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PubMed1998

Rotavirus infection and rates of hospitalisation for acute gastroenteritis in young children in Australia, 1993-1996.

OBJECTIVE: To determine rates of hospitalisation of young children for acute gastroenteritis in Australia, and to estimate the proportion of these admissions caused by rotavirus infection. DESIGN: Analysis of hospital admission records, and parallel, prospectively collected data on rotavirus-positive admissions. SETTING: Hospitals admitting young children in all Australian States and Territories in 1993-1996. PATIENTS: All children under five years admitted to hospital for acute gastroenteritis (International Classification of Diseases, ninth revision principal diagnosis codes 003.0, 004.0-009.3 and 558.9). MAIN OUTCOME MEASURES: Rate of hospital admission per 1000 children per year by State, and the proportion of admissions caused by rotavirus infection. RESULTS: There were almost 20,000 hospital admissions annually in Australia for acute gastroenteritis in children under five years, at an average rate of 15/1000. An estimated 50% of these were attributable to rotavirus infection, implying a rate of hospitalisation for rotavirus-related gastroenteritis of 7.5/1000/year. Among children under two years this rate was 11.6/1000. Rotavirus incidence rates generally followed a typical seasonal pattern in temperate regions of the country, with sharp peaks in mid to late winter. Rates of hospitalisation varied markedly, even between States with apparently similar patterns of disease, while the incidence in the Northern Territory was 3-5 times higher than other States. CONCLUSIONS: Rotavirus-related gastroenteritis is a major cause of hospital admissions in young children, and large savings to the healthcare system are possible if it can be prevented at reasonable cost. Variation in treatment practices between States may be worth studying in greater detail as another source of potential savings.

Acute Disease↗
PubMed1994

Serotype and serosubtype distribution of strains of Neisseria meningitidis isolated in South Australia and the Northern Territory of Australia: 1971-1989.

Strains of meningococci isolated from patients in South Australia (SA) and the Northern Territory (NT) with either bacteremia or meningitis (or both) were serotyped and serosubtyped using monoclonal antibodies in a whole cell ELISA technique. From SA, 144 isolates were examined for the period 1971 through 1989 and from the NT, 38 isolates from 1975 through 1977 and 1983 through 1989 were examined. During the periods of study the principal serogroups were group B in South Australia and group A in the Northern Territory. About 60% of the SA strains were typable and subtypable: the predominant types were 4, 2a, 15 and 14, in that order; the predominant subtypes were P1.2, P1.1 and P1.10, in that order. Of the strains from the NT about 80% were typable, the predominant type was type 4 and all 19 group A strains were identified as type 4, subtype P1.10.

Adult↗
PubMed2005

Patient choice cesarean--the Maine experience.

BACKGROUND: Patient choice cesarean refers to elective primary cesarean in the absence of a medical or obstetrical indication. The purpose of this study was to determine obstetricians' attitudes and practices with respect to patient choice cesarean in Maine, United States. METHODS: A questionnaire was sent to all Maine Fellows of the American College of Obstetricians and Gynecologists actively practicing obstetrics, after receiving institutional review exemption. Data were analyzed using descriptive statistics, Fisher exact, or chi-square tests. RESULTS: Seventy-eight of 110 (70.9%) obstetricians responded. Of these, 60 of 71 (84.5%) respondents performed or were willing to perform patient choice cesarean. However, 15 of 71 (21.1%) preferred a cesarean delivery for themselves (women) or partners (men). Indications included urinary continence (53.3%), adverse previous birth experience (41.7%), anal continence (35.0%), concern for fetal death or injury (33.3%), and fear of childbirth, preservation of sexual function, or pelvic organ prolapse (26.7% each). Less frequent were pain (11.7%), convenience (8.3%), and provider availability (10.0%). In addition, 82.1 percent believed medical evidence and 85.9 percent believed ethical issues sometimes or always supported patient choice cesarean. Responses were similar by gender, age, and time interval from training completion with two exceptions. Women under age 35 years were more likely to opt for a cesarean delivery themselves (p = 0.04), and 42.9 percent of respondents under age 35 years interpreted the medical literature as supporting cesarean in all cases versus 4.2 percent of older colleagues (p = 0.008). Sixty-four of 78 (82.1%) respondents would find a randomized trial of planned vaginal versus planned cesarean delivery helpful in addressing the issue of patient choice cesarean. CONCLUSIONS: Although Maine obstetricians were willing to perform patient choice cesarean, few preferred this delivery mode for themselves or their partners. A randomized trial of planned vaginal versus planned cesarean delivery is highly desired.

Adult↗
PubMed1970

Australia antigen in chronic hepatitis in Australia.

Of 53 cases of active chronic liver disease two were found to be carriers of Australia antigen Au (1)-an elderly woman with typical lupoid hepatitis and an elderly mortuary attendant with serologically atypical active chronic hepatitis. Au (1) was detected also in the serum of 7 out of 20 patients with clinically atypical acute hepatitis-one was an elderly Italian woman, one had hepatitis in the puerperium, and five had a history of transfusion or inoculation. The antigen was not found in 20 typical cases of infectious hepatitis in young people in 86 patients with other diseases. Antibody to Au (1) was present in only 2 out of 102 patients who had received numerous transfusions.We conclude, firstly, that Au (1) antigen is rare in white Australians (in keeping with the low incidence of serum hepatitis in Australia), and, secondly, that Au (1) positivity in hepatitis patients is associated with transfusions and with older age. We suggest that active chronic hepatitis and lupoid hepatitis may follow infection of susceptible individuals with Au (1)-positive hepatitis virus, but persistence of the virus in high titre does not appear to be necessary for chronicity of the disease.

Acute Disease↗
PubMed1998

Measles control in Australia. Report of the Measles Control in Australia Workshop, 5 November 1997.

The proceedings of the Measles Control in Australia Workshop held on 5 November 1998 are presented in this report. Prompted by the possibility of a global elimination campaign in the near future the Workshop considered the factors involved in elimination of measles from Australia. Epidemiology, surveillance, laboratory diagnosis methods, mathematical modelling, and the cost and logistics were all addressed. Mass vaccination for all 2-18 year olds, and a routine 2-dose regimen with scheduled doses at 12 months and school entry were recommended. Intensified surveillance, based on a sensitive case definition and laboratory confirmation (measles specific IgM) of suspected cases was identified as a crucial component of the campaign. The continuation of high vaccination coverage for each of the two doses would be essential to maintain elimination once established.

Adolescent↗
PubMed2003

TSN Database Australia, a new tool to monitor antimicrobial resistance in Australia.

An electronic network of Australian microbiology laboratories was established to monitor the emergence and occurrence of antimicrobial resistance among clinically relevant bacteria. It is believed that the data network collected approximately 42 per cent of all antibacterial susceptibility test results generated by Australian laboratories. The network comprised 94 hospitals and 9 private commercial laboratories. Selected data elements were extracted and electronically transmitted to a central location. Upon receipt, all data were first normalised and thereafter examined for errors. Duplicate results for the same patient were identified to prevent skewing of the data toward resistance. All data passing quality assessment was staged for release of a new database release that occurred monthly. Unusual test results were first validated prior to their inclusion into the database. Using an Internet-based query tool, individual institutions could query their own data, but could only query aggregated data for other regional or national analyses. Individual patient results could be examined nor could the results of any individual institution other than their own. As of March 2002, TSN Database Australia contained 14,648,752 test results, from 2,000,394 strains (453 different taxa) and 1,213,605 patients. Since the same database concept has been established in 10 other countries (United States of America, Europe, and Canada), observations made in Australia may be compared to those observed elsewhere in the world. This article will describe TSN in greater detail, describe the query tool and some of the analyses that are possible.

Anti-Bacterial Agents↗
PubMed1998

Australia's health system: the search for a cure. The Australian Democrats' discussion paper on Australia's health system.

The Australian Democrats' believe that Australia is currently at a critical time in the development of its health care system. The twin pressures of higher demands and inadequate funding have led to alarmingly heavier pressure on the public health infrastructure. Increasingly, the choices confronting society is one of how to allocate limited resources in the health sector. Awareness is growing on the impact wider issues such as unemployment, fragmentation of communities are having on society's health. In the face of new challenges confronting Australia's health system of the needs of an aging population, adoption of new developments in medical treatment and technology and new relationships which are developing between the public and private health sector, the Democrats acknowledge that although there are no easy responses, it is important, nonetheless to recognise their complexities and work collaboratively towards viable solutions. Through this discussion paper, based on consultation with a wide range of stakeholder groups and individuals, the Australian Democrats' have sought to outline the options for addressing the challenges and debate which will serve to contribute to the development of a fair, efficient and equitable health care system for all Australians, now and into the future.

Australia↗
PubMed2004

Comparison of cancer survival in UK and Australia: rates are higher in Australia for three major sites.

Relative survival of patients diagnosed with cancers of the colorectum, lung and female breast from Yorkshire, UK and New South Wales (NSW), Australia in 1992-2000 were compared using multiple regression models to adjust for various factors. Statistically significant differences were observed for all sites, Yorkshire patients having a 47-58% higher risk of excess death than those of NSW.

Adolescent↗
PubMed2003

Coding accuracy for endophthalmitis diagnosis and cataract procedures in Western Australia. The Endophthalmitis Population Study of Western Australia (EPSWA): second report.

As an initial phase of the Endophthalmitis Population Study of Western Australia (EPSWA), this paper reports the results from an intensive comparative validation of all possible surgery-related endophthalmitis cases identified for the period from 1980 to June 1999 from the Hospital Morbidity Data System (HMDS) of the WA Record Linkage Project with external sources. The external sources were the microbiology and anaesthetic databases from Royal Perth Hospital (where most of the cases of endophthalmitis were treated) and surgeon logbooks of two vitreoretinal surgeons treating endophthalmitis in Perth over the study period. As it was discovered that a large proportion of all cases coded with endophthalmitis did not have any ocular surgery, the validation also included a sample from these cases. The purpose of validating these cases was to ensure that our count of post-operative endophthalmitis had not excluded any cases whose surgery might not have been recorded in the HMDS database. It was also intended to provide an estimate of all miscoded endophthalmitis cases as a first step towards future improvement of coding accuracy. Since we suspected that phaco-emulsification was under-coded, we also examined a sample of cataract procedures. Of all surgery-related endophthalmitis cases coded in the HMDS, only 50.9% (274 of 538) were found to be valid cases. External sources identified 83 cases of endophthalmitis, 49 did not have endophthal-mitis codes but were in the HMDS file with an associated code. Of the remaining externally identified cases, 13 were missing altogether from the HMDS file, 7 of which were correctly coded in the notes while the other 6 were coded with associated codes, and 21 were diagnosed after the date the HMDS file was extracted. The validation of a random sample of the non-surgery-related cases coded with endophthalmitis suggested that the vast majority of them were miscoded (88%, 139 of 158 sampled from 1474 cases). The systematic coding errors reported in this paper may be attributed to both the clinical and the coding departments of the hospital. In any case, coding inaccuracy itself is a serious concern for data quality of any linked database systems and for epidemiological researchers using such data. The increased use of aggregated data in epidemiological research further underscores the importance of coding accuracy and thus data validation. The use of external sources for case identification and case validation are two ways of ensuring data completeness/quality and validity of results.

Cataract↗
PubMed1998

Tuberculosis notifications in Australia, 1996. Communicable Diseases Network Australia New Zealand.

Since the implementation of the National Mycobacterial Surveillance System (NMSS) in 1991, the epidemiology and trends of tuberculosis in Australia have been described in a series of annual reports. This article presents an analysis of the data for tuberculosis notifications for 1996. A total of 1,037 notifications of tuberculosis were received for the year 1996, and the crude rates of new and relapsed disease were reported at 5.37 per 100,000 and 0.29 per 100,000 respectively. Rates of tuberculosis have remained stable over the last decade and the majority of notifications and highest rates of disease continue to occur in the overseas-born population.

Adolescent↗
PubMed1999

Tuberculosis notifications in Australia, 1997. National TB Advisory Group. Communicable Disease Network Australia and New Zealand.

Since the inception of the National Mycobacterial Surveillance System (NMSS) in 1991, annual crude notification rates for tuberculosis (TB) have remained stable at between 5 and 6 per 100,000 population. In 1997, there was a total of 1,001 TB notifications in Australia, of which 954 were new TB cases and 47 relapses. The corresponding annual crude notification rate for new and relapsed TB was 5.15 and 0.25 per 100,000 respectively. Seventy-nine per cent of notifications that had a country of birth reported were overseas born. In keeping with trends observed over recent reporting years, the populations for which notified TB rates were highest include the overseas born from high prevalence countries and indigenous Australians. The lowest rates of disease have continued to be reported in the non-indigenous, Australian born population. Surveillance reports over the last seven years indicate that the rate of disease in this population is gradually declining.

AIDS-Related Opportunistic Infections↗
PubMed2003

Low levels of fluoroquinolone resistance in Escherichia coli. A five-year trend in Australia measured through the use of TSN Database Australia.

In many countries, fluoroquinolones are among the most commonly used antibacterial drugs. Concerns about bacterial resistance to these and other frequently used drugs have been raised by the medical and scientific communities. While fluoroquinolone resistance has not yet developed among many bacteria, emergence of resistance in Escherichia coli would be a problem as multiple resistances to other antibiotics is now a common problem. This paper examines trends in resistance to fluoroquinolones in Escherichia coli through analysis of data collected from Australian institutions between 1997 and 2001. During the study period, norfloxacin and ciprofloxacin were the most frequently tested fluoroquinolones in Australian laboratories. An examination of results for strains tested simultaneously against both drugs indicated that testing against either drug accurately predicted resistance or susceptibility for the other (99.7% agreement). Over 400,000 tests were performed to determine the fluoroquinolone susceptibility of E. coil. Data were analysed by the test method used (Calibrated Dichotomous Sensitivity (CDS) or National Committee for Clinical Laboratory Standards (NCCLS)). The data indicate that fluoroquinolone resistance in E. coli has not yet emerged as a significant problem in Australia, but there are some indications of low level increases in resistance rates. Norfloxacin results are likely to be a better guide to fluoroquinolone resistance in this species using this method of surveillance.

Australia↗
PubMed1993

Has informed consent finally arrived in Australia? A comment on the law following the decision of the High Court of Australia in Rogers v. Whitaker.

A struggle is going on all over the world between medical paternalism and patient autonomy. The battlegrounds include clinics, hospitals, academic settings and the courts. The High Court has awarded the most recent round, six to nothing, to autonomy, but the fight is by no means over. The judgements, the current law in Australia, and the implications for medical practice are discussed.

Adult↗
PubMed1994

Minimizing drug-related harm in Australia-Australia's National Drug Strategy.

The article describes the nature, origins and development of Australia's recently announced National Drug Strategy (NDS). The NDS aims to minimize the harmful effects of drugs and drug use in Australian society and covers the period 1993-97. The National Drug Strategic Plan is discussed, and the means by which the NDS will be monitored. The National Campaign Against Drug Abuse (NCADA), the forerunner to the NDS, is reviewed in terms of its major achievements. The Campaign was particularly successful in raising the policy profile of alcohol and tobacco, the drugs causing the most harm in Australian society. The relationship between the latest evaluation of NCADA and the NDS is also described.

Journal Article↗
PubMed2005

Multivalvulid myxozoans from eastern Australia: three new species of Kudoa from scombrid and labrid fishes of the Great Barrier Reef, Queensland, Australia.

Three new species of Kudoa, each having 6 polar capsules, are described from the somatic muscle of fishes collected on the Great Barrier Reef, Queensland, Australia. Kudoa grammatorcyni n. sp. was observed in the shark mackerel Grammatorcynus bicarinatus. Spores are stellate in apical view, width (all measurements in microm) 8.62 (8.03-8.95); thickness 8.14 (7.63-8.68); suture width 7.7 (7.24-8.16); length 6.54 (6.32-6.71); polar capsule length 3.68 (3.55-3.82); polar capsule width 1.72 (1.65-1.84). Kudoa scomberomori n. sp. is described from the Spanish mackerel Scomberomorus commerson. Spores are stellate in apical view, width 7.56 (6.84-8.16); thickness 6.79 (6.18-7.63); suture width 5.92 (5.26-6.32); length 5.43 (5.00-6.18); polar capsule length 3.24 (3.03-3.55); polar capsule width 1.37 (1.25-1.51). Kudoa thalassomi n. sp. is described from the moon wrasse Thalassoma lunare. Spores are stellate in apical view, width 10.66 (9.47-11.84); thickness 9.37 (8.55-10.79); suture width 7.98 (6.84-8.82); length 6.65 (6.18-7.11); polar capsule length 4.92 (4.74-5.00); polar capsule width 2.12 (2.04-2.24). All 3 species differ in spore morphology from the 1 previously described myxozoan with 6 polar capsules, Hexacapsula neothunni from yellowfin tuna Neothunnus macropterus, which has since been reassigned to Kudoa.

Animals↗