To investigate potential transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during a domestic flight within Australia, we performed epidemiologic analyses with whole-genome ...sequencing. Eleven passengers with PCR-confirmed SARS-CoV-2 infection and symptom onset within 48 hours of the flight were considered infectious during travel; 9 had recently disembarked from a cruise ship with a retrospectively identified SARS-CoV-2 outbreak. The virus strain of those on the cruise and the flight was linked (A2-RP) and had not been previously identified in Australia. For 11 passengers, none of whom had traveled on the cruise ship, PCR-confirmed SARS-CoV-2 illness developed between 48 hours and 14 days after the flight. Eight cases were considered flight associated with the distinct SARS-CoV-2 A2-RP strain; the remaining 3 cases (1 with A2-RP) were possibly flight associated. All 11 passengers had been in the same cabin with symptomatic persons who had culture-positive A2-RP virus strain. This investigation provides evidence of flight-associated SARS-CoV-2 transmission.
To determine which measures of heatwave have the greatest predictive power for increases in health service utilisation in Perth, Western Australia.
Three heatwave formulas were compared, using ...Poisson or zero‐inflated Poisson regression, against the number of presentations to emergency departments from all causes, and the number of inpatient admissions from heat‐related causes. The period from July 2006 to June 2013 was included. A series of standardised thresholds were calculated to allow comparison between formulas, in the absence of a gold standard definition of heatwaves.
Of the three heatwave formulas, Excess Heat Factor (EHF) produced the most clear dose‐response relationship with Emergency Department presentations. The EHF generally predicted periods that resulted in a similar or higher rate of health service utilisation, as compared to the two other formulas, for the thresholds examined.
The EHF formula, which considers a period of acclimatisation as well as the maximum and minimum temperature, best predicted periods of greatest health service demand. The strength of the dose‐response relationship reinforces the validity of the measure as a predictor of hazardous heatwave intensity.
The findings suggest that the EHF formula is well suited for use as a means of activating heatwave plans and identifies the required level of response to extreme heatwave events as well as moderate heatwave events that produce excess health service demand.
To support immunisation providers through a cold chain management audit.
An electronic audit survey using the National Vaccine Storage Guidelines as a gold standard was developed for general practice ...(GP) and community pharmacy. It included automated feedback, with individualised support from a clinical nurse specialist as required. Responses were analysed to determine the proportion of providers meeting criteria in four categories: procedures, refrigerators and equipment, temperature monitoring and emergency storage.
Of 818 providers invited, 420 GPs (89.6%) and 276 pharmacies (82%) responded. Over 70% met all procedural and emergency storage criteria. Although most providers (98.1% GPs, 97.0% pharmacies) used a data logger, the proportion measuring at 5-minute intervals, reviewing data logger printouts weekly and manually recording minimum and maximum temperatures was lower. In total, 58% of providers required follow-up by the clinical nurse specialist, most regarding the need for equipment.
An electronic audit enabled public health to engage with a large number of immunisation providers. Most reported high compliance with the national guidelines although opportunities for education were identified and actioned.
Electronic solutions can support public health units to engage with providers to ensure vaccines remain effective and wastage is limited.
Changes in natural hazards related to climate change are evident in New South Wales (NSW), Australia, and are projected to become more frequent and intense. The impacts of climate change may ...adversely affect health and wellbeing, directly via extreme weather events such as heatwaves, storms and floods, and indirectly via impacts on food security, air and water quality, and other environmental amenities. The NSW Government's Climate Change Policy Framework recognises the need to reduce the effects of climate change on health and wellbeing. A conceptual framework can support the aims and objectives of the policy framework by depicting the effects of climate change on health, and individual and social wellbeing, and areas for policy actions and responses. A proposed conceptual framework has been developed, modelled on the Driving force, Pressure, State, Exposure, Effect and Action (DPSEEA) framework of the World Health Organization - a framework which shows the link between exposures and health effects as well as entry points for interventions. The proposed framework presented in this paper was developed in consultation with researchers and policy makers. The framework is guiding current research examining vulnerabilities to climate change and the effects of a range of exposures on health and wellbeing.
The NSW (New South Wales) Climate Change Policy Framework, launched by the NSW Government in 2016, recognises that climate change presents risks to health and wellbeing. Risks to health and wellbeing ...come from direct impacts of extreme weather events, and from indirect impacts through effects on air, water, food and ecosystems. Responding to these challenges offers an opportunity to protect and promote health by enhancing environmental amenities, and building adaptive capacity and resilience in populations and systems. To develop policy that effectively protects and promotes health in the face of climate change in NSW it is necessary to define the expected impacts of climate change on health and wellbeing in NSW.
Abstract In 61 young adults with type 1 diabetes mellitus, the estimated glucose disposal rate (eGDR), a validated marker for insulin resistance, correlated positively with the prevalence of ...microvascular complications. In the absence of an established vascular risk calculator specific to diabetes, the eGDR may present a useful clinical tool in the assessment of complication risk in type 1 diabetes.
Prompt treatment of patients with genital Chlamydia shortens the period of infectivity with benefits to the individual and wider community. With large numbers of genital Chlamydia notifications, ...predominantly occurring in younger age groups, short message service (SMS) is a potentially useful technology for recalling this patient group quickly and efficiently. In the sexual health unit of Population Health-Midwest, Western Australia, genital Chlamydia cases were recalled for treatment with an SMS. Ninety-four per cent (n = 60) of clients responded to the SMS, with 84% (n = 54) responding on the same day they were contacted. All clients (n = 64) were treated for their infection, with 72% (n = 46) having directly-observed treatment within one day of being informed of their results via SMS. Our results suggest that SMS is a highly effective, youth-friendly communication tool.
To determine inequities in clinical adherence to national diagnostic and management guidelines for acute coronary syndrome (ACS) for Aboriginal and non‐Aboriginal ACS patients at a regional hospital.
...Covering two study periods (2011–12; 2013–14), records of Aboriginal (n=276) and a random selection of non‐Aboriginal patients (n=333) presenting to the Emergency Department with chest pain were retrospectively reviewed using an audit protocol. Groups were compared using logistic regression, controlling for age, sex and comorbidity.
Pathway utilisation improved overall, but risk stratification improved only for non‐Aboriginal patients (OR=3.34, 95%CI 1.88–5.94). Performance of two troponin measurements increased to 88% for both Aboriginal and non‐Aboriginal presentations. Although initially higher for non‐Aboriginal presentations, the likelihood of admission was found to be similar in the repeat audit (75.6% vs 78.6%; p=0.60), reflecting a rise in Aboriginal presentations being admitted (OR=2.30, 95%CI 1.27–4.15). There was no significant difference in proportions transferred, receiving angiograms or for ST Elevation Acute Coronary Syndrome (a severe form of Acute Coronary Syndrome) being thrombolysed. Discharge against medical advice remained higher among Aboriginal presentations (OR=4.22, 95%CI 0.88–20.29).
Although there was a general improvement in adherence to the chest pain pathway and a reduction in inequity in the treatment of Aboriginal people, there is continuing need for improvement in adherence to guidelines to optimise the management of ACS in this regional setting.
Objective:
Translation of evidence into practice by health systems can be slow and incomplete and may disproportionately impact disadvantaged populations. Coronary heart disease is the leading cause ...of death among Aboriginal Australians. Timely access to effective medical care for acute coronary syndrome substantially improves survival. A quality-of-care audit conducted at a regional Western Australian hospital in 2011–2012 compared the Emergency Department management of Aboriginal and non-Aboriginal acute coronary syndrome patients. This audit is used as a case study of translating knowledge processes in order to identify the factors that support equity-oriented knowledge translation.
Methods:
In-depth interviews were conducted with a purposive sample of the audit team and further key stakeholders with interest/experience in knowledge translation in the context of Aboriginal health. Interviews were analysed for alignment of the knowledge translation process with the thematic steps outlined in Tugwell’s cascade for equity-oriented knowledge translation framework.
Results:
In preparing the audit, groundwork helped shape management support to ensure receptivity to targeting Aboriginal cardiovascular outcomes. Reporting of audit findings and resulting advocacy were undertaken by the audit team with awareness of the institutional hierarchy, appropriate timing, personal relationships and recognising the importance of tailoring messages to specific audiences. These strategies were also acknowledged as important in the key stakeholder interviews. A follow-up audit documented a general improvement in treatment guideline adherence and a reduction in treatment inequalities for Aboriginal presentations.
Conclusion:
As well as identifying outcomes such as practice changes, a useful evaluation increases understanding of why and how an intervention worked. Case studies such as this enrich our understanding of the complex human factors, including individual attributes, experiences and relationships and systemic factors that shape equity-oriented knowledge translation. Given the potential that improving knowledge translation has to close the gap in Aboriginal health disparities, we must choose strategies that adequately take into account the unique contingencies of context across institutions and cultures.
Periods of successive extreme heat and cold temperature have major effects on human health and increase rates of health service utilisation. The severity of these events varies between geographic ...locations and populations. This study aimed to estimate the effects of heat waves and cold waves on health service utilisation across urban, regional and remote areas in New South Wales (NSW), Australia, during the 10-year study period 2005–2015. We divided the state into three regions and used 24 over-dispersed or zero-inflated Poisson time-series regression models to estimate the effect of heat waves and cold waves, of three levels of severity, on the rates of ambulance call-outs, emergency department (ED) presentations and mortality. We defined heat waves and cold waves using excess heat factor (EHF) and excess cold factor (ECF) metrics, respectively. Heat waves generally resulted in increased rates of ambulance call-outs, ED presentations and mortality across the three regions and the entire state. For all of NSW, very intense heat waves resulted in an increase of 10.8% (95% confidence interval (CI) 4.5, 17.4%) in mortality, 3.4% (95% CI 0.8, 7.8%) in ED presentations and 10.9% (95% CI 7.7, 14.2%) in ambulance call-outs. Cold waves were shown to have significant effects on ED presentations (9.3% increase for intense events, 95% CI 8.0–10.6%) and mortality (8.8% increase for intense events, 95% CI 2.1–15.9%) in outer regional and remote areas. There was little evidence for an effect from cold waves on health service utilisation in major cities and inner regional areas. Heat waves have a large impact on health service utilisation in NSW in both urban and rural settings. Cold waves also have significant effects in outer regional and remote areas. EHF is a good predictor of health service utilisation for heat waves, although service needs may differ between urban and rural areas.
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