Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 17.927
Filtrar
3.
Epidemiol Psychiatr Sci ; 29: e94, 2020 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-31973775

RESUMEN

AIMS: Previous studies analysing blood alcohol concentration (BAC) at the time of suicide have primarily focused on sociodemographic factors. Limited research has focused on psychosocial factors and co-ingestion of other substances to understand the mechanisms of how alcohol contributes to death by suicide. The aim was to examine time trends, psychosocial factors related to acute alcohol use and co-ingestion of alcohol and other substances before suicide. METHODS: The Queensland Suicide Register in 2004-2015 was utilised and analysed in 2019. The cut-off point for positive BAC was set at ⩾0.05 g/dl. Substances were categorised as medicines, illegal drugs and other. Medicines were coded by the Anatomical Therapeutic Chemical (ATC) classification system. Joinpoint regression, univariate odds ratios, age and sex-adjusted odds ratios and Forward Stepwise logistic regression were performed. RESULTS: BAC information was available for 6744 suicides, 92% of all cases in 2004-2015. The final model showed that independent factors distinguishing BAC+ from BAC- were: age group 25-44 years, Australian Indigenous background, being separated or divorced, hanging, diagnosis of substance use, lifetime suicidal ideation, relationship and interpersonal conflict, not having psychotic and other psychiatric disorder, and no nervous system drugs or any other substances in blood at the time of suicide. CONCLUSIONS: Our findings suggest that people who die by suicide while under the influence of alcohol are more likely to be under acute stress (e.g. separation) and not have earlier psychiatric conditions, except substance use. This highlights the importance of more strict alcohol policies, but also the need to improve substance use treatment.


Asunto(s)
Consumo de Bebidas Alcohólicas/sangre , Nivel de Alcohol en Sangre , Sistema de Registros/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Adulto , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Australia/epidemiología , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Trastornos Relacionados con Sustancias/epidemiología , Suicidio/psicología
4.
N Engl J Med ; 382(4): 318-327, 2020 01 23.
Artículo en Inglés | MEDLINE | ID: mdl-31971677

RESUMEN

BACKGROUND: The meningococcal group B vaccine 4CMenB is a new, recombinant protein-based vaccine that is licensed to protect against invasive group B meningococcal disease. However, its role in preventing transmission and, therefore, inducing population (herd) protection is uncertain. METHODS: We used cluster randomization to assign, according to school, students in years 10 to 12 (age, 15 to 18 years) in South Australia to receive 4CMenB vaccination either at baseline (intervention) or at 12 months (control). The primary outcome was oropharyngeal carriage of disease-causing Neisseria meningitidis (group A, B, C, W, X, or Y) in students in years 10 and 11, as identified by polymerase-chain-reaction assays for PorA (encoding porin protein A) and N. meningitidis genogroups. Secondary outcomes included carriage prevalence and acquisition of all N. meningitidis and individual disease-causing genogroups. Risk factors for carriage were assessed at baseline. RESULTS: A total of 237 schools participated. During April through June 2017, a total of 24,269 students in years 10 and 11 and 10,220 students in year 12 were enrolled. At 12 months, there was no difference in the prevalence of carriage of disease-causing N. meningitidis between the vaccination group (2.55%; 326 of 12,746) and the control group (2.52%; 291 of 11,523) (adjusted odds ratio, 1.02; 95% confidence interval [CI], 0.80 to 1.31; P = 0.85). There were no significant differences in the secondary carriage outcomes. At baseline, the risk factors for carriage of disease-causing N. meningitidis included later year of schooling (adjusted odds ratio for year 12 vs. year 10, 2.75; 95% CI, 2.03 to 3.73), current upper respiratory tract infection (adjusted odds ratio, 1.35; 95% CI, 1.12 to 1.63), cigarette smoking (adjusted odds ratio, 1.91; 95% CI, 1.29 to 2.83), water-pipe smoking (adjusted odds ratio, 1.82; 95% CI, 1.30 to 2.54), attending pubs or clubs (adjusted odds ratio, 1.54; 95% CI, 1.28 to 1.86), and intimate kissing (adjusted odds ratio, 1.65; 95% CI, 1.33 to 2.05). No vaccine safety concerns were identified. CONCLUSIONS: Among Australian adolescents, the 4CMenB vaccine had no discernible effect on the carriage of disease-causing meningococci, including group B. (Funded by GlaxoSmithKline; ClinicalTrials.gov number, NCT03089086.).


Asunto(s)
Portador Sano/prevención & control , Infecciones Meningocócicas/prevención & control , Vacunas Meningococicas/inmunología , Neisseria meningitidis Serogrupo B/aislamiento & purificación , Neisseria meningitidis/aislamiento & purificación , Adolescente , Australia/epidemiología , Portador Sano/epidemiología , Femenino , Humanos , Masculino , Neisseria meningitidis/genética , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Serogrupo , Método Simple Ciego
5.
BJOG ; 127(3): 345-354, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31749274

RESUMEN

OBJECTIVES: To describe the population of women having bariatric surgery and compare the pregnancy outcomes for women having bariatric surgery with a non-bariatric surgery population having a first and second pregnancy. DESIGN: Population-based record linkage study. SETTING: New South Wales (NSW), Australia. POPULATION: All women aged 15-45 years with a hospital record in NSW (2002-2014) and all women giving birth in NSW (1994-2015; n = 1 606 737 women). METHODS: Pregnancy and birth outcomes were compared between first and second pregnancies using repeated-measures logistic regression and paired Student's t-tests. Bariatric and non-bariatric groups were also compared. MAIN OUTCOME MEASURES: Maternal diabetes, preterm birth (<37 weeks of gestation) and large for gestational age. RESULTS: There was a 13-fold increase in hospitalisations for primary bariatric surgery during 2002-2014. Compared with the general birthing population, women who had bariatric surgery experienced higher rates of hypertension, diabetes, and preterm birth. Among women who had bariatric surgery between a first and second pregnancy, there were reduced rates of hypertension (OR 0.39, 95% CI 0.29-0.53), spontaneous preterm birth (OR 0.37, 95% CI 0.16-0.86), infants that were large for gestational age (OR 0.63, 95% CI 0.44-0.88), and the admission of infants to a special care nursery or neonatal intensive care (OR 0.64, 95% CI 0.46-0.90) in the second pregnancy. Rates for small-for-gestational age and gestational diabetes following surgery were 8.3 and 11.4%, respectively CONCLUSIONS: Bariatric surgery between a first and second pregnancy was associated with reductions in obesity-related adverse pregnancy outcomes. Bariatric surgery performed for the management of obesity in accordance with current clinical criteria is associated with improved pregnancy outcomes in a subsequent pregnancy. TWEETABLE ABSTRACT: Bariatric surgery for obesity may improve pregnancy and birth outcomes in a subsequent pregnancy.


Asunto(s)
Cirugía Bariátrica , Diabetes Gestacional , Obesidad , Nacimiento Prematuro/epidemiología , Sistema de Registros/estadística & datos numéricos , Adulto , Australia/epidemiología , Cirugía Bariátrica/métodos , Cirugía Bariátrica/estadística & datos numéricos , Peso al Nacer , Cesárea/estadística & datos numéricos , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiología , Femenino , Humanos , Recién Nacido , Almacenamiento y Recuperación de la Información , Obesidad/epidemiología , Obesidad/cirugía , Paridad , Embarazo , Resultado del Embarazo/epidemiología
6.
Int J Gynaecol Obstet ; 148(1): 41-47, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31544242

RESUMEN

OBJECTIVES: To develop a model for predicting emergency cesarean for fetal distress (ECFD) at term using a combination of maternal and late pregnancy ultrasound parameters measured at more than 36 gestational weeks. METHODS: A study of prospectively collected data, including ultrasound scans at 36-38 weeks, for singleton non-anomalous deliveries at Mater Mother's Hospital, Brisbane, Australia, between January 2010 and April 2017. Univariable and multivariable mixed-effects generalized linear models were generated. The final model was validated by the K-fold cross validation technique. RESULTS: Overall, 5439 women met the inclusion criteria; of these, 230 (4.2%) underwent ECFD. There were more nulliparous women and women with induction of labor (IOL) in the ECFD cohort (both P < 0.001). ECFD neonates had lower z-scores for estimated fetal weight (EFW), cerebroplacental ratio (CPR), and middle cerebral artery pulsatility index; and higher scores for umbilical artery pulsatility index. Ethnicity, nulliparity, IOL, EFW z-score, and CPR z-score were included in the final prediction model, which showed high accuracy with an area under the receiver operator characteristic curve of 0.77. CONCLUSION: The study shows that a prediction model combining the continuous standardized measures of CPR and EFW and several maternal factors was able to identify ECFD with improved accuracy.


Asunto(s)
Cesárea/estadística & datos numéricos , Sufrimiento Fetal/diagnóstico , Adulto , Australia/epidemiología , Femenino , Sufrimiento Fetal/epidemiología , Peso Fetal , Humanos , Recién Nacido , Arteria Cerebral Media/diagnóstico por imagen , Valor Predictivo de las Pruebas , Embarazo , Tercer Trimestre del Embarazo , Estudios Prospectivos , Ultrasonografía Prenatal/métodos , Arterias Umbilicales/diagnóstico por imagen
7.
Int J Cancer ; 146(3): 874-883, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-31107541

RESUMEN

Substantial changes in the prevalence of the principal kidney and bladder cancer risk factors, smoking (both cancers) and body fatness (kidney cancer), have occurred but the contemporary cancer burden attributable to these factors has not been evaluated. We quantified the kidney and bladder cancer burden attributable to individual and joint exposures and assessed whether these burdens differ between population subgroups. We linked pooled data from seven Australian cohorts (N = 367,058) to national cancer and death registries and estimated the strength of the associations between exposures and cancer using adjusted proportional hazards models. We estimated exposure prevalence from representative contemporaneous health surveys. We combined these estimates to calculate population attributable fractions (PAFs) with 95% confidence intervals (CIs), accounting for competing risk of death, and compared PAFs for population subgroups. During the first 10-year follow-up, 550 kidney and 530 bladder cancers were diagnosed and over 21,000 people died from any cause. Current levels of overweight and obesity explain 28.8% (CI = 17.3-38.7%), current or past smoking 15.5% (CI = 6.0-24.1%) and these exposures jointly 39.6% (CI = 27.5-49.7%) of the kidney cancer burden. Current or past smoking explains 44.4% (CI = 35.4-52.1%) of the bladder cancer burden, with 24.4% attributable to current smoking. Ever smoking explains more than half (53.4%) of the bladder cancer burden in men, and the burden potentially preventable by quitting smoking is highest in men (30.4%), those aged <65 years (28.0%) and those consuming >2 standard alcoholic drinks/day (41.2%). In conclusion, large fractions of kidney and bladder cancers in Australia are preventable by behavior change.


Asunto(s)
Terapia Conductista , Costo de Enfermedad , Neoplasias Renales/epidemiología , Neoplasias de la Vejiga Urinaria/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , Australia/epidemiología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Predicción , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Neoplasias Renales/prevención & control , Estilo de Vida , Masculino , Persona de Mediana Edad , Sobrepeso/complicaciones , Sobrepeso/epidemiología , Prevalencia , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiología , Fumar/terapia , Cese del Hábito de Fumar , Neoplasias de la Vejiga Urinaria/prevención & control , Adulto Joven
8.
Lancet ; 394(10215): 2173-2183, 2019 12 14.
Artículo en Inglés | MEDLINE | ID: mdl-31810609

RESUMEN

BACKGROUND: The relevance of blood lipid concentrations to long-term incidence of cardiovascular disease and the relevance of lipid-lowering therapy for cardiovascular disease outcomes is unclear. We investigated the cardiovascular disease risk associated with the full spectrum of bloodstream non-HDL cholesterol concentrations. We also created an easy-to-use tool to estimate the long-term probabilities for a cardiovascular disease event associated with non-HDL cholesterol and modelled its risk reduction by lipid-lowering treatment. METHODS: In this risk-evaluation and risk-modelling study, we used Multinational Cardiovascular Risk Consortium data from 19 countries across Europe, Australia, and North America. Individuals without prevalent cardiovascular disease at baseline and with robust available data on cardiovascular disease outcomes were included. The primary composite endpoint of atherosclerotic cardiovascular disease was defined as the occurrence of the coronary heart disease event or ischaemic stroke. Sex-specific multivariable analyses were computed using non-HDL cholesterol categories according to the European guideline thresholds, adjusted for age, sex, cohort, and classical modifiable cardiovascular risk factors. In a derivation and validation design, we created a tool to estimate the probabilities of a cardiovascular disease event by the age of 75 years, dependent on age, sex, and risk factors, and the associated modelled risk reduction, assuming a 50% reduction of non-HDL cholesterol. FINDINGS: Of the 524 444 individuals in the 44 cohorts in the Consortium database, we identified 398 846 individuals belonging to 38 cohorts (184 055 [48·7%] women; median age 51·0 years [IQR 40·7-59·7]). 199 415 individuals were included in the derivation cohort (91 786 [48·4%] women) and 199 431 (92 269 [49·1%] women) in the validation cohort. During a maximum follow-up of 43·6 years (median 13·5 years, IQR 7·0-20·1), 54 542 cardiovascular endpoints occurred. Incidence curve analyses showed progressively higher 30-year cardiovascular disease event-rates for increasing non-HDL cholesterol categories (from 7·7% for non-HDL cholesterol <2·6 mmol/L to 33·7% for ≥5·7 mmol/L in women and from 12·8% to 43·6% in men; p<0·0001). Multivariable adjusted Cox models with non-HDL cholesterol lower than 2·6 mmol/L as reference showed an increase in the association between non-HDL cholesterol concentration and cardiovascular disease for both sexes (from hazard ratio 1·1, 95% CI 1·0-1·3 for non-HDL cholesterol 2·6 to <3·7 mmol/L to 1·9, 1·6-2·2 for ≥5·7 mmol/L in women and from 1·1, 1·0-1·3 to 2·3, 2·0-2·5 in men). The derived tool allowed the estimation of cardiovascular disease event probabilities specific for non-HDL cholesterol with high comparability between the derivation and validation cohorts as reflected by smooth calibration curves analyses and a root mean square error lower than 1% for the estimated probabilities of cardiovascular disease. A 50% reduction of non-HDL cholesterol concentrations was associated with reduced risk of a cardiovascular disease event by the age of 75 years, and this risk reduction was greater the earlier cholesterol concentrations were reduced. INTERPRETATION: Non-HDL cholesterol concentrations in blood are strongly associated with long-term risk of atherosclerotic cardiovascular disease. We provide a simple tool for individual long-term risk assessment and the potential benefit of early lipid-lowering intervention. These data could be useful for physician-patient communication about primary prevention strategies. FUNDING: EU Framework Programme, UK Medical Research Council, and German Centre for Cardiovascular Research.


Asunto(s)
Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , LDL-Colesterol/sangre , Medición de Riesgo/métodos , Adulto , Anciano , Australia/epidemiología , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Estados Unidos/epidemiología
9.
Epidemiol Psychiatr Sci ; 29: e78, 2019 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-31839014

RESUMEN

AIMS: Associations between childhood abuse and various psychotic illnesses in adulthood are commonly reported. We aim to examine associations between several reported childhood adverse events (sexual abuse, physical abuse, emotional abuse, neglect and interpersonal loss) among adults with diagnosed psychotic disorders and clinical and psychosocial outcomes. METHODS: Within a large epidemiological study, the 2010 Australian National Survey of Psychosis (Survey of High Impact Psychosis, SHIP), we used logistic regression to model childhood adverse events (any and specific types) on 18 clinical and psychosocial outcomes. RESULTS: Eighty percent of SHIP participants (1466/1825) reported experiencing adverse events in childhood (sexual abuse, other types of abuse and interpersonal loss). Participants reporting any form of childhood adversity had higher odds for 12/18 outcomes we examined. Significant associations were observed with all psychosocial outcomes (social dysfunction, victimisation, offending and homelessness within the previous 12 months, and definite psychosocial stressor within 12 months of illness onset), with the strongest association for homelessness (odds ratio (OR) = 2.82). Common across all adverse event types was an association with lifetime depression, anxiety and a definite psychosocial stressor within 12 months of illness onset. When adverse event types were non-hierarchically coded, sexual abuse was associated with 11/18 outcomes, other types of abuse 13/18 and, interpersonal loss occurring in the absence of other forms of abuse was associated with fewer of the clinical and psychosocial outcomes, 4/18. When adverse events types were coded hierarchically (to isolate the effect of interpersonal loss in the absence of abuse), interpersonal loss was associated with lower odds of self-reproach (OR = 0.70), negative syndrome (OR = 0.75) and victimisation (OR = 0.82). CONCLUSIONS: Adverse childhood experiences among people with psychosis are common, as are subsequent psychosocial stressors. Mental health professionals should routinely enquire about all types of adversities in this group and provide effective service responses. Childhood abuse, including sexual abuse, may contribute to subsequent adversity, poor psychosocial functioning and complex needs among people with psychosis. Longitudinal research to better understand these relationships is needed, as are studies which evaluate the effectiveness of preventative interventions in high-risk groups.


Asunto(s)
Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Abuso Sexual Infantil/psicología , Maltrato a los Niños/psicología , Trastornos Psicóticos/epidemiología , Adolescente , Adulto , Adultos Sobrevivientes de Eventos Adversos Infantiles/estadística & datos numéricos , Anciano , Ansiedad/epidemiología , Ansiedad/psicología , Australia/epidemiología , Niño , Maltrato a los Niños/estadística & datos numéricos , Abuso Sexual Infantil/estadística & datos numéricos , Depresión/epidemiología , Depresión/psicología , Femenino , Humanos , Acontecimientos que Cambian la Vida , Masculino , Persona de Mediana Edad , Prevalencia , Trastornos Psicóticos/psicología , Clase Social , Estrés Psicológico , Adulto Joven
11.
BMC Complement Altern Med ; 19(1): 374, 2019 Dec 21.
Artículo en Inglés | MEDLINE | ID: mdl-31864327

RESUMEN

BACKGROUND: The use of Complementary Medicines (CMs) has significantly increased in Australia over the last decade. This study attempts to determine the extent to which complementary and alternative medicines are recorded, ceased or initiated in the acute hospital setting and investigate which health professionals have a role in this process. METHODS: A cross-sectional study of inpatients was conducted at a major tertiary teaching hospital. Patient's medical records were examined to determine the rates of complementary medicine (CM) use and recording on medication charts and discharge prescriptions. Patient progress notes were audited to determine which health professionals were involved with the initiation or cessation of CMs during the inpatient stay. RESULTS: Three hundred and forty-one patients were included for analysis of which 44.3% (n = 151) participants were recorded as utilizing a CM. Patients were admitted on a mean of 2 (±1.4[Sd]; 0-9[range]) CMs and discharged on a mean of 1.7 CMs (±1.3[Sd]; 0-5[range]). 274 individual CMs were recorded on inpatient medication reconciliation forms with multivitamins, magnesium, fish oil and cholecalciferol recorded the most frequently. One hundred and fifty-eight changes to patient CM usage were recorded during the patient hospitalisation. One hundred and seven of these changes (68%) were not accounted for in the patient progress notes. CONCLUSION: Patients use of CM in this hospital setting do not reflect the national estimated usage. On the occasions that CM products are included in patient records, they are subsequently deprescribed following patient examination in hospital. It is currently unclear which health professionals have a role in this deprescribing process.


Asunto(s)
Terapias Complementarias/estadística & datos numéricos , Adolescente , Adulto , Anciano , Australia/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
12.
Aust N Z J Public Health ; 43(6): 577-581, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31667975

RESUMEN

OBJECTIVE: A major public health challenge in Australia is the lack of national adolescent abortion data. This descriptive study identifies, collates and describes publicly available adolescent abortion data in high-income countries including Australia, to describe trends over 10 years and provide recommendations for strengthening data collection. METHODS: Data were extracted from publicly available government sources that met inclusion criteria. All relevant adolescent abortion data from 2007 to 2017 were extracted from datasets and analysed. RESULTS: Eleven high-income countries were included. Incidence data for the adolescent population were available for all countries and states. Incidence of adolescent abortion over 10 years shows a downward trend in all countries. Gestational age at time of abortion was the second-most available variable. The level and type of data across all countries varied; there was a lack of age range standardisation and aggregation of gestational weeks differed, making comparisons difficult. CONCLUSION: A minimum data set of standardised abortion information will enable appropriate adolescent abortion policies and services to be developed that are informed by high quality, up-to-date intelligence. Implications for public health: Availability of data affects government's ability to adequately monitor national adolescent health outcomes and plan and evaluate appropriate reproductive health policy and services.


Asunto(s)
Aborto Inducido/estadística & datos numéricos , Servicios de Planificación Familiar/estadística & datos numéricos , Adolescente , Australia/epidemiología , Femenino , Edad Gestacional , Accesibilidad a los Servicios de Salud , Humanos , Incidencia , Vigilancia de la Población , Embarazo , Estudios Retrospectivos
13.
BMC Health Serv Res ; 19(1): 792, 2019 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-31684952

RESUMEN

BACKGROUND: There is little published data on brain imaging and intracranial haemorrhage after hospital inpatient falls. Imaging protocols for inpatient falls have been adopted from head injury guidelines developed from data in patients presenting to the Emergency Department. We sought to describe the use of brain computed tomography (CT) following inpatient falls, and determine the incidence and potential risk factors for intracranial haemorrhage. METHODS: We identified inpatient falls in acute medical wards at Monash Health, a large hospital network in the southeast region of Melbourne in Australia, from the incident reporting system during a 32 month period. We examined the post-fall medical assessment form, neurological observation chart and the diagnostic imaging system for details of the fall and brain CT findings. We used survival analysis to evaluate the timeliness of brain imaging and determined potential risk factors for intracranial haemorrhage by logistic regression. RESULTS: From 934 falls in 789 medical inpatients, 191 brain CT scans were performed. The median age of patients was 77 years. Only 55% of falls were from standing height and 24% experienced a head strike. Less than 10% of patients received an urgent scan within one hour, and timeliness of imaging was influenced by anticoagulation status rather than guideline determination of urgency. The overall incidence of intracranial haemorrhage was 0.9%. The factors associated with intracranial haemorrhage were head strike, anticoagulation, loss of consciousness or amnesia, drop in Glasgow Coma Scale and advanced chronic kidney disease. CONCLUSIONS: The incidence of intracranial haemorrhage was low as most inpatient falls were at low risk for head injury. Research is needed to determine if guidelines specific for hospital inpatients may reduce unnecessary scans without compromising case detection, and improve timeliness of urgent scans.


Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Unidades Hospitalarias/estadística & datos numéricos , Hospitalización , Hemorragias Intracraneales/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Femenino , Humanos , Incidencia , Hemorragias Intracraneales/epidemiología , Masculino , Estudios Retrospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos X
14.
Prev Vet Med ; 173: 104806, 2019 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-31704561

RESUMEN

A retrospective study was conducted on 1,178,329 cattle slaughtered at an eastern Australian abattoir between 2010 and 2018. The data were searched for records in which a diagnosis of hydatid disease was made by routine meat inspection and apparent prevalence was calculated. True prevalence of hydatid disease in any organ was then estimated using previously reported sensitivity and specificity for diagnosis of hepatic hydatid disease by routine meat inspection. Mixed effects logistic regression was conducted to assess putative associations between dentition (age), sex, and feed-type (grass- or grain-fed), and hydatid disease reported at slaughter, with origin (Property Identification Code [PIC] region) included as a random effect. Regression was also conducted on subsets stratified by dentition and feed-type to account for measurement bias resulting from differences in sensitivity and specificity between groups of cattle. Discrete-Poisson models (SaTScan, v.9.5) were used to detect spatio-temporal clustering of hydatid-positive cattle within PIC regions. The apparent prevalence of hydatid disease reported in any organ was 8.8% (n = 104,038; 95% confidence interval [CI] 8.8-8.9%). The liver, lungs, heart, spleen, and kidneys were reported infected with hydatid cysts. Of cattle reported infected with hydatid cysts, 75.6% had both the liver and lungs reported infected. True prevalence was estimated to be 33.0% (95% CI 24.4-44.4%). Significant interaction between dentition and feed-type was identified. Risk of reported hydatid disease was highest in both eight-tooth grass- and eight-tooth grain-fed cattle (OR 17.5, 95% CI 17.0-18.1, reference level [ref] zero-tooth; OR 4.8, 95% CI 4.4-5.2, ref zero-tooth, respectively). Sex was also significantly associated with reported cases of hydatid disease at slaughter, with the highest odds in females (two-tooth group, OR 1.2, 95% CI 1.1-1.2, ref male). Three spatio-temporal clusters of hydatid-positive regions were identified. The most likely cluster was located in north eastern New South Wales from June 2012 to September 2015 (log likelihood ratio 4774, P < 0.001). This study indicates a higher prevalence of hydatid disease than previously recognised and demonstrates that an effect of sex cannot be ruled out. The identification of clusters could indicate periods when hosts of Echinococcus were more abundant, or localised climatic events that facilitated transmission to cattle. Given the high prevalence, the financial impact of hydatid disease on the Australian beef industry and risk factors associated with variation in spatial distribution should be determined to target interventions.


Asunto(s)
Enfermedades de los Bovinos/parasitología , Equinococosis/veterinaria , Mataderos , Animales , Australia/epidemiología , Bovinos , Enfermedades de los Bovinos/epidemiología , Equinococosis/epidemiología , Femenino , Modelos Logísticos , Masculino , Estudios Retrospectivos
15.
Artículo en Inglés | MEDLINE | ID: mdl-31738865

RESUMEN

This eleventh national annual immunisation coverage report focuses on data for the calendar year 2017 derived from the Australian Immunisation Register (AIR) and the National Human Papillomavirus (HPV) Vaccination Program Register. This is the first report to include data on HPV vaccine course completion in Aboriginal and Torres Strait Islander (Indigenous) adolescents. 'Fully immunised' vaccination coverage in 2017 increased at the 12-month assessment age reaching 93.8% in December 2017, and at the 60-month assessment age reaching 94.5%. 'Fully immunised' coverage at the 24-month assessment age decreased slightly to 89.8% in December 2017, following amendment in December 2016 to require the fourth DTPa vaccine dose at 18 months. 'Fully immunised' coverage at 12 and 60 months of age in Indigenous children reached the highest ever recorded levels of 93.2% and 96.9% in December 2017. Catch-up vaccination activity for the second dose of measles-mumps-rubella-containing vaccine was considerably higher in 2017 for Indigenous compared to non-Indigenous adolescents aged 10-19 years (20.3% vs. 6.4%, respectively, of those who had not previously received that dose). In 2017, 80.2% of females and 75.9% of males aged 15 years had received a full course of three doses of human papillomavirus (HPV) vaccine. Of those who received dose one, 79% and 77% respectively of Indigenous girls and boys aged 15 years in 2017 completed three doses, compared to 91% and 90% of non-Indigenous girls and boys, respectively. A separate future report is planned to present adult AIR data and to assess completeness of reporting.


Asunto(s)
Programas de Inmunización , Inmunización , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Papillomaviridae/inmunología , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Cobertura de Vacunación , Adolescente , Algoritmos , Informes Anuales como Asunto , Australia/epidemiología , Preescolar , Estudios de Cohortes , Femenino , Servicios de Salud del Indígena , Humanos , Lactante , Masculino , Infecciones por Papillomavirus/virología , Sistema de Registros
16.
Artículo en Inglés | MEDLINE | ID: mdl-31738866

RESUMEN

The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all jurisdictions in Australia. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2018 influenza season. In this observational surveillance system, cases were defined as patients admitted to any of the 17 sentinel hospitals with influenza confirmed by nucleic acid detection. Data were also collected on a frequency-matched control group of influenza-negative patients admitted with acute respiratory infection. During the period 3 April to 31 October 2018 (the 2018 influenza season), 769 patients were admitted with confirmed influenza to one of 17 FluCAN sentinel hospitals. Of these, 30% were elderly (≥65 years), 28% were children (<16 years), 6.4% were Aboriginal and Torres Strait Islander peoples, 2.2% were pregnant and 66% had chronic comorbidities. A small proportion of FluCAN admissions were due to influenza B (13%). Estimated vaccine coverage was 77% in the elderly (≥65 years), 45% in non-elderly adults with medical comorbidities and 26% in children (<16 years) with medical comorbidities. The estimated vaccine effectiveness (VE) in the target population was 52% (95% CI: 37%, 63%). There were a smaller number of hospital admissions detected with confirmed influenza in this national observational surveillance system in 2018 than in 2017, with the demographic profile reflecting the change in circulating subtype from A/H3N2 to A/H1N1.


Asunto(s)
Subtipo H1N1 del Virus de la Influenza A/inmunología , Subtipo H3N2 del Virus de la Influenza A/inmunología , Vacunas contra la Influenza/inmunología , Gripe Humana/epidemiología , Cobertura de Vacunación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Informes Anuales como Asunto , Australia/epidemiología , Estudios de Casos y Controles , Femenino , Hospitalización , Hospitales , Humanos , Gripe Humana/prevención & control , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Embarazo , Vigilancia de Guardia , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA