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This study examined whether parent-reported atypical development in their child's first year was associated with age of diagnosis and age when parents first needed to consult a specialist about their child's development. It involved 423 children who participated in the Australian Autism Biobank. Most parents retrospectively identified [greater or equal to] 1 domain of atypical child development. Atypical development in most domains was associated with an earlier age when parents felt specialist consultation was needed. Atypical development in the "gaze abnormalities", "lack of response to social stimuli", and "no social communication" subdomains within the social domain was associated with an earlier age of diagnosis, as was atypical development in the "hypo/hypersensitivity" and "preoccupation with parts of objects" subdomains within the stereotyped/restricted behavior domain.

This study aimed to explore the rates of motor difficulties in children from the Australian Autism Biobank, and how early motor concerns impacted on children functionally. Children with autism aged 2-7 years, including 441 with a Vineland Adaptive Behavior Scale (VABS-II) motor subscale and 385 with a Mullen Scales of Early Learning (MSEL) fine motor subscale were included (n total = 514; 80% male). Approximately 60% of children on the MSEL and ~ 25% on the VABS-II had clinically significant motor impairments. More children with delayed sitting and walking motor milestones had early childhood parent reported motor difficulties (p < 0.001). Early motor delays or concerns may assist identifying individuals who will likely benefit from early ongoing developmental monitoring and early support.

Background Few studies have focused on the prevalence of obesity and hypertension among young people (ages 15-24). Aim To characterise the prevalence of obesity and systolic hypertension in young people aged 15-24 years across Australia. Methods Using data from the 2011-2012 Australian Health Survey, a national cross-sectional population-based survey, we included 2163 young people aged 15-24 years. Risk factors were estimated using multinomial logistic regression. Results The prevalence of obesity increased from 8% to 15% through the ages of 15-24 among males, but the prevalence of overweight and obesity were both 14% for females across all age groups. Low levels of physical activity were a strong risk factor for obesity for both males (odds ratio (OR) 5.95, 95% confidence intervals ( CI)1.83-19.36) and females ( OR 3.20 95% CI 0.69-14.87). Low socioeconomic status was associated with obesity among females only (first quintile OR 4.65, 95% CI 1.97-10.99). Although the prevalence of hypertension was low (4% males, 3% females), the prevalence of high normal blood pressure was substantial, especially among males (28% males, 14% females). Conclusions Overweight, obesity and high normal blood pressure were highly prevalent among Australian young people. Low levels of physical activity were identified as a risk factor for obesity for both male and females. Programmes targeting physical activity participation may need to be tailored differently for males and females, with a focus on females during early adolescence but early adult life for males. [ABSTRACT FROM AUTHOR]

BACKGROUND: Obesity in childhood and adolescence is associated with health problems, increases in cardiovascular disease (CVD) risk factors and a greater likelihood of becoming overweight as an adult. A description of the sociodemographic distribution of overweight and obesity among children and adolescents in the population may allow us to determine if health promotion resources should be differentially allocated to particular groups. METHODS: The New South Wales Schools Fitness and Physical Activity Survey, 1997 (n=5518) was a cross-sectional survey which measured height, weight, waist and hip girths and skinfold thicknesses of randomly selected New South Wales students in school years 4, 6, 8 and 10. Height and weight only were measured among Year 2 students. The mean ages of students in school years 2, 4, 6, 8 and 10 were 7.3 y, 9.3 y, 11.3 y, 13.3 y and 15.3 y, respectively. The values of body mass index (BMI), waist girth, waist-to-hip ratio (WHR) and sum of three skinfolds for students resident in urban and rural areas and in tertiles of socioeconomic status (SES) were compared. RESULTS: There were no differences on any of the anthropometric measures between urban and rural boys and girls, with the exception that WHR was higher among urban girls. Among boys, there were no differences between the SES tertiles on any of the measures. Among girls, each of the anthropometric measures (except sum of skinfolds) was inversely associated with SES, with body fatness tending to be lower in the high SES tertile, compared with the low and middle SES tertiles. None of the statistical interactions between school year and body fatness was significant, suggesting that the relationship is consistent from childhood to adolescence. CONCLUSION: On the basis of these results, we suggest that health promotion programs aimed at weight management among Australian girls of lower SES are not warranted. We recommend that health promotion programs emphasize regular physical... [ABSTRACT FROM AUTHOR]

The article reports on evaluation of a mass-media-led campaign to increase Pap smear screening. A health education campaign was designed to encourage women to have a Pap smear took place in New South Wales (NSW), Australia in early 1988. This test encouraged the women between the age of 18 and 70. The campaign involved the mass media, some related community activities and mailing of an educational package to all general practitioners. The logistic regression models estimated that, for women over 50 years and older in NSW, there was a 30% increase overall in Pap smears during the 4 months following the campaign and a 50% increase amongst those who had not had a smear in the previous 2 years.

The article presents a study which qualitatively examines the risks of silicosis and silica related lung cancer in Australia. It aims to revise the previous estimates of the risks of silicosis and silica dust. The methods used in the study feature different risk function and exposure unit conversion factors. The translation of the risk estimates into predicted number of cases and the occupational health problem related to silica is discussed.

The data from an epidemiological study on multiple sclerosis in Australia have been analysed to determine the relation between the prevalence of the disease and educational level, and the association between level of disability and employment status. There was a significantly higher frequency of multiple sclerosis in those who left school at an older age and achieved a higher educational level. The explanation of this finding remains speculative and may be related to genetic or environmental factors. The study confirmed the recognised association between moderate-severe disability and divorce-separation and lower rates of employment. [ABSTRACT FROM AUTHOR]

Abstract: Long-term survival and progression of disability in multiple sclerosis have not been studied previously in Australia. We report the findings in a cohort of 159 patients from Newcastle. Median survival time from onset of symptoms to death was 42 years. When expected survival rates are compared with those of the Australian population, there is approximately a 10% reduction in survival time in multiple sclerosis patients, after 20 years or more from disease onset. The expected time to reach DSS 3 and DSS 6 was 7 years and 27 years respectively. Survival time of multiple sclerosis patients and rate of progression of the disease are similar in the Northern and Southern Hemispheres. [Copyright &y& Elsevier]

The prevalence of multiple sclerosis (MS) in Newcastle, Australia increased significantly between 1961 and 1981 and the incidence of the disease also increased between the decades 1950–1959 and 1971–1981. The present study sought to determine whether there has been a further increase in the frequency of MS in the subsequent 15 years, and to examine the potential factors underlying this change. The incidence, prevalence and clinical profile of multiple sclerosis were therefore re-examined in Newcastle, Australia in 1996 using comparable diagnostic criteria and methods to those employed in studies in the same region in 1961 and 1981. There has been a significant progressive increase in prevalence from 19.6 to 59.1 per 100,000 population and a significant increase in incidence from 1.2 to 2.4 per 100,000 population from 1961 to 1996. The most pronounced increase in prevalence was in females and in the age-group over 60 years, and there was also an increased incidence in females aged 20–29 years. There was little change in the age of disease onset, but duration of disease in females had increased substantially. The significant increase in prevalence is attributed to increased incidence, particularly in females; and to increased survival. Although such trends in prevalence have been observed in the Northern Hemisphere, this is the first such study in the Southern Hemisphere to show a longitudinal increase in prevalence and incidence over a period of this duration. [Copyright &y& Elsevier]

Background: In patients with CKD, the risk of developing colorectal cancer is high and outcomes are poor. Screening using fecal immunochemical testing (FIT) is effective in reducing mortality from colorectal cancer, but performance characteristics of FIT in CKD are unknown., Methods: To determine the detection rates and performance characteristics of FIT for advanced colorectal neoplasia (ACN) in patients with CKD, we used FIT to prospectively screen patients aged 35-74 years with CKD (stages 3-5 CKD, dialysis, and renal transplant) from 11 sites in Australia, New Zealand, Canada, and Spain. All participants received clinical follow-up at 2 years. We used a two-step reference standard approach to estimate disease status., Results: Overall, 369 out of 1706 patients who completed FIT (21.6%) tested positive; 323 (87.5%) underwent colonoscopies. A total of 1553 (91.0%) completed follow-up; 82 (4.8%) had died and 71 (4.2%) were lost. The detection rate of ACN using FIT was 6.0% (5.6%, 7.4%, and 5.6% for stages 3-5 CKD, dialysis, and transplant). Sensitivity, specificity, and positive and negative predictive values of FIT for ACN were 0.90, 0.83, 0.30, and 0.99, respectively. Of participants who underwent colonoscopy, five (1.5%) experienced major colonoscopy-related complications, including bowel perforation and major bleeding., Conclusions: FIT appears to be an accurate screening test for patients with CKD, such that a negative test may rule out the diagnosis of colorectal cancer within 2 years. However, the risk of major complications from work-up colonoscopy are at least ten-fold higher than in the general population., (Copyright © 2019 by the American Society of Nephrology.)

Background: Globally, disadvantaged populations suffer a high burden of chronic kidney disease (CKD). The trajectory to CKD during childhood and adolescence remains unclear due to a paucity of longitudinal studies., Methods: This was a prospective, population-based cohort study in which since 2002 we have followed 3418 children (1469 non-Aboriginal and 1949 Aboriginal) attending participating schools across New South Wales (NSW), Australia. The albumin:creatinine ratio was measured by dipstick every 2 years together with the body mass index (BMI) and blood pressure. We used multivariable logistic generalised estimating equation models to examine whether Aboriginal children had a higher prevalence of albuminuria compared with non-Aboriginal children with increasing age and to identify potential risk factors., Results: The mean age at enrolment was 10.6 years, at which time 14.2 % of the children were obese and 16.0 % overweight, with 11.5 % found to have albuminuria. Over 8 years (11,387 participant-years) of follow-up the prevalence of albuminuria increased to 18.5 %, overweight to 16.1 % and obesity to 17.2 %. The BMI standard deviation score (SDS) was found to have a differential effect on the risk of albuminuria in Aboriginal and non-Aboriginal children (P interaction < 0.01). The prevalence of albuminuria decreased as the BMI SDS increased in both groups of children, but it increased more in non-Aboriginal children, leading to a 2.5 % higher prevalence of albuminuria in overweight Aboriginal children (95 % confidence interval 1.0-4.2 %)., Conclusion: Compared with non-Aboriginal children, Aboriginal children are of higher risk of albuminuria when overweight or obese. We hypothesise that overweight and obesity are key contributors to the development of adult onset CKD among Aboriginal Australians, which needs further exploration in future studies.

Background: For dialysis patients with a cancer history, a period of surveillance is generally recommended before listing for transplantation. However, the outcomes of patients with cancer recurrence and/or a second primary cancer after transplantation are unknown., Aim: To determine the prognosis of kidney transplant recipients who developed cancer after transplantation and whether this varied with cancer types (first cancer, recurrence, second primary cancer)., Methods: Using data from the Australian and New Zealand Dialysis and Transplant Registry, we compared the cancer-specific and all-cause mortality among recipients with different cancer types using adjusted Cox proportional hazard models., Results: Of the 21,415 recipients transplanted between 1965 and 2012, 3% (651 of 21,415) had a previous cancer history. A total of 2840 (13%) recipients developed cancer after the first transplant, of whom 2760 (97.2%) developed a first cancer, 23 (0.8%) experienced cancer recurrence, and 57 (2%) developed a second primary cancer. There were no significant differences in the risks of cancer-specific and all-cause mortality between recipients who developed their first cancer after transplant, those with cancer recurrence (adjusted hazard ratios [aHRs], 0.79; 95% confidence interval [95% CI], 0.38-1.67; P = 0.54 and aHRs, 0.86; 95% CI, 0.45-1.66; P = 0.66, respectively) and recipients who developed a second primary cancer after transplantation (aHRs, 1.01; 95%CI, 0.63-1.62; P = 0.95 and aHRs, 1.16; 95% CI, 0.79-1.69; P = 0.45, respectively)., Conclusion: Among patients with a previous history of malignancy, recurrent and second primary cancers are infrequent after renal transplantation. A history of previous malignancy does not have an additive effect on the cancer-specific and overall survival of kidney transplant recipients who develop cancer.

Objective: To examine women's informed preference for the management of a mildly abnormal Pap smear and the impact of a decision aid., Methods: Women (n=106) were given a choice of management supported by a decision aid and surveyed before, and after decision making to evaluate predictors of choice and decision aid impact., Results: HPV triage was preferred by most women (65%) although a substantial minority selected repeat Pap testing (35%). Women who chose HPV triage were more likely to have had children, have had a previous abnormal Pap smear and were more distressed than women who chose a repeat Pap test. In total, 68% of women made an informed choice. Rapid timing of follow-up was important for women choosing HPV testing. The lower chance of colposcopy and greater opportunity for regression, were rated as important by women choosing Pap testing. Decisional conflict was lower among women who chose HPV triage. No other differences in short-term psychological outcomes were found., Conclusion: The decision aid supported informed choice among the majority of women. Women tailored their choice to their practical, health and psychological needs., Practice Implications: Offering women an informed choice for a mildly abnormal Pap smear may enable women to select the management that best suits their circumstances.

In order to determine the influence of age of onset, sex, onset symptoms, clinical course and interval from onset to first relapse on the subsequent outcome of multiple sclerosis (MS), data from 2934 cases of MS documented in a large population based study undertaken in Australia have been analysed. Disability on prevalence day (30 June 1981) was defined on the Kurtzke disability scale as mild (DSS 0-3), moderate (DSS 4-6) and severe (DSS 7-9). Prognostic factors associated with mild vs moderate/severe, and moderate vs severe disability on prevalence day were identified by logistic regression analysis. A worse prognosis was significantly associated with older age of onset, progressive disease course, onset symptoms that were multiple, pyramidal or cerebellar, and a short interval between onset and first relapse.

Stages of change for exercise, sociodemographic variables, and beliefs about the health benefits of exercise were obtained for a representative sample of Australian adults (N = 4404). Logistic regression analysis was used to examine the relationship between exercise stage of change and sociodemographic variables and beliefs about the benefits of exercise. Thirteen percent of respondents stated that they did not exercise and did not intend to start; 10% stated that they did not exercise but were thinking of starting; 16% stated that they exercise occasionally and were not thinking of doing more; 23% stated that they exercised occasionally and were thinking of doing more; and 38% stated that they exercised regularly and intended to continue. Intention to do more exercise generally decreased with increasing age, but increased with level of education. An increased frequency of exercise and an intention to do more exercise was associated with the belief that exercise would help to prevent heart disease and with a higher level of education. The results provide a useful profile of the exercise habits (and intention to change those habits) of population subgroups. Public communication campaigns on the benefits of physical activity should focus particularly on those who do not intend to exercise, older adults, and the less well educated.

Three drug use surveys employing a standardised questionnaire format and sampling procedure were conducted on samples of New South Wales school students in 1983, 1986 and 1989. Alcohol and tobacco were the most frequently used substances across the surveys, with rates of use of illicit substances being considerably lower. Declines in the prevalence of alcohol, tobacco and stimulant use were found between 1983 and 1986 and between 1986 and 1989 for both males and females. Rates of use of inhalants, sedatives, hallucinogens and narcotics declined between 1983 and 1986, but remained unchanged between the 1986 and 1989 samples. Cannabis use declined significantly among females between 1983 and 1989, but not among males. Possible reasons for the general decline in drug use over the six-year period are discussed.

This paper presents findings on drug prevalences for licit and illicit drugs among New South Wales secondary school students (n = 3753) in late 1989. It also considers the accuracy of students' perceptions of the drug causing the most and fewest drug-related deaths. Data were analysed by age and gender, using logistic regression for the prevalence data. Findings indicate that licit drugs (tobacco, alcohol and analgesics) were the most frequently and widely used. Rates for illicit drugs were low, although there was some degree of experimental use of cannabis which increased amongst older males. Perceptions were found to be inaccurate in emphasising the dangers of the illicit drug heroin over those of the licit drugs tobacco and alcohol. Reasons for these findings are discussed, and more in-depth research recommended into the relationship between drug prevalences and perceptions for different age groups, and its relevance for planning drug prevention initiatives.

In November 1986, a pilot needle and syringe exchange was established in Sydney adjacent to a methadone maintenance unit. A retrospective study was carried out to determine the effect of increasing the availability of sterile needles and syringes on the treatment outcome of the methadone maintenance unit. In this study, an increase in availability of sterile needles and syringes was not found to be associated with an increase in the presence of illicit injectable drugs in the urine specimens of clients of the methadone programme compared to a control methadone unit where there was no known change in needle and syringe availability. This study suggests that an increase in the availability of sterile needles and syringes does not appear to lead to an increase in the frequency of intravenous drug use. The possibility of drug and alcohol treatment centres acting as needle and syringe exchange or distribution outlets therefore requires consideration.

This is a review of 963 cases of self-poisoning with drugs (8.5% of all medical emergencies) treated in the three major Newcastle hospitals over a 3 1/2-year period. The number of patients admitted rose from 243 (July 1976 to June 1977) to 326 (January to December, 1979)-an overall increase of 34%. The most common drugs used were benzodiazepines (34.9% of cases); barbiturates (11.2%); tricyclic depressants (9.2%); paracetamol (8.1%) and phenothiazines (6.2%). In four of 134 cases involving barbiturates, phenobarbitone had been used as part of an anticonvulsant regimen. Six patients died in hospital and 31 who committed suicide with drugs were not admitted to the hospital, but were investigated by the Regional Forensic Pathologist.