Shanley Chong

Trends in knee arthroscopy and subsequent arthroplasty in an Australian population: a retrospective cohort study.

BackgroundKnee arthroscopy is a common procedure in orthopaedic surgery. In recent times the efficacy of this procedure has been questioned with a number of randomized controlled trials demonstrating a lack of effect in the treatment of osteoarthritis. Consequently, a number of trend studies have been conducted, exploring rates of knee arthroscopy and subsequent conversion to Total Knee Arthroplasty (TKA) with varying results. Progression to TKA is seen as an indicator of lack of effect of primary knee arthroscopy.The aim of this paper is to measure overall rates of knee arthroscopy and the proportion of these patients that undergo subsequent total knee arthroplasty (TKA) within 24 months, and to measure trends over time in an Australian population.MethodsWe conducted a retrospective cohort study of all adults undergoing a knee arthroscopy and TKA in all hospitals in New South Wales (NSW), Australia between 2000 and 2008. Datasets obtained from the Centre for Health Record Linkage (CHeReL) were analysed using negative binomial regression. Admission rates for knee arthroscopy were determined by year, age, gender and hospital status (public versus private) and readmission for TKA within 24 months was calculated.ResultsThere was no significant change in the overall rate of knee arthroscopy between 2000 and 2008 (-0.68%, 95% CI: -2.80 to 1.49). The rates declined in public hospitals (-1.25%, 95% CI: -2.39 to -0.10) and remained relatively steady in private hospitals (0.42%, 95% CI: -1.43 to 0.60). The proportion of patients 65 years or over undergoing TKA within 24 months of knee arthroscopy was 21.5%. After adjusting for age and gender, there was a significant decline in rates of TKA within 24 months of knee arthroscopy for all patients (-1.70%, 95% CI:-3.13 to -0.24), patients admitted to private hospitals (-2.65%, 95% CI: -4.06 to -1.23) and patients aged ≥65 years (-3.12%, 95% CI: -5.02 to -1.18).ConclusionsRates of knee arthroscopy are not increasing, and the proportion of patients requiring a TKA within 24 months of a knee replacement is decreasing in the age group most likely to have degenerative changes in the knee.

Risk factors of incident type 2-diabetes mellitus over a 3-year follow-up: Results from a large Australian sample

AIMS To describe the incidence of type 2 diabetes mellitus (T2DM) among middle-aged and older Australian adults and to examine a broad range of risk factors of T2DM. METHODS A large cohort of Australian adults aged 45 and up was sampled from the general population and was followed up for approximately 3 years (n=60,404). Physician-diagnosed T2DM was self-reported at baseline (2006-2008) and follow-up (2010). Incident T2DM was determined as not reporting T2DM at baseline, but reporting T2DM at follow-up. A broad range of risk factors, including socio-demographic characteristics, health status, family history, and lifestyle behaviors were examined at baseline. Multiple logistic regression was used for selecting potential predictors of incident T2DM, and age and reported family history of T2DM were tested as potential effect modifiers. RESULTS Of the 54,997 without T2DM at baseline, 888 reported T2DM at follow-up (cumulative incidence 1.6% over 3.4 years, annual incidence rate 0.44%). Adjusted for other risk factors, being male, older age, higher relative socio-economic disadvantage, being born in Asia, lower educational attainment, medical history of hypertension and dyslipidemia, family history of T2DM, overweight/obese, smoking, long sleeping hours, and psychological distress were significantly associated with higher odds of developing T2DM. Particularly, hypertension, dyslipidemia, and overweight/obesity were stronger predictors of T2DM among middle-aged than older adults (≥60 years). CONCLUSIONS Understanding risk factors for incident T2DM could help identify at-risk populations and develop upstream preventive strategies to combat the epidemic of diabetes.

Mortality rates after surgery in New South Wales

Studies have been conducted to determine 30‐day and 365‐day mortality rates after surgical procedures in different regions; however, there is a lack of data for mortality rates in New South Wales (NSW), Australia. The aim of this study was to determine 30‐day and 365‐day post‐operative mortality rates after selected common operations performed in NSW.

Gestational Diabetes Mellitus: A Study of Women Who Fail to Attend Appointments

One of the challenges clinicians face in managing patients with diabetes is to ensure that patients comply with their therapy. Patients may lack motivation to adhere to recommendations from diabetologists, diabetes nurse educators, and dietitians, and their attendance to clinic appointments can be erratic. A recent study demonstrated that clinic nonattendance and noncompliance to therapy were both independent predictors of mortality for patients with type 2 diabetes.1 Women with gestational diabetes mellitus (GDM) are usually informed by their obstetrics or diabetes team (at their first educational session) that suboptimal glycemic control could affect the well-being of their developing fetuses, and this may provide greater motivation for them to adhere to therapy. In addition to antenatal visits, women with GDM must attend education sessions on GDM management, and they require regular follow-up with their diabetes team until delivery. To date, there is little information in the literature addressing compliance issues for women with GDM. Because optimal GDM management has been shown to affect pregnancy outcomes for women with GDM, we hypothesized that nonattendance to diabetes-related appointments may have adverse effects on the pregnancy outcomes of women with GDM. In this study, we assessed the attendance of diabetes-related appointments for women with GDM and explored clinical factors that were associated with failure-to-attend (FTA) rates for these women in a single public hospital in the southwestern part of Sydney, Australia. We also evaluated the pregnancy outcomes of women with GDM who had failed to attend two or more of their diabetes appointments during pregnancy. A retrospective review was conducted on all pregnant women who were diagnosed with GDM and who had received diabetes education at the Diabetes Centre at Liverpool Hospital between 1 January and 31 December 2011. Demographic data, including age, parity, BMI, ethnicity, family history of diabetes, history of previous …

Lifestyle Changes After a Diagnosis of Type 2 Diabetes

Objective. Whether patients with type 2 diabetes change their lifestyle in response to their diagnosis and maintain behavior changes is unclear. This study aimed to 1) compare changes in lifestyle behaviors among participants who were newly diagnosed with type 2 diabetes and those never diagnosed with type 2 diabetes and 2) investigate changes in lifestyle behaviors in relation to the duration of newly diagnosed type 2 diabetes. Methods. We used self-reported information from the New South Wales 45 and Up Study and a follow-up study. Changes in body weight; amount of walking, moderate to vigorous physical activity (MVPA), and sitting; fruit and vegetable consumption; and smoking status and number of cigarettes smoked were used as measures of health behavior change. These variables were compared between participants in a “new type 2 diabetes” group and a “no type 2 diabetes” group. Results. The new type 2 diabetes group had a smaller decrease in vegetable consumption, lost more weight, and were more likely to quit smoking than the no type 2 diabetes group. MVPA, fruit consumption, and number of cigarettes smoked did not change significantly for either group. Although no significant changes were found in any of the health behaviors based on time since diagnosis, the magnitude of changes in weight and walking increased as duration of diagnosis increased, whereas changes in MVPA, number of cigarettes smoked, and proportion of participants who quit smoking decreased. Conclusion. In this population-based study, participants with incident type 2 diabetes reported only minimal changes in their lifestyle factors after receiving their diagnosis.

Measuring glycated haemoglobin in women with gestational diabetes mellitus: How useful is it?

Glycated haemoglobin (HbA1c) is an important tool for assessing glycaemic status in patients with diabetes, but its usefulness in gestational diabetes mellitus (GDM), is unclear.

Urine albumin–creatinine ratio in women with gestational diabetes: Its link with glycaemic status

Micro‐albuminuria has been established as a marker for micro‐vascular disease. Spot urine albumin‐to‐creatinine ratio (UACR), even in the high normal range, predicts future cardiovascular events. The value of UACR in women with gestational diabetes mellitus (GDM) during pregnancy is uncertain.

Effects of Distant Green Space on Physical Activity in Sydney, Australia

BACKGROUND The aim was to investigate the association between distant green space and physical activity modified by local green space. METHODS Information about physical activity, demographic and socioeconomic background at the individual level was extracted from the New South Wales Population Health Survey. The proportion of a postcode that was parkland was used as a proxy measure for access to parklands and was calculated for each individual. RESULTS There was a significant relationship between distant green space and engaging in moderate-to-vigorous physical activity (MVPA) at least once a week. No significant relationship was found between adequate physical activity and distant green space. No significant relationships were found between adequate physical activity, engaging in MVPA, and local green space. However, if respondents lived in greater local green space (≥25%), there was a significant relationship between engaging in MVPA at least once a week and distance green space of ≥20%. CONCLUSION This study highlights the important effect of distant green space on physical activity. Our findings also suggest that moderate size of local green space together with moderate size of distant green space are important levers for participation of physical activity.

A feasibility study using geographic access to general practices and routinely collected data in public health and health services research

BACKGROUND Advances in geographic information systems (GIS) and increased availability of routinely collected data have the potential to contribute to public health and health services research. The aim of this feasibility study was to explore the use of GIS to measure access to general practices and its relationship to selected antenatal behaviours. METHODS We obtained the Perinatal Data Collection, 2004-2008, for South Western Sydney Local Health District from the New South Wales Ministry of Health. Using a GIS, we generated circular and polygon-based 1 km and 2 km road network buffers from a maternal residential address and then calculated the number of general practices within those buffers (density measures). Distances to general practices from maternal residences were also calculated in the GIS as another measure of geographic access to general practices (proximity measures). We used generalised estimating equations logistic regression to examine associations between access to general practices, and smoking during pregnancy and late first antenatal visit. RESULTS The numbers of general practices within circular buffers were significantly greater than within polygon-based road network buffers. The average distance to the five closest general practices from a mothers residence was 2.3 km ± 3.0 km (median 1.4 km, range 0.05 km to 40.0 km). For two of the five measures of access, a higher number of general practices was associated with increased risk for late first antenatal visit. However, the associations were weak, with odds ratios very close to unity. Choice of metrics of geographic access to general practices did not alter the associations with smoking during pregnancy or late first antenatal visit. CONCLUSION GIS can be used to quantify measures of geographic access to health services for public health and health services research. Geographic access to general practices was generally not associated with smoking during pregnancy or late first antenatal visit. GIS and routinely collected health data can be used to answer novel questions in public health and health services research.