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1.
BMC Infect Dis ; 21(1): 9, 2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407180

RESUMEN

BACKGROUND: To determine the prevalence of enteric infections in Aboriginal children aged 0-2 years using conventional and molecular diagnostic techniques and to explore associations between the presence of pathogens and child growth. METHODS: Cross-sectional analysis of Aboriginal children (n = 62) residing in a remote community in Northern Australia, conducted from July 24th - October 30th 2017. Stool samples were analysed for organisms by microscopy (directly in the field and following fixation and storage in sodium-acetate formalin), and by qualitative PCR for viruses, bacteria and parasites and serology for Strongyloides-specific IgG. Child growth (height and weight) was measured and z scores calculated according to WHO growth standards. RESULTS: Nearly 60% of children had evidence for at least one enteric pathogen in their stool (37/62). The highest burden of infection was with adenovirus/sapovirus (22.9%), followed by astrovirus (9.8%) and Cryptosporidium hominis/parvum (8.2%). Non-pathogenic organisms were detected in 22.5% of children. Ten percent of children had diarrhea at the time of stool collection. Infection with two or more pathogens was negatively associated with height for age z scores (- 1.34, 95% CI - 2.61 to - 0.07), as was carriage of the non-pathogen Blastocystis hominis (- 2.05, 95% CI - 3.55 to - 0.54). CONCLUSIONS: Infants and toddlers living in this remote Northern Australian Aboriginal community had a high burden of enteric pathogens and non-pathogens. The association between carriage of pathogens/non-pathogens with impaired child growth in the critical first 1000 days of life has implications for healthy child growth and development and warrants further investigation. These findings have relevance for many other First Nations Communities that face many of the same challenges with regard to poverty, infections, and malnutrition.


Asunto(s)
Infecciones por Adenovirus Humanos/epidemiología , Adenovirus Humanos/genética , Infecciones por Astroviridae/epidemiología , Infecciones por Caliciviridae/epidemiología , Criptosporidiosis/epidemiología , Cryptosporidium/genética , Gastroenteritis/epidemiología , Mamastrovirus/genética , Sapovirus/genética , Infecciones por Adenovirus Humanos/virología , Adenovirus Humanos/aislamiento & purificación , Animales , Infecciones por Astroviridae/virología , Australia/epidemiología , Infecciones por Caliciviridae/virología , Preescolar , Estudios Transversales , Criptosporidiosis/parasitología , Cryptosporidium/aislamiento & purificación , Diarrea/epidemiología , Diarrea/parasitología , Diarrea/virología , Heces/parasitología , Heces/virología , Femenino , Gastroenteritis/parasitología , Gastroenteritis/virología , Humanos , Lactante , Recién Nacido , Masculino , Mamastrovirus/aislamiento & purificación , Grupo de Ascendencia Oceánica , Reacción en Cadena de la Polimerasa/métodos , Prevalencia , Sapovirus/aislamiento & purificación
2.
BMC Infect Dis ; 21(1): 10, 2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407203

RESUMEN

BACKGROUND: Campylobacter spp. infections are a globally important cause of enterocolitis, causing substantial morbidity. Capturing accurate information on hospitalisations is challenging and limited population-level data exist to describe the clinico-epidemiological characteristics of hospitalised cases. METHODS: Hospital administrative and laboratory datasets were linked to identify Campylobacter-associated hospitalisations between 2004 and 2013. Accuracy of morbidity coding was assessed using laboratory diagnosis as a gold standard, with health department surveillance data used to calculate population-based rates. Additional patient-level data were collected via review of medical records. Descriptive statistics were used to assess changes in rates and proportions and to assess relationships between key variables including age, length of stay, comorbidity and complications. RESULTS: In total 685 Campylobacter-associated hospital admissions were identified, with the sensitivity of morbidity coding 52.8% (95% CI 48.9-56.7%). The mean annual rate of hospitalisation was 13.6%. Hospitalisation rates were higher for females across most age-groups, while for both genders marked increases were observed for those aged ≥60 years. Median admission age was 39.5 years, with an average length of stay of 3.5 days. Comorbidities were present in 34.5% (237/685) of admissions, with these patients more likely to develop electrolyte disturbances, hypotension, renal impairment or acute confusion (all p < 0.001). Bacteraemia and acute kidney injury were observed in 4.1% (28/685) and 3.6% (23/685) of admissions, respectively. Inpatient mortality was low (0.15%). CONCLUSION: Under reporting of Campylobacter-associated hospitalisations is substantial but can be improved through data linkage. We observed demographic differences among those hospitalised but further work is needed to determine risk factors and predictors for hospitalisation.


Asunto(s)
Infecciones por Campylobacter/epidemiología , Campylobacter/aislamiento & purificación , Tiempo de Internación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Infecciones por Campylobacter/microbiología , Niño , Preescolar , Comorbilidad , Estudios Transversales , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Factores de Riesgo , Adulto Joven
3.
Viruses ; 13(1)2021 01 08.
Artículo en Inglés | MEDLINE | ID: mdl-33430050

RESUMEN

Phylodynamic inference is a pivotal tool in understanding transmission dynamics of viral outbreaks. These analyses are strongly guided by the input of an epidemiological model as well as sequence data that must contain sufficient intersequence variability in order to be informative. These criteria, however, may not be met during the early stages of an outbreak. Here we investigate the impact of low diversity sequence data on phylodynamic inference using the birth-death and coalescent exponential models. Through our simulation study, estimating the molecular evolutionary rate required enough sequence diversity and is an essential first step for any phylodynamic inference. Following this, the birth-death model outperforms the coalescent exponential model in estimating epidemiological parameters, when faced with low diversity sequence data due to explicitly exploiting the sampling times. In contrast, the coalescent model requires additional samples and therefore variability in sequence data before accurate estimates can be obtained. These findings were also supported through our empirical data analyses of an Australian and a New Zealand cluster outbreaks of SARS-CoV-2. Overall, the birth-death model is more robust when applied to datasets with low sequence diversity given sampling is specified and this should be considered for future viral outbreak investigations.


Asunto(s)
/epidemiología , /genética , Australia/epidemiología , Teorema de Bayes , Simulación por Computador , Evolución Molecular , Humanos , Modelos Estadísticos , Nueva Zelanda/epidemiología , Pandemias , Filogenia , /aislamiento & purificación
4.
J R Soc Interface ; 18(174): 20200657, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33404371

RESUMEN

COVID-19 is highly transmissible and containing outbreaks requires a rapid and effective response. Because infection may be spread by people who are pre-symptomatic or asymptomatic, substantial undetected transmission is likely to occur before clinical cases are diagnosed. Thus, when outbreaks occur there is a need to anticipate which populations and locations are at heightened risk of exposure. In this work, we evaluate the utility of aggregate human mobility data for estimating the geographical distribution of transmission risk. We present a simple procedure for producing spatial transmission risk assessments from near-real-time population mobility data. We validate our estimates against three well-documented COVID-19 outbreaks in Australia. Two of these were well-defined transmission clusters and one was a community transmission scenario. Our results indicate that mobility data can be a good predictor of geographical patterns of exposure risk from transmission centres, particularly in outbreaks involving workplaces or other environments associated with habitual travel patterns. For community transmission scenarios, our results demonstrate that mobility data add the most value to risk predictions when case counts are low and spatially clustered. Our method could assist health systems in the allocation of testing resources, and potentially guide the implementation of geographically targeted restrictions on movement and social interaction.


Asunto(s)
/epidemiología , Brotes de Enfermedades , Salud Pública , Viaje , Australia/epidemiología , Trazado de Contacto , Demografía , Brotes de Enfermedades/prevención & control , Brotes de Enfermedades/estadística & datos numéricos , Humanos , Modelos Biológicos , Medición de Riesgo
5.
Vaccine ; 39(2): 255-262, 2021 01 08.
Artículo en Inglés | MEDLINE | ID: mdl-33317870

RESUMEN

BACKGROUND: Pandemic planning has historically been oriented to respond to an influenza virus, with vaccination strategy being a key focus. As the current COVID-19 pandemic plays out, the Australian government is closely monitoring progress towards development of SARS-CoV2 vaccines as a definitive intervention. However, as in any pandemic, initial supply will likely be exceeded by demand due to limited manufacturing output. METHODS: We convened community juries in three Australian locations in 2019 to assess public acceptability and perceived legitimacy of influenza pandemic vaccination distribution strategies. Preparatory work included literature reviews on pandemic vaccine allocation strategies and on vaccine allocation ethics, and simulation modelling studies. We assumed vaccine would be provided to predefined priority groups. Jurors were then asked to recommend one of two strategies for distributing remaining early doses of vaccine: directly vaccinate people at higher risk of adverse outcomes from influenza; or indirectly protect the general population by vaccinating primary school students, who are most likely to spread infection. RESULTS: Thirty-four participants of diverse backgrounds and ages were recruited through random digit dialling and topic-blinded social media advertising. Juries heard evidence and arguments supporting different vaccine distribution strategies, and questioned expert presenters. All three community juries supported prioritising school children for influenza vaccination (aiming for indirect protection), one by 10-2 majority and two by consensus. Justifications included that indirect protection benefits more people and is likely to be more publicly acceptable. CONCLUSIONS: In the context of an influenza pandemic, informed citizens were not opposed to prioritising groups at higher risks of adverse outcomes, but if resources and epidemiological conditions allow, achieving population benefits should be a strategic priority. These insights may inform future SARS-CoV-2 vaccination strategies.


Asunto(s)
/epidemiología , Asignación de Recursos para la Atención de Salud/organización & administración , Programas de Inmunización/organización & administración , Vacunas contra la Influenza/provisión & distribución , Gripe Humana/prevención & control , Pandemias/prevención & control , Vacunación/ética , Adolescente , Adulto , Australia/epidemiología , Niño , Femenino , Humanos , Esquemas de Inmunización , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/economía , Gripe Humana/epidemiología , Gripe Humana/inmunología , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Orthomyxoviridae/inmunología , Salud Pública/economía , Salud Pública/métodos , Vacunación/economía , Cobertura de Vacunación/estadística & datos numéricos
6.
Lancet Infect Dis ; 21(1): e2-e10, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32986997

RESUMEN

Human T-cell lymphotropic virus type-1 (HTLV-1) has a large global burden and in some key communities, such as Indigenous Australians living in remote areas, greater than 45% of people are infected. Despite HTLV-1 causing serious malignancy and myelopathic paraparesis, and a significant association with a range of inflammatory comorbidities and secondary infections that shorten lifespan, few biomedical interventions are available. HTLV-1 starkly contrasts with other blood-borne sexually transmitted viral infections, such as, HIV, hepatitis B virus, and hepatitis C virus, with no antiviral treatments that reduce virus-infected cells, no rapid diagnostics or biomarker assays suitable for use in remote settings, and no effective vaccine. We review how the replication strategies and molecular properties of HTLV-1 establish a long-term stealthy viral pathogenesis through a fine-tuned balance of persistence, immune cell dysfunction, and proliferation of proviral infected cells that collectively present robust barriers to treatment and prevention. An understanding of the nature of the HTLV-1 provirus and opposing actions of viral-coded negative-sense HBZ and positive-sense regulatory proteins Tax, p12 and its cleaved product p8, and p30, is needed to improve the biomedical tools for preventing transmission and improving the long-term health of people with this lifelong infection.


Asunto(s)
Regulación Viral de la Expresión Génica , Infecciones por HTLV-I/epidemiología , Infecciones por HTLV-I/patología , Interacciones Huésped-Patógeno , Virus Linfotrópico T Tipo 1 Humano/genética , Virus Linfotrópico T Tipo 1 Humano/patogenicidad , Linfocitos T/patología , Australia/epidemiología , Humanos , Recurrencia
7.
Vaccine ; 39(2): 309-316, 2021 01 08.
Artículo en Inglés | MEDLINE | ID: mdl-33334616

RESUMEN

A vaccine for COVID-19 is urgently needed. Several vaccine trial designs may significantly accelerate vaccine testing and approval, but also increase risks to human subjects. Concerns about whether the public would see such designs as ethical represent an important roadblock to their implementation; accordingly, both the World Health Organization and numerous scholars have called for consulting the public regarding them. We answered these calls by conducting a cross-national survey (n = 5920) in Australia, Canada, Hong Kong, New Zealand, South Africa, Singapore, the United Kingdom, and the United States. The survey explained key differences between traditional vaccine trials and two accelerated designs: a challenge trial or a trial integrating a Phase II safety and immunogenicity trial into a larger Phase III efficacy trial. Respondents' answers to comprehension questions indicate that they largely understood the key differences and ethical trade-offs between the designs from our descriptions. We asked respondents whether they would prefer scientists to conduct traditional trials or one of these two accelerated designs. We found broad majorities prefer for scientists to conduct challenge trials (75%) and integrated trials (63%) over standard trials. Even as respondents acknowledged the risks, they perceived both accelerated trials as similarly ethical to standard trial designs. This high support is consistent across every geography and demographic subgroup we examined, including vulnerable populations. These findings may help assuage some of the concerns surrounding accelerated designs.


Asunto(s)
/administración & dosificación , Toma de Decisiones , Pandemias/prevención & control , Proyectos de Investigación , Vacunación/psicología , Asia/epidemiología , Australia/epidemiología , /psicología , /biosíntesis , Conducta de Elección , Ensayos Clínicos como Asunto , Femenino , Humanos , Inmunidad Innata/efectos de los fármacos , Esquemas de Inmunización , Inmunogenicidad Vacunal , Masculino , América del Norte/epidemiología , Seguridad del Paciente , Salud Pública , Encuestas y Cuestionarios , Factores de Tiempo , Reino Unido/epidemiología , Vacunación/métodos
8.
Diabet Med ; 38(1): e14417, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33020999

RESUMEN

AIMS: To determine if the frequency of severe diabetic ketoacidosis at presentation of new-onset type 1 diabetes to an Australian tertiary centre increased during the initial period of restrictions resulting from the COVID-19 pandemic (March to May 2020). METHODS: Data were collected on presentations of newly diagnosed type 1 diabetes as well as on all paediatric presentations to the emergency department of a tertiary centre between 2015 and 2020. Data from the period of initial COVID restrictions in Australia (March to May 2020) were compared to the period March to May of the previous 5 years (pre-pandemic periods). RESULTS: The number of new diagnoses of type 1 diabetes was comparable in the pandemic period and pre-pandemic periods (11 in 2020 vs range 6-10 in 2015-2019). The frequency of severe diabetic ketoacidosis was significantly higher in the pandemic period compared to the pre-pandemic periods (45% vs 5%; P <0.003), odds ratio 16.7 (95% CI 2.0, 194.7). The overall frequency of diabetic ketoacidosis was also significantly higher during the pandemic period (73% vs 26%; P <0.007), odds ratio 7.5 (95% CI 1.7, 33.5). None of the individuals tested positive for COVID-19. Presentations of people aged <18 years to the emergency department decreased by 27% in the pandemic period compared to the average of the pre-pandemic periods (4799 vs 6550; range 6268 to 7131). CONCLUSIONS: A significant increase in the frequency of severe diabetic ketoacidosis at presentation of type 1 diabetes was observed during the initial period of COVID-19 restrictions. We hypothesize that concern about presenting to hospital during a pandemic led to a delay in diagnosis. These data have important implications for advocacy of seeking healthcare for non-pandemic-related conditions during a global pandemic.


Asunto(s)
/epidemiología , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/epidemiología , Cetoacidosis Diabética/epidemiología , Adolescente , Australia/epidemiología , Niño , Preescolar , Diabetes Mellitus Tipo 1/diagnóstico , Femenino , Humanos , Masculino , Pandemias , Centros de Atención Terciaria/estadística & datos numéricos
9.
Clin Microbiol Infect ; 27(1): 118-124, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32979575

RESUMEN

OBJECTIVES: The case fatality rate (CFR) of coronavirus disease 2019 (COVID-19) varies significantly between countries. We aimed to describe the associations between health indicators and the national CFRs of COVID-19. METHODS: We identified for each country health indicators potentially associated with the national CFRs of COVID-19. We extracted data for 18 variables from international administrative data sources for 34 member countries of the Organization for Economic Cooperation and Development (OECD). We excluded the collinear variables and examined the 16 variables in multivariable analysis. A dynamic web-based model was developed to analyse and display the associations for the CFRs of COVID-19. We followed the Guideline for Accurate and Transparent Health Estimates Reporting (GATHER). RESULTS: In multivariable analysis, the variables significantly associated with the increased CFRs were percentage of obesity in ages >18 years (ß = 3.26; 95%CI = 1.20, 5.33; p 0.003), tuberculosis incidence (ß = 3.15; 95%CI = 1.09, 5.22; p 0.004), duration (days) since first death due to COVID-19 (ß = 2.89; 95%CI = 0.83, 4.96; p 0.008), and median age (ß = 2.83; 95%CI = 0.76, 4.89; p 0.009). The COVID-19 test rate (ß = -3.54; 95%CI = -5.60, -1.47; p 0.002), hospital bed density (ß = -2.47; 95%CI = -4.54, -0.41; p 0.021), and rural population ratio (ß = -2.19; 95%CI = -4.25, -0.13; p 0.039) decreased the CFR. CONCLUSIONS: The pandemic hits population-dense cities. Available hospital beds should be increased. Test capacity should be increased to enable more effective diagnostic tests. Older patients and patients with obesity and their caregivers should be warned about a potentially increased risk.


Asunto(s)
/epidemiología , Obesidad/epidemiología , Obesidad/mortalidad , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/mortalidad , Adulto , Factores de Edad , Anciano , Américas/epidemiología , Australia/epidemiología , /patología , Comorbilidad , Europa (Continente)/epidemiología , Femenino , Capacidad de Camas en Hospitales/estadística & datos numéricos , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Obesidad/patología , Densidad de Población , Población Rural , Índice de Severidad de la Enfermedad , Factores de Tiempo , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/patología , Población Urbana
10.
Lancet Psychiatry ; 8(1): 36-47, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33156999

RESUMEN

BACKGROUND: Understanding the time-varying association of pre-migration and post-migration stressors in refugees' mental health could help in designing tailored health promotion services at different resettlement stages and improving the efficiency of resource allocation. In this study, we explored these time-varying associations. METHODS: We used data from the first four waves (October, 2013, to February, 2017) of a national refugee-based longitudinal study, the Building a New Life in Australia (BNLA) project. Post-traumatic stress disorder (PTSD) and high risk of severe mental illness (HR-SMI) were used to assess mental health. The independent variables included the number of potentially traumatic events experienced during the pre-migration process, and a range of post-migration stressors. We used logistic regression models to analyse the relative importance of variables and time-varying associations between the pre-migration potentially traumatic events, post-migration resettlement stressors, and refugees' mental health. Analyses were stratified by gender, and sociodemographic covariates included age, marital status, education level, country of birth, and weekly income. RESULTS: 2399 participants were surveyed in Wave 1 of the BNLA project in 2013-14, of whom 2009 (83·7%) responded in Wave 2 in 2014-15, 1894 (78·9%) in Wave 3 in 2015-16, and 1929 (80·4%) in Wave 4 in 2016-17. The three most important factors associated with mental health in each wave differed for male and female refugees, but the socioeconomic stressors of loneliness and adjustment to life in Australia were consistently prominent. Positive associations between socioeconomic stressors and mental ill-health were found for both genders, with a peak at Wave 2 (adjusted odds ratio [AOR] among men, 1·60 [95% CI 1·26-2·03], p=0.0001 for PTSD; AOR 1·86 [1·35-2·55], p=0·0001 for HR-SMI; and among women, AOR 1·81 [1·27-2·57], p=0·0009 for PTSD; AOR 2·24 [1·49-3·38], p=0·0001 for HR-SMI). Associations between loneliness and mental health fluctuated, but were significant for both genders in Wave 4 (among men, AOR 1·90 [1·21-2·99], p=0·0051 for PTSD; AOR 3·70 [2·18-6·27], p<0·0001 for HR-SMI; and among women, AOR 3·65 [2·08-6·39], p<0·0001 for PTSD; AOR 3·68 [2·02-6·69], p<0·0001 for HR-SMI). The association between difficulties in adjustment to life in Australia and male refugees' mental ill-health increased continuously during the resettlement period. INTERPRETATION: Gender-specific and time-sensitive services should be considered to improve refugees' mental health. For both genders, improved economic conditions that complement social security benefits deserve attention and are relevant throughout the resettlement process. At the later stage of resettlement, services to reduce loneliness could be carried out, and reducing stressors related to adjustment to life in the host country is especially needed for male refugees. FUNDING: None.


Asunto(s)
Emigración e Inmigración , Refugiados/psicología , Trastornos por Estrés Postraumático/psicología , Estrés Psicológico/complicaciones , Adulto , Australia/epidemiología , Femenino , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , Salud Mental/estadística & datos numéricos , Salud Mental/tendencias , Persona de Mediana Edad , Refugiados/estadística & datos numéricos , Trastornos por Estrés Postraumático/epidemiología , Estrés Psicológico/epidemiología , Encuestas y Cuestionarios , Adulto Joven
11.
Sci Total Environ ; 759: 143460, 2021 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-33234275

RESUMEN

Gout is a rheumatic arthritis disease which poses a health burden. Monitoring the prevalence of gout is key to reduce the community burden of gout disease and associated health costs. Allopurinol has been used as a first line gout preventive medication in Australia which is metabolised into oxypurinol and excreted in urine. Wastewater-based epidemiology (WBE) was applied to estimate temporal trends of gout prevalence in an Australian community over eight-years via the quantification of oxypurinol in wastewater. A total of 180 wastewater samples collected between 2012 and 2019 were analysed for oxypurinol to estimate allopurinol consumption in a community in South East Queensland, Australia. Annual gout prevalence was estimated by daily defined doses (DDD) consumed and ranged from 24 to 32 DDD/day/1000, an equivalent gout prevalence of 2.3 to 3.2% over the eight-year period. A statistically significant increase in allopurinol consumption was observed over the period (Slope = 0.094, p = 0.0001), equating to year-on-year increases in gout prevalence of 3.6% per year. To the best of our knowledge, this is the first long-term gout prevalence study using wastewater, adding epidemiological and public health insights in the gout research field.


Asunto(s)
Gota , Aguas Residuales , Australia/epidemiología , Gota/epidemiología , Humanos , Prevalencia , Queensland
13.
Environ Pollut ; 268(Pt A): 115698, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33049483

RESUMEN

Children's respiratory health are particularly vulnerable to outdoor air pollution, but evidence is lacking on the very acute effects of air pollution on the risk of acute upper respiratory infections (AURI) and acute lower respiratory infections (ALRI) in children. This study aimed to evaluate the risk of cause-specific AURI and ALRI, in children within 24 h of exposure to air pollution. We obtained data on emergency cases, including 11,091 AURI cases (acute pharyngitis, acute tonsillitis, acute obstructive laryngitis and epiglottitis, and unspecified acute upper respiratory infections) and 11,401 ALRI cases (pneumonia, acute bronchitis, acute bronchiolitis, unspecified acute lower respiratory infection) in Brisbane, Australia, 2013-2015. A time-stratified case-crossover analysis was used to examine the hourly association of AURI and ALRI with high concentration (95th percentile) of four air pollutants (particulate matters with aerodynamic diameter <10 µm (PM10) and <2.5 µm (PM2.5), ozone (O3), nitrogen dioxide (NO2)). We observed increased risk of acute tonsillitis associated with PM2.5 within 13-24 h (odds ratio (OR), 1.45; 95% confidence interval [CI], 1.02-2.06) and increased risk of unspecified acute upper respiratory infections related to O3 within 2-6 h (OR, 1.38, 95%CI, 1.12-1.70), NO2 within 1 h (OR, 1.19; 95%CI, 1.01-1.40), and PM2.5 within 7-12 h (OR, 1.21; 95%CI, 1.02-1.43). Cold season and nigh-time air pollution has greater effects on AURI, whereas greater risk of ALRI was seen in warm season and daytime. Our findings suggest exposures to particulate and gaseous air pollution may transiently increase risk of AURI and ALRI in children within 24 h. Prevention measures aimed at protecting children's respiratory health should consider the very acute effects of air pollution.


Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire , Ozono , Infecciones del Sistema Respiratorio , Contaminantes Atmosféricos/análisis , Contaminación del Aire/efectos adversos , Contaminación del Aire/análisis , Australia/epidemiología , Niño , Exposición a Riesgos Ambientales/análisis , Humanos , Dióxido de Nitrógeno/análisis , Ozono/análisis , Material Particulado/análisis , Infecciones del Sistema Respiratorio/epidemiología
19.
Artículo en Inglés | MEDLINE | ID: mdl-33333879

RESUMEN

The current status of gestational diabetes mellitus in Australia reveals an almost quadrupling prevalence over the last decade. A narrative review of the current Australian literature reveals unique challenges faced by Australian maternity clinicians when addressing this substantial disease burden in our diverse population. Rising rates of maternal overweight and obesity, increasing maternal age and the diversity of ethnicity are key epidemiological impactors, overlaid by the 2015 changes in screening and diagnostic parameters. Our vast land mass and the remote location of many at risk women requires innovative and novel ideas for pathways to diagnose and effectively manage women with gestational diabetes mellitus. By modifying and modernizing models of care for women with gestational diabetes mellitus, we have the ability to address accessibility, resource management and our acute response to global events such as the COVID 19 pandemic. With continuing research, education and robust discourse, Australia is well placed to meet current and future challenges in the management of gestational diabetes mellitus.


Asunto(s)
Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiología , Australia/epidemiología , Femenino , Humanos , Embarazo , Prevalencia
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