Showing papers by "Susan M. Jack published in 2018"
TL;DR: A vaccine that prevents GAS cellulitis and other skin infections, in addition to throat infections, would maximise its value and commercial viability, with a cost-effective price in line with other recently-licensed and funded vaccines in Australia.
31 citations
TL;DR: In New Zealand, the impact of the school-based sore throat service component of the RFPP was evaluated by as discussed by the authors, who found that after the implementation of the program, the national ARF incidence rate dropped by 28% from 40 per 100 000 at baseline (2009-11) to 29 per 100000 by 2016 (95% CI 24-34, P <001).
Abstract: Background: Acute rheumatic fever (ARF) has largely disappeared from high-income countries However, in New Zealand (NZ) rates remain high in indigenous (Māori) and Pacific populations In 2011, NZ launched an intensive and unparalleled primary Rheumatic Fever Prevention Programme (RFPP) We evaluated the impact of the school-based sore throat service component of the RFPP Methods: The evaluation used national trends of all-age first episode ARF hospitalisation rates before (2009-11) and after (2012-16) implementation of the RFPP A retrospective cohort study compared first-episode ARF incidence during time-not-exposed (23 093 207 person-days) and time-exposed (68 465 350 person-days) with a school-based sore throat service among children aged 5-12 years from 2012 to 2016 Results: Following implementation of the RFPP, the national ARF incidence rate declined by 28% from 40 per 100 000 [95% confidence interval (CI) 35-46] at baseline (2009-11) to 29 per 100 000 by 2016 (95% CI 24-34, P <001) The school-based sore throat service effectiveness overall was 23% [95% CI -6%-44%; rate ratio (RR) 077, 95% CI 056-106] Effectiveness was greater in one high-risk region with high coverage (46%, 95% CI 16%-66%; RR 054, 95% CI 034-084) Conclusions: Population-based primary prevention of ARF through sore throat management may be effective in well-resourced settings like NZ where high-risk populations are geographically concentrated Where high-risk populations are dispersed, a school-based primary prevention approach appears ineffective and is expensive
30 citations
TL;DR: Poor sanitation facilities appear to be a major source of Salmonella Typhi in Fiji, with transmission by drinking contaminated surface water and consuming unwashed produce and having an unimproved or damaged sanitation facility.
Abstract: Background Typhoid fever is endemic in Fiji, with high reported annual incidence. We sought to identify the sources and modes of transmission of typhoid fever in Fiji with the aim to inform disease control. Methodology/Principal findings We identified and surveyed patients with blood culture-confirmed typhoid fever from January 2014 through January 2017. For each typhoid fever case we matched two controls by age interval, gender, ethnicity, and residential area. Univariable and multivariable analysis were used to evaluate associations between exposures and risk for typhoid fever. We enrolled 175 patients with typhoid fever and 349 controls. Of the cases, the median (range) age was 29 (2–67) years, 86 (49%) were male, and 84 (48%) lived in a rural area. On multivariable analysis, interrupted water availability (odds ratio [OR] = 2.17; 95% confidence interval [CI] 1.18–4.00), drinking surface water in the last 2 weeks (OR = 3.61; 95% CI 1.44–9.06), eating unwashed produce (OR = 2.69; 95% CI 1.48–4.91), and having an unimproved or damaged sanitation facility (OR = 4.30; 95% CI 1.14–16.21) were significantly associated with typhoid fever. Frequent handwashing after defecating (OR = 0.57; 95% CI 0.35–0.93) and using soap for handwashing (OR = 0.61; 95% CI 0.37–0.95) were independently associated with a lower odds of typhoid fever. Conclusions Poor sanitation facilities appear to be a major source of Salmonella Typhi in Fiji, with transmission by drinking contaminated surface water and consuming unwashed produce. Improved sanitation facilities and protection of surface water sources and produce from contamination by human feces are likely to contribute to typhoid control in Fiji.
28 citations
TL;DR: The outcomes of this study will provide all stakeholders with important information regarding how early adversity may lead to health and behavioural disparities and how these may be altered through early interventions.
Abstract: Introduction Adverse early experiences are associated with long-lasting disruptions in physiology, development and health. These experiences may be ‘biologically embedded’ into molecular and genomic systems that determine later expressions of vulnerability. Most studies to date have not examined whether preventive interventions can potentially reverse biological embedding. The Nurse-Family Partnership (NFP) is an evidence-based intervention with demonstrated efficacy in improving prenatal health, parenting and child functioning. The Healthy Foundations Study is an innovative birth cohort which will evaluate the impact of the NFP on biological outcomes of mothers and their infants. Methods and analysis Starting in 2013, up to 400 pregnant mothers and their newborns were recruited from the British Columbia Healthy Connections Project—a randomised controlled trial of the NFP, and will be followed to child aged 2 years. Women were recruited prior to 28 weeks’ gestation and then individually randomised to receive existing services (comparison group) or NFP plus existing services (intervention group). Hair samples are collected from mothers at baseline and 2 months post partum to measure physiological stress. Saliva samples are collected from infants during all visits for analyses of stress and immune function. Buccal swabs are collected from infants at 2 and 24 months to assess DNA methylation. Biological samples will be related to child outcome measures at age 2 years. Ethics and dissemination The study received ethical approval from seven research ethics boards. Findings from this study will be shared broadly with the research community through peer-reviewed publications, and conference presentations, as well as seminars with our policy partners and relevant healthcare providers. The outcomes of this study will provide all stakeholders with important information regarding how early adversity may lead to health and behavioural disparities and how these may be altered through early interventions. Trial registration number NCT01672060; Pre-results.
15 citations
TL;DR: This integrative review is the first to critique and synthesize what is known of how Indigenous mothers in Canada experience selecting and using health services to meet the health needs of their infants, revealing significant gaps in the literature and a need for future research.
Abstract: In Canada, Indigenous infants experience significant health disparities when compared to non-Indigenous infants, including significantly higher rates of birth complications and infant mortality rates. The use of primary health care is one way to improve health outcomes; however, Indigenous children may use health services less often than non-Indigenous children. To improve health outcomes within this growing population, it is essential to understand how caregivers, defined here as mothers, select and use health services in Canada. This integrative review is the first to critique and synthesize what is known of how Indigenous mothers in Canada experience selecting and using health services to meet the health needs of their infants. Themes identified suggest both Indigenous women and infants face significant challenges; colonialism has had, and continues to have, a detrimental impact on Indigenous mothering; and very little is known about how Indigenous mothers select and use health services to meet the health of their infants. This review revealed significant gaps in the literature and a need for future research. Suggestions are made for how health providers can better support Indigenous mothers and infants in their use of health services, based on what has been explored in the literature to date.
7 citations
TL;DR: A 5-domain descriptive system of a glaucoma-specific preference-based instrument, the HUG-5, was developed and remains to be evaluated for validity and reliability in the glau coma patient population.
Abstract: Purpose To develop a descriptive system for a glaucoma-specific preference-based health-related quality of life (HRQoL) instrument: the Health Utility for Glaucoma (HUG-5). Methods The descriptive system was developed in 2 stages: item identification and item selection. A systematic literature review of HRQoL assessment of glaucoma was conducted using a comprehensive search strategy. Purposeful sampling was used to recruit patients with different clinical characteristics. Relevant items were presented to glaucoma patients through face-to-face, semistructured interviews. Framework methodology was applied to analyze interview content. The recurring themes identified through an iterative content analysis represented topics of most importance and relevance to patients. These themes formed the domains of the HUG-5 descriptive system. Three versions of the descriptive system, differing in explanatory detail, were pilot tested using a focus group. Results The literature review identified 19 articles which contained 266 items. These items were included for the full-text review and were used to develop an interview guide. From 12 patient interviews, 22 themes were identified and grouped into 5 domains that informed the 5 questions of the descriptive system. The HUG-5 measures visual discomfort, mobility, daily life activities, emotional well-being, and social activities. Each question has 5 response levels that range from "no problem" to "severe problem." The focus group comprised 7 additional patients unanimously preferred the version that contained detailed, specific examples to support each question. Conclusions A 5-domain descriptive system of a glaucoma-specific preference-based instrument, the HUG-5, was developed and remains to be evaluated for validity and reliability in the glaucoma patient population.
4 citations
4 citations
TL;DR: This is the first study using a mixed methods approach including a case-based survey of physicians practicing in diverse settings to explore the factors that influence clinical decision-making and the results may assist with strategies to implement high value care resulting in improved patient outcomes and limiting costs.
Abstract: Background: Despite soaring healthcare costs, patient outcomes are suboptimal in the USA. Efforts to limit healthcare costs and improve quality of care have had limited success. An improved understanding of factors that influence clinical decision-making may provide insight into optimizing the quality and costs of care. The process of healthcare decision-making is contextual, complex and poorly understood. This study aims to explore the factors that influence clinical decision-making in the setting of limited evidence of effectiveness, limited or conflicting guidance, significant resource burden and variation in values and preferences. Rationale for study design: This sequential explanatory mixed methods study includes a case-based survey (quantitative phase). The results of the survey will guide the sampling and questions for the semi-structured interviews (qualitative phase). The interviews will provide an in-depth explanation of the survey results. Combining the two methods provides complementary information and deeper understanding of the phenomenon of clinical decision-making. Methods: The quantitative strand will consist of case-based surveys in the fields of neonatology and cardiology. Participants are asked to pick the best management choice for each question followed by a rating of the influence of different factors on a 7-point Likert scale. Follow-up questions explore knowledge and influence of evidence, guideline recommendations and costs on decision-making. Analysis of the survey results will inform sampling and the focus of qualitative interviews. The interviews will be analyzed using qualitative description. Discussion: To our knowledge, this is the first study using a mixed methods approach including a case-based survey of physicians practicing in diverse settings to explore the factors that influence clinical decision-making. The results of this study may assist with strategies to implement high value care resulting in improved patient outcomes and limiting costs.
3 citations
TL;DR: Cardiologists rate evidence-based practice as an important factor influencing their decision-making whether or not they make CPG-concordant choices, which should consider physicians’ perceptions of effectiveness of the management options.
Abstract: Background: Practice variation is common and may represent variation in values and preferences in the setting of limited evidence regarding optimal care or indicate deficiencies in care. Methods: We administered a case-based survey to cardiologists in the United States and Canada. Participants selected their preferred management option and then rated the influence of 7 factors (safety, effectiveness, patient-centered care, efficiency, local hospital practice, medicolegal concerns and prior experience) on their decision using a scale of 1 (unimportant) to 7 (critically important). Follow-up questions explored knowledge and attitudes on healthcare costs. The relationship between management choice and perceived influence of each factor was examined using repeated measures ANOVA. Free text comments were analyzed using basic content analysis. Results: One hundred and six cardiologists completed the survey. Respondents rated safety (5.8), effectiveness (5.7) and patient-centered care (5.7) as important determinants irrespective of their management choice. Cardiologists frequently (range 19%-87%) chose options not recommended by clinical practice guidelines (CPG), with individual cardiologists sometimes choosing guideline-suggested options and sometimes not. Differences in ratings of factors between those who chose guideline-suggested options and those who did not varied based on the case. Respondents considered cost to be important in decision-making; however, they did not feel well informed and, consequently, seldom discussed this with patients. Conclusion: Cardiologists rate evidence-based practice as an important factor influencing their decision-making whether or not they make CPG-concordant choices. Sources of practice variation include case-context, local hospital practice and medicolegal concerns. Implementation strategies to improve high value patient-centered care should consider physicians’ perceptions of effectiveness of the management options. Successful strategies to improve patient-centered care will require engagement from physicians, particularly to understand how best to support their ability to counsel and involve patients when choosing treatment options and considering cost in these decisions. A deeper understanding of practice variation and its implications will require use of qualitative methods.
2 citations