Adelaide Research & Scholarship
Adelaide Research & Scholarship (AR&S) is the University of Adelaide’s digital repository. AR&S provides a platform for the collection, organisation, access and preservation of the research and scholarly outputs of the University community in digital formats, as well as digital management of information in physical formats.
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Exposure to doxycycline increases risk of carrying a broad range of enteric antimicrobial resistance determinants in an elderly cohort
(Elsevier, 2024) Carpenter, L.; Miller, S.; Flynn, E.; Choo, J.M.; Collins, J.; Shoubridge, A.P.; Gordon, D.; Lynn, D.J.; Whitehead, C.; Leong, L.E.X.; Ivey, K.L.; Wesselingh, S.L.; Inacio, M.C.; Crotty, M.; Papanicolas, L.E.; Taylor, S.L.; Rogers, G.B.
Objectives High rates of antibiotic prescription in residential aged care are likely to promote enteric carriage of antibiotic-resistant pathogens and increase the risk of antibiotic treatment failure. Despite their importance, relationships between antibiotic exposures and patterns of enteric resistance carriage in this population remain poorly understood. Methods We conducted a cross-sectional metagenomic cohort analysis of stool samples from residents of five long-term aged-care facilities in South Australia. Taxonomic composition was determined, and enteric carriage of antibiotic resistance genes (ARGs) was identified and quantified against the Comprehensive Antibiotic Resistance Database. Both the detection and abundance of stool taxa and ARGs were related to antibiotic exposures up to 12 months prior. Factors associated with the abundance of ARGs of high clinical concern were identified. Results Stool samples were provided by 164 participants (median age: 88 years, IQR 81–93; 72% female). Sixty-one percent (n = 100) of participants were prescribed antibiotics at least once in the prior 12 months (median prescriptions: 4, range: 1–52), most commonly a penicillin (n = 55, 33.5%), cephalosporin (n = 53, 32.3%), diaminopyrimidine (trimethoprim) (n = 36, 22%), or tetracycline (doxycycline) (n = 21, 12.8%). More than 1100 unique ARGs, conferring resistance to 38 antibiotic classes, were identified, including 20 ARGs of high clinical concern. Multivariate logistic regression showed doxycycline exposure to be the greatest risk factor for high ARG abundance (adjusted odds ratio [aOR]=14.8, q<0.001) and a significant contributor to inter-class selection, particularly for ARGs relating to penicillins (aOR=3.1, q=0.0004) and cephalosporins (aOR=3.4, q=0.003). High enteric ARG abundance was associated with the number of separate antibiotic exposures (aOR: 6.4, q<0.001), exposures within the prior 30 days (aOR: 4.6, q=0.008) and prior 30–100 days (aOR: 2.6, q=0.008), high duration of antibiotic exposure (aOR: 7.9, q<0.001), and exposure to 3 or more antibiotic classes (aOR: 7.4, q<0.001). Carriage of one or more ARGs of high clinical concern was identified in 99% of participants (n = 162, median: 3, IQR: 2–4), involving 11 ARGs conferring resistance to aminoglycosides, four to beta-lactams, one to glycopeptides, three to fluoroquinolones, and one to oxazolidinones. Carriage of ARGs of high clinical concern was positively associated with exposure to doxycycline (aminoglycoside, fluoroquinolone, and oxazolidinone ARGs) and trimethoprim (fluoroquinolone and beta-lactam ARGs). Analysis of doxycycline impact on microbiota composition suggested that observed resistome changes arose principally through direct ARG selection, rather than through the antibiotic depletion of sensitive bacterial populations. Conclusions The gut microbiome of aged care residents is a major reservoir of antibiotic resistance. As a critical antibiotic in medical practice, a comprehensive understanding of the impact of doxycycline exposure on the gut resistome is paramount for informed antibiotic use, particularly in an evolving landscape of prophylactic applications. Near-universal asymptomatic carriage of clinically critical resistance determinants is highly concerning and reinforces the urgent need for improved management of antibiotic use in long-term aged care.
Executive Function Outcomes at School Age in Children Born Moderate-to-Late Preterm
(Elsevier, 2025) Rossetti, L.; Pascoe, L.; Mainzer, R.M.; Ellis, R.; Olsen, J.E.; Spittle, A.J.; Doyle, L.W.; Cheong, J.L.Y.; Anderson, P.J.
Objective To compare executive function (EF) outcomes at school age between children born moderate-to-late preterm (MLP; 32-36 weeks' gestation) and term (≥37 weeks’ gestation) across subdomains of attentional control, cognitive flexibility, goal setting, and everyday executive behaviors. Study design Two hundred one children born MLP and 201 born at term were recruited from the Royal Women's Hospital, Melbourne, Australia. Children completed EF measures at 9 years of corrected age. Group differences in mean or median outcome z-scores were estimated using linear or quantile regression. EF impairment risk ratios [RRs] between groups were estimated using generalized linear models. Analyses were adjusted for multiple birth and social risk. Results One hundred fifty-nine children born MLP (79%) and 134 born at term (67%) were assessed. Compared with the term group, the MLP group performed poorer in goal setting (mean difference = −0.26, 95% CI = −0.50, −0.03, P = .03) and cognitive flexibility (mean difference = −0.32, 95% CI = −0.59, −0.05, P = .02). Children born MLP were at increased risk of behavioral executive dysfunction (RR = 1.86, 95% CI = 1.05, 3.27, P = .03), impairments in cognitive flexibility (RR = 1.80, 95% CI = 1.05, 3.09, P = .03), and goal setting (RR = 1.69, 95% CI = 1.08, 2.65, P = .02). Conclusions Children born MLP demonstrate a pattern of increased EF difficulties at school-age compared with term children, mostly within the goal setting subdomain. These difficulties are likely to affect other outcomes such as academic performance and social skills.
Equity, curriculum form and state differences in Australian senior secondary education
(Springer Nature, 2025) O’Connor, K.; Roberts, P.; Di Gregorio, E.
This article considers differences and similarities in curriculum form between the senior secondary certificates offered across Australia, drawing on three different understandings of curriculum form, one focused on the grid or map of the curriculum and its core categories and levels of specification, one on the cultural assumptions underpinning significant policy reforms, and one on the internal relations between curriculum contents and the divisions evident in the curriculum assigned to particular groups of students. It highlights differences between these perspectives and the value of engaging them collectively to understand the various senior secondary systems operating across Australia, how they have changed over time and their equity implications. It shows that the certificates continue to be different in multiple ways despite decades of standardising reform but that shifts have occurred within states once defined as progressive, with practices changing to align with larger states’ conservative agendas. The differences which do continue are also shown to be in some respects arbitrary, with common patterns evident in relation to the knowledges valued and the distinctions enforced between university and non-university pathways which are obfuscated by the highly complex rules and requirements evident in each jurisdiction. Further research and analysis considering the enactment of these requirements within schools is needed to better understand the equity implications of different requirements and approaches and to think about what kind of curriculum form might be needed to enable an equitable educational system in Australia.
Effects of pre- and post-surgery physical activity interventions on physical activity and sedentary behaviour levels following knee and hip arthroplasty: a systematic review and meta-analysis of randomised controlled trials
(Elsevier, 2025) d'Unienville, N.; Singh, B.; Gower, B.; Szeto, K.; Badger, H.; Krywanio, M.; Maher, C.; Thewlis, D.
Objective To evaluate general exercise and behavioural interventions designed to improve physical activity (PA) or reduce sedentary behaviour in total knee or hip arthroplasty (TKA/THA) patients. Design A systematic review and meta-analysis were conducted on randomised controlled trials reporting PA or sedentary behaviour changes in TKA/THA patients, with effects calculated using standardised mean differences (SMD). Subgroup analyses assessed whether effects differed based on intervention characteristics, arthroplasty timing, outcome type, and follow-up duration. Risk of bias and certainty of evidence were assessed using the PEDro scale and GRADE, respectively. Results Twenty-three trials were included, with meta-analyses including 1265 and 270 participants for PA and sedentary behaviour outcomes, respectively. PA interventions did not decrease sedentary behaviour (SMD=−0.19; 95% CI: −0.66 to 0.29; very low certainty of evidence), but did improve PA (SMD=0.16; 95% CI: 0.01 to 0.30; high certainty of evidence). This included improvements in step count (SMD=0.22; 95% CI: 0.05 to 0.40), but not moderate-to-vigorous PA (SMD=−0.01, 95% CI: −0.33 to 0.30). Interventions were most effective when they integrated wearable activity trackers (e.g., Fitbits; SMD=0.38; 95% CI: 0.18 to 0.57), behaviour change techniques (SMD=0.20, 95% CI: 0.01 to 0.39), and began less than two weeks after surgery (SMD=0.32, 95% CI: 0.14 to 0.50). Conclusion PA interventions, particularly those integrating behavioural strategies and wearable technology, promote PA in arthroplasty patients, but their effects on sedentary behaviour are unclear. These findings suggest that implementing evidence-based PA interventions be considered an essential component of acute arthroplasty care to enhance overall patient health.
Early childhood caries intervention in Aboriginal Australian children: Follow-up at child age 9 years
(Public Library of Science (PLoS), 2025) Ju, X.; Hedges, J.; Haag, D.G.; Soares, G.H.; Smithers, L.G.; Jamieson, L.M.; Malele-Kolisa, Y.
Objective Dental caries is one of the most common preventable diseases among Indigenous children. The study aimed to estimate the efficacy of an Early Childhood Caries (ECC) intervention among Aboriginal Australian children over 9 years, and to explore potential risk factors associated with dental caries among Indigenous Australian children. Methods Data were from a randomized controlled trial conducted in South Australia, Australia. Four hundred and forty-eight women pregnant with an Aboriginal child were randomly allocated to either an immediate (II) or delayed (DI) intervention group between January 2011 and May 2012. The immediate intervention comprised (1) provision of dental care to mothers during pregnancy; (2) application of fluoride varnish to teeth of children at ages 6, 12; and 18 months; (3) motivational interviewing delivered in conjunction with; and (4) anticipatory guidance. Mothers/children in the DI group received the same intervention commencing at child aged 2 years. Follow-ups occurred when children were aged 2-, 3-, 5-, 7- and 9-years. In this analysis, outcomes were severity of caries experience: mean dmft/DMFT at child aged 9 years. Dependent variables included mothers’ baseline and seven years follow-up characteristics (age, education level, source of income, residential location, smoking and alcohol status) and children’s birth and feeding, and dental behaviours characteristics (sex, gestation, birth weight, breastfeeding status and sweet food consumption, and frequency of tooth brushing). Multivariable log-Poisson regression models with robust standard error estimation were applied as a statistical model to estimate multivariable relationships of dental caries and other covariates. Risk ratios (RRs) with their 95%CI were calculated. Sensitivity analyses were conducted by using the inverse-probability-of censoring weighting (IPCW) to overcome the loss-follow-up issues. Results Data were available for 367 (II = 180 and DI = 187) children at age 9 years. The mean dmft was 3.41 (95% CI: 2.95–3.87) and DMFT was 0.31(95%CI: 0.22–0.41). In multivariable modelling, mean dmft was higher (RR = 1.13, 95% CI: 1.01–1.26) among DI children than II children, but there were no significant differences in the permanent dentition. Risk factors for caries severity in both the primary and permanent dentition included lower mothers’ education level (<12 years level: dmft; RR = 1.56, 95% CI:1.31–1.86; and ‘Trade or TAFT: DMFT: RR =3.40, 95%CI: 1.16-9.98). Other risk factors for dental caries experience in the primary dentition included preterm birth, low birth weight, child not breastfed and sugar consumption more than 10%, and in permanent dentition was self-rated ‘fair/poor’ or ‘Good’ children’s oral health, compared with self-rated ‘Excellent/very good’ oral health. Conclusion The present study suggests that, within this cohort, initiating an early childhood caries intervention during pregnancy and infancy may be associated with lower caries experience in the primary dentition by age 9 years compared to a later start. Low maternal education level was associated with caries severity in both primary and permanent dentitions. Sugar consumption, a modifiable risk factor, greater than 10% was an important contributor to dental caries in primary teeth.