General Practice publications
Permanent URI for this collection
Browse
Recent Submissions
Item Metadata only Barriers and facilitators for the implementation of nurse-delivered chronic disease management within general practice: a mixed methods systematic review protocol(Lippincott, Williams & Wilkins, 2023) Grivell, N.; Brown, B.; Fuller, J.; Chai-Coetzer, C.L.; McEvoy, R.D.; Hoon, E.Objective: The objective of this review is to identify the barriers and facilitators for the implementation of nursedelivered models of care for chronic diseases to inform the development and evaluation of nurse-delivered models of care for chronic sleep disorders. Introduction: Increasing prevalence of sleep disorders and subsequent demand for specialist-led sleep services has prompted investigation into the management of uncomplicated sleep disorders by general practitioners. Models of sleep health care with enhanced roles for general practice nurses have been investigated within the context of randomized controlled trials; however, it is unclear how best to implement these models into clinical practice. With limited research exploring the implementation of nurse-delivered models of sleep health care within general practice, this review will examine the barriers and facilitators for the implementation of nurse-delivered models of care for chronic disease. This will inform the integration of new nurse-delivered models of care for chronic sleep disorders into routine general practice. Inclusion criteria: Studies that report barriers and facilitators for the implementation of nurse-delivered models of care for chronic diseases for adults into a general practice setting will be included. Methods: Six databases will be searched: MEDLINE, CINAHL, Embase, Scopus, Cochrane Library, and Emcare. The search will be limited to qualitative, quantitative, and mixed methods studies. Studies will be included if they contain data that report on barriers and facilitators for implementation of nurse-delivered models of care for chronic diseases. This review will be conducted in accordance with the JBI approach to mixed methods convergent integrated systematic reviews. Systematic review registration number: PROSPERO CRD42021273346Item Open Access Associations of body size with all-cause and cause-specific mortality in healthy older adults(Nature Publishing Group, 2023) Carr, P.R.; Webb, K.L.; Neumann, J.T.; Thao, L.T.P.; Beilin, L.J.; Ernst, M.E.; Fitzgibbon, B.; Gasevic, D.; Nelson, M.R.; Newman, A.B.; Orchard, S.G.; Owen, A.; Reid, C.M.; Stocks, N.P.; Tonkin, A.M.; Woods, R.L.; McNeil, J.J.In the general population, body mass index (BMI) and waist circumference are recognized risk factors for several chronic diseases and all-cause mortality. However, whether these associations are the same for older adults is less clear. The association of baseline BMI and waist circumference with all-cause and cause-specific mortality was investigated in 18,209 Australian and US participants (mean age: 75.1 ± 4.5 years) from the ASPirin in Reducing Events in the Elderly (ASPREE) study, followed up for a median of 6.9 years (IQR: 5.7, 8.0). There were substantially different relationships observed in men and women. In men, the lowest risk of all-cause and cardiovascular mortality was observed with a BMI in the range 25.0–29.9 kg/m2 [HR25-29.9 vs 21–24.9 kg/m2: 0.85; 95% CI, 0.73–1.00] while the highest risk was in those who were underweight [HRBMI <21 kg/m2 vs BMI 21–24.9 kg/m2: 1.82; 95% CI 1.30–2.55], leading to a clear U-shaped relationship. In women, all-cause mortality was highest in those with the lowest BMI leading to a J-shaped relationship (HRBMI <21 kg/m2 vs BMI 21–24.9 kg/m2: 1.64; 95% CI 1.26–2.14). Waist circumference showed a weaker relationship with all-cause mortality in both men and women. There was little evidence of a relationship between either index of body size and subsequent cancer mortality in men or women, while non-cardiovascular non-cancer mortality was higher in underweight participants. For older men, being overweight was found to be associated with a lower risk of all-cause mortality, while among both men and women, a BMI in the underweight category was associated with a higher risk. Waist circumference alone had little association with all-cause or cause-specific mortality risk. Trial registration ASPREE https://ClinicalTrials.gov number NCT01038583.Item Metadata only Factors associated with treatment and control of hypertension in a healthy elderly population free of cardiovascular disease: a cross-sectional study(Oxford University Press, 2019) Chowdhury, E.; Nelson, M.R.; Ernst, M.E.; Margolis, K.L.; Beilin, L.J.; Johnston, C.I.; Murray, A.M.; Woods, R.L.; Wolfe, R.; Tonkin, A.M.; Williamson, J.D.; Stocks, N.P.; McNeil, J.; Reid, C.; Congress of the European-Society-of-Cardiology (ESC) / World Congress of Cardiology (31 Aug 2019 - 4 Sep 2019 : Paris, FRANCE)Introduction Despite readily available treatments, control of high blood pressure (BP) in the ageing population remains suboptimal. Gaps in understanding the management of high BP amongst the elderly exist, as most studies have been in predominantly middle-aged populations. Purpose We explored pharmacological BP lowering treatment and control among elderly hypertensive participants free from overt cardiovascular disease (CVD), and identified factors related to both “untreated” and “treated but uncontrolled” high BP. Methods We analyzed baseline data from 19,114 individuals aged ≥65 years enrolled from Australia and the US in the ASPirin in Reducing Events in the Elderly (ASPREE) study. Hypertension was defined as an average systolic/diastolic BP ≥140/90 mmHg and/or use of any BP-lowering medication. `Controlled hypertensives” were those receiving BP-lowering medication and with BP <140/90 mmHg. Descriptive analyses were used to summarize hypertension control rates; logistic regression was used to investigate relationships with treatment and BP control. Results Overall, 74% (14,213/19,114) of participants were hypertensive, and of these 29% (4,151/14,213) were untreated. Among those treated, 47% (4,732/10,062) had BP <140/90 mmHg. Participants who were untreated were more likely to be men, have higher educational status, and be in good physical health, and less likely to have significant comorbidities. The factors related to “treated but uncontrolled” hypertension included older age, being men, Black race (versus White), using BP lowering monotherapy and residing in Australia (versus US) (Figure 1). Conclusion(s) There were high levels of “untreated” and “treated but uncontrolled” BP, in an otherwise healthy elderly population, suggesting that opportunities for better BP control exist through targeting intervention to high-risk individuals.Item Open Access The effect of depressive symptoms on disability-free survival in healthy older adults: a prospective cohort study(Wiley, 2022) Roebuck, G.; Lotfaliany, M.; Agustini, B.; Forbes, M.; Mohebbi, M.; McNeil, J.; Woods, R.L.; Reid, C.M.; Nelson, M.R.; Shah, R.C.; Ryan, J.; Newman, A.B.; Owen, A.; Freak-Poli, R.; Stocks, N.; Berk, M.; ASPREE Investigator Group,Background: Gerontology and ageing research are increasingly focussing on healthy life span (healthspan), the period of life lived free of serious disease and disability. Late-life depression (LLD) is believed to impact adversely on physical health. However, no studies have examined its effect on healthspan. This study investigated the effect of LLD and subthreshold depression on disability-free survival, a widely accepted measure of healthspan. Methods: This prospective cohort study used data from the ASPirin in Reducing Events in the Elderly study. Participants were aged ≥70 years (or ≥65 years for African-American and Hispanic participants) and free of dementia, physical disability and cardiovascular disease. Depressive symptoms were measured using the 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10). LLD and subthreshold depression were defined as CES-D-10 scores ≥8 and 3–7, respectively. Disability-free survival was defined as survival free of dementia and persistent physical disability. Results: A total of 19,110 participants were followed up for a maximum of 7.3 years. In female participants, LLD was associated with lower disability-free survival adjusting for sociodemographic and lifestyle factors, medical comorbidities, polypharmacy, physical function and antidepressant use (HR, 1.50; 95% CI, 1.23–1.82). In male participants, LLD was associated with lower disability-free survival adjusting for sociodemographic and lifestyle factors (HR, 1.30; 95% CI, 1.03–1.64). Subthreshold depression was also associated with lower disability-free survival in both sexes. Conclusions: LLD may be a common and important risk factor for shortened healthspan.Item Metadata only The effect of low-dose aspirin on frailty phenotype and frailty index in community-dwelling older adults in the ASPirin in Reducing Events in the Elderly study(Oxford University Press, 2022) Espinoza, S.E.; Woods, R.L.; Ekram, A.R.M.S.; Ernst, M.E.; Polekhina, G.; Wolfe, R.; Shah, R.C.; Ward, S.A.; Storey, E.; Nelson, M.R.; Reid, C.M.; Lockery, J.E.; Orchard, S.G.; Trevaks, R.; Fitzgerald, S.M.; Stocks, N.P.; Chan, A.; McNeil, J.J.; Murray, A.M.; Newman, A.B.; et al.; Lipsitz, L.A.BACKGROUND: Frailty is associated with chronic inflammation, which may be modified by aspirin. The purpose of this study was to determine whether low dose aspirin reduces incident frailty in healthy older adult participants of the ASPirin in Reducing Events in the Elderly (ASPREE) trial. METHODS: In the U.S and Australia, 19,114 community-dwelling individuals aged ≥70 years (U.S minorities ≥65 years) and free of overt cardiovascular disease, persistent physical disability, and dementia, were enrolled in ASPREE, a double-blind, placebo-controlled trial of 100mg daily aspirin versus placebo. Frailty, a pre-specified study endpoint, was defined according to a modified Fried frailty definition (Fried frailty) and the frailty index based on the deficit accumulation model (frailty index). Competing risk Cox proportional hazards models were used to compare time to incident frailty by aspirin versus placebo. Sensitivity analysis was conducted to include frailty data with and without imputation of missing data. RESULTS: Over a median 4.7 years, 2252 participants developed incident Fried frailty, and 4451 had incident frailty according to the frailty index. Compared with placebo, aspirin treatment did not alter the risk of incident frailty (Fried frailty HR: 1.04, 95% CI 0.96-1.13; frailty index HR: 1.03, 95% CI 0.97-1.09). The proportion of individuals classified as frail, and the trajectory in continuous frailty scores over time, were not different between the aspirin and placebo treatment groups. The results were consistent across a series of subgroups. CONCLUSIONS: Low dose aspirin use in healthy older adults when initiated in older ages does not reduce risk of incident frailty or the trajectory of frailty.Item Metadata only Effects of aspirin on the long-term management of depression in older people: a double-blind randomised placebo-controlled trial(Springer, 2021) Berk, M.; Agustini, B.; Woods, R.L.; Nelson, M.R.; Shah, R.C.; Reid, C.M.; Storey, E.; Fitzgerald, S.M.; Lockery, J.E.; Wolfe, R.; Mohebbi, M.; Dodd, S.; Murray, A.M.; Stocks, N.; Fitzgerald, P.B.; Mazza, C.; McNeil, J.J.Late-life depression is common and often inadequately managed using existing therapies. Depression is also associated with increased markers of inflammation, suggesting a potential role for anti-inflammatory agents. ASPREE-D is a sub-study of ASPREE, a large multi-centre, population-based, double-blind, placebo-controlled trial of aspirin vs placebo in older Australian and American adults (median follow-up: 4.7 years) of whom 1879 were depressed at baseline. Participants were given 100 mg daily dose of aspirin or placebo. Depressive symptoms were assessed annually using the validated, self-rated short version of the Center for Epidemiological Studies Depression scale. There was a significant increase in depressive scores (0.6; 95% CI 0.2 to 0.9; χ2 (1)=10.37; p=0.001) and a decreased score in the mental health component of a quality of life scale (–0.7; 95% CI –1.4 to –0.1; χ2 (1)=4.74; p=0.029) in the aspirin group compared to the placebo group. These effects were greater in the first year of follow-up and persisted throughout the study, albeit with small to very small effect sizes. This study failed to demonstrate any benefit of aspirin in the long-term course of depression in this community-dwelling sample of older adults over a 5-year period, and identified an adverse effect of aspirin in the course of depression in those with pre-existing depressive symptoms.Item Open Access Factors associated with vitamin D testing, deficiency, intake and supplementation in patients with chronic pain(Taylor & Francis (Informa Healthcare), 2018) Gaikwad, M.; Vanlint, S.; Moseley, G.L.; Mittinty, M.; Stocks, N.Vitamin D deficiency is a public health issue, with reports of six- to twenty-five–fold rise in vitamin D testing. Vitamin D deficiency has been linked to many chronic diseases such as diabetes mellitus, cardiovascular disease, depression, and chronic pain. Identifying factors associated with risk of deficiency in individuals with chronic pain will help minimize time and cost. This study aims to examine the factors associated with vitamin D testing, intake, and physician-advised supplementation in individuals with chronic pain. Using a cross-sectional design, data were collected from 465 individuals with chronic pain. These data were analyzed using penalized logistic regression with the LASSO technique. Fifty-seven percent reported being tested for vitamin D, about 40% reported being diagnosed with vitamin D deficiency, and of those who had been tested, 60% reported taking vitamin D supplementation. The findings suggest older age (OR 3.12, CI [1.02, 9.50]) and higher mean pain intensity score (OR 2.02, CI [1.13, 3.59]) increased an individual's chance of being vitamin D deficient. Unemployment or on leave due to pain (OR 1.79, [CI 1.03, 3.11]), part-time employment (OR 1.86, CI [1.02, 3.39]), and being a resident of Australia (OR 2.32, CI [1.13, 4.72]) increased chances of being tested for vitamin D. Being diagnosed with vitamin D deficiency (OR 6.67, CI [2.75, 16.19]), unemployed or on leave due to pain (OR 3.71, CI [1.25, 11.00]), and in part-time employment (OR 2.69, CI [0.86, 8.38]) were associated with physician-advised vitamin D supplementation. Our results may have practical implications, as identifying pretest risk factors may assist in identifying who is at risk of vitamin D deficiency, whom to test, and when to treat.Item Metadata only Factors associated with treatment and control of hypertension in a healthy elderly population free of cardiovascular disease: a cross-sectional study(Oxford University Press, 2019) Chowdhury, E.K.; Nelson, M.R.; Ernst, M.E.; Margolis, K.L.; Beilin, L.J.; Johnston, C.I.; Woods, R.L.; Murray, A.M.; Wolfe, R.; Storey, E.; Shah, R.C.; Lockery, J.E.; Tonkin, A.M.; Newman, A.B.; Williamson, J.D.; Abhayaratna, W.P.; Stocks, N.P.; Fitzgerald, S.M.; Orchard, S.G.; Trevaks, R.E.; et al.BACKGROUND: Despite readily available treatments, control of blood pressure (BP) with population ageing remains suboptimal. Further, there are gaps in the understanding of the management of high BP in the aged. We explored antihypertensive treatment and control among elderly hypertensive participants free from overt cardiovascular disease (CVD), and identified factors related to both 'untreated' and 'treated but uncontrolled' high BP. METHODS: We analyzed baseline data from 19,114 individuals aged ≥65-years enrolled from Australia and US in the ASPirin in Reducing Events in the Elderly (ASPREE) study. Hypertension was defined as an average systolic/diastolic BP ≥140/90mmHg and/or the use of any BP lowering medication. 'Controlled hypertension' was defined if participants were receiving antihypertensive medication and BP <140&90mmHg. Descriptive analyses were used to summarize hypertension control rates; logistic regression was used to investigate relationships with treatment and BP control. RESULTS: Overall, 74% (14,213/19,114) of participants were hypertensive; and of these 29% (4,151/14,213) were untreated. Among those treated participants, 53% (5,330/10,062) had BP≥140/90 mmHg. Participants who were untreated were more likely to be men, have higher educational status, and be in good physical health, and less likely to have significant comorbidities. The factors related to 'treated but uncontrolled' BP included older age, male, Black race (versus White), using antihypertensive monotherapy (versus multiple) and residing in Australia (versus US). CONCLUSION: High levels of 'untreated' and 'treated but uncontrolled' BP occur in healthy elderly people without CVD , suggesting there are opportunities for better BP control in the primary prevention of CVD in this population.Item Open Access Effectiveness of a peer-mediated educational intervention in improving general practitioner diagnostic assessment and management of dementia: a cluster randomised controlled trial(BMJ Journals, 2018) Pond, D.; Mate, K.; Stocks, N.; Gunn, J.; DIsler, P.; Magin, P.; Marley, J.; Paterson, N.; Horton, G.; Goode, S.; Weaver, N.; Brodaty, H.Objective Test effectiveness of an educational intervention for general practitioners (GPs) on quality of life and depression outcomes for patients. Design Double-blind, cluster randomised controlled trial. Setting General practices in Australia between 2007 and 2010. Participants General practices were randomly allocated to the waitlist (n=37) or intervention (n=66) group, in a ratio of 1:2. A total of 2030 (1478 intervention; 552 waitlist) community-dwelling participants aged 75 years or older were recruited via 168 GPs (113 intervention; 55 waitlist). Interventions A practice-based academic detailing intervention led by a peer educator that included: (1) training in use of the GP assessment of cognition dementia screening instrument; (2) training in diagnosis and management based on Royal Australian College of General Practitioners Dementia Guidelines; (3) addressing GPs’ barriers to dementia diagnosis; and (4) a business case outlining a cost-effective dementia assessment approach. Outcome measures Primary outcome measures were patient quality of life and depression; secondary outcome measures were: (1) sensitivity and specificity of GP identification of dementia; (2) referral to medical specialists and/or support services; (3) patient satisfaction with care; and (4) carer quality of life, depression and satisfaction with care. Results The educational intervention had no significant effect on patient quality of life or depression scores after 12 months. There were however improvements in secondary outcome measures including sensitivity of GP judgement of dementia (p=0.002; OR 6.0, 95% CI 1.92 to 18.73), satisfaction with GP communication for all patients (p=0.024; mean difference 2.1, 95% CI 0.27 to 3.93) and for patients with dementia (p=0.007; mean difference 7.44, 95% CI 2.02 to 12.86) and enablement of carers (p=0.0185; mean difference 24.77, 95% CI 4.15 to 45.40). Conclusion Practice-based academic detailing did not improve patient quality of life or depression scores but did improve detection of dementia in primary care and patient satisfaction with GP communication. Trial registration number ACTRN12607000117415; Preresults.Item Metadata only Garlic lowers blood pressure in hypertensive individuals, regulates serum cholesterol, and stimulates immunity: an updated meta-analysis and review(Oxford University Press, 2016) Ried, K.Background: Garlic has been shown to have cardiovascular protective and immunomodulatory properties. Objectives: We updated a previous meta-analysis on the effect of garlic on blood pressure and reviewed the effect of garlic on cholesterol and immunity. Methods: We searched the Medline database for randomized controlled trials (RCTs) published between 1955 and December 2013 on the effect of garlic preparations on blood pressure. In addition, we reviewed the effect of garlic on cholesterol and immunity. Results: Our updated meta-analysis on the effect of garlic on blood pressure, which included 20 trials with 970 participants, showed a mean ± SE decrease in systolic blood pressure (SBP) of 5.1 ± 2.2 mm Hg (P < 0.001) and a mean ± SE decrease in diastolic blood pressure (DBP) of 2.5 ± 1.6 mm Hg (P < 0.002) compared with placebo. Subgroup analysis of trials in hypertensive subjects (SBP/DBP ≥140/90 mm Hg) at baseline revealed a larger significant reduction in SBP of 8.7 ± 2.2 mm Hg (P < 0.001; n = 10) and in DBP of 6.1 ± 1.3 mm Hg (P < 0.001; n = 6). A previously published meta-analysis on the effect of garlic on blood lipids, which included 39 primary RCTs and 2300 adults treated for a minimum of 2 wk, suggested garlic to be effective in reducing total and LDL cholesterol by 10% if taken for >2 mo by individuals with slightly elevated concentrations [e.g., total cholesterol >200 mg/dL (>5.5 mmol/L)]. Garlic has immunomodulating effects by increasing macrophage activity, natural killer cells, and the production of T and B cells. Clinical trials have shown garlic to significantly reduce the number, duration, and severity of upper respiratory infections. Conclusions: Our review suggests that garlic supplements have the potential to lower blood pressure in hypertensive individuals, to regulate slightly elevated cholesterol concentrations, and to stimulate the immune system. Garlic supplements are highly tolerated and may be considered as a complementary treatment option for hypertension, slightly elevated cholesterol, and stimulation of immunity. Future long-term trials are needed to elucidate the effect of garlic on cardiovascular morbidity and mortality.Item Metadata only Best-practice integrated health care governance - applying evidence to Australia's health reform agenda: Is Australia ready for evidence into policy?(Australasian Medical Publishing Company, 2014) Nicholson, C.; Jackson, C.; Marley, J.Item Open Access The acute and sub-chronic effects of cocoa flavanols on mood, cognitive and cardiovascular health in young healthy adults: a randomized, controlled trial(Frontiers Media, 2015) Massee, L.; Ried, K.; Pase, M.; Travica, N.; Yoganathan, J.; Scholey, A.; Macpherson, H.; Kennedy, G.; Sali, A.; Pipingas, A.Cocoa supplementation has been associated with benefits to cardiovascular health. However, cocoa's effects on cognition are less clear. A randomized, placebo-controlled, double-blind clinical trial (n = 40, age M = 24.13 years, SD = 4.47 years) was conducted to investigate the effects of both acute (same-day) and sub-chronic (daily for four-weeks) 250 mg cocoa supplementation on mood and mental fatigue, cognitive performance and cardiovascular functioning in young, healthy adults. Assessment involved repeated 10-min cycles of the Cognitive Demand Battery (CDB) encompassing two serial subtraction tasks (Serial Threes and Sevens), a Rapid Visual Information Processing task, and a mental fatigue scale over the course of half an hour. The Swinburne University Computerized Cognitive Assessment Battery (SUCCAB) was also completed to evaluate cognition. Cardiovascular function included measuring both peripheral and central blood pressure and cerebral blood flow. At the acute time point, consumption of cocoa significantly improved self-reported mental fatigue and performance on the Serial Sevens task in cycle one of the CDB. No other significant effects were found. This trial was registered with the Australian and New Zealand Clinical Trial Registry (Trial ID: ACTRN12613000626763). Accessible via http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12613000626763&ddlSearch=Registered.Item Metadata only An evaluation of the additional benefit of population screening for dementia beyond a passive case-finding approach(Wiley, 2017) Mate, K.E.; Magin, P.J.; Brodaty, H.; Stocks, N.P.; Gunn, J.; Disler, P.B.; Marley, J.E.; Pond, C.D.Objective: General practitioners (GPs) fail to identify more than 50% of dementia cases using the existing passive case-finding approach. Using data from the “Ageing in General Practice” study, we sought to establish the additional benefit of screening all patients over the age of 75 for dementia beyond those patients already identified by passive case-finding. Method: Patients were classified as “case-finding” (n = 425) or “screening” (n = 1006) based on their answers to four subjective memory related questions or their GP’s clinical judgement of their dementia status. Cognitive status of each patient was formally assessed by a research nurse using the Cambridge Cognition Examination (CAMCOG-R). Patients then attended their usual GP for administration of the GP assessment of Cognition (GPCOG) dementia screening instrument, and follow-up care and/or referral as necessary in light of the outcome. Results: The prevalence of dementia was significantly higher in the case-finding group (13.6%) compared to the screening group (4.6%; p < 0.01). The GPCOG had a positive predictive value (PPV) of 61% in the case-finding group and 39% in the screening group; negative predictive value was >95% in both groups. GPs and their patients both found the GPCOG to be an acceptable cognitive assessment tool. The dementia cases missed via case-finding were younger (p = 0.024) and less cognitively impaired (p = 0.020) than those detected. Conclusion: There is a very limited benefit of screening for dementia, as most people with dementia could be detected using a case-finding approach, and considerable potential for social and economic harm because of the low PPV associated with screening.Item Metadata only How abnormal is binge eating? 18-Year time trends in population prevalence and burden(Wiley-Blackwell, 2017) Mitchison, D.; Touyz, S.; González-Chica, D.; Stocks, N.; Hay, P.Objective: Although findings suggest that binge eating is becoming increasingly normative, the ‘clinical significance’ of this behaviour at a population level remains uncertain. We aimed to assess the time trends in binge-eating prevalence and burden over 18 years. Method: Six cross-sectional face-to-face surveys of the Australian adult population were conducted in 1998, 2005, 2008, 2009, 2014, and 2015 (Ntotal = 15 126). Data were collected on demographics, 3-month prevalence of objective binge eating (OBE), health-related quality of life, days out of role, and distress related to OBE. Results: The prevalence of OBE increased six-fold from 1998 (2.7%) to 2015 (13.0%). Health-related quality of life associated with OBE improved from 1998 to 2015, where it more closely approximated population norms. Days out of role remained higher among participants who reported OBE, although decreased over time. Half of participants who reported weekly (56.6%) and twice-weekly (47.1%) OBE reported that they were not distressed by this behaviour. However, the presence of distress related to OBE in 2015 was associated with greater health-related quality-of-life impairment. Conclusion: As the prevalence of binge eating increases over time, associated disability has been decreasing. Implications for the diagnosis of disorders associated with binge eating are discussed.Item Metadata only Cohort Profile: Melbourne Atopy Cohort study (MACS)(Oxford University Press, 2016) Lowe, A.; Lodge, C.; Allen, K.; Abramson, M.; Matheson, M.; Thomas, P.; Barton, C.; Bennett, C.; Erbas, B.; Svanes, C.; Wjst, M.; Real, F.; Perret, J.; Russell, M.; Southey, M.; Hopper, J.; Gurrin, L.; Axelrad, C.; Hill, D.; Dharmage, S.Item Metadata only Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams: a cluster randomized trial(Oxford University Press, 2016) Zwar, N.; Bunker, J.; Reddel, H.; Dennis, S.; Middleton, S.; van Schayck, O.; Crockett, A.; Hasan, I.; Hermiz, O.; Vagholkar, S.; Xuan, W.; Marks, G.Background: Early detection and intervention for chronic obstructive pulmonary disease (COPD) could potentially slow disease progress and minimize harm. Objectives: To assess the effectiveness of early intervention by a practice nurse-GP team on quality of life (QoL) and process of care in patients with newly diagnosed COPD, compared with usual care. Nurses and GPs in intervention practices were educated to develop and implement disease management plans for COPD. Methods: A 12-month, multicentre, pragmatic randomized controlled trial with blinded outcome assessment was conducted. Participants were current and former smokers aged 40 to 85 years newly identified as having COPD on post-bronchodilator spirometry. The primary outcome was health-related QoL, assessed with the St George's Respiratory Questionnaire (SGRQ). Secondary outcome measures were other QoL measures, lung function, disease knowledge, smoking and immunization status, inhaler technique and health service use. Results: Of the 10 234 patients from 36 practices in Sydney invited to a case-finding appointment, 1641 (16%) attended and 287 (18%) were diagnosed with COPD. Nineteen practices (144 patients) were randomized to the intervention group and 17 practices (110 patients) to the control group. Only 15.3% (n = 22) patients in the intervention group saw the nurse for COPD care following case finding. There was no between-group difference in SGRQ score at follow-up (mean difference -0.21; P = 0.86). Influenza vaccination was higher in the intervention group (OR 2.31: P = 0.035), but there were no other significant between-group differences in outcomes. Conclusions: Intervention uptake was low and had no additional beneficial effect, over usual care, on participants' health-related QoL.Item Metadata only Risk of venous thromboembolism in women taking the combined oral contraceptive: a systematic review and meta-analysis(Royal Australian College of General, 2016) Bateson, D.; Butcher, B.; Donovan, C.; Farrell, L.; Kovacs, G.; Mezzini, T.; Raynes-Greenow, C.; Pecoraro, G.; Read, C.; Baber, R.Background: Much scientific, media and patient interest surrounds the risk of venous thromboembolism (VTE) in women taking combined oral contraceptives (COCs). Objectives: We conducted a systematic review and meta-analysis to assess VTE risk in women taking COCs, focusing on drospirenone. Methods: Literature searches of clinical studies on COCs in which VTE was reported were undertaken in May 2015. No overall estimate of VTE risk between drospirenone-containing COCs and other COCs was produced because of heterogeneity of the study designs. Results: The final review and meta-analysis included 15 studies. No increased risk of VTE with drospirenone was seen in prospective or case control studies, but the risk of VTE was increased in retrospective cohort and nested case control studies. Discussion: The difference in risk of VTE based on the choice of progestin in COCs is, at worst, very small in absolute terms and should not be the sole factor considered when choosing the 'right' COC for each woman.Item 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.Item Metadata only Why older women do or do not seek help from the GP after a fall: a qualitative study(Oxford University Press, 2014) Dollard, J.; Braunack-Mayer, A.; Horton, K.; Vanlint, S.BACKGROUND: It is recommended that older people report their falls to their general practitioner (GP), to identify falls risk factors. However, many older people do not report falling to their GP. Little is known about the reasons why older people do and do not seek help about falling. OBJECTIVE: To explore why older women do or do not seek GP help after a fall. METHODS: A qualitative study, using semi-structured interviews with 11 community-dwelling women aged ≥ 65 years, living in Adelaide, Australia, who had fallen in the last 12 months. Interviews focused on women's experience of falling and seeking GP help. Interviews were analysed using constant comparison. RESULTS: Four women sought GP help when they believed their fall-related injury was serious enough. Family and a bystander persuaded three women to attend for a fall-related injury. The four women who did not seek help believed their fall or fall-related injury was not serious enough to seek help and justified this by using internal rationales (they monitored and managed the outcome of falling, they wanted to be associated with a positive image and attitude, and they recognized and interpreted the cause and control of falling) and external rationales (they did not want to waste GPs' time for trivial reasons and they believed they did not have timely access to their GP). CONCLUSIONS: Given the reasons why some older women do not seek help for falling, GPs should routinely ask older women for their 12-month fall history.Item Open Access The Heart Health Study - increasing cardiovascular risk assessment in family practice for first degree relatives of patients with premature ischaemic heart disease: a randomised controlled trial(BioMed Central, 2015) Stocks, N.; Broadbent, J.; Lorimer, M.; Tideman, P.; Chew, D.; Wittert, G.; Ryan, P.This study aimed to increase cardiovascular disease (CVD) risk assessment in adult first degree relatives of patients with premature ischaemic heart disease (PIHD) using written and verbal advice.A prospective, randomised controlled trial.Cardiovascular wards at three South Australian hospitals. Cardiovascular risk assessments were performed in general practice.Patients experiencing PIHD (heart disease in men aged <55 years or women aged < 65 years) and their first degree relatives.Patients distributed either general information about heart disease and written advice to attend their general practitioner (GP) for CVD risk assessment or general information about heart disease only, to their first degrees relatives.The primary outcome was the proportion of relatives who attended their GP for CVD risk assessment within 6 months of the patients' PIHD event.One hundred forty four patients were recruited who had 541 eligible relatives; 97/541 (18 %) of relatives agreed to participate. A larger number of intervention 41/55 (75 %) than control group 9/42 (21 %) [difference 53 %, 95 % CI 36 % - 71 %] relatives attended their GP for a CVD assessment, and 34 % of these had moderate to very high 5-year absolute risk for CVD.This low cost intervention demonstrates that individuals who have a family history of PIHD and are at moderate or high risk of CVD can be targeted for early intervention of modifiable risk factors. Further research is required to improve the uptake of the intervention in relatives.The trial was registered with the Australian Clinical Trials Registry (ACTRN), Registration ID 12613000557730 .