Hudson Birden - Academia.edu (original) (raw)
Papers by Hudson Birden
Rural and Remote Health, Jul 17, 2007
Introduction: Rural background and training have previously been found to increase the likelihood... more Introduction: Rural background and training have previously been found to increase the likelihood of rural practice. However, practitioners of many health professions remain in shortage in rural and remote Australia. This study builds on previous work in that it includes medical, nursing and allied health professions, considers the role of the health professional's family in employment decisions, and includes a broader array of factors influencing employment preference and the preferred location of practice. The survey also examines when students might work in a rural area. Method: The survey was designed after an extensive review of relevant literature and existing surveys, consultation with rural clinicians, and piloting with students. Approximately 500 students per year are anticipated to complete the survey while on
BMC Infectious Diseases, Feb 1, 2011
Background: Differences in the determinants of Chlamydia trachomatis ('chlamydia') and Mycoplasma... more Background: Differences in the determinants of Chlamydia trachomatis ('chlamydia') and Mycoplasma genitalium (MG) genital infection in women are not well understood. Methods: A cohort study of 16 to 25 year old Australian women recruited from primary health care clinics, aimed to determine chlamydia and MG prevalence and incidence. Vaginal swabs collected at recruitment were used to measure chlamydia and MG prevalence, organism-load and chlamydia-serovar a cross-sectional analysis undertaken on the baseline results is presented here. Results: Of 1116 participants, chlamydia prevalence was 4.9% (95% CI: 2.9, 7.0) (n = 55) and MG prevalence was 2.4% (95% CI: 1.5, 3.3) (n = 27). Differences in the determinants were found-chlamydia not MG, was associated with younger age [AOR:0.9 (95% CI: 0.8, 1.0)] and recent antibiotic use [AOR:0.4 (95% CI: 0.2, 1.0)], and MG not chlamydia was associated with symptoms [AOR:2.1 (95% CI: 1.1, 4.0)]. Having two or more partners in last 12 months was more strongly associated with chlamydia [AOR:6.4 (95% CI: 3.6, 11.3)] than MG [AOR:2.2 (95% CI: 1.0, 4.6)] but unprotected sex with three or more partners was less strongly associated with chlamydia [AOR:3.1 (95%CI: 1.0, 9.5)] than MG [AOR:16.6 (95%CI: 2.0, 138.0)]. Median organism load for MG was 100 times lower (5.7 × 10 4 / swab) than chlamydia (5.6 × 10 6 /swab) (p < 0.01) and not associated with age or symptoms for chlamydia or MG. Conclusions: These results demonstrate significant chlamydia and MG prevalence in Australian women, and suggest that the differences in strengths of association between numbers of sexual partners and unprotected sex and chlamydia and MG might be due to differences in the transmission dynamics between these infections.
Australian Journal of Primary Health, 2005
BMC Public Health, Mar 9, 2011
Background: Cohort studies are an important study design however they are difficult to implement,... more Background: Cohort studies are an important study design however they are difficult to implement, often suffer from poor retention, low participation and bias. The aims of this paper are to describe the methods used to recruit and retain young women in a longitudinal study and to explore factors associated with loss to follow up. Methods: The Chlamydia Incidence and Re-infection Rates Study (CIRIS) was a longitudinal study of Australian women aged 16 to 25 years recruited from primary health care clinics. They were followed up via the post at three-monthly intervals and required to return questionnaires and self collected vaginal swabs for chlamydia testing. The protocol was designed to maximise retention in the study and included using recruiting staff independent of the clinic staff, recruiting in private, regular communication with study staff, making the follow up as straightforward as possible and providing incentives and small gifts to engender good will. Results: The study recruited 66% of eligible women. Despite the nature of the study (sexual health) and the mobility of the women (35% moved address at least once), 79% of the women completed the final stage of the study after 12 months. Loss to follow up bias was associated with lower education level [adjusted hazard ratio (AHR): 0.7 (95% Confidence Interval (CI): 0.5, 1.0)], recruitment from a sexual health centre as opposed to a general practice clinic [AHR: 1.6 (95% CI: 1.0, 2.7)] and previously testing positive for chlamydia [AHR: 0.8 (95% CI: 0.5, 1.0)]. No other factors such as age, numbers of sexual partners were associated with loss to follow up. Conclusions: The methods used were considered effective for recruiting and retaining women in the study. Further research is needed to improve participation from less well-educated women.
The Medical Journal of Australia, Sep 1, 2013
Medical Teacher, Jul 1, 2013
Introduction: We undertook a systematic review to identify the best evidence for how professional... more Introduction: We undertook a systematic review to identify the best evidence for how professionalism in medicine should be taught. Methods: Eligible studies included any articles published between 1999 and 2009 inclusive. We reviewed papers presenting viewpoints and opinions as well as empirical research. We performed a comparative and thematic synthesis on all papers meeting inclusion criteria in order to capture the best available evidence on how to teach professionalism. Results: We identified 217 papers on how to teach professionalism. Of these, we determined 43 to be best evidence. Few studies provided comprehensive evaluation or assessment data demonstrating success. As yet, there has not emerged a unifying theoretical or practical model to integrate the teaching of professionalism into the medical curriculum. Discussion: Evident themes in the literature are that role modelling and personal reflections, ideally guided by faculty, are the important elements in current teaching programmes, and are widely held to be the most effective techniques for developing professionalism. While it is generally held that professionalism should be part of the whole of a medical curriculum, the specifics of sequence, depth, detail, and the nature of how to integrate professionalism with other curriculum elements remain matters of evolving theory.
Publication details for: Steve E. Hrudey & Elizabeth J. Hrudey, Safe Drinking Water: Lessons ... more Publication details for: Steve E. Hrudey & Elizabeth J. Hrudey, Safe Drinking Water: Lessons from Recent Outbreaks in Affluent Nations London, IWA Publishing, 2004, 486pp, 1843390426 (hardback). Includes references.
Meta-analysis of RCTs finds that increasing consumption of polyunsaturated fat as a replacement f... more Meta-analysis of RCTs finds that increasing consumption of polyunsaturated fat as a replacement for saturated fat reduces the risk of coronary heart disease. Evidence Based Medicine, 15, 108-109.
Australian and New Zealand journal of public health, Oct 1, 2004
Objective: To cr itique current models of public involvement in the management of public health r... more Objective: To cr itique current models of public involvement in the management of public health risks. Methods: Two case studies are used to highlight the challenges of contemporar y practice. Results: Current models often result in affected communities having perceptions of risk that conflict with those responsible for risk management. This can lead to ineffective decision making. Conclusions: Involving the public throughout the risk assessment and risk management process may lessen conflict and result in better decisions. Implications: Those responsible for responding to public health risks should aim for transparent processes that highlight assumptions and uncertainties, and in volve the public wherever possible.
Water Research, 1981
... Hudson H. Birden * , a and Irina Cech a. ... BACKGROUND On September 1. 197"/. the first... more ... Hudson H. Birden * , a and Irina Cech a. ... BACKGROUND On September 1. 197"/. the first author, a sanitarian for the State of Connecticut Department of Health, made an inspection of facilities at a nursery school operated at a private resiclance on Birch Road, South Windsor. ...
Rural and Remote Health, Sep 15, 2014
The Asia-Pacific region is the likeliest location for the next significant outbreak of highly pat... more The Asia-Pacific region is the likeliest location for the next significant outbreak of highly pathogenic avian influenza (HPAI). Indonesia has experienced HPAI H5N1 outbreaks in poultry and humans each year since 2003 and has had the highest case fatality rate for human cases. The purposes of this study were to capture the knowledge of avian influenza and of poultry-raising practices in two regions of Indonesia and to evaluate the impact and extent of activities undertaken to 2010 through the National Strategic Plan for Avian Influenza Control at the village level. Methods: A combination of quantitative and qualitative methods was used to investigate the multiple influences on behaviours, decisions and actions taken by poultry-raising households, and by villages and communities, regarding the threat of HPAI. Between June 2010 and May 2011 a structured survey of 400 households was conducted on Lombok and of 402 on Bali, inviting Sector 3 (small-scale independent commercial poultry farms) and Sector 4 (village household) poultry raisers to participate. Focus groups and in-depth interviews were convened with key stakeholders, including livestock and animal health and public health officials, community leaders and villagers.
Medical Teacher, Dec 22, 2015
Background: We interviewed graduates from the first two cohorts of a postgraduate medical program... more Background: We interviewed graduates from the first two cohorts of a postgraduate medical program that had a senior year longitudinal integrated clerkship (LIC) in a practice setting in rural New South Wales, Australia to determine how well their training prepared them to be junior doctors (3-4 years after graduation), and what aspects of that training they thought were particularly useful. Methods: In-depth interviews. Results: Fourteen junior doctors were interviewed. Participants reported feeling well prepared in ability to develop close relationships with clinical supervisors, good clinical and procedural skills, ability to work autonomously and work in teams, knowledge of health systems, ability to ensure self-care, and professionalism. Consensus view was that a rural placement was an excellent way to learn medicine for a variety of reasons including relationships with clinicians, less competition for access to patients, and opportunities to extend their clinical skills and act up to intern level. Conclusion: The advantages we found in the training these junior doctors received which prepared them well for internship were integral both to the longitudinal, unstructured placement, and to the fact that it was carried out in a rural area. The two aspects of these placements appear to act synergistically, reinforcing the learning experience.
Human Resources for Health, Aug 18, 2009
Background: Rural and remote areas of Australia are facing serious health workforce shortages. Wh... more Background: Rural and remote areas of Australia are facing serious health workforce shortages. While a number of schemes have been developed to improve recruitment to and retention of the rural health workforce, they will be effective only if appropriately targeted. This study examines the factors that most encourage students attending rural clinical placements to work in rural Australia, and the regions they prefer. Methods: The Careers in Rural Health Tracking Survey was used to examine the factors that most influence medical, nursing and allied health students' preference for practice locations and the locations preferred. Results: Students showed a preference for working in large urban centres within one year, but would consider moving to a more rural location later in life. Only 10% of students surveyed said they would never work in a rural community with a population of less than 10 000. Almost half the sample (45%) reported wanting to work overseas within five years. The type of work available in rural areas was found to be the factor most likely to encourage students to practice rurally, followed by career opportunities and challenge Conclusion: The decision to practise rurally is the result of a complex interaction between a number of factors including ethnicity, discipline, age and sex, among others. Incentives that aim to entice all students to rural practice while considering only one of these variables are likely to be inadequate.
The Medical Journal of Australia, Feb 1, 2008
have developed a joint program for training medical students through placements of up to 40 weeks... more have developed a joint program for training medical students through placements of up to 40 weeks on the New South Wales North Coast.
Medical Teacher, 2015
The Editorial Office is very grateful to the reviewers listed below who have given their time and... more The Editorial Office is very grateful to the reviewers listed below who have given their time and expertise so willingly over the past year. Their comments and advice have contributed significantly in helping to ensure that Medical Teacher continues to meet the needs of its readers.
Australian Family Physician, 2008
This study compared temperature control in different types of vaccine storing refrigerators in ge... more This study compared temperature control in different types of vaccine storing refrigerators in general practice and tested knowledge of general practice staff in vaccine storage requirements. Temperature data loggers were set to serially record the temperature within vaccine refrigerators in 28 general practices, recording at 12 minute intervals over a period of 10 days on each occasion. A survey of vaccine storage knowledge and records of divisions of general practice immunisation contacts were also obtained. There was a significant relationship between type of refrigerator and optimal temperature, with the odds ratio for bar style refrigerator being 0.005 (95% CI: 0.001-0.044) compared to the purpose built vaccine refrigerators. Score on a survey of vaccine storage was also positively associated with optimal storage temperature. General practices that invest in purpose built vaccine refrigerators will achieve standards of vaccine cold chain maintenance significantly more reliably ...
Background. Mycoplasma genitalium (MG) is an emerging sexually transmitted infection (STI) that i... more Background. Mycoplasma genitalium (MG) is an emerging sexually transmitted infection (STI) that is potentially associated with reproductive tract sequelae in women. This study aimed to estimate MG incidence and treatment failure and provide estimates of organism load in infection. Methods. 1110 women aged 16-25 years were recruited from primary care clinics in Australia. Women were tested for MG at baseline, 6 months, and 12 months, and MG organism load was measured by quantitative polymerase chain reaction (PCR). MG-positive cases were screened for MG 23S ribosomal RNA (rRNA) gene point mutations shown to confer azithromycin resistance using high-resolution melt following PCR. Results. MG incidence rate was 1.3 per 100 person-years (n = 14; 95% confidence interval [CI], .8-2.3); women reporting 3 or more sex partners in the last 12 months had an increased rate of incident infection (rate ratio [RR], 5.1; 95% CI, 1.3-19.6]). There were 3 cases of MG reinfection (0.8 per 100 person-years [95% CI, .1-.9]. Organism load was higher for prevalent than incident infection (P = .04). There were 3 cases of treatment failure (9.4% [95% CI, 2.0-25.0]); organism load was higher in cases with treatment failure than in successfully treated cases (P < .01). An MG 23S rRNA mutation was detected in 5 cases (3 cases of treatment failure and 2 successfully treated). Conclusions. Although MG incidence was relatively low, testing should be recommended for women considered to be at increased risk based on sexual history. Our results also suggest that organism load might be important in azithromycin treatment failure.
AUSTRALIAN HEALTH REVIEW, 2007
Australian universities provide good examples of how to meet the growing challenges to the traini... more Australian universities provide good examples of how to meet the growing challenges to the training of doctors that have resulted from information overload in traditional curricula, new models of care, including multidisciplinary team dynamics,
Rural and Remote Health, Jul 17, 2007
Introduction: Rural background and training have previously been found to increase the likelihood... more Introduction: Rural background and training have previously been found to increase the likelihood of rural practice. However, practitioners of many health professions remain in shortage in rural and remote Australia. This study builds on previous work in that it includes medical, nursing and allied health professions, considers the role of the health professional's family in employment decisions, and includes a broader array of factors influencing employment preference and the preferred location of practice. The survey also examines when students might work in a rural area. Method: The survey was designed after an extensive review of relevant literature and existing surveys, consultation with rural clinicians, and piloting with students. Approximately 500 students per year are anticipated to complete the survey while on
BMC Infectious Diseases, Feb 1, 2011
Background: Differences in the determinants of Chlamydia trachomatis ('chlamydia') and Mycoplasma... more Background: Differences in the determinants of Chlamydia trachomatis ('chlamydia') and Mycoplasma genitalium (MG) genital infection in women are not well understood. Methods: A cohort study of 16 to 25 year old Australian women recruited from primary health care clinics, aimed to determine chlamydia and MG prevalence and incidence. Vaginal swabs collected at recruitment were used to measure chlamydia and MG prevalence, organism-load and chlamydia-serovar a cross-sectional analysis undertaken on the baseline results is presented here. Results: Of 1116 participants, chlamydia prevalence was 4.9% (95% CI: 2.9, 7.0) (n = 55) and MG prevalence was 2.4% (95% CI: 1.5, 3.3) (n = 27). Differences in the determinants were found-chlamydia not MG, was associated with younger age [AOR:0.9 (95% CI: 0.8, 1.0)] and recent antibiotic use [AOR:0.4 (95% CI: 0.2, 1.0)], and MG not chlamydia was associated with symptoms [AOR:2.1 (95% CI: 1.1, 4.0)]. Having two or more partners in last 12 months was more strongly associated with chlamydia [AOR:6.4 (95% CI: 3.6, 11.3)] than MG [AOR:2.2 (95% CI: 1.0, 4.6)] but unprotected sex with three or more partners was less strongly associated with chlamydia [AOR:3.1 (95%CI: 1.0, 9.5)] than MG [AOR:16.6 (95%CI: 2.0, 138.0)]. Median organism load for MG was 100 times lower (5.7 × 10 4 / swab) than chlamydia (5.6 × 10 6 /swab) (p < 0.01) and not associated with age or symptoms for chlamydia or MG. Conclusions: These results demonstrate significant chlamydia and MG prevalence in Australian women, and suggest that the differences in strengths of association between numbers of sexual partners and unprotected sex and chlamydia and MG might be due to differences in the transmission dynamics between these infections.
Australian Journal of Primary Health, 2005
BMC Public Health, Mar 9, 2011
Background: Cohort studies are an important study design however they are difficult to implement,... more Background: Cohort studies are an important study design however they are difficult to implement, often suffer from poor retention, low participation and bias. The aims of this paper are to describe the methods used to recruit and retain young women in a longitudinal study and to explore factors associated with loss to follow up. Methods: The Chlamydia Incidence and Re-infection Rates Study (CIRIS) was a longitudinal study of Australian women aged 16 to 25 years recruited from primary health care clinics. They were followed up via the post at three-monthly intervals and required to return questionnaires and self collected vaginal swabs for chlamydia testing. The protocol was designed to maximise retention in the study and included using recruiting staff independent of the clinic staff, recruiting in private, regular communication with study staff, making the follow up as straightforward as possible and providing incentives and small gifts to engender good will. Results: The study recruited 66% of eligible women. Despite the nature of the study (sexual health) and the mobility of the women (35% moved address at least once), 79% of the women completed the final stage of the study after 12 months. Loss to follow up bias was associated with lower education level [adjusted hazard ratio (AHR): 0.7 (95% Confidence Interval (CI): 0.5, 1.0)], recruitment from a sexual health centre as opposed to a general practice clinic [AHR: 1.6 (95% CI: 1.0, 2.7)] and previously testing positive for chlamydia [AHR: 0.8 (95% CI: 0.5, 1.0)]. No other factors such as age, numbers of sexual partners were associated with loss to follow up. Conclusions: The methods used were considered effective for recruiting and retaining women in the study. Further research is needed to improve participation from less well-educated women.
The Medical Journal of Australia, Sep 1, 2013
Medical Teacher, Jul 1, 2013
Introduction: We undertook a systematic review to identify the best evidence for how professional... more Introduction: We undertook a systematic review to identify the best evidence for how professionalism in medicine should be taught. Methods: Eligible studies included any articles published between 1999 and 2009 inclusive. We reviewed papers presenting viewpoints and opinions as well as empirical research. We performed a comparative and thematic synthesis on all papers meeting inclusion criteria in order to capture the best available evidence on how to teach professionalism. Results: We identified 217 papers on how to teach professionalism. Of these, we determined 43 to be best evidence. Few studies provided comprehensive evaluation or assessment data demonstrating success. As yet, there has not emerged a unifying theoretical or practical model to integrate the teaching of professionalism into the medical curriculum. Discussion: Evident themes in the literature are that role modelling and personal reflections, ideally guided by faculty, are the important elements in current teaching programmes, and are widely held to be the most effective techniques for developing professionalism. While it is generally held that professionalism should be part of the whole of a medical curriculum, the specifics of sequence, depth, detail, and the nature of how to integrate professionalism with other curriculum elements remain matters of evolving theory.
Publication details for: Steve E. Hrudey & Elizabeth J. Hrudey, Safe Drinking Water: Lessons ... more Publication details for: Steve E. Hrudey & Elizabeth J. Hrudey, Safe Drinking Water: Lessons from Recent Outbreaks in Affluent Nations London, IWA Publishing, 2004, 486pp, 1843390426 (hardback). Includes references.
Meta-analysis of RCTs finds that increasing consumption of polyunsaturated fat as a replacement f... more Meta-analysis of RCTs finds that increasing consumption of polyunsaturated fat as a replacement for saturated fat reduces the risk of coronary heart disease. Evidence Based Medicine, 15, 108-109.
Australian and New Zealand journal of public health, Oct 1, 2004
Objective: To cr itique current models of public involvement in the management of public health r... more Objective: To cr itique current models of public involvement in the management of public health risks. Methods: Two case studies are used to highlight the challenges of contemporar y practice. Results: Current models often result in affected communities having perceptions of risk that conflict with those responsible for risk management. This can lead to ineffective decision making. Conclusions: Involving the public throughout the risk assessment and risk management process may lessen conflict and result in better decisions. Implications: Those responsible for responding to public health risks should aim for transparent processes that highlight assumptions and uncertainties, and in volve the public wherever possible.
Water Research, 1981
... Hudson H. Birden * , a and Irina Cech a. ... BACKGROUND On September 1. 197"/. the first... more ... Hudson H. Birden * , a and Irina Cech a. ... BACKGROUND On September 1. 197"/. the first author, a sanitarian for the State of Connecticut Department of Health, made an inspection of facilities at a nursery school operated at a private resiclance on Birch Road, South Windsor. ...
Rural and Remote Health, Sep 15, 2014
The Asia-Pacific region is the likeliest location for the next significant outbreak of highly pat... more The Asia-Pacific region is the likeliest location for the next significant outbreak of highly pathogenic avian influenza (HPAI). Indonesia has experienced HPAI H5N1 outbreaks in poultry and humans each year since 2003 and has had the highest case fatality rate for human cases. The purposes of this study were to capture the knowledge of avian influenza and of poultry-raising practices in two regions of Indonesia and to evaluate the impact and extent of activities undertaken to 2010 through the National Strategic Plan for Avian Influenza Control at the village level. Methods: A combination of quantitative and qualitative methods was used to investigate the multiple influences on behaviours, decisions and actions taken by poultry-raising households, and by villages and communities, regarding the threat of HPAI. Between June 2010 and May 2011 a structured survey of 400 households was conducted on Lombok and of 402 on Bali, inviting Sector 3 (small-scale independent commercial poultry farms) and Sector 4 (village household) poultry raisers to participate. Focus groups and in-depth interviews were convened with key stakeholders, including livestock and animal health and public health officials, community leaders and villagers.
Medical Teacher, Dec 22, 2015
Background: We interviewed graduates from the first two cohorts of a postgraduate medical program... more Background: We interviewed graduates from the first two cohorts of a postgraduate medical program that had a senior year longitudinal integrated clerkship (LIC) in a practice setting in rural New South Wales, Australia to determine how well their training prepared them to be junior doctors (3-4 years after graduation), and what aspects of that training they thought were particularly useful. Methods: In-depth interviews. Results: Fourteen junior doctors were interviewed. Participants reported feeling well prepared in ability to develop close relationships with clinical supervisors, good clinical and procedural skills, ability to work autonomously and work in teams, knowledge of health systems, ability to ensure self-care, and professionalism. Consensus view was that a rural placement was an excellent way to learn medicine for a variety of reasons including relationships with clinicians, less competition for access to patients, and opportunities to extend their clinical skills and act up to intern level. Conclusion: The advantages we found in the training these junior doctors received which prepared them well for internship were integral both to the longitudinal, unstructured placement, and to the fact that it was carried out in a rural area. The two aspects of these placements appear to act synergistically, reinforcing the learning experience.
Human Resources for Health, Aug 18, 2009
Background: Rural and remote areas of Australia are facing serious health workforce shortages. Wh... more Background: Rural and remote areas of Australia are facing serious health workforce shortages. While a number of schemes have been developed to improve recruitment to and retention of the rural health workforce, they will be effective only if appropriately targeted. This study examines the factors that most encourage students attending rural clinical placements to work in rural Australia, and the regions they prefer. Methods: The Careers in Rural Health Tracking Survey was used to examine the factors that most influence medical, nursing and allied health students' preference for practice locations and the locations preferred. Results: Students showed a preference for working in large urban centres within one year, but would consider moving to a more rural location later in life. Only 10% of students surveyed said they would never work in a rural community with a population of less than 10 000. Almost half the sample (45%) reported wanting to work overseas within five years. The type of work available in rural areas was found to be the factor most likely to encourage students to practice rurally, followed by career opportunities and challenge Conclusion: The decision to practise rurally is the result of a complex interaction between a number of factors including ethnicity, discipline, age and sex, among others. Incentives that aim to entice all students to rural practice while considering only one of these variables are likely to be inadequate.
The Medical Journal of Australia, Feb 1, 2008
have developed a joint program for training medical students through placements of up to 40 weeks... more have developed a joint program for training medical students through placements of up to 40 weeks on the New South Wales North Coast.
Medical Teacher, 2015
The Editorial Office is very grateful to the reviewers listed below who have given their time and... more The Editorial Office is very grateful to the reviewers listed below who have given their time and expertise so willingly over the past year. Their comments and advice have contributed significantly in helping to ensure that Medical Teacher continues to meet the needs of its readers.
Australian Family Physician, 2008
This study compared temperature control in different types of vaccine storing refrigerators in ge... more This study compared temperature control in different types of vaccine storing refrigerators in general practice and tested knowledge of general practice staff in vaccine storage requirements. Temperature data loggers were set to serially record the temperature within vaccine refrigerators in 28 general practices, recording at 12 minute intervals over a period of 10 days on each occasion. A survey of vaccine storage knowledge and records of divisions of general practice immunisation contacts were also obtained. There was a significant relationship between type of refrigerator and optimal temperature, with the odds ratio for bar style refrigerator being 0.005 (95% CI: 0.001-0.044) compared to the purpose built vaccine refrigerators. Score on a survey of vaccine storage was also positively associated with optimal storage temperature. General practices that invest in purpose built vaccine refrigerators will achieve standards of vaccine cold chain maintenance significantly more reliably ...
Background. Mycoplasma genitalium (MG) is an emerging sexually transmitted infection (STI) that i... more Background. Mycoplasma genitalium (MG) is an emerging sexually transmitted infection (STI) that is potentially associated with reproductive tract sequelae in women. This study aimed to estimate MG incidence and treatment failure and provide estimates of organism load in infection. Methods. 1110 women aged 16-25 years were recruited from primary care clinics in Australia. Women were tested for MG at baseline, 6 months, and 12 months, and MG organism load was measured by quantitative polymerase chain reaction (PCR). MG-positive cases were screened for MG 23S ribosomal RNA (rRNA) gene point mutations shown to confer azithromycin resistance using high-resolution melt following PCR. Results. MG incidence rate was 1.3 per 100 person-years (n = 14; 95% confidence interval [CI], .8-2.3); women reporting 3 or more sex partners in the last 12 months had an increased rate of incident infection (rate ratio [RR], 5.1; 95% CI, 1.3-19.6]). There were 3 cases of MG reinfection (0.8 per 100 person-years [95% CI, .1-.9]. Organism load was higher for prevalent than incident infection (P = .04). There were 3 cases of treatment failure (9.4% [95% CI, 2.0-25.0]); organism load was higher in cases with treatment failure than in successfully treated cases (P < .01). An MG 23S rRNA mutation was detected in 5 cases (3 cases of treatment failure and 2 successfully treated). Conclusions. Although MG incidence was relatively low, testing should be recommended for women considered to be at increased risk based on sexual history. Our results also suggest that organism load might be important in azithromycin treatment failure.
AUSTRALIAN HEALTH REVIEW, 2007
Australian universities provide good examples of how to meet the growing challenges to the traini... more Australian universities provide good examples of how to meet the growing challenges to the training of doctors that have resulted from information overload in traditional curricula, new models of care, including multidisciplinary team dynamics,