A data-driven approach to multiple-stressor impact assessment for a marine protected area

The coastal environment is not managed in a way that considers the impact of cumulative threats, despite being subject to threats from all realms (marine, land, and atmosphere). Relationships between threats and species are often nonlinear; thus, current (linear) approaches to estimating the impact of threats may be misleading. We developed a data-driven approach to assessing cumulative impacts on ecosystems and applied it to explore nonlinear relationships between threats and a temperate reef fish community. We used data on water quality, commercial fishing, climate change, and indicators of recreational fishing and urbanization to build a cumulative threat map of the northern region in New South Wales, Australia. We used statistical models of fish abundance to quantify associations among threats and biophysical covariates and predicted where cumulative impacts are likely to have the greatest impact on fish. We also assessed the performance of no-take zones (NTZs), to protect fish from cumulative threats across 2 marine protected area networks (marine parks). Fishing had a greater impact on fish than water quality threats (i.e., percent increase above the mean for invertivores was 337% when fishing was removed and was 11% above the mean when water quality was removed inside NTZs), and fishing outside NTZs affected fish abundances inside NTZs. Quantifying the spatial influence of multiple threats enables managers to understand the multitude of management actions required to address threats.

Emergence of Poultry-Associated Human Salmonella enterica Serovar Abortusovis Infections, New South Wales, Australia

Salmonella enterica serovar Abortusovis is a ovine-adapted pathogen that causes spontaneous abortion. Salmonella Abortusovis was reported in poultry in 2009 and has since been reported in human infections in New South Wales, Australia. Phylogenomic analysis revealed a clade of 51 closely related isolates from Australia originating in 2004. That clade was genetically distinct from ovine-associated isolates. The clade was widespread in New South Wales poultry production facilities but was only responsible for sporadic human infections. Some known virulence factors associated with human infections were only found in the poultry-associated clade, some of which were acquired through prophages and plasmids. Furthermore, the ovine-associated clade showed signs of genome decay, but the poultry-associated clade did not. Those genomic changes most likely led to differences in host range and disease type. Surveillance using the newly identified genetic markers will be vital for tracking Salmonella Abortusovis transmission in animals and to humans and preventing future outbreaks.

The impact of COVID-19 on adult burns: A statewide review of epidemiology and clinical outcomes

INTRODUCTION

The COVID-19 pandemic has significantly impacted the clinical presentations of burns and the provision of services. This study aims to describe and analyse patterns and trends in adult burns across New South Wales (NSW) and the Australian Capital Territory.

METHODS

A NSW statewide retrospective review was conducted from 2017 to 2022 for adult patients with burns. A comparative analysis was performed for the COVID-19 group (2020-2022) and control group between 2017 and 2019.

RESULTS

We found a total of 11,433 patients (7102 non-COVID vs 4331 COVID-19). The average age in the COVID-19 group was 1.4 years older than counterparts (40.6 vs 42.0, p < 0.001). The 18 - 25 and 36 - 45 age groups experienced significantly lower proportions of presentations, whereas, the 76-85 years experienced significantly higher proportions. There was a significantly higher proportion of pressure injuries (0.1% vs 0.4%, p < 0.001) and contact burns (17.2% vs 18.7%), but lower explosions (1.3% vs 0.2%) for the COVID-19 group compared to their counterparts. The mean TBSA% was 0.4% greater in the COVID-19 group compared to their counterparts (2.4 vs 2.8, p < 0.001). There were significantly more operating sessions (0.2 vs 0.3, p < 0.001). The mean length of stay was significantly greater by 0.8 days for the COVID-19 group compared to their counterparts (1.5 vs 2.3, p < 0.001).

CONCLUSIONS

Epidemiological changes were not greatly different to previous years from the impact of COVID-19. The shift in elderly presentations and operative interventions reflects the holistic care of burns units working in a new landscape with an invigorated focus on telehealth and outpatient care.

Genome characterization of influenza A and B viruses in New South Wales, Australia, in 2019: A retrospective study using high-throughput whole genome sequencing

BACKGROUND

During the 2019 severe influenza season, New South Wales (NSW) experienced the highest number of cases in Australia. This study retrospectively investigated the genetic characteristics of influenza viruses circulating in NSW in 2019 and identified genetic markers related to antiviral resistance and potential virulence.

METHODS

The complete genomes of influenza A and B viruses were amplified using reverse transcription-polymerase chain reaction (PCR) and sequenced with an Illumina MiSeq platform.

RESULTS

When comparing the sequencing data with the vaccine strains and reference sequences, the phylogenetic analysis revealed that most NSW A/H3N2 viruses (n = 68; 94%) belonged to 3C.2a1b and a minority (n = 4; 6%) belonged to 3C.3a. These viruses all diverged from the vaccine strain A/Switzerland/8060/2017. All A/H1N1pdm09 viruses (n = 20) showed genetic dissimilarity from vaccine strain A/Michigan/45/2015, with subclades 6B.1A.5 and 6B.1A.2 identified. All B/Victoria-lineage viruses (n = 21) aligned with clade V1A.3, presenting triple amino acid deletions at positions 162-164 in the hemagglutinin protein, significantly diverging from the vaccine strain B/Colorado/06/2017. Multiple amino acid substitutions were also found in the internal proteins of influenza viruses, some of which have been previously reported in hospitalized influenza patients in Thailand. Notably, the oseltamivir-resistant marker H275Y was present in one immunocompromised patient infected with A/H1N1pdm09 and the resistance-related mutation I222V was detected in another A/H3N2-infected patient.

CONCLUSIONS

Considering antigenic drift and the constant evolution of circulating A and B strains, we believe continuous monitoring of influenza viruses in NSW via the high-throughput sequencing approach provides timely and pivotal information for both public health surveillance and clinical treatment.

The New South Wales Sudden Cardiac Arrest Registry: A Data Linkage Cohort Study

BACKGROUND

Sudden cardiac arrest (SCA) in young people aged 1 to 50 years often occurs with no presenting symptoms or risk factors prompting screening for cardiovascular disease prior to their cardiac arrest. Approximately 3,000 young Australians suffer from sudden cardiac death (SCD) each year, making this a major public health issue. However, there is significant variation in the way incidence is estimated resulting in discrepancy across reporting which impacts our ability to understand and prevent these devastating events. We describe the New South Wales (NSW) Sudden Cardiac Arrest Registry: a retrospective, data linkage study which will identify all SCAs in the young in NSW from 2009 through to June 2022.

OBJECTIVE

To determine the incidence, demographic characteristics and causes of SCA in young people. We will develop an NSW-based registry that will contribute to a greater understanding of SCA including risk factors and outcomes.

METHODS

The cohort will include all people who experience a SCA in the NSW community aged between 1 to 50 years. Cases will be identified using the following three datasets: the Out of Hospital Cardiac Arrest Register housed at NSW Ambulance, the NSW Emergency Department Data Collection, and the National Coronial Information System. Data from eight datasets will be collected, anonymised and linked for the entire cohort. Analysis will be undertaken and reported using descriptive statistics.

CONCLUSIONS

The NSW SCA registry will be an important resource for the improved understanding of SCA and inform the widespread impacts it has on individuals, their families and society.

Trends in female sterilisations in New South Wales, 2010-2019

BACKGROUND

Female sterilisation remains a common contraceptive method in many countries.

AIMS

The aim is to analyse the recent changes in the incidence of female sterilisation in New South Wales (NSW).

METHODS

Data were obtained from the NSW Admitted Patients Data Collection for all female patients who had undergone one of the five sterilisation procedures in a public or private hospitals in NSW during 2010 and 2019. Denominators for calculating sterilisation rates were estimated using census and other population data.

RESULTS

The number of sterilisation cases dropped from 3407 in 2010 to 2561 in 2019, and the sterilisation rate declined from 22.6 per 10 000 females aged 20-49 in 2010 to 15.4 in 2019. Incidence was at its peak in the 35-39 age group in both years. Indigenous females had higher sterilisation rates than non-Indigenous females born in Australia or overseas. While some foreign-born females had higher sterilisation rates than for those who were in Australia or overseas on average their rates were lower than those who were born in Australia or overseas. There was a clear socio-economic gradient such that females living in the most disadvantaged areas had much higher sterilisation rates than those living in the least disadvantaged areas. The Indigenous, ethnic and socio-economic differences in sterilisation rates persisted in both years of this study.

CONCLUSION

Although fertility rates in NSW changed little over the 10-year interval a steady decline in sterilisation occurred, consistent with other forms of contraception (particularly long-acting reversible types) increasing concurrently in popularity.

Exclusive Breastfeeding at Discharge in Regional New South Wales, Australia: The Role of Antenatal Care (2011-2020)

Increasing the number of infants exclusively breastfeeding on discharge from the hospital after birth is a key goal of breastfeeding policy in New South Wales (NSW), Australia. Despite consistent efforts, exclusive breastfeeding on discharge rates have declined over the past decade. Using pooled data from the New South Wales Perinatal Data Collection from 2011 to 2020, we examined the association between antenatal care (ANC) and exclusive breastfeeding at discharge from birth admission outcomes for mother-baby dyads in Southern New South Wales Local Health District (SNSWLHD). Our study confirmed that exclusive breastfeeding rates in SNSWLHD have declined over the past decade, providing local evidence to support action. Late entry to ANC and a failure to attend the recommended number of ANC visits were important predictors of a lower rate of exclusive breastfeeding on discharge. Improving accessibility to ANC visits for rural and regional mothers has potential to positively impact breastfeeding rates in SNSWLHD. We suggest that wider implementation of caseload midwifery models may have a positive impact on breastfeeding outcomes in the region for all mother-baby dyads, but particularly for Aboriginal mothers and infants, younger mothers and mothers experiencing disadvantage.

The Epidemiology of Infective Endocarditis in New South Wales, Australia: A Retrospective Cross-Sectional Study From 2001 to 2020

OBJECTIVES

This study aimed to investigate the demographic differences amongst patients diagnosed with infective endocarditis (IE), predictors of adverse events, and the association between clinical decision-making and adverse health outcomes amongst patients with IE.

DESIGN

A retrospective cross-sectional study was conducted using the New South Wales (NSW) Admitted Patient Data Collection (APDC) from the Centre for Health Record Linkage (CHeReL).

PARTICIPANTS

All patients (N=18,044) from 2001 to 2020 in New South Wales who received a diagnosis of IE using ICD-10-AM diagnostic code 133.0 were included.

METHODS

Categorical variables were compared using the chi-square test or Fisher's exact test, while the t-test was used for continuous variables. The association between clinical decision-making and adverse health outcomes amongst patients with IE were examined via generalised linear mixed models.

RESULTS

Sex, age, birthplace and referral impacted clinical decision-making, in-hospital death and severity of the disease. Women experienced a higher risk of death and fewer escalations of care. Admission and mortality increased with age, with those aged 60 and above responsible for 60.8% of hospitalisations. Despite octogenarians making up one-fifth of admissions and having the worst mortality rate (15.1%), they experienced only one in 10 intensive care (ICU) admissions. Overseas-born patients had fewer escalations of care and experienced less severe disease if referred by a medical practitioner. One out of 10 admissions that resulted in a hospital death were given non-emergency status, and one in two ICU patients died in hospital.

CONCLUSIONS

Sex, age, place of birth, and clinical decision-making were important predictors of severe disease and death in hospital, lending weight that health care clinical decisions may adversely impact health outcomes for populations of interest.

Implementation of a successful infection prevention and control governance structure and capacity building strategies during COVID-19 pandemic - A brief report

An analysis of the Clinical Excellence Commissions response to COVID-19 prevention and protection measures identified the need to build on the existing governance process to achieve a more structured and methodical approach. The infection prevention and control measures and strategies implemented within health and nonhealth care, proved to be effective and sustainable with the ability to build additional clinician capacity even during an ongoing pandemic.

Impact of Antenatal Care on Perinatal Outcomes in New South Wales, Australia: A Decade-Long Regional Perspective

Low birth weight (LBW) and preterm birth are adverse perinatal outcomes that pose a significant risk to a child's healthy beginning. While antenatal care (ANC) is an established intervention for pregnancy care, little is understood about how the number and timing of ANC visits can impact these adverse health outcomes. This study aimed to examine the impact of the number and timing of ANC visits on LBW and preterm birth in a regional setting. A decade-long perinatal dataset related to singleton live births that took place in the Southern New South Wales Local Health District (SNSWLHD) was utilized. The outcomes of interest were LBW and preterm birth, and the exposure variables were based on the Australian pregnancy guidelines on the number and timing of ANC visits. A multivariable logistic regression was performed to measure the association between outcome and exposure while adjusting for potential confounders. A greater level of protection against LBW and preterm birth was observed among mothers who had an adequate number of visits, with early entry (first trimester) into ANC. The protective effect of an adequate number of ANC visits against LBW and preterm birth among mothers with late entry into ANC (third trimester) was found to be statistically non-significant.

Government Actions and Their Relation to Resilience in Healthcare During the COVID-19 Pandemic in New South Wales, Australia and Ontario, Canada

BACKGROUND

Resilience, a system's ability to maintain a desired level of performance when circumstances disturb its functioning, is an increasingly important concept in healthcare. However, empirical investigations of resilience in healthcare (RiH) remain uncommon, particularly those that examine how government actions contribute to the capacity for resilient performance in the healthcare setting. We sought to investigate how governmental actions during the coronavirus disease 2019 (COVID-19) pandemic related to the concept of resilience, how these actions contributed to the potential for resilient performance in healthcare, and what opportunities exist for governments to foster resilience within healthcare systems.

METHODS

We conducted case studies of government actions pertaining to the COVID-19 pandemic in New South Wales, Australia and Ontario, Canada. Using media releases issued by each government between December 2019 and August 2020, we performed qualitative content analysis to identify themes relevant to the resilience potentials (anticipate, monitor, respond, learn) and RiH.

RESULTS

Direct references to the term 'resilience' appeared in the media releases of both governments. However, these references focused on the reactive aspects of resilience. While actions that constitute the resilience potentials were evident, the media releases also revealed opportunities to enhance learning (eg, a need to capitalize on opportunities for double-loop learning and identify strategies appropriate for complex systems) and anticipating (eg, incorporating the concept of hedging into frameworks of RiH).

CONCLUSION

Though fostering RiH through government action remains a challenge, this study suggests opportunities to realize this goal. Articulating a proactive vision of resilience and recognizing the complex nature of current systems could enhance governments' ability to coordinate resilient performance in healthcare. Reflection on how anticipation relates to resilience appears necessary at both the practical and conceptual levels to further develop the capacity for RiH.

Rates of homicide and homicide associated with severe mental illness in NSW between 1993 and 2016

OBJECTIVE

To describe the characteristics of offenders found not guilty on the grounds of mental illness (NGMI) in New South Wales and rates of NGMI and other homicide verdicts.

METHOD

Demographic, legal and clinical data after referral to the NSW Mental Health Review Tribunal following an NGMI verdict for homicide matched with results from the National Homicide Monitoring Program.

RESULTS

Between 1993 and 2016, a total of 2159 homicide offenders were dealt with by the NSW courts, including 169 (7.8%) who were found NGMI. Over this period, the rate of non-NGMI homicide convictions fell from 1.83 per 100,000 per annum to 0.65 per 100,000 per annum (Kendall's tau = -0.79, p ⩽ 0.001) while the rate of NGMI homicide fluctuated, with an average annual rate of about 0.1 per 100,000 per annum (Kendall's tau = 0.17, p = 0.23). There was no association between the annual rates of NGMI and non-NGMI homicides (Pearson r = -0.3, p = 0.16) but falling rate of non-NGMI homicide meant that the proportion of NGMI offences doubled from 5.5% in the first 12 years to 11% in the second 12 years. Nearly all (88.7%) of those found NGMI had a schizophrenia-related psychosis. However, there were high rates of psychiatric comorbidity including substance use disorder (60.7%) and a history of a prior head injury (41.1%). Most (83.4%) of the NGMI offenders had previous contact with mental health services, but only half of these had received treatment with antipsychotic medication.

CONCLUSION

The fall in conviction for homicide offences in the last 24 years has not been matched by a reduction in NGMI homicide verdicts. More assertive treatment of emerging psychosis and comorbid substance use disorders, and improved continuity of care of chronic psychosis might prevent some homicides.

Food system policy making and innovation at the local level: Exploring the response of Australian local governments to critical food systems issues

ISSUES ADDRESSED

Urgent action is required by all levels of government to create a food system capable of nourishing a rapidly growing population while remaining within planetary boundaries. This study investigated policies and programs implemented by Australian local governments (LGs) that aim to contribute to a healthy, sustainable and equitable food system.

METHODS

An online survey was completed by LGs (n = 64) in New South Wales and Victoria, Australia. Questions focused on LGs' food system-related policies and programs, barriers to and enablers of engaging in food system work and organisational responsibilities for food system work.

RESULTS

Preventing food waste, organising food-related social/cultural events and providing potable water were the most commonly reported activities. Few LGs reported policies/activities on market gardening or sustainable agricultural practices, or strengthening food system resilience. LGs implemented a wide range of initiatives, such as hosting food forums, using research to identify and address food access issues and providing healthy food and drink options within LG-owned/managed facilities. Enablers of food system work included internal LG support, human resources, external funding and partnerships. Barriers included lack of community interest, short-term and/or project-based funding, internal governance issues and restrictive state government planning frameworks.

CONCLUSION

Australian LGs undertake a wide range of actions addressing diverse food system issues; however, internal and external barriers constrain their involvement in creating a healthy, sustainable and equitable food system. SO WHAT?: Legislative reform, combined with increased financial and human resource capacity, would support LGs to expand, strengthen and sustain their food system work.

The burden of diabetes-related foot disease among older adults in Australia

Diabetes‐related foot disease (DFD) is imposing an enormous burden on the health system and society due to the rapid growth of diabetes worldwide. Given the paucity of robust data on the disease burden of DFD in Australia, this study aimed to estimate the burden of disease due to DFD. The burden of DFD was estimated using the disability‐adjusted life‐years (DALY) approach. Data of 27 931 individuals aged 45 years and older with diabetes residing in New South Wales (NSW) from the 45 and Up Study survey were used in this study by linking it with the emergency department, hospital admissions and the deaths' registry data. The disease burden of DFD was estimated as 8915 DALY in NSW and 27 164 DALY in Australia in 2011. The burden was prominent among males and people aged 65 years and older. Most of the DALY (87%) was attributed to years of life lost or the fatal burden due to diabetes‐related lower limb amputation (DRLEA). The total monetary values of DALY of DFD for NSW and Australia were estimated at approximately AUD 2 billion and AUD 6 billion annually, respectively. Preventative and curative priorities should be given to DRLEA to reduce this burden and target males, especially those aged 65 years and older.

Prevalence and Burden of Diabetes-Related Foot Disease in New South Wales, Australia: Evidence from the 45 and Up Study Survey Data Linked with Health Services Data

Diabetes-related foot disease (DFD) is a major public health concern due to the higher risks of hospitalisation. However, estimates of the prevalence of DFD in the general population are not available in Australia. This study aims to estimate the prevalence of DFD and diabetes-related lower-extremity amputation (DLEA) among people aged 45 years and over in New South Wales (NSW), Australia. The NSW 45 and Up Study baseline survey data of 267,086 persons aged 45 years and over, linked with health services' administrative data from 2006 to 2012 were used in our study. Of these, 28,210 individuals had been diagnosed with diabetes, and our study identified 3035 individuals with DFD. The prevalence of DFD, diabetic foot ulcer (DFU), diabetic foot infection (DFI), diabetic gangrene (DG), and DLEA were 10.8% (95%CI: 10.3, 11.2), 5.4% (95% CI: 5.1, 5.8), 5.2% (95%CI: 4.9, 5.5), 0.4% (95%CI: 0.3, 0.5), and 0.9% (95%CI: 0.7, 1.0), respectively. DFD, DFU, DFI, DG, and DLEA were the most common among those who were older, born in Australia, from low-income households (<AUD 20,000), or were without private health insurance. Interventional messages to reduce all forms of DFD should target those who are from high-risk groups.

Residency and movement patterns of adult Port Jackson sharks (Heterodontus portusjacksoni) at a breeding aggregation site

Examining the movement ecology of mesopredators is fundamental to developing an understanding of their biology, ecology and behaviour, as well as the communities and ecosystems they influence. The limited research on the residency and movements of benthic marine mesopredators has primarily used visual tags, which do not allow for the efficient and accurate monitoring of individual space use. In this study, the authors investigated the residency and movement patterns of Port Jackson sharks Heterodontus portusjacksoni (Meyer 1793) at a breeding aggregation site in Jervis Bay, south-eastern Australia, using passive acoustic telemetry to further our understanding of the movement ecology of these important mesopredators. Between 2012 and 2014, individuals were tagged with acoustic transmitters, and their residency and movements within the bay were monitored for up to 4 years. H. portusjacksoni showed strong preferences for particular reefs within and between breeding seasons. Males had significantly higher residency indices at their favoured sites relative to females, suggesting that males may be engaging in territorial behaviour. Conversely, female H. portusjacksoni exhibited higher roaming indices relative to males indicating that females may move between sites to assess males. Finally, H. portusjacksoni showed temporal variation in movements between reefs with individuals typically visiting more reefs at night relative to the day, dusk and dawn corresponding with their nocturnal habits.

Field succession studies and casework can help to identify forensically useful Diptera

Fly development rates, and to a lesser extent succession data, can be used to provide an estimate of a minimum postmortem interval (mPMI). Yet, these data are most useful when a full account of species' ecology, seasonality, and distribution is known. We conducted succession experiments on human cadavers over different seasons near Sydney, Australia, to document forensically useful information, including the pre-appearance interval for carrion flies. We also compiled a detailed record of flies identified in casework collected in 156 cases distributed across New South Wales, Australia. We then compared the occurrence of fly species from both field and casework datasets to identify any consistencies or gaps to determine how useful species might be for forensic investigations. In the field experiments, we found differences in species diversity and abundance between seasons, as well as yearly variation between two winter seasons. Most fly species we recorded ovipositing showed a 2- or 3-day delay between adult arrival and oviposition in summer, with a longer delay in winter. Species that were previously encountered in casework, such as Calliphora augur (Fabricius, 1775) and Calliphora ochracea Schiner, 1868, were confirmed as forensically useful, with their colonization behavior and seasonal preferences documented here. Although not encountered in casework, we confirmed Hemipyrellia fergusoni Patton, 1925 as a primary colonizer of human cadavers. Our study emphasizes the need to link field and casework data for a complete understanding of all aspects of a carrion fly's ecology to assist forensic investigators in mPMI estimations.

Cancer transmissions and non-transmissions from solid organ transplantation in an Australian cohort of deceased and living organ donors

Evidence on cancer transmission from organ transplantation is poor. We sought to identify cases of cancer transmission or non-transmission from transplantation in an Australian cohort of donors and recipients. We included NSW solid organ deceased donors 2000-2012 and living donors 2004-2012 in a retrospective cohort using linked data from the NSW Biovigilance Register (SAFEBOD). Central Cancer Registry (CCR) data 1972-2013 provided a minimum one-year post-transplant follow-up. We identified cancers in donors and recipients. For each donor-recipient pair, the transmission was judged likely, possible, unlikely, or excluded using categorization from international guidelines. In our analysis, transmissions included those judged likely, while those judged possible, unlikely, or excluded were non-transmissions. In our cohort, there were 2502 recipients and 1431 donors (715 deceased, 716 living). There were 2544 transplant procedures, including 1828 (72%) deceased and 716 (28%) living donor transplants. Among 1431 donors, 38 (3%) had past or current cancer and they donated to 68 recipients (median 6.7-year follow-up). There were 64 (94%) non-transmissions, and 4 (6%) transmissions from two living and two deceased donors (all kidney cancers discovered during organ recovery). Donor transmitted cancers are rare, and selected donors with a past or current cancer may be safe for transplantation.

An Australian collector's authority file, 1973-2020

Background

Biodiversity databases contain omissions and errors, including those resulting from data entry mistakes and from the use of outdated or incorrect data sources. Some of these omissions and errors can be minimised by the use of authority files, such as expert-compiled taxonomic name databases. However, there are few publicly available authority files for collecting events, and the "where", "when" and "by whom" of specimen data are typically entered into biodiversity databases separately and directly, item by item from specimen labels.

New information

Here I describe a publicly available compilation of 3829 of my own collecting events over a 48-year period in Australia. Each record contains a unique combination of date, georeferenced location and location notes.

Opportunities for strengthening sexual health education in schools: Findings from a student needs assessment in NSW

ISSUE ADDRESSED

Comprehensive sexuality education (CSE) is important for the sexual and reproductive health of young people. To better understand young people's views and experiences of sexual health education in NSW, a student needs assessment survey was conducted in 2017.

METHODS

This paper presents the findings from 1603 NSW students in Years 8-12 following online recruitment. Descriptive analyses explored students' views and experiences in relation to sources of sexual health information, education providers, school-based topics covered and resources drawn on.

RESULTS

Findings indicate that school, parents, friends and social media are students' most common sources of information on sexual and reproductive health. Approximately one-third of students reported wanting more information on topics related to relationships, reproductive health, consent and sexual decision-making and sexual harassment, abuse and bullying, and two-thirds of transgender and gender diverse students wanted more information on gender identity. For the topics which students reported receiving the least information about at school, they were most likely to seek this out on social media and websites.

CONCLUSION

Findings provide valuable insight for improving CSE in NSW. The influence of social media, parents and the internet should be taken into consideration when developing resources and programme content. Professional development for educators could contribute to improving the quality of CSE delivered. Accurate and up to date resources must be utilised to support student engagement and effective learning.

Influenza outbreaks in aged care facilities in New South Wales in 2017: impact and lessons for surveillance

Introduction

A record number of influenza outbreaks in aged care facilities (ACFs) in New South Wales (NSW) during 2017 provided an opportunity to measure the health impact of those outbreaks and assess the quality of routinely available surveillance data.

Methods

Data for all ACF influenza outbreaks in NSW in 2017 were extracted from the Notifiable Conditions Information Management System. The numbers of outbreaks, residents with influenza-like illness (ILI), hospital admissions and deaths were assessed. For each outbreak the attack rate; duration; timeliness of notification; resident and staff influenza vaccination coverage; and antiviral use for treatment or prophylaxis were analysed. Data were considered for NSW in total and separately for seven of the state's local health districts. Data completeness was assessed for all available variables.

Results

A total of 538 ACF outbreaks resulted in 7,613 residents with ILI, 793 hospitalisations and 338 deaths. NSW outbreaks had a median attack rate of 17% and median duration of eight days. Data completeness, which varied considerably between districts, limited the capacity to accurately consider some important epidemiological and policy issues.

Discussion

Influenza outbreaks impose a major burden on the residents and staff of ACFs. Accurate assessment of the year-to-year incidence and severity of influenza outbreaks in these facilities is important for monitoring the effectiveness of outbreak prevention and management strategies. Some key data were incomplete and strategies to improve the quality of these data are needed, particularly for: the number of influenza-related deaths among residents; resident and staff vaccination coverage prior to outbreaks; and recorded use of antiviral prophylaxis.

Method-Specific Suicide Mortality Trends in Australian Men from 1978 to 2017

In 2017 Australia saw the highest overall suicide rate in the past 10 years, with male suicide rates three times higher than in women. Since the mid-1980s there have been major changes in suicide epidemiology in Australia with large shifts in method of suicide among both men and women. This study examined method-specific suicide trends in Australian men over the past 40 years by state. Suicide mortality data for the period 1978 to 2017 was obtained from the Australian Institute of Health and Welfare (AIHW) National Mortality Database and log-linear Poisson regression analysis was used to analyse suicide mortality. This study found large differences between states in patterns and trends in suicide mortality from 1978 to 2017. Hanging, gas and firearms were the most common methods of suicide in Australia. We found statistically significant increasing trends in hanging suicide among men in all six states. The study findings highlight the growing concern of hanging-related suicide in all states in Australia since the late 1970s. New suicide prevention strategies focusing on the ubiquity and ease of hanging as a method will be needed in order for Australia to reduce suicide mortality in future.

An improved SPEI drought forecasting approach using the long short-term memory neural network

Droughts are slow-moving natural hazards that gradually spread over large areas and capable of extending to continental scales, leading to severe socio-economic damage. A key challenge is developing accurate drought forecast model and understanding a models' capability to examine different drought characteristics. Traditionally, forecasting techniques have used various time-series approaches and machine learning models. However, the use of deep learning methods have not been tested extensively despite its potential to improve our understanding of drought characteristics. The present study uses a deep learning approach, specifically the Long Short-Term Memory (LSTM) to predict a commonly used drought measure, the Standard Precipitation Evaporation Index (SPEI) at two different time scales (SPEI 1, SPEI 3). The model was compared with other common machine learning method, Random Forests, Artificial Neural Networks and applied over the New South Wales (NSW) region of Australia, using hydro-meteorological variables as predictors. The drought index and predictor data were collected from the Climatic Research Unit (CRU) dataset spanning from 1901 to 2018. We analysed the LSTM forecasted results in terms of several drought characteristics (drought intensity, drought category, or spatial variation) to better understand how drought forecasting was improved. Evaluation of the drought intensity forecasting capabilities of the model were based on three different statistical metrics, Coefficient of Determination (R²), Root Mean Square Error (RMSE), and Mean Absolute Error (MAE). The model achieved R² value of more than 0.99 for both SPEI 1 and SPEI 3 cases. The variation in drought category forecasted results were studied using a multi-class Receiver Operating Characteristic based Area under Curves (ROC-AUC) approach. The analysis revealed an AUC value of 0.83 and 0.82 for SPEI 1 and SPEI 3 respectively. The spatial variation between observed and forecasted values were analysed for the summer months of 2016-2018. The findings from the study show an improvement relative to machine learning models for a lead time of 1 month in terms of different drought characteristics. The results from this work can be used for drought mitigation purposes and different models need to be tested to further enhance our capabilities.

Breast cancer treatment and survival differences in women in remote and socioeconomically disadvantaged areas, as demonstrated by linked data from New South Wales (NSW), Australia

INTRODUCTION

Reducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks. Reducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks.

METHODS

A retrospective cohort study used linked data for invasive breast cancers, diagnosed in May 2002 to December 2015 from the NSW Cancer Registry, with corresponding inpatient, and medical and pharmaceutical insurance data. Associations between treatment modalities, area socioeconomic status and residential remoteness were explored using logistic regression. Predictors of breast cancer survival were investigated using Kaplan-Meier product-limit estimates and multivariate competing risk regression.

RESULTS

Results indicated a high 5-year disease-specific survival in NSW of 90%. Crude survival was equivalent by residential remoteness and marginally lower in lower socioeconomic areas. Competing risk regression showed equivalent outcomes by area socioeconomic status, except for the least disadvantaged quintile, which showed a higher survival. Higher sub-hazard ratios for death occurred for women with breast cancer aged 70 + years, and more advanced stage. Adjusted analyses indicated more advanced stage in lower socioeconomic areas, with less breast reconstruction and radiotherapy, and marginally less hormone therapy for women from these areas. Conversely, among these women who had breast conserving surgery, there was higher use of chemotherapy. Remoteness of residence was associated in adjusted analyses with less radiotherapy and less immediate breast reconstruction. In these short term data, remoteness of residence was not associated with lower survival.

CONCLUSION

This study provides benchmarks for monitoring future variations in treatment and survival.

Female breast cancer in New South Wales, Australia, by country of birth: implications for health-service delivery

BACKGROUND

NSW has a multicultural population with increasing migration from South East Asia, the Western Pacific and Eastern Mediterranean.

OBJECTIVE

To compare cancer stage, treatment (first 12 months) and survival for 12 country of birth (COB) categories recorded on the population-based NSW Cancer Registry.

DESIGN

Historic cohort study of invasive breast cancers diagnosed in 2003-2016.

PATIENTS

Data for 48,909 women (18+ ages) analysed using linked cancer registry, hospital inpatient and Medicare and pharmaceutical benefits claims data.

MEASUREMENT

Comparisons by COB using multivariate logistic regression and proportional hazards regression with follow-up of vital status to April 30th, 2020.

RESULTS

Compared with the Australia-born, women born in China, the Philippines, Vietnam and Lebanon were younger at diagnosis, whereas those from the United Kingdom, Germany, Italy and Greece were older. Women born in China, the Philippines, Vietnam, Greece and Italy lived in less advantaged areas. Adjusted analyses indicated that: (1) stage at diagnosis was less localised for women born in Germany, Greece, Italy and Lebanon; (2) a lower proportion reported comorbidity for those born in China, the Philippines and Vietnam; (3) surgery type varied, with mastectomy more likely for women born in China, the Philippines and Vietnam, and less likely for women born in Italy, Greece and Lebanon; (4) radiotherapy was more likely where breast conserving surgery was more common (Greece, Italy, and Lebanon) and the United Kingdom; and (5) systemic drug therapy was less common for women born in China and Germany. Five-year survival in NSW was high by international standards and increasing. Adjusted analyses indicate that, compared with the Australian born, survival from death from cancer at 5 years from diagnosis was higher for women born in China, the Philippines, Vietnam, Italy, the United Kingdom and Greece.

CONCLUSIONS

There is diversity by COB of stage, treatment and survival. Reasons for survival differences may include cultural factors and healthier migrant populations with lower comorbidity, and potentially, less complete death recording in Australia if some women return to their birth countries for treatment and end-of-life care. More research is needed to explore the cultural and clinical factors that health services need to accommodate.

Long lead time drought forecasting using lagged climate variables and a stacked long short-term memory model

Drought forecasting with a long lead time is essential for early warning systems and risk management strategies. The use of machine learning algorithms has been proven to be beneficial in forecasting droughts. However, forecasting at long lead times remains a challenge due to the effects of climate change and the complexities involved in drought assessment. The rise of deep learning techniques can solve this issue, and the present work aims to use a stacked long short-term memory (LSTM) architecture to forecast a commonly used drought measure, namely, the Standard Precipitation Evaporation Index. The model was then applied to the New South Wales region of Australia, with hydrometeorological and climatic variables as predictors. The multivariate interpolated grid of the Climatic Research Unit was used to compute the index at monthly scales, with meteorological variables as predictors. The architecture was trained using data from the period of 1901-2000 and tested on data from the period of 2001-2018. The results were then forecasted at lead times ranging from 1 month to 12 months. The forecasted results were analysed in terms of drought characteristics, such as drought intensity, drought onset, spatial extent and number of drought months, to elucidate how these characteristics improve the understanding of drought forecasting. The drought intensity forecasting capability of the model used two statistical metrics, namely, the coefficient of determination (R²) and root-mean-square error. The variation in the number of drought months was examined using the threat score technique. The results of this study showed that the stacked LSTM model can forecast effectively at short-term and long-term lead times. Such findings will be essential for government agencies and can be further tested to understand the forecasting capability of the presented architecture at shorter temporal scales, which can range from days to weeks.

Integrative species delimitation and community structure of nematodes in three species of Australian flathead fishes (Scorpaeniformes: Platycephalidae)

This study aimed to determine the integrative characterisation of nematodes from three species of edible flathead fishes (Scorpaeniformes: Platycephalidae) in New South Wales, Australia, and describe nematode communities within three species of flatheads. Tiger (Platycephalus richardsoni (Castelnau); n = 20) and sand flatheads (Platycephalus bassensis (Cuvier); n = 20), sourced from the Nelson Bay area, and dusky flathead (Platycephalus fuscus (Cuvier); n = 20) from the Manning River, Taree, were examined for the presence of nematodes. The nematodes were initially classified morphologically as 12 different morphotypes belonging to the families Anisakidae (Anisakis types I, II, and III, Contracaecum type II, Terranova types I and II), Raphidascarididae (Hysterothylacium types IV, VI, VIII, and H. zhoushanense larva), and Gnathostomatidae (Echinocephalus sp. larva), Capillariidae (Capillaria sp.), followed by genetic identification through sequencing of the internal transcribed spacer (ITS-1, 5.8S, ITS-2) regions. Phylogenetic analyses revealed the evolutionary relationship between the identified larval specimens in the present study with available GenBank larval and adult nematodes. Sand flathead was 90% infected with nematodes followed by tiger flathead at 85% and dusky flathead at 15%. Nematodes infecting estuarine dusky and oceanic sand and tiger flatheads contrasted markedly. The analysis of similarities (ANOSIM) showed significant differences (p < 0.001) in the composition of taxa within nematode communities between the three species of flatheads (global R = 0.208) with the highest difference being between sand and dusky flatheads (R = 0.308, p < 0.001). The findings of the present study provide a foundation for future investigations of the community composition, life cycles, and distribution of nematode populations in edible fish in Australia and explore and clarify their significance to public health.

An Ethics Framework for Making Resource Allocation Decisions Within Clinical Care: Responding to COVID-19

On March, 24, 2020, 818 cases of COVID-19 had been reported in New South Wales, Australia, and new cases were increasing at an exponential rate. In anticipation of resource constraints arising in clinical settings as a result of the COVID-19 pandemic, a working party of ten ethicists (seven clinicians and three full-time academics) was convened at the University of Sydney to draft an ethics framework to support resource allocation decisions. The framework guides decision-makers using a question-and-answer format, in language that avoids philosophical and medical technicality. The working party met five times over the following week and then submitted a draft Framework for consideration by two groups of intensivists and one group of academic ethicists. It was also presented to a panel on a national current affairs programme. The Framework was then revised on the basis of feedback from these sources and made publicly available online on April 3, ten days after the initial meeting. The framework is published here in full to stimulate ongoing discussion about rapid development of user-friendly clinical ethics resources in ongoing and future pandemics.

Online social media tells a story of Anaselina, Paraselina, and Selivinga (Orthoptera, Tetrigidae), rare Australian pygmy grasshoppers

Knowledge on the pygmy grasshoppers of Australia is, despite the numerous endemics being described from this unique continent, still scarce. Of interest is the Vingselina genus group, including genera Anaselina Storozhenko, 2019, Paraselina Storozhenko, 2019, Selivinga Storozhenko, 2019 and Vingselina Sjöstedt, 1921. The systematic position of this group, currently assigned to Batrachideinae (Bufonidini), is probably not correct. In this study new records are presented of Anaselinaminor (Sjöstedt, 1921), Paraselinabrunneri (Bolívar, 1887), P.trituberculata (Sjöstedt, 1932), and Selivingatribulata Storozhenko, 2019, all except A.minor the first records of the species since their original descriptions. The first photographs of living specimens of A.minor, P.brunneri, P.trituberculata and S.tribulata are provided and their habitats described. All the records were compiled by citizen scientists who use online social media, such as iNaturalist. Lastly, P.multifora (Rehn, 1952) syn. nov. represents a junior synonym of P.brunneri.

A Complexity Perspective on Narrative Identity Reconstruction in Mental Health Recovery

The issue of complex nonlinear change processes is one of the least understood aspects of recovery and one of the most difficult to apply in recovery-oriented health care. The purpose of this article is to explore the recovery stories of 17 mental health peer support workers to understand their narrative identity reconstruction in recovery using a complexity perspective. Using the Life Story Model of Identity (LSMI), a narrative thematic analysis of interviews suggests that self-mastery as part of personal agency is an important component of participants' narrative identity reconstruction. Self-mastery is particularly evident in redemptive story turning points (positive outcome follows negative experience). A complexity perspective suggests that participants realized their adaptive capacity in relation to self-mastery as part of recovery and that its use at story turning points critically influenced their recovery journey. Further exploring self-mastery as adaptive growth in narrative identity reconstruction appears to be a fruitful research direction.

Clinical Profiles and Survival Outcomes of Patients With Well-Differentiated Neuroendocrine Tumors at a Health Network in New South Wales, Australia: Retrospective Study

Background

Neuroendocrine tumors (NETs) are a heterogeneous group of malignancies with varying and often indolent clinicobiological characteristics according to their primary location. NETs can affect any organ and hence present with nonspecific symptoms that can lead to a delay in diagnosis. The incidence of NETs is increasing in Australia; data regarding characteristics of NETs were collected from the cancer registry of Hunter New England, Australia.

Objective

This study aimed to explore the clinical profiles and treatment and survival outcomes of patients with well-differentiated NETs in an Australian population.

Methods

We reviewed the data of all adult patients who received the diagnosis of NET between 2008 and 2013. The clinicopathological, treatment, and follow-up data were extracted from the local Cancer Clinical Registry. We also recorded the level of remoteness for each patient by matching the patient’s residential postcode to the corresponding Australian Bureau of Statistics 2011 remoteness area category. Univariate analysis was used to find the factors associated with NET-related mortality. Survival analysis was computed.

Results

Data from 96 patients were included in the study (men: 37/96, 38.5%, and women: 59/96, 61.5%). The median age at diagnosis was approximately 63 years. A higher proportion of patients lived in remote/rural areas (50/96, 52.1%) compared with those living in city/metropolitan regions (46/96, 47.9%). The most common primary tumor site was the gastroenteropancreatic tract, followed by the lung. The factors significantly associated with NET-related mortality were age, primary tumor site, surgical resection status, tumor grade, and clinical stage of the patient. At 5 years, the overall survival rate was found to be 62%, and the disease-free survival rate was 56.5%.

Conclusions

Older age, advanced unresectable tumors, evidence of metastasis, and higher-grade tumors were associated with poorer outcomes. Lung tumors had a higher risk of NET-related mortality compared with other sites.

Epidemiology of lymphogranuloma venereum in New South Wales, 2006-2015

Aim

To describe the epidemiology of lymphogranuloma venereum (LGV) in New South Wales (NSW) from 2006 to 2015.

Methods

LGV notification data between 2006 and 2015 from New South Wales were analysed to describe time trends in counts and rates by gender, age group and area of residence, as well as anatomical sites of infection. A positivity ratio was calculated using the number of LGV notifications per 100 anorectal chlamydia notifications per year. Data linkage was used to ascertain the proportion of LGV cases that were co-infected with HIV.

Results

There were 208 notifications of LGV in NSW from 2006 to 2015; all were among men, with a median age of 42 years, and half were residents of inner-city Sydney. Annual notifications peaked at 57 (1.6 per 100,000 males) in 2010, declined to 16 (0.4 per 100,000 males) in 2014, and then increased to 34 (0.9 per 100,000 males) in 2015. Just under half (47.4%) of LGV cases were determined to be co-infected with HIV.

Conclusion

The number of LGV notifications each year has not returned to the low levels seen prior to the peak in 2010. Continued public health surveillance is important for the management and control of LGV.

Psychological Distress and Risk of Myocardial Infarction and Stroke in the 45 and Up Study

Background The interplay between mental and physical health remains poorly understood. We investigated whether psychological distress is associated with risk of myocardial infarction (MI) and stroke in a population-based prospective study. Methods and Results We included participants without prior stroke/MI from the New South Wales 45 and Up Study. We categorized baseline psychological distress as low, medium, and high/very high on the 10-item Kessler Psychological Distress scale and identified stroke and MI through linkage to hospital admission and mortality records. We obtained sex and age-stratified adjusted and unadjusted hazard ratios for the association between psychological distress and MI and stroke. We investigated for interaction between psychological distress and each of age and sex. Among 221 677 participants, 16.2% and 7.3% had moderate and high/very high psychological distress at recruitment, respectively. During 4.7 (±0.98 SD) years of follow-up, 4573 MIs and 2421 strokes occurred. Absolute risk of MI and stroke increased with increasing psychological distress level. In men aged 45 to 79 years, high/very high versus low psychological distress was associated with a 30% increased risk of MI (fully adjusted hazard ratios, 1.30; 95% CI, 1.12-1.51), with weaker estimates in those aged ≥80 years. Among women, high/very high psychological distress was associated with an 18% increased risk of MI (adjusted hazard ratio, 1.18; 95% CI, 0.99-1.42) with similar findings across age groups. In the age group of participants aged 45 to 79 years, high/very high psychological distress and male sex had a supra-additive effect on MI risk. Similar estimates were observed for stroke, with high/very high psychological distress associated with a 24% and 44% increased stroke risk in men and women, respectively, with no evidence of interaction with age or sex. Conclusions Psychological distress has a strong, dose-dependent, positive association with MI and stroke in men and women, despite adjustment for a wide range of confounders.

Domestic fire emergency escape plans among the aged in NSW, Australia: the impact of a fire safety home visit program

Background

Domestic fire-related injuries and deaths among the aged remain a concern of many countries including Australia. This study aimed to assess the impact of a home fire safety visit project on domestic fire emergency escape plans among the 373 aged persons using multivariate analyses.

Method

The study used data from a collaborative intervention program by three emergency agencies in New South Wales. It covered 373 older people at registration and 156 at post home visit follow-up. The five fire emergency escape plan outcome measures (participants having a working smoke alarm, finding out what to do if there was a fire at their home, making a plan to escape their home in the event of a fire, finding out how to escape their home in an emergency and finding out how to maintain their installed smoke alarm) were examined by adjusting for key characteristics of participants, using a generalized estimating equation (GEE) model that adjusted for repeated measures in order to examine the association between the home visit program and fire emergency escape plans.

Results

There were significant improvements in participants’ likelihood of finding out what to do if there was a fire in their home [AOR; 95% CI 1.89 (1.59–2.26)], making a plan to escape their home [AOR; 95% CI 1.80 (1.50–2.17)], how to escape their home in an emergency [AOR; 95% CI 1.33 (1.07–1.66)] and how to maintain their smoke alarm [AOR; 95% CI 1.77 (1.48–2.12)]. Female participants were less likely to have a plan to escape their home in the event of a fire [AOR; 95% CI 0.86 (0.75–0.99)] and to find out how to escape their home in an emergency [AOR; 95% CI 0.71 (0.61–0.82)] compared with their male counterparts. Additionally, participants who spoke languages other than English at home were significantly less likely to have a working smoke alarm [AOR; 95% CI 0.88 (0.38–0.69)].

Conclusion

Our findings suggest that home visit programs are able to increase fire safety of vulnerable and isolated older people.

Hot and bothered? Associations between temperature and crime in Australia

Temperature and crime is one of the most extreme relationships between the atmospheric environment and human behaviour, yet our knowledge about it is primarily based on Northern Hemisphere research. This study used both temporal and spatial models to investigate the relationship between temperature and crime in New South Wales (NSW), Australia, using an 11-year data set. Results suggested that assault and theft counts were significantly higher in summer than winter (17.8 and 3.7%, respectively), while fraud counts were not significantly different. Using linear and quadratic terms for maximum daily temperature, a linear regression model indicated that daily assault counts significantly increased with rising temperature and the rate of increase slowed as temperatures exceeded 30 °C. Theft counts significantly increased with rising temperature then declined as temperatures exceeded 30°C. Again, there was no evidence of a relationship between temperature and frequency of fraud count. Spatial modelling revealed that 96% of local government areas (LGAs) in NSW had a higher summer assault rate than winter. The findings of this study provide an empirical foundation for understanding crime-temperature relationships in Australia.

Anncaliia algerae Microsporidial Myositis, New South Wales, Australia

We describe the successful management of Anncaliia algerae microsporidial myositis in a man with graft versus host disease after hemopoietic stem cell transplantation. We also summarize clinical presentation and management approaches and discuss the importance of research into the acquisition of this infection and strategies for prevention.

Factors Associated with Home Fire Escape Plans in New South Wales: Multinomial Analysis of High-Risk Individuals and New South Wales Population

The preparation and practice of home-escape plans are important strategies for individuals and families seeking to reduce and/or prevent fire-related injury or death. The aim of this study was to assess the prevalence of and factors associated with, home-escape plans in the state of New South Wales (NSW), Australia. The study used data from two surveys—a 2016 fire safety attitudes and behaviour survey administered to high-risk individuals (n = 296) and a 2013 NSW health survey covering 13,027 adults aged 16 years and above. It applied multinomial logistic regression analyses to these data to identify factors associated with having a written home-fire escape plan, having an unwritten home-fire escape plan and not having any home-fire escape plan. The prevalence of written home-escape plans was only 4.3% (95% CI: 2.5, 7.5) for the high-risk individuals and 7.9% (95% confidence interval [CI]: 7.3, 8.6) for the entire NSW population. The prevalence of unwritten escape plans was 44.6% (95% CI: 38.8, 50.5) for the high-risk individuals and 26.2% (95% CI: 25.1, 27.2) for the NSW population. The prevalence of no-escape plan at all was 51.1% (95% CI: 45.2, 56.9) for the high-risk individuals and 65.9% (95% CI: 64.8, 67.1) for the NSW population. After adjusting for other covariates, the following factors were found to be significantly associated with unwritten-escape plan and no-escape plan prevalence: speaking only the English language at home, practicing home-fire escape plans infrequently, being married, being female and testing smoke alarms less often. Future fire interventions should target people who speak only English at home and people who test their smoke alarms infrequently. These interventions should be accompanied by research aimed at reversing the trend toward use of more flammable materials in homes.

Playground activities and gender variation in objectively measured physical activity intensity in Australian primary school children: a repeated measures study

BACKGROUND

Recent studies have sought to address the limited time for physical activity by focusing on increasing physical activity intensity among students during non-curricula periods and specifically school break times. We objectively measured the intensity of student physical activity (PA) during recess and lunch breaks at primary schools in the Western Sydney region of New South Wales (NSW), Australia using a 12-month repeated measures observation design study.

METHODS

Systematic direct observation of recess and lunch breaks over a ten-week period in 2014 and 2015. 120 recess and lunch breaks across twenty schools (2014) with 839 periodic observations and across 15 schools with 587 periodic observations in 2015. Both observation periods were conducted over 10-weeks in Term 4 (September - December).

RESULTS

The mean proportion of vigorous physical activity reported as a percentage (%VPA) across both time points was 16.6% (SD = 23.4). 36.8% (SD = 26.0) of time was spent walking and the remaining time (46.6%; SD = 30.4) was spent in sedentary activities. There was a significant decline in %VPA and increase in sedentary activity (p < 0.01) between the two time periods of measurement. In 2014, boys spent twice as much time in %VPA than girls during breaks in the school day and in 2015 this increased to nearly three times as much time in %VPA. %VPA also varied on the type of surface PA took place and the types of activities the children were allowed to undertake during breaks.

CONCLUSIONS

Recess and lunch breaks potentially offer an opportunity for children to participate in unstructured PA during the school day. Substantial variations in the %VPA during these periods exist. Addressing playground gender participation disparities and space usability/accessibility may be a necessary first step in promoting higher PA intensities during breaks.

Prescription opioid dispensing in New South Wales, Australia: spatial and temporal variation

Background

Patterns of opioid dispensing often exhibit substantial temporal and geographical variability, which has implications for public health policy decisions and interventions. The study examined recent trends in prescription opioid dispensing and identified high dispensing areas and factors associated with the doses dispensed.

Methods

Three years (1 January 2013–31 December 2015) of dispensing data of prescription opioids in local government areas (LGAs) for New South Wales (NSW), Australia’s most populous state, were analyzed. The proportion of individuals who were dispensed opioids was computed for four age-groups. A Chi-square test was used to examine trends over time in proportions of the population who were dispensed opioids in four age-groups. The number of prescriptions over time and quantities in daily defined dose/1000 people/day (denoted DDD) were also examined. LGAs with relatively high levels of dispensing were identified and mapped. A multivariate regression model was used to identify factors associated with DDD.

Results

Overall, codeine, oxycodone and tramadol were the main opioids in terms of DDD, number of prescriptions and number of individuals who were dispensed these medications. Quantity (in DDD), and population dispensed to were consistently higher for women than men over time. Proportions of individuals who were dispensed opioids increased significantly over time in all four age-groups. In the multivariate model, age, urbanization, sex and socio-economic indexes for areas were significantly associated with doses dispensed among opioid users. All areas with very high dispensing were outside major metropolitan areas.

Conclusions

Given that over-use of opioids is a major public health problem and that long-term use has substantial side effects including dependence, it is important to understand spatial patterns of opioid prescribing to enable targeted interventions. Nationwide implementation of real-time drug-monitoring programs and access to monitoring databases from both doctor and pharmacy point-of-care sources may potentially reduce excessive and undue use of opioid.

Spiny trapdoor spiders (Euoplos) of eastern Australia: Broadly sympatric clades are differentiated by burrow architecture and male morphology

Spiders of the infraorder Mygalomorphae are fast becoming model organisms for the study of biogeography and speciation. However, these spiders can be difficult to study in the absence of fundamental life history information. In particular, their cryptic nature hinders comprehensive sampling, and linking males with conspecific females can be challenging. Recently discovered differences in burrow entrance architecture and male morphology indicated that these challenges may have impeded our understanding of the trapdoor spider genus Euoplos in Australia's eastern mesic zone. We investigated the evolutionary significance of these discoveries using a multi-locus phylogenetic approach. Our results revealed the existence of a second, previously undocumented, lineage of Euoplos in the eastern mesic zone. This new lineage occurs in sympatry with a lineage previously known from the region, and the two are consistently divergent in their burrow entrance architecture and male morphology, revealing the suitability of these characters for use in phylogenetic studies. Divergent burrow entrance architecture and observed differences in microhabitat preferences are suggested to facilitate sympatry and syntopy between the lineages. Finally, by investigating male morphology and plotting it onto the phylogeny, we revealed that the majority of Euoplos species remain undescribed, and that males of an unnamed species from the newly discovered lineage had historically been linked, erroneously, to a described species from the opposite lineage. This paper clarifies the evolutionary relationships underlying life history diversity in the Euoplos of eastern Australia, and provides a foundation for urgently needed taxonomic revision of this genus.

Management of Ciguatoxin Risk in Eastern Australia

Between 2014 and 2016, five cases of ciguatera fish poisoning (CFP), involving twenty four individuals, were linked to Spanish Mackerel (Scomberomorus commerson) caught in the coastal waters of the state of New South Wales (NSW) on the east coast of Australia. Previously, documented cases of CFP in NSW were few, and primarily linked to fish imported from other regions. Since 2015, thirteen individuals were affected across four additional CFP cases in NSW, linked to fish imported from tropical locations. The apparent increase in CFP in NSW from locally sourced catch, combined with the risk of CFP from imported fish, has highlighted several considerations that should be incorporated into risk management strategies to minimize CFP exposure for seafood consumers.

Living Well? Strategies Used by Women Living With Metastatic Breast Cancer

Metastatic breast cancer is a disease of changing status-once an imminent death sentence, now a chronic (albeit incurable) disease. Medical intervention advances mean women with metastatic breast cancer now have symptoms alleviated and, potentially, life extended. Living with this disease, however, requires more than a medical approach to symptoms. We were interested to know whether women manage, and if so, how, to "live well" with metastatic cancer. We conducted interviews with 18 women. Women differed in the approaches they used. Most common was the attempt to reestablish a sense of normality in their lives. However, a second group reevaluated and reprioritized their lives; and a third group was restricted in their capacity to live well because of symptoms. The findings provide the foundation for future research exploring normalization of experiences of metastatic cancer, and other chronic illnesses, where people are living with knowledge that they have contracted time.

Giardiasis in NSW: Identification of Giardia duodenalis assemblages contributing to human and cattle cases, and an epidemiological assessment of sporadic human giardiasis

Two genetic assemblages (A and B) of the protozoan parasite species, Giardia duodenalis, infect humans, domestic animals and wildlife. In New South Wales, Australia, over 2000 sporadic human giardiasis cases are reported annually, but parasite sources and links between sporadic cases are unknown. This study describes G. duodenalis assemblages contributing to human and cattle cases in NSW, and examines demographic, spatial, and temporal distributions of NSW human infections and G. duodenalis assemblages. Genotyping by PCR-restriction fragment length polymorphism of the glutamate dehydrogenase (gdh) gene identified G. duodenalis assemblage B as the most common (86%) cause of infection among human cases (n=165). Approximately 37% of cattle DNA samples were PCR positive (18S rRNA, gdh), and G. duodenalis assemblages E (69%) or B (31%) were identified from these samples. Human assemblage A was more common among older age groups, and seasonality in the geographic dispersal of human assemblage A was observed. The results of this study indicate G. duodenalis assemblage B is highly prevalent among humans in NSW, and the potential for cross-species transmission exists between humans and cattle in this region. Spatio-temporal and demographic distributions of human assemblage A and B are highlighted, and risk factors associated with these dispersal patterns warrants further research.

Queensland tick typhus in rural New South Wales

We report five cases of Rickettsia australis infection from southern coastal New South Wales, Australia. All patients presented with a cutaneous eruption of erythematous papules and pustules and systemic features of malaise, headache, lymphadenopathy and myalgia. Acute kidney injury (AKI) was present in two of five cases and one of five cases had acute delirium. Improvement was only seen after treatment with doxycycline 100 mg b.i.d. Positive serology for R. australis was present in four of five cases and a positive polymerase chain reaction (PCR) was seen in one of five cases. Histology showed varying features, from neutrophilic vasculitis to Sweet's syndrome and lymphocytic vasculitis. Recent significant advances in the diagnosis of R. australis infection include an eschar swab or biopsy PCR and isolation of specific Rickettsia on serology. These investigations should be considered in the presence of any of the following features: eschar at site of a tick bite or lymphadenopathy and fever with an eruption of erythematous papules and pustules.

Are international differences in breast cancer survival between Australia and the UK present amongst both screen-detected women and non-screen-detected women? survival estimates for women diagnosed in West Midlands and New South Wales 1997-2006

We examined survival in screened-detected and non-screen-detected women diagnosed in the West Midlands (UK) and New South Wales (Australia) in order to evaluate whether international differences in survival are related to early diagnosis, or to other factors relating to the healthcare women receive. Data for women aged 50 - 65 years who had been eligible for screening from 50 years were examined. Data for 5,628 women in West Midlands and 6,396 women in New South Wales were linked to screening service records (mean age at diagnosis 53.7 years). We estimated net survival and modelled the excess hazard ratio of breast cancer death by screening status. Survival was lower for women in the West Midlands than in New South Wales (5-year net survival 90.9% [95% CI 89.9%-91.7%] compared with 93.4% [95% CI 92.6%-94.1%], respectively). The difference was greater between the two populations of non-screen-detected women (4.9%) compared to between screen-detected women, (1.8% after adjustment for lead-time and over-diagnosis). The adjusted excess hazard ratio of breast cancer death for West Midlands compared with New South Wales was greater in the non-screen-detected group (EHR 2.00, 95% CI 1.70 - 2.31) but not significantly different to that for women whose cancer had been screen-detected (EHR 1.72, 95% CI 0.87 - 2.56). In this study more than one in three breast cancer deaths in the West Midlands would have been avoided if survival had been the same as in New South Wales. The possibility that women in the UK receive poorer treatment is an important potential explanation which should be examined with care.

Impact of deprivation on breast cancer survival among women eligible for mammographic screening in the West Midlands (UK) and New South Wales (Australia): Women diagnosed 1997-2006

Women diagnosed with breast cancer in the UK display marked differences in survival between categories defined by socio-economic deprivation. Timeliness of diagnosis is one of the possible explanations for these patterns. Women whose cancer is screen-detected are more likely to be diagnosed at an earlier stage. We examined deprivation and screening-specific survival in order to evaluate the role of early diagnosis upon deprivation-specific survival differences in the West Midlands (UK) and New South Wales (Australia). We estimated net survival for women aged 50-65 years at diagnosis and whom had been continuously eligible for screening from the age of 50. Records for 5,628 women in West Midlands (98.5% of those eligible, mean age at diagnosis 53.7 years) and 6,396 women in New South Wales (99.9% of those eligible, mean age at diagnosis 53.8 years). In New South Wales, survival was similar amongst affluent and deprived women, regardless of whether their cancer was screen-detected or not. In the West Midlands, there were large and persistent differences in survival between affluent and deprived women. Deprivation differences were similar between the screen-detected and non-screen detected groups. These differences are unlikely to be solely explained by artefact, or by patient or tumour factors. Further investigations into the timeliness and appropriateness of the treatments received by women with breast cancer across the social spectrum in the UK are warranted.

Parechovirus Genotype 3 Outbreak among Infants, New South Wales, Australia, 2013-2014

Syndromic surveillance was useful for outbreak monitoring, and public health response helped reduce hospitalization times.

From October 2013 through February 2014, human parechovirus genotype 3 infection was identified in 183 infants in New South Wales, Australia. Of those infants, 57% were male and 95% required hospitalization. Common signs and symptoms were fever >38°C (86%), irritability (80%), tachycardia (68%), and rash (62%). Compared with affected infants in the Northern Hemisphere, infants in New South Wales were slightly older, both sexes were affected more equally, and rash occurred with considerably higher frequency. The New South Wales syndromic surveillance system, which uses near real-time emergency department and ambulance data, was useful for monitoring the outbreak. An alert distributed to clinicians reduced unnecessary hospitalization for patients with suspected sepsis.

Using a cluster randomized controlled trial to determine the effects of intervention of battery and hardwired smoke alarms in New South Wales, Australia: Home fire safety checks pilot program

INTRODUCTION

In 2014, Fire & Rescue New South Wales piloted the delivery of its home fire safety checks program (HFSC) aimed at engaging and educating targeted top "at risk" groups to prevent and prepare for fire. This pilot study aimed to assess the effectiveness of smoke alarms using a cluster randomized controlled trial.

METHODS

Survey questionnaires were distributed to the households that had participated in the HFSC program (intervention group). A separate survey questionnaire was distributed to the control group that was identified with similar characteristics to the intervention group in the same suburb. To adjust for potential clustering effects, generalized estimation equations with a log link were used.

RESULTS

Multivariable analyses revealed that battery and hardwired smoking alarm usage increased by 9% and 3% respectively among the intervention group compared to the control group. Females were more likely to install battery smoke alarms than males. Respondents who possessed a certificate or diploma (AOR=1.31, 95% CI 1.00-1.70, P=0.047) and those who were educated up to years 8-12 (AOR=1.32, 95% CI 1.06-1.64, P=0.012) were significantly more likely to install battery smoke alarms than those who completed bachelor degrees. Conversely, holders of a certificate or diploma and people who were educated up to years 8-12 were 31% (AOR=0.69, 95% CI 0.52-0.93, P=0.014) and 24% (AOR=0.76, 95% CI 0.60-0.95, P=0.015) significantly less likely to install a hardwired smoke alarm compared to those who completed bachelor degrees.

CONCLUSIONS

This pilot study provided evidence of the benefit of the HFSC in New South Wales.

PRACTICAL APPLICATIONS

Fire safety intervention programs, like HFSC, need to be targeted to male adults with lower level of schooling even when they are aware of their risks.

Foot abscess in sheep: Evaluation of risk factors and management options

Foot abscess of sheep is a painful, suppurative and necrotic infection of the phalanges and interphalangeal joints. Sheep affected by foot abscess may be acutely lame and pregnant ewes may die with secondary pregnancy toxemia when they fail to maintain their required level of nutrition. We conducted a cross-sectional observational study to identify and quantify possible risk factors for foot abscess. A questionnaire was designed and used to conduct telephone interviews with 115 sheep farmers in the Central Tablelands of NSW in November 2012. They were asked to provide information on their farm, the animals, and management-related information for the lambing period of a selected cohort of ewes. Multivariable logistic regression analyses were conducted using two outcome variables: (a) the presence of foot abscess, and (b) low (<1%), medium (between 1% and 5%) or high (>5%) levels of foot abscess. High levels of clover in the paddocks grazed by sheep was associated with increased odds of foot abscess in both the models (binary model odds ratio [OR]: 3.18; 95% confidence interval [CI]: 1.22, 8.77 and ordinal model OR: 2.92; 95% CI: 1.35, 6.54). High risk was also associated with the farmer's observation that it had been a wet season (ordinal model OR: 7.89, 95% CI: 2.72, 24.43) and moving sheep during lambing (binary model OR: 14.15, 95% CI: 2.30, 296.61). Similarly, farms with shale/slate type soils had lower odds of the disease compared to farms with basalt-derived soils. Farmers who used foot-baths (binary model OR: 4.05, 95% CI: 1.15, 19.34) and antibiotics (ordinal model OR: 3.16, 95% CI: 1.38, 7.66) had higher odds of foot abscess, as might be expected as they adopted these measures to deal with an increased prevalence of foot abscess. The findings from this study can be used to provide extension advice to farmers and for designing further confirmatory studies.