Biomedical subjects

David Sibbritt

Publications and source records attributed to David Sibbritt.

12 recordsLinked to original sources

PubMed2007

Gender and socio-economic differences in BMI of secondary high school students in Ho Chi Minh city.

OBJECTIVE: To assess the nutritional status of adolescents in Ho Chi Minh City, and in particular determine the prevalence of overweight and obesity in adolescents across different sub groups, based on gender, household economic status and geographic location. DESIGN: A cross-sectional survey based on a two-stage cluster sampling design. SETTING: Secondary high schools in Ho Chi Minh City. SUBJECTS: There were 1504 adolescents involved in the study, of which 50% were girls and the mean age of participants was 13.1 years. RESULTS: Overall, 4.9% of the students were overweight and 0.6% were obese, while 13.1% of the students were underweight. The prevalence of underweight was significantly higher in boys than girls (p=0.001) and overweight and obesity were also higher in boys although these differences were not statistically significant (p=0.074). There was a much higher prevalence of overweight and obesity in students from schools in wealthy urban districts (8.2% and 0.6%, respectively) in comparison to students from schools in rural or semi-rural districts (1.6% and 0.2%, respectively) and these differences were statistically significant (p<0.001). CONCLUSIONS: A transition in nutritional status is underway in this population of adolescents where overweight and obesity are emerging as a public health problem, but underweight remains a significant problem.

Adolescent↗

PubMed2006

A profile of middle-aged women who consult a chiropractor or osteopath: findings from a survey of 11,143 Australian women.

PURPOSE: The aim of this study is to examine the prevalence of chiropractic and osteopathy use and the profile of chiropractor/osteopath users among middle-aged Australian women. METHODS: This article reports on research conducted as part of the Australian Longitudinal Study on Women's Health. The focus of this article is the middle-aged women who responded to Survey 3 in 2001 when they were between the ages of 50 and 55 years. The demographic characteristics, health status, and health service use of chiropractic/osteopathy users and nonusers were compared using chi2 tests for categorical variables and t tests for continuous variables. RESULTS: We estimate that 16% of middle-aged women consult with a chiropractor or osteopath (after adjustment for the oversampling of rural women). Area of residence, education, and employment status were all statistically significantly associated with chiropractic and osteopath use. Specifically, women who live in nonurban areas were more likely to consult a chiropractor or osteopath, compared with women who live in urban areas. Women are significantly more likely to consult with a chiropractor/osteopath if they have had a major personal injury in the previous year, and women who use chiropractic/osteopathy are also high users of 'conventional' health services. CONCLUSIONS: Chiropractic/osteopathy use among women in Australia is substantial and cannot be ignored by those providing or managing primary health care services for women. It is essential that the interface and communication between chiropractors/osteopaths and other health care providers be highlighted and maximized to establish and maintain effective overall patient coordination and management.

Australia↗

PubMed2006

Transforming the SF-36 to account for death in longitudinal studies with three-year follow-up.

BACKGROUND: Analyses of longitudinal health-related quality of life data often exclude participants who die, which limits the generalizability of the results. Methods to incorporate death as a valid score in the Medical Outcomes Study Short-Form (SF-36) have been suggested but need to be evaluated in other populations. OBJECTIVES: We sought to apply a method of transforming the SF-36 Physical Component Score (PCS) to include death. A transformation to estimate the probability of being "healthy" in 3 years, based on the current PCS value, will be developed and validated. SUBJECTS: Women in the Australian Longitudinal Study on Women's Health (ALSWH), ages 70-75 years at Survey 1 in 1996 (n = 12,432), were followed-up at 3 yearly intervals for 6 years. RESULTS: The transformation derived from the ALSWH data provides evidence that the methodology for transforming the PCS to account for deaths is sound. The 3-year equation provided good estimates of the probability of being healthy in 3 years and the method allowed deaths to be included in an analysis of changes in health over time. CONCLUSIONS: For longitudinal studies involving the SF-36 in which subjects have died, we support the recommendation that both the PCS and its transformed value which includes deaths should be analyzed to examine the influence of deaths on the study conclusions. Using study data to derive empirical parameters for the transformations may be appropriate for studies with follow-up intervals of other lengths.

Aged↗

PubMed2006

Factors associated with adolescents' physical inactivity in Xi'an City, China.

PURPOSE: To explore the sociodemographic and environmental factors at community, school, and household levels associated with physical inactivity. METHODS: In a cross-sectional study in 2004, physical activity level was assessed using a validated questionnaire in 1787 students. Physical inactivity was defined as less than 150 min.wk of moderate activity (4-6 METs) or less than 60 min.wk of vigorous activity (> 6 METs). Sociodemographic and environmental information was recorded on self-administered questionnaires. Hierarchical multiple logistic models were developed based on a conceptual framework of factors related to physical activity. RESULTS: Overall, girls were twice as likely to be inactive. Adolescents aged 14 yr were 30% less likely to be inactive compared with those younger than 13 yr (95% CI: 0.5-0.9). Paternal education was inversely associated with inactivity (OR: 0.6, 95% CI: 0.4-0.9). Adolescents living in neighborhoods without sidewalks were 1.3 times more likely to be inactive (95% CI: 1.0-1.6). At the school level, lack of extracurricular exercise (OR: 1.3, 95% CI: 1.1-1.6) and fewer sports meetings (OR: 2.0, 95% CI: 1.4-2.9) were associated with physical inactivity. Difficult access to community recreational facilities (moderate OR: 1.4, 95% CI: 1.0-1.9; difficult OR: 1.7, 95% CI: 1.2-2.4) and concerns about safety in the neighborhood (OR: 2.1, 95% CI: 1.1-4.1) were associated with inactivity. There were some differences associated with physical inactivity between boys and girls. CONCLUSION: Strategies to promote physical activity in Chinese adolescents should integrate associated factors at household, school, and community levels and address the important gender differences in factors associated with physical inactivity in youth.

Adolescent↗

PubMed2006

[Prevalence of overweight and obesity and its associated risk factors in students aged 11-17 in Xi'an in 2004].

OBJECTIVE: To assess the magnitude of overweight and obesity and its associated sociodemographic factors in adolescents attending junior high schools in Xi'an, Shanxi province. METHODS: A total of 1 804 adolescents attending junior high schools in Xi'an (age: 11-17 years) were enrolled randomly from 30 schools in 6 districts in Xi'an. Overweight and obesity was categorized with body mass index (BMI) cutoffs from Working Group of Obesity in China (WGOC). Underweight was defined by BMI-Z < or = -2 s. Sociodemographic information was collected from the parents of the survey participants using self-administered, structured and precoded questionnaires. RESULTS: Overall 17.4% of adolescents were overweight or obese (overweight 11.2%; obesity 6.2%), but there was a marked gender difference in the prevalence with 20.2% of boys versus 14.4% of the girls being overweight or obese. The prevalence of underweight was 2.7%. In a multivariate model, age, residence, household wealth, and parents' BMI were significantly associated with overweight and obesity (P < 0.05). After having been adjusted for age and gender, the odds ratio of an adolescent being overweight and obese was 2.7 (95% CI: 1.8-4.0) folds higher in urban areas than in rural areas, and was 1.6 (95% CI: 1.04-2.5) folds higher for adolescents from rich families than those from poor families. An adolescent with one or both parents overweight was 1.8 (95% CI: 1.3-2.5) more likely to be overweight themselves compared to those with normal weight parents. CONCLUSIONS: Overweight and obesity is a major public health problem in adolescents in Xi'an. Overweight and obesity is more prevalent in younger boys from richer families living in urban districts and those whose parents were either overweight or obese.

Adolescent↗

PubMed2005

The use of complementary and alternative therapies by patients with cancer.

The aim of this research was to assess the prevalence and predictors of complementary and alternative therapy (CAT) use among cancer patients in Australia. A total of 1492 cancer patients attending nine major public cancer treatment centers in New South Wales, Australia, were asked to complete the Supportive Care Needs Survey. Of the 1354 consenting patients, 888 (65%) returned a completed survey. This article reports the secondary analyses of the survey data, specifically focusing on CAT use. For all cancers, 17.1% of patients were using at least one CAT. The two main demographic characteristics of CAT users were gender and age, where females were more likely to use CAT than males and that CAT use declined as age increased. Time since diagnosis was identified as the only significant clinical predictor of CAT use, where CAT use increased with time until 5 years since diagnosis. Our research shows that herbal treatments and naturopathy are the most popular CAT used by cancer patients (constituting over 30% of all CAT use recorded). The use of CAT among cancer patients is a significant issue in cancer care, especially considering the potential interactions between CAT and conventional medicines. Given that many cancer patients may not be aware of potential risks associated with these interactions it is important that oncologists and others involved in cancer patient care are informed about CAT and its use amongst their patients.

Adolescent↗

PubMed2004

The effective use of a summary table and decision tree methodology to analyze very large healthcare datasets.

Very large datasets typically consists of millions of records, with many variables. Such datasets are stored and maintained by organizations because of the perceived potential information they contain. However, the problem with very large datasets is that traditional methods of data mining are not capable of retrieving this information because the software may be overwhelmed by the memory or computing requirements. In this article we outline a method that can analyze very large datasets. The method initially performs a data reduction step through the use of a summary table, which is then used as a reference dataset that is recursively partitioned to grow a decision tree.

Data Interpretation, Statistical↗

PubMed2004

Aspiration pneumonitis in an overdose population: frequency, predictors, and outcomes.

OBJECTIVE: To characterize the frequency of aspiration pneumonitis in an unselected population of overdose patients and, further, to identify factors that predispose to aspiration pneumonitis and the outcomes of patients with aspiration pneumonitis compared with those without. DESIGN: Retrospective cohort study. SETTING: Toxicology unit of a tertiary referral hospital. PATIENTS: All poisoning admissions. MEASUREMENTS AND MAIN RESULTS: A total of 71 of 4,562 poisoning admissions to the Hunter Area Toxicology Service between January 1997 and October 2002 had definite aspiration pneumonitis (1.6%; 95% confidence interval, 1.2-2.0). Older age, Glasgow Coma Score of <15, spontaneous emesis, seizures, delayed presentation to hospital, and ingestion of tricyclic antidepressants were associated with an increased risk of aspiration pneumonitis. Paracetamol poisoning and female sex were associated with a decreased risk of aspiration pneumonitis with univariate analysis. Ingestion of alcohol, benzodiazepines, antipsychotics, and administration of activated charcoal were not associated with aspiration pneumonitis. A logistic regression model for predicting aspiration pneumonitis contained seven predictors: age, sex, Glasgow Coma Score of <15 (odds ratio, 3.14; 95% confidence interval, 1.87-5.27), emesis (odds ratio, 4.17; 95% confidence interval, 2.44-7.13), seizure, tricyclic antidepressant ingestion, and time from ingestion to presentation (delay of >24 hrs [odds ratio, 4.42; 95% confidence interval, 2.42-8.10]). The mortality for patients with aspiration pneumonitis was 8.5% compared with 0.4% for those without (odds ratio, 23; 95% confidence interval, 9-60; p <.0001), and they had a significantly higher intensive care unit admission rate. The median length of stay of patients with aspiration pneumonitis was 126 hrs (interquartile range, 62-210 hrs) compared with 14.7 hrs (interquartile range, 7-23 hrs) in patients without (p <.0001). CONCLUSIONS: Our study has shown a number of risk factors in overdose patients that are associated with aspiration pneumonitis that may allow the early identification of these patients for appropriate observation and management. Patients with aspiration pneumonitis have a significantly increased mortality and length of stay in the hospital.

Adult↗

PubMed2004

Alprazolam is relatively more toxic than other benzodiazepines in overdose.

AIMS: To describe alprazolam poisoning and the relative toxicity of alprazolam compared with other benzodiazepines. METHODS: A database of consecutive poisoning admissions to a regional toxicology service was searched to identify consecutive benzodiazepine deliberate self poisonings, which were coded as alprazolam, diazepam or other benzodiazepine. Major outcomes used were length of stay (LOS), intensive care (ICU) admission, coma (GCS < 9), flumazenil administration and requirement for mechanical ventilation. Prescription data were obtained for benzodiazepines for the study period. RESULTS: There were 2063 single benzodiazepine overdose admissions: 131 alprazolam overdoses, 823 diazepam overdoses and 1109 other benzodiazepine overdoses. The median LOS for alprazolam overdoses was 19 h which was 1.27 (95% CI 1.04, 1.54) times longer compared with other benzodiazepines by multiple linear regression. For patients with alprazolam overdoses, 22% were admitted to ICU which was 2.06 (95% CI 1.27, 3.33) times more likely compared with other benzodiazepines after multivariate analysis adjusting for age, dose, gender, time to ingestion and co-ingested drugs. Flumazenil was administered to 14% of alprazolam patients and 16% were ventilated, which was significantly more than for other benzodiazepine overdoses (8% and 11%, respectively). Twelve percent of alprazolam overdoses had a GCS < 9 compared with 10% for other benzodiazepines. From benzodiazepine prescription data, total alprazolam prescriptions in Australia increased from 0.13 million in 1992 to 0.41 million in 2001. Eighty five percent of prescriptions were for panic disorder, anxiety, depression or mixed anxiety/depression. CONCLUSIONS: Alprazolam was significantly more toxic than other benzodiazepines. The increased prescription of alprazolam to groups with an increased risk of deliberate self poisoning is concerning and needs review.

Adolescent↗

PubMed2004

Developing a decision tree algorithm for the diagnosis of suspected spider bites.

OBJECTIVE: To develop a diagnostic algorithm (decision tree) to improve the ability to identify or predict medically important spider bites (funnel-web and redback spiders) from information about the circumstances and initial clinical effects of spider bites. METHODS: A dataset of definite spider bites with expert identification of all spiders was used from a previous Australia-wide prospective study. Spider bites were categorized as: big black spider (BBS), redback spider (RED) and other spider (OTH). Big black spider included funnel-web spiders (most medically significant), but also other spiders of similar appearance. Fifteen predictor variables were based on univariate analysis from previous studies and clinical experience. They included information about the circumstances and early clinical effects of bites. The data were analyzed using CART (Classification and Regression Trees), a 'decision tree' algorithm used to create a tree-like structure to describe a data set. RESULTS: Of 789 spider bites there were 49 (6.2%) bites by BBS, 68 (8.6%) bites by RED and 672 (85.2%) bites by OTH. A decision tree was developed that included six predictor variables (fang marks/bleeding; state/territory; local diaphoresis; month; time of day; and proximal or distal bite region). The decision tree accurately classified 47 out of the 49 (96%) BBS, and no funnel-web spiders were incorrectly classified (100% sensitivity). Two hundred and forty-four of 789 were classified as OTH and included no BBS. CONCLUSIONS: A decision tree based on a small amount of information about the circumstances and early clinical effects of spider bites safely predicted all funnel-web spider bites. Application of this algorithm would allow the early institution of appropriate treatment for funnel-web spider bites and the immediate discharge of 31% as other spider bites (reassurance only).

Algorithms↗

PubMed2003

Complementary and alternative medicine (CAM) use among elderly Australian women who have cancer.

The use of complementary and alternative medicine (CAM) in the general population has grown considerably in recent years. However, little is known about the prevalence of CAM use amongst women with cancer. Our research provides the first step in addressing this gap in knowledge by reporting on a survey of 9375 Australian women aged 73-78. We found that, for all cancers combined, 14.5% of women with cancer consulted an alternative practitioner. This percentage varied depending on the type of cancer: skin (15.0%), breast (11.5), bowel (8.8%), and other (16.5%). Our findings suggest that CAM is now a significant practice issue for those delivering cancer-patient care and management.

Aged↗

PubMedDate not supplied

Emergency department performance indicators that encompass the patient journey.

OBJECTIVE: The study aimed to provide a recommended list of performance indicators from routinely collected data that measure most aspects of the patient journey through the emergency department (ED). METHODS: Data from a large tertiary ED were used to investigate the proposed performance indicators, which fell into 7 categories: background information, time from arrival to triage, time from triage to treatment, length of stay, readmission rate, left without being seen, and deaths in the ED. MAIN RESULTS: Category 1 patients were triaged, treated, and discharged rapidly. For category 2 patients, the times from arrival to triage increased but times from triage to treatment were relatively stable. Patients in categories 3 and 4 were not triaged rapidly and both the arrival to triage and triage to treatment processes were unstable and deteriorating. The average time to treatment for patients treated outside recommended times was unstable and increasing for categories 2, 3, and 4. The number of patients who left without being seen was stable except for 2 periods, and the readmission rate was stable except for 1 period of increase. CONCLUSION: The performance indicators use only routinely collected data and clearly identify the areas in which this ED performed poorly.

Emergency Service, Hospital↗