Lawrence Lam is an epidemiologist, medical statistician and research psychologist with a special interest in paedatric and adolescent mental health. His research interests include environmental child health, risky behaviours among young people, and rehabilitation of traumatic brain injury among children and young people.
Before joining UTS, Lawrence developed a program of post-graduate studies in health education at the Hong Kong Institute of Education. He also worked with the Hong Kong Mental Health Association to develop a mental health training programme for teachers.
Lawrence has worked as a hospital epidemiologist and medical statistician at Sydney's Royal Alexandra Hospital for Children, and taught master classes in epidemiology and biostatistics at the University of Sydney. He was also the Head of Evaluation, Head of Epidemiology and Medical Statistics, and Deputy Head of the Population and Public Health domain of the School of Medical Sydney, the Notre Dame University Australia.
Fellow of the American College of Epidemiology (FACE)
Member of the Australian Statistics Society Inc.
Member of the Australia and New Zealand Mental Health Association
Member of the Australian Infant, Child, Adolescent, and Family Mental Health Association
Immediate Past Vice President of the Hong Kong Society of Behavioural Health
Can supervise: YES
- Child and adolescent mental health
- Early childhood social-emotional health and well being
- Child and adolescent mild traumatic head injury
- Chronic disease care and management
- Internet addiction among young people
Areas of research supervision
- Paediatric and adolescent mental health
- Trauma management, rehabilitation, injury prevention
- Behavioural epidemiology and addiction
- Cyberpsychology and problematic internet use
- Epidemiology/ Clinical Epidemiology
- Medical Statistics
- Quantitative Research Methodologies
- Evidence-Based Medicine
- Health Assessment and Psychometrics
- Health program evaluation
- Cyberpsychology and Internet Addiction/Problematic Internet Use
- Injury prevention and risk management
The development of Psychological and Health-related assessment instruments has had a long history since the late nineteenth century. James Cattell laid the foundation for the specialised area of psychological assessment within the study of Modern Psychology by suggesting the establishment of the "Mental Test". In 1895, Alfred Binet applied a scientific approach to evaluate the properties of the assessment on intelligence he had designed and effectively developed the specialised area of study now called Psychometrics. Since then many assessment tools have been designed for use in clinical practices as well as research. It has been estimated that there are more than 100 different psychological tests or assessment instruments developed and commonly used internationally and the number is growing. These instruments have been studied with rigorous scientific methods for their psychometric properties. © 2010 Bentham Science Publishers Ltd. All rights reserved.
Ferguson, C, Hickman, LD, Phillips, J, Newton, PJ, Inglis, SC, Lam, L & Bajorek, BV 2019, 'An mHealth intervention to improve nurses' atrial fibrillation and anticoagulation knowledge and practice: the EVICOAG study.', European Journal of Cardiovascular Nursing, vol. 18, no. 1, pp. 7-15.View/Download from: UTS OPUS or Publisher's site
There is a need to improve cardiovascular nurses' knowledge and practices related to stroke prevention, atrial fibrillation and anticoagulation therapy.The aim of this study was to evaluate the efficacy of EVICOAG - a novel mHealth, smartphone-based, spaced-learning intervention on nurses' knowledge of atrial fibrillation and anticoagulation.Nurses employed in four clinical specialties (neuroscience, stroke, rehabilitation, cardiology) across three hospitals were invited to participate. In this quasi-experimental study, 12 case-based atrial fibrillation and anticoagulation learning scenarios (hosted by an mHealth platform) were delivered to participants' smartphones over a 6-week period (July-December 2016) using a spaced timing algorithm. Electronic surveys to assess awareness and knowledge were administered pre (T1) and post (T2) intervention.From 74 participants recruited to T1, 40 completed T2. There was a 54% mean improvement in knowledge levels post-intervention. The largest improvement was achieved in domains related to medication interaction and stroke and bleeding risk assessment. Post-intervention, those who completed T2 were significantly more likely to use CHA2DS2-VASc (2.5% vs. 37.5%) and HAS-BLED (2.5% vs. 35%) tools to assess stroke and bleeding risk, respectively ( P<0.01).The EVICOAG intervention improved nurses' knowledge of atrial fibrillation and anticoagulation, and influenced their uptake and use of stroke and bleeding risk assessment tools in clinical practice. Future research should focus on whether a similar intervention might improve patient-centred outcomes such as patients' knowledge of their condition and therapies, medication adherence, time in the therapeutic range and quality of life.
Hosie, A, Phillips, J, Lam, L, Kochovska, S, Noble, B, Brassil, M, Kurrle, SE, Cumming, A, Caplan, GA, Chye, R, Le, B, Ely, EW, Lawlor, PG, Bush, SH, Davis, JM, Lovell, M, Brown, L, Fazekas, B, Cheah, SL, Edwards, L & Agar, M 2019, 'Multicomponent non-pharmacological intervention to prevent delirium for hospitalised people with advanced cancer: study protocol for a phase II cluster randomised controlled trial.', BMJ open, vol. 9, no. 1, pp. e026177-e026177.View/Download from: UTS OPUS or Publisher's site
INTRODUCTION:Delirium is a significant medical complication for hospitalised patients. Up to one-third of delirium episodes are preventable in older inpatients through non-pharmacological strategies that support essential human needs, such as physical and cognitive activity, sleep, hydration, vision and hearing. We hypothesised that a multicomponent intervention similarly may decrease delirium incidence, and/or its duration and severity, in inpatients with advanced cancer. Prior to a phase III trial, we aimed to determine if a multicomponent non-pharmacological delirium prevention intervention is feasible and acceptable for this specific inpatient group. METHODS AND ANALYSIS:The study is a phase II cluster randomised wait-listed controlled trial involving inpatients with advanced cancer at four Australian palliative care inpatient units. Intervention sites will introduce delirium screening, diagnostic assessment and a multicomponent delirium prevention intervention with six domains of care: preserving natural sleep; maintaining optimal vision and hearing; optimising hydration; promoting communication, orientation and cognition; optimising mobility; and promoting family partnership. Interdisciplinary teams will tailor intervention delivery to each site and to patient need. Control sites will first introduce only delirium screening and diagnosis, later implementing the intervention, modified according to initial results. The primary outcome is adherence to the intervention during the first seven days of admission, measured for 40 consecutively admitted eligible patients. Secondary outcomes relate to fidelity and feasibility, acceptability and sustainability of the study intervention, processes and measures in this patient population, using quantitative and qualitative measures. Delirium incidence and severity will be measured to inform power calculations for a future phase III trial. ETHICS AND DISSEMINATION:Ethical approval was obtained for all four sites. Trial r...
Kwah, LK, Green, J, Butler, J & Lam, L 2019, 'Quality of clinical practice guidelines for management of limb amputations: A systematic review', Physical Therapy, vol. 99, no. 5, pp. 577-590.View/Download from: Publisher's site
© 2019 American Physical Therapy Association. Background. The quality of clinical practice guidelines (CPGs) is important to ensure guideline adoption by clinicians. Purpose. The aim of this review was to identify CPGs for the management of limb amputations, appraise the quality of CPGs, and synthesize recommendations from comprehensive CPGs of high quality. Data Sources. MEDLINE, EMBASE, CINAHL, PEDro, guideline-specific websites, websites for associations or networks for people with amputations, and Google Scholar were searched from April 2007 to April 2017. Study Selection. Publications were included if they were CPGs or consensus statements/standards endorsed by a certified organization, covered the management of limb amputations, were freely accessible, and were written in English. Data Extraction. Two reviewers independently screened titles and abstracts for eligible CPGs and rated the quality of CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE-II) instrument. Data Synthesis. Of the 15 included CPGs, 11 were of low to moderate quality and 4 were of high quality. Mean (or median) domain scores on AGREE-II were as follows: 83% for domain 1 (scope and purpose), 61% for domain 2 (stakeholder involvement), 7% for domain 3 (rigor of development), 65% for domain 4 (clarity and presentation), 24% for domain 5 (applicability), and 21% for domain 6 (editorial independence). Strong recommendations from comprehensive and high-quality CPGs were few and focused on the development of individualized treatment plans, exercises for improving physical function and the ability to perform activities of daily living, and the assessment of physical function and prognostic factors. Limitations. CPGs that were not written in English were excluded. Final recommendations from CPGs might differ if different criteria were used. Low domain scores on the AGREE-II might be due to poor reporting rather than poor methodology in the CPG development process. Conclusions. ...
Lam, LT, Rai, A & Lam, MK 2019, 'Attachment problems in childhood and the development of anxiety in adolescents: A systematic review of longitudinal and prospective studies', Mental Health and Prevention, vol. 14.View/Download from: UTS OPUS or Publisher's site
© 2019 Elsevier GmbH The association between early relationships and the experience of infant and mother, and the subsequent development of the child through their life span has long been studied. Attachment, as a most prominent construct in early child development, has been the focal point of investigation since the inception of the theoretical concept by Bowlby. In recent years, research has expanded to examine the effect of attachment on the mental health and socio-emotional development of young children and their on-going adjustment into adolescence. However, most studies in the field concentrated on the relationship of childhood attachment and internalising symptoms as a generic assessment of mental health problems. To provide more precise information on the effect of attachment insecurity on individual mental health problems, a systematic review (the first in a series) of available longitudinal and prospective studies was conducted. 11 studies were identified after an extensive search of the literature in accordance to the PRISMA guidelines. Of these, 4 satisfied all selection criteria and provided sufficient data on the effect of attachment insecurity during infancy or early childhood and anxiety in adolescence. Information was extracted and analysed systematically from each study and tabulated. The overall results obtained from these studies indicated a significant and possible causal relationship between attachment insecurity during infancy or early childhood and the development of anxiety in adolescence. These results were discussed in light of theoretical and practical preventive implications.
Li, C, Ivarsson, A, Lam, LT & Sun, J 2019, 'Basic Psychological Needs Satisfaction and Frustration, Stress, and Sports Injury Among University Athletes: A Four-Wave Prospective Survey.', Frontiers in psychology, vol. 10.View/Download from: UTS OPUS or Publisher's site
The prevalence of sports injury among athletes is rather high, suggesting the need to better understand the causes of sports injury, including the risk factors, for preventive purposes. Grounded in basic psychological needs theory (BPNT) and the Model of Stress and Athletic Injury, the aim of this four-wave prospective survey study was to investigate the relationships among basic psychological needs satisfaction and frustration, stress responses, and sports injury. Study variables, including basic psychological need satisfaction/frustration, and perceived stress, were measured using a survey from 112 university athletes at the 1st, 2nd, and 3rd months of the study. Sports injury was assessed using a self-report form at the 2nd, 3rd, and 4th months of study. Results of the Bayesian multilevel analysis showed that basic psychological need satisfaction negatively predicted sports injuries, whereas stress was a positive predictor. In addition, basic psychological need satisfaction had an indirect effect on injury occurrence via stress. However, basic psychological need frustration did not predict sports injury. BPNT is a viable model to provide additional explanations to psychological risk factors of injury. Intervention programs may be formulated based on the evidence obtained on the model.
Luckett, T, Agar, M, DiGiacomo, M, Ferguson, C, Lam, L & Phillips, J 2019, 'Health status of people who have provided informal care or support to an adult with chronic disease in the last 5 years: results from a population-based cross-sectional survey in South Australia.', Australian Health Review, vol. 43, no. 4, pp. 408-414.View/Download from: UTS OPUS or Publisher's site
Support for Australian carers is warranted to ensure their continuing contributions to society and return to productivity after their caring role is completed.
Orr, R, Bogg, T, Fyffe, A, Lam, LT & Browne, GJ 2019, 'Graded Exercise Testing Predicts Recovery Trajectory of Concussion in Children and Adolescents.', Clinical Journal of Sport Medicine.View/Download from: Publisher's site
OBJECTIVE:To determine whether graded exercise testing can predict recovery trajectory of concussion in children and adolescents. DESIGN:Prospective study. SETTING:Children's Hospital, Westmead, Australia. PARTICIPANTS:One hundred thirty-nine children aged 12 to 16 years at 5 to 7 days after an acute concussive injury. INTERVENTION:Graded exercise testing on a treadmill at the subacute phase to assess symptom provocation and determine clinical recovery indicating readiness to commence a return to activity (RTA) protocol. Exercise time to symptom exacerbation and clinical recovery were measured. MAIN OUTCOME MEASURES:Standard concussion assessment and clinical testing (neurocognitive, vestibular/ocular, and balance) were conducted to determine major clinical drivers/indicators. RESULTS:Participants (mean age 12.4 ± 2.8 years, 73% male) had a confirmed sport-related concussion. The main clinical drivers identified on exercise testing were headache, balance, and vestibular dysfunction. Participants fell into 1 of 2 groups, exercise-tolerant (54%) and exercise-intolerant (46%). Exercise-tolerant patients showed mild clinical indicators, no symptom exacerbation during 10.3 ± 3.3 minutes of exercise, were safely transitioned to a RTA protocol, and recovered within 10 days. Exercise-intolerant patients had high clinical indicators, significant symptom exacerbation at 4.2 ± 1.6 minutes of exercise, and prolonged recovery of 45.6 days. No adverse effects from exercise were reported in either group. Combined use of provocative exercise and clinical testing was 93% predictive of outcome. CONCLUSIONS:Exercise testing during the subacute phase after a concussion can predict longer recovery. Exercise testing can identify a unique window where patients can be safely transitioned to activity, enabling clinicians to better inform patients and families, allocate resources and streamline care.
Phillips, JL, Heneka, N, Lovell, M, Lam, L, Davidson, P, Boyle, F, McCaffrey, N, Fielding, S & Shaw, T 2019, 'A phase III wait-listed randomised controlled trial of novel targeted inter-professional clinical education intervention to improve cancer patients' reported pain outcomes (The Cancer Pain Assessment (CPAS) Trial): study protocol.', Trials, vol. 20, no. 1.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Variations in care models contribute to cancer pain being under-recognised and under-treated in half of all patients with cancer. International and national cancer pain management guidelines are achievable with minimal investment but require practice changes. While much of the cancer pain research over the preceding decades has focused on management interventions, little attention has been given to achieving better adherence to recommended cancer pain guideline screening and assessment practices. This trial aims to reduce unrelieved cancer pain by improving cancer and palliative doctors' and nurses' ('clinicians') pain assessment capabilities through a targeted inter-professional clinical education intervention delivered to participants' mobile devices ('mHealth'). METHODS:A wait-listed, randomised control trial design. Cancer and/or palliative care physicians and nurses employed at one of the six participating sites across Australia will be eligible to participate in this trial and, on enrolment, will be allocated to the active or wait-listed arm. Participants allocated to the active arm will be invited to complete the mHealth cancer pain assessment intervention. In this trial, mHealth is defined as medical or public health practice supported by mobile devices (i.e. phones, patient monitoring devices, personal digital assistants and other wireless devices). This mHealth intervention integrates three evidence-based elements, namely: the COM-B theoretical framework; spaced learning pedagogy; and audit and feedback. This intervention will be delivered via the QStream online platform to participants' mobile devices over four weeks. The trial will determine if a tailored mHealth intervention, targeting clinicians' cancer pain assessment capabilities, is effective in reducing self-reported cancer pain scores, as measured by a Numerical Rating Scale (NRS). DISCUSSION:If this mHealth intervention is found to be effective, in addition to improving cancer pain ...
Clark, K, Lam, L, Talley, NJ, Watts, G, Phillips, JL, Byfieldt, NJ & Currow, DC 2018, 'A pragmatic comparative study of palliative care clinician's reports of the degree of shadowing visible on plain abdominal radiographs.', Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, vol. 26.View/Download from: UTS OPUS or Publisher's site
The assessment of constipation symptoms is based on history and physical examination. However, the experience is highly subjective perhaps explaining why palliative medicine doctors continue to use plain abdominal radiographs as part of routine assessment of constipation. Previous studies have demonstrated poor agreement between clinicians with this work in palliative care, limited further by disparity of clinicians' experience and training. The aim of this work was to explore whether there was less variation in the assessments of faecal shadowing made by more experienced clinicians compared to their less experienced colleagues. This pragmatic study was conducted across six palliative care services in Sydney (NSW, Australia). Doctors of varying clinical experience were asked to independently report their opinions of the amount of shadowing seen on 10 plain abdominal radiographs all taken from cancer patients who self-identified themselves as constipated. There were 46 doctors of varying clinical experience who participated including qualified specialists, doctors in specialist training and lastly, doctors in their second- and third post-graduate years. Poor agreement was seen between the faecal shadowing scores allocated by doctors of similar experience and training (Fleiss's kappa (FK): RMO 0.05; registrar 0.06; specialist 0.11). Further, when the levels of agreement between groups were considered, no statistically significant differences were observed. Although the doctors did not agree on the appearance of the film, the majority felt they were able to extrapolate patients' experiences from the radiograph's appearance. As it remains challenging in palliative care to objectively assess and diagnose constipation by history and imaging, uniform and objective assessment and diagnostic criteria are required. It is likely that any agreed criteria will include a combination of imaging and history. The results suggest the use of radiographs alone to diagnose and assess...
Ferreira, DH, Boland, JW, Phillips, JL, Lam, L & Currow, DC 2018, 'The impact of therapeutic opioid agonists on driving-related psychomotor skills assessed by a driving simulator or an on-road driving task: A systematic review.', Palliative Medicine, vol. 32, no. 4, pp. 786-803.View/Download from: UTS OPUS or Publisher's site
Driving cessation is associated with poor health-related outcomes. People with chronic diseases are often prescribed long-term opioid agonists that have the potential to impair driving. Studies evaluating the impact of opioids on driving-related psychomotor skills report contradictory results likely due to heterogeneous designs, assessment tools and study populations. A better understanding of the effects of regular therapeutic opioid agonists on driving can help to inform the balance between individual's independence and community safety.To identify the literature assessing the impact of regular therapeutic opioid agonists on driving-related psychomotor skills for people with chronic pain or chronic breathlessness.Systematic review reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis statement; PROSPERO Registration CRD42017055909.Six electronic databases and grey literature were systematically searched up to January, 2017. Inclusion criteria were as follows: (1) empirical studies reporting data on driving simulation, on-the-road driving tasks or driving outcomes; (2) people with chronic pain or chronic breathlessness; and (3) taking regular therapeutic opioid agonists. Critical appraisal used the National Institutes of Health's quality assessment tools.From 3809 records screened, three studies matched the inclusion criteria. All reported data on people with chronic non-malignant pain. No significant impact of regular therapeutic opioid agonists on people's driving-related psychomotor skills was reported. One study reported more intense pain significantly worsened driving performance.This systematic review does not identify impaired simulated driving performance when people take regular therapeutic opioid agonists for symptom control, although more prospective studies are needed.
Hatano, Y, Matsuoka, H, Lam, L & Currow, DC 2018, 'Side effects of corticosteroids in patients with advanced cancer: a systematic review', SUPPORTIVE CARE IN CANCER, vol. 26, no. 12, pp. 3979-3983.View/Download from: UTS OPUS or Publisher's site
Lam, LT & Wong, EMY 2018, 'Factors associated with the social competence and emotional well-being among young children in an Asian urban city', Early Child Development and Care, vol. 188, no. 3, pp. 336-344.View/Download from: Publisher's site
© 2016 Informa UK Limited, trading as Taylor & Francis GroupThis cross-sectional observational study aims to examine the current status and familial factors associated with social competence and emotional well-being among young children in an urban city in the East Asia region. Early childhood teachers assessed the social competence and the emotional state of preschool children with the Social Competence and Behavioural Evaluation (SCBE-30) Scale. Data were analysed with multiple regression modelling. Results suggested few variables were significantly associated with social competence. These included being a boy, aged 5 years or older, had more than one sibling, whose mother spoke a language other than the local language, and whose carers were not biological parents. Being a male with a mother who spoke a language other than the local language was associated with anger–aggression, while parental work arrangement was the only variable associated with anxiety–withdrawal. Results have a direct implication on the individual and structural levels of child care and early childhood education.
Lam, LT, Lam, MK, Benrimoj, C & Cardens, VG 2018, 'Application of the Social Network Analysis to Better Comprehend Relationships in Qualitative Health Data.', Studies in health technology and informatics, vol. 252, pp. 86-91.View/Download from: UTS OPUS or Publisher's site
OBJECTIVE:To explore social network analysis (SNA) as an additional approach to elucidate quantifiable insight from qualitative health-related textual data. METHODS:Key concepts gained from thematic analyses of a set of qualitative health data obtained from an implementation study was analysed using the Excel Add-on module NodeXL. RESULTS:Our results show that SNA provided useful visualisation and quantifiable information of the relationship between key concepts obtained from the thematic analysis. DISCUSSION:SNA is a useful technique for exploring and analysing qualitative data, particularly when the research interest is in complex relationships that may exist among a large number of qualitative variables. In addition to providing a way to visualise the relationship between concepts, SNA provides metric measures that can be further analysed quantitatively. CONCLUSION:The SNA approach allows researchers to explore deeper relationships that may exist among various variables and enable researchers to derive potentially a fuller and more complete appreciation and comprehension of health-related data.
Luckett, T, Phillips, J, Agar, M, Lam, L, Davidson, PM, McCaffrey, N, Boyle, F, Shaw, T, Currow, DC, Read, A, Hosie, A & Lovell, M 2018, 'Protocol for a phase III pragmatic stepped wedge cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of screening and guidelines with, versus without, implementation strategies for improving pain in adults with cancer attending outpatient oncology and palliative care services: the Stop Cancer PAIN trial', BMC HEALTH SERVICES RESEARCH, vol. 18.View/Download from: UTS OPUS or Publisher's site
Phillips, JL, Heneka, N, Hickman, L & Lam, L 2018, 'Self-Perceived Pain Assessment Knowledge and Confidence (Self-PAC) Scale for Cancer and Palliative Care Nurses: a Preliminary Validation Study.', Pain Management Nursing, vol. 19, no. 6, pp. 819-626.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Pain is highly prevalent in all health care settings, and frequently poorly managed. Effective pain management is predicated on a continuous cycle of screening, assessing, intervening and evaluating. Identifying gaps in nurses' self-perceived pain assessment competencies is an essential first step in the design of tailored interventions to embed effective pain assessment into routine clinical practice, and improve patient reported pain outcomes. Yet, few validated instruments focus on the competencies required for undertaking a comprehensive pain assessment, with most focusing on clinician's pain management competencies. AIM:To examine the validity of the 'Self-Perceived Pain Assessment Knowledge and Confidence' (Self-PAC) Scale. DESIGN:Preliminary instrument validation. SETTING:Two Australian cancer and palliative care services. PARTICIPANTS/SUBJECTS:186 cancer and palliative care nurses. METHODS:The Self-PAC Scale was administered to participants online. Factor Analyses, including Exploratory and Confirmatory, were applied to examine the structural validity, Cronbach's alpha was calculated for internal consistency. Criterion validity was investigated by comparing responses from experienced and non-experienced nurses. RESULTS:Two components resulted with a single factor structure for pain assessment confidence and a two-factor structure for the knowledge of pain assessment. The factor loading for the subscales ranged from 0.653 to 0.969, with large proportions of the variances explained by the factors. Cronbach's alpha of the subscales ranged from 0.87-0.92 and significant difference in responses were found between experienced and non-experienced nurses. CONCLUSION:Preliminary validation of the Self-PAC Scale suggests that it is a helpful instrument for assessing cancer and palliative care nurse' pain assessment competencies.
Piper, SE, Bailey, PE, Lam, LT & Kneebone, II 2018, 'Predictors of mental health literacy in older people', ARCHIVES OF GERONTOLOGY AND GERIATRICS, vol. 79, pp. 52-56.View/Download from: UTS OPUS or Publisher's site
Soundappan, SS, Karpelowsky, J, Lam, A, Lam, L & Cass, D 2018, 'Diagnostic accuracy of surgeon performed ultrasound (SPU) for appendicitis in children', Journal of Pediatric Surgery, vol. 53, no. 10, pp. 2023-2027.View/Download from: UTS OPUS or Publisher's site
© 2018 Aim: Compare the diagnostic accuracy of surgeon performed ultrasound to radiology performed ultrasound in children presenting with suspected appendicitis to a tertiary care pediatric hospital in Australia. Methods: Children under 16 presenting to the emergency department of The Children's Hospital at Westmead were considered for the study. Patients with obvious signs of appendicitis not requiring ultrasound and those with established ultrasound diagnosis of appendicitis were excluded. Ultrasound was performed by a Pediatric Surgeon (SPU) after obtaining consent. The treating team was blinded to the results. Patient underwent formal ultrasound in radiology (RPU) and treatment was based on the formal report. SPU result was reviewed by a radiologist blinded to results of RPU. The results were compared. Results: 65 children underwent ultrasound. 35 were male. Median age was 10 (range3–15). Median weight was 36 kg (range 12.6–76.2 kg), z-score median 0.21 (− 1.83 to 2.74). Symptom duration ranged from few hours to 2 weeks but majority (45) had symptoms for less than 48 h. Prevalence of appendicitis was 45%. Thirty two underwent surgery. Negative appendicectomy rate was 9.4%. Thirty three did not have surgery. 8 represented but only one proceeded to appendicectomy. SPU was done earlier than RPU (median 12 h vs 14.15 h) p = 0.088. Diagnostic accuracy using ROC did not reveal significant difference. Conclusion: SPU can be performed earlier than RPU with reliable accuracy. Training surgical trainees will enable early diagnosis and management of appendicitis.
Vongmany, J, Luckett, T, Lam, L & Phillips, JL 2018, 'Family behaviours that have an impact on the self-management activities of adults living with Type 2 diabetes: a systematic review and meta-synthesis.', Diabetic Medicine, vol. 35, no. 2, pp. 184-194.View/Download from: UTS OPUS or Publisher's site
To identify family behaviours that adults with Type 2 diabetes' perceive as having an impact on their diabetes self-management.Research suggests that adults with Type 2 diabetes perceive that family members have an important impact on their self-management; however, it is unclear which family behaviours are perceived to influence self-management practices.This meta-synthesis identified and synthesized qualitative studies from the databases EMBASE, Medline and CINAHL published between the year 2000 and October 2016. Studies were eligible if they provided direct quotations from adults with Type 2 diabetes, describing the influence of families on their self-management. This meta-synthesis adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement.Of the 2606 studies screened, 40 were included. This meta-synthesis identified that adults with Type 2 diabetes perceive family behaviours to be either: 1) facilitators of diabetes self-management; 2) barriers to diabetes self-management; or 3) equivocal behaviours with the potential to both support and/or impede diabetes self-management. Seven sub-themes were identified within these themes, including: four facilitator sub-themes ('positive care partnerships'; 'family watchfulness'; 'families as extrinsic motivator' and 'independence from family'); two barrier sub-themes ('obstructive behaviours' and 'limited capacity for family support'); and one equivocal behaviours subtheme ('regular reminders and/or nagging').While most family behaviours are unambiguously perceived by adults with Type 2 diabetes to act as facilitators of or barriers to self-management, some behaviours were perceived as being neither clear facilitators nor barriers; these were termed 'equivocal behaviours'. If the concept of 'equivocal behaviours' is confirmed, it may be possible to encourage the adult living with Type 2 diabetes to reframe these behaviours so that they are perceived as enabling their diabetes se...
Boyce, MJ, Lam, L, Chang, F, Mahant, N, Fung, VSC & Bradnam, L 2017, 'Validation of Fear of Falling and Balance Confidence Assessment Scales in Persons With Dystonia.', Journal of Neurologic Physical Therapy, vol. 41, no. 4, pp. 239-244.View/Download from: UTS OPUS or Publisher's site
Falls are problematic for people living with neurological disorders and a fear of falling can impact on actual falls. Fear of falling is commonly assessed using the Falls Self-Efficacy Scale International (FES-I) or the Activities-specific Balance Confidence (ABC) Scale. These scales can predict risk of falling. We aimed to validate the FES-I and the ABC in persons with dystonia.We conducted an online survey of people with dystonia, collecting information on demographics, 6-month falls history, dystonia disability, and the FES-I and ABC scales. Scales were validated for structural validity and internal consistency. We also examined goodness-of-fit, convergent validity, and predictive validity, and determined cutoff scores for predicting falls risk.Survey responses (n = 122) showed that both FES-I and ABC scales have high internal validity and convergent validity with the Functional Disability Questionnaire in persons with dystonia. Each scale examines a single factor, fear of falling (FES-I) and balance confidence (ABC). At least one fall was reported by 39% of participants; the cutoff value for falls risk was found to be 29.5 and 71.3 for the FES-I and the ABC respectively.The FES-I and the ABC scales are valid scales to examine fear of falling and balance confidence in persons with dystonia. Fear of falling is high and balance confidence is low and both are worse in those with dystonia who have previously fallen.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A182).
Clark, K, Lam, LT, Talley, NJ, Phillips, JL & Currow, DC 2017, 'Identifying Factors That Predict Worse Constipation Symptoms in Palliative Care Patients: A Secondary Analysis.', Journal of Palliative Medicine, vol. 20, no. 5, pp. 528-532.View/Download from: UTS OPUS or Publisher's site
OBJECTIVE: The aim of this work was to investigate whether variables identified as likely to impact the experience of constipation in other clinical settings similarly affected the experiences of constipated palliative care patients. BACKGROUND: The majority of palliative care patients with cancer are likely to be bothered by constipation symptoms at some point in their disease trajectory. Despite this, it remains unclear as to which factors predict more severe problems. METHODS: This study was conducted in a sample of 94 constipated palliative care patients who were asked to voluntarily complete a series of questions regarding their demographic and other characteristics, including whether they had chronic constipation symptoms, that is, constipation symptoms for 12 months. Other variables included age, body mass index, sex, performance status, and regular opioids and their doses. At the same time, they were asked to complete the Patient Assessment of Constipation Symptoms (PAC-SYM) and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaires. RESULTS: Descriptive statistics summarized baseline data. Unadjusted associations between the selected variables on PAC-SYM were examined by using bi-variate analyses. Significant variables identified on bi-variate analyses were included in a multivariate analysis. The final results identified that only the chronicity of constipation symptoms predicted more severe symptoms. This relationship persisted when this single variable was retained in the final model, illustrating that PAC-SYM scores are 0.41 higher in patients with chronic constipation compared with those without it (p = 0.02). In contrast, regular opioid use was not identified as a significant factor (p = 0.56). DISCUSSION: This study suggests that the factor most likely to predict worse constipation symptoms was the duration that people had experienced problems. Further, those who perceived their constipation symptoms to be more severe had a po...
Currow, D, Watts, GJ, Johnson, M, McDonald, CF, Miners, JO, Somogyi, AA, Denehy, L, McCaffrey, N, Eckert, DJ, McCloud, P, Louw, S, Lam, L, Greene, A, Fazekas, B, Clark, KC, Fong, K, Agar, MR, Joshi, R, Kilbreath, S, Ferreira, D, Ekström, M & Australian national Palliative Care Clinical Studies Collaborative (PaCCSC) 2017, 'A pragmatic, phase III, multisite, double-blind, placebo-controlled, parallel-arm, dose increment randomised trial of regular, low-dose extended-release morphine for chronic breathlessness: Breathlessness, Exertion And Morphine Sulfate (BEAMS) study protocol.', BMJ Open, vol. 7, no. 7, pp. 1-19.View/Download from: UTS OPUS or Publisher's site
INTRODUCTION: Chronic breathlessness is highly prevalent and distressing to patients and families. No medication is registered for its symptomatic reduction. The strongest evidence is for regular, low-dose, extended- release (ER) oral morphine. A recent large phase III study suggests the subgroup most likely to benefit have chronic obstructive pulmonary disease (COPD) and modified Medical Research Council breathlessness scores of 3 or 4. This protocol is for an adequately powered, parallel-arm, placebo-controlled, multisite, factorial, block-randomised study evaluating regular ER morphine for chronic breathlessness in people with COPD. METHODS AND ANALYSIS: The primary question is what effect regular ER morphine has on worst breathlessness, measured daily on a 0-10 numerical rating scale. Uniquely, the coprimary outcome will use a FitBit to measure habitual physical activity. Secondary questions include safety and, whether upward titration after initial benefit delivers greater net symptom reduction. Substudies include longitudinal driving simulation, sleep, caregiver, health economic and pharmacogenetic studies. Seventeen centres will recruit 171 participants from respiratory and palliative care. The study has five phases including three randomisation phases to increasing doses of ER morphine. All participants will receive placebo or active laxatives as appropriate. Appropriate statistical analysis of primary and secondary outcomes will be used. ETHICS AND DISSEMINATION: Ethics approval has been obtained. Results of the study will be submitted for publication in peer-reviewed journals, findings presented at relevant conferences and potentially used to inform registration of ER morphine for chronic breathlessness. TRIAL REGISTRATION NUMBER: NCT02720822; Pre-results.
Lam, LT & Lam, MK 2017, 'The association between financial literacy and Problematic Internet Shopping in a multinational sample', Addictive Behaviors Reports, vol. 6, pp. 123-127.View/Download from: UTS OPUS or Publisher's site
© 2017 The Authors Purpose To examine the association between financial literacy and Problematic Internet Shopping in adults. Methods This cross-sectional online survey recruited participants, aged between 18 and 60 years, through an online research facility. The sample consisted of multinational participants from mainly three continents including Europe, North America, and Asia. Problematic Internet Shopping was assessed using the Bergen Shopping Addiction Scale (BSAS). Financial Literacy was measured by the Financial Literacy subscale of the Financial Wellbeing Questionnaire. Multiple linear regression analyses were conducted to elucidate the relationship between the study and outcome variables with adjustment for other potential risk factors. Results Of the total of 997 respondents with an average age of 30.9 (s.d. = 8.8), 135 (13.8%) could be classified as having a high risk of being Problematic Internet Shoppers. Results from the multiple regression analyses suggested a significant and negative relationship between financial literacy and Problematic Internet Shopping with a regression coefficient of − 0.13, after controlling for the effects of potential risk factors such as age, region of birth, employment, income, shopping frequency, self-regulation and anxiety (t = − 6.42, p < 0.001). Conclusions The clinical management of PIS should include a financial counselling as a component of the treatment regime. Enhancement of financial literacy in the general population, particularly among young people, will likely have a positive effect on the occurrence of PIS.
Lam, LT & Wong, EMY 2017, 'Enhancing social-emotional well-being in young children through improving teachers' social-emotional competence and curriculum design in Hong Kong', International Journal of Child Care and Education Policy, vol. 11, no. 1, pp. 1-14.View/Download from: UTS OPUS or Publisher's site
This study aimed to evaluate an intervention programme for the enhancement of social-emotional well-being of young children through improving the social-emotional competence of kindergarten teachers and a specifically designed curriculum, in an urban city in the East Asia region. The design and some preliminary results on the outcome evaluations of the intervention programme are reported in this paper. The design of the intervention programme was based on the conceptual framework of the evidence-based Wisconsin Pyramid Model for Supporting Social Emotional Competence in Infants and Young Children. Kindergarten teachers and children under their care were recruited using a random cluster sampling technique with teachers undergoing a training programme for 2 months with hands on workshops. The social-emotional well-being of preschool children was assessed with the Social Competence and Behavioural Evaluation (SCBE-30) Scale pre- and post-intervention. Changes in outcome measures that compared assessments between baseline and post-intervention were analysed with adjustment to clustering effects. Results suggested a statistically significant improvement in social competence and reduction to anxiety-withdrawal and anger-aggression after intervention. These results were indicative of a potentially successful intervention programme that would require a proper trail to establish its efficacy.
Luckett, T, Spencer, L, Morton, RL, Pollock, CA, Lam, L, Silvester, W, Sellars, M, Detering, KM, Butow, PN, Tong, A & Clayton, JM 2017, 'Advance care planning in chronic kidney disease: A survey of current practice in Australia.', Nephrology, vol. 22, no. 2, pp. 139-149.View/Download from: UTS OPUS or Publisher's site
Advancse care planning (ACP) in nephrology is widely advocated but not always implemented. The aims of this study were to describe current ACP practice, identify barriers/facilitators and perceived need for health professional education and chronic kidney disease (CKD)-specific approaches.An anonymous cross-sectional survey was administered online. Nephrology health professionals in Australia and New Zealand were recruited via professional societies, email lists and nephrology conferences. Multiple regression explored the influence of respondents' attributes on extent of involvement in ACP and willingness to engage in future.375 respondents included nephrologists (23%), nurses (65%), social workers (4%) and others (8%). 54% indicated that ACP at their workplace was performed ad-hoc and 61% poorly. Perceived barriers included patient/family discomfort (84%), difficulty engaging families (83%), lack of clinician expertise (83%) and time (82%), health professional discomfort (72%), cultural/language barriers (65%), lack of private space (61%) and lack of formal policy/procedures (60%). Respondents overwhelmingly endorsed the need for more dialysis-specific ACP programs (96%) and education (95%). Whilst 85% thought ACP would be optimally performed by specially-trained staff, comments emphasized that all clinicians should have a working proficiency. Respondents who were more willing to engage in future ACP tended to be non-physicians (Odds ratio [OR] 4.96, 95% confidence intervals [CI] 1.74-14.07) and reported a greater need for CKD-specific ACP materials (OR 10.88, 95% CI 2.38-49.79).ACP in nephrology needs support through education and CKD-specific resources. Endorsement by nephrologists is important. A multi-disciplinary approach with a gradient of ACP expertise is also recommended.
Phillips, JL, Heneka, N, Hickman, L, Lam, L & Shaw, T 2017, 'Can A Complex Online Intervention Improve Cancer Nurses' Pain Screening and Assessment Practices? Results from a Multicenter, Pre-post Test Pilot Study.', Pain Management Nursing, vol. 18, no. 2, pp. 75-89.View/Download from: UTS OPUS or Publisher's site
Unrelieved cancer pain has an adverse impact on quality of life. While routine screening and assessment forms the basis of effective cancer pain management, it is often poorly done, thus contributing to the burden of unrelieved cancer pain. The aim of this study was to test the impact of an online, complex, evidence-based educational intervention on cancer nurses' pain assessment capabilities and adherence to cancer pain screening and assessment guidelines. Specialist inpatient cancer nurses in five Australian acute care settings participated in an intervention combining an online spaced learning cancer pain assessment module with audit and feedback of pain assessment practices. Participants' self-perceived pain assessment competencies were measured at three time points. Prospective, consecutive chart audits were undertaken to appraise nurses' adherence with pain screening and assessment guidelines. The differences in documented pre-post pain assessment practices were benchmarked and fed back to all sites post intervention. Data were analyzed using inferential statistics. Participants who completed the intervention (n = 44) increased their pain assessment knowledge, assessment tool knowledge, and confidence undertaking a pain assessment (p < .001). The positive changes in nurses' pain assessment capabilities translated into a significant increasing linear trend in the proportion of documented pain assessments in patients' charts at the three time points (χ(2) trend = 18.28, df = 1, p < .001). There is evidence that learning content delivered using a spaced learning format, augmented with pain assessment audit and feedback data, improves inpatient cancer nurses' self-perceived pain screening and assessment capabilities and strengthens cancer pain guideline adherence.
Clark, K, Lam, LT, Talley, NJ, Quinn, J, Blight, A, Byfieldt, N & Currow, DC 2016, 'Assessing the Presence and Severity of Constipation with Plain Radiographs in Constipated Palliative Care Patients', JOURNAL OF PALLIATIVE MEDICINE, vol. 19, no. 6, pp. 617-621.View/Download from: Publisher's site
Hosie, A, Lobb, E, Agar, M, Davidson, P, Chye, R, Lam, L & Phillips, J 2016, 'Measuring delirium point-prevalence in two Australian palliative care inpatient units', INTERNATIONAL JOURNAL OF PALLIATIVE NURSING, vol. 22, no. 1, pp. 13-21.View/Download from: UTS OPUS
Johnson, MJ, Booth, S, Currow, DC, Lam, LT & Phillips, JL 2016, 'A Mixed-Methods, Randomized, Controlled Feasibility Trial to Inform the Design of a Phase III Trial to Test the Effect of the Handheld Fan on Physical Activity and Carer Anxiety in Patients With Refractory Breathlessness', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 51, no. 5, pp. 807-815.View/Download from: UTS OPUS or Publisher's site
Luckett, TR, Phillips, J, Lintzeris, N, Allsop, D, Lee, J, Solowij, N, Martin, J, Lam, L, Aggarwal, R, McCaffrey, N, Currow, D, Chye, R, Lovell, M, McGregor, I & Agar, M 2016, 'Clinical trials of medicinal cannabis for appetite-related symptoms from advanced cancer: A survey of preferences, attitudes and beliefs among patients willing to consider participation', Internal Medicine Journal, vol. 46, no. 11, pp. 1269-1275.View/Download from: UTS OPUS or Publisher's site
Middleton, S, Gardner, A, Della, PR, Lam, L, Allnutt, N & Gardner, G 2016, 'How has the profile of Australian nurse practitioners changed over time?', COLLEGIAN, vol. 23, no. 1, pp. 69-77.View/Download from: Publisher's site
Watts, GJ, Clark, K, Agar, M, Davidson, PM, McDonald, C, Lam, LT, Sajkov, D, McCaffrey, N, Doogue, M, Abernethy, AP & Currow, DC 2016, 'Study protocol: a phase III randomised, double-blind, parallel arm, stratified, block randomised, placebo-controlled trial investigating the clinical effect and cost-effectiveness of sertraline for the palliative relief of breathlessness in people with chronic breathlessness', BMJ OPEN, vol. 6, no. 11.View/Download from: UTS OPUS or Publisher's site
Knowles, S, Lam, LT, McInnes, E, Elliott, D, Hardy, J & Middleton, S 2015, 'Knowledge, attitudes, beliefs and behaviour intentions for three bowel management practices in intensive care: effects of a targeted protocol implementation for nursing and medical staff.', BMC Nursing, vol. 14, no. 6.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians' intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs' knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices. METHODS: A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May - June 2008; post: Feb - May 2009). RESULTS: Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema. CONCLUSION: This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians' knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management pr...
Lam, LT & Lam, MKP 2015, 'Competency of health information acquisition and intention for active health behaviour in children', International Archives of Medicine, vol. 8, no. 1, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
© Under License of Creative Commons Attribution 3.0 License. Objective: To investigate the association between competency of health information acquisition, both online and offline, and the intention for active health behaviour in children. Methods: This study was a population-based cross-sectional health survey utilising a two-stage random cluster sampling design conducted in a major city. Competency of health information acquisition was assessed by a rating scale designed specifically for this study. The intention for active health behaviour was measured by a vignettebased question. Data were analysed using multiple logistic regression modelling techniques with adjustment to the cluster sampling effect and potential confounding factors. Results: After adjusting for potential confounding factors and the cluster sampling effect, intention for active health behaviour was significantly associated with competency of health information acquisition both online (OR=1.06, 95%C.I.=1.01-1.12) and offline (OR=1.08, 95%C.I.=1.02-1.18). Conclusions: Results suggested a positive relationship between competency of health information acquisition, both online and offline, and the intention for active health behaviour which have important public health implications on child health behaviour.
Lam, LT & Wong, EMY 2015, 'Stress Moderates the Relationship Between Problematic Internet Use by Parents and Problematic Internet Use by Adolescents', JOURNAL OF ADOLESCENT HEALTH, vol. 56, no. 3, pp. 300-306.View/Download from: Publisher's site
© European Federation of Adapted Physical Activity, 2015. This study aimed to explore the patterns, characteristics, and perceived risk factors of sports-related injuries among Paralympic athletes. One hundred and sixty Chinese athletes with either physical disabilities or visual impairments participating at a province-level Paralympic Games were recruited. Data on the occurrence of injuries during training and competitions were collected using a self-reported injury form. Of the 160 respondents, 82 (51%) reported a sports-related injury with track and field being the most commonly reported place of injury and lower limbs (77%) the most reported body area in young athletes with disabilities. Tried and not in condition (50%), decline in muscle coordination (35%), overtraining (39%), anxiety/overexcitement (39%), weather (46%), and lack of awareness for self-protection (43%) were nominated as main risk factors of injuries. Anxiety/overexcitement was perceived as a major cause resulting in moderate and severe injuries. It was concluded that the prevalence of injury among Chinese Paralympic athletes involving in the province-level Paralympic Games was relatively high. Risk factors especially for training volume, anxiety/overexcitement, weather, and self-protection awareness should be considered when planning injury prevention strategies.
Clark, K, Lam, L, Currow, DC & Agar, M 2014, 'A Prospective Study to Investigate Contributory Factors That Lead to Constipation in Palliative Care Patients', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 47, no. 6, pp. E1-E4.View/Download from: Publisher's site
Ho, RC, Zhang, MW, Tsang, TY, Toh, AH, Pan, F, Lu, Y, Cheng, C, Yip, PS, Lam, LT, Lai, CM, Watanabe, H & Mak, KK 2014, 'The association between internet addiction and psychiatric co-morbidity: a meta-analysis.', BMC Psychiatry, vol. 14, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: This study evaluates the association between Internal Addiction (IA) and psychiatric co-morbidity in the literature. METHODS: Meta-analyses were conducted on cross-sectional, case-control and cohort studies which examined the relationship between IA and psychiatric co-morbidity. Selected studies were extracted from major online databases. The inclusion criteria are as follows: 1) studies conducted on human subjects; 2) IA and psychiatric co-morbidity were assessed by standardised questionnaires; and 3) availability of adequate information to calculate the effect size. Random-effects models were used to calculate the aggregate prevalence and the pooled odds ratios (OR). RESULTS: Eight studies comprising 1641 patients suffering from IA and 11210 controls were included. Our analyses demonstrated a significant and positive association between IA and alcohol abuse (OR = 3.05, 95% CI = 2.14-4.37, z = 6.12, P < 0.001), attention deficit and hyperactivity (OR = 2.85, 95% CI = 2.15-3.77, z = 7.27, P < 0.001), depression (OR = 2.77, 95% CI = 2.04-3.75, z = 6.55, P < 0.001) and anxiety (OR = 2.70, 95% CI = 1.46-4.97, z = 3.18, P = 0.001). CONCLUSIONS: IA is significantly associated with alcohol abuse, attention deficit and hyperactivity, depression and anxiety.
Lam, LT 2014, 'Internet gaming addiction, problematic use of the internet, and sleep problems: a systematic review.', Current Psychiatry Reports, vol. 16, pp. 1-9.View/Download from: UTS OPUS or Publisher's site
The effect of problematic use of the Internet on mental health, particularly depression among young people, has been established but without a probable model for the underlying mechanism. In this study, a model is presented to describe possible pathways for the linkage between Internet gaming addiction and depression possibly mediated by sleep problems. A systematic review was conducted to gather epidemiological evidence to support or refute the link between addictive Internet gaming, problematic Internet use, and sleep problems including insomnia and poor sleep quality. Seven studies were identified through a systematic literature search, of these three related to addictive Internet gaming and four on problematic Internet uses and sleep problems. Information was extracted and analysed systematically from each of the studies and tabulated as a summary. Results of the review suggest that additive gaming, particularly massively multiplayer online role-playing games MMORPG, might be associated with poorer quality of sleep. Results further indicated that problematic Internet use was associated with sleep problems including subjective insomnia and poor sleep quality.
Lam, LT 2014, 'Mental health literacy and mental health status in adolescents: A population-based survey', Child and Adolescent Psychiatry and Mental Health, vol. 8, no. 1, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
Â© 2014 Lam. Background: This study aims to investigate the association between mental health literacy and the mental health status, particularly depression, among adolescents. Methods: This was a population-based health survey utilising a two-stage sampling technique. Mental health literacy was measured by the Australian National Mental Health Literacy and Stigma Youth Survey with the depression vignette only. Depression was assessed by the Depression sub-scale of the Depression, Anxiety, Stress Scale. Data were analysed using multiple logistic regression modelling techniques with adjustment for cluster sampling effect. Results: A total of 1678 students responded to the survey providing usable information. Only 275 (16.4%) respondents were classified as having an adequate mental health literacy level with correct identification of depression and also intended to seek help, with 392 (23.4%) of the total sample correctly identified the vignette as depression. Two hundred and forty eight (14.8%) were classified to have moderate to severe depression. Multiple logistic regression analysis results suggested that young people who had experienced moderate to severe level of depression in the week prior to the survey were more likely to have an inadequate level of MHL (OR = 1.52, 95% C.I. = 1.01-2.31) after adjusting for a potential confounding factors and cluster sampling effects. Conclusions: Results suggested that mental health literacy level was associated with mental health status, particularly depression of young people. The results have important implications, both clinically and on a population level, on the prevention of mental health problems and for the improvement of the mental health status of adolescents.
Lam, LT 2014, 'Risk factors of Internet addiction and the health effect of internet addiction on adolescents: a systematic review of longitudinal and prospective studies.', Current Psychiatry Reports, vol. 16, no. 11, pp. 1-9.View/Download from: UTS OPUS or Publisher's site
Internet gaming addiction was included in the latest version of the DSM-V as a possible disorder recently, while debate is still on-going as to whether the condition called "Internet Addiction" (IA) could be fully recognised as an established disorder. The major contention is how well IA could fulfil the validation criteria as a psychiatric disorder as in other well-established behavioural addictions. In addition to various proposed validation criteria, evidence of risk and protective factors as well as development of outcomes from longitudinal and prospective studies are suggested as important. A systematic review of available longitudinal and prospective studies was conducted to gather epidemiological evidence on risk and protective factors of IA and the health effect of IA on adolescents. Nine articles were identified after an extensive search of the literature in accordance to the PRISMA guidelines. Of these, eight provided data on risk or protective factors of IA and one focused solely on the effects of IA on mental health. Information was extracted and analysed systematically from each study and tabulated. Many exposure variables were studied and could be broadly classified into three main categories: psychopathologies of the participants, family and parenting factors, and others such as Internet usage, motivation, and academic performance. Some were found to be potential risk or protective factors of IA. It was also found that exposure to IA had a detrimental effect on the mental health of young people. These results were discussed in light of their implications to the fulfilment of the validation criteria.
Lam, LT & Yang, L 2014, 'Is low health literacy associated with overweight and obesity in adolescents: an epidemiology study in a 12-16 years old population, Nanning, China, 2012.', Archives of Public Health, vol. 72, no. 1, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: The problem of overweight and obesity in children and adolescents is considered an epidemic in both developed and developing world by the WHO. There has been little study on the relationship between health literacy and body weight among adolescents.This epidemiological study aims to investigate the association between low health literacy and overweight and obesity among a population of Chinese adolescents aged 12-16 years in the city of Nanning, China in 2012. METHODS: This study was a population-based cross-sectional health survey utilising a two-stage random cluster sampling design. The sample consisted of high school students aged between 12-16 years with the total student population attending high schools in a large city as the sample frame. Health literacy was measured by the Chinese version of the short form of the Test of Functional Health Literacy translated for and validated among Taiwanese adolescents. Overweight and obesity were assessed in accordance to the recommendation of the World Health Organization (WHO) Global Database of Body Mass Index classification methods. Data were analysed using logistic regression modelling techniques with adjustment to the cluster sampling effect. RESULTS: A total of 1035 students responded to the survey providing usable information with 628 (48.1%) respondents classified as high, 558 (42.8%) moderate, and 119 (9.1%) low levels of health literacy. After adjusting for potential confounding factors and the cluster sampling effect, low health literacy was significantly associated with overweight and obesity (OR = 1.84, 95% C.I. = 1.13-2.99). CONCLUSION: Results suggested that low health literacy level was associated with many aspects of adolescence health including their body weight. These results have public health implications on an important global problem of adolescence body weight. Enhancing the health literacy should be considered as part of the strategies in combating adolescence weight problem.
Phillips, JL, Heneka, NA, Hickman, L, Lam, L & Shaw, T 2014, 'Impact of a novel online learning module on specialist palliative care nurses' pain assessment competencies and patients' reports of pain: Results from a quasi-experimental pilot study', Palliative Medicine, vol. 28, no. 6, pp. 521-529.View/Download from: UTS OPUS or Publisher's site
Background: Pain is a complex multidimensional phenomenon moderated by consumer, provider and health system factors. Effective pain management cuts across professional boundaries, with failure to screen and assess contributing to the burden of unrelieved pain.
Phillips, JL, Lam, L, Luckett, T, Agar, M & Currow, D 2014, 'Is the Life Space Assessment applicable to a palliative care population? : A brief methodological report on its relationship to measures of performance and quality of life. Brief Methodological Report.', Journal of Pain and Symptom Management, vol. 47, no. 6, pp. 1121-1127.View/Download from: UTS OPUS or Publisher's site
The spatial environments that palliative care patients frequent for business and leisure constrict as their disease progresses and their physical functioning deteriorates. Measuring a persons movement within his or her own environment is a clinically relevant and patient-centered outcome because it measures function in a way that reflects actual and not theoretical participation.
Lam, LT & Li, Y 2013, 'The Validation of the Chinese Aggression and Victimization Scale (CAVS) for Adolescents', Journal of Child and Adolescent Trauma, vol. 6, no. 4, pp. 301-308.View/Download from: UTS OPUS or Publisher's site
The psychometric properties of the Chinese Aggression and Victimization Scale (CAVS) were examined among 484 adolescents aged between 11 and 16 years. Confirmatory Factor Analysis (CFA) was applied and the goodness of fit of the model to the data was determined using multiple criteria. Results confirmed a two-factor structure which fitted well with the data. Cronbach's alpha coefficients for age and sex yielded evidence for good internal reliability with values ranging from 0.63 to 0.88 that were not affected by age or sex. The convergent validity was investigated by correlations among the CAVS and the CES-Depression for Children, Zung's Anxiety Scale, and the Self-Esteem Scale. Results showed that both subscales and the total scale were positively and significantly correlated with depression and anxiety, but negatively related to the Self-Esteem scale. The CAVS is a valid instrument for measuring aggressive behavior and victimization among adolescents. © 2013 Copyright Taylor and Francis Group, LLC.
Lam, LT & Li, Y 2013, 'The validation of the E-Victimisation Scale (E-VS) and the E-Bullying Scale (E-BS) for adolescents', COMPUTERS IN HUMAN BEHAVIOR, vol. 29, no. 1, pp. 3-7.View/Download from: UTS OPUS or Publisher's site
Lam, LT, Cheng, Z & Liu, X 2013, 'Violent Online Games Exposure and Cyberbullying/Victimization Among Adolescents', CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING, vol. 16, no. 3, pp. 159-165.View/Download from: UTS OPUS or Publisher's site
Luckett, T, Davidson, PM, Lam, L, Phillips, JL, Currow, D & Agar, M 2013, 'Do Community Specialist Palliative Care Services That Provide Home Nursing Increase Rates of Home Death for People with Life-Limiting Illnesses? A Systematic Review and Meta-Analysis of Comparative Studies', Journal of Pain and Symptom Management, vol. 45, no. 2, pp. 279-297.View/Download from: UTS OPUS or Publisher's site
Context. Systematic reviews and meta-analyses suggest that community specialist palliative care services (SPCSs) can avoid hospitalizations and enable home deaths. But more information is needed regarding the relative efficacies of different models. Family caregivers highlight home nursing as the most important service, but it is also likely the most costly.
Waters, K, Kol-Castro, C, Varghese, A, Lam, LT, Prelog, K & Cheng, A 2013, 'Correlations between polysomnographic and lateral airway radiograph measurements in paediatric obstructive sleep apnoea', JOURNAL OF PAEDIATRICS AND CHILD HEALTH, vol. 49, no. 6, pp. 445-451.View/Download from: UTS OPUS or Publisher's site
Avakian, Z, Shiraev, T, Lam, L & Hope, N 2012, 'Dynamic hip screws versus proximal femoral nails for intertrochanteric fractures', ANZ JOURNAL OF SURGERY, vol. 82, no. 1-2, pp. 56-59.View/Download from: UTS OPUS or Publisher's site
Duff, J, Di Staso, R, Cobbe, KA, Draper, N, Tan, S, Halliday, E, Middleton, S, Lam, L & Walker, K 2012, 'Preventing hypothermia in elective arthroscopic shoulder surgery patients: A protocol for a randomised controlled trial', BMC Surgery, vol. 12.View/Download from: UTS OPUS or Publisher's site
Background: Patients having arthroscopic shoulder surgery frequently experience periods of inadvertent hypothermia. This common perioperative problem has been linked to adverse patient outcomes such as myocardial ischaemia, surgical site infection and coagulopathy. International perioperative guidelines recommend patient warming, using a forced air warming device, and the use of warmed intraoperative irrigation solutions for the prevention of hypothermia in at-risk patient groups. This trial will investigate the effect of these interventions on patients temperature, thermal comfort, and total recovery time. Method/Design: The trial will employ a randomised 2 × 2 factorial design. Eligible patients will be stratified by anaesthetist and block randomised into one of four groups: Group one will receive preoperative warming with a forced air warming device; group two will receive warmed intraoperative irrigation solutions; group three will receive both preoperative warming and warmed intraoperative irrigation solutions; and group four will receive neither intervention. Participants in all four groups will receive active intraoperative warming with a forced air warming device. The primary outcome measures are postoperative temperature, thermal comfort, and total recovery time. Primary outcomes will undergo a two-way analysis of variance controlling for covariants such as operating room ambient temperature and volume of intraoperative irrigation solution. Discussion: This trial is designed to confirm the effectiveness of these interventions at maintaining perioperative normothermia and to evaluate if this translates into improved patient outcomes. © 2012 Duff et al.; licensee BioMed Central Ltd.
Lam, MK & Lam, LT 2012, 'Health information-seeking behaviour on the Internet and health literacy among older Australians', ELECTRONIC JOURNAL OF HEALTH INFORMATICS, vol. 7, no. 2.View/Download from: UTS OPUS
Sandler, G, Soundappan, SSV, Manglick, MP, Fahy, FE, Ross, F, Lam, L & Cass, D 2012, 'Pediatric "Off-Road Vehicle" Trauma Determinants of Injury Severity and Type', PEDIATRIC EMERGENCY CARE, vol. 28, no. 12, pp. 1328-1333.View/Download from: UTS OPUS or Publisher's site
Smith, TA, Davidson, PM, Lam, LT, Jenkins, CR & Ingham, JM 2012, 'The use of non-invasive ventilation for the relief of dyspnoea in exacerbations of chronic obstructive pulmonary disease; a systematic review', Respirology, vol. 17, no. 2, pp. 300-307.View/Download from: UTS OPUS or Publisher's site
Background and objective: Non-invasive ventilation (NIV) improves outcomes in patients with acute exacerbations of COPD (AECOPD); however, the efficacy in relieving dyspnoea is uncertain. The objective of this systematic review was to identify, synthesize and interpret the data regarding the relief of dyspnoea afforded by NIV in patients admitted with acute respiratory failure occurring during AECOPD. Methods: Randomized controlled trials (RCTs) comparing usual medical care (UMC) to UMC plus NIV and reporting dyspnoea as a patient-reported outcome were identified by searching relevant databases and manual searching. The full text of potentially relevant articles was retrieved. Data describing the impact of NIV on dyspnoea was extracted. Results: Four RCTs met the review criteria.One found NIV did not relieve dyspnoea. The other three RCTs reported NIV relieving dyspnoea. The degree of dyspnoea relief was clinically significant in two of these three studies. However, in all but one RCT, methodological or reporting limitations constrain the confidence that can be had in this conclusion. Conclusions: Limited data exist to determine if NIV relieves subjective dyspnoea in AECOPD. Due to limitations in these studies, it is not possible to definitively conclude if NIV relieves dyspnoea. Standardized reporting and analysis of patient reported outcomes will facilitate objective comparisons of interventions with respect to symptom relief. Future studies involving NIV should routinely incorporate patient reported outcomes in order to answer the important clinical question: 'Does NIV relieve dyspnoea?'
To, THM, Clark, K, Lam, L, Shelby-James, T & Currow, DC 2012, 'The Role of Ondansetron in the Management of Cholestatic or Uremic Pruritusd-A Systematic Review', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 44, no. 5, pp. 725-730.View/Download from: UTS OPUS or Publisher's site
Abeyasundara, SL, Rajan, V, Lam, L, Harvey, JG & Holland, AJA 2011, 'The Changing Pattern of Pediatric Burns', JOURNAL OF BURN CARE & RESEARCH, vol. 32, no. 2, pp. 178-184.View/Download from: UTS OPUS or Publisher's site
Clark, K, Lam, L & Currow, D 2011, 'Exploring the Relationship Between the Frequency of Documented Bowel Movements and Prescribed Laxatives in Hospitalized Palliative Care Patients', AMERICAN JOURNAL OF HOSPICE & PALLIATIVE MEDICINE, vol. 28, no. 4, pp. 258-263.View/Download from: UTS OPUS or Publisher's site
Peng, ZW, Lam, LT & Jin, G 2011, 'Factors associated with social interaction anxiety among Chinese adolescents', East Asian Archives of Psychiatry, vol. 21, no. 4, pp. 135-141.View/Download from: UTS OPUS
Objectives: To investigate potential risk factors for social anxiety, particularly social interaction anxiety among the Chinese adolescents. Methods: A cross-sectional health survey was conducted in Guangzhou city of the Guangdong Province where high school students aged 13 to 18 years were recruited. The sample was selected from all high schools in the city using a 2-stage random cluster sampling technique. Social interaction anxiety was assessed using the Social Interaction Anxiety Scale. Information collected in the survey included: demographics, self-perception on school performance, relationship with teachers and peers, satisfaction with self-image, achievements, and parenting style of the mother. The parent-child relationship, specifically the relationship between respondents and their mothers, was assessed using the mother attachment subscale of the Inventory of Parent and Peer Attachment. Self-esteem was assessed using the Rosenberg Self-Esteem Scale. The multiple linear regression technique was applied to investigate associations between selected potential risk factors and social interaction anxiety, with adjustments for cluster sampling. Results: Lower family income, lower self-esteem, and hostility were significantly associated with social interaction anxiety among adolescents. Variables identified as risk factors of anxiety disorder in the literature, such as gender, were not associated with social interaction anxiety in this sample. Conclusions: These results were consistent with those of other studies conducted mainly in the United States and Europe. Regarding non-significant results related to gender, they need viewing in the context of parenting styles of Chinese mothers. © 2011 Hong Kong College of Psychiatrists.
Quinlivan, J, Lam, L & Fisher, J 2011, 'A randomized trial of a 4-step multidisciplinary approach to the antenatal care of obese pregnant women', ANZJOG, vol. 51, no. 2, pp. 141-146.View/Download from: UTS OPUS or Publisher's site
Quinlivan, JA, Julania, S & Lam, L 2011, 'Antenatal dietary interventions in obese pregnant women to restrict gestational weight gain to institute of medicine recommendations: a meta-analysis.', Obstetrics and Gynecology, vol. 118, pp. 1395-1401.View/Download from: UTS OPUS or Publisher's site
Sandler, G, Linh, N, Lam, L, Manglick, MP, Soundappan, SSV & Holland, AJA 2011, 'Trampoline Trauma in Children Is It Preventable?', PEDIATRIC EMERGENCY CARE, vol. 27, no. 11, pp. 1052-1056.View/Download from: UTS OPUS or Publisher's site
Sheehan, C, Clark, K, Lam, L & Chye, R 2011, 'A Retrospective Analysis of Primary Diagnosis, Comorbidities, Anticholinergic Load, and Other Factors on Treatment for Noisy Respiratory Secretions at the End of Life', JOURNAL OF PALLIATIVE MEDICINE, vol. 14, no. 11, pp. 1211-1216.View/Download from: UTS OPUS or Publisher's site
Boufous, S, Ivers, R, Senserrick, T, Norton, R, Stevenson, M, Chen, HY & Lam, LT 2010, 'Risky driving behavior and road traffic crashes among young Asian Australian drivers: Findings from the DRIVE study', Traffic Injury Prevention, vol. 11, no. 3, pp. 222-227.View/Download from: Publisher's site
Objective: To examine differences in risky driving behavior and likelihood of traffic crash according to the country of birth of recently licensed young drivers. The groups examined include those born in Australia, those born in Asia, and those born in other countries. Design and setting: The DRIVE study is a prospective cohort study of drivers aged 17-24 years holding their first-year provisional driver license in New South Wales, Australia. Information obtained from 20,822 participants who completed a baseline questionnaire was linked to police-reported traffic crashes. Main outcome measures: Self-reported risky driving behaviors and police-reported traffic crashes in young drivers. Results: Young drivers who were born in Asian countries were less likely to report engaging in risky driving behaviors than their Australian-born counterparts. The proportion of participants reporting a high level of risky driving was 31.5 percent (95% confidence intervale [CI], 30.8-32.1) among Australian-born drivers compared to 25.6 percent (95% CI, 23.1-28.2) among Asian-born drivers and 30.4 percent (95% CI, 28.4-32.5) among those born in other regions. Asian-born participants had half the risk of a crash as a driver than their Australian-born counterparts (relative risk [RR] 0.55; 95% CI, 0.41-0.75) after adjusting for a number of demographic factors and driving and risk-taking behaviors. The comparative risk was even lower among those aged 17 years (RR 0.29; 95% CI, 0.29-0.75). Risk estimates for people born in other regions did not differ to those for Australian-born respondents. Conclusions: The study highlights the lower level of risky driving and significantly reduced crash risk for Australian drivers born in Asian countries relative to those born locally. Further research is needed to examine factors underlying this reduced risk and the impact of the length of residence in the host country. © 2010 Taylor & Francis Group, LLC.
Browne, GJ, Noaman, F & Lam, LT 2010, 'Erratum: The nature and characteristics of abdominal injuries sustained during children's sports (Pediatric Emergency Care (2010) 26:1 (30-35))', Pediatric Emergency Care, vol. 26, no. 3, p. 235.View/Download from: Publisher's site
Browne, GJ, Noaman, F, Lam, LT & Soundappan, SV 2010, 'The nature and characteristics of abdominal injuries sustained during children's sports', Pediatric Emergency Care, vol. 26, no. 1, pp. 30-35.View/Download from: Publisher's site
Objective: To increase the evidence base by characterizing various features of pediatric sports-related abdominal injuries. Design: A review of the trauma database at The Children's Hospital at Westmead was undertaken for all abdominal injuries presenting to the emergency department between 2001 and 2006. Setting: The Children's Hospital at Westmead is a tertiary-level pediatric trauma center servicing Sydney's west. It sees approximately 50,000 patients a year. Participants: Only those injuries occurring during an organized sport were included for analysis. Thirty-three of the original 513 patients were eligible for inclusion. Main Outcome Measures: The data collected included basic demographics, mechanism of injury, sport injury, time to presentation, length of stay, diagnoses, treatment, and complications. Injury severity scores were assigned retrospectively. Results: Males sustained more injuries than females. Collisions and falls were the most common modes of injury. Rugby was the most common sport for injury. Most patients presented within 12 hours, and most presented with musculoskeletal injuries. Injury severity was usually mild; treatment, conservative; length of stay, short; and complications, uncommon. When characteristics were compared by sex, males had mostly collision injuries in high-impact/contact sports, with females having more falls in other sports. When characteristics were compared by age, the only statistically significant difference was in the organ injured: older children had more single solid organ injuries, and younger children had more multiple and hollow viscus injuries. Conclusions: Sports-related abdominal injuries in children are mostly minor and not as common as other injury mechanisms. Despite this, they can be serious, with early diagnosis often delayed because of their subtle nature. Sports-related abdominal injuries in children require a high index of suspicion in the part of the clinician if they are to be recognized early and...
Clark, K, Lam, L, Chye, R & Currow, D 2010, 'Retrospective analysis of contributing factors to laxative prescription in hospitalised palliative care patients.', Palliative Medicine, vol. 24, pp. 410-418.
Clark, K, Lam, LT, Agar, M, Chye, R & Currow, DC 2010, 'The impact of opioids, anticholinergic medications and disease progression on the prescription of laxatives in hospitalized palliative care patients: a retrospective analysis', PALLIATIVE MEDICINE, vol. 24, no. 4, pp. 410-418.View/Download from: Publisher's site
Hsu, P, Lam, LT & Browne, G 2010, 'The pulmonary index score as a clinical assessment tool for acute childhood asthma', Annals of Allergy, Asthma and Immunology, vol. 105, no. 6, pp. 425-429.View/Download from: Publisher's site
Background Asthma in the pediatric population imposes a significant burden on the Australian health care system. The lack of a standardized asthma assessment tool is an area that needs to be addressed. Objective To validate the pulmonary index score (PIS) against the National Asthma Council Guidelines (NACG) asthma assessment. Methods The project was approved by The Children's Hospital at Westmead Human Research Ethics Committee. Sixty-five patients aged 1 to 12 years with acute asthma were assessed independently using both the PIS and the NACG on presentation to the emergency department. Results These results indicate that the PIS (1) has high internal consistency (Cronbach α = .835); (2) correlates well with the NACG, with significant differences in PIS values across different NACG severity categories; (3) predicts with good sensitivity (85% for nonmild cases and 88% for severe cases) and specificity (75% for nonmild cases and 77% for severe cases) the various categories of asthma severity according to the NACG; and (4) significantly differs between admitted (mean PIS = 8.4) and nonadmitted (mean PIS = 5.0) patients. Conclusion Use of the PIS may provide an objective and standardized approach to the assessment and monitoring of asthma in children. © 2010 American College of Allergy, Asthma & Immunology.
Kim, LHS, Ward, D, Lam, L & Holland, A 2010, 'The impact of Laser Doppler Imaging on time to grafting decision in paediatric burns.', Journal of Burn Care and Research, vol. 31, pp. 328-332.
Lam, L & Peng, ZJ 2010, 'The effect of pathological use of the Internet on adolescent mental health: A prospective study.', Archives of Pediatrics and Adolescent Medicine, vol. 164, pp. 901-906.View/Download from: Publisher's site
Martiniuk, ALC, Ivers, R, Glozier, N, Patton, G, Lam, L, Boufous, S, Stevenson, M & Norton, R 2010, 'Does psychological distress increase the risk of motor vehicle crashes in young people? Findings from the DRIVE study.', Journal of Adolescent Health, vol. 47, pp. 488-495.
Nguyen, K, Ward, D, Lam, L & Holland, AJA 2010, 'Laser Doppler Imaging prediction of burn wound outcome in children: Is it possible before 48 h?', Burns, vol. 36, no. 6, pp. 793-798.View/Download from: Publisher's site
Background: Laser Doppler Imaging (LDI) assists in prediction burn wound outcome. Previous data has validated this technique in children between 48 and 72 h after burn. Aim: To evaluate the ability of Laser Doppler Imaging (LDI) to predict burn wound outcome in paediatric patients prior to and after 48 h from the time of injury. Methods: A prospective evaluation was performed in 400 children over a 12-month period that presented to our burns clinic. Patients were divided into two groups: those that presented within 48 h of injury (n = 160) and those that presented after 48 h (n = 240). Patients were reviewed until healing had occurred or operative intervention was required. Results: The median age of the patients was 2.4 years (range 0.1-15.9 years). For patients who presented within 48 h, the sensitivity and specificity of the LDI was 78% and 74% respectively compared to 75% and 85% for those scanned after 48 h. This difference was not statistically significant. Conclusions: LDI predicted burn wound outcome in children within 48 h of the burn wound. Moderate degrees of movement, infection, whether first aid was administered and type of dressing did not impact on the accuracy of LDI. Crown Copyright © 2009 Published by Elsevier Ltd and ISBI. All rights reserved.
Quinlivan, J, Lam, L, Wan, SH & Petersen, RW 2010, 'Selecting medical students for academic and attitudinal outcomes in a Catholic medical school.', Medical Journal of Australia, vol. 193.
Shatrov, JG, Birch, SCM, Lam, LT, Quinlivan, JA, McIntyre, S & Mendz, GL 2010, 'Chorioamnionitis and cerebral palsy: A meta-analysis', Obstetrics and Gynecology, vol. 116, no. 2, pp. 387-392.View/Download from: Publisher's site
Soundappan, SSV, Holland, A, Lam, L, Roy, G, Evans, JB, Adams, S & Cass, DT 2010, 'Off-road vehicle trauma in children: A New South Wales perspective', Pediatric Emergency Care, vol. 26, no. 12, pp. 909-913.View/Download from: Publisher's site
OBJECTIVE:: There is paucity of data on off-road vehicle injuries in children in Australia. We performed a retrospective study from 1998 to 2003 to analyze the frequency and nature of injuries in children involved in off-road vehicle crashes in the state of New South Wales. METHODS:: Medical records were identified from search of the trauma database and hospital medical records database for off-road (all-terrain) vehicles. RESULTS:: A total of 271 children were identified, 86% of whom were boys. The mean age was 10 years (range, 2-16 years); and the mean length of stay, 5.8 (9) days (range, 1-40 days). The mean injury severity score was 6 (5.9). Most were drivers (85%). Injury mechanism was falls in 161; collision with stationary object, 54; moving object, 4; rollovers, 7; and others, 8. Eighty-four percent were on 2 wheelers, whereas 11% were quad bikes, and the rest were on tricycles or other vehicles. Distribution of the body region injured was head and neck in 66 patients; face, 51; chest, 25; abdomen, 36; pelvis, 5; spines, 14; upper limbs, 96; and lower limbs, 116. Only 55% were helmeted at the time of the incident. Sixty-five percent of these children required surgical treatment. Most were fractures (98) followed by soft tissue injuries (49). Seventeen had posthead injury sequelae requiring rehabilitation support, and 21 required multiple surgeries. There were 7 deaths during the study period in New South Wales. CONCLUSIONS:: Off-road motor vehicle injuries are a significant problem in children. There are no legal safety regulations for use of these vehicles. With the increasing sales of these vehicles, the incidence of injury may rise. There seems a need for education and legislation in relation to the safety issues concerned with these vehicles. Copyright © 2010 by Lippincott Williams & Wilkins.
Clark, K, Lam, L & Currow, D 2009, 'Reducing gastric secretions-a role for histamine 2 antagonists or proton pump inhibitors in malignant bowel obstruction?', SUPPORTIVE CARE IN CANCER, vol. 17, no. 12, pp. 1463-1468.View/Download from: Publisher's site
Clark, K, Lam, LT, Gibson, S & Currow, D 2009, 'The effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta-analysis of randomised control trials', ANAESTHESIA, vol. 64, no. 6, pp. 652-657.View/Download from: Publisher's site
Lam, L & Lam, M 2009, 'The use of information technology and mental health among older care-givers in Australia', AGING & MENTAL HEALTH, vol. 13, no. 4, pp. 557-562.View/Download from: Publisher's site
Lam, LT, Peng, Z, Mai, J & Jing, J 2009, 'The association between internet addiction and self-injurious behaviour among adolescents', Injury Prevention, vol. 15, no. 6, pp. 403-408.View/Download from: Publisher's site
Objective: To examine the association between internet addiction and self-injurious behaviour (SIB) in adolescence. Methods: Population-based cross-sectional survey of 1618 high school students aged 13-18 years in Guangzhou city, Guangdong Province, PR China. Deliberate SIB was measured using self-reported questionnaire; internet addiction was assessed using the Internet Addiction Test (IAT). Results: 263 (16.3%) participants reported having committed some form of SIB in the past 6 months. 73 (4.5%) had committed SIB 6 times or more, and 157 (9.7%)1-5 times. The majority of respondents were classified as normal users of the internet (n = 1392, 89.2%), with 158 (10.2%) moderately and 10 (0.6%) severely addicted to the internet. After adjusting for potential confounders, the odds ratio for SIB was 2.0 (95% CI 1.1 to 3.7) for those who were classified as moderately and severely addicted to the internet when compared to the normal group. Conclusions: SIB is common in adolescence in the study population in China. Addiction to the internet is detrimental to mental health and increases the risk of selfinjury among adolescents. Clinicians need to be aware of potential co-morbidities of other addictions among adolescent self-injured patients.
Lam, LT, Peng, Z-W, Mai, J-C & Jing, J 2009, 'Factors Associated with Internet Addiction among Adolescents', CYBERPSYCHOLOGY & BEHAVIOR, vol. 12, no. 5, pp. 551-555.View/Download from: Publisher's site
Liu, HL, Lam, LT, Zeng, Q, Han, SQ, Fu, G & Hou, CC 2009, 'Effects of drinking water with high iodine concentration on the intelligence of children in Tianjin, China', Journal of Public Health, vol. 31, no. 1, pp. 32-38.View/Download from: Publisher's site
ObjectiveThis study aimed to investigate the effects of drinking water with high concentrations of iodine on the intelligence of children in Tianjin, China.MethodsIt was a population-based health survey utilizing a random cluster sampling design conducted in June 2005. Participants were recruited from the total population of primary school children attending years 1-4 with ages ranging from 8 to 10 years. Intelligence quotient (IQ) was assessed using the combined Raven's test, second edition. Linear regression analyses were applied to test for any association between water iodine concentration and IQ.ResultsA total of 1229 students were recruited with a mean IQ of 105.8 (95 CI: 104.2-107.3). Water analyses indicated iodine concentrations were high in one rural region and exceedingly high in another with median values of 137.5 and 234.7 g/l, respectively. There was a significant association between residing in the very high water iodine region and a reduction of IQ by an average of about nine points (P = 0.022), after adjusting for the potential confounding factors.ConclusionExposure to high iodine concentrations in drinking water has detrimental effects on the intelligence of children.
Martiniuk, ALC, Ivers, RQ, Glozier, N, Patton, GC, Lam, LT, Boufous, S, Senserrick, T, Williamson, A, Stevenson, M & Norton, R 2009, 'Self-harm and risk of motor vehicle crashes among young drivers: Findings from the DRIVE Study', CMAJ, vol. 181, no. 11, pp. 807-812.View/Download from: Publisher's site
Background: Some motor vehicle crashes, particularly single-vehicle crashes, may result from intentional self-harm. We conducted a prospective cohort study to assess the risk that intentional self-harm poses for motor vehicle crashes among young drivers. Methods: We prospectively linked survey data from newly licensed drivers aged 17-24 years to data on licensing attempts and police-reported motor vehicle crashes during the follow-up period. We investigated the role of recent engagement in self-harm on the risk of a crash. We took into account potential confounders, including number of hours of driving per week, psychological symptoms and substance abuse. Results: We included 18 871 drivers who participated in the DRIVE Study for whom data on self-harm and motor vehicle crashes were available. The mean follow-up was 2 years. Overall, 1495 drivers had 1 or more crashes during the follow-up period. A total of 871 drivers (4.6%) reported that they had engaged in self-harm in the year before the survey. These drivers were at significantly increased risk of a motor vehicle crash compared with drivers who reported no self-harm (relative risk [RR] 1.42, 95% confidence interval [CI] 1.15-1.76). The risk remained significant, even after adjustment for age, sex, average hours of driving per week, previous crash, psychological distress, duration of sleep, risky driving behaviour, substance use, remoteness of residence and socio-economic status (RR 1.37, 95% CI 1.09-1.72). Most of the drivers who reported self-harm and had a subsequent crash were involved in a multiple-vehicle crash (84.1% [74/88]). Interpretation: Engagement in self-harm behaviour was an independent risk factor for subsequent motor vehicle crash among young drivers, with most crashes involving multiple vehicles. © 2009 Canadian Medical Association or its licensors.
Lam, LT 2008, 'Time in bed and low Body Mass Index (BMI) among adolescents in China', Sleep and Hypnosis, vol. 10, no. 1, pp. 11-18.
Study Objective: To investigate the association between time in bed and low Body Mass Index (BMI < 18.5 kg/m2) among adolescents. Methods: This is a population school-based health survey utilising a two-stage random cluster sampling design. One thousand two hundred and sixty seven (n=1267) subjects aged 13 to 17 years participated in the study. They were recruited from the total population of adolescents attending high school in the Nanning, the capital city of the Guangxi Province, China. Time in bed was measured by self-reported time to bed and rise in a normal school week. Body Mass Index was calculated from body weight and height assessed by health professionals. Results: There was a significant dose-response relationship between time in bed and low BMI. After adjusting far the potential confounding factors, young people who were in bed for a shorter period of time (<7 hours) had a reduced risk of about 30% for low BMI (OR= 0.76, 95% C.I.=0.58-0.99) compared to those who were in bed 7-8 hours. No significant increase in risk were found for those who slept for longer than 8 hours (OR=1.42, 95% C.I.=0.93-2.19) when compared with the controls. Conclusions: Time in bed is associated with low BMI among adolescents suggesting a potential link to chronic energy deficiency (CED). It would be prudent for clinicians to include the assessment of potential CED in the evaluation and diagnosis of sleep-related problems among adolescents.
Lam, LT 2008, 'Uncorrected or untreated vision problems and occupational injuries among the adolescent and adult population in Australia', Injury Prevention, vol. 14, no. 6, pp. 396-400.View/Download from: Publisher's site
Objective: To investigate the relationship between uncorrected or untreated vision problems and occupational injuries in the adolescent and adult population in Australia. Design: National Health Survey conducted via personal interviews with a stratified random sample. Setting: Population-based. Subjects: Individuals selected from the total population aged 15 or older. Exposure measures: Information on uncorrected or untreated vision problems was collected by personal interview via responses to screening questions. Main outcome measures: Information on occupational injuries also collected via personal interview. Results: After adjustment for potential confounders, the odds of occupational injury increased by ∼60% (OR = 1.57, 95% CI = 1.11 to 2.24) for those who had any uncorrected or untreated vision problems, and by 3 1/2 times (OR = 3.52, 95% CI = 1.64 to 7.55) for those with untreated macular degeneration compared with healthy subjects. Conclusions: Uncorrected or untreated vision problems, particularly macular degeneration, significantly increased the risk of occupational injury. Vision examination should be recommended and implemented regularly for all workers.
Objective: This study investigates the association between duration of sleep and ADHD tendency among adolescents. Method: This population-based health survey uses a two-stage random cluster sampling design. Participants ages 13 to 17 are recruited from the total population of adolescents attending high school in one city of China. Duration of sleep is measured by self-reported time to bed and rise. ADHD tendency is assessed via a structured personal interview. Data are analyzed using linear regression modeling with adjustment for the effects of cluster sampling. Results: There is a highly significant and negative association between duration of sleep and ADHD tendency ( t = -4.99, p <.001) with a regression coefficient of -0.73 after adjusting for the potential confounding factors. Conclusion: Duration of sleep is associated with ADHD tendency among adolescents. It would be prudent for clinicians to include the assessment of sleep problems, including lack of sleep, in evaluating potential ADHD patients for treatment programs. (J. of Att. Dis. 2008; 11(4) 437-444). © 2008 Sage Publications.
Lam, M & Lam, L 2008, 'Access and the use of information technology in the older Australian population: A comparison among the healthy, chronically ill, and people with disability with and without limitation to core functioning', Journal on Information Technology in Healthcare, vol. 6, no. 4, pp. 261-272.
Objective: To examine the access and usage of information technology in Australia among various groups of older people including healthy, chronically ill, and disabled people with and without limitations to core functional activities. Methods: Cross-sectional population-based national health survey with stratified random sampling from the total population of people with disability, aged 60 years or older and carers of people with disability. Data were analysed using logistic regression analyses with bootstrapping resampling (a statistical method for estimating the sampling distribution of an estimator by sampling with replacement from the original sample) and estimation statistical techniques. Results: After adjusting for demographic variables there was no significant association between health conditions and access to Internet except for those who were disabled with both physical and communication limitations. In terms of the use of the Internet a 50% reduction of odds (Odds Ratio (OR) = 0.5, 95% Confidence Intervals (CI) = 0.11-0.89) were found for this group when compared to the healthy group. A significant result was found for the disability with physical limitation only group with a 30% reduction (OR = 0.73, 95%CI = 0.50-0.95). Conclusions: Disabled people with physical and communication limitations are more disadvantaged in terms of using the Internet. More attention should be paid to the design of computer devices for physically restricted people. © The Journal on Information Technology in Healthcare.
Marchant, J, Cheng, NG, Lam, LT, Fahy, FE, Soundappan, SV, Cass, DT & Browne, GJ 2008, 'Bystander basic life support: An important link in the chain of survival for children suffering a drowning or near-drowning episode', Medical Journal of Australia, vol. 188, no. 8, pp. 484-485.
Eight children suffered drowning or near-drowning in Sydney pools over an 11-day period in January 2007. Four received basic life support (BLS) within 5 minutes of immersion and survived with good functional neurological outcomes. The other four were not discovered for ≥5 minutes and all died. This cluster serves as a reminder that timely effective bystander BLS is crucial to survival and good clinical outcomes in near-drowning episodes.
Marchant, J, Cheng, NG, Lam, LT, Fahy, FE, Soundappan, SV, Cass, DT & Browne, GJ 2008, 'Erratum: Bystander basic life support: An important link in the chain of survival for children suffering a drowning or near-drowning episode (Medical Journal of Australia (2008) vol. 188 (484-485))', Medical Journal of Australia, vol. 189, no. 1, p. 56.
Ridda, I, Motbey, C, Lam, L, Lindley, IR, McIntyre, PB & MacIntyre, CR 2008, 'Factors associated with pneumococcal immunisation among hospitalised elderly persons: A survey of patient's perception, attitude, and knowledge', Vaccine, vol. 26, no. 2, pp. 234-240.View/Download from: Publisher's site
Aim: To investigate attitudes, perceptions and knowledge of elderly hospital patients in regard to vaccination in general and pneumococcal vaccination in particular. Setting: A hospital-based patient survey in Sydney, Australia. Participants: Patients aged 60 years and older who are admitted to selected wards in an 800-bed tertiary referral hospital in Sydney, Australia. Methods: A face-to-face interview administered to 200 inpatients. Results: Approximately half (49%) of the patients had a positive attitude to vaccination whereas 59% had less positive perception. There were 35% of the patients who were unvaccinated against influenza and pneumococcal disease. Positive perception (OR 2.9, 95% C.I. = 1.3-6.5) and attitude (OR 4.4, 95% C.I. = 2.0-9.4) significantly predicted vaccination with both vaccines. Similarly the odds of receiving pneumococcal vaccination for those who had a more positive attitude and more correct knowledge were significant (OR = 2.3, 95% C.I. = 1.0-5.4; OR = 2.7, 95% C.I. = 1.1-6.8). We explored reasons for non-vaccination. Physician recommendation was listed as an important factor by patients. Conclusions: Positive perception and attitude towards vaccination are significant factors associated with immunisation status. For the pneumococcal vaccination, having influenza vaccination is related to pneumococcal vaccination. © 2007 Elsevier Ltd. All rights reserved.
Lam, LT 2007, 'The association between climatic factors and childhood illnesses presented to hospital emergency among young children', International Journal of Environmental Health Research, vol. 17, no. 1, pp. 1-8.View/Download from: Publisher's site
There has been an increasing concern about the effect of climatic change on human health in recent years. It has been suggested that young children are particularly at risk due to the reduced regulating mechanism against extreme climatic changes. However, few studies on the associations between climatic factors and childhood illness, specifically among young children, have been found in the literature. This epidemiological study utilized data collected on all young patients aged less than 6 years who presented to an emergency department for a period of two years. Information on climate and outdoor air quality variables was obtained from the Bureau of Meteorology. Data were analysed with various ARIMA time series models for each common childhood illness. Results suggested that maximum daily temperature was a significant risk factor for fever (t = 5.29, p < 0.001) with a regression coefficient of 0.37 (SE = 0.07) and gastroenteritis (t = 2.69, p = 0.007) with a regression coefficient of 0.10 (SE = 0.04). The UV index was also found to be significantly but negatively related to gastroenteritis (t = -2.37, p = 0.018). However, none of the climatic variables were associated with respiratory problems after adjusting for other air quality variables and infectious disease. © 2007 Taylor & Francis.
Lam, LT & Yang, L 2007, 'Overweight/obesity and attention deficit and hyperactivity disorder tendency among adolescents in China', International Journal of Obesity, vol. 31, no. 4, pp. 584-590.View/Download from: Publisher's site
Objective: This study aims to investigate whether there is any association between attention deficit hyperactivity disorder (ADHD) tendency and overweight/obesity among adolescents. Design: This study was a population-based health survey utilizing a two-stage random cluster sampling design. Subjects: Subjects were recruited from the total population of adolescents who attended high school years 1, 2 and 3 with ages ranging from 13 to 17 years. Measurements: Individual body weight and height were measured by medical professionals. Overweight and obesity were determined according to the CDC classification. ADHD tendency was assessed via a structured personal interview using a standardizsed scale. Results: In all, 1429 students were recruited with 85 (6.3%) classified overweight and 42 (3.1%) obese with a mean BMI score of 19.1 (s.e.=0.15). For ADHD tendency, the average score was 15.48 (s.e.=0.28) with a median score of 16.0. There was a significant association between ADHD tendency and obesity among these adolescent (t=2.18, P=0.040), after adjusting for the potential confounding factors. However, the association between ADHD tendency and overweight did not reach a significant level. Conclusion: ADHD tendency is associated with overweight/obesity among adolescents. Clinician should be aware of the increased risk of ADHD among obese adolescents. ADHD should be assessed and proper treatment should be provided in the management of obese. © 2007 Nature Publishing Group All rights reserved.
Lam, LT & Yang, L 2007, 'Short duration of sleep and unintentional injuries among adolescents in China', American Journal of Epidemiology, vol. 166, no. 9, pp. 1053-1058.View/Download from: Publisher's site
Using a population-based cross-sectional health survey, the authors investigated the association between nightly duration of sleep and unintentional injuries among high school students in Nanning, China. The survey utilized a two-stage random cluster-sampling design. In March 2005, adolescents aged 13-17 years were recruited from students attending the first 3 years of high school in Nanning. Sleep duration was measured by self-reported usual times of going to bed and rising during a normal school week. Unintentional injury was assessed via a structured personal interview. Data were analyzed using multinomial logistic regression with adjustment for the effects of cluster sampling. After adjustment for potentially confounding factors, adolescents who slept less than 7 hours per night during a normal school week were approximately two times more likely to have experienced multiple episodes of unintentional injury during the 3-month presurvey period (odds ratio = 2.2, 95% confidence interval: 1.1, 4.8) than those who slept 7 hours or more (p < 0.05). There was also a nonsignificantly (p > 0.05) increased risk of single injury for adolescents with short sleep durations (odds ratio = 1.5, 95% confidence interval: 0.9, 2.3). Findings suggest that a short nightly duration of sleep can be considered a potential risk factor for multiple unintentional injuries among adolescents. © The Author 2007. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved.
Lau, JTF, Tsui, HY & Lam, LT 2007, 'Alcohol consumption, sex, and use of psychotropic substances among male Hong Kong-mainland China cross-border substance users', Addictive Behaviors, vol. 32, no. 4, pp. 686-699.View/Download from: Publisher's site
The study investigated the prevalence and associated factors for co-occurrence of psychotropic substance use, alcohol consumption and sexual activities among substance users. Totally, 1167 Hong Kong Chinese males aged 18-30 having used substances in mainland China in the last year were identified. Of them, 72.5% and 42.7% respectively reported having consumed alcohol and engaged in sexual activities in conjunction with the last episode of substance use. Among those using substances exclusively in mainland China, multivariate analyses showed that having friends who frequently used substances in China (OR = 3.18) and being accompanied by friends in the last episode of substance use (OR = 2.31) were associated with alcohol consumption; older age (OR = 2.01), higher education level (OR = 2.31), alcohol consumption (OR = 2.72), belief that substance use increased sexual potency (OR = 2.81) and use of multiple types of psychotropic substances in China (OR = 2.94) were significantly associated with having sex in conjunction with the last episode of using psychotropic substances. Cross-border psychoactive substance use often co-occurs with alcohol and sex. High levels of risk are involved. Different types of preventive programs need to be integrated. © 2006 Elsevier Ltd. All rights reserved.
Lau, JTF, Tsui, HY, Lam, LT & Lau, M 2007, 'Cross-boundary substance uses among Hong Kong Chinese young adults', Journal of Urban Health, vol. 84, no. 5, pp. 704-721.View/Download from: Publisher's site
The study documents the characteristics of Hong Kong residents who used substances in mainland China. Characteristics of such users were compared with those using substances elsewhere. A cross-sectional survey was used. Data analyses were stratified by gender, and multivariate analyses were performed. Respondents, Hong Kong adults aged 18-30 (n = 6,528), were interviewed using a mixed interviewer and computerized mobile phone method, at the Hong Kong-mainland China boundary. Cross-border substance users and other types of substance users had characteristics that were quite different (e.g., education level, perceived harmfulness of substance use in general, having friends who frequently used substances in mainland China). Cross-boundary substance users also found it easier to obtain substances in mainland China than in Hong Kong (males: 60.5%, females: 39.6%) and perceived no chance of being arrested in mainland China because of substance use (men: 28.8%, women: 24.5%). They tended to use substances in discos/rave parties together with friends (men: 77%, women: 81%), and substances were often obtained for free (men: 63.2%, women: 78%). Ecstasy and ketamine were often used (men: 86.5% & 79.4%, women: 81% & 70.2%), and multiple uses of different substances were common (men: 81.3%, women: 68.6%). Lower price, peer influence, and better availability were reasons behind cross-boundary substance use behaviors. Cross-boundary substance users have specific characteristics. Prevention policies should take these characteristics into account. Regional collaborations are highly warranted. © 2007 The New York Academy of Medicine.
Liu, HL, Lam, LT, Wang, T, Hou, CC, Zeng, Q, Feng, LH & Chen, XM 2007, 'The health effects of odor emission from domestic renovation on household residents in Tianjin, China', Journal of Environmental Health, vol. 69, no. 7, pp. 46-50.
The health effects of odors emitted from the human environment have received some discussion in the literature. Little has been written, however, about the health effects of odor emissions from renovation. The authors therefore conducted a cross-sectional study with a simple randomized sampling design. The sample was selected from a building-and-constraction registry that registered all building and domestic renovation applications in Tianjin, China. Information on demographics, physical symptoms, and health status was collected via personal interviews. Air samples were also collected from each household for chemical analysis. Data were analyzed with weighted logistic-regression models. A significant association was found between exposure to odor emission and unspecific physical symptoms. After potential confounders were adjusted for, it was found that people who had been exposed to moderate-to-strong odor emissions from renovations were about four times more likely to report experiencing unspecific discomfort than were people who had been exposed to weak odor emissions (odds ratio = 4.05; 95 percent confidence interval = 1.49-11.03). The results indicate that odor emissions from domestic renovation have a detrimental effect on human physical health. This effect seemed to be independent from that generated by chemicals. Implications and prevention strategies are discussed.
Soundappan, SVS, Holland, AJA, Fahy, F, Manglik, P, Lam, LT & Cass, DT 2007, 'Transfer of pediatric trauma patients to a tertiary pediatric trauma centre: Appropriateness and timeliness', Journal of Trauma - Injury, Infection and Critical Care, vol. 62, no. 5, pp. 1229-1233.View/Download from: Publisher's site
OBJECTIVE: To study the appropriateness of, and time taken, to transfer pediatric trauma patients in New South Wales to The Children's Hospital at Westmead (CHW), a pediatric trauma center. METHODS: All trauma patients transferred to CHW from June 2003 to July 2004 were included in the study. Indications and time periods relevant to the transfer of the patient from the referring institute were retrieved and analyzed. Pediatric and adult retrieval services were compared. RESULTS: Three hundred ninety-eight patients were transferred to CHW, of whom 332 were from the metropolitan region. Falls and burns were the commonest mechanism of injury. Burn was the commonest indication for transfer (107 of 398). Mean Injury Severity Score was eight. Nearly half the patients had minor injuries (Injury Severity Score <9). Patients spent an average of 5 hours at the referring hospital. Pediatric retrieval ambulances had significantly longer mean transfer times than did nonpediatric ambulance services with a total time spent of about 2.64 hours versus 1.30 hours, respectively. For aeromedical transfers, on the other hand, the difference between pediatric retrieval services and nonpediatric air ambulances was not significant. CONCLUSIONS: The majority of the patients transferred had minor injuries. Pediatric trauma patients spend considerable time in their referring hospitals. Pediatric retrieval services appear to take significantly longer to transfer patients than nonpediatric ambulance transfers even after allowing for patient age and injury severity. Although this did not result in mortality or morbidity, there appears to be considerable scope for a reduction in transfer times through better coordination of these services. © 2007 Lippincott Williams & Wilkins, Inc.
Browne, GJ & Lam, LT 2006, 'Concussive head injury in children and adolescents related to sports and other leisure physical activities', British Journal of Sports Medicine, vol. 40, no. 2, pp. 163-168.View/Download from: Publisher's site
Objective: To compare the characteristics of children and adolescents with concussive head injury (CHI) sustained during organised sports or other leisure physical activity. Methods: This was a case series study reviewing the medical records retrospectively over a four year period of children 6-16 years presenting to the emergency department with a CHI after participating in sport and/or recreation activity. Results: There were 592 cases of sport and recreation related concussion over the study period (2000-2003). Most of the patients (n = 424, 71.6%) were male, with half (n = 304, 51.4%) being older than 10 years of age. A total of 152 (25.7%) cases of CHI were related to playing sports. Most cases (71.2%) were mild concussion. The cause of injury was a fall (n = 322, 54.4%) or a collision. Nearly a quarter of the children (n = 143, 24.2%) were admitted to hospital, with imaging performed in 134 (22.7%). Most children were treated appropriately and no adverse events were reported. Conclusions: A severe CHI in a child is six times more likely to have resulted from organised sport than from other leisure physical activities. Outcomes for CHI in children is excellent, although their management places a considerable burden on emergency services. The need for activity restriction and the benefits of this in reducing long term cognitive effects of CHI are uncertain.
Ivers, RQ, Blows, SJ, Stevenson, MR, Norton, RN, Williamson, A, Eisenbruch, M, Woodward, M, Lam, L, Palamara, P & Wang, J 2006, 'A cohort study of 20 822 young drivers: The DRIVE study methods and population', Injury Prevention, vol. 12, no. 6, pp. 385-389.View/Download from: Publisher's site
Background and objective: Research on young drivers directly linking risk factors to serious injury and death outcomes is required. The DRIVE Study was established to facilitate this aim. This paper outlines the study methods and describes the population that has been recruited, in order to demonstrate that the necessary heterogeneity in risk factors has been attained. Design, setting and participants: Drivers aged 17-24 years holding their first-stage provisional driver's licence from New South Wales, Australia, were recruited into a prospective cohort study. The participants were contacted by mail and asked to complete the study questionnaire at an online site or via a mailed questionnaire. Baseline data collection involved a questionnaire with questions to drivers about their training, risk perception, driver behavior, sensation-seeking behavior and mental health. Participants gave consent for prospective data linkage to their data on licensing, crashes and injuries, held in routinely collected databases. Results: 20 822 drivers completed the baseline questionnaire, of whom 45.4% were men, 74.3% resided in capital cities and 25.7% in regional or remote areas. The recruited study population showed a wide variation in the risk factors under examination. For example, almost 40% of drivers reported drinking alcohol at hazardous levels and about 32% of participants seemed to be at a high or very high risk of psychological distress. Participants reported a mean of 67.3 h (median 60 h) of supervised driver training while holding their learner's permit. Conclusions: The DRIVE Study has a robust study design aimed at minimizing bias in the collection of outcome data. Analyses of baseline data showed substantial heterogeneity of risk factors in the study population. Subsequent prospective linkages comparing relative differences in exposures at baseline with the outcomes of interest have the potential to provide important new information needed to develop targeted interv...
Lam, LT, Yang, L, Zheng, Y, Ruan, C & Lei, Z 2006, 'Attention deficit and hyperactivity disorder tendency and unintentional injury among adolescents in China', Accident Analysis and Prevention, vol. 38, no. 6, pp. 1176-1182.View/Download from: Publisher's site
This study aims to investigate the association between ADD tendency, with or without hyperactivity, and all types of unintentional injuries among adolescents. This study was a population-based health survey utilising a two-stage random cluster sampling design. The study was conducted among high school students in Nanning, the capital city of the Guangxi Province, China. Subjects were recruited from the total population of adolescents who attended high school years 1, 2, and 3 with ages ranging from 13 to 17 years. Information on ADD was collected by trained health professional via personal interviews. Other information, including unintentional injury was collected via a self-report health survey questionnaire. One thousand and twenty-nine (n = 1429) students were recruited with 115 (7.9%) identified as having a high ADD tendency, and 340 (22.6%) reported as having experienced an injury in the last 3 months. After adjusting for other potential confounding factors, results from the logistic regression analyses indicated that adolescents who scored high on the ADD tendency had an increased risk of injury by about 70% as compared to those who scored low (OR = 1.68, 95%CI = 1.18-2.40). ADD tendency has been identified as a potential risk factor of injury among adolescents. Screening for risk factors can be considered as a potential preventive strategy. © 2006 Elsevier Ltd. All rights reserved.
Liu, HL, Lam, LT, Hou, CC, Xu, Y & Chen, XM 2006, 'A study of Legionella pneumophilia in Tianjin, China', International Journal of Environmental Health Research, vol. 16, no. 1, pp. 15-20.View/Download from: Publisher's site
Legionella is a bacterium identified as the causative agent of Legionnaires' disease commonly found in water and soil in natural environments and human habitats. While most studies are focused on cooling tower water as the source of infection, few studies have compared Legionella from cooling-tower water and water in man-made environments. This cross-sectional study with a randomized cluster sampling design aims to provide information on Legionella found in cooling-tower water and water in man-made environments. Legionella was identified using a dual analytical approach: the serological and the 16SrRNA semi-nest PCR methods. Nine different types of Legionella were identified with the Lp7 type detected in China for the first time. Results indicated slight but insignificantly increased odds (OR = 1.64, 95%CI = 0.54-4.98) of Legionella detection in cooling tower water as compared to water obtained from fountains and parks, suggesting that the mechanism of exposure plays an important role in the causal pathway of outbreaks of Legionnaires' disease. © 2006 Taylor & Francis.
Scheinberg, A, Hall, K, Lam, LT & O'Flaherty, S 2006, 'Oral baclofen in children with cerebral palsy: A double-blind cross-over pilot study', Journal of Paediatrics and Child Health, vol. 42, no. 11, pp. 715-720.View/Download from: Publisher's site
Aim: To assess the effectiveness of oral baclofen in reducing spasticity and improving function in children with cerebral palsy. Methods: A double-blind, randomised cross-over pilot study of oral baclofen versus placebo. Assessment tools included the Goal Attainment Scale, Pediatric Evaluation of Disability Inventory, Modified Tardieu Scale and parent questionnaire. Results: Fifteen children with mean age 7.4 years (SD = 2.7 years) and spastic or spastic/dystonic quadriplegia (Gross Motor Function Classification System Level IV or V) were enrolled. Children scored significantly better on the Goal Attainment Scale with baclofen compared with placebo (F(1,13) = 4.5, P = 0.05). There was no significant difference between baclofen and placebo for the Pediatric Evaluation of Disability Inventory or Modified Tardieu Scale. Parent questionnaire results are described. Conclusion: This pilot study demonstrates that oral baclofen has an effect beyond placebo in improving goal-oriented tasks, such as transfers, in children with spastic quadriplegic cerebral palsy. © 2006 The Authors.
Soundappan, S, Smith, NF, Lam, LT, Holland, AJA, McCaskill, M & Cass, DT 2006, 'A trauma series in the injured child: Do we really need it?', Pediatric Emergency Care, vol. 22, no. 10, pp. 710-716.View/Download from: Publisher's site
BACKGROUND: To study the use of trauma series radiographs in children that required activation of a trauma call. METHODS: A retrospective review of patients younger than 16 years who presented to The Children's Hospital at Westmead between January and December 2004 with an injury that required activation of the trauma team. Patients transferred from other institutions were excluded. RESULTS: Two hundred seventy-four children were included in the study, with 166 boys. The mean age was 8 years, and average Injury Severity Score was 4. Sixteen children had an Injury Severity Score of above 15. One hundred thirty-one children had a complete trauma series performed; 104 had one or more of the series performed, whereas 39 had no radiographs. Data analysis revealed that patients with findings in a chest radiograph (13) had either chest wall contusion(s) or reduced air entry on the involved side. Logistic regression analyses identified features that were significantly associated with a positive finding on the radiographs of the anteroposterior chest including a distracting injury in the chest area (odds ratio [OR], 10.49; 95% confidence interval [CI], 2.98-36.97), abnormal air entry on auscultation (OR, 31.86; 95% CI, 2.80-365.12), and need for intubation (OR, 6.23; 95% CI, 1.56-24.91). However, no clinical variable(s) showed a statistically significant correlation with abnormal radiographic findings on the lateral cervical spine (2) or anteroposterior pelvis (4). CONCLUSIONS: This study suggests that selective use of individual components of the full trauma series in the conscious pediatric patient, when an adequate clinical examination can be performed, would be safe. This approach should reduce the exposure to ionizing radiation of pediatric trauma patients and hospital staff. © 2006 Lippincott Williams & Wilkins, Inc.
Lam, LT 2005, 'Hospitalisation due to sports-related injuries among children and adolescents in New South Wales, Australia: An analysis on socioeconomic and geographic differences', Journal of Science and Medicine in Sport, vol. 8, no. 4, pp. 433-440.View/Download from: Publisher's site
This population-based epidemiological study aims to investigate the associations between socioeconomic status, geographic location, and sports-related injuries among children and adolescents in New South Wales (NSW), Australia. Data utilised in this study were collected as part of the routine vital health information system via all hospitals in NSW. Included were all patients aged between 5-19 years admitted to a hospital because of sports-related injuries in NSW between 1996 and 2000. The crude age-and-sex-specific hospitalisation rates (/100,000 population-years) by socioeconomic levels and geographic residential locations were calculated. Negative Binomial regression analyses were also performed to examine the associations between socioeconomic status, geographic location and the rate of hospitalisation after adjusting for the age and sex of children and adolescents. The results indicated a significant association between geographic location and hospitalisation due to sports-related injury, after adjusting for age, sex, and socioeconomic status. The risk of hospital admission with sports-related injury among children and adolescents in rural areas was nearly 10% higher than for those in the metropolitan areas (RR=1.12, 95%C.I.=1.07-1.32)). However, no association between socioeconomic status and hospitalisation with sports-related injury was found. Greater efforts are required in the implementation of safety strategies in research, training, and education for the prevention of sports-related injury in rural areas.
Lam, LT 2005, 'Parental modelling of cycling for children: Demographic and socioeconomic determinants', International Journal of Health Promotion and Education, vol. 43, no. 4, pp. 131-136.View/Download from: Publisher's site
Aim: This study aimed to investigate the demographic and socioeconomic characteristics of bicycle ownership by parents, and positive parental modelling of cycling for children in New South Wales, Australia. Methods: This was a randomised population-based cross-sectional telephone survey of parents residing within the metropolitan areas of NSW. Results: A random sample of 1278 parents with children aged 4-12 years who owned a bicycle was recruited. Nearly 40 per cent (n=500) of the interviewed parents owned a bicycle themselves and 217 (17%) respondents reported to exhibit positive modelling behaviour. Results suggested that male respondents were two and a half times more likely to own a bicycle than females (OR=2.5, 95%CI=1.9-3.4). Parents from an English speaking background were about two times more likely to own a bicycle than their non-English speaking counterparts (OR=2.4, 95%CI=1.7-3.5). In comparison to parents with lower education levels, parents with higher eduction levels were nearly two times more likely to own a bicycle, with an odds of 1.7 (95%CI=1.2-2.2) for parents with certificates or diplomas and an odds of 1.6 (95%CI=1.2-2.1) for parents with university or higher levels. In terms of positive modelling of cycling, male parents were nearly two times more likely to go riding with their children compared with females (OR=1.7, 95%CI=1.1-2.5). Parents with children aged 7-9 years were nearly two and a half times more likely to exhibit parental modelling as compared with parents of the youngest age group (OR=2.4, 95%CI=1.5-3.7). Conclusion: The findings indicate that parents of young children 4-6 years old, particularly mothers, should be encouraged to demonstrate more positive modelling behaviour in cycling.
Lam, LT 2005, 'Parental risk perceptions of childhood pedestrian road safety: A cross cultural comparison', Journal of Safety Research, vol. 36, no. 2, pp. 181-187.View/Download from: Publisher's site
Introduction: This cross-sectional community-based randomized telephone survey, aimed to compare the parental risk perceptions on childhood pedestrian road safety among three different major community language speaking groups and the mainstream English speaking Australians in Sydney, Australia. Method: This was a community-based telephone survey with subjects randomly selected from the population of specific cultural languages in Sydney. Results: Results indicated that Chinese and Arabic speaking parents or caregivers perceived the road environments as significantly less hazardous for their 4-12 year old children as pedestrians when compared with Vietnamese and English speaking parents. This was true even after adjusting for the age of child, socioeconomic status, and the living environments of respondents. Conclusion: The implication of the results was discussed in light of possible application to childhood safety behavior across different cultures. Impact to the industry: The results obtained have highlighted the importance of cultural factors in risk perceptions, and safety behaviors. Cultural differences in risk perceptions should be taken into consideration in the design of safety education programs. © 2005 National Safety Council and Elsevier Ltd. All rights reserved.
Lam, LT & Lam, MKP 2005, 'The association between sudden illness and motor vehicle crash mortality and injury among older drivers in NSW, Australia', ACCIDENT ANALYSIS AND PREVENTION, vol. 37, no. 3, pp. 563-567.View/Download from: Publisher's site
Lam, LT, Norton, R, Connor, J & Ameratunga, S 2005, 'Suicidal ideation, antidepressive medication and car crash injury', ACCIDENT ANALYSIS AND PREVENTION, vol. 37, no. 2, pp. 335-339.View/Download from: Publisher's site
Lam, LT, Yang, L, Liu, Y, Geng, WK & Liu, DC 2005, 'Different quantitative measures of the impact of injury deaths on the community in the Guangxi Province, China', Accident Analysis and Prevention, vol. 37, no. 4, pp. 761-766.View/Download from: Publisher's site
Injury has been identified as a major health problem in China. Different quantitative measures based on the concept of years of potential life lost have been derived for assessing the burden of injury and other diseases. However, few studies have been conducted to compare the usefulness of these measures in terms of providing practical information. This study aims to examine the utility of different measures in assessing the impact of injury to Chinese society. This is a population-based epidemiological study utilising surveillance and fielded-gathered data. Data are obtained from the disease surveillance information system and record on each death certificate. The mortality rates, years of potential life lost (YPLL), potentially years of productive life lost (PYPLL), and the valued years of potential life lost (VYPLL) are calculated and compared for deaths due to injury and other major diseases. Data on different causes of injury were analysed in the same manner. In comparison to other causes of death, injury deaths had the highest annual rates of YPLL (1265.1 years/100,000 persons), PYPLL (517.8 years/100,000 persons), and VYPLL (378.6 years/100,000 persons). Premature deaths due to injury provided the only positively valued VYPLL among all major causes of death. Among the injury deaths, motor vehicle traffic-related death caused the largest YPLL (13,274 years), PYPLL (5461 years), and VYPLL (3064 years). In considering the burden of deaths to society, mortality rate only is an insufficient measure. The age, the years of overall life and expected productivity and related economic consequences have to be taken into consideration. As an indicator of the economic impact and burden of premature deaths to society, the VYPLL seems to be an advantageous utility. Injury posts the greatest public health problem to the developing economy of China. © 2005 Elsevier Ltd. All rights reserved.
Yang, L, Lam, LT, Liu, Y, Geng, WK & Liu, DC 2005, 'Epidemiological profile of mortality due to injuries in three cities in the Guangxi Province, China', Accident Analysis and Prevention, vol. 37, no. 1, pp. 137-141.View/Download from: Publisher's site
This study aimed to provide epidemiological information on injury mortality in three major cities in Guangxi Province of South Western China. This was a population-based descriptive study utilising surveillance and field-gathered data. Data were obtained from the disease surveillance information system and record on each death certificate. Mortality rates were compared between sex and among different age groups for different causes of injury. Regression modelling was applied to examine for any increasing trend of injury mortality within the study period. Drowning was a severe problem for boys and girls younger than 5 years. Among all estimated mortality rates (per 100,000 person-years) for all sex, age groups, and categories of death, they were the highest with a rate of 29.8 (95%CI = 16.7-42.9) for boys and 29.6 (95%CI = 15.9-43.3) for girls. The overall mortality rates of motor vehicle and other transport-related injury was also similar to those developed countries. There was a marginally significant trend of increasing injury mortality within the study period. © 2004 Elsevier Ltd. All rights reserved.
Lam, LT 2004, 'Different quantitative measures of the impact of premature deaths on the community in Australia', Australian and New Zealand Journal of Public Health, vol. 28, no. 6, pp. 555-558.View/Download from: Publisher's site
Objective: Different quantitative measures based on the concept of years of potential life lost have been derived for assessing the burden of diseases and injuries. However, few studies have been conducted to compare the usefulness of these measures in terms of providing practical information. This study aims to examine the utility of different measures in assessing the impact of premature deaths on Australian society. Methods: This population-based study was conducted utilising data on the underlying causes of death officially reported by the Australian Bureau of Statistics. The mortality rates, potential years of life lost (PYLL), potentially productive years of life lost (PPYLL), and the valued potential years of life lost (VPYLL), are calculated and compared for deaths due to all known underlying causes. Results: In comparison with other causes of death, injury deaths had the second-highest annual rates of PYLL (1,206.7 years), the highest PPYLL (543.5 years), and VPYLL (489.7 years). Premature deaths due to injury were the only positively valued VPYLL among all major causes of death. Among injury deaths, intentional injury deaths caused the largest VPYLL (7,591.6 years), with a higher rate than unintentional injury deaths. Conclusion: As an indicator of the economic impact and burden of premature deaths to society, the VPYLL seems to be an advantageous utility. Injury poses the greatest public health problem to the Australian economy.
Lam, LT 2004, 'Environmental factors associated with crash-related mortality and injury among taxi drivers in New South Wales, Australia', Accident Analysis and Prevention, vol. 36, no. 5, pp. 905-908.View/Download from: Publisher's site
This exploratory study aims to investigate the associations between some environmental factors and the increased risk of motor vehicle crash-related injuries among taxi drivers. Information utilised in the study are obtained from police reports of all road traffic accidents that occurred on the roads between 1996 and 2000 in New South Wales (NSW), Australia. Of the 7923 taxi drivers who involved in crashes, nearly 10% (n = 750) were killed or injured. Results indicate sex, and two environmental factors are significantly associated with an increased risk of crash-related mortality and injury among taxi drivers. The adjusted relative risk of crash-related mortality and injury is increased by 60% for those who work the night shift (OR = 1.59, 95%CI = 1.35-1.88), and by 20% for those who do not carry any passenger on board (OR = 1.20, 95%CI = 1.02-1.41) should these drivers involve in a crash. The increased relative risk of crash-related mortality and injury is nearly 2.5 times for female taxi drivers (OR = 2.30, 95%CI = 1.45-3.65) when compared with their male counterparts. © 2003 Elsevier Ltd. All rights reserved.
Lam, LT, Norton, R, Woodward, M, Connor, J & Ameratunga, S 2004, 'Erratum: Passenger carriage and car crash injury: A comparison between younger and older drivers (Accident Analysis and Prevention (2003) 35:6 (861-867) PII: S000145750200091X)', Accident Analysis and Prevention, vol. 36, no. 5, p. 931.View/Download from: Publisher's site
Browne, GJ, Lam, LT & Barker, RA 2003, 'The usefulness of a modified adult protocol for the clearance of paediatric cervical spine injury in the emergency department', Emergency Medicine, vol. 15, no. 2, pp. 133-142.View/Download from: Publisher's site
Objective: To determine if the use of a modified adult protocol that uses cervical spine imaging on presentation for the assessment of cervical spine injury in children improves clinical outcome. Methods: This is a case series study on all consecutive trauma patients presenting from April to July 2000 inclusive to the ED of a major paediatric trauma hospital. Children presenting to the ED with potential cervical spine injury (CSI) were identified using standard selection criteria. Patient demographics, mechanism of injury, method and time of presentation, associated injuries, radiological investigation and clinical outcome were recorded. The major outcome measures for this study were: time to clearance of the cervical spine, length of stay in the ED and admission to an in-hospital bed. Data were analysed for compliance to the protocol, this being the standard assessment pathway of cervical spine clearance used by our trauma service. Results: The trauma registry identified 1721 trauma presentations during the 4-month study period; 208 presentations representing 200 children with potential CSI were entered into the study. Males represented 72.5% of the study population, having a mean age of 8.32 years, although 29% were less than 5 years of age. The majority of presentations (69%) occurred outside of normal working hours. In 17.8% of cases the cervical spine was cleared based on clinical assessment alone, half less than 5 years of age. Compliance to the protocol occurred in 78% of presentations. However, when examined by age group, children 5 years of age or above were 1.5 times more likely to comply with the protocol as compared with younger children. Adequate plain imaging was not obtained in 18% of presentations, this group almost exclusively less than 5 years of age. There were no missed injuries and no short or long-term neurological sequelae reported during this study. There were no differences in time to clearance, length of stay and admission rate between c...
Objective: To assess the occurrence of hypovolaemic shock in children who have sustained traumatic femoral fracture. Methods: A retrospective descriptive study was performed on a cohort of children with traumatic femoral fracture presenting over a five and a half year period from 1 January 1996 to 1 July 2001. Selected parameters for analysis included administration of a fluid bolus, as well as all available vital signs within 4 h following injury relating to pulse, systolic blood pressure, respiratory rate, skin capillary refill time and mental status. Fluid and blood transfusion records were examined, as was the need for intraosseous access. Initial haemoglobin and haematocrit results were also obtained. Results: There was no evidence for haemodynamic instability in the 100 patients who met the selection criteria when compared with internationally accepted normal vital sign parameters. No significant difference was found in the initial vital signs between patients who received fluid bolus and those that didn't. No patient needed intraosseous access or fluid resuscitation. One patient received blood transfusion without evidence of haemodynamic instability. Haemoglobin and haematocrit values were not significantly decreased. Ninety-two percent of patients in this study had isolated femoral fracture. Conclusions: No evidence for haemodynamic instability was found in a cohort of children with traumatic femoral fracture.
Chu, RSL, Browne, GJ & Lam, LT 2003, 'Traction splinting of femoral shaft fractures in a paediatric emergency department: Time is of the essence?', Emergency Medicine, vol. 15, no. 5-6, pp. 447-452.View/Download from: Publisher's site
Objective: To describe the use of traction splinting in children with femoral shaft fracture and to determine if timing of traction splinting application effects outcome. Methods: A retrospective descriptive study conducted over a five and a half year period (1 January 1996 to 1 July 2001) on children presenting with femoral shaft fracture to a Paediatric trauma centre. Data were collected on all children with a radiological diagnosis of fracture to the femoral shaft. Evidence for hypovolaemic shock and neurovascular compromise was sought. The administration of parenteral analgesia and whether a validated pain scale was employed to monitor pain relief was documented. The use of a traction splint or other leg splint device before arrival in the ED and subsequent changes to splinting in hospital were noted. Times to perform radiographic examination and femoral nerve block were also recorded. Results: Ninety-five (95) patients met the study inclusion criteria with 66.3% having some form of immobilization and 70% administered parenteral analgesia in the pre-hospital setting. In only 7.3% of patients was a Thomas splint traction applied within 2 h of arrival. Adverse clinical outcome was not reported in any patient regardless of time to application of Thomas splint traction. The application of Thomas splint traction in the ED resulted in a significant delay in the performance of diagnostic radiographs and femoral nerve block. Conclusions: The timing of traction splinting is not associated with poor outcome in isolated paediatric femoral shaft fracture provided effective analgesia has been administered in a timely fashion.
Chu, RSL, Browne, GJ, Cheng, NG & Lam, LT 2003, 'Femoral nerve block for femoral shaft fractures in a paediatric emergency department: Can it be done better?', European Journal of Emergency Medicine, vol. 10, no. 4, pp. 258-263.View/Download from: Publisher's site
Background: The relatively simple technique of administering a femoral nerve block is known to be quick, safe and effective in providing prolonged analgesia to children with femoral shaft fracture. Although medical literature supports its use in the emergency setting, no studies have been conducted on how this is undertaken in practice. Objective: The aim of this study is to describe the practice of femoral nerve block in previously well children who present to our Emergency Department with femoral shaft fracture. Setting: This study was conducted at the Emergency Department of a tertiary paediatric hospital in Sydney, Australia. Methods: A retrospective descriptive study was conducted by gathering data on all patients presenting to the Emergency Department between 1 January 1996 and 1 July 2001 with traumatic fracture to the femoral shaft. Whether femoral nerve block had been performed in the emergency setting; the time taken for femoral nerve block to be performed; the type of local anaesthetic used; the dose of local anaesthetic administered, and the level of training and area of expertise of doctors performing the femoral nerve block were determined from the clinical records. One-way analysis of variance and Student's t-tests were conducted to compare the average dosages of local anaesthetic used by the different medical sub-specialities involved. Student's t-tests were applied to analyse the time differences for performing femoral nerve block between emergency- and non-emergency-based medical staff. Results: The majority (111) of the 117 patients who met the inclusion criteria for the study had isolated femoral shaft fractures (94.9%). Femoral nerve blocks were performed in 97 of our study patients (82.9%). No correlation was found between the age of the child and the time taken for a femoral nerve block. In 76 cases in which a femoral nerve block was given (64.9%), a member of staff external to the Emergency Department performed the procedure. The average t...
Frampton, A, Browne, GJ, Lam, LT, Cooper, MG & Lane, LG 2003, 'Nurse administered relative analgesia using high concentration nitrous oxide to facilitate minor procedures in children in an emergency department', Emergency Medicine Journal, vol. 20, no. 5, pp. 410-413.
Aims: To describe the experience of using high concentration nitrous oxide (N2O) relative analgesia administered by nursing staff in children undergoing minor procedures in the emergency department (ED) and to demonstrate its safety. Method: Data were collected over a 12 month period for all procedures in the ED performed under nurse administered N2O sedation. All children greater than 12 months of age requiring a minor procedure who had no contraindication to the use of N2O were considered for sedation by this method. The primary outcome measure was the incidence of a major complication namely respiratory distress or hypoxia during the procedure. Secondary outcome measures were minor complications and the maximum concentration of N2O used. Results: Data were collected for a total of 224 episodes of nurse administered N2O sedation over a 1 2 month period. In 73.2% of children no complications were recorded. One major complication was recorded (respiratory distress) and the most common minor complication was mask intolerance in 17%. The mean maximum concentration of N2O used was 60.2%. Conclusions: N2O is a safe analgesic in children over the age of 1 year undergoing painful or stressful procedures in the ED. It may safely be administered in concentrations of up to 70% by nursing staff after appropriate training.
Habashy, D, Lam, LT & Browne, GJ 2003, 'The administration of β2-agonists for paediatric asthma and its adverse reaction in Australian and New Zealand emergency departments: A cross-sectional survey', European Journal of Emergency Medicine, vol. 10, no. 3, pp. 219-224.View/Download from: Publisher's site
Aim To determine the current use of β2-agonists, in particular salbutamol, for the management of acute asthma in children in emergency departments throughout Australia and New Zealand. Methods A cross-sectional survey using a questionnaire that sought to determine the current use of salbutamol and any adverse drug reactions in paediatric emergency departments. Results Out of 37 hospitals eligible as paediatric emergency departments, 33 (89.1%) responded to the survey, 54.5% having guidelines for the management of acute asthma. Of the paediatric emergency departments surveyed, 45.5% used metered-dose inhaler spacer combination in the treatment of mild to moderate asthma. All paediatric emergency departments used nebulized salbutamol for acute severe asthma. In addition, 85% of paediatric emergency departments used continuous-infusion intravenous salbutamol in unresponsive patients, 63.6% administering a single-dose intravenous salbutamol bolus before commencing the infusion. District paediatric emergency departments were more likely to treat with continuous-infusion intravenous salbutamol outside of the intensive care unit. Clinical unresponsiveness to inhaled salbutamol and clinical improvement were the reported criteria in all paediatric emergency departments for the use and cessation of intravenous salbutamol. Adverse drug reactions were common: tremor (90%), hypokalaemia (45.5%) and supraventricular tachycardia (21%), particularly if continuous-infusion intravenous salbutamol administered. Eight deaths from asthma were reported, none being related to adverse drug reactions. Conclusion We report a wide variation of salbutamol use in paediatric emergency departments and a high prevalence of type A adverse drug reactions when continuous-infusion intravenous salbutamol therapy was administered. More evidence is needed on the clinical significance of the adverse effects reported in this study and optimal doses for the safe use of continuous-infusion intravenous sal...
Lam, LT 2003, 'A neglected risky behavior among children and adolescents: Underage driving and injury in New South Wales, Australia', Journal of Safety Research, vol. 34, no. 3, pp. 315-320.View/Download from: Publisher's site
Problem: Among different causes of injury, roads and traffic-related incidents contributed most to all child deaths. The majority of childhood and adolescent traffic-related deaths are young people killed as pedestrians or bicyclists. Underage driving is a particular risky behavior much neglected. This study aimed to describe some characteristics related to motor-vehicle crashes and crash-related injury in which the vehicle was driven by a young person who was under the legal age of obtaining a learner license in New South Wales, Australia. Methods: Data used in this study were made available from the Roads and Traffic Authority of NSW for the period between 1996 and 2000. Crash information was collected and reported by NSW police at the scene of these motor-vehicle crash incidents. Results: There were 526 crashes involving an underage driver recorded within the study period. The majority (79.5%) of these underage drivers were males with slightly more than half (58.0%) aged 15 years, and nearly 30% aged 14 years. Among these, 83.6% involved the driver of the vehicle being killed or injured. Among the injured or killed passengers, 128 (73.6%) were nonadult passengers under the age of 18 years. Seventy of these crashes occurred while the car was in pursuit by police. The adjusted relative risk of injury to at least one occupant in the vehicle should a crash occur for female underage drivers was two times (OR=2.01, 95% CI=1.27-3.20) as compared to male underage drivers. Discussion: Underage driving poses a serious problem in terms of crash outcomes. Experimental driving and late-night outings for adolescents should be discouraged. Well-designed studies are required to further investigate the relationship between underage driving and on road risk-taking behavior among licensed adolescents. Impact on industry: Data obtained from this study indicate that adults, particularly parents, should discourage underage adolescents from experimenting driving and should actively ...
Lam, LT 2003, 'Childhood and adolescence poisoning in NSW, Australia: An analysis of age, sex, geographic, and poison types', Injury Prevention, vol. 9, no. 4, pp. 338-342.View/Download from: Publisher's site
Objective: This study aims to investigate whether there is any association between the types of poison substances and geographic locations for different age groups and sex. Design: This is a population based epidemiological study utilising routinely collected inpatient statistics. Setting: Data are collected as part of the routine vital health information system via all hospitals in New South Wales (NSW), Australia. Patients: All patients aged between 0-19 years who were admitted to a hospital because of poisoning by the four major types of substances that were defined in the study in NSW in 2000. Main results: The standardised incidence ratios of poisoning related hospitalisation between metropolitan and rural areas varied across different poison types when compared with the NSW average. While there are few differences between metropolitan and rural areas for analgesic and chemical related poisoning admissions across different age groups and sex, differences in the standardised incidence ratios between geographic locations for psychotropic and venom related poisoning admissions were found. No significant difference in standardised mortality ratios were found between metropolitan and rural areas except for females in the 10-14 years age group (standardised mortality ratio 3.24, 95% confidence interval 1.69 to 6.21). Conclusions: The results obtained in this study, on the whole, provide some evidence for an association between poison types and geographic locations for psychotropic and venom related poisoning.
Lam, LT 2003, 'Factors associated with fatal and injurious car crash among learner drivers in New South Wales, Australia', Accident Analysis and Prevention, vol. 35, no. 3, pp. 333-340.View/Download from: Publisher's site
This exploratory study investigated factors associated with car crash injury among learner drivers across difference ages by using data routinely collected by the NSW police. The results obtained indicated that some factors are commonly associated with car crash injury across nearly all ages. On the other hand, some others are more age specific. On the whole, female learner drivers were more at risk of being killed or injured as compared to males. The drivers of 16 years old had an increased risk of crash injury due to environmental factors, such as special road feature, and distraction outside the vehicle. The increased risk of crash injury for older drivers (≥25 years) was associated with distractions from both inside and outside vehicle. Night time driving posed a special risk to learner drivers aged 20-24 years old, but not other age groups. Speeding was a common factor for the increased risk of crash injury across all age groups. The implication of the results and limitations of the study were discussed. © 2002 Elsevier Science Ltd. All rights reserved.
Lam, LT 2003, 'Factors associated with young drivers' car crash injury: Comparisons among learner, provisional, and full licensees', Accident Analysis and Prevention, vol. 35, no. 6, pp. 913-920.View/Download from: Publisher's site
This exploratory study aimed to investigate factors associated with car crash injury among young drivers aged <25 years with different license status. Of special interest were the differences in risk patterns among different license holders of different age groups. Data utilised in this study were obtained from the New South Wales (NSW) police. The results indicated that female young drivers were more at risk of being killed or injured in a crash than males. Some risk factors, in particular environment-related factors, were identified as license-status-and-age specific. On the contrary, disregarding their driving experiences and ages, young drivers were more influenced by their own behaviours and driving conditions. Young drivers of 16-17 years with learner and provisional licenses tended to have increased risk of crash injury due to special road features. Night-time driving seemed to be a problem for older and more experienced drivers only. Fully licensed drivers of 18-19 and 20-24 years were more susceptible to the influence of alcohol. Risk-taking, speeding, fatigue, and carrying many passengers increased the risk of crash injury to car occupants for nearly all young drivers disregarding their ages and driving experiences. The results obtained provided indicative information on areas where the graduated licensing systems in NSW might be effective, and on other areas that might be lacking. A population-based case-control study was proposed to overcome the limitations of this study. © 2003 Elsevier Science Ltd. All rights reserved.
Lam, LT & Lam, MK 2003, 'Associations between social, economic resources and mental, physical illnesses in a population of older people in New South Wales, Australia', Journal of Mental Health and Aging, vol. 9, no. 4, pp. 223-232.
This cross-sectional study aims to investigate the association between social and economic resources and the likelihood of being diagnosed with mental and physical illnesses in a well defined population of older people, aged 60 or above, who are referred to an aged care assessment program. The likelihood of being diagnosed with mental illness was increased by 40% for older people who were socially isolated (OR = 1.44, 95% CI = 1.12-1.85), and about 50% for those who stayed in care providing facilities (OR = 1.51, 95% CI = 1.06-2.15), as compared to those who were not isolated and staying with spouse/relatives. A nearly 50% reduction of likelihood for mental illness diagnosis for those who lived in the nonmetropolitan areas (OR = 0.52, 95% CI = 0.41-0.67) as compared to those staying in metropolitan areas. The likelihood of being diagnosed with both mental and physical illnesses was increased for older people who were economically more disadvantaged (mental: OR = 1.50, 95% CI = 1.12-2.00; physical: OR = 1.42, 95% CI = 1.09-1.83). Results from this study shed light on possible community health strategies for older people.
Lam, LT, Norton, R, Woodward, M, Connor, J & Ameratunga, S 2003, 'Passenger carriage and car crash injury: A comparison between younger and older drivers', Accident Analysis and Prevention, vol. 35, no. 6, pp. 861-867.View/Download from: Publisher's site
This study was conducted to investigate the effects of passenger carriage, including the number of passengers and the ages of passengers, on the risk of car crash injury. The study utilised data obtained from a case-control study conducted in the Auckland region of New Zealand between 1998 and 1999. Cases were car drivers who involved in crashes in which at least one occupant was hospitalised or killed. Controls were selected from a cluster random sample of car drivers on the roads in the same region. Self-report information on the numbers of passengers carried and their ages at the time of crash or at the time of the roadside survey, as well as potential confounding factors, was obtained from the drivers, or a proxy, using an interviewer-administered questionnaire. A total of 571 cases (93% response rate), including 195 younger drivers (aged <25 years), and 588 controls (79% response rate), including 94 younger drivers participated in the study. After adjusting for other risk factors, the odds of car crash injury among younger drivers was 15.55 times (95% CI 5.76-42.02) for those who carried two or more same age passengers, and 10.19 times (95% CI 2.84-36.65) for those who carried two or more other age passengers, compared with unaccompanied drivers. In comparison, no increase in risk was observed for older drivers who carried two or more passengers regardless of age. The carriage of two or more passengers, irrespective of the ages of passengers, significantly increases the risk of car crash injury among younger drivers. Passenger restriction as part of the graduate licensing system was discussed in the light of these results. © 2003 Elsevier Science Ltd. All rights reserved.
Phin, SJ, McCaskill, ME, Browne, GJ & Lam, LT 2003, 'Clinical pathway using rapid rehydration for children with gastroenteritis', Journal of Paediatrics and Child Health, vol. 39, no. 5, pp. 343-348.View/Download from: Publisher's site
Objective: To determine in the Emergency Department (ED) the efficacy of a clinical pathway using rapid rehydration for children moderately dehydrated as a result of acute gastroenteritis. Methods: This was a prospective study using historical controls, set in the ED of the Children's Hospital at Westmead, NSW, Australia. Subjects were aged from 6 months to 16 years presenting with vomiting and diarrhoea for <48 h who were mildly or moderately dehydrated. The intervention was a clinical pathway involving rapid rehydration using N/2 saline + 2.5% dextrose intravenously at 20 mL/kg per h for 2 h, or Gastrolyte R (Aventis Pharma, Lane Cove, NSW, Australia) via nasogastric tube at the Same rate. There were 145 children in the prospective intervention group and 170 in the historical control group. The outcome measures were admission rate, percentage of patients discharged from the ED in 8 h or less, rate of re-presentations within 48 h requiring admission, and rate of procedures with intravenous cannula or nasogastric tube. Results: In the moderately dehydrated children, significant reductions were observed in the admission rate and the number discharged in 8 h or less in the intervention group compared with the control group, with no significant difference in the rate of re-presentation and the rate of procedures. In the moderately dehydrated children in the intervention group, the admission rate was 29 of 52 (55.8%) compared with the controls 26 of 27 (96.3%) (P < 0.001) and the number discharged in 8 h or less was 23 of 52 (44.2%) compared with 1 of 27 (3.7%) in the controls (P < 0.01). Conclusion: The clinical pathway utilizing rapid rehydration in children moderately dehydrated from gastroenteritis is effective in reducing admission rates and lengths of stay in the ED.
Ross, FI, Elliott, EJ, Lam, LT & Cass, DT 2003, 'Children under 5 years presenting to paediatricians with near-drowning', Journal of Paediatrics and Child Health, vol. 39, no. 6, pp. 446-450.View/Download from: Publisher's site
Objective: To characterize children aged under 5 years who present to paediatricians following near-drowning and the circumstances surrounding the event, identify high-risk groups and document short-term outcome. Methodology: Monthly notifications to the Australian Paediatric Surveillance Unit (an active, national surveillance system) between 1994 and 1996. Collection of additional case information from reporting doctors by postal questionnaire. Results: All 169 reported cases of near-drowning were admitted to hospital (mean (SD) stay 6 (17) days) and 15% required intensive care (mean (SD) stay 19 (32) days). The mean (SD) age for near drowning was 26 (13) months and 22% children were aged between 12 and 18 months. Males predominated (1.6:1) and 69 (41%) of episodes occurred in summer (December - February). The majority (82%) of near-drownings occurred in the child's home, usually in a swimming pool or bath. Children who nearly drowned at home were significantly younger than those who nearly drowned in natural waterways or public pools. Neurological damage at discharge following near-drowning was reported in 7%. Conclusions: Children reported in this national case series represent the severe end of the spectrum of those who nearly drown, as indicated by their presentation to a paediatrician, universal hospitalization and adverse neurological outcome. The home is the site of most near-drownings and males and toddlers were at particular risk. Unimpeded access to pools and lack of supervision were identified as potentially modifiable factors for prevention. The study suggests the need for additional community education regarding the risks of near-drowning and for further research on long-term neuro-developmental outcomes following near-drowning.
Browne, GJ & Lam, LT 2002, 'Isolated extradural hematoma in children presenting to an emergency department in Australia', Pediatric Emergency Care, vol. 18, no. 2, pp. 86-90.View/Download from: Publisher's site
Background: Isolated extradural hematoma (EDH) is becoming more frequently recognized in emergency departments (EDs) in children. We describe the natural history of children with isolated EDH presenting to a large Children's Hospital ED. Methods: This is a descriptive case series study using a retrospective review of the medical records of children presenting to the ED with a diagnosis of isolated EDH over 8 years. Comparison was made with children having other injuries in addition to EDH. The cause, nature of injury, presentations to hospital, management, outcome, and any association with nonaccidental injuries (NAI) were analyzed. Results: Of the 35 cases with a final diagnosis of isolated EDH initially presenting to the ED, 70% were over 3 years of age (mean 6.6 years), and 60% were boys. A fall of less than half a meter was the cause of isolated EDH in 51.4% of patients. The remaining cases resulted from a fall from a height greater than half a meter (17.1%), a motor vehicle accident (11.4%), being hit by an object (8.6%), a bicycle accident (5.7%), and a skateboard accident (5.7%). Children younger than 3 years presented within 24 hours of injury in 70% of cases, compared with 65% of older children. In 95% of cases, presentation was nonspecific, suggesting a medical rather than a surgical problem. This resulted in a delay in seeking emergency care and a delay in final diagnosis for these patients. Surgical drainage was required in 68.6% of cases, with older children being more likely to be managed conservatively. In 23.4% of cases, minor residual neurologic deficit occurred; there were no cases of serious long-term problems. There were no cases of NAI in the children studied. Conclusion: This report highlights falls as a common cause of isolated EDH in children. Delay in presentation for clinical assessment is common, because many children have nonspecific presentation that is suggestive of a medical problem. No cases of NAI were reported in this study.
Cheng, NG, Browne, GJ, Lam, LT, Yeoh, R & Oomens, M 2002, 'Spacer compliance after discharge following a mild to moderate asthma attack', Archives of Disease in Childhood, vol. 87, no. 4, pp. 302-305.View/Download from: Publisher's site
Aim: To assess MDIS usage in patients discharged from a children's hospital emergency department following a mild to moderate asthma attack. Methods: Prospective observational study of 73 consecutive patients presenting to a children's hospital emergency department with a mild to moderate asthma attack. Demographic data, whether asthma literature/written MDIS instructions were provided, and who provided MDIS instructions (either a discharge coordinator or other emergency department staff) were noted. Parents of patients were telephoned after the first week following discharge and questioned about patient improvement, MDIS use/reasons for not using MDIS, and unscheduled presentations to their local doctor or hospital. Results: Following discharge, 50/73 (68.5%) patients used MDIS exclusively (compliers), while 23/73 used nebulisers some or all of the time (non-compliers). There was no difference in patient improvement or unscheduled presentations between compliers and non-compliers. Most non-compliers 14/23 (60.9%) changed because of parental preference; ease of nocturnal nebuliser use was a possible factor. Compliance was associated with the age of the patient, spacer usage at hospital, the size of device used at hospital, and whether an information fact sheet was given. Conclusions: Most children discharged from the emergency department following a mild to moderate asthma attack continue MDIS use exclusively in the first week. MDIS compliance may be associated with knowledge, experience, and ease of spacer usage. The study shows that education for parents is crucial for MDIS compliance.
Chin, R, Browne, GJ, Lam, LT, McCaskill, ME, Fasher, B & Hort, J 2002, 'Effectiveness of a croup clinical pathway in the management of children with croup presenting to an emergency department', Journal of Paediatrics and Child Health, vol. 38, no. 4, pp. 382-387.View/Download from: Publisher's site
Objective: The aim of this study was to evaluate the safety and effectiveness of a clinical pathway for croup in an emergency department (ED). Methodology: This before-and-after intervention study on all consecutive children aged 6 months to 10 years who presented to our ED with moderate/severe croup was conducted over a 6-month period. Children with a clinical croup score (CSS) of 2 or more and resting stridor were considered eligible for entry into the study. Children were treated with either oral dexamethasone, or a combination of oral dexamethasone suspension and nebulized adrenaline. Children were clinically assessed, observed in the emergency short-stay ward and discharged or admitted according to the clinical pathway. The following outcomes were measured: admission rates, hospital re-presentation, length of stay, and adverse clinical events. Children in the post-intervention group were followed up by telephone within 48 h of discharge. Results: There were 157 patients recruited in the pre-intervention group and 110 in the post-intervention group. Significant reductions were reported in the length of stay (18.9 h compared with 5.2 h), hospital admission (52.9% compared with 18.0%) and intensive care admission (10.2% compared with 0.0%) after the introduction of the croup clinical pathway. No children in the study experienced an adverse clinical event. Follow-up interviews of parents indicated that the new treatment strategy was well received. Conclusion: The use of the croup clinical pathway in the ED is safe and effective in guiding consistent management, resulting in reduced admission rates, earlier discharge home, and no reported adverse events.
Lam, LT 2002, 'Attention Deficit Disorder and hospitalization due to injury among older adolescents in New South Wales, Australia', Journal of Attention Disorders, vol. 6, no. 2, pp. 77-82.View/Download from: Publisher's site
The association between Attention Deficit Disorder (ADD) and injuries among children has long been studied. More recently, research interest has extended to the long-term consequences of childhood ADD in adolescents and young adults, mainly focusing on motor vehicle-related accidents, but not other injuries. Very little work has investigated the associations between individual characteristics, type of injuries, outcomes, and the diagnosis of ADD upon admission of injured patients to a hospital. To investigate these associations, this study used a population-based epidemiological design that analyzed data routinely collected on patients hospitalized due to injuries. Results showed that younger, male, and more socioeconomically disadvantaged patients were more likely to be diagnosed with ADD upon admission. Significant association between different causes of injuries, in particular self-inflicted injuries, and diagnosis of ADD were also found. Patients diagnosed with ADD stayed in the hospital longer than others regardless of the cause of their injury. These results illustrate clearly that ADD is underrecognized among injured patients upon admission to hospitals. Information on the ADD status of injured patients is important for treatment decision making. A screening tool should be developed for assessing all injured patients upon admission to hospitals. Copyright © 2002 Multi-Health Systems Inc.
PROBLEM: Motor-vehicle accidents are one of the major causes of injury in most motorized countries. Driver distractions have been suggested as a contributor to traffic accidents. Moreover, age of the driver seems to have a role in the relationship between distractions and car crashes. But very few studies have investigated the effect of driver's age on this relationship. This exploratory study investigated the association between distractions, both inside and outside the vehicle, and the increased risk of car crash injury among drivers across different ages. METHOD: This study used a case series design to analyze data routinely collected by the NSW police in Australia. A special focus of this study was on how drivers' age affects the risk of car crash injury, which was determined by using a well-documented risk estimation methodology. RESULTS: The results obtained indicated that drivers of all ages, on the whole, are more susceptible to distractions inside the vehicle than distractions coming from outside. Age was shown to affect the relationship between in-vehicle distraction and the risk of car crash injury. A separate analysis was also conducted on hand-held phone usage while driving with results supplementing previous findings reported in the literature. IMPACT TO INDUSTRY: Safety strategies to countermeasure in-vehicle distractions have been suggested and discussed.
Rainbow, J, Browne, GJ & Lam, LT 2002, 'Controlling seizures in the prehospital setting: Diazepam or midazolam?', Journal of Paediatrics and Child Health, vol. 38, no. 6, pp. 582-586.View/Download from: Publisher's site
Objective: To determine which is the most effective and safe treatment for controlling seizures in children out-of-hospital: diazepam or midazolam. Methods: A retrospective review of the medical records of children presenting to the Emergency Department of the Children's Hospital at Westmead (CHW-ED) with seizures requiring treatment in the field by paramedics was carried out over a 4-year period (April 1996 to March 2000). In New South Wales, children with seizures in the prehospital setting received 0.5 mg/kg per rectum (p.r.) or 0.1 mg/kg i.v. diazepam until March 1998 and from March 1997 onwards they received 0.15 mg/kg i.m. or 0.1 mg/kg i.v. midazolam. The main outcome measured was cessation of seizure in the prehospital setting. Secondary outcomes were time taken to initiate treatment and the frequency of cardiorespiratory compromise. Results: Over the 4-year period, 2566 children presented to CHW-ED with a seizure; 107 children were eligible for entry into the present study. Of these 107 patients, 62 received diazepam and 45 received midazolam. Thirty-one (50.0%) in the diazepam group and 15 (33.3%) in the midazolam group were febrile seizures. Both groups were similar in terms of demographics and seizure type. A comparison of diazepam with midazolam showed that both drugs were effective in stopping seizures within 5 min of drug administration (37.1% cf. 51.1%). Fewer patients in the midazolam group suffered apnoea (20.0% cf. 29.0%; P < 0.05). Conclusion: Midazolam controls seizures as effectively as diazepam in the prehospital setting. Furthermore, midazolam potentially reduces respiratory depression and time to treatment.
Browne, GJ, Giles, H, McCaskill, ME, Fasher, BJ & Lam, LT 2001, 'The benefits of using clinical pathways for managing acute paediatric illness in an emergency department', Journal of Quality in Clinical Practice, vol. 21, no. 3, pp. 50-55.View/Download from: Publisher's site
The aim of this study was to provide an evaluation of the overall effectiveness of using a number of clinical pathways in treating common acute paediatric conditions in an emergency department. This was a before and after study conducted on the effectiveness of three clinical pathways (gastroenteritis, asthma, and croup) in the emergency department of the Children's Hospital at Westmead, conducted over two separate yearly periods January to December 1996 and January to December 1999 representing before and after the introduction of clinical pathways in the emergency department. The main outcomes of the effectiveness of the pathways, namely admission to an in-patient bed, length of hospital stay and re-presentation after discharge from the ED were compared. Other outcomes of interest such as parental satisfaction and patient waiting times were also presented. Any deviation from a key clinical pathway process was reported. A total of 2854 children were managed by a clinical pathway compared to 2680 children managed before clinical pathways were introduced. The admission rate was reduced by threefold (9.1% compared to 23.6%) with a twofold reduction in length of hospital stay (32.7 h compared to 17.5 h). In 3.6% of children using a clinical pathway an unscheduled medical visit or re-presentation to the emergency department occurred after discharge, compared to 4.9% before the use of clinical pathways. No adverse events were reported in these children. In 76 cases deviation from a clinical pathway process was reported. High parental satisfaction was reported for clinical pathways throughout the study. Clinical pathways in this emergency department allowed rapid stabilisation of children, reducing admission rate, with a shortened length of hospital stay and few patients re-presenting after discharge and were well accepted by parents.
Browne, GJ, McCaskill, ME, Giles, H, Lam, LT, Fasher, BJ & Exley, B 2001, 'Paediatric walk-out patients: Characteristics and outcomes', Journal of Paediatrics and Child Health, vol. 37, no. 3, pp. 235-239.View/Download from: Publisher's site
Objective: To investigate the characteristics and outcomes of patients who walked out from a tertiary children's hospital emergency department (ED) without seeing a medical officer. Methods: A prospective study of patients who walked-out from the ED of a children's hospital, without seeing a medical officer. Information collected at triage included demographics, presenting problems, time of arrival, time of departure and reason for leaving. Charts were reviewed and those at high risk of serious illness or adverse outcome were contacted by telephone within 24 h. Further information collected during follow up included outcome, such as adverse events and admission to hospital. Data were analysed by comparing the walk-out and non-walk-out groups with regard to demographic variables, presenting problems and outcomes. Results: Over a 29 week period, 1037 (5.5%) patients walked out from the ED of the hospital without seeing a medical officer. Comparisons between the walk-out and non-walk-out patients indicated no differences in terms of demographics. However, significant differences were found between the triage categories, presenting problems and arrival time. Of these, 829 (79.9%) were followed up by telephone. This revealed the predominant presenting problem was non-urgent and infectious in nature and no adverse events occurred. The admission rate for walk-out patients (1.5%) was significantly lower in comparison with the non-walk-out group (6.9%; odds ratio 0.2; 95% confidence interval 0.1-0.3). Walk-out patients who were eventually hospitalized had a shorter mean length of stay than non-walk-out patients (20.4 vs 34.8 h, respectively; t = 17.78, P < 0.0001). Conclusions: Medical resources are limited and, therefore, some extended waiting in the ED is necessary. Paediatric patients who walk-out of the ED without seeing a medical officer have simple illnesses that resolve without medical intervention or adverse events.
Lam, LT 2001, 'Factors associated with parental safe road behaviour as a pedestrian with young children in metropolitan New South Wales, Australia', Accident Analysis and Prevention, vol. 33, no. 2, pp. 203-210.View/Download from: Publisher's site
A cross-sectional population-based randomised telephone survey of parents with children aged between 5 and 12 years was conducted to investigate factors associated with safe road behaviour of parents as pedestrians with their young children in Sydney metropolitan and near by cities in New South Wales, Australia. Parental perception of the road environment as hazardous associated significantly with their safe road behaviour as pedestrian while with their children. This held true even after adjusting for the non-English speaking background and the age of the child. Knowledge of road rules, on the other hand, was not associated with parental safe road behaviour. The results of this study suggested that parental safe road behaviour require much attention in future research and in programme development. The perception of the road environment is a very important factor in motivating safe road behaviour. This should be taken into consideration in designing road safety campaigns. © 2001 Elsevier Science Ltd.
Problem: Pedestrian injury is a major hazard to the health of children in most developed countries, including Australia. In a previous study it was found that parental road risk perception is a significant factor associated with their modeling of safe behavior as pedestrians. This study aimed to investigate factors that affect parental road risk perception. Method: This cross-sectional population-based randomized telephone survey aimed to study factors associated with risk perception on pedestrian road safety among parents with young children aged 4-12 years. Results: Five factors were found to be significantly associated with parental risk perception. They included age of child, sex of parent, employment of parent, living environment, and previous injury experience. The results suggested that the age of the child contributed greatest to the variance explained by the regression model. However, other factors remained significant even after adjusting for each other. Discussion: Results were discussed in light of the design and development of childhood pedestrian road safety campaigns. Impact on industry: Parental risk perceptions determine their safe road modeling behavior. In this study, significant factors that affect parental road risk perception have been identified. The information obtained can be used in the design of road safety programs that aim at changing the road risk perception of parents. © 2001 National Safety Council and Elsevier Science Ltd.
Browne, G, Lam, L, Giles, H, Mccaskill, M, Exley, B & Fasher, B 2000, 'The effects of a seamless model of management on the quality of care for emergency department patients', Journal of Quality in Clinical Practice, vol. 20, no. 4, pp. 120-126.View/Download from: Publisher's site
The aim of this study was to examine the effectiveness of the seamless model of management on the quality of care for emergency department (ED) patients. This was a pre- and postintervention study of comparing post intervention data with the baseline on several variables of interest. The intervention was the seamless model of ED management, designed and implemented as a response to the challenge of increasing work load at the ED. Information on patients' waiting times, critical care performance, patients' satisfaction and staff morale was collected at baseline and postintervention for comparison. The results indicated significant improvements on all outcome measures were found postintervention. The average waiting time reduced by 40%, from 92.1 to 55.3 min, as well as the time to craniotomy from 120 to 45 min for more severe patients. Complaints from patients were reduced by 80% and staff morale had improved with a 48% reduction in sick days and a 80% reduction in staff resignations. Ambulatory patients presenting to the department saw a 20% improvement in their waiting time. We report a successful restructuring process that used routinely collected clinical and administrative data to highlight problems. Using these data and through a systematic planning process, appropriate strategies for restructuring were developed by emergency staff in partnership with the hospital executive. Significant improvements in waiting time and patient care were clearly demonstrated.
Cass, D, Ross, FI, Gowdie, C, Lam, LT & Holland, AJA 1999, 'Perils in the nursery ', Medical Journal of Australia, vol. 171, no. 6, p. 332.
Lam, LT, Ross, FI & Cass, DT 1999, 'Children at play: The death and injury pattern in New South Wales, Australia, July 1990 - June 1994', Journal of Paediatrics and Child Health, vol. 35, no. 6, pp. 572-577.View/Download from: Publisher's site
Objectives: To describe and to understand the pattern of play-related deaths and injury (excluding organized sports) among children in New South Wales (NSW), Australia. Methodology: This study utilized a state-wide prospective surveillance data collection of paediatric traumatic deaths and injuries at the Royal Alexandra Hospital for Children. Deaths and injury cases were selected from the NSW Trauma Death Registry and Childsafe NSW database. Information including basic demographics, the surrounding circumstances of death and injury incidents, and the required treatment was collected. Results: There were 30 play-related deaths and 92 drownings over the 4-year period. The male to female ratio was about 2:1. Excluding drowning, which has been reported elsewhere, and sports, the leading causes of play-related deaths were burns (eight) and asphyxiation (eight). An average of 6444 presentations to the emergency departments per year were recorded with sex ratio and age distribution pattern similar to the deaths. The home was the most common place (55.5%) of play-related injury, specifically the living and sleeping area. Falls, both under and above 1 metre, were the most common causes of injury (50.9%). The leading mechanism was cuts and lacerations (21.2%). Nearly one-third (32.7%) of all injuries were to the head, with face, cheek, forehead and scalp as the most common injured body part. Significant associations between place of injury, injured body parts and age were observed. Conclusions: Play-related injury is common among children, and in some cases causes severe injury and death. To tackle the problem of play-related deaths and injuries, a holistic approach is suggested. This includes the provision of a safe environment, supervision by parents, education of children and detailed data collection.
Lam, LT, Ross, FI, Cass, DT, Quine, S & Lazarus, R 1999, 'The impact of work related trauma on the psychological health of nursing staff: a cross sectional study.', The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation, vol. 16, no. 3, pp. 14-20.
This study aims to investigate the effects of work-related trauma exposure on the health of nursing staff in hospitals. The survey was conducted using a randomised sample of 314 nurses. Half (52.2%, n = 189) of staff surveyed had multiple exposures to different kinds of trauma. Results on the General Health Questionnaire (GHQ) and Beck's Depression Inventory--Revised (BDI-R) suggested that nearly 40% of staff experienced poor health, while nearly 10% experienced moderate to severe depression. Results of the logistic analyses, after adjusting for confounders, suggested that high and long term trauma exposure is detrimental to the mental health of nurses. These findings indicate that hospital nursing staff, in particular those who have high exposure to trauma, are in urgent need of support services such as debriefing and counselling.
Cass, DT, Ross, F & Lam, L 1996, 'School bus related deaths and injuries in New South Wales', Medical Journal of Australia, vol. 165, no. 3, pp. 134-137.
Objective: To report the circumstances of paediatric bus related deaths and injuries in New South Wales (NSW) to identify preventable factors. Design: Retrospective survey using two surveillance systems - the NSW Paediatric Death Review Database and the Childsafe Injury Surveillance System. Patients: Children (0-14 years of age) who died or were injured as a result of a school bus related incident. Results: Twenty-two deaths and 58 injuries were recorded. Three of the children who died were passengers (two deaths were due to errant behaviour), two were alighting from the bus (bus door entrapment) and 17 (77%) were pedestrians crossing the road before or as the bus departed. The major causes of death were head injury and blood loss. Seventeen of the injured children were pedestrians and most (82%) of these sustained serious injury requiring admission to hospital. Conclusions: The greatest risk to schoolchildren from bus related injuries was as pedestrians after alighting from a bus, especially when moving behind the bus. Preventable factors include slowing of traffic (40 kph) near stationary school buses, and parents waiting on the side of the road where the child alights from the bus. Continuing road safety education remains important for schoolchildren and parents as well as for drivers.
Cass, DT, Ross, F & Lam, LT 1996, 'Childhood drowning in New South Wales 1990-1995: A population-based study', Medical Journal of Australia, vol. 165, no. 11-12, pp. 610-612.
Objective: To review the circumstances of children drowning in New South Wales (NSW), 1990-1995, and to analyse trends. Design: The NSW Paediatric Trauma Death Review Data Unit received coronial notification of childhood drowning deaths. Age-specific annual drowning rates per 100,000 population were calculated. Subjects: Children aged 0-14 years who died of drowning. Results: 132 children drowned (96 [73%] aged 0-4 years). There was was an overall decrease in incidence of drowning, from 2.0 to 1.5 per 100,000 population, and a decline in domestic pool drownings (from a peak of 15 in 1992 to five in 1995), and in drownings in waterways (from nine to six over the six-year period). However, drownings in baths and dams did not decrease. In general, boys were at higher risk than girls. Conclusions: Analysis of the drowning incidents indicates that, despite the decreases documented, we should not be complacent, and preventive programs are still warranted. All pools and darns should have well maintained fences between the body of water and the house. All infants aged under three and all epileptic children should be supervised in the bath by an adult. Children should be taught to swim, warned of the dangers of rivers and surf, and adequately supervised.
Lam, L 2017, 'The mental health literacy of internet addiction among adolescents: An initial measure development and validation' in Internet Addiction Prevalence, Risk Factors and Health Effects, Nova Science Publishers, USA, pp. 1-17.View/Download from: UTS OPUS
This study aims to describe the initial development and to investigate
the psychometric properties of an instrument for measuring the Mental
Health Literacy (MHL) of Internet Addiction (IA). The formation of the
items was based on the Australian National Survey of Mental Health
Literacy and Stigma Youth Survey. It was designed as a vignette-based
questionnaire depicting behavioural characteristics of a severe problem
with Internet usage. These symptomatic behaviours were based on the
description in the Young Internet Addiction Test (IAT). This newly
developed instrument was administered to 348 adolescents aged between
15-18 years randomly recruited from high schools in a large city.
Responses on the recognition of the problem from the vignette with the
recognition of another vignette depicting depression were compared. The
convergent validity of the intended action to seek help was investigated
using the Self-Stigma of Seeking Help Scale (SSOSH), and the personal
identification of the problem by the IAT. The results of this study
provided supporting evidence for the validity of the MHL of IA measure.
As the unique measure of the MHL of IA, this could play an important
role in understanding the level of MHL in the population of an emerging
area of psychiatric problem.
Lam, L 2016, 'Associations between Parental Problematic Internet Use and their children's Mental Health: A parent-child dyad Study' in Columbus, AM (ed), Advances in Psychology Research, Nova, USA, pp. 95-106.View/Download from: UTS OPUS
Background: Effect of parental Problematic Internet Use (PIU) on their children had
never been studied until recently. This study aimed to examine possible influence of
parental PIU on the mental health of their children.
Methods: This was a population-based parent-and-child dyad cross-sectional study
utilising a cluster random sampling technique with children aged between 13-17 years.
PIU for both parents and their children was measured by the Internet Addiction Test
(IAT). Mental health status, and stress level of children were assessed using the
Depression, Anxiety, Stress Scale (DASS). Data were analysed using logistic regression
modelling techniques to examine the relationship between parental PIU and child's
mental health status.
Results: Of the 1098 parent-and-child dyads, 263 (24.0%) students and 62 (5.7%)
parents could be classified as moderate and severe users. About 19% (n = 209) and 23%
(n = 251) of children exhibited moderate to severe symptoms of depression and anxiety
respectively. Logistic regression analysis results suggested a significant interaction
between parental PIU and children's stress level on child depression. Stratified regression
analyses by stress level resulted in a significant relationship between parental PIU and
depression in the low stress group (OR = 2.16, 95% C.I. = 1.05-4.43). On the other hand,
the association between parental PIU and depression in the high stress group, as well as
anxiety became insignificant.
Wan, GB & Lam, LT 2010, 'The Child Behaviour Scale Chinese (CBSC) - A Validation Study' in Psychological and Health-Related Assessment Tools Developed in China, pp. 1-9.View/Download from: Publisher's site
The Child Behaviour Checklist (CBCL), developed based on the conceptual framework of child developmental psychopathology proposed by Achenbach, has been considered as the most studied instrument in assessing child behavioural problems. For younger pre-school age children, a specific CBCL/1.5-5 has also been recently developed. However, this specific form of the CBCL has not been translated into Chinese, and thus not validated as a Chinese version. The Child Behaviour Scales-Chinese (CBSC) has been developed by researchers in China for the purpose of providing a useful behavioural assessment instrument for young pre-school children. Studies were conducted to evaluate the psychometric properties of the CBSC. Results obtained from the Confirmatory Factor Analysis indicated that 46 items were to be retained from the pool of 60 with a seven factor structure. Cronhach's Alpha values for both sexes and total provided evidence for good internal reliability with values ranging from 0.59 to 0.90. Correlations on all subscales between CBSC and CBCL suggested moderate to high concordance providing evidence for reasonable convergent validity. The ICC for all subscales and the total between repeated administrations of CBSC within a period of 4-6 weeks were significantly and moderately high ranging from 0.52 to 0.72. These preliminary results suggest that the CBSC is a valid instrument for assessing young pre-school children in China. Studies could be further conducted to provide more evidence on the externalisation and internalisation factors structure on which the design of the instrument has been based. © 2010 Bentham Science Publishers Ltd. All rights reserved.
Ferguson, C, Hickman, L, Phillips, J, Newton, P, Inglis, S, Lam, L & Bajorek, B 2017, 'An mHealth intervention to improve nurses' atrial fibrillation and anticoagulation knowledge and practice: the EVICOAG study', International Journal of Stroke, Stroke Society of Australasia, SAGE Publications, Queenstown, New Zealand, pp. 9-9.
Ferguson, C, Hickman, L, Phillips, J, Newton, P, Inglis, S, Lam, L & Bajorek, B 2017, 'Exploring the acute care registered nurses' contribution in anticoagulation decision making for stroke prevention in atrial fibrillation', International Journal of Stroke, Stroke Society of Australasia, SAGE Publications, Queenstown, New Zealand, pp. 48-48.
Lovell, M, Luckett, T, Phillips, J, Agar, M, Ryan, L, Lam, L, McCaffrey, N, Boyle, F, Stubbs, J, Shaw, T, Currow, D, Hosie, A & Davidson, P 2015, 'Clinical Trial Protocol - Implementing Clinical Practice Guidelines For Cancer Pain In Adults To Ensure Equitable, Cost-Effective, Evidence-Based, Person-Centred Care: A Phase III Pragmatic Stepped Wedge Cluster Randomised Controlled Trial Of Guidelines And Screening With Implementation Strategies Versus Guidelines And Screening Alone To Improve Pain In Adults With Cancer Attending Outpatients Oncology And Palliative Care Centres', Asia-Pacific Journal of Clinical Oncology, pp. 162-162.
Phillips, JL, Heneka, N, Lam, L & Shaw, T 2014, 'A complex Qstream (R) pain assessment intervention on cancer nurses' pain screening and assessment practices: results from a quasi-experimental study', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, pp. 136-136.
Phillips, JL, Heneka, N, Lam, LT & Shaw, T 2014, 'Multi-Centre Pre-Post Test Trial of a complex Qstream (C) pain assessment intervention on cancer nurses' pain screening and assessment practices', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, pp. 206-206.
Lam, LT 2005, 'Attention deficit disorder and hospitalization owing to intra- and interpersonal violence among children and young adolescents', Journal of Adolescent Health, pp. 19-24.View/Download from: Publisher's site
To investigate the associations between intra-and interpersonal violence and related injuries and the diagnosis of attention deficit disorder (ADD) among children and young adolescents. This was a population-based epidemiological study that analyzed data routinely collected on hospitalized patients owing to injuries. Data were obtained from the routinely collected inpatient statistics. Information included patients' demographics, diagnostic classifications of admitting problem, classification of external causes of injury, length of stay, and outcome of hospitalization. Patients with comorbidity of ADD were identified by the ICD-9CM diagnosis code. Data were analyzed univirately using Pearson Chi-square tests. Logistic regression analyses were also applied to calculate the adjusted odds ratio and their corresponding 95% confidence intervals. Significant associations between suicide and self-harm, injuries owing to assault, and diagnosis of ADD were found. Patients diagnosed with ADD stayed in the hospital longer than others, disregarding the cause of their injury. Children and adolescents with ADD are at risk of being victims of assaults, as well as suicide and self harm. Assessment for ADD can be considered as part of school-age childhood screening programs. © 2005 Society for Adolescent Medicine. All rights reserved.
Lawrence has been collaborating with colleagues of the following institutes around the world:
School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, CHINA
Department of Adolescence Medicine, The University of Hong Kong, Hong Kong SAR, CHINA
The Hong Kong Institute of Education, Hong Kong SAR, CHINA
Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, CHINA
School of Public Health, Guangxi Medical University, Guangxi, CHINA
Institute of Psychology and Behaviour, Henan University, Kaifeng, CHINA
Institute of Mental Health, Singapore
Center for Internet Addiction, St. Bonaventure University, US