ORCID Profile
0000-0002-0788-7404
Current Organisation
University of Adelaide
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Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/10253890701379023
Abstract: Perception of stress with consequent activation of a neuroendocrine cascade causes changes in immune function that may be bi-directional, with alterations in basal levels of biological parameters outside the optimal range. In this cross-sectional study of 302 healthy persons (males 56.3%, females 43.7%) aged 41-46 years, higher stress levels, as assessed by questionnaire measures of recurrent and recent perceived stress, were associated with a 4-fold greater risk of having a high compared to mid-range serum neopterin concentration, indicating activation of cellular immune mechanisms [adjusted odds ratio, OR (95% confidence intervals, CI): Low stress=1.00 (reference group) Medium stress=4.13 (1.51, 11.29) High stress=4.63, (1.35, 15.83), p for trend=0.01]. Higher stress levels were associated with a 3-fold greater risk of having signs of humoral immune activation, as indicated by salivary IgA concentration [high compared to mid-range salivary IgA: Low stress=1.00 (reference group) Medium stress=1.06 (0.48, 2.34) High stress=3.62 (1.26, 10.39), p for trend=0.02], but also a 4-fold greater risk of humoral immune depression [low compared to mid-range IgA: Low stress=1.00 (reference group) Medium stress=1.72 (0.74, 3.99) High stress=4.38 (1.47, 13.00), p for trend=0.02]. In conclusion, in this cross-sectional study, higher stress levels were associated with higher serum neopterin and both elevated and depressed salivary IgA levels. These findings emphasise the importance of considering that stress may have bi-directional effects on immune mechanisms, and are consistent with an activational effect of chronic, perceived stress on cellular immunity, and a bi-directional effect on IgA levels, one aspect of humoral immunity.
Publisher: Elsevier BV
Date: 07-2011
DOI: 10.1016/J.IJROBP.2010.03.036
Abstract: To establish benchmark outcomes for combined modality treatment to be used in future prospective studies of osteolymphoma (primary bone lymphoma). In 1999, the Trans-Tasman Radiation Oncology Group (TROG) invited the Australasian Leukemia and Lymphoma Group (ALLG) to collaborate on a prospective study of limited chemotherapy and radiotherapy for osteolymphoma. The treatment was designed to maintain efficacy but limit the risk of subsequent pathological fractures. Patient assessment included both functional imaging and isotope bone scanning. Treatment included three cycles of CHOP chemotherapy and radiation to a dose of 45 Gy in 25 fractions using a shrinking field technique. The trial closed because of slow accrual after 33 patients had been entered. Accrual was noted to slow down after Rituximab became readily available in Australia. After a median follow-up of 4.3 years, the five-year overall survival and local control rates are estimated at 90% and 72% respectively. Three patients had fractures at presentation that persisted after treatment, one with recurrent lymphoma. Relatively high rates of survival were achieved but the number of local failures suggests that the dose of radiotherapy should remain higher than it is for other types of lymphoma. Disability after treatment due to pathological fracture was not seen.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Elsevier BV
Date: 2017
Publisher: Environmental Health Perspectives
Date: 05-2020
DOI: 10.1289/EHP5779
Publisher: Informa UK Limited
Date: 11-11-2009
Publisher: SAGE Publications
Date: 11-2009
DOI: 10.4278/AJHP.0801158
Abstract: Evaluate the effectiveness of distance physical activity interventions to establish intervention features that are key to success. Computerized searches for randomized controlled trials (RCTs) of distance physical activity interventions and visual scans of reference lists were performed between March 2004 and July 2006. Studies were included if they (1) employed a randomized controlled design, (2) encouraged physical activity in adults, and (3) had no face-to-face contact between participants and researchers or health educators. Twenty-two studies were found that met the inclusion criteria. Authors assessed the quality of the studies and coded articles according to key intervention features. This review is a systematic narrative review. Heterogeneity and poor study quality made formal meta-analysis inappropriate. Nevertheless, effect sizes were calculated for studies comparing intervention with control. Overall, distance interventions increased physical activity in the short term (between-group effect size range, −.2 to .45). Print medium plus telephone contact was the most effective delivery mode. Poor study quality prevented firm conclusions. However, distance interventions were found to promote physical activity in the short term for some populations. This review provided limited support for the efficacy of distance exercise interventions and revealed limitations of the extant literature. Expansion of RCT research into distance approaches to promoting physical activity is warranted.
Publisher: Mary Ann Liebert Inc
Date: 06-2014
Abstract: Ross River virus (RRV) disease is the most widespread mosquito-borne disease in Australia. The disease is maintained in enzootic cycles between mosquitoes and reservoir hosts. During outbreaks and in endemic regions, RRV transmission can be sustained between vectors and reservoir hosts in zoonotic cycles with spillover to humans. Symptoms include arthritis, rash, fever and fatigue and can persist for several months. The prevalence and associated morbidity make this disease a medically and economically important mosquito-borne disease in Australia. Climate, environment, and RRV vector and reservoir host information were used to develop predictive models in four regions in NSW over a 13-year period (1991-2004). Polynomial distributed lag (PDL) models were used to explore long-term influences of up to 2 years ago that could be related to RRV activity. Each regional model consisted of a unique combination of predictors for RRV disease highlighting the differences in the disease ecology and epidemiology in New South Wales (NSW). Events up to 2 years before were found to influence RRV activity. The shorter-term associations may reflect conditions that promote virus lification in RRV vectors whereas long-term associations may reflect RRV reservoir host breeding and herd immunity. The models indicate an association between host populations and RRV disease, lagged by 24 months, suggesting two or more generations of susceptible juveniles may be necessary for an outbreak. Model sensitivities ranged from 60.4% to 73.1%, and model specificities ranged from 57.9% to 90.7%. This was the first study to include reservoir host data into statistical RRV models the inclusion of host parameters was found to improve model fit significantly. The research presents the novel use of a combination of climate, environment, and RRV vector and reservoir host information in statistical predictive models. The models have potential for public health decision-making.
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.JACI.2015.05.009
Abstract: Studies from the United Kingdom, the United States, and Australia have reported increased childhood food allergy and anaphylaxis prevalence in the 15 years after 1990. We sought to examine whether childhood food allergy/anaphylaxis prevalence has increased further since 2004-2005. We examined hospital anaphylaxis admission rates between 2005-2006 and 2011-2012 and compared findings with those from 1998-1999 to 2004-2005. Overall population food-related anaphylaxis admission rates (per 10(5) population per year) increased from 5.6 in 2005-2006 to 8.2 in 2011-2012 (a 1.5-fold increase over 7 years). The highest rates occurred in children aged 0 to 4 years (21.7 in 2005-2006 and 30.3 in 2011-2012, a 1.4-fold increase), but the greatest proportionate increase occurred in those aged 5 to 14 years (5.8-12.1/10(5) population/y, respectively, a 2.1-fold increase) compared with those aged 15 to 29 years and 30 years or older (a 1.5- and 1.3-fold increase, respectively). Not only did absolute food-related anaphylaxis admissions increase, but the modeled year-on-year rate of increase in overall food-related anaphylaxis admissions also increased over time from an additional 0.35 per 10(5) population/y in 1998-1999 (all ages) to 0.49 in 2004-2005 and 0.63 in 2011-2012 (P < .001). Food-related anaphylaxis has increased further in all age groups since 2004-2005. Although the major burden falls on those aged 0 to 4 years, there is preliminary evidence for a recent acceleration in incidence rates in those aged 5 to 14 years. This contrasts with the previous decade in which the greatest proportionate increase was in those aged 0 to 4 years. These findings suggest a possible increasing burden of disease among adolescents and adults who carry the highest risk for fatal anaphylaxis.
Publisher: Wiley
Date: 1999
DOI: 10.1002/(SICI)1098-2272(1999)16:4<344::AID-GEPI2>3.0.CO;2-Q
Publisher: Frontiers Media SA
Date: 19-02-2019
Publisher: American Diabetes Association
Date: 07-2006
DOI: 10.2337/DC05-2315
Abstract: OBJECTIVE—This randomized controlled trial assesses the effect on glycemic control of continuous glucose monitoring system (CGMS)-guided insulin therapy adjustment in young people with type 1 diabetes on intensive diabetes treatment regimens with continuous subcutaneous insulin infusion (CSII) or glargine. RESEARCH DESIGN AND METHODS—Pediatric subjects were recruited if they had an HbA1c (A1C) & % and had been on CSII or glargine for at least 3 months. Thirty-six subjects were randomized to insulin adjustment on the basis of 72 h of CGMS every 3 weeks or intermittent self-monitoring of blood glucose (SMBG) for 3 months. A1C and fructosamine were measured at baseline and 6 and 12 weeks. Follow-up A1C was measured at 6 months. Mean baseline A1C was 8.2% (n = 19) in the CGMS group and 7.9% (n = 17) in the control group. RESULTS—There was a significant improvement in A1C from baseline values in both groups, but there was no difference in the degree of improvement in A1C at 12 weeks between the CGMS (−0.4% [95% CI −0.7 to −0.1]) and the control group (−0.4% [−0.8 to 0.2]). In the CGMS group, improved A1C was at the cost of increased duration of hypoglycemia. CONCLUSIONS—CGMS is no more useful than intermittent fingerstick SMBG and frequent review in improving diabetes control in reasonably well-controlled patients on near-physiological insulin regimens when used in an outpatient clinic setting.
Publisher: Cambridge University Press (CUP)
Date: 09-08-2010
DOI: 10.1017/S0950268810001901
Abstract: Infectious gastroenteritis is a common illness in Australia as elsewhere. Data from a year-long national gastroenteritis survey in 2001–2002 showed that gastroenteritis was more common in the northern and hotter part of Australia. These data were used to quantify associations between local weather variables and gastroenteritis in people aged years while controlling for socioeconomic status. A distributed lag model was used to examine the influence of weather over a period of days prior to an event and the maximal effect was found at a lag of 2–5 days. The total effect over the preceding week indicated a relative increase from baseline in the probability of gastroenteritis of 2·48% (95% CI 1·01–3·97) for each degree rise (°C) over that period. Given the very high burden of gastroenteritis, this represents a substantial effect at the population level and has relevance for health predictions due to climate change.
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.JSBMB.2013.01.011
Abstract: Vitamin D deficiency is common and implicated in risk of several human diseases. Evidence on the relative quantitative contribution of environmental, genetic and phenotypic factors to vitamin D status (assessed by the serum concentration of 25-hydroxyvitamin D, 25(OH)D) in free-living populations is sparse. We conducted a cross-sectional study of 494 Caucasian adults aged 18-61years, randomly selected from the Australian Electoral Roll according to groups defined by age, sex and region (spanning 27°-43°South). Data collected included personal characteristics, sun exposure behaviour, biomarkers of skin type and past sun exposure, serum 25(OH)D concentration and candidate single nucleotide polymorphisms. Ambient ultraviolet radiation (UVR) levels in the month six weeks before blood s ling best predicted vitamin D status. Serum 25(OH)D concentration increased by 10nmol/L as reported time in the sun doubled. Overall, 54% of the variation in serum 25(OH)D concentration could be accounted for: 36% of the variation was explained by sun exposure-related factors 14% by genetic factors (including epistasis) and 3.5% by direct measures of skin phenotype. Novel findings from this study are demonstration of gene epistasis, and quantification of the relative contribution of a wide range of environmental, constitutional and genetic factors to vitamin D status. Ambient UVR levels and time in the sun were of prime importance but it is nonetheless important to include the contribution of genetic factors when considering sun exposure effects. This article is part of a Special Issue entitled 'Vitamin D Workshop'.
Publisher: IOP Publishing
Date: 06-2021
Abstract: Increasing temperature and its impact on population health is an emerging significant public health issue in the context of climate change in Australia. While previous studies have primarily focused on risk assessment, very few studies have evaluated heat-attributable emergency department (ED) visits and associated healthcare costs, or projected future health and economic burdens. This study used a distributed lag non-linear model to estimate heat attributable ED visits and associated healthcare costs from 13 hospitals in Perth, Western Australia, and to project the future healthcare costs in 2030s and 2050s under three climate change scenarios—Representative Concentration Pathways (RCPs)2.6, RCP4.5 and RCP8.5. There were 3697 ED visits attributable to heat (temperatures above 20.5 °C) over the study period 2012–2019, accounting for 4.6% of the total ED visits. This resulted in AU$ 2.9 million in heat-attributable healthcare costs. The number of ED visits projected to occur in the 2030s and 2050s ranges from 5707 to 9421 under different climate change scenarios, which would equate to AU$ 4.6–7.6 million in heat associated healthcare costs. The heat attributable fraction for ED visits and associated healthcare costs would increase from 4.6% and 4.1% in 2010s to 5.0%–6.3% and 4.4%–5.6% in 2030s and 2050s, respectively. Future heat attributable ED visits and associated costs will increase in Perth due to climate change. Excess heat will generate a substantial population health challenge and economic burdens on the healthcare system if there is insufficient heat adaptation. It is vital to reduce greenhouse gas emissions, develop heat-related health interventions and optimize healthcare resources to mitigate the negative impact on the healthcare system and population health in the face of climate change.
Publisher: Springer Science and Business Media LLC
Date: 24-05-2017
DOI: 10.1007/S00484-016-1189-9
Abstract: The extreme heat wave in Australia in 2009 resulted in significantly increased number of daily deaths. The circumstances that lead to deaths during extreme heat have not been explored before in Australia. This study aims to identify the in idual and community risk factors for deaths during this extreme heat wave in Adelaide. A matched case-control study was conducted. Cases were those who died in the Adelaide metropolitan area during the heat wave period. For each case, two community controls were randomly selected, matched by age and gender. Face-to-face or telephone interviews were conducted to collect data of demographic information, living environment, social support, health status and behavioural changes during the heat wave. Descriptive analysis, as well as simple and multiple conditional logistic regressions were performed. In total, 82 deaths and 164 matched community controls were included in the analysis, with a median age of 77.5 (range 26.6-100.7). The multiple logistic regression model indicated that, compared with controls, the risk of death during the heat wave was significantly increased for people living alone (AOR = 42.31, 95 % CI 2.3, 792.8) or having existing chronic heart disease (AOR = 22.4, 95 % CI 1.7, 303.0). In addition, having air conditioning in bedrooms (AOR = 0.004, 95 % CI 0.00006, 0.28) and participating in social activities more than once a week (AOR = 0.011, 95 % CI 0.0004, 0.29) indicated significant protective effects. We have identified factors that could significantly impact on the likelihood of deaths during heat waves. Our findings could assist in the development of future intervention programs and policies to reduce mortality associated with a warmer climate.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2003
DOI: 10.1097/01.EDE.0000082374.08684.0D
Abstract: Evidence for a causal relationship between disinfection byproducts in chlorinated water and cancer is not conclusive. This study investigates the association between disinfection byproducts in chlorinated water, as measured by trihalomethane concentration, and the frequency of micronuclei in urinary bladder epithelial cells, thereby assessing the carcinogenic potential of disinfection byproducts. A cohort study was undertaken in 1997 in 3 Australian communities with varying levels of disinfection byproducts in the water supply. Exposure was assessed using both available dose (total trihalomethane concentration in the water supply) and intake dose (calculated by adjusting for in idual variations in ingestion, inhalation, and dermal absorption). Micronuclei in urinary bladder epithelial cells were used as a preclinical biomarker of genotoxicity. Cells were scored for micronuclei for 228 participants, of whom 63% were exposed to disinfection by products and 37% were unexposed. Available dose of total trihalomethane for the exposed group ranged from 38 to 157 micro g/L, whereas intake dose ranged from 3 to 469 micro g/kg per day. Relative risk for DNA damage to bladder cells, per 10 micro g/L of available dose total trihalomethane, was 1.01 (95% confidence interval [CI] = 0.97-1.06) for smokers and 0.996 (CI = 0.961-1.032) for nonsmokers. Relative risk, per 10 micro g/kg per day of intake dose of total trihalomethane, was 0.99 (CI = 0.96-1.03) for smokers and 1.003 (CI = 0.984-1.023) for nonsmokers. This study provides no evidence that trihalomethane concentrations, at the levels we investigated, are associated with DNA damage to bladder cells.
Publisher: Institute of Mathematical Statistics
Date: 05-1992
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-1991
DOI: 10.1097/00007890-199112000-00015
Abstract: We reviewed the medical records of 97 patients undergoing T cell-depleted allogeneic bone marrow transplantation at our institution from 1984 to 1990 to determine the incidence of hepatic dysfunction, including venoocclusive disease of the liver following BMT. All patients received allogeneic marrow that had been purged with monoclonal antibody to the CD6 surface antigen (T12) and rabbit complement as the sole method of graft-versus-host disease prophylaxis. No additional immunosuppressive agents were routinely administered to these patients. Overall, 55% of patients in our series developed two-fold elevations in serum bilirubin, SGOT, or alkaline phosphatase within the first 30 days following BMT. A five-fold elevation in any liver function test was noted in only 19% of patients. Logistic regression analysis revealed that the presence of GVHD, female sex, and administration of hotericin B all were independently associated with laboratory evidence of hepatic dysfunction. While LFT abnormalities were common in our series, they were generally mild, and the development of VOD was rare. Only three patients (3.1%) fulfilled clinical criteria sufficient to establish a diagnosis of VOD. Among the 86 patients whose ablative regimen consisted of cyclophosphamide (60 mg/kg x2) and total-body irradiation (1200-1400 cGy in 200 cGy fractions), only 1 patient (1.2%) developed VOD. Our experience suggests that patients undergoing allogeneic BMT are at low risk for VOD and other serious hepatic complications when they receive high-dose cyclophosphamide, fractionated TBI, and T cell-depleted marrow without hepatotoxic medications for GVHD prophylaxis.
Publisher: Elsevier BV
Date: 2007
DOI: 10.1016/J.NEUROPSYCHOLOGIA.2006.11.020
Abstract: Intra-in idual variability in reaction time increases with age and with neurological disorders, but the neural correlates of this increased variability remain uncertain. We hypothesized that both faster mean reaction time (RT) and less intra-in idual RT variability would be associated with larger corpus callosum (CC) size in older adults, and that these associations would be stronger in adults with mild cognitive disorders. A normative s le (n=432) and a s le with mild cognitive disorders (n=57) were compared on CC area, RT mean and RT variability adjusting for age, sex, education, APOE genotype, smoking, alcohol consumption, grip strength, visual acuity, handedness and lung function. S les did not differ in CC area or intra-cranial volume. In the normative s le, simple RT (SRT) and choice RT (CRT) were negatively associated with CC area but there were minimal associations between CC area and intra-in idual RT variability. In the mild cognitive disorders s le, SRT, CRT and intra-in idual variability on the SRT task were associated with CC area. Increased RT variability explained up to 12.7 percent of the variance in CC area in the s le with mild cognitive disorders, but less than 1 percent of the variance in CC area in the normative s le. There were no associations with APOE genotype. We conclude that intra-in idual variability is associated with CC area in mild cognitive disorders, but not in normal aging. We propose that biological limits on reserve capacity must occur in mild cognitive disorders that result in stronger brain-behavior relationships being observed.
Publisher: Elsevier BV
Date: 07-2015
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.CANCERGEN.2016.08.003
Abstract: Colorectal cancer (CRC) is the most common malignancy in the human digestive system. Previous results regarding the association between microRNA-27a rs895819 polymorphisms and CRC risk are controversial. We therefore performed a meta-analysis of seven studies totaling 2230 cases and 2775 controls to systematically evaluate this association. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were obtained using a fixed-effects model. A moderate evidence for the association between mir-27a polymorphism and CRC risk was found under multiple genetic models (dominant model: OR = 1.15, 95% CI: 1.02-1.29, p = 0.02 recessive model: OR = 1.49, 95% CI: 1.27-1.76, p <0.001 homozygote model: OR = 1.53, 95% CI: 1.28-1.83, p <0.001 allele model: OR = 1.21, 95% CI: 1.11-1.31, p 0.05). In conclusion, this meta-analysis suggested that rs895819 polymorphism in mir-27a may be a potential genetic risk factor for CRC, particularly in Chinese populations.
Publisher: American Psychological Association (APA)
Date: 2007
DOI: 10.1037/0894-4105.21.1.31
Abstract: The primary focus of this study was to examine whether there is early neuropsychological impairment in presymptomatic Huntington's disease (HD). A broad neuropsychological assessment battery was administered to 24 asymptomatic gene carriers (HD+) and 31 noncarriers (HD-). The gene carriers revealed inferior cognitive functioning as compared with the noncarriers in memory and executive functions. When the gene carriers were assigned to 2 groups based on predicted years to onset (with 15 and over being HD+ late and under 15 being HD+ near), the HD+ near group performed significantly worse than the HD+ late group in all domains but ability to shift conceptually and visuospatial memory. Results suggest that early cognitive deficits are detectable prior to motor symptoms, first in memory functions and then in executive functions and perceptual motor speed.
Publisher: Oxford University Press (OUP)
Date: 13-12-2022
DOI: 10.1093/IJE/DYAC229
Abstract: With high temperature becoming an increasing health risk due to a changing climate, it is important to quantify the scale of the problem. However, estimating the burden of disease (BoD) attributable to high temperature can be challenging due to differences in risk patterns across geographical regions and data accessibility issues. We present a methodological framework that uses Köppen–Geiger climate zones to refine exposure levels and quantifies the difference between the burden observed due to high temperatures and what would have been observed if the population had been exposed to the theoretical minimum risk exposure distribution (TMRED). Our proposed method aligned with the Australian Burden of Disease Study and included two parts: (i) estimation of the population attributable fractions (PAF) and then (ii) estimation of the BoD attributable to high temperature. We use suicide and self-inflicted injuries in Australia as an ex le, with most frequent temperatures (MFTs) as the minimum risk exposure threshold (TMRED). Our proposed framework to estimate the attributable BoD accounts for the importance of geographical variations of risk estimates between climate zones, and can be modified and adapted to other diseases and contexts that may be affected by high temperatures. As the heat-related BoD may continue to increase in the future, this method is useful in estimating burdens across climate zones. This work may have important implications for preventive health measures, by enhancing the reproducibility and transparency of BoD research.
Publisher: Wiley
Date: 15-10-1997
DOI: 10.1002/(SICI)1097-0258(19971015)16:19<2177::AID-SIM646>3.0.CO;2-N
Abstract: Analysis of a major multi-site epidemiologic study of heart disease has required estimation of the pairwise correlation of several measurements across subpopulations. Because the measurements from each subpopulation were subject to s ling variability, the Pearson product moment estimator of these correlations produces biased estimates. This paper proposes a model that takes into account within and between sub-population variation, provides algorithms for obtaining maximum likelihood estimates of these correlations and discusses several approaches for obtaining interval estimates.
Publisher: Informa UK Limited
Date: 1999
Publisher: Informa UK Limited
Date: 1999
Publisher: American Medical Association (AMA)
Date: 10-1997
DOI: 10.1001/ARCHOPHT.1997.01100160405001
Abstract: To compare success rates of conjunctival autografting and bare sclera excision for primary and recurrent pterygium in the tropics and to evaluate risk factors for pterygium recurrence. A prospective, controlled clinical trial was performed in which 123 primary and 34 recurrent pterygia, matched for age and pterygium morphology, were randomized in 2 separate studies to receive either bare sclera excision or conjunctival autograft. The surgical procedures were performed by one surgeon and reviewed at 1, 3, 6, and 12 months after surgery by an independent observer. Pterygium morphology was clinically graded as atrophic, intermediate, or fleshy according to an assessment of pterygium translucency. Risk factors were assessed using likelihood ratio tests. Weibull curves were used to estimate recurrence rates allowing for the interval censoring. In the group with primary pterygium (mean follow-up, 15.1 months), 38 (61%) of the 62 cases of bare sclera excision (heretofore referred to as the bare sclera group) had pterygium recur in contrast with 1 (2%) of the 61 cases of conjunctival autograft (heretofore referred to as the conjunctival autograph group) (P<.001, likelihood ratio X2 test). Nontranslucency, or fleshiness of the pterygium, and not age was a significant risk factor for recurrence in the bare sclera group (P<.001, likelihood ratio X2 test). In the group with recurrent pterygium (mean follow-up, 13.2 months), 14 (82%) of the 17 bare sclera group had pterygium recur, while no recurrences occurred among 17 cases in the conjunctival autograft group. Nontranslucency was again a highly significant factor for recurrence (P<.001, likelihood ratio X2 test). Pterygium recurrence is related to pterygium morphology and fleshiness of the pterygium is a significant risk factor for recurrence if bare sclera excision is performed. Conjunctival autografting for primary and recurrent pterygium is effective in reducing pterygium recurrence compared with bare sclera excision.
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.ACTATROPICA.2022.106454
Abstract: Ross River virus (RRV) infection is one of the emerging and prevalent arboviral diseases in Australia and the Pacific Islands. Although many studies have been conducted to establish the relationship between temperature and RRV infection, there has been no comprehensive review of the association so far. In this study, we performed a systematic review and meta-analysis to assess the effect of temperature on RRV transmission. We searched PubMed, Scopus, Embase, and Web of Science with additional lateral searches from references. The quality and strength of evidence from the included studies were evaluated following the Navigation Guide framework. We have qualitatively synthesized the evidence and conducted a meta-analysis to pool the relative risks (RRs) of RRV infection per 1 °C increase in temperature. Subgroup analyses were performed by climate zones, temperature metrics, and lag periods. A total of 17 studies met the inclusion criteria, of which six were included in the meta-analysis The meta-analysis revealed that the overall RR for the association between temperature and the risk of RRV infection was 1.09 (95% confidence interval (CI): 1.02, 1.17). Subgroup analyses by climate zones showed an increase in RRV infection per 1 °C increase in temperature in humid subtropical and cold semi-arid climate zones. The overall quality of evidence was "moderate" and we rated the strength of evidence to be "limited", warranting additional evidence to reduce uncertainty. The results showed that the risk of RRV infection is positively associated with temperature. However, the risk varies across different climate zones, temperature metrics and lag periods. These findings indicate that future studies on the association between temperature and RRV infection should consider local and regional climate, socio-demographic, and environmental factors to explore vulnerability at local and regional levels.
Publisher: Proceedings of the National Academy of Sciences
Date: 18-05-2010
Publisher: Wiley
Date: 20-10-2014
DOI: 10.1111/BCP.12422
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.SCITOTENV.2021.149806
Abstract: The occurrence or exacerbation of kidney disease has been documented as a growing problem associated with hot weather. The implementation of effective prevention measures requires a better understanding of the risk factors that increase susceptibility. To fill gaps in knowledge, this study reviews the current literature on the effects of heat on kidney-disease outcomes (ICD-10 N00-N39), including morbidity and mortality. Databases were systematically searched for relevant literature published between 1990 and 2020 and the quality of evidence evaluated. We performed random effects meta-analysis to calculate the pooled relative risks (RRs) of the association between high temperatures (and heatwaves) and kidney disease outcomes. We further evaluated vulnerability concerning contextual population characteristics. Of 2739 studies identified, 91 were reviewed and 82 of these studies met the criteria for inclusion in a meta-analysis. Findings showed that with a 1 °C increase in temperature, the risk of kidney-related morbidity increased by 1% (RR 1.010 95% CI: 1.009-1.011), with the greatest risk for urolithiasis. Heatwaves were also associated with increased morbidity with a trend observed with heatwave intensity. During low-intensity heatwaves, there was an increase of 5.9% in morbidity, while during high-intensity heatwaves there was a 7.7% increase. There were greater RRs for males, people aged ≤64 years, and those living in temperate climate zones. Similarly, for every 1 °C temperature increase, there was a 3% (RR 1.031 95% CI: 1.018-1.045) increase in the risk of kidney-related mortality, which also increased during heatwaves. High temperatures (and heatwaves) are associated with an elevated risk of kidney disease outcomes, particularly urolithiasis. Preventive measures that may minimize risks in vulnerable in iduals during hot spells are discussed.
Publisher: Elsevier BV
Date: 05-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-1997
Publisher: WHO Press
Date: 13-03-2017
Publisher: BMJ
Date: 04-2000
DOI: 10.1136/BJO.84.4.385
Abstract: To evaluate the success rates of conjunctival autografting for primary and recurrent pterygium performed in a tertiary ophthalmic centre. The outcome of 139 cases with primary pterygia and 64 cases with recurrent pterygia who underwent excision with conjunctival autografting was retrospectively reviewed. Outcome was evaluated in terms of recurrence of pterygia onto the cornea. The recurrence rates were determined using Weibull survival functions, in a mixture model that included a component allowing for cure. The suitability of this model was verified using Turnbull's non-parametric method for interval censored data (1974). Estimated recurrence free probabilities were based on the fitted Weibull survival curves. Mean follow up was 8.4 months in the primary group, and 9.5 months for the recurrent group. 29 out of 139 cases of primary pterygia recurred (20.8%) while 20 out of 64 cases in the recurrent group (31.2%) recurred. Recurrence rates varied widely among surgeons, ranging from 5% to 82%. Recurrence rates were inversely related to previous experience in performing conjunctival grafting. The recurrence free probability was 84% at 3 months, 73% at 1 year for primary pterygia, and 80% at 3 months, 67% at 1 year for recurrent pterygia. There was no statistical difference in recurrence rates between primary and recurrent groups (p= 0.80). The success of conjunctival autografting for pterygium in this series varies widely, and may be related to a significant learning curve or differing surgical techniques for this procedure. This may account for the wide variation in reported success of this procedure in the ophthalmic literature.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Wiley
Date: 11-2009
DOI: 10.1111/J.1445-5994.2008.01878.X
Abstract: Atrial fibrillation (AF) is an important predisposing factor for ischaemic stroke. There is evidence to suggest that even in appropriate candidates warfarin therapy is underutilized. We assessed the prevalence of AF in an Australian stroke unit to determine the degree of undertreatment at presentation. A retrospective analysis of all patients admitted to our Stroke Unit between October 2004 and September 2006 was carried out. All patients with a diagnosis of AF, either new or old, were then selected from this group to determine the overall prevalence and anticoagulation status. Data regarding prior stroke, stroke severity and discharge anticoagulation status were also determined. Data from a total of 500 patients were analysed. Our results showed that AF-related strokes accounted for a large proportion (28%) of all admissions and were associated with a larger neurological deficit. Most patients (68%) with a prior diagnosis of AF without having obvious contraindications were either not anticoagulated or under-anticoagulated when presenting with an ischaemic stroke or transient ischaemic attack. Our results stress the importance of initiating and maintaining anticoagulation in patients with AF and without obvious contraindications to minimize the risk of subsequent stroke.
Publisher: SAGE Publications
Date: 04-09-2008
Abstract: High participation is a key requirement for effective cancer screening. Many strategies to improve participation hold that a person's knowledge and beliefs dictate screening behavior. We compared perception of colon cancer risk in participants and nonparticipants in a population-based study of screening colonoscopy, and also assessed past screening behavior. Surprisingly, while past screening behavior was a predictor of participation, we found that participants perceived their risk of colorectal cancer to be significantly and substantially lower than the real figure and that of nonparticipants. Our data suggest that health promotion strategies aimed at improving health knowledge may not be effective in improving population screening rates.
Publisher: Wiley
Date: 20-07-2017
DOI: 10.1111/PHP.12780
Abstract: Data on personal sun exposure over a period exceeding the immediate past days or weeks are typically self-reported in brief questionnaire items. The validity of such self-reporting of longer term personal sun exposure, for ex le over a year, including detail on variation across seasons, has not previously been investigated. In a volunteer s le (n = 331) of Australian adults aged 18 years and over, we assessed the 12-month reliability of sun exposure reported separately for each season, and its accuracy compared to a daily sun diary in the same season. Seasonal time outdoors displayed fair-to-good reliability between baseline and end of study (12 months), with responses showing higher agreement at lower levels of time outdoors. There was good agreement for ranking of in iduals' time outdoors with the daily sun diary data, although the actual diary time outdoors was typically considerably lower than the self-reported questionnaire data. Place of residence, education, being a smoker, day of the week (i.e. working day vs nonworking day) and working mainly outdoors were significant predictors of agreement. While participants overestimated their actual time outdoors, the self-report questionnaire provided a valid ranking of long-term sun exposure against others in the study that was reliable over time.
Publisher: Wiley
Date: 06-12-2008
DOI: 10.1111/J.1742-6723.2007.01044.X
Abstract: To determine the proportion of ED staff who are susceptible to pertussis. There was evidence that some winter leave in southern Tasmania might be a reason of pertussis infection among unimmunized staff. This results in loss of in idual earning and loss of availability of staff during the peak demand periods in the ED. There is evidence in the literature that underdiagnosis and undertreatment of pertussis occurs worldwide. All ED staff were approached to participate in this seroprevalence study. A self-completed questionnaire was used to record pervious immunization history for pertussis. Blood s les were collected and analysed to detect and quantify immunoglobulin G and immunoglobulin A titres for pertussis. All confidence intervals (CI) are at 95%. The Royal Hobart Hospital and the co-located Hobart Private Hospital. Ninety-seven of 106 eligible staff took part in the present study, a participation rate of 92% (CI 84-96). Ninety-one of 97 subjects (94%, CI 87-98) believed that they had been immunized for pertussis in childhood six subjects had either not been immunized or were unsure (6%, CI 2-13). Twenty-three subjects (24%, CI 16-33) had been immunized as adults. There was serologic evidence of recent infection for 21 participants (22%, CI 14-31). Thirty-one participants (32%, CI 23-42) were susceptible to pertussis on the basis of low immunoglobulin G titres. ED staff should routinely be offered booster immunization for pertussis.
Publisher: S. Karger AG
Date: 2003
DOI: 10.1159/000073768
Abstract: i Background: /i There is some community survey evidence for a cohort difference in female sexual orientation. i Objective: /i To determine whether there is a cohort difference in sexual orientation in Australia. i Methods: /i A community survey was carried out with a s le of 7,447 adults from the age groups 20–24, 40–44 and 60–64 years. As part of this survey respondents were asked a question on sexual orientation which was answered privately. i Results: /i A strong age cohort difference was found for women, with younger women more frequently reporting a homosexual or bisexual orientation. By contrast, no age cohort difference was found for men. i Conclusion: /i These findings suggest that a heterosexual orientation may have become less common in younger cohorts of Australian women. This finding is consistent with data from other recent studies.
Publisher: Wiley
Date: 08-2008
Publisher: Wiley
Date: 30-09-2011
DOI: 10.1111/J.1399-3038.2010.01099.X
Abstract: Observations of increasing allergy prevalence with decreasing distance from the Equator and positive associations with ambient ultraviolet radiation have contributed to a growing interest in the possible role of vitamin D in the etiology of allergy. The aims of this study were to describe any latitudinal variation in the prevalence of childhood allergy in Australia and to evaluate, in parallel, the in idual associations between ultraviolet radiation (UVR)- and vitamin D-related measures and hayfever asthma and both conditions. Participants were population-based controls who took part in a multicenter case-control study, aged 18-61 yr and resident in one of four study regions ranging in latitude from 27°S to 43°S. Data were derived from a self-administered questionnaire, interview and examination by a research officer and biologic s ling. Latitude and longitude coordinates were geocoded from participants' residential locations and climatic data were linked to postcodes of current residence. Stored serum was analyzed for 25-hydroxyvitamin D concentrations and silicone rubber casts of the skin were used as an objective measure of cumulative actinic damage. There was an inverse latitude gradient for asthma (a 9% decrease per increasing degree of latitude) however, this pattern did not persist after adjusting for average daily temperature. There was no association between any of the UVR- or vitamin D-related measures and childhood asthma, but greater time in the sun in winter between the ages 6-15 yr was associated with an increase in the odds of having hayfever [adjusted odds ratios (OR) 1.29 95% CI 1.01-1.63]. Oral supplementation with cod liver oil in childhood increased the odds of a history of having both asthma and hayfever (2.87 1.00-8.32). Further investigation of the possible role of early vitamin D supplementation in the development of allergy is warranted. Our results also suggest that solar exposure during childhood may be important in allergic sensitization. Plausible explanations, including biologic mechanisms, exist for both observations.
Publisher: Elsevier BV
Date: 11-2023
Publisher: MDPI AG
Date: 22-07-2018
DOI: 10.3390/ATMOS9070286
Abstract: Workers exposed to high ambient temperatures, either indoors or out, work slower. The few studies that have measured this loss of productivity show a degree of consistency across widely varying settings. I develop a class of 5-parameter probability models that express productivity as a function of environmental heat and show how the method of fitting can be adapted according to the completeness of the data available. As well as modelling the mean output, it is important to also consider variation between workers, and the model presented here achieves this. The method is illustrated using three previously published datasets from different industries and work environments.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-02-2011
Publisher: MDPI AG
Date: 26-07-2022
Abstract: (1) Background: Limited research has suggested that cardiopulmonary health outcomes should be considered in relation to pollen exposure. This study sets out to test the relationship between pollen types (grasses, trees, weeds) and cardiovascular, lower respiratory and COPD health outcomes using 15 years (2003–2017) of data gathered in Adelaide, South Australia (2) Methods: A time-series analysis by months was conducted using cardiopulmonary data from hospital admissions, emergency presentations and ambulance callouts in relation to daily pollen concentrations in children (0–17) for lower respiratory outcomes and for adults (18+). Incidence rate ratios (IRR) were calculated over lags from 0 to 7 days (3) Results: IRR increases in cardiovascular outcomes in March, May, and October were related to grass pollen, while increases in July, November, and December were related to tree pollen. IRRs ranged from IRR 1.05 (95% confidence interval (CI) 1.00–1.10) to 1.25 (95% CI 1.12–1.40). COPD increases related to grass pollen occurred only in May. Pollen-related increases were observed for lower respiratory outcomes in adults and in children (4) Conclusion: Notable increases in pollen-related associations with cardiopulmonary outcomes were not restricted to any one season. Prevention measures for pollen-related health effects should be widened to consider cardiopulmonary outcomes.
Publisher: Springer Science and Business Media LLC
Date: 08-03-2016
Publisher: SAGE Publications
Date: 11-09-2016
Abstract: There is contradictory evidence for a role of dietary fat in risk of multiple sclerosis (MS). To examine the association between usual fat intake (total, saturated, monounsaturated (MUFA), polyunsaturated (PUFA), omega-3 and omega-6) and risk of a first clinical diagnosis of CNS demyelination (FCD). Multi-centre incident case-control study in four regions of Australia during 2003–2006. Cases were aged 18–59 years and had a FCD controls were matched to a case on age, sex and location. Dietary data were collected using a validated food frequency questionnaire. In 267 cases and 517 controls with dietary data, higher intake (per g/day) of omega-3 PUFA (adjusted odds ratio, AOR=0.61 (95% CI 0.40–0.93)), and particularly that derived from fish (AOR=0.54 (95% CI 0.31–0.93)) rather than from plants (AOR=0.75 (95% CI 0.39–1.43)) was associated with a decreased risk of FCD. Total fat intake and intake of other types of fat were not associated with FCD risk. There was a significant decrease in FCD risk with higher intake of omega-3 PUFA, particularly that originating from fish. There was no evidence to indicate that the intake of other types of dietary fat or fat quantity in the previous 12 months was associated with an altered risk of FCD.
Publisher: Wiley
Date: 31-07-2003
DOI: 10.1034/J.1600-0447.2003.00163.X
Abstract: Examinations are anecdotally viewed as extremely stressful to Singapore schoolchildren. We test this postulate by obtaining parental ratings of children's emotional stress levels longitudinally in a large representative s le of sixth (P6) and fifth (P5) class primary schoolchildren, respectively, exposed and unexposed to a streaming examination. Children's stress levels were rated monthly by a parent for 10 months. Analyses failed to find evidence of any differential stress impact across P6 and P5 comparison groups, apart from a subset of P6 children whose parents complied with every monthly survey. The streaming examination in the final year of primary school did not emerge as a general stressor to children, but achieved salience within a defined subset of children whose parents were highly study compliant. Study compliance may be a proxy variable of some import, and have wider relevance to other cohort studies and to intervention trials.
Publisher: Oxford University Press (OUP)
Date: 12-04-2013
DOI: 10.1093/AJE/KWS361
Abstract: Inconsistent evidence exists regarding the association between work-related factors and risk of multiple sclerosis (MS). We examined the association between occupational exposures and risk of a first clinical diagnosis of central nervous system demyelination (FCD), which is strongly associated with progression to MS, in a matched case-control study of 276 FCD cases and 538 controls conducted in Australia (2003-2006). Using a personal residence and work calendar, information on occupational history and exposure to chemicals and animals was collected through face-to-face interviews. Few case-control differences were noted. Fewer cases had worked as professionals (≥6 years) than controls (adjusted odds ratio (AOR) = 0.60, 95% confidence interval (CI): 0.37, 0.96). After further adjustment for number of children, cases were more likely to have ever been exposed to livestock than controls (AOR = 1.54, 95% CI: 1.03, 2.29). Among women, there was an increase in FCD risk associated with 10 or more years of exposure to livestock (AOR = 2.78, 95% CI: 1.22, 6.33) or 6 or more years of farming (AOR = 2.00, 95% CI: 1.23, 3.25 also adjusted for number of children). Similar findings were not evident among men. Thus, farming and exposure to livestock may be important factors in the development of FCD among women, with this finding further revealed after the confounding effect of parity or number of children is considered.
Publisher: Springer Science and Business Media LLC
Date: 24-04-2014
DOI: 10.1007/S00484-013-0663-X
Abstract: Studies in temperate countries have shown that both hot weather in summer and cold weather in winter increase short-term (daily) mortality. The gradual warming, decade on decade, that Australia has experienced since the 1960s, might therefore be expected to have differentially affected mortality in the two seasons, and thus indicate an early impact of climate change on human health. Failure to detect such a signal would challenge the widespread assumption that the effect of weather on mortality implies a similar effect of a change from the present to projected future climate. We examine the ratio of summer to winter deaths against a background of rising average annual temperatures over four decades: the ratio has increased from 0.71 to 0.86 since 1968. The same trend, albeit of varying strength, is evident in all states of Australia, in four age groups (aged 55 years and above) and in both sexes. Analysis of cause-specific mortality suggests that the change has so far been driven more by reduced winter mortality than by increased summer mortality. Furthermore, comparisons of this seasonal mortality ratio calculated in the warmest subsets of seasons in each decade, with that calculated in the coldest seasons, show that particularly warm annual conditions, which mimic the expected temperatures of future climate change, increase the likelihood of higher ratios (approaching 1:1). Overall, our results indicate that gradual climate change, as well as short-term weather variations, affect patterns of mortality.
Publisher: BMJ
Date: 11-2022
DOI: 10.1136/BMJOPEN-2022-066851
Abstract: We aim to establish daily risk estimates of the relationships between grass, tree and weed pollen and asthma health outcomes. Time series regression analysis of exposure and health outcomes using interaction by month to determine risk estimates all year round. Metropolitan Adelaide, South Australia. Health outcomes for asthma are based on 15 years of hospital admissions, 13 years emergency presentations and ambulance callouts. In adults (≥18 years), there were 10 381 hospitalisations, 26 098 emergency department (ED) presentations and 11 799 ambulance callouts and in children (0–17 years), 22 114, 39 813 and 3774, respectively. The cumulative effect of 7 day lags was calculated as the sum of the coefficients and reported as incidence rate ratio (IRR) related to an increase in 10 grains of pollen/m 3 . In relation to grass pollen, children and adults were disparate in their timing of health effects. Asthma outcomes in children were positively related to grass pollen in May, and for adults in October. Positive associations with weed pollen in children was seen from February to May across all health outcomes. For adults, weed pollen-related health outcomes were restricted to February. Adults were not affected by tree pollen, while children’s asthma morbidity was associated with tree pollen in August and September. In children, IRRs ranged from 1.14 (95% CI 1.06 to 1.21) for ED presentations for tree pollen in August to 1.98 (95% CI 1.06 to 3.72) for weed pollen in February. In adults, IRRs ranged from 1.28 (95% CI 1.01 to 1.62) for weed pollen in February to 1.31 (95% CI 1.08 to 1.57) for grass pollen in October. Monthly risk assessment indicated that most pollen-related asthma health outcomes in children occur in the colder part of the year, while adults are affected in the warm season. The findings indicate a need for year-round pollen monitoring and related health c aigns to provide effective public health prevention.
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.JACI.2021.12.795
Abstract: Food anaphylaxis admission rates have increased steadily in recent decades. Global food allergy prevention guidelines recommending early introduction of allergenic foods were introduced in 2015-2016. Australian guidelines to not delay the introduction of allergenic foods were introduced in 2007-2008. Our aim was to examine whether introduction of Australian guidelines (2007-2008) and global allergy prevention guidelines (2015-2016) were associated with reductions in food anaphylaxis admission rates. We compared food anaphylaxis admission rates across 3 periods: 1998-1999 to 2006-2007, 2007-2008 to 2014-2015, and 2015-2016 to 2018-2019. Annual food anaphylaxis admission rates increased 9-fold between 1998-1999 and 2018-2019, from 2.0 per 10 Although food anaphylaxis continues to increase overall, there is preliminary evidence indicating a slowing in the year-on-year rate of increase among those aged 1 to 4, 5 to 9, and 10 to 14 years, coinciding with introduction of updated infant feeding and allergy prevention guidelines in 2007-2008 and 2015-2016. Changes to the guidelines may have contributed to an attenuated rate of increase in food anaphylaxis in these age groups, as well as to increased rates in those younger than 1 year.
Publisher: Informa UK Limited
Date: 1992
DOI: 10.3109/10428199209053603
Abstract: An attempt to prevent the blast crisis in chronic myeloid leukemia by the use of pulsed doses of (cytarabine cytosine arabinoside) and lomustine was attempted as a cooperative group study by Cancer and Leukemia Group B. The basis for this study was to delay the development of blast crisis by pulsing dose of drugs known to be effective against emerging "blast" cells. The experimental arm which consisted of cytarabine and lomustine did not produce overall results superior to conventional treatment with busulfan. This was related to the non-hematologic effects of the combination which produced significant gastrointestinal toxicity leading to relatively early discontinuation of the combination. Nevertheless, the trial design allowed relatively prompt discontinuation of experimental arm and cross-over to conventional treatment with either hydrea or busulfan. No evidence existed that the use of new drug combinations in CML prejudiced the patient's chance to response to conventional chemotherapy. Thus, a role model for future trials in this disease was developed. With the development of the interferons and other experimental forms of therapy this conceptual development may be of significance.
Publisher: SAGE Publications
Date: 13-05-2013
Abstract: Lifestyle factors prior to a first clinical demyelinating event (FCD), a disorder often preceding the development of clinically definite multiple sclerosis (MS), have not previously been examined in detail. Past tobacco smoking has been consistently associated with MS. This was a multicentre incident case-control study. Cases ( n = 282) were aged 18–59 years with an FCD and resident within one of four Australian centres (from latitudes 27°S to 43°S), from 1 November 2003 to 31 December 2006. Controls ( n = 558) were matched to cases on age, sex and study region, without CNS demyelination. Exposures measured included current and past tobacco and marijuana, alcohol and beverage use, physical activity patterns, blood pressure and physical anthropometry. A history of smoking ever was associated with FCD risk (AOR 1.89 (95%CL 1.82, 3.52)). Marijuana use was not associated with FCD risk after adjusting for confounders such as smoking ever but the estimates were imprecise because of a low prevalence of use. Alcohol consumption was common and not associated with FCD risk. No case-control differences in blood pressure or physical anthropometry were observed. Past tobacco smoking was positively associated with a risk of FCD but most other lifestyle factors were not. Prevention efforts against type 2 diabetes and cardiovascular disease by increasing physical activity and reducing obesity are unlikely to alter MS incidence, and more targeted c aigns will be required.
Publisher: JSTOR
Date: 09-1994
DOI: 10.2307/2532797
Publisher: Informa UK Limited
Date: 04-2004
Publisher: SAGE Publications
Date: 2002
DOI: 10.1046/J.1440-1614.2001.01024.X
Abstract: To examine the current distribution of mental health research in Australia and compare this with the priorities of various stakeholder groups. A content analysis was carried out on a year's worth of published articles and a year's worth of competitive research grants. A questionnaire for stakeholders was developed in which respondents were asked to rate priorities for research using the same categories. Questionnaires were sent to mental health researchers,members of panels that evaluate mental health research grant applications,general practitioners, psychiatrists, clinical psychologists, mental health nurses, mental health consumer and carer advocates, and members of the National Mental Health Working Group. Different groups of stakeholders tended to have differing perspectives on research priorities, with some major differences between committees that evaluate research grants and consumer and carer groups. Different stakeholder groups also tended to obtain their information about research from different sources. However, there were also a number of areas of agreement. When different research topics are considered,the following tended to be under-researched: affective disorders,suicide, primary care and community settings, prevention and promotion,evaluation of services, Aboriginal and Torres Strait Islander peoples,and socially and economically disadvantaged people. It is of concern that committees that evaluate research are guided by different values from consumers and carers in setting priorities. Nevertheless, there is consensus across stakeholder groups that a number of areas should be a high priority.
Publisher: Elsevier BV
Date: 05-1993
DOI: 10.1016/0952-8180(93)90013-5
Abstract: To compare outcomes during conventional analgesia (as-needed intramuscular dosing) and patient-controlled analgesia (PCA) in postoperative patients by analyzing data from published comparative trials. Meta-analyses of 15 randomized control trials. Seven hundred eighty-seven adult patients (aged 16 to 65) undergoing various operative procedures. Either PCA or conventional analgesia for postoperative pain control. Data were extracted on analgesic efficacy, analgesic use, patient satisfaction, length of hospital stay, and side effects. Meta-analyses of the data showed the following: (1) greater analgesic efficacy when PCA was used, with a mean additional benefit of 5.6 on a scale of 0 to 100 (SED, 2.2 p = 0.006) (2) a nonsignificant trend toward reduced analgesic use in PCA patients, based on a count of trials finding in one direction or the other (p = 0.092) (3) a 42% difference in the proportion of patients expressing satisfaction over dissatisfaction (SED, 20% p = 0.02), with PCA being preferred (4) a nonsignificant trend toward shortening of length of hospital stay with PCA use (mean, 0.15 days, SED, 0.13 p = 0.24) (5) no significant differences in the occurrence of any side effect. Patient preference strongly favors PCA over conventional analgesia. Patients using PCA also obtain better pain relief than those using conventional analgesia, without an increase in side effects. Favorable effect of PCA upon analgesic usage and length of hospital stay did not in the initial trials attain statistical significance. Nonetheless, the favorable trends in the mean effect sizes for both outcomes argue that further studies of both outcomes should be performed to determine whether the favorable impact of PCA upon either may become statistically significant if larger numbers of patients are enrolled.
Publisher: Wiley
Date: 30-12-2012
DOI: 10.1002/PRI.529
Abstract: Age-related thoracic hyperkyphosis can lead to poor health outcomes including pain and dysfunction. Physiotherapists are fundamentally involved in the assessment and treatment of this problem but there is no published data that details assessment and treatment strategies or the attitudes of practitioners with respect to hyperkyphosis. The purpose of the study is to ascertain current physiotherapy practice for, and attitudes to, the assessment and treatment of thoracic hyperkyphosis in Australia. A stratified random s le (N = 468) of Australian physiotherapists in all states and territories working in hospitals, outpatient clinics and community clinics were sent an anonymous cross-sectional postal survey. The survey had six sections identifying clinical profile, prevalence, measurement strategy, treatment frequency, treatment strategy and evidence source. A response rate of 47% with anonymity preserved was achieved. The majority of respondents had a musculoskeletal practice profile (75%). Seventy-eight per cent encountered hyperkyphosis at least weekly, and three treatment sessions were most commonly given (35%). Visual inspection was almost universally used to assess the degree of hyperkyphosis (98%), and for 64% it was their only measurement tool. Postural re-education was the most common treatment strategy (90%) but the range of treatments reported was erse. The primary source of evidence used by the majority of respondents was their undergraduate education, and there was concern expressed that physiotherapists lack good evidence upon which to make therapeutic decisions about hyperkyphosis. Thoracic hyperkyphosis is commonly encountered by physiotherapists. Measurement of treatment efficacy is highly subjective, and the treatment modalities employed are erse. Many physiotherapists based their management of hyperkyphosis on their undergraduate education alone.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2005
DOI: 10.1097/01.EDE.0000147105.94041.E6
Abstract: Chronic exposure to arsenic through drinking water has the potential to cause adverse pregnancy outcomes, although the association has not been demonstrated conclusively. This cross-sectional study assessed the association between arsenic in drinking water and spontaneous abortion, stillbirth, and neonatal death. In this cross-sectional study, 533 women were interviewed. Information on sociodemographic characteristics, drinking water use, and adverse pregnancy outcomes was obtained through a structured pretested interviewer-administered questionnaire. The respondents reported use of a total of 223 tube wells for 208 wells, water s les were measured using an ultraviolet/visible spectrophotometry method, whereas 15 were measured by flow-injection hydride generation atomic absorption spectrometry (FIHG-AAS). Excess risks for spontaneous abortion and stillbirth were observed among the participants chronically exposed to higher concentrations of arsenic in drinking water after adjusting for participant's height, history of hypertension and diabetes, and (for neonatal death only) age at first pregnancy. Comparing exposure to arsenic concentration of greater than 50 microg/L with 50 microg/L or less, the odds ratios were 2.5 (95% confidence interval=1.5-4.3) for spontaneous abortion, 2.5 (1.3-4.9) for stillbirth, and 1.8 (0.9-3.6) for neonatal death. These study findings suggest that chronic arsenic exposure may increase the risk of fetal and infant death.
Publisher: Elsevier BV
Date: 12-2002
DOI: 10.1016/S0277-9536(01)00319-7
Abstract: Youth suicide has risen in most developed nations over the past 50 years, especially among males, but the increase remains to be explained. Statistical analyses were used to examine associations between youth suicide rates in 11-21 mainly Western, developed nations and 32 socio-economic and cultural variables. The central hypothesis was that suicide rates would be correlated with various cultural measures of social attachment and integration, especially in idualism. Socio-economic variables were included in the analysis to demonstrate the relative strength of the cultural associations. The study found a strong positive correlation between male youth suicide rates and subjective measures of health, optimism, and several indices of in idualism, including personal freedom and control. Correlations between female youth suicide and in idualism were smaller, attaining significance in only one instance. Male youth suicide and in idualism were negatively correlated with older people's sense of parental duty. Correlations between suicide and other possibly relevant cultural variables--tolerance of suicide, belief in God and national pride--were not significant. The analysis of socio-economic variables yielded only one significant, but doubtful, correlation. The findings can be interpreted as supporting two very different hypotheses: that youth suicide represents "an island of misery in an ocean of happiness" or "the tip of an iceberg of suffering". In favouring the latter interpretation, and consistent with Durkheim's theories on suicide, it is argued that increased youth suicide reflects a failure of Western societies to provide appropriate sites or sources of social identity and attachment, and, conversely, a tendency to promote unrealistic or inappropriate expectations of in idual freedom and autonomy.
Publisher: SAGE Publications
Date: 12-2000
DOI: 10.2466/PMS.2000.91.3.707
Abstract: The familial incidence of Scotopic Sensitivity/Irlen Syndrome was investigated in two s les. One s le involved parents and siblings of 126 children identified with symptoms who had been referred for screening. The other s le involved parents and siblings of 33 children who had been identified with symptoms through mass screening of all children in Grades 3 to 6 at two local schools. Two different s les were taken to investigate the possibility of parental referral bias. Familial incidence may be inflated in a referred s le because some parents may be aware of their own symptoms and actively seek assistance. For the s le of children referred for screening, there was an 81% chance of either one or both parents showing similar symptoms and a 76% chance of siblings being similarly affected. For the s le of children identified through school screening, there was an 85% chance of either one or both parents showing similar symptoms and a 54% chance of siblings being similarly affected. The data confirm previous estimates of incidence and suggest that Scotopic Sensitivity/Irlen Syndrome may be a genetically-based deficit in visual processing.
Publisher: Springer Science and Business Media LLC
Date: 26-10-2012
DOI: 10.1007/S00484-012-0597-8
Abstract: We have investigated the association between tropical weather condition and age-sex adjusted death rates (ADR) in Thailand over a 10-year period from 1999 to 2008. Population, mortality, weather and air pollution data were obtained from four national databases. Alternating multivariable fractional polynomial (MFP) regression and stepwise multivariable linear regression analysis were used to sequentially build models of the associations between temperature variable and deaths, adjusted for the effects and interactions of age, sex, weather (6 variables), and air pollution (10 variables). The associations are explored and compared among three seasons (cold, hot and wet months) and four weather zones of Thailand (the North, Northeast, Central, and South regions). We found statistically significant associations between temperature and mortality in Thailand. The maximum temperature is the most important variable in predicting mortality. Overall, the association is nonlinear U-shape and 31 °C is the minimum-mortality temperature in Thailand. The death rates increase when maximum temperature increase with the highest rates in the North and Central during hot months. The final equation used in this study allowed estimation of the impact of a 4 °C increase in temperature as projected for Thailand by 2100 this analysis revealed that the heat-related deaths will increase more than the cold-related deaths avoided in the hot and wet months, and overall the net increase in expected mortality by region ranges from 5 to 13 % unless preventive measures were adopted. Overall, these results are useful for health impact assessment for the present situation and future public health implication of global climate change for tropical Thailand.
Publisher: MDPI AG
Date: 14-11-2017
Publisher: Wiley
Date: 09-03-2017
DOI: 10.1002/BRB3.670
Publisher: Elsevier BV
Date: 10-1994
DOI: 10.1016/0735-1097(94)90873-7
Abstract: This study attempted to determine the effect of unreported patient deaths on estimates of pacemaker reliability. The reliability of pacemakers is usually reported with reference to implant registration data and returned product analysis without censoring when follow-up data are missing. We studied 73 patients (mean [+/- SD] age 77 +/- 8 years) undergoing implantation of a ventricular-inhibited (VVI) pacemaker who were subsequently found to be at increased risk of experiencing premature pacemaker failure. Survival curves for patients and pacemakers were constructed by the Kaplan-Meier method with appropriate censoring at the time of unrelated death or elective explantation of a normal device. To examine the effect of unreported loss of follow-up data, patient mortality was then ignored, and follow-up for pacemakers without known failure was assumed to continue to the date of analysis. There were 13 device failures, with a median pacemaker survival time of 37 months. Twenty-three patients died, all of causes unrelated to the pacemaker system median patient survival time was only 44 months. Ignoring this attrition inflated follow-up time from 122 to 188 patient-years and reduced the apparent pacemaker failures at 30 months by almost half, from 37% to only 20%. Modeling the process shows that when the patient mortality rate is more than half the pacemaker failure rate, ignoring censoring inflates the device survival estimate by > or = 10% from the median survival onward. When medical device survival curves are generated by implant registration data and returned product analysis, they should be adjusted for unreported loss of follow-up.
Publisher: Elsevier BV
Date: 06-2022
Publisher: Elsevier BV
Date: 04-2021
Publisher: Springer Science and Business Media LLC
Date: 11-2002
DOI: 10.1007/S00127-002-0590-3
Abstract: The National Survey of Mental Health and Well-being in Australia has provided a rare opportunity to investigate not only the sociodemographic distribution of well-being, but also how it is related to impaired mental or physical health, to specific groups of psychiatric disorders and disability in daily life. A national household s le of 10,641 in iduals (response rate 78 %) representative of the adult population was interviewed with the Composite International Diagnostic Interview and completed scales measuring recent symptoms, disablement and well-being. The latter was measured by the single item Life Satisfaction Scale of Andrews and Withey (1976) expressed as percentage, with 100 % being "delighted". The mean score for the Australian adult population was 70.4 % (95 % CI 70.0, 70.8), which matches the proposed universal norm. Men and women had very similar mean scores. Well-being was higher in persons with tertiary education and in those owning or purchasing their homes. It was lower in persons with physical or mental disorders, particularly depression. For alcohol use, a U-shaped relationship was found, whereby well-being was lower both in abstainers and in heavy users. Multiple regression analysis showed that when adjustment is made for confounders, women had higher life satisfaction than men and that high life satisfaction became less common with age in men, but even more so in women. Life satisfaction was impaired for respondents with high psychological distress, especially in the unemployed, the orced and those with tertiary education, whether or not their symptoms led to a CIDI-A diagnosis of depression. The correlates of well-being are essentially in the expected direction. Depressive disorder has a stronger association with low well-being than other psychiatric diagnoses. Of particular interest is the existence of a small number of persons with current anxiety or depressive disorders who report having high life satisfaction. This deserves further investigation.
Publisher: Wiley
Date: 15-04-1993
DOI: 10.1002/1097-0142(19930415)71:8<2585::AID-CNCR2820710825>3.0.CO;2-S
Abstract: The value of chemotherapy after standard postoperative external beam radiation in the treatment of malignant gliomas remains controversial. Despite recent recommendations from the Brain Tumor Cooperative Group that chemotherapy should be considered part of the standard treatment of patients with high-grade astrocytomas, several recent trials have questioned the efficacy of this approach. Using results from 16 randomized clinical trials involving more than 3000 patients, the authors compared the survival rates of patients who received radiation alone or radiation with chemotherapy. The combined data were analyzed using the statistical method of meta-analysis as described by DerSimonian and Laird. The estimated increase in survival for patients treated with combination radiation and chemotherapy was 10.1% at 1 year (95% confidence interval, 6.8, 13.3%) and 8.6% at 2 years (5.2, 12.0%). These absolute increases in survival (treated-control [TC]) in patients treated with chemotherapy represent relative increases (T-C)/C of 23.4% at 1 year (15.8, 30.9%) and 52.4% at 2 years (31.7, 73.2%). This survival advantage is conferred by several different chemotherapeutic agents. When the prognostic variables of age and histology are factored into the analysis, however, the data suggest that the survival benefit from chemotherapy occurs earlier in patients with anaplastic astrocytoma (AA) than in patients with glioblastoma. The authors concluded that chemotherapy is advantageous for patients with malignant gliomas and should be considered part of the standard therapeutic regimen. Additional randomized trials using optimal radiation and chemotherapy may still be needed to precisely define which subgroups of patients, based on prognostic variables, will benefit most from chemotherapy after radiation.
Publisher: Informa UK Limited
Date: 11-2013
Publisher: Elsevier BV
Date: 10-2021
Publisher: SAGE Publications
Date: 18-02-2010
Abstract: Increasing prevalence and variable geographic patterns of occurrence of multiple sclerosis suggest an environmental role in causation. There are few descriptive, population-level, data on whether such variability applies to first demyelinating events (FDEs). We recruited 216 adults (18—59 years), with a FDE between 1 November 2003 and 31 December 2006 in a multi-center incident case-control study in four locations on the south-eastern and eastern seaboard of Australia, spanning latitudes 27° south to 43° south. Population denominators were obtained from the Australian Bureau of Statistics censuses of 2001 and 2006. Age and sex adjusted FDE incidence rates increased by 9.55% (95% confidence interval (CI) 7.37—11.78, p 0.001) per higher degree of latitude. The incidence rate gradient per higher degree of latitude varied by gender (male: 14.69% (95% CI 9.68—19.94, p 0.001) female 8.13% (95% CI 5.69—10.62, p 0.001)) and also by the presenting FDE type: optic neuritis 11.39% (95% CI 7.15—15.80, p 0.001) brainstem/cerebellar syndrome 9.47% (95% CI 5.18—13.93, p 0.001) and spinal cord syndrome 5.36% (95% CI 1.78—9.06, p = 0.003). Differences in incidence rate gradients were statistically significant between males and females ( p = 0.02) and between optic neuritis and spinal cord syndrome ( p = 0.04). The male to female ratio varied from 1 : 6.7 at 27° south to 1 : 2.5 at 43° south. The study establishes a positive latitudinal gradient of FDE incidence in Australia. The latitude-related factor(s) influences FDE incidence variably according to subtype and gender, with the strongest influence on optic neuritis presentations and for males. These descriptive case analyses show intriguing patterns that could be important for understanding the etiology of multiple sclerosis.
Publisher: Springer Science and Business Media LLC
Date: 2006
Publisher: Springer Science and Business Media LLC
Date: 23-10-2004
Publisher: BMJ
Date: 04-04-2022
DOI: 10.1136/OEMED-2021-107888
Abstract: Exposure to extreme temperatures is associated with increased emergency department (ED) presentations. The resulting burden on health service costs and the potential impact of climate change is largely unknown. This study examines the temperature-EDs/cost relationships in Adelaide, South Australia and how this may be impacted by increasing temperatures. A time series analysis using a distributed lag nonlinear model was used to explore the exposure–response relationships. The net-attributable, cold-attributable and heat-attributable ED presentations for temperature-related diseases and costs were calculated for the baseline (2014–2017) and future periods (2034–2037 and 2054–2057) under three climate representative concentration pathways (RCPs). The baseline heat-attributable ED presentations were estimated to be 3600 (95% empirical CI (eCI) 700 to 6500) with associated cost of $A4.7 million (95% eCI 1.8 to 7.5). Heat-attributable ED presentations and costs were projected to increase during 2030s and 2050s with no change in the cold-attributable burden. Under RCP8.5 and population growth, the increase in heat-attributable burden would be 1.9% (95% eCI 0.8% to 3.0%) for ED presentations and 2.5% (95% eCI 1.3% to 3.7%) for ED costs during 2030s. Under the same conditions, the heat effect is expected to increase by 3.7% (95% eCI 1.7% to 5.6%) for ED presentations and 5.0% (95% eCI 2.6% to 7.1%) for ED costs during 2050s. Projected climate change is likely to increase heat-attributable emergency presentations and the associated costs in Adelaide. Planning health service resources to meet these changes will be necessary as part of broader risk mitigation strategies and public health adaptation actions.
Publisher: Springer Science and Business Media LLC
Date: 03-2006
Publisher: Springer Science and Business Media LLC
Date: 04-2018
Publisher: Elsevier BV
Date: 2007
DOI: 10.1016/J.NEUROPSYCHOLOGIA.2007.02.006
Abstract: Estimates of white matter hyperintensities (WMH) derived from T2-weighted MRI were investigated in relation to cognitive performance in 469 healthy community-dwelling adults aged 60-64 years. Frontal lobe WMH but not WMH from other brain regions (temporal, parietal, and occipital lobes, anterior and posterior horn, periventricular body) were associated with elevated within-person reaction time (RT) variability (trial to trial fluctuations in RT performance) but not performance on several other cognitive tasks including psychomotor speed, memory, and global cognition. The findings are consistent with the view that elevated within-person variability is related to neurobiological disturbance, and that attentional mechanisms supported by the frontal cortex play a key role in this type of variability.
Publisher: Elsevier BV
Date: 2010
DOI: 10.1016/J.SCITOTENV.2016.10.019
Abstract: Although many in idual studies have examined the association between temperature and blood pressure (BP), they used different methods and also their results were somewhat inconsistent. The aims of this study are to quantitatively summarize previous studies and to systematically assess the methodological issues to make recommendations for future research. We searched relevant empirical studies published before January 2016 concerning temperature and BP among adults using the MEDLINE, Embase and PubMed databases. Mean changes in systolic (SBP) and diastolic blood pressure (DBP) per 1°C reduction in temperature were pooled using a random-effects meta-analysis. Of 23 studies included, 14 were used for meta-analysis. Consistent, statistically significant, inverse associations were observed between ambient temperature (mean, maximum, minimum outdoor temperature and indoor temperature) and BP. An 1°C decrease in mean daily outdoor temperature was associated with an increase in SBP and DBP of 0.26mmHg (95% CI: 0.18-0.33) and 0.13 (95% CI: 0.11-0.16), respectively. The increase was greater in people with conditions related to cardiovascular disease. An 1°C decrease in indoor temperature was associated with 0.38mmHg (0.18-0.58) increase in SBP, while the effects on DBP were not estimated due to limited studies. Among the previous studies on temperature-BP relationship, temperature and BP measurements are not accurate enough and statistical methods need to be improved. Lower ambient temperatures seem to increase adults' BP and people with conditions related to cardiovascular disease are more susceptible to drops in temperature. Indoor temperature appeared to have a stronger effect on BP than outdoor temperature. To understand temperature-BP relationship well, a study combining repeated personal temperature exposure and ambulatory BP monitoring, applying improved statistical methods to examine potential non-linear relationship is warranted.
Publisher: BMJ
Date: 26-05-2017
Abstract: We have undertaken a clinic-based survey of neuromyelitis optica spectrum disorders (NMOSDs) in Australia and New Zealand to establish incidence and prevalence across the region and in populations of differing ancestry. NMOSD is a recently defined demyelinating disease of the central nervous system (CNS). The incidence and prevalence of NMOSD in Australia and New Zealand has not been established. Centres managing patients with demyelinating disease of the CNS across Australia and New Zealand reported patients with clinical and laboratory features that were suspicious for NMOSD. Testing for aquaporin 4 antibodies was undertaken in all suspected cases. From this group, cases were identified who fulfilled the 2015 Wingerchuk diagnostic criteria for NMOSD. A capture-recapture methodology was used to estimate incidence and prevalence, based on additional laboratory identified cases. NMOSD was confirmed in 81/170 (48%) cases referred. Capture-recapture analysis gave an adjusted incidence estimate of 0.37 (95% CI 0.35 to 0.39) per million per year and a prevalence estimate for NMOSD of 0.70 (95% CI 0.61 to 0.78) per 100 000. NMOSD was three times more common in the Asian population (1.57 (95% CI 1.15 to 1.98) per 100 000) compared with the remainder of the population (0.57 (95% CI 0.50 to 0.65) per 100 000). The latitudinal gradient evident in multiple sclerosis was not seen in NMOSD. NMOSD incidence and prevalence in Australia and New Zealand are comparable with figures from other populations of largely European ancestry. We found NMOSD to be more common in the population with Asian ancestry.
Publisher: SAGE Publications
Date: 19-01-2011
Abstract: Most regions of Australia are exposed to hot summers and regular extreme heat events and numerous studies have associated high ambient temperatures with adverse health outcomes in Australian cities. Extreme environmental heat can trigger the onset of acute conditions, including heat stroke and dehydration, as well as exacerbate a range of underlying illnesses. Consequently, in the absence of adaptation, the associated mortality and morbidity are expected to increase in a warming climate, particularly within the vulnerable populations of the elderly, children, those with chronic diseases, and people engaged in physical labour in noncooled environments. There is a need for further research to address the evidence needs of public health agencies in Australia. Building resilience to extreme heat events, especially for the most vulnerable groups, is a priority. Public health professionals and executives need to be aware of the very real and urgent need to act now.
Publisher: Elsevier BV
Date: 03-1996
DOI: 10.1016/0959-8049(95)00607-9
Abstract: The follicular lymphomas pursue an indolent course in many patients. Long-term follow-up in large series is therefore necessary to establish whether cure is taking place, and if so, at what stage in the dissemination of the disease process it becomes unlikely. The time to, and site of relapse, together with its impact on survival has been studied in 398 patients entered into the British National Lymphoma Investigation limited and disseminated disease trials between 1974 and 1980. Relapse data were compared with various models to obtain maximum likelihood estimates of the proportions permanently remaining relapse-free following treatment. Long-term relapse-free survival was observed in 54.8 +/- 14.9% (95% CI) of patients at 15 years with Ann Arbor stage I disease, 29.2 +/- 13.6% in patients with stage II disease, 18.1 +/- 6.6% with stage III and 13.0 +/- 5.9% with IV disease. Relapse time-course data for all trial arms conform closely to lognormal distributions allowing maximum likelihood estimates of proportions remaining permanently relapse-free to be derived. Using this methodology, over a quarter of patients treated with involved radiotherapy alone or radiotherapy plus 6 months of chlorambucil in the limited disease (Ann Arbor stage I and II) trial are unlikely to relapse at any time in the future. Over 10% of patients treated in the disseminated disease trials with disease classified as Ann Arbor stage III are also statistically unlikely to relapse. The finding that a proportion of patients is statistically unlikely to experience a clinically obvious relapse is consistent with clinical cure. It is especially interesting that a small proportion of patients with disseminated disease and treated by chemotherapy have fallen into this category, but additional data are required to know at what point statistical cure becomes unlikely. Whether "clinical cure" is the same as "pathological cure" in this disease remains uncertain.
Publisher: Environmental Health Perspectives
Date: 08-2004
DOI: 10.1289/EHP.6866
Abstract: Many interventions have been advocated to mitigate the impact of arsenic contamination of drinking water in Bangladesh. However, there are few data on the true magnitude of arsenic-related disease in Bangladesh nationally. There has also been little consideration given to possible adverse effects of such interventions, in particular, diarrheal disease. The purpose of this study was to estimate and compare the likely impacts of arsenic mitigation interventions on both arsenic-related disease and water-borne infectious disease. We found that arsenic-related disease currently results in 9,136 deaths per year and 174,174 disability-adjusted life years (DALYs undiscounted) lost per year in those exposed to arsenic concentrations > 50 microg/L. This constitutes 0.3% of the total disease burden in Bangladesh in terms of undiscounted DALYs. We found intervention to be of overall benefit in reducing disease burden in most scenarios examined, but the concomitant increase in water-related infectious disease significantly reduced the potential benefits gained from intervention. A minimum reduction in arsenic-related DALYs of 77% was necessary before intervention achieved any reduction in net disease burden. This is assuming that interventions were provided to those exposed to > 50 microg/L and would concomitantly result in a 20% increase in water-related infectious disease in those without access to adequate sanitation. Intervention appears to be justified for those populations exposed to high levels of arsenic, but it must be based on exposure levels and on the effectiveness of interventions not only in reducing arsenic but in minimizing risk of water-related infections. Key words: arsenic/adverse effects, Bangladesh, burden of disease, diarrhea, risk assessment, water pollutants, water supply.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2010
Publisher: MDPI AG
Date: 06-08-2022
Abstract: This study aimed to estimate respiratory disease hospitalization costs attributable to ambient temperatures and to estimate the future hospitalization costs in Australia. The associations between daily hospitalization costs for respiratory diseases and temperatures in Sydney and Perth over the study period of 2010–2016 were analyzed using distributed non-linear lag models. Future hospitalization costs were estimated based on three predicted climate change scenarios-RCP2.6, RCP4.5 and RCP8.5. The estimated respiratory disease hospitalization costs attributable to ambient temperatures increased from 493.2 million Australian dollars (AUD) in the 2010s to more than AUD 700 million in 2050s in Sydney and from AUD 98.0 million to about AUD 150 million in Perth. The current cold attributable fraction in Sydney (23.7%) and Perth (11.2%) is estimated to decline by the middle of this century to (18.1–20.1%) and (5.1–6.6%), respectively, while the heat-attributable fraction for respiratory disease is expected to gradually increase from 2.6% up to 5.5% in Perth. Limitations of this study should be noted, such as lacking information on in idual-level exposures, local air pollution levels, and other behavioral risks, which is common in such ecological studies. Nonetheless, this study found both cold and hot temperatures increased the overall hospitalization costs for respiratory diseases, although the attributable fractions varied. The largest contributor was cold temperatures. While respiratory disease hospitalization costs will increase in the future, climate change may result in a decrease in the cold attributable fraction and an increase in the heat attributable fraction, depending on the location.
Publisher: Wiley
Date: 05-1996
DOI: 10.1111/J.1423-0410.1996.TB01326.X
Abstract: Human serum albumin solutions have been used as plasma replacement fluids for many years and adverse events associated with their use are rare. Albumex 5 is a new albumin solution manufactured by a combination of the Cohn fractionation process and a chromatographic technique. A multicentre, randomised study was conducted to compare the safety of Albumex 5 and 5% normal serum albumin (5% NSA) in patients undergoing large volume therapeutic plasmapheresis for a variety of disorders. Up to six exchanges were performed on each patient. A total of 208 evaluable exchanges were performed on 40 patients, 109 5% NSA and 99 Albumex 5. There were 9 adverse events (reaction rate of 8.3%) in 6 patients with 5% NSA and 12 events (reaction rate 12.1%) in 8 patients with Albumex 5. The difference is not statistically significant (p = 0.37, Fisher's exact test). None of the adverse events were considered serious. Only six reactions were thought to be possibly related to the product and three exchanges were modified as a result of an adverse event one with Albumex 5 was interrupted and two with 5% NSA were slowed. Albumex 5 can be considered to be a safe product with a low adverse event rate.
Publisher: Wiley
Date: 2001
DOI: 10.1002/SIM.781
Abstract: An important but difficult problem in clinical trials is to determine the presence of cured patients when long-term survivors are observed. The likelihood ratio test has been studied for this purpose in the gamma mixture model. However, its asymptotic null distribution is not readily available due to a violation of boundary conditions in the standard asymptotic theory. In this paper, a simulation study is employed to examine a proposed asymptotic null distribution of the likelihood ratio test. We find that the distribution can also be used to approximate the asymptotic null distribution of the likelihood ratio test in the Weibull and log-normal mixture models when the censoring rate is not too light. However, the simulation study also shows that null distribution of the likelihood ratio test deviates significantly from the suggested distribution under moderate s le sizes when the censoring rate is small or the hazard rate is large. Consequently caution is needed in this case to determine the presence of cured patients. Finally, the results are used to confirm the presence of cured patients in a leukaemia study.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Wiley
Date: 15-07-2005
DOI: 10.1111/J.1360-0443.2005.01158.X
Abstract: To investigate associations, including non-linear relationships, between cognitive function and alcohol consumption, testing for moderating effects of age and gender and for differences across outcome measures. Design Cross-sectional general population s les of three age cohorts. Setting Canberra and Queanbeyan, Australia. The total s le of 7485 consisted of 2404 men and women aged 20-24 years, 2530 aged 40-44 years, and 2551 aged 60-64 years, selected from the electoral rolls. Measurements Self-report data using hand-held computers provided weekly alcohol consumption from the Alcohol Use Disorders Identification Test (AUDIT) frequency, quantity and binge-drinking items, and socio-demographic factors. Spot-the-Word, digits backwards, the Symbol-Digit Modalities Test (SDMT), immediate recall and reaction-time tests were conducted by trained interviewers. Findings varied across dependent variables, but there was a general tendency for light drinkers (up to 20/10 g alcohol per day in men/women, respectively) to perform better than abstainers, occasional drinkers or those drinking at hazardous/harmful levels (>40/20 g per day in men/women). Poorer performance of hazardous/harmful drinkers was seen only in men, whereas that of abstainers was evident in both sexes but was stronger in women. After adjustment for education and race, male hazardous/harmful drinkers no longer performed significantly less well than light drinkers, whereas male and female abstainers and occasional drinkers still did so. Abstainers have poorer cognitive function than light drinkers and further investigation is needed to determine what factors contribute to this.
Publisher: Wiley
Date: 20-12-2016
Abstract: Patients presenting with clinically isolated syndrome (CIS) may proceed to clinically definite multiple sclerosis (CDMS). Midsagittal corpus callosum area (CCA) is a surrogate marker for callosal atrophy, and can be obtained from a standard MRI study. This study explores the relationship between CCA measured at CIS presentation (baseline) and at 5 years post presentation, with conversion from CIS to CDMS. The association between CCA and markers of disability progression is explored. Corpus callosum area was measured on MRI scans at presentation and 5-year review following diagnosis of a first demyelinating event, or evidence of progressive MS, in 143 participants in the Ausimmune/AusLong Study. Relationships between CCA (at baseline and follow-up) and clinical outcomes were assessed. Mean CCA at baseline study was 6.63 cm Baseline CCA obtained from standard MRI protocols may be compared with subsequent MRI examinations as a surrogate for neurodegeneration and cerebral atrophy in patients with MS. This study demonstrates an association between CCA and disability in in iduals presenting with CIS who convert to MS.
Publisher: Wiley
Date: 07-08-2007
DOI: 10.1111/J.1445-5994.2007.01451.X
Abstract: As cancer survival is improving approximately by 1-2% per year, delays in the clinical trials that lead to that improvement could cost lives. To review the process of ethics committee approval for a multicentre clinical trial of cancer treatment and to estimate the delay it will cause in obtaining the results and the effects of such delays on survival for all cancers in Australia. A survey was sent to each of the 15 centres participating in the study to obtain details about submissions they had made to their ethics committees and the replies received from them. The survey response rate was 100%. The average time required to complete an ethics submission was 12 h, and the average length of time for a final reply was 70 days. Wide variation was noted in the replies, 40% were considered constructive. Most centres said the effort in ethics submissions is sufficient to limit participation in other clinical trials that are available. The multicentre system of ethics approval has significantly delayed this multicentre trial and may delay advances in cancer care. Extrapolating this delay to determine an influence on improvements in cancer survival suggests that it may be responsible for 60 cancer deaths per year. A method for measuring the effect on the shape of the accrual curve is defined, and the term DIABOLECAL (Delays in Accrual Brought On Largely by Ethics Committee Activity Lag-time) is proposed to describe it. Attempts to overcome this problem have been introduced overseas.
Publisher: Oxford University Press (OUP)
Date: 25-05-2017
DOI: 10.1093/IJE/DYX069
Publisher: Informa UK Limited
Date: 16-10-2007
DOI: 10.1080/10934520701567197
Abstract: Arsenic groundwater contamination in Bangladesh warrants immediate remediation. This randomised controlled intervention trial was conducted to determine the effectiveness of two possible interventions: dug wells and three-pitcher filters. A total of 640 in iduals participated with 218 randomised to the dug well group, 216 to the three-pitcher group and 206 to a control group. Data were collected at baseline and at 1, 6 and 12 months after the intervention. Self reported compliance with dug wells remained below 20% during the entire 12 months of the study. The compliance with the three-pitcher filters decreased after 6 months and became similar to the compliance of the dug well group after 12 months. A substantial decrease in urinary arsenic metabolites occurred only among those who were compliant with dug wells and three-pitcher filter systems after 1 month of intervention as opposed to control participants. However, a persistent reduction in urinary arsenic concentrations was observed only among the dug well users after 12 months of intervention. Our results show that a functional dug well could be offered as a long-term alternative to tube wells, but use of this option is likely to be low, unless appropriate behavioural change measures are taken. Our study also demonstrates that arsenic removal technologies such as three-pitcher filters are an effective option as a short-term measure. The three-pitcher filters that are not adequately maintained are not an effective option for a year. These arsenic removal technologies may be even harmful in the long term if the resultant water quality is not properly monitored.
Publisher: Hogrefe Publishing Group
Date: 03-2004
Publisher: Springer Science and Business Media LLC
Date: 04-2003
DOI: 10.1007/S00127-003-0620-9
Abstract: Retrospective reports of low care from either parent are found to be associated with increased risk for anxiety and depression in adulthood. Furthermore, fathers are generally reported as having been less caring than mothers, which raises the issue of whether greater care from fathers across the whole population would benefit mental health. A community survey was carried out in Canberra, Australia, with 2404 adults aged 20-24 and 2530 aged 40-44. Respondents retrospectively reported on affection shown by their parents and on other aspects of family functioning. These data were analysed in relation to risk for anxiety and depressive symptoms and neuroticism. Retrospective reporting of greater affection from both fathers and mothers was generally associated with fewer anxiety and depression symptoms and lower neuroticism. However, there was a significant interaction effect, such that mental health was worse in families where the father was reported to show a higher level of affection but the mother a lower level. Such families were found to have a range of problems, including higher rates of emotional problems in the parents, conflict in the home, parental separation or orce, and parental mistreatment. These family problems accounted for much of the interaction effect observed. Greater affection from the father is not always associated with lower risk for anxiety and depression. Where the father is more affectionate than the mother there tends to be increased family problems and increased risk. It is possible that family problems lead fathers to show increased affection to their children or mothers to show reduced affection.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-07-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-03-2012
Publisher: Elsevier BV
Date: 04-2007
DOI: 10.1016/J.SOCSCIMED.2006.12.009
Abstract: Participating in the social and civic life of communities is protectively associated with the onset and course of physical and mental disorders, and is considered important in achieving health promotion goals. Despite its importance in health research, there is no systematically developed measure of community participation. Our aim was to undertake the preliminary development of a community participation questionnaire, including validating it against an external reference, general psychological distress. Participants were 963 randomly selected community members, aged 19-97, from coastal New South Wales, Australia, who completed an anonymous postal survey. There were 14 types of community participation, most of which were characterised by personal involvement, initiative and effort. Frequency of participation varied across types and between women and men. Based on multiple linear regression analyses, controlling for socio-demographic factors, nine types of participation were independently and significantly associated with general psychological distress. Unexpectedly, for two of these, "expressing opinions publicly" and "political protest", higher levels of participation were associated with higher levels of distress. The other seven were: contact with immediate household, extended family, friends, and neighbours participating in organised community activities taking an active interest in current affairs and religious observance. We called these the "Big 7". Higher levels of participation in the Big 7 were associated with lower levels of distress. Participating in an increasing number of the Big 7 types of participation was strongly associated in linear fashion with decreasing distress.
Publisher: BMJ
Date: 05-04-2016
Abstract: Explaining patterns in the sex ratio (male/female) of cardiovascular disease (CVD) mortality would improve understanding of mortality transitions under modernisation. Little research has examined secular trends in this ratio across populations, taking age and cohort into account. We examine cohort effects in the ratios of CVD mortality (including ischaemic heart disease and cerebrovascular disease) among 4 East Asian populations that vary in the timing of their modernisation, and assess the effect of smoking on these patterns in comparison with Western populations. The sequential method for log-linear models is applied to analyse age, period and cohort effects for sex ratios. Age and cohort effects are fitted first, with population as offset period effects are fitted in a second model using the fitted values from the first model as the offset. Lung cancer mortality serves as a proxy for smoking. Increases in sex ratios of CVD mortality began in earlier cohorts in Western than in East Asian populations. Once begun, increases were more rapid in East Asia. The cohort effect for the sex ratio of CVD mortality differs from that for lung cancer mortality. Trends in sex ratios of CVD mortality by cohort are similar before and after adjustment for lung cancer mortality in East Asia the increasing trend across 1900-1945 cohorts is maintained in Western populations after adjustment. The sex ratio of CVD mortality has increased across successive cohorts living in increasingly modernised environments. There is scant evidence that this increase is attributable to changing sex-specific rates of smoking.
Publisher: Wiley
Date: 03-2000
DOI: 10.1111/J.0006-341X.2000.00237.X
Abstract: Nonparametric methods have attracted less attention than their parametric counterparts for cure rate analysis. In this paper, we study a general nonparametric mixture model. The proportional hazards assumption is employed in modeling the effect of covariates on the failure time of patients who are not cured. The EM algorithm, the marginal likelihood approach, and multiple imputations are employed to estimate parameters of interest in the model. This model extends models and improves estimation methods proposed by other researchers. It also extends Cox's proportional hazards regression model by allowing a proportion of event-free patients and investigating covariate effects on that proportion. The model and its estimation method are investigated by simulations. An application to breast cancer data, including comparisons with previous analyses using a parametric model and an existing nonparametric model by other researchers, confirms the conclusions from the parametric model but not those from the existing nonparametric model.
Publisher: American Medical Association (AMA)
Date: 25-01-1993
Publisher: Public Library of Science (PLoS)
Date: 26-11-2013
Publisher: Wiley
Date: 12-2009
Publisher: SAGE Publications
Date: 08-2007
Abstract: Rising multiple sclerosis incidence over the last 50 years and geographic patterns of occurrence suggest an environmental role in the causation of this multifactorial disease. Design options for epidemiological studies of environmental causes of multiple sclerosis are limited by the low incidence of the disease, possible diagnostic delay and budgetary constraints. We describe scientific and methodological issues considered in the development of the Australian Multicentre Study of Environment and Immune Function (the Ausimmune Study), which seeks, in particular, to better understand the causes of the well-known MS positive latitudinal gradient. A multicentre, case-control design down the eastern seaboard of Australia allows the recruitment of sufficient cases for adequate study power and provides data on environmental exposures that vary by latitude. Cases are persons with an incident first demyelinating event (rather than prevalent multiple sclerosis), sourced from a population base using a two tier notification system. Controls, matched on sex, age (within two years) and region of residence, are recruited from the general population. Biases common in case-control studies, eg, prevalence-incidence bias, admission-rate bias, non-respondent bias, observer bias and recall bias, as well as confounding have been carefully considered in the study design and conduct of the Ausimmune Study. Multiple Sclerosis 2007 13 : 827—839. msj.sagepub.com
Publisher: Elsevier BV
Date: 06-2021
Publisher: American Psychological Association (APA)
Date: 05-2005
DOI: 10.1037/0894-4105.19.3.309
Abstract: Intrain idual variability in cognitive test performance has the potential to be a good marker of preclinical Alzheimer's disease status (S. C. Li & U. Lindenberger, 1999). Using cross-sectional community data from 2,317 in iduals aged 60-64 years, the authors of this study found that variability was greater in in iduals who met criteria for mild cognitive impairment or aging-associated cognitive decline but not for age-associated memory impairment. Higher variability was associated with lower education and a non-English-speaking background. In contrast to previous findings, variability in this study did not contribute uniquely to meeting criteria for mild cognitive impairment. The reasons for the differences may reside in the authors' method of estimating mean independent variability, the use of an occasion-specific measure, or the relatively younger age of the participants. Follow-up of the cohort in 4 years will yield data on the prospective validity of variability as a risk factor for impairment.
Publisher: Elsevier BV
Date: 05-1997
DOI: 10.1016/S0735-1097(97)00050-8
Abstract: This study sought to determine whether a moderate intensity supervised exercise training program, performed immediately after an uncomplicated acute myocardial infarction, improves recovery in cardiac autonomic function compared with standard advice about activity at home. Exercise training has beneficial effects on cardiac autonomic function and may improve prognosis after acute myocardial infarction. Thirty-nine male and 10 female patients, mean (+/-SE) age 57 +/- 1 years, with an uncomplicated acute myocardial infarction were randomized to either a 6-week moderate intensity supervised hospital-based exercise training program (exercise group) or to an unsupervised low intensity home walking program (control group). Outcome measures included changes in baroreflex sensitivity (phenylephrine bolus method) and heart rate variability (24-h Holter monitoring) and the endurance time at 85% of peak oxygen consumption. At baseline, there were no significant differences in left ventricular ejection fraction (57 +/- 2% vs. 53 +/- 2%), frequency of anterior infarction (27% vs. 18%) and peak creatine kinase (1,256 +/- 170 vs. 2,599 +/- 295 IU) between the exercise and control groups. Baroreflex sensitivity (10.5 +/- 1.0 vs. 8.4 +/- 1.2 ms/mm Hg) and time domain measures of heart rate variability were also similar. After completion of the program, the exercise group exercised for a median of 15 min (interquartile range 12 to 25) at a workload of 104 +/- 7 W compared with 7 min (interquartile range 3.5 to 12) at a workload of 89 +/- 8 W in the control group (p < 0.01). There were significant (p 0.1). A hospital-based exercise training program increased endurance capacity but did not improve recovery of cardiovascular antonomic function after uncomplicated acute myocardial infarction.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Cambridge University Press (CUP)
Date: 09-2005
DOI: 10.1017/S0033291705004976
Abstract: Background. There is continuing controversy about how age affects depression and anxiety, with a lack of consistent results across studies. Two reasons for this inconsistency are age bias in measures and different patterns of exposure to risk factors across age groups in various studies. Method. Data on anxiety and depression symptoms were collected in a community survey of 7485 persons aged 20–24, 40–44 or 60–64 years. These measures were investigated for factorial invariance across age groups. Data were also collected on a wide range of potential risk factors, including social, physical health and personal factors, with the aim of determining whether these factors might partly or wholly account for age group differences. Results. The invariance of correlated latent factors representing anxiety and depression was examined across age groups, and a generalized measure of psychological distress was computed. Depression, anxiety and psychological distress showed a decline across age groups for females and a decline from 40–44 to 60–64 years for males. Some of these age differences were accounted for by other risk factors, with the most important being recent crises at work and negative social relationships with family and friends. Conclusion. Psychological distress generally declined across the age range 20–64 years and this was not attributable to measurement bias. Differential exposure to risk factors explained some, but not all, of the age group difference. Therefore other mechanisms that explain the lower level of distress in older age groups remain to be identified.
Publisher: Springer Science and Business Media LLC
Date: 05-09-2007
DOI: 10.1007/S00520-006-0116-8
Abstract: Because increasing numbers of people now survive for months or years with advanced cancer, communication between patients, service providers, and family caregivers often continues over long periods. Hence, understanding of the goals of medical treatment may develop and change as time elapses and disease progresses. This understanding is closely related to the "awareness of dying," which has been studied in both qualitative and quantitative research. However, when both a patient and family caregiver are involved, the question of "awareness" becomes more complex. A recent longitudinal study reported on patient and caregiver knowledge of treatment goals, but no comparison of such knowledge using matched interview schedules and paired data analysis has been provided. This report examines patterns of awareness and factors associated with these patterns. One hundred sixty-three patients with incurable cancer and their nominated principal family caregivers (136) were recruited from The Canberra Hospital Oncology Services. Participants' understanding of the treatment goals were measured by interview questions at weeks 1 and 12. One-third of both patients and caregivers understood that the treatment goal was not curative however, not all patient and caregiver pairs had the same understanding. In 15% of pairs, both patient and caregiver believed that the goal of treatment was curative, while another 13% said that they did not know the aim of the treatment. Thirty-nine percent of pairs registered incongruent responses in which only one member of the pair understood that the treatment was not intended to cure the disease. Over time, a few respondents changed their perception of the treatment goals toward accurate clarification. Bivariate analysis using an awareness variable, constructed for the purpose, showed that in 6 months before death, at least one person in 89% of pairs understood that the treatment was noncurative. Time-to-death, gender, and place of residence were also important predictors of knowledge. Discrepancies between patients and their caregivers may complicate the delivery of effective care when patients are seriously ill. Misunderstanding or uncertainty about treatment goals will obstruct proper informed consent. Health professionals providing care for families dealing with advanced cancer must recognize that the discussion of treatment goals is a dynamic process, which may require them to extend their communication skills.
Publisher: Springer Science and Business Media LLC
Date: 29-11-2007
Abstract: A high ponderal index at birth has been associated with later obesity and it has been suggested that intervention to prevent obesity and its sequela should consider the antenatal period. In this context, we investigated the association between maternal nutrition and birth anthropometry. We analyzed data on 1040 mother-infant pairs collected during the Tasmanian Infant Health Survey (TIHS), Tasmania, 1988-1989. Maternal dietary intake during pregnancy was measured by food frequency questionnaire (FFQ) applied soon after birth. Outcomes of interest were birth weight, birth length, head circumference, ponderal index, head circumference -to-ponderal index ratio, placenta-to-birth weight ratio and head circumference-to-birth length index. In multiple regression model, an increase of 10 g of absolute protein intake/day was associated with a reduction in birth weight of 17.8 g (95% CI: -32.7, -3.0 P=0.02). Protein intake was also associated negatively with ponderal index (beta=-0.01 95% CI: -0.02, -0.00 P=0.01). A 1 % increase in carbohydrate intake resulted in a 1% decline in placental weight relative to birth weight. Higher protein intake in the third trimester was associated with a reduced ponderal index among large birth weight infants but not low birth weight infants. This raises the possibility that any effect of high protein in altering infant anthropometry at birth may involve changes in body composition and future work to examine how a high-protein diet influences body composition at birth is warranted.
Publisher: SAGE Publications
Date: 2005
DOI: 10.1080/02724980443000232
Abstract: We aimed to identify demographic, health, and biomarker correlates of reaction time performance and to determine whether biomarkers explained age differences in reaction time performance. The s le comprised three representative cohorts aged 20–24, 40–44, and 60–64 years, including a total of 7,485 participants. Reaction time measures of intrain idual variability and latency were used. The measure of intrain idual variability used was independent of mean reaction time. Older adults were more variable than younger adults in choice reaction time performance but not simple reaction time performance. The most important correlates of reaction time performance after gender and education were biological markers such as forced expiratory volume at one second, grip strength, and vision. Few measures of physical or mental health or lifestyle were associated with poorer performance on reaction time measures. Biomarkers explained the majority of age-related variance in simple reaction time and a large proportion of variance in choice reaction time. We conclude that for the ages studied, biomarkers are more important than health factors for explaining age differences in reaction time performance.
Publisher: Informa UK Limited
Date: 04-2004
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.JOCN.2009.09.016
Abstract: Both transthoracic (TTE) and transoesophageal (TOE) echocardiography are used routinely to investigate ischaemic stroke. We retrospectively assessed the incidence of abnormalities on TTE/TOE and whether an abnormal TTE/TOE result could have been predicted on the basis of ancillary tests and clinical cardiological examination. Data from 428 patients were analysed. The diagnostic yield of TTE was 12%. For TOE there was a diagnostic yield of 40% in tests actually performed. Overall, echocardiography altered management in 5% of patients. A significant correlation was found between clinical cardiac disease, stroke subtype and the diagnostic yield of TTE. We conclude that the vast majority of abnormal findings occur in patients who already have clinical evidence of cardiac disease. This suggests that the use of these tests should not be "routine", but determined on an in idual patient basis.
Publisher: JSTOR
Date: 03-1998
DOI: 10.2307/2534003
Publisher: S. Karger AG
Date: 2005
DOI: 10.1159/000082351
Abstract: This epidemiological study aimed at determining the prevalence of mild cognitive impairment (MCI) in 60- to 64-year-old in iduals using different diagnostic criteria. Community dwelling in iduals (n = 2,551) in the age range of 60–64 years were recruited randomly through the electoral roll. They were screened using the MMSE and a short cognitive battery, and those who screened positive underwent detailed medical and cognitive assessments. Extant MCI-related diagnoses were established by consensus. Predictive regression models on the sub-s le were used to determine population prevalence for the diagnoses. Of the 224 subjects who screened positive for MCI, 112 underwent a detailed assessment and 74% met the criteria for at least one recognised diagnosis of mild cognitive deficit (MCI and related diagnoses). By predictive regression modelling, the prevalence of any MCI diagnosis was 13.7% (95% CI 9.1–30.2) in the population of 60- to 64-year-olds. The estimated prevalence rates for specific diagnoses were: MCI 3.7%, ageing-associated cognitive decline 3.1%, Clinical Dementia Rating score (0.5) 2.8%, age-associated memory impairment 1%, other cognitive disorders 0.9%, and mild neurocognitive disorder 0.6%. Agreement on ‘caseness’ between various proposed diagnoses was at best fair and generally poor. Memory and other cognitive problems not meeting the threshold for dementia are relatively common in 60- to 64-year-old in iduals living in the community. The prevalence rate varies up to six-fold according to the diagnostic criteria applied, with limited overlap between diagnoses. There is an urgent need for standardization of the criteria.
Publisher: Informa UK Limited
Date: 07-2005
Publisher: American Society of Clinical Oncology (ASCO)
Date: 1993
DOI: 10.1200/JCO.1993.11.1.155
Abstract: This clinical trial was designed to compare the effectiveness of the standard melphalan and prednisone regimen to that of melphalan, prednisone, and interferon in patients with untreated multiple myeloma. Between October 1985 and March 1988, 278 patients were accrued to a multi-institutional, randomized clinical trial. Responding patients were treated for 2 years before termination of therapy. After a median follow-up of 23 months, the overall remission rate for the melphalan rednisone treatment group was 44% compared with 33% for the group receiving melphalan rednisone/interferon alfa-2b. The durations of response and survival were identical for the two treatment groups. Median survival was 3.17 years on melphalan rednisone treatment and 3.0 years on melphalan rednisone/interferon alfa-2b treatment. Both hematologic and nonhematologic toxicities were greater in the melphalan rednisone/interferon alfa-2b treatment group, but were usually of a mild or moderate degree and did not interfere with the completion of therapy. The frequency of deaths in the two treatment groups attributable to the treatment itself was similar. This study shows no advantage to the concomitant delivery of interferon alfa-2b with standard melphalan and prednisone as initial treatment for patients with multiple myeloma.
Publisher: Informa UK Limited
Date: 11-2008
Publisher: MDPI AG
Date: 18-05-2015
Publisher: Wiley
Date: 02-2010
DOI: 10.1111/J.1447-0756.2009.01113.X
Abstract: The aim of this study was to examine women's perceptions of their care at the time of unexplained stillbirth, and whether these appear to affect wishes for management in subsequent pregnancy. An Internet-based survey was conducted of women after unexplained stillbirth, seeking information about their perceptions of management, and their wishes for care in a subsequent pregnancy. One hundred and five completed surveys were included in the study group. Only 18 respondents (17%) reported that the diagnosis was broken in an uncaring way. Twenty respondents (19%) felt 'rushed into making decisions'. Almost all respondents (95%) felt that they were given adequate time with the baby after delivery. Fifty-seven respondents (54%) consented to perinatal autopsy. Most women (93%) wanted additional testing in their next pregnancy, 81% wanted delivery before the due date, but only 26% wanted cesarean delivery next time. Women's perceptions of care at the time of an unexplained stillbirth did not appear to influence their wishes for management in the next pregnancy.
Publisher: Elsevier BV
Date: 05-1995
DOI: 10.1016/0167-8140(95)01545-R
Abstract: The purpose of this study was to determine the influence of changes in dose rate over the range 0.8-240 Gy/h on acute oropharyngeal mucosal reactions in human subjects, and to estimate the values of the important parameters that influence these reactions. Sixty-one patients requiring radiotherapy to palliate incurable head and neck cancer were treated on a telecaesium unit, using opposing lateral portals to total midline doses, varying between 30 and 42 Gy in 10 daily fractions over 2 weeks, at dose rates of 0.8, 1.8, 3.0 and 240 Gy/h according to a central composite study design. The severity and time course of reactions were charted at least twice weekly for each patient, using the EORTC/RTOG acute mucosal reaction grading system. Duration of reaction at each grade was observed to provide a more sensitive reflection of effect than the proportion of patients reaching any particular reaction grade. Analysis of duration by direct and indirect methods suggest alpha/beta ratios in the range 7-10 Gy and half-time (t1/2) values in the range 0.27-0.5 h, if mono-exponential repair kinetics are assumed. The t1/2 values are short and raise the question as to whether the repair kinetics of this tissue are well described by a mono-exponential function. Further prospective studies involving multiple daily fraction treatment regimes delivered at high dose rate, in which interfraction interval is deliberately varied, are needed to find out whether the parameters derived from this project are applicable to fractionated treatment courses at high dose rate.
Publisher: JSTOR
Date: 12-1994
DOI: 10.2307/2533438
Publisher: Environmental Health Perspectives
Date: 12-2014
DOI: 10.1289/EHP.1307524
Publisher: Elsevier BV
Date: 03-2009
Publisher: Elsevier BV
Date: 07-2020
Publisher: Elsevier
Date: 2003
Publisher: BMJ
Date: 06-2016
Publisher: Wiley
Date: 09-2009
Publisher: Elsevier BV
Date: 08-1995
DOI: 10.1016/0167-8140(95)01599-C
Abstract: Dose-response relationships have been studied using an ordinal visual scale and reflectance spectrophotometry data from 123 treatment sites on 110 patients treated with 10 dose fractions over 12-14 days. Dose rates varied between 3 and 240 Gy/h and total doses of between 25 and 41 Gy were given using teletherapy apparatus. We found qualitative scoring of erythematous skin reactions to be subject to considerable inter- and intra-observer variation. Reflectance spectrophotometry provided more reproducible information, some of which was undetectable by naked eye. Baseline erythema readings were significantly higher in male patients and at anatomical sites of previous heavy UV exposure. In addition, a pronounced decline in erythema readings during the second week of therapy and 'reciprocal vicinity' (abscopal) effects adjacent to the field, undetected by the eye, were observed in a subset of patients. Meaningful dose-response relationships could be derived only from reflectance data with peak change from the pretreatment baseline measure providing the best discrimination. Peak erythema measures following treatment were found to depend on the age and gender of the patient as well as the treatment site and its baseline erythema measurement. This was independent of the total dose administered or the instantaneous dose rate at which it was delivered. The rate of erythema development was also dose rate dependent but only weakly dependent on the biological dose intensity (Gy equiv./day) of the treatment course. The data raise the question of whether irradiation-induced erythema is exclusively a secondary phenomenon occurring as a result of basal cell killing. The short repair half time value of 0.06 h obtained by direct analysis is perplexing and may reflect a dose rate-dependent physiological vasodilatory response to irradiation and/or a multi-component cellular repair process.
Publisher: BMJ
Date: 11-05-2011
DOI: 10.1136/BMJ.D2807
Publisher: Springer Science and Business Media LLC
Date: 25-01-2013
Publisher: Public Library of Science (PLoS)
Date: 27-05-2015
Publisher: SAGE Publications
Date: 15-12-2011
Abstract: The rapid rise in extreme heat events in Australia recently is already taking a health toll. Climate change scenarios predict increases in the frequency and intensity of extreme heat events in the future, and population health may be significantly compromised for people who cannot reduce their heat exposure. Exposure to extreme heat presents a health hazard to all who are physically active, particularly outdoor workers and indoor workers with minimal access to cooling systems while working. At air temperatures close to (or beyond) the core body temperature of 37°C, body cooling via sweating is essential, and this mechanism is h ered by high air humidity. Heat exposure among elite athletes and the military has been investigated, whereas the impacts on workers remain largely unexplored, particularly in relation to future climate change. Workers span all age groups and erse levels of fitness and health status, including people with higher than “normal” sensitivity to heat. In a hotter world, workers are likely to experience more heat stress and find it increasingly difficult to maintain productivity. Modeling of future climate change in Australia shows a substantial increase in the number of very hot days ( °C) across the country. In this article, the authors characterize the health risks associated with heat exposure on working people and discuss future exposure risks as temperatures rise. Progress toward developing occupational health and safety guidelines for heat in Australia are summarized.
Publisher: Hindawi Limited
Date: 12-01-2016
DOI: 10.1111/ANE.12554
Abstract: Anxiety and depression are common in multiple sclerosis (MS). We evaluated the prevalence and factors associated with anxiety, depression and fatigue at the 5-year review of a longitudinal cohort study following a first clinical diagnosis of CNS demyelination (FCD). Cases with a FCD were recruited soon after diagnosis and followed annually thereafter. A variety of environmental, behavioural and clinical covariates were measured at five-year review. Anxiety and depression were measured using the Hospital Anxiety & Depression Scale (HADS), and fatigue by the Fatigue Severity Scale (FSS). Of the 236 cases, 40.2% had clinical anxiety (median HADS-A: 6.0), 16.0% had clinical depression (median HADS-D: 3.0), and 41.3% had clinical fatigue (median FSS: 4.56). The co-occurrence of all three symptoms was 3.76 times greater than expectation. Younger age, higher disability, concussion or other disease diagnosis were independently associated with a higher anxiety score male sex, higher disability, being unemployed, less physical activity, and antidepressant and/or anxiolytic-sedative medication use were independently associated with a higher depression score. Higher disability, immunomodulatory medication use, other disease diagnosis and anxiolytic-sedative medication use were independently associated with having fatigue, while female sex, higher BMI, having had a concussion, being unemployed and higher disability were associated with a higher fatigue score. These results support previous findings of the commonality of anxiety, depression and fatigue in established MS and extend this to post-FCD and early MS cases. The clustering of the three symptoms indicates that they may share common antecedents.
Publisher: American Association for Cancer Research (AACR)
Date: 11-2009
DOI: 10.1158/1055-9965.EPI-09-0191
Abstract: Past sun exposure is linked to a wide range of disease outcomes but is difficult to measure accurately. Silicone skin casts measure skin damage, but some studies show that age rather than sun exposure is the most important determinant of cast score. We examined skin damage scores from silicone casts of the back of the hand in a large adult s le (n = 534) with a broad range of past cumulative UV radiation (UVR) doses. Participants were ages 18 to 61 years and resided in one of four locations down the eastern Australian seaboard, spanning 27-43°S. Data were collected by questionnaire and during a nurse-led interview and examination. Silicone casts were graded from 1 to 6, where higher score represents greater damage. Higher skin damage score was associated with lighter skin pigmentation [adjusted odds ratio (AOR), 4.51 95% confidence interval (95% CI), 2.33-8.75], fairer natural hair color, particularly red hair (AOR, 11.31 95% CI, 4.08-31.36), and blue/gray eyes (AOR, 1.72 95% CI, 1.14-2.59). Higher cumulative UVR dose, particularly before age 18 years, was associated with higher skin damage score (AOR, 2.06 95% CI, 1.15-2.67 per 1,000 KJ/m2), as was number of sunburns, even after adjustment for cumulative UVR dose (AOR, 2.86 95% CI, 1.50-5.43 for & sunburns ever compared with no sunburns ever). Silicone casts of the dorsum of the hand provide a measure of cumulative UVR dose and number of sunburns over the lifetime, which persists after adjustment for chronological age. They can be used as an objective measure of cumulative past sun exposure in epidemiologic studies, but other determinants of skin damage, such as skin pigmentation, should be concurrently evaluated. (Cancer Epidemiol Biomarkers Prev 2009 (11):2887–94)
Publisher: Wiley
Date: 06-04-2005
DOI: 10.1111/J.1398-9995.2005.00757.X
Abstract: We examined the role of fish intake in the development of atopic disease with particular reference to the possibility of differential effects on allergen-specific subgroups of sensitization. The exposure of interest was parental report of fish intake by children aged 8 years at the 1997 Childhood Allergy and Respiratory Health Study (n = 499). The outcomes of interest were subgroups of atopy: house dust mite (HDM)-pure sensitization [a positive skin-prick test (SPT) > or = 2 mm to Der p or Der f only], ryegrass-pure sensitization (a positive SPT > or = 2 mm to ryegrass only) asthma and hay fever by allergen-specific sensitization. A significant association between fish intake and ryegrass-pure [adjusted odds ratio (AOR) 0.37 (0.15-0.90)] but not HDM-pure sensitization [AOR 0.87 (0.36-2.13)] was found. Fish consumption significantly decreased the risk for ryegrass-pure sensitization in comparison with HDM-pure sensitization [AOR 0.20 (0.05-0.79)]. We have demonstrated a differential effect of fish intake for sensitization to different aeroallergens. This may be due to the different timing of allergen exposure during early life. Further investigation of the causes of atopic disease should take into account allergen-specific subgroups.
Publisher: Wiley
Date: 12-2012
Abstract: Multiple sclerosis (MS) is a debilitating disease that causes significant morbidity within a young demographic. Diagnostic guidelines for MS have evolved, and imaging has played an increasingly important role in diagnosis over the last two decades. For imaging to contribute to diagnosis in a meaningful way, it must be reproducible. Consensus guidelines for MRI in MS exist to define correct sequence type and imaging technique, but it is not clear to what extent they are followed. This study reviewed MRI studies performed on Australian in iduals presenting with a first clinical diagnosis of central nervous system demyelination (FCD) for adherence to published guidelines and discussed practical implementation of MS guidelines in light of recent updates. The Ausimmune study was a prospective case control study of Australian participants presenting with FCD from 2003 to 2006. Baseline cranial and spinal cord MRI studies of 226 case participants from four separate Australian regions were reviewed. MRI sequences were classified according to anatomical location, slice plane, tissue weighting and use of gadolinium-containing contrast media. Results were compared with the 2003 Consortium of Multiple Sclerosis Centres MRI protocol for the diagnosis of MS. The composition of core cranial MRI sequences performed varied across the 226 scans. Of the studies, 91% included sagittal fluid attenuated inversion recovery (FLAIR) sequences. Cranial axial T2-weighted, axial FLAIR and axial proton density-weighted sequences were performed in 88%, 60% and 16% (respectively) of scans. Only 25% of the studies included a T1-weighted contrast-enhanced sequence. Concordance with the guidelines in all sequences was very low (2). Only a small number of MRI investigations performed included all of the sequences stipulated by consensus guidelines. This is likely due to poor awareness in the imaging community of the guidelines and the rationale behind certain sequences. Radiologists with a sub-speciality interest in neuroradiology should take ownership of this issue and ensure that recommended imaging guidelines are followed.
Publisher: Oxford University Press (OUP)
Date: 07-08-2009
DOI: 10.1093/IJE/DYP271
Publisher: Elsevier BV
Date: 03-1996
DOI: 10.1016/0959-8049(95)00635-4
Abstract: The Ann Arbor staging classification has long been recognised to have shortcomings when used to stage the follicular lymphomas. To date, the identification of important prognostic variables has not succeeded in producing a superior staging classification that reflects the stages of dissemination of these processes in a way that can be used in the testing of new therapeutic strategies. A fresh look is taken at these factors. Data from 398 patients entered into the British National Lymphoma Investigation trials between 1974 and 1980, were analysed to evaluate the performance of the Ann Arbor staging classification. Multiple regression and proportional hazards techniques were used to determine what factors independently influence response to initial treatment, the durability of that response and ultimate survival, and to isolate factors that relate to disease progression from those that have other mechanisms of action. The Ann Arbor staging classification fared poorly, minimally separating relapse-free and cause-specific survival probabilities in patients with the largest staging groupings, III and IV. Significant prognostic heterogeneity was seen in both of these stage groupings, with 22% of patients with stage IV disease on the basis of marrow involvement having slightly better outcomes than patients with stage III disease. Significant differences in outcome were also observed between patients of different age and sex in each Ann Arbor stage grouping. Increasing number of lymph node regions involved, constitutional symptoms, the presence of splenomegaly and increasing age were observed to have powerfully independent adverse influence on probability of complete response to treatment and cause-specific survival. The evolution of the follicular lymphomas is reflected at the clinical level by an increase in the number of lymph node regions involved and splenomegaly. Simple classifications based on simple counts of lymph node regions involved and splenomegaly are more successful than the Ann Arbor staging classification in sub iding the series into patient subgroups that, regardless of gender or age, experience significantly different probabilities of responding completely to therapy and, as a consequence, relapse-free and cause-specific survival expectations. The definition of poor prognosis in subgroups may be of value in selecting patients for newer and more intensive therapeutic approaches.
Publisher: Wiley
Date: 07-03-2007
DOI: 10.1111/J.1399-3038.2006.00509.X
Abstract: Studies on the role of non-milk fluids in the development of child atopic disease are scarce. We had a unique opportunity to investigate prospective association between the introduction of fruit syrup, orange juice, sterilized water, vitamins and honey at 1 month and the development of child atopic disease. The exposure of interest was measured by parental report of non-milk fluids introduction to infants aged 1 month at the Tasmanian Infant Health Survey, 1988-89, Tasmania. Data on the outcomes of interest (atopic sensitization, asthma, eczema and hay fever) were collected during the 1997 Childhood Allergy and Respiratory Health Study when children were 8 yr old. Relative risks were derived from generalized linear model with a log link function and binomial error structure. None of the non-milk fluids appeared to be a significant predictor of atopic sensitization. Only sterilized water was a significant risk factor for asthma (adjusted relative risk = 1.59 95% confidence intervals: 1.14-2.22), which may be partly because of associated overall better hygienic conditions and decreased exposure to early infections in the household. In summary, we were unable to find evidence for an association between introduction of non-milk fluids in infancy and childhood atopic disease.
Publisher: SAGE Publications
Date: 23-10-2018
Abstract: Transition probabilities are the engine within many health economics decision models. However, the probabilities of progression of disability due to multiple sclerosis (MS) have not previously been estimated in Australia. To estimate annual probabilities of changing disability levels in Australians with relapsing-remitting MS (RRMS). Combining data from Ausimmune/Ausimmune Longitudinal (2003–2011) and Tasmanian MS Longitudinal (2002–2005) studies ( n = 330), annual transition probabilities were obtained between no/mild (Expanded Disability Status Scale (EDSS) levels 0–3.5), moderate (EDSS 4–6.0) and severe (EDSS 6.5–9.5) disability. From no/mild disability, 6.4% (95% confidence interval (CI): 4.7–8.4) and 0.1% (0.0–0.2) progressed to moderate and severe disability annually, respectively. From moderate disability, 6.9% (1.0–11.4) improved (to no/mild state) and 2.6% (1.1–4.5) worsened. From severe disability, 0.0% improved to moderate and no/mild disability. Male sex, age at onset, longer disease duration, not using immunotherapies greater than 3 months and a history of relapse were related to higher probabilities of worsening. We have estimated probabilities of changing disability levels in Australians with RRMS. Probabilities differed between various subgroups, but due to small s le sizes, results should be interpreted with caution. Our findings will be helpful in predicting long-term disease outcomes and in health economic evaluations of MS.
Publisher: Cambridge University Press
Date: 02-08-2007
Publisher: Oxford University Press (OUP)
Date: 18-04-2013
DOI: 10.1111/CEI.12077
Abstract: The increasing prevalence of immune-related diseases, including multiple sclerosis, may be partly explained by reduced microbial burden during childhood. Within a multi-centre case–control study population, we examined: (i) the co-morbid immune diseases profile of adults with a first clinical diagnosis of central nervous system demyelination (FCD) and (ii) sibship structure in relation to an autoimmune (FCD) and an allergic (asthma) disease. FCD cases (n = 282) were aged 18–59 years controls (n = 558) were matched on age, sex and region. Measures include: history of doctor-diagnosed asthma sibling profile (number dates of birth) and regular childcare attendance. FCD cases did not differ from controls with regard to personal or family history of allergy, but had a greater likelihood of chronic fatigue syndrome [odds ratio (OR) = 3·11 95% confidence interval (CI) 1·11, 8·71]. Having any younger siblings showed reduced odds of FCD (OR = 0·68 95% CI: 0·49, 0·95) but not asthma (OR = 1·47 95% CI: 0·91, 2·38). In contrast, an increasing number of older siblings was associated with reduced risk of asthma (P trend = 0·04) but not FCD (P trend = 0·66). Allergies were not over-represented among people presenting with FCD. Sibship characteristics influence both FCD and asthma risk but the underlying mechanisms differ, possibly due to the timing of the putative ‘sibling effect’.
Publisher: Springer Science and Business Media LLC
Date: 26-08-2016
Publisher: Springer Science and Business Media LLC
Date: 04-03-2010
Publisher: Springer Science and Business Media LLC
Date: 13-05-2010
DOI: 10.1007/S00420-010-0534-2
Abstract: To determine and characterise the health impacts of extreme heat events on the population in five regions of New South Wales (NSW). Such data provide evidence necessary for the development of policy and programme initiatives designed to reduce the burden of disease due to the impact of climate change. A case-only approach was used to analyse 1,497,655 emergency hospital admissions in Sydney East and West, Illawarra, Gosford-Wyong and Newcastle. The distribution of daily minimum and maximum temperatures in each region was used to define extreme heat (≥99th percentile). We investigated the susceptibility of the main causes of emergency hospital admission to extreme heat. We also examined the presence of underlying conditions as a risk modifier of emergency hospital admission on extreme heat. Logistic regression model was used to estimate the effect modifications. Main causes: On days of extreme heat, the risk of emergency hospital admission due to heat-related injuries, dehydration and other disorders of fluid, electrolyte and acid-base balance increased more than the risk of admission from other causes. Underlying conditions: Those with underlying mental and behavioural disorders, diseases of nervous and circulatory system, especially cardiac, diseases of respiratory system, especially asthma and chronic obstructive pulmonary disease, neoplasms and renal disease, especially renal failure, were more susceptible to an extreme heat event. In this study, we identified several main diagnoses and underlying conditions for emergency hospital admission that are particularly susceptible to extreme heat events. This knowledge can contribute directly to establishing health programmes that would effectively target those with higher relative risk of emergency hospital admission due to extreme heat.
Publisher: Elsevier BV
Date: 11-1997
DOI: 10.1016/S0167-8140(97)00146-1
Abstract: A limited number of studies have suggested that oral sucralfate reduces the acute and late gastro-intestinal side-effects of pelvic radiotherapy and sucralfate enemas ameliorate symptoms of chronic proctitis. Sucralfate may act via local bFGF at the mucosal level in promoting angiogenesis and reducing epithelial associated microvascular injury. This multi-institutional study was designed to test the hypothesis that sucralfate given as an enema would have a significant protective effect against acute radiation induced rectal injury by direct application to the mucosa. Eighty-six patients having radiotherapy for localised carcinoma of the prostate were randomised in a double-blind placebo-controlled study to receive either 15 ml of placebo suspension or 3 g of sucralfate in 15 ml suspension, given as a once daily enema during and for 2 weeks following radiotherapy. Assessment was based on the EORTC/RTOG acute toxicity criteria and a patient self-assessment diary. There was no significant difference between placebo and sucralfate for peak incidences of EORTC/RTOG proctitis. For the placebo and sucralfate arms 95 and 88% (difference 7 +/- 11%) suffered some degree of proctitis, with 71 and 61% (difference 10 +/- 19%) reaching grade 2, respectively. The median period to onset of grade 2 proctitis was 33.5 and 36 days, with the median duration being 9.5 and 15 days, respectively, again these difference being non-significant. Thirty-five and 37% of patients rated the effect of radiotherapy on bowel habit as 'a lot' with a moderate or severe effect on normal daily living in 52 and 49%, respectively. This study suggests that sucralfate given as a once daily enema does not substantially reduce the incidence of symptoms associated with acute radiation proctitis and its routine clinical use cannot be recommended. This cohort of patients will be followed to determine if any difference develops in relation to late toxicity.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Keith Dear.