Biomedical subjects

A J Plant

Publications and source records attributed to A J Plant.

At least 37 records · Page 2Linked to original sources

PubMed2000

Development of a Vietnamese version of the Short form-36 Health Survey.

We aimed to test the psychometric properties of a culturally relevant translation of the medical outcomes study short form-36 health survey (SF-36) with prospective Vietnamese migrants. The translated survey was interviewer-administered to 1610 Vietnamese aged over 15 years who had applied to migrate to Australia. All but two SF-36 items had good discriminant validity, and all eight scales of the Vietnamese version of the SFS-36 had good discriminant validity, which supports the use of SF-36 constructs to assess self-reported health status among Vietnamese migrants. However, the mental health, vitality and bodily pain scales demonstrated low internal consistency. This finding is likely to be a product of the increased diversity among scale items following modifications to improve cultural relevance. Further modifications to improve the internal consistency of these scales are required.

Adolescent↗

PubMed2000

Middle-ear disease in remote Aboriginal Australia: a field assessment of surgical outcomes.

Chronic middle-ear disease is highly prevalent among Australian Aboriginal people, and many undergo surgical treatment. However, the outcomes of surgery in this group have not been fully evaluated. This is a descriptive study of operations for middle-ear disease (excluding grommets) on Aboriginal patients in Kimberley hospitals between 1 October 1986 and 31 December 1995. Logistic regression was used to model predictors of surgical outcome. Success was defined by an intact tympanic membrane and air-bone gap of < or = 25 dB at review at, or later than, six months post-operation. A success rate of 53 per cent was observed; increasing age was the only variable predictive of success. Successful outcomes were more likely in adults and children aged > 10 years, however, this does not take into account the necessity of hearing for language acquisition and learning. Dedicated resources must be allocated for post-operative follow-up of Aboriginal patients so that much-needed, rigorous evaluations of ENT surgery can be conducted.

Adolescent↗

PubMed2000

Tuberculin reactivity and the risk of tuberculosis: a review.

SETTING: Although various studies have examined the association between tuberculin reactivity and the risk of tuberculosis (TB), this evidence has not been collated and examined to determine the strength and consistency of the association across multiple studies. OBJECTIVE: To review the evidence supporting the association between tuberculin reactivity and the risk of TB. DESIGN: Prospective studies which included raw data on the incidence of TB according to three or more tuberculin reactor categories were located using electronic search methods. The findings of these studies were recalibrated if necessary and compared. RESULTS: All 11 studies identified demonstrated that increased tuberculin skin test (TST) reactivity was associated with an increased risk of TB, and several found that low tuberculin reactivity was associated with a protective effect. The magnitude of the association between TST reactivity and the risk of TB varied substantially. The association between tuberculin reactivity and the risk of TB was greater among studies that reported a lower incidence of TB among the smallest tuberculin reactor category. CONCLUSION: All studies reviewed support a positive association between tuberculin reactivity and the risk of TB. However, this review found a substantial degree of variation in the extent of increased risk associated with larger tuberculin reactions.

Humans↗

PubMed1999

Lack of association between seropositivity to Chlamydia pneumoniae and carotid atherosclerosis.

Since the Chlamydia pneumoniae (C. pneumoniae)-specific antibody was shown to be associated with acute myocardial infarction and chronic coronary heart disease, the role of C. pneumoniae in the etiology of cardiovascular disease has been studied by a number of groups. We investigated the association between the C. pneumoniae-specific antibody, measured by microimmunofluorescence, risk factors for cardiovascular disease, and atherosclerosis in a randomly selected urban population. Overall, immunoglobulin-G (IgG) seroprevalence to C. pneumoniae in this sample of 1,034 subjects was 58%, whereas IgA seroprevalence was 32%. There was a decline in seropositivity with age for IgG but not IgA. Men were more likely than women to be IgG (66% vs 51%, chi-square p = 0.001) and IgA seropositive (36% vs 28%, chi-square p = 0.005). Current smokers had higher IgA seropositivity than nonsmokers (43% vs 30%). Those patients with a family history of cerebrovascular disease were more likely to have IgG antibody than those without (75% vs 57%, chi-square p= 0.007). Neither IgG nor IgA seropositivity was associated with the standard risk factors of hypertension, hyperlipidemia, or family history of ischemic heart disease, nor was seropositivity associated with carotid intima medial thickening (IMT) or atherosclerotic plaque as measured by carotid B-mode ultrasound. There was no difference between those participants who were IgG or IgA seropositive and seronegative in measurements of mean IMT, prevalence of abnormal IMT, and percentage with atherosclerotic plaque. In conclusion, although C. pneumoniae was associated with several risk factors for cardiovascular disease in a large cross-sectional population, we found no independent association between seroprevalence to C. pneumoniae and carotid atherosclerosis as measured by carotid IMT.

Adult↗

PubMed1999

Australian doctors' beliefs and practice regarding Helicobacter pylori.

OBJECTIVE: To determine beliefs and behaviours of Australian doctors regarding Helicobacter pylori. DESIGN: Anonymous reply-paid postal survey mailed in December 1995 and again in March 1996. SUBJECTS: All members on the mailing lists of the Gastroenterological Society of Australia Endoscopy Section (n = 397) and the Australian Society of Infectious Diseases (n = 264; those without medical qualifications were asked not to reply), and 400 general practitioners (GPs) randomly selected from the Royal Australian College of General Practitioners. MAIN OUTCOME MEASURES: Differences between specialist groups in belief in a causative association between H. pylori and peptic disease and in use of eradication therapy and pre- and post-treatment testing for H. pylori. RESULTS: 92.6% of doctors believed H. pylori causes duodenal ulcer, with GPs significantly less likely to believe than gastroenterologists (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.00-0.81). In duodenal ulcer, 93.4% of doctors believed H. pylori eradication therapy should be given, but fewer (83.4%) claimed to give it "always or mostly", with GPs less likely to report giving it than gastroenterologists (OR, 0.06; 95% CI, 0.02-0.19). For non-ulcer dyspepsia, gastrointestinal surgeons were more likely than gastroenterologists to believe in a causative link with H. pylori (OR, 5.6; 95% CI, 3.0-10.7) and in a need for eradication therapy (OR, 3.6; 95% CI, 1.7-7.7). Most doctors (79.3%) believed in confirming the presence of H. pylori before eradication therapy in duodenal ulcer. Only 51.6% believed post-eradication testing necessary (45.5%), yet 79.1% reported performing it. CONCLUSIONS: Significant differences exist between specialist groups in beliefs and self-reported behaviours regarding H. pylori.

Adult↗

PubMed1999

Unrecognised transmission of tuberculosis in prisons.

BACKGROUND: Tuberculosis (TB) is a public health concern in correctional facilities. High turnover of inmate populations may preclude timely diagnosis of TB, so that unrecognised transmission may be common. OBJECTIVE: To determine the proportion of inmates with new skin test conversions who had identifiable exposure to diagnosed cases of TB in the correctional system, and to test the hypothesis that source cases of TB may be undiagnosed during incarceration. SETTING: Maryland Division of Corrections, USA. SUBJECTS: All inmates whose skin test converted from negative to positive at annual screening. DESIGN: All cases of TB in inmates, diagnosed in the prisons during the relevant time period, were identified. Movements of skin test converters and potential source cases within the prisons were matched. We then matched all inmates discharged from the prison system with all new cases of tuberculosis notified to the Maryland Department of Health & Mental Hygiene tuberculosis registry in 1994. RESULTS: The inmate turnover was 21% per year. Probable exposure to a diagnosed source case was found in 13% of converters, possible exposure in 10% and no exposure in 72%. In a further 5% exposure status could not be determined. We identified four cases of pulmonary tuberculosis notified to the state in 1994, within 3 months of discharge in released inmates, who were not known to have tuberculosis whilst incarcerated. CONCLUSIONS: Significant transmission of TB due to undiagnosed index cases may occur in prisons due to high population turnover. New skin test conversions in inmates should be treated as new infection, even in the absence of identifiable exposure to TB.

Contact Tracing↗

PubMed1999

Barriers to immunisation in general practice.

OBJECTIVE: To identify barriers to immunisation in general practice. METHOD: The study was conducted in Perth, Western Australia, as a cross-sectional postal survey between November 1996 and January 1997. Questionnaires were sent to all known GPs in three of the seven metropolitan Divisions of General Practice, of whom 301 (72%) responded. RESULTS: When a child presented with a minor illness and there were no contraindications to immunisation, 62% of GPs said they would always or frequently offer immunisation. Immunisation would be withheld incorrectly because of an upper respiratory tract infection by 43% of GPs and because of antibiotics by 50%. Combined diphtheria-tetanus vaccine (CDT) would be substituted incorrectly for diphtheria-tetanus-pertussis vaccine (DTP) by 41% if there was an unexplained temperature of 38 degrees C following a previous dose of DTP. While more than half (56%) reported that vaccines were correctly stored, only 26% reported that the refrigerator temperature was checked daily. Eighty per cent reported that they completed an Australian Childhood Immunisation Register notification form. CONCLUSIONS: GPs require ongoing education about contra-indications to immunisation and when substitution of CDT for DTP is required. There is room for increased opportunistic immunisation and encouragement to notify the Australian Childhood Immunisation Register when they immunise a child. IMPLICATIONS: A major challenge is to find an innovative approach that would encourage and enable GPs to assess immunisation status and offer immunisation where appropriate at every clinical encounter.

Adult↗

PubMed1999

Travel health: perceptions and practices of travel consultants.

BACKGROUND: The global increase in international travel puts travelers at risk of travel-related morbidity and mortality. Prior to travel, most travelers have contact with a travel agency, thereby providing an opportunity for intervention. With this in mind we aimed to determine some of the travel-related health knowledge, practices and needs of travel consultants. METHODS: A cross sectional study was undertaken in which one travel consultant from each of 166 Western Australian travel agencies was asked to complete a self-administered questionnaire. RESULTS: One hundred and forty-five travel agencies (87%) agreed to participate in the study. Fifty-six percent indicated that they "usually" gave broad travel-related health guidelines and recommended their clients consult a medical practitioner. Almost all travel consultants reported discussing travel health insurance; very few provided information on sexually transmissible diseases, the risks associated with drug use, or first aid kits. Over 80% responded correctly to statements eliciting their knowledge on yellow fever, malaria, and food safety; the majority incorrectly answered questions on dengue fever and altitude sickness. Fifty-six percent of respondents thought that there was "not enough" readily accessible travel health information; 52% said they would like to be more involved in providing health information to their clients. CONCLUSIONS: Contact between travelers and travel agents offers an opportunity to promote awareness of travel-related health hazards. While travel consultants' health knowledge on some topics is adequate, in other areas it is inconsistent. Many travel consultants in Western Australia expressed a willingness to be involved in future health promotion activities. This participation may be best nurtured by providing travel consultants with: (1) better health education so they are able to identify high-risk travelers and destinations for medical referral; and, (2) health information in a format they feel comfortable distributing to their clients.

Cross-Sectional Studies↗

PubMed1999

Longitudinal incidence of tuberculosis in South-East Asian refugees after re-settlement.

SETTING: A State refugee screening programme in Victoria. OBJECTIVE: To determine the longitudinal incidence of tuberculosis (TB) in South-East Asian refugees in the first five years after re-settlement, and to determine predictors of risk. DESIGN: A retrospective cohort study of 1101 refugees from Laos, Cambodia and Vietnam screened for TB after arrival in Australia, in the 6-month period from July 1989 to January 1990. Incident cases of TB were identified by matching the refugee database with the TB notification database for 1989-1994, giving five years of follow-up data. Preventability was assessed for incident cases by reviewing medical records. MAIN OUTCOME: The development of active tuberculosis in the first five years after re-settlement. RESULTS: The incidence of active TB was 363/100000 during the first year after re-settlement, and 109/100000/year during the first five years. There were no incident cases of TB in refugees with initial skin test reactions <10 mm. Skin test reaction size was the only predictor of risk of TB. CONCLUSIONS: There is a high risk of tuberculosis in South-East Asian refugees, particularly in the first year after re-settlement. This risk decreases with time. Migration stress, concurrent illnesses and poor nutrition may be explanations for this observation. Refugees are at high risk for TB, even after pre- and post-migration screening, emphasising the importance of preventive therapy and follow up in this group.

Adult↗

PubMed1998

Trends in infectious disease mortality in Australia, 1979-1994.

OBJECTIVE: To examine trends in infectious disease mortality in Australia over the period 1979-1994. DESIGN: Descriptive study based on Australian Bureau of Statistics data. PARTICIPANTS AND SETTING: All persons who died in Australia during 1979-1994. OUTCOME MEASURES: Infectious diseases as the underlying cause of death by International Classification of Diseases, Ninth Revision codes. RESULTS: Overall mortality from infectious diseases declined from 29.2/100,000 population in 1979-1981 to 24.1/100,000 in 1992-1994 (P = 0.02). Respiratory infection was the major category of infectious disease mortality, declining from 15.8/100,000 in 1979-1981 to 10.6/100,000 in 1992-1994. HIV infection (increasing from 0 to 2.9/100,000) replaced kidney/urinary tract infection (3.3 to 1.5/100,000) as the second most common category of infectious disease mortality. There were also significant increases in mortality from septicaemia (1.0 to 2.6/100,000), and viral hepatitis (0.2 to 0.5/100,000). The only group in which infectious disease mortality increased was men aged 25-44 years (3.4 to 15.1/100,000). The Northern Territory had the highest mortality rate from infectious disease, but showed a substantial decline (162 to 76/100,000) over the study period. There were also significant declines in Victoria, Queensland, and Western Australia. CONCLUSIONS: Mortality from infectious disease in Australia declined overall between 1979 and 1994. The substantial decline in the Northern Territory suggests a decline among indigenous Australians. HIV infection has become a leading cause of infectious disease mortality, particularly among adult males.

Adolescent↗

PubMed1998

"Death by proxy": ethics and classification in epidemiology.

Epidemiology is reductionist in that it usually relies on creating categories of people or risk factors. Classification must be undertaken as part of any study, however by the act of choosing groups, individuals are (potentially) consigned to either a higher or lower risk group. We discuss this from an ethical perspective and consider: (a) whether the groupings commonly chosen genuinely represent the risk factor of interest, (b) the implications for individuals when consigned to groups and (c) the implications for epidemiology.

Community Health Planning↗

PubMed1998

The contribution of community health surveys to aboriginal health in the 1990s.

Community health surveys take place in many Aboriginal communities. We considered these surveys to determine their potential to contribute to Aboriginal health in the 1990s. Community health surveys--also known as health audits, community health screenings or check-ups--usually consist of a team of health professionals travelling to an Aboriginal community to measure a wide variety of parameters on as many of the people in the community as possible. For the individual participant, community health surveys represent a sporadic screening program which should meet the World Health Organization's criteria for screening. From the population health perspective, these surveys represent prevalence surveys which may contribute little new knowledge regarding Aboriginal health and do not, of themselves, change the urgent need for preventive health programs. Community health surveys should meet minimum scientific standards (i.e. have a clearly stated aim and use valid measurements and statistical techniques) and should incorporate practically feasible protocols and services for the follow-up of individuals with screen-detected abnormalities. They must have ethical and community approval and incorporate genuine consultation and feedback of results to the Aboriginal communities involved, in order for them to be justified.

Australia↗

PubMed1998

Preventability of incident cases of tuberculosis in recently exposed contacts.

SETTING: Contacts of tuberculosis (TB) cases are at risk for TB. If contact screening and intervention are effective, one would expect a reduced incidence of TB in contacts who have been screened. OBJECTIVE: To measure the incidence of TB in contacts during a 2-year follow up, and to estimate the preventability of incident cases. METHODS: A retrospective cohort study of 783 contacts screened in Victoria, Australia, in 1991. Contacts were matched with the TB registry for the following 2 years. Screening records were reviewed. RESULTS: The rate of TB in contacts was 511/100000 population/year for the first 2 years. In Poisson regression models the only significant variable predicting disease was skin test reaction size. Six of eight incident cases were potentially preventable, with a lowest achievable incidence rate of 128/100000/year. CONCLUSION: Contacts who underwent screening for TB through a state screening programme had a high incidence of TB during the 2 year follow up. Published rates of TB of 425-670/100000 in untreated contacts suggests that the Victorian screening programme had minimal impact on the natural history of disease progression. Intrinsic programme factors such as the appropriateness of the guidelines, adherence to guidelines and rates of preventive therapy need to be evaluated. The devolution of the TB programme in the 1980s also reduced its efficacy. Systematic assessment of screening programmes for efficacy and outcome is part of good public health practice.

Adolescent↗

PubMed1997

Changes in bed resources and admission patterns in acute public hospitals in Victoria, 1987-1995.

OBJECTIVE: To describe changes in admission patterns, bed resources and hospital use in acute public hospitals and their relationship with early readmissions and interhospital transfers in Victoria between 1987 and 1995. DESIGN: Descriptive study of longitudinal trends using data from the Victorian inpatient Minimum Database and the Acute Health Services Branch of the Department of Human Services, Victoria. SETTING: State of Victoria. MAIN OUTCOME MEASURES: Acute public hospital beds and hospital separations per 1000 population; separation type (same-day or longer); mean length of stay; interhospital transfers; and readmissions to the same hospital within 28 days. RESULTS: Between 1987-88 and 1994-95, public hospital beds in Victoria decreased from 3.2 to 2.8/1000 population, and mean length of hospital stay decreased from 6.4 to 4.2 days. There was a significant direct correlation between number of beds/1000 and length of stay (r = 0.90; 95% confidence interval [CI], 0.52-0.98). Bed occupancy remained constant at 80%. Over the same period, same-day admissions increased from 22% to 42% of hospital separations, interhospital transfers increased from 2.7% to 4% of separations, and readmissions to the same hospital within 28 days for any reason increased from 12.4% to 15% of separations (21% increase). Beds/1000 were inversely correlated with interhospital transfers (r = -0.83; 95% CI, -0.31 to -0.97), while readmission rates were inversely correlated with beds/1000 (r = -0.89; 95% CI, -0.98 to -0.50) and length of hospital stay (r = -0.95; 95% CI, -0.99 to -0.74). CONCLUSIONS: There were significant changes in the patterns of use of public hospitals between 1987 and 1995, possibly reflecting technological advances and changes in clinical practice, as well as policy to improve efficiency. Early readmission rates may be a useful proxy measure of potentially avoidable adverse outcomes.

Diagnosis-Related Groups↗

PubMed1997

Health outcomes and infectious disease control.

With the development of improved health systems, antibiotics and vaccines throughout the 20th century, the prospects of control of infectious diseases improved. During the same time-frame, an approach to disease control was developed which used the health outcomes resulting from various interventions to choose, guide and modify those interventions. Despite these major advances in the control of diseases, infectious diseases have (with occasional exceptions) not only continued to occur but in many instances the situation had deteriorated with the emergence and re-emergence in recent years of a range of infectious diseases. In this paper we consider why infectious disease control has not benefited from the move towards a health outcomes approach, why infectious disease control might benefit from such a move, and the differences between infectious and non-infectious diseases when considering health outcomes. We follow-up with some practical approaches to the use of health outcomes. We argue that appropriate use of health outcomes when planning and evaluating infectious disease control programs will improve human health.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Incidence and prevalence of hepatitis C among clients of a Brisbane methadone clinic: factors influencing hepatitis C serostatus.

The objective of this study was to describe the incidence and prevalence of hepatitis C infection among clients of a methadone program in Queensland. The clinical notes of clients receiving methadone for treatment of opiate dependence who first registered at the clinic after 1989 were perused for information about their serological status for hepatitis C and hepatitis B infections during a six-week period in 1994. We followed hepatitis C negative clients until August-September 1995. At study entry, 69 per cent of the clients were recorded as being hepatitis C positive. Of those who were negative, the seroconversion rate was 11 per 100 person-years. The high incidence and prevalence of hepatitis C among methadone clients emphasises the need for effective early intervention strategies to prevent the transmission of hepatitis C among injecting drug users.

Adolescent↗

PubMed1997

A review of Q fever in Australia 1991-1994.

Q fever continues to be an important disease in Australia. Despite the development of an effective vaccine that has been commercially available since 1989, the number of cases notified has continued to increase. This study reviewed national notifications of Q fever between 1991 and 1994, together with demographic, socioeconomic and occupational information, to investigate temporal and spatial disease patterns. Based on notification data, Q fever can be considered primarily a disease of adult males that occurs in eastern Australia: southern Queensland and northern New South Wales have the highest levels of activity. A significant association between Q fever activity of areas and the presence of livestock was found. A strong association with the meat industry was also confirmed. Q fever is conservatively estimated to cost Australia around A$1 million and more than 1700 weeks of work time annually. There is a need to increase awareness of this disease and its prevention. An extension program in rural communities and provision of vaccine to all abattoir workers would appear to be sensible public health approaches.

Adolescent↗

PubMed1997

Missed opportunities for prevention of tuberculosis in Victoria, Australia.

SETTING: Victoria, Australia. OBJECTIVE: To ascertain missed opportunities for prevention in all persons notified in 1991 to the state registry with active tuberculosis (TB), and to examine aspects of case management relevant to prevention. DESIGN: A descriptive study. Records were reviewed for 231/236 cases of TB notified in the state of Victoria in 1991. Documentation of past screening for TB, preventive therapy, treatment of active disease and follow up was sought for all cases. Past screening was defined as past contact screening, migrant screening, refugee screening and health undertakings for TB. RESULTS: Of the 231 cases, 13 were not confirmed to have TB. Of the remaining 218 cases, 78% were foreign born, and of these, nearly half were diagnosed within 3 years of arriving in Australia. Nearly half of all cases (97/218) had some form of past screening for TB. The most common type of screening was refugee and migrant screening (45/218, 21%) followed by tuberculosis health undertakings (25/218, 12%) and contact screening (15/218, 7%). Of those with past screening, 70% (68/97) had a positive screening result at the time. Among these, the first screening episode resulted in the diagnosis of active TB in 5/68, and TB infection in 63/68. In the latter group only 5% (3/63) received preventive therapy. CONCLUSION: There are significant missed opportunities for prevention in Victoria, particularly in the foreign born cases who receive screening on entry into the country. For screening to be a meaningful exercise, preventive therapy should be used where medically indicated.

Adolescent↗