Medicine & Health

Publication Search Results

Now showing 1 - 10 of 134
  • (2011) Lee, Evelyn; Holt, Martin; Mao, Limin; Prestage, Garrett; Zablotska, Iryna; Spratling, Tim; Norton, Graham; Watts, Peter; de Wit, John
    The Queensland Community Periodic Survey is a cross-sectional survey of gay and homosexually active men recruited at a range of gay community sites around Queensland. The project was funded by Queensland Health. The major aim of the survey was to provide data on sexual, drug use, and testing practices related to the transmission of HIV and other sexually transmissible infections (STIs) among gay men.

  • (2011) MacIntyre, Raina; Torzillo, Paul; McIntyre, Peter; Richmond, Peter; Andrews, Ross; Goldblatt, David; Grabenstein, John; Ridda, Iman; Menzies, Robert; Macartney, Kristine
    Conference Paper
    Researchers, policy makers, healthcare professionals, advisory groups and industry representatives reviewed the latest research and discussed future directions at a forum on adult vaccination against pneumococcal disease on 29-30th August, 2011 at UNSW in Sydney, Australia. The Forum was organized and chaired by Professor Raina MacIntyre with sponsorship from CSL Biotherapies. Hosted by the School of Public Health and Community of Medicine at UNSW, the forum featured national and international speakers including Professor David Goldblatt, Professor Peter McIntyre, Professor Peter Richmond and Dr John Grabenstein. This report describes some of the key messages and issues discussed at the forum.

  • (2011) Sunderland, Matthew; Slade, Tim; Stewart, Gavin; Andrews, Gavin
    Journal Article
    Objective: To present scoring rules for predicting DSM-IV mental illness in the past 12 month using the Kessler Psychological Distress Scale in the Australian population. Method: The method described in Kessler et al., [1] was closely followed using data from the 2007 Australian Survey of Mental Health and Wellbeing. A series of 93 nested logistic regression models were generated and compared to estimate the predicted probabilities of mental illness for each survey respondent using scores on the Kessler Psychological Distress Scale. The best model was selected using information theoretic criteria. Concordance between the predicted probabilities of mental illness generated by the best models with DSM-IV defined mental illness, assessed using the Composite International Diagnostic Interview, was determined using receiver operating characteristic analysis. Results: The best fitting models were found to contain the quadratic form of the Kessler Psychological Distress Scale (both 6 item and 10 item versions). Age was found to be significant in the model predicting mood, anxiety, and substance use with serious impairment using the 6 item version whilst age and gender was found to be significant in the model for the 10 item version. The concordance between the predicted probabilities of mood, anxiety, and substance use with serious impairment generated from the best models and DSM-IV mood, anxiety, and substance use with serious impairment was within an acceptable level for both versions. Results were similar when predicting DSM-IV mood, anxiety, and substance use without seriousness indicators and DSM-IV anxiety and depression. The performance of predicted probabilities was then examined in various subpopulations of the Australian population. Conclusions: Using a logistic regression model, the Kessler Psychological Distress Scale can be used to generate predicted probabilities of mental illness with an acceptable level of agreement in Australian-based population studies where it is not feasible to conduct a comprehensive assessment.

  • (2011) Apte, Minoti; Pirola, Romano; Wilson, Jeremy
    Journal Article
    Significance : Prominent fibrosis is a major histological feature of chronic pancreatitis, a progressive necroinflammatory condition of the pancreas, most commonly associated with alcohol abuse. Patients with this disease often develop exocrine and endocrine insufficiency characterised by maldigestion and diabetes. Up until just over a decade ago, there was little understanding of the pathogenesis of pancreatic fibrosis in chronic pancreatitis. Recent Studies : In recent times, significant progress has been made in this area, mostly due to the identification, isolation and characterisation of the cells, namely pancreatic stellate cells (PSCs) that are now established as key players in pancreatic fibrogenesis. In health, PSCs maintain normal tissue architecture via regulation of the synthesis and degradation of extracellular matrix (ECM) proteins. During pancreatic injury, PSCs transform into an activated phenotype that secretes excessive amounts of the ECM proteins that comprise fibrous tissue. Critical Issues : This Review summarises current knowledge and critical aspects of PSC biology which have been increasingly well characterised over the past few years, particularly with respect to the response of PSCs to factors that stimulate or inhibit their activation and the intracellular signalling pathways governing these processes. Based on this knowledge, several therapeutic strategies have been examined in experimental models of pancreatic fibrosis, demonstrating that pancreatic fibrosis is a potentially reversible condition, at least in early stages. Future Directions : These will involve translation of the laboratory findings into effective clinical approaches to prevent/inhibit PSC activation so as to prevent, retard or reverse the fibrotic process in pancreatitis.

  • (2011) Vonalaufen, Alain; Phillips, Phoebe; Xu, Zhihong; Zhang, John; Yang, Lu; Pirola, Romano; Wilson, Jeremy; Apte, Minoti
    Journal Article
    Background and aims Administration of repeated lipopolysaccharide (LPS) injections in alcohol-fed rats leads to significant pancreatic injury including fibrosis. However, it remains unknown whether alcoholic (chronic) pancreatitis has the potential to regress when alcohol is withdrawn. The aims of the study were (1) to compare the effect of alcohol withdrawal/continuation on pancreatic acute injury and fibrosis; and (2) to assess the effects of alcohol 6 LPS on pancreatic stellate cell (PSC) apoptosis in vivo and in vitro. Methods Rats fed isocaloric LiebereDeCarli liquid diets 6 alcohol for 10 weeks were challenged with LPS (3 mg/kg/week for 3 weeks) and then either switched to control diet or maintained on an alcohol diet for 3 days, 7 days or 3 weeks. Pancreatic sections were assessed for acute tissue injury, fibrosis, PSC apoptosis and activation. Cultured rat PSCs were exposed to 10 mM ethanol 6 1 mg/ml LPS for 48 or 72 h and apoptosis was assessed (Annexin V, caspase-3 and terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL)). Results Withdrawal of alcohol led to resolution of pancreatic lesions including fibrosis and to increased PSC apoptosis. Continued alcohol administration perpetuated pancreatic injury and prevented PSC apoptosis. Alcohol and LPS significantly inhibited PSC apoptosis in vitro, and the effect of LPS on PSC apoptosis could be blocked by Toll-like receptor 4 small interfering RNA. Conclusions Induction of PSC apoptosis upon alcohol withdrawal is a key mechanism mediating the resolution of pancreatic fibrosis. Conversely, continued alcohol intake perpetuates pancreatic injury by inhibiting apoptosis and promoting activation of PSCs. Characterisation of the pathways mediating PSC apoptosis has the potential to yield novel therapeutic strategies for chronic pancreatitis.

  • (2011) Deacon, Rachel; Wand , Handan; Stelzer-Braid , Sacha; Treloar, Carla; Maher, Lisa
    Journal Article
    Understanding patterns of newly acquired hepatitis C virus (HCV) infection is fundamental to assessing the impact of prevention and treatment interventions. However, identifying newly acquired cases is difficult, usually requiring documented testing before and after exposure. As the proportion of cases identified as newly acquired by current New South Wales surveillance methodologies is significantly lower than that identified nationally, the impact on the identification of newly acquired cases of systematic reporting of past negative HCV test results from notifying laboratories was assessed. HCV notifications data for 2007 from two New South Wales laboratories were analysed. Cases with a negative HCV antibody test within the past 24 months were classified as newly acquired. These were linked to the NSW Department of Health (NSW Health)-identified cases to assess the effectiveness of accessing laboratory data. The laboratories accounted for approximately half of all new HCV notifications in 2007. Of the 2,206 newly diagnosed cases, 21 (1.0%) were newly acquired, 18 of which had not been identified under the current surveillance system, increasing the total number of newly acquired cases to 83 from 65. This increased the yield by 28% and increased the proportion of newly acquired cases from 65/4,192 (1.6%) to 83/4,196 (2.0%). Laboratory-identified cases were significantly more likely than NSW Health-identified cases to be aged 30 years or over. Combined with current reporting mechanisms, laboratory data on previous HCV test results have the potential to increase the number of newly acquired cases identified through the New South Wales surveillance system and to enhance the identification of cases among those aged 30 years or more.

  • (2011) Bryant, Joanne; Ward, James; Worth, Heather; Hull, Peter; Solar , Sarina; Bailey , Sandra
    Journal Article

  • (2011) Grebely, Jason; Bryant, Joanne; Hull, Peter; Hopwood, Maxwell; Lavis, Yvonna; Dore, Gregory; Treloar, Carla
    Journal Article
    Assessment and treatment for hepatitis C virus (HCV) in the community remains low. We evaluated factors associated with HCV specialist assessment and treatment in a cross-sectional study to evaluate treatment considerations in a sample of 634 participants with self-reported HCV infection in New South Wales, Australia. Participants having received HCV specialist assessment (n = 294, 46%) were more likely to be have been older (vs <35 years; 35¨C44 OR 1.64, P = 0.117; 45¨C54 OR 2.00, P = 0.024; ¡Ý55 OR 5.43, P = 0.002), have greater social support (vs low; medium OR 3.07, P = 0.004; high OR 4.31, P < 0.001), HCV-related/attributed symptoms (vs none; 1¨C10 OR 3.89, P = 0.032; 10¨C21 OR 5.01, P = 0.010), a diagnosis of cirrhosis (OR 2.40, P = 0.030), have asked for treatment information (OR 1.91, P = 0.020), have greater HCV knowledge (OR 2.49, P = 0.001), have been told by a doctor to go onto treatment (OR 3.00, P < 0.001), and less likely to be receiving opiate substitution therapy (OR 0.10, P < 0.001) and never to have seen a general practitioner (OR 0.24, P < 0.001). Participants having received HCV treatment (n = 154, 24%) were more likely to have greater fibrosis (vs no biopsy; none/minimal OR 3.45, P = 0.001; moderate OR 11.47, P < 0.001; severe, OR 19.51, P < 0.001), greater HCV knowledge (OR 2.57; P = 0.004), know someone who has died from HCV (OR 2.57, P = 0.004), been told by a doctor to go onto treatment (OR 3.49, P < 0.001), were less likely to have been female (OR 0.39, P = 0.002), have recently injected (OR 0.42, P = 0.002) and be receiving opiate substitution therapy (OR 0.22, P < 0.001). These data identify modifiable patient-, provider- and systems-level barriers associated with HCV assessment and treatment in the community that could be addressed by targeted interventions.

  • (2011) Mao, Limin; Kippax, Susan; Holt, Martin; Prestage, Garrett; Zablotska, Iryna; de Wit, John
    Journal Article
    Objective Three decades into the HIV epidemic and with the advancement of HIV treatments, condom and non-condom-based anal intercourse among gay men in resource-rich countries needs to be re-assessed. Methods The proportions of men engaging in a range of anal intercourse practices were estimated from the ongoing cross-sectional Gay Community Periodic Surveys in six states in Australia from 2007 to 2009. Comparisons were made between HIV-negative men, HIV-positive men with an undetectable viral load and those with a detectable viral load. Results Condoms play a key role in gay men's anal intercourse practices: 33.8% of HIV-negative men, 25.1% of HIV-positive men with an undetectable viral load and 22.5% of those with a detectable viral load reported consistent condom use with all male partners in the 6 months before the survey. Among HIV-negative men, the second largest group were men who had unprotected anal intercourse (UAI) only in the context of HIV-negative seroconcordant regular relationships. Among HIV-positive men, the second largest group was men who had UAI in casual encounters preceded by HIV status disclosure to some, but not all, casual partners. Conclusions A minority, yet sizeable proportion, of men consistently engaged in a number of UAI practices in specific contexts, suggesting they have adopted deliberate HIV risk-reduction strategies. While it is important that HIV behavioural prevention continues to reinforce condom use, it needs to address both the challenges and opportunities of the substantial uptake of non-condom-based risk-reduction strategies.

  • (2011) Treloar, Carla; Hull, Peter; Bryant, Joanne; Hopwood, Maxwell; Grebely, Jason; Lavis, Yvonna
    Journal Article
    Background Assessment and uptake of treatment for hepatitis C among people who inject drugs (PWID) is low and strategies to enhance hepatitis C care in this group are needed. Knowledge of hepatitis C and its treatment is one precursor to decisions about treatment. Methods We conducted a cross-section study designed to evaluate treatment considerations in participants with self-reported hepatitis C infection in New South Wales, Australia. Participants were recruited from needle and syringe programs, opiate substitution clinics, pharmacies that dispensed opiate substitution treatment and from the mailing list of a community-based hepatitis C organisation and completed a self-administered survey. Knowledge of hepatitis C was assessed by a 48-item scale addressing the natural history and treatment of hepatitis C. Factors associated with knowledge were assessed by ordinal regression. Results Among the 997 participants recruited, 407 self-reported acquiring hepatitis C through injecting drug use and had never received hepatitis C treatment. Knowledge about hepatitis C was overall poor and the effects of the long term consequences of hepatitis C were over-estimated. Higher knowledge scores were associated with recruitment site, higher education levels and recent contact with a general practitioner. One-third of participants indicated that they did not intend to have treatment and one-fifth did not answer this question. Conclusion Knowledge is a precursor to informed decisions about hepatitis C treatment. These results indicate that efforts to support those less engaged with hepatitis C care (and specifically those on opiate substitution treatment) and those with lower literacy are required.