Joenpera J.,Australian Institute of Health and Welfare
Australasian Journal on Ageing | Year: 2017
Objective: Provide an overview of how care needs in permanent residential aged care differ by dementia status. Methods: On entry into permanent residential aged care, people's care needs are assessed on the Aged Care Funding Instrument (ACFI). ACFI also captures health conditions that are considered to affect the cost of people's care, such as dementia. Data were compared between 2009 and 2015. Results: Assessed care needs have increased regardless of dementia status. However, compared with people without dementia, people with dementia were more likely to be rated ‘high’ in each of the three care need domains. In addition, people with dementia were more likely to require some assistance in specific areas that underlie these broad domains, such as nutrition, continence and cognition. Conclusion: Dementia is associated with increased complexity in assessed care needs in permanent residential aged care. © 2017 Australian Institute of Health and Welfare Australasian Journal on Ageing © 2017 AJA Inc.
News Article | November 3, 2016
Homeless women need somewhere to live. Landlords need someone to manage their properties. Put the two together and the result is a solution to a significant social issue. Melbourne’s Property Initiatives Real Estate manages apartments for investors and developers, and directs all profitstowards developing long-term housing for women and children in need. Jeanette Large is the chief executive of the agency, which operates as a fixed trust under Women’s Property Initiatives (WPI), a not-for-profit company which develops and owns the properties. Large says most of the women housed have escaped family violence. Indeed, the Australian Institute of Health and Welfare says one-third of the 520,000 people who sought help from Australian homelessness services between 2011 and 2014 did so because of domestic violence. Launched in April 2015, Large says the real estate agency was created to overcome the funding limitations of philanthropy. WPI has always depended on donations and government grants and needed to find a way to become more self-sustaining while continuing to grow. The company owns 68 properties in Melbourne, housing 180 women and children. It is building seven properties and recently obtained funding for a further seven from the Victorian government’s rapid housing assistance program. Large says it made sense for WPI to start a real estate agency because many of the required skills in managing and tenanting its properties had already been developed, although the team needed to acquire sales expertise to sell homes. “Real estate agencies are, by and large, profitable businesses,” she says. “If you are looking at creating a profit to be able to acquire or build or develop more housing, you need a big profit.” It will be “a couple of years” before the real estate agency business breaks even, says Large, and five years before it has created the sort of profit required to develop new homes: “It is a long-term goal.” Social enterprise researcher Prof Jo Barraket says there are unique challenges for social enterprises providing services for the survivors of family violence. “One of the challenges is ensuring protection of the women they serve. So they often don’t tend to get involved in front-end retail activity, unless it is online, because they could compromise the security of the very women they seek to assist,” says Barraket who, supported by Social Traders, wrote the Finding Australia’s Social Enterprises 2016 report. Director of the centre for social impact Swinburne, Barraket defines social enterprises as for-profit businesses that trade to tackle social problems, improve communities, provide access to training and employment or help the environment. They devote at least 50% of their profits to their cause. Recognising the security issues in dealing with people affected by family violence, some social enterprises develop alternative models, she says. A case in point is the not-for-profit publisher the Big Issue, which developed a women’s subscription enterprise. “The Big Issue realised, somewhere down the track, that most of their sellers were men and that was partly because it is quite unsafe for homeless women to be selling the Big Issue on street corners,” says Barraket. “Often they might be homeless because of family violence issues and it was exposing them. So rather than saying ‘We are not helping women,’ the Big Issue came up with a different business, which happens in a women’s-only safe space, where women are fulfilling the subscriptions for the Big Issue. “So they found a way around it.” The job readiness service Fitted for Work is another not-for-profit that has set up a social enterprise arm to supplement its funding. Its co-founder, Marion Webster, says there are “tremendous opportunities” for social enterprises to provide for women escaping family violence. “But I think there are some warnings, in that setting up a social enterprise is setting up a small business,” she says. Given that social enterprises are often not the core business of a not-for-profit, many people working in not-for-profits don’t have business experience. “Nor do they have access to the resources to do a proper feasibility study,” says Webster. “And given that we know 80% of small businesses fail, you would have to say it is a pretty risky business unless you have the skills within the organisation and the opportunity to do a proper feasibility study and enough money to start it up. “But I think [social enterprises are] one of the areas that have to be developed because organisations, increasingly, have to generate their own income.” Fitted for Work aims to assist long-term unemployed and disadvantaged women find work and gain financial independence. One of its social enterprise elements is a vintage clothing shop, Dear Gladys. The shop contributed 16% to Fitted for Work’s total budget in 2012-13. Fitted for Work has also earned revenue through its training and induction service, She Works, which helped recruit female tram drivers in Melbourne. Webster says when she started the organisation in 2005 with Renata Singer, they didn’t ask where their clients had come from, but knew all had experienced significant disadvantage. “There were many who disclosed they had been victims of family violence in one way or another and, certainly among the women we worked with who were exiting prison, a lot of those had experienced both drug and family violence issues,” she says. One of the things Fitted for Work offers is a bespoke dressing service: “Many of these women had never had the opportunity for someone to give them attention, one on one, for at least an hour. “Women would come in, extremely under-confident. Some of them were not used to being physically touched because of their previous experiences. And then they would put on a very good and well-chosen outfit and they would look at themselves in the mirror and they could not believe what they were looking at. “They just saw themselves completely transformed. It really was a very powerful experience for them.”
News Article | October 31, 2016
There are currently more than 353,800 Australians living with dementia, according to Australian Institute of Health and Welfare statistics. It's a figure that's expected to increase to 400,000 in less than five years, and without a breakthrough, it could be as high as 900,000 by 2050. The Australian Bureau of Statistics cites it as the second leading cause of death in Australia. Depending on the type of dementia, various treatments are used to help with symptoms, but most do not slow down the condition's progression. Until a cure is found, the kind of care and support patients receive from carers, family, and friends to improve the quality of life is key. This is where virtual reality can help. Virtual reality (VR) is already being used in certain areas of healthcare for robotic surgery, medical personnel training, phobia treatment, and as a diagnostics tool. For people living with dementia, VR can offer relief by triggering memories and positive emotions, even for those in the later stages who are often responsive to very little. Build VR, a Victoria-based company that specialises in VR, virtual tours, and 360-degree video and photography, recently released their Solis VR unit, a Gear VR handset for care homes that marks a big step forward in the quality of care for those living with dementia in Australia. Marc Pascal, co-founder of Build VR, told TechRepublic that the company's work in aged-care was a result of his and fellow co-founder Sally Darling's personal experiences of the difficulties of having a family member who needs professional care. "Her father passed away some months before her and I met. We'd been to these facilities, especially the one where her father was staying, so she had a lot of personal insight. It's traumatic for everyone in the family. These facilities — they're kind of out of sight, out of mind. They're beautiful facilities but the residents are bored." The company was touring facilities with their VR demonstrations, before eventually leading to plans to develop a unit that was more specifically for people living with dementia. "Our first demonstration was about 18 months ago," Pascal said. "We went to a facility, we had a dozen residents try it and most of them had dementia — we didn't know that before we arrived. So everyone was a bit apprehensive as to what the reaction would be, but the reaction was amazing. All the staff loved it and it pretty much became a hit, because we have all these residents now communicating with each other, talking about what they're seeing and even sharing some stories. "We went to a number of facilities across Victoria, often the same trial, the same demo, to get the feedback based on what content they would like, what they don't like ... we went through over a hundred VR experiences and then we settled on five." Those five VR experiences now form the five categories of video scenarios that the handset offers users: Travel, adventure, animals, aquatic, and relaxation. The user starts in a computer generated atrium in front of a wall with five paintings, each one reflecting a VR experience. When the user looks at a painting, a 360-degree video begins, which could be of anything ranging from scuba diving, canoeing, or a trip to Bali. "Another thing we did was figure out how to sync a tablet with the headset, so a staff member can actually see what the resident is experiencing in real-time — that's proven very popular too, they can help guide them and see what they like and what they don't like." Pascal said that one of the many positive effects of the handset is offering a distraction if dementia patients are experiencing boredom or displaying repetitive behaviour. "In terms of dementia residents it's more about how they're behaving before they try it," he said. "There's one woman in particular I remember: She had been making a repetitive moan every few seconds and was really not reacting to anything. We got her to try Solis and within about 10 seconds she just stopped, she was just fixated with what was she was experiencing, which was a canoe trip. She didn't [make the noise] again until I left. And she was in high-care." It can also affect users in some quite profound ways. Pascal shared a story where an elderly Italian gentleman cried when they removed the goggles from him. When asked why he was so emotional, he said that he had given up ever returning to Venice, and he had felt like he was there in a gondola. "Words like 'beautiful', 'paradise', 'Garden of Eden' continue to be used in every presentation. The other thing they really like about it is that it's the newest technology; they feel special. I say, '15-year-olds would love to have this technology and you get to have it' — and they love that too. "And the response from carers is emotional. They want so much to be able to provide more for their residents." In terms of the uptake of Solis VR, some facilities are initially wary of new tech such as virtual reality that could be possibly seen by some as gimmicky or irrelevant. "There are a lot of technophobes in this world and a lot of them are carers," Pascal said. "When they first see the tech they're a bit intimidated, and once they get used to it, they love it. There are some [companies] that just sell [their products to the facilities]; try and make quick cash and leave, but we didn't want to do that. We're about the long-term to help." Alzheimer's Australia, which estimates that 1.2 million people are involved in the care of a person with dementia, has taken a slightly different route to improve dementia care through the use of VR. Rather than an experience tailored to the person with the condition, Alzheimer's Australia Vic last month released a free app in collaboration with Deakin University that allows anyone with a smartphone and Google Cardboard to see through the eyes and experience the challenges of a person living with dementia. The app, Educational Dementia Immersive Experience (EDIE) provides an experience from the point of view of EDIE (Eddie), who has dementia. The user gets a first-hand experience of how a seemingly simple task like going to the bathroom in the middle of the night can be affected by the diagnosis. The intended result is an increased sense of awareness and empathy towards what dementia actually means, and what it's like to live with it. Like Build VR, Alziemier's Australia had previously conducted demonstrations and training workshops before rolling out something that was both more accessible and more mobile. Tanya Petrovich, manager for Business Development at Alzheimer's Australia Vic, told TechRepublic the organisation was looking to update their training after doing much the same thing over the last 30 years. "Our first foray into virtual reality was with our virtual dementia experience, which we have here in Parkville. We projected the game onto the wall and people can come into the room and experience what it might be like to live with dementia, and we used that in a workshop scenario," Petrovich said. "We wanted to make it more widely available, so we were looking round at mobile platforms. One of the first ones we looked at was actually Oculus Rift, which is a fabulous platform, but it's a bit clunky in terms of mobility. So we started looking at Google Cardboard and Gear VR. "The Cardboard obviously is really affordable platform; we've gone with that for getting the message out to as broad an audience as we possibly can." VR gave Alzheimer's Australia Vic the opportunity to show, rather than tell, what dementia is. Petrovich stressed the idea of empathy and a shift in perspective was the big focus. "We had [the app] evaluated by Swinburne [University] — we did the same workshop with the VR and without the VR; everything was the same apart from the VR elements. And we found that with VR, there was a threefold increase in empathy developed by the participants, so there was a greater understanding of a person living with dementia. When they were interviewed, they spoke from the point of view from the person living with dementia. Whereas in the other workshop without the VR, they spoke more from the point of view of the carer, so there was a shift in perspective, and that's really what we're after." Next year, Alzheimer's Australia Vic's 'Enabling EDIE' workshops will introduce more scenarios with Gear VR. The headset user will be able to experience more scenarios and navigate around EDIE's house while receiving instructions from EDIE's wife. From there, the organisation will evaluate all feedback before looking at a possible second version of the smartphone app. "It's been really successful; VR certainly has great potential in getting people to understand perspective of the person living with the disease," Petrovich said. "There's lots of things we can change in the environment and supports we can put in place to make it a lot easier for the person [with dementia]. "The potential for it I think is huge. I do see lots of other uses for it and I do hope that, particularly healthcare, people use it more so." For Build VR, customisation and interaction is the big focus for the future. Pascal envisions an interactive profile for each dementia patient as part of their very own CG atrium. More personalised video content, such as a grandchild's birthday party, could be uploaded on the same day it happened, allowing less active patients to experience the event as if they're there. "You could have, potentially, in the near future, an old man connecting with his grandson and doing a trip through his hometown together," he said. "In terms of dementia, it's really being about doing everything we can to bring back those memories. "Now you're not just sitting and experiencing; you're interacting. And your actions will have a reaction, which will have another reaction. And that's really what virtual reality should be and that's where it's going. The desktop PC version of VR can do that; mobile just needs to catch up. And it will, I see in the next 12 months you'll be able to do that."
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.
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.
Draper B.,University of New South Wales |
Karmel R.,Australian Institute of Health and Welfare |
Gibson D.,University of Canberra |
Peut A.,Australian Institute of Health and Welfare |
Anderson P.,Australian Institute of Health and Welfare
International Psychogeriatrics | Year: 2011
Background: People with dementia may have adverse outcomes following periods of acute hospitalization. This study aimed to explore the effects of age upon hospitalization outcomes for patients with dementia in comparison to patients without dementia. Methods: Data extracted from the New South Wales Admitted Patient Care Database for people aged 50 years and over for the period July 2006 to June 2007 were linked to create person-based records relating to both single and multiple periods of hospitalization. This yielded nearly 409,000 multi-day periods of hospitalization relating to almost 253,000 persons. Using ICD-10-AM codes for dementia and other principal diagnoses, the relationship between age and hospitalization characteristics were examined for people with and without dementia. Results: Dementia was age-related, with 25% of patients aged 85 years and over having dementia compared with 0.9% of patients aged 50-54 years. People with dementia were more likely to be admitted for fractured femurs, lower respiratory tract infections, urinary tract infections and head injuries than people without dementia. Mean length of stay for admissions for people with dementia was 16.4 days and 8.9 days for those without dementia. People with dementia were more likely than those without to be re-admitted within three months for another multi-day stay. Mortality rates and transfers to nursing home care were higher for people with dementia than for people without dementia. These outcomes were more pronounced in younger people with dementia. Conclusion: Outcomes of hospitalization vary substantially for patients with dementia compared with patients without dementia and these differences are frequently most marked among patients aged under 65 years. © Copyright International Psychogeriatric Association 2011.
News Article | November 7, 2016
A new national study published by Australia’s National Research Organisation for Women’s Safety (ANROWS) shows that intimate partner violence poses one of the highest health risks for all Australian women, and is the greatest contributor to health risk amongst women aged 18 to 44. The contribution of intimate partner violence to the “burden of disease” is greater for women of child-bearing age than alcohol use, tobacco use, cholesterol, obesity and other diseases. The pattern found in Australia is, unfortunately, not uncommon in other high income nations, as identified by the World Health Organization. The study was commissioned by ANROWS and conducted by the Australian Institute of Health and Welfare (AIHW) to contribute to evidence for implementation of Australia’s National Plan to Reduce Violence against Women and their Children (2010-2022). The National Plan is an initiative of the Council of Australian Government’s (COAG) and its goal is a significant and sustained reduction in rates of violence against women and their children by 2022. The published study shows that one in three Australian women have experienced physical, sexual and/or emotional abuse by an intimate partner. The figure is one in six women when emotional abuse is excluded. Some groups, including Aboriginal and Torres Strait Islander (Indigenous Australian) women experience higher rates of intimate partner violence; disability and socio-economic marginalisation also increase risks of intimate partner violence victimisation. Women who are pregnant or who have children in their care are also especially vulnerable to intimate partner violence. The burden of disease is accepted globally as a rigorous, best-practice methodology for measuring the health impact of injuries, illnesses and conditions (collectively referred to as “diseases” in this methodology), and making comparisons between them. The burden of disease measures loss of health at a population level for a particular year, in this case 2011. The methodology uses representative national datasets for prevalence rates of diseases in the population. The Australian Bureau of Statistics’ (ABS) Personal Safety Survey (2012) provided the data source on prevalence of intimate partner violence among women in the Australian population. The study also uses the ABS’ Aboriginal and Torres Strait Islander Social Survey and General Social Survey to calculate prevalence rates of diseases. Data on emotional abuse in cohabiting relationships has been included in the calculation for the total population of Australian women, but these data are not available at the national level for racial minorities, including Aboriginal and Torres Strait Islander women. The health loss calculation takes into account premature death and the severity and impact of non-fatal diseases to produce a “Disability-Adjusted Life Year” (DALY). The DALY is a single measure of years lost due to homicide or suicide and poor health associated with disability, chronic illness, mental health conditions, substance abuse, maternal and reproductive health disorders, and sexually transmitted infections. The results of the DALY are expressed as percentages, or “rates of burden”. The AIHW examination of the burden of disease of intimate partner violence is drawn from its broader burden of disease study which calculated the burden of about 200 diseases. The examination of the burden of disease of intimate partner violence involved a meta-analysis of 43 studies linking intimate partner violence to health issues (more than 7,000 such studies were considered for inclusion but most were deemed insufficiently rigorous for the meta-analysis). Data from these studies were extracted to calculate whether there was a strong or weak association between intimate partner violence and the seven most prominent diseases emerging from the analysis: depression, anxiety, suicide and self-harm, homicide and injuries, alcohol-use disorder, preterm and low birth weight complications and early pregnancy loss. Research shows that intimate partner violence makes a strong impact on health outcomes. This is because this violence is perpetrated over a period of time and the effects are cumulative. Some of the health consequences are immediate, such as physical injuries, while others may develop over time as a result of violence, and they can be co-occurring years after the abuse ends, such as alcohol dependency and poor mental health. The effects of intimate partner violence also have a profound compounding effect on health, by deepening existing inequalities, as is the case with Indigenous Australian women. Flow-on health risks extend to children who are exposed to violence. In the ANROWS-AIHW study, intimate partner violence contributes 2.2 percent to the burden of disease of all women. To put this in context, the highest burden is 8.3 percent due to tobacco use and the second and third highest health burden is 5.1 percent each for being overweight or obese and physical inactivity. High cholesterol contributes less to the total burden of disease at 1.9 percent for all Australian women. As the figure below shows, despite the proportion of the burden seeming to be a small percentage, intimate partner violence actually ranks seventh amongst all health risk factors for women aged over 18 years. When we drill into the data for women of child-bearing age, intimate partner violence is the highest health risk factor. Intimate partner violence contributes to 5 percent of the disease burden of women aged 18 to 44 years, compared to 4 percent for alcohol use and over 2 percent for tobacco use. This ranking remains whether or not intimate partner violence includes emotional abuse alongside physical and sexual violence. The biggest proportion of the health burden of intimate partner violence is due to its impact on depressive disorders (39% of intimate partner violence burden for all women) and anxiety disorders (33 percent), followed by suicide and self-inflicted injuries (21 percent) and homicide & violence (13 percent). While there are no national data for emotional abuse of Indigenous women, the available data on physical and sexual violence show that intimate partner violence is more prevalent for Indigenous women (noting that perpetrators may be Indigenous or non-Indigenous). Amongst all adult age groups, Indigenous women experience a burden of disease of 6.4 percent due to physical and sexual violence, compared to 4.6 percent for all Australian women (for both cohabiting and non-cohabiting relationships). This makes intimate partner violence the third highest of all health risks for Indigenous women (compared to the 7th highest for all Australian women). Amongst Indigenous women aged 18 to 44, the burden of physical and sexual violence is 10.9 percent compared to 7.3 percent for all Australian women. This is the highest disease burden for Indigenous women in this age group, even greater than alcohol use (7 percent), being overweight or obese (6.2 percent) and tobacco (5.9 percent). Looking at the impact of this violence on other health issues, the burden of disease of intimate partner violence accounts for half of suicide and self-inflicted injuries as well as half of early pregnancy loss; and over a third each for anxiety and depressive disorders. Overall, the difference of the disease burden of intimate partner violence is 6.3% higher than for non-Indigenous women at the national level; for women of child-bearing age, the difference is 15.3%. The Role of the Health Sector The burden of disease study shows that intimate partner violence is the greatest risk to health for Australian women aged 18 to 44. Moreover, there is a gap in the burden of disease between Indigenous and non-Indigenous Australian women; the burden of disease attributed to intimate partner violence is more than six times greater for Indigenous women than non-Indigenous women. This finding highlights that significantly reducing and ultimately ending intimate partner violence against Indigenous women, is necessary to achieve another COAG goal—closing the gap between Indigenous and non-Indigenous Australians in a number of key areas including health and life expectancy. While the causes of intimate partner violence are complex, the World Health Organization (WHO) and other research bodies have well-established the empirical basis for its prevention. The United Nations and others, including Australia’s Our Watch, ANROWS and VicHealth have established that gender inequality is the most significant driver of intimate partner violence, although a wide range of factors are contributors to it. They include beliefs, family relationships, norms, social structures and practices within communities, workplaces, schools and sporting clubs, institutions such as the media and the criminal justice system and for Indigenous women, the intersections of gender and racialised inequality associated with colonisation. The burden of disease study by ANROWS-AIHW shows that reducing and ultimately eliminating intimate partner violence will have a significant positive impact in preventing and reducing mental illness, suicide and self-harm, homicide, and alcohol misuse as well as improving maternal and reproductive health. It indirectly shines a light on the role of health practitioners in early detection of intimate partner abuse, sensitive inquiry and appropriate referral to reduce the harmful effects of continued exposure to this significant health risk. Health practitioners and others also have a critical role in the long-term counselling and mental health support for women recovering from intimate partner violence. The impacts of intimate partner violence are broad and deep—achieving the goal of the National Plan to Reduce Violence against Women and their Children 2010-2022, and the goal of the closing the gap on Indigenous disadvantage, requires concerted effort from all sectors and there can no longer be any doubt about the role of health sector in responding to intimate partner violence.
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.
Budd A.C.,Australian Institute of Health and Welfare |
Sturrock C.J.,Australian Institute of Health and Welfare
Sexual Health | Year: 2010
Cytological and cancer surveillance will provide the most effective indications of short-term effects and long-term outcomes of the introduction of the human papillomavirus (HPV) vaccine in Australia. This article outlines how this surveillance is proposed to occur through the established national monitoring mechanisms of the National Cervical Screening Program in the annual Australian Institute of Health and Welfare (AIHW) publication 'Cervical screening in Australia'. Cytological surveillance will be possible principally through cytology data provided annually by the state and territory cervical cytology registers, and it is expected that these data will provide the earliest and most comprehensive indications of effects from the HPV vaccine. Some potential issues in interpreting these data are also discussed, including the potentially confounding effects of the introduction of new National Health and Medical Research Council guidelines 'Screening to prevent cervical cancer: guidelines for the management of asymptomatic women with screen-detected abnormalities' some 9 months before the introduction of the vaccine. Cancer surveillance over the long term will be possible using cervical cancer incidence data reported annually for the National Cervical Screening Program in 'Cervical screening in Australia' using data sourced from the Australian Cancer Database. In a final discourse, the HPV vaccine and cervical screening are discussed concurrently, and the importance of continued cervical screening in the HPV vaccine era emphasised. © CSIRO 2010.
Australian Institute of Health and Welfare,Australian Institute of Health and Welfare
Asia-Pacific Journal of Clinical Oncology | Year: 2015
Aim: The Australian Institute of Health and Welfare (AIHW) is a major national agency that provides authoritative information and statistics on Australia's health and welfare. The AIHW and the Australasian Association of Cancer Registries collaborate every year to provide updated information on cancer occurrences and trends in Australia. Method: The actual number of cases diagnosed and deaths, for all cancers combined and selected cancers, are presented from 1982 to 2011 for incidence and from 1982 to 2012 for mortality, with projections to 2014. Data on key population groups, survival, prevalence, hospitalizations and national population screening programs are also provided. Results: In 2014, it was estimated that 123920 new cases of cancer (excluding basal and squamous cell carcinoma of the skin) were diagnosed. Prostate cancer was the most commonly diagnosed cancer in males whereas breast cancer was the most commonly diagnosed cancer in females. It was estimated that 45780 deaths from cancer occurred in Australia in 2014. Lung cancer was the most common cause of cancer death in both males and females. Conclusion: From 1982 to 2014, it was estimated that the number of new cancer cases diagnosed in Australia more than doubled from 47417 to 123920. More males (55%) than females (45%) were diagnosed with cancer in 2014. From 1982 to 2014, the number of people who died in Australia from cancer almost doubled from 24922 to 45780. In 2014, more males (57%) than females (43%) were estimated to have died from cancer. © 2015 Wiley Publishing Asia Pty Ltd.