Mark Kotowicz

Publications (3)9.9 Total impact

• Article: Skeletal morbidity among survivors of critical illness.

  Neil R Orford, Kym Saunders, Elizabeth Merriman, Margaret Henry, Julie Pasco, Peter Stow, Mark Kotowicz
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  ABSTRACT: To describe the incident fracture rate in survivors of critical illness and to compare fracture risk with population-matched control subjects. Retrospective longitudinal case-cohort study. A tertiary adult intensive care unit in Australia. All patients ventilated admitted to intensive care and requiring mechanical ventilation for ≥48 hrs between January 1998 and December 2005. None. New fractures were identified in the study population for the postintensive care unit period (intensive care unit discharge to January 2008). The incident fracture rate and age-adjusted fracture risk of the female intensive care unit population were compared with the general population adult females derived from the Geelong Osteoporosis Study. Over the 8-yr period, a total of 739 patients (258 women, 481 men) were identified. After a median follow-up of 3.7 yrs (interquartile range, 2.0-5.9 yrs) for women and 4.0 yrs (interquartile range, 2.1-6.1 yrs) for men, incident fracture rates (95% confidence interval) per 100 patient years were 3.84 (2.58-5.09) for females 2.41 (1.73-3.09) for males. Compared with an age-matched random population-based sample of women, elderly women were at increased risk for sustaining an osteoporosis-related fracture after critical illness (hazard ratio, 1.65; 95% confidence interval, 1.08-2.52; p = .02). The increase in fracture risk observed in postintensive care unit older females suggests an association between critical illness and subsequent skeletal morbidity. The explanation for this association is not explored in this study and includes the effects of pre-existing patient factors and/or direct effects of critical illness. Prospective research evaluating risk factors, the relationship between critical illness and bone turnover, the extent and duration of bone loss, and the associated morbidity in this population is warranted.
  Critical care medicine 02/2011; 39(6):1295-300. · 6.37 Impact Factor
• Article: The prevalence of mood and anxiety disorders in Australian women.

  Lana Williams, Felice Jacka, Julie Pasco, Margaret Henry, Seetal Dodd, Geoffrey Nicholson, Mark Kotowicz, Michael Berk
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  ABSTRACT: We aimed to report the prevalence, age-of-onset and comorbidity of mood and anxiety disorders in an age-stratified representative sample of Australian women aged 20 years and over. Mood and anxiety disorders were diagnosed utilising a clinical interview (SCID-I/NP). The lifetime and current prevalence of these disorders was determined from the study population (n = 1095) and standardized to 2006 census data for Australia. Approximately one in three women (34.8%) reported a lifetime history of any mood and/or anxiety disorder, with mood disorders (30.0%) being more prevalent than anxiety disorders (13.5%). Of these, major depression (23.4%), panic disorder (5.5%) and specific phobia (3.5%) were the most common. The lifetime prevalence of other disorders was low (< or =3%). A total of 14.4% of women were identified as having a current mood and/or anxiety disorder, with similar rates of mood (8.9%) and anxiety disorders (8.0%) observed. The median age-of-onset for mood disorders was 27.0 years and 18.5 years for anxiety disorders. This study reports the lifetime and current prevalence of mood and anxiety disorders in the Australian female population. The findings emphasize the extent of the burden of these disorders in the community.
  Australasian Psychiatry 06/2010; 18(3):250-5. · 0.86 Impact Factor
• Source

  Available from: PubMed Central

  Article: Trials and tribulations of recruiting 2,000 older women onto a clinical trial investigating falls and fractures: Vital D study.

  Kerrie M Sanders, Amanda L Stuart, Elizabeth N Merriman, Meaghan L Read, Mark A Kotowicz, Doris Young, Roderick Taylor, Ian Blair-Holt, Alistair G Mander, Geoffrey C Nicholson
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  ABSTRACT: Randomised, placebo-controlled trials are needed to provide evidence demonstrating safe, effective interventions that reduce falls and fractures in the elderly. The quality of a clinical trial is dependent on successful recruitment of the target participant group. This paper documents the successes and failures of recruiting over 2,000 women aged at least 70 years and at higher risk of falls or fractures onto a placebo-controlled trial of six years duration. The characteristics of study participants at baseline are also described for this study. The Vital D Study recruited older women identified at high risk of fracture through the use of an eligibility algorithm, adapted from identified risk factors for hip fracture. Participants were randomised to orally receive either 500,000 IU vitamin D3 (cholecalciferol) or placebo every autumn for five consecutive years. A variety of recruitment strategies were employed to attract potential participants. Of the 2,317 participants randomised onto the study, 74% (n = 1716/2317) were consented onto the study in the last five months of recruiting. This was largely due to the success of a targeted mail-out. Prior to this only 541 women were consented in the 18 months of recruiting. A total of 70% of all participants were recruited as a result of targeted mail-out. The response rate from the letters increased from 2 to 7% following revision of the material by a public relations company. Participant demographic or risk factor profile did not differ between those recruited by targeted mail-outs compared with other methods. The most successful recruitment strategy was the targeted mail-out and the response rate was no higher in the local region where the study had extensive exposure through other recruiting strategies. The strategies that were labour-intensive and did not result in successful recruitment include the activities directed towards the GP medical centres. Comprehensive recruitment programs employ overlapping strategies simultaneously with ongoing assessment of recruitment rates. In our experience, and others direct mail-outs work best although rights to privacy must be respected. ISRCTN83409867 and ACTR12605000658617.
  BMC Medical Research Methodology 11/2009; 9:78. · 2.67 Impact Factor