Article Types
Research
Spatial and Temporal Patterns in Childhood and Adolescent Asthma Hospitalisations in Queensland, Australia: A 20-Year Ecological Study Across Climate Zones
Objectives To examine spatial, temporal and seasonal patterns in childhood and adolescent asthma hospitalisations across Queensland, and assess variation in hospitalisation risk by age and sex across climate regions. Design A retrospective, population-based ecological study using area-level administrative data from hospital admissions. Setting All public and private hospitals in Queensland, Australia, 1 January 2000–31 December 2019. Participants Children and adolescents aged 0–19years who were admitted to hospital with a principal diagnosis of asthma. Main Outcome Measures Age-standardised admission rates and relative risks (RRs) from spatial models; temporal patterns from time-series analysis; spatial variation from mapping; age-, sex- and climate zone-specific risks. Results Hospitalisations among children aged 0–4years declined from 48.1% (1640 admissions) in 2000 to 23.2% (721 admissions) in 2019, whereas proportions in older age groups increased. Seasonal peaks occurred in May, June and February, with male patients showing a stronger February peak and female patients maintaining higher risks into July. Hot desert regions had the highest RRs, rising from 3.73 (95% credible interval [CrI], 3.71–3.74) in 2000–2001 to 9.37 (95% CrI, 9.28–9.47) in 2009–2010, then declining to 2.37 (95% CrI, 2.37–2.38) in 2018–2019. Hot semi-arid and tropical savanna regions showed persistently elevated risks (hot semi-arid: RR, 1.86–3.75; tropical savanna: RR, 1.81–4.58). Three temporal phases were evident statewide: an early lower-risk period (2000–2002), a higher-risk period (2002–2012) and a later reduction (2012–2019), with most RRs between 0.5 and 1.5. Seasonality was strongest in hot desert zones (seasonal strength, 0.519) and weakest in tropical savanna zones (0.063). Conclusions Childhood and adolescent asthma hospitalisations in Queensland exhibit significant spatiotemporal variation, with burden shifting from younger to older children, and climate-specific risks, although observed reductions in the youngest age group may partly reflect diagnostic and hospital admission practice changes. Higher asthma risks in arid and tropical savanna regions underscore the need for geographically tailored services and planning. These findings suggest that targeted public health strategies might help reduce asthma burden in vulnerable communities.
Jialu Wang, Javier Cortes-Ramirez, Janet Davies, Wenbiao Hu
The Association Between Access Block And Ambulance Ramping, And The Impact of COVID-19: A Retrospective Observational Cohort Study of 25 Queensland Hospitals
ObjectiveTo explore the characteristics of ambulance ramping and its association with access block before, during and after the first wave of the coronavirus disease 2019 (COVID-19) pandemic.DesignRetrospective observational study.SettingExploratory data analysis and statistical modelling covering the ambulance–emergency department (ED) interface of the 25 largest public hospitals in Queensland between 1 January 2018 and 31 December 2022.Main Outcome MeasuresPrimary outcome: The association between ramping, assessed as the ambulance performance target patient off-stretcher time (POST) and access block, and how COVID-19 affected these time-sensitive processes. Secondary outcomes: The association between POST and ambulance response time and between ramping and ED length of stay.ResultsA significant decline in POST performance was observed across the study period, with the mean difference between pre– and post–COVID-19 periods being 13.1min (95% CI, 12.9–13.3min) and 8.9min (95% CI, 8.7–9.1min) for Priority 1 and Priority 2 responses, respectively. POST compliance within 30min dropped from 74% (718,912) pre–COVID-19 to 66% (694,633) during the first wave of COVID-19 and 57% (309,815) post–COVID-19, all below the 90% target. The proportion of patients experiencing access block increased from 10% (91,168) to 17% (87,757) over this same time period. Regression analyses revealed a positive relationship between POST and access block, response time and POST, and ramping and ED length of stay. Before COVID-19, no significant relationship existed between POST and access block for triage category 1 patients, but longer POST was linked to a higher likelihood of access block for categories 2–5. This trend increased across all categories during and post–COVID-19.ConclusionAchieving the POST target of transferring 90% of patients within 30min is becoming more difficult, with performance declining. The strong association of POST with access block suggests that access block is driving ramping increases. To reduce delays, efforts should focus on improving access to ward beds and managing hospital capacity issues.
Hwan-Jin Yoon, Justin Boyle, Ibrahima Diouf, Emma Bosley, Andrew Staib, Vahid Riahi, Hamed Hassanzadeh, Mahnaz Samadbeik, Clair Sullivan, Sankalp Khanna, James F. Lind
Interval Cancer Characteristics, Staging and Survival Among National Bowel Cancer Screening Program Participants, Western Australia, 2018: A Retrospective Observational Cohort Study
ObjectiveTo examine the features of interval colorectal cancer (interval CRC) in Western Australia in the context of the National Bowel Cancer Screening Program (NBCSP), including incidence, characteristics and survival by NBCSP participant characteristics.Study DesignRetrospective observational cohort study, analysis of linked National Cancer Screening Register and Western Australian Cancer Registry data.Participants, SettingParticipants in the Western Australian NBCSP (50–74years of age) with negative immunochemical faecal occult blood test (iFOBT) results during the 2018 screening round (1 January 2018–31 December 2018) were followed up for interval CRC diagnoses until 31 December 2020, and for death until 30 September 2022.Main Outcome MeasuresCrude and adjusted incidence rates of interval CRC were analysed overall and by sex, age group and residential socio-economic and remoteness categories. Survival outcomes for people with interval CRC were also assessed.ResultsOf 122,851 NBCSP participants with negative screening results in 2018, 51 people were diagnosed with interval CRC during follow-up (crude incidence rate, 21 per 100,000 person-years; 95% confidence interval [CI], 16–27). The adjusted incidence rate ratio of interval CRC was higher for men than women (adjusted incidence rate ratio [aIRR], 5; 95% CI, 3–11) and for people aged 70–74years than for those aged 50–59years (aIRR, 3; 95% CI, 1–6). Nineteen of 51 interval CRCs were diagnosed 19–24months after negative iFOBT results, 25 were located on the right side of the colon and 34 were adenocarcinomas. Only 13 interval CRCs were stage I tumours at diagnosis. During follow-up (median, 33months; interquartile range, 28–42months), the all-cause mortality rate among the 51 people with interval CRC was 41 per 1000 person-years (95% CI, 18–92), and the colorectal cancer mortality rate was 35 per 1000 person-years (95% CI, 14–83).ConclusionsWe provide a comprehensive analysis of interval CRC staging and clinical characteristics in the context of the NBCSP in Western Australia, facilitating the definition of benchmarks for monitoring programme performance.
Shantelle J. Smith, Rachael Moorin, Dagmawi Tadesse, Kathleen O'Connor, Thi Ninh Ha
Valproate Prescribing for Female Adolescents and Management of the Associated Teratogenicity Risk, Royal Children's Hospital, Melbourne, 2022–2024: A Retrospective Audit of Medical Records Data
ObjectivesTo assess the frequency of valproate prescribing for female patients of childbearing age at the Royal Children's Hospital, Melbourne, and to assess the frequency of documented discussions with these patients about the teratogenicity of valproate and the discussions or prescribing of contraception.Study DesignRetrospective audit of hospital electronic medical records data; analysis of Pharmaceutical Benefits Scheme (PBS) valproate dispensing data.Setting, Participants13- to 18-year-old girls or women prescribed valproate at the Royal Children's Hospital, Melbourne during 29 May 2022–29 May 2024; PBS valproate dispensing data for Australia for the 2023 calendar year.Main Outcome MeasuresCharacteristics of adolescent female patients prescribed valproate; documented discussions of valproate-related teratogenicity, and discussions or prescribing of contraception; population valproate prescribing rates for Australia and by state.ResultsValproate was prescribed for 245 female patients aged 13–18years during 2022–2024 (median age, 16years; interquartile range [IQR], 14–17years); the median prescribed daily dose was 600mg (IQR, 400–800mg; range, 200–2000mg). Valproate was prescribed for treating epilepsy for 221 patients (90%), including 97 (44%) with drug-resistant epilepsy; 160 patients (65%) had neurodevelopmental disabilities. Teratogenicity was discussed with 32 patients (13%), less frequently with patients with a neurodevelopmental disability (9% vs. 20%; odds ratio [OR], 0.41; 95% confidence interval [95% CI], 0.19–0.88). Contraception was discussed with 69 patients (28%); the proportion was larger for patients with neurodevelopmental disabilities (34% vs. 16%; OR, 2.66; 95% CI, 1.37–5.14). Contraception was prescribed for 50 patients (20%); the proportion was larger for patients with neurodevelopmental disabilities (25% vs. 12%; OR, 2.50; 95% CI, 1.18–5.30). The national PBS-subsidised dispensing rate during 2023 was 621 per 100,000 girls and women aged 13–18years; in Victoria it was 556 per 100,000 girls and women aged 13–18years.ConclusionDespite the risk of teratogenicity, valproate was prescribed for a considerable number of female adolescents at the Royal Children's Hospital during 2022–2024 and across Australia during 2023. Its teratogenicity was discussed with few patients, nor were discussions or prescribing contraception frequent. Contraception was more frequently discussed and prescribed for patients with neurodevelopmental disability, but teratogenicity was discussed less often.
Briana Davis, Monica S. Cooper, Michael South, Jeremy L. Freeman, Emma Macdonald-Laurs
Early Cessation of Acetylcysteine Treatment After Paracetamol Overdose (NACSTOP 2): A Non-Inferiority Randomised Controlled Trial
ObjectivesTo determine whether ceasing acetylcysteine treatment for adults with acute paracetamol overdose after at least 12h of the two-bag acetylcysteine regimen is non-inferior to providing the full 20-h two-bag regimen.Study DesignOpen label, non-inferiority randomised controlled trial.SettingEmergency departments of six Australian metropolitan hospitals (four in Melbourne, two in Sydney), 1 December 2019–31 July 2024.ParticipantsAdults who required acetylcysteine treatment following single or staggered paracetamol ingestions whose serum alanine transaminase (ALT) level was below 40IU/L on presentation, and whose ALT levels were below 40IU/L and serum paracetamol concentrations below 20mg/L after 12 h of acetylcysteine treatment.InterventionControl group (standard care): two-bag intravenous acetylcysteine regimen (200mg/kg over 4h, followed by 100mg/kg over 16h). Intervention group: Acetylcysteine stopped at least 12h after treatment initiation and the 20-h infusion period completed with intravenous compound sodium lactate.Main Outcome MeasuresDifference in ALT level between presentation and 20h after acetylcysteine treatment initiation; non-inferiority was defined as the upper limit of the 95% confidence interval (CI) of the difference between median changes in ALT level for the intervention and control groups being less than 3IU/L.ResultsOf 2830 people who presented with paracetamol overdose, 860 received acetylcysteine treatment; 186 people who met both the presentation and 12-h acetylcysteine treatment blood test inclusion criteria (median age, 17years; interquartile range [IQR], 16–23years; 162 women [87%]) were randomly assigned to the intervention (93 participants) and control groups (93 participants). Median acetylcysteine infusion time in the intervention group was 13h (IQR, 13–13 h). The median change in ALT level between arrival and 20h after starting intravenous acetylcysteine treatment was similar for the intervention (−1IU/L; IQR, −4 to 1IU/L) and control groups (0IU/L; IQR, −2 to 2IU/L); the difference in median change (−1IU/L; 95% CI, −2 to 1IU/L) was consistent with the non-inferiority criterion. No patients developed hepatic injury or hepatotoxicity.ConclusionAn abbreviated acetylcysteine treatment regimen was non-inferior to the standard 20-h two-bag regimen for people with paracetamol overdose who were at low risk of hepatic failure.Trial RegistrationACTRN12619001549112 (prospective)
Anselm Wong, Richard McNulty, Sarah E. Hodgson, Naren Gunja, Andis Graudins
Adolescent Pregnancy Among Girls Known to Child Protection Services: An Australian Longitudinal Cohort Study Using Data Linkage
In a population cohort of 44,216 adolescent girls, about 73.5% of those who became pregnant were known to child protection services. Exposure to higher levels of child protection response was associated with increased cumulative incidence and an earlier age of pregnancy.
Oliver Watkeys, Kimberlie Dean, Kristin R. Laurens, Stacy Tzoumakis, Vaughan J. Carr, Melissa J. Green
Early Palliative Care and Quality of End-of-Life Care for People With Terminal Cancer, Victoria, 2018–2023: A Retrospective, Population-Based Cohort Study
ObjectivesTo determine how many people who die of cancer in Victoria receive palliative care and early palliative care (more than 3months before death); to assess the impact of early palliative care on the quality of end-of-life care.Study DesignRetrospective, population-based cohort study; analysis of linked Victorian Cancer Registry data and routinely collected data for inpatient, non-admitted health service and emergency department care during the 12months prior to death.Setting, ParticipantsVictorian adults who died of cancer during 1 January 2018–31 January 2023.Main Outcome MeasuresProportions of people who received palliative care (any time) or early palliative care (more than 3months prior to death); likelihood of quality of end-of-life care measures: dying outside an acute hospital; chemotherapy, two or more emergency department visits, two or more hospital admissions during final 30days of life; advance care plan at death.ResultsOf 53,305 people who died of cancer (mean age, 74.8years [standard deviation, 13.0years]; 29,527 men [55.4%]), palliative care was provided for 38,697 (72.6%); 17,409 people (32.7%) received early palliative care. The most frequent palliative care type was palliative approach to care (Z51.5 code; 33,974 people, 63.7%). The overall proportion of people who received palliative care did not change markedly during 2018–2022; the proportion who received early palliative care declined slightly, from 34.8% (95% confidence interval [CI], 33.6–35.9) to 33.0% (95% CI, 31.7–33.8). People who received early palliative care were more likely than people who received late palliative care to have an advance care plan (adjusted odds ratio [aOR], 1.46; 95% CI, 1.38–1.55) and to die outside hospital (aOR, 2.50; 95% CI, 2.37–2.64); they were less likely to have two or more of emergency department presentations (aOR, 0.75; 95% CI, 0.70–0.81), two or more hospital admissions (aOR, 0.58; 95% CI, 0.55–0.61) or chemotherapy (aOR, 0.51; 95% CI, 0.47–0.55) during their final 30days of life.Conclusion72.6% of people who died of cancer in Victoria during 2018–2023 had received palliative care, but only 33% had received it early. End-of-life care may be improved by providing palliative care early. The low early palliative care rate, despite the potential for improved outcomes for people who receive it, indicates that action is needed.
Chris Schilling, Olivia Wawryk, Anna Collins, Vijaya Sundararajan, Brian H. Le, Jennifer Philip
Strengthening Care for Children (SC4C), an Integrated Paediatrician‒General Practitioner Model for Reducing Hospital Referral Rates: a Stepped-Wedge Cluster Randomised Controlled Trial
ObjectivesTo assess the effectiveness of Strengthening Care for Children (SC4C) for reducing the number of referrals by general practitioners of patients under 18years of age to hospital services.Study DesignStepped-wedge cluster randomised trial; data collected for up to 16months after the intervention.SettingGeneral practices in North Western Melbourne and Central and Eastern Sydney primary health networks, 1 May 2021–30 September 2023.ParticipantsGeneral practitioners who worked at least two clinical sessions each week, saw patients under 18years of age, and for whom at least 1 month of referrals data during the control period were available; families of people under 18years attending these practices.InterventionWeekly (6 months) then fortnightly (6 months) general practitioner–paediatrician co-consultations; monthly paediatrician-led case discussions; weekday phone and email support by paediatricians.Main Outcome MeasuresProportion of general practitioner visits in which patients were referred to publicly funded hospital outpatient clinics or emergency departments (patient level), overall and by baseline referral rate. Secondary outcomes: Referrals after completion of the intervention; general practitioner confidence regarding child health care; low value care for frequent childhood conditions; family preference for general practitioner or paediatrician care.ResultsOne hundred and thirty participating general practitioners from 22 general practices conducted 50,101 consultations during the control period; 125 general practitioners from 21 general practices received the intervention and undertook 96,804 consultations. Patients were referred to hospitals in 2.3% of control period consultations and 1.9% of intervention period consultations (risk difference, −0.34 [95% confidence interval {CI}, −0.69 to 0.004] percentage points). Among general practitioners with high referral rates at baseline (5% or higher), patients were referred to hospital outpatient or emergency department in 7.3% of control period consultations and in 3.0% of intervention period consultations (risk difference, −4.28 [95% CI, −6.59 to −1.97] percentage points); the referral rate was also lower after the intervention period (sustainability vs. control periods: 2.9% vs. 5.8%; risk difference, −2.92 [95% CI, −5.36 to −0.48] percentage points). The proportions of general practitioners confident about their knowledge and skills regarding child health care were larger during the intervention than the control period. Quality of care and family preference for general practitioner-led care for their children remained high across the study. No adverse events were recorded.ConclusionStrengthening primary care for children reduces the frequency of hospital referrals of children by general practitioners with high referral rates, increases rates of general practitioner confidence about caring for children and maintains family preference for general practitioner-led care.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001299998 (prospective)
Harriet Hiscock · Cecilia Moore · Sonia Khano · Lena A. Sanci · Kim M. Dalziel · Gary Freed · Douglas I. R. Boyle · Tammy Meyers Morris · Siaw-Teng Liaw · Jane Le · Yvonne A. Zurynski · Susan Woolfenden · Raghu Lingam
The epidemiology of acute rheumatic fever and rheumatic heart disease in Queensland, 2017–2021: a population‐level cohort study using linked administrative data
The significant ARF and RHD burden among Indigenous Queenslanders, and vast disparity with non-Indigenous populations, calls for an urgent whole-of-government response to redress. Analysis of linked administrative data can inform place-based ARF and RHD strategies
Carl J Francia (Saibai Koedal awgadhalayg, Guda Maluylgal Nation) · Leanne M Johnston · Ingrid Stacey · Robert N Justo · John F Fraser · Judith M Katzenellenbogen
The clinical presentation, investigation, and management of women diagnosed with endometriosis in Australian general practices, 2011–2021: an open cohort study
Supporting general practitioners in the identification and management of endometriosis could reduce diagnostic delays and optimise clinical care
Danielle Mazza · Kailash Thapaliya · Sharinne B Crawford · Alissia Hui · Maryam Moradi · Luke E Grzeskowiak
The number of cancer‐related deaths that could be attributable to spatial disparities in survival in Australia, 2010–2019: a retrospective population‐based cohort study
By quantifying the impact of geographical disparities in cancer survival, these findings highlight the need for evidence-based interventions to improve cancer survival across Australia
Charlotte K Bainomugisa · Jessica Cameron · Paramita Dasgupta · Peter Baade
Birth prevalence, clinical sequelae, and management of congenital cytomegalovirus infections in Australia, 1999–2023: a national prospective study
Universal newborn screening could improve timely detection and avert neurological and other adverse consequences of CMV infections
Ece Egilmezer · Suzy M Teutsch · Carlos Nunez · Stuart T Hamilton · Adam W Bartlett · Pamela Palasanthiran · Elizabeth J Elliott · William D Rawlinson
The risk of death after hospitalisation following intentional self‐poisoning: a retrospective observational study (PAVLOVA‐2)
Aftercare for people who have poisoned themselves should include both mental health assessments and reviews of physical health conditions
Firouzeh Noghrehchi · Nicholas A Buckley · Rose Cairns
Disease‐specific survival for people with chronic myeloid leukaemia, South Australia, 1980–2020: a retrospective cohort study
Disease-specific mortality for people with CML has declined substantially with the introduction of tyrosine kinase inhibitors
Kerri Beckmann · Brendon J Kearney · Naranie Shanmuganathan · David Yeung · Tim Hughes
A retrospective cross‐sectional analysis of the economic impact of environmental risk factors on inpatient hospital separations in the Northern Territory
Improving housing, water quality and sanitation will prevent disease and reduce health care expenditure. Delivering on environmental health commitments through meaningful partnerships and coordinated action across sectors is essential for closing the gap
Geetanjali Lamba · Danielle Esler · Yuejen Zhao · Tracy Ward · Christine Connors · Michael Spry (Marranunggu)
Non‐technical errors associated with deaths in surgical care, Australia, 2012–2019, by surgical specialty (Australian and New Zealand Audit of Surgical Mortality): a retrospective cohort study
Specialty-specific interventions could target certain identified problems, but systemwide strategies should receive priority
Jesse Ey · Victoria Kollias · Octavia Lee · Kelly Hou · Matheesha Herath · John B North · Ellie Treloar · Suzanne Edwards · Martin Bruening · Adam J Wells · Guy J Maddern
The early implementation phase of the Omega‐3 Test‐and‐Treat Program for reducing the risk of preterm birth, South Australia, 2021–22: an implementation evaluation study
The program could be integrated into routine antenatal care to reduce the risk of preterm birth in Australia
Karen P Best · Celine Northcott · Lucy A Simmonds · Philippa Middleton · Lisa N Yelland · Vanessa Moffa · Khoa Lam · Penelope Coates · Cornelia Späth · Carol WK Siu · Karen Glover · Rhiannon Smith · Robert Gibson · Maria Makrides
Changes in patient management after preoperative MRI for newly diagnosed breast cancer: a multicentre prospective observational study
MRI for selected women where conventional imaging is suboptimal may improve surgical planning and thus afford better outcomes
Michael L Marinovich · Nehmat Houssami · Andrew Spillane · Gregory B Mann · Donna Taylor · Michelle Reintals · Nadine Phillips · Max K Bulsara · Patsy Siok Hwa Soon · Tracey Dickens · Christobel M Saunders
Cause‐specific mortality among Queensland people with cirrhosis, by cirrhosis aetiology and decompensation status, 2007–22: a retrospective cohort study
Targeted public health measures for particular patient subgroups are required to save lives among people with cirrhosis
Vikas Bhasker · Jessica R Fong · Paul J Clark · Gunter F Hartel · Richard Skoien · James O’Beirne · Elizabeth E Powell · Patricia C Valery
The detection of avian influenza virus in human pathology laboratories in Australia, New Zealand, and South Pacific nations
Avian influenza viruses can be detected by human diagnostic testing platforms routinely used for testing for influenza A viruses
Lisa M Sedger · Vishal Ahuja · Katherine A Lau · Deane L Byers · Torsten Theis · Peter D Kirkland · Catherine Pitman
Sharing custodianship of learning: development of an Indigenous Nation‐led learning charter model centring self‐determination and wellbeing
The Indigenous Nation-led learning charter sets the aspirations for all Aboriginal and Torres Strait Islander learners learning on a specific Country. It provides guidance and leadership in partnership with schools that centres First Nations learners
Hayley McQuire · Melinda Mann
The power of recognising more: a qualitative study of young people’s perspectives on broader recognition for learning and wellbeing
Redefining success in education to include recognition of broader learning — shaped by learners and their contexts — can enhance engagement, improve outcomes, disrupt disadvantage, and support more equitable systems that promote wellbeing and lifelong learning
Charlie Connell‐Tobin · Linh Dang · Mietta Symmons‐Joyce · Annette C Cairnduff · Andrew PR Kellett · Lauren Langley · Philippa Collin
Greenhouse gas emissions associated with anaesthetic gases in Australia, 2002–2022: a retrospective descriptive analysis
Continuing to reduce the use of anaesthetic gases will advance the decarbonisation of Australian health care
Krista Verlis · Jessica F Davies · Forbes McGain · Hayden Burch · Alexandra L Barratt · Luise Kazda
Socio‐economic position and the prevalence of ten chronic diseases in Australia, 2021: a whole of population census data analysis
Knowing whose health is most affected by socio-economic disadvantage is integral for effective, targeted health interventions
Joanna Y Gong · Emily D Williams · Agus Salim · Spiros Fourlanos · Jonathan E Shaw · Dianna J Magliano
Identifying modifiable causes of stress in clinicians and administrators working in New South Wales psychiatric emergency care centres, 2023–24: a qualitative study
Conflicting demands in crisis care units can be alleviated by a flat team hierarchy and clear treatment protocols
Jacqueline P Huber · Alyssa Milton · Matthew Brewer · Kat Fry · Sean Evans · Jason Coulthard · Nicholas Glozier