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S F Hurley

Publications and source records attributed to S F Hurley.

At least 19 recordsLinked to original sources
PubMed1997

Effectiveness of needle-exchange programmes for prevention of HIV infection.

BACKGROUND: Needle-exchange programmes (NEPs) are potentially a key strategy for containing the spread of HIV infection among injecting drug users, but their implementation has been limited by uncertainty about their effectiveness. We used an ecological study design to compare changes over time in HIV seroprevalence in injecting drug users worldwide, for cities with and without NEPs. METHODS: Published reports of HIV seroprevalence in injecting drug users were identified, and unpublished information on HIV seroprevalence for injecting drug users entering drug treatment in the USA between 1988 and 1993 was obtained from the Centers for Disease Control and Prevention. Details of the implementation of NEPs were obtained from published reports and experts. For each of the 81 cities with HIV seroprevalence data from more than 1 year and NEP implementation details, the rate of change of seroprevalence was estimated by regression analysis. The average difference in this rate for cities with and without NEPs was calculated. FINDINGS: On average, seroprevalence increased by 5.9% per year in the 52 cities without NEPs, and decreased by 5.8% per year in the 29 cities with NEPs. The average annual change in seroprevalence was 11% lower in cities with NEPs (95% CI -17.6 to -3.9, p = 0.004). INTERPRETATION: A plausible explanation for this difference is that NEPs led to a reduction in HIV incidence among injecting drug users. Despite the possibility of confounding, our results, together with the clear theoretical mechanisms by which NEPs could reduce HIV incidence, strongly support the view that NEPs are effective.

HIV Infections↗
PubMed1997

Association of adult glioma with medical conditions, family and reproductive history.

A population-based case-control study of 416 histologically diagnosed, incident gliomas in adults was carried out in Melbourne, Australia, to determine whether past medical, family or reproductive histories are risk factors for developing glioma. A total of 422 controls were selected from the Australian electoral roll and matched to cases for age, sex and post code of residence. An increased risk of developing glioma was observed among first-born individuals OR (95% CI) 2.0 (1.4-2.9). It is possible that this effect is due to residual confounding by socio-economic status or that it is a chance finding. Alternatively, it may be that this is due to some other effect linked to the first pregnancy, such as maternal age, birth weight or circumstances of delivery. There was no apparent association between the development of glioma and other neuropsychiatric or general medical conditions or with family history or reproductive history. Allergies (asthma and eczema) were not associated with a decreased risk of glioma, as has previously been suggested.

Adult↗
PubMed1996

Lifetime cost of human immunodeficiency virus-related health care.

Estimates of the lifetime cost of illnesses are needed for temporal and international comparisons and for assessment of the efficiency of prevention strategies. The goal of the present study was to estimate the average present value, at both the time of diagnosis and the time of seroconversion, of the lifetime cost of health care for HIV infection. Australian data on the monthly cost of HIV-related health care for homosexual men were linked with published data on disease progression using survival analysis methods. Future costs were discounted at 5% per annum. For a patient diagnosed when his CD4+ count fell below 500 x 10(6)/L, the average present value in 1992-1993 of lifetime cost was approximately $93,000, of which 49% was for drugs and 32% was for hospital bed-days. For a man infected in 1992-1993 and diagnosed when his CD4+ count falls below 500 x 10(6)/L, the average present value of lifetime cost at the time of seroconversion is approximately $70,000. These estimates are lower than the lifetime cost of $119,000 reported recently in the United States. However, when the U.S. figure was adjusted to make discounting of future costs consistent between the two studies, lifetime costs were approximately 17% lower in the United States. The lower American costs appear to be due to lower rates of hospitalization and drug prescribing, possibly because of reduced access to health services, but underestimation of costs due to study methodology might also explain the difference.

Australia↗
PubMed1996

A comparison of patient interview data with pharmacy and medical records for patients with acquired immunodeficiency syndrome or human immunodeficiency virus infection.

To assess the reliability of information reported by patients with AIDS or HIV infection, 123 homosexual men were recruited in Victoria, Australia, in 1992-1993 and interviewed to collect data retrospectively and prospectively on HIV-related illness and treatment. These data were compared with information in medical and pharmacy records. There was no evidence of bias in the patient report of date of diagnosis of HIV infection or date or result of most recent CD4 count, although there was considerable imprecision. Past and current prescription of AZT were recalled accurately by patients compared with medical records (kappa = 0.89 and 0.86, respectively), but previous HIV-related illnesses and enrollment in clinical studies or trials were generally recalled poorly (kappa < 0.4 in some cases). Data collected prospectively on prescription of drugs and use of health care services were reasonably accurately reported by patients. This analysis supports the need for routine assessment of the validity of patient-reported exposure and outcome data in epidemiological studies in order to minimize the possible biases that can result from inaccurate information.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Health care and its costs for children with perinatally acquired HIV infection.

OBJECTIVE: To describe survival patterns, use of health services and related costs for Australian children with perinatally acquired human immunodeficiency virus (HIV) infection. METHODOLOGY: A retrospective cross-sectional survey was made of 20 children with HIV infection (91% of those diagnosed) and 13 children with maternal antibodies who subsequently seroreverted, treated at 10 medical centres. Details of disease progression and use of health services were obtained from hospital medical records. Monthly costs for three phases of infection were estimated by linking service usage rates with estimates of the unit cost of each service. The average lifetime cost was estimated by combining monthly costs and phase duration estimates from the literature. RESULTS: Patterns of disease progression were similar to those reported internationally, with a median survival of 8 years. Use of health services increased with severity of illness. Mean monthly costs were $120 per month (1992 Australian dollars) for children with maternal antibodies who subsequently seroreverted, $320 per month for children with HIV infection but no acquired immunodeficiency syndrome (AIDS)-defining illness, and $1830 per month for children with AIDS. The present value of total lifetime cost for a child with HIV infection was $48174, 46% of which was for treatment of AIDS. DISCUSSION: The mean lifetime cost for a perinatally infected child was just over half that for a man with HIV in Australia. Health service usage and costs were lower for Australian than American children with HIV.

Australia↗
PubMed1996

Tobacco smoking and alcohol consumption as risk factors for glioma: a case-control study in Melbourne, Australia.

OBJECTIVE: To investigate possible associations between tobacco smoking and alcohol consumption and the risk of adult glioma. DESIGN: This was a population based, case-control study. Relative risks (RR) were estimated using logistic regression analysis. SETTING: Melbourne, Australia. PARTICIPANTS: These comprised 416 case subjects (166 women, 250 men), 66% of those eligible; and 422 control subjects (170 women, 252 men), 43.5% of those potentially eligible. RESULTS: There was no increase in risk of glioma with having ever smoked tobacco (RR 1.29, 95% CI 0.95, 1.75) for all subjects, adjusted for age, a reference date, and gender. There was a slight increase in risk for men (RR 1.64, 95% CI 1.1, 2.45), but not for women (RR 0.99, 95% CI 0.62, 1.62). For men, there was no increase in risk with increasing pack-years of cigarette smoking, but the risk was significantly increased in subjects who had smoked for less than 10 years. There was no increase in risk associated with having ever drunk alcohol for all subjects (RR 0.96, 95% CI 0.67, 1.37), women (RR 0.69, 95% CI 0.4, 1.15) or men (RR 1.40, 95% CI 0.81, 2.43). CONCLUSIONS: This study does not support an association between either tobacco smoking or alcohol consumption and glioma. The pattern of risk associated with tobacco smoking in men appears inconsistent with a causal role, and may be due to chance, response bias, or uncontrolled confounding.

Adult↗
PubMed1995

The usage and costs of health services for HIV infection in Australia.

OBJECTIVE: To describe patterns of health-service usage and the resulting costs in 1992-1993 for Australian men. DESIGN: A prospective survey, stratified by phase of illness. SETTING: Hospital and community-based care. PATIENTS: A total of 128 homosexual men: 20 in phase 1 (CD4+ count > or = 500 x 10(6)/l), 31 in phase 2 (CD4+ count < 500 and > or = 200 x 10(6)/l), 30 in phase 3 (CD4+ count < 200 x 10(6)/l), and 47 in phase 4 (AIDS). MAIN OUTCOME MEASURES: Mean monthly service usage rates and costs. RESULTS: Health-service utilization increased and became more hospital-based as illness worsened; the main exception was use of antiretroviral drugs, which peaked in phases 2 and 3. Hospital admission was rare before diagnosis of AIDS. Hospital bed-days per patient per month averaged 3.3 for AIDS patients until the final 3 months of life increasing to 15.8 in the 3 months before death. Mean monthly costs (in 1992-1993 Australian dollars) were $331 [95% confidence interval (CI), 218-455] in phase 1, $667 (95% CI, 540-836) in phase 2, $1372 (95% CI, 1044-1776) in phase 3, and $4615 (95% CI, 3456-5985) for AIDS patients until the last 3 months of life and $13,308 (95% CI, 10,538-16,516) in the 3 months before death. Drugs comprised 57% of total costs in phase 1, but only 30% of costs for patients with AIDS, whereas hospital bed-days comprised 10% of phase 1 costs and 60% of AIDS costs. CONCLUSIONS: Health-care utilization and resulting costs increased with severity of illness, and were particularly high for AIDS patients in the 3 months before death. Service-utilization patterns and components of costs varied between each phase.

Acquired Immunodeficiency Syndrome↗
PubMed1995

A method for estimating baseline health care costs.

STUDY OBJECTIVES: Studies estimating the cost of specific illnesses do not generally take into account the fact that health care costs would have been incurred in the absence of the disease of interest. The goal of this study was to develop a method of estimating age specific baseline health care costs. These costs were calculated for Australian men, and their magnitude was compared with the costs of caring for men with HIV infection. DESIGN: Information about health service usage was obtained from the 1989-90 national health survey and linked with data on the costs of services to obtain average monthly costs for individual and total health services. SETTING: The Australian community. PARTICIPANTS: Average total health service costs per man per month were $103 (Australian). Hospital admissions comprised approximately 40% of these costs and casualty/outpatient visits, consultations with a doctor, and prescribed medication comprised 10%, 13%, and 12%, respectively. Costs increased with age, from around $60 per month for men aged 20-39 years to $213 per month for men aged 60 and over. CONCLUSION: Baseline costs comprised around 18% of health care costs for men with asymptomatic HIV infection, but less than 1% of costs for men with AIDS. These estimates provide an essential baseline for determining the costs attributable to specific diseases.

Adult↗
PubMed1994

Dietary factors and the risk of glioma in adults: results of a case-control study in Melbourne, Australia.

In a population-based case-control study of 416 incident gliomas in adults carried out in Melbourne, Australia, between 1987 and 1991, 409 age-sex-matched case-control pairs (243 male and 166 female) had adequate data available to examine associations between the dietary intake of N-nitroso compounds, N-nitroso precursors, other nutrients including N-nitroso inhibitors, and the risk of glioma. Dietary intakes were based on the reported frequency of consumption of 59 food items. Increased odds ratio (OR) were observed in males who consumed high levels of bacon, corned meats, apples, melons and oil. OR less than unity were observed in men consuming cabbage and cola drinks, and in women who consumed wholegrain bread, pasta, corned meat, bananas, cauliflower, brocoli, cola drinks and nuts. Generally, N-nitroso associations were greater in men and micronutrient associations were greater in women. Elevated OR in men, but not women, were associated with the intake of N-nitroso dimethylamine (NDMA), retinol and vitamin E. The intake of nitrate (largely of vegetable origin) was protective in women but not in men. When analyzed using multiple logistic regression, the association with NDMA intake in males was not modified by dietary micronutrient intakes. In females, beta carotene alone, though not directly associated with risk, modified the effect of NDMA. On balance, this study added only limited support to the N-nitroso hypothesis of glial carcinogenesis.

Australia↗
PubMed1994

Mammographic screening: measurement of the cost in a population based programme in Victoria, Australia.

STUDY OBJECTIVES: To estimate the cost per woman participating in a mammographic screening programme, and to describe methods for measuring costs. DESIGN: Expenditure, resource usage, and throughput were monitored over a 12 month period. Unit costs for each phase of the screening process were estimated and linked with the probabilities of each screening outcome to obtain the cost per woman screened and the cost per breast cancer detected. SETTING: A pilot, population based Australian programme offering free two-view mammographic screening. PARTICIPANTS: A total of 5986 women aged 50-69 years who lived in the target area, were listed on the electoral roll, had no previous breast cancer, and attended the programme. RESULTS: Unit costs for recruitment, screening, and recall mammography were $17.54, $60.04, and $175.54, respectively. The costs of clinical assessment for women with subsequent clear, benign, malignant (palpable), and malignant (impalpable) diagnoses were $173.71, $527.29, $436.62, and $567.22, respectively. The cost per woman screened was $117.70, and the cost per breast cancer detected was $11,550. CONCLUSIONS: The cost per woman screened is a key variable in assessment of the cost effectiveness of mammographic screening, and is likely to vary between health care settings. Its measurement is justified if decisions about health care services are to be based on cost effectiveness criteria.

Aged↗
PubMed1994

Psychological consequences of screening mammography.

OBJECTIVE: To examine the psychological consequences at a number of stages in the screening process for women attending a screening mammography programme. SETTING: A pilot mammographic screening programme in Melbourne, Australia. METHOD: The psychological consequences questionnaire (PCQ; a reliable and valid measure of the psychological consequences of screening mammography) was used to measure the emotional, social, and physical functioning of women in a mammographic screening programme and a control community sample. A screening group (in whom no abnormality was detected at initial screen; n = 142) had four measurements: at screening clinic; before results were received; one week after all-clear results were received; and eight months after initial visit. The recall group (who were recalled for further investigation which showed the detected abnormality to be benign; n = 58) had measurements at the same points as the screening group and an additional measurement while waiting at the recall assessment clinic. A randomly selected community control group (n = 52) had measurements one week, two weeks, three weeks, and eight months after consenting to participate. RESULTS: Emotional, social, and physical functioning of women in the screening group did not change over time and at no point differed significantly from that of community controls. The profiles of emotional and physical dysfunction of women in the recall group differed significantly from those of the screening and control groups. The level of emotional and physical dysfunction in the recall group was highest while waiting at recall assessment clinic, and scores were still significantly higher than scores obtained at comparable times from screening and control groups one week after obtaining notification that there was no sign of cancer (emotional P < 0.001; physical P < 0.05). This difference had disappeared eight months after the screening visit, when the level of emotional and physical functioning was similar to that of the screening and control groups. Social dysfunction scores did not change significantly over time and were similar for all three groups. CONCLUSIONS: Given that up to 10% of women are recalled for further investigations on first round screening, significant numbers of women may have psychological consequences. This speaks for the necessity for accurate reading of mammograms to minimise the false positive recall rate, and for counselling services to be available at recall assessment centres.

Attitude to Health↗
PubMed1994

Recruitment activities and sociodemographic factors that predict attendance at a mammographic screening program.

A random sample of 2266 women aged 50 to 69 years was used to investigate factors that predict attendance at a free Australian mammographic screening program. The most important predictor was receipt of a personal invitation letter. A letter that included an appointment time increased attendance 132-fold initially and decreased to 20 times baseline after 14 days. A letter that did not include an appointment time increased attendance 12-fold, and a second letter to nonattenders increased attendance approximately 13-fold. Attendance declined with increasing distance from the program and with increases in the percentage of non-English speaking women in a neighborhood, but was higher in areas of higher socioeconomic status.

Age Factors↗
PubMed1993

Tumours of the brain and presence of antibodies to Toxoplasma gondii.

The possible association between prior infection with the protozoan Toxoplasma gondii and development of brain tumours was investigated as part of two Australian population-based case-control studies of adult brain tumours. One study, based in Adelaide, South Australia, collected blood from 73 subjects with glioma, 53 subjects with meningioma and 348 controls. The other study, based in Melbourne, Victoria, collected blood from 44 subjects with glioma and 67 controls. All tumours had been verified histologically. IgG antibodies to T. gondii were measured using Enzyme Linked Immunosorbent Assay (ELISA) techniques. In both the centre-specific and combined analyses, there was no difference between subjects with glioma and controls in the prevalence of antibody test-positivity (35% test-positive in glioma versus 33% in controls, age-, sex- and centre-adjusted odds ratio (OR) = 1.00, 95% confidence interval (CI): 0.64-1.56). In the Adelaide study, there was a statistically significant increased risk of meningioma associated with antibody test-positivity (47% test-positive in meningioma versus 31% in controls, P = 0.02, adjusted OR = 2.09, 95% CI: 1.14-3.83). Our results do not support the hypothesis that antibody positivity to T. gondii is a risk factor for glioma, but suggest that it might be associated with meningioma.

Adult↗
PubMed1993

Smoking as a risk factor for cortical ischaemia presumably due to carotid occlusive disease.

Smoking is now a well established risk factor for ischaemic stroke. However, the risk associated with smoking may differ between subgroups of ischaemic stroke. To test the hypothesis that cortical ischaemia due to carotid artery occlusive disease, the latter of which has previously been linked to smoking, may have a higher smoking risk compared to other forms of cerebral ischaemia, we identified 178 cases of cortical ischaemia presumably due to carotid occlusive disease in our previous case-control population and compared the odds ratios (OR) for smoking risk in this group with that in group of 244 cases of other forms of cerebral ischaemia combined. All cases were individually matched for age (+/- 5 years) and sex with neighbourhood controls. Multiple conditional logistic regression was used to adjust for potentially confounding factors. The OR for current smokers in the cortical group was higher than that in the non-cortical group [OR 4.4, 95% confidence interval 2.2, 8.9 vs. 2.1 (1.1, 4.1)], particularly for those who smoked more than 60 pack-years [5.5 (2.2, 14.0) vs. 1.5 (0.6, 3.8)] and those who currently smoked more than one pack per day [20.2 (3.3, 122.3) vs. 2.6 (0.8, 8.2)], but not significantly. Overall, there is some evidence to suggest that smoking may be a more potent risk factor for cortical than for other forms of cerebral ischaemia, particularly at high smoking rates. Further studies are needed to substantiate this finding.

Adult↗
PubMed1992

Effectiveness, costs, and cost-effectiveness of recruitment strategies for a mammographic screening program to detect breast cancer.

BACKGROUND AND PURPOSE: Since effective and affordable recruitment methods are essential for the widespread implementation of mammographic screening for detection of breast cancer, we studied the effectiveness, the costs, and the cost-effectiveness of various recruitment strategies in the population targeted by a pilot Australian program that offered free mammography screening between 1988 and 1990. METHODS: We evaluated three public recruitment strategies--local newspaper articles, community promotion, and promotion to physicians--and five personal strategies--invitation letters with or without specified appointment times, either alone or with a follow-up letter, or telephone call to nonattenders. The effectiveness of public recruitment strategies was estimated from monthly attendance rates by Poisson regression analysis, while the probability of attendance in response to personal strategies was calculated using logistic regression analysis. Costs were determined by resource usage studies. The cost-effectiveness ratios for personal strategies were determined using decision analysis. RESULTS: The costs in 1988-1989 Australian dollars per woman recruited were $22 for local newspaper articles and $106 for community promotion. No detectable increase in attendance resulted from promotion to physicians. When the cost of reserving an appointment was considered, the most cost-effective personal recruitment strategy was an invitation letter without a specified appointment time, followed by a second letter to nonattenders. This strategy recruited 35.6% of women in the sample targeted and cost $10.52 per attendee. In comparison, the most effective personal recruitment strategy was a letter with a specified appointment time followed by a second letter to nonattenders, which recruited 44.1% of women at an average cost of $19.99 and a marginal cost of $59.71 per additional attendee. CONCLUSIONS: Personal recruitment strategies were more cost-effective than public strategies. The most cost-effective personal strategy was an invitation letter without a specified appointment time, followed by a second letter to nonattenders.

Australia↗
PubMed1992

Linking prescription and patient-identifying data: a pilot study.

OBJECTIVE: To link a Pharmaceutical Benefits Scheme (PBS) prescription data set with patient-identifying data held by the Health Insurance Commission (HIC) and to then determine the prevalence of prescribing of cardiovascular drugs, non-steroidal anti-inflammatory drugs, hypnotics and minor tranquillizers, and diuretics (prescribed without other cardiovascular drugs) by age and sex in two defined populations. DESIGN: Prescription data for a three-month period in 1985 were matched with patient-identifying information to obtain a database which included the patient's age, sex and an identifying number, for each prescription record. The percentages of the population taking a drug from each of the drug categories mentioned above were then determined and the effect of age, sex and region of residence on prescribing prevalence was investigated using logistic regression analysis. SETTING: Two rural regions of Australia with a total population of 65,087 residents. MEASUREMENTS AND MAIN RESULTS: Of the 101,383 prescriptions dispensed over the period 96% could be matched with HIC information. In the two regions combined, the percentages of the population taking a cardiovascular drug, non-steroidal anti-inflammatory drug, hypnotic or minor tranquilizer, or diuretic (without other cardiovascular drugs) were 10.4%, 5.8%, 3.5% and 2.5%, respectively. Prescribing rates were higher for females than males, increased with age and varied between the two regions. Approximately 5% of women aged 30-39 years were taking diuretics without other cardiovascular drugs, compared with only 0.2% of men in the same age group. CONCLUSIONS: This pilot study illustrates the use of a patient-identified prescription database for drug utilisation review, therapeutic audit and hypothesis generation.

Adult↗
PubMed1992

The cost of breast cancer recurrences.

Information about the costs of recurrent breast cancer is potentially important for targeting cost containment strategies and analysing the cost-effectiveness of breast cancer control programmes. We estimated these costs by abstracting health service and consumable usage data from the medical histories of 128 patients, and valuing each of the resources used. Resource usage and costs were summarised by regarding the recurrence as a series of episodes which were categorised into five anatomical site-based groups according to the following hierarchy: visceral, central nervous system (CNS), bone, local and other. Hospital visits and investigations comprised 78% of total costs for all episodes combined, and there were significant differences between the site-based groups in the frequency of hospital visits and most investigations. Total costs were most accurately described by separate linear regression models for each group, with the natural logarithm of the cost of the episode as the dependent variable, and predictor variables including the duration of the episode, duration squared, duration cubed and a variable indicating whether the episode was fatal. Visceral and CNS episodes were associated with higher costs than the other groups and were more likely to be shorter and fatal. A fatal recurrence of duration 15.7 months (the median for our sample) was predicted to cost $10,575 (Aus + 1988; or 4,877 pounds). Reduction of the substantial costs of recurrent breast cancer is likely to be a sizable economic benefit of adjuvant systemic therapy and mammographic screening. We did not identify any major opportunities for cost containment during the management of recurrences.

Adult↗