Delia Hendrie

A 26-Year Population-Based Study of Burn Injury Hospital Admissions in Western Australia

The aim of the study was to use state-wide health administrative data to assess the incidence, temporal trends, and external cause of burn injury-related hospital admissions and mortality in Western Australia from 1983 to 2008. Linked hospital morbidity and death data for all persons hospitalized with an index burn injury in Western Australia for the period 1983–2008 were identified. Annual age-specific incidence and age standardized rates were estimated. Poisson regression analyses were used to estimate temporal trends in hospital admissions and mortality. Zero-truncated negative binomial regression analysis was used to identify factors associated with hospital length of stay. From 1983 to 2008, there were 23,450 hospitalizations for an index burn injury. Hospital admission rates declined by an average annual rate of 2% (incidence rate ratio [IRR], 95% confidence interval [CI] = 0.983, 0.981–0.984), and burn-related mortality declined by an average annual rate of 2% (IRR, 95% CI = 0.98, 0.96–1.01). Aboriginal people while having significantly higher hospitalization rates than non-Aboriginal people experienced a greater 26-year decline in hospitalizations of 58% (IRR, 95% CI = 0.42, 0.37–0.48) compared with 32% (IRR, 95% CI = 0.68, 0.65–0.71) for non-Aboriginal people. Children younger than 5 years, 20- to 24-year-old men, and adults older than 65 years remain at high risk for burn injury, and males continue to be hospitalized twice as frequently as females. The results demonstrate declines in burn injury hospitalizations and mortality in both Aboriginal and non-Aboriginal populations. Continued research is required of the impacts of medical interventions and the burn pathway of identified high-risk populations.

A prospective study of the costs of falls in older adults living in the community

Objective:To establish the hospital cost and three‐month, post‐hospital community and personal costs associated with older adults discharged to the community after a fall. The timing, incidence and the determinants of these costs to the various sectors were also examined.

Unequal Access To Breast-Conserving Surgery In Western Australia 1982–;2000

Background:  The purpose of the present study was to examine the effects of demographic, locational and social disadvantage and the possession of private health insurance in Western Australia on the likelihood of women with breast cancer receiving breast‐conserving surgery rather than mastectomy.

A study of burn hospitalizations for children younger than 5 years of age: 1983-2008

OBJECTIVE: Burn injury is a leading cause of emergency department visits and hospitalizations for young children. We aimed to use statewide linked health administrative data to evaluate the incidence, temporal trends, and cause of burn injuries for children younger than 5 years hospitalized for burn injuries in Western Australia for the period 1983–2008. METHODS: Epidemiologic analysis of linked hospital morbidity and death data of children younger than 5 years hospitalized with an index burn injury in Western Australia for the period 1983–2008. Poisson regression analyses were used to estimate temporal trends in hospital admissions and the external cause of the burn injury. RESULTS: From 1983 to 2008, there were 5398 hospitalizations for an index burn injury and 3 burn-related deaths. Hospital admission rates declined by an average annual rate of 2.3% (incidence rate ratio: 0.977 [95% confidence interval: 0.974–0.981]). More than half of the admissions were for scald burns. Hospitalizations declined for injury caused by scald, flame, contact, and electrical burns; however, the number of hospital admissions increased for chemical burns during the study period. CONCLUSIONS: The burn-injury hospitalizations reported in this study were preventable. Most burns occurred in the home and resulted from exposure to a household hazard. Further effort needs to be devoted to burn prevention and safety strategies, particularly in relation to scalds, to further reduce the incidence of burn injury in young children.

The influence of socio-economic and locational disadvantage on survival after a diagnosis of lung or breast cancer in Western Australia

Objectives The effects of demographic, locational and socio-economic disadvantage, and the influence of private health care on five-year mortality rates in patients with lung cancer or after breast cancer surgery in Western Australia were examined. Methods The Western Australian Record Linkage Project was used to extract all hospital morbidity, cancer and death records of all people with lung or breast cancer in Western Australia from 1982 to 1996. Mortality rate ratios after a diagnosis of lung cancer or breast cancer surgery were estimated using Cox regression. Two sets of analyses were carried out: demographically adjusted from 1982 to 1996; and demographically and disadvantage adjusted from 1992 to 1996. Results Overall, 87.7% of lung cancer and 17.8% of breast cancer patients were deceased by five years. Lung and breast cancer patients treated in rural hospitals had higher mortality rates (1992-1996: relative risk (RR) 1.24, 95% confidence interval (CI) 1.07-1.44, and RR 1.20, 95% CI 0.92-1.56, respectively; 1982-1996: RR 1.20, 95% CI 1.11- 1.30, and RR 1.19, 95% CI 1.06-1.33, respectively), whereas location of residence had little effect. Lung and breast cancer patients treated in private hospitals had lower mortality (1992-1996: RR 0.85, 95% CI 0.76-0.95, and RR 0.90, 95% CI 0.77-1.05, respectively; 1982-1996: RR 0.91, 95% CI 0.84-0.97, and RR 0.92, 95% CI 0.85-0.99, respectively), although insurance status was not a factor. Women with breast cancer had significantly worse survival in the more socio-economically disadvantaged groups (1992-1996: RR 1.41 to 1.26; 1982-1996: RR 1.45 to 1.29). Conclusions Survival was poorer in patients treated in the public hospital system, but the possession of private health insurance was not predictive of better outcomes. People treated in rural hospitals had worse survival, whereas location of residence was not an independent factor. Women in more socio-economically advantaged groups who underwent breast cancer surgery had improved survival.

Prenatal screening for Down syndrome in Australia: Costs and benefits of current and novel screening strategies

To analyse the cost‐effectiveness and performance of noninvasive prenatal testing (NIPT) for high‐risk pregnancies following first‐trimester screening compared with current practice.

Internet-Based Photoaging Within Australian Pharmacies to Promote Smoking Cessation: Randomized Controlled Trial

Background Tobacco smoking leads to death or disability and a drain on national resources. The literature suggests that cigarette smoking continues to be a major modifiable risk factor for a variety of diseases and that smokers aged 18-30 years are relatively resistant to antismoking messages due to their widely held belief that they will not be lifelong smokers. Objective To conduct a randomized controlled trial (RCT) of a computer-generated photoaging intervention to promote smoking cessation among young adult smokers within a community pharmacy setting. Methods A trial was designed with 80% power based on the effect size observed in a published pilot study; 160 subjects were recruited (80 allocated to the control group and 80 to the intervention group) from 8 metropolitan community pharmacies located around Perth city center in Western Australia. All participants received standardized smoking cessation advice. The intervention group participants were also digitally photoaged by using the Internet-based APRIL Face Aging software so they could preview images of themselves as a lifelong smoker and as a nonsmoker. Due to the nature of the intervention, the participants and researcher could not be blinded to the study. The main outcome measure was quit attempts at 6-month follow-up, both self-reported and biochemically validated through testing for carbon monoxide (CO), and nicotine dependence assessed via the Fagerström scale. Results At 6-month follow-up, 5 of 80 control group participants (6.3%) suggested they had quit smoking, but only 1 of 80 control group participants (1.3%) consented to, and was confirmed by, CO validation. In the intervention group, 22 of 80 participants (27.5%) reported quitting, with 11 of 80 participants (13.8%) confirmed by CO testing. This difference in biochemically confirmed quit attempts was statistically significant (χ2 1=9.0, P=.003). A repeated measures analysis suggested the average intervention group smoking dependence score had also significantly dropped compared to control participants (P<.001). These differences remained statistically significant after adjustment for small differences in gender distribution and nicotine dependence between the groups. The mean cost of implementing the intervention was estimated at AU

The obesity-driven rising costs of type 2 diabetes in Australia : projections from the Fremantle Diabetes Study

5.79 per participant. The incremental cost-effectiveness ratio was AU

Reducing the burden of road traffic injury: translating high-income country interventions to middle-income and low-income countries

46 per additional quitter. The mean cost that participants indicated they were willing to pay for the digital aging service was AU

The cost-effectiveness of evidence-based guidelines and practice for screening and prevention of tuberculosis

20.25 (SD 15.32). Conclusions Demonstrating the detrimental effects on facial physical appearance by using a computer-generated simulation may be both effective and cost-effective at persuading young adult smokers to quit. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12609000885291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12609000885291 (Archived by WebCite at http://www.webcitation.org/6F2kMt3kC)