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Biomedical subjects

Peter A Leggat

Publications and source records attributed to Peter A Leggat.

At least 19 recordsLinked to original sources
PubMed2007

Qualitative analysis of the impact of a lymphatic filariasis elimination programme using mass drug administration on Misima Island, Papua New Guinea.

BACKGROUND: Papua New Guinea is the only endemic country in the Western Pacific Region that has not yet introduced a countrywide programme to eliminate lymphatic filariasis. However, on Misima Island in Milne Bay Province, government and private sectors have collaborated to implement a pilot elimination programme. Although interim evaluation indicated that the programme has been parasitologically successful, an appreciation that sustainable health gains depend on understanding and accommodating local beliefs prompted this qualitative study. METHODS: We investigated Misima community members knowledge and attitudes about lymphatic filariasis and the elimination programme. A combination of focus groups and key informant interviews were used to explore participants perceptions of health; knowledge of the aetiology and symptoms of filariasis, elephantiasis and hydrocele; attitudes towards the disease and mass drug distribution; and the social structure and decision-making protocols within the villages. RESULTS: Focus group discussions proved inferior to key informant interviews for gathering rich data. Study participants did not consider lymphatic filariasis ("pom") a major health problem but were generally positive about mass drug administration campaigns. A variety of conditions were frequently and incorrectly attributed to filariasis. Participants expressed the belief that individuals infected with filariasis always had visible manifestations of disease. A common misconception was that taking drugs during campaigns provided long-term immunity against disease. The role of mosquito vectors in transmission was not generally appreciated and certain clinical presentations, particularly hydrocele, were associated with supernatural forces. Multiple adverse events were associated with mass drug administration campaigns and most study participants mentioned community members who did not participate in campaigns. CONCLUSION: Important issues requiring educational intervention and elimination activity modification in the Misima region were identified during this study. Research outcomes should assist Papua New Guinea in developing and implementing a national elimination strategy and inform discussions regarding the appropriateness of current elimination strategies.

Journal Article↗
PubMed2006

Survey of visitors to a National Park in the savannah region of northeast Brazil: practices, incidents and hazardous situations.

BACKGROUND: Wilderness travellers to remote National Parks of Brazil may be particularly at risk of tropical diseases and injury. The aim of this study was to describe injury and illness, potentially hazardous situations, accidents and other incidents experienced by travellers to a remote National Park in Brazil. METHOD: The study was done in the National Park, "Serra da Capivara", in Piauí State northeast Brazil. Key informants were interviewed using semi-structured interviews, and a self-administered questionnaire was used for visitors. Questions included information on health problems and risk behaviour in the park, as well as pre-travel health advice. RESULTS: In total, 14 tour guides, 7 hotel managers and 17 health professionals were interviewed, as key informants. Eighty visitors returned the completed questionnaires (60 Brazilian, 20 foreigners). The key informants reported different risk behaviour of groups and individuals travellers, and incidents most commonly mentioned were minor injuries, insect bites/bee stings and allergic reactions. Seventy percent of the Brazilian and 55% of the foreign visitors had obtained pre-travel health advice, but only 5% of Brazilians and 15% of foreign visitors has obtained this advice from a physician. The most common source of information was other people who already had visited the park and travel books. Of the Brazilians, 13.3% reported some health incident during their stay, most commonly bee bites and headache. Two foreign travellers reported three incidents (insect bites/bee stings, diarrhoea and sunburn). Most commonly reported hazardous situations perceived by the tourists were possible accidents caused by falling from a stairway or falling stones, poisonous animals and insect bites/bee stings. CONCLUSIONS: Surveys conducted at remote tourist destinations are a feasible approach to report vulnerable situations, practices and incidents of visitors to a National Park. We have shown that most travellers are not adequately prepared and many experienced vulnerable situations during their visit to the National Park. It is important that visitors to National Parks in Brazil are encouraged to obtain travel health advice. The most common and potentially serious incident (bee stings) is rarely addressed in pre-travel health advice. Travel health advisers should ensure that they have access to locally relevant information for travellers, so that appropriate preventive measures can be instituted.

Accidents↗
PubMed2006

Assistance provided abroad to insured travellers from Australia following the 2004 Asian tsunami.

BACKGROUND: On 26 December 2004, the Asian tsunami hit countries around the Indian Ocean rim, particularly around its earthquake-associated epicentre off Indonesia. A number of popular tourist destinations for Australian travellers are located in this region. This study was designed to investigate travel insurance claims reported by travellers from Australia following the Asian tsunami and to examine the role of travel insurance and emergency assistance companies. METHODS: In December 2005, all claims reported, following the Asian tsunami on 26 December 2004, to a major Australian travel insurance company were examined for those claims associated with the Asian tsunami. RESULTS: Twenty-two tsunami-related claims were submitted of which nine travellers (40.9%) used the travel insurance company's emergency assistance service. Four travellers (18.2%) cancelled their trip to Asia, mainly to Thailand. Five travellers (27.3%), who were already abroad, also curtailed their trip as a result of the tsunami. Half of travellers (50.0%) were claiming loss of personal belongings. Of those using the emergency assistance service, five travellers (22.7%) sought policy and claiming advice, two (9.1%) sought assistance with flight rearrangements, and one (4.5%) sought situation advice. There was also assistance provided following the death of one insured traveller as a direct consequence of the tsunami, which included a lump sum payment to the deceased estate. The mean refund, where a travel insurance claim was paid, was Australian dollars (AUD)2234 (SD=AUD5755). CONCLUSIONS: This study highlights the importance of travellers taking out appropriate travel insurance, which provides for emergency assistance. Travel insurance agencies do play some role after emergencies, such as the Asian tsunami. This assistance predominantly involves dealing with cancellation of travellers' intended visits to the affected area, but does also involve some assistance to travellers affected by the crisis. Travellers should be advised to seek travel health advice well before departure overseas and to ensure that they are aware of travel advisories for their destination.

Adult↗
PubMed2006

Professional organisation profile: Travel Health Advisory Group, Australia.

The Australian Travel Health Advisory Group was established in 1997 and its membership has been active in several areas, including networking, policy development, research and education in Australia. Information is given on purpose, membership and the various activities of the group.

Advisory Committees↗
PubMed2006

Hostellers' knowledge of transmission and prevention of avian influenza when travelling abroad.

BACKGROUND: Little is known about hostellers' knowledge of transmission and prevention of avian influenza when travelling abroad. This study was designed to investigate these in the Australian context. METHODS: In 2006, hostellers attending a travellers' information evening in Brisbane, Queensland, were asked to complete self-administered questionnaires. RESULTS: Forty-two questionnaires (60.8%) were returned. Over two-thirds of attendees were females (71.4%, 30). About two-thirds of the hostellers attending the travellers' information evening reported being aged 29 years or younger (64.2%, 27). On a five-point rating scale, the median rating of hostellers indicated that they were moderately concerned about avian influenza (3.0) with the range being 1-5. About one-fifth of hostellers did not know or were not sure what the source of avian influenza infection in humans was and most of this group also did not know how bird flu was prevented (p<0.05). Almost all hostellers (40, 95.2%) responded to the question concerning the source of infection for avian influenza. Nominated sources of infection included handling sick poultry (69.0%, 29), eating poultry (45.2%, 19), contact with humans who have avian influenza (38.1%, 16), and handling healthy poultry (26.2%, 11). More than four-fifths 35 (83.3%) of hostellers responded to the question concerning precautions against avian influenza. Nominated precautions included hand washing (28.6%, 12), avoiding birds (23.8%, 10), avoiding affected areas (14.3%, 6), not eating poultry (7.1%, 3), and avoiding poultry droppings (7.1%, 3). Hand washing was the only measure to prevent bird flu that was significantly more likely to be nominated following the travel health lecture (p<0.05). CONCLUSIONS: Hostellers attending the travellers' information night in Australia reported having moderate concern about avian influenza. They also had a variable knowledge of the sources of infection of avian influenza. Most hostellers correctly identified infected poultry as a source; however, human-to-human transmission as the predominant current source of avian influenza infections in humans was incorrectly identified by nearly two-fifths of hostellers. Although hostellers responded positively to hand washing advice provided in the travel health lecture, reinforcement of other possible measures to prevent avian influenza, particularly the possible role of antiviral drugs, may be needed.

Adult↗
PubMed2006

Dermatitis and aircrew.

Dermatitis is a common problem both in the workplace and in the general community. Airline personnel represent a novel occupational group as they are also exposed to a wide range of potential chemical irritants and other aggravating factors, such as low relative humidity and airborne pollutants. Common skin irritants include dielectric fluids from electrodischarge machining, 'prepreg' materials and sealants in aircraft manufacture, kerosene and various jet-fuel components. Commercial jet fuel is a complex mixture of aliphatic and aromatic compounds, and there is potential for dermal exposure among refueling and maintenance crew. Low relative humidity appears to exacerbate dermatitis amongst aircrew, especially on longer flight durations. Pilots may also be exposed to additional skin irritants outside of the cabin environment, such as ethylene glycol, hydraulic fluid or jet fuel, all of which may be encountered during routine inspections of aircraft before and after flight. Given these factors, preventive measures must carefully consider the undoubted potential for contact with irritants and allergens, which may lead to dermatitis in airline personnel.

Air Pollution, Indoor↗
PubMed2006

Needlestick and sharps injuries among nurses in a tropical Australian hospital.

Although needlestick and sharps injuries (NSI) represent a major hazard in nursing practice, most studies rely on officially reported data and none have yet been undertaken in tropical environments. Therefore, we conducted a cross-sectional NSI survey targeting all nurses within a tropical Australian hospital, regardless of whether they had experienced an NSI or not. Our overall response rate was 76.7%. A total of 39 nurses reported 43 NSI events in the previous 12 months. The most common causative device was a normal syringe needle, followed by insulin syringe needles, i.v. needles or kits and blood collection needles. Half of the nurses' NSI events occurred beside the patient's bed: drawing up medication was the most common reason. Nurses working in the maternity/neonatal wards were only 0.3 times as likely to have experienced an NSI as their counterparts in the medical or surgical wards. Overall, our study has shown that NSI events represent an important workplace issue for tropical Australian nurses. Their actual rate might also be higher than official reports suggest.

Accidents, Occupational↗
PubMed2006

Prevalence of hand dermatoses related to latex exposure amongst dentists in Queensland, Australia.

OBJECTIVES: To investigate the epidemiology of hand dermatoses symptoms and allergies, particularly those that suggested possible latex allergy. METHODS: In 2004, a self-reporting questionnaire was mailed to a random sample of 400 dentists from the Queensland Branch of the Australian Dental Association. RESULTS: A total of 285 questionnaires (73.1%) were completed and returned. Of the respondents, 73.3% were male and 26.7% female, with a mean age of 45.2 years (SD = 11.9 years) of whom 89.1% were general dentists, the remainder being specialists. Almost one third (29.1%) had experienced symptoms of hand dermatoses at some stage during the previous 12 months, with 15.1% experiencing symptoms during the previous three weeks. The most common symptom or sign was dry and cracked hands or fingers (22.5%). Only 2.1% of dentists had been medically diagnosed with latex allergy. The most common symptom or sign following the use of latex products was dermatitis (11.2%). CONCLUSIONS: Overall, this study showed that occupational dermatoses constitute a major occupational health problem among dentists in Queensland, Australia. Symptoms appear to be reported at a similar prevalence to other studies in developed countries. The identification of atopic dermatitis as a significant risk factor again stresses the importance of allergic disease and its relationship with occupational skin conditions. Although reducing exposure to potential allergens and irritants is an important minimisation strategy, further research is needed to identify occupational and non-occupational factors associated with occupational dermatoses in dental personnel.

Adult↗
PubMed2006

A comparison of tobacco smoking among dentists in 15 countries.

This study was conducted as a systematic review of all modern literature describing the prevalence and associations of tobacco smoking among dentists. A keyword search of appropriate MeSH terms was initially undertaken to identify relevant material. Reference lists of manuscripts were also examined to locate further publications. A total of 35 English-language studies published in the past 25 years met the inclusion criteria. Results suggest that the prevalence of smoking is generally quite low among dentists, and that it has also declined in many countries during recent years. The lowest rates were documented in the United States (USA), Thailand, Finland, Australia and Canada. When multiple studies were examined over time, it appears that dentists in Australia and the USA consistently report the lowest prevalence. Overall, this review suggests that dentists have one of the lowest smoking rates among all health professionals. There were a few exceptions however, namely Italy and Jordan, where dentists appear to be smoking at fairly high rates. Nevertheless, it is important that tobacco usage continues its decline in future years so that the dental profession may remain exemplars at the forefront of preventive oral care.

Australia↗
PubMed2006

24 years of pneumoconiosis mortality surveillance in Australia.

Asbestosis, silicosis and Coal Worker's Pneumoconiosis (CWP) represent three of the most important occupationally-related dust diseases in Australia. To gain a clear picture of pneumoconiosis trends over time, a 24-yr retrospective analysis of national mortality data was performed for the period 1979 to 2002. Over 1,000 pneumoconiosis-related fatalities occurred during this time, 56% of which were caused by asbestosis, 38% by silicosis and 6% by CWP. Between 1979 and 1981, silicosis accounted for 60% of all pneumoconiosis-related fatalities in Australia, followed by asbestosis (31%). By 2002 however, asbestosis was causing 78% of all fatalities, while silicosis accounted for only 19%. Asbestos-related mortality increased three-fold between 1979 and 2002, with a clear excess risk demonstrated among males. On the other hand, mortality rates for silicosis and CWP declined significantly during the same time period. Overall, this study suggests that pneumoconiosis, particularly asbestosis, continues to be an important occupational disease in Australia. Although progress has been made in reducing deaths due to occupational silicosis and CWP, asbestosis rates continue to rise, reflecting the long latency between dust exposure and clinical disease. Countries which continue to use asbestos products in the workplace should note the tragic legacy of this material within contemporary Australia.

Asbestos↗
PubMed2005

A case of exposure to Bancroftian filariasis in a traveller to Thailand.

A New Zealander travelling recreationally to Asia became exposed to Bancroftian filariasis. The traveller had presented incidentally with gastrointestinal illness. In addition to diarrhoea, the traveller's symptoms were non-specific and there was no eosinophilia, lymphoedema, lymphangitis, lymphadenitis, or pain. The immunochromatographic test for Wuchereria bancrofti was positive indicating that there was or had been an adult filarial worm. The illness resolved completely following treatment with ivermectin.

Adult↗
PubMed2005

Accidents and repatriation.

Accidents and injury contribute greatly to the morbidity and mortality of travellers worldwide, with road traffic accidents being a major contributer. Those travelers with serious illness and injury may need specialised medical evacuation services, which may involve an air ambulance and a specialised medical team. Such aeromedical repatriations require considerable organisation and liaison between the sending and receiving medical services and other interested parties. However, the majority of travellers requiring emergency assistance are stable patients requiring referral for medical or dental attention or special requirements for carriage on scheduled aircraft.

Accident Prevention↗
PubMed2005

Risk assessment in travel medicine.

Risk assessment is an integral part of pre-travel and post- assessment. Risk assessment largely determines what health and safety advice and interventions are given within the relevant prevailing travel health guidelines. Risk assessment needs time and depends on information, including that given by the traveller. Risk assessment also needs to be documented. Risk assessment of the traveller preferably starts before they enter the consulting room, where travellers may complete a pre-travel health questionnaire. Armed with this information, risk assessment may be assisted by access to computerised travel health databases and the published literature. Experience of travel to the destination may also assist in risk assessment and the tour operator, overseas employer or agency, the traveller or even the travel health advisers themselves may provide this information.

Delivery of Health Care↗
PubMed2005

Needlestick and Sharps Injuries among Australian medical students.

We investigated the prevalence and distribution of Needlestick and Sharps Injuries (NSI) among a group of Australian medical undergraduates from 4 consecutive grades. Data was obtained by means of an anonymous, self-reporting survey. A total of 254 questionnaires were obtained (response rate 97.3%). Among them, 35 students (13.8%) had suffered a total of 41 NSI incidents. By gender, 71.4% of the NSI reporters were female and 28.6% were male. NSI prevalence varied significantly with respect to students' year of study (P for Trend=0.0106), ranging from 7.3% in the 1st year to 26.8% in the 3rd year. Of the 41 NSI incidents, 29.2% were caused by a glass item, 24.4% by a hollow bore needle, 24.4% by another device and 22.0% by a surgical device. The distribution by causative device also varied from year to year. Overall, this study has shown that NSI represent an important hazard for Australian medical students. As such, the importance of intervention strategies to reduce NSI exposures must remain an essential facet of medical education, worldwide. Future preventive measures will also need to consider the unique situation of medical students in Australia, as elsewhere.

Australia↗
PubMed2005

The historical development of occupational health in Australia Part 2: 1970-2000.

Australian occupational health was shaped by various social, political and economic forces during the latter half of the last century. An overall downturn in manufacturing and increased wage restraint during the early 1970s, encouraged trade unions to turn their attention to broader social issues, such as workplace health. Mainstream Australian society was also being influenced by wider community sentiment during this time, including anti-war protests, environmental lobby groups and the women's movement. Interest in occupational health subsequently flourished, with formalised education commencing in the 1970s, and the number of tertiary courses rapidly increasing throughout the 1980s. Occupational health and worker's compensation legislation similarly evolved throughout the latter stages of the twentieth century. Australian workplace health and safety is now based on a theory of self-regulation and managed in a tri-partite model, consisting of employers, trade unions and government departments. In Part 1 of our occupational health review, we outlined the historical development of Australian occupational health between 1788 and 1970. In the current paper, Part 2, we describe the historical development of Australian occupational health between 1970 and 2000.

Australia↗
PubMed2005

Intradermal pre-exposure rabies immunisation in New Zealand.

BACKGROUND: Rabies is a fatal infection and immunisation is important to consider in those travellers going to rabies endemic areas. In those at high risk, a course of three immunisations may be given by the intramuscular (IM) or intradermal (ID) route, both of which are approved by the World Health Organization (WHO) and the Centers for Disease Control (CDC). Little is known in the New Zealand context regarding the effectiveness of pre-exposure ID rabies immunisation. METHODS: The data was collected prospectively on all travellers requiring the immunisation from July 2001 to September 2003 in Auckland. The standard WHO rabies immunisation protocol was used with three ID injections of 0.1 ml, given on days 0, 7, and 21 or 28 with a booster after 12 months. The vaccine used was the Pasteur Merieux human diploid cell vaccine (HDCV) or the Rabipur Purified chick embryo cell (PCEC) vaccine. Both vaccines are approved by the WHO and the CDC, and are interchangeable. Serology was performed approximately 2 weeks after completion of the primary immunisation course or after a booster, wherever possible. Antibody levels were measured using EIA, and levels of >0.5 IU/ml were considered protective. RESULTS: Of the 263 travellers assessed in this study, 125 were males and 138 were females. The mean age of the cohort was 34.8 years (SD=11.7). There were not found to be any statistically significant correlations between age and antibody levels neither was there any significant association between gender and antibody levels. In addition to the sample group, a further 12 travellers had rabies serology performed but were excluded from the study because they had IM vaccines as part of their primary course. Whilst rabies serology ranged from 0.2 to 27.9 IU/ml in the study cohort, the mean antibody level for the group was 4.7 IU/ml (SD=4.1 IU/ml). The mean antibody level for males was 4.3 IU/ml (SD=3.3), and for females, 5.2 IU/ml (SD=4.6). Of the 263 travellers, all had some level of detectable antibodies. The overall seroconversion rate was 95.1%. CONCLUSIONS: ID rabies immunisation appears effective, when given according to the standard WHO protocol, in New Zealand. ID rabies immunisation is also more affordable for travellers, especially those on a restrictive budget. ID rabies immunisation can continue to be recommended, particularly where follow-up serology can be done before travel and where there are staff who are experienced in ID immunisation.

Adolescent↗