ORCID Profile
0000-0002-2837-0973
Current Organisations
University of Technology Sydney
,
Flinders University
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: MDPI AG
Date: 03-03-2023
Abstract: This study aimed to understand the experiences, barriers, and facilitators of rural general practitioners’ involvement with high-acuity patients. Semi-structured interviews with rural general practitioners in South Australia who had experience delivering high-acuity care were audio-recorded, transcribed verbatim, and analyzed through content and thematic approaches incorporating Potter and Brough’s capacity-building framework. Eighteen interviews were conducted. Barriers identified include the inability to avoid high-acuity work in rural and remote areas, pressure to handle complex presentations, lack of appropriate resources, lack of mental health support for clinicians, and impacts on social life. Enablers included a commitment to community, comradery in rural medicine, training, and experience. We concluded that general practitioners are a vital pillar of rural health service delivery and are inevitably involved in disaster and emergency response. While the involvement of rural general practitioners with high-acuity patients is complex, this study suggested that with the appropriate system, structure and role supports, rural general practitioners could be better empowered to manage high-acuity caseloads locally.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-07-2022
Publisher: Springer Science and Business Media LLC
Date: 06-03-2023
DOI: 10.1186/S12889-023-15253-2
Abstract: Indigenous youth worldwide continue to experience disproportional rates of poorer mental health and well-being compared to non-Indigenous youth. Mentoring has been known to establish favorable outcomes in many areas of health but is still in its early phases of research within Indigenous contexts. This paper explores the barriers and facilitators of Indigenous youth mentoring programs to improve mental health outcomes and provides evidence for governments’ response to the United Nations Declaration on the Rights of Indigenous Peoples. A systematic search for published studies was conducted on PubMed, Embase, Scopus, CINAHL, and grey literature through Trove, OpenGrey, Indigenous HealthInfoNet, and Informit Indigenous Collection. All papers included in the search were peer-reviewed and published from 2007 to 2021. The Joanna Briggs Institute approaches to critical appraisal, data extraction, data synthesis, and confidence of findings were used. A total of eight papers describing six mentoring programs were included in this review six papers were from Canada, and two originated from Australia. Studies included mentor perspectives (n = 4) (incorporating views of parents, carers, Aboriginal assistant teachers, Indigenous program facilitators, young adult health leaders, and community Elders), mentee perspectives (n = 1), and both mentor and mentee perspectives (n = 3). Programs were conducted nationally (n = 3) or within specific local Indigenous communities (n = 3) with varying mentor styles and program focus. Five synthesized findings were identified from the data extraction process, each consisting of four categories. These synthesized findings were: establishing cultural relevancy, facilitating environments, building relationships, facilitating community engagement, and leadership responsibilities, which were discussed in the context of extant mentoring theoretical frameworks. Mentoring is an appropriate strategy for improving general well-being. However, more research is needed to explore program sustainability and maintaining outcomes in the long term.
Publisher: Frontiers Media SA
Date: 27-08-2021
Abstract: Breast cancer is the primary problem threatening women’s health. The combined application of valproic acid (VPA) and hydroxyurea (HU) has a synergistic effect on killing breast cancer cells, but the molecular mechanism remains elusive. Replication protein A2 phosphorylation (pRPA2), is essential for homologous recombination (HR) repair and cell cycle. Here we showed that in response to HU, the VPA significantly decreased the tumor cells survival, and promoted S-phase slippage, which was associated with the decrease of pCHK1 and WEE1 CDK1-mediated checkpoint kinases phosphorylation pathway and inhibited pRPA2/Rad51-mediated HR repair pathway the mutation of pRPA2 significantly diminished the above effect, indicating that VPA-caused HU sensitization was pRPA2 dependent. It was further found that VPA and HU combination treatment also resulted in the decrease of endonuclease MUS81. After MUS81 elimination, not only the level of pRPA2 was abolished in response to HU treatment, but also VPA-caused HU sensitization was significantly down-regulated through pRPA2-mediated checkpoint kinases phosphorylation and HR repair pathways. In addition, the VPA altered the tumor microenvironment and reduced tumor burden by recruiting macrophages to tumor sites the Kaplan-Meier analysis showed that patients with high pRPA2 expression had significantly worse survival. Overall, our findings demonstrated that VPA influences HR repair and cell cycle through down-regulating MUS81-pRPA2 pathway in response to HU treatment.
Publisher: Elsevier BV
Date: 06-2003
DOI: 10.1016/S0306-9877(03)00072-0
Abstract: The world is rapidly ageing. It is against this backdrop that there are increasing incidences of dementia reported worldwide, with Alzheimer's disease (AD) being the most common form of dementia in the elderly. It is estimated that AD affects almost 4 million people in the US, and costs the US economy more than 65 million dollars annually. There is currently no cure for AD but various therapeutic agents have been employed in attempting to slow down the progression of the illness, one of which is oestrogen. Over the last decades, scientists have focused mainly on the roles of oestrogen in the prevention and treatment of AD. Newer evidences suggested that testosterone might also be involved in the pathogenesis of AD. Although the exact mechanisms on how androgen might affect AD are still largely unknown, it is known that testosterone can act directly via androgen receptor-dependent mechanisms or indirectly by converting to oestrogen to exert this effect. Clinical trials need to be conducted to ascertain the putative role of androgen replacement in Alzheimer's disease.
Publisher: MDPI AG
Date: 31-08-2021
Abstract: There is an increasing body of literature that considers the relevance and experiences of cultural competency and safety training in health professional students. However, less is written about Australian tertiary learners’ experiences of engaging with cultural competency training. The aim of this study is to explore tertiary students’ willingness or resistance to cultural competency and safety pedagogy. Qualitative student feedback to a teaching unit was collected and triangulated with data from focus groups with tutors. Results were thematically analyzed. Willingness and resistance to cultural competency and safety teaching emerged as two key themes. Willingness to engage with the unit was largely due to student interest in the content, teaching environment and relevance of cultural competency to students’ future practice. Resistance was linked to the students feeling personally attacked, or culturally confronted, with tutors noting the topics around sexuality and white privilege being more resisted. Acknowledging reasons for student resistance and developing strategies to reduce resistance can facilitate more student engagement with cultural competency topics, ultimately leading to their future provision of culturally competent healthcare.
Publisher: Wiley
Date: 04-2021
DOI: 10.1111/AJR.12719
Abstract: Inter‐professional education is a growing area of importance that enables training of health care professionals and students to develop skills in collaborative clinical practice, a critical aspect of disability care. However, research is limited on appropriate on‐site inter‐professional training for the rural and remote disability workforce. This paper aims to explore the features of an effective inter‐professional training approach for rural disability workforce. Riverland, South Australia. Clinical educators, allied health professionals, health and service providers and students. A qualitative‐explorative research design, involving focus group discussion and a thematic analysis method were employed in this study. Participants of the focus group discussion completed a capacity building training program centred on inter‐professional education, cultural‐safety and the National Disability Insurance Scheme. National Disability Services Social Impact Measurement Tool was used to evaluate and explore the features of effective inter‐professional training program for existing and emerging disability workforce in rural regions. Four themes emerged from data analysis: inter‐professional education focus structured inter‐professional training building collaborative learning environment and culturally appropriate care practice. Inter‐professional supervision was identified as a key enabler for capacity building in an area with limited health workforce. Inter‐agency collaboration and professional network were identified as important elements to support disability health workforce retention and the transition from novice to practitioner. Prior knowledge about the needs of persons with disability and empathetic relationships influenced the quality of practice. In situ training programs, which provide real‐life rural practice context and harness inter‐agency collaboration, improve effectiveness of rural disability workforce readiness for practice.
Publisher: MDPI AG
Date: 14-05-2023
Abstract: This study explores the barriers and facilitators to point-of-care ultrasound (POCUS) use and adoption in rural healthcare since POCUS is a useful resource for rural clinicians to overcome the challenges associated with limited on-site clinical support, such as limited diagnostic imaging services and infrastructure. A qualitative descriptive study was employed, interviews with ten rural clinicians were conducted, and the data were analysed using the Walt and Gilson health policy framework to guide interpretation. Barriers include a lack of standardised training requirements, the cost of the devices and challenges recouping the costs of purchase and training, difficulty with the maintenance of skills, and a lack of an effective method to achieve quality assurance. Coupling POCUS with telemedicine could address the issues of the maintenance of skills and quality assurance to facilitate increased POCUS use, leading to positive patient safety and social and economic implications.
Publisher: MDPI AG
Date: 09-05-2022
DOI: 10.20944/PREPRINTS202205.0099.V1
Abstract: Diabetes mellitus (DM) is associated with severe COVID-19 infection and complications. This study assessed COVID-19 vaccine acceptance and hesitancy in diabetes and explored reasons for nonvaccinating. A web-based cross-sectional survey using a mixed method approach was distributed to participants aged & ge years with self-reported DM in 11 Sub-Saharan African (SSA) countries from March& ndash May 2021 corresponding to the early vaccine roll out period in most SSA countries. Responses to comments were analyzed for reasons for vaccine hesitancy and facilitators for vaccine uptake. Of the 73 participants with DM, 65.8% were males, older than 35 years (86.3%), had a post-secondary education (90%) and a significant proportion were from South Africa (39.7%), Nigeria (28.8%) and Ghana (13.7%). 64.4% had COVID-19 symptoms, 46.6% were tested for COVID-19 of which 19.2% tested positive. Few participants (6.8%) had taken COVID-19 vaccination, 65.8% were willing to take the vaccine, while 26.0% either refused or hesitated to take the vaccines. The main reasons identified for not taking the vaccine were: concerns about the vaccine safety, its effects, and efficacy, mistrust of the pharmaceutical companies, the conspiracy theories around the vaccines, the process of production, and personal belief of the participants. However, participants stated they would take the vaccine if given more education about it, receive positive feedback from those vaccinated, are rewarded for taking the vaccine or if vaccination becomes a condition for travel and employment. The findings of this study showed that uptake of COVID-19 vaccine was very low in this high-risk group. It is imperative that efforts to increase uptake of vaccine such as provision of education and relevant information, are made.
Publisher: MDPI AG
Date: 15-06-2022
DOI: 10.20944/PREPRINTS202205.0099.V2
Abstract: Abstract: Diabetes mellitus (DM) is associated with severe COVID-19 infection and complications. This study assessed COVID-19 vaccine acceptance and hesitancy in diabetes and explored reasons for nonvaccinating. This was a web-based cross-sectional survey using a mixed-method approach conducted between March-May 2021 corresponding to most SSA countries' early vaccine rollout period. Participants were those aged & ge years with self-reported DM in 11 Sub-Saharan African (SSA) countries. Responses to comments on reasons for vaccine hesitancy and facilitators for vaccine uptake were analyzed. Of the 73 participants with DM, 65.8% were males older than 35 years (86.3%), had post-secondary education (90%), and a significant proportion was from South Africa (39.7%), Nigeria (28.8%) and Ghana (13.7%). 64.4% had COVID-19 symptoms, 46.6% were tested for COVID-19, of which 19.2% tested positive. Few participants (6.8%) had taken the COVID-19 vaccination, 65.8% were willing to take the vaccine, while 26.0% either refused or hesitated to take the vaccine. The main reasons identified for not taking the vaccine were: advice from religious leaders, concerns about the vaccine safety, its effects, and efficacy, mistrust of the pharmaceutical companies, the conspiracy theories around the vaccines, the process of production, and the personal belief of the participants. However, participants stated they would take the vaccine if given more education about it, receive positive feedback from those vaccinated, are rewarded for taking the vaccine or if vaccination becomes a condition for travel and employment. The findings of this study showed that uptake of the COVID-19 vaccine was very low in this high-risk group. It is imperative that efforts to increase the uptake of vaccines, such as the provision of education and relevant information, are made.
Publisher: Oxford University Press (OUP)
Date: 28-05-2021
DOI: 10.1093/JRR/RRAB037
Abstract: An abscopal effect occurs when localized radiotherapy causes the regression of tumors distant from the irradiated site. However, such a clinically detectable abscopal effect from radiotherapy alone is rare. This study investigated whether valproic acid ([VPA], a histone deacetylase inhibitor [HDACi]) treatment can stimulate radiation-induced abscopal effect. We used 7,12-dimethylbenz[a]anthracene, a typical environmental carcinogen, to establish a rat model with multiple breast tumors. Only one tumor received 8 Gy fractionated doses of X-rays (2 Gy daily fractions over four days) and 200 mg/kg VPA was administered intraperitoneally. We monitored the growth of both irradiated and unirradiated tumors after treatments. The unirradiated tumor was collected for hematoxylin and eosin (HE) staining, immunohistochemistry (IHC) (CD8, Granzyme B, Cleaved Caspase-3, BrdU, Ki67, F4/80 and CD68), double immunofluorescence (F4/80 and CD86), Western blot (Cleaved Caspase-3) and qRT-PCR (CD86, CD163, IL-1β, IL-6, IL-12, IL-23, IL-10, TGF-β) analysis. We found ionizing radiation (IR) + VPA treatment inhibited both irradiated and unirradiated tumor growth as compared to IR alone. Such observe abscopal effect was mediated by the recruitment of activated CD8+ T cells into the unirradiated tumor sites, which released Granzyme B to cause tumor cell apoptosis. Furthermore, IR + VPA treatment led to macrophages infiltration into the unirradiated tumor sites and polarization to M1 phenotype, resulted in increased levels of pro-inflammatory cytokines such as IL-1β and IL-12, and decreased levels of anti-inflammatory cytokines such as IL-10 and TGF-β. Our data supports the proposition that VPA may be a potential therapeutic candidate to trigger radiation-induced abscopal effect by modulating the unirradiated tumor immune microenvironment.
Publisher: Wiley
Date: 17-11-2022
Abstract: Demand for ED care is increasing at a rate higher than population growth. Strategies to attenuate ED demands include erting low‐acuity general practice‐type ED attendees to alternate primary healthcare settings. The present study assessed the ED attendees' receptiveness to accept triage nurse's face‐to‐face advice to explore alternate options for medical care and what factors influence the level of acceptance. The ED attendees of four major public hospital EDs in Brisbane were surveyed between August and October 2018, using a questionnaire informed by Health Belief Model's cues to action. Of the 514 valid responses, 81% of respondents were very likely/likely to accept the triage nurse's advice to see a general practitioner. Self‐perceived urgency of presenting condition/s (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.78–0.97), not having confidence in general practitioner (OR 0.37, 95% CI 0.21–0.66) and having a medical record at the hospital (OR 0.60, 95% CI 0.36–0.99) were negatively associated with the likelihood of accepting the advice. For every point increase in perceived seriousness, the odds of accepting the advice decreased by 16% (95% CI 6–25%). Most of the participants believed that EDs were for emergent care and they attended the ED because they perceived their presenting condition/s to be serious and/or urgent. The acceptability of face‐to‐face advice by triage nurse to seek help in general practice was influenced by perceived threats of the illness, and the underlying beliefs about availability, accessibility, suitability and affordability of the service.
Publisher: Springer Science and Business Media LLC
Date: 21-01-2021
DOI: 10.1186/S13643-021-01587-8
Abstract: All in iduals should have the right to engage meaningfully in occupations that meet their aspirations and life goals as well as promote their health and well-being. For in iduals with disability, meaningful engagement in occupations is supported by timely, effective, and adaptive health and support services. However, research has revealed multiple barriers preventing utilization of these services by in iduals with disability from culturally and linguistically erse (CALD) backgrounds. This review aims to identify gaps and solutions in health and support services of in iduals with disability from CALD backgrounds to meaningfully engage in occupations. A scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. A detailed search strategy will be used to search CINAHL, PubMed, Embase, Scopus, PsycInfo, JBI, and Cochrane Library, as well as grey literature in Trove, Mednar, and OpenGrey from January 1974 onwards. Two reviewers will independently screen all citations and full-text articles for eligibility against specific inclusion and exclusion criteria. Potential conflicts will be resolved through discussion. Data will be extracted and presented in a diagrammatic or tabular form accompanied by a narrative summary. The scoping review will present the health and support service needs of in iduals with disability from CALD backgrounds and will extend the current reviews as it focuses the engagement in meaningful occupation. Findings from this review have the potential to inform local policy discussions and practice-based disability care. Open Science Framework ( 10.17605/OSF.IO/HW2FB ).
Publisher: Springer Science and Business Media LLC
Date: 28-11-2022
DOI: 10.1186/S12888-022-04403-2
Abstract: The COVID-19 pandemic has resulted in serious mental health conditions, particularly among older adults. This research explored the prevalence of COVID-19-related anxiety and its associated factors among older adults residing in Bangladesh. This cross-sectional study was conducted among 1,045 older Bangladeshi adults aged ≥ 60 years through telephone interviews in September 2021. A semi-structured interview schedule was used to collect data on participants’ characteristics and COVID-19-related anxiety. The anxiety level was measured using the Bengali version of the five-point Coronavirus Anxiety Scale (CAS). A linear regression model explored the factors associated with COVID-19-related anxiety. Overall, the prevalence of COVID-19-related anxiety was 23.2%. The regression analysis revealed that the average COVID-19-related anxiety score was significantly higher among females (β: 0.43, 95% CI: 0.05 to 0.81), and among those who faced difficulty getting medicine (β: 0.57, 95% CI: 0.16 to 0.97), felt isolated (β: 0.60, 95% CI: 0.24 to 0.95), and felt requiring additional care during the pandemic (β: 0.53, 95% CI: 0.16 to 0.91). Alternatively, the average COVID-19-related anxiety score was significantly lower among those who were widowed (β: -0.46, 95% CI: -0.87 to -0.04) and living distant from the health centre (β: -0.48, 95% CI: -0.79 to -0.17). The findings of the present study suggest providing immediate psychosocial support package to the older adults, particularly females and those who are vulnerable to receive health and social care support during the COVID-19 pandemic in Bangladesh.
Publisher: Wiley
Date: 18-05-2023
DOI: 10.1111/AJR.12994
Abstract: Australian rural and remote areas are faced with the double burden of an ageing population paired with inequitable access to health resources due to the paradigm of major city centred health care. This complicates fall management within this space. Paramedics are a registered health profession, which provides mobile, equitable health care. However, this resource is not being effectively utilised in rural and remote areas where primary care access barriers may cause patient needs to go unmet. To describe the existing literature and describe the international scope of current paramedicine practice in the out‐of‐hospital management of falls amongst older adults in rural and remote settings. Joanna Briggs Institute scoping review methodology was employed. CINAHL (EBSCO), MEDLINE (Ovid), EMBASE (Ovid), SCOPUS (Elsevier), Google Scholar and These Global were searched and Australian, New Zealand and the UK ambulance service guidelines were sought. Two records met inclusion criteria. Currently, rural and remote paramedic fall management involves preventative health promotion through patient education, population‐based screening and referrals. The use of paramedics to screen at‐risk populations and refer is vital, as many rural adults had screened positive to fall risks and other unmet needs. There is poor recollection of physically printed education material and low acceptance of further in‐home assessments following paramedic departure. This scoping review has highlighted a significant knowledge gap on this topic. Further research is needed to effectively utilise paramedicine within areas where access to primary care is not possible to achieve downstream, risk reducing care in the home.
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.ECOENV.2022.113779
Abstract: Polycyclic aromatic hydrocarbons (PAHs) are common persistent organic pollutants that are carcinogenic, teratogenic and mutagenic, causing a variety of harm to human health. In this study, we investigated the mechanism of how valproic acid (VPA) interferes with the carcinogenesis of PAHs protect normal tissues via the regulation of macrophages' function. Using the established model of transformed malignant breast cancer by 7,12-dimethylbenz[a]anthracene (DMBA), a representative PAH carcinogen, we discovered VPA induces the polarization of macrophages toward the M1 phenotype in the tumor tissues, facilitates the expression of pro-inflammatory cytokines such as IFN-γ, IL-12 and TNF-α, activates CD8
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-06-2022
Publisher: Elsevier BV
Date: 10-2023
Publisher: Cambridge University Press (CUP)
Date: 08-03-2021
DOI: 10.1017/S1049023X21000200
Abstract: This scoping review aims to map the roles of rural and remote primary health care professionals (PHCPs) during disasters. Disasters can have catastrophic impacts on society and are broadly classified into natural events, man-made incidents, or a mixture of both. The PHCPs working in rural and remote communities face additional challenges when dealing with disasters and have significant roles during the Prevention, Preparedness, Response, and Recovery (PPRR) stages of disaster management. A Johanna Briggs Institute (JBI) scoping review methodology was utilized, and the search was conducted over seven electronic databases according to a priori protocol. Forty-one papers were included and sixty-one roles were identified across the four stages of disaster management. The majority of disasters described within the literature were natural events and pandemics. Before a disaster occurs, PHCPs can build in idual resilience through education. As recognized and respected leaders within their community, PHCPs are invaluable in assisting with disaster preparedness through being involved in organizations’ planning policies and contributing to natural disaster and pandemic surveillance. Key roles during the response stage include accommodating patient surge, triage, maintaining the health of the remaining population, instituting infection control, and ensuring a team-based approach to mental health care during the disaster. In the aftermath and recovery stage, rural and remote PHCPs provide long-term follow up, assisting patients in accessing post-disaster support including delivery of mental health care. Rural and remote PHCPs play significant roles within their community throughout the continuum of disaster management. As a consequence of their flexible scope of practice, PHCPs are well-placed to be involved during all stages of disaster, from building of community resilience and contributing to early alert of pandemics, to participating in the direct response when a disaster occurs and leading the way to recovery.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-07-2020
Publisher: Wiley
Date: 07-10-2021
DOI: 10.5694/MJA2.51295
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.WNEU.2022.02.001
Abstract: Gliomas are the most common primary malignant tumor of the central nervous system. At the present time, radiotherapy (RT) is the cornerstone of therapeutic approaches, but the worldwide research trends in RT for gliomas in the world are unclear. This bibliometric analysis aimed to investigate trends in glioma RT research since 2011. The Web of Science database was searched, and SigmaPlot 14.0 and VOSviewer software were used to analyze and visualize the trends. Bibliometric analysis of 5106 articles was conducted. While the number of publications per year was relatively steady, the number of citations grew exponentially from 356 in 2011 to 21,051 in 2020. Articles originated from 89 countries, with the majority from the United States. Journal of Neuro-Oncology and Texas A&M University were the journal and institution, respectively, with the highest number of publications. The articles mainly involved oncology, neurology, radiology, and surgery. This bibliometric analysis found an increased focus on glioblastoma, survival, and chemotherapy in glioma RT research.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2017
DOI: 10.11124/JBISRIR-2016-003103
Abstract: The current mixed methods review aims to develop an aggregated synthesis of quantitative, qualitative and economic systematic evidence on chronic hepatitis C virus (HCV) infection management intervention delivered in community settings so as to gain an increased understanding of the clinical effectiveness, cost-effectiveness and acceptability of community-based chronic HCV management. This review will contribute to the development of a community-based chronic HCV intervention and inform clinical practice and policy discussion. The overarching question is: What is the clinical effectiveness, cost-effectiveness and acceptability of community-based programs for chronic HCV management? The sub-questions to be addressed in the review are: What is the clinical effectiveness (proportion of antiviral treatment completion and sustained virologic response) of the community-based chronic HCV management programs? What is the acceptability (treatment uptake, adherence, engagement and satisfaction) of community-based chronic HCV management programs from the perspective of involved patients? How are the models funded and are they cost-effective? What are the organizational and operational elements of the models of community-based chronic HCV management?
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.MRGENTOX.2021.503422
Abstract: Triple-negative breast cancer (TNBC) treatment has only limited effect, and it causes a significant number of deaths. Histone deacetylase inhibitors (HDACis) are emerging as promising anti-tumor agents in many types of cancers. We thus hypothesized that 2-hexyl-4-pentynoic acid (HPTA), a novel HDACi, could sensitize TNBC to hydroxyurea (HU, a ribonucleotide reductase inhibitor). In the present study, we investigated the effect of HPTA, alone or in combination with HU on cell survival, DNA double-strand breaks (DSBs), key homologous recombination (HR) repair proteins and cell cycle progression in MDA-MB-468 and MDA-MB-231 human TNBC cell lines. HPTA and HU synergistically inhibited the survival of TNBC cell lines and resulted in the accumulation of DNA double-strand breaks (DSBs). HPTA can sensitize TNBC cells to HU by inhibiting replication protein A2 (RPA2) hyperphosphorylation-mediated HR repair, and lessen cell accumulation in S-phase by inhibiting ATR-CHK1 signaling pathway. Taken together, our data suggested that HPTA enhances HU therapeutic effect by blocking the HR repair and regulating cell cycle progression in TNBC.
Publisher: Queensland University of Technology
Date: 2022
DOI: 10.5204/REP.EPRINTS.227473
Abstract: Demand for public hospital emergency departments’ services and care is increasing, placing considerable restraint on their performance and threatens patient safety. Many factors influence such demand including in idual characteristics (e.g. perceptions, knowledge, values and norms), healthcare availability, affordability and accessibility, population aging, and internal health system factors (e.g patient flow, discharge process). To alleviate demand, many initiatives have been trialled or suggested, including early identification of at-risk patients, better management of chronic disease to reduce avoidable ED presentation, expanded capacity of front-line clinician to manage sub-acute and non-urgent care, improved hospital flow to reduce access block, and ersion to alternate site for care. However, none have had any major or sustained impact on the growth in ED demand. A major focus of the public discourse on ED demand has been the use and integration of primary healthcare and ED, based on the assumption that between 10%–25% of ED presentations are potentially avoidable if patients’ access to appropriate primary healthcare (PHC) services were enhanced. However, this requires not only improved access but also appropriateness in terms of the patients’ preference and PHC providers’ capacity to address the needs. What is not known at the moment is the extent of the potential for ersion of non-urgent ED patients to PHC and the cost-benefits of such policy and funding changes required, particularly in the Australian context. There is a need to better understand ED patients’ needs and capacity constraint so as to effect delivery of accessible, affordable, efficient and responsive services. Jennie Money Doug Morel
Publisher: Springer Science and Business Media LLC
Date: 13-02-2023
DOI: 10.1038/S41419-023-05649-8
Abstract: Cell cycle checkpoint kinases play a pivotal role in protecting against replicative stress. In this study, valproic acid (VPA), a histone deacetylase inhibitor (HDACi), was found to promote breast cancer MCF-7 cells to traverse into G2/M phase for catastrophic injury by promoting PPP2R2A (the B-regulatory subunit of Phosphatase PP2A) to facilitate the dephosphorylation of Chk1 at Ser317 and Ser345. By contrast, VPA protected normal 16HBE cells from HU toxicity through decreasing PPP2R2A expression and increasing Chk1 phosphorylation. The effect of VPA on PPP2R2A was at the post-transcription level through HDAC1/2. The in vitro results were affirmed in vivo. Patients with lower PPP2R2A expression and higher pChk1 expression showed significantly worse survival. PPP2R2A D197 and N181 are essential for PPP2R2A-Chk1 signaling and VPA-mediated bidirectional effect on augmenting HU-induced tumor cell death and protecting normal cells.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 31-12-2021
Publisher: Wiley
Date: 14-06-2023
DOI: 10.1111/JOCN.16789
Abstract: This study aimed to explore what constitutes brilliant aged care. Although many aged care services do not offer the care that older people and carers need and want, some perform better. Rather than focus on problems with aged care, this study examined brilliant aged care—practices that exceeded expectation. The methodology for this study was informed by grounded theory, underpinned by constructionism to socially construct meaning. This study invited nominations for a Brilliant Award via a survey, and interviews with the nominees via web conference. After receiving survey responses from 10 nominators, interviews were conducted with 12 nominees. Data were analysed using reflexive thematic analysis and documented according to COREQ guidelines to optimise rigour and transparency. According to participants, brilliant aged care involved being relationally attuned to older people, a deep understanding of the older person, recognition of aged care as more than a job, innovative practices and permission to reprioritise. This study suggests that, in aged care, brilliance happens. It emphasises the importance of meaningful connections and relationships in aged care, where thoughtful acts acknowledge an older person's value and humanity as well as creativity and innovation. For those who manage and deliver aged care, the findings suggest that small practice changes can make a positive difference to older people. Brilliant aged care can involve acts of empathy enthusiasm for aged care innovative practices, even those that are small scale and reprioritising workplace tasks to spend time with older people. For policymakers, this study highlights the need to recognise and raise the profile of the pockets of brilliance within the aged care sector. This might be achieved via awards and other initiatives that serve to celebrate and learn from brilliance in its myriad forms. The nominees, who included carers, were invited to participate in workshops with other carers and older people to co‐design a model of brilliant aged care, during which workshop participants discussed and critiqued the findings constructed from the data.
Publisher: Informa UK Limited
Date: 24-02-2021
Publisher: Oxford University Press (OUP)
Date: 30-09-2022
DOI: 10.1093/NOP/NPAC078
Abstract: Histone deacetylase inhibitors (HDACi) including valproic acid (VPA) have the potential to improve radiotherapy (RT) efficacy and reduce treatment adverse events (AE) via epigenetic modification and radio-sensitization of neoplastic cells. This systematic review and meta-analysis aimed to assess the efficacy and AE associated with HDACi used as radio-sensitizers in adult solid organ malignancy patients. A systematic review utilized electronic searches of MEDLINE(Ovid), Embase(Ovid), The Cochrane Library, and the International Clinical Trials Registry Platform to identify studies examining the efficacy and AEs associated with HDACi treatment in solid organ malignancy patients undergoing RT. Meta-analysis was performed with overall survival (OS) reported as hazard ratios (HR) as the primary outcome measure. OS reported as median survival difference, and AEs were secondary outcome measures. Ten studies reporting on the efficacy and/or AEs of HDACi in RT-treated solid organ malignancy patients met inclusion criteria. All included studies focused on HDACi valproic acid (VPA) in high-grade glioma patients, of which 9 studies (n = 6138) evaluated OS and 5 studies (n = 1055) examined AEs. The addition of VPA to RT treatment protocols resulted in improved OS (HR = 0.80, 95% CI 0.67–0.96). No studies focusing on non-glioma solid organ malignancy patients, or non-VPA HDACi met the inclusion criteria for this review. This review suggests that glioma patients undergoing RT may experience prolonged survival due to HDACi VPA administration. Further randomized controlled trials are required to validate these findings. Additionally, more research into the use of HDACi radio-adjuvant treatment in non-glioma solid organ malignancies is warranted.
Publisher: Springer Science and Business Media LLC
Date: 18-07-2019
Publisher: JMIR Publications Inc.
Date: 18-07-2022
DOI: 10.2196/38553
Abstract: Access to rehabilitation to support cancer survivors to exercise is poor. Group exercise–based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy. We aimed to evaluate the efficacy of a group exercise–based cancer rehabilitation program delivered via telehealth compared to usual care for improving the quality of life of cancer survivors. A parallel, assessor-blinded, pragmatic randomized controlled trial with embedded cost and qualitative analysis will be completed. In total, 116 cancer survivors will be recruited from a metropolitan health network in Melbourne, Victoria, Australia. The experimental group will attend an 8-week, twice-weekly, 60-minute exercise group session supervised via videoconferencing supplemented by a web-based home exercise program and information portal. The comparison group will receive usual care including standardized exercise advice and written information. Assessments will be completed at weeks 0 (baseline), 9 (post intervention), and 26 (follow-up). The primary outcome will be health-related quality of life measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire), and adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semistructured interviews will be completed within an interpretive description framework to explore the patient experience. The primary outcome will be analyzed using linear mixed effects models. A cost-effectiveness analysis will also be performed. The trial commenced in April 2022. As of June 2022, we enrolled 14 participants. This trial will inform the future implementation of cancer rehabilitation by providing important data about efficacy, safety, cost, and patient experience. Australian New Zealand Clinical Trials Registry ACTRN12621001417875 c5crwtr PRR1-10.2196/38553
Publisher: Frontiers Media SA
Date: 27-03-2023
DOI: 10.3389/FGENE.2023.1121018
Abstract: Background: Breast cancer (BRCA) is regarded as a lethal and aggressive cancer with increasing morbidity and mortality worldwide. cGAS-STING signaling regulates the crosstalk between tumor cells and immune cells in the tumor microenvironment (TME), emerging as an important DNA-damage mechanism. However, cGAS-STING-related genes (CSRGs) have rarely been investigated for their prognostic value in breast cancer patients. Methods: Our study aimed to construct a risk model to predict the survival and prognosis of breast cancer patients. We obtained 1087 breast cancer s les and 179 normal breast tissue s les from the Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEX) database, 35 immune-related differentially expression genes (DEGs) from cGAS-STING-related genes were systematically assessed. The Cox regression was applied for further selection, and 11 prognostic-related DEGs were used to develop a machine learning-based risk assessment and prognostic model. Results: We successfully developed a risk model to predict the prognostic value of breast cancer patients and its performance acquired effective validation. The results derived from Kaplan-Meier analysis revealed that the low-risk score patients had better overall survival (OS). The nomogram that integrated the risk score and clinical information was established and had good validity in predicting the overall survival of breast cancer patients. Significant correlations were observed between the risk score and tumor-infiltrating immune cells, immune checkpoints and the response to immunotherapy. The cGAS-STING-related genes risk score was also relevant to a series of clinic prognostic indicators such as tumor staging, molecular subtype, tumor recurrence, and drug therapeutic sensibility in breast cancer patients. Conclusion: cGAS-STING-related genes risk model provides a new credible risk stratification method to improve the clinical prognostic assessment for breast cancer.
Publisher: Oxford University Press (OUP)
Date: 31-08-2020
Abstract: This study investigated whether valproic acid (VPA, a histone deacetylase inhibitor) can interfere with the carcinogenicity of polycyclic aromatic hydrocarbons (PAHs). A typical representative compound of PAHs, 7,12-Dimethylbenz[a]anthracene (DMBA), was used to induce rat breast cancer. The results showed that therapeutic concentration of VPA (50 and 100 mg/kg) delayed the occurrence of tumors, reduced tumor formation rate and attenuated tumors growth, and have a protective effect on normal tissues. The macrophage-mediated inflammatory response was found to be associated with the observed effect of VPA. In addition, we screened and validated a possible gene, Sema3c, which was involved in DMBA-induced breast cancer development and can be inhibited by VPA.
Publisher: Oxford University Press (OUP)
Date: 22-07-2022
Abstract: Radioprotectors safeguard biological system exposed to ionizing radiation (IR) by protecting normal cells from radiation damage during radiotherapy. Due to the toxicity and limited clinical utility of the present radioprotectors, it prompts us to identify novel radioprotectors that could alleviate IR-induced cytotoxicity of normal tissues. To identify new radioprotectors, we screened a chemical molecular library comprising 253 compounds in normal human fibroblasts (HFs) or 16HBE cells upon IR by CCK-8 assays and clonogenic survival assays. Fasudil was identified as a potential effective radioprotector. The results indicated that Fasudil exerts radioprotective effects on HFs against IR-induced DNA double-strand breaks (DSBs) through the regulation of DSB repair. Fasudil increased homologous recombination (HR) repair by 45.24% and decreased non-homologous end-joining (NHEJ) by 63.88% compared with untreated cells, without affecting changes to cell cycle profile. We further found that fasudil significantly facilitated the expression and foci formation of HR core proteins such as Rad51 and BRCA1 upon IR, and decreased the expression of NHEJ-associated proteins such as DNA-PKcs at 24 h post-IR. Our study identified fasudil as a novel radioprotector that exert radioprotective effects on normal cells through regulation of DSB repair by promoting HR repair.
Publisher: Public Library of Science (PLoS)
Date: 15-12-2022
DOI: 10.1371/JOURNAL.PONE.0278988
Abstract: Opioid Use Disorder (OUD) and opioid overdose (OD) impose huge social and economic burdens on society and health care systems. Research suggests that Medication for Opioid Use Disorder (MOUD) is effective in the treatment of OUD. We use machine learning to investigate the association between patient’s adherence to prescribed MOUD along with other risk factors in patients diagnosed with OUD and potential OD following the treatment. We used longitudinal Medicaid claims for two selected US states to subset a total of 26,685 patients with OUD diagnosis and appropriate Medicaid coverage between 2015 and 2018. We considered patient age, sex, region level socio-economic data, past comorbidities, MOUD prescription type and other selected prescribed medications along with the Proportion of Days Covered (PDC) as a proxy for adherence to MOUD as predictive variables for our model, and overdose events as the dependent variable. We applied four different machine learning classifiers and compared their performance, focusing on the importance and effect of PDC as a variable. We also calculated results based on risk stratification, where our models separate high risk in iduals from low risk, to assess usefulness in clinical decision-making. Among the selected classifiers, the XGBoost classifier has the highest AUC (0.77) closely followed by the Logistic Regression (LR). The LR has the best stratification result: patients in the top 10% of risk scores account for 35.37% of overdose events over the next 12 month observation period. PDC score calculated over the treatment window is one of the most important features, with better PDC lowering risk of OD, as expected. In terms of risk stratification results, of the 35.37% of overdose events that the predictive model could detect within the top 10% of risk scores, 72.3% of these cases were non-adherent in terms of their medication (PDC .8). Targeting the top 10% outcome of the predictive model could decrease the total number of OD events by 10.4%. The best performing models allow identification of, and focus on, those at high risk of opioid overdose. With MOUD being included for the first time as a factor of interest, and being identified as a significant factor, outreach activities related to MOUD can be targeted at those at highest risk.
Publisher: MDPI AG
Date: 27-06-2022
Abstract: Diabetes mellitus (DM) is associated with severe COVID-19 infection and complications. This study assesses COVID-19 vaccine acceptance and hesitancy in people with DM, and explores the reasons for not being vaccinated. This was a web-based cross-sectional survey using a mixed-method approach conducted in March–May 2021, corresponding to most Sub-Saharan African (SSA) countries’ early vaccine rollout period. Participants were those aged ≥18 years with self-reported DM in 11 Sub-Saharan African (SSA) countries. Responses to comments on the reasons for vaccine hesitancy and facilitators for vaccine uptake were analyzed. Of the 73 participants with DM, 65.8% were males, older than 35 years (86.3%), had postsecondary education (90%), and a significant proportion were from South Africa (39.7%), Nigeria (28.8%) and Ghana (13.7%). At the time of this study, 64.4% experienced COVID-19 symptoms, 46.6% were tested for COVID-19, of which 19.2% tested positive. Few participants (6.8%) had received a COVID-19 vaccination, 65.8% were willing to take the vaccine when it becomes available in their country, while 26.0% either refused or remained hesitant towards taking the vaccine. The main identified reasons for not taking the vaccine were: advice from religious leaders concerns about the safety, effects, and efficacy of the vaccines mistrust of the pharmaceutical companies producing the vaccines and the process of production the conspiracy theories around the vaccines and the personal belief of the participants regarding vaccination. However, participants stated they would take the vaccine if they were more educated about it, received positive feedback from those vaccinated, were rewarded for taking the vaccine, or if vaccination became a condition for travel and employment. In conclusion, this study shows that the uptake of the COVID-19 vaccine was very low in this high-risk group. Efforts to increase the uptake of COVID-19 vaccines among people with diabetes are imperative, such as the provision of education and relevant information.
Publisher: BMJ
Date: 11-2022
DOI: 10.1136/BMJOPEN-2022-063659
Abstract: This systematic review aims to improve our knowledge of enablers and barriers to implementing obesity-related anthropometric assessments in clinical practice. A mixed-methods systematic review. Medline, Embase and CINAHL to November 2021. Quantitative studies that reported patient factors associated with obesity assessments in clinical practice (general practice or primary care) and qualitative studies that reported views of healthcare professionals about enablers and barriers to their implementation. We used random-effects meta-analysis to pool ratios for categorical predictors reported in ≥3 studies expressed as pooled risk ratio (RR) with 95% CI, applied inverse variance weights, and investigated statistical heterogeneity (I 2 ), publication bias (Egger’s test), and sensitivity analyses. We used reflexive thematic analysis for qualitative data and applied a convergent integrated approach to synthesis. We reviewed 22 quantitative (observational) and 3 qualitative studies published between 2004 and 2020. All had ≥50% of the quality items for risk of bias assessments. Obesity assessment in clinical practice was positively associated with patient factors: female sex (RR 1.28, 95% CI 1.10 to 1.50, I 2 99.8%, mostly UK/USA), socioeconomic deprivation (RR 1.21, 95% CI 1.18 to 1.24, I 2 73.9%, UK studies), non-white race/ethnicity (RR 1.27, 95% CI 1.03 to 1.57, I 2 99.6%) and comorbidities (RR 2.11, 95% CI 1.60 to 2.79, I 2 99.6%, consistent across most countries). Obesity assessment was also most common in the heaviest body mass index group (RR 1.55, 95% CI 0.99 to 2.45, I 2 99.6%). Views of healthcare professionals were positive about obesity assessments when linked to patient health (convergent with meta-analysis for comorbidities) and if part of routine practice, but negative about their role, training, time, resources and incentives in the healthcare system. Our evidence synthesis revealed several important enablers and barriers to obesity assessments that should inform healthcare professionals and relevant stakeholders to encourage adherence to clinical practice guideline recommendations.
Publisher: Elsevier BV
Date: 09-2009
DOI: 10.1016/J.HEALTHPOL.2009.01.008
Abstract: Some doctors perform the dual roles of prescribing and dispensing pharmaceuticals. The dispensing doctors (DDs) role may give rise to prescribing behaviours that vary from those of non-DDs. The aim of this review was to systematically and comparatively appraise the research evidence related to the practices of DDs. A systematic search of bibliographic databases and reference lists from selected papers were the sources of the data. Inclusion criteria were papers published in English, between 1970 and 2008 that provided quantitative data comparing the practices of DDs and non-DDs. At least two of the authors abstracted data from all eligible papers using a purpose-made data extraction form. Twenty-one papers were included in this review. Evidence indicated that DDs prescribed more pharmaceutical items and less often generically than non-DDs. There was limited evidence to suggest that DDs prescribed less judiciously and were associated with poor dispensing standards. Patient convenience and access to pharmaceuticals were main reasons for doctors to dispense. DDs can fill an important gap in the provision of pharmaceuticals for their patients especially where health workforce shortages exist. There was evidence the dispensing role influenced prescribing. Patient convenience should be balanced against scarce medical resources, being utilised for dispensing.
Publisher: Springer Science and Business Media LLC
Date: 06-01-2023
Publisher: Informa UK Limited
Date: 2021
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/PY11030
Abstract: Due to the chronic shortages of GPs in Australian rural and remote regions, considerable numbers of international medical graduates (IMG) have been recruited. IMG experience many difficulties when relocating to Australia with one of the most significant being effective GP−patient communication. Given that this is essential for effective consultation it can have a substantial impact on health care. A purposive s le of seven practising GPs (five IMG, two Australian-trained doctors (ATD)) was interviewed using a semistructured face-to-face interviewing technique. GPs from Nigeria, Egypt, United Kingdom, India, Singapore and Australia participated. Interviews were transcribed and then coded. The authors used qualitative thematic analysis of interview transcripts to identify common themes. IMG−patient communication barriers were considered significant in the Wheatbelt region as identified by both IMG and ATD. ATD indicated they were aware of IMG−patient communication issues resulting in subsequent consults with patients to explain results and diagnoses. Significantly, a lack of communication between ATD and IMG also emerged, creating a further barrier to effective communication. Analysis of the data generated several important findings that rural GP networks should consider when integrating new IMG into the community. Addressing the challenges related to cross-cultural differences should be a priority, in order to enable effective communication. More open communication between ATD and IMG about GP−patient communication barriers and education programs around GP−patient communication would help both GP and patient satisfaction.
Publisher: BMJ
Date: 2023
DOI: 10.1136/BMJOPEN-2022-069120
Abstract: Chronic disease is a leading cause of death and disability that disproportionately burdens culturally and linguistically erse (CALD) communities. Self-management is a cornerstone of effective chronic disease management. However, research suggests that patients from CALD communities may be less likely to engage with self-management approaches. The Natural Helper Programme aims to facilitate patient engagement with self-management approaches (ie, ‘activation’) by embedding cultural mentors with lived experience of chronic disease into chronic disease clinics rogrammes. The Natural Helper Trial will explore the effect of cultural mentors on patient activation, health self-efficacy, coping efforts and health-related quality of life (HRQoL) while also evaluating the implementation strategy. A hybrid type-1 effectiveness-implementation cluster-randomised controlled trial (phase one) and a mixed-method controlled before-and-after cohort extension of the trial (phase 2). Hospital clinics in highly multicultural regions in Australia that provide healthcare for patients with chronic and/or complex conditions, will participate. A minimum of 16 chronic disease clinics (clusters) will be randomised to immediate (active arm) or delayed implementation (control arm). In phase 1, the active arm will receive a multifaceted strategy supporting them to embed cultural mentors in their services while the control arm continues with usual care. Each cluster will recruit an average of 15 patients, assessed at baseline and 6 months (n=240). In phase 2, clusters in the control arm will receive the implementation strategy and evaluate the intervention on an additional 15 patients per cluster, while sustainability in active arm clusters will be assessed qualitatively. Change in activation over 6 months, measured using the Patient Activation Measure will be the primary effectiveness outcome, while secondary effectiveness outcomes will explore changes in chronic disease self-efficacy, coping strategies and HRQoL. Secondary implementation outcomes will be collected from patient–participants, mentors and healthcare providers using validated questionnaires, customised surveys and interviews aligning with the Reach, Effectiveness, Adoption, Implementation, Maintenance framework to evaluate acceptability, reach, dose delivered, sustainability, cost-utility and healthcare provider determinants. This trial has full ethical approval (2021/ETH12279). The results from this hybrid trial will be presented at scientific meetings and published in peer-reviewed journals. ACTRN12622000697785.
Publisher: Wiley
Date: 17-12-2020
Abstract: To estimate the proportion of ED patients in urban Queensland who are potentially suitable for general practitioner (GP) care. A retrospective analysis was conducted using ED Information System data from Metro North Hospital and Health Service in Brisbane, Australia for three consecutive financial years (2014-2015 to 2016-2017). The hospitals included two Principal Referral and two Public Acute hospitals. GP-type patients were calculated using the Australian Institute of Health and Welfare (AIHW), Australasian College for Emergency Medicine (ACEM) and the validated Sprivulis methods. Of the 822 841 ED presentations, 219 567 (27%) were potentially GP-type patients by AIHW, 49 307 (6%) by ACEM and 61 836 (8%) by Sprivulis methods. The higher proportion of GP-type presentations were during 08.00 to 17.00 hours by AIHW and ACEM methods. Of the lower-acuity triage categories of 4 (286 154 presentations) and 5 (5658 presentations), AIHW estimated that 62% and 80% of the patients were GP-type patients, as compared to 9% and 22% by ACEM, and 9% and 0.3% by Sprivulis method. The mean costs of adult GP-type patients is $345 by the AIHW and $406 by the ACEM method, lower than non-GP type patients ($706 and $622, respectively). There is considerable variation in what is considered GP-type ED presentations based on the three methods employed and this variation may have fuelled the debate surrounding what is 'avoidable' ED utilisation. Regardless, the study findings provide an interesting addition to defining and addressing appropriate utilisation of ED services.
Publisher: Wiley
Date: 19-03-2022
Abstract: To inform local, state and national strategies intended to reduce demand for ED care, the present study aimed to identify key factors influencing the current provision of acute care within primary healthcare (PHC) and explore the policy and system changes potentially required. Semi‐structured interviews with key stakeholders were audio‐recorded, transcribed verbatim and analysed through content and thematic approaches incorporating the Walt and Gilson health policy framework. Eleven interviews were conducted. Five key considerations were highlighted, namely the barriers and enablers for general practitioners (GPs) in providing acute care, barriers to patient use of PHC instead of ED, suggestions for new PHC models and improvements for current ED models. Additionally, economic issues relating to clinic funding and GP remuneration, complexities of state or federal funding and management of urgent care centres (UCC) were identified. Potential policy changes included GP clinics incorporating emergency appointments, GP triage, further patient streaming and changes to the ED medical workforce model, as well as linking hospitals with PHC clinics. Suggested system changes included improving rapid access to non‐GP specialists, offering qualifications for urgent care within PHC, developing integrated information technology systems and educating patients regarding appropriate healthcare system pathways. The present study suggested that while PHC has the potential to attenuate the demands for ED services, a whole‐of‐system approach focusing on realignment of priorities and integrated changes are needed.
Publisher: Cambridge University Press (CUP)
Date: 04-12-2018
DOI: 10.1017/S1041610217002447
Abstract: Behavioral and psychological symptoms of dementia (BPSD) are a common problem in long-term care facilities (LTC). Clinical guidelines dictate that first-line treatments for BPSD are psychosocial and behavioral interventions if these are unsuccessful, psychotropic medications may be trialed at low doses and their effects can be monitored. There have previously been no studies with nationally representative s les to investigate psychotropic administration in LTCs in Australia. This study determines the prevalence of psychotropic administration in a representative stratified random s le of 446 residents living with dementia from 53 Australian LTCs. Questionnaire and medical chart data in this study is drawn from a larger cross-sectional, mixed methods study on quality of life in Australian LTCs. It was found that 257 (58%) residents were prescribed psychotropic medications including: antipsychotics ( n = 160, 36%), benzodiazepines ( n = 136, 31%), antidepressants ( n = 117, 26%), and anti-dementia medications ( n = 9, 2%). BPSD were found to be very common in the s le, with 82% ( n = 364) of participants experiencing at least one BPSD. The most prevalent BPSD were depression ( n = 286, 70%) and agitation ( n = 299, 67%). Although detailed background information was not collected on in idual cases, the prevalence found is indicative of systematic industry-wide, over-prescription of psychotropic medications as a first-line treatment for BPSD. This study highlights a clear need for further research and interventions in this area.
Publisher: Springer Science and Business Media LLC
Date: 22-05-2019
Publisher: AMPCo
Date: 07-2017
DOI: 10.5694/MJA17.00323
Publisher: JMIR Publications Inc.
Date: 06-04-2022
Abstract: ccess to rehabilitation to support cancer survivors to exercise is poor. Group exercise–based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy. e aimed to evaluate the efficacy of a group exercise–based cancer rehabilitation program delivered via telehealth compared to usual care for improving the quality of life of cancer survivors. parallel, assessor-blinded, pragmatic randomized controlled trial with embedded cost and qualitative analysis will be completed. In total, 116 cancer survivors will be recruited from a metropolitan health network in Melbourne, Victoria, Australia. The experimental group will attend an 8-week, twice-weekly, 60-minute exercise group session supervised via videoconferencing supplemented by a web-based home exercise program and information portal. The comparison group will receive usual care including standardized exercise advice and written information. Assessments will be completed at weeks 0 (baseline), 9 (post intervention), and 26 (follow-up). The primary outcome will be health-related quality of life measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire), and adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semistructured interviews will be completed within an interpretive description framework to explore the patient experience. The primary outcome will be analyzed using linear mixed effects models. A cost-effectiveness analysis will also be performed. he trial commenced in April 2022. As of June 2022, we enrolled 14 participants. his trial will inform the future implementation of cancer rehabilitation by providing important data about efficacy, safety, cost, and patient experience. ustralian New Zealand Clinical Trials Registry ACTRN12621001417875 c5crwtr RR1-10.2196/38553
Publisher: Frontiers Media SA
Date: 12-05-2021
DOI: 10.3389/FIMMU.2021.646384
Abstract: Inadequate sustained immune activation and tumor recurrence are major limitations of radiotherapy (RT), sustained and targeted activation of the tumor microenvironment can overcome this obstacle. Here, by two models of a primary rat breast cancer and cell co-culture, we demonstrated that valproic acid (VPA) and its derivative (HPTA) are effective immune activators for RT to inhibit tumor growth by inducing myeloid-derived macrophages and polarizing them toward the M1 phenotype, thus elevate the expression of cytokines such as IL-12, IL-6, IFN-γ and TNF-α during the early stage of the combination treatment. Meanwhile, activated CD8 + T cells increased, angiogenesis of tumors is inhibited, and the vasculature becomes sparse. Furthermore, it was suggested that VPA/HPTA can enhance the effects of RT via macrophage-mediated and macrophage-CD8 + T cell-mediated anti-tumor immunity. The combination of VPA/HPTA and RT treatment slowed the growth of tumors and prolong the anti-tumor effect by continuously maintaining the activated immune response. These are promising findings for the development of new effective, low-cost concurrent cancer therapy.
Publisher: Frontiers Media SA
Date: 25-03-2021
Abstract: Ionizing radiation (IR) can induce DNA double-strand breaks (DSBs) in tumor cells during radiotherapy (RT), but the efficiency of RT is limited because of the toxicity to normal cells. Locating an adjuvant treatment to alleviate damage in normal cells while sensitizing tumor cells to IR has attracted much attention. Here, using the 7,12-dimethylbenz[α]anthracene (DMBA)-induced malignant transformed MCF10A cells, we found that valproate (VPA), a histone deacetylase inhibitor (HDACi), radiosensitized transformed cells while alleviated IR-induced damage in normal cells at a safe dose (0.5 mM). We further demonstrated the decrease of homologous recombination (HR)-associated Rad51 in the transformed cells was related to the increase of its ubiquitination regulated by E3 ligase RFWD3 for the radiosensitization, which was opposite to normal cells, indicating that RFWD3-dependent ubiquitination on Rad51 was involved in the VPA-mediated radio-bidirectional effect. Through DMBA-transformed breast cancer rat model, VPA at 200 mg/kg radiosensitized tumor tissue cells by increasing RFWD3 and inhibited Rad51, while radioprotected normal tissue cells by decreasing RFWD3 and enhanced Rad51. In addition, we found high-level Rad51 was associated with tumorigenesis and poor prognosis in breast cancer patients. Our findings uncovered RFWD3-dependent Rad51 ubiquitination was the novel mechanism of VPA-mediated radio-bidirectional effect, VPA is a potential adjuvant treatment for tumor RT.
Publisher: Frontiers Media SA
Date: 13-09-2022
DOI: 10.3389/FPUBH.2022.982095
Abstract: The onset of the coronavirus disease (COVID-19) pandemic and its overwhelming physical and mental health burden can result in stigmatization toward the disease and those affected. This study aimed to measure the prevalence of COVID-19-related stigma and its associated factors among older people in Bangladesh. This cross-sectional study was conducted among 1,045 Bangladeshi older adults aged 60 years and above through telephone interviews in September 2021. The outcome was measured using an eight-point Stigma Scale, adapted to the Bengali language. Level of stigma was indicated by the cumulative score of the eight-items, ranging from 0 to 8, with a higher score indicating a higher level of stigma. On average, participants had stigmas on three of the eight items, and 62.6% had a high stigma score. The most prevalent stigmas were as follows: COVID-19 is a punishment from God (79.3%), patients with previous COVID-19 must be isolated (67.3%), and people infected with COVID-19 did not meet hygiene standards (63.9%). Participants who lived in rural areas (β: 0.67, 95% CI: 0.39 to 0.95) and who perceived needing additional care during the pandemic (β: 0.35, 95% CI: 0.09 to 0.60) had a higher average stigma score, whereas stigma scores were lower among unemployed/retired participants (β: −0.22, 95% CI: −0.45 to 0.00). The study findings suggest implementing interventions to raise awareness through appropriate health literacy interventions and mass media c aigns.
Publisher: Research Square Platform LLC
Date: 03-01-2022
DOI: 10.21203/RS.3.RS-1138036/V1
Abstract: BackgroundFailure to use antenatal care (ANC) and inadequate receipt of components of ANC pose a significant risk for both the pregnant woman and baby. This study aimed to examine a regional analysis of factors associated with no or inadequate receipt of components of ANC services among Indian women.MethodInformation on 184,628 women of reproductive age 15-49 years from the 2015-16 India National Family Health Survey (NFSH-4) was used. Survey multinomial logistic regression analyses that adjust for cluster and survey weights were conducted to assess the socio-demographic and other factors associated with no or receipt of inadequate receipt of components of ANC in the six regions in India.ResultsAcross regions in India, 18% of women reported no ANC, and the prevalence of inadequate and adequate receipt of components of ANC in all six regions ranged from 16% to 43% and 34% to 81%, respectively. Our analyses revealed that in all six regions, poor households reported increased odds of receiving no or inadequate receipts of components of ANC. In all six regions, inadequate receipts of components of ANC was significantly higher among women who had limited knowledge about pregnancy complications and post-delivery complications. In all the six regions except the East region, women who delivered their babies at home reported higher odds of receiving no or inadequate receipts of components of ANC and women who had no postnatal checkup after delivery reported higher odds of receiving no or inadequate receipts of components of ANC in all regions except South, West and North East regions. Low levels of women's education and women who delivered their babies at home were associated with increased odds of receiving no or inadequate receipts of components of ANC in all six regions except North and East regions.ConclusionA better understanding of the factors associated and incorporating them into the short- and long-term intervention strategies, including free financial support from the Indian government to encourage pregnant women from lower socioeconomic groups to use health services across all regions.
Publisher: Springer Science and Business Media LLC
Date: 11-10-2023
Publisher: MDPI AG
Date: 10-05-2017
DOI: 10.3390/IJMS18051027
Publisher: American Medical Association (AMA)
Date: 02-05-2001
Publisher: Oxford University Press (OUP)
Date: 16-01-2017
DOI: 10.1093/RPD/NCW380
Abstract: To assess the health statue of chronically exposed Chinese medical radiation workers. A cross-sectional study of 530 medical radiation workers in a city of China was conducted to document the health status and the monitored annually absorbed doses. Long-term and low-dose radiation exposure can affect a number of health indicators in the in iduals, which covered the cardiovascular system, hematologic system, ophthalmology, liver and kidney's functions, chromosome aberration and micronucleus. The differences in the health status between male and female in iduals were associated with job types and exposed years of service. The monitored doses of in iduals were lower than the limit value of the national standard. The health status in chronically exposed in iduals demonstrated some gender difference associated with length of exposure and work type. This study provides some evidence to understand the health status of medical radiation workers in China and have the potentially to inform screening and clinical diagnosis.
Publisher: Pro Pharma Communications International
Date: 15-12-1970
Publisher: Public Library of Science (PLoS)
Date: 07-07-2022
DOI: 10.1371/JOURNAL.PONE.0269375
Abstract: Hijras in Bangladesh face considerable discrimination, stigma, and violence despite the 2013 legislation that recognized Hijras as a third gender. There is a dearth of published literature describing the extent of human rights violations among this population and their associated factors. A questionnaire was administered to 346 study participants aged 15 years and older, living in five urban cities of Bangladesh who self-identified as Hijra, in 2019. The six human rights violation indicators (Economic, Employment, Health, Education, Social and Civic and Political Right) assessed were categorized as binary. Associations between sociodemographic characteristics and the six human rights violations were tested using univariate and multivariate logistic regression. Human right violations including economic, educational, political, employment, health and social/civil right violations were reported in 73.3%, 59.3%, 58.5%, 46.4%, 42.7%, and 34.4% of the participants, respectively. Economic rights violations were associated with bisexuality (Adjusted odds ratios [AOR] 3.60, 95%CI: 1.57, 8.26) and not living with family (AOR 2.71, 95%CI: 1.21, 6.09), while Hijras who earned more than 10,000 Bangladesh Taka experienced higher odds of educational (AOR 2.77, 95%CI: 1.06, 7.19) and political rights violations (AOR 4.30, 95%CI: 1.06, 7.44). Living in Dhaka city was associated with a reduced odds for economic and political rights violation while experiencing violations of one human right could lead to violation of another in the Hijra community. Human rights violations were common in Bangladesh Hijras, particularly the Bisexual Hijras. Media and educational awareness c aigns are needed to address the underlying roots of a violation. Programs focused on the families, young people and high-income earners of this community are needed in Bangladesh.
Publisher: Springer Science and Business Media LLC
Date: 03-01-2023
DOI: 10.1186/S12889-022-14812-3
Abstract: Failure to use antenatal care (ANC) and inadequate receipt of components of ANC pose a significant risk for the pregnant woman and the baby. This study aimed to examine a regional analysis of factors associated with receiving no ANC and inadequate receipt of components of ANC services among Indian women. Information from 173,970 women of reproductive age 15–49 years from the 2019–21 India National Family Health Survey (NFSH-5) was analysed. Logistic regression analyses that adjusted for cluster and survey weights were conducted to assess the socio-demographic and other factors associated with receiving non-use of ANC and inadequate receipt of components of ANC, respectively, in the six regions and 28 states, and 8 union territories in India. Across regions in India, 7% of women reported no ANC, and the prevalence of inadequate and adequate receipt of components of ANC in all six regions ranged from 67 to 89% and 8% to 24%, respectively. Of all the 36 federated entities, the prevalence of inadequate receipt of ANC components was less than two-thirds in Tamil Nadu, Puducherry, Andaman and the Nicobar Islands, Odisha, and Gujarat. Our analyses revealed that associated factors vary by region, state, and union territories. Women from poor households reported increased odds of receiving no ANC in North, East and North-eastern regions. Women who reported no schooling in South, East and Central regions were associated with increased odds of receiving no ANC. Women from poor households in Himachal Pradesh, Bihar, Uttar Pradesh, Nagaland, Manipur, Uttar Pradesh, and Madhya Pradesh states reported significantly higher odds of inadequate components ANC than women from rich households. The receipt of inadequate components of ANC was significantly higher among women who never read magazines in Delhi, Ladakh, Karnataka, Telangana, Jharkhand, Maharashtra, Uttar Pradesh, Chhattisgarh, Arunachal Pradesh, Manipur, and Mizoram states in India. A better understanding of the factors associated with and incorporating them into the short- and long-term intervention strategies, including free financial support from the Indian government to encourage pregnant women from lower socioeconomic groups to use health services across all regions, states and union territories.
Publisher: Rural and Remote Health
Date: 09-07-2021
DOI: 10.22605/RRH6328
Publisher: MDPI AG
Date: 18-10-2022
Abstract: The present study aimed to assess the changes in the prevalence and determinants of self-reported hypertension among older adults during the COVID-19 pandemic in Bangladesh. This repeated cross-sectional study was conducted on two successive occasions (October 2020 and September 2021), overlapping the first and second waves of the COVID-19 pandemic in Bangladesh. The survey was conducted through telephone interviews among Bangladeshi older adults aged 60 years and above. The prevalence of hypertension was measured by asking a question about whether a doctor or health professional told the participants that they have hypertension or high blood pressure and/or whether they are currently using medication to control it. We also collected information on the socio-economic characteristics of the participants, their cognitive ability, and their COVID-19-related attributes. A total of 2077 older adults with a mean age of 66.7 ± 6.4 years participated in the study. The s les were randomly selected on two successive occasions from a pre-established registry developed by the ARCED Foundation. Thus, the s le in the 2021-survey (round two n = 1045) was not the same as that in the 2020-survey (round one n = 1031) but both were drawn from the same population. The findings revealed that the prevalence of hypertension significantly increased across the two periods (43.7% versus 56.3% p = 0.006). The odds of hypertension were 1.34 times more likely in round two than in the round one cohort (AOR 1.34, 95% CI 1.06–1.70). We also found that having formal schooling, poorer memory or concentration, and having had received COVID-19 information were all associated with an increased risk of hypertension in both rounds (p 0.05). The findings of the present study suggest providing immediate support to ensure proper screening, control, and treatment of hypertension among older adults in Bangladesh.
Publisher: AMPCo
Date: 08-2011
DOI: 10.5694/J.1326-5377.2011.TB03272.X
Abstract: To evaluate the prescribing practices of Australian dispensing doctors (DDs) and to explore their interpretations of the findings. Sequential explanatory mixed methods. The quantitative phase comprised analysis of Pharmaceutical Benefits Scheme (PBS) claims data of DDs and non-DDs, 1 July 2005-30 June 2007. The qualitative phase involved semi-structured interviews with DDs in rural and remote general practice across Australian states, August 2009-February 2010. The number of PBS prescriptions per 1000 patients and use of Regulation 24 of the National Health (Pharmaceutical Benefits) Regulations 1960 (r. 24) DDs' interpretation of the findings. 72 DDs' and 1080 non-DDs' PBS claims data were analysed quantitatively. DDs issued fewer prescriptions per 1000 patients (9452 v 15 057 P = 0.003), even with a similar proportion of concessional patients and patients aged > 65 years in their populations. DDs issued significantly more r. 24 prescriptions per 1000 prescriptions than non-DDs (314 v 67 P = 0.008). Interviews with 22 DDs explained that the fewer prescriptions were due to perceived expectation from their peers regarding prescribing norms and the need to generate less administrative paperwork in small practices. Contrary to overseas findings, we found no evidence that Australian DDs overprescribed because of their additional dispensing role.
Publisher: Wiley
Date: 02-2021
DOI: 10.1111/AJR.12702
Publisher: MDPI AG
Date: 03-2023
Abstract: This study explored the barriers and facilitators to hepatitis C virus (HCV) treatment for Aboriginal and Torres Strait Islander peoples in rural South Australia as viewed from a healthcare provider perspective in the era of direct acting antivirals (DAAs). Phase 1 was a qualitative systematic review examining the barriers and enablers to diagnosis and treatment amongst Indigenous peoples living with HCV worldwide. Phase 2 was a qualitative descriptive study with healthcare workers from six de-identified rural and regional Aboriginal Community-Controlled Health Services in South Australia. The results from both methods were integrated at the analysis phase to understand how HCV treatment could be improved for rural Aboriginal and Torres Strait Islander peoples. Five main themes emerged: the importance of HCV education, recognizing competing social and cultural demands, the impact of holistic care delivery and client experience, the effect of internal barriers, and overlapping stigma, discrimination, and shame determine how Indigenous peoples navigate the healthcare system and their decision to engage in HCV care. Continued efforts to facilitate the uptake of DAA medications by Aboriginal and Torres Strait peoples in rural areas should utilize a multifaceted approach incorporating education to community and cultural awareness to reduce stigma and discrimination.
Publisher: SAGE Publications
Date: 31-07-2016
Abstract: A significant paradigm shift in the care of non-urgent, low-acuity patients by paramedics has been gathering momentum over the last two decades. However the current nomenclature to define paramedics who specialise in the low-acuity setting is confusing, inconsistent and arguably misrepresentative. This commentary contends that two discernible paradigms lie along the spectra of low-acuity service delivery in paramedicine and argues that the nomenclature should also reflect this difference. Consistency in nomenclature has implications for the evolving professionalism in paramedicine and the movement towards national registration.
Publisher: MDPI AG
Date: 13-05-2022
DOI: 10.3390/NU14102042
Abstract: The prevalence of underweight among children below 60 months old in Nigeria remains a significant public health challenge, especially in northern geopolitical zones (NGZ), ranging from 15% to 35%. This study investigates time-based trends in underweight prevalence and its related characteristics among NGZ children below 60 months old. Extracted NGZ representative dataset of 33,776 live births from the Nigeria Demographic and Health Survey between 2008 and 2018 was used to assess the characteristics related to underweight prevalence in children aged 0–23, 24–59, and 0–59 months using multilevel logistics regression. Findings showed that 11,313 NGZ children below 60 months old were underweight, and 24–59-month-old children recorded the highest prevalence (34.8% 95% confidence interval: 33.5–36.2). Four factors were consistently significantly related to underweight prevalence in children across the three age groups: poor or average-income households, maternal height, children who had diarrhoea episodes, and children living in the northeast or northwest. Intervention initiatives that include poverty alleviation through cash transfer, timely health checks of offspring of short mothers, and adequate clean water and sanitation infrastructure to reduce the incidence of diarrhoea can substantially reduce underweight prevalence among children in NGZ in Nigeria.
Publisher: Research Square Platform LLC
Date: 02-11-2020
DOI: 10.21203/RS.3.RS-35393/V2
Abstract: Background: All in iduals should have the right to engage meaningfully in occupations that meet their aspirations and life goals as well as promote their health and wellbeing. For in iduals with disability, meaningful engagement in occupations is supported by timely, effective and adaptive health and support services. However, research has revealed multiple barriers preventing utilization of these services by in iduals with disability from culturally and linguistically erse (CALD) backgrounds. This review aims to identify gaps and solutions in health and support services of in iduals with disability from CALD backgrounds to meaningfully engage in occupations. Methods: A scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. A detailed search strategy will be used to search CINAHL, PubMed, Embase, Scopus, PsycInfo, JBI and Cochrane Library, as well as grey literature in Trove, Mednar and OpenGrey from January 1974 onwards. Two reviewers will independently screen all citations and full-text articles for eligibility against specific inclusion and exclusion criteria. Potential conflicts will be resolved through discussion. Data will be extracted and presented in a diagrammatic or tabular form accompanied by a narrative summary. Discussion: The scoping review will present the health and support service needs of in iduals with disability from CALD backgrounds and will extend the current reviews as it focuses the engagement in meaningful occupation. Findings from this review have the potential to inform local policy discussions and practice-based disability care. Systematic review registration: Open Science Framework (osf.io/hw2fb).
Publisher: Research Square Platform LLC
Date: 17-06-2020
DOI: 10.21203/RS.3.RS-35393/V1
Abstract: Background: All in iduals should have the right to engage meaningfully in occupations that meet their aspirations and life goals as well as promote their health and wellbeing. For in iduals with disability, meaningful engagement in occupations is supported by timely, effective and adaptive health and support services. However, research has revealed multiple barriers preventing utilisation of these services by in iduals with disability from culturally and linguistically erse (CALD) backgrounds. This review aims to identify gaps and solutions in health and support services of in iduals with disability from CALD backgrounds to meaningfully engage in occupations. Methods: A scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review guidelines. A detailed search strategy will be used to search CINAHL, PubMed, Embase, Scopus, PsychInfo, JBI and Cochrane Library, as well as grey literature in Trove, Mednar and OpenGrey. Studies will be screened for eligibility against specific inclusion and exclusion criteria for relevant studies. Data will be extracted using the JBI data extraction instrument and presented in a diagrammatic or tabular form accompanied with a narrative summary. Discussion: The scoping review will present the health and support service needs of in iduals with disability from CALD backgrounds and will extend the current reviews as it focuses the engagement in meaningful occupation. Findings from this review have the potential to inform local policy discussions and practice-based disability care.
Publisher: American Association for the Advancement of Science (AAAS)
Date: 14-10-2016
Abstract: The relationship between bio ersity and ecosystem productivity has been explored in detail in herbaceous vegetation, but patterns in forests are far less well understood. Liang et al. have amassed a global forest data set from ,000 s le plots in 44 countries. A positive and consistent relationship can be discerned between tree ersity and ecosystem productivity at landscape, country, and ecoregion scales. On average, a 10% loss in bio ersity leads to a 3% loss in productivity. This means that the economic value of maintaining bio ersity for the sake of global forest productivity is more than fivefold greater than global conservation costs. Science , this issue p. 196
Publisher: Elsevier BV
Date: 06-2023
Publisher: Elsevier BV
Date: 11-2020
Location: Australia
Start Date: 2011
End Date: 2013
Funder: Department of Health, Government of Western Australia
View Funded Activity