South West Area Health Service Research Articles

Randomised controlled trial of the impact of haemodiafiltration on uraemic neuropathy: FINESSE study protocol

IntroductionThe majority of patients undergoing haemodialysis (HD) show evidence of uraemic neuropathy, a condition with no known disease-modifying treatments. The pathogenesis of uraemic neuropathy is poorly understood, but may be...

Adaptation of child oral health education leaflets for Arabic migrants in Australia: a qualitative study

BackgroundThe purpose of this study was to gain an in-depth understanding of Arabic-speaking mothers views on the usefulness of existing oral health education leaflets aimed at young children and also to record their views on the tailored versions of these leaflets.MethodsThis qualitative study was nested within a large ongoing birth cohort study in South Western Sydney, Australia. Arabic-speaking mothers (n = 19) with young children were purposively selected and approached for a semi-structured interview. Two original English leaflets giving advice on young children’s oral health were sent to mother’s prior to the interview. On the day of interview, mothers were given simplified-English and Arabic versions of both the leaflets and were asked to compare the three versions. Interviews were audio-recorded, subsequently transcribed verbatim and analysed by thematic analysis. Ethical approval was obtained from Human Research Ethics Committees of the former Sydney South West Area Health Service, University of Sydney and Western Sydney University.ResultsMothers reported that simplified English together with the Arabic version of the leaflets were useful sources of information. Although many mothers favoured the simplified version over original English leaflets, the majority favoured the leaflets in Arabic. Ideally, a “dual Arabic - simplified English leaflet” was preferred. The understanding of key health messages was optimised through a simple layout and visual images.ConclusionsThere is a need to tailor oral health education leaflets for Arabic-speaking migrants. Producers of dental leaflets should also consider a “dual Arabic – simplified English leaflet” to improve oral health knowledge of Arabic-speaking migrants. The use of simple layout and pictures assists Arabic-speaking migrants to understand the content of dental leaflets.

Hepatitis‐Viral

Hepatitis‐Viral

Predictors of neonatal outcomes amongst a methadone- and/or heroin-dependent population referred to a multidisciplinary Perinatal and Family Drug Health Service

Although methadone maintenance therapy is the standard of care for opioid-dependent pregnant women, there exists controversy over the benefits and side effects of treatment to the neonate. Our aim was to document predictors of neonatal outcomes within an opioid-using population, with particular reference to methadone treatment in the context of continued heroin use. Analysis was performed on a cohort of 183 opioid-using pregnant women seen by the Sydney South West Area Health Service between 2004 and 2007 and between 2009 and 2011. Neonatal outcomes were analysed according to maternal opioid use: methadone only, methadone and heroin, or heroin only. Logistic regression was used to examine independent predictors of neonatal outcomes. No difference in the frequency of low birth weight neonates or the rate of prematurity was found between the methadone-only, methadone-and-heroin and heroin-only groups (P = 0.30; P = 0.42). Methadone treatment was not found to increase the treatment requirement for neonatal abstinence syndrome compared with those using heroin only (P = 0.91). Women using methadone only were more likely to retain custody of their child at hospital discharge than women using methadone and heroin and heroin only (80.4, 59.0, 40.0%; P < 0.001). Methadone treatment was beneficial in predicting the discharge custody status of the neonate. Engagement with antenatal care was found to reduce the likelihood of preterm birth and to be independently associated with the neonate being discharged in the care of the mother. Women who continue to use heroin should not be denied methadone treatment for fear of worse neonatal outcomes.

Increasing Tumor Thickness is Associated with Recurrence and Poorer Survival in Patients with Merkel Cell Carcinoma

Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous neuroendocrine tumor usually occurring on sun-exposed skin in elderly patients. Clinical and pathologic factors associated with disease progression and mortality in patients with MCC are poorly defined. Recently, it has been reported that p63 expression in primary MCC is strongly associated with clinical outcome. MCC patients diagnosed between July 1, 1993 and July 31, 2009 were identified from the surgical pathology records of the Sydney South West Area Health Service. Clinical, pathologic, treatment, and survival data were obtained and immunohistochemical analyses for p53, p63, and Ki-67 were performed. The associations of clinical and pathologic features with disease-free and disease-specific survival were analyzed. Ninety-five patients were identified (67 males, 28 females; median age at diagnosis of primary MCC 76 [range, 42-93] years). Increasing primary tumor thickness was significantly associated with poorer disease-free survival (5-year survival 18 % in tumors >10 mm thick compared with 69 % for patients with tumors ≤10 mm thick, p = 0.002) and disease-specific survival (5-year survival 74 % in tumors >10 mm thick compared with 97 % for patients with tumors ≤10 mm thick, p = 0.006). There was a strong positive correlation between the Ki-67 index (proportion of Ki-67-positive tumor nuclei) and tumor thickness (r = 0.39, n = 45, p = 0.008). Positive staining for p63 in MCC was infrequent (9 % of primary MCC) and showed no significant association with disease outcome. Tumor thickness is significantly associated with disease-free survival in MCC. We recommend that primary tumor thickness be routinely recorded in the pathology reports of patients with primary MCC.

Do smoke-free environment policies reduce smoking on hospital grounds? Evaluation of a smoke-free health service policy at two Sydney hospitals

To evaluate the compliance of hospital staff, inpatients and visitors with Sydney South West Area Health Service's Smoke-free Environment Policy. Six sites were observed at two Sydney hospitals 2 weeks before implementation of the policy and at 2 weeks, 6 months, 12 months, 18 months and 2 years after implementation. There was an overall significant 36% (P≤0.05) reduction in observed smoking incidents on hospital grounds 2 years after implementation. Two years after implementation, observed smoking incidents reduced by 44% (P≤0.05) in staff, 37% (P≤0.05) in visitors and remained unchanged among inpatients. The Smoke-free Environment Policy was effective in reducing visitors and staff observed smoking on hospital grounds, but had little effect on inpatients' smoking. Identifying strategies to effectively manage nicotine addiction and promote cessation amongst hospital inpatients remains a key priority.

Female employees' perceptions of organisational support for breastfeeding at work: findings from an Australian health service workplace

BackgroundWomen's return to work can be a significant barrier to continued breastfeeding. Workplace policies and practices to promote and support continued, and longer duration of, breastfeeding are important. In the context of the introduction of a new breastfeeding policy for Area Health Services in New South Wales, Australia, a baseline survey was conducted to describe current practices and examine women's reports of perceived organisational support on breastfeeding intention and practice.MethodsA cross sectional survey of female employees of the Sydney South West Area Health Service was conducted in late 2009. A mailed questionnaire was sent to 998 eligible participants who had taken maternity leave over the 20-month period from January 2008 to August 2009. The questionnaire collected items assessing breastfeeding intentions, awareness of workplace policies, and the level of organisational and social support available. For those women who had returned to work, further questions were asked to assess the perceptions and practices of breastfeeding in the work environment, as well as barriers and enabling factors to combining breastfeeding and work.ResultsReturning to work was one of the main reasons women ceased breastfeeding, with 60 percent of women intending to breastfeed when they returned to work, but only 40 percent doing so. Support to combine breastfeeding and work came mainly from family and partners (74% and 83% respectively), with little perceived support from the organisation (13%) and human resources (6%). Most women (92%) had received no information from their managers about their breastfeeding options upon their return to work, and few had access to a room specially designated for breastfeeding (19%). Flexible work options and lactation breaks, as well as access to a private room, were identified as the main factors that facilitate breastfeeding at work.ConclusionsEnabling women to continue breastfeeding at work has benefits for the infant, employee and organisation. However, this baseline study of health employees revealed that women felt largely unsupported by managers and their organisation to continue breastfeeding at work.

Urinary placental growth factor differentiates the hypertensive disorders of pregnancy

To evaluate the discriminating capacity of urinary placental growth factor (uPlGF) for different hypertensive diseases of pregnancy during the third trimester. A prospective descriptive case-control study conducted in an urban tertiary referral hospital and district general hospital, Sydney South West Area Health Service, Australia. Inpatients and outpatients with and without hypertension in the third trimester were recruited. Eligible patients provided a urine sample for protein, creatinine and a uPlGF level by ELISA. Patients were categorised into clinical hypertensive groups based on the diagnostic criteria of SOMANZ. Eighty-eight women were evaluated; 41 had hypertension (15 pre-eclampsia; 13 gestational hypertension; eight chronic hypertension; five pre-eclampsia superimposed on chronic hypertension) and 47 women without hypertension as the control group. There was a significant difference in uPlGF levels between the pre-eclamptic group (median 2.56 IQR 1.12-4.51) and the normotensive controls (median 13.18 IQR 5.95-31.39) (P < 0.0001); the gestational hypertensive group (median 3.74 IQR 2.49-4.91) and the normotensive group (median 13.18 IQR 5.95-31.39) (P=0.002) and for a subgroup comparison of placental-mediated hypertension (median 2.75 IQR 1.38-4.82) versus non-placental-mediated hypertensives (median 6.96 IQR 3.87-12.54) (P=0.007). Urinary placental growth factor is a simple non-invasive test, which is discriminatory for pre-eclampsia in the third trimester of pregnancy. Results from this study indicate that it may be discriminatory for hypertension related to placental dysfunction (pre-eclampsia and gestational hypertension) when compared with hypertension unrelated to placental function. Further work is required to assess the ability to detect hypertensive diseases before they are clinically apparent.

Combining top-down and bottom-up change management strategies in implementation of ACP: the My Wishes program in South West Sydney, Australia

Attempts to introduce advance care planning (ACP) and make it a part of normal clinical practice present significant challenges and one way of approaching these is to utilise the change...

The Correlation Between Atopic Dermatitis Disease Severity and Quality of Life is Complex

S A T U R D A Y 153 The Correlation Between Atopic Dermatitis Disease Severity and Quality of Life is Complex F. C. Lewer, K. Keat, P. K. Burton, B. S. Frankum, B. Wainstein, C. H. Katelaris; University of Western Sydney, Sydney, AUSTRALIA, Sydney South West Area Health Service, Sydney, AUSTRALIA, Sydney Children’s Hospital, Sydney, AUSTRALIA. RATIONALE:This study aims to assess whether atopic dermatitis disease severity (as assessed by the SCORing Atopic Dermatitis [SCORAD] assessment tool) is a good indicator of the impact on quality of life (QOL) in the paediatric population. METHODS: Children aged between 2 and 17 years of age that present to the Paediatric Immunology Clinic at Campbelltown Hospital in Sydney, Australia, with atopic dermatitis are assessed using the SCORAD and the PedsQL QOL survey as part of clinical practice. The PedsQL is a general non disease-specific QOL assessment tool. Children are reassessed at subsequent visits and tracked longitudinally. This study is an audit of this data. RESULTS: Preliminary findings for 31 children suggest there is not a strong correlation between disease severity and QOL. Overall correlation between SCORAD and QOL is lower than expected (r5-0.382, p50.11). Visits with children under the age of 5 (n512) have a greater correlation between their SCORAD and QOL scores (r5-0.624, p50.03) than visits of children aged 5 years old or above (n532) (r5-0.304, p50.09, not statistically significant). Surprisingly, there was a trend for visits of children with a SCORAD of 40 or less (n522) to have an almost absent correlation between SCORAD and QOL (r50.059) although this was not statistically significant (p50.795). Those with a SCORAD over 40 (n522) have a strong negative correlation (r5-0.516, p50.014). CONCLUSIONS: This preliminary data indicates a complex relationship between disease severity and effects on QOL, in the setting of atopic dermatitis. This relationshipmay becomemore evident as we examine a larger sample size.

Prevalence of chronic hepatitis B in South Western Sydney: evaluation of the country of birth method using maternal seroprevalence data

To estimate the prevalence of hepatitis B infection and evaluate the country of birth (Census) method of describing hepatitis B distribution in an Australian health service with a large migrant population. The prevalence of chronic hepatitis B in Sydney South West Area Health Service (SSWAHS, population 1.3 million) was estimated by applying the prevalence of hepatitis B surface antigen (HBsAg) in high or intermediate hepatitis B prevalence countries to SSWAHS residents from those countries, using 2006 Census data. The Australian hepatitis B prevalence (0.7%) was applied to the remainder. This method was validated using HBsAg seroprevalence in 42,274 women aged 15-44 years who delivered at SSWAHS public maternity hospitals during 2007 to 2009. The SSWAHS prevalence of HBsAg using the Census method was 2.0% for all ages and 2.3% for 15-44 year old women. The seroprevalence in 15-44 year old mothers was 1.8%. The adjusted population prevalence was 1.6%. The two methods produced broadly similar descriptions of relative hepatitis B burden by local government area and country of birth. The Census method overestimates the prevalence of hepatitis B infection by 30%, but produces similar patterns of hepatitis B burden across the area. Health services can estimate the prevalence and distribution of chronic hepatitis B using readily available data to focus delivery of prevention and treatment services.

Sydney epilepsy incidence study to measure illness consequences: the SESIMIC observational epilepsy study protocol.

BackgroundEpilepsy affects an estimated 50 million people and accounts for approximately 1% of days lost to ill health globally, making it one of the most common, serious neurological disorders. While there are abundant global data on epilepsy incidence, prevalence and treatment, there is a paucity of Australian incidence data. There is also a general lack of information on the psychosocial impact and socioeconomic consequences of a new diagnosis of epilepsy on an individual, their family, household, and community which are often specific to the health and social system of each country.Methods/DesignThe Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) is an Australian population-based epilepsy incidence and outcome study that will recruit every newly diagnosed case of epilepsy in the Sydney South West Area Health Service to an epilepsy register. Multiple and overlapping sources of notification will be used to identify all new cases of epilepsy over a 24 month period in the Eastern Zone of the Sydney South West Area Health Service (SSWAHS) and follow up will occur over 12 months. SEISMIC will use the International League Against Epilepsy (ILAE) definitions and classifications for epidemiologic studies of epilepsy. The study will examine outcomes including mood, quality of life, employment, education performance, driving status, marital and social problems, medication use, health care usage, costs and stigma.DiscussionThis study is designed to examine how clinical, psychological factors, socioeconomic circumstances, and healthcare delivery influence the experience of epilepsy for individuals and families allowing better targeting of specific services and informing policy makers and practitioners. In addition, the study will provide the basis for a longitudinal population-based cohort study and potentially inform qualitative sub-studies and randomised controlled trials of intervention strategies. The study has been registered on the Australia New Zealand Clinical Trial Registration database with ANZCTRN12609000059268.

Letter – Lessons learnt from a pilot bicycle program with community mental health service consumers

Physical activity improves mental health. Building on previous work promoting cycling in the general community, we trialled an innovative cycling program for mental health service consumers in the former Sydney South West Area Health Service. The poor physical health of people with a mental illness is well documented. Increasing consumer?s physical health is difficult and the literature surrounding the issue is limited. One study found that outside activity significantly improves self esteem and mood.

Influenza A testing and detection in patients admitted through emergency departments in Sydney during winter 2009: implications for rational testing

To examine factors associated with testing and detection of influenza A in patients admitted to hospital for acute care during the winter 2009 pandemic influenza outbreak. Retrospective observational study of patients who were tested for influenza A after being admitted to hospital through emergency departments of the Sydney South West Area Health Service from 15 June to 30 August 2009. The association of factors such as age, diagnosis at admission, hospital and week of admission with rates of testing and detection of influenza A. 17,681 patients were admitted through nine emergency departments; 1344 (7.6%) were tested for influenza A, of whom 356 (26.5%) tested positive for pandemic influenza. Testing rates were highest in 0-4-year-old children, in the peak period of the outbreak, and in patients presenting with a febrile or respiratory illness. Positive influenza test results were common across a range of diagnoses, but occurred most frequently in children aged 10-14 years (64.3%) and in patients with a diagnosis at admission of influenza-like illness (59.1%). Using multivariate logistic regression, patients with a diagnosis at admission of fever or a respiratory illness at admission were most likely to be tested (odds ratios [ORs], 15 [95% CI, 11-21] and 17 [95% CI, 15-19], respectively). These diagnoses were stronger predictors of influenza testing than the peak testing week (Week 4; OR, 7.0 [95% CI, 3.8-13]) or any age group. However, diagnosis at admission and age were significant but weak predictors of a positive test result, and the strongest predictor of a positive test result was the peak epidemic week (Week 3; OR, 120 [95% CI, 27-490]). The strongest predictor of a clinician's decision to test for influenza was the diagnosis at admission, but the strongest predictor of a positive test was the week of admission. A rational approach to influenza testing for patients who are admitted to hospital for acute care could include active tracking of influenza testing and detection rates, testing patients with a strong indication for antiviral treatment, and admitting only those who test negative to "clean" wards during the peak of an outbreak.

‘Where There’s Smoke …’

See related article, pages 588–593. Premature ventricular complexes (PVCs) are easily recognized abnormalities on a 12-lead electrocardiogram or rhythm strip. During medical school and residency, it was a surprise and disappointment to learn that such an obvious abnormality was dismissed as a benign rhythm disturbance and was not indicative of serious disease. In this issue of Stroke, Agarwal and colleagues1 report that PVCs seen on a single baseline 2-minute rhythm strip were associated with an increased risk of incident stroke. These findings are reported in a large cohort (>14 000) of middle-aged (45 to 64 years) American men and women followed for 15 to 17 years in the Atherosclerosis Risk in Communities (ARIC) study. In the 6.1% with PVCs, the adjusted hazard ratio for stroke was 1.4 (95% CI, 1.08 to 1.80) and the adjusted hazard ratio for a combined end point of stroke and death was 1.62 (95% CI, 1.44 to 1.83). Increased stroke risk was observed irrespective of gender and race. There was a marked increase in stroke risk in those participants with ≥4 PVCs in a 2-minute recording. PVCs are suggested to be a “culprit arrhythmia”2 in the development of cardiomyopathy and are reported to predict a heightened risk of new-onset atrial fibrillation (AF)3 and cardiovascular death.4,5 An association of PVCs with stroke risk has been reported in an earlier smaller study cited by the ARIC investigators. In the large ARIC study, PVCs were associated with new-onset AF and death. Agarwal and colleagues1 identified apparent effect modification on stroke risk between established stroke risk factors and the …

Reply

Internal Medicine JournalVolume 39, Issue 12 p. 860-861 Reply M. Leung, M. Leung Liverpool Hospital, Sydney South West Area Health Service,Search for more papers by this authorI. Piatkov, I. Piatkov Diversity Health Institute Research Laboratory, Westmead Hospital, Sydney West Area Health Service andSearch for more papers by this authorR. Leong, R. Leong Gastroenterology and Liver Services, Concord Hospital, Sydney South West Area Health Service, Sydney, New South Wales, AustraliaSearch for more papers by this author M. Leung, M. Leung Liverpool Hospital, Sydney South West Area Health Service,Search for more papers by this authorI. Piatkov, I. Piatkov Diversity Health Institute Research Laboratory, Westmead Hospital, Sydney West Area Health Service andSearch for more papers by this authorR. Leong, R. Leong Gastroenterology and Liver Services, Concord Hospital, Sydney South West Area Health Service, Sydney, New South Wales, AustraliaSearch for more papers by this author First published: 30 December 2009 https://doi.org/10.1111/j.1445-5994.2009.02084.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume39, Issue12December 2009Pages 860-861 RelatedInformation

Do Prostate HDR Brachytherapy Catheters Shift between Planning and Treatment Delivery?

Do Prostate HDR Brachytherapy Catheters Shift between Planning and Treatment Delivery?

Decreasing presentations of seizures to emergency departments in a large Australian population

This study was designed (1) to compare the prevalence of emergency department (ED) presentations in Western Zone Sydney South West Area Health Service (WZS) between 1998–2002 and 2003–2007 for epilepsy (including status epilepticus (SE) and convulsions), hospital admission rates, and proportion of first seizure presentations; and (2) to compare these data with those for New South Wales (NSW) and Australia-wide figures. Using health department data sets, we found 19,834 presentations to WZS EDs between 1998 and 2007 (24.85/10,000 population/year). When the periods 2003–2007 and 1998–2002 in WZS are compared, ED presentations fell by 3% ( P = 0.03) and hospital admissions fell by 6% ( P = 0.001). The prevalence of ED presentations for seizures in NSW did not change ( P = 0.92), but hospital admissions fell by 3% ( P < 0.0001). When 1999/2000–2002/2003 was compared with 2003/2004–2006/2007, the prevalence of hospital admissions in Australia fell by 1% ( P = 0.0002). Rates of presentation for epilepsy in WZS have fallen over the last decade. Most presentations were first seizures rather than recurrences. The reason for this is speculative, but may reflect improved levels of education and health care delivery.

Diagnosis of endometriosis by detection of nerve fibres in an endometrial biopsy: a double blind study

Diagnosis of endometriosis currently requires a laparoscopy and this need probably contributes to the considerable average delay in diagnosis. We have reported the presence of nerve fibres in the functional layer of endometrium in women with endometriosis, which could be used as a diagnostic test. Our aim was to assess efficacy of nerve fibre detection in endometrial biopsy for making a diagnosis of endometriosis in a double-blind comparison with expert diagnostic laparoscopy. Endometrial biopsies, with immunohistochemical nerve fibre detection using protein gene product 9.5 as marker, taken from 99 consecutive women presenting with pelvic pain and/or infertility undergoing diagnostic laparoscopy by experienced gynaecologic laparoscopists, were compared with surgical diagnosis. In women with laparoscopic diagnosis of endometriosis (n = 64) the mean nerve fibre density in the functional layer of the endometrial biopsy was 2.7 nerve fibres per mm(2) (+/-3.5 SD). Only one woman with endometriosis had no detectable nerve fibres. Six women had endometrial nerve fibres but no active endometriosis seen at laparoscopy. The specificity and sensitivity were 83 and 98%, respectively, positive predictive value was 91% and negative predictive value was 96%. Nerve fibre density did not differ between different menstrual cycle phases. Women with endometriosis and pain symptoms had significantly higher nerve fibre density in comparison with women with infertility but no pain (2.3 and 0.8 nerve fibre per mm(2), respectively, P = 0.005). Endometrial biopsy, with detection of nerve fibres, provided a reliability of diagnosis of endometriosis which is close to the accuracy of laparoscopic assessment by experienced gynaecological laparoscopists. This study was registered with the Australian Clinical Trials Registry (ACTR) 00082242 (registered: 12/12/2007). The study was approved by the Ethics Review Committee (RPAH Zone) of the Sydney South West Area Health Service (Protocol number X05-0345) and The University of Sydney Human Research Ethics Committee (Ref. No. 10761) and all women gave their informed consent for participation.

High prevalence of prostatic neoplasia in Australian men

The purpose of this study was to document the extremely high level of prostatic neoplasia among Australian men. The study was based on histological assessment of prostate tissue sampled from an unselected series of 133 cadavers referred for coronial autopsy at the Department of Forensic Medicine, Sydney South West Area Health Service, New South Wales. Evidence of neoplastic growth was identified in prostate tissue sampled from 30% of the 70 men aged 50 years and over, with invasive carcinoma present in 25.7% of subjects, and suspected prostatic intraepithelial neoplasia (PIN) in a further 4.3% of subjects. These findings were in marked contrast to the 63 subjects under 50 years of age. In this age group one subject had invasive prostate carcinoma, and one other had suspected PIN. The prevalence of invasive prostate carcinoma is extraordinarily high in this sample of Australian men. Among those subjects who were 50 years of age or over, more than one in four had apparently undiagnosed invasive cancer of the prostate gland.