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Exposure to family and domestic violence in the prenatal period is associated with an increased risk of hospitalization for bronchiolitis in children under 2 years
No full textBackground: Existing research has acknowledged a correlation between stress in pregnancy and poorer respiratory health in offspring. However, research focusing on stress caused by family and domestic violence in the prenatal period is missing.
Methods: A retrospective cohort study included children born 1987–2010 who were identified as being exposed to FDV in the prenatal period (n = 1477) from two sources: WA Police Information Management System and WA Hospital Morbidity Data Collection (HMDC) and a non-exposed comparison group (n = 41 996). Hospitalization for bronchiolitis was identified in HMDC. Cox regression was used to estimate the adjusted and unadjusted hazard ratio and 95% confidence interval for bronchiolitis hospitalizations contact.
Results: Children exposed to FDV had a 70% (HR 1.70, 95% CI: 1.49–1.94) increased risk of hospitalization for bronchiolitis than non-exposed counterparts by age two. Children exposed to FDV had a longer average hospital stay for bronchiolitis than non-exposed children (4.0 days vs. 3.8 days, P \u3c 0.001).
Conclusions: Prenatal exposure to FDV is associated with bronchiolitis hospitalization in children \u3c2 years. Along with other risk factors, clinicians should give consideration to maternal stress factors, including experiencing FDV as a potential contributor to bronchiolitis
Hypertension among people living with human immunodeficiency virus in sub-Saharan Africa: a systematic review and meta-analysis
No full textWe performed a systematic review and meta-analysis of hypertension in people living with human immunodeficiency virus (HIV) in sub-Saharan Africa (SSA). We searched the PubMed, Google Scholar, African Index Medicus, and Embase databases to identify studies published from January 1, 2010, to December 31, 2021. We used a random-effects model to estimate the pooled prevalence of hypertension and mean SBP/DBP level on a sex-specific basis. We included 48 studies reporting data on a pooled sample of 193,843 people living with HIV (PLW-HIV) in SSA. The pooled mean SBP/DBP level was 120 (95% CI 113–128)/77 (95%CI 72–82) mmHg, while the overall pooled prevalence of hypertension was 21.9% (95% CI 19.9–23.9%). Further meta-regression analyses suggested that the prevalence of hypertension was 1.33 times greater in males, 1.23 times greater in individuals receiving antiretroviral therapy (ART) and 1.45 times greater in those individuals with a CD4-count ≥ 200. This meta-analysis of the contemporary pattern of BP levels among PLW-HIV in SSA, suggests that around one in five of such individuals also have hypertension. Given the further context of greater access to ART and subsequently greater longevity, study findings support calls to integrate cardiovascular management into routine HIV care
The retirement village experiential learning journey (RV-ELJ): an Australian case study in university course curriculum to reduce ageism and promote working with older adults
No full textBackground: An aging population means health services are dealing with increasing numbers of older adults, placing challenges on healthcare systems. Research demonstrates many students who are in the health sciences carry negative views toward older adults, affecting their choice to work with older adults. This study evaluated whether course curriculum via an experiential learning activity that exposed Pre-Medicine students to older adults in retirement villages, improves attitudes to working with older adults upon graduation.
Methods: A survey using validated tools namely Australian Aging Sematic Differential (AASD); Relating to Older People (ROPE):Reactions to Aging Questionnaire (RAQ); Geriatric Attitudes Scale(GAS) was implemented. Thematic analysis to evaluate students’ reflective essays post placement was conducted (n = 11).Results: There were significant positive shifts in attitudes toward older adults and aging (AASD/GAS), along with improvements in students ’self-perceptions of aging supported by qualitative analysis.
Discussion: The results support the need for educational interventions like the RV-ELJ model for reducing ageism and encouraging a mind-set shift toward working with older adults. It is important to expose students to settings where older adults live independently to build rapport and breakdown prejudices and stereotypes. This is likely to encourage interest in working with older adults
Echocardiographic estimation of pulmonary artery wedge pressure: invasive derivation, validation, and prognostic association beyond diastolic dysfunction grading
No full textAim: Grading of diastolic function can be useful, but indeterminate classifications are common. We aimed to invasively derive and validate a quantitative echocardiographic estimation of pulmonary artery wedge pressure (PAWP) and to compare its prognostic performance to diastolic dysfunction grading.
Methods and results: Echocardiographic measures were used to derive an estimated PAWP (ePAWP) using multivariable linear regression in patients undergoing right heart catheterization (RHC). Prognostic associations were analysed in the National Echocardiography Database of Australia (NEDA). In patients who had undergone both RHC and echocardiography within 2 h (n = 90), ePAWP was derived using left atrial volume index, mitral peak early velocity (E), and pulmonary vein systolic velocity (S). In a separate external validation cohort (n = 53, simultaneous echocardiography and RHC), ePAWP showed good agreement with invasive PAWP (mean ± standard deviation difference 0.5 ± 5.0 mmHg) and good diagnostic accuracy for estimating PAWP \u3e15 mmHg [area under the curve (95% confidence interval) 0.94 (0.88–1.00)]. Among patients in NEDA [n = 38,856, median (interquartile range) follow-up 4.8 (2.3–8.0) years, 2756 cardiovascular deaths], ePAWP was associated with cardiovascular death even after adjustment for age, sex, and diastolic dysfunction grading [hazard ratio (HR) 1.08 (1.07–1.09) per mmHg] and provided incremental prognostic information to diastolic dysfunction grading (improved C-statistic from 0.65 to 0.68, P \u3c 0.001). Increased ePAWP was associated with worse prognosis across all grades of diastolic function [HR normal, 1.07 (1.06–1.09); indeterminate, 1.08 (1.07–1.09); abnormal, 1.08 (1.07–1.09), P \u3c 0.001 for all].
Conclusion: Echocardiographic ePAWP is an easily acquired continuous variable with good accuracy that associates with prognosis beyond diastolic dysfunction gradin
An Entangled but Separate System: Examining the Experiences of Colonial Offenders in Western Australia, 1829-1868
Get PDFCrime and punishment are omnipresent features of Western Australia’s colonial history. The establishment of a colony on invaded Noongar boodja in 1829 is indicative of the first criminal act. Within six months, a system of incarceration had been established for British offenders. Despite this, the importation of male imperial convicts from Britain and Ireland between 1850 and 1868 has become synonymous with the colony’s penal history. The historiographical preoccupation with imperial convicts ignores the people convicted within the colony, and subsequently, their lived experiences have been overlooked. This is to the detriment of understanding offenders, their motivations, and their interactions with the carceral network. Understanding the treatment of local offenders is more pertinent when considering that the colonial and imperial systems were amalgamated in 1858, making the silence surrounding the former in academic literature more pronounced. The experiences of colonial offenders can be traced through examining petitions written by inmates or on their behalf, as well as archival material and newspaper reports relating to the institutions in which they were incarcerated.
This thesis examines, across three parts, how the carceral network developed in accordance with colonial needs and was shaped by those involved in its operations, including government officials and the gaolers. This thesis argues that prisoner experience was influenced by a multitude of factors. The cultural background of the prisoner was one of the most influential factors affecting their experiences, and it provided their basic understanding of incarceration. Familial circumstances, economic pressures, health and motivations for their crime were also vital for shaping how a prisoner perceived their incarceration. This must be considered alongside other influences, such as the conditions in the prison buildings and the regulations that were established to control the inmates.
This research examines the experiences of colonial offenders and employs a methodology comprised of History of Experience (HEX) and biography to interpret the sources and illuminate the lives of the prisoners. It uses a theoretical perspective underpinned by a neo-Marxist approach to class, including the concept of the lumpenproletariat, to illuminate how the colony attempted to create a productive proletariat class. This thesis makes a unique contribution to the existing scholarship through its analysis of the previously overlooked experiences of colonial offenders in Western Australia’s carceral network between 1829 and 1868
Optimising Care for Musculoskeletal Conditions to Reduce Burden on Hospital Emergency Department and Orthopaedic Services
Get PDFWorldwide health care systems are under increasing pressure due to aging amongst ever growing populations with increasing co-morbidity and treatment options (WA DoH, 2019). Furthermore, how people choose to engage with health care and access and literacy for health information is also changing, as is understanding of the factors associated with good health outcomes. These changes are driving evolution in health care delivery. There is a need for high quality and sustainable models of care accompanied by judicious evaluation of impact in terms of health services deliverables and the consumer experience of care. This thesis explores the feasibility and applicability of alternative models of care for musculoskeletal conditions in the Western Australian (WA) public hospital system, particularly in the context of the primary community interface, which is the emergency department.
The first alternative model of care is the ‘Virtual Fracture Clinic’ (Mackenzie et al., 2018), also known as ‘the direct discharge model’ (Geerdink, Augustinus, et al., 2021). This model was first established in the National Health Service (NHS) in Scotland to reduce the burden on orthopaedic outpatient services and cost of care for people with minor self-limiting fractures (MSLF). The first focus of this thesis is therefore on MSLF management in the WA public hospital system and the adaptation of the virtual fracture clinic model into this jurisdiction.
Western Australian public hospital injury management pathways usually start in the emergency department (ED) and then connect patients to outpatient services for follow up. Evolution in one part of the pathway is inextricably linked to development in the whole pathway. The second model of care presented in this thesis is a physiotherapy-led ED Musculoskeletal Diversion Pathway, a health service innovation developed by the thesis author. This model of care can be applied broadly to all single system musculoskeletal conditions that bring people to the ED.
Accordingly, this thesis will present the results of studies that inform a new methodology to capture and describe current ED patient perspectives (Chapters 2 and 3), survey and describe current health service practices (Chapter 5) and evaluate the initial implementation of two alternative models of care for MSLF management in WA public hospitals, namely an Australian adaptation of a virtual fracture clinic (Chapter 6) and the ED Musculoskeletal Diversion Pathway (Chapter 8)
\u27Advance Australia Fair: A Heart-to-Heart Reflection of Australia’s Nationhood post Voice Referendum\u27
Get PDFThe outcome of the Voice Referendum creates an opportunity for all Australians to look within and question Australia’s nationhood and the notion of being a land of opportunity, mateship and a fair go for all. Based on anecdotal evidence gained through Cherie’s lived experience, reflections, conversations, and observations, she voices her perspective about the Uluru Statement, the Referendum campaign and outcome, the Healing Gathering; and she also seeks to explore, what needs to be done differently for Australians to share the responsibility and hope in reconciling and unifying the nation. Through observations and discussions, Voice opponents instantly transitioned back to their normal lives but openly expressed resentment towards its perceived irrelevance. Supporters of it, are still experiencing an emotional rollercoaster of bewilderment, rejection and an overwhelming sense of injustice. But, from Cherie’s first-hand experience, Aboriginal people are being further subjected to the adverse effects of entrenched and systemic racism. The consequences of dirty politics have not only been harmful and culturally unsafe but has also enabled open displays of righteous hostility in Australia’s mainstream arena. This unwelcomed spotlight has potentially set reconciliation backwards; and Aboriginal people have again been abandoned by politicians to bear the brunt of it and fend for themselves. Now that the Voice has been silenced, the political puppeteers have faded to the background with no accountability. This political trajectory cannot continue. Australians must become a united voice and demand more from those who claim to represent Australia’s national interest. More integrity, more transparency, more accountability. In Cherie’s opinion, to truly achieve reconciliation and Advance Australia Fair, re-education of Australia’s past, present, and future is paramount. It is time for Australians to have a genuine heart-to-heart about the inclusion of Aboriginal people in Australia’s nationhood, and the collective hope, pride and legacy being passed onto future generations
The Australian Traumatic Brain Injury Initiative: Systematic review of clinical factors associated with outcomes in people with moderate-severe traumatic brain injury
No full textThe aim of the Australian Traumatic Brain Injury Initiative (AUS-TBI) is to design a data dictionary to inform data collection and facilitate prediction of outcomes for moderate-severe traumatic brain injury (TBI) across Australia. The process has engaged diverse stakeholders across six areas: social, health, clinical, biological, acute interventions, and long-term outcomes. Here, we report the results of the clinical review. Standardized searches were implemented across databases to April 2022. English-language reports of studies evaluating an association between a clinical factor and any clinical outcome in at least 100 patients with moderate-severe TBI were included. Abstracts, and full-text records, were independently screened by at least two reviewers in Covidence.
The findings were assessed through a consensus process to determine inclusion in the AUS-TBI data resource. The searches retrieved 22,441 records, of which 1137 were screened at full text and 313 papers were included. The clinical outcomes identified were predominantly measures of survival and disability. The clinical predictors most frequently associated with these outcomes were the Glasgow Coma Scale, pupil reactivity, and blood pressure measures. Following discussion with an expert consensus group, 15 were recommended for inclusion in the data dictionary. This review identified numerous studies evaluating associations between clinical factors and outcomes inpatients with moderate-severe TBI. A small number of factors were reported consistently, however, how and when these factors were assessed varied. The findings of this review and the subsequent consensus process have informed the development of an evidence-informed data dictionary for moderate-severe TBI in Australia
Should my child be given antibiotics? A systematic review of parental decision making in rural and remote locations
No full textBackground: The emergence and growth in antibiotic resistant bacteria is a critical public health problem exacerbated by the misuse of antibiotics. Children frequently succumb to illness and are often treated with antibiotic medicines which may be used improperly by the parent. There is limited evidence of the factors influencing parental decision-making about the use of antibiotics in low-resource contexts. The aim of this systematic review was to understand and describe how parents living in rural and remote locations make choices about their children\u27s antibiotic use.
Method: The CINAHL, Web of Science, Medline, Scopus and Academic Search Premier databases were systematically searched from 31 January until 28 June in 2023. No date restrictions were applied and additional search methods were utilised to identify further studies that met inclusion criteria. Eligibility criteria included studies which reported on factors contributing to parental decisions about their children\u27s use of antibiotics in rural and remote settings. The Joanna Briggs Institute Critical Appraisal Checklists were employed to evaluate studies. Characteristics and findings were extracted from studies, and data was synthesised descriptively and presented in summary tables.
Results: A total of 3827 articles were screened and 25 worldwide studies comprising of quantitative, qualitative and prospective designs were included in the review. Studies that reported the number of rural caregivers consisted of 12 143 participants. Data analysis produced six broad themes representing the mechanisms that influenced parents in their access and use of antibiotics: the child\u27s symptoms; external advice and influences; parent-related determinants; barriers to healthcare; access to antibiotics; and socio-demographic characteristics.
Conclusions: A number of factors that influence parents\u27 prudent use of antibiotics in rural contexts were identified. In seeking to enhance appropriate use of antibiotics by parents in rural and remote settings, these determinants can serve to inform interventions. However, the identified studies all relied upon parental self-reports and not all studies reviewed reported survey validation. Further research incorporating validated measures and intervention strategies is required.
Registration details: Should my child be given antibiotics? A systematic review of parental decision making in rural and remote locations; CRD42023382169; 29 January 2023 (date of registration). Available from PROSPERO
Do bisphosphonates and RANKL inhibitors alter the progression of coronary artery calcification? A systematic review
No full textObjectives: To determine whether bisphosphonates and NF-κB ligand (RANKL) inhibitors delay coronary artery calcification (CAC).
Design: A systematic review was conducted. Data sources MEDLINE, EMBASE and CENTRAL.
Eligibility criteria: Longitudinal studies investigating CAC progression in adults (\u3e18 years) taking either a bisphosphonate or denosumab compared with those who did not.
Data extraction and synthesis: Study and participant characteristics, and primary outcome (∆CAC from baseline to follow-up) were extracted. The Risk Of Bias In Non-Randomised Studies-of Interventions (ROBINS-I) and Risk-of-Bias Tool for Randomised Trials (RoB2) tools were used to assess the risk of bias for observational and randomised controlled trials (RCTs), respectively. Outcome measures were reported.
Results: Four observational studies and one RCT (n=377) were included. Three studies solely reported the effect of bisphosphonates on ∆CAC; one study (n=56) demonstrated a statistically significant CAC reduction in the intervention group (−372 mm3 /year) compared with control (+159mm3 /year) (p3 /year) versus control (+2220mm3 /year), however, no p value comparing groups was reported. One study (n=115) found no statistically significant difference between intervention and control. One study (n=42) exclusively investigated the effect of RANKL on ∆CAC; there was a statistically significant reduction in CAC at 6-month follow-up between intervention (−133±124 modified Agatston unit (AU)) and control (+188±72 modified AU), p=0.03. One study (n=150) compared both bisphosphonates and denosumab to control and found no statistically significant difference between either intervention group and control over 24 months. Meta-analysis was not performed due to limited, heterogeneous studies.
Conclusions: There is insufficient evidence supporting the correlation between bisphosphonate or RANKL inhibitor use and CAC progression. Further research is warranted