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1.
Bone Joint J ; 103-B(4): 769-774, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33789468

RESUMO

AIMS: Complex fractures of the femur and tibia with associated severe soft tissue injury are often devastating for the individual. The aim of this study was to describe the two-year patient-reported outcomes of patients in a civilian population who sustained a complex fracture of the femur or tibia with a Mangled Extremity Severity Score (MESS) of ≥ 7, whereby the score ranges from 2 (lowest severity) to 11 (highest severity). METHODS: Patients aged ≥ 16 years with a fractured femur or tibia and a MESS of ≥ 7 were extracted from the Victorian Orthopaedic Trauma Outcomes Registry (January 2007 to December 2018). Cases were grouped into surgical amputation or limb salvage. Descriptive analysis were used to examine return to work rates, three-level EuroQol five-dimension questionnaire (EQ-5D-3L), and Glasgow Outcome Scale-Extended (GOS-E) outcomes at 12 and 24 months post-injury. RESULTS: In all, 111 patients were included: 90 (81%) patients who underwent salvage and 21 (19%) patients with surgical amputation. The mean age of patients was 45.8 years (SD 15.8), 93 (84%) were male, 37 (33%) were involved in motor vehicle collisions, and the mean MESS score was 8.2 (SD 1.4). Two-year outcomes in the cohort were poor: six (7%) patients achieved a GOS-E good recovery, the mean EQ-5D-3L summary score was 0.52 (SD 0.27), and 17 (20%) patients had returned to work. CONCLUSION: A small proportion of patients with severe lower limb injury (MESS ≥ 7) achieved a good level of function 24 months post-injury. Further follow-up is needed to better understand the long-term trajectory of these patients, including delayed amputation, hospital readmissions, and healthcare utilization. Cite this article: Bone Joint J 2021;103-B(4):769-774.


Assuntos
Fraturas do Fêmur/cirurgia , Escala de Gravidade do Ferimento , Traumatismos da Perna/cirurgia , Fraturas da Tíbia/cirurgia , Amputação , Feminino , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Sistema de Registros , Vitória
2.
Int J Qual Health Care ; 33(1)2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33693639

RESUMO

BACKGROUND: Reorientation programmes have been an important component of neurotrauma rehabilitation for adults who suffer from post-traumatic amnesia (PTA) after traumatic brain injury (TBI); however, research testing the efficacy of acute programmes is limited. OBJECTIVE: This study aimed to determine if it is feasible to provide a standardized environmental reorientation programme to adults suffering from PTA after TBI in an acute care hospital setting, and whether it is likely to be beneficial. METHODS: We conducted a randomized controlled trial with concealed allocation and intention-to-treat analysis. A total of 40 participants suffering from PTA after TBI were included. The control group received usual care; the experimental group received usual care plus a standardized orientation programme inclusive of environmental cues. The primary outcome measure was time to emergence from PTA measured by the Westmead PTA Scale, assessed daily from hospital admission or on regaining consciousness. RESULTS: Adherence to the orientation programme was high, and there were no study-related adverse responses to the environmental orientation programme. Although there were no statistically significant between-group differences in time to emergence, the median time to emergence was shorter for those who received the standardized reorientation programme (9.0 (6.4-11.6) versus 13.0 (4.5-21.5) days). Multivariate analysis showed that the Glasgow Coma Scale (GCS) at scene (P = 0.041) and GCS at arrival at hospital (P = 0.0001) were significant factors contributing to the longer length of PTA. CONCLUSION: Providing an orientation programme in acute care is feasible for adults suffering from PTA after TBI. A future efficacy trial would require 216 participants to detect a between-group difference of 5 days with an alpha of 0.05 and a power of 80%.


Assuntos
Amnésia/etiologia , Amnésia/reabilitação , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/reabilitação , Orientação , Adulto , Estudos de Viabilidade , Feminino , Escala de Coma de Glasgow , Humanos , Análise de Intenção de Tratamento , Masculino , Projetos Piloto , Estudos Prospectivos , Vitória
3.
J Law Med ; 28(2): 389-420, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33768748

RESUMO

Australia is obliged under the Convention on the Rights of Persons with Disabilities to provide decision-making support to people with cognitive impairment. While there has been considerable recent activity looking at how the law should respond to the challenges raised by the Convention, there has been little discussion in Australia of how these changes will impact upon the care of people with dementia (the largest class of person with cognitive impairment in Australia). This section examines current Australian legal approaches to decision-making for people with dementia in four jurisdictions (New South Wales, South Australia, Victoria and Western Australia) through an analysis of reported tribunal decisions in each of these jurisdictions. It notes the scope for informal supported decision-making and the basis for the invocation of guardianship orders, including the new Victorian supportive guardianship order, and compares the new standards raised by the Convention. The section considers legal reforms which could improve the implementation of supported decision-making for people living with dementia.


Assuntos
Demência , Competência Mental , Tomada de Decisões , Humanos , New South Wales , Vitória , Austrália Ocidental
4.
Artigo em Inglês | MEDLINE | ID: mdl-33573066

RESUMO

Barriers to accessing healthcare exist following serious injury. These issues are not well understood and may have dire consequences for healthcare utilisation and patients' long-term recovery. The aim of this qualitative study was to explore factors perceived by allied health professionals to affect access to healthcare beyond hospital discharge for people with serious injuries in urban and regional Victoria, Australia. Twenty-five semi-structured interviews were conducted with community-based allied health professionals involved in post-discharge care for people following serious injury across different urban and regional areas. Interview transcripts were analysed using thematic analysis. Many allied health professionals perceived that complex funding systems and health services restrict access in both urban and regional areas. Limited availability of necessary health professionals was consistently reported, which particularly restricted access to mental healthcare. Access to healthcare was also felt to be hindered by a reliance on others for transportation, costs, emotional stress and often lengthy time of travel. Across urban and regional areas, a number of factors limit access to healthcare. Better understanding of health service delivery models and areas for change, including the use of technology and telehealth, may improve equitable access to healthcare.


Assuntos
Assistência ao Convalescente , Alta do Paciente , Pessoal Técnico de Saúde , Acesso aos Serviços de Saúde , Humanos , Pesquisa Qualitativa , Vitória
6.
Harm Reduct J ; 18(1): 20, 2021 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-33596940

RESUMO

The COVID-19 crisis has had profound impacts on health service provision, particularly those providing client facing services. Supervised injecting facilities and drug consumption rooms across the world have been particularly challenged during the pandemic, as have their client group-people who consume drugs. Several services across Europe and North America closed due to difficulties complying with physical distancing requirements. In contrast, the two supervised injecting facilities in Australia (the Uniting Medically Supervised Injecting Centre-MSIC-in Sydney and the North Richmond Community Health Medically Supervised Injecting Room-MSIR-in Melbourne) remained open (as at the time of writing-December 2020). Both services have implemented a comprehensive range of strategies to continue providing safer injecting spaces as well as communicating crucial health information and facilitating access to ancillary services (such as accommodation) and drug treatment for their clients. This paper documents these strategies and the challenges both services are facing during the pandemic. Remaining open poses potential risks relating to COVID-19 transmission for both staff and clients. However, given the harms associated with closing these services, which include the potential loss of life from injecting in unsafe/unsupervised environments, the public and individual health benefits of remaining open are greater. Both services are deemed 'essential health services', and their continued operation has important benefits for people who inject drugs in Sydney and Melbourne.


Assuntos
/prevenção & controle , Redução do Dano , Controle de Infecções/métodos , Programas de Troca de Agulhas , Transtornos Relacionados ao Uso de Opioides/reabilitação , Equipamento de Proteção Individual , Abuso de Substâncias por Via Intravenosa/reabilitação , Austrália , Assistência à Saúde , Overdose de Drogas/terapia , Habitação , Humanos , Máscaras , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , New South Wales , Tratamento de Substituição de Opiáceos , Encaminhamento e Consulta , Ressuscitação/métodos , Transtornos Relacionados ao Uso de Substâncias , Vitória
7.
ANZ J Surg ; 91(3): 415-419, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33538101

RESUMO

BACKGROUND: In Australia, the COVID-19 pandemic has caused severe social disruptions, including restrictions to the movement of people. Healthcare centres around the world have seen changes in the nature of injuries acquired during the COVID-19 pandemic; we therefore hypothesize that social isolation measures have changed the pattern of plastic and reconstructive surgery presentations. METHODS: A prospective cohort study was designed comparing patient presentations during the enforced COVID-19 lockdown to two previous periods. All emergency referrals requiring operative intervention by the plastic and reconstructive surgery unit of our institution were included. Patient demographics, place and mechanism of injury, drug and alcohol involvement, delays to presentation, length of admission and complication rates were collected. RESULTS: Demographics and complication rates were similar across all groups. A 31.8% reduction in total number of emergency cases was seen during the lockdown period. Increase in do-it-yourself injuries (P = 0.001), bicycle injuries (P = 0.001) and injuries acquired via substance abuse (P = 0.041) was observed. Head and neck injuries, mostly due to animal bites and falls, were also more prevalent compared to the same period the previous year (P = 0.007). As expected, over 80% of plastic surgery operations during the COVID-19 period were due to injuries acquired at home, a significant increase compared to previous periods. CONCLUSION: Despite changes in the pattern of presentations requiring plastic and reconstructive emergency surgery, traumatic injuries continued to occur during the pandemic. Thus, planning will be essential to ensure resource allocation for emergency procedures is sustained as second and third waves of COVID-19 cases emerge worldwide.


Assuntos
/epidemiologia , Emergências , Pandemias , Quarentena , Adulto , Comorbidade , Feminino , Humanos , Masculino , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos , Vitória/epidemiologia
8.
Epidemiol Infect ; 149: e44, 2021 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-33563349

RESUMO

Much of our current understanding about novel coronavirus disease 2019 (COVID-19) comes from hospitalised patients. However, the spectrum of mild and subclinical disease has implications for population-level screening and control. Forty-nine participants were recruited from a group of 99 adults repatriated from a cruise ship with a high incidence of COVID-19. Respiratory and rectal swabs were tested by polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Sera were tested for anti-SARS-CoV-2 antibodies by enzyme-linked immunosorbent assay (ELISA) and microneutralisation assay. Symptoms, viral shedding and antibody response were examined. Forty-five participants (92%) were considered cases based on either positive PCR or positive ELISA for immunoglobulin G. Forty-two percent of cases were asymptomatic. Only 15% of symptomatic cases reported fever. Serial respiratory and rectal swabs were positive for 10% and 5% of participants respectively about 3 weeks after median symptom onset. Cycle threshold values were high (range 31-45). Attempts to isolate live virus were unsuccessful. The presence of symptoms was not associated with demographics, comorbidities or antibody response. In closed settings, incidence of COVID-19 could be almost double that suggested by symptom-based screening. Serology may be useful in diagnosis of mild disease and in aiding public health investigations.


Assuntos
Anticorpos Antivirais/sangue , /virologia , Navios , Avaliação de Sintomas , Eliminação de Partículas Virais , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Testes de Neutralização , Turismo , Uruguai , Vitória/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-33573536

RESUMO

Abstract: Significant reductions in the incidence of enteroviruses and noroviruses, both transmitted primarily by the faecal-oral route, were noted in 2020 compared to the previous decade, in Victoria, Australia. The enterovirus specimen positivity rate was reduced by 84.2% in 2020, while the norovirus outbreak positivity rate declined by 49.0%. The most likely explanation for these reductions is the concurrence of social restrictions, physical distancing, personal hygiene awareness and international and domestic border closures in response to the COVID-19 pandemic.


Assuntos
/epidemiologia , Infecções por Caliciviridae/virologia , Enterovirus , Gastroenterite/epidemiologia , Gastroenterite/virologia , Norovirus , Infecções por Caliciviridae/epidemiologia , Infecções por Enterovirus/epidemiologia , Infecções por Enterovirus/virologia , Humanos , Incidência , Vitória/epidemiologia
13.
Oecologia ; 195(3): 759-771, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33595714

RESUMO

Trade-offs between photosynthesis and the costs of resource capture inform economic strategies of plants across environmental gradients and result in predictable variation in leaf traits. However, understudied functional groups like hemiparasites that involve dramatically different strategies for resource capture may have traits that deviate from expectations. We measured leaf traits related to gas exchange in mistletoes and their eucalypt hosts along a climatic gradient in relative moisture supply, measured as the ratio of precipitation to pan evaporation (P/Ep), in Victoria, Australia. We compared traits for mistletoes vs. hosts as functions of relative moisture supply and examined trait-trait correlations in both groups. Eucalypt leaf traits responded strongly to decreasing P/Ep, consistent with economic theory. Leaf area and specific leaf area (SLA) decreased along the P/Ep gradient, while C:N ratio, leaf thickness, N per area, and δ13C all increased. Mistletoes responded overall less strongly to P/Ep based on multivariate analyses; individual traits sometimes shifted in parallel with those of hosts, but SLA, leaf thickness, and N per area showed no significant change across the gradient. For mistletoes, leaf thickness was inversely related to leaf dry matter content (LDMC), with no relationship between SLA and mass-based N. In mistletoes, reduced costs of transpiration (reflecting their lack of roots) and abundant succulent leaf tissue help account for observed differences from their eucalypt hosts. Trait-based analysis of atypical functional types such as mistletoes help refine hypotheses based on plant economics and specialized adaptations to resource limitation.


Assuntos
Erva-de-Passarinho , Fotossíntese , Folhas de Planta , Plantas , Vitória
14.
Environ Pollut ; 274: 116498, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33524649

RESUMO

Poor air quality is an emerging problem in Australia primarily due to ozone pollution events and lengthening and more severe wildfire seasons. A significant deterioration in air quality was experienced in Australia's most populous cities, Melbourne and Sydney, as a result of fires during the so-called Black Summer which ran from November 2019 through to February 2020. Following this period, social, mobility and economic restrictions to curb the spread of the COVID-19 pandemic were implemented in Australia. We quantify the air quality impact of these contrasting periods in the south-eastern states of Victoria and New South Wales (NSW) using a meteorological normalisation approach. A Random Forest (RF) machine learning algorithm was used to compute baseline time series' of nitrogen dioxide (NO2), ozone (O3), carbon monoxide CO and particulate matter with diameter < 2.5 µm (PM2.5), based on a 19 year, detrended training dataset. Across Victorian sites, large increases in CO (188%), PM2.5 (322%) and ozone (22%) were observed over the RF prediction in January 2020. In NSW, smaller pollutant increases above the RF prediction were seen (CO 58%, PM2.5 80%, ozone 19%). This can be partly explained by the RF predictions being high compared to the mean of previous months, due to high temperatures and strong wind speeds, highlighting the importance of meteorological normalisation in attributing pollution changes to specific events. From the daily observation-RF prediction differences we estimated 249.8 (95% CI: 156.6-343.) excess deaths and 3490.0 (95% CI 1325.9-5653.5) additional hospitalisations were likely as a result of PM2.5 and O3 exposure in Victoria and NSW. During April 2019, when COVID-19 restrictions were in place, on average NO2 decreased by 21.5 and 8% in Victoria and NSW respectively. O3 and PM2.5 remained effectively unchanged in Victoria on average but increased by 20 and 24% in NSW respectively, supporting the suggestion that community mobility reduced more in Victoria than NSW. Overall the air quality change during the COVID-19 lockdown had a negligible impact on the calculated health outcomes.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Fogo , Afro-Americanos , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Cidades , Controle de Doenças Transmissíveis , Monitoramento Ambiental , Humanos , New South Wales , Pandemias , Material Particulado/análise , Estações do Ano , Vitória
15.
Health Res Policy Syst ; 19(1): 6, 2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461584

RESUMO

Globally, insufficient physical activity (PA) is one of the main risk factors for premature mortality. Although insufficient PA is prevalent in nearly every demographic, people with socio-economic disadvantage participate in lower levels of PA than those who are more affluent, and this contributes to widening health inequities. PA promotion interventions in primary healthcare are effective and cost effective, however they are not widely implemented in practice. Further, current approaches that adopt a 'universal' approach to PA promotion do not consider or address the additional barriers experienced by people who experience socioeconomic disadvantages. To address the research to policy and practice gap, and taking Australia as a case study, this commentary proposes a novel model which blends an implementation science framework with the principles of proportionate universalism. Proportionate universalism is a principle suggesting that health interventions and policies need to be universal, not targeted, but with intensity and scale proportionate to the level of social need and/or disadvantage. Within this model, we propose interrelated and multi-level evidence-based policies and strategies to support PA promotion in primary healthcare while addressing health inequities. The principles outlined in the new model which blends proportionate (Pro) universalism principles and Practical, Robust Implementation and Sustainability Model (PRISM), 'ProPRISM' can be applied to the implementation of PA promotion interventions in health care settings in other high-income countries. Future studies should test the model and provide evidence of its effectiveness in improving implementation and patient health outcomes and cost-effectiveness. There is potential to expand the proposed model to other health sectors (e.g., secondary and tertiary care) and to address other chronic disease risk factors such as unhealthy diet, smoking, and alcohol consumption. Therefore, this approach has the potential to transform the delivery of health care to a prevention-focused health service model, which could reduce the prevalence and burden of chronic disease and health care costs in high-income countries.


Assuntos
Exercício Físico , Promoção da Saúde/métodos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Ciência da Implementação , Atenção Primária à Saúde , Humanos , Desenvolvimento de Programas , Vitória
18.
Viruses ; 13(1)2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33477885

RESUMO

Since the identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the etiological agent of the current COVID-19 pandemic, a rapid and massive effort has been made to obtain the genomic sequences of this virus to monitor (in near real time) the phylodynamic and diversity of this new pathogen. However, less attention has been given to the assessment of intra-host diversity. RNA viruses such as SARS-CoV-2 inhabit the host as a population of variants called quasispecies. We studied the quasispecies diversity in four of the main SARS-CoV-2 genes (ORF1a, ORF1b, S and N genes), using a dataset consisting of 210 next-generation sequencing (NGS) samples collected between January and early April of 2020 in the State of Victoria, Australia. We found evidence of quasispecies diversity in 68% of the samples, 76% of which was nonsynonymous variants with a higher density in the spike (S) glycoprotein and ORF1a genes. About one-third of the nonsynonymous intra-host variants were shared among the samples, suggesting host-to-host transmission. Quasispecies diversity changed over time. Phylogenetic analysis showed that some of the intra-host single-nucleotide variants (iSNVs) were restricted to specific lineages, highlighting their potential importance in the epidemiology of this virus. A greater effort must be made to determine the magnitude of the genetic bottleneck during transmission and the epidemiological and/or evolutionary factors that may play a role in the changes in the diversity of quasispecies over time.


Assuntos
/genética , Genoma Viral/genética , Quase-Espécies/genética , Glicoproteína da Espícula de Coronavírus/genética , Proteínas Virais/genética , Austrália , Sequência de Bases , Variação Genética , Sequenciamento de Nucleotídeos em Larga Escala , Filogenia , Poliproteínas/genética , Análise de Sequência de RNA , Vitória
20.
Environ Sci Pollut Res Int ; 28(11): 14182-14191, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33506421

RESUMO

The COVID-19 pandemic not only has created a global health crisis but also has dramatic effects on the environment. To fight the spread of Coronavirus, governments imposed social distancing policies, which caused negative and positive impacts on the environment. Victoria, the second-most populated state in Australia, was hit by two waves of COVID-19. During the second wave of the pandemic, Victoria, especially Melbourne, experienced one of the most stringent and longest lockdowns globally. In this study, the changes in mobility trends, traffic, air pollution, noise pollution, and waste generation during the first and second waves of COVID-19 in Victoria are evaluated and compared. It was observed that the pandemic had both positive and negative impacts on the environment. During the second wave of the pandemic in Victoria, the mobility trends of public transport hubs, retail and recreation venues, and workplaces experienced a significant drop in movements at respective values of 85%, 83%, and 76% compared to the period of 5 weeks from 3 January to 6 February 2020. PM2.5 levels were lower by 23% at Alphington and 24% at Footscray from 16 March to 1 May 2020 compared with the average PM2.5 levels in the past 4 years. It was estimated that the respective daily generations of used face masks during the first wave and second wave of the pandemic in Victoria were approximately 104 and 160 tons.


Assuntos
Coronavirus , Controle de Doenças Transmissíveis , Meio Ambiente , Humanos , Pandemias , Vitória
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