I graduated from the University of Sydney with First Class Honours and the University Medal in mathematical statistics, a Master of Biostatistics and a PhD in mathematical statistics. I am a graduate of the NSW Biostatistics Training Program.
Before joining UTS in mid-2016, I was an associate professor of biostatistics at UNSW, Associate Dean (Postgraduate Coursework) in UNSW Medicine, and Director of the Master of Public Health Program at UNSW. I also led the establishment of StatsCentral, a university wide statistical consulting unit at UNSW. I have also been a senior lecturer in biostatistics at the School of Public Health, University of Sydney.
I am past President of Australasian Epidemiological Association.
Associate Editor, Statistics, and Member Editorial Board, Public Health Research and Practice.
My research has been funded by the NHMRC, ARC, and the Department of Foreign Affairs and Trade.
I am also a member of:
- the Public Health Association of Australia
- The Statistical Society of Australia
Can supervise: YES
My research interests include the application of statistical methods in public health and clinical research. I am particularly interested in screening and diagnostic tests, data linkage and the health of blood donors.
- Public Health
I am Deputy Head of School (Teaching and Learning) in the UTS School of Public Health and I have responsibility for teaching and learning in the School including:
Arora, A, Manohar, N, Hector, D, Bhole, S, Hayen, A, Eastwood, J & Scott, JA 2020, 'Determinants for early introduction of complementary foods in Australian infants: Findings from the HSHK birth cohort study', Nutrition Journal, vol. 19, no. 1.View/Download from: Publisher's site
© 2020 The Author(s). Objective: The purpose of this study was to examine the timing of introduction of complementary (solid) foods among infants in South Western Sydney, Australia, and describe the maternal and infant characteristics associated with very early introduction of solids. Methods: Mother-infant dyads (n = 1035) were recruited into the "Healthy Smiles Healthy Kids" study by Child and Family Health Nurses at the first post-natal home visit. Data collected via telephone interviews at 8, 17, 34 and 52 weeks postpartum included timing of introduction of solids and a variety of maternal and infant characteristics (n = 934). Multiple logistic regression was used to identify factors independently associated with the risk of introducing solids very early, which for the purpose of this study was defined as being before 17 weeks. Results: The median age of introduction of solids was 22 weeks. In total, 13.6% (n = 127) of infants had received solids before 17 weeks and 76.9% (n = 719) before 26 weeks of age. The practice of introducing solids early decreased with older age of the mother. Compared to women < 25 years of age, those who were 35 years or older were 72% less likely to introduce solids very early (OR = 0.28, CI95 0.14-0.58). Single mothers had more than twice the odds of introducing solids before the age of 17 weeks compared to married women (OR = 2.35, CI95 1.33-4.16). Women who had returned to work between 6 to 12 months postpartum were 46% less likely to introduce solids very early compared with those who were not working at the child's first birthday (OR = 0.54, CI95 0.30-0.97). Women born in Vietnam and Indian sub-continent had lower odds of introducing solids very early compared to Australian born women (OR = 0.42, CI95 0.21-0.84 and OR = 0.30, CI95 0.12-0.79, respectively). Infants who were exclusively formula-fed at 4 weeks postpartum had more than twice the odds of receiving solids very early (OR = 2.34, CI95 1.49-3.66). Conclusions: Women wh...
Gattellari, M, Hayen, A, Leung, DYC, Zwar, NA & Worthington, JM 2020, 'Supporting anticoagulant treatment decision making to optimise stroke prevention in complex patients with atrial fibrillation: a cluster randomised trial', BMC family practice, vol. 21, no. 1, p. 102.View/Download from: Publisher's site
BACKGROUND: Anticoagulation for preventing stroke in atrial fibrillation is under-utilised despite evidence supporting its use, resulting in avoidable death and disability. We aimed to evaluate an intervention to improve the uptake of anticoagulation. METHODS: We carried out a national, cluster randomised controlled trial in the Australian primary health care setting. General practitioners received an educational session, delivered via telephone by a medical peer and provided information about their patients selected either because they were not receiving anticoagulation or for whom anticoagulation was considered challenging. General practitioners were randomised to receive feedback from a medical specialist about the cases (expert decisional support) either before or after completing a post-test audit. The primary outcome was the proportion of patients reported as receiving oral anticoagulation. A secondary outcome assessed antithrombotic treatment as appropriate against guideline recommendations. RESULTS: One hundred and seventy-nine general practitioners participated in the trial, contributing information about 590 cases. At post-test, 152 general practitioners (84.9%) completed data collection on 497 cases (84.2%). A 4.6% (Adjusted Relative Risk = 1.11, 95% CI = 0.86-1.43) difference in the post-test utilization of anticoagulation between groups was not statistically significant (p = 0.42). Sixty-one percent of patients in both groups received appropriate antithrombotic management according to evidence-based guidelines at post-test (Adjusted Relative Risk = 1.0; 95% CI = 0.85 to 1.19) (p = 0.97). CONCLUSIONS: Specialist feed-back in addition to an educational session did not increase the uptake of anticoagulation in patients with AF. TRIAL REGISTRATION: ANZCTRN12611000076976 Retrospectively registered.
Johnson, K, Hayen, A, Lassere, MND & Mengersen, K 2020, 'Bias, coverage, and asymptotic behaviour of random effects meta-analysis: a clinically driven simulation study.', International journal of evidence-based healthcare.View/Download from: Publisher's site
AIMS:The study of foundational features of meta-analysis is incomplete and continues to remain important. Using simulations we study bias and coverage and the asymptotic behaviour of the DerSimonian and Laird (D&L) meta-analysis with varying trial numbers and sizes, levels of risk, and extent of treatment effects. METHODS:With simulated data we model risk of untoward events in randomized controlled trials in meta-analyses. Treatment effect is expressed as relative risk reduction, with effect size estimated by the odds ratio which is then compared with the known population odds ratio. Performance is measured as bias, standardized bias and coverage, with thresholds for desirable results being prespecified. RESULTS:Bias, standardized bias, and coverage varied substantially across meta-analyses of different trial size and number, risk mean and distribution, and relative risk reduction. Although improvements were observed with increasing trial size and number, there was widespread lack of satisfactory performance. Performance using normal risk distributions was worse compared with performance using constant or narrow uniform risk distributions. Asymptotic behaviour using very large trial numbers failed to show bias that appeared to approach zero for any distribution. CONCLUSION:The D&L random effects meta-analysis method performed modestly at best. We were unable to demonstrate asymptotic normality. These results question the validity of the random effects method. The findings need replication and extension, which, if confirmed, would warn against generic use of the D&L method.
Liu, B, He, W-Q, Newall, AT, Quinn, HE, Bartlett, M, Hayen, A, Sheppeard, V, Rose, N, MacIntyre, CR & McIntyre, P 2020, 'Effectiveness of acellular pertussis vaccine in older adults: nested matched case-control study.', Clinical Infectious Diseases.View/Download from: Publisher's site
BACKGROUND:Despite recommendations that older adults receive acellular pertussis vaccines, data on direct effectiveness in adults aged over 50 years are sparse. METHODS:Case-control study nested within an adult cohort. Cases were identified from linked pertussis notifications and each matched to three controls on age, sex and cohort recruitment date. Cases and controls were invited to complete a questionnaire, with verification of vaccination status by their primary care provider. Vaccine effectiveness (VE) was estimated by conditional logistic regression, with adjustment for reported contact with children and area of residence. RESULTS:Of 1112 notified cases in the cohort, we had complete data for 333 cases and 506 controls. Among 172 PCR-diagnosed cases (mean age 61 years), 11.2% versus 19.5% of controls, had provider-verified pertussis vaccination, on average 3.2 years earlier. Adjusted VE against PCR-diagnosed pertussis was 52% (95%CI 15 to 73%); non-significantly higher if vaccinated within 2 years (63%, -5 to 87%). Adjusted VE was similar in adults born before 1950, presumed primed by natural infection (51%; -8% to 77%) versus those born 1950 or later who may have received whole-cell pertussis vaccine (53%; -11% to 80%); p-heterogeneity=0.9. Among 156 cases identified by single-point serology, adjusted VE was -55% (-177% to 13%). CONCLUSION:We found modest protection against PCR-confirmed pertussis among older adults (mean age 61 years, range 46-81) within five years after acellular vaccine. The most likely explanation for the markedly divergent VE estimate from cases identified by single titre serology is misclassification arising from limited diagnostic specificity in our setting.
Manohar, N, Hayen, A, Bhole, S & Arora, A 2020, 'Predictors of early introduction of core and discretionary foods in australian infants—results from HSHK birth cohort study', Nutrients, vol. 12, no. 1.View/Download from: Publisher's site
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Early introduction of complementary foods can have a detrimental impact on children’s long-term health. This study examined the timing and determinants of early introduction of core and discretionary foods among infants in Sydney, Australia. Mothers (n = 1035) from an ongoing population-based birth cohort study were interviewed at 8, 17, 34 and 52 weeks postpartum. The outcome was ‘age at which particular core and discretionary food items were first introduced’. Multivariable logistic regression models were used to investigate family and infant-related determinants of early introduction of core (<17 weeks of age) and discretionary foods (<52 weeks of age). Of the 934 mother-infant dyads interviewed, 12% (n = 113) of infants were introduced core foods before 17 weeks of age (median: 22). Mothers working part-time (adjusted odds ratio (OR): 3.42, 95% confidence interval (CI): 1.54–7.62) and those exclusively formula-feeding their babies at four-weeks postpartum (adjusted OR 3.26, 95% CI: 1.99–5.33) were most likely to introduce core foods early. Ninety-five percent (n = 858) of infants were introduced discretionary foods before 52 weeks of age (median: 28). Low socio-economic status was significantly associated with early introduction of discretionary foods (adjusted OR: 3.72, 95% CI: 1.17–11.78). Compliance with infant feeding guidelines related to core foods was better; however, discretionary foods were introduced early in most infants.
Manohar, N, Hayen, A, Fahey, P & Arora, A 2020, 'Obesity and dental caries in early childhood: A systematic review and meta-analyses.', Obesity reviews : an official journal of the International Association for the Study of Obesity.View/Download from: Publisher's site
Obesity and dental caries in children are significant health problems. The aims of this review are to identify whether children aged 6 years and younger with overweight and/or obesity have higher dental caries experience compared with children with normal weight and, secondly, to identify the common risk factors associated with both conditions. Medline, Embase, and seven other databases were systematically searched followed by lateral searches from reference lists, grey literature, theses, conference proceedings, and contacting field experts. Longitudinal observational studies addressing overweight and/or obesity and dental caries in children aged 6 years and younger were included. A random effects model meta-analyses were applied. Nine studies were included in this review. Children with overweight and obesity had a significantly higher dental caries experience compared with children with normal weight (n = 6). The pooled estimates showed that difference in caries experience between the two groups was statistically significant. Low levels of parental income and education were identified to be associated with both conditions in the sample population. Children with overweight and obesity are more vulnerable to dental caries. Low levels of parental income and education influence the relationship between the two conditions. However, the quality of evidence varied considerably; therefore, findings should be interpreted cautiously.
Paul, RC, Nazneen, A, Banik, KC, Sumon, SA, Paul, KK, Akram, A, Uzzaman, MS, Iqbal, T, Tejada-Strop, A, Kamili, S, Luby, SP, Gidding, HF, Hayen, A & Gurley, ES 2020, 'Hepatitis E as a cause of adult hospitalization in Bangladesh: Results from an acute jaundice surveillance study in six tertiary hospitals, 2014-2017', PLoS neglected tropical diseases, vol. 14, no. 1, p. e0007586.View/Download from: Publisher's site
In the absence of reliable data on the burden of hepatitis E virus (HEV) in high endemic countries, we established a hospital-based acute jaundice surveillance program in six tertiary hospitals in Bangladesh to estimate the burden of HEV infection among hospitalized acute jaundice patients aged ≥14 years, identify seasonal and geographic patterns in the prevalence of hepatitis E, and examine factors associated with death. We collected blood specimens from enrolled acute jaundice patients, defined as new onset of either yellow eyes or skin during the past three months of hospital admission, and tested for immunoglobulin M (IgM) antibodies against HEV, HBV and HAV. The enrolled patients were followed up three months after hospital discharge to assess their survival status; pregnant women were followed up three months after their delivery to assess pregnancy outcomes. From December'2014 to September'2017, 1925 patients with acute jaundice were enrolled; 661 (34%) had acute hepatitis E, 48 (8%) had hepatitis A, and 293 (15%) had acute hepatitis B infection. Case fatality among hepatitis E patients was 5% (28/589). Most of the hepatitis E cases were males (74%; 486/661), but case fatality was higher among females-12% (8/68) among pregnant and 8% (7/91) among non-pregnant women. Half of the patients who died with acute hepatitis E had co-infection with HAV or HBV. Of the 62 HEV infected mothers who were alive until the delivery, 9 (15%) had miscarriage/stillbirth, and of those children who were born alive, 19% (10/53) died, all within one week of birth. This study confirms that hepatitis E is the leading cause of acute jaundice, leads to hospitalizations in all regions in Bangladesh, occurs throughout the year, and is associated with considerable morbidity and mortality. Effective control measures should be taken to reduce the risk of HEV infections including improvements in water quality, sanitation and hygiene practices and the introduction of HEV vaccine to high-ris...
Peng, Z, Hayen, A, Kirk, MD, Pearson, S, Cheng, AC & Liu, B 2020, 'Microbiology testing associated with antibiotic dispensing in older community-dwelling adults', BMC Infectious Diseases, vol. 20, no. 1.View/Download from: Publisher's site
© 2020 The Author(s). Background: It is commonly recommended that microbiological assessment should accompany the use of antibiotics prone to resistance. We sought to estimate the rate of microbiology testing and compare this to dispensing of the World Health Organization classified "watch" group antibiotics in primary care. Methods: Data from a cohort of older adults (mean age 69 years) were linked to Australian national health insurance (Pharmaceutical Benefits Scheme & Medicare Benefits Schedule) records of community-based antibiotic dispensing and microbiology testing in 2015. Participant characteristics associated with greater watch group antibiotic dispensing and microbiology testing were estimated using adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) in multivariable zero-inflated negative binomial regression models. Results: In 2015, among 244,299 participants, there were 63,306 watch group antibiotic prescriptions dispensed and 149,182 microbiology tests conducted; the incidence rate was 0.26 per person-year for watch group antibiotic dispensing and 0.62 for microbiology testing. Of those antibiotic prescriptions, only 19% were accompanied by microbiology testing within-14 to + 7 days. After adjusting for socio-demographic factors and co-morbidities, individuals with chronic respiratory diseases were more likely to receive watch group antibiotics than those without, e.g. asthma (aIRR:1.59, 95%CI:1.52-1.66) and chronic obstructive pulmonary disease (COPD) (aIRR:2.71, 95%CI:2.48-2.95). However, the rate of microbiology testing was not comparably higher among them (with asthma aIRR:1.03, 95%CI:1.00-1.05; with COPD aIRR:1.00, 95%CI:0.94-1.06). Conclusions: Priority antibiotics with high resistance risk are commonly dispensed among community-dwelling older adults. The discord between the rate of microbiology testing and antibiotic dispensing in adults with chronic respiratory diseases suggests the potential for excessive empirical pres...
Zhu, L, Hayen, A & Bell, KJL 2020, 'Legacy effect of fibrate add-on therapy in diabetic patients with dyslipidemia: A secondary analysis of the ACCORDION study', Cardiovascular Diabetology, vol. 19, no. 1.View/Download from: Publisher's site
© 2020 The Author(s). Background: The Action to Control Cardiovascular Risk in Diabetes (ACCORD)-Lipid study found no evidence of a beneficial effect of statin-fibrate combined treatment, compared to statins alone, on cardiovascular outcomes and mortality in type 2 diabetes mellitus after 5 years of active treatment. However, a beneficial reduction in major CVD events was shown in a pre-specified sub-group of participants with dyslipidemia. The extended follow-up of this trial provides the opportunity to further investigate possible beneficial effects of fibrates in this group of patients. We aimed to evaluate possible "legacy effects" of fibrate add-on therapy on mortality and major cardiovascular outcomes in patients with dyslipidemia. Methods: The ACCORD-lipid study was a randomized controlled trial of 5518 participants assigned to receive simvastatin plus fenofibrate vs simvastatin plus placebo. After randomized treatment allocation had finished at the end of the trial, all surviving participants were invited to attend an extended follow-up study (ACCORDION) to continue prospective collection of clinical outcomes. We undertook a secondary analysis of trial and post-trial data in patients who had dyslipidemia. The primary outcome was all-cause and cardiovascular mortality, and secondary outcomes were nonfatal myocardial infarction, stroke, congestive heart failure and major coronary heart disease. We used an intention-to-treat approach to analysis to make comparisons between the original randomized treatment groups. Results: 853 participants with dyslipidemia had survived at the end of the trial. Most participants continued to use statins, but few used fibrates in either group during the post-trial period. The incidence rates in the fenofibrate group were lower with respect to all-cause mortality, CVD mortality, nonfatal myocardial infarction, congestive heart failure and major coronary heart disease than those in the placebo group over a post-trial follow-up....
Morgan, DP, Muscatello, D, Travaglia, J & Hayen, A 2020, 'Retrospective observational cohort study of out-of-hospital cardiac arrest outcomes in Tasmania 2010–2014', EMA - Emergency Medicine Australasia.View/Download from: Publisher's site
© 2020 Australasian College for Emergency Medicine Objective: This study aims to present overall survival rates to hospital discharge for out-of-hospital cardiac arrest (OHCA) in Tasmania and to identify predictors of survival. Methods: A retrospective observational cohort study was undertaken from 1 January 2010 to 31 December 2014. A probabilistically linked data set was created from paramedic electronic medical records and hospital patient records. Logistic regression was used to assess factors associated with survival of OHCA. Results: During the study, 2949 incidents of OHCA were reviewed and 1146 had emergency management provided, with an overall survival rate to hospital discharge of 135 (12%). A number of independent factors are associated with improved outcomes including if the initial presenting cardiac rhythm was either ventricular fibrillation or ventricular tachycardia (adjusted odds ratio [OR] 8.75, 95% confidence interval [CI] 5.15–14.89) (P < 0.0001) relative to those who were found in a non-shockable rhythm. Another factor was age group (overall P < 0.001). Those aged 85+ years had a reduced overall survival rate (2.9%), which was lower than those <16 years of age (OR 0.37, 95% CI 0.07–1.94; adjusted OR 0.38, CI 0.03–1.00) (P < 0.001). The odds of surviving OHCA decreased by 9% for every minute defibrillation of a shockable rhythm was delayed were witnessed by a bystander (OR 0.90, 95% CI 0.85–0.95). Conclusion: Time to defibrillation for witnessed arrests, other than paramedic witnessed arrest was associated with better overall survival rates than unwitnessed OHCA. Further factors such as the event being of cardiac aetiology, bystander cardio-pulmonary resuscitation performed, initial presenting cardiac rhythm of ventricular fibrillation or ventricular tachycardia and decreasing age were all associated with increased probability of survival.
Asefa, F, Cummins, A, Dessie, Y, Hayen, A & Foureur, M 2020, 'Gestational weight gain and its effect on birth outcomes in sub-Saharan Africa: Systematic review and meta-analysis', PLoS ONE, vol. 15, no. 4.View/Download from: Publisher's site
© 2020 Asefa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction An increased metabolic demand during pregnancy is fulfilled by gaining sufficient gestational weight. Women who gain inadequate-weight are at a high-risk of premature birth or having a baby with low-birth weight. However, women who gain excessive-weight are at a high-risk of having a baby with macrosomia. The aim of this review was to determine the distribution of gestational weight gain and its association with birth-outcomes in Sub-Saharan Africa. Methods For this systematic review and meta-analysis, we performed a literature search using PubMed, Medline, Embase, Scopus, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. We searched grey-literature from Google and Google Scholar, and region-specific journals from the African Journals Online (AJOL) database. We critically appraised the included studies using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Two independent reviewers evaluated the quality of the studies and extracted the data. We calculated pooled relative-risks (RR) with 95% confidence intervals. Results Of 1450 retrieved studies, 26 met the inclusion criteria. Sixteen studies classified gestational weight gain according to the United States Institute of Medicine recommendations. The percentage adequate amount of gestational weight ranged from 3% to 62%. The percentage of inadequate weight was >50% among nine studies. Among underweight women, the percentage of women who gained inadequate gestational weight ranged from 67% to 98%. Only two studies were included in the meta-analyses to evaluate the association of gestational weight gain with pre-eclampsia and macrosomia. No difference was observed among wo...
Asante, AD, Ir, P, Jacobs, B, Supon, L, Liverani, M, Hayen, A, Jan, S & Wiseman, V 2019, 'Who benefits from healthcare spending in Cambodia? Evidence for a universal health coverage policy.', Health policy and planning, vol. 34, no. Supplement_1, pp. i4-i13.View/Download from: Publisher's site
Cambodia's healthcare system has seen significant improvements in the last two decades. Despite this, access to quality care remains problematic, particularly for poor rural Cambodians. The government has committed to universal health coverage (UHC) and is reforming the health financing system to align with this goal. The extent to which the reforms have impacted the poor is not always clear. Using a system-wide approach, this study assesses how benefits from healthcare spending are distributed across socioeconomic groups in Cambodia. Benefit incidence analysis was employed to assess the distribution of benefits from health spending. Primary data on the use of health services and the costs associated with it were collected through a nationally representative cross-sectional survey of 5000 households. Secondary data from the 2012-14 Cambodia National Health Accounts and other official documents were used to estimate the unit costs of services. The results indicate that benefits from health spending at the primary care level in the public sector are distributed in favour of the poor, with about 32% of health centre benefits going to the poorest population quintile. Public hospital outpatient benefits are quite evenly distributed across all wealth quintiles, although the concentration index of -0.058 suggests a moderately pro-poor distribution. Benefits for public hospital inpatient care are substantially pro-poor. The private sector was significantly skewed towards the richest quintile. Relative to health need, the distribution of total benefits in the public sector is pro-poor while the private sector is relatively pro-rich. Looking across the entire health system, health financing in Cambodia appears to benefit the poor more than the rich but a significant proportion of spending remains in the private sector which is largely pro-rich. There is the need for some government regulation of the private sector if Cambodia is to achieve its UHC goals.
Bell, KJL, Azizi, L, Nilsson, PM, Hayen, A, Irwig, L, Östgren, CJ & Sundström, J 2019, 'Correction: Prognostic impact of systolic blood pressure variability in people with diabetes.', PloS one, vol. 14, no. 10, pp. e0224538-e0224538.View/Download from: Publisher's site
[This corrects the article DOI: 10.1371/journal.pone.0194084.].
Brown, J, Elkington, J, Hall, A, Keay, L, Charlton, JL, Hunter, K, Koppel, S, Hayen, A & Bilston, LE 2019, 'Can child restraint product information developed using consumer testing sustain correct use 6 months after child restraint purchase? Study protocol for a cluster randomised controlled trial.', Injury Prevention.View/Download from: Publisher's site
With long-standing and widespread high rates of errors in child restraint use, there is a need to identify effective methods to address this problem. Information supplied with products at the point of sale may be a potentially efficient delivery point for such a countermeasure. The aim of this study is to establish whether product materials developed using a consumer-driven approach reduce errors in restraint use among purchasers of new child restraint systems.A cluster randomised controlled trial (cRCT) will be conducted. Retail stores (n=22) in the greater Sydney area will be randomised into intervention sites (n=11) and control sites (n=11), stratified by geographical and socioeconomic indicators. Participants (n=836) will enter the study on purchase of a restraint. Outcome measures are errors in installation of the restraint as observed by a trained researcher during a 6-month follow-up home assessment, and adjustment checks made by the parent when the child is placed into the restraint (observed using naturalistic methods). Process evaluation measures will also be collected during the home visit. An intention-to-treat approach will be used for all analyses. Correct use and adjustment checks made by the parent will be compared between control and intervention groups using a logistic regression model. The number of installation errors between groups will be compared using Poisson regression.This cRCT will determine the effectiveness of targeted, consumer-driven information on actual error rates in use of restraints. More broadly, it may provide a best practice model for developing safety product information.ACTRN12617001252303p; Pre-results.
Chen, Y, Kirk, MD, Stuart, R, Cheng, AC, Pearson, S-A, Hayen, A, Banks, E & Liu, B 2019, 'Socio-demographic and health service factors associated with antibiotic dispensing in older Australian adults.', PloS one, vol. 14, no. 8.View/Download from: Publisher's site
BACKGROUND:Widespread use of antibiotics has led to the development of antibiotic resistance. However, there are limited data describing antibiotic use in the community setting, and examining factors associated with greater use. Our study aimed to quantify antibiotic dispensing in older adults in the community according to socio-demographics and health services use. METHODS:Prospective analysis of a population-based cohort study of 239,981 adults aged ≥45 years in Australia (the Sax Institute's 45 and Up Study). Data on socio-demographics and health from a questionnaire, were linked to 2015 antibiotic dispensing data from the Pharmaceutical Benefits Scheme (PBS), as well as other administrative health databases. We estimated the Defined Daily Dose (DDD) of systemic antibiotics dispensed, defined by an Anatomic Therapeutic Classification code beginning with J01, in 2015. We also conducted Poisson regression with robust standard errors to identify factors associated with antibiotic dispensing. RESULTS:Overall, 49.3% of 45 and Up Study participants had at least one systemic antibiotic dispensed in 2015 with a total of 392,856 prescriptions dispensed and an average of 36.5 DDDs/1000-persons/day in the study population. The quantity of antibiotics dispensed increased with increasing age (25.6 DDDs/1000/day in <60 years old versus 50.4 DDDs/1000/day in 80+ year old) and was higher comparing women to men (39.9 versus 32.4 DDDs/1000/day). Of factors examined, the greatest dispensing of antibiotics was among those who had been resident in an aged care facility and those with >15 general practitioner consultations in the last year (80.5 and 88.3 DDDs/1000/day, respectively). These factors remained strongly associated with greater antibiotic dispensing after adjusting for age, sex, education, income, area of residence and co-morbidities. CONCLUSIONS:Residence in aged care facilities and high GP visits are associated with greater antibiotic dispensing. This study provides im...
Clarke, S, Richmond, R, Worth, H, Wagle, R & Hayen, A 2019, 'Effect of a participatory intervention in women's self-help groups for the prevention of chronic suppurative otitis media in their children in Jumla Nepal: a cluster-randomised trial.', BMC pediatrics, vol. 19, no. 1.View/Download from: Publisher's site
BACKGROUND:Chronic suppurative otitis media (CSOM) causes preventable deafness and disproportionately affects children living in poverty. Our hypothesis was that health promotion in women's groups would increase their knowledge, attitudes and practices (KAP) regarding ear disease and reduce the prevalence of CSOM in their children. METHODS:We did a cluster randomised trial in two village development committees (VDCs) in Jumla, Nepal. In July 2014, 30 women's groups were randomly allocated to intervention or control, stratified by VDC and distance to the road. The intervention groups participated in three sessions of health promotion using the WHO Hearing and Ear Care Training Resource Basic Level. The primary outcome was women's KAP score and the secondary outcome was prevalence of CSOM in their children at 12 month follow-up. Analyses were by intention to treat. Participants and the research team were not masked to allocation. RESULTS:In June and July 2014 we recruited 508 women and 937 of their children. 12 months later there was no difference in the women's KAP score (mean difference 0.14, 95% CI - 0.1 to 0.38, P = 0.25) or the prevalence of CSOM in their children (OR 1.10, 95%CI 0.62 to 1.84, P = 0.75) between intervention and control groups. However, overall, there was a significant improvement in the KAP score (mean difference - 0.51, 95% CI - 0.71,to - 0.31, P < 0.0001) and in the prevalence of CSOM from baseline 11.2% to follow-up 7.1% (P < 0.0001). CONCLUSIONS:Health promotion in women's groups did not improve maternal KAP or reduce prevalence of CSOM. Over time there was a significant improvement in women's KAP score and reduction in the prevalence of CSOM which may be attributable to our presence in the community offering treatment to affected children, talking to their parents and providing ciprofloxacin drops to the local health posts. More research is needed in low resource settings to test our findings. TRIAL REGISTRATION:Australia and New Zealand ...
Drost, F-JH, Nieboer, D, Morgan, TM, Carroll, PR, Roobol, MJ & Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP) Consortium 2019, 'Predicting Biopsy Outcomes During Active Surveillance for Prostate Cancer: External Validation of the Canary Prostate Active Surveillance Study Risk Calculators in Five Large Active Surveillance Cohorts.', European urology, vol. 76, no. 5, pp. 693-702.View/Download from: Publisher's site
BACKGROUND:Men with prostate cancer (PCa) on active surveillance (AS) are followed through regular prostate biopsies, a burdensome and often unnecessary intervention, not without risks. Identifying men with at a low risk of disease reclassification may help reduce the number of biopsies. OBJECTIVE:To assess the external validity of two Canary Prostate Active Surveillance Study Risk Calculators (PASS-RCs), which estimate the probability of reclassification (Gleason grade ≥7 with or without >34% of biopsy cores positive for PCa) on a surveillance biopsy, using a mix of months since last biopsy, age, body mass index, prostate-specific antigen, prostate volume, number of prior negative biopsies, and percentage (or ratio) of positive cores on last biopsy. DESIGN, SETTING, AND PARTICIPANTS:We used data up to November 2017 from the Movember Foundation's Global Action Plan (GAP3) consortium, a global collaboration between AS studies. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:External validity of the PASS-RCs for estimating reclassification on biopsy was assessed by calibration, discrimination, and decision curve analyses. RESULTS AND LIMITATIONS:Five validation cohorts (Prostate Cancer Research International: Active Surveillance, Johns Hopkins, Toronto, Memorial Sloan Kettering Cancer Center, and University of California San Francisco), comprising 5105 men on AS, were eligible for analysis. The individual cohorts comprised 429-2416 men, with a median follow-up between 36 and 84 mo, in both community and academic practices mainly from western countries. Abilities of the PASS-RCs to discriminate between men with and without reclassification on biopsy were reasonably good (area under the receiver operating characteristic curve values 0.68 and 0.65). The PASS-RCs were moderately well calibrated, and had a greater net benefit than most default strategies between a predicted 10% and 30% risk of reclassification. CONCLUSIONS:Both PASS-RCs improved the balance between detect...
Hall, AB, Ho, C, Albanese, B, Keay, L, Hunter, K, Charlton, J, Hayen, A, Bilston, LE & Brown, J 2019, 'User-driven design of child restraint information to reduce errors in use: A pilot randomised controlled trial', Injury Prevention.View/Download from: Publisher's site
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. Background: Incorrect use of child restraints is a long-standing problem that increases the risk of injury in crashes. We used user-centred design to develop prototype child restraint instructional materials. The objective of this study was to evaluate these materials in terms of comprehension and errors in the use of child restraints. The relationship between comprehension and errors in use was also explored. Methods: We used a parallel-group randomised controlled trial in a laboratory setting. The intervention group (n=22) were provided with prototype materials and the control group (n=22) with existing instructional materials for the same restraint. Participants installed the restraint in a vehicle buck, secured an appropriately sized mannequin in the restraint and underwent a comprehension test. Our primary outcome was overall correct use, and our secondary outcomes were (1) comprehension score and (2) percent errors in the installation trial. Results: There was 27% more overall correct use (p=0.042) and a higher mean comprehension score in the intervention group (mean 17, 95% CI 16 to 18) compared with the control group (mean 12, 95% CI 10 to 14, p<0.001). The mean error percentage in the control group was 23% (95% CI 16% to 31%) compared with 14% in the intervention group (95% CI 8% to 20%, p=0.056). For every one point increase in comprehension, there was an almost 2% (95% CI-2.7% to-1.0%) reduction in errors (y=45.5-1.87x, p value for slope <0.001). Conclusions: Consumer-driven design of informational materials can increase the correct use of child restraints. Targeting improved comprehension of informational materials may be an effective mechanism for reducing child restraint misuse.
Ho, KC, Rahardjo, D, Stapleton, F, Wiles, L, Hibbert, PD, White, AJR, Hayen, A & Jalbert, I 2019, 'Can the appropriateness of eye care be measured through cross-sectional retrospective patient record review in eye care practices in Australia? The iCareTrack feasibility study.', BMJ open, vol. 9, no. 3.View/Download from: Publisher's site
OBJECTIVES:The CareTrack study found that a wide range of appropriateness of care (ie, care in line with evidence-based or consensus-based guidelines) was delivered across many health conditions in Australia. This study therefore aimed to demonstrate the feasibility of using the CareTrack method (a retrospective onsite record review) to measure the appropriateness of eye care delivery. DESIGN:Cross-sectional feasibility study. SETTING AND PARTICIPANTS:Two hundred and thirteen patient records randomly selected from eight optometry and ophthalmology practices in Australia, selected through a combination of convenience and maximum variation sampling. METHODS:Retrospective record review designed to assess the alignment between eye care delivered and 93 clinical indicators (Delphi method involving 11 experts) extracted from evidence-based clinical practice guidelines. PRIMARY OUTCOME MEASURE:Number of eligible patient records, sampling rates and data collection time. This feasibility study also tested the ability of 93 clinical indicators to measure percentage appropriate eye care for preventative, glaucoma and diabetic eye care. A secondary outcome was the percentage of practitioner-patient encounters at which appropriate eye care was received. RESULTS:A median of 20 records (range 9 to 63) per practice were reviewed. Data collection time ranged from 3 to 5.5 hours (median 3.5). The most effective sampling strategy involved random letter generation followed by sequential sampling. The appropriateness of care was 69% (95% CI 67% to 70%) for preventative eye care, 60% (95% CI 56% to 58%) for glaucoma and 63% (95% CI 57% to 69%) for diabetic eye care. CONCLUSIONS:Appropriateness of eye care can be measured effectively using retrospective record review of eye care practices and consensus-based care indicators.
Jo, HE, Glaspole, I, Goh, N, Hopkins, PMA, Moodley, Y, Reynolds, PN, Chapman, S, Walters, EH, Zappala, C, Allan, H, Macansh, S, Grainge, C, Keir, GJ, Hayen, A, Henderson, D, Klebe, S, Heinze, SB, Miller, A, Rouse, HC, Duhig, E, Cooper, WA, Mahar, AM, Ellis, S, McCormack, SR, Ng, B, Godbolt, DB & Corte, TJ 2019, 'Implications of the diagnostic criteria of idiopathic pulmonary fibrosis in clinical practice: Analysis from the Australian Idiopathic Pulmonary Fibrosis Registry.', Respirology (Carlton, Vic.), vol. 24, no. 4, pp. 361-368.View/Download from: Publisher's site
BACKGROUND AND OBJECTIVE:Current guidelines for the diagnosis of idiopathic pulmonary fibrosis (IPF) provide specific criteria for diagnosis in the setting of multidisciplinary discussion (MDD). We evaluate the utility and reproducibility of these diagnostic guidelines, using clinical data from the Australian IPF Registry. METHODS:All patients enrolled in the registry undergo a diagnostic review whereby international IPF guidelines are applied via a registry MDD. We investigated the clinical applicability of these guidelines with regard to: (i) adherence to guidelines, (ii) Natural history of IPF diagnostic categories and (iii) Concordance for diagnostic features. RESULTS:A total of 417 participants (69% male, 70.6 ± 8.0 years) with a clinical diagnosis of IPF underwent MDD. The 23% of participants who did not meet IPF diagnostic criteria displayed identical disease behaviour to those with confirmed IPF. Honeycombing on radiology was associated with a worse prognosis and this translated into poorer prognosis in the 'definite' IPF group. While there was moderate agreement for IPF diagnostic categories, agreement for specific radiological features, other than honeycombing, was poor. CONCLUSION:In clinical practice, physicians do not always follow IPF diagnostic guidelines. We demonstrate a cohort of IPF patients who do not meet IPF diagnostic guideline criteria, based largely on their radiology and lack of lung biopsy, but who have outcomes identical to those with IPF.
Manohar, N, Hayen, A & Arora, A 2019, 'Obesity and dental caries in early childhood: a systematic review protocol.', JBI database of systematic reviews and implementation reports.View/Download from: Publisher's site
OBJECTIVE:The objectives of this review are to examine whether overweight/obese children experience more dental caries compared with non-overweight/non-obese children, and to identify common risk factors associated with both conditions. INTRODUCTION:Systematic reviews have shown that any evidence on a link between overweight and/or obesity and dental caries remains inconclusive. This relationship has not been assessed for children under six years of age with primary dentition. Therefore, an updated systematic review of this topic is necessary as its findings will be important for young children, clinicians, researchers and policy makers. INCLUSION CRITERIA:Studies examining children under six years of age and with complete primary dentition at the time of dental caries assessment will be included. The exposure of interest is the overweight and/or obesity status of children under six years of age. The outcome is dental caries in children with complete primary dentition. There will be no restriction on setting, date or language. METHODS:MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials, Embase, PsycINFO, ProQuest Central, Scopus, CINAHL, and Google Scholar will be searched for eligible studies. The electronic database search will be supplemented by OpenGrey and Grey Literature Report databases, ProQuest Dissertations and Theses Global, and the International Association for Dental Research conference websites. Two reviewers will independently screen and select studies, assess methodological quality and extract data. Meta-analysis will be performed, if possible, and the Grading of Recommendations Assessment Development and Evaluation (GRADE) Summary of Findings presented. SYSTEMATIC REVIEW REGISTRATION NUMBER:PROSPERO CRD42018085292.
Parry, M, Green, D, Zhang, Y & Hayen, A 2019, 'Does Particulate Matter Modify the Short-Term Association between Heat Waves and Hospital Admissions for Cardiovascular Diseases in Greater Sydney, Australia?', International journal of environmental research and public health, vol. 16, no. 18.View/Download from: Publisher's site
Little is known about the potential interactive effects of heat waves and ambient particulate matter on cardiovascular morbidity. A time-stratified case-crossover design was used to examine whether particulate matter (PM10) modifies the association between heat waves and emergency hospital admissions for six cardiovascular diseases in Greater Sydney, Australia during the warm season for 2001-2013. We estimated and compared the effect of heat waves on high- and low-level PM10 days at lag0-lag2, adjusting for dew-point temperature, ambient ozone, ambient nitrogen dioxide, and public holidays. We also investigated the susceptibility of both younger (0-64 years) and older populations (65 years and above), and tested the sensitivity of three heat wave definitions. Stronger heat wave effects were observed on high- compared to low-level PM10 days for emergency hospital admissions for cardiac arrest for all ages combined, 0-64 years and 65 years and above; conduction disorders for 0-64 years; and hypertensive diseases for all ages combined and 0-64 years. Overall, we found some evidence to suggest that PM10 may modify the association between heat waves and hospital admissions for certain cardiovascular diseases, although our findings largely differed across disease, age group, lag, and heat wave definition.
Pathirana, T, Hayen, A, Doust, J, Glasziou, P & Bell, K 2019, 'Lifetime risk of prostate cancer overdiagnosis in Australia: quantifying the risk of overdiagnosis associated with prostate cancer screening in Australia using a novel lifetime risk approach.', BMJ open, vol. 9, no. 3.View/Download from: Publisher's site
OBJECTIVES:To quantify the risk of overdiagnosis associated with prostate cancer screening in Australia using a novel lifetime risk approach. DESIGN:Modelling and validation of the lifetime risk method using publicly available population data. SETTING:Opportunistic screening for prostate cancer in the Australian population. PARTICIPANTS:Australian male population (1982-2012). INTERVENTIONS:Prostate-specific antigen testing for prostate cancer screening. PRIMARY AND SECONDARY OUTCOME MEASURES:Primary: lifetime risk of overdiagnosis in 2012 (excess lifetime cancer risk adjusted for changing competing mortality); Secondary: lifetime risk of prostate cancer diagnosis (unadjusted and adjusted for competing mortality); Excess lifetime risk of prostate cancer diagnosis (for all years subsequent to 1982). RESULTS:The lifetime risk of being diagnosed with prostate cancer increased from 6.1% in 1982 (1 in 17) to 19.6% in 2012 (1 in 5). Using 2012 competing mortality rates, the lifetime risk in 1982 was 11.5% (95% CI 11.0% to 12.0%). The excess lifetime risk of prostate cancer in 2012 (adjusted for changing competing mortality) was 8.2% (95% CI 7.6% to 8.7%) (1 in 13). This corresponds to 41% of prostate cancers being overdiagnosed. CONCLUSIONS:Our estimated rate of overdiagnosis is in agreement with estimates using other methods. This method may be used without the need to adjust for lead times. If annual (cross-sectional) data are used, then it may give valid estimates of overdiagnosis once screening has been established long enough for the benefits from the early detection of non-overdiagnosed cancer at a younger age to be realised in older age groups.
Rhee, J, Meller, A, Krysinska, K, Gonski, P, Naganathan, V, Zwar, N, Hayen, A, Cullen, J, O'Keefe, J-A, McDonald, J, Harris-Roxas, B & Caplan, GA 2019, 'Advance care planning for patients with advanced illnesses attending hospital outpatient clinics study: a study protocol for a randomised controlled trial.', BMJ open, vol. 9, no. 1.View/Download from: Publisher's site
INTRODUCTION:It is unclear whether advance care planning (ACP) undertaken with patients living in the community can improve patient care and avoid unwanted interventions and hospital admissions. We have designed a randomised controlled trial (RCT) to examine if ACP undertaken with patients with advanced illnesses attending hospital outpatient clinics can reduce unplanned hospital admissions and improve patient and caregiver well-being. METHODS AND ANALYSIS:Pragmatic RCT involving patients from subspecialty outpatient clinics at five clinical sites in Sydney, Australia. Participants will be ≥18 years screened as potentially having palliative care needs and at risk of dying in 6-12 months. The patients will be randomised to intervention or control group. Intervention group will undertake ACP discussions facilitated by a trained health professional. The control group will receive written information on ACP, representing the current standard of care. The primary outcome is the number of unplanned hospital admissions at the 6-month follow-up. Secondary outcomes include: (i) patient's health-related quality-of-life and quality of chronic disease care; (ii) caregiver's health-related quality-of-life and caregiver burden and (iii) other health outcomes including ambulance usage, emergency department presentations, hospital admissions, resuscitation attempts, intensive care unit admissions, deaths, documentation of patient wishes in patient records and audit of ACP discussions and documents. The staff's self-reported attitudes and knowledge of ACP will also be measured. The data will be collected using self-report questionnaires, hospital records audit, audit of ACP documentation and data linkage analysis. Semistructured interviews and focus group discussions with patients, caregivers and healthcare professionals will explore the acceptability and feasibility of the intervention. ETHICS AND DISSEMINATION:Approved by South-East Sydney Local Health District Human Research E...
Morgan, DP, Muscatello, D, Hayen, A & Travaglia, J 2019, 'Human factors influencing out-of-hospital cardiac arrest survival.', Emergency medicine Australasia : EMA, vol. 31, no. 4, pp. 600-604.View/Download from: Publisher's site
OBJECTIVE:Programmes that reduce the time to defibrillation are likely to improve overall survival rates from out-of-hospital cardiac arrests (OHCAs). This research sought to identify human factors common among community responders taking an automated external defibrillator (AED) to a victim of an OHCA that are either barriers or enablers of desired behaviour. METHODS:A qualitative methodology was used. Community members who had access to an AED and who had been notified of an incident of OHCA near them were approached to participate in the research. Participants completed a written survey and undertook a semi-structured interview. A thematic analysis was undertaken using NVivo software and triangulated against findings from an automated data-mining package, Leximancer. RESULTS:The study found that 100% of people who were notified of the need for an AED responded. Twelve participants subsequently identified during interviews that they held some form of leadership role in their community. First aid training and previous experience of, and competency in managing emergencies were the strongest motivations for their response. Personal risk was not a concern when responding to victims in immediately life-threatening situations. CONCLUSION:Prospective programmes may be able to be designed to increase the likelihood that community members with AEDs will respond in advance of emergency medical services by targeting common human factors, such as leadership behaviour, training, competency and experience in managing emergencies, leading to better overall survival rates from OHCA.
Zhu, L, Bell, KJL & Hayen, A 2019, 'Estimated legacy effects from simulated post-trial data were less biased than from combined trial/post-trial data.', Journal of clinical epidemiology, vol. 114, pp. 30-37.View/Download from: Publisher's site
OBJECTIVES:"Legacy effects" describe the phenomena where treatment effects are apparent during the post-trial period that are not attributable to the direct effects observed within the trial. We investigate different approaches to analysis of trial and extended follow-up data for the evaluation of legacy effects. STUDY DESIGN AND SETTING:We conducted a simulation to compare three approaches, which differed in terms of the time period and selection of trial participants included in the analysis. RESULTS:The most common approach used for estimating legacy effects in the literature, which combines initial trial and post-trial follow-up data, gave the most biased estimates. Approaches using post-randomized controlled trial data had better performance in most scenarios. When the size of the legacy effect was set to differ according to whether or not drugs were taken after trial, the stratified approach using post-trial data but only from participants taking the drug after trial was less biased but often had lower power to detect a legacy effect. CONCLUSION:When estimating legacy effects, approaches to analysis that are restricted to post-trial follow-up data are preferred. If data are available on participant drug use after trial, then both stratified and unstratified approaches to analysis of the post-trial data should be investigated.
Arnolda, G, Chien, TD, Hayen, A, Hoi, NTX, Maningas, K, Joe, P, Cavallin, F, Trevisanuto, D & Moccia, L 2018, 'A comparison of the effectiveness of three LED phototherapy machines, single- and double-sided, for treating neonatal jaundice in a low resource setting', PLoS ONE, vol. 13, no. 10.View/Download from: Publisher's site
© 2018 Arnolda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Neonatal jaundice is one of the most common reasons for hospital admission in low resource settings. Treatment is frequently inadequate as conventional phototherapy requires frequent bulb changes. LED phototherapy has comparable efficacy to conventional phototherapy, and the bulbs last over 40,000 hours. This observational study compares the effectiveness of three LED machines, two single-sided and one double-sided in routine use in Vietnam. Methods We included all infants weighting 1500g and with jaundice diagnosed visually or by Total Serum Bilirubin (TSB) measurement at The Da Nang Hospital for Women and Children (Da Nang, Vietnam). The primary endpoint was the average hourly change in TSB over the first six hours of treatment. The secondary endpoints were duration of treatment; average hourly change in TSB over treatment, and length of stay in the neonatal unit. Multivariable analysis and bootstrap methods was performed to compare outcomes, adjusting for potential confounders. Results All outcomes were comparable in the two single-sided machines. The double-sided machine showed 54% increase in the hourly speed of TSB reduction (1.3 μmol/L/hr, 95% CI 0.3-2.3), with a 45% increase in the speed of TSB reduction over the duration of treatment (0.9 μmol/ L/hr, 95% CI 0.6-1.3). In addition, the double-sided machine was associated with 21% reduction in the duration of treatment (14 hours, 95% CI 5-22) and 16% reduction of length of stay (14 hours, 95% CI 3-25). Conclusion The results confirm and quantify the benefits of increasing surface-area exposure during phototherapy. Adjusted for multiple potential confounders, use of double-sided phototherapy can substantially increase the speed of TSB reducti...
Bell, KJL, Azizi, L, Nilsson, PM, Hayen, A, Irwig, L, Ostgren, CJ & Sundrom, J 2018, 'Prognostic impact of systolic blood pressure variability in people with diabetes', PLOS ONE, vol. 13, no. 4.View/Download from: Publisher's site
Guinness, L, Paul, RC, Martins, JS, Asante, A, Price, JA, Hayen, A, Jan, S, Soares, A & Wiseman, V 2018, 'Determinants of health care utilisation: The case of Timor-Leste', International Health, vol. 10, no. 6, pp. 412-420.View/Download from: Publisher's site
© The Author(s) 2018. Background: Health financing and delivery reforms designed to achieve universal health coverage (UHC) need to be informed by an understanding of factors that both promote access to health care and undermine it. This study examines the level of health care utilisation in Timor-Leste and the factors that drive it. Methods: Data from a nationally representative cross-sectional survey of health care utilisation in 1712 households were used to develop multilevel models exploring how need and predisposing and enabling factors explain health care utilisation at both primary and secondary care facilities. Results: Need was found to be the key driver in seeking both primary care and hospital services. Rural households were less likely to go to hospital (odds ratio 0.7) than urban households. The poorest quintile was also less likely to use more expensive hospital services than other socio-economic groups. Conclusions: Understanding the determinants of seeking health care in Timor-Leste is of considerable policy significance, because health care is free at the point of use. Our findings indicate that the public resources for health care are subsidising the rich more than the poor. Health care reforms in Timor-Leste need to reduce the 'other' costs of health care, such as distance barriers, to address these inequities.
Hall, A, Ho, C, Keay, L, McCaffery, K, Hunter, K, Charlton, JL, Hayen, A, Bilston, L & Brown, J 2018, 'Barriers to correct child restraint use: A qualitative study of child restraint users and their needs', SAFETY SCIENCE, vol. 109, pp. 186-194.View/Download from: Publisher's site
Morony, S, Lamph, E, Muscat, D, Nutbeam, D, Dhillon, HM, Shepherd, H, Smith, S, Khan, A, Osborne, J, Meshreky, W, Luxford, K, Hayen, A & McCaffery, KJ 2018, 'Improving health literacy through adult basic education in Australia.', Health Promotion International, vol. 33, no. 5, pp. 867-877.View/Download from: Publisher's site
Adults with low literacy are less empowered to take care of their health, have poorer health outcomes and higher healthcare costs. We facilitated partnerships between adult literacy teachers and community health providers to deliver a health literacy training program in adult basic education classrooms. Following course completion we interviewed 19 adult education teachers (15 delivering the health literacy program; 4 delivering standard literacy classes) and four community health providers (CHPs) about their experiences, and analysed transcripts using Framework analysis. Written feedback from eight teachers on specific course content was added to the Framework. Health literacy teachers reported a noticeable improvement in their student's health behaviours, confidence, vocabulary to communicate about health, understanding of the health system and language, literacy and numeracy skills. CHP participation was perceived by teachers and CHPs as very successful, with teachers and CHPs reporting they complemented each other's skills. The logistics of coordinating CHPs within the constraints of the adult education setting was a significant obstacle to CHP participation. This study adds to existing evidence that health is an engaging topic for adult learners, and health literacy can be successfully implemented in an adult basic learning curriculum to empower learners to better manage their health. Health workers can deliver targeted health messages in this environment, and introduce local health services. Investment in adult literacy programs teaching health content has potential both to meet the goals of adult language and literacy programs and deliver health benefit in vulnerable populations.
Nahidi, S, Blignault, I, Hayen, A & Razee, H 2018, 'Psychological Distress in Iranian International Students at an Australian University.', Journal of Immigrant and Minority Health, vol. 20, no. 3, pp. 651-657.View/Download from: Publisher's site
This study investigated psychological distress in Iranian international students at UNSW Australia, and explored the psychosocial factors associated with high levels of distress. A total of 180 Iranian international students pursuing undergraduate and postgraduate degrees during 2012/2013 completed an email questionnaire containing socio-demographic items and five standardized and validated scales. Multivariable logistic regression was used to analyse the predictors of psychological distress. Compared to domestic and international students at two other Australian universities, a significantly smaller proportion of Iranian international students scored as distressed on the Kessler Psychological Distress Scale (K10). Greater levels of psychological distress were associated with being female, poorer physical health, less social support, less religious involvement and spirituality, and negative attitudes towards seeking professional psychological help. Findings from this growing group of international students can help inform culturally competent mental health promotion and service provision in their host countries.
Paul, RC, Gidding, HF, Nazneen, A, Banik, KC, Sumon, SA, Paul, KK, Luby, SP, Gurley, ES & Hayen, A 2018, 'A Low-Cost, Community Knowledge Approach to Estimate Maternal and Jaundice-Associated Mortality in Rural Bangladesh.', The American journal of tropical medicine and hygiene, vol. 99, no. 6, pp. 1633-1638.View/Download from: Publisher's site
In the absence of a civil registration system, a house-to-house survey is often used to estimate cause-specific mortality in low- and middle-income countries. However, house-to-house surveys are resource and time intensive. We applied a low-cost community knowledge approach to identify maternal deaths from any cause and jaundice-associated deaths among persons aged ≥ 14 years, and stillbirths and neonatal deaths in mothers with jaundice during pregnancy in five rural communities in Bangladesh. We estimated the method's sensitivity and cost savings compared with a house-to-house survey. In the five communities with a total of 125,570 population, we identified 13 maternal deaths, 60 deaths among persons aged ≥ 14 years associated with jaundice, five neonatal deaths, and four stillbirths born to a mother with jaundice during pregnancy over the 3-year period before the survey using the community knowledge approach. The sensitivity of community knowledge method in identifying target deaths ranged from 80% for neonatal deaths to 100% for stillbirths and maternal deaths. The community knowledge approach required 36% of the staff time to undertake compared with the house-to-house survey. The community knowledge approach was less expensive but highly sensitive in identifying maternal and jaundice-associated mortality, as well as all-cause adult mortality in rural settings in Bangladesh. This method can be applied in rural settings of other low- and middle-income countries and, in conjunction with hospital-based hepatitis diagnoses, used to monitor the impact of programs to reduce the burden of cause-specific hepatitis mortality, a current World Health Organization priority.
Saha, A, Hayen, A, Ali, M, Rosewell, A, MacIntyre, CR, Clemens, JD & Qadri, F 2018, 'Socioeconomic drivers of vaccine uptake: An analysis of the data of a geographically defined cluster randomized cholera vaccine trial in Bangladesh.', Vaccine, vol. 36, no. 31, pp. 4742-4749.View/Download from: Publisher's site
BACKGROUND:Evaluations of oral cholera vaccines (OCVs) have demonstrated their effectiveness in diverse settings. However, low vaccine uptake in some settings reduces the opportunity for prevention. This paper identifies the socioeconomic factors associated with vaccine uptake in a mass vaccination program. METHODS:This was a three-arm (vaccine, vaccine plus behavioral change, and non-intervention) cluster randomized trial conducted in Dhaka, Bangladesh. Socio-demographic and vaccination data were collected from 268,896 participants. A geographical information system (GIS) was used to design and implement the vaccination program. A logistic regression model was used to assess the association between vaccine uptake and socioeconomic characteristics. RESULTS:The GIS supported the implementation of the vaccination program by identifying ideal locations of vaccination centres for equitable population access, defining catchment areas of daily activities, and providing daily coverage maps during the campaign. Among 188,206 individuals in the intervention arms, 123,686 (66%) received two complete doses, and 64,520 (34%) received one or no doses of the OCV. The vaccine uptake rate was higher in females than males (aOR: 1.80; 95% CI = 1.75-1.84) and in younger (<15 years) than older participants (aOR: 2.19; 95% CI = 2.13-3.26). Individuals living in their own house or having a higher monthly family expenditure were more likely to receive the OCV (aOR: 1.60; 95% CI = 1.50-1.70 and aOR: 1.14; 95% CI = 1.10-1.18 respectively). Individuals using treated water for drinking or using own tap as the source of water were more likely to receive the OCV (aOR: 1.23; 95% CI = 1.17-1.29 and aOR: 1.14; 95% CI = 1.02-1.25 respectively) than their counterpart. Vaccine uptake was also significantly higher in participants residing farther away from health facilities (aOR: 95% 1.80; CI = 1.36-2.37). CONCLUSION:The GIS was useful in designing field activities, facilitating vaccine delivery an...
Wiseman, V, Thabrany, H, Asante, A, Haemmerli, M, Kosen, S, Gilson, L, Mills, A, Hayen, A, Tangcharoensathien, V & Patcharanarumol, W 2018, 'An evaluation of health systems equity in Indonesia: Study protocol', International Journal for Equity in Health, vol. 17, no. 1.View/Download from: Publisher's site
© 2018 The Author(s). Background: Many low and middle income countries are implementing reforms to support Universal Health Coverage (UHC). Perhaps one of the most ambitious examples of this is Indonesia's national health scheme known as the JKN which is designed to make health care available to its entire population of 255 million by end of 2019. If successful, the JKN will be the biggest single payer system in the world. While Indonesia has made steady progress, around a third of its population remains without cover and out of pocket payments for health are widespread even among JKN members. To help close these gaps, especially among the poor, the Indonesian government is currently implementing a set of UHC policy reforms that include the integration of remaining government insurance schemes into the JKN, expansion of provider networks, restructuring of provider payments systems, accreditation of all contracted health facilities and a range of demand side initiatives to increase insurance uptake, especially in the informal sector. This study evaluates the equity impact of this latest set of UHC reforms. Methods: Using a before and after design, we will evaluate the combined effects of the national UHC reforms at baseline (early 2018) and target of JKN full implementation (end 2019) on: progressivity of the health care financing system; pro-poorness of the health care delivery system; levels of catastrophic and impoverishing health expenditure; and self-reported health outcomes. In-depth interviews with stakeholders to document the context and the process of implementing these reforms, will also be undertaken. Discussion: As countries like Indonesia focus on increasing coverage, it is critically important to ensure that the poor and vulnerable - who are often the most difficult to reach - are not excluded. The results of this study will not only help track Indonesia's progress to universalism but also reveal what the UHC-reforms mean to the poor.
Bradd, P, Travaglia, J & Hayen, A 2018, 'Allied health leadership in New South Wales: a study of perceptions and priorities of allied health leaders.', Australian health review : a publication of the Australian Hospital Association, vol. 42, no. 3, pp. 316-320.View/Download from: Publisher's site
Objective The aim of the present study was to investigate the opinions and perceptions of senior allied health (AH) leaders in relation to AH leadership, governance and organisation from an Australian public health perspective. The target group was the New South Wales (NSW) Health AH directors or advisors, the most senior public AH professionals in NSW. Methods The study was conducted over a 6-month period in 2014-15 and comprised two parts: (1) data collection through a 46-question online survey that sought the views of AH leaders about the field of AH in NSW; and (2) two confirmatory focus groups with members of the NSW Health Allied Health Directors Committee. Results The online questionnaire generated novel information about the field of AH in the public sector of NSW, including the current organisation, governance and culture of AH. Focus group participants explored key findings in greater depth, including the effects of AH on and value of AH to the health system as a whole, as well as the attributes and competencies required by AH leaders. Participants identified the need to build and grow their influence, to more clearly demonstrate AH's contribution and to realign efforts towards more strategic issues influencing governance, performance, professional standards and advocacy. This entailed broadening the vision and scope of AH Directors as well as across discipline leaders. Conclusion The results provide new information about Australian AH leadership, governance, culture and organisation, and highlight potential priorities for future leadership activities. What is known about this topic? Although leadership is considered an essential element in the provision of high-quality health care, leadership across AH remains underexamined. What does this paper add? There is a paucity of literature pertaining to AH leadership nationally and internationally. This paper describes the issues affecting AH leaders and leadership in NSW, as reported by senior AH leaders. Wh...
Bradd, P, Travaglia, J & Hayen, A 2018, 'Developing allied health leaders to enhance person-centred healthcare.', Journal of health organization and management, vol. 32, no. 7, pp. 908-932.View/Download from: Publisher's site
PURPOSE:The purpose of this paper is to present findings from a mixed methods study investigating leadership development of allied health practitioners within a large public healthcare organization in Australia. DESIGN/METHODOLOGY/APPROACH:The South Eastern Sydney Local Health District Allied Health Leadership Development Program was undertaken with an allied health cohort ( n=16) between May 2014 and March 2015 and comprised all-day workshops, action learning sets and individual coaching. Using experiential learning, the program tested whether practice development methods and action learning approaches developed the leadership skills of participants compared with a control group ( n=17). Descriptive statistics were collected to evaluate participant and program outcomes. Leadership, workplace culture and engagement measures were analyzed as part of the study. FINDINGS:The Allied Health Leadership Development Program received high ratings by participants. They reported enhanced skills in leading self and others through mechanisms such as critical reflection and facilitation, and greater confidence managing change and with engaging staff, colleagues and patients in decision making, affecting the quality and safety of healthcare. Statistically significant differences were found with transformational leadership elements, leadership outcomes, and measures of workplace culture and engagement after program completion for intervention group participants, compared with the control group. RESEARCH LIMITATIONS/IMPLICATIONS:Results provide new empirical evidence about the effectiveness of using practice development for allied health leadership development. PRACTICAL IMPLICATIONS:This low-cost leadership program can be replicated by other organizations. ORIGINALITY/VALUE:Outcomes from an Allied Health Leadership Development Program have not been previously reported in the literature.
Nayak, A, Hayen, A, Zhu, L, McGeechan, K, Glasziou, P, Irwig, L, Doust, J, Gregory, G & Bell, K 2018, 'Legacy effects of statins on cardiovascular and all-cause mortality: a meta-analysis', BMJ OPEN, vol. 8, no. 9.View/Download from: Publisher's site
Arora, A, Manohar, N, Hayen, A, Bhole, S, Eastwood, J, Levy, S & Scott, JA 2017, 'Determinants of breastfeeding initiation among mothers in Sydney, Australia: Findings from a birth cohort study', International Breastfeeding Journal, vol. 12, no. 1.View/Download from: Publisher's site
© 2017 The Author(s). Background: Breastfeeding has short-term and long-term benefits for both the infant and the mother. The objective of this study was to identify the incidence of breastfeeding initiation among women in South Western Sydney, and the factors associated with the initiation of breastfeeding. Methods: Child and Family Health Nurses recruited mother-infant dyads (n=1035) to the Healthy Smiles Healthy Kids birth study in South Western Sydney, an ethnically and socio-economically diverse area, at the first post-natal home visit. A sample of 935 women completed a structured, interviewer-administered questionnaire at 8weeks. Multivariate logistic regression analysis was used to identify those factors independently associated with the initiation of breastfeeding. Results: In total, 92% of women (n=860) commenced breastfeeding in hospital. Women who completed a university degree were more likely to initiate breastfeeding compared to those who did not complete high school (AOR=7.16, 95% CI 2.73, 18.79). Vietnamese women had lower odds of breastfeeding initiation compared to Australian born women (AOR=0.34. 95% CI 0.13, 0.87). Women who had more than one child were less likely to breastfeed than those who had one child (AOR=0.38, 95% CI 0.19, 0.79). Women who gave birth via a caesarean section were less likely to breastfeed their baby compared to those who had a vaginal delivery (AOR=0.27, 95% CI 0.14, 0.52). Women who drank alcohol during pregnancy had 72% lower odds to breastfeed compared to those who did not drink alcohol during pregnancy (AOR=0.28, 95% CI 0.11, 0.71). Women who reported that their partner preferred breastfeeding were more likely to initiate breastfeeding (AOR=11.77, 95% CI 5.73, 24.15) and women who had chosen to breastfeed before pregnancy had more than 2.5 times the odds of breastfeeding their baby compared to those women who made their decision either during pregnancy or after labour (AOR=2.80, 95% CI 1.31, 5.97). Conclusions: Women...
Asante, AD, Irava, W, Limwattananon, S, Hayen, A, Martins, J, Guinness, L, Ataguba, JE, Price, J, Jan, S, Mills, A & Wiseman, V 2017, 'Financing for universal health coverage in small island states: evidence from the Fiji Islands.', BMJ Global Health, vol. 2, no. 2, pp. e000200-e000200.View/Download from: Publisher's site
BACKGROUND: Universal health coverage (UHC) is critical to global poverty alleviation and equity of health systems. Many low-income and middle-income countries, including small island states in the Pacific, have committed to UHC and reforming their health financing systems to better align with UHC goals. This study provides the first comprehensive evidence on equity of the health financing system in Fiji, a small Pacific island state. The health systems of such states are poorly covered in the international literature. METHODS: The study employs benefit and financing incidence analyses to evaluate the distribution of health financing benefits and burden across the public and private sectors. Primary data from a cross-sectional survey of 2000 households were used to assess healthcare benefits and secondary data from the 2008-2009 Fiji Household Income and Expenditure Survey to assess health financing contributions. These were analysed by socioeconomic groups to determine the relative benefit and financing incidence across these groups. FINDINGS: The distribution of healthcare benefits in Fiji slightly favours the poor-around 61% of public spending for nursing stations and 26% of spending for government hospital inpatient care were directed to services provided to the poorest 20% of the population. The financing system is significantly progressive with wealthier groups bearing a higher share of the health financing burden. CONCLUSIONS: The healthcare system in Fiji achieves a degree of vertical equity in financing, with the poor receiving a higher share of benefits from government health spending and bearing a lower share of the financing burden than wealthier groups.
Bell, KJL, Hayen, A, Glasziou, P, Irwig, L & Bauer, DC 2017, 'Change in Bone Mineral Density Is an Indicator of Treatment-Related Antifracture Effect.', Annals of Internal Medicine, vol. 166, no. 2, pp. 152-152.View/Download from: Publisher's site
Bell, KJL, Hayen, A, Glasziou, P, Mitchell, AS, Farris, M, Wright, J, Duerr, H-P, Mitchell, P & Irwig, L 2017, 'EARLY CRT MONITORING USING TIME-DOMAIN OPTICAL COHERENCE TOMOGRAPHY DOES NOT ADD TO VISUAL ACUITY FOR PREDICTING VISUAL LOSS IN PATIENTS WITH CENTRAL RETINAL VEIN OCCLUSION TREATED WITH INTRAVITREAL RANIBIZUMAB: A Secondary Analysis of Trial Data.', Retina (Philadelphia, Pa.), vol. 37, no. 3, pp. 509-514.View/Download from: Publisher's site
Our primary purpose was to assess the clinical (predictive) validity of central retinal thickness (CRT) and best corrected visual acuity (BCVA) at 1 week and 1 month after starting treatment with ranibizumab for central retinal vein occlusion. The authors also assessed detectability of response to treatment.The authors used data from 325 participants in the CRUISE study, which included measurement of time-domain CRT and BCVA at baseline, 1 week, 1 month, and 6 months postrandomization. Analysis of covariance models were fitted to assess clinical validity, and distributions of change were constructed to assess detectability of response.There was no evidence that 1-week CRT, and very strong evidence that 1-week BCVA were associated with baseline-adjusted BCVA at 6 months (P = 0.17 and P < 0.001, respectively). There was strong evidence that both 1-month CRT and 1-month BCVA were associated with baseline-adjusted 6-month BCVA (P = 0.005 and P < 0.001, respectively), but simultaneous adjustment found evidence of independent association only for BCVA (P = 0.71 and P < 0.001 for CRT and BCVA, respectively). Detectability of response tended to be higher for CRT than BCVA at 1 week and 1 month but by 6 months these were equivalent for CRT and BCVA.In this study, BCVA monitoring of treated central retinal vein occlusion patients seemed more informative than time-domain optical coherence tomography monitoring.
Brignell, A, Albein-Urios, N, Woolfenden, S, Hayen, A, Iorio, A & Williams, K 2017, 'Overall prognosis of preschool autism spectrum disorder diagnoses', Cochrane Database of Systematic Reviews, vol. 2017, no. 8.View/Download from: Publisher's site
© 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This is a protocol for a Cochrane Review (Prognosis). The objectives are as follows: The primary objective of this review is to synthesise the available evidence on the proportion of individuals who have a diagnosis of autism spectrum disorder at baseline and at follow-up one or more years later. The secondary objectives of this review are to: investigate whether there are differences in the proportions of individuals with autism spectrum disorder who maintain a diagnosis at follow-up dependent on use of the different classification systems (i.e. DSM or ICD criteria) and their revisions; and investigate the proportion of individuals with autism spectrum disorder who maintain diagnosis at follow-up in important subgroups of individuals, including those of different ages and those with different language levels (verbal/non-verbal; standard score ≤ 70 or > 70), IQs (≤ 70 or > 70), adaptive behaviour (standard score ≤ 70 or > 70), and different diagnostic subgroups (Asperger's syndrome/disorder, autistic disorder, childhood autism, PDD-NOS, atypical autism, PDD and autism spectrum disorder). We will investigate potential sources of heterogeneity that may impact outcomes such as differences in study participation, study design, length of follow-up, participant attrition and participant outcome measurement factors. We will use internationally recognised standards for systematic reviews to guide the review.
Burston, J, Adhikari, S, Hayen, A, Doolan, H, Kelly, ML, Fu, K, Jensen, TO & Konecny, P 2017, 'A Role for Antimicrobial Stewardship in Clinical Sepsis Pathways: a Prospective Interventional Study.', Infection Control and Hospital Epidemiology, pp. 1-7.View/Download from: Publisher's site
OBJECTIVE To evaluate the impact of early infectious diseases (ID) antimicrobial stewardship (AMS) intervention on inpatient sepsis antibiotic management. DESIGN Interventional, nonrandomized, controlled study. SETTING Tertiary-care referral hospital, Sydney, Australia. PATIENTS Consecutive, adult, non-intensive care unit (non-ICU) inpatients triggering an institutional clinical sepsis pathway from May to August 2015. INTERVENTION All patients reviewed by an ID Fellow within 24 hours of sepsis pathway trigger underwent case review and clinic file documentation of recommendations. Those not reviewed by an ID Fellow were considered controls and received standard sepsis pathway care. The primary outcome was antibiotic appropriateness 48 hours after sepsis trigger. RESULTS In total, 164 patients triggered the sepsis pathway: 6 patients were excluded (previous sepsis trigger); 158 patients were eligible; 106 had ID intervention; and 52 were control cases. Of these 158 patients, 91 (58%) had sepsis, and 15 of these 158 (9.5%) had severe sepsis. Initial antibiotic appropriateness, assessable in 152 of 158 patients, was appropriate in 80 (53%) of these 152 patients and inappropriate in 72 (47%) of these patients. In the intervention arm, 93% of ID Fellow recommendations were followed or partially followed, including 53% of cases in which antibiotics were de-escalated. ID Fellow intervention improved antibiotic appropriateness at 48 hours by 24% (adjusted risk ratio, 1.24; 95% confidence interval, 1.04-1.47; P=.035). The appropriateness agreement among 3 blinded ID staff opinions was 95%. Differences in intervention and control group mortality (13% vs 17%) and median length of stay (13 vs 17.5 days) were not statistically significant. CONCLUSION Sepsis overdiagnosis and delayed antibiotic optimization may reduce sepsis pathway effectiveness. Early ID AMS improved antibiotic management of non-ICU inpatients with suspected sepsis, predominantly by de-escalation. Further stu...
Deng, L, Reekie, J, Hayen, A, Kong, M, Kaldor, JM, Ward, J & Liu, B 2017, 'Comparison of recording of hepatitis B infection in the NSW Perinatal Data Collection with linked hepatitis B notifications', Public Health Research and Practice, vol. 27, no. 5.View/Download from: Publisher's site
© 2017 Deng et al. Objective: Results of routine maternal antenatal hepatitis B (HBV) screening have been recorded in the New South Wales (NSW) Perinatal Data Collection (PDC) since January 2011. We evaluated the accuracy of this reporting in 2012, the first year that comprehensive data were available, by linking the PDC to HBV notifications. Methods: PDC records of mothers giving birth in 2012 were probabilistically linked to HBV notifications recorded in the NSW Notifiable Conditions Information Management System (NCIMS). Sensitivity and specificity of the PDC record of HBV status were determined using a linked HBV notification from the NCIMS database as the gold standard. Results were also examined according to health service (area health service, hospital level, public or private) and individual factors (maternal age, country of birth, Aboriginality, parity, timing of first antenatal visit). Results: Among 99 510 records of women giving birth in NSW in 2012, positive HBV status was recorded for 0.69% of the women according to the PDC record and 0.90% from linked NCIMS records. The overall sensitivity of the HBV status variable in the PDC data was 65.5% (95% confidence interval [CI] 62.4, 68.7) and positive predictive value was 85.3% (95% CI 82.6, 87.9). In general, the low prevalence of HBV meant we had limited statistical power to assess differences between health service factors and maternal factors; however, sensitivity was significantly lower in PDC data for HBV in Australian-born non-Aboriginal women (37.0%; 95% CI 27.5, 46.7) than in overseas-born women (69.9%; 95% CI 66.6, 73.1; p < 0.001). Conclusions: PDC records of HBV status for women giving birth in 2012 had high specificity but poor sensitivity. Sensitivity varied across area health services and levels of maternal services, and by various maternal factors. Because the results of maternal HBV screening can be used to monitor HBV prevalence in adults, analysis of the PDC records in subsequent years...
Deng, L, Reekie, J, Ward, JS, Hayen, A, Kaldor, JM, Kong, M, Hunt, JM & Liu, B 2017, 'Trends in the prevalence of hepatitis B infection among women giving birth in New South Wales.', Medical Journal of Australia, vol. 206, no. 7, pp. 301-305.View/Download from: Publisher's site
OBJECTIVES: To evaluate the effect of targeted and catch-up hepatitis B virus (HBV) vaccination programs in New South Wales on HBV prevalence among women giving birth for the first time. DESIGN: Observational study linking data from the NSW Perinatal Data Collection for women giving birth during 2000-2012 with HBV notifications in the NSW Notifiable Conditions Information Management System. MAIN OUTCOME MEASURES: HBV prevalence in Indigenous Australian, non-Indigenous Australian-born, and overseas-born women giving birth. RESULTS: Of 482 944 women who gave birth to their first child, 3383 (0.70%) were linked to an HBV notification. HBV prevalence was 1.95% (95% CI, 1.88-2.02%) among overseas-born women, 0.79% (95% CI, 0.63-0.95%) among Indigenous Australian women, and 0.11% (95% CI, 0.09-0.12%) among non-Indigenous Australian-born women. In Indigenous Australian women, prevalence was significantly lower for those who had been eligible for inclusion in the targeted at-risk newborn or universal school-based vaccination programs (maternal year of birth, 1992-1999: 0.15%) than for those who were not (born ≤ 1981: 1.31%; for trend, P < 0.001). There was no statistically significant downward trend among non-Indigenous Australian-born or overseas-born women. HBV prevalence was higher among Indigenous women residing in regional and remote areas than those in major cities (adjusted odds ratio [aOR], 2.23; 95% CI, 1.40-3.57), but lower for non-Indigenous (aOR, 0.39; 95% CI, 0.28-0.55) and overseas-born women (aOR, 0.61; 95% CI, 0.49-0.77). CONCLUSION: Among women giving birth, there was a significant reduction in HBV prevalence in Indigenous women associated with the introduction of the HBV vaccination program in NSW, although prevalence remains higher than among non-Indigenous Australian-born women, and it also varies by region of residence. Continuing evaluation is needed to ensure that the prevalence of HBV infections continues to fall in Australia.
Gale, M, Hayen, A, Truman, G, Varma, R, Forssman, BL & MacIntyre, CR 2017, 'Demographic and geographical risk factors for gonorrhoea and chlamydia in greater Western Sydney, 2003-2013.', Communicable diseases intelligence quarterly report, vol. 41, no. 2, pp. E134-E141.
Notification rates of sexually transmitted infections (STIs) have increased in New South Wales as elsewhere in Australia. Understanding trends in chlamydia and gonorrhoea notifications at smaller geographical areas may assist public health efforts to deliver targeted STI interventions.Routinely collected disease notification data from 2 local health districts within the greater Western Sydney area were analysed. De-identified notifications of gonorrhoea and chlamydia were extracted for people aged over 15 years during the period 1 January 2003 to 31 December 2013. Sex-specific and age-specific population notification rates for each infection were calculated. Incidence rate ratios were also calculated with age group, sex, year and local government area (LGA) of residence as explanatory variables.Rates of gonorrhoea and chlamydia increased among males and females over the period. Males had a 4-fold increased risk of gonorrhoea (P<0.0001). Compared with the 30-44 years age group, young people aged 15-29 years had a 70% increased risk of gonorrhoea and a 4-fold increased risk of chlamydia (P values < 0.0001). Chlamydia notifications demonstrated smaller and more uniform annual increases across LGAs compared with gonorrhoea notifications, which appeared more highly clustered.Analysis of notification rates of chlamydia and gonorrhoea in the greater Western Sydney area suggest that young people aged 15-29 years and residents of particular LGAs are at greater risk of infection. A limitation was the unknown effect of patterns of testing. Nevertheless, these results can support the planning of local sexual health clinical services as well as the design of targeted health promotion interventions.
Griffiths, G, Woolfenden, S, Williams, K, Raman, S, Tzioumi, D & Hayen, A 2017, 'Comprehensive paediatric assessments for children in out of home care', Cochrane Database of Systematic Reviews, vol. 2017, no. 1.View/Download from: Publisher's site
© 2017 The Cochrane Collaboration. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of comprehensive paediatric assessments in identifying physical, developmental, mental health, and behavioural needs, and in facilitating access to appropriate interventions compared with usual care (partial assessment) or no assessment for children entering out of home care.
BACKGROUND: Population-based cancer screening has been established for several types of cancer in Australia and internationally. Screening may perform differently in practice from randomised controlled trials, which makes evaluating programs complex. MATERIALS AND METHODS: We discuss how to assess the evidence of benefits and harms of cancer screening, including the main biases that can mislead clinicians and policy makers (such as volunteer, lead-time, length-time and overdiagnosis bias). We also discuss ways in which communication of risks can inform or mislead the community. RESULTS: The evaluation of cancer screening programs should involve balancing the benefits and harms. When considering the overall worth of an intervention and allocation of scarce health resources, decisions should focus on the net benefits and be informed by systematic reviews. Communication of screening outcomes can be misleading. Many messages highlight the benefits while downplaying the harms, and often use relative risks and 5-year survival to persuade people to screen rather than support informed choice. LESSONS LEARNED: An evidence based approach is essential when evaluating and communicating the benefits and harms of cancer screening, to minimise misleading biases and the reliance on intuition.
Jo, HE, Glaspole, I, Grainge, C, Goh, N, Hopkins, PMA, Moodley, Y, Reynolds, PN, Chapman, S, Walters, EH, Zappala, C, Allan, H, Keir, GJ, Hayen, A, Cooper, WA, Mahar, AM, Ellis, S, Macansh, S & Corte, TJ 2017, 'Baseline characteristics of idiopathic pulmonary fibrosis: analysis from the Australian Idiopathic Pulmonary Fibrosis Registry.', European Respiratory Journal, vol. 49, no. 2.View/Download from: Publisher's site
7The prevalence of idiopathic pulmonary fibrosis (IPF), a fatal and progressive lung disease, is estimated at 1.25-63 out of 100 000, making large population studies difficult. Recently, the need for large longitudinal registries to study IPF has been recognised.The Australian IPF Registry (AIPFR) is a national registry collating comprehensive longitudinal data of IPF patients across Australia. We explored the characteristics of this IPF cohort and the effect of demographic and physiological parameters and specific management on mortality.Participants in the AIPFR (n=647, mean age 70.9±8.5 years, 67.7% male, median follow up 2 years, range 6 months-4.5 years) displayed a wide range of age, disease severity and co-morbidities that is not present in clinical trial cohorts. The cumulative mortality rate in year one, two, three and four was 5%, 24%, 37% and 44% respectively. Baseline lung function (forced vital capacity, diffusing capacity of the lung for carbon monoxide, composite physiological index) and GAP (gender, age, physiology) stage (hazard ratio 4.64, 95% CI 3.33-6.47, p<0.001) were strong predictors of mortality. Patients receiving anti-fibrotic medications had better survival (hazard ratio 0.56, 95% CI 0.34-0.92, p=0.022) than those not on anti-fibrotic medications, independent of underlying disease severity.The AIPFR provides important insights into the understanding of the natural history and clinical management of IPF.
Jo, HE, Glaspole, I, Grainge, C, Goh, N, Hopkins, PMA, Moodley, Y, Reynolds, PN, Chapman, S, Walters, EH, Zappala, C, Allan, H, Keir, GJ, Hayen, A, Cooper, WA, Mahar, AM, Ellis, S, Macansh, S & Corte, TJ 2017, 'Erratum: “Baseline characteristics of idiopathic pulmonary fibrosis: Analysis from the Australian Idiopathic Pulmonary Fibrosis Registry.” Helen E. Jo, Ian Glaspole, Christopher Grainge, Nicole Goh, Peter M.A. Hopkins, Yuben Moodley, Paul N. Reynolds, Sally Chapman, E. Haydn Walters, Christopher Zappala, Heather Allan, Gregory J. Keir, Andrew Hayen, Wendy A. Cooper, Annabelle M. Mahar, Samantha Ellis, Sacha Macansh and Tamera J. Corte (European Respiratory Journal (2017) 49 (1601592) DOI: 10.1183/13993003.01592-2016)', European Respiratory Journal, vol. 49, no. 3.View/Download from: Publisher's site
Copyright ©ERS 2017. This article from the February 2017 issue of the European Respiratory Journal was published with an error in figure 5. The legend identifying “Anti-fibrotics” and “No anti-fibrotics” in figure 5c was mistakenly transposed in production. The figure has been corrected and is reproduced below. The article has been corrected and republished online.
Improve the understanding of outcomes and complications of dialysis in Adolescents and Young Adults (AYA) to inform decisions about dialysis modality in this patient population.Registry data on Australian AYA aged 13 to 20 years who commenced dialysis between 1/1/2000 and 31/12/2013 were retrieved from the Australia and New Zealand Dialysis and Transplantation Registry and analysed to determine associations between demographic characteristics, dialysis modality and outcomes.During the study period 300 AYA commenced dialysis at a median age of 17.2 years (IQR 15.6 to 18.6 years). Haemodialysis (HD) was the initial dialysis modality in 201 patients (67%). No significant differences between AYA receiving HD and peritoneal dialysis (PD) were noted in patient gender, age, race, primary renal disease, treating centre type, remoteness of residential area, lateness of referral, or period of study. Mean haemoglobin levels were lower in the HD group (p = 0.005) and significantly fewer HD patients attended school full time compared to patients managed on PD (p = 0.002 first year; p = 0.05 second year).Dialysis modality choice does not appear to be influenced by patient characteristics nor dialysis outcomes. Future research is required to examine the reasons that HD is preferred over PD and to determine the optimal method of dialysis for this age group.
Muscat, DM, Morony, S, Smith, SK, Shepherd, HL, Dhillon, HM, Hayen, A, Trevena, L, Luxford, K, Nutbeam, D & McCaffery, KJ 2017, 'Qualitative insights into the experience of teaching shared decision making within adult education health literacy programmes for lower-literacy learners.', Health Expectations, vol. 20, no. 6, pp. 1393-1400.View/Download from: Publisher's site
BACKGROUND: Enhancing health literacy can play a major role in improving healthcare and health across the globe. To build higher-order (communicative/critical) health literacy skills among socially disadvantaged Australians, we developed a novel shared decision making (SDM) training programme for adults with lower literacy. The programme was delivered by trained educators within an adult basic education health literacy course. OBJECTIVE: To explore the experience of teaching SDM within a health literacy programme and investigate whether communicative/critical health literacy content meets learner needs and teaching and institutional objectives. DESIGN AND PARTICIPANTS: Qualitative interview study with 11 educators who delivered the SDM programme. Transcripts were analysed using the Framework approach; a matrix-based method of thematic analysis. RESULTS: Teachers noted congruence in SDM content and the institutional commitment to learner empowerment in adult education. The SDM programme was seen to offer learners an alternative to their usual passive approach to healthcare decision making by raising awareness of the right to ask questions and consider alternative test/treatment options. Teachers valued a structured approach to training building on foundational skills, with language reinforcement and take-home resources, but many noted the need for additional time to develop learner understanding and cover all aspects of SDM. Challenges for adult learners included SDM terminology, computational numerical risk tasks and understanding probability concepts. DISCUSSION AND CONCLUSIONS: SDM programmes can be designed in a way that both supports teachers to deliver novel health literacy content and empowers learners. Collaboration between adult education and healthcare sectors can build health literacy capacity of those most in need.
Saha, A, Hayen, A, Ali, M, Rosewell, A, Clemens, JD, MacIntyre, CR & Qadri, F 2017, 'Socioeconomic risk factors for cholera in different transmission settings: An analysis of the data of a cluster randomized trial in Bangladesh', VACCINE, vol. 35, no. 37, pp. 5043-5049.View/Download from: Publisher's site
Saha, A, Rosewell, A, Hayen, A, MacIntyre, CR & Qadri, F 2017, 'Improving immunization approaches to cholera.', Expert Review of Vaccines, vol. 16, no. 3, pp. 235-248.View/Download from: Publisher's site
INTRODUCTION: Cholera's impact is greatest in resource-limited countries. In the last decade several large epidemics have led to a global push to improve and implement the tools for cholera prevention and control. Areas covered: PubMed, Google Scholar and the WHO website were searched to review the literature and summarize the current status of cholera vaccines to make recommendations on improving immunization approaches to cholera. Oral cholera vaccines (OCVs) have demonstrated their effectiveness in endemic, outbreak response and emergency settings, highlighting their potential for wider adoption. While two doses of the currently available OCVs are recommended by manufacturers, a single dose would be easier to implement. Encouragingly, recent studies have shown that cold chain requirements may no longer be essential. The establishment of the global OCV stockpile in 2013 has been a major advance in cholera preparedness. New killed and live-attenuated vaccines are being actively explored as candidate vaccines for endemic settings and/or as a traveller's vaccine. The recent advances in cholera vaccination approaches should be considered in the global cholera control strategy. Expert commentary: The development of affordable cholera vaccines is a major success to improve cholera control. New vaccines and country specific interventions will further reduce the burden of this disease globally.
van Leeuwen, PJ, Hayen, A, Thompson, JE, Moses, D, Shnier, R, Böhm, M, Abuodha, M, Haynes, A-M, Ting, F, Barentsz, J, Roobol, M, Vass, J, Rasiah, K, Delprado, W & Stricker, PD 2017, 'A multiparametric magnetic resonance imaging-based risk model to determine the risk of significant prostate cancer prior to biopsy.', BJU International.View/Download from: Publisher's site
OBJECTIVE: To develop and externally validate a predictive model for detection of significant prostate cancer. PATIENTS AND METHODS: Development of the model was based on a prospective cohort including 393 men who underwent multiparametric magnetic resonance imaging (mpMRI) before biopsy. External validity of the model was then examined retrospectively in 198 men from a separate institution whom underwent mpMRI followed by biopsy for abnormal prostate-specific antigen (PSA) level or digital rectal examination (DRE). A model was developed with age, PSA level, DRE, prostate volume, previous biopsy, and Prostate Imaging Reporting and Data System (PIRADS) score, as predictors for significant prostate cancer (Gleason 7 with >5% grade 4, ≥20% cores positive or ≥7 mm of cancer in any core). Probability was studied via logistic regression. Discriminatory performance was quantified by concordance statistics and internally validated with bootstrap resampling. RESULTS: In all, 393 men had complete data and 149 (37.9%) had significant prostate cancer. While the variable model had good accuracy in predicting significant prostate cancer, area under the curve (AUC) of 0.80, the advanced model (incorporating mpMRI) had a significantly higher AUC of 0.88 (P < 0.001). The model was well calibrated in internal and external validation. Decision analysis showed that use of the advanced model in practice would improve biopsy outcome predictions. Clinical application of the model would reduce 28% of biopsies, whilst missing 2.6% significant prostate cancer. CONCLUSIONS: Individualised risk assessment of significant prostate cancer using a predictive model that incorporates mpMRI PIRADS score and clinical data allows a considerable reduction in unnecessary biopsies and reduction of the risk of over-detection of insignificant prostate cancer at the cost of a very small increase in the number of significant cancers missed.
Wiseman, V, Asante, A, Ir, P, Limwattananon, S, Jacobs, B, Liverani, M, Hayen, A & Jan, S 2017, 'System-wide analysis of health financing equity in Cambodia: a study protocol.', BMJ Global Health, vol. 2, no. 1, pp. e000153-e000153.View/Download from: Publisher's site
BACKGROUND: To assess progress towards universal health coverage, countries like Cambodia require evidence on equity in the financing and distribution of healthcare benefits. This evidence must be based on a system-wide perspective that recognises the complex roles played by the public and private sectors in many contemporary healthcare systems. OBJECTIVE: To undertake a system-wide assessment of who pays and who benefits from healthcare in Cambodia and to understand the factors influencing this. METHODS: Financing and benefit incidence analysis will be used to calculate the financing burden and distribution of healthcare benefits across socioeconomic groups. Data on healthcare usage, living standards and self-assessed health status will be derived from a cross-sectional household survey designed for this study involving a random sample of 5000 households. This will be supplemented by secondary data from the Cambodian National Health Accounts 2014 and the Cambodian Socioeconomic Survey (CSES) 2014. We will also collect qualitative data through focus group discussions and in-depth interviews to inform the interpretation of the quantitative analyses. POTENTIAL IMPACT: This study will produce previously unavailable information on who pays for, and who benefits from, health services across the entire health system of Cambodia. This evidence comes at a critical juncture in healthcare reform in South-East Asia with so many countries seeking guidance on the equity impact of their current financing arrangements that include a complex mix of public and private providers.
Robertson, H, Nicholas, N, Travaglia, J, Hayen, A & Georgiou, A 2017, 'A Virtual Earth Model of the Dementias in China.', Studies in Health Technology and Informatics, vol. 245, pp. 569-572.View/Download from: Publisher's site
This developmental project was undertaken to explore how applying spatial science analysis and visualisation methods might inform societies undergoing significant structural and demographic change. China is rapidly transitioning to an aged society. It already exceeds all other countries in its population aged 65 years and over. Dementia is closely correlated with ageing and intersects with a variety of physical and cognitive disabilities. Information dashboards are a growing part of health and social policy data environments. These visual data applications increasingly include mapping capabilities. In this paper, we explore the utility of a geographic modelling approach to exploring the complex nature of population ageing and the dementias in China.
Asante, A, Price, J, Hayen, A, Jan, S & Wiseman, V 2016, 'Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses', PLOS ONE, vol. 11, no. 4.View/Download from: Publisher's site
Bell, K, Hayen, A, Glasziou, P, Irwig, L, Eastell, R, Harrison, S, Black, DM & Bauer, DC 2016, 'Potential Usefulness of BMD and Bone Turnover Monitoring of Zoledronic Acid Therapy Among Women With Osteoporosis: Secondary Analysis of Randomized Controlled Trial Data', Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, vol. 31, no. 9, pp. 1767-1773.View/Download from: Publisher's site
We aimed to compare the clinical validity and the detectability of response of short-term changes in bone mineral density (BMD; hip and spine) and bone turnover markers (serum PINP and CTX) through secondary analysis of trial data. We analyzed data on 7765 women with osteoporosis randomized to 5-mg once-yearly infusions of zoledronic acid or placebo in the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly Pivotal Fracture Trial (HORIZON-PFT; trial ran from 2002 to 2006) and the first extension trial (trial ran from 2006 to 2009). We assessed the clinical validity and detectability of response for 1-year measurements of the following monitoring tests: total hip and lumbar spine BMD, serum N-terminal propeptide of type I collagen (sPINP), and serum C-telopeptide of type I collagen (sCTX; 6-month measurement used). Clinical validity was assessed by examining prediction of clinical fracture in Cox models; detectability of response to treatment was assessed by the ratio of signal to noise, estimated from the distributions of change in zoledronic acid and placebo groups. Baseline measurements were available for 7683 women with hip BMD, 558 with spine BMD, 1246 with sPINP, and 517 women with sCTX. Hip BMD and sPINP ranked highly for prediction of clinical fracture, whereas sPINP and sCTX ranked highly for detectability of response to treatment. Serum PINP had the highest overall ranking. In conclusion, serum PINP is potentially useful in monitoring response to zoledronic acid. Further research is needed to evaluate the effects of monitoring PINP on treatment decisions and other clinically relevant outcomes. © 2016 American Society for Bone and Mineral Research
Chughtai, AA, Seale, H, Tham, CD, Hayen, A, Rahman, B & MacIntyre, CR 2016, 'Compliance with the Use of Medical and Cloth Masks Among Healthcare Workers in Vietnam', ANNALS OF OCCUPATIONAL HYGIENE, vol. 60, no. 5, pp. 619-630.View/Download from: Publisher's site
Dyda, A, Dyda, A, Karki, S, Hayen, A, MacIntyre, CR, Menzies, R, Banks, E, Kaldor, JM & Liu, B 2016, 'Influenza and pneumococcal vaccination in Australian adults: a systematic review of coverage and factors associated with uptake.', BMC Infectious Diseases, vol. 16, no. 1, pp. 515-515.View/Download from: Publisher's site
In the absence of an adult vaccination register, coverage estimates for influenza and pneumococcal vaccination come from surveys and other data sources.Systematic review and meta-analysis of studies examining vaccination coverage in Australian adults from 1990 to 2015, focusing on groups funded under the National Immunisation Program, and intervals prior to and following the introduction of universal funding.Twenty-two studies met the inclusion criteria; 18 used self-report to determine vaccination status. There were 130 unique estimates of coverage extracted. Among adults aged ≥65y, during the period of universal funding (1999-onwards), the summary estimate of annual influenza vaccination coverage from 27 point estimates was 74.8 % (95 % CI 73.4-76.2 %; range 63.9-82.4 %); prior to this period (1992-1998) from 10 point estimates it was 61.3 % (95 % CI 58.0-64.6 %; range 44.3-71.3 %). For the period of universal funding for pneumococcal vaccination (2005-onwards) the summary estimate for coverage was 56.0 % (95 % CI 53.2-58.8 %; range 51.2-72.8 %, 10 point estimates); prior to 2005 it was 35.4 % (95 % CI 18.8-52.0 %; range 15.4-45.2 %). Coverage for both vaccines was significantly higher following the introduction of universal funding. Influenza vaccination coverage in those aged 18-65 years with a medical indication was lower but data were not combined. Seven studies reported on Aboriginal Australians with three studies reporting five coverage estimates for influenza vaccination in adults ≥65 years (range 71 % - 89 %).Adult influenza and pneumococcal vaccination coverage has increased since the introduction of universal funding, but remains sub-optimal, with pneumococcal coverage lower than influenza.This review highlights the need for more coverage data overall and in high risk groups, to support public health programs to improve coverage.
Fahim, MA, Hayen, AD, Horvath, AR, Dimeski, G, Coburn, A, Tan, K-S, Johnson, DW, Craig, JC, Campbell, SB & Hawley, CM 2016, 'Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice', CLINICAL CHEMISTRY AND LABORATORY MEDICINE, vol. 54, no. 5, pp. E149-E150.View/Download from: Publisher's site
Fletcher, BR, Hinton, L, Bray, EP, Hayen, A, Hobbs, FDR, Mant, J, Potter, JF & McManus, RJ 2016, 'Self-monitoring blood pressure in patients with hypertension: an internet-based survey of UK GPs', BRITISH JOURNAL OF GENERAL PRACTICE, vol. 66, no. 652, pp. E831-E837.View/Download from: Publisher's site
Liu, B, Cowling, C, Hayen, A, Watt, G, Mak, DB, Lambert, S, Taylor, H & Kaldor, JM 2016, 'Relationship between Community Drug Administration Strategy and Changes in Trachoma Prevalence, 2007 to 2013', PLOS NEGLECTED TROPICAL DISEASES, vol. 10, no. 7.View/Download from: Publisher's site
MacIntyre, CR, Shaw, P, Mackie, FE, Boros, C, Marshall, H, Barnes, M, Seale, H, Kennedy, SE, Moa, A, Hayen, A, Chughtai, AA, O'Loughlin, EV & Stormon, M 2016, 'Immunogenicity and persistence of immunity of a quadrivalent Human Papillomavirus (HPV) vaccine in immunocompromised children', VACCINE, vol. 34, no. 36, pp. 4343-4350.View/Download from: Publisher's site
McCaffery, KJ, Morony, S, Muscat, DM, Smith, SK, Shepherd, HL, Dhillon, HM, Hayen, A, Luxford, K, Meshreky, W, Comings, J & Nutbeam, D 2016, 'Evaluation of an Australian health literacy training program for socially disadvantaged adults attending basic education classes: study protocol for a cluster randomised controlled trial', BMC PUBLIC HEALTH, vol. 16.View/Download from: Publisher's site
Mealing, N, Hayen, A & Newall, AT 2016, 'Assessing the impact of vaccination programmes on burden of disease: Underlying complexities and statistical methods', VACCINE, vol. 34, no. 27, pp. 3022-3029.View/Download from: Publisher's site
Muscat, DM, Shepherd, HL, Morony, S, Smith, SK, Dhillon, HM, Trevena, L, Hayen, A, Luxford, K, Nutbeam, D & McCaffery, K 2016, 'Can adults with low literacy understand shared decision making questions? A qualitative investigation', PATIENT EDUCATION AND COUNSELING, vol. 99, no. 11, pp. 1796-1802.View/Download from: Publisher's site
Muscat, DM, Smith, S, Dhillon, HM, Morony, S, Davis, EL, Luxford, K, Shepherd, HL, Hayen, A, Comings, J, Nutbeam, D & McCaffery, K 2016, 'Incorporating health literacy in education for socially disadvantaged adults: an Australian feasibility study', INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH, vol. 15.View/Download from: Publisher's site
Nathan, S, Bethmont, A, Rawstorne, PR, Ferry, M & Hayen, A 2016, 'Trends in drug use among adolescents admitted to residential treatment in Australia', MEDICAL JOURNAL OF AUSTRALIA, vol. 204, no. 4, pp. 149-+.View/Download from: Publisher's site
Nathan, S, Rawstorne, P, Hayen, A, Bryant, J, Baldry, E, Ferry, M, Williams, M, Shanahan, M & Jayasinha, R 2016, 'Examining the pathways for young people with drug and alcohol dependence: a mixed-method design to examine the role of a treatment programme.', BMJ Open, vol. 6, no. 5, pp. 1-14.View/Download from: Publisher's site
Young people with drug and alcohol problems are likely to have poorer health and other psychosocial outcomes than other young people. Residential treatment programmes have been shown to lead to improved health and related outcomes for young people in the short term. There is very little robust research showing longer term outcomes or benefits of such programmes. This paper describes an innovative protocol to examine the longer term outcomes and experiences of young people referred to a residential life management and treatment programme in Australia designed to address alcohol and drug issues in a holistic manner.This is a mixed-methods study that will retrospectively and prospectively examine young people's pathways into and out of a residential life management programme. The study involves 3 components: (1) retrospective data linkage of programme data to health and criminal justice administrative data sets, (2) prospective cohort (using existing programme baseline data and a follow-up survey) and (3) qualitative in-depth interviews with a subsample of the prospective cohort. The study will compare findings among young people who are referred and (a) stay 30 days or more in the programme (including those who go on to continuing care and those who do not); (b) start, but stay fewer than 30 days in the programme; (c) are assessed, but do not start the programme.Ethics approval has been sought from several ethics committees including a university ethics committee, state health departments and an Aboriginal-specific ethics committee. The results of the study will be published in peer-reviewed journals, presented at research conferences, disseminated via a report for the general public and through Facebook communications. The study will inform the field more broadly about the value of different methods in evaluating programmes and examining the pathways and trajectories of vulnerable young people.
Thompson, JE, van Leeuwen, PJ, Moses, D, Shnier, R, Brenner, P, Delprado, W, Pulbrook, M, Boehm, M, Haynes, AM, Hayen, A & Stricker, PD 2016, 'The Diagnostic Performance of Multiparametric Magnetic Resonance Imaging to Detect Significant Prostate Cancer', JOURNAL OF UROLOGY, vol. 195, no. 5, pp. 1428-1435.View/Download from: Publisher's site
Woolfenden, S, Eapen, V, Jalaludin, B, Hayen, A, Kemp, L, Dissanyake, C, Hendry, A, Axelsson, E, Overs, B, Eastwood, J, Črnčec, R, McKenzie, A, Beasley, D, Murphy, E & Williams, K 2016, 'Prevalence and factors associated with parental concerns about development detected by the Parents' Evaluation of Developmental Status (PEDS) at 6-month, 12-month and 18-month well-child checks in a birth cohort.', BMJ Open, vol. 6, no. 9, pp. 1-13.View/Download from: Publisher's site
Early identification of developmental vulnerability is vital. This study aimed to estimate the prevalence of moderate or high developmental risk on the Parents' Evaluation of Developmental Status (PEDS) at 6-month, 12-month and 18-month well-child checks; identify associated risk factors; and examine documentation of the PEDS at well-child checks.A prospective birth cohort of 2025 children with 50% of those approached agreeing to participate. Demographic data were obtained via questionnaires and linked electronic medical records. Telephone interviews were conducted with parents to collect PEDS data.Multiple logistic regression analyses identified risk factors for moderate or high developmental risk on the PEDS. A Cumulative Risk Index examined the impact of multiple risk factors on developmental risk and documentation of the PEDS at the well-child checks.Of the original cohort, 792 (39%) had 6-month, 649 (32%) had 12-month and 565 (28%) had 18-month PEDS data. Parental concerns indicating moderate or high developmental risk on the PEDS were 27% (95% CI 24 to 30) at 6 months, 27% (95% CI 24 to 30) at 12 months and 33% (95% CI 29 to 37) at 18 months. Factors associated with moderate or high developmental risk were perinatal risk (OR 12 months: 1.7 (95% CI 1.1 to 2.7)); maternal Middle Eastern or Asian nationality (OR 6 months: 1.6 (95% CI 1.1 to 2.4)), (OR 12 months: 1.7 (95% CI 1.1 to 2.7)); and household disadvantage (OR 6 months: 1.5 (95% CI 1.0 to 2.2). As the number of risk factors increased the odds increased for high or moderate developmental risk and no documentation of the PEDS at well-child checks.Children with multiple risk factors are more likely to have parental concerns indicating developmental vulnerability using the PEDS and for these concerns to not be documented.
Clarke, PM, Walter, SJ, Hayen, A, Mallon, WJ, Heijmans, J & Studdert, DM 2015, 'Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era', BRITISH JOURNAL OF SPORTS MEDICINE, vol. 49, no. 13, pp. 898-902.View/Download from: Publisher's site
De, S, Williams, GJ, Hayen, A, Macaskill, P, McCaskill, M, Isaacs, D & Craig, JC 2015, 'Value of white cell count in predicting serious bacterial infection in febrile children under 5 years of age', POSTGRADUATE MEDICAL JOURNAL, vol. 91, no. 1073, pp. 493-499.View/Download from: Publisher's site
Fahim, MA, Hayen, A, Horvath, AR, Dimeski, G, Coburn, A, Johnson, DW, Hawley, CM, Campbell, SB & Craig, JC 2015, 'N-Terminal Pro-B-Type Natriuretic Peptide Variability in Stable Dialysis Patients', CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, vol. 10, no. 4, pp. 620-629.View/Download from: Publisher's site
Fahim, MA, Hayen, AD, Horvath, AR, Dimeski, G, Coburn, A, Tan, K-S, Johnson, DW, Craig, JC, Campbell, SB & Hawley, CM 2015, 'Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice', CLINICAL CHEMISTRY AND LABORATORY MEDICINE, vol. 53, no. 5, pp. 715-722.View/Download from: Publisher's site
Gale, M, Muscatello, DJ, Dinh, M, Byrnes, J, Shakeshaft, A, Hayen, A, MacIntyre, CR, Haber, P, Cretikos, M & Morton, P 2015, 'Alcopops, taxation and harm: a segmented time series analysis of emergency department presentations', BMC PUBLIC HEALTH, vol. 15.View/Download from: Publisher's site
Hohenberg, M, Brennan, N & Hayen, A 2015, 'Can ambulatory blood pressure machines improve postural blood pressure data collection for geriatric patients admitted to a geriatric ward? A pilot study', AUSTRALASIAN JOURNAL ON AGEING, vol. 34, pp. 50-50.
Jamous, KF, Kalloniatis, M, Hennessy, MP, Agar, A, Hayen, A & Zangerl, B 2015, 'Clinical model assisting with the collaborative care of glaucoma patients and suspects', CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY, vol. 43, no. 4, pp. 308-319.View/Download from: Publisher's site
Memari, N, Hayen, A, Bell, KJL, Rychetnik, L, Morton, RL, McCaffery, K, Thompson, JF, Irwig, L & Turner, RM 2015, 'How Often Do Patients with Localized Melanoma Attend Follow-Up at a Specialist Center?', ANNALS OF SURGICAL ONCOLOGY, vol. 22, pp. S1164-S1171.View/Download from: Publisher's site
Mortimer, NJ, Rhee, J, Guy, R, Hayen, A & Lau, AYS 2015, 'A web-based personally controlled health management system increases sexually transmitted infection screening rates in young people: a randomized controlled trial', JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION, vol. 22, no. 4, pp. 805-814.View/Download from: Publisher's site
Muscat, DM, Morony, S, Shepherd, HL, Smith, SK, Dhillon, HM, Trevena, L, Hayen, A, Luxford, K, Nutbeam, D & McCaffery, K 2015, 'Development and field testing of a consumer shared decision-making training program for adults with low literacy', PATIENT EDUCATION AND COUNSELING, vol. 98, no. 10, pp. 1180-1188.View/Download from: Publisher's site
O'Leary, F, Hayen, A, Lockie, F & Peat, J 2015, 'Defining normal ranges and centiles for heart and respiratory rates in infants and children: a cross-sectional study of patients attending an Australian tertiary hospital paediatric emergency department', ARCHIVES OF DISEASE IN CHILDHOOD, vol. 100, no. 8, pp. 733-737.View/Download from: Publisher's site
Stuart, KE, Housami, N, Taylor, R, Hayen, A & Boyages, J 2015, 'Long-term outcomes of ductal carcinoma in situ of the breast: a systematic review, meta-analysis and meta-regression analysis', BMC CANCER, vol. 15.View/Download from: Publisher's site
Thompson, JE, Hayen, A, Landau, A, Haynes, A-M, Kalapara, A, Ischia, J, Matthews, J, Frydenberg, M & Stricker, PD 2015, 'Medium-term oncological outcomes for extended vs saturation biopsy and transrectal vs transperineal biopsy in active surveillance for prostate cancer', BJU INTERNATIONAL, vol. 115, no. 6, pp. 884-891.View/Download from: Publisher's site
Wiseman, V, Asante, A, Price, J, Hayen, A, Irava, W, Martins, J, Guinness, L & Jan, S 2015, 'Ten best resources for conducting financing and benefit incidence analysis in resource-poor settings', HEALTH POLICY AND PLANNING, vol. 30, no. 8, pp. 1053-1058.View/Download from: Publisher's site
Woolfenden, S, Williams, K, Eapen, V, Mensah, F, Hayen, A, Siddiqi, A & Kemp, L 2015, 'Developmental vulnerability - don't investigate without a model in mind', CHILD CARE HEALTH AND DEVELOPMENT, vol. 41, no. 3, pp. 337-345.View/Download from: Publisher's site
Yoshioka, N, Wong, E, Kalloniatis, M, Yapp, M, Hennessy, MP, Agar, A, Healey, PR, Hayen, A & Zangerl, B 2015, 'Influence of education and diagnostic modes on glaucoma assessment by optometrists', OPHTHALMIC AND PHYSIOLOGICAL OPTICS, vol. 35, no. 6, pp. 682-698.View/Download from: Publisher's site
Zangerl, B, Hayen, A, Mitchell, P, Jamous, KF, Stapleton, F & Kalloniatis, M 2015, 'Therapeutic endorsement enhances compliance with national glaucoma guidelines in Australian and New Zealand optometrists', OPHTHALMIC AND PHYSIOLOGICAL OPTICS, vol. 35, no. 2, pp. 212-224.View/Download from: Publisher's site
Asante, AD, Price, J, Hayen, A, Irava, W, Martins, J, Guinness, L, Ataguba, JE, Limwattananon, S, Mills, A, Jan, S & Wiseman, V 2014, 'Assessment of equity in healthcare financing in Fiji and Timor-Leste: a study protocol.', BMJ Open, vol. 4, no. 12, pp. 1-10.View/Download from: Publisher's site
Equitable health financing remains a key health policy objective worldwide. In low and middle-income countries (LMICs), there is evidence that many people are unable to access the health services they need due to financial and other barriers. There are growing calls for fairer health financing systems that will protect people from catastrophic and impoverishing health payments in times of illness. This study aims to assess equity in healthcare financing in Fiji and Timor-Leste in order to support government efforts to improve access to healthcare and move towards universal health coverage in the two countries.The study employs two standard measures of equity in health financing increasingly being applied in LMICs-benefit incidence analysis (BIA) and financing incidence analysis (FIA). In Fiji, we will use a combination of secondary and primary data including a Household Income and Expenditure Survey, National Health Accounts, and data from a cross-sectional household survey on healthcare utilisation. In Timor-Leste, the World Bank recently completed a health equity and financial protection analysis that incorporates BIA and FIA, and found that the distribution of benefits from healthcare financing is pro-rich. Building on this work, we will explore the factors that influence the pro-rich distribution.The study is approved by the Human Research Ethics Committee of University of New South Wales, Australia (Approval number: HC13269); the Fiji National Health Research Committee (Approval # 201371); and the Timor-Leste Ministry of Health (Ref MS/UNSW/VI/218).Study outcomes will be disseminated through stakeholder meetings, targeted multidisciplinary seminars, peer-reviewed journal publications, policy briefs and the use of other web-based technologies including social media. A user-friendly toolkit on how to analyse healthcare financing equity will be developed for use by policymakers and development partners in the region.
Bell, KJ, Glasziou, PP, Hayen, A & Irwig, L 2014, 'Criteria for monitoring tests were described: validity, responsiveness, detectability of long-term change, and practicality.', Journal of Clinical Epidemiology, vol. 67, no. 2, pp. 152-159.View/Download from: Publisher's site
OBJECTIVES: To describe how evidence from trials and cohort studies may be used to guide choice of test for monitoring patients with chronic disease. STUDY DESIGN AND SETTING: Exploration of potential criteria for choosing the best monitoring test. Criteria are defined and options for assessment measures for test performance on each criterion discussed. RESULTS: Monitoring in clinical practice occurs in three main phases: before treatment, response to treatment, and long-term monitoring. Four important criteria may be used to choose the best test for monitoring a patient in each of these phases. Clinical validity describes the ability of the test to predict the clinically relevant outcome that we are trying to control or prevent. Responsiveness describes how much the test changes in response to an intervention relative to background random variation. Detectability of long-term change describes the size of changes in the test over the long term relative to background random variation. Practicality describes the ease of use, invasiveness, and cost of the test. Test performance generally requires longitudinal data from trial and/or cohort studies using statistical methods such as those discussed. CONCLUSION: Four specific criteria can help clinicians inform evidence-based decisions on which monitoring test to use.
Bell, KJL, Beller, E, Sundstrom, J, McGeechan, K, Hayen, A, Irwig, L, Neal, B & Glasziou, P 2014, 'Ambulatory blood pressure adds little to Framingham Risk Score for the primary prevention of cardiovascular disease in older men: secondary analysis of observational study data', BMJ OPEN, vol. 4, no. 9.View/Download from: Publisher's site
De, S, Williams, GJ, Hayen, A, Macaskill, P, McCaskill, M, Isaacs, D & Craig, JC 2014, 'Value of white cell count in predicting serious bacterial infection in febrile children under 5 years of age.', Archives of Disease in Childhood, vol. 99, no. 6, pp. 493-499.View/Download from: Publisher's site
OBJECTIVE: The leukocyte count is frequently used to evaluate suspected bacterial infections but estimates of its test performance vary considerably. We evaluated its accuracy for the detection of serious bacterial infections in febrile children. DESIGN: Prospective cohort study. SETTING: Paediatric emergency department. PATIENTS: Febrile 0-5-year-olds who had a leukocyte count on presentation. OUTCOME MEASURES: Accuracy of total white blood cell and absolute neutrophil counts for the detection of urinary tract infection, bacteraemia, pneumonia and a combined ('any serious bacterial infection') category. Logistic regression models were fitted for each outcome. Reference standards were microbiological/radiological tests and clinical follow-up. RESULTS: Serious bacterial infections were present in 714 (18.3%) of 3893 illness episodes. The area under the receiver operating characteristic curve for 'any serious bacterial infection' was 0.653 (95% CI 0.630 to 0.676) for the total white blood cell count and 0.638 (95% CI 0.615 to 0.662) for absolute neutrophil count. A white blood cell count threshold >15×10(9)/L had a sensitivity of 47% (95% CI 43% to 50%), specificity 76% (95% CI 74% to 77%), positive likelihood ratio 1.93 (95% CI 1.75 to 2.13) and negative likelihood ratio 0.70 (95% CI 0.65 to 0.75). An absolute neutrophil count threshold >10×10(9)/L had a sensitivity of 41% (95% CI 38% to 45%), specificity 78% (95% CI 76% to 79%), positive likelihood ratio 1.87 (95% CI 1.68 to 2.09) and negative likelihood ratio 0.75 (95% CI 0.71 to 0.80). CONCLUSIONS: The total white blood cell count and absolute neutrophil count are not sufficiently accurate triage tests for febrile children with suspected serious bacterial infection.
Gale, M, Holden, J, Kitchener, S, Knight, V, McNulty, A, Price, K, Leeman, C, Cunningham, P, Hayen, A & MacInytre, CR 2014, 'Lessons learnt from the first Australian 'pop-up' HIV testing site', SEXUAL HEALTH, vol. 11, no. 6, pp. 585-586.View/Download from: Publisher's site
Hindmarsh, D, Loh, M, Finch, CF, Hayen, A & Close, JC 2014, 'Effect of comorbidity on relative survival following hospitalisation for fall-related hip fracture in older people.', Australasian Journal on Ageing, vol. 33, no. 3, pp. E1-E7.View/Download from: Publisher's site
AIM: To assess the effect of comorbidity on relative survival after hip fracture. METHODS: Relative survival analysis was undertaken in 16 838 fall-related hip fracture hospitalisations in New South Wales, Australia. Comorbidity was measured on the basis of additional diagnosis codes on the same hospital separation as the hip fracture using the Charlson Comorbidity Index (CCI). Interval-specific relative survival and relative excess risk of death were calculated. RESULTS: Comorbidity was more frequently documented in men than women across the age groups. Survival decreased with increasing age and increasing comorbidity, but the relative impact of comorbidity was greater in the younger-old age group (65-74 years). The excess mortality in men was not accounted for by age or comorbidities. CONCLUSIONS: This study demonstrates an association between increasing comorbidity and death particularly in the first 3 months post hip fracture. It also highlights a relative excess risk of death in men after hip fracture after adjusting for age and comorbidity.
Jamous, KF, Kalloniatis, M, Hayen, A, Mitchell, P, Stapleton, FJ & Zangerl, B 2014, 'Application of clinical techniques relevant for glaucoma assessment by optometrists: concordance with guidelines', OPHTHALMIC AND PHYSIOLOGICAL OPTICS, vol. 34, no. 5, pp. 580-591.View/Download from: Publisher's site
Jansen, J, Bonner, C, McKinn, S, Irwig, L, Glasziou, P, Doust, J, Teixeira-Pinto, A, Hayen, A, Turner, R & McCaffery, K 2014, 'General practitioners' use of absolute risk versus individual risk factors in cardiovascular disease prevention: an experimental study.', BMJ Open, vol. 4, no. 5, pp. 1-8.View/Download from: Publisher's site
To understand general practitioners' (GPs) use of individual risk factors (blood pressure and cholesterol levels) versus absolute risk in cardiovascular disease (CVD) risk management decision-making.Randomised experiment. Absolute risk, systolic blood pressure (SBP), cholesterol ratio (total cholesterol/high-density lipoprotein (TC/HDL)) and age were systematically varied in hypothetical cases. High absolute risk was defined as 5-year risk of a cardiovascular event >15%, high blood pressure levels varied between SBP 147 and 179 mm Hg and high cholesterol (TC/HDL ratio) between 6.5 and 7.2 mmol/L.4 GP conferences in Australia.144 Australian GPs.GPs indicated whether they would prescribe cholesterol and/or blood pressure lowering medication. Analyses involved logistic regression.For patients with high blood pressure: 93% (95% CI 86% to 96%) of high absolute risk patients and 83% (95% CI 76% to 88%) of lower absolute risk patients were prescribed blood pressure medication. Conversely, 30% (95% CI 25% to 36%) of lower blood pressure patients were prescribed blood pressure medication if absolute risk was high and 4% (95% CI 3% to 5%) if lower. 69% of high cholesterol/high absolute risk patients were prescribed cholesterol medication (95% CI 61% to 77%) versus 34% of high cholesterol/lower absolute risk patients (95% CI 28% to 41%). 36% of patients with lower cholesterol (95% CI 30% to 43%) were prescribed cholesterol medication if absolute risk was high versus 10% if lower (95% CI 8% to 13%).GPs' decision-making was more consistent with the management of individual risk factors than an absolute risk approach, especially when prescribing blood pressure medication. The results suggest medical treatment of lower risk patients (5-year risk of CVD event <15%) with mildly elevated blood pressure or cholesterol levels is likely to occur even when an absolute risk assessment is specifically provided. The results indicate a need for improving uptake of absolute risk guidelines...
Joshi, C, Torvaldsen, S, Hodgson, R & Hayen, A 2014, 'Factors associated with the use and quality of antenatal care in Nepal: a population-based study using the demographic and health survey data', BMC PREGNANCY AND CHILDBIRTH, vol. 14.View/Download from: Publisher's site
Liaw, S-T, Taggart, J, Yu, H, de Lusignan, S, Kuziemsky, C & Hayen, A 2014, 'Integrating electronic health record information to support integrated care: Practical application of ontologies to improve the accuracy of diabetes disease registers', JOURNAL OF BIOMEDICAL INFORMATICS, vol. 52, pp. 364-372.View/Download from: Publisher's site
Loy, CT, Hayen, A & McKinnon, C 2014, 'Protocol for REducing Anti-Psychotic use in residential care-Huntington Disease (REAP-HD): a pilot cluster randomised controlled trial of a multifaceted intervention for health professionals.', BMJ Open, vol. 4, no. 12, pp. 1-8.View/Download from: Publisher's site
Antipsychotics are commonly used for management of behavioural symptoms in dementia, among people in residential care. This continues to occur despite their modest effectiveness, potential harms including increased risk of death and stroke, and absence of detrimental effect when people with dementia were randomised to antipsychotic withdrawal. This study aims to test the hypothesis that the multifaceted REducing Anti-Psychotic use in residential care-Huntington Disease (REAP-HD) programme is more effective than standard staff education (SSE) in reducing antipsychotic use for people with HD in residential care facilities (RCF).this is a cluster randomised controlled trial with blinded outcome assessment. The study population is healthcare professionals looking after people with HD in individual RCF, in the state of New South Wales. Each RCF will be centrally randomised to the REAP-HD programme or the comparator, SSE. Blinded outcome assessment will be performed by examining drug charts and using the Neuropsychiatric Inventory-Q (NPI-Q). Primary outcome is the proportion of people with HD who have had a reduction in antipsychotic use 4 months after the intervention. Secondary outcome measures are (1) change in severity of behavioural symptoms, as measured by the NPI-Q at 4 months (to ensure antipsychotic reduction has not lead to worsening behavioural symptoms), and (2) proportion of people with HD who have had a reduction in antipsychotic dosage at 4 months for each strategy, compared to 4 months prior to enrolment (to capture the possibility that both arms reduced antipsychotic use). Analysis will be by Intention-To-Treat and take into account the clustering. Recruitment is ongoing, as of July 2014.This protocol has been approved by the Western Sydney Local Health District Human Research Ethics Committee, trial registration ACTRN12614000083695. Study results will be disseminated through peer-reviewed publication in an anonymous manner.ACTRN12614000083695, the Aus...
Macintyre, CR, Ridda, I, Gao, Z, Moa, AM, McIntyre, PB, Sullivan, JS, Jones, TR, Hayen, A & Lindley, RI 2014, 'A randomized clinical trial of the immunogenicity of 7-valent pneumococcal conjugate vaccine compared to 23-valent polysaccharide vaccine in frail, hospitalized elderly.', PLoS ONE, vol. 9, no. 4, pp. 1-14.View/Download from: Publisher's site
BACKGROUND: Elderly people do not mount strong immune responses to vaccines. We compared 23-valent capsular polysaccharide (23vPPV) alone versus 7-valent conjugate (PCV7) vaccine followed by 23vPPV 6 months later in hospitalized elderly. METHODS: Participants were randomized to receive 23vPPV or PCV7-23vPPV. Antibodies against serotypes 3, 4, 6A, 6B, 9V, 14, 18C, 19A, 19F, 23F were measured by enzyme-linked immunosorbent (ELISA) and opsonophagocytic (OPA) assays at baseline, 6 months and 12 months. RESULTS: Of 312 recruited, between 40% and 72% of subjects had undetectable OPA titres at baseline. After one dose, PCV7 recipients had significantly higher responses to serotypes 9V (both assays) and 23F (OPA only), and 23vPPV recipients had significantly higher responses to serotype 3 (ELISA), 19F and 19A (OPA only). In subjects with undetectable OPA titres at baseline, a proportionately greater rise in OPA titre (P<0.01) was seen for all serotypes after both vaccines. The GMT ratio of OPA was significantly higher at 12 months in the PCV7-23vPPV group for serotypes 6A, 9V, 18C and 23F. OPA titre levels for these serotypes increased moderately after 6 months, whereas immunity waned in the 23vPPV only arm. CONCLUSION: We did not show overwhelming benefit of one vaccine over the other. Low baseline immunity does not preclude a robust immune response, reiterating the importance of vaccinating the frail elderly. A schedule of PCV7-23vPPV prevents waning of antibody, suggesting that both vaccines could be useful in the elderly. Follow up studies are needed to determine persistence of immunity. TRIAL REGISTRATION: The Australian Clinical Trials Registry ACTRN12607000387426.
McManus, RJ, Wood, S, Bray, EP, Glasziou, P, Hayen, A, Heneghan, C, Mant, J, Padfield, P, Potter, JF & Hobbs, FD 2014, 'Self-monitoring in hypertension: a web-based survey of primary care physicians.', Journal of Human Hypertension, vol. 28, no. 2, pp. 123-127.View/Download from: Publisher's site
Although self-monitoring of blood pressure is common among people with hypertension, little is known about how general practitioners (GPs) use such readings. This survey aimed to ascertain current views and practice on self-monitoring of UK primary care physicians. An internet-based survey of UK GPs was undertaken using a provider of internet services to UK doctors. The hyperlink to the survey was opened by 928 doctors, and 625 (67%) GPs completed the questionnaire. Of them, 557 (90%) reported having patients who self-monitor, 191 (34%) had a monitor that they lend to patients, 171 (31%) provided training in self-monitoring for their patients and 52 (9%) offered training to other GPs. Three hundred and sixty-seven GPs (66%) recommended at least two readings per day, and 416 (75%) recommended at least 4 days of monitoring at a time. One hundred and eighty (32%) adjusted self-monitored readings to take account of lower pressures in out-of-office settings, and 10/5 mm Hg was the most common adjustment factor used. Self-monitoring of blood pressure was widespread among the patients of responding GPs. Although the majority used appropriate schedules of measurement, some GPs suggested much more frequent home measurements than usual. Further, interpretation of home blood pressure was suboptimal, with only a minority recognising that values for diagnosis and on-treatment target are lower than those for clinic measurement. Subsequent national guidance may improve this situation but will require adequate implementation.
Naylor, JM, Hayen, A, Davidson, E, Hackett, D, Harris, IA, Kamalasena, G & Mittal, R 2014, 'Minimal detectable change for mobility and patient-reported tools in people with osteoarthritis awaiting arthroplasty.', BMC Musculoskeletal Disorders, vol. 15, pp. 1-9.View/Download from: Publisher's site
BACKGROUND: Thoughtful use of assessment tools to monitor disease requires an understanding of clinimetric properties. These properties are often under-reported and, thus, potentially overlooked in the clinic. This study aimed to determine the minimal detectable change (MDC) and coefficient of variation per cent (CV%) for tools commonly used to assess the symptomatic and functional severity of knee and hip osteoarthritis. METHODS: We performed a test-retest study on 136 people awaiting knee or hip arthroplasty at one of two hospitals. The MDC95 (the range over which the difference [change] for 95% of patients is expected to lie) and the coefficient of variation per cent (CV%) for the visual analogue scale (VAS) for joint pain, the six-minute walk test (6MWT), the timed up-and-go (TUG) test, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Hip Disability and Osteoarthritis Outcome Score (HOOS) subscales were calculated. RESULTS: Knee cohort (n = 75) - The MDC95 and CV% values were as follows: VAS 2.8 cm, 15%; 6MWT 79 m, 8%; TUG +/-36.7%, 13%; KOOS pain 20.2, 19%; KOOS symptoms 24.1, 22%; KOOS activities of daily living 20.8, 17%; KOOS quality of life 26.6, 44. Hip cohort (n = 61) - The MDC95 and CV% values were as follows: VAS 3.3 cm, 17%; 6MWT 81.5 m, 9%; TUG +/-44.6%, 16%; HOOS pain 21.6, 22%; HOOS symptoms 22.7, 19%; HOOS activities of daily living 17.7, 17%; HOOS quality of life 24.4, 43%. CONCLUSIONS: Distinguishing real change from error is difficult in people with severe osteoarthritis. The 6MWT demonstrates the smallest measurement error amongst a range of tools commonly used to assess disease severity, thus, has the capacity to detect the smallest real change above measurement error in everyday clinical practice.
Sinha, YK, Craig, JC, Sureshkumar, P, Hayen, A & Brien, JA 2014, 'Risk of bias in randomized trials of pharmacological interventions in children and adults.', The Journal of Pediatrics, vol. 165, no. 2, pp. 367-371.e1.View/Download from: Publisher's site
OBJECTIVE: To determine whether randomized controlled trials of pharmacologic interventions in children are more likely to be biased than similar trials in adults. STUDY DESIGN: Trials involving only children and published in MEDLINE between January 2008 and October 2009 (n=100) were randomly selected and matched, by drug class and therapeutic area, with a similar trial completed in adults. The Cochrane risk of bias tool was used to compare the pediatric and adult trials. RESULTS: The characteristics of adult and pediatric trials included were similar, except that adult studies were more likely to be conducted in Europe and published in specialty journals. Two-thirds of all trials were single center, and 62% had 100 or fewer participants. Many trials had an unclear risk of bias for allocation concealment (65% adult, 52% pediatric). More pediatric trials had a low risk of bias for random sequence generation (59% pediatric, 41% adult, P=.002) and blinding of outcome assessment (63% pediatric, 48% adult, P=.04) than adult trials; however, a sensitivity analysis of trials published since 2008 (and so matched by year of publication) did not confirm this finding, suggesting year of publication was an important confounder. CONCLUSIONS: When randomized controlled trials are matched for drug class and therapeutic area, trials involving children display a similar risk of bias. Differences in the risk of bias between pediatric and adult trials are not caused by differences in the capacity of researchers to conduct and report trials of high quality.
Thompson, AM, Turner, RM, Hayen, A, Aniss, A, Jalaty, S, Learoyd, DL, Sidhu, S, Delbridge, L, Yeh, MW, Clifton-Bligh, R & Sywak, M 2014, 'A Preoperative Nomogram for the Prediction of Ipsilateral Central Compartment Lymph Node Metastases in Papillary Thyroid Cancer', THYROID, vol. 24, no. 4, pp. 675-682.View/Download from: Publisher's site
Thompson, JE, Moses, D, Shnier, R, Brenner, P, Delprado, W, Ponsky, L, Pulbrook, M, Böhm, M, Haynes, AM, Hayen, A & Stricker, PD 2014, 'Multiparametric magnetic resonance imaging guided diagnostic biopsy detects significant prostate cancer and could reduce unnecessary biopsies and over detection: a prospective study.', Journal of Urology, The, vol. 192, no. 1, pp. 67-74.View/Download from: Publisher's site
PURPOSE: Multiparametric magnetic resonance imaging appears to improve prostate cancer detection but prospective studies are lacking. We determined the accuracy of multiparametric magnetic resonance imaging for detecting significant prostate cancer before diagnostic biopsy in men with abnormal prostate specific antigen/digital rectal examination. MATERIALS AND METHODS: In this single center, prospective study men older than 40 years with abnormal prostate specific antigen/digital rectal examination and no previous multiparametric magnetic resonance imaging underwent T2-weighted, diffusion-weighted and dynamic contrast enhanced imaging without an endorectal coil. Imaging was allocated alternately to 1.5/3.0 Tesla. Imaging was double reported independently using PI-RADS (Prostate Imaging Reporting and Data System) by specialist radiologists. Transperineal grid directed 30-core biopsy was performed with additional magnetic resonance imaging directed cores for regions of interest outside template locations. Four significant cancer definitions were tested. Chi-square and logistic regression analysis was done. Men undergoing prostatectomy were analyzed. RESULTS: Of the 165 men who enrolled in the study 150 were analyzed. Median age was 62.4 years, median prostate specific antigen was 5.6 ng/ml, 29% of patients had an abnormal digital rectal examination and 88% underwent initial biopsy. Multiparametric magnetic resonance imaging was positive (PI-RADS 3 to 5) in 66% of patients, 61% had prostate cancer and 30% to 41% had significant prostate cancer (definitions 1 to 4). For significant cancer sensitivity was 93% to 96%, specificity was 47% to 53%, and negative and positive predictive values were 92% to 96% and 43% to 57%, respectively (definitions 1 to 4). Radical prostatectomy results in 48 men were similar. Aggregate PI-RADS (4 to 20) performed similarly to overall PI-RADS (1 to 5). Negative and positive predictive values (100% and 71%, respectively) were similar in me...
Tighe, M, Afzal, NA, Bevan, A, Hayen, A, Munro, A & Beattie, RM 2014, 'Pharmacological treatment of children with gastro-oesophageal reflux', Cochrane Database of Systematic Reviews, no. 11.View/Download from: Publisher's site
Gastro-oesophageal reﬂux (GOR) is a common disorder, characterised by regurgitation of gastric contents into the oesophagus. GOR
is a very common presentation in infancy in both primar y and secondary care settings. GO R can affect approximately 50% of infants
younger than three months old. The natural history of GOR in infancy is generally that of a functional, self-limiting condition that
improves with age; < 5% of children with vomiting or regurgitation continue to have symptoms after infancy. Older children and children
with co-existing medical conditions can have a more protracted course. The de ﬁnition of gastro-oesophageal reﬂux disease (GORD)
and its precise distinction from GOR are de bated, but consensus guidelines from the North American Society of Gastroenterology,
Hepatology and Nutrition deﬁne GORD as ’troublesome symptoms or complications of GOR.’
This Cochrane review aims to provide a robust analysis of currently available pharmacological interventions used to treat children with
GOR by assessing all outcomes indicating beneﬁt or harm.
Woolfenden, S, Eapen, V, Williams, K, Hayen, A, Spencer, N & Kemp, L 2014, 'A systematic review of the prevalence of parental concerns measured by the Parents' Evaluation of Developmental Status (PEDS) indicating developmental risk.', BMC Pediatrics, vol. 14, pp. 1-13.View/Download from: Publisher's site
BACKGROUND: Parental concerns about their children's development can be used as an indicator of developmental risk. We undertook a systematic review of the prevalence of parents' concerns as an indicator of developmental risk, measured by the Parents' Evaluation of Developmental Status (PEDS) and associated risk factors. METHODS: Electronic databases, bibliographies and websites were searched and experts contacted. Studies were screened for eligibility and study characteristics were extracted independently by two authors. A summary estimate for prevalence was derived. Meta-regression examined the impact of study characteristics and quality. Meta-analysis was used to derive pooled estimates of the impact of biological and psychosocial risk factors on the odds of parental concerns indicating high developmental risk. RESULTS: Thirty seven studies were identified with a total of 210,242 subjects. Overall 13.8% (95% CI 10.9 -16.8%) of parents had concerns indicating their child was at high developmental risk and 19.8% (95% CI 16.7-22.9%) had concerns indicating their child was at moderate developmental risk. Male gender, low birth weight, poor/fair child health rating, poor maternal mental health, lower socioeconomic status (SES), minority ethnicity, not being read to, a lack of access to health care and not having health insurance were significantly associated with parental concerns indicating a high developmental risk. CONCLUSIONS: The prevalence of parental concerns measured with the PEDS indicating developmental risk is substantial. There is increased prevalence associated with biological and psychosocial adversity. TRIAL REGISTRATION: PROSPERO Registration: CRD42012003215.
Bell, KJL, Hayen, A, Irwig, L, Takahashi, O, Ohde, S & Glasziou, P 2013, 'When to remeasure cardiovascular risk in untreated people at low and intermediate risk: observational study', BMJ-BRITISH MEDICAL JOURNAL, vol. 346.View/Download from: Publisher's site
Bonner, C, Jansen, J, McKinn, S, Irwig, L, Doust, J, Glasziou, P, Hayen, A & McCaffery, K 2013, 'General practitioners' use of different cardiovascular risk assessment strategies: a qualitative study', MEDICAL JOURNAL OF AUSTRALIA, vol. 199, no. 7, pp. 485-489.View/Download from: Publisher's site
De, S, Williams, GJ, Hayen, A, Macaskill, P, McCaskill, M, Isaacs, D & Craig, JC 2013, 'Accuracy of the "traffic light" clinical decision rule for serious bacterial infections in young children with fever: a retrospective cohort study', BMJ-BRITISH MEDICAL JOURNAL, vol. 346.View/Download from: Publisher's site
Griffiths, G, Woolfenden, S, Williams, K, Raman, S, Tzioumi, D & Hayen, A 2013, 'Comprehensive paediatric assessments for children in out of home care', Cochrane Database of Systematic Reviews, vol. 2013, no. 12.View/Download from: Publisher's site
© 2013 The Cochrane Collaboration. This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness of comprehensive paediatric assessments in identifying physical, developmental, mental health, and behavioural needs, and in facilitating access to appropriate interventions compared with usual care (partial assessment) or no assessment for children entering out of home care.
Naresh, CN, Hayen, A, Weening, A, Craig, JC & Chadban, SJ 2013, 'Day-to-Day Variability in Spot Urine Albumin-Creatinine Ratio', AMERICAN JOURNAL OF KIDNEY DISEASES, vol. 62, no. 6, pp. 1095-1101.View/Download from: Publisher's site
Naylor, JM, Kamalasena, G, Hayen, A, Harris, IA & Adie, S 2013, 'Can the Oxford Scores Be Used to Monitor Symptomatic Progression of Patients Awaiting Knee or Hip Arthroplasty?', JOURNAL OF ARTHROPLASTY, vol. 28, no. 9, pp. 1454-1458.View/Download from: Publisher's site
Rogerson, TE, Chen, S, Kok, J, Hayen, A, Craig, JC, Sud, K, Kable, K & Webster, AC 2013, 'Tests for Latent Tuberculosis in People With ESRD: A Systematic Review', AMERICAN JOURNAL OF KIDNEY DISEASES, vol. 61, no. 1, pp. 33-43.View/Download from: Publisher's site
Williams, K, Perkins, D, Wheeler, D, Hayen, A & Bayl, V 2013, 'Can questions about social interaction correctly identify preschool aged children with autism?', JOURNAL OF PAEDIATRICS AND CHILD HEALTH, vol. 49, no. 2, pp. E167-E174.View/Download from: Publisher's site
Maher, LM, Hope, K, Torvaldsen, S, Lawrence, G, Dawson, A, Wiley, K, Thomson, D, Hayen, A & Conaty, S 2013, 'Influenza vaccination during pregnancy: Coverage rates and influencing factors in two urban districts in Sydney', Vaccine, vol. 31, no. 47, pp. 5557-5564.View/Download from: Publisher's site
Background: Pregnant women have an increased risk of complications from influenza. Influenza vaccination during pregnancy is considered effective and safe; however estimates of vaccine coverage are low. This study aimed to determine influenza vaccination
Bell, K, Hayen, A, McGeechan, K, Neal, B & Irwig, L 2012, 'Effects of additional blood pressure and lipid measurements on the prediction of cardiovascular risk', EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, vol. 19, no. 6, pp. 1474-1485.View/Download from: Publisher's site
Bell, KJL, Hayen, A, Irwig, L, Hochberg, MC, Ensrud, KE, Cummings, SR & Bauer, DC 2012, 'The potential value of monitoring bone turnover markers among women on alendronate', JOURNAL OF BONE AND MINERAL RESEARCH, vol. 27, no. 1, pp. 195-201.View/Download from: Publisher's site
Clarke, PM, Walter, SJ, Hayen, A, Mallon, WJ, Heijmans, J & Studdert, DM 2012, 'Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era.', BMJ (Clinical research ed.), vol. 345, pp. e8308-e8308.View/Download from: Publisher's site
To determine whether Olympic medallists live longer than the general population.Retrospective cohort study, with passive follow-up and conditional survival analysis to account for unidentified loss to follow-up.15,174 Olympic athletes from nine country groups (United States, Germany, Nordic countries, Russia, United Kingdom, France, Italy, Canada, and Australia and New Zealand) who won medals in the Olympic Games held in 1896-2010. Medallists were compared with matched cohorts in the general population (by country, age, sex, and year of birth).Relative conditional survival.More medallists than matched controls in the general population were alive 30 years after winning (relative conditional survival 1.08, 95% confidence interval 1.07 to 1.10). Medallists lived an average of 2.8 years longer than controls. Medallists in eight of the nine country groups had a significant survival advantage compared with controls. Gold, silver, and bronze medallists each enjoyed similar sized survival advantages. Medallists in endurance sports and mixed sports had a larger survival advantage over controls at 30 years (1.13, 1.09 to 1.17; 1.11, 1.09 to 1.13) than that of medallists in power sports (1.05, 1.01 to 1.08).Olympic medallists live longer than the general population, irrespective of country, medal, or sport. This study was not designed to explain this effect, but possible explanations include genetic factors, physical activity, healthy lifestyle, and the wealth and status that come with international sporting glory.
Derrick, GE, Hayen, A, Chapman, S, Haynes, AS, Webster, BM & Anderson, I 2012, 'A bibliometric analysis of research on Indigenous health in Australia, 1972-2008', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, vol. 36, no. 3, pp. 269-273.View/Download from: Publisher's site
Hatfield, J, Williamson, A, Sherker, S, Brander, R & Hayen, A 2012, 'Development and evaluation of an intervention to reduce rip current related beach drowning', ACCIDENT ANALYSIS AND PREVENTION, vol. 46, pp. 45-51.View/Download from: Publisher's site
Hayen, A, Bell, K, Glasziou, P & Irwig, L 2012, 'A Counterargument to Encounter Frequency and Target Achievement: Measurement Variability', ARCHIVES OF INTERNAL MEDICINE, vol. 172, no. 4, pp. 374-374.View/Download from: Publisher's site
Jansen, J, McCaffery, KJ, Hayen, A, Ma, D & Reddel, HK 2012, 'Impact of graphic format on perception of change in biological data: implications for health monitoring in conditions such as asthma', PRIMARY CARE RESPIRATORY JOURNAL, vol. 21, no. 1, pp. 94-100.View/Download from: Publisher's site
McCaffery, KJ, Dixon, A, Hayen, A, Jansen, J, Smith, S & Simpson, JM 2012, 'The Influence of Graphic Display Format on the Interpretations of Quantitative Risk Information among Adults with Lower Education and Literacy: A Randomized Experimental Study', MEDICAL DECISION MAKING, vol. 32, no. 4, pp. 532-544.View/Download from: Publisher's site
Morrow, AM, Hayen, A, Quine, S, Scheinberg, A & Craig, JC 2012, 'A comparison of doctors', parents' and children's reports of health states and health-related quality of life in children with chronic conditions', CHILD CARE HEALTH AND DEVELOPMENT, vol. 38, no. 2, pp. 186-195.View/Download from: Publisher's site
Naresh, CN, Hayen, A, Craig, JC & Chadban, SJ 2012, 'Day-to-Day Variability in Spot Urine Protein-Creatinine Ratio Measurements', AMERICAN JOURNAL OF KIDNEY DISEASES, vol. 60, no. 4, pp. 561-566.View/Download from: Publisher's site
Otton, JM, Lonborg, JT, Boshell, D, Feneley, M, Hayen, A, Sammel, N, Sesel, K, Bester, L & McCrohon, J 2012, 'A method for coronary artery calcium scoring using contrast-enhanced computed tomography', JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY, vol. 6, no. 1, pp. 37-44.View/Download from: Publisher's site
Turner, RM, Hayen, A, Macaskill, P, Irwig, L & Reddel, HK 2012, 'Control charts demonstrated limited utility for the monitoring of lung function in asthma', JOURNAL OF CLINICAL EPIDEMIOLOGY, vol. 65, no. 1, pp. 53-61.View/Download from: Publisher's site
Williamson, A, Hatfield, J, Sherker, S, Brander, R & Hayen, A 2012, 'A comparison of attitudes and knowledge of beach safety in Australia for beachgoers, rural residents and international tourists', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, vol. 36, no. 4, pp. 385-391.View/Download from: Publisher's site
Wyld, M, Morton, RL, Hayen, A, Howard, K & Webster, AC 2012, 'A Systematic Review and Meta-Analysis of Utility-Based Quality of Life in Chronic Kidney Disease Treatments', PLOS MEDICINE, vol. 9, no. 9.View/Download from: Publisher's site
Bell, KJL, Kirby, A, Hayen, A, Irwig, L & Glasziou, P 2011, 'Monitoring adherence to drug treatment by using change in cholesterol concentration: secondary analysis of trial data', BMJ-BRITISH MEDICAL JOURNAL, vol. 342.View/Download from: Publisher's site
Herbert, RD, Hayen, A, Macaskill, P & Walter, SD 2011, 'Interval Estimation for the Difference of Two Independent Variances', COMMUNICATIONS IN STATISTICS-SIMULATION AND COMPUTATION, vol. 40, no. 5, pp. 744-758.View/Download from: Publisher's site
Lung, TWC, Hayes, AJ, Hayen, A, Farmer, A & Clarke, PM 2011, 'A meta-analysis of health state valuations for people with diabetes: explaining the variation across methods and implications for economic evaluation', QUALITY OF LIFE RESEARCH, vol. 20, no. 10, pp. 1669-1678.View/Download from: Publisher's site
Palmer, SC, Hayen, A, Macaskill, P, Pellegrini, F, Craig, JC, Elder, GJ & Strippoli, GFM 2011, 'Serum Levels of Phosphorus, Parathyroid Hormone, and Calcium and Risks of Death and Cardiovascular Disease in Individuals With Chronic Kidney Disease A Systematic Review and Meta-analysis', JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, vol. 305, no. 11, pp. 1119-1127.View/Download from: Publisher's site
Sinha, Y, Silove, N, Hayen, A & Williams, K 2011, 'Auditory integration training and other sound therapies for autism spectrum disorders (ASD).', Cochrane Database of Systematic Reviews, no. 12, pp. 1-46.View/Download from: Publisher's site
BACKGROUND: Auditory integration therapy was developed as a technique for improving abnormal sound sensitivity in individuals with behavioural disorders including autism spectrum disorders. Other sound therapies bearing similarities to auditory integration therapy include the Tomatis Method and Samonas Sound Therapy. OBJECTIVES: To determine the effectiveness of auditory integration therapy or other methods of sound therapy in individuals with autism spectrum disorders. SEARCH METHODS: For this update, we searched the following databases in September 2010: CENTRAL (2010, Issue 2), MEDLINE (1950 to September week 2, 2010), EMBASE (1980 to Week 38, 2010), CINAHL (1937 to current), PsycINFO (1887 to current), ERIC (1966 to current), LILACS (September 2010) and the reference lists of published papers. One new study was found for inclusion. SELECTION CRITERIA: Randomised controlled trials involving adults or children with autism spectrum disorders. Treatment was auditory integration therapy or other sound therapies involving listening to music modified by filtering and modulation. Control groups could involve no treatment, a waiting list, usual therapy or a placebo equivalent. The outcomes were changes in core and associated features of autism spectrum disorders, auditory processing, quality of life and adverse events. DATA COLLECTION AND ANALYSIS: Two independent review authors performed data extraction. All outcome data in the included papers were continuous. We calculated point estimates and standard errors from t-test scores and post-intervention means. Meta-analysis was inappropriate for the available data. MAIN RESULTS: We identified six randomised comtrolled trials of auditory integration therapy and one of Tomatis therapy, involving a total of 182 individuals aged three to 39 years. Two were cross-over trials. Five trials had fewer than 20 participants. Allocation concealment was inadequate for all studies. Twenty different outcome measures were used and only ...
Turner, RM, Bell, KJL, Morton, RL, Hayen, A, Francken, AB, Howard, K, Armstrong, B, Thompson, JF & Irwig, L 2011, 'Optimizing the Frequency of Follow-Up Visits for Patients Treated for Localized Primary Cutaneous Melanoma', JOURNAL OF CLINICAL ONCOLOGY, vol. 29, no. 35, pp. 4641-4646.View/Download from: Publisher's site
Turner, RM, Hayen, A, Dunsmuir, WTM & Finch, CF 2011, 'Air temperature and the incidence of fall-related hip fracture hospitalisations in older people', OSTEOPOROSIS INTERNATIONAL, vol. 22, no. 4, pp. 1183-1189.View/Download from: Publisher's site
Wang, LW, Fahim, MA, Hayen, A, Mitchell, RL, Baines, L, Lord, S, Craig, JC & Webster, AC 2011, 'Cardiac testing for coronary artery disease in potential kidney transplant recipients.', Cochrane Database of Systematic Reviews, no. 12, pp. 1-95.View/Download from: Publisher's site
BACKGROUND: Patients with chronic kidney disease (CKD) are at increased risk of coronary artery disease (CAD) and adverse cardiac events. Screening for CAD is therefore an important part of preoperative evaluation for kidney transplant candidates. There is significant interest in the role of non-invasive cardiac investigations and their ability to identify patients at high risk of CAD. OBJECTIVES: We investigated the accuracy of non-invasive cardiac screening tests compared with coronary angiography to detect CAD in patients who are potential kidney transplant recipients. SEARCH METHODS: MEDLINE and EMBASE searches (inception to November 2010) were performed to identify studies that assessed the diagnostic accuracy of non-invasive screening tests, using coronary angiography as the reference standard. We also conducted citation tracking via Web of Science and handsearched reference lists of identified primary studies and review articles. SELECTION CRITERIA: We included in this review all diagnostic cross sectional, cohort and randomised studies of test accuracy that compared the results of any cardiac test with coronary angiography (the reference standard) relating to patients considered as potential candidates for kidney transplantation or kidney-pancreas transplantation at the time diagnostic tests were performed. DATA COLLECTION AND ANALYSIS: We used a hierarchical modelling strategy to produce summary receiver operating characteristic (SROC) curves, and pooled estimates of sensitivity and specificity. Sensitivity analyses to determine test accuracy were performed if only studies that had full verification or applied a threshold of ≥ 70% stenosis on coronary angiography for the diagnosis of significant CAD were included. MAIN RESULTS: The following screening investigations included in the meta-analysis were: dobutamine stress echocardiography (DSE) (13 studies), myocardial perfusion scintigraphy (MPS) (nine studies), echocardiography (three studies), exerci...
Wang, LW, Fahim, MA, Hayen, A, Mitchell, RL, Lord, SW, Baines, LA, Craig, JC & Webster, AC 2011, 'Cardiac Testing for Coronary Artery Disease in Potential Kidney Transplant Recipients: A Systematic Review of Test Accuracy Studies', AMERICAN JOURNAL OF KIDNEY DISEASES, vol. 57, no. 3, pp. 476-487.View/Download from: Publisher's site
Wong, G, Howard, K, Chapman, JR, Tong, A, Bourke, MJ, Hayen, A, Macaskill, P, Hope, RL, Williams, N, Kieu, A, Allen, R, Chadban, S, Pollock, C, Webster, A, Roger, SD & Craig, JC 2011, 'Test performance of faecal occult blood testing for the detection of bowel cancer in people with chronic kidney disease (DETECT) protocol', BMC PUBLIC HEALTH, vol. 11.View/Download from: Publisher's site
Bell, KJL, Hayen, A, Irwig, L, Macaskill, P, Craig, JC, Ensrud, KE & Bauer, DC 2010, 'The Value of Routine BMD Monitoring After Starting Bisphosphonate Treatment', JOURNAL OF BONE AND MINERAL RESEARCH, vol. 25, no. 1, pp. 173-174.View/Download from: Publisher's site
Bell, KJL, Hayen, A, Macaskill, P, Craig, JC, Neal, BC, Fox, KM, Remme, WJ, Asselbergs, FW, van Gilst, WH, MacMahon, S, Remuzzi, G, Ruggenenti, P, Teo, KK & Irwig, L 2010, 'Monitoring Initial Response to Angiotensin-Converting Enzyme Inhibitor-Based Regimens An Individual Patient Data Meta-Analysis From Randomized, Placebo-Controlled Trials', HYPERTENSION, vol. 56, no. 3, pp. 533-U429.View/Download from: Publisher's site
Bell, KJL, Irwig, L, March, LM, Hayen, A, Macaskill, P & Craig, JC 2010, 'Should response rules be used to decide continued subsidy of very expensive drugs? A checklist for decision makers', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, vol. 19, no. 1, pp. 99-105.View/Download from: Publisher's site
Craig, JC, Williams, GJ, Jones, M, Codarini, M, Macaskill, P, Hayen, A, Irwig, L, Fitzgerald, DA, Isaacs, D & McCaskill, M 2010, 'The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses', BMJ-BRITISH MEDICAL JOURNAL, vol. 340.View/Download from: Publisher's site
Du, W, Finch, CF, Hayen, A, Bilston, L, Brown, J & Hatfield, J 2010, 'Relative Benefits of Population-Level Interventions Targeting Restraint-Use in Child Car Passengers', PEDIATRICS, vol. 125, no. 2, pp. 304-312.View/Download from: Publisher's site
Finch, CF, White, P, Dennis, R, Twomey, D & Hayen, A 2010, 'Fielders and batters are injured too: A prospective cohort study of injuries in junior club cricket', JOURNAL OF SCIENCE AND MEDICINE IN SPORT, vol. 13, no. 5, pp. 489-495.View/Download from: Publisher's site
Hayen, A, Bell, K, Glasziou, P, Neal, B & Irwig, L 2010, 'Monitoring Adherence to Medication by Measuring Change in Blood Pressure', HYPERTENSION, vol. 56, no. 4, pp. 612-U107.View/Download from: Publisher's site
Hayen, A, Macaskill, P, Irwig, L & Bossuyt, P 2010, 'Appropriate statistical methods are required to assess diagnostic tests for replacement, add-on, and triage', JOURNAL OF CLINICAL EPIDEMIOLOGY, vol. 63, no. 8, pp. 883-891.View/Download from: Publisher's site
Sherker, S, Williamson, A, Hatfield, J, Brander, R & Hayen, A 2010, 'Beachgoers' beliefs and behaviours in relation to beach flags and rip currents', ACCIDENT ANALYSIS AND PREVENTION, vol. 42, no. 6, pp. 1785-1804.View/Download from: Publisher's site
Bell, KJL, Hayen, A, Macaskill, P, Craig, JC, Neal, BC & Irwig, L 2009, 'Mixed models showed no need for initial response monitoring after starting antihypertensive therapy', JOURNAL OF CLINICAL EPIDEMIOLOGY, vol. 62, no. 6, pp. 650-659.View/Download from: Publisher's site
Bell, KJL, Hayen, A, Macaskill, P, Irwig, L, Craig, JC, Ensrud, K & Bauer, DC 2009, 'Value of routine monitoring of bone mineral density after starting bisphosphonate treatment: secondary analysis of trial data', BMJ-BRITISH MEDICAL JOURNAL, vol. 338.View/Download from: Publisher's site
Hindmarsh, DM, Hayen, A, Finch, CF & Close, JCT 2009, 'Relative survival after hospitalisation for hip fracture in older people in New South Wales, Australia', OSTEOPOROSIS INTERNATIONAL, vol. 20, no. 2, pp. 221-229.View/Download from: Publisher's site
Keenan, K, Hayen, A, Neal, BC & Irwig, L 2009, 'Long term monitoring in patients receiving treatment to lower blood pressure: analysis of data from placebo controlled randomised controlled trial', BMJ-BRITISH MEDICAL JOURNAL, vol. 338.View/Download from: Publisher's site
McManus, RJ, Glasziou, P, Hayen, A, Mant, J, Padfield, P, Potter, J, Bray, EP & Mant, D 2009, 'Blood pressure self monitoring: Questions and answers from a national conference', BMJ (Online), vol. 338, no. 7685, pp. 38-42.View/Download from: Publisher's site
Poulos, RG, Hayen, A, Chong, SSS & Finch, CF 2009, 'Geographic mapping as a tool for identifying communities at high risk of fire and burn injuries in children', BURNS, vol. 35, no. 3, pp. 417-424.View/Download from: Publisher's site
Robinson, DA, Ghaly, B, Hayen, A & Lusby, RJ 2009, 'Statin therapy and carotid endarterectomy: a review of trends in New South Wales, 1990-2004', ANZ JOURNAL OF SURGERY, vol. 79, no. 6, pp. 456-461.View/Download from: Publisher's site
Turner, RM, Hayen, A, Dunsmuir, WTM & Finch, CF 2009, 'Spatial temporal modeling of hospitalizations for fall-related hip fractures in older people', OSTEOPOROSIS INTERNATIONAL, vol. 20, no. 9, pp. 1479-1485.View/Download from: Publisher's site
Wong, G, Hayen, A, Chapman, JR, Webster, AC, Wang, JJ, Mitchell, P & Craig, JC 2009, 'Association of CKD and Cancer Risk in Older People', JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, vol. 20, no. 6, pp. 1341-1350.View/Download from: Publisher's site
Boufous, S, Finch, C, Hayen, A & Williamson, A 2008, 'The impact of environmental, vehicle and driver characteristics on injury severity in older drivers hospitalized as a result of a traffic crash', JOURNAL OF SAFETY RESEARCH, vol. 39, no. 1, pp. 65-72.View/Download from: Publisher's site
Du, W, Hayen, A, Bilston, L, Hatfield, J, Finch, C & Brown, J 2008, 'Association Between Different Restraint Use and Rear-Seated Child Passenger Fatalities A Matched Cohort Study', ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE, vol. 162, no. 11, pp. 1085-1089.View/Download from: Publisher's site
Du, W, Hayen, A, Finch, C & Hatfield, J 2008, 'Comparison of methods to correct the miscounting of multiple episodes of care when estimating the incidence of hospitalised injury in child motor vehicle passengers', ACCIDENT ANALYSIS AND PREVENTION, vol. 40, no. 4, pp. 1563-1568.View/Download from: Publisher's site
Hayen, A, Smith, DP, Patel, MI & O'Connell, DL 2008, 'Patterns of surgical care for prostate cancer in NSW, 1993-2002: rural/urban and socio-economic variation', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, vol. 32, no. 5, pp. 417-420.View/Download from: Publisher's site
Lujic, S, Finch, C, Boufous, S, Hayen, A & Dunsmuir, W 2008, 'How comparable are road traffic crash cases in hospital admissions data and police records? An examination of data linkage rates', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, vol. 32, no. 1, pp. 28-33.View/Download from: Publisher's site
McManus, RJ, Glasziou, P, Hayen, A, Mant, J, Padfield, P, Potter, J, Bray, EP & Mant, D 2008, 'Blood pressure self monitoring: questions and answers from a national conference', BRITISH MEDICAL JOURNAL, vol. 337.View/Download from: Publisher's site
Du, W, Finch, C, Hayen, A & Hatfield, J 2007, 'Differences in injury rates in child motor vehicle passengers in rural and urban areas in New South Wales, July 2000 to June 2004', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, vol. 31, no. 5, pp. 483-488.View/Download from: Publisher's site
Du, W, Finch, CF, Hayen, A & Hatfield, J 2007, 'Trends in hospitalisation rates for road traffic injuries in child motor vehicle passengers in New South Wales, July 1998 June 2005', MEDICAL JOURNAL OF AUSTRALIA, vol. 187, no. 9, pp. 515-518.View/Download from: Publisher's site
Hayen, A, Dennis, RJ & Finch, CF 2007, 'Determining the intra- and inter-observer reliability of screening tools used in sports injury research', JOURNAL OF SCIENCE AND MEDICINE IN SPORT, vol. 10, no. 4, pp. 201-210.View/Download from: Publisher's site
Hayen, AD, Boufous, S & Harrison, JE 2007, 'A discussion of the potential benefits to injury surveillance through inclusion of date of injury in hospitalisation data in New South Wales and Australia.', New South Wales public health bulletin, vol. 18, no. 7-8, pp. 130-132.
Most hospitalised injury cases have sudden onset at a specific time and date, due to a well-defined external cause (eg, a road crash). Date of injury is not presently recorded in routine hospital separations data in NSW or Australia, though it is in New Zealand. Benefits of adding date of injury to the Inpatient Statistics Collection would include: more accurate estimation of the population incidence of serious injury; better assessment of the health system utilisation and costs attributable to injurious events; and better linkage of hospital data with other data relevant to injury measurement and control (eg, road crash data).
Pang, CNI, Hayen, A & Wilkins, MR 2007, 'Surface accessibility of protein post-translational modifications', JOURNAL OF PROTEOME RESEARCH, vol. 6, no. 5, pp. 1833-1845.View/Download from: Publisher's site
Poulos, R, Hayen, A, Finch, C & Zwi, A 2007, 'Area socioeconomic status and childhood injury morbidity in New South Wales, Australia', INJURY PREVENTION, vol. 13, no. 5, pp. 322-327.View/Download from: Publisher's site
Hayen, A & Mitchell, R 2006, 'A description of interpersonal violence-related hospitalisations in New South Wales.', New South Wales public health bulletin, vol. 17, no. 1-2, pp. 8-12.
Ho, E, Hayen, A & Wilkins, MR 2006, 'Characterisation of organellar proteornes: A guide to subcellular proteomic fractionation and analysis', PROTEOMICS, vol. 6, no. 21, pp. 5746-5757.View/Download from: Publisher's site
Mitchell, R & Hayen, A 2006, 'Sport- or leisure-related injury hospital admissions: Do we need to get more out of being struck?', JOURNAL OF SCIENCE AND MEDICINE IN SPORT, vol. 9, no. 6, pp. 498-505.View/Download from: Publisher's site
Brotherton, JML, Hull, BP, Hayen, A, Gidding, HF & Burgess, MA 2005, 'Probability of coincident vaccination in the 24 or 48 hours preceding sudden infant death syndrome death in Australia', PEDIATRICS, vol. 115, no. 6, pp. E643-E646.View/Download from: Publisher's site
Garnett, SP, Hayen, A & Peat, J 2005, 'The art and science of regression modelling; methods for building valid models to explore hormone and body composition interactions', Pediatric Endocrinology Reviews, vol. 3, no. 1, pp. 40-44.
Multiple linear regression modelling is commonly used to investigate how hormones and body composition interact, but for valid interpretation a sound methodological approach must be used. It is particularly important that the assumptions for regression are met so that spurious associations are not generated. In this article we show how different approaches to building a multiple linear regression model can influence perceived associations, using examples from the literature and our own data related to predicting fasting insulin and leptin levels from total body fat and fat distribution in children.
Peat, JK, Allen, J, Nguyen, N, Hayen, A, Oddy, WH & Mihrshahi, S 2004, 'Motherhood meets epidemiology: measuring risk factors for breast-feeding cessation', PUBLIC HEALTH NUTRITION, vol. 7, no. 8, pp. 1033-1037.View/Download from: Publisher's site
Correll, PK, Hayen, A & Eyeson-Annan, M 2003, 'Hepatitis B immunisation in children aged 10-13 years in New South Wales, 2001.', New South Wales public health bulletin, vol. 14, no. 1-2, pp. 17-20.
Harvey, L, Hayen, A & Eyeson-Annan, M 2003, 'Continuous NSW health survey: quarterly report on health status, health behaviours, and risk factors.', New South Wales public health bulletin, vol. 14, no. 7, pp. 144-146.View/Download from: Publisher's site
Hayen, A & Quine, MP 2002, 'Areas of components of a Voronoi polygon in a homogeneous poisson process in the plane', ADVANCES IN APPLIED PROBABILITY, vol. 34, no. 2, pp. 281-291.View/Download from: Publisher's site
Hayen, A, Lincoln, D, Moore, H & Thomas, M 2002, 'Trends in potentially avoidable mortality in NSW.', New South Wales public health bulletin, vol. 13, no. 11-12, pp. 226-236.
Hayen, A & Quine, M 2000, 'Calculating the proportion of triangles in a Poisson-Voronoi tessellation of the plane', JOURNAL OF STATISTICAL COMPUTATION AND SIMULATION, vol. 67, no. 4, pp. 351-358.View/Download from: Publisher's site
By using an adaptation of the radial generation method, we give an integral formula for the proportion of triangles in a Poisson-Voronoi tessellation, which gives a value of 0.011 2354 to 7 decimal places. We also obtain the first four moments of some characteristics of triangles. © 2000 Applied Probability Trust.
© Oxford University Press, 2014. When it comes to analyzing the results from effect studies, some specific statistical methods need to be used, primarily due to the time component that is used in the outcome measure. In addition, there is a recent call for multilevel analyses taking cluster effect (e.g. teams or regions) into account. These statistical measures are not easy to conduct, especially when one is not aware of what is happening to the data. This chapter provides sufficient knowledge on the statistical side of things to be able to fully understand how these analyses work.
Gonski, P, Rhee, J, Meller, A, Krysinska, K, Naganathan, V, Zwar, N, Hayen, A, Cullen, J, O'Keefe, JA, McDonald, J, Harris-Roxas, B & Caplan, G 2019, 'Implementation of advance care planning for patients with advanced illnesses attending hospital outpatient clinics', AUSTRALASIAN JOURNAL ON AGEING, WILEY, pp. 61-61.
Hall, A, Ho, C, Albanese, B, Keay, L, Hunter, K, Charlton, J, Hayen, A, Bilston, L & Brown, J 2018, 'USER-CENTRED INSTRUCTIONS REDUCE MISUSE OF CHILD RESTRAINT SYSTEMS: RESULTS FROM A CONTROLLED LABORATORY TRIAL', INJURY PREVENTION, BMJ PUBLISHING GROUP, pp. A38-A38.View/Download from: Publisher's site
Paul, RC, Nazneen, A, Banik, KC, Sumon, SA, Paul, KK, Sazzad, HMS, Jony, MHK, Uzzaman, MS, Rahman, M, Luby, SP, Gidding, H, Hayen, A & Gurley, ES 2016, 'INCIDENCE OF ADULT DEATHS ASSOCIATED WITH HEPATITIS E VIRUS IN BANGLADESH', AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE, 65th Annual Meeting of the American-Society-of-Tropical-Medicine-and-Hygiene (ASTMH), AMER SOC TROP MED & HYGIENE, Atlanta, GA, pp. 583-583.
Saha, A, Hayen, A, Ali, M, Rosewell, A, MacIntyre, CR & Qadri, F 2017, 'VACCINATION AND SOCIOECONOMIC RISK FACTORS FOR CHOLERA IN AN ENDEMIC SETTING OF BANGLADESH', AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE, 66th Annual Meeting of the American-Society-of-Tropical-Medicine-and-Hygiene (ASTMH), AMER SOC TROP MED & HYGIENE, Baltimore, MD, pp. 68-68.
Krischcok, L, Hayen, A & Kennedy, SE 2015, 'DIALYSIS OUTCOMES IN AUSTRALIAN ADOLESCENTS AND YOUNG ADULTS', NEPHROLOGY, WILEY-BLACKWELL, pp. 55-55.