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McGuinness SL, Eades O, Zhong S, Clifford S, Fisher J, Kelsall HL, Kirkman M, Russell G, Skouteris H, Leder K. A longitudinal qualitative exploration of victorian healthcare workers' and organisations' evolving views and experiences during COVID-19. BMC Health Serv Res 2024; 24:596. [PMID: 38715025 PMCID: PMC11077789 DOI: 10.1186/s12913-024-11067-z] [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] [Received: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has profoundly impacted individuals, society, and healthcare organisations worldwide. Recent international research suggests that concerns, needs, and experiences of healthcare workers (HCWs) have evolved throughout the pandemic. This longitudinal qualitative study explored the evolving views and experiences of Victorian healthcare workers (HCWs) and organisational key personnel during the coronavirus disease (COVID-19) pandemic. METHODS We recruited participants from the Coronavirus in Victorian Health and Aged care workers (COVIC-HA) study cohort. We conducted two rounds of semi-structured interviews with HCWs and organisational key personnel from three different healthcare settings (hospital, aged care and primary care) in Victoria, Australia, in May-July 2021 and May-July 2022. Data were analysed thematically using trajectory and recurrent cross-sectional approaches, guided by a temporal change framework. RESULTS Twelve HCWs and five key personnel from various professional roles participated in interviews at both timepoints. Expected themes derived from mid-2021 interviews (navigating uncertainty, maintaining service delivery, and addressing staff needs) evolved over time. Concerns shifted from personal health and safety to workforce pressures, contributing to HCW burnout and fatigue and ongoing mental health support needs. New themes emerged from mid-2022 interviews, including managing ongoing COVID-19 impacts and supporting the healthcare workforce into the future. Clear and consistent communication, stable guidelines and forward-looking organisational responses were considered crucial. CONCLUSIONS Our longitudinal qualitative study highlighted the evolving impact of the COVID-19 pandemic on HCWs' perceptions, health and wellbeing and uncovered long-term sector vulnerabilities. Analysing HCW experiences and key personnel insights over time and across different pandemic phases provided crucial insights for policymakers to protect the healthcare workforce. Findings emphasise the need for proactive strategies that prioritise HCWs' wellbeing and workforce sustainability. Policy makers must invest in HCW health and wellbeing initiatives alongside healthcare system improvements to ensure resilience and capacity to meet future challenges. TRIAL REGISTRATION This study was approved through the Victorian Streamlined Ethical Review Process (SERP: Project Number 68,086) and registered with ANZCTR (ACTRN12621000533897) on 6 May 2021.
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Affiliation(s)
- Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Alfred Health, Melbourne, VIC, Australia.
| | - Owen Eades
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Shannon Zhong
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Sharon Clifford
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Helen L Kelsall
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Maggie Kirkman
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Grant Russell
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Helen Skouteris
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Royal Melbourne Hospital, Melbourne, VIC, Australia
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Sohail A, Barry A, Auburn S, Cheng Q, Lau CL, Lee R, Price RN, Furuya-Kanamori L, Bareng P, McGuinness SL, Leder K. Imported malaria into Australia: surveillance insights and opportunities. J Travel Med 2024; 31:taad164. [PMID: 38127641 PMCID: PMC10998534 DOI: 10.1093/jtm/taad164] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Malaria continues to pose a significant burden in endemic countries, many of which lack access to molecular surveillance. Insights from malaria cases in travellers returning to non-endemic areas can provide valuable data to inform endemic country programmes. To evaluate the potential for novel global insights into malaria, we examined epidemiological and molecular data from imported malaria cases to Australia. METHODS We analysed malaria cases reported in Australia from 2012 to 2022 using National Notifiable Disease Surveillance System data. Molecular data on imported malaria cases were obtained from literature searches. RESULTS Between 2012 and 2022, 3204 malaria cases were reported in Australia. Most cases (69%) were male and 44% occurred in young adults aged 20-39 years. Incidence rates initially declined between 2012 and 2015, then increased until 2019. During 2012-2019, the incidence in travellers ranged from 1.34 to 7.71 per 100 000 trips. Cases were primarily acquired in Sub-Saharan Africa (n = 1433; 45%), Oceania (n = 569; 18%) and Southern and Central Asia (n = 367; 12%). The most common countries of acquisition were Papua New Guinea (n = 474) and India (n = 277). Plasmodium falciparum accounted for 58% (1871/3204) of cases and was predominantly acquired in Sub-Saharan Africa, and Plasmodium vivax accounted for 32% (1016/3204), predominantly from Oceania and Asia. Molecular studies of imported malaria cases to Australia identified genetic mutations and deletions associated with drug resistance and false-negative rapid diagnostic test results, and led to the establishment of reference genomes for P. vivax and Plasmodium malariae. CONCLUSIONS Our analysis highlights the continuing burden of imported malaria into Australia. Molecular studies have offered valuable insights into drug resistance and diagnostic limitations, and established reference genomes. Integrating molecular data into national surveillance systems could provide important infectious disease intelligence to optimize treatment guidelines for returning travellers and support endemic country surveillance programmes.
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Affiliation(s)
- Asma Sohail
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Department of Infectious Diseases, Grampians Health, Ballarat 3350, Australia
| | - Alyssa Barry
- Institute for Physical and Mental Health and Clinical Translation (IMPACT) and School of Medicine, Deakin University, Geelong 3220, Australia
- Disease Elimination Program, Burnet Institute, Melbourne 3004, Australia
| | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin 0800, Australia
| | - Qin Cheng
- Drug Resistance and Diagnostics, Australian Defence Force Malaria and Infectious Disease Institute, Brisbane 4051, Australia
| | - Colleen L Lau
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
| | - Rogan Lee
- Parasitology Unit, Institute of Clinical Pathology and Medical Research, Sydney 2145, Australia
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin 0800, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Luis Furuya-Kanamori
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
| | - Paolo Bareng
- Institute for Physical and Mental Health and Clinical Translation (IMPACT) and School of Medicine, Deakin University, Geelong 3220, Australia
| | - Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Department of Infectious Diseases, Alfred Health, Melbourne 3004, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Victorian Infectious Diseases Service, Melbourne Health, Melbourne 3052, Australia
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Sohail A, Anders KL, McGuinness SL, Leder K. The epidemiology of imported and locally acquired dengue in Australia, 2012-2022. J Travel Med 2024; 31:taae014. [PMID: 38243558 PMCID: PMC10911064 DOI: 10.1093/jtm/taae014] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Dengue is the most important arboviral disease globally and poses ongoing challenges for control including in non-endemic countries with competent mosquito vectors at risk of local transmission through imported cases. We examined recent epidemiological trends in imported and locally acquired dengue in Australia, where the Wolbachia mosquito population replacement method was implemented throughout dengue-prone areas of northern Queensland between 2011 and 2019. METHODS We analysed dengue cases reported to the Australian National Notifiable Disease Surveillance System between January 2012 and December 2022, and Australian traveller movement data. RESULTS Between 2012 and 2022, 13 343 dengue cases were reported in Australia (median 1466 annual cases); 12 568 cases (94.2%) were imported, 584 (4.4%) were locally acquired and 191 (1.4%) had no origin recorded. Locally acquired cases decreased from a peak in 2013 (n = 236) to zero in 2021-22. Annual incidence of imported dengue ranged from 8.29/100 000 (n = 917 cases) to 22.10/100 000 (n = 2203) annual traveller movements between 2012 and 2019, decreased in 2020 (6.74/100 000 traveller movements; n = 191) and 2021 (3.32/100 000 traveller movements; n = 10) during COVID-19-related border closures, then rose to 34.79/100 000 traveller movements (n = 504) in 2022. Imported cases were primarily acquired in Southeast Asia (n = 9323; 74%), Southern and Central Asia (n = 1555; 12%) and Oceania (n = 1341; 11%). Indonesia (n = 5778; 46%) and Thailand (n = 1483; 12%) were top acquisition countries. DENV-2 (n = 2147; 42%) and DENV-1 (n = 1526; 30%) were predominant serotypes. CONCLUSION Our analysis highlights Australia's successful control of locally acquired dengue with Wolbachia. Imported dengue trends reflect both Australian travel destinations and patterns and local epidemiology in endemic countries.
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Affiliation(s)
- Asma Sohail
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
- Infectious Diseases Department, Grampians Health Service, 1 Drummond Street North, Ballarat, Victoria 3350, Australia
| | - Katherine L Anders
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
- World Mosquito Program, Monash University, 12 Innovation Walk, Clayton, Victoria 3800, Australia
| | - Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
- Infectious Diseases Department, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
- Victorian Infectious Diseases Service, Melbourne Health, 300 Grattan Street, Parkville, Victoria 3050, Australia
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McGuinness SL, Leder K. Dengue severity in travellers: challenges and insights. J Travel Med 2023; 30:taad146. [PMID: 37991398 PMCID: PMC10755200 DOI: 10.1093/jtm/taad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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Kelsall HL, Di Donato MF, McGuinness SL, Collie A, Zhong S, Eades O, Sim MR, Leder K. Workers' compensation claims for COVID-19 among workers in healthcare and other industries during 2020-2022, Victoria, Australia. Occup Environ Med 2023; 80:667-673. [PMID: 37932037 DOI: 10.1136/oemed-2023-108982] [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] [Received: 05/02/2023] [Accepted: 10/05/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE To identify and characterise COVID-19 workers' compensation claims in healthcare and other industries during the pandemic in Victoria, Australia. METHODS We used workers' compensation claims identified as COVID-19 infection related from 1 January 2020 to 31 July 2022 to compare COVID-19 infection claims and rates of claims by industry and occupation, and in relation to Victorian COVID-19 epidemiology. A Cox proportional hazards model assessed risk factors for extended claim duration. RESULTS Of the 3313 direct and indirect COVID-19-related claims identified, 1492 (45.0%) were classified as direct COVID-19 infection accepted time-loss claims and were included in analyses. More than half (52.9%) of COVID-19 infection claims were made by healthcare and social assistance industry workers, with claims for this group peaking in July-October 2020. The overall rate of claims was greater in the healthcare and social assistance industry compared with all other industries (16.9 vs 2.4 per 10 000 employed persons) but industry-specific rates were highest in public administration and safety (23.0 per 10 000 employed persons). Workers in healthcare and social assistance were at increased risk of longer incapacity duration (median 26 days, IQR 16-61 days) than in other industries (median 17 days, IQR 11-39.5 days). CONCLUSIONS COVID-19 infection claims differed by industry, occupational group, severity and timing and changes coincided with different stages of the COVID-19 pandemic. Occupational surveillance for COVID-19 cases is important and monitoring of worker's compensation claims and incapacity duration can contribute to understanding the impacts of COVID-19 on work absence.
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Affiliation(s)
- Helen Louise Kelsall
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael F Di Donato
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The Alfred Hospital Travel Medicine Clinic, Alfred Hospital, Melbourne, Victoria, Australia
| | - Alex Collie
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shannon Zhong
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Owen Eades
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Malcolm Ross Sim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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McGuinness SL, Lau CL, Leder K. Co-circulation of Murray Valley encephalitis virus and Japanese encephalitis virus in south-eastern Australia. J Travel Med 2023; 30:taad059. [PMID: 37185780 PMCID: PMC10658655 DOI: 10.1093/jtm/taad059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Department of Infectious Diseases, The Alfred Hospital, Melbourne 3004, Australia
| | - Colleen L Lau
- School of Public Health, The University of Queensland, Brisbane 4006, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne 3000, Australia
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McGuinness SL, Zhong S, Eades O, Di Donato M, Collie A, Kelsall HL, Leder K. Workplace leave patterns among Victorian health care workers during the COVID-19 pandemic. Intern Med J 2023; 53:1896-1900. [PMID: 37772777 DOI: 10.1111/imj.16238] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/29/2023] [Indexed: 09/30/2023]
Abstract
We analysed aggregate work absences during the coronavirus disease 2019 (COVID-19) pandemic from two Victorian hospital sites and corresponding individual-level survey data to understand changes in the rates and types of workplace absence. We found changing reasons for workplace absences as the pandemic progressed and observed higher rates of annual and sick leave during the months coinciding with increased COVID-19 cases and workforce burnout.
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Affiliation(s)
- Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Shannon Zhong
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Owen Eades
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Michael Di Donato
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alex Collie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helen L Kelsall
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
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McGuinness SL, Eades O, Seale H, Cheng AC, Leder K. Pre-travel vaccine information needs, attitudes, drivers of uptake and the role for decision aids in travel medicine. J Travel Med 2023; 30:taad056. [PMID: 37074157 PMCID: PMC10289516 DOI: 10.1093/jtm/taad056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Many travellers do not receive vaccines pre-travel. Tools such as vaccine decision aids could support informed vaccine decision-making. We aimed to characterise Australians' pre-travel vaccine attitudes, behaviours and information needs and examine the role for decision aids in travel medicine. METHODS Online cross-sectional survey of Australian adults in December 2022. We included questions on demographics, pre-travel health-seeking behaviour, and information needs. We measured vaccine confidence (Vaccine Confidence Index Index) and used hypothetical disease scenarios to evaluate behavioural and social drivers of vaccination. We used multivariable logistic regression models to identify predictors of vaccine uptake and thematically analysed free-text responses. RESULTS We received complete survey responses from 1223/1326 Australians (92% response rate). Amongst those reporting previous overseas travel, 67% (778/1161) reported past pre-travel health encounter(s) and 64% (743/1161) reported past pre-travel vaccination. Half (50%) strongly agreed that vaccines were important for their health; fewer strongly agreed that vaccines were safe (37%) and effective (38%). In multivariable analyses, past pre-travel vaccine uptake was associated with increasing age (OR = 1.17 [95% CI 1.08-1.27] p < 0.001 per ten-year increase) and travel to higher-risk destinations (OR = 2.92 [2.17-3.93] p < 0.001); travellers visiting friends and relatives (VFRs) were less likely to have received pre-travel vaccines (OR = 0.74 [0.56-0.97] p = 0.028). Predictors for wanting vaccination against hypothetical diseases included past pre-travel vaccination (Disease X: OR 2.60 [1.91-3.56] p < 0.001) and confidence in vaccine safety (Disease X: OR 7.18 [5.07-10.18], p < 0.001); past VFR travel was predictive of not wanting vaccination (Disease X: OR 0.72 [0.52-1.00], p = 0.049). Most (63%) were interested in using a vaccine decision aid, generally together with a trusted health professional. CONCLUSIONS Health professionals play an important role in supporting pre-travel vaccine decision-making. However, our findings indicate that reliable, accurate and engaging digital resources, such as decision aids, could support travellers to make informed pre-travel vaccine decisions.
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Affiliation(s)
- Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne 3004, Australia
| | - Owen Eades
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne 3004, Australia
| | - Holly Seale
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney 2052, Australia
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Monash Infectious Diseases Service, Monash Health and School of Clinical Sciences, Monash University, Melbourne 3168, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne 3000, Australia
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McGuinness SL, Eades O, Grantham KL, Zhong S, Johnson J, Cameron PA, Forbes AB, Fisher JR, Hodgson CL, Kasza J, Kelsall H, Kirkman M, Russell GM, Russo PL, Sim MR, Singh K, Skouteris H, Smith K, Stuart RL, Trauer JM, Udy A, Zoungas S, Leder K. Mental health and wellbeing of health and aged care workers in Australia, May 2021 - June 2022: a longitudinal cohort study. Med J Aust 2023; 218:361-367. [PMID: 37032118 DOI: 10.5694/mja2.51918] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 11/28/2022] [Accepted: 12/19/2022] [Indexed: 04/11/2023]
Abstract
OBJECTIVES To assess the mental health and wellbeing of health and aged care workers in Australia during the second and third years of the coronavirus disease 2019 (COVID-19) pandemic, overall and by occupation group. DESIGN, SETTING, PARTICIPANTS Longitudinal cohort study of health and aged care workers (ambulance, hospitals, primary care, residential aged care) in Victoria: May-July 2021 (survey 1), October-December 2021 (survey 2), and May-June 2022 (survey 3). MAIN OUTCOME MEASURES Proportions of respondents (adjusted for age, gender, socio-economic status) reporting moderate to severe symptoms of depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder scale, GAD-7), or post-traumatic stress (Impact of Event Scale-6, IES-6), burnout (abbreviated Maslach Burnout Inventory, aMBI), or high optimism (10-point visual analogue scale); mean scores (adjusted for age, gender, socio-economic status) for wellbeing (Personal Wellbeing Index-Adult, PWI-A) and resilience (Connor Davidson Resilience Scale 2, CD-RISC-2). RESULTS A total of 1667 people responded to at least one survey (survey 1, 989; survey 2, 1153; survey 3, 993; response rate, 3.3%). Overall, 1211 survey responses were from women (72.6%); most respondents were hospital workers (1289, 77.3%) or ambulance staff (315, 18.9%). The adjusted proportions of respondents who reported moderate to severe symptoms of depression (survey 1, 16.4%; survey 2, 22.6%; survey 3, 19.2%), anxiety (survey 1, 8.8%; survey 2, 16.0%; survey 3, 11.0%), or post-traumatic stress (survey 1, 14.6%; survey 2, 35.1%; survey 3, 14.9%) were each largest for survey 2. The adjusted proportions of participants who reported moderate to severe symptoms of burnout were higher in surveys 2 and 3 than in survey 1, and the proportions who reported high optimism were smaller in surveys 2 and 3 than in survey 1. Adjusted mean scores for wellbeing and resilience were similar at surveys 2 and 3 and lower than at survey 1. The magnitude but not the patterns of change differed by occupation group. CONCLUSION Burnout was more frequently reported and mean wellbeing and resilience scores were lower in mid-2022 than in mid-2021 for Victorian health and aged care workers who participated in our study. Evidence-based mental health and wellbeing programs for workers in health care organisations are needed. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12621000533897 (observational study; retrospective).
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Affiliation(s)
| | - Owen Eades
- Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
| | | | - Shannon Zhong
- Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
| | - Josphin Johnson
- Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
| | - Peter A Cameron
- Monash University, Melbourne, VIC
- The Alfred Emergency and Trauma Centre, Alfred Health, Melbourne, VIC
| | | | | | - Carol L Hodgson
- Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
| | | | | | | | | | - Philip L Russo
- Monash University, Melbourne, VIC
- Cabrini Health, Melbourne, VIC
| | | | - Kasha Singh
- The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
- Peninsula Health, Melbourne, VIC
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
| | - Karen Smith
- Monash University, Melbourne, VIC
- Ambulance Service of Victoria, Melbourne, VIC
| | - Rhonda L Stuart
- Monash University, Melbourne, VIC
- Monash Health, Melbourne, VIC
| | | | - Andrew Udy
- Alfred Health, Melbourne, VIC
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC
| | | | - Karin Leder
- Monash University, Melbourne, VIC
- Royal Melbourne Hospital, Melbourne, VIC
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McGuinness SL, Lau CL, Leder K. The evolving Japanese encephalitis situation in Australia and implications for travel medicine. J Travel Med 2023; 30:taad029. [PMID: 36869722 PMCID: PMC10075061 DOI: 10.1093/jtm/taad029] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023]
Abstract
The recent emergence of Japanese encephalitis in south-eastern Australia highlights the changing epidemiology of this important disease and the need for integrated surveillance to inform risk-based discussions and vaccination advice for travellers and endemic populations.
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Affiliation(s)
- Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia
| | - Colleen L Lau
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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McGuinness SL, Josphin J, Eades O, Clifford S, Fisher J, Kirkman M, Russell G, Hodgson CL, Kelsall HL, Lane R, Skouteris H, Smith KL, Leder K. Organizational responses to the COVID-19 pandemic in Victoria, Australia: A qualitative study across four healthcare settings. Front Public Health 2022; 10:965664. [PMID: 36249244 PMCID: PMC9557753 DOI: 10.3389/fpubh.2022.965664] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/07/2022] [Indexed: 01/24/2023] Open
Abstract
Objective Organizational responses that support healthcare workers (HCWs) and mitigate health risks are necessary to offset the impact of the COVID-19 pandemic. We aimed to understand how HCWs and key personnel working in healthcare settings in Melbourne, Australia perceived their employing organizations' responses to the COVID-19 pandemic. Method In this qualitative study, conducted May-July 2021 as part of the longitudinal Coronavirus in Victorian Healthcare and Aged Care Workers (COVIC-HA) study, we purposively sampled and interviewed HCWs and key personnel from healthcare organizations across hospital, ambulance, aged care and primary care (general practice) settings. We also examined HCWs' free-text responses to a question about organizational resources and/or supports from the COVIC-HA Study's baseline survey. We thematically analyzed data using an iterative process. Results We analyzed data from interviews with 28 HCWs and 21 key personnel and free-text responses from 365 HCWs, yielding three major themes: navigating a changing and uncertain environment, maintaining service delivery during a pandemic, and meeting the safety and psychological needs of staff . HCWs valued organizational efforts to engage openly and honesty with staff, and proactive responses such as strategies to enhance workplace safety (e.g., personal protective equipment spotters). Suggestions for improvement identified in the themes included streamlined information processes, greater involvement of HCWs in decision-making, increased investment in staff wellbeing initiatives and sustainable approaches to strengthen the healthcare workforce. Conclusions This study provides in-depth insights into the challenges and successes of organizational responses across four healthcare settings in the uncertain environment of a pandemic. Future efforts to mitigate the impact of acute stressors on HCWs should include a strong focus on bidirectional communication, effective and realistic strategies to strengthen and sustain the healthcare workforce, and greater investment in flexible and meaningful psychological support and wellbeing initiatives for HCWs.
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Affiliation(s)
- Sarah L. McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia,Alfred Health, Melbourne, VIC, Australia,*Correspondence: Sarah L. McGuinness
| | - Johnson Josphin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Owen Eades
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sharon Clifford
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Maggie Kirkman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Grant Russell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Carol L. Hodgson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia,Alfred Health, Melbourne, VIC, Australia
| | - Helen L. Kelsall
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Riki Lane
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Helen Skouteris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Karen L. Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia,Ambulance Victoria, Melbourne, VIC, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia,Royal Melbourne Hospital, Melbourne, VIC, Australia
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McGuinness SL, Johnson J, Eades O, Cameron PA, Forbes A, Fisher J, Grantham K, Hodgson C, Hunter P, Kasza J, Kelsall HL, Kirkman M, Russell G, Russo PL, Sim MR, Singh KP, Skouteris H, Smith KL, Stuart RL, Teede HJ, Trauer JM, Udy A, Zoungas S, Leder K. Mental Health Outcomes in Australian Healthcare and Aged-Care Workers during the Second Year of the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19:ijerph19094951. [PMID: 35564351 PMCID: PMC9103405 DOI: 10.3390/ijerph19094951] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 01/27/2023]
Abstract
Objective: the COVID-19 pandemic has incurred psychological risks for healthcare workers (HCWs). We established a Victorian HCW cohort (the Coronavirus in Victorian Healthcare and Aged-Care Workers (COVIC-HA) cohort study) to examine COVID-19 impacts on HCWs and assess organisational responses over time. Methods: mixed-methods cohort study, with baseline data collected via an online survey (7 May–18 July 2021) across four healthcare settings: ambulance, hospitals, primary care, and residential aged-care. Outcomes included self-reported symptoms of depression, anxiety, post-traumatic stress (PTS), wellbeing, burnout, and resilience, measured using validated tools. Work and home-related COVID-19 impacts and perceptions of workplace responses were also captured. Results: among 984 HCWs, symptoms of clinically significant depression, anxiety, and PTS were reported by 22.5%, 14.0%, and 20.4%, respectively, highest among paramedics and nurses. Emotional exhaustion reflecting moderate–severe burnout was reported by 65.1%. Concerns about contracting COVID-19 at work and transmitting COVID-19 were common, but 91.2% felt well-informed on workplace changes and 78.3% reported that support services were available. Conclusions: Australian HCWs employed during 2021 experienced adverse mental health outcomes, with prevalence differences observed according to occupation. Longitudinal evidence is needed to inform workplace strategies that support the physical and mental wellbeing of HCWs at organisational and state policy levels.
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Affiliation(s)
- Sarah L. McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Alfred Health, Melbourne, VIC 3004, Australia
- Correspondence:
| | - Josphin Johnson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Alfred Health, Melbourne, VIC 3004, Australia
| | - Owen Eades
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Alfred Health, Melbourne, VIC 3004, Australia
| | - Peter A. Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Alfred Health, Melbourne, VIC 3004, Australia
| | - Andrew Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Kelsey Grantham
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Carol Hodgson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Alfred Health, Melbourne, VIC 3004, Australia
| | - Peter Hunter
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Alfred Health, Melbourne, VIC 3004, Australia
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Helen L. Kelsall
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Maggie Kirkman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Grant Russell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Philip L. Russo
- School of Nursing and Midwifery, Monash University, Melbourne, VIC 3800, Australia;
- Cabrini Health, Melbourne, VIC 3144, Australia
| | - Malcolm R. Sim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Kasha P. Singh
- Peninsula Health, Melbourne, VIC 3199, Australia;
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC 3000, Australia
| | - Helen Skouteris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Karen L. Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Ambulance Victoria, Melbourne, VIC 3108, Australia
| | - Rhonda L. Stuart
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Monash Health, Melbourne, VIC 3168, Australia
| | - Helena J. Teede
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Monash Health, Melbourne, VIC 3168, Australia
| | - James M. Trauer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Andrew Udy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Alfred Health, Melbourne, VIC 3004, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Alfred Health, Melbourne, VIC 3004, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
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Eisen DP, Leder K, Woods RL, Lockery JE, McGuinness SL, Wolfe R, Pilcher D, Moore EM, Shastry A, Nelson MR, Reid CM, McNeil JJ, McBryde ES. Effect of aspirin on deaths associated with sepsis in healthy older people (ANTISEPSIS): a randomised, double-blind, placebo-controlled primary prevention trial. Lancet Respir Med 2020; 9:186-195. [PMID: 32950072 DOI: 10.1016/s2213-2600(20)30411-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/06/2020] [Accepted: 08/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sepsis is a serious global health issue and a major cause of death and disability. The availability of a simple, community-based preventive strategy could substantially reduce the burden of sepsis. We aimed to establish whether low-dose aspirin reduced deaths or hospital admissions associated with sepsis in older people. METHODS ANTISEPSIS was a substudy of ASPREE (a randomised controlled primary prevention trial of low-dose aspirin [100 mg per day] compared with placebo in community dwelling older adults conducted in Australia and the USA), with the Australian cohort included in the ANTISEPSIS substudy. Inclusion criteria were participants aged at least 70 years who did not have major illnesses. Participants were block randomised (1:1) via a centralised web portal and stratified by general practice and age. Participants, investigators, and staff were masked to the intervention. Teams of clinical specialist investigators assessed potential sepsis events to establish if they satisfied the primary endpoint of death associated with sepsis. The analyses were by intention-to-treat with univariate survival analysis methods, the log-rank test, and Cox proportional hazards regression. This study is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613000349741. RESULTS Between March 10, 2010, and Dec 24, 2014, of 20 288 individuals assessed for eligibility, 16 703 participants aged 70 years and older at trial entry were enrolled and followed up for a median of 4·6 years (IQR 3·6-5·6). 8322 (49·8%) participants were assigned to receive aspirin and 8381 (50·2%) to placebo. 203 deaths were considered to be associated with sepsis. Univariate analysis showed similar rates of death associated with sepsis in the two study groups (hazard ratio for aspirin vs placebo 1·08, 95% CI 0·82-1·43; p=0·57). Adverse events were previously reported in the ASPREE trial. INTERPRETATION Daily low-dose aspirin treatment did not reduce deaths associated with sepsis in community dwelling older adults. Our findings do not support the use of aspirin as a primary prevention strategy to reduce the burden of sepsis in this population. FUNDING National Health and Medical Research Council of Australia, National Institutes of Health, Monash University.
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Affiliation(s)
- Damon P Eisen
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jessica E Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Infectious Diseases, Alfred Health, Prahran, VIC, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - David Pilcher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care, Alfred Health, Prahran, VIC, Australia
| | - Elizabeth M Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Adithya Shastry
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; The School of Public Health, Curtin University, Bentley, WA, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Emma S McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Douglas, QLD, Australia
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Muhi S, Ko DK, McGuinness SL, Biggs BA, Mahanty S, Delany C. A mixed-method analysis of screening for Strongyloides stercoralis prior to immunosuppression: A problem of limited bandwidth? Intern Med J 2020; 52:790-799. [PMID: 32687250 DOI: 10.1111/imj.14991] [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: 05/07/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Guidelines recommend screening for strongyloidiasis prior to immunosuppression in those at epidemiological risk, as hyperinfection following immunosuppression is often fatal. The uptake of this recommendation is unknown, and we aimed to explore this in our setting. AIMS Determine the proportion of adult patients at epidemiological risk for strongyloidiasis who were screened prior to immunosuppression at the Royal Melbourne Hospital, Explore the factors that influenced clinicians' decision to screen for strongyloidiasis prior to immunosuppression. METHODS This study used a mixed-methods approach. First, a 12-month (1 January 2018 to 1 January 2019) retrospective observational study was used to quantify the proportion of those at epidemiological risk who were screened prior to immunosuppression, while also identifying variables that were positively or negatively associated with screening. Second, clinicians from relevant specialties were recruited for focus group sessions to explore factors that influenced their decision to screen according to an interpretivist framework. RESULTS 230 newly immunosuppressed patients at epidemiological risk of strongyloidiasis were identified, of whom 87 (37.8%) were screened prior to immunosuppression. In multivariate analysis, older patients, outpatients and people from non-English speaking backgrounds were significantly less likely to be screened. In focus groups, a number of barriers and enablers to screening were identified. Notably, clinicians reported that a major barrier was the cognitive load required to clinically reason about this uncommon disease, in addition to other priorities. CONCLUSION We identified many missed opportunities to screen patients at risk of hyperinfection, particularly those most vulnerable. To improve screening, this study highlights the importance of reducing cognitive load by using decision-support tools, which may facilitate screening in vulnerable patients and in time-constrained settings. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Stephen Muhi
- The Royal Melbourne Hospital, Victorian Infectious Diseases Service
| | - Dong-Kyoon Ko
- The Royal Melbourne Hospital, Victorian Infectious Diseases Service
| | - Sarah L McGuinness
- Department of Infectious Diseases at the Alfred Hospital.,School of Public Health and Preventative Medicine, Monash University
| | - Beverley-Ann Biggs
- The Royal Melbourne Hospital, Victorian Infectious Diseases Service.,Department of Medicine at the Peter Doherty Institute, University of Melbourne
| | | | - Clare Delany
- Department of Medical Education at The University of Melbourne
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McGuinness SL, O'Toole J, Forbes AB, Boving TB, Patil K, D'Souza F, Gaonkar CA, Giriyan A, Barker SF, Cheng AC, Sinclair M, Leder K. A Stepped Wedge Cluster-Randomized Trial Assessing the Impact of a Riverbank Filtration Intervention to Improve Access to Safe Water on Health in Rural India. Am J Trop Med Hyg 2020; 102:497-506. [PMID: 31264565 DOI: 10.4269/ajtmh.19-0260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Sustainable and low-cost methods for delivery of safe drinking water in resource-limited settings remain suboptimal, which contributes to global diarrhea morbidity. We aimed to assess whether delivery of riverbank filtration-treated water to newly installed water storage tanks (improved quality and access, intervention condition) reduced reported diarrhea in comparison to delivery of unfiltered river water (improved access alone, control condition) in rural Indian villages. We used a stepped wedge cluster-randomized trial (SW-CRT) design involving four clusters (villages). Selection criteria included village size, proximity to a river, and lack of existing or planned community-level safe water sources. All adults and children were eligible for enrollment. All villages started in the control condition and were sequentially randomized to receive the intervention at 3-month intervals. Our primary outcome was 7-day-period prevalence of self- or caregiver-reported diarrhea, measured at 3-month intervals (five time points). Analysis was by intention to treat. Because blinding was not possible, we incorporated questions about symptoms unrelated to water consumption to check response validity (negative control symptoms). We measured outcomes in 2,222 households (9,836 participants). We did not find a measurable reduction in diarrhea post-intervention (RR: 0.98 [95% CI: 0.24-4.09]); possible explanations include low intervention uptake, availability of other safe water sources, low baseline diarrheal prevalence, and reporting fatigue. Our study highlights both the difficulties in evaluating the impact of real-world interventions and the potential for an optimized SW-CRT design to address budgetary, funding, and logistical constraints inherent in such evaluations.
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Affiliation(s)
- Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne O'Toole
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew B Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Thomas B Boving
- Department of Civil and Environmental Engineering, University of Rhode Island, Kingston, Rhode Island.,Department of Geosciences, University of Rhode Island, Kingston, Rhode Island
| | - Kavita Patil
- The Energy and Resources Institute (TERI), Goa, India
| | | | | | - Asha Giriyan
- The Energy and Resources Institute (TERI), Goa, India
| | - S Fiona Barker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Martha Sinclair
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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McGuinness SL, O'Toole J, Barker SF, Forbes AB, Boving TB, Giriyan A, Patil K, D'Souza F, Vhaval R, Cheng AC, Leder K. Household Water Storage Management, Hygiene Practices, and Associated Drinking Water Quality in Rural India. Environ Sci Technol 2020; 54:4963-4973. [PMID: 32167297 DOI: 10.1021/acs.est.9b04818] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Household drinking water storage is commonly practiced in rural India. Fecal contamination may be introduced at the water source, during collection, storage, or access. Within a trial of a community-level water supply intervention, we conducted five quarterly household-level surveys to collect information about water, sanitation, and hygiene practices in rural India. In a random subsample of households, we tested stored drinking water samples for Escherichia coli, concurrently observing storage and access practices. We conducted 9961 surveys and collected 3296 stored water samples. Stored water samples were frequently contaminated with E. coli (69%), and E. coli levels were the highest during the wet season. Most households contributing two or more drinking water samples had detectable E. coli in some (47%) or all (44%) samples. Predictors of stored water contamination with E. coli included consumption of river water and open defecation; consumption of reverse osmosis-treated water and safe water access practices appeared to be protective. Until households can be reached with on-premises continuous safe water supplies, suboptimal household water storage practices are likely to continue. Improvements to source water quality alone are unlikely to prevent exposure to contaminated drinking water unless attention is also given to improving household water storage, access, and sanitation practices.
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Affiliation(s)
- Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Joanne O'Toole
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - S Fiona Barker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Andrew B Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Thomas B Boving
- Department of Geosciences & Department of Civil and Environmental Engineering, University of Rhode Island, Kingston, Rhode Island 02281, United States
| | - Asha Giriyan
- The Energy and Resources Institute (TERI), Southern Regional Centre, Santa Cruz, Goa 403005, India
| | - Kavita Patil
- The Energy and Resources Institute (TERI), Southern Regional Centre, Santa Cruz, Goa 403005, India
| | - Fraddry D'Souza
- The Energy and Resources Institute (TERI), Southern Regional Centre, Santa Cruz, Goa 403005, India
| | - Ramkrishna Vhaval
- The Energy and Resources Institute (TERI), Southern Regional Centre, Santa Cruz, Goa 403005, India
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
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McGuinness SL, O'Toole J, Ayton D, Giriyan A, Gaonkar CA, Vhaval R, Cheng AC, Leder K. Barriers and Enablers to Intervention Uptake and Health Reporting in a Water Intervention Trial in Rural India: A Qualitative Explanatory Study. Am J Trop Med Hyg 2020; 102:507-517. [PMID: 31933461 DOI: 10.4269/ajtmh.19-0486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Consumption of unsafe drinking water contributes to the global disease burden, necessitating identification and implementation of effective, acceptable, and sustainable water interventions in resource-limited settings. In a quantitative stepped-wedge cluster randomized trial of a community-based water intervention in rural India, we identified low rates of intervention uptake and reported diarrhea. To better understand and explain these findings, we performed a qualitative study examining barriers and enablers to intervention uptake and health reporting using the COM-B model, where capabilities, opportunities, and motivators interact to generate behavior. We conducted 20 focus groups and one semi-structured interview with participants and four focus groups with data collectors. Multifactorial barriers to intervention uptake included distorted perceptions of water-related health effects, implementation issues that reduced treated water availability; convenience of, and preference for, alternative drinking water sources; delivery of water to plastic storage tanks (perceived as affecting water quality and taste); and resistance to change. Enablers included knowledge of water-related health risks, proximity to tanks, and social opportunity. Barriers to health reporting included variability in interpretation of illness, suspicion regarding the consequences of reporting disease, weariness with repeated questions, and perceived inaction on health data already provided; low survey implementation fidelity was also important. Enablers included surveyor initiatives to encourage reporting and a sense of social responsibility. This qualitative explanatory study allowed better understanding of our quantitative results. It also identified obstacles and facilitators to implementing and evaluating community water interventions, providing insight on how to achieve better intervention uptake and health reporting in future studies.
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Affiliation(s)
- Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne O'Toole
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Darshini Ayton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Asha Giriyan
- The Energy and Resources Institute (TERI), Panaji, India
| | | | | | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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18
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Sohail A, McGuinness SL, Lightowler R, Leder K, Jomon B, Bain CA, Peleg AY. Spectrum of illness among returned Australian travellers from Bali, Indonesia: a 5-year retrospective observational study. Intern Med J 2019; 49:34-40. [PMID: 29869360 DOI: 10.1111/imj.13993] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 05/02/2018] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bali, Indonesia, presents significant infectious and non-infectious health risks for Australian travellers. Understanding this spectrum of illnesses has the potential to assist clinicians in evaluating unwell returning travellers and guide provision of pre-travel advice. AIM To describe the spectrum of illnesses seen in returned travellers from Bali. METHODS Using a novel text mining approach, we performed a retrospective, observational study of all adult emergency department presentations to a metropolitan health service in Melbourne, from 2011 to 2015. Outcome measures included demographic, clinical and laboratory features of travel-related illnesses. RESULTS A total of 464 patients met inclusion criteria. Gastroenteritis (119/464, 26%), systemic febrile illness (88/464, 19%) and respiratory tract infection (51/464, 11%) were the most common diagnoses. Dengue was the most common laboratory-confirmed diagnosis (25/464, 5%). No cases of malaria were identified. Common non-infectious presentations included traumatic injury (47/464, 10%) and animal bites requiring rabies post-exposure prophylaxis (29/464, 6%). A total of 110 patients (24%) was admitted to the hospital; those presenting with systemic febrile illness were more likely to be admitted compared to those presenting with other illnesses (odds ratio 3.42, 95% confidence interval 2.02-5.75, P < 0.001). CONCLUSION This is the first study to use a text mining approach to identify and describe emergency department presentations related to diseases acquired in Bali by Australian travellers. Although infections are important causes of illness, trauma and animal bites account for a significant number of hospital presentations. Our findings contribute to the knowledge on the health risks for travellers to Bali, and will assist clinicians in relevant pre- and post-travel evaluations.
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Affiliation(s)
- Asma Sohail
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Sarah L McGuinness
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rachel Lightowler
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Karin Leder
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.,Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Bismi Jomon
- AKM-Information Development Division, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Christopher A Bain
- School of Population Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Faculty of Information Technology, Monash University, Melbourne, Victoria, Australia
| | - Anton Y Peleg
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.,Biomedicine Discovery Institute, Department of Microbiology, Monash University, Melbourne, Victoria, Australia
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19
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Cornelisse VJ, Wright EJ, Fairley CK, McGuinness SL. Sexual safety and HIV prevention in travel medicine: Practical considerations and new approaches. Travel Med Infect Dis 2018; 28:68-73. [PMID: 30562582 DOI: 10.1016/j.tmaid.2018.12.006] [Citation(s) in RCA: 6] [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] [Received: 06/22/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 11/25/2022]
Abstract
Travellers who engage in sexual contact with a new sexual partner abroad may be at high risk of HIV and other sexually transmitted infections (STIs), but these risks can be reduced through appropriate planning during the pre-travel clinic visit. Here we discuss strategies available to the clinician to maximise travellers' sexual safety during travel. Strategies may include immunizations, condoms, HIV pre-exposure prophylaxis (PrEP), HIV post-exposure prophylaxis (PEP), self-initiated treatment of symptomatic bacterial STIs, post-exposure prophylaxis for bacterial STIs and hormonal contraception. We discuss the role of these different strategies for travellers, and provide resources to assist clinicians in making clinical decisions and in educating travellers about sexual safety.
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Affiliation(s)
- Vincent J Cornelisse
- Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Department of Infectious Diseases, The Alfred Hospital, Alfred Health, Melbourne, Australia.
| | - Edwina J Wright
- Central Clinical School, Monash University, Melbourne, Australia; Department of Infectious Diseases, The Alfred Hospital, Alfred Health, Melbourne, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Sarah L McGuinness
- Department of Infectious Diseases, The Alfred Hospital, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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20
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McGuinness SL, Barker SF, O'Toole J, Cheng AC, Forbes AB, Sinclair M, Leder K. Effect of hygiene interventions on acute respiratory infections in childcare, school and domestic settings in low- and middle-income countries: a systematic review. Trop Med Int Health 2018; 23:816-833. [PMID: 29799658 DOI: 10.1111/tmi.13080] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 12/01/2022]
Abstract
OBJECTIVES Acute respiratory infections (ARIs) disproportionately affect those living in low- and middle-income countries (LMICs). We aimed to determine whether hygiene interventions delivered in childcare, school or domestic settings in LMICs effectively prevent or reduce ARIs. METHODS We registered our systematic review with PROSPERO (CRD42017058239) and searched MEDLINE, EMBASE, CENTRAL, and Scopus from inception to 17 October 2017 for randomised controlled trials (RCTs) examining the impact of hygiene interventions on ARI morbidity in adults and children in community-based settings in LMICs. We stratified data into childcare, school and domestic settings and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess evidence quality. RESULTS We identified 14 cluster RCTs evaluating hand-hygiene interventions in LMICs with considerable heterogeneity in setting, size, intervention delivery and duration. We found reduced ARI-related absenteeism and illness in childcare settings (low- to moderate-quality evidence). In school settings, we found reduced ARI-related absenteeism and laboratory-confirmed influenza (moderate- to high-quality evidence), but no reduction in ARI illness (low-quality evidence). In domestic settings, we found reduced ARI illness and pneumonia amongst children in urban settlements (high-quality evidence) but not in rural settlements (low-quality evidence), and no effect on secondary transmission of influenza in households (moderate-quality evidence). CONCLUSIONS Evidence suggests that hand-hygiene interventions delivered in childcare, school and domestic settings can reduce ARI morbidity, but effectiveness varies according to setting, intervention target and intervention compliance. Further studies are needed to develop, deliver and evaluate targeted and sustainable hygiene interventions in LMICs.
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Affiliation(s)
- Sarah L McGuinness
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC, Australia
| | - S Fiona Barker
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joanne O'Toole
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Allen C Cheng
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC, Australia
| | - Andrew B Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Martha Sinclair
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Karin Leder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia
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21
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Leder K, Borwein S, Chanthavanich P, Chatterjee S, Htun K, Marma ASP, Nakatani I, Ok JJ, Pakasi L, Pandey P, Piyaphanee W, Rupali P, Schwartz E, Shinozuka T, Phu PTH, Watanabe H, Visser J, Wilder-Smith A, Zhang M, McGuinness SL. Travel medicine perspectives of select travel medicine experts practicing in the Asia-Pacific region. J Travel Med 2017; 24:3095984. [PMID: 28426112 DOI: 10.1093/jtm/tax012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 02/07/2017] [Indexed: 11/14/2022]
Affiliation(s)
- Karin Leder
- School of Public Health and Preventive Medicine, Monash University and Victorian Infectious Disease Service, Royal Melbourne Hospital at the Doherty Institute, Melbourne, Australia
| | | | - Pornthep Chanthavanich
- Department of Tropical Paediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Kaythi Htun
- Directorate of Defence Medical Services, Myanmar
| | | | | | - Jin-Ju Ok
- Travel Clinic, International Health Care Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | | | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Eli Schwartz
- Center for Geographic Medicine and Tropical Diseases, Chaim Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tadashi Shinozuka
- Japanese society of Travel Medicine and Srndagaya International Clinic, Tokyo, Japan
| | | | - Hiroshi Watanabe
- Department of Infection Control and Prevention, Kurume University School of Medicine, Japan
| | | | | | - Min Zhang
- Guangdong International Healthcare Center, Guangzhou, China
| | - Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University and Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia
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22
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Turner DP, McGuinness SL, Cohen J, Waring LJ, Leder K. Use of pre-travel vaccine-preventable disease serology as a screening tool to identify patients in need of pre-travel vaccination: a retrospective audit. J Travel Med 2017; 24:3062777. [PMID: 28355621 DOI: 10.1093/jtm/tax011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND Vaccination is a safe and effective public health intervention that not only protects individual travellers from vaccine-preventable diseases (VPDs), but prevents them from becoming a source of disease in their destination and on their return. Obtaining an accurate vaccination history from travellers during a pre-travel review can be difficult; serology may be used to identify patients who are non-immune to specific diseases in order to guide vaccination requirements. Clinically relevant data about the usefulness of serology in this setting are lacking. We performed a retrospective audit of pre-travel VPD serology requested by practitioners of a busy community-based travel clinic. METHODS All serological results for measles, mumps, rubella, varicella zoster virus, hepatitis A and B requested over a 5-year period were extracted and analysed. Results were stratified by gender and year of birth and compared using Stata. RESULTS Four thousand four hundred and fifty-one serological assays from 1445 individual were assessed. Overall, 47% of patients tested had at least one negative serological result. High rates of seropositivity for measles, mumps and rubella were seen in those born prior to 1966 but >10% of travellers born after 1966 lacked serological evidence of protection against these diseases. Hepatitis A and B serological results revealed broadly lower rates of immunity in our community likely reflecting the absence of these vaccines from historical vaccine protocols. CONCLUSIONS Serology can be a useful tool in the identification of non-immune travellers to enable targeted vaccination prior to travel. We recommend that travel health clinicians assess patients' vaccination and infection histories, and strongly consider serology or vaccination where there is doubt about immunity. This will help protect the traveller and prevent importation of disease into destination or home communities.
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Affiliation(s)
- David P Turner
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University and Infectious Diseases Department, Alfred Hospital, Melbourne, VIC, Australia
| | | | - Lynette J Waring
- Department of Microbiology and Immunoserology, Melbourne Pathology, Collingwood, VIC, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University and Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, Australia
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23
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Tai AY, McGuinness SL, Robosa R, Turner D, Huang GKL, Leder K, Korman TM, Thevarajan I, Stewardson AJ, Padiglione AA, Johnson DF. Management of dengue in Australian travellers: a retrospective multicentre analysis. Med J Aust 2017; 206:295-300. [PMID: 28403751 DOI: 10.5694/mja16.01056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 12/01/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the epidemiology, clinical and laboratory features and outcomes of dengue in returned Australian travellers, applying the revised WHO dengue classification (2009) to this population. DESIGN, SETTING AND PARTICIPANTS Retrospective case series analysis of confirmed dengue cases hospitalised at one of four Australian tertiary hospitals, January 2012 - May 2015. MAIN OUTCOME MEASURES Clinical features, laboratory findings and outcomes of patients with dengue; dengue classification according to 2009 WHO guidelines. RESULTS 208 hospitalised patients (median age, 32 years; range, 4-76 years) were included in the study. Dengue was most frequently acquired in Indonesia (94 patients, 45%) and Thailand (40, 19%). The most common clinical features were fever (98% of patients) and headache (76%). 84 patients (40%) met the WHO criteria for dengue with warning signs, and one the criteria for severe dengue; the most common warning signs were mucosal bleeding (44 patients, 21%) and abdominal pain (43, 21%). Leukopenia (176 patients, 85%), thrombocytopenia (133, 64%), and elevated liver enzyme levels (154, 76%) were the most common laboratory findings. 46 patients (22%) had serological evidence of previous exposure to dengue virus. WHO guidelines were documented as a management benchmark in ten cases (5%); 46 patients (22%) received non-steroidal anti-inflammatory drugs (NSAIDs). CONCLUSIONS A significant proportion of returning Australian travellers hospitalised for dengue have unrecognised warning signs of severe disease. Many received NSAIDs, which can increase the risk of haemorrhage in dengue. As travel to Asia from Australia continues to increase, it is vital for averting serious outcomes that clinicians can recognise and manage dengue.
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Affiliation(s)
| | | | - Roselle Robosa
- Monash Infectious Diseases, Monash Health and Monash University, Melbourne, VIC
| | - David Turner
- Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, VIC
| | | | - Karin Leder
- Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, VIC
| | - Tony M Korman
- Monash Infectious Diseases, Monash Health and Monash University, Melbourne, VIC
| | - Irani Thevarajan
- Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, VIC
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McGuinness SL, O'Toole JE, Boving TB, Forbes AB, Sinclair M, Gautam SK, Leder K. Protocol for a cluster randomised stepped wedge trial assessing the impact of a community-level hygiene intervention and a water intervention using riverbank filtration technology on diarrhoeal prevalence in India. BMJ Open 2017; 7:e015036. [PMID: 28314746 PMCID: PMC5372111 DOI: 10.1136/bmjopen-2016-015036] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Diarrhoea is a leading cause of death globally, mostly occurring as a result of insufficient or unsafe water supplies, inadequate sanitation and poor hygiene. Our study aims to investigate the impact of a community-level hygiene education program and a water quality intervention using riverbank filtration (RBF) technology on diarrhoeal prevalence. METHODS AND ANALYSIS We have designed a stepped wedge cluster randomised trial to estimate the health impacts of our intervention in 4 rural villages in Karnataka, India. At baseline, surveys will be conducted in all villages, and householders will receive hygiene education. New pipelines, water storage tanks and taps will then be installed at accessible locations in each village and untreated piped river water will be supplied. A subsequent survey will evaluate the impact of hygiene education combined with improved access to greater water volumes for hygiene and drinking purposes (improved water quantity). Villages will then be randomly ordered and RBF-treated water (improved water quality) will be sequentially introduced into the 4 villages in a stepwise manner, with administration of surveys at each time point. The primary outcome is a 7-day period prevalence of self-reported diarrhoea. Secondary outcomes include self-reported respiratory and skin infections, and reported changes in hygiene practices, household water usage and water supply preference. River, tank and tap water from each village, and stored water from a subset of households, will be sampled to assess microbial and chemical quality. ETHICS AND DISSEMINATION Ethics approval was obtained from the Monash University Human Research Ethics Committee in Australia and The Energy and Resources Institute Institutional Ethics Committee in India. The results of the trial will be presented at conferences, published in peer-reviewed journals and disseminated to relevant stakeholders. This study is funded by an Australian National Health and Medical Research Council (NHMRC) project grant. TRIAL REGISTRATION NUMBER ACTRN12616001286437; pre-results.
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Affiliation(s)
- Sarah L McGuinness
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne E O'Toole
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Thomas B Boving
- Department of Civil and Environmental Engineering and Geosciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Andrew B Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Martha Sinclair
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sumit K Gautam
- The Energy and Resources Institute (TERI), Bangalore, Karnataka, India
| | - Karin Leder
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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25
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McGuinness SL, Whiting SE, Baird R, Currie BJ, Ralph AP, Anstey NM, Price RN, Davis JS, Tong SYC. Nocardiosis in the Tropical Northern Territory of Australia, 1997-2014. Open Forum Infect Dis 2016; 3:ofw208. [PMID: 27942539 PMCID: PMC5144655 DOI: 10.1093/ofid/ofw208] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/05/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nocardia is an opportunistic pathogen that can cause life-threatening disease. We aimed to characterize the epidemiological, microbiological, and clinical features of nocardiosis in the tropical north of Australia. METHODS We conducted a retrospective cohort study of nocardiosis diagnosed between 1997 and 2014. Population-based incidences were calculated using district population data. RESULTS Clinically significant nocardiosis was identified in 61 patients. The unadjusted population-based annual incidence of nocardiosis was 2.02 (95% confidence interval [CI], 1.55-2.60) per 100000 people and was 1.7 (95% CI, .96-2.90) fold higher in Indigenous compared with non-Indigenous persons (P = .027). Of 61 patients, 47 (77%) had chronic lung disease, diabetes, and/or hazardous alcohol consumption; 22 (36%) were immunocompromised; and 8 (13%) had no identified comorbidities. Disease presentations included pulmonary (69%; 42 of 61), cutaneous (13%; 8 of 61), and disseminated nocardiosis (15%; 9 of 61). The most commonly identified species were Nocardia asteroides and Nocardia cyriacigeorgica (each 11%). Linezolid was the only antimicrobial to which isolates were universally susceptible; 89% (48 of 54), 60% (32 of 53), and 48% (26 of 54) of isolates were susceptible to trimethoprim-sulfamethoxazole, ceftriaxone, and imipenem, respectively. Eighteen patients (30%) required intensive care unit (ICU) admission, and 1-year mortality was 31%. CONCLUSIONS The incidence of nocardiosis in tropical Australia is amongst the highest reported globally. Nocardiosis occurs in both immunocompromised and immunocompetent hosts, and it is associated with high rates of ICU admission, 1-year mortality, and resistance to commonly recommended antimicrobials. Diagnosis should be considered in patients with consistent clinical features, particularly if they are Indigenous or have chronic lung disease.
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Affiliation(s)
| | | | - Rob Baird
- Department of Infectious Diseases and; Territory Pathology, Royal Darwin Hospital, Darwin, Australia
| | - Bart J Currie
- Department of Infectious Diseases and; Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Anna P Ralph
- Department of Infectious Diseases and; Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Nicholas M Anstey
- Department of Infectious Diseases and; Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Ric N Price
- Department of Infectious Diseases and; Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Australia;; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Joshua S Davis
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Australia;; Department of Infectious Diseases, John Hunter Hospital, Newcastle, Australia
| | - Steven Y C Tong
- Department of Infectious Diseases and; Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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26
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McGuinness SL, Boyd R, Kidd S, McLeod C, Krause VL, Ralph AP. Epidemiological investigation of an outbreak of cutaneous sporotrichosis, Northern Territory, Australia. BMC Infect Dis 2016; 16:16. [PMID: 26758905 PMCID: PMC4711041 DOI: 10.1186/s12879-016-1338-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 01/06/2016] [Indexed: 01/24/2023] Open
Abstract
Background An outbreak of cutaneous sporotrichosis occurred in the Darwin region of the Northern Territory (NT) in 2014. We aimed to determine the source and risk factors associated with the outbreak and describe the clinical spectrum of cases seen. Methods Epidemiological investigation of cases of cutaneous sporotrichosis identified through the Royal Darwin Hospital was undertaken to investigate risk factors and potential sources of infection. Data were collected through chart review and individual patient interviews. Environmental investigation followed identification of a common risk factor. Results Nine confirmed cases of cutaneous sporotrichosis caused by Sporothrix schenckii were identified with onset of symptoms between April and July 2014. Patients were aged 29 to 70 years and seven were male (78 %). Two strains of S. schenckii were identified, neither of which have been previously documented. One common risk factor was identified: all patients were occupational or recreational gardeners, with each reporting exposure to mulching hay, originating from a single NT farm. Local environmental health officers visited the farm and the owners confirmed that the implicated hay had been stored over the monsoon season and had been affected by rain. Storage of hay over the wet season was a new practice. Conclusions This constitutes the third reported outbreak of S. schenckii sporotrichosis attributable to contaminated hay in Australia and the first outbreak of sporotrichosis in the NT. This outbreak prompted public health interventions, including distribution of information to general practitioners, farmers and suppliers in the Top End. Media reporting led to the identification and treatment of an additional case. Local practitioners should remain alert to the possibility of further occurrences of sporotrichosis.
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Affiliation(s)
- Sarah L McGuinness
- Centre for Disease Control, Department of Health, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia
| | - Rowena Boyd
- Centre for Disease Control, Department of Health, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia
| | - Sarah Kidd
- National Mycology Reference Centre, Microbiology & Infectious Diseases, SA Pathology, Frome Road, Adelaide, SA, 5000, Australia
| | - Charlie McLeod
- Royal Darwin Hospital, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia
| | - Vicki L Krause
- Centre for Disease Control, Department of Health, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia
| | - Anna P Ralph
- Royal Darwin Hospital, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia. .,Global and Tropical Health, Menzies School of Health Research, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia.
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McGuinness SL, Spelman T, Johnson DF, Leder K. Response to Letter. J Travel Med 2015; 22:429-30. [PMID: 26503097 DOI: 10.1111/jtm.1_12238] [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] [Received: 07/13/2015] [Accepted: 08/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah L McGuinness
- Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Melbourne, Australia
| | - Tim Spelman
- Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Melbourne, Australia
| | - Douglas F Johnson
- Department of General Medicine and Infectious Diseases, Austin Health, Melbourne, Australia
| | - Karin Leder
- Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Melbourne, Australia.,Infectious Disease Epidemiology Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Turner D, McGuinness SL, McGuiness S, Leder K. Leprosy: diagnosis and management in a developed setting. Intern Med J 2015; 45:109-12. [PMID: 25582940 DOI: 10.1111/imj.12638] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 05/25/2014] [Accepted: 08/18/2014] [Indexed: 11/30/2022]
Abstract
Leprosy remains an important global health concern, but little has been published about its diagnosis and management in developed settings. It has been postulated that delay in diagnosis is common in developed settings. We reviewed all the cases of leprosy seen at a major tertiary referral centre between 1999 and 2013 and demonstrated that delay in diagnosis is common, especially when patients present with symptoms of leprosy reactions rather than classical symptoms, such as hypo-pigmented hypo-aesthetic skin lesions and neuropathy.
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Affiliation(s)
- D Turner
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Blyth CC, Gilroy NM, Guy SD, Chambers ST, Cheong EY, Gottlieb T, McGuinness SL, Thursky KA. Consensus guidelines for the treatment of invasive mould infections in haematological malignancy and haemopoietic stem cell transplantation, 2014. Intern Med J 2015; 44:1333-49. [PMID: 25482744 DOI: 10.1111/imj.12598] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [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: 11/29/2022]
Abstract
Mould species represent the pathogens most commonly associated with invasive fungal disease in patients with haematological malignancies and patients of haemopoietic stem cell transplants. Invasive mould infections in these patient populations, particularly in the setting of neutropenia, are associated with high morbidity and mortality, and significantly increase the complexity of management. While Aspergillus species remain the most prevalent cause of invasive mould infections, Scedosporium and Fusarium species and the Mucormycetes continue to place a significant burden on the immunocompromised host. Evidence also suggests that infections caused by rare and emerging pathogens are increasing within the setting of broad-spectrum antifungal prophylaxis and improved survival times placing immunosuppressed patients at risk for longer. These guidelines present evidence-based recommendations for the antifungal management of common, rare and emerging mould infections in both adult and paediatric populations. Where relevant, the role of surgery, adjunctive therapy and immunotherapy is also discussed.
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Affiliation(s)
- C C Blyth
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia; Department of General Paediatrics, Princess Margaret Hospital for Children, Subiaco, Western Australia; PathWest Laboratory Medicine WA, Subiaco, Western Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia
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McGuinness SL, Spelman T, Johnson DF, Leder K. Immediate recall of health issues discussed during a pre-travel consultation. J Travel Med 2015; 22:145-51. [PMID: 25594824 DOI: 10.1111/jtm.12183] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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] [Received: 09/04/2014] [Revised: 10/24/2014] [Accepted: 10/27/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND An important role of pre-travel consultations is to improve travelers' understanding of travel-related diseases, but the efficacy of education provided is unknown. This study sought to assess recall and knowledge immediately following a pre-travel consultation. METHODS The study was conducted at a hospital-based pre-travel clinic in Melbourne, Australia. Travelers aged ≥16 years seen between September 2010 and March 2012 were invited to complete an anonymous self-administered questionnaire immediately following their consultation to assess knowledge of appropriate preventive measures and presumptive self-treatment strategies for common travel risks. The doctor of each participating traveler also completed a survey regarding issues discussed. RESULTS A total of 300 participants were recruited (34% male, median age 31 years). Most were traveling for vacation (77%) and reported previous travel (95%). Main travel destinations were Asia (43%), Americas (21%), and Africa (17%). Doctors' and travelers' surveys showed variable levels of concordance: 94% of patients recalled discussion of malaria, 84% rabies, and 76% dengue. For malaria, 95% remembered discussions regarding insect repellents, and 92% recalled that medical advice should be sought if fever developed. For travelers with whom rabies was discussed, 94% recalled that medical advice must be urgently sought following a bite/scratch. For travelers' diarrhea (TD), 99% knew to drink only boiled/bottled water, but 13% did not recall avoiding unpeeled fruit/vegetables as a prevention strategy. There was 20% discordance between doctors and travelers regarding antibiotics for TD self-treatment, but only 4% discordance regarding prescription of malaria prophylaxis. Factors associated with improved recall were doctor discussion, previous travel, and a university education. CONCLUSIONS Key travel health messages are well assimilated after pre-travel consultation. However, large amounts of information are discussed and immediate recollection of all information is not possible. This study reinforces the importance of providing supplementary information (eg, written and/or electronic resources) to accompany pre-travel consultations.
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Affiliation(s)
- Sarah L McGuinness
- Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Melbourne, Australia
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Osthoff M, McGuinness SL, Wagen AZ, Eisen DP. Urinary tract infections due to extended-spectrum beta-lactamase-producing Gram-negative bacteria: identification of risk factors and outcome predictors in an Australian tertiary referral hospital. Int J Infect Dis 2015; 34:79-83. [PMID: 25769526 DOI: 10.1016/j.ijid.2015.03.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [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: 01/21/2015] [Revised: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Extended-spectrum beta-lactamase-expressing Gram-negative bacilli (ESBL-GNB) now commonly cause community-acquired infections, including urinary tract infections (UTI), and represent a challenge for practitioners in choosing empirical antibiotics. The aim of this study was to describe the epidemiology and clinical characteristics of UTIs/bacteriuria due to ESBL-GNB in Australia. METHODS At a single-site tertiary referral hospital, 100 cases with UTIs/bacteriuria due to ESBL-GNB were matched to 100 cases where UTIs/bacteriuria were caused by organisms matching the ESBL bacterial species that had routine susceptibility to antibiotics. Potential risk factors for ESBL-GNB UTI/bacteriuria and differences in clinical outcomes were identified. RESULTS Length of admission prior to positive sample (odds ratio (OR) 1.3, p = 0.03, per week), exposure to antibiotics (OR 5.7, p < 0.001), return from overseas travel (OR 6.5, p = 0.002), and nursing home residency (OR 4.2, p = 0.03) were identified as risk factors associated with ESBL-GNB UTI/bacteriuria in the multivariate analysis. In addition, ESBL-GNB-infected cases subsequently had a longer inpatient stay (median 6 vs. 2 days, p = 0.002) and were admitted to the intensive care unit more frequently (28/100 vs. 8/100, p < 0.001). CONCLUSIONS Our results emphasize the need for culture of a mid-stream urine specimen prior to commencing antibacterials, especially in patients with the risk factors identified herein associated with ESBL-GNB UTI/bacteriuria.
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Affiliation(s)
- Michael Osthoff
- Victorian Infectious Diseases Service at the Peter Doherty Institute for Infection and Immunology, Royal Melbourne Hospital, Victoria, Australia; Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Sarah L McGuinness
- Victorian Infectious Diseases Service at the Peter Doherty Institute for Infection and Immunology, Royal Melbourne Hospital, Victoria, Australia
| | - Aaron Z Wagen
- Victorian Infectious Diseases Service at the Peter Doherty Institute for Infection and Immunology, Royal Melbourne Hospital, Victoria, Australia
| | - Damon P Eisen
- Victorian Infectious Diseases Service at the Peter Doherty Institute for Infection and Immunology, Royal Melbourne Hospital, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia.
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McGuinness SL, Doyle JS, Street AC. Two forms of immunological recovery and immune reconstitution inflammatory syndrome in one patient. Med J Aust 2012; 197:92-3. [PMID: 22794052 DOI: 10.5694/mja12.10678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
OBJECTIVE To determine if exogenous neurotrophins can prevent spiral ganglion neuron degeneration in the rat cochlea. BACKGROUND The loss of hair cells resulting in sensorineural hearing loss also leads to the secondary degeneration of spiral ganglion neurons. The effectiveness of cochlear implantation in patients with profound sensorineural hearing loss relies in part on the survival of spiral ganglion neurons; therefore, any therapy that can prevent or halt the loss of these neurons would be of potential clinical benefit. Previous research has shown that intracochlear infusion with neurotrophins can provide trophic support to SGNs in deafened guinea pigs. Whether this effect is seen in other species remains to be determined. METHODS After documenting the rate of spiral ganglion neuron degeneration after ototoxic deafening, we investigated the trophic effects of exogenous brain-derived neurotrophic factor (BDNF) on rat spiral ganglion neurons. The left cochleae of profoundly deafened rats were implanted with a drug delivery system connected to a mini-osmotic pump. BDNF or artificial perilymph was infused for 28 days; then the cochleae were prepared for histological study. RESULTS Treatment with BDNF led to a statistically significant increase in spiral ganglion neuron density and a highly significant increase in spiral ganglion neuron soma area compared with artificial perilymph-treated and untreated deafened cochleae. CONCLUSION The study has demonstrated the trophic advantage of exogenous BDNF in the mature rat cochlea and provides confidence that spiral ganglion neuron rescue after sensorineural hearing loss with exogenous BDNF may have clinical application.
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Affiliation(s)
- Sarah L McGuinness
- Department of Otolaryngology, University of Melbourne, East Melbourne, Victoria, Australia
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