The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
S E Bursell - One of the best experts on this subject based on the ideXlab platform.
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health related behaviours in a remote Indigenous Population with type 2 diabetes a central australian primary care survey in the telehealth eye and associated medical services network teamsnet project
Diabetic Medicine, 2019Co-Authors: Alicia J Jenkins, Chris Ryan, Anthony C Keech, Alex Brown, John Boffa, Kerin Odea, S E BursellAbstract:AIM There is a wealth of data concerning the health behaviours of Indigenous Australians, but the health behaviours of Indigenous Australians with diabetes are not systematically documented. At the clinical level, understanding a person's health behaviours can help identify and address barriers to diabetes care and promote good clinical outcomes. METHODS We used a novel survey tool to systematically collect health behaviour data on Smoking, Nutrition, Alcohol consumption, Physical activity and Emotional well-being (SNAPE) from Indigenous Australians with Type 2 diabetes in a remote primary care setting in Alice Springs. RESULTS At least one of the five surveys in the SNAPE tool was completed by 210 participants: 30% male, mean age 52.6 years (range 22.9 - 87.4). Fifty per cent of men and 23% of women were current smokers (P < 0.001). None of the participants reported an adequate intake of vegetables. Only 9.6% reported an adequate fruit intake. Some 49% of men and 32% of women consumed alcohol in the past year (P = 0.022), and 46% of drinkers were considered high-risk or likely-dependent drinkers. On average, participants walked 10 min or more at a time 6.0 days a week and spent 4.8 h sitting on a weekday. Mean adapted Patient Health Questionnaire 9 score was 4.61, with 34% of participants having mild depressive symptoms and 11% having moderate-severe depressive symptoms. CONCLUSIONS Our SNAPE survey tool results present a high-risk, disadvantaged Indigenous Population with Type 2 diabetes. More resources will be needed to sustainably implement interventions with the goal of improving health behaviours and subsequent long-term health.
Ric N Price - One of the best experts on this subject based on the ideXlab platform.
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neurosyphilis still prevalent and overlooked in an at risk Population
PLOS ONE, 2020Co-Authors: Prashanth S Ramachandran, Robert W Baird, Bart J Currie, James Burrow, Peter Markey, Sally Singleton, Michael Lowe, Ric N PriceAbstract:BACKGROUND Neurosyphilis (NS) presents with a variety of clinical syndromes that can be attributed to other aetiologies due to difficulties in its diagnosis. We reviewed all cases of NS from the "Top End" of the Australian Northern Territory over a ten-year period to assess incidence, clinical and laboratory manifestations. METHODS Patient data (2007-2016) were extracted from hospital records, centralised laboratory data and Northern Territory Centre for Disease Control records. Clinical records of patients with clinically suspected NS were reviewed. A diagnosis of NS was made based on the 2014 US CDC criteria. Results were also recategorized based on the 2018 US CDC criteria. RESULTS The Population of the "Top End" is 185,570, of whom 26.2% are Indigenous. A positive TPPA was recorded in 3126 individuals. A total of 75 (2.4%) of TPPA positive patients had a lumbar puncture (LP), of whom 25 (35%) were diagnosed with NS (9 definite, 16 probable). Dementia was the most common manifestation (58.3%), followed by epilepsy (16.7%), psychosis (12.5%), tabes dorsalis (12.5%) and meningovascular syphilis (8.3%). 63% of probable NS cases were not treated appropriately due to a negative CSF VDRL. Despite increased specificity of the 2018 US CDC criteria, 70% of patient in the probable NS group were not treated appropriately. The overall annual incidence [95%CI] of NS was 2.47[1.28-4.31] per 100 000py in the Indigenous Population and 0.95[0.50-1.62] in the non-Indigenous Population (rate ratio = 2.60 [1.19-5.70];p = 0.017). CONCLUSION Neurosyphilis is frequently reported in the NT, particularly in Indigenous Populations. Disturbingly, 60% of probable neurosyphilis patients based on the 2014 criteria, and 70% based on the 2018 criteria with were not treated appropriately. It is critical that clinicians should be aware of the diagnosis of NS and treat patients appropriately.
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high incidence of neurosyphilis in the top end of australia a systematic approach to its diagnosis
Journal of Neurology Neurosurgery and Psychiatry, 2017Co-Authors: Prashanth S Ramachandran, Ric N Price, James BurrowAbstract:Objectives Neurosyphilis (NS) can present in a variety of clinical syndromes and may be attributed to other aetiologies due to difficulties in its diagnosis. We reviewed all cases of NS from the ‘Top End’ of the Northern Territory over a ten-year period to assess incidence, clinical and laboratory manifestations. Methods Patient data (2007–2016) was extracted from hospital records, centralised laboratory data and the Centre for Disease Control (CDC). The clinical records of patients with clinically suspected NS were reviewed. A diagnosis of confirmed NS was made in those patients with a positive serum Treponema pallidum particle agglutination assay (TPPA) and CSF Venereal Disease Research Laboratory (VDRL) test. Probable NS was made in those with a positive serum TPPA and abnormal CSF. Results The Population of the ‘Top End’ is 170 000, of whom 27% are Indigenous. A positive TPPA was recorded in 3112 individuals. A total of 75 (2.4%) of TPPA positive patients had a lumbar puncture (LP), of whom 28 (37%) were diagnosed with NS (9 confirmed, 19 probable) and a further two patients had possible NS. Dementia was the most common manifestation (18/29) followed by meningovascular (3), psychosis (4), tabes dorsalis (3) and epilepsy (2). Nine (30%) were not treated for NS due to a negative CSF VDRL despite meeting criteria. The overall incidence (95% CI) of NS was 33 (18–54) per 100 000 person years in the Indigenous Population and 12 (7–20) in the non-Indigenous Population (rate ratio=2.7 (1.3–5.5); p=0.0064). Conclusions Syphilis is common in the NT and NS is frequently reported, particularly in Indigenous Populations. Disturbingly, nearly a third of patients with NS were not treated appropriately because of over-reliance on CSF VDRL positivity. We propose a systematic approach to the diagnosis of NS, which will avoid misdiagnosis.
John R Condon - One of the best experts on this subject based on the ideXlab platform.
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establishing contemporary trends in hepatitis b sero epidemiology in an Indigenous Population
PLOS ONE, 2017Co-Authors: Jane Davies, Steven Y C Tong, Rob Baird, Miles Beaman, Geoff Higgins, Benjamin C Cowie, John R Condon, Joshua S DavisAbstract:Background Indigenous Populations globally are disproportionately affected by chronic hepatitis B virus (HBV) infection however contemporary sero-prevalence data are often absent. In the Indigenous Population of the Northern Territory (NT) of Australia the unique C4 sub-genotype of HBV universally circulates. There are no studies of the sero-prevalence, nor the impact of the vaccination program (which has a serotype mismatch compared to C4), at a Population-wide level. Methods We examined all available HBV serology results obtained from the three main laboratories serving NT residents between 1991 and 2011. Data were linked with a NT government database to determine Indigenous status and the most recent test results for each individual were extracted as a cross-sectional database including 88,112 unique individuals. The primary aim was to obtain a contemporary estimate of HBsAg positivity for the NT by Indigenous status. Results Based on all tests from 2007–2011 (35,633 individuals), hepatitis B surface antigen (HBsAg) positivity was 3·40% (95%CI 3·19–3·61), being higher in Indigenous (6·08%[5·65%-6·53%]) than non-Indigenous (1·56%[1·38%-1·76%]) Australians, p<0·0001. Birth cohort analysis showed HBsAg positivity fell over time for Indigenous people, with this decrease commencing prior to universal infant vaccination (which commenced in 1990), with an ongoing but slower rate of decline since 1990, (0·23% decrease per year versus 0·17%). Conclusions HBsAg positivity is high in the NT, particularly in the Indigenous Population. HBsAg positivity has fallen over time but a substantial part of this decrease is due to factors other than the universal vaccination program.
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trends in cancer incidence and survival for Indigenous and non Indigenous people in the northern territory
The Medical Journal of Australia, 2016Co-Authors: John R Condon, Xiaohua Zhang, Karen Dempsey, Lindy Garling, Steven GuthridgeAbstract:OBJECTIVE To assess trends in cancer incidence and survival for Indigenous and non-Indigenous Australians in the Northern Territory. DESIGN Retrospective analysis of Population-based cancer registration data. SETTING New cancer diagnoses in the NT, 1991-2012. MAIN OUTCOME MEASURES Age-adjusted incidence rates; rate ratios comparing incidence in NT Indigenous and non-Indigenous Populations with that for other Australians; 5-year survival; multivariable Poisson regression of excess mortality. RESULTS The incidence of most cancers in the NT non-Indigenous Population was similar to that for other Australians. For the NT Indigenous Population, the incidence of cancer at several sites was much higher (v other Australians: lung, 84% higher; head and neck, 325% higher; liver, 366% higher; cervix, 120% higher). With the exception of cervical cancer (65% decrease), incidence rates in the Indigenous Population did not fall between 1991-1996 and 2007-2012. The incidence of several other cancers (breast, bowel, prostate, melanoma) was much lower in 1991-1996 than for other Australians, but had increased markedly by 2007-2012 (breast, 274% increase; bowel, 120% increase; prostate, 116% increase). Five-year survival was lower for NT Indigenous than for NT non-Indigenous patients, but had increased for both Populations between 1991-2000 and 2001-2010. CONCLUSION The incidence of several cancers that were formerly less common in NT Indigenous people has increased, without a concomitant reduction in the incidence of higher incidence cancers (several of which are smoking-related). The excess burden of cancer in this Population will persist until lifestyle risks are mitigated, particularly by reducing the extraordinarily high prevalence of smoking.
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incidence and survival after acute myocardial infarction in Indigenous and non Indigenous people in the northern territory 1992 2004
The Medical Journal of Australia, 2009Co-Authors: Jiqiong You, John R Condon, Yuejen Zhao, Steven GuthridgeAbstract:Objective: To estimate the incidence and survival rates of acute myocardial infarction (AMI) for Northern Territory Indigenous and non-Indigenous Populations. Design and participants: Retrospective cohort study for all new AMI cases recorded in hospital inpatient data or registered as an ischaemic heart disease (IHD) death between 1992 and 2004. Main outcome measures: Population-based incidence and survival rates by age, sex, Indigenous status, remoteness of residence and year of diagnosis. Results: Over the 13-year study period, the incidence of AMI increased 60% in the NT Indigenous Population (incidence rate ratio [IRR], 1.04; 95% CI, 1.02–1.06), but decreased 20% in the non-Indigenous Population (IRR, 0.98; 95% CI, 0.97–1.00). Over the same period, there was an improvement in all-cases survival (ie, survival with and without hospital admission) for the NT Indigenous Population due to a reduction in deaths both pre-hospital and after hospital admission (death rates reduced by 56% and 50%, respectively). The non-Indigenous all-cases death rate was reduced by 29% as a consequence of improved survival after hospital admission; there was no significant change in pre-hospital survival in this Population. Important factors that affected outcome in all people after AMI were sex (better survival for women), age (survival declined with increasing age), remoteness (worse outcomes for non-Indigenous residents of remote areas), year of diagnosis and Indigenous status (hazard ratio, 1.44; 95% CI, 1.21–1.70). Conclusions: Our results show that the increasing IHD mortality in the NT Indigenous Population is a consequence of a rise in AMI incidence, while at the same time there has been some improvement in Indigenous AMI survival rates. The simultaneous decrease in IHD mortality in NT non-Indigenous people was a result of reduced AMI incidence and improved survival after AMI in those admitted to hospital. Our results inform Population
Steven Guthridge - One of the best experts on this subject based on the ideXlab platform.
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trends in cancer incidence and survival for Indigenous and non Indigenous people in the northern territory
The Medical Journal of Australia, 2016Co-Authors: John R Condon, Xiaohua Zhang, Karen Dempsey, Lindy Garling, Steven GuthridgeAbstract:OBJECTIVE To assess trends in cancer incidence and survival for Indigenous and non-Indigenous Australians in the Northern Territory. DESIGN Retrospective analysis of Population-based cancer registration data. SETTING New cancer diagnoses in the NT, 1991-2012. MAIN OUTCOME MEASURES Age-adjusted incidence rates; rate ratios comparing incidence in NT Indigenous and non-Indigenous Populations with that for other Australians; 5-year survival; multivariable Poisson regression of excess mortality. RESULTS The incidence of most cancers in the NT non-Indigenous Population was similar to that for other Australians. For the NT Indigenous Population, the incidence of cancer at several sites was much higher (v other Australians: lung, 84% higher; head and neck, 325% higher; liver, 366% higher; cervix, 120% higher). With the exception of cervical cancer (65% decrease), incidence rates in the Indigenous Population did not fall between 1991-1996 and 2007-2012. The incidence of several other cancers (breast, bowel, prostate, melanoma) was much lower in 1991-1996 than for other Australians, but had increased markedly by 2007-2012 (breast, 274% increase; bowel, 120% increase; prostate, 116% increase). Five-year survival was lower for NT Indigenous than for NT non-Indigenous patients, but had increased for both Populations between 1991-2000 and 2001-2010. CONCLUSION The incidence of several cancers that were formerly less common in NT Indigenous people has increased, without a concomitant reduction in the incidence of higher incidence cancers (several of which are smoking-related). The excess burden of cancer in this Population will persist until lifestyle risks are mitigated, particularly by reducing the extraordinarily high prevalence of smoking.
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incidence and survival after acute myocardial infarction in Indigenous and non Indigenous people in the northern territory 1992 2004
The Medical Journal of Australia, 2009Co-Authors: Jiqiong You, John R Condon, Yuejen Zhao, Steven GuthridgeAbstract:Objective: To estimate the incidence and survival rates of acute myocardial infarction (AMI) for Northern Territory Indigenous and non-Indigenous Populations. Design and participants: Retrospective cohort study for all new AMI cases recorded in hospital inpatient data or registered as an ischaemic heart disease (IHD) death between 1992 and 2004. Main outcome measures: Population-based incidence and survival rates by age, sex, Indigenous status, remoteness of residence and year of diagnosis. Results: Over the 13-year study period, the incidence of AMI increased 60% in the NT Indigenous Population (incidence rate ratio [IRR], 1.04; 95% CI, 1.02–1.06), but decreased 20% in the non-Indigenous Population (IRR, 0.98; 95% CI, 0.97–1.00). Over the same period, there was an improvement in all-cases survival (ie, survival with and without hospital admission) for the NT Indigenous Population due to a reduction in deaths both pre-hospital and after hospital admission (death rates reduced by 56% and 50%, respectively). The non-Indigenous all-cases death rate was reduced by 29% as a consequence of improved survival after hospital admission; there was no significant change in pre-hospital survival in this Population. Important factors that affected outcome in all people after AMI were sex (better survival for women), age (survival declined with increasing age), remoteness (worse outcomes for non-Indigenous residents of remote areas), year of diagnosis and Indigenous status (hazard ratio, 1.44; 95% CI, 1.21–1.70). Conclusions: Our results show that the increasing IHD mortality in the NT Indigenous Population is a consequence of a rise in AMI incidence, while at the same time there has been some improvement in Indigenous AMI survival rates. The simultaneous decrease in IHD mortality in NT non-Indigenous people was a result of reduced AMI incidence and improved survival after AMI in those admitted to hospital. Our results inform Population
Ajay Saxena - One of the best experts on this subject based on the ideXlab platform.
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usefulness of a rapid on site plasmodium falciparum diagnosis paracheck pf in forest migrants and among the Indigenous Population at the site of their occupational activities in central india
American Journal of Tropical Medicine and Hygiene, 2005Co-Authors: Neeru Singh, Ajay SaxenaAbstract:Logistic, economic, and technical factors limit rapid access to microscopic confirmation of malaria in many tropical countries, including India. The occurrence of high-grade fever and three deaths during the hot summer months in some forest migrants created an emergency situation in Jabalpur in central India. A cheap and rapid malaria test, Paracheck® Pf, was tested in this group of migrants in parallel with microscopy. The Indigenous Population at the site of occupational activities of these migrants approximately 250 km from Jabalpur was also screened by both methods. The results of this field investigation are very encouraging. Among migrants, the test had a sensitivity of 100% and a specificity of 67%. The positive and negative predictive values were 94% and 100%, respectively. Among Indigenous Population, the corresponding values were 100%, 97.3%, 98.4%, and 100%, respectively, indicating the usefulness of test as a diagnostic tool for providing on-site confirmation of symptomatic diagnosis of Plasmodium falciparum malaria.
