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Biomedical subjects

A J Plant

Publications and source records attributed to A J Plant.

At least 19 recordsLinked to original sources
PubMed1998

Preventability of incident cases of tuberculosis in recently exposed contacts.

SETTING: Contacts of tuberculosis (TB) cases are at risk for TB. If contact screening and intervention are effective, one would expect a reduced incidence of TB in contacts who have been screened. OBJECTIVE: To measure the incidence of TB in contacts during a 2-year follow up, and to estimate the preventability of incident cases. METHODS: A retrospective cohort study of 783 contacts screened in Victoria, Australia, in 1991. Contacts were matched with the TB registry for the following 2 years. Screening records were reviewed. RESULTS: The rate of TB in contacts was 511/100000 population/year for the first 2 years. In Poisson regression models the only significant variable predicting disease was skin test reaction size. Six of eight incident cases were potentially preventable, with a lowest achievable incidence rate of 128/100000/year. CONCLUSION: Contacts who underwent screening for TB through a state screening programme had a high incidence of TB during the 2 year follow up. Published rates of TB of 425-670/100000 in untreated contacts suggests that the Victorian screening programme had minimal impact on the natural history of disease progression. Intrinsic programme factors such as the appropriateness of the guidelines, adherence to guidelines and rates of preventive therapy need to be evaluated. The devolution of the TB programme in the 1980s also reduced its efficacy. Systematic assessment of screening programmes for efficacy and outcome is part of good public health practice.

Adolescent↗
PubMed1997

Changes in bed resources and admission patterns in acute public hospitals in Victoria, 1987-1995.

OBJECTIVE: To describe changes in admission patterns, bed resources and hospital use in acute public hospitals and their relationship with early readmissions and interhospital transfers in Victoria between 1987 and 1995. DESIGN: Descriptive study of longitudinal trends using data from the Victorian inpatient Minimum Database and the Acute Health Services Branch of the Department of Human Services, Victoria. SETTING: State of Victoria. MAIN OUTCOME MEASURES: Acute public hospital beds and hospital separations per 1000 population; separation type (same-day or longer); mean length of stay; interhospital transfers; and readmissions to the same hospital within 28 days. RESULTS: Between 1987-88 and 1994-95, public hospital beds in Victoria decreased from 3.2 to 2.8/1000 population, and mean length of hospital stay decreased from 6.4 to 4.2 days. There was a significant direct correlation between number of beds/1000 and length of stay (r = 0.90; 95% confidence interval [CI], 0.52-0.98). Bed occupancy remained constant at 80%. Over the same period, same-day admissions increased from 22% to 42% of hospital separations, interhospital transfers increased from 2.7% to 4% of separations, and readmissions to the same hospital within 28 days for any reason increased from 12.4% to 15% of separations (21% increase). Beds/1000 were inversely correlated with interhospital transfers (r = -0.83; 95% CI, -0.31 to -0.97), while readmission rates were inversely correlated with beds/1000 (r = -0.89; 95% CI, -0.98 to -0.50) and length of hospital stay (r = -0.95; 95% CI, -0.99 to -0.74). CONCLUSIONS: There were significant changes in the patterns of use of public hospitals between 1987 and 1995, possibly reflecting technological advances and changes in clinical practice, as well as policy to improve efficiency. Early readmission rates may be a useful proxy measure of potentially avoidable adverse outcomes.

Diagnosis-Related Groups↗
PubMed1997

Incidence and prevalence of hepatitis C among clients of a Brisbane methadone clinic: factors influencing hepatitis C serostatus.

The objective of this study was to describe the incidence and prevalence of hepatitis C infection among clients of a methadone program in Queensland. The clinical notes of clients receiving methadone for treatment of opiate dependence who first registered at the clinic after 1989 were perused for information about their serological status for hepatitis C and hepatitis B infections during a six-week period in 1994. We followed hepatitis C negative clients until August-September 1995. At study entry, 69 per cent of the clients were recorded as being hepatitis C positive. Of those who were negative, the seroconversion rate was 11 per 100 person-years. The high incidence and prevalence of hepatitis C among methadone clients emphasises the need for effective early intervention strategies to prevent the transmission of hepatitis C among injecting drug users.

Adolescent↗
PubMed1997

A review of Q fever in Australia 1991-1994.

Q fever continues to be an important disease in Australia. Despite the development of an effective vaccine that has been commercially available since 1989, the number of cases notified has continued to increase. This study reviewed national notifications of Q fever between 1991 and 1994, together with demographic, socioeconomic and occupational information, to investigate temporal and spatial disease patterns. Based on notification data, Q fever can be considered primarily a disease of adult males that occurs in eastern Australia: southern Queensland and northern New South Wales have the highest levels of activity. A significant association between Q fever activity of areas and the presence of livestock was found. A strong association with the meat industry was also confirmed. Q fever is conservatively estimated to cost Australia around A$1 million and more than 1700 weeks of work time annually. There is a need to increase awareness of this disease and its prevention. An extension program in rural communities and provision of vaccine to all abattoir workers would appear to be sensible public health approaches.

Adolescent↗
PubMed1997

Missed opportunities for prevention of tuberculosis in Victoria, Australia.

SETTING: Victoria, Australia. OBJECTIVE: To ascertain missed opportunities for prevention in all persons notified in 1991 to the state registry with active tuberculosis (TB), and to examine aspects of case management relevant to prevention. DESIGN: A descriptive study. Records were reviewed for 231/236 cases of TB notified in the state of Victoria in 1991. Documentation of past screening for TB, preventive therapy, treatment of active disease and follow up was sought for all cases. Past screening was defined as past contact screening, migrant screening, refugee screening and health undertakings for TB. RESULTS: Of the 231 cases, 13 were not confirmed to have TB. Of the remaining 218 cases, 78% were foreign born, and of these, nearly half were diagnosed within 3 years of arriving in Australia. Nearly half of all cases (97/218) had some form of past screening for TB. The most common type of screening was refugee and migrant screening (45/218, 21%) followed by tuberculosis health undertakings (25/218, 12%) and contact screening (15/218, 7%). Of those with past screening, 70% (68/97) had a positive screening result at the time. Among these, the first screening episode resulted in the diagnosis of active TB in 5/68, and TB infection in 63/68. In the latter group only 5% (3/63) received preventive therapy. CONCLUSION: There are significant missed opportunities for prevention in Victoria, particularly in the foreign born cases who receive screening on entry into the country. For screening to be a meaningful exercise, preventive therapy should be used where medically indicated.

Adolescent↗
PubMed1996

The incidence of hepatitis B infection in Australia: an epidemiological review.

Hepatitis B virus (HBV) infection in Australia remains a significant problem despite the availability of an inexpensive vaccine. National information about incidence, prevalence, morbidity and the extent of vaccine coverage is incomplete; improved surveillance would allow for better targeting and evaluation of prevention activities. Our estimates indicate that 75%-90% of cases of vertical transmission of HBV are preventable through vaccination of newborns whose mothers are carriers.

Adolescent↗
PubMed1996

Time to initiation of anti-tuberculosis treatment.

SETTING: Fairfield Hospital, Victoria, Australia. OBJECTIVE: To examine delay in initiation of treatment for tuberculosis (TB). DESIGN: Delay in the initiation of treatment for 142 notified TB patients was examined by a retrospective record review. Particular attention was given to the periods between (1) onset of symptoms and initiation of treatment, and (2) determination of sputum positivity and initiation of treatment. An expert panel nominated 30 days and 3 days as 'acceptable' periods for (1) and (2), respectively. RESULTS: Only 31% of patients commenced treatment within 30 days of onset of symptoms. This was so for both sputum smear-positive and negative cases, and was not significantly related to the site of infection, referral source, age, gender or ethnicity of the patient. Of patients with smear-positive pulmonary TB, 86% received treatment within 3 days of this result being demonstrated. Those with a delay of greater than 3 days were all investigated by private doctors through private laboratories. CONCLUSION: There are appreciable delays in initiation of treatment for TB. Measures to combat these unacceptable delays are discussed.

Aged↗
PubMed1996

Has access to hospital improved for Aborigines in the northern territory?

One of the stated aims of Australia's health care system is to achieve equity of access to health care according to need for all Australians, with the ultimate goal of moving toward statistical equality of good health for all. This paper examines how, using routinely collected population health data, we might answer the question of whether access to hospital care for Aborigines in the Northern Territory (NT) improved in relation to access for non-Aborigines during the period 1979 to 1988. Some of the advantages and shortfalls of this approach are discussed and an 'index of access' is postulated. This index is shown to be moving towards 1 during the period, suggesting that access to hospitals has improved for Aborigines compared with non-Aborigines, but that a substantial shortfall still exists. While this index can be useful for measuring progress toward achieving the horizontal equity of equal access for equal need, the more difficult task of defining and measuring progress toward vertical equity goals with respect to the persistent and gross inequalities in health status between Aboriginal and non-Aboriginal Australians deserves priority.

Adult↗
PubMed1996

Investigation of notifications of hepatitis C in 1994: the experience of three health departments.

Laboratories must notify health departments of cases of hepatitis C in Queensland, the Northern Territory (NT) and the Australian Capital Territory (ACT). Our objectives were to estimate the minimum proportion of notified cases of hepatitis C that were recent infections and to determine the risk factors for infection of the notified cases. We conducted a retrospective investigation of all eligible notifications received at the health departments in Queensland, the Northern Territory and the Australian Capital Territory. Of the 963 notifications about which information was received, 16 per cent were repeat notifications. These were excluded from further analysis. In Queensland, 7 per cent, and in both NT and ACT, 3 per cent of the notifications were considered to be recent infections. The most common risk factor reported for both recent and all other hepatitis C cases was a history of injecting drug use, although the proportion of cases with that history was different in NT from ACT and Queensland. Cases were tested because of screening programs: for drugs and alcohol, in sexually transmitted diseases clinics and prison; and because of clinical indications such as a risk factor, symptoms, or results of liver function tests. Another common reason for testing was a request from a patient. A significant proportion of recorded notifications was repeat notifications. Most notifications were of patients who had become infected more than 12 months ago and the most common risk factor was injecting drug use. There was not a high proportion of cases with unknown risk factors.

Age Distribution↗
PubMed1995

High rate of transmission of tuberculosis in an office: impact of delayed diagnosis.

We identified two cases of tuberculosis (TB) in office co-workers in Melbourne, Victoria, Australia; the Mycobacterium tuberculosis isolates were found to be identical with use of restriction fragment length polymorphism. Contact tracing was performed for 195 of 210 workers by means of the tuberculin skin test. Risk of infection was assessed according to a number of variables. Office contacts were exposed to infectious TB for 4 months; at least 24% of employees were infected. There was an association between sitting in proximity to the case during the period of exposure (OR, 4.24; 95% CI, 1.06-19.67). On-site workers had a higher risk of being infected (OR, 5.48; CI, 1.51-23.54) than did visiting workers. Workers in this office were exposed to open pulmonary TB for prolonged periods. The prevalence of TB infection (24%) among these workers was high compared with the infection rate (2%-7%) in the general community. Delay in diagnosis was the major factor responsible for the spread of TB in this office.

Adult↗
PubMed1995

Aborigines and tuberculosis: why they are at risk.

Aborigines have higher rates of Mycobacterium tuberculosis than the rest of the community. There are insufficient contemporary data to assess how much risk tuberculosis poses to the Aboriginal community. Tuberculosis is of particular concern because of its interaction with human immuno-deficiency virus (HIV). We aimed to ascertain the available data about tuberculosis in Australian Aborigines: to determine morbidity and mortality of tuberculosis in Australian Aborigines, to ascertain the extent of known risk factors for tuberculosis in Australian Aborigines and to consider the public health implications of our findings. Sparse evidence suggests that Aborigines have higher rates of infection and of clinical tuberculosis than non-Aboriginal Australians, along with a high prevalence of known risk factors for tuberculosis. However, there is a paucity of data about specific risk factors and tuberculosis in Aborigines. In addition, Aborigines have a high prevalence of risk factors for HIV infection. The existence of concurrent risk factors for tuberculosis and HIV, in a population that already has a high rate of infection with tuberculosis is cause for grave concern. Tuberculosis control is centred on correct and rapid diagnosis and appropriate treatment, as well as efficient contact tracing. These are the most important strategies for control of tuberculosis among Aborigines, and are especially important when there is concurrence of other risk factors. Appropriate preventive therapy for infected people should also be considered.

Australia↗
PubMed1993

Influenza vaccination in Victoria, 1992.

OBJECTIVES: To determine the rates and patterns of vaccination against influenza in the Victorian population. Further, to determine rates of vaccination against influenza in residents of Victorian nursing homes and hostels. DESIGN: Between May and June of 1992 we conducted a telephone survey of 537 systematically selected Victorian residents. We obtained information on age, sex, vaccination status, and level of risk for the complications of influenza. We conducted a separate postal survey of 143 randomly selected Victorian nursing homes and hostels to establish rates of vaccination within these institutions. PARTICIPANTS: Residents of Victoria listed in the White Pages telephone directories in both metropolitan and rural areas. We made calls during working hours to both residential and business numbers, and spoke to the first person who answered the telephone. Participants in the nursing home survey were the matrons or directors of nursing of randomly chosen facilities in the State, who filled out questionnaires relating to their residents. RESULTS: The vaccination rate against influenza in the whole population was 13.3%. This and all other figures quoted are adjusted for age, unless otherwise specified. There was a significant difference in vaccination rates between rural (9%) and metropolitan (16%) areas (P < 0.05). Using the National Health and Medical Research Council (NHMRC) guidelines, 29% of the population had at least one indication for vaccination. Of people at low risk for complications of influenza, 7.8% were vaccinated. Of people with one or more specific indications for vaccination, 29.4% were vaccinated. Vaccination rates increased with increasing number of indications and with increasing age, approaching 45% in people over 65 years and 50% in people with three or more indications for vaccination. The postal survey of nursing homes and hostels revealed that a mean of 52% of residents per facility were vaccinated against influenza. This figure varied between 45% in rural facilities and 53% in metropolitan facilities. CONCLUSIONS: We estimate that 550,000 doses of influenza vaccine were used in Victoria in 1992. Approximately 50% of these were given to people at low risk for complications of influenza. These findings highlight the need to target high risk groups for vaccination, reassure the general public, and educate health care professionals.

Adolescent↗