[Show abstract][Hide abstract] ABSTRACT: In 2002/03 the Queensland Government responded to high rates of alcohol-related harm in discrete Indigenous communities by implementing alcohol management plans (AMPs), designed to include supply and harm reduction and treatment measures. Tighter alcohol supply and carriage restrictions followed in 2008 following indications of reductions in violence and injury indicators. Despite the plans being in place for over a decade, no comprehensive independent review has assessed to what level the designed aims were achieved and what effect the plans have had on Indigenous community residents and service providers. This study will describe the long-term impacts on important health, economic and social outcomes of Queensland's AMPs.
The project has two main studies, 1) outcome evaluation using de-identified epidemiological data on injury, violence and other health and social indicators for across Queensland, including de-identified databases compiled from relevant routinely-available administrative data sets, and 2) a process evaluation to map the nature, timing and content of intervention components targeting alcohol. Process evaluation will also be used to assess the fidelity with which the designed intervention components have been implemented, their uptake and community responses to them and their perceived impacts on alcohol supply and consumption, injury, violence and community health. Interviews and focus groups with Indigenous residents and service providers will be used. The study will be conducted in all 24 of Queensland's Indigenous communities affected by alcohol management plans.
This evaluation will report on the impacts of the original aims for AMPs, what impact they have had on Indigenous residents and service providers. A central outcome will be the establishment of relevant databases describing the parameters of the changes seen. This will permit comprehensive and rigorous surveillance systems to be put in place and provided to communities empowering them with the best credible evidence to judge future policy and program requirements for themselves. The project will inform impending alcohol policy and program adjustments in Queensland other Australian jurisdictions.The project has been approved by the James Cook University Human Research Ethics Committee (approval number H4967 & H5241).
BMC Public Health 01/2014; 14(1):15. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Insecticide applications are not particularly effective on Aedes aegypti mosquitoes which has been attributed to their 'closet' behaviour, or ability to rest in places that remain unexposed to insecticides. Some researchers have suggested that insecticides repel mosquitoes, which would result in less exposure and increased dispersal. If repellence due to insecticides is a fact, acquiring a vector-borne disease, such as dengue, could legitimately be attributed to local vector control efforts and this would lead to restitution claims. This study thus investigated the effect of insecticide presence on mosquito behaviour indirectly via oviposition and directly via olfactory response. In all experiments, oviposition in each insecticide compared to its water and ethanol controls was not significantly different. This indicates that Ae. aegypti mosquitoes are not affected by insecticide presence and that increased dispersal is unlikely to be caused by vector control spraying.
[Show abstract][Hide abstract] ABSTRACT: Weather variations have clear associations with the epidemiology of dengue fever and populations of Aedes aegypti mosquitoes. Data on humidity associations, however, lags with respect to its effect on host-biting, nectar-seeking and survival. This experimental study on Ae. aegypti, sourced from the arid tropics, investigated the effect of low and high relative humidity and diet in relation to host-biting, temporal variations in feeding frequency, and mosquito mortality. In each environmental setting, 10 replicates, containing one male and five female mosquitoes, were challenged with different nutritional sources every six hours over 12 days. Results showed that host-biting did not diminish in low humidity and was six times higher than expected. Sucrose feeding was observed to significantly moderate host-biting and water alone was inadequate for survival. The high host-biting rates help to explain the intensity of dengue epidemics, while the ability of the mosquito to disregard adverse humidity-related conditions helps to explain how dengue epidemics in arid tropical regions can be just as devastating as those in the wet tropics.
[Show abstract][Hide abstract] ABSTRACT: When a parasite finds a new wildlife host, impacts can be significant. In the late 1980s populations of Spectacled Flying-foxes (SFF) (Pteropus conspicillatus), a species confined, in Australia, to north Queensland became infected by paralysis tick (Ixodes holocyclus), resulting in mortality. This Pteropus-tick relationship was new to Australia. Curiously, the relationship was confined to several camps on the Atherton Tableland, north Queensland. It was hypothesised that an introduced plant, wild tobacco (Solanum mauritianum), had facilitated this new host-tick interaction. This study quantifies the impact of tick paralysis on SFF and investigates the relationship with climate. Retrospective analysis was carried out on records from the Tolga Bat Hospital for 1998-2010. Juvenile mortality rates were correlated to climate data using vector auto-regression. Mortality rates due to tick paralysis ranged between 11.6 per 10,000 bats in 2003 and 102.5 in 2009; more female than male adult bats were affected. Juvenile mortality rates were negatively correlated with the total rainfall in January to March and July to September of the same year while a positive correlation of these quarterly total rainfalls existed with the total population. All tick affected camps of SFF were located in the 80% core range of S. mauritianum. This initial analysis justifies further exploration of how an exotic plant might alter the relationship between a formerly ground-dwelling parasite and an arboreal host.
PLoS ONE 01/2013; 8(9):e73078. · 3.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Few hematologic and biochemical reference intervals for wild amphibians have been established. Reference values would aid in early detection of emerging infectious diseases, which are a significant problem for amphibian conservation efforts. Objective: We aimed to establish reference intervals for a wide range of hematologic and plasma biochemistry variables for 2 species of Australian tree frogs, describe morphologic features of leukocytes, and analyze the effects of season, year, and parasite status on blood values. Methods: Blood specimens were collected from reference populations of wild adult Australian tree frogs, Litoria caerulea and L infrafrenata, for analysis of hematologic (manual) variables, plasma biochemical (auto-mated) analytes, and plasma and serum proteins using automated meth-ods, refractometry, and electrophoresis. Results: Inter-and intraspecies differences were found in L caerulea (n = 80) and L infrafrenata (n = 66) frogs for hematologic and biochemical variables. Intraspecies differences were largely associated with seasonal variations. In the dry season, both species had higher WBC counts, with higher lymphocyte counts in L caerulea and higher neutrophil counts in L infrafrenata, and uric acid concentrations. In the wet season, both species had higher glucose and potassium concentrations, L caerulea frogs had higher neutrophil counts, and L infrafrenata frogs had higher total protein, phosphorus, and sodium concentrations, AST activity, PCV, hemoglobin concentration, and RBC, thrombocyte, and basophil counts. Hemogrega-rines were identified in 19% of blood samples from L infrafrenata frogs; multiple hematologic and biochemical variables were altered in infected frogs. Conclusions: Wide interspecies and seasonal variations highlight the need to establish species-and season-specific reference intervals for amphibians. Hematologic and plasma biochemical reference values should be useful in assessing the health status and in detecting emerging diseases in wild amphibians.
[Show abstract][Hide abstract] ABSTRACT: To assess a mailed self-collection kit for chlamydia testing as an intervention to increase post-treatment retesting rates.
This prospective intervention study took place at a sexual health clinic in Townsville, North Queensland (Australia) between 2006 and 2008. The intervention consisted of offering to mail a self-collection kit for retesting 3 months after treatment. The achieved retesting rates were compared to those from the previous year and to concurrent controls who did not participate in the intervention. Both control groups received standard advice on retesting.
Of the 46 participants in the intervention group, 34.8% returned the sample for retesting 3 to 4 months after initial treatment, in comparison to 6.8% of the historic control groups (n=206) and 1.4% of the concurrent control group (n=142) (P<0.001, respectively).
Retesting rates for Chlamydia trachomatis were substantially and significantly improved using the mailed self-collection kit evidencing that the kit could deliver a much needed intervention to improve notoriously low retesting rates.
Sexual Health 06/2011; 8(2):248-50. · 1.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To document rates of serious injuries in relation to government alcohol restrictions in remote Australian Indigenous communities.
An ecological study using Royal Flying Doctor Service injury retrieval data, before and after changes in legal access to alcohol in four remote Australian Indigenous communities, Queensland, 1 January 1996-31 July 2010.
Changes in rates of aeromedical retrievals for serious injury, and proportion of retrievals for serious injury, before and after alcohol restrictions.
After alcohol restrictions were introduced in 2002-2003, retrieval rates for serious injury dropped initially, and then increased in the 2 years before further restrictions in 2008 (average increase, 2.34 per 1000 per year). This trend reversed in the 2 years after the 2008 restrictions (average decrease, 7.97 per 1000 per year). There was a statistically significant decreasing time trend in serious-injury retrieval rates in each of the four communities for the period 2 years before the 2002-2003 restrictions, 2 years before the 2008 restrictions, and the final 2 years of observations (2009-2010) (P < 0.001 for all four communities combined). Overall, serious-injury retrieval rates dropped from 30 per 1000 in 2008 to 14 per 1000 in 2010, and the proportions of serious-injury retrievals decreased significantly for all four communities.
The absolute and the proportional rates of serious-injury retrievals fell significantly as government restrictions on legal access to alcohol increased; they are now at their lowest recorded level in 15 years.
The Medical journal of Australia 05/2011; 194(10):503-6. · 2.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There is currently no data on the safety and efficacy of the Advantage sling despite its widespread use.
We compared the efficiency and safety outcome data of 556 tension-free vaginal tape (TVT) and 108 Advantage slings after assessing for potential confounding factors.
The two groups proved comparable. Bladder injury rates were 4.6% for the Advantage group and 2.9% for the TVT group (p = 0.36). Subjective stress incontinence cure were 83.3% and 85.3%, respectively (p = 0.66). Incidences of de novo urgency, urge incontinence, and voiding difficulties were 22.2% vs 14.7% (p = 0.06), 9.3% vs 7.4% (p = 0.55), and 11.1% vs 6.7% (p = 0.11), respectively.
No major differences between the two slings were observed apart from a non-significant trend towards more de novo urgency and voiding difficulty symptoms with the Advantage group. It may be possible that due to its different biomechanical properties, the Advantage slings should be left looser.
International Urogynecology Journal 05/2010; 21(9):1157-62. · 2.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To develop, implement and evaluate the processes of a novel approach to chlamydia testing that is accessible, confidential, free of charge, easy to use, and allows for self-collection of specimens, their transportation by regular mail and the central management of results.
A 'self-collection kit' was developed including all items and instructions necessary to obtain a sample. A network of distribution sites at locations frequented by the target population has been established. The 'kits' can be requested via an advertised website and by phone. Specimens are returned via reply paid mail. A centralised system for the management of results and follow up has been established. Test results are conveyed by the participant's method of choice. Treatment is organised via a network of health care providers.
Of the first 100 returned kits 99% were safely packed and 86% were sent back with a completely filled out pathology request form. Ninety-two participants provided contact details; 70.7% indicated mobile phone or SMS as the preferred methods to receive results. Seven positive cases were identified and treatment was confirmed for all within 6 days.
These findings provide evidence that the presented approach to chlamydia testing is easy to implement, achieves excellent follow-up and treatment rates, and therefore opens important new channels to otherwise difficult to access high-risk populations, such as young people and geographically and socially isolated populations.
Sexual Health 07/2009; 6(2):163-9. · 1.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A prospective study was undertaken to develop an evidence-based outreach chlamydia screening program and to assess the viability and efficiency of this complementary approach to chlamydia testing within the routine operations of a primary healthcare service.
A primary healthcare service based in Townsville, Queensland, Australia, identified high-prevalence groups for chlamydia in the community. Subsequently, a series of outreach clinics were established and conducted between August 2004 and November 2005 at a defence force unit, a university, high school leavers' festivities, a high school catering for Indigenous students, youth service programs, and backpacker accommodations.
All target groups were easily accessible and yielded high participation. Chlamydia prevalence ranged between 5 and 15% for five of the six groups; high school leavers had no chlamydia. All participants were notified of their results and all positive cases were treated (median treatment interval 7 days). Five of the six assessed groups were identified as viable for screening and form the basis for the ongoing outreach chlamydia screening program.
The present study developed an evidence-based outreach chlamydia screening program and demonstrated its viability as a complementary approach to chlamydia testing within the routine operations of the primary healthcare service, i.e. without the need for additional funding. It contributes to the evidence base necessary for a viable and efficient chlamydia management program. Although the presented particulars may not be directly transferable to other communities or health systems, the general two-step approach of identifying local high-risk populations and then collaborating with community groups to access these populations is.
Sexual Health 04/2009; 6(1):51-6. · 1.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to develop a novel urine transport method to be used in self-collection-based screening for Chlamydia trachomatis. The method needed to be suitable for C trachomatis PCR detection, be economical and suitable for transport by standard envelope mailing.
An anhydrous gel composed of super-absorbent polymer and buffering agent was used to desiccate urine into a dry granulous state, which could subsequently be reconstituted upon arrival at a laboratory. DNA was then extracted from the reconstituted solution using the Roche MagNA Pure protocol for the detection of C trachomatis by PCR. Collections of urine specimens from three populations with widely differing chlamydia prevalence (100%,n = 56; 47%, n = 70; 3%, n = 97) were used. We determined the gel method's impact on C trachomatis PCR sensitivity and specificity using neat and gel-processed urine specimens. An equine herpes virus PCR was used to test for assay inhibition.
Overall, the sensitivity of the gel-based method ranged from 94.6-100% compared with neat urine, with a specificity of 100%. No PCR inhibition or decrease in analytical sensitivity was observed using the gel-processed extracts.
The gel-based method was found to be suitable for the detection of C trachomatis by PCR. In addition, its ease of use, effectiveness at ambient temperature and low cost makes it well-suited for self-collection kits used in population-based C trachomatis screening, particularly for geographically and socially isolated individuals.
[Show abstract][Hide abstract] ABSTRACT: Infestation of the head louse Pediculus humanus var capitis DeGeer (Phthiraptera: Pediculidae) is an important public health problem in Australia, with up to a third of children infested in some primary schools. Insecticide resistance and inadequate attention to the application instructions of topical pediculicides are common reasons for treatment failure. This study evaluated six popular Australian over-the-counter products against head lice, primarily comprised of different botanical extracts, and compared them with permethrin 1% (Quellada) and a non-treatment control in order to assess their in vitro efficacy. We also assessed commonly used criteria for evaluating pediculicide efficacy in vitro. All tested products failed to demonstrate high levels of efficacy with the exception of Tea Tree Gel((R)), which outperformed 1% permethrin. Permethrin had a high level of efficacy, but using stringent criteria 18% of lice were not dead at 3 h, indicating some resistance to Quellada. Commonly used less stringent criteria were shown to overestimate mortality of head lice as a result of the protective phenomenon of stasis or sham death observed in exposed lice that may recover after some time. Using two different levels of stringency resulted in different rankings of efficacy for most products, with the exception of the first ranked product, Tea Tree Gel. Rankings of efficacy also varied over time, even within the different assessment criteria. Government regulatory agencies should require standard in vitro tests using stringent mortality criteria, with an observation period of >or= 6 h, to determine the efficacy of new pediculicides, and only products that cause a minimum mortality rate (e.g. 80%) in head lice collected from the target population should be licensed for sale.
Medical and Veterinary Entomology 10/2008; 22(3):264-72. · 2.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare the safety and efficacy of the transobturator tape (Monarc) with the retropubic tape (tension-free vaginal tape, TVTR) for the treatment of urodynamic stress incontinence (USI) a prospective, single-blinded, multi-centre randomised clinical controlled trial was undertaken in four urogynaecology units in Australia. One hundred and eighty-seven women with USI were randomly allocated to undergo surgery with either the Monarc sling (n = 80) or TVT (n = 107). Outcome measures were intra-operative complications (especially bladder injury), as well as peri-operative complications, symptomatology, quality of life and urodynamic outcomes. At 3 months, data were available on 140 women, 82 (59%) TVT and 58 (42%) Monarc. The TVT group was significantly more likely to be complicated by bladder injury (7 TVT, 0 Monarc, p < 0.05). Blood loss and operative time were significantly less in the Monarc group, which was 49 mls (31) vs that of the TVT group, which was 64 mls (41) p < 0.05; 18.5 min (6.5) TVT vs 14.6 min (6) Monarc (p < 0.001). The subjective and objective stress incontinence cure rates were 86.6% (71) vs 72.4% (42) p = 0.77 and 79.3 vs 84.5%, p = 0.51 for the TVT and Monarc groups, respectively. Both groups reported similar improvement in incontinence impact and satisfaction with their operation, although return to activity was significantly quicker with the transobturator route (p = 0.029). The transobturator tape appears to be as effective as the retro-pubic tape in the short term, with a reduction in the risk of intra-operative bladder injury, shorter operating time, decreased blood loss, and quicker return to usual activities.
International Urogynecology Journal 03/2008; 19(2):171-8. · 2.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: The progress in chlamydia testing/management seems to have stalled in Australia over the last years with persistent high prevalences observed in known risk groups. A novel approach is needed to lower the barriers to testing especially in those who are socially isolated and/or live in rural or remote locations.
Aim: To develop, implement and evaluate a novel approach to chlamydia testing in the form of a 'self-collection testing kit' that is easily accessible, confidential, free of charge, easy to use, and allows for home self-collection of specimens, their transportation by regular mail and the central management (notification, treatment and follow-up) of results.
Methods: The developed 'kit' consists of all necessary items and instructions to obtain a sample. A network of 'kit' distribution sites at locations frequented by the target population has been established in urban as well as rural and remote areas. The 'kits' can also be requested via an advertised website and a 1800 phone number. Specimens are returned via reply paid mail. A centralised system for the management of results and follow up of individuals has been developed. Test results are conveyed to participants by the method of their choice including email, SMS and phone. Treatment is organised via a network of health care providers in various locations.
Results/Discussion: First promising results and experiences from the implementation phase of this novel approach to chlamydia testing will be presented covering distribution and uptake of 'kits', return of specimens as well as management and follow up.
If eventually proven successful, this approach to chlamydia testing will provide significant opportunities for increasing access to testing across Australia especially in rural and remote areas. An extension to gonorrhoea testing is possible.
This project is supported by the 'National Chlamydia Pilot Program' funding of innovative chlamydia projects.
[Show abstract][Hide abstract] ABSTRACT: The objective is to study the long-term outcomes of posterior colporrhaphy with composite polyglactin 910-polypropylene mesh (Vypro 2, Ethicon, Somerville, NJ, USA) utilizing an overlay technique. Seventy-eight patients involved in our previous study were contacted 3 years after their initial operation for follow-up (Lim YN, Rane A, Muller R, Int Urogynecol J 16:126-131, 2005). Thirty-seven (47%) returned for follow-up and completed a standardized questionnaire survey, whereas a further 16 (20%) returned their postal questionnaires. Mean age was 61.3 (SD 10.8) years, and follow-up was 35.7 (SD 4.5) months. There were statistically significant improvements in vaginal lump sensation and constipation (p < 0.001) but no differences with defecatory difficulties or dyspareunia. De novo dyspareunia was reported in 27%. On examination, the incidences of mesh vaginal erosion and rectocele recurrence were 30% and 22%, respectively. It appears that posterior colporrhaphy incorporating Vypro 2 mesh with an overlay method is associated with unacceptably high incidence of complications.
International Urogynecology Journal 09/2007; 18(9):1053-7. · 2.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A twelve-month survey for mosquito predators was conducted in Townsville, Queensland, Australia, which is located in the arid tropics. The survey revealed the presence of five predaceous insects but only Anisops sp. (backswimmers) and Diplonychus sp. were common. Predatorial capacity and factors influencing this capacity were then assessed for adult Anisops sp. and adult and nymph stages of Diplonychus sp. against Culex annulirostris mosquito immatures under laboratory conditions. Predatorial capacity bioassays showed that adult Diplonychus sp. preyed upon both larval and pupal stages of Cx. annulirostris quite successfully. Nymphs of Diplonychus sp. proved to be more successful with smaller prey immatures, and Anisops sp adults did not prey successfully on any prey pupae. Increasing the foraging area and introducing aquatic vegetation significantly reduced the predatorial capacity of Diplonychus sp. nymphs, while only vegetation and not foraging area had a significant effect on adult Diplonychus sp. predation capacity. Overall, adult Diplonychus sp. proved to be a more efficient predator than Anisops sp., and field trials are now recommended to further assess the potential of Diplonychus sp. as a biocontrol agent.
Journal of Vector Ecology 07/2007; 32(1):16-21. · 1.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Anthrax bioterrorism is a new threat to Australians. How they would respond to an anthrax bioterrorism event is unknown.
A national telephone survey of Australian adults.
We successfully interviewed 1001 Australian adults (response rate 63%). The threat of anthrax bioterrorism was of medium to high concern to 57% of survey participants. In the event of an anthrax bioterrorism event, the first point of care would be GPs for 60% of survey participants, and 71% were confident in their doctor's ability to recognise anthrax. Most would accept vaccination if anthrax bioterrorism cases were reported locally, or even elsewhere in Australia.
Australian GPs should be included in any bioterrorism planning to respond to such threats.
Australian family physician 04/2006; 35(3):172-4. · 0.71 Impact Factor