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Kendall S, Lighton S, Sherwood J, Baldry E, Sullivan EA. Incarcerated aboriginal women's experiences of accessing healthcare and the limitations of the 'equal treatment' principle. Int J Equity Health 2020; 19:48. [PMID: 32245479 PMCID: PMC7118909 DOI: 10.1186/s12939-020-1155-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Colonization continues in Australia, sustained through institutional and systemic racism. Targeted discrimination and intergenerational trauma have undermined the health and wellbeing of Australia’s Aboriginal and Torres Strait Islander population, leading to significantly poorer health status, social impoverishment and inequity resulting in the over-representation of Aboriginal people in Australian prisons. Despite adoption of the ‘equal treatment’ principle, on entering prison in Australia entitlements to the national universal healthcare system are revoked and Aboriginal people lose access to health services modelled on Aboriginal concepts of culturally safe healthcare available in the community. Incarcerated Aboriginal women experience poorer health outcomes than incarcerated non-Indigenous women and Aboriginal men, yet little is known about their experiences of accessing healthcare. We report the findings of the largest qualitative study with incarcerated Aboriginal women in New South Wales (NSW) Australia in over 15 years. Methods We employed a decolonizing research methodology, ‘community collaborative participatory action research’, involving consultation with Aboriginal communities prior to the study and establishment of a Project Advisory Group (PAG) of community expert Aboriginal women to guide the project. Forty-three semi-structured interviews were conducted in 2013 with Aboriginal women in urban and regional prisons in NSW. We applied a grounded theory approach for the data analysis with guidance from the PAG. Results Whilst Aboriginal women reported positive and negative experiences of prison healthcare, the custodial system created numerous barriers to accessing healthcare. Aboriginal women experienced institutional racism and discrimination in the form of not being listened to, stereotyping, and inequitable healthcare compared with non-Indigenous women in prison and the community. Conclusions ‘Equal treatment’ is an inappropriate strategy for providing equitable healthcare, which is required because incarcerated Aboriginal women experience significantly poorer health. Taking a decolonizing approach, we unpack and demonstrate the systems level changes needed to make health and justice agencies culturally relevant and safe. This requires further acknowledgment of the oppressive transgenerational effects of ongoing colonial policy, a true embracing of diversity of worldviews, and critically the integration of Aboriginal concepts of health at all organizational levels to uphold Aboriginal women’s rights to culturally safe healthcare in prison and the community.
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Affiliation(s)
- S Kendall
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Broadway, 2007, Australia
| | - S Lighton
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Broadway, 2007, Australia
| | - J Sherwood
- Faculty of Medicine and Health, The University of Sydney, Sydney, 2006, Australia
| | - E Baldry
- School of Social Sciences, UNSW Sydney, Sydney, 2052, Australia
| | - E A Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Broadway, 2007, Australia. .,Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.
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Sullivan EA, Vaughan G, Li Z, Peek MJ, Carapetis JR, Walsh W, Frawley J, Rémond MGW, Remenyi B, Jackson Pulver L, Kruske S, Belton S, McLintock C. The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high‐income setting: a prospective cohort study. BJOG 2019; 127:47-56. [DOI: 10.1111/1471-0528.15938] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2019] [Indexed: 12/19/2022]
Affiliation(s)
- EA Sullivan
- Faculty of Health and Medicine The University of Newcastle Newcastle NSW Australia
- Australian Centre for Public and Population Health Research Faculty of Health University of Technology Sydney Sydney NSW Australia
| | - G Vaughan
- Australian Centre for Public and Population Health Research Faculty of Health University of Technology Sydney Sydney NSW Australia
| | - Z Li
- Australian Centre for Public and Population Health Research Faculty of Health University of Technology Sydney Sydney NSW Australia
| | - MJ Peek
- ANU Medical School College of Health and Medicine The Australian National University Canberra ACT Australia
| | - JR Carapetis
- Telethon Kids InstituteThe University of Western Australia Perth WA Australia
- Perth Children's Hospital Perth WA Australia
| | - W Walsh
- The University of New South Wales Sydney NSW Australia
- Prince of Wales Hospital Sydney NSW Australia
| | - J Frawley
- Australian Centre for Public and Population Health Research Faculty of Health University of Technology Sydney Sydney NSW Australia
| | - MGW Rémond
- Australian Centre for Public and Population Health Research Faculty of Health University of Technology Sydney Sydney NSW Australia
| | - B Remenyi
- Menzies School of Health Research Charles Darwin University Darwin NT Australia
| | | | - S Kruske
- The University of Queensland Brisbane Qld Australia
- Institute for Urban Indigenous Health Ltd Brisbane Qld Australia
| | - S Belton
- Menzies School of Health Research Charles Darwin University Darwin NT Australia
| | - C McLintock
- National Women's Health Auckland City Hospital Auckland New Zealand
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Li Z, Wang AY, Bowman M, Hammarberg K, Farquhar C, Johnson L, Safi N, Sullivan EA. Cumulative live birth rates following a 'freeze-all' strategy: a population-based study. Hum Reprod Open 2019; 2019:hoz004. [PMID: 30895269 PMCID: PMC6400239 DOI: 10.1093/hropen/hoz004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 09/09/2018] [Revised: 12/07/2018] [Accepted: 02/07/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the cumulative live birth rate following a ‘freeze-all’ strategy compared with a ‘fresh-transfer’ strategy? SUMMARY ANSWER The ‘freeze-all’ strategy resulted in a similar cumulative live birth rate as the ‘fresh-transfer’ strategy among high responders (>15 oocytes retrieved) but did not benefit normal (10–15 oocytes) and suboptimal responders (<10 oocytes). WHAT IS KNOWN ALREADY Frozen-thawed embryo transfer is associated with a decreased risk of adverse obstetric and perinatal outcomes compared with fresh embryo transfer. It is unclear whether the ‘freeze-all’ strategy should be offered to all women undergoing ART treatment. STUDY DESIGN, SIZE, DURATION A population-based retrospective cohort study using data collected by the Victorian Assisted Reproductive Treatment Authority. This study included 14 331 women undergoing their first stimulated ART cycle with at least one oocyte fertilised between 1 July 2009 and 30 June 2014 in Victoria, Australia. Demographic characteristics, type of ART procedures and resulting pregnancy and birth outcomes were recorded for the stimulated cycle and associated thaw cycles until 30 June 2016, or until a live birth was achieved, or until all embryos from the stimulated cycle had been used. PARTICIPANTS/MATERIALS, SETTING, METHODS Women were grouped by whether they had undergone the ‘freeze-all’ strategy (n = 1028) where all embryos were cryopreserved for future transfer, or the ‘fresh-transfer’ strategy (n = 13 303) where selected embryo(s) were transferred in the stimulated cycle, and remaining embryo(s) were cryopreserved for future use. A discrete-time survival model was used to evaluate the cumulative live birth rate following ‘freeze-all’ and ‘fresh-transfer’ strategy. MAIN RESULTS AND THE ROLE OF CHANCE A total of 1028 women undergoing ‘freeze-all’ strategy and 13 303 women undergoing ‘fresh-transfer’ strategy had 1788 and 22 334 embryo transfer cycles resulting in 452 and 5126 live births, respectively. Most women (61.3%) in the ‘freeze-all’ group had more than 15 oocytes retrieved in the stimulated cycle compared with 18.1% of women in the ‘fresh-transfer’ group (P < 0.001). For high responders (>15 oocytes), the cumulative live birth rate in the ‘freeze-all’ group was similar to the ‘fresh-transfer’ group (56.8% vs. 56.2%, adjusted hazard ratio (AHR) 0.90, 95% CI 0.77–1.04). However, the likelihood of a live birth was lower in the ‘freeze-all’ group compared with the ‘fresh-transfer’ group among normal responders (10–15 oocytes) (33.2% vs. 46.3%, AHR 0.62, 95% CI 0.46–0.83) and suboptimal responders (<10 oocytes) (14.6% vs. 28.0%, AHR 0.67, 95% CI 0.14–1.01). During the minimum follow-up time of 2 years, 34.1%, 24.4% and 8.4% of suboptimal, normal and high responders, respectively, in the ‘freeze-all’ group did not return for any embryo transfer after the stimulated cycle, whereas all women in the ‘fresh-transfer’ group had at least one embryo transferred in the stimulated cycle. LIMITATIONS REASONS FOR CAUTION A limitation of this population-based study is the lack of information available on clinic-specific protocols for the ‘freeze-all’ strategy and the potential impact of these on outcomes. Data were not available on whether the ‘freeze-all’ strategy was used to prevent ovarian hyperstimulation syndrome (OHSS). WIDER IMPLICATIONS OF THE FINDINGS This study presents population-based evidence on clinical efficacy associated with a ‘freeze-all’ and ‘fresh-transfer’ strategy. The ‘freeze-all’ strategy may benefit some subgroups of patients, including women who are high responders and those who are at risk of OHSS, but should not be offered universally. Clinicians should consider the potential impact of electively deferring embryo transfer on treatment discontinuation in choosing the optimal embryo transfer strategy for couples undergoing ART treatment. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was received to undertake this study. There is no conflict of interest, except that M.B. is a shareholder in Genea Ltd.
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Affiliation(s)
- Z Li
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney NSW, Australia.,Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - A Y Wang
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - M Bowman
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney NSW, Australia
| | - K Hammarberg
- Victorian Assisted Reproductive Treatment Authority, Melbourne VIC, Australia.,School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne VIC, Australia
| | - C Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland 1010, New Zealand
| | - L Johnson
- Victorian Assisted Reproductive Treatment Authority, Melbourne VIC, Australia
| | - N Safi
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - E A Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
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Li Z, Wang AY, Bowman M, Hammarberg K, Farquhar C, Johnson L, Safi N, Sullivan EA. ICSI does not increase the cumulative live birth rate in non-male factor infertility. Hum Reprod 2018; 33:1322-1330. [DOI: 10.1093/humrep/dey118] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/14/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Z Li
- Sydney Medical School, The University of Sydney, Sydney NSW, Australia
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - A Y Wang
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - M Bowman
- Sydney Medical School, The University of Sydney, Sydney NSW, Australia
| | - K Hammarberg
- Victorian Assisted Reproductive Treatment Authority, Melbourne Vic, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne Vic, Australia
| | - C Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - L Johnson
- Victorian Assisted Reproductive Treatment Authority, Melbourne Vic, Australia
| | - N Safi
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - E A Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
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Sullivan EA, Koro S, Tabrizi S, Kaldor J, Poumerol G, Chen S, O'Leary M, Garland SM. Prevalence of sexually transmitted diseases and human immunodeficiency virus among women attending prenatal services in Apia, Samoa. Int J STD AIDS 2016; 15:116-9. [PMID: 15006074 DOI: 10.1258/095646204322764316] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is no routine prenatal screening for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) in pregnancy in Samoa. Testing for chlamydial infection is not available. To gather information on pregnant women, a prevalence survey was conducted in Apia, Samoa, utilizing two prenatal hospital clinics. Pregnant ( n = 427) women were tested for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis using polymerase chain reaction (PCR), and for syphilis ( n = 441) by rapid plasmid reagin (RPR) and HIV ( n = 441) by enzyme-linked immunosorbent assay (ELISA). Results were: chlamydia 30.9% (132); trichomoniasis 20.8%; gonorrhoea 3.3%; syphilis 0.5%; and HIV 0%. Overall 42.7% had at least 1 STD. Young women aged <25 years were three times more likely to have a STD than older women (odds ratio = 3.0, 95% confidence intervals 2.0, 4.5). The lack of inexpensive, reliable field diagnostics remain a barrier to sustainable STD control programmes for pregnant women living in developing countries.
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Affiliation(s)
- E A Sullivan
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
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Abstract
STUDY QUESTION What type of transferred embryo is associated with a lower rate of ectopic pregnancy? SUMMARY ANSWER The lowest risk of ectopic pregnancy was associated with the transfer of blastocyst, frozen and single embryo compared with cleavage stage, fresh and multiple embryos. WHAT IS KNOWN ALREADY Ectopic pregnancy is a recognized complication following assisted reproductive technology (ART) treatment. It has been estimated that the rate of ectopic pregnancy is doubled in pregnancies following ART treatment compared with spontaneous pregnancies. However, it was not clear whether the excess rate of ectopic pregnancy following ART treatment is related to the underlying demographic factors of women undergoing ART treatment, the number of embryos transferred or the developmental stage of the embryo. STUDY DESIGN, SIZE, DURATION A population-based cohort study of pregnancies following autologous treatment cycles between January 2009 and December 2011 were obtained from the Australian and New Zealand Assisted Reproduction Technology Database (ANZARD). The ANZARD collects ART treatment information and clinical outcomes annually from all fertility centres in Australia and New Zealand. PARTICIPANTS/MATERIALS, SETTING, METHODS Between 2009 and 2011, a total of 44 102 pregnancies were included in the analysis. The rate of ectopic pregnancy was compared by demographic and ART treatment factors. Generalized linear regression of Poisson distribution was used to estimate the likelihood of ectopic pregnancy. Odds ratios, adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated. MAIN RESULTS AND THE ROLE OF CHANCE The overall rate of ectopic pregnancy was 1.4% for women following ART treatment in Australia and New Zealand. Pregnancies following single embryo transfers had 1.2% ectopic pregnancies, significantly lower than double embryo transfers (1.8%) (P < 0.01). The highest ectopic pregnancy rate was 1.9% for pregnancies from transfers of fresh cleavage embryo, followed by transfers of frozen cleavage embryo (1.7%), transfers of fresh blastocyst (1.3%), and transfers of frozen blastocyst (0.8%). Compared with fresh blastocyst transfer, the likelihood of ectopic pregnancy was 30% higher for fresh cleavage stage embryo transfers (AOR 1.30, 95% CI 1.07-1.59) and was consistent across subfertility groups. Transfer of frozen blastocyst was associated with a significantly decreased risk of ectopic pregnancy (AOR 0.70, 95% CI 0.54-0.91) compared with transfer of fresh blastocyst. LIMITATIONS, REASON FOR CAUTION A limitation of this population-based study is the lack of information available on clinical- specific protocols and processes for embryo transfer (i.e. embryo quality, cryopreservation protocol, transfer techniques, etc.) and the potential impact on outcomes. WIDER IMPLICATIONS OF THE FINDINGS The lowest risk of ectopic pregnancy was associated with the transfer of a single frozen blastocyst. This finding adds to the increasing evidence of better perinatal outcomes following frozen embryo transfers. The approach of freezing all embryos in the initiated fresh cycle and transfer of a single frozen blastocyst in the subsequent thaw cycle may improve the overall pregnancy and birth outcomes following ART treatment, in part by reducing the ectopic pregnancy rate. STUDY FUNDING/COMPETING INTERESTS There is no funding for this study. Authors declared no competing interest related to this study.
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Affiliation(s)
- Z Li
- Faculty of Health, University of Technology Sydney, Sydney 2007, Australia School of Women's and Children's Health, The University of New South Wales, Sydney 2031, Australia Sydney Medical School, The University of Sydney, Sydney 2006, Australia
| | - E A Sullivan
- Faculty of Health, University of Technology Sydney, Sydney 2007, Australia School of Women's and Children's Health, The University of New South Wales, Sydney 2031, Australia
| | - M Chapman
- School of Women's and Children's Health, The University of New South Wales, Sydney 2031, Australia
| | - C Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland 1142, New Zealand
| | - Y A Wang
- Faculty of Health, University of Technology Sydney, Sydney 2007, Australia School of Women's and Children's Health, The University of New South Wales, Sydney 2031, Australia
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Li Z, Wang YA, Ledger W, Edgar DH, Sullivan EA. Clinical outcomes following cryopreservation of blastocysts by vitrification or slow freezing: a population-based cohort study. Hum Reprod 2014; 29:2794-801. [DOI: 10.1093/humrep/deu246] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chambers GM, Lee E, Hoang VP, Hansen M, Bower C, Sullivan EA. Hospital utilization, costs and mortality rates during the first 5 years of life: a population study of ART and non-ART singletons. Hum Reprod 2013; 29:601-10. [DOI: 10.1093/humrep/det397] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wang YA, Nikravan R, Smith HC, Sullivan EA. Higher prevalence of gestational diabetes mellitus following assisted reproduction technology treatment. Hum Reprod 2013; 28:2554-61. [DOI: 10.1093/humrep/det270] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rogenhofer N, Schleussner E, Kamin G, Seeliger G, Sur SD, Campbell BK, Raine-Fenning NJ, Wang YA, Sullivan EA, Chapman M, Johnson S, Godbert S, Larsen J, Buchanan P, Alonzo T, Zinaman M, Venkatakrishnan R, ucurovic S, Brosens JJ, Quenby S, Kuroda K, Klerkx EPF, Janssen M, van Blerkom J, Campo R, Ombelet W. Session 03: The impact of new clinical evidence in (early) pregnancy. Hum Reprod 2013. [DOI: 10.1093/humrep/det158] [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: 11/13/2022] Open
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Corda L, Wang YA, Sullivan EA, Bay B, Mortensen EL, Kesmodel US, Braam SC, Weiss N, de Bruin JP, Hompes PGA, van der Veen F, van Wely M, Mol BW, Mutsaerts MAQ, Tromp L, Scholtens S, Kerstjens-Frederikse WS, Hoek A, De Walle HEK, Jayaprakasan K, Pandian D, Hopkisson J, Campbell B, Maalouf W, Fiore S, Kremer J, Huppelschoten AG, van Empel IWH, Adang EMM, Groenewoud H, Nelen WLDM, Troude P, Santin G, Bouyer J, Rochebrochard EDL. Reproductive epidemiology and health economy. Hum Reprod 2013. [DOI: 10.1093/humrep/det222] [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: 11/14/2022] Open
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Chambers GM, Lee E, Hoang VP, Hansen M, Bower C, Sullivan EA, Stocker LJ, Bewley S, Macklon NS, Cheong Y, Petersen GL, Hougaard CO, Pinborg A, Pedersen IH, Kamper-Jorgensen M, Schmidt L, Gianotten J, Scholten I, Limpens J, Hompes PGA, van der Veen F, Mol BWJ. Session 50: Reproduction and society. Hum Reprod 2013. [DOI: 10.1093/humrep/det183] [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: 11/15/2022] Open
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Chambers GM, Wang YA, Chapman MG, Hoang VP, Sullivan EA, Abdalla HI, Ledger W. What can we learn from a decade of promoting safe embryo transfer practices? A comparative analysis of policies and outcomes in the UK and Australia, 2001-2010. Hum Reprod 2013; 28:1679-86. [DOI: 10.1093/humrep/det080] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sullivan EA, Zegers-Hochschild F, Mansour R, Ishihara O, de Mouzon J, Nygren KG, Adamson GD. International Committee for Monitoring Assisted Reproductive Technologies (ICMART) world report: assisted reproductive technology 2004. Hum Reprod 2013; 28:1375-90. [PMID: 23442757 DOI: 10.1093/humrep/det036] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Have changes in assisted reproductive technology (ART) practice and outcomes occurred globally between 2003 and 2004? SUMMARY ANSWER Globally, ART practice has changed with an increasing prevalence of the use of ICSI rather than conventional IVF. In 2004, a small but increasing number of countries are incorporating single embryo transfer. There remain unacceptably high rates of three or more embryo transfers in select countries resulting in multiple births and adverse perinatal outcomes. WHAT IS KNOWN ALREADY World data on the availability, effectiveness and safety of ART have been published since 1989. The number of embryos transferred is a major determinant of the iatrogenic increase in multiple pregnancies and is highly correlated with the likelihood of multiple birth and excess perinatal morbidity and mortality. STUDY DESIGN, SIZE, DURATION Cross-sectional survey of countries and regions undertaking surveillance of ART procedures started in 2004 and their corresponding outcomes. PARTICIPANTS/MATERIALS, SETTING, METHODS Of total, 2184 clinics from 52 reporting countries and regions. Number of ART clinics, types of cycles and procedures, pregnancy, delivery and multiple birth rates and perinatal outcomes. MAIN RESULTS AND THE ROLE OF CHANCE A total of 954 743 initiated cycles resulted in an estimated 237 809 babies born. This was a 2.3% increase in the number of reported cycles from 2003. The availability of ART varied by country and ranged from 14 to 3844 treatment cycles per million population. Over one-third (37.2%) of ART clinics performed <100 cycles per year with only 19.9% performing ≥ 500 cycles per year. Of all cycles, 60.6% were ICSI. Frozen embryo transfers (FETs) represented 31% of the initiated cycles. The overall delivery rate per fresh aspiration for IVF and ICSI was 20.2% compared with 16.6% per FET. The average number of embryos transferred was 2.35. Single (16.3%) and double embryo transfers accounted for 73.2% of cycles. The overall proportion of deliveries with twins and triplets from IVF and ICSI was 25.1 and 1.8%, respectively, but varied widely by country and region. The proportion of premature deliveries per fresh aspiration for IVF and ICSI was 33.7% compared with 26.3% per FET. The perinatal death rate was 25.8 per 1000 births for fresh aspiration for IVF and ICSI compared with 14.2 per 1000 births per FET. LIMITATIONS, REASONS FOR CAUTION Data are incomplete with seven countries not providing data to the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) in 2004 that had in 2003. The validity of data reflects current data collection practice. In 2004, 79.3% of the clinics in participating countries reported to their national or regional registries and to ICMART. In addition, the number of ART cycles per million population is a measure which is affected by a country's government policy, regulation, funding and the number of service providers. WIDER IMPLICATIONS OF THE FINDINGS ART practice, effectiveness and outcomes vary markedly internationally. Notably, the increasing proportion of cycles that are FET, the change in practice to single embryo transfer and the cessation of the transfer of three or more embryos in some countries has resulted in improved perinatal outcomes with minimal impact on pregnancy rates. STUDY FUNDING/COMPETING INTEREST(S) ICMART receives financial support from ASRM, ESHRE, FSA, Japan Society for Reproductive Medicine, REDLARA, MEFS and SART.
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Affiliation(s)
- E A Sullivan
- National Perinatal Statistics and Epidemiology Unit, School of Women's and Children's Health, University of New South Wales, Randwick Hospitals Campus, McNevin Dickson Building Room Level 2, Randwick, NSW 2031, Australia.
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Koike A, Fukuda A, Sugihara K, Haruki A, Morimoto Y, Kleijkers SHM, Van Montfoort APA, Smits LJM, Viechtbauer W, Roseboom TJ, Nelissen ECM, Coonen E, Derhaag JG, Bastings L, Schreurs IEL, Evers JLH, Dumoulin JCM, Tuuri T, Makinen S, Soderstrom-Anttila V, Vainio J, Suikkari AM, Wang YA, Sullivan EA, Farquhar C, Popovich I, Windsor B, Jordan V, Shea B. SESSION 48: CULTURE, CRYO AND COCHRANE. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.47] [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: 11/14/2022] Open
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Liebermann J, Pelts E, Matthews J, Sanchez S, Brohammer B, Wagner Y, Sipe C, Feinberg E, Lederer K, Beltsos A, Veleva Z, Tapanainen JS, Martikainen H, Sullivan EA, Wang YA, Malchau S, Loft A, Rasmusen S, Larsen EC, Nyboe Andersen A, Pinborg A, Fedder J, Loft A, Parner ET, Rasmussen S, Pinborg A, Kuwahara A, Saitoh H, Ishihara O, Irahara M, Delrieu D, Himaya E, Saumet J, Dzineku F, Phillips S, Velez MP, Kadoch IJ. SESSION 63: ESET AND PERINATAL OUTCOME. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.62] [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: 11/12/2022] Open
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Wang YA, Sullivan EA, Sullivan EA, Wang YA, Abeywardana S, Kovacs G, Henningsen AA, Wennerholm UB, Gissler M, Skjaerven R, Nyboe Andersen A, Nygren KG, Tiitinen A, Romundstad LB, Forman JL, Pinborg A, Fulford B, Bunting L, Tsibulsky I, Boivin J, Connolly M, Postma MJ, Crespi S, Nyboe Andersen A, Ziebe S, Druckenmiller S, Knopman JM, DeVore S, Krey L, Noyes N, Privitera L, Remohi J, Morgan M, Pellicer A, Garrido N. SELECTED ORAL COMMUNICATION SESSION, SESSION 73: EPIDEMIOLOGY & HEALTH ECONOMICS Wednesday 6 July 2011 14:00 - 15:45. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.73] [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: 11/12/2022] Open
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Dean JH, Chapman MG, Sullivan EA. The effect on human sex ratio at birth by assisted reproductive technology (ART) procedures--an assessment of babies born following single embryo transfers, Australia and New Zealand, 2002-2006. BJOG 2010; 117:1628-34. [PMID: 20875033 DOI: 10.1111/j.1471-0528.2010.02731.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the effect on the human sex ratio at birth by assisted reproductive technology (ART) procedures. DESIGN Retrospective population-based study. SETTING Fertility clinics in Australia and New Zealand. POPULATION The study included 13,368 babies by 13,165 women who had a single embryo transfer (SET) between 2002 and 2006. METHODS Logistic regression was used to model the effect on the sex ratio at birth of ART characteristics [in vitro fertilisation (IVF) or intracytoplasmic sperm insemination (ICSI) SET, cleavage-stage or blastocyst SET, and fresh or thawed SET] and biological characteristics (woman's and partner's age and cause of infertility). MAIN OUTCOME MEASURES Proportion of male births. RESULTS The crude sex ratio at birth was 51.3%. Individual ART procedures had a significant effect on the sex ratio at birth. More males were born following IVF SET (53.0%) than ICSI SET (50.0%), and following blastocyst SET (54.1%) than cleavage-stage SET (49.9%). For a specific ART regimen, IVF blastocyst SET produced more males (56.1%) and ICSI cleavage-stage SET produced fewer males (48.7%). CONCLUSIONS The change in the sex ratio at birth of SET babies is associated with the ART regimen. The mechanism of these effects remains unclear. Fertility clinics and patients should be aware of the bias in the sex ratio at birth when using ART procedures.
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Affiliation(s)
- J H Dean
- Reproductive and Perinatal Epidemiology Research Unit, The University of New South Wales, NSW, Australia.
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Farquhar CM, Wang YA, Sullivan EA. A comparative analysis of assisted reproductive technology cycles in Australia and New Zealand 2004-2007. Hum Reprod 2010; 25:2281-9. [DOI: 10.1093/humrep/deq187] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wang YA, Kovacs G, Sullivan EA. Transfer of a selected single blastocyst optimizes the chance of a healthy term baby: a retrospective population based study in Australia 2004-2007. Hum Reprod 2010; 25:1996-2005. [DOI: 10.1093/humrep/deq145] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wang YA, Kovacs G, Sullivan EA, Sullivan EA, Wang YA, Scotland G, Mclernon D, Kurinczuk JJ, Jamieson M, Lyall H, Rajkhowa M, Harrold A, Bhattacharya S, Romundstad LB, Vatten LJ, Sunde A, During VV, Skjaerven R, Romundstad PR, Norgaard L, Bergholt T, Pinborg A. Session 20: Single Embryo Transfer & Art Pregnancy. Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.20] [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: 11/14/2022] Open
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Saha R, Svedberg P, Johansson F, Bergqvist A, Boivin J, Bunting L, Tsibulsky I, Kalebic N, Harrison C, Sozou PD, Hartshorne GM, Stoop D, Nekkebroeck J, Devroey P, Dean JH, Chapman M, Sullivan EA, Overbeek A, van den Berg MH, van Leeuwen FE, Lambalk CB, Kaspers GJL, van Dulmen-den Broeder E, Mutsaerts M, Huiting HG, Groen H, Kuchenbecker WKH, Land JA, Stolk RP, Hoek A. Session 69: Factors Influencing Fertility and Infertility Treatment. Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.69] [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: 11/14/2022] Open
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Wang YA, Chapman M, Costello M, Sullivan EA. Better perinatal outcomes following transfer of fresh blastocysts and blastocysts cultured from thawed cleavage embryos: a population-based study. Hum Reprod 2010; 25:1536-42. [DOI: 10.1093/humrep/deq067] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wang YA, Healy D, Black D, Sullivan EA. Age-specific success rate for women undertaking their first assisted reproduction technology treatment using their own oocytes in Australia, 2002-2005. Hum Reprod 2008; 23:1633-8. [PMID: 18441345 DOI: 10.1093/humrep/den135] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Woman's age is an independent factor determining the success of assisted reproductive technology treatment. This study presents the age-specific success rate of first autologous fresh treatment in Australia during 2002-2005. METHODS This is a retrospective population-based study of 36,412 initiated first autologous fresh cycles conducted in Australian clinics during 2002-2005. Pregnancy and live delivery rates per initiated cycle were determined for each age. RESULTS The overall live delivery rate per initiated cycle was 20.4% with the highest success rate in women aged between 22 and 36 years. Male factor only infertility had a higher live delivery rate (22.0%) than female factor only infertility (19.2%). Advancing woman's age was associated with a decline in success rate. For women > or = 30 years, each additional 1 year in age was associated with an 11% (99% CI: 10-12%) reduction in the chance of achieving pregnancy and a 13% (99% CI: 12-14%) reduction in the chance of a live delivery. If women aged 35 years or older would have had their first autologous fresh treatment 1 year earlier, 15% extra live deliveries would be expected. CONCLUSIONS This study suggested that women aged 35 years or older should be encouraged to seek early fertility assessment and treatment where clinically indicated.
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Affiliation(s)
- Y A Wang
- Perinatal and Reproductive Epidemiology Research Unit, School of Women's and Children's Health, The University of New South Wales, McNevin Dickson Building, Randwick Hospitals Campus, Randwick, NSW 2031, Australia.
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Lawrie Z, Sullivan EA, Davies PSW, Hill RJ. Body change strategies in children: relationship to age and gender. Eat Behav 2007; 8:357-63. [PMID: 17606233 DOI: 10.1016/j.eatbeh.2006.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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] [Received: 05/09/2006] [Revised: 10/03/2006] [Accepted: 11/09/2006] [Indexed: 10/23/2022]
Abstract
The "Body Image and Body Change Inventory Questionnaire" was administered to 958 students, aged 8.00-13.99 years, to determine the types of strategies used by children to accomplish changes in body size/shape. Each individual strategy score was compared for each gender and with respect to age. The girls' score for food restrictive practices was significantly higher than for other body change strategies. For the boys, the score for the use of food and exercise strategies to increase muscle size was significantly higher than all other practices except exercise strategies to increase body size. Both boys and girls reported the lowest scores for food and exercise strategies to increase body weight. The variance explained by age was small and not considered biologically significant. While the findings do not demonstrate a relationship between desire to change body size/shape and age, weight concerns should not be overlooked, as both genders seem concerned with keeping their body weight low. The different practices used by each gender demonstrate that different body image ideals hold for boys and girls.
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Affiliation(s)
- Z Lawrie
- Children's Nutrition Research Centre, Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Australia
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Abstract
To study the media messages portrayed to children, 925 students, from 9 to up to 14 years of age, completed "The Sociocultural Influences Questionnaire." The media section is the focus of this paper, and the responses from three questions were selected to examine the media's influence to be slimmer, increase weight, or increase muscle size. While the girls and boys exhibited different levels of agreement with each media influence, both genders disagreed that media messages were implying they should gain weight. This is in agreement with the belief that the media perpetuates the ideal of thinness and there is a negative stigma associated with being overweight.
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Affiliation(s)
- Z Lawrie
- University of Queensland, Brisbane, Australia
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Ford JB, Henry RL, Sullivan EA. Comparison of selected reasons for hospitalization of children among children's/tertiary hospitals, Australia, 1996-97 and 1997-98. J Paediatr Child Health 2004; 40:374-9. [PMID: 15228566 DOI: 10.1111/j.1440-1754.2004.00405.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 12/01/2022]
Abstract
OBJECTIVES To describe the major characteristics of admissions to children's/tertiary hospitals (compared to other hospitals) and to compare characteristics of local and non-local admissions to specialist children's hospitals. METHODS A cross-sectional analysis of a routinely collected data set of hospitalizations in Australia in 1996-97 and 1997-98. RESULTS Hospital-specific proportions of asthma and bronchitis, tonsillectomy and/or adenoidectomy and gastroenteritis varied considerably. Multivariate analysis comparing the characteristics of admitted patients by locality showed that non-local admissions of patients with asthma and bronchitis and gastroenteritis to selected children's hospitals were significantly more likely to be Indigenous children and/or children who had been transferred from another hospital. Non-local admissions of tonsillectomy and/or adenoidectomy patients to selected hospitals were significantly more likely to be public patients. CONCLUSIONS Differences in the characteristics of admitted patients to children's hospitals by locality raise issues about equality of access and availability of appropriate services for these children and their families.
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Affiliation(s)
- J B Ford
- School of Women's and Children's Health, University of New South Wales, New South Wales, Australia.
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Bosnich B, Lo STD, Sullivan EA. Dissymmetric arsine complexes. Separation of the racemic and meso isomers of linear quadridentate arsines via their metal complexes. Inorg Chem 2002. [DOI: 10.1021/ic50152a001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bosnich B, Sullivan EA. Conformational dissymmetry. Axial-equatorial isomer distributions of N-methyl-substituted aliphatic five-membered chelate rings. Inorg Chem 2002. [DOI: 10.1021/ic50153a035] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marks GB, Bai J, Stewart GJ, Simpson SE, Sullivan EA. Effectiveness of postmigration screening in controlling tuberculosis among refugees: a historical cohort study, 1984-1998. Am J Public Health 2001; 91:1797-9. [PMID: 11684606 PMCID: PMC1446881 DOI: 10.2105/ajph.91.11.1797] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study assessed the effectiveness of postmigration screening for the control of tuberculosis (TB) among refugee migrants. METHODS We conducted a historical cohort study among 24 610 predominantly Southeast Asian refugees who had arrived in Sydney, Australia, between 1984 and 1994. All had been screened for TB before arrival and had radiologic follow-up for 18 months after arrival. Incident cases of TB were identified by record linkage analysis with confirmatory review of case notes. RESULTS The crude annual incidence rate over 10-year follow-up was 74.9 per 100 000 person-years. Only 29.6% of the cases were diagnosed as a result of routine follow-up procedures. CONCLUSIONS Enhanced passive case finding is likely to be more effective than active case finding for the control of TB among refugees.
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Affiliation(s)
- G B Marks
- South Western Sydney Area Health Service, Sydney, Australia.
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Abstract
We have used record linkage analysis to describe the incidence of tuberculosis in a cohort of 24 652 predominantly south-east Asian refugees who arrived in Sydney, Australia during the period 1984 to 1994. Cases that had been registered with the State Department of Health were confirmed by examination of case records. After an average follow-up interval of 10.3 years there were 189 cases of tuberculosis, equivalent to an average incidence rate of 74.9 cases per 100 000 person-years. The highest incidence rate was in 40-49 year olds and 47% of cases were in women. One hundred and twenty seven cases (67%) were pulmonary and, of these, 64 (50%) were direct smear positive. The incidence of tuberculosis in this cohort is similar to that observed among Vietnamese migrants to Australia and the USA and substantially higher than the incidence among people born in Australia. It is important to maintain awareness of the diagnosis of tuberculosis, especially in countries such as Australia, where the incidence in the general population is low but where there are large populations of migrants and refugees in whom a higher incidence is expected.
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Affiliation(s)
- G B Marks
- South Western Sydney Area Health Service, University of Sydney, Australia.
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Marks GB, Bai J, Simpson SE, Sullivan EA, Stewart GJ. Incidence of tuberculosis among a cohort of tuberculin-positive refugees in Australia: reappraising the estimates of risk. Am J Respir Crit Care Med 2000; 162:1851-4. [PMID: 11069825 DOI: 10.1164/ajrccm.162.5.2004154] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [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: 11/16/2022] Open
Abstract
Estimates of the lifetime risk of tuberculosis have varied widely and may not be applicable in all current settings. The aim of this study was to measure the incidence of reactivation of latent tuberculosis in a cohort of 15,489 predominantly Southeast Asian refugees aged 12 yr and over who arrived in Sydney, Australia during the period 1984 to 1994 and who had a clear chest X-ray on arrival. Tuberculin skin test (TST) reaction size and the presence of a BCG scar were recorded at entry. Incident cases of tuberculosis, occurring before June 1998, were identified by record linkage analysis with confirmatory review of case notes. There were 122 cases of tuberculosis over an average 10.3 yr of follow-up (crude annual incidence, 76.2/100,000). There was a linear increase in risk with increasing TST reaction size above 10 mm. The risk, and the relation of risk to TST reaction size, were unrelated to BCG scar status. Among those whose initial TST reaction was >/= 15 mm, the annual incidence rate in the first 3 yr was 213 (95% CI, 150 to 300) per 100,000 person-years and in the subsequent 10 yr the rate averaged 122 (95% CI, 90 to 165) per 100,000 person-years. The observed rates are similar to those estimated in the general population of the United States in the 1950s and 1960s. Further data on the prognosis of tuberculosis and the effects of isoniazid preventive therapy in Southeast Asian migrants to Western countries are required to inform policy and practice for the prevention of tuberculosis in this population.
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Affiliation(s)
- G B Marks
- South Western Sydney Area Health Service, Institute of Respiratory Medicine, University of Sydney, School of Paediatrics, University of New South Wales, Sydney, New South Wales, Australia.
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Abstract
Traditional tests for detection of syphilis are labour intensive and costly. Enzyme immunoassays (EIAs) are readily automated and cost effective if large numbers of tests are performed. Four experiments were devised to evaluate a syphilis EIA test kit where resources are limited: (1) testing antenatal patients; (2) testing refugees; (3) testing a high prevalence population; and (4) testing "problem sera" (containing autoantibodies or antibodies to other infective agents). Forty-one available syphilitic sera from antenatal patients were tested to evaluate sensitivity. Specificity was determined through testing sera determined to be nonreactive with rapid plasma reagin and Treponema pallidum hemagglutination tests, calculating the sample size (456) on the confidence interval (CI) required. Two runs were performed on antenatal sera, giving sensitivities of 32% (95% CI: 20%, 47%) and 37% (95% CI: 24%, 52%) and specificities of 92% (95% CI: 89%, 94%) and 90% (95% CI 87%, 92%), respectively. We present a method to evaluate a serological test where resources are limited. Unexpectedly, the test kit performed poorly as a screening test. New serological tests need to be evaluated in-house prior to adoption.
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Affiliation(s)
- I B Gosbell
- Department of Microbiology and Infectious Diseases, South Western Sydney Area Health Service, Liverpool, Australia.
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Abstract
BACKGROUND Blood culture results have profound implications for patients. Comprehensive overviews of blood cultures have been uncommon, and focused on tertiary referral hospitals. AIM To present a review of blood culture results from a laboratory servicing community hospitals in Sydney, Australia. METHODS Retrospective chart review of patients with positive blood cultures from 1 June 1993 to 31 May 1994. RESULTS During the survey period there were 107,382 hospital admissions; 12,109 blood culture sets from 9292 patients were processed. Of these 1197 sets were positive, representing 974 febrile episodes in 923 patients. There were 476 episodes of contamination. Of the episodes of true bacteraemia, Escherichia coli was isolated in 139, Staphylococcus aureus in 91 (22 methicillin-resistant), other enterobacteriaceae in 60, and Streptococcus pneumoniae in 5 1. The diagnoses attributable to bacteraemia included intravenous catheter-related sepsis (122 episodes), urinary tract infection (88), bacteraemia from unknown source (79), intra-abdominal and biliary sepsis (91), pneumonia (35), and meningitis (21). Sixty-eight patients died directly due to bacteraemia. Multivariate analysis showed underlying disease (OR 3.97) or shock (OR 28.1) predicted death. Blood cultures confirmed clinical diagnoses in 258 episodes, but made a de novo diagnosis in 205 episodes. CONCLUSIONS This study describes the clinical and laboratory features of bacteraemias occurring in smaller public hospitals, as distinct from tertiary referral centres. It demonstrated that intravenous catheter-related sepsis was very common in smaller hospitals. The clinical diagnosis was frequently confirmed, and a de novo diagnosis was often established by a positive blood culture. Unfortunately nearly half the positive blood cultures represented contamination.
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Affiliation(s)
- I B Gosbell
- Department of Microbiology and Infectious Diseases, South Western Area Pathology Service, School of Pathology, Faculty of Medicine, University of New South Wales.
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Abstract
OBJECTIVE Epidemiological surveillance of tuberculosis (TB) in Australia is dependent on the accuracy of the notification data. We have investigated the specificity of TB notification for the diagnosis of this disease. METHOD We used data from notifications to the NSW Department of Health to identify members of a cohort of refugees who were screened between 1984 and 1993 and subsequently developed TB during that period. We reviewed notification data and, in most instances, case notes and x-ray films, to independently confirm or refute the diagnosis of TB. RESULTS Two hundred and fifty members of the cohort were identified in the notification database. After excluding refugees on treatment prior to arrival in Australia, and those who were notified as 'quiescent' and 'atypical' cases, there were 189 cases notified as active TB. There was evidence to support the diagnosis of active TB in 125 cases (66%) and evidence that subjects did not have active disease in 60 cases (32%). We could not determine the status of the remaining four notified cases. CONCLUSION This study has shown that, in a population of refugees subject to screening, nearly one-third of cases notified as active tuberculosis from the study population were actually not active tuberculosis cases. IMPLICATIONS The use of the TB notification database may result in overestimation of the incidence of TB in population groups who are subject to active screening.
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Affiliation(s)
- J Bai
- Department of Respiratory Medicine, Liverpool Health Service, New South Wales.
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Abstract
OBJECTIVE To provide a population-based baseline of immunization rates in children aged 2 years and younger in New South Wales (NSW) in 1992, permitting more accurate evaluation of the efficacy of current programmes. METHODS A cross-sectional population-based survey of 622 households from areas resident to over 73% of all children aged 4 years and younger in NSW. RESULTS Of the 322 households with children aged 3-24 months, 212 (66%; confidence interval (CI): 57-75%) were up-to-date with the recommended immunization schedule, 68 (21%; CI: 15-27%) had not commenced any immunization, and 42 (13%; CI: 9-17%) were partially immunised. Ability to read English (odds ratio (OR): 5.43; CI: 2.37-12.44) and receipt of hepatitis B immunization (OR; 2.54; CI: 1.27-5.07%) were highly associated with up-to-date immunization; whilst a history of any illnesses, frequent doctor visits in the past 12 months (OR: 0.47; CI: 0.27-0.85%) and older age (16-24 months) (OR: 0.26; CI: 0.12-0.50%) were less likely to be associated with up-to-date immunization. CONCLUSIONS In 1992 NSW had low levels of up-to-date immunization. Significantly, one-fifth of NSW families with children aged 3-24 months did not have a record of any immunizations. This could not be explained by delay in commencing immunization. Poor competency in reading English was strongly associated with failure to immunise, suggesting that there had been inadequate targeting of immunization campaigns in non-English-speaking communities.
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Affiliation(s)
- E A Sullivan
- Epidemiology Unit, South-western Sydney Area Health Service, Liverpool, New South Wales, Australia
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Abstract
OBJECTIVE To determine the epidemiology of varicella-zoster virus (VZV) infection in Australia using currently available data sources. DESIGN Analysis of national death data (23 years), congenital and neonatal cases (one year) and attendances at sentinel general practices (two years); hospital admissions in NSW and SA (six years); serological studies in 1995 involving antenatal clinics in Sydney and Brisbane and child-care centre staff and refugees in Sydney; and case-ascertainment in 1995 in South Western Sydney among public hospital staff, child-care centre staff and the community. RESULTS In Australia, there have been an average of 3.5 deaths from chickenpox (mostly children) and 11 from herpes zoster (mostly older people) each year since 1980. The crude death rate for chickenpox has declined (p > 0.05). In 1995, there were 14 cases of neonatal and two of congenital varicella. Average annual admission rates for NSW and SA showed 1,200 hospital bed-days used for chickenpox, more than 20% with complications, and more than 7,300 bed days for zoster; annually more than 880 in-patient admissions were complicated by VZV. Most people encounter the virus in their first 15 years, but some remain susceptible into their 20s; 25% of cases and 37% of hospital admissions for chickenpox occur in people > or = 15 years of age. CONCLUSION VZV infection involves people of all ages. It causes substantial morbidity and mortality, particularly at the extremes of life. The death rate from chickenpox but not zoster has fallen since the introduction of acyclovir in the 1980s. Surveillance of VZV infection must be given priority once vaccines become available, to monitor changes in morbidity and mortality.
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Affiliation(s)
- K G Chant
- South Western Sydney Public Health Unit, New South Wales
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Abstract
We identified 41 New York City residents who had been hospitalized at least overnight between January 1992 and September 1993 because of a toxic isoniazid (INH) exposure. Review of the available medical charts of 33 patients revealed that median age was 19 years, 27 (82%) were females, and 24 (83%) were taking INH chemoprophylaxis for tuberculosis infection. Twenty-two patients had seizures. Twenty-seven (82%) patients had attempted suicide using INH, and another three patients had intentionally misused INH by making up missed doses at one time. All patients survived. Physicians should be aware of the potential for INH toxicity and should assess their patients' current mental and psychosocial status when prescribing it. INH toxicity should be considered when young patients, particularly females, present with unexplained intractable seizures, and treatment with pyridoxine should be given.
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Affiliation(s)
- E A Sullivan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Abstract
OBJECTIVES To determine whether subjects older than 75 years are included in the randomized controlled trials of antiparkinsonian medications conducted during the last 30 years and to identify study characteristics that are associated with the exclusion of patients of advanced age. METHODS A systematic search was conducted on MEDLINE from January 1966 until September 1996 of all randomized controlled trials of drugs used to treat the motor symptoms of Parkinson disease. Articles were abstracted for the age of subjects date of publication, geographic location, drug class studied, stage of Parkinson disease of subjects, and the number of subjects in each trial. RESULTS One hundred twelve articles met the inclusion criteria. The weighted mean (+/- SD) age for subjects in all trials was 62.2 +/- 3.9 years. Forty-two studies (37.5%) included subjects older than 75 years. However, in 31 articles (27.7%) it could not be determined if subjects older than 75 years were included. Among the 8 studies that provided the actual number of subjects within specific age groups, only 8 (5.5%) of 145 subjects were older than 75 years. Publication in the last decade was significantly associated with a decreased likelihood of including subjects older than 75 years (odds ratio, 0.19; 95% confidence interval, 0.06-0.62). CONCLUSIONS The relatively small number of subjects older than 75 years included in controlled trials of antiparkinsonian drugs seriously impedes our understanding of the efficacy and safety of these drugs in a large subgroup of frail patients for whom these products are prescribed. The tendency to exclude subjects of advanced age is highest in the most recently published articles that study new advances in pharmacotherapy. There is inadequate reporting of the age characteristics of subjects in clinical trials. This limitation hinders the synthesis of data regarding drug efficacy and toxicity relevant to older age groups.
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Affiliation(s)
- S L Mitchell
- Hebrew Rehabilitation Center for Aged Research and Training Institute, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass., USA
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Affiliation(s)
- L H Gibson
- Department of Radiology, Medical College of Virginia Hospitals, Richmond 23298, USA
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Sullivan EA, Staehling N, Philen RM. Eosinophilia-myalgia syndrome among the non-L-tryptophan users and pre-epidemic cases. J Rheumatol 1996; 23:1784-7. [PMID: 8895159] [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: 02/02/2023]
Abstract
OBJECTIVE Eosinophilia-myalgia syndrome (EMS) has been associated with L-tryptophan (LT) use since 1989, but as yet no etiologic agent has been identified. We describe the non-L-tryptophan associated cases of EMS, and those patients with illness onset preceding the 1989 epidemic. METHODS Review of all patients in the EMS national state based surveillance system administered by the Centers for Disease Control and Prevention (CDC) who satisfied the EMS surveillance case definition. RESULTS Of 1345 persons with EMS that satisfied the CDC surveillance case definition for EMS, 26 (2%) persons reported not having used LT (non-LT). Persons who did not use LT were significantly younger (mean age 39 years; p = 0.02) and were more likely than LT users to have onset of their illness before the EMS epidemic (before July 1, 1989) (p < 0.001). Non-LT users reported fewer pulmonary symptoms but had rates of neuropathy and scleroderma-like skin changes similar to LT users. Non-LT users had lower mean eosinophil counts (5.6 x 10(9) cells/I LT users 6.2 x 10(9) cells/I), reported no EMS attributable deaths, but were hospitalized (48%) more often than LT users (34%). Of the 1345 EMS cases, 191 (14%) reported a pre-epidemic illness onset. Symptoms of peripheral edema, rash, scleroderma-like skin change, alopecia, and neuropathy were more prevalent in pre-epidemic patients. Mean eosinophil count was significantly higher for epidemic patients than for pre-epidemic patients (p = 0.004). CONCLUSION Non-LT EMS cases were more likely to be younger and to have a pre-epidemic illness onset of EMS, but otherwise were similar to LT associated EMS cases. Pre-epidemic EMS cases were more likely to report the presence of neuropathy and scleroderma-like skin change, but not pulmonary symptoms, hospitalization, or death.
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Affiliation(s)
- E A Sullivan
- Division of Environmental Hazards and Health Effects, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, USA
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Sullivan EA, Kamb ML, Jones JL, Meyer P, Philen RM, Falk H, Sinks T. The natural history of eosinophilia-myalgia syndrome in a tryptophan-exposed cohort in South Carolina. Arch Intern Med 1996; 156:973-979. [PMID: 8624177] [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: 05/22/2023]
Abstract
BACKGROUND In a previous study, we did follow-up on 418 patients who were exposed to tryptophan in 1989, of whom 47 (11%) had definite and 63 (9%) possible eosinophilia-myalgia syndrome (EMS). METHODS We assessed mortality and clinical spectrum of illness since 1989 for 242 (58%) of the 418 tryptophan-exposed patients from the original study. To assess outcomes, we used hospital and death records, interviewer-administered questionnaires, physical examinations, and laboratory tests. RESULTS During the follow-up interval, mortality from all causes was 19% in those with definite EMS, 7% in possible EMS, and 3% in those who were not ill. The age- and sex-adjusted mortality in those with definite EMS was more than 3 times that of the general population or of tryptophan users in the practice who were not ill. Six deaths (66%) among the definite EMS case patients occurred during the 18 months immediately after symptom onset. Compared with the tryptophan users who were not ill, survivors with definite EMS continued to report excess morbidity for 6 major EMS symptoms (myalgia, arthralgia, weakness, rash, alopecia, and sclerodermiform skin changes), but they also reported that the symptom number and severity diminished with time. None of the tryptophan users who were not ill in 1989 developed a symptom complex suggesting new EMS during the follow-up interval. CONCLUSIONS This study assessing a tryptophan-exposed population found those persons who developed EMS during the 1989 epidemic were at increased risk for death, particularly early after disease onset. Survivors reported improvement or resolution of major symptoms, suggesting that the severity of EMS diminishes with time. We found no evidence of delayed onset of EMS in tryptophan users who were not ill in 1989, regardless of the brand used.
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Affiliation(s)
- E A Sullivan
- Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Ga, USA
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Abstract
Skin phototype was assessed in 257 Asian Australians by self-reporting questionnaire. Minimal erythema dose, minimal melanogenic dose and minimal immediate pigment darkening dose were measured in a subgroup of 50 subjects. About 15% of Asian Australians in this study report that they have skin type I or II. Phototesting confirms that there is a UV-sensitive group and a wide spectrum of UV-sensitivity in this population. Whether Fitzpatrick's skin typing system adequately identifies this UV-sensitive group needs assessment by a larger study. The relationship between burning tendency and tanning capacity in Asians may differ from Caucasians.
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Affiliation(s)
- D G Stanford
- Dermatology Centre, Liverpool Hospital, New South Wales, Australia
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Abstract
22 patients infected with fluoroquinolone-resistant Mycobacterium tuberculosis in New York City were identified between January, 1991, and November, 1993. In 16 patients resistance arose as a result of inadequate or inappropriate treatment. 6 patients had primary infection with fluoroquinolone-resistant organisms; 5 acquired the organisms nosocomially. Seven distinct patterns of restriction-fragment length polymorphism were identified in isolates from 21 patients. Fluoroquinolones should be restricted to patients with multidrug-resistant disease or intolerance to other antituberculosis drugs. All patients with multidrug-resistant tuberculosis should be on directly observed therapy.
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Affiliation(s)
- E A Sullivan
- New York City Department of Health, New York, USA
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Abstract
Monoamine oxidase inhibitors (MAOIs) are attracting renewed attention as effective antidepressants for refractory depressions, particularly among the elderly. However, widespread fears concerning the interactions of MAOIs with tyramine-containing foods have led to the development of long and complicated diets. These diets have served as an obstacle to the ready use of MAOIs, yet very little systematic or critical review of the basis for food restriction has been undertaken. An international survey of MAOI diets was conducted and from the diets collected, foods were categorized according to frequency of restriction on the diet lists. On the basis of this survey and a critical review of the literature it was determined that only four foods clearly warrant absolute prohibition: aged cheese, pickled fish (herring), concentrated yeast extracts and broad bean pods. While there is insufficient evidence to prohibit alcohol completely (even chianti wine) true moderation must apply. It is suggested that a radically simplified diet should be investigated on a prospective basis.
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Abstract
A number of Pd(II) and Pt(II) complexes of amino acids and dipeptides have been isolated and characterized. The solution and solid-state circular dichroism of the amino acid complexes show a fairly consistent pattern, which is opposite to that shown by the dipeptide complexes. Some of the problems associated with the interpretation of the spectra in terms of spectroscopic assignment and structural features are discussed.
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Abstract
An identifiable relationship exists between the absolute configuration of chiral diamine ligands and the circular dichroism of their complexes with palladium(II) and platinum(II). Complexes which contain simple C-substituted diamines with the R-absolute configuration show positive circular dichroism in the region associated with the 1A1g → 1Eg transition, both in solution and the solid state. There is no general consistency in the sign of the 1A1g → 1A2g transition, and only for solution does the sign of the net circular dichroism show a correlation with the absolute configuration of the ligands.
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Livingstone SE, Sullivan EA. Thio derivatives of β-diketones and their metal chelates. XI. Stability constants of nicke(II), copper(II). zinc(II), cadniium(II), and lead(II) chelates of two monothio-β-diketones. Aust J Chem 1969. [DOI: 10.1071/ch9691363] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The acid dissociation
constant (pKD) of the monothio derivative of benzoyl-acetone, viz.
3-mercapto-1-phenylbut-2-en-1-one (I), was found to be 10.43 in 74.5 vol. %
dioxan-water solution. Stoicheiometric stability constants (log kn)
of five metal chelates of (I) and of the monothio derivative of
dibenzoylmethane, viz. 3-mercapto-1,3- diphenylprop-2-en-1-one (II), have been
measured in 74.5 vol. % dioxan- water solution with both chloride and
perchlorate as supporting electrolyte. ��� With chloride as supporting electrolyte the
values obtained for log kav are as follows: with ligand (I),
copper(II) 10.11, nickel(II) 9.25, zinc(II) 6.68, lead(II) 6.06, cadmium(II)
6.12; with ligand (II), copper(II) 10.66, nickel(II) 10.20, zinc(II) 7.44,
lead(II) 7.11, cadmium(II) 6.90. With perchlorate as supporting electrolyte
zinc, lead, and cadmium give values of log kav which are 1.5-1.9
units greater. The thermodynamic stability constants (logKn)
were calculated from the stoicheiometric constants by use of the equations
���������� Log K1 = logk1 + 2.30������� logK2
= log k2 + 1.15
For the copper and nickel
complexes of both (1) and (II) log Kav is greater than pKD;
such a situation has been reported in only a few instances. ��� From the data obtained with chloride as a
supporting medium, approximate stoicheiometric stability constants were
calculated for the chloro complexes MCl+ (M
= Zn, Cd, Pb) in 74.5 vol.
% dioxan. The values obtained were: ZnCl+,
5.0; CdCl+, 5.7; PbCl+,
5.0.
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