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1.
Artigo em Inglês | MEDLINE | ID: mdl-33800753

RESUMO

The levels of trace elements in whole blood and plasma have been widely used for assessing nutritional status and monitoring exposure and can vary widely in populations from different geographical regions. In this study, whole blood samples (n = 120) and plasma samples (n = 120) were obtained from healthy donors attending the Red Cross Blood Bank (Queensland Red Cross Blood Service), which provided information for age and sex. There were 71 males (age range: 19-73 years) and 49 females (age range: 18-72 years) for whole blood samples, and 59 males (age range: 19-81 years) and 61 females (age range: 19-73 years) for plasma samples. The main aim of the study was to provide information on blood reference levels of 21 trace elements (Ag, Al, As, Bi, Br, Cd, Co, Cr, Cu, Hg, I, Mn, Mo, Ni, Pb, Sb, Se, Tl, U, V, Zn) in Queensland. The study also aimed to assess differences in trace element blood levels between males and females and the effect of age. The trace element levels in blood samples were analysed using inductively coupled plasma mass spectrometry (ICP-MS) and the standard reference materials of Seronorm (Trace Elements Whole Blood) and UTAK (Trace Elements Serum) were used for quality control and assurance. The study found wide variations of trace element levels in whole blood and plasma, and generally the levels were comparable to other countries. No detectable levels were found for Bi, Cr, U and V in whole blood, but V levels were found in plasma samples. There were significant differences between males and females for whole blood Cu (p < 0.001), I (p = 0.009), Tl (p = 0.016) and Zn (p = 0.016). Significant differences were also found for plasma Cu (p < 0.001) and Se (p = 0.003) between males and females. There were trends of increased levels of blood Pb, Se and Zn with age. The study has provided further information on a wide range of trace elements in blood as reference levels for Queensland and Australia which are currently lacking.


Assuntos
Oligoelementos , Austrália , Feminino , Masculino , Plasma , Queensland , Análise Espectral , Oligoelementos/análise
2.
Artigo em Inglês | MEDLINE | ID: mdl-33809540

RESUMO

One of the key challenges with implementing and sustaining interprofessional education initiatives is the lack of governance structures and processes to guide them. This case study presents a process evaluation of an intersectoral advisory group that facilitated a novel interprofessional clinical education model in rural health settings in the state of Queensland, Australia. The group consisted of health and academic partners to guide the implementation and promote sustainability of this new model. The advisory group process was evaluated mid-way and at conclusion of the group functions, using focus group discussions. The focus group audio recordings were transcribed verbatim and subjected to inductive content analysis. Categories were developed for reporting. Three broad categories were identified: Characteristics of the group, functions of the group and multifaceted communication within the group and between sectors. By identifying and mapping the processes used by a strategic, high-level intersectoral advisory group consisting of members from the health and academic fields, key recommendations have been formulated to guide similar work in the future.


Assuntos
Relações Interprofissionais , Serviços de Saúde Rural , Austrália , Humanos , Educação Interprofissional , Queensland
3.
Artigo em Inglês | MEDLINE | ID: mdl-33805472

RESUMO

The 2019-2020 summer wildfire event on the east coast of Australia was a series of major wildfires occurring from November 2019 to end of January 2020 across the states of Queensland, New South Wales (NSW), Victoria and South Australia. The wildfires were unprecedent in scope and the extensive character of the wildfires caused smoke pollutants to be transported not only to New Zealand, but also across the Pacific Ocean to South America. At the peak of the wildfires, smoke plumes were injected into the stratosphere at a height of up to 25 km and hence transported across the globe. The meteorological and air quality Weather Research and Forecasting with Chemistry (WRF-Chem) model is used together with the air quality monitoring data collected during the bushfire period and remote sensing data from the Moderate Resolution Imaging Spectroradiometer (MODIS) and Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) satellites to determine the extent of the wildfires, the pollutant transport and their impacts on air quality and health of the exposed population in NSW. The results showed that the WRF-Chem model using Fire Emission Inventory (FINN) from National Center for Atmospheric Research (NCAR) to simulate the dispersion and transport of pollutants from wildfires predicted the daily concentration of PM2.5 having the correlation (R2) and index of agreement (IOA) from 0.6 to 0.75 and 0.61 to 0.86, respectively, when compared with the ground-based data. The impact on health endpoints such as mortality and respiratory and cardiovascular diseases hospitalizations across the modelling domain was then estimated. The estimated health impact on each of the Australian Bureau of Statistics (ABS) census districts (SA4) of New South Wales was calculated based on epidemiological assumptions of the impact function and incidence rate data from the 2016 ABS and NSW Department of Health statistical health records. Summing up all SA4 census district results over NSW, we estimated that there were 247 (CI: 89, 409) premature deaths, 437 (CI: 81, 984) cardiovascular diseases hospitalizations and 1535 (CI: 493, 2087) respiratory diseases hospitalizations in NSW over the period from 1 November 2019 to 8 January 2020. The results are comparable with a previous study based only on observation data, but the results in this study provide much more spatially and temporally detailed data with regard to the health impact from the summer 2019-2020 wildfires.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Incêndios Florestais , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Humanos , New South Wales/epidemiologia , Nova Zelândia , Oceano Pacífico , Material Particulado/análise , Queensland , Fumaça/análise , América do Sul , Austrália do Sul , Vitória
4.
BMC Geriatr ; 21(1): 223, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794805

RESUMO

BACKGROUND: Foot problems are common in older adults and associated with poorer physical function, falls, frailty and reduced quality of life. Comprehensive Geriatric Assessment (CGA), a multidisciplinary process that is considered the gold standard of care for older adults, does not routinely include podiatry assessment and intervention in hospitalized older adults. AIMS: To introduce foot assessment to inpatient CGA to determine prevalence of foot disease, foot disease risk factors and inappropriate footwear use, assess inter-rater reliability of foot assessments, determine current podiatry input and examine associations between patient characteristics and foot disease risks. METHODS: Prospective, observational cohort study of older adults on geriatric rehabilitation wards. Foot assessment completed using the Queensland Foot Disease Form (QFDF) in addition to routine CGA. RESULTS: Fifty-two patients (median age [inter-quartile range] 86.4 [79.2-90.3] years, 54% female) were included. Six patients (12%) had foot disease and 13 (25%) had a 'high risk' or 'at risk' foot. Foot disease risk factor prevalence was peripheral arterial disease 9 (17%); neuropathy 10 (19%) and foot deformity 11 (22%). Forty-one patients (85%) wore inappropriate footwear. Inter-rater agreement was substantial on presence of foot disease and arterial disease, fair to moderate on foot deformity and fair on neuropathy and inappropriate footwear. Eight patients (15%) saw a podiatrist during admission: 5 with foot disease, 1 'at risk' and 2 'low risk' for foot disease. Patients with an at risk foot or foot disease had significantly longer median length of hospital stay (25 [13.7-32.1] vs 15.2 [8-22.1] days, p = 0.01) and higher median Malnutrition Screening Test scores (2 [0-3] vs 0 [0-2], p = 0.03) than the low-risk group. Patients with foot disease were most likely to see a podiatrist (p < 0.001). CONCLUSION: Foot disease, foot disease risk factors and inappropriate footwear are common in hospitalized older adults, however podiatry assessment and intervention is mostly limited to patients with foot disease. Addition of routine podiatry assessment to the multidisciplinary CGA team should be considered. Examination for arterial disease and risk of malnutrition may be useful to identify at risk patients for podiatry review.


Assuntos
Avaliação Geriátrica , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Prospectivos , Queensland , Reprodutibilidade dos Testes
5.
J Zoo Wildl Med ; 52(1): 268-275, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33827185

RESUMO

The impetus of this study was the imperative to establish blood biomarker values for clinically healthy mahogany gliders (Petaurus gracilis) in order to monitor the health status of eight captive individuals during their movement to a new facility. The study established ranges for 18 hematologic and 21 biochemical blood biomarkers for healthy individuals in a captive environment. The reported values are consistent with those published for other Australian glider and possum species. No statistically significant differences were found between the sexes, but significant age effects were observed. Specifically, subadult animals reported significantly higher total white cell counts, lymphocyte counts, alkaline phosphatase, creatine kinase, and glucose and chloride levels, compared to adult animals. Although there were no clinically significant changes in blood biomarkers associated with the relocation, many of the hematologic and biochemical biomarkers demonstrated the expected changes associated with the physiological stress of relocation. Specifically, triglycerides, glucose, globulins, creatinine kinase, aspartate transferase (AST), total protein, urea, phosphorous, potassium, sodium, chloride, neutrophils, and hematocrit showed changes with the large environmental change. The majority of the blood biomarkers returned to baseline levels 5 wk postrelocation, with all but one aged animal showing no signs of chronic health derangements following the relocation. The abnormal blood biomarker profiles of two geriatric individuals, one male diagnosed with pericloacal and adrenal gland tumors at the beginning of the study, and one female diagnosed with chronic urinary tract infections and suspected bone marrow disease following the relocation, are presented. The findings of this study inform the health monitoring of native gliders in captivity, rehabilitation, and clinical research scenarios. These findings also provide useful baseline data to aid in the health assessment of captive-bred individuals during their reintroduction into free-living populations.


Assuntos
Espécies em Perigo de Extinção , Marsupiais/sangue , Estresse Fisiológico , Animais , Biomarcadores/sangue , Feminino , Masculino , Queensland , Valores de Referência
6.
J Law Med ; 28(2): 503-520, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33768755

RESUMO

Recent parliamentary inquiries into end-of-life choices identify the need to provide legal certainty for health practitioners working in end-of-life care. A concern identified is the lack of clarity surrounding the operation, status and application of the doctrine of double effect. This discussion clarifies these concerns. Although the doctrine is judicially recognised in several overseas jurisdictions, in Australia the doctrine of precedent means that it does not form part of the common law. In most jurisdictions, the fault element for murder includes recklessness, and application of the doctrine does not avoid criminal liability being established against orthodox criminal law principles. Although the prosecution of a medical practitioner who incidentally causes death in the proper course of medical treatment is a rare event, it remains a live issue. Legislative protection of medical practitioners, as has occurred in Queensland, South Australia and Western Australia, is the means to achieve the certainty sought.


Assuntos
Criminosos , Austrália , Princípio do Duplo Efeito , Humanos , Responsabilidade Legal , Queensland , Austrália Ocidental
7.
Int J Pharm Pract ; 29(2): 152-156, 2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33729527

RESUMO

OBJECTIVES: The global coronavirus pandemic has expedited digitisation in every industry, especially healthcare, and has highlighted the potential for informatics pharmacists to provide valuable input into crisis management. Informatics pharmacists can combine their clinical and information technology skills to help provide essential patient safety services related to medication management, procurement and analytics. The objective of this study was to determine the key opportunities for a pharmacist informatician to improve patient care and outcomes during the COVID-19 pandemic. METHODS: Fourteen expert informatics professionals involved in the provision of digital health in Queensland, Australia, were invited to participate in a brief semistructured interview. Transcripts were manually coded, through iterative readings of the text to identify participant responses related to opportunities for a pharmacist informatician to assist during COVID-19. Inductive thematic analysis as described by Braun and Clarke, was used to identify groups of text related to the provision of digital health, informatics and change of practice during a pandemic. The relevant codes were then grouped into themes to help answer the research question. KEY FINDINGS: Twelve experts agreed to participate, they included nine informatics pharmacists and three digital health experts from hospital and community. Two key themes and 13 codes related to enabling safer and more efficient workflow and use of data analytics to optimise care were identified. The first theme related to 'social distancing without compromising care' for example, by using the electronic capabilities of digital hospitals and telehealth services. The second theme related to the use of real-time data streaming to optimise patient flow and timely medication procurement and management. Examples of quotes from transcripts were used to provide context and answer the research question. CONCLUSIONS: The experts interviewed identified areas where informatics pharmacists have the potential to assist with maintaining high quality patient care during this pandemic, and in future disasters. Improving awareness, training, and the integration about informatics roles as a result of this global pandemic will likely assist with future patient management in the event of future disasters.


Assuntos
Assistência à Saúde/organização & administração , Informática Médica , Modelos Organizacionais , Pandemias , Farmacêuticos , Sistemas de Dados , Humanos , Assistência ao Paciente , Papel Profissional , Qualidade da Assistência à Saúde , Queensland
8.
Artigo em Inglês | MEDLINE | ID: mdl-33672190

RESUMO

School-based programs can effectively prevent substance use; however, systematic reviews and consultation with stakeholders identified a need for effective, culturally inclusive programs for Aboriginal and/or Torres Strait Islander (hereafter Aboriginal) youth. This paper describes the development of Strong & Deadly Futures, a six-lesson, curriculum-aligned wellbeing and substance use prevention program that was designed for, and with, the Aboriginal youth. Formative reviews and consultation recommended that the program (i) combine effective components of mainstream prevention with cultural elements, highlighting Aboriginal cultural strengths; (ii) avoid stigma and celebrates the cultural diversity by catering to both Aboriginal and non-Aboriginal students; and (iii) use digital technology to enhance engagement, implementation and scalability. Guided by an Appreciative Inquiry approach, the program was developed in partnership with an Indigenous Creative Design Agency, and four schools in New South Wales and Queensland, Australia. Aboriginal (n = 41) and non-Aboriginal students (n = 36) described their role models, positive aspects of their community and reasons to avoid substance use; these formed the basis of an illustrated story which conveyed the key learning outcomes. Feedback from teachers, students and content experts supported the acceptability of the program, which will be evaluated in a subsequent randomised controlled trial.


Assuntos
Serviços de Saúde do Indígena , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Austrália , Humanos , Internet , New South Wales , Grupo com Ancestrais Oceânicos , Queensland , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle
9.
BMC Geriatr ; 21(1): 193, 2021 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743597

RESUMO

BACKGROUND: There is limited best- practice evidence to address behavioral and psychiatric symptoms for those with dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, 'Harmony in the Bush', based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia. METHODS: A quasi-experimental (nonrandomized, pre-post) intervention study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focused on the theory of the Progressively Lowered Stress Threshold principles and delivery of person-centered care plan with integrated music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff's caregiving stress, using Caregivers Stress Inventory. This study adheres to the CONSORT guidelines. RESULTS: Mean age of residents with dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was similar reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency. CONCLUSIONS: The Harmony in the Bush model is effective in reducing agitation among dementia residents with significant reduction in staff stress levels in nursing homes in rural Australia. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458.


Assuntos
Demência , Agitação Psicomotora , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Demência/epidemiologia , Demência/terapia , Feminino , Humanos , Masculino , Casas de Saúde , Agitação Psicomotora/diagnóstico , Agitação Psicomotora/epidemiologia , Agitação Psicomotora/terapia , Queensland
10.
Aust Vet J ; 99(5): 163-171, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33751558

RESUMO

OBJECTIVE: Pleurisy in pigs has economic impacts in the production stage and at slaughter. This study sought to establish if some micro-organisms can be found in high numbers in lungs with pleurisy by assessing batches of pigs at an abattoir in Queensland Australia. DESIGN: Samples of lung (including trachea/bronchus and lymph nodes) from a maximum of 5 pleurisy affected pigs were collected from 46 batches of pigs representing 46 Queensland farms. PROCEDURE: Pleurisy-affected lung areas were cultured by traditional bacteriological methods and bacteria quantified by plate scores. Additionally, tracheal or bronchial swabs and apical lobe fluid were tested for Mycoplasma hyopneumoniae DNA and the superior tracheobronchial lymph nodes were tested for porcine circovirus type 2 DNA by polymerase chain reaction (PCR). All apparently significant bacteria were identified via PCR or sequencing. Typing was undertaken on some of the bacterial isolates. RESULTS: The most prevalent pathogens were M. hyopneumoniae, Streptococcus suis and Porcine Circovirus type 2, being found in 34, 38 and 31 batches, respectively. Other bacteria found were Actinobacillus species (29 batches), Pasteurella multocida (24 batches), Mycoplasma flocculare (9 batches), Actinobacillus pleuropneumoniae (7 batches), Mycoplasma hyorhinis (4 batches), Bisgaard Taxon 10 (1 batch), Glaesserella parasuis (1 batch), Streptococcus minor (1 batch) and Streptococcus porcinus (1 batch). Most batches had more than one bacterial species. CONCLUSION: The high percentage of batches infected with S. suis (83%), M. hyopneumoniae (74%) and PCV2 (70%) and clustering by a batch of these pathogens, as well as the presence of many secondary pathogens, suggests synergy between these organisms may have resulted in pleurisy.


Assuntos
Pleurisia , Doenças dos Suínos , Matadouros , Animais , Austrália/epidemiologia , Pulmão , Mycoplasma , Pleurisia/epidemiologia , Pleurisia/veterinária , Queensland/epidemiologia , Streptococcus , Suínos , Doenças dos Suínos/epidemiologia
11.
Arch Virol ; 166(5): 1469-1475, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33721100

RESUMO

In 2018, an outbreak resulting in deaths of 28 breeding pigeons was reported north of Brisbane, Australia. The affected birds had runny nasal discharge and poor body condition. Two birds were submitted to Biosecurity Sciences Laboratory, Brisbane, for investigation. A range of diagnostic tests excluded a number of known pathogens, and no virus was isolated in cell culture. Histopathological examination revealed severe acute multifocal necrosis in the liver with eosinophilic intranuclear inclusions in hepatocytes and Kupffer cells. High-throughput sequencing (HTS) revealed full-length sequences for pigeon adenovirus 1 (PiAd-A) and pigeon torque teno virus (PTTV). This report indicates concomitant PiAd-1and PTTV infections in Australian pigeons.


Assuntos
Adenoviridae/isolamento & purificação , Doenças das Aves/virologia , Coinfecção/veterinária , Columbidae/virologia , Infecções por Vírus de DNA/veterinária , Torque teno virus/isolamento & purificação , Animais , Animais Domésticos , Doenças das Aves/epidemiologia , Doenças das Aves/patologia , Coinfecção/epidemiologia , Coinfecção/patologia , Coinfecção/virologia , Infecções por Vírus de DNA/epidemiologia , Infecções por Vírus de DNA/patologia , Infecções por Vírus de DNA/virologia , DNA Viral/genética , Genoma Viral/genética , Fígado/virologia , Necrose , Filogenia , Queensland/epidemiologia
13.
Science ; 372(6539)2021 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-33766942

RESUMO

Animals in the wild are able to subsist on pathogen-infected and poisonous food and show immunity to various diseases. These may be due to their microbiota, yet we have a poor understanding of animal microbial diversity and function. We used metagenomics to analyze the gut microbiota of more than 180 species in the wild, covering diverse classes, feeding behaviors, geographies, and traits. Using de novo metagenome assembly, we constructed and functionally annotated a database of more than 5000 genomes, comprising 1209 bacterial species of which 75% are unknown. The microbial composition, diversity, and functional content exhibit associations with animal taxonomy, diet, activity, social structure, and life span. We identify the gut microbiota of wild animals as a largely untapped resource for the discovery of therapeutics and biotechnology applications.


Assuntos
Animais Selvagens/microbiologia , Bactérias , Microbioma Gastrointestinal , Genoma Bacteriano , Metagenoma , Animais , Animais Selvagens/classificação , Animais Selvagens/fisiologia , Bactérias/classificação , Bactérias/genética , Bactérias/isolamento & purificação , Toxinas Bacterianas/metabolismo , Comportamento Animal , Biodiversidade , Bases de Dados de Ácidos Nucleicos , Dieta , Ecossistema , Ilhas Malvinas , Fezes/microbiologia , Interações entre Hospedeiro e Microrganismos , Israel , Madagáscar , Metagenômica , Peptídeo Hidrolases/genética , Peptídeo Hidrolases/metabolismo , Filogenia , Queensland , Uganda
14.
ANZ J Surg ; 91(3): 249-254, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33522697

RESUMO

BACKGROUND: Several public health initiatives in Australia were implemented in March 2020 to contain the spread of COVID-19. The effect of these initiatives on surgical provision is unknown. The primary objective was to determine the effect of public health policies and surgical society guidelines implemented during the pandemic on elective and emergency caseload of surgical specialities operating within South East Queensland. METHODS: This observational study utilized non re-identifiable electronic data to quantify the caseload of surgical specialities across five secondary and tertiary referral hospitals in South East Queensland prior to and during the implementation of such initiatives. All patients undergoing a surgical procedure between 1 March and 24 April 2019 and the same period in 2020 were included. Participants' demographic and clinical information, such as age, the American Society of Anesthesiologists score, surgical date and location, surgical subspecialty and procedure name, was included. RESULTS: During the 2020 time period, there were 2991 elective cases compared to 4422 surgeries occurring in the same period in 2019 (32.4% reduction). Meanwhile, 2082 emergency surgeries were performed in the 2020 period compared to 2362 in 2019 (12.0% decrease). Ophthalmology and dental/ear, nose and throat/maxillofacial surgery experienced the largest reduction in elective surgeries, whereas emergency caseload increased for vascular and cardiothoracic services, and only slightly decreased for plastics and urology. CONCLUSION: The public health initiatives and guidance implemented during the COVID-19 pandemic reduced surgical specialties' elective caseload. However, emergency caseload was not affected to the same extent. This insight helps to guide resource allocation in future waves of the pandemic.


Assuntos
/epidemiologia , Procedimentos Cirúrgicos Eletivos/normas , Emergências , Pandemias , Saúde Pública , Política Pública , Centros de Atenção Terciária/estatística & dados numéricos , Adulto , Idoso , Comorbidade , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Queensland/epidemiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-33632091

RESUMO

Abstract: The implementation of public health measures to control the current COVID-19 pandemic (such as wider lockdowns, overseas travel restrictions and physical distancing) is likely to have affected the spread of other notifiable diseases. This is a descriptive report of communicable disease surveillance in Central Queensland (CQ) for six months (1 April to 30 September 2020) after the introduction of physical distancing and wider lockdown measures in Queensland. The counts of notifiable communicable diseases in CQ in the six months were observed and compared with the average for the same months during the years 2015 to 2019. During the study's six months, there were notable decreases in notifications of most vaccine-preventable diseases such as influenza, pertussis and rotavirus. Conversely, notifications increased for disease groups such as blood-borne viruses, sexually transmitted infections and vector-borne diseases. There were no reported notifications for dengue fever and malaria which are mostly overseas acquired. The notifications of some communicable diseases in CQ were variably affected and the changes correlated with the implementation of the COVID-19 public health measures. Background: The current COVID-19 pandemic has led to some significant changes to local, regional and national public health practices including social distancing and wider lockdown. These measures have been previously reported to be associated with reductions in the incidence of gastrointestinal and respiratory diseases as well as of other airborne transmitted agents.1,2 A preliminary analysis was conducted assessing the impact of these measures on nationally notifiable diseases across Australia;3 however, the impact of these measures on communicable diseases within regional Australia is not well established. Like most regional areas, Central Queensland (CQ) has a lower population density and considerable distance from major cities; it will be informative to understand how these measures impact on notifiable conditions in this regional setting. We aimed to identify the patterns of change in reported notifiable conditions to the Central Queensland Public Health Unit (CQPHU), during a six-month period (1 April to 30 September 2020) following the implementation of COVID-19 measures. Here, we compare these notifications to the surveillance data for the same six-month period for the previous five years (2015 to 2019). Methods: The study encompasses all notifiable conditions reported from CQ, which covers approximately 226,000 population and is spread over 117,588 square kilometres. Communicable diseases data were retrieved from the Queensland Notifiable Conditions System (NoCS), an online epidemiological database, from 1 January 2015 to 30 September 2020. The data were collected under the Public Health Act 2005, a legislative authority that provides permission to access health information. Permission to publish was given by the Communicable Diseases Branch of Queensland. Data were extracted on selected notifiable diseases in Queensland: blood-borne viruses (BBV), gastrointestinal diseases, sexually transmissible infections (STIs), vaccine-preventable diseases (VPDs), vector-borne diseases, zoonotic diseases and other diseases. For each disease, the count for six months following the implementation of COVID-19 public health measures (1 April to 30 September 2020) was compared with the average for the same six-month period during the years 2015 to 2019. Results: From 1 April to 30 September 2020, after the implementation of Queensland's COVID-19 preventive measures, there was a decrease seen in several diseases notifications reported to the CQPHU, mostly VPDs, when compared with the same months for each of 2015 to 2019 and for the 5-year average (2015-2019) for those months (Table 1). However, increases in notifications for April-September 2020 were observed in a greater number of other notifiable disease groups.


Assuntos
/epidemiologia , Doenças Transmissíveis/epidemiologia , Saúde Pública/métodos , Animais , Controle de Doenças Transmissíveis , Notificação de Doenças , Surtos de Doenças , Humanos , Incidência , Pandemias , Vigilância da População , Queensland/epidemiologia , Zoonoses/epidemiologia
16.
Med J Aust ; 214(5): 212-217, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33580553

RESUMO

OBJECTIVE: To investigate whether integrating pharmacists into general practices reduces the number of unplanned re-admissions of patients recently discharged from hospital. DESIGN, SETTING: Stepped wedge, cluster randomised trial in 14 general practices in southeast Queensland. PARTICIPANTS: Adults discharged from one of seven study hospitals during the seven days preceding recruitment (22 May 2017 - 14 March 2018) and prescribed five or more long term medicines, or having a primary discharge diagnosis of congestive heart failure or exacerbation of chronic obstructive pulmonary disease. INTERVENTION: Comprehensive face-to-face medicine management consultation with an integrated practice pharmacist within seven days of discharge, followed by a consultation with their general practitioner and further pharmacist consultations as needed. MAJOR OUTCOMES: Rates of unplanned, all-cause hospital re-admissions and emergency department (ED) presentations 12 months after hospital discharge; incremental net difference in overall costs. RESULTS: By 12 months, there had been 282 re-admissions among 177 control patients (incidence rate [IR], 1.65 per person-year) and 136 among 129 intervention patients (IR, 1.09 per person-year; fully adjusted IR ratio [IRR], 0.79; 95% CI, 0.52-1.18). ED presentation incidence (fully adjusted IRR, 0.46; 95% CI, 0.22-0.94) and combined re-admission and ED presentation incidence (fully adjusted IRR, 0.69; 95% CI, 0.48-0.99) were significantly lower for intervention patients. The estimated incremental net cost benefit of the intervention was $5072 per patient, with a benefit-cost ratio of 31:1. CONCLUSION: A collaborative pharmacist-GP model of post-hospital discharge medicines management can reduce the incidence of hospital re-admissions and ED presentations, achieving substantial cost savings to the health system. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12616001627448 (prospective).


Assuntos
Clínicos Gerais , Modelos Organizacionais , Readmissão do Paciente/estatística & dados numéricos , Farmacêuticos , Corporações Profissionais/organização & administração , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Reconciliação de Medicamentos , Pessoa de Meia-Idade , Atenção Primária à Saúde/normas , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Qualidade de Vida , Queensland
17.
Nutr Metab Cardiovasc Dis ; 31(3): 827-833, 2021 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-33549458

RESUMO

BACKGROUND AND AIM: Frailty has emerged as a third category of complication in patients with type 2 diabetes mellitus (T2DM). It has been suggested that adequate protein intake is an important dietary strategy for counteracting frailty. Therefore, we explored the association between protein intake and functional biomarkers of frailty in older adults with T2DM. METHODS AND RESULTS: Frailty was operationalized as the presence of three of the following: exhaustion, low muscle strength, low physical activity, slow gait speed, and weight loss. Functional biomarkers included handgrip strength (HGS), chair stands, the short physical performance battery and gait speed. Eighty-seven older adults (71.2 ± 8.2 years; 66.7% males) were included. A total of n = 6 (~7%) and n = 32 (~37%) participants were identified as frail and pre-frail respectively. No significant difference was observed for protein intake across staging of frailty (pre-frail/frail: 1.3 ± 0.4 g/kg BW; non-frail: 1.4 ± 0.4 g/kg BW; P = 0.320). A significant association was observed for total protein intake and HGS (ß = 0.44; 95% CI: 0.23-1.8; P = 0.01). However, this was no longer significant after adjusting for age, gender, physical activity, energy intake and total appendicular lean muscle (ß = 0.03; 95% CI: -0.45-0.60; P = 0.78). Nil other associations were observed between total protein intake and functional biomarkers of frailty. CONCLUSION: Adequate protein intake was not associated with functional biomarkers in older adults with T2DM. Future research should focus on the efficacy of protein on attenuating functional decline in vulnerable older adults with low protein intake.


Assuntos
Diabetes Mellitus Tipo 2 , Proteínas na Dieta/administração & dosagem , Idoso Fragilizado , Fragilidade/diagnóstico , Vida Independente , Fatores Etários , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Exercício Físico , Feminino , Fragilidade/epidemiologia , Fragilidade/fisiopatologia , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Avaliação Nutricional , Estado Nutricional , Queensland/epidemiologia , Recomendações Nutricionais , Velocidade de Caminhada , Perda de Peso
18.
Aust Crit Care ; 34(2): 176-181, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33487546

RESUMO

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a relatively common condition of varied aetiology associated with high morbidity and mortality. A range of therapies have been proven to be useful for patients with ARDS, including ventilatory and nonventilatory strategies. Prone positioning is one of the nonventilatory strategies and has been proven to be safe and is associated with significant mortality benefit in patients with moderate to severe ARDS. It is now included in several international guidelines as the standard of care for these cases. OBJECTIVES: The aim of the study was to develop, implement, and evaluate a prone positioning program in two nonmetropolitan, nontertiary intensive care units in South East Queensland. METHODS: A Plan-Do-Study-Act quality improvement model was used to implement changes in clinical practice in relation to prone positioning of patients. RESULTS: A description of the methods used to promote a complex change strategy is provided in this article. CONCLUSIONS: In this article, we demonstrate the feasibility of introducing a nonventilatory intervention of prone positioning in the management of patients with moderate to severe ARDS in regional intensive care in South East Queensland. This implementation strategy could be replicated and adopted in other similar intensive care units that do not have the ability to provide tertiary services such as extracorporeal life support.


Assuntos
/terapia , Pneumonia Viral/terapia , Decúbito Ventral , /terapia , Adulto , Idoso , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Queensland/epidemiologia
19.
Artigo em Inglês | MEDLINE | ID: mdl-33440875

RESUMO

Limited research exists on the experiences of parents bereaved by suicide. Our earlier qualitative analysis examined the experiences of parents' suicide bereavement at 6 and 12 months after their loss. The current study aimed to extend the analysis over 24 months, outlining the key themes of parents' suicide bereavement experience. In the frames of a longitudinal study of suicide bereavement in Queensland, Australia, parents were interviewed at 6, 12, and 24 months after their loss. Thematic analysis was used to further explore new themes and three key themes identified in earlier analyses: searching for answers and sense-making, coping strategies and support, and finding meaning and purpose. Results at 24 months revealed a clearer differentiation between strategies adopted by mothers and fathers. Anger and blame had changed towards feelings of depression. A polarization was observed between parents still oscillating in brooding rumination and those who have shifted towards sense-making. The former more frequently reported depression symptoms, and the latter reported a more positive attitude towards life and acceptance of their loss. Consistent with the dual-process model, parents managed to reach acceptance after oscillating between sense-making and meaning making. Findings provide insights how suicide loss affects parents, with implications for postvention.


Assuntos
Luto , Suicídio , Austrália , Feminino , Humanos , Estudos Longitudinais , Pesquisa Qualitativa , Queensland
20.
J Zoo Wildl Med ; 51(4): 868-878, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33480567

RESUMO

Lumholtz's tree-kangaroo (Dendrolagus lumholtzi) is one of two species of tree-kangaroos found in Queensland, Australia. There is little information about ocular anatomy and pathology in any species of tree-kangaroo, and there are claims of blindness from unknown causes in free-ranging Lumholtz's tree-kangaroos. This study investigated ocular anatomy and pathology in 80 individuals, using examination of 31 live animals and histopathologic examination of eyes from 49 carcasses. Tree-kangaroos were found to have a typical vertebrate eye with immuno-histochemical evidence for dichromatic color vision. Only 5.4% of animals had evidence of pathology from traumatic injury, infection, or a variety of nonspecific lesions. Toxoplasmosis was implicated in ocular lesions in three animals. This study did not find evidence of widespread blindness in free-ranging animals nor evidence of toxic optic neuropathy. Examinations of live animals highlighted the need to establish normal ocular examination parameters and vision testing protocols suitable for use in tree-kangaroos and the need for more comprehensive examination and testing of animals thought to have vision loss of unknown origin.


Assuntos
Oftalmopatias/veterinária , Olho/anatomia & histologia , Macropodidae , Animais , Animais Selvagens , Oftalmopatias/patologia , Feminino , Masculino , Queensland
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