Now showing 1 - 10 of 168
  • Publication
    Journal Article
    Hearing loss in Australian First Nations children at 6-monthly assessments from age 12 to 36 months: Secondary outcomes from randomised controlled trials of novel pneumococcal conjugate vaccine schedules.
    (2024-06-03)
    Leach, Amanda Jane
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    Wilson, Nicole
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    Arrowsmith, Beth
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    Beissbarth, Jemima
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    Mulholland, Kim
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    Santosham, Mathuram
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    Torzillo, Paul John
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    McIntyre, Peter
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    Smith-Vaughan, Heidi
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    Skull, Sue A
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    Oguoma, Victor M
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    Chatfield, Mark D
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    Lehmann, Deborah
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    Brennan-Jones, Christopher G
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    Binks, Michael J
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    Licciardi, Paul V
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    Andrews, Ross M
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    Snelling, Tom
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    Carapetis, Jonathan
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    Chang, Anne B
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    In Australian remote communities, First Nations children with otitis media (OM)-related hearing loss are disproportionately at risk of developmental delay and poor school performance, compared to those with normal hearing. Our objective was to compare OM-related hearing loss in children randomised to one of 2 pneumococcal conjugate vaccine (PCV) formulations.In 2 sequential parallel, open-label, randomised controlled trials (the PREVIX trials), eligible infants were first allocated 1:1:1 at age 28 to 38 days to standard or mixed PCV schedules, then at age 12 months to PCV13 (13-valent pneumococcal conjugate vaccine, +P) or PHiD-CV10 (10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine, +S) (1:1). Here, we report prevalence and level of hearing loss outcomes in the +P and +S groups at 6-monthly scheduled assessments from age 12 to 36 months. From March 2013 to September 2018, 261 infants were enrolled and 461 hearing assessments were performed. Prevalence of hearing loss was 78% (25/32) in the +P group and 71% (20/28) in the +S group at baseline, declining to 52% (28/54) in the +P groups and 56% (33/59) in the +S group at age 36 months. At primary endpoint age 18 months, prevalence of moderate (disabling) hearing loss was 21% (9/42) in the +P group and 41% (20/49) in the +S group (difference -19%; (95% confidence interval (CI) [-38, -1], p = 0.07) and prevalence of no hearing loss was 36% (15/42) in the +P group and 16% (8/49) in the +S group (difference 19%; (95% CI [2, 37], p = 0.05). At subsequent time points, prevalence of moderate hearing loss remained lower in the +P group: differences -3%; (95% CI [-23, 18], p = 1.00 at age 24 months), -12%; (95% CI [-30, 6], p = 0.29 at age 30 months), and -9%; (95% CI [-23, 5], p = 0.25 at age 36 months). A major limitation was the small sample size, hence low power to reach statistical significance, thereby reducing confidence in the effect size.In this study, we observed a high prevalence and persistence of moderate (disabling) hearing loss throughout early childhood. We found a lower prevalence of moderate hearing loss and correspondingly higher prevalence of no hearing loss in the +P group, which may have substantial benefits for high-risk children, their families, and society, but warrant further investigation.ClinicalTrials.gov NCT01735084 and NCT01174849.
  • Publication
    Journal Article
    The first confirmed human case of rabies, Timor-Leste, 2024.
    (2024-05-01)
    Amaral Mali, Marcelo
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    Machado, Filipe de Neri
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    Moniz, Filomeno Pinto
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    Bosco Alves Dos Santos, Frederico
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    Laot, Perpetua Ana Mery Estela
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    Pereira Tilman, Ari Jayanti
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    Florindo, Tanizio Ebryes
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    Barros, Cristovao de Alexandria
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    Barbosa, Adriano
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    Oliveira Lima, Jose A
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    Goncalves, Joao Paulo
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    Borges, Francisco
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    Hornay, Elisabeth
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    Moises, Joanico
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    de Jesus Neto, Osmenia
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    Varela, Liliana
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    da Costa, Agapito
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    Francis, Joshua R
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    Monteiro, Merita Antonio A
    In March 2024, the first ever human case of rabies, following a dog bite, was detected in Timor-Leste. This paper briefly discusses the circumstances of transmission, clinical presentation, palliative care of the case and public health measures taken. Timor-Leste was previously considered rabies-free. Any person who is bitten or scratched by an animal that could potentially transmit rabies virus (especially dogs, bats, monkeys or cats) in Timor-Leste should be assessed for consideration of provision of rabies post-exposure prophylaxis.
  • Publication
    Journal Article
    The first confirmed outbreak of chikungunya reported in Timor-Leste, 2024.
    (2024-04-09)
    Machado, Filipe de Neri
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    Monteiro Fernandes, Anferida
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    Dos Santos, Frederico Bosco Alves
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    Mali, Marcelo Amaral
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    Pereira Tilman, Ari J
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    Soares da Silva, Endang
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    Hornay, Elizabeth
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    Salles de Sousa, Antonio
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    Oakley, Tessa
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    Cruz, Edinha da
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    Sarmento, Nevio
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    Niha, Maria A V
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    Soares, Ana Fatima
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    Cardoso Gomes, Eva Estrelita
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    de Deus Alves, Jose
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    Soares, Jose Paulo
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    Francis, Joshua R
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    Monteiro, Merita Antonio
    Timor-Leste is a mountainous, half-island nation with a population of 1.3 million, which shares a land border with Indonesia and is 550 km from Darwin, Australia. Since independence in 2002, Timor-Leste has achieved significant development; however, high levels of poverty remain. Chikungunya virus (CHIKV) is endemic in over 100 countries in Africa, Asia, Europe and in the Americas. It is transmitted by the bite of infected Aedes aegypti or Ae. albopictus mosquitoes, which are present in Timor-Leste and which contribute to annual rainy-season dengue virus (DENV) outbreaks. Symptomatic people typically suffer from acute onset of fever, usually accompanied by severe arthritis or arthralgia. Joint pain can be debilitating for several days, and may sometimes last for weeks, months or years. Unlike DENV infection which has significant mortality, most people recover completely. Between 2002 and 2023, there were 26 cases of CHIKV notified in Australia who acquired their infection in Timor-Leste; however, laboratory testing capability for CHIKV in Timor-Leste only became available in 2021 using polymerase chain reaction (PCR). The first locally diagnosed case was notified in November 2023. In January 2024, an outbreak of CHIKV was recognised in Timor-Leste for the first time, with 195 outbreak cases reported during 1-31 January 2024; all were PCR positive. There were no cases hospitalised, and no deaths. The median age of cases was 17 years (range 1-76 years); 51% were males. Cases were reported across the country; most (88/195) were from Dili, although the highest incidence was seen in the neighbouring municipality of Ermera (monthly incidence rate of 58.8 cases per 100,000 population). This first reported outbreak of CHIKV in Timor-Leste highlights the need for improved mosquito-borne illness control and response strategies, including minimising breeding sites and promoting early presentation for treatment and differential diagnosis from DENV, and consideration of the deployment of Wolbachia-infected mosquitoes, particularly as they have shown to reduce the transmission of CHIKV, DENV and Zika virus, all of which pose threats in Timor-Leste.
  • Publication
    Journal Article
    Comprehensive observational study evaluating the enduring effectiveness of 4CMenB, the meningococcal B vaccine against gonococcal infections in the Northern Territory and South Australia, Australia: study protocol.
    (2024-05-08)
    Marshall, Helen
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    Ward, James
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    Wang, Bing
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    Andraweera, Prabha
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    McMillan, Mark
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    Flood, Louise
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    Bell, Charlotte
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    Sisnowski, Jana
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    ; ; ; ; ;
    Leong, Lex
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    Lawrence, Andrew
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    Whiley, David M
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    Karnon, Jonathan
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    van Hal, Sebastian
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    Lahra, Monica M
    The effectiveness of antibiotics for treating gonococcal infections is compromised due to escalating antibiotic resistance; and the development of an effective gonococcal vaccine has been challenging. Emerging evidence suggests that the licensed meningococcal B (MenB) vaccine, 4CMenB is effective against gonococcal infections due to cross-reacting antibodies and 95% genetic homology between the two bacteria, and that cause the diseases. This project aims to undertake epidemiological and genomic surveillance to evaluate the long-term protection of the 4CMenB vaccine against gonococcal infections in the Northern Territory (NT) and South Australia (SA), and to determine the potential benefit of a booster vaccine doses to provide longer-term protection against gonococcal infections.This observational study will provide long-term evaluation results of the effectiveness of the 4CMenB vaccine against gonococcal infections at 4-7 years post 4CMenB programme implementation. Routine notifiable disease notifications will be the basis for assessing the impact of the vaccine on gonococcal infections. Pathology laboratories will provide data on the number and percentage of positive tests relative to all tests administered and will coordinate molecular sequencing for isolates. Genome sequencing results will be provided by SA Pathology and Territory Pathology/New South Wales Health Pathology, and linked with notification data by SA Health and NT Health. There are limitations in observational studies including the potential for confounding. Confounders will be analysed separately for each outcome/comparison.The protocol and all study documents have been reviewed and approved by the SA Department for Health and Well-being Human Research Ethics Committee (HREC/2022/HRE00308), and the evaluation will commence in the NT on receipt of approval from the NT Health and Menzies School of Health Research Human Research Ethics Committee. Results will be published in peer-reviewed journals and presented at scientific meetings and public forums.
  • Publication
    Journal Article
    Factors leading to diagnostic delay in tuberculosis in the tropical north of Australia.
    Tuberculosis (TB) incidence is decreasing in the Northern Territory (NT) but still exceeds rates elsewhere in Australia. Deaths and morbidity from advanced TB continue, with delay in diagnosis a contributor to adverse outcomes.We aimed to describe the delay in diagnosis of TB, identify risk factors for delay and examine the associations between delay and clinical outcomes.We conducted a historical cohort analysis which included adult inpatients diagnosed with TB at the Royal Darwin Hospital from 2010 to 2020. Patient delay was measured as time from symptom onset to first seeking care, and health system delay was quantified as time from first relevant clinical contact to diagnosis. The sum of these two periods was the total delay. Ethics approval was granted by NT HREC (2020-3852).Eighty-four cases were included; the median total delay was 90 days (interquartile range (IQR): 60-121), patient delay was 53 days (IQR: 30-90), and health system delay was 21 days (IQR: 12-45). Patient delay was longer among patients with extrapulmonary (median: 100 days (IQR: 90-105) compared with pulmonary TB patients (39 days (IQR: 27-54), P < 0.0001). Health system delay was longer in those aged ≥45 years (30 days (IQR: 16-51) vs younger patients (14 days (IQR: 8-30), P = 0.007) and among non-smokers (31 days (IQR: 21-55) vs 21 days (IQR: 10-40), P = 0.048). Median delay was longer among patients with non-drug-related complications of disease (P < 0.0001), those admitted to critical care (P < 0.0001), and those with respiratory failure (P = 0.001).The patient delays we report are longer than reported elsewhere in Australia. The next steps will require concerted efforts to improve community awareness of TB and strategies to strengthen health systems through better resourcing and healthcare provider support.
  • Publication
    Journal Article
    A brief description of the epidemiology of dengue in Dili, Timor-Leste, 2018-2022.
    (2024-04-09)
    Machado, Filipe de Neri
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    Dos Santos, Frederico Bosco Alves
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    Mali, Marcelo Amaral
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    Pereira Tilman, Ari J
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    Soares da Silva, Endang
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    Soares, Noel Gama
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    Sarmento, Nevio
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    Niha, Maria A V
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    Soares, Ana Fatima
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    Taal, Abdoulie
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    Francis, Joshua R
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    Miller, Megge
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    Flint, James
    Dengue virus (DENV) infection causes 390 million infections per year and 40,000 deaths globally. It is endemic in many countries in Asia, Africa, the Americas, the Caribbean, and Oceania. Dengue is endemic in Timor-Leste year-round, but peak transmission occurs during the rainy season. We briefly describe the epidemiology of DENV in the Municipality of Dili between 2018 and 2022. There were 6,234 cases notified, with a mean annual incidence rate of 330 cases per 100,000 population. There were 55 deaths (case fatality rate 0.9%). The peak annual incidence (3,904 cases) occurred in 2022 after an outbreak was declared in January of that year; this outbreak included 760 cases of dengue haemorrhagic fever and 35 deaths. The number of outbreak cases requiring hospital treatment exceeded the usual capacity, but facilities established for coronavirus disease 2019 (COVID-19) isolation and treatment were repurposed to meet this demand. Existing strategies of vector control, minimising breeding sites and promoting early presentation for treatment should continue, as should the utilisation of surveillance systems and treatment facilities established during the COVID-19 pandemic. However, dengue incidence remains high, and other dengue control strategies-including the deployment of Wolbachia-infected mosquitoes-should be considered in Timor-Leste.
  • Publication
    Journal Article
    Rheumatic heart disease in Timor-Leste school students: an echocardiography-based prevalence study.
    (2018-04-16)
    Davis K
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    Remenyi B
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    Dos Santos J
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    Bayley N
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    Paratz E
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    Reeves B
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    Appelbe A
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    Cochrane A
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    Johnson TD
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    Korte LM
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    Do Rosario IM
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    Da Silva Almeida IT
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    Carapetis JR
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    To determine the prevalence of rheumatic heart disease (RHD) in school-aged children and young people in Timor-Leste. Prospective cross-sectional survey. Echocardiography was performed by Australian cardiologists to determine the presence of RHD. Demographic data were also collected. Patients in whom RHD was detected were entered into a register to allow monitoring of adherence to secondary prophylaxis; the first dose of benzathine penicillin G (BPG) was administered on the day of screening. Schools in urban (Dili) and rural (Ermera) Timor-Leste. School students aged 5-20 years. Definite and borderline RHD, as defined by World Heart Federation echocardiographic criteria. 1365 participants were screened; their median age was 11 years (IQR, 9-14 years), and 53% were girls. The estimated prevalence of definite RHD was 18.3 cases per 1000 population (95% CI, 12.3-27.0 per 1000), and of definite or borderline RHD 35.2 per 1000 (95% CI, 26.5-46.4 per 1000). Definite (adjusted odds ratio [aOR], 3.5; 95% CI, 1.3-9.4) and definite or borderline RHD (aOR, 2.7; 95% CI, 1.4-5.2) were more prevalent among girls than boys. Eleven children (0.8%) had congenital heart disease. Of the 25 children in whom definite RHD was identified, 21 (84%) received education and a first dose of BPG on the day of screening; all 25 have since received education about primary care for RHD and have commenced penicillin prophylaxis. The rates of RHD in Timor-Leste are among the highest in the world, and prevalence is higher among girls than boys. Community engagement is essential for ensuring follow-up and the effective delivery of secondary prophylaxis.
  • Publication
    Guideline
    Public Health Management of Invasive Group A Streptococcal Disease in the Northern Territory Guideline
    (NT Health, 2022-05-18)
    Merridew, Nancy
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    Centre for Disease Control (CDC), Department of Health, Northern Territory
    Invasive group A Streptococcal (iGAS) infection is a rare but serious disease that occurs in a complex relationship with clinical and social determinants of health. Public health responses to iGAS vary between jurisdictions. The release of this updated version of the Northern Territory (NT) iGAS public health management guidelines co-incides with iGAS becoming nationally notifiable in all Australian states and territories from July 2021.1 iGAS has been notifiable in the Northern Territory since May 2011 and in Queensland since December 2015. An ongoing public health response to iGAS is supported by Australian surveillance data.1-3 The NT population is burdened by particularly high rates of group A Streptococcal (GAS)-related disease. These NT guidelines are based on local epidemiology, expert opinion and available local and international evidence (see Appendix). Dosing revisions in this document are in line with current Australian Therapeutic Guidelines and the Central Australian Rural Practitioners Association (CARPA) Standard Treatment Manual
  • Publication
    Journal Article
    Rotavirus outbreak in a remote Aboriginal community: the burden of disease.
    (2006-12)
    Gelbart B
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    Hansen-Knarhoi M
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    Binns P
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    To document the burden of disease caused by an outbreak of rotavirus (RV) gastroenteritis in a remote Aboriginal community. During an outbreak of RV gastroenteritis, data were collected from patients notes, hospital and laboratory data. Age, date of presentation, severity of illness, number of total presentations, presentations per patient, total clinic hours per presentation, stool analysis, treatment and outcomes were measured. These data were compared with a time period of equal duration in order to establish a baseline burden of gastroenteritis. In a remote Aboriginal community 26 patients were managed for acute diarrhoea between 19 September 2005 and 5 October 2005. Gastroenteritis was the diagnosis in 24 cases for which there were 55 presentations. Stool specimens were analysed in 14 (58%) cases. RV was identified in eight (57%) of these specimens. The majority (80%) had mild disease. Moderate disease was noted in 15% and 5% were follow-up reviews. There were no severe cases of gastroenteritis. Four patients required evacuation to hospital. From a total of 607 presentations to the clinic during this time period, 55 (9%) were managed for acute diarrhoea. In the comparative time period there were five (0.9%) cases of acute diarrhoea from a total of 571 presentations. Rotavirus gastroenteritis places a large burden on remote Aboriginal communities and health-care centres in the form of morbidity, overworked clinic staff, economic cost and reduced capacity for primary health-care duties.
      1214
  • Publication
    Journal Article
    Birth outcomes in women with gestational diabetes managed by lifestyle modification alone: The PANDORA Study.
    (2019-10-03)
    Cheng E
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    Longmore D
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    Barzi F
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    Barr ELM
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    Lee I
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    Boyle JA
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    Oats J
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    McIntyre HD
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    Kirkwood M
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    Dempsey K
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    Zhang X
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    ; ;
    Zimmet P
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    Brown ADH
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    Shaw JE
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    To assess outcomes of women in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) cohort with gestational diabetes mellitus (GDM) managed by lifestyle modification compared with women without hyperglycaemia in pregnancy. Indigenous (n=97) and Europid (n=113) women managed by lifestyle modification were compared to women without hyperglycaemia (n=235). Multivariate linear and logistic regressions assessed whether GDM-lifestyle women had poorer outcomes compared to women without hyperglycaemia. Women with GDM-lifestyle had higher body mass index and lower gestational weight gain than women without hyperglycaemia. On univariate analysis, gestational age at delivery was lower and induction rates were higher in women with GDM-lifestyle than without hyperglycaemia. On multivariable regression, GDM-lifestyle was associated with lower gestational age at delivery (by 0.73 weeks), lower birthweight z-score (by 0.26, p=0.007), lower likelihood of large for gestational age (LGA) [OR (95% CI): 0.55 (0.28, 1.02), p=0.059], and greater likelihood of labour induction [2.34 (1.49, 3.66), p < 0.001] than women without hyperglycaemia CONCLUSION: Women with GDM managed by lifestyle modification had higher induction rates and their offspring had lower birthweight z-scores, with a trend to lower LGA than those without hyperglycaemia in pregnancy. Further studies are indicated to explore reasons for higher induction rates.
      4096