North Sydney, Australia
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Merom D.,University of Western Sydney | Merom D.,University of Sydney | Pye V.,NSW Biostatistical Officer Training Program | Macniven R.,University of Sydney | And 5 more authors.
Preventive Medicine | Year: 2012

Objective: To examine older people's participation in fall prevention exercise/physical activities. Methods: Participants comprised 5,681 randomly selected older people (≥ 65. years) who took part in the 2009 New South Wales (Australia) Fall Prevention telephone survey (61% response-rate). The instrument consisted of 11 prompted activities including two separate questions on participation in strength and balance training. Tai chi, dance, team sports, golf, bowls and specific balance training were classified as balance-challenging activities. Correlates of low participation were examined using multivariable logistic regression. Results: One in eight older people (12.0%, 95% CI: 11.0-13.0) participated in strength training, 6.0% (95% CI: 5.2-6.7) participated in balance training and 21.8% (95% CI: 20.5-23.0) participated in balance-challenging activities. Adherence to public health recommendations (≥ 2. days/week) for strength or balance-challenging activities was reported by 21.0% (95% CI: 9.8-22.2) with 5.3% adhering to both forms. Engagements in strength or in balance-challenging activities were lower among those who had low education (< high-school), lived in disadvantaged neighbourhoods, were obese, had fair/poor self-rated health, had problems with walking or used a walking aid or had fallen in the past year. Conclusion: Participation in best practice exercise to prevent falls is low. Population-based approaches and targeted strategies for high-risk group are needed. © 2012 Elsevier Inc..


Mealing N.M.,University of New South Wales | Mealing N.M.,Center for Epidemiology and Research | Dobbins T.A.,University of New South Wales | Pearson S.-A.,University of New South Wales
Pharmacoepidemiology and Drug Safety | Year: 2012

Purpose: Fact of death is not always available on data sets used for pharmacoepidemiological research. Proxies may be an appropriate substitute in the absence of death data. The purposes of this study were to validate a proxy for death in adult cancer patients and to assess its performance when estimating survival in two cohorts of cancer patients. Methods: We evaluated 30-, 60-, 90- and 180-day proxies overall and by cancer type using data from 12 394 Australian veterans with lung, colorectal, breast or prostate cancer. The proxy indicated death if the difference between the last dispensing record and the end of the observational period exceeded the proxy cutoff. We then compared actual survival to 90-day proxy estimates in a subset of 4090 veterans with 'full entitlements' for pharmaceutical items and in 3704 Australian women receiving trastuzumab for HER2+ metastatic breast cancer. Results: The 90-day proxy was optimal with an overall sensitivity of 99.3% (95%CI: 98.4-99.7) and a specificity of 97.6% (95%CI: 91.8-99.4). These measures remained high when evaluated by cancer type and spread of disease. The application of the proxy using the most conservative date of death estimate (date of last dispensing) generally underestimated survival, with estimates up to 3months shorter than survival based on fact of death. Conclusions: A 90-day death proxy is a robust substitute to identify death in a chronic population when fact of death is not available. The proxy is likely to be valid across a range of chronic diseases as it relies on the presence of 'regular' dispensing records for individual patients. © 2011 John Wiley & Sons, Ltd.


Schaffer A.,Center for Epidemiology and Research | Muscatello D.,Center for Epidemiology and Research | Broome R.,Environmental Health Branch | Corbett S.,Center for Population Health | Smith W.,Environmental Health Branch
Environmental Health: A Global Access Science Source | Year: 2012

Background: From January 30-February 6, 2011, New South Wales was affected by an exceptional heat wave, which broke numerous records. Near real-time Emergency Department (ED) and ambulance surveillance allowed rapid detection of an increase in the number of heat-related ED visits and ambulance calls during this period. The purpose of this study was to quantify the excess heat-related and all-cause ED visits and ambulance calls, and excess all-cause mortality, associated with the heat wave. Methods. ED and ambulance data were obtained from surveillance and administrative databases, while mortality data were obtained from the state death registry. The observed counts were compared with the average counts from the same period from 2006/07 through 2009/10, and a Poisson regression model was constructed to calculate the number of excess ED visits, ambulance and deaths after adjusting for calendar and lag effects. Results: During the heat wave there were 104 and 236 ED visits for heat effects and dehydration respectively, and 116 ambulance calls for heat exposure. From the regression model, all-cause ED visits increased by 2% (95% CI 1.01-1.03), all-cause ambulance calls increased by 14% (95% CI 1.11-1.16), and all-cause mortality increased by 13% (95% CI 1.06-1.22). Those aged 75 years and older had the highest excess rates of all outcomes. Conclusions: The 2011 heat wave resulted in an increase in the number of ED visits and ambulance calls, especially in older persons, as well as an increase in all-cause mortality. Rapid surveillance systems provide markers of heat wave impacts that have fatal outcomes. © 2012 Schaffer et al; licensee BioMed Central Ltd.


Thrift A.P.,Center for Epidemiology and Research | Nancarrow H.,University of Sydney | Bauman A.E.,University of Sydney
Australian and New Zealand Journal of Public Health | Year: 2011

Objective: Social gradients in Aboriginal health are seldom explored. This study describes social gradients and trends in smoking during pregnancy among Aboriginal mothers in NSW. Methods: This was a secondary analysis of the NSW Midwives Data Collection (MDC) 1994-2007, covering all births in NSW. Analyses examined associations between socio-demographic characteristics and smoking during pregnancy. Results: Data from 1,214,206 pregnant women showed that 17.4% smoked during pregnancy. The rate of smoking during pregnancy among all NSW women declined from 22.3% in 1994 to 12.8% in 2007; the rate among Aboriginal women remained high, declining from 61.4% in 1994 to 50.2% in 2007. Smoking was substantially higher among Aboriginal mothers compared to non-Aboriginal mothers. Socio-economic analyses showed that the smoking rate among low SES Aboriginal mothers was approximately two and a half times that of high SES Aboriginal women, a similar gradient to non-Aboriginal women. Conclusions: Indicators of socioeconomic position are a consistent, independent correlate of smoking during pregnancy for Aboriginal and non-Aboriginal women. Implications: There is a need for a social inequalities approach to smoking during pregnancy, specifically targeting more disadvantaged Aboriginal mothers and all teenage mothers for smoking prevention. Strategies to access more disadvantaged mothers should not be missed through broadly focused Aboriginal tobacco control strategies. © 2011 The Authors.


Sparks R.,CSIRO | Keighley T.,CSIRO | Muscatello D.,Center for Epidemiology and Research
IIE Transactions (Institute of Industrial Engineers) | Year: 2010

Exponentially Weighted Moving Average (EWMA) plans for negative binomial counts with a non-homogeneous (time-varying) mean are developed for monitoring disease counts. These plans are used to identify unusual disease outbreaks or unusual epidemics. Time-varying means are typical for disease counts. The recommended surveillance plan in this article differs from the traditional approach of using standardized forecast errors based on the normality assumption, which suffers assumption concerns. The article demonstrates that the proposed EWMA plan has efficient detection properties for signaling unusually large outbreaks. These plans may be a useful tool for epidemiologists. © 2010 "IIE".


Agho K.,University of Western Sydney | Stevens G.,University of Western Sydney | Taylor M.,University of Western Sydney | Barr M.,Center for Epidemiology and Research | Raphael B.,University of Western Sydney
Environmental Research | Year: 2010

Introduction: According to the World Health Organisation (WHO), global warming has the potential to dramatically disrupt some of life's essential requirements for health, water, air and food. Understanding how Australians perceive the risk of global warming is essential for climate change policy and planning. The aim of this study was to determine the prevalence of, and socio-demographic factors associated with, high levels of perceived likelihood that global warming would worsen, concern for self and family and reported behaviour changes. Methods: A module of questions on global warming was incorporated into the New South Wales Population Health Survey in the second quarter of 2007. This Computer Assisted Telephone Interview (CATI) was completed by a representative sample of 2004 adults. The weighted sample was comparable to the Australian population. Bivariate and multivariate statistical analyses were conducted to examine the socio-demographic and general health factors. Results: Overall 62.1% perceived that global warming was likely to worsen; 56.3% were very or extremely concerned that they or their family would be directly affected by global warming; and 77.6% stated that they had made some level of change to the way they lived their lives, because of the possibility of global warming. After controlling for confounding factors, multivariate analyses revealed that those with high levels of psychological distress were 2.17 (Adjusted Odds Ratio (AOR)=2.17; CI: 1.16-4.03; P=0.015) times more likely to be concerned about global warming than those with low psychological distress levels. Those with a University degree or equivalent and those who lived in urban areas were significantly more likely to think that global warming would worsen compared to those without a University degree or equivalent and those who lived in the rural areas. Females were significantly (AOR=1.69; CI: 1.23-2.33; P=0.001) more likely to report they had made changes to the way they lived their lives due to the risk of global warming. Conclusions: A high proportion of respondents reported that they perceived that global warming would worsen, were concerned that it would affect them and their families and had already made changes in their lives because of it. These findings support a readiness in the population to deal with global warming. Future research and programs are needed to investigate population-level strategies for future action. © 2010.


Gilbert G.L.,University of Sydney | Cretikos M.A.,Center for Epidemiology and Research | Cretikos M.A.,University of Sydney | Hueston L.,University of Sydney | And 3 more authors.
PLoS ONE | Year: 2010

Background: The first wave of pandemic influenza A(H1N1)2009 (pH1N1) reached New South Wales (NSW), Australia in May 2009, and led to high rates of influenza-related hospital admission of infants and young to middle-aged adults, but no increase in influenza-related or all-cause mortality. Methodology/Principal Findings: To assess the population rate of pH1N1 infection in NSW residents, pH1N1-specific haemagglutination inhibition (HI) antibody prevalence was measured in specimens collected opportunistically before (2007-2008; 474 specimens) and after (August-September 2009; 1247 specimens) the 2009 winter, and before the introduction of the pH1N1 monovalent vaccine. Age- and geographically-weighted population changes in seroprevalence were calculated. HI antibodies against four recent seasonal influenza A viruses were measured to assess cross-reactions. Pre-and post-pandemic pH1N1 seroprevalences were 12.8%, and 28.4%, respectively, with an estimated overall infection rate of 15.6%. pH1N1 antibody prevalence increased significantly - 20.6% overall - in people born since 1944 (26.9% in those born between 1975 and 1997) but not in those born in or before 1944. People born before 1925 had a significantly higher pH1N1 seroprevalence than any other age-group, and against any seasonal influenza A virus. Sydney residents had a significantly greater change in prevalence of antibodies against pH1N1 than other NSW residents (19.3% vs 9.6%). Conclusions/Significance: Based on increases in the pH1N1 antibody prevalence before and after the first pandemic wave, 16% of NSW residents were infected by pH1N1 in 2009; the highest infection rates (27%) were among adolescents and young adults. Past exposure to the antigenically similar influenza A/H1N1(1918) is the likely basis for a very high prevalence (49%) of prepandemic cross-reacting pH1N1 antibody and sparing from pH1N1 infection among people over 85 years. Unless pre-season vaccine uptake is high, there are likely to be at least moderate rates including some life-threatening cases of pH1N1 infection among young people during subsequent winters. © 2010 Gilbert et al.


Bentley J.P.,Center for Epidemiology and Research
New South Wales public health bulletin | Year: 2012

The reporting of Aboriginal and Torres Strait Islander peoples on the NSW Admitted Patient Data Collection was ascertained using a stratified purposive sample of NSW public hospital patients in 2010. Information was collected by interviewing patients and compared with patient information obtained on admission. The study used the methods used in the national survey by the AIHW in 2007 and the study results were compared to the AIHW survey results. The level of correct reporting was 90.7% (95% CI 84.6-94.2). These results, while indicative, should be interpreted with caution as some people may not have identified themselves as Aboriginal or Torres Strait Islander either on hospital admission or in the survey, and non-random sampling can produce non-representative samples.


Scandol J.P.,Center for Epidemiology and Research
New South Wales public health bulletin | Year: 2012

Health Statistics NSW is a new web-based application developed by the Centre for Epidemiology and Research at the NSW Ministry of Health. The application is designed to be an efficient vehicle for the timely delivery of health statistics to a diverse audience including the general public, health planners, researchers, students and policy analysts. The development and implementation of this web application required the consideration of a series of competing demands such as: the public interest in providing health data while maintaining the privacy interests of the individuals whose health is being reported; reporting data at spatial scales of relevance to health planners while maintaining the statistical integrity of any inferences drawn; the use of hardware and software systems which are publicly accessible, scalable and robust, while ensuring high levels of security. These three competing demands and the relationships between them are discussed in the context of Health Statistics NSW.


Churches T.,Center for Epidemiology and Research
New South Wales public health bulletin | Year: 2010

Surveillance has a fundamental role during public health emergencies to provide accurate and relevant information to guide decision making. For each phase of the NSW response to the pandemic H1N1 (2009) influenza there were significant differences in the public health surveillance objectives and response mechanisms. Consequently each phase placed a different emphasis on the various sources and types of surveillance information which were collected and reported upon. We examine whether the NSW public health surveillance systems were able to inform effective public health management throughout all phases of the pandemic (H1N1) 2009 influenza.

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