Mohammed Mohsin

Socio-demographic factors associated with smoking and smoking cessation among 426,344 pregnant women in New South Wales, Australia

BackgroundThis study explores the socio-demographic characteristics of pregnant women who continue to smoke during the pregnancy, and identifies the characteristics of the smokers who were likely to quit smoking during the pregnancy period.MethodsThis was secondary analysis of the New South Wales (NSW) Midwives Data Collection (MDC) 1999–2003, a surveillance system covering all births in NSW public and private hospitals, as well as home births. Bivariate and multiple logistic regression analyses were performed to explore the associations between socio-demographic characteristics and smoking behaviour during pregnancy.ResultsData from 426,344 pregnant women in NSW showed that 17.0% continued to smoke during pregnancy. The smoking rate was higher among teenage mothers, those with an Aboriginal (indigenous) background, and lower among more affluent and overseas-born mothers. This study also found that unbooked confinements, and lack of antenatal care in the first trimester were strongly associated with increased risk of smoking during pregnancy. About 4.0% of the smoking women reported they may quit smoking during their pregnancy. Findings showed that mothers born overseas, of higher socio-economic status, first time mothers and those who attended antenatal care early showed an increased likelihood of smoking cessation during pregnancy. Those who were heavy smokers were less likely to quit during pregnancy.ConclusionAlthough the prevalence of smoking during pregnancy has been declining, it remains a significant public health concern. Smoking cessation programs should target the population subgroups of women at highest risk of smoking and who are least likely to quit. Effective antismoking interventions could reduce the obstetric and perinatal complications of smoking in pregnancy.

Perceptions of the Physical Environment, Stage of Change for Physical Activity, and Walking among Australian Adults

Abstract Data for this study were from a population survey of 1,200 adults ages 40–60 years, sampled from the Illawarra region of New South Wales. Questionnaire items on perceptions of the environment were factor analyzed into: Aesthetic Environment and Practical Environment. For both factors, those in the Contemplation stage had more negative views of the environment than those in Maintenance. Those who walked for 0–20 min/week held more negative perceptions of their environment than those who walked for 21–120 min/week and those who walked for > 120 min/week. The health promotion implications of these findings are that environments perceived as attractive and as providing convenient access to services and facilities may influence motivational readiness for physical activity and time spent walking.

A population follow-up study of patients who left an emergency department without being seen by a medical officer.

Objectives: To describe the population of emergency department patients who leave without being seen by a medical officer, to investigate the circumstances of their visit and to ascertain whether they subsequently receive alternative medical care. Methods: A follow-up study was conducted of patients who were initially triaged, but left without being seen by a medical officer between July 2003 and October 2003 in a tertiary referral hospital emergency department in Sydney, Australia. Emergency Department Information System data were reviewed for population demographics, presenting complaints and acuity rating of patients. Follow-up telephone interviews were conducted within 7 days after the patient left the emergency department. Results: During the study period, 8.6% (1272 of 14 741) of the emergency department patients left without seeing a doctor and 35.9% (457 of 1272) of these patients who walks out were contacted for follow-up. The results from bivariate and multivariate analyses showed that walkout rates significantly varied by sociodemographic and clinical characteristics of the patients. Young patients aged 0–29 years, and those with longer waiting time for triage and triaged as “less urgent” were more likely to walk out than others. Overcrowding in the emergency department had a significant association with walkout of patients. Prolonged waiting time was the most common reason for leaving emergency departments without being seen by a doctor. Only 12.7% (58 of 457) of the walkout patients revisited emergency departments within 7 days of their departure and of those who were subsequently admitted following their return to hospital accounted for 5.0% (23 of 457). Of the follow-up patients, 39.4% felt angry about their emergency department experiences. Conclusions: The number of patients who leave an emergency department without seeing a doctor is strongly correlated with waiting time for medical review. Achieving shorter emergency department waiting times is central to reducing the numbers of people leaving without being seen. The rate of patients who leave without being seen is also strongly correlated with triage category. These findings highlight the importance of accurate triaging, as this clearly influences waiting time. It is also likely that there are patients who benefit from the reassurance of the triage assessment, and therefore feel less urgency for medical review. These may be cases where immediate medical review is not essential. This area should be further explored. These results are important for planning and staffing health services. Decision makers should identify and target factors to minimise walkouts from public hospital emergency departments.

Maternal and neonatal factors influencing premature birth and low birth weight in Australia.

This study identified the influences of neonatal and maternal factors on premature birth and low birth weight in New South Wales, Australia. Bivariate and multivariate analyses were used to explore the association of selected neonatal and maternal characteristics with premature birth and low birth weight. The findings of this study showed that premature birth and low birth weight rate significantly varied by infant sex, maternal age, marital status, Aboriginality, parity, maternal smoking behaviour during pregnancy and maternal hypertension. First-born infants, and infants born to mothers aged less than 20 years, or who were single, separated/divorced, Aboriginal or who smoked during the pregnancy, were at increased risk of being premature or of low birth weight. This study also found that risk factors for premature births and low birth weight were similar in both singleton and multiple births. Gestational age was confirmed to be the single most important risk factor for low birth weight. The findings of this study suggest that in order to reduce the incidence of low birth weight and premature births, health improvement strategies should focus on anti-smoking campaigns during pregnancy and other healthcare programmes targeted at the socially disadvantaged populations identified in the study.

Comparison of the Humphrey swedish interactive thresholding algorithm (SITA) and full threshold strategies.

Purpose: To compare the Swedish interactive thresholding algorithm (SITA) strategy with the full threshold strategy in routine clinical practice. Methods: Using the Humphrey visual field analyzer model 750 (Allergan Humphrey, San Leandro, CA), 108 subjects were tested with 24–2 SITA (version A9) and 24–2 full threshold strategies. Test results were compared for time taken and reliability and on the basis of seven criteria of abnormality. Results: The SITA required on average 48.8% less time than the full threshold strategy. Patient reliability parameters were somewhat better with SITA. There was a strong correlation between mean deviation and pattern standard deviation. Average threshold sensitivity at each point was increased by 1.31 dB with SITA, but greater differences were seen at points with lower sensitivity. Using the full threshold strategy as our standard for comparison, the sensitivity of SITA varied from 83.0% to 93.2% in detecting the variously defined abnormalities. Fields shown as normal with full threshold strategy corresponded with those found to be normal with SITA in 79.0 to 96.3% cases depending on criteria for abnormality. There were a few cases in which SITA suggested an early abnormality but results of full threshold testing remained normal. On average, the size and depth of scotomas decreased slightly with SITA, but this difference was not statistically significant. Of the 70 patients surveyed about their preference, 65 (92.9%) preferred SITA. Conclusion: Full threshold and SITA strategies are comparable in detecting glaucomatous defects. The SITA strategy requires significantly less time to perform and is a satisfactory alternative to full threshold algorithms in clinical practice for diagnosis and management of glaucoma.

The influence of antenatal and maternal factors on stillbirths and neonatal deaths in new South wales, australia.

This study identified the influences of maternal socio-demographic and antenatal factors on stillbirths and neonatal deaths in New South Wales, Australia. Bivariate and multivariate analyses were used to explore the association of selected antenatal and maternal characteristics with stillbirths and neonatal deaths. The findings of this study showed that stillbirths and neonatal deaths significantly varied by infant sex, maternal age, Aboriginality, maternal country of birth, socioeconomic status, parity, maternal smoking behaviour during pregnancy, maternal diabetes mellitus, maternal hypertension, antenatal care, plurality of birth, low birth weight, place of birth, delivery type, maternal deaths and small gestational age. First-born infants, twins and infants born to teenage mothers, Aboriginal mothers, those who smoked during the pregnancy and those of lower socioeconomic status were at increased risk of stillbirths and neonatal deaths. The most common causes of stillbirths were conditions originating in the perinatal period: intrauterine hypoxia and asphyxia. Congenital malformations, including deformities and chromosomal abnormalities, and disorders related to slow fetal growth, short gestation and low birth weight were the most common causes of neonatal deaths. The findings indicate that very low birth weight (less than 2,000 g) contributed 75.6% of the population-attributable risks to stillbirths and 59.4% to neonatal deaths. Low gestational age (less than 32 weeks) accounted for 77.7% of stillbirths and 87.9% of neonatal deaths. The findings of this study suggest that in order to reduce stillbirths and neonatal deaths, it is essential to include strategies to predict and prevent prematurity and low birth weight, and that there is a need to focus on anti-smoking campaigns during pregnancy, optimizing antenatal care and other healthcare programmes targeted at the socially disadvantaged populations identified in this study.

Socioeconomic correlates and trends in smoking in pregnancy in New South Wales, Australia

Objective This study describes trends (1994–2007) in smoking in pregnancy (SIP) among an Australian population sample of women. This study also examines trends in the socioeconomic distribution of SIP over the 14-year period. Methods Bivariate and multiple logistic regression analyses of the NSW Midwives Data Collection were used to explore the associations and trends in SIP by sociodemographic factors. Results The prevalence of SIP in New South Wales (NSW) declined from 22.1% (1994) to 13.5% in 2007. However, the largest decrease in SIP rates was among the highest socioeconomic group (67.9% decline), and smaller declines were observed among teenage and remote rural mothers. Maternal age, ethnicity, Aboriginality, area of remoteness and socioeconomic status were independently associated with SIP. The distribution of NSW mothers has changed, with fewer younger mothers and more from an Asian background. Conclusion This study reported large declines in SIP prevalence, with a population effect similar to that expected following exposure to (Cochrane-defined) intensive behavioural interventions. However, no specially targeted public health efforts were made during this period to influence SIP, so that social norm change is the likely explanation for these population health changes. The relative decline in SIP was smaller among low-socioeconomic status mothers, by language spoken at home, Aboriginality and area of remoteness, suggesting that inequalities in SIP have increased over this 14-year period. This information informs equity-based approaches to targeting further smoking cessation programs for pregnant Australian women.

Stroke Unit Care in a Real-Life Setting: Can Results From Randomized Controlled Trials Be Translated Into Every-Day Clinical Practice? An Observational Study of Hospital Data in a Large Australian Population

Background and Purpose— In randomized trials, acute stroke units are associated with improved patient outcomes. However, it is unclear whether this evidence can be successfully translated into routine clinical practice. We aimed to determine the effect of a coordinated rollout of funding for 22 stroke units on patient outcomes in Australia. Methods— A multicenter observational study was undertaken using health administrative data recording admissions for a primary diagnosis of ischemic stroke from July 2000 to June 2006. Analyses were stratified by hospital type (major principal referral, smaller nonprincipal referral hospitals). Results— We analyzed 17 659 admissions for ischemic stroke. Among major principal referral hospitals with acute stroke units, the proportion of admissions resulting in death or discharge to home was unchanged after stroke unit rollout (10.7% vs 10.6% and 44.1% vs 45.0%, respectively; P=0.37). In contrast, significant differences in discharge destination were noted across time among smaller nonprincipal referral hospitals (P<0.001). Before the rollout of stroke units, 13.8% of admissions to smaller hospitals resulted in a death, decreasing to 10.5% after stroke units were implemented. Discharges to home increased from 38.8% to 44.5%. Discharges to nursing homes decreased from 6.3% to 4.9%. Differences across time remained significant when controlling for patient demographics, comorbidities, indicators of poor prognosis, and clustering of outcomes at hospital level. Improved outcomes were observed across all ages and among patients with indicators for a poor prognosis. Conclusions— This multicenter analysis of a large Australian population of hospital stroke admissions demonstrates short-term benefits from implementing stroke units in nonprincipal referral hospitals.

A Literature Review on Care at the End-of-Life in the Emergency Department.

The hospitalisation and management of patients at the end-of-life by emergency medical services is presenting a challenge to our society as the majority of people approaching death explicitly state that they want to die at home and the transition from acute care to palliation is difficult. In addition, the escalating costs of providing care at the end-of-life in acute hospitals are unsustainable. Hospitals in general and emergency departments in particular cannot always provide the best care for patients approaching end-of-life. The main objectives of this paper are to review the existing literature in order to assess the evidence for managing patients dying in the emergency department, and to identify areas of improvement such as supporting different models of care and evaluating those models with health services research. The paper identified six main areas where there is lack of research and/or suboptimal policy implementation. These include uncertainty of treatment in the emergency department; quality of life issues, costs, ethical and social issues, interaction between ED and other health services, and strategies for out of hospital care. The paper concludes with some areas for policy development and future research.

Factors associated with walkout of patients from New South Wales hospital emergency departments, Australia.

Objective  To explore the association between daily patient numbers, sociodemographic, clinical and system characteristics and walkout rates of patients from New South Wales (NSW) public hospital ED (without seeing a medical officer).