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ABSTRACTAimPatient‐reported outcome measures (PROMs) and patient‐reported experience measures (PREMs) are increasingly used in research to quantify how patients feel and function, and their experiences of care, however, knowledge of their... more
ABSTRACTAimPatient‐reported outcome measures (PROMs) and patient‐reported experience measures (PREMs) are increasingly used in research to quantify how patients feel and function, and their experiences of care, however, knowledge of their utilization in routine nephrology is limited.MethodsThe Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) PROMs working group conducted a prospective cross‐sectional survey of PROMs/PREMs use among renal ‘parent hospitals’. One survey per hospital was completed (August–November 2017). Descriptive statistics reported type and frequency of measures used and purpose of use.ResultsSurvey response rate was 100%. Fifty‐five of 79 hospitals (70%) used at least one PROMs or PREMs for specific patient groups. PROMs were more likely to be collected from patients receiving comprehensive conservative care (45% of hospitals) than dialysis patients (32%, 31% and 28% of hospitals for home haemodialysis, peritoneal dialysis and facility dialysis...
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ABSTRACT Background: Eggs and egg-containing foods are frequently implicated in outbreaks of gastroenteritis, with public health authorities investigating numerous events each year. Methods: Outbreaks linked to eggs were identified via... more
ABSTRACT Background: Eggs and egg-containing foods are frequently implicated in outbreaks of gastroenteritis, with public health authorities investigating numerous events each year. Methods: Outbreaks linked to eggs were identified via the OzFoodNet Outbreak Register for the period 2001-2009. Additional data were also sought on traceback of eggs during outbreaks. Outbreaks were summarised by food vehicle, aetiological agent, outbreak setting, investigation methods and traceback microbiology. Results: During the study period 11% (114 / 1045) of foodborne outbreaks were linked to eggs. The causative agents in all outbreaks were Salmonella spp. Over 2300 persons were affected with a median outbreak size of 11 cases (range 2 to 319). Restaurants and private residences were the most common settings while restaurant and bakery outbreaks resulted in greater case numbers. Desserts or sauces that contained raw or minimally cooked egg were the most common food vehicles. Analytical epidemiology was utilised in one third of identified outbreaks, with 75% demonstrating an association with egg containing foods. Forty percent of outbreaks had traceback conducted to the farm level. Among these farms, 50% yielded the outbreak strain in the farm environment or from sampled eggs. Conclusion: Eggs and egg-containing foods are a significant cause of Salmonella outbreaks. To prevent outbreaks commercial food premises require ongoing instruction on the safety of foods containing raw or minimally cooked eggs.
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Research Interests: Australia, Environmental Health, Adolescent, Disease Outbreaks, Humans, and 15 moreChild, Female, Disease, Male, Gastroenteritis, Clinical Sciences, Middle Aged, Adult, Retrospective Studies, Food Contamination, Outbreak, Cohort Studies, Child preschool, Foodborne diseases, and Population surveillance
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Objective: Very little is known about whether overweight and obese children have long-term risk for mental health problems. This study examined the association between overweight and obesity in childhood and DSM-IV mood, anxiety, and... more
Objective: Very little is known about whether overweight and obese children have long-term risk for mental health problems. This study examined the association between overweight and obesity in childhood and DSM-IV mood, anxiety, and substance use disorders in young adulthood. Method: Participants in a national Australian school survey when aged 7–15 years in 1985 were re-interviewed 20 years later as young adults aged 26–36 years (1135 women, 1108 men). Body mass index (BMI) was calculated from measured height and weight in childhood and adulthood. Children were classified as overweight or obese based on a BMI ≥85th centile for age and sex-specific height and weight. Obesity in adulthood was defined as BMI of ≥30. Twelve-month DSM-IV diagnoses of mood, anxiety and substance use disorders were obtained from the Composite International Diagnostic Interview. The relative risk (RR) for each class of mental disorder was estimated for childhood overweight/obesity versus non-overweight, and for four weight trajectories: non-overweight in childhood and non-obese in adulthood; overweight in childhood and non-obese in adulthood; non-overweight in childhood and obese in adulthood; and overweight in childhood and obese in adulthood. Results: Childhood overweight and obesity was associated with an increased risk of mood disorder in adulthood (RR = 1.54, 95%CI 1.06–2.23, p = 0.03), with a similar risk observed among girls and boys. When weight in adulthood was taken into consideration, increased risk of mood disorder was observed only among overweight girls who were obese in adulthood (adjusted RR = 2.03, 95%CI 1.22–3.66, p = 0.006), with childhood overweight or obesity in non-obese adults not associated with any mental disorder. Conclusions: Childhood overweight may increase risk for mood disorder in adulthood, especially among overweight girls who become obese women. These results suggest that prevention of childhood overweight is equally important in both sexes for reducing risk of diagnosed mood disorder in adulthood.
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Chronic kidney disease (CKD) is common in Australia and specifically in Tasmania, and is characterised by an accumulation of potentially-harmful compounds in the blood ("Uraemia"). The presented work is a pilot study to assess... more
Chronic kidney disease (CKD) is common in Australia and specifically in Tasmania, and is characterised by an accumulation of potentially-harmful compounds in the blood ("Uraemia"). The presented work is a pilot study to assess the feasibility of a larger cohort study, and concentrates on uraemic compounds derived from tryptophan. Disruptions in tryptophan metabolism, mainly via the Tryptophan-Kynurenine pathway were associated with various neurological and psychological disorders as well as premature cardiovascular disease which often accompany CKD. In a preliminary untargeted metabolomics study (RPLC - Thermo LTQ-Orbitrap) we conducted paired comparisons (Wilcoxon test) between serum samples from 12 patients pre- and post-dialysis, which varied considerably from 6 healthy controls (Mann-Whitney; PLS/DA). Determination of tryptophan metabolites and their hemodialysis clearance rates led to compound selection for quantitative analysis, including markers for inflammation and...
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The Australian Government Department of Health and Ageing established OzFoodNet in 2000 to collaborate nationally to investigate foodborne disease. OzFoodNet conducts studies on the burden of illness, co-ordinates national investigations... more
The Australian Government Department of Health and Ageing established OzFoodNet in 2000 to collaborate nationally to investigate foodborne disease. OzFoodNet conducts studies on the burden of illness, co-ordinates national investigations into outbreaks of foodborne disease, develops nationally standardised protocols and tools for surveillance, identifies foods or commodities that may cause human illness and trains people to investigate foodborne illness. This quarterly report documents investigation of outbreaks of gastrointestinal illness and clusters of disease potentially related to food, occurring in Australia from 1 January to 31 March 2010.
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The Australian Government Department of Health and Ageing established OzFoodNet in 2000 to collaborate nationally to investigate foodborne disease. OzFoodNet conducts studies on the burden of illness, co-ordinates national investigations... more
The Australian Government Department of Health and Ageing established OzFoodNet in 2000 to collaborate nationally to investigate foodborne disease. OzFoodNet conducts studies on the burden of illness, co-ordinates national investigations into outbreaks of foodborne disease, develops nationally standardised protocols and tools for surveillance, identifies foods or commodities that may cause human illness and trains people to investigate foodborne illness. This quarterly report documents investigation of outbreaks of gastrointestinal illness and clusters of disease potentially related to food, occurring in Australia from 1 October to 31 December 2009.
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Aim: This study examines tryptophan metabolism in Chronic Kidney Disease (CKD) and its link to consequent neuropsychological symptoms. Background: Neuropsychological disorders (depression, anxiety and cognitive dysfunction) are related to... more
Aim: This study examines tryptophan metabolism in Chronic Kidney Disease (CKD) and its link to consequent neuropsychological symptoms. Background: Neuropsychological disorders (depression, anxiety and cognitive dysfunction) are related to disruption in tryptophan metabolism, mainly via the kynurenine pathway, induced by inflammation and hypothalamo–pituitary– adrenal (HPA) axis activity. Tryptophan metabolites (indoles) produced by gutmicroflora are also related to inflammation and other conditions accompanying CKD. Methods: Subjects (n = 30) were initially recruited with an eGFR of 15–29 ml/ min per 1.73 m2 and were alive at the 2-year follow-up. Neuropsychological measures were undertaken at baseline and 2 years. Serum samples were analysed for inflammation, HPA activity markers, tryptophan and ten of its metabolites. Results: The expected accumulation of uremic molecules was observed in the serum of patients once eGFR < 15, significantly higher than patients with better kidney...
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The Australian Government Department of Health established the OzFoodNet network in 2000 to collaborate nationally to investigate foodborne disease. In each Australian state and territory, OzFoodNet epidemiologists investigate outbreaks... more
The Australian Government Department of Health established the OzFoodNet network in 2000 to collaborate nationally to investigate foodborne disease. In each Australian state and territory, OzFoodNet epidemiologists investigate outbreaks of enteric infection. In addition, OzFoodNet conducts studies on the burden of illness and coordinates national investigations into outbreaks of foodborne disease. This quarterly report documents investigations of outbreaks of gastrointestinal illness and clusters of disease potentially related to food, which commenced in Australia between 1 October and 31 December 2015. Data were received from OzFoodNet epidemiologists in all Australian states and territories. The data in this report are provisional and subject to change. During the 4th quarter of 2015 (1 October to 31 December), OzFoodNet sites reported 585 outbreaks of enteric illness, including those transmitted by contaminated food or water. Outbreaks of gastroenteritis are often not reported to...
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The Australian Government Department of Health established the OzFoodNet network in 2000 to collaborate nationally to investigate foodborne disease. In each Australian state and territory, OzFoodNet epidemiologists investigate outbreaks... more
The Australian Government Department of Health established the OzFoodNet network in 2000 to collaborate nationally to investigate foodborne disease. In each Australian state and territory, OzFoodNet epidemiologists investigate outbreaks of enteric infection. In addition, OzFoodNet conducts studies on the burden of illness and coordinates national investigations into outbreaks of foodborne disease. This quarterly report documents investigations of outbreaks of gastrointestinal illness and clusters of disease potentially related to food, which commenced in Australia between 1 October and 31 December 2015. Data were received from OzFoodNet epidemiologists in all Australian states and territories. The data in this report are provisional and subject to change. During the 4th quarter of 2015 (1 October to 31 December), OzFoodNet sites reported 585 outbreaks of enteric illness, including those transmitted by contaminated food or water. Outbreaks of gastroenteritis are often not reported to...
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Table S1. Concentration range of spiked analytes in calibration mix. (XLS 20Â kb)
Table S2. Spearman rank correlation coefficients for associations of psychological and cognitive functioning, with clinical parameters and serum metabolites. (XLS 36Â kb)
BACKGROUND Chronic kidney disease (CKD) is a significant and growing health burden globally. Tasmania has the highest state prevalence for non-Indigenous Australians and it has consistently had the lowest incidence and prevalence of... more
BACKGROUND Chronic kidney disease (CKD) is a significant and growing health burden globally. Tasmania has the highest state prevalence for non-Indigenous Australians and it has consistently had the lowest incidence and prevalence of dialysis in Australia. OBJECTIVE To examine the gap between the high community prevalence of CKD in Tasmania and the low use of dialysis. METHODS This is a retrospective cohort study using linked data from five health and two pathology datasets from the island state of Tasmania, Australia. The study population consists of any person (all ages including children) who had a blood measurement of creatinine with the included pathology providers between 1/1/2004 and 31/12/2017. This study population includes within it a CKD cohort, which were detected via pathology or documentation of kidney replacement therapy (dialysis or kidney transplant, KRT). Kidney function (eGFR) was calculated using CKD-EPI formula. Individuals with two measures of eGFR<60mL/min/1...
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Research Interests: Nephrology, Epidemiology, Australia, Dialysis, Medicine, and 15 moreComorbidity, Multivariate Analysis, Humans, Kidney, Female, Male, Clinical Sciences, Aged, Age Factors, Chi Square Distribution, Chronic Kidney Failure, Proportional Hazards Models, Heart Diseases, Recovery of Function, and Cause of death
Raw Data in five data sheets including Patients relevant metadata, quantified metabolites (given at Iźg/L as well as Iźmol/L), psychology measures, common medication and comorbidities. (XLS 58Â kb)
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Chromatography and mass spectrometry conditions. (PDF 276Â kb)
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Objective To report (using linked laboratory data) the incidence, prevalence and geographic variation of chronic kidney disease (CKD) across the whole island population of Tasmania, Australia. Methods A retrospective cohort study (the... more
Objective To report (using linked laboratory data) the incidence, prevalence and geographic variation of chronic kidney disease (CKD) across the whole island population of Tasmania, Australia. Methods A retrospective cohort study (the Tasmanian Chronic Kidney Disease study (CKD.TASlink)) using linked data from five health and two pathology datasets from the island state of Tasmania, Australia between 1/1/2004 and 31/12/2017. We used data on 460,737 Tasmanian adults (aged 18 years and older, representing 86.8% of the state’s population) who had a serum creatinine measured during the study period. We defined CKD as per Kidney Disease Outcomes Quality Initiative, requiring two measures of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2, at least three months apart. Kidney replacement therapy (KRT) included dialysis or kidney transplantation. Results We identified 56,438 Tasmanians with CKD during the study period, equating to an age-standardised annual incidence of 1.0...
This study examines the associations between medication adherence and burden, and health-related quality of life (HRQOL) in predialysis chronic kidney disease (CKD). A prospective study targeting adults with advanced CKD (estimated... more
This study examines the associations between medication adherence and burden, and health-related quality of life (HRQOL) in predialysis chronic kidney disease (CKD). A prospective study targeting adults with advanced CKD (estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2) and not receiving renal replacement therapy was conducted in Tasmania, Australia. The actual medication burden was assessed using the 65-item Medication Regimen Complexity Index, whereas perceived burden was self-reported using a brief validated questionnaire. Medication adherence was assessed using a four-item Morisky-Green-Levine Scale (MGLS) and the Tool for Adherence Behaviour Screening (TABS). The Kidney Disease and Quality of Life Short-Form was used to assess HRQOL. Of 464 eligible adults, 101 participated in the baseline interview and 63 completed a follow-up interview at around 14 months. Participants were predominantly men (67%), with a mean age of 72 (SD 11) years and eGFR of 21 (SD 6) m...
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This study aimed to examine the association between medication-related factors and risk of hospital readmission in older patients with chronic kidney disease (CKD). A retrospective analysis was conducted targeting older CKD (n = 204)... more
This study aimed to examine the association between medication-related factors and risk of hospital readmission in older patients with chronic kidney disease (CKD). A retrospective analysis was conducted targeting older CKD (n = 204) patients admitted to an Australian hospital. Medication appropriateness (Medication Appropriateness Index; MAI), medication regimen complexity (number of medications and Medication Regimen Complexity Index; MRCI) and use of selected medication classes were exposure variables. Outcomes were occurrence of readmission within 30 and 90 days, and time to readmission within 90 days. Logistic and Cox hazards regression were used to identify factors associated with readmission. Overall, 50 patients (24%) were readmitted within 30 days, while 81 (40%) were readmitted within 90 days. Mean time to readmission within 90 days was 66 (SD 34) days. Medication appropriateness and regimen complexity were not independently associated with 30- or 90-day hospital readmissi...
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Potentially inappropriate medications (PIMs) use is associated with increased morbidity and mortality in chronic kidney disease (CKD). However, there is paucity of data on how hospitalization affects PIMs use in older adults with CKD.... more
Potentially inappropriate medications (PIMs) use is associated with increased morbidity and mortality in chronic kidney disease (CKD). However, there is paucity of data on how hospitalization affects PIMs use in older adults with CKD. Therefore, we aimed to measure the impact of hospitalization on PIMs use in older CKD patients, and identify factors predicting PIMs use. A retrospective cohort study was conducted in older adults (≥ 65 years) with CKD admitted to an Australian tertiary care hospital over a 6-month period. PIMs use was measured, upon admission and at discharge, using the Medication Appropriateness Index (MAI) and Beers criteria (2015 version) for medications recommended to be avoided in older adults and under certain conditions. The median age of the 204 patients was 83 years (interquartile range (IQR): 76-87 years) and most were men (61%). Overall, the level of PIMs use (MAI) decreased from admission to discharge [median (IQR): 6 (3-12) to 5 (2-9); p &lt; 0.01)]. More than half of the participants (55%) had at least one PIM per Beers criteria on admission, which reduced by discharge (48%; p &lt; 0.01). People admitted with a higher number of medications (β 0.72, 95% CI 0.56 to 0.88) and lower eGFR values (β -0.11, 95% CI -0.18 to -0.04) had higher MAI scores after adjusting for age, sex and Charlson&#39;s comorbidity index (CCI). PIMs were commonly used in older CKD patients. Hospitalization was associated with a reduction in PIMs use, but there was considerable scope for improvement in these susceptible individuals.
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Chronic kidney disease (CKD) is characterized by high rates of hospital admissions and readmissions. However, there is a scarcity of research into medication-related factors predicting such outcomes in this patient group. To evaluate the... more
Chronic kidney disease (CKD) is characterized by high rates of hospital admissions and readmissions. However, there is a scarcity of research into medication-related factors predicting such outcomes in this patient group. To evaluate the effect of medication regimen complexity at hospital discharge on subsequent readmissions and their timing in older adults with CKD. This was a 12-month retrospective cohort study of 204 older (⩾65 years) CKD patients in an Australian tertiary care hospital. Medication regimen complexity was quantified using the 65-item medication regimen complexity index (MRCI). The outcomes were the occurrence of readmission in 30 days and time to readmission within 12 months. Logistic regression was used to identify factors predicting 30-day readmission, and a competing risks proportional subdistribution hazard model, accounting for deaths, was used for factors predicting time to readmission. Overall, 50 (24%) patients, predominantly men (72%), were readmitted wit...
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Access to dialysis treatment and the types of treatments employed in Australia differs by Indigenous status. We examined whether dialysis treatment utilisation in Indigenous and non-Indigenous Australians also differs by gender. Using... more
Access to dialysis treatment and the types of treatments employed in Australia differs by Indigenous status. We examined whether dialysis treatment utilisation in Indigenous and non-Indigenous Australians also differs by gender. Using registry data we evaluated 21,832 incident patients (aged ≥18 years) commencing dialysis, 2001-2013. Incidence rates were calculated and multivariate regression modelling used to examine differences in dialysis treatment (modality, location and vascular access creation) by race and gender. Dialysis incidence was consistently higher in Indigenous women compared to all other groups. Compared to Indigenous women, both non-Indigenous women and men were more likely to receive peritoneal dialysis as their initial treatment (non-Indigenous women RR=1.91, 95%CI 1.55-2.35; non-Indigenous men RR=1.73, 1.40-2.14) and were more likely to commence initial treatment at home (non-Indigenous women RR=2.07, 1.66-2.59; non-Indigenous men RR=1.95, 1.56-2.45). All groups ...