Research Publications and Outputs

The potential value of monitoring bone turnover markers among women on alendronate

Sun, 01 Jan 2012 00:00:00 GMT

The potential value of monitoring bone turnover markers among women on alendronate Bell, Katy J.L.; Hayen, Andrew; Irwig, Les; Hochberg, Marc C; Ensrud, Kristine E; Cummings, Steven R; Bauer, Douglas C Biochemical markers of bone turnover have been proposed to monitor the response to bisphosphonate therapy for osteoporosis, but this requires true between-person differences in the response to therapy.. Using mixed models we analysed 3 annual measurements of two markers (bone alkaline phosphatise (BAP) and cross linked N-telopeptide of type I collagen (NTX)) from the Fracture Intervention Trial. We compared marker variation among women allocated to alendronate with that among women allocated to placebo to estimate how much variation was due to true between-person differences in response to treatment, and how much was due to random within-person fluctuations unrelated to treatment. For both markers we found that the mean effect of treatment differed by the baseline level of marker. After allowing for this and other effects, we found large true between-person differences in response to treatment for both markers, with a coefficient of variation for NTX of 25.1% and for BAP of 21.2%. However random within-person fluctuation was even larger, with a coefficient of variation for change in NTX of 42.5% and for change in BAP of 25.8%. Although repeated measurements have the potential to reduce within person variability, even triplicate baseline marker measurements resulted in an averaged value that was only within 30% of the true value with 95% certainty. In summary, although bone turn-over markers appear promising for monitoring between person differences in response to treatment, their use in clinical practice is currently limited by large random within-person variation.

Use of randomised trials to decide when to monitor response to new treatment.

Tue, 01 Jan 2008 00:00:00 GMT

Use of randomised trials to decide when to monitor response to new treatment. Bell, Katy J.L.; Irwig, Les; Craig, Jonathan C; Macaskill, Petra Is monitoring initial response to treatment always helpful in clinical management of patients? Bell and colleagues have developed a framework for deciding whether surrogate outcomes should be used to monitor initial response to treatment in chronic disease.

Incremental benefits and harms of the 2017 American College of Cardiology/American Heart Association high blood pressure guideline.

Mon, 01 Jan 2018 00:00:00 GMT

Incremental benefits and harms of the 2017 American College of Cardiology/American Heart Association high blood pressure guideline. Bell, Katy J.L.; Doust, Jenny; Glasziou, Paul The recent recommendations from the American College of Cardiology and the American Heart Association (ACC/AHA) to lower the thresholds for defining hypertension and for treating higher-risk patients1 have been controversial. For example, the Clinical Guidelines Committee of the American College of Physicians (ACP) argued that the changes are “not supported by evidence and may result in low-value care,” and the American Academy for Family Physicians (AAFP) raised concerns that the “harms of treating a patient to a lower blood pressure (BP) were not assessed.” The Table summarizes key differences between the ACC/AHA guideline and prior guidelines.

Monitoring Adherence to Medication by Measuring Change in Blood Pressure.

Fri, 01 Jan 2010 00:00:00 GMT

Monitoring Adherence to Medication by Measuring Change in Blood Pressure. Hayen, Andrew; Bell, Katy J.L.; Glasziou, Paul; Neal, Bruce; Irwig, Les After starting antihypertensives, blood pressure is monitored for several reasons, including assessment of adherence. We aimed to estimate the accuracy of blood pressure monitoring for detecting early nonadherence. We conducted a secondary analysis of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a large randomized trial of blood pressure lowering to reduce the risk of recurrent stroke. We compared change in blood pressure 3 months after randomization in people who had discontinued treatment (nonadherent) with those who stayed on treatment (adherent). We also used an indirect method, assessing whether change in blood pressure discriminated between active (adherent) and placebo (nonadherent) groups. Both methods gave similar results. For the 3433 subjects, the mean (SD) of the change in systolic blood pressure was −15.8 mm Hg (SD 18.7 mm Hg) in the adherent group and −4.2 mm Hg (SD 18.1 mm Hg) in the nonadherent group. After recalibration of the mean change in the nonadherent group to 0 mm Hg and in the adherent group to −11.6 mm Hg, the absence of a fall in systolic blood pressure at 3 months had a sensitivity of 50% and a specificity of 80% for detecting nonadherence (50% of nonadherent patients and 20% of adherent patients had a rise in blood pressure). Discriminatory power was modest over the range of cutoffs (area under the receiver–operator curve 0.67). Monitoring blood pressure is poor at detecting nonadherence to blood pressure–lowering treatment. Further research should look at other methods of assessing adherence.

Depression Following Major Life Transitions in Women: A Review and Theory

Wed, 01 Jan 2020 00:00:00 GMT

Depression Following Major Life Transitions in Women: A Review and Theory Moustafa, Ahmed; Crouse, Jacob; Herzallah, Mohammad; Salama, Mohamed; Mohamed, Wael; Misiak, Błażej; Frydecka, Dorota; Al-Dosari, Nasser; Megreya, Ahmed; Mattock, Karen Depression can occur due to common major life transitions, such as giving birth, menopause, retirement, empty-nest transition, and midlife crisis. Although some of these transitions are perceived as positive (e.g., giving birth), they may still lead to depression. We conducted a systematic literature review of the factors underlying the occurrence of depression following major life transition in some individuals. This review shows that major common life transitions can cause depression if they are sudden, major, and lead to loss (or change) of life roles (e.g., no longer doing motherly or fatherly chores after children leave family home). Accordingly, we provide a theoretical framework that explains depression caused by transitions in women. One of the most potential therapeutic methods of ameliorating depression associated with life transitions is either helping individuals accept their new roles (e.g., accepting new role as a mother to ameliorate postpartum depression symptoms) or providing them with novel life roles (e.g., volunteering after retirement or children leave family home) may help them overcome their illness.

Optimizing the frequency of follow-up visits for patients treated for localized primary cutaneous melanoma

Sat, 01 Jan 2011 00:00:00 GMT

Optimizing the frequency of follow-up visits for patients treated for localized primary cutaneous melanoma Turner, Robin M; Bell, Katy J.L.; Morton, Rachael L; Hayen, Andrew; Francken, Anne B; Howard, Kirsten; Armstrong, Bruce; Thompson, John F; Irwig, Les To develop more evidence-based guidelines for the frequency of patient follow-up after treatment of localized (American Joint Committee on Cancer [AJCC] stage I or II) melanoma. Methods: We used data from Melanoma Institute Australia on an inception cohort of 3,081 consecutive patients first diagnosed with stage I or II melanoma between January 1985 and December 2009. Kaplan-Meier curves and Cox models were used to characterize the time course and predictors for recurrence and new primaries. We modeled the delay in diagnosis of recurrence or new primary as well as the number of monitoring visits required using two monitoring schedules: first, according to 2008 Australian and New Zealand guidelines and, second, with fewer visits, especially for those at lowest risk of recurrence. Results: For every 1,000 patients beginning follow-up, 229 developed recurrence and 61 developed new primary within 10 years. There was only a small difference in modeled delay in diagnosis (extra 44.9 and 9.6 patients per 1,000 for recurrence and new primary, respectively, with delay greater than 2 months) using a schedule that requires far fewer visits (3,000 fewer visits per 1,000 patients) than recommended by current guidelines. AJCC substage was the most important predictor of recurrence, whereas age and date of primary diagnosis were important predictors of developing new primary. Conclusion: By providing less intensive monitoring, more efficient follow-up strategies are possible. Fewer visits with a more focused approach may address the needs of patients and clinicians to detect recurrent or new melanoma.

Prevalence of Differentiated Thyroid Cancer in Autopsy Studies Over Six Decades: A Meta-Analysis.

Fri, 01 Jan 2016 00:00:00 GMT

Prevalence of Differentiated Thyroid Cancer in Autopsy Studies Over Six Decades: A Meta-Analysis. Furuya-Kanamori, Luis; Bell, Katy J.L.; Clark, Justin; Glasziou, Paul; Doi, Suhail A.R. Differentiated thyroid cancer (DTC) incidence has been reported to have increased three- to 15-fold in the past few decades. It is unclear whether this represents overdiagnosis or a true increase in incidence. Therefore, the current study aimed to estimate the prevalence of incidental DTC in published autopsy series and determine whether this prevalence has been increasing over time.

Value of routine monitoring of bone mineral density after starting bisphosphonate treatment: secondary analysis of trial data.

Thu, 01 Jan 2009 00:00:00 GMT

Value of routine monitoring of bone mineral density after starting bisphosphonate treatment: secondary analysis of trial data. Bell, Katy J.L.; Hayen, Andrew; Macaskill, Petra; Irwig, Les; Craig, Jonathan C; Bauer, Douglas C To assess the value of monitoring response to bisphosphonate treatment by means of measuring bone mineral density. In this paper we investigate the effects of alendronate on bone density at the individual level. We compare the variability of bone density for patients receiving placebo with that for patients taking treatment, using mixed models12 to make inferences about whether the effect of treatment varies among individuals or is uniform. Between-person (treatment related) variation and within-person (measurement related) variation in hip and spine bone mineral density.

Prevalence of incidental prostate cancer: A systematic review of autopsy studies

Thu, 01 Jan 2015 00:00:00 GMT

Prevalence of incidental prostate cancer: A systematic review of autopsy studies Bell, Katy J.L.; Del Mar, Chris; Wright, Gordon; Dickinson, James; Glasziou, Paul Prostate cancer screening may detect nonprogressive cancers, leading to overdiagnosis and overtreatment. The potential for overdiagnosis can be assessed from the reservoir of prostate cancer in autopsy studies that report incidental prostate cancer rates in men who died of other causes. We aimed to estimate the age‐specific incidental cancer prevalence from all published autopsy studies. We identified eligible studies by searches of Medline and Embase, forward and backward citation searches and contacting authors. We screened the titles and abstracts of all articles; checked the full‐text articles for eligibility and extracted clinical and pathology data using standardized forms. We extracted mean cancer prevalence, age‐specific cancer prevalence and validity measures and then pooled data from all studies using logistic regression models with random effects. The 29 studies included in the review dated from 1948 to 2013. Incidental cancer was detected in all populations, with no obvious time trends in prevalence. Prostate cancer prevalence increased with each decade of age, OR = 1.7 (1.6–1.8), and was higher in studies that used the Gleason score, OR = 2.0 (1.1–3.7). No other factors were significantly predictive. The estimated mean cancer prevalence increased in a nonlinear fashion from 5% (95% CI: 3–8%) at age <30 years to 59% (95% CI: 48–71%) by age >79 years. There was substantial variation between populations in estimated cancer prevalence. There is a substantial reservoir of incidental prostate cancer which increases with age. The high risk of overdiagnosis limits the usefulness of prostate cancer screening.

Epidemiology of COVID-19 infection in young children under five years: A systematic review and meta-analysis

Fri, 01 Jan 2021 00:00:00 GMT

Epidemiology of COVID-19 infection in young children under five years: A systematic review and meta-analysis Bhuiyan, M.U.; Stiboy, E.; Hassan, M.Z.; Chan, M.; Islam, M.S.; Haider, N.; Jaffe, A.; Homaira, N. Introduction: Emerging evidence suggests young children are at greater risk of COVID-19 infection than initially predicted. However, a comprehensive understanding of epidemiology of COVID-19 infection in young children under five years, the most at-risk a

Priority allocation of pandemic influenza vaccines in Australia – Recommendations of 3 community juries

Fri, 01 Jan 2021 00:00:00 GMT

Priority allocation of pandemic influenza vaccines in Australia – Recommendations of 3 community juries Degeling, C.; Williams, J.; Carter, S.M.; Moss, R.; Massey, P.; Gilbert, G.L.; Shih, P.; Braunack-Mayer, A.; Crooks, K.; Brown, D.; McVernon, J. Background: Pandemic planning has historically been oriented to respond to an influenza virus, with vaccination strategy being a key focus. As the current COVID-19 pandemic plays out, the Australian government is closely monitoring progress towards develo

Patient privacy in the COVID-19 era: Data access, transparency, rights, regulation and the case for retaining the status quo

Fri, 01 Jan 2021 00:00:00 GMT

Patient privacy in the COVID-19 era: Data access, transparency, rights, regulation and the case for retaining the status quo Henderson, J.

Effects of the COVID-19 pandemic on environmental sustainability in anaesthesia. Response to Br J Anaesth 2020

Fri, 01 Jan 2021 00:00:00 GMT

Effects of the COVID-19 pandemic on environmental sustainability in anaesthesia. Response to Br J Anaesth 2020 McGain, F.; Muret, J.; Lawson, C.; Sherman, J.D.

Concerns and motivations about COVID-19 vaccination

Fri, 01 Jan 2021 00:00:00 GMT

Concerns and motivations about COVID-19 vaccination Dodd, R.H.; Pickles, K.; Nickel, B.; Cvejic, E.; Ayre, J.; Batcup, C.; Bonner, C.; Copp, T.; Cornell, S.; Dakin, T.; Isautier, J.; McCaffery, K.J.

Constructing an ethical framework for priority allocation of pandemic vaccines

Fri, 01 Jan 2021 00:00:00 GMT

Constructing an ethical framework for priority allocation of pandemic vaccines Fielding, J; Sullivan, S.G.; Beard, F.; Macartney, K.; Williams, J.; Dawson, A.; Gilbert, G.L.; Massey, P.; Crooks, K.; Moss, R.; McCaw, J.M.; McVernon, J. BACKGROUND: Allocation of scarce resources during a pandemic extends to the allocation of vaccines when they eventually become available. We describe a framework for priority vaccine allocation that employed a cross-disciplinary approach, guided by ethica

Sex matters: COVID-19 in kidney transplantation

Fri, 01 Jan 2021 00:00:00 GMT

Sex matters: COVID-19 in kidney transplantation Vinson, Amanda J; Chong, Anita S; Clegg, Deborah; Falk, Christine; Foster, Bethany J; Halpin, Anne; Mannon, Roslyn B; Palmer, Biff F; Oertelt-Prigione, Sabine; West, Lori J; Wong, Germaine; Sapir-Pichhadze, Ruth

COVID-19 misinformation in Australia: key groups and trends over time in a national longitudinal survey (Preprint)

Fri, 01 Jan 2021 00:00:00 GMT

COVID-19 misinformation in Australia: key groups and trends over time in a national longitudinal survey (Preprint) Pickles, Kristen; Cvejic, Erin; Nickel, Brooke; Copp, Tessa; Bonner, Carissa; Leask, Julie; Ayre, Julie; Batcup, Carys; Cornell, Samuel; Dakin, Thomas; Dodd, Rachael H; Isautier, Jennifer M J; McCaffery, Kirsten J BACKGROUND: Misinformation about COVID-19 is common and has been spreading rapidly across the globe through social media platforms and other information systems. Understanding what the public knows about COVID-19 and identifying beliefs based on misinform

How to use imperfect tests for COVID-19 (SARS-CoV-2) to make clinical decisions

Fri, 01 Jan 2021 00:00:00 GMT

How to use imperfect tests for COVID-19 (SARS-CoV-2) to make clinical decisions Bell, Katy J.L.; Stanaway, Fiona F; Irwig, Les M; Horvath, Andrea R; Teixeira-Pinto, Armando; Loy, Clement

COVID-19: estimated number of deaths if Australia had experienced a similar outbreak to England and Wales

Fri, 01 Jan 2021 00:00:00 GMT

COVID-19: estimated number of deaths if Australia had experienced a similar outbreak to England and Wales Stanaway, Fiona; Irwig, Les M; Teixeira-Pinto, Armando; Bell, Katy J.L.

Research priorities for COVID-19 sensor technology

Fri, 01 Jan 2021 00:00:00 GMT

Research priorities for COVID-19 sensor technology Tong, Allison; Sorrell, Tania C.; Black, Andrew J.; Caillaud, Corinne; Chrzanowski, Wojciech; Li, Eugena; Martinez-Martin, David; McEwan, Alistair; Wang, Rex; Motion, Alice; Bedoya, Alvaro Casas; Huang, Jun; Azizi, Lamiae; Eggleton, Benjamin

The mental health status and approaches of accessing antenatal care information among pregnant women during COVID-19 epidemic:a cross-sectional study in China (Preprint)

Fri, 01 Jan 2021 00:00:00 GMT

The mental health status and approaches of accessing antenatal care information among pregnant women during COVID-19 epidemic:a cross-sectional study in China (Preprint) Jiang, Hong; Jin, Longmei; Qian, Xu; Xiong, Xu; La, Xuena; Chen, Weiyi; Yang, Xiaoguang; Yang, Fengyun; Zhang, Xinwen; Abudukelimu, Nazhakaiti; Li, Xingying; Xie, Zhenyu; Zhu, Xiaoling; Zhang, Xiaohua; Zhang, Lifeng; Wang, Li; Li, Lingling BACKGROUND: China was the first country in the world to experience a large-scale COVID-19 outbreak. The rapid spread of the disease and enforcement of public health measures has caused distress among vulnerable populations such as pregnant women. With a l

Understanding country-specific determinants of stillbirth using household surveys: The case of Afghanistan

Mon, 01 Jan 2018 00:00:00 GMT

Understanding country-specific determinants of stillbirth using household surveys: The case of Afghanistan Christou, Aliki; Dibley, Michael J.; Rasooly, Mohammad Hafiz; Mubasher, Adela; Hofiani, Sayed Murtaza Sadat; Rashidi, Mohammad Khakerah; Kelly, Patrick J.; Raynes-Greenow, Camille Background: Stillbirth rates in Afghanistan have declined little in the past decade with no data available on key risk factors. Health care utilisation and maternal com- plications are important factors influencing pregnancy outcomes but rarely captured for stillbirth in national surveys from low‐ and middle‐income countries. The 2010 Afghanistan Mortality Survey (AMS) is one of few surveys with this information. Methods: We used data from the 2010 AMS that included a full pregnancy history and verbal autopsy. Our sample included the most recent live birth or stillbirth of 13 834 women aged 12‐49 years in the three years preceding the survey. Multivariable Poisson regression was used to identify sociodemographic, maternal, and health care utilisation risk factors for stillbirth. Results: The risk of stillbirth was increased among women in the Central Highlands (aRR: 3.01, 95% CI 1.35, 6.70) and of Nuristani ethnicity (aRR: 9.15, 95% CI 2.95, 28.74). Women who did not receive antenatal care had three times increased risk of stillbirth (aRR: 3.03, 95% CI 1.73, 5.30), while high‐quality antenatal care was impor- tant for reducing the risk of intrapartum stillbirth. Bleeding, infection, headache, and reduced fetal movements were antenatal complications strongly associated with stillbirth. Reduced fetal movements in the delivery period increased stillbirth risk by almost seven (aRR: 6.82, 95% CI 4.20, 11.10). Facility births had a higher risk of still- births overall (aRR: 1.55, 95% CI 1.12, 2.16), but not for intrapartum stillbirths. Conclusions: Targeted interventions are needed to improve access and utilisation of services for high‐risk groups. Early detection of complications through improved quality of antenatal and obstetric care is imperative. We demonstrate the potential of household surveys to provide country‐specific evidence on stillbirth risk factors for LMICs where data are lacking.

Understanding pathways leading to stillbirth: the role of care-seeking and care received during pregnancy and childbirth in Kabul province, Afghanistan

Wed, 01 Jan 2020 00:00:00 GMT

Understanding pathways leading to stillbirth: the role of care-seeking and care received during pregnancy and childbirth in Kabul province, Afghanistan Christou, Aliki; Alam, Ashraful; Hofiani, Sayed Murtaza Sadat; Rasooly, Mohammad Hafiz; Mubasher, Adela; Rashidi, Mohammad Khakerah; Dibley, Michael; Raynes-Greenow, Camille Background: The underlying pathways leading to stillbirth in low- and middle-income countries are not well understood. Context-specific understanding of how and why stillbirths occur is needed to prioritise interventions and identify barriers to their effective implementation and uptake. Aim: To explore the contribution of contextual, individual, household-level and health system factors to stillbirth in Afghanistan. Methods: Using a qualitative approach, we conducted semi-structured in-depth interviews with women and men that experienced stillbirth, female elders, community health workers, healthcare providers, and government officials in Kabul province, Afghanistan between October-November 2017. We used thematic analysis to identify contributing factors and developed a conceptual map describing possible pathways to stillbirth. Findings: We found that low utilisation and access to healthcare was a key contributing factor, as were unmanaged conditions in pregnancy that increased women’s risk of complications and stillbirth. Sociocultural factors related to the treatment of women and perceptions about medical interventions deprived women of interventions that could potentially prevent stillbirth. The quality of care from public and private providers during pregnancy and childbirth was a recurring concern exacerbated by health system constraints that led to unnecessary delays; while environmental factors linked to the ongoing conflict were also perceived to contribute to stillbirth. These pathways were underscored by social, cultural, economic factors and individual perceptions that contributed to the three-delays.

‘I should have seen her face at least once’: parent’s and healthcare providers’ experiences and practices of care after stillbirth in Kabul province, Afghanistan

Fri, 01 Jan 2021 00:00:00 GMT

‘I should have seen her face at least once’: parent’s and healthcare providers’ experiences and practices of care after stillbirth in Kabul province, Afghanistan Christou, Aliki; Ashraful, Alam; Hofiani, Sayed Murtaza Sadat; Mubasher, Adela; Rasooly, Mohammad Hafiz; Rashidi, Mohammad Khakerah; Raynes-Greenow, Camille Objective This study aimed to explore bereaved parents’ and healthcare providers experiences of care after stillbirth. Study design Qualitative in-depth interviews with 55 women, men, female elders, healthcare providers and key informants in Kabul province, Afghanistan between October and November 2017. Results Inadequate and insensitive communication and practices by healthcare providers, including avoiding or delaying disclosing the stillbirth were recurring concerns. There was a disconnect between parents’ desires and healthcare provider’s perceptions. The absence of shared decision-making on seeing and holding the baby and memory-making, manifested as profound regret. Health providers’ reported hospitals were not equipped to separate women who had a stillbirth and acknowledged that psychological support would be beneficial. However, the absence of trained personnel and resource constraints prevented provision of such support. Conclusion Findings can inform future provision of perinatal bereavement care. Given resource constraints, communication training can be considered with longer term goals to develop context-appropriate bereavement care guidelines.

Setting minimum clinical performance specifications for tests based on disease prevalence and minimum acceptable positive and negative predictive values: Practical considerations applied to COVID-19 testing

Wed, 01 Jan 2020 00:00:00 GMT

Setting minimum clinical performance specifications for tests based on disease prevalence and minimum acceptable positive and negative predictive values: Practical considerations applied to COVID-19 testing Ping Loh, Tze; Lord, Sarah J; Bell, Katy J.L.; Kathryn Bohn, Mary; Yee Lim, Chun; Markus, Corey; Fares Taie, Hernan; Adeli, Khosrow; Lippi, Giuseppe; Sandberg, Sverre; Horvath, Andrea OBJECTIVES: Several guidelines for the evaluation of laboratory tests for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection have recommended establishing an a priori definition of minimum clinical performance specifications before test selection and method evaluation. METHODS: Using positive (PPV) and negative predictive values (NPV), we constructed a spreadsheet tool for determining the minimum clinical specificity (conditional on NPV or PPV, sensitivity and prevalence) and minimum clinical sensitivity (conditional on NPV or PPV, specificity and prevalence) of tests. RESULTS: At a prevalence of 1%, there are no minimum sensitivity requirements to achieve a desired NPV of 60%-95% for a given clinical specificity above 20%. It is not possible to achieve 60-95% PPV even with 100% clinical sensitivity, except when the clinical specificity is near 100%. The opposite trend is seen in high prevalence settings (60%), where a relatively low minimum clinical sensitivity is required to achieve a desired PPV for a given clinical specificity, and a higher minimum clinical specificity is required to achieve a desired NPV for a given clinical sensitivity. DISCUSSION: The selection of laboratory tests and the testing strategy for SARS-CoV-2 involves delicate trade-offs between NPV and PPV based on prevalence and clinical sensitivity and clinical specificity. Practitioners and health authorities should carefully consider the clinical scenarios under which the test result will be used and select the most appropriate testing strategy that fulfils the a priori defined clinical performance specification.

Lessons from the COVID-19 pandemic: People’s experiences and satisfaction with telehealth during the COVID-19 pandemic in Australia (Preprint)

Wed, 01 Jan 2020 00:00:00 GMT

Lessons from the COVID-19 pandemic: People’s experiences and satisfaction with telehealth during the COVID-19 pandemic in Australia (Preprint) Isautier, Jennifer Mj; Copp, Tessa; Ayre, Julie; Cvejic, Erin; Meyerowitz-Katz, Gideon; Batcup, Carys; Bonner, Carissa; Dodd, Rachael; Nickel, Brooke; Pickles, Kristen; Cornell, Samuel; Dakin, Thomas; McCaffery, Kirsten J BACKGROUND: In response to the COVID-19 pandemic, telehealth has rapidly been adopted to deliver healthcare services around the world. To date, research has not investigated how people's experience with telehealth services compare to traditional in-person visits during the pandemic in Australia. OBJECTIVE: To determine how participants perceived telehealth consults in comparison to traditional in-person visits, and to investigate whether people believe that telehealth services would be useful beyond the pandemic. METHODS: A national cross-sectional community survey was conducted between June 5th and June 12th in Australia. Participants aged 18 years and over and living in Australia were recruited via targeted advertisements on social media (Facebook and Instagram) (n=1369). Participants responded to survey questions about their telehealth experience, which included a free-text response option. A generalised linear model was used to estimate adjusted relative risks of having a poorer telehealth experience compared to traditional in-person visits. Content analysis was used to determine the reasons provided for why telehealth experiences were worse than traditional in-person visits. RESULTS: Of the 596 telehealth users, the majority of respondents (62%) rated their telehealth experience as "just as good" or "better" than a traditional in-person medical appointment. On average, respondents perceived that telehealth would be moderately to very useful for medical appointments after the COVID-19 pandemic is over (M=3.67 out of 5, SD=1.1). Being male (p=0.007), having a history of both depression and anxiety (p=0.037), or lower patient activation (individuals' willingness to take on the role of managing their health/healthcare) (p=0.037) were associated with a poorer telehealth experience. Six overarching themes were identified from free-text responses of why telehealth experience was poorer than a traditional in-person medical appointment: communication is not as effective; limitations with technology; issues with obtaining prescriptions and pathology; reduced confidence in doctor; additional burden for complex care; and inability to be physically examined. CONCLUSIONS: Telehealth appointments were reported to be comparable to traditional in-person medical appointments by most of our sample. Telehealth may be worthwhile as mode of healthcare delivery while the pandemic continues and may be worthwhile beyond the pandemic.

Estimating the extent of asymptomatic COVID-19 and its potential for community transmission: Systematic review and meta-analysis

Wed, 01 Jan 2020 00:00:00 GMT

Estimating the extent of asymptomatic COVID-19 and its potential for community transmission: Systematic review and meta-analysis Byambasuren, Oyungerel; Cardona, Magnolia; Bell, Katy J.L.; Clark, Justin; McLaws, Mary-Louise; Glasziou, Paul Background: The prevalence of true asymptomatic COVID-19 cases is critical to policy makers considering the effectiveness of mitigation measures against the SARS-CoV-2 pandemic. We aimed to synthesize all available research on the asymptomatic rates and transmission rates where possible. Methods: We searched PubMed, Embase, Cochrane COVID-19 trials, and Europe PMC (which covers pre-print platforms such as MedRxiv). We included primary studies reporting on asymptomatic prevalence where: (a) the sample frame includes at-risk population, and (b) there was sufficiently long follow up to identify pre-symptomatic cases. Meta-analysis used fixed effect and random effects models. We assessed risk of bias by combination of questions adapted from risk of bias tools for prevalence and diagnostic accuracy studies. Results: We screened 2,454 articles and included 13 low risk-of-bias studies from seven countries that tested 21,708 at-risk people, of which 663 were positive and 111 were asymptomatic. Diagnosis in all studies was confirmed using a RT-PCR test. The proportion of asymptomatic cases ranged from 4% to 41%. Meta-analysis (fixed effect) found that the proportion of asymptomatic cases was 17% (95% CI: 14%�20%) overall; higher in aged care 20% (14%�27%), and lower in non-aged care 16% (13%�20%). Five studies provided direct evidence of forward transmission of the infection by asymptomatic cases. Overall, there was a 42% lower relative risk of asymptomatic transmission compared to symptomatic transmission (combined Relative Risk: 0.58; 95% CI 0.335�0.994, p = 0.047). Discussion: Our estimates of the prevalence of asymptomatic COVID-19 cases and asymptomatic transmission rates are lower than many highly publicized studies, but still sufficient to warrant policy attention. Further robust epidemiological evidence is urgently needed, including in sub-populations such as children, to better understand the importance of asymptomatic cases for driving spread of the pandemic.

Public Health Ethics in a Pandemic

Wed, 01 Jan 2020 00:00:00 GMT

Public Health Ethics in a Pandemic Verweij, Marcel; Dawson, Angus

Retrospective case-control study of 2017 g2p[4] rotavirus epidemic in rural and remote australia

Wed, 01 Jan 2020 00:00:00 GMT

Retrospective case-control study of 2017 g2p[4] rotavirus epidemic in rural and remote australia Middleton, B.F.; Danchin, M.; Quinn, H.; Ralph, A.P.; Pingault, N.; Jones, M.; Estcourt, M.; Snelling, T. Background: A widespread G2P[4] rotavirus epidemic in rural and remote Australia provided an opportunity to evaluate the performance of Rotarix and RotaTeq rotavirus vaccines, ten years after their incorporation into Australia’s National Immunisation Program. Methods: We conducted a retrospective case-control analysis. Vaccine-eligible children with laboratory-confirmed rotavirus infection were identified from jurisdictional notifiable infectious disease databases and individually matched to controls from the national immunisation register, based on date of birth, Aboriginal status and location of residence. Results: 171 cases met the inclusion criteria; most were Aboriginal and/or Torres Strait Islander (80%) and the median age was 19 months. Of these cases, 65% and 25% were fully or partially vaccinated, compared to 71% and 21% of controls. Evidence that cases were less likely than controls to have received a rotavirus vaccine dose was weak, OR 0.79 (95% CI, 0.46–1.34). On pre-specified subgroup analysis, there was some evidence of protection among children <12 months (OR 0.48 [95% CI, 0.22–1.02]), and among fully vs. partially vaccinated children (OR 0.65 [95% CI, 0.42–1.01]). Conclusion: Despite the known effectiveness of rotavirus vaccination, a protective effect of either rotavirus vaccine during a G2P[4] outbreak in these settings among predominantly Aboriginal children was weak, highlighting the ongoing need for a more effective rotavirus vaccine and public health strategies to better protect Aboriginal children.

Changes in public perceptions and experiences of the Australian health?care system: A decade of change

Wed, 01 Jan 2020 00:00:00 GMT

Changes in public perceptions and experiences of the Australian health?care system: A decade of change Ellis, Louise A.; Pomare, Chiara; Gillespie, James A.; Root, Jo; Ansell, James; Holt, Joanna; Wells, Leanne; Tran, Yvonne; Braithwaite, Jeffrey; Zurynski, Yvonne BACKGROUND: The views and experiences of the Australian public are an important barometer of the health system. This study provides key findings about the changing views held by Australians over time regarding their individual experiences and perceptions of the overall performance of the health system. METHODS: A population-based online survey was conducted in 2018 (N = 1024). Participants were recruited through market research panels. The results were compared with previous Australian population survey data sets from 2008 (N = 1146), 2010 (N = 1201) and 2012 (N = 1200), each of which used different population samples. The survey included questions consistent with previous surveys regarding self-reported health status, and questions about use, opinions and experiences of the health system. RESULTS: Overall, there has been a shift in views from 2008 to 2018, with a higher proportion of respondents now viewing the Australian health-care system more positively (X2 (2, N = 4543) = 96.59

Counting stillbirths and COVID 19—there has never been a more urgent time

Wed, 01 Jan 2020 00:00:00 GMT

Counting stillbirths and COVID 19—there has never been a more urgent time Homer, Caroline S E; Leisher, Susannah Hopkins; Aggarwal, Neelam; Akuze, Joseph; Babona, Delly; Blencowe, Hannah; Bolgna, John; Chawana, Richard; Christou, Aliki; Davies-Tuck, Miranda; Dandona, Rakhi; Gordijn, Sanne; Gordon, Adrienne; Jan, Rafat; Korteweg, Fleurisca; Maswime, Salome; Murphy, Margaret M; Quigley, Paula; Storey, Claire; Vallely, Lisa M; Waiswa, Peter; Whitehead, Clare; Zeitlin, Jennifer; Flenady, Vicki

The 2020 special report of the MJA–Lancet Countdown on health and climate change: lessons learnt from Australia’s “Black Summer”

Wed, 01 Jan 2020 00:00:00 GMT

The 2020 special report of the MJA–Lancet Countdown on health and climate change: lessons learnt from Australia’s “Black Summer” Zhang, Y.; Beggs, P.J.; McGushin, A.; Bambrick, H.; Trueck, S.; Hanigan, I.C.; Morgan, G.G.; Berry, H.L.; Linnenluecke, M.K.; Johnston, F.H.; Capon, A.G.; Watts, N. The MJA–Lancet Countdown on health and climate change was established in 2017, and produced its first Australian national assessment in 2018 and its first annual update in 2019. It examines indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. In the wake of the unprecedented and catastrophic 2019–20 Australian bushfire season, in this special report we present the 2020 update, with a focus on the relationship between health, climate change and bushfires, highlighting indicators that explore these linkages. In an environment of continuing increases in summer maximum temperatures and heatwave intensity, substantial increases in both fire risk and population exposure to bushfires are having an impact on Australia’s health and economy. As a result of the “Black Summer” bushfires, the monthly airborne particulate matter less than 2.5 ?m in diameter (PM2.5) concentrations in New South Wales and the Australian Capital Territory in December 2019 were the highest of any month in any state or territory over the period 2000–2019 at 26.0 ?g/m3 and 71.6 ?g/m3 respectively, and insured economic losses were $2.2 billion. We also found growing awareness of and engagement with the links between health and climate change, with a 50% increase in scientific publications and a doubling of newspaper articles on the topic in Australia in 2019 compared with 2018. However, despite clear and present need, Australia still lacks a nationwide adaptation plan for health. As Australia recovers from the compounded effects of the bushfires and the coronavirus disease 2019 (COVID-19) pandemic, the health profession has a pivotal role to play. It is uniquely suited to integrate the response to these short term threats with the longer term public health implications of climate change, and to argue for the economic recovery from COVID-19 to align with and strengthen Australia’s commitments under the Paris Agreement.

Supplementary data 1: Disparities in COVID-19 related knowledge, attitudes, beliefs and behaviours by health literacy

Thu, 29 Oct 2020 00:00:00 GMT

Supplementary data 1: Disparities in COVID-19 related knowledge, attitudes, beliefs and behaviours by health literacy McCaffery, Kirsten; Dodd, Rachael H; Cvejic, Erin; Ayre, Julie; Batcup, Carys; Isautier, Jennifer MJ; Copp, Tessa; Bonner, Carissa; Pickles, Kristen; Nickel, Brooke; Dakin, Thomas; Cornell, Samuel; Wolf, Michael S Supplementary data for Disparities in COVID-19 related knowledge, attitudes, beliefs and behaviours by health literacy. Box 1. Survey Items and Scoring Scale

Supplementary data 2: Disparities in COVID-19 related knowledge, attitudes, beliefs and behaviours by health literacy

Thu, 29 Oct 2020 00:00:00 GMT

Supplementary data 2: Disparities in COVID-19 related knowledge, attitudes, beliefs and behaviours by health literacy McCaffery, Kirsten; Dodd, Rachael H; Cvejic, Erin; Ayre, Julie; Batcup, Carys; Isautier, Jennifer MJ; Copp, Tessa; Bonner, Carissa; Pickles, Kristen; Nickel, Brooke; Dakin, Thomas; Cornell, Samuel; Wolf, Michael S Supplementary data for Disparities in COVID-19 related knowledge, attitudes, beliefs and behaviours by health literacy. Table S1. Knowledge, attitudes, beliefs and behaviours related to COVID-19 in full analysis sample.

Suplementary data 3: Disparities in COVID-19 related knowledge, attitudes, beliefs and behaviours by health literacy

Thu, 29 Oct 2020 00:00:00 GMT

Suplementary data 3: Disparities in COVID-19 related knowledge, attitudes, beliefs and behaviours by health literacy McCaffery, Kirsten; Dodd, Rachael H; Cvejic, Erin; Ayre, Julie; Batcup, Carys; Isautier, Jennifer MJ; Copp, Tessa; Bonner, Carissa; Pickles, Kristen; Nickel, Brooke; Dakin, Thomas; Cornell, Samuel; Wolf, Michael S Supplementary data for Disparities in COVID-19 related knowledge, attitudes, beliefs and behaviours by health literacy. COVID survey baseline form

Validation of multiplex PCR sequencing assay of SIV

Wed, 01 Jan 2020 00:00:00 GMT

Validation of multiplex PCR sequencing assay of SIV Moriarty, Ryan V; Fesser, Nico; Sutton, Matthew S; Venturi, Vanessa; Davenport, Miles P; Schlub, Timothy; O'Connor, Shelby L Background: The generation of accurate and reproducible viral sequence data is necessary to understand the diversity present in populations of RNA viruses isolated from clinical samples. While various sequencing methods are available, they often require high quality templates and high viral titer to ensure reliable data. Methods: We modified a multiplex PCR and sequencing approach to characterize populations of simian immunodeficiency virus (SIV) isolated from nonhuman primates. We chose this approach with the aim of reducing the number of required input templates while maintaining fidelity and sensitivity. We conducted replicate sequencing experiments using different numbers of quantified viral RNA (vRNA) or viral cDNA as input material. We performed assays with clonal SIVmac239 to detect false positives, and we mixed SIVmac239 and a variant with 24 point mutations (SIVmac239-24X) to measure variant detection sensitivity. Results: We found that utilizing a starting material of quantified viral cDNA templates had a lower rate of false positives and increased reproducibility when compared to that of quantified vRNA templates. This study identifies the importance of rigorously validating deep sequencing methods and including replicate samples when using a new method to characterize low frequency variants in a population with a small number of templates. Conclusions: Because the need to generate reproducible and accurate sequencing data from diverse viruses from low titer samples, we modified a multiplex PCR and sequencing approach to characterize SIV from populations from non-human primates. We found that increasing starting template numbers increased the reproducibility and decreased the number of false positives identified, and this was further seen when cDNA was used as a starting material. Ultimately, we highlight the importance of vigorously validating methods to prevent overinterpretation of low frequency variants in a sample.

The impact of frailty on prolonged hospitalisation and mortality in elderly inpatients in Vietnam: a comparison between the frailty phenotype and the Reported Edmonton Frail Scale

Tue, 01 Jan 2019 00:00:00 GMT

The impact of frailty on prolonged hospitalisation and mortality in elderly inpatients in Vietnam: a comparison between the frailty phenotype and the Reported Edmonton Frail Scale Nguyen, A; Nguyen, TX; Nguyen, TN; Nguyen, TH; Pham, T; Cumming, R; Hilmer, S; Vu, H Aims To investigate the impact of frailty on outcomes in older hospitalized patients, including prolonged length of stay and all-cause mortality 6 months after admission, using both the frailty phenotype and the Reported Edmonton Frail Scale (REFS). Patients and methods This study is the follow-up phase of a study designed to investigate the prevalence of frailty and its impact on adverse outcomes in older hospitalized patients at the National Geriatric Hospital in Hanoi, Vietnam. Results A total of 461 participants were included, with a mean age 76.2±8.9 years, and 56.8% were female. The prevalence of frailty was 31.9% according to the REFS and 35.4% according to Fried's criteria. The kappa coefficient was 0.57 (95% CI =0.49-0.66) between the two frailty criteria in identifying frail and non-frail participants. There was a trend toward increasing the likelihood of prolonged hospitalization in participants with frailty defined by Fried's criteria (adjusted OR =1.49, 95% CI =0.94-2.35) or by REFS (adjusted OR =1.43, 95% CI =0.89-2.29). During 6 months of follow-up, 210 were lost and 18/251 (7.2%) participants died. Mortality was higher in those with frailty defined by either Fried's criteria or REFS. On multivariable survival analysis, adjusted HRs for mortality were 2.65 (95% CI =1.02-6.89) for Fried's criteria and 4.19 (95% CI =1.59-10.99) for REFS. Conclusion Fried's frailty phenotype or REFS can be used as a screening tool to detect frailty in older inpatients in Vietnam and predict mortality. Frailty screening can help prioritize targeted frailty-tailored treatments, such as nutrition, early mobility and medication review, for these vulnerable patients to improve clinical outcomes.

Prevalence of mild cognitive impairment among older people in Kazakhstan and potential risk factors.

Tue, 01 Jan 2019 00:00:00 GMT

Prevalence of mild cognitive impairment among older people in Kazakhstan and potential risk factors. Tsoy, R; Turuspekova, S; Klipitskaya, N; Mereke, A; Cumming, R Background: There have been no epidemiological studies of mild cognitive impairment (MCI) in Central Asia. Objective: The objective of this study was to describe the prevalence of, and risk factors for, MCI in an urban population in Kazakhstan. Methods: Adults aged 60 years and over were randomly selected from registers of 15 polyclinics in Almaty. Of 790 eligible people, 668 agreed to participate (response rate 85%). Subjects were screened using the Montreal Cognitive Assessment (MoCA). Those who scored 26 or lower on the MoCA were assessed by a multidisciplinary team and a diagnosis of normal cognition, MCI or dementia was made. Results: The median MoCA score was 22 and the prevalence of MCI was 30%. MoCA scores were lower, and MCI prevalence was higher, among those with less education and those with older age. There was no difference in MoCA scores or MCI prevalence by sex or ethnic group (Kazakh or Russian). High blood pressure, older age, and lower education were associated with increased odds of MCI in crude analyses but only age and education remained statistically significant in an adjusted logistic regression model. Conclusions: The prevalence of MCI in Kazakhstan is high. Higher levels of education may lead to lower prevalence of MCI in the future.

Cognitive test norms and comparison between healthy ageing, mild cognitive impairment, and dementia: A population-based study of older Aboriginal Australians

Tue, 01 Jan 2019 00:00:00 GMT

Cognitive test norms and comparison between healthy ageing, mild cognitive impairment, and dementia: A population-based study of older Aboriginal Australians Lavrencic, L; Bennett, H; Daylight, G; Draper, B; Cumming, R; Mack, H; Garvey, G; Lasschuit, D; Hill, Y; Chalkley, S; Delbaere, K; Broe, G; Radford, K Objective: The prevalence of dementia and cognitive impairment is higher in Aboriginal Australians compared to the national population, increasing the need to understand cognitive impairment in this at-risk population. This article reports normative data for a range of commonly used cognitive tests, in a population-based small normative sample of older Aboriginal Australians living in urban/regional New South Wales. Method: Participants included a representative random sample of community-dwelling older adults (60 years and older) with no cognitive impairment (n= 31),mild cognitive impairment (MCI;n= 38), or dementia diagnosis (n= 35), all from the Koori Growing Old Well Study. Cognitive tests included the Adden-brooke's Cognitive Examination Revised (ACE-R), Digit Span (Forward and Back-ward), Logical Memory, and the Oral Trail Making Test (A and B). Results: Descriptive statistics and percentile scores for each test were reported for the normative sample. Comparison of performance between the diagnostic groups showed significant differences between the groups on most cognitive tests. The control group consistently performed better than the dementia group; and better than the MCI group on all tests, except for simple attention and sequencing tasks (Digit Span Forward and Oral Trail Making A). The MCI group also scored better than the dementia group on all tests, except for the Logical Memory Recognition task. Conclusion: Results support the utility of these cognitive tests that are commonly used in clinical and research settings, and demonstrate that these tests can discriminate between diagnostic groups in Aboriginal Australians. The normative data provided will enhance cognitive assessment of individuals within this population.

The Ironbark program: Implementation and impact of a community-based fall prevention pilot program for older Aboriginal and Torres Strait Islander people

Mon, 01 Jan 2018 00:00:00 GMT

The Ironbark program: Implementation and impact of a community-based fall prevention pilot program for older Aboriginal and Torres Strait Islander people Lukaszyk, C; Coombes, J; Sherrington, C; Tiedemann, A; Keay, L; Mackean, T; Clemson, L; Cumming, R; Broe, T; Ivers, R Aim: To document the implementation and investigate within-group impact of The Ironbark Program: a community-based, Aboriginal-specific fall prevention program,in New South Wales, Australia. Methods: The Ironbark Program was trialled in six Aboriginal communities over a three- to six-month period. A mixed methods approach was used for program evaluation: strength, balance and gait were assessed to measure participant physical function and BMI was monitored. Semi-structured participant interviews investigated program suitability, relevance and impact. Results: Ninety-eight Aboriginal people aged 40+years registered for the pilot program, 77 (79%) of whom were present at all assessment time points. There were significant improvements in participant leg strength (average time to complete five repetition sit-to-stand: 14 seconds to 11 seconds), balance (timed single-leg stance:5.6 seconds to 7.8 seconds), gait (timed 4 m walk: 0.51 m/s to 0.94 m/s) and a significant decrease in BMI (32.0 to 31.6) was observed. Participants reported enjoying the program and stated they would recommend it to others. Conclusion: The evaluation of the Ironbark Program demonstrated acceptability,and showed significant improvements in physical function. If proven to be effective in a definitive trial, this program could be used widely to prevent falls in older Aboriginal people. Implications: Key features of the Ironbark Program were local Aboriginal management, culturally relevant resources, ongoing availability and enabling program use for people aged less than 65 years. These features should be retained on the pro-gram’s upscale, and may be incorporated into other healthy ageing programs developed for the Aboriginal population.

Poor dietary intake of nutrients and food groups are associated with increased risk of periodontal disease among community-dwelling older adults: a systematic literature review

Tue, 01 Jan 2019 00:00:00 GMT

Poor dietary intake of nutrients and food groups are associated with increased risk of periodontal disease among community-dwelling older adults: a systematic literature review O'Connor, J; Milledge, K; O'Leary, F; Cumming, R; Eberhard, J; Hirani, V Context Periodontal disease is a chronic inflammatory gum condition that is more prevalent in older populations. The development of periodontal disease has been directly linked to inflammatory dietary habits. Objective This systematic review aimed to 1) describe the relationship and 2) describe the direction of the relationship between dietary intake (nutrients and food groups) and periodontal disease in community-dwelling, older adults. PRISMA guidelines were followed for this review. Data Sources A systematic search of the databases MEDLINE, EMBASE, Global Health, CINAHL, Science Direct, Informit, and Cochrane Library was conducted from the earliest possible date until September 2018. Search terms were related to main themes: “periodontal disease,” “gingivitis,” “gum diseases,” “dietary intake” and “older adults.” The search produced 779 records, and after additional publications were obtained and duplicates were removed, 666 publications underwent title and abstract screening. Included papers were written in English and were based on populations of healthy, older adults living in community-based settings. Nine papers met inclusion criteria and were included in this review. Data Extraction Sample size, participant characteristics, inclusion and exclusion criteria, periodontal measures, dietary measures, confounders, and results were sorted by study type, author, year, and country. Data Analysis Quality of the extracted data was analyzed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Conclusions Inverse associations were found between fatty acids, vitamin C, vitamin E, beta-carotene, fiber, calcium, dairy, fruits, and vegetables and risk of periodontal disease. Overall, this review found a relationship between poor dietary intake and increased risk of periodontal disease; however, this needs to be further explored.

Body shape, fear of falling, physical performance, and falls among individuals aged 55 years and above

Tue, 01 Jan 2019 00:00:00 GMT

Body shape, fear of falling, physical performance, and falls among individuals aged 55 years and above Kioh, S; Mat, S; Kamaruzzaman, S; Ibrahim, F; Mokhtar, M; Hairi, N; Cumming, R; Myint, P; Tan, M Purpose To evaluate the relationship between waist-to-hip ratio (WHR) and fall-related outcomes in community-dwelling individuals aged 55 and above. Methods Cross-sectional data obtained from the first wave of the Malaysian Elders Longitudinal Research (MELoR) study were utilized for this study. Participants aged 55 years and over were recruited using simple random sampling from the electoral rolls of three local parliamentary constituencies. Socio-demographics, falls history and medical history were obtained through home-based computer-assisted interviews while anthropometric measurements, including WHR, and physical performance were obtained during hospital-based health checks. WHR was categorized into three arbitrary categories stratified by gender. Results Data on both falls and WHR were available for 1335 participants, mean age ± standard deviation (SD) = 68.4 ± 7.1 years. Logistic regression analyses using dummy variables revealed that individuals within the higher WHR group were significantly more likely to report a history of fall in the preceding 12 months {adjusted odds ratio (aOR) [95% confidence interval (CI)] = 1.78 (1.18–2.67)}, fear of falling [aOR (95% CI) = 1.58 (1.08–2.32)], impaired timed-up-and-go [2.14 (1.44–3.17)] and reduced functional reach [1.68 (1.18–2.38)] compared to those with lower WHR. A higher WHR remained independently associated with increased risk of falls compared to those with lower WHR after additional adjustment for fear of falling and functional performance. Conclusion Our finding suggests WHR as an independent risk factor for higher risk of fall which may indicate body shape as a potentially modifiable risk factor for falls in adults in aged 55 years and over.

Pro-inflammatory diet increases circulating inflammatory biomarkers and falls risk in community-dwelling older men

Tue, 01 Jan 2019 00:00:00 GMT

Pro-inflammatory diet increases circulating inflammatory biomarkers and falls risk in community-dwelling older men Cervo, M; Scott, D; Seibel, M; Cumming, R; Naganathan, V; Blyth, F; Le Couteur, D; Handelsman, D; Ribeiro, R; Waite, L; Shivappa, N; Hebert, J; Hirani, V Background: The relations between diet, chronic inflammation, and musculoskeletal health are unclear, especially among older men.Objective:This study aimed to determine associations of the Dietary Inflammatory Index (DII) with inflammatory biomarkers, musculoskeletal health, and falls risk in community-dwelling older men. Methods:The cross-sectional analysis included 794 community-dwelling men, mean age 81.1±4.5 y, who participated in the 5-y follow-up of the Concord Health and Aging in Men Project. Of these, 616 were seen again 3 y later for the longitudinal analysis. Energy-adjusted DII (E-DII) was calculated from a validated diet history questionnaire. Bone mineral density (BMD) was measured using DXA. Twenty-four inflammatory biomarkers were analyzed. Incident falls over 3 y were determined through telephone interviews every 4 mo. Multiple regression, linear mixed effects models, negative binomial regression, and mediation analysis were utilized in this study. Results:A higher E-DII score (indicating a more proinflammatory diet) was associated with higher concentrations ofIL-6 (β: 0.028 pg/mL; 95% CI: 0.003, 0.053), IL-7 (β: 0.020 pg/mL; 95% CI: 0.002, 0.037), and TNF-α (β: 0.027 pg/mL;95% CI: 0.003, 0.051). A higher E-DII score was also associated with lower appendicular lean mass adjusted for BMI (ALMBMI) (β:−0.006 kg/m2; 95% CI:−0.010,−0.001). For every unit increase in E-DII (range:−4.91 to+3.66 units),incident falls rates increased by 13% (incidence rate ratio: 1.13; 95% CI: 1.05, 1.21) over 3 y. Mediation analysis showed that the association between E-DII and 3-y incident falls was influenced by the concentrations of IL-7 by 24%. There was no association between E-DII and BMD. Conclusions:Consumption of a proinflammatory diet was associated with increased concentrations of IL-6, IL-7, and TNF-α; increased falls risk; and lower ALMBMI in community-dwelling older men. The association between incident falls and E-DII was partly mediated by concentrations of IL-7.

Frailty and Cause-Specific Hospitalizations in Community-Dwelling Older Men

Wed, 01 Jan 2020 00:00:00 GMT

Frailty and Cause-Specific Hospitalizations in Community-Dwelling Older Men Hsu, B; Naganathan, V; Blyth, F; Hirani, V; Le Couteur, D; Waite, L; Seibel, M; Handelsman, D; Cumming, R Objectives The types of medical conditions leading to hospitalization in frail older people have not been investigated. The objectives were to evaluate associations between frailty and (a) risk of all-cause and cause-specific hospitalization, and (b) rate of all-cause and cause-specific hospitalizations. Design, Setting and Participants Community-dwelling men aged 70+ years in the Concord Health and Ageing in Men Project (CHAMP) were assessed for frailty at baseline (2005–2007, n=1705). Measurements Frailty was determined by both the Fried frailty phenotype (FP) and the Rockwood frailty index (FI). Non-elective and elective hospitalization data were accessed from the New South Wales (NSW) Admitted Patient Data Collection and mortality from the NSW Deaths Registry for the period 2005–2017. Causes of hospitalization were categorized using ICD-10 classification of principal diagnoses based on organ system involved into 14 major categories. Results Nearly 80% of CHAMP men had at least one non-elective hospitalization and 63% had an elective hospitalization over a 9-year follow-up. Men with FP frailty were twice as likely to have a non-elective hospitalization (HR: 1.98, 95%CI: 1.61–2.44) and a greater number of non-elective hospitalizations (IRR: 1.44, 95%CI: 1.22-1.70). Similar relationships were found between FI frailty and non-elective hospitalizations. Men with frailty (either FP or FI) were more likely to have at least one non-elective hospitalization for 13 of the 14 cause-related admissions. In contrast, frailty was only associated with 3 cause-related elective hospitalizations. Men with frailty were also more likely to have an increased number of non-elective hospitalizations for all 14 causes, but only for 6 causes of elective hospitalizations. Conclusions Our findings suggest frailty increases the risk and number of non-elective hospitalizations in older men for a wide range of cause. Strategies on early identification of frailty, followed by appropriate preventative strategies to lower the risk of non-elective hospital admissions are warranted.

Prospective associations between dietary antioxidant intake and frailty in older Australian men: The Concord Health and Ageing in Men Project

Wed, 01 Jan 2020 00:00:00 GMT

Prospective associations between dietary antioxidant intake and frailty in older Australian men: The Concord Health and Ageing in Men Project Das, A; Cumming, R; Naganathan, V; Blyth, F; Ribeiro, R; Le Couteur, D; Handelsman, D; Waite, L; Simpson, S; Hirani, V Background: The objective of the study is to evaluate the prospective associations between antioxidant intake and incident frailty among older Australian men aged ≥75 years. Methods: Seven hundred and ninety-four men participated in a detailed diet history interview at the Concord Health and Ageing in Men Project (CHAMP) study third wave (considered baseline nutrition here) and 781 men participated at the fourth wave (considered 3-year follow-up here). The main outcome measurement was incident frailty at 3-year follow-up, using the Cardiovascular Health Study definition. Dietary adequacy of antioxidant intake was assessed by comparing participants' median intakes of four dietary antioxidants (vitamin A, E, C, and zinc) to the nutrient reference values (NRVs). Attainment of the NRVs was incorporated into a dichotomized variable "poor" (meeting ≤2 antioxidants) or "good" (meeting ≥3 antioxidants) as the independent variable using the cut-point method. Also, intakes of each individual dietary antioxidant at baseline nutrition were categorized into quartiles. Analyses were performed using multinomial logistic regression. Results: Incidence of pre-frailty was 53.0% and frailty was 6.4% at 3-year follow-up. Poor dietary antioxidant intake (meeting ≤2) at baseline nutrition was associated with incident frailty at 3-year follow-up in unadjusted (OR: 2.59 [95% CI: 1.47, 4.59, p = .001]) and adjusted (OR: 2.46 [95% CI: 1.10, 5.51, p = .03]) analyses. The lowest quartile of vitamin E intake (<7.08 mg/d) was significantly associated with incident frailty (OR: 2.46 [95% CI: 1.01, 6.00, p = .05]). Conclusions: Poor antioxidant intake, particularly vitamin E, is a plausible factor associated with incident frailty among older men. This supports the need for clinical trials of diets rich in antioxidants or possibly low-dose antioxidant supplements, for prevention of frailty.

The Preventable Burden of Breast Cancers for Premenopausal and Postmenopausal Women in Australia: A Pooled Cohort Study

Tue, 01 Jan 2019 00:00:00 GMT

The Preventable Burden of Breast Cancers for Premenopausal and Postmenopausal Women in Australia: A Pooled Cohort Study Arriaga, M; Vajdic, C; Canfell, K; MacInnis, R; Banks, E; Byles, J; Magliano, D; Taylor, A; Mitchell, P; Giles, G; Shaw, J; Gill, T; Klaes, E; Velentzis, L; Cumming, R; Hirani, V; Laaksonen, M Estimates of the future breast cancer burden preventable through modifications to current behaviours are lacking. We assessed the effect of individual and joint behaviour modifications on breast cancer burden for premenopausal and postmenopausal Australian women, and whether effects differed between population subgroups. We linked pooled data from six Australian cohort studies (n = 214,536) to national cancer and death registries, and estimated the strength of the associations between behaviours causally related to cancer incidence and death using adjusted proportional hazards models. We estimated exposure prevalence from representative health surveys. We combined these estimates to calculate Population Attributable Fractions (PAFs) with 95% confidence intervals (CIs), and compared PAFs for population subgroups. During the first 10 years follow-up, there were 640 incident breast cancers for premenopausal women, 2,632 for postmenopausal women, and 8,761 deaths from any cause. Of future breast cancers for premenopausal women, any regular alcohol consumption explains 12.6% (CI = 4.3-20.2%), current use of oral contraceptives for ≥5 years 7.1% (CI = 0.3-13.5%), and these factors combined 18.8% (CI = 9.1-27.4%). Of future breast cancers for postmenopausal women, overweight or obesity (BMI ≥25 kg/m2 ) explains 12.8% (CI = 7.8-17.5%), current use of menopausal hormone therapy (MHT) 6.9% (CI = 4.8-8.9%), any regular alcohol consumption 6.6% (CI = 1.5-11.4%), and these factors combined 24.2% (CI = 17.6-30.3%). The MHT-related postmenopausal breast cancer burden varied by body fatness, alcohol consumption and socio-economic status, the body fatness-related postmenopausal breast cancer burden by alcohol consumption and educational attainment, and the alcohol-related postmenopausal breast cancer burden by breast feeding history. Our results provide evidence to support targeted and population-level cancer control activities.

SIRT1 polymorphisms and serum-induced SIRT1 protein expression in aging and frailty: the CHAMP study

Wed, 01 Mar 2017 00:00:00 GMT

SIRT1 polymorphisms and serum-induced SIRT1 protein expression in aging and frailty: the CHAMP study Razi, S; Cogger, V; Kennerson, M; Benson, V; McMahon, A; Blyth, F; Handelsman, D; Seibel, M; Hirani, V; Naganathan, V; Waite, L; de Cabo, R; Cumming, R; Le Couteur, D The nutrient sensing protein, SIRT1 influences aging and nutritional interventions such as caloric restriction in animals, however, the role of SIRT1 in human aging remains unclear. Here, the role of SIRT1 single-nucleotide polymorphisms (SNPs) and serum-induced SIRT1 protein expression (a novel assay that detects circulating factors that influence SIRT1 expression in vitro) were studied in the Concord Health and Ageing in Men Project (CHAMP), a prospective cohort of community dwelling men aged 70 years and older. Serum-induced SIRT1 expression was not associated with age or mortality, however participants within the lowest quintile were less likely to be frail (odds ratio (OR) 0.34, 95% confidence interval (CI) 0.17–0.69, N = 1,309). Serum-induced SIRT1 expression was associated with some markers of body composition and nutrition (height, weight, body fat and lean % mass, albumin, and cholesterol) but not disease. SIRT1 SNPs rs2273773, rs3740051, and rs3758391 showed no association with age, frailty, or mortality but were associated with weight, height, body fat and lean, and albumin levels. There were some weak associations between SIRT1 SNPs and arthritis, heart attack, deafness, and cognitive impairment. There was no association between SIRT1 SNPs and the serum-induced SIRT1 assay. SIRT1 SNPs and serum-induced SIRT1 expression in older men may be more closely associated with nutrition and body composition than aging and age-related conditions.

A longitudinal study of the influence of comorbidities and lifestyle factors on low back pain in older men

Tue, 01 Aug 2017 00:00:00 GMT

A longitudinal study of the influence of comorbidities and lifestyle factors on low back pain in older men Parreira, P; Maher, C; Ferreira, M; Machado, G; Blyth, F; Naganathan, V; Waite, L; Seibel, M; Handelsmann, D; Cumming, R Older adults are largely under-represented in low back pain (LBP) research. In light of the ageing population, it is crucial to understand the influence of comorbidities and lifestyle factors on the risk and prognosis of LBP in older adults. The aims of this study were to describe the course of LBP in older men; to investigate whether comorbidities/lifestyle factors can predict the course of LBP in older men; to assess if comorbidities/lifestyle factors increase the risk of developing LBP in older men. The study sample comprised 1685 older men living in suburban Sydney, Australia. Low back pain, sociodemographic measures, lifestyle factors, and comorbidities were assessed. Of the 1012 men with LBP at baseline, 58% still reported having pain at the 24-month follow-up. Of those without pain at baseline (n = 673), 28% reported pain at follow-up. The odds of persistent pain at 24 months increased with each additional alcoholic drink/wk (odds ratio [OR] = 1.10, 95% confidence interval [CI]: 1.01-1.22; P = 0.03) and each additional unit of body mass index (OR = 1.28, 95% CI: 1.04-1.60; P = 0.02), but reduced for men who speak English at home (OR = 0.58, 95% CI: 0.35-0.96; P = 0.03). In older men, free of LBP at baseline (n = 673), for every additional comorbidity there was an increased risk of developing LBP (OR = 1.17, 95% CI: 1.00-1.37; P = 0.05). These results demonstrate the influence of lifestyle factors and comorbidities on LBP in older men and suggest that the consideration of these issues in management may improve outcomes.

Polypharmacy in older adults: association rule and frequent-set analysis to evaluate concomitant medication use

Wed, 01 Feb 2017 00:00:00 GMT

Polypharmacy in older adults: association rule and frequent-set analysis to evaluate concomitant medication use Held, F; Le Couteur, D; Blyth, F; Hirani, V; Naganathan, V; Waite, L; Seibel, M; Handelsman, D; Cumming, R; Allore, H; Gnjidic, D The aim of this study was to apply Association Rule and Frequent-Set analysis, and novel means of data visualisation to ascertain patterns of medication use and medication combinations contributing to medication group clusters according to geriatric syndrome status in older adults. Participants were community-dwelling men (aged ≥70 years, n=1686), Sydney, Australia. Medication exposure was categorised at medication class level and data were analysed according to geriatric syndrome status (presence of at least one syndrome including frailty, falls, cognitive impairment and urinary incontinence). Association Rule and Frequent-Set analysis were performed to identify "interesting" patterns of medication combinations that occur together. This analysis involves advanced computer algorithms that investigated all possible combinations of medications in the dataset in order to identify those which are observed more or much less frequently than expected. Frequent-Set Analysis demonstrated one unexpected medication combination, antiulcer and antidiabetic medications (3.5% of participants) in the overall population (n=1687). Frequency of medication combinations was similar in participants with (n=666) and without (n=1020) geriatric syndromes. Among participants with geriatric syndromes, the most frequent combinations included antigout with lipid-lowering agents (5.7%) followed by angiotensin II and diuretics combination (22%). This novel methodology can be used to detect common medication combinations overall by data visualisation, and against specific adverse drug reactions such as geriatric syndromes. This methodology may be a valuable pharmacovigilance approach to monitor large databases for the safety of medications.

Associations of impaired renal function with decline in muscle strength and muscle function in older men: findings from the CHAMP Study

Tue, 01 Oct 2019 00:00:00 GMT

Associations of impaired renal function with decline in muscle strength and muscle function in older men: findings from the CHAMP Study Toyama, T; van den Broek-Best, O; Ohkuma, T; Handelsman, D; Waite, L; Seibel, M; Cumming, R; Naganathan, V; Sherrington, S; Hirani, V; Wang, A Background Advanced kidney disease is associated with reduced muscle strength and physical performance. However, associations between early stages of renal impairment and physical outcomes are unclear. Methods The Concord Health and Ageing in Men Project is a prospective study of 1,705 community-dwelling men aged 70 years and older. Participants with estimated glomerular filtration rate (eGFR) more than 30 mL/min/1.73 m2 were included and further divided into four eGFR categories. Physical parameters including grip strength, gait speed, appendicular lean mass (ALM, a sum of skeletal mass of arms and legs), ALM adjusted for body mass index (ALMBMI), and muscle function (measured using grip strength divided by arm lean mass) were assessed at both baseline and 5-year follow-up. Associations between kidney function and changes in physical parameters were analyzed using linear and logistic regression models. Results Our study included 789 men with a median age of 75 years and median eGFR of 72 mL/min/1.73 m2 at baseline. Over 5 years, grip strength, gait speed, ALMBMI, and muscle function all declined in the whole cohort, compared with baseline. The multivariable analyses showed that poorer renal function was associated with more rapid declines in grip strength, gait speed, and muscle function in participants with mild-to-moderate renal impairment (GFR category stage G3, eGFR < 60 mL/min/1.73 m2) (p = .01, p < .01, p = .02, respectively) but less so in those with eGFR more than 60 mL/min/1.73 m2, whereas eGFR category did not have a significant impact on declines in ALMBMI. These results remained unchanged with or without adjustment for age. Conclusions In community-dwelling older men, mild-to-moderate renal impairment at baseline was associated with declines in grip strength, gait speed, and muscle function over time despite preservation of muscle mass.