Australian Population Research Articles

Radiological assessment of Sella Turcica morphology correlates with skeletal classes in an Austrian population: an observational study.

This study aimed to analyze variations in the sella turcica (ST) concerning its size, shape, and bridging, providing first reference values in Austrian individuals. Additionally, it assessed associations between these morphological and demographic parameters and their correlation with patients' skeletal class. 208 lateral cephalometric radiographs (154 female, 54 male; age 8-58 years) from DPU Dental Clinic (Austria) were included. Size, skeletal class, shape, age, and gender of ST were tested for significance in correlation using, (M)ANOVA, and chi-square. Linear dimensions of ST ranged from 11.1 to 12.9mm across readers, with a standard deviation of 2.0-2.2mm. Normal ST (49.76%) and round ST (58.77%) were the most frequent. ST bridging was detected in 6.97%. Skeletal class I appeared most frequently (54.8%). Statistical significance was observed between age, gender, and ST length, with further significant age effects on ST shape. Moreover, age showed significant modification of ST shape, while skeletal parameters appeared unaffected by other ST parameters. These preliminary findings define normal ST dimensions in an Austrian population, offering reference values for clinical interpretation and broadening the available European data. Clear associations between morphological and demographic parameters were detected. Additionally, these findings may contribute to diagnostic and therapeutic strategies in orthodontics and craniofacial pathology. Future studies employing cone beam computed tomography (CBCT) along a larger sample size could enhance the generalizability of these findings.

Field therapies for actinic keratosis: an Australian cost‐effectiveness analysis

AbstractBackgroundActinic keratoses have a high prevalence in the older Australian population, with most patients presenting with field actinic damage. Despite this high prevalence, no field therapies are subsidised under the Pharmaceutical Benefits Scheme.ObjectivesTo determine which therapy for field actinic damage is the most cost‐effective when comparing 5‐fluorouracil (5‐FU), imiquimod (IMQ), and methyl‐aminolevulinate photodynamic therapy (MAL‐PDT) at 12 months post‐treatment.MethodsA decision tree was constructed using TreeAge Pro, representing the likely clinical trajectories of patients with field actinic damage treated with 5‐FU, IMQ, and MAL‐PDT. The cost‐effectiveness analysis was performed from the patient perspective, assuming an outpatient setting. Efficacy data was derived from a single‐blinded, multi‐centre prospective randomised control trial. Cost data were derived from Australian dermatology clinics and pharmacies. One‐way and probabilistic sensitivity analyses were conducted.Results5‐FU was the most cost‐effective treatment. It was cheaper and more effective than all other treatments, with a cost‐effectiveness ratio of AU$201 per patient achieving ≥75% clearance in field actinic damage. The cost‐effectiveness ratios of IMQ, and MAL‐PDT were AU$940, and AU$8058 per patient achieving ≥75% clearance respectively. Both sensitivity analyses showed certainty in 5‐FU's dominance over the other treatments.Conclusions5‐FU is the most cost‐effective treatment option for Australian patients presenting with actinic field damage on the head area.

DPYD genotype-guided dose personalisation for fluoropyrimidine-based chemotherapy prescribing in solid organ cancer patients in Australia: GeneScreen 5-FU study protocol

BackgroundFluoropyrimidine (FP) chemotherapies are commonly prescribed for upper and lower gastrointestinal, breast and head and neck malignancies. Over 16,000 people with cancer require FP chemotherapies per annum in Australia. Between 10 and 40% patients experience grade 3–4 (≥ G3) toxicities that require hospital-based management ± intensive care admission. Approximately 1% of patients die secondary to FP toxicities. Prospective screening for DPYD gene variants (encoding the key enzyme for FP catabolism) can identify patients at risk of ≥ G3 toxicity and allow for dose adjustment prior to first FP exposure. Evidence supports this as a cost-effective method of improving patient safety and reducing healthcare burden internationally; however, no Australian data confirms its feasibility on a large scale.MethodThis investigator-led, single-arm study will determine large scale feasibility of prospective DPYD genotyping, confirming patient safety and cost-effectiveness within the Australian health care system. 5000 patients aged 18 years and older with solid organ cancers requiring FP chemotherapy will be consented and genotyped prior to commencing treatment, and early toxicity (within 60 days) post-FP exposure will be determined. Toxicity data for DPYD variant carriers who have dose adjustments will be compared to the wild-type cohort and historical cohorts of carriers who did not undergo genotyping prior to FP exposure, and prospective variant carriers who do not undergo dose-adjustment. Prevalence of the four standard DPYD gene variants will be confirmed in an Australian population. Additionally, health economic analysis, implementation research via semi-structured interviews of patients and clinicians, and feasibility of UGT1A1 genotyping will be conducted.DiscussionThis study will determine the prevalence of DPYD gene variant status in Australia and its impact on FP-induced toxicity among Australians with cancer. Feasibility and cost-effectiveness for Australian health care system will be estimated to support national roll-out of prospective DPYD genotyping prior to FP administration. Additionally, feasibility will be confirmed with the intention of including UGT1A1 in future pharmacogenomic panels to aid chemotherapy prescribing.Trial registrationThis trial was registered with the Australian and New Zealand Cancer Trials Registry on 13th Dec 2023, ACTRN12623001301651.

Aging Well? Exploring Self-Reported Quality of Life in the Older Austrian Population Based on Repeated Cross-Sectional Data

ABSTRACT Increase in life expectancy around the world puts aging societies with all their challenges on the Global Public Health agenda. In Austria, additional years of life gained are not spent in good health, as healthy life expectancy is far below the European average. Using repeated cross-sectional data from three waves of the Austrian Health Interview Survey (2006, 2014 and 2019), including a total of 10,056 participants aged 65 years and above, this study examined the change in self-reported quality-of-life (QoL) over time and explored associated factors. QoL, estimated by domain scores of the WHOQOL-BREF questionnaire, increased over time but decreased with age in all survey waves. Observed mean scores were significantly higher in males than in females in all QoL domains except the social domain but sex differences disappeared in most domains in the multivariable regression analyses. Instead, factors associated with significantly higher QoL scores included younger age, higher socioeconomic status, living in Western Austria and having no chronic conditions. Statistically significant observed sex differences in QoL in the older-aged Austrian population disappeared when adjusting for income and education. Strategies and measures to increase financial capabilities may have a significant impact on QoL and well-being in this age group.

Colonialism and imperialism in Austrian history curricula and textbooks (1945–2023)

The article considers the depiction of colonialism and imperialism in Austrian textbooks (n = 61) and curricula issued since the commencement of the Second Republic in 1945. The analysis indicates that textbooks made use of the freedom afforded them by state stipulations, which, while evidently taking a distinctly eurocentric point of view, give textbook authors scope for taking decisions on the inclusion or exclusion of particular topics. The textbooks studied covered various aspects of this area of history that curricula did not list expressly, such as the impact of European colonial aggression on Indigenous populations. Simultaneously, the analysis showed a long absence from textbooks of colonialism’s implications throughout history to the present day, and demonstrated that textbooks reproduced racist ideas well into the 2000s, with corresponding effects on perceptions of history among Austrian population today.

Persistent symptoms after COVID-19: an Australian stratified random health survey on long COVID.

To determine the impact of persistent symptoms after coronavirus disease 2019 (COVID-19) in an Australian population. We conducted a statewide health survey of a stratified random sample of adults who had had a confirmed acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19-positive group) and their close contacts (control group). The sample was drawn from Victoria's COVID-19 database between January 2020 and October 2022. Data were collected from 12 688 survey respondents between September 2022 and April 2023 (11 174 in the COVID-19-positive group and 1514 in the control group). Persistent new symptoms, recovery, and daily function using validated questionnaires for fatigue, neurocognitive symptoms, anxiety, depression and quality of life. At a mean of 12.6 months after infection, 4560 respondents in the COVID-19-positive group (39.1%; 95% CI, 37.9-40.3%) reported at least one persistent new symptom, compared with 216 respondents in the control group (20.8%; 95% CI, 18.5-23.1%). A total of 1656 respondents (14.2%; 95% CI, 13.4-15.0%) were classified as having clinical long COVID using the criteria of at least one persistent new symptom and less than 80% recovery three months after the infection. Of the respondents with clinical long COVID, 535 (3.2%; 95% CI, 2.6-3.8%) reported at least moderate problems with usual activities at 12 months after their infection. The proportion of respondents with clinical long COVID was lower for those with more recent infections. The risk factors for clinical long COVID were female sex, age 40-49 years, infection severity, chronic illness, and past anxiety or depression. Factors associated with a decreased risk of having clinical long COVID included infection when the Omicron strain was dominant and infection when the Delta strain was dominant, as compared with when the ancestral strain of the virus was dominant. Persistent symptoms after COVID-19 are common, though with a lower incidence following infection from less virulent strains. Although long COVID can be largely managed in primary care, a minority of people who have persistent symptoms and impaired function may require specialist care pathways, the effectiveness of which should be a focus of future research.

The economic burden of long COVID in Australia: more noise than signal?

To estimate the potential economic burden of long COVID in Australia. A stock-and-flow model of weekly estimated numbers of people with long COVID (January 2021 to June 2023); application of proxy cost estimates from people living with myalgic encephalomyelitis/chronic fatigue syndrome; time series analysis of labour market and social security datasets. The working age Australian population. The likely number of Australians severely impacted by long COVID; the economic cost of long COVID; and the impacts of long COVID, determined by analysis of labour market data. At its peak in late 2022, between 181 000 and 682 000 Australians may have experienced some long COVID symptoms, of whom 40 000-145 000 may have been severely affected. Severe cases potentially decreased to affecting 10 000-38 000 people by June 2023. The likely economic burden of long COVID in Australia during 2022 was between $1.7 billion and $6.3 billion (some 0.07% to 0.26% of gross domestic product). Labour market data suggest that between 25 000 (February 2023) and 103 000 (June 2023) more working age Australians reported being unable to work due to long term sickness than would have been predicted based on pre-COVID-19 trends. This does not appear to have translated into increased claims for Disability Support Pensions, but numbers of working age Carer Allowance recipients have grown markedly since 2022. Long COVID likely imposed a small but significant aggregate toll on the Australian economy, while exposing tens of thousands of Australians to substantial personal economic hardship and contributing to labour market supply constraints. Yet while some signal from long COVID is discernible in the labour force data, Australia lacks adequate direct surveillance data to securely guide policy making.

Therapeutic approaches and conceptions of practice of osteopaths in Australia - a national cross-sectional study and exploratory factor analysis of the Osteo-TAQ

BackgroundHealth professionals develop their own approach to patient care based on education, experience and philosophical stance. Literature suggests that this practice approach informs patient care, and clinical outcomes. The Osteopaths’ Therapeutic Approaches Questionnaire (Osteo-TAQ) is a novel 36-item instrument developed from qualitative grounded theory research with osteopaths in the United Kingdom. The aim of the study was to develop evidence for the structural and construct validity of the Osteo-TAQ in the Australian osteopathic profession and provide initial descriptive data about the therapeutic approaches of osteopaths in Australia.MethodsA cross-sectional study design was used to collect data from registered osteopaths in Australia using the Osteo-TAQ and analysed with Exploratory Factor Analysis (EFA). The EFA utilised parallel analysis to determine the number of factors to extract and McDonald’s omega calculated as the reliability estimation statistic.Results691 Australian osteopaths provided data for the study, representing 25% of the Australian osteopathic profession. Empirically the number of factors to extract based on the parallel analysis was seven. Two- and three-factor solutions were evaluated given the underpinning theory identifying two conceptions of practice and three interrelated therapeutic approaches. Both the two- and three-factor solutions were consistent with the underpinning theory with acceptable reliability estimations for each factor. Descriptive data suggested the most common element of the therapeutic approach of Australian osteopaths was establishing rapport, while the least common was ‘only talking’ with their patients.ConclusionsThis study provides evidence for the structural, content and construct validity of the Osteo-TAQ in an Australian osteopathic practitioner population. The results support both a two- and three-factor structure for the Osteo-TAQ in an Australian osteopathic population, with each factor demonstrating acceptable reliability estimations supporting the items comprising each factor as measuring a single construct. From a theoretical and empirical perspective, it can be inferred that the Osteo-TAQ tool encapsulates an osteopaths’ conception of practice (professional artistry and technical rational) and three main therapeutic approaches to patient care: Educator, Communicator and Treater. Further research is required to explore each of these therapeutic approaches to better understand how they relate to an individual osteopath’s conception of practice, and their associations with other measures of practice including clinical outcomes.

Understanding long-term risk in Percutaneous Coronary Intervention (PCI) in the Australian contemporary era with a focus on defining Complex Revascularisation in High-Risk Indicated Patients (CHIP)

BackgroundComplex Revascularisation in High-Risk Indicated Patients (CHIP) is emerging in Percutaneous Coronary Intervention (PCI). We document the frequency and outcomes following CHIP PCI in the Australian population, to understand risk and guide clinical decision-making. We propose a scoring system to define CHIP procedures. MethodsPatients undergoing PCI from Melbourne Intervention Group registry between 2005 and 2018 were analysed. Patients were stratified based on the number of high-risk features defined as 1)presence of ≥3 patient factors including age > 75yo, COPD, diabetes, renal impairment (eGFR<60 mL/min/1.73 m2), PVD, and 2)LVEF<30 %, and/or 3)having one complex coronary anatomical feature such as LMCA PCI, ACC/AHA B2/C lesion PCI, presence of multi-vessel disease or CTO PCI. National Death Index linkage was performed for long-term mortality analysis. Outcomes were analysed according to 4 risk categories – low risk(score 0), intermediate risk(score 1), high-risk(score 2), and very high-risk(score 3). Results20,973patients were analysed. Majority of patients underwent intermediate-risk procedures(71.7 %), with low rates of high-risk(6.6 %), and very high-risk(0.2 %). Lesion success inversely correlates with risk; low-risk(99.4 %), intermediate-risk(95.1 %), high-risk(94.3 %), very high-risk(92.5 %),p < 0.001. In-hospital and 30-day death correlates with risk; low-risk(0.0 %/0.1 %), intermediate-risk(0.3 %/0.5 %), high-risk(1.5 %/2.9 %), very high-risk(2.4 %/7.1 %),p < 0.001. Long-term mortality correlates with risk; low-risk(12.3 %), intermediate-risk(15.8 %), high-risk(49.3 %), very high-risk(76.2 %),p < 0.001. On multivariate analysis, increasing risk correlates with long-term mortality; intermediate-risk(HR1.41), high-risk(HR6.42), and very high-risk(14.05). ConclusionIn the Australian practice, proportion of patients undergoing high and very high-risk PCI procedures are low. Despite good procedural success and in-hospital outcomes, long-term mortality is poor. Further research into appropriate patient selection, and direct comparison of CHIP PCI to those treated medically and surgically should be considered.

Foreign bodies in the ear and nose of the Australian paediatric population: A standardised approach.

Foreign bodies (FBs) in the ears and noseare common presentations among paediatric patients, necessitating prompt and appropriate management to avoid potential complications. This article presents a standardised approach for FB retrieval based on local clinical data from a tertiary paediatric centre, addressing the challenges of identifying patients requiring specialist referral. The approach involves a detailed initial consultation and succinct examination todetermine the most suitable retrieval method. Patient preparation and equipment availability are key to successful outcomes. A combination of microsuction and alligator forceps with adequate illumination is strongly recommended, along with various adjunct tools commonly available. Urgent referral to otorhinolaryngology is indicated for button batteries and previous failed attempts. This comprehensive approach seeks to achieve successful FB removal and optimise patient outcomes in both community and hospital settings.

Trends of Benzotriazoles and Benzothiazoles in Australian Pooled Urine Samples from 2012 to 2023.

Benzotriazoles (BZTs) and benzothiazoles (BTs) are high-production-volume chemicals utilized in many different commercial products and industrial processes, such as metal corrosion inhibitors, vulcanization accelerators, plastic-associated UV stabilizers, and pharmaceutical precursors. This study assessed age, gender, and temporal trends of BZTs and BTs in deidentified surplus pathology urine samples, pooled and stratified by age, gender, and sample collection year from a general Australian population (168 pools representing 16,800 individuals). Tolyltriazole (TTri), 5,6-dimethyl-1H-benzotriazole (DMBZT), 1,3-benzothiazole (BTH), 2-hydroxybenzothiazole (2-OH-BTH), and 2-aminobenzothiazole (2-amino-BTH) were detected in >50% of the pools. TTri was frequently detected in pooled samples representing ≤45-year-olds (both genders). Concentrations of DMBZT, BTH (females), 2-OH-BTH, and 2-amino-BTH (females) increased with age significantly, with adults (>15 years old) showing higher levels than children (≤15 years old). Gender differences in DMBZT concentrations (females > males) were observed across all sampling years and only in some for TTri (males > females: >45 years old), BTH (females > males), and 2-amino-BTH (males > females). A temporal increase in BTH, 2-OH-BTH, and 2-amino-BTH levels within the studied period (2012-2023) has been observed. Our findings suggest ongoing exposure of the Australian general population to BZTs and BTs, highlighting age, gender, and temporal trends of these compounds as measured via their urinary concentrations.

Peritoneal dialysis-related peritonitis due to Pasteurella multocida in Australia.

Domestic animals are common in Australian households; however, there is little research into the potential risks these animals pose to patients undergoing in-home peritoneal dialysis (PD). Cats and dogs are known to carry many potential pathogens, including Pasteurella multocida. We reviewed the ANZDATA Peritoneal Dialysis Peritonitis Registry for cases of peritonitis due to Pasteurella multocida between 2011 and 2023. Cases identified were younger and more likely to be female compared with the Australian PD population who developed peritonitis due to other organisms. Of the total 32 episodes, 75% were using automated PD with glucose-based solutions. Two cases requiring removal of the PD catheter and transfer to haemodialysis and no deaths were reported. Whilst outcomes were largely favourable, it is likely that many of these cases could have been prevented. Education for people undergoing PD should include information about the potential infectious hazards of domestic animals.

Ultra-processed food consumption and risk of cardiovascular mortality in Australia: preliminary results from prospective observational study

Abstract Background/Introduction A large proportion of the Australian population emigrated from countries where traditional dietary patterns are protective of cardiovascular health. Yet, recent evidence suggests that 42% of a modern Australian diet's total energy intake is comprised of ultra-processed foods. This is concerning as previous meta-analyses and umbrella reviews based on population studies have found an association between ultra-processed food consumption and adverse health outcomes, including cardiovascular disease and mortality. However, this has yet to be explored in an Australian population. Purpose To determine the association between ultra-processed food consumption and the risk of cardiovascular mortality in an Australian cohort. Methods Prospective data from the Melbourne Collaborative Cohort Study (MCCS; n = 38054) were analysed. UPF consumption at baseline (1990 to 1994) was assessed in accordance with the NOVA food classification system using data from a 121-item food frequency questionnaire. Energy-adjusted ultra-processed food consumption was then categorised into quartiles. Cardiovascular mortality was obtained through data linkage with national and local registries up to 2015 and 2019, respectively. This was done using the International Classification of Diseases (ICD) codes (390-459 and I00-I99). Unadjusted and adjusted multivariate logistic regression models were fitted to estimate associations between ultra-processed food consumption (exposure) and cardiovascular mortality (outcome). Results A total of 4,242 incident cardiovascular deaths occurred (2,272 for males and 1,970 for females) during the follow-up period. After adjusting for sociodemographic characteristics and lifestyle and health-related behaviours, higher UPF consumption was associated with a higher risk of cardiovascular mortality (aOR high (quartile 4) vs. low (quartile 1) category = 1.26, 95%CIs 1.14 to 1.39, ptrend &amp;lt; 0.001). Conclusion(s) In this large prospective cohort of Australian adults, higher ultra-processed food consumption was associated with an increased risk of cardiovascular mortality. These findings support previous research and guidelines recommending the reduction of ultra-processed food consumption as part of a heart-healthy diet.

Characterisation of identity-informative genetic markers in the Australian population with European ancestry

Identity-informative single nucleotide polymorphisms (iiSNPs) are valuable genetic markers for human identification and kinship testing in forensic casework, especially when the quality and quantity of DNA evidence is not suitable for routine short tandem repeat (STR) profiling. This study analysed 105 buccal samples representing the Australian population with European ancestry in order to assign allele frequencies and conduct population genetic analyses for 94 iiSNPs and 20 STRs. The markers were assessed by calculating relevant forensic statistics and testing for deviations from Hardy-Weinberg and linkage equilibrium. No linkage of statistical significance was observed between any of the pair-wise combinations of the combined 114 identity-informative markers and only one STR exhibited deviation from Hardy-Weinberg equilibrium (D8S1179). The probability of matching genotypes being observed within this population was of the order of 10−23 for STRs, 10−38 for iiSNPs and 10−60 for the combined identity-informative marker panel, improving the ability to discriminate between individuals when calculating likelihood ratios in direct or indirect matching scenarios. Further, the addition of iiSNPs will facilitate identifications when suboptimal STR profiles are recovered from compromised or challenging samples and aid comparisons to genetic relatives for familial or kinship testing.

Predictors of new-onset in-hospital atrial fibrillation in 122 089 patients admitted with COVID-19: an Australian statewide population study

Abstract Background New-onset atrial fibrillation (AF) when encountered in COVID-19 patients may be associated with increased mortality and thromboembolic events. Few studies have investigated predictors of new-onset AF in the context of COVID-19 and no study has assessed the utility of CHA2DS2VASc score in predicting new-onset AF in COVID-19 patients. Purpose This study aims to identify independent predictors of new-onset in-hospital AF in patients admitted with COVID-19. Methods Patients admitted with COVID-19 (1-Jan-2020 to 30-Sept-2021) were identified from the Admitted-Patient-Data-Collection database in an Australian state, stratified by AF status (no-AF vs new-AF during index COVID-19 admission) and followed-up until 31-Mar-2022. Patients with prior-AF were excluded from analysis. New-AF was defined as new-onset AF during the hospital admission for COVID-19. Independent predictors of new-AF were identified using multivariable logistic regression. Receiver Operating Characteristic (ROC) derived Area Under Curve (AUC) score was performed to determine the predictive power of independent predictors of new-AF. Results The cohort comprised 122089 COVID-19 patients (median age 62.7 yrs; 48.5% males) of whom 5140 developed new-AF (4.2%). Compared to patients with no-AF, patients with new-AF had a higher prevalence of comorbidities and cardiac risk factors (hypertension, diabetes and smoking) as well as a higher CHA2DS2VASc score (p &amp;lt; 0.001) (Table 1). Independent predictors of new-AF included referral from Emergency Department (adjusted odds ratio [aOR] =1.63, 95% confidence interval [CI]=1.49-1.78, intensive-care-unit admission (aOR=3.46, 95%CI=3.22-3.71), current/ex-smoker (aOR=1.20, 95%CI=1.12-1.27), prior coronary revascularization (percutaneous coronary intervention or coronary artery bypass graft surgery) (aOR=1.33, 95%CI=1.01-1.75), valvular heart disease (aOR=3.20, 95%CI=2.73-3.75), malignancy (aOR=1.15, 95%CI=1.02-1.29), chronic pulmonary disease (aOR=1.30, 95%CI=1.19-1.42) and higher CHA2DS2VASc score (per-1-score increase: aOR=1.62, 95%CI=1.59-1.65) (all P&amp;lt;0.05). CHA2DS2VASc score alone had an AUC score of 0.729 (95%CI=0.72-0.74) (Figure 1). Adding the above additional independent variables to CHA2DS2VASc score improved the predictive model to an overall AUC score of 0.773 (95%CI=0.77-0.78), p &amp;lt; 0.001. Conclusions This study identified patients at risk of developing new-AF in the setting of COVID-19 infection. Our multivariable logistic regression analysis that included CHA2DS2VASc score has a relatively good predictive value and if confirmed in other COVID-19 cohorts, may be used to identify patients in whom antiarrhythmic and more aggressive thromboprophylactic strategies can be considered.

Aortic dimensions in a large Australian adult cohort. New normal range?

Abstract Background There is little published data worldwide about the normal range of aortic dimensions in adults. Guidelines for dilated aortic dimensions and recommendations for surgery are based on small population cohorts and absolute values. Adjustment for BSA and height are becoming more accepted, however the normal range of aortic dimensions for a large population has not been previously published. We present the distribution of aortic dimensions in a large Australian population, with indexation for BSA and height as well as centiles of age. Methods All patients &amp;gt;18 years of age attending for routine echocardiography at our institution from 2007-2022 were included in the database. Measurements of aortic root, sinotubular junction and ascending aorta using ASE criteria were collated. Dimensions were adjusted for BSA and height. Data was analysed for centiles of weight and height and across decades of age. Results A total of 117,912 patients were included in the analysis, aged 62.8+17.6 years (range 18-107), 59% male, 83.7+21.1 kgs (range 32-337) and 169.8+10.3 cm (range 107-218). The aortic root and ascending aortic dimensions are presented in absolute values (average + SD), and height adjusted (cm/m) and BSA adjusted (cm/m2) values. Data was expressed per centile of height, age and weight. There was a progressive increase in aortic dimensions as expected for increasing height, however a robust relationship was identified when dimensions were indexed according to height at all centiles regardless of age and body weight. In contrast, when adjusted for BSA, the aortic dimensions were progressively and predictably under-reported in patients over 80kg for assessment for normal vs dilated. When analysed for centiles of age, there was a small progressive increase in dimensions observed with increasing age. The indexation for height was independently robust across patients of all centiles of height. Conclusion Aortic dimensions are consistently 2.0+0.5 cm/m when adjusted for patient height across all body weight and age centiles. Adjustment for BSA in patients over 80kg tends to under-represent aortic dimensions when assessing for dilatation. Dimensions tend to increase gently with increasing age. We propose a new nomogram for normal aortic dimensions in adults.

Haemorrhoid artery ligation - recto anal repair (HAL-RAR) blind versus Doppler: a systematic review and meta-analysis.

Haemorrhoids remain a highly prevalent condition in Australia, affecting 39% of the adult Australian population. While haemorrhoidectomy remains the gold standard in the management of haemorrhoids, newer techniques such as haemorrhoid artery ligation-recto anal repair (HAL-RAR) are emerging as promising management modalities. We compare the efficacy of non-Doppler guided (non-DG) HAL-RAR versus Doppler-guided (DG) HAL-RAR in the management of haemorrhoids. This study was registered with PROSPERO (CRD42022353806) and adhered to PRISMA 2020 guidelines. We conducted a systematic review using Medline, Embase and Cochrane database for comparative studies between Doppler-guided HAL-RAR and non-Doppler-guided HAL-RAR in accordance with the PRISMA 2020 statement for reporting systematic reviews. Five studies were included in our systematic review and meta-analysis. There was no clinically significant difference in operative times (SMD 0.46, 9% CI -3.16 0 4.08, P = 0.804) or post-operative bleeding (P = 0.142) between the two groups. DG HAL-RAR patients were more likely to have post-operative urinary retention (P < 0.001). Non-DG patients were less likely to experience recurrence (OR 5.12, P < 0.001). Our review of non-DG HAL-RAR compared to DG HAL-RAR reflects the non-inferiority of the non-DG HALRAR procedure. We hope that these results would provide a guide to clinicians performing HAL-RAR, and would provide some cost savings for institutions who are unable to procure the necessary equipment for DG HAL-RAR.

Revealed and stated preferences for sharing of patient-reported data in Austria

Abstract Objectives Routine collection of health data is essential for creating sustainable, efficient, and equitable health systems. While administrative health data are collected automatically, successful routine collection of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) depends on voluntary participation. The aim of this study is to investigate how to increase participation in routine patient-reported data collection. Methods This mixed methods study used representative survey data from the Austrian population aged 18-70 (N = 1260) and 15 semi-structured narrative interviews with citizens and health data experts collected in 2024. Survey respondents were shown examples of PREMs and PROMs and indicated their willingness to share them, depending on the recipient and purpose. Interviewees answered the same questions while providing insight into their decision-making process, which was analyzed using thematic analysis. Wilcoxon rank sum tests were used to assess differences in willingness to share across recipients and data collection purposes. Results Survey respondents were more willing to share PREMs than PROMs (“rather yes” vs. “rather no”, p &amp;lt; 0.001). One explanation given in the interviews is that PROMs are more personal and convey sensitive information. In terms of sharing PROMs, people were most likely to share with their GP (81%) and least likely to share with private companies (7%). Facilitators for sharing identified in the interviews were improving personal care and the health system, while barriers were use for profit generation and fear of negative consequences for the person sharing. Conclusions The results suggest handling the collection of PROMs demands greater caution compared to PREMs. Furthermore, clearly communicating personal and societal benefits arising from the collection and analysis of self-reported health data may increase participation in routine self-reported health data collection. Key messages • The collection of self-reported health data depends on voluntary participation. Clearly communicating personal and societal benefits of sharing self-reported data can motivate participation. • Self-reported data collection is essential for sustainable and efficient health systems. Compared to PREMs, people are more reluctant to share PROMs because they contain sensitive information.

Linking health-related behaviours to quality of life in older adults: A latent class analysis

Abstract Background Life expectancy and healthy life years diverge considerably in Austria, and quality of life (QoL) varies widely among older people. Identifying the factors most relevant to QoL in older people is crucial. We aimed to investigate the association between health behaviour, including lifestyle and preventive behaviour, and QoL in this population. Methods Cross-sectional data from the Austrian Health Interview Survey (2019) were used, including 3,995 individuals aged 65 years and older. We performed latent class analysis (LCA) to identify patterns of health behaviours. Variables were selected based on the WHO framework of Active Ageing including factors related to lifestyle (physical exercise, fruit/vegetable intake, BMI, oral health, smoking, alcohol use) and the health care system (satisfaction, unmet needs, participation in screening, health checks and vaccination). Domain scores of the WHOQOL-BREF were used for QoL assessment. Class differences were assessed by survey regressions. Results In the LCA, four different behavioural classes emerged among the older-aged Austrian population, including (class 1) ‘best preventive behaviour and very good lifestyle’ (17.7%), (class 2) ‘worst lifestyle and worst preventive behaviour, high unmet healthcare needs and unsatisfied with the system’ (16.5%), (class 3) ‘very good preventive behaviour and best lifestyle, but worst vaccination probability’ (24.8%) and (class 4) ‘poor preventive behaviour, good lifestyle, but no physical activity’ (41.0%). The classes with unhealthy lifestyles (classes 2 and 4) had worse QoL in all domains compared to the classes with healthy lifestyles (classes 1 and 3). The four classes differ on demographic, socio-economic and health characteristics. Conclusions To improve the QoL of the older population, policies and interventions need to be tailored to the specific characteristics and needs of each behavioural class. Key messages • This study explores the relationship between health behaviour and QoL in older Austrians. • Findings support the development of differentiated interventions targeting different types of behaviour.

Testing the psychometric characteristics of EQ-5D-5L and respiratory bolt-ons using a sample of the Australian population.

The EQ-5D has been used to assess health related quality of life (HRQoL) in respiratory conditions. However, the core descriptive system may not be sensitive to all the HRQoL impacts of these conditions. To increase the sensitivity of the descriptive system, two respiratory specific bolt-ons, have been developed. Psychometric assessment of the bolt-ons in comparison to other validated instruments is required to facilitate their use. Therefore, the aim of this study is to test the psychometric characteristics of the EQ-5D-5L + R using a large dataset collected in Australia. A cross-sectional online survey was used to recruit adult respondents (≥ 18 years) representative of the Australian population. Descriptive and psychometric analyses were used to understand the performance of the EQ-5D-5L and bolt-ons in comparison to other validated instruments. The construct validity was estimated using correlations. Known-group validity was tested to determine the sensitivity of the instruments to differences across different severity groups. Overall 10,033 respondents (52% female) completed the survey, of which 300 had a respiratory condition. There were moderate to high correlation between bolt-ons with EQ-5D-5L and WHODAS. The EQ-5D-5L + bolt-ons slightly reduced the ceiling effect in comparison to the EQ-5D-5L. The effect size was larger for people with respiratory conditions than people who did not have a respiratory condition. The results show that adding the respiratory bolt-on to the EQ-5D-5L might slightly improve the instruments descriptive sensitivity. The choice of bolt-on may be driven by whether overall problems or limitations are being measured.