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1.
BMC Public Health ; 20(1): 1037, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32605552

RESUMO

BACKGROUND: Australia, like other nations, has experienced a shift in dietary patterns away from home cooking of nutritious foods, towards a reliance on pre-prepared convenience meals. These are typically energy-dense, nutrient-poor and contribute to the rising prevalence of obesity and chronic disease burden. The aims of this study were to evaluate whether a community-based cooking program instigated a change to participants' skills, attitudes, knowledge, enjoyment and satisfaction of cooking and cooking confidence (self-efficacy). METHODS: The pseudo-random, pre-post study design consisted of an intervention and a control group. Participant recruitment and group allocation was based on their program start dates. Intervention participants were surveyed three times (baseline, 7 weeks and 6 months) and the control group were surveyed at baseline and 5 weeks. All participants were registered via an online website and were 18 years or over. Upon consent, participants were offered four levels of commitment, defined by different assessments. The minimum participation level included an online survey and levels 2, 3 and 4 involved attendance at a clinic with increasing functional, anthropometric and biomarker measurements. Primary endpoints were participants' cooking confidence as a proxy for self-efficacy. Secondary endpoints were dietary intake, physical activity levels, body composition, anthropometry, blood, urine and faecal biomarkers of systemic, physical and mental health. DISCUSSION: The community cooking program provided participants with information and advice on food sourcing, preparation and nutrition to improve home cooking skills. The study was designed to explore whether food literacy programs are efficacious in improving participant physical health and well-being in order to combat the rise in obesity and diet-related disease. It will support future use of public health cooking program initiatives aimed at improving food literacy, self-efficacy and physical and mental health. The extensive data collected will inform future research into the relationship between diet, the gut-microbiota and human health. TRIAL REGISTRATION: Retrospectively registered on 16.08.2019 with the Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12619001144101 . Protocol version 4.


Assuntos
Culinária , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Autoeficácia , Adulto , Austrália , Biomarcadores , Doença Crônica , Dieta/efeitos adversos , Dieta/estatística & dados numéricos , Feminino , Humanos , Estilo de Vida , Masculino , Obesidade/epidemiologia , Obesidade/prevenção & controle , Satisfação Pessoal , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa , Inquéritos e Questionários , Austrália Ocidental/epidemiologia
2.
Artigo em Inglês | MEDLINE | ID: mdl-32418513

RESUMO

Background: Notification rates of gonorrhoea in Australia for heterosexual young adults rose by 63% between 2012 and 2016. In Western Australian major cities, there was a 612% increase among non-Aboriginal females and a 358% increase in non-Aboriginal males in the ten-year period 2007-2016. A qualitative public health investigation was initiated to inform appropriate action. Methods: Eighteen semi-structured telephone interviews were conducted with non-Aboriginal heterosexual young adults aged 18-34 years living in Perth, Western Australia, who had recently been notified to the Department of Health with gonorrhoea, to explore the context of their sexual interactions and lifestyles which could have predisposed them to contracting gonorrhoea. Data were thematically analysed. Results: Common themes were having several casual sexual partners, limited communication between sexual partners about condom use or sexual history prior to engaging in sexual activity, inconsistent condom use, normalisation of some sexually transmissible infections amongst young people, and poor understandings and assessment of sexually transmissible infection risk. Conclusion: The findings support public health interventions that focus on communication between sexual partners and shifting of risk perceptions in sexual health education programs, ensuring accessibility of quality sexual health information, increasing condom accessibility and acceptability, and on strategies for addressing misperceptions of young people in relation to sexually transmitted infections.


Assuntos
Gonorreia/epidemiologia , Comportamento Sexual , Adulto , Feminino , Heterossexualidade , Humanos , Masculino , Saúde Pública , Fatores de Risco , Saúde Sexual , Parceiros Sexuais , Austrália Ocidental/epidemiologia , Adulto Jovem
3.
PLoS Med ; 17(3): e1003061, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32182239

RESUMO

BACKGROUND: Migrant women, especially from Indian and African ethnicity, have a higher risk of stillbirth than native-born populations in high-income countries. Differential access or timing of ANC and the uptake of other services may play a role. We investigated the pattern of healthcare utilisation among migrant women and its relationship with the risk of stillbirth (SB)-antepartum stillbirth (AnteSB) and intrapartum stillbirth (IntraSB)-in Western Australia (WA). METHODS AND FINDINGS: A retrospective cohort study using de-identified linked data from perinatal, birth, death, hospital, and birth defects registrations through the WA Data Linkage System was undertaken. All (N = 260,997) non-Indigenous births (2005-2013) were included. Logistic regression analysis was used to estimate odds ratios and 95% CI for AnteSB and IntraSB comparing migrant women from white, Asian, Indian, African, Maori, and 'other' ethnicities with Australian-born women controlling for risk factors and potential healthcare-related covariates. Of all the births, 66.1% were to Australian-born and 33.9% to migrant women. The mean age (years) was 29.5 among the Australian-born and 30.5 among the migrant mothers. For parity, 42.3% of Australian-born women, 58.2% of Indian women, and 29.3% of African women were nulliparous. Only 5.3% of Maori and 9.2% of African migrants had private health insurance in contrast to 43.1% of Australian-born women. Among Australian-born women, 14% had smoked in pregnancy whereas only 0.7% and 1.9% of migrants from Indian and African backgrounds, respectively, had smoked in pregnancy. The odds of AnteSB was elevated in African (odds ratio [OR] 2.22, 95% CI 1.48-2.13, P < 0.001), Indian (OR 1.64, 95% CI 1.13-2.44, P = 0.013), and other women (OR 1.46, 95% CI 1.07-1.97, P = 0.016) whereas IntraSB was higher in African (OR 5.24, 95% CI 3.22-8.54, P < 0.001) and 'other' women (OR 2.18, 95% CI 1.35-3.54, P = 0.002) compared with Australian-born women. When migrants were stratified by timing of first antenatal visit, the odds of AnteSB was exclusively increased in those who commenced ANC later than 14 weeks gestation in women from Indian (OR 2.16, 95% CI 1.18-3.95, P = 0.013), Maori (OR 3.03, 95% CI 1.43-6.45, P = 0.004), and 'other' (OR 2.19, 95% CI 1.34-3.58, P = 0.002) ethnicities. With midwife-only intrapartum care, the odds of IntraSB for viable births in African and 'other' migrants (combined) were more than 3 times that of Australian-born women (OR 3.43, 95% CI 1.28-9.19, P = 0.014); however, with multidisciplinary intrapartum care, the odds were similar to that of Australian-born group (OR 1.34, 95% CI 0.30-5.98, P = 0.695). Compared with Australian-born women, migrant women who utilised interpreter services had a lower risk of SB (OR 0.51, 95% CI 0.27-0.96, P = 0.035); those who did not utilise interpreters had a higher risk of SB (OR 1.20, 95% CI 1.07-1.35, P < 0.001). Covariates partially available in the data set comprised the main limitation of the study. CONCLUSION: Late commencement of ANC, underutilisation of interpreter services, and midwife-only intrapartum care are associated with increased risk of SB in migrant women. Education to improve early engagement with ANC, better uptake of interpreter services, and the provision of multidisciplinary-team intrapartum care to women specifically from African and 'other' backgrounds may reduce the risk of SB in migrants.


Assuntos
Emigrantes e Imigrantes , Emigração e Imigração , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Recursos em Saúde , Disparidades em Assistência à Saúde/etnologia , Serviços de Saúde Materna , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Natimorto/etnologia , Adulto , Grupo com Ancestrais do Continente Africano , Grupo com Ancestrais do Continente Asiático , Recursos em Saúde/tendências , Disparidades em Assistência à Saúde/tendências , Humanos , Serviços de Saúde Materna/tendências , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos , Educação de Pacientes como Assunto/tendências , Fatores Raciais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Austrália Ocidental/epidemiologia , Adulto Jovem
4.
Artigo em Inglês | MEDLINE | ID: mdl-32114974

RESUMO

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%).


Assuntos
Gonorreia/epidemiologia , Antibacterianos/uso terapêutico , Austrália/epidemiologia , Território da Capital Australiana , Ciprofloxacino/uso terapêutico , Gonorreia/tratamento farmacológico , Humanos , Testes de Sensibilidade Microbiana , Neisseria gonorrhoeae , New South Wales/epidemiologia , Northern Territory/epidemiologia , Resistência às Penicilinas , Penicilinas/uso terapêutico , Queensland/epidemiologia , Austrália do Sul/epidemiologia , Tasmânia/epidemiologia , Vitória/epidemiologia , Austrália Ocidental/epidemiologia
5.
Med J Aust ; 212(5): 215-221, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32030754

RESUMO

OBJECTIVES: To assess the risks of stroke and cardiovascular mortality for Aboriginal and non-Aboriginal Australians with atrial fibrillation. DESIGN: Retrospective data linkage cohort study. SETTING, PARTICIPANTS: All people aged 20-84 years hospitalised with atrial fibrillation in Western Australia during 2000-2012. MAIN OUTCOME MEASURES: Stroke incidence rates and mortality after hospitalisation for atrial fibrillation, and 10-year risks of stroke and of cardiovascular and all-cause mortality. RESULTS: Among 55 482 index admissions with atrial fibrillation, 7.7% of 20-59-year-old patients and 1.3% of 60-84-year-old patients were Aboriginal Australians. A larger proportion of Aboriginal patients aged 20-59 years had CHA2 DS2 -VASc scores of 2 or more (59.8% v 21.8%). In 20-59-year-old Aboriginal patients, the incidence during follow-up (maximum, 10 years; median, 7.1 years) of stroke (incidence rate ratio [IRR], 3.2; 95% CI, 2.5-4.1) and fatal stroke (IRR, 5.7; 95% CI, 3.9-8.9) were markedly higher than for non-Aboriginal patients. Stroke incidence was higher for 60-84-year-old patients, but the difference between Aboriginal and non-Aboriginal patients was smaller (IRR, 1.6; 95% CI, 1.3-2.0). Cardiovascular mortality during follow-up was also higher for 20-59-year-old Aboriginal patients (IRR, 4.4; 95% CI, 4.3-5.9). The hazards of stroke (adjusted HR [aHR], 1.67; 95% CI, 1.22-2.28) and cardiovascular mortality (aHR, 1.47; 95% CI, 1.18-1.83) in younger Aboriginal patients remained significantly higher after multivariable adjustment; age/sex, principal diagnosis of atrial fibrillation, and CHA2 DS2 -VASc score were the most influential factors. CONCLUSION: Stroke risk and cardiovascular mortality are markedly higher for Aboriginal than non-Aboriginal patients with atrial fibrillation, particularly for patients under 60. Strategies for providing evidence-based therapies and cardiovascular prevention to Aboriginal people with atrial fibrillation must be improved.


Assuntos
Fibrilação Atrial/complicações , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Grupo com Ancestrais Oceânicos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Austrália Ocidental/epidemiologia , Adulto Jovem
6.
Gynecol Oncol ; 156(3): 611-615, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31983516

RESUMO

OBJECTIVE: Risk factors for ovarian borderline tumors and low-grade serous carcinoma (LGSC) are poorly understood. The aim of this study was to examine the association between infertility, pelvic inflammatory disease (PID), endometriosis, ectopic pregnancy, hysterectomy, tubal ligation and parity and the risk of serous borderline tumor (SBT), mucinous borderline tumor (MBT) and LGSC. METHODS: This was a population-based cohort study using linked administrative and hospital data. Participants were 441,382 women born between 1945 and 1975 who had been admitted to hospital in Western Australia between 1 January 1980 and 30 June 2014. We used Cox regression to estimate hazard ratios (HRs). RESULTS: We observed an increased rate of SBT associated with infertility, PID and ectopic pregnancy (HRs and 95% CIs were, respectively, 1.98 (1.20-3.26); 1.95 (1.22-3.10) and 2.44 (1.20-4.96)). We did not detect an association between any of the factors under study and the rate of MBT. A diagnosis of PID was associated with an increased rate of LGSC (HR 2.90, 95% CI 1.21-6.94). CONCLUSIONS: The association with PID supports the hypothesis that inflammatory processes within the upper gynaecological tract and/or peritoneum may predispose to the development of SBT and LGSC.


Assuntos
Cistadenocarcinoma Seroso/epidemiologia , Infertilidade/epidemiologia , Neoplasias Císticas, Mucinosas e Serosas/epidemiologia , Neoplasias Ovarianas/epidemiologia , Doença Inflamatória Pélvica/epidemiologia , Gravidez Ectópica/epidemiologia , Adulto , Estudos de Coortes , Cistadenocarcinoma Seroso/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Neoplasias Císticas, Mucinosas e Serosas/patologia , Neoplasias Ovarianas/patologia , Gravidez , Austrália Ocidental/epidemiologia
7.
Epidemiol Infect ; 147: e310, 2019 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-31775940

RESUMO

This study compares the frequency and severity of influenza A/H1N1pdm09 (A/H1), influenza A/H3N2 (A/H3) and other respiratory virus infections in hospitalised patients. Data from 17 332 adult hospitalised patients admitted to Sir Charles Gairdner Hospital, Perth, Western Australia, with a respiratory illness between 2012 and 2015 were linked with data containing reverse transcription polymerase chain reaction results for respiratory viruses including A/H1, A/H3, influenza B, human metapneumovirus, respiratory syncytial virus and parainfluenza. Of these, 1753 (10.1%) had test results. Multivariable regression analyses were conducted to compare the viruses for clinical outcomes including ICU admission, ventilation, pneumonia, length of stay and death. Patients with A/H1 were more likely to experience severe outcomes such as ICU admission (OR 2.5, 95% CI 1.2-5.5, P = 0.016), pneumonia (OR 3.0, 95% CI 1.6-5.7, P < 0.001) and lower risk of discharge from hospital (indicating longer lengths of hospitalisation; HR 0.64 95% CI 0.47-0.88, P = 0.005), than patients with A/H3. Patients with a non-influenza respiratory virus were less likely to experience severe clinical outcomes than patients with A/H1, however, had similar likelihood when compared to patients with A/H3. Patients hospitalised with A/H1 had higher odds of severe outcomes than patients with A/H3 or other respiratory viruses. Knowledge of circulating influenza strains is important for healthcare preparedness.


Assuntos
Hospitalização , Vírus da Influenza A Subtipo H1N1 , Vírus da Influenza A Subtipo H3N2 , Influenza Humana/virologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Vírus da Influenza A Subtipo H1N1/patogenicidade , Vírus da Influenza A Subtipo H3N2/isolamento & purificação , Vírus da Influenza A Subtipo H3N2/patogenicidade , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Influenza Humana/terapia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pandemias , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Índice de Gravidade de Doença , Austrália Ocidental/epidemiologia , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-31623384

RESUMO

Seasonality in glucose metabolism has been observed in adult populations; however, little is known of the associations between season and glucose metabolism in children. In this study, we examined whether markers of glucose metabolism (fasting glucose, insulin and HbA1c) varied by season in a paediatric population (6-13 years of age) located in Perth (Western Australia, n = 262) with data categorised by weight. Linear regression was used to analyse the nature of the relationships between mean daily levels of terrestrial ultraviolet radiation (UVR) (prior to the day of the blood test) and measures of glucose metabolism. Fasting blood glucose was significantly lower in autumn compared to spring, for children in combined, normal and obese weight categories. Fasting insulin was significantly lower in autumn and summer compared to winter for individuals of normal weight. HbA1c was significantly higher in summer (compared with winter and spring) in overweight children, which was in the opposite direction to other published findings in adults. In children with obesity, a strong inverse relationship (r = -0.67, p = 0.002) was observed for fasting glucose, and daily terrestrial UVR levels measured in the previous 6 months. Increased safe sun exposure in winter therefore represents a plausible means of reducing fasting blood sugar in children with obesity. However, further studies, using larger paediatric cohorts are required to confirm these relationships.


Assuntos
Exposição Ambiental/efeitos adversos , Jejum/sangue , Insulina/sangue , Raios Ultravioleta/efeitos adversos , Biomarcadores/sangue , Glicemia/metabolismo , Criança , Feminino , Humanos , Masculino , Estações do Ano , Austrália Ocidental/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-31546738

RESUMO

BACKGROUND: A growing body of epidemiological and clinical evidence has implicated air pollution as an emerging risk factor for cardiometabolic disease. Whilst individuals spend up to two-thirds of daily time in their domestic residential environment, very few studies have been designed to objectively measure the sub-clinical markers of cardiometabolic risk with exposure to domestic indoor air pollutants. This cross-sectional study aims to investigate associations between the components of domestic indoor air quality and selected sub-clinical cardiometabolic risk factors in a cohort of healthy adults living in Perth, Western Australia. METHODS: One hundred and eleven non-smoking adults (65% female) living in non-smoking households who were aged between 35-69 years were recruited for the project. Study subjects were invited to participate in all sections of the study, which included: Domestic indoor air monitoring along with the concurrent 24 h ambulatory monitoring of peripheral and central blood pressure and measures of central hemodynamic indices, standardized questionnaires on aspects relating to current health status and the domestic environment, a 24 h time-activity diary during the monitoring period, and clinic-based health assessment involving collection of blood and urine biomarkers for lipid and glucose profiles, as well as measures of renal function and an analysis of central pulse wave and pulse wave velocity. RESULTS: This study provides a standardized approach to the study of sub-clinical cardiometabolic health effects that are related to the exposure to indoor air pollution. CONCLUSION: The findings of this study may provide direction for future research that will further contribute to our understanding of the relationship that exists between indoor air pollution and sub-clinical markers of cardiometabolic risk.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/análise , Doenças Assintomáticas/epidemiologia , Doenças Cardiovasculares/epidemiologia , Biomarcadores Ambientais , Exposição Ambiental/análise , Adulto , Idoso , Estudos Transversais , Monitoramento Ambiental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Austrália Ocidental/epidemiologia
10.
Maturitas ; 128: 4-9, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31561821

RESUMO

INTRODUCTION: It is uncertain whether depression and exposure to antidepressants increase the risk of cardiovascular events in later life. This study attempts to clarify whether the risk of cardiovascular events associated with exposure to antidepressant medications varies according to history of depression. METHODS: Cohort study of 5522 Australian men aged 70-89 years living in the metropolitan region of Perth, Western Australia, who were followed for novel cardiovascular events over 12 years. Clinical diagnoses followed the International Classification of Diseases (ICD) codes for ischaemic heart disease, cerebrovascular events and depressive disorders. Participants self-reported their use of medications. Other study measures included age, schooling, smoking history and the following concurrent morbidities: diabetes, hypertension, cancer, dementia, and respiratory diseases, gastrointestinal and renal diseases. RESULTS: 374 men (6.8%) had a recorded or current diagnosis of depression and 365 (6.6%) were using an antidepressant. Prevalent depression and antidepressant use were associated with increased mortality hazard, but not the interaction between them (hazard ratio, HR = 0.46, 95%CI = 0.33, 0.65). Depression (HR = 1.50, 95%CI = 1.21, 1.86) and antidepressants (HR = 1.52, 95%CI = 1.20, 1.93) were associated with an increased risk of cardiovascular events, but the interaction term was associated with decreased risk (HR = 0.51, 95%CI = 0.30, 0.87). All analyses were adjusted for other study measures. DISCUSSION: Depression and antidepressant use were associated with an increase in the 12-year risk of cardiovascular events, while antidepressants were associated with a decrease in the risk of cardiovascular events among older men with depression, but not among those without. This suggests that the effect of this interaction on the risk of cardiovascular events may be driven by the ability of antidepressants to lead to clinical improvements in mood.


Assuntos
Antidepressivos/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Depressão/epidemiologia , Transtorno Depressivo/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/efeitos adversos , Estudos de Coortes , Depressão/complicações , Depressão/tratamento farmacológico , Transtorno Depressivo/complicações , Transtorno Depressivo/tratamento farmacológico , Humanos , Classificação Internacional de Doenças , Masculino , Prevalência , Fatores de Risco , Austrália Ocidental/epidemiologia
11.
Aust Vet J ; 97(10): 418-421, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31556108

RESUMO

This study reports the prevalence of potential faecal pathogens in the microbiome detected in a cohort of cats and dogs with diarrhoea in Perth, Western Australia. Records from a commercial diagnostic laboratory using faecal PCR testing between July 2014 and August 2015 were reviewed.Of 289 feline faecal samples reviewed, Salmonella spp. (1.7%), Campylobacter spp. (47.6%), Clostridium perfringens (81.3%), Giardia spp. (11.1%), Toxoplasma gondii (1.2%), Tritrichomonas foetus (4.8%), panleukopenia virus (6.5%) and coronavirus (39.5%) were detected. In dogs, Salmonella spp. (5.4%), Campylobacter spp. (36.3%), C. perfringens (85.4%), Giardia spp. (6.2%), parvovirus (9.4%), coronavirus (4.7%) and distemper virus (1.5%) were detected.


Assuntos
Doenças do Gato/microbiologia , Diarreia/veterinária , Doenças do Cão/microbiologia , Microbioma Gastrointestinal , Animais , Doenças do Gato/epidemiologia , Gatos , Coronavirus/isolamento & purificação , Diarreia/epidemiologia , Diarreia/microbiologia , Doenças do Cão/epidemiologia , Cães , Fezes/microbiologia , Feminino , Giardia/isolamento & purificação , Bactérias Gram-Negativas/isolamento & purificação , Masculino , Reação em Cadeia da Polimerase/veterinária , Austrália Ocidental/epidemiologia
12.
J Pediatr ; 215: 90-97.e1, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31493909

RESUMO

OBJECTIVE: To describe the long-term neurodevelopmental and cognitive outcomes for children born preterm. STUDY DESIGN: In this retrospective cohort study, information on children born in Western Australia between 1983 and 2010 was obtained through linkage to population databases on births, deaths, and disabilities. For the purpose of this study, disability was defined as a diagnosis of intellectual disability, autism, or cerebral palsy. The Kaplan-Meier method was used to estimate the probability of disability-free survival up to age 25 years by gestational age. The effect of covariates and predicted survival was examined using parametric survival models. RESULTS: Of the 720 901 recorded live births, 12 083 children were diagnosed with disability, and 5662 died without any disability diagnosis. The estimated probability of disability-free survival to 25 years was 4.1% for those born at gestational age 22 weeks, 19.7% for those born at 23 weeks, 42.4% for those born at 24 weeks, 53.0% for those born at 25 weeks, 78.3% for those born at 28 weeks, and 97.2% for those born full term (39-41 weeks). There was substantial disparity in the predicted probability of disability-free survival for children born at all gestational ages by birth profile, with 5-year estimates of 4.9% and 10.4% among Aboriginal and Caucasian populations, respectively, born at 24-27 weeks and considered at high risk (based on low Apgar score, male sex, low sociodemographic status, and remote region of residence) and 91.2% and 93.3%, respectively, for those at low risk (ie, high Apgar score, female sex, high sociodemographic status, residence in a major city). CONCLUSIONS: Apgar score, birth weight, sex, socioeconomic status, and maternal ethnicity, in addition to gestational age, have pronounced impacts on disability-free survival.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Previsões , Recém-Nascido Prematuro , Adulto , Feminino , Seguimentos , Idade Gestacional , Humanos , Incidência , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Masculino , Estudos Retrospectivos , Austrália Ocidental/epidemiologia , Adulto Jovem
13.
Int J Food Microbiol ; 308: 108305, 2019 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-31476731

RESUMO

In recent years, the number of human salmonellosis cases in Western Australia (WA) has increased more dramatically than in any other Australian state. In 2017, the number of cases in WA was more than double the five-year average, and eggs had emerged as the key culprit for several Salmonella foodborne disease outbreaks. To better understand such an epidemiologically intriguing situation, our research goal was to investigate the prevalence, serovar diversity, multilocus sequence types, and antimicrobial resistance of non-typhoidal Salmonella contamination in retail eggs produced and sold in WA. A total of 200 visually clean and intact retail egg samples (each containing a dozen eggs) were purchased for one year (2017-2018) from supermarkets in metropolitan Perth, the capital of WA. For each sample, the contents and shells of the 12 eggs were separately pooled and cultured according to standard methods. Overall, Salmonella was detected in 11.5% (23/200) of the tested egg samples. Salmonella was isolated from 4.5% (9/200) and 3% (6/200) of eggshells and egg contents, respectively. In 4% (8/200) of the samples, Salmonella was recovered from both eggshell and egg contents. Isolates from positive retail egg samples were serotyped as either S. Typhimurium (52.2% [12/23]) or S. Infantis (39.1% [9/23]). Both serotypes were concurrently recovered from two different retail egg samples. We retained a set of both S. Typhimurium (n = 29) and S. Infantis (n = 12) isolates from all Salmonella-positive retail packs (n = 23) for further characterization. Only two (S. Typhimurium) isolates showed resistance to ampicillin, of which one carried ß-lactamase resistance gene blaTEM-1b. The remaining isolates (39/41) were susceptible to all 14 antimicrobials included in the minimum inhibitory concentrations (MICs) testing panel. Multilocus sequence typing and serotyping were perfectly mirrored, as all S. Typhimurium isolates were characterized as sequence type (ST)-19, and all S. Infantis isolates were ST-32. This study points to the noteworthy Salmonella prevalence rate in retail egg samples in WA. Our results illustrate minimal public health risks arising from antimicrobial resistance Salmonella from Australian eggs.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana/genética , Casca de Ovo/microbiologia , Ovos/microbiologia , Microbiologia de Alimentos/métodos , Salmonella/isolamento & purificação , Animais , Austrália , Genômica , Humanos , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Salmonella/classificação , Salmonella/genética , Intoxicação Alimentar por Salmonella/epidemiologia , Infecções por Salmonella/epidemiologia , Sorogrupo , Sorotipagem , Austrália Ocidental/epidemiologia
14.
BMC Pregnancy Childbirth ; 19(1): 287, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399075

RESUMO

BACKGROUND: To compare the prevalence of preterm birth, post term birth, intra-uterine growth restriction and distribution of Apgar scores in offspring of foreign-born women in Western Australia with that of their Australian-born non-Indigenous and Indigenous counterparts. METHODS: A population-based linked data study, involving 767,623 singleton births in Western Australia between 1980 and 2010 was undertaken. Neonatal outcomes included preterm birth, post term births, intra-uterine growth restriction (assessed using the proportion of optimal birth weight) and low Apgar scores. These were compared amongst foreign-born women from low, lower-middle, upper middle and high income countries and Australian-born non-Indigenous and Indigenous women over two different time periods using multinomial logistic regression adjusted for covariates. RESULTS: Compared with Australian born non-Indigenous women, foreign-born women from low income countries were at some increased risk of extreme preterm (aRRR 1.59, 95% CI 0.87, 2.89) and very early preterm (aRRR 1.63, 95% CI 0.92, 2.89) births during the period from 1980 to 1996. During the period from 1997 to 2010 they were also at some risk of extreme preterm (aRRR 1.42, 95% CI 0.98, 2.04) very early preterm (aRRR 1.34, 95% CI 1.11, 1.62) and post term birth (aRRR 1.93, 95% CI 0.99, 3.78). During this second time period, other adverse outcomes for children of foreign-born women from low income and middle income countries included increases in severe (aRRR 1.69, 95% CI 1.30, 2.20; aRRR 1.72, 95% CI 1.53, 1.93), moderate (aRRR 1.54, 95% CI 1.32, 1.81; aRRR 1.59, 95% CI 1.48, 1.70) and mild (aRRR 1.28, 95% CI 1.14, 1.43; aRRR 1.31, 95% CI 1.25, 1.38) IUGR compared to children of Australian-born non-Indigenous mothers. Uniformly higher risks of adverse outcomes were also demonstrated for infants of Indigenous mothers. CONCLUSIONS: Our findings illustrate the vulnerabilities of children born to foreign women from low and middle-income countries. The need for exploratory research examining mechanisms contributing to poorer birth outcomes following resettlement in a developed nation is highlighted. There is also a need to develop targeted interventions to improve outcomes for these women and their families.


Assuntos
Índice de Apgar , Emigrantes e Imigrantes/estatística & dados numéricos , Retardo do Crescimento Fetal/etnologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Gravidez Prolongada/etnologia , Nascimento Prematuro/etnologia , Adulto , Países Desenvolvidos , Países em Desenvolvimento , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Recém-Nascido , Modelos Logísticos , Masculino , Gravidez , Gravidez Prolongada/epidemiologia , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Austrália Ocidental/epidemiologia , Adulto Jovem
16.
Anaerobe ; 60: 102065, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31260739

RESUMO

Despite being considered a major hospital-associated pathogen for many years, Clostridium difficile has been isolated increasingly from people without hospital contact. In this study, we investigated the prevalence of C. difficile in the immediate outdoor environment of several hospitals in Perth, Western Australia, to provide further insight into potential sources of community-acquired C. difficile infection. Over 6 months, a total of 159 samples consisting of soil, mulch, lawn and sand were collected from outdoor surroundings of four different old (age>50 years) and new (age<10 years) hospitals. Samples were cultured in a C. difficile selective enrichment broth. Toxin gene profiling using PCR, and PCR ribotyping, was performed on all C. difficile recovered. C. difficile was isolated from 96 of the 159 samples (60.4%). Of the 112 isolates, 33 (29.5%) were toxigenic and 49 (43.8%) were identified as novel strains. Ribotypes (RTs) 014/020 (14.3%) and 010 (13.4%) constituted the highest proportion of isolates. Interestingly, RT 017, a strain endemic to the Asia-Pacific region (but not Australia), was found in a newly laid lawn. This study adds to existing knowledge of potential sources of C. difficile in Western Australia. More research is required to determine the route of transmission of C. difficile from community sources into the hospital.


Assuntos
Infecções por Clostridium/epidemiologia , Infecções por Clostridium/microbiologia , Clostridium difficile , Microbiologia Ambiental , Microbiologia do Solo , Adulto , Idoso , Infecções por Clostridium/transmissão , Clostridium difficile/isolamento & purificação , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/transmissão , Diarreia/epidemiologia , Diarreia/microbiologia , Hospitais , Humanos , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Prevalência , Vigilância em Saúde Pública , Austrália Ocidental/epidemiologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-31344807

RESUMO

Indigenous children have much higher rates of ear and lung disease than non-Indigenous children, which may be related to exposure to high levels of geogenic (earth-derived) particulate matter (PM). The aim of this study was to assess the relationship between dust levels and health in Indigenous children in Western Australia (W.A.). Data were from a population-based sample of 1077 Indigenous children living in 66 remote communities of W.A. (>2,000,000 km2), with information on health outcomes derived from carer reports and hospitalisation records. Associations between dust levels and health outcomes were assessed by multivariate logistic regression in a multi-level framework. We assessed the effect of exposure to community sampled PM on epithelial cell (NuLi-1) responses to non-typeable Haemophilus influenzae (NTHi) in vitro. High dust levels were associated with increased odds of hospitalisation for upper (OR 1.77 95% CI [1.02-3.06]) and lower (OR 1.99 95% CI [1.08-3.68]) respiratory tract infections and ear disease (OR 3.06 95% CI [1.20-7.80]). Exposure to PM enhanced NTHi adhesion and invasion of epithelial cells and impaired IL-8 production. Exposure to geogenic PM may be contributing to the poor respiratory health of disadvantaged communities in arid environments where geogenic PM levels are high.


Assuntos
Poluentes Atmosféricos/análise , Otopatias/epidemiologia , Material Particulado/análise , Doenças Respiratórias/epidemiologia , Adolescente , Poluentes Atmosféricos/toxicidade , Adesão Celular/efeitos dos fármacos , Linhagem Celular , Criança , Pré-Escolar , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/metabolismo , Células Epiteliais/virologia , Haemophilus influenzae , Humanos , Povos Indígenas/estatística & dados numéricos , Lactente , Recém-Nascido , Interleucina-8/metabolismo , Razão de Chances , Material Particulado/toxicidade , Austrália Ocidental/epidemiologia
18.
PLoS One ; 14(6): e0218760, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31242238

RESUMO

BACKGROUND: The prediction of readmission or death after a hospital discharge for heart failure (HF) remains a major challenge. Modern healthcare systems, electronic health records, and machine learning (ML) techniques allow us to mine data to select the most significant variables (allowing for reduction in the number of variables) without compromising the performance of models used for prediction of readmission and death. Moreover, ML methods based on transformation of variables may potentially further improve the performance. OBJECTIVE: To use ML techniques to determine the most relevant and also transform variables for the prediction of 30-day readmission or death in HF patients. METHODS: We identified all Western Australian patients aged 65 years and above admitted for HF between 2003-2008 in linked administrative data. We evaluated variables associated with HF readmission or death using standard statistical and ML based selection techniques. We also tested the new variables produced by transformation of the original variables. We developed multi-layer perceptron prediction models and compared their predictive performance using metrics such as Area Under the receiver operating characteristic Curve (AUC), sensitivity and specificity. RESULTS: Following hospital discharge, the proportion of 30-day readmissions or death was 23.7% in our cohort of 10,757 HF patients. The prediction model developed by us using a smaller set of variables (n = 8) had comparable performance (AUC 0.62) to the traditional model (n = 47, AUC 0.62). Transformation of the original 47 variables further improved (p<0.001) the performance of the predictive model (AUC 0.66). CONCLUSIONS: A small set of variables selected using ML matched the performance of the model that used the full set of 47 variables for predicting 30-day readmission or death in HF patients. Model performance can be further significantly improved by transforming the original variables using ML methods.


Assuntos
Insuficiência Cardíaca/mortalidade , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Estudos de Coortes , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/terapia , Humanos , Aprendizado de Máquina , Masculino , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Fatores de Risco , Austrália Ocidental/epidemiologia
19.
Ann Thorac Surg ; 108(6): 1815-1821, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31238032

RESUMO

BACKGROUND: When, and on whom, aspirin should be ceased before elective cardiac surgery is controversial. This study assessed the incidence of preoperative aspirin resistance and whether the quantitative antiplatelet effect of aspirin was associated with perioperative outcomes. METHODS: Aspirin-induced antiplatelet effect was measured by multiple electrode aggregometry in 250 adult cardiac surgical patients within 24 hours before surgery. Aspirin resistance was defined by a normal platelet function testing result for those who had continued taking aspirin until the day before the platelet function testing. RESULTS: Aspirin resistance was observed in 16 (11.9%) patients (95% confidence interval [CI], 7.4-18.4). Of the 250 patients included, 75 (30%) required allogeneic blood product transfusion subsequently. Aspirin induced antiplatelet effect (odds ratio [OR], 0.991 per unit increment in the area under the curve on the platelet function testing, with a smaller area indicating more platelet inhibition; 95% CI, 0.982-0.999; P = .035), a higher EuroSCORE [European System for Cardiac Operative Risk Evaluation] II risk (OR, 1.184 per EuroSCORE II risk percentage increment; 95% CI, 1.017-1.379; P = .001), and a lower body mass index (OR, 0.926 per unit increment; 95% CI, 0.867-0.990; P = .024) were the only factors independently associated with requiring perioperative allogeneic blood product transfusion. CONCLUSIONS: The degree of aspirin effect immediately before cardiac surgery was weakly associated with the risks of postoperative bleeding and allogeneic blood product transfusion, suggesting that measuring aspirin-induced antiplatelet effect before cardiac surgery may be useful as an adjunct in optimizing patient blood management for patients who are at high risk of bleeding and requiring allogeneic blood transfusion.


Assuntos
Aspirina/efeitos adversos , Procedimentos Cirúrgicos Cardíacos , Doença da Artéria Coronariana/terapia , Resistência a Medicamentos , Hemorragia Pós-Operatória/epidemiologia , Idoso , Doença da Artéria Coronariana/sangue , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/efeitos adversos , Testes de Função Plaquetária , Hemorragia Pós-Operatória/induzido quimicamente , Prognóstico , Estudos Retrospectivos , Austrália Ocidental/epidemiologia
20.
Respir Res ; 20(1): 81, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31167662

RESUMO

BACKGROUND: The differential diagnosis of paediatric respiratory conditions is difficult and suboptimal. Existing diagnostic algorithms are associated with significant error rates, resulting in misdiagnoses, inappropriate use of antibiotics and unacceptable morbidity and mortality. Recent advances in acoustic engineering and artificial intelligence have shown promise in the identification of respiratory conditions based on sound analysis, reducing dependence on diagnostic support services and clinical expertise. We present the results of a diagnostic accuracy study for paediatric respiratory disease using an automated cough-sound analyser. METHODS: We recorded cough sounds in typical clinical environments and the first five coughs were used in analyses. Analyses were performed using cough data and up to five-symptom input derived from patient/parent-reported history. Comparison was made between the automated cough analyser diagnoses and consensus clinical diagnoses reached by a panel of paediatricians after review of hospital charts and all available investigations. RESULTS: A total of 585 subjects aged 29 days to 12 years were included for analysis. The Positive Percent and Negative Percent Agreement values between the automated analyser and the clinical reference were as follows: asthma (97, 91%); pneumonia (87, 85%); lower respiratory tract disease (83, 82%); croup (85, 82%); bronchiolitis (84, 81%). CONCLUSION: The results indicate that this technology has a role as a high-level diagnostic aid in the assessment of common childhood respiratory disorders. TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry (retrospective) - ACTRN12618001521213 : 11.09.2018.


Assuntos
Algoritmos , Tosse/diagnóstico , Tosse/epidemiologia , Transtornos Respiratórios/diagnóstico , Transtornos Respiratórios/epidemiologia , Smartphone , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Austrália Ocidental/epidemiologia
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