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Moodley K.,Stellenbosch University | Hardie K.,Hunter New England Population Health | Selgelid M.J.,Monash University | Waldman R.J.,George Washington University | And 3 more authors.
Bulletin of the World Health Organization | Year: 2013

Humanitarian emergencies result in a breakdown of critical health-care services and often make vulnerable communities dependent on external agencies for care. In resource-constrained settings, this may occur against a backdrop of extreme poverty, malnutrition, insecurity, low literacy and poor infrastructure. Under these circumstances, providing food, water and shelter and limiting communicable disease outbreaks become primary concerns. Where effective and safe vaccines are available to mitigate the risk of disease outbreaks, their potential deployment is a key consideration in meeting emergency health needs. Ethical considerations are crucial when deciding on vaccine deployment. Allocation of vaccines in short supply, target groups, delivery strategies, surveillance and research during acute humanitarian emergencies all involve ethical considerations that often arise from the tension between individual and common good. The authors lay out the ethical issues that policy-makers need to bear in mind when considering the deployment of mass vaccination during humanitarian emergencies, including beneficence (duty of care and the rule of rescue), non-maleficence, autonomy and consent, and distributive and procedural justice.


Eastwood K.,Hunter New England Population Health | Durrheim D.N.,University of Newcastle | Jones A.,University of Newcastle | Butler M.,Hunter New England Population Health
Medical Journal of Australia | Year: 2010

Objective: To investigate the Australian public's expectations, concerns and willingness to accept vaccination with the pandemic (H1N1) 2009 influenza vaccine. Design, setting and participants: A computer-assisted telephone interview survey was conducted between 20 August and 11 September 2009 by trained professional interviewers to study issues relating to vaccine uptake and perceived safety. The sample comprised 1155 randomly selected representative adults who had participated in a 2007 national study exploring knowledge and perceptions of pandemic influenza. Main outcome measures: Likely acceptance of pandemic (H1N1) 2009 vaccination, factors associated with acceptance, and respondents' willingness to share Australian vaccine with neighbouring developing countries. Results: Of 1155 possible participants, 830 (72%) were successfully interviewed. Twenty per cent of the study group (169/830) reported that they had developed influenza-like symptoms during the 2009 pandemic period. Most respondents (645/830, 78%) considered pandemic (H1N1) 2009 to be a mild disease, and 211/830 (25%) regarded themselves as being at increased risk of infection. Willingness to accept pandemic (H1N1) 2009 vaccination was high (556/830, 67%) but was significantly lower than when pandemic vaccination uptake was investigated in 2007 (88%; P< 0.0001). Respondents who had already been vaccinated against seasonal influenza and those who perceived pandemic (H1N1) 2009 to be severe were significantly more willing to accept vaccination. Most respondents (793/822, 96%) were willing to share surplus vaccine with developing countries in our region. Conclusion: Although two-thirds of Australian adults surveyed were willing to accept pandemic (H1N1) 2009 vaccination, and most supported sharing vaccine with developing countries, there is a need for accessible information on vaccine safety for those who are undecided about vaccination.


Lambert S.D.,Western Research Institute | Jones B.L.,University of Pittsburgh | Girgis A.,Western Research Institute | Lecathelinais C.,Hunter New England Population Health
Annals of Behavioral Medicine | Year: 2012

Background Although a number of cross-sectional studies document the distress experienced by partners and caregivers of cancer survivors, few have considered their potential differential patterns of adjustment over time. Purpose Identify distinct trajectories of anxiety and depression among partners and caregivers of cancer survivors and predictors of these trajectories. Methods Participants completed a survey to examine the impact of caring for, or living with, a cancer survivor at 6, 12, and 24 months post-survivor diagnosis. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (Nanxiety0510; Ndepression0511). Results Anxiety trajectories included: no anxiety (15.1% scored <3; 37.8% scored 3-5); chronic, borderline anxiety (33.2%); and chronic, clinical anxiety (13.9%). The depression trajectories were: no depression (38.9% scored <2; 31.5% scored around 3); a sustained score of 7 (25.5%); and chronic, clinical depression (4.1%). Variables associated with the trajectories included most of the psychosocial variables. Conclusions Findings highlight that most caregivers maintained their baseline level of distress, which is particularly concerning for participants reporting chronic anxiety or depression. © The Society of Behavioral Medicine 2012.


Whilst schools provide a potentially appropriate setting for preventing substance use among young people, systematic review evidence suggests that past interventions in this setting have demonstrated limited effectiveness in preventing tobacco, alcohol and other drug use. Interventions that adopt a mental wellbeing approach to prevent substance use offer considerable promise and resilience theory provides one method to impact on adolescent mental well-being. The aim of the proposed study is to examine the efficacy of a resilience intervention in decreasing the tobacco, alcohol and illicit drug use of adolescents. A cluster randomised controlled trial with schools as the unit of randomisation will be undertaken. Thirty two schools in disadvantaged areas will be allocated to either an intervention or a control group. A comprehensive resilience intervention will be implemented, inclusive of explicit program adoption strategies. Baseline surveys will be conducted with students in Grade 7 in both groups and again three years later when the student cohort is in Grade 10. The primary outcome measures will include self-reported tobacco, alcohol, marijuana and other illicit drug use. Comparisons will be made post-test between Grade 10 students in intervention and control schools to determine intervention effectiveness across all measures. To the authors' knowledge this is the first randomised controlled trial to evaluate the effectiveness of a comprehensive school-based resilience intervention, inclusive of explicit adoption strategies, in decreasing tobacco, alcohol and illicit drug use of adolescents attending disadvantaged secondary schools. ACTRN12611000606987.


Dalton C.B.,Hunter New England Population Health
Communicable diseases intelligence | Year: 2011

Flutracking is a national weekly online survey of influenza-like illness (ILI) completed by community members. Flutracking integrates participants' ILI symptom information with their influenza vaccination status to monitor influenza activity and field vaccine effectiveness (FVE). This report summarises results from the 2010 Flutracking season compared with previous seasons. Nationally, participation in Flutracking has more than doubled between 2008 and 2010, with 5,346 new participants enrolled or recruited in 2010 and a peak weekly participation of 10,773. By the end of the 2010 season, 5,904 of 9,109 (64.8%) participants had received the monovalent pandemic vaccine and/or the 2010 seasonal vaccine. From 2007 to 2010 FVE calculations demonstrated that the seasonal vaccine was effective except in 2009 during the pandemic. Peak 2010 ILI activity occurred in early June and August, and peak weekly 2010 ILI rates (4.2% among unvaccinated participants) were lower than the peak ILI rates during the 2009 pandemic (6.0% among unvaccinated participants). However, the decrease in laboratory notifications was much larger than the decrease in Flutracking rates. In summary, the number of Flutracking participants continued to steadily increase over the 2010 influenza season. The system has shown value in providing weekly vaccination uptake data during and beyond the 2009 influenza pandemic, as well as rapid FVE estimates that are qualitatively aligned with findings from other analyses of vaccine efficacy. Flutracking has also provided estimates of weekly community ILI activity that were not biased by health seeking behaviour and clinician testing practices.


Paterson B.J.,Hunter Medical Research Institute | Durrheim D.N.,Hunter Medical Research Institute | Durrheim D.N.,Hunter New England Population Health
Journal of Epidemiology and Global Health | Year: 2013

The goal of syndromic surveillance is the earlier detection of epidemics, allowing a timelier public health response than is possible using traditional surveillance methods. Syndromic surveillance application for public health purposes has changed over time and reflects a dynamic evolution from the collection, interpretation of data with dissemination of data to those who need to act, to a more holistic approach that incorporates response as a core component of the surveillance system. Recent infectious disease threats, such as severe acute respiratory syndrome (SARS), avian influenza (H5N1) and pandemic influenza (H1N1), have all highlighted the need for countries to be rapidly aware of the spread of infectious diseases within a region and across the globe. The International Health Regulations (IHR) obligation to report public health emergencies of international concern has raised the importance of early outbreak detection and response. The emphasis in syndromic surveillance is changing from automated, early alert and detection, to situational awareness and response. Published literature on syndromic surveillance reflects the changing nature of public health threats and responses. Syndromic surveillance has demonstrated a remarkable ability to adapt to rapidly shifting public health needs. This adaptability makes it a highly relevant public health tool. © 2013 Ministry of Health, Saudi Arabia.


Lambert S.D.,University of New South Wales | Girgis A.,University of New South Wales | Lecathelinais C.,Hunter New England Population Health | Stacey F.,Hunter Medical Research Institute
Supportive Care in Cancer | Year: 2013

Purpose: This study aims to examine the prevalence of psychosocial variables associated with anxiety and depression among partners and caregivers of cancer survivors, compare prevalence with community norms and report differences across cancer diagnosis. Methods: A prospective survey of partners and caregivers was undertaken to assess anxiety and depression and potential psychosocial variables associated with these outcomes at 6 and 12 months post-survivor diagnosis (N = 436). Results: Although the proportion of anxious participants decreased over time (p = 0.01), the percentage of those depressed remained stable (p = 0.68). Most participants who were depressed were also anxious. To a certain extent, the prevalence of anxiety and depression exceeded community norms and varied across cancer types. Partners and caregivers particularly vulnerable included those of lung, haematological or head and neck survivors. High use of avoidant coping and interference in regular activities were associated with both anxiety and depression across time points. Of the different types of support measured, only lower emotional/informational support was associated with anxiety and depression at 6 months, whereas lower positive social interaction was associated with depression at 12 months. Additional variables associated with anxiety and depression at 12 months included higher unmet needs and involvement in personal and medical tasks, respectively. Conclusions: Even at 12 months post-survivor diagnosis, almost a third of participants reported anxiety, a result partially predicted by high use of avoidant coping and interference in regular activities. Understanding variables associated with partners' and caregivers' anxiety and depression can lead to optimal referral to supportive care services and inform the tailoring of interventions to address those variables contributing to anxiety and depression at particular time points. © 2012 Springer-Verlag.


Boyes A.,Hunter Medical Research Institute | D'Este C.,Hunter Medical Research Institute | D'Este C.,University of Newcastle | Carey M.,Hunter Medical Research Institute | And 2 more authors.
Supportive Care in Cancer | Year: 2013

Purpose: Use of the Distress Thermometer (DT) as a screening tool is increasing across the cancer trajectory. This study examined the accuracy and optimal cut-off score of the DT compared to the Hospital Anxiety and Depression Scale (HADS) for detecting possible cases of psychological morbidity among adults in early survivorship. Methods: This study is a cross-sectional survey of 1,323 adult cancer survivors recruited from two state-based cancer registries in Australia. Participants completed the DT and the HADS at 6 months post-diagnosis. Results: Compared to the HADS subscale threshold ≥8, the DT performed well in discriminating between cases and non-cases of anxiety, depression and comorbid anxiety-depression with an area under the curve of 0.85, 0.84 and 0.87, respectively. A DT cut-off score of ≥2 was best for clinical use (sensitivity, 87-95 %; specificity, 60-68 %), ≥4 was best for research use (sensitivity, 67-82 %; specificity, 81-88 %) and ≥3 was the best balance between sensitivity (77-88 %) and specificity (72-79 %) for detecting cases of anxiety, depression and comorbid anxiety-depression. The DT demonstrated a high level of precision in identifying non-cases of psychological morbidity at all possible thresholds (negative predictive value, 77-99 %). Conclusions: The recommended DT cut-off score of ≥4 was not supported for universal use among recent cancer survivors. The optimal DT threshold depends upon whether the tool is being used in the clinical or research setting. The DT may best serve to initially identify non-cases as part of a two-stage screening process. The performance of the DT against 'gold standard' clinical interview should be evaluated with cancer survivors. © 2012 Springer-Verlag.


Rowe S.C.,Hunter New England Population Health | Wiggers J.H.,University of Newcastle | Wolfenden L.,University of Newcastle | Francis J.L.,University of Newcastle
Journal of Studies on Alcohol and Drugs | Year: 2010

Objective: Although strategies exist to minimize alcoholrelated harms associated with establishments licensed to serve alcohol, such establishments are associated with a disproportionate level of harm.To date, understanding the association between such establishments and alcohol-related harms, and hence the opportunities for reducing harm, has been limited by inadequate information regarding incidents of alcohol-related crime.To address this deficiency, this study was undertaken to describe the association between such establishments and incidents of crime using enhanced police-recorded, alcohol-related crime intelligence.Method: A descriptive analysis was undertaken of intoxicated people who had last consumed alcohol in establishments licensed to serve alcohol (841 bars, 551 licensed social clubs, 11 nightclubs, and 18 other locations) preceding their involvement in police-recordedincidents of violence, disorder, or motor vehicle crashes.The study area encompassed 21 nonmetropolitan police commands in the state of New South Wales, Australia.Results: Among intoxicated persons involvedin incidents of violence, disorder, or motor vehicle crashes, the risk of being recorded as having last consumed alcohol in a bar or nightclub before the incident was at least twice that of licensed social clubs and other establishments.Approximately 20% of establishments accounted for 80% of intoxicated persons involved in such incidents, and 6% of establishments were in the top 20% of establishments for all three offense types.Conclusions: The disproportionate burden of alcohol-related crime associated with establishments licensed to serve alcohol may be reduced if harm-reduction strategies address the specific risks posed by bars and nightclubs, and individual high-risk establishments.(J.Stud.Alcohol Drugs, 71, 909-916, 2010).Copyright © 2010 Rutgers University.


Girgis A.,University of New South Wales | Lambert S.D.,University of New South Wales | McElduff P.,University of Newcastle | Bonevski B.,University of Newcastle | And 3 more authors.
Psycho-Oncology | Year: 2013

Objective The objective of this study was to identify caregivers' unmet needs and the psychosocial variables associated with unmet need count within the first 24 months post-survivor diagnosis. Methods Caregivers completed a comprehensive survey measuring the primary outcome, psychosocial variables, and demographics of interest at 6 (n = 547), 12 (n = 519), and 24 (n = 443) months post-survivor diagnosis. Results Although prevalence of unmet needs significantly decreased over time, almost a third of caregivers still reported unmet needs at 24 months. Unmet needs were more prevalent among caregivers of lung cancer survivors, at 6 and 24 months. Top ranking unmet needs across time included 'managing concerns about cancer coming back', 'reducing stress in the person with cancer's life', 'understanding the experience of the person with cancer', and 'accessible hospital parking'. At 24 months, some of the top ranking unmet needs were related to caregivers' well-being and relationships. Increased interference in activities due to caregiving, anxiety, depression, avoidant and active coping, and out-of-pocket expenses was associated with reporting more unmet needs. Less involvement in caregiving roles and increased physical well-being and social support were associated with reporting less unmet needs. For some variables (e.g. anxiety and depression), association with unmet needs strengthened over time. Conclusions This is the first longitudinal analysis of caregivers' unmet needs as they enter early and extended survivorship. Findings provide valuable insights into caregiver's unmet needs over time and identified a sub-group of caregivers at risk of experiencing unmet needs, extending previous research and informing the timing and content of psychosocial services. Copyright © 2012 John Wiley & Sons, Ltd. Copyright © 2012 John Wiley & Sons, Ltd.

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