ORCID Profile
0000-0002-8720-8300
Current Organisation
UNSW Sydney
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Land Use and Environmental Planning | Transport Planning | Urban and Regional Studies (excl. Planning) | Human Geography
Publisher: Springer Science and Business Media LLC
Date: 11-04-2017
Publisher: MDPI AG
Date: 27-07-2020
Abstract: The aim of this study was to report on breastfeeding duration up to 24 months and determine the predictors of breastfeeding duration among women in South Western Sydney, one of the most culturally erse and socioeconomically disadvantaged regions of New South Wales (NSW), Australia. Mother–infant dyads (n = 1035) were recruited to the Healthy Smiles Healthy Kids birth cohort study. Study data were collected through telephone interviews at 2, 4, 8, 12, and 24 months postpartum. Cox proportional hazards models were used to determine factors associated with the risk of stopping full breastfeeding at six months and any breastfeeding at 12 and 24 months. The majority of mothers (92.3%) had initiated breastfeeding. At six months, 13.5% of infants were fully breastfed, while 49.9% received some breast milk. Only 25.5% and 2.9% of infants received some breast milk at 12 and 24 months, respectively. Lower maternal education level, lower socioeconomic status, full-time employment, maternal smoking during pregnancy, and caesarean delivery were associated with increased risk of stopping full breastfeeding at six months and any breastfeeding at 12 and 24 months. Older maternal age and partner’s preference for breastfeeding were associated with an increased likelihood of continuing any breastfeeding at 12 and 24 months. These findings present a number of opportunities for prolonging breastfeeding duration in disadvantaged communities in NSW.
Publisher: Springer Science and Business Media LLC
Date: 28-08-2020
DOI: 10.1186/S13104-020-05239-3
Abstract: This study aims to determine the social determinants and behavioural factors influencing frequency of toothbrushing among primary school children residing in the rural community of Lithgow in New South Wales, Australia. All six primary schools of Lithgow were approached to participate in a cross-sectional survey prior to implementation of water fluoridation. A validated oral health survey questionnaire was completed by 703 parents of the children. Multivariable logistic regression analysis was employed to determine significant predictors associated with frequency of toothbrushing. Parents with a positive attitude towards water fluoridation had 74% higher odds (OR = 1.74, 95% CI 1.17–2.60) of their children brushing twice or more daily. Children living in a single parent household had 34% reduced odds (OR = 0.66, 95% CI 0.43–0.99) of brushing twice daily. Poor maternal oral health was significantly associated with suboptimal dental hygiene practices in children, where mothers who had any tooth extracted had 7% reduced odds of their children brushing their teeth twice or more daily (OR = 0.93, 95% CI 0.90–0.97). Subsequently, children with increased consumption of chocolates per day were less likely to brush twice or more daily. Finally, children with dental insurance had two times higher odds (OR = 2.04, 95% CI 1.40–2.96) of brushing twice daily.
Publisher: Springer Science and Business Media LLC
Date: 08-08-2020
DOI: 10.1186/S12875-020-01230-W
Abstract: Studies report that increased levels of patient activation is associated with increased engagement with the health care system, better adherence to treatment protocols, and improved health outcomes. This study aims to evaluate the outcomes of a 12-month Patient-Centred Medical Home (PCMH) model called ‘WellNet’ on the activation levels of patients with one or more chronic diseases in general practices across Northern Sydney, Australia. A total of 636 patients aged 40 years and above with one or more chronic conditions consented to participate in the WellNet program which was delivered across six general practices in Northern Sydney, Australia. The WellNet intervention includes team-based care with general physicians and trained chronic disease management care coordinators collaborating with patients in designing a patient-tailored care plan with improved self-management support and care navigation according to the level of risk and health care needs. The level of patient activation was measured using the validated PAM 13-item scale at baseline and follow-up. A before and after case-series design was employed to determine the adjusted mean differences between baseline and 12-months using repeated measures analysis of covariance (ANCOVA). Additionally, the backward stepwise multivariable regression models were employed to identify significant predictors of activation at follow-up. Of the 626 patients, 420 reported their PAM scores at follow-up. The mean (SD) baseline PAM score was 57.9 (13.0). The adjusted model showed significant mean difference in PAM scores by increase of 6.5 (95% CI 5.0–8.1 p -value 0.001) after controlling for baseline covariates. The multivariable regression models showed that older age (B = − 0.14 95% CI -0.28, − 0.01) and private insurance (uninsured patients) (B = − 3.41 95% CI -6.50, − 0.32) were significantly associated with lower PAM scores at 12 months whereas higher baseline PAM score (B = 0.48 95% CI 0.37, 0.59) was significantly associated with higher follow-up PAM score. The WellNet study is the first of its kind in Australia to report on changes in the patient activation levels among patients with one or more chronic diseases. PCMH has the potential to improve patient activation and engagement which can lead to long-term health benefits and sustained self-management behaviours.
Publisher: Medip Academy
Date: 24-04-2017
DOI: 10.18203/2394-6040.IJCMPH20171751
Abstract: Background: The aim of the study was to compare the efficiency of green tea mouthwash, Listerine mouthwash and Chlorhexidine mouthwash in plaque reduction among orthodontic patients. Methods: The study employed a double blinded, simple randomized, cross over design with a control group consisting of 30 orthodontic patients undergoing fixed appliance therapy. All the subjects were ided into group 1 (Green tea), group 2 (Listerine) and group 3 (Chlorhexidine) as 10 subjects per group. Gingival status was assessed using Sulcus Bleeding Index and plaque accumulation was assessed using Turesky-Gilmore-Glickman modification of Quigley Hein Index. After a relapse period of 15 days, group 1 and 2 were crossed over, however, group 3 remained the same. Indices were again recorded at baseline and 15th day. Results: The mean gingival and plaque score was reduced in all the three groups. However, green tea mouthwash was estimated to have the highest mean difference from 2.17 ± 0.610 at baseline to 1.48 ± 0.474 on the 15th day. Conclusions: Effective use of mouthwashes as supplements for tooth brushing has proved to be beneficial in oral hygiene and maintenance. The findings of this study provide useful insights on the effectiveness of different compositions of mouthwashes.
Publisher: MDPI AG
Date: 28-10-2022
Abstract: The use of fluoride is effective in preventing dental caries. However, an excessive intake of fluoride leads to dental fluorosis, making it necessary to regularly monitor the fluoride intake especially for infants. There is hitherto a lack of information on fluoride content in infant foods from an Australian perspective. Therefore, this study aims to estimate the amount of fluoride content from a range of commercially available ready-to-eat (RTE) infant foods and drinks available in Australia. Based on an external calibration method, potentiometry involving a fluoride ion selective electrode and a silver|silver chloride reference electrode was conducted to analyse the fluoride content of a total of 326 solid food s les and 49 liquid food s les in this work. Our results showed an overall median (range) fluoride content of 0.16 (0.001–2.8) µg F/g of solid food s les, and 0.020 (0.002–1.2) µg F/mL of liquid food s les. In addition, ~77.5% of the liquid s les revealed a fluoride content 0.05% µg F/mL. The highest variation of fluoride concentration (0.014–0.92 µg F/g) was found in formulas for ≥6 month-old infants. We have attributed the wide fluoride content variations in ready-to-eat infant foods and drinks to the processing steps, different ingredients and their origins, including water. In general, we found the fluoride content in most of the collected s les from Australian markets to be high and may therefore carry a risk of dental fluorosis. These results highlight the need for parents to receive appropriate information on the fluoride content of ready-to-eat infant food and drinks.
Publisher: Elsevier BV
Date: 06-2021
Publisher: MDPI AG
Date: 26-02-2021
Abstract: Evidence shows that inadequate or low health literacy (LHL) levels are significantly associated with economic ramifications at the in idual, employer, and health care system levels. Therefore, this study aims to estimate the economic burden of LHL among a culturally and linguistically erse (CALD) community in Blacktown: a local government area (LGA) in Sydney, Australia. This study is a secondary analysis of cross-sectional data from publicly available datasets, including 2011 and 2016 census data and National Health Survey (NHS) data (2017–2018) from the Australian Bureau of Statistics (ABS), and figures on Disease Expenditure in Australia for 2015–2016 provided by the Australian Institute of Health and Welfare (AIHW). This study found that 20% of Blacktown residents reported low levels of active engagement with health care providers (Domain 6 of the Health Literacy Questionnaire (HLQ)), with 14% reporting a limited understanding of the health information required to take action towards improving health or making health care decisions (Domain 9 of the HLQ). The overall extra/delta cost (direct and indirect health care costs) associated with LHL in the Blacktown LGA was estimated to be between $11,785,528 and $15,432,239 in 2020. This is projected to increase to between $18,922,844 and $24,191,911 in 2030. Additionally, the extra disability-adjusted life year (DALY) value in 2020, for all chronic diseases and age-groups—comprising the extra costs incurred due to years of life lost (YLL) and years lived with disability (YLD)—was estimated at $414,231,335. The findings of our study may enable policymakers to have a deeper understanding of the economic burden of LHL in terms of its impact on the health care system and the production economy.
Publisher: Springer Singapore
Date: 2018
Publisher: MDPI AG
Date: 30-10-2020
DOI: 10.3390/NU12113343
Abstract: Understanding the determinants of early introduction of sugar sweetened beverages (SSBs) may assist in designing effective public health interventions to prevent childhood weight related conditions (obesity). This study explores the relationship between family/infant characteristics and the early introduction of SSBs among infants in Sydney, Australia. Mothers (n = 934) from an ongoing birth cohort study were interviewed at 8, 17, 34, and 52 weeks postpartum. Multivariable logistic regression analysis was used to identify family/infant factors independently associated with the likelihood of early introduction of SSBs ( weeks of age). Of the 934 mothers interviewed, 42.7% (n = 399) of infants were introduced to SSBs before 52 weeks. Mothers who were born in Vietnam (adjusted Odds Ratio (AOR) = 2.14 95% confidence interval (CI) 1.33, 3.47), other Asian countries (AOR = 1.62 95% CI 1.02, 2.58) as well as single mothers (AOR = 3.72 95% CI 2.46, 5.62) had higher odds of introducing SSBs early to their infants. Mothers from highly advantaged socioeconomic background (AOR = 0.43 95% CI 0.28, 0.68), those who breastfed their baby for 17–25 weeks (AOR = 0.60 95% CI 0.37, 0.99), 26–51 weeks (AOR = 0.65 95% CI 0.45, 0.94), and 52 weeks or more (AOR = 0.62 95% CI 0.43, 0.90) and those who introduced solids between 17–25 weeks (AOR = 0.58 95% CI 0.36, 0.91) and 26 weeks or more (AOR = 0.55 95% CI 0.34, 0.91) had reduced odds of introducing SSBs early. Tailoring health promotion programs for these vulnerable groups may delay the introduction of SSBs.
Publisher: Springer Science and Business Media LLC
Date: 24-08-2020
DOI: 10.1186/S12955-020-01539-1
Abstract: Evidence suggests that Patient-centred Medical Home (PCMH) model facilitates person-centred care and improves health-related quality of life for patients with chronic illness. This study aims to evaluate changes in health-related quality of life (HRQoL), before and after enrolment into a 12-month integrated care program called ‘WellNet’. This study includes 616 eligible consented patients aged 40 years and above with one or more chronic conditions from six general practices across Sydney, Australia. The WellNet program included a team of general practitioners (GPs) and clinical coordinators (CCs) providing patient-tailored care plans configured to in idual risk and complexity. HRQoL was recorded using the validated EuroQol five dimensions five levels (EQ-5D-5L) instrument at baseline and 12 months. Additionally, patients diagnosed with osteoarthritis also reported HRQoL using short versions of Knee and/or Hip disability and osteoarthritis outcome scores (KOOSjr and HOOSjr). A case-series study design with repeated measures analysis of covariance (ANCOVA) was used to assess changes in mean differences of EQ-5D index scores after controlling for baseline covariates. Additionally, backward stepwise multivariable linear regression models were conducted to determine significant predictors of EQ-5D index scores at follow-up. Out of 616 patients, 417 (68%) reported EQ-5D scores at follow-up. Almost half (48%) of the WellNet patients reported improved EQ-5D index scores at follow-up. After controlling for baseline covariates, the adjusted mean difference was statistically significant whilst also meeting the bare minimal clinically important difference (MCID) with a change of 0.03 (95% CI 0.01, 0.05). The multivariable regression models determined that baseline EQ-5D scores and positive diagnosis of a respiratory illness were significant predictors of HRQoL at follow-up. There were significant improvements across both KOOS and HOOS assessments, specifically, the pain and symptom scores in both scales met statistical significance in addition to meeting the MCID. Patient-tailored chronic disease management (CDM) plans designed by team of GPs and CDM clinical coordinators could lead to better HRQoL among primary care patients.
Publisher: Elsevier BV
Date: 08-2023
Publisher: MDPI AG
Date: 23-11-2017
Publisher: Springer Science and Business Media LLC
Date: 13-02-2019
Publisher: Public Library of Science (PLoS)
Date: 28-10-2021
DOI: 10.1371/JOURNAL.PONE.0259220
Abstract: The Edmonton Obesity Staging System (EOSS) is based on weight related health complications among in iduals with overweight and obesity requiring clinical intervention. We aimed to assess the clinical usefulness of a new screening tool based on the EOSS for activating weight management discussions in general practice. We enrolled five General Practitioners (GPs) and 25 of their patients located nationwide in metropolitan areas of Australia to test the feasibility, acceptability, and accuracy of the new ‘EOSS-2 Risk Tool’, using cross-sectional and qualitative study designs. Diagnostic accuracy of the tool for the presence of EOSS ≥2 criteria was based on clinical information collected prospectively. To assess feasibility and applicability, we explored the views of GP and patient participants by thematic analysis of transcribed verbatim and de-identified data collected by semi-structured telephone interviews. Nineteen (76%) patients were aged ≥45 years, five (20%) were male, and 20 (80%) were classified with obesity. All 25 patients screened positive for EOSS ≥2 criteria by the tool. Interviews with patients continued until data saturation was reached resulting in a total of 23 interviews. Our thematic analysis revealed five themes: GP recognition of obesity as a health priority (GPs expressed strong interest in and understanding of its importance as a health priority) obesity stigma (GPs reported the tool helped them initiate health based and non-judgmental conversations with their patients) patient health literacy (GPs and patients reported increased awareness and understanding of weight related health risks), patient motivation for self-management (GPs and patients reported the tool helped focus on self-management of weight related complications), and applicability and scalability (GPs stated it was easy to use, relevant to a range of their patient groups, and scalable if integrated into existing patient management systems). The EOSS-2 Risk Tool is potentially clinically useful for activating weight management discussions in general practice. Further research is required to assess feasibility and applicability.
Publisher: Research Square Platform LLC
Date: 23-08-2019
Abstract: Background: Patients presenting with multiple chronic conditions have complex healthcare needs that are challenging to manage in primary care. This paper aims to evaluate the effectiveness of a patient-centred medical home (PCMH) model for improving clinical outcomes in high risk patients in Sydney, Australia. Methods: A cohort study design with a comparison group and a case-series study design were used to evaluate ‘between-group’ and ‘within-group’ effectiveness of a 12-month PCMH treatment called ‘WellNet’ delivered across several general practices in Sydney, Australia. The intervention group consists of 636 eligible participants who had been diagnosed with one or more chronic diseases and/or one or more elevated clinical risk factors and had a Hospital Admission Risk Profile (HARP) score of greater than 10 at study enrolment between October 2016 and October 2017. The comparison group consists of 7750 randomly selected and well-matched patients receiving usual general practice (GP) care at four geographically comparable general practices in Sydney. Data collected from the general practices include socio-demographics clinical measures and self-completed health surveys. Outcomes include 12-month changes in clinical outcomes and patient reported general and disease-specific health assessments. Paired s le t-test and independent s les t-test will be used to determine significant ‘within-group’ and ‘between-group’ differences respectively. In addition, analysis of covariance (ANCOVA) and repeated measures ANCOVA will be used to determine any differences in the clinical measures and assessments after adjusting for covariates such as age, gender and baseline values. Discussion: To our knowledge, the WellNet study is the first study in Australia to generate evidence on the feasibility of recruitment, retention, and adherence into, as well as effectiveness of a comprehensive PCMH model using GP-based data. Baseline findings show that mean age of the study participants was 70.05 years with nearly even gender distribution of males and females. The most prevalent chronic diseases in descending order were: circulatory system disorders (69.8%), diabetes (47.4%), musculoskeletal disorders (43.5%), respiratory diseases (28.7%), mental illness (18.8%), and cancer (13.6%). Findings of this study may be beneficial to both patients and providers in terms of improved health outcomes, shared-decision making, and increased satisfaction in delivery of care respectively.
Publisher: MDPI AG
Date: 15-07-2021
DOI: 10.3390/NU13072433
Abstract: Food security among migrants and refugees remains an international public health issue. However, research among ethnic minorities in Australia is relatively low. This study explored the factors that influence the understanding of food labelling and food insecurity among Libyan migrants in Australia. An online survey was completed by 271 Libyan migrant families. Data collection included the 18-item US Household Food Security Survey Module (for food security) and a question from the Food Standards Australia New Zealand Consumer Label Survey (for food labelling comprehension). Multivariable logistic regression modelling was utilised to identify the predictors of food label comprehension and food security. Food insecurity prevalence was 72.7% (n = 196) while 35.8% of families (n = 97) reported limited food label understanding. Household size, food store location, and food affordability were found to be significantly related to food insecurity. However, gender, private health insurance, household annual income, education, and food store type and location were found to be significantly related to food labelling comprehension. Despite the population’s high educational status and food labelling comprehension level, food insecurity remained an issue among the Libyan migrants. Policy makers should consider the incorporation of food label comprehension within a broader food security approach for migrants.
Publisher: APESB (Associacao de Apoio a Pesquisa em Saude Bucal)
Date: 2017
Publisher: Springer Science and Business Media LLC
Date: 04-2020
Publisher: APESB (Associacao de Apoio a Pesquisa em Saude Bucal)
Date: 2017
Publisher: Springer Science and Business Media LLC
Date: 29-11-2018
Publisher: Springer Science and Business Media LLC
Date: 24-11-2021
DOI: 10.1186/S12889-021-12202-9
Abstract: The burden of food insecurity remains a public health challenge even in high income countries, such as Australia, and especially among culturally and linguistically erse (CALD) communities. While research has been undertaken among several migrant communities in Australia, there is a knowledge gap about food security within some ethnic minorities such as migrants from the Middle East and North Africa (MENA). This study aims to determine the prevalence and correlates of food insecurity among Libyan migrant families in Australia. A cross-sectional design utilising an online survey and convenience s ling was used to recruit 271 participants, each representing a family, who had migrated from Libya to Australia. Food security was measured using the single-item measure taken from the Australian Health Survey (AHS) and the 18-item measure from the United States Department of Agriculture Household Food Security Survey Module (USDA HFSSM). Multivariable logistic regression was used to identify independent correlates associated with food insecurity. Using the single-item measure, the prevalence of food insecurity was 13.7% whereas when the 18-item questionnaire was used, more than three out of five families (72.3%) reported being food insecure. In the multivariable logistic regression analysis for the single-item measure, those living alone or with others reported higher odds of being food insecure (AOR = 2.55, 95% CI 1.05, 6.21) compared to those living with their spouse, whereas higher annual income (≥AUD 40,000) was associated with lower odds of food insecurity (AOR = 0.30, 95% CI 0.11, 0.84). Higher annual income was also associated with lower odds of food insecurity (AOR = 0.49, 95% CI 0.25, 0.94) on the 18-item measure. On both single and 18-item measures, larger family size (AOR = 1.27, 95% CI 1.07, 1.49 and AOR = 1.21, 95% CI 1.01, 1.47 respectively) was associated with increased odds of food insecurity. This study provides evidence that food insecurity amongst Libyan migrants in Australia is a widespread problem and is associated with a number of sociodemographic and socio-economic factors. The findings of this study serve to contribute to the depth and breadth of food security research among vulnerable communities, in this instance Libyan migrant families.
Publisher: Hindawi Limited
Date: 2017
DOI: 10.1155/2017/9419648
Abstract: Aim . To assess the prevalence of dental caries, oral hygiene knowledge, status, and practices among visually impaired in iduals in Chennai, Tamil Nadu. Materials and Methods . A cross-sectional study was conducted among 404 visually impaired in iduals in Chennai city, Tamil Nadu. Four schools were randomly selected for conducting the study. The oral hygiene status, prevalence of caries, and knowledge and attitude towards oral care among visually impaired in iduals were collected and analysed. Results . In the present study, whilst 42% of in iduals had fair oral hygiene status, 33% had good hygiene followed by 25% having poor oral hygiene. The overall mean number of DMFT was estimated to be 4.5 ± 2.7 . The mean number of decayed teeth was 3.1 ± 2.2 , mean number of missing teeth was 0.8 ± 1.4 , and mean number of filled teeth was 0.5 ± 1.3 . Conclusion . Whilst oral hygiene status was found to be relatively fair, there was a high rate of dental caries among the s le population. This shows that there is lack of knowledge regarding oral health maintenance. Therefore, early identification of caries coupled with effective oral health promotion programs providing practical knowledge to visually impaired students would prove beneficial.
Publisher: MDPI AG
Date: 21-09-2020
Abstract: Patient-centred care by a coordinated primary care team may be more effective than standard care in chronic disease management. We synthesised evidence to determine whether patient-centred medical home (PCMH)-based care models are more effective than standard general practitioner (GP) care in improving biomedical, hospital, and economic outcomes. MEDLINE, CINAHL, Embase, Cochrane Library, and Scopus were searched to identify randomised (RCTs) and non-randomised controlled trials that evaluated two or more principles of PCMH among primary care patients with chronic diseases. Study selection, data extraction, quality assessment using Joanna Briggs Institute (JBI) appraisal tools, and grading of evidence using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach were conducted independently. A quantitative synthesis, where possible, was pooled using random effects models and the effect size estimates of standardised mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals were reported. Of the 13,820 citations, we identified 78 eligible RCTs and 7 quasi trials which included 60,617 patients. The findings suggested that PCMH-based care was associated with significant improvements in depression episodes (SMD −0.24 95% CI −0.35, −0.14 I2 = 76%) and increased odds of remission (OR 1.79 95% CI 1.46, 2.21 I2 = 0%). There were significant improvements in the health-related quality of life (SMD 0.10 95% CI 0.04, 0.15 I2 = 51%), self-management outcomes (SMD 0.24 95% CI 0.03, 0.44 I2 = 83%), and hospital admissions (OR 0.83 95% CI 0.70, 0.98 I2 = 0%). In terms of biomedical outcomes, with exception to total cholesterol, PCMH-based care led to significant improvements in blood pressure, glycated haemoglobin, and low-density lipoprotein cholesterol outcomes. The incremental cost of PCMH care was identified to be small and significantly higher than standard care (SMD 0.17 95% CI 0.08, 0.26 I2 = 82%). The quality of in idual studies ranged from “fair” to “good” by meeting at least 60% of items on the quality appraisal checklist. Additionally, moderate to high heterogeneity across studies in outcomes resulted in downgrading the included studies as moderate or low grade of evidence. PCMH-based care has been found to be superior to standard GP care in chronic disease management. Results of the review have important implications that may inform patient, practice, and policy-level changes.
Publisher: Elsevier BV
Date: 09-2023
Publisher: Elsevier BV
Date: 10-2023
Start Date: 12-2016
End Date: 05-2021
Amount: $190,000.00
Funder: Australian Research Council
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