Medicine and Health Sciences Commons^™

Equitable Expanded Carrier Screening Needs Indigenous Clinical And Population Genomic Data, Simon Easteal, Ruth M. Arkell, Renzo F. Balboa, Shayne A. Bellingham, Alex D. Brown, Tom Calma, Matthew C. Cook, Megan Davis, Hugh J.S Dawkins, Marcel E. Dinger, Michael S. Dobbie, Ashley Farlow, Kylie G. Gwynne, Azure Hermes, Wendy E. Hoy, Misty R. Jenkins, Simon H. Jiang, Warren Kaplan, Stephen Leslie, Bastien Llamas, Graham J. Mann, Brendan J. Mcmorran, Rebekah E. Mcwhirter, Cliff J. Meldrum, Shivashankar H. Nagaraj, Saul J. Newman, Jack S. Nunn, Lyndon Ormond-Parker, Neil J. Orr, Devashi Paliwal, Hardip R. Patel, Glenn Pearson, Greg R. Pratt, Boe Rambaldini, Lynette W. Russell, Ravi Savarirayan, Matthew Silcocks, John C. Skinner, Yassine Souilmi, Carola G. Vinuesa, Gareth Baynam

Medical Papers and Journal Articles

Expanded carrier screening (ECS) for recessive monogenic diseases requires prior knowledge of genomic variation including DNA variants that cause disease. The composition of pathogenic variants differs greatly among human populations, but historically research about monogenic diseases has focused mainly on people with European ancestry. By comparison, less is known about pathogenic DNA variants in people from other parts of the world. Consequently, inclusion of currently under-represented Indigenous and other minority population groups in genomic research is essential to enable equitable outcomes in ECS and other areas of genomic medicine. Here we discuss this issue in relation to the implementation of …

How Well Do Australian Government Urban Planning Policies Respond To The Social Determinants Of Health And Health Equity?, Michael Mcgrevy, Patrick Harris, Toni Delaney-Crowe, Matt Fisher, Peter Sainsbury, Emily Riley, Fran Baum

Medical Papers and Journal Articles

There is now wide recognition and evidence that the built environment affects population health and health equity. This research provides a thematic analysis of 108 urban planning policy documents from Australian state, territory, and federal governments to address the question: How well do Australian government urban planning policies respond to the social determinants of health and health equity? Health and health equity were discussed explicitly in several policies, most often as a secondary or co-benefit to environmental, social, and economic concerns. The most significant themes in the documents associated with health were visions for urban development that is compact, mixed …

Parents' Ability To Access Community Health Occupational Therapy Services In A Disadvantaged Area: A Proof Of Concept Study, Rachel Smith, Gisselle Gallego

Medical Papers and Journal Articles

Introduction: In New South Wales children from disadvantaged backgrounds have poorer health outcomes and reduced access to health services than their more advantaged counterparts. This study aimed to identify barriers and enablers to accessing child and family occupational therapy services in a disadvantaged area.

Methods: This was a mixed methods study that included: 1) a retrospective analysis of de-identified routinely collected Community Health service utilisation data from 2016-2017, and a 2) face to face interview guided survey with parents and carers.

Results: The retrospective data analysis showed outreach at the targeted suburbs’ Early Childhood Health Centres (ECHC) improved attendance for …

Eliminating Hepatitis C: Part 2. Assessing Your Patient For Antiviral Treatment, Chloe Layton, Jacqui Richmond, David Baker, Louise Owen, Gail Matthews, Erin Oliver-Landry, Jessica Howell, Joseph Doyle

Medical Papers and Journal Articles

With the introduction of direct-acting antivirals (DAAs) in Australia in 2016, most people with chronic hepatitis C can be cured of this infection. GPs and suitably qualified nurse practitioners working in all areas of primary care have a key role in identifying, testing and treating their patients with hepatitis C. The previous article in this series discussed how to identify your patients with hepatitis C. This article provides practical advice on assessing a patient after diagnosis in preparation for DAA therapy. This includes determining whether they can be safely treated in general practice or require specialist referral.

Complementary Medicine Use And Health Literacy In Older Australians, Caroline A. Smith, Esther Chang, Gisselle Gallego

Medical Papers and Journal Articles

Objectives: To investigate whether complementary medicine (CAM) use is associated with health literacy levels and decision self-efficacy.

Design: A cross-sectional survey was distributed to men and women aged 65 years and older who participated in a randomised control trial (N = 153) in Sydney, Australia.

Results: One hundred and fifty-three people completed the survey of those 66% were females and the mean age was 76 years. Most participants used or were currently using CAM in the past 12 months (75%). The most common source of CAM information were GPs. Participants with higher levels of social support were found more likely …

The Impact Of Mandatory Iodine Fortification And Supplementation On Pregnant And Lactating Women In Australia, Stephen Hurley, Creswell J. Eastman, Gisselle Gallego

Medical Papers and Journal Articles

Background and Objectives: In Australia, two public health measures were introduced between 2009 and 2010 to reduce iodine deficiency. However there has been a shortage of information regarding their effectiveness and the ongoing prevalence of iodine deficiency in Australia. The primary aim of this study was to assess the extent to which these public health measures have reduced rates of iodine deficiency among pregnant and lactating women.

Methods and Study Design: A review was conducted to identify all studies published since January 2010 that quantitatively measured the iodine status of pregnant and/or lactating women in Australia.

Results: We found 25 …

Transnational Parent-Child Separation And Reunion During Early Childhood In Chinese Migrant Families: An Australian Snapshot, Yat Man Louise Hui, Julie Stevenson, Gisselle Gallego

Medical Papers and Journal Articles

Limited international research exists on reasons for transnational child care, or developmental consequences of separations and reunions on young Chinese children. This descriptive study portrays a sample of children from Chinese migrant families residing in western Sydney, New South Wales, Australia, whose parents temporarily relinquished their care to grandparents in China. Data were collected via retrospective health record audits. The majority of parents were first-time parents and the majority of children were first-borns sent back to China during infancy. The average duration of transnational parent–child separation was 20 months. Results showed that male child subjects who experienced multiple transnational separations …

Adherence To Prescribing Restrictions For Her2-Positive Metastatic Breast Cancer In Australia: A National Population-Based Observational Study (2001-2016), Benjamin Daniels, Federico Girosi, Hanna Tervonen, Belinda E. Kiely, Sarah J. Lord, Nehmat Houssami, Sally-Anne Pearson

Medical Papers and Journal Articles

Background: Targeted cancer therapy is often complex, involving multiple agents and chemotherapeutic partners. In Australia, prescribing restrictions are put in place to reflect existing evidence of cost-effectiveness of these medicines. As therapeutic options continue to expand, these restrictions may not be perceived to align with best practice and it is not known if their use in the real-world clinic adheres to these restrictions. We examined the treatment of women receiving trastuzumab for HER2-positive metastatic breast cancer (HER2+MBC) to determine the extent to which treatment adhered to national prescribing restrictions.

Patients and methods: Our population-based, retrospective cohort study used dispensing records …

How Are Junior Doctors Managing Patients With Self-Limiting Illnesses At Their First Presentation? A Video Vignette Study, Eugene D'Souza, Catherine Krejany, Rosie Meng, Moyez Jiwa

Medical Papers and Journal Articles

Purpose: To conduct a video vignette survey of medical students and doctors investigating test ordering for patients presenting with self-limiting or minor illness.

Methods: Participants were shown six video vignettes of common self-limiting illnesses and invited to devise investigation and management plans for the patients’ current presentation. The number of tests ordered was compared with those recommended by an expert panel. A Theory of Planned Behaviour Questionnaire explored participants’ beliefs and attitudes about ordering tests in the context of self-limiting illness.

Results: Participants (n=61) were recruited from across Australia. All participants ordered at least one test that was not recommended …

Carers' Preferences For The Delivery Of Therapy Services For People With Disability In Rural Australia: Evidence From A Discrete Choice Experiment, G Gallego, A Dew, M Lincoln, K Bulkeley, J Brentnall, C Vietch

Medical Papers and Journal Articles

Background: The implementation of the Australian National Disability Insurance Scheme (NDIS) is expected to generate a responsive, person-centred system that will empower people with disability to choose the services and support they receive. However little attention has been paid to examine how users of the NDIS will choose and spend their individual budgets. This study aimed to determine quantitatively the relative importance that carers of people with a disability living in rural Australia place on different therapy service delivery characteristics.

Methods: A stated preference discrete choice experiment (DCE) was incorporated into a survey of carers of people with disability living …

Vitamin D Deficiency And Segregation Status In Prisoners, Zelda Doyle, John Dearin, Joe Mcgirr

Medical Papers and Journal Articles

Purpose: The purpose of this paper is to investigate if any exposure to segregation minimal association in a single male prison population had any association with an increased risk of vitamin D deficiency.

Design/methodology/approach: A retrospective case study was undertaken with all inmates who had a 25-hyrdoxy-vitamin D test taken during the study period deemed eligible. Hand searching of the medical records by an independent party identified eligible participants whose data were recorded for analysis.

Findings: In total, 124 prisoners were deemed eligible for inclusion; 67 were vitamin D sufficient and 57 were vitamin D deficient by Australian standards. Time …

An Education Intervention To Improve Health Literacy And Decision Making About Supporting Self-Care Among Older Australians: A Study Protocol For A Randomised Controlled Trial, C Smith, E Chang, G Gallego, L Balneaves

Medical Papers and Journal Articles

Background: Older Australians are high consumers of complementary and alternative medicines (CM). To help older people to take an active role in their health, we will develop and evaluate a novel educational intervention to support decision self-efficacy, and improve health literacy skills.

Methods: The primary hypothesis is that participants receiving a web/DVD plus booklet intervention compared with a booklet-only group will demonstrate an increase in decision self-efficacy. This study is a randomized controlled trial. One hundred and sixty-eight people aged 65 years and older will be recruited from community settings comprising retirement villages and community groups, based in Sydney, Australia. …

Complementary Therapies For Labour And Birth: A Randomized Controlled Trial Of Antenatal Integrative Medicine For Pain Management In Labour, K Levett, C Smith, A Bensoussan, H Dahlen

Medical Papers and Journal Articles

Objective: To evaluate the effect of an antenatal integrative medicine education programme in addition to usual care for nulliparous women on intrapartum epidural use.

Design: Open-label, assessor blind, randomized controlled trial.

Setting: 2 public hospitals in Sydney, Australia.

Population: 176 nulliparous women with low-risk pregnancies, attending hospital-based antenatal clinics.

Methods and intervention: The Complementary Therapies for Labour and Birth protocol, based on the She Births and acupressure for labour and birth courses, incorporated 6 evidence-based complementary medicine techniques: acupressure, visualisation and relaxation, breathing, massage, yoga techniques, and facilitated partner support. Randomisation occurred at 24–36 weeks’ gestation, and participants attended a …

Effect Of Medical Student Preference On Rural Clinical School Experience And Rural Career Intentions, L Walters, A Seal, J Mcgirr, R Stewart, D Dewitt, D Playford

Medical Papers and Journal Articles

Introduction: The key parameter for rural clinical schools (RCSs) is to provide at least 1 year of clinical training in rural areas for 25% of Australian Commonwealth supported medical students with the intent to influence future rural medical workforce outcomes. The objective of this study was to describe the association between a medical student’s selection preference and their RCS experience and rural career intent.

Methods: Medical students completing an RCS placement in 2012 and 2013 were encouraged to complete a survey regarding their experience and future career intent. Data were analysed to compare medical students for whom the RCS was …

Assessing The Feasibility Of A Web-Based Registry For Multiple Orphan Lung Diseases: The Australasian Registry Network For Orphan Lung Disease (Arnold) Experience, K Casamento, A Laverty, M Wilsher, J Twiss, E Gabbay, I Glaspole, A Jaffe

Medical Papers and Journal Articles

Background: We investigated the feasibility of using an online registry to provide prevalence data for multiple orphan lung diseases in Australia and New Zealand.

Methods: A web-based registry, The Australasian Registry Network of Orphan Lung Diseases (ARNOLD) was developed based on the existing British Paediatric Orphan Lung Disease Registry. All adult and paediatric respiratory physicians who were members of the Thoracic Society of Australia and New Zealand in Australia and New Zealand were sent regular emails between July 2009 and June 2014 requesting information on patients they had seen with any of 30 rare lung diseases. Prevalence rates were calculated …

Doctors' Perspectives On Psa Testing Illuminate Established Differences In Prostate Cancer Screening Rates Between Australia And The Uk: A Qualitative Study, K Pickles, S Carter, L Rychetnik, V Entwistle

Medical Papers and Journal Articles

Objectives: To examine how general practitioners (GPs) in the UK and GPs in Australia explain their prostate-specific antigen (PSA) testing practices and to illuminate how these explanations are similar and how they are different.

Design: A grounded theory study.

Setting: Primary care practices in Australia and the UK.

Participants: 69 GPs in Australia (n=40) and the UK (n=29). We included GPs of varying ages, sex, clinical experience and patient populations. All GPs interested in participating in the study were included.

Results: GPs’ accounts revealed fundamental differences in whether and how prostate cancer screening occurred in their practice and in the …

Experience Of A Tutor Centric Model For Sonography Training Of Emergency Department Registrars In An Australian Urban Emergency Department 2009–2012, Greg Sweetman, Mark Fear, Kathryn Hird

Medical Papers and Journal Articles

Purpose: To assess the impact of a regular sonographer proctored training program for emergency medicine trainees in the use of Emergency Department bedside ultrasound

Methods: Emergency Department (ED) Registrars in the Swan District Hospital ED were provided with proctored instruction in bedside ultrasound in performance of extended focused assessment sonography in trauma (eFAST) and abdominal aortic aneurysm (AAA) detection. Training was conducted by credentialed sonographers for individual trainees in a 1:1 or 1:2 setting for 1 hour on a weekly basis. Registrars who trained in the Department between Jan 2009 to Dec 2012 were invited to participate in a survey …

Tracking Funded Health Intervention Research, Lesley A. King, Robyn S. Newson, Gillian E. Cohen, Jacqueline Schroeder, Selina Redman, Lucie Rychetnik, Andrew J. Milat, Adrian Bauman, Simon Chapman

Medical Papers and Journal Articles

Objective: To describe the research publication outputs from intervention research funded by Australia’s National Health and Medical Research Council (NHMRC).

Design and setting: Analysis of descriptive data and data on publication outputs collected between 23 July 2012 and 10 December 2013 relating to health intervention research project grants funded between 1 January 2003 and 31 December 2007.

Main outcome measures: Stages of development of intervention studies (efficacy, effectiveness, replication, adaptation or dissemination of intervention); types of interventions studied; publication output per NHMRC grant; and whether interventions produced statistically significant changes in primary outcome variables.

Results: Most of the identified studies …

Should I Stay Or Should I Go? Exploring The Job Preferences Of Allied Health Professionals Working With People With Disability In Rural Australia, G Gallego, A Dew, M Lincoln, A Bundy, R Chedid, K Bulkeley, J Brentnall, C Veitch

Medical Papers and Journal Articles

Introduction: The uneven distribution of allied health professionals (AHPs) in rural and remote Australia and other countries is well documented. In Australia, like elsewhere, service delivery to rural and remote communities is complicated because relatively small numbers of clients are dispersed over large geographic areas. This uneven distribution of AHPs impacts significantly on the provision of services particularly in areas of special need such as mental health, aged care and disability services.

Objective: This study aimed to determine the relative importance that AHPs (physiotherapists, occupational therapists, speech pathologists and psychologists – “therapists”) living in a rural area of Australia and …

Australian Fathers' Study: What Influences Paternal Engagement With Antenatal Care?, T Jeffrey, K Luo, B Kueh, R Petersen, J Quinlivan

Medical Papers and Journal Articles

This mixed-methods study explores factors associated with and levels of engagement of fathers in antenatal care. One hundred expectant fathers were recruited from antenatal clinics and community settings in Western Australia. They completed validated questionnaires. Eighty-three percent of expectant fathers reported a lack of engagement with antenatal care. Factors significantly associated with lack of engagement in multivariate analysis were working more than 40 hours a week and lack of adequate consultation by antenatal care staff. In qualitative analysis, 6 themes emerged in association with a lack of engagement. They were role in decision making, time pressures, the observer effect, lack …

Impact Of Geography On The Control Of Type 2 Diabetes Mellitus: A Review Of Geocoded Clinical Data From General Practice, Moyez Jiwa, Ori Gudes, Richard Varhol, Narelle Mullan

Medical Papers and Journal Articles

Objective: To review the clinical data for people with diabetes mellitus with reference to their location and clinical care in a general practice in Australia.

Materials and methods: Patient data were extracted from a general practice in Western Australia. Iterative data-cleansing steps were taken. Data were grouped into Statistical Area level 1 (SA1), designated as the smallest geographical area associated with the Census of Population and Housing. The data were analysed to identify if SA1s with people aged 70 years and older, and with relatively high glycosylated haemoglobin (HbA1c) were significantly clustered, and whether this was associated with their medical …

Values In Breast Cancer Screening: An Empirical Study With Australian Experts, Lisa Parker, Lucie Rychetnik, Stacy Carter

Medical Papers and Journal Articles

Objective:

To explore what Australian experts value in breast screening, how these values are conceptualised and prioritised, and how they inform experts’ reasoning and judgement about the Australian breast-screening programme.

Design:

Qualitative study based on interviews with experts.

Participants:

33 experts, including clinicians, programme managers, policymakers, advocates and researchers selected for their recognisable influence in the Australian breast-screening setting.

Setting:

Australian breast-screening policy, practice and research settings.

Results:

Experts expressed 2 types of values: ethical values (about what was good, important or right) and epistemological values (about how evidence should be created and used). Ethical values included delivering benefit, avoiding …

Management Of Behavioural Change In Patients Presenting With A Diagnosis Of Dementia: A Video Vignette Study With Australian General Practitioners, M Jiwa, P Nichols, P Magin, G Pagey, X Meng, R Parsons, V Pillai

Medical Papers and Journal Articles

Objective: To test the impact of feedback on the proposed management of standardised patients presenting with behavioural change with a diagnosis of dementia in Australian primary care.

Materials and methods: A video vignette study was performed with Australian general practitioners (GPs) in 2013. Participants viewed six pairs of matched videos depicting people presenting changed behavior in the context of a dementia diagnosis in two phases. In both phases GPs indicated their diagnosis and management. After phase 1, GPs were offered feedback on management strategies for the patients depicted. Analyses focused on identification of change in management between the two phases …

A Randomised Trial Deploying A Simulation To Investigate The Impact Of Hospital Discharge Letters On Patient Care In General Practice, M Jiwa, X Meng, C O'Shea, P Magin, A Dadich, V Pillai

Medical Papers and Journal Articles

Objective: To determine how the timing and length of hospital discharge letters impact on the number of ongoing patient problems identified by general practitioners (GPs).

Trial design: GPs were randomised into four groups. Each viewed a video monologue of an actor-patient as he might present to his GP following a hospital admission with 10 problems. GPs were provided with a medical record as well as a long or short discharge letter, which was available when the video was viewed or 1 week later. GPs indicated if they would prescribe, refer or order tests for the patient’s problems.

Methods: Setting Primary …