Distinguished Professor of Public Health.
MD (UNSW), MBBS (USYD), MPH (USYD), MMed (Sexual Health) (USYD), FAFPHM, Cert Sexual and Reproductive Health, Cert Executive and Management Development
Professor Sullivan is a highly experienced University executive, public health physician and research leader who is nationally and internationally recognised for her outstanding contributions to public health particularly in the fields of maternal, sexual and reproductive health. She was the Assistant Deputy Vice-Chancellor (Research) and the academic lead for UTS's Athena SWAN Gender Equity Initiative from 2015-2018 with UTS receiving a Bronze Award. She was also the Head of the Discipline of Public Health and inaugural Director, Australian Centre for Public and Population Health Research (ACPPHR) at the Faculty of Health from 2016- February 2019.
Liz has a strong commitment to public health and achievng health equity, and is known for her reseach programs to improve the health and wellbeing of reproductive populations with a focus on Aboriginal women's health, justice health and non-communicable diseases in pregnancy. With over 25 years of experience, Liz's impressive track record of scholarship and innovation wth strong international and national networks of collaboration enables her to deliver responsive and agile solutions to improve the health and wellbeing of communities in need.
Professor Sullivan is a senior academic leader with proven administrative, operational and strategic managemnt expertise. She has a highly successful track record of research development and management, with more than $20 million in research and contract funding as a chief investigator, several national and international collaborations and published over 200 peer review publications and AIHW and WHO Reports. She is an onging contributor to media and a frequently invited expert to present at conferences. She has served extensively by invitation on national and international government committees relating to research, techical advice, performance and strategy and is highly committed to the development of public health research and training that also reflects industry, community and government needs, enhancing capability beyond the University sector. Liz was an appointed member on the NHMRC Council (2015-2018 Trienim) and the National and Regional Network for Athena SWAN. She has successfully supervised and mentored many high degree students.
Can supervise: YES
- Social justice
- Justice health
- population health and health services with a focus on vulnerable reproductive populations (Aboriginal women; pregnant women with mental health and or substance use (drug and alcohol), severe rare illness in pregnancy; pregnancy in prison; and infertility)
- Reproductive health
- use of population data to inform policy and practice particularly in the areas of pregnancy and fertility treatment including assisted reproductive technology
Schaap, T, Bloemenkamp, K, Deneux-Tharaux, C, Knight, M, Langhoff-Roos, J, Sullivan, E, van den Akker, T & INOSS 2019, 'Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity.', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 126, no. 3, pp. 394-401.View/Download from: UTS OPUS or Publisher's site
Develop a core outcome set of international consensus definitions for severe maternal morbidities.Electronic Delphi study.International.Eight expert panels.All 13 high-income countries represented in the International Network of Obstetric Surveillance Systems (INOSS) nominated five experts per condition of morbidity, who submitted possible definitions. From these suggestions, a steering committee distilled critical components: eclampsia: 23, amniotic fluid embolism: 15, pregnancy-related hysterectomy: 11, severe primary postpartum haemorrhage: 19, uterine rupture: 20, abnormally invasive placentation: 12, spontaneous haemoperitoneum in pregnancy: 16, and cardiac arrest in pregnancy: 10. These components were assessed by the expert panel using a 5-point Likert scale, following which a framework for an encompassing definition was constructed. Possible definitions were evaluated in rounds until a rate of agreement of more than 70% was reached. Expert commentaries were used in each round to improve definitions.Definitions with a rate of agreement of more than 70%.The invitation to participate in one or more of eight Delphi processes was accepted by 103 experts from 13 high-income countries. Consensus definitions were developed for all of the conditions.Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process. These should be used in national registrations and international studies, and should be taken up by the Core Outcomes in Women's and Newborn Health initiative.Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process.
Cullen, P, Vaughan, G, Li, Z & Sullivan, E 2019, 'Counting Dead Women in Australia: An In-Depth Case Review of Femicide', Journal of Family Violence, vol. 34, no. 1, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
© 2018 Springer Science+Business Media, LLC, part of Springer Nature Gender-based fatal violence (femicide) is a preventable cause of premature death. The Counting Dead Women Australia (CDWA) campaign is a femicide census counting violent deaths of women in Australia from 2014. We conducted a cross-sectional in-depth review of CDWA cases Jan-Dec 2014 to establish evidence of antecedent factors and describe femicide in Australia. Victim (n = 81) and perpetrator (n = 83) data were extracted from the CDWA register, law databases and coronial reports. Mixed methods triangulation of socio-demographic and incident characteristics. Women ranged in age from 20 to 82 years of age (44 ± 15.4). There were 83 perpetrators, of which 13 were unknown (not yet apprehended). Known perpetrators (n = 70) ranged in age from 16 to 72 years of age (40 ± 12.7) and 89% were male (62/70). The location of the crime was most frequently the victim's home (49/70). In cases where the relationship between the victim and perpetrator was known (n = 59), over half of femicides were committed by intimate-partners (33/59). Intimate-partner perpetrators were more likely to have a history of violence and commit murder-suicide than other perpetrators. Femicide is overwhelmingly perpetrated by males, with women most vulnerable in their own home and with their intimate partners. Furthermore, intimate-partner femicide is associated with modifiable risk factors, including previous violence and mental health issues, which represents opportunities for early intervention within healthcare settings as practitioners are well-placed to identify risk and provide support. In line with recommendations for multi-sectoral approach, future research should target identification of risk and protective factors, and improved coordination of data collection.
Donnolley, NR, Chambers, GM, Butler-Henderson, KA, Chapman, MG & Sullivan, E 2019, 'A validation study of the Australian Maternity Care Classification System.', Women and Birth, vol. 32, pp. 204-212.View/Download from: UTS OPUS or Publisher's site
The Maternity Care Classification System is a novel system developed in Australia to classify models of maternity care based on their characteristics. It will enable large-scale evaluations of maternal and perinatal outcomes under different models of care independently of the model's name.To assess the accuracy, repeatability and reproducibility of the Maternity Care Classification System.All 70 public maternity services in New South Wales, Australia, were invited to classify three randomly allocated model case-studies using a web-based survey tool and repeat their classifications 4-6 weeks later. Accuracy of classifications was assessed against the correct values for the case-studies; repeatability (intra-rater reliability) was analysed by percent agreement and McNemar's test between the same participants in both surveys; and reproducibility (inter-rater reliability) was assessed by percent agreement amongst raters of the same case-study combined with Krippendorff's alpha coefficient for a subset of characteristics.The accuracy of the Maternity Care Classification System was high with 90.8% of responses correctly classified; was repeatable, with no statistically significant change in the responses between the two survey instances (mean agreement 91.5%, p>0.05 for all but one variable); and was reproducible with a mean percent agreement across 9 characteristics of 83.6% and moderate to substantial agreement as assessed by a Krippendorff's alpha coefficient of 0.4-0.8.The results indicate the Maternity Care Classification System is a valid system for classifying models of care in Australia, and will enable the legitimate evaluation of outcomes by different models of care.
Lee, W-S, Mihalopoulos, C, Chatterton, ML, Chambers, GM, Highet, N, Morgan, VA, Sullivan, EA & Austin, M-P 2019, 'Policy Impacts of the Australian National Perinatal Depression Initiative: Psychiatric Admission in the First Postnatal Year.', Administration and Policy in Mental Health and Mental Health Services Research, vol. 46, no. 3, pp. 277-287.View/Download from: UTS OPUS or Publisher's site
This paper helps to quantify the impact of the Australian National Perinatal Depression Initiative (NPDI) on postnatal inpatient psychiatric hospitalisation. Based on individual hospital admissions data from New South Wales and Western Australia, we found that the NPDI reduced inpatient psychiatric hospital admission by up to 50% [0.9% point reduction (95% CI 0.70-1.22)] in the first postnatal year. The greatest reduction was observed for adjustment disorders. The NPDI appears to be associated with fewer post-birth psychiatric disorders hospital admissions; this suggests earlier detection of psychiatric disorders resulting in early care of women at risk during their perinatal period.
Javid, N, Hyett, JA, Walker, SP, Sullivan, EA & Homer, CSE 2019, 'A survey of opinion and practice regarding prenatal diagnosis of vasa previa among obstetricians from Australia and New Zealand.', International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 144, pp. 252-259.View/Download from: UTS OPUS or Publisher's site
OBJECTIVES:To define current obstetric opinion and clinical practice regarding the prenatal diagnosis of vasa previa in Australia and New Zealand. METHODS:A population-based cross-sectional survey of Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists was conducted from April to May, 2016. Descriptive analysis was used to define factors influencing opinion and practice regarding definition of vasa previa, attributable risk factors, and the value of screening. RESULTS:Overall, 453 respondents were included in the study. Two-thirds (304/453; 67.1%) defined vasa previa as exposed fetal vessel(s) running over or within 2 cm of the internal os. A higher proportion of ultrasound specialists (30/65; 46.2%) preferred a broader definition as compared with generalists (115/388; 29.6%; P<0.001). Overall, Fellows were supportive (342/430; 79.5%) of both reporting ultrasound-based risk factors at the 20-week anomaly scan and targeted screening (298/430; 69.3%). Only 77/453 (17.0%) respondents recognized all five "known" risk factors for vasa previa. CONCLUSIONS:There was a lack of consensus regarding the definition and diagnosis process for vasa previa. There was also a knowledge gap in risk factors for vasa previa that would inform a targeted screening policy. Nevertheless, support for targeted screening was strong from obstetricians who responded. This article is protected by copyright. All rights reserved.
McCall, SJ, Li, Z, Kurinczuk, JJ, Sullivan, E & Knight, M 2019, 'Maternal and perinatal outcomes in pregnant women with BMI >50: An international collaborative study.', PloS one, vol. 14, no. 2.View/Download from: UTS OPUS or Publisher's site
OBJECTIVE:To examine the association between maternal BMI>50kg/m2 during pregnancy and maternal and perinatal outcomes. MATERIALS AND METHODS:An international cohort study was conducted using data from separate national studies in the UK and Australia. Outcomes of pregnant women with BMI>50 were compared to those of pregnant women with BMI<50. Multivariable logistic regression estimated the association between BMI>50 and perinatal and maternal outcomes. RESULTS:932 pregnant women with BMI>50 were compared with 1232 pregnant women with BMI<50. Pregnant women with BMI>50 were slightly older, more likely to be multiparous, and have pre-existing comorbidities. There were no maternal deaths, however, extremely obese women had a nine-fold increase in the odds of thrombotic events compared to those with a BMI<50 (uOR: 9.39 (95%CI:1.15-76.43)). After adjustment, a BMI>50 during pregnancy had significantly raised odds of preeclampsia/eclampsia (aOR:4.88(95%CI: 3.11-7.65)), caesarean delivery (aOR: 2.77 (95%CI: 2.31-3.32)), induction of labour (aOR: 2.45(95% CI:2.00-2.99)) post caesarean wound infection (aOR:7.25(95%CI: 3.28-16.07)), macrosomia (aOR: 8.05(95%CI: 4.70-13.78)) compared a BMI<50. Twelve of the infants born to women in the extremely obese cohort died in the early neonatal period or were stillborn. CONCLUSIONS:Pregnant women with BMI>50 have a high risk of inferior maternal and perinatal outcomes.
Zeki, R, Li, Z, Wang, AY, Homer, CSE, Oats, JJN, Marshall, D & Sullivan, EA 2019, 'Obstetric anal sphincter injuries among women with gestational diabetes and women without gestational diabetes: A NSW population-based cohort study', Australian and New Zealand Journal of Obstetrics and Gynaecology.View/Download from: Publisher's site
© 2019 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Background: Obstetric anal sphincter injuries (OASIs) are associated with maternal morbidity; however, it is uncertain whether gestational diabetes (GDM) is an independent risk factor when considering birthweight mode of birth and episiotomy. Aims: To compare rates of OASIs between women with GDM and women without GDM by mode of birth and birthweight. To investigate the association between episiotomy, mode of birth and the risk of OASIs. Methods: A population-based cohort study of women who gave birth vaginally in NSW, from 2007 to 2013. Rates of OASIs were compared between women with and without GDM, stratified by mode of birth, birthweight and a multi-categorical variable of mode of birth and episiotomy. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated by multivariable logistic regression. Results: The rate of OASIs was 3.6% (95% CI: 2.6–2.7) vs 2.6% (95% CI: 3.4–2.8; P < 0.001) among women with and without GDM, respectively. Women with GDM and a macrosomic baby (birthweight ≥ 4000 g) had a higher risk of OASIs with forceps (aOR 1.76, 95% CI: 1.08–2.86, P = 0.02) or vacuum (aOR 1.89, 95% CI: 1.17–3.04, P = 0.01), compared with those without GDM. For primiparous women with GDM and all women without GDM, an episiotomy with forceps was associated with lower odds of OASIs than forceps only (primiparous GDM, forceps-episiotomy aOR 2.49, 95% CI: 2.00–3.11, forceps aOR 5.30, 95% CI: 3.72–7.54), (primiparous without GDM, forceps-episiotomy aOR 2.71, 95% CI: 2.55–2.89, forceps aOR 5.95, 95% CI: 5.41–6.55) and (multiparous without GDM, forceps-episiotomy aOR 3.75, 95% CI: 3.12–4.50, forceps aOR 6.20, 95% CI: 4.96–7.74). Conclusion: Women with GDM and a macrosomic baby should be counselled about the increased risk of OASIs with both vacuum and forceps. With forceps birth, this risk can be partially mitigated by performing a concomitant episiotomy.
Li, Z, Wang, AY, Bowman, M, Hammarberg, K, Farquhar, C, Johnson, L, Safi, N & Sullivan, EA 2019, 'Cumulative live birth rates following a 'freeze-all' strategy: a population-based study.', Human reproduction open, vol. 2019, no. 2, pp. 1-9.View/Download from: UTS OPUS or Publisher's site
STUDY QUESTION:What is the cumulative live birth rate following a 'freeze-all' strategy compared with a 'fresh-transfer' strategy? SUMMARY ANSWER:The 'freeze-all' strategy resulted in a similar cumulative live birth rate as the 'fresh-transfer' strategy among high responders (>15 oocytes retrieved) but did not benefit normal (10-15 oocytes) and suboptimal responders (<10 oocytes). WHAT IS KNOWN ALREADY:Frozen-thawed embryo transfer is associated with a decreased risk of adverse obstetric and perinatal outcomes compared with fresh embryo transfer. It is unclear whether the 'freeze-all' strategy should be offered to all women undergoing ART treatment. STUDY DESIGN SIZE DURATION:A population-based retrospective cohort study using data collected by the Victorian Assisted Reproductive Treatment Authority. This study included 14 331 women undergoing their first stimulated ART cycle with at least one oocyte fertilised between 1 July 2009 and 30 June 2014 in Victoria, Australia. Demographic characteristics, type of ART procedures and resulting pregnancy and birth outcomes were recorded for the stimulated cycle and associated thaw cycles until 30 June 2016, or until a live birth was achieved, or until all embryos from the stimulated cycle had been used. PARTICIPANTS/MATERIALS SETTING METHODS:Women were grouped by whether they had undergone the 'freeze-all' strategy (n = 1028) where all embryos were cryopreserved for future transfer, or the 'fresh-transfer' strategy (n = 13 303) where selected embryo(s) were transferred in the stimulated cycle, and remaining embryo(s) were cryopreserved for future use. A discrete-time survival model was used to evaluate the cumulative live birth rate following 'freeze-all' and 'fresh-transfer' strategy. MAIN RESULTS AND THE ROLE OF CHANCE:A total of 1028 women undergoing 'freeze-all' strategy and 13 303 women undergoing 'fresh-transfer' strategy had 1788 and 22 334 embryo transfer cycles resulting in 452 and 5126 live births, respectively....
Gerstl, B, Sullivan, E, Vallejo, M, Koch, J, Johnson, M, Wand, H, Webber, K, Ives, A & Anazodo, A 2019, 'Reproductive outcomes following treatment for a gynecological cancer diagnosis: a systematic review.', Journal of cancer survivorship : research and practice, vol. 13, no. 2, pp. 269-281.View/Download from: UTS OPUS or Publisher's site
PURPOSE:Fertility treatments are available for women diagnosed with a gynecological malignancy, which is important for women who desire a biological family subsequent to treatment. The objective of this study was to report reproductive outcomes following fertility-sparing treatment for a gynaecological cancer. METHODS:Electronic databases were searched to identify studies that reported on reproductive outcomes after treatment for a gynecological malignancy. RESULTS:In total, 77 studies were included which reported on reproductive outcomes after treatment for cervical cancer, endometrial cancer, gestational trophoblastic disease, and ovarian cancer. The main treatments included vaginal or abdominal radical trachelectomy, progestin therapy, salpingo-oophorectomy, and chemotherapy. The mean age at diagnosis for the study population and at birth were 30.5 years and 30.3 years, respectively. There were 4749 pregnancies (42%) reported for the included studies, with a miscarriage rate of 15% and a medical termination rate of 5%. The live birth rate was 74% with a 10% preterm rate. IMPLICATIONS FOR CANCER SURVIVORS:Patients should be offered timely discussions, information, and counseling regarding the impact of gynecological cancer treatment on a patient's fertility. Furthermore, fertility-sparing strategies and fertility preservation should be discussed prior to starting treatment.
Kendall, S, Lighton, S, Sherwood, J, Baldry, E & Sullivan, E 2019, 'Holistic Conceptualizations of Health by Incarcerated Aboriginal Women in New South Wales, Australia.', Qualitative health research, vol. 29, no. 11, pp. 1549-1565.View/Download from: UTS OPUS or Publisher's site
While there has been extensive research on the health and social and emotional well-being (SEWB) of Aboriginal women in prison, there are few qualitative studies where incarcerated Aboriginal women have been directly asked about their health, SEWB, and health care experiences. Using an Indigenous research methodology and SEWB framework, this article presents the findings of 43 interviews with incarcerated Aboriginal women in New South Wales, Australia. Drawing on the interviews, we found that Aboriginal women have holistic conceptualizations of their health and SEWB that intersect with the SEWB of family and community. Women experience clusters of health problems that intersect with intergenerational trauma, perpetuated and compounded by ongoing colonial trauma including removal of children. Women are pro-active about their health but encounter numerous challenges in accessing appropriate health care. These rarely explored perspectives can inform a reframing of health and social support needs of incarcerated Aboriginal women establishing pathways for healing.
Vaughan, G, Dawson, A, Peek, MJ, Carapetis, JR & Sullivan, EA 2019, 'Standardizing clinical care measures of rheumatic heart disease in pregnancy: A qualitative synthesis', Birth.View/Download from: Publisher's site
© 2019 Wiley Periodicals, Inc. Background: Rheumatic heart disease (RHD) is a preventable cardiac condition that escalates risk in pregnancy. Models of care informed by evidence-based clinical guidelines are essential to optimal health outcomes. There are no published reviews that systematically explore approaches to care provision for pregnant women with RHD and examine reported measures. The review objective was to improve understanding of how attributes of care for these women are reported and how they align with guidelines. Methods: A search of 13 databases was supported by hand-searching. Papers that met inclusion criteria were appraised using CASP/JBI checklists. A content analysis of extracted data from the findings sections of included papers was undertaken, informed by attributes of quality care identified previously from existing guidelines. Results: The 43 included studies were predominantly conducted in tertiary care centers of low-income and middle-income countries. Cardiac guidelines were referred to in 25 of 43 studies. Poorer outcomes were associated with higher risk scores (detailed in 36 of 41 quantitative studies). Indicators associated with increased risk include anticoagulation during pregnancy (28 of 41 reported) and late booking (gestation documented in 15 of 41 studies). Limited access to cardiac interventions was discussed (19 of 43) in the context of poorer outcomes. Conversely, early assessment and access to regular multidisciplinary care were emphasized in promoting optimal outcomes for women and their babies. Conclusions: Despite often complex care requirements in challenging environments, pregnancy provides an opportunity to strengthen health system responses and address whole-of-life health for women with RHD. A standard set of core indicators is proposed to more accurately benchmark care pathways, outcomes, and burden.
Wang, Y, Logan, S, Stern, K, Wakefield, CE, Cohn, RJ, Agresta, F, Jayasinghe, Y, Deans, R, Segelov, E, McLachlan, RI, Gerstl, B, Sullivan, E, Ledger, WE & Anazodo, A 2019, 'Supportive oncofertility care, psychological health and reproductive concerns: a qualitative study', Supportive Care in Cancer.View/Download from: Publisher's site
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: Impaired fertility in cancer patients and survivors of reproductive age (15–45 years) may lead to psychological distress and poor mental health outcomes, and may negatively impact quality of life. Limited research has focused on the fertility experiences of those who have had access to supportive oncofertility care. This study aims to explore the fertility-care experiences and reproductive concerns of reproductive age cancer patients at the time of their cancer diagnosis who have had access to oncofertility care. Methods: The qualitative data from a larger mixed method study is presented, comprising 30 semi-structured telephone interviews with newly diagnosed cancer patients across Australia and New Zealand, undertaken between April 2016 and April 2018. Results: Interviews were undertaken with 9 male patients and 21 female patients aged between 15 and 44 years. All patients recalled a discussion about fertility and majority underwent some form of fertility preservation. Thematic analysis identified five main themes: (i) satisfaction with oncofertility care, (ii) a need for individualised treatment and support, (iii) desire for parenthood, (iv) fertility treatment can be challenging, and (v) fertility preservation provides a safety net for the future. Conclusions: Participants who access supportive oncofertility care report low emotional impact of threatened future infertility at the time of cancer diagnosis. These results suggest that such services may assist in lowering the emotional burden of potential infertility in survivors. Long-term research is needed to assess the longitudinal benefits for different models of care.
Hogan, RG, Wang, AY, Li, Z, Hammarberg, K, Johnson, L, Mol, BW & Sullivan, EA 2019, 'Oocyte donor age has a significant impact on oocyte recipients' cumulative live-birth rate: a population-based cohort study', Fertility and Sterility.View/Download from: UTS OPUS or Publisher's site
© 2019 Objective: To study the impact of the donor's and recipient's age on the cumulative live-birth rate (CLBR) in oocyte donation cycles. Design: A population-based retrospective cohort study. Setting: Not applicable. Patient(s): All women using donated oocytes (n = 1,490) in Victoria, Australia, between 2009 and 2015. Intervention(s): None. Main Outcome Measure(s): The association between the donor's and recipient's age and CLBR modeled by multivariate Cox proportional hazard regression with the covariates of male partner's age, recipient parity, and cause of infertility adjusted for, and donor age grouped as <30, 30–34, 35–37, 38–40, and ≥41 years, and recipient age as <35, 35–37, 38–40, 41–42, 43–44, and ≥45 years. Result(s): The mean age of the oocyte donors was 33.7 years (range: 21 to 45 years) with 49% aged 35 years and over. The mean age of the oocyte recipients was 41.4 years (range: 19 to 53 years) with 25.4% aged ≥45 years. There was a statistically significant relationship between the donor's age and the CLBR. The CLBR for recipients with donors aged <30 years and 30–34 years was 44.7% and 43.3%, respectively. This decreased to 33.6% in donors aged 35–37 years, 22.6% in donors aged 38–40 years, and 5.1% in donors aged ≥41 years. Compared with recipients with donors aged <30 years, the recipients with donors aged 38–40 years had 40% less chance of achieving a live birth (adjusted hazard ratio 0.60; 95% CI, 0.43–0.86) and recipients with donors aged ≥41 years had 86% less chance of achieving a live birth (adjusted hazard ratio 0.14; 95% CI, 0.04–0.44). The multivariate analysis showed no statistically significant effect of the recipient's age on CLBR. Conclusion(s): We have demonstrated that the age of the oocyte donor is critical to the CLBR and is independent of the recipient woman's age. Recipients using oocytes from donors aged ≥35 years had a statistically significantly lower CLBR when compared with recipients using oocytes from donors aged <35 ...
Safi, N, Sullivan, E, Li, Z, Brown, M, Hague, W, McDonald, S, Peek, MJ, Makris, A, O'Brien, AM & Jesudason, S 2019, 'Serious kidney disease in pregnancy: an Australian national cohort study protocol.', BMC nephrology, vol. 20, no. 1.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Maternal kidney disease (acute kidney injury (AKI), advanced chronic kidney disease (CKD), dependence on dialysis or a kidney transplant) has a substantial impact on pregnancy, with risks of significant perinatal morbidity. These pregnancies require integrated multidisciplinary care to manage a complex and often challenging clinical situation. The ability to deliver optimal care is currently hindered by a lack of understanding around prevalence, management and outcomes in Australia. This study aims to expand an evidence base to improve clinical care of women with serious kidney impairment in pregnancy. METHODS/DESIGN:The "Kidney Disease in Pregnancy Study" is a national prospective cohort study of women with stage 3b-5 CKD (including dialysis and transplant) and severe AKI in pregnancy, using the Australasian Maternity Outcomes Surveillance System (AMOSS). AMOSS incorporates Australian maternity units with > 50 births/year (n = 260), capturing approximately 96% of Australian births. We will identify women meeting the inclusion criteria who give birth in Australia between 1st August 2017 and 31st July 2018. Case identification will occur via monthly review of all births in Australian AMOSS sites and prospective notification to AMOSS via renal or obstetric clinics. AMOSS data collectors will capture key clinical data via a web-based data collection tool. The data collected will focus on the prevalence, medical and obstetric clinical care, and maternal and fetal outcomes of these high-risk pregnancies. DISCUSSION:This study will increase awareness of the issue of serious renal impairment in pregnancy through engagement of 260 maternity units and obstetric and renal healthcare providers across the country. The study results will provide an evidence base for pre-pregnancy counselling and development of models of optimal clinical care, clinical guideline and policy development in Australia. Understanding current practices, gaps in care and areas for interven...
© The Author(s) 2019. Like the United Kingdom and New Zealand, all eight Australian jurisdictions have legal provisions for the full-time accommodation of young children with their mothers in prison. Whether and how these laws are enacted varies, and there are no national or international norms. This article integrates a review of policies, principles and operating models with findings from a qualitative study, to describe the current landscape in residential programmes for mothers and children in Australian prisons. It demonstrates how current ideologies limit the system's ability to meet the needs of imprisoned mothers, their children and prison staff. Three issues emerge as problematic: the separation of the rights and interests of mothers and children; over-reliance on attachment theory as both rationale and evidence base; and the individualization of responsibility and risk. The study is of international relevance because these themes and concepts are recognizable elsewhere, including the United Kingdom, New Zealand and some European countries.
Anazodo, A, Laws, P, Logan, S & Saunders, CM 2019, 'How can we improve oncofertility care for patients? A systematic scoping review of current international practice and models of care', Human Reproduction Update, vol. 25, no. 2, pp. 159-179.View/Download from: UTS OPUS or Publisher's site
Fertility preservation (FP) is an important quality of life issue for cancer survivors of reproductive age. Despite the existence of broad international guidelines, the delivery of oncofertility care, particularly amongst paediatric, adolescent and young adult patients, remains a challenge for healthcare professionals (HCPs). The quality of oncofertility care is variable and the uptake and utilization of FP remains low. Available guidelines fall short in providing adequate detail on how oncofertility models of care (MOC) allow for the real-world application of guidelines by HCPs.
OBJECTIVE AND RATIONALE
The aim of this study was to systematically review the literature on the components of oncofertility care as defined by patient and clinician representatives, and identify the barriers, facilitators and challenges, so as to improve the implementation of oncofertility services.
A systematic scoping review was conducted on oncofertility MOC literature published in English between 2007 and 2016, relating to 10 domains of care identified through consumer research: communication, oncofertility decision aids, age-appropriate care, referral pathways, documentation, training, supportive care during treatment, reproductive care after cancer treatment, psychosocial support and ethical practice of oncofertility care. A wide range of electronic databases (CINAHL, Embase, PsycINFO, PubMed, AEIPT, Education Research Complete, ProQuest and VOCED) were searched in order to synthesize the evidence around delivery of oncofertility care. Related citations and reference lists were searched. The review was undertaken following registration (International prospective register of systematic reviews (PROSPERO) registration number CRD42017055837) and guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
A total of 846 potentially relevant studies were identified after the removal of duplicates. All titles and abstr...
Anazodo, A, Laws, P, Logan, S, Saunders, C, Travaglia, J, Gerstl, B, Bradford, N, Cohn, R, Birdsall, M, Barr, R, Suzuki, N, Takae, S, Marinho, R, Xiao, S, Chen, Q-H, Mahajan, N, Patil, M, Gunasheela, D, Smith, K, Sender, L, Melo, C, Almeida-Santos, T, Salama, M, Appiah, L, Su, I, Lane, S, Woodruff, TK, Pacey, A, Anderson, RA, Shenfield, F, Sullivan, E & Ledger, W 2019, 'The Development of an International Oncofertility Competency Framework: A Model to Increase Oncofertility Implementation.', The oncologist, vol. 24, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Despite international evidence about fertility preservation (FP), several barriers still prevent the implementation of equitable FP practice. Currently, oncofertility competencies do not exist. The aim of this study was to develop an oncofertility competency framework that defines the key components of oncofertility care, develops a model for prioritizing service development, and defines the roles that health care professionals (HCPs) play. MATERIALS AND METHOD:A quantitative modified Delphi methodology was used to conduct two rounds of an electronic survey, querying and synthesizing opinions about statements regarding oncofertility care with HCPs and patient and family advocacy groups (PFAs) from 16 countries (12 high and 4 middle income). Statements included the roles of HCPs and priorities for service development care across ten domains (communication, oncofertility decision aids, age-appropriate care, referral pathways, documentation, oncofertility training, reproductive survivorship care and fertility-related psychosocial support, supportive care, and ethical frameworks) that represent 33 different elements of care. RESULTS:The first questionnaire was completed by 457 participants (332 HCPs and 125 PFAs). One hundred and thirty-eight participants completed the second questionnaire (122 HCPs and 16 PFAs). Consensus was agreed on 108 oncofertility competencies and the roles HCPs should play in oncofertility care. A three-tier service development model is proposed, with gradual implementation of different components of care. A total of 92.8% of the 108 agreed competencies also had agreement between high and middle income participants. CONCLUSION:FP guidelines establish best practice but do not consider the skills and requirements to implement these guidelines. The competency framework gives HCPs and services a structure for the training of HCPs and implementation of care, as well as defining a model for prioritizing oncofertility service development....
Sullivan, E, Ward, S, Zeki, R, Wayland, S, Sherwood, J, Wang, A, Worner, F, Kendall, S, Brown, J & Chang, S 2019, 'Recidivism, health and social functioning following release to the community of NSW prisoners with problematic drug use: study protocol of the population-based retrospective cohort study on the evaluation of the Connections Program.', BMJ open, vol. 9, no. 7, pp. e030546-e030546.View/Download from: UTS OPUS or Publisher's site
INTRODUCTION:The rising rate of incarceration in Australia, driven by high reoffending, is a major public health problem. Problematic drug use is associated with increasing rates of reoffending and return to custody of individuals. Throughcare provides support to individuals during imprisonment through to post-release, improving both the transition to community and health outcomes post-incarceration. The aim of this study is to evaluate the Connections Programme (CP) that utilises a throughcare approach for release planning of people in prison with a history of problematic drug use. The study protocol is described. METHODS AND ANALYSIS:Population-based retrospective cohort study. The study will use record linkage of the Connections dataset with 10 other New South Wales (NSW) population datasets on offending, health service utilisation, opioid substitution therapy, pregnancy, birth and mortality. The study includes all patients who were eligible to participate in the CP between January 2008 and December 2015 stratified by patients who were offered CP and eligible patients who were not offered the programme (non-CP (NCP)). Propensity-score matching will be used to appropriately adjust for the observable differences between CP and NCP. The differences between two groups will be examined using appropriate univariate and multivariate analyses. A generalised estimating equation approach, which can deal with repeat outcomes for individuals will be used to examine recidivism, mortality and other health outcomes, including perinatal and infant outcomes. Survival analysis techniques will be used to examine the effect of the CP by sex and Indigenous status on the 'time-to' health-related outcomes after adjusting for potential confounders. ETHICS AND DISSEMINATION:Ethical approval was received from the NSW Population and Health Services Research Ethics Committee, the Justice Health and Forensic Mental Health Network Human Research Ethics Committee, the Aboriginal Health and ...
Sullivan, EA, Kendall, S, Chang, S, Baldry, E, Zeki, R, Gilles, M, Wilson, M, Butler, T, Levy, M, Wayland, S, Cullen, P, Jones, J & Sherwood, J 2019, 'Aboriginal mothers in prison in Australia: a study of social, emotional and physical wellbeing.', Australian and New Zealand journal of public health, vol. 43, no. 3, pp. 241-247.View/Download from: UTS OPUS or Publisher's site
OBJECTIVE:To describe the social, emotional and physical wellbeing of Aboriginal mothers in prison. METHODS:Cross-sectional survey, including a Short Form Health Survey (SF-12) and Kessler Psychological Distress Scale (5-item version) administered to Aboriginal women who self-identified as mothers. RESULTS:Seventy-seven Aboriginal mothers in New South Wales (NSW) and 84 in Western Australia (WA) participated in the study. Eighty-three per cent (n=59) of mothers in NSW were in prison for drug-related offences, 64.8% (n=46) of mothers in WA were in prison for offences committed under the influence of alcohol. Sixty-eight per cent (n=52) of mothers in NSW and 35% (n=28) of mothers in WA reported mental health problems. Physical (PCS) and Mental (MCS) component scores of SF-12 varied for mothers in NSW and WA. Mothers in NSW experienced poorer health and functioning than mothers in WA (NSW: PCS 49.5, MCS 40.6; WA: PCS 54.4, MCS 48.3) and high levels of psychological distress (NSW: 13.1; WA 10.1). CONCLUSIONS:Aboriginal mothers in prison have significant health needs associated with physical and mental health, and psychological distress. Implications for public health: Adoption of social and emotional wellbeing as an explanatory framework for culturally secure healthcare in prison is essential to improving health outcomes of Aboriginal mothers in prison in Australia.
Hammarberg, K, Sullivan, E, Javid, N, Duncombe, G, Halliday, L, Boyle, F, Saunders, C, Ives, A, Dickinson, JE & Fisher, J 2018, 'Health care experiences among women diagnosed with gestational breast cancer.', European Journal of Cancer Care, vol. 27, no. 2, pp. 1-11.View/Download from: UTS OPUS or Publisher's site
Gestational breast cancer (GBC) presents many challenges for women and the clinicians who care for them. The aim of this study was to explore the health care experiences of women diagnosed with GBC to inform and improve clinical care of women in this predicament. Semi-structured interviews were conducted with 17 women who had been diagnosed with GBC in the previous 5 years. The overarching themes for perceived quality of care were "communication" and "comprehensive care." "Communication" had two sub themes: "interdisciplinary communication" (the way health professionals from different disciplines communicated with each other about the management of the woman's care) and "patient communication" (how they communicated this to the woman). The "comprehensive care" theme incorporated three sub themes: "the spirit" (psychological care); "the mind" (information provision); and "the body" (management of treatment side effects). Women's own accounts of positive and negative experiences of GBC care provide unique and specific insights which improve understanding of their concerns and needs. The findings can inform advances in quality and efficacy of clinical care; offer guidance for obstetricians, oncologists and allied health professionals about the needs of women diagnosed with GBC and how care can be optimised; and inform the development of resources to assist women and their families.
Gerstl, B, Sullivan, E, Ives, A, Saunders, C, Wand, H & Anazodo, A 2018, 'Pregnancy Outcomes After a Breast Cancer Diagnosis: A Systematic Review and Meta-analysis.', Clinical Breast Cancer, vol. 18, no. 1, pp. e79-e88.View/Download from: UTS OPUS or Publisher's site
Improvements in local and systemic treatment, along with earlier diagnoses through breast awareness and screening, have led to increases in survival and a decline in breast cancer (BC) recurrence. To the best of our knowledge, no meta-analysis has yet focused on pregnancy outcomes after BC treatment. Hence, our research group explored the reproductive outcomes (pregnancy, miscarriage, termination of pregnancy, live births) after BC treatment. The Embase, MEDLINE, PubMed, and Scopus databases were searched. Studies were included that reported on pregnancy and reproductive outcomes after treatment of BC. A meta-analysis of 16 studies with subgroup analyses was conducted. In the matched cohort and case-control studies (n = 1287), subgroup analysis showed that women who had received systemic therapy after surgery had an overall pooled estimate of 14% (95% confidence interval [CI], 0.12-0.16; I2 = 95.4%) of becoming pregnant. Of those who became pregnant, 12% (95% CI, 0.08-0.16; I2 = 65.9%) experienced a miscarriage. For the population-based studies (n = 711), the estimated pooled pregnancy rate was 3% (95% CI, 0.02-0.03; I2 = 85.1%) for women who became pregnant after BC treatment. The pregnancy rate after BC treatment for survivors was on average 40% lower than the general population pregnancy rate. Women with BC should be informed about the subsequent adverse effects of BC and its treatments on conception. With the increasing trend for women to defer childbirth to later in life, provision of fertility-related information, access to fertility preservation, and fertility-related psychosocial support should be offered to women of a reproductive age before they begin BC treatment.
Belton, S, Kruske, S, Jackson Pulver, L, Sherwood, J, Tune, K, Carapetis, J, Vaughan, G, Peek, M, McLintock, C & Sullivan, E 2018, 'Rheumatic heart disease in pregnancy: How can health services adapt to the needs of Indigenous women? A qualitative study.', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 58, no. 4, pp. 425-431.View/Download from: UTS OPUS or Publisher's site
To study rheumatic heart disease health literacy and its impact on pregnancy, and to identify how health services could more effectively meet the needs of pregnant women with rheumatic heart disease.Researchers observed and interviewed a small number of Aboriginal women and their families during pregnancy, childbirth and postpartum as they interacted with the health system. An Aboriginal Yarning method of relationship building over time, participant observations and interviews with Aboriginal women were used in the study. The settings were urban, island and remote communities across the Northern Territory. Women were followed interstate if they were transferred during pregnancy. The participants were pregnant women and their families. We relied on participants' abilities to tell their own experiences so that researchers could interpret their understanding and perspective of rheumatic heart disease.Aboriginal women and their families rarely had rheumatic heart disease explained appropriately by health staff and therefore lacked understanding of the severity of their illness and its implications for childbearing. Health directives in written and spoken English with assumed biomedical knowledge were confusing and of limited use when delivered without interpreters or culturally appropriate health supports.Despite previous studies documenting poor communication and culturally inadequate care, health systems did not meet the needs of pregnant Aboriginal women with rheumatic heart disease. Language-appropriate health education that promotes a shared understanding should be relevant to the gender, life-stage and social context of women with rheumatic heart disease.
Chughtai, AA, Wang, AY, Hilder, L, Li, Z, Lui, K, Farquhar, C & Sullivan, EA 2018, 'Gestational age-specific perinatal mortality rates for assisted reproductive technology (ART) and other births.', Human Reproduction, vol. 33, no. 2, pp. 320-327.View/Download from: UTS OPUS or Publisher's site
Is perinatal mortality rate higher among births born following assisted reproductive technology (ART) compared to non-ART births?Overall perinatal mortality rates in ART births was higher compared to non-ART births, but gestational age-specific perinatal mortality rate of ART births was lower for very preterm and moderate to late preterm births.Births born following ART are reported to have higher risk of adverse perinatal outcomes compared to non-ART births.This population-based retrospective cohort study included 407 368 babies (391 952 non-ART and 15 416 ART)-393 491 singletons and 10 877 twins or high order multiples.All births (≥20 weeks of gestation and/or ≥400 g of birthweight) in five states and territories in Australia during the period 2007-2009 were included in the study, using National Perinatal Data Collection (NPDC). Primary outcome measures were rates of stillbirth, neonatal and perinatal deaths. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to estimate the likelihood of perinatal death.Rates of multiple birth and low birthweight were significantly higher in ART group compared to the non-ART group (P < 0.01). Overall perinatal mortality rate was significantly higher for ART births (16.5 per 1000 births, 95% CI 14.5-18.6), compared to non-ART births (11.3 per 1000 births, 95% CI 11.0-11.6) (AOR 1.45, 95% CI 1.26-1.68). However, gestational age-specific perinatal mortality rate of ART births (including both singletons and multiples) was lower for very preterm (<32 weeks' gestation) and moderate to late preterm births (32-36 weeks' gestation) (AOR 0.61, 95% CI 0.53-0.70 and AOR 0.61, 95% CI 0.53-0.70, respectively) compared to non-ART births. Congenital abnormality and spontaneous preterm were the most common causes of neonatal deaths in both ART and non-ART group.Due to different cut-off limit for perinatal period in Australia, the results of this study should be interpreted with cautions for other countries. Australian definit...
Zeki, R, Oats, JJN, Wang, AY, Li, Z, Homer, CSE & Sullivan, EA 2018, 'Cesarean section and diabetes during pregnancy: An NSW population study using the Robson classification.', The journal of obstetrics and gynaecology research, vol. 44, no. 5, pp. 890-898.View/Download from: UTS OPUS or Publisher's site
AIM:The aim of this study was to identify the main contributors to cesarean section (CS) among women with and without diabetes during pregnancy using the Robson classification and to compare CS rates within Robson groups. METHODS:A population-based cohort study was conducted of all women who gave birth in New South Wales, Australia, between 2002 and 2012. Women with pregestational diabetes (types 1 and 2) and gestational diabetes mellitus (GDM) were grouped using the Robson classification. Adjusted odd ratios (AOR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression. RESULTS:The total CS rate was 53.6% for women with pregestational diabetes, 36.8% for women with GDM and 28.5% for women without diabetes. Previous CS contributed the most to the total number of CS in all populations. For preterm birth, the contribution to the total was 20.5% for women with pregestational diabetes and 5.7% for women without diabetes. Compared to women without diabetes, for nulliparous with pregestational diabetes, the odds of CS was 1.4 (95% CI, 1.1-1.8) for spontaneous labor and 2.0 (95% CI, 1.7-2.3) for induction of labor. CONCLUSION:A history of CS was the main contributor to the total CS. Reducing primary CS is the first step to lowering the high rate of CS among women with diabetes. Nulliparous women were more likely to have CS if they had pregestational diabetes. This increase was also evident in all multiparous women giving birth. The high rate of preterm births and CS reflects the clinical issues for women with diabetes during pregnancy.
Kendall, S, Redshaw, S, Ward, S, Wayland, S & Sullivan, E 2018, 'Systematic review of qualitative evaluations of reentry programs addressing problematic drug use and mental health disorders amongst people transitioning from prison to communities.', Health & justice, vol. 6.View/Download from: UTS OPUS or Publisher's site
The paper presents a systematic review and metasynthesis of findings from qualitative evaluations of community reentry programs. The programs sought to engage recently released adult prison inmates with either problematic drug use or a mental health disorder.Seven biomedical and social science databases, Cinahl, Pubmed, Scopus, Proquest, Medline, Sociological abstracts and Web of Science and publisher database Taylor and Francis were searched in 2016 resulting in 2373 potential papers. Abstract reviews left 140 papers of which 8 were included after detailed review. Major themes and subthemes were identified through grounded theory inductive analysis of results from the eight papers. Of the final eight papers the majority (6) were from the United States. In total, the papers covered 405 interviews and included 121 (30%) females and 284 (70%) males.Findings suggest that the interpersonal skills of case workers; access to social support and housing; and continuity of case worker relationships throughout the pre-release and post-release period are key social and structural factors in program success.Evaluation of community reentry programs requires qualitative data to contextualize statistical findings and identify social and structural factors that impact on reducing incarceration and improving participant health. These aspects of program efficacy have implications for reentry program development and staff training and broader social and health policy and services.
Zeki, R, Wang, AY, Lui, K, Li, Z, Oats, JJN, Homer, CSE & Sullivan, EA 2018, 'Neonatal outcomes of live-born term singletons in vertex presentation born to mothers with diabetes during pregnancy by mode of birth: a New South Wales population-based retrospective cohort study.', BMJ Paediatrics Open, vol. 2, no. 1, pp. e000224-e000224.View/Download from: UTS OPUS or Publisher's site
To investigate the association between the mode of birth and adverse neonatal outcomes of macrosomic (birth weight ≥4000 g) and non-macrosomic (birth weight <4000 g) live-born term singletons in vertex presentation (TSV) born to mothers with diabetes (pre-existing and gestational diabetes mellitus (GDM)).A population-based retrospective cohort study.New South Wales, Australia.All live-born TSV born to mothers with diabetes from 2002 to 2012.Comparison of neonatal outcomes by mode of birth (prelabour caesarean section (CS) and planned vaginal birth resulted in intrapartum CS, non-instrumental or instrumental vaginal birth).Five-minute Apgar score <7, admission to neonatal intensive care unit (NICU) or special care nursery (SCN) and the need for resuscitation.Among the 48 882 TSV born to mothers with diabetes, prelabour CS was associated with a significant increase in the rate of admission to NICU/SCN compared with planned vaginal birth.For TSV born to mothers with pre-existing diabetes, compared with non-instrumental vaginal birth, instrumental vaginal birth was associated with increased odds of the need for resuscitation in macrosomic (adjusted ORs (AOR) 2.6; 95% CI (1.2 to 7.5)) and non-macrosomic TSV (AOR 3.3; 95% CI (2.2 to 5.0)).For TSV born to mothers with GDM, intrapartum CS was associated with increased odds of the need for resuscitation compared with non-instrumental vaginal birth in non-macrosomic TSV (AOR 2.3; 95% CI (2.1 to 2.7)). Instrumental vaginal birth was associated with increased likelihood of requiring resuscitation compared with non-instrumental vaginal birth for both macrosomic (AOR 2.3; 95% CI (1.7 to 3.1)) and non-macrosomic (AOR 2.5; 95% CI (2.2 to 2.9)) TSV.Pregnant women with diabetes, particularly those with suspected fetal macrosomia, need to be aware of the increased likelihood of adverse neonatal outcomes following instrumental vaginal birth and intrapartum CS when planning mode of birth.
Li, Z, Wang, AY, Bowman, M, Hammarberg, K, Farquhar, C, Johnson, L, Safi, N & Sullivan, EA 2018, 'ICSI does not increase the cumulative live birth rate in non-male factor infertility.', Human reproduction (Oxford, England), vol. 33, no. 7, pp. 1322-1330.View/Download from: UTS OPUS or Publisher's site
STUDY QUESTION:What is the cumulative live birth rate following ICSI cycles compared with IVF cycles for couples with non-male factor infertility? SUMMARY ANSWER:ICSI resulted in a similar cumulative live birth rate compared with IVF for couples with non-male factor infertility. WHAT IS KNOWN ALREADY:The ICSI procedure was developed for couples with male factor infertility. There has been an increased use of ICSI regardless of the cause of infertility. Cycle-based statistics show that there is no difference in pregnancy rates between ICSI and IVF in couples with non-male factor infertility. However, evidence indicates that ICSI is associated with an increased risk of adverse perinatal outcomes. STUDY DESIGN, SIZE, DURATION:A population-based cohort of 14 693 women, who had their first ever stimulated cycle with fertilization performed for at least one oocyte by either IVF or ICSI between July 2009 and June 2014 in Victoria, Australia was evaluated retrospectively. The pregnancy and birth outcomes following IVF or ICSI were recorded for the first oocyte retrieval (fresh stimulated cycle and associated thaw cycles) until 30 June 2016, or until a live birth was achieved, or until all embryos from the first oocyte retrieval had been used. PARTICIPANTS/MATERIALS, SETTING, METHODS:Demographic, treatment characteristics and resulting outcome data were obtained from the Victorian Assisted Reproductive Treatment Authority. Data items in the VARTA dataset were collected from all fertility clinics in Victoria. Women were grouped by whether they had undergone IVF or ICSI. The primary outcome was the cumulative live birth rate, which was defined as live deliveries (at least one live birth) per woman after the first oocyte retrieval. A discrete-time survival model was used to evaluate the cumulative live birth rate following IVF and ICSI. The adjustment was made for year of treatment in which fertilization occurred, the woman's and male partner's age at first stimulated cycle,...
Coombes, J, Hunter, K, Mackean, T, Holland, AJA, Sullivan, E & Ivers, R 2018, 'Factors that impact access to ongoing health care for First Nation children with a chronic condition.', BMC Health Services Research, vol. 18, no. 1, pp. 1-9.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Access to multidisciplinary health care services for First Nation children with a chronic condition is critical for the child's health and well-being, but disparities and inequality in health care systems have been almost impossible to eradicate for First Nation people globally. The objective of this review is to identify the factors that impact access and ongoing care for First Nation children globally with a chronic condition. METHODS:An extensive systematic search was conducted of nine electronic databases to identify primary studies that explored factors affecting access to ongoing services for First Nation children with a chronic disease or injury. Due to the heterogeneity of included studies the Mixed Method Appraisal Tool (MMAT) was used to assess study quality. RESULTS:A total of six studies from Australia, New Zealand and Canada were identified and included in this review. Four studies applied qualitative approaches using in-depth semi structured interviews, focus groups and community fora. Two of the six studies used quantitative approaches. Facilitators included the utilisation of First Nation liaison workers or First Nation Health workers. Key barriers that emerged included lack of culturally appropriate health care, distance, language and cultural barriers, racism, the lack of incorporation of First Nation workers in services, financial difficulties and transport issues. CONCLUSION:There are few studies that have identified positive factors that facilitate access to health care for First Nation children. There is an urgent need to develop programs and processes to facilitate access to appropriate health care that are inclusive of the cultural needs of First Nation children.
Chambers, GM, Randall, S, Mihalopoulos, C, Reilly, N, Sullivan, EA, Highet, N, Morgan, VA, Croft, ML, Chatterton, ML & Austin, MP 2018, 'Mental health consultations in the perinatal period: A cost-analysis of Medicare services provided to women during a period of intense mental health reform in Australia', Australian Health Review, vol. 42, pp. 514-521.View/Download from: UTS OPUS or Publisher's site
© AHHA. Objective: To quantify total provider fees, benefits paid by the Australian Government and out-of-pocket patients' costs of mental health Medicare Benefits Schedule (MBS) consultations provided to women in the perinatal period (pregnancy to end of the first postnatal year). Method: A retrospective study of MBS utilisation and costs (in 2011-12 A$) for women giving birth between 2006 and 2010 by state, provider-type, and geographic remoteness was undertaken. Results: The cost of mental health consultations during the perinatal period was A$17.5 million for women giving birth in 2007, rising to A$29 million in 2010. Almost 9% of women giving birth in 2007 had a mental health consultation compared with more than 14% in 2010. An increase in women accessing consultations, along with an increase in the average number of consultations received, were the main drivers of the increased cost, with costs per service remaining stable. There was a shift to non-specialist care and bulk billing rates increased from 44% to 52% over the study period. In 2010, the average total cost (provider fees) per woman accessing mental health consultations during the perinatal period was A$689, and the average cost per service was A$133. Compared with women residing in regional and remote areas, women residing in major cities where more likely to access consultations, and these were more likely to be with a psychiatrist rather than an allied health professional or general practitioner. Conclusion: Increased access to mental health consultations has coincided with the introduction of recent mental health initiatives, however disparities exist based on geographic location. This detailed cost analysis identifies inequities of access to perinatal mental health services in regional and remote areas and provides important data for economic and policy analysis of future mental health initiatives. What is known about the topic?: The mental healthcare landscape in Australia has changed signifi...
Xu, F, Roberts, L, Binns, C, Sullivan, E & Homer, CSE 2018, 'Anaemia and depression before and after birth: a cohort study based on linked population data.', BMC psychiatry, vol. 18, no. 1, pp. 224-224.View/Download from: UTS OPUS or Publisher's site
To investigate the rates of hospitalisation for anaemia and depression in women in the six-year period (3 years before and after birth). To compare hospital admissions for depression in women with and without anaemia.This is a population-based cohort study. Women's birth records (New South Wales (NSW) Perinatal Data Collection) were linked with NSW Admitted Patients Data Collection records between 1 January 2001 and 31 December 2010, so that hospital admissions for mothers could be traced back for 3 years before birth and followed up 3 years after birth.NSW Australia.all women who gave birth to their first child in NSW between 1 January 2004 and 31 December 2008.Hospital admissions for both anaemia and depression were increased significantly in the year just before and after birth compared with the years before and after. Women with anaemia were more likely to be admitted to hospital for depression than those without (for principal diagnosis of depression, adjusted OR = 1.62, 95% CI = 1.25-2.11; for all diagnosis of depression, adjusted OR = 2.01, 95% CI = 1.70-2.38).Depression was associated with anaemia in women before and after birth. This finding highlight the important role of primary care providers in assessing for both anaemia and depressive symptomatology together, given the relationship between the two. Treating or preventing anaemia may help to prevent postnatal depression.
Vaughan, G, Tune, K, Peek, MJ, Jackson Pulver, L, Remenyi, B, Belton, S & Sullivan, EA 2018, 'Rheumatic heart disease in pregnancy: strategies and lessons learnt implementing a population-based study in Australia.', International health, vol. 10, no. 6, pp. 480-489.View/Download from: UTS OPUS or Publisher's site
Background:The global burden of rheumatic heart disease (RHD) is two-to-four times higher in women, with a heightened risk in pregnancy. In Australia, RHD is found predominantly among Aboriginal and Torres Strait Islander peoples. Methods:This paper reviews processes developed to identify pregnant Australian women with RHD during a 2-year population-based study using the Australasian Maternity Outcomes Surveillance System (AMOSS). It evaluates strategies developed to enhance reporting and discusses implications for patient care and public health. Results:AMOSS maternity coordinators across 262 Australian sites reported cases. An extended network across cardiac, Aboriginal and primary healthcare strengthened surveillance and awareness. The network notified 495 potential cases, of which 192 were confirmed. Seventy-eight per cent were Aboriginal and/or Torres Strait Islander women, with a prevalence of 22 per 1000 in the Northern Territory. Discussion:Effective surveillance was challenged by a lack of diagnostic certainty, incompatible health information systems and varying clinical awareness among health professionals. Optimal outcomes for pregnant women with RHD demand timely diagnosis and access to collaborative care. Conclusion:The strategies employed by this study highlight gaps in reporting processes and the opportunity pregnancy provides for diagnosis and re/engagement with health services to support better continuity of care and promote improved outcomes.
Wang, AY, Safi, N, Ali, F, Lui, K, Li, Z, Umstad, MP & Sullivan, EA 2018, 'Neonatal outcomes among twins following assisted reproductive technology: an Australian population-based retrospective cohort study.', BMC pregnancy and childbirth, vol. 18, no. 1, pp. 320-320.View/Download from: UTS OPUS or Publisher's site
While their incidence is on the rise, twin pregnancies are associated with risks to the mothers and their babies. This study aims to investigate the likelihood of adverse neonatal outcomes of twins following assisted reproductive technology (ART) compared to non-ART twins.A retrospective population study using the Australian National Perinatal Data Collections (NPDC) which included 19,662 twins of ≥20 weeks gestational age or ≥ 400 g birthweight in Australia. Maternal outcomes and neonatal outcomes (preterm birth, low birth weight, resuscitation and neonatal death) were compared. Generalized Estimating Equations were used to assess the likelihood of any neonatal outcomes, with adjusted odds ratio (AOR) and 95% confidence intervals (CI) presented. Weinberg's differential rule was used to estimate monozygotic twin rate.ART mothers were 3.3 years older than non-ART mothers. The rates of pregnancy-induced hypertension and gestational diabetes were significantly higher for ART mothers than non-ART mothers (12.2% vs. 8.4%, p < 0.01) and (9.7% vs. 7.5%, p < 0.01) respectively. The incidence of monozygotic twins was 2.0% for ART twins and 1.1% for non-ART twins. Compared with non-ART twins, ART twins had higher rates of preterm birth (AOR 1.13, 95% CI: 1.05-1.22), low birth weight (AOR 1.13, 95% CI: 1.05-1.22), and resuscitation (AOR 1.26, 95% CI: 1.17-1.36). Liveborn ART twins had 28% (AOR 1.28, 95% CI 1.09-1.50) increased odds of having any adverse neonatal outcome compared to liveborn non-ART twins, especially for opposite-sex ART twins (AOR 1.42, 95% CI 1.11-1.82).As ART twins had higher rates of adverse outcome, special prenatal care is recommended. Couples accessing ART should be fully informed of the risk of adverse outcome of twin pregnancies.
McCall, SJ, Li, Z, Kurinczuk, JJ, Sullivan, E & Knight, M 2018, 'Binational cohort study comparing the management and outcomes of pregnant women with a BMI >50-59.9 kg/m2 and those with a BMI ≥60 kg/m2.', BMJ open, vol. 8, no. 8, pp. e021055-e021055.View/Download from: UTS OPUS or Publisher's site
To compare the management, maternal and perinatal outcomes of women with a body mass index (BMI) ≥60 kg/m2 with women with a BMI >50-59.9 kg/m2.International collaborative cohort study.Binational study in the UK and Australia.UK: all pregnant women, and Australia: women who gave birth (birth weight ≥400 g or gestation ≥20 weeks) METHODS: Data from the Australasian Maternity Outcomes Surveillance System and UK Obstetric Surveillance System. Management, maternal and infant outcomes were compared between women with a BMI ≥60 kg/m2 and women with a BMI >50-59.9 kg/m2, using unconditional logistic regression.The sociodemographic characteristics and previous medical histories were similar between the 111 women with a BMI ≥60 kg/m2 and the 821 women with a BMI >50-59.9 kg/m2. Women with a BMI ≥60 kg/m2 had higher odds of thromboprophylaxis usage in both the antenatal (24% vs. 12%; OR 2.25, 95% CI 1.39 to 3.64) and postpartum periods (78% vs. 66%; OR 1.68, 95% CI 1.04 to 2.70). Women with BMI ≥60 kg/m2 had nearly double the odds of pre-eclampsia/eclampsia (adjusted OR 1.83 (95% CI 1.01 to 3.30)). No other maternal or perinatal outcomes were statistically significantly different. Severe adverse outcomes such as perinatal death were uncommon in both groups thus limiting the power of these comparisons. The rate of perinatal deaths was 18 per 1000 births for those with BMI ≥60 kg/m2; 12 per 1000 births for those with BMI >50-59.9 kg/m2; those with BMI ≥60 kg/m2 had a non-significant increased odds of perinatal death (unadjusted OR 1.46, 95% CI 0.31 to 6.74).Women are managed differently on the basis of BMI even at this extreme as shown by thromboprophylaxis. The pre-eclampsia result suggests that future research should examine whether weight reduction of any amount prior to pregnancy could reduce poor outcomes even if women remain extremely obese.
Barreix, M, Barbour, K, McCaw-Binns, A, Chou, D, Petzold, M, Gichuhi, GN, Gadama, L, Taulo, F, Tunçalp, Ö, Say, L & WHO Maternal Morbidity Working Group (MMWG) 2018, 'Standardizing the measurement of maternal morbidity: Pilot study results.', International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 141 Suppl 1, pp. 10-19.View/Download from: UTS OPUS or Publisher's site
To field test a standardized instrument to measure nonsevere morbidity among antenatal and postpartum women.A cross-sectional study was conducted in Jamaica, Kenya, and Malawi (2015-2016). Women presenting for antenatal care (ANC) or postpartum care (PPC) were recruited if they were at least 28 weeks into pregnancy or 6 weeks after delivery. They were interviewed and examined by a doctor, midwife, or nurse. Data were collected and securely stored electronically on a WHO server. Diagnosed conditions were coded and summarized using ICD-MM.A total of 1490 women (750 ANC; 740 PPC) averaging 26 years of age participated. Most women (61.6% ANC, 79.1% PPC) were healthy (no diagnosed medical or obstetric conditions). Among ANC women with clinical diagnoses, 18.3% had direct (obstetric) conditions and 18.0% indirect (medical) problems. Prevalences among PPC women were lower (12.7% and 8.6%, respectively). When screening for factors in the expanded morbidity definition, 12.8% (ANC) and 11.0% (PPC) self-reported exposure to violence.Nonsevere conditions are distinct from the leading causes of maternal death and may vary across pregnancy and the puerperium. This effort to identify and measure nonsevere morbidity promotes a comprehensive understanding of morbidity, incorporating maternal self-reporting of exposure to violence, and mental health. Further validation is needed.
Firoz, T, McCaw-Binns, A, Filippi, V, Magee, LA, Costa, ML, Cecatti, JG, Barreix, M, Adanu, R, Chou, D, Say, L & members of the WHO Maternal Morbidity Working Group (MMWG) 2018, 'A framework for healthcare interventions to address maternal morbidity.', International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 141 Suppl 1, pp. 61-68.View/Download from: UTS OPUS or Publisher's site
The maternal health agenda is undergoing a paradigm shift from preventing maternal deaths to promoting women's health and wellness. A critical focus of this trajectory includes addressing maternal morbidity and the increasing burden of chronic and noncommunicable diseases (NCD) among pregnant women. The WHO convened the Maternal Morbidity Working Group (MMWG) to improve the scientific basis for defining, measuring, and monitoring maternal morbidity. Based on the MMWG's work, we propose paradigms for conceptualizing maternal health and related interventions, and call for greater integration between maternal health and NCD programs. This integration can be synergistic, given the links between chronic conditions, morbidity in pregnancy, and long-term health. Pregnancy should be viewed as a window of opportunity into the current and future health of women, and offers critical entry points for women who may otherwise not seek or have access to care for chronic conditions. Maternal health services should move beyond the focus on emergency obstetric care, to a broader approach that encompasses preventive and early interventions, and integration with existing services. Health systems need to respond by prioritizing funding for developing integrated health programs, and workforce strengthening. The MMWG's efforts have highlighted the changing landscape of maternal health, and the need to expand the narrow focus of maternal health, moving beyond surviving to thriving.
Guida, JP, Costa, ML, Parpinelli, MA, Pacagnella, RC, Ferreira, EC, Mayrink, J, Silveira, C, Souza, RT, Sousa, MH, Say, L, Chou, D, Filippi, V, Barreix, M, Barbour, K, McCaw-Binns, A, von Dadelszen, P, Cecatti, JG & Brazilian Cohort on Severe Maternal Morbidity (COMMAG) study group and the WHO Maternal Morbidity Working Group (MMWG) 2018, 'The impact of hypertension, hemorrhage, and other maternal morbidities on functioning in the postpartum period as assessed by the WHODAS 2.0 36-item tool.', International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 141 Suppl 1, pp. 55-60.View/Download from: UTS OPUS or Publisher's site
To assess the scores of postpartum women using the WHO Disability Assessment Schedule 2.0 36-item tool (WHODAS-36), considering different morbidities.Secondary analysis of a retrospective cohort of women who delivered at a referral maternity in Brazil and were classified with and without severe maternal morbidity (SMM). WHODAS-36 was used to assess functioning in postpartum women. Percentile distribution of total WHODAS score was compared across three groups: Percentile (P)<10, 1090. Cases of SMM were categorized and WHODAS-36 score was assessed according to hypertension, hemorrhage, or other conditions.A total of 638 women were enrolled: 64 had mean scores below P<10 (1.09) and 66 were above P>90 (41.3). Of women scoring above P>90, those with morbidity had a higher mean score than those without (44.6% vs 36.8%, P=0.879). Women with higher WHODAS-36 scores presented more complications during pregnancy, especially hypertension (47.0% vs 37.5%, P=0.09). Mean scores among women with any complication were higher than those with no morbidity (19.0 vs 14.2, P=0.01). WHODAS-36 scores were higher among women with hypertensive complications (19.9 vs 16.0, P=0.004), but lower among those with hemorrhagic complications (13.8 vs 17.7, P=0.09).Complications during pregnancy, childbirth, and the puerperium increase long-term WHODAS-36 scores, demonstrating a persistent impact on functioning among women, up to 5 years postpartum.
Silveira, C, Souza, RT, Costa, ML, Parpinelli, MA, Pacagnella, RC, Ferreira, EC, Mayrink, J, Guida, JP, Sousa, MH, Say, L, Chou, D, Filippi, V, Barreix, M, Barbour, K, Firoz, T, von Dadelszen, P, Cecatti, JG & Brazilian Cohort on Severe Maternal Morbidity (COMMAG) study group and the WHO Maternal Morbidity Working Group (MMWG) 2018, 'Validation of the WHO Disability Assessment Schedule (WHODAS 2.0) 12-item tool against the 36-item version for measuring functioning and disability associated with pregnancy and history of severe maternal morbidity.', International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 141 Suppl 1, pp. 39-47.View/Download from: UTS OPUS or Publisher's site
To validate the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) 12-item tool against the 36-item version for measuring functioning and disability associated with pregnancy and the occurrence of maternal morbidity.This is a secondary analysis of the Brazilian retrospective cohort study on long-term repercussions of severe maternal morbidity (SMM) among women who delivered at a tertiary facility (COMMAG study). We compared WHODAS-12 and WHODAS-36 scores of women with and without SMM using measures of central tendency and variability, tests for instruments' agreement (Bland-Altman plot), confirmatory factor analysis (CFA), and Cronbach alpha coefficient for internal consistency.The COMMAG study enrolled 638 women up to 5 years postpartum. Although the median WHODAS-36 and -12 scores for all women were statistically different (13.04 and 11.76, respectively; P<0.001), there was a strong linear correlation between them. Furthermore, the mean difference and the differences in variance analyses demonstrated agreement of total scores between the two versions. CFA demonstrated how the WHODAS-12 questions are divided into six previously defined factors and Cronbach alpha showed good internal consistency.WHODAS-12 demonstrated agreement with WHODAS-36 for total score and was a good instrument for screening functioning and disability among postpartum women, with and without SMM.
Filippi, V, Chou, D, Barreix, M, Say, L, Barbour, K, Cecatti, JG, Costa, ML, Cottler, S, Fawole, O, Firoz, T, Gadama, L, Ghérissi, A, Gichuhi, GN, Gyte, G, Hindin, M, Jayathilaka, A, Kalamar, A, Koblinsky, M, Kone, Y, Kostanjsek, N, Lange, I, Magee, LA, Mathur, A, McCaw-Binns, A, Morgan, M, Munjanja, S, Petzold, M, Sullivan, E, Taulo, F, Tunçalp, Ö, Vanderkruik, R & von Dadelszen, P 2018, 'A new conceptual framework for maternal morbidity', International Journal of Gynecology and Obstetrics, vol. 141, no. Suppl.1, pp. 4-9.View/Download from: UTS OPUS or Publisher's site
© 2018 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics. Background: Globally, there is greater awareness of the plight of women who have complications associated with pregnancy or childbirth and who may continue to experience long-term problems. In addition, the health of women and their ability to perform economic and social functions are central to the Sustainable Development Goals. Methods: In 2012, WHO began an initiative to standardize the definition, conceptualization, and assessment of maternal morbidity. The culmination of this work was a conceptual framework: the Maternal Morbidity Measurement (MMM) Framework. Results: The framework underscores the broad ramifications of maternal morbidity and highlights what types of measurement are needed to capture what matters to women, service providers, and policy makers. Using examples from the literature, we explain the framework's principles and its most important elements. Conclusions: We express the need for comprehensive research and detailed longitudinal studies of women from early pregnancy to the extended postpartum period to understand how health and symptoms and signs of ill health change. With respect to interventions, there may be gaps in healthcare provision for women with chronic conditions and who are about to conceive. Women also require continuity of care at the primary care level beyond the customary 6 weeks postpartum.
Say, L, Chou, D & WHO Maternal Morbidity Working Group (MMWG) 2018, 'Maternal morbidity: Time for reflection, recognition, and action.', International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 141 Suppl 1, pp. 1-3.View/Download from: Publisher's site
Mayrink, J, Souza, RT, Silveira, C, Guida, JP, Costa, ML, Parpinelli, MA, Pacagnella, RC, Ferreira, EC, Sousa, MH, Say, L, Chou, D, Filippi, V, Barreix, M, Barbour, K, von Dadelszen, P, Cecatti, JG & Brazilian Cohort on Severe Maternal Morbidity (COMMAG) study group and the WHO Maternal Morbidity Working Group (MMWG) 2018, 'Reference ranges of the WHO Disability Assessment Schedule (WHODAS 2.0) score and diagnostic validity of its 12-item version in identifying altered functioning in healthy postpartum women.', International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 141 Suppl 1, pp. 48-54.View/Download from: UTS OPUS or Publisher's site
To compare scores on the 36-item WHO Disability Assessment Schedule 2.0 tool (WHODAS-36) for postpartum women across a continuum of morbidity and to validate the 12-item version (WHODAS-12).This is a secondary analysis of the Brazilian retrospective cohort study on long-term repercussions of severe maternal morbidity. We determined mean, median, and percentile values for WHODAS-36 total score and for each domain, and percentile values for WHODAS-12 total score in postpartum women divided into three groups: "no," "nonsevere," and "severe" morbidities.The WHODAS-36 mean total scores were 11.58, 18.31, and 19.19, respectively for no, nonsevere, and severe morbidity. There was a dose-dependent effect on scores for each domain of WHODAS-36 according to the presence and severity of morbidity. The diagnostic validity of WHODAS-12 was determined by comparing it with WHODAS-36 as a "gold standard." The best cut-off point for diagnosing dysfunctionality was the 95th percentile.The upward trend of WHODAS-36 total mean value scores of women with no morbidity compared with those with morbidity along a severity continuum may reflect the impact of morbidity on postpartum functioning.
Dawson, AJ, Krastev, Y, Parsonage, WA, Peek, M, Lust, K & Sullivan, EA 2018, 'Experiences of women with cardiac disease in pregnancy: a systematic review and metasynthesis.', BMJ open, vol. 8, no. 9, pp. e022755-e022755.View/Download from: UTS OPUS or Publisher's site
OBJECTIVE:Cardiac disease in pregnancy is a leading cause of maternal death in high-income countries. Evidence-based guidelines to assist in planning and managing the healthcare of affected women is lacking. The objective of this research was to produce the first qualitative metasynthesis of the experiences of pregnant women with existing or acquired cardiac disease to inform improved healthcare services. METHOD:We conducted a systematic search of peer-reviewed publications in five databases to investigate the decision-making processes, supportive strategies and healthcare experiences of pregnant women with existing or acquired cardiac disease, or of affected women contemplating pregnancy. Identified publications were screened for duplication and eligibility against selection criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We then undertook a thematic analysis of the data relating to women's experiences extracted from each publication to inform new healthcare practices and communication. RESULTS:Eleven studies from six countries were included in our meta-synthesis. Four themes were revealed. Women with congenital and acquired heart disease identified situations where they had either taken charge of decision-making, lacked control or experienced emotional uncertainty when making decisions. Some women were risk aware and determined to take care of themselves in pregnancy while others downplayed the risks. Women with heart disease acknowledged the importance of specific social support measures during pregnancy and after child birth, and reported a spectrum of healthcare experiences. CONCLUSIONS:There is a lack of integrated and tailored healthcare services and information for women with cardiac disease in pregnancy. The experiences of women synthesised in this research has the potential to inform new evidence-based guidelines to support the decision-making needs of women with cardiac disease in pregnancy. Shared dec...
Jones, J, Wilson, M, Sullivan, E, Atkinson, L, Gilles, M, Simpson, PL, Baldry, E & Butler, T 2018, 'Australian Aboriginal women prisoners' experiences of being a mother: a review.', International Journal of Prisoner Health, vol. 14, no. 4, pp. 221-231.View/Download from: UTS OPUS or Publisher's site
PURPOSE:The rise in the incarceration of Aboriginal and Torres Strait Islander mothers is a major public health issue with multiple sequelae for Aboriginal children and the cohesiveness of Aboriginal communities. The purpose of this paper is to review the available literature relating to Australian Aboriginal women prisoners' experiences of being a mother. DESIGN/METHODOLOGY/APPROACH:The literature search covered bibliographic databases from criminology, sociology and anthropology, and Australian history. The authors review the literature on: traditional and contemporary Aboriginal mothering roles, values and practices; historical accounts of the impacts of white settlement of Australia and subsequent Aboriginal affairs policies and practices; and women's and mothers' experiences of imprisonment. FINDINGS:The review found that the cultural experiences of mothering are unique to Aboriginal mothers and contrasted to non-Aboriginal concepts. The ways that incarceration of Aboriginal mothers disrupts child rearing practices within the cultural kinship system are identified. PRACTICAL IMPLICATIONS:Aboriginal women have unique circumstances relevant to the concept of motherhood that need to be understood to develop culturally relevant policy and programs. The burden of disease and cycle of incarceration within Aboriginal families can be addressed by improving health outcomes for incarcerated Aboriginal mothers and female carers. ORIGINALITY/VALUE:To the authors' knowledge, this is the first literature review on Australian Aboriginal women prisoners' experiences of being a mother.
Gerstl, B, Sullivan, E, Chong, S, Chia, D, Wand, H & Anazodo, A 2018, 'Reproductive Outcomes After a Childhood and Adolescent Young Adult Cancer Diagnosis in Female Cancer Survivors: A Systematic Review and Meta-analysis.', Journal of adolescent and young adult oncology, vol. 7, no. 6.View/Download from: UTS OPUS or Publisher's site
Improvements in cancer therapy for childhood and adolescent and young adult (AYA) survivors have increased in excess of 80% among pediatric patients and in excess of 85% among AYA cancer patients. Our research group explored the late effects consequences of cancer treatment on pregnancy and birth outcomes subsequent to a childhood (0-14 years) or AYA (15-25 years) diagnosis of cancer in female cancer survivors. Embase and Medline databases were searched. There were 17 review (n = 10 matched and n = 7 unmatched) studies that met the inclusion criteria. Subanalyses were conducted on 10 matched studies. The median age for all studies for patients at diagnosis and birth was 11 and 27 years, respectively. In matched cohort studies, female childhood and AYA cancer patients, who received chemotherapy alone, had a pooled estimated rate of 18% of experiencing a live birth compared with 10% of females who received radiotherapy alone and subsequently had a live birth. Females who received surgery alone reported higher pooled estimated rates of 44% for a live birth. For matched retrospective review studies, 79% (n = 973) of women experienced a live birth, of which 22% of these babies were born preterm. This meta-analysis found lower birth rates for survivors. Access to fertility-related information and discussions around fertility preservation options and oncofertility psychosocial support should be offered to all cancer patients and their families before starting cancer treatment.
Wang, AY, Sullivan, EA, Li, Z & Farquhar, C 2018, 'Day 5 versus day 3 embryo biopsy for preimplantation genetic testing for monogenic/single gene defects', Cochrane Database of Systematic Reviews, vol. 2018, no. 12.View/Download from: Publisher's site
© 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the benefits and harms of day 5 embryo biopsy, in comparison to day 3 biopsy, in preimplantation genetic testing for monogenic/single gene defects (PGT-M).
Wang, AY, Chughtai, AA, Lui, K & Sullivan, EA 2017, 'Morbidity and mortality among very preterm singletons following fertility treatment in Australia and New Zealand, a population cohort study.', BMC Pregnancy and Childbirth, vol. 17, no. 50, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Due to high rates of multiple birth and preterm birth following fertility treatment, the rates of mortality and morbidity among births following fertility treatment were higher than those conceived spontaneously. However, it is unclear whether the rates of adverse neonatal outcomes remain higher for very preterm (<32 weeks gestational age) singletons born after fertility treatment. This study aims to compare adverse neonatal outcomes among very preterm singletons born after fertility treatment including assisted reproductive technology (ART) hyper-ovulution (HO) and artificial insemination (AI) to those following spontaneous conception. METHODS: The population cohort study included 24069 liveborn very preterm singletons who were admitted to Neonatal Intensive Care Unit (NICU) in Australia and New Zealand from 2000 to 2010. The in-hospital neonatal mortality and morbidity among 21753 liveborn very preterm singletons were compared by maternal mode of conceptions: spontaneous conception, HO, ART and AI. Univariate and multivariate binary logistic regression analysis was used to examine the association between mode of conception and various outcome factors. Odds ratio (OR) and adjusted odds ratio (AOR) and 95% confidence interval (CI) were calculated. RESULTS: The rate of small for gestational age was significantly higher in HO group (AOR 1.52, 95% CI 1.02-2.67) and AI group (AOR 2.98, 95% CI 1.53-5.81) than spontaneous group. The rate of birth defect was significantly higher in ART group (AOR 1.71, 95% CI 1.36-2.16) and AI group (AOR 3.01, 95% CI 1.47-6.19) compared to spontaneous group. Singletons following ART had 43% increased odds of necrotizing enterocolitis (AOR 1.43, 95% CI 1.04-1.97) and 71% increased odds of major surgery (AOR 1.71, 95% CI 1.37-2.13) compared to singletons conceived spontaneously. Other birth and NICU outcomes were not different among the comparison groups. CONCLUSIONS: Compared to the spontaneous conception group, risk of conge...
Donnolley, NR, Chambers, GM, Butler-Henderson, KA, Chapman, MG & Sullivan, EA 2017, 'More than a name: Heterogeneity in characteristics of models of maternity care reported from the Australian Maternity Care Classification System validation study.', Women and Birth, vol. 30, no. 4, pp. 332-341.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Without a standard terminology to classify models of maternity care, it is problematic to compare and evaluate clinical outcomes across different models. The Maternity Care Classification System is a novel system developed in Australia to classify models of maternity care based on their characteristics and an overarching broad model descriptor (Major Model Category). AIM: This study aimed to assess the extent of variability in the defining characteristics of models of care grouped to the same Major Model Category, using the Maternity Care Classification System. METHOD: All public hospital maternity services in New South Wales, Australia, were invited to complete a web-based survey classifying two local models of care using the Maternity Care Classification System. A descriptive analysis of the variation in 15 attributes of models of care was conducted to evaluate the level of heterogeneity within and across Major Model Categories. RESULTS: Sixty-nine out of seventy hospitals responded, classifying 129 models of care. There was wide variation in a number of important attributes of models classified to the same Major Model Category. The category of 'Public hospital maternity care' contained the most variation across all characteristics. CONCLUSION: This study demonstrated that although models of care can be grouped into a distinct set of Major Model Categories, there are significant variations in models of the same type. This could result in seemingly 'like' models of care being incorrectly compared if grouped only by the Major Model Category.
Dawson, A, Nicholls, R, Bateson, D, Doab, A, Estoesta, J, Brassil, A & Sullivan, E 2017, 'Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study', Reproductive Health, vol. 14, no. 39, pp. 1-13.View/Download from: UTS OPUS or Publisher's site
Xu, F, Sullivan, EA, Forero, R & Homer, CSE 2017, 'The association of Emergency Department presentations in pregnancy with hospital admissions for postnatal depression (PND): a cohort study based on linked population data.', BMC Emergency Medicine, vol. 17, no. 1, pp. 12-12.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: To investigate the impact of presenting to an Emergency Department (ED) during pregnancy on postnatal depression (PND) in women in New South Wales (NSW), Australia. METHOD: An epidemiological population-based study using linked data from the NSW Emergency Department Data Collection (EDDC), the NSW Perinatal Data Collection (PDC) and the NSW Admitted Patients Data Collection (APDC) was conducted. Women who gave birth to their first child in NSW between 1 January 2006 and 31 December 2010 were followed up from pregnancy to the end of the first year after birth. RESULTS: The study population includes 154,328 women who gave birth to their first child in NSW between 2006 and 2010. Of these, 31,764 women (20.58%) presented to ED during pregnancy (95%CI = 20.38-20.78). Women who presented to ED during pregnancy were more likely to be admitted to hospital for the diagnosis of unipolar depression (the adjusted relative risk (RR) =1.86, 95%CI = 1.49-2.31) and the diagnosis of mild mental and behavioural disorders associated with the puerperium (the adjusted RR = 1.55, 95%CI = 1.29-1.87) than those without ED presentation. CONCLUSION: Women's hospital admissions for postnatal depression were associated with frequent ED presentations during pregnancy.
Wilson, M, Jones, J, Butler, T, Simpson, P, Gilles, M, Baldry, E, Levy, M & Sullivan, E 2017, 'Violence in the lives of incarcerated aboriginal mothers in Western Australia', SAGE Open, vol. 7, no. 1, pp. 1-16.View/Download from: UTS OPUS or Publisher's site
© The Author(s) 2017.Drawing on in-depth interviews with incarcerated Aboriginal and Torres Strait Islander mothers in Western Australia, we report on the women's use of violence in their relationships with others. Results reinforce that Aboriginal women are overwhelmingly victims of violence; however, many women report also using violence, primarily as a strategy to deal with their own high levels of victimization. The 'normalization' of violence in their lives and communities places them at high risk of arrest and incarceration. This is compounded by a widespread distrust of the criminal justice system and associated agencies, and a lack of options for community support.
Sullivan, EA, Javid, N, Duncombe, G, Li, Z, Safi, N, Cincotta, R, Homer, CSE, Halliday, L & Oyelese, Y 2017, 'Vasa Previa Diagnosis, Clinical Practice, and Outcomes in Australia.', Obstetrics and Gynecology, vol. 130, no. 3, pp. 591-598.View/Download from: UTS OPUS or Publisher's site
To estimate the incidence of women with vasa previa in Australia and to describe risk factors, timing of diagnosis, clinical practice, and perinatal outcomes.A prospective population-based cohort study was undertaken using the Australasian Maternity Outcomes Surveillance System between May 1, 2013, and April 30, 2014, in hospitals in Australia with greater than 50 births per year. Women were included if they were diagnosed with vasa previa during pregnancy or childbirth, confirmed by clinical examination or placental pathology. The main outcome measures included stillbirth, neonatal death, cesarean delivery, and preterm birth.Sixty-three women had a confirmed diagnosis of vasa previa. The estimated incidence was 2.1 per 10,000 women giving birth (95% CI 1.7-2.7). Fifty-eight women were diagnosed prenatally and all had a cesarean delivery. Fifty-five (95%) of the 58 women had at least one risk factor for vasa previa with velamentous cord insertion (62%) and low-lying placenta (60%) the most prevalent. There were no perinatal deaths in women diagnosed prenatally. For the five women with vasa previa not diagnosed prenatally, there were two perinatal deaths with a case fatality rate of 40%. One woman had an antepartum stillbirth and delivered vaginally and the other four women had cesarean deliveries categorized as urgent threat to the life of a fetus with one neonatal death. The overall perinatal case fatality rate was 3.1% (95% CI 0.8-10.5). Two thirds (68%) of the 65 neonates were preterm and 29% were low birth weight.The outcomes for neonates in which vasa previa was not diagnosed prenatally were inferior with higher rates of perinatal morbidity and mortality. Our study shows a high rate of prenatal diagnosis of vasa previa in Australia and associated good outcomes.
VanderKruik, R, Barreix, M, Chou, D, Allen, T, Say, L, Cohen, LS & Maternal Morbidity Working Group 2017, 'The global prevalence of postpartum psychosis: a systematic review.', BMC Psychiatry, vol. 17, no. 1, pp. 1-9.View/Download from: UTS OPUS or Publisher's site
Mental health is a significant contributor to global burden of disease and the consequences of perinatal psychiatric morbidity can be substantial. We aimed to obtain global estimates of puerperal psychosis prevalence based on population-based samples and to understand how postpartum psychosis is assessed and captured among included studies.In June 2014, we searched PubMed, CiNAHL, EMBASE, PsycINFO, Sociological Collections, and Global Index Medicus for publications since the year 1990. Criteria for inclusion in the systematic review were: use of primary data relevant to pre-defined mental health conditions, specified dates of data collection, limited to data from 1990 onwards, sample size >200 and a clear description of methodology. Data were extracted from published peer reviewed articles.The search yielded 24,273 publications, of which six studies met the criteria. Five studies reported incidence of puerperal psychosis (ranging from 0.89 to 2.6 in 1000 women) and one reported prevalence of psychosis (5 in 1000). Due to the heterogeneity of methodologies used across studies in definitions and assessments used to identify cases, data was not pooled to calculate a global estimate of risk.This review confirms the relatively low rate of puerperal psychosis; yet given the potential for serious consequences, this morbidity is significant from a global public health perspective. Further attention to consistent detection of puerperal psychosis can help provide appropriate treatment to prevent harmful consequences for both mother and baby.
Farquhar, CM, Li, Z, Lensen, S, McLintock, C, Pollock, W, Peek, MJ, Ellwood, D, Knight, M, Homer, CS, Vaughan, G, Wang, A & Sullivan, E 2017, 'Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case-control study.', BMJ Open, vol. 7, no. 10, pp. 1-9.View/Download from: UTS OPUS or Publisher's site
Estimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes.Case-control study.Sites in Australia and New Zealand with at least 50 births per year.Cases were women giving birth (≥20 weeks or fetus ≥400 g) who were diagnosed with placenta accreta by antenatal imaging, at operation or by pathology specimens between 2010 and 2012. Controls were two births immediately prior to a case. A total of 295 cases were included and 570 controls.Data were collected using the Australasian Maternity Outcomes Surveillance System.Incidence, risk factors (eg, prior caesarean section (CS), maternal age) and clinical outcomes of placenta accreta (eg CS, hysterectomy and death).The incidence of placenta accreta was 44.2/100 000 women giving birth (95% CI 39.4 to 49.5); however, this may overestimated due to the case definition used. In primiparous women, an increased odds of placenta accreta was observed in older women (adjusted OR (AOR) women≥40 vs <30: 19.1, 95% CI 4.6 to 80.3) and current multiple birth (AOR: 6.1, 95% CI 1.1 to 34.1). In multiparous women, independent risk factors were prior CS (AOR ≥2 prior sections vs 0: 13.8, 95% CI 7.4 to 26.1) and current placenta praevia (AOR: 36.3, 95% CI 14.0 to 93.7). There were two maternal deaths (case fatality rate 0.7%).Women with placenta accreta were more likely to have a caesarean section (AOR: 4.6, 95% CI 2.7 to 7.6) to be admitted to the intensive care unit (ICU)/high dependency unit (AOR: 46.1, 95% CI 22.3 to 95.4) and to have a hysterectomy (AOR: 209.0, 95% CI 19.9 to 875.0). Babies born to women with placenta accreta were more likely to be preterm, be admitted to neonatal ICU and require resuscitation.
Hilder, L, Walker, JR, Levy, MH & Sullivan, EA 2016, 'Preparing linked population data for research: cohort study of prisoner perinatal health outcomes.', BMC Medical Research Methodology, vol. 16, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
A study of pregnancy outcomes related to pregnancy in prison in New South Wales, Australia, designed a two stage linkage to add maternal history of incarceration and serious mental health morbidity, neonatal hospital admission and infant congenital anomaly diagnosis to birth data. Linkage was performed by a dedicated state-wide data linkage authority. This paper describes use of the linked data to determine pregnancy prison exposure pregnancy for a representative population of mothers.Researchers assessed the quality of linked records; resolved multiple-matched identities; transformed event-based incarceration records into person-based prisoner records and birth records into maternity records. Inconsistent or incomplete records were censored. Interrogation of the temporal relationships of all incarceration periods from the prisoner record with pregnancies from birth records identified prisoner maternities. Interrogation of maternities for each mother distinguished prisoner mothers who were incarcerated during pregnancy, from prisoner control mothers with pregnancies wholly in the community and a subset of prisoner mothers with maternities both types of maternity. Standard descriptive statistics are used to provide population prevalence of exposures and compare data quality across study populations stratified by mental health morbidity.Women incarcerated between 1998 and 2006 accounted for less than 1 % of the 404,000 women who gave birth in NSW between 2000 and 2006, while women with serious mental health morbidity accounted for 7 % overall and 68 % of prisoners. Rates of false positive linkage were within the predicted limits set by the linkage authority for non-prisoners, but were tenfold higher among prisoners (RR 9.9; 95%CI 8.2, 11.9) and twice as high for women with serious mental health morbidity (RR 2.2; 95%CI 1.9, 2.6). This case series of 597 maternities for 558 prisoners pregnant while in prison (of whom 128 gave birth in prison); and 2,031 contemporane...
Ataman, LM, Rodrigues, JK, Marinho, RM, Caetano, JP, Chehin, MB, Alves da Motta, EL, Serafini, P, Suzuki, N, Furui, T, Takae, S, Sugishita, Y, Morishige, KI, Almeida-Santos, T, Melo, C, Buzaglo, K, Irwin, K, Wallace, WH, Anderson, RA, Mitchell, RT, Telfer, EE, Adiga, SK, Anazodo, A, Stern, C, Sullivan, E, Jayasinghe, Y, Orme, L, Cohn, R, McLachlan, R, Deans, R, Agresta, F, Gerstl, B, Ledger, WL, Robker, RL, de Meneses E Silva, JM, Silva, LH, Lunardi, FO, Lee, JR, Suh, CS, De Vos, M, Van Moer, E, Stoop, D, Vloeberghs, V, Smitz, J, Tournaye, H, Wildt, L, Winkler-Crepaz, K, Andersen, CY, Smith, BM, Smith, K & Woodruff, TK 2016, 'Creating a Global Community of Practice for Oncofertility.', Journal of Global Oncology, vol. 2, no. 2, pp. 83-96.View/Download from: UTS OPUS or Publisher's site
Fertility preservation in the cancer setting, known as oncofertility, is a field that requires cross-disciplinary interaction between physicians, basic scientists, clinical researchers, ethicists, lawyers, educators, and religious leaders. Funded by the National Institutes of Health, the Oncofertility Consortium (OC) was formed to be a scientifically grounded, transparent, and altruistic resource, both intellectual and monetary, for building this new field of practice capable of addressing the unique needs of young patients with cancer. The OC has expanded its attention to include other nonmalignant conditions that can threaten fertility, and the work of the OC now extends around the globe, involving partners who together have created a community of shared effort, resources, and practices. The OC creates materials that are translated, disseminated, and amended by all participants in the field, and local programs of excellence have developed worldwide to accelerate the pace and improve the quality of oncofertility research and practice. Here we review the global oncofertility programs and the capacity building activities that strengthen these research and clinical programs, ultimately improving patient care.
Donnolley, N, Butler-Henderson, K, Chapman, M & Sullivan, E 2016, 'The development of a classification system for maternity models of care.', The HIM journal, vol. 45, no. 2, pp. 64-70.View/Download from: UTS OPUS or Publisher's site
A lack of standard terminology or means to identify and define models of maternity care in Australia has prevented accurate evaluations of outcomes for mothers and babies in different models of maternity care.As part of the Commonwealth-funded National Maternity Data Development Project, a classification system was developed utilising a data set specification that defines characteristics of models of maternity care.The Maternity Care Classification System or MaCCS was developed using a participatory action research design that built upon the published and grey literature.The study identified the characteristics that differentiate models of care and classifies models into eleven different Major Model Categories.The MaCCS will enable individual health services, local health districts (networks), jurisdictional and national health authorities to make better informed decisions for planning, policy development and delivery of maternity services in Australia.
Xu, F, Sullivan, E, Binns, C & Homer, C 2016, 'Mental disorders in new parents before and after birth: a population-based cohort study', British Journal of Psychiatry, vol. 2, no. 3, pp. 233-243.View/Download from: UTS OPUS or Publisher's site
Dawson, A, Bateson, D, Estoesta, J & Sullivan, E 2016, 'Towards comprehensive early abortion service delivery in high income countries: insights for improving universal access to abortion in Australia', BMC Health Services Research, vol. 16, no. 1.View/Download from: UTS OPUS or Publisher's site
Mu, Y, McDonnell, N, Li, Z, Liang, J, Wang, Y, Zhu, J & Sullivan, E 2016, 'Amniotic fluid embolism as a cause of maternal mortality in China between 1996 and 2013: a population-based retrospective study.', BMC Pregnancy and Childbirth, vol. 16, no. 1, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: To analyse the maternal mortality ratio, demographic and pregnancy related details in women who suffered a fatal amniotic fluid embolism (AFE) in China. METHODS: A retrospective population based study using data collected as part of the National Maternal Mortality Surveillance System between 1996 and 2013. Data were collected onto a standardised form from women whose cause of death was listed as being secondary to AFE. RESULTS: Records were available for 640 deaths. Over the 17 year period the maternal mortality ratio for AFE decreased from 4.4 per 100,000 births (95 % confidence interval (CI):2.72-6.12) to 1.9 per 100,000 births (95 % CI:1.35-2.54). Over the same period the proportion of maternal deaths secondary to AFE increased from 6.8 to 12.5 %. The mean age of women who died was 30.1 years and the onset of the AFE occurred prior to delivery in 39 %. The most prominent presenting features included premonitory symptoms (29 %), acute fetal compromise (28 %), maternal haemorrhage (16 %) and shortness of breath (15 %). CONCLUSIONS: Maternal mortality secondary to AFE has decreased in China, however at a slower rate than mortality secondary to other conditions. Active surveillance is recommended to assess case fatality rates, risk factors and other lessons specific to this population.
Betran, AP, Torloni, MR, Zhang, JJ & Guelmezoglu, AM 2016, 'WHO Statement on Caesarean Section Rates', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 123, no. 5, pp. 667-670.View/Download from: Publisher's site
Souza, J, Betran, A, Dumont, A, de Mucio, B, Gibbs Pickens, C, Deneux-Tharaux, C, Ortiz-Panozo, E, Sullivan, E, Ota, E, Togoobaatar, G, Carroli, G, Knight, H, Zhang, J, Cecatti, J, Vogel, J, Jayaratne, K, Leal, M, Gissler, M, Morisaki, N, Lack, N, Oladapo, O, Tunçalp, O, Lumbiganon, P, Mori, R, Quintana, S, Costa Passos, A, Marcolin, A, Zongo, A, Blondel, B, Hernández, B, Hogue, C, Prunet, C, Landman, C, Ochir, C, Cuesta, C, Pileggi-Castro, C, Walker, D, Alves, D, Abalos, E, Moises, E, Vieira, E, Duarte, G, Perdona, G, Gurol-Urganci, I, Takahiko, K, Moscovici, L, Campodonico, L, Oliveira-Ciabati, L, Laopaiboon, M, Danansuriya, M, Nakamura-Pereira, M, Costa, M, Torloni, M, Kramer, M, Borges, P, Olkhanud, P, Pérez-Cuevas, R, Agampodi, S, Mittal, S, Serruya, S, Bataglia, V, Li, Z, Temmerman, M & Gülmezoglu, A 2016, 'A global reference for caesarean section rates (C-Model): A multicountry cross-sectional study', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 123, no. 3, pp. 427-436.View/Download from: Publisher's site
© 2015 RCOG. Objective: To generate a global reference for caesarean section (CS) rates at health facilities. Design: Cross-sectional study. Setting: Health facilities from 43 countries. Population/Sample: Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10 045 875 women giving birth from 43 countries for model testing. Methods: We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. Main outcome measures: Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. Results: According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c…). Conclusions: This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS.
Wang, YA, Chughtai, AA, Farquhar, CM, Pollock, W, Lui, K & Sullivan, EA 2016, 'Increased incidence of gestational hypertension and preeclampsia after assisted reproductive technology treatment', FERTILITY AND STERILITY, vol. 105, no. 4, pp. 920-+.View/Download from: UTS OPUS or Publisher's site
Wang, AY, Dill, SK, Bowman, M & Sullivan, EA 2016, 'Gestational surrogacy in Australia 2004-2011: treatment, pregnancy and birth outcomes', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 56, no. 3, pp. 255-259.View/Download from: UTS OPUS or Publisher's site
Anazodo, AC, Gerstl, B, Stern, CJ, McLachlan, RI, Agresta, F, Jayasinghe, Y, Cohn, RJ, Wakefield, CE, Chapman, M, Ledger, W & Sullivan, EA 2016, 'Utilizing the Experience of Consumers in Consultation to Develop the Australasian Oncofertility Consortium Charter.', Journal of adolescent and young adult oncology, vol. 5, no. 3, pp. 232-239.View/Download from: UTS OPUS or Publisher's site
In Australia and New Zealand, there has not been a national systematic development of oncofertility services for cancer patients of reproductive age although many cancer and fertility centers have independently developed services. A number of barriers exist to the development of these services, including a lack of clear referral pathways, a lack of communication between clinicians and patients about fertility preservation, differences in the knowledge base of clinicians about the risk of cancer treatment causing infertility and fertility preservation options, a lack of national health insurance funding covering all aspects of fertility preservation, and storage costs and cultural, religious, and ethical barriers. The development of strategies to overcome these barriers is a high priority for oncofertility care to ensure that equitable access to the best standard of care is available for all patients.The FUTuRE Fertility Research Group led a collaborative consultation process with the Australasian Oncofertility Consumer group and oncofertility specialists to explore consumers' experiences of oncofertility care. Consumers participated in qualitative focus group meetings to define and develop a model of consumer driven or informed "gold standard oncofertility care" with the aim of putting together a Charter that specifically described this.The finalized Australasian Oncofertility Consortium Charter documents eight key elements of gold standard oncofertility care that will be used to monitor the implementation of oncofertility services nationally, to ensure that these key elements are incorporated into standard practice over time.
Anazodo, A, Gerstl, B, Sullivan, E, Ledger, W, Orme, L, Stern, K, Viney, RC, Gillam, L, Jetti, M, Mclachlan, R, Jayasinghe, Y, Cohn, R, Wakefield, C, Dean, R, Agresta, F, Vu, J, Daly, E, Chan, D, Chapman, M, Kemertzis, M, Wand, H & Gilbert, L 2016, 'A Study Protocol for the Australasian Oncofertility Registry: Monitoring referral patterns and the uptake, quality and complications of fertility preservation strategies in Australia and New Zealand', Journal of Adolescent and Young Adult Oncology, vol. 5, no. 3, pp. 215-225.View/Download from: UTS OPUS or Publisher's site
Improvements in cancer diagnosis and treatment in patients of a reproductive age have led to significant improvements in survival rates; however, a patient's fertility can be affected by both cancer and its treatment. As survival rates improve, there is an expectation by clinicians and patients that patient's reproductive potential should be considered and protected as much as possible. However, there is a lack of data about current fertility preservation (FP) uptake as well as accurate data on the acute or permanent reproductive risks of cancer treatment, complications of FP in cancer patients, and the use and success of assisted reproductive technology by cancer survivors. FP remains a major gap in acute cancer management with lifelong implications for cancer survivors. The FUTuRE Fertility research team has established the first binational multisite Australasian Oncofertility Registry, which is collecting a complete oncofertility data set from cancer and fertility centers in Australia and New Zealand. Outcomes from the research study will monitor referral, uptake, and complications of FP, document patient's reproductive potential after treatment, and collect data on the use of assisted reproductive technology following cancer treatment. The data will be linked to other routine health and administrative data sets to allow for other research projects to be carried out. The changes in oncofertility care will be benchmarked against the Australasian Oncofertility Charter. The data will be used to develop evidence-based guidelines and resources, including development of accurate risk projections for patients' risk of infertility, allowing clinicians to make recommendations for FP or assisted reproductive technology.
Andreucci, CB, Bussadori, JC, Pacagnella, RC, Chou, D, Filippi, V, Say, L, Cecatti, JG, Brazilian COMMAG Study Group & WHO Maternal Morbidity Working Group 2015, 'Sexual life and dysfunction after maternal morbidity: a systematic review.', BMC Pregnancy and Childbirth, vol. 15, pp. 307-307.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Because there is a lack of knowledge on the long-term consequences of maternal morbidity/near miss episodes on women's sexual life and function we conducted a systematic review with the purpose of identifying the available evidence on any sexual impairment associated with complications from pregnancy and childbirth. METHODS: Systematic review on aspects of women sexual life after any maternal morbidity and/or maternal near miss, during different time periods after delivery. The search was carried out until May 22(nd), 2015 including studies published from 1995 to 2015. No language or study design restrictions were applied. Maternal morbidity as exposure was split into general or severe/near miss. Female sexual outcomes evaluated were dyspareunia, Female Sexual Function Index (FSFI) scores and time to resume sexual activity after childbirth. Qualitative syntheses for outcomes were provided whenever possible. RESULTS: A total of 2,573 studies were initially identified, and 14 were included for analysis after standard selection procedures for systematic review. General morbidity was mainly related to major perineal injury (3(rd) or 4(th) degree laceration, 12 studies). A clear pattern for severity evaluation of maternal morbidity could not be distinguished, unless when a maternal near miss concept was used. Women experiencing maternal morbidity had more frequently dyspareunia and resumed sexual activity later, when compared to women without morbidity. There were no differences in FSFI scores between groups. Meta-analysis could not be performed, since included studies were too heterogeneous regarding study design, evaluation of exposure and/or outcome and time span. CONCLUSION: Investigation of long-term repercussions on women's sexual life aspects after maternal morbidity has been scarcely performed, however indicating worse outcomes for those experiencing morbidity. Further standardized evaluation of these conditions among maternal morbidity survivors m...
Lindquist, A, Noor, N, Sullivan, E & Knight, M 2015, 'The impact of socioeconomic position on severe maternal morbidity outcomes among women in Australia: a national case-control study.', BJOG : an international journal of obstetrics and gynaecology, vol. 122, no. 12, pp. 1601-1609.View/Download from: Publisher's site
Studies in other developed countries have suggested that socioeconomic position may be a risk factor for poorer pregnancy outcomes. This analysis aimed to explore the independent impact of socioeconomic position on selected severe maternal morbidities among women in Australia.A case-control study using data on severe maternal morbidities associated with direct maternal death collected through the Australasian Maternity Outcomes Surveillance System.Australia.623 cases, 820 controls.Logistic regression analysis to investigate differences in outcomes among different socioeconomic groups, classified by Socio-Economic Indexes for Areas (SEIFA) quintile.Severe maternal morbidity (amniotic fluid embolism, placenta accreta, peripartum hysterectomy, eclampsia or pulmonary embolism).SEIFA quintile was statistically significantly associated with maternal morbidity, with cases being twice as likely as controls to reside in the most disadvantaged areas (adjusted OR 2.00, 95%CI 1.29-3.10). Maternal age [adjusted odds ratio (aOR) 2.20 for women aged 35 or over compared with women aged 25-29, 95%CI 1.64-3.15] and previous pregnancy complications (aOR 1.30, 95%CI 1.21-1.87) were significantly associated with morbidity. A parity of 1 or 2 was protective (aOR 0.58, 95%CI 0.43-0.79), whereas previous caesarean delivery was associated with maternal morbidity (aOR 2.20 for women with one caesarean delivery, 95%CI 1.44-2.85, compared with women with no caesareans).The risk of severe maternal morbidity among women in Australia is significantly increased by social disadvantage. This study suggests that future efforts in improving maternity care provision and maternal outcomes in Australia should include socioeconomic position as an independent risk factor for adverse outcome.
Reid, S, Bajuk, B, Lui, K & Sullivan, EA 2015, 'Comparing CRIB-II and SNAPPE-II as mortality predictors for very preterm infants', Journal of Paediatrics and Child Health, vol. 51, no. 5, pp. 524-528.View/Download from: UTS OPUS or Publisher's site
Aims: This article compares the severity of illness scoring systems clinical risk index for babies (CRIB)-II and score for neonatal acute physiology with perinatal extension (SNAPPE)-II for discriminatory ability and goodness of fit in the same cohort of babies of less than 32 weeks gestation and aims to provide validation in the Australian population. Methods: CRIB-II and SNAPPE-II scores were collected on the same cohort of preterm infants born within a 2-year period, 2003 and 2004. The discriminatory ability of each score was assessed by the area under the receiver operator characteristic curve, and goodness of fit was assessed by the Hosmer-Lemeshow (HL) test. The outcome measure was in-hospital mortality. A multivariate logistic regression model was tested for perinatal variables that might add to the risk of in-hospital mortality. Results: Data for both scores were available for 1607 infants. Both scores had good discriminatory ability (CRIB-II area under the curve 0.913, standard error (SE) 0.014; SNAPPE-II area under the curve 0.907, SE 0.012) and adequate goodness of fit (HL χ2=11.384, 8 degrees of freedom, P=0.183 for CRIB-II; HL χ2=4.319, 7 degrees of freedom, P=0.742 for SNAPPE-II). The multivariate model did not reveal other significant variables. Conclusions: Both severity of illness scores are ascertained during the first 12h of life and perform similarly. Both can facilitate risk-adjusted comparisons of mortality and quality of care after the first post-natal 12h. CRIB-II scores have the advantage of being simpler to collect and calculate.
Ishihara, O, Adamson, GD, Dyer, S, de Mouzon, J, Nygren, KG, Sullivan, EA, Zegers-Hochschild, F & Mansour, R 2015, 'International Committee for Monitoring Assisted Reproductive Technologies: World Report on Assisted Reproductive Technologies, 2007', Fertility and Sterility.View/Download from: UTS OPUS or Publisher's site
Objective: To analyze information on assisted reproductive technology (ART) performed worldwide, and trends in outcomes over successive years. Design: Cross-sectional survey on access, efficiency, and safety of ART procedures performed in 55 countries during2007. Setting: Not applicable. Patient(s): Infertile women and men undergoing ART globally. Intervention(s): Collection and analysis of international ART data. Main Outcome Measure(s): Number of cycles performed, by country and region, including pregnancies, single and multiple birth rates, and perinatal mortality. Result(s): Overall, >1,251,881 procedures with ART were reported, and resulted in 229,442 reported babies born. The availability of ART varied by country, from 12 to 4,140 treatments per million population. Of all aspiration cycles, 65.2% (400,617 of 614,540) were intracytoplasmic sperm injection. The overall delivery rate per fresh aspiration was 20.3%, and for frozen-embryo transfer (FET), 18.4%, with a cumulative delivery rate of 25.8%. With wide regional variations, single-embryo transfer represented 23.4% of fresh transfers, and the proportion of deliveries with twins and triplets from fresh transfers was 22.3% and 1.2%, respectively. The perinatal mortality rate was 19.9 per 1,000 births for fresh invitro fertilization using intracytoplasmic sperm injection, and 9.6 per 1,000 for FET. The proportion of women aged ≥40years increased to 19.8% from 15.5% in2006. Conclusion(s): The international trend toward <3 transferred embryos continued, as did the wider uptake of FET. This was achieved without compromising delivery rates. The application of ART for women aged >40years was a major component of ART services in some regions and countries.
Dawson, AJ, Turkmani, S, Varol, N, Nanayakkara, S, Sullivan, E & Homer, CS 2015, 'Midwives' experiences of caring for women with female genital mutilation: Insights and ways forward for practice in Australia.', Women and Birth, vol. 28, no. 3, pp. 207-214.View/Download from: UTS OPUS or Publisher's site
Female genital mutilation (FGM) has serious health consequences, including adverse obstetric outcomes and significant physical, sexual and psychosocial complications for girls and women. Migration to Australia of women with FGM from high-prevalence countries requires relevant expertise to provide women and girls with FGM with specialised health care. Midwives, as the primary providers of women during pregnancy and childbirth, are critical to the provision of this high quality care.To provide insight into midwives' views of, and experiences working with, women affected by FGM.A descriptive qualitative study was undertaken using focus group discussions with midwives from four purposively selected antenatal clinics and birthing units in three hospitals in urban New South Wales. The transcripts were analysed thematically.Midwives demonstrated knowledge and recalled skills in caring for women with FGM. However, many lacked confidence in these areas. Participants expressed fear and a lack of experience caring for women with FGM. Midwives described practice issues, including the development of rapport with women, working with interpreters, misunderstandings about the culture of women, inexperience with associated clinical procedures and a lack of knowledge about FGM types and data collection.Midwives require education, training and supportive supervision to improve their skills and confidence when caring for women with FGM. Community outreach through improved antenatal and postnatal home visitation can improve the continuity of care provided to women with FGM.
Li, Z, Sullivan, EA, Chapman, M, Farquhar, C & Wang, YA 2015, 'Risk of ectopic pregnancy lowest with transfer of single frozen blastocyst', HUMAN REPRODUCTION, vol. 30, no. 9, pp. 2048-2054.View/Download from: UTS OPUS or Publisher's site
Yeo, KT, Lee, QY, Quek, WS, Wang, YA, Bolisetty, S & Lui, K 2015, 'Trends in Morbidity and Mortality of Extremely Preterm Multiple Gestation Newborns', PEDIATRICS, vol. 136, no. 2, pp. 263-271.View/Download from: UTS OPUS or Publisher's site
Li, Z, Umstad, MP, Hilder, L, Xu, F & Sullivan, EA 2015, 'Australian national birthweight percentiles by sex and gestational age for twins, 2001-2010', BMC PEDIATRICS, vol. 15.View/Download from: UTS OPUS or Publisher's site
Sullivan, EA, Dickinson, JE, Vaughan, GA, Peek, MJ, Ellwood, D, Homer, CSE, Knight, M, McLintock, C, Wang, A, Pollock, W, Pulver, LJ, Li, Z, Javid, N, Denney-Wilson, E & Callaway, L 2015, 'Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study', BMC Pregnancy and Childbirth, vol. 15, pp. 322-322.View/Download from: UTS OPUS or Publisher's site
McDonnell, N, Knight, M, Peek, MJ, Ellwood, D, Homer, CS, McLintock, C, Vaughan, G, Pollock, W, Li, Z, Javid, N & Sullivan, E 2015, 'Amniotic fluid embolism: an Australian-New Zealand population-based study.', BMC Pregnancy and Childbirth, vol. 15, no. 1.View/Download from: UTS OPUS or Publisher's site
Amniotic fluid embolism (AFE) is a major cause of direct maternal mortality in Australia and New Zealand. There has been no national population study of AFE in either country. The aim of this study was to estimate the incidence of amniotic fluid embolism in Australia and New Zealand and to describe risk factors, management, and perinatal outcomes.A population-based descriptive study using the Australasian Maternity Outcomes Surveillance System (AMOSS) carried out in 263 eligible sites (>50 births per year) covering an estimated 96 % of women giving birth in Australia and all 24 New Zealand maternity units (100 % of women giving birth in hospitals) between January 1 2010-December 31 2011. A case of AFE was defined either as a clinical diagnosis (acute hypotension or cardiac arrest, acute hypoxia and coagulopathy in the absence of any other potential explanation for the symptoms and signs observed) or as a post mortem diagnosis (presence of fetal squames/debris in the pulmonary circulation).Thirty-three cases of AFE were reported from an estimated cohort of 613,731women giving birth, with an estimated incidence of 5.4 cases per 100 000 women giving birth (95 % CI 3.5 to 7.2 per 100 000). Two (6 %) events occurred at home whilst 46 % (n = 15) occurred in the birth suite and 46 % (n = 15) in the operating theatre (location not reported in one case). Fourteen women (42 %) underwent either an induction or augmentation of labour and 22 (67 %) underwent a caesarean section. Eight women (24 %) conceived using assisted reproduction technology. Thirteen (42 %) women required cardiopulmonary resuscitation, 18 % (n = 6) had a hysterectomy and 85 % (n = 28) received a transfusion of blood or blood products. Twenty (61 %) were admitted to an Intensive Care Unit (ICU), eight (24 %) were admitted to a High Dependency Unit (HDU) and seven (21 %) were transferred to another hospital for further management. Five woman died (case fatality rate 15 %) giving an estimated maternal morta...
Li, Z, Wang, YA, Ledger, W, Edgar, DH & Sullivan, EA 2014, 'Clinical outcomes following cryopreservation of blastocysts by vitrification or slow freezing: a population-based cohort study', HUMAN REPRODUCTION, vol. 29, no. 12, pp. 2794-2801.View/Download from: UTS OPUS or Publisher's site
Ory, SJ, Devroey, P, Banker, M, Brinsden, P, Buster, J, Fiadjoe, M, Horton, M, Nygren, K, Pai, H, Le Roux, P & Sullivan, E 2014, 'International Federation of Fertility Societies Surveillance 2013: preface and conclusions', FERTILITY AND STERILITY, vol. 101, no. 6, pp. 1582-1583.View/Download from: Publisher's site
Chambers, GM, Van, PH, Lee, E, Hansen, M, Sullivan, EA, Bower, C & Chapman, M 2014, 'Hospital Costs of Multiple-Birth and Singleton-Birth Children During the First 5 Years of Life and the Role of Assisted Reproductive Technology', JAMA PEDIATRICS, vol. 168, no. 11, pp. 1045-1053.View/Download from: Publisher's site
Xu, F, Sullivan, EA, Li, Z, Burns, L, Austin, M-P & Slade, T 2014, 'The increased trend in mothers' hospital admissions for psychiatric disorders in the first year after birth between 2001 and 2010 in New South Wales, Australia', BMC Women's Health, vol. 14, pp. 1-6.View/Download from: UTS OPUS or Publisher's site
The burden of mental and behavioural disorders in Australia has increased significantly over the last decade. The aim of the current study is to describe the hospital admission rates for mental illness over a 10-year period for primiparous mothers in the first year after birth.
This is an Australian population-based descriptive study with linked data from the New South Wales Midwives Data Collection and Admitted Patients Data Collection. The study population included primiparous mothers who gave birth between 1 January 2001 and 31 December 2010. All hospital admissions with a mental health diagnosis in the first year after birth were recorded.
There were 6,140 mothers (1.67%) admitted to hospital with a principal diagnosis of mental health in the first year after birth between 2001 and 2010 in New South Wales (7,884 admissions, 2.15%). The hospital admission rates increased significantly over time, particularly from 2005. The increase in hospital admissions was mainly attributed to the diagnoses of unipolar depression, adjustment disorders and anxiety disorders.
This study shows that hospital admissions for mothers with a mental health diagnosis after birth in New South Wales has significantly increased in the last decade. Possible reasons for this change need to be studied further.
Xu, XK, Wang, YA, Li, Z, Lui, K & Sullivan, EA 2014, 'Risk factors associated with preterm birth among singletons following assisted reproductive technology in Australia 2007–2009–a population-based retrospective study', BMC Pregnancy and Childbirth, vol. 14, no. 1, pp. 152-170.View/Download from: UTS OPUS or Publisher's site
Background: Preterm birth, a leading cause of neonatal death, is more common in multiple births and thus there has being an increasing call for reducing multiple births in ART. However, few studies have compared risk factors for preterm births amongst ART and non-ART singleton birth mothers. Methods: A population-based study of 393,450 mothers, including 12,105 (3.1%) ART mothers, with singleton gestations born between 2007 and 2009 in 5 of the 8 jurisdictions in Australia. Univariable and multivariable logistic regression models were conducted to evaluate sociodemographic, medical and pregnancy factors associated with preterm births in contrasting ART and non-ART mothers. Results: Ten percent of singleton births to ART mothers were preterm compared to 6.8% for non-ART mothers (P < 0.01). Compared with non-ART mothers, ART mothers were older (mean 34.0 vs 29.7 yr respectively), less socio-economically disadvantaged (12.4% in the lowest quintile vs 20.7%), less likely to be smokers (3.8% vs 19.4%), more likely to be first time mothers (primiparous 62.4% vs 40.5%), had more preexisting hypertension and complications during pregnancy. Irrespective of the mode of conception, preexisting medical and pregnancy complications of hypertension, diabetes and antepartum hemorrhages were consistently associated with preterm birth. In contrast, socio-demographic variables, namely young and old maternal age (<25 and >34), socioeconomic disadvantage (most disadvantaged quintile Odds Ratio (OR) 0.95, 95% Confidence Interval (CI): 0.77-1.17), smoking (OR 1.12, 95%CI: 0.79-1.61) and priminarity (OR 1.19, 95%CI: 1.05-1.35, AOR not significant) shown to be associated with elevated risk of preterm birth for non-ART mothers were not demonstrated for ART mothers, even after adjusting for potential confounders. Nonetheless, in multivariable analysis, the association between ART and the elevated risk for singleton preterm birth persisted after controlling for all included confounding medi...
Xu, F, Austin, M-P, Reilly, N, Hilder, L & Sullivan, EA 2014, 'Length of stay for mental and behavioural disorders postpartum in primiparous mothers: a cohort study', International Journal of Environmental Research and Public Health, vol. 11, no. 4, pp. 3540-3552.View/Download from: UTS OPUS or Publisher's site
Background: Previous research showed that there was a significant increase in psychiatric hospital admission of postpartum mothers. The aim of the current study is to describe the length of hospital stays and patient days for mental and behavioural disorders (MBD) of new mothers in the first year after birth. Method: This was a cohort study based on linked population data between the New South Wales (NSW) Midwives Data Collection (MDC) and the NSW Admitted Patients Data Collection (APDC). The study population included primiparous mothers aged from 18 to 44 who gave birth between 1 July 2000 and 31 December 2005. The Kaplan–Meier method was used to describe the length of hospital stay for MBD. Results: For principal diagnoses of MBD, the entire length of hospital stay in the first year postpartum was 11.38 days (95% CI: 10.70–12.06) for mean and 6 days (95% CI: 5.87–6.13) for median. The length of hospital stay per admission was 8.47 days (95% CI: 8.03–8.90) for mean and 5 days (95% CI: 4.90–5.10) for median. There were 5,129 patient days of hospital stay per year for principal diagnoses of postpartum MBD in new mothers between 1 July 2000 and 31 December 2005 in NSW, Australia. Conclusions: MBD, especially unipolar depressions, adjustment disorders, acute psychotic episodes, and schizophrenia, or schizophrenia-like disorders during the first year after birth, placed a significant burden on hospital services due to long hospital stays and large number of admissions.
Zegers-Hochschild, F, Mansour, R, Ishihara, O, Adamson, GD, de Mouzon, J, Nygren, KG & Sullivan, EA 2014, 'International Committee for Monitoring Assisted Reproductive Technology: world report on assisted reproductive technology, 2005.', Fertility and Sterility, vol. 101, no. 2, pp. 366-378.View/Download from: UTS OPUS or Publisher's site
OBJECTIVE: To analyze information on assisted reproductive technology (ART) performed worldwide and trends in outcomes over successive years. DESIGN: Cross-sectional survey on access, effectiveness, and safety of ART procedures performed in 53 countries during 2005. SETTING: A total of 2,973 clinics from national and regional ART registries. PATIENT(S): Infertile women and men undergoing ART globally. INTERVENTION(S): Collection and analysis of international ART data. MAIN OUTCOME MEASURE(S): Number of cycles performed by country and region, including pregnancies, single and multiple birth rates, and perinatal mortality. RESULT(S): Overall, 1,052,363 ART procedures resulted in an estimated 237,315 babies born. The availability of ART varied by country from 15 to 3,982 cycles per million of population. Of all initiated fresh cycles, 62.9% were intracytoplasmic sperm injection. The overall delivery rate per fresh aspiration was 19.6% and for frozen embryo transfer 17.4%, with a cumulative delivery rate of 23.9%. With wide regional variations, single embryo transfer represented 17.5% of cycles, and the proportion of deliveries with twins and triplets from fresh transfers was 23.6% and 1.5%, respectively. CONCLUSION(S): Systematic collection and dissemination of international ART data allows patients, health professionals, and policy makers to examine and compare the impact of reproductive strategies or lack of them as markers of reproductive health.
Chambers, G, Hoang, V, Sullivan, E, Chapman, M, Ishihara, O, Zegers-hochschild, F, Nygren, K & Adamson, G 2014, 'The Impact Of Consumer Affordability On Access To Assisted Reproductive Technologies And Embryo Transfer Practices: An International Analysis', Fertility and Sterility, vol. 101, no. 1, pp. 191-198.e4.View/Download from: UTS OPUS or Publisher's site
Objective: To systematically quantify the impact of consumer cost on assisted reproduction technology (ART) utilization and numbers of embryos transferred. Design: Ordinary least squared (OLS) regression models were constructed to measure the independent impact of ART affordability-measured as consumer cost relative to average disposable income-on ART utilization and embryo transfer practices. Setting: Not applicable. Patient(s): Women undergoing ART treatment. Intervention(s): None. Main Outcome Measure(s): OLS regression coefficient for ART affordability, which estimates the independent effect of consumer cost relative to income on utilization and number of embryos transferred. Result(s): ART affordability was independently and positively associated with ART utilization with a mean OLS coefficient of 0.032. This indicates that, on average, a decrease in the cost of a cycle of 1 percentage point of disposable income predicts a 3.2% increase in utilization. ART affordability was independently and negatively associated with the number of embryos transferred, indicating that a decrease in the cost of a cycle of 10 percentage points of disposable income predicts a 5.1% increase in single-embryo transfer cycles. Conclusion(s): The relative cost that consumers pay for ART treatment predicts the level of access and number of embryos transferred. Policies that affect ART funding should be informed by these findings to ensure equitable access to treatment and clinically responsible embryo transfer practices. (Fertil Steril (R) 2014; 101: 191-8. (C) 2014 by American Society for Reproductive Medicine.)
GM, C, E, L, VP, H, M, H, C, B & Sullivan, E 2014, 'Hospital utilization, costs and mortality rates during the first 5 years of life: a population study of ART and non-ART singletons', Human Reproduction, vol. 29, no. 3, pp. 601-610.View/Download from: Publisher's site
Abstract STUDY QUESTION: Do singletons conceived following assisted reproduction technologies (ARTs) have significantly different hospital utilization, and therefore costs, compared with non-ART children during the first 5 years of life? SUMMARY ANSWER: ART singletons have longer hospital birth-admissions and a small increased risk of re-admission during the first 5 years of life resulting in higher costs of hospital care.
Walker, JR, Hilder, L, Levy, MH & Sullivan, E 2014, 'Pregnancy, prison and perinatal outcomes in New South Wales, Australia: a retrospective cohort study using linked health data', BMC Pregnancy Childbirth, vol. Epub.View/Download from: Publisher's site
Bonello, MR, Xu, F, Li, Z, Burns, L, Austin, M-P & Sullivan, EA 2014, 'Mental and behavioral disorders due to substance abuse and perinatal outcomes: a study based on linked population data in New South Wales, Australia', International Journal of Environmental Research and Public Health, vol. 11, no. 5, pp. 4991-5005.View/Download from: UTS OPUS or Publisher's site
Background: The effects of mental and behavioral disorders (MBD) due to substance use during peri-conception and pregnancy on perinatal outcomes are unclear. The adverse perinatal outcomes of primiparous mothers admitted to hospital with MBD due to substance use before and/or during pregnancy were investigated. Method: This study linked birth and hospital records in NSW, Australia. Subjects included primiparous mothers admitted to hospital for MBD due to use of alcohol, opioids or cannabinoids during peri-conception and pregnancy. Results: There were 304 primiparous mothers admitted to hospital for MBD due to alcohol use (MBDA), 306 for MBD due to opioids use (MBDO) and 497 for MBD due to cannabinoids (MBDC) between the 12 months peri-conception and the end of pregnancy. Primiparous mothers admitted to hospital for MBDA during pregnancy or during both peri-conception and pregnancy were significantly more likely to give birth to a baby of low birthweight (AOR = 4.03, 95%CI: 1.97-8.24 for pregnancy; AOR = 9.21, 95%CI: 3.76-22.57 both periods); preterm birth (AOR = 3.26, 95% CI: 1.52-6.97 for pregnancy; AOR = 4.06, 95%CI: 1.50-11.01 both periods) and admission to SCN or NICU (AOR = 2.42, 95%CI: 1.31-4.49 for pregnancy; AOR = 4.03, 95%CI: 1.72-9.44 both periods). Primiparous mothers admitted to hospital for MBDO, MBDC or a combined diagnosis were almost three times as likely to give birth to preterm babies compared to mothers without hospital admissions for psychiatric or substance use disorders. Babies whose mothers were admitted to hospital with MBDO before and/or during pregnancy were six times more likely to be admitted to SCN or NICU (AOR = 6.29, 95%CI: 4.62-8.57). Conclusion: Consumption of alcohol, opioids or cannabinoids during peri-conception or pregnancy significantly increased the risk of adverse perinatal outcomes. © 2014 by the authors; licensee MDPI, Basel, Switzerland.
Li, Z, Wang, Y, W, L & Sullivan, E 2014, 'Birthweight percentiles by gestational age for births following assisted reproductive technology in Australia and New Zealand, 2002-2010', Human Reproduction, vol. 29, no. 8, pp. 1787-1800.View/Download from: Publisher's site
Study question: What is the standard of birthweight for gestational age for babies following assisted reproductive technology (ART) treatment? Summary answer: Birthweight for gestational age percentile charts were developed for singleton births following ART treatment using population-based data.
Xu, F, Li, Z, Binns, C, Bonello, M, Austin, M-P & Sullivan, E 2014, 'Does infant feeding method impact on maternal mental health?', Breastfeeding Medicine, vol. 9, pp. 215-221.View/Download from: UTS OPUS or Publisher's site
Javid, N, Sullivan, E, Halliday, LE, Duncombe, G & Homer, CS 2014, '"Wrapping myself in cotton wool": Australian women's experience of being diagnosed with vasa praevia', BMC Pregnancy and Childbirth, vol. 14, pp. 318-318.View/Download from: UTS OPUS or Publisher's site
This is the first study to describe women's experience of being diagnosed with or suspected to have VP. The findings from this research reveal the dilemmas these women face even if their baby is ultimately born healthy. Their need for clear and consistent information, sensitive care, support and continuity is evident. Clinicians can use these findings in developing information, counselling and models of care for these women.
Laws, PJ, Xu, F, Welsh, A, Tracy, SK & Sullivan, EA 2014, 'Maternal Morbidity of Women Receiving Birth Center Care in New South Wales: A Matched-Pair Analysis Using Linked Health Data', Birth, vol. 41, pp. 268-275.View/Download from: UTS OPUS or Publisher's site
Around 2 percent of women who give birth in Australia each year do so in a birth center. New South Wales, Australia's largest state, accounts for almost half of these births. Previous studies have highlighted the need for better quality data on maternal morbidity and mortality, to fully evaluate the safety of birth center care.
This study aimed to examine maternal morbidity related to birth center care for women in New South Wales.
A retrospective cohort study with matched-pairs was conducted using linked health data for New South Wales. Maternal outcomes were compared for women who intended to give birth in a birth center, matched with women who intended to give birth in the co-located hospital labor ward.
Rates of maternal outcomes, including postpartum hemorrhage, retained placenta, and postpartum infection, were significantly lower in the birth center group, after controlling for demographic and institutional factors. Interventions such as cesarean section and episiotomy were also significantly lower in these women, and the rate of breastfeeding at discharge was higher. There existed no difference in length of stay, admission to ICU, or maternal mortality.
Birth centers are a safe option for low-risk women; however, further research is required for some rare maternal outcomes.
Mansour, R, Ishihara, O, GD, A, S, D, dM, J, KG, N, Sullivan, E & F, Z 2014, 'International Committee for Monitoring Assisted Reproductive Technologies (ICMART) world report: assisted reproductive technology 2006', Human Reproduction, vol. 29, no. 7, pp. 1536-1551.View/Download from: UTS OPUS or Publisher's site
STUDY QUESTION What are the access, effectiveness and safety of assisted reproductive technology (ART) worldwide in 2006? SUMMARY ANSWER ART access, effectiveness and safety vary markedly among countries. Overall, there was an increase in the use of ICSI, single embryo transfer (SET) and frozen embryo transfer (FET). There was a decline in the multiple delivery rate (DR) and preterm birth rate.
Halliday, LE, Peek, MJ, Ellwood, DA, Homer, CS, Knight, M, McLintock, C, Jackson-Pulver, L & Sullivan, E 2013, 'The Australasian Maternity Outcomes Surveillance System: An evaluation of stakeholder engagement, usefulness, simplicity, acceptability, data quality and stability', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 53, no. 2, pp. 152-157.View/Download from: UTS OPUS or Publisher's site
Background: The Australasian Maternity Outcomes Surveillance System (AMOSS) conducts active, prospective surveillance of severe maternal conditions in Australia and New Zealand (ANZ). AMOSS captures greater than 96% of all births, and utilises an online, active case-based negative reporting system.
Wang, YA, Nikravan, R, Smith, HC & Sullivan, EA 2013, 'Higher prevalence of gestational diabetes mellitus following assisted reproduction technology treatment', HUMAN REPRODUCTION, vol. 28, no. 9, pp. 2554-2561.View/Download from: UTS OPUS or Publisher's site
Sullivan, EA, Zegers-Hochschild, F, Mansour, R, Ishihara, O, de Mouzon, J, Nygren, KG & Adamson, GD 2013, 'International Committee for Monitoring Assisted Reproductive Technologies (ICMART) world report: assisted reproductive technology 2004', HUMAN REPRODUCTION, vol. 28, no. 5, pp. 1375-1390.View/Download from: UTS OPUS or Publisher's site
Li, Z, Chen, M, Guy, R, Wand, H, Oats, J & Sullivan, E 2013, 'Chlamydia Screening In Pregnancy In Australia: Integration Of National Guidelines Into Clinical Practice And Policy', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 53, no. 4, pp. 338-346.View/Download from: UTS OPUS or Publisher's site
Background Chlamydia trachomatis is the most common reportable infection in Australia. Since 2006, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) have recommended chlamydia screening in pregnant women aged <25years. Aims To assess clinical uptake and policy integration of the 2006 RANZCOG recommendation on chlamydia testing in pregnant women aged <25years. Methods A mixed method approach was used involving a literature review, a survey of obstetricians and gynaecologists, and survey of hospital managers from April 2010 to May 2010. Results Of the 1644 participating RANZCOG Fellows, Trainees, and Diplomates, 21.2% reported universal screening for pregnant women <25years (25% of primary care clinicians, 23% of those working in the public hospital sector, 16% of those working in both public and private hospitals, and 13% of those in private hospitals or private practice). There was a strong association between members who agreed with the guideline and offering universal screening to pregnant women aged <25years (adjusted odds ratio=17.1, 95% CI: 6.0-49.2, P<0.01). Of the 143 participating hospital managers who completed the hospital policy questionnaire; 20% reported that their hospital had a formal screening guideline. There were two national and four state/local policy documents recommending chlamydia screening in pregnancy. Conclusions This study shows low uptake of chlamydia screening of young pregnant women by RANZCOG Fellows, Trainees, and Diplomates involved in antenatal care and highlights the need for national clinical leadership regarding screening for chlamydia among pregnant women aged <25years.
Xu, F, Bonello, M, Burns, L, Austin, M-P, Li, Z & Sullivan, E 2013, 'Hospital Admissions for Alcohol Use Disorders Before, During, and After Pregnancy: A Study Based on Linked Population Data in New South Wales, Australia', Alcoholism: Clinical and Experimental Research, vol. 37, no. 10, pp. 1706-1712.View/Download from: UTS OPUS or Publisher's site
Alcohol use disorders (AUD) during pregnancy can have profound lifelong effects on the baby, including fetal alcohol spectrum disorders (FASD). Hospital admission for AUD during pregnancy provides an opportunity for intervention. Characterization of women along the AUD spectrum during pregnancy aids the development of prevention strategies, policy, and clinical management guidelines aimed at this population. This study describes the hospital admission levels for AUD between the sixth month before pregnancy and the first year after birth and explores risk factors associated with the hospital admissions.
This study was based on linked population data between 2002 and 2005 using the New South Wales (NSW) Midwives Data Collection (MDC) and the NSW Admitted Patients Data Collection (APDC), Australia. The study subjects included primiparous mothers who were admitted to hospital in the period from the sixth month before pregnancy to 1 year after birth with at least 1 of the following diagnoses (ICD-10-AM): mental and behavioral disorders due to the use of alcohol (MBDA) (F10.0–10.9); toxic effects of alcohol (T51.0–51.9); maternal care for suspected damage to fetus from alcohol (O35.4); or alcohol rehabilitation (Z50.2).
A total of 175 new mothers had 287 hospital admissions with the principal or stay AUD diagnoses during the study period in NSW. Of the 287 admissions, 181 admissions (63.07%) were reported for an alcohol-related disorder as the principal diagnosis. The hospital admission rate for AUD was 1.76/1,000 person-years (PY) (95% CI: 1.45 to 2.07) during the 6 months prepregnancy. The rate decreased to 0.49/1,000 PY (95% CI: 0.36 to 0.63) during pregnancy and to 0.82/1,000 PY (95% CI: 0.67 to 0.97) in the first year after birth. Women who smoked during pregnancy, lived in a remote area and were younger than 25 years, were more likely to be admitted to hospital with AUD diagnoses. Women in the middle disadvantaged quintile and born i...
Umstad, M, Hale, L, Wang, Y & Sullivan, E 2013, 'Multiple Deliveries: The Reduced Impact Of In Vitro Fertilisation In Australia', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 53, no. 2, pp. 158-164.View/Download from: UTS OPUS or Publisher's site
Background The number of twins born in Australia steadily increased from 2420 sets in 1983 to 4458 sets in 2010. At one stage, almost 25% of all twin deliveries in Australia were a consequence of assisted reproductive technologies. Aims To determine the influence of a policy of single embryo transfer (SET) on the rate of multiple deliveries in Australia. Methods We used population data to compare the prevalence of twin and higher order multiple births in women giving birth in Australia before and after the implementation of the RTAC COP 2001 and 2005 revisions for ART units. Results There was a steady fall in the twin delivery rate for assisted reproductive technologies from 210.4 per 1000 deliveries in 2001 to 84.3 per 1000 deliveries in 2009. In 2009, assisted reproductive technologies accounted for approximately 16% of all twin births from 3% of all conceptions, substantially less than the 24.5% in 2002. Conclusions The decline in multiple births is multifactorial. However, the fall in the proportion of ART multiple births has paralleled adoption of a voluntary policy of SET within a setting of largely public funding of ART.
Sullivan, E, Wang, Y, Norman, R, Chambers, G, Chughtai, A & Farquhar, C 2013, 'Perinatal Mortality Following Assisted Reproductive Technology Treatment In Australia And New Zealand, A Public Health Approach For International Reporting Of Perinatal Mortality', BMC Pregnancy And Childbirth, vol. 13, pp. 1-9.View/Download from: UTS OPUS or Publisher's site
There is a need to have uniformed reporting of perinatal mortality for births following assisted reproductive technology (ART) treatment to enable international comparison and benchmarking of ART practice.
The Australian and New Zealand Assisted Reproduction Database was used in this study. Births of ≥ 20 weeks gestation and/or ≥ 400 grams of birth weight following embryos transfer cycles in Australia and New Zealand during the period 2004 to 2008 were included. Differences in the mortality rates by different perinatal periods from a gestational age cutoff of ≥ 20, ≥ 22, ≥ 24, or ≥ 28 weeks (wks) to a neonatal period cutoff of either < 7 or < 28 days after birth were assessed. Crude and specific (number of embryos transferred and plurality) rates of perinatal mortality were calculated for selected gestational and neonatal periods.
When the perinatal period is defined as ≥ 20 wks gestation to < 28 days after birth, the perinatal mortality rate (PMR) was 16.1 per 1000 births (n = 630). A progressive contraction of the gestational age groups resulted in marked reductions in the PMR for deaths at < 28 days (22 wks 11.0; 24 wks 7.7; 28 wks 5.6); and similarly for deaths at < 7 days (20 wks 15.6, 22 wks 10.5; 24 wks 7.3; 28 wks 5.3). In contrast, a contraction of the perinatal period from < 28 to < 7 days after birth only marginally reduced the PMR from 16.2 to 15.6 per 1000 births which was consistent across all gestational ages.
The PMR for single embryo transfer (SET) births (≥ 20 weeks gestation to < 7 days post-birth) was significantly lower (12.8 per 1000 SET births) compared to double embryo transfer (DET) births (PMR 18.3 per 1000 DET births; p < 0.001, Fisher's Exact Test). Similarly, the PMR for SET births (≥ 22 weeks gestation to < 7 days post-birth) was significantly lower (8.8 per 1000 SET births, p < 0.001, Fisher's Exact Test) when compared to DET births (12.2 per 1000 DET births). The highest PMR (50.5 per 1000 SET births, ...
Chambers, G, Wang, Y, Chapman, M, Hoang, V, Sullivan, E, Abdalla, H & Ledger, W 2013, 'What Can We Learn From A Decade Of Promoting Safe Embryo Transfer Practices? A Comparative Analysis Of Policies And Outcomes In The Uk And Australia, 2001-2010', Human Reproduction, vol. 28, no. 6, pp. 1679-1686.View/Download from: UTS OPUS or Publisher's site
Vaughan, G, Pollock, W, Peek, M, Knight, M, Ellwood, D, Homer, CS, Pulver, LJ, McLintock, C, Ho, MT & Sullivan, E 2012, 'Ethical issues: The multi-centre low-risk ethics/governance review process and AMOSS', The Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 52, no. 2, pp. 195-203.View/Download from: UTS OPUS or Publisher's site
The Australasian Maternity Outcomes Surveillance System (AMOSS) conducts surveillance and research of rare and serious conditions in pregnancy. This multi-centre population health study is considered low risk with minimal ethical impact. Objective: To describe the ethics/governance review pathway undertaken by AMOSS. Method: Prospective, descriptive study during 2009- 2011 of the governance/ethical review processes required to gain approval for Australian and New Zealand (ANZ) maternity units with more than 50 births per year (n = 303) to participate in AMOSS. Results: Review processes ranged from a single application for 24 NZ sites, a single application for eligible hospitals in two Australian states, full Health Research Ethics Committee (HREC) applications for individual hospitals, through simple letters of support. As of September 2011, 46 full/expedited ethics applications, 131 site governance applications and 136 letters of support requests were made over 33 months, involving an estimated 3261 hours by AMOSS staff/investigators, and an associated resource burden by participating sites, to obtain approval to receive nonidentifiable data from 291 hospitals. Conclusion: The AMOSS research system provides an important resource to enhance knowledge of conditions that cause rare and serious maternal morbidity. Yet the highly variable ethical approval processes required to implement this study have been excessively repetitive and burdensome. This process jeopardises timely, efficient research project implementation, without corresponding benefits to research participants. The resource burden to establish research governance for AMOSS confirms the urgent need for the Harmonisation of Multi- centre Ethical Review (HoMER) to further streamline ethics/governance review processes for multi- centre research.
Knight, M, Berg, C, Brocklehurst, P, Kramer, M, Lewis, G, Oats, J, Roberts, C, Spong, C, Sullivan, E, Van Roosmalen, J & Zwart, J 2012, 'Amniotic Fluid Embolism Incidence, Risk Factors And Outcomes: A Review And Recommendations', BMC Pregnancy And Childbirth, vol. 12, no. 1, pp. 1-11.View/Download from: UTS OPUS or Publisher's site
Background: Amniotic fluid embolism (AFE) is a rare but severe complication of pregnancy. A recent systematic review highlighted apparent differences in the incidence, with studies estimating the incidence of AFE to be more than three times higher in North America than Europe. The aim of this study was to examine population-based regional or national data from five high-resource countries in order to investigate incidence, risk factors and outcomes of AFE and to investigate whether any variation identified could be ascribed to methodological differences between the studies. Methods: We reviewed available data sources on the incidence of AFE in Australia, Canada, the Netherlands, the United Kingdom and the USA. Where information was available, the risk factors and outcomes of AFE were examined. Results: The reported incidence of AFE ranged from 1.9 cases per 100 000 maternities (UK) to 6.1 per 100 000 maternities (Australia). There was a clear distinction between rates estimated using different methodologies. The lowest estimated incidence rates were obtained through validated case identification (range 1.9-2.5 cases per 100 000 maternities); rates obtained from retrospective analysis of population discharge databases were significantly higher (range 5.5-6.1 per 100 000 admissions with delivery diagnosis). Older maternal age and induction of labour were consistently associated with AFE. Conclusions: Recommendation 1: Comparisons of AFE incidence estimates should be restricted to studies using similar methodology. The recommended approaches would be either population-based database studies using additional criteria to exclude false positive cases, or tailored data collection using existing specific population-based systems. Recommendation 2: Comparisons of AFE incidence between and within countries would be facilitated by development of an agreed case definition and an agreed set of criteria to minimise inclusion of false positive cases for database studies. Recomm...
Dobbins, T, Sullivan, E, Roberts, C & Simpson, J 2012, 'Australian National Birthweight Percentiles By Sex And Gestational Age, 1998-2007', Medical Journal Of Australia, vol. 197, no. 5, pp. 291-294.View/Download from: UTS OPUS or Publisher's site
Objective: To present updated national birthweight percentiles by gestational age for male and female singleton infants born in Australia. Design and setting: Cross-sectional population-based study of 2.53 million singleton live births in Australia between 1998 and 2007. Main outcome measures: Birthweight percentiles by gestational age and sex. Results: Between 1998 and 2007, women in Australia gave birth to 2 539 237 live singleton infants. Of these, 2 537 627 had a gestational age between 20 and 44 weeks, and sex and birthweight data were available. Birthweight percentiles are presented by sex and gestational age for a total of 2 528 641 births, after excluding 8986 infants with outlying birthweights. Since the publication of the previous Australian birthweight percentiles in 1999, median birthweight for term babies has increased between 0 and 25 g for boys and between 5 g and 45 g for girls. Conclusions: There has been only a small increase in birthweight percentiles for babies of both sexes and most gestational ages since 1991-1994. These national percentiles provide a current Australian reference for clinicians and researchers assessing weight at birth.
Xu, F, Hilder, L, Austin, M-P & Sullivan, EA 2012, 'Data preparation techniques for a perinatal psychiatric study based on linked data', BMC Medical Research Methodology, vol. 12, pp. 1-9.View/Download from: UTS OPUS or Publisher's site
In recent years there has been an increase in the use of population-based linked data. However, there is little literature that describes the method of linked data preparation. This paper describes the method for merging data, calculating the statistical variable (SV), recoding psychiatric diagnoses and summarizing hospital admissions for a perinatal psychiatric study.
The data preparation techniques described in this paper are based on linked birth data from the New South Wales (NSW) Midwives Data Collection (MDC), the Register of Congenital Conditions (RCC), the Admitted Patient Data Collection (APDC) and the Pharmaceutical Drugs of Addiction System (PHDAS).
The master dataset is the meaningfully linked data which include all or major study data collections. The master dataset can be used to improve the data quality, calculate the SV and can be tailored for different analyses. To identify hospital admissions in the periods before pregnancy, during pregnancy and after birth, a statistical variable of time interval (SVTI) needs to be calculated. The methods and SPSS syntax for building a master dataset, calculating the SVTI, recoding the principal diagnoses of mental illness and summarizing hospital admissions are described.
Linked data preparation, including building the master dataset and calculating the SV, can improve data quality and enhance data function.
Wang, Y, Farquhar, C & Sullivan, E 2012, 'Donor Age Is A Major Determinant Of Success Of Oocyte Donation/recipient Programme', Human Reproduction, vol. 27, no. 1, pp. 118-125.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: In recent years, particularly in developed countries, women have tended to delay childbirth until over 40 years of age. Our study aims to identify whether the donor"s age or recipient"s age influences the pregnancy and live birth rate following oocyte recipient cycles. METHODS: A population study included 3889 fresh oocyte recipient cycles. Pregnancy and live delivery rates were compared in recipient age groups (<35, 35-39, 40-44 and >= 45 years) and donor age groups (<30, 30-34, 35-39 and >= 40 years). RESULTS: The highest live birth rate was of cycles in donors aged 30-34 years (25.0%), it decreased (P < 0.05) to 24.1% in donors aged <30 years, 20.7% in donors aged 35-39 years and 11.5% in donors aged >= 40 years. The multivariate analysis showed no significant differences in the success by recipient"s age. Compared with cycles in donors aged 30-34 years, cycles in donors aged 35-39 years had 14 and 18% less chance to achieve a pregnancy [adjusted rate ratio (ARR) 0.86, 95% confidence interval (CI) 0.75-0.98] and a live delivery (ARR 0.82, 95% CI 0.71-0.96), while cycles in donors aged 40 years or older had 42 and 54% less chance to achieve a pregnancy (ARR 0.58, 95% CI 0.41-0.84) and a live delivery (ARR 0.46, 95% CI 0.29-0.73). CONCLUSIONS: Older recipients with younger donors did not have a poorer pregnancy outcome compared with younger recipients with younger donors. Choosing a donor aged <35 years would increase the chance of pregnancy and live delivery for older recipients.
Xu, F, Sullivan, EA, Madden, RC, Black, D & Pulver, LRJ 2012, 'Improvement of maternal Aboriginality in NSW birth data', BMC Medical Research Methodology, vol. 12, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
The Indigenous population of Australia was estimated as 2.5% and under-reported. The aim of this study is to improve statistical ascertainment of Aboriginal women giving birth in New South Wales.
This study was based on linked birth data from the Midwives Data Collection (MDC) and the Registry of Births Deaths and Marriages (RBDM) of New South Wales (NSW). Data linkage was performed by the Centre for Health Record Linkage (CHeReL) for births in NSW for the period January 2001 to December 2005. The accuracy of maternal Aboriginal status in the MDC and RBDM was assessed by consistency, sensitivity and specificity. A new statistical variable, ASV, or Aboriginal Statistical Variable, was constructed based on Indigenous identification in both datasets. The ASV was assessed by comparing numbers and percentages of births to Aboriginal mothers with the estimates by capture-recapture analysis.
Maternal Aboriginal status was under-ascertained in both the MDC and RBDM. The ASV significantly increased ascertainment of Aboriginal women giving birth and decreased the number of missing cases. The proportion of births to Aboriginal mothers in the non-registered birth group was significantly higher than in the registered group.
Linking birth data collections is a feasible method to improve the statistical ascertainment of Aboriginal women giving birth in NSW. This has ramifications for the ascertainment of babies of Aboriginal mothers and the targeting of appropriate services in pregnancy and early childhood.
Xu, F, Austin, M-P, Reilly, N, Hilder, L & Sullivan, EA 2012, 'Major depressive disorder in the perinatal period: using data linkage to inform perinatal mental health policy', Archives of Women's Mental Health, vol. 15, no. 5, pp. 333-341.View/Download from: UTS OPUS or Publisher's site
This study aims to investigate hospital admission of major depressive disorders (MDD) before and after birth. Population data for all primiparous women admitted to the hospital with depressive disorders before and after birth were used. The comparison group consisted of 10 % of primiparous women not admitted to the hospital with a diagnosis of a psychiatric disorder or substance use. A total of 728 women had a first admission with depressive disorders (501 in the first postpartum year). The rate of first hospital admission for depressive disorders decreased during pregnancy and increased markedly in the first three months after birth (peaking in the second month with a rate of 10.74/1,000 person year and rate ratio of 12.56) compared with the 6 months prior to pregnancy. Admission remained elevated in the second postpartum year. Older maternal age, smoking, elective caesarian section and admission to a neonatal intensive care unit or special care nursery were associated with a higher rate of admission. Women born outside Australia and those most socioeconomically disadvantaged were less likely to be admitted to the hospital in the first postpartum year. Overall risk of hospital admission with depressive disorders rose significantly across the entire first postpartum year. This has significant implications for policy and service planning for women with mood disorders in the perinatal period.
Sullivan, E, Wang, Y, Hayward, I, Chambers, G, Illingworth, P, Mcbain, J & Norman, R 2012, 'Single Embryo Transfer Reduces The Risk Of Perinatal Mortality, A Population Study', Human Reproduction, vol. 27, no. 12, pp. 3609-3615.View/Download from: UTS OPUS or Publisher's site
Liu, B, Guthridge, S, Li, S, Markey, P, Krause, V, Mcintyre, P, Sullivan, E, Ward, J, Wood, N & Kaldor, J 2012, 'The End Of The Australia Antigen? An Ecological Study Of The Impact Of Universal Newborn Hepatitis B Vaccination Two Decades On', Vaccine, vol. 30, no. 50, pp. 7309-7314.View/Download from: UTS OPUS or Publisher's site
Background: A universal newborn hepatitis B (HBV) vaccination program was introduced in the Northern Territory of Australia in 1990, followed by a school-based catch-up program. We evaluated the prevalence of hepatitis B infection in birthing women up to 20 years after vaccination and compared this to women born before the programs commenced. Methods: A cohort of birthing mothers was defined from Northern Territory public hospital birth records between 2005 and 2010 and linked to laboratory confirmed notifications of chronic HBV, based principally on a record of hepatitis B surface antigen detection. Prevalence of HBV was compared between women born before or after implementation of the newborn and catch-up vaccination programs. Findings: Among 10797 birthing mothers, 138 (1.3%) linked to a chronic HBV record. HBV prevalence was substantially higher in Aboriginal women compared to non-Indigenous women (2.4% versus 0.04%; p < 0.001). Among 5678 Aboriginal women, those eligible for catch-up and newborn HBV vaccination programs had a significantly lower HBV prevalence than older women born prior to the programs: HBV prevalence respectively 2.2% versus 3.5%, (OR 0.61, 95%CI 0.43-0.88) and 0.8% versus 3.5% (OR 0.21, 95%Cl 0.11-0.43). This represents a risk reduction of respectively 40% and 80% compared to unvaccinated women. Interpretation: The progressively greater reduction in the prevalence of chronic HBV in adult Aboriginal women co-inciding with eligibility for catch-up and newborn vaccination programs is consistent with a significant impact from both programs. The use of data derived from antenatal screening to track ongoing vaccine impact is applicable to a range of settings globally.
Austin, M, Reilly, N & Sullivan, E 2012, 'The Need To Evaluate Public Health Reforms: Australian Perinatal Mental Health Initiatives', Australian And New Zealand Journal Of Public Health, vol. 36, no. 3, pp. 208-211.View/Download from: UTS OPUS or Publisher's site
Objective: To describe the Australian perinatal mental health reforms and explore ways of improving surveillance of maternal mental health morbidity and mortality in this context. Approaches: We reviewed the Australian perinatal (defined as conception to one year postpartum) mental health reforms, in association with an appraisal of the population health methods that could be used for their evaluation. Conclusion: Despite the increasing focus of public health reforms on maternal mental health in the perinatal period, there is currently no national data available to evaluate these reforms or to provide an evidence base for improved health outcomes. National data development and linkage of relevant datasets would go a long way towards enabling such an endeavour. Implications: Inclusion of key mental health items in the Perinatal National Minimum Dataset and use of data linkage techniques will allow for monitoring of trends in maternal mental health morbidity and mortality in response to the Australian reforms. Once this is implemented, cost-benefit analyses can be undertaken.
Xu, F, Sullivan, EA, Black, DA, Pulver, LRJ & Madden, RC 2012, 'Under-reporting of birth registrations in New South Wales, Australia', BMC Pregnancy and Childbirth, vol. 12, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
To determine the rates of birth registration over a five-year period in New South Wales (NSW) and explore the factors associated with the rate of registration.
This is a cross-sectional study using linked population databases. The study population included all births of NSW residents in NSW between 2001 and 2005.
Birth registration rates in NSW were 82.66% in the year of birth, 93.19% in the first year, 94.02% in the second, 94.56% in the third and 95.08% in the fourth year after birth. The non-registration of births was mainly associated with such factors as neonatal and postneonatal death (adjusted OR = 3.84, 95% CI: 3.23-4.57); being Indigenous (adjusted OR = 3.26, 95% CI: 3.10-3.43); maternal age <25 or >39 years (adjusted OR = 2.81, 95% CI: 2.72-2.90); low birthweight (<2,500 grams) (adjusted OR = 1.79, 95% CI: 1.69-1.90); living in remote areas (adjusted OR = 1.57, 95% CI: 1.52-1.63); being born after the first quarter of year (adjusted OR = 1.08-1.56, 95% CI between 1.03-1.12 and 1.49-1.64); mother having more pregnancies (adjusted OR = 1.85-7.29, 95% CI between1.78-1.93 and 6.87-7.73). Mothers who were born overseas were more likely to register their births than those born in Australia (adjusted OR = 0.72, 95% CI: 0.69-0.75). Multiple births were more likely to be registered than singleton births (adjusted OR = 0.84, 95% CI: 0.76-0.92). About one-third of the non-registrations of births in NSW were explained by the risk factors. The reasons for the remaining non-registrations need to be investigated.
Of birth in NSW, 4.92% were not registered by the fourth year after birth.
Homer, CS, Biggs, JB, Vaughan, G & Sullivan, E 2011, 'Mapping Maternity Services In Australia: Location, Classification And Services', Australian Health Review, vol. 35, no. 2, pp. 222-229.View/Download from: UTS OPUS or Publisher's site
Abstract Objective. To describe maternity services available to Australian women and, in particular, the location, classification of services and support services available. Design. A descriptive study was conducted using an online survey that was emailed to eligible hospitals. Inclusion criteria for the study included public and private maternity units with greater than 50 births per year. In total, 278 maternity units were identified. Units were asked to classify their level of acuity (Levels 26). Results. A total of 150 (53%) maternity units responded. Those who responded were reasonably similar to those who did not respond, and were representative of Australian maternity units. Almost three-quarters of respondents were from public maternity units and almost 70% defined themselves as being in a rural or remote location. Maternity units with higher birth rates were more likely to classify themselves as providing higher acuity services, that is, Levels 5 and 6. Private maternity units were more likely to have higher acuity classifications. Interventions such as induction of labour, either using an artificial rupture of membranes (ARM) and oxytocin infusion or with prostaglandins, were common across most units. Although electronic fetal monitoring (EFM) was also widely available, access to fetal scalp pH monitoring was low. Conclusion. Maternity service provision varies across the country and is defined predominately by location and annual birth rate.
Knight, M, Pierce, M, Seppelt, I, Kurinczuk, JJ, Spark, P, Brocklehurst, P, McLintock, C & Sullivan, E 2011, 'Influenza AH1N1v in pregnancy', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 118, no. 9, pp. 1140-1141.View/Download from: Publisher's site
Knight, M, Pierce, M, Seppelt, I, Kurinczuk, JJ, Spark, P, Brocklehurst, P, McLintock, C & Sullivan, E 2011, 'Critical illness with AH1N1v influenza in pregnancy: a comparison of two population-based cohorts', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 118, no. 2, pp. 232-239.View/Download from: UTS OPUS or Publisher's site
Chambers, G, Illingworth, P & Sullivan, E 2011, 'Assisted Reproductive Technology: Public Funding And The Voluntary Shift To Single Embryo Transfer In Australia', Medical Journal Of Australia, vol. 195, no. 10, pp. 594-598.View/Download from: UTS OPUS or Publisher's site
Objectives: To calculate cost savings to the Australian federal and state governments from the reduction in twin and triplet birth rates for infants conceived by assisted reproductive technology (ART) since 2002, and to determine the number of ART treatment programs theoretically funded by means of these savings. Design and setting: Costing model using data from the Australia and New Zealand Assisted Reproduction Database, the National Perinatal Data Collection and Medicare Australia on ART treatment cycles undertaken in Australia between 2002 and 2008. Main outcome measures: Annual savings in maternal and infant inpatient birth-admission costs resulting from the reduction in ART multiple birth rate; theoretical number of ART treatment programs funded and infants born by means of these savings. Results: The reduction in the ART multiple birth rate from 18.8% in 2002 to 8.6% in 2008 resulted in estimated savings to government of $47.6 million in birth-admission costs alone. Theoretically, these savings funded 7042 ART treatment programs comprising one fresh plus one frozen embryo transfer cycle, equating to the birth of 2841 babies. Fifty-five per cent of the increased use of ART services since 2002 has been theoretically funded by the reduction in multiple birth infants. Conclusions: Against a backdrop of supportive public funding of ART in Australia, a voluntary shift to single embryo transfer by fertility clinicians and ART patients has resulted in substantial savings in hospital costs. Much of the growth in ART use has been theoretically cross-subsidised by the move to safer embryo transfer practices.
Laws, P, Lim, C, Tracy, S, Dahlen, H & Sullivan, E 2011, 'Changes To Booking, Transfer Criteria And Procedures In Birth Centres In Australia From 1997-2007: A National Survey', Journal Of Clinical Nursing, vol. 20, no. 19-20, pp. 2812-2821.View/Download from: UTS OPUS or Publisher's site
Aims. This study aimed to describe booking and transfer criteria and procedures available in birth centres in Australia in 2007 and to compare results with those of a previous national birth centre study undertaken in 1997. Background. Approximately 2% of women who give birth in Australia each year do so in a birth centre. A national study on birth centre procedures was conducted in 1997. There have been changes in the management of women in birth centres during the past 10 years and this may be due in part to changes in booking and transfer criteria. Design. Survey. Methods. Questionnaires were sent to 23 birth centres. Questions included: types of procedures, equipment and pain relief available and exclusion criteria for booking and transfer. Of the birth centres, 19 satisfied the inclusion criteria and 16 completed surveys. Results. Changes were noted in booking and transfer criteria and procedures for birth centres between 1997-2007. These included a decline in birth centres accepting postterm pregnancies, vaginal births after caesarean section and women who are obese. There were also reductions in the use of artificial rupture of membranes for augmentation of labour, forceps and opioids. Use of natural therapies was widespread in 2007. Increases in birth centres managing induction of labour and electronic fetal monitoring were also noted. Conclusions. The changes observed in birth centre practice reflect overall changes in maternity care in Australia from 1997-2007. Relevance to clinical practice. Findings of the study suggest that factors such as increasing obesity and limited admission for vaginal births after caesarean section may lead to proportionately more women being unable to access birth centres as their preferred place of birth.
Nair, P, Davies, A, Beca, J, Bellomo, R, Ellwood, D, Forrest, P, Jackson, A, Pye, R, Seppelt, I, Sullivan, E & Webb, S 2011, 'Extracorporeal Membrane Oxygenation For Severe Ards In Pregnant And Postpartum Women During The 2009 H1n1 Pandemic', Intensive Care Medicine, vol. 37, no. 4, pp. 648-654.View/Download from: UTS OPUS or Publisher's site
Purpose: To describe the technical challenges, efficacy, complications and maternal and infant outcomes associated with extracorporeal membrane oxygenation (ECMO) for severe adult respiratory distress syndrome (ARDS) in pregnant or postpartum patients during the 2009 H1N1 pandemic. Methods: Twelve critically ill pregnant and postpartum women were included in this retrospective observational study on the application of ECMO for the treatment of severe ARDS refractory to standard treatment. The study was conducted at seven tertiary hospitals in Australia and New Zealand. Results: Of the 12 patients treated with ECMO, 7 (58%) were pregnant and 5 (42%) were postpartum. Their median (interquartile range [IQR]) age was 29 (26-33) years, 6 (50%) were obese. Two patients were initially treated with veno-arterial (VA) ECMO. All others received veno-venous (VV) ECMO with one or two drainage cannulae. ECMO circuit-related complications were rare, circuit change was needed in only two cases and there was no sudden circuit failure. On the other hand, bleeding was common, leading to relatively large volumes of packed red blood cell transfusion (median [ IQR] volume transfused was 3,499 [1,451-4,874] ml) and was the main cause of death (three cases). Eight (66%) patients survived to discharge and seven were ambulant, with normal oxygen saturations. The survival rate of infants whose mothers received ECMO was 71% and surviving infants were discharged home with no sequelae. Conclusions: The use of ECMO for severe ARDS in pregnant and postpartum women was associated with a 66% survival rate. The most common cause of death was bleeding. Infants delivered of mothers who had received ECMO had a 71% survival rate and, like their mothers, had no permanent sequelae at hospital discharge.
Nygren, K, Sullivan, E, Zegers-hochschild, F, Mansour, R, Ishihara, O, Adamson, G & De Mouzon, J 2011, 'International Committee For Monitoring Assisted Reproductive Technology (icmart) World Report: Assisted Reproductive Technology 2003', Fertility And Sterility, vol. 95, no. 7, pp. 2209-0.View/Download from: UTS OPUS or Publisher's site
Objective: To analyze information on assisted reproductive technologies (ART) performed globally. Design: Data on access, efficacy, and safety of ART were collected for the year 2003 from 54 countries. Setting: National and regional ART registries globally. Patient(s): Patients undergoing ART globally. Intervention(s): Collection and analysis of international ART registry data. Main Outcome Measure(s): Number of cycles performed in reporting countries and regions globally for different ART procedures with resulting pregnancy, live birth and multiple birth rates. Result(s): A total of 433,427 initiated cycles reported in this registry resulted in 173,424 babies born. This corresponded to a delivery rate per aspiration of 22.4% for in vitro fertilization (IVF), 23.3% for intracytoplasmic sperm injection (ICSI), and a delivery rate per transfer of 17.1% for frozen embryo transfer. Although there is wide variation among countries and regions, the overall proportion of deliveries with twins and triplets from IVF and ICSI was 24.8% and 2.0%, respectively. There were wide variations in access, and compared with the previous report (year 2002), there was a 3.9% increase in the number of reported cycles and a minor increase in the delivery rate per aspiration. There was also a marginal decline in the mean number of embryos transfered and in the rate of multiple births. Conclusion(s): ART access, efficacy, and safety varies greatly globally. Collection and analysis of data over time will benefit ART patients, providers, and policy makers. (Fertil Steril (R) 2011;95:2209-22. (C)2011 by American Society for Reproductive Medicine.)
Wang, Y, Costello, M, Chapman, M, Black, D & Sullivan, E 2011, 'Transfers Of Fresh Blastocysts And Blastocysts Cultured From Thawed Cleavage Embryos Are Associated With Fewer Miscarriages', Reproductive BioMedicine Online, vol. 23, no. 6, pp. 777-788.View/Download from: UTS OPUS or Publisher's site
The literature shows an inconsistent relationship between miscarriage and assisted reproduction treatment factors. This study assessed the association between miscarriage and transfer of fresh or thawed embryos at cleavage/blastocyst stages. A population study included 52,874 pregnancies following autologous cycles. The miscarriage rate was compared by groups of transferred embryos (fresh cleavage embryo, fresh blastocyst, thawed cleavage embryo, blastocyst from thawed cleavage embryo, thawed blastocyst), IVF/intracytoplasmic sperm injection procedures, number of embryos transferred and woman"s demographics. The overall miscarriage rate was 18.7%. Women aged 35-39 years and >= 40 years had a 51% and 177% increased hazard of miscarriage, respectively, compared with women <35 years. Women with history of miscarriage had 1.22 times hazard of miscarriage compared with those without previous miscarriage. Singleton pregnancies following fresh double-embryo transfer had 1.43 times higher rate of miscarriage than fresh single-embryo transfer. Fresh blastocyst transfer was associated with 8% less hazard of miscarriage than fresh cleavage-embryo transfer. Compared with pregnancies following thawed cleavage-embryo transfers, thawed blastocyst transfers were at 14% higher hazard of miscarriage. This study suggests that a practice model that includes transferring blastocysts and freezing cleavage embryos in fresh cycles would result in better outcomes.
Sullivan, E, Ellwood, D, Peek, M, Knight, M, Jackson Pulver, LR, Homer, CS, Elliott, E, McLintock, C, Thompson, J, Zurynski, Y, Ho, T, McDonnell, N & Pollock, W 2010, 'Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study', British Medical Journal, vol. 340:c1279, no. NA, pp. 1-6.View/Download from: UTS OPUS
Objective To describe the epidemiology of 2009 A/H1N1 influenza in critically ill pregnant women. Design Population based cohort study. Setting All intensive care units in Australia and New Zealand. Participants All women with 2009 H1N1 influenza who were pregnant or recently post partum and admitted to an intensive care unit in Australia or New Zealand between 1 June and 31 August 2009. Main outcome measures Maternal and neonatal mortality and morbidity.
Guy, RJ, Kong, F, Goller, J, Franklin, N, Bergeri, I, Dimech, W, Reilly, N, Sullivan, E, Ward, J, Kaldor, JM, Hellard, M, Donovan, B & ACCESS Collaboration 2010, 'A new national Chlamydia Sentinel Surveillance System in Australia: evaluation of the first stage of implementation.', Communicable diseases intelligence, vol. 34, no. 3, pp. 319-328.
The Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) was established with funding from the Department of Health and Ageing to trial the monitoring of the uptake and outcome of chlamydia testing in Australia. ACCESS involved 6 separate networks; 5 clinical networks involving sexual health services, family planning clinics, general practices, antenatal clinics, Aboriginal community controlled health services, and 1 laboratory network. The program ran from May 2007 to September 2010. An evaluation of ACCESS was undertaken in early 2010, 2 years after the program was funded. At the time of the evaluation, 76 of the 91 participating sites were contributing data. The jurisdictional distribution of the 76 sites generally matched the jurisdictional distribution of the Australian population. In 2008, the chlamydia testing rates in persons aged 16-29 years attending the 26 general practices was 4.2% in males and 7.0% in females. At the 25 sexual health services, the chlamydia testing rates in heterosexuals aged less than 25 years in 2008 was 77% in males and 74% in females. Between 2004 and 2008, the chlamydia positivity rate increased significantly in heterosexual females aged less than 25 years attending the sexual health services, from 11.5% to 14.1% (P < 0.01). Data completeness was above 85% for all core variables except Aboriginal and/or Torres Strait Islander status and country of birth, which ranged from 68%-100%, and 74%-100%, respectively, per network. There were delays in establishment of the system due to recruitment of 91 sites, multiple ethics applications and establishment of automated extraction programs in 10 different database systems, to transform clinic records into a common, pre-defined surveillance format. ACCESS has considerable potential as a mechanism toward supporting a better understanding of long-term trends in chlamydia notifications and to support policy and program delivery.
Farquhar, CM, Wang, YA & Sullivan, EA 2010, 'A comparative analysis of assisted reproductive technology cycles in Australia and New Zealand 2004-2007', HUMAN REPRODUCTION, vol. 25, no. 9, pp. 2281-2289.View/Download from: Publisher's site
Dean, JH, Chapman, MG & Sullivan, EA 2010, 'The effect on human sex ratio at birth by assisted reproductive technology (ART) procedures - an assessment of babies born following single embryo transfers, Australia and New Zealand, 2002-2006', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 117, no. 13, pp. 1628-1634.View/Download from: Publisher's site
de Mouzon, J, Lancaster, P, Nygren, KG, Sullivan, E, Zegers-Hochschild, F, Mansour, R, Ishihara, O & Adamson, D 2010, 'World Collaborative Report on Assisted Reproductive Technology, 2002 (vol 24, pg 2310, 2009)', HUMAN REPRODUCTION, vol. 25, no. 5, pp. 1345-1345.View/Download from: Publisher's site
Wang, Y, Chapman, M, Costello, M & Sullivan, E 2010, 'Better Perinatal Outcomes Following Transfer Of Fresh Blastocysts And Blastocysts Cultured From Thawed Cleavage Embryos: A Population-based Study', Human Reproduction, vol. 25, no. 6, pp. 1536-1542.View/Download from: UTS OPUS or Publisher's site
Background: Fresh embryo transfer results in higher live birth rates, while thawed embryo transfer appears to result in healthier babies. This study aims to investigate the association between the transfer of fresh or thawed embryos at the cleavage or blastocyst stage and the perinatal outcomes. Methods: This analysis is a retrospective population-based study of 150 376 autologous embryo transfer cycles in Australia during 2002-2006. The rates of pregnancy, live delivery and "healthy baby" delivery (a single baby born live at term, weighing >= 2500 g, surviving for at least 28 days post birth and not having congenital anomalies) were compared after transfer of fresh cleavage embryos, fresh blastocysts, thawed cleavage embryos, blastocysts from thawed cleavage embryos and thawed blastocysts. Results: The live delivery rate was significantly higher for transfer of fresh blastocysts (27.9%) than for blastocysts cultured from thawed cleavage embryos (22.0%), fresh cleavage embryos (21.7%), thawed blastocysts (16.3%) and thawed cleavage embryos (15.2%). Compared with the transfer of fresh blastocysts, the likelihood of a "healthy baby" was significantly lower for blastocysts from thawed cleavage embryos [adjusted odds ratios (AOR) 0.73, 95% confidence intervals (CI) 0.65-0.82], fresh cleavage embryos (AOR 0.67, 95% CI 0.64-0.69), thawed blastocysts (AOR 0.57, 95% CI 0.53-0.62) and thawed cleavage embryos (AOR 0.53, 95% CI 0.51-0.56). Of thaw cycles, transfers of thawed blastocysts (AOR 0.79, 95% CI 0.70-0.89) and thawed cleavage embryos (AOR 0.71, 95% CI 0.63-0.79) had significantly lower odds of "healthy baby" than transfer of blastocysts from thawed cleavage embryos. Conclusions: These data suggest that an optimum practice model to maximize the outcomes of the birth of a "healthy baby" is the transfer of blastocysts and the freezing of cleavage embryos in fresh cycles and subsequent transfer of blastocysts cultured from these thawed cleavage embryos.
Chambers, G, Sullivan, E, Shanahan, M, Ho, M, Priester, K & Chapman, M 2010, 'Is In Vitro Fertilisation More Effective Than Stimulated Intrauterine Insemination As A First-line Therapy For Subfertility? A Cohort Analysis', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 50, no. 3, pp. 280-288.View/Download from: UTS OPUS or Publisher's site
Objective: To compare a strategy of two cycles of intrauterine insemination with controlled ovarian hyperstimulation (IUI/COH) vs one in vitro fertilisation (IVF) treatment programme (one fresh plus associated frozen embryo cycles) in couples presenting with unexplained, mild male or mild female subfertility. Methods: A retrospective cohort design was used and analysed according to intention-to-treat principles. A total of 272 couples underwent an intended course of two cycles of IUI/COH and 176 couples underwent one IVF treatment programme. Results: The cumulative live birth rate (CLBR) per couple for the IUI/COH group was 27.6% compared to 39.2% for the IVF group (P = 0.01). The mean time to pregnancy was 69 days in the IUI/COH group compared to 44 days in the IVF group (P = 0.02). The IVF programme was costlier, with an incremental cost-effectiveness ratio for an additional live birth in the range of $39 637-$46 325. The multiple delivery rate was 13.3% in the IUI/COH group compared to 10.1% in the IVF group (P = 0.55). One set of triplets and one set of quadruplets followed IUI/COH treatment. Conclusions: One IVF treatment programme was more effective, but costlier than an intended course of two cycles of IUI/COH. With consistently higher success rates, shorter times to pregnancy and a trend to less higher order multiple pregnancies, this study supports the view that IVF is now potentially safer and more clinically effective than IUI/COH as a first-line therapy for subfertility.
Laws, P, Tracy, S & Sullivan, E 2010, 'Perinatal Outcomes Of Women Intending To Give Birth In Birth Centers In Australia', Birth-issues In Perinatal Care, vol. 37, no. 1, pp. 28-36.View/Download from: UTS OPUS or Publisher's site
Background: A recent Australian study showed perinatal mortality was lower among women who gave birth in a birth center than in a comparable low-risk group of women who gave birth in a hospital. The current study used the same large population database to investigate whether perinatal outcomes were improved for women intending to give birth in a birth center at the onset of labor, regardless of the actual place of birth. Methods: Data were obtained from the National Perinatal Data Collection (NPDC) in Australia. The study included 822,955 mothers who gave birth during the 5-year period, 2001 to 2005, and their 836,919 babies. Of these, 22,222 women (2.7%) intended to give birth in a birth center at the onset of labor. Maternal and perinatal factors and outcomes were compared according to the intended place of birth. Data were not available on congenital anomalies, or cause, or timing of death. Results: Women intending to give birth in a birth center at the onset of labor had lower rates of intervention and of adverse perinatal outcomes compared with women intending to give birth in a hospital, including less preterm birth and low birthweight. No statistically significant difference was found in perinatal mortality for term babies of mothers intending to give birth in a birth center compared with term babies of low-risk women intending to give birth in a hospital (1.3 per 1,000 births [99% CI = 0.66, 1.95] vs 1.7 per 1,000 births [99% CI = 1.50, 1.80], respectively). Conclusions: Term babies of women who intended to give birth in a birth center were less likely to be admitted to a neonatal intensive care unit or special care nursery, and no significant difference was found in other perinatal outcomes compared with term babies of low-risk women who intended to give birth in a hospital labor ward. Birth center care remains a viable option for eligible women giving birth at term. (BIRTH 37:1 March 2010).
Sullivan, E, Chapman, M, Wang, Y & Adamson, G 2010, 'Population-based Study Of Cesarean Section After In Vitro Fertilization In Australia', Birth-issues In Perinatal Care, vol. 37, no. 3, pp. 184-191.View/Download from: UTS OPUS or Publisher's site
Background: Decisions about method of birth should be evidence based. In Australia, the rising rate of cesarean section has not been limited to births after spontaneous conception. This study aimed to investigate cesarean section among women giving birth after in vitro fertilization (IVF). Methods: Retrospective population-based study was conducted using national registry, data on IVF treatment. The study included 17,019 women who underwent IVF treatment during 2003 to 2005 and a national comparison population of women who gave birth in Australia. The outcome measure was cesarean section. Results: Crude rate of cesarean section was 50.1 percent versus 28.9 percent for all other births. Single embryo transfer was associated with the lowest (40.7%) rate of cesarean section. Donor status and twin gestation were associated with significantly higher rates of cesarean section (autologous, 49.0% vs donor, 74.9%; AOR: 2.20, 95% CI: 1.80, 2.69) and (singleton, 45.0% vs twin gestations, 75.7%; AOR: 3.81, 95% CI: 3.46, 4.20). The gestation-specific rate (60.1%) of cesarean section peaked at 38 weeks for singleton term pregnancies. Compared with other women, cesarean section rates for assisted reproductive technology term singletons (27.8% vs 43.8%, OR: 2.02 [95% Cl: 1.95-2.10]) and twins (62.0% vs 75.7%, OR: 1.92 [95% Cl: 1.74-2.111) were significantly higher. Conclusions: Rates for cesarean section appear to be disproportionatel) high in term singleton births after assisted reproductive technology. Vaginal birth should be supported and the indications for cesarean section evidence based. (BIRTH 37:3 September 2010)
Abeywardana, S, Bower, C, Halliday, J, Chan, A & Sullivan, E 2010, 'Prevalence Of Neural Tube Defects In Australia Prior To Mandatory Fortification Of Bread-making Flour With Folic Acid', Australian And New Zealand Journal Of Public Health, vol. 34, no. 4, pp. 351-355.View/Download from: UTS OPUS or Publisher's site
Objective: To establish baseline prevalence of neural tube defects (NTDs) prior to mandatory folic acid fortification in Australia. Method: Retrospective population based study. Data from the Australian Congenital Anomalies Monitoring System, for 1998-2005 were used to calculate birth prevalence including live/stillbirths of at least 20 weeks gestation or 400 g birthweight. Total prevalence and trends of NTD including terminations of pregnancy (TOPs) before 20 weeks were established using data from South Australia, Victoria and Western Australia because of the incomplete ascertainment in other states. Results: The birth prevalence of NTDs from 1998-2005, was 5/10,000 births. The total prevalence including TOPs was 13/10,000 births. A 26% declining trend in total prevalence was seen from 1992-2005, but the main decline occurred prior to 1998. Women who were Indigenous, socially disadvantaged, young, living in remote areas and had multiple gestations were more likely to give birth to babies with NTDs. Conclusion: The prevalence of NTD has been stable since 1998. Reporting of the birth prevalence alone underestimates the actual prevalence of NTD. Implications: From a public health perspective, future monitoring of NTD following implementation of fortification of bread-making flour with folic acid should include a mixed methods approach; reporting birth prevalence on national data and total prevalence on tri-state data.
Wang, Y, Kovacs, G & Sullivan, E 2010, 'Transfer Of A Selected Single Blastocyst Optimizes The Chance Of A Healthy Term Baby: A Retrospective Population Based Study In Australia 2004-2007', Human Reproduction, vol. 25, no. 8, pp. 1996-2005.View/Download from: UTS OPUS or Publisher's site
The practice of single embryo transfer (SET) is highly accepted by clinicians in Australia. This study investigates whether the SET of blastocysts results in optimal perinatal outcomes. This retrospective population-based study included 34 035 single or double embryo transfer cycles in women who had their first fresh autologous treatment in Australia during 2004-2007. Pregnancy, live delivery and "healthy baby" (live born term singleton of >= 2500 g birthweight and survived for at least 28 days without a notified/reported congenital anomaly) rates per transfer cycle were compared in four groups: selective single embryo transfer (SSET), unselective single embryo transfer (USSET), selective double embryo transfer (SDET) and unselective double embryo transfer (USDET). Live delivery and "healthy baby" rates per transfer following SSET were further compared by number of embryos available. The analysis was stratified by woman"s age and stage of embryo development. The highest rates of live delivery and "healthy baby" per transfer cycle (46.2 and 38.0%) were achieved with transfer of a single blastocyst in women aged younger than 35 years. In women aged younger than 40 years, SSET had a significantly higher rate of "healthy baby" per transfer cycle than did SDET regardless of stage of embryo development. In woman aged younger than 35 years who had SSET, there was no significant difference in live delivery and "healthy baby" rates per transfer cycle whether two, three, four or five embryos were available. For all of these women, SSET of a cleavage embryo had significantly lower rates of live delivery and "healthy baby" per transfer cycle compared with SSET of a blastocyst where only two blastocysts were available. Consultation with the patient with respect to the advantage of extended culture and selective single blastocyst transfer will result in better success rates following assisted reproductive technology treatment in Australia.
Homer, CS, Clements, VJ, McDonnell, N, Peek, M & Sullivan, E 2009, 'Maternal mortality: What can we learn from stories of postpartum haemorrhage?', Women and Birth, vol. 22, no. 3, pp. 97-104.View/Download from: UTS OPUS
Death from pregnancy is rare in developed countries such as Australia but is still common in third world and developing countries. The investigation of each maternal death yields valuable information and lessons that all health care providers involved with the care of women can learn from. The aim of these investigations is to prevent future maternal morbidity and mortality. Obstetric haemorrhage remains a leading cause of maternal death internationally. It is the most common cause of death in developing countries. In Australia and the United Kingdom, obstetric haemorrhage is ranked as the 4th and 3rd most common cause of direct maternal death respectively. In a number of cases there are readily identifiable factors associated with the care that the women received that may have contributed to their death. It is from these identifiable factors that both midwives and doctors can learn to help prevent similar episodes from occurring.
Laws, P, Lim, C, Tracy, S & Sullivan, E 2009, 'Characteristics And Practices Of Birth Centres In Australia', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 49, no. 3, pp. 290-295.View/Download from: UTS OPUS or Publisher's site
Background: Around 2% of women who give birth in Australia each year give birth in a birth centre. There is currently no standard definition of a birth centre in Australia. Aims: This study aimed to locate all birth centres nationally, describe their characteristics and procedures, and develop a definition. Methods: Surveys were sent to 23 birth centres. Questions included: types of procedures, equipment and pain relief available, staffing, funding, philosophies, physical characteristics and transfer procedures. Of the birth centres, 19 satisfied the inclusion criteria and 16 completed surveys. Results: Three constructs of a birth centre were identified. A "commitment to normality of pregnancy and birth" was most commonly reported as the most important philosophy (44%). The predominant model of care was group practice/caseload midwifery (63%). Thirteen birth centres were located within/attached to a hospital, two were on a hospital campus and one was freestanding. The distance to the nearest labour ward ranged from 2 m to 15 km. Reported intrapartum transfer rates ranged from 7% to 29%. Thirteen centres had a special care nursery or neonatal intensive care unit onsite, or both. Eight centres undertook artificial rupture of membranes for induction of labour, while two administered oxytocin or prostaglandins. All centres offered nitrous oxide and local anaesthetic. Twelve centres had systemic opioids available and one offered pudendal analgesia. Fetal monitoring was used in all birth centres. Only three centres conducted instrumental deliveries, while 15 performed episiotomies. Conclusion: Birth centres vary in their philosophies, characteristics and service delivery.
de Mouzon, J, Lancaster, P, Nygren, KG, Sullivan, E, Zegers-Hochschild, F, Mansour, R, Ishihara, O & Adamson, D 2009, 'World Collaborative Report on Assisted Reproductive Technology, 2002', HUMAN REPRODUCTION, vol. 24, no. 9, pp. 2310-2320.View/Download from: Publisher's site
Zegers-Hochschild, F, Adamson, GD, de Mouzon, J, Ishihara, O, Mansour, R, Nygren, K, Sullivan, E & van der Poel, S 2009, 'The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009', HUMAN REPRODUCTION, vol. 24, no. 11, pp. 2683-2687.View/Download from: Publisher's site
Zegers-Hochschild, F, Adamson, GD, de Mouzon, J, Ishihara, O, Mansour, R, Nygren, K, Sullivan, E & Vanderpoel, S 2009, 'International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009', FERTILITY AND STERILITY, vol. 92, no. 5, pp. 1520-1524.View/Download from: Publisher's site
Robson, SJ, Laws, P & Sullivan, EA 2009, 'Adverse outcomes of labour in public and private hospitals in Australia Reply', MEDICAL JOURNAL OF AUSTRALIA, vol. 190, no. 9, pp. 519-519.
Robson, S, Laws, P & Sullivan, E 2009, 'Adverse Outcomes Of Labour In Public And Private Hospitals In Australia: A Population-based Descriptive Study', Medical Journal Of Australia, vol. 190, no. 9, pp. 474-477.View/Download from: UTS OPUS
Objective: To compare the rate of serious adverse perinatal outcomes of term labour between private and public maternity hospitals in Australia. Design, setting and participants: A population-based study of 789240 term singleton births in public and private hospitals in 2001-2004, using data from the National Perinatal Data Collection. Main outcome measures: Third- and fourth-degree perineal injury, requirement for high level of neonatal resuscitation, Apgar score < 7 at 5 minutes, admission to neonatal intensive care unit or special care nursery, and perinatal death. Results: 31.4% of the term singleton births occurred in private hospitals. After adjusting for maternal age, Indigenous status, parity, smoking status, diabetes, hypertension, remoteness of usual residence, and method of birth, the rates of all adverse outcomes studied were higher for public hospital births. For women, the adjusted odds ratio (AOR) for third- or fourth-degree perineal injury was 2.28 (95% Cl, 2.16-2.40). For babies, the odds of a high level of resuscitation (AOR, 2.37; 95% Cl, 2.17-2.59), low Apgar score (AOR, 1.75; 95% Cl, 1.65-1.84), intensive care requirement (AOR, 1.48; 95% Cl, 1.45-1.51) and perinatal death (AOR, 2.02; 95% Cl, 1.78-2.29) were all higher in public hospitals. Conclusion: For women delivering a single baby at term in Australia, the prevalence of adverse perinatal outcomes is higher in public hospitals than in private hospitals.
Lim, J, Sullivan, E & Kennedy, D 2009, 'Mothersafe: Review Of Three Years Of Counselling By An Australian Teratology Information Service', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 49, no. 2, pp. 168-172.View/Download from: UTS OPUS or Publisher's site
MotherSafe was established in January 2000 at the Royal Hospital for Women as Australia"s first "purpose-built" Teratogen Information Service and since then has received over 75 000 calls regarding exposures during pregnancy and lactation. To describe the patterns of use of MotherSafe over a three-year period. Retrospective descriptive epidemiological study using data from the database established at MotherSafe. Records from all the calls logged at MotherSafe between January 2005 and December 2007 were analysed to determine total number of calls, demographic characteristics of callers, including age, caller category and postcode, reason for call, source of referral and type of exposure. A total of 47 138 calls were recorded to the MotherSafe service from January 2005 to December 2007. The majority of calls were regarding exposures in pregnancy (55%) and breast-feeding (38%). Average age of patients was 32.3 years. Of the calls made, 81.9% (38 485 of 46 968) were by consumers (the pregnant or lactating woman herself or a relative). The most common primary exposure categories were: over-the-counter medications (11.3%), psychotropic medication (9.0%), herbal or vitamin products (8.2%), antibiotics (7.0%), gastrointestinal medications (6.8%) and topical products (6.6%). Forty per cent of callers enquired about multiple exposures. The utilisation of MotherSafe by consumers and general practitioners continues to increase, reflecting the strong demand for a teratogen counselling service that provides high-quality, evidence-based information on exposures during pregnancy and lactation.
Wang, Y, Sullivan, E, Healy, D & Black, D 2009, 'Perinatal Outcomes After Assisted Reproductive Technology Treatment In Australia And New Zealand: Single Versus Double Embryo Transfer', Medical Journal Of Australia, vol. 190, no. 5, pp. 234-237.View/Download from: UTS OPUS
Objective: To compare the perinatal outcomes of babies conceived by single embryo transfer (SET) with those conceived by double embryo transfer (DET). Design, setting and participants: A retrospective population-based study of embryo transfer cycles in Australia and New Zealand between 2002 and 2006, using data from the Australia and New Zealand Assisted Reproduction Database. Main outcome measures: Proportion of SET procedures; comparison of SET and DET procedures with respect to multiple births, low birthweight (LBW), preterm birth and fetal death. Results: The proportion of SET procedures has increased from 28.4% in 2002 to 32.0% in 2003, 40.5% in 2004, 48.2% in 2005 and 56.9% in 2006. The multiple birth rate for all babies conceived by SET (4.0%) was 10 times lower than for those conceived by DET (39.1%) (P < 0.01). The average birthweight for all liveborn babies conceived by SET (3290 g) was higher than for those conceived by DET (2934 9) (P < 0.01). The preterm birth rate of all DET-conceived babies (30.3%) was higher than for SET-conceived babies (12.3%) (adjusted odds ratio [AOR], 3.19 [95% Cl, 3.01-3.38]). All babies conceived by DET were more likely to be stillborn than those conceived by SET (AOR, 1.49 [95% Cl, 1.21-1.82]). Singletons conceived by DET were more likely to be born preterm than singletons conceived by SET (AOR, 1.13 [95% Cl, 1.05-1.22]). Liveborn singletons conceived by DET were 15% more likely to have LBW than liveborn singletons conceived by SET (AOR, 1.15 [95% Cl, 1.05-1.26]). There was no significant difference in fetal death rate between DET- and SET-conceived singletons. Conclusion: The increase in proportion of SET procedures has resulted in a lower rate of multiple births and in better perinatal outcomes in Australian and New Zealand assisted reproduction programs.
Sullivan, E, Moran, K & Chapman, M 2009, 'Term Breech Singletons And Caesarean Section: A Population Study, Australia 1991-2005', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 49, no. 5, pp. 456-460.View/Download from: UTS OPUS or Publisher's site
Objective: To describe the method of birth of term breech singletons in Australia. Design, setting and participants: A retrospective population-based study of women who gave birth to term breech singletons in Australia between 1 January 1991 and 31 December 2005 using data from the National Perinatal Data Collection. Main outcome measures: Caesarean section, vaginal breech birth. Results: Method of birth changed for term breech singletons from 1991 (vaginal breech birth 23.1% versus caesarean (no labour 55.6%, labour 21.2%)) to 2005 (vaginal breech birth 3.7% versus caesarean (no labour 76.6%, labour 19.7%)). Overall, the population attributable risk percentage of term breech singletons for all caesarean sections declined from 10.2% in 1991 to 6.9% in 2005. Conclusion: Planned caesarean section is the standard method of birth for term breech singletons in Australia. Active measures including external cephalic version should be supported to reduce the rate of caesarean section where clinically indicated. Retention of a skilled clinical workforce is essential in the provision of the latter and to assist the minority of women having vaginal breech births. Breech presentation is not a major factor in the overall rise in caesarean section experienced by Australia since 1996.
Chambers, G, Sullivan, E, Ishihara, O, Chapman, M & Adamson, G 2009, 'The Economic Impact Of Assisted Reproductive Technology: A Review Of Selected Developed Countries', Fertility And Sterility, vol. 91, no. 6, pp. 2281-2294.View/Download from: UTS OPUS or Publisher's site
Objective: To compare regulatory and economic aspects of assisted reproductive technologies (ART) in developed countries. Design: Comparative policy and economic analysis. Patient(s): Couples undergoing ART treatment in the United States, Canada, United Kingdom, Scandinavia, Japan, and Australia. Outcome Measure(s): Description of regulatory and financing arrangements, cycle costs, cost-effectiveness ratios, total expenditure, utilization, and price elasticity. Result(s): Regulation and financing of ART share few general characteristics in developed countries. The cost of treatment reflects the costliness of the underlying healthcare system rather than the regulatory or funding environment. The cost (in 2006 United States dollars) of a standard IVF cycle ranged from $12,513 in the United States to $3,956 in Japan. The cost per live birth was highest in the United States and United Kingdom ($41,132 and $40,364, respectively) and lowest in Scandinavia and Japan ($24,485 and $24,329, respectively). The cost of an lVF cycle after government subsidization ranged front 50% of annual disposable income in the United States to 6% in Australia. The cost of ART treatment did not exceed 0.25% of total healthcare expenditure in any country. Australia and Scandinavia were the only country/region to reach levels of utilization approximating demand, with North America meeting only 24% of estimated demand. Demand displayed variable price elasticity. Conclusion(s): Assisted reproductive technology is expensive from a patient perspective but not from a societal perspective. Only countries with funding arrangements that minimize out-of-pocket expenses met expected demand. Funding mechanisms should maximize efficiency and equity of access while minimizing the potential harm from multiple births. (Fertil Steril (R) 2009;91:2281-94. (C) 2009 by American Society for Reproductive Medicine.)
Pollock, W, Sullivan, E, Nelson, S & King, J 2008, 'Capacity to monitor severe maternal morbidity in Australia', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 48, no. 1, pp. 17-25.View/Download from: Publisher's site
Tracy, SK, Sullivan, EA & Tracy, MB 2008, '"The baby is breastfeeding'' - Reply', BIRTH-ISSUES IN PERINATAL CARE, vol. 35, no. 3, pp. 259-260.
Pollock, W, Sullivan, E, Nelson, S & King, J 2008, 'Monitoring severe maternal morbidity in Australia - Authors' reply', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 48, no. 3, pp. 356-357.View/Download from: Publisher's site
Cliffe, S, Black, D, Bryant, J & Sullivan, E 2008, 'Maternal deaths in New South Wales, Australia: A data linkage project', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 48, no. 3, pp. 255-260.View/Download from: Publisher's site
Sullivan, E, Wang, Y, Chapman, M & Chambers, G 2008, 'Success rates and cost of a live birth following fresh assisted reproduction treatment in women aged 45 years and older, Australia 2002-2004', HUMAN REPRODUCTION, vol. 23, no. 7, pp. 1639-1643.View/Download from: Publisher's site
Wang, YA, Healy, D, Black, D & Sullivan, EA 2008, 'Age-specific success rate for women undertaking their first assisted reproduction technology treatment using their own oocytes in Australia, 2002-2005', HUMAN REPRODUCTION, vol. 23, no. 7, pp. 1633-1638.View/Download from: Publisher's site
Pollock, W, Sullivan, E, Nelson, S & King, J 2008, 'Capacity to monitor severe maternal morbidity in Australia', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 48, no. 1, pp. 17-25.View/Download from: Publisher's site
Maternal mortality has traditionally been the key element in the monitoring of maternal health and adequacy of obstetric services in Australia and around the world. In developed countries, the ability of maternal mortality to serve this purpose is reduced because of the rarity of maternal mortality, reflected in very low maternal mortality ratios. Internationally, there has been increasing interest in severe maternal morbidity as an indicator to monitor maternal health and maternity services. The aim of this paper is to critically examine the capacity to measure and monitor maternal morbidity in Australia. There is a paucity of reliable maternal morbidity data in Australia; Australia is lagging behind peer countries that are endeavouring to monitor severe maternal morbidity. Dedicated efforts and adequate resources are needed in order to monitor severe maternal morbidity in Australia. © 2008 The Authors.
Tracy, SK, Tracy, MB & Sullivan, E 2008, 'Admission of term infants to neonatal intensive care: A population-based study', Obstetrical and Gynecological Survey, vol. 63, no. 4, pp. 217-218.View/Download from: Publisher's site
Chan, DL & Sullivan, EA 2008, 'Teenage smoking in pregnancy and birthweight: a population study, 2001-2004', MEDICAL JOURNAL OF AUSTRALIA, vol. 188, no. 7, pp. 392-396.
Austin, M-P, Priest, SR & Sullivan, EA 2008, 'Antenatal psychosocial assessment for reducing perinatal mental health morbidity', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, no. 4.View/Download from: Publisher's site
Austin, MP, Priest, SR & Sullivan, EA 2008, 'Antenatal psychosocial assessment for reducing perinatal mental health morbidity', Cochrane Database of Systematic Reviews, no. 4.View/Download from: Publisher's site
Background: Mental health conditions arising in the perinatal period, including depression, have the potential to impact negatively on not only the woman but also her partner, infant, and family. The capacity for routine, universal antenatal psychosocial assessment, and thus the potential for reduction of morbidity, is very significant. Objectives: To evaluate the impact of antenatal psychosocial assessment on perinatal mental health morbidity. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, the Cochrane Depression, Anxiety and Neurosis Group's Trials Register (CCDANTR-Studies), HSRProj in the National Library of Medicine (USA), and the Current Controlled Trials website: http://www.controlledtrials.com/ and the UK National Research Register (last searched March 2008). Selection criteria: Randomised and quasi-randomised controlled trials. Data collection and analysis: At least two review authors independently assessed trials for eligibility; they also extracted data from included trials and assessed the trials for potential bias. Main results: Two trialsmet criteria for an RCT of antenatal psychosocial assessment. One trial examined the impact of an antenatal tool (ALPHA) on clinician awareness of psychosocial risk, and the capacity of the antenatal ALPHA to predict women with elevated postnatal Edinburgh Depression Scale (EDS) scores, finding a trend towards increased clinician awareness of 'high level' psychosocial risk where the ALPHA intervention had been used (relative risk (RR) 4.61 95% confidence interval (CI) 0.99 to 21.39). No differences between groups were seen for numbers of women with antenatal EDS scores, a score of greater than 9 being identified by ALPHA as of concern for depression (RR 0.69 95% CI 0.35 to 1.38); 139 providers. The other trial reported no differences in EPS scores greater than 12 at 16 weeks postpartum between the intervention (communication about the EDS scores with the woman and her hea...
Tracy, SK, Dahlen, H, Caplice, SL, Laws, P, Wang, Y, Tracy, MB & Sullivan, E 2007, 'Birth centers in Australia: A national population-based study of perinatal mortality associated with giving birth in a birth centre', Birth: issues in perinatal care, vol. 34, no. 3, pp. 194-201.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Perinatal mortality is a rare outcome among babies born at term in developed countries after normal uncomplicated pregnancies; consequently, the numbers involved in large databases of routinely collected statistics provide a meaningful evaluation of these uncommon events. The National Perinatal Data Collection records the place of birth and information on the outcomes of pregnancy and childbirth for all women who give birth each year in Australia. Our objective was to describe the perinatal mortality associated with giving birth in "alongside hospital" birth centers in Australia during 1999 to 2002 using nationally collected data. METHODS: This population-based study included all 1,001,249 women who gave birth in Australia during 1999 to 2002. Of these women, 21,800 (2.18%) gave birth in a birth center. Selected perinatal outcomes (including stillbirths and neonatal deaths) were described for the 4-year study period separately for first-time mothers and for women having a second or subsequent birth. A further comparison was made between deaths of low-risk term babies born in hospitals compared with deaths of term babies born in birth centers. RESULTS: The total perinatal death rate attributed to birth centers was significantly lower than that attributed to hospitals (1.51/1,000 vs 10.03/1,000). The perinatal mortality rate among term births to primiparas in birth centers compared with term births among low-risk primiparas in hospitals was 1.4 versus 1.9 per 1,000; the perinatal mortality rate among term births to multiparas in birth centers compared with term births among low-risk multiparas in hospitals was 0.6 versus 1.6 per 1,000. CONCLUSIONS: This study using Australian national data showed that the overall rate of perinatal mortality was lower in alongside hospital birth centers than in hospitals irrespective of the mother's parity.
Tracy, SK, Tracy, MB & Sullivan, E 2007, 'Admission Of Term Infants To Neonatal Intensive Care: A Population-based Study', Birth-issues In Perinatal Care, vol. 34, no. 4, pp. 301-307.View/Download from: UTS OPUS or Publisher's site
Background: Neonatal intensive care and special care nurseries provide a level of care that is both high in cost and low in volume. The aim of our study was to determine the rate of admission of term babies to neonatal intensive care in association with
Tracy, SK, Tracy, MB, Dean, J, Laws, P & Sullivan, E 2007, 'Spontaneous preterm birth of liveborn infants in women at low risk in Australia over 10 years: a population-based study', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 114, no. 6, pp. 731-735.View/Download from: Publisher's site
Tracy, SK, Sullivan, E, Wang, YA, Black, D & Tracy, M 2007, 'Birth outcomes associated with interventions in labour amongst low risk women: A population-based study', Women and Birth, vol. 20, no. 2, pp. 41-48.View/Download from: Publisher's site
Introduction: Despite concern over high rates of operative birth in many countries, particularly amongst low risk healthy women, the obstetric antecedents of operative birth are poorly described. We aimed to determine the association between interventions introduced during labour with interventions in the birth process amongst women of low medical risk. Methods: We undertook a population-based descriptive study of all low risk women amongst the 753,895 women who gave birth in Australia during 2000-2002. Adjusted odds ratios (AOR) were calculated using multinomial logistic regression to describe the association between mode of birth and each of four labour intervention subgroups separately for primiparous and multiparous women. Results: We observed increased rates of operative birth in association with each of the interventions offered during the labour process. For first time mothers the association was particularly strong. Conclusions: This study underlines the need for better clinical evidence of the effects of epidurals and pharmacological agents introduced in labour. At a population level it demonstrates the magnitude of the fall in rates of unassisted vaginal birth in association with a cascade of interventions in labour and interventions at birth particularly amongst women with no identified risk markers and having their first baby. This information may be useful for women wanting to explore other methods of influencing the course of labour and the management of pain in labour, especially in their endeavour to achieve a normal vaginal birth. © 2007.
Austin, M-P, Kildea, S & Sullivan, E 2007, 'Maternal mortality and psychiatric morbidity in the perinatal period: challenges and opportunities for prevention in the Australian setting', MEDICAL JOURNAL OF AUSTRALIA, vol. 186, no. 7, pp. 364-367.
Chambers, GM, Chaptnan, MG, Grayson, N, Shanahan, M & Sullivan, EA 2007, 'Babies born after ART treatment cost more than non-ART babies: a cost analysis of inpatient birth-admission costs of singleton and multiple gestation pregnancies', HUMAN REPRODUCTION, vol. 22, no. 12, pp. 3108-3115.View/Download from: Publisher's site
Hansen, M, Sullivan, E, Jequier, AM, Burton, P, Junk, S, Yovich, J & Bower, C 2007, 'Practitioner reporting of birth defects in children born following assisted reproductive technology: Does it still have a role in surveillance of birth defects?', HUMAN REPRODUCTION, vol. 22, no. 2, pp. 516-520.View/Download from: Publisher's site
Bryant, J, Porter, M, Tracy, S & Sullivan, E 2007, 'Caesarean Birth: Consumption, Safety, Order, And Good Mothering', Social Science & Medicine, vol. 65, no. 6, pp. 1192-1201.View/Download from: Publisher's site
This article draws on qualitative data to explore the beliefs through which decisions about caesarean birth are made and to consider how these might contribute to the increasing rate of caesarean birth. A total of 36 interviews were conducted in Australia, including 12 hospital-based midwives, 6 obstetricians, and 18 women who had experienced caesarean birth within the 2 years prior to the research interview. Data reveal a belief derived from the pervasive discourse of neo-liberalism that women are self-governing autonomous subjects in their birth experience, with entitlement to the consumption of birthing information and services, as guided by obstetricians. Feeding into this belief are coexisting discourses that serve to organise "free choice" in terms of safe/unsafe, order/disorder, life/death; and with ontological meanings, by structuring women"s mothering identities as good/bad. The neo-liberal obligation to manage risk and pursue success for both mothers and babies means that women (and others) are obliged to choose what is set up as the most obvious and sensible option: safe, ordered caesareans. The structuring of discourses in this way shows how caesareans can be positioned as a preferential means of birth. (C) 2007 Elsevier Ltd. All rights reserved.
Haddow, L, Sullivan, E, Taylor, J, Abel, M, Cunningham, A, Tabrizi, S & Mindel, A 2007, 'Herpes Simplex Virus Type 2 (hsv-2) Infection In Women Attending An Antenatal Clinic In The South Pacific Island Nation Of Vanuatu', Sexually Transmitted Diseases, vol. 34, no. 5, pp. 258-261.View/Download from: Publisher's site
The objective of this study was to estimate the prevalence and correlates of herpes simplex virus type 2 infection in women in an antenatal clinic in the South Pacific island nation of Vanuatu. Study Design: A prevalence survey of sexually transmitted infections of pregnant women attending an antenatal clinic at Vila Central Hospital was conducted in 1999-2000. Serum samples were tested for HSV-1 and HSV-2 antibodies by enzyme-linked immunosorbent assay. Results for other sexually transmitted infections and demographic and obstetric variables were analyzed for their association with HSV-2 serostatus. Results: HSV-2 serum antibody results were obtained on 535 women and HSV-1 results on 134. The seroprevalence of HSV-2 was 30% and HSV-1 was 100%. On multivariate analysis, the independent predictors of HSV-2 infection were age, marital status, and trichomoniasis. Conclusions: HSV-2 was common in this sample of sexually active women in Vanuatu. This is the first study of HSV in Vanuatu and one of very few studies in the Pacific region.
Graham, S, Pulver, L, Wang, Y, Kelly, P, Laws, P, Grayson, N & Sullivan, E 2007, 'The Urban-remote Divide For Indigenous Perinatal Outcomes', Medical Journal Of Australia, vol. 186, no. 10, pp. 509-512.
Objective: To determine whether remoteness category of residence of Indigenous women affects the perinatal outcomes of their newborn infants. Design and participants: A population-based study of 35 240 mothers identified as Indigenous and their 35658 babies included in the National Perinatal Data Collection in 2001-2004. Main outcome measures: Australian Standard Geographical Classification remoteness category, birthweight, Apgar score at 5 minutes, stillbirth, gestational age and a constructed measure of perinatal outcomes of babies called "healthy baby" (live birth, singleton, 37-41 completed weeks" gestation, 2500-4499 g birthweight, and an Apgar score at 5 minutes >= 7). Results: The proportion of healthy babies in remote, regional and city areas was 74.9%, 77.7% and 77.6%, respectively. After adjusting for age, parity, smoking and diabetes or hypertension, babies born to mothers in remote areas were less likely to satisfy the study criteria of being a healthy baby (adjusted odds ratio [AOR], 0.87; 95% CI, 0.81-0.93) compared with those born in cities. Babies born to mothers living in remote areas had higher odds of being of low birthweight (AOR, 1.09; 95% CI, 1.01-1.19) and being born with an Apgar score < 7 at 5 minutes (AOR, 1.63; 95% CI, 1.39-1.92). Conclusions: Only three in four babies born to Indigenous mothers fell into the "healthy baby" category, and those born in more remote areas were particularly disadvantaged. These findings demonstrate the continuing need for urgent and concerted action to address the persistent perinatal inequity in the Indigenous population.
Tracy, SK, Sullivan, E, Dahlen, H, Black, D, Wang, YPA & Tracy, MB 2006, 'Does size matter? A population-based study of birth in lower volume maternity hospitals for low risk women', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 113, no. 1, pp. 86-96.View/Download from: Publisher's site
Sullivan, E 2006, 'Prevalence and perinatal outcomes of multiple gestation - Introduction to theme', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 46, pp. S3-S7.View/Download from: Publisher's site
Tracy, SK, Dahlen, H, Tracy, MB & Sullivan, E 2006, 'Does size matter? A population based study of birth in lower volume maternity hospitals for low risk women - Author's reply', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 113, no. 5, pp. 617-U16.View/Download from: Publisher's site
Adamson, GD, de Mouzon, J, Lancaster, P, Nygren, K-G, Sullivan, E & Zegers-Hochschild, F 2006, 'World collaborative report on in vitro fertilization, 2000', FERTILITY AND STERILITY, vol. 85, no. 6, pp. 1586-1622.View/Download from: Publisher's site
Chambers, GM, Ho, MT & Sullivan, EA 2006, 'Assisted reproductive technology treatment costs of a live birth: an age-stratified cost-outcome study of treatment in Australia', MEDICAL JOURNAL OF AUSTRALIA, vol. 184, no. 4, pp. 155-158.
Zegers-hochschild, F, Nygren, K, Adamson, G, De Mouzon, J, Lancaster, P, Mansour, R & Sullivan, E 2006, 'The Icmart Glossary On Art Terminology', Human Reproduction, vol. 21, no. 8, pp. 1968-1970.View/Download from: Publisher's site
The International Committee Monitoring Assisted Reproductive Technologies (ICMART) is an independent, international non-profit organization that has taken a leading role in the development, collection and dissemination of worldwide data on ART. Information on availability, efficacy and safety is provided to health professionals, health authorities and the public. The glossary facilitates dissemination of ART data through a set of agreed definitions as seen in the most recent World Report on ART. It provides a conceptual framework for further international terminology and data development of ART.
Zegers-hochschild, F, Nygren, K, Adamson, G, De Mouzon, J, Lancaster, P, Mansour, R & Sullivan, E 2006, 'The International Committee Monitoring Assisted Reproductive Technologies (icmart) Glossary On Art Terminology', Fertility And Sterility, vol. 86, no. 1, pp. 16-19.View/Download from: Publisher's site
The International Committee Monitoring Assisted Reproductive Technologies (ICMART) is an independent international nonprofit organization that has taken a leading role in the development collection, and dissemination of worldwide data on assisted reproductive technology CART. Information on availability, efficacy, and safety is provided health professionals, health authorities and the public. The glossary facilitates dissemination of ART data through a set -of agreed-upon definitions, as seen in the most recent World Report on ART. It provides a conceptual framework for further international terminology and data development of ART.
Wang, YA, Sullivan, EA, Black, D, Dean, J, Bryant, J & Chapman, M 2005, 'Preterm birth and low birth weight after assisted reproductive technology-related pregnancy in Australia between 1996 and 2000', FERTILITY AND STERILITY, vol. 83, no. 6, pp. 1650-1658.View/Download from: Publisher's site
Henry, A, Birch, MR, Sullivan, EA, Katz, S & Wang, YPA 2005, 'Primary postpartum haemorrhage in an Australian tertiary hospital: a case-control study', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 45, no. 3, pp. 233-236.View/Download from: Publisher's site
Sullivan, EA, Koro, S, Tabrizi, S, Kaldor, J, Poumerol, G, Chen, S, O'Leary, M & Garland, SM 2004, 'Prevalence of sexually transmitted diseases and human immunodeficiency virus among women attending prenatal services in Apia, Samoa', INTERNATIONAL JOURNAL OF STD & AIDS, vol. 15, no. 2, pp. 116-119.View/Download from: Publisher's site
Ford, JB, Henry, RL & Sullivan, EA 2004, 'Comparison of selected reasons for hospitalization of children among children's/tertiary hospitals, Australia, 1996-97 and 1997-98', JOURNAL OF PAEDIATRICS AND CHILD HEALTH, vol. 40, no. 7, pp. 374-379.View/Download from: Publisher's site
Sullivan, EA, Ford, JB, Chambers, G & Slaytor, EK 2004, 'Maternal mortality in Australia, 1973-1996', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 44, no. 5, pp. 452-457.View/Download from: Publisher's site
King, JF, Slaytor, EK & Sullivan, EA 2004, 'Maternal deaths in Australia, 1997-1999', MEDICAL JOURNAL OF AUSTRALIA, vol. 181, no. 8, pp. 413-414.
Sullivan, EA, Abel, M, Tabrizi, S, Garland, SM, Grice, A, Poumerol, G, Taleo, H, Chen, SJ, Kaun, K, O'Leary, M & Kaldor, J 2003, 'Prevalence of sexually transmitted infections among antenatal women in Vanuatu, 1999-2000', SEXUALLY TRANSMITTED DISEASES, vol. 30, no. 4, pp. 362-366.View/Download from: Publisher's site
Sullivan, EA, Willcock, S, Ardzejewska, K & Slaytor, EK 2002, 'A pre-employment programme for overseas-trained doctors entering the Australian workforce, 1997-99', MEDICAL EDUCATION, vol. 36, no. 7, pp. 614-621.View/Download from: Publisher's site
Walters, WAW, Ford, JB, Sullivan, EA & King, JF 2002, 'Maternal deaths in Australia', MEDICAL JOURNAL OF AUSTRALIA, vol. 176, no. 9, pp. 413-414.
Marks, GB, Bai, J, Simpson, SE, Stewart, GJ & Sullivan, EA 2001, 'The incidence of tuberculosis in a cohort of South-East Asian refugees arriving in Australia 1984-94', Respirology, vol. 6, no. 1, pp. 71-74.View/Download from: Publisher's site
We have used record linkage analysis to describe the incidence of tuberculosis in a cohort of 24 652 predominantly south-east Asian refugees who arrived in Sydney, Australia during the period 1984 to 1994. Cases that had been registered with the State Department of Health were confirmed by examination of case records. After an average follow-up interval of 10.3 years there were 189 cases of tuberculosis, equivalent to an average incidence rate of 74.9 cases per 100 000 person-years. The highest incidence rate was in 40-49 year olds and 47% of cases were in women. One hundred and twenty seven cases (67%) were pulmonary and, of these, 64 (50%) were direct smear positive. The incidence of tuberculosis in this cohort is similar to that observed among Vietnamese migrants to Australia and the USA and substantially higher than the incidence among people born in Australia. It is important to maintain awareness of the diagnosis of tuberculosis, especially in countries such as Australia, where the incidence in the general population is low but where there are large populations of migrants and refugees in whom a higher incidence is expected.
Marks, GB, Bai, J, Stewart, GJ, Simpson, SE & Sullivan, EA 2001, 'Effectiveness of postmigration screening in controlling tuberculosis among refugees: A historical cohort study, 1984-1998', AMERICAN JOURNAL OF PUBLIC HEALTH, vol. 91, no. 11, pp. 1797-1799.View/Download from: Publisher's site
Marks, GB, Bai, U, Simpson, SE, Sullivan, EA & Stewart, GJ 2000, 'Incidence of tuberculosis among a cohort of tuberculin-positive refugees in Australia - Reappraising the estimates of risk', AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, vol. 162, no. 5, pp. 1851-1854.View/Download from: Publisher's site
Comino, E, Sullivan, E, Harris, E, Killian, D & Jiang, CY 2000, 'A community-based health service census: Describing the client base', Australian Journal of Primary Health - Interchange, vol. 6, no. 2, pp. 63-71.
This paper describes the results of a census of newly registered clients attending community-based health services in a large health region on the south western outskirts of Sydney to enumerate the client base of these services and to investigate the reach to population groups. Two questionnaires, one for adults and the other for children were administered to all new clients of community, allied and dental health services. These questionnaires collected enhanced demographic information during a three month period that was compared with the resident population. 10,734 new clients were registered. These included 2,638 adults and 3,047 children who were attending community health services. Older adults were over-represented in the adult client population while adults accompanying children to services were largely aged 20-39 years. The data suggest good reach of services to ethnic minority groups when country of birth was considered (32.3% NESB versus 30.4% in the resident population). When language spoken at home was used those who spoke a language other that English at home were under- represented in these data (31.6%) compared to the resident population (39.7%). Adults attending with a child were more likely to be married and to have stayed at school until at least 17 years. The study was the first attempt in NSW to enumerate the client base of community-based health services and was important in demonstrating to staff the value of adequate systems to monitor the use and reach of services. The data suggest a bias of services to more advantaged groups.
Smith, B, Sullivan, E, Bauman, A, Powell-Davies, G & Mitchell, J 1999, 'Lay beliefs about the preventability of major health conditions', HEALTH EDUCATION RESEARCH, vol. 14, no. 3, pp. 315-325.View/Download from: Publisher's site
Gosbell, IB, Sullivan, EA & Maidment, CA 1999, 'An unexpected result in an evaluation of a serological test to detect syphilis', PATHOLOGY, vol. 31, no. 4, pp. 398-402.View/Download from: Publisher's site
Gosbell, IB, Newton, PJ & Sullivan, EA 1999, 'Survey of blood cultures from five community hospitals in south-western Sydney, Australia, 1993-1994', AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE, vol. 29, no. 5, pp. 684-692.View/Download from: Publisher's site
Bai, J, Marks, GB, Stewart, GJ, Simpson, SE & Sullivan, EA 1999, 'Specificity of notification for tuberculosis among screened refugees in NSW', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, vol. 23, no. 4, pp. 410-413.View/Download from: Publisher's site
Sullivan, EM, Burgess, MA & Forrest, JM 1999, 'The epidemiology of rubella and congenital rubella in Australia, 1992 to 1997.', Communicable diseases intelligence, vol. 23, no. 8, pp. 209-214.
Selective rubella vaccination of schoolgirls commenced in 1971 and was followed by a significant reduction in congenital rubella. Infant vaccination with MMR was introduced in 1989 to interrupt circulation of the virus in young children, and in 1994/95 the adolescent school based rubella vaccination program was changed to MMR for both boys and girls. This report reviews the epidemiology of rubella and congenital rubella between 1992 and 1997 using reports to the National Notifiable Diseases Surveillance System (NNDSS) and the Australian Paediatric Surveillance Unit (APSU). Notification rates for rubella exceeded 20 per 100,000 in 1992, 1993 and 1995 and declined to 7.2 per 100,000 in 1997. Sixty-one per cent of notifications occurred between September and December and 68% occurred in males. The incidence rate in males aged 15-22 years peaked at 152.6 per 100,000 in 1995 reflecting the lack of immunisation in this cohort. From 1993 to 1997, 19 children were reported with congenital rubella syndrome, representing 1 in 67,000 live births. Of these, 17 had multiple defects (4 died) and 2 had deafness only. There were also 5 infants with congenital rubella infection but no defects. Australia's rate of congenital rubella syndrome exceeded that of the United Kingdom and the United States of America but this may be partly attributable to differences in reporting practices. The impact of changing the second dose of MMR vaccine to 4 years of age in 1998 will require careful monitoring.
Sullivan, EA, Geoffroy, P, Weisman, R, Hoffman, R & Frieden, TR 1998, 'Isoniazld poisonings in New York City', Journal of Emergency Medicine, vol. 16, no. 1, pp. 57-59.View/Download from: Publisher's site
We identified 41 New York City residents who had been hospitalized at least overnight between January 1992 and September 1993 because of a toxic isoniazid (INH) exposure. Review of the available medical charts of 33 patients revealed that median age was 19 years, 27 (82%) were females, and 24 (83%) were taking INH chemoprophylaxis for tuberculosis infection. Twenty- two patients had seizures. Twenty-seven (82%) patients had attempted suicide using INH, and another three patients had intentionally misused INH by making up missed doses at one time. All patients survived. Physicians should be aware of the potential for INH toxicity and should assess their patients' current mental and psychosocial status when prescribing it. INH toxicity should be considered when young patients, particularly females, present with unexplained intractable seizures, and treatment with pyridoxine should be given.
Sullivan, EA, Chey, T & Nossar, V 1998, 'A population-based survey of immunisation coverage in children aged 2 years and younger in New South Wales. (vol 34, pg 342, 1998)', JOURNAL OF PAEDIATRICS AND CHILD HEALTH, vol. 34, no. 6, pp. 595-595.
Chant, KG, Sullivan, EA, Burgess, MA, Ferson, MJ, Forrest, JM, Baird, LM, Tudehope, DI & Tilse, M 1998, 'Varicella-zoster virus infection in Australia', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, vol. 22, no. 4, pp. 413-418.View/Download from: Publisher's site
Sullivan, EA, Chey, T & Nossar, V 1998, 'Erratum: A population-based survey of immunisation coverage in children aged 2 years and younger in New South Wales (Journal of Paediatrics and Child Health (1998) 34 (342-345))', Journal of Paediatrics and Child Health, vol. 34, no. 6, p. 595.
Sullivan, EA, Chey, T & Nossar, V 1998, 'A population-based survey of immunisation coverage in children aged 2 years and younger in New South Wales', JOURNAL OF PAEDIATRICS AND CHILD HEALTH, vol. 34, no. 4, pp. 342-345.View/Download from: Publisher's site
Mitchell, SL, Sullivan, EA & Lipsitz, LA 1997, 'Exclusion of elderly subjects from clinical trials for Parkinson disease', ARCHIVES OF NEUROLOGY, vol. 54, no. 11, pp. 1393-1398.View/Download from: Publisher's site
Sullivan, EA, Staehling, N & Philen, RM 1996, 'Eosinophilia-myalgia syndrome among the non-L-tryptophan users and pre-epidemic cases', JOURNAL OF RHEUMATOLOGY, vol. 23, no. 10, pp. 1784-1787.
Sullivan, EA, Kamb, ML, Jones, JL, Meyer, P, Philen, RM, Falk, H & Sinks, T 1996, 'The natural history of Eosinophilia-myalgia syndrome in a tryptophan-exposed cohort in South Carolina', ARCHIVES OF INTERNAL MEDICINE, vol. 156, no. 9, pp. 973-979.View/Download from: Publisher's site
Stanford, DG, Georgouras, KE, Sullivan, EA & Greenoak, GE 1996, 'Skin phototyping in Asian Australians.', The Australasian journal of dermatology, vol. 37 Suppl 1, pp. S36-S38.View/Download from: Publisher's site
Skin phototype was assessed in 257 Asian Australians by self-reporting questionnaire. Minimal erythema dose, minimal melanogenic dose and minimal immediate pigment darkening dose were measured in a subgroup of 50 subjects. About 15% of Asian Australians in this study report that they have skin type I or II. Phototesting confirms that there is a UV-sensitive group and a wide spectrum of UV-sensitivity in this population. Whether Fitzpatrick's skin typing system adequately identifies this UV-sensitive group needs assessment by a larger study. The relationship between burning tendency and tanning capacity in Asians may differ from Caucasians.
Stanford, DG, Georgouras, KE, Sullivan, EA & Greenoak, GE 1996, 'Skin phototyping in Asian Australians', Australasian Journal of Dermatology, vol. 37, no. SUPPL. 1.
Skin phototype was assessed in 257 Asian Australians by self-reporting questionnaire. Minimal erythema dose, minimal melonogenic dose and minimal immediate pigment darkening dose were measured in a subgroup of 30 subjects. About 15% of Asian Australians in this study report that they have skin type I or II. Phototesting confirms that there is a UV-sensitive group and a wide spectrum of UV-sensitivity in this population. Whether Fitzpatrick's skin typing system adequately identifies this UV-sensitive group needs assessment by a larger study. The relationship between burning tendency and tanning capacity in Asians may differ from Caucasians.
SULLIVAN, EA, KREISWIRTH, BN, PALUMBO, L, KAPUR, V, MUSSER, JM, EBRAHIMZADEH, A & FRIEDEN, TR 1995, 'EMERGENCE OF FLUOROQUINOLONE-RESISTANT TUBERCULOSIS IN NEW-YORK-CITY', LANCET, vol. 345, no. 8958, pp. 1148-1150.View/Download from: Publisher's site
Philen, RM & Sullivan, E 1992, 'EMS and L-tryptophan', American Family Physician, vol. 46, no. 5.
BEK, MD, SMITH, WT, LEVY, MH, SULLIVAN, E & RUBIN, GL 1992, 'RABIES CASE IN NEW-SOUTH-WALES, 1990 - PUBLIC-HEALTH ASPECTS', MEDICAL JOURNAL OF AUSTRALIA, vol. 156, no. 9, pp. 596-&.
Cetindamar Kozanoglu, D, James, E, Lammers, T, Pearce, A & Sullivan, E 2019, 'Stem Education And Women Entrepreneurs In Technology Enterprises: Explorations From Australia' in Bullough, A, Hechavarria, D, Brush, C & Edelman, L (eds), High-growth Women's Entrepreneurship, Edward Elgar.View/Download from: UTS OPUS
The objective of this chapter is to draw attention to the relationship between STEM education and women's enterprenurship in technology enterprises. By using Australia as a case study, our explorative analysis of secondary data shows how Australia has relatively improved, with gains in the level of women's involvement in STEM education, while it still has to overcome a chasm for women then proceeding from being a STEM alumni into actually becoming an enterpreneur in technology startups. We specifically point out an institutional intervention in STEM education, the Science in Australia Gender Equity (SAGE) initiative. The chapter concludes with a discussion and suggestions for further studies.
Units are striving to improve their success rates, and many treatments are being advocated as 'yet another breakthrough'. The purpose of this book is to help clinicians to evaluate each of these new treatments.
Dawson, A, Turkmani, S, Varol, N, Sullivan, E & Homer, C 2015, 'Midwives' experiences of caring for women with female genital mutilation: Insights and ways forward for practice in Australia', Super Midwives - Making a Difference, Australian College of Midwives, 19th Biennial Conference, Gold Coast, Australia.View/Download from: UTS OPUS or Publisher's site
Bonello, MR, Hilder, L & Sullivan, EA AIHW 2014, Fetal Alcohol Spectrum Disorders: strategies to address information gaps, no. Cat. no. PER 67, Canberra.
Li, Z, Zeki, R, Hilder, L & Sullivan, EA AIHW National Perinatal Epidemiology and Statistics Unit 2013, Australia's mothers and babies 2011, Perinatal statistics series no 4, no. Cat. no. PER 59., Canberra.
2.Macaldowie, A, Wang, A, Chambers, GM & Sullivan, EA University of New South Wales 2013, Assisted reproductive technology in Australia and New Zealand 2011, Sydney: National Perinatal Epidemiology and Statistics Unit.
Macaldowie, A, Wang, YA, Chambers, GM & Sullivan, E AIHW 2012, Assisted reproductive technology in Australia and New Zealand 2010, Assisted reproduction technology series, no. Cat. no. PER 55, Canberra.
Li, Z, Zeki, R, Hilder, L & Sullivan, E AIHW National Perinatal Epidemiology and Statistics Unit 2012, Australia's mothers and babies 2010, Perinatal statistics series no. 27, no. Cat. no. PER 57, Canberra.
Wang, YA, Macaldowie, A, Chambers, GM & Sullivan, EA AIHW 2011, Assisted Reproductive Technology in Australia and New Zealand 2009, Assisted reproduction technology Series No. 15, no. Cat No. PER 49, Canberra.
Li, Z, McNally, L, Hilder, L & Sullivan, E AIHW National Perinatal Epidemiology and Statistics Unit 2011, Australia's mothers and babies 2009, Perinatal statistics series no. 25, no. Cat. no. PER 52, Sydney.
Wang, YA, Chambers, GM, Dieng, M & Sullivan, EA AIHW National Perinatal Statistics Unit 2009, Assisted Reproductive Technology in Australia and New Zealand 2007, Assisted reproduction technology Series No. 13, no. Cat No. PER 47, Sydney.
Laws, PJ & Sullivan, E AIHW National Perinatal Statistics Unit 2009, Australia's mothers and babies 2007, Perinatal Statistics Series no. 23, no. Cat. No. PER 48, Sydney.
Wang, YA, Dean, JH, Badgery-Parker, T & Sullivan, E AIHW National Perinatal Statistics Unit 2008, Assisted Reproductive Technology in Australia and New Zealand 2006, Assisted reproduction technology Series No. 12, no. Cat No. PER 43, Sydney.
Laws, PJ, Hilder, L & Sullivan, E AIHW National Perinatal Statistics Unit 2008, Australia's mothers and babies 2006, Perinatal Statistics Series no. 22, no. Cat. No. PER 46, Sydney.
Abeywardana, S & Sullivan, E AIHW National Perinatal Statistics Unit 2008, Congenital anomalies in Australia 2002-2003, Birth Anomalies series no. 3, no. Cat. no. PER 41, Sydney.
Abeywardana, S, Karim, M, Grayson, N & Sullivan, E AIHW National Perinatal Statistics Unit 2007, Congenital anomalies in Australia 1998-2001, Congenital anomalies series no. 2, no. AIHW Cat No. PER37, Sydney.
Leeds, KL, Gourley, M, Laws, PJ, Zhang, J, Al-Yaman, F & Sullivan, E AIHW 2007, Indigenous mothers and their babies, Australia 2001-2004, Perinatal statistics series no. 19, no. AIHW cat n. PER 38, Canberra.
Wang, YA, Dean, JH & Sullivan, E AIHW National Perinatal Statistics Unit 2007, Assisted Reproductive Technology in Australia and New Zealand 2005, Assisted reproduction technology Series No. 11, no. Cat No. PER 36, Sydney.
Laws, PJ, Abeywardana, S, Walker, J & Sullivan, E AIHW National Perinatal Statistics Unit 2007, Australia's mothers and babies 2005, Perinatal Statistics Series No. 17, no. Cat No PER 40, Sydney.
Sullivan, E WHO Regional Office for the Western Pacific 2006, Second generation surveillance surveys of HIV, other STIs and risk behaviours in six Pacific Island Countries, Manila, Philippines.
Sullivan, E & Wang, YA WHO Regional Office for the Western Pacific 2004, Prevalence surveys of sexually transmitted infections among seafarers and women attending antenatal clinics in Kiribati. 2002-2003, Manila.
Sullivan, E WHO Regional Office for the Western Pacific 2000, STI/HIV antenatal clinic STI survey, Apia, Samoa, Manila, Philippines.
Sullivan, E WHO Regional Office for the Western Pacific 2000, STI/HIV antenatal clinic STI survey, Port Vila, Vanuatu, Manila, Philippines.
Sullivan, E WHO Regional Office for the Western Pacific 1999, Sexually transmitted infections prevalence study methodology. Guidelines for the implementation of STI prevalence surveys Western Pacific Region, 1999, Manila, Philippines.