ORCID Profile
0000-0002-3282-1861
Current Organisations
University of Queensland
,
James Cook University
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Publisher: Portland Press Ltd.
Date: 06-2017
DOI: 10.1042/CS20160970
Abstract: Abdominal aortic aneurysm (AAA) is a common age-related vascular disease characterized by progressive weakening and dilatation of the aortic wall. Thrombospondin-1 (TSP-1 gene Thbs1) is a member of the matricellular protein family important in the control of extracellular matrix (ECM) remodelling. In the present study, the association of serum TSP-1 concentration with AAA progression was assessed in 276 men that underwent repeated ultrasound for a median 5.5 years. AAA growth was negatively correlated with serum TSP-1 concentration (Spearman’s rho −0.129, P=0.033). Men with TSP-1 in the highest quartile had a reduced likelihood of AAA growth greater than median during follow-up (OR: 0.40 95% confidence interval (CI): 0.19–0.84, P=0.016, adjusted for other risk factors). Immunohistochemical staining for TSP-1 was reduced in AAA body tissues compared with the relatively normal AAA neck. To further assess the role of TSP-1 in AAA initiation and progression, combined TSP-1 and apolipoprotein deficient (Thbs1−/−ApoE−/−, n=20) and control mice (ApoE−/−, n=20) were infused subcutaneously with angiotensin II (AngII) for 28 days. Following AngII infusion, Thbs1−/− ApoE−/− mice had larger AAAs by ultrasound (P=0.024) and ex vivo morphometry measurement (P=0.006). The Thbs1−/−ApoE−/− mice also showed increased elastin filament degradation along with elevated systemic levels and aortic expression of matrix metalloproteinase (MMP)-9. Suprarenal aortic segments and vascular smooth muscle cells (VSMCs) isolated from Thbs1−/−ApoE−/− mice showed reduced collagen 3A1 gene expression. Furthermore, Thbs1−/−ApoE−/− mice had reduced aortic expression of low-density lipoprotein (LDL) receptor-related protein 1. Collectively, findings from the present study suggest that TSP-1 deficiency promotes maladaptive remodelling of the ECM leading to accelerated AAA progression.
Publisher: Springer Science and Business Media LLC
Date: 05-01-2022
DOI: 10.1186/S12913-021-07340-0
Abstract: The Ghanaian government has implemented interventions that integrate traditional medicine (TM) into its national health system in response to the high prevalence of TM use. However, empirical evidence of the experiences of service users and the practice of integrated health in Ghana is scanty. Therefore, this study explored the experiences of people with TM integration into the formal health system in Ashanti region using an adapted TM integration framework. A sequential explanatory mixed methods study design comprising survey administration and in-depth interviews for data collection was utilised to address the research objective. Framework analysis was used in analysing the qualitative data and for triangulation of results. Participants were aware of licensing and training of TM practitioners in a science-based university in Ghana. However, knowledge of the existence of TM units in selected hospitals in the region was minimal. Integration knowledge was largely influenced by sex, marital status, household size and residential status, where males and urban dwellers were more familiar with the process than females and rural dwellers. Low patronage of integrated health services in the region was attributable to weak cross referrals. However, service users who had engaged with the integrated system recounted a satisfactory outcome. Service users’ unfamiliarity with the presence of integrated facilities in Ghana could be an impediment to the practice of integrated healthcare. Sensitisation of the public about the practice of an integrated system could refine the Ghanaian integrated system. Regular evaluation of patient satisfaction and outcome measures might also serve as an effective strategy for improving health services delivery since evaluation is becoming an important component of health service design and implementation. There is the need for future studies to focus on exploring the perceptions and experiences of health practitioners and hospital administrators regarding the practice of integrated health in Ghana.
Publisher: Wiley
Date: 02-2019
DOI: 10.1111/IMJ.14335
Abstract: Diabetic ketoacidosis (DKA) is a common and serious complication arising predominantly in patients with type 1 diabetes mellitus. International data demonstrate that infection is one of the most common precipitating causes of DKA. Currently there are limited data regarding the role of antimicrobial stewardship (AMS) in this setting. To provide epidemiologic data regarding infections precipitating DKA, microbiological aetiology and antimicrobial prescribing practices in order to inform AMS interventions. Retrospective chart review of all type 1 diabetes mellitus DKA presentations from May 2015 to June 2018. In total, 249 DKA presentations occurred in 111 patients. Suspected infection accounted for 100/249 (40%) presentations, and only 36/249 (14.5%) were proven or probable infections. Skin and soft tissue infection was the most common (9/36, 25%), followed by urinary tract infection (8/36, 22%) and respiratory tract infection (7/36, 19%). A pathogen was identified in 24/100 presumed infections and included Staphylococcus aureus (24, 46%), Klebsiella pneumoniae (4/24, 17%) and Escherichia coli (3/24, 13%). No viral pathogens were identified. Of 80 empirical antimicrobial prescriptions, 75% were inappropriate based on guideline management of the documented suspected infection. Single agent ceftriaxone was appropriately prescribed in 7/23 (30%) cases, and was most frequently prescribed overall 23/80 (29%). This study demonstrates a lower incidence of infection compared to most previous publications, and suggests that infection-precipitated DKA may be over reported. Furthermore, our findings provide support for the role of AMS in the management of DKA.
Publisher: Wiley
Date: 15-02-2023
DOI: 10.1002/JMRS.650
Abstract: Adjuvant radiotherapy is an established component in the management of metastatic cutaneous squamous cell carcinoma (SCC) involving the parotid gland. Radiotherapy technique, dose and volumes are seldom described sufficiently to allow close examination. We report our treatment outcomes and focus on treatment‐related factors that affect outcomes in this cohort. We performed a retrospective review of patients with metastatic cutaneous SCCs who underwent parotidectomy with or without ipsilateral neck dissection. All patients received adjuvant radiotherapy. Demographics, clinical data and treatment details were collected from an intuitional electronic database. In idual patient‐level radiotherapy technique, volumes and doses were reviewed. Between July 2008 and July 2018, 60 patients met our inclusion criteria. Median follow‐up duration was 32.7 months. The mean age was 66.4 years. The majority of patients (49 patients) received full neck irradiation. The 2‐year and 5‐year loco‐regional failure‐free survival was 87% (95% confidence interval (CI): 0.74–0.93) and 71% (95% CI: 0.52, 0.83), respectively. The 2‐year and 5‐year overall survival was 76% (95% CI: 0.62, 0.85) and 60% (95% CI: 0.45, 0.72), respectively. There were 15 cases of loco‐regional failures, with 6 cases with dermal involvement. Lymphovascular invasion (LVI) was associated with higher loco‐regional failure (hazard ratio: 8.43, 95% CI: 1.85–38.39, P = 0.005) and cancer‐specific mortality (hazard ratio: 5.40, 95% CI: 1.40–20.87, P = 0.015). Treatment technique, intensity‐modulated radiation therapy (IMRT) vs 3D conformal radiotherapy (3D CRT), bolus use, perineural invasion (PNI) and surgical margins were not significantly associated with loco‐regional failure. We demonstrated high loco‐regional control rates with routine use of comprehensive adjuvant radiotherapy. The presence of LVI was identified as a strong predictor for recurrence. Further analysis will help to define optimal radiation dose and techniques.
Publisher: Wiley
Date: 25-04-2022
Abstract: Paediatric status epilepticus (SE) has potential for long‐term sequelae. Existing data demonstrate delays to aspects of care. The objective of the present study was to examine the feasibility of collecting data on children with paediatric SE and describe current management strategies in pre‐hospital and in‐hospital settings. A pilot, prospective, observational cohort study of children 4 weeks to 16 years of age with SE, in four EDs in Australia. Clinical details including medications administered, duration of seizure and short‐term outcomes were collected. Follow up occurred by telephone at 1 month. We enrolled 167 children with SE. Mean age was 5.4 years (standard deviation [SD] 4.1), and 81 (49%) male. Median seizure duration was 10 min (interquartile range 7–30). Midazolam was the first medication administered in 87/100 (87%) instances, mean dose of 0.21 mg/kg (SD 0.13). The dose of midazolam was adequate in 30 (35%), high ( .2 mg/kg) in 44 (51%) and low ( .1 mg/kg) in 13 (15%). For second‐line agents, levetiracetam was administered on 33/55 (60%) occasions, whereas phenytoin and phenobarbitone were administered on 11/55 (20%) occasions each. Mean dose of levetiracetam was 26.4 mg/kg (SD 13.5). One hundred and four (62%) patients were admitted to hospital, with 13 (8%) admitted to ICU and seven (4%) intubated. In children presenting with SE in Australia medical management differed from previous reports, with midazolam as the preferred benzodiazepine, and levetiracetam replacing phenytoin as the preferred second‐line agent. This pilot study indicates the feasibility of a paediatric SE registry and its utility to understand and optimise practice.
Publisher: MDPI AG
Date: 06-09-2021
Abstract: Adolescent obesity is a complex multifactorial disease with a combination of environmental, behavioral, psychosocial, biological, cultural and genetic determinants. It remains a global public health issue that presents a major challenge to chronic disease prevention and health into adulthood. Schools have a rich opportunity to improve youth health and tackle obesity, yet they face barriers in fulfilling this function. This study investigated school stakeholders’ beliefs and perceptions of the barriers and enablers currently experienced by schools, as well as their recommendations towards preventing adolescent obesity. A sequential explanatory mixed-methods study design was utilised with surveys administered for the quantitative phase and in idual interviews for the qualitative phase. Descriptive statistics and inductive thematic analyses were utilised for the survey and interview data, respectively. Triangulation of findings from the quantitative and qualitative phases aided in the better understanding and integration of the overall results. In total, 60 school stakeholders (52 subject teachers, 3 senior teachers and 5 heads of department) from both independent and public high schools in Queensland, Australia responded to the survey, while 14 respondents participated in the interviews. The main perceived causes of obesity were poor eating habits and sedentary lifestyle. Highlighted barriers were busy timetables, shortage of trained staff and funding, lack of robustness in the introduction and implementation of school interventions and insufficient motivation of learners to participate in obesity prevention programs. Enabling factors included parental support, easy access to fitness equipment during recess, supportive government policies, provision of healthier school tuck shop menu options and elimination of sugary drinks from vending machines. A model for the prevention of adolescent obesity was developed based on participants’ perceptions. Tripartite collaboration between the school, government and parents was perceived as fundamental to preventing adolescent obesity. Strategies targeting nutrition, physical activity and overall health, including parental education on health, formal health talks in schools by health professionals and better-targeted advertisement encouraging healthy lifestyle choices, were identified as essential for improved adolescent health outcomes.
Publisher: MDPI AG
Date: 18-02-2022
DOI: 10.3390/TROPICALMED7020030
Abstract: Background: Reproductive health remains a major health concern in developing countries such as Papua New Guinea (PNG). The prevalence of human immunodeficiency virus (HIV) in PNG is the highest in the Southern Pacific region, with women having a higher risk of contracting the infection. Hence, there have been several policies aimed at mitigating the spread of the disease. One of these policies include the use of mass media as a health promotion tool to educate the population on the risk of the disease. Therefore, this study aimed at investigating the association of mass media to HIV testing among women. Methods: Data were obtained from the PNG Demographic and Health Survey (DHS) of 2019. A total of 15,005 reproductive-age women was included in this analysis. Results: The results showed that women with low (aOR = 1.63, 95% CI: 1.39, 1.90) and high (aOR = 1.53, 95% CI: 1.36, 1.72) media exposure were more likely to undertake HIV testing compared to those with no media exposure. Compared to no education, women with incomplete primary (aOR = 1.22, 95% CI: 1.06, 1.40), complete primary (aOR = 1.56, 95% CI: 1.30, 1.87), incomplete secondary (aOR = 2.18, 95% CI: 1.85, 2.58), complete secondary (aOR= 2.33, 95% CI: 1.77, 3.09) and higher (aOR = 3.38, 95% CI: 2.57, 4.46) education were more likely to undertake HIV testing. Compared to women with the poorest wealth index, women with richer indexes were more likely to undertake HIV testing. Women living in rural areas were less likely to undertake HIV testing (aOR = 0.72, 95% CI: 0.63, 0.82). However, marital status, knowledge of transmission and religion were not associated with HIV testing. Conclusion: In conclusion, this study provides strong evidence that mass media exposure increases the likelihood of HIV testing in women of reproductive age in PNG. Mass media c aigns would serve as a cost-effective health promotion tool against the spread of disease.
Publisher: Medip Academy
Date: 22-06-2017
DOI: 10.18203/2349-2902.ISJ20172760
Abstract: Background: For generations, surgical training has followed the ex le of an apprenticeship model. However, many doctors see this training as insufficient and potentially unsafe for the patient. Web-based simulation training for teaching laparoscopic surgery is not only becoming increasingly popular but is cheaper in comparison to the traditional apprenticeship method. Objective is to assess the educational value of web-based training videosMethods: Data was obtained through questionnaires sent to consultant surgeons and surgical trainees at three sites in North Queensland. Study invited participants to complete a 24-item questionnaire on knowledge and attitudes. The questionnaires were distributed using online survey monkey software to send emails to the three Government Hospitals.Results: There was a response rate of 11.40%, Consultant surgeons (13/17 72.20%) and surgical trainees (4/17 22.20%). Majority of participant`s sources of learning laparoscopic surgery was from supervisors in operating theatre (64.30%) and online Web-based training video (WBTV 7.10%), although satisfaction with current web-based training video resources was found to vary widely for a variety of reasons. WBTV were used mainly when required for clinical rotation.Conclusions: There was a response rate of 11.40%, Consultant surgeons (13/17 72.20%) and surgical trainees (4/17 22.20%). Majority of participant`s sources of learning laparoscopic surgery was from supervisors in operating theatre (64.30%) and online Web-based training video (WBTV 7.10%), although satisfaction with current web-based training video resources was found to vary widely for a variety of reasons. WBTV were used mainly when required for clinical rotation.
Publisher: Wiley
Date: 18-11-2022
DOI: 10.1111/JVH.13770
Abstract: Hepatitis B, caused by the hepatitis B virus (HBV), is a global public health issue that affects 290 million people worldwide. Most people with hepatitis B are in low- and middle-income countries (LMIC), where health systems and resources are often constrained. Refugees, asylum seekers and internally displaced persons (IDPs) often face barriers in seeking health care and are a priority population at risk of hepatitis B. No systematic review to date has evaluated the prevalence of hepatitis B amongst refugees in in LMIC. We undertook a systematic review of the literature identifying 28 studies addressing this topic. Though few studies on this topic exist, the available evidence suggests a high prevalence amongst refugees in LMIC, with wide variation between and within countries. Possible risk factors contributing to hepatitis B include unsafe injections, low immunization coverage, low awareness, mother-to-child transmission, and limited health services. Further study is needed to better understand the prevalence and risk factors for hepatitis B amongst refugees in LMIC, to inform public health responses. Vulnerable populations such as refugees are an important group to consider in national and global efforts to eliminate hepatitis B.
Publisher: MDPI AG
Date: 17-09-2022
Abstract: The increasing outbreak of zoonotic diseases presents challenging times for nations and calls for a renewed effort to disrupt the chain of events that precede it. Nigeria’s response to the 2006 bird flu provided a platform for outbreak response, yet it was not its first experience with Influenza. This study describes the impact of SARS-CoV-2 on Influenza surveillance and, conversely, while the 1918 Influenza pandemic remains the most devastating (500,000 deaths in 18 million population) in Nigeria, the emergence of SARS CoV-2 presented renewed opportunities for the development of vaccines with novel technology, co-infection studies outcome, and challenges globally. Although the public health Intervention and strategies left some positive outcomes for other viruses, Nigeria and Africa’s preparation against the next pandemic may involve prioritizing a combination of technology, socioeconomic growth, and active surveillance in the spirit of One Health.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Wiley
Date: 27-08-2022
DOI: 10.1111/IMJ.15706
Abstract: In Australia there is a shortage of rheumatologists potentially translating to poorer outcomes. A possible solution in this setting is telemedicine (TM). To examine the utilisation and provider perceptions of TM in rheumatology in Queensland and explore the challenges faced when using TM before and during COVID‐19. A sequential mixed‐methods study design was used. Rheumatologists completed a questionnaire on demographics, clinical practice, TM uptake, models of care and clinician perceptions of TM. The qualitative phase utilised purposeful s ling of active users of TM through in‐depth semi‐structured interviews. Thirty rheumatologists participated, with 76.7% identifying as active TM users. Use of TM was limited prior to COVID‐19 with 80.9% examining less than five patients per week. Patient populations served by TM included capital city (53.3%), regional (63.3%) and rural/remote (23.3%). Most rheumatologists prescribed conventional or biological disease modifying agents (90% and 55%) through TM consultations. Barriers to TM use included low confidence in joint assessments, limited distribution of technology, access to administrative and peripheral clinical staff and lack of financial incentives. During the COVID‐19 pandemic, a significant expansion of TM via telephone calls occurred and rheumatologists reported low confidence and satisfaction with this model. Familiarity with TM exists in this rheumatologist cohort however, its use in routine practice is limited due to multiple barriers. The COVID‐19 pandemic highlighted low confidence in telephone calls as a form of TM underlining the need for appropriate TM models of care for rheumatology practice.
Publisher: BMJ
Date: 11-2017
DOI: 10.1136/BMJOPEN-2017-018562
Abstract: A challenge of conducting research in critically ill children is that the therapeutic window for the intervention may be too short to seek informed consent prior to enrolment. In specific circumstances, most international ethical guidelines allow for children to be enrolled in research with informed consent obtained later, termed deferred consent (DC) or retrospective consent. There is a paucity of data on the attitudes of parents to this method of enrolment in paediatric emergency research. To explore the attitudes of parents to the concept of DC and to expand the knowledge of the limitations to informed consent and DC in these situations. Children presenting with uncomplicated febrile seizures or bronchiolitis were identified from three separate hospital emergency department databases. Parents were invited to participate in a semistructured telephone interview exploring themes of limitations of prospective informed consent, acceptability of the DC process and the most appropriate time to seek DC. Transcripts underwent inductive thematic analysis with intercoder agreement, using Nvivo 11 software. A total of 39 interviews were conducted. Participants comprehended the limitations of informed consent under emergency circumstances and were generally supportive of DC. However, they frequently confused concepts of clinical care and research, and support for participation was commonly linked to their belief of personal benefit. Participants acknowledged the requirement for alternatives to prospective informed consent in emergency research, and were supportive of the concept of DC. Our results suggest that current research practice seems to align with community expectations.
Publisher: MDPI AG
Date: 12-01-2023
Abstract: The continuous increase in the prevalence of hypertension in Ghana has led to various interventions aimed at controlling the disease burden. Nonetheless, these interventions have yielded poor health outcomes. Subsequently, the Pan-African Society of Cardiology (PASCAR), established a 10-point action plan for inclusion in policies to aid control of hypertension. This scoping review assessed the adherence of health policies to the 10-point action plan towards hypertension control/reduction in Ghana. Eight health policies met the inclusion criteria and were assessed. The programme evaluation and policy design framework were used for synthesis and analysis of extracted data. Overall, there was poor adherence to hypertension control observed in the policies. Specifically, there were low levels of integrating hypertension control/reduction measures, a poor task-sharing approach, and poor financial resource allocations to tackle hypertension control/reduction in most of the policies. There was also low support for research to produce evidence to guide future interventions. For Ghana to achieve the global target of reducing hypertension by the year 2025, its health policies must adhere to evidence-based interventions in hypertension management/control. The study recommends a follow-up study among hypertension patients and healthcare professionals to evaluate the factors militating against hypertension management/control in Ghana.
Publisher: MDPI AG
Date: 19-08-2016
Publisher: Wiley
Date: 18-06-2017
Abstract: Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand. The review outlines current definitions and guidelines of SE management, regional variability in pre-hospital protocols within Australasia and aspects of pre-hospital care that could potentially be improved. Contemporary data is required to determine current practice in our setting. It is important that paediatric neurologists, emergency physicians and pre-hospital care providers are all engaged in future endeavours to improve clinical care and knowledge translation efforts for this patient group.
Publisher: American Society of Tropical Medicine and Hygiene
Date: 02-2022
Abstract: Strongyloidiasis in Papua New Guinea (PNG) is poorly understood. There have been limited surveys describing the levels of endemicity in some regions of PNG, but in the Western Province, its occurrence and level of burden are unknown. This study aimed to determine the seroepidemiology of Strongyloides spp. seropositivity within a community located in the Balimo region of the Western Province. Plasma s les were collected from 120 adult participants and were subjected to anti-IgG Strongyloides spp. serological testing. Logistical regression analyses were performed to identify relationships between strongyloidiasis and attributes of sociodemography. In this cross-sectional cohort study, 22.5% (27/120 95% CI: 15.9–30.8%) of participants were seropositive for strongyloidiasis. Participants with higher body mass indices were less likely to be seropositive for Strongyloides spp. infection (odds ratio [OR] = 0.85, P value = 0.008), and in the multivariable analysis, increasing units of age (adjusted OR [aOR] = 0.93, P value = 0.048) and participants ≤ 40 years old were associated with a decreased likelihood of Strongyloides spp. seropositivity (aOR = 0.07, P value = 0.034). The results from this study indicate that the occurrence of strongyloidiasis is high in the Western Province, PNG, and age is a determining factor of seroreactivity. This study provides evidence of endemic strongyloidiasis in this community and raises questions as to the impact of this neglected disease and other intestinal parasites on disease burden and comorbidities.
Publisher: MDPI AG
Date: 06-06-2023
Abstract: Teachers belong to a high-demand occupational group and experience work-related challenges and discretely erse emotional turmoils of varying intensity while teaching and interacting with students. These experiences often result in high stress levels that contribute to burnout and, consequently, a breach of teachers’ occupational wellbeing. Promoting positive teacher wellbeing substantially influences teaching quality, with a flow-on effect on student wellbeing and academic development. This literature review utilised a framework to systematically explore the factors that impact the occupational wellbeing of kindergarten, primary, and secondary schoolteachers. Thirty-eight (38) studies from an initial 3766 peer-reviewed articles sourced from various databases (CINAHL, Emcare, PychINFO, Scopus, ERIC, and PsycARTICLES) were utilized for this systematic review. Four major factors were identified, including personal capabilities, socioemotional competence, personal responses to work conditions, and professional relationships. Findings highlight the importance of teachers’ occupational wellbeing in dealing with numerous challenges and competing demands, with the need for a high level of self-efficacy for instruction and behavioural management being critically significant. Teachers require adequate organisational support to successfully carry out their roles with stronger resilience and efficient job execution. Teachers also need to have social–emotional competence to be able to create a high-quality classroom environment and a conducive atmosphere that supports healthy teacher–student relationships, reduces stress and increases the occupational wellbeing of teachers. Collaborating with other relevant stakeholders such as parents, colleagues, and a school’s leadership team is critical for creating a positive work environment. A good workplace has the potential to contribute to teachers’ occupational wellbeing and provide a supportive platform for student learning and engagement. This review clearly points to the beneficial effects of prioritising teachers’ occupational wellbeing and its intentional inclusion in the professional development plan of practising teachers. Finally, while primary school teachers and secondary school teachers share many similarities in terms of the challenges they face, there are also some differences in how these challenges impact their wellbeing, and these warrant further investigation.
Publisher: Wiley
Date: 16-12-2020
DOI: 10.1111/AJO.13284
Abstract: Aspirin has been shown to reduce prevalence of both early‐onset pre‐ecl sia (ePET) and fetal growth restriction (FGR). To determine whether aspirin prescribed for risk of ePET reduces the prevalence of small for gestational age (SGA) neonates. Two prospective cohorts were consecutively recruited in a large university hospital in Sydney. The Observational cohort (April 2010 to March 2012) validated an algorithm for ePET screening, where risk for ePET was modelled on history, mean arterial pressure, uterine artery pulsatility index and pregnancy‐associated plasma protein A. The Interventional cohort (April 2012 to December 2017) were screened and allocated women at high risk of developing ePET to aspirin 150 mg. The prevalence of preterm and term SGA was compared using regression analysis. There were 3013 and 8424 women screened in the Observational and Interventional cohorts respectively. Women who screened high risk for ePET were three to four times more likely to give birth to a neonate classified as SGA in the Observational (6.8% vs 1.9%) and Interventional cohorts (6.0% vs 1.8%). In women who screened high risk, there were no statistically significant differences in the prevalence of SGA neonates (6.6% vs 6.0% adjusted odds ratio 0.84 (0.50–1.42)) in women who received aspirin compared to women who did not. Women who screen high risk for ePET have an increased chance of delivering an SGA infant. A reduction in the prevalence of SGA neonates when aspirin was prescribed to women who screened high risk for ePET did not reach clinical significance in our cohort.
Publisher: Wiley
Date: 23-11-2017
DOI: 10.1111/JOCN.13595
Abstract: To examine the attitudes to and knowledge and beliefs about homosexuality of nurses and allied professionals in two early parenting services in Australia. Early parenting services employ nurses and allied professionals. Access and inclusion policies are important in community health and early childhood service settings. However, little is known about the perceptions of professionals who work within early parenting services in relation to lesbian, gay, bisexual and transgender families. This is the final in a series of studies and was undertaken in two early parenting services in two states in Australia using a cross-sectional design with quantitative and qualitative approaches. Validated questionnaires were completed by 51 nurses and allied professionals and tested with chi-squared test of independence (or Fisher's exact test), Mann-Whitney U-test, Kruskal-Wallis one-way analysis of variance or Spearman's rank correlation. Thematic analysis examined qualitative data collected in a box for free comments. Of the constructs measured by the questionnaires, no significant relationships were found in knowledge, attitude and gay affirmative practice scores by sociodemographic variables or professional group. However, attitude scores towards lesbians and gay men were significantly negatively affected by conservative political affiliation (p = 0·038), held religious beliefs (p = 0·011) and frequency of praying (p = 0·018). Six overall themes were found as follows: respect, parenting role, implications for the child, management, disclosure, resources and training. The study provided an in-depth analysis of the attitudes, knowledge and beliefs of professionals in two early parenting services, showing that work is needed to promote acceptance of ersity and the inclusion of lesbian, gay, bisexual and transgender families in planning, developing, evaluating and accessing early parenting services. Access and inclusion plans for lesbian, gay, bisexual and transgender families are crucial in early parenting services in Australia and should be included in professional development programmes.
Publisher: Frontiers Media SA
Date: 19-07-2018
Publisher: AVES Publishing Co.
Date: 2012
DOI: 10.5152/AKD.2012.037
Publisher: MDPI AG
Date: 25-10-2021
Abstract: The government of Ghana has been piloting traditional medicine (TM) integration in 17 health facilities across the country. However, the nature of current practice of integrated healthcare has not been thoroughly explored. This paper sought to explore the experiences and recommendations of orthodox health practitioners and hospital administrators in the Ashanti region regarding the practice of integrated healthcare in Ghana. The study adopted a qualitative, phenomenological approach involving 22 interviews. Purposive s ling technique was used in selecting study participants. Framework analysis was used to draw on the experiences of participants relating to TM integration. Participants were knowledgeable about the existence of integrated health facilities and stated that TM integration has created options in health services. However, participants deemed the integrated system ineffective and attributed the inefficiency to poor processing and certification of TM products, opposition of medical doctors to TM usage, absence of a protocol to guide the integration process, and inadequate publicity. Professional training of TM practitioners and inclusion of TM in medical school curriculum could improve collaboration between the health practitioners. Future research should focus on assessing the opinions and involvements of TM practitioners regarding the integration of traditional therapies into national health systems.
Publisher: Wiley
Date: 10-2014
Abstract: Abdominal aortic aneurysm (AAA) is an important cause of mortality in the elderly. Mouse models are widely used to investigate AAA pathogenesis but their suitability for biomarker discovery is unexplored. We conducted a three-phase study. Phase 1: Aortas from angiotensin-II-infused apolipoprotein E deficient (ApoE(-/-) ) mice with and without AAA were assessed via iTRAQ and analyzed in silico to identify potential circulating markers. Microarray data from ApoE(-/-) mice and human patients were analyzed in parallel. Phase 2: Putative markers were compared between datasets to shortlist common candidates. Phase 3: The relationship of two shortlisted markers and AAA presence was assessed. iTRAQ identified eight proteins with biomarker potential. Microarray data identified 72 and 96 potential biomarkers from ApoE(-/-) mice and human patients, respectively. All three datasets suggested apolipoprotein C1 (ApoC1) as a marker for AAA microarray data identified matrix metalloproteinase 9 (MMP9) as a second potential marker. Plasma ApoC1 and MMP9 concentrations positively correlated with AAA diameter in ApoE(-/-) mice. ApoC1 may be a novel biomarker for AAA.
Publisher: Elsevier BV
Date: 12-2011
DOI: 10.1016/J.ATHEROSCLEROSIS.2011.08.013
Abstract: Abdominal aortic aneurysm (AAA) is usually accompanied by the formation of a large volume of intra-luminal thrombus (ILT). ILT-derived proteins have been suggested as circulating markers for AAA. We conducted a proteomic study screening whole and hexapeptide ligand library (HLL) treated ILT explant secretions to identify potential ILT-derived markers for AAA. Unfractionated and HLL-treated ILT secretions from 3 AAA patients were analysed in parallel using liquid chromatography tandem mass spectrometry (LC-MS/MS). In silico analyses were employed to identify proteins with biomarker potential. Proteomic findings were validated by measuring serum concentrations of 2 representative ILT proteins in 313 AAA patients and 690 controls. A total of 150 proteins were identified from thrombus conditioned media HLL treatment enabled the detection of 53 previously unseen polypeptides. Gene ontology analysis revealed high representation of platelet-secreted proteins. Thrombospondin-1 (TSP-1) and clusterin were selected for further assessment. Serum TSP-1 and clusterin were negatively associated with AAA after adjusting for other risk factors. Odds ratio and 95% confidence intervals were 0.62, 0.41-0.94, and 0.50, 0.33-0.75, for men with serum TSP-1 and clusterin in the fourth compared to first quartiles, respectively. This proteomic analysis has identified a group of proteins concentrated in AAA ILT. Assessment of circulating concentrations of two representative polypeptides suggests for the first time that the ILT selectively sequesters proteins rather than actively releasing them. Further work is required to assess the mechanisms underpinning this observation and the associated clinical implications.
Publisher: Cambridge University Press (CUP)
Date: 2023
DOI: 10.1017/S0950268823000031
Abstract: This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and grey literature were searched for articles reporting the assessment of DALY and its components. We considered studies in which researchers performed DALY calculations using primary epidemiological data input sources. We screened 3053 studies of which 2948 were excluded and 105 studies met our inclusion criteria. Of these studies, 22 were multi-country and 83 were single-country studies, of which 46 were from the Netherlands. Food- and water-borne diseases were the most frequently studied infectious diseases. Between 2015 and 2022, the number of burden of infectious disease studies was 1.6 times higher compared to that published between 2000 and 2014. Almost all studies (97%) estimated DALYs based on the incidence- and pathogen-based approach and without social weighting functions however, there was less methodological consensus with regards to the disability weights and life tables that were applied. The number of burden of infectious disease studies undertaken across Europe has increased over time. Development and use of guidelines will promote performing burden of infectious disease studies and facilitate comparability of the results.
Publisher: Wiley
Date: 18-09-2023
Abstract: The objective of this study was to assess the impact of introduction of a new pulmonary embolism (PE) diagnostic guideline with a raised D‐dimer threshold. This is a single‐site, observational, cohort study with a historical comparison. The new guideline raised the D‐dimer threshold to 1000 ng/mL for most patients with a Wells' score of 4 or less. Patients investigated for PE with a D‐dimer level and/or definitive imaging in 6‐month periods before and after the introduction of the guideline were eligible. Patients with D‐dimers of 500–1000 ng/mL were prospectively followed up at 3 months for missed PE. During the pre‐intervention period, 688 patients were investigated for PE, 366 (53.2%) received definitive imaging and 39 PE were diagnosed (5.7% overall, 10.7% of those imaged). For the 121 patients with D‐dimers ≥500 and ng/mL, 87 (71.9%) were imaged with 7 (5.8%) having a PE diagnosed. Post intervention there were 930 patients, of which 426 (45.8%) received definitive chest imaging and there were 50 patients with PE diagnosed (5.4% overall, 11.7% of those imaged). For the 185 patients with D‐dimers ≥500 and ng/mL, 60 (32.4%) were imaged with 5 (2.7%) having PE diagnosed. No cases of missed PE were identified at 3 months. The introduction of the new guideline was associated with a reduction in overall imaging rates without evidence of missed PE. Further evaluation in other settings is recommended.
Publisher: MDPI AG
Date: 29-05-2020
Abstract: Background and objective: Traditional medicine (TM) was integrated into health systems in Africa due to its importance within the health delivery setup in fostering increased health care accessibility through safe practices. However, the quality of integrated health systems in Africa has not been assessed since its implementation. The objective of this paper was to extensively and systematically review the effectiveness of integrated health systems in Africa. Materials and Methods: A systematic literature search was conducted from October, 2019 to March, 2020 using Ovid Medline, Scopus, Emcare, Web of Science, Cumulative Index to Nursing and Allied Health (CINAHL), and Google Scholar, in order to retrieve original articles evaluating the integration of TM into health systems in Africa. A quality assessment of relevant articles was also carried out using the Quality Assessment Tool for Studies with Diverse Designs (QATDSS) critical appraisal tool. Results: The results indicated that the formulation and execution of health policies were the main measures taken to integrate TM into health systems in Africa. The review also highlighted relatively low levels of awareness, usage, satisfaction, and acceptance of integrated health systems among the populace. Knowledge about the existence of an integrated system varied among study participants, while satisfaction and acceptance were low among orthodox medicine practitioners. Health service users’ satisfaction and acceptance of the practice of an integrated health system were high in the countries assessed. Conclusion: The review concluded that existing health policies in Africa are not working, so the integration of TM has not been successful. It is critical to uncover the barriers in the health system by exploring the perceptions and experiences of stakeholders, in order to develop solutions for better integration of the two health systems.
Publisher: MDPI AG
Date: 19-02-2021
Abstract: The authors wish to make the following change to their paper (Akosah-Twumasi et al [...]
Publisher: Portland Press Ltd.
Date: 26-01-2016
DOI: 10.1042/CS20150547
Abstract: Abdominal aortic aneurysm (AAA) is a significant cause of mortality in older adults. A key mechanism implicated in AAA pathogenesis is inflammation and the associated production of reactive oxygen species (ROS) and oxidative stress. These have been suggested to promote degradation of the extracellular matrix (ECM) and vascular smooth muscle apoptosis. Experimental and human association studies suggest that ROS can be favourably modified to limit AAA formation and progression. In the present review, we discuss mechanisms potentially linking ROS to AAA pathogenesis and highlight potential treatment strategies targeting ROS. Currently, none of these strategies has been shown to be effective in clinical practice.
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.HLC.2021.06.450
Abstract: Indigenous Australians have a high rate of ischaemic heart disease (IHD). There is a paucity of local data for North Queensland regarding the clinical characteristics of Indigenous people who present to the emergency department (ED) with chest pain. The aim of the study is to compare the cardiovascular risk factors, social characteristics, and the clinical outcomes between Indigenous and non-Indigenous patients who presented with cardiac-related chest pain. This is a retrospective single-centre audit. The data was collected through chart reviews of chest pain presentations to the Townsville University Hospital Emergency Department, Queensland, Australia, from January to December 2017. We categorised the patients into Indigenous and non-Indigenous groups and compared their cardiac risk factors and social characteristics. We further classified the patients into three diagnosis groups and we measured the clinical outcomes in the patients with a diagnosis of cardiac-related chest pain. We used a data linkage to the Registry of Births, Deaths and Marriages for the death outcomes. A multivariable analysis was done to determine the risk of major adverse cardiac event (MACE) for Indigenous vs non-Indigenous patients. Indigenous patients were over-represented making up 19.1% of the total cohort (compared with 11.1% of the North Queensland Indigenous population) and presented at a younger age (median age: 45 vs 52, p<0.005). Traditional cardiovascular risk factors were significantly higher in Indigenous patients. The incidence of discharge against medical advice was also higher (6.5% vs 2.7%, p<0.005). There was an underutilisation of the local chest pain pathway amongst the Indigenous group (35.8% vs 44.7%, p<0.005). In patients with a diagnosis of cardiac-related chest pain, the rate of receiving invasive coronary angiogram procedures was similar in both cohorts (44.5% vs 43.7%, p=0.836). With regards to outcomes, Indigenous patients suffered from acute coronary syndrome (ACS) at a younger median age (51 vs 64, p<0.005) and were more likely to have severe three vessel disease (17% vs 6%, p<0.005) leading to coronary bypass graft surgery (CABG) (19% vs 6%, p<0.005). When adjusted for age, gender, and comorbidities, Indigenous patients were more likely to have MACE within 1 year of their chest pain presentation, compared with non-Indigenous patients with the same diagnosis (adjusted odds ration [AOR]=2.0, 95% CI [1.1, 3.8], p=0.03). In our study, Indigenous patients carried a heavier burden of cardiovascular risk factors, presented at a younger age, with more severe coronary disease and had a higher rate of CABG. We found an underutilisation of the local chest pain protocol amongst the Indigenous cohort, which suggests a need to improve support structures in the ED. In our multivariable analysis, Indigenous patients suffered from a significantly higher MACE compared to non-Indigenous patients which indicates that more collaborative efforts are needed to improve the cardiovascular health of local Aboriginal and Torres Strait Islander people.
Publisher: MDPI AG
Date: 03-04-2023
Abstract: The search for an effective treatment of allergic conditions is an ongoing global health challenge due to the high prevalence of allergies. Epinephrine and glucocorticosteroids remain the oldest and most widely used treatment regimen for allergy, and these medications are for short relief. In extreme allergy manifestations, the current treatment options aim to use monoclonal antibody (mAb) to target pathological pathways of inflammation involving mast cells, eosinophils, and basophils. These cells have the propensity to induce an allergic-inflammatory response. Studies have shown that they are responsible for several allergic diseases, such as allergic asthma, atopic dermatitis, rhinitis, and conjunctivitis. Studies evaluating monoclonal antibodies against serum IgE (Omalizumab), Th-2 cytokines, such as IL-4, IL-13 (dupilumab), and IL-5 suggest an attenuation of allergic symptoms and improvement in patients’ overall well-being. However, several factors such as cost of production (i.e., antibody purification), host immunogenicity, safety, and efficacy have hindered the availability of purified mAb in developing countries. Gene therapy is a promising tool for treating allergy, and emerging studies have suggested that antibody gene therapy may be the future for treating extreme cases of allergy manifestations. This paper describes the use of purified monoclonal antibodies for treating severe allergic responses and the associated limitations. It explores the prospects of antibody gene therapy for modulating allergy episodes.
Publisher: MDPI AG
Date: 14-05-2020
Abstract: There are numerous theories on parenting styles, however, they are Western-oriented and may not be applicable to collectivist non-Western societies. A qualitative study which utilised semi-structured interviews was conducted to explore the perceived parenting roles of 26 Sub-Saharan African (SSA) migrant parents (both humanitarian and professional migrants) in their children’s career pathways after they migrated to Australia. Data were analysed using grounded theory methods and this process facilitated the creation of a new framework to provide an in-depth understanding of how SSA parenting styles informed the migrant children’s career choices while living in Australia. The study revealed that most SSA migrant parents maintained their style of parenting as used in their home countries. Interestingly, some parents adapted their parenting styles due to their perceptions of changed circumstances within the host country. Other parents, who would normally be authoritative, became trustful due to their perceived lack of educational expertise to guide their children. Conversely, some other parents who would normally be authoritarian employed wily tactics in influencing their children’s decision, so as to circumvent the strict Australian legal framework around children’s rights. Irrespective of parenting style applied, all the parents aimed to either guide or direct their children’s educational and career development to ensure that they become economically productive adults. From the discourse of the SSA migrants’ perceptions of their parental role, we offer potential explanations for what underpins their parenting preferences and the rippling effects on their children’s career trajectories. Direction for areas of continued research are presented, and implications of the findings are discussed.
Publisher: Graphyonline Publications PVT, Ltd.
Date: 16-11-2015
Publisher: American Society for Microbiology
Date: 12-2018
DOI: 10.1128/AAC.01487-18
Abstract: Short-course regimens for multidrug-resistant tuberculosis (MDR-TB) are urgently needed. Limited data suggest that the new drug bedaquiline (BDQ) may have the potential to shorten MDR-TB treatment to less than 6 months when used in conjunction with standard anti-TB drugs.
Publisher: SAGE Publications
Date: 2023
Publisher: MDPI AG
Date: 04-04-2023
DOI: 10.3390/HEALTHCARE11071041
Abstract: Persons with disabilities (PwDs) constitute about 16% of the global population and face many challenges in every society, including access to sexual and reproductive healthcare. The attitudes of healthcare providers (HPs) exert a major influence on PwDs accessing sexual and reproductive healthcare (SRH). A sequential explanatory mixed methods design was used to investigate the attitudes and perceptions of HPs towards PwDs and SRH delivery in Ghana’s Ashanti region. Quantitative data analysis indicated that overall, 82% of HPs had received information on disability-related issues and had relatively positive attitude towards PwDs, which varied across sub-scales of the Attitude Towards Disability score and associated with their sociodemographic characteristics. HPs faced several challenges in SRH services delivery to PwDs, which included a lack of funding and training, and inadequate staff. Inductive thematic analysis of the qualitative data revealed eight overarching themes. The findings revealed that HPs had prejudice about the mental and sexual health abilities of PwDs. Inadequate skill set, inadequate resources, and limited funding were major challenges identified. Nonetheless, compassion and benevolence towards PwDs, improvision, economic and educational support, awareness creation, and referrals were strategies adopted to overcome these challenges. Mandatory training of HPs is recommended to ensure improved SRH service delivery to PwDs. Future research could explore the perceptions and coping strategies of PwDs.
Publisher: Informa UK Limited
Date: 25-05-2019
DOI: 10.1080/19338244.2018.1461600
Abstract: This article investigates the incidence, prevalence and factors associated with occupational tuberculosis (TB) in healthcare workers (HCWs) in sub-Saharan Africa (SSA). Studies were extracted from MEDLINE, PsycINFO, CINAHL, Cochrane Library, and SCOPUS databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement from inception to the 2
Publisher: Elsevier BV
Date: 10-2010
Publisher: Wiley
Date: 13-07-2018
DOI: 10.1111/MYC.12783
Abstract: Cryptococcosis is an invasive fungal infection caused primarily by Cryptococcus neoformans and Cryptococcus gattii species, presenting predominantly as meningoencephalitis. The aim of this study is to assess all cryptococcal infections managed at our facility from 2001 to 2015 to determine incidence, risk factors, and comparison of outcomes prior to and following introduction of the 2010 Infectious Disease Society of America (IDSA) guidelines. Retrospective analysis of all patients diagnosed and treated for cryptococcal infection occurring between January 2001 and December 2015. Of 102 patients diagnosed with cryptococcal infection, 97 were eligible for study inclusion. There appears to be an overall increased incidence of cryptococcosis in both transplant and non-transplant cohorts with a peak in 2015 of 6 transplant and 13 non-transplant cases. In the meningitis cohort, 38/52 (73%) of identified isolates were C. neoformans, and 14/52 (27%) were C. gattii. Notably, 14/14 (100%) of C. gattii isolates were associated with meningitis, as compared to only 38/64 (59%) C. neoformans associated with meningitis (P: .003). It appears that patients presenting with cough are less likely to have meningitis, 17/27 (63%), (P: .005). When stratifying for culture positive meningitis lumbar puncture opening pressure, the median in the culture positive cohort was 31.5 cm H
Publisher: MDPI AG
Date: 29-08-2021
DOI: 10.3390/DISABILITIES1030019
Abstract: (1) Background: Globally, persons with disabilities (PWDs) face numerous challenges including access to healthcare. This scoping review sought to assess the level of inclusiveness in Ghanaian health policies and reports for PWDs (2) Methods: An extensive search and scoping review of health policies/reports in Ghanaian government websites and Google was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews were followed in selecting and reporting the policies/reports. The program evaluation and policy design framework was employed for content analysis (3) Results: Fifteen policies and reports with political recognition, objectives, and specific resources needed to execute stipulated plans were included. Although these policies and reports had collaborative partnerships with various institutions and organisations in development and implementation plans, the level of inclusiveness of disability issues was very low. Only eight out of the fifteen policies/reports (53%) reviewed considered PWDs, indicating a low level of inclusion. The definition of disability was also limited. (4) Conclusions: To achieve the sustainable development goal of ‘leaving no one behind’ in line with the provisions of the United Nations Convention on the Right of Persons with Disabilities and the Disability Act 715 of Ghana, it is recommended that subsequent health policies should have an in-depth engagement with PWDs from the conceptual design stage right through to implementation and evaluation.
Publisher: Jenny Stanford Publishing
Date: 15-01-2019
DOI: 10.1201/B22372-29
Publisher: Wiley
Date: 27-10-2019
DOI: 10.1111/AJO.13079
Abstract: Bradycardia and cardiac arrest are recognised complications of laparoscopic gynaecological surgery. Anticholinergic agents are indicated in the treatment of perioperative bradyarrhythmia however, their role in the prevention of bradycardia as a result of insufflation of the peritoneum is less well defined. This article systematically reviewed the literature with respect to the role of anticholinergic agents in the prevention of clinically significant bradyarrhythmia during laparoscopic gynaecological surgery. Eight studies were included for review following an extensive database search. This review highlights the paucity of evidence supporting the prophylactic use of anticholinergic agents in preventing clinically significant bradycardia in women undergoing laparoscopic gynaecological surgery.
Publisher: Wiley
Date: 05-2022
DOI: 10.1111/IMJ.15164
Abstract: Group B streptococcus (GBS) is a recognised perinatal and neonatal pathogen. There are reports of increasing GBS sepsis globally outside this demographic. North Queensland is part of tropical Australia, with a relatively high proportion of Indigenous Australians. To analyse the epidemiology of GBS bacteraemia and explore associated risk factors. This was a 10‐year retrospective review of GBS bacteraemia in a tertiary facility in North Queensland, between 2010 and February 2020. Data variables collected included: demographics, risk factors, clinical source and outcomes. Multivariable logistic regression was performed to examine the association of indigenous status and other relevant clinical factors with mortality from GBS bacteraemia at 3 months. Of the 164 total cases, 123 were not pregnancy related. The annual rate of GBS bacteraemia for the indigenous population was 12.48 per 100 000 and 4.84 per 100 000 for the non‐indigenous population. Indigenous patients were more likely to have diabetes and chronic kidney disease compared with the non‐indigenous patients. Males (adjusted odds ratio (AOR) = 4.34 95% CI 1.14−16.56 P = 0.031) and immunosuppressed patients (AOR = 11.49 95% CI 2.73−48.42 P 0.001) were more likely to experience mortality at 3 months from GBS bacteraemia even after adjusting for other risk factors respectively. GBS bacteraemia is deviating from being primarily a neonatal disease. While the indigenous population of North Queensland are disproportionately affected, the demographics affected differ. GBS appears to target the older non‐indigenous patients with greater comorbidities. In the non‐indigenous population, invasive GBS disease is an emerging issue. Three‐month mortality appears to be increased in males and the immunosuppressed.
Publisher: Public Library of Science (PLoS)
Date: 09-11-2017
Publisher: Bentham Science Publishers Ltd.
Date: 31-08-2014
DOI: 10.2174/1389450115666140804155036
Abstract: Abdominal aortic aneurysm (AAA) is an important cause of mortality in older adults. Most AAAs are asymptomatic and screening programs have been introduced to identify AAAs at an early stage in some countries. There is currently no accepted therapy for early stage or small AAAs, which are frequently identified by such programs. In this review, we discuss work underway to identify targets for medical treatments to limit progression of small AAAs. Specifically we discuss studies, which have examined the potential of targeting inflammation, proteolysis, the renin-angiotensin system, the coagulation system and sex hormones as approaches to limiting AAA pathogenesis. As yet, none of the treatment targets have translated into an agent, which can effectively reduce AAA progression in clinical practice.
Publisher: Frontiers Media SA
Date: 11-07-2023
Publisher: MDPI AG
Date: 17-12-2020
Abstract: Malaria occurrence in the Chittagong Hill Tracts in Bangladesh varies by season and year, but this pattern is not well characterized. The role of environmental conditions on the occurrence of this vector-borne parasitic disease in the region is not fully understood. We extracted information on malaria patients recorded in the Upazila (sub-district) Health Complex patient registers of Rajasthali in Rangamati district of Bangladesh from February 2000 to November 2009. Weather data for the study area and period were obtained from the Bangladesh Meteorological Department. Non-linear and delayed effects of meteorological drivers, including temperature, relative humidity, and rainfall on the incidence of malaria, were investigated. We observed significant positive association between temperature and rainfall and malaria occurrence, revealing two peaks at 19 °C (logarithms of relative risks (logRR) = 4.3, 95% CI: 1.1–7.5) and 24.5 °C (logRR = 4.7, 95% CI: 1.8–7.6) for temperature and at 86 mm (logRR = 19.5, 95% CI: 11.7–27.3) and 284 mm (logRR = 17.6, 95% CI: 9.9–25.2) for rainfall. In sub-group analysis, women were at a much higher risk of developing malaria at increased temperatures. People over 50 years and children under 15 years were more susceptible to malaria at increased rainfall. The observed associations have policy implications. Further research is needed to expand these findings and direct resources to the vulnerable populations for malaria prevention and control in the Chittagong Hill Tracts of Bangladesh and the region with similar settings.
Publisher: Frontiers Media SA
Date: 23-03-2017
Publisher: Wiley
Date: 02-05-2018
Abstract: To give voice to the general public's views of prospective and retrospective (deferred) consent in the emergency research setting. A cross-sectional, stratified population-based, telephone survey was conducted in April to July 2016. A questionnaire consisting of standardised health and demographic details, and seven specifically designed, and pilot-tested questions, five closed and two open text, based on literature review and previous surveys in the field was used. Quantitative and qualitative techniques were used in the data analysis. This was a centrally coordinated national telephone survey in Australia, the 2016 National Social Survey, coordinated by Central Queensland University. Data for 1217 adult (18+ years) participants were included in the analysis, with a response rate of 26%. The s le demographics were broadly representative of the Australian population. The majority of respondents were supportive of research in emergency circumstances without prospective informed consent. However, the type of research and level of risk influence its acceptability. Common themes in qualitative analysis included the critical or life-threatening nature of the illness being researched, and the potential harms and benefits of participation. This research provided the first opportunity for the community to contribute to discourse about prospective and retrospective (deferred) consent in the emergency research setting in Australia. Further work is needed to determine community expectations of how this process can be optimised and implemented, and to identify potential situations where this may not be acceptable.
Publisher: Elsevier BV
Date: 09-2023
Publisher: Informa UK Limited
Date: 29-03-2021
Publisher: Wiley
Date: 22-05-2018
DOI: 10.1111/AJO.12825
Abstract: Virtual elimination of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is a global target. A review of the literature was conducted using medical databases and health department websites to examine the current trends related to perinatal HIV exposure and MTCT in Australia in comparison with other high-income countries (HICs). The review discusses the uptake of prevention strategies and barriers that impede MTCT prevention. The literature suggests an increase in the numbers of HIV-exposed deliveries, but a marked decline in the rates of MTCT within HICs. MTCT remains high when the mother's HIV infection is diagnosed late or postpartum. Data supports increasing trends of perinatal HIV exposure in migrant populations from low- and middle-income countries (particularly African women). Increased uptake and earlier initiation of antiretroviral therapy (ART) was associated with overall MTCT decline. Caesarean section remains the main mode of delivery described however, the numbers of planned vaginal deliveries are increasing over time. Heterogeneity of data periods and outcome measures within published literature made comparisons between countries difficult. Future development should focus on clear national guidelines and a potential national database for perinatal HIV, culturally appropriate service provision, and more evidence on acute infections in pregnancy and the effects that longer duration and increased uptake of ART has on the fetus and resistance to ART.
Publisher: Portland Press Ltd.
Date: 11-12-2014
DOI: 10.1042/CS20130425
Abstract: AAA (abdominal aortic aneurysm) is an important cause of sudden death in older adults, but there is no current effective drug therapy for this disease. The UCNs (urocortins1–3) and their receptors: CRFR (corticotrophin-releasing factor receptor)-1 and -2 have been implicated in various CVDs (cardiovascular diseases). We assessed the relative expression of UCN1–3 in AAA by qRT-PCR (quantitative reverse transcription–PCR) and ELISA, and examined in vitro how UCN2 affects human aortic VSMC (vascular smooth muscle cell) Akt phosphorylation, pro-inflammatory cytokine IL (interleukin)-6 secretion, proliferation, cell cycle and apoptosis. UCN2 and CRFR2 expression were significantly up-regulated in biopsies from the AAA body. AAA body biopsies released high amounts of UCN2 in vitro. Median plasma UCN2 concentrations were 2.20 ng/ml (interquartile range 1.14–4.55 ng/ml, n=67) in AAA patients and 1.11 ng/ml (interquartile range 0.76–2.55 ng/ml, n=67) in patients with non-aneurysmal PAD (peripheral artery disease) (P=0.001). Patients with UCN2 in the highest quartile had a 4.12-fold (95% confidence interval, 1.37–12.40) greater prevalence of AAA independent of other risk factors, P=0.012. In vitro, UCN2 significantly inhibited VSMC Akt phosphorylation and proliferation in a dose-dependent manner. UCN2 induced VSMC G1 cell-cycle arrest and increased IL-6 secretion over 24 h. The CRFR2 antagonist astressin-2B significantly abrogated the effects of UCN2 on VSMCs. In conclusion, UCN2 is significantly associated with AAA and inhibits VSMC proliferation by inducing a G1 cell cycle arrest suggesting a plausible regulatory role in AAA pathogenesis.
Publisher: MDPI AG
Date: 14-02-2020
Abstract: Pre-existing acculturation models have focused on in idual orientation and may not be fully applicable to African migrants due to their strong connection to family. In this study, we utilised qualitative semi-structured interviews to explore how 22 migrant families from eight sub-Saharan African representative countries: Congo, Eritrea, Kenya, Nigeria, Rwanda, Sierra Leone, Uganda and Zimbabwe, who now reside in Townsville, Australia experienced the acculturation process. Data were analysed at the family unit level using the three steps of grounded theory method: open, axial and selective coding. The theory derived illustrates that the acculturation process involves two major phases (maintaining core moral values and attaining a sense of belonging) within which six categories were identified. Three of the categories were related to deeply held heritage values and beliefs (family relationships, societal expectations and cultural norms), while the other three (religious beliefs, socio-economic gains and educational values) indicated integration with the host culture. These categories constitute central concerns for the participants and demonstrate what matters to them as a family unit and not as in iduals. We conclude that a selective process of “prioritising family needs” determines the acculturation strategy of sub-Saharan African migrant families, aiding the fulfilment of their migration goals, ensuring effective functioning of the family unit, and enabling them to be productive members of their local community.
Publisher: Springer Science and Business Media LLC
Date: 31-10-2023
Publisher: Elsevier BV
Date: 02-2019
Publisher: MDPI AG
Date: 25-09-2019
Abstract: Background and Objectives: Drowning is a leading cause of unintentional injury related mortality worldwide, and accounts for roughly 320,000 deaths yearly. Over 90% of these deaths occur in low- and middle-income countries with inadequate prevention measures. The highest rates of drowning are observed in Africa. The aim of this review is to describe the epidemiology of drowning and identify the risk factors and strategies for prevention of drowning in Africa. Materials and Methods: A review of multiple databases (MEDLINE, CINAHL, PsycINFO, Scopus and Emcare) was conducted from inception of the databases to the 1st of April 2019 to identify studies investigating drowning in Africa. The preferred reporting items for systematic review and meta-analysis (PRISMA) was utilised. Results: Forty-two articles from 15 countries were included. Twelve articles explored drowning, while in 30 articles, drowning was reported as part of a wider study. The data sources were coronial, central registry, hospital record, sea rescue and self-generated data. Measures used to describe drowning were proportions and rates. There was a huge variation in the proportion and incidence rate of drowning reported by the studies included in the review. The potential risk factors for drowning included young age, male gender, ethnicity, alcohol, access to bodies of water, age and carrying capacity of the boat, weather and summer season. No study evaluated prevention strategies, however, strategies proposed were education, increased supervision and community awareness. Conclusions: There is a need to address the high rate of drowning in Africa. Good epidemiological studies across all African countries are needed to describe the patterns of drowning and understand risk factors. Further research is needed to investigate the risk factors and to evaluate prevention strategies.
Publisher: Springer Science and Business Media LLC
Date: 20-11-2018
Publisher: Oxford University Press (OUP)
Date: 05-09-2023
DOI: 10.1093/INTHEALTH/IHAC059
Abstract: Traditional medicine (TM) plays a vital role in the Ghanaian health system by serving as an alternative healthcare delivery system for the majority of people. However, the quality of practice and level of TM practitioners’ involvement in the integration of TM into the health system have not been fully investigated. This study employed a phenomenological qualitative study design to explore the perceptions, experiences and recommendations of TM practitioners in the Ashanti region regarding TM integration. Data were collected through in idual interviews with 17 participants. Participants had knowledge about TM integration. They cited effective alternative healthcare delivery and improved patient outcomes as the key benefits of TM integration. However, they reported a shortage of approved TM products, poor visibility of TM integration and poor relational coordination of care as factors h ering the integration. Participants recommended improved interprofessional relationships, provision of financial support and improved publicity of TM as possible strategies to enhance TM integration in Ghana. The findings of the study clearly demonstrate that the Ghanaian health system is currently operating a consumer-led, tolerant health system with a parallel (between orthodox and TM practitioners) healthcare delivery model. Successful implementation of an effective TM integration would require improved integrative collaborative coordination of care between orthodox and TM practitioners in Ghana.
Publisher: MDPI AG
Date: 13-06-2022
DOI: 10.3390/V14061283
Abstract: Several neglected infectious pathogens, such as the monkeypox virus (MPXV), have re-emerged in the last few decades, becoming a global health burden. Despite the incipient vaccine against MPXV infection, the global incidence of travel-related outbreaks continues to rise. About 472 confirmed cases have been reported in 27 countries as of 31 May 2022, the largest recorded number of cases outside Africa since the disease was discovered in the early 1970s.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Microbiology Society
Date: 10-2018
DOI: 10.1099/JMM.0.000830
Abstract: The aim of this paper was to determine the correlation between serum cryptococcal antigen and a diagnosis of cryptococcal meningitis in the immunocompetent cohort. A retrospective multicentre analysis of immunocompetent patients diagnosed and treated for cryptococcal meningitis between January 2000 and December 2017 was performed. Sixty-seven of the 143 cases of cryptococcosis occurred in immunocompetent patients. The serum cryptococcal antigen titre was significantly higher in the meningitis group [1 : 256 (IQR: 64-1024)] compared with that for non-meningitis patients [1 : 64 (IQR: 8-256)], P=0.012. The relative risk of meningitis with a serum cryptococcal antigen (CRAG) >1 : 64 was 1.8 (95 % CI: 1.15-2.82). This study demonstrates a clear correlation between serum cryptococcal antigen titre and meningitis. While the serum titre is not definitive for meningitis, in resource-limited settings or cases where lumbar puncture may be contraindicated, this evidence may aid diagnosis and subsequent therapeutic decisions.
Publisher: MDPI AG
Date: 13-01-2021
Abstract: Exposure to household air pollution (HAP) from cooking with unclean fuels and indoor smoking has become a significant contributor to global mortality and morbidity, especially in low- and middle-income countries such as Nigeria. Growing evidence suggests that exposure to HAP disproportionately affects mothers and children and can increase risks of adverse birth outcomes. We aimed to quantify the association between HAP and adverse birth outcomes of stillbirth, preterm births, and low birth weight while controlling for geographic variability. This study is based on a cross-sectional survey of 127,545 birth records from 41,821 in idual women collected as part of the 2018 Nigeria Demographic and Health Survey (NDHS) covering 2013–2018. We developed Bayesian structured additive regression models based on Bayesian splines for adverse birth outcomes. Our model includes the mother’s level and household characteristics while correcting for spatial effects and multiple births per mother. Model parameters and inferences were based on a fully Bayesian approach via Markov Chain Monte Carlo (MCMC) simulations. We observe that unclean fuel is the primary source of cooking for 89.3% of the 41,821 surveyed women in the 2018 NDHS. Of all pregnancies, 14.9% resulted in at least one adverse birth outcome 14.3% resulted in stillbirth, 7.3% resulted in an underweight birth, and 1% resulted in premature birth. We found that the risk of stillbirth is significantly higher for mothers using unclean cooking fuel. However, exposure to unclean fuel was not significantly associated with low birth weight and preterm birth. Mothers who attained at least primary education had reduced risk of stillbirth, while the risk of stillbirth increased with the increasing age of the mother. Mothers living in the Northern states had a significantly higher risk of adverse births outcomes in 2018. Our results show that decreasing national levels of adverse birth outcomes depends on working toward addressing the disparities between states.
Publisher: Wiley
Date: 30-10-2014
DOI: 10.1111/BPA.12175
Publisher: MDPI AG
Date: 05-08-2023
Abstract: Farm animals harbour bacterial pathogens, which are often viewed as important indicators of animal health and determinants of food safety. To better understand the prevalence and inform treatment, we audited laboratory data at the Bacteriology Laboratory of the NVRI from 2018–2021. Antibiotics were classified into seven basic classes: quinolones, tetracyclines, beta-lactams, aminoglycosides, macrolides, nitrofuran, and cephalosporins. Trends were analysed using a generalised linear model with a log link function for the Poisson distribution, comparing proportions between years with an offset to account for the variability in the total number of organisms per year. Avian (73.18%) s les were higher than any other s le. The major isolates identified were Escherichia. coli, Salmonella spp., Klebsiella spp., Staphylococcus spp., Proteus spp., and Pseudomonas spp. We found that antimicrobial resistance to baseline antibiotics increased over the years. Of particular concern was the increasing resistance of Klebsiella spp. to cephalosporins, an important second-generation antibiotic. This finding underscores the importance of farm animals as reservoirs of pathogens harbouring antimicrobial resistance. Effective biosecurity, surveillance, and frugal use of antibiotics in farms are needed because the health of humans and animals is intricately connected.
Publisher: Cold Spring Harbor Laboratory
Date: 16-07-2018
DOI: 10.1101/369991
Abstract: Short-course regimens for multi-drug resistant tuberculosis (MDR-TB) are urgently needed. Limited data suggest that the new drug, bedaquiline (BDQ), may have the potential to shorten MDR-TB treatment to less than six months when used in conjunction with standard anti-TB drugs. However, the feasibility of BDQ in shortening MDR-TB treatment duration remains to be established. Mathematical modelling provides a platform to investigate different treatment regimens and predict their efficacy. We developed a mathematical model to capture the immune response to TB inside a human host environment. This model was then combined with a pharmacokinetic-pharmacodynamic model to simulate various short-course BDQ-containing regimens. Our modelling suggests that BDQ could reduce MDR-TB treatment duration to just 18 weeks (four months) while still maintaining a very high treatment success rate (100% for daily BDQ for two weeks, or 95% for daily BDQ for one week during the intensive phase). The estimated time to bacterial clearance of these regimens ranges from 27 to 33 days. Our findings provide the justification for empirical evaluation of short-course BDQ-containing regimens. If short-course BDQ-containing regimens are found to improve outcomes then we anticipate clear cost-savings and a subsequent improvement in the efficiency of national TB programs.
Publisher: Springer Science and Business Media LLC
Date: 25-06-2023
DOI: 10.1186/S13690-023-01119-X
Abstract: Within the framework of the burden of disease (BoD) approach, disease and injury burden estimates attributable to risk factors are a useful guide for policy formulation and priority setting in disease prevention. Considering the important differences in methods, and their impact on burden estimates, we conducted a scoping literature review to: (1) map the BoD assessments including risk factors performed across Europe and (2) identify the methodological choices in comparative risk assessment (CRA) and risk assessment methods. We searched multiple literature databases, including grey literature websites and targeted public health agencies websites. A total of 113 studies were included in the synthesis and further ided into independent BoD assessments (54 studies) and studies linked to the Global Burden of Disease (59 papers). Our results showed that the methods used to perform CRA varied substantially across independent European BoD studies. While there were some methodological choices that were more common than others, we did not observe patterns in terms of country, year or risk factor. Each methodological choice can affect the comparability of estimates between and within countries and/or risk factors, since they might significantly influence the quantification of the attributable burden. From our analysis we observed that the use of CRA was less common for some types of risk factors and outcomes. These included environmental and occupational risk factors, which are more likely to use bottom-up approaches for health outcomes where disease envelopes may not be available. Our review also highlighted misreporting, the lack of uncertainty analysis and the under-investigation of causal relationships in BoD studies. Development and use of guidelines for performing and reporting BoD studies will help understand differences, avoid misinterpretations thus improving comparability among estimates. The study protocol has been registered on PROSPERO, CRD42020177477 (available at: www.crd.york.ac.uk/PROSPERO/ ).
Publisher: MDPI AG
Date: 25-11-2020
DOI: 10.3390/HEALTHCARE8040514
Abstract: Current trends suggest that adolescent obesity is an on-going and recurrent decimal that is still on the rise in Australia and the social burden associated with it can significantly cause low self-esteem and lack of confidence in personal body image in adulthood. Nonetheless, evidence-based prevention programs are not widely implemented in schools, even though they are commonplace for easy access to adolescents. The primary objective of this systematic review was to assess the scope and efficacy of adolescent obesity intervention strategies in Australian schools, to guide future research. Seven electronic databases were searched for peer-reviewed school-based intervention articles written in the English language and targeting 12–18-year-old adolescents. Intervention characteristics were extracted, and quality, efficacy and outcome measures were assessed utilizing thirteen studies that met the inclusion criteria for this review. Most of the Australian adolescent obesity research emanated from the State of New South Wales and none were nationwide. Five studies successfully met all the requirements in all measured outcomes, four met at least one measured outcome and the remaining four were unsuccessful. Despite the weak evidence of intervention efficacy for most of the reviewed studies, school-based interventions with multi-component combinations of physical activity, nutrition and alignment to a theory yielded promising results. Our findings point to the need for future research to assess the perceptions of school stakeholders in relation to the barriers and enablers to establishing school-based prevention and intervention programs for adolescents.
Publisher: Wiley
Date: 14-06-2018
Abstract: The present study aimed to assess whether dietetic intervention helps patients on fluid-only diets to meet their energy and protein requirements. This topic has not been previously investigated. A quasi-experimental study of 57 patients receiving fluid-only diets was conducted at The Townsville Hospital. The fluid consumption of participants was observed over 24 hours and was used to calculate total energy and protein intakes. The percentage of protein and energy requirements met was compared between patients receiving dietetic intervention and patients who were not. Patients receiving dietetic interventions met a higher percentage of their energy requirements (75.88) than the control group (18.10) based on median intakes (P < 0.001). Patients receiving dietetic intervention also met a higher percentage of their protein requirements (75.99) than the control group (13.80) based on median intakes (P < 0.001). Stratification for age, body mass index (BMI) and fluid diet type showed no change in effect. This study shows that dietetic intervention enabled patients on fluid-only diets to meet up to 80% more of their energy requirements and up to 95% more of their protein requirements. These results were consistent across age, BMI and fluid diet type. The significance of these differences has resulted in a change of clinical practice at the study hospital. All patients on fluid-only diets for three days or longer are now blanket referred for dietetic intervention.
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.YJMCC.2011.06.002
Abstract: Acquired cardiovascular diseases such as coronary heart disease, peripheral artery disease and related vascular problems contribute to more than one-third of worldwide morbidity and mortality. In many instances, particularly in the under developed world, cardiovascular diseases are diagnosed at a late stage limiting the scope for improving outcomes. A range of therapies already exist for established cardiovascular disease, although there is significant interest in further understanding disease pathogenesis in order to improve diagnosis and achieve primary and secondary therapeutic goals. The urocortins are a group of recently defined peptide members of the corticotrophin-releasing factor family. Previous pre-clinical work and human association studies suggest that urocortins have potential to exert some beneficial and other detrimental effects on the heart and major blood vessels. More current evidence however favours beneficial effects of urocortins, for ex le these peptides have been shown to inhibit production of reactive oxygen species and vascular cell apoptosis, and thus may have potential to antagonise the progression of cardiovascular disease. This review summarises published data on the potential role of urocortins in cardiovascular disease.
Publisher: Wiley
Date: 15-08-2022
DOI: 10.1111/IMJ.15594
Abstract: There is an absence of clinically relevant epidemiological data in regional Australia pertaining to haematological malignancies. To determine the incidence and geographical variation of haematological malignancies in North Queensland using a clinically appropriate disease classification. Retrospective, observational study of in idual patient data records of all adults diagnosed with a haematological malignancy between 2005 and 2014 and residing within The Townsville Hospital Haematology catchment region. We report descriptive summaries, incidence rates and incidence‐rate ratios of haematological malignancies by geographic regions. One thousand, five hundred and eighty‐one haematological malignancies (69% lymphoid, 31% myeloid) were diagnosed over the 10‐year study period. Descriptive data are presented for 58 major subtypes, as per the WHO diagnostic classification of tumours of haemopoietic and lymphoid tissues. The overall median age at diagnosis was 66 years with a male predominance (60%). We demonstrate a temporal increase in the incidence of haematological malignancies over the study period. We observed geographical variations in the age‐standardised incidence rates per 100 000 ranging from 0.5 to 233.5. Our data suggest an increased incidence rate ratio for haematological malignancies in some postcodes within the Mackay area compared with other regions. The present study successfully reports on the incidence of haematological malignancies in regional Queensland using a clinically meaningful diagnostic classification system and identifies potential geographic hotspots. We advocate for such contemporary, comprehensive and clinically meaningful epidemiological data reporting of blood cancer diagnoses in wider Australia. Such an approach will have significant implications towards developing appropriate data‐driven management strategies and public health responses for haematological malignancies.
Publisher: Asociatia Pentru Cresterea Vizibilitatii Cercetarii Stiintifice (ACVCS)
Date: 12-2020
Publisher: Frontiers Media SA
Date: 20-07-2023
DOI: 10.3389/FPUBH.2023.1232046
Abstract: Access to sexual and reproductive health (SRH) services is a fundamental human right, but people with disabilities (PwDs) in low-and middle-income countries often face multiple barriers to utilisation. This study aimed to assess the level of SRH services utilisation and the enabling and inhibiting factors among PwDs in Ghana’s Ashanti region. A sequential explanatory mixed-methods study design was employed, involving quantitative ( n = 402) and qualitative ( n = 37) data collection from PwDs. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data were analysed using inductive thematic analysis. The study found that only 33.8% of the PwDs had ever used SRH services. Utilisation was associated with sex, marital status and travel duration to health facility. The qualitative data revealed that factors at the in idual, family/community and health facility levels influenced utilisation of SRH services, acting as both enablers and barriers. PwDs had relatively low utilisation of SRH services in Ghana’s Ashanti region. To increase utilisation, it is recommended to address the stigma and discrimination towards PwDs, provide more training for healthcare providers, improve the accessibility of healthcare facilities, and strengthen the national health insurance scheme. Further research could explore PwDs’ SRH outcomes and strategies to improve these outcomes in Ghana.
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.IJOM.2022.05.005
Abstract: Epithelial-myoepithelial carcinoma (EMC) is a rare salivary gland malignancy. Controversy exists in the literature regarding the effectiveness of treatment modalities employed in the management of EMC. This systematic review was undertaken to understand the presenting characteristics of EMC and identify the most common treatment modalities and their associated outcomes, in order to help guide an evidenced-based approach to the algorithm of care. The MEDLINE (PubMed) and Embase databases were searched (up to February 23, 2022), and the review was performed in accordance with the PRISMA statement. Fifty-seven studies (51 case reports and six case series) describing 91 cases of EMC were included in this review. In the included studies, a slow-growing painless mass was the most common presenting clinical feature. EMC was most frequently treated with surgery alone (65%). Local disease recurrence occurred in 24% of the cases and metastatic disease in 11%. A positive surgical margin was found to be associated with a higher risk of recurrence (P < 0.001), while adjuvant radiotherapy was associated with a decreased risk of local disease recurrence (P = 0.034). Metastatic disease and multimodal therapy were found to be associated with decreased disease-free and overall survival (all P < 0.05). The current literature supports surgery with clear margins as the mainstay of treatment for EMC of the salivary and seromucous glands of the head and neck. In certain situations, radiotherapy may improve disease-free survival.
Publisher: Oxford University Press (OUP)
Date: 05-03-2021
Abstract: Border closure is one of the policy changes implemented to mitigate against coronavirus disease 2019 (COVID-19). We evaluated the effect of border closure on the incidence rate of COVID-19 across nine African countries. An interrupted time series analysis was used to assess COVID-19 incidence rates in Egypt, Tunisia, Democratic Republic of the Congo (DRC), Ethiopia, Kenya, Ghana, Nigeria, Senegal and South Africa (SA). Data were collected between 14 February and 19 July 2020 from online data repositories. The linear trend and magnitude of change were evaluated using the itsa function with ordinary least-squares regression in Stata with a 7-d deferred interruption point, which allows a period of diffusion post-border closure. Overall, the countries recorded an increase in the incidence rate of COVID-19 after border closure. However, when compared with matched control groups, SA, Nigeria, Ghana, Egypt and Kenya showed a higher incidence rate trend. In contrast, Ethiopia, DRC and Tunisia showed a lower trend compared with their controls. The implementation of border closures within African countries had minimal effect on the incidence of COVID-19. The inclusion of other control measures such as enhanced testing capacity and improved surveillance activities will reveal the effectiveness of border closure measures.
Publisher: MDPI AG
Date: 14-03-2023
DOI: 10.3390/HEALTHCARE11060860
Abstract: Educational institutions play a significant role in the community spread of SARS-CoV-2 in Victoria. Despite a series of social restrictions and preventive measures in educational institutions implemented by the Victorian Government, confirmed cases among people under 20 years of age accounted for more than a quarter of the total infections in the state. In this study, we investigated the risk factors associated with COVID-19 infection within Victoria educational institutions using an incremental deep learning recurrent neural network-gated recurrent unit (RNN-GRU) model. The RNN-GRU model simulation was built based on three risk dimensions: (1) school-related risk factors, (2) student-related community risk factors, and (3) general population risk factors. Our data analysis showed that COVID-19 infection cases among people aged 10–19 years were higher than those aged 0–9 years in the Victorian region in 2020–2022. Within the three dimensions, a significant association was identified between school-initiated contact tracing (0.6110), vaccination policy for students and teachers (0.6100), testing policy (0.6109), and face covering (0.6071) and prevention of COVID-19 infection in educational settings. Furthermore, the study showed that different risk factors have varying degrees of effectiveness in preventing COVID-19 infection for the 0–9 and 10–19 age groups, such as state travel control (0.2743 vs. 0.3390), international travel control (0.2757 vs. 0.3357) and school closure (0.2738 vs. 0.3323), etc. More preventive support is suggested for the younger generation, especially for the 10–19 age group.
Publisher: Australian Government Department of Health
Date: 26-04-2022
Abstract: Effective control of coronavirus disease 2019 (COVID-19) has been challenging, in part due to significant asymptomatic and pre-symptomatic transmission of disease. Reducing the time between symptom onset and COVID-19 testing and isolation allows enhanced outbreak control. The purpose of this study is to describe the time taken by participants to present to general practitioner-led (GP) respiratory clinics for assessment following the development of symptoms, and to explore associations between demographic and geographic characteristics and the time to presentation. A total of 314,148 participants, who were assessed in GP respiratory clinics between 1 February and 31 August 2021, were included in the analysis. The median age of participants at presentation was 33 years (interquartile range, IQR: 15–49). The median time from development of symptoms to presentation for assessment at GP respiratory clinics was 2 days (IQR: 1–3). Participants were more likely to present within one day of symptom onset if they were aged between 15 and 64 years (43.4%), lived in urban areas (40.9%) or were nonIndigenous (40.2%). Participants in New South Wales and Victoria had twice the odds (OR 2.01 95% confidence interval (CI): 1.95, 2.08) of presenting at a GP respiratory clinic within one day of symptom onset in August 2021, when there was a COVID-19 outbreak in those states, than they did in March 2021, when there was no COVID-19 outbreak in Australia. The number of days from symptom onset to presentation at a GP respiratory clinic was strongly associated with the presence of a COVID-19 outbreak. Participant age, location of the clinic, and Indigenous status of participants were also associated with the time to presentation. This study highlights the importance of recognising COVID-19 as a potential cause of symptoms, as well as the importance of providing easily accessible, and culturally appropriate, testing facilities for the population.
Publisher: Wiley
Date: 04-06-2018
DOI: 10.1111/JPC.14079
Abstract: Despite increasing rates of emergency department (ED) utilisation, little is known about low-acuity presentations in children ≤5 years. The aims of the study were to estimate the proportion and cost of low-acuity presentations in children ≤5 years presenting to the ED and to determine the relative effect of socio-economic status (SES) on paediatric low-acuity presentations at the ED. This is a retrospective observational study of children ≤5 years presenting to the Cairns Hospital ED over 4 years. A multivariate logistic regression model was used to assess the association between SES and low-acuity presentations. Cost of low-acuity presentations was calculated based on triage score and admission status, using costs obtained from the National Hospital Cost Data Collection. A total of 23 086 children were included in the study, of whom 56.7% were male (mean age = 1.85 ± 1.63 years). Approximately one-third of ED visits were low-acuity presentations (32.4%), and low-acuity presentations increased progressively with SES. In multivariate analysis, children from families with very high SES were twice as likely to have a low-acuity presentation (odds ratio 2.17 95% confidence interval, 1.66-2.85). Low-acuity ED presentations cost the health-care system in excess of A$895 000-A$1 110 000 per year. These findings demonstrate that a significant proportion of paediatric ED visits are of low acuity and that these visits yield a substantial cost to the health system. Further research is required regarding care givers' rationale and potentially other reasons underlying these low-acuity ED presentations.
Publisher: Wiley
Date: 20-12-2019
DOI: 10.1111/JPC.14352
Abstract: There has been an increase in the use of the emergency department (ED) for non-urgent presentations. The aim of this systematic review was to identify the proportion, criteria and predictors of non-urgent ED presentations in paediatric populations. A search of multiple databases was conducted for articles published from inception of the databases to 20 August 2018, which reported the proportion, criteria and predictors of non-urgent ED presentation in paediatric populations. Thirty-one articles met the inclusion criteria. The mean proportion of non-urgent paediatric ED presentations was 41.06 ± 15.16%. There appears to be a weak association between predisposing, enabling and needs factors and non-urgent ED use in paediatric populations. The findings of this review suggest that non-urgent ED use in paediatric populations is high. However, non-urgent ED use and the reasons for the visits in paediatric populations remain understudied.
Publisher: Wiley
Date: 2019
DOI: 10.14814/PHY2.13960
Publisher: Frontiers Media SA
Date: 09-07-2021
DOI: 10.3389/FPSYG.2021.576193
Abstract: This study employed interpretivist, grounded theory method and utilized semi-structured interviews to explore how 31 African migrant high school and university students from eight sub-Saharan African representative countries and currently residing in Townsville, Australia, perceived the roles of their parents in their career development. The study findings revealed that the support (financial, social and emotional) and encouragement (sacrificial love, role modeling and guidance) received from parents underpinned the youths’ perceptions of their parents as influential in their career trajectories. Though participants acknowledged their indebtedness to parents and the system that nurtured them, they faced a dilemma conforming to parental preference or personal conviction, which presented “a fork in the career decision-making road.” Study findings indicate that participants’ reactions and strategies for negotiating parental approval differ based on entry status and gender. Most participants, particularly those with professional entry status, conformed to their parents’ career choice for fear of failure, while a few who followed their personal interests negotiated parental approval through dialogue and educating parents. Male participants with humanitarian entry status opposed their parents’ career preferences and followed their own personal interests. Taken together, all participants had strong desire to obtain parental approval and whether sought early or later, the main focus for all participants was prioritizing family needs and obligations. The practical implications of these findings for all stakeholders are discussed.
Publisher: Wiley
Date: 04-03-2019
DOI: 10.1111/IJLH.12994
Abstract: The standard screening method for alpha thalassaemia is the examination of HbH preparation. It is labour intensive and poorly standardized. The development of a rapid strip immunochromatographic test (ICT) for haemoglobin Barts offers a fast, user friendly and cost-effective alternative screening tool. A total of 180 subjects with results of the thalassaemia screen and genetic testing were included. Results of the ICT and HbH preparation were correlated with genetic results to determine the performance characteristics of the tests and the effect of mean s le age on results. Of 180 subjects, 111 carried alpha thalassaemia mutations and 69 participants had normal genetic results. The ICT had a sensitivity of 63.06% for all alpha gene mutations and 100% for both heterozygous alpha The ICT is a sensitive screening method for significant alpha mutations and detects the majority of homozygous alpha
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 2022
End Date: 2023
Funder: Emergency Medicine Foundation
View Funded ActivityStart Date: 2022
End Date: 2023
Funder: Department of Foreign Affairs and Trade, Australian Government
View Funded Activity