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1.
Environ Monit Assess ; 192(11): 682, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33030635

RESUMO

Sanitary waste disposal and site selection for establishing landfills are challenging problems for environmental planners. This paper aims to take environmental, socio-economic, geological, geomorphological, hydrological and ecological factors into consideration to provide a decision support framework for landfill siting. Analytical hierarchy process (AHP) and Decision Making Trial and Evaluation Laboratory (DEMATEL) are coupled to develop an efficient multi-criteria decision-making method to be utilized in a Geographic Information System (GIS) environment for evaluating the suitability for landfill siting. As the first attempt to employ DEMATEL effectively in a landfill site selection problem, the proposed method is tested with landfill siting scenarios in New South Wales (NSW), Australia. Regional analysis is also performed to identify the potentially most suitable statistical divisions for landfill siting in NSW. The top two ranked zones covering 0.7% and 22% of the study area, respectively, are considered as the optimal areas for establishing landfills, while the bottom two ranked zones are not recommended for further consideration. Further detailed analysis is also conducted on the existing landfills, which shows that 1.0% and 37.0% of them are ranks 1 and 2, respectively. The scenario-based analysis implies that, among the contributing factors; geological and economic factors are highly important.


Assuntos
Técnicas de Apoio para a Decisão , Resíduos Sólidos , Austrália , Monitoramento Ambiental , New South Wales , Instalações de Eliminação de Resíduos
2.
Artigo em Inglês | MEDLINE | ID: mdl-32981492

RESUMO

Cumulatively to 13 September there have been 26,753 case notifications and 674 deaths. The number of new cases reported nationally this fortnight was 764, a 61% decrease from the previous fortnight (1,948). On average this represented 55 cases diagnosed each day over the reporting period, a decrease from 125 cases per day over the previous reporting period. 84% of all cases (640/764) were reported in Victoria, with a smaller number of cases reported from New South Wales (95), Queensland (22), Western Australia (4) and South Australia (3). In Victoria, 97% of cases (621) were locally acquired and were mostly reported from residential aged care facilities; and 3% of cases (19) were reported as under investigation at the date of extract this reporting period. Excluding Victoria, 124 cases were reported nationally, 32% (40) were overseas acquired; 65% (81) were locally acquired, predominantly in New South Wales (62); and 2% (3) of cases were under investigation at this time, all reported in Queensland. The continued decrease in new cases observed this fortnight in Victoria is likely associated with the enhanced public health measures that are currently in place in Victoria. Locally-acquired cases which were predominantly associated with several interconnected clusters continued to be reported in New South Wales. In Queensland, 82% of cases (18/22) were reported as locally acquired from two clusters associated with immigration centres or correctional facilities. A total of 6 deaths were reported from cases diagnosed in this reporting period-all from Victoria, all aged 50 years or older, three male and three female. Although testing rates have declined gradually over the past month they remain high at 14.5 tests per 1,000 population per week. The overall positivity rate for the reporting period was 0.13%. Victoria reported a positivity rate of 0.39% for this reporting period while in all other jurisdictions the positivity rate was 0.05% or lower. For this report, "In focus" is paediatric inflammatory multisystem syndrome temporally associated with SARS-COV-2 (PIMS-TS). A review of Australia's public health response to COVID-19 (as at 13 September 2020) is at Appendix A.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Infecções Assintomáticas , Austrália/epidemiologia , Betacoronavirus , Criança , Pré-Escolar , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/transmissão , Feminino , Instituição de Longa Permanência para Idosos , Hospitalização , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/transmissão , Queensland/epidemiologia , Austrália do Sul/epidemiologia , Vitória/epidemiologia , Austrália Ocidental/epidemiologia , Adulto Jovem
3.
Int J Rheum Dis ; 23(8): 1030-1039, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32881350

RESUMO

AIM: To describe the first Australian cases of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) disease (COVID-19) pneumonia treated with the interleukin-6 receptor antagonist tocilizumab. METHODS: Retrospective, open-label, real-world, uncontrolled, single-arm case series conducted in 2 tertiary hospitals in NSW, Australia and 1 tertiary hospital in Victoria, Australia. Five adult male patients aged between 46 and 74 years with type 1 respiratory failure due to COVID-19 pneumonia requiring intensive care unit (ICU) admission and biochemical evidence of systemic hyperinflammation (C-reactive protein greater than 100 mg/L; ferritin greater than 700 µg/L) were administered variable-dose tocilizumab. RESULTS: At between 13 and 26 days follow-up, all patients are alive and have been discharged from ICU. Two patients have been discharged home. Two patients avoided endotracheal intubation. Oxygen therapy has been ceased in three patients. Four adverse events potentially associated with tocilizumab therapy occurred in three patients: ventilator-associated pneumonia, bacteremia associated with central venous catheterization, myositis and hepatitis. All patients received broad-spectrum antibiotics, 4 received corticosteroids and 2 received both lopinavir/ritonavir and hydroxychloroquine. The time from first tocilizumab administration to improvement in ventilation, defined as a 25% reduction in fraction of inspired oxygen required to maintain peripheral oxygen saturation greater than 92%, ranged from 7 hours to 4.6 days. CONCLUSIONS: Tocilizumab use was associated with favorable clinical outcome in our patients. We recommend tocilizumab be included in randomized controlled trials of treatment for patients with severe COVID-19 pneumonia, and be considered for compassionate use in such patients pending the results of these trials.


Assuntos
Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Idoso , Anti-Inflamatórios/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Interações entre Hospedeiro e Microrganismos , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Vitória
4.
J Law Med ; 27(4): 790-806, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32880398

RESUMO

Australia's criminal law was affected by the COVID-19 pandemic from the outset and then progressively as statutory measures and judicial rulings on matters such as bail entitlements, judge-alone trials, sentences and applications for demonstrations and public assemblies were made by courts. This column identifies some of the major decisions made during the period of the lockdown measures between March and July 2020, and reviews significant New South Wales judgments in relation to the lawfulness of mass gatherings during the period of lockdown as expert assessments of risks of community transmission of the virus waxed and waned. It explores the importation into Australia's criminal law of public health principles for the protection of the community, and its compatibility with traditional principles of criminal justice.


Assuntos
Infecções por Coronavirus , Direito Penal , Direitos Humanos , Pandemias , Pneumonia Viral , Austrália , Betacoronavirus , Humanos , New South Wales
5.
J Law Med ; 27(4): 1047-1073, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32880418

RESUMO

This article confirms that industry compliance and enforcement processes are an essential consideration in the growing pantheon of legal and commercial determinants of public health. While alcohol control laws vary between individual jurisdictions, their development and application are confronted by a common threat of undue industry influence or capture. This necessitates a greater understanding of this phenomenon to better inform a collective and effective international public health response. New South Wales Australia, has developed a layer of alcohol industry compliance laws in the form of disciplinary schemes. This article critically explicates the first of these, the Violent Venues Scheme (VVS), to determine the nature and extent of any capture. This would significantly compromise harm minimisation statutory objects and disrupt the democratic process and the rule of law. In contrast, an influential industry identity, attributed the earlier last drinks laws, VVS and a related scheme as causing the alleged destruction of Sydney's nighttime economy and fun. The research also analyses the indispensible role of a neoliberal paradigm in legitimising exclusive relationships between governments and industry. This is indelibly imprinted on the alcohol regulatory landscape.


Assuntos
Bebidas Alcoólicas , Indústrias , Saúde Pública , Consumo de Bebidas Alcoólicas , Bebidas Alcoólicas/normas , Austrália , Humanos , Indústrias/normas , New South Wales
6.
Crit Care Resusc ; 22(3): 191-199, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32900325

RESUMO

OBJECTIVE: To determine whether hydrocortisone is a cost-effective treatment for patients with septic shock. DESIGN: Data linkage-based cost-effectiveness analysis. SETTING: New South Wales and Queensland intensive care units. PARTICIPANTS AND INTERVENTION: Patients with septic shock randomly assigned to treatment with hydrocortisone or placebo in the Adjunctive Glucocorticoid Therapy in Patients with Septic Shock (ADRENAL) trial. MAIN OUTCOME MEASURES: Health-related quality of life at 6 months using the EuroQoL 5-dimension 5-level questionnaire. Data on hospital resource use and costs were obtained by linking the ADRENAL dataset to government administrative health databases. Clinical outcomes included mortality, health-related quality of life, and quality-adjusted life-years gained; economic outcomes included hospital resource use, costs and cost-effectiveness from the health care payer perspective. We also assessed cost-effectiveness by sex. To increase the precision of cost-effectiveness estimates, we conducted unrestricted bootstrapping. RESULTS: Of 3800 patients in the ADRENAL trial, 1772 (46.6%) were eligible and 1513 (85.4% of those eligible) were included. There was no difference between hydrocortisone or placebo groups in regards to mortality (218/742 [29.4%] v 227/759 [29.9%]; HR, 0.93; 95% CI, 0.78-1.12; P = 0.47), mean number of QALYs gained (0.10 ± 0.09 v 0.10 ± 0.09; P = 0.52), or total hospital costs (A$73 515 ± 61 376 v A$69 748 ± 61 793; mean difference, A$3767; 95% CI, -A$2891 to A$10 425; P = 0.27). The incremental cost of hydrocortisone was A$1 254 078 per quality-adjusted life-year gained. In females, hydrocortisone was cost-effective in 46.2% of bootstrapped replications and in males it was cost-effective in 2.7% of bootstrapped replications. CONCLUSIONS: Adjunctive hydrocortisone did not significantly affect longer term mortality, health-related quality of life, health care resource use or costs, and is unlikely to be cost-effective.


Assuntos
Anti-Inflamatórios/economia , Anti-Inflamatórios/uso terapêutico , Hidrocortisona/economia , Hidrocortisona/uso terapêutico , Choque Séptico/tratamento farmacológico , Análise Custo-Benefício , Feminino , Humanos , Masculino , New South Wales , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Choque Séptico/mortalidade
7.
Artigo em Inglês | MEDLINE | ID: mdl-32829705

RESUMO

Confirmed cases in Australia this reporting period (20 July to 2 August): 6,121 notifications, 71 deaths. Cumulative: 18,367 notifications, 240 deaths. Over the past fortnightly reporting period (20 July to 2 August), the number of new cases reported nationally increased from 3,462 in the previous fortnight to 6,121. The large increase in numbers is due to multiple epidemiologically-linked outbreaks across a range of settings and locations in Victoria (97%; 5,914 cases) with very few (207) cases reported by other jurisdictions in this reporting period. Of the 5,914 cases reported in Victoria, all were locally acquired. Of the remaining 207 cases nationally reported, only 23% were reported as locally acquired. ACT is the only jurisdiction reporting 0 cases, with its last case reported on 9 July. A total of 71 deaths were reported, all from Victoria. On average, 437 cases were reported each day over the reporting period, an increase from 247 cases per day over the previous fortnight. Testing rates remain high across all jurisdictions, with an overall positivity rate for the reporting period of 0.7%. Victoria reported a positivity rate of 1.7% for this reporting period; in all other jurisdictions the positivity rate was 0.07% or lower. Overall, syndromic surveillance of respiratory illness trends continues to show very low levels compared to previous years. 12% of cases have required hospitalisation or intensive care.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Betacoronavirus , Criança , Pré-Escolar , Comorbidade , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Índice de Gravidade de Doença , Distribuição por Sexo , Adulto Jovem
8.
BMC Public Health ; 20(1): 1294, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32847576

RESUMO

BACKGROUND: Mild to moderate road traffic injury (RTI) in people of working age is associated with limited recovery. Less is known about RTI recovery in older age. This study explored the perspectives and factors associated with recovery and health-related quality of life following mild to moderate RTI in older age in New South Wales, Australia. METHODS: A qualitative study using content analysis was undertaken. Participants aged 65 or more years were purposively selected from a larger inception cohort study of health outcomes following mild to moderate RTI conducted in New South Wales, Australia. Semi-structured interviews were undertaken at approximately 12 or 24 months post-injury. Content analysis was used to code and analyse the data, with methodological rigour obtained by double-coding and discussing findings to reach consensus. Results were reported using the consolidated criteria for reporting qualitative research (COREQ). RESULTS: Nineteen participants were invited to participate in the study of which 12 completed interviews. Data saturation was reached at the twelfth interview. Recovery experiences were diverse. Five main themes were identified: recovery is regaining independence; injury and disability in older age; the burden of non-obvious disability; the importance of support; and positive personal approaches. Key facilitators of recovery were: regaining independence; support from family and friends; and positive personal approaches. Key barriers were: threats to independence; passive coping behaviours; non-obvious disabilities (chronic pain, psychological impacts); and reluctance to raise ongoing issues with General Practitioners. Threats to independence, especially not driving and self-care, appeared to have a more profound effect on recovery than physical functioning. CONCLUSION: Older people view injury as a threat to independent functioning. This is somewhat different to what younger people report. Regaining independence is key to older people's recovery and health-related quality of life following RTI, and should be a key consideration for health professionals, services and supports working with this unique cohort. Greater efforts to help older people regain their independence following RTI are needed and can be facilitated by health professionals and appropriate service provision. TRIAL REGISTRATION: Australia New Zealand clinical trial registry identification number ACTRN12613000889752 .


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Pessoas com Deficiência/psicologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/reabilitação , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Vida Independente/psicologia , Masculino , New South Wales/epidemiologia , Pesquisa Qualitativa , Qualidade de Vida/psicologia
10.
PLoS One ; 15(8): e0237775, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32813739

RESUMO

Nile tilapia, Oreochromis niloticus is the third most commonly farmed finfish species in the world, accounting for nearly 5% of global aquaculture production. In the past few decades much of the success of this species has been attributed to the development and distribution of Genetically Improved Farmed Tilapia (GIFT). Despite the increasing availability of GIFT, the productivity of small-scale farming remains highly variable, particularly in developing nations. Commercial fish-feed pellets can increase fish farm productivity; however, many small-scale farmers rely on other means of feeding fish due to the high cost and limited availability of commercial fish feed pellets. Therefore, understanding how locally-sourced feeds affect the production of GIFT is an important step towards improving feeding practices, particularly for farmers with low financial capital. This study used stable isotope analysis (SIA) and 16S rRNA gene sequencing to compare the effects of a locally-sourced vegetable-based diet and commercial pellet-based diets on the relative condition, nutrient assimilation patterns and gastrointestinal microbiota of GIFT. GIFT fed a locally-sourced diet were smaller, and in a significantly poorer condition than those fed with commercial fish feeds. SIA showed no differences in dietary carbon between the two diets; however, δ13C, poor fish condition and the abundance of specific bacterial taxa (of such as Fusobacteria) were correlated. SIA revealed that GIFT fed locally-sourced diets that predominantly consisted of vegetables were significantly enriched in δ15N despite a perceived lack of dietary protein. This enrichment suggests that GIFT fed a locally-sourced diet may be supplementing their diet via cannibalism, a behaviour representative of poor farming practice. Overall this study highlights the need to increase the availability of suitable GIFT feeds in developing nations. The development a low-cost feed alternative could improve the success of small-scale GIFT farmers in PNG, increasing both food and income security within the region.


Assuntos
Ração Animal , Animais Geneticamente Modificados/metabolismo , Aquicultura/métodos , Ciclídeos/metabolismo , Microbioma Gastrointestinal/fisiologia , Animais , Animais Geneticamente Modificados/genética , Animais Geneticamente Modificados/microbiologia , Aquicultura/economia , Aquicultura/organização & administração , Canibalismo , Ciclídeos/genética , Ciclídeos/microbiologia , DNA Bacteriano/isolamento & purificação , Suplementos Nutricionais/economia , Eficiência Organizacional/economia , Fazendas/economia , Fazendas/organização & administração , New South Wales , Nutrientes/metabolismo , RNA Ribossômico 16S/genética
11.
Aust Vet J ; 98(10): 486-490, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32794196

RESUMO

Encephalomyocarditis virus (EMCV) infection was detected by real-time reverse transcription PCR (qRT-PCR) in four adult alpacas (Vicugna pacos) from two properties on the Far North Coast of New South Wales (NSW) in April and May 2018 and in two adult alpacas from a third property on the Central Coast of NSW in October 2018. Viral RNA was detected in a range of samples, including blood, fresh body organs and mucosal swabs. EMCV was isolated from the blood and body organs of five of these alpacas. These animals displayed a range of clinical signs, including inappetence, colic, recumbency and death. Necropsy findings included multifocal to coalescing areas of myocardial pallor, pulmonary congestion and oedema, hepatic congestion and serosal effusion. Histopathological changes comprised acute, multifocal myocardial degeneration and necrosis, with mild, neutrophilic and lymphocytic inflammation (5/5 hearts) and mild, perivascular neutrophilic meningoencephalitis (1/3 brains). This is the first report of disease due to EMCV in alpacas under farm conditions, and it identifies EMCV infection as a differential diagnosis for acute disease and death in this camelid species. In addition to the samples traditionally preferred for EMCV isolation (fresh heart, brain and spleen), blood samples are also appropriate for EMCV detection by qRT-PCR assay.


Assuntos
Camelídeos Americanos , Infecções por Cardiovirus/epidemiologia , Infecções por Cardiovirus/veterinária , Infecções/veterinária , Animais , Vírus da Encefalomiocardite/genética , Coração , New South Wales/epidemiologia
12.
Public Health Res Pract ; 30(2)2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32601653

RESUMO

Objectives and importance of the study: Adult literacy programs aim to empower learners to participate more effectively in everyday life. This includes programs with health content embedded in curricula to target health literacy. Adult learners who attend these programs represent a heterogeneous population, but include a high proportion of hard-to-reach or socially disadvantaged groups in terms of age, ethnicity, educational background, language and prevalence of learning disabilities. In 2014, we conducted a cluster-randomised controlled trial of a health literacy program in adult basic education classes across New South Wales, Australia. This paper reports findings from a qualitative study exploring learners' experience of the course and its perceived impact on their lives, as well as their understanding and confidence about health. STUDY TYPE: Qualitative interview study. METHOD: We conducted semistructured interviews as part of the evaluation of the 18-week health literacy program, with participants purposively recruited from six health literacy classes (n = 22). Researchers trained in qualitative methods interviewed adult learners either face to face or over the phone using a topic guide. Data was analysed using the Framework method, a matrix-based approach to thematic analysis. RESULTS: The majority of interviewees were female, lived in metropolitan areas and were from non-English-speaking backgrounds. Most had existing self-reported health problems and inadequate functional health literacy. Most participants described positive impacts of the health literacy course on their language, literacy and numeracy skills, functional health literacy skills, and health knowledge. They also reported being able to translate this into health actions including interacting with providers, accessing and using healthcare, and managing health and illness (e.g. making healthier food choices). Learners also described positive social outcomes of the course, including feelings of connectedness and interpersonal trust within a new network of learners, and reported sharing new knowledge with others in their communities. CONCLUSIONS: The findings add value to existing limited evidence that has demonstrated the untapped potential of adult basic education to develop health literacy skills among socially disadvantaged groups. Learners valued the opportunity to share experiences in structured group learning, and reported confidence to transfer new knowledge into their home and wider social network.


Assuntos
Atitude Frente a Saúde , Letramento em Saúde/métodos , Promoção da Saúde/métodos , Adulto , Currículo , Feminino , Humanos , Entrevistas como Assunto , Alfabetização , Masculino , Pessoa de Meia-Idade , New South Wales , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto , Populações Vulneráveis
14.
Sci Total Environ ; 736: 139574, 2020 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-32497880

RESUMO

Improving risk assessment and remediation rests on better understanding of contaminant bioavailability. Despite their strong toxicological attributes, little is known about the partitioning behaviour and bioavailability of polar polycyclic aromatic hydrocarbons (PAHs) in aquatic environments. The present study provides an insight into the bioavailable fractions of polar PAHs and their parent analogues in the tissues of the Sydney rock oyster, Saccostrea glomerata, a model aquatic bio-indicator organism. The concentration and distribution patterns of parent and polar PAHs including oxygenated PAHs (oxyPAHs), nitrated PAHs (NPAHs) and heterocyclic PAHs (HPAHs) were determined in water, sediment and oysters from an ecologically and economically important estuary of New South Wales, Australia. Total concentrations of PAHs, oxyPAHs, NPAHs and HPAHs were higher in sediments compared to oyster tissue and water. For most polar PAHs, total concentrations for water, sediment and oyster samples were <1 µg/g (µg/l for water) while parent PAH concentrations were several orders of magnitude higher. Computed biota-sediment accumulation factors (BSAFs) on lipid-normalized oyster concentrations revealed that while ∑oxyPAHs and ∑HPAHs exhibited low accumulation from sediment to oyster tissues (BSAF <1), ∑PAHs and ∑NPAH were found to be accumulated at high levels (BSAF >1). BSAF individual computation showed that bioaccumulation of nine investigated HPAHs in oyster tissues were relatively low and only 2-EAQ (oxyPAH) and 1N-NAP (NPAH) showed high levels of accumulation in oyster tissues, similar to parent PAHs. To the best of our knowledge, this is the first known study on the bioavailability of polar and non-polar PAHs in an Australian aquatic environment. The outcome of this study might be a useful indicator of the potential risks of polar PAHs to humans and other living organisms.


Assuntos
Ostreidae , Hidrocarbonetos Policíclicos Aromáticos/análise , Compostos Policíclicos/análise , Poluentes Químicos da Água/análise , Animais , Austrália , Disponibilidade Biológica , Monitoramento Ambiental , Estuários , Sedimentos Geológicos , Humanos , New South Wales
15.
Aust Vet J ; 98(7): 290-297, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32537943

RESUMO

BACKGROUND: Theileria orientalis infection causes a clinical syndrome in cattle characterised by weakness, reluctance to walk, anaemia, jaundice and death in peri-parturient cows and young calves, referred to as bovine anaemia caused by Theileria orientalis group (BATOG). Abortions in pregnant cows are also reported. Pallor, pyrexia and elevated heart and respiratory rates are typical findings on physical examination. CASE REPORT: A syndrome of abortions, lethargy, inappetence, jaundice and deaths in beef cattle on two separate properties and a separate cluster of three properties within 15 km west of the town of Denmark in Western Australia was associated with the presence of severe regenerative anaemia and the presence of Theileria orientalis Ikeda genotype in blood samples taken from affected cattle and their cohorts. A diagnosis of bovine anaemia caused by the T. orientalis group was based on consistent clinical, haematological, biochemical and PCR findings. Conventional PCR testing detected only the T. orientalis Ikeda type. On the two properties where it was investigated, quantitative PCR testing for parasite load was suggestive of recent infections. Sequencing of T. orientalis major piroplasm surface protein gene PCR products demonstrated that they were identical to those from similar bovine cases in New South Wales. CONCLUSION: The clinical history of affected cattle and the biochemical, haematological and PCR findings were consistent with bovine anaemia caused by the T. orientalis Ikeda genotype. This clinical syndrome had not been recognised in Western Australia before this series of cases.


Assuntos
Anemia/veterinária , Doenças dos Bovinos , Theileria , Theileriose , Animais , Bovinos , Feminino , Genótipo , New South Wales , Austrália Ocidental
17.
Med J Aust ; 213(2): 73-78, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32594567

RESUMO

OBJECTIVE: To assess the cost-effectiveness of a computer-guided quality improvement intervention for primary health care management of cardiovascular disease (CVD) in people at high risk. DESIGN: Modelled cost-effectiveness analysis of the HealthTracker intervention and usual care for people with high CVD risk, based on TORPEDO trial data on prescribing patterns, changes in intermediate risk factors (low-density lipoprotein cholesterol, systolic blood pressure), and Framingham risk scores. PARTICIPANTS: Hypothetical population of people with high CVD risk attending primary health care services in a New South Wales primary health network (PHN) of mean size. INTERVENTION: HealthTracker, integrated into health care provider electronic health record systems, provides real time decision support, risk communication, a clinical audit tool, and a web portal for performance feedback. MAIN OUTCOME MEASURES: Incremental cost-effectiveness ratios (ICERs): difference in costs of the intervention and usual care divided by number of CVD events averted with HealthTracker. RESULTS: The estimated numbers of major CVD events over five years per 1000 patients at high CVD risk were lower in PHNs using HealthTracker, both for patients with prior CVD events (secondary prevention; 259 v 267 with usual care) and for those without prior events (primary prevention; 168 v 176). Medication costs were higher and hospitalisation costs lower with HealthTracker than with usual care for both primary and secondary prevention. The estimated ICER for one averted CVD event was $7406 for primary prevention and $17 988 for secondary prevention. CONCLUSION: Modelled cost-effectiveness analyses provide information that can assist decisions about investing in health care quality improvement interventions. We estimate that HealthTracker could prevent major CVD events for less than $20 000 per event averted. TRIAL REGISTRATION (TORPEDO): Australian New Zealand Clinical Trials Registry, ACTRN 12611000478910.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Atenção Primária à Saúde , Melhoria de Qualidade/organização & administração , Humanos , New South Wales , Prevenção Primária/economia , Fatores de Risco , Prevenção Secundária/economia , Software
20.
Drug Alcohol Rev ; 39(5): 441-446, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32395850

RESUMO

INTRODUCTION AND AIMS: The Australian Treatment Outcomes Profile (ATOP) is a brief clinical tool measuring recent substance use, health and wellbeing among clients attending alcohol and other drug (AOD) treatment services. It has previously been assessed for concurrent validity and inter-rater reliability. In this study we examine whether it is suitable for administration over the telephone. DESIGN AND METHODS: We recruited a sample of 107 AOD clients across public sector specialist AOD treatment services in New South Wales, Australia between 2016 and 2018. Participants had a mean age of 47 years and 46% were female. Participants completed a face-to-face ATOP and a phone ATOP with a researcher within 5 days. Comparisons between the two administration modes were undertaken using Spearman's rank correlation coefficient for continuous or ordinal variables, and Cohen's Kappa for nominal variables. RESULTS: Among 107 participants, 59% were attending for alcohol treatment and 41% for opioid treatment. Most ATOP items (76%) reached above 0.7 (good) or 0.9 (excellent) agreement between face-to-face and telephone use. DISCUSSION AND CONCLUSIONS: Our findings suggest that the ATOP is a suitable instrument for telephone monitoring of recent substance use, health and social functioning among AOD clients. Its validation for remote use over the telephone will support staff to monitor clients' risks and outcomes-of particular relevance in response to the COVID-19 pandemic in which services are increasingly relying on telework approaches to client monitoring.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Centros de Tratamento de Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Telefone , Adulto , Alcoolismo/reabilitação , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales , Pandemias , Reprodutibilidade dos Testes , Inquéritos e Questionários , Resultado do Tratamento
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