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1.
Anticancer Res ; 41(11): 5577-5584, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732428

RESUMO

BACKGROUND/AIM: An update on the incidence, risk factors, clinical sequalae, and management of postoperative pancreatic fistula (POPF) following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). PATIENTS AND METHODS: Retrospective analysis of prospectively collected data from the St George CRS/HIPEC database. RESULTS: Sixty-five (5.7%) out of 1,141 patients developed a POPF. Patients with POPFs were older, had a higher peritoneal cancer index, longer operation time, and required more units of blood intraoperatively. Splenectomy and distal pancreatectomy were significant risk factors for developing POPFs. While there was no effect on overall long-term survival in POPF patients, they did suffer higher rates of Clavien-Dindo grade 3/4 complications, in-hospital deaths, and longer hospital length of stay. Of the 65 POPF patients, 23 were taken back to theatre, 48 required radiological drains and 7 underwent endoscopic retrograde cholangiopancreatography. CONCLUSION: There are multiple risk factors for developing POPFs that are non-modifiable. While POPFs are associated with increased postoperative morbidity, long-term survival does not appear to be affected.


Assuntos
Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Quimioterapia Intraperitoneal Hipertérmica/efeitos adversos , Fístula Pancreática/epidemiologia , Neoplasias Peritoneais/terapia , Quimioterapia Adjuvante , Procedimentos Cirúrgicos de Citorredução/mortalidade , Bases de Dados Factuais , Feminino , Humanos , Quimioterapia Intraperitoneal Hipertérmica/mortalidade , Incidência , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Fístula Pancreática/diagnóstico , Fístula Pancreática/mortalidade , Fístula Pancreática/terapia , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/patologia , Intervalo Livre de Progressão , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
2.
Artigo em Inglês | MEDLINE | ID: mdl-34770043

RESUMO

Diabetes-related foot disease (DFD) is a major public health concern due to the higher risks of hospitalisation. However, estimates of the prevalence of DFD in the general population are not available in Australia. This study aims to estimate the prevalence of DFD and diabetes-related lower-extremity amputation (DLEA) among people aged 45 years and over in New South Wales (NSW), Australia. The NSW 45 and Up Study baseline survey data of 267,086 persons aged 45 years and over, linked with health services' administrative data from 2006 to 2012 were used in our study. Of these, 28,210 individuals had been diagnosed with diabetes, and our study identified 3035 individuals with DFD. The prevalence of DFD, diabetic foot ulcer (DFU), diabetic foot infection (DFI), diabetic gangrene (DG), and DLEA were 10.8% (95%CI: 10.3, 11.2), 5.4% (95% CI: 5.1, 5.8), 5.2% (95%CI: 4.9, 5.5), 0.4% (95%CI: 0.3, 0.5), and 0.9% (95%CI: 0.7, 1.0), respectively. DFD, DFU, DFI, DG, and DLEA were the most common among those who were older, born in Australia, from low-income households (

Assuntos
Diabetes Mellitus , Pé Diabético , Doenças do Pé , Austrália , Diabetes Mellitus/epidemiologia , Pé Diabético/epidemiologia , Hospitalização , Humanos , New South Wales/epidemiologia , Prevalência , Inquéritos e Questionários
4.
Public Health Res Pract ; 31(3)2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34494075

RESUMO

OBJECTIVE: To determine hepatitis C virus (HCV) treatment rates among those newly diagnosed with the virus in the South Western Sydney Local Health District (SWSLHD) in NSW, Australia. STUDY TYPE: Cross-sectional study of patients newly diagnosed with HCV in SWSLHD, based on local Public Health Unit notification data from the second half of 2017. METHODS: A total of 200 consecutive notifications were enrolled in the study. Either the ordering clinician was interviewed, and/or data linkage with local hospital records performed, to determine rates of antiviral treatment in this cohort. Outcomes measured included the proportion of patients: started on antiviral treatment; referred to specialists for consideration of treatment; HCV ribonucleic acid (RNA) negative; and lost to follow-up. Descriptive analysis of factors contributing to those lost to follow-up was performed where available. RESULTS: The follow-up outcome of 93% of patients was traced. General Practitioners (GPs) diagnosed a similar number (102) of new HCV cases to those diagnosed by specialists (94). After detecting a patient as HCV antibody positive and confirming active infection, GPs preferred to refer patients to specialists (53%), rather than further evaluate and treat patients themselves (5%). The remainder of cases from the GP-detected group were lost to follow-up (26%), or HCV RNA negative (16%). Among the speciliast-detected patients, 41% were treated, 18% were lost to follow-up, 20% were RNA negative and the remainder were not treated for reasons including a concurrent diagnosis of hepatocellular carcinoma, or death. The most common reason patients were not started on antiviral treatment was loss to follow-up. CONCLUSION: We found that less than half (47%) of people in South Western Sydney newly diagnosed with HCV, in whom treatment was indicated, received antiviral medication in the 12 months following diagnosis.This figure excludes the 25% cases referred from general practice to specialists, in whom the treatment status is unknown. Approximately one in five newly diagnosed patients (22%) were lost to follow-up and 18% were RNA negative, indicating they had no active HCV infection.


Assuntos
Hepatite C/diagnóstico , Hepatite C/terapia , Saúde Pública , Antivirais/uso terapêutico , Austrália/epidemiologia , Estudos de Coortes , Estudos Transversais , Notificação de Doenças/estatística & dados numéricos , Seguimentos , Clínicos Gerais , Hepacivirus/isolamento & purificação , Humanos , New South Wales/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos
5.
Public Health Res Pract ; 31(3)2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34494077

RESUMO

OBJECTIVES: To describe local operational aspects of the coronavirus disease 2019 (COVID-19) response during the first three waves of outbreaks in New South Wales (NSW), Australia, which began in January, July and December 2020. Type of program or service: Public health outbreak response. METHODS: Narrative with epidemiological linking and genomic testing. RESULTS: Epidemiological linking and genomic testing found that during the first wave of COVID-19 in NSW, a large number of community transmissions went undetected because of limited testing for the virus and limited contact tracing of cases. The second wave of COVID-19 in NSW emerged following reintroduction from the second wave in Victoria, Australia in July 2020, and the third wave followed undetected introduction from overseas. By the second and third waves, cases could be more effectively detected and isolated through an increased ability to test and contact trace, and to rapidly genomic sequence severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) isolates, allowing most cases to be identified and epidemiologically linked. This greater certainty in understanding chains of transmission resulted in control of the outbreaks despite less stringent restrictions on the community, by using a refined strategy of targeted shutdown, restrictions on cases, their close contacts, identified hotspots and venues of concern rather than a whole of community lockdown. Risk assessments of potential transmission sites were constantly updated through our evolving experience with transmission events. However, this refined strategy did leave the potential for large point source outbreaks should any cases go undetected. [Addendum] A fourth wave that began in Sydney in June 2021 challenged this strategy due to the more transmissible nature of the Delta variant of SARS-CoV-2. LESSONS LEARNT: A wave of COVID-19 infections can develop quickly from one infected person. The community needs to remain vigilant, adhering to physical distancing measures, signing in to venues they visit, and getting tested if they have any symptoms. Signing out of venues on exit allows public health resources to be used more efficiently to respond to outbreaks.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Surtos de Doenças/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , Teste para COVID-19/métodos , Criança , Pré-Escolar , Controle de Doenças Transmissíveis/organização & administração , Busca de Comunicante/métodos , Surtos de Doenças/prevenção & controle , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Distanciamento Físico , Saúde Pública , Quarentena/métodos , SARS-CoV-2/isolamento & purificação , Vitória/epidemiologia , Adulto Jovem
6.
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
7.
Med J Aust ; 215(9): 414-420, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34494268

RESUMO

OBJECTIVES: To describe the burden, geographic distribution, and outcomes of firearm-related violence in New South Wales during 2002-2016. DESIGN, SETTING, PARTICIPANTS: Population-based record linkag study of people injured by firearms in NSW, 1 January 2002 - 31 December 2016. MAIN OUTCOME MEASURES: Frequency, proportion, and rate of firearm-related injuries and deaths by intent category (assault, intentional self-harm, accidental, undetermined/other) and socio-demographic characteristics; medical service use (hospitalisations, ambulatory mental health care) before and after firearm-related injuries; associations between rates of firearm-related injury and those of licensed gun owners, by statistical area level 4. RESULTS: Firearm-related injuries were recorded for 2390 people; for 849 people, the injuries were caused by assault (36%), for 797 by intentional self-harm (33%), and for 506 by accidents (21%). Overall rates of firearm injuries were 4.1 per 100 000 males and 0.3 per 100 000 females; the overall rate was higher in outer regional/rural/remote areas (3.8 per 100 000) than in major cities (1.6 per 100 000) or inner regional areas (1.8 per 100 000). During 2002-2016, the overall firearm-related injury rate declined from 3.4 to 1.8 per 100 000 population, primarily because of declines in injuries caused by assault or accidental events. The rate of self-harm injuries with firearms were highest for people aged 60 years or more (41.5 per 100 000 population). Local rates of intentional self-harm injuries caused by firearms were strongly correlated with those of licensed gun owners (r = 0.94). CONCLUSIONS: Rates of self-harm with firearms are higher for older people, men, and residents in outer regional and rural/remote areas, while those for assault-related injuries are higher for younger people, men, and residents of major cities. Strategies for reducing injuries caused by self-harm and assault with firearms should focus on people at particular risk.


Assuntos
Acidentes/estatística & dados numéricos , Violência com Arma de Fogo/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Ferimentos por Arma de Fogo/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Homicídio/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Análise de Regressão , Fatores de Risco , Fatores Sexuais , Adulto Jovem
8.
BMC Pregnancy Childbirth ; 21(1): 620, 2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34517834

RESUMO

BACKGROUND: Guidelines recommend that women at high risk of postpartum haemorrhage deliver at facilities able to handle heavy bleeding. However postpartum haemorrhage is often unexpected. This study aims to compare outcomes and health service use related to transfusion of ≥4 units of red blood cells between women delivering in tertiary and lower level hospitals. METHODS: The study population was women giving birth in public hospitals in New South Wales, Australia, between July 2006 and December 2010. Data were obtained from linked hospital, birth and blood bank databases. The exposure of interest was transfusion of four or more units of red cells during admission for delivery. Outcomes included maternal morbidity, length of stay, neonatal morbidity and need for other blood products or transfer to higher care. Multivariable regression models were developed to predict need of transfusion of ≥4 units of red cells using variables known early in pregnancy and those known by the birth admission. RESULTS: Data were available for 231,603 births, of which 4309 involved a blood transfusion, with 1011 (0.4%) receiving 4 or more units. Women giving birth in lower level and/or smaller hospitals were more likely to receive ≥4 units of red cells. Women receiving ≥4 units in tertiary settings were more likely to receive other blood products and have longer hospital stays, but morbidity, readmission and hysterectomy rates were similar. Although 46% of women had no identifiable risk factors early in pregnancy, 20% of transfusions of ≥4 units occurred within this group. By the birth admission 70% of women had at least one risk factor for requiring ≥4 units of red cells. CONCLUSIONS: Overall outcomes for women receiving ≥4 units of red cells were comparable between tertiary and non-tertiary facilities. This is important given the inability of known risk factors to predict many instances of postpartum haemorrhage.


Assuntos
Transfusão de Sangue , Hospitalização/estatística & dados numéricos , Hospitais Públicos , Parto/sangue , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/terapia , Adulto , Feminino , Humanos , Morbidade , New South Wales/epidemiologia , Gravidez , Fatores de Risco , Dados de Saúde Coletados Rotineiramente
9.
Intern Med J ; 51(9): 1407-1413, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34346147

RESUMO

BACKGROUND: In early 2020, the impending COVID-19 pandemic placed a once-in-a-generation professional and personal challenge on healthcare workers. Publications on direct physical disease abound. The authors wanted to focus on doctors' psychological well-being. AIMS: To assess the impact of the COVID-19 pandemic on doctors' well-being and evaluate their concerns as the pandemic progressed. METHODS: A mixed-methods, hospital-based survey was sent to doctors at the 650-bed tertiary referral hospital in NSW at two different periods (late-March and early May 2020). A validated mental well-being tool (Short Warwick Edinburgh Mental Well-being Scale (SWEMWBS)) was combined with COVID-19-specific questions. RESULTS: Two hundred and thirty-five responses were obtained from 450 doctors, with a response rate of 32% in the first survey and 20% in the second. The majority (35%) of respondents were doctors-in-training, followed by staff-specialists (23%). The highest response was from frontline workers in both surveys, including the intensive care unit (27%), anaesthesia (21%) and emergency department (13%). 'Extreme concern' regarding personal protective equipment (PPE) shortage dropped from 22.6% to 2.2% and 'extreme concern' of contracting COVID-19 fell from 22.6% to 3.4% in the second survey. The proportion of respondents with a 'low' psychological well-being score improved from 38% to 27% between the two surveys. The resulting mean improvement in the SWEMWBS was 3.49 (95% confidence interval = 3.06-3.91, P < 0.001). CONCLUSION: Both COVID-19 specific concerns and psychological well-being improved greatly in the second survey. Possible explanations are the fall in COVID-19 cases in the district, improvements in PPE supply and supportive measures communicated to doctors during this period.


Assuntos
COVID-19 , Pandemias , Pessoal de Saúde , Humanos , New South Wales/epidemiologia , SARS-CoV-2 , Centros de Atenção Terciária
10.
Avian Dis ; 65(1): 77-85, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34339126

RESUMO

Infection of poultry with Eimeria spp., the causative agent of coccidiosis, can predispose birds to necrotic enteritis (NE) caused by netB gene-positive strains of Clostridium perfringens. The detection of Eimeria spp., C. perfringens, and netB were examined in settled dust from broiler flocks under experimental and field conditions. Dust samples were collected from settle plates twice weekly from two experimental flocks inoculated with three species of pathogenic Eimeria in 9-day-old chicks, followed by netB gene-positive C. perfringens 5 days later to produce subclinical and clinical NE. A noninoculated flock was sampled weekly from day 0 and served as a control flock. An additional 227 dust samples from commercial broiler flocks were collected at the end-of-batch (6-7 wk of age; one scraped dust sample per flock). In the NE-subclinical and NE-clinical flocks, high levels of Eimeria spp. and C. perfringens were detected after inoculation followed by a gradual decline over time. In the control flock, C. perfringens and netB were detected at low levels. No significant effect of sampling location was evident on Eimeria spp., C. perfringens, and netB load within poultry houses. These results provide evidence that Eimeria spp., C. perfringens, and netB gene copies can be readily measured in poultry dust samples collected in settle plates and may provide an alternative sampling method for monitoring flock coccidiosis and NE status. Further studies are required to assess the utility for such a test in commercial flocks.


Assuntos
Toxinas Bacterianas/análise , Galinhas , Infecções por Clostridium/veterinária , Clostridium perfringens/isolamento & purificação , Coccidiose/veterinária , Eimeria/isolamento & purificação , Enterotoxinas/análise , Doenças das Aves Domésticas/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real/veterinária , Animais , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/microbiologia , Coccidiose/epidemiologia , Coccidiose/parasitologia , Poeira , New South Wales/epidemiologia , Doenças das Aves Domésticas/microbiologia , Doenças das Aves Domésticas/parasitologia
13.
Clin Neurophysiol ; 132(10): 2532-2539, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34455311

RESUMO

OBJECTIVE: To assess the effect of exenatide (a GLP-1 receptor agonist), dipeptidyl peptidase-IV (DPP-IV) inhibitors, and sodium-glucose co-transporter 2 (SGLT-2) inhibitors on measures of peripheral nerve excitability in patients with type 2 diabetes. METHODS: Patients receiving either exenatide (n = 32), a DPP-IV inhibitor (n = 31), or a SGLT-2 inhibitor (n = 27) underwent motor nerve excitability assessments. Groups were similar in age, sex, HbA1c, diabetes duration, lipids, and neuropathy severity. An additional 10 subjects were assessed prospectively over 3 months while oral anti-hyperglycaemic therapy was kept constant. A cohort of healthy controls (n = 32) were recruited for comparison. RESULTS: Patients receiving a DPP-IV or SGLT-2 inhibitor demonstrated abnormalities in peak threshold reduction, S2 accommodation, superexcitability, and subexcitability. In contrast, patients treated with exenatide were observed to have normal nerve excitability. In the prospective arm, exenatide therapy was associated with an improvement in nerve function as patients demonstrated corrections in S2 accommodation, superexcitability, and subexcitability at follow-up. These changes were independent of the reductions in HbA1c following exenatide treatment. CONCLUSIONS: Exenatide was associated with an improvement in measures of nerve excitability in patients with type 2 diabetes. SIGNIFICANCE: Exenatide may improve peripheral nerve function in type 2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/fisiopatologia , Exenatida/uso terapêutico , Hipoglicemiantes/uso terapêutico , Nervos Periféricos/efeitos dos fármacos , Nervos Periféricos/fisiologia , Idoso , Estudos de Coortes , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Inibidores da Dipeptidil Peptidase IV/farmacologia , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Exenatida/farmacologia , Feminino , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Humanos , Hipoglicemiantes/farmacologia , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Estudos Prospectivos , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Resultado do Tratamento
14.
Aust N Z J Public Health ; 45(5): 437-442, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34309967

RESUMO

OBJECTIVE: Multidrug-resistant tuberculosis (MDR-TB) presents a major global health challenge. In high-income countries, treatment is individualised to optimise efficacy and reduce toxicity. We aimed to evaluate the outcomes of patients with MDR-TB receiving individualised antibiotic therapy in Australia. METHODS: This retrospective cohort study was performed in the city of Sydney in Australia and included patients diagnosed with bacteriologically confirmed MDR-TB diagnosed between 2000 and 2016. The clinical characteristics of patients and treatment details were extracted from medical records. The incidence of adverse events and end-of-treatment outcomes were also evaluated. RESULTS: Fifty-five patients with MDR-TB were identified at TB clinics in seven hospitals. The median age was 32 years (interquartile range [IQR]: 27-36 years). The median duration of the intensive phase treatment was six months (IQR 6-7 months). All patients' treatment administration was directly observed. The commonest reported adverse event was ototoxicity (44%; 23/52) and successful treatment outcomes were achieved by 95% (52/55) of patients. CONCLUSION: This study demonstrated the high treatment success rate that can be achieved using individualised treatment for MDR-TB in a well-resourced setting. Implications for public health: The expansion of individualised therapy promises to contribute to MDR-TB control and advance the ambitious goal of TB elimination by 2035.


Assuntos
Antituberculosos , Tuberculose Resistente a Múltiplos Medicamentos , Adulto , Antituberculosos/efeitos adversos , Austrália/epidemiologia , Humanos , New South Wales/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia
15.
Med J Aust ; 215(7): 325-331, 2021 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-34227120

RESUMO

OBJECTIVES: To describe the population characteristics of people with intellectual disability in New South Wales; to quantify and compare public mental health service use and costs for people with and without intellectual disability in NSW during 2014-15. DESIGN: Retrospective cohort data linkage analysis. SETTING, PARTICIPANTS: People using publicly funded in- or outpatient (admitted or non-admitted) mental health services in NSW, 2014-15. MAIN OUTCOME MEASURES: Numbers of bed days (inpatient mental health services), and treatment days (ambulatory mental health); costs of publicly funded mental health services. RESULTS: People with intellectual disability comprised 1.1% of the NSW population, but 6.3% of people who used public mental health services; 12% of public mental health costs during 2014-15 were for people with intellectual disability. Compared with metropolitan local health districts (LHDs), overall public mental health service costs were lower for rural and regional LHDs (adjusted incidence rate ratio [aIRR], 0.8; 95% CI, 0.8-0.9) and higher for specialty networks (aIRR, 1.2; 95% CI, 1.1-1.3). Per person costs for people with intellectual disability were higher than for those without intellectual disability (aIRR, 2.6; 95% CI, 2.2-3.0). CONCLUSION: People with intellectual disability use public mental health services to a greater degree than other people. They should be explicitly considered by all tiers of mental health policy and service planning in Australia. Population health planning for the needs of people with disabilities would be assisted by including disability identifiers in all health administrative data sets.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Deficiência Intelectual/epidemiologia , Serviços de Saúde Mental/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Lactente , Recém-Nascido , Armazenamento e Recuperação da Informação , Deficiência Intelectual/economia , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , População Rural/estatística & dados numéricos , Adulto Jovem
16.
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
17.
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
18.
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
19.
ANZ J Surg ; 91(9): 1881-1885, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34227205

RESUMO

BACKGROUND: In New South Wales (NSW), Australia, trauma accounts for 6% of deaths. Trauma patients receiving definitive care in regional trauma centres are 34% more likely to have a fatal outcome compared to level 1 centres. Following the implementation of the NSW State Trauma Plan where patients with major trauma are fast tracked to regional trauma services, should NSW rural surgeons and retrieval doctors continue to receive surgical training in neurotrauma? METHODS: The study's primary objective was to ascertain which NSW regional and rural hospitals have the equipment to perform neurotrauma and when it was last used. The study also examined the outcome of those patients who had undergone an emergency neurosurgical procedure. RESULTS: Of the 149 regional and rural hospitals in NSW, 16 stored a Hudson brace, perforator, burr and Gigli saw sterile and ready to use in the operating theatre. Only one hospital utilised the equipment in the last year and 11 in the last 10 years. Of those patients who had undergone an emergency neurosurgical procedure, two patients died prior to transfer and three were confirmed deceased after transfer to a tertiary centre. CONCLUSION: The implementation of the NSW State Trauma Plan has streamlined the trauma triage process and transport of neurotrauma patients to regional and major trauma services. However, it is likely that knowledge of how to perform burr hole and craniectomy for the evacuation of extradural haematoma remains a useful skill for the rural surgeon and retrieval doctor if transport is delayed.


Assuntos
Centros de Traumatologia , Triagem , Austrália , Hospitais Rurais , Humanos , New South Wales/epidemiologia
20.
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
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