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Research paper thumbnail of Hospital Admission Patterns in Children with CAH: Admission Rates and Adrenal Crises Decline with Age

International Journal of Endocrinology, 2016

Objective. To examine patterns of hospitalisation for acute medical conditions in children with c... more Objective. To examine patterns of hospitalisation for acute medical conditions in children with congenital adrenal hyperplasia (CAH). Design. A retrospective study of hospitalisation using administrative data. Setting. All hospitals in NSW, Australia. Patients. All patients admitted with CAH and a random sample of admissions in patients aged 0 to 18 years without adrenal insufficiency (AI). Main Outcome Measures. Admissions and comorbidities by age and sex. Results. Of 573 admissions for medical problems in CAH children, 286 (49.9%) were in males, and 236 (41.2%) had a principal diagnosis of CAH or had an adrenal crisis (AC). 37 (6.5%) ACs were recorded. An infection was found in 43.5% (n = 249) of the CAH patient admissions and 51.7% (n = 1613) of the non-AI group, p < 0.001. Children aged up to one year had the highest number of admissions (n = 149) and six ACs (four in males). There were 21 ACs recorded for children aged 1-5 years. Older CAH children had fewer admissions and fewer ACs. No in-hospital deaths were recorded. Conclusions. Admission for medical problems in CAH children declines with age. An AC was recorded in 6.5% of the admissions, with the majority of ACs occurring in the 1 to 5 years age group and there were no deaths.

Research paper thumbnail of Experience of Endobronchial Valve Management of Chronic Airflow Limitation

Heart, Lung and Circulation, 2013

Research paper thumbnail of Rubella in mothers

Research paper thumbnail of A seroepidemiological study of hepatitis B amongst Fiji health care workers

The Southeast Asian journal of tropical medicine and public health

Hepatitis B immunization for health care workers is common policy in many countries where they co... more Hepatitis B immunization for health care workers is common policy in many countries where they constitute a particular at risk group. A seroepidemiological study of hepatitis B virus (HBV) in Fiji health care workers was conducted to determine whether this occupational group (or subgroups thereof) were at higher risk of infection than the general Fiji population. The purpose of this study was to ascertain whether health staff should be immunized, or whether it would be more productive to focus resources on neonatal immunization. Blood samples were obtained from 2,639 health workers and the sera analysed by radio-immunoassay for hepatitis B surface antigen (HBsAg), and hepatitis B surface antibody (anti-HBs). Prevalence rates of HBV markers of infection were compared with those observed in the general population, from a previous population-based cluster sample survey. Approximately 70% of the health care staff participated in the study. Prevalence of total HBV markers was 24%. The ra...

Research paper thumbnail of The awareness of the risk of elevated cholesterol levels and knowledge about cholesterol-lowering action in Australia

The Medical journal of Australia

We report on a survey of the frequency of the assessment of cholesterol levels and blood pressure... more We report on a survey of the frequency of the assessment of cholesterol levels and blood pressure in the Australian population. Attitudes to risk-factor modification for cardiovascular disease also were evaluated and emphasis was placed on the assessment of knowledge about dietary modification in relation to cardiovascular disease. Respondents in this survey more frequently reported that they had undergone a blood pressure assessment than that they had had their blood cholesterol levels measured (96% and 46% of respondents, respectively). The proportion (5%) of respondents who recalled a cholesterol assessment with elevated cholesterol levels was found to be substantially lower than was that for participants in the 1983 National Heart Foundation Risk Factor Prevalence Study (19% of men and 21% of women had cholesterol levels of more than 6.5 mmol/L). Very few (9%) respondents in this survey nominated that they would reduce their dietary fat intake in order to modify their risk of de...

Research paper thumbnail of Underreporting of AIDS, New South Wales, 1988-1989

The Medical journal of Australia

To determine the completeness of medical practitioner reporting of patients with acquired immunod... more To determine the completeness of medical practitioner reporting of patients with acquired immunodeficiency syndrome (AIDS) in New South Wales and the reasons for underreporting. We compared the number of patients with AIDS reported to the National AIDS Register by medical practitioners from 1 July 1988 to 23 November 1989 with numbers detected from the National Zidovudine Register, AIDS specialist medical practitioner records, death certificates and the Sydney AIDS Prospective Study database. We asked the AIDS specialist medical practitioners to suggest why some patients may not be reported. The number of persons known to have AIDS and the source from which they were detected. We found 457 recorded cases of AIDS in which the diagnosis was made during the study period. Of these 457 cases, 373 (81.6%) had been reported by medical practitioners and 84 had not. Of these 84 cases, 40 were detected from the National Zidovudine Register, 24 from the records of AIDS specialist medical pract...

Research paper thumbnail of Hospitalisation and comorbidities in Parkinson's disease: a large Australian retrospective study

Journal of neurology, neurosurgery, and psychiatry, 2015

Patients with Parkinson's disease (PD) require higher levels of care during hospitalisation. ... more Patients with Parkinson's disease (PD) require higher levels of care during hospitalisation. Management of comorbidities in these patients aims to optimise function while minimising complications. The objective of this study was to examine patterns of hospitalisation of patients with PD in NSW with regards to sociodemographic factors, comorbidities and aspects of clinical management. A retrospective study of all patients with idiopathic PD and a control group of non-PD patients admitted for acute care to NSW hospitals between 2008 and 2012. The study group comprised 5637 cases and 8143 controls. The mean PD patient age was 75.0 years (±10.9). Patients with PD had a significantly longer hospital stay (median 7 days, IQR 3-13 vs 1 day, IQR 1-7, p<0.001) than control patients. Patients with PD were five times more likely to be treated for delirium, three times more likely to experience an adverse drug event and syncope, more than twice as likely to require management of falls/fr...

Research paper thumbnail of Paediatric appendicectomy in NSW: changes in practice over time and between groups

Journal of quality in clinical practice, 1995

The present study examined patterns of appendicectomy among 0- to 14-year-old children in New Sou... more The present study examined patterns of appendicectomy among 0- to 14-year-old children in New South Wales between 1986 and 1989/90. The study, which used routinely collected hospital separation data, showed that the overall rate of appendicectomy in this age group in 1989/90 was 2.5 per 1000 which was a significant (P < 0.01) reduction on the 1986 rate. The rate of appendicectomy with histologically confirmed appendicitis was 1.8 per 1000 in 1989/90 which was significantly (P < 0.01) lower than the corresponding rate for 1986. The proportions of appendicectomies with perforation (10% in 1989/90) and without acute appendicitis ('negative' appendicectomy; 28% in 1989/90) were comparable to previous Australian and overseas reports and changed little during the study period. Differences in the rates of appendicectomy and of perforated appendices were found between geographic areas. However, the area-specific rates of perforation were not systematically associated with the ...

Research paper thumbnail of Trends in pulmonary embolism morbidity and mortality in Australia

Thrombosis Research, 2013

Pulmonary embolism (PE) is a common cause of morbidity and mortality. In this study, we investiga... more Pulmonary embolism (PE) is a common cause of morbidity and mortality. In this study, we investigated patterns of morbidity and mortality from PE in Australia. Australian government databases were used to extract data on age and sex specific rates of mortality between 1997 and 2007, and hospital separations between 1998/9 and 2009/10 to examine changes over time and between age and sex groups. In 2007, 320 deaths were ascribed to PE in Australia, corresponding to a mortality rate of 1.73 per 100,000 population per year. Between 1997 and 2007, the Australian mortality rate decreased in both sexes, but this was significant only in females. By comparison, in 2009/10 there were 9,847 hospital separations for PE, corresponding to a rate of 53.1 per 100,000 population per year. In contrast to the fall in mortality rates, hospital separation rates significantly increased over the study period. Females had higher rates of morbidity and mortality from PE than males. While the mortality rates among the elderly population decreased significantly (from 48.4 to 34.3 per 100,000 population per year in those aged over 85 years), there were significant increases in PE mortality in the younger female age groups. Although mortality rates are decreasing, PE remains a significant cause of morbidity and mortality in Australia, especially in females and the elderly. The burden of morbidity and mortality from PE in Australia is comparable to that found in America and a number of European countries.

Research paper thumbnail of Rubella in mothers

Research paper thumbnail of Foot Orthosis Prescription Habits of Australian and New Zealand Podiatric Physicians

Journal of the American Podiatric Medical Association, 2001

Research paper thumbnail of Variation in selected childhood surgical procedures: The case of tonsillectomy and management of middle ear disease

Journal of Paediatrics and Child Health, 2008

Research paper thumbnail of Agreement between Medical Record Data and Patients' Accounts of Their Medical History and Treatment for Dyspepsia

Journal of Clinical Epidemiology, 1998

Research paper thumbnail of Where the data are deficient: a field evaluation of the effectiveness of pneumococcal vaccination in remote Australia

Australian Journal of Rural Health, 2001

The aims of the study were to: (i) determine whether a field evaluation of a pneumococcal vaccina... more The aims of the study were to: (i) determine whether a field evaluation of a pneumococcal vaccination program conducted in 1991-1993 could show whether the program was effective; and (ii) to describe the epidemiology of invasive pneumococcal disease using laboratory surveillance data. As part of quality assurance, we undertook a retrospective cohort study to compare the hospitalisation and mortality rates of a pneumococcal-vaccine-vaccinated and an unvaccinated group and a correlational study to compare the before- and after-vaccination hospitalisation rates for the vaccinated and unvaccinated groups. We used laboratory data to describe the epidemiology of invasive pneumococcal disease. The cohort study consisted of 815 subjects (306 vaccinated, 509 comparison). No significant differences were observed in the admission rates for pneumonia and lower respiratory tract infection between the two groups. By using a correlational study, we examined before- and after-vaccination hospitalisation rates and this also failed to reveal any differences, except for persons aged 50 years and older. Laboratory surveillance of invasive disease demonstrated that children younger than 6 years and adults younger than 50 years with alcohol-related problems accounted for most of the cases. Despite the study&#39;s limitations, it supports the use of pneumococcal vaccine in persons aged older than 50 years, while at the same time highlighting the ongoing need for better vaccines, especially for children and those aged younger than 50 years with medical conditions predisposing to pneumococcal disease.

Research paper thumbnail of Validation of hepatitis B surveillance data

Australian and New Zealand Journal of Public Health, 1997

Research paper thumbnail of Incidence of pulmonary embolism: a comparison of two Australian hospitals

Internal medicine journal, 2015

In this retrospective observational study, we noted that there were significantly more admissions... more In this retrospective observational study, we noted that there were significantly more admissions at the public than the private hospital due to both a principal (1.87 vs 0.83 per 1000, P < 0.001) and secondary diagnosis of pulmonary embolism (PE) (3.10 vs 2.01 per 1000, P = 0.002), with no difference in mortality. There was a highly significant increase in secondary PE diagnoses at the private hospital (R(2) = 0.68, β = 0.14, P = 0.003) over the study period. Despite disparate rates of PE between the two hospitals, there was no difference in mortality, suggesting there may be an element of overdiagnosis.

Research paper thumbnail of Hospital Admission Patterns in Children with CAH: Admission Rates and Adrenal Crises Decline with Age

International Journal of Endocrinology, 2016

Objective. To examine patterns of hospitalisation for acute medical conditions in children with c... more Objective. To examine patterns of hospitalisation for acute medical conditions in children with congenital adrenal hyperplasia (CAH). Design. A retrospective study of hospitalisation using administrative data. Setting. All hospitals in NSW, Australia. Patients. All patients admitted with CAH and a random sample of admissions in patients aged 0 to 18 years without adrenal insufficiency (AI). Main Outcome Measures. Admissions and comorbidities by age and sex. Results. Of 573 admissions for medical problems in CAH children, 286 (49.9%) were in males, and 236 (41.2%) had a principal diagnosis of CAH or had an adrenal crisis (AC). 37 (6.5%) ACs were recorded. An infection was found in 43.5% (n = 249) of the CAH patient admissions and 51.7% (n = 1613) of the non-AI group, p &amp;amp;amp;amp;amp;amp;lt; 0.001. Children aged up to one year had the highest number of admissions (n = 149) and six ACs (four in males). There were 21 ACs recorded for children aged 1-5 years. Older CAH children had fewer admissions and fewer ACs. No in-hospital deaths were recorded. Conclusions. Admission for medical problems in CAH children declines with age. An AC was recorded in 6.5% of the admissions, with the majority of ACs occurring in the 1 to 5 years age group and there were no deaths.

Research paper thumbnail of Experience of Endobronchial Valve Management of Chronic Airflow Limitation

Heart, Lung and Circulation, 2013

Research paper thumbnail of Rubella in mothers

Research paper thumbnail of A seroepidemiological study of hepatitis B amongst Fiji health care workers

The Southeast Asian journal of tropical medicine and public health

Hepatitis B immunization for health care workers is common policy in many countries where they co... more Hepatitis B immunization for health care workers is common policy in many countries where they constitute a particular at risk group. A seroepidemiological study of hepatitis B virus (HBV) in Fiji health care workers was conducted to determine whether this occupational group (or subgroups thereof) were at higher risk of infection than the general Fiji population. The purpose of this study was to ascertain whether health staff should be immunized, or whether it would be more productive to focus resources on neonatal immunization. Blood samples were obtained from 2,639 health workers and the sera analysed by radio-immunoassay for hepatitis B surface antigen (HBsAg), and hepatitis B surface antibody (anti-HBs). Prevalence rates of HBV markers of infection were compared with those observed in the general population, from a previous population-based cluster sample survey. Approximately 70% of the health care staff participated in the study. Prevalence of total HBV markers was 24%. The ra...

Research paper thumbnail of The awareness of the risk of elevated cholesterol levels and knowledge about cholesterol-lowering action in Australia

The Medical journal of Australia

We report on a survey of the frequency of the assessment of cholesterol levels and blood pressure... more We report on a survey of the frequency of the assessment of cholesterol levels and blood pressure in the Australian population. Attitudes to risk-factor modification for cardiovascular disease also were evaluated and emphasis was placed on the assessment of knowledge about dietary modification in relation to cardiovascular disease. Respondents in this survey more frequently reported that they had undergone a blood pressure assessment than that they had had their blood cholesterol levels measured (96% and 46% of respondents, respectively). The proportion (5%) of respondents who recalled a cholesterol assessment with elevated cholesterol levels was found to be substantially lower than was that for participants in the 1983 National Heart Foundation Risk Factor Prevalence Study (19% of men and 21% of women had cholesterol levels of more than 6.5 mmol/L). Very few (9%) respondents in this survey nominated that they would reduce their dietary fat intake in order to modify their risk of de...

Research paper thumbnail of Underreporting of AIDS, New South Wales, 1988-1989

The Medical journal of Australia

To determine the completeness of medical practitioner reporting of patients with acquired immunod... more To determine the completeness of medical practitioner reporting of patients with acquired immunodeficiency syndrome (AIDS) in New South Wales and the reasons for underreporting. We compared the number of patients with AIDS reported to the National AIDS Register by medical practitioners from 1 July 1988 to 23 November 1989 with numbers detected from the National Zidovudine Register, AIDS specialist medical practitioner records, death certificates and the Sydney AIDS Prospective Study database. We asked the AIDS specialist medical practitioners to suggest why some patients may not be reported. The number of persons known to have AIDS and the source from which they were detected. We found 457 recorded cases of AIDS in which the diagnosis was made during the study period. Of these 457 cases, 373 (81.6%) had been reported by medical practitioners and 84 had not. Of these 84 cases, 40 were detected from the National Zidovudine Register, 24 from the records of AIDS specialist medical pract...

Research paper thumbnail of Hospitalisation and comorbidities in Parkinson's disease: a large Australian retrospective study

Journal of neurology, neurosurgery, and psychiatry, 2015

Patients with Parkinson's disease (PD) require higher levels of care during hospitalisation. ... more Patients with Parkinson's disease (PD) require higher levels of care during hospitalisation. Management of comorbidities in these patients aims to optimise function while minimising complications. The objective of this study was to examine patterns of hospitalisation of patients with PD in NSW with regards to sociodemographic factors, comorbidities and aspects of clinical management. A retrospective study of all patients with idiopathic PD and a control group of non-PD patients admitted for acute care to NSW hospitals between 2008 and 2012. The study group comprised 5637 cases and 8143 controls. The mean PD patient age was 75.0 years (±10.9). Patients with PD had a significantly longer hospital stay (median 7 days, IQR 3-13 vs 1 day, IQR 1-7, p<0.001) than control patients. Patients with PD were five times more likely to be treated for delirium, three times more likely to experience an adverse drug event and syncope, more than twice as likely to require management of falls/fr...

Research paper thumbnail of Paediatric appendicectomy in NSW: changes in practice over time and between groups

Journal of quality in clinical practice, 1995

The present study examined patterns of appendicectomy among 0- to 14-year-old children in New Sou... more The present study examined patterns of appendicectomy among 0- to 14-year-old children in New South Wales between 1986 and 1989/90. The study, which used routinely collected hospital separation data, showed that the overall rate of appendicectomy in this age group in 1989/90 was 2.5 per 1000 which was a significant (P < 0.01) reduction on the 1986 rate. The rate of appendicectomy with histologically confirmed appendicitis was 1.8 per 1000 in 1989/90 which was significantly (P < 0.01) lower than the corresponding rate for 1986. The proportions of appendicectomies with perforation (10% in 1989/90) and without acute appendicitis ('negative' appendicectomy; 28% in 1989/90) were comparable to previous Australian and overseas reports and changed little during the study period. Differences in the rates of appendicectomy and of perforated appendices were found between geographic areas. However, the area-specific rates of perforation were not systematically associated with the ...

Research paper thumbnail of Trends in pulmonary embolism morbidity and mortality in Australia

Thrombosis Research, 2013

Pulmonary embolism (PE) is a common cause of morbidity and mortality. In this study, we investiga... more Pulmonary embolism (PE) is a common cause of morbidity and mortality. In this study, we investigated patterns of morbidity and mortality from PE in Australia. Australian government databases were used to extract data on age and sex specific rates of mortality between 1997 and 2007, and hospital separations between 1998/9 and 2009/10 to examine changes over time and between age and sex groups. In 2007, 320 deaths were ascribed to PE in Australia, corresponding to a mortality rate of 1.73 per 100,000 population per year. Between 1997 and 2007, the Australian mortality rate decreased in both sexes, but this was significant only in females. By comparison, in 2009/10 there were 9,847 hospital separations for PE, corresponding to a rate of 53.1 per 100,000 population per year. In contrast to the fall in mortality rates, hospital separation rates significantly increased over the study period. Females had higher rates of morbidity and mortality from PE than males. While the mortality rates among the elderly population decreased significantly (from 48.4 to 34.3 per 100,000 population per year in those aged over 85 years), there were significant increases in PE mortality in the younger female age groups. Although mortality rates are decreasing, PE remains a significant cause of morbidity and mortality in Australia, especially in females and the elderly. The burden of morbidity and mortality from PE in Australia is comparable to that found in America and a number of European countries.

Research paper thumbnail of Rubella in mothers

Research paper thumbnail of Foot Orthosis Prescription Habits of Australian and New Zealand Podiatric Physicians

Journal of the American Podiatric Medical Association, 2001

Research paper thumbnail of Variation in selected childhood surgical procedures: The case of tonsillectomy and management of middle ear disease

Journal of Paediatrics and Child Health, 2008

Research paper thumbnail of Agreement between Medical Record Data and Patients' Accounts of Their Medical History and Treatment for Dyspepsia

Journal of Clinical Epidemiology, 1998

Research paper thumbnail of Where the data are deficient: a field evaluation of the effectiveness of pneumococcal vaccination in remote Australia

Australian Journal of Rural Health, 2001

The aims of the study were to: (i) determine whether a field evaluation of a pneumococcal vaccina... more The aims of the study were to: (i) determine whether a field evaluation of a pneumococcal vaccination program conducted in 1991-1993 could show whether the program was effective; and (ii) to describe the epidemiology of invasive pneumococcal disease using laboratory surveillance data. As part of quality assurance, we undertook a retrospective cohort study to compare the hospitalisation and mortality rates of a pneumococcal-vaccine-vaccinated and an unvaccinated group and a correlational study to compare the before- and after-vaccination hospitalisation rates for the vaccinated and unvaccinated groups. We used laboratory data to describe the epidemiology of invasive pneumococcal disease. The cohort study consisted of 815 subjects (306 vaccinated, 509 comparison). No significant differences were observed in the admission rates for pneumonia and lower respiratory tract infection between the two groups. By using a correlational study, we examined before- and after-vaccination hospitalisation rates and this also failed to reveal any differences, except for persons aged 50 years and older. Laboratory surveillance of invasive disease demonstrated that children younger than 6 years and adults younger than 50 years with alcohol-related problems accounted for most of the cases. Despite the study&#39;s limitations, it supports the use of pneumococcal vaccine in persons aged older than 50 years, while at the same time highlighting the ongoing need for better vaccines, especially for children and those aged younger than 50 years with medical conditions predisposing to pneumococcal disease.

Research paper thumbnail of Validation of hepatitis B surveillance data

Australian and New Zealand Journal of Public Health, 1997

Research paper thumbnail of Incidence of pulmonary embolism: a comparison of two Australian hospitals

Internal medicine journal, 2015

In this retrospective observational study, we noted that there were significantly more admissions... more In this retrospective observational study, we noted that there were significantly more admissions at the public than the private hospital due to both a principal (1.87 vs 0.83 per 1000, P < 0.001) and secondary diagnosis of pulmonary embolism (PE) (3.10 vs 2.01 per 1000, P = 0.002), with no difference in mortality. There was a highly significant increase in secondary PE diagnoses at the private hospital (R(2) = 0.68, β = 0.14, P = 0.003) over the study period. Despite disparate rates of PE between the two hospitals, there was no difference in mortality, suggesting there may be an element of overdiagnosis.