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PMID:29182618
Autor:Hanigan IC; Cochrane T; Davey R
Endereço:Spatial Epidemiology Group, Centre for Research and Action in Public Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia.
Título:Impact of scale of aggregation on associations of cardiovascular hospitalization and socio-economic disadvantage.
Fonte:PLoS One; 12(11):e0188161, 2017.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: There are numerous studies that show an increased incidence of cardiovascular disease with increasing levels of socio-economic disadvantage. Exposures that might influence the relationship include elements of the built environment and social systems that shape lifestyle risk behaviors. In Canberra (the Australian capital city) there has been a particular housing policy to create 'mixed-tenure' neighborhoods so that small pockets of disadvantage are surrounded by more affluent residences (known as a 'salt-and-pepper' pattern). This may contribute to a scatter of higher incidence rates in very small areas in this population that may be obscured if aggregated data are used. This study explored the effect of changing the scale of the spatial units used in small area disease modelling, aiming to understand the impact of this issue and the implications for local public health surveillance. METHODS: The residence location of hospitalized individuals were aggregated to two differently scaled area units. First, the Australian Bureau of Statistics Statistical Area 2 (SA2) which is normally used as the basis for deidentification and release of health data. Second, these data were aggregated to a smaller level: the Statistical Area 1 (SA1). Generalized Additive Models with penalized regression splines were used to assess the association of age-sex-standardized rates for cardiovascular disease hospital admissions with disadvantage. RESULTS: The relationships observed were different between the two types of spatial units. The SA1 level exposure-response curve for rates against the disadvantage index extended in a linear fashion above the midrange level, while that found at SA2-level suggested a curvilinear form with no evidence that rates increased with higher disadvantage beyond the midrange. CONCLUSION: Our result supports findings of other work that has found disadvantage increases risk of cardiovascular disease. The shape of the curves suggest a difference in associations of cardiovascular disease rates with disadvantage scores between SA1 versus SA2. From these results it can be concluded that scale of analysis does influence the understanding of geographical patterns of socio-economic disadvantage and cardiovascular disease morbidity. Health surveillance and interventions in Canberra should take into account the impact of the scale of aggregation on the association between disadvantage and cardiovascular disease observed.
Tipo de publicação: JOURNAL ARTICLE


  2 / 325 MEDLINE  
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PMID:28399296
Autor:Barton PS; Evans MJ; Pechal JL; Benbow ME
Endereço:Fenner School of Environment and Society, Australian National University, Canberra, ACT 2601, Australia.
Título:Necrophilous Insect Dynamics at Small Vertebrate Carrion in a Temperate Eucalypt Woodland.
Fonte:J Med Entomol; 54(4):964-973, 2017 Jul 01.
ISSN:1938-2928
País de publicação:England
Idioma:eng
Resumo:Insects associated with carrion are critical to the decomposition process and nutrient cycling in ecosystems. Yet the communities of insects associated with carrion vary between locations, and detailed case studies are necessary for identifying differences and similarities among contrasting habitats. In this study, we examined temporal changes in the crawling insect community collected from rabbit carcasses placed in contrasting grassland and tree habitats in southeastern Australia. We collected 18,400 adult insects, including 22 species of fly, 57 species of beetle, and 37 species of ant. We found significant effects of habitat type and time, but not their interaction, on the composition of the entire insect community. Several ant species showed early and rapid colonization and highest abundances during early stages of decay, including Iridomyrmex purpureus (Smith, 1858) under trees, and Iridomyrmex rufoniger (Lowne, 1865) and Rhytidoponera metallica (Smith, 1858) in grassland. We found that most fly species showed highest abundance during active decay, but Chrysomya varipes (Macquart 1851) was more abundant under trees than in grassland during this time. Beetles peaked during active or advanced decay stages, with Saprinus and Omorgus the most abundant genera. Our study demonstrates that strong replication of contrasting environmental treatments can reveal new information on habitat preferences of important carrion insect species. The numerical dominance of ants early in decomposition has implications for insect community structure via potential competitive interactions with flies, and should be more rigorously examined in future carrion studies.
Tipo de publicação: JOURNAL ARTICLE


  3 / 325 MEDLINE  
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PMID:28097646
Autor:Lowrie T; Logan T; Ramful A
Endereço:Faculty of Education, Science, Technology and Mathematics, University of Canberra, Bruce, ACT, Australia.
Título:Visuospatial training improves elementary students' mathematics performance.
Fonte:Br J Educ Psychol; 87(2):170-186, 2017 Jun.
ISSN:2044-8279
País de publicação:England
Idioma:eng
Resumo:BACKGROUND: Although spatial ability and mathematics performance are highly correlated, there is scant research on the extent to which spatial ability training can improve mathematics performance. AIMS: This study evaluated the efficacy of a visuospatial intervention programme within classrooms to determine the effect on students' (1) spatial reasoning and (2) mathematics performance as a result of the intervention. SAMPLE: The study involved grade six students (ages 10-12) in eight classes. There were five intervention classes (n = 120) and three non-intervention control classes (n = 66). METHODS: A specifically designed 10-week spatial reasoning programme was developed collaboratively with the participating teachers, with the intervention replacing the standard mathematics curriculum. The five classroom teachers in the intervention programme presented 20 hr of activities aimed at enhancing students' spatial visualization, mental rotation, and spatial orientation skills. RESULTS: The spatial reasoning programme led to improvements in both spatial ability and mathematics performance relative to the control group who received standard mathematics instruction. CONCLUSIONS: Our study is the first to show that a classroom-based spatial reasoning intervention improves elementary school students' mathematics performance.
Tipo de publicação: JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL


  4 / 325 MEDLINE  
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PMID:27566273
Autor:Roediger JC; Outhred AC; Shadbolt B; Britton PN
Endereço:Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Título:Paediatric Staphylococcus aureus bacteraemia: A single-centre retrospective cohort.
Fonte:J Paediatr Child Health; 53(2):180-186, 2017 Feb.
ISSN:1440-1754
País de publicação:Australia
Idioma:eng
Resumo:AIM: We aimed to describe the clinical epidemiology of Staphylococcus aureus bacteraemia (SAB) at a large, tertiary/quaternary children's hospital in Australia. METHODS: We performed a retrospective chart review of SAB cases at the Children's Hospital at Westmead (CHW) over 5 years; 2006-2011. We compared frequency, clinical profile and outcomes of SAB with published data from CHW; 1994-1998. We compared health-care associated with community-associated (HCA-SAB and CA-SAB; defined epidemiologically) and methicillin-resistant with methicillin susceptible S. aureus (MRSA and MSSA). RESULTS: We identified 174 episodes of paediatric SAB with an average annual admission rate of 1.3/1000 which has not increased compared with a decade earlier. Half of the cases (49%) were CA-SAB; 18% were MRSA. The proportion of CA-MRSA bacteraemia (22%) has increased. The proportion of SAB associated with central venous access devices (CVADs; 40%) has increased. CA-SAB cases were more likely to present with a tissue focus of disease (e.g. osteo-articular, pneumonia) and often required surgery. HCA-SAB less frequently required surgery, a minority is MRSA, and vascular device intervention (removal, sterilisation) is common. Six cases (4%) of infective endocarditis (IE) were identified; three with a history of congenital heart disease, two with CVADs in situ. There were no deaths in this cohort. CONCLUSIONS: Over an 18-year period, the proportion of SAB due to CA-MRSA and SAB associated with CVADs has increased. Categorisation of SAB as HCA and CA reveals two broad phenotypes of paediatric SAB. SAB in children is infrequently associated with IE. The health-care burden of paediatric SAB is considerable', but mortality is low.
Tipo de publicação: JOURNAL ARTICLE


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PMID:27142638
Autor:Bowen JR; Callander I; Richards R; Lindrea KB; Sepsis Prevention in NICUs Group
Endereço:Department of Neonatology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Título:Decreasing infection in neonatal intensive care units through quality improvement.
Fonte:Arch Dis Child Fetal Neonatal Ed; 102(1):F51-F57, 2017 Jan.
ISSN:1468-2052
País de publicação:England
Idioma:eng
Resumo:OBJECTIVE: To decrease the incidence of bloodstream infection (BSI) for neonates <29 weeks gestation through quality improvement. DESIGN: Commencing in September 2011, eight neonatal intensive care units (NICUs) in New South Wales and Australian Capital Territory, Australia participated in the Sepsis Prevention in NICUs Group project, a multicentre quality improvement initiative to reduce neonatal infection through implementation of potentially better practices and development of teaching resources. Data were collected for neonates <29 weeks gestation from D3 to 35, using point of care data entry, for BSI, central line-associated BSI (CLABSI) and antibiotic use. Exponentially weighted moving average data trend lines for rates of BSI, CLABSI and antibiotic use for each NICU were automatically generated and composite charts were provided each month to participating NICUs. RESULTS: Between January 2012 and December 2014, data were collected from D3 to 35 for 1075 neonates <29 weeks gestation who survived >48 h, for a total of 33 933 bed days and 14 447 central line days. There was a significant decrease from 2012 to 2014 in BSI/1000 bed days (7.8±3.0 vs 3.8±1.1, p=0.000), CLABSI/1000 bed days (4.6±2.1 vs 2.1±0.8, p=0.003), CLABSI/1000 central line days (9.9±4.3 vs 5.4±1.7, p=0.012) and antibiotic days/100 bed days (31.1±4.3 vs 25.5±4.2, p=0.046). CONCLUSIONS: This study demonstrates a >50% reduction in BSI in extremely premature neonates from D3 to 35 following a collaborative quality improvement project to reduce neonatal infection across an NICU network, supported by timely provision of data.
Tipo de publicação: JOURNAL ARTICLE; MULTICENTER STUDY


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PMID:26957041
Autor:Mahoney K; Bajuk B; Oei J; Lui K; Abdel-Latif ME; NICUS Network
Endereço:a Medical School, College of Medicine, Biology & Environment, Australian National University , Acton, Canberra, Australian Capital Territory , Australia.
Título:Risk of neurodevelopmental impairment for outborn extremely preterm infants in an Australian regional network.
Fonte:J Matern Fetal Neonatal Med; 30(1):96-102, 2017 Jan.
ISSN:1476-4954
País de publicação:England
Idioma:eng
Resumo:OBJECTIVE: To compare neurodevelopmental outcomes at 2-3 years in extremely premature outborn and inborn infants. DESIGN: Population-based retrospective cohort study. SETTING: Geographically defined area of New South Wales (NSW) and the Australian Capital Territory (ACT) served by a network of 10 neonatal intensive care units (NICUs). PATIENTS: All premature infants <29 weeks gestation born between 1998 and 2004 in the setting. INTERVENTION: At 2-3 years, corrected age, 1473 children were assessed with either the Griffiths Mental Developmental Scales (GMDS) or the Bayley Scales of Infant Development (BSID-II). MAIN OUTCOME MEASURE: Moderate/severe functional disability (FD) defined as: developmental delay (GMDS general quotient (GQ) or BSID-II mental developmental index (MDI)) > 2 standard deviations (SD) below the mean; cerebral palsy (CP) requiring aids; sensorineural or conductive deafness (requiring amplification); or bilateral blindness (visual acuity <6/60 in better eye). RESULTS: At 2-3 years, moderate/severe functional disability does not appear to be significantly different between outborn and inborn infants (adjusted OR 0.782; 95% CI 0.424-1.443). However, there were a significant number of outborn infants lost to follow up (23.3% versus 42.9%). CONCLUSION: In this cohort, at 2-3 years follow up neurodevelopmental outcome does not appear to be significantly different between outborn and inborn infants. These results should be interpreted with caution given the limitation of this study.
Tipo de publicação: JOURNAL ARTICLE


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PMID:27714389
Autor:Korda RJ; Clements MS; Armstrong BK; Trevenar SM; Chalker EB; Newman LA; Kirk MD
Endereço:National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, rosemary.korda@anu.edu.au.
Título:Mesothelioma trends in the ACT and comparisons with the rest of Australia.
Fonte:Public Health Res Pract; 26(4), 2016 Sep 30.
ISSN:2204-2091
País de publicação:Australia
Idioma:eng
Resumo:OBJECTIVES: Inhalation of asbestos fibres is the predominant cause of malignant mesothelioma. Domestic exposure to asbestos is a major community concern in the Australian Capital Territory (ACT) because of loose-fill asbestos home insulation. Little is known about how trends in mesothelioma rates in the ACT compare with those elsewhere. The objective of this study was to describe trends in mesothelioma rates in the ACT and compare them with those for the rest of Australia. METHODS: We used de-identified data from the ACT Cancer Registry (1982- 2014), and the Western Australia (WA) Cancer Registry and the Australian Cancer Database (1982-2011). We calculated crude mesothelioma rates, by 3-year periods, for the ACT and for the rest of Australia (excluding WA). We used Poisson regression to analyse mesothelioma trends from 1994 to 2011 (complete reporting period) using an indirect standardisation approach to adjust for age and sex. RESULTS: There were 140 mesothelioma cases reported to the ACT Cancer Registry between 1982 and 2014 - 81% male and 19% female. Between 1994 and 2011, age- and sex-adjusted mesothelioma rates in the ACT increased over time, on average by 12% per 3-year period (relative risk [RR] 1.12; 95% confidence interval [CI] 0.99, 1.26). Compared with the rest of Australia (excluding WA), ACT rates were, on average, lower (RR 0.84; 95% CI 0.69, 1.02), but they increased at a higher rate (RR 1.12 per 3-year period; 95% CI 0.99, 1.27). These results are strongly influenced by the higher rate of mesothelioma observed in the ACT in 2009-2011, when ACT rates became similar to those for the rest of Australia (excluding WA). CONCLUSIONS: Although mesothelioma rates may have increased more in the ACT than the rest of Australia (excluding WA) during the past two decades, there is considerable uncertainty in the trends. More information is needed regarding the health risks associated with living in a house with loose-fill asbestos insulation. This is the subject of further studies within the ACT Asbestos Health Study.
Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE


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PMID:27628482
Autor:Au J; Perriman DM; Bolton C; Abbott L; Neeman T; Smith PN
Endereço:Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
Título:AO pelvic fracture classification: can an educational package improve orthopaedic registrar performance?
Fonte:ANZ J Surg; 86(12):1019-1023, 2016 Dec.
ISSN:1445-2197
País de publicação:Australia
Idioma:eng
Resumo:BACKGROUND: The unstable pelvic fracture has been described as the 'killing fracture' because of the risk of significant vascular compromise. The ability to correctly classify pelvic fractures may therefore be crucial in optimizing patient outcomes. Pelvic fracture classification is difficult and previous research has indicated that ability is suboptimal in orthopaedic registrars. The objective of this study was to examine the efficacy of an educational package in improving orthopaedic registrars' ability to classify pelvic fractures. METHODS: A total of 35 orthopaedic registrars were recruited in this classification study. An educational package was used to introduce the AO classification of pelvic fractures and teach the registrars how to classify pelvic fractures using pelvic X-rays and computed tomography scans. A classification test assessed their classification ability before and after using the educational package. A third test was performed 2 weeks after the second to assess the stability of learning. RESULTS: The mean score at baseline of 8.4 ± 0.46 increased to 10.5 ± 0.48 after using the educational package, and this was maintained in the follow-up test (10.7 ± 0.54 (F(2,52) = 15.5, P < 0.001)). The proportion of registrars achieving a satisfactory score increased from 46% (16/35) to 77% (23/30) after training, and 90% (19/21) at follow-up (χ (2) = 6.74, P = 0.035). CONCLUSION: The reliability with which orthopaedic registrars classified pelvic fractures was improved using an educational package. An educational package on pelvic fracture classification may prove to be a valuable addition to the orthopaedic training programme.
Tipo de publicação: JOURNAL ARTICLE


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PMID:27431761
Autor:Atique SM; Shadbolt B; Marley P; Farshid A
Endereço:Department of Cardiology, The Canberra Hospital, Canberra, Australia.
Título:Association Between Body Mass Index and Age of Presentation With Symptomatic Coronary Artery Disease.
Fonte:Clin Cardiol; 39(11):653-657, 2016 Nov.
ISSN:1932-8737
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Obesity is increasingly recognized as an important risk factor for coronary artery disease (CAD). HYPOTHESIS: Patients with increased body mass index (BMI) present at a younger age with symptomatic CAD. METHODS: We analyzed data on 2137 consecutive patients admitted for treatment of CAD proven on angiography from 2010 to 2013, excluding those with prior coronary intervention or bypass surgery. RESULTS: Mean age was 64.1 ± 12.4 years; 75% were male; 43.6% were overweight (BMI 25-29.9 kg/m ) and 31.6% were obese (BMI ≥30 kg/m ). Patients with BMI ≥25 kg/m compared with <25 kg/m were more likely to have diabetes (24.5% vs 13.6%), hypertension (56.2% vs 45.5%), and hyperlipidemia (42.4% vs 31.6%; P < 0.0001 for all). On multivariate analysis adjusted for sex and cardiovascular risk factors, patients in higher BMI categories had lower mean age in a linear and stepwise fashion compared with those with normal BMI (P < 0.0001). For example, compared with patients with normal BMI, those with BMI of 35 to 39.9 kg/m were on average 9.2 years younger (P < 0.0001). Multivariate analysis examining the interaction between sex and BMI produced similar results for effect of BMI on age of presentation (P = 0.97 for interaction). CONCLUSIONS: After multivariate adjustment, patients with increased BMI presented at an earlier age with symptomatic CAD compared with patients with normal BMI. Primary prevention efforts in those with increased BMI to reduce risk-factor burden, including evidence-based treatments for weight reduction, promise to reduce risk or delay onset of CAD.
Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY


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PMID:27173359
Autor:Schnitker LM; Beattie ER; Martin-Khan M; Burkett E; Gray LC
Endereço:School of Nursing, Queensland University of Technology, Brisbane, Australia; The Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Australia. Electronic address: linda.schnitker@qut.edu.au.
Título:Characteristics of older people with cognitive impairment attending emergency departments: A descriptive study.
Fonte:Australas Emerg Nurs J; 19(2):118-26, 2016 May.
ISSN:1574-6267
País de publicação:Netherlands
Idioma:eng
Resumo:OBJECTIVE: The objective of this paper is to describe the profile of older people with cognitive impairment (CI) presenting to emergency departments (EDs). METHODS: This was a multi-centre (n=8) observational study of a convenience sample of older (≥70y) ED patients (n=579). Participants were prospectively assessed for CI and surveyed for the duration of their ED stay (n=191). A picture of patients' health status and ED responses to care needs was obtained through application of standardised assessment tools. Additionally, observations of care processes in ED were undertaken. Demographic data were collected through both ED's information system and survey. Outcome data were collected 28 days post-ED visit using follow-up telephone interviews. RESULTS: Of 579 older persons, 191 (33%) persons met criteria for CI. The majority of older ED patients with CI in ED lived in the community (157/177, 88.7%), arrived by ambulance (116/172, 67%), were accompanied by a support person (94/149, 63%), were triaged as urgent to semi-urgent (157/191, 82%), and were hospitalised (108/172, 57%). The median ED length of stay was 6h. In ED, 53% of the sample experienced pain (92/173). Older ED patients with CI pose the following characteristics: prior hospital admissions (43/129, 33%), incontinence (61/178, 34%), dependence in activities in daily living (81/190, 43%), issues in nutrition (73/182, 40%), vision and hearing impairment (93% (160/172) and 26% (44/171) respectively). CONCLUSION: Increased understanding of these presenting characteristics and their impacts on patient risk facilitates tailoring the quality of emergency care to better suit the needs and improve outcomes of this increasing ED population.
Tipo de publicação: JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY



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