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Biomedical subjects

Margaret Hellard

Publications and source records attributed to Margaret Hellard.

12 recordsLinked to original sources
PubMed2006

Postal surveys of physicians gave superior response rates over telephone interviews in a randomized trial.

BACKGROUND AND OBJECTIVES: To compare general practitioner (GP) response to a telephone interview with response to a postal survey with three reminders in a randomized controlled trial. METHODS: GPs were randomly assigned to either a telephone interview or a postal survey. GPs in the telephone group were mailed a letter of invitation and asked to undertake a telephone interview. GPs in the postal group were mailed a letter of invitation and questionnaire. Non-responders were sent up to three reminders, the final by registered post. Response rates were calculated for each group. RESULTS: 416 GPs were randomized to the telephone interview and 451 to the postal survey. Eighty-six in the telephone group and 30 in the postal were ineligible. One hundred thirty-four GPs completed the telephone interview with a response rate of 40.6% (95% confidence interval [CI]: 35.3%, 46.1%). Two hundred fifty-two GPs completed the postal survey with a response rate of 59.9% (95%CI: 55.0%, 64.6%). The difference in response was 19.3% (95%CI: 12.2%, 26.3%). CONCLUSIONS: These results show that postal surveys with three reminders can have superior response rates compared with a telephone interview.

Attitude of Health Personnel↗
PubMed2006

A chlamydia prevalence survey of young women living in Melbourne, Victoria.

BACKGROUND: To estimate the population-based chlamydia prevalence among women aged 18 to 35 years living in Melbourne, Victoria, and to assess the feasibility of using mailed urine specimens to test women. METHODS: A simple random sample of 11,001 households in Melbourne was selected from the telephone directory. Participants completed telephone interviews and provided urine specimens through the mail for chlamydia testing. Urines were tested using polymerase chain reaction. RESULTS: 11,001 households were contacted, with 1532 households identified as including eligible women; telephone interviews were completed, with 979 women giving a response rate of 64%. Six hundred and fifty-seven women provided a urine specimen with a response rate of 43%. Among sexually active women aged 18-24 years, the chlamydia prevalence was 3.7% (95% CI: 1.2%, 8.4%) and 0.2% (95% CI: 0.0%, 1.1%) among 25-35 year olds. Chlamydia prevalence increased significantly with an increasing number of male sexual partners. CONCLUSIONS: This is the first study of its kind in Australia and shows that chlamydia prevalence increases with an increasing number of male sexual partners in the last 12 months. Mailed urine specimens are feasible for conducting population-based chlamydia-prevalence surveys but it is difficult to obtain high response rates with this methodology. Public health resources should now be directed towards investigating how to reach young women at increased risk of infection, ensuring that they are tested for chlamydia.

Adolescent↗
PubMed2006

Chlamydia testing in general practice - a survey of Victorian general practitioners.

BACKGROUND: To assess the current chlamydia testing practices of Victorian general practitioners (GPs). METHODS: GPs were randomly selected from the Australasian Medical Publishing Company's national database of medical practitioners and mailed a letter of invitation asking them to complete a postal survey. Up to three postal reminders were sent to non-responders. RESULTS: Of 421 eligible GPs, 252 (60%) returned a completed survey; 22.9% (95% CI: 17.8%, 28.6%) reported testing at least some asymptomatic patients for chlamydia each week and 26.8% (95% CI: 21.4%, 32.7%) reported that they presumptively treated patients for chlamydia without testing them at least half the time. The majority knew the appropriate specimens for diagnosing chlamydia, but 6-8% thought blood and 6% indicated that the Pap smear could be used to reliably diagnose chlamydia infection. CONCLUSIONS: These findings have implications for the future chlamydia screening pilot program in Australia and indicate that a comprehensive education program will be necessary to inform GPs and equip them with the skills to appropriately test for chlamydia in their practice.

Adult↗
PubMed2005

Blood-borne viral and sexually transmissible infections among psychiatric populations: what are we doing about them?

OBJECTIVE: To discuss the prevalence of blood-borne viral and sexually transmissible infections among psychiatric populations, as well as current treatment approaches, both locally and internationally. METHOD: In this paper, we outline available epidemiological data, as well as interventions designed to target infectious disease risk among those with serious mental illness. RESULTS: Within Australia, the prevalence of blood-borne viral and sexually transmissible infections among at-risk populations remains unacceptably high despite a number of successful harm reduction and prevention strategies. Although the highest rates of new infections occur among young people aged 15-29 years, recent research suggests that psychiatric populations are also at significant risk. However, despite increased rates, there is currently no coordinated strategy to educate, test and reduce disease risk among people suffering with mental illness within Australia. CONCLUSIONS: Although further epidemiological research at a local level is needed, interventions specifically targeting psychiatric populations and younger cohorts in particular, are essential. This will require multidisciplinary, collaborative service development, incorporating mental health, substance use and infectious disease specialists.

Adolescent↗
PubMed2005

A study to investigate the impact of the initiation of highly active antiretroviral therapy on the hepatitis C virus viral load in HIV/HCV-coinfected patients.

Changes in the hepatitis C virus (HCV) viral load (VL) were assessed in a retrospective study of 50 HIV/HCV-coinfected patients who initiated highly active antiretroviral therapy (HAART). Most patients responded to HAART [during the first 6 months, plasma HIV VL fell by a mean 1.39 log10, becoming undetectable (<400 copies/ml) in 22% and CD4+ T cells increased by a mean of 100 cells/microl], but surprisingly, 27 (54%) showed some rise and 25 (50%) showed a significant increase in the HCV VL. This figure was considered to be a minimum estimate. A majority of the patients showed an increase of less than 1 log10 that was associated with a rapid decrease in the HIV VL, whereas an increase in the HCV VL of greater than 1 log10, noted in eight patients, was associated with a baseline CD4+ cell count of less than 200 cells/microl. The increase in the HCV VL was not associated with hepatitis as determined by raised alanine transferase.

Adult↗
PubMed2004

Change in hepatitis C virus genotype in injecting drug users.

Six major genotypes of the hepatitis C virus (HCV) have been described; it is assumed to be uncommon for genotypes to change in chronically infected individuals. Venous blood samples obtained from Vietnamese-Australian injecting drug users who participated in successive studies conducted in Melbourne, Australia, were genotyped using the Bayer line probe assay and genotype confirmed by sequencing whenever possible. Three changes of HCV genotype were observed, and one infection in an individual not exposed previously. The rate of change of genotype was 3 in 11.4 person-years (py), or 26.4 per 100 py (95% CI: 8.5, 81.6). Traditionally-calculated HCV incidence was 1 in 4.3 py, or 23.3 per 100 py (95% CI: 3.3, 165.1). These data imply that HCV genotype change in injecting drug users occurs at least as frequently as infections in naive individuals, and that traditionally-calculated HCV incidence rates represent a minority of actual HCV transmission among practicing injecting drug users.

Genotype↗
PubMed2004

The molecular epidemiology of HIV type 1 among Vietnamese Australian injecting drug users in Melbourne, Australia.

The proportion of human immunodeficiency virus type 1 (HIV-1) among Vietnamese injecting drug users (IDUs) in Melbourne, Australia exceeds that of the background population. To investigate the molecular epidemiology of HIV-1 among this group, the C2-V4 region of the HIV-1 envelope was directly sequenced from 11 Vietnamese Australians and 19 non-Vietnamese Australian controls. A significant difference in the distribution of the HIV-1 subtypes was demonstrated, with greater than 50% of Vietnamese Australian IDU shown to be infected with CRF01_AE-the predominant subtype in Southeast Asia, rather than subtype B, which dominates the Australian epidemic and which was found in 89.5% of the non-Vietnamese controls. The genetic diversity of the CRF01_AE epidemic in Vietnamese Australian IDUs was substantially lower that that of the background subtype B, consistent with a more recent introduction of a limited number of viral strains from Vietnam. These results support public health policy targeting Australian IDUs of Vietnamese ethnicity as a distinct vulnerable population.

Australia↗
PubMed2004

Indications of immune protection from hepatitis C infection.

Hepatitis C affects many millions of people worldwide and is at very high prevalence among people who inject drugs. In our study of hepatitis C virus (HCV) in the social networks of injecting drug users (IDUs), five IDUs with injecting careers of 9 years or more were HCV antibody and RNA negative. All injected frequently with HCV RNA-positive IDUs, and two had recently injected with the syringe of an RNA-positive IDU. Our data suggest the existence of immune protection from HCV infection.

Adult↗
PubMed2004

Rising HIV infection in Victoria: an analysis of surveillance data.

OBJECTIVES: To describe the epidemiology of HIV in Victoria between 1997 and 2002 using HIV surveillance data. METHODS: All HIV diagnoses notified to the Victorian HIV Registry from 1997 to 2002 were described. RESULTS: The average annual number of HIV notifications rose from 160 during 1997-99 to 216 during 2000-02, with the number of infections from men who have sex with men (MSM) increasing by 41%. Notifications from MSM acquired from casual or anonymous partners increased from 65 in 1997-99 to 92 in 2000-02. Infections attributable to heterosexual contact increased from an average number of 30 during 1997-99 to 46 during 2000-02, a 53% increase. CONCLUSIONS: This rise in HIV notifications in Victoria threatens this State's progress in controlling the HIV epidemic. IMPLICATIONS: The surveillance data demonstrate a need to implement effective, innovative and evidence-based programs for HIV prevention.

Disease Notification↗
PubMed2003

Hepatitis C and pregnancy: an update.

Hepatitis C is a slowly progressive disease with significant long-term sequelae including cirrhosis, liver failure and hepatocellular carcinoma. Many women of childbearing years are infected with this virus and are at risk of transmitting it to their offspring. Despite this, there are many unanswered questions about hepatitis C and pregnancy including who to screen, the risk factors associated with infection, how these women should be managed during pregnancy and the options available to them after delivery.

Cesarean Section↗
PubMed2003

Investigation of infection control practices and knowledge of hepatitis C among body-piercing practitioners.

BACKGROUND: Body piercing has become increasingly popular, leading to concerns about the associated risk of hepatitis C virus (HCV) transmission during piercing. Many body-piercing practitioners (BPPs) have recently entered the industry but little is known about their training and understanding of HCV transmission. This study measured BPP knowledge about HCV and infection control procedures. It also tested for HCV contamination within body-piercing establishments. METHODS: BPPs completed a questionnaire about the number and type of piercings performed, their methods for disposing of and reprocessing piercing equipment, and their training and knowledge of HCV. Environmental swabs were collected and tested for HCV RNA. RESULTS: BPPs at 35 establishments were recruited. A total of 31 BPPs had training as a BPP, ranging from 1 hour to 6 years (median: 15 days). Reprocessing of equipment was variable; 8 establishments inadequately reprocessed piercing guns and 4 inadequately reprocessed forceps or guiding equipment. All BPPs were aware of HCV but many did not know how the virus was transmitted. A total of 19 BPPs performed extra cleaning after piercing a customer known to be HCV positive. No environmental swabs tested were positive for HCV RNA. CONCLUSIONS: This study showed that many BPPs had inadequate training, and lacked knowledge and understanding of HCV transmission, infection control, and universal precautions. To reduce the risk of HCV transmission, BPPs should be required to undergo formal training in infection control before being registered as BPPs.

Chi-Square Distribution↗