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1.
BMC Health Serv Res ; 21(1): 955, 2021 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-34511093

RESUMO

BACKGROUND: Internationally, elective spinal surgery rates in workers' compensation populations are high, as are reoperation rates, while return-to-work rates following spinal surgery are low. Little information is available from Australia. The aim of this study was to describe the rates, costs, return to work and reoperation following elective spinal surgery in the workers' compensation population in New South Wales (NSW), Australia. METHODS: This retrospective cohort study used administrative data from the State Insurance Regulatory Authority, the government organisation responsible for regulating and administering workers' compensation insurance in NSW. These data cover all workers' compensation-insured workers in New South Wales (over 3 million workers/year). We identified a cohort of insured workers who underwent elective spinal surgery (fusion or decompression) between January 1, 2010 and December 31, 2018. People who underwent surgery for spinal fracture or dislocation, or who had sustained a traumatic brain injury were excluded. The main outcome measures were annual spinal surgery rates, cost of the surgical episode, cumulative costs (surgical, hospital, medical and physical therapy) to 2 years post-surgery, and reoperation and return-to-work rates 2 years post-surgery. RESULTS: There were 9343 eligible claims (39.1 % fusion; 59.9 % decompression); claimants were predominantly male (75 %) with a mean age of 43 (range 18 to 75) years. Spinal surgery rates ranged from 15 to 29 surgeries per 100,000 workers per year, fell from 2011-12 to 2014-15 and rose thereafter. The average cost in Australian dollars for a surgical episode was $46,000 for a spinal fusion and $20,000 for a decompression. Two years post-fusion, only 19 % of people had returned to work at full capacity; 39 % after decompression. Nineteen percent of patients underwent additional spinal surgery within 2 years of the index surgery, to a maximum of 5 additional surgeries. CONCLUSION: Rates of workers' compensation-funded spinal surgery did not rise significantly during the study period, but reoperation rates are high and return-to-work rates are low in this population at 2 years post- surgery. In the context of the poor evidence base supporting lumbar fusion surgery, the high cost, increasing rates, and the increased likelihood of poor outcomes in the workers' compensation population, we question the value of this procedure in this setting.


Assuntos
Retorno ao Trabalho , Indenização aos Trabalhadores , Adolescente , Adulto , Idoso , Austrália , Estudos de Coortes , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Reoperação , Estudos Retrospectivos , Adulto Jovem
2.
Artigo em Inglês | MEDLINE | ID: mdl-34501545

RESUMO

The 2019 coronavirus disease (COVID-19) pandemic has globally caused widespread disruption, morbidity and mortality. The uptake of COVID-19 vaccination is critical for minimising further impacts of the pandemic. Health and aged care workers (HACWs) play a central role in public confidence in vaccines and are one of the priority groups for COVID-19 vaccination in Australia. Qualitative phone interviews with 19 HACWs aged 21-50 years old from New South Wales, Australia, were conducted, and the data were analysed thematically in order to understand the factors influencing HACWs' acceptance of COVID-19 vaccination. We found that HACWs reported a continuum of COVID-19 vaccination intentions with 12 enthusiastically accepting and 7 hesitant. Using the Behavioral and Social Drivers of COVID-19 Vaccination (BeSD) Framework, we found that participants' acceptance of vaccination was primarily driven by their perceptions of COVID-19 vaccination (such as safety, risk and benefits) and by the information sources, people and norms they trusted. Informed by study findings, we propose several communication strategies which may be helpful in addressing HACWs vaccination acceptance. We note however that as the pandemic continues, further studies with HACWs from diverse backgrounds are needed in order to provide accurate data on diverse motivational and practical drivers of evolving perceptions and attitudes towards vaccination.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Adulto , Idoso , Austrália , Amigos , Humanos , Pessoa de Meia-Idade , New South Wales , Percepção , SARS-CoV-2 , Vacinação , Adulto Jovem
3.
Aust Health Rev ; 45(4): 411-417, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34334156

RESUMO

Objective This study explored the experiences and perceptions of unplanned hospital readmissions from the perspective of Aboriginal and Torres Strait Islander peoples with chronic disease. Method We conducted semi-structured interviews with Aboriginal and Torres Strait Islander patients readmitted to hospital with chronic disease. Interviews covered perceptions of avoidable readmissions, experiences of health care, medications and carer support. Inductive thematic analysis was used to code and analyse the data. Results Fifteen patients with multiple chronic diseases were interviewed. Several participants believed their readmission was unavoidable due to their poor health, while others considered their readmission was avoidable due to perceived health professional and system failures. Enablers to chronic disease management included the importance of continuity of care and strong family networks, although a few participants struggled with isolation. Four themes emerged as barriers: poor communication from health professionals; low levels of health literacy and adherence to chronic disease management; poor access to community services; and health risk behaviours. Conclusions The participants in our study identified complex and interacting patient-, environmental-, encounter- and organisational-level factors as contributing to chronic disease management and unplanned readmissions. Our findings suggest systemic failures remain in access to basic services and access to culturally appropriate care. Family support and continuity of care were valued by participants. What is known about the topic? Aboriginal and Torres Strait Islander peoples with chronic diseases are more likely to be readmitted to hospital compared with non-Aboriginal people. Unplanned readmissions are associated with high health system costs, as well as poorer quality of life and psychological distress for the patient. What does this paper add? This paper describes the experiences and perceptions of unplanned readmissions by Aboriginal and Torres Strait Islander peoples with chronic disease. Our findings suggest systemic failures exist in access to basic services for a safe and secure living environment, and access to culturally appropriate care that is delivered in a manner which promotes health literacy and self-management capacity. What are the implications for practitioners? Practitioners and policy makers should consider involving family members in discharge planning and other medical care, and funding for Aboriginal and Torres Strait Islander health and community services to enhance transport, care coordination, culturally appropriate disability and housing services, and health promotion.


Assuntos
Serviços de Saúde do Indígena , Qualidade de Vida , Austrália , Doença Crônica , Hospitais , Humanos , New South Wales , Grupo com Ancestrais Oceânicos , Percepção
4.
BMJ Open ; 11(8): e048389, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34341049

RESUMO

INTRODUCTION: Consumer engagement is central to high-quality cancer service delivery and is a recognised strategy to minimise healthcare-associated harm. Strategies developed to enhance consumer engagement specifically in relation to preventing healthcare harm include questioning health professionals, raising concerns about possible mistakes or risks in care and encouraging patients and caregivers to report suspected errors. Patients from ethnic minority backgrounds are particularly vulnerable to unsafe care, but current engagement strategies have not been developed specifically for (and with) this population. Using an adapted approach to experience-based codesign (EBCD) to support the target population, the aim of the project is to codesign consumer engagement interventions to increase consumer engagement and safety in New South Wales and Victorian cancer inpatient, outpatient and day procedure services. METHODS AND ANALYSIS: A mixed-method project will be undertaken at six study sites. Our EBCD approach includes a preparatory phase in which we will provide training and support to the codesign participants, in addition to recruiting and training consumer cofacilitators for the codesign workshops. The project will follow the EBCD process of gathering and synthesising observational data from each cancer service, with interview data from consumers and staff. With the resulting in-depth understanding of the safety threats commonly experienced by ethnic minority consumers in each site, we will work through feedback events and codesign groups with consumers and staff to determine how they can be more involved with their care to minimise the potential for patient harm. Consumer engagement interventions will be coproduced in each of the six participating services that are tailored to the ethnic minority populations served. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Western Sydney Local Health District Human Research Ethics Committee. The project will provide strategies for ethnic minority consumers to engage with cancer services to minimise healthcare-associated harm that may be applied to diverse healthcare settings.


Assuntos
Grupos Étnicos , Neoplasias , Austrália , Humanos , Grupos Minoritários , Neoplasias/terapia , New South Wales
5.
BMJ Open ; 11(8): e047890, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344679

RESUMO

INTRODUCTION: Aboriginal and Torres Strait Islander women experience a higher burden of cervical cancer than non-Indigenous women in Australia. Cervical cancer is preventable partly through human papillomavirus (HPV) vaccination; in Australia, this is delivered through the national school-based immunisation programme. While HPV vaccination uptake is high among Australian adolescents, there remain gaps in uptake and completion among Aboriginal and Torres Strait Islander adolescents. This study aims to gain a comprehensive understanding of the barriers and facilitators to HPV vaccination uptake and completion among Aboriginal and Torres Strait Islander adolescents in Queensland, Australia. METHODS AND ANALYSIS: The study will be guided by an Indigenist research approach and an ecological model for health promotion. Yarning, a qualitative Indigenous research method, will be conducted in up to 10 schools. Participants will include Year 7 (12/13 years old) Aboriginal and Torres Strait Islander adolescents; parents/caregivers; and local key informants and immunisation programme partners involved in the delivery of school-based HPV immunisation programme. Participants will be recruited through school representatives and investigator networks using purposive and snowball sampling and samples of convenience. Field notes, HPV vaccination clinic observations and sequential diagramming of the HPV vaccination process will be conducted. Thematic analysis of data will be led by Aboriginal and Torres Strait Islander researchers. Synthesised sequential diagrams of the process of HPV vaccination and qualitative themes summarising key findings will be produced. ETHICS AND DISSEMINATION: The Aboriginal Health and Medical Research Council of New South Wales Ethics Committee (1646/20), the Australian National University Human Research Ethics Committee (HREC, 2020/478), the HREC of the Northern Territory Department of Health and Menzies School of Health Research (19-3484) and the Townsville Hospital and Health Service HREC (HREC/QTHS/73789) have approved the study. Dissemination will occur via conferences and peer-reviewed publications. Further dissemination will be determined in partnership with the Aboriginal and Torres Strait Islander Steering Committee, including Youth Representatives and Consultation Network.


Assuntos
Serviços de Saúde do Indígena , Adolescente , Feminino , Humanos , New South Wales , Northern Territory , Grupo com Ancestrais Oceânicos , Queensland , Vacinação
6.
J Forensic Leg Med ; 82: 102222, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34358925

RESUMO

Women who wake from sleep during sexual assault commonly report confusion and disorientation. Confusion and disorientation, with impaired decision making after waking, are symptoms of 'sleep inertia', and part of the normal transition from sleep to full wakefulness which is maximal in the minutes after wakening and can be prolonged. In this study of 305 adult females (median age 26, range 18-68), who presented for a sexual assault forensic medical examination, 38 (12%) (median age 27, range 18-51) woke to find sexual acts already in progress. For 25 of these women (25/38 for 66%), an act of penile-vaginal penetration was already occurring when the woman woke. Of the 38 women (12%) who woke during the sexual assault, several had factors known to enhance the impairment of sleep inertia including forced arousal (38/38, 100%) and age under 25 (15/38, 39%). 17 (17/38 for 45%) of these women who woke had consumed varying amounts of alcohol prior to sleep and these 17 woke fully during the assault and then stayed awake. A further 16 women, (16/38 for 42%) woke during the sexual assault but returned to sleep during or after the assault, and all these 16 gave a history of intoxication by drugs or alcohol prior to sleep. Importantly 5, (5/38 for 13%) of the women who woke during the assault had consumed no intoxicating substances. A further 68 (23%) of the 305 women, (median age 26, range 18-58) had no memory on waking of the alleged sexual assault despite having other reasons to believe that a sexual assault had occurred. Forensic medical examiners can assist both the justice process, and patient care, by considering the possibility of sleep inertia among victims who report disorientation and slow or confused decision making on waking during a sexual assault.


Assuntos
Vítimas de Crime/psicologia , Delitos Sexuais , Sono , Vigília , Adolescente , Adulto , Idoso , Vítimas de Crime/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , New South Wales , Estudos Retrospectivos , Adulto Jovem
8.
Ecotoxicol Environ Saf ; 223: 112611, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34385057

RESUMO

Understanding the transport behaviour of arsenic (As) from soils to humans is critical when undertaking human health risk assessment and contamination control. This research examined As bioaccessibility in different As fractions and particle size fractions of As-enriched mine soils using different extractions. Bioaccessibility of As ranged from 0.24% to 32% for Solubility Bioaccessibility Research Consortium (SBRC) and Physiologically Based Extraction Test (PBET) methods, with extractable As (using 0.43 M HNO3) being 1.3-24.9%. The highest As bioaccessibility (19-32%) was consistently observed in the fine particle size fraction (< 53 µm) of all three extractions. Sequential extractions revealed that As fractions were mostly associated with crystalline (30-73%) and amorphous (9-59%) Fe/Al oxyhydroxides. The bioaccessibility of As in the gastric phase of SBRC and PBET methods highlighted a positive correlation (R2 = 0.83-0.88, p < 0.01) with exchangeable, surface and amorphous- bound As fractions, while the intestinal phase showed a strong positive correlation (R2 = 0.85-0.89, p < 0.01) with exchangeable and surface bound fractions. The study revealed that As bioaccessibility in soils can potentially be determined using the 0.43 M HNO3 extraction procedure. Health risk assessment confirmed that there was a strong increase in chronic daily intake, hazard quotient and cancer risk, with a reduction in particle size.


Assuntos
Arsênio , Poluentes do Solo , Arsênio/análise , Austrália , Disponibilidade Biológica , Humanos , New South Wales , Medição de Risco , Solo , Poluentes do Solo/análise
10.
Nutrients ; 13(7)2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34371914

RESUMO

Few online food ordering systems provide tailored dietary feedback to consumers, despite suggested benefits. The study aim was to determine the effect of providing tailored feedback on the healthiness of students' lunch orders from a school canteen online ordering system. A cluster randomized controlled trial with ten government primary schools in New South Wales, Australia was conducted. Consenting schools that used an online canteen provider ('Flexischools') were randomized to either: a graph and prompt showing the proportion of 'everyday' foods selected or a standard online ordering system. Students with an online lunch order during baseline data collection were included (n = 2200 students; n = 7604 orders). Primary outcomes were the proportion of foods classified as 'everyday' or 'caution'. Secondary outcomes included: mean energy, saturated fat, sugar, and sodium content. There was no difference over time between groups on the proportion of 'everyday' (OR 0.99; p = 0.88) or 'caution' items purchased (OR 1.17; p = 0.45). There was a significant difference between groups for average energy content (mean difference 51 kJ; p-0.02), with both groups decreasing. There was no difference in the saturated fat, sugar, or sodium content. Tailored feedback did not impact the proportion of 'everyday' or 'caution' foods or the nutritional quality of online canteen orders. Future research should explore whether additional strategies and specific feedback formats can promote healthy purchasing decisions.


Assuntos
Comportamento Infantil , Dieta Saudável , Retroalimentação Psicológica , Comportamento Alimentar , Serviços de Alimentação , Intervenção Baseada em Internet , Instituições Acadêmicas , Estudantes/psicologia , Fatores Etários , Criança , Pré-Escolar , Comportamento do Consumidor , Dieta Saudável/economia , Ingestão de Energia , Feminino , Serviços de Alimentação/economia , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Planejamento de Cardápio , New South Wales , Valor Nutritivo , Recomendações Nutricionais
11.
Artigo em Inglês | MEDLINE | ID: mdl-34206499

RESUMO

Sports clubs increasingly are settings for health promotion initiatives. This study explored organizational change processes and perceived facilitators and barriers relevant to implementing a health promotion initiative within gymnastics settings in New South Wales (NSW), Australia. A multiple-case design investigated the experiences of the state association (Gymnastics NSW) and five clubs from one region of NSW in a participatory Health-Promoting Gymnastics Clubs (HPGC) program. The program aimed to build the capacity of Gymnastics NSW to support affiliated clubs to become health-promoting settings. Interviews with organizational representatives explored their experiences of the program and identified factors that enabled or inhibited program adoption, implementation and sustainability. Facilitators and barriers identified included leadership and champions; organizational capacity and culture; priorities and timing; and characteristics of the HPGC framework. This multi-level, organizational change intervention demonstrated potential to create health-promoting gymnastics settings. Tailoring strategies in diverse club contexts required involvement of organizational leaders in program development and action planning. Despite positive impacts, pre-existing organizational culture inhibited integration of health promotion as a core value. Sustained organizational change may result from professional regulatory requirements (e.g., accreditation and affiliation), and policy directives and funding (for organizational change, not program delivery) from relevant government departments.


Assuntos
Ginástica , Saúde Pública , Austrália , Promoção da Saúde , New South Wales , Inovação Organizacional
12.
BMC Musculoskelet Disord ; 22(1): 611, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34243746

RESUMO

BACKGROUND: Although many people with chronic low back pain (LBP) improve following conservative treatment, one in five will experience worsening symptoms after discharge from treatment and seek health care again. The current LBP clinical care pathway in many health services lacks a well-integrated, systematic approach to support patients to remain physically active and self-manage their symptoms following discharge from treatment. Health coaching can support people to improve physical activity levels and may potentially reduce health care utilisation for LBP. The primary aim of this study is to evaluate the effect of introducing a coordinated support system (linking hospital outpatient physiotherapy services to a public health coaching service) at discharge from LBP treatment, on the future use of hospital, medical, and health services for LBP, compared with usual care provided at discharge. METHODS: Three hundred and seventy-four adults with chronic non-specific LBP will be recruited from the outpatient physiotherapy departments of public hospitals in New South Wales, Australia. Participants will be individually randomised to a support system (n = 187) or usual care group (n = 187). All participants will receive usual care provided at discharge from treatment. Participants allocated to the support system will also receive up to 10 telephone-based health coaching sessions, delivered by the Get Healthy Service®, over a 6-month period. Health coaches will monitor and support participants to improve physical activity levels and achieve personal health-related goals. The primary outcome is the total number of encounters with hospital, medical, and health services for LBP, at 12 months from baseline. A within-trial economic evaluation will quantify the incremental costs and benefits of the support system from a health system perspective, to support reimbursement decision making. DISCUSSION: This study will establish the effect of a coordinated support system, introduced at discharge from treatment, on the future use of hospital, medical, and health services for LBP and various health outcomes. CONCLUSION: Innovative community-driven solutions to support people with chronic LBP after discharge from treatment are urgently needed. Study findings will help inform health care policy and clinical practice in Australia. TRIAL REGISTRATION: Prospectively registered on the Australian New Zealand Clinical Trials Registry ( ACTRN12620000889954 ) on 10/09/2020.


Assuntos
Dor Lombar , Tutoria , Adulto , Austrália , Hospitais Públicos , Humanos , Dor Lombar/diagnóstico , Dor Lombar/terapia , New South Wales , Alta do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
13.
Lancet HIV ; 8(8): e486-e494, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34217426

RESUMO

BACKGROUND: Daily pre-exposure prophylaxis (PrEP) is effective in preventing HIV, but few long-term data are available on effectiveness and adherence in real-world settings. Here, we report trends in HIV incidence over 3 years in individuals at high risk who were prescribed PrEP in New South Wales (NSW), as well as adherence before the transition to subsidised PrEP. METHODS: Expanded PrEP Implementation in Communities-New South Wales (EPIC-NSW) was a pragmatic, prospective, single-arm, implementation study of daily, oral PrEP in 31 sites (sexual health clinics, general practices, and a hospital) in NSW, Australia. Eligible participants were HIV-negative adults (aged ≥18 years) who were at high risk of HIV infection as defined in local PrEP guidelines. Participants were prescribed coformulated (once-daily, oral tablet) tenofovir disoproxil fumarate (300 mg) and emtricitabine (200 mg) as HIV PrEP and were followed up with HIV testing, sexually transmitted infection testing, and PrEP dispensing. Originally planned for 3700 participants followed for 1 year, the study was expanded so that all eligible participants in the state could obtain PrEP and extended until publicly subsidised PrEP became available in Australia. The primary outcome was new HIV infection among all participants who were dispensed PrEP at least once and had at least one follow-up HIV test result. Adherence was estimated by medication possession ratio (MPR), defined as the proportion of PrEP pills dispensed in 90 days, assuming daily dosing. This study is registered with ClinicalTrials.gov, NCT02870790. FINDINGS: Between March 1, 2016, and April 30, 2018, we enrolled 9709 participants. 9596 participants were dispensed PrEP, of whom 9448 (98·3%) were gay or bisexual men. Participants were followed up until March 31, 2019, with at least one follow-up HIV test available in 9520 (99·2%) participants. Mean MPR declined from 0·93 to 0·64 from the first to the ninth quarter. There were 30 HIV seroconversions over 18 628 person-years, an incidence of 1·61 per 1000 person-years (95% CI 1·13-2·30). Being younger, living in a postcode with fewer gay men, reporting more risk behaviours at baseline, and having an MPR of less than 0·6 were each univariately associated with increased HIV incidence. In the final year of follow-up, when PrEP was mostly purchased rather than provided free by the study, HIV incidence remained low at 2·24 per 1000 person-years (1·46-3·44). INTERPRETATION: HIV incidence remained low over up to 3 years of follow-up, including during a transition from study-provided to publicly subsidised PrEP. In a setting of affordable PrEP and associated health-care services, very low HIV incidence of 1 to 2 per 1000 person-years can be maintained in gay and bisexual men who were previously at high risk. FUNDING: New South Wales Ministry of Health, Australian Capital Territory Health Directorate, Gilead Sciences.


Assuntos
Bissexualidade , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Profilaxia Pré-Exposição , Administração Oral , Adolescente , Adulto , Idoso , Feminino , Infecções por HIV/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Gravidez , Estudos Prospectivos , Adulto Jovem
14.
Med J Aust ; 215(3): 130-136, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34198357

RESUMO

OBJECTIVE: To examine relationships between changing general practitioner after entering residential aged care and overall medicines prescribing (including polypharmacy) and that of psychotropic medicines in particular. DESIGN: Retrospective data linkage study. SETTING, PARTICIPANTS: 45 and Up Study participants in New South Wales with dementia who were PBS concession card holders and entered permanent residential aged care during January 2010 - June 2014 and were alive six months after entry. MAIN OUTCOME MEASURES: Inverse probability of treatment-weighted numbers of medicines dispensed to residents and proportions of residents dispensed antipsychotics, benzodiazepines, and antidepressants in the six months after residential care entry, by most frequent residential care GP category: usual (same as during two years preceding entry), known (another GP, but known to the resident), or new GP. RESULTS: Of 2250 new residents with dementia (mean age, 84.1 years; SD, 7.0 years; 1236 women [55%]), 625 most frequently saw their usual GPs (28%), 645 saw known GPs (29%), and 980 saw new GPs (44%). The increase in mean number of dispensed medicines after residential care entry was larger for residents with new GPs (+1.6 medicines; 95% CI, 1.4-1.9 medicines) than for those attended by their usual GPs (+0.7 medicines; 95% CI, 0.4-1.1 medicines; adjusted rate ratio, 2.42; 95% CI, 1.59-3.70). The odds of being dispensed antipsychotics (adjusted odds ratio [aOR], 1.59; 95% CI, 1.18-2.12) or benzodiazepines (aOR, 1.69; 95% CI, 1.25-2.30), but not antidepressants (aOR, 1.32; 95% CI, 0.98-1.77), were also higher for the new GP group. Differences between the known and usual GP groups were not statistically significant. CONCLUSIONS: Increases in medicine use and rates of psychotropic dispensing were higher for people with dementia who changed GP when they entered residential care. Facilitating continuity of GP care for new residents and more structured transfer of GP care may prevent potentially inappropriate initiation of psychotropic medicines.


Assuntos
Demência/tratamento farmacológico , Clínicos Gerais/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Polimedicação , Psicotrópicos/provisão & distribuição , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/provisão & distribuição , Antidepressivos/uso terapêutico , Antipsicóticos/provisão & distribuição , Antipsicóticos/uso terapêutico , Benzodiazepinas/provisão & distribuição , Benzodiazepinas/uso terapêutico , Feminino , Humanos , Prescrição Inadequada/prevenção & controle , Prescrição Inadequada/estatística & dados numéricos , Masculino , New South Wales/epidemiologia , Psicotrópicos/uso terapêutico , Estudos Retrospectivos
15.
BMC Public Health ; 21(1): 1337, 2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-34229652

RESUMO

BACKGROUND: This study describes trends in social inequities in first dose measles-mumps-rubella (MMR1) vaccination coverage in Western Australia (WA) and New South Wales (NSW). Using probabilistically-linked administrative data for 1.2 million children born between 2002 and 2011, we compared levels and trends in MMR1 vaccination coverage measured at age 24 months by maternal country of birth, Aboriginal status, maternal age at delivery, socio-economic status, and remoteness in two states. RESULTS: Vaccination coverage was 3-4% points lower among children of mothers who gave birth before the age of 20 years, mothers born overseas, mothers with an Aboriginal background, and parents with a low socio-economic status compared to children that did not belong to these social groups. In both states, between 2007 and 2011 there was a decline of 2.1% points in MMR1 vaccination coverage for children whose mothers were born overseas. In 2011, WA had lower coverage among the Aboriginal population (89.5%) and children of young mothers (89.3%) compared to NSW (92.2 and 92.1% respectively). CONCLUSION: Despite overall high coverage of MMR1 vaccination, coverage inequalities increased especially for children of mothers born overseas. Strategic immunisation plans and policy interventions are important for equitable vaccination levels. Future policy should target children of mothers born overseas and Aboriginal children.


Assuntos
Cobertura Vacinal , Vacinação , Adulto , Austrália/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Vacina contra Sarampo-Caxumba-Rubéola , New South Wales , Austrália Ocidental , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-34203421

RESUMO

The rate of fires, and particularly residential fires, is a serious concern in industrialized countries. However, there is considerable uncertainty regarding the reported numbers of residential fire incidents as official figures are based on fires reported to fire response agencies only. This population-based study aims to quantify the total number of residential fire incidents regardless of reporting status. The cohort comprised linked person-level data from Fire and Rescue New South Wales (FRNSW) and health system and death records. It included all persons residing at a residential address in New South Wales, Australia, that experienced a fire between 1 January 2005 and 31 December 2014. The capture-recapture method was used to estimate the underreporting number of residential fire-related incidents. Over the study period, 43,707 residential fire incidents were reported to FRNSW, and there were 2795 residential fire-related health service utilizations, of which 2380 were not reported. Using the capture-recapture method, the total number of residential fire incidents was estimated at 267,815 to 319,719, which is more than six times the official records. This study found that 15% of residential fire incidents that were identified in health administrative dataset were reported. The residential fire incidents that were not reported occurred mainly in socio-economically disadvantaged areas among males and adults.


Assuntos
Fatores de Risco , Adulto , Austrália , Estudos de Coortes , Países Desenvolvidos , Humanos , Masculino , New South Wales/epidemiologia
17.
BMC Infect Dis ; 21(1): 685, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34266396

RESUMO

BACKGROUND: Increasing age is the strongest known risk factor for severe COVID-19 disease but information on other factors is more limited. METHODS: All cases of COVID-19 diagnosed from January-October 2020 in New South Wales Australia were followed for COVID-19-related hospitalisations, intensive care unit (ICU) admissions and deaths through record linkage. Adjusted hazard ratios (aHR) for severe COVID-19 disease, measured by hospitalisation or death, or very severe COVID-19, measured by ICU admission or death according to age, sex, socioeconomic status and co-morbidities were estimated. RESULTS: Of 4054 confirmed cases, 468 (11.5%) were classified as having severe COVID-19 and 190 (4.7%) as having very severe disease. After adjusting for sex, socioeconomic status and comorbidities, increasing age led to the greatest risk of very severe disease. Compared to those 30-39 years, the aHR for ICU or death from COVID-19 was 4.45 in those 70-79 years; 8.43 in those 80-89 years; 16.19 in those 90+ years. After age, relative risks for very severe disease associated with other factors were more moderate: males vs females aHR 1.40 (95%CI 1.04-1.88); immunosuppressive conditions vs none aHR 2.20 (1.35-3.57); diabetes vs none aHR 1.88 (1.33-2.67); chronic lung disease vs none aHR 1.68 (1.18-2.38); obesity vs not obese aHR 1.52 (1.05-2.21). More comorbidities was associated with significantly greater risk; comparing those with 3+ comorbidities to those with none, aHR 5.34 (3.15-9.04). CONCLUSIONS: In a setting with high COVID-19 case ascertainment and almost complete case follow-up, we found the risk of very severe disease varies by age, sex and presence of comorbidities. This variation should be considered in targeting prevention strategies.


Assuntos
Envelhecimento , COVID-19/diagnóstico , COVID-19/epidemiologia , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva , Caracteres Sexuais , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/mortalidade , COVID-19/virologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Modelos de Riscos Proporcionais , Fatores de Risco , SARS-CoV-2/patogenicidade , Análise de Sobrevida
18.
Sci Total Environ ; 793: 148591, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34182455

RESUMO

In this paper, a natural headland bypassing is investigated in terms of its short (months to years) and long-term (years to decades) variability and its relationship with wave conditions, climate drivers and anthropogenic interventions. The research is focused on Fingal Head (New South Wales, Australia) where nine detailed topo-bathymetric surveys were undertaken between June 2018 and January 2020. To extend the analysis in time, over 30 years of satellite and aerial images were used to describe the headland bypassing variability based on the shoreline and sandbar position changes. Shoreline and sandbar positions presented moderate to strong correlation between updrift and immediate downdrift of the headland highlighting the influence of the bypassing process for the longshore transport on the study area. Results indicate that the headland bypassing around Fingal Head is governed by two distinct processes and their dominance is controlled by waves and sediment availability. The sandbar-driven bypassing scenario requires a storm wave event to trigger the sandbar system and over seven months to complete the full bypassing cycle. A quicker bypassing cycle (i.e. few months) happens when sediment leaks around the headland following a persistent low energy wave condition that largely accretes the updrift upper beach. Headland bypassing cycles occur in multiple timescales, including seasonal variability of the wave climate to interannual and decadal cycles of shoreline progradation and retreat. Shifts in the large-scale climate drivers such as El Niño-Southern Oscillation, Pacific Decadal Oscillation and Interdecadal Pacific Oscillation were observed to influence on changes to the low frequency of variability of the headland bypassing in the study area by affecting the predominant wave direction and updrift beach sand availability. The understanding of this intermittent nature of the headland bypassing process and particularly considering its periodicity and the related driving forces is crucial to predict future coastal hazards and develop management strategies.


Assuntos
Mudança Climática , Clima , Austrália , Previsões , New South Wales
20.
Nutrients ; 13(6)2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34064220

RESUMO

Young adults are the highest consumers of food prepared outside home (FOH) and gain most weight among Australian adults. One strategy to address the obesogenic food environment is menu labelling legislation whereby outlets with >20 stores in one state and >50 Australia-wide must display energy content in kJ. The aim of this study was to assess the contribution of FOH to the energy and macronutrients, saturated fat, total sugars and sodium intakes of young Australians. One thousand and one 18 to 30-year-olds (57% female) residing in Australia's most populous state recorded all foods and beverages consumed and the location of preparation for three consecutive days using a purpose-designed smartphone application. Group means for the daily consumption of energy, percentage energy (%E) for protein, carbohydrate, total sugars, total and saturated fats, and sodium density (mg/1000 kJ) and proportions of nutrients from FOH from menu labelling and independent outlets were compared. Overall, participants consumed 42.4% of their energy intake from FOH with other nutrients ranging from 39.8% (sugars) to 47.3% (sodium). Independent outlets not required to label menus, contributed a greater percentage of energy (23.6%) than menu labelling outlets (18.7%, p < 0.001). Public health policy responses such as public education campaigns, extended menu labelling, more detailed nutrition information and reformulation targets are suggested to facilitate healthier choices.


Assuntos
Dieta/psicologia , Fast Foods/estatística & dados numéricos , Comportamento Alimentar/psicologia , Rotulagem de Alimentos/métodos , Serviços de Alimentação/estatística & dados numéricos , Adolescente , Adulto , Austrália , Estudos Transversais , Dieta/estatística & dados numéricos , Inquéritos sobre Dietas , Ingestão de Energia , Feminino , Rotulagem de Alimentos/legislação & jurisprudência , Serviços de Alimentação/legislação & jurisprudência , Humanos , Masculino , New South Wales , Política Nutricional , Valor Nutritivo , Restaurantes , Adulto Jovem
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