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  1 / 1238 MEDLINE  
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PMID:28455171
Autor:Moberley S; Licciardi PV; Balloch A; Andrews R; Leach AJ; Kirkwood M; Binks P; Mulholland K; Carapetis J; Tang MLK; Skull S
Endereço:Menzies School of Health Research, Child Health Division, Charles Darwin University, Northern Territory, Australia.
Título:Repeat pneumococcal polysaccharide vaccine in Indigenous Australian adults is associated with decreased immune responsiveness.
Fonte:Vaccine; 35(22):2908-2915, 2017 05 19.
ISSN:1873-2518
País de publicação:Netherlands
Idioma:eng
Resumo:BACKGROUND: Indigenous adults residing in the Northern Territory of Australia experience elevated rates of invasive pneumococcal disease despite the routine use of 23-valent pneumococcal polysaccharide vaccine (23vPPV). We hypothesised that the limited protection from 23vPPV may be due to hyporesponsiveness as a result of vaccine failure from repeated vaccination. To explore this possibility, we evaluated the immune response to a first and second dose of 23vPPV in Indigenous adults and a first dose of 23vPPV in non-Indigenous adults. METHODS: Serotype-specific IgG was measured by ELISA for all 23 vaccine serotypes at baseline and at one month post-vaccination. Individuals were considered to have an adequate immune response if paired sera demonstrated either: a four-fold rise in antibody concentration; a two-fold rise if the post vaccination antibody was >1.3µg/ml but <4.0µg/ml; or a post-vaccination antibody concentration >4.0µg/ml for at least half of the serotypes tested (12/23). Our per-protocol analysis included the comparison of outcomes for three groups: Indigenous adults receiving a second 23vPPV dose (N=20) and Indigenous (N=60) and non-Indigenous adults (N=25) receiving their first 23vPPV dose. RESULTS: All non-Indigenous adults receiving a first dose of 23vPPV mounted an adequate immune response (25/25). There was no significant difference in the proportion of individuals with an adequate response using our definition (primary endpoint), with 88% of Indigenous adults mounted an adequate response following first dose 23vPPV (53/60) compared to 70% having an adequate response following a second dose of 23vPPV (14/20; p=0.05). The risk difference between Indigenous participants receiving first dose compared to non-Indigenous participants receiving first dose was significant when comparing a response threshold of at least 70% (-27%, 95% CI: -43% to -11%; p=0.01) and 90% (-38%, 95% CI: -60% to -16%; p=0.006) of serotypes with a positive response. CONCLUSION: Indigenous participants demonstrated a poorer response to a first dose 23vPPV compared to their non-Indigenous counterparts, with lower IgG following a second 23vPPV dose. These findings highlight the critical need to evaluate the efficacy of future pneumococcal vaccine programs in the Australian Indigenous populations that recommend repeated doses of 23vPPV.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:0 (23-valent pneumococcal capsular polysaccharide vaccine); 0 (Antibodies, Bacterial); 0 (Immunoglobulin G); 0 (Pneumococcal Vaccines)


  2 / 1238 MEDLINE  
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PMID:28468619
Autor:Gorham G; Howard K; Togni S; Lawton P; Hughes J; Majoni SW; Brown S; Barnes S; Cass A
Endereço:Menzies School of Health Research, PO Box 41096, Casuarina, NT, 0811, Australia. gillian.gorham@menzies.edu.au.
Título:Economic and quality of care evaluation of dialysis service models in remote Australia: protocol for a mixed methods study.
Fonte:BMC Health Serv Res; 17(1):320, 2017 05 03.
ISSN:1472-6963
País de publicação:England
Idioma:eng
Resumo:BACKGROUND: Australia's Northern Territory (NT) has the country's highest incidence and prevalence of kidney disease. Indigenous people from remote areas suffer the heaviest disease burden. Concerns regarding cost and sustainability limit the provision of dialysis treatments in remote areas and most Indigenous people requiring dialysis relocate to urban areas. However, this dislocation of people from their family, community and support networks may prove more costly when the broader health, societal and economic consequences for the individual, family and whole of government are considered. METHODS: The Dialysis Models of Care Study is a large cross organisation mixed methods study. It includes a retrospective (2000-2014) longitudinal data linkage study of two NT cohorts: Renal Cohort 1- comprising approximately 2000 adults who received dialysis and Renal Cohort 2- comprising approximately 400 children of those adults. Linkage of administrative data sets from the Australian and New Zealand Dialysis and Transplant Registry, NT Departments of Health, Housing and Education by a specialist third party (SA/NT Datalink) will enable extraction of activity, financial and outcome data. Interviews with patients, clinicians and service providers, using a snowball technique, will canvass relevant issues and assist in determining the full costs and impacts of the five most used dialysis Models of Care. DISCUSSION: The study uses a mixed methods approach to investigate the quantitative and qualitative dimensions of the full costs and outcomes associated with the choice of particular dialysis models of care for any given patient. The study includes a large data linkage component that for the first time links health, housing and education data to fully analyse and evaluate the impact on patients, their families and the broader community, resulting from the relocation of people for treatment. The study will generate a large amount of activity, financial and qualitative data that will investigate health costs less directly related to dialysis treatment, costs to government such as housing and/or education and the health, social and economic outcomes experienced by patients. This approach fills an evidence gap critical to health service planners.
Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T


  3 / 1238 MEDLINE  
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PMID:28886050
Autor:Davies J; Li SQ; Tong SY; Baird RW; Beaman M; Higgins G; Cowie BC; Condon JR; Davis JS
Endereço:Department of Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia.
Título:Establishing contemporary trends in hepatitis B sero-epidemiology in an Indigenous population.
Fonte:PLoS One; 12(9):e0184082, 2017.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Indigenous populations globally are disproportionately affected by chronic hepatitis B virus (HBV) infection however contemporary sero-prevalence data are often absent. In the Indigenous population of the Northern Territory (NT) of Australia the unique C4 sub-genotype of HBV universally circulates. There are no studies of the sero-prevalence, nor the impact of the vaccination program (which has a serotype mismatch compared to C4), at a population-wide level. METHODS: We examined all available HBV serology results obtained from the three main laboratories serving NT residents between 1991 and 2011. Data were linked with a NT government database to determine Indigenous status and the most recent test results for each individual were extracted as a cross-sectional database including 88,112 unique individuals. The primary aim was to obtain a contemporary estimate of HBsAg positivity for the NT by Indigenous status. RESULTS: Based on all tests from 2007-2011 (35,633 individuals), hepatitis B surface antigen (HBsAg) positivity was 3·40% (95%CI 3·19-3·61), being higher in Indigenous (6·08%[5·65%-6·53%]) than non-Indigenous (1·56%[1·38%-1·76%]) Australians, p<0·0001. Birth cohort analysis showed HBsAg positivity fell over time for Indigenous people, with this decrease commencing prior to universal infant vaccination (which commenced in 1990), with an ongoing but slower rate of decline since 1990, (0·23% decrease per year versus 0·17%). CONCLUSIONS: HBsAg positivity is high in the NT, particularly in the Indigenous population. HBsAg positivity has fallen over time but a substantial part of this decrease is due to factors other than the universal vaccination program.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:0 (Hepatitis B Antibodies); 0 (Hepatitis B Surface Antigens)


  4 / 1238 MEDLINE  
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PMID:28854197
Autor:Lantz SM; Karubian J
Endereço:Department of Ecology and Evolutionary Biology, Tulane University, New Orleans, Louisiana, United States of America.
Título:Environmental disturbance increases social connectivity in a passerine bird.
Fonte:PLoS One; 12(8):e0183144, 2017.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:Individual level response to natural and anthropogenic disturbance represents an increasingly important, but as yet little understood, component of animal behavior. Disturbance events often alter habitat, which in turn can modify behaviors of individuals in affected areas, including changes in habitat use and associated changes in social structure. To better understand these relationships, we investigated aspects of habitat selection and social connectivity of a small passerine bird, the red-backed fairywren (Malurus melanocephalus), before vs. after naturally occurring fire disturbance in Northern Territory, Australia. We utilized a social network framework to evaluate changes in social dynamics pre- vs. post-fire. Our study covered the non-breeding season in two consecutive years in which fires occurred, and individuals whose habitat was affected and those that were not affected by fire. Individuals in habitat affected by fires had stronger social ties (i.e. higher weighted degree) after fires, while those that were in areas that were not affected by fire actually had lower weighted degree. We suggest that this change in social connections may be linked to habitat. Before fires, fairywrens used habitat that had similar grass cover to available habitat plots randomly generated within our study site. Fire caused a reduction in grass cover, and fairywrens responded by selecting habitat with higher grass cover relative to random plots. This study demonstrates how changes in habitat and/or resource availability caused by disturbance can lead to substantive changes in the social environment that individuals experience.
Tipo de publicação: JOURNAL ARTICLE


  5 / 1238 MEDLINE  
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PMID:28803587
Autor:Macmorran E; Harch S; Athan E; Lane S; Tong S; Crawford L; Krishnaswamy S; Hewagama S
Endereço:Alice Springs Hospital,Northern Territory,Australia.
Título:The rise of methicillin resistant Staphylococcus aureus: now the dominant cause of skin and soft tissue infection in Central Australia.
Fonte:Epidemiol Infect; 145(13):2817-2826, 2017 10.
ISSN:1469-4409
País de publicação:England
Idioma:eng
Resumo:This study aimed to examine the epidemiology and treatment outcomes of community-onset purulent staphylococcal skin and soft tissue infections (SSTI) in Central Australia. We performed a prospective observational study of patients hospitalised with community-onset purulent staphylococcal SSTI (n = 160). Indigenous patients accounted for 78% of cases. Patients were predominantly young adults; however, there were high rates of co-morbid disease. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was the dominant phenotype, accounting for 60% of cases. Hospitalisation during the preceding 6 months, and haemodialysis dependence were significant predictors of CA-MRSA infection on univariate analysis. Clinical presentation and treatment outcomes were found to be comparable for methicillin-susceptible S. aureus (MSSA) and methicillin-resistant cases. All MRSA isolates were characterised as non-multi-resistant, with this term used interchangeably with CA-MRSA in this analysis. We did not find an association between receipt of an active antimicrobial agent within the first 48 h, and progression of infection; need for further surgical debridement; unplanned General Practitioner or hospital re-presentation; or need for further antibiotics. At least one adverse outcome was experienced by 39% of patients. Clindamycin resistance was common, while rates of trimethoprim-sulfamethoxazole resistance were low. This study suggested the possibility of healthcare-associated transmission of CA-MRSA. This is the first Australian report of CA-MRSA superseding MSSA as the cause of community onset staphylococcal SSTI.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:0 (Anti-Bacterial Agents)


  6 / 1238 MEDLINE  
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PMID:28777799
Autor:Kirkham R; Whitbread C; Connors C; Moore E; Boyle JA; Richa R; Barzi F; Li S; Dowden M; Oats J; Inglis C; Cotter M; McIntyre HD; Kirkwood M; Van Dokkum P; Svenson S; Zimmet P; Shaw JE; O'Dea K; Brown A; Maple-Brown L; Northern Territory Diabetes in Pregnancy Partnership
Endereço:Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Darwin, Australia.
Título:Implementation of a diabetes in pregnancy clinical register in a complex setting: Findings from a process evaluation.
Fonte:PLoS One; 12(8):e0179487, 2017.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Rates of diabetes in pregnancy are disproportionately higher among Aboriginal than non-Aboriginal women in Australia. Additional challenges are posed by the context of Aboriginal health including remoteness and disadvantage. A clinical register was established in 2011 to improve care coordination, and as an epidemiological and quality assurance tool. This paper presents results from a process evaluation identifying what worked well, persisting challenges and opportunities for improvement. METHODS: Clinical register data were compared to the Northern Territory Midwives Data Collection. A cross-sectional survey of 113 health professionals across the region was also conducted in 2016 to assess use and value of the register; and five focus groups (49 healthcare professionals) documented improvements to models of care. RESULTS: From January 2012 to December 2015, 1,410 women were referred to the register, 48% of whom were Aboriginal. In 2014, women on the register represented 75% of those on the Midwives Data Collection for Aboriginal women with gestational diabetes and 100% for Aboriginal women with pre-existing diabetes. Since commencement of the register, an 80% increase in reported prevalence of gestational diabetes among Aboriginal women in the Midwives Data Collection occurred (2011-2013), prior to adoption of new diagnostic criteria (2014). As most women met both diagnostic criteria (81% in 2012 and 74% in 2015) it is unlikely that the changes in criteria contributed to this increase. Over half (57%) of survey respondents reported improvement in knowledge of the epidemiology of diabetes in pregnancy since establishment of the register. However, only 32% of survey respondents thought that the register improved care-coordination. The need for improved integration and awareness to increase use was also highlighted. CONCLUSION: Although the register has not been reported to improve care coordination, it has contributed to increased reported prevalence of gestational diabetes among high risk Aboriginal women, in a routinely collected jurisdiction-wide pregnancy dataset. It has therefore contributed to an improved understanding of epidemiology and disease burden and may in future contribute to improved management and outcomes. Regions with similar challenges in context and high risk populations for diabetes in pregnancy may benefit from this experience of implementing a register.
Tipo de publicação: EVALUATION STUDIES; JOURNAL ARTICLE


  7 / 1238 MEDLINE  
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PMID:28659111
Autor:Georges N; Guthridge SL; Li SQ; Condon JR; Barnes T; Zhao Y
Endereço:Department of Health, Northern Territory Government, Darwin, NT Nick.Georges@nt.gov.au.
Título:Progress in closing the gap in life expectancy at birth for Aboriginal people in the Northern Territory, 1967-2012.
Fonte:Med J Aust; 207(1):25-30, 2017 Jul 03.
ISSN:1326-5377
País de publicação:Australia
Idioma:eng
Resumo:OBJECTIVES: To compare long term changes in mortality and life expectancy at birth (LE) of Aboriginal people in the Northern Territory and of the overall Australian population; to determine the contributions of changes in mortality in specific age groups to changes in LE for each population. DESIGN, SETTING, PARTICIPANTS: Retrospective trend analysis of death and LE data for the NT Aboriginal and Australian populations, 1967-2012. MAIN OUTCOME MEASURES: LE estimates based on abridged life tables; mortality estimates (deaths per 100 000 population); and age decomposition of LE changes by sex and time period. RESULTS: Between 1967 and 2012, LE increased for both NT Aboriginal and all Australians; the difference in LE between the two populations declined by 4.6 years for females, but increased by one year for males. Between 1967-1971 and 1980-1984, LE of NT Aboriginal people increased rapidly, particularly through reduced infant mortality; from 1980-1984 to 1994-1998, there was little change; from 1994-1998 to 2008-2012, there were modest gains in older age groups. Decomposition by age group identified the persistent and substantial contribution of the 35-74-year age groups to the difference in LE between NT Aboriginal people and all Australians. CONCLUSIONS: Early gains in LE for NT Aboriginal people are consistent with improvements in nutrition, maternal and infant care, and infectious disease control. A rapid epidemiological transition followed, when LE gains in younger age groups plateaued and non-communicable diseases became more prevalent. Recent LE gains, across all adult age groups, are consistent with improved health service access and chronic disease management. If LE is to continue improving, socio-economic disadvantage and its associated risks must be reduced.
Tipo de publicação: JOURNAL ARTICLE


  8 / 1238 MEDLINE  
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PMID:28610084
Autor:Weaver HJ
Endereço:School of Science and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland 4556, Australia. Present address: Australian Biological Resources Study, Department of the Environment and Energy, GPO Box 787, Canberra 2601, Australia.. haylee.weaver@environment.gov.au.
Título:Three new species of the sucking louse genus Hoplopleura (Phthiraptera: Anoplura: Hoplopleuridae) from rodents (Mammalia: Rodentia: Muridae) in northern Australia.
Fonte:Zootaxa; 4247(1):31-44, 2017 Mar 23.
ISSN:1175-5334
País de publicação:New Zealand
Idioma:eng
Resumo:Three new species of the rodent louse genus Hoplopleura (Anoplura: Hoplopleuridae) are described and illustrated from Australia: H. melomydis new species from Melomys burtoni (Muridae: Hydromyini, grassland melomys) and M. capensis (Muridae: Hydromyini, Cape York melomys) from Queensland; H. notomydis new species and H. setosa new species from Notomys alexis (Muridae: Hydromyini, spinifex hopping mouse) from the Northern Territory. These new louse species are the first lice recorded from each of the three host rodent species.
Tipo de publicação: JOURNAL ARTICLE


  9 / 1238 MEDLINE  
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PMID:28609854
Autor:Popple LW
Endereço:Entomology Section, Queensland Museum, South Brisbane, Queensland 4101, Australia.. lindsay.popple@uq.net.au.
Título:A revision of the Ewartia oldfieldi (Distant) species complex (Hemiptera: Cicadidae: Cicadettinae) with five new species from eastern and northern Australia.
Fonte:Zootaxa; 4263(3):401-449, 2017 05 10.
ISSN:1175-5334
País de publicação:New Zealand
Idioma:eng
Resumo:The identity of Ewartia oldfieldi (Distant) is re-examined and this species is redescribed. Five new species belonging to the genus Ewartia Moulds are described. Ewartia oldfieldi s. str. occurs in association with wattles (Acacia spp.; Mimosaceae) with large or fleshy phyllodes growing in soils derived from sandstone and coarse-grained metasediments throughout the south-eastern third of Queensland. Ewartia roberti n. sp. is associated with wattles that possess narrow or delicate phyllodes, growing in loam soils in southern Queensland and northern New South Wales. Ewartia lapidosa n. sp. occurs in dryer inland and semi-arid areas between Croydon in northern Queensland and the Capertee Valley in central New South Wales where it occurs on various wattles growing in hard, rocky soils, including those derived from laterite and sandstone. Ewartia etesia n. sp. occurs principally on wattles growing along drainage lines in the Top End of the Northern Territory and the eastern edge of the Kimberley in Western Australia. Ewartia thamna n. sp. occurs in low, shrubby vegetation (presumably on wattles) in gravelly soils on low rises and along floodplains at the southern edge of the Top End in the Northern Territory. Ewartia carina n. sp. occurs in transitional habitats with tropical rainforest elements on the eastern edge of Cape York Peninsula in north Queensland. The distinctive, sometimes variable and typically complex calling songs specific to each of the species are illustrated and documented as part of these descriptions and comparisons.
Tipo de publicação: JOURNAL ARTICLE


  10 / 1238 MEDLINE  
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PMID:28592231
Autor:Harch SAJ; MacMorran E; Tong SYC; Holt DC; Wilson J; Athan E; Hewagama S
Endereço:Alice Springs Hospital, Alice Springs, Northern Territory, Australia. susan.harch@sa.gov.au.
Título:High burden of complicated skin and soft tissue infections in the Indigenous population of Central Australia due to dominant Panton Valentine leucocidin clones ST93-MRSA and CC121-MSSA.
Fonte:BMC Infect Dis; 17(1):405, 2017 Jun 07.
ISSN:1471-2334
País de publicação:England
Idioma:eng
Resumo:BACKGROUND: Superficial skin and soft tissue infections (SSTIs) are common among the Indigenous population of the desert regions of Central Australia. However, the overall burden of disease and molecular epidemiology of Staphylococcus aureus complicated SSTIs has yet to be described in this unique population. METHODS: Alice Springs Hospital (ASH) admission data was interrogated to establish the population incidence of SSTIs. A prospective observational study was conducted on a subset of S. aureus complicated SSTIs (carbuncles and furuncles requiring surgical intervention) presenting during a one month period to further characterize the clinical and molecular epidemiology. High resolution melting analysis was used for clonal complex discrimination. Real-time polymerase chain reaction identifying the lukF component of the Panton Valentine leucocidin (pvl) gene determined pvl status. Clinical and outcome data was obtained from the ASH medical and Northern Territory shared electronic health records. RESULTS: SSTIs represented 2.1% of ASH admissions during 2014. 82.6% occurred in Indigenous patients (n = 382) with an estimated incidence of 18.9 per 1, 000 people years compared to the non-Indigenous population of 2.9 per 1000, with an incident rate ratio of 6.6 (95% confidence interval 5.1-8.5). Clinical and molecular analysis was performed on 50 isolates from 47 patients. Community-associated methicillin-resistant S. aureus (CA-MRSA) predominated (57% of isolates). The high burden of SSTIs is partly explained by the prevalence of pvl positive strains of S. aureus (90% isolates) for both CA-MRSA and methicillin-susceptible S. aureus (MSSA). ST93-MRSA and CC121-MSSA were the most prevalent clones. SSTIs due to ST93-MRSA were more likely to require further debridement (p = 0.039), however they also more frequently received inactive antimicrobial therapy (p < 0.001). CONCLUSIONS: ST93-MRSA and CC121-MSSA are the dominant causes of carbuncles and furuncles in Central Australia. Both of these virulent clones harbor pvl but the impact on clinical outcomes remains uncertain. The high prevalence of CA-MRSA supports empiric vancomycin use in this population when antimicrobial therapy is indicated. Prompt surgical intervention remains the cornerstone of treatment.
Tipo de publicação: JOURNAL ARTICLE; OBSERVATIONAL STUDY
Nome de substância:0 (Bacterial Toxins); 0 (Exotoxins); 0 (Leukocidins); 0 (Panton-Valentine leukocidin)



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