21 research outputs found
Epidemiology of Infectious Diseases in Western Australia
I commenced the Master of Philosophy in Applied Epidemiology
(MAE) in February 2015. My field placements were shared between
the Communicable Diseases Control Directorate, Public Health
Division at the Western Australia Department of Health (CDCD) and
the Telethon Kids Institute (TKI), both located in Perth.
Two of the three projects that I completed at the CDCD involved a
statewide protracted mumps outbreak that went on for the duration
of my MAE and reached almost 900 cases. The epidemiology of this
outbreak including a discussion about vaccination is presented in
Chapter 1. This satisfies the outbreak investigation requirement
of the MAE.
Chapter 2 comprises a late draft manuscript that explores the
vaccine effectiveness (VE) of the measles-mumps-rubella vaccine
among paediatric cases during the mumps outbreak. I designed and
carried out a matched case-control study using paediatric
outbreak cases and controls from a population database. I
measured VE using a conditional logistic regression model and
compared it with the screening method. Both methods yielded a
very low VE this population. This is likely due to a multitude of
factors that are discussed in the chapter.
My work at TKI involved a data analysis using
linked-administrative data on a total population birth cohort
involving all children born in Western Australia between
1996-2012. I explored the burden of hospital separations that
resulted from otitis media (OM), the most common infectious
disease in children, and a common related procedure, myringotomy
with ventilation tube insertion (MVTI). I calculated the
age-specific hospitalisation rates for OM and MVTI over the study
years. The second part of this analysis involved investigating
the maternal and infant risk factors and population attributable
fractions for OM-related hospitalisation in early life. This work
was important because of its implications for practice. All of
this is presented in Chapter 3.
Chapter 4 is an evaluation of SmartVax, a novel, real-time
Adverse Events Following Immunisation (AEFI) surveillance system
using SMS text messages to communicate directly with vaccinees
after their vaccination. This was the third project that I
completed at the CDCD. The chapter begins with a peer-reviewed
publication, Continuous active surveillance of adverse events
following immunisation using SMS technology, that describes the
system and analyses data outputs for children <5 years from
2011-2015. I have included the publication first to provide a
brief system overview including summarised surveillance data, to
give context to the evaluation since SmartVax is a relatively new
and developing system. The publication is followed by the formal
evaluation.
Finally, I include a summary of the teaching exercises that I was
involved in during my MAE. The first was a “lesson from the
field” where I prepared an exercise for my fellow scholars. The
exercise was useful for me and the feedback from my colleagues
was positive. The second was a collaborative teaching exercise
about confounding that we taught to the first year MAE scholars
on their last day of courseblock.
These combined activities at both placements have enriched my
understanding of epidemiology while working in health and
research environments
Starting to smoke: a qualitative study of the experiences of Australian indigenous youth
BackgroundAdult smoking has its roots in adolescence. If individuals do not initiate smoking during this period it is unlikely they ever will. In high income countries, smoking rates among Indigenous youth are disproportionately high. However, despite a wealth of literature in other populations, there is less evidence on the determinants of smoking initiation among Indigenous youth. The aim of this study was to explore the determinants of smoking among Australian Indigenous young people with a particular emphasis on the social and cultural processes that underlie tobacco use patterns among this group. MethodsThis project was undertaken in northern Australia. We undertook group interviews with 65 participants and individual in-depth interviews with 11 youth aged 13–20 years led by trained youth ‘peer researchers.’ We also used visual methods (photo-elicitation) with individual interviewees to investigate the social context in which young people do or do not smoke. Included in the sample were a smaller number of non-Indigenous youth to explore any significant differences between ethnic groups in determinants of early smoking experiences. The theory of triadic influence, an ecological model of health behaviour, was used as an organising theory for analysis. ResultsFamily and peer influences play a central role in smoking uptake among Indigenous youth. Social influences to smoke are similar between Indigenous and non-Indigenous youth but are more pervasive (especially in the family domain) among Indigenous youth. While Indigenous youth report high levels of exposure to smoking role models and smoking socialisation practices among their family and social networks, this study provides some indication of a progressive denormalisation of smoking among some Indigenous youth. ConclusionsFuture initiatives aimed at preventing smoking uptake in this population need to focus on changing social normative beliefs around smoking, both at a population level and within young peoples’ immediate social environment. Such interventions could be effectively delivered in both the school and family environments. Specifically, health practitioners in contact with Indigenous families should be promoting smoke free homes and other anti-smoking socialisation behaviours
Continuous active surveillance of adverse events following immunisation using SMS technology
INTRODUCTION On-going post-licensure surveillance of adverse events following immunisation (AEFI) is critical to detecting and responding to potentially serious adverse events in a timely manner. SmartVax is a vaccine safety monitoring tool that uses automated data extraction from existing practice management software and short message service (SMS) technology to follow-up vaccinees in real-time. We report on childhood vaccine safety surveillance using SmartVax at a medical practice in Perth, Western Australia. METHODS Parents of all children under age five years who were vaccinated according to the Australian National Immunisation Schedule between November 2011 and June 2015 were sent an SMS three days post administration to enquire whether the child had experienced a suspected vaccine reaction. Affirmative replies triggered a follow-up SMS requesting details of the reaction(s) via a link to a survey that could be completed using a smartphone or the web. Rates of reported AEFI including fever, headache, fatigue, rash, vomiting, diarrhoea, rigours, seizures, and local reactions were calculated by vaccination time point. RESULTS Overall, 239 (8.2%; 95% CI 7.2-9.2%) possible vaccine reactions were reported for 2897 vaccination visits over the 44 month time period. The proportion of children experiencing a possible AEFI, mostly local reactions, was significantly greater following administration of diphtheria-tetanus-pertussis-poliomyelitis vaccine at 4 years of age (77/441; 17.5%; 95% CI 13.9-21.0%) compared to the vaccinations given at 2-18 months (p<0.001). Across all time points, local reactions and fatigue were the most frequently reported AEFI. CONCLUSION Automated SMS-based reporting can facilitate sustainable, real-time, monitoring of adverse reactions and contribute to early identification of potential vaccine safety issues.This work was supported by the Western Australia Department of Health
Talking About the Smokes: a large-scale, community-based participatory research project
Objective: To describe the Talking About The Smokes (TATS) project according to the World Health Organization guiding principles for conducting community-based participatory research (PR) involving indigenous peoples, to assist others planning large-scale PR projects.\ud
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Design, setting and participants: The TATS project was initiated in Australia in 2010 as part of the International Tobacco Control Policy Evaluation Project, and surveyed a representative sample of 2522 Aboriginal and Torres Strait Islander adults to assess the impact of tobacco control policies. The PR process of the TATS project, which aimed to build partnerships to create equitable conditions for knowledge production, was mapped and summarised onto a framework adapted from the WHO principles.\ud
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Main outcome measures: Processes describing consultation and approval, partnerships and research agreements, communication, funding, ethics and consent, data and benefits of the research.\ud
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Results: The TATS project involved baseline and follow-up surveys conducted in 34 Aboriginal community-controlled health services and one Torres Strait community. Consistent with the WHO PR principles, the TATS project built on community priorities and strengths through strategic partnerships from project inception, and demonstrated the value of research agreements and trusting relationships to foster shared decision making, capacity building and a commitment to Indigenous data ownership.\ud
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Conclusions: Community-based PR methodology, by definition, needs adaptation to local settings and priorities. The TATS project demonstrates that large-scale research can be participatory, with strong Indigenous community engagement and benefits
Quick List for capturing standardised photographs.
<p>This could be printed on a small card to be carried with the camera as a reminder to research assistants capturing images.</p><p>Quick List for capturing standardised photographs.</p
The camera settings and icons as used in the protocol (these icons and settings are standard across other popular camera models).
<p>In addition the rationale is provided on why these settings were adopted.</p
Capturing the image using the study camera, grey background, and grey scale in a remote context.
<p>The individuals in this image have given written informed consent to publish this image.</p
Definitions used for final outcome scoring of digital images of impetigo.
<p>Definitions used for final outcome scoring of digital images of impetigo.</p
Database form used for Quality Control check by medical photographer.
<p>Database form used for Quality Control check by medical photographer.</p