Medicine & Health

Publication Search Results

Now showing 1 - 10 of 17
  • (2009) Rawstorne, Patrick; Holt, Martin; Kippax, Susan; Worth, Heather; Wilkinson, Jennifer; Bittman, Michael
    This report describes key findings from the e-male survey, a national, online survey of men who have sex with men (MSM) in Australia. The survey was conducted in 2008 by the National Centre in HIV Social Research and attracted over 4,000 men to the survey site. The project aimed to assess whether internet use builds social capital amongst gay and other homosexually active men and the implications of online social networks for HIV prevention. The project also assessed the advantages and disadvantages of internet-based recruitment and data collection among Australian MSM.

  • (2009) Balasooriya, Chinthaka Damith; Toohey, Susan; Hughes, Chris
    Journal Article
    A key aim of educational course design is to encourage students to adopt deeper approaches to learning. This article reports the findings of three studies that explored how medical students responded to three carefully designed educational course units. The findings suggest that while a subgroup of the students responded by adopting deeper approaches (as intended by the designers of the course units), another subgroup responded by adopting more surface approaches. Two further subgroups displayed minimal changes in their approaches despite significant changes in their learning contexts. The finding (in all three studies) of a notable proportion of students adopting more surface approaches is of particular concern, as this could adversely affect the impact of even the most carefully designed educational program. These findings suggest that the context-dependent nature of approaches to learning merits further investigation as it may be more complex than previously described in the literature.

  • (2009) Balasooriya, Chinthaka Damith; Hughes, Christopher; Toohey, Susan
    Journal Article
    This paper presents the results of a study on the impact of a new integrated medical educational design on students' approaches to learning. Although the new program was based on curriculum features identified in the research literature as likely to promote deeper approaches to learning, the results revealed a more complex response from students. While a proportion of students reacted as expected and changed to deeper approaches, a significant subgroup moved in the opposite direction and adopted more surface approaches. Further analysis revealed that specific features of the new curriculum - integration of content, requirement for both independent and collaborative learning - were likely to polarise students. The findings suggest that shifting students towards deeper approaches to learning may be a more complex task than previously understood. The authors suggest some ways in which such major curriculum change may be moderated so that all learners are more likely to benefit.

  • (2009) Travaglia, Joanne
    This thesis sheds new light on the problem of errors and adverse events in medicine. It does so by considering patient safety from a critical, sociological perspective. Four questions drive the thesis: what is meant by patient safety and how did it develop into a major focus for health services at the end of the 20th Century? How can patient safety be examined from a social as well as technical perspective? What are the differences and similarities in the narratives about patient safety emerging from clinicians, health services, patients and the media? What do these narratives tell us about professionals' understanding of key concepts such as error, safety, risk and vulnerability? Empirically, I analyse via data mining techniques a sample of externally documented key international and national inquiries into adverse events and medical errors, and present the results of 30 focus groups comprising 195 individuals who were asked about their views on patient safety. By applying an analytical framework drawn from the work of Bourdieu to these data, I show that what has generally come to be understood to be a technical endeavour, involving the identification of causes, and the implementation and evaluation of solutions to errors and adverse events, can be understood as a field within which stakeholders struggle over taken for granted concepts of error, risk, safety and vulnerability. In doing so, stakeholders utilise a variety of strategies to gain the cultural, symbolic and social capital which can affect the quality of care available to vulnerable individuals and groups. By conceptualising patient safety as a field, it is possible to expand our understanding of the causes of error into the social relations and attitudes between patients and clinicians, and to capture how external forces, such as the legal system, the media, and politics directly affect the practice of health professionals.

  • (2009) Marjadi, Brahmaputra
    Background and Aim: The applicability of internationally-accepted infection control guidelines in rural Indonesia is questionable due to differences in resources availability and local contexts. Infection control barriers specific to rural Indonesia therefore need to be identified to assist in developing targeted infection control programs that are resource- and context-appropriate at the institutional, regional and national levels. Methods: This mixed methods study of ten healthcare facilities (hospitals and clinics, public and private) in a rural Indonesian district, all with severely limited resources, explored clinical practices in four areas: intravenous therapy, antibiotic usage, instrument reprocessing and hand hygiene. The quantitative methods used included univariate, multivariate and survival analyses of primary and secondary clinical data. The qualitative methods included a grounded theory analysis of observations, short and in-depth interviews and focus group discussion data. These two components of the study were synthesised to ascertain the magnitude and underlying factors of healthcare-associated infection risks and barriers to infection control programs. Findings: Inappropriate clinical practices caused excessive and unrecognised risks of primary bloodstream infection, surgical site infection, blood borne virus infection, and the development and spread of multi-resistant bacteria. The four diverse clinical practice areas exhibited common and interwoven underlying factors, which were: healthcare workers’ inadequate clinical knowledge, a lack of managerial support, and cultural beliefs shared by the healthcare workers and community members that prevailed over evidence-based knowledge. Non-clinical factors from inside and outside the healthcare facilities were inter-related and cannot be separated from the ensuing clinical practice inadequacies. An analytical framework that categorises infection control barriers into clinical and non-clinical domains as well as internal and external factors is therefore proposed to ensure a comprehensive infection control program design. Conclusion: The current clinically-focused infection control programs are likely to have limited and temporary results in rural Indonesia due to barriers being in the main non-clinical in origin. An effective and sustainable infection control program needs to concurrently address basic clinical practice improvements and the underlying managerial, attitudinal and cultural barriers. This public health aspect of infection control is often neglected yet crucial for the success of any infection control program in rural Indonesia.

  • (2009) Viali, Satupaitea
    Abstract inserted as part of Final MPH Thesis: Non-Communicable Diseases like diabetes, cardiovascular diseases, cancers and others, have become the major cause of premature death, morbidity and disability in many Pacific countries including Samoa. These are linked by common preventable risk factors like obesity, hypertension, smoking, unhealthy diets and physical inactivity. OBJECTIVES: To determine the trends and development of Non-Communicable diseases and its risk factors in Samoa over the last 24 years using the recently developed diagnostic criteria. RESEARCH DESIGN AND METHODS: This research thesis combines 3 large surveys that were done in 1978, 1991, and 2002, looking at the trends in the prevalence of diabetes, and the prevalence of the NCD risk factors such as blood pressure, obesity, cholesterol and smoking. The 3 survey samples were selected randomly from around similar regions (Urban Upolu, Rural Upolu, and Rural Savaii) of Samoa in 1978, 1991 and 2002, with a total of 5973 individuals (1978 survey = 1467; 1991 survey = 1778; 2002 survey = 2728) available for the thesis analysis. The 1978 and 1991 data sets were secured from Professor P Zimmet, and the 2002 STEPs survey data set was secured from the Samoa Ministry of Health. The 3 surveys methodologies, survey procedures, questionnaires and anthropometric measurements were similar though the diagnostic criteria used to measure obesity slightly differ between the surveys. The blood pressure measurements were similar though the diastolic blood pressure measure in 1978 was higher. The 1978 and 1991 surveys used fasting venous blood sampling to measure fasting plasma glucose, and cholesterol levels at the laboratory. OGTT was also used in 1978 and 1991, but not 2002. The 2002 survey used capillary sampling to measure fasting glucose using a glucometer, and cholesterol level using a cholesterol meter. The combined data was then cleaned, standardized and matched with each survey, to make analysis easier. The recent diagnostic criteria were then applied to all the surveys to diagnose diabetes (1999 WHO Diabetes Criteria), hypertension (WHO 1999, JNC-VII 2003, NHF 1999 Hypertension Criteria), obesity (BMI ≥30 kg/m²), and hypercholesterolaemia. The prevalences using the recent diagnostic criteria were then mapped out. RESULTS: The overall age-standardized prevalence of type 2 diabetes (known or previously unknown) utilizing the current 1999 WHO diagnostic criteria for men and women ≥20 years of age has increased from 5.4% (males 4.8%, females 5.9%) in 1978, to 12.0% (males 10.9%, females 13.5%) in 1991, and to 20.1% (males 17.2%, females 22.2%) in 2002. Among the individuals with diabetes in the 3 surveys, more than 60% had previously undiagnosed diabetes. Compared with the 1978 survey, the diabetes prevalence in 2002 represents a 4-fold increase over the 24 year period. This has occurred along with increasing obesity, urbanization and modernization, aging, cultural changes, and changes in physical activity. There is a high prevalence of non-communicable disease risk factors. The age-standardized prevalence of hypertension defined by the WHO 1999 and JNC-VII 2003 criteria was 47.2% in 1978, 22.5% in 1991, and 24.0% in 2002. The high prevalence of hypertension in 1978 was due to the method used for recording diastolic blood pressure. Hypertension was more common in the urban regions than rural regions in 1978 and 1991 while in 2002, there was no statistical difference between the rates of hypertension between the different regions due to the rise in the prevalence rate of hypertension in rural regions. There is a high prevalence of overweight and obesity in Samoa. Using the WHO classification for BMI, there was an increase in obesity (BMI ≥ 30kg/m²) prevalence in Samoa in the last decade, increasing steeply from 34.9% in 1978 to 51.3% in 1991, and slowing down to an increase to 57.4% in 2002. The prevalence of obesity is significantly higher in females compared with their male counterparts. The overweight prevalence (BMI 25-29.9kg/m²) was 34% in 1978, 31% in 1991 and 29% in 2002. The prevalence of obesity has increased by 65% from 1978 to 2002 with an increase of 47% from 1978 to 1991, and 12% from 1991 to 2002. Prevalence of obesity is increasing with age and is more of a problem in women than men. It is higher in the urban regions but there has been a faster rise in obesity prevalence in rural regions from 1978 to 2002 as the rural regions become urbanized. The prevalence of hypercholesterolaemia (total cholesterol ≥ 5.2 mmol/l) was 30.5% in 1978, and this increased to 51.1% in 1991. There was a marked decline of hypercholesterolaemia in 2002 (14.4%), which may be due to differences in the method of measurement. Although smoking prevalence remains high in Samoa it declined significantly from 42.4% 1978 to 35.3% 1991 but remained essentially steady at 38% in 2002. There was a significant gender difference in smoking with about 60% of men and 20% of women smoking regularly. CONCLUSION: Samoa is experiencing an increasing problem with Non-Communicable diseases like diabetes and some of its risk factors. Diabetes prevalence has dramatically increased by 4-fold in the last 24 years. The prevalence of hypertension has stabilized around 23% though there was a decrease from 1978. The prevalence of obesity has also increased. Smoking prevalence has slightly increased from 1991 to 2002 with a significant number of the population smoking. Hypercholesterolaemia is more common in 1991 with an apparent decrease in 2002. These findings have important implications for public health efforts and policy developments to contain the epidemic of Non-Communicable diseases in Samoa.

  • (2009) Newton, Nicola Clare Alice
    Alcohol and cannabis are the two most commonly used licit and illicit drugs in most developing countries including Australia. The burden of disease, social costs and harms associated with the use of these drugs is considerable. As such, the need for prevention is clear. Although an array of school-based drug prevention programs exist, the majority of these show minimal effects in reducing actual drug use. The most common impediments to their success concern obstacles to implementation and dissemination of programs, and a lack of sequential and developmentally appropriate messages. The aim of this thesis was to address these limitations by developing and evaluating an integrated school-based prevention program to reduce alcohol and cannabis use. The innovative program known as the Climate Schools: Alcohol and Cannabis Course is founded on current evidence-based research, adopts a harm-minimisation approach to drug prevention and is embedded within the school health curriculum. The core content of the program is delivered over the internet using novel cartoon storylines to engage students. The early development of the course consisted of a cross-validation trial to test the feasibility and generalisability of an existing Climate Schools program for alcohol prevention. Extensive collaboration with teachers, students and health professionals was later conducted to extend and modify the Climate Schools framework to include the prevention of cannabis use. To date, this is the first time an internet-based harm-minimisation cannabis prevention program has been developed for use in schools. To establish the efficacy of the comprehensive Climate Schools: Alcohol and Cannabis Course, a cluster randomised controlled trial was conducted with 10 schools in Sydney (n = 764). Results from this trial demonstrated the innovative course to be effective in increasing knowledge regarding alcohol and cannabis use, and in decreasing the use of these drugs six months following the intervention. This novel approach was found to be acceptable to students and teachers as a means of delivering drug education in schools. This thesis provides support for the more widespread dissemination of the Climate Schools model in schools. The barriers to dissemination require further research and are discussed.

  • (2009) Butler, Lyra
    Rationale Within Australia, cardiac rehabilitation attendance is poor, with typically thirty percent of eligible patients attending programs. The majority of cardiac patients are not receiving the support or detailed information required to increase physical activity participation after hospitalisation. Further, many cardiac patients are not exercising independently, regardless of their attendance at cardiac rehabilitation. As physical activity is important in the prevention and treatment of heart disease, there could be substantial benefits to the individual and cost savings for the health system if cardiac patients were more active. Physical activity interventions based on social cognitive theory have demonstrated success in improving physical activity among people with chronic diseases. However, there is little research conducted with cardiac patients, in particular, with those who do not attend cardiac rehabilitation. This research addresses this gap in public health practice by providing an intervention to cardiac patients, irrespective of their attendance at cardiac rehabilitation, thereby addressing a population that is often overlooked and hard to reach. Research aims • To determine the uptake rate of cardiac rehabilitation in the north Illawarra and Shoalhaven areas of New South Wales and identify the characteristics of cardiac rehabilitation attendees and non attendees. • To evaluate the efficacy of a pedometer based physical activity intervention in cardiac patients referred to cardiac rehabilitation. Methodology This thesis consisted of three related studies: a cross sectional analysis of the characteristics of cardiac rehabilitation referrals (n = 944) over a 10 month period; and two randomised controlled trials conducted simultaneously. The Cardiac Rehabilitation Trial participants (n = 110) were patients who had attended cardiac rehabilitation; Community Trial participants (n = 215) were those who did not attend cardiac rehabilitation. The six week intervention evaluated in the trials included self monitoring of daily physical activity using a pedometer and step calendar, and two behavioural counselling and goal setting sessions delivered via telephone. Additional support for intervention group participants was provided through two brief telephone calls made after the six week intervention period. Self reported physical activity levels were collected at baseline, six weeks and six months. The questionnaire also collected information about psychosocial factors affecting physical activity participation. The exercise capacity of the participants in the Cardiac Rehabilitation Trial was objectively measured at baseline, six weeks and six months using a gas exchange analysis system. Results The cardiac rehabilitation uptake rate was 28.8 per cent of referred patients. Cardiac rehabilitation attendees were significantly younger and more likely to have had a coronary artery bypass graft surgery (CABGS) or percutaneous coronary intervention (PCI) procedure than non attendees. Study groups in both trials were not significantly different at baseline. In the Cardiac Rehabilitation Trial, improvements in total weekly physical activity sessions (p=0.002), walking time (p=0.013) and walking sessions (p<0.001) in the intervention group were significantly greater than the change in the control group at the end of the six week intervention. At six months, improvements in the intervention group remained significantly greater than the control group in total physical activity time (p=0.044), total physical activity sessions (p=0.016) and walking sessions (p=0.035) after adjusting for baseline differences. These self reported behavioural changes were corroborated by improvements in cardiorespiratory fitness at six months in the intervention group (p=0.010). Improvements in the intervention group in behavioural (p=0.039) and cognitive (p=0.024) self management strategy use were significantly greater than the controls at six weeks after adjusting for baseline differences. The improvement in cognitive strategy use (p=0.001) remained significantly greater in the intervention group compared to controls at six months after adjusting for baseline differences. Self efficacy, outcome expectancies and psychological distress were not significantly different between groups at six weeks or six months after adjusting for baseline differences. In the Community Trial, improvements in total weekly physical activity time (p=0.027), total physical activity sessions (p=0.003), walking time (p=0.013) and walking sessions (p=0.002) in the intervention group were significantly greater than the control group at six weeks after adjusting for baseline differences. At six months, improvements in total physical activity time (p=0.015), total physical activity sessions (p=0.019), walking time (p=0.002) and walking sessions (p=0.026) in the intervention group remained significantly greater than the control group after adjusting for baseline differences. Improvements in outcome expectancies (p=0.038) and cognitive self management strategy use (p=0.028) in the intervention group were significantly greater than the change in the control group at six weeks, after adjusting for baseline differences. However, these differences did not remain significant at six months. Conclusion This research showed that participation in a six week pedometer based intervention significantly increased the physical activity level and psychosocial status of people with heart disease. These findings suggest the pedometer based intervention could be offered as an effective and accessible option for those who do not attend cardiac rehabilitation to increase their physical activity levels. This intervention could also be promoted as an important adjunct to existing cardiac rehabilitation programs to promote adherence to physical activity after cardiac rehabilitation attendance. These studies provide community based evidence of an effective physical activity intervention for those eligible for cardiac rehabilitation, including those who do not attend. This provides a public health approach to cardiac rehabilitation programs and has the potential to improve health outcomes in this population.

  • (2009) Adily, Armita
    Evidence-based policy and practice (EBPP) in population health in Australia has been promoted largely without sound research. In response, this thesis presents a series of studies undertaken to assess and inform enhancement of capacity for EBPP in Australia. It comprises linked studies designed to examine different yet complementary aspects of capacity for EBPP. Research was conducted at various levels of Australian health care system, from local to national, in order to better understand EBPP and to make a series of recommendations about effective and synergistic response.

  • (2009) Lin, Frank Po-Yen
    Physicians frequently face challenges in predicting which bacterial subpopulations are likely to cause severe infections. A more accurate prediction of virulence would improve diagnostics and limit the extent of antibiotic resistance. Nowadays, bacterial pathogens can be typed with high accuracy with advanced genotyping technologies. However, effective translation of bacterial genotyping data into assessments of clinical risk remains largely unexplored. The discovery of unknown virulence genes is another key determinant of successful prediction of infectious disease outcomes. The trial-and-error method for virulence gene discovery is time-consuming and resource-intensive. Selecting candidate genes with higher precision can thus reduce the number of futile trials. Several in silico candidate gene prioritisation (CGP) methods have been proposed to aid the search for genes responsible for inherited diseases in human. It remains uninvestigated as to how the CGP concept can assist with virulence gene discovery in bacterial pathogens. The main contribution of this thesis is to demonstrate the value of translational bioinformatics methods to address challenges in virulence prediction and virulence gene discovery. This thesis studied an important perinatal bacterial pathogen, group B streptococcus (GBS), the leading cause of neonatal sepsis and meningitis in developed countries. While several antibiotic prophylactic programs have successfully reduced the number of early-onset neonatal diseases (infections that occur within 7 days of life), the prevalence of late-onset infections (infections that occur between 7–30 days of life) remained constant. In addition, the widespread use of intrapartum prophylactic antibiotics may introduce undue risk of penicillin allergy and may trigger the development of antibiotic-resistant microorganisms. To minimising such potential harm, a more targeted approach of antibiotic use is required. Distinguish virulent GBS strains from colonising counterparts thus lays the cornerstone of achieving the goal of tailored therapy. There are three aims of this thesis: 1. Prediction of virulence by analysis of bacterial genotype data: To identify markers that may be associated with GBS virulence, statistical analysis was performed on GBS genotype data consisting of 780 invasive and 132 colonising S. agalactiae isolates. From a panel of 18 molecular markers studied, only alp3 gene (which encodes a surface protein antigen commonly associated with serotype V) showed an increased association with invasive diseases (OR=2.93, p=0.0003, Fisher’s exact test). Molecular serotype II (OR=10.0, p=0.0007) was found to have a significant association with early-onset neonatal disease when compared with late-onset diseases. To investigate whether clinical outcomes can be predicted by the panel of genotype markers, logistic regression and machine learning algorithms were applied to distinguish invasive isolates from colonising isolates. Nevertheless, the predictive analysis only yielded weak predictive power (area under ROC curve, AUC: 0.56–0.71, stratified 10-fold cross-validation). It was concluded that a definitive predictive relationship between the molecular markers and clinical outcomes may be lacking, and more discriminative markers of GBS virulence are needed to be investigated. 2. Development of two computational CGP methods to assist with functional discovery of prokaryotic genes: Two in silico CGP methods were developed based on comparative genomics: statistical CGP exploits the differences in gene frequency against phenotypic groups, while inductive CGP applies supervised machine learning to identify genes with similar occurrence patterns across a range of bacterial genomes. Three rediscovery experiments were carried out to evaluate the CGP methods: a) Rediscovery of peptidoglycan genes was attempted with 417 published bacterial genome sequences. Both CGP methods achieved their best AUC >0.911 in Escherichia coli K-12 and >0.978 Streptococcus agalactiae 2603 (SA-2603) genomes, with an average improvement in precision of >3.2-fold and a maximum of >27-fold using statistical CGP. A median AUC of >0.95 could still be achieved with as few as 10 genome examples in each group in the rediscovery of the peptidoglycan metabolism genes. b) A maximum of 109-fold improvement in precision was achieved in the rediscovery of anaerobic fermentation genes. c) In the rediscovery experiment with genes of 31 metabolic pathways in SA-2603, 14 pathways achieved an AUC >0.9 and 28 pathways achieved AUC >0.8 with the best inductive CGP algorithms. The results from the rediscovery experiments demonstrated that the two CGP methods can assist with the study of functionally uncategorised genomic regions and the discovery of bacterial gene-function relationships. 3. Application of the CGP methods to discover GBS virulence genes: Both statistical and inductive CGP were applied to assist with the discovery of unknown GBS virulence factors. Among a list of hypothetical protein genes, several highly-ranked genes were plausibly involved in molecular mechanisms in GBS pathogenesis, including several genes encoding family 8 glycosyltransferase, family 1 and family 2 glycosyltransferase, multiple adhesins, streptococcal neuraminidase, staphylokinase, and other factors that may have roles in contributing to GBS virulence. Such genes may be candidates for further biological validation. In addition, the co-occurrence of these genes with currently known virulence factors suggested that the virulence mechanisms of GBS in causing perinatal diseases are multifactorial. The procedure demonstrated in this prioritisation task should assist with the discovery of virulence genes in other pathogenic bacteria.