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Biomedical subjects

J E Hiller

Publications and source records attributed to J E Hiller.

At least 19 recordsLinked to original sources
PubMed2006

A life-course approach to measuring socioeconomic position in population health surveillance systems.

Measuring socioeconomic position (SEP) in population chronic disease and risk factor surveillance systems is essential for monitoring socioeconomic inequalities in health over time. Life-course measures are an innovative way to supplement other SEP indicators in surveillance systems. A literature review examined the indicators of early-life SEP that could potentially be used in population health surveillance systems. The criteria of validity, relevance, reliability and deconstruction were used to determine the value of potential indicators. Early-life SEP indicators used in cross-sectional and longitudinal studies included education level, income, occupation, living conditions, family structure and residential mobility. Indicators of early-life SEP should be used in routine population health surveillance to monitor trends in the health and SEP of populations over time, and to analyse long-term effects of policies on the changing health of populations. However, these indicators need to be feasible to measure retrospectively, and relevant to the historical, geographical and sociocultural context in which the surveillance system is operating.

Confounding Factors, Epidemiologic↗
PubMed2005

Occupational blood and body fluid exposure in an Australian teaching hospital.

To examine work-related blood and body fluid exposure (BBFE) among health-care workers (HCWs), to explore potential risk factors and to provide policy suggestions, a 6-year retrospective study of all reported BBFE among HCWs (1998-2003) was conducted in a 430-bed teaching hospital in Australia. Results showed that BBFE reporting was consistent throughout the study period, with medical staff experiencing the highest rate of sharps injury (10.4%). Hollow-bore needles were implicated in 51.7% of all percutaneous injuries. Most incidents occurred during sharps use (40.4%) or after use but before disposal (27.1%). Nursing staff experienced 68.5% of reported mucocutaneous exposure. Many such exposures occurred in the absence of any protective attire (61.1%). This study indicated that emphasis on work practice, attire, disposal systems and education strategies, as well as the use of safety sharps should be employed to reduce work-related injuries among HCWs in Australia.

Blood-Borne Pathogens↗
PubMed2005

Systematic review of endovenous laser treatment for varicose veins.

BACKGROUND: The safety and effectiveness of endovenous laser treatment (EVLT) for varicose veins are not yet fully evaluated. METHODS: Medical bibliographic databases, the internet and reference lists were searched from January 1966 to September 2004. Only case series were available for inclusion in the review. RESULTS: : Thirteen studies met the inclusion criteria. Self-limiting features, such as pain, ecchymosis, induration and phlebitis, were commonly encountered after treatment. Deep vein thrombosis and incorrect placement of the laser in vessels were uncommon adverse events. No study has yet assessed the effectiveness of laser therapy in comparison to saphenofemoral junction ligation with saphenous vein stripping. Occlusion of the saphenous vein and abolition of venous reflux occurred in 87.9-100 per cent of limbs, with low rates of re-treatment and recanalization. CONCLUSION: From the low-level evidence available it seems that EVLT benefits most patients in the short term, but rates of recanalization, re-treatment, occlusion and reflux may alter with longer follow-up. The lack of such data, in addition to the small numbers of patients in the available studies, demonstrates the need for a randomized clinical trial of EVLT versus conventional surgery.

Adult↗
PubMed2005

The index of relative socio-economic disadvantage: general population views on indicators used to determine area-based disadvantage.

OBJECTIVE: To ascertain general population perceptions of the importance of indicators comprising the Index of Relative Socio-economic Disadvantage (IRSD). METHODS: Data for this study came from a face-to-face Health Omnibus survey of 3,001 residents in metropolitan and country South Australia, conducted in 2003. RESULTS: Overall, respondents viewed the IRSD indicators as important. Of the 14 indicators, seven were seen as important by more than two-thirds of respondents (ranging from 90% perceiving the number of families with children and a low income important to 68% perceiving the number of one-parent families with dependent children as important). Younger respondents and those of lower educational attainment were more likely to perceive the indicators as unimportant, compared with older people. For example, 14% of people aged 15-24 vs. 5% of people aged 55-64 (p < or = 0.001) viewed the indicator 'number of one-parent families and dependent children' as unimportant. CONCLUSIONS: While the general population generally recognises the IRSD indicators as important measures of area-based disadvantage, there were systematic age differences in the degree to which individual indicators were deemed important. There was a general lack of support for several indicators (such as proportion of people separated/divorced, houses with no cars). IMPLICATIONS: This research raises the question of which factors are important in representing area-based disadvantage for young people and equally the use of this index when examining variations in the health of young Australians.

Adolescent↗
PubMed2004

Systematic review of safety and effectiveness of an artificial bowel sphincter for faecal incontinence.

BACKGROUND: The aim was to determine the safety and effectiveness of the implantation of an artificial bowel sphincter for the treatment of severe faecal incontinence. METHOD: Medical bibliographic databases, the internet and reference lists were searched from January 1966 to January 2003. Only the lowest level of evidence was available for inclusion in this systematic review. Case series and case reports were selected to assess safety, whereas only case series were selected to assess effectiveness. RESULTS: Fourteen studies met the inclusion criteria. A number of safety issues were reported, including high explantation rates, and rates of adverse events owing to infection, device malfunction, ulceration and pain. Results in published reports were not analysed on an intention-to-treat basis. Continence, quality of life and manometry scores were reported for patients with a functioning device at the end of follow-up. These patients experienced a significant improvement in their level of continence. As no outcome data were presented for those with a non-functioning or explanted device, it is possible that such patients may have a worsened degree of incontinence or decreased quality of life. CONCLUSION: Implantation of an artificial bowel sphincter is of uncertain benefit and may possibly harm many patients. Patient selection is therefore critical and should be enhanced by higher-quality research.

Anal Canal↗
PubMed2003

Systematic review of the safety and effectiveness of methods used to establish pneumoperitoneum in laparoscopic surgery.

BACKGROUND: A systematic review was conducted to determine which of the methods of obtaining peritoneal access and establishing pneumoperitoneum is the safest and most effective. METHODS: Studies that met the inclusion criteria were identified from six bibliographic databases up to May 2002, the internet, hand-searches and reference lists. They were critically appraised using a validated checklist and data were extracted using standardized protocols. RESULTS: Meta-analysis of prospective, non-randomized studies of open versus closed (needle/trocar) access indicated a trend during open access towards a reduced risk of major complications (pooled relative risk (RR(p)) 0.30, 95 per cent confidence interval (c.i.) 0.09 to 1.03). Open access was also associated with a trend towards a reduced risk of access-site herniation (RR(p) 0.21, 95 per cent c.i. 0.04 to 1.03) and, in non-obese patients, a 57 per cent reduced risk of minor complications (RR(p) 0.43, 95 per cent c.i. 0.20 to 0.92) and a trend for fewer conversions to laparotomy (RR(p) 0.21, 95 per cent c.i. 0.04 to 1.17). Data on major complications in studies of direct trocar versus needle/trocar access were inconclusive. Minor complications in randomized controlled trials were fewer with direct trocar access (RR(p) 0.19, 95 per cent c.i. 0.09 to 0.40), predominantly owing to a reduction in extraperitoneal insufflation. CONCLUSION: The evidence on the comparative safety and effectiveness of the different access methods was not definitive, but there were trends in the data that merit further exploration.

Controlled Clinical Trials as Topic↗
PubMed2003

Surfing, self-medicating and safety: buying non-prescription and complementary medicines via the internet.

OBJECTIVE: To examine whether the sale of medicines via the internet supports their safe and appropriate use. DESIGN: e-Pharmacy websites were identified using key words and a metasearch engine and the quality of information published on these websites was surveyed using the DISCERN tool. A case scenario and internet pharmacy practice standards were also used to evaluate the quality of care delivered. SETTING AND PARTICIPANTS: Between July and September 2001 104 websites were surveyed and 27 sent either Sudafed (pseudoephedrine HCl), St John's wort products, or both to a residential address in Melbourne, Australia. MAIN OUTCOME MEASURES: Quality of health information (DISCERN ratings), information exchanged between e-pharmacy staff and consumers, and product and delivery costs. RESULTS: Of 104 e-pharmacies from at least 13 different countries, 63 websites provided some health information but overall the quality of the information was poor. Only three website operators provided adequate advice to consumers to avoid a potential drug interaction. The costs for a daily dose of pseudoephedrine HCl (240 mg) ranged from 0.81 Australian dollars to 3.04 Australian dollars, and delivery costs from 3.28 Australian dollars to 62.70 Australian dollars. CONCLUSION: Consumers who self-select medicines from websites have insufficient access to information and advice at the point of ordering and on delivery to make informed decisions about their safe and appropriate use.

Adult↗
PubMed2002

Magnesium sulphate for preventing preterm birth in threatened preterm labour.

BACKGROUND: Magnesium sulphate is used to inhibit uterine activity in women in preterm labour to prevent preterm birth. OBJECTIVES: To assess the effectiveness and safety of magnesium sulphate therapy given to women in threatened preterm labour with the aim of preventing preterm birth and its sequelae. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (May 2002) and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2002). SELECTION CRITERIA TYPES OF PARTICIPANTS: Women thought to be in preterm labour. Types of interventions: Magnesium sulphate as the only tocolytic, administered intravenously or orally, compared with either placebo, no treatment or alternative tocolytic therapy. Types of outcome measures: Measures of effectiveness, complications, women's satisfaction with their care and health service use. DATA COLLECTION AND ANALYSIS: Assessments of trial eligibility, quality and data extractions were done by at least two of the reviewers. MAIN RESULTS: Over 2000 women were recruited into the 23 included trials. Only nine trials were rated of high quality for the concealment of allocation. In the magnesium sulphate versus control (all studies) no difference was seen for the risk of birth within 48 hours of treatment for women given magnesium sulphate compared with controls when using a random effects model (relative risk (RR) 0.85, 95% confidence interval (CI) 0.58-1.25, 11 trials, 881 women). No benefit was seen for magnesium sulphate on the risk of giving birth preterm (<37 weeks) or very preterm (<34 weeks). The risk of death (fetal and paediatric) was higher for infants exposed to magnesium sulphate (RR 2.82, 95% CI 1.20-6.62, 7 trials, 727 infants). There were only two fetal deaths, both in the magnesium sulphate group in one study. The six other trials reported there were no fetal deaths. No differences for total paediatric mortality were shown in the six trials with data. No beneficial effect was seen from using magnesium sulphate on the risk of other neonatal morbidity. A non-significant reduction in the risk of cerebral palsy was reported at follow up at 18 months corrected age (RR 0.14, 95% CI 0.01-2.60, 1 trial, 99 children). REVIEWER'S CONCLUSIONS: Magnesium sulphate is ineffective at delaying birth or preventing preterm birth, and its use is associated with an increased mortality for the infant. Any further trials should be of high quality, large enough to assess serious morbidity and mortality, compare different dose regimens, and provide neurodevelopmental status of the child.

Female↗
PubMed2001

Quality of life in HCV-infection: lack of association with ALT levels.

OBJECTIVES: To examine the impact of HCV infection in an Australian clinic population and identify the relationships between morbidity, psychosocial variables and one clinical indicator of HCV activity, alanine aminotransferase (ALT). METHOD: Ninety-five untreated HCV-infected patients (21-69 years) in infectious and liver diseases clinics who were all positive for HCV-RNA and had no significant comorbidities or coinfections completed a survey containing the Short Form 36 (SF36), as well as the six-item Social Support Questionnaire (SSQ6), demographic items and questions concerning respondents' perceptions of their mode and duration of infection. Nine volunteers from this group participated in semi-structured qualitative interviews aimed at exploring the social impact of HCV status. These data were compared with serum ALT levels. SF36 scores were compared to population norms and according to participant variables. RESULTS: Mean SF36 scores were significantly lower, across all modalities, than population norms. SF36 scores differed significantly according to age, sex, mode of infection, alcohol and methadone use, and satisfaction with social support. They did not differ significantly according to perceived or actual ALT level or pattern of ALT activity. Worry about ALT was prevalent (>50%) and this was independent of perceived ALT level. CONCLUSIONS AND IMPLICATIONS: HCV-infection is associated with significantly reduced quality of life and includes the perception of substantial social discrimination. ALT levels are of limited usefulness in ascertainment of a person's sense of wellbeing and quality of life in HCV-infection. Increased support and information for affected individuals and measures aimed at countering social discrimination are important recommendations of the current study.

Adult↗
PubMed2001

Attitudes towards infant feeding among adults in a low socioeconomic community: what social support is there for breastfeeding?

An analysis of the role of social support in influencing breastfeeding in a low socioeconomic area in South Australia was undertaken by examining infant feeding attitudes and experiences of mothers, fathers and grandmothers as well as the general community. A random telephone survey of over 3,400 adults (including a more extensive survey of 373 mothers, fathers and grandmothers in the sample) in this area indicated that there was little support for breastfeeding compared to bottle-feeding with similar barriers to breastfeeding found in all target groups as well as the general community. These included breastfeeding in public, the convenience of bottle-feeding, maternal discomfort of breastfeeding, the support required for breastfeeding, fathers' involvement with feeding, and a mother's previous experience of breastfeeding. Strategies promoting and supporting breastfeeding should address these issues and should be directed at the community in general rather than specific groups within the community.

Adolescent↗
PubMed2001

Community attitudes to infant feeding.

A cross-sectional study was designed to describe the social context in which breastfeeding occurs by examining experiences of and attitudes toward infant feeding within the general community. Of the 2500 randomly selected adults who participated in the telephone survey, 61% had been breastfed, the youngest child of 52% of participants (who were also parents) had been mainly breastfed but 58% of babies seen by participants were bottle-fed. The attitudes examined in this survey suggest there was little support for breastfeeding, particularly outside the home. Over 80% of participants agreed that bottle-feeding was more acceptable in public places and 70% agreed there was not always a place to breastfeed when outside the home. In addition, bottle-feeding was considered easier and more convenient indicating the social environment was not very breastfeeding friendly. Interventions to enhance environmental support for breastfeeding need to focus on reducing these barriers so that breastfeeding in public is more acceptable and breastfeeding in general is easier and more convenient.

Bottle Feeding↗
PubMed2000

Education for contraceptive use by women after childbirth.

OBJECTIVES: Postpartum education on contraceptive use is a routine component of discharge planning in many different countries with a wide variety of health care systems. This education is based on assumptions concerning women's receptivity to contraceptive education during the postpartum period and their presumed lack of access to such education after that time. The objective of this review is to assess the effects of education about contraceptive use to postpartum mothers. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, Psychlit, Popline, citations indexes and reference lists of relevant articles. We contacted subject experts to locate additional research, in addition to the Group's Specialised Register of Controlled Trials. Date of the most recent search: April 1999. SELECTION CRITERIA: Trials using random or quasi-random methods of allocation which evaluated the effectiveness of postpartum education about contraceptive use. DATA COLLECTION AND ANALYSIS: Two independent reviewers abstracted data on trial characteristics and results. MAIN RESULTS: Three trials were identified with 5438 women. These trials were conducted in Lebanon, Peru and Nepal. None of the trials examined all major prespecified endpoints. Postpartum education about contraceptive use influenced short-term use assessed between 40 days and three months post-partum. Women in the intervention groups were less likely to be non-users than women in the comparison groups (Odds Ratio (OR) = 0.47, 95% Confidence Interval (CI) 0.39 to 0.58). This benefit was not apparent following analysis of data from better quality studies (OR = 0.67, 95% CI 0.41 to 1.13). An apparent benefit on contraceptive use at six months post-partum (OR = 0.52, 95% CI 0.37 to 0.74) was not apparent following sensitivity analyses (OR = 0.59, 95% CI 0.33 to 1.06). Data are inadequate to assess the impact on cessation of breast feeding and non-attendance at family planning clinics. Unplanned pregnancies, knowledge about contraception and satisfaction with care were not assessed in any trial. REVIEWER'S CONCLUSIONS: The effectiveness of postpartum education about contraceptive use has not yet been established in randomised controlled trials. Such education may be effective in increasing the short-term use of contraception. However, there are only limited data examining a more-important longer-term effect on the prevention of unplanned pregnancies. Research needs to be undertaken to assess the effectiveness of the minimalist education provided in more developed countries and the variety of programs provided in less developed regions. Such research should examine the content, timing, range and organisation of postpartum education on contraceptive use, as well as its impact on breast feeding rates.

Contraception↗
PubMed2000

Epidemiological evidence for a relationship between life events, coping style, and personality factors in the development of breast cancer.

OBJECTIVE: Review empirical evidence for a relationship between psychosocial factors and breast cancer development. METHODS: Standardised quality assessment criteria were utilised to assess the evidence of psychosocial predictors of breast cancer development in the following domains: (a) stressful life events, (b) coping style, (c) social support, and (d) emotional and personality factors. RESULTS: Few well-designed studies report any association between life events and breast cancer, the exception being two small studies using the Life Events and Difficulties Schedule (LEDS) reporting an association between severely threatening events and breast cancer risk. Seven studies show anger repression or alexithymia are predictors, the strongest evidence suggesting younger women are at increased risk. There is no evidence that social support, chronic anxiety, or depression affects breast cancer development. With the exception of rationality/anti-emotionality, personality factors do not predict breast cancer risk. CONCLUSION: The evidence for a relationship between psychosocial factors and breast cancer is weak. The strongest predictors are emotional repression and severe life events. Future research would benefit from theoretical grounding and greater methodological rigour. Recommendations are given.

Adaptation, Psychological↗
PubMed1999

Determinants of infant feeding practices in a low socio-economic area: identifying environmental barriers to breastfeeding.

OBJECTIVE: To identify environmental barriers to breastfeeding. METHOD: Focus groups were conducted with young women, parents-to-be, mothers, fathers and grandmothers in 1996 in northern Adelaide, South Australia (a low socio-economic area). RESULTS: Seven focus groups (4-8 participants per group) were conducted. Breastfeeding was seen as being embarrassing to do in public, and not possible to combine with paid employment. While fathers were not supportive of their partners breastfeeding in public, health professionals were seen as strong advocates of breastfeeding. Bottle feeding was perceived to be more convenient for the mother, more acceptable in public but not as good as breastfeeding for the baby. CONCLUSION: An environmental that enables women to breastfeed is far from being achieved in this low socio-economic area, particularly in relation to breastfeeding in public. IMPLICATIONS: Breastfeeding promotion should have a public health focus, concentrating on creating a supportive breastfeeding environment through a multi strategy approach aimed not just at mothers but also at the community.

Adolescent↗
PubMed1999

'Pharmacist only' medicines.

While there is a global trend to switch medicines from prescription to non-prescription status, Australia has created a unique schedule of 'pharmacist only medicines' (POM). Such medicines may provide consumers with greater choice and control of health care decisions. However, the impact of these actions has not been evaluated. Public health concerns including the appropriate use of medicines, awareness and equity of access to POM, and access to information on POM are discussed using antifungal vaginal products as an example. The National Medicines Policy advocates a partnership approach to achieve improved health outcomes by the quality use of medicines, however currently no data on POM are available. Recommendations include changes to legislation, public health data collection and the provision of quality information including pharmaceutical and non-pharmaceutical interventions.

Drug Costs↗
PubMed1999

Calcium supplementation in nulliparous women for the prevention of pregnancy-induced hypertension, preeclampsia and preterm birth: an Australian randomized trial. FRACOG and the ACT Study Group.

A multicentre, randomized controlled double-blind trial in 5 maternity hospitals in Australia assessed the effect of a daily supplement of calcium (1.8g oral calcium or an oral placebo) taken daily until delivery, from less than 24 weeks' gestation, on the frequency of pregnancy-induced hypertension, preeclampsia and preterm birth (< 37 weeks' gestation) in 456 nulliparas with a singleton pregnancy. Treatment with calcium reduced the risk of preeclampsia (relative risk 0.44 [95% CI, 0.21-0.90], p = 0.02) and the risk of preterm birth (relative risk 0.44 [95% CI, 0.21-0.90], p = 0.02). No significant differences were seen between the 2 groups in the frequency of pregnancy-induced hypertension, although the study only had statistical power to detect large differences in this outcome. An updated systematic review of the 9 randomized trials of calcium supplementation in pregnancy shows a significant reduction in the risk of hypertension and preeclampsia although no effect on preterm birth. Calcium supplementation during pregnancy reduced the risk of preeclampsia and preterm birth in this nulliparous population. The available evidence for systematic review of all the randomized trials of calcium supplementation shows benefit in reducing the risk of hypertension and preeclampsia.

Adult↗
PubMed1999

Breastfeeding in public places.

This study reports the results of a survey of restaurant and shopping center managers concerning breastfeeding in their facilities. Managers from 66 restaurants and 27 shopping centers were interviewed by telephone. One-third of the restaurant managers and 48% of the shopping center managers stated that a mother could breastfeed anywhere in their facility regardless of what other customers might say. The remaining managers would either discourage breastfeeding anywhere in their facility, suggest a mother move to a more secluded area if she wished to breastfeed, or were unsure how they would react. The variability in support for breastfeeding by managers of restaurants and shopping centers will continue to create uncertainty for mothers wishing to breastfeed in these public places.

Attitude to Health↗