Background Injecting-related skin and soft tissue infections (SSTIs) are a preventable cause of inpatient hospitalisation among people who inject drugs (PWID). This study aimed to determine the prevalence of hospitalisation for SSTIs among PWID, and identify similarities and differences in factors associated with hospitalisation for SSTIs versus non-bacterial harms related to injecting drug use. Methods We performed cross-sectional analyses of baseline data from an observational cohort study of PWID attending drug treatment clinics and needle and syringe programs in Australia. Logistic regression models were used to identify factors associated with self-reported hospitalisation for (1) SSTIs (abscess and/or cellulitis), and (2) non-bacterial harms related to injecting drug use (e.g., non-fatal overdose; hereafter referred to as non-bacterial harms), both together and separately. Results 1,851 participants who injected drugs in the previous six months were enrolled (67% male; 85% injected in the past month; 42% receiving opioid agonist treatment [OAT]). In the previous year, 40% (n=737) had been hospitalised for drug-related causes: 20% (n=377) and 29% (n=528) of participants were admitted to hospital for an SSTI and non-bacterial harm, respectively. Participants who were female (adjusted odds ratio [aOR]: 1.53, 95% CI: 1.19-1.97) or homeless (aOR: 1.59, 95% CI: 1.16-2.19) were more likely to be hospitalised for an SSTI, but not a non-bacterial harm. Both types of hospitalisation were more likely among people recently released from prison. Conclusions Hospitalisation for SSTIs is common among PWID. Community-based interventions to prevent SSTIs and subsequent hospitalisation among PWID will require targeting of at-risk groups, including women, people experiencing homelessness, and incarcerated people upon prison release.
Objectives The aim of this work is to describe routine integration of prehospital emergency health records into a health master linkage file, delivering ongoing access to integrated patient treatment and outcome information for ambulance-attended patients in Queensland.Methods The Queensland Ambulance Service (QAS) data are integrated monthly into the Queensland Health master linkage file (MLF) using a linkage algorithm that relies on probabilistic matches in combination with deterministic rules based on patient demographic details, date, time, and facility identifiers. Each ambulance record is assigned an enduring linkage key (unique patient identifier) and further processing determines whether each record matches with a corresponding hospital emergency department, admission, or death registry record. In this study, all QAS electronic ambulance report form (eARF) records from October 2016 to December 2018 where at least one key linkage variable was present (n = 1,771,734) were integrated into the MLF.ResultsThe majority of records (n = 1,456,502; 82.2%) were for transported patients, and 90.1% (n = 1,312,176) of these transports were to public hospital facilities. Of these transport records, 93.9% (n = 1,231,951) matched to ED records and 59.3% (n = 864,394) also linked to admitted patient records. Of ambulance non-transport records integrated into the MLF, 23.6% (n = 74,311) matched with ED records.Conclusion This study demonstrates robust linkage methods, quality assurance processes, and high linkage rates of data across the continuum of care (prehospital/emergency department/admitted patient/death) in Queensland. The resulting infrastructure provides a high-quality linked dataset that facilitates complex research and analysis to inform critical functions such as quality improvement, system evaluation, and design.
Cognitive impairment in psychosis is one of the strongest predictors of functional decline. Problems with decision-making processes, such as goal-directed action and reversal learning, can reflect cortico-striatal dysfunction. The heterogenous symptoms and neurobiology observed in those with psychosis suggests that specific cognitive phenotypes may reflect differing causative mechanisms. As such, decision-making performance could identify subgroups of individuals with more severe cortico-striatal dysfunction and help to predict their functional decline. The present work evaluated the relationship between goal-directed action, reversal learning, and symptom profiles in those with psychosis. We assessed decision-making processes in healthy controls (N = 34) and those with persistent psychosis (N = 45), subclassifying subjects based on intact/impaired goal-directed action. Compared with healthy controls (<20%), a large proportion (58%) of those with persistent psychosis displayed impaired goal-directed action, predicting poor serial reversal learning performance. Computational approaches indicated that those with impaired goal-directed action had a decreased capacity to rapidly update their prior beliefs in the face of changing contingencies. Impaired decision-making also was associated with reduced levels of grandiosity and increased problems with abstract thinking. These findings suggest that prominent decision-making deficits, indicative of cortico-striatal dysfunction, are present in a large proportion of people with persistent psychosis. Moreover, these impairments would have significant functional implications in terms of planning and abstract thinking.
Introduction We performed a systematic review in COVID-19 mechanically ventilated (MV) patients which analysed the effect of tracheostomy timing and technique (surgical vs. percutaneous) on mortality. Secondary outcomes included intensive care unit (ICU)-and hospital-length-of-stay (LOS), decannulation from tracheostomy, duration of MV, and complications. Methods Four databases were screened between 1 January 2020 and 10 January 2022 (PubMed, EMBASE, Scopus, and Cochrane). Papers were selected according to the PRISMA and PICO guidelines. Meta-analysis and meta-regression for main outcomes were performed. Results The search yielded 9,024 potentially relevant studies, of which, 48 (5,320 subjects) were included. High levels of between-study heterogeneity were observed across study outcomes. The pooled mean tracheostomy timing was 16.7 days (95%CI=15.0-18.5, I²=98.9%). Pooled mortality was 21.6% (95%CI=18.1-25.1, I²=90.5%). Meta-regression did not show significant associations between mortality and tracheostomy timing, MV duration, time to decannulation, and tracheostomy technique. Pooled mean estimates ICU-and hospital-LOS were 29.6 (95%CI=24.0-35.2, I²=98.6%) and 38.8 (95%CI=32.1-45.6, I²=95.7%) days; both associated with MV duration [coefficient=0.8, (95%CI=0.2-1.4), p=0.02 and 0.9 (95%CI=0.4-1.4), p=0.01] but not tracheostomy timing. Data were insufficient to assess tracheostomy technique on LOS. Duration of MV was 23.4 days (95%CI=19.2-27.7, I²=99.3%), not associated with tracheostomy timing. Data were insufficient to assess the effect of tracheostomy technique on MV duration. Time to decannulation was 23.8 days (95%CI=19.7-27.8, I²=98.7%), not influenced by tracheostomy timing or technique. The most common complications were stoma infection, ulcers or necrosis and bleeding. Conclusions In COVID-19 patients, the timing and technique of tracheostomy did not clearly impact on patient outcomes. Protocol PROSPERO registration CRD42021272220.
Introduction: Peer victimization and aggression in adolescence are associated with later mental health morbidity. However, studies examining this association have not controlled for adolescent substance use. We aimed to study the associations between peer victimization, peer aggression, and mental disorders in adulthood, adjusting for substance use in adolescence. Methods: Participants were from the prospective Northern Finland Birth Cohort 1986. Data were available for 6682 individuals (70.8% of the original sample). Peer victimization and peer aggression were assessed with items from the Achenbach Youth Self Report at ages 15-16 years. Outcomes were nonorganic psychosis, anxiety disorder, mood disorder, substance use disorder, and any mental disorder (a none-vs-any indicator) at age 33 years collected from nationwide health care, insurance, and pension registers. Family structure, alcohol intoxication frequency, daily smoking, illicit drug use, and baseline psychopathology using Youth Self-Report total score, and parental mental disorders were considered as confounding factors. Results: In multivariable analyses, the association between peer victimization and psychosis (Hazard ratio [HR]: 2.9, 95% confidence interval [CI]: 1.2-6.9, p = .020) and mood disorder (HR: 1.7, 95% CI: 1.2-2.4, p = .012) in females remained significant after adjusting for confounders. Other associations between female and male peer victimization or aggression and the studied outcomes attenuated after adjustments. Conclusions: Some associations between peer victimization and aggression and later mental health morbidity are explained by adolescent substance use. For females, substance use does not account for the increased risk of psychosis and mood disorder in those who experience peer victimization.
Consumer and community engagement (CCE) in the implementation of genomics into health services and associated research is needed to ensure that changes benefit the affected patients. Queensland Genomics was a program to implement genomics into a public health service. We describe its Community Advisory Group’s (CAG) structure and function and provide recommendations based on the CAG members’ perspectives. The CAG provided advice to the Queensland Genomics program and its projects in an advisory capacity. The CAG was also resourced to develop and lead community-focused activities. Key enablers for CAG included; diversity of CAG members’ skills and experience, adequate resourcing, and the CAG’s ability to self-determine their direction. The CAG experienced limitations due to a lack of mechanisms to implement CCE in the Program’s projects. Here, we provide insights and commentary on this CAG, which will be useful for other initiatives seeking to undertake CCE in genomic research and health care.
Background Patients with rheumatic heart disease (RHD) and congestive cardiac failure (CCF) are believed to have an increased risk of melioidosis and are thought to be more likely to die from the infection. This study was performed to confirm these findings in a region with a high incidence of all three conditions. Principal findings Between January 1998 and December 2021 there were 392 cases of melioidosis in Far North Queensland, tropical Australia; 200/392 (51.0%) identified as an Indigenous Australian, and 337/392 (86.0%) had a confirmed predisposing comorbidity that increased risk for the infection. Overall, 46/392 (11.7%) died before hospital discharge; the case fatality rate declining during the study period (p for trend = 0.001). There were only 3/392 (0.8%) with confirmed RHD, all of whom had at least one other risk factor for melioidosis; all 3 survived to hospital discharge. Among the 200 Indigenous Australians in the cohort, 2 had confirmed RHD; not statistically greater than the prevalence of RHD in the local general Indigenous population (1.0% versus 1.2%, p = 1.0). RHD was present in only 1/193 (0.5%) cases of melioidosis diagnosed after October 2016, a period which coincided with prospective data collection. There were 26/392 (6.6%) with confirmed CCF, but all 26 had another traditional risk factor for melioidosis. Patients with CCF were more likely to also have chronic lung disease (OR (95% CI: 4.46 (1.93–10.31), p<0.001) and chronic kidney disease (odds ratio (OR) (95% confidence interval (CI): 2.98 (1.22–7.29), p = 0.01) than those who did not have CCF. Two patients with melioidosis and CCF died before hospital discharge; both were elderly (aged 81 and 91 years) and had significant comorbidity. Conclusions In this region of tropical Australia RHD and CCF do not appear to be independent risk factors for melioidosis and have limited prognostic utility.
Background: Developmental vulnerabilities within children in Queensland have a variety of domains; these domains measure the development of children in their first five years. It is crucial to understand how these domains are grouped, or clustered, with respect to population risk factor profiles. These groups inform policy implementation, which can help to provide assistance to the most vulnerable children across Queensland. Methods: K-means analysis was conducted on data from the Australian Early Development Census and the Australian Bureau of Statistics. The clusters were then compared with respect to their geographic locations and risk factor profiles. The results are presented in this paper and are publicly available via an interactive dashboard application in R Shiny. Results: This study presents a comprehensive clustering analysis for child development vulnerability domains in Queensland. In addition, all of the clustering analyses reveal a strong relationship between developmental vulnerability and socio-economic and remoteness factors. In addition, we found that children who attend preschool and whose primary language is English are, in most cases, in the lowest developmental vulnerability cluster. Conclusion: In this study, the performance of the K-means clustering algorithm has been developed to study the clusters inside child development vulnerabilities when analysing the data at the small area level. Further, R shiny application was created, and the feature of the risk factors in each region was studied.
The integration of micro- and nanoelectronics into or onto biomedical devices can facilitate advanced diagnostics and treatments of digestive disorders, cardiovascular diseases, and cancers. Recent developments in gastrointestinal endoscopy and balloon catheter technologies introduce promising paths for minimally invasive surgeries to treat these diseases. However, current therapeutic endoscopy systems fail to meet requirements in multifunctionality, biocompatibility, and safety, particularly when integrated with bioelectronic devices. Here, we report materials, device designs, and assembly schemes for transparent and stable cubic silicon carbide (3C-SiC)-based bioelectronic systems that facilitate tissue ablation, with the capability for integration onto the tips of endoscopes. The excellent optical transparency of SiC-on-glass (SoG) allows for direct observation of areas of interest, with superior electronic functionalities that enable multiple biological sensing and stimulation capabilities to assist in electrical-based ablation procedures. Experimental studies on phantom, vegetable, and animal tissues demonstrated relatively short treatment times and low electric field required for effective lesion removal using our SoG bioelectronic system. In vivo experiments on an animal model were conducted to explore the versatility of SoG electrodes for peripheral nerve stimulation, showing an exciting possibility for the therapy of neural disorders through electrical excitation. The multifunctional features of SoG integrated devices indicate their high potential for minimally invasive, cost-effective, and outcome-enhanced surgical tools, across a wide range of biomedical applications.
Aim The goal of this study was to investigate the invasion history of the weed Sonchus oleraceus in Australia by comparing the population genetic structure of individuals at different locations in Australia, and in the most likely areas of origin in the native range. Location Samples were collected in Europe and Morocco, North Africa (27 locations), and Australia (17 locations). Methods We performed population genetic analyses using a large dataset comprising 2883 single nucleotide polymorphism markers from 547 plant samples and investigated the invasion history of S. oleraceus with Approximate Bayesian Computation and Random Forest classification algorithms. We compared single and multiple invasion scenarios considering admixture having occurred before and after introduction. Results Our results revealed high levels of inbreeding within sampling locations in the two ranges. Analyses also showed that S. oleraceus was possibly introduced to Australia at least twice: a first introduction around 1000 years ago before British settlement and a more recent introduction (~65 years ago) from Europe and North Africa. We also found evidence of post‐introduction admixture and a potential reintroduction of S. oleraceus from Australia back to its native range. Main conclusions We conclude that the invasion history of S. oleraceus into Australia is probably historic (i.e. prior to British settlements) and complex showing recent evidence of post‐introduction admixture. The complex invasion history of S. oleraceus in Australia poses challenges for the search of potential biological control agents.
Introduction: Attention Deficit Hyperactivity Disorder (ADHD) accounts for a high proportion of paediatric outpatient visits in Australia. Shared care by general practitioners (GPs) would deliver more timely care, closer to home, however GPs indicated the need for interprofessional training support. This study describes the use of Project ECHO®, a guided practice model, to support GPs with ADHD management, by connecting them virtually with an interprofessional team of paediatric specialists using a structured methodology. Methods: A retrospective pre/post-knowledge and self-efficacy survey across twenty-seven aspects of ADHD management was administered, using a seven-point Likert scale. Results: Significant improvement (p < 0.001) in provider self-efficacy was demonstrated across all tested domains. Discussion: Use of the ECHO model™ by an interprofessional team of paediatric specialists achieved an increase in GP knowledge and self-efficacy in the local management of children and young people with complex healthcare needs. Learnings indicate viability to expand the application of the ECHO model™ to address fragmentation for other priority populations across the Australian healthcare and human service sector landscape. Conclusion: Use of the ECHO model™ to support and train GPs was successful. Integration of care was achieved through strengthened partnerships between content and context experts, and the ECHO model™'s case-based learning methodology.
In Queensland (Australia), community-based residential mental health rehabilitation services have three distinct staffing profiles. The traditional ‘clinical’ staffing model has nursing staff occupying most staff roles. The ‘partnership’ approach involves collaboration between the health service and a Non-Government Organisation. Under the ‘integrated’ staffing approach, Peer Support Workers reflect the majority staffing component. This study compares the treatment received by consumers (N = 172) under these staffing models using cross-sectional administrative data. Staffing models were generally comparable on demographic, diagnostic, and symptomatic/impairment measures. However, statistically significant differences were present on a range of treatment variables. Differences mainly occurred between the clinical and integrated approaches, with the integrated staffing model having lower rates of involuntary treatment, antipsychotic polypharmacy, depot use, and chlorpromazine dose equivalence levels. These findings indicate the need to carefully examine the impact of staffing configuration on rehabilitation processes to understand whether differences in approaches are likely to impact rehabilitation outcomes.
Aims The aim of this study was to investigate the rate of revision for distal femoral arthroplasty (DFA) performed as a primary procedure for native knee fractures using data from the Australian Orthopaedic Association National Joint Arthroplasty Registry (AOANJRR). Methods Data from the AOANJRR were obtained for DFA performed as primary procedures for native knee fractures from 1 September 1999 to 31 December 2020. Pathological fractures and revision for failed internal fixation were excluded. The five prostheses identified were the Global Modular Arthroplasty System, the Modular Arthroplasty System, the Modular Universal Tumour And Revision System, the Orthopaedic Salvage System, and the Segmental System. Patient demographic data (age, sex, and American Society of Anesthesiologists grade) were obtained, where available. Kaplan-Meier estimates of survival were used to determine the rate of revision, and the reasons for revision and mortality data were examined. Results The AOANJRR identified 153 primary DFAs performed for native knee fractures in 151 patients during the study period, with 63.3% of these (n = 97) performed within the last five years. The median follow-up was 2.1 years (interquartile range 0.8 to 4.4). The patient population was 84.8% female (n = 128), with a mean age of 76.1 years (SD 11.9). The cumulative percent revision rate at three years was 10%. The most common reason for revision was loosening, followed by infection. Patient survival at one year was 87.5%, decreasing to 72.8% at three years postoperatively. Conclusion The use of DFA to treat native knee fractures is increasing, with 63.3% of cases performed within the last five years. While long-term data are not available, the results of this study suggest that DFA may be a reasonable option for elderly patients with native knee fractures where fixation is not feasible, or for whom prolonged non-weightbearing may be detrimental. Cite this article: Bone Joint J 2022;104-B(7):894–901.
Objectives: To examine the long-term oncological outcomes and urological morbidity of low dose rate prostate brachytherapy (LDRBT) monotherapy using live intraoperative dosimetry planning and an automated needle navigation delivery system for treatment of men with low and intermediate risk prostate cancer. Methods: A prospective database of 400 consecutive patients who underwent LDRBT between July 2003 and June 2015 was retrospectively reviewed to assess urinary side-effects and also biochemical progression based on the Phoenix definition and also a definition of PSA >0.2. Results: Minimum patient follow-up was 5.5 years. Median follow-up of the entire cohort was 11.8 years. The median PSA was 6.1 (0.9-17) and the median Gleason score was 3+4. The RFS freedom from biochemical recurrence based on the Phoenix definition is 85.8% (343/400). The RFS using a 'surgical' definition of PSA <0.2 is 71% (284/400). Of the 297 men followed for more than 10 years, prostate cancer specific survival was 98% (291/297). Post LDRBT urethral stricture developed in 11 men (2.8%, 11/400). For men with > 10 years follow up, 22 men (7.4%, 22/297) required a pad for either stress or urge incontinence. Incontinence was identified in only 2.2% (1/46) of men who had a bladder neck incision (BNI) before LDRBT. Conclusion: LDRBT is associated with excellent prostate cancer specific survival, with a median follow up of 11.8 years. The risk of post-implant urethral stricture and urinary incontinence is low and a pre-implant BNI for management of bladder outflow obstruction does not increase the risk of urinary incontinence or urethral stricture.
Background Lower limb trauma is the most common injury sustained in motorcycle crashes. There are limited data describing this cohort in Australia and limited international data establishing costs due to lower limb trauma following motorcycle crashes. Methods This retrospective cohort study utilised administrative hospitalisation data from Queensland, Australia from 2011-2017. Eligible participants included those admitted with a principal diagnosis coded as lower extremity or pelvic fracture following a motorcycle crash (defined as the index admission). Multiply injured motorcyclists where the lower limb injury was not coded as the primary diagnosis (i.e. principal diagnosis was rather coded as head injury, internal organ injures etc) were not included in the study. Hospitalisation data were also linked to clinical costing data. Logistic regression was used to determine risk factors for 30-day readmission. Costing data were compared between those readmitted and those who weren't, using bootstrapped t-tests and ANVOA Results A total of 3342 patients met eligibility, with the most common lower limb fracture being tibia/fibula fractures (40.8%).212 participants (6.3%) were readmitted within 30-days of discharge. The following were found to predict readmission: male sex (OR 1.84, 95% CI 1.01-1.94); chronic anaemia (OR 2.19, 95% CI 1.41-3.39); current/ex-smoker (OR 1.60, 95% CI 1.21-2.12); emergency admission (OR 2.77, 95% CI 1.35-5.70) and tibia/fibula fracture type (OR 1.46, 95% CI 1.10- 1.94). The most common reasons for readmission were related to ongoing fracture care, infection or post-operative complications. The average hospitalisation cost for the index admission was AU$29,044 (95% CI $27,235- $30,853) with significant differences seen between fracture types. The total hospitalisation cost of readmissions was almost AU$2 million over the study period, with an average cost of $10,977 (95% CI $9,131- $13,059). Conclusions Unplanned readmissions occur in 6.3% of lower limb fractures sustained in motorcycle crashes. Independent predictors of readmission within 30 days of discharge included male sex, chronic anaemia, smoking status, fracture type and emergency admission. Index admission and readmission hospitalisation costs are substantial and should prompt health services to invest in ways to reduce readmission.
Background: The aim of this study was to investigate the relationship of obesity with all-cause revision and revision for infection, loosening, instability, and pain after total knee arthroplasty (TKA) performed in Australia. Methods: Data for patients undergoing primary TKA for osteoarthritis from January 1, 2015, to December 31, 2020, were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). The rates of all-cause revision and revision for infection, loosening, instability, and pain were compared for non-obese patients (body mass index [BMI], 18.50 to 29.99 kg/m2), class-I and II obese patients (BMI, 30.00 to 39.99 kg/m2), and class-III obese patients (BMI, ≥40.00 kg/m2). The results were adjusted for age, sex, tibial fixation, prosthesis stability, patellar component usage, and computer navigation usage. Results: During the study period, 141,673 patients underwent primary TKA for osteoarthritis in Australia; of these patients, 48.0% were class-I or II obese, and 10.6% were class-III obese. The mean age was 68.2 years, and 54.7% of patients were female. The mean follow-up period was 2.8 years. Of the 2,655 revision procedures identified, the reasons for the procedures included infection in 39.7%, loosening in 14.8%, instability in 12.0%, and pain in 6.1%. Class-I and II obese patients had a higher risk of all-cause revision (hazard ratio [HR], 1.12 [95% confidence interval (CI), 1.03 to 1.22]; p = 0.007) and revision for infection (HR, 1.25 [95% CI, 1.10 to 1.43]; p = 0.001) than non-obese patients. Class-III obese patients had a higher risk of all-cause revision after 1 year (HR, 1.30 [95% CI, 1.14 to 1.52]; p < 0.001), revision for infection after 3 months (HR, 1.72 [95% CI, 1.33 to 2.17]; p < 0.001), and revision for loosening (HR, 1.39 [95% CI, 1.00 to 1.89]; p = 0.047) than non-obese patients. The risks of revision for instability and pain were similar among groups. Conclusions: Obese patients with knee osteoarthritis should be counseled with regard to the increased risks associated with TKA, so they can make informed decisions about their health care. Health services and policymakers need to address the issue of obesity at a population level. Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Introduction In China, approximately 85% of people with dementia are cared for by family carers. However, limited research has been conducted to examine family carers’ expectations regarding what they perceive is required for optimal care. Therefore, this study aimed to explore family carers’ expectations regarding dementia care support and services in China. Methods A qualitative study employing semi-structured interviews, with data collected from three public tertiary hospitals where the primary family carers of people with dementia ( N = 21) were recruited from May to December 2019. Purposive maximum variation sampling was used to recruit participants. Data was interpreted both inductively and deductively using thematic analysis. Findings Four themes were identified. The family carers reported minimal support regarding dementia care, and they held little hope of receiving support. However, most carers expressed their limited expectations, such as financial support from the government and respite care services from the community. Carers believed that care was their duty, and some of them were unwilling to move their relative with dementia into a nursing home. Conclusion Health and the three-tier long-term care systems in China are inadequately prepared for the challenges of dementia care, suggesting the need to develop health and social services and improve support for family carers to enable improved care for people with dementia.
Background: Campylobacter spp. infections are the leading cause of foodborne gastroenteritis in high-income countries, including Australia. Campylobacter colonises a variety of mammalian and avian hosts that are reservoirs for human campylobacteriosis. Though most Australian outbreak investigations implicate chicken meat, the proportions of sporadic cases attributable to different animal reservoirs are unknown. Methods: Campylobacter isolates were obtained from notified human cases, and raw meat and offal from the major livestock in Australia: chickens, pigs, and ruminants (cattle and sheep) between 2017 and 2019. Isolates were speciated, with sequence types determined using multi-locus sequence genotyping. We used Bayesian source attribution models to estimate the proportion of human cases attributable to each livestock source by comparing the frequency of sequence types in cases and each animal source. We employed a model comparison approach with ten base models and explored adjusting these for age, gender, jurisdiction, rurality, and season. Four of the ten base models included an ‘unsampled’ source to estimate the proportion of cases attributable to wild, feral, or domestic animal reservoirs not sampled in our study. Results: We included 612 food and 710 human case isolates. The best fitting models attributed >80% of Campylobacter cases to chickens, with a greater proportion of Campylobacter coli (>84%) than Campylobacter jejuni (>77%). The best fitting model that included an unsampled source attributed 14% (95% CrI: 0.3-32%) to the unsampled source and only 2% to ruminants (95% CrI: 0.3-12%) and 2% to pigs (95% CrI: 0.2-11%.) The best fitting model that did not include an unsampled source attributed 12% to ruminants (95%CrI: 1.3-33%) and 6% to pigs (95%CrI: 1.1-19%.) Model fit was not improved by inclusion of case covariates. Conclusions: Chickens were the leading source of Campylobacter infections in our data and should remain the focus of interventions to reduce the burden in Australia.
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