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1.
Artículo en Inglés | MEDLINE | ID: mdl-32114974

RESUMEN

The Australian Gonococcal Surveillance Programme (AGSP) has continuously monitored antimicrobial resistance in clinical isolates of Neisseria gonorrhoeae from all states and territories since 1981. In 2018, there were 9,006 clinical isolates of gonococci from public and private sector sources tested for in vitro antimicrobial susceptibility by standardised methods. This was the highest annual total of isolates tested since the inception of the AGSP. The current treatment recommendation for gonorrhoea, for the majority of Australia, remains dual therapy with ceftriaxone and azithromycin. Decreased susceptibility to ceftriaxone (minimum inhibitory concentration (MIC) value ≥0.06 mg/L) was found nationally in 1.73% of isolates. The highest proportions were reported from Tasmania and non-remote Western Australia (7.3% and 2.1% respectively). In 2018 two extensively drug-resistant isolates were reported from Queensland patients. These two isolates, with ceftriaxone MIC values of 0.50 mg/L, high-level resistance to azithromycin (MIC ≥ 256 mg/L), and resistance to penicillin and ciprofloxacin were identified and reported to the World Health Organization as isolates of international significance. Resistance to azithromycin (MIC value ≥1.0 mg/L) was found nationally in 6.2% of isolates, lower than the 9.3% reported in 2017, but more than double the proportion reported in 2015 (2.6%). The highest proportions were reported from the Australian Capital Territory (8.7%), Victoria (8.3%), and New South Wales (6.5%). High-level resistance to azithromycin (MIC value ≥256 mg/L) was reported in nine isolates nationally in 2018: four from New South Wales, three from Victoria, and two from Queensland. The proportion of isolates resistant to penicillin in non-remote Australia ranged from 8.8% in non-remote Northern Territory to 44.1% in South Australia. In remote Northern Territory penicillin resistance rates remain low (1.9%), and higher in remote Western Australia (6.5%). The proportion of isolates resistant to ciprofloxacin in non-remote Australia ranged from 10.3% in non-remote Northern Territory to 48.3% in South Australia. Ciprofloxacin resistance rates remain comparatively low in remote Northern Territory (1.9%) and remote Western Australia (4.6%).


Asunto(s)
Gonorrea/epidemiología , Antibacterianos/uso terapéutico , Australia/epidemiología , Territorio de la Capital Australiana , Ciprofloxacino/uso terapéutico , Gonorrea/tratamiento farmacológico , Humanos , Pruebas de Sensibilidad Microbiana , Neisseria gonorrhoeae , Nueva Gales del Sur/epidemiología , Northern Territory/epidemiología , Resistencia a las Penicilinas , Penicilinas/uso terapéutico , Queensland/epidemiología , Australia del Sur/epidemiología , Tasmania/epidemiología , Victoria/epidemiología , Australia Occidental/epidemiología
2.
PLoS One ; 15(1): e0227925, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31978087

RESUMEN

BACKGROUND: Hospitals and other health care providers frequently experience difficulties contacting patients and their carers who live remotely from the town where the health service is located. In 2016 Nurse Navigator positions were introduced into the health services by Queensland Health, to support and navigate the care of people with chronic and complex conditions. One hospital in Far North Queensland initiated an additional free telephone service to provide another means of communication for patients and carers with the NNs and for off-campus health professionals to obtain details about a patient utilising the service. Calls made between 7am and 10pm, seven days per week are answered by a nurse navigator. AIM: To report utilisation of the service by navigated clients and remotely located clinicians compared to use of navigators' individual work numbers and direct health service numbers. We report the reason for calls to the free number and examine features of these calls. METHODS: Statistical analysis examined the call reason, duration of calls, setting from where calls originated and stream of calls. Interactions between the reasons for calls and the features of calls, such as contact method, were examined. RESULTS: The major reason for calls was clinical issues and the source of calls was primarily patients and carers. Clinical calls were longer in duration. Shorter calls were mainly non-clinical, made by a health professional. Setting for calls was not related to the reason. The most frequent number used was the individual mobile number of the NN, followed by the hospital landline. Although the free number was utilised by patients and carers, it was not the preferred option. CONCLUSION: As patients and carers preferred to access their NN directly than via the 1800 number, further research should explore options best suited to this group of patients outside normal business hours.


Asunto(s)
Relaciones Enfermero-Paciente , Enfermeras y Enfermeros , Pacientes , Teléfono Celular , Comunicación , Personal de Salud , Hospitales/normas , Humanos , Queensland/epidemiología , Teléfono
3.
Nat Commun ; 11(1): 466, 2020 01 24.
Artículo en Inglés | MEDLINE | ID: mdl-31980604

RESUMEN

Carbapenem-resistant Enterobacteriaceae (CRE) represent an urgent threat to human health. Here we report the application of several complementary whole-genome sequencing (WGS) technologies to characterise a hospital outbreak of blaIMP-4 carbapenemase-producing E. hormaechei. Using Illumina sequencing, we determined that all outbreak strains were sequence type 90 (ST90) and near-identical. Comparison to publicly available data linked all outbreak isolates to a 2013 isolate from the same ward, suggesting an environmental source in the hospital. Using Pacific Biosciences sequencing, we resolved the complete context of the blaIMP-4 gene on a large IncHI2 plasmid carried by all IMP-4-producing strains across different hospitals. Shotgun metagenomic sequencing of environmental samples also found evidence of ST90 E. hormaechei and the IncHI2 plasmid within the hospital plumbing. Finally, Oxford Nanopore sequencing rapidly resolved the true relationship of subsequent isolates to the initial outbreak. Overall, our strategic application of three WGS technologies provided an in-depth analysis of the outbreak.


Asunto(s)
Proteínas Bacterianas/biosíntesis , Proteínas Bacterianas/genética , Enterobacteriaceae Resistentes a los Carbapenémicos/enzimología , Enterobacteriaceae Resistentes a los Carbapenémicos/genética , Brotes de Enfermedades , Enterobacter/enzimología , Enterobacter/genética , Infecciones por Enterobacteriaceae/epidemiología , beta-Lactamasas/biosíntesis , beta-Lactamasas/genética , Quemaduras/microbiología , Enterobacteriaceae Resistentes a los Carbapenémicos/patogenicidad , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Farmacorresistencia Bacteriana Múltiple/genética , Enterobacter/aislamiento & purificación , Infecciones por Enterobacteriaceae/microbiología , Genoma Bacteriano , Humanos , Queensland/epidemiología , Factores R/genética , Ingeniería Sanitaria , Centros de Atención Terciaria , Secuenciación Completa del Genoma/métodos , Resistencia betalactámica/genética
4.
Support Care Cancer ; 28(1): 317-327, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31049670

RESUMEN

PURPOSE: The role of general practitioners in cancer care has expanded in recent years. However, little is known about utilization of primary health care (PHC) services by patients with cancer, particularly among socio-economically disadvantaged groups. We describe utilization of PHC services by patients with cancer, and the nature of the care provided. The study focuses on a disadvantaged group in Australia, namely Indigenous Australians. METHODS: A retrospective audit of clinical records in ten PHC services in Queensland, Australia. Demographic and clinical data of Indigenous Australians diagnosed with cancer during 2010-2016 were abstracted from patient's medical records at the PHC services. The rates of cancer-related visits were calculated using person years at risk as a denominator. RESULTS: A total of 138 patients' records were audited. During 12 months following the cancer diagnosis, patients visited the PHC service on average 5.95 times per year. Frequency of visits were relatively high in remote areas and among socioeconomic disadvantaged patients (IRR = 1.87, 95%CI 1.61-2.17; IRR = 1.79, 95%CI 1.45-2.21, respectively). Over 80% of visits were for seeking attention for symptoms, wound care, and emotional or social support. Patients who did not undergo surgery, had greater comorbidity, received chemotherapy and/or radiotherapy, and male gender had significantly greater rate of visits than their counterparts. CONCLUSION: The frequency of utilization of PHC services, especially by patients with comorbidities, and the range of reasons for attendance highlights the important role of PHC services in providing cancer care. The reliance on PHC services, particularly by patients in remote and disadvantaged communities, has important implications for appropriate resourcing and support for services in these locations.


Asunto(s)
Servicios de Salud del Indígena/estadística & datos numéricos , Neoplasias/terapia , Grupo de Ascendencia Oceánica , Médicos de Atención Primaria/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Auditoría Clínica , Femenino , Médicos Generales/normas , Médicos Generales/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/normas , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud del Indígena/normas , Humanos , Pueblos Indígenas/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Neoplasias/etnología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Pautas de la Práctica en Medicina/normas , Atención Primaria de Salud/normas , Queensland/epidemiología , Derivación y Consulta/normas , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Adulto Joven
5.
Aust N Z J Public Health ; 43(6): 570-576, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31667984

RESUMEN

OBJECTIVE: To investigate the under-identification of Indigenous∗ infants in death records and examine the impact of a multi-stage algorithm on disparities in sudden unexpected deaths in infancy (SUDI). METHODS: Data on SUDI in Queensland between 2010 and 2014 were linked to birth and death registrations, health data, and child protection and coronial records. An algorithm was applied to cases of SUDI and population data to derive Indigenous status. Numbers, proportions and rates of SUDI were compared. RESULTS: Using multiple sources of Indigenous status resulted in a 64.9% increase in the number of infants identified as Indigenous. The Indigenous SUDI rate increased by 54.3%, from 1.38 to 2.13 per 1,000 live births after applying the algorithm to SUDI and live births data. CONCLUSIONS: Applying an algorithm to both numerator and denominator data reduced numerator-denominator incompatibility, to more accurately report rates of Indigenous SUDI and measure the gap in Indigenous infant mortality. Implications for public health: Estimation of the true magnitude of the disparity is restricted by under-identification of Indigenous status in death records. Data linkage improved the reporting of Indigenous infant mortality. Accuracy in reporting of measures is integral to determining genuine progress towards Closing the Gap.


Asunto(s)
Mortalidad Infantil/etnología , Grupo de Ascendencia Oceánica , Muerte Súbita del Lactante/etnología , Algoritmos , Causas de Muerte , Certificado de Defunción , Documentación/normas , Femenino , Humanos , Lactante , Recién Nacido , Almacenamiento y Recuperación de la Información , Masculino , Queensland/epidemiología , Factores de Riesgo , Muerte Súbita del Lactante/epidemiología
6.
Aust Vet J ; 97(12): 505-508, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31588995

RESUMEN

Chlamydial infections in dairy cattle are common and have been sporadically associated with reduced performance and severe disease manifestations. While chlamydial infections are well described in sheep, very little is known about the epidemiology of these infections in dairy cattle in Australia. In this study, we screened for chlamydial infections and assessed on-farm risks in dairy cattle herds from Southeast Queensland (SE Qld) region of Australia. In total, 228 paired vaginal and rectal swabs were collected from 114 visually healthy dairy cows from four farms in SE Qld. Risk factors were rated by observational study and included: hygiene and cleanliness of cows, walkway and parlour, incidence of perinatal mortality, external replacements, mode of breeding, calving pen management, heat reduction strategies, and feed ration usage. Testing for chlamydial pathogens (Chlamydia pecorum, Chlamydia psittaci and Chlamydia abortus) was done using species-specific quantitative polymerase chain reaction (qPCR) assays. Detected rates of chlamydial infection were evaluated against the on-farm risk factors. C. pecorum infection was widespread in all four farms, with 56.1% (64/114) of individual animals shedding this organism from vaginal and rectal, or both sites. C. abortus and C. psittaci were not detected in any animals. No association was found to exist with risk factors and C. pecorum infection rates in our study, however the number of Chlamydia positive animals was statistically different between the herds. This study suggests that subclinical chlamydial infections may impact on dairy herd health at the production level rather than affecting individual animal.


Asunto(s)
Enfermedades de los Bovinos/epidemiología , Enfermedades de los Bovinos/microbiología , Infecciones por Chlamydia/veterinaria , Animales , Bovinos , Enfermedades de los Bovinos/diagnóstico , Chlamydia/aislamiento & purificación , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Industria Lechera , Granjas , Femenino , Queensland/epidemiología , Recto/microbiología , Factores de Riesgo , Vagina/microbiología
7.
Aust Vet J ; 97(11): 473-481, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31631313

RESUMEN

Malocclusions are a misalignment or incorrect positioning of the teeth when the upper and lower jaws close. These are poorly described in the koala and can result in irregular mastication which can have lifelong effects on body condition and oral health. A total of 370 koalas from two populations in Queensland (295) and one in South Australia (75) were examined for malocclusions. The prevalence of malocclusions in South Australian free-ranging koalas, captive Queensland koalas and Queensland free-ranging koalas was 39% (44), 30% (29) and 22% (29) respectively. Four types of malocclusion were identified based on severity of misalignment of the incisor/canine region, types 1, 2, 3 and 4. Maxillary overbite measurements of the molariform teeth were determined and these anisognathic values were then used to describe malocclusions within familial relationships in captive colonies. Captive koalas with a malocclusion had narrower mandibular width that ranged between 0.5 and 1% less than the normal measurements. The specific malocclusions reported in this study affected individuals by leading to tooth rotation, mobility and erosion with inefficient mastication of food and vegetation compaction. These changes increased the oral cavity pathology, by placing animals at risk of periodontal disease. There was evidence of familial links to malocclusion types in captive animals. Therefore captive breeding recommendations should consider known koala malocclusion traits to minimise their effect on future generations.


Asunto(s)
Maloclusión/veterinaria , Phascolarctidae , Desgaste de los Dientes/veterinaria , Animales , Animales Salvajes , Animales de Zoológico , Incisivo , Maloclusión/complicaciones , Maloclusión/epidemiología , Queensland/epidemiología , Australia del Sur/epidemiología , Desgaste de los Dientes/epidemiología , Desgaste de los Dientes/etiología
8.
J Clin Neurosci ; 70: 27-32, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31537459

RESUMEN

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children with a broad injury spectrum and associated continuum in the level of care required. A dearth of data exists regarding children requiring inpatient neurosurgical admission following TBI. A retrospective study of children 0-16 years-old admitted to the neurosurgical unit of a level-1 paediatric trauma hospital in Queensland, Australia following TBI was conducted focusing on the demographics, clinical characteristics, and management of these patients to guide those involved in their management, and identify areas for improvement in injury prevention and trauma system management. Over 48 months, 671 patients were identified (62.6% male) with median age 5.0 years, the majority transferred from peripheral centres. Falls (47.2%) and traffic accidents (21.5%) were the most common mechanisms. Non-displaced skull fracture was the most common injury. Moderate or severe TBI (GCS 3-12) was seen in 14.8% of whom were more likely to require surgery, intensive care, or suffer polytrauma. Clinically significant TBI, defined as moderate/severe TBI, polytrauma, death, requiring neurosurgery, intensive care admission, intubation, or admission three or more nights was detected in 57.97% with higher rates in transferred patients (62.9%) versus primary presentations (50.6%). Mechanisms involving low kinetic forces especially low-height falls and children with non-surgical pathology were less likely to meet criteria for clinically significant TBI. Opportunity exists to optimise triage and transfer practices within the trauma network to minimise the economic and social implications of over-triage with many children requiring only brief observation.


Asunto(s)
Lesiones Traumáticas del Encéfalo/epidemiología , Accidentes por Caídas , Accidentes de Tránsito , Adolescente , Lesiones Traumáticas del Encéfalo/diagnóstico , Lesiones Traumáticas del Encéfalo/etiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Neurocirugia/estadística & datos numéricos , Prevalencia , Queensland/epidemiología , Estudios Retrospectivos , Triaje/métodos
9.
BMC Health Serv Res ; 19(1): 649, 2019 Sep 09.
Artículo en Inglés | MEDLINE | ID: mdl-31500612

RESUMEN

BACKGROUND: Fetal alcohol spectrum disorder (FASD) is a highly prevalent neurodevelopmental disorder associated with prenatal alcohol exposure. Early identification can improve functioning for individuals and reduce costs to society. Gold standard methods of diagnosing FASD rely on specialists to deliver intensive, multidisciplinary assessments. While comprehensive, prevalence rates highlight that this assessment model cannot meet demand, nor is it feasible in remote areas where specialist services are lacking. This project aims to expand the capabilities of remote practitioners in north Queensland, Australia, where 23-94% of the community identify as First Nations people. Integrating cultural protocols with the implementation science theories of Knowledge-To-Action, Experience-Based Co-Design, and RE-AIM, remote practitioners with varying levels of experience will be trained in a co-designed, culturally appropriate, tiered neurodevelopmental assessment process that considers FASD as a potential outcome. This innovative assessment process can be shared between primary and tertiary health care settings, improving access to services for children and families. This project aims to demonstrate that neurodevelopmental assessments can be integrated seamlessly with established community practices and sustained through evidence-based workforce development strategies. METHODS: The Yapatjarrathati project (named by the local First Nations community and meaning 'to get well') is a mixed-method implementation trial of a tiered assessment process for identifying FASD within a remote Australian community. In collaboration with the community, we co-designed: (a) a culturally sensitive, tiered, neurodevelopmental assessment process for identifying FASD, and (b) training materials that up-skill remote practitioners with varying levels of expertise. Qualitative interviews for primary, secondary and end users will be undertaken to evaluate the implementation strategies. RE-AIM will be used to evaluate the reach, effectiveness, adoption, implementation and maintenance of the assessment and training process. DISCUSSION: Co-designed with the local community, integrated with cultural protocols, and based on implementation science theories, the assessment and training process from this project will have the potential to be scaled-up across other remote locations and trialed in urban settings. The Yapatjarrathati project is an important step towards increasing the availability of neurodevelopmental services across Australia and empowering remote practitioners to contribute to the FASD assessment process.


Asunto(s)
Trastornos del Espectro Alcohólico Fetal/prevención & control , Servicios de Salud del Indígena/organización & administración , Servicios de Salud Rural/organización & administración , Competencia Cultural , Estudios de Evaluación como Asunto , Femenino , Trastornos del Espectro Alcohólico Fetal/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud/organización & administración , Humanos , Recién Nacido , Embarazo , Queensland/epidemiología , Población Rural
10.
Biomarkers ; 24(7): 684-691, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31382779

RESUMEN

Background: Australia implemented mandatory folic acid fortification of bread-making flour in 2009. Objective: To assess the impact of folic acid fortification in remote vs. regional urban areas and Indigenous vs. non-Indigenous populations in northern Queensland. Methods: Routinely collected data on folic acid measurements in remote areas and two regional urban centres in northern Queensland between 2004 and 2015 were analysed (n = 13,929) dichotomously (folic deficient vs. non-deficient). Results: Overall prevalence of folic acid deficiency was 3.2% (235/7282) in urban centres compared with 7.2% (480/6647) in remote areas (p < 0.001), and 9.3% (393/4240) in the Indigenous population compared with 3.2% (273/8451) in the non-Indigenous population (p < 0.001). Prevalence of folic acid deficiency dropped from 12.2% (n = 481) in 2004-2008 to 1.5% (n = 126) in 2010-2015 (p < 0.001). This translates into a relative risk reduction (RRR) of 88%. RRR was 79% (7.2% vs. 1.5%) in urban centres, 91% (17.3% vs. 1.5%) in remote areas, 92% (20.5% vs. 1.6%) in the Indigenous population and 80% (7.4% vs. 1.5%) in the non-Indigenous population (p < 0.001 for all). Conclusions: Substantial declines of folic acid deficiency to low and comparable proportions in former high-risk populations indicate that mandatory folic acid fortification of flour has had a population-wide benefit in northern Queensland.


Asunto(s)
Deficiencia de Ácido Fólico/epidemiología , Ácido Fólico/uso terapéutico , Estado de Salud , Estado Nutricional , Australia , Análisis de Datos , Harina , Deficiencia de Ácido Fólico/tratamiento farmacológico , Humanos , Programas Obligatorios , Prevalencia , Queensland/epidemiología , Salud Rural/normas , Salud Urbana/normas
11.
Aust J Rural Health ; 27(4): 304-310, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31429141

RESUMEN

OBJECTIVE: Dysphagia is prevalent in the older population and might lead to complications, such as pneumonia, malnutrition and dehydration. This study examines an older population post hip-fracture surgery to examine the factors correlated with dysphagia, severity of dysphagia and the incidence of dysphagia in a regional setting. DESIGN: This prospective cohort study replicates Love et al's (2013, Age Ageing, 42:782) and compares the studies' results. Participants were assessed for dysphagia within 72 hours post hip-fracture surgery. Descriptive statistics were used to calculate the incidence and severity of dysphagia, and collate pre-operative and post-operative characteristics. Univariate and multivariate logistic regression analyses were used to describe relationships between dysphagia and explanatory variables, and to predict the presence of post-operative oropharyngeal dysphagia. SETTING: General orthopaedic ward at a North Queensland regional hospital. PARTICIPANTS: One-hundred-three participants: 78 women and 25 men, aged 65-94 years. MAIN OUTCOME MEASURE(S): The presence and severity of dysphagia were identified based on the clinical judgement of speech pathologists with at least 2 years' experience in managing patients with acute dysphagia. RESULT: Fifty-four per cent of the participants were diagnosed with dysphagia of varying severity. Female sex, post-operative confusion and living in a residential aged-care facility prior to admission, significantly predicted dysphagia post-surgery. Post-operative confusion and living in a residential aged-care facility prior to admission, were also significantly correlated with severity of dysphagia post-operatively. CONCLUSION: Dysphagia was present in a higher proportion of this cohort than that reported by Love et al. This highlights the necessity of timely assessment and management of dysphagia in an older population post-surgery for a fractured hip.


Asunto(s)
Trastornos de Deglución/epidemiología , Fracturas de Cadera/cirugía , Complicaciones Posoperatorias/epidemiología , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Masculino , Estudios Prospectivos , Queensland/epidemiología , Índice de Severidad de la Enfermedad
12.
BMC Ophthalmol ; 19(1): 192, 2019 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-31438884

RESUMEN

BACKGROUND: A patient's perception of how their glaucoma is managed will influence both adherence to their medication and outcome measures such as quality of life. METHODS: Prospective consecutive study using a Glaucoma Patient-reported Outcome and Experience Measure (POEM) modified for an Australian ophthalmic private clinical practice setting. The Australian Glaucoma POEM consists of eight items related to the patient's understanding of the diagnosis and management, acceptability of the treatment, whether they feel their glaucoma is getting worse, interfering with their daily life and concerns regarding loss of vision as well as addressing whether they feel safe under the care of their glaucoma team and how well their care is organised. RESULTS: Two hundred and two patients (M:F 91:111) participated in the study. Mean ± standard deviation for subject age was 69 ± 13 years. Patient's overall perception of their treatment and outcome was favourable. Younger patients felt their glaucoma interfered more with their daily lives and were more worried about losing vision from glaucoma. The greater the number of medications in use, the more they felt their glaucoma was getting worse and that glaucoma interfered with their daily lives. With all other variables accounted for by the multivariate linear model, female patients more strongly agreed that they understood their glaucoma diagnosis and glaucoma management. The patients with a severe visual defect in their worse eye, reported a greater perceived understanding of their glaucoma diagnosis and management and that they felt that glaucoma had a greater interference on their daily life. They were also more concerned about losing vision from glaucoma than their fellow glaucoma patients with less severe or no visual field deficit in the worse eye. CONCLUSIONS: The modified POEM demonstrates potential to capture the concerns of a practice's glaucoma cohort with a view to enhancing the quality of glaucoma care delivered.


Asunto(s)
Glaucoma/terapia , Presión Intraocular/fisiología , Medición de Resultados Informados por el Paciente , Calidad de la Atención de Salud , Agudeza Visual , Campos Visuales/fisiología , Actividades Cotidianas , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Glaucoma/epidemiología , Glaucoma/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Estudios Prospectivos , Calidad de Vida , Queensland/epidemiología , Encuestas y Cuestionarios , Adulto Joven
13.
Work ; 64(1): 55-65, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31450530

RESUMEN

BACKGROUND: Work-related psychosocial factors such as job strain are thought to contribute to elevated psychological stress in office workers. One factor that may impact the relationship between job strain and psychological distress is the individual's coping resources. OBJECTIVE: The purpose of this study is to examine the interaction effect of coping resources on the relationship between job strain and psychological distress in office workers. METHODS: 220 office workers in Australia and Korea completed the Job Content Questionnaire (to evaluate job strain and social support at work), the Depression, Anxiety, and Stress Scale, (DASS-21, a measure of psychological distress), and the Coping with Job Stress Scale to assess control and escape coping. Hierarchical regression analyses were executed to examine the interaction and moderating effect of coping resources. RESULTS: Job strain had a direct positive relationship with all three domains of psychological distress. The relationship between job strain and depression was positively moderated by escape coping, but negatively moderated by social support. Use of higher levels of escape coping predicted higher levels of depression and anxiety symptoms when higher levels of job strain were perceived. CONCLUSIONS: Findings suggest there may be a direct relationship between job strain and psychological distress in office workers. This relationship, however, may be moderated by the office workers coping resources (coping strategies and social support). It is suggested that the evaluation of coping might be a key consideration in the elements of the assessment of psychological distress in office workers.


Asunto(s)
Adaptación Psicológica , Estrés Laboral/epidemiología , Adulto , Ansiedad/epidemiología , Depresión/epidemiología , Femenino , Humanos , Persona de Mediana Edad , Queensland/epidemiología , República de Corea/epidemiología , Apoyo Social , Estrés Psicológico/epidemiología , Encuestas y Cuestionarios
14.
BMC Health Serv Res ; 19(1): 606, 2019 Aug 29.
Artículo en Inglés | MEDLINE | ID: mdl-31464615

RESUMEN

BACKGROUND: There is a disparity in the burden of gynaecological cancer for Indigenous women compared with non-Indigenous women in Australia. Understanding how Indigenous women currently experience gynaecological cancer care services and factors that impact on their engagement with care is critical. This study explored Indigenous Australian women's experience of gynaecological cancer care at a major metropolitan hospital in Queensland. METHODS: Indigenous women receiving care at a major metropolitan Queensland hospital for investigation or diagnosis of gynaecological cancer were invited to participate in a larger longitudinal study exploring women's experiences of gynaecological cancer care. This component was an in-depth, qualitative interview exploring the women's experiences of hospital care at approximately three-month post initial referral. A peer-approach was used to interview women. Hospital-based care providers involved in the care of Indigenous gynaecological cancer patients were invited to be interviewed. Interviews were transcribed and thematically analysed using an interpretative phenomenological approach enabling a multi-layered, contextualised understanding of the patients' experience and their interaction with tertiary cancer services. RESULTS: Eight Indigenous patients and 18 care providers were interviewed. Analysis of all interviews revealed four broad issues affecting Indigenous patients' early experiences of care: (1) navigating the system, impacted by timely diagnosis, access to support services and follow up; (2) communication and decision-making, patients' decision-making, efficacy of doctor-patient communication, and patients' knowledge about cancer; (3) coping with treatment demands, was impacted by emotional stress, access to services and support by hospital staff; and (4) feeling welcome and safe in the hospital, impacted by patients' relationship with care providers and their access to culturally-safe services. The combination of factors impacting these women's' experience of gynaecological care commonly left these women at breaking point, often with limited access to information, resources or support. CONCLUSIONS: Our findings revealed that experiences of cancer care for Indigenous women are overlain by challenges associated with late referral, misdiagnosis, miscommunication, lack of information, logistics in accessing treatment and services and system cultural insensitivities. Our findings offer insights that can inform cancer care provision to more effectively support Indigenous women accessing gynaecological cancer services.


Asunto(s)
Neoplasias de los Genitales Femeninos/terapia , Evaluación de Necesidades , Grupo de Ascendencia Oceánica/etnología , Adolescente , Adulto , Anciano , Actitud del Personal de Salud , Cuidadores/psicología , Comunicación , Toma de Decisiones , Detección Precoz del Cáncer , Femenino , Neoplasias de los Genitales Femeninos/etnología , Hospitales Urbanos , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Grupo de Ascendencia Oceánica/psicología , Satisfacción del Paciente , Atención Dirigida al Paciente/normas , Investigación Cualitativa , Queensland/epidemiología , Queensland/etnología , Adulto Joven
15.
Asia Pac J Clin Oncol ; 15(6): 309-315, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31313475

RESUMEN

AIM: To quantify the direct out-of-pocket patient co-payments and time opportunity costs (length of hospital stay) incurred by Indigenous and non-Indigenous persons diagnosed with cancer during the first year postdiagnosis. METHODS: CancerCostMod was used, which is a model of cancer costs based upon a whole-of-population data linkage. The base population was a census of all persons diagnosed with cancer in Queensland, Australia between 1 July 2011 and 30 June 2012 (n = 25,553). Individual records were linked to corresponding Queensland Health Admitted Patient Data Collection, Emergency Data Information System, Medicare Benefits Schedule, and Pharmaceutical Benefits Scheme records between 1 July 2011 and 30 June 2015. Queensland data were weighted to be representative of the Australian population (approximately 123,900 Australians, 1.7% Indigenous Australians). RESULTS: After adjusting for age, sex, rurality, area-based deprivation, and cancer group, Indigenous Australians accrued significantly less in postdiagnosis patient co-payments at 0-6 months (61% less) and 7-12 months (63% less). Indigenous Australians also had significantly fewer postdiagnosis hospitalizations at 0-6 months (21% fewer) and 7-12 months (27% fewer). CONCLUSION: There is growing concern regarding the financial burden of cancer to the patient. The time spent away from family and their community may also have an important time opportunity cost, which may affect a person's decision to undertake or continue treatment. This is the first study in Australia to identify the financial cost of co-payments for Indigenous people with cancer, as well as the number and length of hospitalizations as drivers of time opportunity costs.


Asunto(s)
Costo de Enfermedad , Gastos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Neoplasias/economía , Australia , Femenino , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Almacenamiento y Recuperación de la Información , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Queensland/epidemiología
17.
Aust Vet J ; 97(9): 351-356, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31310015

RESUMEN

Koalas (Phascolarctos cinereus) are experiencing significant declines across the northern part of their range. However, unbiased, population-level estimates of mortality are rarely reported, as it's difficult to quantify causes of mortality robustly in this cryptic species. We aimed to determine the relative importance of carpet python (Morelia spilota) predation in a free-living koala population and describe the characteristic pathological findings during necropsy. In total, 503 koalas were captured, underwent veterinary examination and telemetric tagging, and were monitored after release over a four-year period. Mortalities were detected when activity data reported by K-Tracker® biotelemetry collars indicated low or zero activity, or during routine field monitoring events. Experienced koala veterinarians performed thorough, standardised necropsy examinations on retrieved carcasses to determine causes of death. The three, sometimes subtle, cardinal signs used to definitively diagnose carpet python-caused deaths of koalas were a U-shaped primary bite site, slicking of the fur by python saliva (particularly around the face), and diffuse, uniform pulmonary congestion. We found that carpet pythons were important predators of koalas, second only to wild dogs (dingoes and dingo hybrids (Canis familiaris dingo)), accounting for 11.6% of predation deaths and 7.2% of total deaths. Less than half (38%) of the koalas killed by carpet pythons were ingested. Though carpet pythons are known predators of koalas, their relative importance as a cause of mortality hasn't previously been recognised. Population viability analyses and conservation management plans benefit from robust cause-of-death data collected during longitudinal monitoring studies, requiring telemetry methods that facilitate rapid detection of mortalities.


Asunto(s)
Boidae , Phascolarctidae , Conducta Predatoria , Mordeduras de Serpientes/veterinaria , Animales , Autopsia/veterinaria , Causas de Muerte , Femenino , Masculino , Queensland/epidemiología , Mordeduras de Serpientes/mortalidad , Análisis Espacio-Temporal
18.
PLoS Negl Trop Dis ; 13(7): e0007583, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31318873

RESUMEN

BACKGROUND: Rickettsial infections are a common cause of hospitalization in tropical settings, although early diagnosis is challenging in the rural locations where these infections are usually seen. METHODS: This retrospective, clinical audit of microbiologically-confirmed cases of scrub typhus or spotted fever group (SFG) rickettsial infection between 1997 and 2016 was performed a tertiary referral hospital in tropical Australia. Clinical, laboratory and radiological findings at presentation were correlated with the patients' subsequent clinical course. RESULTS: There were 135 locally-acquired cases (95 scrub typhus, 37 SFG, 3 undifferentiated). There were nine hospitalizations during the first 5 years of the study period and 81 in the last 5 years (p for trend = 0.003). Eighteen (13%) of the 135 cases required ICU admission, all of whom were adults. A greater proportion of patients with SFG infection required ICU support (8/37 (22%) compared with 10/95 (11%) scrub typhus cases), although this difference did not reach statistical significance (p = 0.10). Three (8%) of the 37 patients with SFG infection had severe disease (1 died, 2 developed permanent disability) versus 0/95 scrub typhus patients (p = 0.02). Adults with a high admission qSOFA score (≥2) had an odds ratio (OR) of 19 (95% CI:4.8-74.5) for subsequent ICU admission (p<0.001); adults with a high NEWS2 score (≥7) had an OR of 14.3 (95% CI:4.5-45.32) for ICU admission (p<0.001). A patient's respiratory rate at presentation had strong prognostic utility: if an adult had an admission respiratory rate <22 breaths/minute, the negative predictive value for subsequent ICU admission was 95% (95% CI 88-99). CONCLUSIONS: In the well-resourced Australian health system outcomes are excellent, but the local burden of rickettsial disease appears to be increasing and the clinical phenotype of SFG infections may be more severe than previously believed. Simple, clinical assessment on admission has prognostic utility and may be used to guide management.


Asunto(s)
Tifus por Ácaros/epidemiología , Rickettsiosis Exantemáticas/epidemiología , Adulto , Ecocardiografía , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Queensland/epidemiología , Radiografía , Estudios Retrospectivos , Tifus por Ácaros/diagnóstico , Tifus por Ácaros/fisiopatología , Tifus por Ácaros/terapia , Rickettsiosis Exantemáticas/diagnóstico , Rickettsiosis Exantemáticas/fisiopatología , Rickettsiosis Exantemáticas/terapia
19.
Ann Thorac Surg ; 108(4): 1101-1106, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31276645

RESUMEN

BACKGROUND: This study aimed to identify risk factors associated with mortality of patients who undergo cardiac surgery for infective endocarditis. METHODS: A retrospective review was performed of patients with infective endocarditis who underwent cardiac surgery at a quaternary Australian hospital between 2004 and 2014. Patient data were collected and prospectively analyzed. RESULTS: In all, 465 patients underwent surgery during the study period, with 30 deaths (6.45%). Factors independently associated with in-hospital mortality were increasing age (odds ratio [OR] 1.04; 95% confidence interval [CI], 1.01 to 1.07; P = .009), active bacterial endocarditis at time of operation (OR 4.91; 95% CI, 1.01 to 23.8; P = .048), preoperative invasive positive pressure ventilation (OR 3.65; 95% CI, 1.18 to 11.27; P = .025), increasing cardiopulmonary bypass time (OR 1.01; 95% CI, 1.006 to 1.014; P < .001), and increasing European System for Cardiac Operative Risk Evaluation score (OR 21.73; 95% CI, 2.12 to 223.11; P < .01). CONCLUSIONS: The in-hospital mortality of patients with infective endocarditis remains significant, with potential risk factors including increasing age, active bacterial endocarditis, preoperative invasive positive pressure ventilation, increasing cardiopulmonary bypass time, and high European System for Cardiac Operative Risk Evaluation score.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Endocarditis/cirugía , Predicción , Complicaciones Posoperatorias/epidemiología , Medición de Riesgo/métodos , Endocarditis/mortalidad , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Queensland/epidemiología , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Factores de Tiempo
20.
Int J Occup Environ Med ; 10(3): 145-150, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31325297

RESUMEN

Truck drivers are at increased risk of diet- and physical activity-related chronic diseases. Despite this, there is a paucity of data about Australian truck drivers' diet and physical activity behaviors. A multiple choice and short response survey was distributed to truck drivers attending an Australian Truck Show. The survey asked about self-reported health, source of health information, number of serves of fruit, vegetables, unhealthy food, and sugary drink consumed per day, and frequency of moderate- and vigorous-intensity physical activity per week. The survey was completed by 231 truck drivers---almost all were male, with a mean age of 46 (range 20 to 71) years. Over 85% of survey respondents worked more than 9 hrs per day. Nearly 75% acknowledged the need to make changes to improve their health. Half consumed fewer serves of fruit and 88% consumed fewer serves of vegetables than national recommendations. Over 63% consumed at least one serve of unhealthy foods per day, and 65% drank at least one can of sugary drink per day. Most (80%) undertook less than moderate- and vigorous-intensity physical activity levels provided in national recommendations. Of concern, almost 90% of drivers had above the recommended body mass index---approximately 60% were obese. This is almost double the proportion found in the general population. These findings highlight the importance of health promotion to help drivers make better choices about their health behaviors, which are often underpinned by the limitations of their work environment. Health promotion in transport industry workplaces should be an important topic for future research.


Asunto(s)
Conducción de Automóvil/estadística & datos numéricos , Dieta/métodos , Ejercicio Físico/fisiología , Conductas Relacionadas con la Salud/fisiología , Obesidad/epidemiología , Adulto , Anciano , Australia/epidemiología , Índice de Masa Corporal , Enfermedad Crónica , Estudios Transversales , Femenino , Frutas , Humanos , Masculino , Persona de Mediana Edad , Vehículos a Motor , Queensland/epidemiología , Encuestas y Cuestionarios , Verduras , Lugar de Trabajo , Adulto Joven
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