Research

Objective: To determine the effectiveness of an intensive quit-smoking intervention on smoking rates at 36 weeks’ gestation among pregnant Aboriginal and Torres Strait Islander women.Design: Randomised controlled trial.Setting and participants: Pregnant Aboriginal and Torres Strait Islander women (n = 263) attending their first antenatal visit at one of three Aboriginal community-controlled health services between June 2005 and December 2009.Intervention: A general ...

Sandra J Eades BMed, PhD · Rob W Sanson-Fisher PhD, ClinMPsych · Mark Wenitong BMed · Katie Panaretto MB BS · Catherine D’Este BMath, PhD · Conor Gilligan BBiomedSc, PhD · Jessica Stewart BA/LLB, MPP

Objectives: To document the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in the refugee population settling in Western Australia from 1 January 2006 to 31 December 2009 and make recommendations for future screening for chlamydia and gonorrhoea in the refugee population.Design and participants: A prevalence and quality assurance study of 2610 refugees aged 15 years and older who attended the Humanitarian Entrant Health Service in Western Australia ...

Veronica C Hoad MB BS, MPH · Aesen Thambiran MB BS, FRACGP

Objectives: To estimate the incidence of metastatic breast cancer (MBC) in Australian women with an initial diagnosis of non-metastatic breast cancer.Design, setting and participants: A population-based cohort study of all women with non-metastatic breast cancer registered on the New South Wales Central Cancer Register (CCR) in 2001 and 2002 who received care in a NSW hospital.Main outcome measures: 5-year cumulative incidence ...

Sarah J Lord MB BS, MS, FRACGP · M Luke Marinovich BA, MPH · Jillian A Patterson BSc, MBiostats · Nicholas Wilcken MB BS, PhD, FRACP · Belinda E Kiely MB BS, FRACP · Val Gebski BA, MStats, FRANZCR(Hons) · Sally Crossing AM, BEc · David M Roder AM, MPH, DDSc · Melina Gattellari PhD, MPH, BSc(Psychol) · Nehmat Houssami MB BS, PhD, FAFPHM

Objectives: To quantify the effect of previous false-positive mammogram results on rescreening rates in a population of women participating in the BreastScreen WA (BSWA) program.Design and participants: Retrospective cohort study of women aged 50–69 years who received free screening mammograms at BSWA between 1 January 1995 and 31 December 2007.Main outcome measures: Percentages of women attending rescreening, and risk ratios for rescreening.Results: ...

Marcus J H Sim · Siva Prema Siva · Intan S Ramli · Lin Fritschi MB BS, PhD, FAFPHM · Janette Tresham BSc(Agric) · Elizabeth J Wylie MB BS, FRANZCR

Objective: To determine the nutrient intakes and status of preschool children from a representative population sample in Adelaide.Design, setting and participants: Cross-sectional survey of children aged 1–5 years, using a stratified random sampling method and a doorknocking strategy, between September 2005 and July 2007.Main outcome measures: Dietary intake, assessed using a 3-day weighed-food diary; anthropometrics, biomarkers of iron, zinc and vitamin ...

Shao J Zhou PhD · Robert A Gibson BSc, PhD · Rosalind S Gibson PhD · Maria Makrides BSc, PhD

Objective: To determine hepatitis C (HCV) treatment effectiveness and predictors of response in the “real-world” Australian clinic setting. Design, setting and participants: Patients with chronic HCV, who were HCV-treatment-naive at enrolment, and were then treated with standard therapy (pegylated interferon-α plus ribavirin), were recruited prospectively through a national network of 24 HCV clinics ...

Heather F Gidding MAppEpid, PhD · Matthew G Law PhD · Janaki Amin PhD · George Ostapowicz BMed, MD, FRACP · Martin Weltman PhD, FAChAM, FRACP · Graeme A Macdonald MB BS, PhD, FRACP · Joe J Sasadeusz MB BS, PhD, FRACP · Paul AW Haber MD, FRACP, FAChAM · Jacob George MB BS, PhD, FRACP · Gregory J Dore MPH, PhD, FRACP

Objectives: To develop a mathematical model to project the potential impact of hepatitis C virus (HCV) treatment on HCV infection prevalence among people who inject drugs (PWID). Design and setting: An existing model of HCV transmission among PWID was parameterised using data from Victoria, Australia, including specific parameter estimates of the number ...

Margaret E Hellard PhD, FRACP, FAFPHM · Rebecca Jenkinson BEng(Geol), MEpid, PhD · Peter Higgs BSW, MA, PhD · Mark A Stoové BaAppSci(Hons), GradDip(Ed), PhD · Rachel Sacks-Davis BA BSc(Hons[Arts]) · Judy Gold BBiomedSci(Hons), PhD · Matthew Hickman MSc, PhD, FFPH · Peter Vickerman DPhil, BSc · Natasha K Martin PhD

Objective: To describe patterns of testosterone prescribing in Australia over the past two decades by state or territory and by product type.Design and setting: Observational analysis of testosterone prescribing data obtained from two independent data sources — the Pharmaceutical Benefits Scheme (PBS) and IMS, a source of commercial pharmaceutical sales data.Main ...

David J Handelsman MB BS, FRACP, PhD

Objective: To report the perspectives of optometrists, ophthalmologists and patients on a model of shared care for patients with chronic eye diseases. Design, setting and participants: Qualitative study of a model of shared care between optometrists and ophthalmologists for patients with stable age-related macular degeneration, diabetic retinopathy and glaucoma, trialled by the ...

Patricia M O’Connor PhD · C Alex Harper MB BS, FRANZCO · Cathy L Brunton BNurs · Sandra J Clews RN · Sharon A Haymes BScOptom, PhD, MPH · Jill E Keeffe OAM, PhD

Objective: To review patients with severe bilateral vestibular loss associated with gentamicin treatment in hospital. Design and setting: A retrospective case series of presentations to a balance disorders clinic between 1988 and 2010. Main outcome measures: Relationship between vestibulotoxicity and gentamicin dose or dosing profile; indications for prescribing gentamicin. Results: 103 patients (age, 18–84 years; mean, 64 years) presented with imbalance, oscillopsia or both, but none had vertigo. Only three noted some hearing impairment after having gentamicin, but audiometric thresholds for all patients were consistent with their age. In all patients, the following tests gave positive results: a bilateral clinical head-impulse test, a vertical head-shaking test for vertical oscillopsia, and a foam Romberg test. In 21 patients, imbalance occurred during gentamicin treatment (ignored or dismissed by prescribers in 20) and in 66 after treatment; the remaining 16 could not recall when symptoms were first noticed, except that it was after gentamicin treatment in hospital. Total gentamicin dose range was 2–318 mg/kg (mean, 52 mg/kg), daily dose range was 1.5–5.6 mg/kg (mean, 3.5 mg/kg), and duration was 1–80 days (mean, 17 days). Six patients had only a single dose; 26 had five or fewer doses. Serum gentamicin levels, measured in 82 patients, were in the recommended range in 59. Time to diagnosis ranged from 4 days to 15 years. Nephrotoxicity developed in 43 patients. Gentamicin dosage complied with contemporary or current Australian antibiotic guidelines in under half the patients. Conclusions: Gentamicin ototoxicity is vestibular, not cochlear, producing permanent loss of balance, but not of hearing. Gentamicin can be vestibulotoxic in any dose, in any regimen, at any serum level.

Rebekah M Ahmed MB BS, FRACP · Imelda P Hannigan RN · Hamish G MacDougall PhD · Raymond C Chan MB BS, FRACP, FRCPA · G Michael Halmagyi MD, FRACP

To describe the experience of hormone treatment of gender identity disorder (GID) in children and adolescents within a specialist clinic. Design, patients and setting: Cohort study by medical record review of children aged 0–17 years referred during 2003–2011 for management at the GID clinic in a tertiary paediatric referral centre — the Royal ...

Jacqueline K Hewitt MB BS, FRACP · Campbell Paul MB BS, FRANZCP · Porpavai Kasiannan DPM, MD, FRANZCP · Sonia R Grover MB BS, MD, FRANZCOG · Louise K Newman MB BS, PhD, FRANZCP · Garry L Warne MB BS, FRACP

Objective: To determine the risk and timing of a broad range of infective outcomes and mortality after splenectomy.Design, setting and participants: Analysis of a non-identifiable linked hospital discharge administrative dataset for splenectomy cases between July 1998 and December 2006 in Victoria, Australia.Main outcome measures: Age, sex, indication for splenectomy, infectious events ...

Claire Dendle MB BS, FRACP, GCHPE · Vijaya Sundararajan MD, MPH, FACP · Tim Spelman MB BS, BSc, GradCert(Stats) · Damien Jolley MSv(Epi), MSc(Stats) · Ian Woolley MB BS, FRACP, DTMH

Further studies are needed to develop evidence-based recommendations for vaccinations and prophylactic antibiotic regimensThroughout the ages, the function of the spleen was subject to much conjecture. It was variously thought to be both the centre of melancholy by the French and the centre for anger by the English (“to vent one’s spleen”). Of no doubt ...

David F M Looke FRACP, FRCPA, MMedSci · Naomi J Runnegar MB BS, FRACP, FRCPA

Objective: To determine the geographical, epidemiological and clinical features of sporotrichosis (a cutaneous fungal infection caused by Sporothrix schenckii) in the New South Wales mid-north coast.Design and setting: We undertook a retrospective case review of S. schenckii infections that occurred during the period 2000–2010. Microbiology laboratory staff and medical practitioners in ...

Shobini Sivagnanam BSc(Med), MB BS · Aiveen M Bannan MB BS, FRACP, MPH · Sharon C-A Chen FRACP, FRCPA, PhD · Anna P Ralph MB BS, FRACP, PhD

Objective: To determine whether the introduction of an acute surgical unit (ASU) resulted in a greater proportion of patients with acute cholecystitis receiving definitive surgery on index admission with no adverse change in surgical outcomes.Design, setting and participants: A retrospective study of medical records for patients presenting to Nepean Hospital with ...

Lester Pepingco BMedSc, MB BS(Hons) · Guy D Eslick PhD, FACE, FFPH · Michael R Cox MB BS, FRACS, MS

Objective: To describe the management and outcomes of a population-based cohort of patients with pancreatic cancer in Victoria, Australia.Design, setting and patients: Retrospective study based on questionnaires completed from medical histories of patients diagnosed with pancreatic cancer during 2002–2003 in Victoria who were identified from the Victorian Cancer Registry and followed up ...

Antony G Speer BE, MB BS, FRACP · Vicky J Thursfield BSc, GradDip(ApplStats) · Yvonne Torn-Broers BA(Hons) · Michael Jefford MB BS, PhD, FRACP

Objectives: To determine current colorectal cancer (CRC) screening rates and the level of adherence to screening guidelines at a community level.Setting: A cross-sectional cohort of at-risk people aged 56–88 years randomly selected from the Hunter Community Study (HCS), Australia.Main outcome measures: Proportion ever reporting undertaking any CRC testing; current screening ...

Ryan J Courtney BPsych(Hons) · Christine L Paul PhD · Robert W Sanson-Fisher PhD, MClinPsych · Finlay A Macrae MD, FRACP, FRCP · Mariko L Carey PhD · John R Attia MD, PhD · Mark A McEvoy MClinEpi

Objectives: To identify barriers to and facilitators of colorectal cancer (CRC) screening participation among different cultural subgroups in South Australia, and to describe how these might be shared or be distinct across these groups.Design, participants and setting: Qualitative study using individual interviews in Adelaide, South Australia, between July 2009 and December 2010. ...

Sara Javanparast MD, PhD · Paul R Ward PhD · Stacy M Carter MPH(Hons), PhD · Carlene J Wilson BA(Hons), MBA, PhD

Objectives: To document the existence and provisions of Australian universities’ policies on the competing interests of academic staff and university practices in recording, updating and making these declarations publicly accessible. Design and setting: ...

Simon Chapman PhD · Bronwen Morrell BA(Hons) · Rowena Forsyth BA(Hons), PhD · Ian Kerridge BMed(Hons), FRCPA, FRACP · Cameron Stewart BEcLLB(Hons1), PhD, FACLM(Hons)

Objectives: To measure eligibility for medical thromboprophylaxis using two Australasian guidelines — the Australia and New Zealand Working Party Guidelines [WPG] and the National Health and Medical Research Council Guidelines [NHMRCG]) — and ...

J Alasdair Millar PhD, FRACP, FRCP · Joanne E Lett MB ChB · Leonard J Bagley BPharm · Ian K Densie BSR

Objective: To assess the use of Prothrombinex-VF powder for injection (PTX-VF) at Royal Perth Hospital and analyse the efficacy and safety profile of PTX-VF.Design, setting and patients: A prospective observational audit ...

Paul C Kruger MB BS · Annette S Le Viellez BSc(MedSci) · Richard P Herrmann MB BS, FRCPA, FRACP

Objective: To determine the incidence of and factors associated with vitamin D deficiency rickets in Australian children.Design: 18-month questionnaire-based prospective observational study, using Australian Paediatric Surveillance Unit (APSU) data.Setting: ...

on behalf of the APSU Vitamin D Study Group

Objectives: To document and describe outpatient persistent pain management services in Australia.Design, participants and setting: Systematic survey conducted between 1 December 2008 and 31 January 2010 of 57 services providing outpatient care to adult clients with persistent pain, plus five specialised paediatric services throughout Australia.Main outcome measures: Service structure, including funding processes; activity, including client numbers, access to specialised services (inpatient care, pain relief interventions); waiting times; and use of allied-health-professional-based pain management programs.Results: Of 68 services identified, 57 participated in the study. The median waiting time from referral receipt to initial clinical assessment for a publicly funded outpatient adult pain management service was 150 days, compared with 38.5 days for a privately funded service (P < 0.05). There was substantial variability among providers in range of services offered, including provision and duration of allied-health pain management programs. The level of service provision for children and rural patients is notably lower than that reported for urban adult constituents.Conclusions: Persistent pain management services are currently unable to meet service requirements adequately, and waiting times are more prolonged for publicly funded than privately funded services. Greater service provision is required in rural areas and for children.

Malcolm N Hogg MB BS, GrDip(PM), FFPANZCA · Stephen Gibson BBSc, PhD · Amal Helou BHlthSc(Nursing), MM(PM) · Jacklyn DeGabriele BHlthSc(Nursing), GrDip(Midwifery) · Michael J Farrell BAppSc(Phty), MSc(Gerontology), PhD

Objective: To assess whether patients receiving opioid substitution therapy (OST) in general practice cause other patients sufficient distress to change practices — a perceived barrier that prevents general practitioners from prescribing OST.Design, setting and participants: A cross-sectional questionnaire-based survey of consecutive adult patients in the waiting rooms of a network of research general practices in New South Wales during August – December 2009.Main outcome measures: Prevalence of disturbing waiting room experiences where drug intoxication was considered a factor, discomfort about sharing the waiting room with patients being treated for drug addiction, and likelihood of changing practices if the practice provided specialised care for patients with opiate addiction.Results: From 15 practices (eight OST-prescribing), 1138 of 1449 invited patients completed questionnaires (response rate, 78.5%). A disturbing experience in any waiting room at any time was reported by 18.0% of respondents (203/1130), with only 3.1% (35/1128) reporting that drug intoxication was a contributing factor. However, 39.3% of respondents (424/1080) would feel uncomfortable sharing the waiting room with someone being treated for drug addiction. Respondents were largely unaware of the OST-prescribing status of the practice (12.1% of patients attending OST-prescribing practices [70/579] correctly reported this). Only 15.9% of respondents (165/1037) reported being likely to change practices if theirs provided specialised care for opiate-addicted patients. In contrast, 28.7% (302/1053) were likely to change practices if consistently kept waiting more than 30 minutes, and 26.6% (275/1033) would likely do so if consultation fees increased by $10.Conclusions: Despite the frequency of stigmatising attitudes towards patients requiring treatment for drug addiction, GPs’ concerns that prescribing OST in their practices would have a negative impact on other patients’ waiting room experiences or on retention of patients seem to be unfounded.

Simon M Holliday FAChAM, FRACGP, FACRRM · Parker J Magin PhD, FRACGP · Janet S Dunbabin PhD · Ben D Ewald MClinEpid, PhD · Julie-Marie Henry RN, DipAppSc(Nursing) · Susan M Goode BSc(Hons), DipMgmt · Fran A Baker BMath · Adrian J Dunlop PhD, GradDipEpi

Objective: To describe values of serum prostate-specific antigen (PSA) in older men without diagnosed prostate cancer, categorised by age and country of birth, and to describe self-reported prostate cancer screening. Design, participants and setting: A cohort study (the Concord Health and Ageing in Men Project) involving a representative sample of 1434 eligible ...

Melisa J Litchfield BAppSc, MPH(Hons) · Robert G Cumming MB BS, MPH, PhD · David P Smith BA, MPH, PhD · Vasi Naganathan MB BS, FRACP, PhD · David G Le Couteur FRACP, PhD · Louise M Waite MB BS, FRACP, PhD · Fiona M Blyth MB BS(Hons), FAFPHM, PhD · David J Handelsman MB BS, FRACP, PhD