ORCID Profile
0000-0001-8493-0974
Current Organisations
University of Queensland
,
Royal Australasian College of Physicians
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Publisher: MDPI AG
Date: 02-12-2020
Abstract: We undertook a scoping study to map the relevant evidence, summarise the findings, and to help identify gaps in the knowledge base on the relationship between land use/land-use change and human health in Australia. Our systematic search of the scientific literature for relevant articles up to August 2020 identified 37 articles. All 37 articles meeting our inclusion criteria were published after 2003. Zoonotic or vector-borne disease constituted the most common health outcome type studied. Agriculture/grazing was the land use/land-use change type most frequently represented in the literature, followed by coal seam gas extraction and open cut coal mining. The relationship between land use/land use change and human health in Australia, is not conclusive from the existing evidence. This is because of (1) a lack of comprehensive coverage of the topic, (2) a lack of coverage of the geography, (3) a lack of coverage of study types, and (4) conflicting results in the research already undertaken. If we are to protect human health and the ecosystems which support life, more high-quality, specific, end-user driven research is needed to support land management decisions in Australia. Until the health effects of further land use change are better known and understood, caution ought to be practiced in land management and land conversion.
Publisher: SAGE Publications
Date: 12-04-2019
Abstract: Management of a cleft of the lip and/or palate (CL/P) involves a multidisciplinary team approach lasting from birth to potentially postskeletal maturity. This condition is complex, with both medical and psychosocial implications that may place in iduals with a cleft at higher risk of developing psychosocial problems. A self-administered questionnaire was completed by a s le from the Western Australian cleft population comprising 3 age groups: child (n = 100), adolescent (n = 101), and adult (n = 158). Public speaking, being photographed, special relationships, and participation in school were identified as the areas most impacted by having a cleft. Hearing and speech were reported to have a higher importance than facial and dental appearance. Participants rated support given to them by their parents as the most important, with high ratings for treatment providers. For teasing, the impact of cleft was significantly higher among participants with cleft lip and palate for both the adolescent and adult age groups. There was little significant difference by gender across the variables, which suggests that males are just as likely to require support as females. The impact of a cleft across multiple psychosocial domains needs to be recognized and addressed as part of craniofacial team care across age groups.
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 02-2015
Publisher: Cambridge University Press (CUP)
Date: 18-08-2020
DOI: 10.1017/WET.2020.85
Abstract: Glyphosate is an important component of herbicide programs in orchard crops in California. It can be applied alone or in tank-mix combinations under the crop rows or to the entire field and often is used multiple times each year. There has been speculation about the potential impacts of repeated use of glyphosate in perennial crop systems, because of uptake from shallow root systems or indirectly because of effects on nutrient availability in soil. To address these concerns, research was conducted from 2013 to 2020 on key orchard crops to evaluate tree response to glyphosate regimens. Almond, cherry, and prune were evaluated in separate experiments. In each crop, the experimental design was a factorial arrangement of two soil types, four glyphosate rates (0, 1.1, 2.2, and 4.4 kg ae ha −1 , applied three times annually), and two post-glyphosate application irrigation treatments. In the first 2 yr of the study, there was no clear impact of the glyphosate regimens on shikimate accumulation or leaf chlorophyll content, which suggested no direct effect on the crop. In the seventh year of the study, after six consecutive years of glyphosate application to the orchard floors, there were no negative impacts of glyphosate application on leaf nutrient concentration or on cumulative trunk growth in any of the three orchard crops. Lack of a negative growth impact even at the highest treatment rate, which included 18 applications of glyphosate totaling nearly 80 kg ae ha −1 glyphosate over the course of the experiment suggest there is not likely a significant risk to tree health of judicious use of the herbicide in these production systems. Given the economic importance of orchard crops in California, and grower and industry concerns about pesticides generally and specifically about glyphosate, these findings are timely contributions to weed management concerns in perennial specialty crops.
Publisher: MDPI AG
Date: 31-03-2023
DOI: 10.3390/TROPICALMED8040211
Abstract: Introduction: During the first two years of the COVID-19 pandemic, Australia implemented a series of international and interstate border restrictions. The state of Queensland experienced limited COVID-19 transmission and relied on lockdowns to stem any emerging COVID-19 outbreaks. However, early detection of new outbreaks was difficult. In this paper, we describe the wastewater surveillance program for SARS-CoV-2 in Queensland, Australia, and report two case studies in which we aimed to assess the potential for this program to provide early warning of new community transmission of COVID-19. Both case studies involved clusters of localised transmission, one originating in a Brisbane suburb (Brisbane Inner West) in July–August 2021, and the other originating in Cairns, North Queensland in February–March 2021. Materials and Methods: Publicly available COVID-19 case data derived from the notifiable conditions (NoCs) registry from the Queensland Health data portal were cleaned and merged spatially with the wastewater surveillance data using statistical area 2 (SA2) codes. The positive predictive value and negative predictive value of wastewater detection for predicting the presence of COVID-19 reported cases were calculated for the two case study sites. Results: Early warnings for local transmission of SARS-CoV-2 through wastewater surveillance were noted in both the Brisbane Inner West cluster and the Cairns cluster. The positive predictive value of wastewater detection for the presence of notified cases of COVID-19 in Brisbane Inner West and Cairns were 71.4% and 50%, respectively. The negative predictive value for Brisbane Inner West and Cairns were 94.7% and 100%, respectively. Conclusions: Our findings highlight the utility of wastewater surveillance as an early warning tool in low COVID-19 transmission settings.
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/SH18166
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.ANAEROBE.2017.08.008
Abstract: Clostridium difficile infection (CDI) is primarily associated with hospitalised patients, however, community-associated CDI (CA-CDI) has increased in Australia. We aimed to investigate the epidemiology and outcomes of CA-CDI cases presenting to hospital emergency departments in Western Australia (WA). A retrospective case-control study of CA-CDI cases presenting at six emergency departments in WA from July 2013 to June 2014 was performed. Clinical signs, recent medication, hospitalisations and potential risk factors for CA-CDI were investigated for cases (n = 34) and unmatched controls (n = 62) who were infected with another gastrointestinal pathogen, including C ylobacter spp., Salmonella spp., Aeromonas spp., Shigella sonnei and Escherichia coli O157. Elevated white cell count (31.3% vs 8.2%, p < 0.01), female gender (67.6% vs 41.9%, p < 0.05), age ≥65 years (41.2% vs 21.0%, p < 0.05) and antimicrobial use in the previous month (41.2% vs 11.3%, p < 0.01) were significantly more frequent among cases compared to controls. After multivariable analysis, antibiotic use (odds ratio 8.49, 95% confidence interval 2.75-26.21) and age ≥65 years (3.03, 1.05-8.75) were significantly associated with CA-CDI. Ribotype (RT) 014/020 was most common (40.7%) among 27 C. difficile isolates followed by RTs 002 (14.8%), 001, 056 and 244 (all 7.4%). CA-CDI was associated with advanced age and recent antibiotic use compared to those infected with other gastrointestinal pathogens. RT 014 has also recently been found at high prevalence in public lawn spaces, and previously RT 014 strains from humans and pigs in Australia were closely genetically related, suggesting CA-CDI may be linked with these community reservoirs.
Publisher: Springer Science and Business Media LLC
Date: 17-07-2017
Publisher: Frontiers Media SA
Date: 13-06-2018
Publisher: SAGE Publications
Date: 24-02-2022
DOI: 10.1177/00220426211073911
Abstract: The trajectories of people attempting to reduce harmful meth hetamine use are frequently understood within a binary framework of transitioning between states of health and disease. This framework can often be reinforced by service interactions informed by these dominant narratives of recovery and addiction. In this paper, we draw on a critical interactionist analysis of ethnographic fieldwork conducted with people who use meth hetamine, to examine how their experiences could undermine this binary, observing the ways participants experienced growth, change, and progress, without necessarily maintaining abstinence. These findings support a more erse understanding of drug use trajectories, and we explore the concept of ‘living with drug use’, similar to how people live with other chronic conditions by finding ‘health in illness’. Participant experiences are also interpreted within the context of counter public health, arguing for the recognition and integration of values and goals which are ergent from the implicit aims of public health practice.
Publisher: BMJ
Date: 12-2018
DOI: 10.1136/BMJOPEN-2018-026630
Abstract: The C ySource project aims to identify risk factors for human C ylobacter infection in Australia. We will investigate locally relevant risk factors and those significant in international studies in a case–control study. Case isolates and contemporaneous isolates from food and animal sources will be sequenced to conduct source attribution modelling, and findings will be combined with the case–control study in a source-assigned analysis. The case–control study will include 1200 participants (600 cases and 600 controls) across three regions in Australia. Cases will be recruited from c ylobacteriosis notifications to health departments. Only those with a pure and viable C ylobacter isolate will be eligible for selection to allow for whole genome sequencing of isolates. Controls will be recruited from notified cases of influenza, frequency matched by sex, age group and geographical area of residence. All participants will be interviewed by trained telephone interviewers using a piloted questionnaire. We will collect C ylobacter isolates from retail meats and companion animals (specifically dogs), and all food, animal and human isolates will undergo whole genome sequencing. We will use sequence data to estimate the proportion of human infections that can be attributed to animal and food reservoirs (source attribution modelling), and to identify spatial clusters and temporal trends. Source-assigned analysis of the case–control study data will also be conducted where cases are grouped according to attributed sources. Human and animal ethics have been approved. Genomic data will be published in online archives accompanied by basic metadata. We anticipate several publications to come from this study.
Publisher: Cambridge University Press (CUP)
Date: 10-2000
DOI: 10.1086/501707
Abstract: To determine the comparative virulence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S aureus (MSSA) by consideration of predisposing factors and outcomes in patients infected with these organisms in the healthcare setting. Analysis of an historical cohort of 504 bacteremic patients (316 MSSA and 188 MRSA), examining factors associated with mortality. A 916-bed, university-affiliated, tertiary referral hospital. Risk factors for the development of MRSA include male gender, admission due to trauma, immunosuppression, presence of a central vascular line or an indwelling urinary catheter, and a past history of MRSA infection. Overall mortality was 22%. Death due to bacteremia was significantly greater in the MRSA group (risk ratio, 1.68 P .05), although these patients were not found to be more likely to die due to underlying disease during treatment of bacteremia. In those patients who recovered from bacteremia, no significant differences for the outcome of death could be determined between the MRSA and MSSA groups. There is a general consensus in the published literature that MRSA bacteremia is more likely to be associated with death, and we confirm this conclusion. However, in contrast to other studies, our MRSA cohort does not appear to be more at risk of death due to underlying disease during treatment for bacteremia. Similarly, the general consensus that MRSA patients have an increased overall mortality was not confirmed in our study. Differences in comorbidities of patients may provide some explanation of these conflicting results, while an alternate explanation is that MRSA strains are more virulent than MSSA in some centers. Perhaps the most plausible explanation is that treatment is provided earlier and in a more aggressive fashion in some centers, leading to an overall lower mortality rate in all staphylococcal bacteremias in these institutions.
Publisher: Elsevier BV
Date: 04-1998
DOI: 10.1016/S0140-6736(05)79385-5
Abstract: Today, one of the most crucial environmental problems is energy consumption. Excessive energy consumption has led to environmental damage such as climate change. Energy and climate change are interrelated. Energy literacy is one of the tools to achieve energy sustainability. Energy literacy can reduce energy consumption by citizens. This research aimed to a sociological analysis of energy literacy among the citizens of Mashhad. The research method is a survey in which 384 citizens of Mashhad were selected based on a multi-stage cluster s ling method and data gathered by a questionnaire. The results showed that knowledge of energy consumption and attitude and effectiveness towards energy have a significant and direct relationship with energy consumption behavior. The attitude and effectiveness towards energy have a significant and direct relationship with the knowledge of energy consumption. Estimating the goodness of fit indices and the structural and measurement coefficients confirmed the model. Teaching proper behavioral patterns in energy consumption at the family and school can effectively improve citizens' energy literacy.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 06-2000
Abstract: Two human deaths caused by Australian bat lyssavirus (ABL) infection have been reported since 1996. Information was obtained from 205 persons (mostly adults from south Brisbane and the South Coast of Queensland), who reported potential ABL exposure to the Brisbane Southside Public Health Unit from November 1,1996, to January 31, 1999. Volunteer animal handlers accounted for 39% of potential exposures, their family members for 12%, professional animal handlers for 14%, community members who intentionally handled bats for 31%, and community members with contacts initiated by bats for 4%. The prevalence of Lyssavirus detected by fluorescent antibody test in 366 sick, injured, or orphaned bats from the area was 6%. Sequelae of exposure, including the requirement for expensive postexposure prophylaxis, may be reduced by educating bat handlers and the public of the risks involved in handling Australian bats.
Publisher: Elsevier BV
Date: 12-1993
DOI: 10.1016/0166-0934(93)90115-8
Abstract: Proteins derived from the E6, E7 and L1 ORFs of HPV16 and the E7 ORF of HPV18 were produced in insect cells using a baculovirus expression system. HPV ORFs were inserted into baculovirus transfer vectors pAcYM1 or pVL1393/2, and recombinant baculoviruses isolated using a combination of limiting dilution and plaque assay. Using HPV-specific antisera and monoclonal antibodies HPV proteins were identified in lysates of Spodoptera frugiperda (Sf-21) cells infected with HPV-recombinant baculovirus. Immunoreactive HPV16 E7 protein produced in Sf-21 cells had an apparent M(r) of 19 kDa, larger than that predicted from the amino acid sequence, and similar to that of native HPV16 E7 protein in HeLa and CaSki cells. The apparent M(r) of recombinant HPV18-E7, HPV16-L1 and HPV16-E6 proteins was equivalent to the M(r) values predicted from the amino acid sequence. Thermostability studies revealed that the half-life of HPV16-E7 protein in Sf-21 cell lysate was approx. 20 h at 4 degrees C, 2 h at 22 degrees C, and less than 30 min at 37 degrees C. HPV16 L1, HPV16 E7 and HPV18 E7 proteins were predominantly localised in the nucleus of recombinant baculovirus-infected Sf-21 cells, whereas recombinant HPV 16 E6 protein was localised in both the cytoplasm and nucleus of infected insect cells. Northern blot analysis of RNA derived from insect cells infected with vAc16E6E7, a recombinant baculovirus containing both HPV16 E6 and E7 ORF's, revealed the presence of only E6 ORF transcripts, suggesting that the splicing of RNA products derived from the E6 and E7 ORF's, as observed in cervical cancer-derived cell lines, is not performed in insect cells. Baculovirus-derived HPV proteins have similar biological properties to the native proteins and should be suitable for studies on the immunology of HPV.
Publisher: Public Library of Science (PLoS)
Date: 23-01-2014
Publisher: Elsevier BV
Date: 1999
DOI: 10.1016/S0163-4453(99)90023-3
Abstract: Determination of potential infectivity of a new paramyxovirus equine morbillivirus (EMV) from horses to humans and humans to humans as a result of two outbreaks in Queensland which involved 23 horses and three humans. Seroepidemiological testing using neutralizing and immunofluorescing antibodies on people with variable levels of exposure to infected horses and humans. All serological testing on a total of 298 in idual contacts was negative. While the three human cases of EMV were probably infected as a result of very close contact with horses, these data suggest that infectivity from horses or humans is very low.
Publisher: Springer Science and Business Media LLC
Date: 25-04-2022
DOI: 10.1186/S12889-022-13088-X
Abstract: In Australia in 2017, 89% of 15-year-old females and 86% of 15-year-old males had received at least one dose of the HPV vaccine. However, considerable variation in HPV vaccination initiation (dose one) across schools remains. It is important to understand the school-level characteristics most strongly associated with low initiation and their contribution to the overall between-school variation. A population-based ecological analysis was conducted using school-level data for 2016 on all adolescent students eligible for HPV vaccination in three Australian jurisdictions. We conducted logistic regression to determine school-level factors associated with lower HPV vaccination initiation ( 75% dose 1 uptake) and estimated the population attributable risk (PAR) and the proportion of schools with the factor (school-level prevalence). The factors most strongly associated with lower initiation, and their prevalence were small schools (OR = 9.3, 95%CI = 6.1–14.1 33% of schools), special education schools (OR = 5.6,95%CI = 3.7–8.5 8% of schools), higher Indigenous enrolments (OR = 2.7,95% CI:1.9–3.7 31% of schools), lower attendance rates (OR = 2.6,95%CI = 1.7–3.7 35% of schools), remote location (OR = 2.6,95%CI = 1.6–4.3 6% of schools,) and lower socioeconomic area (OR = 1.8,95% CI = 1.3–2.5 33% of schools). The highest PARs were small schools (PAR = 79%, 95%CI:76–82), higher Indigenous enrolments (PAR = 38%, 95%CI: 31–44) and lower attendance rate (PAR = 37%, 95%CI: 29–46). This analysis suggests that initiatives to support schools that are smaller, with a higher proportion of Indigenous adolescents and lower attendance rates may contribute most to reducing the variation of HPV vaccination uptake observed at a school-level in these jurisdictions. Estimating population-level coverage at the school-level is useful to guide policy and prioritise resourcing to support school-based vaccination programs.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Informa UK Limited
Date: 02-12-2018
DOI: 10.1080/15459624.2018.1521973
Abstract: Agricultural operations routinely expose farm workers to high levels of soil dust and other airborne particulate matter that have been linked to adverse health outcomes. The main objective of this study was to investigate exposure to agricultural dust during seeding operations of Western Australian farm workers. Twenty-one wheat-belt farms were recruited to participate in the study. Data were collected over the 6-week seeding period of April-June 2014. Each farm was visited once, and workers were asked to complete a workplace survey that asked questions related to minimizing exposure to agricultural dusts and occupational health and safety issues on their farm. Farmers were also asked to simultaneously participate in monitoring of personal exposure to inhalable or respirable dust along with real-time monitoring for particulate air pollution in their tractor cabin. S ling was undertaken for 4 hr. The results showed that, on average, Western Australian farmers were exposed to personal respirable dust concentrations above the Australian Institute of Occupational Hygienists recommended guideline values, with some farmers being exposed to concentrations up to seven times higher than the value for respirable dusts. In comparison, in-cabin dust concentrations were lower, although some in idual tractors recorded intermittently higher levels, which might be attributed to the type of work activity or process being undertaken. Remaining in tractor cabins with closed doors and windows with properly maintained seals might minimize the infiltration of hazardous dusts and may provide some protection from dust exposures. Future research should focus on educating and providing farm owners and workers with more information on adopting work processes and procedures related to minimizing harmful exposures to agricultural dusts.
Publisher: Informa UK Limited
Date: 17-02-2015
Publisher: Informa UK Limited
Date: 03-08-2021
Publisher: Oxford University Press (OUP)
Date: 20-12-2019
Abstract: Noise presents an ongoing occupational health and safety issue, which despite numerous studies still presents a significant risk in agriculture with high exposures prevalent. In this study, we measured noise exposures associated with significant activities on 42 mixed grain and livestock farms in Western Australia. Employing a mixture of personal noise measurements using dosimeters, noise measurements using sound level meters, and a validated survey, we identified that 32% of farm workers were exposed to noise levels above the LAeq,8h 85 dB(A) limit, before considering extended shifts. We also noted that extended shift lengths, of up to 16 h in some cases, were possible. In addition, we found that 37% of workers were exposed to noise peak of 140 dB(C) or greater. It was further noted that hearing protection is not typically worn for the duration of an activity and is only for a small number of tasks. However we did find some evidence that farmers had begun to implement some form of noise management practice, usually in the form of buying quieter equipment or separating noisy tasks from quiet tasks. Improved education for farmer and farm workers in terms of the risks posed by noise, identifying noisy tasks, is recommended, as well as a programme to encourage better and consistent use of hearing protection.
Publisher: Elsevier BV
Date: 05-1992
DOI: 10.1016/0166-0934(92)90039-G
Abstract: ELISA capture assays were established for the E7 transforming proteins of HPV16 and HPV18, based on a range of previously characterised polyclonal and monoclonal antibodies. No cross-reactivity was observed in the ELISAs between HPV18 E7 and HPV16 E7. Immunoreactive E7 protein (iE7) was measured in a series of HPV-transformed cell lines, and ranged from 0.6 to 17.7 ng iE7/mg cell protein. iE7 was labile at 22 degrees C (t1/2 = 37 min) but relatively more stable at 4 degrees C (t1/2 = 210 min). HPV16 E7 protein at concentrations from 0.10 to 0.69 ng iE7/mg cell protein was detected in 5 of 13 smears from women with abnormal cervical cytology. Assay of E7 protein may play a role in the detection of HPV-induced cervical lesions with malignant potential.
Publisher: AMPCo
Date: 2013
DOI: 10.5694/MJA12.10528
Publisher: SAGE Publications
Date: 05-04-2018
Abstract: People with a cleft of the lip and/or palate (CL/P) differ from their peers due to their facial appearance, hearing and speech difficulties, and the significant time spent attending appointments and recovering from surgical interventions. These differences may impact life outcomes including occupation, income, education, relationships, psychosocial health issues, and lifestyle choices. A self-administered questionnaire was posted to 338 former and current patients of the Cleft Lip and Palate Unit of Princess Margaret Hospital (PMH), Perth, Western Australia. Completed questionnaires were returned by 158 former and current patients. In comparison to the Australian Bureau of Statistics, study participants attained equivalent highest education levels, full-time annual income levels, occupational categories, employment rates, and home ownership levels. They did not marry later and demonstrated positive health–related lifestyle behaviors. However independent living was significantly delayed, and the number of romantic relationships, marriages, and children was lower, with separation/ orce rates also being lower. A key finding was that 78% of participants self-reported that they experienced at least 1 psychosocial health issue and more than half experienced anxiety and/or depression. When comparing the sociological outcomes for the study participants, the psychosocial outcomes were the areas of most concern. Further investigation is required to determine the causes for the high self-reported rates of anxiety and/or depression found in this study.
Publisher: Frontiers Media SA
Date: 09-02-2023
DOI: 10.3389/FPUBH.2023.1010335
Abstract: This review aimed to identify factors in the policymaking environment that influence a Health in all Policies approach in local government, how these vary across different municipal contexts, and the extent that theories of the policy process are applied. A scoping review was conducted to include sources published in English, between 2001 and 2021 in three databases, and assessed for inclusion by two blind reviewers. Sixty-four sources were included. Sixteen factors of the policy process were identified, expanding on previously reported literature to include understanding and framing of health, use of evidence, policy priority, and influence of political ideology. Eleven sources applied or referred to theories of the policy process and few reported findings based on different local government contexts. There are a range of factors influencing a Health in All Policies approach in local government, although a limited understanding of how these differ across contexts. A theory-informed lens contributed to identifying a breadth of factors, although lack of explicit application of theories of the policy process in studies makes it difficult to ascertain meaningful synthesis of the interconnectedness of these factors.
Publisher: Springer Science and Business Media LLC
Date: 20-01-2022
DOI: 10.1007/S00484-022-02243-Z
Abstract: The objective of this study is to determine the impacts of low-intensity heat on human health in regions with hot, humid summers. Current literature has highlighted an increase in mortality and morbidity rates during significant heat events. While the impacts on high-intensity events are established, the impacts on low-intensity events, particularly in regions with hot, humid summers, are less clear. A scoping review was conducted searching three databases (PubMed, EMBASE, Web of Science) using key terms based on the inclusion criteria. We included papers that investigated the direct human health impacts of low-intensity heat events (single day or heatwaves) in regions with hot, humid summers in middle- and high-income countries. We excluded papers written in languages other than English. Of the 600 publications identified, 33 met the inclusion criteria. Findings suggest that low-intensity heatwaves can increase all-cause non-accidental, cardiovascular-, respiratory- and diabetes-related mortality, in regions experiencing hot, humid summers. Impacts of low-intensity heatwaves on morbidity are less clear, with research predominantly focusing on hospitalisation rates with a range of outcomes. Few studies investigating the impact of low-intensity heat events on emergency department presentations and ambulance dispatches were found. However, the data from a limited number of studies suggest that both of these outcome measures increase during low-intensity heat events. Low-intensity heat events may increase mortality. There is insufficient evidence of a causal effect of low-intensity heat events on increasing morbidity for a firm conclusion. Further research on the impact of low-intensity heat on morbidity and mortality using consistent parameters is warranted.
Publisher: Wiley
Date: 25-08-2021
DOI: 10.1002/HPM.3061
Publisher: Springer Science and Business Media LLC
Date: 30-06-2022
DOI: 10.1186/S12879-022-07553-6
Abstract: We aimed to identify risk factors for sporadic c ylobacteriosis in Australia, and to compare these for C ylobacter jejuni and C ylobacter coli infections. In a multi-jurisdictional case–control study, we recruited culture-confirmed cases of c ylobacteriosis reported to state and territory health departments from February 2018 through October 2019. We recruited controls from notified influenza cases in the previous 12 months that were frequency matched to cases by age group, sex, and location. C ylobacter isolates were confirmed to species level by public health laboratories using molecular methods. We conducted backward stepwise multivariable logistic regression to identify significant risk factors. We recruited 571 cases of c ylobacteriosis (422 C. jejuni and 84 C. coli ) and 586 controls. Important risk factors for c ylobacteriosis included eating undercooked chicken (adjusted odds ratio [aOR] 70, 95% CI 13–1296) or cooked chicken (aOR 1.7, 95% CI 1.1–2.8), owning a pet dog aged 6 months (aOR 6.4, 95% CI 3.4–12), and the regular use of proton-pump inhibitors in the 4 weeks prior to illness (aOR 2.8, 95% CI 1.9–4.3). Risk factors remained similar when analysed specifically for C. jejuni infection . Unique risks for C. coli infection included eating chicken pâté (aOR 6.1, 95% CI 1.5–25) and delicatessen meats (aOR 1.8, 95% CI 1.0–3.3). Eating any chicken carried a high population attributable fraction for c ylobacteriosis of 42% (95% CI 13–68), while the attributable fraction for proton-pump inhibitors was 13% (95% CI 8.3–18) and owning a pet dog aged 6 months was 9.6% (95% CI 6.5–13). The population attributable fractions for these variables were similar when analysed by c ylobacter species. Eating delicatessen meats was attributed to 31% (95% CI 0.0–54) of cases for C. coli and eating chicken pâté was attributed to 6.0% (95% CI 0.0–11). The main risk factor for c ylobacteriosis in Australia is consumption of chicken meat. However, contact with young pet dogs may also be an important source of infection. Proton-pump inhibitors are likely to increase vulnerability to infection.
Publisher: Wiley
Date: 09-2020
DOI: 10.1111/IMJ.14648
Abstract: The recent implementation of a scheme to provide universal access to direct-acting antiviral (DAA) medication to treat hepatitis C virus (HCV) places Australia in a unique position to reach global HCV elimination goals. To achieve this, increasing the uptake and success of DAA treatment in general practice settings is essential. To explore current enablers and residual barriers to HCV treatment in general practice settings in the post-interferon era from both general practitioner (GP) and patient perspectives. Semi-structured interviews with 11 GP and 27 patients were conducted to draw out both challenges and facilitators particularly relevant to DAA uptake and treatment journeys. Key enablers for successful treatment identified by this study included peer-led GP support and skill development, utilisation of electronic reminder systems, trusting relationships with patients and engaging with patients' social and family networks. Barriers related to accessible testing facilities and knowledge and confidence with DAA treatment continue to limit GP-led treatment. Despite a universal access scheme, barriers to DAA prescription in general practice settings remain. These include access to fibrosis testing and GP confidence in DAA prescription. Strengthening peer-led GP skill development and utilisation of electronic reminder systems may help GP prioritise HCV treatment. Access to fibrosis testing and pathology services with no out-of-pocket costs to patients, particularly in outer-metropolitan areas, should be urgently addressed.
Publisher: AMPCo
Date: 10-2013
DOI: 10.5694/MJA13.10969
Publisher: American Society of Tropical Medicine and Hygiene
Date: 03-10-2018
Publisher: Informa UK Limited
Date: 02-01-2021
Publisher: Elsevier BV
Date: 10-1996
DOI: 10.1111/J.1467-842X.1996.TB01634.X
Abstract: Laboratories must notify health departments of cases of hepatitis C in Queensland, the Northern Territory (NT) and the Australian Capital Territory (ACT). Our objectives were to estimate the minimum proportion of notified cases of hepatitis C that were recent infections and to determine the risk factors for infection of the notified cases. We conducted a retrospective investigation of all eligible notifications received at the health departments in Queensland, the Northern Territory and the Australian Capital Territory. Of the 963 notifications about which information was received, 16 per cent were repeat notifications. These were excluded from further analysis. In Queensland, 7 per cent, and in both NT and ACT, 3 per cent of the notifications were considered to be recent infections. The most common risk factor reported for both recent and all other hepatitis C cases was a history of injecting drug use, although the proportion of cases with that history was different in NT from ACT and Queensland. Cases were tested because of screening programs: for drugs and alcohol, in sexually transmitted diseases clinics and prison and because of clinical indications such as a risk factor, symptoms, or results of liver function tests. Another common reason for testing was a request from a patient. A significant proportion of recorded notifications was repeat notifications. Most notifications were of patients who had become infected more than 12 months ago and the most common risk factor was injecting drug use. There was not a high proportion of cases with unknown risk factors.
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.DRUGPO.2021.103427
Abstract: Despite its well documented risks and harms, meth hetamine use can also be experienced as a pleasurable, purposeful, and productive activity. Drug use discourse has historically deemphasised the pleasures of drug use, as they can contradict the expectations of neoliberalism that in iduals be moderate, rational consumers. The purpose of this study was to explore the experiences of people trying to reduce or control their meth hetamine use, utilising a critical interactionist approach to excavate the subjugated knowledge of meth hetamine-related pleasure, and construct an understanding of meth hetamine use that incorporated these positive experiences. Qualitative interviews and ethnographic observation were conducted over an eight-month period with a group of twelve people using meth hetamine and accessing recovery services. Transcripts and fieldnotes were analysed thematically with a critical interactionist lens. The pleasures of meth hetamine use were differentiated into pursuing the rush, exploring sociality, self-medication, and desiring productivity. The interwoven nature of these themes presents a multidimensional understanding of meth hetamine use resulting from a cascade of interacting causes and effects, rather than a linear product of in idual choice or structural forces. These findings also highlight the complex symbiotic relationship between pleasure, productivity, and risk for people using meth hetamine which can be traced to the broader cultural and economic context in which use occurs. Interventions and policies responding to harmful meth hetamine use must address the content and nature of the meth hetamine use cascade, acknowledging the erse needs meth hetamine can meet for contemporary neoliberal citizens, and the sometimes complex and sophisticated purposes for which people may utilise its effects.
Publisher: BMJ
Date: 10-2019
DOI: 10.1136/BMJOPEN-2019-032422
Abstract: Private pharmacies are widely established in most low/middle-income countries (LMICs) including Nepal, and are often considered as a patient’s first point of contact for seeking healthcare. The aim of this study was to investigate the pattern of antibiotic dispensing in private pharmacies through exit interviews with patients to review their medication information. Cross-sectional study. Data collection was carried out in 60 days at 33 randomly selected private pharmacies in the Rupandehi district of Nepal. Patients attending private pharmacies (n=1537). The pattern of antibiotic prescribing and dispensing was investigated using WHO’s core prescribing indicator, ‘ the percentage of patients prescribed an antibiotic’ . Frequency distributions were presented based on patients’ characteristics, sources of antibiotic, registration status of pharmacies and education of the pharmacist or drug retailer, and disease or condition. χ 2 tests and regression analysis were applied to explore factors associated with the pattern of antibiotic dispensing. Of patients attending private pharmacies, the proportion receiving at least one antibiotic (38.4%) was above the WHO recommended value (20.0%–26.8%). The most commonly dispensed antibiotics were cefixime (16.9%) and the third-generation cephalosporins (38.0%) class. High dispensing rates of antibiotics for selected conditions (eg, respiratory infections, diarrhoeal cases) appeared contrary to international recommendations. The percentage of antibiotic dispensed was highest for patients who obtained their medicines from unlicensed pharmacies (59.1%). Young people were more likely to receive antibiotics than other age groups. The antibiotic dispensing pattern from private pharmacies in Nepal was high compared with WHO guidelines, suggesting initiatives to reduce inappropriate use of antibiotics should be implemented. The findings of this study may be generalisable to other LMICs in order to assist in developing policies and guidelines to promote more appropriate dispensing and prescribing practices of antibiotics and limit the spread of antibiotic resistance.
Publisher: Wiley
Date: 09-1998
DOI: 10.1046/J.1537-2995.1998.38998409001.X
Abstract: The epidemiology and disease association for the GB virus type C (GBV-C) or hepatitis G virus (HGV) are poorly understood. This study describes the exposure rates to GBV-C/HGV in erse Australian population groups by testing for current infection and evidence of past infection with a reverse transcriptase polymerase chain reaction and an anti-E2 enzyme-linked immunosorbent assay, respectively. Subjects included volunteer blood donors, hepatitis C antibody (anti-HCV)-positive donors, children, hemodialysis patients, pregnant women attending a prenatal clinic, injecting drug users (IVDUs), and adult hemophiliacs. Combined GBV-C RNA and E2 antibody prevalence was 6.5 percent (6/93) in children, 13.3 percent (75/565) in blood donors, 14 percent (14/99) in pregnant women, 22.5 percent (18/80) in hemodialysis patients, 80 percent (56/70) in anti-HCV-positive donors, 88.6 percent (31/35) in IVDUs, and 85.7 percent (54/63) in adult hemophiliacs. Children had the lowest antibody rate, 1.1 percent, whereas the rate was 10.8 percent for blood donors and rose to 45.7 percent for IVDUs, 57.1 percent for anti-HCV-positive donors, and 74.6 percent for hemophiliacs. In contrast, current infection rates were comparable for children, blood donors, and pregnant women (5.4, 2.6, and 6%, respectively), rising to 11.1 percent for hemophiliacs, 24.3 percent for anti-HCV-positive donors, and 48.6 percent for IVDUs. Ten of 12 blood donors had persistent viremia, while 2 had recent infections, 1 with apparent resolution. Exposure to GBV-C can commence at an early age, although ongoing exposure may also occur among adults with no apparent risk factors. GBV-C RNA positivity was not associated with abnormal plasma alanine aminotransferase levels among blood donors.
Publisher: Elsevier BV
Date: 07-2020
Publisher: BMJ
Date: 27-03-2015
Publisher: Elsevier BV
Date: 02-2012
Publisher: Microbiology Society
Date: 07-1994
DOI: 10.1099/0022-1317-75-7-1647
Abstract: We used a capture ELISA to quantify the E7 protein of human papillomavirus type 18 (HPV-18). In HeLa cells, which express low levels of immunoreactive E7 protein (iE7), iE7 had a mean half-life of 13.5 min. In HPV-18 E7 recombinant baculovirus (E7rec BV)-infected Sf21 cells, which express higher levels of E7, the half-life of iE7 was much longer (90 min and > 24 h, with two different E7rec BVs). For two transformed human cervical cell lines expressing HPV-18 E7, exposure of the cells to hydrocortisone resulted in a twofold increase in steady-state levels of the E7 protein: no similar effect was observed with progesterone, oestrogen or testosterone. The half-life of iE7 was unaltered by hydrocortisone or progesterone exposure. An immunoassay which distinguished Ser33-phosphorylated E7 from E7 not phosphorylated at this residue (Ser33dephospho-E7), showed that in HeLa and Sf21 cells the majority of E7 was phosphorylated: the half-life of both species of E7 was similar in HeLa cells, but the half-life of Ser33dephospho-E7 was much shorter (90 min) in Sf21 cells than that of Ser33phospho-E7 (> 24 h). A HeLa-fibroblast fusion cell line with tumorigenic potential (CGL-1) had a similar ratio of dephospho-E7 to total E7 (0.06), as a similar fusion cell line (CGL-4) with no tumorigenic potential (0.03). We conclude that E7 is a labile phosphoprotein, and that the expression and steady-state level of the E7 protein in eukaryotic cells may be influenced by the hormonal environment of the cells.
Publisher: Journal of Infection in Developing Countries
Date: 31-01-2020
DOI: 10.3855/JIDC.11817
Abstract: Introduction: Inappropriate use of antibiotics is recognised as a leading cause of antibiotic resistance. Little is known about antibiotic prescribing practices at public health facilities in low- and middle-income countries. We examined patterns of antibiotic prescribing in public health facilities in Nepal and explored factors influencing these practices. Methodology: A cross-sectional study of antibiotic prescribing in public health facilities was conducted in the Rupandehi district of Nepal. Six public health facilities were selected based on WHO guidelines, and data were extracted from administrative records for 6,860 patient encounters. Patterns of antibiotic prescribing were investigated using descriptive statistics. Chi-squared tests and logistic regressions were applied to explore factors associated with antibiotic prescribing. Results: Of patients attending public health facilities, the proportion prescribed at least one antibiotic (44.7%) was approximately twice the WHO recommended value (20.0 to 26.8%). The antibiotic prescribing rate for hospital inpatients (64.6%) was higher than for other facilities, with the prescribing rate also high in primary health care centres (50.4%) and health posts (52.2%). The most frequently (29.9%) prescribed antibiotic classes were third-generation cephalosporins. Females (p = 0.005) and younger (p 0.001) patients were more likely to be prescribed antibiotics. High prescribing rates of antibiotics for selected diseases appeared contrary to international recommendations. Conclusion: Antibiotic prescribing in public health facilities was high compared with WHO guidelines, suggesting the need for strategies to reduce misuse of antibiotics. This study provides useful information to assist in formulating policies and guidelines to promote more appropriate use of antibiotics in Nepal.
Publisher: Elsevier BV
Date: 06-2014
Publisher: Springer Science and Business Media LLC
Date: 29-04-2022
DOI: 10.1186/S13756-022-01102-1
Abstract: Some evidence suggests that knowledge and attitudes towards rational antibiotic use influences dispensing practice in community drug retail outlets. However, there is limited evidence in resource limited countries, including Ethiopia. We aimed to assess the knowledge and attitudes surrounding antibiotic use or supply and antibiotic resistance, and the non-prescribed antibiotic dispensing practices in community drug retail outlets in non-urban Ethiopia. We conducted a cross-sectional survey of community drug retail outlet staff in the Amhara region, Ethiopia with a focus on non-urban towns. An expert validated self-administered questionnaire was used. Following exploratory factor analysis and best items selection, we summarised our findings and assessed factors associated with non-prescribed antibiotic dispensing. The data were analysed using Stata Statistical Software version 17. P -values 0.05 were considered significant. A total of 276 participants from 270 drug outlets completed the questionnaire. The participants median age was 30 (Interquartile range (IQR) = 25–35) years and 79.7% were pharmacy assistants. The majority demonstrated good levels of knowledge about antibiotic use or supply and antibiotic resistance (77.9% and 76% of the participants responded correctly to more than half of the items, respectively). We identified four attitude domains: the role of antibiotics in recovering from diseases regardless of their cause (median score = 2 (IQR = 2–4), beliefs inconsistent with good practice) professional competency to supply non-prescribed antibiotics, and the non-prescribed antibiotics supply (median score for each domain = 4 (IQR = 4–5), attitudes consistent with good practice) and positive attitudes towards actions to prevent antibiotic resistance and promote appropriate antibiotic use (median score = 4 (IQR = 4–5). Fifty eight percent of the participants reported that they had dispensed antibiotics without a prescription. Participants who did not perceive that they were competent to supply non-prescribed antibiotics (adjusted odds ratio = 0.86, 95% confidence interval = 0.78–0.93) were less likely to report non-prescribed antibiotics dispensing. While most of the participants had appropriate knowledge about and attitudes to antibiotic use and antibiotic resistance, basic knowledge and attitude gaps remain. Despite Ethiopia’s regulatory restrictions, the non-prescribed antibiotic provision continues to be a common practice. Our study highlights the need for multifaceted interventions that may include a strict regulatory system, staff training and public education.
Publisher: Elsevier BV
Date: 03-2018
Publisher: Elsevier BV
Date: 11-2018
Publisher: Microbiology Society
Date: 06-1990
DOI: 10.1099/0022-1317-71-6-1347
Abstract: Human papillomavirus (HPV) type 16 is implicated in the aetiology of anogenital dysplasia which may progress to malignancy. HPV-16 DNA is actively transcribed in cervical carcinomas, the most abundant transcripts being from the E6 and E7 early open reading frames. The E7 protein has been shown to have transforming activity in vitro. In this report we define four immunodominant B epitopes within the protein corresponding to the E7 gene, using a panel of murine monoclonal antibodies. Three epitopes are linear and lie within the N-terminal region of the molecule, and are unique to the HPV-16 E7 protein. One epitope is non-linear and presumed to be conformational. At least three of the four epitopes of the E7 protein are detectable by immunoprecipitation from an HPV-16-infected cervical carcinoma cell line. The demonstrated immunogenicity of the E7 protein allows us to deduce that this molecule may be a potential candidate for incorporation in a vaccine against cervical cancer.
Publisher: SAGE Publications
Date: 14-12-2018
Abstract: To determine if patients with cleft lip and/or palate (CL/P) from a Western Australian (WA) cohort were more dissatisfied with their body esteem than a normative non-cleft cohort, and identify demographic variables that may have significant associations with body esteem. Questionnaire study using the Body-Esteem Scale (BES) and Cleft Research Questionnaire (CRQ). Self-selected participants from a Western Australian CL/P population across 3 age groups (n=359). The BES is comprised of 3 factors: BE-Appearance, BE-Weight and BE-Attribution. Study mean BES factor scores were compared to normative non-cleft scores. Regression analysis was used to determine significant associations within each age group between BES factor scores and CRQ variables of: gender, self-reported body weight category, cleft type and importance of facial appearance rating. Study mean BE-Attribution scores were significantly lower than the normative scores and significantly lower than the mean BE-Appearance and BE-Weight factor scores within the same age groups of this study. Having a cleft type of lip and palate, being overweight, and placing a high importance on facial appearance had significant negative associations with BES scores. Maintaining a normal body weight and placing a lower level of importance on facial appearance had significant positive associations. Gender had no significant associations. In this study, the attribution aspect of body esteem had a greater negative impact on patients than their appearance and body weight. This has important implications for clinical treatment and support of patients.
Publisher: Springer Science and Business Media LLC
Date: 14-01-2021
DOI: 10.1186/S13756-020-00880-W
Abstract: The development of antimicrobial resistance, which is partially attributable to the overuse and/or misuse of antibiotics in health care, is one of the greatest global public health challenges. In Sub-Saharan African (SSA) countries, non-prescribed dispensing of antibiotics in community drug retail outlets (CDROs) has been flagged as one of the contributing factors for the widespread misuse of antibiotics in the community. The current review aimed to estimate the proportion of non-prescription antibiotics requests or consultations that resulted in provision of antibiotics without a valid prescription among CDROs in SSA region, and describe the type of antibiotics dispensed. A literature search was conducted using PubMed, CINAHL, Scopus and Google Scholar. We also searched reference lists of relevant articles. Random effect model meta-analysis was employed to determine the pooled proportion of over the counter sale of antibiotics. Subgroup and meta-regression was undertaken to explore the potential cause of heterogeneity in effect size across studies. Of 671 total citations retrieved, 23 met the inclusion criteria (seven cross-sectional questionnaire-based surveys and 16 cross-sectional client-based studies). The overall pooled proportion of non-prescription antibiotics requests or consultations that resulted in supply of antibiotics without prescription was 69% (95% CI 58–80). Upper respiratory tract infections and/or acute diarrhoea were the most frequently presented case scenarios, and amoxicillin and co-trimoxazole were the most frequently dispensed antibiotics to treat those symptoms. Non-prescribed dispensing of antibiotics was found to be a common practice among CDROs in several SSA countries. Ease of access to and overuse of antibiotics can potentially accelerate the emergence of resistance to antibiotics available in the region. Our review highlights the need for a stringent enforcement of existing policies and/or enacting new regulatory frameworks that would regulate antibiotic supply, and training and educational support for pharmacy personnel (e.g. pharmacists, pharmacy assistants) regarding judicious use of antibiotics and the importance of antimicrobial stewardship.
Publisher: Wiley
Date: 07-2021
DOI: 10.5694/MJA2.51122
Publisher: Elsevier BV
Date: 02-2020
Publisher: Springer Science and Business Media LLC
Date: 03-06-2021
DOI: 10.1186/S12889-021-11163-3
Abstract: Non-prescription dispensing of antibiotics, one of the main sources of antibiotic misuse or over use, is a global challenge with detrimental public health consequences including acceleration of the development of antimicrobial resistance, and is facilitated by various intrinsic and extrinsic drivers. The current review aimed to systematically summarise and synthesise the qualitative literature regarding drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries. Four electronic databases (PubMed, CINAHL, Scopus and Google Scholar) and reference lists of the relevant articles were searched. The Joanna Briggs Institute’s Critical Appraisal Checklist for qualitative studies was used to assess the quality of included studies. The enhancing transparency in reporting the synthesis of qualitative research statement was used to guide reporting of results. Data were coded using NVivo 12 software and analysed using both inductive and deductive thematic analysis. A total of 23 articles underwent full text review and 12 of these met the inclusion criteria. Four main themes were identified in relation to facilitators of non-prescribed sale of antibiotics among community drug retail outlets: i) the business orientation of community drug retail outlets and tension between professionalism and commercialism ii) customers’ demand pressure and expectation iii) absence of or a lax enforcement of regulations and iv) community drug retail outlet staff’s lack of knowledge and poor attitudes about antibiotics use and scope of practice regarding provision. This review identified several potentially amendable reasons in relation to over the counter dispensing of antibiotics. To contain the rise of antibiotic misuse or over use by targeting the primary drivers, this review suggests the need for strict law enforcement or enacting new strong regulation to control antibiotic dispensing, continuous and overarching refresher training for community drug retail outlet staff about antibiotic stewardship, and holding public awareness c aigns regarding rational antibiotic use.
Publisher: Informa UK Limited
Date: 18-11-2020
Publisher: Elsevier BV
Date: 10-2021
Publisher: Oxford University Press (OUP)
Date: 29-08-2020
Abstract: To investigate factors that enable or challenge the initiation and actioning of health and wellbeing policy in Australian local governments using political science frameworks. An online survey was distributed to staff and elected members of Australian local governments. The survey sought responses to a range of variables as informed by political science frameworks. Data were analysed using descriptive statistics and results were compared between local governments of different geographical sizes and locations using Kruskal–Wallis non-parametric testing. There were 1825 survey responses, including 243 CEOs, representing 45% of Australian local governments. Enablers for local government policy initiation and action included the high priority given to health and wellbeing (44%), local leadership (56%) and an organizational (70%) and personal obligation (68%) to the community to act. Less true is a favourable legislative environment (33%), leadership from higher levels of government (29%) and sufficient financial capacity (22%). Cities are better positioned to initiate and action health policy, regardless of the broader legislative environment. Health and wellbeing is a high priority for Australian local governments, despite lack of funding and limited lobbying and support from other sectors and higher levels of government. The insights from political science frameworks assist to understand the policy process, including the interrelatedness of enablers and challenges to initiating and actioning health and wellbeing policy. Further understanding the policy drivers would support practitioners and researchers advocating to influence local health and wellbeing policy.
Publisher: Frontiers Media SA
Date: 09-09-2022
DOI: 10.3389/FNINF.2022.771965
Abstract: Magnetoencephalography is a noninvasive neuromagnetic technology to record epileptic activities for the pre-operative localization of epileptogenic zones, which has received increasing attention in the diagnosis and surgery of epilepsy. As reported by recent studies, pathological high frequency oscillations (HFOs), when utilized as a biomarker to localize the epileptogenic zones, result in a significant reduction in seizure frequency, even seizure elimination in around 80% of cases. Thus, objective, rapid, and automatic detection and recommendation of HFOs are highly desirable for clinicians to alleviate the burden of reviewing a large amount of MEG data from a given patient. Despite the advantage, the performance of existing HFOs rarely satisfies the clinical requirement. Consequently, no HFOs have been successfully applied to real clinical applications so far. In this work, we propose a multi-head self-attention-based detector for recommendation, termed MSADR, to detect and recommend HFO signals. Taking advantage of the state-of-the-art multi-head self-attention mechanism in deep learning, the proposed MSADR achieves a more superior accuracy of 88.6% than peer machine learning models in both detection and recommendation tasks. In addition, the robustness of MSADR is also extensively assessed with various ablation tests, results of which further demonstrate the effectiveness and generalizability of the proposed approach.
Publisher: Frontiers Media SA
Date: 27-11-2018
Publisher: Springer Science and Business Media LLC
Date: 06-01-2021
DOI: 10.1186/S12879-020-05694-0
Abstract: C ylobacter spp. infections are a globally important cause of enterocolitis, causing substantial morbidity. Capturing accurate information on hospitalisations is challenging and limited population-level data exist to describe the clinico-epidemiological characteristics of hospitalised cases. Hospital administrative and laboratory datasets were linked to identify C ylobacter -associated hospitalisations between 2004 and 2013. Accuracy of morbidity coding was assessed using laboratory diagnosis as a gold standard, with health department surveillance data used to calculate population-based rates. Additional patient-level data were collected via review of medical records. Descriptive statistics were used to assess changes in rates and proportions and to assess relationships between key variables including age, length of stay, comorbidity and complications. In total 685 C ylobacter -associated hospital admissions were identified, with the sensitivity of morbidity coding 52.8% (95% CI 48.9–56.7%). The mean annual rate of hospitalisation was 13.6%. Hospitalisation rates were higher for females across most age-groups, while for both genders marked increases were observed for those aged ≥60 years. Median admission age was 39.5 years, with an average length of stay of 3.5 days. Comorbidities were present in 34.5% (237/685) of admissions, with these patients more likely to develop electrolyte disturbances, hypotension, renal impairment or acute confusion (all p 0.001). Bacteraemia and acute kidney injury were observed in 4.1% (28/685) and 3.6% (23/685) of admissions, respectively. Inpatient mortality was low (0.15%). Under reporting of C ylobacter -associated hospitalisations is substantial but can be improved through data linkage. We observed demographic differences among those hospitalised but further work is needed to determine risk factors and predictors for hospitalisation.
Publisher: AMPCo
Date: 11-2015
DOI: 10.5694/MJA15.00655
Publisher: MDPI AG
Date: 12-04-2022
Abstract: There is a high degree of expert consensus that anthropogenic climate change will be catastrophic if urgent and significant measures to reduce carbon emissions are not undertaken worldwide. Australia is a world-leading exporter of coal and gas, and does not have an effective emissions reduction strategy. Though many Australians support action on climate change, this has not affected voting patterns. In this qualitative study, we aimed to explore the attitudes of Australian voters in Brisbane, Queensland, Australia towards potential environmental policies. We approached people in public spaces, and invited them to participate in interviews. Six of the thirty-five interview participants who voted for the two main political parties or were undecided voters agreed with the transition to 100% renewables and/or no new coal mines in Australia. Many thought that renewables were not reliable enough and/or the economy was too dependent on coal to make the transition. There was strong support for political leadership in order to regulate mining and pollution, and for a transition plan for fossil-fuel-dependent communities. Participants were most concerned about tangible environmental issues, such as waste and pollution, and also described needing clear solutions in order to engage with the issues. Some described feeling ‘shouted at’ by protests and messaging about climate change and environmental issues. Our findings suggest that solution-based messaging may increase levels of engagement about climate change, and that waste and pollution can be entry-points for discussions about climate change. It is important to have conversations with people about this important issue.
Publisher: Elsevier BV
Date: 03-2020
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.DRUGPO.2019.02.002
Abstract: Despite the increasing prevalence and distinct nature of meth hetamine-related harms, treatment models are limited, and relapse is common. Meta-ethnography has been increasingly used to synthesise qualitative health research and develop new concepts or theories. This meta-ethnography aimed to explore meth hetamine users' experiences of cessation, recovery, and relapse, to better understand how to tailor support for this population. A systematic review was conducted of six electronic databases, supported by hand searches of leading journals and reviews of reference lists. Reports were included that used naturalistic participant observation to examine meth hetamine cessation, recovery, and relapse with at least 50% of their s le. The life course approach to drug use was used to inform the process of data analysis and interpretation. The final s le was synthesised using Reciprocal Translation supported by open and axial coding. Nineteen sources were selected, thirteen of which were conducted in the United States. Two themes were identified: meth hetamine users are exposed to a range of relapse triggers, but also triggers for recovery, and their susceptibility to these triggers is largely determined by their social environment and the process of recovery requires changes in personal and social identity which can be a barrier to recovery for some users. These findings present the concept of recovery triggers and highlight the role of wider risk environments in determining meth hetamine recovery, and the negative potential of social capital. These themes also address the ongoing debate regarding the agency of drug users, and the impact of this debate on drug user's experiences of recovery.
Publisher: Oxford University Press (OUP)
Date: 12-1995
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/SH17181
Abstract: Introduction Despite a range of interventions, annual numbers of new diagnoses of HIV infection among men who have sex with men (MSM) in Australia have not declined in recent years. Peer-based sexual health clinics targeting MSM, such as the M Clinic in Perth (WA, Australia), have been put in place to provide safe sex counselling and to increase testing rates among MSM and who are at high risk of HIV infection. The aim of this study was to assess the incidence of HIV, chlamydia and gonorrhoea among men attending the M Clinic. Methods: This was a historical cohort study of repeated M Clinic clients from January 2011 to June 2015 inclusive. Testing and risk factor data from M Clinic client software were used to estimate the incidence of HIV, chlamydia and gonorrhoea and associated factors. Results: The incidence of HIV, chlamydia and gonorrhoea was 1.87, 13.58 and 6.48 per 100 person-years respectively. Older men had a higher incidence of HIV infection but a lower incidence of chlamydia and gonorrhoea than younger men. Conclusions: The HIV incidence was higher than found in similar studies in other Australian sexual health clinics, but the incidence of chlamydia and gonorrhoea was similar. The high HIV incidence among clients of the M Clinic points to the importance of making pre-exposure HIV prophylaxis available to clients of the M Clinic and similar services.
Publisher: Oxford University Press (OUP)
Date: 10-10-2022
DOI: 10.1093/JAC/DKAC341
Abstract: Non-prescription dispensing of antibiotics significantly contributes to widespread antibiotic misuse, which in turn hastens the occurrence of antibiotic resistance. It is believed to be common in Ethiopia despite prescription-only regulations. We aimed to quantify non-prescription dispensing of antibiotics in community drug retail outlets (CDROs) with a focus on non-urban towns in the Amhara region of Ethiopia. A multicentre simulated client (SC) study was conducted to measure the non-prescription provision of antibiotics in 225 consenting CDROs. Each CDRO was visited twice by two trained SCs, one to present pre-prepared clinical case scenarios and the other to directly request specific antibiotics. Descriptive statistical analysis was performed to report the findings. The study had 450 interactions across the two visits. Non-prescribed antibiotics were obtained in 198 (88%) of the 225 clinical case scenarios-based visits and in 205 (91%) of the 225 direct antibiotic request visits. Most of the supply was at the first level of demand: 84% of the 198 clinical case scenario visits and 95% of the 205 direct antibiotic request visits. CDRO staff requested further information about the patient or the case in 40% of the clinical case scenarios-based visits and 30% of the direct antibiotic request visits. It was possible to obtain antibiotics without prescription from a high proportion of CDROs, both in clinical scenario-based and direct antibiotic request interactions. Multifaceted interventions including stringent regulatory enforcement, frequent CDRO practice surveillance, CDRO staff training and community health education are needed with greater emphasis on rural areas.
Publisher: SAGE Publications
Date: 13-04-2019
Abstract: Living with a cleft condition involves many years of multidisciplinary therapy, treatment, and surgical intervention. This complex process may have both physical and psychosocial long-term impacts. There is limited evidence of the psychosocial impact of cleft on in iduals in Australia. To obtain an understanding of the adult patient perception of having a cleft and explore the impact of the condition on their lives. Qualitative methodologies at one case study site in Western Australia. Adults with a cleft lip and/or palate (CL/P) who had received treatment at Princess Margaret Hospital, the only treatment center for cleft in Western Australia. In idual in-depth semi-structured qualitative interviews were conducted and recorded and transcribed for analysis. Fifteen adults with a CL/P. Two main themes were identified: lived experience (with 3 subthemes: normality, support networks, and impacts in later life) and advice to others. The majority of participants reported social rejection and isolation, which occurred mostly at school and in some instances at home, but did not often last into adulthood. The greatest protective factor was the support of family and friends, which if missing during their childhood, was desired and appreciated in adulthood. Adults with CL/P may require psychosocial support from their cleft team including referral to clinicians in adult services. There is also the need for earlier psychological interventions and social programs to support those with appearance-related social difficulties.
Publisher: Wiley
Date: 02-2016
DOI: 10.1111/IMJ.12962
Abstract: Murray Valley encephalitis virus (MVEV) is a mosquito-borne flavivirus that causes encephalitis in some cases of infection. It is endemic in Northern Australia and cases occasionally occur in South Eastern Australia. The long-term sequelae of MVEV infection have not previously been well described. To investigate the long-term sequelae of MVEV infection. This was a descriptive case series of all clinical MVEV infections using data linkage and standard surveys. Hospital admissions, emergency department, psychiatric outpatients and mortality data were obtained. We attempted to follow-up all 53 cases of MVEV clinical infection that occurred in Western Australia from 1978 to 2011 inclusive. Two cases opted out of the study. We followed-up 39 surviving cases. Seven of the nine with paralysis or paresis were under 5 years and they fared worse than other patients, requiring lengthy hospitalisation (median duration 133 days). Two died due to complications of quadriplegia following a total of 691 days in hospital. Nine surviving patients, including two with non-encephalitic illness, required care for depression and other psychiatric conditions following MVEV infection. Two patients who were discharged with neurological sequelae had no further documented hospital occasions of service but reported ongoing challenges with cognitive dysfunction and inability to work. This is the first study of long-term outcomes of Murray Valley encephalitis that included cases with no obvious sequelae at discharge. In spite of the small numbers involved, the study demonstrated the significant medical and social burden due to MVEV in Australia.
Publisher: Elsevier BV
Date: 02-1996
DOI: 10.1111/J.1467-842X.1996.TB01338.X
Abstract: The aim of the study was to estimate the prevalence of hepatitis C infection among attenders of several high-volume needle exchanges in southeast Queensland, and to compare the prevalences among the needle exchanges. Clients at four needle exchanges were surveyed over a five-day period by means of a self-administered questionnaire. A high proportion of respondents (76 per cent) reported having been tested for hepatitis C antibodies and the overall prevalence of reported hepatitis C infection was 34 per cent. Thirty-one per cent of the respondents were hetamine injectors, among whom there was a lower prevalence of reported hepatitis C infection than among opioid injectors (odds ratio 0.18, P < 0.01). There were some differences in the respondents' characteristics and in hepatitis C prevalence between different needle exchanges. The reported prevalence of HIV infection was 2 per cent. This study highlights the importance of surveying a range of needle exchanges to obtain a representative s le of needle-exchange clients overall. The low prevalence of hepatitis C in some groups of injecting drug users suggests that it is possible to prevent hepatitis C transmission among injecting drug users, and points to the opportunity for aiming hepatitis C prevention strategies at these groups.
Publisher: Springer Science and Business Media LLC
Date: 21-08-2021
DOI: 10.1186/S12879-021-06558-X
Abstract: C ylobacter spp. cause mostly self-limiting enterocolitis, although a significant proportion of cases require hospitalisation highlighting potential for severe disease. Among people admitted, blood culture specimens are frequently collected and antibiotic treatment is initiated. We sought to understand clinical and host factors associated with bacteraemia, antibiotic treatment and isolate non-susceptibility among C ylobacter -associated hospitalisations. Using linked hospital microbiology and administrative data we identified and reviewed C ylobacter- associated hospitalisations between 2004 and 2013. We calculated population-level incidence for C ylobacter bacteraemia and used logistic regression to examine factors associated with bacteraemia, antibiotic treatment and isolate non-susceptibility among C ylobacter -associated hospitalisations. Among 685 C ylobacter -associated hospitalisations, we identified 25 admissions for bacteraemia, an estimated incidence of 0.71 cases per 100,000 population per year. Around half of hospitalisations (333/685) had blood culturing performed. Factors associated with bacteraemia included underlying liver disease (aOR 48.89, 95% CI 7.03–340.22, p 0.001), Haematology unit admission (aOR 14.67, 95% CI 2.99–72.07, p = 0.001) and age 70–79 years (aOR 4.93, 95% CI 1.57–15.49). Approximately one-third (219/685) of admissions received antibiotics with treatment rates increasing significantly over time ( p 0.05). Factors associated with antibiotic treatment included Gastroenterology unit admission (aOR 3.75, 95% CI 1.95–7.20, p 0.001), having blood cultures taken (aOR 2.76, 95% CI 1.79–4.26, p 0.001) and age 40–49 years (aOR 2.34, 95% CI 1.14–4.79, p = 0.02). Non-susceptibility of isolates to standard antimicrobials increased significantly over time ( p = 0.01) and was associated with overseas travel (aOR 11.80 95% CI 3.18–43.83, p 0.001) and negatively associated with tachycardia (aOR 0.48, 95%CI 0.26–0.88, p = 0.02), suggesting a healthy traveller effect. C ylobacter infections result in considerable hospital burden. Among those admitted to hospital, an interplay of factors involving clinical presentation, presence of underlying comorbidities, complications and increasing age influence how a case is investigated and managed.
Publisher: Cambridge University Press (CUP)
Date: 2019
DOI: 10.1017/S095026881900195X
Abstract: This study compares the frequency and severity of influenza A/H1N1pdm09 (A/H1), influenza A/H3N2 (A/H3) and other respiratory virus infections in hospitalised patients. Data from 17 332 adult hospitalised patients admitted to Sir Charles Gairdner Hospital, Perth, Western Australia, with a respiratory illness between 2012 and 2015 were linked with data containing reverse transcription polymerase chain reaction results for respiratory viruses including A/H1, A/H3, influenza B, human metapneumovirus, respiratory syncytial virus and parainfluenza. Of these, 1753 (10.1%) had test results. Multivariable regression analyses were conducted to compare the viruses for clinical outcomes including ICU admission, ventilation, pneumonia, length of stay and death. Patients with A/H1 were more likely to experience severe outcomes such as ICU admission (OR 2.5, 95% CI 1.2–5.5, P = 0.016), pneumonia (OR 3.0, 95% CI 1.6–5.7, P 0.001) and lower risk of discharge from hospital (indicating longer lengths of hospitalisation HR 0.64 95% CI 0.47–0.88, P = 0.005), than patients with A/H3. Patients with a non-influenza respiratory virus were less likely to experience severe clinical outcomes than patients with A/H1, however, had similar likelihood when compared to patients with A/H3. Patients hospitalised with A/H1 had higher odds of severe outcomes than patients with A/H3 or other respiratory viruses. Knowledge of circulating influenza strains is important for healthcare preparedness.
Publisher: Elsevier BV
Date: 02-1997
DOI: 10.1111/J.1467-842X.1997.TB01664.X
Abstract: The objective of this study was to describe the incidence and prevalence of hepatitis C infection among clients of a methadone program in Queensland. The clinical notes of clients receiving methadone for treatment of opiate dependence who first registered at the clinic after 1989 were perused for information about their serological status for hepatitis C and hepatitis B infections during a six-week period in 1994. We followed hepatitis C negative clients until August-September 1995. At study entry, 69 per cent of the clients were recorded as being hepatitis C positive. Of those who were negative, the seroconversion rate was 11 per 100 person-years. The high incidence and prevalence of hepatitis C among methadone clients emphasises the need for effective early intervention strategies to prevent the transmission of hepatitis C among injecting drug users.
Publisher: Elsevier BV
Date: 03-2022
Publisher: Cold Spring Harbor Laboratory
Date: 19-11-2021
DOI: 10.1101/2021.11.18.21266558
Abstract: Digital proximity tracing applications were rolled out early in the COVID-19 pandemic in many countries to complement conventional contact tracing. Empirical evidence about their benefits for pandemic response remains scarce. We evaluated the effectiveness and usefulness of ‘ COVIDSafe ’, Australia’s national smartphone-based proximity tracing application for COVID-19. In this prospective study, conducted in New South Wales, Australia between May and November 2020, we calculated the positive predictive value and sensitivity of COVIDSafe , its additional contact yield, and the number of averted public exposure events. Semi-structured interviews with public health staff were conducted to assess the application’s usefulness. There were 619 confirmed COVID-19 cases and over 25,300 close contacts during the study period. COVIDSafe was used by 137 (22%) cases and detected 79 (0·3%) close contacts. It had a positive predictive value of 39% and a sensitivity of 15%, and detected 17 (0·07%) additional close contacts that were not identified by conventional contact tracing. The application generated a substantial additional workload for public health staff and was not considered useful. COVIDSafe was not sufficiently effective to make a meaningful contribution to the COVID-19 response in Australia’s most populous state over a 6-month period. This contrasts optimistic projections from modelling studies about the added value of digitally supported contact tracing. We found no evidence that it adds value to conventional contact tracing, and recommend that their implementation should always include comprehensive effectiveness evaluations.
Publisher: Public Library of Science (PLoS)
Date: 17-06-2016
Publisher: MDPI AG
Date: 09-12-2019
Abstract: Background: Agricultural farmworkers are routinely exposed to high levels of airborne dust particles that have been linked to adverse health outcomes. Methods: This study measured personal and environmental exposures to dust particulates by farmworkers during harvesting activities. Farmers completed a workplace survey with regards to their health and safety awareness and practices and researchers observed general farm safety practices on selected farms using a checklist. Results: In this study, farmers were noted to commonly work extended hours and shifts during harvest due to rigid timing deadlines. Results showed that 40% of farmers were exposed to concentrations of inhalable particles greater than SafeWork Australia’s workplace exposure standards for grain dusts, assuming a 16 h working day over 5 shifts. Twenty-two percent were exposed to concentrations that were above the adjusted standard for 12 h shifts. Survey results showed that three-quarters of farm owners provided new workers with some type of induction related to farm safety, however this was mostly undertaken in an arbitrary manner. Despite noting that farming was a dusty occupation and reporting to use protective measures to reduce harmful dust exposures, no workers were observed to wear respiratory protection when working outside of the protection of a vehicle cabin. Conclusion: This study identified substantial gaps in health and safety knowledge among farm managers and workers, and improved education and training are highly recommended.
Publisher: Springer Science and Business Media LLC
Date: 26-11-2019
DOI: 10.1186/S12889-019-7924-5
Abstract: The development of antibiotic resistance is one of the biggest threats to global public health. Inappropriate use of antibiotics is recognised as a leading cause of antibiotic resistance. The aim of this study was to explore the knowledge, attitudes and practices (KAP) towards antibiotic use among adults in Nepal. A quantitative survey was conducted with 220 community members of the Rupandehi district of Nepal, with cluster s ling techniques applied to select households. Interviews were carried out face-to-face using a structured questionnaire. Responses were presented using descriptive analysis, with chi-squared tests and regression analysis applied to identify factors associated with KAP about antibiotic use and the Spearman’s rank order correlation coefficient calculated to examine the relationship between responses to the KAP questions. The s le comprised more females (54%) than males, the average age of respondents was 38.5 years and almost 60% of respondents lived in rural areas. Respondents had relatively good knowledge about aspects of antibiotic use other than identifying antibiotics. The concept of antibiotic resistance was well known but imperfectly understood. Half of respondents (50.9%) were unsure whether skipping doses would contribute to the development of antibiotic resistance, 88.2% indicated they would go to another doctor if not prescribed an antibiotic when they thought one was needed and nearly half (47.7%) believed antibiotics helped them get better more quickly if they had a fever. Most respondents reported correct practices accessing and using antibiotics, however, 84.6% at least sometimes preferred an antibiotic when they have a cough and sore throat. Logistic regression showed respondents with higher levels of education tended to have better knowledge, more appropriate attitudes and better practices about antibiotic use. Rural respondents were less likely to have better knowledge about antibiotic use, while females were more likely to report better practices. The study provides baseline evidence about the knowledge, attitudes and practices regarding antibiotic use among the population of the Rupandehl district. Its findings will be useful in designing effective and targeted interventions to decrease misconceptions about antibiotic use and to increase awareness about the risks of inappropriate use of antibiotics in the community.
Publisher: Elsevier BV
Date: 06-2023
Publisher: SAGE Publications
Date: 06-07-2022
DOI: 10.1177/00914509211031609
Abstract: The orthodox construction of agency within addiction recovery discourse is built upon a fault line between two conflicting principles: that people who use drugs in harmful ways cannot control their behavior, but that they can also regain that control through intentional effort. The conceptual confusion inherent in this framework can harm people using drugs by producing inadequate accounts of commonly invoked aspects of recovery such as “triggers,” “self-control,” and “addictive behavior.” This ethnographic study involved qualitative interviews and observations with nine people over 6 months as they engaged in recovery from harmful meth hetamine use, to explore their experiences of agency, and how these experiences could be shaped by the discourse of volition/compulsion. Thematic analysis was conducted using a posthumanist theoretical framework. We found “relapse triggers” to be diffuse aspects of particular environments rather than specific stimuli, able to provoke what would normally be considered conscious, intentional behavior rather than only autonomic or “mindless” processes. Participants also described their identities as internally ided and multiple, with drug related behaviors separated from their true selves. Finally, agency was experienced as emergent and distributed rather than as a particular resource located within in iduals. Attending to these complex experiences of agency can help resolve the tension between loss of control and personal responsibility for people who use drugs, by renegotiating the historically imposed categorical distinction between volitional and compelled actions, and the cultural constructions of “addictive” versus “normal” behavior.
Publisher: Elsevier BV
Date: 03-2010
Publisher: Informa UK Limited
Date: 13-07-2020
Publisher: Elsevier BV
Date: 08-2021
Publisher: MDPI AG
Date: 19-10-2021
Abstract: Background: Australian adolescents are routinely offered HPV and dTpa (diphtheria, tetanus, pertussis) vaccines simultaneously in the secondary school vaccination program. We identified schools where HPV initiation was lower than dTpa coverage and associated school-level factors across three states. Methods: HPV vaccination initiation rates and dTpa vaccination coverage in 2016 were calculated using vaccine databases and school enrolment data. A multivariate analysis assessed sociodemographic and school-level factors associated with HPV initiation being % absolute lower than dTpa coverage. Results: Of 1280 schools included, the median school-level HPV initiation rate was 85% (interquartile range (IQR):75–90%) and the median dTpa coverage was 86% (IQR:75–92%). Nearly a quarter (24%) of all schools had HPV vaccination initiation % lower than dTpa coverage and 11 % had % difference. School-level factors independently associated with % difference were remote schools (aOR:3.5, 95% CI = 1.7–7.2) and schools in major cities (aOR:1.8, 95% CI = 1.0–3.0), small schools (aOR:3.3, 95% CI = 2.3–5.7), higher socioeconomic advantage (aOR:1.7, 95% CI = 1.1–2.6), and lower proportions of Language-background-other-than-English (aOR:1.9, 95% CI = 1.2–3.0). Conclusion: The results identified a quarter of schools had lower HPV than dTpa initiation coverage, which may indicate HPV vaccine hesitancy, and the difference was more likely in socioeconomically advantaged schools. As hesitancy is context specific, it is important to understand the potential drivers of hesitancy and future research needs to understand the reasons driving differential uptake.
Publisher: Springer Science and Business Media LLC
Date: 10-07-2020
Publisher: Informa UK Limited
Date: 09-10-2022
DOI: 10.1080/13691058.2020.1825813
Abstract: Western Australia criminalises sex work whilst some other Australian jurisdictions have decriminalised the industry. This article examines the role of Western Australia's legislation in reinforcing stigma and discrimination of sex workers. It draws on stigma and discrimination-specific results from open-ended survey responses and interview data collected as part of a larger cross-sectional mixed-methods study. Experiences and/or anticipation of stigma and discrimination resulted in some sex workers concealing their involvement in sex work from family, friends and their home communities. This was a major barrier to accessing health care and protective services and impacted negatively on their mental health and wellbeing. There is a need for policy change and support to shift society's perception of sex work to that of a legitimate occupation to decrease sex workers' experiences of stigma and discrimination and improve their access to and utilisation of health care and protective services. These findings highlight the need for the decriminalisation of the Western Australian sex industry and the development of training programmes for police and healthcare workers to reduce the stigma and discrimination experienced by sex workers in these settings.
Publisher: Elsevier BV
Date: 08-2020
Publisher: Wiley
Date: 06-2008
DOI: 10.1111/J.1445-5994.2008.01688.X
Abstract: Climate change is unequivocal. The fourth assessment report of the Intergovermental Panel on Climate Change has recently projected that global average surface temperature will increase by 1.1 to 6.4 degrees C by 2100. Anthropogenic warming during the twenty-first century would be much greater than that observed in the twentieth century. Most of the warming observed over the last six decades is attributable to human activities. Climate change is already affecting, and will increasingly have profound effects on human health and well-being. Therefore, there is an urgent need for societies to take both preemptive and adaptive actions to protect human populations from adverse health consequences of climate change. It is time to mainstream health risks and their prevention in relation to the effects of climate change on the medical research and policy agenda.
Publisher: SAGE Publications
Date: 09-02-2019
Abstract: In the 30 years since its introduction, meta-ethnography has become a critical tool for synthesizing qualitative health research and providing a holistic understanding of complex health and social phenomena. Meta-ethnography has also been adapted to integrate a wider range of research methodologies, expanded to include a detailed taxonomy of research methods, and has led to the development of multiple other methods of synthesis. In this article, we describe the development of meta-ethnography, its unique research approaches, the innovations that have occurred since its inception, and potential future directions for the method. These include the need for consensus around the role of systematic database searches and critical appraisal, and a clearer path to action for clinicians interpreting qualitative research. Understanding and updating methods such as meta-ethnography will ensure that the exponentially developing field of qualitative research continues to have a meaningful and cumulative impact on complex issues of health and well-being.
No related grants have been discovered for Linda Selvey.