ORCID Profile
0000-0002-4893-5775
Current Organisation
University of Melbourne
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Wiley
Date: 07-2007
Publisher: JMIR Publications Inc.
Date: 13-10-2021
DOI: 10.2196/26425
Abstract: Cancer is one of the predominant causes of morbidity and mortality in older adult populations worldwide. Among a range of barriers, comorbidity particularly poses a clinical challenge in cancer diagnosis, prognosis, and treatment owing to its heterogeneous nature. While accurate comorbidity assessments and appropriate treatment administration can result in better patient outcomes, evidence related to older adult cancer populations is limited as these in iduals are often excluded from regular clinical trials due to age and comorbid conditions. To determine the prevalence of physical comorbidity and the impact of physical comorbidities and rurality on treatment and its outcomes in older adult cancer populations. Scientific databases Embase and PubMed were searched for published scientific literature on physical comorbidity and older adult cancer patients. Google Scholar was searched for scholarly literature published in nonindexed journals. Snowballing was utilized to identify research papers missed in the above searches. Included studies : (1) reported on original research involving cancer patients (2) included patients aged 65 years or older (3) had patients receiving cancer-related treatment and (4) cancer survivors (5) reported on physical comorbidity as a variable (6) were published in English and (7) conducted from any geographical location. In total, 29 studies were selected for data extraction, evidence synthesis, and quality assessment. In these, comorbidities ranged from 37.9%-74.3% in colorectal cancer, 74%-81% in head and neck cancer, and 12.6%-49% in breast cancer. Moderate comorbidities ranged from 13%-72.9%, and severe comorbidities from 2.5%-68.2%. Comorbidity increased with age, with comorbidity affecting both treatment choice and process. Physical comorbidities significantly affected treatment initiation, causing delay, toxicity, and discontinuation. Older adult cancer patients were given less vigorous and nonstandard treatments and were also less likely to be offered treatment. Where patients are given more vigorous treatment, several studies showed better survival outcomes. Appropriate treatment in older adult cancer patients increased both overall and disease-related survival rates. None of the studies noted rurality as a distinct variable. This systematic review concludes that there is evidence to substantiate the adverse effect of comorbidity on treatment and survival outcomes. However, the mechanism by which comorbidity impedes or impacts treatment is unknown in many cases. Some low-quality evidence is available for considering the functional status and biological age in treatment decisions. Future studies that substantiate the value of comprehensive older adult assessments before treatment initiation in cancer patients, including assessing the nature and severity of comorbidities, and additional consideration of rurality as a factor, could lessen the effect of comorbidities on the treatment process.
Publisher: Emerald
Date: 03-10-2018
DOI: 10.1108/JHOM-09-2017-0239
Abstract: Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers inevitably exercise, the concept of “street-level bureaucracy” has tended to artificially separate policy makers and workers. The purpose of this paper is to understand the role of social-organizational context in aligning policy with practice. This mixed-method participatory study focuses on a locally developed tool to implement an Australia-wide strategy to engage and respond to mental health services for parents with mental illness. Researchers: completed 69 client file audits administered 64 staff surveys conducted 24 interviews and focus groups (64 participants) with staff and a consumer representative and observed eight staff meetings, in an acute and sub-acute mental health unit. Data were analyzed using content analysis, thematic analysis and descriptive statistics. Based on successes and shortcomings of the implementation (assessment completed for only 30 percent of clients), a model of integration is presented, distinguishing “assimilist” from “externalist” positions. These depend on the degree to which, and how, the work environment affords clinicians the setting to coordinate efforts to take account of clients’ personal and social needs. This was particularly so for allied health clinicians and nurses undertaking sub-acute rehabilitative-transitional work. A new conceptualization of street-level bureaucracy is offered. Rather than as disconnected, it is a process of mutual influence among interdependent actors. This positioning can serve as a framework to evaluate how and under what circumstances discretion is appropriate, and to be supported by managers and policy makers to optimize client-defined needs.
Publisher: Informa UK Limited
Date: 16-10-2007
DOI: 10.1080/10934520701567197
Abstract: Arsenic groundwater contamination in Bangladesh warrants immediate remediation. This randomised controlled intervention trial was conducted to determine the effectiveness of two possible interventions: dug wells and three-pitcher filters. A total of 640 in iduals participated with 218 randomised to the dug well group, 216 to the three-pitcher group and 206 to a control group. Data were collected at baseline and at 1, 6 and 12 months after the intervention. Self reported compliance with dug wells remained below 20% during the entire 12 months of the study. The compliance with the three-pitcher filters decreased after 6 months and became similar to the compliance of the dug well group after 12 months. A substantial decrease in urinary arsenic metabolites occurred only among those who were compliant with dug wells and three-pitcher filter systems after 1 month of intervention as opposed to control participants. However, a persistent reduction in urinary arsenic concentrations was observed only among the dug well users after 12 months of intervention. Our results show that a functional dug well could be offered as a long-term alternative to tube wells, but use of this option is likely to be low, unless appropriate behavioural change measures are taken. Our study also demonstrates that arsenic removal technologies such as three-pitcher filters are an effective option as a short-term measure. The three-pitcher filters that are not adequately maintained are not an effective option for a year. These arsenic removal technologies may be even harmful in the long term if the resultant water quality is not properly monitored.
Publisher: Springer Science and Business Media LLC
Date: 23-05-2011
Publisher: Elsevier BV
Date: 06-2019
Publisher: Wiley
Date: 02-06-2008
DOI: 10.1111/J.1445-5994.2007.01399.X
Abstract: Improving the care of stroke patients is a national priority for the health system in Australia. In rural areas the challenges may be greater. Although best-practice guidelines for acute and subacute stroke care are well established, their general uptake appears to be limited and implementation strategies are required to promote the use of this evidence-based care. The Rural Organisation of Australian Stroke Teams (ROAST) project sought to promote the evidence-based stroke practice in rural hospitals. This was a prospective observational project designed to improve the services provided to rural stroke patients, primarily through better organisation of care on general medical wards and emergency departments. Using recognized support strategies, we encouraged the use of nationally recognized key performance indicators and provided audit and feedback of adherence to these indicators to participating hospitals. Six Victorian hospitals participated in this initial phase of the ROAST project. Information was collected on 348 patients. Ten of the 11 indicators showed greater than 10% improvement in adherence levels and by the end of the project period compared favourably to levels of adherence described in metropolitan hospitals. The ROAST projected supported a network of clinicians to implement evidence-based guidelines in acute stroke care in the setting of general medical wards. In doing so, this project has shown that it is quite feasible to deliver best-practice care to stroke patients in rural Australia.
Publisher: Wiley
Date: 28-08-2007
DOI: 10.1111/J.1440-1584.2007.00915.X
Abstract: Australian Government initiatives to address medical workforce shortages in rural Australia include increasing the intake of students of rural background and increasing exposure to rural medicine during training. Rural-orientated medical training programs in the USA that selectively admit students from rural backgrounds and who intend to practise as family practitioners have demonstrated success in increasing uptake of practice in rural/underserved areas. However, in examining the specific contribution of rural exposure towards increasing uptake of rural practice, the evidence is inconclusive, largely due to the failure to adjust for these critical independent predictors of rural practice. This paper identifies this evidence gap, examines the concept of rural exposure, and highlights the need to identify which aspects of rural exposure contribute to a positive attitude towards rural practice, thereby influencing students to return to rural areas. The cost of rural exposure through student placements is not insignificant, and there is a need to identify which aspects are most effective in increasing the uptake of rural practice, thereby helping to address the medical workforce shortage experienced in rural Australia.
Publisher: JMIR Publications Inc.
Date: 21-12-2020
Abstract: ancer is one of the predominant causes of morbidity and mortality in older adult populations worldwide. Among a range of barriers, comorbidity particularly poses a clinical challenge in cancer diagnosis, prognosis, and treatment owing to its heterogeneous nature. While accurate comorbidity assessments and appropriate treatment administration can result in better patient outcomes, evidence related to older adult cancer populations is limited as these in iduals are often excluded from regular clinical trials due to age and comorbid conditions. o determine the prevalence of physical comorbidity and the impact of physical comorbidities and rurality on treatment and its outcomes in older adult cancer populations. cientific databases Embase and PubMed were searched for published scientific literature on physical comorbidity and older adult cancer patients. Google Scholar was searched for scholarly literature published in nonindexed journals. Snowballing was utilized to identify research papers missed in the above searches. Included studies : (1) reported on original research involving cancer patients (2) included patients aged 65 years or older (3) had patients receiving cancer-related treatment and (4) cancer survivors (5) reported on physical comorbidity as a variable (6) were published in English and (7) conducted from any geographical location. n total, 29 studies were selected for data extraction, evidence synthesis, and quality assessment. In these, comorbidities ranged from 37.9%-74.3% in colorectal cancer, 74%-81% in head and neck cancer, and 12.6%-49% in breast cancer. Moderate comorbidities ranged from 13%-72.9%, and severe comorbidities from 2.5%-68.2%. Comorbidity increased with age, with comorbidity affecting both treatment choice and process. Physical comorbidities significantly affected treatment initiation, causing delay, toxicity, and discontinuation. Older adult cancer patients were given less vigorous and nonstandard treatments and were also less likely to be offered treatment. Where patients are given more vigorous treatment, several studies showed better survival outcomes. Appropriate treatment in older adult cancer patients increased both overall and disease-related survival rates. None of the studies noted rurality as a distinct variable. his systematic review concludes that there is evidence to substantiate the adverse effect of comorbidity on treatment and survival outcomes. However, the mechanism by which comorbidity impedes or impacts treatment is unknown in many cases. Some low-quality evidence is available for considering the functional status and biological age in treatment decisions. Future studies that substantiate the value of comprehensive older adult assessments before treatment initiation in cancer patients, including assessing the nature and severity of comorbidities, and additional consideration of rurality as a factor, could lessen the effect of comorbidities on the treatment process.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2003
Publisher: Springer Science and Business Media LLC
Date: 14-10-2011
Publisher: Wiley
Date: 18-04-2013
DOI: 10.1111/ANS.12168
Abstract: Surgical checklists are designed to improve patient outcomes following surgery. While such checklists have been widely implemented worldwide, few studies examine surgical checklists within an Australian context. For this purpose, we have performed a literature review using data from OECD member nations to determine the effectiveness of surgical checklists in improving patient outcomes and factors that contribute to their successful implementation. The databases, Pubmed, Medline, EMBASE, Cochrane and CINAHL were searched using the keywords ('surgical' AND 'checklist') and ( (surgical) AND checklist) AND ( (implementation) OR (utilization) OR (usage) ). Studies were limited to those written in the English language, peer-reviewed, published between January 2000 and December 2012, and including an abstract. Our search yielded 2242 papers, of which 72 papers were identified for their potential relevance and selected for full text review. Of these, nine papers met the inclusion criteria and were reviewed in detail. Evidence that supports the use of surgical checklists in countries with a large number of protocols already in place is limited. Adequate checklist implementation plays a central role in checklist effectiveness, which in turn is dependent on multiple factors. Although evidence from OECD member countries is non-conclusive, it does suggest that surgical checklists, when effectively implemented, have the potential to be effective at reducing complication and mortality rates following surgery. Within an Australian context, more studies are needed to fully establish the potential effectiveness of surgical checklists and to monitor checklist use compliance in order to ensure greater patient safety.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2003
DOI: 10.1097/01.EDE.0000082374.08684.0D
Abstract: Evidence for a causal relationship between disinfection byproducts in chlorinated water and cancer is not conclusive. This study investigates the association between disinfection byproducts in chlorinated water, as measured by trihalomethane concentration, and the frequency of micronuclei in urinary bladder epithelial cells, thereby assessing the carcinogenic potential of disinfection byproducts. A cohort study was undertaken in 1997 in 3 Australian communities with varying levels of disinfection byproducts in the water supply. Exposure was assessed using both available dose (total trihalomethane concentration in the water supply) and intake dose (calculated by adjusting for in idual variations in ingestion, inhalation, and dermal absorption). Micronuclei in urinary bladder epithelial cells were used as a preclinical biomarker of genotoxicity. Cells were scored for micronuclei for 228 participants, of whom 63% were exposed to disinfection by products and 37% were unexposed. Available dose of total trihalomethane for the exposed group ranged from 38 to 157 micro g/L, whereas intake dose ranged from 3 to 469 micro g/kg per day. Relative risk for DNA damage to bladder cells, per 10 micro g/L of available dose total trihalomethane, was 1.01 (95% confidence interval [CI] = 0.97-1.06) for smokers and 0.996 (CI = 0.961-1.032) for nonsmokers. Relative risk, per 10 micro g/kg per day of intake dose of total trihalomethane, was 0.99 (CI = 0.96-1.03) for smokers and 1.003 (CI = 0.984-1.023) for nonsmokers. This study provides no evidence that trihalomethane concentrations, at the levels we investigated, are associated with DNA damage to bladder cells.
Publisher: CSIRO Publishing
Date: 26-05-2022
DOI: 10.1071/AH22125
Abstract: What is known about the topic? Avoidable adverse events are often being attributed to health workforce shortages associated with the coronavirus disease 2019 (COVID-19) pandemic and government funding cuts. What does this paper add? Health workforce shortages were predicted well before the COVID-19 pandemic. What are the implications for practitioners? Senior executives and leaders should unitedly take action to influence change in funding and models of care.
Publisher: Elsevier BV
Date: 09-2006
Publisher: BMJ
Date: 30-11-2012
Publisher: SAGE Publications
Date: 12-12-2022
Publisher: Wiley
Date: 09-2011
Publisher: Wiley
Date: 12-07-2010
DOI: 10.1111/J.1741-6612.2010.00392.X
Abstract: To model impact of modifiable risk behaviour on dementia prevalence among the Australian population aged 45 years and over. A group-based computer model was constructed to estimate the impact of modifying risk behaviour on dementia prevalence. Based on population ageing, the number of people aged 45 years and over living with dementia is expected to triple from 187 000 in 2006 to 650 000 by 2051. A drop in proportion ever smokers by 5% every 5 years would lower population with dementia by 2% in 2051. If obesity rate drops by 5%, dementia prevalence would be lower by 6%. A decline in physical inactivity rate by 5% would reduce dementia by 11%. Persistence of the growing trend in obesity and physical inactivity would result in a larger than expected dementia epidemic. Improving the risk behaviours has potential to make a substantial reduction in the number of people with dementia.
Publisher: Elsevier BV
Date: 08-2020
Publisher: SAGE Publications
Date: 05-06-2019
Abstract: This study determined the cultural appropriateness of the Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID-I) as an acceptable tool for diagnosing mental illness among Indigenous people. De-identified qualitative feedback from participants and psychologists regarding the cultural appropriateness of the SCID-I for Indigenous people using open-ended anonymous questionnaires was gathered. Aboriginal Medial Service staff and Indigenous Support Workers participated in a focus group. A total of 95.6% of participants felt comfortable during the 498 questionnaires completed. Psychologists also provided qualitative feedback for 502 (92.3%) interviews, of whom 40.4% established a good rapport with participants. Of the participants, 77.7% understood the SCID-I questions well, while 72.5% did not require any cultural allowances to reach a clinical diagnosis. When administered by a culturally safe trained psychologist, SCID-I is well tolerated in this group.
Publisher: Oxford University PressNew York
Date: 12-10-2009
DOI: 10.1093/ACPROF:OSO/9780195172997.003.0005
Abstract: This chapter discusses the health impacts of global environmental change. Topics covered include relationship between globalization and global environmental change, impacts of climate change, interaction between weather and air pollution effects of economic, social, and demographic disruption and strategies to reduce population health risks from climate change.
Publisher: Springer Science and Business Media LLC
Date: 13-07-2015
Publisher: Informa UK Limited
Date: 2006
Publisher: Informa UK Limited
Date: 04-2004
Publisher: Oxford University Press (OUP)
Date: 26-10-2015
Abstract: Australia is one of the highest users of antibiotics in the developed world. This study aimed to identify consumer antibiotic information needs to improve targeting of medicines information. We conducted a retrospective, mixed-method study of consumers' antibiotic-related calls to Australia's National Prescribing Service (NPS) Medicines Line from September 2002 to June 2010. Demographic and question data were analysed, and the most common enquiry type in each age group was explored for key narrative themes. Relative antibiotic call frequencies were determined by comparing number of calls to antibiotic utilization in Australian Statistics on Medicines (ASM) data. Between 2002 and 2010, consumers made 8696 antibiotic calls to Medicines Line. The most common reason was questions about the role of their medicine (22.4%). Patient age groups differed in enquiry pattern, with more questions about lactation in the 0- to 4-year age group (33.6%), administration (5-14 years: 32.4%), interactions (15-24 years: 33.4% and 25-54 years: 23.3%) and role of the medicine (55 years and over: 26.6%). Key themes were identified for each age group. Relative to use in the community, antibiotics most likely to attract consumer calls were ciprofloxacin (18.0 calls/100,000 ASM prescriptions) and metronidazole (12.9 calls/100,000 ASM prescriptions), with higher call rates than the most commonly prescribed antibiotic amoxicillin (3.9 calls/100,000 ASM prescriptions). Consumers' knowledge gaps and concerns about antibiotics vary with age, and certain antibiotics generate greater concern relative to their usage. Clinicians should target medicines information to proactively address consumer concerns.
Publisher: Informa UK Limited
Date: 07-2005
Publisher: AMPCo
Date: 2015
DOI: 10.5694/MJA14.00236
Abstract: To determine the role of rural background and years of rural clinical school training on subsequent rural clinical practice. Retrospective cohort study of University of Queensland (UQ) medical graduates who graduated during the period 2002-2011 (contacted via internet, telephone and mail, using information obtained from UQ, the Australian Health Practitioner Regulation Agency, and telephone directory and internet searches) who completed an online or hard copy questionnaire during the period December 2012 to October 2013. Current clinical practice in a rural location. Of 1572 graduates to whom the questionnaire was sent, 754 (48.0%) completed the questionnaire. Of the respondents, 236 (31.3%) had a rural background and 276 (36.6%) had attended the University of Queensland Rural Clinical School (UQRCS). Clinical practice location was rural for 18.8% (90/478) of UQ metropolitan clinical school attendees and 41.7% (115/276) of UQRCS attendees (P < 0.001). In the multivariate model with main effects, independent predictors of rural practice were (OR [95% CI]): UQRCS attendance for 1 year (1.84 [1.21-2.82]) or 2 years (2.71 [1.65-4.45]), rural background (2.30 [1.57-3.36]), partner with rural background (3.08 [1.96-4.84]), being single (1.98 [1.28-3.06]) and having a bonded scholarship (2.34 [1.37-3.98]). In the model with interaction between UQRCS attendance and rural background, independent predictors of rural practice were rural background and UQRCS attendance for 1 year (4.44 [2.38-8.29]) or 2 years (7.09 [3.57-14.10]), partner with rural background (3.14 [1.99-4.96]), being single (2.02 [1.30-3.12]) and bonded scholarship (2.27 [1.32-3.90]). The effects of rural background and UQRCS attendance were duration dependent. This study strengthens evidence that, after adjusting for multiple confounders, a number of exposures are independent predictors of rural medical practice. The strong positive interaction between rural background and rural clinical school exposure, and the duration-dependent relationships, could help inform policy changes aimed at enhancing the efficacy of Australia's rural clinical school program.
Publisher: Elsevier BV
Date: 06-2004
DOI: 10.1111/J.1467-842X.2004.TB00699.X
Abstract: To assess the skin irritant potential of a range of laboratory grown cyanobacterial species using skin-patch testing on human volunteers. Cell suspensions and extracts of cyanobacterial cultures of Microcystis aeruginosa (non-toxic strain), Anabaena circinalis and Nodularia spumigena were applied to 64 volunteers in one trial, and Microcystis aeruginosa (toxic strain), Apanocapsa incerta and Cylindrospermopsis raciborskii were applied to 50 volunteers in a second trial. Six cell concentrations of each organism in the range from less than 5000 to greater than 200,000 cells/mL were applied in random order using adhesive skin patches (Finn Chambers). In addition, the applications included two treatments of each cyanobacterial species, involving whole and lysed cells, and positive (sodium lauryl sulphate) and negative (culture media) controls. Patches were removed after 24 hours and assessment of erythema was made by a dermatologist blinded to the species, cell type and concentration. On average, between 20% and 24% of in iduals with 95% confidence interval +/-8% reacted across the concentration range tested for these cyanobacterial species. The reaction rates were lower (11% to 15%) among the subset of subjects not reacting to negative controls. The reaction was mostly mild, and in all cases was resolved without treatment. This was the case for both whole and lysed cells with little difference in reaction rates between these two treatments. There was also no dose-response across the concentration range for any of the cyanobacterial species tested. A small proportion of healthy people (around 20%) may develop a skin reaction to cyanobacteria in the course of normal water recreation, but the reaction is mild and resolved without treatment.
Publisher: Springer Science and Business Media LLC
Date: 13-06-2017
Publisher: BMJ
Date: 05-2019
DOI: 10.1136/BMJOPEN-2018-024231
Abstract: Networks are everywhere. Health systems and public health settings are experimenting with multifarious forms. Governments and providers are heavily investing in networks with an expectation that they will facilitate the delivery of better services and improve health outcomes. Yet, we lack a suitable conceptual framework to evaluate the effectiveness and sustainability of clinical and health networks. This paper aims to present such a framework to assist with rigorous research and policy analysis. The framework was designed as part of a project to evaluate the effectiveness and sustainability of health networks. We drew on systematic reviews of the literature on networks and communities of practice in health care, and on theoretical and evidence-based studies of the evaluation of health and non-health networks. Using brainstorming and mind-mapping techniques in expert advisory group sessions, we assessed existing network evaluation frameworks and considered their application to extant health networks. Feedback from stakeholders in network studies that we conducted was incorporated. The framework encompasses network goals, characteristics and relationships at member, network and community levels, and then looks at network outcomes, taking into account intervening variables. Finally, the short-term, medium-term and long-term effectiveness of the network needs to be assessed. The framework provides an overarching contribution to network evaluation. It is sufficiently comprehensive to account for many theoretical and evidence-based contributions to the literature on how networks operate and is sufficiently flexible to assess different kinds of health networks across their life-cycle at community, network and member levels. We outline the merits and limitations of the framework and discuss how it might be further tested.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2003
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2006
Publisher: CSIRO Publishing
Date: 2008
DOI: 10.1071/AH080479
Abstract: With the rapid ageing of the Australian population, dementia has emerged as a major health and economic challenge. Consensus exists that the number of people with dementia will grow significantly because the prevalence is strongly correlated with age. However, there are substantial gaps in our understanding of the impacts on the dementia ?epidemic? of changes in non-demographic risk factors and of our knowledge of the economic implications. Only a few prevalencebased studies have been conducted to examine the health economics of dementia in Australia. These studies have suggested that considerable resources are absorbed by dementia care, yet there is a lack of integrated models that simultaneously explore epidemiologic and economic perspectives incorporating the impact of preventive and early intervention initiatives. This study reviews the current evidence on the economic implications of dementia in Australia and approaches taken to project the future costs of dementia.
Publisher: AMPCo
Date: 09-2016
DOI: 10.5694/MJA16.00783
Publisher: Wiley
Date: 02-09-2008
DOI: 10.1111/J.1440-1584.2008.00978.X
Abstract: To identify factors that influenced medical students at Monash University to undertake their first year of clinical training (third year of the medical course) at a rural clinical school (RCS). Third-year Monash University medical students undertaking clinical placements at a RCS were surveyed in 2005. A semistructured questionnaire was used to ask students to rate the influence of a list of factors on their decision to undertake their year-long placement at a RCS. Under half (48%) of students studying at an RCS reported that they were of rural background. All surveyed items were identified as having had a positive influence. Greater clinical experience, learning opportunities and patient access were identified as having the greatest positive influence followed closely by free accommodation and other financial and supportive incentives. Future rural career intention was eight times more likely to be a positive influence in rural compared with urban background students. The most important positive influence on Monash third-year medical students' decision to study at an RCS is the perception of high-quality clinical experiences and education. This perception arises from rural exposure during pre-clinical years.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2006
Publisher: Wiley
Date: 11-07-2022
DOI: 10.1111/AJR.12896
Abstract: To assess awareness and risk of Q fever among agricultural show attendees. University of New England's Farm of the Future Pavilion, 2019, Sydney Royal Agricultural Show. Participants were ≥18 years, fluent in English, Australian residents, and gave their informed consent. Participants reported whether they had ever heard of Q fever and then completed the 'Q Tool' (www.qfevertool.com), which was used to assess participants' demographics and risk profiles. Cross-tabulations and logistic regression analyses were used to examine the relationship between these factors. A total of 344 participants were recruited who, in general, lived in major NSW cities and were aged 40-59 years. 62% were aware of Q fever. Living in regional/remote areas and regular contact with livestock, farms, abattoirs and/or feedlots increased the likelihood of Q fever awareness. Direct or indirect contact with feral animals was not associated with Q fever awareness after controlling for the latter risk factors. 40% of participants had a high, 21% a medium, and 30% a low risk of exposure. Slightly less than 10% reported a likely existing immunity or vaccination against Q fever. Among those who were not immune, living in a regional or remote area and Q fever awareness were independently associated with increased likelihood of exposure. Awareness of Q fever was relatively high. Although 61% of participants had a moderate to high risk of exposure to Q fever, they had not been vaccinated. This highlights the need to explore barriers to vaccination including accessibility of providers and associated cost.
Publisher: Elsevier BV
Date: 06-2008
DOI: 10.1111/J.1753-6405.2008.00229.X
Abstract: To compare the National Health Survey (NHS) derived estimates of hospital admissions with the number of hospital separations registered in the National Hospital Morbidity Dataset (NHMD). Using the person weights in the NHS, the Expanded Confidential Unit Record File of the 2004-05 NHS was used to derive a population estimate of the number of hospital admissions in the 12 months preceding the conduct of the survey. These estimates, by age and sex categories and whether or not the admission involved an overnight stay, were compared with the number of hospital separations registered in the NHMD. The number of hospital admissions estimated from the NHS was approximately two thirds the number of hospital separations registered in the NHMD. The discrepancy between the two data sources was greater when hospital episodes did not involve an overnight stay in hospital. There are systematic differences between the number of admissions/separations derived by the NHS and the NHMD for reasons including the technical difference between a hospital admission and a separation, and the s ling frame and scope of the NHS. Researchers looking for in idual level data on hospital utilisation must take note of the differences between NHS and the NHMD, and recognise that there are methods to simulate a representative population by enhancing an existing dataset with information from multiple data sources, thus providing researchers a cost-effective data resource.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2006
Publisher: Elsevier BV
Date: 08-2019
Publisher: Public Library of Science (PLoS)
Date: 07-07-2017
Publisher: Elsevier BV
Date: 04-2004
Publisher: Springer Science and Business Media LLC
Date: 15-09-2009
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1111/J.1753-6405.2010.00626.X
Abstract: This study determines whether the distribution of self-reported private health insurance (PHI) status in the 2004/05 National Health Survey (NHS) is representative of PHI coverage in Australia. Weighted estimates from the NHS 2004/05 are compared with PHI status reported for 2004/05 by the Private Health Insurance Administration Council (PHIAC, the independent regulator of the private health insurance industry). PHI status was imputed to children in the NHS based on PHI status of the adult in the household. The two data sources were deemed to be different if the PHIAC results were not within the 95% CI range for the NHS estimate. PHI status reported in the NHS and PHIAC are generally comparable except for some categories such as hospital cover of males aged 5-9 years and females aged 85 years and older where the NHS estimates are below PHIAC numbers and males aged 25-29, 35-39, and 50-54 years where the NHS estimates are higher. The findings suggest that while the NHS 2004/05 estimates may accurately represent coverage in Australia particularly when examined at an aggregated level, there is some variation in the NHS estimates when examined by sex and age group. Researchers need to be aware of the potential for s ling and reporting bias to contribute to some misrepresentation of PHI status when using the NHS to generalise to the Australian population. Exploring corrective measures will ensure that the NHS continues to be a valuable data resource for health researchers in Australia.
Publisher: Wiley
Date: 26-01-2016
DOI: 10.1111/MEDU.12935
Abstract: To determine the impact of the presence of a medical student on the satisfaction and process of the general practice consultation from the perspective of the general practitioner (GP), patient and student. An observational study was conducted in regional general practices accepting third-year medical students. General practitioners, patients and medical students were asked to complete a questionnaire after each consultation. The main outcome measures were: patient satisfaction GPs' perceived ability to deliver care medical students' satisfaction with their learning experience length of consultation and patient waiting times. Of the 26 GP practices approached, 11 participated in the study (42.3%). Patients returned 477 questionnaires: 252 consultations with and 225 without a student present. Thirteen GPs completed 473 questionnaires: 248 consultations with and 225 without a student. Twelve students attended 255 consultations. Most patients (83.5%) were comfortable with the presence of a student. There were no significant differences between consultations with and without a student regarding the time the patients spent in the waiting room (p = 0.6), the patients' perspectives of how the GPs dealt with their presenting problems (100% versus 99.2% p = 0.6) and overall satisfaction with the consultation (99.2% versus 99.1% p = 0.5). Despite these reassuring findings, a significantly higher proportion of patients in consultations without students raised sensitive or personal issues (26.3% versus 12.6% p < 0.001). There were no statistically significant differences in the lengths of consultations with and without students (81% versus 77% for 6-20 minutes consultation p = 0.1) or in the GPs' perceptions of how they effectively managed the presenting problem (95.1% versus 96.0% p = 0.4). Students found that the majority (83.9%) of the 255 consultations were satisfactory for learning. The presence of a medical student during the GP consultation was satisfactory for all participant groups. These findings support the ongoing and increased placement of medical students in regional general practice. Medical educators and GPs must recognise that patients may not raise personal issues with a student present.
Publisher: Springer Science and Business Media LLC
Date: 02-11-2012
Publisher: Informa UK Limited
Date: 02-2022
DOI: 10.2147/IJGM.S338128
Publisher: BMJ
Date: 26-02-2004
Publisher: BMJ
Date: 06-04-1996
Abstract: To compare the intakes of haem and non-haem iron in iron depleted and iron replete children. Case-control study. Early Childhood Centres and a long day care centre in Sydney, Australia. Children aged 12-36 months depleted in iron and controls matched for age and sex. Iron status by using plasma ferritin concentration. A three day weighed dietary intake record completed by the parents. Risk factors for iron deficiency assessed by questionnaire. Fifty six iron depleted and 68 iron replete children participated. The average daily intake of haem iron was significantly lower in the iron depleted group (t = 2.392, P = 0.018) there was a tendency towards a lower average daily intake of non-haem iron (t = 1.724, P = 0.086) and vitamin C (t = 1.921, P = 0.057) for iron depleted children. Low intake of haem iron (< 0.71 mg/day) was significantly associated with iron depletion with an odds ratio fo 3.0 (P = 0.005). The proportion of iron depleted children who were given whole cows' milk before 12 months of age was almost double that of iron replete children multivariate analysis showed that both haem iron intake and age of introduction of cows' milk were independently associated with iron depletion. The results of this study show that, in young children in developed countries, a lower haem iron intake is a major risk factor for iron depletion the introduction of whole cows' milk before 12 months is further confirmed as a risk factor. Parental education on nutrition should now focus on these two aspects of nutrition for infants and young children.
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1111/J.1753-6405.2008.00311.X
Abstract: To estimate the fraction of remaining life lived with and without dementia among Australian males and females at later life. Analysis was performed by applying the life table technique that integrates mortality and morbidity statistics to derive a single population health indicator. Observed prevalence rates were used to calculate life expectancy with dementia. At the age of 65 years, males are expected to live an additional 18 years, of which 6% would be lived with dementia. Females surviving to 65 years, are likely to live a further 22 years, 9% of which is expected to be lived with dementia. At the age of 85 years, males live a further six years one-sixth of this life spent with dementia. Females surviving to this age would live an additional seven years, with one-fourth of that life with dementia. The portion of life lived with dementia out of total remaining years of life increases with age at the rate of 20 to 30% every five years beyond the age of 65. CONCLUSION. The extension of life expectancy is associated with increased duration of life lived with dementia. As females live longer than males, they experience a greater impact of dementia.
Publisher: Wiley
Date: 08-10-2020
DOI: 10.1111/INM.12798
Publisher: CSIRO Publishing
Date: 2008
DOI: 10.1071/AH080005
Abstract: Letters to the Editor
Publisher: Public Library of Science (PLoS)
Date: 15-05-2013
Publisher: Elsevier BV
Date: 08-1998
DOI: 10.1111/J.1467-842X.1998.TB01424.X
Abstract: This report compares the results from two s ling strategies used to determine the prevalence of elevated blood lead concentrations and iron status in 12-36 month old children in Central Sydney. The two methods were stratified random s ling using census collector districts and an opportunistic s ling strategy using client registers at Early Childhood Centres (ECCs). The response rates were 75.3% (n = 718 of whom 198 were aged 12-36 months) and 24.1% (n = 304) respectively. The geometric mean blood lead concentrations were 0.40 and 0.34 mumol/L respectively (p = 0.001). The traditional random s ling prevalence survey identified a significantly higher proportion of children with blood lead concentrations greater than 0.48 (OR = 0.61, 95% CI 0.40-0.93) and 0.72 mumol/L (OR = 0.44, 95% CI 0.21-0.92) compared to the simpler opportunistic survey. The median plasma ferritin concentration for both studies was 19 micrograms/L (p = 0.4). The prevalence of iron depletion, iron deficiency and iron deficiency anaemia was not significantly different between the two studies. In conclusion, opportunistic s ling through ECCs does not appear to be a substitute for the traditional random s ling prevalence surveys of determine the prevalence of elevated blood lead concentrations in pre-school children in Central Sydney. However, opportunistic s ling through ECCs may be an appropriate method for monitoring iron status, in particular iron depletion, in pre-school children in Central Sydney.
Start Date: 2010
End Date: 2012
Funder: Australian Research Council
View Funded ActivityStart Date: 2015
End Date: 2017
Funder: NHMRC
View Funded Activity