Research

Australia has among the world’s lowest maternal and perinatal mortality rates, with the latter more than halving over the past 40 years. However, as in other high-income countries, a decline in neonatal rather than fetal deaths has mainly contributed to falling rates, leading to calls for more attention to preventing stillbirth. Identified maternal risk ...

Henry Drysdale MB BS · Sanjeeva Ranasinha MEpid, MSc(ApplStat) · Amanda Kendall BMid · Michelle Knight RM, LLB · Euan M Wallace MD, FRCOG, FRANZCOG

The antiprogesterone mifepristone combined with a prostaglandin analogue (misoprostol or gemeprost) is effective for terminating early pregnancy and has a favourable safety profile.

Philip Goldstone MB BS(Hons) · Jill Michelson RN, RM, MBA(HealthAdmin) · Eve Williamson BPharm, PDM

Chlamydia, caused by the bacteria Chlamydia trachomatis, is a sexually transmitted infection (STI) and the most commonly notified disease in Australia and in Western Australia ...

Kellie S H Kwan BA(Hons), GradCertAppEpi · Edwina A Jachimowicz BNsng, MNsgSt(Midwifery), GradDipNseEd · Lisa Bastian BAppSc(Nursing), MPH · Lewis Marshall MPH, FAFPHM, FACSHM · Donna B Mak MPH, FAFPHM, FACRRM

Objective: To present updated national birthweight percentiles by gestational age for male and female singleton infants born in Australia.Design and setting: Cross-sectional population-based study of 2.53 million singleton live births in Australia between 1998 and 2007.Main outcome measures: Birthweight percentiles by gestational age and sex.Results: Between 1998 and 2007, women in Australia gave birth to 2 539 237 live singleton infants. Of these, ...

Timothy A Dobbins BMath, PhD · Elizabeth A Sullivan MD, MPH, FAFPHM · Christine L Roberts MB BS, DrPH, FAFPHM · Judy M Simpson BSc(Hons), PhD

Objective: To examine the frequency and causes of snorkelling-related deaths in Australia.Design, setting and subjects: We conducted a retrospective analysis of snorkelling-related deaths recorded in Australia from 1994 to 2006 inclusive, based on information from the Divers Alert Network Asia–Pacific database, the National Coroners Information System, coronial files from all states and territories, and annual national drowning reports.Main outcome measures: Number ...

John M Lippmann BSc, DipEd, MAppSc · John H Pearn MD, FRACP, FRCP

Traumatic injury accounts for 9% of global mortality, and imposes significant physical and psychological disability on people of all age groups. It remains the leading cause of death in those under 45 years of age. Trauma systems facilitate the timely treatment of patients with major trauma at a trauma centre. This approach has reduced mortality in patients with trauma in Australia and internationally.

Kate A Curtis PhD, RN · Rebecca J Mitchell MA (Psych), MOHS, PhD · Shanley S Chong PhD · Zsolt J Balogh MD, PhD, FRACS · Duncan J Reed MB BS, FACEM · Peter T Clark FACEM, FCICM, FANZCA · Scott D’Amours MDCM, FRCS(C), FRACS · Deborah A Black PhD, MStat, BSc · Mary E Langcake BM BS, BSc(Hons), FRACS · Colman B Taylor MND · Patricia McDougall RN, Cert Hlth Economics · Peter A Cameron MB BS, MD, FACEM

Objective: To identify a level of iodine supplementation to recommend for pregnant and breastfeeding women in Australia.Design, setting and participants: Dietary modelling indicated that mandatory fortification of bread with iodine by replacing salt with iodised salt would still leave a gap in iodine intakes in pregnant and breastfeeding women in Australia. Iodine shortfall was estimated by two separate methods: (i) analysis ...

Dorothy E M Mackerras MPH, PhD · Creswell J Eastman MD, FRACP, FRCPA

Objective: To investigate whether bias in clinical history affects accuracy of electrocardiograph (ECG) interpretation among doctors working in emergency departments.Design and setting: Observational study conducted at four teaching hospitals in Sydney from May to September 2011.Participants: Emergency registrars and physicians (senior doctors), and interns, resident medical officers and senior resident medical officers (junior doctors).Intervention: Participants interpreted 30 ECGs ...

Monique F Cruz BSc(Med), MB BS · James Edwards MB BS, MMedEd, FACEM · Michael M Dinh MB BS, MPH, FACEM · Elizabeth H Barnes MStat

In the early years of transplantation, organs were retrieved from patients who were considered to have died by traditional cardiopulmonary criteria (now known as donation after cardiac death [DCD]) or from live donors. The introduction of diagnostic criteria for brain death provided a more practical and controlled pathway to organ donation. Donation after brain death (DBrD) allowed organ retrieval without prior cessation of circulation, thus minimising warm ischaemic time and enhancing organ function in the recipient.

Tim G Coulson BM, BSc · David V Pilcher MRCP, FRACP, FCICM · Shena M Graham RN, CCC, BN · Gregory I Snell MB BS, FRACP, MD · Bronwyn J Levvey RN, GradDipEpi, BEdStudies · Steve Philpot FCICM · Alvin Teo FCICM · Andrew R Davies FRACP, FCICM

Objective: To compare the Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS initiative with the Better Outcomes in Mental Health Care initiative, to test contentions that Better Access is used more often by advantaged major city patients and that the role of GPs has been reduced to that of referrers.Design and setting: Analysis of Bettering the Evaluation and ...

Christopher M Harrison BPsych(Hons), MSocHlth · Helena C Britt BA, PhD · Janice Charles BA, MSc(Med)

Objectives: To describe the clinical syndrome associated with definite tiger snake (Notechis spp) envenoming and to examine the ability of tiger snake antivenom (TSAV) to bind free venom in vivo. Design, setting and participants: We conducted a prospective cohort study within the Australian Snakebite Project, reviewing all definite tiger snake envenoming cases between October 2004 and June 2011. Definite cases were identified by ...

Geoffrey K Isbister · Margaret A O’Leary · Matthew Elliott · Simon G A Brown

Objective: To determine the increase in intensive care unit (ICU) bed availability that would result from the use of the New South Wales and Ontario Health Plan for an Influenza Pandemic (OHPIP) triage protocols.Design, setting and patients: Prospective evaluation study conducted in eight Australian, adult, general ICUs, between September 2009 and May 2010. All patients who were admitted to the ICU, excluding ...

on behalf of the Influenza Pandemic ICU Triage (iPIT) Study Investigators

How appropriate is the health care delivered to Australians? A seminal study in the United States showed that American adults received “recommended care” only 55% of the time in the years 1999–2000. Estimates of “appropriate care” — defined here as care in line with evidence-based or consensus-based guidelines — are limited in most countries, including Australia, to small groups of conditions ...

William B Runciman MB BCh, FANZCA, PhD · Tamara D Hunt BAppSc(Nursing), CritCareCert · Natalie A Hannaford DipAppSc(Nursing), MPH · Peter D Hibbert BAppSc(Physio), GradDipComp, GradDipEcon · Johanna I Westbrook PhD, GradDipAppEpid, MHA · Enrico W Coiera MB BS, PhD, FACMI · Richard O Day MD, FRACP, MB BS · Diane M Hindmarsh MScAgr, MBiostats · Elizabeth A McGlynn PhD · Jeffrey Braithwaite PhD, MBA, FCHSM

Objectives: To investigate the acceptability and feasibility of using end-of-life (EOL) care pathways in residential aged care facilities (RACFs).Design, setting and participants: Multistage action research approach involving interviews, surveys and prospective audits of deaths and EOL care pathway use among residents and staff of RACFs and associated general practitioners from 14 RACFs in Victoria and South Australia between April 2009 and July 2010.Intervention: ...

Dell E Horey BAppSc, MMedSc(ClinEpi), PhD · Annette F Street BEd(Hons), PhD · Alison F Sands MB BS(Hons), FRACGP

Despite nearly 70% of Australian women of reproductive age using a contraceptive method, estimates are that over 50% of Australian women have had an unplanned pregnancy. This rate, similar to that in the United Kingdom (30%) and United States (49%), may in part be explained by the fact that the combined oral contraceptive pill (COCP) remains the preferred method of contraception in Australia as it is in the UK ...

Danielle Mazza MD, FRACGP · Christopher Harrison BPsych(Hons), MSocHlth · Angela Taft BA, MPH, PhD · Bianca Brijnath BA(Hons), PhD · Helena Britt BA, PhD · Melissa Hobbs RN, MPH · Kay Stewart BPharm(Hons), PhD · Safeera Hussainy BPharm(Hons), PhD

Objective: To estimate the prevalence of mental disorder in a representative sample of Aboriginal and Torres Strait Islander people in Queensland prisons.Design, setting and participants: Cross-sectional assessment of mental health using the Composite International Diagnostic Interview (CIDI) and clinical interviews, conducted by Indigenous mental health clinicians who undertook specific training for this purpose, with support from forensic psychiatrists when indicated. We ...

Edward B Heffernan MB BS, MPH, FRANZCP · Kimina C Andersen BSW · Abhilash Dev BDS, MPH · Stuart Kinner BA(Hons), PhD

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