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Harding J.L.,Baker IDI Heart and Diabetes Institute | Harding J.L.,Monash University | Shaw J.E.,Baker IDI Heart and Diabetes Institute | Shaw J.E.,Monash University | And 6 more authors.
Diabetes Care | Year: 2014

OBJECTIVE: With improvements in cardiovascular disease (CVD) rates among people with diabetes, mortality rates may also be changing. However, these trends may be influenced by coding practices of CVD-related deaths on death certificates. We analyzed trends ofmortality over 13 years in people with diabetes and quantified the potential misclassification of CVD mortality according to current coding methods. RESEARCH DESIGN AND METHODS A total of 1,136,617 Australians with diabetes registered on the National Diabetes Services Scheme between 1997 and 2010 were linked to the National Death Index. Excess mortality relative to the Australian population was reported as standardized mortality ratios (SMRs). Potential misclassification of CVD mortality was determined by coding CVD according to underlying cause of death (COD) and then after consideration of both the underlying and other causes listed in part I of the death certificate. RESULTS: For type 1 diabetes, the SMR decreased in males from 4.20 in 1997 to 3.08 in 2010 (Ptrend < 0.001) and from 3.92 to 3.46 in females (Ptrend < 0.01). For type 2 diabetes, the SMR decreased in males from 1.40 to 1.21 (Ptrend < 0.001) and from 1.56 to 1.22 in females (Ptrend < 0.001). CVD deaths decreased from 35.6 to 31.2% and from 31.5 to 27.2% in males and females with type 1 diabetes, respectively (Ptrend < 0.001 for both sexes). For type 2 diabetes, CVD decreased from 44.5 to 29.2% in males and from 45.5 to 31.6% in females (Ptrend < 0.001 for both sexes). Using traditional coding methods,~38 and 26% of CVD deaths are underestimated in type 1 diabetes and type 2 diabetes, respectively. CONCLUSIONS: All-cause and CVD mortality has decreased in diabetes. However, the total CVD mortality burden is underestimated when only underlying COD is considered. This has important ramifications for understanding mortality patterns in diabetes. © 2014 by the American Diabetes Association.


Peeters A.,Monash University | Nusselder W.J.,Rotterdam University | Stevenson C.,Monash University | Boyko E.J.,University of Washington | And 2 more authors.
European Journal of Epidemiology | Year: 2011

Recent analyses suggest the decline in coronary heart disease mortality rates is slowing in younger age groups in countries such as the US and the UK. This work aimed to analyse recent trends in cardiovascular mortality rates in the Netherlands. Analysis was of annual all circulatory, ischaemic heart disease (IHD), and cerebrovascular disease mortality rates between 1980 and 2009 for the Netherlands. Data were stratified by sex and 10-year age group (age 35-85+). The annual rate of change and significant changes in the trend were identified using joinpoint Poisson regression. For almost all age and sex groups examined the rate of IHD and cerebrovascular disease mortality in the Netherlands has more than halved between 1980 and 2009. The decline in mortality from both IHD and cerebrovascular disease is continuing for all ages and sex groups, with anacceleration in the decline apparent from the late 1990s/early 2000s. The decline in age-specific all circulatory, coronary heart disease and cerebrovascular disease mortality rates continues for all age and sex groups in the Netherlands. © 2011 The Author(s).


Gulson B.,Macquarie University | Gulson B.,CSIRO | Anderson P.,Australian Institute of Health and Welfare | Anderson P.,University of Canberra | Taylor A.,Macquarie University
Environmental Research | Year: 2013

Background: As part of the only national survey of lead in Australian children, which was undertaken in 1996, lead isotopic and lead concentration measurements were obtained from children from 24 dwellings whose blood lead levels were ≥15 μg/dL in an attempt to determine the source(s) of their elevated blood lead. Comparisons were made with data for six children with lower blood lead levels (<10 μg/dL). Methods: Thermal ionisation and isotope dilution mass spectrometry were used to determine high precision lead isotopic ratios (208Pb/206Pb, 207Pb/206Pb and 206Pb/204Pb) and lead concentrations in blood, dust from floor wipes, soil, drinking water and paint (where available). Evaluation of associations between blood and the environmental samples was based on the analysis of individual cases, and Pearson correlations and multiple regression analyses based on the whole dataset. Results and discussion: The correlations showed an association for isotopic ratios in blood and wipes (r=0.52, 95% CI 0.19-0.74), blood and soil (r=0.33, 95% CI -0.05-0.62), and blood and paint (r=0.56, 95% CI 0.09-0.83). The regression analyses indicated that the only statistically significant relationship for blood isotopic ratios was with dust wipes (B=0.65, 95% CI 0.35-0.95); there were no significant associations for lead concentrations in blood and environmental samples. There is a strong isotopic correlation of soils and house dust (r=0.53, 95% CI 0.20-0.75) indicative of a common source(s) for lead in soil and house dust. In contrast, as with the regression analyses, no such association is present for bulk lead concentrations (r=-0.003, 95% CI -0.37-0.36), the most common approach employed in source investigations. In evaluation of the isotopic results on a case by case basis, the strongest associations were for dust wipes and blood. © 2013.


Peng P.,Monash University | Peng P.,Australian Institute of Health and Welfare | Garnier G.,Monash University
Colloids and Surfaces A: Physicochemical and Engineering Aspects | Year: 2012

We quantified the adsorption kinetics of cationic polyacrylamide (CPAM) of three charge densities but constant molecular weight and their effects on the dynamics of a polydisperse calcium carbonate (CC) flocculation at various ionic strengths. The adsorption kinetics of CPAM onto PCC can be explained by the balance of the electrostatic and van der Waals interactions, hydrogen bonding and steric hindrance between the adsorbed and dissolved CPAM molecules and CC. While the amount of adsorbed CPAM onto CC increased as a function of the CPAM charge density in the absence of salt, this relationship reversed at increased ionic strength (. I=. 0.1). Decreasing charge on CPAM molecules allows more amide groups available for hydrogen bonding although reducing electrostatic attraction of CC. So the lower-charge CPAM benefits from the additional hydrogen bonding at higher ionic strength when the contribution of electrostatic attraction is reduced because of charge screening by salt. Discrepancies in quantity between the adsorbed and the polymer predicted from the monolayer surface coverage theory for flocculation rate were apparent. The polymer adsorption kinetics and its conformation were important variables in determining particle flocculation in this study, more than the quantity of adsorbed polymer. © 2012.


Gertig D.M.,Faraday Inc. | Gertig D.M.,University of Melbourne | Brotherton J.M.L.,Faraday Inc. | Brotherton J.M.L.,University of Melbourne | And 4 more authors.
BMC Medicine | Year: 2013

Background: Australia was one of the first countries to introduce a publicly funded national human papillomavirus (HPV) vaccination program that commenced in April 2007, using the quadrivalent HPV vaccine targeting 12- to 13-year-old girls on an ongoing basis. Two-year catch-up programs were offered to 14- to 17- year-old girls in schools and 18- to 26-year-old women in community-based settings. We present data from the school-based program on population-level vaccine effectiveness against cervical abnormalities in Victoria, Australia.Methods: Data for women age-eligible for the HPV vaccination program were linked between the Victorian Cervical Cytology Registry and the National HPV Vaccination Program Register to create a cohort of screening women who were either vaccinated or unvaccinated. Entry into the cohort was 1 April 2007 or at first Pap test for women not already screening. Vaccine effectiveness (VE) and hazard ratios (HR) for cervical abnormalities by vaccination status between 1 April 2007 and 31 December 2011 were calculated using proportional hazards regression.Results: The study included 14,085 unvaccinated and 24,871 vaccinated women attending screening who were eligible for vaccination at school, 85.0% of whom had received three doses. Detection rates of histologically confirmed high-grade (HG) cervical abnormalities and high-grade cytology (HGC) were significantly lower for vaccinated women (any dose) (HG 4.8 per 1,000 person-years, HGC 11.9 per 1,000 person-years) compared with unvaccinated women (HG 6.4 per 1,000 person-years, HGC 15.3 per 1,000 person-years) HR 0.72 (95% CI 0.58 to 0.91) and HR 0.75 (95% CI 0.65 to 0.87), respectively. The HR for low-grade (LG) cytological abnormalities was 0.76 (95% CI 0.72 to 0.80). VE adjusted a priori for age at first screening, socioeconomic status and remoteness index, for women who were completely vaccinated, was greatest for CIN3+/AIS at 47.5% (95% CI 22.7 to 64.4) and 36.4% (95% CI 9.8 to 55.1) for women who received any dose of vaccine, and was negatively associated with age. For women who received only one or two doses of vaccine, HRs for HG histology were not significantly different from 1.0, although the number of outcomes was small.Conclusion: A population-based HPV vaccination program in schools significantly reduced cervical abnormalities for vaccinated women within five years of implementation, with the greatest vaccine effectiveness observed for the youngest women. © 2013 Gertig et al.; licensee BioMed Central Ltd.

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