Search PubMed⌕ Search

Biomedical subjects

Susan M Sawyer

Publications and source records attributed to Susan M Sawyer.

At least 19 recordsLinked to original sources
PubMed2026

Waist-to-height ratio as a practical indicator for screening pediatric metabolic dysfunction-associated steatotic liver disease in diverse populations and genetic backgrounds.

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading chronic liver disease in children and adolescents; this parallels the global obesity epidemic. The contribution of genetic susceptibility to pediatric MASLD, and its interaction with anthropometric and biochemical indices used for non-invasive screening remains poorly understood. We aimed to evaluate waist-to-height ratio (WHtR) as a simple, equitable, and scalable tool for early identification of pediatric MASLD and relate this to genetic risk. METHODS: We combined school-based data from 1010 Chinese children with analyses of the Global Burden of Disease, the 1000 Genomes Project, and the US National Health and Nutrition Examination Survey (NHANES). Thirteen MASLD-related single-nucleotide polymorphisms (SNPs) were genotyped to construct a genetic risk score (GRS). We examined global epidemiological patterns, quantified inter-population allele divergence, and assessed how GRS modifies cutoffs and performance of nine anthropometric and biochemical indices. RESULTS: Genetic analysis revealed minimal frequency divergence across most ancestries (mean Fixation index&#x2009;<&#x2009;0.05), except for the African ancestry where there was moderate divergence. Higher GRS were associated with lower cutoffs across indices. When GRS Z-score increased from -3 to 3, visceral adiposity index showed the sharpest changes (Z-score decreased from 1.5 to -1.8), while BFP (1.2&#xa0;to&#xa0;0.1) and WHtR (1.5&#xa0;to&#xa0;0.1) showed gradual change. Furthermore, incorporating GRS into the base anthropometric models yielded only marginal improvements in overall screening performance [area under the receiver operating characteristic curve (AUC) and Youden Index]. Validation in NHANES showed WHtR&#x2009;&#x2265;&#x2009;0.48 retained high discrimination (AUC&#x2009;>&#x2009;0.87) across most genetic variants. CONCLUSIONS: This study suggests that WHtR is a consistent and practical tool for screening pediatric patients with MASLD across diverse populations. While genetic variation may influence optimal thresholds, WHtR&#x2009;&#x2265;&#x2009;0.48 appears broadly applicable, supporting its potential use as a frontline screening metric in diverse settings.

Humans↗
PubMed2006

Teen smokers reach their mid twenties.

PURPOSE: Most outcome studies of adolescent smokers have focused on tobacco use in the short term. Few have reported on the health of adolescent smokers as they reach young adulthood. METHODS: The design was a 10-year, eight-wave cohort study of a state-wide community sample of 1943 participants in Victoria, Australia. Participants were initially aged 14 to 15 years. Tobacco use was assessed with self-reported frequency of use and a seven-day retrospective diary. The Fagerstrom Test for Nicotine Dependence was used to define nicotine dependence in young adulthood. A computerized interview assessment was used during the teens and in young adulthood. RESULTS: Former daily smokers in adolescence accounted for most cases of nicotine dependence and high-dose (10+ cigarettes per day) smoking in young adulthood. Other substance abuse and psychiatric morbidity in young adulthood were also markedly elevated in this group. This was most clearly evident for cannabis dependence, where close to two-thirds of all cases were formerly daily tobacco smokers. Male smokers were more likely to continue as young adults. Persistent symptoms of depression and anxiety during the teens predicted progression to nicotine dependence, as did having a parent smoking daily. CONCLUSIONS: The poor health outcomes of daily adolescent smokers as they reach young adulthood provide a rationale for greater tobacco control initiatives directed at early users. Clinical interventions might usefully consider factors such as psychiatric morbidity and parental smoking.

Adolescent↗
PubMed2006

Changing their minds with time: a comparison of hypothetical and actual reproductive behaviors in parents of children with cystic fibrosis.

OBJECTIVE: Newborn screening for cystic fibrosis, with appropriate counseling, enables carrier parents to be informed early about future reproductive choices. Previous studies have assessed attitudes toward reproductive decisions in a hypothetical pregnancy or have measured reproductive behaviors. We aimed to measure parent attitudes to reproductive technologies and to compare prospectively these attitudes with later reproductive behaviors. METHODS: Parents of children who had cystic fibrosis and were aged 2 to 7 years were surveyed at baseline using a written questionnaire that explored attitudes to prenatal testing and termination of pregnancy in a hypothetical pregnancy. Parent knowledge and access to genetic counseling services also were assessed. Five years later, we compared attitudes with actual reproductive behaviors. RESULTS: Fifty-six mothers participated at baseline, and 43 were resurveyed 5 years later. Parent knowledge of cystic fibrosis and genetics was very good. A total of 93% had met a genetic counselor at the time of diagnosis, and more than half had on at least 1 subsequent occasion. At baseline, 82% reported that they would be likely to have prenatal diagnosis in a subsequent pregnancy, and 56% reported that they would be likely to terminate an affected pregnancy. Twenty-seven mothers since had been pregnant, with prenatal diagnosis used in 33 of the 55 pregnancies. In 67%, the hypothetically reported behavior regarding use of prenatal testing was the same as their actual behavior. Five of the 33 tested pregnancies were affected; all ended in termination. Reproductive choices in relationship to the number of children wanted, together with attitudes toward prenatal diagnosis and termination of pregnancy, were dynamic over time, with decisions having changed in both directions. CONCLUSIONS: This cohort of parents has actively used reproductive technologies since the birth of a child who has cystic fibrosis that was diagnosed by newborn screening. The dynamic aspect of reproductive choices highlights the importance of ongoing access to genetic counseling beyond the initial period of diagnosis and education, regardless of whether parents report that they expect to use reproductive technologies.

Abortion, Induced↗
PubMed2005

Barriers to delivering asthma care: a qualitative study of general practitioners.

OBJECTIVES: To ascertain what general practitioners' priorities are for achieving optimal outcomes in people with asthma, and the barriers they face in delivering this care. DESIGN: A qualitative study using the Nominal Group Technique (a highly structured meeting to gain information from experts about a particular issue) was conducted between August 2002 and September 2003. GPs in six discussion groups were asked "What do you think is needed to achieve best outcomes for asthma care?" To augment analysis of the discussion, sessions were taped and transcribed. PARTICIPANTS: Forty-nine GPs were recruited: 34 from metropolitan and 15 from rural areas. RESULTS: All groups nominated asthma education for patients and continuing professional education for GPs as major priorities, but they also described educational and structural barriers to achieving these priorities. Other priorities were: medication adherence, facilitating regular patient review, negotiated treatment/management plans, making the correct diagnosis, increased remuneration and consultation time, and safer asthma medications and access to these. Health promotion initiatives and increased public awareness were also priorities. Spirometry was a significant cause of uncertainty. Overall, written asthma action plans were not considered a high priority. CONCLUSIONS: Remarkable consistency was found between GPs' priorities for delivering best asthma care. Our study identified barriers to asthma guideline adherence, including accessible, relevant education for GPs, and structural, time and cost barriers GPs must overcome in providing asthma treatment and patient education.

Asthma↗
PubMed2005

Self-management in adolescents with chronic illness. What does it mean and how can it be achieved?

The concept of self-management is based on the notion that it will improve wellbeing and strengthen self-determination and participation in health care, while reducing health care utilisation and health costs. Increasing self-management is a desirable goal for the 15%-20% of children and adolescents who have a significant ongoing health care need related to a chronic health condition. Promoting self-management in young people with chronic illness can be difficult for parents and health care practitioners. Doctors can help parents recognise the potentially competing aspects of the parenting role--protecting young people's health while supporting their growing independence and autonomy. Optimal care may or may not be achievable, depending on a young person's level of development. As children mature through adolescence, they increasingly want their own voice to be heard, as well as the right to privacy and confidentiality in health care consultations. As well as listening to parents and supporting their roles, doctors should see young people alone for part of the consultation, taking a psychosocial history and carefully maintaining confidentiality.

Adolescent↗
PubMed2005

Confidential health care for adolescents: reconciling clinical evidence with family values.

Community debate about confidential health care for adolescents was triggered recently by the federal government's proposal to allow parents of teenagers aged 16 years and under access to their children's Health Insurance Commission data without their consent. Extensive research evidence highlights the importance of confidentiality in promoting young people's access to health care, particularly for sensitive issues such as mental and sexual health, and substance use. Involving parents is important, but evidence for any benefit from mandatory parental involvement is lacking. The law recognises the rights of mature minors to make decisions about their medical treatment and to receive confidential health care; however, the doctor must weigh up certain factors to assess maturity and ensure that confidentiality around such treatment will be in the young person's best interests. Evaluation of maturity must take into account characteristics of the young person, gravity of the proposed treatment, family factors, and statutory restrictions.

Adolescent↗
PubMed2005

Health risk screening in adolescents: room for improvement in a tertiary inpatient setting.

OBJECTIVE: To determine the extent to which comprehensive health screening of adolescents was undertaken in a tertiary inpatient setting. DESIGN AND SETTING: Retrospective review of 100 consecutive medical records of 13-18-year-old adolescents admitted to The Royal Children's Hospital, Melbourne (first 20 consecutive admissions in 2001 to each of five units--general medicine, adolescent medicine, specialty medicine, general surgery, and specialty surgery). MAIN OUTCOME MEASURES: Documentation of screening for biomedical (height, weight, pubertal staging, and hepatitis B vaccination) and psychosocial concerns (HEADSS framework categorised into four screening levels--none, incomplete, adequate, thorough). Risks identified and actions taken. RESULTS: Weight was recorded for 98 patients, height for 17, pubertal staging for 12, and hepatitis B vaccination status for nine. Documentation of psychosocial screening was absent from 62 charts, inadequate in 29, thorough in three, and complete in seven charts. Adolescent medicine inpatients were more likely than patients in other units to have any screening of psychosocial risk recorded and more likely to be thoroughly screened (P < 0.005). Screening was more often documented for less sensitive issues (eg, home, tobacco) than higher risk behaviours (eg, illicit drug use) (P = 0.013). When screening identified risks, appropriate action was undertaken in most cases. CONCLUSIONS: This study highlights deficiencies in comprehensive health screening in adolescents admitted to a tertiary children's hospital. These results support the development of more consistent approaches to screening adolescent inpatients.

Adolescent↗
PubMed2005

Young adults in children's hospitals: why are they there?

OBJECTIVE: To measure the pattern of admissions of young adults to a children's hospital. DESIGN AND SETTING: Ten-year audit (1992-2001) of admissions of young adults aged 18 years and over to the Royal Children's Hospital (RCH), Melbourne, with a detailed chart review of the 2001 cohort to assess disease complexity and transition planning. OUTCOME MEASURES: Number of admissions, disease complexity, transition planning. RESULTS: There was a significant increase in the number of young adults admitted over 10 years, from 308 in 1992-1993 to 659 in 2000-2001. The greatest increase was in admissions to surgical units. There was significant variation in admission practices between units over time. Many young adults required multidisciplinary care: 57% had more than three medical/surgical units involved in their care, and 34% had two or more allied health units involved. Fifty-one per cent of surgical inpatients and 28% of medical inpatients had no documented plan for transition to adult care. Only 30% of medical and 17% of surgical inpatients in 2001 had been transferred to adult services by 2002. CONCLUSIONS: Both disease complexity and failure of transition planning appear to have contributed to the increased admission of young adults to the RCH. While greater support of transition planning is needed, there are also concerns about the lack of appropriate services within the adult sector for young adults with complex, multidisciplinary healthcare needs.

Adolescent↗
PubMed2005

Impact of disease severity on quality of life in adults with asthma.

Health-related quality of life is increasingly used as an outcome measure in asthma. The aim of this study was to define the relationship between asthma symptoms, lung function and health related quality of life in a community based sample of people with asthma ranging from no recent asthma to severe persistent asthma. We recruited subjects at the age of 42 years from a well-described community cohort, the Melbourne Epidemiological Study of Childhood Asthma, to define this association. 161 subjects completed a respiratory symptom survey, the Asthma Quality of Life Questionnaire and had lung function testing. According to the previous surveys and when applicable in agreement with GINA, subjects were classified into 4 groups: no recent asthma, sporadic asthma, intermittent asthma and persistent asthma, with the persistent asthma group further categorised by wheezing frequency and lung function. 55 had no recent asthma, 31 had sporadic asthma, 39 had intermittent asthma and 36 had persistent asthma. There was clear evidence of lower total scores with increased asthma severity, with median scores of 6.8 for the sporadic asthma group, 6.4 for the intermittent and 5.5 for the persistent asthma group compared to 6.9 in those with no recent asthma. All domain scores within the intermittent and persistent asthma groups were lower than scores for the no recent asthma group (p < 0.01). Those with persistent asthma and low FEV1% had the lowest quality of life scores (4.6). Analysis of this population cohort highlights that health related quality of life in patients with asthma strongly depends on symptom frequency and lung function and underlines the necessity of adequate treatment.

Adult↗
PubMed2005

Reverse gateways? Frequent cannabis use as a predictor of tobacco initiation and nicotine dependence.

AIMS: To examine the risk posed by cannabis use in young people for tobacco use disorders. Specifically we examined whether cannabis use in non-smokers predicted later initiation of tobacco use and whether cannabis use predicted later nicotine dependence in tobacco users. DESIGN: A 10-year eight-wave cohort study. SETTING: State of Victoria, Australia. PARTICIPANTS: A community sample of 1943 participants initially aged 14-15 years. MEASUREMENTS: Self-report of tobacco and cannabis use was assessed in the teens using a computerized interview assessment and in young adulthood with a CATI assessment. The Fagerström Test for Nicotine Dependence was used to define nicotine dependence. FINDINGS: For teen non-smokers, at least one report of weekly cannabis use in the teens predicted a more than eightfold increase in the odds of later initiation of tobacco use (OR 8.3; 95% CI 1.9-36). For 21-year-old smokers, not yet nicotine-dependent, daily cannabis use raised the odds of nicotine dependence at the age of 24 years more than threefold (OR 3.6, 1.2, 10) after controlling for possible confounders, including level of tobacco use and subsyndromal signs of nicotine dependence. CONCLUSIONS: Weekly or more cannabis use during the teens and young adulthood is associated with an increased risk of late initiation of tobacco use and progression to nicotine dependence. If this effect is causal, it may be that a heightened risk of nicotine dependence is the most important health consequence of early frequent cannabis use.

Adolescent↗
PubMed2004

Youth health research ethics: time for a mature-minor clause?

Research into adolescent health issues is hampered by absolute requirements for parental consent. Society's recognition of adolescents' autonomy and decision-making capacity has been embodied in the legal recognition of the mature minor's right to make decisions on matters affecting his or her life. Psychological research indicates that young people from 14 years have decision-making capacity. US and UK research ethics guidelines acknowledge the mature-minor principle, but Australian guidelines are out of step with international practice. An absolute requirement for parental consent in Australian research ethics guidelines is potentially unethical if it denies mature adolescents' autonomy and is a barrier to participation, study validity and improved health outcomes through research findings. There are grounds for considering a mature-minor clause in the National Health and Medical Research Council research ethics guidelines, particularly in the context of youth participation in minimal-risk research.

Adolescent↗
PubMed2004

Back for more: a qualitative study of emergency department reattendance for asthma.

OBJECTIVE: To explore the reasons why individuals recurrently present with asthma to hospital emergency departments. DESIGN: A predominantly qualitative study in which participants were interviewed in-depth about their asthma. Data on medication use, respiratory health and asthma knowledge were also collected, and asthma severity was determined from medical records. SETTING: A tertiary teaching hospital and a suburban hospital emergency department (ED) from 1 March to 30 April 2000, and a rural hospital ED from 1 July to 31 August 2000. PARTICIPANTS: The participation rate was 32% of an initial 195 ED attendees (183 of whom were eligible) aged 18-70 years: 32 had presented to an ED for asthma care on more than one occasion over the preceding 12 months (reattendees), and 29 were non-reattendees. RESULTS: Two-thirds (22/32) of reattendees had chronic severe asthma and presentation to ED was deemed appropriate for 18 of these, indicated by recurrent severe asthma attacks despite seeking prior medical intervention. Reasons for re-presentation identified in a third of all reattendees included poor asthma knowledge, and financial and other barriers to medication use. CONCLUSIONS: We identified potentially preventable issues in about a third of patients (most of whom had mild to moderate asthma) who recurrently presented to EDs for treatment. The remainder of the participants sought emergency asthma treatment appropriately after failing to respond to medical care, and this was frequently in accordance with their asthma management plans.

Adult↗
PubMed2004

Improving asthma outcomes in harder-to-reach populations: challenges for clinical and community interventions.

The burden of asthma differs from country to country and within populations. The factors that influence this variation include asthma prevalence and severity, aspects of healthcare services (such as accessibility, quality and utilisation) and social demographic factors (such as income inequality, cultural and linguistic diversity and indigenous populations). The identification of individuals and populations that are 'harder to reach', 'special' or at greater risk of poor asthma outcomes therefore depends on how the burden of asthma and its management are measured. Meeting the challenge of educating harder-to-reach populations with asthma is the focus of this article. In clinical settings, communication is the mainstay of engaging and building trust to influence behavioural change in individuals; community-based interventions provide valuable opportunities for targeting harder-to-reach populations. However, they require active community consultation and participation and innovative approaches to service delivery, in addition to being theoretically driven and systematically developed.

Asthma↗
PubMed2004

What follows newborn screening? An evaluation of a residential education program for parents of infants with newly diagnosed cystic fibrosis.

OBJECTIVE: The diagnosis of a severe life-limiting condition, such as cystic fibrosis (CF), is generally followed by assessment and treatment of the child and education and counseling for parents. The introduction of newborn screening for CF provides an opportunity for standardized assessment and education. The aim of this study was to evaluate a 5-day residential assessment and education program for parents of infants who receive a diagnosis of CF after newborn screening. METHODS: Eligible parents had a 6- to 30-month-old infant with CF diagnosed by newborn screening. Parents were interviewed by telephone using a structured questionnaire that addressed 3 main themes: 1) initial communication of the diagnosis of CF, 2) the perceived value of the 5-day assessment and education program, and 3) the perceived advantages and disadvantages of the residential component (Care-By-Parent unit) of the program. RESULTS: Fifteen of 17 eligible families took part in the 5-day assessment and education program, 12 of whom used the residential Care-By-Parent unit. At the end of the program, parents believed that they had the knowledge and skills required to manage their child's CF at home. One hundred percent endorsed the timing of the assessment and education program immediately after the child's diagnosis and would recommend it to other families in the same situation. Perceived advantages of the residential program were not having to travel (89%), being able to concentrate on CF (50%), and the benefit of a "home base" at the hospital (39%). Twenty-two percent reported that financial costs related to participation (paternal time off work) were a disadvantage, 17% reported additional strain on family members caring for siblings, and 17% mentioned lack of comfort within the unit. CONCLUSIONS: This time-intensive residential program was evaluated positively by parents of children with newly diagnosed CF. It provides a model for education programs after the diagnosis of CF by newborn screening, as well as for other pediatric conditions that require intensive parent education.

Attitude to Health↗