ABSTRACT
OBJECTIVE: To identify effective methods for local public health departments to secure policy and systems changes that will achieve health equity and improve health outcomes across diverse populations. METHODS: We reviewed 220 documents from a philanthropic initiative that funded collaborative efforts to improve conditions for health and equity in 14 California communities from 2010 to 2020. We examined the role of factors associated with movement-building approaches-such as organizing, base-building, investing in organizational capacity, and forming alliances-in securing policy and systems changes that foster more equitable community conditions. RESULTS: All 14 sites made progress in implementing policies and systems to improve the social determinants of health, including neighborhood conditions and the built environment, health care access, social and community context, economic stability, and education access. All 14 also shifted processes to be more inclusive of and responsive to community members, who in turn gained capacity to advocate for change and build collective power. CONCLUSION: Local public health leaders can make progress toward health equity by drawing on movement-building approaches to change policies and systems that affect social determinants of health.
Subject(s)
Health Policy , Health Status , Humans , Community Participation , Social Determinants of Health , Health Status DisparitiesABSTRACT
OBJECTIVE: In infants with gastroschisis, outcomes were compared between those where operative reduction and fascial closure were attempted ≤24âhours of age (PC), and those who underwent planned closure of their defect >24âhours of age following reduction with a pre-formed silo (SR). SUMMARY OF BACKGROUND DATA: Inadequate evidence exists to determine how best to treat infants with gastroschisis. METHODS: A secondary analysis was conducted of data collected 2006-2008 using the British Association of Pediatric Surgeons Congenital Anomalies Surveillance System, and 2005-2016 using the Canadian Pediatric Surgery Network.28-day outcomes were compared between infants undergoing PC and SR. Primary outcome was number of gastrointestinal complications. Interactions were investigated between infant characteristics and treatment to determine whether intervention effect varied in sub-groups of infants. RESULTS: Data from 341 British and Irish infants (27%) and 927 Canadian infants (73%) were used. 671 infants (42%) underwent PC and 597 (37%) underwent SR. The effect of SR on outcome varied according to the presence/absence of intestinal perforation, intestinal matting and intestinal necrosis. In infants without these features, SR was associated with fewer gastrointestinal complications [aIRR 0.25 (95% CI 0.09-0.67, P = 0.006)], more operations [aIRR 1.40 (95% CI 1.22-1.60, P < 0.001)], more days PN [aIRR 1.08 (95% CI 1.03-1.13, P < 0.001)], and a higher infection risk [aOR 2.06 (95% CI 1.10-3.87, P = 0.025)]. In infants with these features, SR was associated with a greater number of operations [aIRR 1.30 (95% CI 1.17-1.45, P < 0.001)], and more days PN [aIRR 1.06 (95% CI 1.02-1.10, P = 0.003)]. CONCLUSIONS: In infants without intestinal perforation, matting, or necrosis, the benefits of SR outweigh its drawbacks. In infants with these features, the opposite is true. Treatment choice should be based upon these features.
Subject(s)
Gastroschisis/surgery , Canada , Cohort Studies , Digestive System Surgical Procedures/methods , Female , Gastrointestinal Diseases/epidemiology , Humans , Infant , Ireland , Male , Postoperative Complications/epidemiology , Prospective Studies , Treatment Outcome , United KingdomABSTRACT
BACKGROUND: The demographic of Northern Territory prison population differs than elsewhere in Australia and the prevalence of hepatitis B and hepatitis C may therefore be somewhat different from other jurisdictions. There has been no study which has specifically described the serological results of a large proportion of prisoners in Northern Territory correctional facilities over an extended period of time. METHODS: This retrospective longitudinal study reviewed serological results and testing rates for hepatitis B, and hepatitis C performed in correctional facilities in the Northern Territory of Australia between July 1st, 2003 and June 30th, 2017. RESULTS: The proportion of positive records over 14 years for hepatitis B surface antigen (HBsAg) was 641/12,066 (5.3, 95% CI 4.9-5.7), for hepatitis B core antibody (anti-HBc) 4937/12,138 (40.1, 95%CI 39.8-41.6), for hepatitis B surface antibody (anti-HBs) 6966/13,303 (52.4, 95% CI 51.5-53.2), and for hepatitis C antibody 569/12,153 (4.7, 95% CI 4.3-5.1). The proportion of prisoners tested for hepatitis B and hepatitis C has decreased since 2015, while a high proportion of prisoners remain non-immune to hepatitis B. CONCLUSION: There is a relatively high proportion of positive serological markers of hepatitis B, and a lower proportion of positive hepatitis C serology in the Northern Territory's correctional facilities compared to overall Australian rates. As the proportion of prisoners tested for hepatitis B and C has decreased recently, and a high proportion of prisoners remain non-immune to hepatitis B, there are opportunities to increase testing and vaccination rates in this population.
Subject(s)
Hepatitis B/diagnosis , Hepatitis C/diagnosis , Adult , Biomarkers/blood , Correctional Facilities/statistics & numerical data , Databases, Factual , Female , Hepatitis B/epidemiology , Hepatitis B Antibodies/blood , Hepatitis B Surface Antigens/blood , Hepatitis C/epidemiology , Hepatitis C Antibodies/blood , Humans , Longitudinal Studies , Male , Middle Aged , Northern Territory/epidemiology , Prevalence , Retrospective Studies , Young AdultABSTRACT
AIM: To describe the epidemiology of invasive Salmonella disease in children in the Northern Territory, Australia. METHODS: Design: A retrospective review of invasive salmonellosis cases identified by pathology records and the Northern Territory Notifiable Disease Surveillance System. Case definitions: Those aged 18 years or under, with Salmonella cultured from a usually sterile site, collected in the Northern Territory between 1 July 2005 and 30 June 2015. OUTCOME MEASURES: The primary outcome measure was the annual incidence rate of invasive salmonellosis, comparing rates between Indigenous and non-Indigenous children. RESULTS: There were 86 cases of invasive Salmonella infection in children over the 10-year period; an annual incidence of 14.1 per 100 000 population, in those aged less than 18 years. Gastrointestinal Salmonella notifications were similar between Indigenous and non-Indigenous children. In children aged less than 15 years, the rate of invasive salmonellosis was higher in Indigenous children compared to non-Indigenous children (23.4 per 100 000 compared with 11.6 per 100 000); rate ratio 2.0 (95% confidence interval 1.3-3.3, P = 0.002). Indigenous children with invasive salmonellosis had a median hospital stay of 8 days, which was compared to 5 days for non-Indigenous children (P = 0.015). The highest incidence rate of invasive salmonellosis occurred in Indigenous patients less than 12 months of age (138 per 100 000). CONCLUSION: The Northern Territory of Australia has high rates of invasive salmonellosis in children. Indigenous and non-Indigenous children experience similar rates of Salmonella gastroenteritis but Indigenous children experience higher rates of invasive salmonellosis.
Subject(s)
Salmonella Infections , Age Distribution , Child , Humans , Incidence , Infant , Northern Territory/epidemiology , Retrospective Studies , Salmonella Infections/epidemiologySubject(s)
Communicable Diseases , Health Services, Indigenous , Sepsis , Humans , Australia/epidemiology , Indigenous PeoplesSubject(s)
Dengue Virus , Encephalitis, Japanese , Flavivirus , Humans , Encephalitis, Japanese/diagnosis , Antibodies, ViralABSTRACT
AIM: The epidemiology of community-acquired bacterial meningitis has changed following the introduction of routine immunisation against common causative organisms. Indigenous children living in the Northern Territory, Australia, have high rates of bacterial infections. This study describes changes in the epidemiology of childhood bacterial meningitis and the distribution of the burden of disease in the Top End. METHODS: A retrospective review of cases derived from hospital medical records and laboratory data was performed. Inclusion criteria were children aged 3 months to 14 years of age, admitted to Royal Darwin Hospital between 1992 and 2014 and diagnosed with bacterial meningitis. Annual incidence of bacterial meningitis and the distribution of causative pathogens are described. Demographic data, investigations, treatment and outcomes were compared between Indigenous and non-Indigenous children. RESULTS: There were 137 cases of childhood bacterial meningitis identified over the 23-year period. The incidence reduced from 21 per 100 000 children per year for 1992-2002 to 11 per 100 000 per year for 2003-2014 (P = 0.0025). Haemophilus influenzae type b, Streptococcus pneumoniae and Neisseria meningitidis were the most common causative organisms, with a reduction in cases for each pathogen observed across the study period. Indigenous children were over-represented (104/137, 76%). Case fatality rate was 8% (11/137); 91% of fatal cases presented to a remote facility. CONCLUSIONS: The incidence of childhood bacterial meningitis has declined in the Northern Territory of Australia, but Indigenous children are disproportionately affected. Routine immunisation is beneficial for all, although further efforts to 'Close the Gap' between health outcomes in Indigenous and non-Indigenous Australians is required.
Subject(s)
Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/epidemiology , Child, Preschool , Female , Haemophilus influenzae/isolation & purification , Humans , Incidence , Infant , Male , Medical Audit , Native Hawaiian or Other Pacific Islander , Neisseria meningitidis/isolation & purification , Northern Territory/epidemiology , Retrospective Studies , Streptococcus pneumoniae/isolation & purificationABSTRACT
BACKGROUND: In vitro laboratory and animal studies demonstrate a synergistic role for the combination of vancomycin and antistaphylococcal ß-lactams for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Prospective clinical data are lacking. METHODS: In this open-label, multicenter, clinical trial, adults with MRSA bacteremia received vancomycin 1.5 g intravenously twice daily and were randomly assigned (1:1) to receive intravenous flucloxacillin 2 g every 6 hours for 7 days (combination group) or no additional therapy (standard therapy group). Participants were stratified by hospital and randomized in permuted blocks of variable size. Randomization codes were kept in sealed, sequentially numbered, opaque envelopes. The primary outcome was the duration of MRSA bacteremia in days. RESULTS: We randomly assigned 60 patients to receive vancomycin (n = 29), or vancomycin plus flucloxacillin (n = 31). The mean duration of bacteremia was 3.00 days in the standard therapy group and 1.94 days in the combination group. According to a negative binomial model, the mean time to resolution of bacteremia in the combination group was 65% (95% confidence interval, 41%-102%; P = .06) that in the standard therapy group. There was no difference in the secondary end points of 28- and 90-day mortality, metastatic infection, nephrotoxicity, or hepatotoxicity. CONCLUSIONS: Combining an antistaphylococcal ß-lactam with vancomycin may shorten the duration of MRSA bacteremia. Further trials with a larger sample size and objective clinically relevant end points are warranted. Australian New Zealand Clinical Trials Registry: ACTRN12610000940077 (www.anzctr.org.au).
Subject(s)
Anti-Bacterial Agents/pharmacology , Bacteremia/drug therapy , Floxacillin/pharmacology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/drug therapy , Vancomycin/pharmacology , Administration, Intravenous , Adolescent , Adult , Aged , Aged, 80 and over , Animals , Bacteremia/microbiology , Drug Therapy, Combination/methods , Female , Humans , Male , Middle Aged , New Zealand , Prospective Studies , Staphylococcal Infections/microbiology , Time Factors , Treatment Outcome , Young AdultSubject(s)
Gonorrhea , Australia/epidemiology , Gonorrhea/diagnosis , Gonorrhea/epidemiology , Humans , Neisseria gonorrhoeaeABSTRACT
Melioidosis is a severe disease that can be difficult to diagnose because of its diverse clinical manifestations and a lack of adequate diagnostic capabilities for suspected cases. There is broad interest in improving detection and diagnosis of this disease not only in melioidosis-endemic regions but also outside these regions because melioidosis may be underreported and poses a potential bioterrorism challenge for public health authorities. Therefore, a workshop of academic, government, and private sector personnel from around the world was convened to discuss the current state of melioidosis diagnostics, diagnostic needs, and future directions.
Subject(s)
Melioidosis/diagnosis , Humans , Practice Guidelines as TopicABSTRACT
OBJECTIVE: To observe the prevalence, disease associations, and temporal trends in Trichuris trichiura (whipworm) infection in the Northern Territory between 2002 and 2012. DESIGN, PARTICIPANTS AND SETTING: Retrospective observational analysis of consecutive microbiologically confirmed cases of T. trichiura infection among members of the NT population from whom a faecal sample was obtained for testing by NT Government health care facilities between 1 January 2002 and 31 December 2012. MAIN OUTCOME MEASURES: Annual prevalence of T. trichiura infection; age, sex, Indigenous status and place of residence of infected patients; percentage of infected patients with anaemia (haemoglobin level, ≤ 110 g/L) and eosinophilia (eosinophil count, ≥ 0.5 × 10(9)/L). RESULTS: 417 episodes of T. trichiura infection were identified over the 11 years from 63 668 faecal samples. The median age of patients was 8 years (interquartile range [IQR], 3-36 years). Patients were predominantly Indigenous (95.3%; P = 0.001) and from three main geographical areas (Victoria Daly, East Arnhem Land and West Arnhem Land). Infections were associated with anaemia (40.2%) and eosinophilia (51.6%). There was a downward trend in the prevalence of T. trichiura infection diagnosed at NT Government health care facilities, from 123.1 cases (95% CI, 94.8-151.3 cases) per 100,000 Indigenous population in 2002 to 35.8 cases (95% CI, 21.8-49.9 cases) per 100,000 Indigenous population in 2011. CONCLUSIONS: T. trichiura is the most frequently identified soil-transmitted helminth infecting patients in NT Government health care facilities. Cases are identified predominantly in Indigenous patients in remote communities. We have observed a declining prevalence of whipworm infection in the NT.
Subject(s)
Trichuriasis/epidemiology , Trichuris , Adolescent , Adult , Age Factors , Animals , Child , Child, Preschool , Feces/parasitology , Female , Humans , Male , Native Hawaiian or Other Pacific Islander/statistics & numerical data , Northern Territory/epidemiology , Prevalence , Retrospective Studies , Rural Population/statistics & numerical data , Sex Factors , Young AdultSubject(s)
Encephalitis Virus, Murray Valley/genetics , Encephalitis, Arbovirus/diagnosis , Polymerase Chain Reaction/methods , RNA, Viral/blood , RNA, Viral/urine , Blood/virology , Electroencephalography , Encephalitis Virus, Murray Valley/isolation & purification , Encephalitis, Arbovirus/blood , Encephalitis, Arbovirus/urine , Female , Humans , Native Hawaiian or Other Pacific Islander , Northern Territory , Plasma/virology , Urine/virology , Young AdultABSTRACT
Abstract: This retrospective study reviewed the macrolide resistance rates of Group A Streptococcus (GAS) isolates in the Northern Territory from 2012 to 2023. Clindamycin and erythromycin resistance rates peaked in 2021, at 6.0% and 12.2% respectively, and then returned to near baseline at 1-2% in 2023. Increased resistance rates were identified in the Top End of Australia from mid-2020, followed 15 months later by high rates in central Australia in 2022. Factors associated with resistant isolates were living in a rural region and of age 18 years and older. Possible explanations include a transient clonal introduction of a resistant GAS strain to the Northern Territory from 2020 to 2022. Ongoing surveillance is required to monitor regional trends and identify temporal variations in resistant isolates.
Subject(s)
Anti-Bacterial Agents , Clindamycin , Drug Resistance, Bacterial , Erythromycin , Streptococcal Infections , Streptococcus pyogenes , Clindamycin/pharmacology , Humans , Erythromycin/pharmacology , Northern Territory/epidemiology , Streptococcus pyogenes/drug effects , Anti-Bacterial Agents/pharmacology , Streptococcal Infections/epidemiology , Streptococcal Infections/microbiology , Streptococcal Infections/drug therapy , Retrospective Studies , Female , Adult , Male , Adolescent , Middle Aged , Child , Young Adult , Child, Preschool , Aged , Microbial Sensitivity Tests , InfantABSTRACT
BACKGROUND: We describe the recent temporal patterns of respiratory syncytial virus (RSV) and influenza virus detections in the Northern Territory (NT) of Australia, between 2020 and 2023. METHODS: This retrospective analysis of patients presenting with respiratory diseases utilised a multiplex viral nucleic acid detection assay for RSV, influenza and SARS Cov2 (COVID-19) to determine the relative frequency of non-COVID-19 respiratory viral detections by age and month during the study period. RESULTS: During this period of the NT COVID-19 epidemic, disruption of the usual annual wet season RSV outbreak patterns occurred, and the yearly influenza peak was absent for two annual cycles. Our data also reveals that 25% of RSV infections were occurring in patients greater than 40 years of age, compared to 32% of influenza infections presenting in the same period, documenting a greater burden of adult disease than previously documented in the NT. CONCLUSIONS: Loss of non-COVID-19 viral seasonality and a substantial unrecognised RSV adult burden were noted. We will continue to monitor seasonality, and the RSV burden and this will help to target the populations benefiting from recently released RSV vaccine.
Subject(s)
COVID-19 , Influenza, Human , Respiratory Syncytial Virus Infections , Seasons , Humans , Respiratory Syncytial Virus Infections/epidemiology , Influenza, Human/epidemiology , Retrospective Studies , Adult , Female , Male , COVID-19/epidemiology , Middle Aged , Child , Adolescent , Infant , Child, Preschool , Australia/epidemiology , SARS-CoV-2/isolation & purification , Northern Territory/epidemiology , Aged , Young Adult , Respiratory Syncytial Virus, Human/isolation & purificationABSTRACT
Abstract: The Northern Territory (NT) has the highest rates of sexually transmitted infections (STI) in Australia; however, the local prevalence of Mycoplasma genitalium (M. genitalium) has not been previously determined. This study was designed to review M. genitalium detection, to determine the regional NT prevalence and macrolide resistance rates. In our study the NT background prevalence of M. genitalium is 13%, with the highest detection rates occurring in central Australia and in correctional facility inmates. Symptomatic patients attending sexual health clinics have a positivity rate of 12%, but very high macrolide resistance. The decision to screen for M. genitalium should be based on several factors, including the prevalence of the infection in the local population; the availability of effective treatments; and the potential benefits and risks of detection and therapy.
Subject(s)
Mycoplasma Infections , Mycoplasma genitalium , Humans , Mycoplasma genitalium/isolation & purification , Northern Territory/epidemiology , Mycoplasma Infections/epidemiology , Mycoplasma Infections/microbiology , Retrospective Studies , Prevalence , Male , Female , Adult , Anti-Bacterial Agents/pharmacology , Drug Resistance, Bacterial , Middle Aged , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/microbiology , Young Adult , Macrolides/pharmacologyABSTRACT
INTRODUCTION: The effectiveness of antibiotics for treating gonococcal infections is compromised due to escalating antibiotic resistance; and the development of an effective gonococcal vaccine has been challenging. Emerging evidence suggests that the licensed meningococcal B (MenB) vaccine, 4CMenB is effective against gonococcal infections due to cross-reacting antibodies and 95% genetic homology between the two bacteria, Neisseria meningitidis and Neisseria gonorrhoeae, that cause the diseases. This project aims to undertake epidemiological and genomic surveillance to evaluate the long-term protection of the 4CMenB vaccine against gonococcal infections in the Northern Territory (NT) and South Australia (SA), and to determine the potential benefit of a booster vaccine doses to provide longer-term protection against gonococcal infections. METHODS AND ANALYSES: This observational study will provide long-term evaluation results of the effectiveness of the 4CMenB vaccine against gonococcal infections at 4-7 years post 4CMenB programme implementation. Routine notifiable disease notifications will be the basis for assessing the impact of the vaccine on gonococcal infections. Pathology laboratories will provide data on the number and percentage of N. gonorrhoeae positive tests relative to all tests administered and will coordinate molecular sequencing for isolates. Genome sequencing results will be provided by SA Pathology and Territory Pathology/New South Wales Health Pathology, and linked with notification data by SA Health and NT Health. There are limitations in observational studies including the potential for confounding. Confounders will be analysed separately for each outcome/comparison. ETHICS AND DISSEMINATION: The protocol and all study documents have been reviewed and approved by the SA Department for Health and Well-being Human Research Ethics Committee (HREC/2022/HRE00308), and the evaluation will commence in the NT on receipt of approval from the NT Health and Menzies School of Health Research Human Research Ethics Committee. Results will be published in peer-reviewed journals and presented at scientific meetings and public forums.
Subject(s)
Gonorrhea , Meningococcal Vaccines , Neisseria gonorrhoeae , Humans , Gonorrhea/prevention & control , Gonorrhea/epidemiology , Northern Territory/epidemiology , Meningococcal Vaccines/administration & dosage , Meningococcal Vaccines/therapeutic use , Neisseria gonorrhoeae/immunology , South Australia/epidemiology , Observational Studies as Topic , FemaleSubject(s)
Bacteriological Techniques/methods , Burkholderia pseudomallei/isolation & purification , Melioidosis/diagnosis , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Burkholderia/chemistry , Burkholderia/immunology , Burkholderia/isolation & purification , Burkholderia pseudomallei/chemistry , Burkholderia pseudomallei/immunology , Early Diagnosis , Humans , Immunoassay , Male , Melioidosis/microbiology , Middle Aged , Sensitivity and SpecificityABSTRACT
This article summarises our review of 41 Corynebacterium diphtheriae wound swab isolates from the tropical Northern Territory of Australia. On polymerase chain reaction and whole genome sequencing, no isolates were toxigenic strains.
Subject(s)
Corynebacterium diphtheriae , Humans , Northern Territory/epidemiology , Corynebacterium diphtheriae/genetics , Polymerase Chain Reaction , Whole Genome SequencingABSTRACT
Group B streptococcus (GBS) is a significant cause of perinatal morbidity and mortality; prophylactic antibiotics in the obstetric population can mitigate the risk of neonatal infection. The antibiotic of choice is penicillin; however, in women who have a penicillin hypersensitivity, clindamycin is the preferred agent. Worldwide resistance to clindamycin is rising in GBS isolates. In the Top End of the Northern Territory of Australia, we reviewed 113 GBS isolates in 2023. These GBS isolates revealed a 30% resistance to clindamycin. This rate has considerably increased since the Australia-wide survey published in 2011 where GBS resistance to clindamycin was quoted at 4.2%. As a result of this study, we are advocating for a change in practice in patients with known GBS resistance with penicillin hypersensitivity.