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Duko B, Gebremedhin AT, Tessema GA, Dunne J, Alati R, Pereira G. The effects of pre-eclampsia on social and emotional developmental vulnerability in children at age five in Western Australia: A population data linkage study. J Affect Disord 2024; 352:349-356. [PMID: 38360367 DOI: 10.1016/j.jad.2024.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND It is important to explore factors that may hinder early childhood development in AEDC Emotional Maturity and Social Competence domains as these underpin the foundation for health, well-being, and productivity over the life course. No previous study has examined whether, or to what extent, preeclampsia increases the risk of developmental vulnerability in social and emotional domains in early childhood. METHODS We conducted a retrospective population-based cohort study on the association between preeclampsia and childhood developmental vulnerability in emotional maturity and social competence domains in children born in Western Australia in 2009, 2012 and 2015. We obtained records of births, developmental anomalies, midwives notifications and hospitalisations. These data were linked to the Australian Early Development Census (AEDC), from which developmental vulnerability in emotional maturity and social competence domains at a median age of 5 years was ascertained. Causal relative risks (RR) were estimated with doubly robust estimation. RESULTS A total of 64,391 mother-offspring pairs were included in the final analysis. For the whole cohort, approximately 25 % and 23 % of children were classified as developmentally vulnerable or at-risk on AEDC emotional maturity and social competence domains, respectively. Approximately 2.8 % of children were exposed in utero to preeclampsia. Children exposed to preeclampsia were more likely to be classified as developmentally vulnerable or at-risk on the emotional maturity (RR = 1.19, 95%CI:1.11-1.28) and social competence domains (RR = 1.22, 95 % CI:1.13-1.31). CONCLUSION Children exposed to pre-eclampsia in utero were more likely to be developmentally vulnerable in emotional maturity and social competence domains in this cohort. Our findings provide new insights into the harmful effect of preeclampsia on childhood developmental vulnerability.
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Affiliation(s)
- Bereket Duko
- Australian Centre for Precision Health, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; Curtin School of Population Health, Curtin University, Kent St, Bentley, WA 6102, Australia; South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia.
| | | | - Gizachew Assefa Tessema
- Curtin School of Population Health, Curtin University, Kent St, Bentley, WA 6102, Australia; enAble Institute, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia
| | - Jennifer Dunne
- Curtin School of Population Health, Curtin University, Kent St, Bentley, WA 6102, Australia
| | - Rosa Alati
- Curtin School of Population Health, Curtin University, Kent St, Bentley, WA 6102, Australia; enAble Institute, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia; Institute for Social Sciences Research, The University of Queensland, 80 Meier's Rd, Indooroopilly, Queensland 4068, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Kent St, Bentley, WA 6102, Australia; enAble Institute, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia
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Nguyen T. Outcomes for pregnant women with Borderline Personality Disorder who attended a specialist antenatal service. Australas Psychiatry 2024; 32:138-142. [PMID: 38149786 PMCID: PMC10913315 DOI: 10.1177/10398562231222831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Our study focussed on the obstetric and psychosocial outcomes of pregnant women with Borderline Personality Disorder (BPD) who received care via a specialist antenatal clinic in Western Australia. METHOD This study is a retrospective examination of outcomes for 80 women with a confirmed diagnosis of BPD, with findings compared with published population outcome data for the state. RESULTS Pregnant women with BPD appeared to be at a risk of complications including pre-eclampsia and special care nursery admission for their newborns when compared to population data. Furthermore, the studied women had elevated rates of psychiatric admissions during pregnancy, child protection involvement, and domestic violence. Polypharmacy exposure was frequent, with the likely impact on obstetric and neonatal outcomes requiring further study. CONCLUSION The findings reinforced the notion that pregnant women with BPD experience complex multifaceted vulnerabilities and require enhanced multidisciplinary care. Our study further calls for the development of clinical practice guidelines for managing BPD in the perinatal period.
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Affiliation(s)
- Thinh Nguyen
- The University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, WA, Australia; and Peel and Rockingham/Kwinana Health Service, Rockingham, WA, Australia
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Nossent JC, Keen H, Preen D, Inderjeeth C. Cancer Risk and Mortality in Hospitalized Patients With Idiopathic Inflammatory Myopathies in Western Australia. J Rheumatol 2024; 51:396-402. [PMID: 38302176 DOI: 10.3899/jrheum.2023-1044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To compare cancer incidence, type, and survival between patients with idiopathic inflammatory myopathies (IIMs) in Western Australia (WA) and the general population. METHODS Administrative health data for hospitalized patients with incident IIM (n = 803, 56.5% female, median age 62.0 yrs), classified by a validated algorithm as polymyositis (PM; 36.2%), dermatomyositis (DM; 27.4%), inclusion body myositis (IBM; 17.1%), overlap myositis (OM; 10.7%), and other IIM (8.6%), were linked to WA cancer and death registries for the period of 1980 to 2014. Cancer incidence rates (CIRs) before and after IIM diagnosis as well as cancer mortality were compared with age-, sex-, and calendar year-matched controls (n = 3225, 54.9% female, median age 64 yrs) by rate ratios (RRs) and Kaplan-Meier survival estimates. RESULTS The prediagnosis CIR was similar for patients with IIM and controls (6.57 vs 5.95; RR 1.11, 95% CI 0.88-1.39) and for patients evolving to DM (n = 220) or other IIM subtypes (6.59 vs 6.56; RR 1.01, 95% CI 0.38-3.69). During follow-up, CIR was higher for all DM (4.05, 95% CI 3.04-5.29), with increased CIR for lung cancer vs controls (1.05 vs 0.33; RR 3.18, 95% CI 1.71-5.47). Cancer post diagnosis shortened life span by 59 months for patients with IIM (103 vs 162 months, P < 0.01), but reduced survival rates were observed only in patients with DM and IBM. CONCLUSION Cancer risk was not increased prior to IIM, but CIR for lung cancer was increased following DM diagnosis. As cancer reduced survival only in patients with DM and IBM, these data support a strategy of limited cancer screening in IIM.
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Affiliation(s)
- Johannes C Nossent
- J.C. Nossent, MD, PhD, C. Inderjeeth, MBBS, MPH Rheumatology Group, University of Western Australia Medical School, and Department of Rheumatology, Sir Charles Gairdner Hospital;
| | - Helen Keen
- H. Keen, MBBS, PhD, Rheumatology Group, University of Western Australia Medical School, and Department of Rheumatology, Fiona Stanley Hospital
| | - David Preen
- D. Preen, PhD, School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Charles Inderjeeth
- J.C. Nossent, MD, PhD, C. Inderjeeth, MBBS, MPH Rheumatology Group, University of Western Australia Medical School, and Department of Rheumatology, Sir Charles Gairdner Hospital
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Malherbe JAJ, Boan P, Purtill D, Wright M, Cannell P, Gangatharan SA, Sidiqi H, Cooney J. COVID-19 outcomes in haemopoietic stem cell transplant recipients in Western Australia: the value of vaccination and antiviral therapy. Intern Med J 2024; 54:664-670. [PMID: 38572768 DOI: 10.1111/imj.16368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/30/2024] [Indexed: 04/05/2024]
Abstract
Coronavirus-19 (COVID-19) mortality rates among haemopoietic stem cell transplant (HSCT) patients are high, ranging between 20% and 40%. We prospectively evaluated the mortality outcomes of COVID-19 in Western Australian HSCT patients. A total of 32/492 (6.5%) HSCT recipients contracted COVID-19 during the study, of whom 30/32 (94%) developed mild or asymptomatic disease. Two allogeneic HSCT patients were hospitalised for severe COVID-19; one patient died. Stringent healthcare, social isolation practices, aggressive vaccination programmes and rapid access to COVID-19 antivirals may have promoted mild COVID-19 illness in Western Australian HSCT patients, resulting in one of the lowest COVID-19 mortality rates in HSCT recipients worldwide.
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Affiliation(s)
- Jacques A J Malherbe
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Peter Boan
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
- PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| | - Duncan Purtill
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| | - Matthew Wright
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| | - Paul Cannell
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| | - Shane A Gangatharan
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
- PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| | - Hasib Sidiqi
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| | - Julian Cooney
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
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Hilpipre G, Furfaro LL, Porter M, Blyth CC, Yeoh DK. Characterization of invasive Group B Streptococcus isolates from Western Australian infants, 2004-2020. J Med Microbiol 2024; 73. [PMID: 38567639 DOI: 10.1099/jmm.0.001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background. Invasive Group B Streptococcus (GBS; Streptococcus agalactiae) remains a leading cause of infant morbidity and mortality. Intrapartum antibiotic prophylaxis (IAP) has been implemented in many countries with a reduction in early-onset disease, but an effective vaccine may further reduce the disease burden. Candidate vaccines targeting capsular polysaccharides and surface proteins are now in clinical trials.Methods. Using whole-genome sequencing and phenotypic antimicrobial susceptibility testing, we characterized sterile-site GBS isolates recovered from Western Australian infants between 2004 and 2020. Characteristics were compared between three time periods: 2004-2008, 2009-2015 and 2016-2020.Results. A total of 135 isolates were identified. The proportion of serotype III (22.7 % in Period 1 to 47.9 % in Period 3, P=0.04) and clonal complex 17 (13.6-39.6 %, P=0.01) isolates increased over time. Overall coverage of vaccines currently being trialled was >95 %. No isolates were penicillin resistant (MIC>0.25 mg l-1), but 21.5 % of isolates had reduced penicillin susceptibility (MIC>0.12 mg l-1) and penicillin MIC increased significantly over time (P=0.04). Clindamycin resistance increased over time to 45.8 % in the latest period.Conclusions. Based on comprehensive characterization of invasive infant GBS in Western Australia, we found that coverage for leading capsular polysaccharide and surface protein vaccine candidates was high. The demonstrated changes in serotype and molecular type highlight the need for ongoing surveillance, particularly with regard to future GBS vaccination programmes. The reduced susceptibility to IAP agents over time should inform changes to antibiotic guidelines.
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Affiliation(s)
- Ginger Hilpipre
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Lucy L Furfaro
- Division of Obstetrics and Gynaecology, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Michelle Porter
- Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Christopher C Blyth
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Daniel K Yeoh
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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Smith K, Hyde Z, Flicker L, Atkinson D, Malay R, LoGiudice D. Prevalence of functional limitations in older remote-living Aboriginal Australians. Aust J Rural Health 2024; 32:311-319. [PMID: 38345200 DOI: 10.1111/ajr.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION To better tailor prevention and care strategies, there is a need to identify modifiable factors associated with functional impairment in older Aboriginal people, and related service needs. OBJECTIVE To investigate the prevalence and associated factors for functional impairment in older Aboriginal people, and related service needs. DESIGN Cross-sectional survey of 289 Aboriginal people aged ≥45 years living in the remote Kimberley region of Western Australia. Factors associated with functional impairment were explored with logistic regression. FINDINGS 41.2% (95% CI 35.6%-47.0%) of participants required assistance with at least one I/ADL, and 26.0% (95% CI 21.2%-31.3%) required assistance with two or more I/ADLs. A core activity limitation (required assistance with showering, dressing or cooking) was reported by 15.9% (95% CI 12.1%-20.6%). In multivariable logistic regression analyses, older age, diabetes, difficulty walking, head injury, higher depression score and worse cognition were associated with needing help with two or more I/ADLs, while older age, history of stroke, higher depression score and worse cognition were associated with the presence of a core activity limitation. The proportion of participants receiving support with I/ADLs ranged from 71.2% to 97.6%. Support was generally provided by family and friends rather than service providers. DISCUSSION The key modifiable factors associated with functional impairment in older Aboriginal people living in remote regions are diabetes, depression and cognitive impairment. Services required are transport and socio-cultural activities, and ensuring support for family providing the majority of care. CONCLUSIONS This study highlights the need for holistic prevention strategies and care for older Aboriginal people with functional limitations and their families.
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Affiliation(s)
- Kate Smith
- Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Western Australia, Australia
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Perth, Western Australia, Australia
| | - Zoë Hyde
- Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Western Australia, Australia
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - David Atkinson
- Rural Clinical School of Western Australia, University of Western Australia, Broome, Western Australia, Australia
- The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Roslyn Malay
- Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Dina LoGiudice
- Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Boan P, Jamboti J, Musk M, Lavender M, Wrobel JP, Lee F, Shah A, Pereira LA, Robinson JO, Irish A. Utilising organs from hepatitis C virus PCR-positive donors in Western Australia. Intern Med J 2024; 54:678-681. [PMID: 38450913 DOI: 10.1111/imj.16345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/14/2024] [Indexed: 03/08/2024]
Abstract
We transplanted six solid organs from three hepatitis C virus (HCV) polymerase chain reaction (PCR)-positive donors during 2018-2023. Recipients were treated with glecaprevir/pibrentasvir or sofosbuvir/velpatasvir for 4-12 weeks, with all six achieving sustained virological response without significant adverse events. As occurs in other jurisdictions, solid organ transplants from HCR PCR-positive donors can be safely utilised in Australia.
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Affiliation(s)
- Peter Boan
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Department of Microbiology, Fiona Stanley Hospital, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| | - Jagadish Jamboti
- Department of Nephrology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, Curtin University, Perth, Western Australia, Australia
| | - Michael Musk
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Melanie Lavender
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jeremy P Wrobel
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Department of Medicine, University of Notre Dame Australia, Perth, Western Australia, Australia
| | - Felicity Lee
- Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Amit Shah
- Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Lynette A Pereira
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Department of Microbiology, Fiona Stanley Hospital, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
- Department of Infectious Disease, Royal Perth Hospital, Perth, Western Australia, Australia
| | - J Owen Robinson
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Department of Microbiology, Fiona Stanley Hospital, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
- Department of Infectious Disease, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ashley Irish
- Department of Nephrology, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Mackereth GF, Rayner KL, Larkins AJ, Morrell DJ, Pierce EL, Letchford PJ. Surveillance for lumpy skin disease and foot and mouth disease in the Kimberley, Western Australia. Aust Vet J 2024; 102:200-214. [PMID: 38220215 DOI: 10.1111/avj.13313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/20/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024]
Abstract
We quantified the sensitivity of surveillance for lumpy skin disease (LSD) and foot and mouth disease (FMD) in cattle in the Kimberley region of Western Australia. We monitored producer and veterinary activity with cattle for 3 years commencing January 2020. Each year, ~274,000 cattle of 685,540 present on 92 pastoral leases (stations) were consigned to other stations, live export or slaughter. Veterinarians examined 103,000 cattle on the stations, 177,000 prior to live export, and 10,000 prior to slaughter. Detection probabilities for the disease prior to transport or during veterinary procedures and inspections were elicited by survey of 17 veterinarians working in Northern Australia. The veterinarians estimated the probabilities that they would notice, recognise, and submit samples from clinical cases of LSD and FMD, given a 5% prevalence of clinical signs in the herd. We used scenario tree methodology to estimate monthly surveillance sensitivity of observations made by producers and by veterinarians during herd management visits, pre-export inspections, and ante-mortem inspections. Average monthly combined sensitivities were 0.49 for FMD and 0.37 for LSD. Sensitivity was high for both diseases during the dry season and low in the wet season. We estimated the confidence in freedom from the estimated surveillance sensitivity given one hypothetically infected herd, estimated probability of introduction, and prior confidence in freedom. This study provided assurance that the Kimberley is free of these diseases and that routine producer and veterinary interactions with cattle are adequate for the timely detection of the disease should they be introduced.
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Affiliation(s)
- G F Mackereth
- Northern Region, Department of Primary Industries and Regional Development, Broome, Western Australia, 6725, Australia
| | - K L Rayner
- Northern Region, Department of Primary Industries and Regional Development, Broome, Western Australia, 6725, Australia
| | - A J Larkins
- School of Medical, Molecular and Forensic Sciences, Murdoch University, Perth, Western Australia, 6150, Australia
| | - D J Morrell
- Broome Cattle Vets, Broome, Western Australia, Australia
| | - E L Pierce
- Broome Cattle Vets, Broome, Western Australia, Australia
| | - P J Letchford
- Pastoral Veterinary Solutions, Kununurra, Western Australia, Australia
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Brims F, Kumarasamy C, Menon L, Olsen N, de Klerk N, Franklin P. The Western Australian Mesothelioma Registry: Analysis of 60 years of cases. Respirology 2024; 29:288-294. [PMID: 38153786 DOI: 10.1111/resp.14648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Australia introduced a partial ban on asbestos consumption in 1984. There is continuing concern about exposure to asbestos in the built environment and non-occupational exposures. The aim of this study was to describe epidemiological trends of mesothelioma in Western Australia (WA) over the 60 years since the first case was recorded. METHODS Every case of mesothelioma notified to the WA Cancer Registry is reviewed by an expert panel. Data include demographic and clinical variables including principal mode of asbestos exposure and age at first exposure. Trends over time for survival, latency and pathological subtype of mesothelioma where analysed. Incidence rates for cases exposed during home renovation where calculated. RESULTS Two thousand seven hundred ninety-six cases of mesothelioma were identified with males comprising the majority (n = 2368, 84.7%). The median (IQR) age at diagnosis was 70 (62-78) years, and median latency of 47 (38-55) years. Pleural mesothelioma was recorded in 2620 (93.7%) cases with the epithelioid subtype most prevalent (n = 1730, 61.9%). Overall, median survival was 298 (128-585) days and latency 46 (37-54) years, both effectively doubling over the study period. Non-occupational exposures were proportionally higher in females (52.6%), compared with males (9.5%). Home renovation was the primary exposure in 227 (8.1%) cases, with number of cases and incidence rate ratio peaking in 2005/09 but subsequently decreasing. CONCLUSION The annual number of cases of mesothelioma in WA may have hit a plateau. The majority of females have non-occupational exposures and incidence rates from home renovation exposure may have peaked, suggesting the ban on asbestos has been effective.
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Affiliation(s)
- Fraser Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Perth, Western Australia, Australia
| | - Chellan Kumarasamy
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Lalitha Menon
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Nola Olsen
- Department of Health, WA Cancer Registry, Perth, Western Australia, Australia
- School of Global and Population Health, University of Western Australia, Perth, Western Australia, Australia
| | - Nick de Klerk
- School of Global and Population Health, University of Western Australia, Perth, Western Australia, Australia
| | - Peter Franklin
- School of Global and Population Health, University of Western Australia, Perth, Western Australia, Australia
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Teh R, Raymond W, Sieunarine K. Uptake of Best Medical Therapy: Secondary Prevention of Cardiovascular Disease in Vascular Surgical Patients in Western Australia. Angiology 2024; 75:288-294. [PMID: 36927174 DOI: 10.1177/00033197231159246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Best medical therapy (BMT) for peripheral arterial disease (PAD), carotid artery stenosis (CAS) and abdominal aortic aneurysm (AAA) involving concomitant use of antiplatelets, lipid-lowering agents, and blood pressure control, improves patient survival and prevents clinical cardiovascular disease (CVD). We performed a single-center cross-sectional study, over a 4-year period, describing BMT use in Western Australian patients with symptomatic PAD, CAS and AAA in the community. Overall, 45.3% of our cohort (n = 1689) were on appropriate BMT (CAS, 58.1%; PAD, 43.1%; AAA, 41.1%). There was highest uptake of blood pressure control at 93.0% (lipid-lowering agents, 65.3%; antithrombotics 63.5%). PAD was associated with highest uptake of blood pressure control (PAD 93.9%; CAS, 91.4%; AAA, 91.1%, P = .092) whilst CAS had highest uptake of antithrombotics (CAS 76.3%; PAD, 61.0%; AAA 60.4%, P < .001) and lipid-lowering agents (CAS 78.7%; PAD, 63.1%; AAA, 60.4%, P < .001). Our study indicates suboptimal use of BMT in patients with vascular disease in the community. The risk of CVD in CAS is likely misperceived as higher than PAD and AAA.
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Affiliation(s)
- Ryan Teh
- South Metropolitan Health Service, WA Health, Fiona Stanley Hospital, Perth, WA, Australia
| | - Warren Raymond
- Medical School, The University of Western Australia, Crawley, WA, Australia
- School of Health and Medical Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Kishore Sieunarine
- Department of Vascular Surgery, Hollywood Hospital, Perth, WA, Australia
- Medical School, Curtin University, Bentley, WA, Australia
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Foster N, Raby E, Wood FM, Fear M, Pavlos N, Edgar DW. Evaluation of the accuracy of diagnostic coding and clinical documentation for traumatic heterotopic ossification diagnoses in Western Australian hospitals. Injury 2024; 55:111329. [PMID: 38296757 DOI: 10.1016/j.injury.2024.111329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Traumatic heterotopic ossification (tHO) refers to the pathological formation of ectopic bone in soft tissues that can occur following burn, neurological ororthopaedic trauma. As completeness and accuracy of medical diagnostic coding can vary based on coding practices and depend on the institutional culture of clinical documentation, it is important to assess diagnostic coding in that local context. To the authors' knowledge, there is no prior study evaluating the accuracy of medical diagnostic coding or specificity of clinical documentation for tHO diagnoses across Western Australia (WA) trauma centres or across the full range of inciting injury and surgical events. OBJECTIVE To evaluate and compare the clinical documentation and the diagnostic accuracy of ICD-10-AM coding for tHO in trauma populations across 4 WA hospitals. METHODS A retrospective data search of the WA trauma database was conducted to identify patients with tHO admitted to WA hospitals following burn, neurological or orthopaedic trauma. Patient demographic and tHO diagnostic characteristics were assessed for all inpatient and outpatient tHO diagnoses. The frequency and distribution of M61 (HO-specific) and broader, musculoskeletal (non-specific) ICD-10-AM codes were evaluated for tHO cases in each trauma population. RESULTS HO-specific M61 ICD-10-AM codes failed to identify more than a third of true tHO cases, with a high prevalence of non-specific HO codes (19.4 %) and cases identified via manual chart review (25.4 %). The sensitivity of M61 codes for correctly diagnosing tHO after burn injury was 50 %. ROC analysis showed that M61 ICD-10-AM codes as a predictor of a true positive tHO diagnosis were a less than favourable method (AUC=0.731, 95 % CI=0.561-0.902, p = 0.012). Marked variability in clinical documentation for tHO was identified across the hospital network. CONCLUSION Coding inaccuracies may, in part, be influenced by insufficiencies in clinical documentation for tHO diagnoses, which may have implications for future research and patient care. Clinicians should consistently employ standardised clinical terminology from the point of care to increase the likelihood of accurate medical diagnostic coding for tHO diagnoses.
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Affiliation(s)
- Nichola Foster
- Burn Injury Research Node, Institute for Health Research / School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, 6160, Australia; Burn Injury Research Unit and Fiona Wood Foundation, University of Western Australia, Nedlands, Western Australia, 6009, Australia; Physiotherapy Department, Sir Charles Gairdner Osborne Park Health Care Group, North Metropolitan Health Service, Nedlands, Western Australia, 6009, Australia.
| | - Edward Raby
- Burn Injury Research Unit and Fiona Wood Foundation, University of Western Australia, Nedlands, Western Australia, 6009, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, 6150, Australia
| | - Fiona M Wood
- Burn Injury Research Unit and Fiona Wood Foundation, University of Western Australia, Nedlands, Western Australia, 6009, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, 6150, Australia
| | - Mark Fear
- Burn Injury Research Unit and Fiona Wood Foundation, University of Western Australia, Nedlands, Western Australia, 6009, Australia
| | - Nathan Pavlos
- School of Biomedical Sciences, University of Western Australia, Nedlands, Western Australia, 6009, Australia
| | - Dale W Edgar
- Burn Injury Research Node, Institute for Health Research / School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, 6160, Australia; Burn Injury Research Unit and Fiona Wood Foundation, University of Western Australia, Nedlands, Western Australia, 6009, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, 6150, Australia; Safety and Quality Unit, Armadale Kalamunda Group Health Service, East Metropolitan Health Service, Mt Nasura, Western Australia, 6112, Australia
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12
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Inoue M, Adris N, Cai R, Siah C, Kong J, Ragunath K. Incidence, prevalence and clinical management of achalasia since the introduction of high-resolution manometry in Western Australia. Intern Med J 2024; 54:312-319. [PMID: 37272918 DOI: 10.1111/imj.16150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Epidemiological studies in achalasia and its clinical management in Australia are limited. AIMS To determine the prevalence and trends in incidence rates and describe the types of treatment stratified by subtypes of achalasia. METHODS A retrospective observational study was conducted at a single site that offers a state-wide high-resolution manometry (HRM) service in Western Australia (WA). Patients (aged ≥ 18 years) newly diagnosed with achalasia based on HRM findings between 2012 and 2021 were extracted from the HRM database. The crude incidence rate and age-standardised incidence rate (ASIR) along with the 2021-point prevalence were calculated. Trends were assessed by the Kendall τb test. The patients' initial and subsequent treatment modalities were described. RESULTS A total of 296 new cases were identified, and the median age at diagnosis was 56 years. The patient's median age, sex and year of the first treatment did not vary significantly with the subtypes. The lowest and highest ASIR (cases/100 000 person-years) were 0.8 in 2012 and 2.1 in 2021, respectively. Only type 2 achalasia showed a significant increasing trend (P = 0.009). The 2021-point prevalence was 16.9 cases/100 000 people and increased with age. Pneumatic balloon dilatation (PBD) was the most common treatment for types 1 and 2, while laparoscopic Heller myotomy was most common for type 3. Peroral endoscopic myotomy (POEM) has become common in the past 5 years. CONCLUSION The ASIR of type 2 achalasia significantly increased in WA. PBD was most commonly performed, although peroral endoscopic myotomy has recently increased as a preferred treatment option.
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Affiliation(s)
- Madoka Inoue
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Niwansa Adris
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Richmond Cai
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Chiang Siah
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jee Kong
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Krish Ragunath
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
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Coomber K, Baldwin R, Taylor N, Callinan S, Wilkinson C, Toumbourou JW, Chikritzhs T, Miller PG. Characteristics of high- and low-risk drinkers who use online alcohol home delivery in Western Australia. Drug Alcohol Rev 2024; 43:407-415. [PMID: 38048164 DOI: 10.1111/dar.13783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/23/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION Variation in alcohol availability is an important driver of levels of consumption and harm, with recent increases in online alcohol home delivery use expanding availability. There is limited research on the impacts of these changes and the characteristics of consumers who use alcohol home delivery. METHODS This study presents findings from an online survey (n = 465) of Western Australian adults who had purchased alcohol for home delivery within the past 6 months. Analyses compared high-risk and low-risk drinkers on use of, and exposure to, alcohol home delivery. RESULTS Compared to low-risk drinkers, high-risk drinkers were significantly more likely to make more frequent online purchases (odds ratio 5.42), utilise same day delivery (odds ratio 2.91) and purchase through specialised online-only retailers (odds ratio 2.69). High-risk drinkers also reported receiving deliveries while intoxicated more often (odds ratio 11.62), and ordering alcohol for delivery to continue a current drinking session (odds ratio 7.47). High-risk drinkers also received advertising for alcohol home delivery more frequently (odds ratio 1.60) than low-risk drinkers. High-risk drinkers also ordered larger quantities of alcohol than low-risk drinkers (M = 49 vs. 32 standard drinks). DISCUSSION AND CONCLUSIONS Findings from this study indicate that these services are popular with high-risk drinkers and potentially undermine other policy efforts to reduce drinking. Within Australia, stronger legislation (such as mandatory delay between order and delivery) and monitoring (e.g., test purchasing for compliance) are recommended.
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Affiliation(s)
- Kerri Coomber
- School of Psychology, Deakin University, Geelong, Australia
| | - Ryan Baldwin
- School of Psychology, Deakin University, Geelong, Australia
| | - Nicholas Taylor
- School of Psychology, Deakin University, Geelong, Australia
- National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Sarah Callinan
- Centre for Alcohol Policy and Research, La Trobe University, Melbourne, Australia
| | - Claire Wilkinson
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | | | - Tanya Chikritzhs
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Peter G Miller
- School of Psychology, Deakin University, Geelong, Australia
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Ewe K, Fathima P, Effler P, Giele C, Richmond P. Impact of Meningococcal ACWY Vaccination Program during 2017-18 Epidemic, Western Australia, Australia. Emerg Infect Dis 2024; 30:270-278. [PMID: 38270172 PMCID: PMC10826768 DOI: 10.3201/eid3002.230144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
The rising incidence of invasive meningococcal disease (IMD) caused by Neisseria meningitidis serogroup W in Western Australia, Australia, presents challenges for prevention. We assessed the effects of a quadrivalent meningococcal vaccination program using 2012-2020 IMD notification data. Notification rates peaked at 1.8/100,000 population in 2017; rates among Aboriginal and Torres Strait Islander populations were 7 times higher than for other populations. Serogroup W disease exhibited atypical manifestations and increased severity. Of 216 cases, 20 IMD-related deaths occurred; most (19/20) were in unvaccinated persons. After the 2017-2018 targeted vaccination program, notification rates decreased from 1.6/100,000 population in 2018 to 0.9/100,000 population in 2019 and continued to decline in 2020. Vaccine effectiveness (in the 1-4 years age group) using the screening method was 93.6% (95% CI 50.1%-99.2%) in 2018 and 92.5% (95% CI 28.2%-99.2%) in 2019. Strategic planning and prompt implementation of targeted vaccination programs effectively reduce IMD.
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Affiliation(s)
| | | | - Paul Effler
- Wesfarmers Centre of Vaccines and Infectious Diseases, Perth, Western Australia, Australia (K. Ewe, P. Fathima, P. Richmond)
- Perth Children’s Hospital, Perth (K. Ewe, P. Richmond)
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia (P. Fathima)
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth (P. Effler, C. Giele)
- University of Western Australia School of Medicine, Perth (P. Richmond)
| | - Carolien Giele
- Wesfarmers Centre of Vaccines and Infectious Diseases, Perth, Western Australia, Australia (K. Ewe, P. Fathima, P. Richmond)
- Perth Children’s Hospital, Perth (K. Ewe, P. Richmond)
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia (P. Fathima)
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth (P. Effler, C. Giele)
- University of Western Australia School of Medicine, Perth (P. Richmond)
| | - Peter Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Perth, Western Australia, Australia (K. Ewe, P. Fathima, P. Richmond)
- Perth Children’s Hospital, Perth (K. Ewe, P. Richmond)
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia (P. Fathima)
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth (P. Effler, C. Giele)
- University of Western Australia School of Medicine, Perth (P. Richmond)
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15
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Law L, Lo WJ, House C, Rawlins M, Boan P, Musk M. The Western Australian experience of COVID-19 after the borders reopened: evaluation of public health modelling predictions. Intern Med J 2024; 54:234-241. [PMID: 38064419 DOI: 10.1111/imj.16299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/18/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Western Australia (WA) serves as a unique global case study on the impact of coronavirus disease 2019 (COVID-19) on an isolated, prepared and highly vaccinated population. This study builds upon the study performed by House et al. through an extended data set. AIM To examine the impact of COVID-19 at the only quaternary hospital in WA following the border opening from 3 March to 17 July 2022. PARTICIPANTS A total of 257 adults were admitted with COVID-19 under either respiratory or the intensive care unit (ICU). OUTCOMES Admission numbers, disease severity, ICU admission, prevalence of COVID-19 deterioration risk factors, length of stay and mortality. RESULTS A total of 257 patients were admitted with COVID-19, under respiratory (81.7%) and ICU (18.3%). COVID-19 was the primary reason for admission for 67.7%. Ten patients died during the study, with seven deaths attributed to COVID pneumonitis. COVID-19 severity was 37.4% mild, 37.0% moderate, 18.3% severe and 7.4% critical. Risk factors for requiring ICU included incomplete immunisation status (P = 0.011), chronic kidney disease (P = 0.008) and Aboriginal and Torres Strait Islander (ATSI) ethnicity. The WA Department of Health predicted that the number of hospitalisations and ICU cases were significantly higher than the actual number of cases. CONCLUSION The number of hospitalisations and ICU COVID-19 cases were significantly less than predicted, likely due to high population vaccination rates prior to border opening. The main risk factors for COVID-19 severity were incomplete immunisation and ATSI ethnicity.
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Affiliation(s)
- Lynden Law
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Wei Juen Lo
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Caris House
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | | | - Peter Boan
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Michael Musk
- Fiona Stanley Hospital, Perth, Western Australia, Australia
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Hart J, Dowse GK, Porter M, Speers DJ, Keil AD, Bew JD, Mowlaboccus S, Kahler CM. Obstetric and Neonatal Invasive Meningococcal Disease Caused by Neisseria meningitidis Serogroup W, Western Australia, Australia. Emerg Infect Dis 2024; 30:368-371. [PMID: 38270157 PMCID: PMC10826774 DOI: 10.3201/eid3002.230639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Three mother-baby pairs with invasive meningococcal disease occurred over 7 months in Western Australia, Australia, at a time when serogroup W sequence type 11 clonal complex was the predominant local strain. One mother and 2 neonates died, highlighting the role of this strain as a cause of obstetric and early neonatal death.
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Nossent J, Keen H, Preen DB, Inderjeeth CA. The spectrum of idiopathic inflammatory myopathies in Western Australia: epidemiological characteristics and mortality over time. Rheumatol Int 2024; 44:329-337. [PMID: 37819456 PMCID: PMC10796655 DOI: 10.1007/s00296-023-05475-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Abstract
To determine long term overall and subgroup specific incidence rates and associated mortality for idiopathic inflammatory myopathies (IIM) in a population wide study. We included patients hospitalised between 1980 and 2015 with incident IIM as defined by relevant diagnostic codes for dermatomyositis (DM) polymyositis (PM), inclusion body myositis (IBM), other IIM and overlap myositis (OM) in the Western Australia Health Hospital Morbidity Data Collection (n = 846). Trends over time for annual incidence rate per million population (AIR) were analysed by least square regression and Kaplan-Meier survival and mortality rates (MR)/100 person years compared with a matched control group (n = 3681). The averaged AIR for all IIM was 19 (CI 10.4-27.5) and stable over time with point prevalence reaching 205.3 (CI 185.6-226.6) per million in 2015. Over time, the AIR for DM 5.0 (CI 0.6-9.4) and IBM 3.3 (CI 0.7-9.6) was stable, while AIR decreased for PM (p < 0.01) and increased for other IIM (p < 0.01) and OM (p < 0.01). IBM patients were eldest at diagnosis (68 years, CI 59-77) with male preponderance in IBM (53.4%) and other IIM (55.8%) groups. Crude mortality (54.5 vs 41.3%), MR ratio (6.65 vs 5.91) and 5 (65.8% vs 71.6%) and 10-year (52.5% vs 58.7%) survival were all worse for IIM patients (all p < 0.05). IBM patients had highest MR (10.1; CI 8.38-12.14) and lowest 10-year survival (39.2%). While cardiovascular disease and cancer were predominant causes of death, they were proportionally lower in IIM patients, where respiratory and rheumatic disease were more frequent causes of death. While the overall incidence of IIM in WA was stable over 35 years, the spectrum of IIM has changed significantly with increases especially in other IIM and OM. The overall prognosis with IIM remains guarded with 10-year survival just over 50%.
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Affiliation(s)
- Johannes Nossent
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.
- Rheumatology Group, School of Medicine, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia.
| | - Helen Keen
- Rheumatology Group, School of Medicine, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - David B Preen
- School of Population and Global Health, University Western Australia, Perth, Australia
| | - Charles A Inderjeeth
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia
- Rheumatology Group, School of Medicine, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia
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18
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Mackay CA, Gray C, Campbell C, Sharp MJ. Young adult outcomes following premature birth: A Western Australian experience. Early Hum Dev 2024; 188:105920. [PMID: 38128445 DOI: 10.1016/j.earlhumdev.2023.105920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Childhood outcomes following preterm birth are widely published, however long-term adult outcomes are less well described. We aimed to determine the quality of life and burden of co-morbidities experienced by preterm-born young adults in Western Australia. METHODS A retrospective observational study was conducted. Participants born at 23-33 weeks gestation cared for at King Edward Memorial Hospital during 1990 and 1991 were recruited from a historical birth cohort. Participants completed general, medical and reproductive health questionnaires. Results were compared with contemporaneous cohort data and/or population statistics. RESULTS Questionnaires were received from 73 young adults aged 28 to 30 years. The majority of respondents completed high school (94.5 %), were employed fulltime (74.0 %) and had close friends and family relationships. Almost all the participants considered their health to be good (94.0 %) and participated in light exercise (90.0 %). Increased hypertension, hypercholesterolaemia, asthma, neuropsychiatric conditions and visual impairment were reported. Depression Anxiety and Stress Scale (DASS-21) scoring identified increased mild anxiety. Increased consultation with healthcare workers and use of prescription medications were reported. CONCLUSION The group of preterm-born adults surveyed reported a good quality of life, supportive interpersonal relationships and they provided significant contributions to society. They did report increased medical and psychological conditions than the general population.
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Affiliation(s)
- Cheryl A Mackay
- Neonatal Directorate, Child and Adolescent Health Service, Perth, Western Australia, Australia; University of Western Australia, Australia.
| | - Caitlin Gray
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Catherine Campbell
- Neonatal Directorate, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Mary J Sharp
- Neonatal Directorate, Child and Adolescent Health Service, Perth, Western Australia, Australia; University of Western Australia, Australia
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Weber C, Hung J, Atkins ER, Hickling S, Briffa T, Li I. Long-Term Pattern and Associated Costs of Re-hospitalisations in Patients After Index Atrial Fibrillation Admission in Western Australia, 2011-2017. Heart Lung Circ 2024; 33:55-64. [PMID: 38160127 DOI: 10.1016/j.hlc.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/08/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024]
Abstract
AIMS This study aimed to determine total and cardiovascular-specific re-hospitalisation patterns and associated costs within 2 years of index atrial fibrillation (AF) admission in Western Australia (WA). METHOD Patients aged 25-94 years, surviving an index (first-in-period) AF hospitalisation (principal diagnosis) from 2011 to 2015 were identified from WA-linked administrative data and followed for 2 years. Person-level hospitalisation costs ($ Australian dollar) were computed using the Australian Refined Diagnosis Related Groups and presented as median with first and third quartile costs. RESULTS The cohort comprised 17,080 patients, 59.0% men, mean age 69.6±13.3 (standard deviation) years, and 59.0% had a CHA2DS2-VA (one point for congestive heart failure, hypertension, diabetes mellitus, vascular disease or age 65-74 years; two points for prior stroke/transient ischaemic attack or age ≥75 years) score of 2 or more. Within 2 years, 13,776 patients (80.6%) were readmitted with median of 2 (1-4) readmissions. Among total all-cause readmissions (n=54,240), 40.1% were emergent and 36.6% were cardiovascular-related, led by AF (19.5%), coronary events (5.8%), and heart failure (4.2%). The median index AF admission cost was $3,264 ($2,899-$7,649) while cardiovascular readmission costs were higher, particularly stroke ($10,732 [$4,179-23,390]), AF ablation ($7,884 [$5,283-$8,878]), and heart failure ($6,759 [$6,081-$13,146]). Average readmission costs over 2 years per person increased by $4,746 (95% confidence interval [CI] $4,459-$5,033) per unit increase in baseline CHA2DS2-VA score. The average 2-year hospitalisation costs per patient, including index admission, was $27,820 (95% CI $27,308-$28,333) and total WA costs were $475.2 million between 2011 and 2017. CONCLUSIONS Patients after index AF hospitalisation have a high risk of cardiovascular and other readmissions with considerable healthcare cost implications. Readmission costs increased progressively with baseline CHA2DS2-VA score. Better integrated management of AF and coexistent comorbidities is likely key to reducing readmissions and associated costs.
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Affiliation(s)
- Courtney Weber
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.
| | - Joseph Hung
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Emily R Atkins
- Health Systems Science, The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Siobhan Hickling
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Ian Li
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
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Lan NSR, Alexander M, Hillis GS, McQuillan BM, Briffa TG, Sanfilippo FM, Dwivedi G, Rankin JM, Ihdayhid AR. Gender Differences in Coronary Artery Disease Severity and Revascularisation in Patients Referred for Coronary Angiography From Rural and Remote Western Australia. Heart Lung Circ 2024; 33:142-143. [PMID: 38342560 DOI: 10.1016/j.hlc.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/15/2023] [Indexed: 02/13/2024]
Affiliation(s)
- Nick S R Lan
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia; Medical School, The University of Western Australia, Perth, WA, Australia. https://twitter.com/Nick_S_R_Lan
| | - Mikhail Alexander
- Department of Cardiology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Graham S Hillis
- Medical School, The University of Western Australia, Perth, WA, Australia; Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Brendan M McQuillan
- Medical School, The University of Western Australia, Perth, WA, Australia; Department of Cardiology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Tom G Briffa
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Girish Dwivedi
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia; Medical School, The University of Western Australia, Perth, WA, Australia; Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, Perth, WA, Australia
| | - James M Rankin
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, Perth, WA, Australia; Medical School, Curtin University, Perth, WA, Australia.
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21
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Faint N, Coleman M, Spring B, Richardson A, Thornton A, Bacon D, Kumaradevan S, Gardiner FW. Western Australia remote aeromedical substance use disorders outcomes. Intern Med J 2024; 54:86-95. [PMID: 37255269 DOI: 10.1111/imj.16140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/22/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Substance use disorders (SUDs) cause significant harm to regional Australians, who are more likely to misuse alcohol and other drugs (AODs) and encounter difficulty in accessing treatment services. The primary aims of this study were to describe the demographics of patients aeromedically retrieved from regional locations and compare hospital outcomes with a metropolitan-based cohort. AIMS Retrospective case-controlled cohort study. Participants were aeromedically retrieved within Western Australia for SUDs between 1 July 2014 and 30 June 2019. Retrieved patients were case-matched based on age and hospital discharge diagnosis. Descriptive statistics and χ2 analysis were used to summarise the findings. RESULTS One hundred thirty-six (91.3%) aeromedical retrievals were found, with the majority being male (n = 95; 69.9%). These were case-matched to 427 metropolitan patients, the majority male (n = 321; 75.2%). Retrieved patients were more likely (all P < 0.05) Indigenous (odds ratio [OR], 9.35 [95% confidence interval (CI), 5.96-14.85]), unemployed (OR, 2.9 [95% CI, 1.41-6.80]), referred to a tertiary hospital (OR, 2.18 [95% CI, 1.24-3.86]) and to stay longer in hospital (OR, 1.08 [95% CI, 1.02-1.14]). DISCUSSION Findings highlight that unmarried and/or unemployed males were overrepresented in the retrieval group, with over half identifying as Indigenous. Regional variation in retrievals was noted, while amphetamine-type stimulants featured prominently in the retrieval cohort, who experienced longer hospital stays and more restrictive treatment. CONCLUSIONS Comparing clinical outcomes for retrieved regional patients experiencing SUDs, service design and delivery should focus on offering culturally safe care for Indigenous people, catering for regional health care catchment areas, while ideally adopting collaborative and integrated approaches between AODs and mental health services.
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Affiliation(s)
- Nicholas Faint
- Great Southern Mental Health Service, Western Australia Country Health Service, Perth, Western Australia, Australia
| | - Mathew Coleman
- Great Southern Mental Health Service, Western Australia Country Health Service, Perth, Western Australia, Australia
- The Rural Clinical School of Western Australia, The University of Western Australia, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Breeanna Spring
- Public Health and Research, Royal Flying Doctor Service of Australia, Canberra, Australian Capital Territory, Australia
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Queensland, Brisbane, Australia
| | - Alice Richardson
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ashleigh Thornton
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Donna Bacon
- The Rural Clinical School of Western Australia, The University of Western Australia, Perth, Western Australia, Australia
- Geraldton Regional Aboriginal Service, Western Australia Country Health Service, Geraldton, Western Australia, Australia
| | - Santharajah Kumaradevan
- Public Health and Research, Royal Flying Doctor Service of Australia, Canberra, Australian Capital Territory, Australia
| | - Fergus W Gardiner
- The Rural Clinical School of Western Australia, The University of Western Australia, Perth, Western Australia, Australia
- Public Health and Research, Royal Flying Doctor Service of Australia, Canberra, Australian Capital Territory, Australia
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
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22
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Foley DA, Minney-Smith CA, Lee WH, Oakes DB, Hazelton B, Ford TJ, Wadia U, Sikazwe C, Moore HC, Nicol MP, Levy A, Blyth CC. Respiratory Syncytial Virus Reinfections in Children in Western Australia. Viruses 2023; 15:2417. [PMID: 38140658 PMCID: PMC10747877 DOI: 10.3390/v15122417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Respiratory syncytial virus (RSV) reinfection in children is poorly understood. We examined the incidence, characteristics, and outcomes of hospital-attended RSV reinfections in children <16 years in Western Australia between 2012 and 2022. Individuals with repeat RSV detections ≥56 days apart were identified using laboratory data. The incidence of reinfection in the first five years of life was estimated using the total birth population from 2012 to 2017. Clinical data on a subset of reinfection episodes were obtained from two metropolitan pediatric centers. A total of 466 children with hospital-attended reinfections were identified. The median interval between RSV detections was 460 days (interquartile range: 324, 812), with a reinfection rate of 95 per 100,000 individuals (95% confidence interval: 82, 109). Reinfection was most common in children who experienced their first RSV detection <6 months of age. Predisposing factors were identified in 56% of children; children with predisposing factors were older at first and second detections, were more likely to be admitted, and had a longer length of stay. This study highlights the significant burden of hospital-attended RSV reinfections in children with and without predisposing factors. Expanded surveillance with in-depth clinical data is required to further characterize the impact of RSV reinfection.
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Affiliation(s)
- David A. Foley
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
| | - Cara A. Minney-Smith
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
| | - Wei Hao Lee
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
- Department of General Paediatrics, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| | - Daniel B. Oakes
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
| | - Briony Hazelton
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| | - Timothy J. Ford
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| | - Ushma Wadia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA 6009, Australia
- Department of General Paediatrics, Fiona Stanley Hospital, Murdoch, WA 6150, Australia
| | - Chisha Sikazwe
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
- Marshall Centre for Infectious Diseases, School of Biomedical Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
- School of Population Health, Curtin University, Perth, WA 6009, Australia
| | - Mark P. Nicol
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
- Marshall Centre, Biomedical Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Avram Levy
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
- Marshall Centre for Infectious Diseases, School of Biomedical Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Christopher C. Blyth
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA 6009, Australia
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23
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Volkman T, Clarke R, Anstey J, Cherian S. COVID-19 vaccination of children with refugee backgrounds in Western Australia: a retrospective observational study. Med J Aust 2023; 219:549-550. [PMID: 37875281 DOI: 10.5694/mja2.52131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/24/2023] [Indexed: 10/26/2023]
Affiliation(s)
| | | | | | - Sarah Cherian
- Perth Children's Hospital, Perth, WA
- The University of Western Australia, Perth, WA
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24
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Ha NT, Harris M, Bulsara M, Doust J, Kamarova S, McRobbie D, O'Leary P, Parizel PM, Slavotinek J, Wright C, Youens D, Moorin R. Patterns of computed tomography utilisation in injury management: latent classes approach using linked administrative data in Western Australia. Eur J Trauma Emerg Surg 2023; 49:2413-2427. [PMID: 37318517 PMCID: PMC10728237 DOI: 10.1007/s00068-023-02303-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/03/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE Whilst computed tomography (CT) imaging has been a vital component of injury management, its increasing use has raised concern regarding ionising radiation exposure. This study aims to identify latent classes (underlying patterns) of CT use over a 3-year period following the incidence of injury and factors predicting the observed patterns. METHOD A retrospective observational cohort study was conducted in 21,544 individuals aged 18 + years presenting to emergency departments (ED) of four tertiary public hospitals with new injury in Western Australia. Mixture modelling approach was used to identify latent classes of CT use over a 3-year period post injury. RESULTS Amongst injured people with at least one CT scan, three latent classes of CT use were identified including a: temporarily high CT use (46.4%); consistently high CT use (2.6%); and low CT use class (51.1%). Being 65 + years or older, having 3 + comorbidities, history with 3 + hospitalisations and history of CT use before injury were associated with consistently high use of CT. Injury to the head, neck, thorax or abdomen, being admitted to hospital after the injury and arriving to ED by ambulance were predictors for the temporarily high use class. Living in areas of higher socio-economic disadvantage was a unique factor associated with the low CT use class. CONCLUSIONS Instead of assuming a single pattern of CT use for all patients with injury, the advanced latent class modelling approach has provided more nuanced understanding of the underlying patterns of CT use that may be useful for developing targeted interventions.
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Affiliation(s)
- Ninh T Ha
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Mark Harris
- School of Accounting, Economics and Finance, Faculty of Business and Law, Curtin University, Perth, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - Jenny Doust
- Australian Women and Girls' Health Research Centre, School of Public Health, University of Queensland, Brisbane, Australia
| | - Sviatlana Kamarova
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
- School of Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
- Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia
| | - Donald McRobbie
- School of Physical Sciences, University of Adelaide, Adelaide, Australia
| | - Peter O'Leary
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
- Obstetrics and Gynaecology Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- PathWest Laboratory Medicine, QE2 Medical Centre, Nedlands, WA, Australia
| | - Paul M Parizel
- Medical School, University of Western Australia, Perth, WA, Australia
- Department of Radiology, Royal Perth Hospital, Victoria Square, Perth, WA, 6000, Australia
| | - John Slavotinek
- SA Medical Imaging, SA Health and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Cameron Wright
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
- Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, WA, Australia
- Division of Internal Medicine, Medical School, Faculty of Health and Medical Sciences, University of Western, Perth, Australia
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - David Youens
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - Rachael Moorin
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Crawley, Australia
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25
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Nyadanu SD, Tessema GA, Mullins B, Chai K, Yitshak-Sade M, Pereira G. Critical Windows of Maternal Exposure to Biothermal Stress and Birth Weight for Gestational Age in Western Australia. Environ Health Perspect 2023; 131:127017. [PMID: 38149876 PMCID: PMC10752220 DOI: 10.1289/ehp12660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 10/05/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND There is limited and inconsistent evidence on the risk of ambient temperature on small for gestational age (SGA) and there are no known related studies for large for gestational age (LGA). In addition, previous studies used temperature rather than a biothermal metric. OBJECTIVES Our aim was to examine the associations and critical susceptible windows of maternal exposure to a biothermal metric [Universal Thermal Climate Index (UTCI)] and the hazards of SGA and LGA. METHODS We linked 385,337 singleton term births between 1 January 2000 and 31 December 2015 in Western Australia to daily spatiotemporal UTCI. Distributed lag nonlinear models with Cox regression and multiple models were used to investigate maternal exposure to UTCI from 12 weeks preconception to birth and the adjusted hazard ratios (HRs) of SGA and LGA. RESULTS Relative to the median exposure, weekly and monthly specific exposures showed potential critical windows of susceptibility for SGA and LGA at extreme exposures, especially during late gestational periods. Monthly exposure showed strong positive associations from the 6th to the 10th gestational months with the highest hazard of 13% for SGA (HR = 1.13 ; 95% CI: 1.10, 1.14) and 7% for LGA (HR = 1.07 ; 95% CI: 1.03, 1.11) at the 10th month for the 1st UTCI centile. Entire pregnancy exposures showed the strongest hazards of 11% for SGA (HR = 1.11 ; 95% CI: 1.04, 1.18) and 3% for LGA (HR = 1.03 ; 95% CI: 0.95, 1.11) at the 99th UTCI centile. By trimesters, the highest hazards were found during the second and first trimesters for SGA and LGA, respectively, at the 99th UTCI centile. Based on estimated interaction effects, male births, mothers who were non-Caucasian, smokers, ≥ 35 years of age, and rural residents were most vulnerable. CONCLUSIONS Both weekly and monthly specific extreme biothermal stress exposures showed potential critical susceptible windows of SGA and LGA during late gestational periods with disproportionate sociodemographic vulnerabilities. https://doi.org/10.1289/EHP12660.
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Affiliation(s)
- Sylvester Dodzi Nyadanu
- Curtin School of Population Health, Curtin University, Perth, Bentley, Western Australia, Australia
- Education, Culture, and Health Opportunities (ECHO) Ghana, ECHO Research Group International, Aflao, Ghana
| | - Gizachew A. Tessema
- Curtin School of Population Health, Curtin University, Perth, Bentley, Western Australia, Australia
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
- enAble Institute, Curtin University, Perth, Bentley, Western Australia, Australia
| | - Ben Mullins
- Curtin School of Population Health, Curtin University, Perth, Bentley, Western Australia, Australia
| | - Kevin Chai
- Curtin School of Population Health, Curtin University, Perth, Bentley, Western Australia, Australia
| | - Maayan Yitshak-Sade
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Bentley, Western Australia, Australia
- enAble Institute, Curtin University, Perth, Bentley, Western Australia, Australia
- World Health Organization Collaborating Centre for Environmental Health Impact Assessment, Faculty of Health Science, Curtin University, Bentley, Western Australia, Australia
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26
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Watkins PM, Hill AM, Tohira H, Brink D, Finn J, Buzzacott P. Epidemiology of ambulance-attended adults who fell in Western Australia 2015 - 2021: An increasing incidence in an ageing population. Injury 2023; 54:111035. [PMID: 37777369 DOI: 10.1016/j.injury.2023.111035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Emergency Medical Services (EMS) are attending an increasing number of adults who fall. This study aimed to describe the incidence, patient characteristics, treatments and disposition of ambulance attended patients who fell in Western Australia (WA). METHODS An ordinal logistic regression (using STATA) was conducted in this retrospective cohort study, analysing predictors of lower compared to higher transport urgency levels. Participants were adults ( ≥ 18 years) who fell and required ambulance attendance in WA between 1st January 2015 - 31st December 2021. RESULTS A total of 188,720 patients (female = 107,811, 57 %) were attended by ambulances after falls, (median age = 80 years [IQR 67-87]). The age-standardized incidence rate of ambulance attended falls increased from 115 cases/100,000 person-years to 161 cases/100,000 person-years between 2015 and 2021. A total of 89,140 (47 %) patients had an injury recorded by paramedics, most often lacerations or suspected fractures. The electronic patient care record showed, 50,044 (26.5 %) patients received medication and 30,954 (16.4 %) patients received other intervention, e.g., ECG. A total of 148,050 (78 %) patients were transported to hospital with the following urgency levels: 2,371 (2 %) via urgency one; 27,882 (19 %) via urgency two, 93,447 (63 %) via urgency three and 22,584 (15 %) via urgency four and five ( < 1 % unknown urgency). Positive predictors of lower level transport urgency to hospital included being female and older than 65 years of age. CONCLUSION Older, female patients had higher odds of being transported via a lower urgency, with 50 % of this cohort transported via urgency three. While 19 % of patients were attended via a Priority one, only 1 % were transported to hospital via urgency one. The incidence rate of falls requiring ambulance attendance has increased over time, increasing the demand placed on EMS annually.
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Affiliation(s)
- Paige M Watkins
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, Australia.
| | - Anne-Marie Hill
- School of Allied Health, University of Western Australia, Perth, Australia
| | - Hideo Tohira
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, Australia; Discipline of Emergency Medicine, Medical School, The University of Western Australia, Perth, Australia
| | - Deon Brink
- St John Western Australia, Belmont, Australia
| | - Judith Finn
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, Australia; St John Western Australia, Belmont, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Buzzacott
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, Australia
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Hillan A, Korbl J, Wood BA, Trevithick R, Harvey NT. Sebaceous carcinoma in Western Australia: A registry-based study of site-related outcomes. Australas J Dermatol 2023; 64:529-533. [PMID: 37461361 DOI: 10.1111/ajd.14127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/22/2023] [Indexed: 11/10/2023]
Abstract
Sebaceous carcinoma is a rare cutaneous malignancy which is typically regarded as relatively aggressive and has traditionally been subdivided into periorbital or extraorbital tumours. We conducted a retrospective review of all cases of sebaceous carcinoma reported to the Western Australian Cancer Registry between 1987 and May 2019. The incidence of sebaceous carcinoma in Western Australia has increased over the last three decades, with extraorbital tumours being much more common than periorbital tumours. Very few sebaceous carcinomas have led directly to the death of patients; however, adverse outcomes were more likely with periorbital tumours, in particular local recurrence and the need for major surgical intervention.
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Affiliation(s)
- Adeline Hillan
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jasmin Korbl
- Department of Dermatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Benjamin Andrew Wood
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Richard Trevithick
- Western Australia Cancer Registry, East Perth, Western Australia, Australia
| | - Nathan Tobias Harvey
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Division of Pathology and Laboratory Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia
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28
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Hamsanathan P, Katzenellenbogen JM, Andrews D, Carapetis J, Richmond P, McKinnon E, Ramsay J. A Review of Cardiac Surgical Procedures and Their Outcomes for Paediatric Rheumatic Heart Disease in Western Australia. Heart Lung Circ 2023; 32:1398-1406. [PMID: 37852820 DOI: 10.1016/j.hlc.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Surgical intervention is an important treatment modality for advanced rheumatic heart disease (RHD). This study aimed to describe patient characteristics and outcomes from cardiac surgery for RHD in patients referred to the only tertiary paediatric hospital in Western Australia. METHODS An analysis of patient characteristics and cardiac surgery outcomes in patients with RHD was undertaken, using data from clinical cardiac databases, medical notes, and correspondence from rural outreach clinics. RESULTS 29 patients (59% female, 97% Aboriginal, Māori or Pacific Islander) underwent 41 valve interventions over 34 cardiac surgeries for RHD between 2000-2018. Median age at first surgery was 12.2 (range 4-16) years. Severe mitral regurgitation (MR) was the most common indication for primary surgery (62%), followed by mixed mitral regurgitation/aortic regurgitation (21%) and severe aortic regurgitation (17%). Mitral valve repair was the most common valve intervention (56%). Two patients had mitral valve replacement (MVR) at first operation, two patients had MVR at second operation and two had MVR at third operation. There was no early mortality. One patient required early (<30 days) reoperation for aortic valve repair failure. Two patients had late reoperations at 3.3 and 6.1 months after the first procedure for MR. Four (14%) patients experienced documented ARF recurrences. Late mortality occurred in 3 (10%) patients, all due to cardiac causes. On last follow-up echocardiogram 5 patients (17%) had moderate MR and none had severe MR. CONCLUSIONS This is the first study to describe characteristics and outcomes in WA paediatric patients having surgery for RHD. Outcomes are comparable to similar studies, with favourable long-term survival.
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Affiliation(s)
| | - Judith M Katzenellenbogen
- The School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; Telethon Kids Institute, Perth Western Australia, Nedlands, WA, Australia
| | - David Andrews
- Perth Children's Hospital, Perth Western Australia, Nedlands, WA, Australia
| | - Jonathan Carapetis
- Perth Children's Hospital, Perth Western Australia, Nedlands, WA, Australia; Telethon Kids Institute, Perth Western Australia, Nedlands, WA, Australia; Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Peter Richmond
- Perth Children's Hospital, Perth Western Australia, Nedlands, WA, Australia; The School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; Telethon Kids Institute, Perth Western Australia, Nedlands, WA, Australia
| | - Elizabeth McKinnon
- Telethon Kids Institute, Perth Western Australia, Nedlands, WA, Australia
| | - James Ramsay
- Perth Children's Hospital, Perth Western Australia, Nedlands, WA, Australia
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29
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Zhang S, Mittinty M, Davis EA, Cameron E, Haynes A. Childhood-onset type 1 diabetes in Western Australia: An update on incidence and temporal trends from 2001 to 2022. Diabet Med 2023; 40:e15148. [PMID: 37191883 DOI: 10.1111/dme.15148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/21/2023] [Accepted: 05/12/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To determine the incidence and incidence trends over 2001-2022 of childhood-onset type 1 diabetes (T1D) in Western Australia and assess the impact of the COVID-19 pandemic. METHODS Children newly diagnosed with T1D aged 0-14 years in Western Australia from 1 January 2001 to 31 December 2022 were identified from the population-based Western Australian Children's Diabetes Database. Annual age- and sex-specific incidence was calculated, and Poisson regression was used to analyse trends by calendar year, month, sex and age group at diagnosis. Pandemic era impacts were also examined using the regression model adjusted for sex and age group. RESULTS Between 2001 and 2022, 2311 children (1214 boys, 1097 girls) were newly diagnosed with T1D aged 0-14 years, giving an overall mean annual incidence of 22.9 per 100,000 person-years (95% CI: 22.0, 23.9), with no significant difference observed between boys and girls. A significant linear increasing trend was only observed in 10-14 year olds with boys and girls combined (1.2% per year [IRR 1.012 (95% CI: 1.002, 1.022)]). No significant difference in the incidence was observed between the pre- and post-pandemic period. CONCLUSIONS The incidence of type 1 diabetes in 0-14 year old Western Australian children continues to increase in the oldest age group. Longer term monitoring of the incidence during the COVID-19 pandemic is needed to determine its impact on this globally unique population which experienced a delayed start to the pandemic with severe containment measures remaining in place until January 2022.
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Affiliation(s)
- Song Zhang
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, Southern Australia, Australia
| | - Murthy Mittinty
- College of Medicine and Public Health, Flinders University, Adelaide, Southern Australia, Australia
| | - Elizabeth A Davis
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Paediatrics, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Ewan Cameron
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Aveni Haynes
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
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30
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Ha NT, Kamarova S, Youens D, Ho C, Bulsara MK, Doust J, Mcrobbie D, O'Leary P, Wright C, Trevithick R, Moorin R. Use of CT, ED presentation and hospitalisations 12 months before and after a diagnosis of cancer in Western Australia: a population-based retrospective cohort study. BMJ Open 2023; 13:e071052. [PMID: 37899144 PMCID: PMC10619095 DOI: 10.1136/bmjopen-2022-071052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 10/12/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE To examine the use of CT, emergency department (ED)-presentation and hospitalisation and in 12 months before and after a diagnosis of cancer. DESIGN Population-based retrospective cohort study. SETTING West Australian linked administrative records at individual level. PARTICIPANTS 104 009 adults newly diagnosed with cancer in 2004-2014. MAIN OUTCOME MEASURES CT use, ED presentations, hospitalisations. RESULTS As compared with the rates in the 12th month before diagnosis, the rate of CT scans started to increase from 2 months before diagnosis with an increase in both ED presentations and hospitalisation from 1 month before the diagnosis. These rates peaked in the month of diagnosis for CT scans (477 (95% CI 471 to 482) per 1000 patients), and for hospitalisations (910 (95% CI 902 to 919) per 1000 patients), and the month prior to diagnosis for ED (181 (95% CI 178 to 184) per 1000 patients) then rapidly reduced after diagnosis but remained high for the next 12 months. While the patterns of the health services used were similar between 2004 and 2014, the rate of the health services used during after diagnosis was higher in 2014 versus 2004 except for CT use in patients with lymphohaematopoietic cancer with a significant reduction. CONCLUSION Our results showed an increase in demand for health services from 2 months before diagnosis of cancer. Increasing use of health services during and post cancer diagnosis may warrant further investigation to identify factors driving this change.
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Affiliation(s)
- Ninh Thi Ha
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Sviatlana Kamarova
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Nepean Blue Mountains Local Health District, New South Wales Health, Sydney, New South Wales, Australia
| | - David Youens
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Chau Ho
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Max K Bulsara
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- Biostatistics, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jenny Doust
- Australian Women and Girls' Health Research (AWaGHR) Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Donald Mcrobbie
- School of Physical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter O'Leary
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Obstetrics and Gynaecology Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- PathWest Laboratory Medicine, QE2 Medical Centre, Nedlands, Western Australia, Australia
| | - Cameron Wright
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Division of Internal Medicine, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Richard Trevithick
- Western Australian Cancer Registry, Clinical Excellence Division, Department of Health, East Perth, Western Australia, Australia
| | - Rachael Moorin
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Ahmed MA, Bailey HD, Pereira G, White SW, Wong K, McNamara BJ, Rheeder P, Marriott R, Shepherd CCJ. The impact of diabetes during pregnancy on neonatal outcomes among the Aboriginal population in Western Australia: a whole-population study. Int J Epidemiol 2023; 52:1400-1413. [PMID: 37263617 DOI: 10.1093/ije/dyad072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 05/13/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander (hereafter Aboriginal) women have a high prevalence of diabetes in pregnancy (DIP), which includes pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM). We aimed to characterize the impact of DIP in babies born to Aboriginal mothers. METHODS A retrospective cohort study, using routinely collected linked health data that included all singleton births (N = 510 761) in Western Australia between 1998 and 2015. Stratified by Aboriginal status, generalized linear mixed models quantified the impact of DIP on neonatal outcomes, estimating relative risks (RRs) with 95% CIs. Ratio of RRs (RRRs) examined whether RRs differed between Aboriginal and non-Aboriginal populations. RESULTS Exposure to DIP increased the risk of adverse outcomes to a greater extent in Aboriginal babies. PGDM heightened the risk of large for gestational age (LGA) (RR: 4.10, 95% CI: 3.56-4.72; RRR: 1.25, 95% CI: 1.09-1.43), macrosomia (RR: 2.03, 95% CI: 1.67-2.48; RRR: 1.39, 95% CI: 1.14-1.69), shoulder dystocia (RR: 4.51, 95% CI: 3.14-6.49; RRR: 2.19, 95% CI: 1.44-3.33) and major congenital anomalies (RR: 2.14, 95% CI: 1.68-2.74; RRR: 1.62, 95% CI: 1.24-2.10). GDM increased the risk of LGA (RR: 2.63, 95% CI: 2.36-2.94; RRR: 2.00, 95% CI: 1.80-2.22), macrosomia (RR: 1.95, 95% CI: 1.72-2.21; RRR: 2.27, 95% CI: 2.01-2.56) and shoulder dystocia (RR: 2.78, 95% CI: 2.12-3.63; RRR: 2.11, 95% CI: 1.61-2.77). Birthweight mediated about half of the DIP effect on shoulder dystocia only in the Aboriginal babies. CONCLUSIONS DIP differentially increased the risks of fetal overgrowth, shoulder dystocia and congenital anomalies in Aboriginal babies. Improving care for Aboriginal women with diabetes and further research on preventing shoulder dystocia among these women can reduce the disparities.
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Affiliation(s)
- Marwan Awad Ahmed
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Helen D Bailey
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Bridgette J McNamara
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Paul Rheeder
- Department of Internal Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Rhonda Marriott
- Ngangk Yira Research Centre, Murdoch University, Perth, Western Australia, Australia
| | - Carrington C J Shepherd
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Ngangk Yira Research Centre, Murdoch University, Perth, Western Australia, Australia
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Marriott RJ, Singh B, McArdle N, Darcey E, King S, Bond-Smith D, Reynor A, Noffsinger W, Ward K, Mukherjee S, Hillman DR, Cadby G. Does OSA Increase Risk for Cancer?: A Large Historical Sleep Clinic Cohort Study. Chest 2023; 164:1042-1056. [PMID: 37150506 DOI: 10.1016/j.chest.2023.04.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/25/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND The relationship between OSA and cancer is unclear. RESEARCH QUESTION What is the association between OSA and cancer prevalence and incidence in a large Western Australian sleep clinic cohort (N = 20,289)? STUDY DESIGN AND METHODS OSA severity was defined by apnea-hypopnea index (AHI) and nocturnal hypoxemia (duration and percentage at oxygen saturation < 90%) measured by in-laboratory polysomnogram. Measures of potential confounding included age, sex, BMI, smoking status, socioeconomic status, and BP. Outcomes were determined from the Western Australian cancer and death registries. Analyses were confined within periods using consistent AHI scoring criteria: January 1, 1989, to July 31, 2002 (American Sleep Disorders Association criteria), and August 1, 2002, to June 30, 2013 (Chicago criteria). We examined associations of AHI and nocturnal hypoxemia with cancer prevalence using logistic regression and cancer incidence using Cox regression analyses. RESULTS Cancer prevalence at baseline was 329 of 10,561 in the American Sleep Disorders Association period and 633 of 9,728 in the Chicago period. Nocturnal hypoxemia but not AHI was independently associated with prevalent cancer following adjustment for participant age, sex, BMI, smoking status, socioeconomic status, and BP. Of those without prevalent cancer, cancer was diagnosed in 1,950 of 10,232 (American Sleep Disorders Association) and 623 of 9,095 (Chicago) participants over a median follow-up of 11.2 years. Compared with the reference category (no OSA, AHI < 5 events per hour), univariable models estimated higher hazard ratios for cancer incidence for mild (AHI 5-15 events per hour), moderate (AHI 15.1-30 events per hour), and severe (AHI > 30 events per hour) OSA. Multivariable analyses consistently revealed associations between age and, in some cases, sex, BMI, and smoking status, with cancer incidence. After adjusting for confounders, multivariable models showed no independent association between OSA severity and increased cancer incidence. INTERPRETATION Nocturnal hypoxemia is independently associated with prevalent cancer. OSA severity is associated with incident cancer, although this association seems secondary to other risk factors for cancer development. OSA is not an independent risk factor for cancer incidence.
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Affiliation(s)
- Ross J Marriott
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - Bhajan Singh
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia; Department of Pulmonary Physiology & Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
| | - Nigel McArdle
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia; Department of Pulmonary Physiology & Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Ellie Darcey
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - Stuart King
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia; Department of Pulmonary Physiology & Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Daniela Bond-Smith
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia; University of Hawaii Economic Research Organization, University of Hawaii at Mānoa, Honolulu, Hawaii
| | - Ayesha Reynor
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia; Department of Pulmonary Physiology & Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - William Noffsinger
- Department of Pulmonary Physiology & Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Kim Ward
- Department of Pulmonary Physiology & Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Sutapa Mukherjee
- Flinders Health and Medical Research Institute and Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia; Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - David R Hillman
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia; Department of Pulmonary Physiology & Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Gemma Cadby
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
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Bailey HD, Adane AA, White SW, Farrant BM, Shepherd CCJ. Severe maternal morbidity following stillbirth in Western Australia 2000-2015: a population-based study. Arch Gynecol Obstet 2023; 308:1175-1187. [PMID: 36109376 PMCID: PMC10435652 DOI: 10.1007/s00404-022-06782-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 09/01/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE There is scant literature about the management of stillbirth and the subsequent risk of severe maternal morbidity (SMM). We aimed to assess the risk of SMM associated with stillbirths compared with live births and whether this differed by the presence of maternal comorbidities. METHODS In this retrospective cohort study, we used a population-based dataset of all stillbirths and live births ≥ 20 weeks' gestation in Western Australia between 2000 and 2015. SMM was identified using a published Australian composite for use with routinely collected hospital morbidity data. Maternal comorbidities were identified in the Hospital Morbidity Data Collection or the Midwives Notification System using a modified Australian chronic disease composite. Multivariable Poisson regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for factors associated with SMM in analyses stratified by the presence of maternal comorbidities. Singleton and multiple pregnancies were examined separately. RESULTS This study included 458,639 singleton births (2319 stillbirths and 456,320 live births). The adjusted RRs for SMM among stillbirths were 2.30 (95% CI 1.77, 3.00) for those without comorbidities and 4.80 (95% CI 4.11, 5.59) (Interaction P value < 0.0001) for those with comorbidities compared to live births without and with comorbidities, respectively. CONCLUSION In Western Australia between 2000 and 2015, mothers of stillbirths both with and without any maternal comorbidities had an increased risk of SMM compared with live births. Further investigation into why women who have had a stillbirth without any existing conditions or pregnancy complications develop SMM is warranted.
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Affiliation(s)
- Helen D Bailey
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, GPO Box U1987, 6845, Australia.
- Telethon Kids Institute, The University of Western Australia, West Perth 6872, P.O. Box 855, Nedlands, WA, Australia.
| | - Akilew A Adane
- Telethon Kids Institute, The University of Western Australia, West Perth 6872, P.O. Box 855, Nedlands, WA, Australia
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Nedlands, WA, Australia
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Brad M Farrant
- Telethon Kids Institute, The University of Western Australia, West Perth 6872, P.O. Box 855, Nedlands, WA, Australia
| | - Carrington C J Shepherd
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, GPO Box U1987, 6845, Australia
- Telethon Kids Institute, The University of Western Australia, West Perth 6872, P.O. Box 855, Nedlands, WA, Australia
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
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Smith S, Tallon M, Smith J, Jones L, Mörelius E. COVID-19 in Western Australia: 'The last straw' and hopes for a 'new normal' for parents of children with long-term conditions. Health Expect 2023; 26:1863-1873. [PMID: 37309296 PMCID: PMC10485346 DOI: 10.1111/hex.13792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/12/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Children with long-term conditions are vulnerable due to the treatments required for their conditions. Since the start of the coronavirus disease 2019 (COVID-19) pandemic, Western Australians experienced restrictions that changed daily life activities but were able to return to some of their previous routines due to the restrictions. AIM The study explored the stress experiences of parents caring for children with long-term conditions during COVID-19 in Western Australia. DESIGN AND PARTICIPANTS The study was codesigned with a parent representative caring for children with long-term conditions to ensure essential questions were targeted. Twelve parents of children with various long-term conditions were recruited. Ten parents completed the qualitative proforma, and two parents were interviewed in November 2020. Interviews were audio-recorded and transcribed verbatim. Data were anonymised and analysed using reflexive thematic analysis. FINDINGS Two themes were produced: (1) 'Keep my child safe' describes the children's vulnerabilities due to their long-term conditions, the adjustments parents' made to keep their children safe and the various consequences faced. (2) 'COVID-19's silver lining' covers the positives of the COVID-19 pandemic, including their children having fewer infections, the availability of telehealth appointments, relationship improvements and the parent's hopes for a new normal where behaviours prevent transmission of infectious (e.g., hand sanitising). CONCLUSION Western Australia provided a unique context for the COVID-19 pandemic due to no transmission of the virus severe acute respiratory syndrome coronavirus 2 at the time of the study. The tend and befriend theory aids in explaining the parents' stress experiences, and the application highlights a unique aspect of this theory. Parents tended to their children during COVID-19, but many could no longer rely on others for connection, support and respite, and became further isolated in attempting to protect their children due to COVID-19 consequences. The findings highlight that some parents of children with long-term conditions need specific attention during times of pandemics. Further review is recommended to support parents through the impact of COVID-19 and similar crises. PATIENT OR PUBLIC CONTRIBUTION This study was codesigned with an experienced parent representative who was part of the research team and involved throughout the research process to ensure meaningful end-user engagement and ensure essential questions and priorities were addressed.
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Affiliation(s)
- Stephanie Smith
- School of Nursing and MidwiferyEdith Cowan UniversityPerthWestern AustraliaAustralia
- Curtin Medical SchoolCurtin UniversityPerthWestern AustraliaAustralia
- Telethon Kids InstitutePerthWestern AustraliaAustralia
| | - Mary Tallon
- School of NursingCurtin UniversityPerthWestern AustraliaAustralia
- Child and Adolescent Health ServicePerthWestern AustraliaAustralia
| | - James Smith
- School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- School of Medical and Health SciencesEdith Cowan UniversityPerthWestern AustraliaAustralia
| | - Lauren Jones
- Parent RepresentativeBunburyWestern AustraliaAustralia
| | - Evalotte Mörelius
- School of Nursing and MidwiferyEdith Cowan UniversityPerthWestern AustraliaAustralia
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
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Newnham EA, Mergelsberg ELP, Tearne J, McEvoy P, Stanley S, Celenza A, Kavanagh H, Stevenson T, Mavaddat N, Demore G, Hood S. Mental Health Status, Risk and Protective Factors for Healthcare Staff Prior to the First Major COVID-19 Outbreak in Western Australia. Int J Public Health 2023; 68:1606102. [PMID: 37732330 PMCID: PMC10507727 DOI: 10.3389/ijph.2023.1606102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
Objectives: Western Australia's unique public health response delayed the first wave of community COVID-19 transmission for 2 years. We aimed to determine the status of post-traumatic stress (PTSS), depressive, and anxiety symptoms among healthcare staff in major tertiary hospitals, together with associated risk and protective factors prior to the first substantial outbreak of COVID-19. Methods: A cross-sectional study was conducted with 431 healthcare staff immediately prior to the Western Australian border re-opening in 2022. Staff were recruited via notices in email newsletters, at four tertiary hospitals and a public mental health clinic in metropolitan Perth. Validated and original questionnaires were administered via Qualtrics. Results: Moderate levels of PTSS (22.3%), depression (21.9%), and anxiety (25.9%) were reported. Pathway analyses indicated that sleep difficulties, workplace stressors, and infectious disease training were associated with higher PTSS, depression and anxiety symptoms, and younger age was associated with higher levels of depression and anxiety. Nursing roles were associated with higher PTSS. Social support and workplace support were associated with lower levels of depression and anxiety but were not associated with PTSS. Conclusion: The findings illustrate high levels of resilience, but indicate a need for structural supports within the health system to foster staff mental health prior to the onset of emergencies.
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Affiliation(s)
- Elizabeth A. Newnham
- School of Population Health, Curtin University, Perth, WA, Australia
- Curtin enAble Institute, Perth, WA, Australia
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | | | - Jessica Tearne
- Department of Clinical Psychology and Clinical Neuropsychology, Fiona Stanley Hospital, Perth, WA, Australia
- State Major Trauma Unit, Royal Perth Hospital, Perth, WA, Australia
| | - Peter McEvoy
- School of Population Health, Curtin University, Perth, WA, Australia
- Curtin enAble Institute, Perth, WA, Australia
- Centre for Clinical Interventions, North Metropolitan Health Service, Perth, WA, Australia
| | - Susanne Stanley
- Division of Psychiatry, School of Medicine, The University of Western Australia, Perth, WA, Australia
| | - Antonio Celenza
- Emergency Medicine, School of Medicine, University of Western Australia, Perth, WA, Australia
- Emergency Department, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Hyranthi Kavanagh
- Department of Clinical Psychology and Clinical Neuropsychology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Teresa Stevenson
- Peel and Rockingham Kwinana Mental Health Service, Rockingham, WA, Australia
| | - Nahal Mavaddat
- Discipline of General Practice, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Gavin Demore
- Emergency Medicine, School of Medicine, University of Western Australia, Perth, WA, Australia
- Western Australia Country Health Service, Perth, WA, Australia
| | - Sean Hood
- Division of Psychiatry, School of Medicine, The University of Western Australia, Perth, WA, Australia
- Sir Charles Gairdner Hospital Mental Health Unit, North Metropolitan Health Service Mental Health, Public Health and Dental Services (MHPHDS), Perth, WA, Australia
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Abdalla T, Walwyn T, White D, Choong CS, Bulsara M, Preen DB, Ohan JL. Hospitalizations and Cost of Inpatient Care for Physical Diseases in Survivors of Childhood Cancer in Western Australia: A Longitudinal Matched Cohort Study. Cancer Epidemiol Biomarkers Prev 2023; 32:1249-1259. [PMID: 37409970 DOI: 10.1158/1055-9965.epi-22-1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/28/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The long-term effects of childhood cancer are unclear in the Australian context. We examined hospitalization trends for physical diseases and estimated the associated inpatient care costs in all 5-year childhood cancer survivors (CCS) diagnosed in Western Australia (WA) from 1982 to 2014. METHODS Hospitalization records for 2,938 CCS and 24,792 comparisons were extracted from 1987 to 2019 (median follow-up = 12 years, min = 1, max = 32). The adjusted hazard ratio (aHR) of hospitalization with 95% confidence intervals (CI) was estimated using the Andersen-Gill model for recurrent events. The cumulative burden of hospitalizations over time was assessed using the mean cumulative count method. The adjusted mean cost of hospitalization was estimated using the generalized linear models. RESULTS We identified a higher risk of hospitalization for all-cause (aHR, 2.0; 95% CI, 1.8-2.2) physical disease in CCS than comparisons, with the highest risk for subsequent malignant neoplasms (aHR, 15.0; 95% CI, 11.3-19.8) and blood diseases (aHR, 6.9; 95% CI, 2.6-18.2). Characteristics associated with higher hospitalization rates included female gender, diagnosis with bone tumors, cancer diagnosis age between 5 and 9 years, multiple childhood cancer diagnoses, multiple comorbidities, higher deprivation, increased remoteness, and Indigenous status. The difference in the mean total hospitalization costs for any disease was significantly higher in survivors than comparisons (publicly funded $11,483 United States Dollar, P < 0.05). CONCLUSIONS The CCS population faces a significantly higher risk of physical morbidity and higher cost of hospital-based care than the comparisons. IMPACT Our study highlights the need for long-term follow-up healthcare services to prevent disease progression and mitigate the burden of physical morbidity on CCS and hospital services.
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Affiliation(s)
- Tasnim Abdalla
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Thomas Walwyn
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Department of Paediatric and Adolescent Oncology and Hematology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Daniel White
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Catherine S Choong
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Jeneva L Ohan
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
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MacArthur C, Hansen M, Baynam G, Bower C, Kelty E. Trends in prenatal diagnosis of congenital anomalies in Western Australia between 1980 and 2020: A population-based study. Paediatr Perinat Epidemiol 2023; 37:596-606. [PMID: 37143205 PMCID: PMC10947594 DOI: 10.1111/ppe.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 04/09/2023] [Accepted: 04/14/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Advances in screening and diagnostics have changed the way in which we identify and diagnose congenital anomalies. OBJECTIVE To examine changes in rates of prenatal diagnosis of congenital anomalies over time and by demographic characteristics. METHODS We undertook a population-based retrospective cohort study of all children born in Western Australia between 1980 and 2020 and diagnosed with a congenital anomaly. Age at diagnosis (prenatal, neonatal, infancy, early childhood or childhood) prevalence (all-type and type-specific), and prevalence ratios (PR) were calculated. We fit joinpoint regression models to describe the average annual percentage change (APC) in prenatal diagnosis over time, and log-binomial regression models to estimate the association between prenatal diagnosis and demographic characteristics. RESULTS Prenatal diagnosis prevalence between the first (1980-1989: 28.3 per 10,000 births) and last (2005-2014: 156.1 per 10,000 births) decades of the study increased 5.5-fold (95% confidence interval [CI] 5.0, 5.9). Substantial increases were observed for cardiovascular (PR 10.7, 95% CI 8.0, 14.6), urogenital (PR 10.5, 95% CI: 8.7, 12.6) and chromosomal anomalies (PR 7.0, 95% CI 5.9, 8.3). Prenatal diagnosis was positively associated with the birth year (adjusted risk ratio [RR] 1.04, 95% CI 1.03, 1.04), advanced maternal age (RR 1.14, 95% CI 1.11, 1.18), multiple anomalies (RR 2.86, 95% CI 2.77, 2.96) and major anomalies (RR 3.75, 95% CI 3.36, 4.19), and inversely associated with remoteness (RR 0.89, 95% CI: 0.83, 0.95) and Aboriginality (RR 0.90, 95% CI 0.83, 0.97). CONCLUSIONS Increases in prenatal diagnosis of congenital anomalies were observed in Western Australia from 1980 to 2020, reflecting advances in screening. Prenatal diagnosis was less common in remote regions and in Aboriginal children, strengthening calls for increased provision of antenatal care services for these populations.
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Affiliation(s)
- Cassandra MacArthur
- School of Population and Global HealthThe University of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Michele Hansen
- Telethon Kids InstituteThe University of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Gareth Baynam
- Western Australian Register of Developmental AnomaliesKing Edward Memorial HospitalPerthWestern AustraliaAustralia
- Faculty of Health and Medicine, Institute and Division of PaediatricsUniversity of Western AustraliaCrawleyWestern AustraliaAustralia
- Rare Care, Clinical Centre of Expertise for Rare and Undiagnosed DiseasesPerth Children's HospitalPerthWestern AustraliaAustralia
| | - Carol Bower
- Telethon Kids InstituteThe University of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Erin Kelty
- School of Population and Global HealthThe University of Western AustraliaCrawleyWestern AustraliaAustralia
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House CL, Rawlins M, Dyer J, Boan P, Musk M. The unique COVID-19 experience in Western Australia: lessons learnt. Intern Med J 2023; 53:1548-1555. [PMID: 37493390 DOI: 10.1111/imj.16172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/14/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Western Australia (WA) was in a unique position to experience coronavirus disease 2019 (COVID-19) in a highly vaccinated and geographically isolated population. AIM To describe the COVID-19 Omicron experience at the only quaternary hospital in WA following border opening from 3 March to 11 May 2022. PARTICIPANTS A total of 158 adults with microbiologically confirmed COVID-19 were admitted to the respiratory or intensive care unit (ICU). OUTCOMES Admission numbers, disease severity, prevalence of COVID-19 deterioration risk factors, immunisation status, severity of infection, immunosuppression and treatment regimen. RESULTS One hundred fifty-eight COVID-19-positive patients were admitted to the respiratory ward (n = 123) and the ICU (n = 35) during the study period. COVID-19 infection was the primary admission reason in 32.9% of patients, 51.3% were male and the median age was 62 years. Aboriginal or Torres Strait Islanders (ATSI) were overrepresented (13.3%). Care was predominantly ward based (77.2%). Nearly half of the patients had mild COVID-19 (49.4%). Dexamethasone was the most common treatment provided to patients (58.2%). The median length of stay was 5.8 days (interquartile range, 5-15). Eight patients died during the study period (5.1%), with three of those deaths attributable to COVID-19. CONCLUSIONS COVID-19 case numbers following WA state border opening were of lower care acuity and disease severity than predicted. Two-thirds of admissions were for other primary diagnoses, with incidental COVID detection. Hospital admissions were overrepresented by partially or unvaccinated patients and by ATSI Australians. An increase in social support along with general and geriatric medicine speciality input were required to treat hospitalised COVID-19 cases in the WA Omicron wave.
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Affiliation(s)
- Caris L House
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Matthew Rawlins
- Department of Pharmacy, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - John Dyer
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Peter Boan
- Department of Infectious Diseases and Microbiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Michael Musk
- Advanced Lung Disease and Transplant Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Davis JW, Seeber CE, Nathan EA, Strunk T, Gill A, Sharp M. Outcomes to 5 years of outborn versus inborn infants <32 weeks in Western Australia: a cohort study of infants born between 2005 and 2018. Arch Dis Child Fetal Neonatal Ed 2023; 108:499-504. [PMID: 36804194 DOI: 10.1136/archdischild-2022-324749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/30/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE We compared mortality and morbidity of inborn versus outborn very preterm infants <32 weeks' gestation in Western Australia (WA) between 2005 and 2018. DESIGN Retrospective cohort study. PATIENTS Infants <32 weeks' gestation who were born in WA. MAIN OUTCOME MEASURES Mortality was assessed as death before discharge home from the tertiary neonatal intensive care unit. Short-term morbidities included combined brain injury (intracranial haemorrhage grade ≥3 and cystic periventricular leukomalacia) and other major neonatal outcomes. Developmental assessments at age 2, 3 and 5 years were evaluated. We performed multivariable logistic regression analysis of outborn status on outcomes, controlling for gestational age, birth weight z-score, sex and multiple birth. RESULTS A total of 4974 infants were born in WA between 22 and 32 weeks' gestation between 2005 and 2018 of which 4237 (89.6%) were inborn and 443 (10.4%) were outborn. Overall mortality to discharge was higher in outborn infants (20.5% (91/443) vs 7.4% (314/4237); adjusted OR (aOR) 2.44, 95% CI 1.60 to 3.70, p<0.001). Outborn infants had higher rates of combined brain injury than those inborn (10.7% (41/384) vs 6.0% (246/4115); aOR 1.98, 95% CI 1.37 to 2.86), p<0.001). No difference in up to 5-year developmental measures was detected. Follow-up data were available for 65% of outborn and 79% of inborn infants. CONCLUSIONS Outborn preterm infants <32 weeks in WA had increased odds of mortality and combined brain injury than those inborn. Developmental outcomes up to 5 years were similar between groups. Loss to follow-up may have impacted the long-term comparison.
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Affiliation(s)
- Jonathan W Davis
- Newborn Emergency Transport Service of Western Australia, Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - C E Seeber
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Elizabeth A Nathan
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Tobias Strunk
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Andy Gill
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Mary Sharp
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
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Gourd E. Improved cancer coverage for firefighters in Western Australia. Lancet Oncol 2023; 24:960. [PMID: 37573863 DOI: 10.1016/s1470-2045(23)00399-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
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Sarna M, Gebremedhin A, Richmond P, Levy A, Glass K, Moore HC. Determining the true incidence of seasonal respiratory syncytial virus-confirmed hospitalizations in preterm and term infants in Western Australia. Vaccine 2023; 41:5216-5220. [PMID: 37474407 DOI: 10.1016/j.vaccine.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
Respiratory syncytial virus contributes to significant global infant morbidity and mortality. We applied a previously developed statistical prediction model incorporating pre-pandemic RSV testing data and hospital admission data to estimate infant RSV-hospitalizations by birth month and prematurity, focused on infants aged <1 year. The overall predicted RSV-hospitalization incidence rates in infants <6 months were 32.7/1,000 child-years (95 % CI: 31.8, 33.5) and 3.1/1,000 child-years (95 % CI: 3.0, 3.1) in infants aged 6-<12 months. Predicted RSV-hospitalization rates for infants aged <6 months were highest for infants born in April/May. Predicted rates for preterm infants born 29-32 weeks gestation were highest in March-May, whereas infants born >33 weeks had peak RSV-hospitalization rates from May-June, similar to late preterm or term births. RSV-hospitalization rates in the pre-pandemic era were highly seasonal, and seasonality varied with degree of prematurity. Accurate estimates of RSV-hospitalization in high-risk sub-groups are essential to understand preventable burden of RSV especially given the current prevention landscape.
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Affiliation(s)
- Mohinder Sarna
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; Curtin School of Population Health, Curtin University, Bentley, WA, Australia.
| | - Amanuel Gebremedhin
- Curtin School of Population Health, Curtin University, Bentley, WA, Australia
| | - Peter Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; School of Medicine, University of Western Australia and Perth Children's Hospital, Nedlands, WA, Australia
| | - Avram Levy
- PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Perth, WA, Australia; School of Biomedical Sciences, University of Western Australia, Nedlands, Perth, WA, Australia
| | - Kathryn Glass
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; Curtin School of Population Health, Curtin University, Bentley, WA, Australia
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Weber C, Hung J, Briffa T, Li I, Murray K, Hickling S. Unplanned Readmissions and Long-Term Mortality Risk After Incident Heart Failure Hospitalisation in Western Australia, 2001-2015. Heart Lung Circ 2023; 32:958-967. [PMID: 37271618 DOI: 10.1016/j.hlc.2023.04.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 06/06/2023]
Abstract
AIMS To investigate the frequency and predictors of unplanned readmissions after incident heart failure (HF) hospitalisation and the association between readmissions and mortality over two years. METHODS We performed a retrospective cohort study using Western Australian morbidity and mortality data to identify all patients, aged 25-94 years, who survived an incident (first-ever) HF hospitalisation (principal diagnosis) between 2001-2015. Ordinal logistic regression models determined the covariates independently associated with unplanned readmission(s). Cox proportional hazards models with time-varying exposures determined the hazard ratios (HR) of one or more readmissions for mortality over two years after incident HF. RESULTS Of 18,693 patients, 53.4% male, mean age 74.4 (standard deviation [SD] 13.6) years, 61.3% experienced 32,431 unplanned readmissions (39.7% cardiovascular-related) within two years. Leading readmission causes were HF (19.1%), respiratory diseases (12.6%), and ischaemic heart disease (9.6%). All-cause death occurred in 27.2% of the cohort, and the multivariable-adjusted mortality HR of 1 (versus 0) readmission was 2.5 (95% confidence interval [CI], 2.3-2.7) increasing to 5.0 (95% CI, 4.7-5.4) for 2+ readmissions. The adjusted mortality HR of 1 and 2+ (versus 0) HF-specific readmission was 2.0 (95% CI, 1.8-2.1) and 3.6 (95% CI, 3.2-3.9), respectively. Coexistent cardiovascular and other comorbidities were independently associated with increased readmission and mortality risk. CONCLUSION This study underlines the high burden of recurrent unplanned cardiovascular and other readmissions within two years after incident HF hospitalisation, and their additive adverse impact on mortality. Integrated multidisciplinary management of concomitant comorbidities, in addition to HF-targeted treatments, is necessary to improve long-term prognosis in HF patients.
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Affiliation(s)
- Courtney Weber
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.
| | - Joseph Hung
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Ian Li
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Siobhan Hickling
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
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Foley DA, Yeoh DK, Minney-Smith CA, Shin C, Hazelton B, Hoeppner T, Moore HC, Nicol M, Sikazwe C, Borland ML, Levy A, Blyth CC. A surge in human metapneumovirus paediatric respiratory admissions in Western Australia following the reduction of SARS-CoV-2 non-pharmaceutical interventions. J Paediatr Child Health 2023; 59:987-991. [PMID: 37219060 DOI: 10.1111/jpc.16445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/24/2023]
Abstract
AIM Western Australian laboratory data demonstrated a decrease in human metapneumovirus (hMPV) detections through 2020 associated with SARS-CoV-2-related non-pharmaceutical interventions (NPIs), followed by a subsequent surge in metropolitan region in mid-2021. We aimed to assess the impact of the surge in hMPV on paediatric hospital admissions and the contribution of changes in testing. METHODS All respiratory-coded admissions of children aged <16 years at a tertiary paediatric centre between 2017 and 2021 were matched with respiratory virus testing data. Patients were grouped by age at presentation and by ICD-10 AM codes into bronchiolitis, other acute lower respiratory infection (OALRI), wheeze and upper respiratory tract infection (URTI). For analysis, 2017-2019 was utilised as a baseline period. RESULTS hMPV-positive admissions in 2021 were more than 2.8 times baseline. The largest increase in incidence was observed in the 1-4 years group (incidence rate ratio (IRR) 3.8; 95% confidence interval (CI): 2.5-5.9) and in OALRI clinical phenotype (IRR 2.8; 95% CI: 1.8-4.2). The proportion of respiratory-coded admissions tested for hMPV in 2021 doubled (32-66.2%, P < 0.001), with the greatest increase in wheeze (12-75% in 2021, P < 0.001). hMPV test percentage positivity in 2021 was higher than in the baseline period (7.6% vs. 10.1% in 2021, P = 0.004). CONCLUSION The absence and subsequent surge underline the susceptibility of hMPV to NPIs. Increased hMPV-positive admissions in 2021 can be partially attributable to testing, but test-positivity remained high, consistent with a genuine increase. Continued comprehensive testing will help ascertain true burden of hMPV respiratory diseases.
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Affiliation(s)
- David A Foley
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Daniel K Yeoh
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Cara A Minney-Smith
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
| | | | - Briony Hazelton
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Tobias Hoeppner
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Mark Nicol
- Marshall Centre, Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Chisha Sikazwe
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- Marshall Centre, Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Meredith L Borland
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Avram Levy
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- Marshall Centre, Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Chris C Blyth
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
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Metse AP, Eastwood P, Ree M, Lopresti A, Scott JJ, Bowman J. Sleep health of young adults in Western Australia and associations with physical and mental health: A population-level cross-sectional study. Aust N Z J Public Health 2023; 47:100070. [PMID: 37474415 DOI: 10.1016/j.anzjph.2023.100070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES This article aims to report on the sleep health characteristics of a population-level sample of young Australian adults and examine associations with measures of physical and mental health. METHODS A cross-sectional study using data from the Raine Study. Data from participants (n = 1234) born into the study (Generation 2) at the 22-year follow-up were used, including data from a self-report questionnaire and polysomnography. RESULTS The highest prevalence of suboptimal sleep health was seen on measures of sleep duration (30%), onset latency (18%), satisfaction (25%) and regularity (60%). Dissatisfaction with sleep (physical health: β =0.08; mental health: β =0.34) and impaired daytime alertness (physical health: β =0.09; mental health: β =0.08) were significantly associated with poorer physical and mental health and inadequate polysomnography-measured sleep duration was associated poorer mental health (β =0.07) (all ps<0.05). CONCLUSIONS Satisfaction with sleep and daytime alertness, both of which are assessed via self-report, are essential aspects of sleep health for young adults. IMPLICATIONS FOR PUBLIC HEALTH Findings could inform public health interventions, including screening guidelines, to improve the sleep health and, in turn, the physical and mental health of young adults in Australia.
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Affiliation(s)
- Alexandra P Metse
- School of Health, University of the Sunshine Coast, QLD, 4556, Australia; School of Psychological Sciences, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Peter Eastwood
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, 5042, Australia
| | - Melissa Ree
- School of Psychological Sciences, University of Western Australia, Crawley, WA, 6009, Australia
| | - Adrian Lopresti
- College of Health and Education, Murdoch University, Murdoch, WA, 6150, Australia
| | - Joseph J Scott
- School of Education and Tertiary Access, University of the Sunshine Coast, QLD, 4556, Australia; School of Education, Edith Cowan University, Mount Lawley, WA, 6050, Australia
| | - Jenny Bowman
- School of Psychological Sciences, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
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Junaid M, Slack-Smith L, Wong K, Hewitt T, Glasson E, Bourke J, Baynam G, Calache H, Leonard H. Hospitalizations from Birth to 28 Years in a Population Cohort of Individuals Born with Five Rare Craniofacial Anomalies in Western Australia. J Pediatr 2023; 259:113418. [PMID: 37030611 DOI: 10.1016/j.jpeds.2023.113418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/10/2023]
Abstract
OBJECTIVE To describe trends, age-specific patterns, and factors influencing hospitalizations for 5 rare craniofacial anomalies (CFAs). METHODS Data on livebirths (1983-2010; n = 721 019) including rare CFA (craniofacial microsomia, mandibulofacial dysostosis, Pierre Robin sequence, Van der Woude syndrome, and frontonasal dysplasia), episodes of death, and demographic and perinatal factors were identified from the Western Australian Register of Developmental Anomalies, Death Registrations and Midwives Notification System. Information on incident craniofacial and noncraniofacial related admissions, length of hospital stay, and intensive care and emergency-related admissions were identified using principal diagnosis and procedural codes were extracted from the Hospital Morbidity Data Collection and linked to other data sources. Associations of hospitalizations by age groups as well as demographic and perinatal factors were expressed as incidence rate ratio (IRR). RESULTS The incident hospitalizations were 3 times as high for rare CFA (IRR 3.22-3.72) throughout childhood into adolescence than those without. Children with rare CFA had 3-4 times as many potentially preventable hospitalizations until 18 years of age than those without. Specifically, respiratory infections (IRR 2.13-2.35), ear infections (IRR 7.92-26.28), and oral health-related conditions contributed for most noncraniofacial admissions until the adolescence period. A greater incidence of noncraniofacial related hospitalizations was observed among Indigenous children, births with intrauterine growth restrictions, and families with high socioeconomic disadvantage. CONCLUSIONS Throughout childhood, individuals with rare CFA had greater hospital service use, specifically for potentially preventable conditions, than those without. These population-level findings can inform new preventive strategies and early disease management targeted toward reducing preventable hospitalizations.
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Affiliation(s)
- Mohammed Junaid
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia; Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia.
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia; Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia
| | - Timothy Hewitt
- Department of Plastic and Reconstructive Surgery, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Emma Glasson
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia
| | - Jenny Bourke
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia
| | - Gareth Baynam
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia; Western Australian Register of Developmental Anomalies, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia; UWA Centre of Child Health Research, University of Western Australia, Nedlands, Western Australia, Australia
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Wong JWS, Skeldon S, Gill E, Taylor E, Billingham W, Stevenson PG, Shipton N, Ferguson G, Collins R, Newton R, Newell A, Martin AC. The increase in medical admissions with anorexia nervosa during the COVID-19 pandemic in Western Australia. Int J Eat Disord 2023; 56:1661-1666. [PMID: 37134198 DOI: 10.1002/eat.23977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE A comparative study to describe the increase in medical admissions of children and adolescents with anorexia nervosa (AN) in Western Australia in 2019 (pre-pandemic) and 2020 (peri-pandemic). METHOD Patient demographics, physiological parameters, length of stay, time to assessment by the Eating Disorder Service (EDS), and commencement of specialist eating disorder (ED) outpatient treatment was collected for adolescents admitted with AN between 1st January 2019 and 31st December 2020. RESULTS The number of admissions doubled from 126 in 2019 to 268 in 2020. The number of children admitted increased by 52%. The median length of hospital stay was shorter in 2020 (12 vs. 17 days; p < .001), but the 28-day readmission rate was greater (39.9% vs. 22.2%; p < .001). At the time of hospital discharge in 2020, only 60% of patients were able to step-down into specialist ED outpatient treatment, compared to 93% in 2019. The mean number of admissions per child before completing EDS assessment increased significantly in 2020 (2.75 vs. 0, p < .001). DISCUSSION Shorter inpatient stays and delays in the commencement of specialist ED outpatient treatment may have contributed to the increased readmission rate seen in 2020. PUBLIC SIGNIFICANCE This research is important as it explores the reasons for increased medical presentations and admissions of youth with AN during the COVID-19 pandemic in Western Australia. We hope that our lessons learned may be helpful to others trying to balance similar clinical workloads.
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Affiliation(s)
- Jessica W S Wong
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Sarah Skeldon
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Emma Gill
- Eating Disorder Service, Child and Adolescent Mental Health Service, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Ellen Taylor
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Wesley Billingham
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Paul Geoffrey Stevenson
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Nicolene Shipton
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Grant Ferguson
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Rachel Collins
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Rachel Newton
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Amanda Newell
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Andrew C Martin
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
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Richmond HJ, Swift VM, Doyle JE, Morrison NR, Weeks SA, Veselinović T, Jacoby P, Brennan‐Jones CG, Richmond PC, Lehmann D. Early onset of otitis media is a strong predictor of subsequent disease in urban Aboriginal infants: Djaalinj Waakinj cohort study. J Paediatr Child Health 2023; 59:729-734. [PMID: 36807593 PMCID: PMC10946761 DOI: 10.1111/jpc.16378] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/29/2022] [Accepted: 02/01/2023] [Indexed: 02/22/2023]
Abstract
AIM Australian Aboriginal and/or Torres Strait Islander children in rural/remote areas suffer high rates of persistent otitis media (OM) from early infancy. We aimed to determine the proportion of Aboriginal infants living in an urban area who have OM and investigate associated risk factors. METHODS Between 2017 and 2020, the Djaalinj Waakinj cohort study enrolled 125 Aboriginal infants at 0-12 weeks of age in the Perth South Metropolitan region, Western Australia. Proportion of children with OM based on tympanometry at ages 2, 6 and 12 months was evaluated, type B tympanogram indicating middle ear effusion. Potential risk factors were investigated by logistic regression with generalised estimating equations. RESULTS The proportion of children with OM was 35% (29/83) at 2 months, 49% (34/70) at 6 months and 49% (33/68) at 12 months of age. About 70% (16/23) of those with OM at ages 2 and/or 6 months had OM at 12 months compared with 20% (3/15) if no prior OM (relative risk = 3.48, 95% confidence interval (CI): 1.22-40.1). On multivariate analysis, infants living in houses with ≥1 person/room were at increased risk of OM (odds ratio = 1.78, 95% CI: 0.96-3.32). CONCLUSION Approximately half of Aboriginal infants enrolled into the South Metropolitan Perth project have OM by the age of 6 months and early onset of disease strongly predicts subsequent OM. Early surveillance for OM in urban areas is needed for early detection and management to reduce the risk of long-term hearing loss which can have serious developmental, social, behavioural, educational and economic consequences.
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Affiliation(s)
- Holly J Richmond
- Wesfarmers Centre of Vaccines and Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Valerie M Swift
- Wesfarmers Centre of Vaccines and Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - June E Doyle
- Wesfarmers Centre of Vaccines and Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Natasha R Morrison
- Wesfarmers Centre of Vaccines and Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Sharon A Weeks
- Wesfarmers Centre of Vaccines and Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Tamara Veselinović
- Wesfarmers Centre of Vaccines and Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
- The Auditory Laboratory, School of Human SciencesUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Peter Jacoby
- Wesfarmers Centre of Vaccines and Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Christopher G Brennan‐Jones
- Wesfarmers Centre of Vaccines and Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
- School of Allied Health, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
- Discipline of Paediatrics, School of MedicineUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Deborah Lehmann
- Telethon Kids Institute, University of Western AustraliaPerthWestern AustraliaAustralia
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48
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Phillips J, Chan DT, Chakera A, Swaminathan R, Patankar K, Boudville N, Lim WH. Haemodialysis vascular catheter-related blood stream infection: Organism types and clinical outcomes. Nephrology (Carlton) 2023; 28:249-253. [PMID: 36715242 DOI: 10.1111/nep.14147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/15/2022] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
Catheter-related bloodstream infection (CRBI) is an important complication of catheter use for haemodialysis, but it remains unclear whether clinical outcomes following CRBI are influenced by organism type. This study aims to compare clinical outcomes following CRBI from Gram-positive and non-Gram-positive organisms. This was a retrospective cohort study of patients with kidney failure receiving haemodialysis (HD) via vascular catheters who had a documented episode of CRBI in Western Australia between 2005 and 2018. The associations between organism type, likelihood of hospitalization, catheter removal and death from CRBI were examined using adjusted logistic regression models. There were 111 episodes of CRBI in 99 patients (6.1 episodes per 1000-catheter-days at risk). Of the study cohort, 53 (48%) were male and 38 (34%) identified as Aboriginal or Torres Strait Islander. Gram-positive organisms were identified in 73 (66%) CRBI episodes, most commonly Staphylococcus aureus. Of those with non-Gram-positive CRBI, 9 (24%) were attributed to Pseudomonas aeruginosa. One-hundred and two (92%) episodes of CRBI required hospitalization and 15 (13%) patients died from CRBI. Compared with non-Gram-positive CRBI, Gram-positive CRBI was associated with an increased risk of hospitalization and catheter removal, with adjusted odds ratio of 9.34 (95% CI 1.28-68.03) and 3.47 (95% CI 1.25-9.67), respectively. There was no association between organism type and death from CRBI. Staphylococcus aureus remains the most common organism causing CRBI in HD patients. CRBI is associated with substantial morbidity, particularly CRBI attributed to Gram-positive organisms.
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Affiliation(s)
- Jessica Phillips
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Doris T Chan
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Aron Chakera
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | | | - Khalil Patankar
- Department of Renal Medicine, Royal Perth Hospital, Perth, Australia
| | - Neil Boudville
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- Medical School, University of Western Australia, Perth, Australia
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- Medical School, University of Western Australia, Perth, Australia
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49
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Ngweso S, Nzenza T, McMillan K, Sofield D, Lozinskiy M, Hayne D. Current trends in penile cancer survivorship amongst remote patients and Aboriginal people in Western Australia. ANZ J Surg 2023; 93:534-540. [PMID: 36478516 DOI: 10.1111/ans.18177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 08/27/2021] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Penile cancer is a rare urological malignancy, accounting for less than 1% of all cancers in males. Given its rarity, few studies exist reporting survival outcomes. The primary objective of this project was to review the mortality of patients diagnosed with penile cancer in Western Australia between 1992 and 2017 and to determine if Aboriginal and Torres Strait Islander people and patients in rural and remote regions experience discrepancies in survival outcomes. METHODS All cases of penile cancer recorded within the Western Australia Cancer Registry between 1992 and 2017 were reviewed. Analysis was performed using chi-squared test of association, binomial logistic regression and survival analysis was conducted using Kaplan Meier and Cox Regression analysis. RESULTS One hundred eighty-six cases of penile cancer were identified; 62 patients (33%) were from regional or remote locations and nine patients (4.8%) were Aboriginal. 13 of the regional or remote patients and 5 of the Aboriginal patients died from penile cancer. Patients who were Aboriginal (HR 6.512, CI 2.123-19.968; P = 0.001) or from regional or remote Western Australia (HR 2.382, CI 1.050-5.401; P = 0.038) were at an increased risk of penile cancer-specific mortality. CONCLUSIONS Aboriginal people with penile cancer and men from regional and remote Western Australia experience worse penile cancer-specific survival outcomes.
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Affiliation(s)
- Simeon Ngweso
- Department of Urology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group
| | - Tatenda Nzenza
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
- School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Kevin McMillan
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - David Sofield
- Department of Urology, Bethesda Hospital, Claremont, Western Australia, Australia
- Department of Urology, St John of God Hospital, Subiaco, Western Australia, Australia
| | | | - Dickon Hayne
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Urology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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50
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Bailey HD, Gray C, Adane AA, Strobel NA, White SW, Marriott R, Tessema GA, Shepherd CCJ, Sharp M. Early mortality among aboriginal and non-aboriginal women who had a preterm birth in Western Australia: A population-based cohort study. Paediatr Perinat Epidemiol 2023; 37:31-44. [PMID: 36331146 PMCID: PMC10946802 DOI: 10.1111/ppe.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Having a preterm (<37 weeks' gestation) birth may increase a woman's risk of early mortality. Aboriginal and Torres Strait Islander (hereafter Aboriginal) women have higher preterm birth and mortality rates compared with other Australian women. OBJECTIVES We investigated whether a history of having a preterm birth was associated with early mortality in women and whether these associations differed by Aboriginal status. METHODS This retrospective cohort study used population-based perinatal records of women who had a singleton birth between 1980 and 2015 in Western Australia linked to Death Registry data until June 2018. The primary and secondary outcomes were all-cause and cause-specific mortality respectively. After stratification by Aboriginal status, rate differences were calculated, and Cox proportional hazard regression was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and cause-specific mortality. RESULTS There were 20,244 Aboriginal mothers (1349 deaths) and 457,357 non-Aboriginal mothers (7646 deaths) with 8.6 million person-years of follow-up. The all-cause mortality rates for Aboriginal mothers who had preterm births and term births were 529.5 and 344.0 (rate difference 185.5, 95% CI 135.5, 238.5) per 100,000 person-years respectively. Among non-Aboriginal mothers, the corresponding figures were 125.5 and 88.6 (rate difference 37.0, 95% CI 29.4, 44.9) per 100,000 person-years. The HR for all-cause mortality for Aboriginal and non-Aboriginal mothers associated with preterm birth were 1.48 (95% CI 1.32, 1.66) and 1.35 (95% CI 1.26, 1.44), respectively, compared with term birth. Compared with mothers who had term births, mothers of preterm births had higher relative risks of mortality from diabetes, cardiovascular, digestive and external causes. CONCLUSIONS Both Aboriginal and non-Aboriginal women who had a preterm birth had a moderately increased risk of mortality up to 38 years after the birth, reinforcing the importance of primary prevention and ongoing screening.
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Affiliation(s)
- Helen D. Bailey
- Curtin Medical School, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
- Telethon Kids InstituteThe University of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Caitlin Gray
- Telethon Kids InstituteThe University of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Akilew A. Adane
- Telethon Kids InstituteThe University of Western AustraliaNedlandsWestern AustraliaAustralia
- Ngangk Yira Research Institute for ChangeMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Natalie A. Strobel
- Kurongkurl KatitjinEdith Cowan UniversityMount LawleyWestern AustraliaAustralia
| | - Scott W. White
- Division of Obstetrics and GynaecologyThe University of Western AustraliaNedlandsWestern AustraliaAustralia
- Maternal Fetal Medicine ServiceKing Edward Memorial HospitalSubiacoWestern AustraliaAustralia
| | - Rhonda Marriott
- Ngangk Yira Research Institute for ChangeMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Gizachew A. Tessema
- Curtin School of Population Health, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
| | - Carrington C. J. Shepherd
- Curtin Medical School, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
- Telethon Kids InstituteThe University of Western AustraliaNedlandsWestern AustraliaAustralia
- Ngangk Yira Research Institute for ChangeMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Mary Sharp
- Telethon Kids InstituteThe University of Western AustraliaNedlandsWestern AustraliaAustralia
- Department of NeonatologyKing Edward Memorial HospitalSubiacoWestern AustraliaAustralia
- Centre for Neonatal Research and EducationThe University of Western AustraliaNedlandsWestern AustraliaAustralia
- Department of NeonatologyPerth Children's HospitalNedlandsWestern AustraliaAustralia
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