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Milazzo A, McMillan M, Giles L, Page K, Flood L, Marshall H. Geographical distribution of invasive meningococcal disease and carriage: A spatial analysis. Epidemiol Infect 2024; 152:e22. [PMID: 38234190 PMCID: PMC10894902 DOI: 10.1017/s0950268824000116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Little information exists concerning the spatial relationship between invasive meningococcal disease (IMD) cases and Neisseria meningitidis (N. meningitidis) carriage. The aim of this study was to examine whether there is a relationship between IMD and asymptomatic oropharyngeal carriage of meningococci by spatial analysis to identify the distribution and patterns of cases and carriage in South Australia (SA). Carriage data geocoded to participants' residential addresses and meningococcal case notifications using Postal Area (POA) centroids were used to analyse spatial distribution by disease- and non-disease-associated genogroups, as well as overall from 2017 to 2020. The majority of IMD cases were genogroup B with the overall highest incidence of cases reported in infants, young children, and adolescents. We found no clear spatial association between N. meningitidis carriage and IMD cases. However, analyses using carriage and case genogroups showed differences in the spatial distribution between metropolitan and regional areas. Regional areas had a higher rate of IMD cases and carriage prevalence. While no clear relationship between cases and carriage was evident in the spatial analysis, the higher rates of both carriage and disease in regional areas highlight the need to maintain high vaccine coverage outside of the well-resourced metropolitan area.
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Affiliation(s)
- Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Mark McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Lynne Giles
- School of Public Health, The University of Adelaide, Adelaide, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Kira Page
- Australian Centre for Housing Research, Hugo Centre for Population and Migration Studies, The University of Adelaide, Adelaide, Australia
| | - Louise Flood
- Communicable Disease Control Branch, Department for Health and Wellbeing, Government of South Australia, Adelaide, Australia
| | - Helen Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
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Rahaman MR, Dear K, Satter SM, Tong M, Milazzo A, Marshall H, Varghese BM, Rahman M, Bi P. Short-Term Effects of Climate Variability on Childhood Diarrhoea in Bangladesh: Multi-Site Time-Series Regression Analysis. Int J Environ Res Public Health 2023; 20:6279. [PMID: 37444126 PMCID: PMC10341980 DOI: 10.3390/ijerph20136279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023]
Abstract
The aim of this study was to estimate the effects of climate on childhood diarrhoea hospitalisations across six administrative divisions in Bangladesh and to provide scientific evidence for local health authorities for disease control and prevention. Fortnightly hospital admissions (August/2013-June/2017) for diarrhoea in children under five years of age, and fortnightly average maximum temperature, relative humidity and rainfall recordings for six administrative divisions were modelled using negative binomial regression with distributed lag linear terms. Flexible spline functions were used to adjust models for seasonality and long-term trends. During the study period, 25,385 diarrhoea cases were hospitalised. Overall, each 1 °C rise in maximum temperature increased diarrhoea hospitalisations by 4.6% (IRR = 1.046; 95% CI, 1.007-1.088) after adjusting for seasonality and long-term trends in the unlagged model. Using lagged effects of maximum temperature, and adjusting for relative humidity and rainfall for each of the six administrative divisions, the relationship between maximum temperature and diarrhoea hospitalisations varied between divisions, with positive and negative effect estimates. The temperature-diarrhoea association may be confounded by seasonality and long-term trends. Our findings are a reminder that the effects of climate change may be heterogeneous across regions, and that tailored diarrhoea prevention strategies need to consider region-specific recommendations rather than relying on generic guidelines.
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Affiliation(s)
- Md Rezanur Rahaman
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT 2601, Australia
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Keith Dear
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Syed M. Satter
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Michael Tong
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Helen Marshall
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia
- Women’s and Children’s Health Network, Adelaide, SA 5006, Australia
| | - Blesson M. Varghese
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Mahmudur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
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Palinkas ED, Marchi A, Milazzo A, Tassetti L, Zampieri M, D'Alfonso MG, Mori F, Palinkas A, Ciampi Q, Sepp R, Olivotto I, Picano E. Clinical, functional and prognostic correlates of excess left ventricular force in hypertrophic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Excess force generation during myocardial contraction represents a cardinal feature of hypertrophic cardiomyopathy (HCM).
Purpose
To evaluate the anatomical, functional and prognostic correlates of left ventricular (LV) force in HCM.
Methods
We prospectively recruited a consecutive sample of 408 HCM patients with LV ejection fraction (EF) >50%, referred for baseline transthoracic echocardiography in 2 primary HCM centers in Hungary and Italy between 1999 and 2021. LV force was calculated as LV outflow tract gradient+systolic blood pressure/LV end-systolic volume. Patients were followed for a median of 107 months (IQ range, 58–158 months), the study endpoint was all-cause mortality.
Results
Mean LV force was 6.0±4.6 mm Hg/ml. Receiver-operating characteristic analysis identified 7.5 mm Hg/ml the best cut-off value to predict mortality. LV force >7.5 mm Hg/ml was present in 86 patients (21%), more frequently in women (58 vs 27%, p<0.0001), more often in patients with diabetes (16 vs 6%, p=0.003), beta-blocker (81 vs 58%, p<0.0001), calcium channel-blocker (19 vs 9%, p=0.012) and diuretic therapy (19 vs 8%, p=0.004), compared to patients with LV force ≤7.5 mm Hg/ml. Patients with excess LV force had more advanced NYHA class (1.8±0.7 vs 1.4±0.7, p=0.0001), greater left atrial diameter [(LAd), 46.7±6.6 vs 43.0±7.2 mm, <0.0001], LV maximal wall thickness (23.2±5.5 vs 21.6±5.5 mm p=0.01), LV EF (74.6±6.4 vs 67.0±6.8%, <0.0001), mitral regurgitation grade (1.2±0.7 vs 0.7±0.7, p<0.0001) and E/e' (10.3±5.0 vs 7.8±5.0, p=0.005). During follow-up 43 deaths occurred. All-cause death was more frequent in patients with excess LV force (21 vs 8%, p<0.0001). At multivariable Cox regression analysis, excess LV force was an independent predictor of mortality (HR 2.9, 95% CI 1.14–7.26, p=0.025) independent of age (HR 1.03, 95% CI 1.00–1.05, p=0.022) and LAd (HR 1.07, 95% CI 1.02–1.14, p=0.005).
Conclusion
LV force with a threshold of 7.5 mm Hg/ml, independently predicts adverse outcome in patients with HCM and preserved systolic function. Excess LV force generation is associated with female sex, diabetes, NYHA class, medications, LAd, LV wall thickness, EF, mitral regurgitation grade and E/e'.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E D Palinkas
- University of Szeged, Division of Non-Invasive Cardiology, Department of Internal Medicine , Szeged , Hungary
| | - A Marchi
- Careggi University Hospital, Cardiomyopathy Unit , Florence , Italy
| | - A Milazzo
- Careggi University Hospital, Cardiomyopathy Unit , Florence , Italy
| | - L Tassetti
- Careggi University Hospital, Cardiomyopathy Unit , Florence , Italy
| | - M Zampieri
- Careggi University Hospital, Cardiomyopathy Unit , Florence , Italy
| | - M G D'Alfonso
- Careggi University Hospital, Cardiovascular Imaging Division , Florence , Italy
| | - F Mori
- Careggi University Hospital, Cardiovascular Imaging Division , Florence , Italy
| | - A Palinkas
- Elisabeth Hospital of Csongrad , Hodmezovasarhely , Hungary
| | - Q Ciampi
- Fatebenefratelli Hospital of Benevento , Benevento , Italy
| | - R Sepp
- University of Szeged, Division of Non-Invasive Cardiology, Department of Internal Medicine , Szeged , Hungary
| | - I Olivotto
- Careggi University Hospital, Cardiomyopathy Unit , Florence , Italy
| | - E Picano
- CNR – National Research Council, Institute of Clinical Physiology , Pisa , Italy
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Milazzo A, Giles L, Parent N, McCarthy S, Laurence C. The impact of non-pharmaceutical interventions on COVID-19 cases in South Australia and Victoria. Aust N Z J Public Health 2022; 46:482-487. [PMID: 35557482 PMCID: PMC9348509 DOI: 10.1111/1753-6405.13249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/01/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To assess the impact of different non-pharmaceutical interventions (NPIs) on COVID-19 cases across Victoria and South Australia. METHODS Poisson regression models were fit to examine the effect of NPIs on weekly COVID-19 case numbers. RESULTS Mask-wearing in Victoria had a pronounced lag effect of two weeks with an incidence rate ratio (IRR) of 0.27 (95%CI 0.26-0.29). Similarly, the effect of border closure (IRR 0.18; 95%CI 0.14-0.22) in South Australia and lockdown (IRR 0.88; 95%CI 0.86-0.91) in Victoria showed a decrease in incidence two weeks after the introduction of these interventions. CONCLUSIONS With the ongoing COVID-19 pandemic, varying levels of vaccination coverage rates and threats from variants of concern, NPIs are likely to remain in place. It is thus important to validate the effectiveness and timing of different interventions for disease control, as those that are more restrictive such as border control and lockdown can have an enormous impact on society. IMPLICATIONS FOR PUBLIC HEALTH Low case numbers and deaths in Australia's first wave of COVID-19 are thought to be due to the timely use of interventions. The observed two-week lag effect associated with a decrease in incidence provides justification for early implementation of NPIs for COVID-19 management and future pandemics.
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Affiliation(s)
- Adriana Milazzo
- School of Public Health, The University of Adelaide, South Australia,Correspondence to: Dr Adriana Milazzo, School of Public Health, The University of Adelaide, Level 4, 50 Rundle Mall Plaza, Rundle Mall, Adelaide 5005, SA
| | - Lynne Giles
- School of Public Health, The University of Adelaide, South Australia,Robinson Research Institute, The University of Adelaide, South Australia
| | - Natalie Parent
- School of Public Health, The University of Adelaide, South Australia
| | - Sophie McCarthy
- School of Public Health, The University of Adelaide, South Australia
| | - Caroline Laurence
- School of Public Health, The University of Adelaide, South Australia
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Sundararajan K, Bi P, Milazzo A, Poole A, Reddi B, Mahmood MA. Preparedness and response to COVID-19 in a quaternary intensive care unit in Australia: perspectives and insights from frontline critical care clinicians. BMJ Open 2022; 12:e051982. [PMID: 35121600 PMCID: PMC8819546 DOI: 10.1136/bmjopen-2021-051982] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This study was conducted to explore the perspectives and opinions of intensive care unit (ICU) nurses and doctors at a COVID-19-designated pandemic hospital concerning the preparedness and response to COVID-19 and to consolidate the lessons learnt for crisis/disaster management in the future. DESIGN A qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs). Purposeful sampling was conducted to identify participants. A semistructured guide was used to facilitate IDIs with individual participants. Two FGDs were conducted, one with the ICU doctors and another with the ICU nurses. Thematic analysis identified themes and subthemes informing about the level of preparedness, response measures, processes, and factors that were either facilitators or those that triggered challenges. SETTING ICU in a quaternary referral centre affiliated to a university teaching COVID-19-designated pandemic hospital, in Adelaide, South Australia. PARTICIPANTS The participants included eight ICU doctors and eight ICU nurses for the IDIs. Another 16 clinicians participated in FGDs. RESULTS The study identified six themes relevant to preparedness for, and responses to, COVID-19. The themes included: (1) staff competence and planning, (2) information transfer and communication, (3) education and skills for the safe use of personal protective equipment, (4) team dynamics and clinical practice, (5) leadership, and (6) managing end-of-life situations and expectations of caregivers. CONCLUSION Findings highlight that preparedness and response to the COVID-19 crisis were proportionate to the situation's gravity. More enablers than barriers were identified. However, opportunities for improvement were recognised in the domains of planning, logistics, self-sufficiency with equipment, operational and strategic oversight, communication and managing end-of-life care.
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Affiliation(s)
- Krishnaswamy Sundararajan
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Alexis Poole
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Benjamin Reddi
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mohammad Afzal Mahmood
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
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Rahaman MR, Burgess T, Marshall H, Milazzo A, Chaber AL, Crabb D, Bi P. Q fever prevention: Perspectives from university animal science and veterinary students and livestock farmers. Aust J Rural Health 2022; 30:385-392. [PMID: 35099093 DOI: 10.1111/ajr.12840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 12/23/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To explore animal science and veterinary students' and livestock farmers' perceptions concerning Q fever prevention. DESIGN An online survey with an open-ended question seeking knowledge and perceptions about Q fever prevention was distributed among participants during March-September 2019. We applied thematic analysis to identify emerging themes. SETTING Animal science and veterinary students enrolled at the University of Adelaide and members of Livestock South Australia representing cattle, sheep and goat farmers in South Australia. PARTICIPANTS A total of56 animal science and veterinary students and 154 livestock farmers responded to the open-ended question. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Perceived challenges and opportunities for a coordinated Q fever prevention approach including human vaccination reported by the participants. RESULTS Two major themes arose in each group. Students and farmers viewed Q fever vaccination as important. However, excessive cost for students was a barrier and for farmers, it was general practitioners' lack of knowledge of Q fever and access to an accredited immunisation provider. Similarly, both groups highlighted the need for education and increasing public and community awareness of Q fever. CONCLUSION Our findings underscore that a sector-wide approach involving community awareness programmes, education and training for general practitioners, and subsidised vaccination as well as commitment from government and industry partners may contribute to reducing the burden of Q fever among at-risk populations.
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Affiliation(s)
- Md Rezanur Rahaman
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia.,National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, Australia
| | - Teresa Burgess
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Helen Marshall
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,Women's and Children's Health Network, Adelaide, SA, Australia
| | - Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Anne-Lise Chaber
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | | | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
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Rahaman MR, Hodgetts K, Milazzo A, Marshall H, Chaber AL, Crabb D, Bi P. Q fever prevention in Australia: general practitioner and stakeholder perspectives on preparedness and the potential of a One Health approach. Aust N Z J Public Health 2021; 46:196-202. [PMID: 34941007 DOI: 10.1111/1753-6405.13198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/01/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine stakeholder perspectives on the factors of an effective approach to reduce Q fever risk including disease prevention, and the perceived potential benefits of a One Health framework. METHODS Semi-structured interviews were conducted with general practitioners (GPs), veterinarians, government authorities, researchers, and representatives from the farming industry. Transcripts were thematically analysed. RESULTS Six major themes were identified as key factors underpinning an effective approach to Q fever: understanding Q fever burden; effective surveillance; the role of general practitioners and other stakeholders; barriers and enablers of vaccination; an integrated approach; and increased Q fever awareness. Most participants perceived GPs to play a central role in disease detection, notification, treatment and prevention through health promotion and vaccination, despite GPs acknowledging limited awareness of Q fever. Participants suggested leadership is required from the Department of Health (DoH) to foster inter-sectoral communication and collaboration. CONCLUSIONS A One Health approach holds opportunities for zoonosis prevention. We recommend that medical curricula and professional development be enhanced, zoonosis working group networks strengthened, government-industry partnerships established, and relevant stakeholders included within an integrated program. Implications for public health: Updating medical curricula, GP professional development programs and inter-sectoral collaboration led by health departments may reduce Q fever burden.
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Affiliation(s)
- Md R Rahaman
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Australian Capital Territory.,School of Public Health, The University of Adelaide, South Australia
| | | | - Adriana Milazzo
- School of Public Health, The University of Adelaide, South Australia
| | - Helen Marshall
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, South Australia.,Women's and Children's Health Network, South Australia
| | - Anne-Lise Chaber
- School of Animal and Veterinary Sciences, The University of Adelaide, South Australia
| | | | - Peng Bi
- School of Public Health, The University of Adelaide, South Australia
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Laka M, Milazzo A, Merlin T. Inappropriate antibiotic prescribing: understanding clinicians. AUST HEALTH REV 2021; 46:21-27. [PMID: 34607627 DOI: 10.1071/ah21197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022]
Abstract
ObjectiveThe aim of this study was to identify perceived barriers to appropriate antibiotic prescribing across different healthcare settings.MethodsA cross-sectional survey of clinicians in Australian hospitals and primary care was undertaken between June and October 2019. The perceived barriers to appropriate antibiotic prescribing were considered as dependent variables, whereas age, sex, clinical experience, healthcare setting and the use of guidelines were considered independent variables. We used multivariate logistic regression to identify factors predictive of inappropriate antibiotic prescribing. Content analysis of free-text responses provided additional insights into the impediments to appropriate prescribing.ResultsIn all, 180 clinicians completed the survey. Overall, diagnostic uncertainty and limited access to guidelines and prescribing information were significant barriers to appropriate antibiotic prescribing. Factors associated with these barriers were clinical experience, care setting (hospitals vs primary care) and the use of guidelines. Experienced clinicians (>11 years) were less likely to consider that limited access to information negatively affected prescribing practices (experience 11-20 years, odds ratio (OR) 0.66, 95% confidence interval (CI) 0.31-0.84; experience >20 years, OR 0.51, 95% CI 0.24-0.91). Conversely, general practitioners considered diagnostic uncertainty (OR 1.31, 95% CI 1.09-1.63) and patient expectations (OR 1.41, 95% CI 1.12-1.84) were more likely to be perceived barriers to appropriate prescribing. The use of guidelines and clinical experience may counteract this.ConclusionYears of experience, use of guidelines and type of setting were predictors of clinicians' perceptions regarding antibiotic prescribing. Our data highlight the importance of individual and setting characteristics in understanding variations in prescribing practices and designing targeted interventions for appropriate antibiotic prescribing.What is known about the topic?Inappropriate antibiotic prescribing is a significant health issue in Australia. Drivers of inappropriate prescribing are known, but how individual and setting characteristics contribute to variations in prescribing behaviour has not been fully understood.What does this paper add?Diagnostic uncertainty and limited access to prescribing information, including guidelines, formulary restrictions and antibiotic resistance patterns, can limit appropriate antibiotic prescribing. Clinicians' years of experience, the healthcare settings and clinician use of guidelines are important predictors of antibiotic prescribing behaviour.What are the implications for practitioners?The findings of this study can inform the design of tailored interventions to promote rational antibiotic prescribing practices in general practice and hospital settings.
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Affiliation(s)
- Mah Laka
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Adriana Milazzo
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Tracy Merlin
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
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Rahaman R, Burgess T, Milazzo A, Marshall H, Chaber AL, Crabb D, Bi P. 585Do Australian livestock farmers perceive Q fever prevention differently from animal science and veterinary students? Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Objective
To identify the issues around the prevention of Q fever as understood by trainee animal health practitioners and livestock farmers and to compare their varying perceptions.
Methods
An online survey with an open question seeking participants’ suggestions about Q fever prevention was distributed among all animal science and veterinary students enrolled at the University of Adelaide and members of Livestock SA representing livestock farmers during March-September 2019. Students were recruited through their University course whilst livestock farmers were recruited by advertisements and direct emails. Thematic analysis of the data followed the Braun and Clarke framework.
Results
Two major themes arose in each group, whilst each group identified similar themes and sub themes, there was a differing emphasis on the importance of these. Both students and farmers viewed Q fever vaccination is important, but barriers included excessive cost for students while access to a vaccine provider and general practitioners’ inadequate knowledge were emphasized by farmers. Awareness was another major theme: students – generalized lack of awareness amongst themselves and the public; farmers – increasing public awareness is crucial.
Conclusions
Both groups recognized the importance of Q fever vaccination and viewed subsidy an enabler, but students’ perceptions were shaped by the high cost of the vaccine while farmers were most concerned with the impacts of the disease. Findings underscore that strengthening targeted and community awareness programs coupled with a subsidy could promote increased uptake of Q fever vaccination.
Key messages
Increasing awareness and subsidized vaccination could merit Q fever prevention approaches including vaccination.
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Affiliation(s)
| | | | | | | | | | | | - Peng Bi
- The University of Adelaide, Adelaide, Australia
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Laka M, Milazzo A, Merlin T. 512Challenges and opportunities to appropriate antibiotic prescribing: a survey of clinicians’ perceptions in Australia. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Emerging antibiotic resistance is significant threat to global public health. There is evidence on sub-optimal prescribing as a contributing factor to antibiotic resistance. This study aimed to identify behavioral determinants of antibiotic prescribing that may help design effective interventions.
Methods
A cross-sectional survey was undertaken with clinicians (hospital and primary care) in Australia from June–October 2019. Multivariate logistic regression was used to determine if clinicians’ characteristics, and guidelines’ use, are associated with barriers of appropriate antibiotic prescribing.
Results
Inappropriate prescribing behavior is not limited to clinicians’ practices, but also relate to patients’ expectation and clinical culture. Lack of data for evidence-based decision-making and diagnostic uncertainty contribute to sub-optimal antibiotic prescribing. Different care settings and clinicians’ experience influence perceptions of whether unavailability of information, delay in diagnostic results and patient expectations regarding treatment led to inappropriate prescribing behavior. Respondents in primary care and with less experience were more likely to consider that patient demands (primary care: OR 1.76, 95%CI 1.34–2.68 & experience (1-10 years): OR 1.34, 95%CI 1.07–1.59) and lack of data required for decision-making (primary care: OR 1.59, 95%CI 1.09–2.10 & experience (1-10 years): OR 1.63, 95%CI 1.13–1.87) are barriers to appropriate prescribing.
Conclusions
A complex network of social, contextual and clinical factors influence prescribing practices. A holistic approach addressing clinicians’ practices, setting requirements and patient expectations must be considered.
Key messages
For optimal antibiotic prescribing, there is a need to focus on contextual requirements, shared decision-making and availability of relevant information at point-of-care.
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Affiliation(s)
- Mah Laka
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Tracy Merlin
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, Australia
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Milazzo A. 217Using excess heat factor to measure effect of heatwave severity on foodborne disease incidence. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
This study aims to analyse the distribution characteristics of ideal cardiovascular health (ICH) metrics status of the oldest-old and centenarians, and also to explore the relationships with disability and quality of life.
Methods
1002 centenarians and 798 oldest-old were included in the analysis. ICH, disability and quality of life were assessed according to standard methods.
Results
The median number of ICH metrics among centenarians and oldest-old were 4 (4-5) and 3(3-5) respectively. The highest proportion of ICH metrics at ideal levels were glucose (90.2%), BMI (89.8%), and smoking (89.4%), the lowest proportion of ICH metrics at ideal level was blood pressure (8.3%). The disability rates of BADL and IADL decreased with the number of ICH metrics. BADL disability changed from 100.0% to 73.2%, and the IADL disability rate dropped from 100% to 80.0%. BADL disability rate decreased from 45.0% to 25.3% and IADL disability decreased from 100.0% to 57.1% among the oldest-old. The EQ-5D vas, EQ-5D score showed increasing trend along with the number of ICH metrics (p < 0.05). Compared with centenarians who had only 0-2 ICH metrics, the ORs for BADL disability were 0.82, 0.66, 0.52, 0.44, and the ORs for IADL disability were 0.74, 0.65, 0.58, 0.41 for those with 3, 4, 5, ≥6 ICH metrics.
Conclusions
ICH metrics of centenarians and oldest-old were at a relatively good level, and there was a strong and independent inverse relationship between ICH metrics with both disability and lower quality of life.
Key messages
This was the first survey about the distribution of ICH metrics and association with both disability and quality of life based on elderly aged over 80 years old. The results highlighted the importance of cardiovascular prevention even at 80 years and over, which made up for the evidence gap based on this age group.
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Morello BR, Milazzo A, Marshall HS, Giles LC. Lessons for and from the COVID-19 pandemic response - An appraisal of guidance for the public health management of Invasive Meningococcal Disease. J Infect Public Health 2021; 14:1069-1074. [PMID: 34218099 PMCID: PMC8230839 DOI: 10.1016/j.jiph.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/12/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND COVID-19 has focussed public attention on the management of communicable disease like never before. Surveillance, contact tracing, and case management are recognised as key components of outbreak prevention. Development of guidance for COVID-19 has drawn from existing management of other communicable diseases, including Invasive Meningococcal Disease (IMD). IMD is a rare but severe outcome of Neisseria meningitidis infection that can be prevented through vaccination. Cases still occur sporadically, requiring ongoing surveillance and consistent management. To this end, national and international public health agencies have developed and published guidance for identification and management of IMD cases. AIM To assess national and international guidelines for the public health management of IMD, with a focus on the recommendations for identification and management of "close contacts" to IMD cases. METHODS Guidelines from six national and international public health agencies were assessed using a modified version of the Appraisal of Guidelines, Research and Evaluation (AGREE II) Instrument in four key domains: stakeholder involvement, developmental rigour, clarity, and applicability. A direct comparison of terminology and recommendations for identification and management of close contacts to IMD cases was also conducted. RESULTS Guidelines from Europe and the United Kingdom rated most highly using the AGREE II Instrument, both presenting a clear, critical assessment of the strength of the available evidence, and the risks, costs, and benefits behind recommendations for management of close contacts. Direct comparison of guidelines identified inconsistencies in the language defining close contacts to IMD cases. CONCLUSION Discrepancies between guidelines could be due to limited evidence concerning mechanisms behind disease transmission, along with the lack of a consistent process for development and review of guideline recommendations. COVID-19 management has demonstrated that international collaboration for development of public health guidance is possible, a practice that should be extended to management of other communicable diseases.
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Affiliation(s)
- Brianna R Morello
- School of Public Health, The University of Adelaide, Adelaide Health and Medical Sciences Building, Corner of North Terrace and George Street, Adelaide, SA 5005, Australia
| | - Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide Health and Medical Sciences Building, Corner of North Terrace and George Street, Adelaide, SA 5005, Australia
| | - Helen S Marshall
- Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, Corner of North Terrace & George Street, Adelaide, SA 5005, Australia; Robinson Research Institute, The University of Adelaide, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide, SA 5006, Australia
| | - Lynne C Giles
- School of Public Health, The University of Adelaide, Adelaide Health and Medical Sciences Building, Corner of North Terrace and George Street, Adelaide, SA 5005, Australia; Robinson Research Institute, The University of Adelaide, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide, SA 5006, Australia.
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13
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Laka M, Milazzo A, Merlin T. Can evidence-based decision support tools transform antibiotic management? A systematic review and meta-analyses. J Antimicrob Chemother 2021; 75:1099-1111. [PMID: 31960021 DOI: 10.1093/jac/dkz543] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/17/2019] [Accepted: 12/06/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To assess the effectiveness of clinical decision support systems (CDSSs) at reducing unnecessary and suboptimal antibiotic prescribing within different healthcare settings. METHODS A systematic review of published studies was undertaken with seven databases from database inception to November 2018. A protocol was developed using the PRISMA-P checklist and study selection criteria were determined prior to performing the search. Critical appraisal of studies was undertaken using relevant tools. Meta-analyses were performed using a random-effects model to determine whether CDSS use affected optimal antibiotic management. RESULTS Fifty-seven studies were identified that reported on CDSS effectiveness. Most were non-randomized studies with low methodological quality. However, randomized controlled trials of moderate methodological quality were available and assessed separately. The meta-analyses indicated that appropriate antibiotic therapy was twice as likely to occur following the implementation of CDSSs (OR 2.28, 95% CI 1.82-2.86, k = 20). The use of CDSSs was also associated with a relative decrease (18%) in mortality (OR 0.82, 95% CI 0.73-0.91, k = 18). CDSS implementation also decreased the overall volume of antibiotic use, length of hospital stay, duration and cost of therapy. The magnitude of the effect did vary by study design, but the direction of the effect was consistent in favouring CDSSs. CONCLUSIONS Decision support tools can be effective to improve antibiotic prescribing, although there is limited evidence available on use in primary care. Our findings suggest that a focus on system requirements and implementation processes would improve CDSS uptake and provide more definitive benefits for antibiotic stewardship.
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Affiliation(s)
- Mah Laka
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Adriana Milazzo
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Tracy Merlin
- Adelaide Health Technology (AHTA), School of Public Health, University of Adelaide, Adelaide, Australia
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14
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Rahaman MR, Marshall H, Milazzo A, Crabb D, Bi P. Q fever prevention and vaccination: Australian livestock farmers' knowledge and attitudes to inform a One Health approach. One Health 2021; 12:100232. [PMID: 33748388 PMCID: PMC7960538 DOI: 10.1016/j.onehlt.2021.100232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Livestock farmers are at risk of Q fever, a zoonotic disease transmitted to humans from animals such as cattle, sheep and goats. Australia bears substantial Q fever burden, particularly among farmers. A One Health approach engages cross-sectoral collaboration among animal, human and environmental health and is the preferred framework for Q fever prevention. METHODS Cattle, sheep and goat farmers were invited to participate in an online survey in 2019 to gauge perceptions about Q fever and its prevention. Participants were recruited via membership newsletters and social media. Descriptive analyses and logistic regressions were performed. RESULTS A total of 351 farmers completed the survey. Most respondents (80%) had been farming for ≥20 years, with sheep and beef cattle their primary stock. 71% reported knowledge of Q fever, and 85% identified transmission through contaminated dust inhalation was highly likely. The majority of respondents (97%) were aware of Q fever vaccine, and 95% agreed it was effective in preventing disease, yet 42% remained unvaccinated. Reported barriers to vaccination included poor access to a trained doctor and time and cost related to vaccination. Most farmers (≥91%) believed that subsidized vaccination and improved awareness would promote higher uptake. CONCLUSION While Q fever knowledge among respondents was good, their practices related to airborne transmission prevention were poor. Livestock farmers would benefit from adherence to dust and aerosol transmission prevention practices. One Health partnership between government and industry is needed to promote Q fever awareness and address low vaccination rates among livestock farmers by funding vaccination programs.
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Affiliation(s)
- Md Rezanur Rahaman
- School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Helen Marshall
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, South Australia 5005, Australia
- Women's and Children's Health Network, South Australia, Australia
| | - Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Deane Crabb
- Livestock SA, Unit 5, 780 South Road, Glandore, South Australia 5037, Australia
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia
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15
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Laka M, Milazzo A, Merlin T. Factors That Impact the Adoption of Clinical Decision Support Systems (CDSS) for Antibiotic Management. Int J Environ Res Public Health 2021; 18:ijerph18041901. [PMID: 33669353 PMCID: PMC7920296 DOI: 10.3390/ijerph18041901] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 01/22/2023]
Abstract
The study evaluated individual and setting-specific factors that moderate clinicians’ perception regarding use of clinical decision support systems (CDSS) for antibiotic management. A cross-sectional online survey examined clinicians’ perceptions about CDSS implementation for antibiotic management in Australia. Multivariable logistic regression determined the association between drivers of CDSS adoption and different moderators. Clinical experience, CDSS use and care setting were important predictors of clinicians’ perception concerning CDSS adoption. Compared to nonusers, CDSS users were less likely to lack confidence in CDSS (OR = 0.63, 95%, CI = 0.32, 0.94) and consider it a threat to professional autonomy (OR = 0.47, 95%, CI = 0.08, 0.83). Conversely, there was higher likelihood in experienced clinicians (>20 years) to distrust CDSS (OR = 1.58, 95%, CI = 1.08, 2.23) due to fear of comprising their clinical judgement (OR = 1.68, 95%, CI = 1.27, 2.85). In primary care, clinicians were more likely to perceive time constraints (OR = 1.96, 95%, CI = 1.04, 3.70) and patient preference (OR = 1.84, 95%, CI = 1.19, 2.78) as barriers to CDSS adoption for antibiotic prescribing. Our findings provide differentiated understanding of the CDSS implementation landscape by identifying different individual, organisational and system-level factors that influence system adoption. The individual and setting characteristics can help understand the variability in CDSS adoption for antibiotic management in different clinicians.
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Affiliation(s)
- Mah Laka
- School of Public Health, University of Adelaide, Adelaide 5005, Australia; (M.L.); (A.M.)
| | - Adriana Milazzo
- School of Public Health, University of Adelaide, Adelaide 5005, Australia; (M.L.); (A.M.)
| | - Tracy Merlin
- Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Adelaide 5005, Australia
- Correspondence: ; Tel.: +61-(8)-8313-3575
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16
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Rahaman MR, Milazzo A, Marshall H, Chaber AL, Bi P. Q fever vaccination: Australian animal science and veterinary students' One Health perspectives on Q fever prevention. Hum Vaccin Immunother 2020; 17:1374-1381. [PMID: 33180660 DOI: 10.1080/21645515.2020.1829900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Unvaccinated animal science and veterinary students are at risk of Q fever, a vaccine-preventable zoonotic disease transmitted from animals to humans. We investigated students' perspectives on Q fever prevention using a One Health approach combining animal, human and environmental health. Animal science and veterinary students enrolled at the University of Adelaide in 2019 were invited to participate in an online survey to explore their perceptions about Q fever and prevention strategies. We undertook descriptive analysis and logistic regression. Overall, 46% of students reported little to no knowledge of Q fever. Over three-quarters of students reported transmission of Q fever via aerosol inhalation and animal culling, whilst other modes including sexual transmission between humans (7%) was poorly identified. The majority of students reported exposure to cattle, sheep and goats. Of those who reported vaccination status, 5% veterinary and 61% animal science students were unvaccinated for Q fever. Challenges concerning vaccination included cost, time and access to healthcare with strategies aimed at promoting awareness, improving healthcare access and subsidized and mass vaccination. Knowledge of Q fever among respondents, particularly about disease transmission was suboptimal. As a key principle to One Health approach, adherence to biosecurity guidelines during contact with animals could potentially reduce zoonoses including Q fever transmission. Improving access to Q fever vaccine for unvaccinated students is a priority. Findings underscore that university policy for Q fever vaccination needs to consider subsidized vaccination for both animal science and veterinary students.
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Affiliation(s)
- Md R Rahaman
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Helen Marshall
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, Australia.,Department of Pediatrics, Women's and Children's Health Network, Adelaide, Australia
| | - Anne-Lise Chaber
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, Australia
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, Australia
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17
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Ciampi Q, Olivotto I, D'Alfonso M, Tassetti L, Milazzo A, Peteiro J, Monserrat L, Palinkas A, Palinkas E, Tesic M, Djordjevic-Dikic A, Losi M, Canciello G, Re F, Picano E. Prognostic value of reduced heart rate reserve during exercise stress-echocardiography in hypertrophic cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Heart rate reserve (HRR) during exercise evaluates chronotropic incompetence and is a prognostically important marker of cardiac autonomic dysfunction, additive to regional wall motion abnormalities (RWMA) in patients with coronary artery disease.
Objectives
To assess determinants and prognostic value of HRR in patients with hypertrophic cardiomyopathy (HCM).
Methods
From 1998 to 2019, we enrolled 774 HCM patients (age = 48.8±15.9 years, 410 men) with exercise stress echocardiography (ESE) in 10 certified centres of the international stress echo network. During ESE we assessed: left ventricular outflow tract obstruction (LVOTO, significant when >50 mmHg); RWMA; HRR (peak/ rest heart rate), 344 in beta-blockers therapy (44.4%). Patients were followed for a median 49 months (IQ range, 25–78 months). The study end-point was all-cause mortality.
Results
During ESE, we observed stress-induced RWMA in 42 (5.4%) and LVOTO in 248 (33%); HRR was 1.92.±0.41. There were no difference in patients with normal and abnormal HRR with and without beta-blockers therapy (147, 41.1% vs 211, 58.9%, p=0.079). During follow-up, 43 deaths occurred. Beta blockers therapy in univariate analysis did not have prognostic role (HR 1.105, 95% CI 0.602–2.028, p=0.768). The lowest HRR quartile (≤1.62) had a 10-fold higher 6-year death rate (10.9%) than the highest quartile (>2.16, 1.04%): see figure. At multivariable analysis, lowest HRR quartile (HR 2.074, 95% CI 1.082–6.773, p=0.034), age (HR 1.045, 95% CI 1.014–1.077, p=0.004), maximal wall thickness (HR 1.137, 95% CI 1.054–1.226, p=0.001), stress-induced RWMA s(HR 4.289, 95% CI 1.733–10.615, p=0.002) and ≥ moderate mitral regurgitation at rest (HR 3.127, 95% CI 1.507–6.488, p=0.002) predicted death.
Conclusions
A blunted HRR during ESE predicts adverse outcome independent of inducible RWMA in HCM patients. Autonomic dysfunction deserves consideration as a potential therapeutic target in this disease.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Q Ciampi
- Fatebenefratelli Hospital, Division of Cardiology, Benevento, Italy
| | - I Olivotto
- Careggi University Hospital, Cardiology, Florence, Italy
| | - M.A D'Alfonso
- Careggi University Hospital, Cardiology, Florence, Italy
| | - L Tassetti
- Careggi University Hospital, Cardiology, Florence, Italy
| | - A Milazzo
- Careggi University Hospital, Cardiology, Florence, Italy
| | - J Peteiro
- University Hospital A Coruna, Cardiology, A Coruna, Spain
| | - L Monserrat
- University Hospital A Coruna, Cardiology, A Coruna, Spain
| | - A Palinkas
- Elisabeth Hospital of Csongrad, Internal Medicine, Hodmezovasarhely, Hungary
| | - E Palinkas
- University of Szeged, Internal Medicine, Szeged, Hungary
| | - M Tesic
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | | | - M.A Losi
- Federico II University of Naples, Cardiology, Naples, Italy
| | - G Canciello
- Federico II University of Naples, Cardiology, Naples, Italy
| | - F Re
- San Camillo Forlanini Hospital, Cardiology, Rome, Italy
| | - E Picano
- National Council of Research, Cardiology, Pisa, Italy
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18
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Laka M, Milazzo A, Merlin T. Why provision of clinical decision support (CDS) is not enough? Factors influencing the CDS adoption. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Clinical decision support (CDS) can improve the quality and efficiency of care by increasing access to evidence-based data at the point-of-care. However, CDS adoption is limited in clinical settings. The focus on the technical design have overlooked end-users’ perceptions, social and organisational factors that may influence uptake. Using the Unified Theory of Acceptance and Use of Technology (UTAUT) model, we aimed to identify different challenges and opportunities for CDSS adoption in clinical settings.
Methods
A cross-sectional online survey was conducted from June-October 2019 with general practitioners, physicians and surgeons in Australia. To measure the impact of UTAUT moderators (age, gender and experience) and care settings (primary care vs. hospitals) on perceived barriers and facilitators to CDS implementation, multivariate logistic regression was carried out. Qualitative data was thematically analysed for emerging patterns and themes.
Results
Many respondents indicated that CDS can promote evidence-based care (79%) and improve quality and safety (52%). Overall CDS adoption is dependent on factors such as effort expectancy (ease of use), performance expectancy and a facilitating environment for system use. Clinician perceptions of barriers and facilitators to uptake are associated with type of care setting. There was higher likelihood of perceiving ease of use (OR 1.39, 95% CI 1.15-2.07), time limitations (OR 1.95, 95%CI 1.10-3.77), patient' preferences (OR 2.17, 95% CI 1.14-3.37) and threat to professional autonomy (OR 2.15, 95%CI 1.39-3.41) as factors that influence adoption in primary care. Providing relevant information in right format at right time is critical for successful CDS use.
Conclusions
CDS implementation requires a holistic approach addressing users' perceptions and preferences determined through stakeholder consultation. The system design must be easy to use but also facilitated through the provision of on-site training and support.
Key messages
CDS adoption is determined by systems’ ease of use and provision of enabling environment. Users and setting characteristics are important moderators and must be considered in CDS implementation.
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Affiliation(s)
- M Laka
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - A Milazzo
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - T Merlin
- Adelaide Health Technology School of Public Health, The University of Adelaide, Adelaide, Australia
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19
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Rahaman MR, Milazzo A, Marshall H, Bi P. Spatial, temporal, and occupational risks of Q fever infection in South Australia, 2007-2017. J Infect Public Health 2019; 13:544-551. [PMID: 31706842 DOI: 10.1016/j.jiph.2019.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/20/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The burden of Q fever on at risk population groups in Australia is substantial, despite the availability of a vaccine. Our objectives were to: (a) describe the epidemiology of notified Q fever cases in South Australia (SA), (b) identify if Q fever infection is associated with occupational exposure, and (c) detect the possible spatial and temporal association of Q fever with livestock density. METHODS Laboratory confirmed Q fever notifications from January 2007 to December 2017 were obtained from the SA Health Department. Q fever notification rates and incidence rate ratios were calculated for gender, notification year, age group, occupation category, and primary exposure suburb. Spatial mapping and analysis of Q fever notifications was undertaken using livestock data, and abattoirs and saleyards located in SA. RESULTS During the study period 167 Q fever cases were notified. Males predominated (72%), with higher rates observed in the 21-40year age group (1.52/100,000), and eight cases (5%) reported prior Q fever vaccination. Most frequently listed occupation categories were livestock farmers (35%), and abattoir workers (20%), but in 15% of cases, there was no known occupational risk. Highest notifications (22%) were recorded in the suburb containing an abattoir. The number of goats, cattle and sheep was not associated with Q fever notifications. CONCLUSIONS Q fever predominance among males in their twenties and thirties may indicate vaccination under-coverage among the young workforce possibly due to high turnover of workers. Q fever among those vaccinated raises concerns about vaccine efficacy or potential waning immunity. Our findings are consistent with previous studies highlighting abattoir workers as a high-risk occupational group because of its transient workforce, and low vaccination coverage. Q fever notifications in SA may be unrelated with spatial livestock density. Further One Health research involving veterinary, public health and environmental data is required.
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Affiliation(s)
- Md R Rahaman
- School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Helen Marshall
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia.
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20
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Cicolari D, Lizio D, Pedrotti P, Sironi R, Moioli MT, Lascialfari A, Mariani M, Milazzo A, Quattrocchi G, Sormani P, Torresin A. P417Assessment of magnetic resonance imaging scanner-dependence and software-dependence of T1 and T2 relaxation times measurements at 1.5 T. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Cicolari
- University of Milan, Physics, Milan, Italy
| | - D Lizio
- Niguarda Ca" Granda Hospital, Medical Physics, Milan, Italy
| | - P Pedrotti
- Niguarda Ca" Granda Hospital, Angelo De Gasperis, Department of Cardiovascular , Milan, Italy
| | - R Sironi
- Niguarda Ca" Granda Hospital, Radiology, Milan, Italy
| | - M T Moioli
- Niguarda Ca" Granda Hospital, Medical Physics, Milan, Italy
| | | | - M Mariani
- University of Pavia, Physics, Pavia, Italy
| | - A Milazzo
- Niguarda Ca" Granda Hospital, Angelo De Gasperis, Department of Cardiovascular , Milan, Italy
| | - G Quattrocchi
- Niguarda Ca" Granda Hospital, Angelo De Gasperis, Department of Cardiovascular , Milan, Italy
| | - P Sormani
- Niguarda Ca" Granda Hospital, Angelo De Gasperis, Department of Cardiovascular , Milan, Italy
| | - A Torresin
- Niguarda Ca" Granda Hospital, Medical Physics, Milan, Italy
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21
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Longo ABE, Valenti L, Pelusi S, Milazzo A, Quattrocchi G, Sormani P, Facanzani AL, Fargion S, Giannattasio C, Vanzulli A, Pedrotti P. P179Absence of cardiac siderosis at cardiac magnetic resonance in patients with dysmetabolic hyperferritinemia. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - S Pelusi
- University of Milan, Milano, Italy
| | - A Milazzo
- Niguarda Ca" Granda Hospital, Angelo De Gasperis, Department of Cardiovascular , Milan, Italy
| | - G Quattrocchi
- Niguarda Ca" Granda Hospital, Angelo De Gasperis, Department of Cardiovascular , Milan, Italy
| | - P Sormani
- Niguarda Ca" Granda Hospital, Angelo De Gasperis, Department of Cardiovascular , Milan, Italy
| | | | | | - C Giannattasio
- Niguarda Ca" Granda Hospital, Angelo De Gasperis, Department of Cardiovascular , Milan, Italy
| | - A Vanzulli
- Niguarda Ca" Granda Hospital, Radiology, Milan, Italy
| | - P Pedrotti
- Niguarda Ca" Granda Hospital, Angelo De Gasperis, Department of Cardiovascular , Milan, Italy
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22
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Pedrotti P, Luongo A, Masciocco G, Sormani P, Milazzo A, Quattrocchi G, Giannattasio C, Frigerio M, Rimoldi O. 252Tissue characterization indices and global longitudinal strain derived from early CMR scan 1 year after cardiac transplantation predict all-cause mortality and MACE. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez120.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Pedrotti
- Niguarda Ca" Granda Hospital, Cardiovascular Department, Milan, Italy
| | - A Luongo
- Niguarda Ca" Granda Hospital, Cardiovascular Department, Milan, Italy
| | - G Masciocco
- Niguarda Ca" Granda Hospital, Cardiovascular Department, Milan, Italy
| | - P Sormani
- Niguarda Ca" Granda Hospital, Cardiovascular Department, Milan, Italy
| | - A Milazzo
- Niguarda Ca" Granda Hospital, Cardiovascular Department, Milan, Italy
| | - G Quattrocchi
- Niguarda Ca" Granda Hospital, Cardiovascular Department, Milan, Italy
| | - C Giannattasio
- Niguarda Ca" Granda Hospital, Cardiovascular Department, Milan, Italy
| | - M Frigerio
- Niguarda Ca" Granda Hospital, Cardiovascular Department, Milan, Italy
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23
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Sormani P, Ammirati E, Moro C, Raineri C, Cipriani M, Veronese G, D" Elia S, Quattrocchi G, Milazzo A, Maestroni A, Giannattasio C, Frigerio M, Oliva F, Camici PG, Pedrotti P. P452Prognostic performance of clinical presentation and cardiac magnetic resonance ejection fraction and late enhancement pattern at basal examination in acute myocarditis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Sormani
- Niguarda Ca" Granda Hospital, De Gasperis Cardio Center, Milan, Italy
| | - E Ammirati
- Niguarda Ca" Granda Hospital, De Gasperis Cardio Center, Milan, Italy
| | - C Moro
- Desio Hospital, Cardiology, Desio, Italy
| | - C Raineri
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | - M Cipriani
- Niguarda Ca" Granda Hospital, De Gasperis Cardio Center, Milan, Italy
| | - G Veronese
- University of Milan-Bicocca, Milan, Italy
| | - S D" Elia
- Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - G Quattrocchi
- Niguarda Ca" Granda Hospital, De Gasperis Cardio Center, Milan, Italy
| | - A Milazzo
- Niguarda Ca" Granda Hospital, De Gasperis Cardio Center, Milan, Italy
| | - A Maestroni
- Busto Arsizio Hospital, Busto Arsizio, Italy
| | | | - M Frigerio
- Niguarda Ca" Granda Hospital, De Gasperis Cardio Center, Milan, Italy
| | - F Oliva
- Niguarda Ca" Granda Hospital, De Gasperis Cardio Center, Milan, Italy
| | - P G Camici
- Vita Salute University and San Raffaele Hospital, Milan, Italy
| | - P Pedrotti
- Niguarda Ca" Granda Hospital, De Gasperis Cardio Center, Milan, Italy
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Torlasco C, Mollica C, Cassinerio E, Ruffino E, Milazzo A, Quattrocchi G, Sormani P, Abdel-Gadir A, Giannattasio C, Parati G, Cappellini MD, Moon JC, Pedrotti P. P426Left atrial size and function assessment through CMR in thalassemia major patients. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Torlasco
- IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - C Mollica
- IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - E Cassinerio
- IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E Ruffino
- IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - A Milazzo
- Niguarda Ca" Granda Hospital, Milan, Italy
| | | | - P Sormani
- Niguarda Ca" Granda Hospital, Milan, Italy
| | - A Abdel-Gadir
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | | | - G Parati
- IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - M D Cappellini
- IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - J C Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - P Pedrotti
- Niguarda Ca" Granda Hospital, Milan, Italy
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Rahaman MR, Milazzo A, Marshall H, Bi P. Is a One Health Approach Utilized for Q Fever Control? A Comprehensive Literature Review. Int J Environ Res Public Health 2019; 16:E730. [PMID: 30823481 PMCID: PMC6427780 DOI: 10.3390/ijerph16050730] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 02/07/2023]
Abstract
Q fever, a zoonotic disease transmitted from animals to humans, is a significant public health problem with a potential for outbreaks to occur. Q fever prevention strategies should incorporate human, animal, and environmental domains. A One Health approach, which engages cross-sectoral collaboration among multiple stakeholders, may be an appropriate framework and has the underlying principles to control Q fever holistically. To assess whether components of One Health for Q fever prevention and control have been applied, a comprehensive literature review was undertaken. We found 16 studies that had practiced or recommended a One Health approach. Seven emerging themes were identified: Human risk assessment, human and animal serology, integrated human⁻animal surveillance, vaccination for at-risk groups, environmental management, multi-sectoral collaboration, and education and training. Within the multi-sectoral theme, we identified five subthemes: Policy and practice guidelines, information sharing and intelligence exchange, risk communication, joint intervention, and evaluation. One Health practices varied between studies possibly due to differences in intercountry policy, practice, and feasibility. However, the key issue of the need for multi-sectoral collaboration was highlighted across most of the studies. Further research is warranted to explore the barriers and opportunities of adopting a One Health approach in Q fever prevention and control.
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Affiliation(s)
- Md Rezanur Rahaman
- School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Helen Marshall
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia.
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Bollero P, Danesi C, Ricchiuti MR, Milazzo A, Mampieri G, Agrestini C, Mucedero M. Long-term periodontal status of palatally and buccally impacted canines after closed surgical-orthodontic approach. Oral Implantol (Rome) 2018; 10:162-171. [PMID: 29876041 DOI: 10.11138/orl/2017.10.2.162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The aim of this study is to evaluate the periodontal status of palatally and buccally impacted canines exposed with closed technique, and to compare them with the controlateral canines that served as control teeth as well as to compare them each other. Methods 28 patients, 14 with unilateral palatally impacted canines and 14 with unilateral buccally impacted canines comprised the subjects of the study. Mean recall observational period was 2 years 4 months ± 1 year 1 month. Closed eruption technique without the tunnel was performed to expose both the palatally and the buccally impacted canines. Six periodontal variables were considered: probing pocket depth (PPD); width of keratinized tissue (KT); gingival thickness (GT); plaque index (PI); gingival bleeding index (GBI); gingival recession (REC). Results Palatally impacted canines exhibited significant greater PPD on the mesiolingual site compared to their controlaterals (P<0.05). Buccally impacted canines had significant increased KT compared to their contralaterals (P<0.05). Palatally impacted canines had significant greater PPD on the midbuccal site and on all the palatal sites when compared to the buccally impacted canines (P<0.05). Conclusion The changes observed in the periodontal status of impacted canines, although statistically significant, did not reach clinical significance.
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Affiliation(s)
- P Bollero
- Department of Systems Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - C Danesi
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - M R Ricchiuti
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - A Milazzo
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - G Mampieri
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - C Agrestini
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - M Mucedero
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
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Baroni M, Nava S, Quattrocchi G, Milazzo A, Giannattasio C, Roghi A, Pedrotti P. Role of cardiovascular magnetic resonance in suspected cardiac amyloidosis: late gadolinium enhancement pattern as mortality predictor. Neth Heart J 2017; 26:34-40. [PMID: 29058206 PMCID: PMC5758446 DOI: 10.1007/s12471-017-1046-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) has gained a central role in the diagnosis of cardiac amyloidosis (CA). While the diagnostic role of a typical late gadolinium enhancement (LGE) pattern (global subendocardial enhancement coupled with accelerated contrast washout) has been identified, evidence is still conflicting regarding the prognostic role of such examination. METHODS AND RESULTS We retrospectively analysed all patients referring for CMR at Niguarda Hospital (Milan, Italy) from January 2006 to January 2015 for suspected CA. Primary outcome was all-cause mortality. We identified 42 patients and divided them into 2 groups, according to the presence (Group A) or absence (Group B) of a typical amyloidosis LGE pattern. At the end of the follow-up (median 37 months, interquartile range 10-50 months), 31 patients (74%) had died. The hazard ratio for all-cause death was 3.2 (95% confidence interval [CI] 1.5-6.4, p < 0.01) for Group A versus Group B. Median survival time was 17 months (95% CI 7-42 months) for Group A and 70 months (95% CI 49-94 months) for Group B (p < 0.01). Multivariate analysis did not find any adjunctive predictive role for biventricular volumes and ejection fraction, indexed left ventricular mass, transmitral E/e' at echocardiography, age at diagnosis or serum creatinine. CONCLUSION In our population, a typical LGE pattern was significantly associated with higher mortality. Moreover, patients with a typical LGE pattern showed a globally worse prognosis. Our data suggest that the LGE pattern may play a central role in prognostic stratification of patients with suspected CA, thus prompting further diagnostic and therapeutic measures.
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Affiliation(s)
- M Baroni
- Cardiologia 3, A. De' Gasperis Heart Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
| | - S Nava
- Cardiologia 1, A. De' Gasperis Heart Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - G Quattrocchi
- Cardiologia 4, A. De' Gasperis Heart Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - A Milazzo
- Cardiologia 4, A. De' Gasperis Heart Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - C Giannattasio
- Cardiologia 4, A. De' Gasperis Heart Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.,Health Science Department, Bicocca University, Milano, Italy
| | - A Roghi
- Cardiologia 4, A. De' Gasperis Heart Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - P Pedrotti
- Cardiologia 4, A. De' Gasperis Heart Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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Pedrotti P, Campadello P, Masciocco G, Facchetti R, Milazzo A, Quattrocchi G, Gagliardone M, Russo C, Giannattasio C, Frigerio M. Cytomegalovirus Infection and Rejection May Cause Myocardial Tissue Alterations Detectable at Cardiac Magnetic Resonance at One Year Follow-Up After Heart Transplant. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Milazzo A, Giles LC, Zhang Y, Koehler AP, Hiller JE, Bi P. Factors Influencing Knowledge, Food Safety Practices and Food Preferences During Warm Weather of Salmonella and Campylobacter Cases in South Australia. Foodborne Pathog Dis 2017; 14:125-131. [PMID: 28045552 DOI: 10.1089/fpd.2016.2201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess food safety practices, food shopping preferences, and eating behaviors of people diagnosed with Salmonella or Campylobacter infection in the warm seasons, and to identify socioeconomic factors associated with behavior and practices. METHODS A cross-sectional survey was conducted among Salmonella and Campylobacter cases with onset of illness from January 1 to March 31, 2013. Multivariable logistic regression analyses examined relationships between socioeconomic position and food safety knowledge and practices, shopping and food preferences, and preferences, perceptions, and knowledge about food safety information on warm days. RESULTS Respondents in our study engaged in unsafe personal and food hygiene practices. They also carried out unsafe food preparation practices, and had poor knowledge of foods associated with an increased risk of foodborne illness. Socioeconomic position did not influence food safety practices. We found that people's reported eating behaviors and food preferences were influenced by warm weather. CONCLUSIONS Our study has explored preferences and practices related to food safety in the warm season months. This is important given that warmer ambient temperatures are projected to rise, both globally and in Australia, and will have a substantial effect on the burden of infectious gastroenteritis including foodborne disease. Our results provide information about modifiable behaviors for the prevention of foodborne illness in the household in the warm weather and the need for information to be disseminated across the general population. An understanding of the knowledge and factors associated with human behavior during warmer weather is critical for public health interventions on foodborne prevention.
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Affiliation(s)
- Adriana Milazzo
- 1 School of Public Health, The University of Adelaide , Adelaide, South Australia, Australia
| | - Lynne C Giles
- 1 School of Public Health, The University of Adelaide , Adelaide, South Australia, Australia
| | - Ying Zhang
- 1 School of Public Health, The University of Adelaide , Adelaide, South Australia, Australia .,2 School of Public Health, The University of Sydney , Sydney, New South Wales, Australia
| | - Ann P Koehler
- 3 Communicable Disease Control Branch , Department for Health and Ageing, Adelaide, South Australia, Australia
| | - Janet E Hiller
- 1 School of Public Health, The University of Adelaide , Adelaide, South Australia, Australia .,4 School of Health Sciences, Swinburne University of Technology , Melbourne, Victoria, Australia
| | - Peng Bi
- 1 School of Public Health, The University of Adelaide , Adelaide, South Australia, Australia
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Milazzo A, Mnatzaganian G, Elshaug AG, Hemphill SA, Hiller JE. Depression and Anxiety Outcomes Associated with Failed Assisted Reproductive Technologies: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0165805. [PMID: 27835654 PMCID: PMC5106043 DOI: 10.1371/journal.pone.0165805] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 10/18/2016] [Indexed: 11/18/2022] Open
Abstract
Objective Our study examined the psychological outcomes associated with failed ART treatment outcomes in men and women. Search Strategy A systematic search for studies published between January 1980 and August 2015 was performed across seven electronic databases. Inclusion Criteria Studies were included if they contained data on psychosocial outcomes taken pre and post ART treatment. Data Extraction and Synthesis A standardised form was used to extract data and was verified by two independent reviewers. Studies were meta-analysed to determine the association of depression and anxiety with ART treatment outcomes. Narrative synthesis identified factors to explain variations in the size and directions of effects and relationships explored within and between the studies. Main Results Both depression and anxiety increased after a ART treatment failure with an overall pooled standardised mean difference (SMD) of 0.41 (95% CI: 0.27, 0.55) for depression and 0.21 (95% CI: 0.13, 0.29) for anxiety. In contrast, depression decreased after a successful treatment, SMD of -0.24 (95% CI: -0.37,-0.11). Both depression and anxiety decreased as time passed from ART procedure. Nonetheless, these remained higher than baseline measures in the group with the failed outcome even six months after the procedure. Studies included in the narrative synthesis also confirmed an association with negative psychological outcomes in relation to marital satisfaction and general well-being following treatment failure. Conclusion Linking ART failure and psychosocial outcomes may elucidate the experience of treatment subgroups, influence deliberations around recommendations for resource allocation and health policy and guide patient and clinician decision making.
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Affiliation(s)
- Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - George Mnatzaganian
- College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia
| | - Adam G. Elshaug
- Menzies Centre for Health Policy, The University of Sydney, Sydney, New South Wales, Australia
| | - Sheryl A. Hemphill
- Learning Sciences Institute Australia, Faculty of Education and Arts, Australian Catholic University, Melbourne, Victoria, Australia
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Janet E. Hiller
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria Australia
- * E-mail:
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Milazzo A, Giles LC, Zhang Y, Koehler AP, Hiller JE, Bi P. Heatwaves differentially affect risk of Salmonella serotypes. J Infect 2016; 73:231-40. [PMID: 27317378 DOI: 10.1016/j.jinf.2016.04.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/05/2016] [Accepted: 04/20/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Given increasing frequency of heatwaves and growing public health concerns associated with foodborne disease, we examined the relationship between heatwaves and salmonellosis in Adelaide, Australia. METHODS Poisson regression analysis with Generalised Estimating Equations was used to estimate the effect of heatwaves and the impact of intensity, duration and timing on salmonellosis and specific serotypes notified from 1990 to 2012. Distributed lag non-linear models were applied to assess the non-linear and delayed effects of temperature during heatwaves on Salmonella cases. RESULTS Salmonella typhimurium PT135 notifications were sensitive to the effects of heatwaves with a twofold (IRR 2.08, 95% CI 1.14-3.79) increase in cases relative to non-heatwave days. Heatwave intensity had a significant effect on daily counts of overall salmonellosis with a 34% increase in risk of infection (IRR 1.34, 95% CI 1.01-1.78) at >41 °C. The effects of temperature during heatwaves on Salmonella cases and serotypes were found at lags of up to 14 days. CONCLUSION This study confirms heatwaves have a significant effect on Salmonella cases, and for the first time, identifies its impact on specific serotypes and phage types. These findings will contribute to the understanding of the impact of heatwaves on salmonellosis and provide insights that could mitigate their impact.
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Affiliation(s)
- Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, 5000, South Australia, Australia.
| | - Lynne C Giles
- School of Public Health, The University of Adelaide, Adelaide, 5000, South Australia, Australia.
| | - Ying Zhang
- School of Public Health, The University of Adelaide, Adelaide, 5000, South Australia, Australia; School of Public Health, The University of Sydney, Sydney, 2006, New South Wales, Australia.
| | - Ann P Koehler
- Communicable Disease Control Branch, Department for Health and Ageing, Adelaide, 5000, South Australia, Australia.
| | - Janet E Hiller
- School of Public Health, The University of Adelaide, Adelaide, 5000, South Australia, Australia; School of Health Sciences, Swinburne University of Technology, Melbourne, 3122, Victoria, Australia.
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, 5000, South Australia, Australia.
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Milazzo A, Giles L, Zhang Y, Koehler A, Hiller JE, Bi P. Food Safety during Hot Weather: Knowledge and Practices of Salmonella and Campylobacter cases in South Australia. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv097.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rimoldi O, Pedrotti P, Milazzo A, Quattrocchi G, Roghi A. Myocardial tissue characterization using magnetic resonance T1 mapping in normal phenotype and hypertrophic cardiomyopathy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pedrotti P, Masciocco G, D'Angelo L, Milazzo A, Quattrocchi G, Frigerio M, Roghi A, Rimoldi O. Cardiac magnetic resonance T1 mapping pre and post contrast characterizes the myocardium in orthotopic heart transplantation recipients without active rejection. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.4662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pedrotti P, Milazzo A, Quattrocchi G, Roghi A, Rimoldi O. 1013Myocardial tissue characterization using T1 mapping in
normals, phenotype negative relatives and hypertrophic cardiomyopathy
patients. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet070bi] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pedrotti P, Masciocco G, D'Angelo L, Milazzo A, Quattrocchi G, Zanotti F, Frigerio M, Roghi A, Rimoldi O. 939CMR T1 Mapping Pre And Post Contrast Characterizes The
Myocardium In Heart Transplantat Recipients Without Rejection. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet070c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Milazzo A, Featherstone KB, Hall RG. Q fever vaccine uptake in South Australian meat processors prior to the introduction of the National Q Fever Management Program. Commun Dis Intell Q Rep 2005; 29:400-6. [PMID: 16465932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Despite the availability of a vaccine, the incidence of Q fever disease among populations at risk continues to be high. Q fever is an important cause of morbidity for workers, particularly in the meat and agricultural industries. Following an increase in 1998 in the number of Q fever notifications among meat processors to the Communicable Disease Control Branch, South Australia, a survey was conducted in the same year to assess the uptake of Q fever immunisation programs in meat processors and to identify barriers to offering these programs. This survey was conducted prior to the introduction of the National Q Fever Management Program in 2001 that provided a targeted vaccination program to specific at-risk occupations. The results of the survey highlighted that very few meat processors in South Australia offered a Q fever immunisation program to their workers. More importantly, this article highlights that there was a wide variety of attitudes and beliefs about Q fever disease and its prevention. These attitudes and beliefs have the potential to impact on whether workers at risk are offered or seek Q fever vaccination. Previous attitudes may return and levels of protection in at-risk occupations will decrease without a concerted effort at a state level. A replication of this study should benchmark the prevailing attitudes about Q fever programs. In response to the 1998 survey a number of strategies and initiatives were developed to address the barriers to Q fever vaccination in South Australian meat processors. The National Q Fever Management Program (2001-2005) further enhanced the ability to address barriers such as vaccine cost.
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Affiliation(s)
- Adriana Milazzo
- Communicable Disease Control Branch, Department of Health, Adelaide, South Australia.
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Bennett CM, Dalton C, Beers-Deeble M, Milazzo A, Kraa E, Davos D, Puech M, Tan A, Heuzenroeder MW. Fresh garlic: a possible vehicle for Salmonella Virchow. Epidemiol Infect 2004; 131:1041-8. [PMID: 14959768 PMCID: PMC2870050 DOI: 10.1017/s0950268803001158] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A sustained increase in Salmonella enterica serovar Virchow notifications in South Eastern Australia between September 1997 and May 1998 instigated a case-control study and environmental investigations. Cases were defined as having locally acquired culture-confirmed S. Virchow phage-type 8 infection and diarrhoeal disease. Matched controls were selected by progressive digit dialling based on cases' telephone numbers. An exposure and food history questionnaire was administered by telephone. Phage typing and pulse field gel electrophoresis were performed on case and environmental isolates. Thirty-two notifications of S. Virchow infection met the case definition, 37% reported bloody diarrhoea and S. Virchow was isolated from blood in 13% of cases. Twelve patients were admitted to hospital and one died. Fresh garlic (OR 4.1, 95% CI 1.3-12.8) and semi-dried tomatoes (OR 12.6, 95% CI 1.5-103.1) were associated with these cases. The associations remained significant after adjusting for sex and age. S. Virchow (PT 8) was cultured from two brands of semi-dried tomatoes associated with cases in two different states. We provide sufficient evidence for semi-dried tomatoes and fresh garlic to be considered as potential risk foods in future Salmonella outbreak investigations.
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Affiliation(s)
- C M Bennett
- Master of Applied Epidemiology Program, National Centre for Epidemiology and Population Health, Australian Capital Territory
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Fielding JE, Snell P, Milazzo A, Del Fabbro L, Raupach J. An outbreak of Salmonella typhimurium phage type 4 linked to cold set cheesecake. Commun Dis Intell Q Rep 2003; 27:513-4. [PMID: 15508507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- James E Fielding
- Communicable Disease Control Branch, Department of Human Services, Adelaide, South Australia.
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Milazzo A, Tribe IG, Ratcliff R, Doherty C, Higgins G, Givney R. A large, prolonged outbreak of human calicivirus infection linked to an aged-care facility. Commun Dis Intell Q Rep 2002; 26:261-4. [PMID: 12206380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
This report investigates an outbreak of acute gastrointestinal illness, microbiologically and epidemiologically linked to an aged-care facility and seeks to determine if there was a point source of infection. A register of cases that included onset date and time of illness and symptoms was maintained by nursing staff. Faecal specimens were tested for conventional gastrointestinal pathogens and for human calicivirus (HuCV). There were 81 cases reported. Specimens were received for testing from 25 cases. Twenty-three of the 25 (92%) specimens were positive for HuCV RNA by reverse transcriptase polymerase chain reaction (RT-PCR). The 2 negative samples contained RT-PCR inhibitors. Descriptive epidemiology suggested that staffing practices were important in prolonging the outbreak. No point source of infection was identified. Instead environmental contamination, aerosol transmission and work practices that fail to take account of the natural history of HuCV infection probably contributed to the size (81 cases) and duration (3 weeks) of this outbreak among the residents, staff and visitors of an aged-care facility and their contacts. Institutional outbreaks caused by HuCV, formerly called Norwalk-like or small round structured viruses, are extremely difficult to control. Infected staff may contribute significantly to the amplification of outbreaks. Rapid confirmation of HuCV infection is now routinely possible using polymerase chain reaction diagnostics but progress in laboratory technology has not yet translated into faster or more effective interventions.
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Milazzo A, Hall R, Storm PA, Harris RJ, Winslow W, Marmion BP. Sexually transmitted Q fever. Clin Infect Dis 2001; 33:399-402. [PMID: 11438911 DOI: 10.1086/321878] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2000] [Revised: 11/28/2000] [Indexed: 11/03/2022] Open
Abstract
We report the sexual transmission of Coxiella burnetii from a man with occupationally acquired Q fever to his wife. Fifteen days after coitus, his wife also developed serologically proven acute Q fever. C. burnetii DNA sequences were detected by polymerase chain reaction (PCR) performed on semen samples obtained from the husband at 4 and 15 months after the onset of acute Q fever, but PCR results were variable at 23 months, indicating the presence of few organisms.
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Affiliation(s)
- A Milazzo
- Communicable Disease Control Branch, Department of Human Services, University of Adelaide, Adelaide, South Australia 5000
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Milazzo A. Nursery songs. Pharos Alpha Omega Alpha Honor Med Soc 2001; 64:40-1. [PMID: 11258023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- A Milazzo
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, USA
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Milazzo A, Rose N. An outbreak of Salmonella Typhimurium phage type 126 linked to a cake shop in South Australia. Commun Dis Intell Q Rep 2001; 25:73. [PMID: 11432533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- A Milazzo
- Communicable Disease Control Branch, Department of Human Services, South Australia
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Milazzo A. An outbreak of Salmonella typhimurium RDNC A047 linked to a Chinese restaurant in South Australia. Commun Dis Intell (2018) 2000; 24:347. [PMID: 11190818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Pezzano A, Fusco R, Child M, Riccobono S, Milazzo A, Recalcati F, Savonitto S. Assessment of left internal mammary artery grafts using dipyridamole Doppler echocardiography. Am J Cardiol 1997; 80:1603-6. [PMID: 9416946 DOI: 10.1016/s0002-9149(97)00775-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Color Doppler echocardiography of the left mammary artery was combined with dipyridamole testing in order to assess the presence of significant (>70%) graft stenosis in 87 patients with a mammary artery graft to the left anterior descending coronary artery presenting with chest pain. Occluded grafts are detected by absent diastolic flow velocities at baseline, whereas the response of the diastolic flow velocity to dipyridamole distinguishes patients with critical versus noncritical stenosis of a patent graft.
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Affiliation(s)
- A Pezzano
- Cardiology Department A. De Gasperis, Niguarda Ca' Granda Hospital, Milan, Italy
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46
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Coyle P, Krupp L, Doscher C, Zhidian Deng, Milazzo A. Clinical and Immunological Effects of Cooling in Multiple Sclerosis. Neurorehabil Neural Repair 1996. [DOI: 10.1177/154596839601000102] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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47
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Pezzano A, Cali G, Milazzo A, Fusco R, de Pieri G, Faletra F, Pezzano A. Transthoracic 2D echo color Doppler assessment of internal mammary artery to left anterior descending coronary artery graft. Int J Card Imaging 1995; 11:177-84. [PMID: 7499907 DOI: 10.1007/bf01143107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
For noninvasive evaluation of anatomy and flow characteristics of internal mammary artery graft (IMA-graft), 2D echo-Color-Doppler (CDE) was performed in 60 patients (54 M, 6 F, mean age 54.1 +/- 6.9 y), who underwent coronary angiography 20.1 +/- 13 months after a coronary artery bypass graft (CABG). CDE was performed, using an echocardiographic unit equipped with a 5 MHz linear transducer. In all patients, measurements of IMA-graft diameter (mm), and peak systolic and diastolic flow velocity (cm/sec) were obtained at baseline and also in 16 patients after dipyridamole infusion (0.54 mg/Kg/min) and in 10 patients after sublingual nitroglycerin (NTG) (0.4 mg). Angiography showed the IMA-graft patency in 58/60 patients (96.8%). A typical biphasic flow was displayed by CDE in 49/58 patients (84.4%) with angiographic patency. Dipyridamole infusion increased both IMA-graft diameter and peak diastolic flow velocity (PDFV) from 2.28 +/- 0.51mm to 2.9 +/- 0.42mm and from 19.4 +/- 6.2 cm/sec to 93.9 +/- 29 cm/sec, respectively (p < 0.0001). No significant modifications of peak systolic flow velocity (PSFV) were observed. NTG increased PDFV from 29.11 +/- 8 cm/sec to 41.88 +/- 7.20 cm/sec (p < 0.005), while diameter and PSFV showed no statistically significant modifications. CDE is a useful diagnostic tool for noninvasive evaluation of IMA-graft patency both early after surgery and during long-term follow-up. CDE pharmacological stress improves the sensibility of the technique and it can provide indirect information about pathophysiology of recipient coronary vessel.
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Affiliation(s)
- A Pezzano
- Department of Cardiology De Gasperis, Niguarda Hospital, Milan, Italy
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48
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Faletra F, Corno R, De Chiara F, Marcotegui M, Mantero A, Fusco R, Milazzo A, Pezzano A. [Multiplane transesophageal echocardiography. The experience with 250 patients]. G Ital Cardiol 1995; 25:315-25. [PMID: 7642037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Multiplane transesophageal echocardiography provides countless tomographic planes through an angle of 180 degrees, thus overcoming the restriction encountered even with biplane transesophageal echocardiography. However, the incremental diagnostic value and clinical usefulness of this technique over biplane transesophageal echocardiography has not been extensively studied. STUDY POPULATION AND METHODS In order to evaluate its advantages over biplane imaging, 250 patients (129 male, 121 females) aged 14-86 years, underwent multiplane transesophageal echocardiography. Indications for the study were the following: source of embolism in 83 patients, suspected prosthetic dysfunction in 58 patients, valvular disease in 46 patients, congenital heart disease in 30 patients, aortic disease in 17 patients, intra- or paracardiac masses in 11 patients, and other reasons in 5. All the patients underwent an initial comprehensive diagnostic assessment using only the transverse (0 degree) and longitudinal (90 degrees) plane as the biplane imaging technique. "Off-axis" tomographic sections through the full 0 degree to 180 degrees angle were subsequently obtained by means of the gradual electrical rotation of the transducer. The echocardiographic information obtained by rotating the transducer was then compared to that obtained by biplane imaging to determine whether the additional information provided by "off-axis" sections a) carried diagnostic data; b) were to be considered useful but not diagnostic; or c) irrelevant. RESULTS Additional diagnostic information was obtained in 24 out of the 250 patients (9.6%), including the source of embolism in 9 patients, mitral insufficiency in 6 patients, bicuspid aorta in 2 patients, aortic endocarditis in 2 patients, mitral prosthetic dysfunction in 4 patients and complex congenital heart disease in 1 patient. Additional useful but non-diagnostic information was obtained in 162 patients (64.8%). These data mainly allowed a more comprehensive assessment of the cardiac abnormality, enhancing confidence in the transesophageal diagnosis. Finally, data considered to be irrelevant were found in 64 patients (25.6%). CONCLUSIONS The present study indicates that the wide range of tomographic planes provided by multiplane transesophageal echocardiography allows a more comprehensive evaluation of cardiac diseases and makes an accurate diagnosis possible in a significant number of cases.
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Affiliation(s)
- F Faletra
- Dipartimento Cardiologico A. de Gasperis, Ospedale Niguarda, Milano
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Antón F, Labarga P, Pinilla J, Soto MJ, Leoz A, del Cura J, Borque L, Milazzo A. [Lymphocyte subpopulations, neopterin, and beta-2-microglobulin: relationship with clinical stage, risk of progression to AIDS and presence of active infection in HIV infection]. Enferm Infecc Microbiol Clin 1993; 11:373-7. [PMID: 8104488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate the relation between the number of CD4 lymphocytes, the CD4/CD8 ratio and the plasma levels of neopterin and beta-2 microglobulin, and the clinical status, risk of progression without of active opportunistic infections, among HIV-infected patients. METHODS Seventy-two patients infected by HIV in different clinical groups were evaluated upon entering the study and following a mean follow up of 6 months for the parameters studied. RESULTS The values of CD4 lymphocytes and neopterin were related with the clinical status according to the CDC's classification, with no significant differences existing in the beta-2 microglobulin level. The CD4 count as well as the neopterin and the beta-2 microglobulin levels differed significantly when classified to the patients with regard to the risk of progression to AIDS throughout the study. The presence of active opportunistic infections was related with significantly higher concentrations of neopterin without differences recorded for the remaining parameters. CONCLUSIONS The parameters studied are good markers or both clinical status and/or the risk of short-term progression to AIDS. Neopterin levels are high during acute infections. Therefore, its prognostic value should be cautiously evaluated in this situation.
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Affiliation(s)
- F Antón
- Sección de Medicina Interna, Central Hospital San Millán INSALUD, Logroño
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Pinilla J, Gimeno C, Gómez A, Antón F, Labarga P, Campos C, Gil A, Milazzo A. [Clinico-epidemiological study of botulism poisoning in La Rioja (1979-1990)]. Enferm Infecc Microbiol Clin 1993; 11:202-5. [PMID: 8512973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate botulinic poisoning requiring hospital admission in La Rioja (Spain) during one decade from a clinical-epidemiologic point of view. METHODS Chart records from patients admitted to the departments of Internal Medicine, Neurology, the ICU, and the Neurophysiology and Preventive Medicine files of the reference hospital between 1979 and 1990 were retrospectively reviewed. RESULTS Fifteen cases were identified. Home preserves of vegetables were most frequently the foods responsible for the poisoning. The presentation as a sole case constituted half of this series. The most frequent symptomatology was neuro-ophthalmologic and digestive. All the cases were type B. Neurophysiologic studies were compatible with the diagnosis in all the cases in which they were performed. Two cases (13.3%) required intensive care and death occurred in one (6.6%). CONCLUSIONS a) The habit of home preserves was responsible for the presentation of botulism in this environment. b) Early diagnosis was based on complementary clinical tests together with the neurophysiologic study. c) The mild forms were most frequent. Death in this series was 6.6%.
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Affiliation(s)
- J Pinilla
- Secciones de Medicina Interna I y III, Complejo Hospitalario San Millán-San Pedro, Logroño
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