Use of data linkage to improve communicable disease surveillance and control in Australia: Existing practices, barriers and enablers

Objectives: To review the use of data linkage by Australian state and territory communicable disease control units, and to identify barriers to and enablers of data linkage to inform communicable disease surveillance and control activities.Methods: Semi-structured telephone interviews were carried out with one key informant from communicable disease control units in all eight Australian states and territories between October 2017 and January 2018.Results: Key informants from all Australian states and territories participated in the interview. A variety of existing practices were identified, with few jurisdictions making systematic use of available data linkage infrastructure. Key barriers identified from the review included: a lack of perceived need; system factors; and resources. Existing regulatory tools enable data linkage to enhance communicable disease surveillance and control.Conclusions: We identified considerable variation in the use of data linkage to inform communicable disease surveillance and control activities between jurisdictions. We suggest that routinely collected, disparate data are systematically integrated into existing surveillance and response policy cycle to improve communicable disease prevention and control efforts.Implications for public health: Existing gaps in communicable disease surveillance data may affect prevention and control efforts. Data linkage is recognised as a valuable method to close surveillance gaps and should be used to enhance the value of publicly held health data

Application of natural and modified biomacromolecules in miniaturised separative analytical techniques

In pharmaceutical R & D, drug stereochemistry, and consequently the rotation of enantiomers, is very important. Because they act as chiral selectors in vivo, biomacromolecules have been extensively used as chiral selectors for the liquid chromatographic (LC) resolution of enantiomers and more latterly have also been employed in the newer separative technique, capillary electrophoresis (CE). However, at the outset of this research programme, this had generally been restricted to common easily accessible biomacromolecules such as plasma-binding proteins. It was clear that it be would be useful therefore to adapt LC and CE in such a way as would allow the use of a much wider range of biomacromolecules. Accordingly the general aim of this study was to develop LC and CE protocols involving biomacromolecules that would give rise to minimum consumption of the biomacromolecule. To study biomacromolecules in free solution CE, a number of experimental variables had to be established for both optimum chiral discrimination and for investigating biomacromolecule-ligand interactions. The typical and widely used biomacromolecule for chiral discrimination, bovine serum albumin (BSA) was used to study the variables of pH from pH 5.4 to 8.4, concentration of BSA form 0 to 60 mM and concentration of organic modifiers in the range 0 – 20 % v/v for chiral selectivity. This involved an investigation into some unusual artefacts such as ghost peaks and stepped baselines, but ultimately the outcome was a successful free solution CE protocol suitable for the rapid evaluation of chiral discrimination of other biomacromolecules. The conditions were: run buffer (30 mM protein, 67 mM phosphate (pH 7.4) – methanol (97.5 : 2.5, v/v)), capillary CElect p150, 40 cm (35 cm to detector) x 50 mm i.d., temperature of ambient or 25 °C and an applied voltage of 10 kV. The ability of other biomacromolecules, such as human serum albumin (HSA), lactoferrin and protamine, to resolve enantiomers was studied using this protocol including looking at the effect of the addition of modifiers to the buffer such as metal ions like manganese and zinc, competing ligands, e.g. warfarin and ibuprofen, and b-cyclodextrin. As well as using CE, miniaturisation of LC was also studied in view of the success of biomacromolecule-affinity chiral LC. Two different, but similar, microbore LC protocols were employed, i.e. using the protein in free solution or as a pseudo stationary phase. For the former, a Lichrosorb DIOL stationary phase, based on hydroxyl groups immobilised on silica, was chosen in order to minimise the adsorption of protein to the stationary phase. Using this protocol it was demonstrated that free solution microbore LC could be easily be carried out, therefore used to evaluate chiral discrimination and that the use of the system to study in vivo interactions was feasible. The creation of a biomacromolecule pseudo stationary phase, as opposed to conventional chiral stationary phases where the protein is permanently bonded to the stationary phases, involves the biomacromolecule being adsorbed within the pores of the stationary phase. In this way the overall biomacromolecule structure should not be grossly distorted. Three stationary phases were evaluated, viz wide-pore Nucleosil silica, Nucleosil C8 and Lichrosorb DIOL, for optimum biomacromolecule loading and minimal biomacromolecule leakage when mobile phase was pumped through the column. The Nucleosil silica with adsorbed BSA proved the most successful, e.g. a of 3.6 and 4.0 for tryptophan and kynurenine respectively, and robust of the stationary phases with respect to demonstrating the chiral discrimination potential for this system. All the miniaturised systems evaluated were successful, to a greater or lesser degree, for the demonstration of chiral selectivity of biomacromolecules. While CE was better for minimisation of the consumption of the biomacromolecule, it was also important that the biomacromolecule LC systems could be operated in reduced dimensions since these systems have perhaps greater potential for exhibiting enantioselectivity and are more appropriate for the ever increasing need for the study of the interaction of ligands with the biomacromolecule in its ‘natural’ form. With the knowledge gained from this research programme it will now be possible to more easily carry out such studies with much smaller amounts of biomacromolecule, and, accordingly be able to work with biomacromolecules which hitherto it has not been possible to study because of limited availability. While some of the protocols have now been superseded by recent developments the system developed still has potential. The use of such small scale systems offers the potential to study chiral selectivity and drug-biomacromolecule binding of rare or expensive biomacromolecules.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Early discontinuation of endocrine therapy for breast cancer: Who is at risk in clinical practice?

Purpose: Despite evidence supporting at least five years of endocrine therapy for early breast cancer, many women discontinue therapy early. We investigated the impact of initial therapy type and specific comorbidities on discontinuation of endocrine therapy in clinical practice. Methods We identified women in a population-based cohort with a diagnosis of early breast cancer and an incident dispensing of anastrozole, letrozole or tamoxifen from 2003-2008 (N = 1531). Pharmacy and health service data were used to determine therapy duration, treatment for pre-existing and post-initiation comorbidities (anxiety, depression, hot flashes, musculoskeletal pain, osteoporosis, vaginal atrophy), demographic and other clinical characteristics. Time to discontinuation of initial, and any, endocrine therapy was calculated. Cox regression determined the association of different characteristics on early discontinuation. Results Initial endocrine therapy continued for a median of 2.2 years and any endocrine therapy for 4.8 years. Cumulative probability of discontinuing any therapy was 17% after one year and 58% by five years. Initial tamoxifen, pre-existing musculoskeletal pain and newly-treated anxiety predicted shorter initial therapy but not discontinuation of any therapy. Early discontinuation of any therapy was associated with newly-treated hot flashes (HR = 2.1, 95%CI = 1.3-3.3), not undergoing chemotherapy (HR = 1.4, 95%CI = 1.1-1.8) and not undergoing mastectomy (HR = 1.5, 95%CI = 1.2-1.8). Conclusions Less than half of women completed five years of endocrine therapy. Women at greatest risk of stopping any therapy early were those with newly-treated hot flashes, no initial chemotherapy, or no initial mastectomy. This suboptimal use means that the reductions in recurrence demonstrated in clinical trials may not be realised in practice

Using linkage between hospital and ABS mortality data to enhance reporting of deaths among Aboriginal and Torres Strait Islander peoples

Objective: To investigate the potential of record linkage between the Australian Bureau of Statistics (ABS) mortality data and the NSW Admitted Patient Data Collection (APDC) to improve reporting of deaths among Aboriginal and Torres Strait Islander peoples. Methods: ABS mortality data for 2002 to 2006 were linked with APDC records for 2001 to 2006. Six algorithms were developed to enumerate deaths. Possible biases by age, sex and geographic remoteness were investigated. Results: Levels of reporting ranged from baseline reporting on the ABS mortality data to the largest enhancement with the ‘ever reported as Aboriginal or Torres Strait Islander’ algorithm. Enhancement was more likely in females, older people and residents of major cities. Conclusions: Data linkage substantially improved reporting of Aboriginal and Torres Strait Islander deaths. An algorithm that includes both the number of APDC records and the number of facilities reporting a person as Aboriginal or Torres Strait Islander was considered most promising. Implications: Inclusion of other datasets in the enhancement process is warranted to further improve reporting and address possible bias produced by using APDC records only. Further work should take into account the possibility that a person may be falsely reported as Aboriginal or Torres Strait Islander or not reported in either hospital or death records.6 page(s