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2.
Artigo em Inglês | MEDLINE | ID: mdl-32536336

RESUMO

Background: SAEFVIC is the Victorian surveillance system for adverse events following immunisation (AEFI). It enhances passive surveillance by also providing clinical support and education to vaccinees and immunisation providers. This report summarises surveillance, clinical and vaccine pharmacovigilance activities of SAEFVIC in 2018. Methods: A retrospective observational cohort study of AEFI reports received by SAEFVIC in 2018, compared with previous years since 2008. Data were categorised by vaccinee demographics of age, sex, pregnancy and Indigenous status, vaccines administered and AEFI reactions reported. Age cohorts were defined as infant (0-12 months); young child (1-4 years); school-aged (5-17 years); adult (18-64 years); and older person (65+ years). Proportional reporting ratios were calculated for signal investigation of serious adverse neurological events with all vaccines and with influenza vaccines. Clinical support services and educational activities are described. Results: SAEFVIC received 1730 AEFI reports (26.8 per 100,000 population), with 9.3% considered serious. Nineteen percent (n = 329) attended clinical review. Annual AEFI reporting trends increased for infants, children and older persons, but were stable for school-aged and adult cohorts. Females comprised 55% of all reports and over 80% of reports among adults. There were 17 reports of AEFI in pregnant women and 12 (0.7%) in persons identifying as Indigenous Australians. A possible signal regarding serious adverse neurological events (SANE) was detected, but was not supported by signal validation testing. A clinical investigation is ongoing. Two deaths were reported coincident to immunisation with no evidence of causal association. Conclusion: SAEFVIC continues to provide robust AEFI surveillance supporting vaccine safety monitoring in Victoria and Australia, with new signal detection and validation methodologies strengthening capabilities.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Sistemas de Notificação de Reações Adversas a Medicamentos/tendências , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Imunização/efeitos adversos , Imunização/estatística & dados numéricos , Farmacovigilância , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Previsões , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Vigilância da População , Estudos Retrospectivos , Vitória/epidemiologia , Adulto Jovem
3.
Artigo em Inglês | MEDLINE | ID: mdl-32114974

RESUMO

The Australian Gonococcal Surveillance Programme (AGSP) has continuously monitored antimicrobial resistance in clinical isolates of Neisseria gonorrhoeae from all states and territories since 1981. In 2018, there were 9,006 clinical isolates of gonococci from public and private sector sources tested for in vitro antimicrobial susceptibility by standardised methods. This was the highest annual total of isolates tested since the inception of the AGSP. The current treatment recommendation for gonorrhoea, for the majority of Australia, remains dual therapy with ceftriaxone and azithromycin. Decreased susceptibility to ceftriaxone (minimum inhibitory concentration (MIC) value ≥0.06 mg/L) was found nationally in 1.73% of isolates. The highest proportions were reported from Tasmania and non-remote Western Australia (7.3% and 2.1% respectively). In 2018 two extensively drug-resistant isolates were reported from Queensland patients. These two isolates, with ceftriaxone MIC values of 0.50 mg/L, high-level resistance to azithromycin (MIC ≥ 256 mg/L), and resistance to penicillin and ciprofloxacin were identified and reported to the World Health Organization as isolates of international significance. Resistance to azithromycin (MIC value ≥1.0 mg/L) was found nationally in 6.2% of isolates, lower than the 9.3% reported in 2017, but more than double the proportion reported in 2015 (2.6%). The highest proportions were reported from the Australian Capital Territory (8.7%), Victoria (8.3%), and New South Wales (6.5%). High-level resistance to azithromycin (MIC value ≥256 mg/L) was reported in nine isolates nationally in 2018: four from New South Wales, three from Victoria, and two from Queensland. The proportion of isolates resistant to penicillin in non-remote Australia ranged from 8.8% in non-remote Northern Territory to 44.1% in South Australia. In remote Northern Territory penicillin resistance rates remain low (1.9%), and higher in remote Western Australia (6.5%). The proportion of isolates resistant to ciprofloxacin in non-remote Australia ranged from 10.3% in non-remote Northern Territory to 48.3% in South Australia. Ciprofloxacin resistance rates remain comparatively low in remote Northern Territory (1.9%) and remote Western Australia (4.6%).


Assuntos
Gonorreia/epidemiologia , Antibacterianos/uso terapêutico , Austrália/epidemiologia , Território da Capital Australiana , Ciprofloxacino/uso terapêutico , Gonorreia/tratamento farmacológico , Humanos , Testes de Sensibilidade Microbiana , Neisseria gonorrhoeae , New South Wales/epidemiologia , Northern Territory/epidemiologia , Resistência às Penicilinas , Penicilinas/uso terapêutico , Queensland/epidemiologia , Austrália do Sul/epidemiologia , Tasmânia/epidemiologia , Vitória/epidemiologia , Austrália Ocidental/epidemiologia
4.
PLoS One ; 15(1): e0228551, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31999795

RESUMO

Despite overall improvements in cancer survival due to earlier diagnosis and better treatment, socio-economically disadvantaged people have lower cancer survival than more advantaged people. We aimed to examine differences in cancer survival by area-level socio-economic disadvantage in Victoria, Australia and assess whether these inequalities varied by year of diagnosis, age at diagnosis, time since diagnosis and sex. Cases diagnosed with a first primary cancer in 2001-2015 were identified using the Victorian Cancer Registry and followed to the end of 2016. Five-year net survival and the excess risk of death due to a cancer diagnosis were estimated. People living in more disadvantaged areas had lower five-year survival than residents of less disadvantaged regions for 21 of 29 cancer types: head and neck, oesophagus, stomach, colorectum, anus/anal canal, liver, gallbladder/biliary tract, pancreas, lung, melanoma, connective/soft tissue, female breast, ovary, prostate, kidney, bladder, brain and central nervous system, unknown primary, non-Hodgkin lymphoma, multiple myeloma and leukemia. The observed lower survival in more deprived regions persisted over time, except head and neck cancer, for which the gap in survival has widened. Socio-economic inequalities in survival decreased with increasing age at diagnosis for cancers of connective/soft tissue, bladder and unknown primary. For colorectal cancer, the observed survival disadvantage in lower socio-economic regions was greater for men than for women, while for brain and central nervous system tumours, it was larger for women. Cancer survival is generally lower for residents of more socio-economically disadvantaged areas. Identifying the underlying reasons for these inequalities is important and may help to identify effective interventions to increase survival for underprivileged cancer patients.


Assuntos
Neoplasias/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/classificação , Sistema de Registros , Projetos de Pesquisa , Caracteres Sexuais , Fatores Socioeconômicos , Vitória/epidemiologia , Adulto Jovem
5.
Vet Parasitol ; 277: 109019, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31918044

RESUMO

Fasciola hepatica (liver fluke) is a widespread parasite infection of livestock in Victoria, South-eastern Australia, where high rainfall and a mild climate is suitable for the main intermediate host Austropeplea tomentosa. The aims of this study were to quantify the prevalence and intensity of F. hepatica in dairy cattle in the irrigated dairy regions of Victoria and determine if triclabendazole resistance was present in infected herds. Cattle in 83 herds from the following six irrigation regions were tested for F. hepatica: Macalister Irrigation District (MID), Upper Murray (UM), Murray Valley (MV), Central Goulburn (CG), Torrumbarry (TIA) and Loddon Valley (LV). Twenty cattle from each herd were tested using the F. hepatica faecal egg count (FEC) as well as the coproantigen ELISA (cELISA). The mean individual animal true prevalence of F. hepatica across all regions was 39 % (95 % credible interval [CrI] 27%-51%) by FEC and 39 % (95 % CrI 27%-50%) by cELISA with the highest true prevalence (75-80 %) found in the MID. Our results show that 46 % of the herds that took part in this study were likely to experience fluke-associated production losses, based on observations that herd productivity is impaired when the true within-herd prevalence is > 25 %. Using the FEC and cELISA reduction tests, triclabendazole resistance was assessed on 3 herds in total (2 from the 83 in the study; and 1 separate herd that did not take part in the prevalence study) and resistance was confirmed in all 3 herds. This study has confirmed that F. hepatica is endemic in several dairy regions in Victoria: triclabendazole resistance may be contributing to the high prevalence in some herds. From our analysis, we estimate that the state-wide economic loss associated with fasciolosis is in the order of AUD 129 million (range AUD 38-193 million) per year or about AUD 50,000 (range AUD 15,000-75,000) per herd per year.


Assuntos
Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/parasitologia , Resistência a Medicamentos , Fasciola hepatica/efeitos dos fármacos , Animais , Antiplatelmínticos/farmacologia , Bovinos , Indústria de Laticínios , Fasciolíase/tratamento farmacológico , Fasciolíase/prevenção & controle , Fasciolíase/veterinária , Prevalência , Triclabendazol/farmacologia , Vitória/epidemiologia
6.
Sex Transm Infect ; 96(4): 246-250, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31919276

RESUMO

OBJECTIVE: In 2017, there was an outbreak of invasive meningococcal disease (IMD) serogroup C among men who have sex with men (MSM) in Victoria, Australia. A government-funded free meningococcal (MenACWY) vaccination programme targeting all MSM living in Victoria was launched between December 2017 and December 2018. The aim of this study was to examine the vaccine uptake among MSM attending a sexual health clinic in Melbourne. METHODS: This was a retrospective clinical audit of MSM attending the Melbourne Sexual Health Centre (MSHC) during the vaccination programme. We calculated the proportion of MSM who received the meningococcal vaccine on their first visit and at any time during the programme. We performed univariable and multivariable logistic regression to identify the factors associated with the vaccine uptake on the first visit. RESULTS: Of the 10 370 MSM who attended MSHC, 55.5% received the vaccine on their first visit and 67.4% at any time during the programme. MSM had higher odds of receiving the vaccine on the first visit if they were aged 16-25 years (adjusted OR (aOR) 1.21; 95% CI 1.08 to 1.35) or 26-35 years (aOR 1.17; 95% CI 1.07 to 1.29) in comparison with MSM older than 35 years; were HIV-negative and not on pre-exposure prophylaxis (aOR 1.80; 95% CI 1.56 to 2.09); had more than four male partners in the last 12 months (aOR 1.16; 95% CI 1.06 to 1.27); had male partners only (aOR 2.24; 95% CI 1.96 to 2.55); or were born overseas (aOR 1.11; 95% CI 1.03 to 1.21). CONCLUSIONS: Two-thirds of the MSM attending a sexual health clinic received at least one dose of meningococcal vaccine. The vaccination programme coincided temporally with a dramatic reduction in the incidence of IMD. Vaccination should be further promoted among MSM and men who have sex with both men and women.


Assuntos
Surtos de Doenças , Transmissão de Doença Infecciosa/prevenção & controle , Homossexualidade Masculina , Meningite Meningocócica/epidemiologia , Meningite Meningocócica/prevenção & controle , Vacinas Meningocócicas/administração & dosagem , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Vitória/epidemiologia , Adulto Jovem
7.
Occup Environ Med ; 77(3): 185-187, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31896616

RESUMO

OBJECTIVES: Serious mental illness is common among those who have experienced a physical workplace injury, yet little is known about mental health service use in this population. This study aims to estimate the proportion of the workplace musculoskeletal injury population experiencing a mental illness, the proportion who access mental health services through the workers' compensation system and the factors associated with likelihood of accessing services. METHODS: A longitudinal cohort study was conducted with a random sample of 615 workers' compensation claimants followed over three survey waves between June 2014 and July 2015. The primary outcome was receiving any type of mental health service use during this period, as determined by linking survey responses to administrative compensation system records for the 18 months after initial interview. RESULTS: Of 181 (29.4%) participants who met the case definition for a serious mental illness at one or more of the three interviews, 75 (41.4%) accessed a mental health service during the 18-month observation period. Older age (OR=0.96, 95% CI 0.93 to 0.99) and achieving sustained return to work (OR=0.27, 95% CI 0.11 to 0.69) were associated with reduced odds of mental health service use. Although not significant, being born in Australia was associated with an increased odds of service use (OR=2.23, 95% CI 0.97 to 5.10). CONCLUSIONS: The proportion of injured workers with musculoskeletal conditions experiencing mental illness is high, yet the proportion receiving mental health services is low. More work is needed to explore factors associated with mental health service use in this population, including the effect of returning to work.


Assuntos
Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/estatística & dados numéricos , Doenças Musculoesqueléticas/psicologia , Traumatismos Ocupacionais/psicologia , Indenização aos Trabalhadores/estatística & dados numéricos , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Prevalência , Fatores de Risco , Vitória/epidemiologia , Local de Trabalho
8.
Pediatrics ; 145(1)2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31796504

RESUMO

OBJECTIVES: Antibiotics are among the most common prescriptions in children, and non-ß-lactam antibiotics (NBLAs) account for almost half of those prescribed in Australian pediatric hospitals. Despite this, data on NBLA hypersensitivity in children are limited. This study describes reported hypersensitivity reactions to NBLAs in children and the results of allergy evaluation. METHODS: Children with a suspected NBLA allergy who had skin testing and/or an intravenous or oral challenge test (OCT) between May 2011 and June 2018 were included. Patients were excluded if they were >18 years old or did not complete the allergy evaluation for any reason other than allergic reaction. RESULTS: Over the 7-year study period, 141 children had 150 allergy evaluations of 15 different NBLAs. The median time from the initial reported reaction to allergy evaluation was 1.9 (range 0.1-14.9) years. Overall, 27 of the 150 (18.0%) challenge tests to NBLAs had positive results, with the rate of positive OCT results being highest for trimethoprim-sulfamethoxazole (15 of 46; 32.6%) and macrolides (8 of 77; 10.4%). Although 4 children reported initial anaphylactic reactions, no patients had severe symptoms on rechallenge or required adrenaline. Of the challenges that had positive results, the majority of children (23 of 27; 85.2%) had symptoms on repeat challenge similar to those that were initially reported. CONCLUSIONS: Overall, 8 of 10 children with NBLA allergy could be delabeled. On average, patients waited 1.9 years to be rechallenged. Timely access to allergy evaluation to delabel these patients is needed to preserve first-line antibiotics.


Assuntos
Antibacterianos/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Adolescente , Criança , Pré-Escolar , Hipersensibilidade a Drogas/epidemiologia , Feminino , Hospitais Pediátricos , Humanos , Lactente , Macrolídeos/efeitos adversos , Masculino , Estudos Retrospectivos , Testes Cutâneos , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Vitória/epidemiologia
10.
Aust N Z J Public Health ; 44(1): 53-58, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31535416

RESUMO

OBJECTIVE: To determine the clinical characteristics, outcomes and longitudinal trends of sepsis occurring in cancer patients. METHOD: Retrospective study using statewide Victorian Cancer Registry data linked to various administrative datasets. RESULTS: Among 215,763 incident cancer patients, incidence of sepsis within one year of cancer diagnosis was estimated at 6.4%. The incidence of sepsis was higher in men, younger patients, patients diagnosed with haematological malignancies and those with de novo metastatic disease. Of the 13,316 patients with a first admission with sepsis, 55% had one or more organ failures, 29% required care within an intensive care unit and 13% required mechanical ventilation. Treatments associated with the highest sepsis incidence were stem cell/bone marrow transplant (33%), major surgery (4.4%), chemotherapy (1.1%) and radical radiotherapy (0.6%). The incidence of sepsis with organ failure increased between 2008 and 2015, while 90-day mortality decreased. CONCLUSIONS: Sepsis in patients with cancer has high mortality and occurs most frequently in the first year after cancer diagnosis. Implications for public health: The number of cancer patients diagnosed with sepsis is expected to increase, causing a substantial burden on patients and the healthcare system.


Assuntos
Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Neoplasias/complicações , Sepse/epidemiologia , Feminino , Humanos , Incidência , Masculino , Neoplasias/epidemiologia , Estudos Retrospectivos , Web Semântica , Vitória/epidemiologia
11.
Aust N Z J Public Health ; 44(1): 59-64, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31535439

RESUMO

OBJECTIVE: To assess the impact of an enhanced viral hepatitis surveillance program on data completeness and on epidemiological assessment of affected populations. METHODS: Notified cases of non-acute hepatitis B and C were analysed to determine demographic characteristics and risk factors during the period prior to July 2015-June 2016, and during enhanced surveillance of the period July 2016-June 2017, during which time doctors were contacted for information about new diagnoses. RESULTS: During the enhanced period, completeness for country of birth and Indigenous status doubled for both hepatitis B and hepatitis C, from 18-37% to 48-65%. The incidence ratio of hepatitis C among Aboriginal and Torres Strait Islander people increased from eight-fold to 11.4-fold, and the proportion of hepatitis B cases reported as born in China and Vietnam relative to other countries increased. New data fields identified that 12% of hepatitis C diagnoses occurred in a correctional facility, and 2% of hepatitis B cases were healthcare workers. CONCLUSIONS: Improved data completeness highlighted the underlying epidemiology of chronic viral hepatitis, demonstrating the increased burden of infection among specific priority populations. Implications for public health: Enhanced surveillance provides greater insight into the epidemiology of chronic viral hepatitis, identifying groups at risk and opportunities for public health action.


Assuntos
Hepatite B Crônica/epidemiologia , Hepatite C Crônica/epidemiologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Vigilância da População/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Criança , Pré-Escolar , China/etnologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Saúde Pública , Fatores de Risco , Vitória/epidemiologia , Vietnã/etnologia , Adulto Jovem
12.
Int J Cancer ; 146(6): 1541-1552, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31187481

RESUMO

Adiposity increases estrogen receptor (ER)-positive postmenopausal breast cancer risk. While mechanisms underlying this relationship are uncertain, dysregulated sex-steroid hormone production and insulin signaling are likely pathways. Our aim was to quantify mediating effects of fasting insulin and free estradiol in the adiposity and ER-positive postmenopausal breast cancer association. We used data from a case-cohort study of sex hormones and insulin signaling nested within the Melbourne Collaborative Cohort Study. Eligible women, at baseline, were not diagnosed with cancer, were postmenopausal, did not use hormone therapy and had no history of diabetes or diabetes medication use. Women with ER-negative disease or breast cancer diagnosis within the first follow-up year were excluded. We analyzed the study as a cumulative sampling case-control study with 149 cases and 1,029 controls. Missing values for insulin and free estradiol were multiply imputed with chained equations. Interventional direct (IDE) and indirect (IIE) effects were estimated using regression-based multiple-mediator approach. For women with body mass index (BMI) >30 kg/m2 compared to women with BMI 18.5-25 kg/m2 , the risk ratio (RR) of breast cancer was 1.75 (95% confidence interval [CI] 1.05-2.91). The estimated IDE (RR) not through the mediators was 1.03 (95% CI 0.43-2.48). Percentage mediated effect through free estradiol was 72% (IIE-RR 1.56; 95% CI 1.11-2.19). There was no evidence for an indirect effect through insulin (IIE-RR 1.12; 95% CI 0.68-1.84; 28% mediated). Our results suggest that circulating free estradiol plays an important mediating role in the adiposity-breast cancer relationship but does not explain all of the association.


Assuntos
Adiposidade/fisiologia , Neoplasias da Mama/epidemiologia , Estradiol/sangue , Insulina/metabolismo , Pós-Menopausa/metabolismo , Adulto , Idoso , Índice de Massa Corporal , Neoplasias da Mama/sangue , Neoplasias da Mama/metabolismo , Estudos de Casos e Controles , Jejum/sangue , Jejum/fisiologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Pós-Menopausa/sangue , Receptores Estrogênicos/metabolismo , Medição de Risco , Vitória/epidemiologia , Circunferência da Cintura/fisiologia
13.
Environ Pollut ; 256: 113340, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31662257

RESUMO

BACKGROUND: Evidence of health effects following early life exposure to short-to-medium duration of high pollution levels is extremely limited. OBJECTIVES: We aimed to evaluate the associations between: 1. intrauterine exposure to fine particulate matter (PM2.5) from coal mine fire emissions and the frequencies of general practitioner attendances and dispensations of prescribed asthma inhalers, steroid skin creams, and antibiotics during the first year of life; 2. infant exposure and those outcomes during the year following the fire. METHODS: All participants were recruited from the Latrobe Valley of Victoria, Australia. Participants' 24-h average and hourly peak mine fire-specific PM2.5 exposures from 09/02/2014 to 31/03/2014 were estimated using chemical transport modelling. Outcome data were obtained from the Australian Medicare Benefits Schedule and Pharmaceutical Benefits Scheme from each child's birth to 31/12/2016. We used negative binomial and logistic regression models to independently assess risks of the outcomes associated with every 10 and 100 µg m-3 increase in average or peak PM2.5 exposure, respectively, while adjusting for potential confounders. RESULTS: We included 286 of 311 children whose parents consented to be linked, comprising 77 with no exposure, 88 with intrauterine exposure and 121 with exposure in infancy. 10- and 100- µg m-3 increases in average and peak PM2.5 exposure during infancy were associated with greater incidence of antibiotics being dispensed during the year following the fire: the adjusted incidence rate ratios were 1.24 (95% CI 1.02, 1.50, p = 0.036) and 1.14 (1.00, 1.31, p = 0.048) respectively. No other significant associations were observed. CONCLUSION: Exposure to coal mine fire emissions during infancy was associated with increased dispensing of antibiotics. This could reflect increased childhood infections or increased prescriptions of antibiotics in the year following the fire.


Assuntos
Poluição do Ar/análise , Asma/epidemiologia , Infecções Bacterianas/epidemiologia , Dermatite Atópica/epidemiologia , Uso de Medicamentos/estatística & dados numéricos , Exposição Ambiental/análise , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Poluentes Atmosféricos/análise , Asma/terapia , Infecções Bacterianas/terapia , Criança , Minas de Carvão , Dermatite Atópica/terapia , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Fogo , Humanos , Incidência , Lactente , Masculino , Material Particulado/análise , Gravidez , Efeitos Tardios da Exposição Pré-Natal/terapia , Fatores de Tempo , Vitória/epidemiologia
14.
BJOG ; 127(5): 581-589, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31802587

RESUMO

OBJECTIVE: To assess the impact of publicly reporting a statewide fetal growth restriction (FGR) performance indicator. DESIGN: Retrospective cohort study from 2000 to 2017. SETTING: All maternity services in Victoria, Australia. POPULATION: A total of 1 231 415 singleton births at ≥32 weeks of gestation. METHODS: We performed an interrupted time-series analysis to assess the impact of publicly reporting an FGR performance indicator on the rate of detection for severe cases of small for gestational age (SGA). Rates of perinatal mortality and morbidity and obstetric intervention were assessed for severe SGA pregnancies and pregnancies delivered for suspected SGA. MAIN OUTCOME MEASURES: Gestation at delivery, obstetric management and perinatal outcome. RESULTS: The public reporting of a statewide FGR performance indicator was associated with a steeper reduction per quarter in the percentage of severe SGA undelivered by 40 weeks of gestation, from 0.13 to 0.51% (P = 0.001), and a decrease in the stillbirth rate by 3.3 per 1000 births among those babies (P = 0.01). Of babies delivered for suspected SGA, the percentage with birthweights ≥ 10th centile increased from 41.4% (n = 307) in 2000 to 53.3% (n = 1597) in 2017 (P < 0.001). Admissions to a neonatal intensive care unit for babies delivered for suspected SGA but with a birthweight ≥ 10th centile increased from 0.8 to 2.0% (P < 0.001). CONCLUSIONS: The public reporting of an FGR performance indicator has been associated with the improved detection of severe SGA and a decrease in the rate of stillbirth among those babies, but with an increase in the rate of iatrogenic birth for babies with normal growth. TWEETABLE ABSTRACT: The public reporting of hospital performance is associated with a reduction in stillbirth, but also with unintended interventions.


Assuntos
Retardo do Crescimento Fetal/epidemiologia , Indicadores de Qualidade em Assistência à Saúde , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Unidades de Terapia Intensiva Neonatal , Análise de Séries Temporais Interrompida , Admissão do Paciente/estatística & dados numéricos , Admissão do Paciente/tendências , Gravidez , Estudos Retrospectivos , Natimorto/epidemiologia , Vitória/epidemiologia
15.
Ann Thorac Surg ; 109(4): 1251-1259, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31863757

RESUMO

BACKGROUND: Data on the long-term outcomes in children after the Ross operation are limited. This study aimed to assess the long-term outcomes in children who underwent the Ross operation at a single institution. METHODS: The study reviewed all children (n = 140) who underwent the Ross operation at the Royal Children's Hospital in Melbourne, Australia between 1995 and 2018. RESULTS: Mean follow-up time was 8.9 years. Median age at operation was 7.4 years. The root replacement (n = 120, Ross-Konno; n = 38), root inclusion (n = 17), and subcoronary implantation (n = 3) techniques were used. Operative mortality was 5.0% (7 of 140; 3 neonates and 4 infants). There were 6 late deaths. Overall survival at 10 years was 96.2% in children older than 1 year of age and 78.9% in children younger than 1 year of age at operation (P = .003). Freedom from autograft reoperation was 86.0% at 10 years. Age younger than 1-year at operation was a risk factor for autograft reoperation (P = .02). Patients younger than 1 year of age at operation experienced a higher incidence of moderate or greater aortic insufficiency compared with patients who were older than 1 year of age (P = .006). In patients who had a poly-(p-dioxanone)-filament band placed around the sinotubular junction, freedom from moderate or greater aortic insufficiency at 10 years was 100%, compared with 83.1% in patients with no band (P = .09). CONCLUSIONS: In children older than 1 year of age, the Ross operation has excellent outcomes with no operative mortality and a low incidence of aortic insufficiency. In children younger than 1 year of age, the Ross operation is associated with higher operative mortality and a higher incidence of aortic insufficiency. Where possible, the Ross operation should be delayed beyond infancy. Poly-(p-dioxanone)-filament banding may reduce the incidence of aortic insufficiency after the Ross operation.


Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Previsões , Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Lactente , Masculino , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Vitória/epidemiologia
16.
J Matern Fetal Neonatal Med ; 33(4): 533-541, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29961407

RESUMO

Purpose: To provide center-based outcome data on obstetric and neonatal complications arising from expectantly managed pregnancies affected by preterm prelabor rupture of membranes (PPROM) before viability.Materials and methods: We collected data on 130 consecutive pregnancies complicated by spontaneous rupture of membranes before 24 week's gestation, occurring over a 7-year period. These were women who delivered >24 h after membrane rupture, and had no signs of chorioamnionitis or advanced labor at admission. Women with amniocentesis-induced PPROM (n = 7) were analyzed separately. The descriptive statistics of obstetrics and neonatal outcomes were reported.Results: The overall neonatal survival to discharge rate was 33.8%. Stratification of patients into early (12 to 19+6 weeks' gestation) and late pre-viable PPROM (20 to 23+6 weeks' gestation) revealed a 3.6-fold increase in survival rate in the latter group (12.2% versus 43.8%, p < .001). Pre-viable PPROM following amniocentesis predicted a 100% survival outcome, however anhydramnios impacted negatively. The most common neonatal morbidities of those admitted to intensive care unit were respiratory distress syndrome (78.7%) and bronchopulmonary dysplasia (84.4%). The most common maternal morbidities affecting pre-viable PPROM were clinical chorioamnionitis (47.7%), histological chorioamnionitis (81.8%), retained products of conception (39.3%) and preterm labor (45.4%).Conclusions: Later gestational ages at PPROM were associated with better survival rates, however neonatal morbidity remained high. Women experiencing pre-viable PPROM following amniocentesis can be reassured, while those with anhydramnios at any time during the latency period should be adequately counseled regarding poorer outcomes.


Assuntos
Ruptura Prematura de Membranas Fetais , Resultado da Gravidez/epidemiologia , Conduta Expectante , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Recém-Nascido Prematuro , Gravidez , Estudos Retrospectivos , Vitória/epidemiologia
17.
J Foot Ankle Res ; 12: 56, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31827623

RESUMO

Background: There is limited Australian epidemiological research that reports on the foot-health characteristics of people with diabetes, especially within rural and regional settings. The objective of this study was to explore the associations between demographic, socio-economic and diabetes-related variables with diabetes-related foot morbidity in people residing in regional and rural Australia. Methods: Adults with diabetes were recruited from non-metropolitan Australian publicly-funded podiatry services. The primary variable of interest was the University of Texas diabetic foot risk classification designated to each participant at baseline. Independent risk factors for diabetes-related foot morbidity were identified using multivariable analysis. Results: Eight-hundred and ninety-nine participants enrolled, 443 (49.3%) in Tasmania and 456 (50.7%) in Victoria. Mean age was 67 years (SD 12.7), 9.2% had type 1 diabetes, 506 (56.3%) were male, 498 (55.4%) had diabetes for longer than 10 years and 550 (61.2%) either did not know the ideal HbA1c target or reported that it was ≥7.0. A majority had peripheral neuropathy or worse foot morbidity (61.0%). Foot morbidity was associated with male sex (OR 2.42, 95% CI 1.82-3.22), duration of diabetes > 20 years (OR 3.25, 95% CI 2.22-4.75), and Tasmanian residence (OR 3.38, 95% CI 2.35-4.86). Conclusions: A high proportion of the regional Australian clinical population with diabetes seen by the publicly-funded podiatric services in this study were at high risk of future limb threatening foot morbidity, and participants residing in Northern Tasmania are more likely to have worse diabetes-related foot morbidity than those from regional Victoria. Service models should be reviewed to ensure that diabetes-related foot services are appropriately developed and resourced to deliver interdisciplinary evidence-based care.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Pé Diabético/etiologia , Podiatria/economia , População Rural/estatística & dados numéricos , Idoso , Austrália/epidemiologia , Estudos de Coortes , Estudos Transversais , Diabetes Mellitus Tipo 1/epidemiologia , Pé Diabético/epidemiologia , Pé Diabético/mortalidade , Pé Diabético/patologia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/epidemiologia , Podiatria/normas , Prevalência , Estudos Prospectivos , Fatores de Risco , Serviços de Saúde Rural/normas , População Rural/tendências , Fatores Socioeconômicos , Tasmânia/epidemiologia , Vitória/epidemiologia
18.
PLoS One ; 14(11): e0224702, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31675362

RESUMO

INTRODUCTION: Timely adverse event following immunisation (AEFI) signal event detection is essential to minimise further vaccinees receiving unsafe vaccines. We explored the proportional reporting ratio (PRR) ability to detect two known signal events with influenza vaccines with the aim of providing a model for prospective routine signal detection and improving vaccine safety surveillance in Australia. METHODS: Passive AEFI surveillance reports from 2008-2017 relating to influenza vaccines were accessed from the Australian SAEFVIC (Victoria) database. Proportional reporting ratios were calculated for two vaccine-event categories; fever and allergic AEFI. Signal detection sensitivity for two known signal events were determined using weekly data; cumulative data by individual year and; cumulative for all previous years. Signal event thresholds of PRR ≥2 and Chi-square ≥4 were applied. RESULTS: PRR provided sensitive signal detection when calculated cumulatively by individual year or by all previous years. Known signal events were detected 15 and 11 days earlier than traditional methods used at the time of the actual events. CONCLUSION: Utilising a single jurisdiction's data, PRR improved vaccine pharmacovigilance and showed the potential to detect important safety signals much earlier than previously. It has potential to maximise immunisation safety in Australia. This study progresses the necessary work to establish national cohesion for passive surveillance signal detection and strengthen routine Australian vaccine pharmacovigilance.


Assuntos
Vacinas contra Influenza/efeitos adversos , Interpretação Estatística de Dados , Humanos , Influenza Humana/prevenção & controle , Masculino , Modelos Estatísticos , Vigilância da População , Estudos Retrospectivos , Vitória/epidemiologia
19.
PLoS Med ; 16(10): e1002923, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31584941

RESUMO

BACKGROUND: Preterm infants are a group at high risk of having experienced placental insufficiency. It is unclear which growth charts perform best in identifying infants at increased risk of stillbirth and other adverse perinatal outcomes. We compared 2 birthweight charts (population centiles and INTERGROWTH-21st birthweight centiles) and 3 fetal growth charts (INTERGROWTH-21st fetal growth charts, World Health Organization fetal growth charts, and Gestation Related Optimal Weight [GROW] customised growth charts) to identify which chart performed best in identifying infants at increased risk of adverse perinatal outcome in a preterm population. METHODS AND FINDINGS: We conducted a retrospective cohort study of all preterm infants born at 24.0 to 36.9 weeks gestation in Victoria, Australia, from 2005 to 2015 (28,968 records available for analysis). All above growth charts were applied to the population. Proportions classified as <5th centile and <10th centile by each chart were compared, as were proportions of stillborn infants considered small for gestational age (SGA, <10th centile) by each chart. We then compared the relative performance of non-overlapping SGA cohorts by each chart to our low-risk reference population (infants born appropriate size for gestational age [>10th and <90th centile] by all intrauterine charts [AGAall]) for the following perinatal outcomes: stillbirth, perinatal mortality (stillbirth or neonatal death), Apgar <4 or <7 at 5 minutes, neonatal intensive care unit admissions, suspicion of poor fetal growth leading to expedited delivery, and cesarean section. All intrauterine charts classified a greater proportion of infants as <5th or <10th centile than birthweight charts. The magnitude of the difference between birthweight and fetal charts was greater at more preterm gestations. Of the fetal charts, GROW customised charts classified the greatest number of infants as SGA (22.3%) and the greatest number of stillborn infants as SGA (57%). INTERGROWTH classified almost no additional infants as SGA that were not already considered SGA on GROW or WHO charts; however, those infants classified as SGA by INTERGROWTH had the greatest risk of both stillbirth and total perinatal mortality. GROW customised charts classified a larger proportion of infants as SGA, and these infants were still at increased risk of mortality and adverse perinatal outcomes compared to the AGAall population. Consistent with similar studies in this field, our study was limited in comparing growth charts by the degree of overlap, with many infants classified as SGA by multiple charts. We attempted to overcome this by examining and comparing sub-populations classified as SGA by only 1 growth chart. CONCLUSIONS: In this study, fetal charts classified greater proportions of preterm and stillborn infants as SGA, which more accurately reflected true fetal growth restriction. Of the intrauterine charts, INTERGROWTH classified the smallest number of preterm infants as SGA, although it identified a particularly high-risk cohort, and GROW customised charts classified the greatest number at increased risk of perinatal mortality.


Assuntos
Gráficos de Crescimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido Pequeno para a Idade Gestacional/crescimento & desenvolvimento , Neonatologia/normas , Obstetrícia/normas , Adulto , Peso ao Nascer , Feminino , Desenvolvimento Fetal , Humanos , Recém-Nascido , Idade Materna , Gravidez , Resultado da Gravidez , Nascimento Prematuro , Estudos Retrospectivos , Risco , Natimorto , Vitória/epidemiologia , Adulto Jovem
20.
Aust J Rural Health ; 27(6): 527-534, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650640

RESUMO

OBJECTIVE: High-quality data regarding the prevalence of chronic disease in rural areas are essential in understanding the challenges faced by rural populations and for informing strategies to address health care needs. This study compared the prevalence of a range of self-reported chronic conditions and utilisation of GP services and emergency department in a regional Victorian setting between two studies conducted in the same region in 2001-2003 and 2014. DESIGN: Repeat cross-sectional studies conducted over a decade apart. SETTING: The projects were conducted in the Goulburn Valley in regional Victoria. PARTICIPANTS: The earlier study randomly selected households from local government lists. The later study randomly selected householders from the telephone directory. MAIN OUTCOME MEASURES: Participants were asked whether they had been diagnosed with a range of chronic health conditions and how often they had visited a general practitioner or emergency department in the past 12 months. RESULTS: The age-standardised prevalence of depression was higher in the 2014 study than the 2001-2003 study in men (increased by 8.0% (95% CI 4.5, 11.5%)) and women (increased by 13.7% (95% CI 8.4, 19.0%)). Similarly, the prevalence of age-standardised diabetes and hypertension was higher in 2014 than 2001-2003 (men increased by 3.6% (95% CI 0.7, 6.5% (diabetes)) and 13.6% (95% CI 8.6, 18.6% (hypertension)), women increased by 3.1% (95% CI 0.3, 6.5% (diabetes)) and 8.4% (95% CI 2.3, 14.5% (hypertension))). CONCLUSION: The results of this study indicate that the prevalence of self-reported depression, diabetes and hypertension has increased in this regional Victorian area over the past 13 years. The reasons for these observed increases and the subsequent impact on the health care needs of regional communities warrants further investigation.


Assuntos
Doença Crônica/epidemiologia , População Rural , Adulto , Idoso , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Vitória/epidemiologia
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