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1.
Front Public Health ; 9: 625499, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33968879

RESUMO

Objective(s): To estimate the impact of universal community face mask use in Victoria, Australia along with other routine disease control measures in place. Methods: A mathematical modeling study using an age structured deterministic model for Victoria, was simulated for 123 days between 1 June 2020 and 1 October 2020, incorporating lockdown, contact tracing, and case findings with and without mask use in varied scenarios. The model tested the impact of differing scenarios of the universal use of face masks in Victoria, by timing, varying mask effectiveness, and uptake. Results: A six-week lockdown with standard control measures, but no masks, would have resulted in a large resurgence by September, following the lifting of restrictions. Mask use can substantially reduce the epidemic size, with a greater impact if at least 50% of people wear a mask which has an effectiveness of at least 40%. Early mask use averts more cases than mask usage that is only implemented closer to the peak. No mask use, with a 6-week lockdown, results in 67,636 cases and 120 deaths by 1 October 2020 if no further lockdowns are used. If mask use at 70% uptake commences on 23 July 2020, this is reduced to 7,961 cases and 42 deaths. We estimated community mask effectiveness to be 11%. Conclusion(s): Lockdown and standard control measures may not have controlled the epidemic in Victoria. Mask use can substantially improve epidemic control if its uptake is higher than 50% and if moderately effective masks are used. Early mask use should be considered in other states if community transmission is present, as this has a greater effect than later mask wearing mandates.


Assuntos
Epidemias , Controle de Doenças Transmissíveis , Humanos , Vitória/epidemiologia
2.
BMJ Open ; 11(3): e041984, 2021 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-33741660

RESUMO

OBJECTIVES: Larger sibships are associated with poorer cognitive and language outcomes but have different impacts on child emotional development. Previous studies have not taken into account sibling age, nor have impacts across multiple neurodevelopmental domains been considered in the same participant group. This study investigated the influence of family size indicators on early childhood cognitive, language and emotional-behavioural development. The effect of sibling age was considered by evaluating these relationships separately for different sibling age categories. DESIGN: Prospective birth cohort study. SETTING: Participants in the Barwon Infant Study were recruited from two major hospitals in the Barwon region of Victoria, Australia, between 2010 and 2013 (n=1074 children). PARTICIPANTS: The 755 children with any neurodevelopmental data at age 2-3 years excluding twins and those with an acquired neurodisability. OUTCOME MEASURES: Cognitive and language development was assessed using the Bayley Scales of Infant and Toddler Development, Third Edition, and emotional-behavioural development was measured with the Child Behaviour Checklist for Ages 1½-5. RESULTS: Greater household size was associated with a reduced cognitive development score (adjusted mean difference (AMD) -0.66 per extra household member; 95% CI -0.96 to -0.37; p<0.001) without age-specific differences. However, poorer expressive language was only observed for exposure to siblings between 2-6 and 6-10 years older. Having siblings 2-6 years older was associated with less internalising behaviour (AMD -2.1 per sibling; 95% CI -3.1 to -1.0; p<0.001). These associations persisted after multiple comparison adjustment. CONCLUSIONS: The influence of siblings on early childhood development varies substantially by sibling age and the neurodevelopmental outcome under study. Although family size alone appears important for cognitive development, age-specific findings emphasise the importance of sibling interaction in early childhood expressive language development and emotional behaviour.


Assuntos
Cognição , Irmãos , Desenvolvimento Infantil , Pré-Escolar , Estudos de Coortes , Características da Família , Humanos , Estudos Prospectivos , Vitória/epidemiologia
3.
BMC Health Serv Res ; 21(1): 149, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33588840

RESUMO

BACKGROUND: Existing comorbidity measures predict mortality among general patient populations. Due to the lack of outcome specific and patient-group specific measures, the existing indices are also applied to non-mortality outcomes in injury epidemiology. This study derived indices to capture the association between comorbidity, and burden and readmission outcomes for injury populations. METHODS: Injury-related hospital admissions data from July 2012 to June 2014 (161,334 patients) for the state of Victoria, Australia were analyzed. Various multivariable regression models were run and results used to derive both binary and weighted indices that quantify the association between comorbidities and length of stay (LOS), hospital costs and readmissions. The new and existing indices were validated internally among patient subgroups, and externally using data from the states of New South Wales and Western Australia. RESULTS: Twenty-four comorbidities were significantly associated with overnight stay, twenty-seven with LOS, twenty-eight with costs, ten with all-cause and eleven with non-planned 30-day readmissions. The number of and types of comorbidities, and their relative impact were different to the associations established with the existing Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Measure (ECM). The new indices performed equally well to the long-listed ECM and in certain instances outperformed the CCI. CONCLUSIONS: The more parsimonious, up to date, outcome and patient-specific indices presented in this study are better suited for use in present injury epidemiology. Their use can be trialed by hospital administrations in resource allocation models and patient classification models in clinical settings.


Assuntos
Comorbidade , Readmissão do Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Hospitais , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Vitória/epidemiologia , Austrália Ocidental/epidemiologia , Adulto Jovem
5.
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
6.
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
7.
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
8.
Aust N Z J Public Health ; 45(2): 101-107, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33617131

RESUMO

OBJECTIVE: This study explored whether all-cause healthcare attendance rate post-vaccination could detect the two historical influenza safety episodes occurring in 2010 and 2015 using a large de-identified general practitioner (GP) consultations dataset. METHODS: A retrospective observational cohort study was conducted using GP consultation data routinely collected from 2008 to 2017 in Victoria, Australia. Post-vaccination GP consultation rates were monitored, over a 22-week surveillance period each year that aligned with each year's influenza vaccination season, using the Observed minus Expected (O-E) and the Log-Likelihood Ratio (LLR) CUSUM charts. Days 1-7 post-vaccination were considered as the risk period. The LLR CUSUM was designed to detect both a 50% and two-fold rise in the odds of the baseline post-vaccination GP consultation rates. RESULTS: Over the 10-year study period, more than 1.5 million seasonal influenza vaccines doses were administered to 295,091 persons. Overall, 1.29% had a GP consultation within one week of vaccination, but 98.53% of the consultations occurred in days 1-3 post-vaccination. The LLR CUSUM chart detected significant increases in the weekly rates of post-vaccination GP consultation in 2010 in children aged under ten years and in 2015 in adults aged 19-64 years. These increases were aligned by week, but one week earlier and by age category, with the historical adverse events following immunisation (AEFI) signals occurring in 2010 and 2015. However, in the absence of historical AEFI signals, increased rates of post-vaccination GP consultations were identified in three of the eight influenza vaccination years. CONCLUSION: The crude post-vaccination healthcare attendance rate has the potential to offer a sensitive proxy to monitor vaccine safety signal. Implications for public health: Vaccine safety monitoring using syndromic indicator has the potential to augment the existing surveillance systems as part of an integrated vaccine safety monitoring approach.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Medicina Geral/estatística & dados numéricos , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/efeitos adversos , Influenza Humana/prevenção & controle , Vigilância da População/métodos , Vacinação/efeitos adversos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estações do Ano , Convulsões Febris/induzido quimicamente , Vitória/epidemiologia
9.
AIDS Res Hum Retroviruses ; 37(4): 322-328, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33586997

RESUMO

As of January 12, 2021, Australia has reported 28,634 COVID-19 cases. Most (20,411) cases are from the state of Victoria. In response to rising infections and community transmission in July 2020, on August 2nd, several restrictions were imposed for the following 111 days, including an 8pm curfew, a travel restriction to 5 km from home, and closure of nonessential services. It is unknown how this affected people living with HIV (PLHIV), who already experience disproportionate levels of mental health issues, comorbidity, and stigma. An online survey was designed with HIV community-based organizations to investigate the impact of the pandemic on Victorian PLHIV. Participants were recruited voluntarily both through social media and Infectious Diseases clinics at participating hospitals. There were 153 respondents. Most were male (77%), aged between 30 and 60 years (77%), and Australian-born (63%). Forty-three percent, 31%, and 25% reported negative impacts upon personal relationships, employment, and income, respectively. HIV care continued with 95% and 98% being able to access their HIV provider and antiretroviral therapy (ART), respectively. Telehealth was used by 92% and was largely well received. PLHIV reported worry about physical health (68%), mental health (66%), finances (50%),z and accommodation (25%). Fifty percent of participants reported weight gain and 27% increased alcohol intake. This study demonstrated the widespread negative effects of the COVID-19 pandemic on PLHIV in Victoria, although provision of HIV care and ART continued uninterrupted. This highlighted the importance of mental health support and social welfare programs during times of health care and societal strain.


Assuntos
/epidemiologia , Infecções por HIV/complicações , Pandemias , Adulto , /virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vitória/epidemiologia
10.
BMC Health Serv Res ; 21(1): 129, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33557805

RESUMO

BACKGROUND: Excessive waiting times for cancer elective surgery are a concern in publicly funded healthcare systems. Several countries including Australia have introduced healthcare reforms involving time-based targets and public performance reporting (PPR) of hospital data. However, there is mixed evidence of their benefits. We sought to examine the impact of targets and PPR of cancer elective surgery waiting times on access to breast, bowel and lung cancer elective surgery. METHODS: We analysed routinely-collected linked data on admissions and waiting times for patients aged 15 years or over (n = 199,885) who underwent cancer surgery in a public hospital in Victoria, Australia over a 10-year period. We conducted difference-in-differences analyses to compare waiting times before (2006-07 to 2011-12) and after (2012-13 to 2015-16) the introduction of PPR in meeting these targets. RESULTS: Across all cancer types, urgent patients were all treated within 30 days before and after PPR. Following PPR, there was a slight increase in the mean waiting times across all cancer types and urgency categories. Patients with lung cancer waited on average two and half days longer for treatment and patients with breast cancer waited on average half-a-day less. There was no effect of PPR on waiting times for patients with bowel cancer across urgency categories. CONCLUSIONS: Our findings suggest that time-based targets and PPR had minimal impact on surgical waiting times. This may be due to reasonable waiting times prior to PPR, improved efficiency being masked by 20% growth in the population, lack of public knowledge that waiting times are publicly reported, or lack of real-time reporting to drive behavioural change. The use of generic elective surgery recommended waiting time measures for cancer is discussed.


Assuntos
Neoplasias , Listas de Espera , Adolescente , Procedimentos Cirúrgicos Eletivos , Humanos , Armazenamento e Recuperação da Informação , Neoplasias/cirurgia , Vitória/epidemiologia
11.
BMJ Open ; 11(2): e044884, 2021 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568376

RESUMO

OBJECTIVES: Using routinely collected hospital data, this study explored secular trends over time in breast feeding initiation in a large Australian sample. The association between obesity and not breast feeding was investigated utilising a generalised estimating equations logistic regression that adjusted for sociodemographics, antenatal, intrapartum and postpartum conditions, mode of delivery and infant's-related covariates. DESIGN: Population-based retrospective panel. SETTING: A regional hospital that serves 26% of Victoria's 6.5 million population in Australia. PARTICIPANTS: All women experiencing live births between 2010 and 2017 were included. Women with missing body mass index (BMI) were excluded. RESULTS: A total of 7491 women contributed to 10 234 live births. At baseline, 57.2% of the women were overweight or obese, with obesity increasing over 8 years by 12.8%, p=0.001. Although, breast feeding increased over time, observed in all socioeconomic status (SES) and BMI categories, the lowest proportions were consistently found among the obese and morbidly obese (78.9% vs 87.1% in non-obese mothers, p<0.001). In the multivariable analysis, risk of not breast feeding was associated with higher BMI, teenage motherhood, smoking, belonging to the lowest SES class, gravidity >4 and undergoing an assisted vaginal or caesarean delivery. Compared with women with a normal weight, the obese and morbidly obese were 66% (OR 1.66, 95% CI 1.40 to 1.96, p<0.001) to 2.6 times (OR 2.61, 95% CI 2.07 to 3.29, p<0.001) less likely to breast feed, respectively. The detected dose-response effect between higher BMI and lower breast feeding was not explained by any of the study covariates. CONCLUSION: This study provides evidence of increasing breast feeding proportions in regional Victoria over the past decade. However, these proportions were lowest among the obese and morbidly obese and those coming from the most disadvantaged backgrounds suggesting the need for targeted interventions to support breast feeding among these groups. The psychosocial and physiological associations between obesity and breast feeding should further be investigated.


Assuntos
Aleitamento Materno , Obesidade Mórbida , Adolescente , Índice de Massa Corporal , Feminino , Humanos , Sobrepeso , Gravidez , Estudos Retrospectivos , Vitória/epidemiologia
12.
Health Promot J Austr ; 32(2): 352-358, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33571380

RESUMO

ISSUED ADDRESSED: COVID-19 has highlighted the disruptive, cross-sectorial effects a sudden-onset pandemic has on a globally interconnected world. The control of community transmission requires the identification and isolation of hotspots, commonly achieved through blanket measures or through ring-fencing. A simpler and more readily policeable, and geographically more flexible system is needed that allows both law enforcement and the public to detect people moving outside the ringfenced areas. METHODS: A narrative examination of the border closure between New South Wales and Victoria in June to September 2020. RESULTS: Enforcement of people's movement in and out of ring-fenced areas relies on voluntary, ethical compliance coupled with legal prosecution of violators. Despite extensive community health promotion for COVID-safe behaviour, the events of 2020 showed multiple, flagrant violations which were caught during random spot checks, as well as at the Murray River, a hard border set up along readily controllable and patrollable features (bridges). CONCLUSIONS: Given that most medium and long-distance movement in Australia is vehicular-based, this paper advocates for the introduction of European-style local government area based car registration which makes 'out of bounds' vehicle traffic readily recognisable by their number plates. SO WHAT?: Public health promotion, coupled with convenient and ubiquitous observation and enforcement tool, is likely to moderate community behaviour and ensure increased compliance with the directives of health authorities and associated promotion of COVID-safe behaviour.


Assuntos
/epidemiologia , Controle de Doenças Transmissíveis/legislação & jurisprudência , Aplicação da Lei/métodos , Humanos , New South Wales/epidemiologia , Pandemias , Vitória/epidemiologia
14.
Epilepsia ; 62(2): 358-370, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33475165

RESUMO

OBJECTIVE: To study the epilepsy syndromes among the severe epilepsies of infancy and assess their incidence, etiologies, and outcomes. METHODS: A population-based cohort study was undertaken of severe epilepsies with onset before age 18 months in Victoria, Australia. Two epileptologists reviewed clinical features, seizure videos, and electroencephalograms to diagnose International League Against Epilepsy epilepsy syndromes. Incidence, etiologies, and outcomes at age 2 years were determined. RESULTS: Seventy-three of 114 (64%) infants fulfilled diagnostic criteria for epilepsy syndromes at presentation, and 16 (14%) had "variants" of epilepsy syndromes in which there was one missing or different feature, or where all classical features had not yet emerged. West syndrome (WS) and "WS-like" epilepsy (infantile spasms without hypsarrhythmia or modified hypsarrhythmia) were the most common syndromes, with a combined incidence of 32.7/100 000 live births/year. The incidence of epilepsy of infancy with migrating focal seizures (EIMFS) was 4.5/100 000 and of early infantile epileptic encephalopathy (EIEE) was 3.6/100 000. Structural etiologies were common in "WS-like" epilepsy (100%), unifocal epilepsy (83%), and WS (39%), whereas single gene disorders predominated in EIMFS, EIEE, and Dravet syndrome. Eighteen (16%) infants died before age 2 years. Development was delayed or borderline in 85 of 96 (89%) survivors, being severe-profound in 40 of 96 (42%). All infants with EIEE or EIMFS had severe-profound delay or were deceased, but only 19 of 64 (30%) infants with WS, "WS-like," or "unifocal epilepsy" had severe-profound delay, and only two of 64 (3%) were deceased. SIGNIFICANCE: Three quarters of severe epilepsies of infancy could be assigned an epilepsy syndrome or "variant syndrome" at presentation. In this era of genomic testing and advanced brain imaging, diagnosing epilepsy syndromes at presentation remains clinically useful for guiding etiologic investigation, initial treatment, and prognostication.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Epilepsias Mioclônicas/epidemiologia , Espasmos Infantis/epidemiologia , Anticonvulsivantes/uso terapêutico , Pré-Escolar , Estudos de Coortes , Deficiências do Desenvolvimento/etiologia , Deficiências do Desenvolvimento/fisiopatologia , Progressão da Doença , Eletroencefalografia , Epilepsias Mioclônicas/tratamento farmacológico , Epilepsias Mioclônicas/etiologia , Epilepsias Mioclônicas/fisiopatologia , Síndromes Epilépticas/tratamento farmacológico , Síndromes Epilépticas/epidemiologia , Síndromes Epilépticas/etiologia , Síndromes Epilépticas/fisiopatologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Síndrome de Lennox Gastaut/tratamento farmacológico , Síndrome de Lennox Gastaut/epidemiologia , Síndrome de Lennox Gastaut/etiologia , Síndrome de Lennox Gastaut/fisiopatologia , Masculino , Malformações do Desenvolvimento Cortical/complicações , Malformações do Desenvolvimento Cortical/epidemiologia , Malformações do Desenvolvimento Cortical/cirurgia , Mortalidade , Índice de Gravidade de Doença , Espasmos Infantis/tratamento farmacológico , Espasmos Infantis/etiologia , Espasmos Infantis/fisiopatologia , Vitória/epidemiologia
16.
J Paediatr Child Health ; 57(6): 860-866, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33432713

RESUMO

AIM: To examine 10-year trends and inequalities in paediatric admission rates for acute and chronic Ambulatory Care Sensitive Conditions (ACSCs) in Victoria, Australia. METHODS: Secondary data analysis of the Victorian Admitted Episodes Dataset of children aged 0-17 years and 11 months admitted with a principal diagnosis of acute ACSCs: gastroenteritis/dehydration, dental conditions and urinary tract infections (UTIs) or chronic ACSCs: asthma and diabetic ketoacidosis, from 2003 to 2013. Main outcome measure was trends in paediatric hospital admission rates for ACSCs (per 1000 population). RESULTS: Over the 10 years, hospital admission rates remained consistently high for asthma and dental conditions. Children from socioeconomically disadvantaged areas were more likely to be admitted for all acute conditions over time. Dental conditions were the only ACSC associated with increased rates of admissions in regional areas. CONCLUSIONS: Inequalities in paediatric hospital admissions exist for acute conditions and have not changed from 2003 to 2013; disadvantaged Victorian children were more likely to be admitted to hospital at each time point. More equitable access to medical and dental care is needed. Primary care (medical and dental) should be a critical platform to address socio-economic differences and effectively prevent avoidable hospital admissions in children.


Assuntos
Assistência Ambulatorial , Acesso aos Serviços de Saúde , Criança , Hospitalização , Humanos , Atenção Primária à Saúde , Vitória/epidemiologia
17.
BMJ Open ; 11(1): e041782, 2021 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-33419912

RESUMO

OBJECTIVE: This study aimed to determine the frequency of mouthwash use and its association to oral sex practice in heterosexuals. DESIGN: A cross-sectional study. SETTING: Data obtained from a sexual health clinic in Victoria, Australia, between March 2019 and April 2019. PARTICIPANTS: Heterosexual men and women attending the sexual health clinic answered a survey using computer-assisted self-interview. PRIMARY AND SECONDARY OUTCOME MEASURES: Univariable and multivariable logistic regression were performed to examine the association between frequent mouthwash use (ie, daily or weekly mouthwash use) and oral sex practices (including tongue kissing, fellatio, cunnilingus and insertive rimming). RESULTS: There were 681 heterosexuals included in the analysis: 315 (46.3%) men and 366 (53.7%) women. Of participants, 302 (44.3%) used mouthwash frequently, 173 (25.4%) used mouthwash infrequently and 206 (30.2%) never used mouthwash. There was no significant difference in the proportion of frequent mouthwash users between men and women (46.4% of men vs 42.6% of women; p=0.329). The proportion of frequent mouthwash users increased with increasing age groups (39.3% in ≤24 years, 45.2% in 25-34 years and 52.8% in ≥35 years or older; ptrend=0.039) with those aged ≥35 years having a 1.80 times (95% CI: 1.12 to 2.89) higher odds of being a frequent mouthwash user than those aged ≤24 years. There were no significant associations between frequent mouthwash users had sexually transmitted infection (STI) risk after adjusting for age and country of birth. CONCLUSION: Older heterosexuals are more likely to use mouthwash. Given the high proportion and associations of mouthwash use in heterosexuals, future investigations related to oral STIs in this group should include mouthwash use.


Assuntos
Gonorreia , Doenças Sexualmente Transmissíveis , Adulto , Idoso , Estudos Transversais , Feminino , Heterossexualidade , Homossexualidade Masculina , Humanos , Masculino , Antissépticos Bucais , Comportamento Sexual , Vitória/epidemiologia , Adulto Jovem
19.
J Paediatr Child Health ; 57(5): 677-683, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33314475

RESUMO

AIM: Timely delivery of fetal growth restriction (FGR) is a balance between avoiding stillbirth and minimising prematurity. We sought to assess the neonatal outcomes for babies suspected of FGR, both true and false positives. METHODS: This population cohort study examined all singleton births in Victoria, Australia from 2000 to 2017 (n = 1 231 415). Neonatal morbidities associated with neonatal intensive care unit (NICU) admission were assessed for babies born ≥32 weeks' with severe FGR (<3rd centile) and babies with birthweight ≥10th centile who were iatrogenically delivered for suspected FGR. RESULTS: Babies with severe FGR iatrogenically delivered for suspected FGR were more likely to require NICU admission than babies with severe FGR who were not detected (3.0% vs. 1.1%, P < 0.001). After adjusting for potential confounders, the odds of NICU admission were increased (adjusted odds ratio (aOR) = 3.00, 95% confidence interval = 2.45-3.67; P < 0.001). Rates of NICU admission were also higher in ≥10th centile babies iatrogenically delivered for suspected FGR than for ≥10th centile babies who entered labour spontaneously (1.8% vs. 0.5%, P < 0.001). After adjustments, the odds of NICU admission were increased (aOR = 3.91, 95% confidence interval = 3.40-4.49; P < 0.001). NICU admissions were associated with morbidities related to iatrogenic prematurity. CONCLUSIONS: Detection and planned delivery of FGR reduces stillbirth but may be associated with increased neonatal morbidity related to iatrogenic prematurity.


Assuntos
Retardo do Crescimento Fetal , Peso ao Nascer , Estudos de Coortes , Feminino , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Vitória/epidemiologia
20.
J Pediatr ; 231: 61-67.e2, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33340547

RESUMO

OBJECTIVE: To examine the stability of developmental coordination disorder (DCD) throughout childhood in children born very preterm and term. Further, in the very preterm group, to compare perinatal variables and neurobehavioral outcomes at 13 years of age for children with persisting DCD and those with typical motor development. STUDY DESIGN: Prospective study of 180 very preterm and 73 term-born children assessed at 5, 7, and/or 13 years of age using the Movement Assessment Battery for Children, with scores ≤16th percentile used to classify DCD. Children with cerebral palsy or an IQ of <80 were excluded. RESULTS: Children born very preterm had increased odds for DCD at 5 (OR, 5.53; 95% CI, 2.53-12.0; P < .001), 7 (OR, 3.63; 95% CI, 1.43-9.18; P = .06), and 13 years (OR, 4.34; 95% CI, 1.61-11.7; P = .004) compared with term-born children. The rates of DCD in very preterm children reduced from 47.9% at 5 years of age, to 28.5% at 7 years and 27.8% at 13 years of age (OR per year of age, 0.81; 95% CI, 0.75-0.87; P < .001), but less so for term-born children (15.3%, 10.0%, and 8.5% at 5, 7, and 13-years respectively [OR, 0.91; 95% CI, 0.75-1.09; P = .31]). Within the very preterm group at 13 years of age, there was evidence that children with persisting DCD performed poorer across several cognitive domains compared with children with typical motor development, with differences in the order of 0.5-1.0 SD. CONCLUSIONS: Although the rates of DCD decreased across middle childhood for both groups, the odds for DCD were consistently higher for very preterm children compared with term, with important implications for cognitive functioning in the very preterm group.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Lactente Extremamente Prematuro , Doenças do Prematuro/epidemiologia , Transtornos das Habilidades Motoras/epidemiologia , Adolescente , Fatores Etários , Estudos de Casos e Controles , Criança , Pré-Escolar , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/etiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/etiologia , Estudos Longitudinais , Masculino , Transtornos das Habilidades Motoras/diagnóstico , Transtornos das Habilidades Motoras/etiologia , Testes Neuropsicológicos , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Vitória/epidemiologia
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