Predicting haemoglobin deferral using machine learning models: Can we use the same prediction model across countries?

BACKGROUND AND OBJECTIVES: Personalized donation strategies based on haemoglobin (Hb) prediction models may reduce Hb deferrals and hence costs of donation, meanwhile improving commitment of donors. We previously found that prediction models perform better in validation data with a high Hb deferral rate. We therefore investigate how Hb deferral prediction models perform when exchanged with other blood establishments. MATERIALS AND METHODS: Donation data from the past 5 years from random samples of 10,000 donors from Australia, Belgium, Finland, the Netherlands and South Africa were used to fit random forest models for Hb deferral prediction. Trained models were exchanged between blood establishments. Model performance was evaluated using the area under the precision-recall curve (AUPR). Variable importance was assessed using SHapley Additive exPlanations (SHAP) values. RESULTS: Across the validation datasets and exchanged models, the AUPR ranged from 0.05 to 0.43. Exchanged models performed similarly within validation datasets, irrespective of the origin of the training data. Apart from subtle differences, the importance of most predictor variables was similar in all trained models. CONCLUSION: Our results suggest that Hb deferral prediction models trained in different blood establishments perform similarly within different validation datasets, regardless of the deferral rate of their training data. Models learn similar associations in different blood establishments.

Regular high-frequency whole blood donation and risk of cardiovascular disease in middle-aged and older blood donors in Australia.

BACKGROUND: Previous mixed findings on the associations between whole blood (WB) donation and risk of cardiovascular diseases (CVD) may in part reflect inadequate adjustment for the "healthy donor effect" (HDE). METHODS: We used the Sax Institute's 45 and Up Study linked with blood donation history and other health-related databases to examine the association between regular, high-frequency WB donation and the risk of CVD. To mitigate the impact of HDE, we used a "5-years qualification period," in which donors must donate at least 1 WB donation in the 1st and 5th year of "qualification period." We then compared the risk of CVD in the years following the "qualification period" between the regular high-frequency WB donors (≥2 WB donation in each qualification year) and others using Cox proportional-hazards models. Analyses were adjusted for potential confounders, such as sociodemographic, lifestyle, and health-related variables, and results are reported separately for male and female donors. RESULTS: A total of 2736 male and 2917 female donors were included in the analyses. The median years of follow-up per donor was 5.84 years (Q1-Q3, 5.47-6.23). The rate of CVD hospitalization was 11.20 and 4.50 per 1000 person-years for males and females, respectively. In fully adjusted models, the risk (hazard ratio) of CVD in regular high-frequency donors compared to other donors was 0.93 (95% Confidence Interval (CI), 0.68-1.29) for males and 0.79 (95% CI, 0.49-1.28) for females. CONCLUSIONS: We did not observe a statistically significant reduction of CVD risk in regular, high-frequency WB donors when adjusted for potential confounders.

An international comparison of haemoglobin deferral prediction models for blood banking.

BACKGROUND AND OBJECTIVES: Blood banks use a haemoglobin (Hb) threshold before blood donation to minimize donors' risk of anaemia. Hb prediction models may guide decisions on which donors to invite, and should ideally also be generally applicable, thus in different countries and settings. In this paper, we compare the outcome of various prediction models in different settings and highlight differences and similarities. MATERIALS AND METHODS: Donation data of repeat donors from the past 5 years of Australia, Belgium, Finland, the Netherlands and South Africa were used to fit five identical prediction models: logistic regression, random forest, support vector machine, linear mixed model and dynamic linear mixed model. Only donors with five or more donation attempts were included to ensure having informative data from all donors. Analyses were performed for men and women separately and outcomes compared. RESULTS: Within countries and overall, different models perform similarly well. However, there are substantial differences in model performance between countries, and there is a positive association between the deferral rate in a country and the ability to predict donor deferral. Nonetheless, the importance of predictor variables across countries is similar and is highest for the previous Hb level. CONCLUSION: The limited impact of model architecture and country indicates that all models show similar relationships between the predictor variables and donor deferral. Donor deferral is found to be better predictable in countries with high deferral rates. Therefore, such countries may benefit more from deferral prediction models than those with low deferral rates.

Electrocatalytic Properties of Oxygen-Deficient Perovskites Ca3Fe3-xMnxO8 (x = 1-2) for the Hydrogen Evolution Reaction.

We have demonstrated a systematic trend in the electrocatalytic activity for the hydrogen evolution reaction (HER) and its correlations with transition-metal type, structural order, and electrical conductivity. The materials studied in this work, Ca3FeMn2O8 (CaFe1/3Mn2/3O3-1/3), Ca3Fe1.5Mn1.5O8, and Ca3Fe2MnO8, belong to the family of oxygen-deficient perovskites and show a gradual increase in the ordering of oxygen vacancies. Ca3FeMn2O8 (CaFe1/3Mn2/3O3-1/3) contains randomly distributed oxygen vacancies, which begin to order in Ca3Fe1.5Mn1.5O8, and are fully ordered in Ca3Fe2MnO8. The gradual increase in the structural order is associated with a systematic enhancement of the electrocatalytic activity for HER in acidic conditions, Ca3FeMn2O8 < Ca3Fe1.5Mn1.5O8 < Ca3Fe2MnO8. While the improvement of the HER activity is also associated with an increase in the Fe content, we have shown that the type of structural order plays a more important role. We demonstrated this effect by control experiments on an analogous material where all Mn was substituted by Fe, leading to a different type of structural order and showing an inferior HER activity compared to the above three materials. Furthermore, electrical conductivity studies in a wide range of temperatures, 25-800 °C, indicate that the trend in the electrical conductivity is the same as that of the HER activity. These findings reveal several important structure-property relationships and highlight the importance of synergistic effects in enhancing the electrocatalytic properties.

Enhancement of Electrocatalytic and Pseudocapacitive Properties as a Function of Structural Order in A2Fe2O5 (A = Sr, Ba).

Significant enhancements of electrocatalytic activities for both half-reactions of water-electrolysis, i.e., oxygen evolution reaction (OER) and hydrogen evolution reaction (HER), as well as pseudocapacitive charge-storage properties are demonstrated upon changing the structural order in a perovskite-type system. The structural change is prompted by the increase in the ionic radius of the A-site ion in A2Fe2O5. The structure of Sr2Fe2O5 consists of alternating layers of FeO6 octahedra and FeO4 tetrahedra, whereas Ba2Fe2O5 comprises seven different coordination geometries for Fe. We note that the catalytically active metal, i.e., iron, and the oxygen stoichiometry are the same for both materials. Nevertheless, the change in the structural order results in significantly greater electrocatalytic activity of Ba2Fe2O5, manifested in smaller overpotentials, smaller charge-transfer resistance, greater electrocatalytic current, and faster reaction kinetics. In addition, this material shows significantly enhanced pseudocapacitive properties, with greater specific capacitance and energy density compared to Sr2Fe2O5. These findings indicate the important role of structural order in directing the electrochemical properties.

"Please help us with important research": A retrospective analysis examining the impact of research invitation and participation on subsequent blood donor behavior.

BACKGROUND: As over-communication can negatively impact consumer behavior, it is important to understand the impact of research communication on donors' future donation behavior. The aim of this study was to determine the effect of (i) being invited to participate in research, and (ii) participating in that research, on future donation behavior. STUDY DESIGN AND METHODS: A retrospective cohort analysis was conducted with 36,418 donors who were invited to participate in one of 17 research projects, and a matched control group of 36,252 non-invited donors. Poisson regression models were used to examine the associations between invitation or participation in the studies and the likelihood of creating an appointment to donate and attending an appointment at 1, 3, and 6 months. RESULTS: Donors were significantly more likely to create an appointment within 14 days of receiving an invitation compared to controls (RR: 1.91, 95% CI 1.81-2.02), and to return to donate at 1 (RR:1.18, 95% CI 1.13-1.24), 3 (RR:1.10, 95% CI 1.07-1.13) and 6 (RR:1.11, 95% CI 1.09-1.13) months compared to non-invited controls. Donors who participated in the research were more likely to return than control donors at all time points, while donors who were invited but did not participate were also likely to return more at 1 month (RR:1.06, 95% CI 1.00-1.11) and 6 months (RR:1.03, 95% CI 1.00-1.5) than non-invited controls. DISCUSSION: Our findings suggest that research participation is positively associated with future donor behavior and provides reassurance that contacting donors for research does not negatively impact blood collections.

Improving donor retention following a temporary deferral: A cluster randomized controlled trial of deferral educational materials.

BACKGROUND: Providing educational materials to deferred donors has been shown to increase their understanding about their deferral and knowledge about their return. The aim of this study was to determine the effectiveness of educational materials in increasing the retention of deferred donors. STUDY DESIGN AND METHODS: A three-arm cluster randomized controlled trial was conducted, with the following conditions: (a) Incenter Brochure plus Email; (b) Email Only; (c) Control. The Incenter Brochure plus Email condition also included a guided conversation led by staff at the point of deferral. Donors were followed up for 3 months after their deferral had ended to determine if they had attempted to donate. RESULTS: Compared with the Control condition, donors in the Incenter Brochure plus Email condition had increased odds of return at 3 months after their deferral ended (OR: 1.16; 95% CI 1.00-1.33). Subgroup analysis highlighted that novice (OR: 1.38; 95% CI 1.04-1.83) and established donors (OR: 1.36; 95% CI 1.13-1.64) had increased odds of return if they received the incenter materials. Donors who were deferred to maintain their well-being (OR: 1.28; 95% CI 1.03-1.60) and donors with a prior deferral history (OR: 1.55; 95% CI 1.15-1.55) had increased odds of return if they received the incenter materials. No significant differences were found between the Email Only and Control conditions. DISCUSSION: This trial demonstrates the benefits of providing onsite educational materials to donors at the point of deferral. This is a simple, effective strategy to increase the return behavior of donors within 3 months of their deferral ending.

Feeding, caregiving practices, and developmental delay among children under five in lowland Nepal: a community-based cross-sectional survey.

BACKGROUND: Nurturing care, including adequate nutrition, responsive caregiving and early learning, is critical to early childhood development. In Nepal, national surveys highlight inequity in feeding and caregiving practices for young children. Our objective was to describe infant and young child feeding (IYCF) and cognitive and socio-emotional caregiving practices among caregivers of children under five in Dhanusha district, Nepal, and to explore socio-demographic and economic factors associated with these practices. METHODS: We did a cross-sectional analysis of a subset of data from the MIRA Dhanusha cluster randomised controlled trial, including mother-child dyads (N = 1360), sampled when children were median age 46 days and a follow-up survey of the same mother-child dyads (N = 1352) when children were median age 38 months. We used World Health Organization IYCF indicators and questions from the Multiple Indicator Cluster Survey-4 tool to obtain information on IYCF and cognitive and socio-emotional caregiving practices. Using multivariable logistic regression models, potential explanatory household, parental and child-level variables were tested to determine their independent associations with IYCF and caregiving indicators. RESULTS: The prevalence of feeding indicators varied. IYCF indicators, including ever breastfed (99%), exclusive breastfeeding (24-hour recall) (89%), and vegetable/fruit consumption (69%) were common. Problem areas were early initiation of breastfeeding (16%), colostrum feeding (67%), no pre-lacteal feeding (53%), timely introduction of complementary feeding (56%), minimum dietary diversity (49%) and animal-source food consumption (23%). Amongst caregiving indicators, access to 3+ children's books (7%), early stimulation and responsive caregiving (11%), and participation in early childhood education (27%) were of particular concern, while 64% had access to 2+ toys and 71% received adequate care. According to the Early Child Development Index score, only 38% of children were developmentally on track. Younger children from poor households, whose mothers were young, had not received antenatal visits and delivered at home were at higher risk of poor IYCF and caregiving practices. CONCLUSIONS: Suboptimal caregiving practices, inappropriate early breastfeeding practices, delayed introduction of complementary foods, inadequate dietary diversity and low animal-source food consumption are challenges in lowland Nepal. We call for urgent integrated nutrition and caregiving interventions, especially as interventions for child development are lacking in Nepal.

Long-term return and donation pattern of those who begin donating at different ages: A retrospective cohort analysis of blood donors in Australia.

BACKGROUND: This study compared the likelihood of return to donate and donation rate ratio by age of donors at their first donation when followed up to 12 years. STUDY DESIGN AND METHODS: Donation history of two cohorts of first-time donors (those donating in 2007 and 2013) was extracted until March 2019 from Australian Red Cross Lifeblood's national database. Poisson regression analyses compared donor return and negative-binomial regression estimated the rate ratio of donations. RESULTS: A total of 120 469 and 95 381 donors were included in the 2007 and 2013 cohorts, respectively. Compared to donors aged 20-24 years, the likelihood of return in both cohorts increased consistently as age at first donation increased from 30-years and above. Average number of whole-blood and plasmapheresis donations increased as the age at first donation increased from 30-years onward. The whole-blood donation rate was highest for donors ≥60 years, while plasmapheresis donation rate was highest for donors aged 50-59 years. These patterns were largely consistent when stratified by sex. CONCLUSIONS: To continuously ensure the short- to mid-term sufficiency of blood supply in Australia, targeted recruitment of donors aged 30-years and above may be considered, however its feasibility and impact should be explored further given relatively smaller proportion of new donors are middle-aged and older under current policies. Future studies with a longer follow-up period are needed to examine whether the frequency of donation among those who start donating at a younger age increases later in their life when they are 30-years or over.

Visits to general practitioners after iron-related deferrals from blood donation in middle-aged and older Australian blood donors.

BACKGROUND: Australian Red Cross Lifeblood (Lifeblood) advises donors to visit their general practitioner (GP) for medical follow-up if they are deferred from donating due to having a lower than acceptable level of hemoglobin (Hb) and/or serum ferritin (iron-related deferrals). METHODS: We used the Sax Institute's 45 and Up Study data linked to Lifeblood's donor datasets and other health administrative datasets. We examined the rate of visits to a GP after iron-related deferral from donation, and investigated whether an early visit to a GP (within 30 days following the deferral) had an impact on return to make successful donation within 12, 18, and 24 months compared to a delayed or no GP visit. RESULTS: A total of 1928 donors underwent iron-related deferral. The rate of visits to a GP in the first month after deferral was double the rate observed a month prior. However, only 52.4% of those deferred visited a GP early with slightly more than half of those receiving an iron-monitoring test. Return to donate over the 24 months was lower in donors visiting their GP early (adjusted Hazard Ratio [aHR] 0.86, 95% CI 0.77-0.97). Early GP visitors were likely to have a relatively poorer health than the delayed or no GP visit group. CONCLUSIONS: Only half of the donors with an iron-related deferral followed advice from Lifeblood and visited their GP within 30 days of deferral, and these donors have a significantly reduced likelihood of future successful blood donation which may be due to their relatively poorer health status.

Willingness of blood donors in Australia to provide additional data and blood sample for health research.

BACKGROUND: Many blood collection agencies are generating important data on donor health outcomes using large-scale blood donor cohort studies. Such studies can be very effective when donors provide access to linkage of their data to external health databases, and storage and genomic testing of their blood sample. In this study, we aimed to assess the willingness of Australian blood donors to provide additional data and blood sample for donation-related and other health research. STUDY DESIGN AND METHODS: We invited 2017 donors to complete a survey using four methods (postal letter, postal letter and email, email only, and in-center recruitment). The survey asked for information on demographics, lifestyle behaviors, health, experience and attitude to blood donation, and willingness to give blood sample and additional data for research. RESULTS: Response rates ranged from 23.8% for email only to 77.2% for in-center recruitment. Of those who responded (n = 827), 95.5% indicated they would be willing to provide a blood sample for donation and transfusion-related research. Of these, >90.0% were willing for their sample to be used in research involving genetic testing and other health-related topics. Also, >90.0% were willing to consent for linkage of their information to external health databases. CONCLUSIONS: Donors surveyed reported a high willingness to participate in health research by completing surveys, allowing linkage to external datasets, and providing a blood sample. These findings provide strong support for future longitudinal research studies with Australian blood donors.

Prevalence of methicillin-resistant Staphylococcus aureus and pattern of antimicrobial resistance in mastitis milk of cattle in Chitwan, Nepal.

BACKGROUND: The threat of methicillin-resistant Staphylococcus aureus (MRSA) exists globally and has been listed as a priority pathogen by the World Health Organization. One of the sources of MRSA emergence is livestock and its products, often raised in poor husbandry conditions. There are limited studies in Nepal to understand the prevalence of MRSA in dairy animals and its antimicrobial resistance (AMR) profile. A cross-sectional study was conducted in Chitwan, one of the major milk-producing districts of Nepal, from February 2018 to September 2019 to estimate the prevalence of MRSA in milk samples and its AMR profile. The collected milk samples (n = 460) were screened using the California Mastitis Test (CMT) and positive samples were subjected to microbiological analysis to isolate and identify S. aureus. Polymerase Chain Reaction (PCR) was used to identify the presence of the mecA gene and screen for MRSA. RESULTS: In total, 41.5% (191/460) of milk samples were positive in the CMT test. Out of 191 CMT positive milk samples, the biochemical tests showed that the prevalence of S. aureus was 15.2% (29/191). Among the 29 S. aureus isolates, 6.9% (2/29) were identified as MRSA based on the detection of a mecA gene. This indicates that that 1.05% (2/191) of mastitis milk samples had MRSA. The antibiotic sensitivity test showed that 75.9% (22/29) and 48.3% (14/29) S. aureus isolates were found to be sensitive to Cefazolin and Tetracycline respectively (48.3%), whereas 100% of the isolates were resistant to Ampicillin. In total 96.6% (28/29) of S. aureus isolates were multidrug-resistant (MDR). CONCLUSIONS: This study revealed a high prevalence of S. aureus-mediated subclinical mastitis in dairy herds in Chitwan, Nepal, with a small proportion of it being MRSA carrying a mecA gene. This S. aureus, CoNS, and MRSA contaminated milk poses a public health risk due to the presence of a phenotype that is resistant to very commonly used antibiotics. It is suggested that dairy herds be screened for subclinical mastitis and treatments for the animals be based on antibiotic susceptibility tests to reduce the prevalence of AMR. Furthermore, future studies should focus on the Staphylococcus spp. to explore the antibiotic resistance genes in addition to the mecA gene to ensure public health.

Risk of Herpes Zoster Prior to and Following Cancer Diagnosis and Treatment: A Population-Based Prospective Cohort Study.

BACKGROUND: Information on the risks of herpes zoster (zoster) preceding a cancer diagnosis and the role of cancer treatment on risk is limited. METHODS: This was a prospective cohort of 241497 adults, with mean age 62.0 years at recruitment (2006-2009), linked to health datasets from 2006 to 2015. The relation between cancer diagnosis, treatment, and zoster risk was analyzed using time-varying proportional hazards models. RESULTS: Over 1760 481 person-years of follow-up, 20286 new cancer diagnoses and 16350 zoster events occurred. Participants with hematological and solid cancer had higher relative risks of zoster than those without cancer (adjusted hazard ratio [aHR], 3.74 [95% confidence interval {CI}, 3.11-4.51] and 1.30 [95% CI, 1.21-1.40], respectively). Compared to those without cancer, zoster risk was also elevated prior to a hematological cancer diagnosis (aHR for 1-2 years prior, 2.01 [95% CI, 1.31-3.09]), but this was not the case for solid cancers (aHR for 1-2 years prior, 0.90 [95% CI, .75-1.07]). Compared to those without cancer, zoster risk among participants with solid cancers receiving chemotherapy was greater than in those without a chemotherapy record (aHR, 1.83 [95% CI, 1.60-2.09] and 1.16 [95% CI, 1.06-1.26], respectively). CONCLUSIONS: For hematological cancer, increases in zoster risk are apparent in the 2 years preceding diagnosis and treatment; for solid organ cancers, the increased risk appears to be largely associated with receipt of chemotherapy.

Completeness and accuracy of self-reported history of blood donation: results from a cohort of older adults in Australia.

BACKGROUND: The validity of studies relying on self-report of blood donation may be severely threatened by systematic errors. STUDY DESIGN AND METHODS: We linked the Sax Institute's 45 and Up Study data, which asked self-report of blood and plasma donation including the date of most recent donation to the blood donor database at the Australian Red Cross Blood Service. We used the linked data to validate the accuracy of self-reported blood donation history including the completeness and accuracy of reported date of most recent donation. RESULTS: Of the total 142,503 participants, 47.8 and 5.1% reported ever donating blood and plasma, respectively. Of those self-reporting blood donation (n = 23,113) and plasma donation (n = 4,451) within the last 10 years of survey, 6262 (27.1%) and 1444 (33.0%) had no record of donation within that period, respectively. Among those who had a record of blood and plasma donation within 10 years before the survey, 97.6 and 93.0% correctly self-reported ever donating blood and plasma, respectively. Donors consistently reported a donation date more recent than the actual recorded date, and the median discrepancy and variability increased as the length of time from the survey date to the actual date of donation increased. CONCLUSIONS: Almost 98% of donors donating blood within a decade of survey completion date can correctly self-report their history of donation as ever donating blood, whereas 27% of participants self-reporting donation within a decade may not have actually donated blood. Further, self-reported date of blood donation is not a reliable measure of actual date of donation.

Trends in prevalence of soil-transmitted helminth and major intestinal protozoan infections among school-aged children in Nepal.

OBJECTIVES: To assess the trends in prevalence of soil-transmitted helminths (STHs), Entamoeba histolytica and Giardia lamblia among school-aged children in Nepal between 1990 and 2015. METHODS: Systematic literature search in PubMed, MEDLINE, EMBASE, Google Scholar and local peer-reviewed journals for papers published between 1990 and December 2015. We conducted metaregression and meta-analyses to pool studies where applicable. RESULTS: Thirty-nine studies that examined a total of 14 729 stool specimens were included in the meta-analyses. The metaregression of prevalence of hookworms, roundworm, and whipworm showed a significantly decreasing trend over time. In or after 2004, the pooled prevalence of hookworm infections was 1.53% (95% CI, 0.73-2.59), of roundworm 4.31% (95% CI, 2.52-6.53) and of whipworm 2.89% (95% CI, 1.33-4.97) vs. 16.54% (95% CI, 7.64-27.97) for hookworm, 25.20% (95% CI, 13.59-38.97) for roundworm and 11.54% (95% CI 4.25-21.76) for whipworm in 1993-2003. E. histolytica and G. lamblia had stable prevalence since early 1990s, with a pooled prevalences of 4.12% (95% CI, 2.73-5.77) and 9.40% (95% CI, 7.15-11.92), respectively. The prevalence of G. lamblia was significantly higher in urban areas. CONCLUSIONS: We observed a sharp decrease in prevalence of STHs among school-aged children in Nepal in the past decade with prevalences dropping below 5% for STHs with no variation in prevalence in rural and urban areas. However, the prevalence of E. histolytica and G. lamblia remained stable over time. These results suggest that school-based deworming programmes rolled out during the study period had an observable impact on prevalence of STHs.

Influenza and pneumococcal vaccination in Australian adults: a systematic review of coverage and factors associated with uptake.

BACKGROUND: In the absence of an adult vaccination register, coverage estimates for influenza and pneumococcal vaccination come from surveys and other data sources. METHODS: Systematic review and meta-analysis of studies examining vaccination coverage in Australian adults from 1990 to 2015, focusing on groups funded under the National Immunisation Program, and intervals prior to and following the introduction of universal funding. RESULTS: Twenty-two studies met the inclusion criteria; 18 used self-report to determine vaccination status. There were 130 unique estimates of coverage extracted. Among adults aged ≥65y, during the period of universal funding (1999-onwards), the summary estimate of annual influenza vaccination coverage from 27 point estimates was 74.8 % (95 % CI 73.4-76.2 %; range 63.9-82.4 %); prior to this period (1992-1998) from 10 point estimates it was 61.3 % (95 % CI 58.0-64.6 %; range 44.3-71.3 %). For the period of universal funding for pneumococcal vaccination (2005-onwards) the summary estimate for coverage was 56.0 % (95 % CI 53.2-58.8 %; range 51.2-72.8 %, 10 point estimates); prior to 2005 it was 35.4 % (95 % CI 18.8-52.0 %; range 15.4-45.2 %). Coverage for both vaccines was significantly higher following the introduction of universal funding. Influenza vaccination coverage in those aged 18-65 years with a medical indication was lower but data were not combined. Seven studies reported on Aboriginal Australians with three studies reporting five coverage estimates for influenza vaccination in adults ≥65 years (range 71 % - 89 %). CONCLUSIONS: Adult influenza and pneumococcal vaccination coverage has increased since the introduction of universal funding, but remains sub-optimal, with pneumococcal coverage lower than influenza. IMPLICATIONS: This review highlights the need for more coverage data overall and in high risk groups, to support public health programs to improve coverage.

Risk factors of stillbirths in Victoria (Australia): A case-control study.

Stillbirth is one of the most adverse pregnancy outcomes. The rate of stillbirth in high income countries has remained stagnant in recent decades. This study aimed to determine the incidence and risk factors of stillbirths specific to hospital-based deliveries in a secondary level hospital in Melbourne, Australia, over a 5-year period. We conducted a case-control study from January 2007 to December 2011. Univariate and multivariate analyses were conducted in STATA 12.1. The 5-year cumulative incidence of still-birth was 5.3 per 1000 total births (95% CI 4.3, 6.5). Univariate analysis revealed that higher body-mass index, smoking during pregnancy, haemoglobin level (≥14.5 g/dl), previous stillbirth, primiparity, marital status, previous caesarean section and reduced foetal movement in the 2 weeks prior to delivery were associated with increased risk of stillbirth. However, after adjustment for confounders in a multiple-regression model, only previous caesarean section (p = 0.006), unmarried (p = 0.004), high haemoglobin level (p = 0.007) and reduced foetal movement in the 2 weeks prior to delivery (p < 0.001) remained significantly associated with increased risk of stillbirth. The characteristics of our study population was similar to the population of state-wide survey in 2009, however, the incidence in our study was slightly lower. We concluded that previous caesarean section, pregnancy while being unmarried, higher haemoglobin level and reduced foetal movement in the 2 weeks before delivery were significant predictors of stillbirth. The identified risk factors were similar to other studies and the obstetric practice at the hospital or the demographics of the study population did not add to additional risk.

Risk factors and burden of acute Q fever in older adults in New South Wales: a prospective cohort study.

OBJECTIVES: To measure the acute burden of and to identify risk factors associated with notified Q fever in older adults in New South Wales. DESIGN, SETTINGS AND PARTICIPANTS: A prospective cohort of adults aged 45 years and over (the 45 and Up Study) recruited during 2006-2009 and followed using linked Q fever notifications, hospital records and death records during 2006-2012. MAIN OUTCOME MEASURES: Incident cases of Q fever, based on a linked Q fever notification; proportion of cases with a Q fever-coded hospitalisation. RESULTS: A total of 266 906 participants were followed up for 1 254 650 person-years (mean, 4.7 ± 1.0 years per person). In our study population, the incidence of notified Q fever during follow-up was 3.6 (95% CI, 2.7-4.8) per 100 000 person-years. After adjustments, age (≥ 65 years v 45-54 years: hazard ratio [HR], 0.39; 95% CI, 0.16-0.96), sex (women v men: HR, 0.48; 95% CI, 0.26-0.88), and area and type of residence (P < 0.001 for trend) remained significantly associated with Q fever. Compared with those living in an inner regional area but not on a farm, the risk of notified Q fever was highest for those living on a farm in outer regional or remote areas (HR, 11.98; 95% CI, 5.47-26.21), followed by those living on a farm in inner regional areas (HR, 4.95; 95% CI, 1.79-13.65). Of notified Q fever cases, 15 of 39 (38%) had been hospitalised with a diagnosis consistent with Q fever. CONCLUSIONS: Adults living on a farm in outer regional and remote areas are at a substantially greater risk of contracting Q fever. This suggests that, as well as targeting specific occupational groups for vaccination, there would be benefits in increasing public awareness of Q fever and vaccination among those living on and near farms in outer regional and remote areas of Australia.

Trends of etiology and drug resistance in enteric fever in the last two decades in Nepal: a systematic review and meta-analysis.

Prospective time-trend analyses on shifting etiology and trends of drug resistance in enteric fever are scarce. Using published and unpublished datasets from Nepal, we performed a systematic review and meta-analysis to understand the trends in etiology and resistance to antimicrobials that have occurred since 1993. Thirty-two studies involving 21 067 Salmonella enterica serotype Typhi (ST) and S. enterica serotype Paratyphi A (SPA) isolates were included. There was an increasing trend in enteric fever caused by SPA during the last 2 decades (P < .01). We observed sharply increasing trends in resistance to nalidixic acid and ciprofloxacin for both ST and SPA. In contrast, multi-drug resistance (MDR), resistance to traditional first-line antibiotics such as chloramphenicol and co-trimoxazole have significantly decreased for both organisms. The resistance to ceftriaxone has remained low, suggesting it is likely to remain useful as a reserve antibiotic for treatment. Trends in decreasing resistance to traditional first-line antibiotics and decreasing MDR provide an opportunity to reconsider these first-line antimicrobials as therapeutic options.