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Tran H.A.,Hunter Region Mail Center | Ianna E.A.,John Hunter Hospital | Leembruggen N.,John Hunter Hospital
Endocrine Practice | Year: 2010

Objective: To assess the frequency of new thyroid disease, in patients who did not develop thyroid disease during treatment with interferon-α in combination with ribavirin for hepatitis C, during the 6-month period after the end of therapy. Methods: A prospective study was performed in 190 patients who underwent a combination of interferon-α and ribavirin therapy for hepatitis C infection during the 36-month period between 2006 and 2008. Thyroid function tests were performed at the completion of treatment and at 4, 12, and 24 weeks of follow-up. Results: During the 6 months after the completion of interferon-α and ribavirin therapy in the 190 study patients with hepatitis C infection, there were 2 cases of thyroid disease. One patient had the typical biphasic thyroiditis, and the other had primary hypothyroidism. Thus, the prevalence of thyroid disease in this setting was 2 of 190 patients (1.0%). Conclusion: The majority (99%) of patients had normal thyroid outcomes at 6-month follow-up. Only 1 patient had symptoms. This finding is reassuring and eliminates the need for ongoing thyroid surveillance during this time and probably longer. In the absence of symptoms, only a single thyroid-stimulating hormone measurement at 6-month review is recommended. Copyright © 2010 AACE.


Beesley K.,Hunter New England Local Health Network | White J.H.,Hunter Region Mail Center | Alston M.K.,Hunter New England Area Health Service | Sweetapple A.L.,Hunter New England Area Health Service | Pollack M.,Hunter New England Local Health Network
Disability and Rehabilitation | Year: 2011

Purpose This study aimed to qualitatively explore the experience of community dwelling stroke survivors participation in an arts health group programme and possible health benefits to quality of life (QOL) and wellbeing. Method.Sixteen participants were conveniently sampled to participate in two group art programmes, both held weekly over a period of 8 weeks. Qualitative data were collected through two focus groups (n = 9) and individual interviews (n = 11). Qualitative analysis of the data was undertaken, using a grounded theory approach incorporating constant comparison. Results.Age ranged from 43 to 81 years. Four themes emerged including: experience of stroke, benefit of art, benefit for self and benefit of group experience. Participants experienced improved confidence, self-efficacy, QOL and community participation through involvement in an arts health programme. Conclusions.The implementation of an arts health programme after stroke made a substantial impact on well-being and QOL. Results from this study are promising and this is a model that warrants rigorous investigation regarding the impact of art on QOL and wellbeing. This study also highlighted the need for community resources to address community re-integration and service provision in the form of age appropriate, activity-based groups for stroke survivors. © 2011 Informa UK, Ltd.


Cox M.B.,Hunter Medical Research Institute | Cox M.B.,University of Newcastle | Bowden N.A.,Hunter Medical Research Institute | Bowden N.A.,University of Newcastle | And 5 more authors.
Multiple Sclerosis Journal | Year: 2013

Background: Multiple sclerosis (MS) is an autoimmune disorder where a breakdown in the integrity of the blood-brain barrier is thought to allow lymphocytes to enter the central nervous system. Objectives: The purpose of this study was to examine gene expression profiles between MS patients and healthy controls to identify genes intimately involved in the pathobiology of MS. Methods: Whole-genome gene expression analysis was performed using peripheral blood mononuclear cells from 39 healthy controls and 37 MS patients, 24 MS patients receiving no disease modifying therapy and 13 MS patients receiving interferon-beta (IFN-beta). Pathway analysis was performed to identify pathways dysregulated in MS. Results: Gene expression profiling of MS identified a signature of predominately immune associated genes. The plasminogen activation pathway contained an over-representation of significantly differentially expressed genes, including matrix metallopeptidase 9 (MMP9). Treatment with IFN-beta ameliorated the over-expression of MMP9, however the expression of two genes, plasminogen activator urokinase (PLAU) and serpin peptidase inhibitor, clade B (ovalbumin), member 2 (SERPINB2), forming part of the plasminogen activation pathway were not affected by IFN-beta therapy. Conclusions: High expression levels of MMP9 have been associated with MS and the breakdown of the blood-brain barrier, while IFN-beta therapy decreases MMP9 expression. We confirm altered MMP9 expression in MS, and identify dysregulation within the plasminogen activation cascade, a pathway involved in the activation of MMP9. © 2013 The Authors.


White J.H.,Hunter Region Mail Center | Gray K.R.,Westmead Hospital | Magin P.,University of Newcastle | Attia J.,University of Newcastle | And 3 more authors.
Disability and Rehabilitation | Year: 2012

Purpose: To explore the experience of post-stroke fatigue in community-dwelling stroke survivors with and without post-stroke mood disturbance within one year of stroke. Methods: This was a prospective qualitative cohort study including semistructured interviews undertaken at baseline (stroke onset), 3, 6, 9 and 12 months in 23 stroke survivors; eight single interviews were held with "supplementary" participants. Qualitative data analysis involved an inductive thematic approach using a process of constant comparison. Results: Thirty-one participants (17 men, 14 women; age range 3794 years) took part in 122 interviews. The majority of participants was independent and experienced few major depressive symptoms. Three trajectories emerged regarding the participants' experiences of fatigue including experience of fatigue, coping strategies and knowledge. Conclusions: The results of this study suggest that in spite of reasonable objective physical recovery post-stroke, fatigue in community-dwelling stroke survivors may be disabling. The use of qualitative methodology was sensitive in identifying the factors that play a role in the experience of fatigue. The essential role of health professionals in this context is to provide support and education regarding fatigue and to promote participation after stroke in therapy programs. Routine practice for stroke services should include fatigue advice prior to discharge. Implications for Rehabilitation Issues regarding fatigue are of major importance to stroke survivors. Allied health can play a significant role in providing training regarding management of fatigue symptoms to assist maintain community participation. Allied health professions have an important role in assisting stroke survivors to transition through feelings of loss and in providing education concerning new skills to assist manage symptoms of fatigue post-stroke. © 2012 Informa UK, Ltd.


Tran H.,Hunter Region Mail Center | Tran H.,University of Newcastle | Jones T.,Hunter Area Pathology Service | Ianna E.,Hunter Area Pathology Service | And 2 more authors.
Endocrine Practice | Year: 2013

Objective: Hepatitis C virus (HCV) infection is one of the major epidemics afflicting young people in both developed and developing countries. The most common endocrine disorder associated with this infection, especially in conjunction with interferon-α (IFN-α)-based therapy, is thyroid disease (TD). This review examines the development of TD before, during, and after the completion of treatment with combination IFN-α and ribavirin (RBV) for chronic HCV infection. We also summarize the current understanding of the natural history of the condition and propose management and follow-up guidelines.Methods: PubMed was searched up to June 30, 2011 for English-language publications that contained the search terms "hepatitis C virus," "chronic hepatitis C," "HCV," "thyroid disease," "thyroiditis," "autoimmunity," "interferon-alpha," and "ribavirin." Additional publications were identified from the reference lists of identified papers. The included studies were original research publications and included combination IFN-α and RBV use in patients that developed TD.Results: The prevalence of TD before combination IFN-α and RBV therapy ranges from 4.6 to 21.3%; during therapy, 1.1 to 21.3%; and after therapy, 6.7 to 21.3%. The most common TD is thyroiditis. Thyroid function testing (TFT) frequency and diagnostic criteria for various thyroid conditions are not standardized, and many of the existing studies are retrospective.Conclusion: Patients undergoing this therapy should be assessed with a standardized protocol to appropriately detect and manage developed TD. Based on the currently available literature, we recommend that patients receiving combination interferon-α and RBV therapy undergo monthly thyrotropin (TSH) level testing. © 2013 AACE.


Carter G.L.,University of Newcastle | Carter G.L.,Hunter Region Mail Center | Willcox C.H.,University of Newcastle | Willcox C.H.,Center for Psychotherapy | And 6 more authors.
Australian and New Zealand Journal of Psychiatry | Year: 2010

Objective: Deliberate self-harm (DSH), general hospital admission and psychiatric hospital admission are common in women meeting criteria for borderline personality disorder (BPD). Dialectical behaviour therapy (DBT) has been reported to be effective in reducing DSH and hospitalization. Method: A randomized controlled trial of 73 female subjects meeting criteria for BPD was carried out with intention-to-treat analyses and per-protocol analyses. The intervention was DBT and the control condition was treatment as usual plus waiting list for DBT (TAUWL), with outcomes measured after 6 months. Primary outcomes were differences in proportions and event rates of: any DSH; general hospital admission for DSH and any psychiatric admission; and mean difference in length of stay for any hospitalization. Secondary outcomes were disability and quality of life measures. Results: Both groups showed a reduction in DSH and hospitalizations, but there were no significant differences in DSH, hospital admissions or length of stay in hospital between groups. Disability (days spent in bed) and quality of life (Physical, Psychological and Environmental domains) were significantly improved for the DBT group. Conclusion: DBT produced non-significant reductions in DSH and hospitalization when compared to the TAUWL control, due in part to the lower than expected rates of hospitalization in the control condition. Nevertheless, DBT showed significant benefits for the secondary outcomes of improved disability and quality of life scores, a clinically useful result that is also in keeping with the theoretical constructs of the benefits of DBT. © 2010 The Royal Australian and New Zealand College of Psychiatrists.


White J.H.,Hunter Region Mail Center | Bynon B.L.,Hunter Region Mail Center | Marquez J.,University of Newcastle | Sweetapple A.,Hunter Region Mail Center | Pollack M.,Hunter Region Mail Center
Disability and Rehabilitation | Year: 2013

Objectives: To explore whether a pilot secondary stroke prevention group program for community-dwelling chronic stroke survivors assisted participants in modifying their lifestyle to reduce their risk of secondary stroke. Design: A mixed methods study (quantitative and qualitative). Setting: Community. Subjects: Twenty-two community dwelling, chronic stroke survivors. Intervention: The Masterstroke program incorporated a secondary prevention stroke group program over a 9-week period with two 2-h sessions weekly (1 hour for education and 1 hour for exercise). The exercise component incorporated fitness, strength, mobility and balance and education focused on secondary stroke prevention whilst also providing chronic condition self-management support. Main measures: Timed Up and Go (TUG), Six Minute Walk Test (6MWT), Fat and Fibre Barometer, The Stroke and Aphasia Quality of Life Scale (SaQoL-39), and questionnaires for salt intake and stroke knowledge. Qualitative outcomes were participants' perceptions. Data analysis involved an inductive thematic approach with constant comparison. Results: There were insufficient participants for results to reach statistical significance in all categories, however, statistically significant results where achieved with regards to knowledge, TUG, salt intake and quality of life (QoL) scores. Qualitative responses explored participants' experience of the Masterstroke program; results confirmed increases in knowledge about stroke and exercise tolerance, successfulness of a group program and lifestyle modification post stroke. Conclusions: Participation in the Masterstroke program for community dwelling stroke survivors resulted in significant improvements in knowledge, functional balance, dietary behaviours and quality of life. Qualitative interviews support the participants' implementation of lifestyle changes essential for reducing risks of secondary stroke. Results support the utilisation of this model and warrants rigorous investigation regarding long-term impacts of an education and exercise program on community dwelling stroke survivors. Implications for Rehabilitation A program which incorporates exercise and education in a group setting may improve health-related quality of life and functional performance for community dwelling, chronic stroke survivors. It is feasible for a multidisciplinary team to implement a secondary stroke prevention group program for community dwelling, chronic stroke survivors. © 2013 Informa UK, Ltd.


Musgrave R.,Hunter Region Mail Center | Rawlinson N.,Australian National University
Exploration Geophysics | Year: 2010

Acquisition of teleseismic data in south-western New South Wales during 2007 formed the latest stage of a rolling deployment of seismometers over south-eastern Australia, and allowed a revised tomographic model to be constructed for the lithospheric mantle under Victoria and southern NSW. Our aim here is to link the observed distribution of upper-mantle P-wave velocity to the major geological features of the upper crust, which here comprise terranes of the Delamerian and Lachlan orogens. We have extended the definition of the boundaries of these terranes under cover by the use of the tilt-filter of total magnetic intensity, which provides an image with detailed resolution for sources at depths down to ∼5km. We proceed to infer the distribution of deeper sources in the middle and lower crust by two approaches to the use of potential-field images: we exploit the relationship between wavenumber and source depth, through the application of a 20-km low-pass filter to the total magnetic intensity grid; and we take advantage of the lower sensitivity of gravity anomalies to depth of source, compared to magnetic anomalies with dipolar sources, by defining broad features in the isostatic gravity grid. Our interpretation of the low-pass magnetic and isostatic gravity imagery confirms the relationship between high mantle velocity and the Proterozoic Delamerian Orogen, and indicates that a salient of high mantle velocity under the Palaeozoic Stawell Zone results from an underthrust wedge of Delamerian basement. High mantle velocity under the Palaeozoic Wagga-Omeo Zone may be a result of lithospheric thickening that is a corollary of mid- to lower crustal thrust faulting indicated by the potential field data. Low mantle velocity under part of the Melbourne Zone may result from thermochemical resetting of its Proterozoic microcontinental basement by the thermal event responsible for the extensive Cainozoic volcanism in western Victoria; low mantle velocity under the Hay-Booligal Zone, which also appears to be anomalous, may similarly be related to a heat pulse that engendered the swarm of diatremes that is distributed across the zone. © ASEG 2010.


PubMed | Hunter Region Mail Center
Type: Journal Article | Journal: Journal of advanced nursing | Year: 2011

The aims of this study were to obtain information to support Palliative Care healthcare workers to meet the needs of the Sudanese population in death, dying, and bereavement.Australia is a multicultural society and healthcare workers are faced with increasing numbers and diversity of immigrants to whom healthcare professionals strive to provide quality health care.A qualitative interpretive approach was used with data collected from a sample of 15 participants during focus group discussions. Data were collected in 2008-2009, transcribed and analysed.The main themes and ideas identified in the dialogues were analysed under five main headings--Communication issues including disclosure and consent; Concepts of disease and illness; Attitudes towards medical treatments; Customs surrounding death, dying and bereavement; and Spiritual and religious issues.The cultures and traditions of African countries vary widely; this study provides a snapshot of the views of a Sudanese African community about death and dying in Australia.


PubMed | Hunter Region Mail Center
Type: Journal Article | Journal: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer | Year: 2011

Poor nutritional status is common and associated with mortality and morbidity in patients with head and neck cancer (HNC). While there are several established clinical risk factors for poor nutritional status during HNC radiotherapy, the complete aetiology is not known. The association of malnutrition with psychological factors has been recognised in other chronic illnesses but has not been studied in HNC patients who have higher levels of malnutrition and psychological disorder than many other patient populations.Patients with HNC were assessed at three time points: week 1 of radiotherapy treatment (T1, n = 72), end of radiotherapy treatment (T2, n = 64) and 4 weeks post-radiotherapy treatment (T3, n = 58). Nutritional outcome was measured using the Patient-Generated Subjective Global Assessment, and psychological factors measured were depression, anxiety and adjustment style.Linear mixed models indicated that a model containing the variables time, tumour site and baseline depression best explained malnutrition at T2 and T3 (-2 restricted log likelihood = 695.42). The clinical risk factors: cancer stage, number of radiotherapy fractionations, a PEG feeding tube, availability of a care giver and dietitians informal clinical assessment did not predict later nutritional status.Depression is a modifiable risk factor for malnutrition among HNC patients undergoing radiation therapy, offering the potential to ameliorate malnutrition in this group. While the nature of any causal relationship between depression and malnutrition in HNC is yet to be understood, the utility of a short depression screen in predicting malnutrition has been demonstrated and could be adopted in clinical practice.

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