aid at follow-up decision aid participants' numeric knowledge was significantly greater than the controls (P<0.001). This contrasts with the conceptual knowledge scale which improved significantly in both groups from baseline to follow-up (P<0.001). Our theory-based knowledge measure was responsive to change in conceptual knowledge and to the effect on numeric knowledge of a decision aid. This theoretical framework has the potential to guide the development of knowledge measures in other screening settings.
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/SH14099
Abstract: Background Attitudes towards sex and relationships influence laws about what is and is not permissible and social sanctions against behaviours considered unacceptable. They are an important focus for research given their links to sexual behaviour. The aim of the present study was to describe attitudes towards sex and relationships, to identify correlates of scores on a scale of sexual liberalism and to examine responses to jealousy-evoking scenarios among Australian adults. Methods: Computer-assisted landline and mobile telephone interviews were completed by a population-representative s le of 20 094 men and women aged 16–69 years. The overall participation rate among eligible people was 66.2%. Respondents expressed their agreement with 11 attitude statements, five of which formed a valid scale of liberalism, and also responded to a jealousy-evoking scenario. Results: There was general agreement that premarital sex was acceptable (87%), that sex was important for wellbeing (83%) and that sex outside a committed relationship was unacceptable (83%). Respondents were accepting of homosexual behaviour and abortion and few believed that sex education encouraged earlier sexual activity. More liberal attitudes were associated with: being female speaking English at home homosexual or bisexual identity not being religious greater education and higher incomes. Respondents who expressed more liberal attitudes had more erse patterns of sexual experience. Predicted sex differences were found in response to the jealousy-evoking scenario — men were more jealous of a partner having sex with someone else and women were more jealous of a partner forming an emotional attachment — but responses varied with age. Conclusion: Sexual attitudes of Australians largely support a permissive but monogamous paradigm. Since 2002, there has been a shift to less tolerance of sex outside a committed relationship, but greater acceptance of homosexual behaviour.
Publisher: SAGE Publications
Date: 23-07-2014
Abstract: With large collaborations needed to reach s le size requirements for relatively rare events, a major challenge for multi-centre clinical trials is efficiency of recruitment at in idual sites. We used data from an international, multi-centre, randomised trial of preterm prelabour rupture of membranes to assess any impact on recruitment following the introduction of a new Clinical Trial Agreement and to identify site-specific predictors of recruitment to the trial for the purpose of targeting future recruitment sites and strategies. The outcome measure was recruitment rate per 10,000 births, and according to this, an average recruitment rate was determined. Factors that were considered potentially predictive of recruitment above the average rate were classified according to three broad themes: ‘ethics and regulatory requirements’, ‘characteristics of site investigators’ and the ‘research culture’ at the collaborating site. Data were analysed using contingency tables and logistic regression modelling. At 31 January 2009, following the introduction of the Clinical Trial Agreement, 39 centres had obtained ethics approval to commence recruitment, and 38 centres had enrolled at least one woman. Time to first recruit ranged from 25 days to 584 days. Recruitment rates ranged from 0.18 to 6.0 per 10,000 births (mean 1.71/10,000 births) per month. Factors most associated with above-average recruitment rate were the following: implementation of a clearly defined ‘system’ of recruitment, engagement of other staff, time from ethics approval to first recruit and provision of a dedicated trial coordinator. A delay of greater than 3 months in approval of the new Clinical Trial Agreement had an effect which extended into the third year of the trial. Characteristics that were indicative of the presence of a ‘system’ were the best predictors of recruitment. It may be more effective to limit recruitment sites and focus resources on those sites where investigators are engaged with trial processes and have adequate resources and structures to support them.
Publisher: Springer Science and Business Media LLC
Date: 2006
Publisher: CSIRO Publishing
Date: 2010
DOI: 10.1071/SH09150
Abstract: Background: Human papillomavirus (HPV) knowledge has rarely been investigated in the context of a national vaccination program. The present study investigated HPV knowledge after the introduction of a national HPV vaccination program in Australia using a national s le of men and women. Methods: Questions assessing HPV knowledge were part of a broader national study of health and relationships administered via a computer-assisted telephone interview. These findings are from wave four of the study, conducted between 2007 and 2008. Knowledge questions about HPV included its association with cervical cancer, genital warts and abnormal Pap tests. Results: A total of 2634 women and 2556 men between the ages of 18 and 70 were interviewed. Overall, 62.8% (95% confidence interval (CI): 60.8–64.7%) of women and 38.3% (95% CI: 36.3–40.4%) of men had heard of HPV. Of these, 66.0% (95% CI: 64.1–67.9%) correctly answered that HPV is associated with cervical cancer, 50.2% (95% CI: 48.2–52.1%) answered that HPV is associated with abnormal Pap tests and 44.5% (95% CI: 42.5–46.5%) answered that HPV causes warts. Predictors of good knowledge included being female, aged between 26 and 45, holding higher education levels and older age at first sex. Ever having a Pap test was also associated with awareness about HPV. Conclusion: One of the highest levels of knowledge about HPV in Australia to date is reported in the present study. Knowledge about the association between HPV and cervical cancer was particularly high, especially when compared with knowledge of the association with genital warts. This appears to be a consequence of the marketing of the HPV vaccine as a vaccination against cervical cancer.
Publisher: Wiley
Date: 20-02-2003
DOI: 10.1046/J.1532-5415.2003.51109.X
Abstract: To determine the association between poor vision and risk of hip fracture in the Blue Mountains Eye Study. Prospective population-based cohort study. Two post code areas in the Blue Mountains, west of Sydney, Australia. Three thousand six hundred fifty-four community-dwelling Australians aged 49 and older. At baseline, subjects had an extensive eye examination, including refraction, contrast sensitivity and visual field testing, photographs of the lens and retina, and an interview. Hip fractures during the 5-year follow-up were identified by self-report and review of medical records and were radiologically confirmed. For 2-year follow-up (17 hip fractures), the adjusted hazard ratio (HR) for risk of hip fracture in those with corrected visual acuity worse than 20/60 was 8.4 (95% confidence interval (CI) = 1.5-48.5, population attributable risk (PAR) = 27%) for presence of posterior subcapsular cataract, the adjusted HR was 5.0 (95% CI = 1.1-23.0, PAR = 24%) and for visual field loss, the adjusted HR was 5.5 (95% CI = 1.0-29.8, PAR = 55%). In those aged 75 and older, visual acuity worse than 20/60 gave an adjusted HR of 40.6 (95% CI = 5.6-292.5, PAR = 49%). Visual impairment of any type did not predict risk of hip fracture after a 2-year follow-up. Visual impairment is strongly associated with risk of hip fracture in the next 2 years but not over a longer period of time.
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.CCT.2011.04.012
Abstract: Aromatase inhibitors (AIs) have improved the prognosis for breast cancer survivors and are now standard of care for postmenopausal women with hormone receptor positive early stage breast cancer. One side-effect, however, is a decrease in bone mineral density (BMD) and increased fracture risk. Since hormone replacement therapy (HRT) is contraindicated in these women, one prevention option is exercise combined with vitamin D and calcium. The effect of this intervention on drug-induced osteoporosis is unknown. A single-blind randomized controlled trial will be undertaken to test the hypothesis that exercise combined with vitamin D and calcium can prevent the decrease in BMD associated with the use of AIs. Sixty postmenopausal women prescribed an AI for the treatment of breast cancer will be randomized into either an exercise or control group. Participants randomized to the exercise group will undertake a 12-month gym-based exercise program, 3 times per week involving resistance and impact training. Participants in the control group will be advised on the benefits of exercise for preventing osteoporosis, but not prescribed exercise. Both groups will receive vitamin D and calcium supplements. The primary outcome will be total hip bone mineral density measured via dual energy X-ray absorptiometry (DXA). Study outcomes will be compared between groups at baseline, 6months and 12months. This study will investigate the effect of exercise in combination with vitamin D and calcium on prevention of drug-induced osteoporosis in postmenopausal women prescribed AIs for the treatment of breast cancer.
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.BBMT.2007.04.003
Abstract: The Australasian Bone Marrow Transplant Recipient Registry (ABMTRR) commenced collecting data on hematopoietic stem cell transplantation (HSCT) in 1992, and by 2004 had accrued more than 12,000 transplant records from 44 centers. In 2004 the Australian annual per capita autograft activity rate was almost twice that of New Zealand (381 per 10 million compared to 195), whereas the 2 countries had similar allografting activity rates (Australia 145, New Zealand 133). The annual rates of allogeneic HSCT per 10 million population in Australia and New Zealand in 2004 were similar to those in European countries of comparable socioeconomic status. Among the most prominent trends between 1998 and 2004 were increases in the numbers of allogeneic HSCT using peripheral blood stem cells (PBSC), the emergence of reduced intensity conditioning in allogeneic HSCT, increases in numbers of autologous HSCT for recipients aged 60 and over, increases in allogeneic HSCT with unrelated donors, and decreases in numbers of allogeneic HSCT for chronic myelogenous leukemia and autologous HSCT for breast cancer. The cumulative incidence of transplant-related mortality (TRM) at 100 days posttransplant progressively fell over the years 1992 to 2003 and was 8.1% for allogeneic HSCT and 1.1% for autologous HSCT in 2003. The ABMTRR is a valuable data resource providing timely and accurate information on HSCT activity in Australia and New Zealand. Full enumeration of HSCT activity in the 2 countries by the ABMTRR enhances its value in clinical planning and management.
Publisher: Springer Science and Business Media LLC
Date: 23-06-2006
DOI: 10.1007/S11060-006-9158-5
Abstract: Accurate prognosis for patients with anaplastic oligodendroglial gliomas is increasingly difficult to make. Characterisation of these tumours remains challenging, increasing proportions of oligodendroglial diagnoses in gliomas are reported, and no WHO 2000 grade IV exists for them, so that highly anaplastic tumours can only be grouped with glioblastoma (GBM) or with grade III oligodendroglioma, which have differing clinical behaviour. Longer survival times reported for patients with glioblastoma containing an oligodendroglial element (GBMO) suggest that a grade IV for oligodendroglial tumours might exist. In patients with anaplastic gliomas containing an oligodendroglial element, we explored whether microvascular proliferation (MVP) and necrosis were associated with shorter survival, sufficient to create a grade IV. Biopsies for 98 patients with anaplastic oligodendroglioma, anaplastic oligoastrocytoma or tumours with an oligodendroglial and GBM element, discharged 1998-2004, were identified from databases at three allied neurosurgery units. Pathology reports were reviewed for the presence of MVP and necrosis. Anaplastic oligoastrocytoma and GBMO were combined to measure the effect of an astrocytic element on survival. For anaplastic oligodendroglioma patients, median survival time was 24 months, while for anaplastic oligoastrocytoma or GBMO patients, it was 9 months. Age 60 or over (P=0.006) and astrocytic element (P=0.01) were the only independent predictors of survival. Patients 60 and over with an astrocytic element had 4.6 times the risk of death of patients under 60 with anaplastic oligodendroglioma.A grade IV cannot be created using necrosis or MVP since neither feature predicted survival after adjustment for age and an astrocytic element. However age and an astrocytic element were strong predictors of poorer survival in patients with anaplastic oligodendroglial tumours.
Publisher: Elsevier BV
Date: 11-2009
DOI: 10.1016/J.OPHTHA.2009.04.049
Abstract: To report 5-year outcomes from a clinical trial of intravitreal triamcinolone acetonide (IVTA) in eyes with diabetic macular edema (DME) and impaired vision despite previous laser treatment. Prospective, double-masked, randomized clinical trial. After completing the 2-year visit, all eyes, including those initially randomized to receive placebo, received IVTA according to prospectively defined guidelines. A total of 69 eyes (41 patients) were entered into the study, with 34 eyes initially receiving active treatment and 35 eyes receiving placebo. Five-year data were available for 44 of 67 eyes (66%). For the 23 eyes with missing 5-year data, of which 13 received placebo and 10 received IVTA, the last observation was carried forward. Intravitreal injection of 0.1 ml of 40 mg/ml triamcinolone acetonide with adjunctive laser therapy where appropriate. Improvement of best-corrected logarithm of the minimum angle of resolution visual acuity by >or=5 letters after 5 years compared with baseline and 2 years, and incidence of adverse events. Secondary outcome was the change in central macular thickness. Improvement of >or=5 letters after 5 years was found in 14 of 33 eyes (42%) initially treated with IVTA compared with 11 of 34 eyes (32%) initially treated with placebo (z(GEE) = 0.81, P = 0.4). Foveal thickness decreased by 30 microm (95% confidence interval, -47 to 107 microm) less in the initial-IVTA group than in the initial-placebo group at 5 years (z(GEE) = 0.76, P = 0.45) 5 of 11 eyes (45%) from the initial-IVTA group that were phakic at commencement of the third year required cataract surgery. A similar number of eyes from each group required ongoing treatment from the third year onward with both laser and IVTA, indicating that IVTA treatment for 2 years does not lead to reduction in the risk of recurrent edema. The majority of eyes that initially improved with IVTA maintained their gain after 5 years. No new safety concerns were identified. IVTA treatment may be considered in carefully selected cases of impaired vision caused by advanced DME that are unresponsive to other interventions.
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1016/J.CCT.2011.11.008
Abstract: In 2007, we commenced the Healthy Beginnings Trial (HBT) Phase 1 study, which is the first randomised controlled trial (RCT) to test the effectiveness of an early childhood obesity intervention in children aged up to 2 years. The results were promising with significant improvements in infant feeding practices and a lower mean body mass index (BMI). The aims of this proposed Phase 2 study are to determine if the early intervention will lead to a lower mean BMI, lower screen time, improved dietary behaviours and demonstrated cost-effectiveness of the intervention, in children aged 3½ and 5 years. In Phase 1 of HBT 667 families participated in the RCT. No further intervention will be carried out in HBT Phase 2. In this study the intervention and control groups will be compared for children's outcomes at ages 3½ and 5 years. Primary outcome measures will be 1) BMI, 2) selected dietary measures using a validated survey tool, and 3) physical activity and screen time using a new generation of tri-axial accelerometers. Intention to treat principles will be used in the analysis. Multiple imputation will be used to impute outcomes for subjects lost to follow-up. A cost-effectiveness analysis (CEA) and cost-utility analysis for both HBT Phase 1 and 2 will also be conducted. This is the first time that a home-based early intervention strategy has been implemented to prevent the development of childhood obesity and obesity-conducive behaviours. The results of this trial will ascertain whether early intervention during the first 2 years of life is effective and cost-effective in preventing childhood overweight and obesity at 3½ and 5 years old.
Publisher: Wiley
Date: 17-01-2006
DOI: 10.1359/JBMR.060104
Abstract: Osteoporotic fractures are associated with accelerated bone turnover and excess mortality. In a prospective study of 1112 frail subjects (79% female mean age, 86 years), high bone turnover was an independent predictor of all-cause mortality. This association seemed to be mainly manifested in deaths from cardiovascular causes. Osteoporotic fractures are associated with accelerated bone turnover and excess mortality. In a prospective cohort study of elderly men and women, we assessed whether the rate of bone turnover measured by markers of bone remodeling is a direct predictor of mortality. We measured serum concentrations of the aminoterminal propeptide of type I collagen (PINP), a marker of bone formation, and of the carboxyterminal telopeptide of type I collagen (CTX-I), a marker of bone resorption, along with serum PTH and 25-hydroxyvitamin D [25(OH)D] levels in 1112 subjects (79% female mean age, 86 years) living in residential care. Co-morbidity was measured using the Implicit Illness Severity Scale. Fracture data were validated by a radiology report. Mortality and causes of death were ascertained from death certificates. Over a median follow-up of 817 days, 559 (50.3%) subjects died. In univariate analyses, time to death from all causes was significantly (p < 0.01) associated with age (HR = 1.62 per 10 years), male sex (HR = 1.33), immobility (HR = 1.94), co-morbidity (HR = 0.31, mild versus severe), lower weight (HR = 0.83 per 10-kg increase), impaired cognitive function (HR = 2.14, severe versus normal), number of medications (HR = 1.05 each), hip fracture (HR = 2.26), log serum creatinine (HR = 1.67), log PTH (HR = 1.29), CTX-I (HR = 1.70, highest 25% versus lowest 75%), and PINP (HR = 1.46, highest 25% versus lowest 75%). In multivariate analysis adjusting for age, sex, immobility, co-morbidity, weight, cognitive function, number of medications, PTH, and hip fracture status, the highest quartile was significantly more likely to die than the rest for both serum CTX-I (HR = 1.39 95% CI: 1.14-1.70 p = 0.002) and PINP (HR = 1.25 95% CI: 1.02-1.52 p = 0.03). For in idual causes of death, CTX-I was significantly associated with deaths from cardiac causes (HR = 1.78: 95% CI: 1.27-2.50 p < 0.001). We conclude that in the frail elderly, high bone turnover is associated with all cause mortality independently of age, sex, health status, serum PTH levels, and hip fracture status. The mechanism of the effect of bone turnover on mortality seems to be mainly manifested in deaths from cardiovascular causes.
Publisher: AMPCo
Date: 09-2013
DOI: 10.5694/MJA13.10279
Abstract: To assess recent hospital caesarean section (CS) rates in New South Wales, adjusted for case mix to quantify the amount of variation that can be explained by case mix differences and to examine the potential impact on the overall CS rate of reducing variation in practice. Population-based record linkage study of births in 81 hospitals in New South Wales, 2009-2010, using the Robson classification to categorise births, and multilevel logistic regression to examine variation in hospital CS rates within Robson groups. Hospital CS rates. The overall CS rate was 30.9%, ranging from 11.8% to 47.4% (interquartile range, 23.9%-33.1%) among hospitals. The three groups contributing most to the overall CS rate all comprised women with a single cephalic pregnancy who gave birth at term, including: those who had had a previous CS (36.4% of all CSs) nulliparous women with an elective delivery (prelabour CS or labour induction, 23.4%) and nulliparous women with spontaneous labour (11.1%). After adjustment for case mix, marked unexplained variation in hospital CS rates persisted for: nulliparous women at term women who had had a previous CS multifetal pregnancies and preterm births. If variation in practice was reduced for these risk-based groups by achieving the "best practice" rate, this would lower the overall rate by an absolute reduction of 3.6%, from 30.9% to 27.3%. Understanding hospital heterogeneity in performing CS and implementing evidence-based practices may result in improved maternity care. We have identified five risk-based groups as priority targets for reducing practice variation in CS rates.
Publisher: Wiley
Date: 03-2013
DOI: 10.1111/BIRT.12028
Abstract: A high infant birthweight is associated with future risk of a range of adverse health consequences. This study sought to determine whether maternal "junk food" diet (energy-dense, nutrient-poor) predicts high birthweight in first-time mothers in southwest Sydney, Australia. A community-based longitudinal study was conducted with a total of 368 first-time mothers and their newborns. Information about maternal "junk food" diet, including high consumption of soft drink, fast food, and/or processed meat and chips, and self-reported prepregnant weight and height of first-time mothers was collected by a face-to-face interview with mothers between 24 and 34 weeks of pregnancy. Birthweight was measured in hospital and reported by the mother, together with gestational age, when the baby was 6 months old. Logistic regression modeling was used to determine the factors predicting birthweight greater than 4.0 kg. Eleven percent of newborns weighed more than 4.0 kg (12% boys, 9% girls). Compared with mothers who had a "junk food" diet, mothers who had not consumed "junk food" during pregnancy were significantly less likely to have a newborn weighing more than 4.0 kg, with adjusted odds ratio (AOR) 0.36, 95 percent confidence interval (CI) 0.14-0.91, p = 0.03, after adjusting for maternal weight status and gestational age. Compared with healthy and underweight mothers, overweight or obese mothers were more likely to have a newborn weighing more than 4.0 kg (AOR overweight 3.03, 95% CI 1.35-6.80 obese 3.79, 95% CI 1.41-10.25) after allowing for "junk food" diet and gestational age. Maternal "junk food" diet during pregnancy and prepregnant overweight and obesity were independent predictors of high infant birthweight. Early childhood obesity interventions should consider addressing these factors.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.OPHTHA.2014.10.001
Abstract: To characterize in more detail routine treatment patterns of intravitreal ranibizumab for neovascular age-related macular degeneration (nAMD), we analyzed the length of time and the number of injections required until lesions with choroidal neovascularization (CNV) were first graded inactive. Database observational study. Treatment-naïve eyes receiving predominantly ranibizumab for nAMD in routine clinical practice that were tracked in the Fight Retinal Blindness! observational registry. Eyes treated with ranibizumab were followed until CNV was first reported to be "inactive" (i.e., absence of intraretinal fluid and hemorrhages). The length of time until lesion inactivation occurred and the number of injections required. A total of 1096 eyes (65.8% from women) were included in the study. The median number of weeks until a lesion was graded as inactive after beginning treatment was 15 weeks. One to 3 injections were sufficient to inactivate the lesion in 61.1% of eyes. A mean change in visual acuity of +5.5 logarithm of the minimum angle of resolution letters (95% confidence interval, 4.8-6.3) was found from treatment initiation to the time that eyes were reported as inactive. In eyes with a mean treatment frequency less than every 5.3 weeks, a median of only 3 injections (mean=3.7) were required before lesions with CNV were graded as inactive, but if the mean treatment interval extended beyond 5.3 weeks, the median number of injections required increased sharply to 6 injections (mean, 7 injections). Occult lesions became inactive more slowly than classic lesions. Most lesions with CNV became inactive with 3 injections of ranibizumab, but a small proportion remained active for more than 12 months. Injection frequency and lesion type were the main factors that predicted the time and number of injections required to render lesions inactive.
Publisher: American Public Health Association
Date: 03-2015
Abstract: Objectives. We sought to identify the program fidelity factors associated with successful implementation of the Buckle-Up Safely program, targeting correct use of age-appropriate child car restraints. Methods. In 2010, we conducted a cluster randomized controlled trial of 830 families with children attending preschools and long day care centers in South West Sydney, New South Wales, Australia. Families received the Buckle-Up Safely program in the intervention arm of the study (13 services). Independent observers assessed the type of restraint and whether it was used correctly. Results. This detailed process evaluation showed that the multifaceted program was implemented with high fidelity. Program protocols were adhered to and messaging was consistently delivered. Results from multilevel and logistic regression analyses show that age-appropriate restraint use was associated with attendance at a parent information session hosted at the center (adjusted odd ratio [AOR] = 3.66 95% confidence interval [CI] = 1.61, 8.29) and adversely affected by the child being aged 2 to 3 years (AOR = 0.14 95% CI = 0.07, 0.30) or being from a family with more than 2 children (AOR = 0.34 95% CI = 0.17, 0.67). Conclusions. Findings highlight the importance of parents receiving hands-on education regarding the proper use of age-appropriate child restraints.
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.JCLINEPI.2009.08.018
Abstract: The aims of this study were to develop and evaluate a simple index for assessing the risk of fractures after a fall and to propose a selection strategy for identifying elderly in iduals at high risk of both falls and fall-related fractures. Two thousand five institutionalized older men and women were assessed for clinical risk factors and then followed up for falls and fall-related fractures for up to 2 years. Our fracture risk index is derived from seven previously identified significant independent risk factors: weight, lower leg length, balance, cognitive function, type of institution, fracture history, and falls in the past year. The fracture rate was 6.5 times greater in the one-sixth of the falls with the highest index (9.7/100 falls) than in the lowest sixth (1.5/100 falls). Our proposed approach (based on balance, risk of falls, and the fracture risk index) selected a group of older people with high risk of both falls and fall-related fracture. The fracture incidence rate was 144% higher, and the falls incidence rate was 31% higher in the selected residents than in the remainder. The index could help rationalize fracture prevention programs for frail older people.
Publisher: BMJ
Date: 02-09-2031
DOI: 10.1136/BMJ.E3732
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.JCLINEPI.2009.08.019
Abstract: The aim of this study was to demonstrate the feasibility of using linked health records to assess data quality in population health data. Reproductive histories of 155,897 women were constructed by longitudinal linkage of the New South Wales (Australia) birth records in 1998-2005, and 127,952 birth and hospital discharge records in 2000-2005 were cross-sectionally linked. History of Cesarean section (CS) derived from the longitudinal linkage ("gold standard") was used to validate the CS history fields (i.e., "Was the last birth by Cesarean section?" and "Total number of previous Cesarean sections?") in birth records and to validate "vaginal birth after previous Cesarean (VBAC)" and "maternal care for uterine scar" in hospital records. The reporting of CS at last birth was reliable with sensitivity, specificity, positive predictive value (PPV), and negative predictive value all >95% as was the number of previous CS (weighted kappa=0.97). For the hospital data, sensitivity and PPV were 46% and 99% for VBAC, 92% and 99% for maternal care of uterine scar, and 85% and 99%, respectively, for any prior CS. Assessing data quality by record linkage is feasible and can be done more quickly and cheaply than by any traditional validation study.
Publisher: Wiley
Date: 12-01-2005
DOI: 10.1111/J.1471-0528.2004.00395.X
Abstract: To determine, in women with proteinuric pre-ecl sia, whether a discriminant value of proteinuria at the time of diagnosis predicts the presence or absence of subsequent adverse maternal and fetal outcomes. Retrospective cohort study. One teaching hospital and two primary referral hospitals in Sydney, Australia. Three hundred and twenty-one pregnant women with proteinuric pre-ecl sia, managed according to a uniform management protocol. All women with the diagnosis of proteinuric pre-ecl sia in the years 1998-2001 were studied. After exclusion of women with pre-ecl sia superimposed on pre-existing hypertension, a twin pair, unavailable spot urine results, 353 women were analysed using logistic regression to determine separately the predictors of any adverse maternal or fetal outcomes at the time of delivery. Receiver operating characteristic (ROC) curves, sensitivity and specificity were then calculated from the data. Adverse maternal outcomes: severe maternal hypertension (BP > or = 170/110 mmHg), renal insufficiency, liver disease, cerebral irritation, haematological disturbances. Adverse fetal outcomes: small for gestational age, perinatal mortality. There were 108 (34%) adverse maternal outcomes and 60 (19%) adverse fetal outcomes including two stillbirths. In multivariate analysis, an adverse maternal outcome was significantly associated with higher spot urine protein/creatinine ratio at diagnosis (P < 0.0001) with an odds ratio (OR) of 1.003 per mg/mmol (95% confidence interval [CI] 1.002-1.004) and with older maternal age (P= 0.014) with OR 1.06 per year (95% CI 1.01-1.11). An increased risk of adverse fetal outcome was associated with higher spot urine protein/creatinine (P= 0.013 OR 1.44 per log [mg/mmol], 95% CI 1.08-1.92), gestation at diagnosis <34 weeks (P < 0.0001 OR 3.60, 95% CI 1.90-6.82) and early pregnancy systolic blood pressure < or =115 mmHg (P= 0.0002 OR 3.41, 95% CI 1.77-6.57). The area under the receiver operating characteristic (ROC) curve was 0.67 for adverse maternal outcomes and 0.72 for adverse fetal outcomes. With increasing proteinuria, there is increased risk of adverse maternal and fetal outcomes. Although we did not identify a specific spot protein/creatinine ratio that could be used as a definitive screening value for adverse outcomes, it is possible to utilise data from this study to predict the likelihood of adverse maternal and fetal outcomes. A high spot urine protein/creatinine ratio in pre-ecl tic women of greater than 900 mg/mmol ( approximately 9 g/day), or greater than 500 mg/mmol (approximately 5 g/day) in women over 35 years, is associated with a greatly increased likelihood of adverse maternal outcomes.
Publisher: Elsevier BV
Date: 08-2024
Abstract: To examine changes in child car restraint practices in low socioeconomic areas following the introduction of mandatory child car restraint legislation in New South Wales (NSW), Australia. Data from two cross-sectional studies of child car restraint use at pre-schools, early childhood centres and primary schools before and after the introduction of legislating mandatory age-appropriate car restraint use for children up to the age of seven years was used in this analysis. All included observations were from local government areas with socioeconomic status in the lowest 30% of urban Sydney. Children aged 2-5 years were observed in their vehicles as they arrived at observation sites (107 pre-legislation, 360 post-legislation). Multilevel logistic regression was used to examine changes in observed age-appropriate and correct use of car restraints. Age-appropriate car restraint use was higher post-legislation than pre-legislation. After controlling for child's age, parental income, language spoken at home and adjusting for clustering, the odds of children being appropriately restrained post-legislation were 2.3 times higher than in the pre-legislation s le, and the odds of them being correctly restrained were 1.6 times greater. Results indicate an improvement in car restraint practices among children aged 2-5 in low socioeconomic areas after introduction of child restraint laws. Implications : Despite improvements observed with enhanced legislation, further efforts are required to increase optimal child car restraint use.
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.ARCHGER.2010.01.008
Abstract: Older people have a high prevalence of falls and fractures, partly due to vitamin D deficiency. Sunlight is a major source of vitamin D, but many older people living in intermediate care facilities have inadequate sunlight exposure. The aim of this study was to determine the sun exposure practices and attitudes to sunlight in this population. Fifty-seven older residents of intermediate care facilities in Sydney, Australia were interviewed to determine their sun exposure practices, their views on sunlight and health and whether these have changed over their lives, factors affecting sunlight exposure and their knowledge of vitamin D. Sixty percent of the participants preferred to be outdoors, despite more than 92% believing that sunlight was healthy. In their youth however, almost 90% had preferred to be outdoors. Poor health, physical constraints and a sense of lack of ownership of outdoor spaces were barriers to sunlight exposure. Improved physical access, more outdoor leisure activities and promotion of greater autonomy may improve safe and appropriate sunlight exposure in this population.
Publisher: Wiley
Date: 26-12-2015
DOI: 10.1002/JBMR.2311
Abstract: Calcium supplementation, particularly with vitamin D, has been an approved public health intervention to reduce fracture risk. Enthusiasm for this intervention has been mitigated by meta-analyses suggesting that calcium supplementation with or without vitamin D increases myocardial infarction (MI) risk however, concern has been raised over the design of these meta-analyses. We, therefore, undertook a meta-analysis of randomized controlled trials with placebo or no-treatment control groups to determine if these supplements increase all-cause mortality and coronary heart disease (CHD) risk including MI, angina pectoris and acute coronary syndrome, and chronic CHD verified by clinical review, hospital record, or death certificate in elderly women. The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases were searched from January 1, 1966, to May 24, 2013, for potentially eligible studies, reference lists were checked, and trial investigators were contacted where additional unpublished data were required. The search yielded 661 potentially eligible reports of which 18 met the inclusion criteria and contributed information on 63,563 participants with 3390 CHD events and 4157 deaths. Two authors extracted the data independently with trial data combined using random-effects meta-analysis to calculate the relative risk (RR). Five trials contributed CHD events with pooled relative RR of 1.02 (95% confidence interval [CI], 0.96-1.09 p = 0.51). Seventeen trials contributed all-cause mortality data with pooled RR of 0.96 (95% CI, 0.91-1.02 p = 0.18). Heterogeneity among the trials was low for both primary outcomes (I(2) = 0%). For secondary outcomes, the RR for MI was 1.08 (95% CI, 0.92-1.26 p = 0.32), angina pectoris and acute coronary syndrome 1.09 (95% CI, 0.95-1.24 p = 0.22) and chronic CHD 0.92 (95% CI, 0.73-1.15 p = 0.46). In conclusion, current evidence does not support the hypothesis that calcium supplementation with or without vitamin D increases coronary heart disease or all-cause mortality risk in elderly women.
Publisher: Oxford University Press (OUP)
Date: 16-05-2008
Abstract: this study aims to develop and evaluate a simple fracture risk index for use in frail older people. clinical risk factors were assessed at baseline for 2,005 older people (473 males, 1,532 females mean age 85.7 years, SD 7.1 years) living in aged-care facilities. Fractures were ascertained for 2 years from baseline. Cox regression model was used to identify significant risk factors for fracture. Hazard ratios (HRs) from the model were assigned as weights. The risk index was calculated by multiplying the weights of all risk factors. during a mean follow-up of 1.64 years, 401 fractures occurred in 338 participants. Significant independent clinical risk factors for fracture were institution type, balance, history of previous fracture, cognitive function, number of medications, weight and lower leg length (n = 1,813). The index was capable of identifying higher-risk in iduals, with almost an 8-fold increase in the risk of fracture for residents from the lowest 15% to the highest 18% of the score. Among 1-year survivors, a high score (>or=15) indicated approximately a one-in-six chance of fracture, while a low score (<8) indicated only a one-in-forty chance of fracture within a year. The area under the receiver operating characteristic (ROC) curve was 0.69 (95% CI: 0.65-0.72) and 0.68 (95% CI: 0.65-0.71) for identifying someone who would have a fracture in 1 and 2 years respectively. this risk index could identify in iduals at higher fracture risk among institutionalised older people, and thus, could help to rationalise the provision of fracture prevention programs in this population.
Publisher: Elsevier BV
Date: 04-2010
DOI: 10.1111/J.1753-6405.2010.00501.X
Abstract: To report on the prevalence and demographic variation in circumcision in Australia and examine sexual health outcomes in comparison with earlier research. A representative household s le of 4,290 Australian men aged 16-64 years completed a computer-assisted telephone interview including questions on circumcision status, demographic variables, reported lifetime experience of selected sexually transmissible infections (STIs), experience of sexual difficulties in the previous 12 months, masturbation, and sexual practices at last heterosexual encounter. More than half the men (58%) were circumcised. Circumcision was less common (33%) among men under 30 and more common (66%) among those born in Australia. After adjustment for age and number of partners, circumcision was unrelated to STI history except for non-specific urethritis (higher among circumcised men, OR=2.11, p<0.001) and penile candidiasis (lower among circumcised men, OR=0.49, p<0.001). Circumcision was unrelated to any of the sexual difficulties we asked about (after adjusting for age) except that circumcised men were somewhat less likely to have worried during sex about whether their bodies looked unattractive (OR=0.77, p=0.04). No association between lack of circumcision and erection difficulties was detected. After correction for age, circumcised men were somewhat more likely to have masturbated alone in the previous 12 months (OR=1.20, p=0.02). Circumcision appears to have minimal protective effects on sexual health in Australia.
Publisher: Wiley
Date: 20-08-2008
DOI: 10.1111/J.1365-2265.2007.03040.X
Abstract: To investigate whether absence of secondary hyperparathyroidism in the presence of hypovitaminosis D has altered bone turnover, fracture risk and mortality. A prospective cohort study. A total of 1280 older men and women living in residential care facilities. We measured baseline serum 25-hydroxyvitamin D (25OHD), serum intact PTH, serum amino-terminal propeptide of type I collagen (PINP) and serum carboxy-terminal telopeptide of type I collagen (CTX-I). Deaths and fractures were recorded prospectively. Hypovitaminosis D (25OHD 7.0 pmol/l) in the presence of hypovitaminosis D were common in this s le with a prevalence of 77.5% and 53.3%, respectively. In the presence of hypovitaminosis D, residents showing a hyperparathyroid response (n = 406) had significantly higher serum bone turnover markers than in iduals with serum PTH levels < or = 7.0 pmol/l (termed 'low vitamin D, normal PTH', n = 463). After adjusting for risk factors, mortality was significantly higher in the secondary hyperparathyroidism group than in the 'low vitamin D, normal PTH' group [hazard ratio (HR) = 1.35, 95% confidence interval (CI) 1.12-1.64 P = 0.002]. All residents with serum PTH levels < or = 7.0 pmol/l (n = 603) were similar with regard to both bone turnover and mortality, independent of their actual vitamin D status. Absence of secondary hyperparathyroidism in the presence of hypovitaminosis D appears to be common in the frail elderly and is associated with longer survival, similar to that observed in vitamin D-replete elderly subjects.
Publisher: Wiley
Date: 2002
DOI: 10.1002/SIM.1256
Abstract: Two features commonly exhibited by randomized trials of health promotion interventions are cluster randomization and stratification. Ignoring correlations between in iduals within clusters can lead to an inflated type I error rate and hence a P-value which overstates the significance of the result. This paper compares several methods for analysing categorical data from a stratified cluster randomized trial. We propose an extension of a method from survey s ling that uses the design effect to reduce the effective s le size. We compare this with three methods from Zhang and Boos that extend the standard Cochran-Mantel-Haenszel (CMH) statistic by using appropriate covariance matrices, and with a bootstrap method. The comparison is based on empirical type I error rates from a simulation study, in which the number of clusters randomized is small, as in most public health intervention studies. The method that performs consistently well is one of the Zhang and Boos extensions of the standard CMH statistic.
Publisher: American Medical Association (AMA)
Date: 03-1818
Publisher: Wiley
Date: 31-10-2012
Publisher: Cambridge University Press (CUP)
Date: 05-2014
DOI: 10.1017/S1368980013000414
Abstract: A simple FFQ which ranks young children's dietary habits is necessary for population-based monitoring and intervention programmes. The aim of the present study was to determine the reliability and validity of a short FFQ to assess the dietary habits of young children aged 2–5 years. Parents completed a seventeen-item FFQ for their children by telephone on two occasions, two weeks apart. Sixty-four parents also completed 3 d food records for their children. The FFQ included daily servings of fruit and vegetables, frequency of eating lean meat, processed meats, take-away food, snack foods (biscuits, cakes, doughnuts, muesli bars), potato crisps and confectionery, and cups of soft drinks/cordials, juice, milk and water. Weighted kappa and intra-class correlation coefficients were used to assess FFQ reliability and the Bland–Altman method was used to assess validity of the FFQ compared with the 3 d food record. Seven pre-school centres in metropolitan Sydney, Australia. Seventy-seven children aged 2–5 years. The majority of questions had moderate to good reliability: κ w ranged from 0·37 (lean meat) to 0·85 (take-away food consumption). Validity analysis showed a significant increase in mean values from the food record with increasing ordered categories from the FFQ for servings of vegetables and fruit and cups of drinks (all trend P ≤ 0·01). Spearman rank correlation coefficient was ·5 for vegetables, fruit, diet soft drinks and fruit juice. The FFQ provides reliable and moderately valid information about the dietary intakes and habits of children aged 2–5 years, in particular for fruit, vegetables and beverages.
Publisher: S. Karger AG
Date: 2003
DOI: 10.1159/000073509
Abstract: We obtained sup /sup P magnetic resonance spectra from the brains in vivo of 101 males (range 6–72 years). In addition, cognitive test data were obtained from 42 boys (6–13 years) and from 26 adult males (22–56 years) of this test group. Significant correlations were observed in both adults and children between various inorganic phosphate (Pi)-containing sup /sup P peak ratios [e.g. Pi/adenosine triphosphate (ATP)] and (predominantly verbal) cognitive tasks. No change in the Pi/ATP ratio was observed across the age range studied. Brain pH was shown to decrease significantly with age in a relationship best described by a decaying exponential. This indicated that brain pH does not stabilize at adult values until at least the late teens. We explored the possibility of a relationship between brain pH and neuronal density. In particular, we noted that our previous observation of a relationship between pH and IQ in children was not readily detected in the adult populations, whereas phosphorus metabolite ratios (in particular, those containing Pi) were found to correlate with (predominantly verbal) cognitive task performance in both adults and children. We assessed how these observations may be interpreted in the context of a metabolic vs. histological debate.
Publisher: Oxford University Press (OUP)
Date: 04-02-2013
DOI: 10.1093/RHEUMATOLOGY/KES428
Abstract: The aim of this study is to describe pregnancy outcomes among women with JIA. Women who gave birth in New South Wales (NSW), Australia, were linked to hospital discharge records from 2000 to 2010. Women with an ICD-10-AM code of M08 or M09 in the hospital records were considered to have JIA. Logistic regression was used to calculate odds ratios for pregnancy outcomes and the lack of independence in study outcomes for multiple pregnancies in the same woman was taken into account using generalized estimating equations. During the study period, 601,659 women had 941,496 births. Of these births, 78 births could be attributed to 50 women with JIA. Of 78 JIA pregnancies, 53 (68%) were delivered by either Caesarean section (n = 40, 51%) or instrumental delivery (n = 13, 17%) compared with other women, those with JIA had significantly higher rates of pre-ecl sia, postpartum haemorrhage and severe maternal morbidity. Compared with other infants, those with mothers with JIA were more likely to be born prematurely, but were not at increased risk of being small for gestational age, requiring neonatal intensive care, having a low Apgar score at 5 min or severe neonatal morbidity. Infants of women with JIA did not have an increased risk of adverse neonatal outcomes. Intensive obstetric care might be required during pregnancy for women with JIA given the increased risk of maternal morbidity.
Publisher: Springer Science and Business Media LLC
Date: 15-05-2013
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.BBMT.2011.05.003
Abstract: This retrospective registry analysis examined predictive factors for outcome in 57 patients who underwent allogeneic or syngeneic hematopoietic cell transplantation (HCT) for chronic myelofibrosis (CM), either primary (n = 49) or following an antecedent condition (n = 8), reported to the Australasian Bone Marrow Transplant Registry (ABMTRR) between 1993 and 2005. During the 6 years 2000 to 2005, 40 HCTs were performed for CM compared with 17 in the 7 years 1993 to 1999. Twenty-four recipients (42%) were age 50 or over at transplantation all of these patients were transplanted after 1997, and 15 were given reduced intensity conditioning (RIC) pretransplantation. The cumulative incidence of transplantation-related mortality was 18% at 100 days and 25% at 1 year posttransplantation. Up to 1 year posttransplantation 16 patients died, with the most common causes being infection (n = 6) and graft-versus-host disease (GVHD) (n = 5). A total of 27 patients survived for 3 years or longer posttransplantation. None of these patients required regular red blood cell transfusions, and of the 17 who had not had splenectomies, none had detectable splenomegaly. Twelve patients had no detectable bone marrow fibrosis, 7 had grade 1 fibrosis, and in 8 patients no information was available. The overall survival (OS) probability for all patients was 72% at 1 year and 58% at 5 years posttransplantation. Patients age 50 and over who received myeloablative conditioning fared poorly, with 1-year overall actuarial survival of 44% compared with 77% for all other patients (P = .007). In multivariate analysis, age 50 years and over at transplantation was the only significant independent unfavorable risk factor for survival post-HCT (hazard ratio 2.71, 95% confidence interval 1.16-6.34, P = .02). This study shows a clear increase in annual numbers of allogeneic HCT performed for CM in Australia and New Zealand in recent years. Five-year survival was favorable compared with international studies, but for older recipients who received myeloablative conditioning, mortality risk was elevated.
Publisher: Elsevier BV
Date: 10-2014
Publisher: Springer Science and Business Media LLC
Date: 2010
Publisher: Wiley
Date: 05-01-2011
Publisher: Wiley
Date: 17-10-2012
Publisher: American Public Health Association
Date: 12-2012
Abstract: Objectives. We evaluated an education, distribution, and fitting program for increasing age-appropriate and correct child restraint use. Methods. We performed a cluster randomized trial involving 28 early childhood education centers in low socioeconomic status areas in Sydney, Australia. The main outcome was optimal restraint use defined as age-appropriate restraints, installed into the vehicle correctly and used correctly. Results. One service withdrew after randomization, so data are presented for 689 child passengers, aged 3 to 5 years, from 27 centers. More children attending intervention centers were optimally restrained (43% vs 31% P = .01 allowing for clustering). More 3-year-olds were using forward-facing seats rather than booster seats, more 4- to 5-year-olds were using booster seats instead of seat belts alone, and there were fewer errors in use at intervention centers. Among non–English-speaking families, more children attending intervention centers were optimally restrained (43% vs 17% P = .002 allowing for clustering). Conclusions. The program increased use of age-appropriate restraints and correct use of restraints, which translates to improved crash injury protection. Multifaceted education, seat distribution, and fitting enhanced legislation effects, and the effect size was larger in non–English-speaking families.
Publisher: Elsevier BV
Date: 2006
Publisher: Wiley
Date: 04-02-2013
DOI: 10.1111/PPE.12039
Abstract: The extent to which complications or adverse outcomes in a first vaginal birth may contribute to mode of delivery in the next birth remains unclear. This study examines the impact of the first birth on subsequent mode of delivery. The study population included women with a first vaginal birth and a consecutive second birth. Data were obtained from linked birth and hospital records for the state of New South Wales, Australia 2000-09. The primary outcome was the mode of delivery for the second birth. Planned caesarean was modelled using logistic regression intrapartum caesarean and instrumental delivery were modelled using multinomial logistic regression. Of the 114 287 second births, 4.2% were planned caesarean, 3.0% were intrapartum caesarean and 4.8% were instrumental deliveries. Adjusted risk factors from the first birth for a planned second birth caesarean were third to fourth degree tear [odds ratio (OR) = 5.0 [95% confidence interval (CI) 4.6, 5.4]], severe neonatal morbidity (OR = 3.2 [95% CI 2.9, 3.6]), perinatal death (OR = 3.2 [95% CI 2.3, 4.4]), severe maternal morbidity (OR = 2.8 [95% CI 2.3, 3.3]), instrumental delivery, large infant, labour induction, epidural use, use of oxytocin for augmentation and episiotomy. Important risk factors (OR > 2) for intrapartum caesarean in the second birth were perinatal death or severe neonatal morbidity in the first birth. Risk factors for instrumental delivery in the second birth were perinatal death, preterm delivery and instrumental delivery. Obstetrical interventions and adverse pregnancy outcomes in the first birth were associated with increased risk of operative delivery in the second birth.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2010
DOI: 10.1161/STROKEAHA.109.569483
Abstract: Background and Purpose— The main objective of this randomized trial was to determine whether treadmill walking with body weight support was effective at establishing independent walking more often and earlier than current physiotherapy intervention for nonambulatory stroke patients. Methods— A randomized trial with concealed allocation, blinded assessment, and intention-to-treat analysis was conducted. One hundred twenty-six stroke patients who were unable to walk were recruited and randomly allocated to an experimental or a control group within 4 weeks of stroke. The experimental group undertook up to 30 minutes per day of treadmill walking with body weight support via an overhead harness whereas the control group undertook up to 30 minutes of overground walking. The primary outcome was the proportion of participants achieving independent walking within 6 months. Results— Kaplan–Meier estimates of the proportion of experimental participants who achieved independent walking were 37% compared with 26% of the control group at 1 month, 66% compared with 55% at 2 months, and 71% compared with 60% at 6 months ( P =0.13). The experimental group walked 2 weeks earlier, with a median time to independent walking of 5 weeks compared to 7 weeks for the control group. In addition, 14% (95% CI, −1–28) more of the experimental group were discharged home. Conclusions— Treadmill walking with body weight support is feasible, safe, and tends to result in more people walking independently and earlier after stroke. Trial Registration— ClinicalTrial.gov (NCT00167531).
Publisher: Wiley
Date: 07-05-2014
DOI: 10.1002/OBY.20700
Abstract: We sought to determine early life factors that predict body mass index (BMI) and overweight/obesity of children aged 2 years. A longitudinal and prospective analysis was conducted with 330 first-time mothers and their newborns. Children's weight and length were measured at 2 years. Main factors of interest included reported infant feeding practices, children's fruit/vegetable consumption, and television (TV) time. Maternal demographic data, weight and height, and smoking status were collected by face-to-face interview at baseline. Multiple linear and logistic regression models were run to determine factors that predicted BMI or overweight/obesity of children aged 2 years, respectively. At age 2 years, 242 remained in the study (retention rate 73%). Mean (SD) BMI of children was 16.87 kg/m(2) (1.62), with 14% classified as overweight/obese. Factors predicting lower child BMI were longer breastfeeding duration, less TV viewing time, and lower child's birth weight as well as maternal healthy prepregnancy weight status. Factors predicting children's overweight/obesity status were shorter breastfeeding duration, earlier introduction of solid food, and maternal overweight or obesity. At 2 years of age, longer breastfeeding duration was associated with lower BMI, while greater TV viewing time was associated with higher BMI, after adjusting for other factors. Early introduction of solids and maternal overweight or obesity were independently associated with overweight or obesity.
Publisher: Springer Science and Business Media LLC
Date: 19-11-2013
Publisher: SAGE Publications
Date: 25-07-2012
Abstract: Low participation rates in randomised controlled trials involving children are almost a universal problem, leading to high cost and low statistical power. Trial, parent/family, child, and physician factors have been reported to influence parental willingness to consent for paediatric trials. To identify modifiable and unmodifiable factors associated with parental consent. Demographic and clinical characteristics of children and their families and physician characteristics associated with parental consent were evaluated in a recent randomised placebo-controlled trial of prophylactic antibiotics to prevent recurrent urinary tract infection. Of 1109 eligible children identified (mean age, 2.0 years), 412 parents (37.2%) consented. On a multivariate analysis, the only modifiable factor associated with consent was request for consent by a member of the research study team rather than by a member of the clinical team (risk ratio (RR) = 1.9, 95% confidence interval (CI): 1.2–2.9). The unmodifiable factors significantly associated with consent were age of the child (≥4 years) (RR = 1.2, 95% CI: 1.1–1.4), presence of vesicoureteric reflux (RR = 1.5, 95% CI: 1.3–1.8), inpatient management of the index infection (RR = 0.8, 95% CI: 0.7–0.9), and multiple (≥4) symptoms at presentation (RR = 1.3, 95% CI: 1.1–1.5). We have reported data from only one of the four participating centres in this trial. Data on non-consenters in other participating centres were not completely collected. Data on characteristics of the recruiting physician were limited. These findings are applicable for those considering a single randomised controlled trial. Parent, child, and physician factors are associated with consent for trial participation, with most not being modifiable. Having a member of the research study team approach the parent for consent appears to be the only feasible strategy for increasing recruitment to randomised trials in this setting.
Publisher: Springer Science and Business Media LLC
Date: 17-05-2011
Publisher: Springer Science and Business Media LLC
Date: 26-07-2011
DOI: 10.1007/S00520-011-1229-2
Abstract: This study aimed to explore the effect of physician endorsement of question-asking on advanced cancer patients' question-asking behaviour during consultations about palliative care and to explore other potential predictors of patient question-asking. Data were obtained from 80 control group patients from a randomised controlled trial of standard palliative care (PC) consultation (control group) versus provision of a question prompt list (QPL) before the consultation. Consecutive eligible patients with advanced cancer referred to 15 PC physicians from nine Australian PC centres participated. Baseline measures were obtained from patients consultations were audiotaped, transcribed and analysed by blinded coders and physicians estimated the patients' survival. Endorsement of question-asking by the physician was not related to the number of patient questions. Patients with the highest anxiety levels asked 3.5 times as many questions as those with least anxiety (incidence rate ratio (IRR) = 3.54, 95% confidence interval (CI) 1.90-6.59, P = 0.001). After allowing for the effect of anxiety, patients with an estimated survival of >12 weeks asked 76% more questions (IRR = 1.76, 95% CI 1.03-3.00, P = 0.04), whereas age, sex, educational background, occupation, information and involvement preferences and presence of a caregiver were not related to patient question-asking behaviour. Physician endorsement of question-asking alone does not appear to increase questions by advanced cancer patients during consultations about PC. Additional resources such as QPLs may be needed to facilitate patient question-asking.
Publisher: BMJ
Date: 26-10-2010
DOI: 10.1136/BMJ.C5370
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.JAMDA.2015.04.005
Abstract: To evaluate the effectiveness of a leadership and management program in aged care. Double-blind cluster randomized controlled trial. Twelve residential and community-aged care sites in Australia. All care staff employed for 6 months or longer at the aged care sites were invited to participate in the surveys at 3 time points: baseline (time 1), 9 months from baseline (time 2), and 9 months after completion of time 2 (time 3) from 2011 to 2013. At each time point, at least 500 care staff completed a survey. At baseline (N = 503) the largest age group was 45 to 54 years (37%), and the majority of care staff were born in Australia (70%), spoke English (94%), and had at least completed secondary education (57%). A 12-month Clinical Leadership in Aged Care (CLiAC) program for middle managers, which aimed to further develop their leadership and management skills in creating positive workplace relationships and in enabling person-centered, evidence-based care. The primary outcomes were care staff ratings of the work environment, care quality and safety, and staff turnover rates. Secondary outcomes were care staff's intention to leave their employer and profession, workplace stress, job satisfaction, and cost-effectiveness of implementing the program. Absenteeism was excluded due to difficulty in obtaining reliable data. Managers' self-rated knowledge and skills in leadership and management are not included in this article, which focuses on care staff perceptions only. At 6 months after its completion, the CLiAC program was effective in improving care staff's perception of management support [mean difference 0.61, 95% confidence interval (CI) 0.04-1.18 P = .04]. Compared with the control sites, care staff at the intervention sites perceived their managers' leadership styles as more transformational (mean difference 0.30, 95% CI 0.09-0.51 P = .005), transactional (mean difference 0.22, 95% CI 0.05-0.39 P = .01), and less passive avoidant (mean difference 0.30, 95% CI 0.07-0.52 P = .01) and were rated higher on the overall leadership outcomes (mean difference 0.35, 95% CI 0.13-0.56 P = .001) as well as in idual manager outcomes: extra effort (P = .004), effectiveness (P = .001), and satisfaction (P = .01). There was no evidence that CLiAC was effective in reducing staff turnover, or improving patient care quality and safety. While the CLiAC leadership program had direct impact on the primary process outcomes (management support, leadership actions, behaviors, and effects), this was insufficient to change the systems required to support care service quality and client safety. Nevertheless, the findings send a strong message that leadership and management skills in aged care managers can be nurtured and used to change leadership behaviors at a reasonable cost.
Publisher: American Medical Association (AMA)
Date: 08-2011
DOI: 10.1001/ARCHPEDIATRICS.2011.115
Abstract: To assess the effectiveness of a home-based early intervention on infant feeding practices and "tummy time" for infants in the first year of life. Randomized controlled trial with follow-up measures scheduled at 6 and 12 months. Socially and economically disadvantaged areas of Sydney, Australia. We recruited 667 first-time mothers and their infants in 2007 and 2008. The intervention consisted of 5 or 6 home visits from a specially trained research nurse delivering a staged home-based intervention in the antenatal period and at 1, 3, 5, 9, and 12 months. Changes in infant feeding practices and "tummy time." The intervention group had a significantly higher median duration of breastfeeding at 12 months than the control group (17 weeks [95% confidence interval, 13.9-20.4 weeks] vs 13 weeks [95% confidence interval, 10.1-15.0 weeks] P = .03). Compared with the control group, the hazard ratio for stopping breastfeeding in the intervention group was 0.82 (95% confidence interval, 0.68-0.99). The intervention also resulted in a significantly later introduction of solid foods (P < .001 for trend), reducing the proportion of mothers who introduced solids before 6 months by 12% (95% confidence interval, 4%-20%) from 74% to 62%. The intervention also decreased the age at which infants started tummy time (P = .03 for trend) and increased the daily practice of tummy time by 7% from 76% to 83% (P = .05). The home-based early intervention delivered by trained community nurses significantly improved some infant feeding practices and resulted in earlier daily practice of tummy time. anzctr.org.au Identifier: ACTRN012607000168459.
Publisher: BMJ
Date: 10-03-2008
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.IJMEDINF.2011.03.001
Abstract: This study aimed to explore inequities in access to online health information and its relation to socioeconomic status, and to inform the development of the use of the Internet for health promotion. We analyzed cross-sectional baseline survey data for 664 first-time mothers from the Healthy Beginnings Trial conducted in Southwest Sydney, Australia during 2007-2010. First-time mothers' reports of their computer ownership, sources of health information including Internet access and self-rated health as well as demographic data were collected through face-to-face interviews. Multivariate analysis was performed using log-binomial regression. We found that 37% of first-time mothers reported not using the Internet for health information. Maternal education level, household income level and having a computer at home were significant factors associated with the use of the Internet for health information after adjusting for other factors. Mothers who only had school certificate or lower were 1.5 times more likely not to use the Internet for health information than those with university/tertiary education [adjusted risk ratio (ARR) 1.50, 95% CI 1.06-2.12, P=0.03]. Mothers with a household income of less than $40,000 per year were 1.7 times more likely not to use the Internet for health information than those with a household income over $80,000 per year (ARR 1.66, 95% CI 1.24-2.12, P=0.001). These findings have important implications for using the Internet for health promotion among young women. A substantial number of first-time mothers do not access the Internet for health information, in particular among those with lower levels of education, lower household income and without a computer at home.
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.OPHTHA.2015.05.010
Abstract: To analyze the long-term outcomes of eyes with neovascular age-related macular degeneration (AMD) starting treatment with vascular endothelial growth factor (VEGF) inhibitors at least 5 years earlier. Database observational study. Treatment-naïve eyes with neovascular AMD tracked by the Fight Retinal Blindness outcome registry that received at least 1 anti-VEGF injection. Locally weighted scatterplot smoothing curves were used to display visual acuity (VA) results. Change in mean VA and number of injections and visits from baseline up to 7 years after initiating treatment. The mean follow-up time of all 1212 identified eyes was 53.5 months, and 549 (45%) continued attending after 60 months. Mean VA improved from 55.1 to 61.4 letters after 6 months and remained above the mean presenting VA for approximately 6 years. After 7 years, mean VA was 2.6 letters lower than baseline for the 131 eyes still being followed 40% had VA ≥70 (20/40) letters, and 18% had VA ≤35 letters (20/200). Of those with 20/40 VA before treatment, 40% had lost it after 7 years. Geographic atrophy affecting the fovea was thought to be the cause of a ≥10-letter loss after 6.5 years in 37% of a subset of such eyes that were retrospectively analyzed. A median of 6 injections and 9 visits were recorded over the first 12 months, and then 5 treatments and 7 to 9 visits per annum thereafter through 7 years. Treatment was discontinued for 663 eyes (53%) within the first 5 years. Despite initial gains in vision, the mean VA of these eyes had deteriorated to baseline or worse around the time treatment was discontinued. The rate of serious adverse events was low. Good long-term outcomes of VEGF inhibition for neovascular AMD were found in this study. These results may be better than other reports because more injections were given to our patients, possibly associated with a greater incentive for the physician to treat. Further studies to determine how to maximize the proportion of eyes that retain the initial VA gains of anti-VEGF are warranted.
Publisher: Wiley
Date: 06-11-2007
Publisher: American Medical Association (AMA)
Date: 06-2015
DOI: 10.1001/JAMAPEDIATRICS.2015.0258
Abstract: Little evidence exists on whether effects of an early obesity intervention are sustainable. To assess the sustainability of effects of a home-based early intervention on children's body mass index (BMI) and BMI z score at 3 years after intervention. A longitudinal follow-up study of the randomized clinical Healthy Beginnings Trial was conducted with 465 participating mothers consenting to be followed up at 3 years after intervention until their children were age 5 years. This study was conducted in socially and economically disadvantaged areas of Sydney, Australia, from March 2011 to June 2014. No further intervention was carried out in this Healthy Beginnings Trial phase 2 follow-up study. The original intervention in phase 1 comprised 8 home visits from community nurses delivering a staged home-based intervention, with one visit in the antenatal period and 7 visits at 1, 3, 5, 9, 12, 18, and 24 months after birth. Primary outcomes were children's BMI and BMI z score. Secondary outcomes included dietary behaviors, quality of life, physical activity, and TV viewing time of children and their mothers. In total, 369 mothers and their children completed the follow-up study, a phase 2 completion rate of 79.4% (80.9% for the intervention group and 77.7% for the control group). The differences between the intervention and control groups at age 2 years in children's BMI and BMI z score disappeared over time. At age 2 years, the difference (intervention minus control) in BMI (calculated as weight in kilograms ided by height in meters squared) was -0.41 (95% CI, -0.71 to -0.10 P = .009), but by age 5 years it was 0.03 (95% CI, -0.30 to 0.37). No effects of the early intervention on dietary behaviors, quality of life, physical activity, and TV viewing time were detected at age 5 years. The significant effect of this early life home-visiting intervention on child BMI and BMI z score at age 2 years was not sustained at age 5 years without further intervention. Obesity prevention programs need to be continued or maintained during the early childhood years.
Publisher: Wiley
Date: 11-2008
DOI: 10.1111/J.1532-5415.2008.01954.X
Abstract: To investigate which factors best predict whether a fall will result in a fracture. Prospective cohort. Residential care facilities. One thousand three hundred forty-two older men and women (mean age 86.0) who had a fall. Clinical risk factors and bone fragility by calcaneus broadband ultrasound attenuation (BUA) were assessed at baseline, and falls and fall-related fractures were recorded for up to 2 years. All fractures were validated using X-ray reports. During a median follow-up of 1.97 years, 6,646 falls resulted in 308 fractures. Fracture rates were 6.7, 4.8, and 3.1 per 100 falls for BUA in the lowest (10.5-39.7 dB/MHz), middle (39.8-58.9 dB/MHz), and highest (>/=58.9dB/MHz) tertiles, respectively. In multivariate analysis, the odds ratio for any fracture was 1.17 (95% confidence interval=1.08-1.27 P<.001) for every 10-dB/MHz reduction in BUA. Other significant risk factors in the model were lower weight, longer leg length, better balance, no severe cognitive impairment, intermediate care residence, lack of a history of falls in the previous year, and a history of fracture since age 50. For hip fracture, the only significant risk factors were lower weight, longer leg length, intermediate care residence, and lack of falls history. Important risk factors for whether a fracture occurs immediately after a fall include direct measures of bone fragility and a number of anthropometric and clinical factors that may increase or attenuate the mechanical impact of a fall. By identifying those at highest risk of fracture after a fall, these findings should have important implications for fracture prevention strategies.
Publisher: Springer Science and Business Media LLC
Date: 25-10-2013
Publisher: Mary Ann Liebert Inc
Date: 06-2008
Abstract: This study assesses interest in genetic testing for gene variations associated with bipolar disorder and associated information needs. Two hundred in iduals (95 unaffected and 105 affected with either bipolar disorder, schizoaffective disorder--manic type, or recurrent major depression) from families with multiple cases of bipolar disorder were assessed, using mailed, self-administered questionnaires. The percentage of participants reporting interest in genetic testing was associated with the degree of certainty with which any test would indicate the development of bipolar disorder. Interest in genetic testing, given a 25% lifetime risk scenario, was lowest (with 77% of participants indicating interest), and highest for the 100% lifetime risk scenario (92%). Eighty percent of participants indicated interest in genetic testing of their own children of these 30% reported wanting their children tested at birth, and 33% in early childhood. Forty-one percent of participants reported that they would be interested in preimplantation genetic diagnosis, and 54% in prenatal testing. The possibility of ascertainment bias cannot be ruled out. Interest in hypothetical genetic testing for bipolar disorder may not necessarily translate into actual utilization. These results indicate that uptake of genetic testing for genotyping for low-risk alleles related to bipolar disorder is likely to be lower than for testing for high-penetrance gene mutations that follow Mendelian inheritance. The discrepancy between the desired age of testing children and the accepted current practice may be a source of distress and conflict for parents and health professionals alike.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2014
Publisher: Springer Science and Business Media LLC
Date: 29-01-2012
DOI: 10.1007/S10549-012-1964-1
Abstract: The aim of this study was to determine whether an exercise program, commencing 4-6 weeks post-operatively, reduces upper limb impairments in women treated for early breast cancer. Women (n = 160) were randomized to either an 8-week exercise program (n = 81) or to a control group (n = 79) following stratification for axillary surgery. The exercise program comprised a weekly session and home program of passive stretching and progressive resistance training for shoulder muscles. The control group attended fortnightly assessments but no exercises were provided. The primary outcome was self-reported arm symptoms derived from the EORTC breast cancer-specific questionnaire (BR23), scored out of 100 with a low score indicative of fewer symptoms. The secondary outcomes included physical measures of shoulder range of motion, strength, and swelling (i.e., lymphedema). Women were assessed immediately following the intervention and at 6 months post-intervention. The change in symptoms from baseline was not significantly different between groups immediately following the intervention or at 6 m post-intervention. The between group difference immediately following the intervention was 4 (95% CI -1 to 9) and 6 months post-intervention was 4 (-2 to 10). However, the change in range of motion for flexion and abduction was significantly greater in the exercise group immediately following the intervention, as was change in shoulder abductor strength. In conclusion, a supervised exercise program provided some, albeit small, additional benefit at 6 months post-intervention to women who had been provided with written information and reminders to use their arm. Both the groups reported few impairments including swelling immediately following the intervention and 6 months post-intervention. Notably, resistance training in the post-operative period did not precipitate lymphedema.
Publisher: Oxford University Press (OUP)
Date: 30-04-2009
Abstract: risk factors for hip fracture in community-dwelling in iduals have been extensively studied, but there have been fewer studies of institutionalised older people. a total of 1,894 older people (1,433 females, 461 males mean age 86 years, SD 7.1 years) were recruited from 52 nursing homes and 30 intermediate-care nursing care facilities in Australia during March 1999 and February 2003. We assessed clinical risk factors for hip fracture and skeletal fragility by calcaneus broadband ultrasound attenuation (BUA) at baseline and then followed up for fracture for 4 years. Hip fractures were validated by x-ray reports. Survival analysis with age as a time-dependent covariate was used to analyse the data. during a mean follow-up period of 2.65 years (SD 1.38), 201 hip fractures in 191 residents were recorded, giving an overall hip fracture incidence rate of 4.0% per person year (males 3.6% and females 4.1%). Residents living in intermediate-care hostels had a higher crude hip fracture rate (4.6% vs. 3.0%) than those living in high-care nursing homes. In multivariate analysis, an increased risk of hip fracture was significantly associated with older age, cognitive impairment, a history of fracture since age 50, lower body weight, longer lower leg length and poorer balance in intermediate-care hostel residents, but not with lower BUA. institutionalised older people, who are at a higher risk of hip fracture than community-dwelling in iduals, have differences in some risk factors for hip fracture that should be considered in targeting intervention programs.
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 27-08-2013
Abstract: We report the 12-month outcomes of 1140 treatment-naïve eyes with exudative age-related macular degeneration (wet AMD) who were treated for 12 months with intravitreal anti-VEGF drugs in routine clinical practice. Index visit characteristics, such as lesion type and size, visual acuity (VA, in Logarithm of the Minimal Angle of Resolution [logMAR] letters), as well as treatments, outcomes (VA, lesion activity status) and ocular adverse events were recorded in a prospectively designed electronic database. Index visit characteristics associated with the 12-month VA outcome were identified using mixed effects linear regression. Mean change in VA in the cohort after 12 months was +4.7 logMAR letters (95% confidence interval [CI], 3.4-6.1) with a mean of 7.0 injections. No significant difference was found in change in VA, or number of injections by type or size of the lesion. Median time to inactivation of lesions was 194 days. VA at the index visit was the strongest predictor for the 12-month outcomes. Infectious endophthalmitis occurred in 2 cases, and retinal detachment occurred in 1 case from a total of 9162 injections. These findings indicate that VEGF inhibitors can achieve reasonably good outcomes for wet AMD when used in routine clinical practice.
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.EJON.2022.102148
Abstract: This paper reports on patient participant experiences of a larger randomised controlled trial evaluating a shared-care pathway intervention designed to support outpatients at home during their first three cycles of systemic anti-cancer therapies delivered in two large tertiary hospitals in Sydney, Australia. This qualitative study explores the perspectives of patient participants who received the intervention, which involved targeted home visits by community nurses post treatment administration. A qualitative inductive thematic analysis was used to examine data from semi-structured interviews with patients who received the intervention. Twenty-five patient participants were interviewed. We identified four themes: Stepping into the unknown Impact of availability of health and social care support Building confidence to manage self-care Uncertainty, frailty and co-morbidities. Targeted support at home is seen to be effective and welcomed by patients as early stages of each treatment cycle can be extremely challenging, particularly for those who are elderly, frail or with co-morbidities, and for those with limited health and social support. Regular contact with community nursing services can, at least for some patients, support the development of patient self-efficacy in managing aspects of their own care. Some patients are sufficiently confident to self-manage some treatment side effects by treatment cycle four.
Publisher: American Academy of Pediatrics (AAP)
Date: 04-2005
Abstract: Objective. To identify prenatal and perinatal risk factors for clinically severe (stage 3 or 4) retinopathy of prematurity (ROP). Methods. Data were collected prospectively as part of the ongoing Australian and New Zealand Neonatal Network audit of high-risk infants (birth weight of & g or gestational age [GA] of & weeks) admitted to a level III neonatal unit in Australia or New Zealand. Prenatal and perinatal factors to 1 minute of age were examined for the subset of infants with GA of & weeks who survived to 36 weeks’ postmenstrual age and were examined for ROP (n = 2105). The factors significantly associated with stage 3 or 4 ROP were entered into a multivariate logistic regression model. Results. Two-hundred three infants (9.6%) had stage 3 or more ROP. Prematurity was the dominant risk factor, with infants with GA of & weeks having 20 times greater odds of severe ROP than infants with GA of 28 weeks. Birth weight for GA also had a “dose-response” effect the more growth-restricted infants had greater risk, with infants below the 3rd percentile of weight for GA having 4 times greater odds of severe ROP than those between the 25th and 75th percentiles. Male gender was also a significant risk factor (odds ratio: 1.73 95% confidence interval: 1.25–2.40). Conclusions. These data, for a large, essentially population-based cohort, suggest that factors related to the degree of immaturity, intrauterine growth restriction, and male gender contribute to severe ROP.
Publisher: Elsevier BV
Date: 2005
DOI: 10.1016/J.OPHTHA.2004.07.017
Abstract: To investigate the association between elevated intraocular pressure (IOP) and accelerated cataract formation in patients treated with intravitreal triamcinolone. Analysis of longitudinal data from a randomized, double-masked, placebo-controlled trial of intravitreal triamcinolone for age-related macular degeneration (the Intravitreal Triamcinolone Study). Patients with phakic eyes who participated in a randomized clinical trial of intravitreal triamcinolone for age-related macular degeneration were studied. There were 57 phakic eyes in the treatment group and 54 phakic eyes in the control group. One eye per patient was studied. Four milligrams of intravitreal triamcinolone or 1 ml subconjunctival saline. Intraocular pressure rise of at least 5 mmHg (IOP responders) and progression of posterior subcapsular cataract by 2 or more grades using photographic standards from the Age Related Eye Disease Study. Progression of posterior subcapsular cataract (PSC) by 2 or more grades in the treatment group was significantly higher among 16 IOP responders (51% after 2 years) than among 37 nonresponders (3% P<0.0001, log-rank test). There was no significant progression of PSC in the placebo group or the opposite eye of the treatment group. Progression of cortical cataracts also was significantly higher among responders than nonresponders (15% vs. 3% P = 0.015, log-rank test). The progression of nuclear cataracts (13% vs. 3%) was not significantly different between IOP responders and nonresponders (P = 0.3, log-rank test). Although steroid-related cataracts are unlikely to develop in eyes that do not experience elevated IOP after intravitreal triamcinolone, those eyes that do also have a very high risk of rapidly experiencing posterior subcapsular lens opacification. This strong association suggests that the mechanism responsible for the development of steroid-induced PSC cataract and raised IOP may be similar.
Publisher: Springer Science and Business Media LLC
Date: 06-01-2011
Publisher: Elsevier BV
Date: 10-2009
DOI: 10.1016/J.BBMT.2009.06.014
Abstract: Whether the annual mortality rates of long-term hematopoietic cell transplant (HCT) survivors ever return to that of the general population is unclear. This study sought to determine the annual long-term mortality rates of allogeneic and autologous HCT recipients who had survived 5 years or more disease-free posttransplant and calculate their relative survival rates. Patients were included if they had a first allogeneic or syngeneic HCT for acute leukemia, chronic myelogenous leukemia (CML) or myelodysplastic syndromes (MDS), or autologous HCT for acute myelogenous leukemia (AML) or lymphoma in Australia or New Zealand between 1992 and 2001, recorded on the Australasian Bone Marrow Transplant Recipient Registry (ABMTRR) database, and were known to have survived, disease free, 5 years or more posttransplant. The annual mortality rates of 5-year transplant survivors were compared to standard Australian and New Zealand populations using relative survival. A total of 1461 HCT survivors (688 postallograft, 773 postautograft) were included in this study. The 10-year survival probability for 5-year allograft survivors was slightly higher than that of 5-year autologous survivors (93.4% versus 89.6%, P=.06). The relative survival of both allogeneic and autologous 5-year survivors was never <97% of that of the general population. However, it was statistically significantly lower than expected in the sixth to ninth years posttransplant, with no obvious pattern of either improvement or deterioration from 6 to 10 years posttransplant. This study indicates that annual relative survival rates of long-term survivors of allogeneic HCT performed in Australia and New Zealand for acute lymophoblastic leukemkia (ALL), AML, CML, and MDS are slightly, but significantly lower than population rates in the 6th to 10th years posttransplant. Annual relative survival rates of long-term survivors of autologous HCT performed in Australia and New Zealand for AML and lymphomas are also slightly lower than population rates up to the 10th year posttransplant. Late deaths from transplant and disease-related causes are unusual, but continue to occur for many years post-HCT.
Publisher: American Roentgen Ray Society
Date: 04-2003
DOI: 10.2214/AJR.180.4.1800935
Abstract: We examined the age-specific sensitivity and specificity of mammography and sonography in symptomatic women to determine the age below which sonography may be the more accurate imaging test, which may guide the choice of initial breast imaging examination based on the woman's age. Four hundred eighty subjects were s led from all women consecutively attending a symptomatic breast clinic between 1994 and 1996 and ranging in age from 25 to 55 years. We included all 240 women shown to have breast cancer (thus avoiding selection bias) and 240 age-matched women shown not to have cancer. Mammograms and sonograms were prospectively interpreted independently and without knowledge of age by two radiologists in a blinded manner, with a third radiologist arbitrating disagreements. Sensitivity and specificity of each imaging test in relation to age were examined using logistic regression modeling, and accuracy was compared using the chi-square test for paired proportions. Sensitivity and specificity of each test were not linearly associated with age however, the sensitivity of mammography increased substantially in women older than 50 years. Sonographic sensitivity of 81.7% was not significantly greater than mammographic sensitivity of 75.8% (chi(2)(1) = 2.06, p = 0.15). However, in women 45 years old or younger, the sensitivity of sonography was 13.2% (95% confidence interval, 2.1-24.3%) greater than that of mammography. The specificity of both tests was approximately 88.0%. These data show that sonography is the more accurate imaging test in women 45 years old or younger who present with breast symptoms and may be an appropriate initial imaging examination.
Publisher: Wiley
Date: 02-04-2015
DOI: 10.1111/PPE.12188
Abstract: To investigate whether the adverse infant health outcomes associated with early birth and severe neonatal morbidity (SNM) persist beyond the first year of life and impact on paediatric hospitalisations for children up to 6 years of age. The study population included all singleton live births, >32 weeks gestation in New South Wales, Australia, in 2001-2005, with follow-up to 6 years of age. Birth data were probabilistically linked to hospitalisation data (n = 392 964). The odds of hospitalisation, mean hospital length of stay (LOS) and costs, and cumulative LOS were evaluated by gestational age and SNM using multivariable analyses. A total of 74 341 (18.9%) and 41 404 (10.5%) infants were hospitalised once and more than once, respectively. SNM was associated with increased odds of hospitalisation once (adjusted odds ratio [aOR] 1.16 [95% confidence interval 1.10, 1.22]) and more than once [aOR 1.51 (1.43, 1.61)]. Decreasing gestational age was associated with increasing odds of hospitalisation more than once from aOR 1.19 at 37-38 weeks to 1.49 at 33-34 weeks. Average LOS and costs per hospital admission were increased with SNM but not with decreasing gestational age. Cumulative LOS was significantly increased with SNM and decreasing gestational age. Adverse effects of SNM and early birth persist between 1 and 6 years of age. Strategies to prevent early birth and reduce SNM, and to increase health monitoring of vulnerable infants throughout childhood may help reduce paediatric hospitalisations.
Publisher: Springer Science and Business Media LLC
Date: 11-03-2011
Publisher: Elsevier BV
Date: 2002
DOI: 10.1016/S0028-3932(01)00216-0
Abstract: Recent evidence has suggested cerebellar anomalies in developmental dyslexia. Therefore, we investigated cerebellar morphology in subjects with documented reading disabilities. We obtained T1-weighted magnetic resonance images in the coronal and sagittal planes from 11 males with prior histories of developmental dyslexia, and nine similarly-aged male controls. Proton magnetic resonance spectra (TE=136ms, TR=2.4s) were obtained bilaterally in the cerebellum. Phonological decoding skill was measured using non-word reading. Handedness was assessed using both the Annett questionnaire of hand preference and Annett's peg moving task. Cerebellar symmetry was observed in the dyslexics but there was significant asymmetry (right grey matter>left grey matter) in controls. The interpretation of these results depended whether a motor- or questionnaire-based method was used to determine handedness. The degree of cerebellar symmetry was correlated with the severity of dyslexics' phonological decoding deficit. Those with more symmetric cerebella made more errors on a nonsense word reading measure of phonological decoding ability. Left cerebellar metabolite ratios were shown to correlate significantly with the degree of cerebellar asymmetry (P<0.05) in controls. This relationship was absent in developmental dyslexics. Cerebellar morphology reflects the higher degree of symmetry found previously in the temporal and parietal cortex of dyslexics. The relationship of cerebellar asymmetry to phonological decoding ability and handedness, together with our previous finding of altered metabolite ratios in the cerebellum of dyslexics, lead us to suggest that there are alterations in the neurological organisation of the cerebellum which relate to phonological decoding skills, in addition to motor skills and handedness.
Publisher: Informa UK Limited
Date: 28-03-2014
DOI: 10.1080/15389588.2013.833328
Abstract: To conduct a process and impact evaluation of a multifaceted education-based pilot program targeting correct use of age-appropriate restraints in a regional setting with a high proportion of Aboriginal and Torres Strait Islander families. The program was delivered in 2010 in 3 early learning centers where 31 percent of the children were of Aboriginal and Torres Strait Islander descent. Each component of the program was assessed for message consistency and uptake. To measure program effectiveness, participating children were matched 1:1 by age, language spoken at home, and annual household income with 71 children from the control arm of a contemporaneous trial. The outcome measure in the control and program centers (a 4-category ordinal scale of restraint use) was compared using ordinal logistic regression accounting for age of the parent. Process evaluation found that though program components were delivered with a consistency of message, uptake was affected by turnover of all staff at one center and by parents experiencing difficulty in paying for subsidized restraints at each of the centers. Impact evaluation found that children from the centers receiving the program had nearly twice the odds of being in a better restraint category than children matched from the control group (adjusted odds ratio [ORadj] = 2.06, 95% confidence interval [CI], 1.09-3.90). This was a pragmatic study reflecting the real-life issues of implementing a program in preschools where 57 percent of families had a low income and turnover of staff was high. Despite these issues, impact evaluation showed that the integrated educational program showed promise in increasing correct use of age-appropriate restraints. The findings from this pilot study support the use of an integrated educational program that includes access to subsidized restraints to promote best practice child restraint use among communities that include a high proportion of Aboriginal and Torres Strait Islander families in New South Wales. Future trials in similar settings should consider offering more support in centers with high turnover of staff and offering alternative methods of payment when families experience financial difficulties in purchasing the subsidized restraints. If proven in larger trials, this approach could reduce death and injuries in child passengers in this vulnerable group.
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/SH14105
Abstract: Background Current information about numbers of other-sex partners, experiences of different heterosexual behaviours and the recent heterosexual experiences among a representative s le of Australian adults is needed. It is not known whether these practices have changed between 2001–02 and 2012–13. Methods: Computer-assisted telephone interviews were completed by a representative s le of 9963 men and 10 131 women aged 16–69 years from all states and territories. The overall participation rate among eligible people was 66.2%. Results: Men reported more sexual partners than women, although the lifetime number of heterosexual partners reported by women increased significantly between 2001–02 and 2012–13. In 2012–13, 14.7% of men and 8.6% of women reported two or more sexual partners in the last year. Reporting multiple partners was significantly associated with being younger, being bisexual, living in major cities, having a lower income, having a blue-collar occupation and not being married. The proportion of respondents reporting ever having had oral sex or anal intercourse increased significantly since the last survey. At the last heterosexual encounter, 91.9% of men and 66.2% of women had an orgasm, oral sex was reported in only approximately one in four encounters and anal intercourse was uncommon. Conclusion: There were increases between 2001–02 and 2012–13 in partner numbers among women and in the lifetime experience of oral and anal sex. The patterns of heterosexual experience in Australia are similar to those found in studies of representative s les in other countries.
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.BJPT.2021.10.003
Abstract: This statistical analysis plan details the Coaching for Healthy AGEing (CHAnGE) trial analysis methodology. To investigate the effect of a combined physical activity and fall prevention program on physical activity and falls compared to a healthy eating among people aged 60 years and over. The CHAnGE trial is a pragmatic parallel-group cluster-randomised controlled trial with allocation concealment and blinded assessors. Clusters are allocated to either (1) a physical activity and fall prevention intervention or (2) to a healthy eating intervention. The primary outcomes are: objectively measured physical activity at 12 months post-randomisation, and self-reported falls throughout the 12-month trial period. Secondary outcomes include the proportion of participants reporting a fall, the proportion of participants meeting the Australian physical activity guidelines, body mass index, eating habits, mobility goal attainment, mobility-related confidence, quality of life, fear of falling, risk-taking behaviour, mood, well-being, self-reported physical activity, disability, and use of health and community services. We will follow the intention-to-treat principle. All analysis will allow for cluster randomisation using a generalised estimating equation approach. The between-group difference in the number of falls per person-year will be analysed using negative binomial regression models. For the continuously scored primary and secondary outcome measures, linear regression models adjusted for corresponding baseline scores will assess the effect of group allocation. Analyses will take into account cluster randomisation and will be adjusted for baseline scores. A subgroup analysis will assess differential effects of the intervention by baseline physical activity levels and history of falls.
Publisher: Wiley
Date: 22-01-2015
DOI: 10.1002/JBMR.2368
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/SH14103
Abstract: Background It is important to have current reliable estimates of the prevalence, correlates and consequences of sexual coercion among a representative s le of Australian adults and to identify changes over time in prevalence and consequences. Methods: Computer-assisted telephone interviews were completed by a representative s le of 20 094 Australian men and women aged 16–69 years. The participation rate among eligible people was 66.2%. Results: Sexual coercion (i.e. being forced or frightened into sexual activity) was reported by 4.2% of men and 22.4% of women. Sexual coercion when aged ≤16 years was reported by 2.0% of men and 11.5% of women. Correlates of sexual coercion were similar for men and women. Those who had been coerced reported greater psychosocial distress, were more likely to smoke, were more anxious about sex and more likely to have acquired a sexually transmissible infection. Few people had talked to others about their experiences of sexual coercion and fewer had talked to a professional. There were no significant differences between the First and Second Australian Study of Health and Relationships in whether men or women had experienced coercion, talked to anyone about this or talked to a counsellor or psychologist. Conclusion: Sexual coercion has detrimental effects on various aspects of people’s lives. It usually occurs at the ages at which people become sexually active. There is a need to reduce the incidence of sexual coercion, better identify experiences of sexual coercion, and provide accessible services to minimise the detrimental effects of sexual coercion.
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/SH14102
Abstract: Background It is important to have current and reliable estimates of the frequency and correlates of condom use among Australian adults. Methods: A representative s le of 20 094 men and women aged 16–69 years, from all states and territories, completed computer-assisted telephone interviews. The overall participation rate among eligible people was 66.2%. Results: Although most respondents had used a condom at some time in their lives, fewer than half of those who were sexually active in the year before being interviewed had used a condom in that year. Condom use in the last year was associated with youth, speaking a language other than English at home, bisexual identity, greater education, residence in major cities, lower income and having multiple sexual partners in the last year. One-quarter of respondents used a condom the last time they had vaginal intercourse and one-sixth of these were put on after genital contact. Condom use during most recent vaginal sex was associated with youth, lower income, having sex with a non-regular partner and not using another form of contraception. Condom use appears to have increased between 2001–02 and 2012–13. Conclusion: Consistent with other research, this study showed that condom use was strongly associated with partner type and use of other contraception. There may be a need to highlight among people with multiple sexual partners the fact that non-barrier methods of contraception do not offer protection against sexually transmissible infections. The finding that many condoms were applied after genital contact suggests a need to promote both use and correct use of condoms.
Publisher: Springer Science and Business Media LLC
Date: 2002
Abstract: Pertussis notifications have increased over the past decade in Australia and other industrialised countries. This study estimates the effectiveness of pertussis vaccination in one Australian State (New South Wales, NSW) among children aged less than 14 years, during a period when an Australian whole-cell pertussis vaccine was in routine use. Cases notified with pertussis between 1996 and 1998 and pertussis vaccine coverage estimates from the Australian Childhood Immunisation Register were used. Vaccine effectiveness (VE) was calculated using the screening method, with adjustment for age group, year of disease onset and area of residence. VE was highest (91%) in the youngest age group (8-23 months) and lowest (78%) in the oldest age group (9-13 years). Pertussis vaccination is highly effective at preventing pertussis in NSW children, as measured by notified cases. Ongoing monitoring will be important to evaluate VE following Australia's change to an acellular vaccine based program.
Publisher: Informa UK Limited
Date: 24-08-2011
DOI: 10.3109/10428194.2011.582201
Abstract: This study reports on the outcome of 95 allogeneic hematopoietic cell transplants (HCTs) using reduced intensity conditioning (RIC) performed for patients with multiple myeloma (MM) in Australia and New Zealand between 1998 and 2006. The median age at HCT was 52 years. Of the 32 patients for whom the allograft was performed as a first transplant, 15 (47%) had their allograft less than 1 year from diagnosis, while for the 63 patients who had an allograft following an autograft, nine (14%) were allografted within 1 year post-diagnosis (p < 0.001). The cumulative incidence of transplant-related mortality (TRM) was 19% at 1 year post-transplant. At 5 years post-transplant the overall survival (OS) was 40% and progression-free survival (PFS) was 23%, with no apparent survival plateau. Three factors were independently favorable predictors of OS in a Cox regression model: immunoglobulin G (IgG) myeloma (hazard ratio [HR] = 0.42, 95% confidence interval [CI] 0.24-0.75, p = 0.004), a human leukocyte antigen (HLA)-identical sibling donor (HR = 0.37, 95% CI 0.18-0.74, p = 0.005), and less than 1 year between MM diagnosis and RIC HCT (HR = 0.27, 95% CI 0.12-0.59, p = 0.001). Patterns of outcome indicate that RIC HCT may offer the potential for cure for only a small group of patients with MM.
Publisher: Cambridge University Press (CUP)
Date: 31-05-2007
DOI: 10.1017/S0033291707000852
Abstract: For families with multiple cases of bipolar disorder this study explored: attitudes towards childbearing causal attributions for bipolar disorder, in particular the degree to which a genetic model is endorsed and its impact on the perceived stigma of bipolar disorder and predictors of psychological distress. Two hundred in iduals (95 unaffected and 105 affected with either bipolar disorder, schizo-affective disorder – manic type, or recurrent major disorder) were surveyed, using mailed, self-administered questionnaires. Thirty-five (35%) participants reported being ‘not at all willing to have children’ or ‘less willing to have children’ as a result of having a strong family history of bipolar disorder. Being not at all or less willing to have children was associated with perceived stigma of bipolar disorder [odds ratio (OR) 2·42, p =0·002], endorsement of a genetic model (OR 1·76, p =0·046), and being affected (OR 2·16, p =0·01). Among unaffected participants only, endorsement of a genetic model was strongly correlated with perceived stigma ( r s =0·30, p =0·004). Perceiving the family environment as an important factor in causing bipolar disorder was significantly associated with psychological distress (OR 1·58, p =0·043) among unaffected participants. Among affected participants, perceived stigma was significantly correlated with psychological distress (OR 2·44, p =0·02), controlling for severity of symptoms ( p ·001). Having a genetic explanation for bipolar disorder may exacerbate associative stigma among unaffected members from families with multiple cases of bipolar disorder, while it does not impact on perceived stigma among affected family members. Affected family members may benefit from interventions to ameliorate the adverse effects of perceived stigma.
Publisher: Elsevier BV
Date: 2004
DOI: 10.1016/J.JOCN.2003.05.003
Abstract: Increasing interest in evidence-based medicine has created a demand for accurate and accessible information on activity and trends in clinical practice. A database of all neurosurgery admissions at a teaching hospital maintained by a scientist has been utilised to examine changes in practice and complications from 1977 to 2001. A relational database, set up in 1982, now contains an unbroken record of all neurosurgical admissions at Royal North Shore Hospital (RNSH) since 1976. It supplies information for morbidity and mortality meetings, research and administrative purposes. A total of 23,766 admissions from 1977 to 2001 were examined. Statistical analysis of trends in age, gender, length of stay (LOS), diagnostic mix, surgery rates and complications in admissions was based on diagnostic groupings. Proportions of vascular admissions rose and of trauma admissions fell. Mean age increased significantly for tumour, trauma and spinal patients geometric mean LOS declined significantly for tumour, spine, vascular, cranial nerve and peripheral nerve groups. Concurrently, inpatient death rate fell significantly for tumour and vascular patients. Deep vein thrombosis (DVT) rose significantly for trauma, vascular, tumour, spinal and infection patients pulmonary embolism (PE) rose significantly for tumour, trauma and spinal patients. There was no significant change in wound infection rate at approximately 3.5% of all operated patients. Wound haematoma rates fell significantly from 4.0% to 2.9% while the rate of postoperative cerebrospinal fluid (CSF) leak rose significantly from 0.5% to 2.0% of all operated patients. The value of the database is demonstrated by its ability to provide analysis which shows statistically significant changes over time. Declining death rate and LOS indicate improved efficiency in managing patients, but these are offset by rising rates of CSF leak, DVT and PE. Such rises reflect the changing patterns of casemix and surgery performed, and increasing financial pressures on hospital departments.
Publisher: Springer Science and Business Media LLC
Date: 12-2006
Publisher: Hindawi Limited
Date: 05-2005
Publisher: SAGE Publications
Date: 13-01-2014
Abstract: Background. Making informed decisions about cancer screening involves understanding the benefits and harms in conjunction with personal values. There is little research examining factors associated with informed decision making or participation in screening in the context of a decision aid trial. Objectives. To identify factors associated with informed choice and participation in fecal occult blood testing (FOBT) among lower education populations. Design. Randomized controlled trial of an FOBT decision aid conducted between July and November 2008. Setting. Socioeconomically disadvantaged areas in New South Wales, Australia. Participants. Included 572 adults aged 55 to 64 years with lower education. Measurements. Sociodemographic variables, perceived health literacy, and involvement preferences in decision making were examined to identify predictors of informed choice (knowledge, attitudes, and behavior). Results. Multivariate analysis identified independent predictors of making an informed choice as having higher education (relative risk [RR], 1.49 95% confidence interval [CI], 1.13–1.95 P = 0.001), receiving the decision aid (RR, 2.88 95% CI, 1.87–4.44 P 0.001), and being male (RR, 1.48 95% CI, 1.11–1.97 P = 0.009). Participants with no confidence in completing forms and poorer self-reported health were less likely to make an informed choice (RR, 0.74 95% CI, 0.53–1.03 P = 0.05 and RR, 0.57 95% CI, 0.36–0.89 P = 0.007, respectively). Independent predictors of completing the FOBT were positive screening attitudes, receiving the standard information, preference for making the decision alone, and knowing that screening may lead to false-positive/negative results. Limitations. We did not objectively measure health literacy. Conclusions. Participants with the lowest levels of education had greater difficulties making an informed choice about participation in bowel screening. Alternative methods are needed to support informed decision making among lower education populations.
Publisher: Massachusetts Medical Society
Date: 29-10-2009
Publisher: BMJ
Date: 23-09-2015
DOI: 10.1136/BJOPHTHALMOL-2014-305514
Abstract: To describe outcomes of eyes with wet age-related macular degeneration (AMD) sub ided by lesion activity in a large multicentre cohort study. Treatment-naive eyes with subfoveal choroidal neovascularisation receiving antivascular endothelial growth factor therapy enrolled in the Fight Retinal Blindness observational study were included. Lesions were graded at each visit as active if there was intraretinal or subretinal fluid attributable to leak from choroidal neovascularisation lesion or fresh haemorrhage. Eyes were ided into four groups based on the proportion of visits, each eye was graded as active during the first 12 months of treatment (persistent, high, moderate and low activity). 655 eyes were included. Similar mean visual acuity changes compared with baseline were observed in all four groups at 12 months (+6.8, +8.3, +6.2 and +5.5 letters for the low, moderate, high and persistent groups, respectively p<0.001 for each group). The mean number of injections given increased only modestly in groups with more active lesions (7.6, 7.9, 8.4 and 8.3, respectively, p=0.015). Occult and minimally classic lesions were more frequent in the more active groups (p=0.024). Persistent activity of neovascular lesions during 12 months after starting intravitreal therapy was not associated with worse visual outcomes in this observational study of AMD.
Publisher: Wiley
Date: 06-2011
DOI: 10.1038/OBY.2010.285
Abstract: Family functioning is found to be associated with overweight and obesity in childhood, but its association with maternal obesity risk behaviors is not clear. This study aimed to investigate whether family functioning is associated with maternal obesity risk behaviors and to inform the development of early obesity interventions. A total of 408 first-time mothers at 24-34 weeks of pregnancy were included in the study. They participated in the Healthy Beginnings Trial (HBT) conducted in southwest Sydney, Australia in 2008. An analysis of cross-sectional baseline data was conducted using ordinal logistic regression modeling. Key measures were assessed using the McMaster Family Assessment Device, and self-reported obesity risk behaviors including excessive consumption of soft drinks, fast food, and excessive small screen time. The study found that 30% of the study population had a family functioning score ≥2, indicating unhealthy family functioning. About one-third (36%) of the mothers had more than one obesity risk behavior. Mothers with a family functioning score ≥2 were more likely to have more than one obesity risk behavior (47% vs. 32%, P < 0.05) than mothers with a lower score. The proportion of mothers with a family functioning score ≥2 increased from 22% to 29% to 39% as the number of maternal obesity risk behaviors increased from 0 to 1 to 2 or more, giving an adjusted proportional odds ratio (AOR) of 2.0 (95% confidence interval (CI) 1.3-3.0, P = 0.001). Family functioning is independently associated with the number of maternal obesity risk behaviors after allowing for the effects of maternal age and education. Overweight and obesity interventions should consider addressing family functioning.
Publisher: Wiley
Date: 14-01-2010
Publisher: Wiley
Date: 02-2011
Publisher: MDPI AG
Date: 09-10-2012
DOI: 10.3390/NU4101382
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1016/J.PEC.2009.01.012
Abstract: Several countries have recently implemented national bowel cancer screening programs. To ensure equal access to screening, information is needed to suit adults ranging in literacy level. Decision aids are effective in providing balanced information and have been applied in screening. However, few have been designed for populations with lower education and literacy. This article describes the development and preliminary evaluation of a bowel cancer screening decision aid for this group. We conducted face-to-face interviews with adults of varying literacy ability, to develop the decision aid (Stage 1). We applied principles of plain language, created visual illustrations to support key textual messages, and used colour coding to direct the reader through the booklet. We then explored its acceptability and comprehension among consumers with higher and lower education (Stage 2). Participants were recruited from a community s le with lower education and a university alumni network. A total of 75 participants were interviewed, 43 with lower educational attainment and 32 with university education. The decision aid was positively reviewed by both education groups. Results highlighted the need to clarify the purpose of the decision aid and the availability of choice in the context of screening, especially to those with lower education. The 2 stage iterative development process identified important factors to consider in the development of decision tools for this target group, and is recommended. Our findings have implications for how to support people with lower education and literacy make informed screening decisions.
Publisher: SAGE Publications
Date: 10-11-2012
Abstract: To test optimal graphic risk communication formats for presenting small probabilities using graphics with a denominator of 1000 to adults with lower education and literacy. A randomized experimental study, which took place in adult basic education classes in Sydney, Australia. The participants were 120 adults with lower education and literacy. An experimental computer-based manipulation compared 1) pictographs in 2 forms, shaded “blocks” and unshaded “dots” and 2) bar charts across different orientations (horizontal/vertical) and numerator size (small , medium 100–499, large 500–999). Accuracy (size of error) and ease of processing (reaction time) were assessed on a gist task (estimating the larger chance of survival) and a verbatim task (estimating the size of difference). Preferences for different graph types were also assessed. Accuracy on the gist task was very high across all conditions ( %) and not tested further. For the verbatim task, optimal graph type depended on the numerator size. For small numerators, pictographs resulted in fewer errors than bar charts (blocks: odds ratio [OR] = 0.047, 95% confidence interval [CI] = 0.023–0.098 dots: OR = 0.049, 95% CI = 0.024–0.099). For medium and large numerators, bar charts were more accurate (e.g., medium dots: OR = 4.29, 95% CI = 2.9–6.35). Pictographs were generally processed faster for small numerators (e.g., blocks: 14.9 seconds v. bars: 16.2 seconds) and bar charts for medium or large numerators (e.g., large blocks: 41.6 seconds v. 26.7 seconds). Vertical formats were processed slightly faster than horizontal graphs with no difference in accuracy. Most participants preferred bar charts (64%) however, there was no relationship with performance. For adults with low education and literacy, pictographs are likely to be the best format to use when displaying small numerators ( /1000) and bar charts for larger numerators ( /1000).
Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
Date: 10-2004
Abstract: Management of disease in patients undergoing neurosurgical treatment for tumors requires balancing the competing risks of hemorrhage and thrombosis. The authors compared the incidence of clinically apparent deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients admitted for treatment of intracranial and spinal tumors at three institutions. At the public hospital (the Royal North Shore Hospital [RNSH]) nonsequential calf compression was used, and at the other two private neurosurgery services sequential calf compression with low-molecular-weight heparin was used in patients undergoing spinal surgery. All patients wore compression stockings and underwent follow-up scanning after surgery. The authors identified from their neurosurgery databases 2779 discharges of patients with tumor from the RNSH and private hospitals between January 1, 1995 and December 31, 2003. Patient admissions were relatively well matched for age, sex, duration of stay, and tumor type. For patients who underwent spinal surgery, the incidence of DVT was higher in the RNSH (2.6% of admissions) than in private hospitals, where no case of DVT was seen (p = 0.02). The incidence of PE was higher in admissions patients who had been treated for cranial tumors in the RNSH (2.9%) than in those treated in the private hospitals (1.3%, p = 0.01). Possible reasons for these discrepancies include a higher proportion of ambulatory patients before and after surgery in the group treated at private hospitals. More emergency and semi-emergency surgery was performed in the RNSH than in the private hospitals. Nevertheless, fewer patients discharged from the RNSH had undergone surgery, which is a known risk factor for DVT. Patients with intracranial tumors had a higher incidence of PE than those with spinal tumors. The incidence of DVT and PE was higher in patients admitted to the public hospital. The incidence of DVT in patients undergoing spinal procedures was lower when low-molecular-weight heparin was used judiciously, but the incidence of PE in patients undergoing cranial procedures was lower with the private hospital protocol, which did not include prophylaxis with anticoagulating agents.
Publisher: Informa UK Limited
Date: 28-02-2202
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/SH14116
Abstract: Background This study describes the prevalence of (solo) masturbation, paying for sex and a range of other sexual practices among Australians. Methods: A representative s le of 20 094 men and women aged 16–69 years (participation rate among eligible people, 66.2%) were recruited by landline and mobile phone random-digit dialling and computer-assisted telephone interviews in 2012–13. Results: Many respondents (men, 72% women, 42%) had masturbated in the past year. Half (51%) of the men and 24% of women had masturbated in the past 4 weeks. In the past year, more than two-fifths of respondents (men, 63% women, 20%) had looked at pornography in any medium. Approximately 15% of men and 21% of women had used a sex toy. Digital-anal stimulation with a partner was practised by 19% of men and 15% of women, and oral-anal stimulation by 7% of men and 4% of women. Sexual role playing or dressing up were engaged in by 7–8%. Online sex, swinging, group sex, BDSM (bondage and discipline, ‘sadomasochism’ or dominance and submission) and fisting (rectal or vaginal) were each engaged in by less than 3% of the s le. Seventeen per cent of men said they had ever paid for sex 2% had done so in the past year. Conclusion: Most of the solo practices studied were engaged in by more men than women, but women were more likely to have used a sex toy. Autoerotic activities are both substitutes for partnered sex and additional sources of pleasure for people with sexual partners.
Publisher: Mary Ann Liebert Inc
Date: 08-2012
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/SH14115
Abstract: Background This paper describes the methods and process of the Second Australian Study of Health and Relationships. Methods: A representative s le of the Australian population was contacted by landline and mobile phone modified random-digit dialling in 2012–13. Computer-assisted telephone interviews elicited sociodemographic and health details as well as sexual behaviour and attitudes. For analysis, the s le was weighted to reflect the study design and further weighted to reflect the location, age and sex distribution of the population at the 2011 Census. Results: Interviews were completed with 9963 men and 10 131 women aged 16–69 years from all states and territories. The overall participation rate among eligible people was 66.2% (63.9% for landline men, 67.9% for landline women and 66.5% for mobile respondents). Accounting for the survey design and adjusting to match the 2011 Census resulted in a weighted s le of 20 094 people (10 056 men and 10 038 women). The s le was broadly representative of the Australian population, although as in most surveys, people with higher education and higher status occupations were over-represented. Data quality was high, with the great majority saying they were not at all or only slightly embarrassed by the questionnaire and almost all saying they were 90–100% honest in their answers. Conclusions: The combination of methods and design in the Second Australian Study of Health and Relationships, together with the high participation rate, strongly suggests that the results of the study are robust and broadly representative of the Australian population.
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/SH14114
Abstract: Background The aim of this study was to describe important characteristics of Australian adults’ heterosexual regular sexual relationships and examine how these characteristics have changed since 2002. Methods: Computer-assisted landline and mobile telephone interviews were completed by a representative s le of 20 094 Australian residents aged 16–69 years. The participation rate among eligible people was 66.2%. Data were collected on respondents’ social and demographic characteristics, relationship status and duration, cohabitation status, partner’s age, contraception use, expectations about sexual exclusivity, sexual partners in the previous year, actual and ideal frequencies of sex and levels of physical pleasure and emotional satisfaction in their relationships. Results: Most sexually active respondents 89% 74% of all respondents, were in a heterosexual regular relationship. Most (97%) expected sexual exclusivity in their relationships, with 3% reporting extradyadic sex in the previous year. Respondents reported an average frequency of sex of 1.44 times per week, with most reporting very high levels of physical pleasure (men, 88% women, 76%) and emotional satisfaction (men, 86% women, 84%) in their relationships. Comparisons with data from the First Australian Study of Health and Relationships revealed that significantly more sexually active men were in a relationship in the current survey that respondents’ average frequency of sex was significantly lower and that women’s reports of extreme emotional satisfaction had risen. Otherwise, results were consistent with those of the first study. Conclusions: In general, results suggested that the characteristics of Australians’ heterosexual relationships changed little between 2002 and 2013. Despite a decline in respondents’ average weekly frequency of sex, the majority of respondents reported being in a highly satisfying, sexually exclusive relationship.
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/SH14113
Abstract: Background Current information about the characteristics of Australian adults’ first vaginal intercourse and contraception or precautions used on that occasion is needed, as well as whether these characteristics have changed between 2001–02 and 2012–13. Methods: Computer-assisted telephone interviews were completed by a representative s le of 20 094 men and women aged 16–69 years. The overall participation rate among eligible people was 66.2%. Respondents indicated their age at first vaginal intercourse and first oral sex. Those who reported vaginal intercourse were asked the age of their partner, their relationship to their partner, the duration of this relationship, and what contraception or precautions (if any) were used. Results: There was a significant decline in the median age of first vaginal intercourse for both men and women among those born between the 1940s and the 1960s, but no further decline since. There has also been a significant increase in the use of protection at first vaginal intercourse, from less than 20% of men and women in the 1950s to over 90% in the 2000s. For men and women, first vaginal sex before age 16 years was significantly associated with a greater number of lifetime and recent sexual partners, and a greater likelihood of having had a sexually transmitted infection. Conclusion: Given the earlier age at first vaginal intercourse, sex education should begin earlier so that all young people have information about contraception and disease prevention before they begin their sexual careers.
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/SH14112
Publisher: Elsevier BV
Date: 2004
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.BONE.2014.09.015
Abstract: Many people at high risk of fractures are not following traditional guidelines and not being recommended for intervention. This study aimed to propose and evaluate a new set of intervention thresholds. Participants were 213,375 men and women aged ≥50 years living in New South Wales, Australia. Fracture Risk Assessment Paper Charts (Australia) was used to estimate the 10-year fracture risk. The standardized rates (to Australia population distribution 2007) for intervention were calculated for different thresholds: our proposed new thresholds (i.e. 10-year probability of hip fracture: ≥3%, 5% or 7% for 50-69, 70-79 and ≥80 years respectively), thresholds by the National Osteoporosis Guideline Group (NOGG) approach, UK thresholds and US thresholds. The NOGG, UK and US thresholds did not work well in the Australian population. For ex le, the NOGG and UK thresholds respectively qualified only 1 in 12 (8.1%) and 1 in 9 (11.3%) Australian men aged ≥70 years and the US thresholds qualified about 9 in 10 (90.6%) Australian women aged ≥ 70 years. For men or women aged ≥70 years, our proposed new thresholds gave more realistic treatment rates of 21.6% for men and 70.5% for women. Compared to the current Australian guidelines (i.e. T-score ≤ -2.5 and age ≥ 70 years or a fragility fracture), our thresholds identified an additional 4.9% of men and 18.2% of women aged ≥ 70 years for treatment. The proposed new thresholds could identify currently under-recognised high-risk in iduals for treatment. It should be considered as a recommendation for osteoporosis management in Australia.
Publisher: Wiley
Date: 14-09-2017
DOI: 10.1111/AOGS.13201
Abstract: Abnormally invasive placenta involves abnormal adherence of the placenta to the myometrium and is associated with severe pregnancy complications such as blood transfusion and hysterectomy. Knowledge of outcomes has been limited by small s le sizes and a focus on maternal rather than neonatal outcomes. This study uses population-level data collected over 10 years to investigate maternal and neonatal outcomes and trends in incidence of abnormally invasive placenta (also known as placenta accreta, increta and percreta). A population-based record linkage study was performed, including all women who gave birth in New South Wales, Australia, between 2003 and 2012. Data were obtained from birth records, hospital admissions and deaths registrations. Modified Poisson regression models, adjusted for confounding factors, were used to quantify the effect of abnormally invasive placenta on adverse maternal and neonatal outcomes. Abnormally invasive placenta was significantly associated with morbidity for mothers (adjusted relative risk 17.6, 99% confidence interval 14.5-21.2) and infants (adjusted relative risk 3.1, 99% confidence interval 2.7-3.5). Abnormally invasive placenta increased risk of stillbirth (relative risk 5.4, 99% confidence interval 4.0-7.3) and neonatal death (relative risk 8.0, 99% confidence interval 1.5-41.6). The overall rate of abnormally invasive placenta was 24.8 per 10 000 deliveries, and 22.7 per 10 000 among primiparae. Incidence increased by 30%, from 20.6 to 26.9 per 10 000, over the 10-year study period. Abnormally invasive placenta substantially increases the risk of severe adverse outcomes for mothers and babies, and the incidence is increasing. Delivery should occur in tertiary hospitals equipped with neonatal intensive care units. Clinicians should be cognizant of the risks, particularly to infants, and maintain a high index of suspicion of abnormally invasive placenta, including in primiparae.
Publisher: Springer Science and Business Media LLC
Date: 2009
Publisher: Elsevier BV
Date: 03-2201
DOI: 10.1016/J.OPHTHA.2013.09.050
Abstract: To compare outcomes of intravitreal therapy from an observational study cohort with those of participants receiving treatment in the Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab (MARINA) for the treatment of neovascular age-related macular degeneration (wet AMD). Database observational study. Participants in the observational cohort were chosen to match demographic features and entry criteria of the treatment group from MARINA. Outcomes over 12 months were compared. Eight hundred twenty-one anti-vascular endothelial growth factor (anti-VEGF)-naïve eyes treated with ranibizumab with 12 months or more of follow-up were included in the total Fight Retinal Blindness! (FRB-All) cohort, whereas a subset of this cohort of 401 eyes who were matched to the MARINA treatment group were included as the FRB-MARINA cohort. Intravitreal ranibizumab therapy of 0.5 mg for wet AMD. Visual acuity (VA) in logarithm of the minimum angle of resolution (logMAR) letters and treatments given were recorded continuously and anonymously in an electronic database for 12 months. Locally weighted scatterplot smoothing (LOESS) regression was used to plot change in visual acuity data over the course of 12 months for both the FRB-All cohort and the FRB-MARINA cohort, whereas results from the MARINA trial were taken from the published study report. Change in VA in logMAR letters over 12 months, treatment, and visit intensity. Mean visual acuity improvement after 12 months in FRB-MARINA (+5.5 letters) was similar to that of the 0.5-mg group from MARINA (+7.2 letters). Improvement in FRB-ALL was slightly less (+4.9 letters). Mean treatment effect compared with the MARINA control group was similar for the MARINA treated group (+17.6 letters) and the FRB-MARINA cohort (+15.9 letters). A mean of 7.3 injections in 12 months was received by the observational cohorts. Similarity of mean VA improvement in the matched observational cohort with that of the phase 3 clinical trial suggests that these results can be achieved in real-world clinical practice with a modified treatment regimen.
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.OPHTHA.2015.02.009
Abstract: To report 24-month outcomes of anti-vascular endothelial growth factor (VEGF) therapy for treatment-naïve eyes with neovascular age-related macular degeneration (nAMD) using a treat and extend treatment regimen in routine clinical practice. Database observational study. We included treatment-naïve eyes receiving predominantly ranibizumab for nAMD in routine clinical practice treated using a treat and extend regimen that were tracked in the Fight Retinal Blindness observational registry. A cohort of eyes treated by practitioners using exclusively a treat and extend regimen was extracted from the Fight Retinal Blindness observational registry. Change in visual acuity (VA) over 2 years and number of injections and visits. Data from 1198 eyes from 1011 patients receiving anti-VEGF therapy using a treat and extend regimen for treatment-naïve nAMD between January 2007 and December 2012 and with 24-month follow-up were included in the analysis. Mean VA increased by +5.3 logarithm of the minimum angle of resolution letters from 56.5 letters (20/80+1) at initial visit to 61.8 (20/60+2) letters at 24 months. Mean VA gains improved and number of injections increased with successive years from +2.7 letters for eyes commencing in 2007 after a mean of 9.7 injections in 2 years, to +7.8 letters for eyes commencing in 2012 after a mean of 14.2 injections over 2 years. The proportion of eyes with VA >20/40 increased from 27% when starting treatment to 45% after 24 months the proportion with vision of <20/200 remained unchanged (13% initial, 11% at 24 months). Of the included eyes, 90.5% avoided a vision loss of ≥15 letters. There was an overall mean of 13.0 injections over the 24 months, 7.5 injections in the first year and 5.5 in the second year, with a mean of 14.8 clinic visits. These data indicate that eyes managed in routine clinical practice with a treat and extend regimen can achieve good visual outcomes while decreasing the burden of treatments and clinic visits.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 09-02-2007
Abstract: To determine whether provision of a question prompt list (QPL) influences advanced cancer patients’/caregivers’ questions and discussion of topics relevant to end-of-life care during consultations with a palliative care (PC) physician. This randomized controlled trial included patients randomly assigned to standard consultation or provision of QPL before consultation, with endorsement of the QPL by the physician during the consultation. Consecutive eligible patients with advanced cancer referred to 15 PC physicians from nine Australian PC services were invited to participate. Consultations were audiotaped, transcribed, and analyzed by blinded coders patients completed questionnaires before, within 24 hours, and 3 weeks after the consultation. A total of 174 patients participated (92 QPL, 82 control). Compared with controls, QPL patients and caregivers asked twice as many questions (for patients, ratio, 2.3 95% CI, 1.7 to 3.2 P .0001), and patients discussed 23% more issues covered by the QPL (95% CI, 11% to 37% P .0001). QPL patients asked more prognostic questions (ratio, 2.3 95% CI, 1.3 to 4.0 P = .004) and discussed more prognostic (ratio, 1.43 95% CI, 1.1 to 1.8, P = .003) and end-of-life issues (30% v 10% P = .001). Fewer QPL patients had unmet information needs about the future (χ 2 1 = 4.14 P = .04), which was the area of greatest unmet information need. QPL consultations (average, 38 minutes) were longer (P = .002) than controls (average, 31 minutes). No differences between groups were observed in anxiety or patient hysician satisfaction. Providing a QPL and physician endorsement of its use assists terminally ill cancer patients and their caregivers to ask questions and promotes discussion about prognosis and end-of-life issues, without creating patient anxiety or impairing satisfaction.
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/SH14117
Abstract: Background Behavioural and other aspects of sexuality are not always consistent. This study describes the prevalence and overlap of same-sex and other-sex attraction and experience and of different sexual identities in Australia. Methods: Computer-assisted telephone interviews were completed by a representative s le of 20 094 men and women aged 16–69 years recruited by landline and mobile phone random-digit dialling with a response rate (participation rate among eligible people) of 66.2%. Respondents were asked about their sexual identity (‘Do you think of yourself as’ heterosexual/straight, homosexual/gay, bisexual, etc.) and the sex of people with whom they had ever had sexual contact and to whom they had felt sexually attracted. Results: Men and women had different patterns of sexual identity. Although the majority of people identified as heterosexual (97% men, 96% women), women were more likely than men to identify as bisexual. Women were less likely than men to report exclusively other-sex or same-sex attraction and experience 9% of men and 19% of women had some history of same-sex attraction and/or experience. Sexual attraction and experience did not necessarily correspond. Homosexual/gay identity was more common among men with tertiary education and living in cities and less common among men with blue-collar jobs. Many gay men (53%) and lesbians (76%) had some experience with an other-sex partner. More women identified as lesbian or bisexual than in 2001–02. Similarly, more women reported same-sex experience and same-sex attraction. Conclusion: In Australia, men are more likely than women to report exclusive same-sex attraction and experience, although women are more likely than men to report any non-heterosexual identity, experience and attraction. Whether this is a feature of the plasticity of female sexuality or due to lesser stigma than for men is unknown.
No related grants have been discovered for Judy M Simpson.