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Aim: To compare hospital admission patterns after the first year of life in Australian children with developmental disabilities and children with no known disability, according to maternal country of birth and Indigenous status.Method: This was a retrospective cohort study using linked data across health, disability, and hospital admission databases. The study investigated 656 174 children born in Western Australia between 1983 and 2008 with a total of 1 091 834 records of hospital admissions.Results: Children with no known disability born to Indigenous mothers had the highest rate of hospital admissions compared to children of non-Indigenous mothers. Children of foreign-born mothers from low-income countries had the highest rate of hospital admissions if disability was present. Children with cerebral palsy (CP) with or without associated intellectual disability had the highest rate of hospital admissions among children with developmental disability, especially if mothers were foreign-born.Interpretation: Children with CP and intellectual disability, particularly from minority backgrounds (Indigenous Australian and foreign-born mothers), were at higher risk of being admitted to hospital after the first year of life.What This Paper Adds: Hospital admissions in Australian children with and without disabilities differ according to maternal country of birth. Hospital admission rates in children without a developmental disability were greatest for Australian-born Indigenous children. Disabled Australian-born children of foreign-born mothers from low-income countries had the highest hospital admission rates. Hospital admission risk was greatest for Australian-born children with cerebral palsy, especially if mothers were foreign-born. [ABSTRACT FROM AUTHOR]

Objectives: The epidemiology, clinical characteristics and outcomes of antimicrobial-associated anaphylaxis remain ill-defined. We sought to examine antimicrobial anaphylaxis with regard to: (i) the frequency of implicated antimicrobials; (ii) attributable mortality; and (iii) referral for definitive allergy assessment.Methods: This was conducted through a national retrospective multicentre cohort study at five Australian tertiary hospitals (January 2010 to December 2015). Cases of antimicrobial anaphylaxis were identified from ICD-10 coding and adverse drug reaction committee databases.Results: There were 293 participants meeting the case definition of antimicrobial anaphylaxis and 310 antimicrobial anaphylaxis episodes. Of 336 implicated antimicrobials, aminopenicillins (62/336, 18.5%) and aminocephalosporins (57/336, 17%) were implicated most frequently. ICU admission occurred in 43/310 (13.9%) episodes; however, attributable mortality was low (3/310, 1%). The rate of anaphylaxis to IV antibiotics was 3.5 (95% CI=2.9-4.3) per 100 000 DDDs and the rate of hospital-acquired anaphylaxis was 1.9 (95% CI=2.1-3.3) per 100 000 occupied bed-days. We observed overall low rates of hospital discharge documentation (222/310, 71.6%) and follow-up by specialist allergy services (73/310, 23.5%), which may compromise medication safety and antimicrobial prescribing in future.Conclusions: This study demonstrated that a high proportion of severe immediate hypersensitivity reactions presenting or acquired in Australian hospitals are secondary to aminopenicillins and aminocephalosporins. Overall rates of hospital-acquired anaphylaxis, predominantly secondary to cephalosporins, are low, and also associated with low inpatient mortality. [ABSTRACT FROM AUTHOR]

This article outlines client and service data from an early psychosis service in New South Wales (NSW), Australia, and presents a client and service profile, with a focus on the psychiatric, psychosocial, and physical health profile of young people with early psychosis. Implications for practice are discussed. Client and service data were captured through a range of processes and comprise a number of different datasets, specifically client demographical information and service data as routinely collected (N = 601), psychosocial data collected through a file audit (N = 33), and client physical health data maintained by the physical health nurse (N = 39). The service researcher extracted all data from each of the databases and analyzed the data descriptively for client and service profile information. The client profile data indicate early psychosis clients present with a range of psychiatric, psychosocial, and physical health vulnerabilities. The data presented support the need for mental health care to be provided in conjunction with primary health care, vocational and employment support, exercise and dietary interventions, and support with substance use. Furthermore, this article highlights the importance of family inclusive practice and trauma-informed care in early psychosis services. The findings support calls for services to be integrated and young people to be responded to holistically through the integration of psychological, psychosocial, and physical health care. [ABSTRACT FROM AUTHOR]

Aim: World-wide, approximately 14% of children have prevalent asthma. As most bone accrual occurs in childhood, and data suggest a detrimental role in bone from asthma and/or medications, we investigated whether asthma was associated with radiologically confirmed fractures in a large cohort of children.Methods: Data from the Barwon Asthma Study (2005), a population-based, cross-sectional survey of all children attending 91 primary schools in the Barwon Statistical Division, were linked to the Geelong Osteoporosis Study Fracture Grid (2006-2007), a fracture register encompassing the Barwon Statistical Division (n = 16 438; 50.5% boys; aged 3.5-13.6 years). Asthma, ascertained from parent-reported symptoms using the International Study of Asthma and Allergies in Childhood questionnaire, was categorised as: (i) recent wheeze; and number of (ii) recent wheezy episodes; (iii) doctor visits for wheeze symptoms; and (iv) doctor visits for asthma check-ups. Using logistic regression analyses, stratified by sex and adjusted for age and medication use, we determined whether asthma was associated with radiologically confirmed fractures.Results: In total, 961 fractures were observed among 823 Barwon Asthma Study participants (5.9% of total sample; 61.1% boys). Recent wheeze and 1-3 recent wheezy episodes were associated with increased odds of fracture in boys (odds ratio (OR) 1.26, 95% confidence interval (CI) 1.03-1.55; OR 1.40, 95% CI 1.12-1.77, respectively), but not girls (OR 1.03, 95% CI 0.78-1.37; OR 0.67, 95% CI 0.38-1.19). Results were independent of age, and sustained after adjustment for medication.Conclusions: Independent of age, asthma was associated with fracture for boys, but not girls. There is an imperative for strategies to promote bone health among children with asthma. [ABSTRACT FROM AUTHOR]

Aim: Penetrating head injuries (pHIs) are associated with high morbidity and mortality. Data on pHIs in children outside North America are limited. We describe the mechanism of injuries, neuroimaging findings, neurosurgery and mortality for pHIs in Australia and New Zealand.Methods: This was a planned secondary analysis of a prospective observational study of children <18 years who presented with a head injury of any severity at any of 10 predominantly paediatric Australian/New Zealand emergency departments (EDs) between 2011 and 2014. We reviewed all cases where clinicians had clinically suspected pHI as well as all cases of clinically important traumatic brain injuries (death, neurosurgery, intubation >24 h, admission >2 days and abnormal computed tomography).Results: Of 20 137 evaluable patients with a head injury, 21 (0.1%) were identified to have sustained a pHI. All injuries were of non-intentional nature, and there were no gunshot wounds. The mechanisms of injuries varied from falls, animal attack, motor vehicle crashes and impact with objects. Mean Glasgow Coma Scale on ED arrival was 10; 10 (48%) had a history of loss of consciousness, and 7 (33%) children were intubated pre-hospital or in the ED. Fourteen (67%) children underwent neurosurgery, two (10%) craniofacial surgery, and five (24%) were treated conservatively; four (19%) patients died.Conclusions: Paediatric pHIs are very rare in EDs in Australia and New Zealand but are associated with high morbidity and mortality. The absence of firearm-related injuries compared to North America is striking and may reflect Australian and New Zealand firearm regulations. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to assist clinicians evaluating refugee children for latent tuberculosis infection (LTBI) by comparing paired tuberculin skin test (TST) and Quantiferon Gold In-Tube (QGIT) test results with clinical management decisions and follow-up data in a large cohort of newly arrived refugee children.Methods: This was a retrospective analysis of all refugee children (<15 years of age) evaluated for LTBI with both TST and interferon-γ release assay between 2007 and 2010 in the Illawarra-Shoalhaven region of New South Wales, Australia. Demographics, country of origin, bacille Calmette-Guerin (BCG) vaccination status, chest X-ray results, TST and QGIT test results, clinical management and outcome on long-term follow-up were assessed.Results: Of 272 children evaluated, complete results were available for 212 (78%). The vast majority (207; 98%) were from Africa or Southeast Asia. Overall, 33 (16%) children were treated for LTBI; 13 (39%) had concordant TST and QGIT results and 20 (61%) discordant results. Of 63 (30%) TST-positive (≥10 mm) children, 46 (73%) were QGIT assay-negative, 44 (70%) had a BCG scar, 3 (5%) were younger than 2 years and 6 (10%) were treated for LTBI. Of 32 QGIT assay-positive children, 15 (47%) were TST negative, 31 (97%) had a BCG scar, all were older than 2 years and 14 (44%) were treated for LTBI.Conclusions: Discordant TST and QGIT results were found in a high percentage of refugee children. QGIT is convenient and more specific than TST to diagnose LTBI in BCG-vaccinated children, although a careful tuberculosis exposure history and clinical assessment to rule out active disease remain important. [ABSTRACT FROM AUTHOR]

Reducing lethal violence against women requires comprehensive measures addressing individual, social, economic, cultural, and situational factors. Regarding situational factors, access to weapons—and firearm access in particular—has received notable research attention. However, most study comes from the United States of America, and findings may not apply elsewhere. The current study examines whether changing gun laws in Australia affected female firearm homicide victimization. Female firearm homicide victimization may have been affected; however, no significant impacts were found for male firearm homicide victimization. Findings suggest there may be value in preventing legal access to firearms by persons who have a history of intimate partner violence, although considerable further study is required. [ABSTRACT FROM AUTHOR]

The home care sector comprises one of Australia’s fastest growing workforces, yet few papers capture the overall landscape of Australian home care. This integrative review investigates home care with the aim of better understanding care recipients and their needs, funding, and regulation; care worker skills, tasks, demographics, employment conditions, and training needs. Over 2,700 pieces of literature were analyzed to inform this review. Results suggest sector fragmentation and a home care workforce who, although well-placed to improve outcomes for care recipients, are in need of better training and employment support. Suggestions for future research regarding Australian home care include studies that combine both aged and disability aspects of care, more research around care recipients, priority needs and strategies for addressing them, and how best to prepare home care workers for their roles. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the utilisation of Medicare Benefit Scheme items for chronic disease in the management of cardiovascular disease (CVD) in general practice and to compare characteristics of CVD patients with and without a General Practice Management Plan (GPMP). Subgroup analysis of Treatment of Cardiovascular Risk using Electronic Decision Support (TORPEDO) baseline data was collected in a cohort comprising 6123 patients with CVD. The mean age (s.d.) was 71 (±13) years, 55% were male, 64% had a recorded diagnosis of coronary heart disease, 31% also had a diagnosis of diabetes and the mean number of general practice (GP) visits (s.d.) was 11 (±9) in 12 months. A total of 1955/6123 (32%) received a GPMP in the 12 months before data extraction; 1% received a Mental Health Plan. Factors associated with greater likelihood of receiving a GPMP were: younger age, had a diagnosis of diabetes, BMI > 30kgm-2, prescription of blood pressure-lowering therapy and more than ten general practice visits. Enhancing utilisation of existing schemes could augment systematic follow up and support of patients with CVD. [ABSTRACT FROM AUTHOR]

In 1999, the Australian Federal Government introduced Medicare items for Health Assessments for people aged 75 years and older (75+ health assessments). This research examined uptake of these assessments and identified predictors of use by women from the Australian Longitudinal Study on Women's Health (ALSWH). Assessments were identified for each year from 1999 to 2013 using linked Medicare data. Time to first assessment was examined, as well as social and health factors associated with having an assessment. From 1999 to 2013, 61.8% of women had at least one assessment. Almost one-third had an assessment within 2 years of their introduction, 25% of women died before having an assessment and 13% survived but did not have an assessment. Factors associated with assessment included being widowed, private health insurance, marital status, education, having arthritis and urinary incontinence, and less difficulty managing on income. Many women never received an assessment, and many only received one. Promotion of the 75+ health assessments is necessary among older women to increase uptake. [ABSTRACT FROM AUTHOR]

Background: Most countries face an ageing population, increasing chronic diseased, and constrictions on budget for providing health services. Involving patients in their own care by allowing them access to their patient data is a trend seen in many places.Methods: Data on the type and level of access citizens have to their own health data in three countries was gathered from public sources.Results: Data from each individual country is presented and the experiences of Denmark, Estonia and Australia are examined whilst similarities and differences explored. The discussion adopts a citizen-centred perspective to consider how the different e-portal systems support, protect and structure citizen interactions with their own health data in three key areas: Security, privacy and data protection; User support; and Citizen adoption and use.Conclusions: The paper highlights the impact of opt-in/opt-out approaches on citizen access and the lack of a structured approach to addressing differences in citizen health and e-health literacy. This research also confirms while current data provides detail on the availability and use of personal health data by citizens, questions still remain over the ultimate impact on patient outcomes of these initiatives. It is anticipated the insights generated from the three countries experiences, supporting citizen access to their health data will be useful to improve these initiatives and guide other countries aspiring to support similar initiatives. [ABSTRACT FROM AUTHOR]

Purpose:The HOME FAST was developed and trialled in Australia as a screening tool designed to be used by any health professional to identify older people at increased risk of falls and to facilitate referral for more detailed assessment and intervention. This study aimed to evaluate the clinical utility of the HOME FAST from the perspective of users. Method:A mixed-methods approach using survey data (n = 32), focus group data (n = 46) and interview data (n = 5) from occupational therapists, physiotherapists, community nurses and other health professionals working in hospitals, community services and private practice, located in the UK, Canada and Australia. Data were integrated using a matrix of quantitative and qualitative data that aligned the findings with established theoretical constructs of clinical utility. Results:Findings across the data sources provide evidence of the clinical utility of the HOME FAST, and these findings align with theoretical constructs about how a tool such as the HOME FAST is adopted in practice. Conclusion:The HOME FAST can be used in a variety of international setting in developed countries and by different health professionals as a screening tool. A manual would assist in the consistent application of the HOME FAST.Implications for RehabilitationHazards in the home environment are a key contributor to falls risk for older peopleThe Home Falls and Accidents Screening Tool (HOME FAST) was designed for any health professional to screen older people at increased risk of falling because of home hazards.Even with psychometric evidence of the reliability and validity of a tool, it is critical that the tool can be easily adopted by clinicians (clinical utility), otherwise its applicability to practice and research is limited.An international mixed-method study has provided evidence of the clinical utility of the HOME FAST. [ABSTRACT FROM PUBLISHER]

Background: Job insecurity has been associated with certain health outcomes. We examined the role of job insecurity as a risk factor for incident diabetes.Methods: We used individual participant data from 8 cohort studies identified in 2 open-access data archives and 11 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. We calculated study-specific estimates of the association between job insecurity reported at baseline and incident diabetes over the follow-up period. We pooled the estimates in a meta-analysis to produce a summary risk estimate.Results: The 19 studies involved 140 825 participants from Australia, Europe and the United States, with a mean follow-up of 9.4 years and 3954 incident cases of diabetes. In the preliminary analysis adjusted for age and sex, high job insecurity was associated with an increased risk of incident diabetes compared with low job insecurity (adjusted odds ratio [OR] 1.19, 95% confidence interval [CI] 1.09-1.30). In the multivariable-adjusted analysis restricted to 15 studies with baseline data for all covariates (age, sex, socioeconomic status, obesity, physical activity, alcohol and smoking), the association was slightly attenuated (adjusted OR 1.12, 95% CI 1.01-1.24). Heterogeneity between the studies was low to moderate (age- and sex-adjusted model: I2 = 24%, p = 0.2; multivariable-adjusted model: I2 = 27%, p = 0.2). In the multivariable-adjusted analysis restricted to high-quality studies, in which the diabetes diagnosis was ascertained from electronic medical records or clinical examination, the association was similar to that in the main analysis (adjusted OR 1.19, 95% CI 1.04-1.35).Interpretation: Our findings suggest that self-reported job insecurity is associated with a modest increased risk of incident diabetes. Health care personnel should be aware of this association among workers reporting job insecurity. [ABSTRACT FROM AUTHOR]

Objective Incident reporting systems are critical to understanding adverse events, in order to create preventative and corrective strategies. There are very few systems dedicated to Emergency Medicine with published results. All EDs in Australia and New Zealand were contacted to encourage the use of an Emergency Medicine - specific online reporting system called the Emergency Medicine Events Register (EMER). Methods We conducted an analysis of the first 150 incidents entered into EMER. EMER captures Emergency-medicine-specific details including triage score, clinical presentation, outcome, contributing factors, mitigating factors, other specialities involved and patient journey stage. These details were analysed by an expert panel. Results Over the first 26 months, 150 incidents were reported into EMER. The most common categories reported, in order, were diagnostic error, procedural complication and investigation errors. Most incidents contained more than one category of error. The most common stage of the patient's journey in which an incident was detected was after discharge from the ED. Conclusion A focus on correct diagnosis, procedure performance and investigation interpretation may reduce errors in the ED. The ability to learn from incidents and make system changes to enhance patient safety in healthcare organisations is an inherent part of providing a proactive, quality culture. [ABSTRACT FROM AUTHOR]

Aim: To describe the hospital costs, hospital types and differences across states and territories for children with medical complexity cared for in Australian public hospitals.Methods: Retrospective national administrative database study of 212 Australian public hospitals from six states (excluding Queensland) and two territories that submitted cost data to the National Hospital Costing Data Collection for 2010-2011. Participants included all hospitalised patients with comparisons between adults and children (17 years of age and younger), and adults with chronic diseases and children with medical complexity. Total hospital costs were the main outcome measure.Results: The National Hospital Costing Data Collection contained data from 212 public hospitals; total admissions (adults and children) were 3 519 140 at a total hospital cost of $16 187 400 000. Children accounted for 350 499 (9.9%) of the admissions at a total hospital cost of $1 931 585 123 (11.9%). Of all children, those with medical complexity accounted for 48 758 (13.9%), and their total hospital costs were $620 948 769 (32.1%). Six children's hospitals had 145 213 (41%) of the total children admissions at a total hospital cost of $936 041 843 (48%). Across the states and territories, the number of childhood admissions ranged from 9164 to 146 618 with 4.7-14.8% for children with medical complexity. Total hospital costs ranged from $44 to $592 million with 15.4-39.4% for children with medical complexity.Conclusions: The national burden of hospitalised children is substantial. Children with medical complexity only account for a small percentage of hospitalisations but almost one third of total hospital costs for children, with children's hospitals bearing the major costs. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to compare hospital admissions from infancy to adulthood, between children born with orofacial clefts (OFC) and those without OFC.Methods: The method used was a cohort study using record-linked administrative datasets. Participants included all children liveborn in Western Australia (WA) between 1980 and 2010 diagnosed with OFC, who were frequency matched by year of birth to randomly selected liveborn children without OFC. We calculated rate ratios (RR) of hospital admission, number and reason of admissions, cumulative length of stay, for each cleft type (cleft lip only (CLO), cleft lip and palate (CL+P), cleft palate only (CPO), no OFC) and by age period (infancy, pre-school, primary and high school ages, and early adulthood).Results: Overall, 1396 children were diagnosed with an OFC and compared with 6566 children without OFC. Individuals born with OFC were up to three times more likely to be admitted to hospital, had more admissions and longer cumulative length of stay in all age periods. Children with OFC were also more likely to be admitted for ear and digestive system conditions (RR up to 30 and six times higher, respectively). Children with CL+P and CPO were more likely to be admitted for respiratory conditions (RR 1.3-2.0) and children with CPO were six times more likely to be admitted for care for other congenital anomalies.Conclusions: Throughout childhood, individuals born with OFC were more likely to be admitted, and had more hospitalisations than those without OFC. Children born with CL+P or CPO had a higher hospitalisation burden than children born with CLO. [ABSTRACT FROM AUTHOR]

Approximately 560 new cases of Hodgkin lymphoma (HL) are diagnosed annually in Australia. Standard first-line therapy is ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine). It is unknown how survival outcomes in patients receiving ABVD in current clinical practice, with routine positron emission tomography (PET) imaging and modern supportive measures, compare with results from published trials. This is a retrospective multi-centre study of patients with previously untreated HL between November 1999 and December 2014 receiving ABVD induction. Baseline characteristics, treatment details, toxicity and outcome data were collected from hospital records. The primary endpoint was overall survival (OS). Secondary endpoints included overall response rate (ORR), progression-free survival (PFS), response to treatment and toxicity. One hundred and eighty-nine eligible patients were identified. Median age was 32 years (range 17-79). Nodular-sclerosing HL was the most common subtype (78 %), 44 % had B symptoms and 11 % had marrow involvement. Median number of cycles of ABVD administered was 6 (range 3-8). Eighteen patients (11 %) had dose delay, 21 (13 %) had dose reductions and 11 (8 %) had both. The ORR, defined predominantly by PET scan, was 96 % (CR 89 %). Five-year OS and PFS were 93 and 84 %, respectively in early disease (stage I-IIA) and 89 and 63 % in advanced disease (stage IIB, III and IV). No poor prognostic factors were identified on multivariate testing. The most common grade 3/4 toxicity was neutropenia (53 %). Our study confirms the excellent prognosis and manageable toxicity in HL patients receiving ABVD in phase III studies are reflected in patients treated in routine clinical practice in the modern era. [ABSTRACT FROM AUTHOR]

There is a growing appetite for large complex databases that integrate a range of personal, socio-demographic, health, genetic and financial information on individuals. It has been argued that 'Big Data' will provide the necessary catalyst to advance both biomedical research and health economics and outcomes research. However, it is important that we do not succumb to being data rich but information poor. This paper discusses the benefits and challenges of building Big Data, analysing Big Data and making appropriate inferences in order to advance cancer care, using Cancer 2015 (a prospective, longitudinal, genomic cohort study in Victoria, Australia) as a case study. Cancer 2015 has been linked to State and Commonwealth reimbursement databases that have known limitations. This partly reflects the funding arrangements in Australia, a country with both public and private provision, including public funding of private healthcare, and partly the legislative frameworks that govern data linkage. Additionally, linkage is not without time delays and, as such, achieving a contemporaneous database is challenging. Despite these limitations, there is clear value in using linked data and creating Big Data. This paper describes the linked Cancer 2015 dataset, discusses estimation issues given the nature of the data and presents panel regression results that allow us to make possible inferences regarding which patient, disease, genomic and treatment characteristics explain variation in health expenditure. [ABSTRACT FROM AUTHOR]

Objective: The clinical epidemiology of childhood encephalitis in Australia is inadequately understood. We aimed to describe recent trends in childhood encephalitis-related hospitalisation.Study Design: We identified encephalitis-related hospital admissions (2000-2012) in national datasets among children ≤14 years using ICD encephalitis codes. We calculated hospitalisation rates and analysed trends by year, age, gender, location, indigenous status and aetiology.Results: Rates of childhood encephalitis hospitalisations significantly declined over an 11-year period (2000-2012; average hospitalisation rate 3.2/100 000). Varicella encephalitis hospitalisations decreased significantly, associated with high levels of varicella vaccine coverage since 2006. Acute disseminated encephalomyelitis (ADEM) was the most common 'specified' cause of encephalitis hospitalisation (15%-17%), and its rate has significantly increased. The highest hospitalisation rates occurred in the <1 year age group (5.8/100 000) and varied by location (highest in Northern Territory). The majority (58.9%) of hospitalised encephalitis had no cause identified; this proportion was highest in the <1 year age group (77%). The most common specified infectious causes included: herpes simplex virus, enterovirus, bacterial meningoencephalitis and varicella. When aggregated, the proportion of childhood encephalitis coded as viral was 21.2%.Conclusion: Hospitalisation of childhood encephalitis has slightly decreased in Australia. High rates of childhood immunisation have been associated with a reduction of varicella-associated encephalitis in Australian children. ADEM, an immune-mediated encephalitis, is the most common recognised cause of encephalitis in children. Young children (<1 year) have the highest admission rates. The high proportion of 'unspecified' encephalitis deaths and hospitalisations is an ongoing challenge. [ABSTRACT FROM AUTHOR]

Background: The Seven Countries Study in the 1960s showed very low mortality from coronary heart disease (CHD) in Japan, which was attributed to very low levels of total cholesterol. Studies of migrant Japanese to the USA in the 1970s documented increase in CHD rates, thus CHD mortality in Japan was expected to increase as their lifestyle became Westernized, yet CHD mortality has continued to decline since 1970. This study describes trends in CHD mortality and its risk factors since 1980 in Japan, contrasting those in other selected developed countries.Methods: We selected Australia, Canada, France, Japan, Spain, Sweden, the UK and the USA. CHD mortality between 1980 and 2007 was obtained from WHO Statistical Information System. National data on traditional risk factors during the same period were obtained from literature and national surveys.Results: Age-adjusted CHD mortality continuously declined between 1980 and 2007 in all these countries. The decline was accompanied by a constant fall in total cholesterol except Japan where total cholesterol continuously rose. In the birth cohort of individuals currently aged 50-69 years, levels of total cholesterol have been higher in Japan than in the USA, yet CHD mortality in Japan remained the lowest: >67% lower in men and > 75% lower in women compared with the USA. The direction and magnitude of changes in other risk factors were generally similar between Japan and the other countries.Conclusions: Decline in CHD mortality despite a continuous rise in total cholesterol is unique. The observation may suggest some protective factors unique to Japanese. [ABSTRACT FROM AUTHOR]

Unhealthy food environments are known to be major drivers of diet-related non-communicable diseases globally, and there is an imperative for major food companies to be publicly accountable for their actions to improve the healthiness of food environments. This paper examines the prevalence of publicly available policies and commitments of major packaged food and soft drink manufacturers, and fast-food restaurants in Australia, New Zealand and Fiji with respect to reducing food marketing to children and product (re)formulation. In each country, the most prominent companies in each sector were selected. Company policies, commitments and relevant industry initiatives were gleaned from company and industry association websites. In Australia and New Zealand, there are a higher proportion of companies with publicly available marketing and formulation policies than in Fiji. However, even in Australia, a large proportion of the most prominent food companies do not have publicly available policies. Where they exist, policies on food marketing to children generally focus on those aged less than 12, do not apply to all types of media, marketing channels and techniques, and do not provide transparency with respect to the products to which the policies apply. Product formulation policies, where they exist, focus mostly on salt reduction and changes to the make-up of overall product portfolios, and do not generally address saturated fat, added sugar and energy reduction. In the absence of strong policies and corresponding actions by the private sector, it is likely that government action (e.g. through co-regulation or legislation) will be needed to drive improved company performance. [ABSTRACT FROM AUTHOR]

Aim Examine metrics and policies regarding nurse workforce across four countries. Background International comparisons inform health policy makers. Methods Data from the OECD were used to compare expenditure, workforce and health in: Australia, Portugal, the United Kingdom ( UK) and the United States ( US). Workforce policy context was explored. Results Public spending varied from less than 50% of gross domestic product in the US to over 80% in the UK. Australia had the highest life expectancy. Portugal has fewer nurses and more physicians. The Australian national health workforce planning agency has increased the scope for co-ordinated policy intervention. Portugal risks losing nurses through migration. In the UK, the economic crisis resulted in frozen pay, reduced employment, and reduced student nurses. In the US, there has been limited scope to develop a significant national nursing workforce policy approach, with a continuation of State based regulation adding to the complexity of the policy landscape. The US is the most developed in the use of nurses in advanced practice roles. Ageing of the workforce is likely to drive projected shortages in all countries. Limitations There are differences as well as variation in the overall impact of the global financial crisis in these countries. Conclusion Future supply of nurses in all four countries is vulnerable. Implications for nursing and health policy Work force planning is absent or restricted in three of the countries. Scope for improved productivity through use of advanced nurse roles exists in all countries. [ABSTRACT FROM AUTHOR]

The CHOIR and CREATE studies led to changes in hemoglobin targets around the world for patients with chronic kidney disease. The aim of this study was to determine what effect these pivotal studies had on hemoglobin levels and survival. Data were extracted from Australia's Renal Anaemia Database for patients with chronic kidney disease between October 2000 and December 2009. Survival was significantly longer in patients with chronic kidney disease who died between 2007 and 2009 compared to those who died between 2000 and 2006. [ABSTRACT FROM AUTHOR]

This study examined whether a change in frequency of administration of erythropoietin-stimulating agent affected hemoglobin levels in patients on peritoneal dialysis. Data were extracted from the Australian Renal Anaemia Management database for the years 2002 and 2008. Less frequent dosing and increasing age were associated with higher hemoglobin levels, while increasing ferritin levels and later years were associated with lower hemoglobin levels. [ABSTRACT FROM AUTHOR]

To describe the nursing workforce in very remote Australia, characteristics and key issues. Data were collected from four main sources: the refined CRANAplus database of remote health facilities; the 2006 census which provided population and percentage of Indigenous people in communities in very remote Australia; a national survey on occupational stress among nurses and an earlier study into violence and remote area nurses conducted in 1995. A descriptive analysis of the data was conducted. Health facilities in very remote Australia. The registered nursing workforce in very remote Australia is mostly female (89%) and ageing, with 40.2% 50 years or over, compared to 33% nationally. Many (43%) are in remote Indigenous communities. Over the last decade, there has been a significant decrease in registered nurses with midwifery qualifications (55%) and in child health nurses (39%) in very remote Australia. Only 5% have postgraduate qualifications in remote health practice. The nursing workforce in very remote areas of Australia is in trouble. The workforce is ageing, the numbers of nurses per population has fallen and the numbers of midwives and child health nurses have dropped significantly over the last 15 years. As many of these nurses work in Indigenous communities, if these trends continue it is likely to have a negative effect on 'closing the gap' in Indigenous health outcomes. [ABSTRACT FROM AUTHOR]

Background: We aimed to make individual patient data from the International Stroke Trial (IST), one of the largest randomised trials ever conducted in acute stroke, available for public use, to facilitate the planning of future trials and to permit additional secondary analyses.Methods: For each randomised patient, we have extracted data on the variables assessed at randomisation, at the early outcome point (14-days after randomisation or prior discharge) and at 6-months and provide them as an analysable database.Results: The IST dataset includes data on 19 435 patients with acute stroke, with 99% complete follow-up. Over 26.4% patients were aged over 80 years at study entry. Background stroke care was limited and none of the patients received thrombolytic therapy.Conclusions: The IST dataset provides a source of primary data which could be used for planning further trials, for sample size calculations and for novel secondary analyses. Given the age distribution and nature of the background treatment given, the data may be of value in planning trials in older patients and in resource-poor settings. [ABSTRACT FROM AUTHOR]

Objective: This article describes the establishment of the Australian Schizophrenia Research Bank (ASRB), which operates to collect, store and distribute linked clinical, cognitive, neuroimaging and genetic data from a large sample of people with schizophrenia and healthy controls. Method: Recruitment sources for the schizophrenia sample include a multi-media national advertising campaign, inpatient and community treatment services and non-government support agencies. Healthy controls have been recruited primarily through multi-media advertisements. All participants undergo an extensive diagnostic and family history assessment, neuropsychological evaluation, and blood sample donation for genetic studies. Selected individuals also complete structural MRI scans. Results: Preliminary analyses of 493 schizophrenia cases and 293 healthy controls are reported. Mean age was 39.54 years (SD = 11.1) for the schizophrenia participants and 37.38 years (SD = 13.12) for healthy controls. Compared to the controls, features of the schizophrenia sample included a higher proportion of males (cases 65.9%; controls 46.8%), fewer living in married or de facto relationships (cases 16.1%; controls 53.6%) and fewer years of education (cases 13.05, SD = 2.84; controls 15.14, SD = 3.13), as well as lower current IQ (cases 102.68, SD = 15.51; controls 118.28, SD = 10.18). These and other sample characteristics are compared to those reported in another large Australian sample (i.e. the Low Prevalence Disorders Study), revealing some differences that reflect the different sampling methods of these two studies. Conclusion: The ASRB is a valuable and accessible schizophrenia research facility for use by approved scientific investigators. As recruitment continues, the approach to sampling for both cases and controls will need to be modified to ensure that the ASRB samples are as broadly representative as possible of all cases of schizophrenia and healthy controls. [ABSTRACT FROM AUTHOR]

Research is an important part of emergency medicine and provides the scientific underpinning for optimal patient care. Although increasing numbers of emergency physicians participate in research activities, formal research training is currently neither part of emergency physician training in Australia nor easily available for clinicians interested in clinical research. In a two-part series, which is targeted at part-time clinical researchers in the ED, we set out and explain the key elements for conducting high-quality and ethical research. Part I addressed ethical and regulatory aspects. In Part II, we describe important elements of research science, and practical elements of research conduct and administration, which form the basis for high-quality research. [ABSTRACT FROM AUTHOR]

Background: Decisions about method of birth should be evidence based. In Australia, the rising rate of cesarean section has not been limited to births after spontaneous conception. This study aimed to investigate cesarean section among women giving birth after in vitro fertilization (IVF). Methods: Retrospective population-based study was conducted using national registry data on IVF treatment. The study included 17,019 women who underwent IVF treatment during 2003 to 2005 and a national comparison population of women who gave birth in Australia. The outcome measure was cesarean section. Results: Crude rate of cesarean section was 50.1 percent versus 28.9 percent for all other births. Single embryo transfer was associated with the lowest (40.7%) rate of cesarean section. Donor status and twin gestation were associated with significantly higher rates of cesarean section (autologous, 49.0% vs donor, 74.9%; AOR: 2.20, 95% CI: 1.80, 2.69) and (singleton, 45.0% vs twin gestations, 75.7%; AOR: 3.81, 95% CI: 3.46, 4.20). The gestation-specific rate (60.1%) of cesarean section peaked at 38 weeks for singleton term pregnancies. Compared with other women, cesarean section rates for assisted reproductive technology term singletons (27.8% vs 43.8%, OR: 2.02 [95% CI: 1.95–2.10]) and twins (62.0% vs 75.7%, OR: 1.92 [95% CI: 1.74–2.11]) were significantly higher. Conclusions: Rates for cesarean section appear to be disproportionately high in term singleton births after assisted reproductive technology. Vaginal birth should be supported and the indications for cesarean section evidence based. (BIRTH 37:3 September 2010) [ABSTRACT FROM AUTHOR]

The overlap between autism and Rett syndrome clinical features has led to many cases of Rett syndrome being initially diagnosed with infantile autism or as having some autistic features. Both conditions seriously disrupt social and language development and are often accompanied by repetitive, nonpurposeful stereotypic hand movements. The aims of this study were to compare the early and subsequent clinical courses of female subjects with Rett syndrome categorised by whether or not a diagnosis of autism had been proposed before Rett syndrome had been diagnosed and compare the spectrum of methyl-CpG binding protein 2 (MECP2) mutations identified among the two groups. This study made use of a total of 313 cases recorded in two databases: the Australian Rett Syndrome Database (ARSD) and the International Rett Syndrome Phenotype Database (InterRett). Cases with an initial diagnosis of autism had significantly milder Rett syndrome symptoms and were more likely to remain ambulant, to have some functional hand use and not to have developed a scoliosis. Females with the p.R306C or p.T158M mutations in the MECP2 gene were more likely to have an initial diagnosis of autism, and the specific Rett syndrome symptoms were noted at a later age. We recommend that females who are initially considered to have autism be carefully monitored for the evolution of the signs and symptoms of Rett syndrome. [ABSTRACT FROM AUTHOR]

Randomised trials have established the importance of oxaliplatin (O) and irinotecan (I) in advanced colorectal cancer (CRC). However, patients enrolled in clinical studies represent a restricted population and little is known about the use of O and I in the general population and the subsequent outcomes outside clinical studies. We used the Australian Health Insurance Commission (HIC) database to describe prescribing patterns of O and I and their impact on survival in all patients with 5-fluorouracil (5-FU) refractory CRC in Australia in 2002 and 2003. In 2999 patients, there was a marked increase in initial treatment with O rather than I; 48% of patients received O first in 2002 vs 66% in 2003 (P<0.001). Overall 40-45% of patients received both O and I; however, younger patients were more likely to receive both drugs (P<0.001). After 5-FU failure and treatment with O or I, the proportion of patients surviving 6 or 12 months was estimated to be 0.67 (95% CI, 0.66-0.69) and 0.42 (95% CI, 0.40-0.44), respectively. Survival was superior for patients who received both O and I; however, the sequence of agents had no impact. Older patients (> or =70 years) had inferior survival no matter which drug was used as initial treatment. Analysis of the Australian HIC database provides a valuable means of assessing patterns of use and outcomes of new therapies. [ABSTRACT FROM AUTHOR]

This article describes the Australian Twin Attention-deficit/hyperactivity disorder (ADHD) Project (ATAP), the results of research conducted using this database and plans for future studies. Information has been actively collected from Australian families with twin children since 1991 for the ATAP database. The value of assessing siblings as well as twins is emphasized. Much work has gone into continuing the involvement of families in the study though this does become more difficult when twins reach maturity. The main focus of the project is ADHD in children and adolescents plus comorbid conditions including conduct disorder, oppositional defiant disorder, and generalized anxiety disorder. A major challenge has been how to retain continuity in the assessments, while at the same time covering changes in psychiatric classification, such as the move to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994). Changes in the scale can affect the reports of twin similarity. Over the years, these twins have become part of other twin studies and future plans include linking different twin databases to investigate the relationships between childhood behavior and adult conditions. Recruitment, assessment and retention of twin families require a major commitment but create a significant resource for collaboration in areas outside the original aim. [ABSTRACT FROM AUTHOR]

Aim: Prior to July 2013, a solo medical specialist provided a pain management service 1.5-2 days/week to children and young people aged 0-19 years, and their families at John Hunter Children's Hospital, Newcastle, NSW. A new multidisciplinary children's complex pain team now continues that service. This study aimed to identify the demographic and clinical characteristics of children, young people and their families referred to a paediatric pain specialist in the 5.5 years prior to the establishment of a multidisciplinary service and to quantify anecdotal observations, determine service priorities and identify clinical improvement opportunities.Methods: A retrospective review of the medical records of all new patients seen between January 2008 and June 2013 was conducted. Data sets for patient demographics, clinical characteristics, service outputs and disposition at discharge were determined prior to data extraction.Results: A total of 114 children and young people aged between 7 days and 18 years (mean ± SD = 12.54 ± 3.6 years) were consecutively referred to the service. Many demographics are consistent with those previously reported; however, the number of children who identified as being of Aboriginal origin (11%), with rare diseases (28%), new diagnoses made (47%), child protection reports submitted (14%) and psychological morbidity in children (58%) and caregivers (38%) are new findings in the context of pain management and serve as indicators of the complex service needs of these patients and their families.Conclusion: The complexities encountered in this small cohort provide an indication of the time investment needed to understand and manage complex paediatric pain, especially in the contexts of complex families, time-poor general practitioners and under-resourced communities. [ABSTRACT FROM AUTHOR]

An abstract of the article "Drug Allergy Reports on Medicalalert ® Devices," by Caroline Foreman and colleagues is presented.