School of Population Health & Clinical Practice

Permanent URI for this community

https://hdl.handle.net/2440/13901

The School of Population Health and Clinical Practice is one of the six Schools in the Faculty of Health Sciences created when the Faculty was restructured in 2005.

Browse

Now showing 1 - 20 of 4142

Metadata only
10-minute consultation: funny turn
(British Med Journal Publ Group, 2011) Leung, E.; Hamilton-Bruce, M.; Stocks, N.; Koblar, S.
Metadata only
21st century cognitive behavioural therapy for anger: a systematic review of research design, methodology and outcome
(Cambridge University Press, 2018) Fernandez, E.; Malvaso, C.; Day, A.; Guharajan, D.
Background: Past reviews of cognitive behavioural therapy (CBT) for anger have focused on outcome in specific subpopulations, with few questions posed about research design and methodology. Since the turn of the century, there has been a surge of methodologically varied studies awaiting systematic review. Aims: The basic aim was to review this recent literature in terms of trends and patterns in research design, operationalization of anger, and covariates such as social desirability bias (SDB). Also of interest was clinical outcome. Method: After successive culling, 42 relevant studies were retained. These were subjected to a rapid evidence assessment (REA) with special attention to design (ranked on the Scientific Methods Scale) measurement methodology (self-monitored behaviour, anger questionnaires, and others’ ratings), SDB assessment, and statistical versus clinical significance. Results: The randomized controlled trial characterized 60% of the studies, and the State Trait Anger Expression Inventory was the dominant measure of anger. All but one of the studies reported statistically significant outcome, and all but one of the 21 studies evaluating clinical significance laid claim to it. The one study with neither statistical nor clinical significance was the only one that had assessed and corrected for SDB. Conclusions: Measures remain relatively narrow in scope, but study designs have improved, and the outcomes suggest efficacy and clinical effectiveness. In conjunction with previous findings of an inverse relationship between anger and SDB, the results raise the possibility that the favourable picture of CBT for anger may need closer scrutiny with SDB and other methodological details in mind.
Metadata only
4CMenB sustained vaccine effectiveness against invasive meningococcal B disease and gonorrhoea at three years post program implementation
(Elsevier, 2023) Wang, B.; Giles, L.; Andraweera, P.; McMillan, M.; Almond, S.; Beazley, R.; Mitchell, J.; AHoure, M.; Denehy, E.; Flood, L.; Marshall, H.
Abstract not available
Metadata only
75+ health assessments
(Royal Australian College of General Practitioners, 2001) Newbury, J.; Marley, J.
Metadata only
A 5-year follow-up of general practice patients experiencing depression
(Oxford Univ Press, 2003) Wilson, I.; Duszynski, K.; Mant, A.
Background. Depression is a common disease in primary care and produces significant morbidity in the community. Little is known about the outcomes of depression in general practice. Objectives. This research set out to explore both the longitudinal management and outcomes of depression as seen in general practice. Methods. The Medic-GP database is a collection of the medical records of >50 000 people seen in nine Australian general practices. It was used to follow the management of depressed patients over 4–5 years. Records from 1994–1995 were searched for depression or similar words. Individual records of patients whose notes mentioned depression were randomly selected and examined to determine if they were diagnosed with depression. Records of patients who were diagnosed as suffering from depression were examined to determine progress over the ensuing 5 years. Results. Six hundred of 5889 patients were examined in detail. A total of 382 patients (63.7%) were diagnosed with depression; 219 had been diagnosed during this time interval. The main findings were 64.7% of patients were female; 93.6% of patients received an antidepressant at some time during the study; 16% of patients were referred to a psychiatrist; 7.3% were hospitalized; 30% of patients who ceased antidepressants without a recurrence had courses of antidepressants of 3 months or less; and only 22.5% of patients had a single episode of depression. Conclusion. Unlike cross-sectional studies, this study has shown a high rate of prescription of antidepressants. GPs often prescribed short courses of antidepressants, and depression behaves as a chronic, recurrent disease.
Metadata only
A baseline survey of the microbiological quality of chicken portions and carcasses at retail in two Australian states (2005 to 2006)
(Int Assoc Milk Food Environmental Sanitarians Inc, 2008) Pointon, A.; Sexton, M.; Dowsett, P.; Saputra, T.; Kiermeier, A.; Lorimer, M.; Holds, G.; Arnold, G.; Davos, D.; Combs, B.; Fabiansson, S.; Raven, G.; McKenzie, H.; Chapman, A.; Sumner, J.
Raw poultry products were purchased from the retail market place in two Australian states, New South Wales (n = 549) and South Australia (n = 310). The products sampled on a proportional volume basis were chicken portions with the skin off or skin on, in bulk or tray packs, and whole carcasses. They were collected from butcher shops, supermarkets, and specialty stores from urban areas during the winter (2005) and summer (2006) months. The samples were analyzed to determine the prevalence and concentration of Escherichia coli, Salmonella, and Campylobacter spp. in addition to total viable counts. Salmonella was found in 47.7 and 35.5% of retail chicken samples (35.3 and 21.9% were the less virulent Salmonella Sofia), at mean counts of −1.42 and −1.6 log MPN/cm2 in New South Wales and South Australia, respectively. Campylobacter was found in 87.8 and 93.2% of samples at mean counts of 0.87 and 0.78 log CFU/cm2, respectively. In both states in both seasons, the mean total viable count was 5 log CFU/cm2. On whole birds, E. coli was detected in all winter samples and on 92.9 and 85.7% of summer samples in New South Wales and South Australia, respectively; the log of the geometric mean per square centimeter was 0.5 in winter and slightly lower in summer. On chicken portions, E. coli was detected in around 90% of winter samples in both states, and in summer on 75.1 and 59.6% of samples in New South Wales and South Australia, respectively. The log of the geometric mean CFU per square centimeter for E. coli was 0.75 and 0.91 in winter, and 0.66 and 0.5 in summer in New South Wales and South Australia, respectively.
Open Access
A before and after study of the impact of academic detailing on the use of diagnostic imaging for shoulder complaints in general practice
(BioMed Central Ltd., 2007) Broadhurst, N.; Barton, C.; Rowett, D.; Yelland, L.; Matin, D.; Gialamas, A.; Beilby, J.
Background: The aim of this study was to assess the impact that Academic Detailing (AD) had on General Practitioners' use of diagnostic imaging for shoulder complaints in general practice and their knowledge and confidence to manage shoulder pain. Methods: One-to-one Academic Detailing (AD) for management of shoulder pain was delivered to 87 General Practitioners (GPs) in metropolitan Adelaide, South Australia, together with locally developed clinical guidelines and a video/DVD on how to examine the shoulder. Three months after the initial AD a further small group or an individual follow up session was offered. A 10-item questionnaire to assess knowledge about the shoulders was administered before, immediately after, and 3 months after AD, together with questions to assess confidence to manage shoulder complaints. The number of requests for plain film (X-ray) and ultrasound (US) imaging of the shoulder was obtained for the intervention group as well as a random comparison group of 90 GP's from the same two Divisions. The change in the rate of requests was assessed using a log Poisson GEE with adjustment for clustering at the practice level. A linear mixed effects model was used to analyse changes in knowledge. Results: In an average week 54% of GPs reported seeing fewer than 6 patients with shoulder problems. Mean (SD) GP knowledge score before, immediately after and 3-months after AD, was 6.2/10 (1.5); 8.6/10 (0.96) and; 7.2/10 (1.5) respectively (p < 0.0001). Three months after AD, GPs reported feeling able to take a more meaningful history, more confident managing shoulder pain, and felt their management of shoulder pain had improved. Requests for ultrasound imaging were approximately 43.8% higher in the period 2 years before detailing compared to six months after detailing (p < 0.0001), but an upward trend toward baseline was observed in the period 6 months to 1 year after AD. There was no statistically significant change in the rate of requests from before to after AD for plain-radiographs (p = 0.11). No significant changes in the rate of requests over time were observed in the control groups. Conclusion: These results provide evidence that AD together with education materials and guidelines can improve GPs' knowledge and confidence to manage shoulder problems and reduce the use of imaging, at least in the short term.
Metadata only
A biophysical model to assess the trade-off between larval recruitment and catch in southern Australia's largest prawn fishery
(Wiley-Blackwell, 2016) Mcleay, L.; Doubell, M.; Roberts, S.; Dixon, C.; Andreacchio, L.; James, C.; Luick, J.; Middleton, J.
Data from stock assessment surveys, published research and climate sensors were linked to model the interaction between fishing, physical‐oceanographic processes and spatial patterns of larval settlement for western king prawn [Penaeus (Melicertus) latisulcatus]. This information was used to evaluate the trade‐off between larval recruitment and catch during fishing periods that demand high prices but coincide with spawning. Total rates of larval settlement were maximized when tidal currents and atmospheric physical‐forcing components were coupled with simulations of larval swimming behaviour under average gulf temperatures. Average gulf temperatures sustained longer larval durations and increased larval settlement rates by over 12% compared with warmer gulf conditions simulated under a scenario of global warming. Reproductive data coupled with outputs from the biophysical model identified consistent inter‐annual patterns in the areas contributing to larval settlement success. Areas located in the north‐east, and central‐west of the fishery, consistently contributed to over 40% of all larvae reaching a settlement in each year. Harvest sensitivity analyses indicated that changes in the spatial patterns of pre‐Christmas fishing could lead to improvements in overall rates of the larval settlement while maintaining or improving the levels of catch. Future studies to refine the model inputs relating to physical processes, larval behaviour and mortality rates for P. latisulcatus coupled with surveys of juvenile prawn abundance to ground truth the modelled predictions, would allow stock recruitment relationships to be more closely examined and inform adaptive management of the fishery in the future.
Metadata only
A bowel cancer screening plan at last
(Australasian Medical Publishing Company, 2015) Frank, O.R.; Stocks, N.P.
Metadata only
A brief conceptual tutorial of multilevel analysis in social epidemiology: linking the statistical concept of clustering to the idea of contextual phenomenon
(British Med Journal Publ Group, 2005) Merlo, J.; Chaix, B.; Yang, M.; Lynch, J.; Rastam, L.
Study objective: This didactical essay is directed to readers disposed to approach multilevel regression analysis (MLRA) in a more conceptual than mathematical way. However, it specifically develops an epidemiological vision on multilevel analysis with particular emphasis on measures of health variation (for example, intraclass correlation). Such measures have been underused in the literature as compared with more traditional measures of association (for example, regression coefficients) in the investigation of contextual determinants of health. A link is provided, which will be comprehensible to epidemiologists, between MLRA and social epidemiological concepts, particularly between the statistical idea of clustering and the concept of contextual phenomenon. Design and participants: The study uses an example based on hypothetical data on systolic blood pressure (SBP) from 25 000 people living in 39 neighbourhoods. As the focus is on the empty MLRA model, the study does not use any independent variable but focuses mainly on SBP variance between people and between neighbourhoods. Results: The intraclass correlation (ICC = 0.08) informed of an appreciable clustering of individual SBP within the neighbourhoods, showing that 8% of the total individual differences in SBP occurred at the neighbourhood level and might be attributable to contextual neighbourhood factors or to the different composition of neighbourhoods. Conclusions: The statistical idea of clustering emerges as appropriate for quantifying "contextual phenomena" that is of central relevance in social epidemiology. Both concepts convey that people from the same neighbourhood are more similar to each other than to people from different neighbourhoods with respect to the health outcome variable.
Metadata only
A brief conceptual tutorial on multilevel analysis in social epidemiology: interpreting neighbourhood differences and the effect of neighbourhood characteristics on individual health
(British Med Journal Publ Group, 2005) Merlo, J.; Chaix, B.; Yang, M.; Lynch, J.; Rastam, L.
Study objective: Using a conceptual rather than a mathematical approach, this article proposed a link between multilevel regression analysis (MLRA) and social epidemiological concepts. It has been previously explained that the concept of clustering of individual health status within neighbourhoods is useful for operationalising contextual phenomena in social epidemiology. It has been shown that MLRA permits investigating neighbourhood disparities in health without considering any particular neighbourhood characteristic but only information on the neighbourhood to which each person belongs. This article illustrates how to analyse cross level (neighbourhood–individual) interactions, how to investigate associations between neighbourhood characteristics and individual health, and how to use the concept of clustering when interpreting those associations and geographical differences in health. Design and participants: A MLRA was performed using hypothetical data pertaining to systolic blood pressure (SBP) from 25 000 subjects living in the 39 neighbourhoods of an imaginary city. Associations between individual characteristics (age, body mass index (BMI), use of antihypertensive drug, income) or neighbourhood characteristic (neighbourhood income) and SBP were analysed. Results: About 8% of the individual differences in SBP were located at the neighbourhood level. SBP disparities and clustering of individual SBP within neighbourhoods increased along individual BMI. Neighbourhood low income was associated with increased SBP over and above the effect of individual characteristics, and explained 22% of the neighbourhood differences in SBP among people of normal BMI. This neighbourhood income effect was more intense in overweight people. Conclusions: Measures of variance are relevant to understanding geographical and individual disparities in health, and complement the information conveyed by measures of association between neighbourhood characteristics and health.
Metadata only
A brief conceptual tutorial on multilevel analysis in social epidemiology: investigating contextual phenomena in different groups of people
(British Med Journal Publ Group, 2005) Merlo, J.; Yang, M.; Chaix, B.; Lynch, J.; Rastam, L.
Study objective: (1) To provide a didactic and conceptual (rather than mathematical) link between multilevel regression analysis (MLRA) and social epidemiological concepts. (2) To develop an epidemiological vision of MLRA focused on measures of health variation and clustering of individual health status within areas, which is useful to operationalise the notion of “contextual phenomenon”. The paper shows how to investigate (1) whether there is clustering within neighbourhoods, (2) to which extent neighbourhood level differences are explained by the individual composition of the neighbourhoods, (3) whether the contextual phenomenon differs in magnitude for different groups of people, and whether neighbourhood context modifies individual level associations, and (4) whether variations in health status are dependent on individual level characteristics. Design and participants: Simulated data are used on systolic blood pressure (SBP), age, body mass index (BMI), and antihypertensive medication (AHM) ascribed to 25 000 subjects in 39 neighbourhoods of an imaginary city. Rather than assessing neighbourhood variables, the paper concentrated on SBP variance between individuals and neighbourhoods as a function of individual BMI. Results: The variance partition coefficient (VPC) showed that clustering of SBP within neighbourhoods was greater for people with a higher BMI. The composition of the neighbourhoods with respect to age, AHM use, and BMI explained about one fourth of the neighbourhood differences in SBP. Neighbourhood context modified the individual level association between BMI and SBP. Individual level differences in SBP within neighbourhoods were larger for people with a higher BMI. Conclusions: Statistical measures of multilevel variations can effectively quantify contextual effects in different groups of people, which is a relevant issue for understanding health inequalities.
Metadata only
A brief experience for medical students in a remote Aboriginal community
(Royal Australian College of General, 2015) Benson, J.; Ryder, C.; Gill, M.; Balabanski, A.
Background: Aboriginal and Torres Strait Islander peoples, particularly those in remote communities, have lower access to health services when compared with the rest of the Australian population. This research examined the expectations and outcomes of medical students who went on a 2-day trip to a remote Aboriginal community. Methods: Activities were organised by community members, ground staff and fly-in fly-out health professionals. Students wrote about their expectations and post-trip reflections on personal, medical and cultural themes. Results: Twenty-three students participated in this study. Themes included complex, different and increased illnesses; how culture affects day-to-day life and health; personal growth; administrative, health delivery and advocacy skills; learning cultural awareness first-hand; and future career options. Discussion: The 2-day trip gave students a profound learning experience. To build a culturally appropriate and dedicated workforce for Aboriginal and Torres Strait Islander peoples, medical schools should consider incorporating short trips to remote Aboriginal and Torres Strait Islander communities into their curriculum.
Metadata only
A brief history of snake venoms affecting hemostasis
(Marcel Dekker Inc, 2006) Marsh, N.
The earliest reports of snake venoms affecting hemostasis occur in the 17th century and first half of the 18th century with the observations of Nieremberius (1635), van Helmont (1648), Richard Mead (1702), and Geoffrey and Hunauld (1737). However, our detailed knowledge of this field of toxinology stems largely from the work in the second half of the 18th century of Felice Fontana, who is credited with being the first investigator to inject viper venom into dogs. Fontana's work foreshadowed many seminal discoveries that were to be made in the next 200 years, but a fallow period of research followed Fontana until three Britons took up investigations into snake venoms beginning in the late 19th century: Charles Martin, who worked on Australian snake venoms; Gwyn Macfarlane, who studied Russell's viper venom, initially in relation to the treatment of hemophilia; and Alistair Reid, who worked on the Malayan pit viper and was the first to suggest the use of snake venom, thrombin-like enzymes in "therapeutic defibrination" as an alternative anticoagulant strategy. From the 1960s onwards, the explosion of research activity generated in part by molecular biology, has provided a vast amount of data in this field. Notably, studies on venom factors affecting platelet function are part of this more recent history, and in the last 20 years, a wide range of C-type lectins and disintegrins have been discovered. Molecular techniques have now enabled the identification of gene structure, the cloning of genes, the production of recombinant protein, and the elucidation of protein function at the molecular level. Overall, a significant number of snake venom toxins affecting hemostasis have been put to use in both the research and routine coagulation laboratory settings and show much promise in a variety of clinical situations. Copyright © 2006 Taylor & Francis Group, LLC.
Metadata only
A case-based discussion of clinical problems in the management of patients treated with ruxolitinib for myelofibrosis
(Wiley, 2017) Ho, P.; Bajel, A.; Burbury, K.; Dunlop, L.; Durrant, S.; Forsyth, C.; Perkins, A.; Ross, D.
Ruxolitinib is a dual janus kinase 1 (JAK1)/JAK2 inhibitor used to treat splenomegaly and symptoms associated with myelofibrosis (MF). Current therapeutic options for symptomatic MF include supportive care, myelosuppressive therapy (such as hydroxycarbamide) and janus kinase (JAK) inhibitors (in particular ruxolitinib). Allogeneic stem cell transplantation remains the only potentially curative treatment for MF, and younger transplant-eligible patients should still be considered for allogeneic stem cell transplantation; however, this is applicable only to a small proportion of patients. There is now increasing and extensive experience of the efficacy and safety of ruxolitinib in MF, both in clinical trials and in 'real-world' practice. The drug has been shown to be of benefit in intermediate-1 risk patients with symptomatic splenomegaly or other MF-related symptoms, and higher risk disease. Optimal use of the drug is required to maximise clinical benefit, requiring an understanding of the balance between dose-dependent responses and dose-limiting toxicities. There is also increasing experience in the use of ruxolitinib in the pre-transplantation setting. This paper aims to utilise several 'real-life' cases to illustrate several strategies that may help to optimise clinical practice.
Metadata only
A case-control study of the protective benefit of cervical screening against invasive cervical cancer in NSW women
(Kluwer Academic Publ, 2008) Yang, B.; Morrell, S.; Zuo, Y.; Roder, D.; Tracey, E.; Jelfs, P.
Objective: To examine the effects of different Pap screening patterns in preventing invasive cervical cancer among women in New South Wales, Australia. Methods: A total of 877 women aged 20–69 years diagnosed with invasive cervical cancer during 2000–2003 were matched with 2,614 controls by month and year of birth. Screening behavior patterns in 4 years preceding the time of cancer diagnosis in the cases were classified into none (no Pap test in the 4 years), ‘irregular’ (1 of the 4 years with Pap test(s)), and ‘regular’ (2 or more of the 4 years with a Pap test), and compared with those in the matched non-cases over the same period. Conditional logistic regression modeling was used to estimate the relative risk, approximated by the odds ratio, of invasive cervical cancer for regular and irregular cervical screening compared with no screening in the previous 4 years, before and after controlling for potential confounders including the first recorded Pap test result in the preceding 6-year reference period. Results Compared with no screening, irregular Pap screening in the 4 years preceding the cancer diagnosis is estimated to reduce the risk of invasive cervical cancer by about 85% (RR = 0.15, 95% CI: 0.120–0.19); regular Pap screening reduces the risk by about 96% (RR = 0.04, 95% CI: 0.03–0.05). After adjusting for the index Pap test result, the relative risks for invasive cervical cancer were 0.19 (95% CI: 0.13–0.27) for irregular screening and 0.07 (95% CI: 0.04–0.10) for regular Pap screening. Conclusions Regular and irregular Pap tests among women aged 20–69 years were highly effective in preventing invasive cancer. At-risk women with no Pap test history should be encouraged to undergo a Pap test every 2 years, but any Pap screening over a 4-year period remains highly protective against future invasive cervical cancer.
Metadata only
A chain is as strong as its weakest link but that link could be the subject matter of the questionnaire!
(Oxford Univ Press, 2002) Stocks, N.; Gunnell, D.
Metadata only
A checklist for comprehensive health assessment for the over 70's
(Council Ageing, 2002) Byles, J.; Tavener, M.; Fitzgerald, P.; Nair, B.; Higginbotham, N.; Jackson, C.; Heller, R.; Newbury, J.
Objectives: To describe the development and performance of an instrument for health assessment of older Australian veterans and war widows, including: (a) the underlying dimensions of the assessment instrument, (b) problems identified and (c) associations with health related quality of life. Method: Participants were randomly selected veterans and war widows aged 70 years and over, living independently in 10 regions of NSW and QLD. The intervention consisted of a series of preventive care home visit health assessments by health professionals using a specially developed 113‐item screening checklist, together with targeted health education materials, telephone follow‐up and computer generated reports to the veteran's local medical officer. Main outcome measures were underlying facets of the checklist, and associations with self reported quality of life. Results: 904 home visit assessments were conducted using the checklist. Problems identified included having no recent hearing check, poor rate of vaccination against pneumonia and tetanus vaccination, and problems with feet. Exploratory factor analysis of the checklist reported four main factors, explaining 31% of the variance. Three out of four checklist scales were significantly associated with both physical and mental component scores of the SF‐36 quality of life measure.Conclusions: The preventive care checklist proved easy to administer, acceptable to participants, and contained valid items for use with an older veteran population.
Open Access
A checklist for managed access programmes for reimbursement co-designed by Canadian patients and caregivers
(Wiley Online Library, 2018) Young, A.; Menon, D.; Street, J.; Al-Hertani, W.; Stafinski, T.
Reimbursement decisions on orphan drugs carry significant uncertainty, and as the amount increases, so does the risk of making a wrong decision, where harms outweigh benefits. Consequently, patients often face limited access to orphan drugs. Managed access programmes (MAPs) are a mechanism for managing risk while enabling access to potentially beneficial drugs. Patients and their caregivers have expressed support for these programmes and see patient input as critical to successful implementation. However, they have yet to be systematically involved in their design.The aim of this study was to co-design with patients and caregivers a tool for the development of managed access programmes.Building upon established relationships with the Canadian Organization for Rare Disorders, the project team collaborated with patients and caregivers using the principles of participatory action research. Data were collected at two workshops and analysed using a thematic network approach.Patients and caregivers co-designed a checklist comprised of six aspects of an ideal MAP relating to accountability (programme goals); governance (MAP-specific committee oversight, patient input, international collaboration); and evidence collection (outcome measures and continuation criteria, on-going monitoring and registries). They recognized that health-care resources are finite and considered disease or drug eligibility criteria for deciding when to use a MAP (eg drugs treating diseases for which there are no other legitimate alternatives).A patient and caregiver-designed checklist was created, which emphasized patient involvement and transparency. Further research is needed to examine the feasibility of this checklist and roles for other stakeholders.
Metadata only
A cluster of haematuria cases in a pesticide-manufacturing plant
(LIPPINCOTT WILLIAMS & WILKINS, 1998) Gun, R.; Seymour, A.; Mathew, T.
In a pesticide manufacturing and formulating facility, 10 employees out of 48 were shown to have haematuria on dipstick testing. They included seven of the 27 production workers, all of whom had worked in both of two particular areas prior to the commencement of the routine urine testing. Five of the seven production workers with haematuria underwent further investigations, and in all five the haematuria was glomerular in origin. Two underwent renal biopsy, which showed irregular attenuation of the glomerular basement membrane (GBM) but no abnormality by light microscopy. Immunofluorescence studies were negative. This case series of glomerular haematuria is not readily explained by chance, false positive dipstick testing, or a recognizable non-occupational cause. Thin GBM disease, which is a benign condition, appears the likely explanation. Thin GBM disease is usually an autosomal dominant condition, but clustering of these genotypes in this small population is improbable.

Browse

Browsing School of Population Health & Clinical Practice by Title

Results Per Page

Sort Options