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PURPOSE: There is limited evidence regarding the impact of public health restrictions on hip fracture hospitalization by place of fracture occurrence. This study aimed to examine the impact of COVID-19 public health restrictions on fall-related hip fracture hospitalization rates by place of occurrence. METHODS: This retrospective cohort study was conducted using hospitalization data in New South Wales, Australia, between January 2014 and June 2022. Older adults aged ≥65â¯years admitted to hospital following a fall-related hip fracture. An interrupted time-series analysis using autoregressive integrated moving average models evaluated the impact of public health restrictions on fall-related hip fracture hospitalization by place of fracture occurrence (home/residence, residential aged care facility (RACF), or away from usual residence). RESULTS: The mean observed fall-related hip fracture hospitalization rate during COVID-19 public health restrictions (36.3 per 100,000 people per month) was 13.4â¯% lower than the forecasted rate (41.1 per 100,000 people per month). The mean observed hospitalization rates for fall-related hip fractures at home/residence, at a RACF, and away from the usual residence were 3.8â¯%, 18.5â¯%, and 40.1â¯% lower than the forecasted rates, respectively. Level changes in the fall-related hip fracture hospitalization rates at RACFs and away from usual residences were -0.9 per 100,000 people per month (95â¯% CI -1.6 to -0.2) and -1.7 per 100,000 people per month (95â¯% CI -2.5 to -0.9), respectively. CONCLUSIONS: There was a decline in fall-related hip fracture hospitalization rates among older adults, where the fracture occurred at RACFs and away from a person's usual residence during COVID-19 public health restrictions.
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Key predictors of three trajectory group membership of potentially preventable hospitalisations were age, the number of comorbidities, the presence of chronic obstructive pulmonary disease and congestive heart failure, and frailty risk at the occurrence of hip fracture. These predictors of their trajectory group could be used in targeting prevention strategies. PURPOSE: Although older adults with hip fracture have a higher risk of multiple readmissions after index hospitalisation, little is known about potentially preventable hospitalisations (PPH) after discharge. This study examined group-based trajectories of PPH during a five-year period after a hip fracture among older adults and identified factors predictive of their trajectory group membership. METHODS: This retrospective cohort study was conducted using linked hospitalisation and mortality data in New South Wales, Australia, between 2013 and 2021. Patients aged ≥ 65 years who were admitted after a hip fracture and discharged between 2014 and 2016 were identified. Group-based trajectory models were derived based on the number of subsequent PPH following the index hospitalisation. Multinominal logistic regression examined factors predictive of trajectory group membership. RESULTS: Three PPH trajectory groups were revealed among 17,591 patients: no PPH (89.5%), low PPH (10.0%), and high PPH (0.4%). Key predictors of PPH trajectory group membership were age, number of comorbidities, dementia, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), frailty risk, place of incident, surgery, rehabilitation, and length of hospital stay. The high PPH had a higher proportion of patients with ≥ 2 comorbidities (OR: 1.86, 95% confidence interval (CI): 1.04-3.32) and COPD (OR: 2.97, 95%CIs: 1.76-5.04) than the low PPH, and the low and high PPHs were more likely to have CHF and high frailty risk as well as ≥ 2 comorbidities and COPD than the no PPH. CONCLUSIONS: Identifying trajectories of PPH after a hip fracture and factors predictive of trajectory group membership could be used to target strategies to reduce multiple readmissions.
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BACKGROUND: Individuals diagnosed with cancer via emergency admission are likely to have poor outcomes. This study aims to identify cancer diagnosed through an emergency hospital admission and examine predictors associated with mortality within 12-months. METHOD: A population-based retrospective 1:1 propensity-matched case-comparison study of people who had an emergency versus a planned hospital admission with a principal diagnosis of cancer during 2013-2020 in New South Wales, Australia using linked hospital, cancer registry and mortality records. Conditional logistic regression examined predictors of mortality at 12-months. RESULTS: There were 28,502 matched case-comparisons. Individuals who had an emergency admission were four times more likely to die within 12-months (Odds Ratio (OR) 3.93; 95 % confidence interval (CI) 3.75-4.13) compared to individuals who had a planned admission for cancer. Older individuals, diagnosed with lung (OR 1.89; 95 %CI 1.36-2.63) or digestive organ, excluding colorectal (OR1.78; 95 %CI 1.30-2.43) cancers, where the degree of spread was metastatic (OR 3.61; 95 %CI 2.62-4.50), who had a mental disorder diagnosis (OR 2.08; 95 %CI 1.89-2.30), lived in rural (OR 1.27; 95 %CI 1.17-1.37) or more disadvantaged neighbourhoods had a higher likelihood of death within 12-months following an unplanned admission compared to referent groups. Females (OR 0.87; 95 %CI 0.81-0.93) had an 13 % lower likelihood of mortality within 12-months compared to males. CONCLUSIONS: While some emergency cancer admissions are not avoidable, the importance of preventive screening and promotion of help-seeking for early cancer symptoms should not be overlooked as mechanisms to reduce emergency admissions related to cancer and to improve cancer survival.
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Serviço Hospitalar de Emergência , Neoplasias , Humanos , Neoplasias/epidemiologia , Neoplasias/diagnóstico , Neoplasias/mortalidade , Neoplasias/patologia , Masculino , Feminino , Estudos Retrospectivos , Idoso , Pessoa de Meia-Idade , Estudos de Casos e Controles , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adulto , Hospitalização/estatística & dados numéricos , New South Wales/epidemiologia , Idoso de 80 Anos ou mais , Adulto Jovem , Austrália/epidemiologia , Taxa de Sobrevida , Sistema de Registros , AdolescenteRESUMO
BACKGROUND: Variation persists in the quality of end-of-life-care (EOLC) for people with cancer. This study aims to describe the characteristics of, and examine factors associated with, indicators of potentially burdensome care provided in hospital, and use of hospital services in the last 12 months of life for people who had a death from cancer. METHOD: A population-based retrospective cohort study of people aged ≥ 20 years who died with a cancer-related cause of death during 2014-2019 in New South Wales, Australia using linked hospital, cancer registry and mortality records. Ten indicators of potentially burdensome care were examined. Multinominal logistic regression examined predictors of a composite measure of potentially burdensome care, consisting of > 1 ED presentation or > 1 hospital admission or ≥ 1 ICU admission within 30 days of death, or died in acute care. RESULTS: Of the 80,005 cancer-related deaths, 86.9% were hospitalised in the 12 months prior to death. Fifteen percent had > 1 ED presentation, 9.9% had > 1 hospital admission, 8.6% spent ≥ 14 days in hospital, 3.6% had ≥ 1 intensive care unit admission, and 1.2% received mechanical ventilation on ≥ 1 occasion in the last 30 days of life. Seventeen percent died in acute care. The potentially burdensome care composite measure identified 20.0% had 1 indicator, and 10.9% had ≥ 2 indicators of potentially burdensome care. Compared to having no indicators of potentially burdensome care, people who smoked, lived in rural areas, were most socially economically disadvantaged, and had their last admission in a private hospital were more likely to experience potentially burdensome care. Older people (≥ 55 years), females, people with 1 or ≥ 2 Charlson comorbidities, people with neurological cancers, and people who died in 2018-2019 were less likely to experience potentially burdensome care. Compared to people with head and neck cancer, people with all cancer types (except breast and neurological) were more likely to experience ≥ 2 indicators of potentially burdensome care versus none. CONCLUSION: This study shows the challenge of delivering health services at end-of-life. Opportunities to address potentially burdensome EOLC could involve taking a person-centric approach to integrate oncology and palliative care around individual needs and preferences.
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Neoplasias , Assistência Terminal , Feminino , Humanos , Idoso , Estudos Retrospectivos , Cuidados Paliativos , Hospitalização , Neoplasias/terapia , MorteRESUMO
Aim: To examine the impact of concussion on objective measures of school performance. Materials & methods: Population-based matched cohort study using linked health and education records of young people aged ≤18 years hospitalized with concussion in New South Wales, Australia, during 2005-2018, and matched comparisons not hospitalized with any injury. Results: Young people with concussion had higher risk of not achieving the national minimum standards for literacy and numeracy assessments, ranging from 30% for numeracy to 43% for spelling, and not completing high school, ranging from 29% for year 10 to 77% for year 12, compared with matched peers. Conclusion: Young people hospitalized with concussion have impaired school performance compared with uninjured matched peers.
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BACKGROUND: Hearing loss can have a negative impact on individuals' health and engagement with social activities. Integrated approaches that tackle barriers and social outcomes could mitigate some of these effects for cochlear implants (CI) users. This review aims to synthesise the evidence of the impact of a CI on adults' health service utilisation and social outcomes. METHODS: Five databases (MEDLINE, Scopus, ERIC, CINAHL and PsychINFO) were searched from 1st January 2000 to 16 January 2023 and May 2023. Articles that reported on health service utilisation or social outcomes post-CI in adults aged ≥ 18 years were included. Health service utilisation includes hospital admissions, emergency department (ED) presentations, general practitioner (GP) visits, CI revision surgery and pharmaceutical use. Social outcomes include education, autonomy, social participation, training, disability, social housing, social welfare benefits, occupation, employment, income level, anxiety, depression, quality of life (QoL), communication and cognition. Searched articles were screened in two stages ̶̶̶ by going through the title and abstract then full text. Information extracted from the included studies was narratively synthesised. RESULTS: There were 44 studies included in this review, with 20 (45.5%) cohort studies, 18 (40.9%) cross-sectional and six (13.6%) qualitative studies. Nine studies (20.5%) reported on health service utilisation and 35 (79.5%) on social outcomes. Five out of nine studies showed benefits of CI in improving adults' health service utilisation including reduced use of prescription medication, reduced number of surgical and audiological visits. Most of the studies 27 (77.1%) revealed improvements for at least one social outcome, such as work or employment 18 (85.7%), social participation 14 (93.3%), autonomy 8 (88.9%), education (all nine studies), perceived hearing disability (five out of six studies) and income (all three studies) post-CI. None of the included studies had a low risk of bias. CONCLUSIONS: This review identified beneficial impacts of CI in improving adults' health service utilisation and social outcomes. Improvement in hearing enhanced social interactions and working lives. There is a need for large scale, well-designed epidemiological studies examining health and social outcomes post-CI.
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Implante Coclear , Implantes Cocleares , Adulto , Humanos , Qualidade de Vida , Estudos Transversais , Serviços de SaúdeRESUMO
OBJECTIVE: This study aimed to compare academic performance and high school completion of young people hospitalised for a burn compared with young people not hospitalised for an injury. DESIGN: A retrospective population-based matched case-comparison cohort study. PARTICIPANTS: Young people aged ≤18 years hospitalised for a burn during 2005-2018 in New South Wales, Australia, with age, sex and residential postcode-matched peers not hospitalised for any injury during 1 July 2001 and 31 December 2018. MAIN OUTCOME MEASURES: Performance below the national minimum standard (NMS) on the National Assessment Plan for Literacy and Numeracy assessments and not completing high school. RESULTS: Young females hospitalised for a burn had a 72% higher risk of poorer reading compared with their peers (adjusted relative risk (ARR) 1.72; 95% CI 1.33 to 2.23), while young males hospitalised with a burn showed no higher risk (ARR 1.14; 95% CI 0.91 to 1.43). Young males (ARR 1.05; 95% CI 0.81 to 1.35) and females (ARR 1.34; 95% CI 0.93 to 1.94) hospitalised with a burn had no higher risk of not reaching the NMS for numeracy compared with peers. Young people hospitalised with a burn had at least twice the risk of not completing year 10 (ARR 3.86; 95% CI 1.68 to 8.86), year 11 (ARR 2.45; 95% CI 1.89 to 3.18) and year 12 (ARR 2.09; 95% CI 1.63 to 2.67) compared with matched counterparts. CONCLUSIONS: Young females hospitalised with a burn displayed poorer academic performance for reading compared with matched peers, while males and females were more likely to leave school earlier. Identifying unmet learning support needs of young burn survivors should be investigated.
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Queimaduras , Hospitalização , Masculino , Feminino , Humanos , Adolescente , Estudos Retrospectivos , Estudos de Coortes , Queimaduras/epidemiologia , Estudos de Casos e ControlesRESUMO
OBJECTIVES: To describe if there has been a change in the reporting of adverse events associated with spinal manipulation in randomised clinical trials (RCTs) since 2016. DESIGN: A systematic literature review. DATA SOURCES: Databases were searched from March 2016 to May 2022: MEDLINE (Ovid), Embase, CINAHL, ICL, PEDro and Cochrane Library. The following search terms and their derivatives were adapted for each platform: spinal manipulation; chiropractic; osteopathy; physiotherapy; naprapathy; medical manipulation and clinical trial. METHODS: Domains of interest (pertaining to adverse events) included: completeness and location of reporting; nomenclature and description; spinal location and practitioner delivering manipulation; methodological quality of the studies and details of the publishing journal. Frequencies and proportions of studies reporting on each of these domains were calculated. Univariable and multivariable logistic regression models were fitted to examine the effect of potential predictors on the likelihood of studies reporting on adverse events. RESULTS: There were 5399 records identified by the electronic searches, of which 154 (2.9%) were included in the analysis. Of these, 94 (61.0%) reported on adverse events with only 23.4% providing an explicit description of what constituted an adverse event. Reporting of adverse events in the abstract has increased (n=29, 30.9%) while reporting in the results section has decreased (n=83, 88.3%) over the past 6 years. Spinal manipulation was delivered to 7518 participants in the included studies. No serious adverse events were reported in any of these studies. CONCLUSIONS: While the current level of reporting of adverse events associated with spinal manipulation in RCTs has increased since our 2016 publication on the same topic, the level remains low and inconsistent with established standards. As such, it is imperative for authors, journal editors and administrators of clinical trial registries to ensure there is more balanced reporting of both benefits and harms in RCTs involving spinal manipulation.
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Doenças Ósseas , Quiroprática , Manipulação da Coluna , Humanos , Manipulação da Coluna/efeitos adversos , Coluna Vertebral , Doenças Ósseas/etiologia , Bases de Dados FactuaisRESUMO
OBJECTIVES: To quantify changes in sport-related concussion and traumatic brain injury claims in New Zealand during the first two years of the COVID-19 pandemic (i.e., 2020 and 2021). DESIGN: Population-based cohort study. METHODS: This study included all new sport-related concussion and traumatic brain injury claims that were registered with the Accident Compensation Corporation in New Zealand during 1 January 2010 to 31 December 2021. Annual sport-related concussion and traumatic brain injury claim rates per 100,000 population from 2010 to 2019 were used to fit autoregressive integrated moving average models, from which forecast estimates with 95â¯% prediction intervals for 2020 and 2021 were derived and compared against corresponding observed values to obtain estimates of absolute and relative forecast errors. RESULTS: Sport-related concussion and traumatic brain injury claim rates were 30â¯% and 10â¯% lower than forecasted in 2020 and 2021, respectively, equating to an estimated total of 2410 fewer sport-related concussion and traumatic brain injury claims during the two-year period. CONCLUSIONS: There was a large reduction in sport-related concussion and traumatic brain injury claims in New Zealand during the first two years of the COVID-19 pandemic. These findings highlight the need for future epidemiological studies examining temporal trends of sport-related concussion and traumatic brain injury to account for the impact of the COVID-19 pandemic.
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Traumatismos em Atletas , Concussão Encefálica , Lesões Encefálicas Traumáticas , COVID-19 , Futebol Americano , Humanos , Traumatismos em Atletas/epidemiologia , Nova Zelândia/epidemiologia , Estudos de Coortes , Pandemias , COVID-19/epidemiologia , Concussão Encefálica/epidemiologia , Lesões Encefálicas Traumáticas/epidemiologia , Futebol Americano/lesõesRESUMO
BACKGROUND: To inform healthcare planning and resourcing, population-level information is required on the use of health services among young people with a mental disorder. This study aims to identify the health service use associated with mental disorders among young people using a population-level matched cohort. METHOD: A population-based matched case-comparison retrospective cohort study of young people aged ≤ 18 years hospitalised for a mental disorder during 2005-2018 in New South Wales, Australia was conducted using linked birth, health, and mortality records. The comparison cohort was matched on age, sex and residential postcode. Adjusted rate ratios (ARR) were calculated for key demographics and mental disorder type by sex. RESULTS: Emergency department visits, hospital admissions and ambulatory mental health service contacts were all higher for males and females with a mental disorder than matched peers. Further hospitalisation risk was over 10-fold higher for males with psychotic (ARR 13.69; 95%CI 8.95-20.94) and anxiety (ARR 11.44; 95%CI 8.70-15.04) disorders, and for both males and females with cognitive and behavioural delays (ARR 10.79; 95%CI 9.30-12.53 and ARR 14.62; 95%CI 11.20-19.08, respectively), intellectual disability (ARR 10.47; 95%CI 8.04-13.64 and ARR 11.35; 95%CI 7.83-16.45, respectively), and mood disorders (ARR 10.23; 95%CI 8.17-12.80 and ARR 10.12; 95%CI 8.58-11.93, respectively) compared to peers. CONCLUSION: The high healthcare utilisation of young people with mental disorder supports the need for the development of community and hospital-based services that both prevent unnecessary hospital admissions in childhood and adolescence that can potentially reduce the burden and loss arising from mental disorders in adult life.
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Deficiência Intelectual , Serviços de Saúde Mental , Adulto , Adolescente , Masculino , Feminino , Humanos , Estudos Retrospectivos , Estudos de Coortes , Aceitação pelo Paciente de Cuidados de SaúdeRESUMO
INTRODUCTION: While the majority of adults with severe-to-profound hearing loss and poor speech perception outcomes with hearing aids benefit from receiving a cochlear implant, the long-term health and social benefits for implant recipients are yet to be explored. The objective of the ARCHS research is to provide a better understanding of the health and social factors that play a role in the lives of adults with a cochlear implant up to 10 years after the procedure. METHOD AND ANALYSIS: This research will involve conducting two retrospective cohort studies of adults aged ≥18 years who received a cochlear implant during 2011-2021 using linked administrative data first within New South Wales (NSW) and second Australia-wide. It will examine health service use and compare health and social outcomes for younger (18-64 years) and older (≥65 years) cochlear implant recipients. ETHICS AND DISSEMINATION: Ethical approval was received from the NSW Population Health Services Research Ethics Committee for the NSW cohort study (Reference: 2022/ETH00382/2022.07) and from the Macquarie University ethics committee for the national cohort study (Reference: 520221151437084). Research findings will be published in peer-reviewed journals and presented at scientific conferences.
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Implante Coclear , Implantes Cocleares , Auxiliares de Audição , Adulto , Humanos , Adolescente , Estudos Retrospectivos , Estudos de Coortes , Implante Coclear/métodosRESUMO
OBJECTIVES: To synthesise competition and training injury data in amateur boxing. DESIGN: Systematic review and meta-analysis. Pooled estimates of competition injury incidence rates per 1000 athlete-exposures (IIRAE) and per 1000â¯min of exposure (IIRME), and training injury incidence rates per 1000â¯h of exposure (IIRHE) were obtained by fitting random-effects models. METHODS: MEDLINE, Embase, AMED, AUSPORT, and SPORTDiscus databases were searched from inception to 27 May 2022. Cohort studies with prospectively collected injury and exposure data from amateur boxing competition or training published in peer-reviewed journals were eligible for inclusion. RESULTS: Seventeen studies were eligible for inclusion. The competition IIRAE and IIRME summary estimates were 54.7 (95â¯% CI 33.8-88.4) and 6.8 (95â¯% CI 4.2-10.9), respectively. The training IIRHE summary estimate was 1.3 (95â¯% CI 0.2-7.0). The most commonly injured body regions in the competition and training settings were the head and neck (median: 72â¯%; range: 46â¯% to 100â¯%) and upper limb (median: 49â¯%; range: 40â¯% to 53â¯%), respectively. The predominant types of injury were contusions (median: 35â¯%; range: 5â¯% to 100â¯%) and lacerations and abrasions (median: 20â¯%; range: 0â¯% to 69â¯%) in the competition setting, and sprains and strains (median: 60â¯%; range: 50â¯% to 81â¯%) in the training setting. CONCLUSIONS: Amateur boxing athletes sustain, on average, 1 injury every 2.5â¯h of competition and every 772â¯h of training. There is a need for identifying injury mechanisms and modifiable risk factors that can be targeted by preventive measures to reduce the burden of injury in amateur boxing.
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Traumatismos em Atletas , Boxe , Traumatismos Craniocerebrais , Humanos , Boxe/lesões , Traumatismos em Atletas/epidemiologia , Estudos Prospectivos , Atletas , Traumatismos Craniocerebrais/epidemiologia , IncidênciaRESUMO
OBJECTIVES: To examine the availability and content of publicly available concussion information published by peak amateur and professional combat sport governing bodies in Australia. DESIGN: Cross-sectional study; document analysis. METHODS: Publicly available concussion information was retrieved from the websites of eleven peak Australian amateur and professional combat sport governing bodies. Data on type of source material, concussion definition, provision of medical services, concussion evaluation, and return-to-sport information were extracted. The quality of the information was assessed using a modified version of the Global Rating Scale. RESULTS: Eight out of eleven combat sport governing bodies provided concussion information in source documents ranging from competition rules to position statements to specific policies. Five governing bodies provided information on post-contest concussion evaluation or testing, four of which mentioned the Sport Concussion Assessment Tool. Eight governing bodies provided information on return-to-sport, of which six stipulated mandatory minimum rest periods and four indicated that athletes should complete a graduated return-to-sport protocol. The provided concussion information was generally of low quality, with a median score of 3 out of 9 (range: 1-4). CONCLUSIONS: There is substantial scope and an urgent need for improving concussion guidelines across peak combat sport governing bodies in Australia to improve the health and safety of their athletes.
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Traumatismos em Atletas , Concussão Encefálica , Atletas , Traumatismos em Atletas/diagnóstico , Austrália , Concussão Encefálica/diagnóstico , Estudos Transversais , Humanos , Volta ao EsporteRESUMO
BACKGROUND: Commercial delivery cyclists represent a uniquely vulnerable and poorly understood road user. The primary aim of this study was to pilot whether cycling injuries could be categorised as either commercial or non-commercial using documentation entered into routine hospital medical records, in order to determine the feasibility of conducting a large cohort study of commercial cycling injuries in the future. A secondary aim was to determine which key demographic, incident and injury characteristics were associated with commercial versus non-commercial cycling injuries in emergency. METHODS: Pilot retrospective cohort study of adults presenting to an acute public hospital emergency department between May 2019 and April 2020 after sustaining a cycling-related injury. Multinomial logistic regression was used to examine the demographic, incident and injury characteristics associated with commercial compared to non-commercial cycling. RESULTS: Of the 368 people presenting to the emergency department with a cycling-related injury, we were able to categorise 43 (11.7%) as commercial delivery cyclists, 153 (41.6%) as non-commercial cyclists and the working status of 172 (46.7%) was unable to be confirmed. Both commercial and unconfirmed cyclists were more likely to be younger than non-commercial cyclists. Compared to non-commercial cyclists, commercial cyclists were 11 times more likely to speak a language other than English (AOR 11.3; 95% CI 4.07-31.30; p<0.001), less likely to be injured from non-collision incidents than vehicle collisions (AOR 0.36; 95% CI 0.15-0.91; p=0.030) and were over 13 times more likely to present to the emergency department between 8.00pm and 12.00am compared to the early morning hours (12.00 to 8.00am) (AOR 13.43; 95% CI 2.20-82.10; p=0.005). CONCLUSIONS: The growth of commercial cycling, particularly through online food delivery services, has raised concern regarding commercial cyclist safety. Improvements in the recording of cycling injury commercial status is required to enable ongoing surveillance of commercial cyclist injuries and establish the extent and risk factors associated with commercial cycling.
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BACKGROUND: Children and young people who sustain injuries resulting in a hospital admission may experience adverse effects for months or years following the event. Understanding the attributable burden and health service needs is vital for public health planning as well as individual care provision. This study aims to identify the hospitalised morbidity associated with injury among young people by sex using a population-level matched cohort. METHOD: A population-level matched case-comparison retrospective cohort study of young people aged ≤18 years hospitalised for an injury during 2005-2018 in New South Wales, Australia using linked birth, health, and mortality records. The comparison cohort was matched on age, gender and residential postcode. Adjusted rate ratios (ARR) were calculated for age group, injury severity and nature of injury by sex. RESULTS: There were 122,660 (60.9%) males and 78,712 (39.1%) females aged ≤18 years hospitalised after sustaining an injury. Males (ARR 2.89; 95%CI 2.81-2.97) and females (ARR 2.79; 95%CI 2.68-2.90) who were hospitalised after an injury had a higher risk of subsequent hospital admission than their matched peers. Males (ARR 3.38; 95%CI 2.81-4.05) and females (ARR 3.41; 95%CI 2.72-4.26) with serious injuries had a higher risk of admission compared to peers. Males with dislocations, sprains and strains (ARR 3.40; 95%CI 3.03-3.82), burns (ARR 3.37; 95%CI 2.99-3.80), and fractures (ARR 3.20; 95%CI 3.07-3.33), and females with burns (ARR 3.84; 95%CI 3.40-4.33), dislocations, sprains and strains (ARR 3.54; 95%CI 2.96-4.23), and traumatic brain injury (ARR 3.39; 95%CI 3.01-3.82) had the highest risk of subsequent hospitalisation compared to peers. CONCLUSION: Patient management and care extends beyond the injury admission as many young people face high levels of contact with health services in the months and years following injury. These findings will inform health service planning and trauma care management for young people and families affected by injury.
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Queimaduras , Entorses e Distensões , Adolescente , Criança , Estudos de Coortes , Feminino , Hospitalização , Hospitais , Humanos , Masculino , Estudos RetrospectivosRESUMO
AIM: This study aims to identify the hospitalised morbidity associated with three common chronic health conditions among young people using a population-based matched cohort. METHODS: A population-level matched case-comparison retrospective cohort study of young people aged ≤18 years hospitalised with asthma, type 1 diabetes (T1D) or epilepsy during 2005-2018 in New South Wales, Australia using linked birth, health and mortality records. The comparison cohort was matched on age, sex and residential postcode. Adjusted rate ratios (ARR) were calculated by sex and age group. RESULTS: There were 65 055 young people hospitalised with asthma, 6648 with epilepsy, and 2209 with T1D. Young people with epilepsy (ARR 10.95; 95% confidence interval (CI) 9.98-12.02), T1D (ARR 8.64; 95% CI 7.72-9.67) or asthma (ARR 4.39; 95% CI 4.26-4.53) all had a higher risk of hospitalisation than matched peers. Admission risk was highest for males (ARR 11.00; 95% CI 9.64-12.56) and females with epilepsy (ARR 10.83; 95% CI 9.54-12.29) compared to peers. The highest admission risk by age group was for young people aged 10-14 years (ARR 5.50; 95% CI 4.77-6.34) living with asthma, children aged ≤4 years (ARR 12.68; 95% CI 11.35-14.17) for those living with epilepsy, and children aged 5-9 years (ARR 9.12; 95% CI 7.69-10.81) for those living with T1D compared to peers. CONCLUSIONS: The results will guide health service planning and highlight opportunities for better management of chronic health conditions, such as further care integration between acute, primary and community health services for young people.
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Asma , Diabetes Mellitus Tipo 1 , Epilepsia , Adolescente , Asma/epidemiologia , Asma/terapia , Criança , Doença Crônica , Estudos de Coortes , Diabetes Mellitus Tipo 1/terapia , Epilepsia/epidemiologia , Epilepsia/terapia , Feminino , Hospitais , Humanos , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVES: To compare academic performance and high school completion of young people admitted to hospital with epilepsy and matched peers from the general population not admitted to hospital with epilepsy during the study period. METHODS: A population-based matched case-comparison cohort study of young people aged ≤18 years hospitalised with epilepsy during 2005-2018 in New South Wales, Australia, using linked birth, health, education, and mortality records. The comparison cohort was matched on age, sex, and residential postcode. Generalised linear mixed modelling examined risk of school performance below the national minimum standard (NMS), and generalised linear regression examined risk of not completing high school for young people hospitalised with epilepsy compared to matched peers not hospitalised with epilepsy during the study period. Adjusted relative risks (ARRs) with 95% confidence intervals (CIs) were derived from the final models. RESULTS: Young people hospitalised with epilepsy had more than 3 times higher risk of not achieving the NMS for numeracy (ARR: 3.40; 95%CI 2.76â4.18) and reading (ARR: 3.15; 95%CI 2.60â3.82), compared to matched peers. Young people hospitalised with epilepsy had a 78% higher risk of not completing year 10 (ARR: 1.78; 95%CI 1.14â2.79), 18% higher risk of not completing year 11 (ARR: 1.18; 95%CI 0.97â1.45), and 38% higher risk of not completing year 12 (ARR: 1.38; 95%CI 1.14â1.67), compared to matched counterparts. CONCLUSION: Young people hospitalised with epilepsy have higher risk of not achieving minimum standards for numeracy and reading and not completing high school compared to matched peers. There is a need for effective strategies and interventions (e.g., early seizure control and improved multidisciplinary management and care coordination) to minimise the potential adverse effect of epilepsy on education and its sequelae such as early school leaving, unemployment and poverty in adulthood.
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Epilepsia , Adolescente , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Escolaridade , Epilepsia/epidemiologia , Humanos , Instituições AcadêmicasRESUMO
BACKGROUND: With the increasing use of mobile technology, ecological momentary assessments (EMAs) may enable routine monitoring of patient health outcomes and patient experiences of care by health agencies. This rapid review aims to synthesise the evidence on the use of EMAs to monitor health outcomes after traumatic unintentional injury. METHOD: A rapid systematic review of nine databases (MEDLINE, Web of Science, Embase, CINAHL, Academic Search Premier, PsychINFO, Psychology and Behavioural Sciences Collection, Scopus, SportDiscus) for English-language articles from January 2010-September 2021 was conducted. Abstracts and full-text were screened by two reviewers and each article critically appraised. Key information was extracted by population characteristics, age and sample size, follow-up time period(s), type of EMA tools, physical health or pain outcome(s), psychological health outcome(s), general health or social outcome(s), and facilitators or barriers of EMA methods. Narrative synthesis was undertaken to identify key EMA facilitator and barrier themes. RESULTS: There were 29 articles using data from 25 unique studies. Almost all (84.0%) were prospective cohort studies and 11 (44.0%) were EMA feasibility trials with an injured cohort. Traumatic and acquired brain injuries and concussion (64.0%) were the most common injuries examined. The most common EMA type was interval (40.0%). There were 10 key facilitator themes (e.g. feasibility, ecological validity, compliance) and 10 key barrier themes (e.g. complex technology, response consistency, ability to capture a participant's full experience, compliance decline) identified in studies using EMA to examine health outcomes post-injury. CONCLUSIONS: This review highlighted the usefulness of EMA to capture ecologically valid participant responses of their experiences post-injury. EMAs have the potential to assist in routine follow-up of the health outcomes of patients post-injury and their use should be further explored.
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Avaliação Momentânea Ecológica , Envio de Mensagens de Texto , Humanos , Avaliação de Resultados em Cuidados de Saúde , Cooperação do Paciente , Estudos ProspectivosRESUMO
BACKGROUND: Emerging adulthood is a distinct segment of an individual's life course. The defining features of this transitional period include identity exploration, instability, future possibilities, self-focus, and feeling in-between, all of which are thought to affect quality of life, health, and well-being. A longitudinal cohort study with a comprehensive set of measures would be a valuable resource for improving the understanding of the multifaceted elements and unique challenges that contribute to the health and well-being of emerging adults. OBJECTIVE: The main aim of this pilot study was to evaluate the feasibility and acceptability of recruiting university graduates to establish a longitudinal cohort study to inform the understanding of emerging adulthood. METHODS: This pilot study was conducted among graduates at a large university. It involved collecting web-based survey data at baseline (ie, graduation) and 12 months post baseline, and linking survey responses to health records from administrative data collections. The feasibility outcome measures of interest included the recruitment rate, response rate, retention rate, data linkage opt-out rate, and availability of linked health records. Descriptive statistics were used to evaluate the representativeness of the sample, completeness of the survey responses, and data linkage characteristics. RESULTS: Only 2.8% of invited graduates (238/8532) agreed to participate in this pilot cohort study, of whom 59.7% (142/238) responded to the baseline survey. The retention rate between the baseline and follow-up surveys was 69.7% (99/142). The completeness of the surveys was excellent, with the proportion of answered questions in each survey domain ranging from 87.3% to 100% in both the baseline and follow-up surveys. The data linkage opt-out rate was 32.4% (77/238). CONCLUSIONS: The overall recruitment rate was poor, while the completeness of survey responses among respondents ranged from good to excellent. There was reasonable acceptability for conducting data linkage of health records from administrative data collections and survey responses. This pilot study offers insights and recommendations for future research aiming to establish a longitudinal cohort study to investigate health and well-being in emerging adults. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry number ACTRN12618001364268; https://tinyurl.com/teec8wh. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/16108.